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Background: Conventional methods for evaluation of block success are time consuming and need patient cooperation. The aim of this study was to evaluate whether the Perfusion Index and Plethysmographic Variability Index can be used to predict brachial nevre block success.Materials and Methods: Thirty-four patients, aged 18-65 years, who were transferred to elective or emergency surgery were included. Brachial plexus block was applied. Those with cardiac disease, chronic obstructive pulmonary disease and asthma were excluded from the study. Bedside, non-invasive, serial plethysmographic variability index (PVI) and perfusion index (PI) measurements of the patients were made using the Radical-97 Pulse Oximeter device from the fourth finger tip of the blocked hand.Results: When the PVI values measured from the blocked arm were compared; The difference between 0 and 5 minutes, 5th and 10th minutes and 0 to 10 minutes was statistically significant. When PI values were compared as 0 and 5 minutes, 5 and 10 minutes, 0 and 10 minutes, the changes were statistically significant. ( p, Amaç: Blok başarısının değerlendirilmesi kullanılan için geleneksel yöntemler zaman alıcıdır ve hasta kooperasyonuna ihtiyaç duyar. Bu çalışmanın amacı Perfüzyon İndeksi ve Pletismografik Variabilite İndeksinin brakiyal sinir blokajının başarısını tahmin etmek için kullanılıp kullanılamayacağını değerlendirmektir.Materyal ve metod: Bu çalışmaya 18-65 yaş arası, elektif veya acil cerrahi operasyona alınan 34 hasta dahil edildi. Brakial pleksus bloğu uygulandı. Kardiyak hastalığı, kronik obstrüktif akciğer hastalığı ve astım hastalığı olanlar çalışma dışı bırakıldı. Hastaların yatak başı, noninvaziv, seri pletismografik variabilite indeksi (PVI) ve perfüzyon indeksi (PI) ölçümleri, blok uygulanan elin dördüncü parmak ucundan Radical-97 Pulse Oksimetre cihazı kullanılarak yapıldı. Bulgular: Blok yapılan koldan ölçülen PVI değerleri karşılaştırıldığında; 0 ile 5. dk, 5. dk ile 10. dk ve 0 ile 10.dk arasındaki farklılık istatistiksel olarak anlamlı bulundu. PI değerleri 0 ve 5.dk, 5 ve 10.dk, 0 ve 10.dk olarak karşılaştırıldığında değişimler istatistiksel olarak anlamlı bulundu. ( p

Preeclampsia increases the risk of cardiovascular mortality and morbidity both during pregnancy and long term after the labor by causing cardiac changes that may lead to atrial and ventricular arrhythmias.We aimed to investigate noninvasive predictors of atrial and ventricular arrhythmias and cardiac structural changes in preeclampsia.The study included 34 preeclampsia patients as the study group and 33 healthy pregnant women as the control group. The presence of fragmented QRS morphology, P dispersion, QT dispersion, Tp-e/QTc ratio, inter- and intra-atrial electromechanical delay, left ventricular mass index was evaluated in the groups by 12 lead- ECG and standard and tissue Doppler echocardiography.Left ventricular mass index and relative wall thickness, and E/Em ratio was significantly higher in preeclampsia. Inter- and intra-atrial electromechanical delay and Tp-e were prolonged, and P dispersion, QT dispersion, and Tp-e/QTc ratio were increased significantly in patients with preeclampsia. In addition, fragmented QRS morphology was seen in 76.5% of patients with preeclampsia while it was present in only 27.3% of the control group (Preeclampsia causes significant cardiac structural and electrocardiographic alterations that may increase the risk of atrial and/or ventricular arrhythmias. A more thorough and earlier cardiac assessment and closer follow-up of these patients would be useful to avoid further complications.

Background Obese non-alcoholic fatty liver disease (NAFLD) was found to increase the risk of developing atrial fibrillation (AF) regardless of the metabolic syndrome subgroups that may accompany it. In this study, the effect of NAFLD on the structural and electrical functions of the heart was investigated using tissue Doppler echocardiography (TDE) in non-obese NAFLD patients without any known risk factors for AF.Material and methods The study included 43 female patients (31.3±3.8 years), who had stage 2–3 hepatosteatosis detected by liver ultrasonography and diagnosed as non-obese NAFLD (patient group), and 31 healthy women (control group, 32.5±3.6 years). In addition to standard echocardiographic parameters, inter- and intra-atrial electromechanical delay (EMD) were evaluated by TDE.Results Interatrial EMD (PA lateral – PA tricuspid) and intraatrial EMD (PA septum – PA tricuspid) were significantly longer in patient group (16.1±3.4 vs. 12.5±2.3 ms, pConclusion Inter-atrial and intra-atrial EMD were detected in young women with non-obese NAFLD. In addition, at the subclinical level, structural and functional impairment was detected However, large-volume prospective studies are required to cobfirm these findings regarding the development of AF in non-obese NAFLD patients.

Sol koroner arterin pulmoner arterden (ALCAPA) anormal kökeni, nadir görülen doğuştan kalp anomalisidir. Genellikle klinik seyir; ileri sol kalp yetmezliği ve yaşamın ilk aylarında ortaya çıkan mitral kapak yetersizliğidir. Bununla birlikte, bazı durumlarda sağ koroner arterden oluşan kollateraller miyokard perfüzyonu için yeterlidir. ALCAPA'lı hastalarda aritmi veya erişkin yaşamda ani kalp ölümü ilk klinik başvuru olabilir. Göğüs ağrısı ve çarpıntı şikayetleri ile acil servise başvuran ve sol koroner arterde anormal köken saptanan 66 yaşında kadın hastayı sunmaktayız., Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart anomaly. Usually the clinical course; advanced left heart failure and mitral valve insufficiency that occurs in the first months of life. However, in some cases collaterals consisting of the right coronary artery are sufficient for myocardial perfusion. Arrhythmia or sudden cardiac death in adult life may be the first clinical presentation in patients with ALCAPA. We present a 66-year-old female patient who was admitted to the emergency department with complaints of chest pain and palpitations and was found to have an abnormal origin in the left coronary artery.

Introduction:Obesity is usually related to insulin resistance and glucose metabolism disorders. The relationship between insulin resistance and epicardial adipose tissue and atrial electromechanical delay has been described in previous studies.Aim:This study aims to demonstrate the effects of metformin on epicardial adipose tissue and electromechanical delay in patients using metformin for insulin resistance.Materials and methods:A total of 30 patients using metformin for insulin resistance were included in the study. Pre-treatment and post-treatment epicardial adipose tissue and electromechanical delay were evaluated.Results:There was a statistically significant decrease in epicardial adipose tissue thickness after 3 months of metformin therapy (6.4 ± 2.1 versus 4.7 ± 2.0; p = 0.008). Furthermore, the inter-atrial and intra-atrial electromechanical delay also significantly decreased after 3 months of metformin monotherapy (23.6 ± 8.2 versus 18.1 ± 5.8; p < 0.001, 9.1 ± 2.9 versus 6.3 ± 3.6; p = 0.003, respectively).Conclusion:In this study, we show that metformin monotherapy significantly decreases epicardial adipose tissue thickness and electromechanical delay in obese children.

Background: The aim of this retrospective study was to evaluate the indications, characteristics and anesthesia management of epidermoid bullosa patients who underwent surgery in our hospital. Materials and Methods: In this study, records of this patient group in the hospital information system and anesthesia records were examined. Demographic data, preoperative characteristics, surgical indication, anesthesia technique, blood transfusion and complications were recorded. Results: A total of 19 patients were included in the study. Since some of the patients had multiple operations, 25 surgical data were used. All patients were operated due to contracture release and pseudo syndactyly. All patients underwent general anesthesia. No new postoperative lesions were observed. Conclusions: In this patient group, also known as butterfly disease, attention should be paid to the management of the patient perioperatively and be prepared for the complications that may occur in each stage of anesthesia. It should be kept in mind that even minor traumas in epidermoid bullosa patients may cause lesions that affect patients' lives. And our priority should be the first rule of medicine, “Primum Non Nocere”, Amaç: Bu retrospektif çalışmanın amacı, hastanemizde ameliyat olan epidermoid bülloza hastalarının ameliyat endikasyonlarını, özelliklerini ve anestezi yönetimini değerlendirmektir.Materyal ve metod: Bu çalışmada bu hasta grubunun hastane bilgi sistemindeki kayıtları ve anestezi kayıtları incelendi. Hastaların demografik verileri, preoperatif özellikleri, cerrahi endikasyonu, anestezi tekniği, kan transfüzyonu ve komplikasyonları kaydedildi.Bulgular: Toplam 19 hasta çalışmaya dahil edildi. Hastaların bir kısmı birden fazla defa ameliyat olduğundan 25 ameliyat verisi kullanıldı. Hastaların tamamının kontraktür açılması ve psödosindaktili nedeniyle opere olduğu görüldü. Hastaların tamamında genel anestezi uygulandı. Hiçbirinde postoperatif yeni lezyon gözlenmedi. Sonuç: Kelebek hastalığı olarak da bilinen bu hasta grubunda peroperatif hasta yönetimine dikkat edilmeli anestezinin her aşamasında oluşabilecek komplikasyonlara karşı hazırlıklı olunmalıdır. Epidermoid Bülloza hastalarında minör travmalarla bile hastaların hayatını etkileyen lezyonlar oluşabileceği hatırda tutulmalı. Ve önceliğimiz tıbbın ilk kuralı olan “önce zarar verme” olmalıdır.

Aim: Transcatheter aortic valve implantation has been used widely as an alternative treatment method for patients with symptomatic aortic stenosis carrying high surgical risk. Despite technological advances and increased experience, its early and late mortality rate is still relatively high and it is important to predict upcoming cardiac events and mortality for the management of patients. In this study, we aimed to investigate the clinical and laboratory parameters affecting mortality after these procedures performed in our clinic. Material and Methods: The patients who underwent TAVI due to severe AS between May 2015 and March 2019 were investigated retrospectively. Demographic, echocardiographic and laboratory data of all patients were recorded. During the follow-up period (mean: 556 days), patients were divided into 2 groups; deceased patients (group 1, n=13) and living patients (group 2, n=34). The data of the patients before TAVI procedure were compared between the two groups.Results: Among demograhic data, the ratio of chronic kidney disease was significantly higher in the deceased group. Among echo parameters, left ventricular ejection fraction was significantly lower and pulmonary artery pressure was significantly higher in the deceased group. Of laboratory parameters, blood urea nitrogen and creatinine levels were significantly higher and toral protein levels were significantly lower in the deceased group. Additionally, leukocyte, uric acid, CRP and CRP/albumin ratio were significantly higher and albumin was significantly lower in the deceased patients.Conclusion: The presence of chronic kidney disease, low left ventricular EF, high pulmonary artery pressure, high CRP levels, increased CRP/albumin ratio and high uric acid levels preceding TAVI may be helpful to determine the risk of mortality after the TAVI procedure.

Background/aim In the literature, there is a paucity of data about the effects of fibromyalgia syndrome (FMS) on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS. Materials and methods The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS (fQRS) morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography. Results Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em) was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.