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Constrictive pericarditis is a rare complication which occurs after coronary bypass grafting operation. Classic constrictive pericarditis after cardiac operation coronary bypass grafting operation is considered to be progressive and irreversible, for which definitive therapy is a pericardiectomy. Herein, we reported a transient form of constrictive pericarditis that resolves without surgical intervention., Koroner bypass greft cerrahisi sonrası konstriktif perikardit gelişmesi nadir bir komplikasyondur. Kardiyak cerrahi koroner bypass greft cerrahisi sonrası gelişen klasik konstriktif perikardit ilerleyici ve geri dönüşümsüz seyirlidir ve kesin tedavisi perikardiyektomidir. Bu yazıda cerrahi müdahele olmaksızın düzelen konstriktif perikarditin geçici formunu sunmaktayız.

Drought has become a recurrent phenomenon in Turkey in the last few decades. Significant drought conditions were observed during years of late 1980s and the trend continued in the late 1990s. The country’s agricultural sector and water resources have been under severe constraints from the recurrent droughts. In this study, spatial and temporal dimensions of meteorological droughts in Turkey have been investigated from vulnerability concept. The Standardized Precipitation Index (SPI) method was used to detail geographical variations in the drought vulnerability based on frequency and severity of drought events at multiple time steps. Critical (threshold) rainfall values were derived for each station at multiple-time steps in varying drought categories to determine least amount of rainfall required to avoid from drought initiation. The study found that drought vulnerability portrays a very diverse but consistent picture with varying time steps. At regional scale, south-eastern and eastern Anatolia are characterized with moderate droughts at shorter time steps, while the occurrence of severe droughts at shorter time steps is observed at non-coastal parts of the country. A similar picture was observed with very severe droughts. The critical (threshold) values exhibited rising numbers during the growing season at 3-month step in the South-eastern Anatolia, which might have significant consequences considering presence of large irrigation projects under-development in the region. In general, rainfall amounts required for non-drought conditions decrease from the coastal parts toward the interiors with increasing time steps.

Işık, Turgay (Balikesir Author), Aim: Acute vascular events show a circadian rhythm and daily variation. Previous studies demonstrated that ST segment elevation myocardial infarction (STEMI) increases in winter season; however, the prognosis of the patients that presented at different seasons has not been investigated yet. In this study we investigated the seasonal mortality variation of the patients who underwent primary percutaneous coronary intervention (PCI) for STEMI. Materials and methods: We reviewed 2644 consecutive patients treated with primary PCI for STEMI. The date of STEMI was obtained from medical record. Patients were divided into groups depending on the season to the applicant. Group I (Autumn) had 570 (21.6%) patients, Group II (Winter) had 807 (305%) patients, Group III (Spring) had 734 (27.8%) patients and Group IV (Summer) had 533 (20.2%) patients. Results: Age, sex and most of cardiovascular risk factors and angiographic features were comparable among groups. When compared to the group IV, in hospital reinfarction (re-MI) incidence was significantly higher in group II (3.2% vs 0.8%, p: 0.009). There were no differences between groups for in hospital and long term mortality, long term re-MI, target vessel revascularization and major adverse cardiac events (MACE). Conclusion: This study showed that there were no seasonal variation in hospital and long-term mortality, long term re-MI and MACE after primary PCI for STEMI. Besides, in hospital re- MI incidence was significantly higher in winter when compared to the summer.

OBJECTIVES: The aim of this study was to evaluate the prognostic value of fragmented QRS (fQRS) on electrocardiography (ECG) patients with acute ST‐segment elevation in myocardial infarction (STEMI), who are undergoing primary percutaneous coronary intervention (PCI). METHODS: We prospectively enrolled 414 consecutive STEMI patients (mean age of 55.2 ± 12.2 years old, range of 26–91‐years old) undergoing primary PCI. The study patients were divided into two groups according to the presence or absence of fQRS as shown by ECG in the first 48 hours. The presence of fQRS group was defined as fQRS(+) (n = 91), and the absence of fQRS group was defined as the fQRS(–) (n = 323) group. Clinical characteristics and the one‐year outcome of the primary PCI were analyzed. RESULTS: The patients in the fQRS(+) group were older (mean age 60.7 ± 12.5 vs. 53.6 ± 11.6 years old, P

Flash floods associated with heavy precipitation has become a hazardous phenomenon along the Mediterranean coasts of Turkey in recent years. During 3 and 4 November 1995 heavy and intense rainstorm activity over the Aegean coast led to flash flooding in the city of Izmir. Damage exceeded $50 million and 61 people died as a result of the flood. The Karsiyaka district suffered the most severe damage. This study presents an analysis of the meteorological settings that led to the development of these intense storms and describes the role of the terrain features involved in the Izmir flood. The important mesoscale features which initiated the severe weather outbreak included pronounced low-level advection, positive vorticity and strong upper level divergence. A surface low centered over the Aegean Sea enhanced the advection of warm and moist unstable air masses coming from the southwest over the Mediterranean Sea along a southwesterly low level jet (LLJ). A squall line oriented NE-SW over the Aegean Sea also contributed to the storm development, and intensity of the storms was further enhanced by the orographic effect. The presence of a frontal system, the stability indices associated with the event, and other meteorological features are all reminiscent of the synoptic type flash floods identified by Maddox. While the pressure and moisture patterns were favorable for severe storm activity, nonmeteorological factors including the topography, geomporphology, and and land-use contributed to the flooding to a great extent. Settling in the flood-prone zone, insufficient floodwater structures, and the lack of channel improvements in the creeks enhanced flood damage to the city. Many of the deaths occurred in the settlements located in the flood-prone zone of the Ilica and Dallik creeks. Language: en

Miyokardit, değişik nedenler ile meydana gelen inflamatuar yanıta ikincil kalbin miyokart tabakasını etkileyen bir hastalıktır. En yayın sebebi virüslerdir. Klinik seyri genellikle kendini sınırlayıcı ve selimdir, ancak klinik kötüleşme-hemodinamik durumun bozulması da mümkündür. Bu çalışmada biz 2000-2011 yılları arasında literatürü gözden geçirerek miyokardit tanısı, klinik seyri ve tedavi seçeneklerinin güncellemeyi amaçladık., Myocarditis is disorder effecting myocardium of the heart secondary to inflammatory response caused by various reasons. The most common cause of myocarditis is viruses. Clinical course is usually self-limiting and benign; however, clinical deterioration, which impairs hemodynamic state, is also possible. In this study, we presented updated diagnosis, clinical course and treatment options of myocarditis by review of literature between 2000 and 2011.

Ayhan, Erkan (Balikesir Author), Background: Neutrophil to lymphocyte (NLR) is the strongest white blood cell predictor of adverse outcomes for stable coronary artery disease and mortality in patients presenting with ST-segment elevation myocardial infarction. We sought to determine the prognostic value of NLR in non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). Methods: A total of 308 (mean age 59.22±11.93; 234 males, 74 females) patients with NSTEMI and UAP were prospectively evaluated. Admission NLR was measured as part of the automated complete blood count. The study population was divided into tertiles based on admission NLR values. A high NLR (n=102) was defined as a value in the third tertile (>3.04), and a low NLR (n=206) was defined as a value in the lower two tertiles (≤3.04). Patients were followed for clinical outcomes for up to 3-years after discharge. Results: Kaplan-Meier survival analysis showed 3-years mortality rate of 21.6% in patients with high NLR versus 3% in low NLR group (p3.04 yielded a sensitivity of 79%, a specificity of 71%. We used Cox proportional hazard models to examine the association between NLR and adverse clinical outcomes. A significant association was noted between high admission NLR level and the adjusted risk of cardiovascular mortality (hazard ratio: 6.3, 95% confidence interval:1.6-24.3, p=0.008). There was a good correlation between NLR levels and age (r:0.22, p

Ayhan, Erkan (Balikesir Author), Amaç: Adiponektin, insülin duyarlılığını düzenleyen ve adipositden sekrete edilen bir proteindir ve dolaşımdaki seviyesinin azalması insülin direnci ile ilişkilidir. Biz, stabil anjina pektorisli hastalarda serum adiponektin ve kan gli- koz seviyeleri ile koroner arter hastalığı şiddeti arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve yöntem: Bu çalışmaya stabil anjina pektorisli 160 hasta (82 erkek) dahil edildi. Hastalar başvuru es- nasındaki kan glikoz seviyerine göre 3 gruba ayrıldı; 24 hasta normal kan glikoz grubu,53 hasta bozulmuş glikoz tolerans grubu ve 53 hasta diabetes mellitus (DM) grubu. Koroner lezyonların şiddeti Gensini skoru kullanarak de- ğerlendirildi. Tüm gruplarda serum adiponektin seviyeleri de ölçüldü. Bulgular: Hipertansiyon, hiperlipidemi, obesite ve insü- lin direnci DM grupta anlamlı olarak daha yüksekdi. DM’li hastalarda serum adiponektin seviyeleri anlamlı olarak daha düşük saptandı (13.55±7.16, p=0.002). Ortalama Gensini skoru DM grupta 40.84 ±37.25 olarak saptandı (p=0.006). Sonuç: Stabil anjina pektorisi olan hastalarda serum adi- ponektin düzeyleri koroner arter hastalığı yaygınlığı için bir ipucu olabilir., Objectives: Adiponectin is an adipocyte-secreted protein that modulates insulin sensitivity and whose low circulat- ing concentration is associated with insulin resistance. We evaluated the association between serum adiponec- tin and blood glucose levels with coronary artery disease severity on the angiogram in patients with stable angina pectoris. Materials and methods: The study included 160 patients (82 males) with stable angina pectoris. The patients were divided into three groups according to the blood glucose levels on admission; thus, 24 had normal glucose group, 53 had impaired glucose tolerance group, and 53 had diabetes mellitus (DM) group. The severity of coronary lesions was assessed using the Gensini score. Serum adiponectin levels were measured in the all group. Results: The hypertension, hyperlipidemia, obesity, and insulin resistance were significantly higher in the DM group. Patients with DM significantly lower serum levels of adiponectin (13.55±7.16, p=0.002). The mean Gensini score was 40.84± 37.25 in the DM group (p=0.006). Conclusion: Serum adiponectin levels may be a clue for severity coronary artery disease in patients with stable angina pectoris.

Ayhan, Erkan (Balikesir Author), Amaç: Bu çalışmamızda ST yükselmeli miyokard enfarktüsü (STYME) ile hastaneye başvuran ve primer PCI yapılan hastalarda hastaneye başvuru anında bakılan sodyum düzeyinin hastane içi morbidite ve mortalite ile ilişkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu çalışmaya 1 Şubat 2011 - 1 Eylül 2011 tarihleri arasında hastanemiz acil servisine başvurup STYME tanısı alan ve semptomların başlangıcından sonra ilk 12 saat içinde (hemodinamik bozukluğu olan ve göğüs ağrısı devam eden hastalar için ilk 18 saat) primer PCI işlemi yapılan 366 (312 erkek, 44 kadın) hasta dahil edildi ve prospektif olarak izlendi. Hastalar düzeltilmiş plaz- ma sodyum düzeyine göre normonatremik, (plazma sodyum düzeyi: 136-145 mEq) ve hiponatremik (plazma sodyum düzeyi ?135 mEq) olmak üzere iki gruba ayrıldı. Çalışmamız için hastanemiz Eğitim ve Planlama Kurulu (EPK)’ndan onay alınmıştır. Bulgular: Hastaların 310 tanesi normonatremi, 56 tanesi hiponatremi grubuna alındı. Hastane içi mortalite normonatremi grubun- daki 310 hastanın 11’inde (% 3,5), hiponatremi grubundaki 56 hastanın 6’sında görüldü (%10,7). Bu bulgulara göre, hastaneye baş- vuru anında hiponatremi varlığı hastane içi mortaliteyi anlamlı derecede artırmaktadır. Hiponatremi ile birlikte kadın cinsiyet, > 65 yaş, anemi, çoklu damar hastalığı, Killip sınıfının > 1 olması, diyabet, hipertansiyon, aile öyküsü hastane içi mortalite artışı açısından anlamlı olarak bulundu. Çok değişkenli analizde hiponatremi varlığının hastane içi mortaliteyi bağımsız olarak artırdığı tespit edildi (OR=5,8, %95 GA=1,25 - 21,47, p< 0,1). Sonuç: ST yükselmeli miyokard enfarktüsü ile hastaneye başvuran ve primer PCI yapılan hastalarda hastaneye başvuru anında hiponatremi varlığı hastane içi mortaliteyi artırmaktadır., Aim: We investigated that relationship between sodıum levels defıned as contact hospital on in hospital morbidity and mortality in patients undergoing primary PCI for ST segment elevation myocardial infarction (STEMI) Material and Method: This study included 366 patients (312 men, 44 women) who admitted to our Emergency Department between 1 February 2011- 1 September 2011 for STEMI and treated with primary PCI in the first 12 hours after onset of symptoms (hemodynamic instability and ongoing chest pain patients for first 18 hours). Patients were divided into two groups according to corrected level of plasma sodium; normonatremia ( plasma sodium level:136 #8211; 145 mEq/dl) and hyponatremia (plasma sodium level: #8804;135 mEq/ dl). Results: Of 366 patients, 310 patients were in normonatremia group and 56 patients were in hyponatremia group. In-hospital mortality developed in 11 of 310 normonatremic patients ( % 3.5) and 6 of 56 hyponatremic patients (%10.7). According to these signs the presence of hyponatremia at hospital admission had significantly increased in-hospital mortality. Hyponatremia with female gender, age >65, anemia, multivessel disease, Killip class >1, diabetes, hypertension, family history had significantly increased in-hospital mortality. In multivariate analysis, presence of hyponatremia was found independently increased of in-hospital mortality (OR= 5.8 95% CI:1.25 -21.47, p=0.02) Conclusion: In patients with STEMI and ondergoing primary PCI, presence of hyponatremia at the time admission of hospital, increases in-hospital mortality.

Ayhan, Erkan (Balikesir Author), Objectives: Red cell distribution width (RDW), a marker of variation of the size of the circulating red blood cells, was evaluated in patients with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). Background: Higher RDW is associated with mortality in patients with symptomatic cardiovascular disease, heart failure, and also in the general population. We hypothesized that admission RDW would be predictive of adverse clinical outcomes in NSTEMI and UAP. Methods: A total of 310 (mean age 59.28±11.93; 236 males, 74 females) patients with NSTEMI and UAP were prospectively enrolled into this study. Admission RDW was measured as part of the automated complete blood count. The study population was divided into tertiles based on admission RDW values. A high RDW (n=95) was defined as a value in the third tertile (>14%), and a low RDW (n=215) was defined as a value in the lower two tertiles (≤14%). Patients were followed for clinical outcomes for up to 3-years after discharge. Results: Kaplan-Meier survival analysis showed 3-years mortality rate of 19% in patients with high RDW versus 5.6% in low RDW group (p14% yielded a sensitivity of 60%, a specificity of 72.5%. We used Cox proportional hazard models to examine the association between RDW and adverse clinical outcomes. A significant association was noted between high admission RDW level and the adjusted risk of cardiovascular mortality (hazard ratio: 3.2, 95% confidence interval:1.3-7.78, p=0.01). There was a good correlation between RDW levels and age (r:0.246, p

Soylu, Özer (Balikesir Author), Amaç: Bu çalışmada, ST yükselmeli miyokart enfarktüsü (STYME) nedeniyle primer perkütan koroner girişim (PKG) uygulanan hastalarda gastrointestinal kanama (GİK) sıklığı, risk faktörleri ve prognozu araştırıldı. Çalışma planı: Çalışmaya STYME nedeniyle primer PKG uygulanan ardışık 2541 hasta (2111 erkek, 430 kadın; ort. yaş 56.5±11.8) alındı. Klinik, anjiyografik veriler ve hastane içi sonuçlar geriye dönük olarak toplandı. Gastrointestinal kanama, antitrombotik ya da antikoagülan tedaviyi kesecek ve eritrosit infüzyonu gerektirebilecek kadar belirgin olan alt ya da üst GİK veya kara dışkı varlığı olarak tanımlandı. Bulgular: Primer PKG sonrası 27 hastada (%1.1) GİK gelişti. Gastrointestinal kanama görülmeyenlerle (n=2514) kıyaslandığında, GİK gelişenler hastalar daha yaşlıydı (65.9±13.5 ve 56.4±11.8; p70 yaş (OO 3.33, %95 GA 1.4-8.0; p=0.007) ve glomerüler filtrasyon hızının, Objectives: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Study design: We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5±11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion. Results: Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9±13.5 years vs. 56.4±11.8 years; p

Uyarel, Hüseyin (Balikesir Author), Objectives: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Study design: We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5±11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion. Results: Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9±13.5 years vs. 56.4±11.8 years; p

Uyarel, Hüseyin (Balikesir Author), Background: One of the major concerns remaining in the treatment With stenting of patients With acute myocardial infarction (AMI) is the occurrence of stent thrombosis (ST). The aim of the current Study is to investigate the incidence, predictors, and long-term Outcomes of early ST after primary coronary stenting for AMI in a large population. Methods: We reviewed 1960 consecutive patients (mean age 56 +/- 11.6 years, 1658 males) treated With primary coronary stenting for AMI between 2003 and 2008. All clinical., angio-graphic, and follow-up data Were retrospectively collected. Early, ST was defined as thrombosis that Occurred in the first 30 days after primary coronary stenting. Results: Early ST was observed in 89 (4.5%) patients. Five variables, selected from the multivariate analysis, Were weighted proportionally to their respective odds ratio (OR) for early ST (premature clopidogrel therapy discontinuation [10 points], stent diameter 65 years [2 points]). Three strata of risks were defined (low risk, score 0-4; intermediate risk, score 5-12; and high risk, score 1324) and had a strong association with early ST and long-term cardiovascular mortality. Long-term cardiovascular mortality Was 5-fold more in patients With early ST than that without ST (24.1% vs 4.7%, respectively, P < .001). Conclusions: Early ST after primary coronary stenting in AMI is strongly related With increased long-term cardiovascular mortality. Premature clopidogrel therapy discontinuation is the most powerful predictor of early ST