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Biomedical subjects

Sule Korkmaz

Publications and source records attributed to Sule Korkmaz.

At least 73 records · Page 4Linked to original sources
PubMed2004

Influence of haematological parameters before coronary angioplasty on subsequent restenosis.

OBJECTIVES: Restenosis is the major limitation of coronary interventions occurring in nearly a third of the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with no single, definite predictor demonstrated in an individual patient. Platelets are known to play an important role in the pathogenesis of subsequent restenosis. METHODS AND RESULTS: In a prospective study, follow-up coronary angiographies were performed in 102 consecutive patients with stable angina who underwent a successful PTCA for single-vessel coronary artery disease. Demographics, baseline lipid profiles (total cholesterol, HDL- and LDL-cholesterol, triglycerides) and haematological parameters (red cell, white cell and platelet counts, haemoglobin concentration, haematocrite %, mean platelet volume, platelet mass and fibrinogen levels) were compared between patients with and without restenosis. In the restenosis group, mean platelet volume (8.82 +/- 0.78 fl vs. 8.13 +/- 0.64 fl, p < 0.001), white cell count (8673 +/- 322 x 10(3)/microl vs. 7513 +/- 232 x 10(3)/microl, p < 0.01) and fibrinogen level (4.2 +/- 1.4 g/l vs 3.6 +/- 1.1 g/l) were significantly higher. The relative odds for developing angiographically defined restenosis were 2.49 times greater in diabetics (p = 0.11) and 2.54 times greater in men (p = 0.13). It is 1.43 times greater in patients with higher fibrinogen levels (p = 0.16). But, the relative odds for developing restenosis were 10.43 times greater in patients with larger pre-procedural mean platelet volumes (p < 0.01). CONCLUSIONS: There was a positive correlation between mean platelets volume and loss in luminal diameter between post-angioplasty and follow-up angiographies (r = +2.345, p = 0.01). There was no association between restenosis and haemoglobin, haematocrit, red cell count, white cell count, platelet count, platelet mass and plasma fibrinogen level. The development of restenosis after successful coronary angioplasty may be mainly influenced by the platelet size.

Angina Pectoris↗
PubMed2004

Prevalence of angiographically significant coronary artery disease in patients with rheumatic mitral stenosis.

OBJECTIVE: In order to evaluate the prevalence of angiographically significant coronary artery disease (CAD) in patients with predominant mitral stenosis (mitral valve area < or = 1.5 cm2), coronary angiograms of the 837 consecutive patients with mitral stenosis (482 women and 355 men; median age = 50 years [ranging from 35 to 77]) were retrospectively analysed. METHODS AND RESULTS: Significant CAD was defined as at least 50% diameter narrowing of a major coronary artery. Significant CAD was detected in 63 patients (7.5%, 30 men and 33 women). Patients with CAD were significantly older than those without CAD (median: 59 vs. 49 years; p < 0.0001, respectively). With respect to coronary risk factors, diabetes mellitus (28.6% vs. 9.4%; p < 0.0001), hypertension (46% vs. 16.7%; p < 0.0001) and family history of CAD (34.9% vs. 17.3%; p = 0.001) were significantly more frequent in the CAD+ group as compared to the CAD- group. Serum levels of cholesterol were significantly higher in CAD+ group as compared to the CAD-patients (median: 199 vs. 176 mg/dl; p = 0.003). No significant differences were noted between the two groups in both serum levels of HDL-cholesterol (p = 0.12) and triglycerides (p = 0.08). Of the 63 patients with CAD, 21 (33.3%) had angina pectoris (AP) and, in patients free of CAD, AP was present in 106 (13.7%). The sensitivity and specificity of AP for the presence of significant CAD were 33.3% and 86.3%, respectively. The positive predictive value of AP for the presence of CAD was 16.5% and the negative predictive value of its absence was 94.1%. CONCLUSION: It is concluded that routine coronary angiography is not necessarily indicated in predominant mitral stenosis particularly in patients who are younger than 40 years and have no coronary risk factors and typical chest pain.

Adult↗
PubMed2004

[Aspirin resistance].

Aspirin is an effective antithrombotic agent for many patients. However, patients taking aspirin might exhibit variable responses to in vitro tests for platelet aggregation and might experience breakthrough thromboembolic events. Although this phenomenon has been called aspirin resistance, the lack of an uniform definition or agreement on diagnostic criteria precludes definitive recommendations at this time. Aspirin resistance has been defined in patients with cardiovascular, cerebrovascular, and peripheral vascular disease. In this article, mechanisms related with aspirin resistance and clinical background in which resistance is defined, are reviewed.

Aspirin↗
PubMed2003

Dynamic cardiomyoplasty: impact of effective pacing.

Dynamic cardiomyoplasty, in which the transposed latissimus dorsi muscle is wrapped around the heart and then electrically stimulated to augment systolic dysfunction, is an alternative surgical treatment for severe cardiomyopathies. Critical to success of this operation is to provide the wrapped skeletal muscle with more fatigue-resistant structure through repetitive electrical stimulation. A cardiostimulating device is important in this regard to perform synchronised contraction contributing to symptomatic improvement. Here in, we present a case with dynamic cardiomyoplasty improving following renewal of impaired myostimulator device.

Aged↗
PubMed2003

Swyer-James syndrome with myocardial bridge: a case report.

Swyer-James syndrome is an uncommon disease with unknown aetiology. It is generally discovered on a chest radiograph as increased translucency involving one hemithorax because of diminished vascular markings. Pulmonary vascularization on the affected side is greatly reduced leading to radiological translucency. Myocardial bridging describes an angiographic entity, which is any degree of systolic narrowing of a coronary artery observed in at least one angiographic projection. It is a congenital anomaly of the coronary artery and may occur in 5-12% of the human population. We report a patient suffering from chest tightness and with diagnosed Swyer-James syndrome also having myocardial bridge.

Adult↗
PubMed2003

Determinants of persistent atrial fibrillation in patients with DDD pacemaker implantation.

Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of 19.8 +/- 11.8 months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently (P < 0.03) and left atrial dimension was higher (3.5 +/- 0.6 vs 3.0 +/- 0.5 cm, P < 0.001). Average P maximum and P wave dispersion (PWD) values calculated in a 12-lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF (P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks (RR 8.95, P < 0.001), increased left atrial dimension (RR 2.1, P < 0.02), P maximum duration 120 ms (RR 6.1, P < 0.001), and PWD 40 ms (RR 12.2, P < 0.001) were associated with an increased risk of persistent AF. Cut-off points were 120 ms for P maximum and 40 ms for PWD. Sensitivity, specificity, and positive and negative predictive values were calculated as 76.2, 82.5, 53.3, and 92.9 for P maximum and as 85.7, 87.5, 64.3, and 95.9 for PWD, respectively. In patients with DDD pacemakers, previous AF attacks, increased left atrial dimension, P maximum value of 120 ms, and a PWD value of 40 ms were associated with a significantly increased risk of persistent AF. These patients must further be managed with other treatment modalities to prevent the development of persistent AF.

Aged↗
PubMed2003

Increased dispersion of refractoriness in patients with atrial fibrillation in the early postoperative period after coronary artery bypass grafting.

INTRODUCTION: Increased atrial effective refractory period (AERP) dispersion is well correlated with vulnerability to atrial fibrillation (AF). However, the preoperative electrophysiologic characteristics of atrial abnormalities that may play an important role in the development of AF postoperatively in patients with coronary artery bypass grafting (CABG) have not been investigated in detail. METHODS AND RESULTS: Fifty-six consecutive patients who underwent CABG were enrolled in this study. Eighteen patients (14 men and 4 women; mean age 57.7 +/- 5.2 years) with AF in the early postoperative period and 38 patients (28 men and 10 women; mean age 56.3 +/- 6.4 years) without AF were compared with regard to preoperative clinical, echocardiographic, angiographic, and electrophysiologic parameters. Preoperative PA interval and AERP dispersion values were higher (P < 0.05) in patients who developed AF in the early postoperative period. PA interval (P < 0.05, odds ratio = 1.64, 95% confidence interval 1.17-2.30), AERP in the high right atrium (AERP(HRA); P < 0.05, odds ratio = 0.94, 95% confidence interval 0.91-0.97), AERP in the right posterolateral atrium (AERP(RPL); P < 0.05, odds ratio = 0.79, 95% confidence interval 0.63-0.98), AERP in the distal coronary sinus (AERP(DCS); P < 0.05, odds ratio = 0.84, 95% confidence interval 0.74-1.02), and AERP dispersion (P < 0.001, odds ratio = 1.29, 95% confidence interval 1.12-1.47) were independently related to post-CABG AF in univariate analysis. Increases in preoperative PA interval and AERP dispersion were found to be associated with a high risk for development of post-CABG AF. CONCLUSION: AERP dispersion is a suitable electrophysiologic indicator for atrial vulnerability. The presence of increased preoperative AERP dispersion and PA interval may indicate patients at high risk for development of AF in the early postoperative period after coronary artery bypass grafting.

Atrial Fibrillation↗
PubMed2003

Diagnostic value of aVL derivation for right ventricular involvement in patients with acute inferior myocardial infarction.

BACKGROUND: Right ventricular (RV) involvement is associated with increased morbidity and mortality in patients with acute inferior myocardial infarction (MI). Although electrocardiography is probably the most useful, simple, and objective tool for the diagnosis of acute MI, there are no well-defined criteria in the standard 12-lead electrocardiogram to properly identify RV involvement in patients with acute inferior MI. Our objective was to evaluate the value of ST-segment depression in lead aVL in diagnosing RV involvement in patients with acute inferior MI. MATERIALS AND METHODS: Sixty-seven patients, hospitalized with acute inferior myocardial infarction, were included in this study. The diagnosis of acute inferior myocardial infarction was based on the clinical history, characteristic enzyme pattern of CK-MB values, and the appearance of ST-segment elevation > or = 1 mm in at least two of the leads (leads II, III, aVF). RV infarction was defined by ST-segment elevation > or = 1mm in lead V4R. ST-segment depression in lead aVL that is more than 1 mm was accepted as a diagnostic criterion for RV involvement in patients with acute inferior MI. RESULTS: Thirty-one patients had >1 mm ST-segment depression and 28 of them had right ventricular infarction according to lead V4R. Thirty-six patients showed < or =1 mm ST-segment depression indicating no right ventricular involvement but four of them also had right ventricular infarction according to V4R. CONCLUSION: More than 1 mm ST-segment depression in lead aVL was found to have high sensitivity (87%), specificity (91%), high positive and negative predictive value (90%, 88%, respectively), and high diagnostic accuracy (89%) in diagnosing RV involvement in patients with acute inferior MI. Therefore, by using a simple 12-lead electrocardiographic sign, ST-segment depression >1 mm in lead aVL, obtained on admission, it is possible to identify RV involvement in patients with acute inferior MI.

Adult↗
PubMed2003

Differential effect of aspirin on platelet aggregation in patients with coronary artery disease in relation with associated risk factors.

Platelets play a key role in the pathogenesis of atherosclerosis and acute coronary syndromes and antiplatelet therapy offers a clinical benefit. Although aspirin is the most widely used agent, there are several conditions in which aspirin may fail to provide a full antithrombotic benefit. Furthermore, data concerning the relationship between platelet function, aspirin, and the associated risk factors are limited. In the present study. ADP and collagen-induced platelet aggregation of 200 consecutive patients with suspected coronary artery disease (CAD) who underwent coronary angiography were evaluated. The patients were classified into three groups according to the number of stenotic vessels. One hundred and eight patients were using 300 mg/day of aspirin. The associated cardiovascular risk factors were also considered. The collagen-induced platelet aggregation of smokers was significantly higher than non-smokers (P < 0.05). Although platelet aggregation was higher in diabetic and hypertensive patients, the difference was not statistically significant. No significant correlation was found between platelet aggregation and other risk factors. The collagen-induced platelet aggregation of the subjects with non-stenotic vessels was reduced by aspirin (P < 0.05). Aspirin did not sufficiently inhibit ADP and collagen-induced aggregation in patients with CAD. This finding supports the idea that the nonplatelet-mediated effects of aspirin could be more important than its antiplatelet effect in clinical use and the use of new potent antiplatelet drugs may complete its antiplatelet effect.

Adult↗
PubMed2002

Spontaneous rectus muscle hematoma following streptokinase therapy for acute myocardial infarction: a case report.

There is no doubt that appropriate use of thrombolytic drugs improves survival in patients with acute myocardial infarction. Streptokinase, one of the most commonly used thrombolytic drugs in large clinical trials, is not fibrin-specific and brings about a lytic state with potential for bleeding. We report a case of spontaneous rectus muscle hematoma following streptokinase therapy for acute myocardial infarction and review the relevant literature. To our knowledge, this is the first case reported in the literature.

Female↗
PubMed2002

Extrinsic left atrial compression in a patient with achalasia.

Left atrial compression by the esophagus, the stomach, or both is an uncommon but important cause of hemodynamic compromise. Achalasia is a disease of the esophagus with dilatation of the distal part and constriction of the lower oesophageal sphincter. Dilated esophagus is a rare cause of left atrial compression. Timely and precise diagnosis is of paramount importance in cases of left atrial compression and echocardiography enables clinicians to make a differential diagnosis successfully in most cases. Correction of primary pathology will usually lead to the return of normal hemodynamic function. We describe a case of extrinsic left atrial compression caused by the dilated esophagus due to achalasia that caused paroxysms of atrial tachycardia and hemodynamic compromise.

Constriction, Pathologic↗
PubMed2002

Coronary artery anomalies in adult patients.

BACKGROUND: Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. MATERIAL/METHODS: 58,023 coronary angiographies were performed in the cardiology clinic of our hospital from 1978 to 2001. Coronary artery anomalies were discovered in 257 of these cases (0.44%). The mean age of these patients was 51.9+/-11.4 years (18-82). 80% were male (n=207). RESULTS: The circumflex artery (CXA) was the most frequently involved vessel (51.1%). Coronary arteries originating from the pulmonary artery were not encountered in our series due to the natural history of the disease. In 54 patients with coronary artery fistulae, 18 (33.3%) were closed by operation. Perioperative mortality was 5.5%. Acquired coronary artery fistulae or aneurysms due to trauma or inflammatory diseases are completely different entities and beyond the scope of this article. In 76 patients, open heart surgery was required for additional lesions, 57 of which were coronary artery bypass grafts. CONCLUSIONS: Being usually asymptomatic, coronary artery anomalies are usually discovered incidentally in the adult population. These pathologies are important for practical purposes, especially for interventional cardiologists, radiologists and cardiac surgeons, who should be aware of these anatomical entities. LMCA originating from the right coronary system has been reported to result in sudden death and myocardial ischemia, so these mostly asymptomatic patients must be followed closely.

Adolescent↗
PubMedDate not supplied

Beta-blocker-induced psoriasis: a rare side effect--a case report.

Beta blockers are one of the oral agents shown to decrease cardiovascular morbidity and mortality rates in randomized, controlled trials, and hence, they are widely used for the management of many cardiovascular situations. In terms of side effects there are 3 major modes of action: (1) contraction of smooth muscles, particularly of bronchi with nonselective agents; (2) exaggerated cardiac effects; and (3) central nervous system effects. There are also some rare side effects of beta blockers, some of which are unpredictable, but the others are related to mode of action at the cellular level. Beta-blocking agents may cause psoriaform eruptions and worsen existing psoriasis. Psoriasis may be an inconvenient side effect of beta blockade. Herein, we report a case of beta-blocker-induced psoriasis.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Relationship between plaque morphology of carotid artery and aortic valve calcification.

Aortic and mitral valvular calcifications are found to be associated with atherosclerotic risk factors and are largely accepted as part of a generalized atherosclerotic process. As well as the severity of stenosis, embologenic properties of plaques are also responsible for ischemic potentials of atherosclerotic plaques in carotid arteries. In this study, the authors aimed to define the characteristics of plaque morphology in patients with and without aortic valvular calcification (AVC) and to show the association between AVC and carotid plaque characteristics. Carotid plaque morphology in 182 consecutive patients with AVC was compared with plaque characteristics in 170 patients without AVC. Risk factors for atherosclerosis, age, and gender were similar in patients with and without AVC. The presence of carotid atherosclerosis, complex atheromas, and carotid artery stenosis was significantly higher in patients with AVC when compared with those without AVC (p < 0.001, p < 0.001, and p < 0.05, respectively). Unstable plaques (Types I and II) were also found to be more common in the patients with AVC than in those without AVC (p < 0.001). This study demonstrated the strong correlation between AVC and carotid atheromas. The plaques in patients with AVC are more unstable in morphology than in those without AVC, and this may explain the higher stroke incidence in these patients.

Aortic Valve↗