Cardiogenic Shock Due to Coronary Artery Stent Thrombosis

Stent thrombosis is an uncommon but serious complication that causes sudden death or myocardial infarction (MI). A large MI, especially with ST elevation, can cause cardiogenic shock and pose a significant incidence of morbidity and mortality. Largeness of ischemic territory is the main reason that causes cardiogenic shock. The fundamental treatment strategies are immediate coronary revascularization and perfusion support to avoid end organ damage with medically or mechanical in intensive care units. The prevention, incidences, mechanisms, management, and clinical impacts of cardiogenic shock discussed under this topic

Role of Interventional Treatment of Thoracic Aorta

An aging western and oriental population coupled with breakthrough advances in modern diagnostic imaging modalities has evoked renewed interest in the hitherto underdiagnosed acute and chronic diseases of the aorta, which also include aortic aneurysm and aortic dissection. Although classical surgical strategies still dominate the clinical management of acute and chronic pathologies of the ascending aorta and the proximal arch region, the emergence of novel endovascular concepts has offered an interesting therapy alternative for the treatment of descending aortic pathology in suitable patients and is highly likely to evolve as the primary treatment strategy in majority of the cases. Moreover, the use of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an attempt to improve clinical outcome in aortic arch pathologies has helped avoid the high risk of open arch repair or complete replacement. Notwithstanding these recent advancements, the complex nature of the underlying vascular disease still dictates that the proposed management of every diagnosed patient is discussed in a team constituting cardiologists, cardiac surgeons, anesthesiologists, and radiologists, with the conceptualization of individualized therapeutic strategies and conducted in a center with significant surgical and endovascular experience

Obesity and Coronary Artery Disease

The impact of obesity can be better understood by studying the growing medical and socioeconomic burden of this often neglected public health epidemic. Traditionally associated with cardiovascular risk factors like hypertension, hyperlipidemia, and diabetes mellitus, morbid obesity has increasingly contributed to mortality among Western as well as Third World populations. Contemporary evidence has also consistently linked this patient cohort with a greater risk to develop coronary artery disease. Recent population‐based registries indicate that 43 and 24% of all cases of coronary revascularization were performed in overweight and obese patients, respectively. In this context, although popular thought has reaffirmed the positive correlation between obesity and increased cardiovascular morbidity, some authors have opined a better clinical outcome in overweight and obese patients, a phenomenon they termed “obesity paradoxon.” Conflicting data and the possibility of confounding bias have festered an ongoing debate challenging this “obesity paradox.” In this review article, we present updated evidence and discuss the validity of the “obesity paradoxon” in a variety of clinical settings

NEW LIFE STYLES: THE GATED COMMUNITIES

Mimarlığın en çok deneyimlenen biçimi olarak konutun, toplumsal, ekonomik ve politik gelişmelerden direkt etkilenen konumu ile farklılaştığı ve bu nedenlerle son dönemde birçok alanda tartışılan tüketim kültürünün bir aracı haline geldiği söylenebilir. Tüketim dinamikleri çerçevesinde 1980 sonrası Türkiye‟sinde ortaya çıkan yeni kentli seçkinlerin “kaliteli yaşam†arayışları karşılığını, önce kent içindeki sınırlı sayıdaki boş arsalarda, sonrasında ise kent dışı alanlara, banliyölere yayılan kapalı konut sitelerinde bulmuştur. Bu çalışmanın amacı, tüketim kültürünün kent üzerinde yarattığı dönüşümleri ve konut mimarisi üzerindeki etkilerini kapalı konut siteleri bağlamında incelemek, bu sitelerin ortaya çıkış nedenlerini irdelemek, olumlu-olumsuz yanlarını üzerinde farkındalık yaratmaktır. Sonuç olarak çalışma, özelleşmiş ev yerleşkeleri üzerine kurgulanan farklı bir yaşam tipi temasını ve meşrulaştırılma sürecini, tüketim kültürü dinamikleri çerçevesinde inceleyecek ve İzmir örneği özelinde tartışacaktır. In present days, it is a fact that, there is an important transformation in the world and industrial society has been evolving the information society. The changes in the technological, economical, social, political, cultural areas and social life affect the architecture. The transformation has begun with rapid developments in microelectronic and computer technology; a new content and conformation has been emerged in architecture by carrying the design action to computer. There are some architectural rapprochements which are foreground because their different characteristics from conventional buildings and are determined and are introduced as a â€non-standard‟ in the architectural media. These design rapprochements that has pretentious ideas for the architecture of future, has close relations with scientific and technological developments for being non-standard. In this context, in this article under some captions like as ecological architecture, computer architecture, new materials and building systems, genetic architecture; the effects of scientific-technologic studies on architecture at the end of 20th century, the non-standard architectures in contemporary architecture and the utopic architectural rapprochements which can be shape the far future are investigated

Interventional Therapies for Post-Cardiac Arrest Patients Suffering from Coronary Artery Disease

Acute myocardial infarction and coronary artery disease (CAD) are the most common causes for the development of malignant arrhythmia often leading to cardiogenic shock and cardiac arrest. Structural heart disease represents the main pathology in older patients, whereas young adults mostly suffer from cardiomyopathies and channelopathies. This book chapter delineates modern interventional therapies for patients with cardiogenic shock or aborted cardiac arrest. Epidemiological data on the incidence of malignant arrhythmia depending causing cardiac arrest depending on the presence or absence of CAD and myocardial infarction are presented. Realistic difficulties within clinical decision-making are counterbalanced for and against an early, aggressive and invasive therapeutic approach including early coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management and mechanical cardiac assist devices, depending on the individual clinical presentation and underlying cardiac arrhythmia

A Different Way of Coronary Lesion Preparation: Stentablation and Rotastenting

Calcified coronary lesions are challenging to deal with, as they require optimal lesion preparation. Direct stenting in this scenario is associated with risk of stent-underexpansion, which is related to in-stent restenosis, target lesion revascularization and stent-thrombosis. We report on the interventional management of an underexpanded bare-metal stent not amenable to high-pressure balloon dilation and cutting-balloon. By using rotablation we could abrade the underexpanded stent struts and the calcification with subsequent implantation of a drug-eluting stent. Follow-up of 6 months revealed good results without evidence of significant restenosis. Our clinical experience and case reports in the literature suggest that this strategy might be an option for underexpanded stents not amenable to conventional techniques

The value of multimodality imaging for detection, characterisation and management of a wall adhering structure in the right atrium

The case presents a wall adherent structure in the right atrium in a young patient with peripheral tcell lymphoma followed by successful prolonged lysis therapy resulting in the resolution of the thrombus is presented. This case highlights the utility of multimodality imaging in an accurate assessment of the right atrium thrombus and the effectiveness of prolonged lysis therapy.peer-reviewe

The Validity and Reliability of the Turkish Version of the Integrative Self-knowledge Scale

AbstractThe aim of this research is to examine the validity and reliability of the Turkish version of the Integrative self -knowledge Scale (ISKS; Ghorbani, Watson, & Hargis, 2008). Participants were 396 university students (277 were female and 119 were male) from Sakarya University. The results of confirmatory factor analysis indicated that the three dimensional model was well fitted and Chi-Square value (x2=108. 38, df=49, p=0. 00) which was calculated for the adaptation of the model was found to be significant. The goodness of fit index values of the model were RMSEA=.055, NFI=.97, CFI=.98, IFI=.98, RFI=.96, GFI=.96, and SRMR=.041. The internal consistency coefficients of three subscales were .74, .77, and .83, respectively. The overall internal consistency coefficient of the scale was .86. The corrected item-total correlations of ISKS ranged from .37 to .67. Overall findings demonstrated that this scale had high validity and reliability scores and that it may be used as a valid and reliable instrument in order to assess self-knowledge levels of individuals

The combined S velocity achieved from tricuspid annulus and pulmonary annulus with tissue Doppler imaging could predict the proximal right coronary artery occlusion in patients with inferior myocardial infarction

Aim: To investigate if combined S velocity (CSV) calculated from tricuspid annulus and pulmonary annulus with tissue Doppler imaging in individuals with acute inferior myocardial infarction were linked to proximal RCA lesions. Methods: The study comprised 48 patient who had been diagnosed with acute inferior myocardial infarction and had culprit lesions in the right coronary artery. The RCA occlusion in Group A was proximal to the right ventricular branch, while the RCA occlusion in Group B was distant to the RV branch. The combined S velocity was tested, as well as other echocardiographic parameters. Results: In terms of metrics indicating right ventricular function, there were substantial disparities between the groups. A favorable association was established in the univariate correlation analysis between CSV and tissue Doppler imaging derived tricuspid annulus systolic velocity (St), pulmonary annulus motion velocity evaluated by TDI (PAMVUT), RV tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). CSV was identified as an independent predictor of proximal RCA occlusion in a multivariate logistic regression test. In the ROC analysis, CSV<18.3 cm/s and PAMVUT<8.6 cm/s indicated proximal RCA occlusion with 83 percent sensitivity and 71 percent specificity (AUC=0.83, p<0.001), and 85 percent sensitivity and 71 percent specificity (AUC=0.81, p<0.001), respectively. Conclusion: CSV measurements were revealed to be an important predictor of proximal RCA occlusions in this investigation

Miokarditis vezan uz slinavku i šap u sisajuće teladi.

Foot-and-mouth disease (FMD) can lead to myocarditis in young animals, but the age distributions of calves with myocarditis have not been described, nor the biochemical profile in these calves. In an area endemic with foot-and-mouth disease, calves less than 6 months of age in infected farms were examined for clinical lesions and abnormalities in respiratory rate, heart rate and heart rhythm. In total, 53 calves were identified to be suspected of having foot-and-mouth disease infection. In 6 calves myocarditis was suspected based on tachypnea, tachycardia and gallop rhythm. In these 6 calves, cardiac troponin-I (cTnI) and aspartate aminotransferase (AST) were significantly higher (P<0.0001), but the levels of Creatinine Kinase MB (CK-MB) and Lactate dehydrogenase (LDH) were not. These 6 calves died within 2 days and histopathology confirmed myocarditis. All calves with myocarditis were younger than 2-months old, suggesting that myocarditis caused by FMD is mainly found in very young suckling calves.Slinavka i šap može dovesti do miokarditisa u mladih životinja. Dosada nije opisana dobna raspodjela miokarditisa ni biokemijski profil u teladi oboljele od slinavke i šapa. U jednom području gdje se slinavka i šap javlja endemijski, telad mlađa od šest mjeseci bila je na zaraženim farmama klinički pretražena posebice na poremećaje u frekvenciji bila, disanja i srčanog ritma. Ukupno su 53 teleta bila sumnjiva na slinavku i šap. Sumnja na miokarditis postavljena je u šest teladi i to na osnovi tahipneje, tahikardije i galopirajućeg ritma. U te su teladi razine srčanog troponina-I (cTnI) i aspartat-aminotransferaze (AST) bile značajno više (P<0,0001), dok razine kreatinin-kinaze MB (CK-MB) i laktat-dehidrogenaze (LDH) nisu. Tih šest teleta uginulo je unutar dva dana te je u njih miokarditis bio potvrđen patohistološki. Sva telad s miokarditisom bila je mlađa od dva mjeseca, što upućuje na zaključak da se miokarditis uzrokovan virusom slinavke i šapa pretežito javlja u sisajuće teladi najranije dobi