Kemal Arda

Hepatic vein Doppler waveform changes in early stage (Child‐Pugh A) chronic parenchymal liver disease

Doppler waveform changes can be found in chronic parenchymal liver disease, especially in the late stages. We investigated the contribution of Doppler ultrasound in diagnosing early‐stage chronic parenchymal liver disease.

Carotid Disease in Patients Scheduled for Coronary Artery Bypass: Analysis of 678 Patients

The purpose of this article is to investigate the frequency of carotid disease and to identify high-risk groups among patients scheduled for isolated coronary artery bypass grafting (CABG) procedures under nonemergent conditions. A total of 678 consecutive patients underwent preoperative carotid artery duplex scanning (CADS) before CABG procedures. Morphology of carotid artery was determined and five groups were formed. Age, sex, cervical bruit, diabetes mellitus (DM), hypertension, smoking, history of cerebrovascular event (CVE), peripheral vascular disease (PVD), and severity of coronary artery disease were investigated to describe the high-risk group for carotid artery disease. In 41% of patients carotid examination produced normal findings; 46.2% had less than 60% luminal stenoses, 7.1% had 60-79% stenoses, 4.6% had 80-99% stenoses, and 1.2% had total occlusion. Previous cerebral ischemic events (CVE) (p < 0.05), hypertension (p < 0.01), smoking (p < 0.01), advanced age (p < 0.01), and female sex (p < 0.01) were identified as high-risk factors for carotid artery stenoses. There was a linear association between carotid disease and coronary disease (p < 0.05). Documentation of previous CVE, hypertension, smoking, advanced age, female sex, and severe coronary artery disease may be helpful in identifying patients at high risk for carotid artery stenoses.

Topical Treatment of Venous Microangiopathy in Patients with Venous Ulceration with Essaven Gel A Placebo-Controlled, Randomized Study

Carotid artery atherosclerosis is a strong predictor of stroke and represents a potential source of cerebral emboli. The aim of this study was to investigate whether an association exists between mitral annular calcification and carotid atheroma. In addition, the characteristics of carotid atheromas were compared between patients with and without mitral annular calcifica tion. The authors found that there was a significant association between the presence of mitral annular calcification and carotid atheroma. Mitral annular calcification in the elderly may be a form of atherosclerosis.

Spontaneous Pneumopericardium and Pneumomediastinum

A 20-year-old man with a 5-year history of ulcerative colitis presented with sudden chest pain and diarrhea. Chest radiography, echocardiography, and computed tomography demonstrated pneumomediastinum and pneumopericardium. The condition resolved completely after one week.

Goldenhar's Syndrome

A 12-year-old male was admitted with postaxial polydactyly on the right hand, congenital heart disease, vertebral anomaly, and facial asymmetry. Investigations confirmed the diagnosis of a congenital disease, Goldenhars syndrome, with the rare associations of polydactyly and probable autosomal dominant inheritance.

Evaluation of the Early Hemodynamic Changes in Carotid Arteries During Ventricular and Dual Chamber Pacing

In spite of a wide choice of pacemakers, there are some problems in making more rational clinical decisions for individual patients since mode selection and programming is usually performed on the basis of a clinical hunch. The aim of this study was to measure the differences in carotid flow in patients with a pacemaker programmed in the dual chamber and in the single chamber pacing modes. Sixty patients with implanted bipolar DDD pacemakers were enrolled in this study. Blood peak systolic velocity (PSV) and end‐diastolic velocity (EDV), cross‐sectional area, resistive index (RI), and pulsatility index (PI) were measured in the common (CCA), internal (ICA), and external (ECA) carotid arteries before pacemaker implantation and after dual chamber and ventricular pacing at 60 beats/min. PSVs in the left CCA (79.3 ± 24.9 cm/s) and right CCA (84.1 ± 18.7) were shown to significantly decrease after VVI pacing (60.1 ± 16.6 and 62.1 ± 20.0, respectively). There was also a similar significant decrease in PSV in the left and right ICAs and ECAs. Besides PSV, RI, and PI in the left and right CCAs, ICAs, and ECAs significantly decreased after VVI pacing. There was no similar decrease after DDD pacing. Cross‐sectional area and flow volume in the CCA, ICA, and ECA were similar after DDD and VVI pacing and before pacemaker implantation suggesting that cardiac output was similar when the measurements were recorded. Carotid artery PSVs, pulsatility, and RIs were found to be significantly decreased during VVI pacing compared to baseline and DDD pacing. The greater incidence of adverse cerebral outcomes in patients with VVI rather than DDD pacing may be partly due to decreased carotid PSVs.

Does claudication affect the development of coronary collaterals

Atherothrombosis is a generalized disease process that affects large- and medium-diameter arteries throughout the arterial tree. In this study, we aimed to evaluate the correlation between collaterals in different vascular beds. Patients who had undergone digital subtraction angiography for symptomatic lower extremity peripheral arterial disease and coronary angiography after an acute anterior myocardial infarction (MI) were compared with a control group composed of those patients who were hospitalized for acute anterior MI and underwent coronary angiography but had no claudication and had an ankle-brachial index of greater than 0.9 in both legs. In claudicants, stenosis in the left anterior descending artery (LAD) (90.3 ± 17.5 vs 78.6 ± 13.8, P = 0.005) was greater compared with the patients without claudication. The collaterals to the LAD (88% vs 37.5%, P = 0.001) and the collateral grades (1.7 ± 0.7 vs 0.7 ± 0.9, P = 0.001) were higher in the patients with claudication compared with those without claudication. A previous history of angina (52.2% vs 16.3%, P = 0.001), claudication (39.1% vs 4.6%, P = 0.001), and peripheral collaterals (45.7% vs 6.9%, P = 0.001) were higher in the patients with coronary collaterals than in those without. The factors affecting the development of coronary collaterals were claudication [relative risk (RR): 8.8; 95% confidence interval (CI): 2.1–39.8], peripheral collaterals (RR: 1.1; 95% CI: 1.1–1.3), and LAD stenosis (RR: 1.2; 95% CI: 0.03–29.1). Our results suggest that the presence of collateralization or angiogenesis in one vascular bed highly predicts collateralization in another arterial bed.

Do some genetic mutations predict the development of dilated cardiomyopathy in patients with Becker's muscular dystrophy?

Becker’s muscular dystrophy (BMD) is an Xlinked recessive disease characterized by progressive muscular weakness. Gene mutations at the p21 band of the X chromosome coding for the protein dystrophin are found in BMD. Cardiac involvement in BMD was first recognized in 1966,1 and since then, dilated cardiomyopathy has been reported in patients with this disease. An 18-year-old man presented with dyspnea and orthopnea lasting for 3 months. On physical examination, he had mild proximal weakness, pes cavus, and all tendon reflexes were preserved with the exception of diminished ankle jerks. One of his older brothers died of congestive heart failure with mild neurologic symptoms. His parents

Inflammatory Pseudotumor of the Lung

A case of inflammatory pseudotumor is reported. Inflammatory pseudotumor is a rare pulmonary tumor-like lesion and its pathogenesis remains obscure. Diagnosis of the lesion is usually not difficult on radiologic examinations but it must not be mistaken for a malignant tumor.