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Introduction and objectives In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC). Materials and methods The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease. Results The median follow-up was 79 (31–179) months and the median age of the patients was 23 (16–71). The median tumor size was 4 (1–18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r = −0.490, p = 0.024 and r = −0.450, p = 00.041, respectively). Conclusions There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

Objectives: This study aims to evaluate cardiometabolic risk factors in ankylosing spondylitis (AS) patients and their relationship with epicardial fat thickness (EFT). Patients and methods: The study included 50 consecutive AS patients (29 males, 21 females; mean age 40.5±9.4 years; range 25 to 60 years) with a median disease duration of 8.3 years and 50 healthy controls (33 males, 17 females; mean age 39.8±6.4 years, range 24 to 58 years). All patients’ EFT was measured with echocardiography. Results: Both body mass index and waist circumference measurements were higher in AS patients than healthy controls (25.4±3.5. vs. 24.5±2.9 kg/m 2 , p=0.005; 96.2±10.8 vs. 86.7±12.6 cm, p

WOS: 000358062100010, PubMed ID: 25986074, Background: Cancer antigen-125 (CA-125) might be a useful biomarker to predict long-term mortality in patients with recent exacerbation of chronic obstructive pulmonary disease (COPD). Methods: A total of 87 consecutive patients with COPD were evaluated prospectively. Mean age of patients was 68 +/- 10 years (55% males, 45% females) with a median follow-up period of 49 months. Optimal cut-off value of CA-125 to predict mortality was found as >93.34 U/ml, with 91% specificity and 40% sensitivity. Results: After follow-up, 20 out of 87 (23%) experienced cardiovascular death. CA-125 levels were higher among those who died compared to those who survived [55 (12-264) versus 28 (5-245) U/ml, p = 0.013]. In multivariate Cox proportional-hazards model with forward stepwise method, only CA-125 > 93.34 U/ml on admission (HR 3.713, 95% Cl: 1.035-13.323, p = 0.044) remained associated with an increased risk of death. Conclusions: For the first time, we demonstrated that CA-125 helps the risk stratification of patients with COPD.

Aim: Our aim was to evaluate whether there was a relationship between mean platelet volume and myocardial perfusion defect in diabetic patients using myocardial perfusion imaging. Method: Forty-four diabetic patients with myocardial perfusion defect (group 1) and 44 diabetic patients without myocardial perfusion defect (group 2), matched for age and gender, were retrospectively examined. Levels of mean platelet volume (MPV) in the two groups were assessed. Results: MPV was higher in group 1 than group 2 patients (8.76 ± 0.76 and 8.25 ± 0.78 fl), respectively, p = 0.003). Levels of glucose, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, haemoglobin (Hb) and glycosylated haemoglobin (HbA1c), and body mass index (BMI) in the two groups were not statistically significantly different. Multivariate logistic regression analyses showed that MPV was the only variable independently associated with myocardial perfusion defects (OR: 2.401, 95% CI: 1.298-4.440, p = 0.013). Conclusion: This study showed that higher MPV was associated with myocardial perfusion defects. Higher MPV in diabetic patients was independently related to myocardial perfusion defects and may be an indicator of myocardial ischaemia.

Introduction. There is an increasing interest in the association between erectile dysfunction (ED) and cardiovascular risk factor. Epicardial adipose tissue (EAT) is associated with insulin resistance, increased cardiometabolic risk, and coronary artery disease. Our aim was to investigate relationships between epicardial fat thickness (EFT) as a cardiometabolic risk factor and erectile dysfunction.Method. We selected 30 erectile dysfunction patients without comorbidities and 30 healthy individuals. IIEF-5 score was applied to all patients, and IIEF-5 score below 22 was considered as erectile dysfunction. EFT was measured by echocardiography.Results. Body mass index (BMI) was higher in ED patients than those without ED (28.19 ± 4.45 kg/m2versus23.84±2.36 kg/m2,P = 0.001, resp.). Waist circumstance (WC) was higher in ED patients than those without ED (106.60±5.90versus87.86 ± 14.51,P = 0.001, resp.). EFT was higher in ED patients compared to non-ED patients (0.49 ± 0.09 cm versus0.45 ± 0.03 cm,P = 0.016, resp.). There was positive correlation among BMI, WC, and EFT. There was negative correlation between EFT and IIEF-5 score (r : -0.632,P = 0.001).Conclusion. EAT, BMI, and WC as cardiometabolic risk factors were higher in erectile dysfunction patients.

Background Heart rate decrease after exercise, that is associated with reactivation of parasympathetic system, is important, as it is also associated with mortality. Previous studies have shown that this is an independent mortality predictor in patients having no coronary artery disease and having normal left ventricular function. In our study, we aimed to study heart rate recovery (HRR) after exercise in patients having impaired left ventricular function. Methods One hundred and two consecutive patients (68 males, 34 females) requested to perform an exercise stress test were included in our study. Patients were divided into two groups as those having a normal heart rate reserve (Group1, n = 72) and those having an abnormal heart rate reserve (Group2, n = 30). Results In Group1 and Group2, resting heart rate averages were found to be 83.61 ± 18.01/min and 85.10 ± 13.40/min, respectively (P > 0.05), and maximum heart rates during exercise were 141.42 ± 19.70/min and 121.17 ± 19.01/min while those in Group1 had statistically significantly higher heart rates (P < 0.001). A statistically significant positive association was found in the correlation test carried out between the maximum heart rate during the treadmill exercise test and ejection fraction (EF) value (r = 0.201; P < 0.05). Metabolic equivalents of task values obtained during the treadmill exercise test in Group1 and Group2 were 9.48 ± 2.28 and 8.36 ± 2.50, respectively, and the difference between the said values was statistically significant (P < 0.05). Conclusions We believe that the association between low EF and abnormal HRR is worth studying and randomized large-scale studies are needed to determine mortality risk.

Objective: Combined sedation with propofol and benzodiazepines, known as balanced propofol sedation (BPS), was developed to increase patient comfort during endoscopy. However, the effects of BPS on P-wave dispersion (Pwd), QT interval, and corrected QT (QTc) interval after endoscopy have not been investigated. Methods: The study population consisted of 40 patients with BPS and 42 without sedation who were scheduled to undergo upper endoscopy in this cross-sectional prospective study. Patients with hypertension, diabetes mellitus, renal failure, chronic obstructive pulmonary disease, coronary artery disease, or valvular heart disease and those on medications that interfere with cardiac conduction times were excluded. Electrocardiograms (ECGs) was recorded in all patients pre-endoscopy and 10 min post-endoscopy. QT, QT dispersion (QTd), and Pwd were defined from 12-lead ECG. The QTc interval was calculated using Bazett’s formula. All analyses were performed using SPSS 15.0. Results: Post-endoscopy P max duration and Pwd were prolonged compared with baseline values (86±13 ms vs. 92±10 ms and 29±12 ms vs. 33±12 ms, respectively; p0.05). Conclusion: The present study showed that P-wave duration and Pwd values increased after endoscopy with a combination of midazolam and propofol sedation. Physicians should be made aware of the potential effects of BPS in terms on P-wave duration and Pwd values.

Background/aim: To evaluate the predictability of vardenafil success in patients with erectile dysfunction (ED) by using cardiological tests. Materials and methods: Patients diagnosed with ED who did not benefit from lifestyle changes (n = 68) were evaluated with an abridged 5-item version of the International Index of Erectile Function (IIEF-5). The pretreatment and posttreatment IIEF-5 scores were compared with pretreatment data obtained from cardiological examinations. Results: When pretreatment scores were compared with test parameters, mitral flow E/A ratio and tissue Doppler imaging (TDI) E?/A?, exercise test duration, exercise capacity in MET, and percentage of maximum heart rate were found to be statistically significant. Furthermore, there was a significant negative correlation between mitral flow E/A ratio, TDI E?/A?, exercise test duration, exercise capacity in MET, and the difference in post- and pretreatment IIEF-5 scores. Conclusion: As a diastolic function indicator, TDI E?/A? positively correlates with pretreatment IIEF-5 scores and negatively correlates with the beneficial effect of vardenafil treatment. As a result, the cardiological status of the patient correlates with individual IIEF-5 scores, and it seems to be useful in predicting vardenafil success.

Arteriovenous fistula presents rarely with ascites. Diagnosis, with an elusive clinical presentation, is often incidental or delayed. A 35-year-old woman presented with ascites and cardiac decompensation. Contrast enhanced computed tomography revealed arteriovenous fistula between the left common iliac artery aneurysm and the left common iliac vein. The patient underwent endovascular treatment with arterial access was performed, with implantation of a stent graft in the iliac artery to cover the fistulous communication. At follow-up 1 month later, she was asymptomatic without ascites. Arteriovenous fistula should be considered in the differential diagnosis of patients with ascites and cardiac decompensation. The endovascular treatment of the arteriovenous fistula should be considered as a first line option.

Aim:Obstructive characterized with intermittant obstruction of upper air tracts and leading to somnolence during all day. Aortic stiffness is associated with poor cardiovascular outcome and an early indicator of mortality and morbidity. In the present study we aimed to investigate aortic stiffness and aortic dispensability in OSAS patients. Material and methods: We selected 30 obstructive apnea syndrome patients without co-morbidities and 30 healthy individuals. All patients underwent echocardiography to measure aortic stiffness and compared to between groups. Results: There is no difference in term of age and sex in two groups. There were no difference in ejection fraction, thickness of interventiculer septum and posterior wall in between groups. Aortic strain was higher in OSAS patients compared to healthy individuals (8.64±3.41 and 5.92±2.43, p=0.024). Also, aortic dispensability was lower in OSAS patients than those with control groups (2.30±1.98 and 3.35±1.38, p=0.021). Conclusion: Aortic stiffness was increased where as aortic dispensability was decreased in obstructive sleep apnea patients without co-morbidities. Arterial stiffness could be easily evaluated by transthoracic echocardiography in OSAS patients and these patients should be evaluated in detail to follow up and threat in terms of cardiovascular disease, Amaç: Uyku apne sendromu; uyku boyunca üsthava yollarının tekrarlayıcı şekilde tıkanıklığı ileseyreden ve gün boyunca aşırı uyuklama şikayetineneden olan bir hastalıktır. Arteriyel sertlik olumsuzkardiyovasküler olaylarla ilişki olup birçokçalışmada kardiyovasküler olaylara bağlı gelişenmortalite ve morbiditenin erken belirleyicisi olarakkullanılmaktadır.Biz bu çalışmamızda uyku apnesendromlu hastalarda arteriyel sertliğin göstergesiolan aort gerilimi ve esneyebilirliğiniekokardiyografi yöntemi değerlendirmeyiamaçladık.Gereç ve yöntemler: Çalışmaya uyku apnesendromu olup eşlik eden hastalığı olmayan 30hasta ve 30 sağlıklı kontrol alındı. Tüm hastalara,aortik sertlik hesaplanmak üzere ekokardiyografiyapıldı ve değerler gruplar arasında karşılaştırıldı.Bulgular: Hastaların yaş ve cinsiyetleri arasındaİstatiksel fark saptanmadı. Hastalarınekokardiyografik parametrelerinden ejeksiyonfraksiyonu, interventriküler septum ve posteriorduvar kalınlığı arasında gruplar arasında istatikselfark saptanmadı. Aort gerilimi UAS’u olanhastalarda kontrol grubuna göre daha yüksek olaraksaptandı (8.64±3.41 ve 5.92±2.43, p=0.024).Ayrıca, aort esneyebilirliği uyku apne sendromuolan hastalarda kontrol grubuna göre daha düşükolarak saptandı (2.30±1.98 ve 3.35±1.38, p=0.021).Sonuç: Uyku apne sendromu olup eşlik edenhastalığı olmayan hastalarda aortik sertlik artmış veaortik esneyebilirlik azalmıştır. Uyku apnesendromu olan hastalarda transtorasikekokardiyografi arteriyel sertlik kolaycadeğerlendirilebilir ve risk faktörlerine yönelik dahayoğun tedavi ile kardiyovasküler hastalıklar vemortalitede azalma sağlanabilir.Anahtar kelimeler: Uyku apne sendromu, aortsertliği, kardiyovasküler hastalık

Turkish Anaesthesiology and Intensive Care Society, Objectives: Our aim was to determine whether there is a relationship between admission gamma-glutamyltransferase (GGT) and subsequent heart failure hospitalizations in patients with acute coronary syndrome. Study design: We selected 123 patients with newly diagnosed acute coronary syndrome of ejection fraction (EF) 49 IU/L on admission, presence of hypertension and hyperlipidemia, left ventricular ejection fraction (LVEF), right ventricular dysfunction, moderate-to-severe mitral regurgitation, alanine aminotransferase level, and antiplatelet agent usage were found to have prognostic significance in univariate Cox proportional hazards analysis. In multivariate Cox proportional-hazards model, increased GGT >49 IU/L on admission (hazard ratio [HR] 2.663, p=0.047), presence of hypertension (HR 4.107, p=0.007), and LVEF (HR 0.911, p=0.002) were found to be independent factors to predict new-onset heart failure requiring hospitalization. Conclusion: Hospitalization in heart failure was associated with increased admission GGT levels. Increased admission GGT level in acute coronary syndrome with heart failure should be monitored closely and treated aggressively. © 2014 Turkish Society of Cardiology., Sarikaya, S.; Bozok Üniversitesi Tip Fakültesi, Kardiyoloji Anabilim Dali, 66000 Yozgat, Turkey; email: cardiology58@gmail.com

WOS:000335444500041 PubMed: 26060490 Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke and death. Patients with hypertensive have an increased risk of developing atrial fibrillation. RDW (Red blood cell distribution width) levels are elevated in cardiovascular disorders including heart failure, stable coronary disease, acute coronary syndrome, slow coronary flow and stroke. Objective: We aimed to investigate the relation between RDW and AF in patients with hypertensive Method: We retrospectively examined 126 consecutive hypertensive patients (63 hypertensive patients with AF and 63 hypertensive patients without AF matched with age and sex Results: The mean age of the study population was 71,09 +/- 8,50 (af group) and 70,97 +/- 8,24 (non-af group) years. RDW level was different among patients with atrial fibrillation and without atrial fibrillation.(15,13 +/- 1,58 and 14,05 +/- 1,15 p

A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients.Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid).Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3 ± 3.9 versus 24.1 ± 2.3, p = 0.001; 19.5 ± 4.3 versus 13.8 ± 2.1, p = 0.001; and 11.4 ± 2.8 versus 8.8 ± 1.5, p = 0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels.This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias' in non-dipper pre-hypertensive patients.

Evidence suggests that symptoms of migraine are related to the involvement of the autonomic nervous system. Data on atrial conduction system are limited in migraineurs. We aimed to assess atrial electromechanical delay using tissue Doppler imaging (TDI) in patients with migraine. Forty-five migraine patients and age- and sex-matched 26 control subjects were enrolled in the study. All the patients and controls underwent resting surface electrocardiogram (ECG) and TDI. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin) and P-wave dispersion (Pd) were measured from the 12-lead ECG. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Interatrial (PA lateral-PA tricuspid) and intraatrial (PA septal-PA tricuspid) electromechanical delays were calculated. Pd was significantly higher in migraine patients than in controls (p 0.05), whereas Pmax and Pmin were not different between both groups (p 0.05). PA lateral and PA septal durations were significantly higher in migraine patients than in controls (p 0.001 and p 0.05, respectively). However, PA tricuspid duration was similar between the groups (p 0.05). Both interatrial and intraatrial conduction times were delayed in migraineurs as compared to the controls (p 0.001). Interatrial delay and intraatrial delay variables were found as an independent risk factors separately on predicting atrial conduction abnormalities in migraineurs. An interatrial delay of 18 ms and an intraatrial delay of 5 ms were found to be cutoff values in ROC analysis (p 0.001). This is the first report to provide a hypothetical suggestion that there is an atrial electromechanical delay in patients with migraine.

WOS: 000321809200007, Background: Cardiovascular death is decreasing in the general population; however, it appears in still higher rates and even increases gradually in hemodialysis (HD) patients. This situation has led to a debate about cardiovascular adverse effects of HD which lead to significant changes in cardiac and hemodynamic events. It is known that troponins are often elevated in HD patients, and high levels of troponin are associated with increased mortality. Therefore, it is difficult to interpret the value of elevations in chronic kidney disease patients. Methods: Echocardiographic and biochemical parameters of 41 patients treated with HD were evaluated before and after a HD session. Results: HD led to an increased heart rate, and tissue Doppler imaging parameters such as early diastolic mitral peak velocity (E)/early diastolic myocardial peak velocity (e) and septal e decreased significantly after HD. HD caused an increase in troponin I, myoglobin and cardiac creatine kinase (CK MB) levels (p = 0.019, p < 0.001 and p = 0.018, respectively). A decrease in the left ventricular peak systolic myocardial (LV S') velocity (p = 0.011) was detected in patients with increased levels of cardiac damage markers (group 2) compared to those without increased levels of cardiac damage markers (group 1) in HD. Conclusion: A decrease in LV S' velocity was found to be an independent predictor of an increase of myocardial injury enzymes in HD (odds ratio = 1.099; p = 0.039). We concluded that HD may lead to significant acute stress upon the myocardium. Copyright (c) 2013 S. Karger AG, Basel

Koroner anjiyografi (KAG) sonrasi gelisen gecici amneziler literaturde tanimlanmistir. Bu makalede, KAG sonrasi akut izole amnezisi gelisen ve serebral goruntulemede sag oksipital enfarkt saptanan bir olgu sunulmustur. 58 yasinda sag elli erkek hasta, istirahatta olan gogus agrisi sikâyeti ile hastanemize basvurdu. Hastaya stabil anjina pektoris on tanisi ile KAG yapildi. Islem sirasinda, intra-arteriyel iodiksanol (non-iyonik, dimerik) kontrast madde 300 cc dozunda kullanildi. Islemden yaklasik bes dakika sonra hastada amnezi gelisti. Norolojik muayenesinde, izole parsiyel retrograd amnezi disinda patoloji saptanmadi. Hastanin amnezisini aciklayacak isleme ait hemodinamik instabilite ve/veya kan parametrelerinde bozukluk saptanmadi. Hastamiza vaskuler risk faktorleri tasidigi icin serebral goruntulenme yapildi. Beyin ve diffuzyon manyetik rezonans goruntulenmede sag oksipital lobda akut enfarkt izlendi. KAG’den dort saat sonra hastanin amnezisi tamamen duzeldi. Bir hafta sonra tekrarlanan serebral goruntulemede sag oksipital enfarkt alaninin sebat ettigi izlendi ve kontrast maddeye bagli bir etki olmadigi ortaya kondu. Olgumuzda gelisen amnezi, arteriyel vazospazma ve/veya katater manuplasyonuna sekonder embolik bir hadise olarak dusunulmustur. Bu yazida, cogu zaman kontrast maddenin tetikledigi gecici norotoksik bir etkiye baglanarak ayrintili tetkik yapilmayan postanjiyografik amnezi vakalarinda –ozellikle vaskuler risk faktorleri tasiyan grupta- mutlaka serebral goruntulenmenin yapilmasi gerektigi vurgulanmistir.

WOS: 000305811600012, PubMed ID: 22386346, Background: Increased gamma-glutamyl transferase (GGT) level is associated with increased oxidative stress, all-cause mortality, the development of cardiovascular disease, and metabolic syndrome. However, its role in acute pulmonary embolism (PE) is unknown. In this study, we aimed to investigate the relationship between GGT and early mortality in patients with acute PE. Methods: A total of 127 consecutive patients with confirmed PE were evaluated. The optimal cutoff value of GGT to predict early mortality was measured as more than 55 IU/L with 94.4% sensitivity and 66.1% specificity. Patients with acute PE were categorized prospectively as having no increased (group I) or increased (group II) GGT based on a cutoff value. Results: Of these 127 patients, 18 patients (14.2%) died during follow-up. Among these 18 patients, 1 (1.4%) patient was in group I, and 17 (30.9%) patients were in group II (P < .001). gamma-Glutamyl transferase level on admission, presence of shock, heart rate, oxygen saturation, right ventricular dilatation/hypokinesia, main pulmonary artery involvement, troponin I, alanine aminotransferase, alkaline phosphatase, and creatinine levels were found to have prognostic significance in univariate analysis. In the multivariate Cox proportional hazards model, GGT level on admission (hazard ratio [HR], 1.015; P = .017), presence of shock (HR, 15.124; P = .005), age (HR, 1.107; P = .010), and heart rate (HR, 1.101; P = .032) remained associated with an increased risk of acute PE-related early mortality after the adjustment of other potential confounders. Conclusions: We have shown that a high GGT level is associated with worse hemodynamic parameters, and it seems that GGT helps risk stratification in patients with acute PE. (C) 2012 Elsevier Inc. All rights reserved.

We present an image of a 51-year-old female smoker who was admitted with angina. There was no history of cocaine or any other drug use. The coronary angiography showed a significant focal narrowing involving the mid-segment of the left anterior descending coronary artery (LAD), which persisted despite routine intracoronary injection of 200 μg nitroglycerin (Fig. 1a). The abnormal finding in Fig. 1a was considered to be a significant atherosclerotic stenosis. Therefore, the lesion was not further evaluated by giving other vasodilators such as adenosine. The left main, left circumflex and right coronary arteries were normal. She remained asymptomatic throughout the angiography and was scheduled for drug-eluting stent implantation to be performed on the next day. At the second catheterisation, we observed that the significant narrowing in the mid-segment of the LAD had disappeared completely (Fig. 1b). The procedure was discontinued without stenting and the patient was successfully treated with a calcium-channel blocker. Fig. 1 The diagnostic (a), and pre-intervention (b) images show the complete resolution of the mid-segment vasospasm in the LAD on coronary angiography. The arrows indicate the alleged culprit lesion Coronary vasospasm occurs in 3% to 4% of patients during coronary cannulation and angiography [1]. Usually, the vasospasm is confined to the ostial/proximal part of the coronary artery, demonstrating a short, concentric, smooth area of narrowing, and it ceases after relocating the catheter and/or giving intracoronary nitroglycerin. Several local vasoconstrictor mechanisms have been postulated. They include mechanical irritation triggering a myogenic reflex, and endothelial dysfunction with loss of nitric oxide supply [2]. While often producing vasodilatation, angiographic dye has also been reported to cause coronary vasospasm [3]. Intracoronary administration of vasodilators is the suggested acute treatment for coronary vasospasm in the catheterisation laboratory [4]. Nitroglycerin in doses of 100–200 μg bolus should be the first agent used. Intracoronary calcium-channel blockers can be attempted in patients refractory to nitroglycerin [5]. The key learning points of this illustrative report are as follows: (a) intracoronary nitroglycerin cannot always relieve coronary vasospasm; (b) there may be dramatic differences in the sensitivity of the coronary artery to possible mechanical stimulation by the catheter tip on different days; (c) coronary vasospasm, if especially at a point away from the catheter tip, may easily mimic a fixed lesion, leading to unnecessary intervention.

We examined the relationship between glycosylated hemoglobin (HbA1c) level and coronary flow rate in patients with type 2 diabetes mellitus (DM) and angiographically normal coronary arteries.The study included 54 consecutive patients (36 males, 18 females; age range 37 to 72 years) with type 2 DM, whose coronary arteries were found normal on coronary angiography. All patients underwent echocardiography and plasma HbA1c levels were measured before coronary angiography. To determine slow coronary flow (SCF), coronary flow rates of the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries were assessed using the TIMI frame count (TFC) method.None of the patients had echocardiographic abnormalities. The mean HbA1c level was 7.4±2.0%, and the mean TFCs were 34.3±6.5, 22.4±3.5, and 20.4±2.2 for the LAD, Cx, and RCA, respectively. HbA1c levels were7% in 26 patients, and ≥7% in 28 patients. Thirty-eight patients (70.4%) were found to have SCF in at least one coronary artery. TIMI frame counts of all three coronary arteries were significantly greater in patients in whom HbA1c was ≥7% (p0.001). TIMI frame counts showed significant correlations with the HbA1c level (LAD: r=0.782; Cx: r=0.707; RCA: r=0.515; p0.001 for all). The mean HbA1c level was significantly higher in patients with SCF compared to patients without SCF (7.8±1.9% vs. 5.6±0.9%; p0.001). The incidence of SCF was significantly greater in patients with HbA1c ≥7.0% than those with HbA1c7.0% (96.4% vs. 61.5%; p=0.004). Increased HbA1c (≥7%) significantly increased the risk for SCF in at least one coronary artery (OR=16.875; 95% CI 1.972-144.38).Our findings suggest that there is a strong correlation between the HbA1c level and coronary flow rate.

WOS: 000208702502314, …

Amaç: Hipertansiyon ciddi bir sağlık sorunudur. Antihipertansif tedavideki gelişmelere rağmen hastaların önemli bir kısmında kan basıncı kontrol altında değildir. Kan basıncının kontrolsüz olmasını etkileyen faktörleri araştırmak amacıyla son 1 yıldır antihipertansif tedavi alan hastaların sağlık karnelerini geriye doğru inceledik. Gereç ve Yöntem: En az 1 yıldır düzenli ilaç kullanan 107 ardışık hasta çalışmaya alındı. Kan basınçları değerlendirildi. Sağlık karneleri, antihipertansif ilaçlar yönünden son 1 yılı içerecek şekilde incelendi. Tüm değişiklikler not edildi. Bulgular: Çalışmaya katılanların %25.3’ünde son ofis ölçümüne göre kan basıncı kontrol altındaydı. Katılımcıların %74.8’inde son 1 yılda ekleme haricinde ilaç değişikliği yapıldığı, %65.4’ünde hastanın kullanmakta olduğu ilaç ya da ilaçlara ekleme tarzı değişiklik yapıldığı saptandı. Son 1 yılda ekleme haricinde ilaç değişikliği yapılması kan basıncının kontrol altında olmaması riskini 9.124 kat arttırıyordu. Sonuç: Hipertansif hastaların önemli bir kısmında kan basıncı kontrol altında değildir. Hipertansiyon hastalarında kontrolsüz kan basıncının hekim ve ilaç temelli nedenleri olduğunu düşünmekteyiz., Aim: Hypertension is a serious health problem. High blood pressure is uncontrolled among most of the patients despite improvements in the antihypertesnive therapy. In order to search for factors associated with uncontrolled blood pressure, we retrospectively reviewed the previous recipes of the patients. Material and Methods: 107 consecutive patients, who were on regular therapy with drugs for at least 1 year, were enrolled into study. Blood pressure measurements were evaluated. Previous recipes were searched for antihypertensive drugs back to 1 year. All changes were noted. Results: High blood pressure was under control among 25.3% of the participants. 74.8% of participants were noticed to have a modification, which was a kind of replacement with another drug, in their antihypertensive drugs, and 65.4% had an add on modification in their antihypertensive drugs. Replacement of drugs with another one within the last one year increased the risk of having uncontrolled blood pressure by 9.124 folds. Conclusion: A significant proportion of hypertensive patients had their blood pressure uncontrolled. We think that there are physician and medication based reasons for uncontrolled blood pressure among hypertensive patients.

ĂƐƚĂLJĂ LJĂƉŦůĂŶ ĞŬŽŬĂƌĚŝLJŽŐƌĂĮĚĞ ^Žů ǀĞŶƚƌŝŬƺů ;>sͿ ĚŝͲ LJĂƐƚŽů ƐŽŶƵ ĕĂƉŦ͗ϰ͕ϴ İŵ >s ƐŝƐƚŽů ƐŽŶƵ ĕĂƉŦ͗ϯ͕ϰ İŵ ŝŶͲ ƚĞƌǀĞŶƚƌŝŬƺůĞƌ ƐĞƉƚƵŵ ĚŝLJĂƐƚŽůŝŬ ŬĂůŦŶůŦŒŦ͗ ϭ͕ϲ İŵ͕ ĂƌŬĂ ĚƵǀĂƌ ĚŝLJĂƐƚŽůŝŬ ŬĂůŦŶůŦŒŦ͗ϭ͕ϯ İŵ >s ĞũĞŬƐŝLJŽŶ ĨƌĂŬƐŝͲ LJŽŶƵ͗ йϰϱ Žƌƚ ĕĂƉŦ͗Ϯ͕ϵ İŵ ƐŽů ĂƚƌŝLJƵŵ ĕĂƉŦ͗ ϰ͕Ϭ İŵ͕ ĂƉŝŬĂů ǀĞ ĂŶƚĞƌŝŽƌ ĚƵǀĂƌůĂƌ ŚŝƉŽŬŝŶĞƟŬ ŽůĂƌĂŬ ƐĂƉƚĂŶͲ ĚŦ͘ ,ĂƐƚĂLJĂ ďĂƔǀƵƌƵƐƵŶƵŶ ďŝƌŝŶİŝ ƐĂĂƟŶĚĞ ƐĂŒ ĨĞŵŽƌĂů, Koroner arter anomalileri, neden olabildikleri göğüs ağrısı, nefes darlığı, miyokard iskemisi, kalp yetmezliği, ventriküler aritmi ve ani kardiyak ölüm nedeniyle ayırıcı tanıda dikkate alınması ge- reken klinik durumlardır. Karşı sinüs valsalvadan köken alan sağ koroner arter anomalisi oldukça nadir görülen, koroner anjiyografi sırasında standart kateterle ve manipülasyonla sağ koroner os- tiyumun kanüle edilememesi durumunda şüphelenilmesi gereken bir koroner anomalidir. Burada, akut koroner sendrom kliniği ile başvuran, sol ventrikül sistolik disfonksiyonu olan hastada sol sinüs valsalva görüntülemesi ile tanı konulan bir sol sinüs valsalvadan köken alan sağ koroner arter anomalisi olgusunu sunuyoruz

Background: The aim of this study is to evaluate the affect of rapid maxillary expansion (RME) on cardiologic parameter.Methods: 12 patients (4 male and 8 females) with maxillary deficiency and bilateral cross-bite were selected to this study group. Before RME 24 h Holter monitoring of electrocardiography was used on patients. The prevalence analysis of arrhythmias, mean heart rate (MHR) and ventricular premature contraction (VPC) analysis was assessed over a 24-h period. Six months after achieving successfully expansion the Holter procedure was repeated again on patients.Results: VPC count per day and MHR, detected on 24 h ambulatory electrocardiography, showed significant statistical difference was present in pre and post-treatment periods. (VPC; 54.25±69.56/day, 6.50±5.98/day pConclusion: The patients with maxillary deficiency may have been a potential with cardiologic abnormalities. The expansion may improve the cardiac problems by expansion.

Background and objective: Metabolic syndrome (MetS) is described as a group of various abnormal metabolic risk factors such as obesity, dyslipidemia, increased blood pressure, increased plasma glucose levels, prothrombotic condition and proinflammatory state. These parameters are related to decreased parasympathetic and increased sympathetic activity. We aimed to evaluate autonomic function using a combination with heart rate variability (HRV) and heart rate turbulence (HRT) in metabolic syndrome to compare non-metabolic syndrome(non-MetS). Methods: We selected consecutive 50 patients with MetS and 50 patients with healthy non-MetS individuals. All patients underwent 24 hours holter monitoring to evaluate HRT and HRV parameters. Results: Age of patients was not different in two groups. Mean age of MetS patients was 57,50±12,13 and 54,6±10,25 in non- MetS individuals. Sex of patients was non different in MetS compared to non-MetS (37 female and 13 male vs. 22 female, 28 male p

PP-093 Right ventricular (RV) dysfunction may develop in the course of chronic obstructive pulmonary disease (COPD) and it is important predictor of morbidity and mortality. The polymorphism of the gene of multidrug resistance-1 (MDR-1) responded to drug resistance have been associated with some