Coronary sinus dilatation is associated with left ventricular systolic dysfunction and poor functional status in subjects with chronic heart failure.

BACKGROUND AND AIMS: Reliable echocardiographic markers additional to plasma biomarkers that would establish prognosis of chronic heart failure and guide therapeutic approach would be beneficial. In our hypothesis, echocardiographic assessment of coronary sinus anatomic alteration, which has been ignored, may be part of remodeling process in heart failure. We also aimed to evaluate relationship between coronary sinus anatomic alteration and left ventricular systolic dysfunction. We echocardiographically analysed 112 patients with heart failure and 61 normal subjects. Left/right ventricular volumes, left atrial area and mean coronary sinus were measured. Coronary sinus diameter was significantly higher in patients than in control group. Statistically positive correlation were present between coronary sinus measurements and left/right ventricular volumes (R = 0.5, P < 0.001; R = 0.4, P < 001, respectively), left atrial area (R = 0.6, P < 0.001), NYHA class (R = 0.3, P < 0.001), mitral regurgitation (R = 0.329, P < 0.001), tricuspid regurgitation (R = 0.215, P < 0.02) and left ventricular mass (R = 0.482, P < 0.001). Statistically negative correlation were present between coronary sinus measurements and left ventricle ejection fraction (R = -0.4, P < 0.001). However, coronary sinus diameter was not correlated with body surface area and pulmonary artery pressure. Tricuspid and mitral regurgitation, left ventricular mass, ejection fraction and functional class were included in multivariate analysis and only ejection fraction was independent predictor of coronary sinus diameter (P = 0.012). We demonstrated that, dilated coronary sinus is possibly a part of entire process of cardiac remodeling and echocardiographic assessment of dilated coronary sinus may provide useful additional information, predicting the severity of chronic heart failure and poor functional class.

Effectiveness of Ankaferd blood stopper in the topical control of active bleeding due to cutaneous-subcutaneous incisions.

OBJECTIVE: To assess the effectiveness of Ankaferd blood stopper (ABS) in the topical control of bleeding due to cutaneous/subcutaneous incisions. METHODS: We included in this study, 69 patients with cancer that were admitted for port insertion to the Emergency Department of Gaziantep University Hospital, Gaziantep, Turkey, between May and July 2008. We used the wet compress form of ABS in 37 patients (group I), and regular dry sterile sponges in 32 patients (group II), to stop the bleeding that occurs during the clinically indicated vascular port insertion in patients with cancer. The success rate in terms of bleeding control, time needed to stop the bleeding, recurrence of bleeding, and complications were recorded. RESULTS: A total of 69 patients were included in this study. The average time needed to stop the bleeding was 32.97 +/- 29.9 seconds for group I, and 123.75 +/- 47.5 seconds for group II. Bleeding restarted in 24% in group I, and in 50% in group II. Among the patients in group I, 13.5% developed localized redness, and 8.1% minor swelling, while 8.1% reported local pain at the wound site; in 5.4% of the patients, the sutures at the wound site opened. The same parameters were recorded for group II; 9.4% for localized redness, 0.0% for minor swelling, 6.2% reported local pain, and the sutures at the wound site opened in 3.2% (p=0.592). CONCLUSION: The Ankaferd blood stopper was proven to stop local bleeding in a shorter time, with a lower recurrence rate in comparison with the sterile sponge.

The effect of chronic carbon-monoxide exposure on the peak expiratory flow values of grill-kebab chefs.

OBJECTIVE: To determine the effect of chronic carbon-monoxide (CO) exposure on blood carboxy-hemoglobin (COHb) values in grill-kebab chefs, and if there is any subsequent airway obstruction. METHODS: The study was carried out in Sahinbey Hospital, Medical School of Gaziantep University, Gaziantep, Turkey, between March 2007 and November 2007. Forty male grill-kebab chefs, working in restaurants for at least 3 years, and 48 non-smoker, male healthy volunteers were gathered for this study. The ages, body mass indexes (BMI), blood pressure (BP), COHb, N-terminal pro brain natriuretic peptide (NT-proBNP), and peak expiratory flow (PEF) values of the grill-kebab chefs and controls was measured. Statistical analysis was carried out using the SSPS 13.0 software. RESULTS: The average age for the study group was 33.0 +/- 9.1, and for the control group was 34.7+/- 6.5 years. The average occupation time for the study group was 16.1+/-7.3 years. The clinical attributes, ages, BMI, BP, and NT-proBNP values of both groups were similar. The COHb (6.5+/-1.5/2.0+/-1.1%) values were higher in grill-kebab chefs compared with the control group. The NT-proBNP values were determined as normal (<60 microg/L) in both groups. A higher decrease in PEF speed (average: 65.1/7.1 L/min) was recorded in the grill-kebab chefs. CONCLUSION: Chronic exposure to CO decreases PEF, with narrowing of the airway in grill-kebab chefs.

Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning.

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this study we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.