Ruptured aneurysm of noncoronary sinus of Valsalva: demonstration with magnetic resonance imaging.

There are few published reports regarding imaging findings of sinus of Valsalva aneurysms (SVA) with magnetic resonance imaging (MRI). We present an unusual form of ruptured SVA, emphasizing the diagnostic importance of MRI among a range of imaging techniques. This case report describes a case of idiopathic (thought to be congenital in origin), acutely symptomatic ruptured noncoronary SVA diagnosed by MRI and confirmed with conventional angiography and surgery. MRI accurately showed aneurysm size, location, and rupture into the right atrium and provided valuable information about this rare lesion.

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study).

Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16,270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1,000 primary care units in Turkey. The mean age of the patients was 60+/-11 years (60.1% women). Of 16,270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1,083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15,187 treated patients, 4,912 (30.2%) had a controlled systolic blood pressure, 7,063 (43.4%) a controlled diastolic blood pressure, and in 3,931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.

Determination of the site of metabolism of total, free, and complexed prostate-specific antigen.

OBJECTIVES: To determine the site of metabolism of total prostate-specific antigen (tPSA), free PSA (fPSA), and complexed PSA (cPSA). METHODS: A total of 20 male patients, 50 years old or older, having a clinical indication for left and right heart catheterization were enrolled in this study. Selective blood samples were obtained from the infrarenal, infrahepatic, and suprahepatic inferior vena cava, renal vein, hepatic vein, superior vena cava, pulmonary artery, and femoral artery. cPSA concentration was accepted as the difference between tPSA and fPSA concentrations. RESULTS: We found that tPSA and fPSA concentrations in the infrarenal inferior vena cava were significantly higher than in the systemic artery. There was no significant difference between the systemic artery and the infrarenal inferior vena cava for cPSA concentration. Although fPSA concentration decreased significantly across the renal circulation, the decreases in cPSA and tPSA concentrations were statistically insignificant. In the hepatic circulation, we found that tPSA, fPSA, and cPSA concentrations were significantly decreased. No decrease in tPSA, fPSA, and cPSA concentrations were noted across the pulmonary circulation. CONCLUSIONS: Our results indicate that fPSA and tPSA are released into serum from the prostate but the prostate may not have a significant role in complex formation of PSA. In addition, the liver has a significant role in the elimination of tPSA, fPSA, and cPSA. By contrast, the kidneys have a significant role only in the elimination of fPSA. We also found that the lungs did not have a significant role in the elimination of tPSA, fPSA, or cPSA.

Mechanical complications of intra-aortic balloon counterpulsation.

Intra-aortic balloon counterpulsation (IABP) related complications in a heterogeneous group of patients who received an IABP before or after thrombolytic therapy and mechanical revascularization or in the management of refractory unstable angina and myocardial infarction related mechanical complications were evaluated prospectively. Ninety-one patients were enrolled to the study. Mean IABP duration was 4.3+/-2.4 days. While the IABP was in place, three patients (3.3%) had femoral artery emboli, four patients (4.4%) had lower extremity ischemia that resolved after the removal of the balloon, eight patients (8.8%) had groin hematoma requiring blood transfusion (< or =2 units) and four patients (4.4%) had intra-aortic balloon rupture. The relation of several risk factors to groin hematoma requiring < or =2 units blood transfusion, emboli, lower extremity ischemia and to total complications was evaluated. A chi-squared analysis showed that nadroparine use was more often complicated with emboli (P = 0.00005) and ischemic events (emboli and/or lower extremity ischemia) (three patients; 30% of nadroparine group vs. four patients; 4.9% of heparin group, P = 0.005) and hypercholesterolemia (>200 mg/dl) was more often complicated with lower extremity ischemia (P = 0.017). Forward conditional logistic regression analysis did not show any relation between the risk factors identified and emboli, lower extremity ischemia, ischemic events and groin hematoma (P>0.05), but an inverse relation was found between IABP duration and total complications (P = 0.0198). In conclusion, IABP related complications were found to remain unchanged but were not life-threatening and were inversely related to IABP duration and this suggests shorter periods of IABP use whenever possible and one must be cautious to use low molecular weight heparin in patients with an IABP in place.

Effect of intraaortic balloon counter-pulsation on QT dispersion in acute anterior myocardial infarction.

The present prospective non-randomized study aimed to examine whether intraaortic balloon counter-pulsation (IABP) has a favorable effect on QT dispersion in patients with acute anterior MI. Patients with acute anterior MI who presented within 6 h after the symptom onset were assigned to the IABP + streptokinase or streptokinase (STK) group. The IABP + STK group was consisted of 26 men and two women (mean age 52.9+/-10.2). The STK group was consisted of 19 men and two women (mean age 54.4+/-10.8). In the IABP + STK group, mean QT interval dispersion significantly shortened 6 h after treatment (50.9+/-15.6 ms before STK, and 36+/-13.9 ms 6 h after STK; P = 0.001) and did not significantly change 24 h after STK (35.6+/-11.2 ms). In the STK group, mean QT interval dispersion did not vary significantly before and 6 h after STK (57.14+/-13.2 ms before STK, and 56.07+/-13.3 ms 6 h after STK; P > 0.05) but 24 h after STK it significantly shortened to 40.42+/-10.8 ms (P < 0.001). Before STK, mean QT interval dispersions in the IABP + STK and STK groups were 50.9+/-15.6 ms and 57.14+/-13.2 ms, respectively (P > 0.05), 6 h after STK, mean QT interval dispersions were 36+/-13.9 ms and 56.07+/-13.3 ms, respectively (P = 0.0001) and 24 h after STK, mean QT interval dispersions were 35.6+/-11.2 ms and 40.42+/-10.8 ms, respectively (P > 0.05). In conclusion this study demonstrates that the adjunct of IABP to thrombolytic therapy, in the setting of acute anterior MI, significantly decreases QT interval dispersion at 6 h and this effect might be secondary to accelerated reperfusion and/or other beneficial effects of IABP.

Traumatic tricuspid insufficiency following blunt chest trauma.

The insufficiency of the tricuspid valve developed due to blunt chest trauma is a rare and an insidiously progressing clinical incident. In this article we present a case which showed tricuspid insufficiency because of the rupture of the anterior papillary muscle due to trauma and which was treated surgically.

Concomitant use of intraaortic balloon counterpulsation and streptokinase in acute anterior myocardial infarction.

Using a prospective, nonrandomized design, the authors sought to determine whether concomitant use of intraaortic balloon counterpulsation (IABP) and streptokinase in acute anterior myocardial infarction (MI) would improve the in-hospital mortality rate and angiographic findings. The study included 45 patients with an acute anterior MI. All patients received intravenous streptokinase. Among these, 25 patients had concomitant IABP while the remaining 20 patients had streptokinase alone. All patients underwent cardiac catheterization. Patients treated with concomitant IABP had a significantly higher frequency of thrombolysis in myocardial infarction (TIMI) grade 3 flow (n: 11; 44% vs n: 1; 5%, p<0.05), and there was a trend toward a lower in-hospital mortality rate in the IABP group (n: 0; 0% vs n: 3; 15%, p=0.08). The angiographic presence of thrombus image and grade > or =2 coronary collateral circulation to the infarct-related coronary artery for the IABP and non-IABP groups did not differ significantly. The preliminary results of this study suggest that concomitant use of IABP and streptokinase in acute anterior MI increases the incidence of TIMI grade 3 flow and may have decreased the in-hospital mortality rate without unacceptable rates of vascular or hemorrhagic complications.

[Demographic and clinical features of coronary artery patients in the district of Antalya and comparison of them with Turkey's averages]. / Antalya bölgesindeki koroner arter hastalarinin demografik ve klinik özellikleri ve bu özelliklerinin Türkiye ortalamalari ile karsilastirilmasi.

OBJECTIVES: Many studies have proved high plasma cholesterol and triglyceride levels as determinant major risk factors for coronary artery disease. It is also well known that coronary artery disease incidence and related mortality and morbidity is low in communities applying Mediterranean diet. Turkey, having a high incidence of coronary artery disease, is unique because of the diversity of eating habits in different regions of the country. The inhabitants of Antalya region of interest in our study, are generally kept Mediterranean diet. We thought to determine the clinical and demographic features of the coronary artery disease patients living in the district of Antalya, and to find out if they correlate with Turkey's averages when compared. We also searched for the preventive effect of Mediterranean diet, if there was any. METHODS: 516 patients, who were admitted to the department of cardiology, were investigated in terms of age, sex, smoking habits, hypertension, hyperlipidemia, diabetes, family history, angina class, usage of aspirin and nitrates. RESULTS: The results revealed that clinical and demographical features of the coronary artery disease in the district of Antalya were similar with turkey's averages and that the benefits brought by the preventive effects of Mediterranean diet, might have been comprised by smoking.

Ischemia modified albumin levels cannot predict stress induced ischemia shown by myocardial perfusion scintigraphy.

PURPOSE: Ischemia modified albumin (IMA) is a new marker of ischemia which is used in especially emergency room. Aim of this study is showing the association of IMA with stress induced ischemia on Tc-99m 2-methoxyisobutyl-nitrate (MIBI) myocardial perfusion scintigraphy (MPS). METHODS: 56 patients (23 F, 33 M; 56.04 ± 8.45 years old) were included in our study. Stress-rest two days protocol Tc-99m MIBI MPS single photon emission tomography (SPECT) was performed to all patients. IMA levels from the blood samples which were taken before and after the treadmill test were measured. Thirty patients additionally underwent coronary angiography. RESULTS: The difference of IMA levels of ischemia between positive and negative groups was not statistically significant. Also, there was not statistically significant difference between IMA levels of patients who have narrowing in the coronary arteries and not. CONCLUSION: Although IMA is an important marker of ischemia, probably because of other ischemic process during stress; it cannot reflect stress induced ischemic changes on MPS.

Thoracic aortocaval fistula due to gunshot wound.

This article presents a patient with an arteriovenous fistula between the brachiocephalic trunk and superior vena cava, a site not otherwise reported in the literature so far. The fistula was presumably the result of an accidental gunshot wound 8 years previously. Following the diagnosis, the fistula was repaired without any complication and the patient's symptoms disappeared.

Erythrocyte selenium-glutathione peroxidase activity is lower in patients with coronary atherosclerosis.

To obtain further insight into the role of erythrocyte antioxidant systems in the development of atherosclerosis, intraerythrocyte enzyme activities and selenium levels in erythrocytes were determined in 37 patients with angiographically proved coronary artery stenosis and 15 subjects with normal coronary angiograms as controls. In a preliminary study, the enzymatic activities of glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GR) and selenium-dependent glutathione peroxidase (Se-GPx) were measured in both venous and arterial blood samples obtained from patients before angiography. The data of the preliminary study, which showed that only the Se-GPx decreased in the patients, led us to concentrate on the Se-GPx and Se levels to determine the changes in these variables. Our results showed that there was a decrease in both the activity of Se-GPx and Se levels in erythrocytes parallel to the increase in the severity of coronary artery disease. It was concluded that these parameters might be used as determinants in the assessment of the severity of the disease.

Comparative clinical and angiographic analysis of the initial efficacy and long-term follow-up of Wiktor stent implantation with conventional balloon angioplasty.

This study was retrospectively designed to examine if the Wiktor stent, a balloon-expandable tantalum coil stent, provides a more favorable procedural and long-term clinical and angiographic outcome than does conventional coronary balloon angioplasty (POBA). From April 1995 to April 1996, we implanted 56 Wiktor stents in 46 lesions (LAD: 23, RCA: 16, CX: 7) in 42 patients (average age 53 +/- 10 years). Coronary lesions from the stent group were matched with similar lesions of another 42 POBA patients whose characteristics were identical to the Wiktor group. Revascularization indications in the Wiktor and POBA groups, respectively, were recent myocardial infarction (RMI) (45%, 40%), unstable (31%, 39%) and stable (24%, 21%) angina pectoris. 7% of the stents and 17% of the POBA balloons were less than 3 mm in diameter (p > 0.05). Procedural success was significantly greater in the Wiktor group than in the POBA group (100% vs. 92%, p < 0.05). Neither major cardiac event (death, CABG, acute myocardial infarction) nor (sub)acute occlusion was encountered in the Wiktor group during the hospitalization period and 1 month follow-up. There was 1 urgent CABG and 4 subacute occlusions in the POBA group. Control angiography at 8 months was performed in patients of both groups, of whom some were symptomatic at long-term follow-up or completely event free for 8 months. Angiographic restenosis (> 50% diameter stenosis) occurred in 25% of the Wiktor patients and in 43% of those in the POBA group (p < 0.05). For an 18 month clinical follow-up, 91% of the patients in the Wiktor group were asymptomatic and without ischemia in radionuclide imaging (RI), whereas 79% of the POBA patients were angina-free and 74% were without ischemia in the RI study. In conclusion, Wiktor stent implantation, with no major cardiac event or subacute occlusion, provides a more favorable procedural and long-term clinical and angiographic outcome than does conventional POBA.

Los niveles de albúmina modificada por la isquemia no predicen la isquemia inducida por el estrés en la gammagrafía de perfusión miocárdica / Ischemia modified albumin levels cannot predict stress induced ischemia shown by myocardial perfusion scintigraphy

Propósito. La albúmina modificada por isquemia (AMI) es un nuevo marcador de isquemia que se utiliza especialmente en urgencias. El objetivo de este estudio es mostrar la asociación de la AMI con isquemia inducida por el estrés en la gammagrafía de perfusión miocárdica (MPS) con 99mTc 2-metoxi-nitrato (MIBI). Métodos. En nuestro estudio se incluyeron 56 pacientes (23 mujeres, 33 hombres; 56, 04 ± 8,45 años). A todos los pacientes se les realizó un MPS con MIBI siguiendo un protocolo reposo-estrés de 2 días. Los niveles séricos de AMI se midieron antes y después de la prueba de esfuerzo. Además, a treinta pacientes se les realizó un estudio hemodinámico. Resultados. No se encontró una diferencia estadística significativa entre los niveles de AMI en los grupos de pacientes que tenían isquemia y los que no tenían isquemia. Además, no hubo diferencia estadísticamente significativa entre los niveles de AMI de los pacientes con estenosis en las arterias coronarias y los que no mostraron estenosis. Conclusión. A pesar de que la AMI es un marcador importante de la isquemia, no puede reflejar el estrés inducido por cambios isquémicos en el MPS probablemente a causa de otros procesos isquemicos que se producen durante el estrés(AU)

Purpose. Ischemia modified albumin (IMA) is a new marker of ischemia which is used in especially emergency room. Aim of this study is showing the association of IMA with stress induced ischemia on Tc-99m 2-methoxyisobutyl-nitrate (MIBI) myocardial perfusion scintigraphy (MPS). Methods. 56 patients (23 F, 33 M; 56.04±8.45 years old) were included in our study. Stress-rest two days protocol Tc-99m MIBI MPS single photon emission tomography (SPECT) was performed to all patients. IMA levels from the blood samples which were taken before and after the treadmill test were measured. Thirty patients additionally underwent coronary angiography. Results. The difference of IMA levels of ischemia between positive and negative groups was not statistically significant. Also, there was not statistically significant difference between IMA levels of patients who have narrowing in the coronary arteries and not. Conclusion. Although IMA is an important marker of ischemia, probably because of other ischemic process during stress; it cannot reflect stress induced ischemic changes on MPS(AU)