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OBJECTIVE: Coronary artery disease is the most frequent disease that was detected in pilots at fatal aviation accidents. Military and civilian aviation is enormously crowding in population and aircrew is getting older. We evaluated the features of CAD in aircrew diagnosed by Multi-sliced CT Coronary Angiography (MSCTA). MATERIAL AND METHOD: We retrospectively analyzed the distribution and number of coronary artery lesions of 17 pilots (46.2±5.1) and 13 aircrews (40.0±2.5) from their medical recordings. RESULTS: Two and three vessel disease was higher in pilots whereas one vessel disease was slightly higher in other aircrew (p=0.163>0.05) (Table 1). Two and three vessel disease was higher in subjects with positive family history whereas subjects with one vessel disease had no family history (Table 2). Family history was statistically correlated with presence of coronary artery disease (p=0.023<0.05, ß=0.445). Single vessel disease located on LAD or Cx was in 12 and 5 of subjects, respectively. LAD was the most frequent coronary artery which was diseased as single or included in two or three vessel disease totally in 25 of subjects. CONCLUSION: CAD is dominated at the left coronary system which could be a potential for acute incapacitation in fl ight during acute ischemia. LAD artery was mostly included artery within single or multi-vessel disease. Family history correlated with multivessel and diffused type of CAD. So close follow up and screening program e.g.treadmill test, MSCTA when necessary, may conveniently be performed in aviators and effective primary prevention of aircrew older than 40 years old is critically signifi cant. [ABSTRACT FROM AUTHOR]

The prevalence of coronary artery anomalies has been reported between 0.6 to 1.3% in angiographic series and 0.3% in autopsy series. Anomalous origin of the RCA from the left sinus of Valsalva represents less than 3% of total coronary anomalies. They may develop clinical symptoms like ventricular arrhythmias, syncope, myocardial infarction and sudden death in the absence of critically fi xed stenosis, especially in case of interarterial course between aorta and pulmonary artery. A 51-year-old man was admitted to our outpatient clinic for chest pain. He have had hypertension and hypercholesterolemia. Physical examination was normal. Electrocardiography showed nonspecifi c ST-T changes. Two-dimensional transthoracic echocardiography revealed normal fi ndings. To clarify coronary anatomy, we performed three-dimensional volume rendered multi-detector computed tomography image of the coronary arteries. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. Severe intracoronary atherosclerotic lesion was observed at proximal LAD. The multi-detector computed tomography scan may be helpful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, because this situation will require surgical treatment to avoid sudden cardiac death. We herein report a case of abnormal origin of the right coronary artery with the inter-aortopulmonary course and severe stenotic lesion at proximal LAD [ABSTRACT FROM AUTHOR]

Sinus valsalva aneurysm is a rare cardiac anomaly. The aneurysm most commonly originates from the right coronary sinus. It may be congenital or acquired; a coexisting cardiac lesion may be present. Sinus valsalva aneurysm can lead to signifi cant dysfunction of the aortic root and aortic regurgitation. A 67-year-old man was admitted to our outpatient clinic for palpitation. He have had hypertension for thirteen years. 2/4 diastolic murmur was heard at the right second intercostal space. Electrocardiography showed chronic atrial fi brillation. Two-dimensional transthoracic echocardiography revealed moderate aortic regurgitation and aneurysmatic dilatation of the right sinus valsalva. To clarify coronary anatomy, we performed cardiac computed tomography angiography. Oblique coronal view (Figure 1A, arrow) and three-dimensional reconstructed computed tomograhic angiography image of aorta (Figure 1B, arrow) demonstrated asymmetrical aneurysmal change involving the right coronary cusp. The acquired sinus valsalva aneurysm is more common than the congenital and associated with infections (syphilis, tuberculosis), atherosclerosis, connective tissue disorders or trauma. Aortic regurgitation, rupture, fi stulas, thrombus formation, myocardial ischemia complicate sinus valsalva aneurysm. We herein report a case of sinus valsalva aneurysm of the right coronary sinus associated with ascending aortic aneurysm. Computed tomograhic angiography have shown value in the diagnosis of sinus valsalva aneurysm. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We investigated the association between serum bilirubin level and carotid intima– media thickness (cIMT). The study population consisted of healthy aviators without coronary artery disease, who underwent carotid doppler ultrasonography for periodic medical examination. METHODS: The medical records of 50 aviators who applied to Aeromedical Examination Center were included in this study. Their ages, fl ight hours, body mass index (BMI), serum bilirubin levels and cIMT values were obtained by a retrospective analysis of medical records and analyzed. The subjects with known CVD, clinical signs of CAD, peripheral artery disease, hypertension and diabetes mellitus were excluded from the study. They were divided into 2 groups, cIMT of less than 0.458 mm was defi ned Group 1(n= 25) and more than 0.458 mm was Group 2(n=25). RESULTS: Mean ages of Group 1 and 2 were 32±4.4 and 32.24±4.94 (p=0.953), respectively. BMI values were 25.10±2.59; 25.15±2.57 respectively (p=0.764). Flight hours were 1470.96±884.36; 1287.09±830.24 respectively (p=0.322). Serum bilirubin levels were 0.87±0.42 mg/L; 1.18±0.49 mg/L; respectively (p=0.018). No statistically difference was found between these groups except serum bilirubin levels. DISCUSSION: The highest serum bilirubin levels were observed in Group 2. These results showed that serum bilirubin level was independently and positively associated with carotid IMT. In contrast to previous research,serum bilirubin level may not be an independent predictor of the extent of subclinical atherosclerosis assessed by cIMT. The contribution of serum bilirubin level to the atherosclerotic process have not been fully clarifi ed yet. [ABSTRACT FROM AUTHOR]

Coronary collaterals occur frequently in the presence of occlusive coronary artery disease. These collaterals can reduce or prevent myocardial ischemia in case of proximal vessel occlusion. Development of collateral connections will be triggered of multiple prolonged ischemia that stimulate the growth of new small vessels. The coronary collateral circulation is an adaptive response to myocardial ischemia. Functionally suffi cient coronary collaterals are associated with reduced mortality in patients with stable coronary artery disease and reduced infarct size in patients with acute myocardial infarction. A 71-year-old man was admitted to our outpatient clinic with an atypical chest pain and dyspnea. There has been not any cardiac events up to the present. Electrocardiography demonstrated non-spesifi c ST-T changes. A transthoracic echocardiogram showed grade 1 diastolic dysfunction and normal left ventricular function. Cardiac enzymes were seen in normal limits. During coronary angiography,(BP 140/78, mean 98 mmHg; HR 74bpm) totally coronary occlusion detected in the mid segment of right coronary artery(RCA) (Fig.1A), left anterior descending artery (LAD) were seen as an insignifi cant stenosis. Unexpected huge collateral was found between the distal LAD and the distal RCA during contrast medium injection into the left main coronary artery(LMCA) which briskly opacificated(Fig. 1B). The collateral between LAD and distal RCA is very pronounced and mimicking the coronary artery anomaliy. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Circadian blood pressure variation in normotensive patients with panic disorder" by H. Alici and colleagues that was published in the 2014 issue.

A letter to the editor is presented in response to the article "Increased platelet distribution width is associated with ST-segment elevation myocardial infarction and thrombolysis failure" by M. Cetin and colleagues that was published in 2014 issue.

The article presents case study of a 24-year-old male who was admitted to the clinic after suffering with congestive heart failure, and states that transthoracic echocardiography of the patient was performed and the patient was found to be suffering with Behcet's disease.

A letter to the editor in response to the article "Serum Bilirubin Level and Aortic Intima-Media Thickness in Patients Without Clinical Manifestation of Atherosclerotic Cardiovascular Disease'' by G.Y. Kalkan and colleagues is presented.

OBJECTIVE: We present a case of a coincidental occurrence of right hemicolectomy and pulmonary artery dilatation in a military pilot. CASE: 40-year old male navy helicopter pilot was admitted to our center for 5 year periodic medical examinations. Medical history revealed an appendectomy and right hemicolectomy in 2002 because of lymphadenopathy in 5x6cm size and edema of the mesocolon close to hepatic flexure. Histopathological examination of the appendices revealed probable carcinoid tumor. The pilot had recovered uneventfully and had been allowed for flying duties. In February 2012, due to his recurrent abdominal pain he underwent colonoscopy and diagnosed with diverticulosis. His indirect bilirubin was 2.17 mg/dl. During this visit, ECG showed regular sinus rhythm. Biochemical analysis revealed LDL: 197 mg/dl and indirect bilirubin: 2.01 mg/dl. Teleradiography showed prominent pulmonary conus. In his echocardiography; his left ventricle functions and diameters were normal, right heart volumes were also normal (right atrium: 36 mm, right ventricle: 34 mm). Tricuspid valve E/A velocity: 53/33 cm/s, pulmonary artery diameter (PAD): 26.8 mm, diameter of pulmonary conus: 36.1 mm. Thorax CT revealed his PAD 30 mm. An arachnoid cyst in 40x25 mm size was detected in incidentally performed brain CT. He is qualified as fit to fly. CONCLUSION: Considering the pilot‟s history, the examinations carried out to diagnose the sickness isn‟t satisfying. A disease associated with right hemicolon, liver, heart and pulmonary artery makes us to think of a chronic process such as Chron‟s disease, mucinous carcinoma, lymphoid hyperplasia. His arachnoid cyst is a coincidental occurrence. [ABSTRACT FROM AUTHOR]

CASE: 32 year-old male F-16 pilot visited our center for 5 year aircrew periodic medical examination which consists of physical exam, blood tests, chest x-ray, pulmonary function test, ECG and transthoracic echocardiography (TTE). Chest auscultation revealed paradoxical splitting of S2 and no souffle of heart. Biochemical analysis was normal. The electrocardiogram showed regular sinus rhythm with no abnormality. Chest x-ray showed mild increase in pulmonary conus. TTE demonstrated mild enlargement in right heart volumes (right atrium: 39 mm, right ventricle: 44 mm), mild tricuspid insufficiency, pulmonary arterial flow velocity: 202 cm/s, aortic flow velocity: 178 cm/s, pulmonary artery pressure: 27 mmHg and a 9 mm defect in interatrial septum with left-right shunt, and no Eisenmenger development (QP/QS: 1.8). Left ventricle systolic and diastolic functions were normal. The pilot was referred to cardiac center for surgery or percutaneous closure but he didn‟t accept any intervention and was permanently grounded. CONCLUSION: Since we hadn‟t performed TTE in the past in periodic medical examination, the pilot has not been diagnosed previously. The unique flying environment hadn‟t adversely affected his disease. If the pilot had accepted a percutaneous closure for his ASD, he would have been considered as fit to fly on the conditions with no complication, no residual shunt and no arrhythmia and after 6 months acetylsalicylic acid treatment with warfarin. [ABSTRACT FROM AUTHOR]

Aims This study investigates the effect of a new combination of glucosamine hydrochloride, chondroitin sulfate, methylsulfonylmethane, Harpagophytum procumbens root extract (standardized to 3% harpagoside) and bromelain extract (GCMHB) on formalin-induced damage to cartilage tissue in the rat knee joint and evaluates this combination in comparison with another combination of glucosamine hydrochloride, chondroitin sulfate and methylsulfonylmethane (GKM). Materials and methods Animals in the control group were injected with formalin into the knee joint (FCG). Animals in the GCMHB-500 group were given 500 mg/kg GCMHB + formalin, and those in the GKM-500 group were given 500 mg/kg GKM + formalin. Finally, a healthy group (HG) was also used. GCMHB and GKM were administered to rats orally once a day for 30 days. At the end of this period, the rats were sacrificed and the levels of MDA, NO, 8-OH/Gua, and tGSH in the knee joint tissue were measured. Analysis of IL-1β and TNF-α gene expression was done and the tissue was evaluated histopathologically. Key findings MDA, NO and 8-OH/Gua levels and IL-1β and TNF-α gene expression were significantly lower in the GCMHB-500 group compared to the FCG group, whereas tGSH was significantly higher in the GCMHB-500 group than in the FCG group. No significant difference was found for the IL-1β, TNF-α and oxidant/antioxidant parameters between the GKM and FCG groups. The histopathological analysis showed that GCMHB could prevent damage to the cartilage joint, whereas GKM could not. Significance GCMHB may be used clinically by comparing with GKM in the treatment of osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases, among which atherosclerotic heart disease, are known to be one of the most important mortality and morbidity causes in patients with rheumatoid arthritis (RA). Ischemia modified albumin (IMA) is a potential marker that can be used to assess atherosclerosis‐related myocardial ischemia. Another frequently used marker for the assessment of atherosclerotic lesions is the carotid intima media thickness (CIMT). Aim: To evaluate the role that IMA has on atherosclerosis development and its clinical usability in patients with RA, by assessing the values of IMA and CIMT. Methods and materials: Our prospective study was conducted between June 2012 and March 2013 at the Rheumatology Department of Necmettin Erbakan Meram Medical School, Turkey. Fifty‐two RA patients, diagnosed according to the 1987 criteria of the American College of Rheumatology, and an age‐ and sex‐matched control group of 46 healthy subjects were included in this study. Results: No significant difference was detected between the groups with respect to age, sex and body mass index. In the patient group the IMA and CIMT values were found to be 0.37 ± 0.12 absorbance units (ABSU) and 0.80 ± 0.22 mm, respectively, while in the control group they were 0.31 ± 0.11 ABSU and 0.51 ± 0.18 mm, respectively. The IMA and CIMT values were significantly higher in the patient group (P = 0.022 and P < 0.0001, respectively). A positive correlation was found between IMA, CIMT and Disease Activity Score of 28 joints (P = 0.016 and P = 0.002, respectively). Conclusion: Since the values of IMA were higher in the patient group compared to controls and because of its correlation with CIMT, we suggest the use of IMA as an early marker of atherosclerosis in RA patients. [ABSTRACT FROM AUTHOR]

Objective The chemoreceptor network, consisting of the glossopharyngeal nerve and carotid body (GPN-CB), is essential for the regulation of blood pH. Its ischemic insults after subarachnoid hemorrhage (SAH), which may contribute to acidosis, have not been investigated. Methods Twenty-three hybrid rabbits were used. They were divided into 3 groups: 5 as a control group, 5 as a sham group, and the remaining 13 as the study group. Injections included 1 cm 3 serum saline and 1 cm 3 autolog arterial blood into the cisterna magna in the sham and study group, respectively. Blood pH values of all animals were recorded. After 2 weeks, animals were euthanized. The number of normal and degenerated neurons of the carotid bodies (CBs) was counted by stereologic methods and analyzed statistically. Results Two of 13 rabbits died within the second week. The mean blood pH values were measured as 7.35 ± 0.07 in the control group (n = 5), 7.33 ± 0.06 in the sham group (n = 5), 7.29 ± 0.05 in rabbits with slight acidosis (n = 6), and 7.23 ± 0.02 in rabbits with prominent acidosis (n = 7). In the control group, the average normal neuronal density of the CBs was 6432 ± 790/mm 3 and the degenerated neuron density was 11 ± 3/mm 3 , whereas the degenerated neuronal density in CBs was 35 ± 8/mm 3 in the sham group and 1034 ± 112/mm 3 in the slight acidosis–developed group (n = 6; P < 0.05). Conversely, degenerated neuron density of CBs was 2134 ± 251/mm 3 in the prominent acidosis–developed animals (n = 7; P < 0.005). Interestingly, in the rabbits who died, the degenerated neuron density of the CB was 3160 ± 840/mm 3 . Conclusion An inverse relationship between neurodegeneration in the CB and pH values secondary to the disruption of the GPN-CB network after SAH was found, which may contribute to developing acidosis. [ABSTRACT FROM AUTHOR]

Objective The Adamkiewicz artery (AKA) supplies pudendal nerve roots and conus medullaris. The aim of this study was to elucidate if there is any relationship between neurodegenerative changes of the Onuf nucleus (ON)–pudendal nerve ganglia complex secondary to vasospasm of the AKA after spinal subarachnoid hemorrhage (SAH). Methods This study was conducted on 22 rabbits, which were randomly divided into 3 groups: control ( n = 5), sham ( n = 5), and spinal SAH ( n = 12). Experimental spinal SAH was induced at the L2 level. After 2 weeks, the ON–pudendal nerve ganglia complex and AKA were examined histopathologically. Bladder volume values were estimated, and results were analyzed statistically. Results Two animals died within the first week of experiment. Histopathologically, severe vasospasm of the AKA and neuronal degeneration and neuronal apoptosis were observed in the ON–pudendal nerve ganglia complex in 5 animals of the SAH group. The mean volume of the imaginary AKA, mean bladder volumes, and degenerated neuron densities of ON and pudendal nerve ganglia were estimated. We found that vasospasm of the AKA led to numerous neuron degenerations in ON and pudendal ganglia and consequently urinary retention ( P < 0.005). Conclusions ON–pudendal nerve ganglia complex degeneration secondary to vasospasm of the AKA may be a cause of urinary retention after spinal SAH. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction is considered as an early change in atherogenesis. Raised levels of systemic inflammatory markers are associated with cardiovascular disease (CVD). Endocan (previously known as endothelial cell specific molecule-1, ESM-1), is a potential immunoinflammatory marker that may be linked to CVD. Endocan is released by vascular endothelial cells in several organs. Endocan may play an important role in regulating cell adhesion and raised plasma levels may reflect endothelial dysfunction. Endocan levels are elevated in conditions such as chronic kidney disease, renal transplant rejection, tumor progression and hypertension. Endocan is a potential inflammatory and CVD marker. Further studies are needed to assess the relevance of endocan in clinical practice. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Intracardiac Thrombosis in Behcet's Disease: A Rare Complication' by G. Saghi and N. Doghmi in the January 2013 issue.

A letter to the article "Association of red blood cell distribution width levels with severity of coronary artery disease in patients with non-ST elevation myocardial infarction" by Omer Sahin, Mahmut Akpek and colleagues in the 2015 issue is presented.

Bilateral common carotid artery ligation (BCCAL) leads to acute craniocervicocerebral ischemia, retrograde blood flow, increased blood pressure, and significant hemodynamic and histomorphological changes at the posterior cerebral vasculature. We examined the potential relationship between denervation injury following BCCAL-induced cervical sympathetic trunk (CST) ischemia and heart rate after permanent BCCAL. Rabbits (n = 25) were randomly divided into three groups: an unoperated control group (GI, n = 6); a sham-operated control group (GII, n = 6), and an experimental group subjected to BCCAL (GIII, n = 13); and then followed for one month. All animals were then sacrificed and the stellate ganglia (STGs) were examined histologically using stereological methods. The densities of degenerated neurons in the STGs were compared with heart rates and the results were analyzed with the Mann-Whitney U test. The mean normal neuron density in STGs was 10.340 ± 954/mm 3 and the degenerated neuron density was 12 ± 3/mm 3 in the GI group (p > 0.5). The mean heart rates and degenerated neuron densities of STGs were recorded as 267 ± 19/min and 237 ± 45/mm 3 in GII (p < 0.005 for GII vs. GI); and 190 ± 11/min 1421 ± 230/mm 3 in GIII (p < 0.0001 for GIII vs. GI and p < 0.005 for GIII vs. GII). An inverse and meaningful association was observed between the heart rate and degenerated neuronal density in the STGs. BCCAL may lead to hazardous histomorphological changes in the CST. A high density of degenerated neurons in the STG may provoke excessive sympathetic hypoactivity-related cardiac damage and bradyarrhythmias after stenoocclusive carotid artery diseases.

Background and Study Aim:   Basic neurophysiologic principles of the light reflex are well known. However, the effects of degenerated axon densities of oculomotor nerves (OMNs) secondary to posterior communicating artery (PComA) vasospasm following subarachnoid hemorrhage (SAH) have not been investigated. Our aim was to study this subject., Methods:  This study was conducted on 19 rabbits. There was a control group of five animals, a sham group of five animals in which saline was injected into the cisterna magna and a study group of nine animals in which homologous blood was injected into the cisterna magna. Pupillary diameters were measured for 1 week, then the animals were decapitated. The normal and degenerated axon densities of the OMNs were examined by stereological methods. Vasospasm indexes (VSIs) of posterior communicating arteries (PComAs) supplying OMNs were estimated and analyzed statistically., Results:  The pupillary diameter was 5.439 ± 368 µm, and the mean axon density of the OMNs was 0.924 ± 324/mm 3 in the control group. The pupillary diameter and degenerated axon density of the OMNs in animals of the sham group were 6.980 ± 0.370 µm and 36 ± 8/mm 3 , respectively. The pupillary diameter was 9.942 ± 653 µm, and degenerated axon density of the OMNs was 265 ± 57/mm 3 in animals with SAH. The mean VSI values of PComAs were 0.927 ± 0.224 in the control group, 1.542 ± 0.257 in the sham group, and 2.321 ± 0.324 in the SAH group., Conclusion:  We found a linear relationship between the axon density of the OMNs and pupillary diameters. High degenerated neuron density in the OMNs may be responsible for an unresponsive pupillary that has not been mentioned in the literature., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Plasma levels of estimated whole blood viscosity (eWBV) have been increased by endothelial inflammation. Because there were no consistent data for assessing the eWBV levels for prediction of cardiovascular event (CVE) in patients with chronic kidney disease (CKD). We aimed to investigate the relationship between plasma eWBV levels and CVEs in patients with CKD., Materials and Methods: We conducted a prospective, cross-sectional, long-term follow-up study, assessing the relationship between plasma eWBV levels and CVE (either fatal or nonfatal) in patients with newly diagnosed CKD. We also evaluated estimated glomerular filtration rate (eGFR), pentraxin 3 (PTX3), high-sensitivity C-reactive protein (hsCRP), and flow-mediated dilatation (FMD)., Results: Study patients were divided into 2 groups: patients with CVE and patients without CVE. The eWBV levels were higher in patients with CVE. Additionally, PTX3 and hsCRP were higher, and FMD and eGFR were lower in patients with CVE compared to those without CVE. According to the Cox regression analysis, WBV, plasma asymmetric dimethylarginine levels, FMD, hsCRP, eGFR, systolic blood pressure, calcium, and history of diabetes were independent predictors of CVEs in patients with CKD. Kaplan Meier survival curves were generated to establish the impact of the WBV on the cumulative survival of the cohort. Patients with eWBV values higher than 5.2 centipoise (cP) had lower survival rates when compared to patients with eWBV values lower than 5.2 cP (log rank = 4.49 df = 1 P = .034)., Conclusion: In conclusion, plasma eWBV levels may increase the presence of lower eGFR and affect CVE in patients with CKD independent of classical and unconventional risk factors.