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Aim: Prolongation of P wave time and increase of its dispersion as an independent predictor of atrial fibrillation. In patients with paroxysmal atrial fibrillation (PAF) as in healthy people, exercise augments sympathetic activity and therefore can cause the development of atrial fibrillation. The aim of this study is to evaluate the effect of exercise on P wave dispersion and to predict the development of atrial fibrillation.Methods: One hundred and ninety-eight patients (93 women, 105 men, mean age: 59.05 +/- 11.01 years) having the diagnosis of PAF were included in the study. The left atrial diameter of all these patients was more than 4.0 cm. One hundred and fifty-five patients (72 females, 83 males, mean age: 58.41 +/- 10.79 years), with left atrial diameter more than 4.0 cm and without PAF were taken as control group. Symptom limited exercise test with modified Bruce protocol was performed on all patients. Rest, maximum exercise and recovery, and first, third, and fifth-minute 12-derivation ECG was taken in all patients. The velocity of ECG was adjusted to 50 mm/s; shortest and largest P wave durations were measured and P wave dispersion was calculated.Results: The mean left atrial diameter was 4.41 +/- 0.58 cm in PAF patients and 4.38 +/- 0.48 cm in control group. No differences were found between PAF patients with the controls in exercise time (10.38 +/- 2.93 vs 10.81 +/- 2.75 minutes); METs (6.98 +/- 1.72 vs 7.28 +/- 1.75 minutes); resting heart rate (79.13 +/- 14.86 vs 79.69 +/- 10.43 bpm); peak heart rate (146.83 +/- 23.21 vs 146.94 +/- 16.13 bpm). Maximum exercise P wave duration and P wave dispersion were greater than the rest measurements in PAF group (respectively P < 0.0001 and P = 0.0004).Conclusion: In PAF patients, P wave dispersion is significantly longer at rest, maximum exercise and recovery time than in a control group without PAF. [ABSTRACT FROM AUTHOR]

The purpose of our study was to determine the normal cardiovascular responses of healthy Turkish children to exercise and to determine the reference values. Two hundred and eighty-four healthy children (115 girls, 169 boys) aged 5-14 were enrolled in the study. Exercise time (ET), workload that can be tolerated with exercise (MET value), change in heart rate (A HR), peak systolic and peak diastolic blood pressures (SBPmax and DBPmax), change in systolic blood pressure (delta SBP), and peak rate-pressure product (RPPmax) were positively correlated with age. There was no correlation between peak heart rate (HRmax) and age and there was also no significant increase in change in diastolic blood pressure (delta DBP) with increasing age. The means +/- SD values for ET, workload, HRmax, delta HR, SBPmax, DBPmax, delta SBP, deltaDBP, and RPPmax were 13.18 +/- 1.4 min, 8.56 +/- 0.93 MET, 171.46 +/- 1.91/min, 67.22 +/- 6.65/min, 125.16 +/- 13.36 mmHg, 73.32 +/- 4.06 mmHg, 24.3 +/- 5.96 mmHg, 7.2 +/- 6.9 mmHg, and 21504.7 +/- 2176.4, respectively. The values found in our study may be accepted as reference values of healthy Turkish children for exercise testing. The formula modified as (200-age) x 0.85 is thought to be more suitable to predict the target heart rate in children.

Background: The relationship between prolonged intubation period and postoperative complication incidence following cardiac surgery was investigated., Material/method: Evaluated were 237 adult patients who underwent coronary artery bypass graft operation, of whom 115 (group I) had intubation periods of more than 24 hrs (mean: 56.1+/-39.1 hrs) and 122 (group II) less than 24 hrs (mean: 16.25+/-14.6 hrs). Preoperative and postoperative pulmonary function test values as well as postoperative changes in the two groups were compared., Results: Mean hospital stay for group I and II patients were determined as 24.6+/-2.04 and 10.61+/-3.04 days, respectively (p<0.0001). The preoperative pulmonary function test results compared with the predicted values for both groups were similar. A significant decrease was determined in the postoperative pulmonary function test values in both groups, but the decrease in group I was significantly higher than in group II. Pulmonary complications developing in groups I and II were 26.09% (30 patients) and 7.38% (9 patients), respectively (p<0.0001). Also, total general complications were 39.14% (45 patients) and 13.12% (16 patients), respectively., Conclusion: Under similar conditions, the patients whose partial bypass time and aortic clamp period were significantly longer needed to be ventilated for more than 24 hours, being related to late complications following bypass operation, and the complication risk of this group was 3.5 times higher than for those who remained intubated less than 24 hours.

Objective and Background: Various studies have suggested that body size and in-hospital mortality are related. However, only a few analysed the effects of obesity on pulmonary complications following coronary artery bypass graft surgery (CABG). The purpose of the present study was to assess early changes in lung volumes, respiratory complications and arterial blood gas tension following CABG in obese women., Methods: Pulmonary function tests (PFTs), treadmill exercise capacity tests (TM), arterial blood gases and pulmonary complications were studied in 124 obese (mean age 57.2+/-5.8 years) and 108 non-obese (mean age 58.6+/-5.9 years) female patients undergoing elective CABG. PFT, TM tests, arterial blood gas analyses and CXR were performed in the preoperative and postoperative periods and pulmonary complications were recorded. Breathing and coughing exercises, early ambulation and pulmonary clearing techniques were used by physical therapists to prevent pulmonary complications after CABG surgery., Results: Postoperative PFT and TM tests deteriorated significantly in both groups (P<0.0001). The deterioration in the obese group was highly significant. The postoperative deterioration of blood gas measurements in obese patients was also statistically significant compared to non-obese patients. Early pulmonary complications developed in 21 (16.94%) of the obese patients and in 10 (9.25%) of non-obese patients. Duration of mechanical ventilation, intensive care unit and hospital stays were longer compared to the non-obese patients (P=0.008, P<0.0001, P=0.0386, respectively)., Conclusion: Obesity has a detrimental effect on pulmonary function, exercise capacity, blood gas measurements and complications rates in postoperative period following CABG surgery.

The aim of this study was to investigate improvement in the cardiovascular response to isometric and isotonic exercises after reverting rhythm to sinus in patients with atrial fibrillation. Twenty seven cases with nonvalvular paroxysmal atrial fibrillation were included in the study. Sinus rhythm could not be restored in two cases so they were excluded. The remaining cases were divided into two groups according to the existence of cardiac diseasc. Group 1 (n:14, mean age. 60.8 +/- 14.9 years) included cases with cardiac diseases (8 of the patients had hypertension in addition to the cardiac disease) and group 2 (n:11, mean age. 64.8 +/- 13.9 years) included those without cardiac disease (patients with hypertension and diabetes mellitus). Isometric and isotonic exercise tests were performed in all of the patients before and 48 hours after the rhythm was reverted to sinus and the values in atrial fibrillation were compared with those in sinus rhythm (following cardioversion). The isotonic exercise period increased significantly in only group 1 patients following cardioversion (P = (0.0061). In both groups, the increase in heart rate during atrial fibrillation was significantly higher compared to those after being reverted to sinus, at all stages of the isotonic exercise (in groups 1 and 2, heart rate in patients with atrial fibrillation increased from 96.5 +/- 19.3 to 173.3 +/- 19.3 beats/min and 96.1 +/- 12.6 to 185.0 +/- 12.1 beats/ min, respectively; and in sinus rhythm, it ranged from 85.1 +/- 11.4 to 164.6 +/- 9.1 beats/min and 81.3 +/- 11.4 to 157.6 +/- 15.1 beats/min, respectively). Systolic arterial pressure increased significantly during atrial fibrillation in group 1, at the 2nd stage of the isotonic exercise test (P = 0.0070). In group 2, systolic arterial pressure increased significantly at the 3rd stage in sinus rhythm and at the 4th stage when in rhythm in atrial fibrillation. Also, diastolic arterial pressure increased significantly during atrial fibrillation only at the 3rd stage of the exercise. As a result, restoring sinus rhythm by cardioversion improves excessive heart rate responses to exercise significantly in patients with atrial fibrillation during both isometric and isotonic exercises. Also, we have revealed that the exercise time increased significantly by restoring sinus rhythm in patients with heart disease.

The effects of smoking on postoperative lung volumes, arterial blood gas tensions, and pulmonary complications were studied prospectively in 213 consecutive Turkish patients undergoing elective coronary artery bypass graft surgery. One hundred and seventeen patients were current smokers (19 females, 98 males, mean age. 59.0 +/- 6.1 years. group 1) and 96 were nonsmokers (40 females, 56 males mean age. 59.6 +/- 5.8 years, group 2). Demographic data and the anesthesia and surgical methods were similar in both groups. Pulmonary function tests, arterial blood gas analyses, and chest radiographs were done preoperatively and postoperatively. Pulmonary complications were recorded. Postoperative partial arterial oxygen tension values in both groups revealed moderate hypoxemia which was more intense in smokers (decreased from preop. 82.0 +/- 7.8 mmHg to postop. 66.1 +/- 8.0 mmHg). Mean partial carbon dioxide tension increased significantly, remaining within acceptable limits (from 32.5 +/- 2.2 mmHg to 38.6 +/- 3.6 mmHg) in smokers following surgery. The postoperative pulmonary function test values decreased significantly in both groups but the deterioration in the smoking group was highly significant, except for FMFT. In the smokers, the preoperative mVC/pFVC (%) value was at the lower normal limit which indicates slight restrictive respiratory problems. Patients in both groups developed a severe restrictive ventilatory defect after coronary artery surgery (P < 0.0001 for both), but this restriction was also statistically significant in the smoking group compared to nonsmokers after surgery (mVC/pFVC from 74.7 +/- 12.6% to 52.3 +/- 10.0% and 80.8 +/- 13.5% to 63.2 +/- 10.7%. in the smokers and nonsmokers, respectively). Also, the significantly greater decrease in the FEV1/FVC ratio in the smokers (from 75.4 +/- 12.2% to 72.2 +/- 11.5%) (P = 0.037) was indicative of greater airway obstruction. Pulmonary complications developed in 20.5% (24 people) of the smokers and 10.4% (10 people) of the nonsmokers. The mean time to extubation, intensive care unit stay, and hospital stay for groups 1/2 were 19.9 +/- 11.5/14.1 +/- 4.3 hours (P < 0.0001) 3.2 +/- 1.3/2.4 +/- 0.6 days (P < 0.0001), and 14.1 +/- 4.4/12.5 +/- 2.4 days (P = 0.0013), respectively. For the male group, we obtained results similar to those for the whole (males + females) study population and concluded that the observed differences in various parameters between smokers and nonsmokers were not due to gender. As a result. we revealed that cigarette smoking affects pulmonary functions by causing obstructive type respiratory problems and by worsening existing restrictive type respiratory problems postoperatively. The postoperative deterioration in blood gas measurements of smokers was also statistically significant compared with nonsmokers. In addition, the incidence of pulmonary complications in smokers was 2-fold greater than in nonsmokers and was related to the number of cigarettes consumed daily, leading to prolongation of the postoperative intubation period, and ICU and hospital stays.

The aim of the present study was to evaluate the tolerance to various exercises by determining the cardiovascular response to static and dynamic exercises in patients with nonvalvular atrial fibrillation. Fifty patients (mean age: 63.6 +/- 10.3 years; male: 25, female: 25) with chronic (more than one year) nonvalvular atrial fibrillation were included in the study. All patients underwent exercise tests, adjusted appropriately according to their symptoms, as dynamic exercise on a Marquette Case 15 device according to a modified Bruce protocol. Heart rate, and systolic and diastolic arterial pressures were measured at rest and at all stages of the exercise; and the heart rate-pressure products were evaluated. A handgrip test was also conducted as static exercise. The measurements were made before, at the 1st, 2nd and 3rd minutes, and in the recovery periods of the exercise. The percent values of the changes of the 1st, 2nd and 3rd minute measurements in relation to the initial values for both exercises were compared. In addition, the maximal responses to the exercise tests and the post exercise values were also compared. For statistical evaluations, the paired Student-t test was used. Heart rate and pressure-heart rate product values obtained at 1, 2, and 3 minutes during the treadmill exercise test were significantly high compared to the handgrip values (P < 0.0001). The arterial systolic and diastolic pressure values in the 1st minute were also significantly higher during the handgrip test (P = 0.0100 and P = 0.0320, respectively). The values of diastolic arterial pressure at the 2nd minute during the handgrip test, and systolic arterial pressure at the 3rd minute during the treadmill test were found to be statistically significant (P = 0.0240, P = 0.0340, respectively). The mean exercise time and MET value during the treadmill exercise test were 7.18 +/- 2.65 minutes and 5.32 +/- 1.38 mL.kg(-1) x dk(-1). respectively. During the recovery period, the 5th minute, heart rate and pressure-heart rate product values were significantly high after the treadmill test (P < 0.0001). In this study, we revealed that the heart rate response to static exercise was lower and the patients tolerated the static exercise better. Therefore, we decided that the short duration of static exercise is not harmful for the noncomplicated chronic atrial fibrillation cases.

The objective of the present study was to compare pre- and postoperative pulmonary function tests in adult patients who had intubation periods greater and less than 24 hours following elective open heart surgery. Group 1 consisted of 91 patients (18 females and 73 males) gr, whose intubation periods were more than 24 hours (mean: 8.1+/-18.6 hours); and group 2 75 patients (13 females and 62 males) who had intubation periods less than 24 hours (mean: 13.25+/-3.60 hours). The pulmonary function test measurements were obtained from a vitalograph before and after the operation (just before being discharged from the hospital), All patients underwent cardiopulmonary physiotherapy and a rehabilitation programme during their hospital stay. The patients were similar in height and weight. The duration of hospitalization of the patients who had a prolonged intubation period was 17.26+/-9.7 days, while that of the control group was 10.64+/-2.04 days (P<0.0001). When the preoperative pulmonary function test values of each patient were compared with the expected values, the percent values of forced expiratory volume for one second, flow velocity of the mid-forced expiration and forced expiratory flow which were achieved by group 2 were significantly high compared to those of group 1 (P=0.014, P= 0.03 and P<0.0001, respectively). However, the percent values of forced vital capacity were similar. When the percent variations of the differences between the pre- and postoperative pulmonary function test values of the groups were compared, all values except the flow velocity of the mid-forced expiration, and forced vital capacity, were found to be significantly lower statistically in the group having a prolonged intubation period. As a result, it was determined that the patients whose preoperative pulmonary function test values were poor, had longer intubation periods and similarly, they continued to be worse after the operation. We believe that it is advantageous to apply more intensive pulmonary rehabilitation for prolonged periods to these patients in the postoperative period.

Background: Antibiotic combinations are frequently used in order to obtain wide-spectrum effects in the treatment of serious infections such as septicemia and endocarditis, and also to produce an in vivo effect against strains which are defined as resistant to the known inhibiting or fatal dose of one antibiotic. The synergistic effects of combinations such as aminoglycoside + beta-lactam, aminoglycoside + quinolone and quinolone + beta-lactam on Pseudomonas aeruginosa have been revealed in different studies. The multiple resistance rate of nosocomial P. aeruginosa strains isolated from intensive care units (ICUs) has been reported as high in many studies., Methods: In this study, the effects of various combinations of antibiotics (aminoglycoside + beta-lactam and aminoglycoside + quinolone) against 101 multiresistant P. aeruginosa strains which were isolated from the ICUs of three different hospitals in Istanbul were investigated using the E-test method. The combinations for which the highest synergistic effects were determined by the E-test method were also tested with the checkerboard method, i.e. in addition to the E-test method, in 19 of a total of 23 strains., Results: When the synergistic results which were obtained with the combinations of aminoglycoside + beta-lactam were compared with those of the aminoglycoside + quinolone combinations, they were determined to be higher for the two aminoglycosides gentamicin (GM) and tobramycin (TM). We determined the synergistic rates to be 23, 21, 19, 18, 16, 14, 10 and 10% for GM + ceftriaxone (TX), GM + piperacillin (PP), GM + ceftazidime (TZ), TM + PP, TM + TX, TM + TZ, GM + ciprofloxacin (CI) and TM + CI, respectively. The GM + TX combination - for which the highest synergistic effects were determined with the E-test stripes - was also determined as synergistic with the checkerboard method in 19 of a total of 23 strains (23%), and the agreement rate between the two methods was 100% (kappa > 0.7). The highest synergistic effects against strains which were sensitive to both of the antibiotics which constitute the combinations were found for the GM + TX combination, as 50%, whereas for strains which were resistant to both of the antibiotics, this was found for the TM + PP combination, also as 50%., Conclusions: We consider that the minimal inhibitory concentration values of antibiotics are not sufficient alone in order to constitute a combination for multiresistant strains and it would be advisable to begin a treatment by applying a combination study. The E-test method has been evaluated as a good alternative for combination investigations because of its ease both of application and evaluation and also for its good agreement with the standard checkerboard method., (Copyright 2002 S. Karger AG, Basel)

Platelets, which have an important role in hemostatic mechanisms and which were prepared by single and random methods were investigated to measure quantity, and aggregation response during 5 days of storage. The aggregation response and quantitative values of platelet concentrates (PCs), 60 of which were prepared by a single donor method and 62 by a random method were investigated during the 1st, 3rd, and 5th days of storage. The single donor platelets (SDP) were obtained by using the MCS Plus apheresis device and the random donor platelets (RDP) were obtained by two-phase centrifugation in the Heraeus 8500i centrifuge device (during the first phase, platelet rich plasma was obtained then platelet concentrate was obtained from this product) and were stored at 22 degrees C on a circular agitator. In addition, pH, PO2, PCO2, glucose and lactate values were measured in order to evaluate the effects of storage. The aggregation response was measured using adenosine diphosphate (ADP), epinephrine (EPN), collagen (COLL) and ristocetin (RIST). The cell count in mm3 and the total cell count were also measured. The total cell counts and cells in mm3 of the PCs which were prepared by the single donar method on the 1st, 3rd and 5th days, were: 3.11 x 10(11), 3.09 x 10(11), 3.07 x 10(11) and 292 x 10(3), 290 x 10(3), 289 x 10(3) and of those prepared by the random method were: 5.71 x 10(10), 5.69 x 10(10), 5.66 x 10(10) and 156 x 10(3), 153 x 10(3), 151 x 10(3). The mean aggregation responses of the PCs prepared by the two methods on the 1st, 3rd and 5th days, expressed as a % were: ADP: 94.8-93.2, 81.6-78.7, 44.3-8.2; COLL: 91.7-89.6, 79.2-74.2, 29.8-11.1; EPN: 88.5-91.3, 64.2-62.7, 39.4-4.5 and RIST: 89.4-89.4, 76.5-73.6, 14.4-3.2. Other data related to platelet storage were obtained by measuring the pH, PO2, PCO2, glucose and lactate levels of the PCs. In our study, it was determined that in spite of the optimal storage conditions, the aggregation response of the PCs decreased significantly, whereas, the numerical values changed little during the storage period.