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Ailesel Akdeniz ateşi (AAA) tekrarlayan ateş, periton, sinoviya ve plevra gibi seröz zarların inflamasyonu ile karakterize, otoimmün bir hastalıktır. Hastalık sıklıkla jeneralize peritonit, plevrit veya monoartrit semptomları ile seyreder. Ailesel Akdeniz ateşine bağlı izole perikardit olguları oldukça nadirdir. Bu yazıda, AAA’nın neden olduğu yedi yıldır tekrarlayan ateş nöbetleri yakınması ile başvuran 60 yaşında erkek perikardiyal efüzyon mayi ve kardiyak tamponad olgusu sunuldu.

It is very important to decrease pulmonary artery pressure (PAP) in patients with chronic obstructive pulmonary disease (COPD) in order to prevent progression to right heart failure. We showed an acute improvement of PAP by non-invasive positive pressure ventilation (NPPV) treatment in patients with hypercapnic respiratory failure. In 26 patients with COPD (18 males and 8 females), physical examination, Doppler echocardiographic evaluation and arterial blood gases analysis were performed on admission and at discharge. PAP was measured by Doppler echocardiography. NPPV was used when 2 of the following were present without contraindications: 1. Respiratory distress with moderate to severe dyspnea, 2. Arterial pH less than 7.35 with PaCO2 above 45 mmHg, 3. Respiratory rate of 25/minute or greater. Mean age of the patients was 62.6 ± 10.8 year, and mean usage of the NPPV was 12.6 ± 5.5 day. Mean and systolic PAPs of the patients (43.8 ± 16.9 mmHg and 66.7 ± 23.3 mmHg) were significantly decreased with NPPV treatment (26.6 ± 8.4 mmHg, p< 0.0001 and 41.8 ± 14.6 mmHg, p< 0.0001). Also, each parameter of the arterial blood gases was improved significantly with NPPV usage. An echocardiographic assessment in the COPD patients having NPPV treatment due to acute respiratory failure, might be a useful and easy method to show an improvement of PAP as a supportive measure in the management of those patients, in addition to beneficial effects of that treatment on respiratory acidosis, hypercapnia and hypoxemia.

Objectives: We aimed to evaluate serum adiponectin levels in relation to the NYHA functional capacity class in patients with heart failure (HF). Study design: The study included 49 patients (40 males, 9 females; mean age 63 years) with HF, whose functional capacity was NYHA class II to IV. Echocardiographic examination was performed and serum adiponectin levels were measured. The results were compared in relation to the NYHA classes and with those of 41 control subjects (24 males, 17 females; mean age 54.2 years) without HF. Results: Functional capacity was NYHA class II in 13 patients (26.5%), class III in 23 patients (46.9%), and class IV in 13 patients (26.5%). Compared to the control group, the HF group exhibited a significantly higher mean age (p=0.001), lower body mass index (p=0.004), decreased left ventricular ejection fraction (EF) (33.2±7.7% vs. 64.9±4.3%; p=0.0001), and increased serum adiponectin level (4.0±3.2 μmg/dl vs. 2.4±2.3 μmg/dl; p=0.009). Both EF (p=0.001) and adiponectin level (p=0.004) showed significant differences between the NYHA groups, with the latter showing a sharp increase from 2.6±2.6 μmg/ dl in class II to 6.8±3.7 μmg/dl in class IV. In all paired comparisons between the three NYHA groups, EF and serum adiponectin level exhibited significant differences except for the serum adiponectin level for NYHA class II and III (for NYHA class II and IV, p=0.003; for class III and IV, p=0.008). In correlation analysis, serum adiponectin level was in a significantly inverse correlation with EF (r=-0.380, p=0.0001), and a positive correlation with the NYHA class (r=0.423, p=0.0001). Conclusion: Serum adiponectin levels significantly increase in patients with HF, in parallel with deterioration in functional capacity and with significant decreases in EF.

Amaç: Cheyne-Stokes solunumu (CSS), kalp yetersizliği (KY) hastalarında sık görülür ve mortaliteyi artırır. Bu çalışmada, CSS olan KY hastalarında adaptif servo-ventilasyon (ASV) tedavisinin, CSS ve nörohormonlar üzerine akut etkisini değerlendirmeyi amaçladık. Yöntemler: Fonksiyonel kapasitesi NYHA II-III olan 1 kadın, 19 erkek KY hastası prospektif olarak çalışmaya alındı. Hastalara bir gecelik polisomnografik (PSG) tetkik yapıldı. Cheyne-Stokes solunumu saptanan 10 hastaya, medikal tedavinin yan ısıra, başka bir gece de ASV uygulanarak eş zamanlı PSG kayıtları alındı. Arteryel kan gazları, plazma epinefrin, norepinefrin ve serum N- terminal pro- B tipi beyin natriüretik peptit (NT-pro-BNP) düzeyleri, ilk yatışlarında ve ASV tedavisi sonrası olmak üzere iki kez çalışıldı. Tedavi öncesi ile tedavi sonrası parametrelerin değerlendirilmesinde Wilcoxon testi ve CSS olan ve olmayan grupların değerlendirilmesinde ise Mann-Whitney-U testi kullanıldı. Bulgular: Cheyne-Stokes solunumlu 10 hastanın ortalama yaşı 62.2±11.1 yıl idi. Etyoloji, 9 hastada iskemik, 1 hastada ise idyopatik dilate kardiyomiyopati idi. Adaptif servo-ventilasyon tedavisi ile 10 hastanın CSS’nun düzeldiği polisomnografik olarak saptandı. Adaptif servo-ventilasyon tedavisi öncesi ve sonrası PaCO2, PH, HCO3 değerlerinde anlamlı bir farklılık saptanmazken; tedavi öncesi PaO2 75.3 mmHg ve SatO2 %94.7 iken tedavi sonrası sırasıyla 84.7 mmHg ve %96.5’e anlamlı olarak yükseldi (p=0.007 ve p=0.008). Adaptif servo-ventilasyon tedavisi öncesi NT-proBNP 3029.6±1450.5 pg/ml, norepinefrin 625.4±304.7 pg/ml ve epinefrin 65.4±24.1 pg/ml ölçümleri ile normalden yüksek saptandılar; ancak tedavi sonrası NT-proBNP 1694.0±925.9 pg/ml, norepinefrin 333.9±165.4 pg/ml ve epinefrin 45.0±20.5 pg/ml değerleri ile anlamlı olarak düşme gösterdiler (sırasıyla p=0.005, p=0.005 ve p=0.02). Sonuç: Cheyne-Stokes solunumlu KY hastalarında, uygulanan bir gecelik ASV tedavisi, CSS’nu giderir, arteryel parsiyel oksijen basıncını ve satürasyonunu düzeltir ve katekolaminler ile NT-proBNP düzeylerinde anlamlı düşme sağlar. Kalp yetersizlikli hastalarda ASV tedavisinin uzun dönemde morbidite ve mortalite üzerine etkisinin değerlendirilmesi için prospektif çalışmalara ihtiyaç vardır.

Objective: Cheyne Stokes respiration (CSR) is frequently seen in the patients with heart failure (HF) and it increases mortality. In the present study, we aimed to evaluate acute effects of adaptive servo ventilation (ASV) on CSR and neurohormones in the patients with HF. Methods: Nineteen males and 1 female patients with HF in the functional capacity of NYHA II-III were included into the study prospectively. One night polysomnography (PSG) was performed to all patients. In addition to medical treatment, 10 patients having CSR were applied ASV in another night together with PSG.. Arterial blood gases, plasma epinephrine and norepinephrine, serum N-terminal -pro-B type brain natriuretic peptide (NT-pro-BNP) were studied in the first night and after ASV treatment. A Wilcoxon test was used for comparison of parameters before and after treatment; and Mann-Whitney-U test was used for comparison of parameters between the patients with CSR and without CSR. Results: Mean age of 10 patients with CSR was 62.2±11.1 years. Their etiologies were ischemic in 9 patients and idiopathic dilated cardiomyopathy in 1 patient. While there were no significant differences in the levels of PaCO2, HCO3, PH, before and after treatment; PaO2 (75.3 mmHg) and SatO2 (94.7%) significantly increased after the therapy (84.7 mmHg, 96.5% and p=0.007 and p=0.008 respectively). While NT-proBNP (3029.6±1450.5 pg/ml), norepinephrine (625.4±304.7 pg/ml) and epinephrine (65.4±24.1 pg/ml) were higher than normal before ASV treatment, all of them showed significant reductions after treatment (1694.0±925.9 pg/mvl, 333.9±165.4 pg/ml and 45.0±20.5 pg/ml; p=0.005, p=0.005 and p=0.02, respectively). Conclusions: One night ASV treatment improves CSR, partial pressure of oxygen in arterial blood, and oxygen saturation and provides significant reductions in plasma catecholamines and NT-proBNP levels in the patients with HF and CSR. Prospective studies are needed to evaluate long-term effects of ASV treatment on morbidity and mortality in the patients with HF. © Copyright 2009 by AVES Yayincilik Ltd.

Cheyne-Stokes solunumu (CSS), konjestif kalp yetersizliği (KKY) hastalarında sık görülür ve mortaliteyi artırır. Bu çalışmada, CSS'lu kalp yetersizliği hastalarında Adaptif Servo-Ventilation (ASV) tedavisinin, CSS ve nörohormonal parametreler üzerine akut etkinliğinin değerlendirilmesi amaçlanmıştır.Fonksiyonel kapasitesi NYHA II-III olan KKY'li 1 kadın, 19 erkek çalışmaya alındı. Hastalara bir gecelik polisomnografik (PSG) tetkik yapıldı. CSS saptanan 10 hastaya, medikal tedavinin yanısıra, başka bir gecede ASV uygulanarak eş zamanlı PSG kayıtları alındı. Arteryel kan gazları, plazma epinefrin, norepinefrin ve serum NT-proBNP düzeyleri, ilk yatışlarında ve ASV tedavisi sonrası olmak üzere iki kez çalışıldı.CSS'lu 10 hastanın ortalama yaşı 62,2±11,1 idi. Etiyoloji, 9 hastada iskemik, 1 hastada ise idiyopatik dilate kardiyomiyopati idi. ASV tedavisi ile 10 hastanın CSS'nun düzeldiği polisomnografik olarak saptandı. ASV tedavisi öncesi ve sonrası PaCO2, PH, HCO3 değerlerinde anlamlı bir farklılık saptanmazken; tedavi öncesi PaO2 75,3 mmHg ve SatO2 %94,7 iken tedavi sonrası sırasıyla 84,7 mmHg ve %96,5'e anlamlı olarak yükseldi (p=0,007 ve p=0,008). ASV tedavisi öncesi NT-proBNP 3029,6 pg/ml, norepinefrin 625,4 pg/ml ve epinefrin 65,4 pg/ml ölçümleri ile normalden yüksek saptandılar; ancak tedavi sonrası NT-proBNP 1694,0 pg/ml, norepinefrin 333,9 pg/ml ve epinefrin 45,0 pg/ml değerleri ile anlamlı olarak düşme gösterdiler. (sırasıyla p=0,005, p=0,005 ve p=0,02).CSS'lu KKY'li hastalarda, medikal tedavinin yanısıra uygulanan bir gecelik ASV tedavisi, CSS'yi giderir, arteryel parsiyel oksijen basıncını ve satürasyonunu düzeltir ve katekolaminler ile NT-proBNP düzeylerinde anlamlı düşme sağlar. Kalp yetersizlikli hastalarda ASV tedavisinin uzun dönemde morbidite ve mortalite üzerine etkisinin değerlendirilmesi için prospektif çalışmalara ihtiyaç vardır. Cheyne-Stokes respiration (CSR) is frequently seen in the patients with congestive heart failure (CHF) and it increases mortality. In the present study, it is aimed to evaluate acute effects of adaptive servo ventilation (ASV) on CSR and neurohormones in the heart failure patients with CSR19 males and 1 female patients with CHF in the functional capacity of NYHA II-III. were taken into study. One night polysomnography (PSG) was performed to all patients. In addition to medical treatment, 10 patients having CSR were applied ASV in another night together with PSG., arterial blood gases, plasma epinephrine and norepinephrine, serum NT-proBNP were studied in the first night and after ASV treatmentMean age of 10 patients with CSR was 62,2±11,1 years. Their etiologies were ischemic in 9 patients and idiopathic dilated cardiomyopathy in 1 patient. While there were no significant difference in the levels of PaCO2, HCO3, PH, before and after treatment.; PaO2 (75,3 mmHg) and SatO2 (94,7%) significantly increased after the therapy (84,7 mmHg, 96,5% and p=0,007 and p=0,008 respectively). While NT-proBNP (3029,6 pg/ml), norepinephrine (625,4 pg/ml) and epinephrine (65,4 pg/ml) were higher than normal before ASV treatment, all of them showed significant reductions after treatment (1694,0 pg/ml, 333,9 pg/ml and 45,0 pg/ml; p=0,005, p=0,005 and p=0,02 respectivelyOne night ASV treatment improves CSR, partial pressure of oxygen in arterial blood, and oxygen saturation and provides significant reductions in plasma catecholamines and NT-proBNP levels in the patients with CHF and CSR. Prospective studies are needed to evaluate long-term effects of ASV treatment on morbidity and mortality in the patients with heart failure. 91

Objectives: We investigated the effect of nasal continuous positive airway pressure (CPAP) on blood pressure (BP) and left ventricular structure in male patients with severe obstructive sleep apnea (OSA). Study design: Thirty-three male patients with severe OSA underwent CPAP treatment for six months. Compliance was defined as the use of CPAP for at least 3.5 hours per night during treatment; thus, 25 patients (mean age 47.9±8.2 years) were compliant with a mean of 5.3±1.9 hours, and eight patients (mean age 48.6±8.4 years) were noncompliant with a mean of 1.0±0.8 hours. Before and after CPAP, echocardiographic assessments were made to determine left ventricular structure (interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass, and left ventricular mass index) and function (E/A ratio, isovolumic relaxation time, mitral deceleration time, and velocity of mitral flow propagation), and systolic and diastolic blood pressures were measured. In the compliant group, 20 patients had hypertension, 22 patients had diastolic dysfunction, and 16 patients had left ventricular hypertrophy (LVH). All noncompliant patients were hypertensive, four had diastolic dysfunction, and four had LVH. Results: Systolic and diastolic BPs significantly decreased after CPAP treatment, the decreases being more pronounced in the compliant group (p

Objectives: We investigated the effect of nasal continuous positive airway pressure (CPAP) on blood pressure (BP) and left ventricular structure in male patients with severe obstructive sleep apnea (OSA). Study design: Thirty-three male patients with severe OSA underwent CPAP treatment for six months. Compliance was defined as the use of CPAP for at least 3.5 hours per night during treatment; thus, 25 patients (mean age 47.9±8.2 years) were compliant with a mean of 5.3±1.9 hours, and eight patients (mean age 48.6±8.4 years) were noncompliant with a mean of 1.0±0.8 hours. Before and after CPAP, echocardiographic assessments were made to determine left ventricular structure (interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass, and left ventricular mass index) and function (E/A ratio, isovolumic relaxation time, mitral deceleration time, and velocity of mitral flow propagation), and systolic and diastolic blood pressures were measured. In the compliant group, 20 patients had hypertension, 22 patients had diastolic dysfunction, and 16 patients had left ventricular hypertrophy (LVH). All noncompliant patients were hypertensive, four had diastolic dysfunction, and four had LVH. Results: Systolic and diastolic BPs significantly decreased after CPAP treatment, the decreases being more pronounced in the compliant group (p

Amaç: Metabolik sendrom (MS), kardiyovasküler hastalık riskini artırdığı kabul edilen bir durumdur. Bu çalışmanın amacı, NCEP (ATP III) kriterlerine göre MS tanısı konmuş hastalarda, sol ventrikül fonksiyonlarını atriyoventriküler plan yer değişimi (AVPD), miyokardiyal performans indeksi (MPİ) ve konvansiyonel metodlarla değerlendirmektir. Yöntemler: Metabolik sendromlu 53 kadın hasta (ortalama yaş 53.5±6.9 yıl) ve 30 sağlıklı kadın (ortalama yaş 52.7±6.3 yıl, p>0.05) tam ekokardiyografik değerlendirmeye alındı. Olguların hiçbirinde kalp ve akciğer hastalığı yoktu. Sistolik mitral AVPD 4 bölgeden (septal, lateral, anteriyor ve posteriyor) M-mod ekokardiyografi ile ölçüldü ve ortalama AVPD’den sol ventrikül ejeksiyon fraksiyonu (EF) hesaplandı (EF-AVPD). Sol ventrikül EF, ayrıca biplan Simpson (EF-2D) ve Teichholz (EF-T) metodlarıyla da değerlendirildi. Miyokardiyal performans indeksi, Doppler ekokardiyografi ile (isovolümik kontraksiyon zamanı + isovolümik relaksasyon zamanı) / aortik ejeksiyon zamanı) formülünden hesaplandı. Bulgular: Metabolik sendromlu kadınlar, sağlıklı kişilerle kıyaslandığında hafif sol ventrikül diyastolik disfonksiyonu (DD) gösterdiler. Hasta ve kontrol gruplarında EF-2D ve EF-T anlamlı fark oluşturmadı ve normal sınırlardaydı. Metabolik sendromlu hastalar sağlıklı kişilere göre sol ventrikül global disfonksiyonu gösterdiler (MPİ sırasıyla 0.56±0.12 ve 0.46±0.11, p