Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

AbstractSignificant left main coronary artery (LMCA) stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES), extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion). However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI) with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI). In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management

What is the optimal length of stay in hospital for ST elevation myocardial infarction treated with primary percutaneous coronary intervention?

Backgound: The aim of this study was to evaluate the safety and practicality of very early (within 48 h) discharge with long-term follow-up results, and to define an optimal length of stay in hospital for patients with ST elevation myocardial infarction (STEMI) according to their demographic characteristics and risk assessment. Methods: A total of 267 patients with STEMI successfully treated with primary coronary intervention were retrospectively analyzed. Patients was divided into four groups according to length of hospitalization: 24 hours, 48 hours, 72 hours, and more than 72 hours. The groups were compared in terms of the patients’ demographic and clinical characteristics, short- and long-term follow-up results, mortality, revascularization and major adverse cardiac events (MACE). Results: More than two thirds of the patients were discharged within 48 hours (68.9%). No difference was observed between groups in terms of one month and one year MACE and one year restenosis. However, one month restenosis was slightly higher in the fourth group. At the end of the first year, there had been only four deaths, and these were in the third and fourth groups. There were no deaths among patients discharged within 48 hours. Killip class, left ventricular ejection fraction, multi-vessel disease and diabetes were the major determinants of length of stay in hospital. Conclusions: Very early discharge is safe and feasible and does not increase the mortality rate. Uncomplicated STEMI patients with single vessel disease could be discharged after 24 hours. Patients with multi-vessel disease classified in the low risk group could be discharged after 48 hours. (Cardiol J 2011; 18, 4: 378–384

THE EVALUATION OF PROGRAM OF EDUCATION APPLICATION SCHOOLS ACCORDING TO TEACHERS’ OPINIONS

In this study, the opinions of teachers working at education application schools are collected in order to evaluate the educational program of Education Application school which has been in progress since 2002. The study is a qualitative one in which the constructed interview technique has been used. Frequency has been used to analyze the data. The target population of the study is teachers working at education application schools in Bolu and Düzce. The working group of the study is 15 teachers from these cities. The data gathered at the end of the study are; an Evaluation study has never been carried out about the program of education application schools by asking teachers’ opinions since the beginning. According to opinions of teachers, they cannot apply the program completely and have some problems during the application process. Teachers agree that the educational program of education application schools is not functional. Teachers expressed that the operation, evaluation and teaching methods of the program are not suitable. Moreover, they stated that the expressions of objectives are not compatible with the students, and they indicated that there are objectives that are not stated in a behavioristic way. It is found that that the properties of students are ignored in the preparation process and the number of classes in the program is excessive., It can be alleged that it is suitable for the programme of the education application schools to be revised or to be developed again.     Article visualizations

Numeričko istraživanje prijenosa topline u toplinskim mostovima obzirom na položaj toplinske izolacije različitih geometrija

In the present study, heat transfer structures were investigated for thermal bridges on both intermediate floor beamed wall block and balcony extension intermediate floor beamed wall. Temperature and heat flux contours were obtained for all models in the case of internal and external insulation cases with different insulation thicknesses (Si = 3 cm, 5 cm and 7 cm). Results showed that high heat transfer rates were obtained in the region of heat bridges for all building models. However the heat transfer rate did not decrease on the heat bridge region in the case of internal insulation. The most appropriate insulation model was the external insulation case and it was also obviously determined that heat transfer rate decreased with increments of insulation thickness.U ovom radu istražuje se prijenos topline u toplinskim mostovima postavljenim na podovima međukatova i na balkonskim istakama. Određene su temperature i gustoće toplinskih tokova za sve modele za slučajeve vanjske i unutrašnje izolacije, s različitim debljinama izolacije (Si = 3 cm, 5 cm i 7 cm). Rezultati istraživanja su pokazali vrlo visoke vrijednosti toplinskih tokova u području toplinskih mostova kod svih ugradbenih modela. Doduše nije došlo do opadanja toplinskog toka u toplinskim mostovima u slučaju postavljanja unutrašnje izolacije. Puno se prikladnijim pokazao model u slučaju postavljanja vanjske izolacije i jasno je određeno da dolazi u tom slučaju do smanjenja toplinskog toka s povećavanjem debljine izolacije

Localized Aortic Root Dissection Secondary to Contrast Agent Injection: Feasibility of Conservative Follow-up With Echocardiography

Introduction: Iatrogenic aortocoronary dissection (ACD) is a nightmare in interventional cardiology. Although ACD is rarely reported, the real-world prevalence is suspected of being higher due to unreported cases. The right coronary artery (RCA) ostium is involved in the majority of cases, and dissections are usually limited to the aortic sinus in half of the clinical presentations. There are different treatment strategies, including interventional approaches, surgery, and medical follow-up. Immediate stent deployment to the coronary osteum might be a life-saving procedure, and the surgical approach should be preferred in occasions of dissection extension beyond the sino-tubular junctions. Catheter trauma and subintimal progression of guidewires are major causes of ACD occurrence.Case Presentation: Herein presented is a case report of spontaneous ACD observed after contrast injection to the RCA ostium. Approximately 8 cc of radiocontrast agent was injected into the right coronary ostium. Antegrade and retrograde dissections which extended to the distal RCA and aortic root were observed. The right sinus of Valsalva was stained with contrast agent, and the border of the stained area was extended to the sinotubular junction. Medical follow-up was proposed by the heart team. Close follow-up with echocardiographic examination indicated the complete regression of the dissection.Conclusion: The authors consider conservative follow-up with echocardiogaphy rather than computed tomography and/or magnetic resonance to be the most appropriate imaging technique for use with stable patients

Clinical Implications of Congenital Absence of Circumflex Coronary Artery

Introduction: Coronary artery anomalies are rare clinical entities reported in 0.6% to 5.6% of diagnostic coronary angiographies. Anomalous origins of coronary arteries from distal segments are rarely reported. Presented herein is a coronary anomaly in which the circumflex artery (CX) originated as a continuation of the posterolateral branch of the right coronary artery (RCA) with separate left anterior descending (LAD) artery origination from the left sinus of Valsalva. The clinical presentation of such a rare anomaly is discussed, and the current literature regarding the congenital absence of CX is reviewed. Case Presentation: A 66-year-old male presented with angina pectoris. Coronary angiography revealed critical stenosis in the mid segment of the LAD artery and an anomalous origin of CX artery from the distal RCA. The CX was coursing as a continuation of the posterolateral branch of the RCA. Coronary angioplasty and stent deployment was performed for the LAD lesion, and the patient was discharged with medical therapy. The patient did not report recurrent anginal symptoms under medical therapy. Conclusion: The congenital absence of the circumflex coronary artery is a rare coronary anomaly. The clinical presentation may vary, though most cases are asymptomatic during diagnosis. Such cases require close clinical follow-up since they entertain a future risk for being symptomatic, especially in the setting of atherosclerotic disease

Entrapment of hydrophilic coated coronary guidewire tips: Which form of management is best?

Fracture, detachment and entrapment of coronary guidewires is seen infrequently. Different treatment strategies have been performed for such cases in medical literature. Here, we present three different cases of hydrophilic coated coronary guidewire non-metallic tip entrapment. Conservative management was preferred as the main strategy, with a practical approach to fix the guidewire remnant to the coronary bed during intervention. All three patients were asymptomatic following the interventions. Besides case presentation and our treatment, we also briefly review the history and management strategies reported and discussed in the medical literature. (Cardiol J 2010; 17, 1: 104-108

Investigation of the effect of REM sleep deprivation on epileptic seizures caused by pentylenetetrazole in mice

Aim: To investigate whether different periods of rapid eye movement sleep deprivation (REM SD) contribute to seizure susceptibility, hippocampal oxidative status and balance of inhibition-excitation in the acute epilepsy model. Methods: REM SD was performed using the modified multiple platforms method on adult male BALB/c mice. Pentylentetrazol (PTZ) was injected to induce seizures and hippocampal total antioxidant status (TAS), total oxidant status (TOS), gamma aminobutyric acid (GABA), and glutamate levels were measured using the ELISA method. Results: PTZ-induced seizures following 8 h and 72 h REM SD significantly reduced the hippocampal TAS levels, but did not affect the TOS levels. In REM SD groups, especially after 8 hours of REM sleep loss, there was a significant increase in glutamate in PTZ induction. The hippocampal GABA levels were increased by PTZ-induced seizures after 72 h REM SD. PTZ- induction after 8 hours of RAM SD leads to a significant increase in the seizure duration. Conclusion: It can be speculated that the REM SD can contribute to seizure susceptibility by changing the oxidant-antioxidant balance and excitatory and inhibitory tone in the hippocampus

Yarım Düzlem Üzerine Oturan Elastik Tabakanın Sürtünmesiz Ve Ayrılmalı Temas Problemi

Konferans Bildirisi -- Teorik ve Uygulamalı Mekanik Türk Milli Komitesi, 2015Conference Paper -- Theoretical and Applied Mechanical Turkish National Committee, 2015Bu çalışmada, yarım düzlem üzerine oturan ve rijit iki dikdörtgen blok aracılığıyla yüklenmiş bir tabakanın simetrik ayrılmalı temas problemi elastisite teorisine göre incelenmiştir. Temas eden tüm yüzeyler sürtünmesiz olup, kütle kuvvetlerinin etkisi ihmal edilmiştir. Problem integral dönüşüm teknikleri ve sınır şartları kullanılarak temas gerilmelerinin bilinmeyen fonksiyonlar olduğu bir integral denklem sistemine indirgenmiştir. Uygun Gauss-Jacobi integrasyon formülleri yardımıyla integral denklem sistemi sayısal olarak çözülmüştür. Temas gerilmeleri ve temas uzunluklarına ait sayısal sonuçlar çeşitli boyutsuz büyüklükler için belirlenmiştir.In this study, symmetric receding contact problem for an elastic layer resting on an elastic half plane loaded by means of two rectangular rigid stamps is considered according to theory of elasticity. The problem is solved under the assumptions that all surfaces are frictionlesss, the effect of gravity forces is neglected. The problem is reduced a system of integral equation in which the contact pressures are unknown functions by using the integral transform tecnique and boundary conditions of the problem. The system of singular integral equation is solved numerically by making use of appropriate Gauss-Jacobi integration formulas. Numerical results for the contact pressures and contact areas are investigated for various dimensionless quantities

Ostry zespół wieńcowy w następstwie samoistnej dyssekcji pomostu z lewej tętnicy piersiowej wewnętrznej w 9. roku po operacji

Spontaneous left internal mammary artery (LIMA) dissection is an extremely rare condition. It generally occurs as a complication of interventional manipulation in the early post-operative period. Here we present a case of spontaneous LIMA dissection nine years after surgery seemed to be chronic deforming jetflow secondary to kinking segment of LIMA. Kinking of LIMA usually occurs in the intraoperative period during harvesting of LIMA, and usually gives symptoms in the early post-operative period. Such a time delay for the progression of spontaneous dissection has not previously been reported. Kardiol Pol 2011; 69, 9: 970–97