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Introduction Veno-venous extracorporeal membrane oxygenation (ECMO) support has been used for respiratory insufficiency. Its role in blood oxygenation has been well documented. However, the effects on myocardial electrophysiology have not been studied in detail. Aim To reveal the acute effects of extracorporeal support on new electrocardiography (ECG) parameters in patients with preserved left ventricular functions. Material and methods This retrospective study was conducted in three separate clinics. Sixteen consecutive patients under veno-venous ECMO for respiratory insufficiency who soon could be successfully weaned were analyzed. Immediately before and 2 hours after initiation of ECMO, ECG was performed. P wave, QT, QTc and T wave peak to end were measured and calculated from obtained surface 12-lead ECG. Results There were statistically significant differences immediately before and 2 hours after initiation of ECMO treatment in the Tp-e interval and Tp-e/QTc ratio, the maximum QTc, minimum QTc, and QTc dispersion values, and P wave dispersion (p < 0.0001 for each). All ECG parameters were significantly decreased with ECMO support. Conclusions All atrial and ventricular repolarization parameters were decreased in patients with VV-ECMO support. Despite the limited role of ECMO in intractable arrhythmias, the findings of the study revealed that ECMO therapy for respiratory insufficiency may improve atrial ventricular depolarization and repolarization. Therefore, simple 12-lead surface ECG with new ECG parameters may be evaluated for better outcomes.

Background: Predisposition to atrial fibrillation in mitral valve surgery has been well demonstrated. The changes in electrocardiographic parameters (Pmax, Pmin and P-wave dispersion) related to AF risk are unknown. We aimed to document the relationship between electrocardiographic changes and mitral valve replacement through right or left atrial surgical approaches. Methods: We retrospectively studied 154 patients, who underwent mitral valve replacement surgery from 2008 to 2018. Seventy-nine patients were operated with right atriotomy and transseptal approach (Group 1), and 75 patents were operated with left atriotomy (Group 2). ECGs obtained at hospital admittance and postoperatively at 24 hours were blindly analyzed. Results: Preoperative demographic characteristics were similar. Pmax, Pmin and P-wave dispersion were similar preoperatively. All parameters increased in both groups compared with the preoperative values (P < .05). Postoperative Pmax, Pmin and P-wave dispersion all were statistically significantly higher with the right atrial approach (P < .05). Postoperative AF also was more common in Group 1 (P < .05). Conclusion: Right atrial approach may lead to higher P-wave changes and atrial arrhythmias. This may be due to more extensive surgical disruption. The changes in atrial anatomic structure can increase atrial arrhythmic propensity and can cause atrial fibrillation.

Aim: We were aimed to demonstrate the effect of oxytocin on both ventricular and atria depolarization parameters. Material and Methods: We planned cross-sectional study. The Seventy- five patients, who were their last trimester and nulipar and admitted to hospital for spontaneous labor, were included to this study. A 12-lead ECG was recorded for each woman twice at 12 hour before oxytocin infusion at rest while in the supine position and shortly after from labor and upon cessation of oxytocin infusion. The Tp-e interval was defined as the interval between the peak and end of the T wave, measurements of the Tp-e interval were performed from precordial leads, and the Tp-e/QTc ratio and P wave dispersion, QTc was calculated from these measurements. In total, 280 pregnant women, of whom 98 were of advanced age and 182 were under 35 years of age were included in the study. The risk of arrhythmia was evaluated by calculating the electrocardiographic P-wave duration, QT interval, T peak-to-end interval, and the Tp-e/QT ratio.Go to:Results: There were statistically significant differences in the Tp–e interval and Tp-e/QTc ratio and other parameters before and after oxytocin infusion , the maximum QTc, minimum QTc, and QTc dispersion values, P wave dispersion and other parameters of repolarization were significantly higher after labor compared to the before labor. Although there were no differences in the Tp-e interval and Tp-e/QTc ratio between the groups, the maximum QTc, minimum QTc, and QTc dispersion values were significantly higher in advanced-age pregnancies compared to the control group. In addition, the P dispersion was greater in advanced-age pregnancies. In correlation analysis, the increased dispersion of QTc and P were positively correlated with maternal age. Multiple linear regression analysis showed that QTc dispersion was independently associated with maternal age. Go to: Conclusion: In conclusion, although study population was small and arrhythmic potential of oxytocin was evaluated with surface ECG. The repolarization parameters were increased in women with oxytocin infusion during their labor. To obtain these repolarization parameters are easy and usage of these parameters as a cardiac arrhythmic risk factor are logical.

Aim: To evaluate cardiac arrhythmias with surface 12 lead electrocardiography (ECG) parameters during pregnancy in women with mild heart failure. Material and Cardiovascular deaths usually occur in older pregnancies and arrhythmia is the third most common cause. Our study aimed to determine whether the risk of arrhythmia increases in pregnancy with advanced age.Go to:Methods:This cross-sectional study was approved by the local ethics committee of bicard clinic and our hospital 53 consecutive patients were accepted. All patients were admitted to hospital for cesarean section. Patients were grouped to heart failure (group 1) and control (group 2) (healthy group). A 12 lead ECG and N-terminal pro B-type natriuretic peptide (NT-pro BNP) plasma levels was recorded for every woman at 48 hour before cesarean section. They were evaluated P wave, qt, qtc and Twave peak to end, preoperative NT-pro BNP and compared statistically.In total, 280 pregnant women, of whom 98 were of advanced age and 182 were under 35 years of age were included in the study. The risk of arrhythmia was evaluated by calculating the electrocardiographic P-wave duration, QT interval, T peak-to-end interval, and the Tp-e/QT ratio.Go to:Results: There were statistically significant differences in the Tp–e interval and Tp-e/QTc ratio between the two groups, the maximum QTc, minimum QTc, and QTc dispersion values, P wave dispersion were significantly higher in group-1 compared to the group-2. In addition, preoperative NT-pro BNP plasma levels was greater in the group 1 pregnant women. And there was a positive correlation between ECG parameters and NT-pro BNP plasma levels in group 1.Although there were no differences in the Tp-e interval and Tp-e/QTc ratio between the groups, the maximum QTc, minimum QTc, and QTc dispersion values were significantly higher in advanced-age pregnancies compared to the control group. In addition, the P dispersion was greater in advanced-age pregnancies. In correlation analysis, the increased dispersion of QTc and P were positively correlated with maternal age. Multiple linear regression analysis showed that QTc dispersion was independently associated with maternal age.Go to: Conclusion: In conclusion, repolarization parameters were increased in patients with heart failure with elevated NT-pro BNP. Pregnancy and heart failure has known risk for pregnant women. But there is no clear cut atrial and ventricular arrhythmias risk scoring parameters for these kind patients. We found that ECG parameters which had significantly different in pregnant women with heart failure than control group and these changes correlated with NT-pro BNP levels. This is pathological; arrhythmia risk scorings should be established to reduce mortality and morbidity in heart failure patients with elevated BNP levels.

Studies related tosmoking cessation counseling in hospitalized patients are increasing. Smokershospitalized for a variety of reasons either temporarily stop orreduce the amount of smoking in the hospital. It is suggested that this periodbe utilized as an opportunity for smoking cessation intervention while in thehospital and followed up within one month by phone after discharge. Patients whoare hospitalized due to a smoking-related illness are more prone to theseattempts. The efficacy of drugs other than NRT (Nicotine replacement therapy)has not been proven. In our country, family physician departments can assumebedside cigarette counseling. However, problems such as restructuring ofhospital automation systems, solving drug procurement and reimbursement,setting up automated calling systems and integrating with smoking cessationhotline should be solved., Hastanede yatan hastalara sigara bıraktırma danışmanlığı verilmesi ileilgili çalışmalar artmaktadır. Hastanelerde çeşitli nedenlerle yatan hastalarsigara içmeye ya ara vermekte ya da miktarını azaltmaktadırlar. Bu süre birfırsata dönüştürülerek hastalara yatak başında sigara bırakma danışmanlığıverilmesi ve taburcu olduktan sonra telefonla bir ay içinde takibi yapılması önerilmektedir.Sigara kullanımına bağlı bir hastalıktan dolayı yatan hastalar bu girişimleredaha yatkın olmaktadır. NRT (Nikotine replasman tedavisi) dışında ilaçlarınetkinliği kanıtlanmamıştır. Ülkemizde aile hekimliği ana bilim dalları yatakbaşı sigara danışmanlığını üstlenebilir. Ancak, hastane otomasyon sistemlerininyeniden yapılanması, ilaç temini ve geri ödeme problemlerinin çözülmesi, otomatikarama sistemlerinin kurulması ve sigara bıraktırma hattıyla entegre çalışmasıgibi problemlerin çözülmeleri gerekir.

Cadmium Zinc Telluride (CdZnTe) is a good candidate for detection of x-ray and gamma-rays due to its high atomic number and large bandgap. CdZnTe is a II-VI group semiconductor and by changing ZnTe concentration, its properties can be altered. CdZnTe crystals having 4% ZnTe is commonly used as a substrate for Mercury Cadmium Telluride (HgCdTe) which is an important absorbing material for infrared imaging applications. For x-ray and gamma-ray detection, on the other hand, ZnTe concentration is kept around 10%. Due to high resistivity of CdZnTe crystals, preparation of surfaces prior to deposition of electrodes is important. After cutting and mechanical polishing, subsurface damages are observed on the crystals, which have a negative effect on the resistivity of the crystal near to the surface alongside with the dangling bonds on the surface. Decrease in the resistivity results in high leakage current that hinders the collection of electrons produced by absorption of photons. In addition, to have a strong bonding with electrode metal, surface should be clean from contaminants like oxygen and carbon. Achieving clean surface with low leakage current can be achieved by employment of chemical polishing step prior to electrode deposition. Bromine-alcohol solutions are used for chemical polishing without much control over the etching conditions. In this study, we report on the results of optimization study of chemical polishing by bromine-alcohol. Different alcohols (methanol, ethanol, propanol) were employed with different concentrations and etching durations. In addition, etching is conducted for different orientations to examine orientation dependency of the solution.

Cadmium Zinc Telluride (CD1-xZnxTe has become a crucial material for x-ray and gamma ray detection due to its wide band-gap, high atomic number and high density, which offer high efficiency and sharp spectroscopic resolution at room temperature. In addition, due to being lattice matched, it can also be used as substrate for the epitaxial growth of HgCdTe that can be used for infrared detection with high resolution. Hence, increasing the single crystal yield of CdZnTe from the grown ingot gained importance for the development of such detectors. In this study, a combination of modeling and experimental approaches has been developed in order to obtain high quality CdZnTe bulk crystals with good single crystal yield. A multi-zone Vertical Gradient Freeze (VGF) furnace was used for CdZnTe growth experiments. A global temperature model of the multi-zone furnace including complete geometry was employed using CrysMAS crystal growth modeling software. The correlation studies between the model and experimental behavior of the furnace are discussed in order to create a reliable model for temperature predictions. Temperature models were also included solid-liquid interface study in order to observe the interface shape at various stages of growth which would provide valuable insight about the quality and the yield of the ingot. Growth parameters and crucible geometries were estimated by CrysMAS simulations and interchanged between experiments. Effectiveness of temperature models and simulations was supported by experimental results such as single-crystalline yield, grain evolution and crystalline quality comparison by DCRC measurements of five successful crystal growths with moderate single crystal grain sizes.

Aluminum induced texturing (AIT) is one of the most promising texturing methods, which can be applied on glass substrates for solar cell applications. Combination of different dimensional structures exhibits the opportunity to achieve enhanced light trapping schemes. Here in this study, float glass and macro textured sandy and prism glasses went through Aluminum induced texturing (AIT) process in order to enhance light management. Surface morphologies were investigated by FE-SEM and optical measurements in terms of transmittance and haze were conducted. Micro or nano sized craters were formed on each type of glass surface successfully by using acidic and basic etching solutions. It was shown for every type of glass that AIT process enhances haze values remarkably. Moreover, it was demonstrated that basic solution is superior to acidic solution in terms of optical properties. In this work, random macro-scale surface texture and imprinted inverted pyramid-like pattern were used to combine AIT textures to attain high haze values. Superior haze was achieved from macro-nano combined texture surface having more scattered light from prism glass substrate with a maximum haze value of 90 %. Comparison of AIT textured float, prism and sandy glasses in terms of haze.

In order to evaluate the effects of lateral osteotomies performed during rhinoplastic surgery on the lacrimal drainage system, a new technique for imaging the lacrimal passages, Active Transport Dacryocystography, was applied in a total of 16 patients. In all cases, free passage of contrast media from the punctum to the inferior meatus was observed. We did not record any pathologic alteration such as mucosal edema or discontinuity of the bony structure that would have resulted in nasolacrimal obstruction.

Purpose: To report the results of Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with toxic anterior segment syndrome (TASS) after cataract surgery. Setting: Department of Ophthalmology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey. Methods: In this prospective study of consecutive patients who had DSAEK for corneal failure due to TASS, the main outcome measures were corneal clarity, mean spherical equivalent (SE) refraction, preoperative and postoperative visual acuities, central corneal thickness, and endothelial cell count (ECC). Results: The mean follow-up in the 10 eyes (10 patients) was 17.1 months ± 2.4 (SD). There were no graft dislocations postoperatively, and no graft required repositioning. All grafts were clear at 12 months. Two eyes had initial graft rejection that resolved with treatment. All eyes had improved postoperative corrected distance visual acuity, with 7 eyes (70%) attaining 0.5 or better. The mean SE refraction in measurable cases (5 eyes) was 1.2 ± 0.6 preoperatively and 0.9 ± 1.0 postoperatively (P = .141). The decrease in mean pachymetry from preoperatively (691 ± 15 µm) to 12 months postoperatively (614 ± 23 µm) was statistically significant (P = .005). The mean ECC was 2740 ± 236 cells/mm2 preoperatively, 1690 ± 209 cells/mm2 at 6 months, and 1683 ± 206 cells/mm2 at 12 months. The decrease between preoperatively and 6 and 12 months (P = .05) and between 6 months and 12 months (P = .008) was statistically significant. Conclusion: Descemet-stripping automated endothelial keratoplasty was safe and effective in eyes with TASS-associated corneal edema, yielding encouraging surgical and visual outcomes. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2010 ASCRS and ESCRS.

Background: Pursestring suture for ascending aortic cannulation in open heart surgery that requires cardiopulmonary bypass may cause serious events, especially in patients who have a thin or calcific aorta. We introduce a novel suturing method, called the ‘tangential suture technique’, and submit our clinical experience. Methods: Adult patients undergoing cardiopulmonary bypass were included in this study. Patients in whom the tangential suture technique was applied (Group A; n = 146) were compared with patients in whom the classic pursestring technique was applied (Group B; n = 152). Results: The age (38 ± 11 years vs 36 ± 10 years), sex (males 65.1% vs 62.5%) and operation types were similar in both groups. Although the difference was not significant (P > 0.05), subadventitial haematoma occurred more frequently in Group B (13 patients; 8.6%) than in Group A (3 patients; 2.1%). However, none in Group A required opening the adventitia. No aortic dissection was observed in peri- or postoperative periods in either group. In Group B, seven (4.6%) patients required repair by suture after tying of pursestring sutures following decannulation because of bleeding, while none was required in Group A (P = 0.0156). Conclusions: Tangential suture technique allows the needle to take a longer segment from the media layer while decreasing the likelihood of entering the lumen. Because the tract of the suture almost perfectly fits to the needle curve, tissue injury is less, even on fragile aortas, and this ensures more stable closure of the hole when the suture is tied following decannulation. By considering both its theoretical advantages and our clinical experience, we believe tangential suture technique should be preferred to the classic method.

SUMMARY Neurological complications in patients with eclampsia are varied and include headache, visual disturbances, focal neurological deficits, altered mental status and coma. Occasionally, a focal neurological deficit includes a variety of visual disturbances. The pathophysiology of CNS abnormalities in patients with eclampsia is uncertain. Our cases, combined with a review of the literature, demonstrate that there is no correlation among severity of hypertension, parity, and location of lesions at initial magnetic resonance (MR) imaging findings or between the severity of hypertension and neurological symptoms. Two typical patterns are seen on MR images of patients with eclampsia. Lesions in the region of the posterior cerebral circulation are most common and are frequently associated with visual disturbances. Although there are lesions in the deep white matter or basal ganglia, a focal neurological deficit or alterations in mental status may not develop. This demonstrates the sensitivity of MR imaging in the detection of abnormalities in patients with eclampsia, even those without neurological deficits.

We described a new technique (called 'bicuspidization'), which is performed by using autogenous material, without replacement of the aortic valves for the surgical treatment of aortic stenosis and/or insufficiency and tested it in in vitro sheep model. Different stress conditions were simulated by applying three different flow patterns (hemodynamic challenge tests) successively by using a centrifugal pump. It was demonstrated that the competency of the new bicuspid valves was excellent (zero insufficiency). There was a 10-11 mm Hg-increase on trans-valvular gradient comparing the normal hearts. The autogenous bicuspid valve has not blocked the way of the coronary flow in the closed position.

Purpose: To assess the effect of verapamil (80 mg) oral administration on portal and splanchnic hemodynamics in patients with advanced posthepatitic cirrhosis using duplex Doppler ultrasound (US). Methods: Fourteen patients with post-hepatitic liver cirrhosis were included in the study. Duplex Doppler sonographic examinations were performed before, and 2–3 h after, 80 mg verapamil oral administration. Portal and splanchnic hemodynamics including vessel diameters (mm), mean flow velocities (cm/s), blood flows (ml/min), Doppler indices such as pulsatility and resistive indices (PI and RI), were investigated before and after verapamil administration. Results: After verapamil administration; diameter of portal vein, splenic vein, and superior mesenteric artery (SMA) showed increase of 8%, 10%, and 7% (P < 0.05 to < 0.001), respectively. Increases of 20%, 38%, and 47% were found in blood flows (P < 0.05 to < 0.0001) with respect to the above vessels. Decreases of 17%, 10%, 11%, and 7% were found in SMA PI, SMA RI, splenic artery (SA) PI, and SA RI, respectively (P < 0.05 to < 0.0001). Conclusions: Verapamil appears to have splanchnic, portal, splenic, portocollateral and probably intrahepatic vasodilator effects in patients with advanced posthepatitic liver cirrhosis. Verapamil should be further investigated in the treatment of patients with advanced liver cirrhosis with prospective studies measuring portal and wedged hepatic pressure.

We read with great interest the article (November, 2000) by Drs Vural and Tas,demir [1]. We have several concerns regarding the paper. As the authors emphasized, posterior left ventriculectomy or Batista procedure is an important surgical option for severe or end-stage heart failure. We think the amount and extension of resected viable muscle segment is a very crucial point for this special procedure. We noticed, in 41% (11/27) of the patients, the authors included anterior papillary muscle (APM) in the resected wall muscle. Although, they did not compare two techniques (resection vs. preservation of APM), we prefer to protect APM. It is clear that they defend resecting as large as possible of the left ventricular (LV) myocardium to obtain maximum bene®t. However, Felipe and his colleagues [2] did not ®nd any correlation between LV ejection fraction changes and the degree of myocardium resection. In the other 59% (16/27) of the patients, they did not resect the APM, but they replaced the mitral valve without reattaching the cords to the ventricular wall. Batista procedure improves systolic function while decreasing diastolic compliance, resulting in reduced ventricular function [3]. Thus, immediate hemodynamic improvements appear to drive mainly from a reduced severity of mitral regurgitation. Ventriculectomy ensures acute remodeling of the heart and decreasing chamber volume/mass ratio. Numerous clinical and experimental studies demonstrate the importance of preserving papillary continuity of the mitral valve. Lillehei [4] ®rst reported on the preservation of papillary muscles and chordea tendinea and its bene®ts to ventricular function following mitral valve replacement (MVR). High incidence of postoperative `low cardiac output syndrome' after MVR, subsequently introduced techniques of preservation of the mitral apparatus. Studies by Hansen [5] and Sarris [6] using load-independent measurement of LV contractility demonstrated that a division of all chordea tendinea was accompanied by a 47% reduction in LV maximal systolic elastance (Emax). Furthermore, the effects of chordal detachment and reattachment on LV function were assessed by load-independent measurements of Emax. When all chordea were detached, a signi®cant decline of LV contractility was seen, which has subsequently restorated to baseline levels after reattaching the native chordea by repair of the papillary muscles. Maintaining of chordal, annular, subvalvular continuity and mitral geometric relationship are considered very important in valvular surgery. These parameters maybe even more important for the patients with severely compromised LV function. We think, for the ventricules that really need help, it is luxury that neglecting all of the advantageous we discussed above, just because of the fear of papillary muscle distortion. Hepatomegaly, an important sign of the right heart failure, is considered as a strong indicator for the operative mortality. We couldn't ®nd the incidence of tricusbid valve insuf®ciency accompanied to the hepatomegaly in the paper. Also, there is no any statement that if they did any surgical procedure (like annuloplasty, replacement) to the tricusbid valve. If they did not perform any procedure to the right side, why didn't they consider it? We would like to learn their opinion in this subject. Finally, we want to correct some clerical errors in the paper. There are discrepancies between text (or Table 1, abstract) and Table 3 for preoperative LVESV (259 ^ 66 ml vs. 251 ^ 52 ml) and LVEDV (342 ^ 83 ml vs. 335 ^ 68 ml) values. European Journal of Cardio-thoracic Surgery 19 (2001) 537±538

We read with great interest the article (August 2000) by Vasquez-Jimenez et al. [1]. They emphasized the cardiac lymph uid as the most direct medium for analyzing metabolical changes in the myocardial cell. The lymphatic drainage of the heart ows from subendocardial vessels to an extensive capillary plexus lying throughout the subepicardium [2]. The lymphatics begin in the tissues with blind-end lymphatic capillaries. These capillaries are very porous and easily collect large particles accompanied by interstitial uid [3]. Endothelial cells of the venous microcirculation and lymphatic vessels provide the exit sites and also work as conduits for some metabolic end products of myocytes and some hormonal substances. Endothelial cells of the lymphatic capillaries are anchored within the interstitium and to neighboring myocytes by a ®brillar collagen network. When the interstitial uid volume rises, it serves to exert a tension on these collagen ®bers and dilates lymphatic capillaries to foster the clearance of tissue uid. The extensive lymphatic circulation of the myocardium is responsible for returning tissue uid and plasma protein that gained access to the interstitium to the systemic and osmotic pressures and the uid volume of the extracellular space, while protecting against interstitial edema. Cardiac lymph also contains hormones that were released into the interstitium from secretory granules (atrial natriuretic peptide) and adrenergic neurons (norepinephrine) [4]. These substances can have important systemic effects. Another function of the cardiac lymph relates to the removal of cellular elements and tissue debris from the interstitium. This makes the lymphatic circulation an essential element in the myocardium's response to injury and wound healing. Because of these functions, the lymphatic system plays an important role for myocardial functions and cardiac lymph uid can be used as markers for the myocardial edema, reperfusion injury and myocardial damage. We have several concerns regarding the issue. We would like to ask the authors about the importance of lymphatic circulation on myocardial protection. As they know, we have to create external pressure on superior vena cava (SVC) (by using snare or vena cava clamp) for some open heart surgeries that require total cardiopulmonary bypass and total circulatory arrest (valve surgeries, congenital heart disease, arcus and ascending aorta surgery, etc.). We wonder, if the connection system and contractility might be affected with myocardial edema that caused by impaired lymphatic circulation, especially in the `right drainage types'. Do they advise using cuffed venous cannules to prevent this problem? We understand that the researchers were snared SVC, while preparing the swine heart. Did they ®nd any difference in ow rate on the `right drainage type' compare with the other types? Also, we want to learn if the impaired lymphatic circulation has any role on early graft failure of orthotopic and heterotopic heart transplantation and how the lymphatic system regenerates itself on these cases. The knowledge on cardiac lymphatics is very limited and their importance is almost always neglected in cardiac surgery practice. So, we congratulate the authors for such a good paper related the subject. We think, Dr VasquezJimenez and his colleagues deserve credits for their contributions on this unique subject.