Akut miyokard infarktüsünde (AMÝ) baþarýlý erken ve geç trombolitik tedavi ile infarkttan sorumlu arter açýklýðýnýn saðlanmasýnýn, ventrikül hacimleri üzerine tehdit altýndaki miyokardý kurtarmadan da öte etkileri iddia edilmiþtir. Bu "açýk arter hipotezini" irdelemek üzere, ilk kez hastalanan ve erken dönemde intravenöz strepkokinaz tedavisi uygulanan, anjiyografik olarak sol ön inen koroner arter (LAD) lezyonu sorumlu kabul edilen 42 anterior AMÝ olgusu incelenmiþtir. Hastalar, anjiyogramlarýnda infarkttan sorumlu arterlerinin açýk veya kapalý oluþuna göre iki gruba ayrýlmýþtýr. Sol ventrikül hacimleri ve ejeksiyon fraksiyonlarý (EF), 30 derece RAO pozisyonda alýnan ventrikülogramlarýn projeksiyonlarý üzerinden, tek plan alan-uzunluk elipsoid yöntemi kullanýlarak bulunmuþtur. Ýnfarkt alanlarý (ÝA) ise sol ventrikülü 24 eþit parçaya ayýran çaplardan, fraksiyonel kýsalmalarý normal kiþilerin ortalama deðerlerinden 2 standart sapma daha aþaðýda olanlarýnýn toplamý ile bulunmuþtur. LAD reperfüzyonu saðlananlarda ÝA, sistol sonu ve diyastol sonu volüm indeksleri anlamlý olarak düþük iken (p<0.01, p<0.001, p<0.001), EF ve sol ventrikül basýnçlarýnda iyileþme gözlenmemiþtir (p>0.05, p>0.02, p>0.3). Sol ventrikül hacimlerinin ÝA ile önemli linear iliþki göstermesinden ötürü, erken reperfüzyonun infarktlý doku geniþleme ve incelmesini azalttýðý düþünülebilir. Fakat perfüzyon saðlanamayan gruptaki ÝA deðerleri (ÝA>5) gözönne alýnýrsa, her iki grubun ÝA arasýnda anlamlý fark olmazken (p>0.01), perfüzyonlu grupta sistol sonu volüm indeksi (ESVÝ) daha düþük bulunmuþtur (p<0.02). Bu bulgular trombolitik tedavi ile infarkt yapan arter reperfüzyonunun, esas etkisi olan miyokard kurtarýlmasýndan öte sol ventrikül boþluklarýný küçülttüðünü, tedavinin baþarýsý yönünden de EF yerine ESVÝ'nin tetkik edilmesinin uygun olacaðýný düþündürmektedir.

Following thrombolysis in acute myocardial infarction (AMI), the patency of infarct-related artery has been claimed to have additional effects on ventricular volumes more than salvaging the jeopardized myocardium. To scrutinize this "open artery hypothesis", we evaluated 42 initial anterior AMI cases with left anterior descending coronary artery (LAD) involvement who have been given streptokinase early. Angiographically the patients have been divided into two groups according to the patency of infarct related artery. Left ventricular volumes and ejection fractions (EF) have been calculated from the projections of left ventriculograms in RAO-30 degree position, using single plane area-length ellipsoid method. Infarct sizes (IS) have been derived from the number of ventricular radii of which the fractional shortenings were 2 standard deviations lower than the mean values of normal individuals. While IS values, end-systolic and end-diastolic volumes were significantly reduced in those with attained reperfusion of LAD (p<0.01, p<0.001, p<0.001, respectively), EF and pressures did not differ notably (p>0.05, p>0.2, p>0.3). It may be considered that early reperfusion reduces infarct expansion since there is a significant linear correlation between left ventricular volumes and IS. However, when IS is more than 5 radii, patients with patent arteries have smaller end-systolic volume indices (p<0.02), although IS values are similar (p>0.1). Hence, these findings suggest that early reperfusion of infarct-related artery, beyond salvaging the myocardium, reduces ventricular cavities which may reflect the prognosis better than EF.

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Hafif ve orta derecede esansiyel hipertansiyonlu yaþlarý 38-70 arasýnda (54.4±10.6) vücu kitle indeksi ortalama 27.7±7.9 olan hastada nitrendipin'in 2 (NT) 3 glikoz metabolizmasýna etkileri araþtýrýldý. 15 günlük ilaçsýz bir devreden sonra 1 hafta süreyle placebo, bilhare günde 20 mg NT verildi. NT'den önce ve sonra 75 gr glikozla 4 saatlik OGTT yapýldý. Açlýk ve OGTT'nin 1. ve 3. saatlerinde insülin ve peptide, açlýk ve OGTT'nin 1. saatinde eritrosit Na+ ve K+ düzeyleri ölçüldü. NT'den önce ve sonra yapýlan OGTT esnasýnda serum glikoz düzeyleri arasýnda anlamlý bir deðiþiklik olmadý. NT'den önce açlýk, 1. ve 3. saat insulin düzeyleri sýrasýyla 12.4±5.8 µU/ml, 88.6±51.3 µu/ml ve 15±9.5 µU/ml, NT'den sonra ise 15.9±15.4 µU/ml, 87.2±48.1 µU/ml ve 18.2±12.9 µU/ml bulundu. Yine NT'den önce açlýk, 1. ve 3. saat C peptide düzeyleri sýrasýyla 2.8±0.8 ng/ml, 6.7±1.7 ng/ml, 4.4±2 ng/ml, ng/ml NT'den sonra ise 2.6±1 ng/ml, 4.9±2.2 ng/ml olarak saptandý. Ýnsülin ve C reptid düzeylerinde NT tedavisiyle anlamlý bir deðiþiklik olmadý. NT'den önce ve sonra serum sodyum ve potasyum düzeyleri normal sýnýrlarda bulundu. NT'den önce açlýk ve OGTT'nin 1 saatindeki eritrosi Na+ düzeyleri (mg Na+/mgHb) sýrayla 2.7±1 ve 2.8±0.9, eritrosit K+ düzeyleri (mgK+/MgHb) ise 13.7±2 ve 14±1.8 iken NT'den sonra eritrosit Na+ 3±1.2 ve 3.4±2 eritrosit K+ ise 13.7±1.9 ve 13.98±1.8 bulundu. NT tedavisiyle açlýk ve OGTT esnasýnda ölçülen eritrosit Na+ ve K+ düzeylerinde anlamlý bir deðiþiklik olmadýðý görüldü. Sonuç olarak, hipertansif hastalarda bir kalsiyum antagonisti olan NT'nin glikoz metabolizmasýný anlamlý olarak deðiþtirmediði kanýsýna varýldý.

This study was destigned to investigate the effects of nitrendipine (NT) on glucose metabolism in patients with uncomplicated mild to moderate essential hypertension, following a drug-free period of two weeks and placebo period of one week, 15 patients (mean age 54.4±10.6 and body mass index 27.7±7.9) were given a single-dose of 20 mg/day nitrendipine. In these patients 4 hours OGTT was performed with 75 gr of glucose, before and after therapy; plasma insulin and C-peptide levels were determined before OGTT and at the first and third hour of OGTT, and erythrocyte K+, Na+ levels before and at the first hour of OGTT. Plasma glucose levels did not change significantly during OGTT before and after NT therapy. Before therapy fasting, first and third hours of OGTT insulin levels were 12.4±5.8 mU/ml, 88.6±51.3 mU/ml, and 15±9.5 mU/ml, respectively, and after therapy 15.9±15.4 mU/ml, 87.2±48.1 mU/ml, 18.2±12.9 mU/ml, respectively. Before therapy, plasma peptide were 2.8±0.8 ng/ml, 6.7±1.7 ng/ml, 4.4±2 ng/ml, while fasting, at the first and third hour of OGTT, respectively, and after therapy 2.6±1 ng/ml, 6.9±2.9 ng/ml, 4.9±2.2 ng/ml, respectively. Insulin and C peptide levels did not change with NT therapy. Before therapy fasting and at the first hour of OGTT erythrocyte Na+ levels (mgNa+/mgHb) were 2.7±1 and 2.8±0.9 erythrocyte K+ levels (mgK+/mgHb) 13.7±2 and 14±1.8, respectively and after therapy erythrocyte Na+ levels were 3±1.2 and 3.4±2, eryth rocyte K+ were 13.7±1.9, 13.3±1.7, respectively. Before and after NT therapy serum sodium and potassium levels were in normal limits. As it is seen, no significant difference was found in erythrocyte Na+ and K+ levels by NT therapy. In conclusion, nitrendipine did not significantly alter the glucose metabolism in hypertensive patients.

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Çalýþmamýz, hastanemizde izlenmekte olan talasemi majör ve intermedialý hastalarýn kardiyak deðerlendirmesini yapmak, pulsed Doppler ekokardiyografik inceleme ile sol ventrikül diyastolik disfonksiyonu olanlarý belirleyerek kalp tutulumunu erken dönemde saptamak, serum ferritin düzeyi ile kardiyak fonksiyonlar arasýnda iliþki varlýðýný araþtýrmak ve talasemi majör ile intermedialýlarý kardiyak yönden karþýlaþtýrmak amacýyla planlanmýþtýr. Talasemi intermedialý 15 hasta (5-23 yaþ) ve hipertransfüzyon programý uygulanmakta olan talasemi majörlü 50 hasta (1-21 yaþ) ile kontrol grubu olarak ayný yaþ ve cinsteki 65 saðlýklý çocuk incelenmiþ, hastalarýn hematolojik verileri (transfüzyon tedavisine baþlama yaþý, toplam transfüzyon sayýsý, ferritin düzeyi) izlem kartlarýndan öðrenilmiþtir. Talasemili 65 hastanýn 36'sýnýn kardiyak deðerlendirmesi, transfüzyon öncesi 2. saatte ve sonrasý 4. saatte olmak üzere 2 kez, diðer hastalarýn ise transfüzyon öncesi veya sonrasý bir kez yapýlmýþtýr. Elektrokardiyografik ve telekardiyografik deðerlendirmeden sonra, M-mode ekokardiyografik inceleme ile sol ventrikül sistolik fonksiyonlarý, pulsed Doppler ekokardiyografik inceleme ile sol ventrikül diyastolik doluþuna ait akým örnekleri kaydedilmiþtir. Transfüzyon öncesi ve sonrasý ekokardiyografik ölçümler anlamlý farklýlýk göstermemektedir. Talasemi majör ve intermedialý hastalarýn ekokardiyografik ölçümleri kontrol grupla karþýlaþtýrýldýðýnda sistolik disfonksiyon olmaksýzýn sol ventrikül diyastolik doluþ örneðinin restriktif özellik gösterdiði, pik erken diyastolik akým velositesinin (E) arttýðý, pik geç (atriyal) diyastolik akým velositesinin (A) azaldýðý, bu iki velosite oranýnýn (E/A) yükseldiði saptanmýþtýr (p<0.05). Talasemi majörlü ve intermedialý hastalarýn sistolik ve diyastolik fonksiyonlarý ile ilgili ölçümler istatistiksel olarak belirgin bir farklýlýk göstermektedir. Ferritin düzeyleri 2000 ng/ml'nin altýnda ve üzerinde olan hastalarýn sol ventrikül diyastolik doluþu ile ilgili ölçümleri arasýnda anlamlý farklýlýk (p<0.05) saptanmýþ, ferritin düzeyi 200 ng/ml'nin üzerinde olanlarýn restriktif bozukluðunun daha belirgin olduðu bulunmuþtur. Sonuç olarak, çalýþmamýzda talasemi intermedialý 15 hastanýn 6'sýnda (% 40), talasemi majörlü 50 hastanýn 16'sýnda (% 32) sistolik disfonksiyon geliþmeden, diyastolik doluþun resriktif özellikte bozulduðu "pulsed Doppler" ekokardiyografik inceleme ile gösterilmiþtir.

Our study aims to evaluate the cardiac status of patients with thalassemia major and intermedia to determine those with left ventricular diastolic dysfunction using pulsed Doppler echocardiography at an early stage of cardiac involvement, to investigate the effect of chelation therapy on cardiac involvement. We have studied 15 patients with thalassemia intermedia (5 to 23 years of age) and 50 patients with thalassemia major (1 to 21 years of age) on hypertransfusion program with a control group of 65 healthy children of the same age and sex. Hematologic findings (the initial age of transfusion therapy, total transfusion amount, serum ferritin level) were recorded. Cardiac evaluation of 36 of the 65 patients with thalassemia was made both 2 hours before and 4 hours after transfusion therapy. With M-mode echocardiography, left ventricular systolic function and with pulsed Doppler echocardiography left ventricular diastolic filling patterns were recorded. Measurements showed that in respect to the control group, patients with thalassemia major and intermedia had a restrictive pattern of left ventricular diastolic filling without evidence of systolic dysfunction (increased peak early diastolic flow velocity (E) and decreased peak late (atrial) diastolic flow velocity (A) and increased ratio of these two velocities (E/A) (p<0.05). Six (40 %) of 15 patients with thalassemia intermedia and 16 (32 %) of 50 patients with tahalassemia major had diastolic dysfunction. It was also shown that a significant difference existed in left ventricular diastolic filling measurements between patients having serum ferritin level below and above 2000 ng/ml. The patients who had serum ferritin level above 2000 ng/ml showed more significant diastolic dysfunction.

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Kalp cerrahisinde aort kros klempi kaldýrýldýktan sonra ventriküler fibrilasyon oluþmasý sýk rastlanan bir durumdur. Ventriküler fibrilasyon ve konturþoklar ile tedavisi ise miyokardial injuriye katkýda bulunan olaylardýr. Aort kros klempi kaldýrýlmadan önce verilen intravenözlidokainin etkilerini araþtýrmak için çalýþma grubu olarak seçilen 20 hastaya aort kros klempi kaldýrýlmasýndan üç dakika önce 200 mg. intravenöz lidokalin verildi. Kontrol grubundaki 22 hastaya ise herhangi bir medikasyon yapýlmadý. Multipl temel deðiþkenler (klemp zamanlarý, medikasyonlar, cerrahinin yaygýnlýðý ve tipi) her iki grupta benzerdi. Aort kros klempi kaldýrýldýktan sonra çalýþma grubundaki 20 hastanýn 5 inde, kontrol grubundaki 22 hastanýn ise 17 sinde ventriküler fibrilasyon oluþtu (p<0.05). Fibrile olgularda çalýþma grubunda ortalama 1.46 konturþok, kontrol grubunda ise ortalama 2.66 konturþok gerekti (p<0.05). Serum potasyum seviyesi keza lidokainden baðýmsýz olarak ventriküler fibrilasyon insidensini etkiledi. Yüksek serum potasyum seviyeleri daha düþük ventriküler fibrilasyon insidensi ile birlikte idi. Bütün potasyum seviyelerinde lidokain baðýmsýz olarak koruyucu etki gösterdi, lidokain ve yüksek serum potasyum seviyesi kombinasyonu ise fibrilasyondan korumada en büyük etkiye sahipti.

Ventricular fibrillation is common after aortic declamping during cardiac surgery. Ventricular fibrillation and its treatment with countershock increases the myocardial injury. In order to evaluate the effects of lidocaine who were given intravenously, 200 mg lidocaine was given 3 minutes before aortic declamping to 20 patients who were selected as a study group. No medication was given before aortic declamping to 22 patients in the control group. Several baseline variables were similar in the two groups (clamp times, medications, the extent and type of surgery). Ventricular fibrillation occurred after aortic declamping in 5 of 20 patients in the study group and 17 of 22 patients in the control group (p<0.05). A mean of 1.64 countershock in the study group and mean of 1.64 countershock in the study group and mean 2.66 countershocks in the control group were necessary in cases with fibrillation (p<0.05). The serum potassium level also affected the incidence of ventricular fibrillation independently of lidocaine. Elevated serum potassium levels were associated with a lower incidence of ventricular fibrillation. Although lidocaine was independently protective at all potassium levels, the combination of lidocaine and a high serum potassium level had the greatest effect in preventing fibrillation.

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Heparin in vitro olarak iyonize kalsiyumu baðlar, intravenöz bolus verildiðinde vazodilatatör etki gösterir. Heparinin in vivo etkilerini araþtýrmak için açýk kalp ameliyatý planlanan 30 hasta iki gruba ayrýldý. Birinci gruptaki 20 hastaya 300 IU/kg intravenöz bolus heparin verildi. Bu grupta heparin verilmesinden sonra ortalama arteryel basýnç ve iyonize kalsiyum seviyelerinde önemli azalmalar meydana geldi. Ýkinci gruptaki 10 hastaya ise bolus heparin verilmesinden hemen önce 125 mg kalsiyum klorid verildi. Bu grupta iyonize kalsiyum seviyelerinde yükselme oldu, ortalama arteryel basýnçta bir deðiþme olmadý. Bu verilerden açýk kalp cerrahisinde özellikle riskli hastalarda kardiopulmoner bypass öncesi iyonize kalsiyum seviyelerine özel dikkat edilmesinin, heparinin yavaþ enjeksiyonunun faydalý olacaðý sonucuna varýldý.

Heparin binds ionized calcium in vitro and possesses vasodilating properties when given as an intravenous bolus. In order to evaluate in vivo effects of heparin, 30 patients undergoing open heart surgery, were divided in two groups. 300 IU/kg bolus heparin was given intravenously to 20 patients in group I. Important decreases occurred in mean arterial pressure and ionized calcium levels in this group. 125 mg calcium chloride was given to 10 patients in group 2 just before bolus heparin administration. Ionized calcium levels become elevated in this group: there was no change in mean arterial pressure. These data suggest that slow injection of heparin would be beneficial in patients with low ionized calcium levels before cardiopulmonary bypass, especially in risky patients.

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Kardiyak ve pulmoner patolojileri bulunmayan siroz tanýsý almýþ ve asiti bulunan 16 hastada pulsed Doppler ekokardiyografi ile sol ventrikül diyastolik fonksiyonlarý ölçülmüþ ve parasentezle en az 4 lt sývý alýndýktan 1 saat sonra ölçümler tekrarlanmýþtýr. Sirozlu hastalarda parasentez öncesi ortalama E hýzý (cm/sn) 52.64±3.4, ortalama A hýzý 64.4±3.2; parasentez sonrasý ortalama E hýzý 54.68±0.07, A hýzý 64.95±0.03 cm/sn bulunmuþtur. Ýstatistiki olarak parasentezin ölçülen parametreleri deðiþtirmediði gösterilmiþtir (p>0.05). Kontrollerde ortalama E hýzý 59.73±1.6 cm/sn, A hýzý 44.20±1.4 cm/sn bulunmuþ ve hasta grubuyla karþýlaþtýrýldýðýnda sirotik hastalarda mitral erken doluþ hýzý kontrollere göre farklý bulunamamýþ (p>0.05), atrial hýzýn hasta grubunda arttýðý tespit edilmiþtir (p<0.05). Sirotik hastalarda sol ventrikül diyastolik fonksiyonun bozulduðu ve parasentezle bu durumun düzelmediði gösterilmiþ, muhtemelen volüm yüklenmesi dýþýnda bazý hormonal ve metabolik faktörlerin de mevcut kardiyak anormallikten sorumlu olabileceði düþünülmüþtür.

In 16 patients with clinical and histopathological diagnosis of liver cirrhosis and ascites, left ventricular diastolic function was assessed by pulsed Doppler echocardiography before and after paracentesis, and the results were compared with those obtained from 15 healthy subjects. In healthy subjects, mean values of mitral early filling velocity (E) and veloccity after atrial contraction (A) were 59.7±1.6 and 44.2±1.4 cm/sec, respectively. In cirrhotic patients, before paracentesis, the mean E and A wave velocities were found to be 52.64±3.4 and 64.4±3.2 cm/sec respectively. In these patients, A veloity was found to be significantly higher (p<0.05) than controls, without significant differencces in E velocity values, suggesting the presence of diastolic dysfunction in cirrhotic patients. After paracentesis, E and A wave velocities were found to be 54.68±0.07 and 64.94±0.03 cm/sec, respectively. No statistically significant change was observed in these velocities with paracentesis. In conclusion left ventricular diastolic function was found impaired in cirrhotic patients and not altered by paracentesis suggesting the possible role of some neurohumoral and metabolic factors rather than volume overloading.

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Þubat 1992 ile Mayýs 1992 tarihleri arasýnda Koþuyolu Kalp ve Araþtýrma Hastanesi hemodinami laboratuvarýnda koroner anjiyografi uygulanan hastalardan, randomize seçilen 100 olguya sol intern mammarya arter (ÝMA) anjiyografisi yapýldý. Hastalar fizik aktivitelerine göre hafif, orta ve aðýr fizik aktiviteli olarak gruplandýrýldý. Sol ÝMA'in subklavian arterden ayrýldýktan sonraki ilk 3 cm'lik kýsmýnda ve beþinci interkostal aralýða (5. ÝKA) rastlayan bölümündeki (muhtemel anastomoz yeri) çaplarý ölçüldü. Bu deðerler arterin orjininde hafif, orta ve aðýr fizik aktiviyete sahip olgularda sýrasýyla 2.51±0.3, 2.75±0.32 ve 2.93±0.27 mm olarak belirlendi. Bu çaplar 5. interkostal aralýkta (ÝKA) yine sýrasýyla 1.93±0.19, 2.07±0.16 ve 2.2±0.19 mm idi. Aðýr ve orta derecede fizik aktiviteye sahip olgularýn ÝMA çaplarýnýn, gerek ilk 3 cm'lik bölümünde, gerekse 5. ÝKA rastlayan bölümündeki çaplarýnýn hafif fizik aktiviteye sahip olgulara göre istatistik olarak anlamlý derecede büyük olduðu saptandý (p<0.05). Kadýnlarda orjindeki ortalama ÝMA çapý 2.45±0.37 mm. 5. ÝKA'ta 1.88±0.31 olarak saptandý. Onbeþ hastada (% 15) sol ÝMA anomalisi kaydedildi. Olgularýn hiç birinde lümende daralmaya neden olan aterosklerotik lezyon saptanmadý. Düþük fizik aktiviteye sahip olgularda, arter çapýnýn diðer gruplara göre belirgin olarak düþük bulunmasý nedeniyle, koroner yataðýn distal ve posterior bölümlerinin ÝMA ile kanlandýrýlmasý gereken hallerde ve/veya koroner arter hastalýðý ile birlikte sol ventrikül hipertrofisinin olduðu durumlarda preoperatif ÝMA anjiografisinin yararlý olabileceðini düþünüyoruz.

We performed selective left int. mammary artery (ÝMA) angiography to 100 randomly allocated cases between February 1992 and May 1992 at the Koþuyolu Heart and Research Hospital catheterization laboratory. Patients were classified according to their physical activity as heavy, light and intermediate groups. We measured the internal diameter of the left ÝMA in the first 3 cm after its take-off from the left subclavian artery and at the intercostal space (the probable anastomosis site). The values at the former site were 2.51±0.3, 2.75±0.32 and 2.93±0.27 mm for the light, intermediate and heavy physical activity groups, respectively. For the same groups the internal diameter of left ÝMA were 1.93±0.19, 2.07±0.19 mm at the 5th intercostal space. There was left ÝMA anomaly in 15 percent of cases. We failed to observe atherosclerotic luminal stenosis in any case. As were found the internal diameter of ÝMA in the light-activity group significantly lower than that of the other groups, it appears rational in this type of patients to perform preoperative ÝMA angiography if revascularization of the distal and posterior portions of the myocardial vascular bed is needed and/or when severe myocardial hypertrophy is associated with coronary artery disease.

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Komplikasyonsuz hafif ve orta derecede esansiyel hipertansiyonlu yaþlarý ortalama 48±8 olan 16 hastada 3x20 mg nikardipin'in (NC), ortalama 53 olan 20 hastada 1x20 mg nitrendipin'in (NT) ve 53±10 olan 12 hastada da 1x240 mg verapamil SR'nin (VR) izometrik egzersiz sýrasýndaki antihipertansif etkileri araþtýrýldý. Ýki haftalýk ilaçsýz ve bir haftalýk placebo devresi sonunda istirahatte ve izometrik egzersiz esnasýnda kan basýncý ve kalp hýzý (KH) ölçüldü ve ikili çarpým (DP) hesaplandý. Ýki haftalýk antihipertansif tedaviden sonra izometrik egzersiz ve ölçümler tekrarlandý. Tedaviden sonra her üç grubun izometrik egzersiz esnasýndaki baþlangýç ve maksimal ortalama sistolik kan basýncý (SKB) ve diyastolik kan basýncý (DKB) deðerleri anlamlý farklýlýk göstermedi. KH NC grubunda VR grubundakinden anlamlý olarak yüksek, DP ise VR grubunda anlamlý olarak düþük bulundu. Tedaviden önce 3 grup arasýnda SKB ve DKB nin inisiyalden maksimale artýþ ortalama deðerleri (D) arasýndaki anlamlý bir fark yokken, tedaviden sonra VR grubunda diðer iki gruba göre anlamlý olarak düþük bulundu. KH D deðerleri tedaviden önce NC grubunda anlamlý düþüklük gösterirken, tedavi sonrasý bu fark ortadan kalktý. Bu bulgulara göre her üç kalsiyum antagonisti de izometrik egzersiz sýrasýnda kan basýncý artýþý üzerine etkili olmakta, kardiyovasküler cevabý ve O2 tüketimini azaltmaktadýr. Yalnýz VR hem KB, hem KH'ný azaltýcý etkisi nedeniyle miyokardýn 0 tüketimini deðer iki ajana göre daha çok azalmaktadýr.

The antihypertensive effect of calcium antagonists was studied in patients with mild-to-moderate uncomplicated essential hypertension after isometric exercise, following a 2-week washout and one-week placebo period the measurements of blood pressure and heart rate (HR) were made at rest and after isometric exercise. After 2-week drug treatment with nicardipine (NC) (20 mgx3 daily) in 16 patients (mean age 48±8), nitrendipine (NT) (20 mg once daily) in 20 patients (mean age 53) and verapamil slow-release formulation (VR) (240 mg once daily) in 12 patients (mean age 53±10) the same measurements were made. The initial and the maximum mean systolic (SBP) and diastolic blood pressure (DBP) during isometric exercise were not significantly different between three groups and HR was significantly higher in NC group than in VR group and DP was significantly lower in VR group after treatment. Although the means of the differences between initial and maximum, (D), SBP and DBP in three groups were not significantly different before treatment, the difference was significantly lower in VR group than the other two groups after treatment. D HR were significantly lower in NC group before treatment, but this difference disappeared after therapy. It is concluded that NC, NT and VR are similarly effective in reducing the blood pressure rise, cardiovascular response and myocardial O2 consumption during isometric exercise. But VR reduces myocardial O2 consumption more than NC and NT by decreasing both the HR and blood pressure.

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Bu çalýþmada Týp 1 diabetes mellituslu (Tip 1 DM) 16 hastada (9 erkek, 7 kýz, ortalama 12.31±0.51 yaþ) sol ventrikül diyastolik ve sistolik fonksiyonlarý (LVDF, LVSF) Doppler ekokardiyografi ile incelendi ve kontrol grubu (KG) (10 erkek, 8 kýz, ortalama 12.66±0.49 yaþ) ile karþýlaþtýrýldý. Tip 1 DM'lu hastalarda KG'na göre LVDF parametrelerinden erken diyastolik ortalama ve zirve akým hýzlarýnýn (EVM, p<0.025, EVP, p<0.0005), E/A oranýnýn (p<0.0005), EVM integralin (p<0.025) anlamlý olarak azaldýðý, geç diyastolik akýmýnýn akselerasyon (AAA, p<0.0005) ve deselerasyon (ADA, p<0.005) averajlarýnýn arttýðý, fakat LVSF parametrelerinin etkilenmediði gözlendi. Sonuç olarak, Tip 1 DM'lu hastalarýmýzda LVDF'un etkilendiðini, fakat LVSF'nun etkilenmediðini söyleyebiliriz.

Left ventricular diastolic and systolic functions (LVDF, LVSF) were investigated by Doppler echocardiography in 16 patients (9 male, 7 female, average 13.3±0.5 years) with type 1 diabetes mellitus (type 1 DM) and compared with a control group (CG) (10 male, 8 female, average 12.7±0.5 years). Compared to the CG, it was observed that among the LVDF parameters early diastolic mean and peak flow velocities (EVM, p<0.025, EVP, p<0.0005), E/A ratio (p<0.0005), and EVM integral (p<0.025) significantly decreased, acceleration (AAA, p<0.0005) and deceleration (ADA, p<0.005) averages of late diastolic flow increased, but LVSF parameters were not affected in patients with type 1 DM. In conclusion, diastolic left ventricular function was affected in our type 1 diabetic adolescent patients but not the systolic function.

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Ünlü Science Citation Index'in taradýðý dergilerde 1991 yýlýnda yer alan Türkiye'den kaynaklý 1080 adet bilim ve teknoloji yayýnýndan 398'i (% 37'si) týp alanýnýn ilgilendiriyordu. Bir önceki yýla göre % 15'lik artýþ kaydedildi. Editöre mektup türünden ziyade, tam metinli makale sayýsýnýn daha fazla yükselmesi memnuniyet vericiydi. Ýç hastalýklarý, nükleer týp, radyoloji ile nöroloji 1991'de paylarýný en çok arttýran bilim dallarýydý. Kardiyoloji bütünüyle 11 tam metinli makale ile orta düzeyini korudu. Kurumlarýmýzdan Ankara, Gazi, GATA ve Cerrahpaþa týp fakülteleri hamle yapanlardandý. Son on yýllýk dönemde týp merkezlerimizin literatüre katký paylarýnda, eski büyük fakültelerin aleyhine geliþme çarpýcýydý: hem daha yeni kurulan fakülteler, hem de üniversite-dýþý kurumlar uluslararasý yayýnlardan paylarýný önemli ölçüde arttýrdý.

Medical source items originating from Turkey's institutions which appeared in 1991 in journals covered by the Science Citation Index amounted to 398. This represented a share of 1.8 per mille in global medicine and constituted a rise by 15 % over the preceding year. Internal medicine, nuclear medicine, radiology and neurosurgery increased their share of publications in 1991 more than other fields. Cardiology fared average with 11 articles (with full text). A somewhat anticipated trend prevailed in the past decade: while the share of the 4 major medical faculties declined from 84 % to 53 %, this was outweighed by newer faculties as well as by institutions not affilated with universities.

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Koroner arter anevrizmalarý (KAA)'nýn oluþumundan sýklýkla hýzlý ilerleyen ateroskleroz sorumlu tutulmaktadýr. Yaygýn tromboze, emboli ve rüptür en sýk görülen komplikasyonlarýdýr. Hastalarýn hayatta kalma oraný, bir veya iki koroner arteri anlamlý derecede daralmýþ hastalarla ayný olmaktadýr. Bu yazýda KAA'nýn klinik ve laboratuvar bulgularý ile tedavi yaklaþýmlarý sunulmaya çalýþýlmaktadýr.

This brief review deals with the various aspects of coronary artery aneurysms (CAA) which are defined as a localized or diffuse abnormal dilatation along the coronary arteries. The incidence at the Gülhane Military Academy was noted as 1.6 % in 5940 patients subjected to coronary arteriography which was in agreement with many other reports. Accelerated atherosclerosis often underlies CAA in which thrombosis, distal arterial embolism and rupture are complications most commonly observed. The annual attrition rate in medically managed patients with CAA has varied around 3 %, a rate which seemed not improved by surgical approach.

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Akut miyokard infarktüslü hastalarda üç farklý plazminojen aktivatörü ile elde edilen sonuçlar kýsaca gözden geçirildi. Reperfüzyon saðlanmýþ koroner arterin, özellikle ilk saatteki yeniden týkanmasý bellibaþlý bir sorun olarak sürmektedir. Antitrombotik ve antiagregan tedavinin (heparin ve aspirin) kýsýtlamalarý ve deðeri irdelendi. Akut miyokard infarktüslü hastalarýn daha büyük bir bölümünü trombolitik tedavi yararlarýna ekspoze etmek amacýyla, akut iskemili hastalarýn hastaneye daha erken ulaþmalarýna yol açabilecek daha iyi bir eðitim ve organizasyona eriþme gereðine dikkat çekildi.

Results obtained in the treatment with three different types of plasminogen activators in patients with acute myocardial infarction were briefly reviewed. Reocclusion or the reperfused coronary artery, particularly during the first hour, remains a major problem. The limitations and value of antithrombotic and antiaggregant treatment (heparin and aspirin) were discussed. It was pointed out that a better organization should be sought to enable earlier arrival of acutely ischemic patients to the hospitals with the purpose of exposing a greater proportion of patients with acute myocardial infarction to the benefits of thrombolytic therapy.

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Primer kalp tümörleri nadir görülür. Burada, iki boyutlu ekokardiografi ile saptanýp ameliyat olmuþ, histopatolojik ve elektron mikroskopik olarak indiferansiye mezankimal hücreli kardiak sarkom tanýsý konmuþ bir sað ventrikül kitlesi olgusu bildirilmiþtir. Hasta postoperatif dönemde kaybedilmiþtir. Kalp tümörlerinin klinik belirtilerinin deðiþkenliði nedeniyle tanýya varmada iki boyutlu ekokardiografi deðerli bir araç ve düþüncemize göre erken taný için zaruridir. Yazarlarýn bilgisine göre elektron mikroskopik tetkiki yapýlmýþ primer kalp sarkomu olgusu, ülkemizde ilk kez bildirilmektedir.

Primary heart neoplasms are rare. We present a case of right ventricular mass evaluated by 2-D echocardiography who underwent surgery and died postoperatively. Histopathological and electron microscopic diagnosis was undifferentiated mesenchymal cell sarcoma of the heart. In view of the variability of the clinical features of cardiac tumors. 2-D echocardiography is a valuable tool and, in our opinion, essential for early diagnosis. To the authors' knowledge this is the first report of a case of primary cardiac sarcoma in Turkey in whom electron microscopic evaluation was done.

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