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Bu çalýþma, tek baþýna atriyal fibrilasyonlu (AF) olgularda PW doku Doppler yardýmý ile, sim/s rifmine (SR) döniiþiin sol ventrikiil (SV) bölgesel miyokard doku hýziarýna etkisini deðerlendirmek amact ile plan/andý. Çalýþmaya tek baþma AF' si olan 27 hasta alýndý. Tiim hastalardan PW Doku Doppler ile mitral amýu/us, interventriküler septum (ÝVS), SV serbest duvan ve apikal segmentlerinden mi yokard doku Doppler kayttiarý alýndt. Sistolik ejeksiyon (Sm), diyasýolik erken doluþ (Em) ve aýriyal kontraksiyon (Aný) dalgalan (cm/sn); 5 ardtþtk sikliisten kaya edilen ölçüm/erin ortalamasý almarak hesap/andt. Hastalar SR' ne döndükten ortalama 14±2 giin sonra ölçümler tekrarlandý ve SR grubu oluþturuldu. Kontrol grubu olarak ise benzer yaþ aralýðma sahip 10 sað ltklt gönüllü almdt. Tek baþýna AF' si olan hastalar SR döndüriildükten sonra Sm ve Em dalga hýzlarýn da hiç bir segmenlfe deðiþiklik göz/ennýezken (p>0.05 ), Am dalga hýzlannda artt þ saptandt (p<0.05). Hasta/ann tüm segmentlerinde AF ve SR' de iken elde edilen Em ve Am dalga htzlan kontrol grubundan anlamlý derecede diiþükken (p<0.05 ); Sm dalga htzlan arasmda fark gözlenmedi (p >0.05). Hastalarm AF ve SR' de iken ÝVS' den alman Sm dalga lýtzlan, mitral annu/ us ve serbest duvar Sm dalga hýzlarmdan düþük; apikal bölge Sm dalga hýzýndan ise yüksek bulundu (p<0.05). Her iki ritimde iken segmentler arasýnda Em ve Am dalga hýzlarý yönünden fark saptanmadý (p>0.05 ). Hastalarýn AF ritminde iken SV ejeksiyon fraksiyonu (EF) ile mitral annulus Sm dalga hý zlarý arasýnda anlamlý pozitif korelasyon saptandý (r:0.87, p<0.05). Tek baþma AF' li olgulardan alman SV miyokardiyal doku Doppler kayýtlarýnda: 1) Em dalga hiZindaki azalma, SV katýlýðýnda artýþý ve e/astik rekoyldeki azalmayý ; 2) Aný dalga hýzýndaki azalma, atriyal kontraksiyonun miyokard Am dalga oluþumuna katktsýný yansýýmakta olup; AF ile azalmaktadtr, 3) Mitral annulus Sm dalga htzý ile EF arastnda anlamlt pozitif korelasyon mevcuttur.

This study was planned to evaluate the effect of canversion to sin us rhythm on left ventricle (LV) regional myocardial tissue velocities by PW tissue Doppler in patients with lone atrial fibrillation (AF). Twenty-seven patients with )one AF were enrolled. PW tissue Doppler tracings of mitral annulus, interventricular septum (IVS), posterior wall and apical segments of LV were obtained. Sm, Em and Am waves were taken as means of the measuremenýs of S consecutive beats. The sinus group was composed by the measurements which were repeated on days 14±2 following canversion to sinus rhythm. The control group w as composed of I O heal thy volunteers having a similar age profile. There were no changes in Sm and Am velocities for each segment when patients were converted to sinus rhythm from AF (p>0.05), whereas there were increase in Am velocities (p<0.05). The Em and Am velocities of all segments were found to be significantly lower than those of the control group (p<0.05) both in patients with AF and sinus rhythm but there were no signific iant differences for Sm velocities. The Sm velocities of IVS of patients when they were in either AF or sinus rhythm were lower than the mitral annulus and free wall and higher than the apical Sm velocities (p<0.05). There were no differences between segments for Em and Am velocities for patients either in AF or sinus rhythm. There was a positive correlation between LV ejection fraction (EF) and mitral annulus Sm velocities when patients were in AF rhythm (r:0.87, p<0.05). The following statements were concluded from the LV myocardial tissue Doppler tracings obtained from patients with !one AF: 1) the decrease in Em wave ve1ocity reflects the increase in LV stiffness and the decrease in elast ic recoil; 2) the decrease in Am wave velocity refl ects the contribution of atrial contraction on myocardial Am wave formatian and Am wave velocity decreases with AF, 3) there is a sig nifi cant positive correlation between mitral annulus Sm ve1ocity and LV EF.

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Anjiyografide koroner arterleri normal bulunan ancak sintigrafide iskemi saptanan hipertansif hastalar uzun siireden beri araþllrma konusu olmuþtur. Bununla birlikte araþiirma/ar bu hastalarm daha çok anjiyografik özellikleri üzerinde yoðu n/aþmýþtýr . Bu çaliþmacia yukanda tamm/ anan hasta grubunun klinik, ekokardiyografik ve aritmojenik özelliklerinin araþtminýasý amaç/andý. P eýfüzyon sililigrafisinde geçici peýfiizyon defekti saptanan ancak koroner anjiyografide anlam/i koroner arter hastalýðý saptarýmayan 54 hasta (30 kadm, 24 erkek, yaþ ort. 57±9 yil) çaliþma grubuna a/mdý. Miyokard p eýfiizyo n sintigrafisi normal bulunan 80 lýipertansif olgu (58 kadm, 22 erkek, yaþ ort. 57±10 yil) ise konrrol grubunu oluþturdu. Hastalardan detaylý anamnez alýndýkran sonra, fizik nwayene, biyokimya analizi, ekokardiyografik inceleme ve 12 derivasyon/u EKG kaydý yapýldý. Peýfiizyon sinifgrafisinde defekt sapranan 26 ve sinrigrafisi normal bulunan 30 hasrada 24 saatlik Ho/ter monitorizasyonu ile arirmik olaylar incelendi. Klinik ve ekokardiyografik bulgular /ojistik regresyon analizi ile deðerlendirildið inde, tüm çaliþma grubunda peýfüzyon defekti varlýðý ile iliþkili faktörler erkek cinsiyet, kan basmcý yüksekliðinin siiresi, soll'ellfrikül diyasto/ sonu çapý ve mitral ak ýmmda A dalgasý hý zý idi (sýrasýyla p<0.001, p=0.002, p=0.01 ve p<0.001 ). Kadm hipertansiflerde en önemli faktörler kan basmcý yüksekliðinin süresi ile A hýzý (sýrasýyla p=0.02 ve p=0.006), erkek hiperta/ISif/erde ise sol vemrikül eliyasrol sonu çapý, ejeksiyon f raksiyonu ve A dalgasý hý z ý idi (sýrasýyla p=0.007, p=0.01 ve p=0.002). Yaþ, sigara kul/ammý , HDL-K düzeyi, görece/i duvar ka lml ý ð ý ve sol ventrikiil kitlesi ile peýfiizyon def ekri var/iðý arasýnda anlam/i bir iliþki saptanmadý. 24 saatlik ambularuvar EKG fetkikinde venrrikiiler ve supravenrriküler aritmi/erin sý klýð ý bakýnundan çalý þma gruplarý arasmda fark sapranmadý . Kompleks aritmi sýkliðý ve repolarizasyon dispersiyonu da her iki grupta benzer idi. Sonuç olarak koroner arterleri normal olan lýipertan sif hastalarda, sinrigrafide iskemi varlýðýnýn özellikle diyastolik fonksiyon bozukluðu ile bir- likte ortaya çýkr ý ð ý na, özellikle erkek olgularda ilaveten sisro/ikfonksiyon/arda görece/i bir azalmaya iþa ret ettið ine, ancak ek aritmojenik erkisinin olmadýðý na karar verildi.

Ischemic hypertensive patients with normal coronary arteries have been a research area for a long time. However studies have been intensively focused on the angiographic but not on elinical features of these patients. In this study we investigated clinical, echocardiographic and arrhythmogenic features of the patients depicted above. Fifty-four hypertensive patients (30 female, 24 male, mean age 57±9 years) who showed a revers ible perfu sion defect on scintigraphy but no significant angiographic stenosis wer e included in the study group. Eighty hypertensive patients (58 female, 22 male, mean age 57±1 O years) w ith normal myocardial perfusion scintigraphy served as a control group. After detailed histories were taken from the patients, physical exami n a tion , biochemi ca l a n a l ys is, echocardiographic examination and 12-lead ECG recording were performed. Arrhythmic events were investigated in 26 patients with and in 30 patients without perfusion defects using 24-hours Holter monitoring. When we assessed elinical and echocardiographic findings with logistic regression analysis, the factors related with the presence of myocardial perfusion defects were found as male gender, duration of high blood pressure, left ventricular end-diastolic dimension and mitral A wav e velocity in the who le study group (p

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Diyabetes nýellir us, koroner arter hastalýðr aortik disfonksiyon için önemli bir risk oluþturnraktadtr. Çalýþmamýzýn amacý, diyabetik olan koroner arter hastalarmda aortan111 e/astik özelliklerindeki deðiþiklikleri göstermek ve buna gliserol Irinitra/m (GT) etkisini araþtmýýaktrr . Metod: Bu amaçla çalrþmaya diyabet i ve koroner arter hastaltðr olan 17 olgu (13 kadur, 4 erkek, yaþ ortalamasr 58.4±9.4 yri) çaltþma grubu (ÇG) olarak ve koroner arter lýastaltðr o/an.jakat diyabeti olmayan 20 olgu (14 kadm, 6 erkek, yaþ ortalamost 56.0±10.7 yri) kontrol grubu (KG) olarak altndr. Hastalara transtorasik ekokardiyografi yaptldr. Ýntravenöz yol ile 200 pg GT öncesi ve sonrasmda, aortik sistolik ve eliyasto/ik çap indeksleri ve aorrik "distensibilite" ve "stiffiýess" indeks ölçüldü. Bulgular: Her iki grupta GT öncesi yaption karþtlaþttrnýada yaþ, cinsiyet, sigara ku/lamnýt stkltðt, sisto/ik ve eliyasto/ik tansiyon ortalamalan, aortik sisro/ik ve di yasto/ik çaplan indeksleri baktnundan anlamlt farklt/tk yokttý. Çaltþma grubunda KG'ye göre aortik "distensibilite" daha düþiik (s rrasryla 0.0015± 0.0005 ve 0.0026± 0.0007 nýmHg·l, p

Diabetes mellitus is a major risk factor for coronary artery disease and aortic dysfunction. The aim of this study was to determine the changes in the aortic elastic properties in patients (pts) with diabetic coronary artery disease and to search the effect glycerol trinitrate (GT). Method: Patients with coronary artery disease were allocated into two groups. Study group (SG) consisted of 17 pts ( 13 women 4 men; mean age 58.4±9.4 years) with diabetes mellitus, and the control group (CG) 20 pts (14 women, mean age 56.0±10.7 years) without diabetes mellitus. Aortic systolic and di astolic dameter indexes and aortic distensibility and stiffness index were measured before and after 200 pg GT (i ntravenously) by transthorasic echocardiography. Results: There were no statistically significant differences between the two groups before GT with regard to age, sex, smoking, systolic and diastolic blood pressures, aortic systolic and diastolic diameter indexes. Aortic distensibility was found to be lower and stiffness index was found to be higher in SG (for the distensibility 0.0015± 0.0005 vs 0.0026±0.0007 mmHg-1, p

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Bu ça lýþmanýn amacý , Ebstein anamalisinin rekonstrüktij onarýnýlarýnm erken ve geç dönem sonuçlarým bildirmek/ ir. 1985 - Kasýný 2000 tarilý/eri arasmda 8 hastaya Ebstein anamalisi nedeniyle cerrahi giriþim uygulandt. Hastalarýn altýsý kadýn, ikisi tanesi erkek olup yaþ ortalamasý 14.2 ± 6.7 ytl (5-23) idi. Tiiný hastalar sinüs ritminde olup, sað atriyaltronýbiise baðlý geliþen pulmoner emboli bir hastada ilk bulguydu. Eþlik eden anamaliler ASD (%37.5) ve VSD (%12.5) olarak tespit edildi. Triküspit kapak seviyesi, mitra/e göre ortalama 2.3 ± 0.9 cm (1.2-4.6) daha aþaðýda yer alýyordu. Rekonstriiktif giriþim olarak Danielson prosediirii (%50), triküspit annuloplasti (%37.5) ve Hardy prosedürü (%12.5) uygulannuþ olup hastalar ortalama 7.3 ± 3 yt! (2.5-12.5) takip edildiler. Erken morta/iteye rastlanmadý. Geç mortalite 1 hasta ile %12.5'dir. Hastalarýn yarýsýnda görülen geçici AV-taný blok hastalar tabUI·cu edilmeden düzelnýiþti . Bir hastada postoperarif 30. ayda ciddi sað kalp yetmezliði geliþti. Preoperatif sað atrial tronýbiis bulunan hastada ise postoperarif 6. ytlda rekürren tronýbüs oluþtu. Sað atriyýmý çaplarýmn (5.9 ± 0.5 cm; 5-6.5 cm) postoperarif kontrollerde (4.5 ± 0.5 cm; 4-5.5 cm) anlamlý þekilde küçiildüðii tespit edildi (p=0.001 ). Trikiispit kapaðm rekonstriiksiyonu sonucu yetmezliðin ortadan kalkmasý, sað atrium ve ventrikül fonksiyonlarm oluný/u yönde etkileyerek hastalarýn fonksiyonel kapasitelerinin artmasým ve kalp yetmez liðinin düze/nýesini saðlayacaktýr. Geç dönem ge liþebilecek sað kalp yetmezliði nedeniyle hastalar yakm takip altýnda tutulmalýdýr.

The aim of this study was to show early and longterm results of the reconstructive treatment of Ebstein's anomaly. Between 1985 and November, 2000, 8 patients (six of whom female) were operated. Mean age was 14.2 ± 6.7 years (range, 5 to 23). Sinus rhythm prevailed in all patients. Pulmonary embolism due to right atrial thrombosis was the presenting symptom in one patient. Associated anomalies were ASO (37.5%) and VSD (12.5%). The tricuspid valve was Iocated 2.3 ± 0.9 cm (range, 1.2- 4.6 cm) below the mitral valve. W e have performed Danielson procedure (50%), tricu spid annuloplasty (37.5%) and Hardy procedure (12.5%) as reconstructive techniques. The mean follow-up period was 7.3 ± 3 years (range, 2.5 to 1 2.5). There was no early mortality and one Iate death. Transient complete AV block developed in one-half of the patients. One patient was rehospitalized with severeTight heart failure 30 months post operatively. Another one with previous right atrial thrombosis presented again with the same finding 6 years after operation. The right atrial dimensions (5.9 ± 0.5 cm; range, 5 to 6.5) decreased signi ficantly (p = 0.001) after surgery (4.5 ± 0.5; range, 4 to 5.5). Reconstructive treatment of Ebstein's anomaly with reducing tricuspid insufficiency and remodelling of the right atrial and ventricular chambers favorably affects the functional capacity of the patients. These have to be followed up closely for the possibility of right heart failure in the Iate postoperative period.

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Beyaz ön/ük hipertansiyonu (BÖH) hekim ofisinde yapýlan ilk muayenelerinde sisto/ik (SKB) ve/veya eliyasto/ik kan basý nçlarý ( DKB) yiiksek bulunan fakat daha sonra anýiJ/t· lawvar kan basmcý monitörleri (AKBM) ile yapýlan ölçiinýlerde deðerleri normal saptanan kiþiler için kullamlan bir tamnýdýr. Bu çalýþmaya, son 10 giin içinde herlýcmgi bir antihipertansif ilaç kullanmaya n, diabetes mellitus, kareliyak veya diðer sistemik hastalýðý olmayan, ofis ölçiim/ erine göre klinik hipertansif (KHT, SKB?.140 ve/veya DKB?.90 mmHg) olan 96 kiþi (57K, 39E; yaþ ort: 51.3±1.3) ile ofis ölçümlerine göre nornýotansif (NT, SKB<140 ve DKB<90 mmHg) olan 132 kiþi alýndý (101K, 31E; yaþ ort: 41.4±1.0). AKBM ile 48 saatlik, gece ve gündüz ortalanýalarý ile load (belirlenen siirede belli limit/ erin üzerindeki ölçüm/erin elde edilen toplaný ölçüm sayýsma oraný, o/o) deð erle ri hem SKB hem de DKB için hesaplandý. Bireysel uykuya yatma ve kalkma saatleri giindiiz ve geceyi belirlemek için ku l/am/dý . Load limitleri olarak SKB ve DKB için sýras ýyla giindiiz 140/90, gece 125180 mmHg sýnýrlarý kullanýldý. Klinik hipertansif kiþilerden (KHT) gündüz AKBM deðerleri SKB

Parameters in Patients with White Coat Hypertension Versus Normotensive Subjects and Untreated Hypertensive Patients M. C emri, U. Hodoðlugil, M. Ceyhan, D. Bar/as, H. Dörtlemez, H. Zengil White coat hypertension is defined to be present when an individual is hypertensive in the physician's office, but normotensive when their blood pressure (BP) is measured with ambulatory blood pressure monitoring (ABPM). To assess the elinical importance of the white coat hypertension, we aimed to compare ambulatory blood pressure parameters in patients with white coat hypertension versus normotensive subjects and untreated hypertensive patients. The study was carried out on 96 hypertensive patients (57 F, 39 M; mean age: 51±1.3 years) and 132 normotensive subjects (101 F, 31 M; m ean age 41.4± 1.0) according to office measurements. After office BP measurements were recorded 3-4 times, ABPM was applied for 48 hours to each subject. We calculated 48-hour of, day and night mean load (proportion of elevated BP over a certain Jimit for a period) values for systolic and diastolic BPs. Of the 96 hypertensive patients, 20 (20.8%) had white coat hypertension (12 F, 8 M; mean age: 52.9±3.7 years) and 76 had sustained hypertension. Although 48-hour day and night mean and load values for systolic and diastolic BPs in patients with white coat hypertension were significantly lower than in those with sustained hypertension, they usere significantly higher than in normotensive subjects. These results suggest that white coat hypertension may be of elinical importance.

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TEKHARF Çalýþmasý orijinal ve yeni kahortuna ait 2445 kiþide (ortalama yaþ 51 ±14) beden kitle indeksi (BKÝ), bel çevresi ve bel-kalça oram (B/K), cinsiyet ve yaþ gruplarý katmanlamasiyle 2000 yý lýnda kesitsel olarak deðerlendirildi. Ayrýca 9/0 erkek ve 955 kadmda BKÝ'ne iliþkin son /0 yý ldaki deðiþim deðerlendirildi . KKH tamsý anamnezde angina var lýðý ve 12-derivasyon lu isýirahat EKG'nin Minnesota kodlamasýna dayanýlarak kondu . Yaþlamýýadan arýndJ/an net deðiþim ler baðlamýnda, ortalama BKÝ'nin 10 y1/da erkekle ve kadmda 1.29 ve 1.26 kgfný2 arliiði hesaplandý (ki bu ortalama 4 ve 3 kg þiþman/amaya karþilýk gelir). Son taranýada erkek ve kaduýlarda BKÝ sýrasiyle 26,8 ve 29,2 kgtmý . bel çevresi de 91.8 ile 89,4 cm idi; obezite prevalans1 30 yaþ ve üzerindekilerde sýrasiyle %21 ve %43 bulundu. Diðer parametrelerle en iyi kore/asyomt sergilediði anlaþýlan bel çevresinin, kan basmcýyla iyi korelasyonunu (r 0.3-0.5), plazma trigliseridleri, apo C-lll ve B ile korelasyon larý (r =0.27-0.38) izledi. Bel çevresinin glukoz ile pozitif yönde, HDL-kolesterol, sigara içimi ve fizik etkenlik ile ters yönde ýlýný lý (r = 0.14 dolaymda) birer bað mtý s 1 gözlem/endi. On yýllýk prospektif incelemede nýültivariye analizde BKÝ erkeklerde fatal ve nonfatal KKH'nm baðýmsýz bir öngördürüciisii bulundu; her birim BKÝ artýþý KKH riskini %9 arttýrýyordu . Yeni geliþen KKH için BKI yine erkeklerde 1.09'/uk nisbi risk ile baðýmsýz öngördiiriicii olarak ortaya çý ktý. Yaþ-ayarlý bel çevresi ve viielli aðýrlýðýilin da prevalan KKH olasýlý ð ý ile an lamlý iliþk isi kaydedildi. Sonuç . olarak, obezite ve santral obezitenin ye tiþkinlerinýizde yaygmlaþnýasý , özellikle erkeklerde kardiyovasküler morbidile ve ný ortaliteye önemli katkýda bulunmaktadýr. Anahtar kelimeler:

In the original and new cohorts of the Turkish Adult Risk Factor Study, body mass index (BMI), waist circumference and waist-to-hip ratio (WHR) were cross-sectionally assessed among 2445 participants (mean age 51 ±14 years). In addition, BMI was prospectively evaluated over 10 years in over 2000 men and women. Coronary heart disease (CHD) was diagnosed based on elinical findings and Minnesota coding of resting electrocardiograms. At standardized age, mean BMI soared in a decade by + 1.29 and + 1.26 kg/m2, respectively, in men and women. In the last survey, in men and women, respectively, mean BMI was 26,8 and 29,2 kg/m2, and mean waist circumference w as 91.8 and 89,4 cm, respectively. Waist circumference, the best correlate of other risk parameters in both genders, exhibited correlations of moderate degree with (systolic or) diastolic pressure, plasma triglycerides, apo C-III and apo B, inverse correlations of mild degree with HDL-cholesterol, smoking and physical activity and direct correlation with blood glucose. In a prospective logistic regression analysis, BMI significantly and independently predicted nonfatal and/or fatal coronary heart disease (CHD) risk in men placing 9% excess risk for each inerement of 1 unit. Both waist circumference and body weight were significantly associated, after age adjustment, with prevalent CHD in both genders on bivariate analysis. It was concluded that the rising prevalence of (central) obesity in Turkish adults is contributing particularly among men to the existing high cardiovascular morbidity and mortality. Key words:

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Plazmacia lýomosisrein ve lipoprotein (a) [LP(a)] yüksekliðinin koroner arter lzasrahð uýda riskfaktörü olarak erkileri son zamanlarda stk araþttnlmtþ olmakla birlikte, çaliþma ve mera analiz sonuçlan hala çeliþkilidir. Aynca toplumýmwzda genç yaþta koroner arter lzastah ðý olanlar arasmda, bu n/ann risk faktörü olarak önemini araþttran yeterli çaliþma bulunmamaktadýr. Bu amaçla akut miyokad infarktiisii geçiren 45 yaþ altý 92 hasta ve 30 konrol grubu üzerinde lýomosistein ve Lp( a)'mn risk faktörü olarak önemlerini ve birbirleri ile olan etkileþimlerini araþtu ·dýk. Miyokad infarktüsii geçiren hastalarda plazma· lýomosisrein düzeyi kontrol grubuna göre anlamh olarak daha yüksek bulunmakla birlikte [geometrik ort. 12.4 }lmoi!L (%95 Cl 10.9-13.9) ve 10.0 pmoi!L (%95 Cl 5.1 -14.9)], Lp(a) her iki grupta benzer düzeydeydi. Homosistein ve lipoprotein düzeyleri dört dilime ayrýldt ðtnda lýomosisrei nin dördüncü diliminde Ml riskinde anianý/i arttþ sap/mýdi. Lipoprotein (a) için dilimter arasmda anlamlý fark yoktýt. Ayýca olgularýn tümü, konrol grubunda saptanan homosistein ve lipoprotein ( a) düzeylerinin %90 persanriline göre aynldtðmda, listünde kalanlarda homosis/einin hem tek deðiþkenli hem de çok deðiþkenli analizde (p=0.01, OR 1.87%95 Cl1.34-2.75) Ml için anlamlý baðmýs t z riskfaktörü olduðu saptandi. Lipoprotein (a)'nm, lýonýosistein in miyokard infarktiisiindeki risk oramm arttnet etkisi de yokttt. Ku·k beþ yaþ altmda infarktüs için en ciddi baðtmSIZ risk faktörleri sigara içiciliði (p=0.0004) ile total kolesterol/HDL oram (p=0.01) idi. Sigara içenlerde homosistein düzeyi içmeyeniere göre dalýa yüksekti (p=0.004). Sonuç olarak 45 yaþ altmda plazma homosistein yüksekliðinin miyokard infarktüsii için önemli bir baðýmst z riskfaktörü olabileceð i kamsýna vanld1. Lipoprotein (a) yüksekfiðinin ise bu grupta miyokard infarktüsü için baðýmst z bir risk oluþturmadýði ve lýomosisteinin etkisini artmct bir özellið inin olmayabileceði saptandi.

Although the effects of elevation of homocysteine and lipoprotein (a) in plasma have widely been investigated recently as a risk factor in coronary artery disease, the resuts of the studies and meta analyses are stili controversial. To that end, we investigated the significance of homocystein and Iipoprotein (a) levels as risk factors as well on their interaction, in a group of 92 patients with to acute myocardial infaretion and a group of 30 controls, all among 45 years-old. Although plasma homocystein levels were significantly higher in patients who sustained a to myocardial infaretion compared to the control group [geometric mean 12.4 ý.ýmol/L (%95 CI 10.9-13.9 ý.ýmol/L) and 10.0 (mol/L (%95 CI 5. 1-14.9 ý.ýmol/L)], Lp(a) levels were similar in both groups. When homocystein and lipoprotein levels were divided in to quartiles, MI risk was significantly increased (OR 1.54) in the fourth quartile of homocystein. There was no significant difference between quartiles of Iipoprotein (a). When all subjects were separated according to the 90'" percentile of homocystein and lipoprotein (a) of the control group, patients with values above this percentile fo r homocystein had a significantly independent risk for MI in both univariate and multivariate analysis (p=O.Ol, OR 1.87 %95 CI 1.34- 2.75). Moreover lipoprotein (a) had no potential effect on the risk potential of homocystein. The strongest independent risk factors in subjects under 45 years-old were smoking (p=0,0004) and total cholesteroi/HDL-C ratio (p=O.O 1 ). Homocystein levels were higher in smokers compared to nonsmokers (p=0.004). lt was, there fore concluded that an increased level of plasma homocystein was a significant independent risk factor for myocardial infaretion in those under 45 years-old, where as elevated lipoprotein(a) level was not.

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Triküspid annulusu ve vena kava inferior arasýnda çizgisel radyofrekans kateter ablasyonu tipik atriyal fiatterin tedavisinde etkili ve güvenilir bir yöntemdir. Bu çalýþma , standart abiasyon kateterierine (4 mm uç/u) göre daha büyük ve derin abiasyon lezyonu meydana getirebilen uzun uçtu kateterlerin tipik atJ·iyal fiatter çizgisel ablasyonunda daha etkili olup olmadýðýný araþtýrmak için plan/ andý. Ardýþýk 21 hastada toplam 24 abiasyon giriþim i (ll'i 4 mm uçtu, 13'ü 8 mm uç/u kateter ile) uygulandý. Kýsa uçtu kateter kullamlanlarla karþýlaþtýrýldýðmda uzun uç/u kateter kullamlanlarda ortalama iþlem sýlresi (78 ± 40141 ± 40 dak, p=0,002 ), skopi zamaný (47 ± 271 18 ± 5 dak, p=0,0006) daha kýsa; uygulanan abiasyon sayýsý (9 ± 4,1 15,7 ± 4,1, p=0,0003) daha az ve erken dönem baþarý oraný (%73 1 %92, p=0,05) daha yüksekti. Ortalama 12 ± 6 aylýk takip süresinde 4 mm uçtu kateter kulanýlan hastalarýn %25'inde, 8 mm uçtu kateter kullamlan/arýn %8'inde nüks gözlendi. Uzun dönem baþarý oram büyük uç/u kateter kullanýlanlarda anlamlý olarak daha yüksekti (%54 1 %84, p=0,03). Bu bulgular tipik atriya/ flallerin çizgisel radyofrekans kateter abiasyonundu uzun uçtu kateter kullanýlmasýnýn standart kateteriere göre daha etkili, iþlem süresini ve radyasyona maruz kalma süresini kýsaltan bir yaklaþým olduðunu göstermektedir .. Analýtar kelime/er:

Although the effects of elevation of homocysteine and lipoprotein (a) in plasma have widely been Türk Kardiyol Dem Arþ 2001; 29: 396-399 investigated recently as a risk factor in coronary artery disease, the resuts of the studies and meta analyses are stili controversial. To that end, we investigated the significance of homocystein and Iipoprotein (a) levels as risk factors as well on their interaction, in a group of 92 patients with to acute myocardial infaretion and a group of 30 controls, all among 45 years-old. Although plasma homocystein levels were significantly higher in patients who sustained a to myocardial infaretion compared to the control group [geometric mean 12.4 ý.ýmol/L (%95 CI 10.9-13.9 ý.ýmol/L) and 10.0 (mol/L (%95 CI 5. 1-14.9 ý.ýmol/L)], Lp(a) levels were similar in both groups. When homocystein and lipoprotein levels were divided in to quartiles, MI risk was significantly increased (OR 1.54) in the fourth quartile of homocystein. There was no significant difference between quartiles of Iipoprotein (a). When all subjects were separated according to the 90'" percentile of homocystein and lipoprotein (a) of the control group, patients with values above this percentile fo r homocystein had a significantly independent risk for MI in both univariate and multivariate analysis (p=O.Ol, OR 1.87 %95 CI 1.34- 2.75). Moreover lipoprotein (a) had no potential effect on the risk potential of homocystein. The strongest independent risk factors in subjects under 45 years-old were smoking (p=0,0004) and total cholesteroi/HDL-C ratio (p=O.O 1 ). Homocystein levels were higher in smokers compared to nonsmokers (p=0.004). lt was, there fore concluded that an increased level of plasma homocystein was a significant independent risk factor for myocardial infaretion in those under 45 years-old, where as elevated lipoprotein(a) level was not.

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Siyam ikizleri, klinisyenler ve araþtýrmacýlar açýsmdan bir "zor" olarak ilgi gören, çok nadir ve en ilginç yenidoðan anamalilerden biridir. Etyolojisi bilinmemekle birlikte, iki temel teori; fizyon ve füzyon sorumlu tutulmaktadýr. Siyam ikizleri birleþim yerleri ve paylaþtýk/arý organlar açýsýndan biiyük deðiþkenlik gösterirler. Bu vakalarda antenafal tam uygun obstetrik ve perinatal yaklaþýmýn önceden planlanmas ý için gereklidir. Bu makalede antenata/ olarak tanýmlanmýþ iki siyam ikizi vakasmdaki kardiak malformasyonlar sunula caktýr. Nadir olmalan nedeniyle etyolojisi henüz tam olarak aydýn/atýimam ýþ olan bu vakaIann tammlanmasý1ýuý. embryolojik çalýþmalara katký yanýnda obstetrik ve cerrahi deneyimlere yardýmcý olacaðým inamyoruz.

The linear radiofrequency catheter ablation between tricuspid annulus and vena cava inferior is an effective and safe method for the treatment of typical atrial flutter. The present study was planned to assess whether the Iong-tip e lectrode ablation catheter, which can allow the creation of larger and deeper ablation lesions the than standard catheter (4- mm tip electrode), is more effective for linear ablation of typical atriaJ flutter. A total of 24 ablation procedures (4-mm tip in l l patients, 8-mm tip in 13 patientS')' were performed to 21 consecutive patients. The mean procedure- (78 ± 40 1 41 ± 40 min, p=0.002) and fluoroscopy-durations (47 ± 27 1 18 ± 5 min, p=0.0006) were shorter; the mean numbers of energy applications (9 ± 4.1 1 5.7 ± 4.1, p=0.0003) were lower; acute success rate (73% 1 92%, p=0.05) was higher with long tip e1ectrod.e catheters as compared with the standard catheter. The recurrence rate was 25% with 4-mm tip electrode catheter while it was 8% with 8-mm-tip electrode catheter during the mean follow-up period (12 ± 6 months). Furthermore, chronic success rate was higher with long tip electrode catheter (54% 1 84%, p=0.03). These findings demonstrate that long tip electrode catheter (8-mm) is more effective than the standard catheter ( 4-mm), and it reduces the procedureduration and exposure to radiation for linear catheter ablation of typical atrial flutter. Key words:

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