A. İyisoy

Chitosan-coated alginate microspheres for embolization and/or chemoembolization: In vivo studies

In this study, chitosan-coated alginate microspheres were prepared by the ionic complexation of alginate and chitosan biopolymers to use in embolization and/or chemoembolization studies. Biopolymeric microspheres were prepared by the ionic gelation technique of alginate with a suitable divalent cation (i.e. CaCl2) in a suspension medium composed of mineral oil and petroleum ether including emulsifier (i.e. Tween-80) and then obtained microspheres were coated with chitosan in an aqueous chitosan solution while the medium was magnetically stirred. The obtained microspheres are in the size range of 100–400 µm and they can be prepared as required by changing the preparation conditions (i.e. stirring rate, concentration of biopolymers, molecular weight and concentration of chitosan, etc.). In the in vivo studies, New Zealand rabbits were used as the test animals. Both complete and partial embolization of the kidney were achieved by using the microspheres. The renal angiograms obtained before/after embolization and the histopathological observations showed the feasibility of the chitosan-coated alginate microspheres as an alternative embolization and/or chemoembolization agent.

Safety of gadodiamide mixed with a small quantity of iohexol in patients with impaired renal function undergoing coronary angiography

Gadolinium-based contrast agents can be used in diagnostic and interventional angiography, and are safe in recommended doses in patients with impaired renal function, but the image quality is usually unsatisfactory. The objective of the present study is to evaluate the safety of gadolinium mixed with a small quantity of iodine-based contrast agent and the image quality of this mixture in patients with renal insufficiency undergoing diagnostic coronary angiography. Forty-two patients with baseline creatinine level >1.5 mg/dl were randomized into gadolinium or iodine groups. In the gadolinium group gadodiamide was mixed with 1 : 3 iohexole and in the iodine group only this agent was used as contrast material. Peak creatinine levels 48–72 h after the procedure were measured. The primary end point was the development of contrast-induced nephropathy (CIN), defined as >25% increase of baseline creatinine levels, and the secondary end points were absolute and relative changes in baseline creatinine levels. Total contrast volumes used were not different between groups (57 ± 11 ml in gadolinium and 55 ± 10 ml in iodine; P = 0.68). Mean creatinine level did not increase significantly in the gadolinium group (from 1.9 ± 0.3 to 1.9 ± 0.4 mg/dl; P = 0.06), but did in the iodine group (from 2.0 ± 0.4 to 2.3 ± 0.5 mg/dl; P = 0.001). No patient had CIN in the gadolinium group whereas 5 (23%) patients had this phenomenon in the iodine group (P = 0.048). Contrast regimen was very well tolerated in the gadolinium group, with only transient headache in two patients. Gadodiamide mixed with a small quantity of iohexol is safe in patients with azotemia undergoing diagnostic coronary angiography. The image qualities obtained with this combination are also satisfactory in all of the cases. Further evaluation of the safety of this technique is warranted, especially in other types of diagnostic and interventional procedures in which a higher amount of contrast dye is needed.

Relationship of Systolic Blood Pressure and Body Mass Index With Left Ventricular Mass and Mass Index in Adolescents

Prevalence of hypertension (HT) is growing among children and adolescents. Its diagnosis is commonly ignored as it does not produce any end-organ damage in adolescents. We evaluated whether the blood pressure (BP) and confounding factors were related to myocardial mass increase; an earlier representative of HT; among adolescents. We have demonstrated that heart rate, body mass index (BMI), left ventricular mass (LVM), interventricular septum, and LV mass indexed to body surface area (BSA) and height significantly increased as the category of BP increased. We have also showed that the systolic BP (SBP), diastolic BP (DBP), and BMI were significantly correlated with the LVM and LVM indexed to BSA and height. Linear regression analysis revealed a significant relationship between SBP, BMI, and LVM, LVM indexed to BSA and height. Hypertension may cause myocardial hypertrophy even at a young age. Height is an alternative and practical way of determining the left ventricular mass index (LVMI) in adolescents. The BMI is significantly related to LVM and LVMI as well as SBP and DBP are. The results support that overweight and obesity should be controlled strictly in the management of HT in a young population.

Percutaneous closure of a tricuspid paravalvular leak with an Amplatzer duct occluder II via antegrade approach.

Paravalvular leaks are seen after valve-replacement surgery and most patients with these leaks are asymptomatic, probably due to the small size of the leak. Nevertheless, a paravalvular leak after tricuspid valve replacement is a rare complication and may cause severe haemoylsis and hepatic dysfunction. It is usually treated surgically. There are no data on percutaneous transcatheter closure of paravalvular leaks. In this report, we present a successful percutaneous closure of a paravalvular leak using an Amplatzer duct occluder II device after a tricuspid valve replacement in a patient with high operative risk who had also had mitral and aortic valve replacements.

Relationship Between Noninvasive Reperfusion Criteria and Pulsed‐Wave Tissue Doppler Parameters in Patients With Acute Myocardial Infarction Receiving Thrombolytic Therapy

Several studies have proven that noninvasive reperfusion criteria (NRC) have prognostic significance in patients receiving thrombolytic therapy (TT) after acute myocardial infarction (acute MI). In this study, we investigated the relationship between NRC and pulsed tissue Doppler (PTD) parameters in patients receiving TT after acute MI, and the role of PTD in the management and follow‐up of patients with acute MI. The study group (n= 41) was divided into four subgroups defined as: anterior and posterior MI, with or without NRC. In the first PTD measurements (2–3 days after acute MI), all acute MI patients had significantly smaller peak systolic (S‐wave) velocity in all evaluated segments and longer Q‐Speak durations (time elapsed from the inscription of the Q‐wave on the surface ECG to the peak of the S‐wave in PTD) as compared with control patients (n= 22; P < 0.001 for both). Among the diastolic parameters, the E/A ratio was significantly smaller in the study group compared with the control group (P < 0.001) . Among the patients who had received TT in the first 2 hours, those patients who had NRC displayed significantly higher peak S‐wave values in all evaluated segments than those without NRC (P < 0.05) . The second PTD study (4–5 weeks after acute MI), revealed that the difference between the systolic PTD parameters of the noninfarcted regions of the study and control groups disappeared. Infarct‐related segments, however, displayed significant improvement only in patients having NRC. There was a significant positive correlation between the mean mitral annular S‐wave velocity and left ventricular ejection fraction (r = 0.59, P < 0.001) . In conclusion, a significant relationship was observed between the PTD parameters and the NRC, which are known to have prognostic significance. (ECHOCARDIOGRAPHY, Volume 20, April 2003)

Thrombolytic therapy in a patient with inferolateral myocardial infarction after carbon monoxide poisoning

Introduction: ST segment elevation myocardial infarction (STEMI) due to coronary artery occlusion caused by intracoronary thrombosis in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. We present a case of intracoronary large and mobile thrombus formation after CO poisoning. Case presentation: A previously healthy 50-year-old woman was referred for CO poisoning. She had chest pain after exposure to CO. Her initial mental status was preoccupied with chest pain. Her initial CO fraction was 28.1%, and initial laboratory data showed creatine kinase–myocardial isoenzyme of 134 U/L (upper limit 25 U/L) and troponin I of >50 ng/mL (upper limit 0.06 ng/mL). Electrocardiography was carried out on admission, revealing an ST segment elevation in the inferolateral leads. After initial evaluation, coronary angiography was performed and an intracoronary large mobile thrombus was seen in the proximal left anterior descending (LAD) artery with no significant stenosis. We administered tenecteplase with heparin. After the thrombolytic therapy, ST elevation in the inferolateral leads resolved. Repeat angiography was performed after 24 h; the thrombus in LAD had resolved. The patient was discharged after 5 days, with persistent Q wave in the inferior leads and mild hypokinesia of the inferoposterior wall suggesting myocardial injury. Conclusion: We describe intracoronary thrombus formation induced by CO poisoning. Because intracoronary thrombus can result in myocardial infarction, its consideration following CO poisoning is important. Patients with CO poisoning who have symptoms of STEMI should be carefully evaluated with serial electrocardiograms, cardiac biomarkers, and an echocardiogram. When there is evidence of acute myocardial injury, a primer in coronary angiography can determine which patients could benefit from intervention.

Radiofrequency catheter ablation of a left lateral accessory pathway in a patient with persistent left superior vena cava.

Persistent left superior vena cava is an unusual congenital anomaly that can coexist with accessory atrioventricular pathways. This anomaly can cause difficulty in mapping because of the dilated coronary sinus. This study describes a successful catheter ablation in a young male with persistent left superior vena cava and Wolff-Parkinson-White Syndrome as a result of a left lateral accessory pathway.

Seasonal Variability of QT Dispersion in Healthy Young Males

Background: There are few data related to the seasonal influences on the QT dispersion.

A coronary artery anomaly: type IV dual left anterior descending artery.

Summary Coronary artery anomalies are seen in about 1.3% of patients undergoing coronary angiography. However, the dual type of left anterior descending (LAD) artery is a rare form of coronary artery anomaly. There are four types of dual LAD; type IV describes the anomaly of a rudimentary LAD artery terminating in the mid-portion of the anterior interventricular sulcus, and the presence of another LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus.

Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew.

OBJECTIVES For the purpose of flight safety military aircrew must be healthy. P-wave dispersion (PWD) is the p-wave length difference in an electrocardiographic (ECG) examination and represents the risk of developing atrial fibrillation. In the study we aimed at investigating PWD in healthy military aircrew who reported for periodical examinations. MATERIAL AND METHODS Seventy-five asymptomatic military aircrew were enrolled in the study. All the subjects underwent physical, radiologic and biochemical examinations, and a 12-lead electrocardiography. P-wave dispersions were calculated. RESULTS The mean age of the study participants was 36.15±8.97 years and the mean p-wave duration was 100.8±12 ms in the whole group. Forty-seven subjects were non-pilot aircrew, and 28 were pilots. Thirteen study subjects were serving in jets, 49 in helicopters, and 13 were transport aircraft pilots. Thirty-six of the helicopter and 11 of the transport aircraft aircrew were non-pilot aircrew. P-wave dispersion was the lowest in the transport aircraft aircrew, and the highest in jet pilots. P-wave dispersions were similar in the pilots and non-pilot aircrew. Twenty-three study subjects were overweight, 19 had thyroiditis, 26 had hepatosteatosis, 4 had hyperbilirubinemia, 2 had hypertension, and 5 had hyperlipidemia. The PWD was significantly associated with thyroid-stimulating hormone (TSH) levels. Serum uric acid levels were associated with p-wave durations. Serum TSH levels were the most important predictor of PWD. CONCLUSIONS When TSH levels were associated with PWD, uric acid levels were associated with p-wave duration in the military aircrew. The jet pilots had higher PWDs. These findings reveal that military jet pilots may have a higher risk of developing atrial fibrillation, and PWD should be recorded during periodical examinations.