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Öğe Aberrant right ventricular branch of right coronary artery with mitral valve prolapse(2004) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer Ali; Özhan, Hakan; Akdemir, Ramazan; Özkökeli, Mehmet; Uyan, CihangirA 37-year-old man presented with a three-week history of chest pain. Transthoracic echocardiography demonstrated a mitral valve prolapse and mild mitral insufficiency. Coronary angiography showed normal left main, circumflex, left anterior descending and right coronary arteries; however, the right ventricular branch of the right coronary artery had a separate ostium. Concomitant congenital heart abnormaliries have been observed with coronary artery anomalies. Primary congenital coronary and valvular anomalies may have genetic heredity. In the present case, mitral valve prolapse was accompanied by a right ventricular coronary artery origin anomaly which, to the best of our knowledge, is the first report in the literature in which both anomalies presented together. © 2004 Pulsus Group Inc. All rights reserved.Öğe Aberrant right ventricular coronary artery: Case report(2003) Akdemir, Ramazan; Yazıcı, Mehmet; Tataroğlu, Cenk; Uyan, Cihangir; Gündüz, Hüseyin; Erbilen, EnverThis case describes a 50-year-old woman with the abnormal origin of a right ventricular branch of the right coronary artery originating from the same ostium in the right coronary sinus. Coronary artery anomalies, constitute roughly 0.64% to 1.2% of all the representations encountered during coronary angiography. We suggest that the presence of such a vessel must be shown in patients undergoing coronary angiography and/or cardiac surgery.Öğe Akut viral hepatit'te N-asetilsistein tedavisi(2003) Gündüz, Hüseyin; Tabak, Ö. Fehmi; Tamer, Ali; Özaras, Reşat; Mert, AliAmaç: Akut viral hepatit (AVH) sık, uzun seyirli ve seyrek olmayarak ciddi sorunlara yol açabilen önemli bir hastalıktır. Ülkemizin de aralarında bulunduğu gelişmekte olan ülkeler için bir toplum sağlığı sorunu niteliğindedir AVH olgularında hastalık süresini kısaltabilen bir tedaviye gereksinim açık iken bu alandaki boşluk henüz doldurulabilmiş değildir. Çalışmamızın amacı hücre içi glutatyon miktarını arttırarak potansiyel toksik ajanlar olan serbest oksijen radikalleri ile reaksiyona girip hücresel bütünlüğü koruyabilen N-asetilsistein (NAS)in AVH tedavisindeki etkisini araştırmaktır. Gereç ve Yöntem: Bu amaçla AVH tanısıyla yatırılarak izlenen hastalari iki gruba ayırıp çalışma grubunda günde üç kez 200 mg (600 mg/gün), oral NAS; kontrol grubunda ise plasebo kapsüller uyguladık. Hastaların çalışmaya dahil edilmelerinden itibaren serum total ve direkt bilirubin, ALT, AST, alkali fosfataz, albümin ve globulin seviyeleri, protrombin aktiviteleri haftada iki kere ölçüldü. Bu izlem serum total bilirubin seviyesinin 2 mg/dl'ye, ALT düzeyinin 100 U/L'nin altına inmesine kadar sürdürülerek hastalar taburcu edildi. Bulgular: İ.Ü Cerrahpaşa Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Enfeksiyon Hastalıkları Bilim Dalı'na AVH tanısıyla yatırılan 41 olgu çalışmaya alındı. Olguların 13 (%31.7)'ü kadın, 28 (%68.3)'i erkekti. Tüm olgularda ortanca yaş 24 (sınırlar:15-52) olup A tipinde ortanca yaş 17 (sınırlar:16-28), B tipinde ise ortanca yaş 26 (sınırlar:15-52) bulundu. Çalışma grubunda ortanca yaş 23 (sınırlar:15-48) kontrol grubunda ise ortanca yaş 24 (sınırlar:16-52) bulundu. HAV ile enfekte hastaların yaşı belirgin olarak küçüktü. Olguların serolojik ayırımında A tipi 9 (%22), B tipi 32 (%78) olguda bulundu. Çalışma grubunda A tipi 4 (%20), B tipi 16 (%80), kontrol grubunda ise A tipi 5 (%23.7), B tipi 16 (%76.4) idi. ALT nin normale dönüş süresi çalışma grubunda 19.7±6.9 gün (A tipi 11.2±6.1 gün, B tipinde 21.8±6.1gün), kontrol grubunda ise 20.4±6.5 gün (A tipi 16±7.4 gün, B tipi 21.8 ±6.7 gün) bulundu. Total bilirubin'in normale dönüş süresi çalışma grubunda 13.7±8.5 gün (A tipi 7.9± 4.9 gün, B tipi 15.2±8.6 gün), kontrol grubunda ise 16.9±7.8 gün (A tipi 12±6.3 gün, B tipi 18.4 ± 8.1 gün) olarak bulundu. Sonuç: NAS kullandığımız hastaların ALT ve total bilirubin değerlerinin normale dönme süresi dolayısıyla hastanede yatış süresi kısalmamış veya olumsuz yönde etkilenip uzamamıştır. Bu bulguların ikterli AVH'in tedavisi için NAS'in önerilemeyeceği sonucu çıkartılabilmektedir. Ayrıca bu ilacın AVH olgularında zararlı olmadığı da anlaşılmıştır.Öğe Albendazole versus metronidazole treatment of adult giardiasis: An open randomized clinical study(WJG Press, 2004) Karabay, Oguz; Tamer, Ali; Gündüz, Hüseyin; Kayaş, Derya; Arınç, Hüseyin; Çelebi, HarikaAim: To investigate the efficacy and tolerability of albendazole and metranidazole treatment in giardiasis. Methods: The open comparative randomized trial was carried out prospectively from December 1999 to July 2001 in Duzce City of Turkey. The diagnosis was based on the presence of signs and symptoms compatible with giardiasis including a positive stool examination of giardia cysts or trophozoite. Metranidazole group consisted of 29 patients and was given metranidazole 500 mg, three times a day for 5 d and albendazole group was consisted of 28 patients and was given albendazole 400 mg/d for 5 d. Results: There were no significant differences in demographical and therapeutical effects and patient's compliance between both groups. But side effects were seen more in metranidazole group than in albendazole group. Conclusion: Albendazole is as effective as metranidazole in adults' giardiasis. Albendazole has less side effect potentials than metranidazole in the treatment of giardiasis. Copyright © 2004 by The WJG Press.Öğe Angiotensin-converting enzyme, angiotensin II receptor, apolipoprotein E and endothelial constitutive nitric oxide synthase gene polymorphisms in dilated cardiomyopathy(2004) Özhan, Hakan; Zungur, Mustafa; Yazıcı, Mehmet; Akdemir, Ramazan; Gündüz, Hüseyin; Erbilen, Enver; Albayrak, Sinan; Uyan, CihangirAmaç: Dilate kardiyomiyopati (DCM) sol yada her iki ventrikülün sistolik fonksiyonlarının bozulması ve genişlemesi ile karakterize bir hastalıktır. Ailesel kökenli DCM'nin tanımlanmasından sonra ailesel olmayan DCM olguları için de genetik faktörlerin rol oynayabileceği düşünülmüş ve konuyla ilgili araştırmalar yapılmıştır. Makalemizde ülkemizde yaşayan DCM'li olgularda, hastalığın patofizyolojisinde rol oynaması muhtemel dört aday genin polimorfizmleri araştırılmıştır (Angiotensin dönüştürücü enzim (ACE) I/D polimorfizmi, angiotensin II reseptör (AGTR1) 1166 A/C polimorfizmi, apolipoprotein E (APOE) ve endotelyal konstitütif nitrik oksit sentaz (ecNOS) geni polimorfizmi). Ortalama yaşı 58±12 olan ardışık 76 hasta ve yaş ortalaması 59±12 olan 88 kontrol grubu çalışmaya alındı. Bütün hastalara ve kontrol grubuna ekokardiyografik çalışma yapıldı. DCM tanısı için ekokardiyografik olarak end-diastolik çapın >55mm ve ejeksiyon fraksiyonunun <%40 altında olması kriter alındı. Yine hasta grubuna koroner anjiografi yapılarak hastalar iskemik ve idyopatik DCM gruplarına ayrıldı. Spesifik kalp kası hastalığı, izole sağ ventrikül genişlemesi, kapak ve perikard hastalığı olanlar çalışma dışında tutuldu. Hasta ve kontrol grubunun kan hücrelerinden deoxiribonükleik asit (DNA) spesifik polimeraz zincir reaksiyonu (PCR) yöntemi ile genetik analiz yapıldı. Gen distribüsyonu ki kare testi ile değerlendirildi. Bağımsız risk için multivariate regresyon analizi uygulandı. 0,05 altındaki p değerleri istatistiksel olarak anlamlı kabul edildi. Sonuçlar: Hasta ve kontrol grubunun allel sıklıkları, ekokardiyografi, biyokimya analizi sonuçları ve demografik verileri karşılaştırıldı. APO E gen allel sıklığına ait dağılım her iki grupta farklılık gösterse de regresyon analizi sonuçlarına göre bu farklılığın bağımsız bir risk oluşturmadığı gözlendi.Öğe Aort darlığında plazma homosistein yüksekliği koroner arter hastalığı varlığını gösterebilir mi?(2003) Gündüz, Hüseyin; Akdemir, Ramazan; Tamer, Ali; Binak, Emrah; Ayarcan, YaseminAmaç: Kalsifik aort kapak hastalığı tespit edilen hastalardaki kardiyak risk faktörleri koroner arter hastalığı (KAH) ile benzer olup, koroner arter hastalığı prevalansı artmıştır. Son zamanlarda yapılan çalışmalarda; artmış plazma homosistein konsantrasyonunun koroner arter hastalığı için bağımsız bir risk faktörü olduğu, çeşitli mekanizmalarla ateroskleroza yol açarak aterosklerotik damar hastalıklarını ve venöz sistemde trombüs oluşumunu kolaylaştırıcı etki gösterdiği tespit edilmiştir. Fakat aort darlığı olan hastalarda plazma homosistein düzeyinin koroner arter hastalığı varlığı ile ilişkisi araştırılmamıştır. Bu çalışmanın amaçları; orta-ileri aort darlığı olan hastalarda plazma homosistein düzeyininin koroner arter hastalığı varlığını ne şekilde etkilediğini araştırmak ve aort darlığında homosistein düzeyi, koroner arter hastalığı varlığının noninvaziv bir belirleyicisi olabilir mi sorusuna cevap aramaktır. Gereç ve Yöntem: Çalışmaya transtorasik ekokardiyografi ile orta-ileri derecede aort darlığı tespit edilen ve sonrasında koroner anjiyografi yapılan toplam 58 hasta (koroner arter hastalığı olan 30, koroner arter hastalığı olmayan 28 hasta) alındı. Hastaların 12 saatlik açlık sonrası venöz kan örnekleri alınarak serum total kolesterol, LDL ve HDL kolesterol, trigliserid ve ELİSA yöntemiyle homosistein düzeyleri ölçüldü. Bulgular: Koroner arter hastalığı olan hastalarda (17 erkek,13 kadın, ortalama yaş 66±10 yıl) total kolesterol 266±45 mg/dL, trigliserid 194±93 mg/dL, LDL mg/dL 174±44, HDL 45±5 mg/dL, Homosistein düzeyi 13.2±3.1 µmol/l bulundu. Koroner arter hastalığı olmayan hastalarda ise (18 erkek,10 kadın, ortalama yaş 61±12 yıl) total kolesterol 204±38 mg/dL trigliserid 122±73 mg/dL, LDL 132±33 mg/dL, HDL 48±5 mg/dL, homosistein düzeyi 8.3±2.2 µmol/l bulundu. Koroner arter hastalığı olan hastalarda total kolesterol (p<0.01), LDL (p<0.05) ve homosistein düzeyi (p<0.01) anlamlı olarak yüksek bulundu. Sonuç: Bu sonuçlar orta-ileri aort darlığı olan hastalarda plazma homosistein düzeyindeki yüksekliğin koroner arter hastalığı varlığı ile korele olduğunu göstermektedir. Ayrıca aort darlığında koroner arter hastalığı varlığını gösteren bir noninvaziv test olarak araştırılması gerektiğini düşündürtmektedir.Öğe Atrial fibrillation after electrical shock: a case report and review(B M J Publishing Group, 2004) Akdemir, Ramazan; Gündüz, Hüseyin; Erbilen, Enver; Özer, İlker; Albayrak, Sinan; Ünlü, Hakan; Uyan, CihangirA 52 year old man was admitted to an emergency department with a fast ventricular rate atrial fibrillation after an electrical shock. Electrical cardioversion was attempted after echocardiographic examination. This failed, but the heart rate slowed. Successful pharmacological cardioversion was achieved after 16 hours of amiodarone infusion. Preexcitation syndrome was detected on baseline echocardiograph. Serum cardiac specific markers were all within normal limits. No abnormal findings were detected by chest radiography, echocardiographic, or coronary angiographic investigations. Acute onset atrial fibrillation after electrical injury is discussed.Öğe Blood pressure changes after aortic coarctation surgery performed in adulthood(Wiley, 2005) Özkökeli, Mehmet; Şensöz, Yavuz; Günay, Rafet; Ateş, Mehmet; Gündüz, Hüseyin; Tayyareci, Gülşah; Akçar, MuratObjective: The aim of this study was to assess the effect of aortic coarctation surgery in adult patients on arterial blood pressure in the early postoperative period. Methods: Ninety-three adult patients (61 male, 32 female) aged 15-43 years who had operation since 1962 for aortic coarctation in Siyami Ersek Cardiovascular Surgery Center were retrospectively evaluated. Tube graft interposition was done in 31 patients; resection and end-to-end anastomosis were performed in 32 patients; 24 patients had undergone pathchplasty; and 6 patients by-pass shunting performed. The effect of surgery on the blood pressure was investigated. Results: The mean systolic and diastolic blood pressure significantly reduced after operation (systolic 193.6 +/- 33.7 mmHg vs 147.4 +/- 22.0 mmHg, diastolic 99.8 +/- 17.9 mmHg vs 82.0 +/- 10.8 mmHg). From 93 patients (all with hypertension) 54 (58 %) became normotensive after operation according to Vlth Joint National Committee classification. The number of normotensive patients after operation was 28 (of 37) for 15-19 years age group, 14 (of 23) for the 20-24 years age group, 4 (of 16) for 25-29 years age group, 6 (of 11) for 30-34 years age group, and 2 (of 6) for the over 35 years old age group. Conclusion: The diastolic and systolic blood pressures reduce significantly in the adult patients operated for aortic coarctation. On the other hand, persistent hypertension seemed to increase in the older age groups in spite of the surgery.Öğe Can serum lipid and CRP levels predict the "severity" of aortic valve stenosis?(Taylor & Francis Ltd, 2003) Gündüz, Hüseyin; Akdemir, Ramazan; Binak, Emrah; Tamer, Ali; Keser, Nurgül; Uyan, CihangirBackground - Results of the studies performed have suggested that hypercholesterolaemia and inflammation are important aetiologic factors in aortic valve stenosis (AVS). However up to now no such data has been obtained to evaluate whether these predictors may still serve as valuable tools to estimate the progression and severity of AVS. If factors contributing to the "progression" of degenerative process can be understood and preventive measures can be taken, both clinical and economical beneficial effects can be achieved. The objective of this study is to investigate the correlation of serum cholesterol, triglyceride and CRP levels with the severity of aortic stenosis echocardiographically evaluated in patients with aortic valve stenosis. Material and methods -Aortic valvular areas of 60 patients (pts) hospitalized in our clinic with suspected AVS were calculated with Doppler echocardiography. Patients were grouped into mild, moderate and advanced AVS, each category containing 20 pts, and then were subclassified regarding those with and without coronary artery disease(CAD). Results -Total cholesterol and CRP levels were found to be 215 +/- 42 mg/dl and 2.0 +/- 1.4 mg/dl; 224 +/- 43 mg/dl and 2.4 +/- 2.1 mg/dl; 225 +/- 55 mg/dl and 2.7 +/- 2.1 mg/dl in pts with mild, moderate and advanced AVS, respectively. A statistically significant difference was not detected among the three groups (p>0.05). When subclasses were classified the levels were found to be much more increased in those patients having additional CAD. Conclusion - We have demonstrated that severity of AVS does not correlate significantly with hypercholesterolaemia and CRP and their levels do not rise in accordance with increasing severity of AVS. Elevations of lipid levels in AVS were found to correlate with the presence of CAD rather than the severity of AVS. So, not in patients with simply AVS but in patients under higher cardiovascular risks, investigation of CRP plus lipid levels might provide benefit with respect to preventive treatment and benefit from cholesterol-lowering drugs can be expected in such kind of patients.Öğe The cardiac effects of a mobile phone positioned closest to the heart(2009) Tamer, Ali; Gündüz, Hüseyin; Özyıldırım, SerkanAmaç: Bu çalışmanın amacı cep telefonu (CT) prekordiyal bölgedeyken kalp hızı değişkenliği (KHD), QT ve P-dalga dispersiyonu ve kan basıncı (KB) değerlerini kullanarak kardiyak elektriksel aktiviteye CT’nun etkisini değerlendirmektir. Yöntemler: Bu prospektif çalışmaya 24 sağlıklı gönüllü alındı. İlk aşamada, CT olmaksızın, CT prekordiyal bölgede kalbin üzerinde kapalı, açık ve aranırken modlarında 12 derivasyonlu elektrokardiyografi (EKG) ve KB değerleri kaydedildi. İkinci aşamada; CT olmaksızın ve CT açık ve prekordiyal bölgedeyken 30’ar dakikalık Holter-EKG ve tansiyon-Holter ölçümleri yapıldı. P-dalga ve QT dispersiyonu 12 derivasyonlu EKG kayıtlarından hesaplandı, KHD ise 24-saat Holter kayıtlarından ölçüldü. İstatistiksel analizde, cep telefonu olmaksızın ve CT açık modunda, hemodinami ve KHD parametrelerinin karşılaştırılması için eşleştirilmiş t testi kullanıldı. Cep telefonu olmaksızın, kapalı, açık ve aranırken modlarında, hemodinami ve EKG parametrelerinin karşılaştırılması için tekrarlayan ölçümler için ANOVA testi kullanıldı. Bulgular: Çalışmanın ilk aşamasında; gruplar arasında KB, kalp hızı, P-dalga ve QT dispersiyonu parametreleri açısından anlamlı ilişki tespit edilmedi (p>0.05). İkinci aşamada; 2 grup arasında KB, kalp hızı ve KHD parametreleri arasında anlamlı ilişki saptanmadı (p>0.05). Sonuç: Sağlıklı erişkin bireylerde CT farklı modlarda kalbe en yakın pozisyonda kalp hızı, kan basıncını etklilememekte ve kardiyak otonomik disfonksiyona neden olmamaktadır.Öğe Cardiac emergencies caused by honey ingestion: a single centre experience(B M J Publishing Group, 2004) Özhan, Hakan; Akdemir, Ramazan; Yazıcı, Mehmet; Gündüz, Hüseyin; Duran, Sadık; Uyan, CihangirAn unusual type of food poisoning is commonly seen in the Black Sea coast of Turkey attributable to andromedotoxin containing toxic honey ingestion. This study is a retrospective case series of 19 patients admitted to an emergency department in 2002, poisoned by "mad'' honey. All of the patients had the complaints of nausea, vomiting, sweating, dizziness, and weakness, several hours after ingesting "mad'' honey. Physical examination showed hypotension in 15 patients, sinus bradycardia in 15, and complete atrioventricular block (AVB) in four patients on admission. Two patients with bradycardia and two with AVB fell and injured their heads. Three of them presented with local haematoma. One patient had a 6 cm cut on his head without any neurological deficit and his cranial computed tomography imaging was normal. Hypotension and conduction disorders resolved with atropine treatment, resulting in complete recovery within 24 hours.Öğe A case of coronary artery fistula with mitral stenosis(Kluwer Academic Publ, 2003) Gündüz, Hüseyin; Akdemir, Ramazan; Binak, Emrah; Ayarcan, Yasemin; Kurtoğlu, Nuri; Uyan, CihangirCoronary artery fistulae, being a rare form of congenital anomalies of the coronary arteries, are usually discovered by chance during coronary arteriography. However, these fistulae can cause an important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. The coincidence of mitral stenosis and congenital artery fistula is rare in the literature. In our case report, a patient with a coronary artery fistula originating from the circumflex, draining to the main pulmonary artery, discovered at cardiac catheterization and coronary angiography done with a prediagnosis of mitral stenosis is presented in the light of the literature.Öğe A case of hypothyroidism mimicking acute coronary syndrome(2006) Gündüz, Hüseyin; Arınç, Hüseyin; Yolcu, Mustafa; Akdemir, Ramazan; Kanat, Mustafa; Uyan, CihangirHypothyroid patients have increased concentrations of creatinine kinase that is mostly due to increased CK-MM. However, CK-MB has also been reported to increase above reference values in hypothyroid patients without apparent myocardial damage. This may create confusion during the evaluation of myocardial injury in a hypothyroid patient presenting with chest pain. Troponin I is considered as a superior marker for the diagnosis of myocardial infarction in hypothyroid patients. However, there are some reports showing an increase in the level of troponin I without any myocardial damage in hypothyroid patients as in our case. In this report, we present a 47 years old male hypothyroid patient who had chest pain, abnormal electrocardiographic findings and increased cardiac enzymes suggesting acute coronary syndrome although he had normal coronary arteriogram. © Springer 2005.Öğe Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation(2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Ünlü, Hakan; Bulur, Serkan; Uyan, Cihangir; Arınç, HüseyinThe aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). This new transthoracic Doppler echocardiographic technique is easier and equally or more practical than qualitative and quantitative methods used to grade MR in patients both with normal and low left ventricular ejection fraction (LVEF). Color M-mode echocardiography allows resolution of regurgitant flow propagation along the echocardiography beam inside the left atrium. The characteristics of the velocity of this jet have not been studied in detail before. The present study compares the different qualitative and quantitative methods of MR grading with the RFPV. We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA) and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these 3 methods was determined. The mean RFPV for mild, moderate and severe MR were 26.4±7 cm/s, 43.3±7 cm/s and 60.3±7.3, respectively (p<0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1-64.3% for mild and 100-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC and RJA (p<0.0001, r=.87; p<0.0001, r=-.84; p<0.0001, r=.76, respectively). This results show that RFPV is a reliable and simple semi-quantitative new method that can be used for determining severity of MR.Öğe Color m-mode regurgitant flow propagation velocity: a new echocardiographic method for grading of mitral regurgitation(Blackwell Publishing, 2005) Akdemir, Ramazan; Özhan, Hakan; Bulur, Serkan; Ünlü, Hakan; Gündüz, Hüseyin; Arınç, Hüseyin; Uyan, CihangirPurpose: The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). Methods: We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients, and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA), and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these three methods was determined. Results: The mean RFPV for mild, moderate, and severe MR were 26.4 +/- 7 cm/sec, 43.3 +/- 7 cm/sec, and 60.3 +/- 7.3 respectively (P < 0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1%-64.3% for mild and 100%-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC, and RJA (P < 0.0001, r = 0.87; P < 0.0001, r = -0.84, P < 0.0001, r = 0.76, respectively). Conclusion: This results show that RFPV is a reliable and simple semiquantitative new method that can be used for determining severity of MR.Öğe Color M-mode regurgitant flow propagation velocity: A new echocardiographic method for grading of mitral regurgitation(2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Yazici, Mehmet; Erbilen, Enver; Albayrak, Sinan; Ünlü, HakanThe aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR). This new transthoracic Doppler echocardiographic technique is easier and equally or more practical than qualitative and quantitative methods used to grade MR in patients both with normal and low left ventricular ejection fraction (LVEF). Color M-mode echocardiography allows resolution of regurgitant flow propagation along the echocardiography beam inside the left atrium. The characteristics of the velocity of this jet have not been studied in detail before. The present study compares the different qualitative and quantitative methods of MR grading with the RFPV. We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA) and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these 3 methods was determined. The mean RFPV for mild, moderate and severe MR were 26.4±7 cm/s, 43.3±7 cm/s and 60.3±7.3, respectively (p<0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1-64.3% for mild and 100-68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC and RJA (p<0.0001, r=.87; p<0.0001, r=-.84; p<0.0001, r=.76, respectively). This results show that RFPV is a reliable and simple semi-quantitative new method that can be used for determining severity of MR.Öğe Dissection of the ascending thoracic aorta as a complication of percutaneous coronary intervention(2008) Uyan, Cihangir; Arınç, Hüseyin; Gündüz, Hüseyin; Akdemir, RamazanAcute aortic dissection is a medical emergency with high morbidity and mortality requiring emergent diagnosis and therapy. A 79-year-old woman with acute aortic dissection due to percutaneous coronary intervention was presented. Aortic dissection is an uncommon but potentially lethal illness that can present in an occult manner making the initial diagnosis difficult. Aggressive medical management is mandatory, as well as urgent diagnostic testing and cardiothoracic consultation. © 2008 Uyan et al, publisher and license Dove Medical Press Ltd.Öğe Diyalize giren hastalarda önyük azalmasının kapak yetersizliklerine etkisi(2005) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Akdemir, Ramazan; Oğuzhan, Abdurrahman; Uyan, CihangirAmaç: Diyalize giren kronik böbrek yetersizlikli hastaların vücut sıvısındaki artışa bağlı olarak ekokardiyografi sırasında kalp büyüklüğü ve sol ventrikül kitlesine ait ölçümler olduğundan farklı, kapak yetersizliğiyse olduğundan fazla olarak değerlendirilebilmektedir. Çalışmamızda diyalizle birlikte yapılan ultrafiltrasyonun, sol ventrikül ve sol atriyum büyüklüklerine, vena kava inferior çapları ve kollapsibilitesine etkisi ayrıca diyaliz öncesi kapak yetersizliği saptanan hastaların yetersizlik varlığı ve ciddiyetine olan etkisi incelendi. Gereç ve Yöntemler: Bu çalışmaya son dönem böbrek yetmezliği tanısı konmuş, hipervolemisi olan ve hemodiyalizle birlikte ultrafiltrasyon yapılacak 16’sı erkek, 14’ü kadın toplam 30 hasta alındı. Diyalizle birlikte yapılan ultrafiltrasyon öncesi ve sonrası ekokardiyografi ile sol ventrikül diyastolik-sistolik genişlikleri, septum ve arka duvar diyastolik-sistolik kalınlıkları, sol atriyum genişliği, aort çapı ve varsa perikardiyal sıvı ölçümleri yapıldı. Mitral, aort, triküspid ve pulmoner kapak fonksiyonları, varsa kaçak akımları 4 üzerinden derecelendirildi. Vena kava inferior inspiratuar ve ekspiratuar çapları ölçülüp, vena kava inferior çökebilirlik indeksi hesaplandı. Bulgular: Hemodiyaliz sonrası sol atriyum büyüklüğünde, sol ventrikül diyastolik ve sistolik genişliklerinde anlamlı azalma oldu. Hastaların mitral ve triküspid yetersizliği ciddiyetinde belirgin azalma olurken, aort ve pulmoner yetersizlikleri ciddiyetindeyse belirgin azalma saptanmadı. Vena kava inferior inspiryum ve ekspiryumdaki çaplarında anlamlı küçülme, çökebilirliğinde anlamlı artış saptandı. Sonuç: Diyalizde sıvı azaltılmasına bağlı hemodinamik ve ekokardiyografik parametrelerde anlamlı değişiklikler olmaktadır. Özellikle kapak yetersizliklerinin varlığında ve ciddiyetinde azalma olmaktadır.Öğe Does the prevalence of nasal polyps increase in patients using statins?(Springer, 2007) Yılmaz, Fahrettin; Gündüz, Hüseyin; Arınç, Hüseyin; Talay, Fahrettin; Özyıldırım, Serhan; Akyürek, Fatma; Uyan, CihangirSeveral statins inhibit T-helper I development and induce T-helper 2 polarization and production of T-helper 2 cytokines that promote the activation and chemotaxis of eosinophils. Whether statins promote the development of nasal polyps has so far been uncertain. No studies have evaluated the frequency of the development of nasal polyps in patients using statins. To better define the relationship of statin use to the presence of nasal polyps, the investigators explored the frequency of the development of nasal polyps in patients who were using statins. A total of 200 patients who were using statins and 200 who were not using statins (400 cases) were investigated. All patients were examined for nasal polyps by anterior rhinoscopy or investigation with a fiber-optic endoscope. In addition, immunoglobulin E levels were measured, a skin prick test was performed, and the results from the 2 groups were compared. Nasal polyps were detected in 4 subjects who were using statins, whereas 5 nasal polyps were found in the control group; differences between the 2 groups were statistically insignificant (P >.05). When the atopy status of the 2 groups was compared, prick test positivity and serum immunoglobulin E levels were found to be 15% and 44 +/- 31 IU/mL in the statin group and 19% and 68 +/- 23 IU/mL in the control group (P >.05). These results show that nasal polyposis is a multifactorial disease with several different causes; however, the frequency of the development of nasal polyps does not increase in patients who use statins.Öğe The effect of decreasing preload on valvular regurgitation in patients undergoing dialysis(Turkiye Klinikleri, 2005) Arinç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Akdemir, Ramazan; O?uzhan, Abdurrahman; Uyan, CihangirObjective: In chronic renal patients undergoing dialysis, calculations of left ventricular diameter and mass may be inordinately large and valve regurgitation may be develop to a high degree as a result of volume overload. In our study, we investigated the effect of ultrafiltration on left ventricular and atrial diameters, as well as on the collapsibility of the inferior vena cava and severity of valvular regurgitation present before dialysis. Material and Methods: A total of 30 patients, 16 male and 14 female, with a diagnosis of end-stage renal disease with hypervolemia and scheduled to undergo ultrafiltration in addition to hemodialysis were included in our study. Before and after ultrafiltration, left ventricular diastolic and systolic diameters, interventricular septum and posterior wall diastolic and systolic thicknesses, left atrial and aortic root diameters, and the severity of pericardial effusion, if present, were noted. Mitral, tricuspid, aortic and pulmonary valve functions were measured and, if regurgitation was present, its severity was staged in 4 categories. Inferior vena cava expiratory and inspiratory diameters were measured and a collapsibility index was calculated. Results: There was a significant decrease in left atrial and ventricular diastolic and systolic diameters after hemodialysis. Although the severity of mitral and tricuspid regurgitation decreased significantly, aortic and pulmonary regurgitation was not affected. A significant decrease in IVC expiratory and inspiratory diameters and an increase in collapsibility were noted. Conclusion: Dialysis causes significant changes in hemodynamic and echocardiographic parameters due to a decrease in intravascular fluid. In particular, a decrease in the presence and severity of valvular regurgitation occurs as a result of this procedure. Copyright © 2005 by Türkiye Klinikleri.
