Kounis Syndrome together with Myocardial Bridging Leading to Acute Myocardial Infarction at Young Age

Kounis syndrome, also named as “allergic angina syndrome,” is a diagnosis in which exposure to an allergen causes mostly coronary spasm and rarely plaque rupture, resulting in ischemic myocardial events. Myocardial bridging is defined as an intramural segment of a coronary artery and its systolic compression by overlying fibers. Myocardial bridging generally has a benign prognosis and mostly affects the mid portion of left anterior descending coronary artery. However, some cases with myocardial ischemia, infarction, and sudden death have also been reported. A 17-year-old boy presented to the clinic with acute anterolateral myocardial infarction after having first dose of clindamycin and diagnosed as Kounis syndrome. Further diagnostic workup of the patient showed myocardial bridging at the mid left anterior descending artery. In this report, we present the combination of Kounis syndrome and myocardial bridging leading to myocardial infarction at young age

Korištenje otpadnog mulja i diatomita kao medija u proizvodnji sadnica običnog bora (Pinus sylvestris L.) i procjena preživljavanja sadnica na terenu

Although several organic and inorganic substrates are added to growing media for improving its physical and chemical characteristics, the need for search of new materials and/or mixtures that reduces the high-priced peat content in substrates is still interesting. This study evaluated the feasibility of reducing the peat content in substrates by replacing it with different amounts of diatomite and sewage sludge for Scots pine seedling (Pinus sylvestris L.) growth and their land performance. In order to evaluate the feasibility of reducing the peat content in substrates by replacing it with different amounts of diatomite and sewage sludge, an experiment was carried out in a temperature-controlled greenhouse under natural light. To evaluate the land performance of Scots pine seedlings grown in different substrates, a trial was established between the years 2013-2017 in Sarıkamış, Kars (NE Anatolia). Sewage sludge application, due to its high organic matter and macro and micronutrient content, has improved the composition of the rhizosphere, thereby resulting in growth acceleration. As a result of the evaluations made in terms of both seedling morphological characteristics and land performance; the best performance was determined in the 9th (50%P+50%SS) and 3rd (75%SS+25%DE) mixtures.Unatoč tome što se supstratu za uzgoj dodaju određeni organski i anorganski supstrati kako bi se poboljšale njegove fizičke i kemijske karakteristike, i dalje je zanimljiva potreba za istraživanjem novih materijala i/ili smjesa koje smanjuju udio skupocjenog treseta u supstratima. U ovom radu procijenit će se izvedivost smanjenja sadržaja treseta u supstratima njegovom zamjenom s različitim količinama diatometa i mulja iz otpadnih voda za rast sadnica običnog bora (Pinus sylvestris L.) te njihovo preživljavanje na terenu. Kako bi se procijenila izvedivost smanjenja sadržaja treseta u supstratima zamjenom s različitim količinama diatometa i mulja iz otpadnih voda, provedeno je istraživanje u stakleniku, pod prirodnim svjetlom i u kontroliranim temperaturnim uvjetima. Između 2013. i 2017. godine u mjestu Sarıkamış, Kars (SI Anadolija) pokrenuto je istraživanje kojim će se procijeniti učinak koje zemljište ima na sadnice običnog bora koje rastu u različitim supstratima. Visoko organske tvari te makro i mikrohranjivi sastojci koji se nalaze u mulju iz otpadnih voda poboljšali su sastav rizosfere. što je rezultiralo bržim rastom sadnica. Kao rezultat evaluacija obavljenih u pogledu morfoloških karakteristika sadnica i utjecaja koji zemljište ima na preživljavanje sadnica; najbolji učinak postignut je u 9. (50%P + 50%SS) i 3. smjesi (75%SS + 25%DE)

Mean platelet volume is elevated in patients with patent foramen ovale

INTRODUCTION: Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review. MATERIAL AND METHODS: Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium. RESULTS: There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively). CONCLUSIONS: Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms

Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

<p>Abstract</p> <p>Purpose</p> <p>Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study.</p> <p>Patients and Methods</p> <p>In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months.</p> <p>Results</p> <p>Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%).</p> <p>Conclusion</p> <p>We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.</p

Evaluation of atrial conduction features with tissue doppler imaging in patients with chronic obstructive pulmonary disease

The electrical activity of atria can be demonstrated by P waves on surface electrocardiogram (ECG). Atrial electromechanical delay (AEMD) measured with tissue Doppler imaging (TDI) echocardiography can be a useful non-invasive method for evaluating atrial conduction features. We investigated whether AEMD is prolonged in patients with chronic obstructive pulmonary disease (COPD)

Kounis syndrome: myocardial infarction secondary to an allergic insult - a rare clinical entity

The association of an acute coronary syndrome with mast cell activation secondary to allergen exposure is known as the Kounis syndrome. We present two cases of the Kounis syndrome: (i) one was misdiagnosed as acute ST elevation myocardial infarction and treated with thrombolytics; (ii) the second diagnosis was made after a recurrence two months after the first incident

“CONTRAST” STUDY: COMPARİSİON OF NEPHROPROTECTİVE THREE PROTOCOLS: ACETYLCYSTEİNESODİUM BİCARBONATE-THEOPHYLLİNE, TO PREVENT CONTRAST-İNDUCED NEPHROPATHY

Aim. The purpose of this study was to compare three prophylactic regimens, sodium-bicarbonate based hydration, sodium-bicarbonate + N-acetylcysteine (NAC), and sodium-bicarbonate + NAC + theophylline, for the prevention of contrast induced nephropathy.Material and methods. We prospectively randomized 151 patients with baseline eGFR values between 30–59 ml/min/1.73m² who were also undergoing coronary angiography with three prophylactic treatments: intravenous hydration with sodiumbicarbonate (3 ml/kg/h for 1 hours before and 1 ml/kg/h for 6 hours after contrast exposure, group 1; n=50), hydration + NAC (600 mg p. o. twice daily the preceding day and the day of angiography, group 2; n=50), and hydration + NAC + theophylline (600 mg p. o. NAC and 200 mg theophylline p. o. twice daily for the preceding day and the day of angiography, group 3; n=51). The incidence of contrast induced nephropathy (0,5 mg/dl increase in serum creatinine from the baseline value 48 hours after intravascular injection of contrast) from the three groups was compared.Results. Of the 151 patients, 4 patients (7.8%) in group 3 experienced CIN (p=0.01). CIN did not develop in group 1 and 2.Conclusion. Among patients with eGFR values between 30–59 ml/min/1.73m² undergoing coronary angiography, use of sodium-bicarbonate based hydration alone and sodium-bicarbonate with NAC was associated with a reduction in the rate of contrast induced nephropathy. Sodium-bicarbonate with theophylline therapy was found to have no effect for the prevention of contrast-induced nephropathy

Mean platelet volume is elevated in patients with patent foramen ovale

INTRODUCTION: Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review. MATERIAL AND METHODS: Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium. RESULTS: There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively). CONCLUSIONS: Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms

Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

Purpose: Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study

From Clinical Misdiagnosis to Electrophysiological Diagnosis: Two Male Asystole Cases

Differential diagnosis of epilepsy and syncope may be difficult. Arrhythmias such as asystole, or ventricular fibrillation, may lead to cerebral hypoperfusion mimicking partial or secondary generalized tonic-clonic seizures. While performing an electroencephalogram (EEG) for epilepsy diagnosis, simultaneous electrocardiogram (ECG) recording may detect cardiac pathology. In this article, through 2 cases, who had cardiac asystole during the EEG, we demonstrate the importance of ECG during EEG. To rule out cardiac pathology in syncope cases, all necessary investigations must be done