İhsan Alur

YouTube as a source of information on varicose veins.

Background There has been little investigation of videos related to varicose veins in Internet media. This study aimed to investigate the characteristics and scientific accuracy of the videos related to varicose veins which were uploaded to the youtube.com website. Methods The YouTube site was searched in October 2014 using the keywords varicose vein, varicose veins, and varicosis with no filter. The contents of the reviewed videos were assigned to three groups as useful, partly useful, and not useful by using the criteria including the scientific contents of the videos, contemporariness and accuracy of the insight, and presentation of the data particularly regarding the visual features. The statistical analysis was based only on the videos rated as ‘useful.’ Results In total, 1519 (84.4%) of 1800 videos evaluated were excluded. Many of the sources uploading videos to the website were healthcare professionals (32.7% n = 92). Regarding the source of the upload, those from official institutions/associations were viewed statistically significantly more often than videos uploaded by all others (p = 0.001). The rated usefulness was significantly higher for videos uploaded by official institutions/associations (100%) than those uploaded by others (p = 0.01). Conclusions Official institutions/associations should be encouraged to produce and upload videos including up-to-date and comprehensive information regarding the disease. Likewise, additional search tools would be useful to locate videos uploaded by academic figures and institutions.

Choroidal changes after cardiopulmonary bypass.

Aim: Choroid, which is the vascular tissue responsible for blood supply to the outer parts of the retina, might be affected by hemodynamic events. We aimed to reveal choroidal thickness and ocular pulse amplitude changes after cardiopulmonary bypass in which gross hemodynamic alterations occur. Methods: Forty-two eyes of 42 patients who underwent heart surgery with cardiopulmonary bypass were examined in this prospective, cross-sectional case series. The spectral domain optical coherence tomography (Spectralis, Heidelberg, Germany) was used to analyze sub-foveal choroidal thickness. The ocular pulse amplitude, the surrogate of gross choroidal blood flow, was measured with the Pascal dynamic contour tonometer (Pascal DCT, Swiss Microtechnology AG, Port, Switzerland).. The intraocular pressure was also measured with this tonometer. The examinations were performed pre-operatively and post-operatively at the first week and first month. Results: The mean age of the patients was 58.8 ± 12.4 years. The mean sub-foveal choroidal thickness and ocular pulse amplitude values did not change statistically significantly after the operations at the follow-up visits (p>0.05). Also, there were no important correlations between cardiopulmonary bypass time and mean sub-foveal choroidal thickness and ocular pulse amplitude changes at the post-operative first week (p>0.05). The intraocular pressure values were decreased markedly at the control visits (p<0.05). Conclusions: Sub-foveal choroidal thickness and ocular pulse amplitude are unchanged, while intraocular pressure decreases one week and one month after cardiopulmonary bypass.

Effects of coronary artery bypass grafting surgery on retinal vascular caliber, ocular pulse amplitude and retinal thickness measurements

Aim: The retina and ocular vasculature are vulnerable to alterations in systemic hemodynamics, such as in open heart surgeries. Our aim was to investigate retinal vascular caliber (RVC), ocular pulse amplitude (OPA), peripapillary retinal nerve fiber layer (RNFL) and macular thickness in coronary artery bypass grafting (CABG) surgery patients. Methods: Twenty-six patients who had a history of CABG surgery and 26 age-sex-matched healthy participants were recruited for this prospective, cross-sectional and comparative study. The RVC, peripapillary RNFL and macular thickness measurements were taken with spectral-domain optical coherence tomography. The OPA, a surrogate of pulsatile ocular blood flow, was measured with the Pascal dynamic contour tonometer. Results: There were no statistically significant differences between the CABG surgery patients and the controls with regard to RVC, OPA, peripapillary RNFL thickness and macular thickness measurements (p>0.05). Conclusions: CABG surgery does not affect retinal structures and pulsatile ocular blood flow in the long-term follow-up.

Less painful tumescent solution for patients undergoing endovenous laser ablation of the saphenous vein.

BACKGROUND This study aims to investigate the efficacy of lidocaine, prilocaine, and bupivacaine used in tumescent solution during endovenous laser treatment (EVLT) on intraoperative and postoperative pain. METHODS This prospective randomized study included 90 patients. The patients were divided into 3 groups including 30 patients in each group, according to the content of local anesthetics in tumescent solution. All patients received EVLT treatment with lidocaine in group 1, prilocaine in group 2, and bupivacaine in group 3. Visual analog scale was used for the evaluation of intraoperative and postoperative pain. RESULTS The mean intraoperative pain score was 2.27 ± 1.53 in group 1, 1.97 ± 1.54 in group 2, and 3.05 ± 0.73 in group 3. On the first day postoperatively, the mean pain score was 2.57 ± 1.7 in group 1, 3.27 ± 1.23 in group 2, and 1.13 ± 0.94 in group 3 (P = 0.0001). Intraoperative and postoperative mean pain scores during first day follow-up were significantly lower in group 3. CONCLUSIONS Tumescent anesthesia is the most critical component of EVLT to improve comfort by reducing the pain. Therefore, we conclude that bupivacaine is an optimal alternative to lidocaine and prilocaine in tumescent anesthesia and can be used safely.

Evaluating Coronary–Cameral Fistulas

To the Editor: Having read the interesting case report by Banerjee and Patra1 in the August 2016 issue of the Journal, we wish to contribute to their discussion on coronary–cameral fistulas (CCFs). Acquired CCFs may be iatrogenic or post-traumatic. For a CCF to be classified as acquired, it must not have been present at birth, it must not have been seen on prior angiographic images, and its cause must be known. Potential causes are previous myocardial infarction; a diagnostic or interventional endovascular procedure, such as percutaneous transluminal coronary angioplasty or stenting; aortic or mitral valve surgery; coronary artery bypass grafting; congenital heart surgery for tetralogy of Fallot, ventricular septal defect (VSD), double-chambered right ventricle, or transposition of the great arteries with VSD; septal myectomy in the treatment of hypertrophic cardiomyopathy; chest trauma; permanent pacemaker implantation; and complications after endomyocardial biopsy.2,3 Although most CCFs are asymptomatic, the size of the fistula and severity of the left–right shunt might cause symptoms. Clinical findings include a continuous cardiac murmur; difficulty breathing; exertional dyspnea; high-flow heart failure caused by the left–right shunt (except when fistulas open to the left ventricle [LV]); pulmonary hypertension; cardiac arrhythmias; stroke; endocarditis; chest pain or myocardial infarction caused by coronary steal; cardiac tamponade from fistula aneurysm, dissection, or rupture; and sudden cardiac death.2-4 Because the left–right shunt fraction can be restricted by high intracavitary pressure, substantial hemodynamic changes might not be observed when CCFs open to the LV. However, ischemic chest pain or myocardial infarction might develop in these patients because of coronary steal.4

''Transcatheter Aortic Valve Implantatiton (TAVI)'' Komplikasyonları

Aortic root rupture (ARR) is a severe complication of Trans-catheter Aortic Valve Replacement (TAVR) or Trans-catheter Aortic Valve Implantation (TAVI). Although its incidence has been reported as 1%, it is estimated to be higher (2). The symptoms and the time of onset of clinical manifestations vary depending on the magnitude of the rupture area and the injury. It may be asymptomatic if the annular tear is small or there may be development of pericardial effusion, sub-epicardial/peri-aortic hematoma at the heart base or between the aorta and the pulmonary artery, new-onset aortic wall thinning, mitral or tricuspid regurgitation, para-valvular leakage, VSD, limited or disseminated aortic dissection, contrast medium extravasation, conduction anomalies and ECG changes. If the annular leakage is large, it may result in pericardial tamponade, hypotensive shock and death (1, 2). Anatomical factors that increase the ARR may include aortic annulus of <20 mm, narrow aortic root, intensive calcification on aortic valve leaves, presence of peripheral calcification, particularly on the annulus, calcification at the left ventricular outflow tract (LVOT) and annular junction site of sinus valsalvas, intensively calcified bicuspid aortic valve (BAV), calcified nodules reaching 4-5 mm, a high calcium score of over safety limits, coronary arteries close to the

A rare complication: an attempt of retrieval of an aortic valve wrapped with pig tail catheter during transcatheter aortic valve implantation

Transcatheter aortic valve implantation is preferred to treat high surgical risk patients with severe aort stenosis. Wrapping of a pig tail catheter with device struts during transcatheter aortic valve implantation is a very rare complication. In this report, we present the images and videos of an attempt of retrieval of an aortic valve wrapped with pig tail catheter during transcatheter aortic valve implantation in a 71-year-old man.

Rapidly Occurring Carotid Artery Aneurysm in a Patient with Behcet Disease

Behcet disease (BD) is a chronic systemic inflammatory disorder characterized by recurrent oral and genital ulcerations, üveitis, and skin lesions. Vascular system involvement is common in BD. Aneurysm formation appears to be more common than arterial occlusion. Extracranial carotid aneurysms in BD are extremely rare. In this report, we present rapidly expanding carotid pseudoaneurysm in a BD patient and its surgical treatment.

The association between coronary flow rate and impaired heart rate recovery in patients with metabolic syndrome: A preliminary report

BACKGROUND The aim of this study is to evaluate heart rate recovery (HRR) and association between coronary flow rate and HRR in patients with metabolic syndrome (MS) who had morphologically normal coronary angiogram. METHODS Study population included 43 patients with MS and 37 control subjects without MS. All patients were selected from individuals who had recently undergone coronary angiography in our hospital and were diagnosed as having angiographically normal coronary arteries. Exercise stress test results obtained prior to coronary angiography were evaluated for calculating HRR and other parameters. In addition, coronary flow was objectively evaluated for each major coronary artery in each subject using TIMI frame count method. RESULTS All HRR values calculated were detected significantly lower in MS group compared to controls (HRR first: 32 ± 9 vs. 37 ± 10; p = 0.01, second: 46 ± 11 vs. 52 ± 11; p = 0.03, third: 51 ± 12 vs. 59 ± 12; p = 0.00, fourth: 54 ± 13 vs. 61 ± 2; p = 0.02). TIMI frame counts for each major epicardial coronary artery and mean TIMI frame count were also found to be significantly higher in MS group compared to controls (left anterior descending artery:51 ± 24 vs. 39 ± 15; p = 0.009, left circumflex artery: 32 ± 11 vs. 24 ± 7; p = 0.001, right coronary artery: 33 ± 14 vs. 24 ± 10; p = 0.003, mean TIMI frame count: 38 ± 15 vs. 29 ± 9;p = 0.002). Additionally, significant negative correlations were also detected between HRR first minute and coronary TIMI frame count values in patients with MS. None of MS parameters did not affect HRR values, however mean TIMI frame count independently associated with HRR first minute (p = 0.04) in patients with MS. CONCLUSIONS Impaired coronary blood flow occurring in MS might be a clue of autonomic dysfunction in addition to previously known endothelial dysfunction.

Acute Myocardial Infarction in a Young Female Patient Using Oral Contraceptives Possessing a Factor V Leiden Mutation

It is known that there is an interaction between oral contraceptive pills and the cardiovascular-hemostatic system. In this case report, we discuss a 29-year-old female patient, who had been taking oral contraceptive drugs, who was admitted to the emergency department with chest pain. Acute anterior myocardial infarction was diagnosed.