Zakir Karadağ

Effect of long-term and high-dose allopurinol therapy on endothelial function in normotensive diabetic patients

Abstract Objectives. Endothelial dysfunction is a well known risk factor for atherosclerosis. Uric acid levels are associated with endothelial dysfunction and atherosclerosis even if in physiological range. Xanthine oxidase inhibition with allopurinol decreases uric acid levels and oxidative stress and improves endothelial function. We have investigated the effect of high-dose and long-term allopurinol therapy on endothelial function in diabetic normotensive patients. Methods. This study is a randomized, single-blind, placebo-controlled trial. Both treatment and placebo groups consisted of 50 patients. In the treatment group, daily oral 900 mg allopurinol was started after randomization and maintained for 12 weeks. Brachial artery flow-mediated dilatation (FMD) and nitrate-induced dilatation (NID) were measured at baseline and after the allopurinol therapy to evaluate endothelial function. Results. HbA1c and uric acid levels decreased after allopurinol therapy (6.1 ± 2.1 vs 5.5 ± 1.0%, 5.0 ± 0.8 vs 3.3 ± 0.5 mg/dl, respectively, p = 0.01) but no change was observed in the placebo group (7.7 ± 1.9% vs 7.6 ± 2.0%, 5.3±2.1 vs 5.6 ± 0.8 mg/dl, respectively, p > 0.05). FMD and NID increased significantly in the treatment group (5.6 ± 2.1% vs 8.5 ± 1.2%, 10 ± 7.4% vs 14 ± 4.0%, 10 ± 7.4% vs 14 ± 4.0%, respectively, p = 0.01), whereas no change was observed in the placebo group (5.8 ± 1.8% vs 6.1 ± 0.8%, 12 ± 9.5 vs 10 ± 3.8%, respectively, p > 0.05). Conclusion. Long-term and high-dose allopurinol therapy significantly improved endothelial function in diabetic normotensive patients. In addition, allopurinol therapy contributes to the lower HbA1c levels.

Does Nebivolol Prevent Contrast-Induced Nephropathy in Humans?

An experimental study showed that nebivolol is an effective agent in contrast‐induced nephropathy (CIN) prophylaxis.

Impaired aortic elastic properties in normotensive patients with psoriasis

Abstract Objective. Psoriasis is a chronic inflammatory disease affecting approximately 1.5–3% of the general population. Several studies have demonstrated an association between psoriasis and atherosclerosis. The aim of this study is the investigate relation between aortic wall stiffness and duration and severity of the disease in patients with psoriasis. Method. The study population included 58 patients with psoriasis (27 men, mean age = 36.3 ± 10.6 years, and mean disease duration = 9.8 ± 6.7 years) and 36 healthy control subjects (17 men, and mean age = 40.0 ± 11.1 years). Aortic stiffness index, aortic strain and distensibility, were calculated from the aortic systolic and diastolic diameters measured by echocardiography and blood pressure obtained by sphygmomanometer. Cardiac functions were determined by using echocardiography, consisting of standard two-dimensional and conventional Doppler. Results. The conventional echocardiographic parameters were similar between patients and controls. There were significant differences between the control and the patient groups in aortic stiffness index (2.7 ± 1.0 vs 2.0 ± 0.8, p = 0.001), aortic strain (10.3±3.3% vs 14.2±4.5%, p <0.001) and distensibility (4.2 ± 1.7 × 10−6 cm2/dyn vs 5.8 ± 2.0 × 10−6 cm2/dyn, p=0.001). There were significant negative correlations between the disease duration and distensibility (r = −0.54, p < 0.001), aortic strain (r=−0.41, p=0.001), aortic diameter change (r = −0.35, p = 0.007) and positive correlations between the disease duration and aortic stiffness index (r = 0.58, p < 0.001). Also heart rate and high-sensitive C reactive protein were significantly higher in psoriasis patients than in healthy controls (80.0 ± 11.8 beats/min vs 72.4 ± 8.8 beats/min, p = 0.001 and 9.7 ± 21.4 mg/l vs 3.7 ± 2.1 mg/l, p = 0.04, respectively). Conclusion. Aortic stiffness measurements were found abnormal in patients with psoriasis. We have also demonstrated that there were significant correlations between aortic stiffness parameters and disease duration. This study suggests that aortic stiffness measurement could be used for assessment of cardiovascular risk in psoriasis patients, and that only continuous long-term disease control may be helpful in reducing the cardiovascular risk associated with psoriasis.

Successful thrombolysis using recombinant tissue plasminogen activator in cases of severe pulmonary embolism with mobile thrombi in the right atrium.

Hereby, we report two cases of acute pulmonary embolism with concomitant right-sided thrombus, which were successfully treated using recombinant tissue plasminogen activator (rtPA). These patients had life-threatening acute right ventricular failure, which dramatically improved within hours following thrombolysis. These cases emphasize the clinical utility of rtPA for the treatment of life-threatening pulmonary embolism.

Esophageal rupture complicated by acute pericarditis

Esophageal perforation is a serious condition with a high mortality rate. Delayed detection of esophageal perforation may result in devastating complications such as mediastinitis and pericarditis. Esophageal perforation is rarely due to aspiration of foreign bodies. Here we report the case of a 59-year-old male patient with complicated esophageal perforation due to ingestion of a chicken bone, whose first signs are considered to be acute non-specific pericarditis.

The relationship between epicardial adipose tissue and P wave and QT dispersions.

OBJECTIVE Epicardial adipose tissue (EAT) secretes various pro-inflammatory and atherogenic mediators that have several endocrine and paracrine effects on heart. This study investigated the influence of EAT on QT and P wave dispersions (QTd, PWd), as simple, non-invasive tools of proarrhythmia on surface ECG. METHODS This was a cross-sectional study and included 70 patients with normal coronary arteries who underwent 12-derivation electrocardiography, echocardiography and biochemical examinations in order for QTd, PWd, and EAT thickness to be measured. RESULTS Median EAT thickness was 4.1 mm. Correlation analyses revealed that EAT was significantly associated with age (r=0.412, p<0.001), weight (r=0.262, p=0.028), body mass index (r=0.396, p<0.001), left atrium diameter (r=0.518, p<0.001), fasting plasma glucose (r=0.245, p=0.041), maximum P wave duration (r=0.343, p=0.004), minimum P wave duration (r=0.275, p=0.021) and PWd (r=0.265, p=0.026). No relation was found between study parameters and QTd. However, P wave dispersion was significantly related to EAT thickness (r=0.265, p=0.026), left atrium diameter (r=0.483, p<0.001), and the triglyceride levels (r=0.267, p=0.028). Multiple linear regression analyses revealed left atrial diameter as the only independent predictor of PWd. CONCLUSION A significant association between EAT and PWd was demonstrated in the study. While EAT is related to both increased PWd and left atrial size, left atrial diameter seems to be more important than EAT for prediction of atrial fibrillation (AF) in patients with normal coronary arteries.

Relation between Severity of the Disease and Arrhythmia Incidence in Patients with Psoriasis

Zakir Karada g, Hatice Yildiz, Ozgur Gunebakmaz, Bahadir Şarli, Mikail Yarlio glues, Orhan Do gdu, _ Idris Ardic, _ Ibrahim Gul, Ali Do gan, Mehmet Gungor Kaya, Ali Ergin, Ekrem Aktas Recep Tayyip Erdo gan University Faculty of Medicine, Department of Cardiology, Rize, Ni gde State Hospital Division of Dermatology, Ni gde, Harran University Faculty of Medicine, Department of Cardiology, Şanliurfa, Kayseri Training and Research Hospital, Clinics of Cardiology, Kayseri, Ankara Training and Research Hospital, Clinics of Cardiology, Ankara, Sivas _ Izzettin Keykavus State Hospital, Clinics of Cardiology, Sivas, Kahramanmaras Sutcu _ Imam University Faculty of Medicine, Department of Cardiology, Kahramanmaras, Cumhuriyet University Faculty of Medicine, Department of Cardiology, Sivas, Erciyes University Faculty of Medicine, Department of Cardiology, Kayseri, Erciyes University Faculty of Medicine, Department of Dermatology, Kayseri

No Relevant Association Between Coronary Artery Ectasia and Mean Platelet Volume, Gamma Glutamyl Transferase and Uric Acid Levels

PP-311 In this study we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma glutamyl transferase (GGT), uric acid and coronary artery ectasia (CAE) in a large patient population. A total of 406 patients (245 male, mean age 55±9 years) were selected as