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Background The neuropathological mechanism of heart rhythm disorders, following spinal cord pathologies, to our knowledge, has not yet been adequately investigated. In this study, the effect of the ischemic neurodegeneration of the thoracic sympathetic nuclei (TSN) on the heart rate (HR) was examined following a spinal subarachnoid hemorrhage (SSAH). Methods This study was conducted on 22 rabbits. Five rabbits were used as a control group, five as SHAM, and twelve as a study group. The animals’ HRs were recorded via monitoring devices on the first day, and those results were accepted as baseline values. The HRs were remeasured after injecting 0.5 cc of isotonic saline for SHAM and 0.5 cc of autolog arterial blood into the thoracic spinal subarachnoid space at T4–T5 for the study group. After a three-week follow-up with continuous monitoring of their HRs, the rabbit's thoracic spinal cords and stellate ganglia were extracted. The specimens were evaluated by histopathological methods. The densities of degenerated neurons in the TSN and stellate ganglia were compared with the HRs. Results The mean HRs and mean degenerated neuron density of the TSN and stellate ganglia in control group were 251 ± 18/min, 5 ± 2/mm3, and 3 ± 1/mm3, respectively. The mean HRs and the mean degenerated neuron density of the TSN and stellate ganglia were detected as 242 ± 13/min, 6 ± 2/mm3, and 4 ± 2/mm3 in SHAM (P > 0.05 vs. control); 176 ± 19/min, 94 ± 12/mm3, and 28 ± 6/mm3 in the study group (P Conclusions SAH induced TSN neurodegeneration may have been responsible for low HRs following SSAH. To date this has not been mentioned in the literature.

Background: The heart is innervated by the autonomic nervous system, which contributes to the control of the heart’s rhythm and coronary circulation. It has been suggested that the cardiac fibers of the vagus nerve play important roles in controlling circulatory functions and in protecting against atherosclerotic pathologies in coronary arteries. Aims: To investigate the presence of atherosclerotic differences in the coronary arteries of cholesterol-fed rabbits by measuring the density of cardiac ganglia neurons. Study Design: Animal experiment. Methods: This study was conducted using 45 male rabbits. Over a period of 16 weeks, they were kept on an atherogenic diet of water ad libitum and high fat (8.6%) containing saturated fatty acids with 205 mg/kg of cholesterol (1%) per day. Then, their hearts were removed and examined by histopathological methods. Atherosclerotic plaques of the main coronary arteries were examined using the Cavalieri method. Atherosclerosis index values (AIVs) were estimated as the wall surface area/plaque surface area, and the results were analyzed with the Kruskal-Wallis and Mann-Whitney U tests. Results: While the average atherosclerosis index value was estimated to be ≤8% in 21 animals, the atherosclerosis index value was 9-20% in animals with minor plaque detection (n=11) and ≥20% in animals with major plaque detection (n=10). Increased atherosclerosis index values were more common in animals with low neuron densities than in animals with high neuron densities (p

Background Neurogenic stunned myocardium (NSM) is a devastating complication of subarachnoid hemorrhage (SAH). The most widely accepted mechanism in the pathogenesis of NSM and takotsubo cardiomyopathy is catecholamine-mediated direct myocardial injury. The aim of this study is to examine if there is any effect of sympathetic overactivity of the stellate ganglions on myocardial tissues, secondary to vagal complex degeneration in SAH-induced NSM. Materials and Methods This study was conducted on 25 New Zealand female rabbits. After the examination, all animals were assigned into 3 groups randomly: a control group (n = 5), a sham group (n = 5), and a study group (n = 15) that was subjected to experimental SAH with double injection of blood into the cisterna magna. After 7 animals exhibited NSM, all animals were killed. Their brains, vagal complexes, stellate ganglions, and hearts were extracted and examined by histopathologic methods. Degenerated nodose ganglion neurons and stellate ganglion neuron densities were compared with degenerated myocardial tissue/normal myocardial tissue ratios, and the results were analyzed with the Mann-Whitney U test. Results Three rabbits in the study group died immediately after the second injection of blood. NSM developed in 7 animals after 1 to 5 days, which was diagnosed with transthoracic echocardiography. Interestingly, the animals that developed NSM had more stellate ganglia neurons and more degenerated neuron densities of nodose ganglia (P Conclusions NSM and takotsubo cardiomyopathy may be induced by vagal complex degeneration and sympathetic overactivity, which originated from more neurons, including stellate ganglia and more degenerated neuron densities of nodose ganglia.

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/mm3 and the degenerated neuron density was 12 ± 3/mm3 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/mm3 in GII (p

Subarachnoid hemorrhage (SAH) can lead to neurogenic pulmonary edema (NPE), and chylomicron metabolism may be altered unfavorably in acute lung injury. This study aimed to investigate the possible effect of NPE on the development of coronary fat embolism.This study was conducted on 27 rabbits, 5 of which were used as the control (n=5). Experimental SAH was induced in 15 of the animals by injecting homologous blood into the cisterna magna, and the remaining 7 animals were administered only isotonic saline solution (Sham, n=7) in the same manner under general anesthesia. After 21 days, all the animals were euthanized, and their hearts, lungs, and brains underwent histopathological examination.Six animals died of SAH during the experiment, and foamy hemorrhagic parenchymal lesions and intra-alveolar hemorrhage were observed in their lungs. The histopathologic findings revealed minimal changes in the lungs, heart, and brains of the surviving animals; however, an abundant amount of fat globules was found in the coronary arteries of the six nonsurviving animals. There was a meaningful difference between the number of occluded coronary arteries with fatty globules in the surviving and nonsurviving animals (P.001). However, the difference between the survivors and the isotonic-saline-injected group was not meaningful (P.05). Coronary fat embolism was an important mortality factor following SAH (P.005).In SAH-induced NPE, the leakage of chylomicrons into the systemic circulation may lead to coronary fat embolism, which has not yet been reported in the literature.

Graphical abstract, Highlights • RHT in transit is a rare medical emergency with a high mortality rate. • Optimal therapy is not defined, and treatment selection remains a subject of debate. • Thrombolysis has been suggested as a better treatment modality.

Objective The prognosis of cardiovascular diseases (CVDs) is directly associated with systolic function based on the measurement of ejection fraction (EF), and many studies have indicated that the left ventricular global strain (LVGS) provides better predictivity than the EF measurement in the diagnosis, prognosis, survival, and CVD staging. However, these studies did not investigate the correlation between the EF measurement and the LVGS parameters, or which parameters are better correlated with LVGS, but we analyzed the association between three EF measurement methods and LVGS. Materials and Methods This study included 62 patients that applied to the clinic between October 2015 and March 2016. An echocardiography examination of these patients was performed. The exclusion criteria were atrial fibrillation and suboptimal image quality. Results Sixty-two patients (the average age 61.0±12.6 years; 56% male and 44% female) were enrolled in the study. A statistically significant association was found between the visual EF and Simpson EF measurements and the LVGS parameters (p

Objective The chemoreceptor network, consisting of the glossopharyngeal nerve and carotid body (GPN-CB), is essential for the regulation of blood pH. Its ischemic insuts following subarachnoid hemorrhage (SAH)which may contribute to develop acidosis has not been investigated. Materials and Methods Twent-three hybrid rabbits were used.They divided into three groups; Five (n=5) as control group, five (n=5) as SHAM group, the remaining 13 (n=13) as study group. 1cc serum saline, 1cc autolog arterial blood into the cisterna magna were injected; in SHAM and study group, respectively. Blood pH values of all annimals were recorded. After two weeks, animal were decapitated. The number of normal and degenerated neuron density ofCBs were counted by stereological methods,analysed statistically. Results Two of 13 rabbits died within the second week. The mean blood pH values were measured as 7.35±0.07 in control, 7.33±0.06 in SHAM, 7.29±0.05 in rabbits with slight acidisis (n=6) and 7.23±0.02 in in rabbits with prominent acidosis. In control groups, the average normal neuronal density of the CB was 6432±790/mm 3 and degenerated neuron density was 11±3/mm 3 while the degenerated neuronal density in CB was 35±8/mm 3 in SHAM group, 1034±112/mm 3 in slight acidis developed group (n=6; p 3 in the prominent acidosis developed animals (n=8; p 3 Conclusion Inverse relationship between neurodegeneration in the CB and PH values secondary to the disruption ofGPN-CBnetwork following SAH was foundwhich may contribute to develop acidosis.

Aim Syntax score II (SSII) is a highly predictive scoring system, which is used to improve individualized assessment of patients with complex coronary artery disease and facilitates clinical decision making. Surrogate markers [carotid intima-media thickness (CIMT), epicardial fat tissue (EFT)] are also used for risk assessment, but their relation with SSII is not well established. Method We enrolled 543 consecutive patients, who underwent coronary angiography for stable angina pectoris and acute coronary syndrome, in the study. SSII was calculated for each patient and the patients were divided into two groups as low SSII group and high SSII group according to their median SSII. Results The average age of the patients was 61.4 years and 75% of the patients were male. The multivariate analysis indicated that only EFT (p: 0,035), CIMT (p:0,04) and Hypertension (HT) (p: 0,014) were independently associated with high SSII. Discussion EFT and CIMT, the surrogate markers which can be simply and non-invasively determined, are of the independent predictors of high SSII. The inclusion of these parameters in the risk classification may provide additional clinical benefit.

Background: Paroxysmal nocturnal hemoglobinuria is a rare acquired autoimmune disease relation to defect of hematopoietic stem, and is often associated with high rate of life-threatening venous thrombosis. Method: Lower extremity vein thrombosis is rarer than cerebral and hepatic veins in terms of thrombosis localization. Patients are exposed to intravascular hemolysis, smooth muscle dystonia, renal failure, arterial and pulmonary hypertension, recurrent infectious diseases and an increased risk of especially terrible thrombotic complications. The diagnosis is made by flow cytometry. Deficiency of the glycophosphatidylinositol - anchored complement regulatory proteins CD55 and CD59 accounts for the intravascular hemolysis that is the primary clinical manifestation of the disease. Besides, paroxysmal nocturnal hemoglobinuria is frequently associated with aplastic anemia or low-risk myelodysplasia and may be asymptomatic. Result: A patient, who developed thrombosis of the bilateral common iliac veins with the diagnosis of paroxysmal nocturnal hemoglobinuria, is described.

BACKGROUND/AIMS Calcium channel blockers are increasingly used for the treatment of hypertension. Menopause and hypertension are both important risk factors for liver damage and several other circulatory abnormalities. The aim of this study was to determine the effects of amlodipine and lacidipine in an ovariectomy-induced postmenopausal period model and a deoxycorticosterone acetate-salt-induced hypertensive model in rats. METHODS In this study, animals were divided into six groups as follows: control (Group 1), hypertension (Group 2), ovariectomy (Group 3), ovariectomy and hypertension (Group 4), ovariectomy, hypertension and amlodipine-treated (Group 5), and ovariectomy, hypertension and lacidipine-treated (Group 6). At the end of the experiment, the livers were removed and tissue samples were histologically and stereologically examined. RESULTS The numerical densities of the hepatocytes according to group were 0.000422, 0.00329, 0.000272, 0.00259, 0.00374 and 0.000346 μm3, respectively. Significant differences were found between values of all groups (p

bayir, yasin/0000-0003-3562-6727; WOS: 000271721200001 PubMed: 19714493 The ability of amiodarone to prevent pathological changes and oxidative stress after isoproterenol (ISO)-induced myocardial injury was investigated in rats. A better understanding of the processes involved in the pathophysiology of myocardial infarction has led to the search for drugs that can limit the extent of myocardial injury. Amiodarone was administered to groups of rats groups once per day for 30 days. On days 29 and 30, the rats of the ISO control and drug treatment groups were administered 180 mg/kg ISO subcutaneously at an interval of 24 h for two consecutive days. In the control groups, clinical indicators, such as creatine kinase-isoenzymes and troponin-I, were found to be statistically higher than in the drug groups. Parallel to this increase in indicators, a significant decrease in glutathione levels and activities of superoxide dismutase and an increase in malondialdehyde level were detected. Biochemical and histopathologic results in the ISO-induced model of myocardial injury emphasize the beneficial action of amiodarone as a cardioprotective agent.

We describe the case of a 60-year-old male hypertensive patient who was admitted to our department with intermittent claudication. An echocardiography evaluation detected apical hypertrophy without an intracavity pressure gradient. Transthoracic echocardiography has been the first-line imaging method for patients with suspected hypertrophic cardiomyopathy (HCM), but the method's shortcomings in evaluating the apex are well known. Thus, images from the patient's magnetic resonance imaging and angiography examinations confirmed the classic features of apical HCM. In addition, a 3-dimensional computed tomography evaluation disclosed Leriche syndrome concurrent with severe bilateral stenosis of the renal arteries. Apical HCM combined with severe renal artery stenosis is very rare and has not previously been reported with Leriche syndrome.

Purpose The objective of this study was to investigate the factors that may influence image quality on multidetector computed tomography (MDCT) coronary angiography (CA). Materials and Methods Two hundred twenty-four consecutive patients (161 men and 63 women; mean age, 52 years; age range, 34–76 years) evaluated with MDCT CA were included in the study. The evaluation of the quality of the patients' images was mainly based on the contrast material phase (early phase, optimal phase, or late phase) and the level of stepladder artifact (none, acceptable, or unacceptable). In addition, factors such as patient selection, patient preparation, scanning, processing, and steps of analysis, which may be affecting the quality of a final image, were examined independently. Results Patients who could not achieve sufficient breath-holding despite multiple breath exercises, those with a calcium score of 500 or higher, those with a heart rate greater than 90 bpm after metoprolol administration (because of shortening of the diastolic phase in the most still period), and those whose scanning was not completed were excluded from the study. The results for the remaining 224 patients were evaluated. Based on the contrast phase, there were 66 (29.5%) patients in the first group (early), 93 (41.5%) in the second group (optimal), and 65 (29%) in the third group (late). Among the 224 patients, the images of 152 (67.9%) had no stepladder artifact, those of 67 (29.9%) were of acceptable image quality, and those of 5 (2.2%) were of unacceptable image quality. Conclusion It is important to obtain high-quality images to achieve correct interpretation with coronary artery CT angiography. This study aimed to describe a technique performed on 224 patients based on an array of factors ranging from patient selection to postprocessing. The results show that patient selection, cooperation with the patient, and breath-holding exercises play a very important role in obtaining the best images. In addition, a proper scanning technique (e.g., placement of electrocardiographic electrodes and contrast material phase) and postprocessing (e.g., reconstruction interval) may also contribute to obtaining high-quality images.

Background: Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models. Methods: A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn’t specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy. Results: After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery. Conclusion: The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

An oxidant/antioxidant imbalance in favour of oxidants appears to occur in chronic cor pulmonale (CCP). Oxidative stress could also be a critical event in the pathogenesis of this condition. Trimetazidine (TMZ) has antioxidant properties and may affect the utilization of oxygen radicals. We investigated the effect of TMZ (20 mg three times daily, orally) on activities of erythrocyte malondialdehyde (MDA) and catalase (eCAT), erythrocyte and plasma glutathione peroxidase (GSH-Px) and plasma superoxide dismutase (pSOD) in CCP patients. We also assessed changes in plasma levels of brain natriuretic peptide (BNP) with TMZ therapy. Sixty CCP patients with significantly higher MDA and markedly lower pSOD, eCAT and GSH-Px (erythrocyte) activities than 24 healthy controls were randomly allocated to receive routine treatment or routine treatment plus TMZ. After 3 months' therapy, greater pSOD, eCAT and GSH-Px (erythrocyte and plasma) activities and lower MDA activity were found with TMZ treatment compared with routine treatment. Plasma BNP levels were significantly lower in TMZ-treated patients and higher in the routine treatment group than in the control group. TMZ improved antioxidant levels, decreased oxidative stress and decreased plasma BNP levels in CCP patients.

We tested whether particular electrocardiogram (ECG) changes can identify the right coronary (RCA) or left circumflex (LCX) artery as the responsible vessel in inferior wall acute myocardial infarction (AMI) in 73 patients. A standard 12-lead ECG was performed within 6 h of onset of chest pain. Coronary angiography was performed between 1 week and 6 weeks after the infarction. RCA and LCX lesions were detected in 53 and 20 patients, respectively. The most useful ECG parameters for implicating the RCA were a higher ST elevation in lead III than lead II (specificity 94%, sensitivity 86%) and an S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL (specificity 94%, sensitivity 92%). Absence of these criteria was associated with LCX occlusion (specificity 100%, sensitivity 87%). These results indicate that composite ECG criteria are useful in predicting the artery involved in inferior wall AMI.

Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS. Materials and methods: A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients. Results: Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions. Conclusion: BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.

Circulatory disorders are observed in the lower extremities of some patients after spinal surgery when a monopolar electrocautery knife (MEK) is used. Despite known the knowledge that electric currents can be hazardous to living tissues, MEK has been widely used in spine surgery. In this study, we investigated if MEK can cause endothelial injury in femoral arteries (FA).Eighteen rabbits were included in this study, two of which were used as the reference group. The remaining animals were subjected to paravertebral soft tissue dissection along levels L1-L4. Half of the animals were dissected with MEK, and the other half were dissected with scissors and bipolar cautery. One month after the surgery, endothelial changes of the FAs were examined stereologically.Endothelial desquamation, cytoplasmic and nuclear condensations, cellular shrinkage and cellular loss were developed in the FAs of the MEK group. The endothelial cell density was 270 cells/mm2 in normal animals, 240 cells/mm2 in the non- MEK group and 190 cells/mm2 in the MEK group. The difference between the non-MEK and normal groups was not meaningful (P0.05). The difference between the MEK and non-MEK groups was statistically significant (P0.05); differences between the MEK and normal animals were even more significant (P0.001).Sharp dissection with MEK can have a detrimental effect on the endothelial cells of the FAs and cause postoperative circulatory disorders in the lower extremities. Therefore, long-term high-voltage electrocauterization should be avoided during spinal surgery unless absolutely necessary.Bazı hastalarda spinal cerrahide monopolar elektrokoter (MEK) bıçak kullanımı sonrası alt ekstremitede sürkülasyon bozuklukları gözlenmektedir. Elektirik akımın yaşayan dokular için zararlı olduğu bilinmesine rağmen MEK spinal cerrahide kullanılır. Bu çalışmada MEK in femoral arter endotel hasarı yapıp yapmayacağını araştırmayı amaçladık.Bu çalışmaya 18 tavşan alındı ve 2 si kontrol grup olarak kullanıldı. Geri kalan deneklerin paravertebral yumuşak dokuları L1-L4 mesafesi arasından diseke edildi. Deneklerin yarısın da MEK diğer yarısında bipolar koter kullanıldı. Cerrahiden 1 ay sonar femoral arter endoteli değişiklikleri sterolojikal olarak incelendi.MEK grubunun femoral arter endotelinde endotelyal deskuamasyon, sitoplazmik ve nükleer kondensasyon, hücresel çekilme ve hücre kaybı gelişti. Endotel hücre dansitesi normal hayvanlarda 270 cells/mm2, non- MEK grubunda 240 cells/mm2, MEK grubunda 190 cells/mm2 idi. Non- MEK ve normal grup arasında anlamlı fark yoktu (P0.05). Non- MEK ve MEK arasında önemli fark vardı (P0.05). MEK ve normal grup arasında fark daha önemliydi (P0.001).MEK le yapılan keskin diseksiyon femoral arter endotelini etkilemektedir ve postoperative alt ekstremite sirkülasyon bozukluklarına neden olabilir. Bu nedenle uzun sureli ve yüksek voltajlı elektrokoterizasyon spinal cerrehide eğer kesinlikle gerekli değilse kullanılmasını önermiyoruz.

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disorder characterized pathologically by fatty or fibrofatty replacement and electrical instability of the right ventricular myocardium. This cardiac entity leads to sudden cardiac death, syncope, recurrent ventricular tachycardia, and in some cases, heart failure in a younger population. Contrast angiography, echocardiography, radionuclide angiography, ultrafast computed tomography (CT), and cardiovascular magnetic resonance imaging are techniques used to diagnose functional and morphologic characteristics of the disease. CT is sensitive in detecting intramyocardial fat because of its low attenuation. Recently the advances in multislice CT (MDCT) have improved temporal resolution, which has increased effectiveness in providing morphologic and functional information. We present a case with ARVD evaluated through 16-row MDCT. Fatty infiltration was clearly demonstrated by 16-slice CT; thus, multislice CT may have a significant role in the assessment and follow-up of patients with ARVD.

Red cell distribution width (RDW) is a measure of the heterogeneity of cell size in the peripheral blood and has been shown to be an independent correlate of adverse outcomes in healthy participants and in some cardiac conditions. We examined the association between RDW and the complexity of coronary artery disease (CAD).The study population included 193 nonanemic patients who had undergone coronary angiography for stable angina pectoris. Baseline RDW was measured as part of the automated complete blood count. Patients were classified depending on whether the SYNTAX score was 0 (no angiographically apparent CAD) or at least 1 where CAD was present angiographically.Patients with angiographic CAD had significantly elevated RDW levels compared with the patients without CAD (14.4±1.3 vs. 12.5±0.9, P0.001). There was a good correlation between RDW and the SYNTAX score (r=0.55, P0.001). In a receiver operating characteristic curve analysis, an RDW value of 13.25 was identified as an effective cut-point in the segregation of the presence or absence of CAD [area under curve=0.87, 95% confidence interval (CI) 0.81-0.92]. An RDW value of more than 13.25 yielded a sensitivity of 84%, a specificity of 79%, a positive predictive value of 89%, and a negative predictive value of 71%. In multivariate analysis, RDW was observed to be an independent predictor for both angiographic CAD (odds ratio=4.80, 95% CI 2.41-9.57, P0.001) and for a high (32) SYNTAX score (odds ratio=2.28, 95% CI 1.45-3.60, P=0.01).RDW is a readily available clinical laboratory value that is associated with both the presence and the complexity of CAD.

Background: It has been shown that mitral stenosis (MS) impairs left ventricular (LV) systolic function; however, this issue has not been studied comprehensively. We aimed to evaluate the role of 2D strain in the assessment of subclinical LV systolic dysfunction in patients with MS. Methods: Seventy-two patients with isolated MS (mild, moderate and severe) and 31 healthy control subjects constituted the study population. 2D echocardiography images were obtained from LV apical 4-chamber (4C), long axis (LAX), and 2-chamber (2C) views. Peak longitudinal strain and strain rate (Sr) were obtained from 4C, LAX, and 2C views. Global strain and Sr were calculated by averaging the three apical views. Results: There were no significant differences in LV ejection fraction and LV systolic or diastolic dimensions between the groups. Patients with MS had significantly lower LV longitudinal strain and Sr measurements than the control group. In addition, there were no significant differences in MS subgroups with respect to LV strain and Sr measurements. Conclusion: We demonstrated that patients with MS had lower LV functions using 2D strain imaging, and this is independent of the hemodynamic severity of MS. In the detection of subclinical LV dysfunction in patients with MS, 2D strain imaging appears to be useful.

Objectives Two-dimensional (2D) strain imaging has been established as a reliable and reproducible technique for the assessment of left and right ventricular function using transthoracic echocardiography (TTE). However, the reproducibility of transesophageal echocardiographic (TEE) 2D strain imaging and the agreement with TTE 2D strain imaging remains unclear. In the present study, the authors studied the reproducibility of TEE 2D strain imaging parameters. Design A comparative, observational clinical study. Setting The echocardiography laboratory of the tertiary referral center. Participants Healthy individuals with a suspected patent foramen ovale. Interventions None. Measurements and Main Results Thirty-four patients were included in the study. None of the patients had any structural cardiovascular disease. TTE and TEE images of the subjects were recorded and analyzed offline (EchoPAC 6.1; GE Vingmed Ultrasound AS, Horten, Norway). Longitudinal strain and strain rate measurements of the 4 chambers, the apical long axis, 2 chambers, and the right ventricle were obtained for each record of TTE and TEE. The mean age of the patients in this study was 36 ± 9.2 years. Bland-Altman analysis showed that there were generally good agreements between strain and strain rate measurements on TEE and TTE. The inter- and intraobserver agreement for TEE parameters was good. Conclusions Transesophageal 2D strain imaging is a reproducible method to measure ventricular function and has a good agreement with TTE 2D strain imaging.

To investigate if intra and postoperative thoracal epidural analgesia could decrease plasma concentrations of brain natriuretic peptide (BNP) in patients who were at risk for, or had, coronary artery disease (CAD) and undergoing lower extremity operations. Materials and methods: Sixty patients with risk of CAD scheduled to undergo lower extremity surgery were divided into 3 groups. Group G was administered general anesthesia followed by intravenous patient-controlled analgesia (I.V PCA) (n = 20). Group L was administered lumbar epidural anesthesia followed by lumbar epidural analgesia (n = 20). Group T was administered general anesthesia combined with intra and postoperative thoracal epidural analgesia as well as I.V PCA (n = 20). Visual analog scale pain scores, hemodynamics, plasma catecholamines, cardiac troponin I (cTnI), atrial natriuretic peptide (ANP), and BNP were measured preoperatively and measurements were extended to 90 min after skin incision, towards the end of surgery, and in the morning of day 1, 2, and 3 postoperation. The data were statistically compared using multiple comparison tests. Results: Baseline ANP and BNP concentrations were similar in all groups (G: 25.8 ± 4.51 and 25.9 ± 8.52 pg/mL; L: 23.9 ± 3.67 and 20.8 ± 9.8 pg/mL; T: 24.7 ± 4.27 and 23.0 ± 5.98 pg/mL, respectively). The postoperative plasma BNP concentrations of group T were lower than those of groups L and G. and similarly group L was lower compared to group G in terms of postoperative plasma BNP concentrations (P < 0.05). Peak plasma concentrations of BNP were 162.4 ± 29.4, 110.6 ± 12.2, and 69.0 ± 6.9 for groups G, L, and T, respectively (P < 0.05). However, there was no group difference in peak plasma ANP concentrations. Baseline epinephrine and norepinephrine concentrations were also similar across the groups. Peak plasma epinephrine concentrations of group T were lower than those of groups G and L (P < 0.05). Plasma cTnI concentrations were within normal limits (

The anesthetic and cardiopulmonary effects of a combination of continuous intravenous infusion using a mixture of 6 g L(-1) thiopental-75 g L(-1) guafinesine-3 mg L(-1) metedomidine (0.30 mL/kg/h) and Oxygen-Sevoflurane (OS) anesthesia (TGM-OS anesthesia) in horses were evaluated. The concentration of sevoflurane (Sevo) required maintaining surgical anesthesia was around 1.5% in TGM-OS and 3.3% in OS anesthesia. Mean Arterial Blood Pressure (MABP) was maintained at around 77 mm Hg under TGMOS anesthesia, while dobutamine (0.43 +/- 0.13 mu g kg(-1)) infusion was necessary to maintain MABP at 60 mmHg under OS anesthesia. No apparent complication was observed during and after anesthesia in all cases. Recovery from anesthesia tinder TGM-OS anesthesia was very calm and smooth. The times required for the horse to return both sternal and standing position in group under TGM-OS anesthesia tended to be shorter than group under OS anesthesia which statistical differences were p

Purpose: Depending on the perfusing interventricular septum of the arteries, there are 3 types of circulation dominance: right, left, and balanced. In this study, coronary artery branches supplying the ventricular septum were investigated in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. In addition, the association of coronary artery variations with coronary arterial disease was investigated. Materials and Methods: The study included 325 consecutive patients (214 men and 108 women, with a mean age of 59 ± 14 years) who underwent MDCT coronary angiography. Multidetector computed tomography was performed with a 16-detector-row computed tomographic scanner. The type of dominance, coronary arterial diseases, and coronary artery variations were recorded. Results: In our study, the types of coronary circulation were right, left, and balanced in 227 (70%), 40 (12.5%), and 58 (17.5%) patients, respectively. Dominance of right circulation was detected in 150 of 217 (69%) of men and in 77 of 108 (71%) of women; dominance of left circulation was found in 26 of 217(12%) of men and in 14 of 108 (13%) of women; balanced/codominance circulation was found in 41 of 217 (19%) of men and in 17 of 108 (16%) of women. However, no significant differences were detected between the sexes for the type of coronary circulation. Coronary artery disease was determined in 68 patients (20.9%) by MDCT, and coronary artery variations were also determined in 34 patients (10.4%). Both the number and the rate of coronary artery variations were significantly higher among the patients with left artery dominance. Conclusions: Knowledge of coronary artery variations and pathologies is important in planning the treatment and in interpretation of findings of cardiovascular diseases. Our study indicated that, although right dominance circulation is more common in general population, both the coronary diseases and coronary artery variations are more common in individuals with left dominance circulation.

Rheumatic fever, a multisystem disease following infection with group A beta-hemolytic streptococcus, is common among young (5-15 years) but can occur in adults as well. Recently, brain natriuretic peptide (BNP) has been validated as a marker of cardiac function and prognosis. Plasma adrenomedullin (ADM) levels are elevated in various pathological states including cardiovascular and inflammatory diseases. We aim to assess the relationship between ADM and BNP levels in adult patients with acute and convalescent rheumatic fever (ARF).This case -controlled prospective study included 45 patients with ARF (mean age 21.04+/-1.91 years) and 30 age/gender-matched control subjects. Brain natriuretic peptide and adrenomedullin levels were studied in the acute and convalescent phase of ARF. Adrenomedullin was detected by enzyme immunoassay kit of peptides, while brain natriuretic peptide was measured by a commercially available instrument. The study was carried out between May 2006 and October 2006 in Atatürk University Medical Faculty Hospital. Statistical analysis was performed using Shapiro-Wilk, Mann Whitney U, Wilcoxon signed rank, Chi-square tests and Pearson correlation analysis.Plasma ADM and plasma BNP levels were significantly higher (p0.05) in adults with ARF, regardless of whether they were in acute or convalescent phase of disease. Plasma ADM levels were 74.43+/-3.4 pmol/mL in acute phases, 59.35+/-1.45 pmol/mL in the convalescent phase, and 44.79+/-13.12 pmol/mL in control group. Plasma BNP levels were 197.51+/-47.41 pg/mL in the acute phase, 145.25+/-51.25 pg/mL in the convalescent phase, and 33.45+/-10.42 pg/mL in control group. The differences were statistically significant for all (p0.05). Plasma ADM and BNP levels in the acute phase of disease showed significant negative correlation with the left ventricular ejection fraction (r=-0.56, p0.05 and r=-0.61, p0.05, respectively).In patients with acute and convalescent rheumatic fever, BNP and ADM levels were high compared to those of healthy subjects and this could be used as a complementary tool in the treatment and prognosis of ARF.

Background Though retrograde neuronal death and vascular insufficiency have been well established in plegics following intracerebral hemorrhage, the effects of plegia on arterial nervorums of peripheral nerves have not been reported. In this study, the histopathological effects of the intracerebral hemorrhage on the dorsal root ganglions and sciatic nerves via affecting the arterial nervorums were investigated. Methods This study was conducted on 13 male hybrid rabbits. Three animals were taken as control group and did not undergo surgery. The remaining 10 subjects were anesthetized and were injected with 0.50 ml of autologous blood into their right sensory-motor region. All rabbits were followed-up for two months and then sacrificed. Endothelial cell numbers and volume values were estimated a three dimensionally created standardized arterial nervorums model of lumbar 3. Neuron numbers of dorsal root ganglions, and axon numbers in the lumbar 3 nerve root and volume values of arterial nervorums were examined histopathologically. The results were analyzed by using a Mann-Whitney-U test. Results Left hemiplegia developed in 8 animals. On the hemiplegic side, degenerative vascular changes and volume reduction in the arterial nervorums of the sciatic nerves, neuronal injury in the dorsal root ganglions, and axonal injury in the lumbar 3 were detected. Statistical analyses showed a significant correlation between the normal or nonplegic sides and plegic sides in terms of the neurodegeneration in the dorsal root ganglions (p < 0.005), axonal degeneration in the lumbar 3 nerve roots (p < 0.005), endothelial cell degeneration in the arterial nervorums (p < 0.001), and volume reduction in the arterial nervorums (p < 0.001). Conclusion Intracerebral hemorrhage resulted in neurodegeneration in the dorsal root ganglion and axonolysis in the sciatic nerves, endothelial injury, and volume reduction of the arterial nervorums in the sciatic nerves. The interruption of the neural network connection in the walls of the arterial nervorums in the sciatic nerves may be responsible for circulation disorders of the arterial nervorums, and arterial nervorums degeneration could result in sciatic nerves injury.

BACKGROUND Baroreceptor reflexes are regulated by nerve terminals of the glossopharyngeal and vagal nerves. The body of pressure-sensitive neurons of these nerves is located in the petrosal ganglion of both nerves. We examined whether there is a relationship between the neuron numbers of the inferior ganglion of the glossopharyngeal nerve and blood pressure values. METHODS Petrosal ganglions were examined in 18 male hybrid rabbits divided into three equal groups: Group A normotensive (TA=90-100 mmHg), Group B hypertensive (TA>100 mmHg); and Group C hypotensive (TA

OBJECTIVE An anomalous origin and course of the coronary arteries can be benign or life threatening. Recently, because of new advances in computed tomography technology, radiologists have begun to interpret the diseases of coronary arteries. We aimed to demonstrate some remarkable anomalies of coronary arteries, some of which were not shown by multidetector computed tomography (MDCT) coronary angiography previously, and to discuss the clinical importance of these anomalies. MATERIALS AND METHODS Seven hundred twenty-five consequent patients referred to Florence Nightingale Hospital and Ataturk University Hospital for MDCT coronary angiography were included in this study. The patients were between the ages of 33 and 78 years (mean +/- SD, 59 +/- 13.86 years). Four hundred ninety-seven patients (68.6%) were men, and 228 (31.4%) were women. All the examinations were evaluated by both a radiologist and a cardiologist. RESULTS The incidence of anomalous anatomical origin and course of the coronaries found in our study group was 5.79% (n = 42). The anomalies found in our study are absence of the right coronary artery (RCA; n = 1, 0.13%), ectopic origin of RCA from the left anterior descending (LAD) artery (n = 1, 0.13%), absence of the left main coronary artery (n = 4, 0.52%), ectopic origin of the left main coronary artery from the right sinus of Valsalva (n = 1, 0.13%), double LAD and ectopic origin of LAD from RCA (n = 1, 0.13%), ectopic origin of the left circumflex artery from the right sinus of Valsalva (n = 3, 0.39%), ectopic origin of the left circumflex artery from RCA (n = 2, 0.26%), and myocardial bridging (n = 29, 4%). CONCLUSIONS An anomalous origin of the coronary anatomy must be present in the interpretations because of its importance for patients, cardiologists, and surgeons. As a conclusion, our study showed that MDCT, especially volume rendering and maximum intensity projection techniques, may be useful for assessment of complex variations, when the conventional angiography may not be sufficient.

Diabetic ketoacidosis (DKA) is an important medical emergency and may cause electrocardiogram (ECG) changes mimicking myocardial infarction. In the literature, hyperkalemia-associated ST-segment elevations have been defined in DKA; it has been demonstrated that these changes resolve completely after the treatment of hyperkalemia. We aimed to present a case with DKA in whom ST-segment elevation in inferior derivations was observed, but serum potassium level (4.4 mEq/L) was normal. The patient was admitted to the emergency department with complaints of nausea, bloody vomiting, and epigastric pain. Intravenous 0.9% saline, soluble insulin, and proton pump inhibitor were begun. Because of bloody vomiting, antiaggregant and anticoagulant therapy was not administered and coronary angiography was not considered at the beginning. Two hours after the beginning of the treatment, the blood glucose level dramatically decreased (from 712 to 263 mg/dL), and the metabolic acidosis view in arterial blood gas sample was improved. The repeated ECG depicted complete ST segment resolution. Transthoracic echocardiogram determined normal ventricular wall motion. Cardiac biomarkers remained in normal limits in the follow-up period. Coronary angiography performed 3 days after hospital admission was evaluated as normal. The patient recovered uneventfully, and gastrointestinal tract bleeding did not repeat. The ECG was repeated, and ST segments in izoelectric line were observed.

We present a woman having congenital anomalies of the inferior vena cava and partial anomalous pulmonary venous return from the right lung with atrial septal defect in a 38-year-old. Congenital anomalies of inferior vena cava are rare. They are seen more often in young males. If there are not other anomalies, they are latent for a long time. Peripheral venous thrombosis, chronic venous insufficiency, dyspnea and fatigue are often the first symptoms of these anomalies. Surgical repair of atrial septal defect with partial anomalous pulmonary venous return include provision of durably unobstructed systemic and pulmonary venous pathways, closure of the atrial septal defect, and avoidance of arrhythmias. The diagnosis has been determined by compression ultrasonography with color doppler assessment, multidetector computed tomography angiography and echocardiography.