Asuman Biçer

Transcatheter closure of congenital coronary arterial fistulas in adults.

ObjectivesWe have described our experience with transcatheter occlusion of congenital coronary arterial fistulas in adults. MethodsSix symptomatic patients, mean aged 41±12 years (four men, two women) underwent transcatheter occlusion of fistulas. All had chest pain or dyspnea on exertion. Four of the patients had single fistula. Two of the patients had multiple fistulas. The fistulas originated from the left anterior descending coronary artery in four patients, and from the circumflex artery in two. They all drained into the pulmonary trunk. Graft stenting was used in two patients who had multiple fistulas, and coils in four who had a single fistula. The coils were implanted through a microcatheter, which was passed through a JL 4 8F guiding catheter. ResultsCoils were used to completely occlude fistulas. Two 3.0×20 mm coronary graft stents were deployed in the coronary arteries to occlude the fistulas. The procedures were uncomplicated. At follow up, all patients underwent coronary angiography, and one of the patients with coil embolization and one of the patients with graft stenting had small residual flow. Patients chest pain or dyspneas have resolved after the procedure. ConclusionTranscatheter closure in adults of congenital coronary fistulas with graft stents and coils are safe and effective, and can be regarded as an acceptable alternative to surgery.

Thymosin beta 4 is associated with collateral development in coronary artery disease

Abstract Objectives: Thymosin beta 4 (Tβ4) plays an essential role in cardiac vessel development and is currently being developed as a therapeutic agent for the treatment of coronary artery disease (CAD) in some experimental studies. Thus, we aimed to investigate the association of serum Tβ4 levels and collateral formation in patients presenting with severely stenotic CAD. Methods: Thirteen patients with poor collateral development and 16 age- and sex-matched patients with good collateral development who had ≥ 95% stenosis in at least one major coronary artery on coronary angiogram (CAG) were enrolled in the study. The Gensini score was calculated for each patient by using CAG results. Collateral development was classified according to the Cohen-Rentrop method. Serum Tβ4 levels were measured with enzyme-linked immune sorbent assay. Results: There were no statistically significant differences between the two groups in regard to clinical and laboratory characteristics of the patients except for Tβ4 levels. The Tβ4 levels in the well-collateralized study group were found to be significantly higher than those of the poorly collateralized study group and serum Tβ4 levels were positively correlated with the collateral development. Conclusions: Our findings suggest that serum Tβ4 levels are significantly associated with the collateral development in severe CAD.

Impaired global and segmental myocardial deformation assessed by two-dimensional speckle tracking echocardiography in patients with vitamin B12 deficiency

BACKGROUND Contrary effects of vitamin B12 deficiency have been shown on the cardiovascular system. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by using the two dimensional (2D) speckle tracking echocardiography (STE) in patients with vitamin B12 deficiency and normal LV ejection fraction. METHODS Twenty-five patients with vitamin B12 deficiency (B12 levels < 200 pg/mL; mean age: 29.6 ± 8.2 years, 15 female), and 27 healthy controls (B12 levels > 200 pg/mL; mean age: 30.1 ± 6.9 years, 13 female) were included in the study. 2D echocardiography images were transferred to a workstation for further offline analysis. Longitudinal peak systolic (LPSS) and global strain (LGS) was obtained from 4 chamber and apical long axis (APLAX) views. RESULTS Standard echocardiographic parameters and tissue Doppler imaging (TDI) velocities were compared between the groups. All LPSS values in the patient group except for apical 4C septal wall longitudinal strain were significantly decreased than those in the control group. There was a positive correlation between B12 levels and strain values except apical 4C septal wall strain values. CONCLUSIONS We found that in patients with vitamin B12 deficiency, global and segmental myocardial deformation was impaired and this impairment was correlated with the levels of vitamin B12.

Eggshell-Like Appearance Around the Heart Mimicking Left Ventricular Mass

A 66-year-old male patient was admitted to the cardiology department with a new-onset angina. He had a history of hypertension, pericardiocentesis 24 years ago, coronary angiography, and percutaneous coronary intervention ≈4 years ago. He was on medications, including acetyl salicylic acid, clopidogrel, metoprolol succinate, valsartan, and hydrochlorothiazide. The results of his physical examination and biochemical tests were normal. ECG showed negative T waves on the D1, aVL, V5, and V6 derivations and ST-segment depression in inferior leads (Figure 1). Chest radiograph showed cardiomegaly and calcification on the apicolateral wall of the left ventricle (LV) (Figure 2). With the diagnosis of unstable angina, coronary angiography (Toshiba Infinix CSi, Japan) was performed and revealed critical coronary stenoses. On fluoroscopy, a structure of 2 pieces with a calcified wall, close to …

Psöriazisli hastalarda kalp hızı değişkenliği ve türbülans analizi

Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery.Iki tarafli ses teli felci (ISTF) siklikla tiroid ve paratiroid cerrahisi gibi iyatrojenik bir hasar sonucu olusur. Fakat serebral infarkt sonrasi hava yolu tikanikligina neden olan BVKP nadir olarak bildirilmistir. Bu yazida tekrarlayan serebral infarktin, gec ortaya cikan ve hayati tehdit eden bir komplikasyonu olarak solunum durmasi ile sonuclanan bir ISTF olgusu sunduk. Atmis yedi yasinda erkek hasta, son 3-4 aydir giderek artan solunum yetmezligi sikayetiyle acil servisimize basvurdu. Ozgecmisinde kalp yetmezligi ve kronik obstruktif akciger hastaligi oykusu olmayan hasta, yaklasik bir yil once bir ayda iki kez serebral infarkt gecirmisti. Yapilan solunum sistemi muayenesinde bilateral wheezing ve stridor; norolojik muayenesinde ise sag tarafta kuvvet kaybi mevcuttu. Ust solunum yolu obstruksiyonunu degerlendirilmek uzere endoskopik laringoskopi yapildi. Laringoskopide iki tarafli ses tellerinin orta hatta sabit ve hareketsiz oldugu goruldu. Solunum yetmezliginde artma ve tekrarlayan solunum durmasi nedeniyle hastaya trakeostomi acildi. Operasyon sonrasi hastanin solunum yetmezligi geriledi. Solunum fonksiyonlari normale donen hasta taburcu edildi.Dysphagia aortica is a rare etiological factor of dysphagia resulting from extrinsic compression of the esophagus by thoracic aorta. There is no gold standard diagnostic proscedure for dysphagia aortica. Dysphagia aortica is usually escaped to attention in the differential diagnosis of dyssphagia. Here, we reported compression of the esophagus by thoracic aorta in a 54 years-old male patient who comsplained from dysphagia.

Psöriazis hastalarında artmıs QT dispersiyonu

Objectives: Hepatitis C and interferon may trigger autoimmunity. We aimed to investigate the effects of combination treatment of peginterferon alpha (peg-IFN) + ribavirin in patients with chronic hepatitis C (CHC) on thyroid function tests and thyroid auto antibodies. Materials and Methods: The study included 45 outpatients with proven CHC having normal thyroid functions and previously not treated. The patients received combination of Peg-IFN+ribavirin. Values of fT3, fT4, TSH, antitiroglobulin (Anti-Tg) and thyroid peroxidase antibody (Anti-TPO) were measured at initial, fi rst, third and sixth months of treatment. Frequency of thyroid dysfunction was evaluated according to age and gender of patients. Results: Thyroid dysfunction emerged in 15 (%33.3) of 45 patients at the end of the six month of antiviral treatment. Symptomatic thyroid disease was confi rmed in 2 patients.Subclinical hyperthyroidism was determined in four patients (%8.9), and subclinical hypothyroidism in 3 patients (%6.7) at the end of third month.At the end of sixth month; symptomatic hyperthyroidism was observed in one patient (%2.2), subclinical hyperthyroidism in six (%13.3) and subclinical hypothyroidism in 7 patients (%15.6), and symptomatic hypothyroidism was determined in one patient (%2.2).At the end of the sixth month of antiviral treatment; Anti-Tg antibodies were positive in 12 patients (%26.7) and antiTPO in 11 patients (4 male and 7 female) (%24.5). No sig- nifi cant relationship was found between thyroid dysfunction and age, gender and ALT levels of patients (p>0.05). Conclusion: Periodic follow-up examinations should be done for thyroid autoimmunity and thyroid functions in CHC patients receiving combination treatment of PegINF+ribavirin.In adults, urethral foreign body is commonly observed with mental disorder, psychiatric or sexual behavior distursbance. In this paper, we reported a case which electrical cable wire was inserted into the urethra by the husband.Objectives: Dietary high fructose consumption which is closely associated with endothelial dysfunction via insulin resistance has recently increased in developed countries.Insulin resistance has a promoter effect on many meta-bolic disorders such as syndrome X, polycystic ovary syn-drome, Type 2 diabetes mellitus etc. Our aim in this study is to understand the impact of increased fructose intake on metabolisms of glucose, insulin and endothelial dys-function by measuring nitric oxide (NO) and endothelin-1(ET-1) levels in hepatic tissue which is crucial in fructose metabolism. Materials and Methods: We designed an animal study to understand increased fructose intake on hepatic en-dothelium. Twenty adult male albino rats were divided into two groups; the study group (group 1, n=10) received isocaloric fructose enriched diet (fructose-fed rats, con-taining 18.3% protein, 60.3% fructose and 5.2% fat) while the control group received purifi ed regular chow (group 2,n=10) for 2 weeks. After feeding period, blood and hepatictissue samples were collected and glucose, insulin, NO and ET-1 levels were analysed. Results: We found increased fasting glucose and insulin levels and impaired glucose tolerance in fructose fed rats. Higher NO and lower ETn1 levels were also detected in hepatic tissue samples of the group 1. Conclusion: Increased fructose consumption has delete- rious effects on glucose tolerance, insulin resistance and may cause to endothelial dysfunction. Key words: Fructose consumption, endothelial dysfunc-tion, nitric oxide, endothelin-1, liver.Oral squamous cell papilloma is a cutaneus lesions occurring due to human papilloma virus infections. These lesions spread locally and tend to have a high recurrence rate. Cases usually have a slow progression rather than acute symptoms. The course of disease is mostly subclinical. Although there are various treatment modalities which are recommended for the treatment of the disease, there is no particular and effective treatment modality that was proven. Limited surgical excisions result in frequent recurrences due to the presence of HPV in latent form around the lesions. Therefore, surgical excisions are combined with the other treatments such as systemically used interferons. We aimed to present a case of squmous cell papilloma with locally extensive lesions in the oral mucosa. Our patient was managed by the surgical excision and systemically given interferon treatment.