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Aim:In this retrospective study, our objective was to evaluate children with arterial or venous thromboembolism, who were treated with tissue plasminogen activator (tPA) in our hospital.Materials and Methods:The medical records of 56 tPA treatments administered to 53 patients with thrombosis in the paediatric intensive care unit and paediatric clinic at Çukurova University, Balcalı Hospital between September 2013 and August 2018, were investigated retrospectively.Results:Thirty-three of the patients were males (58.9%). The median age was 13.5 months (0-203 months). Fifty-two of the patients received low-dose tPA treatment (91.2%) and the mean treatment duration was 63.8±43.3 hours (3-192 hours). Thrombolytic treatment was administered to 38 patients (67.8%) with catheter-related arterial thrombus, to 8 patients (14.3%) with intracardiac thrombus, to 4 patients (7.2%) with pulmonary arterial thrombus, and to 6 patients (10.7%) with deep venous thrombus. No complication was observed in 47 treatments (83.9%). However, 7 patients had minor (12.5%) and 2 patients had major bleeding (3.6%). Recanalization could not be achieved in 8 cases (14.3%) and 4 patients underwent thrombectomy. The use of anticoagulant treatment with tPA did not change the complication rate or the success rate of the recanalization.Conclusion:We determined that low-dose tPA treatment was effective in the treatment of life-, limb- or organ-threatening arterial and venous thromboembolism in children. However, randomized studies with larger sample sizes and control groups are required.

Introduction Effective physiotherapy interventions are required for haemophilic arthropathy (HA) of the elbow due to its biomechanical differences and contribution to upper limb functionality. Aim To investigate the effects of manual therapy & exercises on bleeding frequency, pain, range of motion (ROM), strength, joint health, functionality and quality of life (QoL) in HA of the elbow. Methods Seventeen participants with HA of the elbow were randomized as Manual Therapy & Exercises Group (MTEG = 9) and Home Exercises Group (HEG = 8). Soft tissue mobilization, joint traction (grade I-II) and Mulligan's mobilization with movement as manual therapy, and stretching/strengthening exercises were applied to MTEG, while HEG had only same exercises as home programme. The interventions lasted 3 days/weekly for 5 weeks. Bleeding frequency was evaluated with patients' records; pain with Numeric Pain Scale; ROM with goniometer; strength with digital dynamometer; joint health with HJHS; functionality with Quick-Disability of Arm, Shoulder and Hand questionnaire; and QoL with Oxford Elbow Score. Results Bleeding frequency and activity pain were decreased, while elbow ROMs and flexor strength were increased in MTEG (P ˂ 0.05). Also significantly improvements were seen in joint health, functionality and QoL in MTEG. HEG showed improvements in activity pain, QoL and some ROMs. MTEG had better results in ROMs, joint health and functionality (P ˂ 0.05). Conclusion Manual therapy & exercises may be used without causing bleeding and pain to increase the functionality, joint health and QoL, and is superior to home exercise for joint health and functionality. Home exercises may be ameliorated in pain, QoL and some ROMs.

Objective: Immune thrombocytopenia is a bleeding disorder related to deficiency of the main element in primary hemostasis, platelets. But it rarely results in an opposite clinical complication as thrombosis. The mechanism of this unexpected complication is not fully understood still and the treatment of the patients in this thrombocytopenic and thrombotic condition is critical and hard to manage. Here we present a case of immune thrombocytopenia with cerebral infarct with his clinical management details. Case: A seven-year old boy diagnosed with Immune thrombocytopenia at the age of 1 in another clinic and treated with IVIG when the platelet levels fell and bleeding symptoms appeared. The patient refered to our clinic with severe refractory thrombocytopenia. After being diagnosed with ITP, IVIG treatment and HDDXM treatment (20 mg/m2/day for 4 days) was given 2 cure in a month then the patient follow up in the clinic. It is learned that the family continued with HDDXM and sometimes IVIG treatment when needed in the local hospital. When the child was 6 years old, because of inability to walk and talk he was referred and it was revealed that he had cerebral infarct in the ICA area with a platelet level of 11000/mm3. He was followed in pediatric ICU. He was treated with thrombocytopenia with replacement and steroids in addition to physical treatment for stroke. Anticoagulation was used as the clinical and laboratory picture allowed. Result: The patient was discharged with the better clinical Picture and his chronic treatment planned mostly with steroids. Conclusion: Stroke in the immune thrombocytopenic clinic is a rare but hard to manage condition. Although its mechanism not understand well, the clinician should be identify and manage it carefully. Disclosures No relevant conflicts of interest to declare.

Background: Sickle cell anemia (SCA) is a hemoglobinopathy as a result of substitution of glutamic acid with valine in the 6th position of the β globin chain. The vaso-occlusive crises of patients are often caused by pain that requires in-patient treatment. The attack rate is reported to changed between 0.5-1.0 attacks per year per patient. It could be reach up to 10% in 5% of patients. Identification of the SCA painful crisis and the determination of appropriate treatment is very important for the pain relief. Recently studies support that ketamine treatment is beneficial in patients who do not respond to traditional methods. Ketamine is a non-competitive antagonist at the NMDA receptor. We used retrospective visual analogue scale (VAS) scoring system in acute painful crisis patients and then applied ketamine and tramadol to investigate the effect of treatment and side effects and the maximum change in pain score within the first hour after drug administration retrospectively. The aim of this study is evaluate the level of ketamine effect in painful crises. Methods: Patients older than 6 years of age with acute painful crisis, defined as VAS of greater or equal to 4 were enrolled.The retrospective data was collected from electronic records and included age, sex, vital signs, changes in pain score within 1 hour, and side effects. Ketamine (0.25 mg / kg / dose) and tramadol (0.1-0.4 mg / kg / h) were administered. Patients with a pain score of Results: Ketamine group (n = 16), 6 female (37.5%), 10 male (63.5%) and the mean age was 15.4 (7-21) years. Tramadol group (n = 31) 15 female (48%), 16 male (52%) and the mean age was 15.6 (6-21) years. The age and sex groups were similar (p> 0.05). After drug administration, vital signs were observed in all patients in normal range to their age. In the tramadol and ketamine groups, the number of patients who responded at 20 minutes were 9(29%)-9(56%), 12(38%)-11(68%) (p Conclusion: In the treatment of painful crises, ketamine administration was found to be more effective than tramadol in the first hour. Due to the longer duration of the initial effect of tramadol treatment, ketamine should be considered as an option in the rapid treatment of painful crises. Disclosures No relevant conflicts of interest to declare.

WOS: 000360292000004, PubMed ID: 26301344, Objective: Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels. Methods: This was a prospective, multicenter study that included 70 patients hospitalized with acute decompensated HF and left ventricular ejection fraction

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY, WOS: 000329858400162, …, Turkish Soc Cardiol

Amaç: Renal bozukluğun kardiyovasküler olaylar için yüksek riskle bağlantılı olduğu gösterilmiştir. Kreatinin yüksekliğinin hafif formları bile kötü kardiyovasküler sonuçlarla ilişkilidir. Aşikar renal bozukluğun olmadığı hastalarda kreatinin düzeyleri ile koroner arter hastalığının anjiyografik yaygınlığının ilişkisini araştırmak için retrospektif bir çalışma tasarlandı. Yöntemler: Tipik kararlı anjina pektoris ile Türkiye Yüksek İhtisas hastanesine başvuran ve diyaliz öyküsü olmadan kreatinin düzeyi ?3 mg/dl olan 892 ardışık hasta (ortalama yaşı 62±10 yıl olan 311’i kadın ve ortalama yaşı 56±11 yıl olan 581 erkek) retrospektif olarak tarandı. Aşikar renal hastalığı olmayan hastalar kreatinin düzeyine göre 3 gruba ayrıldı (Grup A: Kr50%) ve düşük skor gruplarına ayrıldılar. Yüksek darlık ve yaygınlık skorlarının klinik öngördürücülerini belirlemek amacı ile lojistik regresyon analiz yapıldı. Bulgular: Kreatinin düzeyine göre ayrılan her bir grubun koroner arter hastalığının anjiyografik yaygınlığı farklıydı (p, Objective: Renal dysfunction has been shown to be linked to high risk for cardiovascular events. Even milder forms of creatinine elevation are associated with poor cardiovascular outcomes. We designed a retrospective study and searched the association of angiographic extent of coronary artery disease and creatinine levels in patients without overt renal dysfunction. Methods: We retrospectively reviewed 892 consecutive patients with typical stable angina pectoris (311 female with mean age of 62±10 years, 581 male with mean age of 56±11 years) at Türkiye Yüksek İhtisas Hospital and creatinine level ≤3 mg/dl without history of hemodialysis. Patients without overt renal disease were divided into 3 groups according to level of creatinine (Group A: Cr level 50%) versus low stenosis and low extension scores. Logistic regression analysis was performed to establish the clinical predictors of high total stenosis and high extension scores. Results: Each group of patients according to level of creatinine showed marked difference in terms of angiographic extent of coronary artery disease (p

WOS: 000294311800008, PubMed ID: 21821502, Objective: Percutaneous mitral balloon valvuloplasty (PMBV) is the method of choice in treatment of patients with hemodynamically significant mitral stenosis. We aimed to analyze acute and long-term clinical and echocardiographic consequences of PMBV. Methods: In this retrospective cohort study; 311 patients who underwent PMBV in our Cardiology Clinic at Turkiye Yuksek Ihtisas Education and Research Hospital between January 2000 and March 2004 were evaluated for acute procedural outcomes and primary endpoints (death, rePMBV, mitral valve replacement (MVR)). All 311 patients were contacted by phone call or letter at least five years after the procedure. Of the 311 patients, 87 who defined NYHA class II-IV symptoms were invited for a control visit and detailed echocardiographic evaluation. Sixty-three patients out of 87 who completed follow-up were enrolled for long-term consequences. Those 63 patients were subclassified into two groups as those without any negative event (n=26) (Group 1) and those with mitral valve area (MVA) (< 1.5 cm(2)), rePMBV or referral to MVR (n=37) (Group 2) on follow up to 6.4 +/- 1.6 years. Results: In the analysis of 311 patients, acute post procedural success, which was defined as mitral valve area (MVA) cm2 without severe mitral regurgitation, was 94% and was only associated with preprocedural MVA (p=0.008). In the logistic regression analysis, preprocedural MVA was the only independent parameter, associated with acute procedural success (Exp beta=0.004, 95%CI 0.0001-0.234, p=0.008). In the long-term follow up of 63 patients, the patients with uneventful course (Group 1) had significantly higher MVA (p < 0.001), lower mean (p=0.001) and peak (p < 0.001) transmitral gradients immediately after the procedure when we compared to the patients in Group 2. It was also noticed that patients with at least 60% improvement in MVA experienced composite end point much less frequently compared to those with less than 60% improvement in MVA (5% vs. 30.4%, p=0.009). Kaplan-Meier analysis yielded significantly diverging cumulative survival curves for those with and without at least 60% improvement in MVA (p=0.003). Conclusion: Concerning long-term follow up data of patients undergoing PMBV in a single center, it seems only acute postprocedural MVA was significantly associated with long-term consequences. (Anadolu Kardiyol Derg 2011; 11:515-20)

WOS: 000265432300009, PubMed ID: 18413331, In this study, factors leading to the failure of internal mammary artery grafting was investigated among patients with coronary bypass. In all, 1323 patients were evaluated. It was found that lower grade diameter stenosis in the native vessel during postoperative angiogram and wall motion score index independently affected the fate of internal mammary artery as a graft. Grafting with internal mammary artery to native vessels with lower grade stenosis and to myocardium with poor wall score might not be a rational approach.

OBJECTIVE As the endothelium and inflammatory cells play a crucial role in the development of collaterals after a sudden or slowly progressing stenosis of coronary arteries, the levels of soluble endothelial adhesion molecules (CAMs) including vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1) and E-selectin were compared between patients with poor coronary collaterals and patients with well-developed collaterals. METHODS In the study, 97 non-diabetic subjects with single-vessel disease were included. Collateral supply to the stenotic coronary artery was determined by angiographic grading system of 0-3 (Rentrop et al. J Am Coll Cardiol 1985; 5:587-592). Serum levels of adhesion molecules were measured by enzyme-linked immunosorbent assay. RESULTS Patients were divided into two groups according to the collateral degree (group A: 50 patients with grade 0 and 1; group B: 47 patients with grade 2 and 3 collaterals). The groups were well matched with respect to baseline clinical and angiographic characteristics. Levels of soluble VCAM-1 (mean+/-SEM; 875+/-26.6 versus 742.7+/-35.1 ng/ml; P=0.004), ICAM-1 (322.4+/-12.4 versus 269.4+/-13.3 ng/ml; P=0.005), and E-selectin (43.6+/-2.6 versus 33+/-2.4 ng/ml; P=0.004) were found to be significantly higher in group A in comparison with group B. In addition, when patients were divided into four groups according to the collateral degree, patients with grade 0 collaterals had the highest values and those with grade 3 collaterals had the lowest values for all these molecules. CONCLUSIONS We concluded that poor collateral circulation is associated with increased levels of soluble CAMs in patients with obstructive coronary artery disease. However, further studies are needed to elucidate the exact role of these inflammatory markers in the setting of poor collateral circulation.

Background: Patients with atrial septal defect (ASD) have an increased risk for atrial fibrillation (AF). Previously it was shown that maximum P wave duration and P wave dispersion in 12-lead surface electrocardiograms are significantly increased in individuals with a history of paroxysmal AF. We studied P maximum and P dispersion in adult patients with ASD during normal sinus rhythm. In addition, the impact of surgical closure of ASD on these variables within 1 year after surgery was evaluated. Methods: Thirty-four patients (21 women, 13 men; mean age: 35 ± 11 years) operated on for ostium secundum type ASD and 24 age-matched healthy subjects (13 women, 11 men; mean age: 37 ± 10 years) were investigated. P maximum, P minimum, and P dispersion (maximum – minimum P wave duration) were measured from the 12-lead surface electrocardiography. Results: P maximum was found to be significantly longer in patients with ASD as compared to controls (115.2 ± 9 vs 99.3 ± 14 ms; P < 0.0001). In addition, P dispersion of the patients was significantly higher than controls (37 ± 9 vs 29.8 ± 10 ms; P = 0.003). P minimum was not different between the two groups (P = 0.074). After surgical repair of ASD, 10 patients (29%) experienced one or more episodes of paroxysmal AF. Patients with postoperative AF were older (45 ± 6 vs 30 ± 10 years; P = 0.001), and had a higher preoperative pulmonary artery peak systolic pressure as compared to those without postoperative AF (51 ± 11 vs 31 ± 9 mmHg; P < 0.0001). No significant difference in the pulmonary-to-systemic flow ratio was observed preoperatively between the two groups (P = 0.56). P maximum and P dispersion were significantly higher in patients with postoperative paroxysmal AF at baseline and at postoperative first month, sixth month, and first year as compared to those without it (for P maximum P = 0.027, P = 0.014, P = 0.001, P < 0.0001, respectively; for P dispersion P = 0.037, P = 0.026, P = 0.001, P < 0.0001, respectively). In addition, in patients with postoperative AF, no significant changes were detected in both of these P wave indices during postoperative follow-up. However, in the other group, P maximum and P dispersion were found to be significantly decreased at postoperative 6 months and 1 year as compared to baseline. P minimum was similar throughout the postoperative follow-up as compared to baseline in both groups. Conclusions: Mechanical and electrical changes in atrial myocardium may cause greater P maximum and P dispersion in patients with ASD. Surgical closure of the ASD can regress these pathological changes of atrial myocardium with a result in decreased P maximum and P dispersion. However, higher P maximum and P dispersion at baseline, which have not decreased after surgery, may be associated with postoperative paroxysmal AF, especially for older patients.

Background: P-wave dispersion (PWD), defined as the difference between the maximum and minimum P-wave duration, has been proposed as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The aim of the present study was to evaluate PWD in patients with AS. Methods: The study population consisted of two groups: Group I consisted of 98 patients with AS (76 men, 22 women; aged 63 ± 8 years) and group II consisted of 98 healthy subjects (same age and sex) without any cardiovascular disease. A 12-lead electrocardiogram was recorded for each subject. The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum and minimum P-wave duration was calculated and was defined as the PWD. All patients and control subjects were also evaluated by echocardiography to measure the left atrial diameter, left ventricular ejection fraction, left ventricular wall thicknesses, and the maximum and mean aortic gradients. Patients were also evaluated for the presence of paroxysmal AF. Results: Maximum P-wave duration and PWD of group I were found to be significantly higher than those of group II. In addition, patients with paroxysmal AF had significantly higher PWD than those without paroxysmal AF. There was no significant difference between the two groups regarding minimum P-wave duration. In addition, there was no significant correlation between echocardiographic variables and PWD. Conclusion: PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients with AS than in those without it. Further assessment of the clinical utility of PWD for the prediction of paroxysmal AF in patients with severe AS will require longer prospective studies.