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Aim: The choice of anesthesia management for hip fracture surgery is among the modifiable risk factors that can affect the outcome. This study aims to investigate the effects of two different anesthesia techniques on kidney functions with the RIFLE (Risk, Injury, Failure, Loss, and End-stage renal failure) risk score in patients who were operated on for hip fracture. Material and Method: Serum creatinine values lower than 1.5 times (Normal value: 1.2 mg/dL) and glomerular filtration rate (GFR) below 60 mg/dl, over 65 years old, without serious comorbidity, hemoglobin (Hb) value over 9 g/dl 60 patients were included. The demographic data and biochemical parameters of the patients were recorded. The patients were randomized into two groups as spinal anesthesia (Group S) and general anesthesia (Group G). During the surgery, a urinary catheter was applied to the patients and urine output was monitored. Balance liquid electrolyte regimen was applied and after Hb control, an appropriate blood regimen was planned with Hb above 9 g/dl. Postoperatively, patients were followed at 6th, 12th, and 24th hours on the first day, and then at 24-hour intervals in the first postoperative week, and were evaluated with the RIFLE risk scores. Results: There was no statistically significant difference between the groups in terms of demographic data, fracture type, laboratory values, and urine volumes (p > 0.05). In the comparison of intragroup urea values, the decrease in the 5th time interval compared to the baseline value was statistically significant in Group G. There was no statistically significant difference between the measurement times in Group S (p > 0.05). Preoperative creatinine values were found to be statistically significantly higher than other measurement times in the patient group in Group S (p < 0.05). In both groups, it was found that all measurement time urine amounts were statistically different from each other (p < 0.05). In comparisons between groups, There was no statistically significant difference in terms of RIFLE risk score and postoperative outcome at all measurement times (p>0.05). Conclusion: There is no difference between the anesthesia method applied in hip fracture surgery and the change in renal function of patients, based on RIFLE criteria and laboratory parameters. In addition, a significant improvement in renal functions was observed in both groups, especially during the discharge period, according to preoperative values, which may indicate that the stress response to surgery can be effectively limited in both anesthesia methods.

Amaç: Cerrahi erken menopoz, doğal yaşlanma sürecinden ziyade tıbbi nedenlerle meydana gelen erken menopozdur. Nabız dalga hızı (NDH) ve büyütme indeksi (Augmentasyon indeksi, AIx), arteryel sertliğin değerlendirilmesi için basit ve invazif olmayan parametrelerdir. Bu çalışmanın amacı, cerrahi erken menopoz hastalarında arteryel sertliği araştırmaktır.Materyal ve Metod: Çalışmaya cerrahi erken menopozlu 40 hasta ve 40 sağlıklı kontrol dahil edildi. Hastaların arter sertliği ve hemodinamik parametreleri, Mobil-O-Graph NG (IEM GmbH, Stolberg, Almanya) 24 saatlik ambulatuvar kan basıncı monitör arteriyografisi ile ölçüldü.Bulgular: Başlangıç demografik, laboratuvar ve ekokardiyografik parametrelerde gruplar arasında fark yoktu. Cerrahi erken menopozlu hastalarda (n=40) etiyoloji değerlendirildiğinde 27 hastada (% 67.5) malignite, 11 hastada (%27.5) miyom ve 2 hastada (%5) kanama idi. Nabız dalga hızı (NDH), erken menopoz grubunda (6.5 m/s, (4,7-8,2) 5.6 m/s'ye (4,5-9,0 m/s) karşı anlamlı olarak daha yüksekti; P, BackgroundSurgical early menopause is early menopause due to medical reasons rather than the natural aging process. Pulse wave velocity (PWV) and augmentation index (AIx) are simple and non-invasive parameters for assessment of arterial stiffness. The aim of this study investigated the arterial stiffness in the surgical early menopause patients.Material and MethodWe included 40 patients with surgical early menopause and 40 healthy controls for the study. The patients’ arterial stiffness and hemodynamic parameters were measured with Mobil-O-Graph NG (IEM GmbH, Stolberg, Germany) 24-hour ambulatory blood pressure monitor arteriography.ResultThere was no difference between the groups in baseline demographic, laboratory, and echocardiographic parameters. In patients with surgical early menopause (n=40), the etiology was malignancy in 27 (67.5%), myoma in 11 (27.5%) and bleeding in 2 (5%) patients. PWV was significantly higher in the early menopause group (6.5 m/s, (4.7-8.2) versus 5.6 m/s, (4.5-9.0 m/s); P

Tam Metin / Full Text ESCI PMID: 34177289 WOS:000660311100004 Arterial stiffness is related to arteriolosclerotic diseases and is a marker of adverse cardiovascularevents. Mitral annular calcification (MAC) is progressive calcium deposition on the posterior and inferior mitral annulus and is associated with atherosclerotic cardiovascular diseases. Cardio-ankle vascular index (CAVI)is a measurement technique used to estimate the degree of arterial stiffness without effect from blood pressure. The aim of this study is to research arterial stiffness using CAVI in patients with MAC.Materials and Methods: The study was cross-sectional and observational and included 98 patients with MACconfirmed by echocardiography who referred to the cardiology clinics and met study inclusion criteria and 38controls without MAC. CAVI measurements were obtained by using the Vascular Screening System VaSeraVS-1000 (Fukuda Denshi, Tokyo, Japan) device.Results: The two groups were similar in terms of demographic characteristics, including age, sex, hypertension, coronary artery disease, body surface area, and smoking (P > .05). Left atrial volume index wassignificantly higher in patients with MAC compared with the control group (P < .001). Right arm CAVI, leftarm CAVI, and mean CAVI were significantly higher in the MAC group than the control group (P = .037, P= .005, and P = .014, respectively) and increased with MAC severity. There was a significant positive correlation between mean CAVI and MAC grade (r = 0.278, P = .001). Also, when ankle-brachial index (ABI) wasmeasured with CAVI, left and right extremity ABI values were significantly lower in patients with MAC (P =.017 and P = .005, respectively).Conclusion: CAVI increased in all patients with MAC and associated with increasing grade of calcification

Introduction Ranolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, and Tp‐e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P‐wave dispersion (PWD) in patients with stable coronary artery disease (CAD). Methods This study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P‐wave times, and PWD were analyzed from 12 lead electrodes. Results There was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp‐e interval (87.3 ± 14.4 vs. 90.8 ± 12.4 msn, P, Ranolazine leads to asymptomatic cardiac electrocardiographic changes in stable coronary artery disease patients. Myocardial repolarization parameters (Tp‐e interval, QTc interval, Tp‐e/QT, Tp‐e/QTc ratios) and P‐wave dispersion (PWD) were significantly lower in stable CAD patients receiving ranolazine therapy.

Background Chronic kidney disease (CKD) patients are at higher risk for cardiac arrhythmias. The risk of arrhythmia may change with different treatment modalities. We proposed to compare the effects of varied therapy methods on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, Tp‐e/QTc ratios) and P‐wave dispersion (PWD) in patients with CKD. Methods Three groups were formed from the patients aged between 18 and 65 years, as Group 1 consisting of CKD patients receiving hemodialysis (HD) three times a week, Group 2 consisting of predialysis CKD patients and Group 3 consisting of CKD patients who underwent successful transplantation. All patients’ basic demographic data, risk factors, and echocardiographic parameters were recorded, and electrocardiographic repolarization parameters and PWD were analyzed. Results The PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups (P = .020, P .05). PWD was significantly increased in the predialysis group compared to other two groups (P, The Tp‐e interval, Tp‐e/QT and Tp‐e/QTc ratios, P‐wave dispersion (PWD) were significantly higher in pre‐dialysis chronic kidney disease group, but PR, QT, QTc intervals were significantly shorter in transplantation group compare to other groups. Our results may suggest that the predialysis group is the most increased risk for the ventricular arrhythmias and the least increased risk for the transplant patients. Again, prolonged PWD may suggest that the predialysis group is the most increased risk for atrial fibrillation compare to other groups.

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are new systemic inflammation markers and predictor of adverse cardiovascular outcomes. Approximately 10% of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) have chronic total occlusion (CTO) of the non-infarct-related artery. The presence of concurrent CTO is associated with short- and long-term morbidity and mortality. Here, we aimed to investi-gate the relationship of NLR and PLO with coexistent CTO in STEMI patients.Materials and Methods: Ninety consecutive STEMI patients with concurrent CTO were included in the study group and 100 STEMI patients without CTO were included in the control group retrospectively. The relationship between inflammatory markers and concurrent CTO in STEMI was analyzed.Results: STEMI patients with concurrent CTO had increased NLR, PLR, C-reaktive protein and troponin while decreased glomerular filtration rate, left ventricular ejection fraction (LVEF) in comparison with patients without CTO. In multivariate analysis, NLR (p=0.002), PLR (p=0.042), CRP (p=0.002), hypertension (p, Amaç: Nötrofil/lenfosit oranı (NLR) ve trombosit/lenfosit oranı (PLR), yeni sistemik inflamasyon belirteçleri ve olumsuz kardiyovasküler sonuçların öngörücüleridir. Primer perkütan koroner girişim (PCI), akut ST-segment yükselmeli miyokart enfarktüsü (STYME) olan hastalarda etkili bir tedavi stratejisidir. Enfarktla ilişkili olmayan arterde kronik total okluzyon (KTO), bu hastaların %10'unda mevcuttur ve kısa ve uzun dönem morbidite ve mortalite ile ilişkilidir. Biz burada, ST segment yükselmeli miyokard enfarktüslü (STYME) hastalarda NLO ve PLR' nin eşzamanlı kronik total okluzyon (KTO) ile ilişkisini araştırmayı amaçladık.Materyal ve Metod: STYME ile başvuran ve eşzamanlı başka damarda CTO'su olan ve olmayan toplam yüz doksan hasta alındı. İnflamatuvar belirteçler ve eşzamanlı CTO arasındaki ilişki analiz edildi.Bulgular: STYME’lü hastalarda eşzamanlı KTO'su olan hastalarda, KTO'su olmayan hastalara kıyasla NLR, PLR, C-reaktif protein (CRP) ve troponin artarken, glomerüler filtrasyon hızı (eGFR), sol ventrikül ejeksiyon fraksiyonu (LVEF) azaldı. Çok değişkenli analizde NLR (p=0,002), PLR (p=0,042), CRP (p=0,002), HT (p5.6) ve (> 164) kestirim değerleri saptandı.Sonuç: Basit ve kolay hesaplanan laboratuvar parametreleri olan PLR ve NLR, STYME'lü hastalarda eşzamanlı CTO'nun öngörülmesine yardımcı olabilmektedir.

Arslan, Ugur/0000-0001-8572-3571; Yenercag, Mustafa/0000-0002-0933-7852 WOS: 000524288900001 PubMed: 32198929 Background Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure (HF). Nonresponse to CRT is one of the main obstacles to its application in clinical practice. Herein, we investigated the utilization of the optimization technique using noninvasive cardiac output measurement (NICOM) based Mobil-O-Graph device that measures several circulation parameters noninvasively. Methods Seventy-five CRT nonresponder HF patients with an implanted CRT device were included. Patients were randomized equally to 3 groups: NICOM, echocardiographic, and empirical optimization groups. After 3 months of optimization, changes in six minutes walk test (6-MWT), cardiac output (CO), left ventricular ejection fraction (LVEF), and end-systolic volume (LVESV) were measured. New York Heart Association (NYHA) class and hospitalization for HF were also determined. Results There were no statistically significant differences among the three groups in terms of demographics, baseline characteristics. In the NICOM group, the 6-MWT, LVEF, CO, and LVESV measurements showed significant improvements compared to baseline values (P < .05). There was no significant improvement in 6-MWT, LVEF, CO, NYHA class, and LVESV in Echo and Empirical groups after 3 months (P > .05). 6-MWT, CO, LVESV percentages, and hospitalization for HF were significantly different between the groups (P < .05). In post hoc analyzes, the percentages of the change in 6-MWT, CO, LVESV, and hospitalization for HF were significantly higher in the NICOM group (P < .017). Conclusions This study suggests that Mobil-O-Graph device optimization according to CO measures does appear to have potential hemodynamic and clinical benefits in nonresponder CRT patients. Use of Mobil-O-Graph device as an option for optimization of CRT devices can be an attractive method of improving CRT outcomes.

Dasatinib is one of the second-generation tyrosine kinase inhibitors (TKI) that used as the first line for the treatment of Philadelphia chromosome (Ph) positive chronic myeloid leukemia (CML). Several cardiovascular side effects such as pleural-pericardial effusion, pulmonary hypertension, prolonged QTc interval, and platelet dysfunction have been reported. A 59-year-old female with worsening dyspnoea was diagnosed with cardiac tamponade twice in six months period after initiation of Dasatinib 100 mg per day for CML. She was successfully treated with drainage of effusion percutaneously and discontinuation of Dasatinib. Recurrent cardiac tamponade is a rare complication related to the use of Dasatinib. It should be kept in mind that Dasatinib is a potential agent for pericardial effusion, especially when other possibilities are excluded.

Coronary artery anomalies (CAAs) are defined as variants of normal epicardial coronary arteries. They are mostly detected incidentally during coronary angiography. Clinical studies have shown that abnormal origins and courses of coronary arteries make them more prone to atherosclerosis. Percutaneous treatment for atherosclerotic occlusions in anomalous coronary arteries has some difficulties, including inadequate guiding-catheter support and the need for an experienced operator. Here, we describe successful percutaneous coronary interventions for critical stenoses in 2 different CAAs and present a brief literature review.

PMID:33960310 WOS:000648811900009 Q4 Objective: The present study evaluates the arterial stiffness and hemodynamic parameters in patients with a supraphysiological estrogen level due to in vitro fertilization (IVF) with controlled ovarian hyperstimulation (COH). Methods: A total of 82 female patients aged 24–45 years were included. Their arterial stiffness parameters were analyzed before and after the appropriate COH protocol involving arteriography using Mobil-O-Graph NG (IEM GmbH, Stolberg, Germany) 24-hour ambulatory blood pressure monitor. Results: Systolic, diastolic, mean, central systolic, and diastolic blood pressures, as well as peripheral vascular resistance, were significantly lower after COH therapy (p=0.001, 0.002, 0.05). Conclusion: Arterial stiffness and hemodynamic parameters significantly decreased in IVF patients who underwent COH therapy. The long-term clinical significance of this short-term effect should be investigated with prospective studies. There was no significant difference in all parameters before and after COH when the pregnancy (+) and pregnancy (-) patients were compared.

Calcific aortic stenosis (AS) is a common valvular disease especially in elderly population. Inflammation plays significant role in the pathophysiological mechanism. Systemic immune-inflammation index (SII) is a novel marker of immune system and inflammation that includes neutrophil, lymphocyte, and platelet cell counts. The aim of this study was to investigate the predictive value of SII in calcific severe AS.Severe calcific AS patients were categorized into two groups: High flow-high gradient (HFHG) AS (n = 289) and low flow-low gradient AS (n = 79). Control group included 273 patients with similar clinical and demographic characteristics but without AS. SII was calculated as absolute platelet count × absolute neutrophil count/absolute lymphocyte count.SII levels were 525 ± 188, 835 ± 402, and 784 ± 348 in control, HFHG AS, and LFLG AS groups, respectively (P .001). Correlation analyses revealed significant and positive correlation between SII and mean aortic transvalvular pressure gradient (r = .342, P .001), and negative and significant correlation between SII and AVA (r = -.461, P .001). Multivariate analysis performed in separate models demonstrated sex, CAD, LDL, and SII levels (Odds ratio [OR]: 1.004, 95 CI%:1.003-1.004) as independent predictors of severe AS in Model 1. According to Model 2, sex, CAD, LDL, and high SII (661) (OR:5.78, 95 CI%:3.93-4.89) remained as independent predictors of severe AS.SII levels can be useful to predict severe calcific AS patients and significantly correlate with AVA and mean aortic transvalvular pressure gradient.

Saphenous vein grafts (SVGs) are widely used conduits for the surgical revascularization of coronary arteries, but they are associated with poor long-term patency rates. Acute SVG thromboses often present as acute coronary syndrome and have an extensive atherosclerotic and thrombotic burden. Percutaneous coronary intervention (PCI) is the first treatment option; however, it carries a high risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Reducing the thrombus burden and preventing distal embolization during PCI can be achieved by using some pharmacological strategies (e.g., glycoprotein IIb/IIIa antagonists) and devices (e.g., thrombectomy and filter devices). There are yet no better therapeutic options for patients undergoing PCI of SVG occlusions. Here, we introduce a 52-year-old male patient admitted with a typical acute chest pain of 1 hour’s duration. Electrocardiography showed signs of acute inferoposterior myocardial infarction. A thrombotic SVG occlusion was detected in primary PCI, and a huge thrombus content was aspirated. After the thrombus aspiration with stent implantation, the chest pain was relieved and the ST-segment elevation was improved. The patient has been followed without any symptoms for 10 months.

Introduction Arrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II). Methods The study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO2) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method. Results When the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group. Conclusion In our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.

Purulent pericarditis is characterized by a purulent pericardial fluid, which usually originates from the extension of a nearby bacterial infection site or by blood dissemination. Candida species is a rare cause of pericarditis; and if not treated, it is extremely fatal. In this report, we describe a 54-year-old man who had esophagojejunostomy due to gastric adenocancer 2 months before his admission into our emergency department with dyspnea, orthopnea, chest pain, and somnolence. Physical and echocardiographic examinations revealed massive fibrinous pericardial effusion, causing pericardial tamponade. We performed urgent pericardiocentesis. The culture of the purulent pericardial fluid illustrated Candida albicans. There was no gastropericardial fistula after endoscopic and computed tomographic evaluations of the gastrointestinal tract. After receiving 1 month of antimicrobial treatment, the patient recovered completely. During his follow-up, he remained asymptomatic and had no pericardial fluid for 6 months. Our case indicates the possibility of the occurrence of purulent pericarditis with tamponade, secondary to the dissemination of Candida albicans from total parenteral nutrition after gastric carcinoma surgery without gastropericardial fistulae or anastomosis leak.

WOS: 000506799400001 PubMed: 31928280 Background: Increasing arterial stiffness is associated with atherosclerosis and there is an association between atherosclerosis and tinnitus may occur. Objectives: The aim of this study was to investigate the relationship between arterial stiffness and tinnitus using the central pulse-wave analysis method. Methods: This prospective, single center study included 98 participants, comprising 49 patients diagnosed with subjective idiopathic tinnitus (Group 1) and a control group of 49 healthy subjects (Group 2). The Mobil-O-Graph 24 h Pulse wave analysis (PWA) Monitor (I.E.M. GmbH, Stolberg, Germany) was used to determine the arterial stiffness and cardiovascular hemodynamic parameters. Central pulse pressure (CPP), Augmentation index and pulse wave velocity (PWV) were obtained with the device. Results: No statistically significant difference was determined between Groups in respect of age, smoking and hypertension (p > .05). Statistically significantly higher Central Pulse Pressure (CPP) values and pulse wave velocity were higher in Group 1 compared to the control group (p < .005). No statistical variation was detected in terms of the augmentation index (18.5 +/- 11.3 vs 16.7 +/- 10.3, p = .543). Conclusion: Our results marked that arterial stiffness is associated with tinnitus. The relationship was examined via oscillometric method, which is simple to perform and has been recommended in guidelines for the determination of cardiovascular event risk.

Kalp yetersizligi, insan yasam omrunun uzamasi, kullanilan ilac ve ilac disi tedaviler ve ilerleyen tetkik ve tani yontemleri nedeniyle klinik hayatimizda karsimiza daha fazla cikmaktadir. Bu kitapta kalp yetersizligi tanisini, baska hastaliklar ile iliskisini, tedavisinde kullanilan ilac, cihaz ve cerrahi yontemleri pratik bilgiler de sunarak anlatmaya calistik. Kardiyoloji, Ic Hastaliklari ve Aile Hekimligi uzmanlari basta olmak uzere kalp yetersizligi ile ilgilenen tum hekim arkadaslarin ilgiyle okuyacaklarini dusunmekteyiz.Bu sebeple son yayin ve kilavuzlar isiginda kalp yetersizligi ile iliskili guncel verileri iceren “Kalp Yetersizliginde Pratik Bilgiler” isimli kitabimizi siz okuyucularimiza kazandirmaktan gurur duyuyoruz.Kalp yetersizligi ile ilgilenen hekim arkadaslarimiza faydali olacagini umdugumuz kitabin bolumlerin yazilmasinda emegi gecen tum degerli meslektaslarimiza tesekkur ederiz.

WOS: 000464335400008 PubMed: 30874517 For long-term patency, a left internal mammary artery (LIMA) graft is considered the gold standard for left anterior descending artery (LAD) revascularization. Subsequent occlusion of a LIMA graft may be related to atherosclerosis, narrowing at anastomotic locations, fixed torsions within the graft, straight tubular stenosis, dissection, or vasospasm. Late thrombotic occlusion of a LIMA, however, is rare, and the cause is not known, though case reports can be found in the literature. The present case is a description of the successful revascularization via percutaneous intervention of an ostial LIMA thrombotic occlusion occurring 5 years after bypass surgery in a 71-year old patient diagnosed with acute coronary syndrome.

Woven coronary artery anomaly is a very rare vascular disease in which the etiology is unclear. The epicardial coronary arteries, in these cases, are separated by thin tunnels and have the shape of a hair braid. It is considered as a benign anomaly, but may be associated with ischemia and adverse cardiac events. In recent years, reported adverse events associated these cases have increased in the literature. We present here a woven case with coronary artery anomaly that was associated with myocardial ischemia and pulmonary edema and was successfully revascularized by percutaneous intervention.

An 82-year-old female patient presented with complaints of dyspnea and increasing palpitations caused by food reflux. There was no risk factor except hypertension. On physical examination, the heart rate was 120 beats/min and arrhythmic and blood pressure was 130/80 mmHg. Electrocardiography showed high-rate atrial fibrillation. Laboratory parameters were unremarkable. Echocardiography illustrated a hyperechogenic and well-circumscribed mass, 40×55 mm size, in the posterior left atrium (Figure 1, Video 1). The mass size increased with breathing and the Valsalva maneuver. There was no pathology on chest radiography. The atrial fibrillation returned to sinus rhythm spontaneously, but paroxysmal atrial fibrillation attacks were observed, which were related to food reflux at follow-up. Subsequently, cardiac computed tomography, performed to determine the etiology, failed to demonstrate any pathological findings involving the left atrium. However, there was a sliding hernia in the paraesophageal region compressing the left atrium from the inferior-posterior region (Figure 2). Hiatal hernia surgery was recommended on account of the intermittently repeating symptoms. The patient refused the operation, and she is under follow-up with medical treatment.

Background/aim This study aimed to determine plasma thiol, disulphide, and serum ischemia-modified albumin (IMA) levels and ferroxidase activity in patients with ascending aorta dilatation (AAD) in comparison to those without AAD and to evaluate the predictive value of these oxidative stress parameters for AAD. Materials and methods This study was designed as a cross-sectional study of 184 patients who applied to our cardiology clinic. Our study population consisted of patients with AAD (n = 85) and without AAD (n = 99). A spectrophotometric method was used to determine plasma thiol, disulphide, and serum IMA levels and ferroxidase activity. Results The native thiol and the total thiol levels were significantly higher in the control group than the AAD group (P < 0.001), whereas the disulphide and IMA levels and the ferroxidase activity were similar between the groups. The native thiol and the total thiol levels were inversely and significantly correlated with ascending aortic diameter (r = –0.38, P < 0.001; r = –0.39, P < 0.001; respectively). The left ventricle mass and the total thiol levels were independent predictors of ascending aortic diameter (β= 0.223, P = 0.02; β= –0.340, P < 0.001; respectively). Conclusion Among oxidative stress parameters including thiols, disulphide, IMA, and ferroxidase activity, only the lower total thiol levels appear to confer a high risk for AAD development. Along with the proven diagnostic imaging methods, thiol levels may be helpful to diagnose and stratify patients with AAD.

The abstract not available.

BACKGROUND: This study evaluated the atrial electromechanical delay (AEMD) and the left atrial (LA) mechanical functions in patients with surgical early menopause. METHODS: A total of 62 patients were included in the study: 33 patients with surgical early menopause and 29 age- and sex-matched healthy controls. The duration distance from the start of the P wave to the beginning of the A wave for the lateral mitral annulus, septal mitral annulus, and lateral tricuspid annulus was assessed by tissue Doppler echocardiography. The differences in these durations were used to calculate the inter- and intra-atrial mechanical delays. LA volumes were evaluated using the biplane area-length technique, and LA mechanical function values were measured. RESULTS: The baseline laboratory and clinical characteristics were similar between the two groups. Surgical early menopause patients displayed increased static atrial electromechanical connection (PA?) times for the septal mitral annulus and lateral tricuspid annulus compared to the controls. However, the lateral mitral annulus, the inter-atrial, the intra-LA, and the right atrial EMD PA? times were not significantly altered in surgical early menopause patients compared to controls. Importantly, the LA volume index (28.1 ± 8.17 vs. 24.89 ± 7.96 mL/m2, p = 0.019), the maximal LA volume (49.6 ± 14.1 vs. 42.9 ± 16.1 mL, p = 0.004), the minimal LA volume (18.4 ± 7.0 vs. 15.2 ± 9.0 mL, p = 0.022), and the atrial precontraction LA volume (31.0 ± 10.9 vs. 24.9 ± 10.1 mL, p = 0.006) were higher in the patients with surgical early menopause compared to the controls. The LA reservoir, conduit and pumping functions and the total, passive, and active emptying volumes were all comparable between the two groups (p = 0.09; 0.06; 0.68; 0.06; 0.48; 0.07, respectively). CONCLUSIONS: Patients with surgical early menopause demonstrated impaired atrial electrical delay and electromechanical functions. © 2019 Korean Society of Echocardiography.

Amac: Gunumuz saglik hizmetleri, profesyonel isletmecilik bakis acisi ile sekillenmektedir. Daha fazla hasta cekme, gelen hastalari memnun etme ve hastanin ihtiyac duydugunda tekrar ayni hastaneyi tercih etmesini saglama saglik yoneticilerinin gundemlerindeki konulardandir. Bu calisma, bir Egitim ve Arastirma Hastanesinde Merkezi Hekim Randevu Sisteminden (MHRS) randevu alan hastalarin hizmetten beklentilerinin ve ihtiyaclarinin karsilanma duzeyinin olculmesi ve alinan sonuclara gore hastane ici iyilestirme faaliyetlerinin planlanmasini amaclamistir. Materyal ve Metot: Arastirma Ankara Ataturk Egitim ve Arastirma Hastanesi polikliniklerine basvuran ayaktan hastalari kapsamaktadir. Arastirmanin orneklemini 2014, 2015 ve 2016 yilinda ayni ay icinde poliklinik hizmeti almis 313 hasta olusturmustur. Hastalarin MHRS’den memnun olma duzeylerini olcmek amaciyla 8 soruluk bir anket formu gelistirilmistir. Anket sonuclari Microsoft Office Excel 2007 programinda degerlendirilmistir. Verilerin analizinde bagimsiz iki oran testi uygulanmistir. Bulgular: Elde edilen bulgular isiginda hastanenin poliklinigine basvuran hastalarin memnuniyet duzeyleri yuksek bulunmustur. Sadece, hastalar, randevu aldiginiz hekime muayene olabildiniz mi? sorusuna 2014 yili icin %80 oraninda evet derlerken 2015 yilinda bu oran %63,1’e dusmustur ve bu oran istatistiksel acidan anlamli bulunmustur (z=1,973; p=0,048). Sonuc: MHRS’den memnuniyeti daha da artirmak amaciyla bu tur calismalarin daha kapsamli bir sekilde yapilmasi ve iyilestirici faaliyetlerin gelistirilmesi onerilmektedir.

Objective Several studies have shown that left ventricular (LV) dysfunction is increased in individuals with diabetes. However, there are scarce data about LV function in prediabetics. This study assessed the early changes in LV diastolic and systolic myocardial function in normotensive prediabetics using tissue Doppler echocardiography (TDE). Subjects and methods We evaluated 94 patients with prediabetes (mean age of 50.8 ± 6.9 years, 78 female) without known cardiovascular diseases and 70 healthy volunteers with similar demographic characteristics. Systolic and diastolic function of the left ventricle was evaluated with transthoracic echocardiography according to the latest consensus recommendations including TDE. Results The mean results of septal and lateral parts of the mitral annulus Pulsed wave TDE showed that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em to atrial peak velocity (Am) ratio were significantly lower whereas early diastolic peak flow velocity (E) to Em ratio, myocardial isovolumetric relaxation time (IVRTm), myocardial isovolumetric contraction time (IVCTm) and myocardial performance index (MPI) values were significantly higher in patients with prediabetes (preDM). In addition, mean left atrium (LA) diameter measured with M-mode echocardiography was significantly higher in prediabetics than controls. Conclusion PreDM is associated with subclinical LV systolic and diastolic dysfunction as evaluated by TDE.