comparison of two electrophysiology centers in different social and economic regions of Turkey during first quarter of the year

Introduction: More and more patients have been undergoing electrophysiological study [EPS] as the number of rhythmologists have increased. Due to the increased interest in the study, today EPS applications are made even in second step public hospitals or private hospitals. Our aim is to compare two electrophysiology labs, that are in different regions with social and economic development, in terms of patient demography, diagnosis, amount of diagnostic and curative interventions

Materials and Methods: In this study, two centers from two different regions of Turkey were selected; a training and research center [center 1] in the Western part and a public hospital [center 2] in the Eastern part of the country. Records of the patients who undergone EPS in these two centers were retrospectively analyzed. Independent parametric data were evaluated by T-test, and categorical data via Mann-Whitney U test. A p value below 0.05 was accepted for significance

Results: A total of 83 patients were retrospectively analyzed [42 from center 1, 41 from center 2]. Patients' baseline demographic data was similar except intellectual status. Nevertheless, both groups differed based on the number of patients with diagnosis of atrioventricular reciprocating tachycardia [P=0.047]. There was a significant difference in procedure types. Center 1 performed significantly higher number of curative procedures [P=0.039] than center 2

Conclusion: Nowadays, EPS is spread from specialized centers to middle-sized hospitals. Since specialized centers have more access to the advanced devices such as electro-anatomic mapping rather than conventional equipment, they are evaluating more complex cases with a variety of different diagnosis. Constructing a referral system from peripheral hospitals to distinguished centers in electrophysiology field would eliminate unnecessary and/or repeated procedures and decrease the expenses

Autologous blood pleurodesis: a good choice in patients with persistent air leak

The study compares the efficiency, side effects and complications of autologous blood pleurodesis with talcum powder and tetracycline. This prospective study evaluated 50 patients with persistent air leak resulting from primary and secssondary spontaneous pneumothorax between February 2004 and March 2009. The patients inclussded 32 [64.0%] males and 18 [36.0%] females with a median age of 39 years [range 14-69 years]. All cases had persistent air leak of more than seven days. Pleurodesis was performed using autologous blood in 20 [40.0%] patients, talc powder in 19 [38.0%] patients and tetracycline in 11 [22.0%] patients through a chest tube. Air leak cessation times after pleurodesis, side effects and pulmonary function tests [PFT] in the first and third months were measured. Recurrent primary spontaneous pneumothorax was the cause of persistent air leak in all cases. Air leaks were expiratory only in 54.0% of cases. We obtained a success rate of 75.0% using autologous blood, 84.2% using talc powder and 63.6% using tetracycline. Mean air leak termination interval was significantly [P < 0.001] shorter in patients treated with autologous blood in comparison to talc powder and tetracycline. We observed a significant [P < 0.05] decline in PFT in patients treated with talc powder compared with tetracycline and autologous blood. Vital capacity, FVC and FEV1 were significantly lower in patients treated with tetracycline compared with autologous blood. This study shows that autologous blood pleurodesis compared to talc powder and tetracycline is related with shorter leak cessation time and less pulmonary function decline in patients with persistent air leak. We think further randomized clinical trials of pleurodesis as treatment could increase its use in thorax surgery by demonstrating the safety and the efficacy of this procedure

Cardiac Autonomic Function Evaluated by the Heart Rate Turbulence Method was not Changed in Obese Patients without Co-morbidities

Obese subjects are more prone to sudden deaths and arrhythmias than non-obese subjects. Heart rate turbulence (HRT) impairment reflects cardiac autonomic dysfunction, in particular impaired baroreflex sensitivity and reduced parasympathetic activity. Our aim was to evaluate the cardiac autonomic function in obesity by the HRT method. Ninety obese subjects and 112 healthy subjects were included in the study. Twenty-four hours ambulatory electrocardiograms were recorded and Holter recordings were analyzed. HRT parameters, turbulence onset (TO) and turbulence slope (TS), were calculated with HRT View Version 0.60-0.1 software program. HRT were calculated in 43 obese and 43 control subjects who had at least one ventricular premature beat in their Holter recordings. We excluded 47 obese patients and 69 control subjects who showed no ventricular premature beats in their Holter recordings from the statistical analysis. There were no significant differences in TO and TS between obese and control subjects (TO obese: -1.6+/-2.2%, TO control: -2.1+/-2.6%, p>0.05; TS obese: 8.2+/-5.2, TS control: 10.1+/-6.7, p>0.05, respectively). HRT parameters seem to be normal in obese patients without comorbidities.