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Left ventricular apical thrombusThe study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography.The incidence of the LVAT was 8.5% (High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.

Atherosclerosis is a chronic inflammatory vascular condition characterised by intimal thickening with cholesterol accumulation and macrophage foam cell infiltration causing plaque formation at the site of the injured vessel wall. This condition is a major contributor to carotid artery stenosis (CAS). Sortilin, a member of the mammalian vacuolar protein sorting 10 protein family, promotes uptake of low-density lipoprotein particles into macrophages with consequent foam cell formation independent of the low-density lipoprotein receptor, and thereby, accelerates atherosclerotic plaque formation and progression. We investigated the correlation between serum sortilin levels and the severity of extracranial CAS.The study included 149 patients who underwent carotid angiography for suspected carotid artery disease. The North American Symptomatic Carotid Endarterectomy Trial 2011 criteria were used to determine the degree of CAS. Serum sortilin concentrations were measured using the enzyme-linked immunosorbent assay.Serum sortilin levels were significantly higher in the severe CAS than in the non-severe CAS group (2.71 ± 0.71 ng/mL vs 1.63 ± 0.57 ng/mL, P .001). Receiver operating characteristic curve analysis showed that serum sortilin levels1.66 ng/mL predicted severe CAS with sensitivity of 83.49% and specificity of 56.76%.Current data suggest that prediction of severe CAS may serve as an atherosclerosis biomarker and significantly contribute to research on disease progression in atherosclerosis, as well as in other arterial diseases. Sortilin may be a potential therapeutic target owing to its role in the pathogenesis of atherosclerotic carotid artery disease.

This study evaluated the impact of the baseline estimated glomerular filtration rate (eGFR) on clinical and angiographic outcomes and long-term in-stent restenosis (ISR) rates in patients undergoing elective carotid artery stenting (CAS) procedures. Consecutive patients who underwent CAS were retrospectively enrolled (n = 456). At the end of 3 years of follow-up, patients who had died or were lost follow-up were excluded from the study and a final analysis was performed using data from the remaining 405 patients. The study population (n = 405) was divided into 3 tertiles based on the tertile values of the eGFR level (T1, T2, and T3); then, clinical and procedural characteristics and 3-year ISR rates were compared between the groups. An ISR of 50% was detected in 49 (12%) surviving patients. The 3-year ISR was higher among patients with the lowest eGFR values (T1) by 3.7 times (95% CI: 2.01-11.38) than that among patients with the highest eGFR values (T3). These significant relationships persisted following adjustment for confounders. A lower baseline eGFR level was significantly associated with an increased ISR rate. Decreased renal function may be a predictor of ISR after CAS using first-generation stents.

Background Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. Method This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 +/- 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. Results Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823-0.924; p < 0.001). Conclusion The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency. WOS:000642132800001 2-s2.0-85104816621 PubMed: 33880976

Introduction: Percutaneous endovascular methods have emerged to the contemporary revascularization choice in patients with infrapopliteal (IP) arterial disease. However, restenosis remains to be the Achilles' heel of this minimally invasive revascularization techniques. We aimed to analyze the association between preprocedural (neutrophil to lymphocyte ratio) Neutrophil-to-Lymphocyte ratio (NLR) and subsequent patency in a cohort of patients with symptomatic IP disease undergoing balloon angioplasty. Methods: All patients primarily treated with angioplasty of at least one IP artery causing severe symptoms or critical limb ischemia (CLI) (Rutherford category 1–6) between January 2014 and August 2015 were analyzed. The baseline demographic, clinical, and angiographic features admission laboratory test results were obtained from hospital files and computer records. NLR was calculated as the preprocedural ratio of neutrophils to lymphocytes. Results: The study population involved 42 (43.8%) CLI patients and 52 (54.2%) claudicants. The most frequent target vessel was the posterior tibial artery. Primary patency at 1 month was 81.9% and 62.7% at 6 months. NLR (odds ratio: 0.04, P = 0.03) independently predicted patency at 1 month but did not have a role on arterial patency after 1 month. Only smoking (odds ratio: 4.8, P = 0.01) associated with patency at 6 months. Conclusion: Preprocedural NLR was an independent risk factor for IP arterial patency at short-term. It may be used as a risk factor for subsequent amputation or recurrent interventions.

Background and aim: The objective of this study was to assess the potential role of mitral regurgitation (MR) in the release of copeptin in heart failure patients with reduced ejection fraction (HFrEF). Methods: The study included 63 patients of whom 33 had functional mild MR (Group 1) and 30 had functional severe MR (Group 2). The functional class of both groups was New York Heart Association (NYHA) Class III. Blood samples for the determination of plasma copeptin and B-type natriuretic peptide (BNP) levels were obtained on the same day with the echo-cardiographic examination. Standard echocardiographic studies were performed. Results: Copeptin and BNP levels showed a substantial agreement in the whole study group (Kappa level: 0.607, p < 0.0001). Also, copeptin and BNP showed a strong correlation and were both increased and significantly higher in Group 2 than in Group 1 (p < 0.001 and p < 0.05, respectively). Left ventricular global longitudinal strain and left ventricular ejection fraction values were similar in both groups. The study population were divided into two subgroups on the basis of copeptin median level (6.4 ng/mL), and the prevalence of severe MR was significantly higher in the above-median-copeptin subgroup. A linear regression analysis showed that the presence of severe MR was the only independent predictor of high circulating plasma copeptin level (OR 7.5, 95% CI 2.8–12.1; p = 0.002). Conclusions: Severe MR is an independent predictor of elevated plasma copeptin level in HFREF irrespective of systolic function.

INTRODUCTION[|]Postoperative atrial fibrillation (POAF) is a frequent and serious complication after aorto-coronary bypass graft (ACBG) surgery which unfortunately increases morbidity and mortality. Postoperative stroke, hemodynamic instability, renal failure, infection, inotropic agent and coronary unit need are complications caused by POAF. Inflammation and oxidative stress are among several mechanisms contributing to the pathogenesis of POAF. Monocyte to HDL ratio (M/H ratio) is a newly defined parameter of both inflammation and oxidative stress. In this study we investigated M/H ratio in predicting POAF after ACBG surgery.[¤]METHODS[|]Total number of 311 patients who underwent ACBG surgery were included in our study. Blood samples were obtained from the patients after 12 hours of fasting for analysis of routine biochemistry and lipid panel in the morning of ACBG surgery. Patients were monitored for the occurrence of POAF continuously through hospitalization. [¤]RESULTS[|]POAF was demonstrated in 71 patients after ACBG operation. M/H ratio was significantly higher in POAF+ group compared to POAF – group (p< 0.001). Median age of POAF (+) patients is 62.0+-10.1 which was significantly higher than POAF (-) patients. Other atrial fibrillation risk factors such as hypertension, diabetes mellitus, smoking or alcohol consumption were similar between groups. Potassium level was statistically lower in POAF+ group compared to POAF- group. (p= 0,01)[¤]DISCUSSION AND CONCLUSION[|]M/H ratio is an indicator of inflammation and oxidative stress which both plays an important role in the pathogenesis of atrial fibrillation. M/H ratio was found be statistically higher in POAF + patients compared to POAF – patients.[¤]

Giriş: Kontrast madde nefropatisi (KMN) primer perkütan koroner girişim (p-PKG)uygulanan ST yükselmeli miyokart infarktüsü (STEMİ) hastalarda ciddi birkomplikasyondur. Monosit/yüksek dansiteli lipoprotein (HDL) oranı (MHR) sonzamanlarda inflamasyon ve oksidatif stres işaretleyici tanımlamıştır. Buçalışmanın amacı, p-PKG uygulanan hastalarda KMN riski için MHR öngörü değeriniaraştırmaktır.Hastalar veYöntem: STEMİ tanısı ile hastaneye yatırılan ve p-PKG uygulanan2120 hasta retrospektif olarak değerlendirildi. Kontrast maruziyeti sonrası 72saat içinde başlangıç serum kreatininde ≥ %25 göreceli artış veya ≥ 0.5 mg/dLmutlak artış olması KMN olarak tanımlandı. MHR acil servis başvurusundahesaplandı. KMN riski ile MHR arasındaki ilişki değerlendirildi.Bulgular: KMN insidansı (n= 139) %6.6 idi. Yaş (p= 0.001), bazal kreatinin (p, Introduction: Contrast-inducednephropathy (CIN) is a serious complication in patients with ST segmentelevation myocardial infarction (STEMI) undergoing primary percutaneouscoronary intervention (p-PCI). The monocyte to high-density lipoprotein (HDL)cholesterol ratio (MHR) has recently been defined as an inflammation andoxidative stress marker. The aim of this study was to evaluate the predictivevalue of MHR for risk of CIN in patients with ST who underwent p-PCI.Patients and Methods:Dataof a 2120 patients who were hospitalised with the diagnosis of STEMI andunderwent p-PCI were retrospectively evaluated. A relative increase in serumcreatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from thebaseline within 72 h of contrast exposure was defined as CIN. MHR was calculatedon emergency admission. The risk of CIN was evaluated across MHR values.Results: Theincidence of CIN was 6.6% (n= 139). Age (p= 0.001), baseline creatinine levels(p< 0.001), DM (p< 0.001), HT (p< 0.001) and anaemia (p= 0.001) werehigher in patients with CIN. The patients were divided into 2 groups based onthe development of CIN. Peripheral monocyte count, HDL levels and MHR did notdiffer between the groups. After correction for all baseline confounders,neither peripheral monocyte count nor MHR were found to be independentpredictors of CIN development in our multivariate logistic regression analyses.Conclusion: Because MHR does not differmuch from that in stable patients at the early phase of infarction, it cannotbe a potential predictor of CIN development in patients with STEMI whounderwent p-PCI.

Femoral artery aneurysm (FAA) is a rare peripheral vascular aneurysm that can lead to thrombosis, embolism and fatal rupture in untreated cases. The clinical presentation of FAA varies from the finding of an asymptomatic mass on routine physical examination to acutelimb-threatening ischemia. Presently, a case of FAA that caused deep vein thrombosis and compartment syndrome has been described. Although the current treatment method recommended for FAA is an open surgical procedure, in this case, an endovascular intervention was performed due to high risk of surgical mortality.

Objective: This study is a comparison of the electrocardiogram (ECG) findings of detainees and convicts who participated in a hunger strike recorded at the end of the strike and 2 months later. Methods: A total of 81 male detainees and convicts (mean age 41+-9.4 years) who participated in a hunger strike between September 2012 and November 2012 were included in this study. The mean duration of the fast was 45+-9.6 days. Measurements of blood pressure, body weight, and serum electrolytes (sodium, potassium, calcium) obtained on the last day of the hunger strike and 2 months later were compared, as well as 12-lead ECG readings obtained at the same intervals, which were scanned and transferred to a high-resolution electronic format and evaluated. Results: The mean weight loss for the 81 patients during the hunger strike was 6+-3.7 kg. Early repolarization (ER) (inferior: 10, lateral: 5, inferolateral: 1) was detected in 16 (19.7%) ECGs taken on the last day of fasting, and in 4 (4.9%) (inferior: 3, lateral: 1) of those measured 2 months after the strike (p

Introduction: The aim of this study was to investigate an easily available inflammatory marker and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) in patients with cardiac syndrome X (CSX). Patients and Methods: The study population included 100 patients of which 50 had CSX (CSX group) and 50 had normal coronary angiograms (control group). Results: Total white blood cell (WBC) count, monocyte count, neutrophil count, NLR, high-sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP) and MHR were higher in the CSX group (p< 0.05), whereas high-density lipoprotein cholesterol (HDL-C) level was significantly lower in the CSX group as compared with that in the control group (p< 0.05). In the correlation analysis, MHR revealed a significantly positive correlation with hs-CRP (r= 0.375, p< 0.001) and CRP (r= 0.403, p< 0.001). In the multivariate logistic regression analysis, MHR was independently associated with the presence of CSX (odds ratio: 1.250, 95% confidence interval [CI]: 1.240-1.461, p< 0.001). Using a cut-off level of 90.6, pre-procedural MHR predicted the presence of slow coronary flow (SCF) with a sensitivity of 78% and specificity of 70%. Conclusion: In conclusion, our findings revealed that higher MHR levels were significantly and independently associated with the presence of CSX.

Background In addition to proinflammatory properties, eosinophils can stimulate platelet activation and enhance prothrombotic pathways. In this study, we aimed to investigate the association between the eosinophil percentage (EOS%) and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled a total of 1,909 patients who were diagnosed with STEMI. Ventricular arrhythmia, reinfarction, the need for cardiopulmonary resuscitation, target vessel revascularization, congestive heart failure, and cardiovascular mortality during index hospitalization were defined as MACE. Results Three hundred and eighty patients (19.7%) reached the combined endpoint with MACE. The rates of inhospital mortality and MACE were significantly higher in low EOS% group as compared to high EOS% group (4% vs. 1.1%, p p p p Conclusions Low EOS% on admission may be associated with high inhospital MACE in STEMI patients. EOS% may be used as a novel biomarker for risk stratification of these patients.

Drug-induced torsades de pointes (TdP) is a rare but potentially fatal adverse effect of commonly prescribed medications including cardiac and noncardiac drugs. Importantly, many drugs have been reported to cause the characteristic Brugada syndrome-linked electrocardiography (ECG) abnormalities and/or (fatal) ventricular tachyarrhythmias. Chlorpheniramine and propranolol have the arrhythmogenic effects reported previously. A review of literature revealed a large number of case reports of chlorpheniramine or propranolol use resulting in QTc prolongation, TdP, or both. However, we wish to report the case of a patient who was treated with a combination of chlorpheniramine and propranolol, whose ECG showed no QT prolongation but who suffered from cardiac arrest due to TdP.

The aim of this study was to investigate the midterm effects of transradial coronary angiography (TRCAG) on the radial and brachial artery diameter, the vasodilator characteristics, as well as to assess the factors determining functional recovery. This study included 136 consecutive patients who underwent TRCAG. The radial artery was evaluated with ultrasonography before and 1 month after the procedure. The basal right radial artery diameter (2.97 ± 0.46 vs. 2.82 ± 0.51, p

Objective: Slow coronary flow (SCF) phenomenon is described as the delayed opacification of the distal vasculature and angiographically normal coronary arteries. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tpe) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. In this study, we intended to evaluate ventricular repolarization in patients with SCF by using the Tpe interval and Tpe/QT ratio. Methods: The study population included 33 patients with angiographically proven SCF and 33 control patients with angiographically proven normal coronary arteries without associated SCF. Coronary flow rates of patients and the control group were documented by TIMI (Thrombolysis in Myocardial Infarction) frame count. From the electrocardiograms, Tpe interval and Tpe/QT ratio were calculated and compared between groups. Results: No statistically significant difference was found between the two groups in terms of basic characteristics. Mean Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were prolonged in the study group compared to the control group (p

The bicuspid aortic valve is associated with disorders of the aortic wall, including coarctation of the aorta and aortic dissection. The histologic abnormality underlying aortic complications in bicuspid aortic valve is cystic medial necrosis. The elastic properties of the aorta are abnormal in bicuspid aortic valve. Here, we present a case of aortic thrombotic occlusion in a patient with a bicuspid aortic valve.

Background The chronic consumption of androgenic anabolic steroids has shown to cause atrial arrhythmias. Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate repolarization dispersion measured from the 12-lead surface electrocardiogram (including Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio) in bodybuilders who are using anabolic androgenic steroids (AAS). Methods We selected a population of 33 competitive bodybuilders, including 15 actively using AAS for ≥ 2 years (users) and 18 who had never used AAS (nonusers), all men. Results QT, cQT, QTd, cQTd, JT, and cJT were significantly increased in AAS users bodybulders compared to the nonusers (all P < 0.001). Tp-e interval, Tp-e/QT ratio, and Tp-e/cQT ratio were also significantly higher in AAS user group compared to the nonuser group (all P < 0.001). QRS duration was not different between the groups. There were negative correlation between Em and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = −0.657, P < 0.01; r = −0.607, P = 0.02; r = −0.583, P = 0.02; respectively).There were also negative correlation between Sm and Tp-e, Tp-e/QT ratio, Tp-e/cQT ration (r = −0.681, P < 0.01; r = −0.549, P = 0.03; r = −0.544, P = 0.023; respectively). Conclusion In conclusion, we have presented a strong evidence suggesting that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were increased in AAS users, which suggest that there might be a link between AAS use and ventricular arrthymias and sudden death.

Background: Atrial fibrillation is the most common clinically significant arrhythmia. It is now established that atrial high-rate episodes are highly correlated with atrial fibrillation. Aims: To investigate the relation between diastolic electrocardiographic parameters and subclinical atrial fibrillation detected by cardiac implantable electronic devices. Study Design: Ccross-sectional study. Methods: A total of 203 patients who had a dual-chamber, rate-modulated pacing pacemaker implanted due to sinus node dysfunction were prospectively enrolled in this study. Atrial high-rate episodes were defined as any lasting more than 5 min with an atrial rate of ≥220 beats per minute during the previous year. Patient groups were categorized on the basis of pacemaker interrogation as the absence of atrial high-rate episodes [atrial high-rate episodes (-)] and the presence of atrial high-rate episodes [atrial high-rate episodes (+)]. Episodes related to atrial over sensing were excluded. Twelve-lead surface electrocardiography was independently analyzed by two experienced readers for the measurement of diastolic electrocardiography parameters. Results: Among 203 patients (mean age: 67.5±9.1, 60.1% male), 51 (25.1%) with atrial high-rate episodes were defined as group 1 and 152 (74.9%) without atrial high-rate episodes were defined as group 2. Both groups were similar in terms of demographic characteristics and cardiovascular risk factors. Tend-Q and Tend-P were significantly longer in group 2. PQ interval was statistically longer in group 1. Corrected QT interval was significantly longer in group 1. Diastolic electrocardiography index, heart rate and PQ and QT intervals were the only independent predictors of atrial high-rate episodes in patients with dual pacemakers in multivariate analysis. Conclusion: Abnormal diastolic electrocardiography parameters are powerful predisposing factors for the initiation of incident atrial fibrillation. Diastolic electrocardiography parameters and a novel diastolic index predict atrial high-rate episodes. Evaluating these parameters enables clinicians to identify patients who are at high risk and who may benefit from prophylactic treatment.

Background: Epicardial adipose tissue (EAT) is thought to be associated with the extension and severity of coronary artery disease (CAD), and echocardiographic measurement of EAT thickness is considered to be a possible cardiovascular risk indica­tor. The European Society of Cardiology Task Force recommends further non-invasive testing in patients with an intermediate pre-test probability (PTP) for the diagnosis of CAD. Aim: We sought to evaluate the clinical usefulness of performing EAT measurements in patients with a high-intermediate PTP. Methods: Patients referred to an outpatient clinic with stable chest pain symptoms, with PTP for CAD between 66% and 85%, were included in the study. Echocardiographic measurement of the EAT was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. Single-photon emission computed tomography (SPECT) was performed in all patients. The diagnosis of CAD was based on the presence of reversible perfusion defects on SPECT. Results: A total of 126 patients (76 men, 60.3%) with a mean age of 65.3 ± 9.1 years were recruited. The EAT thickness was 7.3 ± 0.7 mm in patients with positive SPECT and 6.2 ± 0.6 mm in patients with negative SPECT (p < 0.001). Multivariable analysis revealed higher rates of positive SPECT in patients with higher EAT (odds ratio [OR] 9.80; 95% confidence interval [CI] 3.72–25.79; p < 0.001), and receiver operating characteristic curve analysis showed that the greatest specificity was obtained when the cut-off value of EAT thickness was 6.75 mm (sensitivity 76%; specificity 74%). Conclusions: In patients with high-intermediate PTP, EAT is a useful measurement that may assist in risk stratification.

Amac: Kontrast madde nefropatisi (CIN) uzamis hastanede yatis suresi, artmis kardiyovaskuler komplikasyonlar ve mortalite ile iliskilidir. Trombosit/lenfosit orani (PLR) tromboz ve inflamasyon arasindaki dengeyi gosteren potansiyel bir belirtec olarak tanimlanmis ve artan kardiyovaskuler morbidite ve mortalite ile iliskili bulunmustur. Biz bu calismada PLR’nin primer perkutan koroner girisim (pPCI) yapilan ST yukselmeli miyokard infarktusu (STEMI) hastalarda CIN gelisimini tahmin etmede bagimsiz bir risk faktoru olup olmadigi arastirdik. Gerec ve Yontemler: Kurumumuza akut STEMI ile basvuran ve pPCI yapilan 1348 hasta geriye donuk olarak degerlendirildi. Hastane dosya ve bilgisayar kayitlarindan veriler elde edildi. CIN gelisimi sonlanim noktasi olarak kabul edildi. Bulgular: 127 (%9.4) hastada CIN gelismisti. 16 hastaya renal replasman tedavisi uygulandi. Hastane ici mortalite orani %2,7(n = 37) bulunmustur. Hastalar CIN gelisimine gore iki gruba ayrildi. Yas (P = 0,001), bazal GFR (P < 0,001), grade 3 ve uzeri kronik bobrek hastaligi (P < 0,001), bazal kreatinin (P < 0,001), EF (P < 0,001), DM varligi (P < 0,001) gruplar arasinda farkli idi. Cok degiskenli analizlerde, PLR (odds ratio [OR] 1.012, %95 guven araligi [CI] 1,006-1,017, P < 0,001) CIN gelisimini bagimsiz olarak ongordu. Sonuclar: PLR, kolay ulasilabilir yaygin olarak kullanilan ve nispeten ucuz biyomarkerdir ve STEMI nedeniyle pPCI uygulanan hastalarda CIN gelisiminin bagimsiz bir belirleyicisidir.

Amac: ST segment yukselmeli miyokard enfarktusu (STEMI) olan hastalarda, primer perkutan koroner girisim (pPKI) oncesi enfarktus iliskili arter acikligi daha iyi klinik sonuclar ile iliskilidir. Bununla birlikte, STEMI ortaminda pPKI oncesinde IRA acikliginin ongorduruculeri ile ilgili sinirli veri vardir. STEMI'de monosit sayisi /yuksek yogunluklu lipoprotein orani (MHR) ile enfarktla iliskili arterin acikligi arasindaki iliskiyi degerlendirmek istedik. Gerec ve Yontemler: Toplam 726 hasta calismaya alindi. IRA acikligi, miyokard enfarktusunde tromboliz (TIMI) akim siniflamasi ile belirlendi. PKI oncesi IRA'da TIMI akim derecesine gore calisma populasyonu, TIMI 0,1 veya 2 grup (tikali IRA, n=624) ve TIMI 3 grubu (patent IRA, n=102) olmak uzere iki gruba ayrildi. MHR hesaplamak icin basvuruda kan ornekleri toplandi. Tum hastalarin 92'sinde (%20,4) IRA'da pre-pPKI TIMI 3 akimi vardi. Bulgular: MHR, tikanan IRA grubunda anlamli derecede yuksekti (22,4 ± 5,4'e karsilik 17,8 ± 6,9, P < ,001). Tikali IRA grubunda, glikoz, troponin I ve trombosit/lenfosit orani (PLR) duzeyleri de yuksekti (P < 0.05). Cok degiskenli regresyon analizinde, basvuru sirasindaki MHR degeri (odds orani [1,391]; %95 guven araligi [CI]: 1,116-1,272, P < 0,001) ve prasugrel veya tikagrelorun hastane oncesi kullanimi (OR: 7,045; CI:1,687-29,414, P = 0,007) IRA acikliginin bagimsiz ongorduruculeri olarak bulundu. Sonuclar: IRA acikligi, pPKI oncesi hizli etkili antitrombosit tedavi alan hastalarda daha sik gorulmektedir ve daha dusuk bir MHR degeri IRA acikligini bagimsiz bir sekilde tahmin eder.

Aim: We sought to determine whether intramedullary fixation with proximal femoral nail antirotation produces comparable outcomes to dynamic hip screw in the treatment of unstable trochanteric fractures. Materials and methods: Patients were randomly allocated to receive proximal femoral nail antirotation (Group 1, n = 96, mean age; 77.22 ± 6.82 years) or dynamic hip screw (Group 2, n = 102, mean age; 76.86 ± 6.74 years). Outcome measures were time of operation and fluoroscopy, amount of blood loss and occurrence of surgery-related complications. Tip–apex distance and femoral neck shortening were also evaluated. Patients were evaluated at the sixth month to assess the recovery of walking ability. Survival information was obtained from a civil registry. Results: Operative and fluoroscopy times were significantly shorter and blood loss was significantly lower in Group 1 than those in Group 2. Complication rates, mean tip–apex indices and recovery of walking ability were similar between groups, whereas independent walking was more common in Group 1 than in Group 2. Until the sixth month, screw cutout occurred in eight (7.8 %) and seven (7.3 %) patients in Group 1 and Group 2, respectively (p = 0.88). Three-year survival rate was 61.6 ± 9.4 vs 57.3 ± 9.7 % in Group 1 and Group 2, respectively (p = 0.50). Conclusion: Proximal femoral nail antirotation technique offers better recovery than dynamic hip screw, whereas both techniques possess the same risk of postoperative complications. © 2014, Springer-Verlag Berlin Heidelberg.

Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS. The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI. PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p

Purpose: This prospective randomized pilot study reports our institutional experience and early results using Sonoma Wrx (Sonoma Orthopedic Products, Santa Rosa, CA) in the treatment of extra-articular and simple intra-articular distal radius fractures. Material and methods: A total of 64 patients, were enrolled in the study. They were considered eligible if they had; unstable extra-articular distal radius fractures and simple intra-articular distal radius fractures suitable for closed reduction (AO types; A2.2, A2.3, A3.1 C2.1, C2.2). Patients in group I received intramedullary fixation using the Sonoma Wrx® device and patients in group II received standard volar locking plate fixation. Radiographic criteria of acceptable healing were used for evaluation. Results: Two groups were similar in terms of baseline characteristics. Mean time of operation was significantly shorter in Group 1 vs. in group 2 (36.81 ± 7.11 vs. 48.97 ± 5.9 minutes, p = 0.001). Time to healing of the fracture was not different between two groups (5.45 ± 1.09 vs. 5.70 ± 1.04 weeks for Group 1 vs. 2, respectively p = 0.36). Overall complications occurred in 9 patients in group 1 and in 15 patients in group 2 (p = 0.17). Follow-up was completed in all patients with a median time of 12 months and 13 months in group 1 and 2, respectively. On radiographic evaluation radial inclination, radial height and volar tilt were not significantly different between group 1 and 2, respectively. There were no significant differences between two groups in regard to wrist rotational degrees measured in last follow-up visit. Conclusion: Sonoma Wrx Device is reliable and effective in terms of achieving satisfactory outcomes in treatment of distal radius fractures. It may be reasonable to use this device to prevent complications that are related to extensive soft tissue dissection. © 2014 Springer-Verlag.

We report a case of Kounis syndrome (allergic angina) documented with normal coronary arteries on angiography and echocardiographically proved moderate mitral stenosis in a patient with severe chest pain and electrocardiographic ST-segment elevations but with normal troponin levels.

Coronary angiography and percutaneous coronary artery intervention are important tools for the diagnosis and treatment of coronary artery disease. Nevertheless, despite both technical and pharmacological advances, bleeding and vascular complications remain problematic. With recent trials supporting the safety and decreased bleeding risk associated with the radial approach, radial access has become more popular, and conferences providing instruction on this technique are often standing room only. Herein, a case in which coronary angiography was performed by punching through the radial artery snuff box (fovea radialis) is described. Radial angiography from the snuff box allows for easier palpation and punching, less risk of neuropathy and bleeding, and less compression after the procedure.

Background The association between oral contraceptives (OC) and myocardial infarction remains controversial. The new generation contraceptive Yasmin (30 µg ethinyl estradiol and 3 mg drospirenone) has a lower estrogen and newer progestin component. To date, there are no data available for the myocardial infarction risk and outcome for drospirenone. We aimed to investigate the effect of Yasmin use on cardiovascular outcomes in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. Methods We retrospectively evaluated 1851 patients who underwent primary angioplasty for acute STEMI. Of them, 440 female patients (23.8%) composed the study population and 12 female (2.7%) were taking the oral contraceptive-Yasmin at the time of infarction. Patients were divided into two groups based on their age (≥50 (n = 339) and

The aim of this study was to evaluate left atrial deformations using speckle tracking echocardiography for predicting left atrial appendage (LAA) thrombus in patients with suspected cardioembolic stroke who were in normal sinus rhythm. A total of 153 ischemic stroke patients (89 males, 64 females) in sinus rhythm who were suspected of having cardioembolism were included in the study. The patients underwent conventional two-dimensional (2D) echocardiogram and 2D speckle tracking echocardiogram of the left atrium. Left atrial peak strain (LA-4C-RES) and left atrial precontraction strain (LA-4C-PUMP) were measured. Patients were divided into 2 groups according to the presence of thrombus in the LAA in transesophageal echocardiography. Both LA-4C-RES and LA-4C-PUMP values were found to be significantly lower in patients with LAA thrombus (11.8 ± 1.4% vs. 33 ± 12%, P < 0.001 and 5.8 ± 1.3% vs. 14.2 ± 5.3%, P < 0.001, respectively). A good inverse correlation was present between LA-4C-RES values and LAA morphologic parameters (with LAA area: r = -0.70, P < 0.001, with LAA length: r = -0.60, P < 0.001), and a good positive correlation was present with LAA emptying velocity with pulse Doppler (r = 0.74, P < 0.001). The area under the receiver-operating characteristic curve of the LA-4C-RES was 0.94 (0.90-0.98, P < 0.001), for the LA-4C-PUMP, the area was 0.92 (0.87-0.96, P < 0.001) to predict LAA thrombus. Left atrial deformation parameters measured by 2D speckle tracking method was found to predict impaired LAA functions and the presence of LAA thrombus in ischemic stroke patients with suspected cardioembolism, but who are in sinus rhythm.

Purpose: We aimed to assess the predictive value of peak troponin I level for the occurrence of new-onset AF in myocardial infarction. Methods: A total of 1553 patients, who were hospitalized with diagnosis of STEMI and underwent primary PCI, were retrospectively evaluated. New-onset AF was defined as any newly diagnosed AF that occurred during index hospitalization after primary PCI. Results: New-onset AF was observed in 90 patients (5.8% of the study population). Patients who developed AF were older (56.1 vs. 62.6 years, p

Background Right ventricular (RV) effects of long-term use of anabolic–androgenic steroids (AAS) are not clearly known. The aim of this study was to assess RV systolic functions by two-dimensional speckle tracking echocardiography (2DSTE) in AAS user and nonuser bodybuilders. Methods A total of 33 competitive male bodybuilders (15 AAS users, 18 AAS nonusers) were assessed. To assess RV systolic functions, all participants underwent standard two-dimensional and Doppler echocardiography, and 2DSTE. Results Interventricular septal thickness, left ventricle posterior wall thickness, relative wall thickness, and left ventricle mass index were significantly higher in AAS users than nonusers. While standard diastolic parameters were not statistically different between the groups, tissue Doppler parameters including RV E′ and E′/A′ were lower in AAS users than nonusers (10.1 ± 2.0 vs. 12.7 ± 2.1; P = 0.001, 1.1 ± 0.1 vs. 1.5 ± 0.4; P = 0.009, respectively). Tricuspid annular plane systolic excursion, RV fractional area change, and RV S′ were in normal ranges. However, RV S′ was found to be lower in users than nonusers (12.2 ± 2.2 vs. 14.6 ± 2.8, P = 0.011). RV free wall longitudinal strain and strain rate were decreased in AAS users in comparison with nonusers (−20.2 ± 3.1 vs. −23.3 ± 3.5; P = 0.012, −3.2 ± 0.1 vs. −3.4 ± 0.1; P = 0.022, respectively). In addition, there were good correlations between 2DSTE parameters and RV S′, E′, and E′/A′. Conclusion Despite normal standard systolic echo parameters, peak systolic RV free wall strain and strain rate were reduced in AAS user bodybuilders in comparison with nonusers. Strain and strain rate by 2DSTE may be useful for early determination of subclinical RV dysfunction in AAS user bodybuilders.

Objective: The aim of this study was to evaluate the relationship between peripheral artery disease (PAD) severity and complexity, as evaluated by TransAtlantic Inter-Society Consensus-II (TASC-II) classification, and neutrophil-to-lymphocyte (N/L) ratio. Methods: A total of 407 patients underwent peripheral angiography due to signs and symptoms of PAD; of these, 64 patients were excluded and the remaining 343 patients were enrolled in this cross-sectional study. Patients with previous peripheral revascularizations, acute coronary syndrome, vasculitis, non-atherosclerotic stenosis, and malignancy were excluded. Patients were divided into 4 groups according to TASC-II classification, and clinical and laboratory data were compared. The chi-square test, Student’s t-test, Mann–Whitney U test, analysis of variance, Kruskal–Wallis test, Spearman’s correlation analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. Results: Lymphocyte count was weakly correlated (r=–0.169, p=0.002) whereas neutrophil count and N/L ratio were moderately correlated with the TASC score (r=0.432, p3.05 (sensitivity=75.0%, specificity=62.9%, area under the curve=0.678, 95% CI=0.688–0.784, p

WOS: 000384729500007, PubMed ID: 27319275, Background: Vasculogenic erectile dysfunction is a harbinger of vascular disease. Comprehensive cardiac workup is accepted to be beneficial in men with this condition, especially those with otherwise unrecognized cardiovascular disease. We aimed to evaluate the role of two-dimensional speckle-tracking echocardiography (2D-STE) for noninvasive evaluation in patients with documented arteriogenic erectile dysfunction. Methods: 64 consecutive men with Doppler proven erectile dysfunction of more than 3 months of duration were recruited. Patients divided into 2 groups according to mean peak systolic velocity (PSV). Patients with PSV < 20 cm/sn constituted Group 1 and patients with PSV >= 20 cm/sn constituted Group 2. All underwent echocardiography and were compared. According to the 2D-STE analysis for the left atrium (LA); strain during ventricular systole (LARes), during late diastole (LA-Pump), strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LASRa) values and for LV; global longitudinal strain (GLS), strain rate in systole (GSRs), strain rate in early diastole (GSRe), and strain rate in late diastole (GSRa) values were obtained. Results: Beside diastolic parameters, LA-Res and LA-Pump were found to be significantly different between groups. GLS and GSR values were lower in Group 1. Moreover, correlation analysis revealed a significant correlation of GLS values with PSV (r = -0.4, P = .001). Conclusion: Myocardial deformation parameters by 2D-STE are valuable for detection of subclinical cardiovascular dysfunction in men with arteriogenic erectile dysfunction. This noninvasive method may be used as an emerging prognostic marker for risk stratification. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Cardiac tamponade is a life-threatening condition requiring urgent intervention. It may either be drained surgically or percutaneously. Percutaneous drainage of pericardial effusion bears the risk of laceration and perforation of the myocardium and the coronary vessels, air embolism, pneumothorax, dysrhythmias, puncture of the peritoneal cavity and abdominal viscera, internal mammary artery fistula, acute pulmonary edema, and purulent pericarditis. Here, we report an easy and safe approach for pericardiocentesis under the guidance of agitated saline contrast injection through a Seldinger needle before inserting guidewire and catheter. This cheap, easy, feasible, and comfortable method of injection of agitated saline contrast before the insertion of guidewire and catheter may prevent the undesired complications.

Ventricular septal rupture and ventricular pseudoaneurysm formation are rare complications of acute myocardial infarction. Immediate intervention is mandatory in these circumstances. Our case is a unique presentation of an anterior myocardial infarction in an 85-year-old male, complicated by ventricular septal rupture and ventricular pseudoaneurysm formation.

Iatrogenic coronary artery dissection is a rare condition. But, it is potentially catastrophic complication. We present a case of iatrogenic right coronary artery dissection resulting from vigorous hand-injection of contrast medium. The patient was treated successfully by stenting and was obtain optimal coronary blood flow., Yatrojenik koroner arter diseksiyonu nadir fakat yıkıcı bir komplikasyondur. Kontrast maddenin güçlü enjeksiyonu sonucu oluşan yatrojenik sağ koroner arter diseksiyonu olgusu sunuyoruz. Hasta stentleme işlemi ile başarılı şekilde tedavi edildi ve optimal kan akımı sağlandı.

Objective: The aim of the study was to present the results of osteosynthesis with elastic expandable intramedullary nail for clavicle fractures.Methods: The study included 17 patients (11 males, 6 females; mean age 36.4 years, range: 21 to 54 years) who underwent surgery for a displaced clavicle fracture and had a shortening of more than 2 cm. The Constant Score and DASH (Disabilities of The Arm, Shoulder and Hand) scoring were used to determine the functional status of the patients.Results: Mean operation time was 30.4 (range: 25 to 42) minutes and mean follow-up period was 10.3 (range: 8 to 19) months. Mean union time was 15.8 (range: 9 to 20) weeks. A superficial infection was treated with wound debridement and antibiotherapy in one patient. No patient suffered from neurovascular compromise, deep infection or implant irritation. Implant fracture developed at months after surgery in one patient treated for Type B1 clavicle fracture and healed without any other intervention. There was no statistically significant shortening (p>0.05). In the final follow-up, the mean Constant Score was 94.3 (range: 86 to 97), and mean DASH score was 11.8 (range: 7.3 to 17.4).Conclusion: Expandable elastic locking intramedullary nail appears to provide minimal complication and high success rate for the surgical treatment of non-comminuted displaced clavicle shaft fractures. Additional studies with large series are necessary for further investigation., Amaç: Çalışmamızda yetişkin orta cisim klavikula kırıklarında ekspanse olabilen esnek kilitli intrame¬düller çivi uygulanan olguların sonuçları değerlendirmek amaçlanmıştır.Çalışma planı: Tamamen ayrışmış ve en az iki cm kısalığı bulunan ve ekspanse olabilen esnek kilitli intramedüller çivi ile tespit yapılan 11 erkek ve 6 kadın hasta çalışmaya dahil edildi. Hastaların son takiplerinde erken ve geç dönem komplikasyonları ve Constant ve DASH skorlama sistemine göre fonksiyonel skorları değerlendirildi.Bulgular: Ortalama ameliyat süresi 30.4 (25-42) dakika idi. Ortalama takip süresi 10.3 (8-19) ay, ortalama kaynama süresi ise 15.8 (9-20) hafta idi. Bir hastada yüzeyel enfeksiyon görüldü. Hiçbir hastada derin enfeksiyon görülmedi. Hiçbir hastada nörovasküler komplikasyon ile karşılaşılmadı. Hiçbir hastada implant migrasyonu ve irritasyonu ile karşılaşılmadı. Bir hastada uygulama hatasına bağlı olduğu düşünülen instabiliteye yol açmayan implant kırılması görüldü. Sağlam tarafla karşılaştı¬rıldığında hiçbir hastada anlamlı kısalık görülmedi. Hastaların son kontrollerinde ortalama Constant skoru 94.3 (86-97), DASH skoru ise 11.8 (7.3-17.4) idi.Çıkarımlar: Ekspanse olabilen esnek kilitli intramedüller çivi ayrışmış orta diafiz klavikula kırıkların¬da minimal invaziv olarak uygulanabilen, düşük komplikasyon oranı olan ve iyi fonksiyonel sonuçlar elde edilmesini sağlayan bir yöntem olarak görülmektedir. Daha geniş serileri içeren karşılaştırmalı çalışmaların gerekliliği aşikardır.

Objective: Timing of surgery in hip fracture patients using antiplatelet agents is a controversial issue. Clopidogrel is an antiplatelet drug widely used in the treatment of many diseases. In this study, we aimed to investigate the outcomes of early surgery in hip fracture patients using clopidogrel.Methods: Elderly patients with femoral neck fractures who underwent open surgery between 2009 and 2014 were evaluated. Two hundred and eleven patients were included in the study. Patients were separated into 3 groups. Group 1 was constituted of patients using clopidogrel who had been operated on within 48 h after admission (n=74), Group 2 was constituted of patients using clopidogrel who had been operated on after the fifth day of admission (n=55), and Group 3 was constituted of patients not using clopidogrel who had been operated on within 48 h after admission (n=83). Length of hospital stay, amount of blood transfusion, rate of complication, and mortality rate were assessed for comparison of groups.Results: Age, sex, preoperative hemoglobin values, and ASA scores were not different between the groups. Amount of blood transfusions was higher in Group 1 (p=0.023). Duration of hospital stay was longer in Group 2 (p, Amaç: Antiplatelet tedavi alırken kalça kırığı gelişen hastaların cerrahi müdahale zamanlaması tartışmalı bir durumdur. Klopidogrel birçok hastalığın tedavisinde yaygın olarak kullanılan antiplatelet bir ilaçtır. Bu çalışmada klopidogrel tedavisi alırken kalça kırığı olan hastaların cerrahi müdahale sonuçlarını karşılaştırmayı amaçladık.Çalışma planı: 2009 ile 2014 yılları arasında ileri yaş femur boyun kırığı nedeni ile açık cerrahi uygulanan hastalar geriye dönük olarak tarandı. Çalışmaya 211 hasta dahil edildi. Hastalar; klopidogrel kullanan ve ilk 48 saat içinde opere edilenler (grup 1, 74 hasta), klopidogrel kullanan ve beşinci günden sonra opere edilen (grup 2, 55 hasta) ve herhangi bir antiagregan kullanmayan (grup 3, 82 hasta) olarak üç gruba ayrıldı. Gruplar kan transfüzyon miktarı, yatış süresi, komplikasyon ve mortalite açısından karşılaştırıldı.Bulgular: Gruplar arasında yaş cinsiyet operasyon öncesi hemoglobin değerleri ve ASA skorları açısından anlamlı fark tespit edilemedi. Birinci gruptaki hastaların daha fazla kan transfüzyonu ihtiyacı oldu (p=0.023). İkinci grupta hastanede kalış süresi daha yüksek idi (p

Objective: To evaluate whether a complete analysis of electrocardiograms (ECGs) taken before hip fracture surgery could provide prognostic data regarding in-hospital perioperative cardiovascular complications (PCVCs). Methods: Elderly patients who underwent surgery using a proximal femoral nail due to peritrochanteric fracture between 2009 and 2013 were retrospectively evaluated. Patients’ 12-lead preoperative ECGs were analyzed and corrected QT intervals (QTcs) were calculated. Following analysis, ECGs with atrial fibrillation, left or right bundle branch block, ventricular premature beats, Q-waves, ventricular strain, sinus bradycardia or tachycardia were designated as abnormal. The relationship between observed ECG abnormalities and calculated QTc interval, and the development of in-hospital PCVC was evaluated. Results: In total, 190 male and 232 female patients were included in the study. Two hundred nineteen (51.9%) patients had a fractured right hip and 203 (48.1%) had a fractured left hip. ECGs of 133 patients were abnormal. Seventeen patients (4.02%) died and 62 patients (14.6%) developed PCVCs. There was a statistically significant increase (P=0.0183) in PCVC as perioperative cardiac risk factors increased. Of the abnormal ECG changes, only atrial fibrillation, paced rhythm and ventricular strain were found to be related to PCVCs (P

Objective: Delaying the treatment of bone and tendon injuries may cause unmanageable complications. Bonesetters continue to cause delays in treatment. The purpose of this study was to analyze the medical outcomes of delay due to bonesetter intervention and factors affecting patient treatment preference. Methods: Among outpatients treated at our clinic between January 2010–December 2012, bonesetter-intervened patients were included, and patient demographics, clinical outcomes, and possible social factors were retrospectively analyzed. Clinical examinations and radiological screening measurements were used to evaluate outcomes. Results: Of the 162 patients, 97 (59.8%) were male, and mean age was 27.5±9.4 years. Eighty-nine (54.9%) of the patients lived in a rural area, and 108 (66.7%) underwent surgery. Bonesetter preference was dictated primarily by elderly relatives (47.6%) or neighbors (33.3%). Patients with a primary school education and unemployed patients mostly preferred bonesetters (p=0.03 and p

This letter to the editor reports on a case of third-generation oral contraceptive pill use associated with spontaneous coronary dissection of the left coronary artery and proximal thrombotic occlusion of the right coronary artery (RCA).

Introduction: This prospective randomized pilot study sought to determine whether fixation with Sonoma CRx intramedullary pin is a comparable alternative to minimally invasive plating fixation in patients with displaced clavicle fractures. Materials and methods: A total of 45 consecutive patients (Robinson class B1 or B2) were randomly allocated into two groups; intramedullary pin (IMP) group (n = 24, mean age; 33.17 ± 8.60 years, 14 males 58.3 %) received Sonoma CRx Collarbone pin (Sonoma, USA) whereas locking midshaft superior plating (MIPPO) group (n = 21, 32.38 ± 8.41 years, 12 males) patients received minimally invasive locking midshaft superior plating (Acumed, USA). Patients were followed up with a mean time of 11.82 ± 4.22 and 14.45 ± 6.43 months, respectively. Functional status, as the primary outcome measure, was assessed using quick disability of the arm, shoulder and hand (DASH) scores. Results: Mean time of operation and mean time of fluoroscopy were significantly shorter in the IMP group than those in MIPPO group (p

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that is associated with high maternal morbidity and mortality. Onset is usually between the last month of pregnancy and up to the fifth month postpartum. PPCM usually presents with signs and symptoms of heart failure and rarely with thromboembolic complications. The true incidence of thromboemboli in PPCM is unknown. Herein we report an unusual case of PPCM in a previously healthy woman who presented with recurrent transient ischemic attacks due to thrombus in the left ventricle. Resumo: A miocardiopatia periparto (MPP) é uma forma rara de miocardiopatia dilatada, associada a elevada mortalidade e morbilidade materna. A doença manifesta-se habitualmente entre o último mês de gravidez até ao 5.° mês depois do parto. A MPP apresenta-se habitualmente com sinais e sintomas de insuficiência cardíaca e, raramente, com complicações tromboembólicas. A verdadeira incidência de tromboembolismo na MPP não é conhecida. Apresentamos um caso, pouco habitual, de MPP em mulher previamente saudável que se apresentou com acidentes isquémicos transitórios recorrentes, devido à presença de trombo no ventrículo esquerdo. Keywords: Peripartum cardiomyopathy, Transient ischemic attacks, Transthoracic echocardiography, Palavras-chave: Miocardiopartia periparto, Acidente isquémico transitório, Ecocardiografia transtorácica

Background and aim: There is still no gold standard technique for graft fixation during anterior cruciate ligament reconstruction. We compared the functional outcomes of patients receiving either ToggleLoc with ZipLoop technology or Translig transverse crosspin device for femoral graft fixation.Materials and methods: A total of 118 patients were randomly allocated into two groups to receive either Translig® transverse crosspin (Translig group 1: n = 51, mean age 28.34 ± 7.83 years, age 18–40 years) or ToggleLoc with ZipLoop technology (ToggleLoc group: n = 67, mean age 26.85 ± 8.76, age 16-41 years) for femoral graft fixation. Early and 1-year assessment was made with Lysholm knee scale, International Knee Documentation Committee Scoring, Tegner Activity Level Scale, KT-1000 arthrometer and pivot shift test.Results: Preoperative vs. postoperative functional parameters showed significant improvement in both groups. Two groups were similar in terms of Lysholm knee scale, IKDC and Tegner activity scores (p > 0.05). The KT-1000 arthrometer revealed slightly less anterior sliding in Translig group than that in ToggleLoc group (p > 0.05). ToggleLoc technique allowed a radiographically more horizontal placement of the graft than Translig technique.Conclusion: Two distinct techniques used in this study are likely to be suitable for femoral graft fixation during anterior cruciate ligament reconstruction with the femoral tunnel being created via anteromedial approach. © 2014, Springer-Verlag Berlin Heidelberg.