An empirical study on rural structures and temporary-seasonal migration in Southeastern Anatolia

Ph.D. - Doctoral Progra

Katatere bağlı inatçı sol ana koroner arter spazmı

Fifty one year old female patient was taken into the catheter laboratory for coronary angiography with the diagnosis of typical angina pectoris (CCS Class 2). A 6F JL4 Judkins catheter was placed into the left coronary artery.Immediately after sitting into the left main artery, damping in the pressure tracing was seen and catheter was removed from left main coronary artery (Figure 1). There was a 90% stenosis in the left coronary artery ostium which was seen in the non selectively taken image. LAD and Cx were seemed to be normal. 200 micrograms of nitroglycerin was non selectively administered for the possibility of left coronay artery spasm. 5F JL4 catheter was placed into the left coronary system very delicately. Because damping in the pressure recording recurred, catheter was removed. After administrating 200 micrograms of nitroglycerin a 5F JL4 catheter with two side holes was placed delicately. The procedure was terminated because of the pressure damping and chest pain. RCA was seen to be normal. After taken into the coronary unit, beta blocker therapy was switched to calcium channel blocker therapy and 24 hours of intravenous nitroglycerine infusion was administered. A multislice CT was planned to evaluate the suspected lesion in the left main coronary ostium. In the MSCT was reported that left main coronary ostium was normal and patient was treated medically (Figure 2). The patients with left main coronary lesions are the most risky patients in terms of complication. Therefore, pressure damping should be evaluated immediately after placing into the left coronary system. Damping is entity which is often seen in patients with severe left coronary lesions. Another finding suggestive of severe left main lesion is that no reflux of radiocontrast agent into the aorta is seen. In patients with no other obstructive lesions in the other coronary vessels before preceding to the diagnosis of "isolated coronary ostial lesion", the possibility of catheter induced coronary spasm should be evaluated.This spasm can persist, as occurred in our case, even after recurrent nitroglycerin administration and attempts for placing into the left system with delicate maneuvers and smaller catheters. Multislice CT should be kept in mind to evaluate the left coronary ostium in these group of patients.MSCT is an assisting imaging modality for diagnosis in these group of patients (1,2).Fifty one year old female patient was taken into the catheter laboratory for coronary angiography with the diagnosis of typical angina pectoris (CCS Class 2). A 6F JL4 Judkins catheter was placed into the left coronary artery.Immediately after sitting into the left main artery, damping in the pressure tracing was seen and catheter was removed from left main coronary artery (Figure 1). There was a 90% stenosis in the left coronary artery ostium which was seen in the non selectively taken image. LAD and Cx were seemed to be normal. 200 micrograms of nitroglycerin was non selectively administered for the possibility of left coronay artery spasm. 5F JL4 catheter was placed into the left coronary system very delicately. Because damping in the pressure recording recurred, catheter was removed. After administrating 200 micrograms of nitroglycerin a 5F JL4 catheter with two side holes was placed delicately. The procedure was terminated because of the pressure damping and chest pain. RCA was seen to be normal. After taken into the coronary unit, beta blocker therapy was switched to calcium channel blocker therapy and 24 hours of intravenous nitroglycerine infusion was administered. A multislice CT was planned to evaluate the suspected lesion in the left main coronary ostium. In the MSCT was reported that left main coronary ostium was normal and patient was treated medically (Figure 2). The patients with left main coronary lesions are the most risky patients in terms of complication. Therefore, pressure damping should be evaluated immediately after placing into the left coronary system. Damping is entity which is often seen in patients with severe left coronary lesions. Another finding suggestive of severe left main lesion is that no reflux of radiocontrast agent into the aorta is seen. In patients with no other obstructive lesions in the other coronary vessels before preceding to the diagnosis of "isolated coronary ostial lesion", the possibility of catheter induced coronary spasm should be evaluated.This spasm can persist, as occurred in our case, even after recurrent nitroglycerin administration and attempts for placing into the left system with delicate maneuvers and smaller catheters. Multislice CT should be kept in mind to evaluate the left coronary ostium in these group of patients.MSCT is an assisting imaging modality for diagnosis in these group of patients (1,2)

Topikal kapsaisin yamasına bağlı gelişen koroner vazospazm ve akut miyokart enfarktüsü

Capsaicin is the active component of chili peppers, which has been shown to possess several beneficial effects. Currently, the best-known medical use of capsaicin is as a topical painkiller. Drug-induced myocardial infarction is not a common phenomenon and the underlying mechanism has been related with coronary spasm in the majority of cases. We present a 29-year-old man who experienced coronary vasospasm and acute myocardial infarction (AMI) which were possibly induced by the use of a topical capsaicin patch to relieve lumbago. He presented with chest pain of one hour onset. The electrocardiogram showed ST-segment elevation in the leads II, III, and aVF, consistent with inferior wall AMI. Echocardiography confirmed inferior hypokinesia. Urgent coronary angiography showed normal right and left coronary arteries. Since he had no cardiac risk factors for coronary artery disease, nor a history of recent emotional or physical stress, or ingestion of any illicit substance, the vasospasm and subsequent AMI was attributed to the use of the capsaicin patch for six days. Upon institution of appropriate treatment and removal of the patch, no new anginal attacks or ischemic episodes were seen within a follow-up of one month. This is the first case report of AMI induced by the use of a topical capsaicin patch.Kapsaisin, yararlı birçok etkisi olduğu gösterilen acı kırmızıbiberin aktif bileşenidir. Günümüzde topikal ağrıkesici olarak kullanılmaktadır. İlaç kullanımı ile ilişkili miyokart enfarktüsü sık görülen bir durum değildir ve olguların çoğunda altta yatan mekanizma koroner vazospazm ileilişkilidir. Bu yazıda, bel ağrısını dindirmek için topikal kapsaisin yaması kullandığı sırada koroner vazospazm ve sonrasında akut miyokart enfarktüsü (AME) geçiren 29 yaşında bir erkek hasta sunuldu. Göğüs ağrısı başladıktan bir saat sonra başvuran hastanın elektrokardiyogramında, II, III, ve aVF derivasyonlarında inferiyor duvar enfarktüsü ile uyumlu ST-segment yükselmesi izlendi. Ekokardiyografik incelemede inferiyor hipokinezi görüldü. Acil koroner anjiyografide hastanın sağ ve sol koroner arterleri normal bulundu. Hastada koroner arter hastalığı için hiçbir risk faktörü, yakın zamanda yaşanmış duygusal veya fiziksel sıkıntı veya herhangi bir yasak madde alımı gibi bir durum olmadığından, vazospazm ve sonrasındaki AME, altı gündür kullanmakta olduğu kapsaisin yamasına bağlandı. Uygun tedaviye başlanması ve yamanın çıkarılması sonrasında, hastada bir aylık takip süresi içinde herhangi bir anjina atağı veya iskemik epizot görülmedi. Sunulan olgu, topikal kapsaisin yamasına bağlı olarak AME geliştiği bildirilen ilk olgudur

Streptokinaz ile tedavi edilen akut miyokart infaktüsünde gelişen retroperitoneal hematom : Olgu sunumu

Retroperitoneal hematom (RPH) çoğunlukla travma, vasküler lezyonlar, cerrahi girişim, antikoagülan tedavi ve bazen de idiyopatik olarak görülebilen ve ölümcül seyredebilen bir durumdur. Çoğunlukla destek tedavisinin yapıldığı, çok az vakada cerrahi girişimin uygulandığı bir durumdur. Akut miyokart infaktüsü (Anterior) tanısıyla 78 yaşındaki bayan hastaya streptokinaz tedavisi verildi. Streptokinaz sonrasında şiddetli sol yan ağrısı, sırt ağrısı ve uyluk ağrısı başladı. Sol alt extremitede hareket kısıtlılığı ve parastezi gelişti. Herhangi bir travma, düşme yada antikoagülan kullanım öyküsü yoktu. Hastaya intraabdominal kanama şüphesi ile abdominal BT çekildi ve retroperitoneal alanda hematom ile uyumlu lezyon gözlendi. Bunun üzerine hastanın antikoagülan ilaçları kesildi ve hastaya eritrosit süspansiyonu verildi. Hastanın abdomen USG ile takiplerinde hematom boyutlarında artma gözlenmedi. Klinik olarak şikayetleri gerileyen vital bulguları stabil seyreden hasta kontrole çağrılarak taburcu edildi. Literatürde streptokinaza bağlı RPH vakası nadir bulunmasından ötürü bu vakayı paylaşmayı uygun buluyoruz.Retroperitoneal hematoma (RPH) is a potentially life threatening condition commonly associated with trauma, vascular lesions, surgical intervention and anticoagulant therapy which may occasionally be seen as an idiopathic presentation. Treatment of RPH is usually supportive, with only a minority of cases undergoing surgical intervention. A 78 year old female diagnosed with acute myocardial infarction (anterior) received streptokinase treatment. She had severe left side pain, back pain and thigh pain following streptokinase administration. Paresthesia and movement restriction developed in her left lower extremity. The patient reported no history of trauma, falling or anticoagulant use. CT was performed due to suspected intraabdominal hemorrhage, and a lesion consistent with hematoma was detected in the retroperitoneal area. Subsequently, anticoagulant medications were discontinued and the patient received erythrocyte suspension. Size of the hematoma was not increased in the follow-up abdominal USG. Upon regression of her clinical complaints and with stabile vital findings, the patient was discharged and scheduled for a control visit. We would like to report this case as streptokinase related RPH cases are rare in the literature

Aortik elastisite ve aortik elastisitenin sol ventrikül dolum ve diyastolik parametreleri ile ilişkisinin transtorasik ve transözofajiyal ekokardiyografi değerlendirilmesi

Amaç: Aort boyutlar ve elastik özelliklerini transtorasik ekokardiyografi (TTE) ve transözofageal ekokardiyografi (TEE) ile karşılaştıran sınırlı veri vardır. Bu nedenle, TTE ve TEE elde edilen aort boyutlar ve aortik elastik indekslerinin karşılaştırmanın yanı sıra bunların sol ventrikül (LV) dolum ve diyastolik parametreleri ile ilişkisini araştırmayı amaçladık. Yöntem: Çalışmaya kırk iki hasta dahil edildi. Tüm hastaların TTE ve TEE kayıtlarından aort boyutları ve ilgili elastikiyet parametreleri, sol ventrikül dolum ve diyastolik parametreleri, sol atriyal volüm indeksi (LAVİ), sol ventrikül kütle i n- deksi hesaplandı. TTE ve TEE elde edilen aort elastikiyeti indeksleri ve sol ventrikül dolum ve diyastolik parametreleri için korelasyon analizi yapıldı. Bulgular: TTE ve TEE ile elde edilen aort boyutları ve elastikiyeti indeksleri arasında anlamlı bir fark yoktu. Korelasyon analizinde yaş, E / A, E / E`ve LAVİ hem TTE hem de TEE ile edilen aort elastikiyeti indeksleri ile anlamlı derecede ilişkili iken, sol ventrikül kitle indeksi sadece TEE ile elde edilen aort elastikiyeti indeksleri ile ilişkili saptandı. Sonuç: TTE ile karşılaştırıldığında, TEE elde edilen aortik elastik özellikleri sol ventrikül dolum ve diyastolik parame treleri ile daha yakından ilişkili bulunmuştur. Buna ek olarak, TEE ve TTE ile elde edilen aort fonksiyon indeksleri iyi gözlemci içi ve gözlemciler arası değişkenliği ile benzerdir.Background: There are limited data comparing aortic d imensions and elastic properties between transthoracic echocardiography (TTE) and transesophage al echocardiography (TEE). Therefore, we aimed to investigate aortic d imensions and indices of aortic elastic properties as well as their relation with left ventricular (LV) filling and diastolic parameters obtained from TTE and TEE. Method: Forty two patients were included in the study. Aortic dimensions and related elasticity parameters, LV filling and diastolic parameters, left atrial volume index (LAVi), LV mass index were calculated from TTE and TEE recordings in all patients. The correlation analyses were performed for aortic elasticity indices and LV filling and diastolic parameters obtained from TTE and TEE. Results: There were no significant differences in aortic d imensions and elasticity indexes obtained from TTE and TEE. The correlation analysis r evealed that while age E/A, E/E` and LAVi were significantly correlated with aortic elasticity indexes obtained from both TTE and TEE, LV mass index was significantly correlated with only TEE aortic elasticity indices. Conclusion: When compared to TTE, aortic elastic properties obtained from TEE were more closely related with LV filling and diastolic parameters. In addition, the indexes of aortic function were comparable between TEE and TTE with good intra and interobserver variability

The Effectiveness of the Schroth Best Practice Program and Chêneau-Type Brace Treatment in Adolescent Idiopathic Scoliosis: Long-Term Follow-Up Evaluation Results

Background: Although the number of studies showing the efficacy of conservative treatment in adolescent idiopathic scoliosis has increased, studies with long-term follow-up are very limited. The aim of this study was to present the long-term effects of a conservative management method including exercise and brace in adolescent idiopathic scoliosis patients. Methods: This retrospective cohort study included patients with idiopathic scoliosis who presented at our department and were followed up for at least 2 years after completing the treatment. The main outcome measurements were the Cobb angle and angle of trunk rotation (ATR). Results: The cohort participants were 90.4% female, with a mean age of 11 years and the maximum Cobb angle was mean 32.1°. The mean post-treatment follow-up period was 27.8 months (range 24–71 months). The improvements after treatment in mean maximum Cobb angle (p p = 0.001) were statistically significant. At the end of treatment, the maximum Cobb angle was improved in 88.1% of the patients and worsened in 11.9% compared to baseline. In the long-term follow-up evaluations, 83.3% of the curvatures remained stable. Conclusions: The results of this study showed that moderate idiopathic scoliosis in growing adolescents can be successfully halted with appropriate conservative treatment and that long-term improvement is largely maintained