High speed development
of technology, population growth, ecological and geographical change,
intensified communications between countries due to social and cultural
activities, emerging of new diseases and the increase of the
comprehensibility of the causes of diseases, development of new
alternatives in treatment, pharmacy and technology made the reconsideration
of specialization training in terms of content, period, rotations and
standarts unavoidable.
It is a must that
specialization training, wherever it occurs, has to carry the minimum
standards. In other words, there should be no deviation from obligatory
standardization in medical specialization training field.
The inspection based on
scientific principles of councils and commissions composed of
specialist scientists is necessary in order to ensure the quality in
specialization training and a specific minimum standard of education
inter-institutions. As the result of these inspections, deem unauthorized
for training completely or for specialization trainings. Suspended
permissions should not be re-granted until the desired conditions are
attained.
The inspection based on
scentific principles of the training institutions in terms of
physical structure, medical tools and equipment, academic staff and
the training unit will secure the constant and high quality. The
service quality for human health expected from medical specialization
training will therefore increase.
Through the
appraisal of knowledge and ability at the
conclusion of the specialization training and qualification tests, the
existence of unqualified specialists will be
prevented and the competent specialists will carry on the
in the field. When necessary, the permission for part-time education
for some specialization branches may be given to the
institutions. The institutions deem unqualified should be affiliated
with the qualified ones in order to acquire the necessary support
until the minimum standards are attained.
Diagnostic and therapeutic approach
with a mobile angiograph: Three years of experience in a center without
on-site surgical back-up
Akdemir R, Özhan H,
Yazıcı M, Gündüz H, Erbilen E, Duran S, Albayrak S, Arınç H, Uyan C.
The aim of the present study
is to assess the safety and efficacy of performing angiography and PCI with
a mobile C-arm angiograph in a center without on-site surgical back-up, and
compare the data with the literature.
1485 coronary angiograms and
172 PCI procedures performed in our center using a mobile angiograph from
January 2001 till May 2003 were analysed retrospectively. Half of the
patients that have undergone PCI had refractory unstable angina and
one-third had acute myocardial infarction (AMI). Clinical and demographic
characteristics of the patients, procedural success, early and late outcomes
of the patients were taken into account. The PCI procedures were considered
effective when the post-PCI residual stenosis did not exceed 50% with the
distal Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow.
The safety of PCI was
assessed by the analysis of in-hospital complications (death, urgent need
for repeated revascularization, AMI with or without ST elevation and
stroke). The mortality rate was 1,2% (2 deaths), 2 (1,2%) patients developed
acute MI with ST segment elevation, 1 (0.6%) patient underwent repeated PCI
and 3 (1,8%) patients were referred for urgent by-pass surgery.
Diagnostic and PCI
procedures can be safely performed using a mobile angiograph. The efficacy
and safety requirements of PCI, performed in a center without on-site
surgical back-up facility using a mobile angiograph were similar with the
data obtained from the literature.
Key Words:
Mobile angiograph, on-site surgery, angioplasty
Comparison of radial versus femoral
routes for diagnostic coronary angiography
Akdemir R, Özhan H,
Yazıcı M, Gündüz H, Erbilen E, Albayrak S, Uyan C.
The
radial artery approach is becoming more popular for diagnostic cardiac
catheterization and interventional procedures because of its lower incidence
of access site complications and decreased patient discomfort after the
procedure. The purpose of the present study was to compare the radial versus
femoral approach for coronary angiography which has not been published in a
domestic journal before.
107 patients were randomized
to coronary angiography via femoral versus radial access. Six of 56 patients
randomised to the radial group and one patient from femoral group crossed
over to the other group. Data collected prospectively from January to May
2003. The quality of the angiograms was good in all patients. Procedural
duration, success rates and complications were analyzed in the two groups.
Procedure and floroscopy times were significantly shorter in the femoral
artery access group. (15, 26±3.93 versus 19.1±4.6 min for procedure and
4.53±1.19 versus 6.1±1.97 min for floroscopy, respectively). More contrast
material were used in the radial artery group; whereas access site bleeding
complications and postpocedure stay in hospital were significantly lower.
Coronary angiography
performed via transradial route is a safe and reliable procedure.
Key Words:
Coronary angiography, radial versus femoral approach
Total coronary occlusion is
found in the early hours of transmural myocardial infarction. The goal of
the therapy is mainly focused on epicardial coronary arteries. Little
attention is paid to the coronary microvasculature. When a coronary artery
is occluded, detrimental changes occur in the cardiac capilleries and
arterioles. After relief of the occlusion, blood flow to the ischemic tissue
may still be impeded, a phenomenon known as no-reflow. Potential mechanisms
of no-reflow are as follows: endothelial ischemic damage and microvascular
obstruction, leucocyte plugging and activation, reactive oxygen species,
functional abnormalities of the vessels, mechanical compression, activation
of tissue factor, and microembolization of atherosclerotic debris. The
incidence of no-reflow is between 0.6-2% in invasive procedures.It is more
frequent in primary coronary angioplasty, rotational atherectomy, TEC and
saphenous venous procedures. From a practical standpoint the best way to
reduce no-reflow is to reduce infarct size by early reperfusion and use of
glycoprotein IIb/III a antagonist and mechanical devices.
Transcatheter therapatic techniques
for the treatment of congenital heart diseases
Atak R, Alyan Ö, Şenen K,
İleri M, Duru E.
In recent years,
parallel to the improvements in interventional cardiology, cardiac
catheterization became a theraphetic rather than a diagnostic tool. First
theraphetic approaches by catheterization were defined in early 1950's.
However the former large sheats and catheters lead to low sucsess and high
complication rates. Nowadays, many disorders of pediadric and adult
age groups can easily be managed by cardiac catheterization techniques as
the new devices are introduced and operator experiences are increased.
Especially in children, recent reports have shown that atrial septal defects
and patent ductus arteriosus can successfully be treated via
transcatheterization techniques. Similarly in selective patients
same success rates are approved also in adults. In this paper, treatment of
congenital heart disease, particularly atrial septal defects, patent ductus
arteriosus and ventricular septal defects, via cardiac catheterization
techniques were reviewed.
Is BioGlue beneficial in repair of left ventricular
posterior free wall rupture?
Tütün U, Aksöyek A, Ulus
A.T, Hızarcı M, Katırcıoğlu S.F.
Rupture of the left
ventricular wall is an infrequent but lethal complication after mitral valve
replacement. In this study, the case of a patient in whom posterior free
wall rupture occured following mitral valve replacement (MVR) and repaired
by non-suturing tecnique is described. Although the benefit of using a
teflon patch and Bioglue surgical adhesive to repair the rupture is
outlined, there is not any known perfect surgical method to overcome this
serious problem.
This is a case report of a
surgical disaster leading to the death of patient. BioGlue provided
temporary control of the bleeding left ventricle.
Bilateral renal artery stent
implantation in a patient with severe coronary artery disease and left
ventricular dysfunction
Yazıcı M, Nazlı C, Kınay
O, Kılıçaslan B, Ergene O.
Renovascular disease is one
of the most common causes of secondary hypertension. Renal
revascularization can potentially cure or better control the hypertension
and and renal insufficiency. In a patient presented with effort angina
and uncontrolled
hypertension, angiography revealed bilateral and subtotal renal artery
stenosis (left 95%, right: 99%) with severe coroner artery disease (three
vessels) and left ventricular dysfunction (EF: 25%). Herein, it is reported;
successful stent implantation following balloon predilatation in this case.
Right coronary artery-right pulmonary artery
fistula in a patients with acromegaly
Boyacı A, Aras D, Güray
Ü, Kütük E.
We encountered a 60-year-old
patient with both acromegalic features and coronary artery fistula having
unstable angina and dyspnea on exertion. The serum level of growth hormone
was increased to 12.63 ng/ml. Magnetic resonance imaging disclosed a
microadenom in the enlarged cella. The patient was diagnosed as having
acromegaly due to overproduction of a pituitary tumor. He manifested cardiac
hypertrophy with hypertension and diabetes mellitus. Coronary angiography
revealed a markedly dilated tortuous right coronary artery to right
pulmonary artery fistula and a Qp/Qs of 1.1. The patient refused the
surgical closure or coil embolization of the fistula and discharged with
medical theraphy of diabetes and hypertension.
