Mustafa Yildiz

Arterial distensibility as determined by carotid-femoral pulse wave velocity in patients with Behçet’s disease

Abstract Behçet’s disease (BD) is a chronic, multisystem disorder characterized by genital and oral aphthae, skin lesions, uveitis, and tendency to thrombosis. Pulse wave velocity (PWV) is an important factor in determining cardiovascular mortality and morbidity. It is an index of arterial wall stiffness and inversely related to the arterial distensibility. In this study we investigated the arterial distensibility in BD by PWV. We studied 14 patients with BD (18–44xa0years old, 10 men) and 28 healthy subjects (18–39xa0years old, 21 men) without known cardiovascular disease. Arterial distensibility was assessed by automatic carotid-femoral PWV measurement using the Complior Colson device. PWV is calculated from measurements of pulse transit time and the distance traveled by the pulse between two recording sites, according to the following formula: pulse wave velocity (m/s)=distance (m)/transit time(s). The mean ages, systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate, and PWV of Behçet’s disease and control subjects were 32.1±7.4 vs 27.9±6.1xa0years, 112.9±12.0 vs 108.7±10.0xa0mmHg, 72.1±10.7 vs 67.7±7.5xa0mmHg, 40.7±12.2 vs 41.0±10.7xa0mmHg, 74.1±10.2 vs 77.2±10.1 bpm, and 8.4±1.4 vs 8.5±1.1 m/s, respectively. Differences between all parameters studied were not found to be statistically significant (p>0.05). The carotid-femoral PWV, an index of arterial stiffness and a marker of atherosclerosis, is not increased in patients with BD compared with control subjects.

Effect of electromagnetic field induced by radio frequency waves at 900 to 1800 MHz on bone mineral density of iliac bone wings.

Objective: Telecommunication has gained a different meaning in daily life with the introduction of the mobile phone system. However, electromagnetic pollution has increased in parallel to this improvement. In this study, we aimed to investigate the effects of electromagnetic waves emitted from cellular phones operating at a frequency of 900 to 1800 MHz on the bone mineral density of the human iliac bone wings, which are the most common carriage sites for mobile phones. Materials and Methods: A total of 150 male volunteer participants were included in this study. The mean age was 31.85 years, and the age range was between 21 and 57 years. The participants were separated into 2 groups based on as follows: iliac side exposed to electromagnetic wave (group 1) and unexposed side (group 2). Of the total number of participants, 122 were carrying their phones on their right iliac wings, whereas 28 were carrying their phones on their left iliac wings. The mean daily carriage duration was 14.7 hours (between 12 and 20 h), and the mean duration for cellular phone use was 6.2 years (between 4 and 9 yr). Mineral bone density was measured using dual-energy x-ray absorptiometry in the right and the left iliac wings of all the participants. The SPSS 15 software (SPSS Inc, Chicago, IL) was used for statistical analysis. In the comparison of the 2 sides, Student t test was performed and P < 0.05 was considered significant. Results: The mean dual-energy x-ray absorptiometry values measured from group 1 were slightly lower than those from group 2, but there was no statistically significant difference between the groups (P > 0.05). In addition, the mean values of group 1 were not as low as those measured in osteopeny or osteoporosis cases. Conclusions: Current data may suggest that taking into consideration cellular phone use when iliac bone graft is necessary in clinical practice would constitute an important factor for more favorable outcomes.

Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6u2009±u20098.1xa0years (range 2–33xa0years) and all were on colchicine therapy with a mean colchicine dosage of 1.2u2009±u20090.4xa0mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93xa0ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12u2009±u20090.96] vs 0.095 [0.01–0.80] pu2009<u20090.001, respectively). PCT levels higher than 0.5xa0ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (pu2009<u20090.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

Assessment of Arterial Distensibility in Patients With Cardiac Syndrome X

This study aims to investigate arterial distensibility by using carotid-femoral (aortic) pulse wave velocity measurements in patients with cardiac syndrome X. The authors studied 10 patients with cardiac syndrome X (mean age 49.4 ±7.5, 39 to 67 years old, 3 men) and 10 healthy subjects (mean age 50.0 ±10.5, 38 to 70 years old, 3 men). Carotid-femoral pulse wave velocity measured by a Complior Colson device was calculated for each patient. The carotid-femoral pulse wave velocity was increased in patients with cardiac syndrome X as compared with age-matched control subjects (10.25 ±1.28 vs 8.95 ±0.89 m/s, p = 0.01). In contrast, there were no significant differences in the age, weight, height, body mass index, waist/hip ratio, systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and heart rate (p=0.76,p=0.17,p=0.36,p=0.08, p=0.21,p=0.14,p=0.89,p=0.30,p=0.10, p = 0.36, respectively). No significant correlation was found between pulse wave velocity and age, sex, height, weight, heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, and pulse pressure in the studied groups (p>0.05). The arterial distensibility was decreased in patients with cardiac syndrome X. The deterioration in these patients showed that this disease might be a more generalized disturbance of the vasculature. Measurements of carotid-femoral pulse wave velocity may provide a simple and noninvasive technique to identify patients at increased risk of vascular disease.

Right ventricular function in patients with acute anterior myocardial infarction: tissue Doppler echocardiographic approach.

Objective — Our purpose was to investigate the right ventricular (RV) performance of patients with a first acute anterior myocardial infarction (AAMI) by using pulsed wave Doppler tissue (PWDT) samplings of tricuspid annulus and RV free wall. Methods and results — The study group included 31 patients with AAMI and 20 age-matched controls. Conventional indexes of RV functions were the magnitude of tricuspid annular plane systolic excursion (TAPSE), and the transpulmonary and transtricuspid Doppler parameters. PWDT velocities were obtained by placing the sample volume at the lateral tricuspid annulus and the mid-segment of RV free wall; the peak systolic (S), early (E) and late (A) diastolic PWDT velocities and time intervals from ECG-Q wave to their peaks were analysed. Standard indexes were comparable except TAPSE that was significantly lower in AAMI-patients (p < 0.001). S velocities were similar; A of both regions (p = 0.018 and 0.012) and E of RV free wall (p = 0.011) were significantly increased in AAMI-group. Q-Sa intervals in both regions (p = 0.007 and 0.015) and Q-Ea of tricuspid annulus (p = 0.045) were significantly shorter in patients with AAMI.TAPSE and E of RV free wall had significant negative correlations with left ventricular systolic volume index and right atrial filling fraction (AFF), respectively (r = -0.46, p = 0.01 for both). A of tricuspid annulus had a positive correlation with left AFF (r = 0.42, p = 0.02). Conclusion — PWDT imaging of tricuspid annulus and RV free wall is capable to sensitively detect the adaptive mechanisms and unfavourable diastolic properties of RV dynamics in patients with AAMI.

Acute effect of DDD versus VVI pacing on arterial distensibility.

Pulse wave velocity (PWV) is a new technique and frequently used today to determine the elastic distensibility of great arteries. Increased arterial stiffness and PWV have been proposed as possible mechanisms in the initiation and/or progression and/or complications of atherosclerosis and cardiovascular disease. We evaluated the acute effect of two frequently used pacing modes (DDD vs. VVI) on arterial distensibility using PWV. Methods: Seventeen patients (age, 56 ± 14 years) implanted with DDD pacemakers were included in the study. All patients were pacemaker dependent and continuously paced at the programmed rate. PWV was measured first in DDD mode, and then the mode was switched to VVI, and PWV was measured again at the same programmed heart rate as in the DDD mode. Results: Although systolic blood pressure significantly decreased from 129 ± 18 to 119 ± 16 mm Hg (p = 0.001) after switching the mode from DDD to VVI, diastolic blood pressure (81 ± 12 vs. 80 ± 13 mm Hg; p = 0.38) did not change. In addition, PWV significantly increased from 11 ± 2.46 m/s in DDD mode to 11.29 ± 2.43 m/s (p = 0.01) after having been programmed to VVI mode. Conclusions: Our results suggest that VVI pacing increases PWV, and therefore decreases arterial distensibility, and thus may contribute to the development and progression of atherosclerosis.

Management of a patient with active rheumatoid arthritis and suspected tuberculosis causing effusive-constrictive pericarditis

In the following case report we present a patient who has been admitted for pericardial effusion causing cardiac compression with active rheumatoid arthritis and suspected tuberculosis. The patient was successfully treated with intravenous pulse steroid for active rheumatoid arthritis, with prophylactic anti-tuberculosis agents for suspected tuberculosis and with surgical pericardiectomy for the thickened pericardium as well as recurrent pericardial effusion.

Henoch Schonlein purpura mimicking Crohn's ileitis

Dear Sir,nnHenoch Schonlein Purpura (HSP) is a systemic vasculitis of small sized vessels commonly seen in childhood and characterized by purpuric rashes, arthritis, gastrointestinal (GIS) and renal manifestations. GIS involvement is common, however, intestinal perforation, necrosis, strictures and intussusceptions occur very rarely.1 Such complications usually occur in the early childhood and have been reported in the adults very rarely.2–4 In this report we describe a young patient presenting with acute abdomen. Intestinal obstruction was the preceding finding and the skin rashes appeared at the post-operative follow-up.nnAn 18-year-old male without having previous GIS symptoms was admitted to the emergency care unit with severe abdominal pain, nausea, vomiting and obstipation for two days. At physical examination, he …

Effect of Obesity on Coronary Collateral Vessel Development in Patients with Coronary Artery Disease

The purpose of this study was to compare coronary collateral circulation and with other risk factors in patients with coronary artery disease and different body mass index. Between January 1999 and December 2001, of 867 patients who underwent angiography for the first time, 90 patients (24 women and 66 men), with occlusion in only 1 coronary artery participated in the study. Information regarding age, body mass index, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, preinfarction angina, and use of oral beta blockers and nitrates were recorded for all patients. The patients were separated into 2 groups in accordance with development of their coronary collateral circulation; those with insufficient (Rentrop 0, 1, and 2) and those with sufficient coronary collateral circulation. They were also divided into 3 groups on the basis of body mass index as follows: (I) 18.0-24.9 kg/m2, (II) 25.0-29.9 kg/m2, and (III) more than 30 kg/m2. In the obesity and overweight groups, hyperlipidemia, diabetes mellitus, and nitrate use were identified more frequently than in the other groups (p<0.05). Use of oral nitrates more than 6 months before the myocardial infarction and existence of preinfarction angina affected collateral coronary vessel development in the positive direction (p=0.01, p=0.03, respectively). There was no correlation between coronary artery disease and coronary collateral vessel development in the obese patients (p=0.6). Although it has been shown that coronary collateral vessel development was affected negatively in obese patients with coronary artery disease, no statistical significance was identified.

Hyperosmolar hyperglycaemic nonketotic coma associated with acute myocardial infarction: report of three cases.

Diabetes mellitus is one of the most commonly associated diseases of patients suffering an acute myocardial infarction. Although the coexistence of acute myocardial infarction with other clinical manifestations of diabetes have been well described, extremely few data exists about the concomitant occurrence of hyperosmolar hyperglycaemic nonketotic coma and myocardial infarctions. This article presents three patients with this association and aimed to discuss the clinical course and treatment strategies of this rare condition.