The relation of fragmented QRS with tissue Doppler derived parameters in patients with b-thalassaemia major

Purpose: The most important complication encountered in patients with b-thalassaemia major is degenerative fibrosis developing as a result of iron accumulation in myocardial tissue. Dysfunction pursues this accumulation. Recently, presence of fragmented QRS (fQRS) in ECG has been regarded as a predictor of myocardial fibrosis. We aimed in our study to investigate the frequency with which fQRS develops in patients with b-thalassaemia major and to disclose the correlation between fQRS frequency and Doppler-derived indices. Methods: The patients with b-thalassaemia major (n=66; mean age: 23±6 years) and healthy controls (n=30; mean age: 23±4 years) were included. fQRS pattern was described as presence of RSR’ manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. 2D, M-mode, conventional Doppler, tissue Doppler echocardiography parameters were assessed. Mean serum ferritin levels over past 5 years were also calculated. Results: When compared to those in control group, fQRS was more frequent in b-thalassaemia major group, indicating statistical significance (p = 0.001). While E/Em and ferritin level exhibited statistically significant increase in thalassaemia patients with fQRS (p < 0.05), the mean Em and Sm values were found to be significantly low (p < 0.05). Conclusions: fQRS was frequently observed in the patients with b-thalassaemia major, which was of statistical significance. Tissue Doppler-derived diastolic and systolic indices in thalassaemia cases with fQRS showed statistically significant impairment compared to those without fQRS. In conclusion, fQRS may represent a novel noninvasive marker for cardiac involvement in patients with b-thalassaemia major

Management of bladder stones associated with foreign bodies following incontinence and contraception surgery

Aim of the study: To investigate success of endoscopic lithotripsy for bladder stone following stress urinary incontinance surgery and contraception surgery. Materials and methods: Charts of patients admitted in two centers between January 2006 and March 2013 were retrospectively reviewed and seven women were enrolled in our study. Patients demographic parameters including age, main complaint(s), previous surgery type, time to diagnosis were analyzed. Also operative time, hospitalisation lenght, perioperative and postoperative complication( s) were evaluated. Results: Five patients had undergone tension free vaginal tape procedure and one patient had undergone transobturator tape procedure. Median age was 62 (50-71) years. In one patient bladder stone formed around an intrauterine device. Dysuria (85%), hematuria (57%) and recurrent urinary tract infection (57%) were the main complaints. The median diagnosis time was 44.1 months. Abdominal ultrasonography and non contrast enhanced computer tomography were performed for five and two patients respectively and diagnosis was confirmed cystoscopically. Endoscopic lithotripsy using Holmium laser lithotripter or pneumatic lithotripter was used for all cases. The mean operation time was 41.2 minutes (20-70) and success was 100%. There was no intraoperative complication. Only one patient had fever higher than 38ºC postoperatively and was treated by appropriate antibiotic. The median hospitalisation time was 1.57 day. Conclusion: In conclusion endoscopic lithotripsy is a safe and effective approach to manage bladder stone associated with mid-urethral synthetic slings and intrauterine devices

Duplicated Renal System with H Shaped Ureter: An Extraordinary Anomaly

Duplex collecting systems are the most commonly encountered anomaly of the urinary system. Complete duplex system with an H shaped ureter is a very rare situation. There are only two reported H ureter cases in the literature. Herein, we aimed to present an H shaped ureter case, which was identified while performing ureterorenoscopy to a 48-year-old female patient due to a right distal ureteral stone

The evaluation of relationship between neutrophil-to-lymphocyte ratio and slow coronary flow

Objective: The aim of this study was to investigate thecorrelations between leukocyte counts, the neutrophil-tolymphocyteratio (NLR), and slow coronary flow (SCF).Methods: We evaluated 135 patients undergoing coronaryangiography (CAG) within coronary artery disease(CAD) indication. We divided patients into three groupsaccording to the CAG findings. Group 1 consisted of 45patients with an SCF pattern; group 2 consisted of 45 patientswith at least 50% lumen narrowing in at least oneepicardial coronary artery; and group 3 (control group)consisted of 45 patients with normal coronary arteries.The quantification of the coronary flow was assessed usingthe thrombolysis in myocardial infarction (TIMI) framecount method for each of the coronary arteries. Bloodsamples were collected from the patients after a 12 hovernight fasting. The NLR ratio was calculated from theautomated complete blood count.Results: NLR in CAD was higher than in both the SCFand control groups (p=0.008, p<0.001, respectively).However, there was no statistically significant differencebetween SCF and control group (p=0.768). Neutrophilcounts in CAD were higher than in both SCF and controlgroups, but only the difference between CAD and SCFgroups was statistically significant (p=0.010).Conclusion: Our study revealed that circulating neutrophilcounts and NLR were related to the coronary arterydisease, as expected.Key words: Neutrophil-to-lymphocyte ratio, leukocyte subtype, slow coronary flow, coronary artery diseas