Characteristics of venous insufficiency in western Turkey: VEYT-I study.

OBJECTIVES: Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. METHOD: Randomized patients who applied to a health-care centre were included in this study. The Tübingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. RESULTS: A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 ± 9.4. CONCLUSION: The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

Three cases with May-Thurner syndrome: a possibly under-reported disorder.

The May-Thurner syndrome is an acquired stenosis of the left common iliac vein causing left lower leg edema, thigh discomfort, and deep venous thrombosis. This condition was first described by May and Thurner in 1956 in 22% of autopsy series. They concluded that it was the underlying factor for deep venous thrombosis on the left side. Here, we present three young female patients with May-Thurner syndrome, but without actual thrombosis. One of these patients was successfully treated with a Wall stent, and the other two patients underwent clinical follow-up with anticoagulant therapy.

Simultaneous bilateral carotid endarterectomy: our first experience.

UNLABELLED: Indications for and against bilateral carotid surgery as a simultaneous or a staged procedure and patient selection criteria for simultaneous bilateral carotid endarterectomies (SBCE) are discussed. METHODS: Six patients who underwent 12 SBCE (group A) were compared with 20 patients who underwent 40 bilateral staged endarterectomies (group B). The indications and surgical management were similar and the accompanying risk factors were comparable in both groups. A shunt or patch was not used and the occlusion time was 12.5+/-2'. Total occlusion time in the SBCE was 25+/-2.5'. RESULTS: The results are comparable in both groups. In the SBCE group no major neurological complications were noted except for a transient hypoglossal paresis. In group B a case with transient ischemic attack (TIA) was noted; however no mortality, myocardial infarct, respiratory problems or permanent damage of the central nerves were observed in either groups. CONCLUSION: Although our number of patients was not satisfactory to yield a conclusion, our results, together with that of the international literature were encouraging for SBCE. SBCE can be safely performed, in experienced hands with a better preoperative assessment of the function of the circle of Willis in association with meticulous surgical technique and proper patient selection.

Chlamydia pneumonia seropositivity correlates with serum fibrinogen and lipoprotein a levels: any role in atherosclerosis?

The aim of the study is to determine the impact of Chlamydial seropositivity on atherosclerosis in a group of patient requiring coronary and/or carotid revascularization. A population of 30 diabetic patients (group 3) and 26 nondiabetic patients (group 2) with angiographically documented coronary and/or carotid artery disease were enrolled for the study. Volunteers from the relatives of hospital staff with no known disease (n=29; group 1) were included as the control group. Serum samples from the participants were assayed for cardiovascular risk factors including total serum cholesterol, triglyceride and lipoprotein levels, fibrinogen, Hb A1c levels and IgG titers for Chlamydia pneumonia (C. pneumonia). Chlamydial seropositivity was analysed further to determine a possible impact on atherogenesis. Serum LDL cholesterol levels revealed statistically significant difference between groups 1 and 2 (p=0.001). There was no difference between groups 2 and 3 regarding LDL cholesterol levels. There was no significant difference among the groups with respect to C. pneumonia seropositivity and the other atherosclerotic risk factors. Chlamydial seropositivity was found to be more frequent in males than in females (p=0.008). In the C. pneumonia seropositive group, serum fibrinogen and lipoprotein a levels were found to be significantly higher than the seronegative group (p=0.0001 and p=0.001, respectively). Other atherogenic risk factors were similar in the seropositive and negative groups. The causal role of Chlamydial infections in atherosclerotic plaque formation might be due to their influence on the serum fibrinogen and lipoprotein a levels.

Detection of Chlamydia pneumoniae and Helicobacter pylori DNA in human atherosclerotic plaques by PCR.

Chlamydia pneumoniae and Helicobacter pylori can cause persistent infections of the respiratory and gastrointestinal tract, respectively. It has been suggested that persistent infection of arteries with these bacteria can contribute to the development of atherosclerosis. The aims of this study were to determine the presence of C. pneumoniae and H. pylori DNA in atherosclerotic plaque samples by PCR and to evaluate the correlation between clinical status and DNA positivity of these bacteria. Eighty-five consecutive patients (mean age, 59 +/- 10; 75 male, 10 female) undergoing coronary artery bypass grafting, carotid endarterectomy, and surgery of the abdominal aorta for atherosclerotic obstructive lesions were included in the study. Forty-six endarterectomy specimens from the atherosclerotic lesions and 39 specimens from healthy regions of the ascending aorta, which were accepted as the control group, were excised. The presence of microorganism DNA in endarterectomy specimens was assessed by PCR. C. pneumoniae DNA was found in 12 (26%) of 46 endarterectomy specimens and none of the healthy vascular-wall specimens (P < 0.001), while H. pylori DNA was found in 17 (37%) of 46 endarterectomy specimens and none of the controls (P < 0.001). Either C. pneumoniae or H. pylori DNA was positive in 23 (50%) of 46 patients and none of the controls (P < 0. 001). Six of the atherosclerotic lesions showed coexistence of both of the microorganism DNAs. The presence of C. pneumoniae and H. pylori DNA in a considerable number of atherosclerotic plaques but their absence in healthy vascular wall supports the idea that they may have a role in the development of atherosclerosis, especially in countries where infection is prevalent and where conventional risk factors fail to explain the high prevalence of atherosclerotic vascular disease.

Myxoma on anterior mitral leaflet presenting with symptoms of cerebellar artery infarction.

This report describes a patient who had dizziness and loss of balance. During routine investigation, a mass located on the anterior mitral valve leaflet was detected on transthoracic echocardiography. The patient underwent surgery for a mass located on the mitral valve, and histopathologic examination determined the mass was a myxoma.

Pseudoaneurysm formation in surgically treated Behçet's syndrome--a case report.

Behçet's syndrome is a multisystem disorder with unknown etiology. Clinically it is mostly seen as a systemic vasculitis; almost 30% of the patients have vascular involvements, and most of these are venous thrombosis and arterial aneurysms. Obstructions of the femoral and tibial arteries have also been reported in the literature. The authors present here a patient with Behçet's syndrome who had pseudoaneurysms on both femoral arteries after aortobifemoral bypass surgery.

Cervical aortic arch with aneurysm formation.

Cervical aortic arch is a very rare anomaly presented as a pulsatile mass on the neck and usually with symptoms of dysphagia, cough and hoarseness. Rarer than the cervical aortic arch, is the aneurysm formation and, despite the equal sex distribution of cervical aortic arch, aneurysm formation always occurs in young females with only nine cases reported. We report herein a 24-year-old woman, diagnosed as cervical aortic arch with aneurysm formation due to basophilic degeneration, treated successfully with surgical intervention. To our knowledge no similar case has been reported.

Two Surgically Treated Patients With Severe Symptoms of Takayasu Arteritis

Takayasu arteritis, also known as the aortitis syndrome, is a panarteritis that affects the arcus aorta and its major branches, seen usually in young women. As Takayasu arteritis has a progressive nature, surgery is usually indicated only in complications of the arteritis. In this report we present two surgically treated cases with severe complications of Takayasu arteritis. We also review the syndrome.

Benign mesenchymoma of the esophagus.

Benign mesenchymoma is an extremely rare neoplasm mostly located in or about the kidney and is composed of a haphazard mixture of adult fat, fibrous tissue and tangled blood vessels, scattered nests or masses of smooth muscle cells, occasionally islands of cartilage, bone, and lymphoid tissue as well as other mesenchymal elements. Only two cases of benign mediastinal mesenchymomas were reported in the literature. In this report we describe a benign mesenchymoma of the mediastinum which presented itself with symptoms and signs of the traction diverticula of the esophagus.

Atrial fibrillation after coronary artery bypass surgery: predictors and the role of MgSO4 replacement.

BACKGROUND: Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. The aim of the study was to identify factors associated with atrial fibrillation (AF) and to determine the efficacy of postoperative magnesium sulphate (MgSO4) replacement on the incidence of AF after coronary artery bypass grafting (CABG) operation. METHODS: Fifty patients undergoing CABG were studied prospectively. Consenting patients with good left ventricular function and without any documented arrhythmias were randomly divided into two groups of 25 patients each in a double-blind fashion. The clinical characteristics of both groups were similar. In the study group, 200 mEq MgSO4 was given for the first 5 postoperative days, in the control group, placebo was given instead of MgSO4. RESULTS: Five (20%) patients in the control group and one (4%) patient in the MgSO4 group experienced AF. There was no significant relationship between the development of AF and the following variables: age; sex; diabetes mellitus; hypertension; previous myocardial infarction; smoking; extension of coronary artery disease; aortic cross-clamp time; number of grafts; cardiopulmonary bypass time; postoperative pericarditis; and anemia. CONCLUSION: The use of MgSO4 in early postoperative period is effective in reducing the incidence of AF after CABG in patients with good ventricular function.

Mitral valve surgery in the presence of pulmonary hypertension.

Mitral valve surgery was performed in 59 patients with severe pulmonary hypertension (average systolic pulmonary artery pressure 77.1 +/- 18.6 mmHg; range 50-115 mmHg) between 1983 and 1990. Thirty-eight patients had been subjected to mitral valve replacement, 16 patients both mitral and aortic valve replacement, and 5 patients had open mitral commissurotomy, with an operative (30 day) mortality of 5.0%. These 3 deaths happened during the early postoperative period. Survivors were followed up for a period ranging from 6 months to 7 years with a mean of 36 months. Four late deaths (7.1%) occurred in patients with valve replacement. Actuarial survival was 93 +/- 3% at 5 years, and 90.7 +/- 4.4% at 7 years. Right ventricular catheterization was performed on 14 patients a mean of 38 months following operation. Systolic pulmonary artery pressure had decreased from a mean of 77.1 +/- 18.6 to 39.7 +/- 14.0 mmHg (p less than 0.001) and 90% of the survivors were in New York Heart Association Class 1 or II compared to 23.7% preoperatively. The clinical and hemodynamic findings in this series suggest that severe pulmonary hypertension is not a contraindication, and pulmonary hypertension decreases significantly after mitral valve surgery.

Surgical treatment of renovascular hypertension in children.

Hypertension of renovascular origin in pediatric patients is frequently encountered. Herein, we review our experience, as well as that of others, with this type of patient, and discuss the characteristic features of renovascular hypertension and the favourable response to reconstructive vascular surgery.

De Vega's tricuspid annuloplasty: analysis of 195 patients.

In the years 1984-1989, 195 De Vega tricuspid annuloplasties were performed in association with mitral or mitral-aortic valve procedures. Preoperatively, 9 patients (4.6%) were in New York Heart Association functional class II, 124 (63.6%) were in class III, and the remaining 62 (31.8%) were in class IV. Tricuspid insufficiency was recognized by routine digital palpation of the tricuspid valve during the operation in 42 (21.5%) of the patients. Hospital mortality rate was 7.6% (15 patients). Late deaths occurred in 6 (3.0%) cases during a follow-up period of 3 to 72 months (mean 42 months). 8 patients (4.1%) required reoperation. Tricuspid annuloplasty failure was observed in 4 patients (2%). These valves were replaced with biological valves in three patients and with a mechanical valve in one patient. 112 of the survivors (64.3%) were evaluated by echocardiography and/or right ventriculography. Analysis of postoperative data showed that in 84 of the 112 patients (75%) tricuspid regurgitation disappeared completely after annuloplasty, 88% of surviving patients were in functional class I or II. For the series presented actuarial survival rate at 6 years was 79.1% +/- 14.4%. In the light of this study we recommend De Vega's annuloplasty as the method of choice for moderate to severe functional tricuspid insufficiency.

Abdominal aortic aneurysm with inferior vena cava obstruction: case report.

Behçet's syndrome, a multisystem disorder, is characterized by recurrent oral and genital aphthous ulcerations, eye lesions, and skin changes. Other manifestations, although rare, may affect the nervous, gastrointestinal, or locomotor system, as well as veins and arteries. Vascular lesions occur in approximately 30% of reported cases. Although thrombosis in the larger veins is frequent, arterial thrombosis is somewhat less likely to occur. Only a few cases of arterial aneurysm have been documented in the literature. This report describes a patient who had suffered from Behçet's syndrome for fifteen years and in whom a complete obstruction of the inferior vena cava was demonstrated. An aortoiliac bypass was performed successfully, and the patient had had a good clinical recovery at long-term follow-up.

Hypertension because of an arteriovenous fistula between the right renal artery and the inferior vena cava secondary to a gunshot wound: a case report.

A case of a renovascular hypertension due to an arteriovenous fistula between the right renal artery and the IVC secondary to a gunshot wound 8 years previously is reported. The diagnosis was made initially by the clinical signs of a continuous bruit heard over the anterior abdomen and by the characteristic findings of diastolic hypertension. Diagnosis was confirmed by abdominal aortography. In the operation, the right renal artery was ligated and divided proximally between the aorta and the aneurysm and distally beyond the fistulous communication and a Gore-Tex graft was anastomosed between distal part of the renal artery and abdominal aorta. The result was confirmed by postoperative aortography and by disappearance of the preoperative physical findings. The present case, to our knowledge, is the sixth in the literature.

Arterial embolism. An analysis of 115 surgical procedures.

Arterial embolus is usually a serious complication of rheumatic or atherosclerotic heart disease. One hundred-fifteen surgical procedures performed in 86 patients with arterial emboli in a 10 years' period in the Department of Adult Thoracic and Cardiovascular Surgery of our university are analyzed regarding the etiology, the treatment, and the results of this complication. Most of the patients were delayed cases showing mild to severe degrees of trophic, sensory and motor disturbances in the limbs without gangrene. These cases are also subjected to vascular surgery (removal of the embolus) as a chance to enable them to use their extremities in lieu of prosthese even when motor and sensory changes persist.