Amaç: Koroner arter baypas greft (KABG) ameliyatý sonrasý, hastalarýn takip etmeleri gereken bir hastalýk süreci vardýr ve saðlýklý davranýþlar bu süreçte anahtar rol oynamaktadýr. Bu çalýþmada, KABG sonrasý taburcu olan hastalarýn saðlýðý geliþtirme davranýþlarýný deðerlendirerek etkili faktörlerin belirlenmesi amaçlandý.
Yöntemler: Araþtýrma Mart-Haziran 2016 tarihleri arasýnda poliklinik kontrolüne gelen 152 hasta ile kesitsel olarak yapýldý. Veriler hasta bilgi formu ve Saðlýklý Yaþam Biçimi Davranýþlarý Ölçeði II (SYBDÖ) ile toplandý. Verilerin deðerlendirilmesine sayý, yüzdelik, standart sapma, ortalama, baðýmsýz t ve anova testi kullanýldý.
Bulgular: Araþtýrma kapsamýna alýnan hastalarýn yaþ ortalamasý 58±13 idi. Hastalarýn %71.6’sý erkekti. %55.4’ü 1–4 ay önce KABG ameliyatý olduðunu, %88.4’ü taburcu olduktan sonra düzenli olarak kontrollere geldiðini ifade etmiþtir. Koroner arter baypas greft olan hastalarýn SYBD puan ortalamasý 110.28±17.32 olarak bulundu. Elli beþ yaþ altýnda ve kadýn hastalarýn, evli olanlarýn, geliri giderinden yüksek olanlarýn, ek hastalýðý olmayanlarýn, 1–4 ay öncesinde KABG ameliyatý geçirenlerin, taburcu olduktan sonra düzenli kontrole gelenlerin ve taburcu olurken hastalýkla ilgili yeterli düzeyde eðitim alanlarýn SYBD toplam puaný diðer gruplara kýyasla anlamlý derecede yüksek bulundu (p<0.05).
Sonuç: Bu çalýþmada, KABG ameliyatý geçiren hastalarýn SYBD puan ortalamalarý orta düzeyde olduðu ve taburcu olma sýrasýnda verilen eðitimlerin saðlýðý geliþtirici davranýþlar üzerinde olumlu etkilerinin olduðu bulundu.

Objective: After coronary artery bypass graft (CABG) surgery, there is a disease management process that patients should follow, and healthy behaviors play a key role in this process. The aim of this study was to evaluate the health-promoting behaviors of patients after CABG surgery and to determine the influential factors.
Methods: This was a cross-sectional study of 152 patients who were admitted to the polyclinic between March and June 2016 and underwent a CABG procedure. The data were collected using a patient information form and the Health-Promoting Lifestyle Profile (HPLP). Number, percentage, SD, mean, independent t and analysis of variance tests were used to evaluate and describe the data.
Results: The mean age of the patients in the study was 58±13.71 years. Of the total, 6% of the patients were male, 55.4% stated that they had the CABG surgery between 1 and 4 months prior, and 88.4% went to check-ups regularly after discharge. The mean HPLP score of the enrolled patients was 110.28±17.32. The patients who were under 55 years of age, married, had a comfortable income, no comorbid disease, those who underwent the CABG surgery between 1 and 4 months earlier, went to follow-up regularly after discharge, and those who were educated about their disease had a higher HPLP score (p<0.05).
Conclusion: This study found that patients who underwent CABG surgery had a moderate HPLP score and that training on health-promoting behaviors at discharge had a positive effect on their implementation.

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Amaç: Akut koroner sendrom (AKS) nedeni ile yatýþý yapýlan hastalarda taburcu olma sonrasý uzun dönem takip sonuçlarýnýn antitrombotik yönetim yaklaþýmlarý (AYY), klinik sonuçlar ve saðlýk durumu açýsýndan gerçek yaþam koþullarýnda deðerlendirilmesidir.
Yöntemler: Bu kayýt çalýþmasý semptom baþlangýcýný takiben 24 saat içinde AKS tanýsý ile hastaneye yatýþý yapýlan ve taburcu edilebilen 1034 hastada (514’ü ST-segment yükselmeli miyokart enfarktüsü [STYME] ve 520’si kararsýz angina/ ST-segment yükselmesiz miyokart enfarktüsü [KA/STYzME] tanýlý) yürütüldü. AYY, klinik sonuçlar ve saðlýk durumu açýsýndan 24-aylýk takip verileri kaydedildi.
Bulgular: Taburcu edilme sonrasý 2 yýl için genel tüm-nedenli mortalite oraný %6.4 (KA/STYzME için %6.7 ve STYME için %6.0) olup, kardiyovasküler (KV) olay hastalarýn %9.4’ünde (KA/STYzME için %9.8 ve STYME için %8.9) ve kanama komplikasyonu ise hastalarýn %2.0’sinde (STYME için %2.3 ve KA/STYzME için %1.7) gözlendi. EuroQol-görsel analog skala skorlarý STYME’li hastalarda 78.9’dan 81.6’ya, KA/STYzME’li hastalarda 76.0 dan 76.2’ye yükseldi. Taburcu edilme sýrasýnda ve takip eden 2 yýl sonunda EuroQol-5D indeks skorlarý STEMI grubunda sýrasýyla 0.7 ve 0.9, UA/STEMI grubunda ise her iki dönemde de 0.8 idi. Taburcu olurken ikili antitrombosit (AT) tedavi altýnda olan hastalarýn %57.5’ i taburcu olma sonrasý 2 yýl süresince de ayný tedavi altýnda idi. 1AT/0 antikoagülan (AK) ve ≥2AT/0AK kullanýmý ile iliþkili KV olay riski sýrasýyla %10.5% ve %8.9, mortalite riski sýrasýyla %10.5 ve %5.8 ve kanama riski sýrasýyla %0.9 ve %2.2 olarak bulundu.
Sonuç: AKS’li hastalarýn gerçek yaþam koþullarýnda deðerlendirilmesine yönelik sonuçlarýmýz, taburcu edilen AKS’li hastalarda uzun dönem takibin önemine ve AKS yönetimi güncel tedavi uygulamalarýnýn daha iyi takip sonuçlarý ile olasý iliþkisine iþaret etmektedir.

Objective: The aim of this study was to evaluate the long-term, post-discharge follow-up of antithrombotic management patterns (AMPs), clinical outcomes, and real-life health status of patients hospitalized acute coronary syndrome (ACS).
Methods: A total of 1034 patients hospitalized for ACS within 24 hours of symptom onset who survived to discharge were included. Of those, 514 had ST-segment elevation myocardial infarction (STEMI) and 520 had unstable angina (UA)/non-STEMI (NSTEMI). Data on follow-up AMPs, clinical outcomes, and health status were collected during 24 months of follow-up.
Results: The overall all-cause mortality was 6.4% (6.7% in UA/NSTEMI and 6.0% in STEMI patients), cardiovascular (CV) events had occurred in 9.4% (9.8% in UA/NSTEMI and 8.9% in STEMI patients), and bleeding events in 2.0% (2.3% in STEMI and 1.7% in UA/NSTEMI patients) of patients at 2 years after discharge. EuroQol-visual analogue scales scores increased from 78.9 to 81.6 in STEMI patients, and from 76.0 to 76.2 in UA/NSTEMI patients. Discharge and 2-year post-discharge scores for the EuroQol-5D index were 0.7 and 0.9, respectively in STEMI patients, while it was 0.8 for each period in UA/STEMI patients. Overall, 57.5% of the patients on dual antiplatelet (AP) therapy at discharge remained on this treatment at 2 years after discharge. The use of 1AP/0 anticoagulant (AC) and ≥2AP/0AC were associated with a CV event risk of 10.5% and 8.9%, a mortality risk of 10.5% and 5.8%, and a bleeding event risk of 0.9% and. 2.2%, respectively.
Conclusion: These findings in a real-life population of ACS patients emphasize the importance of longer-term follow-up of ACS patients surviving hospitalization and support the likelihood of more favorable long-term outcomes in ACS management with the current treatment practices.

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Amaç: Bu çalýþmada, Ailevi Akdeniz Ateþi (AAA) hastalarýnda lipit profili ve aterojenik indeks düzeylerini ve bunlarýn trombosit indeksleri ile olan iliþkisini araþtýrmayý amaçladýk.
Yöntemler: Bu geriye dönük çalýþmaya AAA’lý 63 hasta ve saðlýklý 51 birey dahil edildi. Enflamatuvar belirteçlerin (eritrosit sedimantasyon hýzý [ESR], C-reaktif protein [CRP] ve fibrinojen), trombosit indekslerinin (ortalama trombosit hacmi, trombosit krit, büyük trombosit oraný ve trombosit daðýlým geniþliði) ve lipit parametrelerinin (toplam kolesterol, trigliserit, düþük yoðunluklu lipoprotein kolesterol ve yüksek yoðunluklu lipoprotein kolesterol) düzeyleri kaydedildi. Ayrýca, aterojenik indeksler (plazma aterojenik indeksi [AIP], aterojenik katsayý [AK], Castelli risk indeksleri I ve II [CRI-I ve II]) lipit parametreleri kullanýlarak hesaplandý.
Bulgular: AAA’lý hastalarda AIP, AK, CRI-I ve II düzeyleri saðlýklý kontrol grubuna göre anlamlý derecede yüksek iken, yüksek yoðunluklu lipoprotein kolesterol düzeyi anlamlý derecede düþüktü (p<0.05). Bununla birlikte, diðer incelenen parametreler açýsýndan anlamlý bir fark tespit edilmedi (p>0.05). AAA’lý erkek hastalarda AIP, AK, CRI-I ve II düzeyleri kadýn hastalara göre anlamlý derecede yüksek iken, trombosit, ESR ve yüksek yoðunluklu lipoprotein kolesterol düzeyleri anlamlý derecede düþüktü (p<0.05). AAA’lý hastalarda CRP düzeyi ile yüksek yoðunluklu lipoprotein kolesterol ve toplam kolesterol düzeyleri arasýnda negatif korelasyon bulundu (sýrasýyla, r=−0.275, p=0.032 ve r=−0.313, p=0.014). Ayrýca, yüksek yoðunluklu lipoprotein kolesterol düzeyi ile hastalýk süresi arasýnda negatif korelasyon saptandý (r=−0.269, p=0.049).
Sonuç: AAA’da özellikle erkek hastalarda, artmýþ aterosklerotik kardiyovasküler hastalýk riskinin belirlenmesi için aterojenik indekslerin kullanýmý önerilebilir.

Objective: The aim of this study was to investigate lipid profiles and atherogenic indices and their association with platelet indices in Familial Mediterranean Fever (FMF) patients.
Methods: A total of 63 FMF patients and 51 healthy individuals were included in this retrospective study. Inflammatory marker values (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and fibrinogen), platelet indices (mean platelet volume, plateletcrit value, platelet large cell ratio, and platelet distribution width), lipid profiles (levels of total cholesterol, triglycerides, high-density lipoprotein [HDL] cholesterol, and low-density lipoprotein cholesterol) were recorded. Atherogenic indices (atherogenic index of plasma [AIP], atherogenic coefficient [AC], Castelli’s risk indices I and II [CRI I and II]) were calculated using lipid parameters.
Results: In FMF patients, while AIP, AC, and CRI I and II values were significantly higher than in the healthy control group, the HDL cholesterol level was significantly lower (all p<0.05). However, no significant difference was determined in terms of the other studied parameters (all p>0.05). In male FMF patients, whereas AIP, AC, and CRI I and II values were significantly higher than in female FMF patients, the platelet count, ESR, and HDL cholesterol levels were significantly lower (all p<0.05). The level of CRP was negatively correlated with HDL cholesterol (r=−0.275; p=0.032) and total cholesterol level (r=−0.313; p=0.014) in FMF patients. HDL cholesterol level was negatively correlated with disease duration (r=−0.269; p=0.049).
Conclusion: The use of atherogenic indices may be recommended to identify patients with an increased risk of atherosclerotic cardiovascular disease in FMF, especially in male patients.

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Amaç: Bu çalýþmada huzursuz bacak sendromlu (HBS) hastalarda kalp hýzý deðiþkenliðini (KHD) inceleyerek kalp otonom fonksiyonlarýný araþtýrmayý amaçladýk.
Yöntemler: HBS tanýsý konulan 35 hasta ve benzer özelliklere sahip 35 saðlýklý birey çalýþmaya alýndý. HBS semptomlarýnýn þiddeti Uluslararasý Huzursuz Bacak Çalýþma Grubu Þiddeti Ölçeði kullanýlarak deðerlendirildi. HBS semptom þiddeti ve KHD parametreleri arasýndaki iliþki deðerlendirildi.
Bulgular: Yaþ, cinsiyet veya vücut kitle indeksi açýsýndan iki grup arasýnda istatistiksel açýdan anlamlý farklýlýklar yoktu. HBS grubunda ortalama kalp atým hýzý 85±7.1 /dk iken kontrol grubunda 79.6±5.5 /dk idi (p=0.001). Kontrol grubuna göre tüm normal deðerler arasý aralýklarýn (NN) standart sapmasý (SSNN), tüm kayýt süresince hesaplanmýþ 5-dakikalýk NN aralýklarýnýn ortalama sapmasý (SSNN indeksi) ve yine tüm kayýt süresince bir 5-dakikalýk zaman diliminde ortalama NN aralýklarýnýn hesaplanmýþ SS’si (SSANN) HBS grubunda anlamlý derecede daha düþüktü (tümü için p<0.05). Ýki grup arasýnda ardýþýk NN aralýklarýnýn ortalama kare farklýlýklarýnýn kare kökü (RMSSD) ve 24 saatlik kayýt boyunca 50 milisaniyeden daha uzun süre fark eden bitiþik RR aralýklarýnýn oraný (pNN50) açýsýndan fark yoktu (sýrasýyla, p=0.119 ve p=0.07). HBS hastalarýnda düþük frekans (DF)/yüksek frekans (YF) oraný kontrol grubuna göre anlamlý derecede daha yüksek idi (sýrasýyla, 2248.6±245.6 ve 712.1±346.3, 10.7±3.7 ve 2.9±1.8; p<0.0001 ve p<0.0001). Kontrol grubuyla karþýlaþtýrýldýðýnda HBS grubunda DF güç deðerleri daha düþük olmasýna raðmen farklýlýk istatistiksel açýdan anlamlý deðildi (p=0.07). HBS semptomlarýnýn þiddet derecesi SDNNN, SDANN indeksi ve pNN50 ile negatif (sýrasýyla, r=-0.453 ve p=0.009, r=-0.340 ve p=0.046, r=-0.446 ve p=0.007) ve YF ile pozitif bir korelasyon göstermekteydi (r=0.681 ve p<0.0001).
Sonuç: Çalýþma verileri kardiyak otonomik bozukluðun HBS ile iliþkili olduðunu göstermiþtir.

Objective: The aim of the present study was to investigate cardiac autonomic effects in restless leg syndrome (RLS) using heart rate variability (HRV).
Methods: A total of 35 patients with RLS and 35 healthy individuals were enrolled in the study. The severity of RLS symptoms was assessed using the International Restless Legs Syndrome Study Group rating scale (IRLS). The correlation between the severity of RLS symptoms and HRV parameters measured on an electrocardiogram was analyzed.
Results: There were no statistically significant differences between the 2 groups with respect to age, gender, or body mass index. The mean heart rate was 85±7.1 bpm in the RLS group compared with 79.6±5.5 bpm in the control group (p=0.001). The standard deviation (SD) of all normal to normal (NN) intervals (SDNN), the mean of the deviation of 5-minute NN intervals over the entire recording (SDNN index), and the SD of the average NN intervals calculated over a 5-minute period of the entire recording (SDANN) were significantly lower in the RLS group compared with the control group (p<0.05 for all). There were no statistically significant differences between the 2 groups in the square root of the mean squared differences of successive NN intervals (RMSSD) and the proportion of adjacent RR intervals differing by >50 milliseconds in the 24-hour recording (pNN50) values (p=0.119 and p=0.07, respectively). In patients with RLS, the low frequency (LF) power and LF/high frequency (HF) ratio were significantly higher than those in the control group (2248.6±245.6 vs 712.1±346.3, 10.7±3.7 vs 2.9±1.8; p<0.0001 and p<0.0001, respectively). Compared with the control group, the RLS group had lower values for HF power, but the difference was not statistically significant (p=0.07). The severity of RLS symptoms was negatively correlated with the SDNN, SDANN index, and pNN50 (r=-0.453 and p=0.009, r=-0.340 and p=0.046, r=-0.446 and p=0.007, respectively), and positively correlated with LF power (r=0.681 and p<0.0001).
Conclusion: The study data demonstrated that cardiac autonomic impairment is associated with RLS.

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Amaç: Genellikle saðlýk hizmetlerindeki klinik olmayan durumlarý ifade eden hizmet kalitesi (HK), temel olarak “saðlýk hizmeti saðlayýcýlarý” ve müþteriler arasýndaki iliþkiye ve saðlýk hizmetlerinin verildiði ortama odaklanmaktadýr. Bu çalýþmada, miyokart enfarktüsü (ME) geçiren hastalarýn bakýþ açýsýndan HK’yi deðerlendirmeyi amaçladýk.
Yöntemler: Tabriz Shahid Madani Kardiyoloji Kliniði’ndeki 164 ME hastasý üzerinde bir kesitsel çalýþma gerçekleþtirildi. Çalýþmaya katýlacak kiþiler, uygun örnekleme yöntemi kullanýlarak seçildi. Hizmet kalitesi, onaylý bir “Saðlýk Hizmet Kalitesinde Kapsamlý Kalite Ölçümü Anketi” kullanýlarak deðerlendirildi ve ölçümlerin güvenilirliði Cronbach alfa güvenilirlik katsayý temel alýnarak doðrulandý (α=0.81). Hizmet kalitesi, müþterinin bakýþ açýsýndan saðlýk ile ilgili olmayan durumlarýn önem ve performansý dikkate alýnarak HK=10-(Önem x Performans) formülü kullanýlarak hesaplandý. Önem puanlarý 1 ila 10 arasýnda, performans puanlarý ise 0 ila 1 arasýnda deðiþmekte idi.
Bulgular: Çalýþmada yer alan 164 katýlýmcýnýn yaklaþýk %75’i erkekti ve bunlarýn yaklaþýk %44’ü 51 ila 65 yaþ arasýnda idi. Müþterilerin bakýþ açýsýndan, toplam HK skoru 10 üzerinden 6.80 ve tüm HK bileþenleri için tek tek verilen skorlar kabul edilebilir düzeyin altýndaydý. Gizlilik, haysiyet ve devamlýlýk en yüksek skorlarý alýrken, destek gruplarýna eriþim en düþük skora sahipti.
Sonuç: Çalýþma bulgularý, HK’nin iyileþtirilebilmesi için bir fýrsat oluþturmuþtur. Müþteriler için önemli olan ve destek gruplarýna eriþim gibi düþük skorlar almýþ bulunan hizmetlerin kalitesinin artýrýlmasý için, hasta ve saðlýk hizmet saðlayýcýlarýnýn kalite düzeltme faaliyetlerinde birlikte yer almalarý etkin bir strateji olabilir.

Objective: Service quality (SQ) generally refers to the non-clinical aspects of health services and primarily focuses on the relationship between the care provider and the customers, and the environment in which care services are delivered. The aim of this study was to assess the SQ provided for myocardial infarction (MI) from the patients’ perspective.
Methods: A cross-sectional study was conducted with 164 patients with MI at the Tabriz Shahid Madani cardiology clinic. Study participants were selected using convenience sampling. SQ was measured using a validated Comprehensive Quality Measurement in Healthcare SQ questionnaire. The reliability was confirmed based on Cronbach’s alpha coefficient (α=0.81). SQ was calculated using the formula SQ=10–(importance × performance), based on the importance and performance of non-health-related aspects from the customers’ perspective. Importance scores ranged from 1 to 10 and performance was scored between 0 and 1.
Results: Of 164 participants, about 75% were men and almost 44% were between 51 and 65 years of age. From the customers’ perspective, the total SQ score was 6.80 (0-10 scale), and the individual scores for all SQ aspects were below an acceptable level. Confidentiality, dignity and continuity were given the highest scores, while availability of support groups had the lowest score.
Conclusion: The study findings revealed an opportunity to improve SQ. Patient and provider participation in quality improvement activities could be an effective strategy to improve the aspects of health care quality that were most important to the customers and those with low scores, such as availability of support groups.

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Amaç: Bu çalýþma ile, statinlerin, erken miyokart enfarktüsü (EME) geçiren hastalarda dolaþýmdaki SIRT1 ve endotel nitrik oksit sentaz (eNOS) proteinlerinin ekspresyonu üzerindeki ve SIRT1 geninin tekli nükleotit polimorfizmlerinin (SNP) daðýlýmý üzerindeki etkisi araþtýrýlmýþtýr.
Yöntemler: Bu çalýþmaya, 45 yaþýn altýnda ST yükselmeli miyokart enfarktüsü (STYEME) geçiren 108 hasta dahil edildi. Ýndeks olaydan sonra 79 hasta statin kullanýrken, 29 hasta ME sonrasý statinlerle tedavi edilmedi veya 4. hafta kontrolünde tedavi kesilmiþdi. Kontrol grubu, daha önce herhangi bir kardiyovasküler olayý bulunmayan 91 saðlýklý hasta tarafýndan oluþturuldu. Kan örnekleri en erken ME’den 3 ay sonra alýndý. Oluþturulan 3 çalýþma grubunda SIRT1 ve eNOS proteinlerinin miktarý, toplam antioksidan statüsü (TAS), toplam oksidan statüsü (TOS) ve oksidatif stres indeksi (OSI) gibi oksidatif stres belirteçlerinin yaný sýra SNP rs7069102 ve rs2273773’ün daðýlýmý incelendi.
Bulgular: Her iki SNP için statin tedavisi alan hastalarda, tüm genotiplerde ve allellerde, kontrol grubu ile karþýlaþtýrýldýðýnda, SIRT1 düzeylerinde anlamlý bir artýþ (p<0.001) ve eNOS düzeylerinde belirgin bir azalma gözlemledik (p=0.001). Her iki SNP de, statin tedavisinden baðýmsýz olarak, iki ME grubu arasýnda benzer bir frekansta daðýlým gösterdi.
Sonuç: Statinler erken ME sonrasý kalbi koruyucu bir rol oynayabilecek SIRT1 proteinini uyarmaktadýr. Diðer taraftan, eNOS protein seviyeleri statin tedavisine bakýlmaksýzýn ME geçirmiþ olan hastalarda düþük bulunmuþtur. Bu da eNOS ekspresyonundaki azalmanýn SIRT1 ile nedensel bir baðý olmadan hastalýða özgü olduðunu düþündürmektedir.

Objective: The present study was an investigation of the effect of statins on the expression of circulating sirtuin 1 (SIRT1) and endothelial nitric oxide synthase (eNOS) proteins, and on the distribution of single nucleotide polymorphisms (SNPs) of the SIRT1 gene in patients with a history of premature myocardial infarction (PMI).
Methods: A total of 108 patients who had suffered from a premature ST-elevation myocardial infarction (STEMI) under the age of 45 years were enrolled in this study. While 79 patients had been taking statins since the index event, 29 patients had not been treated with statins post myocardial infarction (MI) or the therapy had been withdrawn at the 4-week follow-up control. The control group consisted of 91 healthy patients without a previous cardiovascular event. The levels of SIRT1 and eNOS protein; oxidative stress markers, like total antioxidant status (TAS), total oxidant status (TOS), and the oxidative stress index (OSI); as well as the distribution of the SNPs rs7069102 and rs2273773 were measured and analyzed.
Results: A significant increase in the SIRT1 level (p<0.001) and a significant decrease in the eNOS level (p=0.001) was observed in all genotypes and alleles for both SNPs in patients who received statin therapy compared with the control group. Both SNPs were distributed in a similar frequency in the 2 MI groups, irrespective of statin treatment.
Conclusion: Statins induce SIRT1 protein, which might have a cardioprotective role after PMI. In addition, the eNOS protein level was low in all of the MI patients, suggesting that impairment of eNOS expression is disease-specific without a causal link to SIRT1.

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Pulmoner atrezi (PA), ventriküler septal defekt (VSD) ile birlikte basit bir kapak atrezisinden, akciðer yataðýnýn aortadan ayrýlan kollateral arterler ile kanlandýðý gerçek pulmoner arterlerin bulunmadýðý veya aðýr hipoplazik olduðu tabloya kadar çok geniþ spektrum halinde görülebilmektedir. Pulmoner arterin ve dallarýnýn boyutu ile birlikte eþlik eden diðer karmaþýk kalp lezyonlarýnýn varlýðý tedavi yönteminde ve tüm düzeltme seçeneklerinin belirlenmesinde önemlidir. Basit formlarýnda Fallot tetralojisi onarýmý tarzýnda tam düzeltme ameliyatý yapýlýrken, spektrumun diðer ucundaki hastalarda çok sayýda giriþim gerekmekte ve yaþam kalitesi oldukça deðiþken olmaktadýr. Pulmoner arter ve dallarýnýn boyutu, eþlik eden kollateral arterlerin varlýðý tedavi yönetiminde belirleyicidir. Burada ilk olgu 40 günlük, ikinci olgu iki günlük iken muayene sýrasýnda üfürüm fark edilmesi üzerine yapýlan ekokardiyografik incelemede VSD, pulmoner atrezi tanýsý konmuþ olan ve pulmoner arterlerin koroner arter aracýlýðý ile kanlanmasýnýn saðlandýðý iki olguyu sunmak istedik. Ýkinci olgumuzda taný kateter anjiyografi ile kesinleþti. Ýlk olgumuzda ancak cerrahi sýrasýnda kesin taný konulabildi. Bu çalýþmayý sunmaktaki amacýmýz pulmoner atrezili hastalarda pulmoner arter boyutu, pulmoner konfluansýn varlýðý, kanlanmasýnýn nereden saðlandýðý ve eþlik eden kollateral arterlerin tedavi yönetimindeki önemini vurgulamaktýr.

Pulmonary atresia (PA) and ventricular septal defect (VSD) can occur in a variety of ways, from simple valve atresia to a condition in which circulation to the pulmonary bed occurs through collateral arteries separated from the aorta and there are no real pulmonary arteries, or they are present but hypoplastic. The size of the pulmonary arteries and concomitant complex cardiac lesions are important in making decisions about treatment and correctional alternatives. While complete correction surgeries in the style of a correction of tetralogy of Fallot are performed in simpler cases, many very invasive procedures are also performed and the resulting quality of life is very variable. The size of the pulmonary artery and its branches and the presence of accompanying collateral vessels are determining factors in the management of the disease. In this report, 2 cases of VSD and PA, in which the circulation of the pulmonary arteries was through the coronary arteries, diagnosed as a result of echocardiography performed following murmurs heard during examination, are described. The first patient was 40 days old and the second was 2 days old. In the second case, diagnosis was confirmed by catheter angiography, and in the first case, the final diagnosis was made during surgery. The aim of this report is to emphasize the importance of pulmonary artery size, the presence of pulmonary confluence, the origin of circulation, and concomitant collateral arteries when considering treatment methods.

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Semptomlu paroksismal atriyal fibrilasyonu olan hastalarda pulmoner ven izolasyonu etkili bir tedavidir. Bir alternatif olarak kriyoablasyon balon tedavisi geliþtirilmiþtir. Kriyoablasyon komplikasyonlarý esasen frenik sinir felci, vasküler komplikasyonlar, inme ve daha düþük insidansla baþka etkenlerle iliþkilidir. Özofagus lezyonlarý nadir olduðu gibi tamamýyla anlaþýlamamýþtýr.

Pulmonary vein isolation is an effective treatment for patients with symptomatic paroxysmal atrial fibrillation. Cryoablation balloon therapy has been developed as an alternative. Cryoablation complications have primarily been related to phrenic nerve palsy, vascular complications, stroke, and others of lesser incidence. Esophageal lesions are rare and they are not yet completely understood.

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Kounis sendromu allerji, aþýrý duyarlýlýk, anaflaksi veya anaflaktik reaksiyonlar gibi durumlarda enflamatuvar hücrelerin aktivasyonu sonucu akut koroner sendrom tablosunun görülmesi olarak tanýmlanýr. Birçok enflamatuvar durumun tedavisinde kullanýlan kortikosteroidler paradoksal olarak allerjik reaksiyonlara hatta anaflaksiye sebep olabilirler. Bu yazýda triamsinolon kullanýmý sonrasý ST yükselmesiz miyokart enfarktüsü meydana gelen ve antihistaminik tedavi ile düzelen 52 yaþýnda bir kadýn hasta sunuldu. Baþka bir merkezde dermatit tanýsýyla, triamsinolon asetonid 40 mg/ml (iv) enjekte edilen ve tedavinin ilk dozundan yaklaþýk 15 dakika sonra göðüs aðrýsý baþlayan hastanýn fizik muayanesi ve transtorasik ekokardiyografisi (EKO) normal olmasýna karþýn laboratuvar incelemelerinde troponin pozitifliði ve EKG’sinde (elektrokardiyografi) inferolateral derivasyonlarda ST çökmesi mevcuttu. Konservatif amaçlý antiiskemik tedavi baþlanýp antihistaminik (45.5 mg/2 mL Ý.V, feniramin maleat -Avil amp-) tedavi uygulandýktan sonra EKG bulgularý ve kliniði tamamen düzelen olguya yapýlan koroner anjiyografide koroner arterler normal olarak deðerlendirildi. Kalp - özellikle koroner arterler- aþýrý duyarlýlýk reaksiyonlarý ve anaflakside en fazla hasar gören organlardan biridir. Bu nedenle Kounis sendromu nadir görülen bir durum deðildir; ancak klinik pratikte oldukça az sayýda gözlendiði bildirilmektedir. Doðru tanýmlanamayan olgular nedeni ile Kounis sendromunun atlanýlmasý, istenmeyen týbbi sonuçlara yol açabilir. Hýzlý ve doðru teþhis için Kounis sendromu akýlda tutulmalýdýr.

Kounis syndrome is defined as the clinical development of acute coronary syndrome caused by the activation of inflammatory cells due to an allergy, hypersensitivity, anaphylaxis, or anaphylactic reaction. Corticosteroids that are used in the treatment of many inflammatory conditions may paradoxically cause allergic reactions and even anaphylaxis. This article is a description of the case of a 52-year-old female patient who had a non-ST elevation myocardial infarction after the administration of triamcinolone that was relieved with antihistaminic treatment. The patient had been diagnosed with dermatitis at another medical center and injected with 40 mg/mL (intravenous [IV]) of triamcinolone acetonide and developed chest pain 15 minutes after the first dose. Despite a normal physical examination and echocardiogram, laboratory tests revealed troponin positivity and an inferolateral ST depression was present on an electrocardiogram (ECG). The ECG findings and clinical symptoms resolved completely after conservative anti-ischemic treatment and antihistaminic therapy (pheniramine maleate 45.5 mg/2 mL, Avil ampoule, IV; Sanofi-Aventis, Paris, France) and coronary angiography evaluation of the arteries was normal. The heart, and in particular the coronary arteries, are among the organs that are most damaged during hypersensitivity reactions and anaphylaxis. Although Kounis syndrome is not a rare condition, few cases have been reported in clinical practice. The failure to recognize Kounis syndrome due to inadequately defined cases may lead to unwanted medical results. Kounis syndrome should be kept in mind in order to make a rapid and accurate diagnosis.

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Koroner anjiyografi ve perkütan koroner giriþimler, koroner arter hastalýðý tanýsýnda ve tedavisinde önemli rol oynamaktadýr. Teknik ve farmakolojik ilerlemelere raðmen kanama ve damar komplikasyonlarý hala problem oluþturmaktadýr. Radiyal yaklaþýmla ilgili güvenilirlik ve kanama riskinin azaldýðýný bildiren son çalýþmalarla birlikte, radiyal yaklaþým daha popüler hale geldi ve bu tekniðin öðrenilmesinin artmasýyla birlikte popülerliðini koruyacaktýr. Bu yazýda, radiyal arter enfiye kutusundan (fovea radialis) girilerek yapýlan koroner anjiyografi olgusu sunuldu. Enfiye kutusundan yapýlan radiyal anjiyografi, daha kolay palpasyon ve giriþim, daha az nöropati ve kanama ve iþlem sonrasý daha az basý gereksinimi gibi kolaylýklar sunmaktadýr.

Coronary angiography and percutaneous coronary artery intervention are important tools for the diagnosis and treatment of coronary artery disease. Nevertheless, despite both technical and pharmacological advances, bleeding and vascular complications remain problematic. With recent trials supporting the safety and decreased bleeding risk associated with the radial approach, radial access has become more popular, and conferences providing instruction on this technique are often standing room only. Herein, a case in which coronary angiography was performed by punching through the radial artery snuff box (fovea radialis) is described. Radial angiography from the snuff box allows for easier palpation and punching, less risk of neuropathy and bleeding, and less compression after the procedure.

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Burada sidofovir ile baþarýyla tedavi edilen bir kalp-böbrek alýcýsýnda yaygýn adenovirüs enfeksiyonu olgusunu tanýmlýyoruz. Eriþkin solid organ transplant alýcýlarýnda prognozu genellikle kötü, ölüm oranlarý %40–60 arasý birkaç adenovirüs enfeksiyonu olgusu bildirilmiþtir. Aðýr yaygýn adenovirüs enfeksiyonlarý organ rejeksiyon, ventrikül iþlev bozukluðu allogreft vaskülopatisi, greft kaybý ve yeniden transplantasyon gerekliliði gibi giderek artan olumsuz transplant olaylarý riskiyle iliþkilendirilmiþtir. Hastada klinik iyileþmemenin olmamasý, hemorajik sistit baþlangýcý ve akut böbrek hasarý geçici olarak baðýþýklýk sistemini baskýlayýcý ilaçlarýn uygulanmasýný durdurup bir antiviral ilaca baþlama kararýmýza etkili faktörler olmuþtur. Antibiyotiklere yanýt vermedikleri ve kültürlerin negatif olduðu durumlarda transplant hastalarýnda adenovirüsten kuþkulanýlmasý önemlidir. Baðýþýklýk sistemi risk altýnda olan hastalarda sonuçlarý iyileþtirmede erken taný ve tedavi önem taþýr.

Presently described is a case of disseminated adenovirus infection in a heart-kidney transplant recipient that was successfully treated with cidofovir. There are several reports of adenovirus infections in adult solid organ transplant recipients and the prognosis is usually poor, with mortality rates of 40% to 60%. Severe disseminated adenovirus infections have been associated with increased risk of adverse transplant events, such as rejection, ventricular dysfunction, allograft vasculopathy, graft loss, and the need for re-transplantation. The patient’s lack of clinical improvement, the onset of hemorrhagic cystitis and acute kidney injury were factors in our decision to temporarily discontinue administration of immunosuppressive agents and start an antiviral agent. It is important to suspect adenovirus in transplant patients when they do not respond to antibiotics and cultures are negative. Early diagnosis and treatment are critical to improving outcomes in immunocompromised patients.

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