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Irbesartan decreases mIcroalbumInurIa In patIents wIth type II
dIabetes mellItus followIng coronary artery bypass graftIng
Uçar H.İ, Tok M, Doğan Ö.F, Durukan B,
Gürbüz A, Atalar E, Furat C, Farsak B, Güvener M, Yorgancıoğlu A.C, Doğan R,
Demircin M, Paşaoğlu İ.
Microalbuminuria is a sensitive sign of
increased capillary permeability and thus may be a useful predictor to
assess the systemic inflammatory response, especially renal dysfunction,
after coronary artery bypass surgery. The aim of this study was to
investigate the effectiveness of the irbesartan, an angiotensine receptor
blocking agent, on microalbuminuria in patients with type two diabetes
mellitus undergoing on-pump coronary bypass surgery.
Fourty patients with type
II diabetes mellitus undergoing elective coronary artery bypass grafting
were inclu-ded in this study. The patients were divided into two groups as
Group I who received 300 mg irbesartan daily at least 6 months
preoperatively and group II who were assigned to conventional therapy other
than angiotensine receptor bloking agent. Four intervals of urine samples
were obtained and evaluated for microalbuminuria using a Micral-test sticks.
Preoperative, postoperative
first hour, postoperative first day (POD 1) and postoperative fifth day (POD
5) microalbuminuria levels in group I were 16.5±17.2 mg/l, 28.5±17.2 mg/l,
59.0±29.8 mg/l, 23.0 ± 20.0 mg/l, and 30.0±17.7 mg/l, 51.0±28.4 mg/l,
75.0±25.6 mg/l, 52.5±27.5 mg/l in group II, respectively. Between the groups
preoperative, postoperative first hour and POD 5 values were statistically
significant (p = 0.018, P = 0.008, and p = 0.001, respectively). However,
the difference of POD 1 values between the groups were at the threshold of
signi-ficancy (p = 0.071). Preoperative plasma levels of hsCRP (high
sensitive C-reactive protein) (0.35±0.17 mg/l vs 0.50±0.32 mg/l) showed a
trend towards significancy (p = 0.069). Although POD 1 hsCRP levels
(10.0±2.0 mg/l vs 17.8±3.9 mg/l) did not differ (p = 0.405), decrease in
POD 5 hsCRP levels in group I (8.6±2.9 mg/l vs 10.9±3.2 mg/l) was
statistically significant between the groups (p = 0.024).
Irbesartan, as an AII
receptor bloking agent, plays an important role in decreasing
microalbuminuria in diabe-tic patients undergoing coronary artery bypass
surgery.
How does percutaneous mItral balloon valvuloplasty affect plasma
E-selectIn level In patIents wIth mItral stenosIs and sInus
rhythm?
Topaloğlu S, Aras D, Ergün
K, Geyik B, Ayaz S, Baser K, Özeke Ö, Kısacık H.L, Korkmaz Ş.
To determine whether
plasma level of soluble E-selectin (sE-selectin) increases
in rheumatic mitral stenosis (MS) patients with sinus rhythm,
who have scheduled for percutaneous mitral balloon
valvuloplasty (PMBV), and to examine the effect of PMBV on
sE-selectin level.
Twenty-six symptomatic
patients with rheumatic MS suitable for PMBV and 21 healthy
volunteers were enrolled in the study. Transthoracic and
transesophageal echocardiography were performed before PMBV
in each patient. Blood samples were obtained from all
patients before and after (at 24th hour and 4th week) the
PMBV to analyze the sE-selectin level. sE-selectin
levels were compared between study patients and controls,
and between peripheral and intracardiac blood.
After PMBV, the mitral valve area (MVA) increased and the
LA diameter, mean LA pressure and transmitral pressure
gradient decreased signifacantly. The basal peripheral sP-selectin
level was significantly higher in study group than in
control group (p<0.0001). In study group sP-selectin level
was found to be similar between peripheral blood and left
atrial blood. At 24th hour after PMBV, sE-selectin level
decreased from 92.26±24.76 ng/ml to 72.27±21.70ng/ml
(p<0.0001) and at 4th-week follow-up it was decreased to
56.19±21.28ng/ml (p<0.0001). In study group correlation
analysis demonstrated a significant positive correlation
between basal peripheral sE-selectin level and
prevalvuloplasty mean transmitral gradient or LA pressure.
This study suggests
that in patients with MS and sinus rhythm sE-selectin level,
an inflammatory marker, are elevated compared to controls.
After PMBV elevated sE-selectin level shows a progessive
decline, which is directly correlated with the increase in
MVA.
The effect on N-AcetylcysteIne on myocardIal functIon undergoIng
coronary artery bypass surgery
Karabay B.C, Uçar H.İ, Öç
M, Tok M, Öç B, Farsak B, Yılmaz M, Güvener M, Yorgancıoğlu C,
Doğan R, Demircin M, Paşaoğlu İ, Ersoy Ü.
Although the preoperative pulmonary
functions of the patients whom undergone cardiovascular surgery can
clinically be normal, the pulmonary functions may deteriorate at the
intraoperative and postoperative period because of the extracorporeal
circulation, by usage of cardioplegic and anesthetic solutions.The objective
of this study is to search the effects of N-acetylcysteine on the pulmonary
and the kidney functions of the patients who underwent coronary artery
surgery.
From April 2005 to June 2005, 10 of 20
patients who are going to put into practice of cardiovasculer surgery taken
in the Group 1(NAC (-), n=10), other 10 is taken in the study group Group 2
( NAC(+), n=10). Smokers were exluded from the study. For the NAC (+) group
600 mg. N-acetylcysteine was added in to the extracorporeal circulation.
Respiratory function test was made and preoperative, postoperative on the
3th, 5th day only the Forced expiratory volume (FEV1) values were measured.
About the respiratory function test (RFT),
preoperative FEV1 values of the respiratory functions was lower than the
values of postoperative 3th and 5th days. Preoperatively in NAS (+) group
88.4±7.8 and in NAS (-) group 87.9±9.7, there was no statistical
significance between the the groups (p = 0.811). There were statisticaly
significance for pos-toperatif 3th day NAS (+); 82.35±6,7 and NAS (-);
71,8±12,7 (p < 0.001), and postoperative 5th day NAS (+); 86.8±8.2 ve NAS
(-); 76.8±11.3 (p < 0.001). There was no statistical significance between
the the groups about cardiopulmonary bypass time (p = 0.6), Xclamp time (p =
0.8) and flow (p = 0.5). Atrial fibrillation was the only arrhythmia and
there was no statistical significance between the the groups (p = 0.628).
As well as the usage of N-asetilsistein
at open heart surgery has a protective effects on respiratory system, at the
same time has an additional effects on improvent of respiratory functions
test much more significant and faster through the 5th day.
KeyWords:
Open heart surgery, N-acetylcysteine, Cardiopulmonary bypass, Pulmonary
function
EvaluatIon of left maIn coronary artery
dIsease wIth respect to clInIcal features and rIsk factors In
young and elderly patIents
Selçuk M.T, Selçuk H, Çelenk M.K,
Maden O, Özeke Ö, Korkmaz Ş, Demirkan D.
The goal of our study
is to investigate the clinical presentation features and
risk factors of patients with left main coronary artery (LMCA)
stenoses, and to examine possible variations in these
parameters with respect to age.
Coronary angiograms of
9296 patients were reviewed and a total of 101 patients, in
whom at least 50% narrowing was present in the LMCA, were
enrolled in the study. Study subjects were categorized as "elder"
and "young" groups according to whether they were over or
under 50 years of age, with the latter threshold identified
as 1 standard deviation (SD) below mean age (60.9± 11.3).
All subjects were evaluated in terms of gender, age, risk
factors, extent of coronary atherosclerosis, clinical
presentation and electrocardiographic (ECG) findings.
Comparisons were made between the groups with respect to
data obtained in these parameters.
There were 22 (22%)
and 79 (78%) subjects in the young and elder groups,
respectively. 76 subjects (77%) were male.
In 97 (96%) of the
study subjects, majör coronary vessel atherosclerosis was
present in addition to LMCA disease. Only 4 (4%) patients
displayed isolated LMCA stenosis. Left anterior descending
artery stenosis (LAD) as well as 3 vessel disease were
significantly more common in the elder (age> 50 years) group
(p= 0.03). There was no difference between the groups with
regard to involvement of other vessels (p> 0.05). Overall
prevalences of diabetes and hypertension were 17.8% and
34.7%, respectively. Both were more common in the elder
group with the difference being statistically significant
(p< 0.05). Overall frequencies of smoking and hyperlipidemia
were 29.7% and 40.6%; there was no difference between the
groups with respect to these (p> 0.05). Neither was there a
differential for family history of ischemic heart disease (overall
18%) (p> 0.05).
Clinically, 4 patients
(4%) had been admitted with acute myocardial infarction
(MI), 64 (63.6%) presented with unstable angina (USAP)
and 32 had sought care with chronic stable angina. USAP was
the most frequent presentation in both groups. There was no
difference between the groups in terms of clinical picture
at admission.
Overall, ST segment
depression with T inversion was most common, being present
in 50.5% of the study subjects; chronic MI pattern (of
undetermined age) and precordial R loss were observed in in
16 (15.8%) and 8 (7.9%) patients respectively. The ECG was
completely normal in 10 patients (9.9%). The groups did not
show a meaningful difference with respect to aforementioned
parameters. However, bundle branch block, complete AV block,
atriyal fibrillation and ventricular ectopy were
significantly more frequent in the elder group (p< 0.05).
Key Words: Left main
coronary artery, Coronary risk factor, Coronary angiography
Formerly patent
foramen ovale was thought an anotomical variation often
found at autopsy. However, it can be diagnosed premortem
with introducing the contrast echocardiography in clinical
practice. The studies consisting diagnosed cases reveals the
association between cerebrovascular accidents and migraine,
and efforts are directed to management of this previously
assenting innocent variation. In this review we tried to
discuss patent foramen ovale in the light of current
knowledge.
Currently coronary is the major
cause of all deaths. Invasive cardiology techniques,
progressively employed in that area intracoroner stent
techniques that mostly employed in invasive cardiology, in-stent
restenosis is an important problem that possed over that
hoped for. Drug eluting stents, in order tromboze diminish
in-stent restenosis, a technology that developed in last
decade. In-stent intimal hiperplazi is major factor of
physiopathology of the in-stent restenosis. In drug eluting
stents, variable cytotoxic agents that coated on the stent
by polymer technology is deve-loped by based on precaution
of intimal hiperplazi and for that reason restenosis
hypotesis.
In clinical practise when
compared by naked stents showed that diminished stent
restenosis. But , with widespreod of the employed areas,
observed that decrease in positive effects in meet some sick
groups. In that compile clinical states that making
limitations in drug eluting stents is examined.
Acute
myocardIal InfarctIon In a patIent wIth essentIal
thrombocythemIa treated wIth prImary coronary angIoplasty
Atalar E, Can İ, Özer N,
Kılıç H, Aksöyek S, Övünç K, Özmen F.
We describe a case of
essential thrombocythemia in a 53-year old man who
presented with acute anterior myocardial infarction and a
platelet count of 1,428,000/mm3. Primary coronary
angioplasty and stenting were performed after emergent
platelet pheresis. Glycoprotein IIb/IIIa receptor antagonist
tirofiban was administered during the procedure and 48 hours
thereafter. Postangioplasty course was uncomplicated.
The patient required
repeat platelet pheresis and was discharged with
acetylsalicyclic acid, clopidogrel, hydroxyurea, enalapril
and metoprolol on the third day of hospitalization.
Spontaneous rIght coronary artery dIssectIon: A case report
Bayar N, Özcan Ö, Canbay
A, Diker E.
Spontaneous
coronary artery dissection is an unusual cause of acute
coronary syndrome. It has most often been described in
healthy peripartum women with no risk factors for
atherosclerosis. We describe the case of a 52-year-old man
with no previous history of atherosclerotic heart disease
who presented with acute inferior and right ventricular
myocardial infarction and found to have a spontaneous
right coronary artery dissection at cardiac catheterization.
