Measurement of radioactivity levels and assessment of radioactivity hazards of soil samples in Karaman, Turkey.

In this study, the levels of the natural and artificial radioactivity in soil samples collected from surrounding of Karaman in Turkey were measured. Activity concentrations of the concerned radionuclides were determined by gamma-ray spectrometry using a high-purity germanium detector with a relative efficiency of 40 % at 1.332 MeV. The results obtained for the (238)U series ((226)Ra, (214)Pb and (214)Bi), (232)Th series ((228)Ac), (40)K and fission product (137)Cs are discussed. To evaluate the radiological hazard of radioactivity in samples, the radium equivalent activity (Raeq), the absorbed dose rate (D), the annual effective dose and the external (Hex) and internal hazard index (Hin) were calculated and presented in comparison with the data collected from different areas in the world and Turkey.

The severity of coronary atherosclerosis in diabetic and non-diabetic metabolic syndrome patients diagnosed according to different criteria and undergoing elective angiography.

Our aim in this study was to evaluate the relationship between metabolic syndrome (MS) as defined by different criteria and the severity of coronary lesions in a sample of diabetic and non-diabetic patients undergoing elective coronary angiography. All patients had blood and urine tests, physical examinations were performed before angiography, and finally they were classified based on three criteria (World Health Organisation-WHO, Adult Treatment Panel-ATP III and International Diabetes Federation-IDF). Eighty-eight patients were diabetic, and 96 patients were non-diabetic. Among all patients, diabetics had significantly higher Gensini scores (P < 0.001). According to WHO criteria (P = 0.005) and IDF criteria (P = 0.015) metabolic syndrome patients had higher Gensini scores, but for ATP III criteria difference was not significant. When we evaluated diabetics and non-diabetics separately, non-diabetic patients with MS had significantly higher scores with WHO definition (P = 0.015) and mildly higher but not significant values with other MS criteria (P = 0.057 for both IDF and ATP III). Neither any one of MS components nor gender revealed significant relationship with coronary disease severity. In our study with a cohort of Turkish patients undergoing elective coronary angiography; we concluded that MS should be taken into consideration, especially in non-diabetic patients.

Effect of dobutamine stress on basal septal tissue dynamics in hypertensive patients with basal septal hypertrophy.

Left ventricular outflow tract (LVOT) obstruction has been classically observed in hypertrophic cardiomyopathy in which the LVOT obstruction is associated with asymmetric septal hypertrophy producing a systolic pressure gradient across the LVOT. Basal septal hypertrophy (BSH) with hypertension may result in dynamic LVOT obstruction as well. It was suggested that regional hypertrophy may be related to enhanced ventricular dynamics.

Characteristics of coronary heart disease in renal transplant recipients.

The aim of this study was to identify the characteristics of coronary heart disease (CHD) in renal transplant recipients as well as to assess the impact of coronary angiography on allograft function. The 21 cases including 2 women and 19 men who underwent coronary angiography were retrospectively studied for age at transplantation and at diagnosis of coronary disease; risk factors; angio findings; serum creatinine and blood urea nitrogen (BUN) values before and after angio; and revascularization procedures. The mean ages at transplantation and at diagnosis were 40 +/- 7 years and 44 +/- 7 years, respectively. Eighteen patients (86%) had hypertension, 16 (76%) exhibited hyperlipidemia, and 5 (24%) diabetes mellitus. Coronary angiography revealed three-vessel disease in 10 patients, two-vessel disease in 3 patients, one-vessel disease in 4 patients, ectatic vessels in 2 patients, and normal coronary arteries in 2 patients. The mean serum creatinine and BUN levels after angio were not significantly different from the baseline values (pre creatinine and BUN 1.7 +/- 0.5 mg/dL and 33.8 +/- 8.6 mg/dL versus post 1.8 +/- 0.6 mg/dL and 32.8 +/- 10.0 mg/dL, respectively). Ten patients with three-vessel disease underwent coronary artery bypass surgery; 4 patients, coronary angioplasty. The other patients received medical therapy. The study showed an increased likelihood of three-vessel disease among recipients compared with the general population and confirmed that coronary artery bypass surgery may be performed successfully in these patients. In conclusion coronary angiography is a safe diagnostic procedure with respect to allograft function.

Association between the metabolic syndrome and newly diagnosed coronary artery disease.

This case-control study was designed to outline age- and gender-related differences of metabolic risk factors in a group of patients with coronary artery disease (CAD). Accordingly, a total of 366 consecutive patients with a recent diagnosis of CAD (139 women, 41-79 yr; 227 men, 39-78 yr) were screened between October 1999 and April 2001 at Baskent University Adana Medical Center, and 366 age- and gender-matched individuals were selected as a control group. We compared demographics, blood pressure, body mass index, waist circumference, lipid profile, fasting and post-prandial glucose-insulin levels between CAD patients and the control group. Prevalence of metabolic syndrome was 72.6% in females, and 39.0% in males with CAD. Hypertension, obesity and diabetes were more common in female patients; 64.5% of female patients had premature CAD and 83.5% of those had metabolic syndrome. In logistic (OR: 3.57 for women and OR: 1.59 for men) regression analysis, metabolic syndrome was independently associated with CAD in both genders. As a conclusion, prevalence of metabolic syndrome was significantly higher in patients with CAD than the control group, especially in female patients. The metabolic syndrome was independently associated with CAD in both genders.

Is Doppler tissue velocity during early left ventricular filling preload independent?

BACKGROUND: Transmitral Doppler flow indices are used to evaluate diastolic function. Recently, velocities measured by Doppler tissue imaging have been used as an index of left ventricular relaxation. OBJECTIVE: To determine whether Doppler tissue velocities are influenced by alterations in preload. METHODS: Left ventricular preload was altered in 17 patients (all men, mean (SD) age, 49 (8) years) during echocardiographic measurements of left ventricular end diastolic volume, maximum left atrial area, peak early Doppler filling velocity, and left ventricular myocardial velocities during early filling. Preload altering manoeuvres included Trendelenberg (stage 1), reverse Trendelenberg (stage 2), and amyl nitrate (stage 3). Systolic blood pressure was measured at each stage. RESULTS: In comparison with baseline, left ventricular end diastolic volume (p = 0.001), left atrial area (p = 0.003), peak early mitral Doppler filling velocity (p = 0.01), and systolic blood pressures (p = 0.001) were all changed by preload altering manoeuvres. Only left ventricular myocardial velocity during early filling remained unchanged by these manoeuvres. CONCLUSIONS: In contrast to standard transmitral Doppler filling indices, Doppler tissue early diastolic velocities are not significantly affected by physiological manoeuvres that alter preload. Thus Doppler tissue velocities during early left ventricular diastole may provide a better index of diastolic function in cardiac patients by providing a preload independent assessment of left ventricular filling.

Effects of spironolactone on heart rate variability and left ventricular systolic function in severe ischemic heart failure.

Recent data show that blockade of aldosterone receptors by spironoloctone reduces the risk of morbidity and death among patients with severe heart failure. Heart failure secondary to ischemia is characterized by an imbalance of the autonomic nervous system, which can be assessed by analysis of the heart rate variability (HRV). Spironolactone's effects on HRV are not well defined. If spironolactone has beneficial effects on HRV, this would contribute to favorable results. We therefore measured Holter-derived HRV indexes in a group of 126 patients with heart failure, aged 36 to 83 years, with angiographically proved coronary artery disease, on 3 separate occasions. Patients' sodium intake was restricted; therapy with enalapril, furosemide, and digoxin was begun, and 2 weeks after this standard therapy, spironolactone 50 mg/day was added. Evaluations were done at baseline, and the first and 12th months. After spironolactone, the triangular interpolation of the NN histogram (from 233.0 +/- 98 to 291.7 +/- 74 ms and 340.5 +/- 130 ms, p <0.001) and the percentage of differences between successive normal RR intervals differing >50 ms over a 24-hour electrocardiography (from 2.9 +/- 2.4% to 4.3 +/- 5.2% and 3.9 +/- 2.6%, p <0.002) increased significantly. Ejection fraction and functional classes were also improved. These data imply that in patients with heart failure who are taking conventional drugs, the addition of spironolactone induces a favorable sympathovagal balance. These changes, as assessed by the triangular interpolation of the NN histogram and the percentage of differences between successive normal RR intervals differing >50 ms over a 24-hour electrocardiography, and observed at 1 month after therapy, persisted in the long term.

Loss of nocturnal decline of blood pressure in patients with nasal polyposis.

The objective of this study was to assess the blood pressure pattern in patients with nasal polyposis. Twenty-seven patients with nasal polyposis (18 males and 9 females), ranging in age from 15 to 72 years (mean 37.1 years) were eligible for inclusion in the study. All patients were hospitalized overnight before surgery. After the basal blood pressure measurements were taken, non-invasive ambulatory blood pressure monitoring was carried out. Oxygen saturation was measured via a finger probe and venous blood sampling was taken for catecholamine level during the full night. All measurements were repeated 4 months after nasal surgery. Mean values for nocturnal decline in blood pressure and heart rate before surgery were less marked than those measured after surgery. Mean decline values (+/- SD) were; 4.6 +/- 2.4 mmHg for systolic blood pressure, 5.8 +/- 3.8 mmHg for diastolic blood pressure, and 7.9 +/- 3.9 beats/min for heart rate before surgery, 9.3 +/- 2.8 mmHg, 8.5 +/- 4.1 mmHg and 10.4 +/- 4.3 beats/min after surgery (p < 0.01), respectively. Whereas mean and minimum SaO2 (%) significantly increased (p < 0.01), catecholamine levels decreased (p < 0.05 for adrenaline, p < 0.01 for noradrenaline) after surgery. A correlation was found between BMI and blood pressure as well as between duration of obstruction and blood pressure. Patients who snored had higher blood pressure values than those who did not. Our data show that in cases of nasal polyposis, hypoxia, hypercapnia, snoring, and sleep disorders may develop and persons with nasal polyposis and snoring have an increased risk of hypertension and loss of nocturnal decline in blood pressure.

Effect of trimetazidine on late potentials after acute myocardial infarction.

The purpose of this study was to evaluate the effect of trimetazidine on late potentials in patients with acute myocardial infarction. A total of 60 patients (52 males, mean age 55 +/- 2 years, and 8 females, mean age 54 +/- 1.8 years) with the diagnosis of acute myocardial infarction were included in this study. The study was designed as a randomized, double-blinded, and placebo-controlled trial. Signal-averaged electrocardiography and echocardiography were performed during the first 2 days of acute myocardial infarction and were repeated between days of 8 and 15 (mean 11). Patients were treated with trimetazidine (n = 30) or placebo (n = 30). In the placebo group, the total filtered QRS duration and low-amplitude terminal signal duration increased (from 102.7 +/- 1.8 ms to 113.3 +/- 1.8 ms, and from 32.2 +/- 0.9 ms to 38.3 +/- 1.1 ms; P < 0.001), the root mean square voltage of the terminal 40 ms of the QRS decreased (from 28.6 +/- 2.1 microV to 21.4 +/- 1.3 microV; P < 0.001), and the incidence of late potentials increased (from 30% to 46%; P < 0.01) significantly. In the trimetazidine group, these measurements were a decrease from 102.9 +/- 1.9 ms to 100 +/- 2.0 ms (NS), an increase from 31.6 +/- 0.9 ms to 32.5 +/- 0.9 ms (NS), a decrease 9.3 +/- 2.0 microV to 27.3 +/- 1.8 microV (P < 0.01), and a decrease from 33% to 30% (NS), respectively. The ejection fraction was 47.1 +/- 1.3% to 50.8 +/- 1.2% in the placebo group (P = 0.05), and 48.1 +/- 1.1% to 53.4 +/- 1.2% (P < 0.01) in the trimetazidine group. It is concluded that trimetazidine reduces late potentials after acute myocardial infarction without changing blood pressure and heart rate.

The effects of hormone replacement therapy on echocardiographic basic cardiac functions in postmenopausal women.

This prospective study was designed to investigate the effects of hormone replacement therapy (HRT) on systolic and diastolic functions. Twenty-eight non-smoking, healthy postmenopausal women who had not received any kind of HRT for at least three years within the onset of menopause were included in the study. All patients received 0.625 mg conjugated oestrogens and 2.5 mg medroxyprogesterone acetate as daily HRT regimen. Their basic systolic and diastolic functions were investigated echocardiographically using standard positions and windows before and 6 months after initiation of HRT. The means of age, weight and length of postmenopausal period were 49.3 +/- 5.8 years, 63.5 +/- 8.7 kg and 46.3 +/- 7.1 months, respectively. Heart rate and systolic and diastolic pressures were similar during the pre- and post-treatment periods. After 6 months of HRT, the mean left ventricular end-systolic and end-diastolic volumes were decreased significantly (71.3 +/- 16.4 versus 56.3 +/- 22.8 ml, 144.5 +/- 26.1 versus 111.7 +/- 24.0 ml, respectively, P < 0.05). Left ventricular ejection fraction was increased (45.1 +/- 6.2% versus 54.8 +/- 4.1%, P < 0.05). Improvement in diastolic function was significant compared with the pretreatment period (E/A 0.90 +/- 0.2 versus 1.10 +/- 0.4, deceleration time 238 +/- 36.8 versus 201 +/- 24.2 ms, respectively, P < 0.05). Based on our preliminary results, we conclude that besides the known favourable effects on women's lives, HRT may also improve cardiac performance and age-related dysfunctions. The present results further suggest that oestrogens exert many direct effects on the cardiovascular system, other than the metabolic changes related to lipoproteins.

Management of brucella endocarditis of a prosthetic valve.

A case of chronic brucella endocarditis of a prosthetic valve is reported. The diagnosis of this infection was established by positive blood cultures and high brucella agglutination titre. The patient was successfully managed by combination of medical therapy (consisting of streptomycin, trimethoprim-sulphamethoxazole, rifampin and tetracycline) and surgery.

Acetate hemodialysis does not increase the frequency of arrhythmia in hemodialysis patients.

Arrhythmia is one of the most important causes of mortality in patients on hemodialysis and may develop due to cardiovascular diseases or fluid-electrolyte or acid-base abnormalities. Previous studies have shown that acetate hemodialysis (AHD) increased the frequency of arrhythmia. To evaluate the frequency and the causes of arrhythmias during AHD, we studied 33 randomly selected patients (25 male and 8 female, mean age of 45+/-18 years) who were under AHD (4 h, 3 times/week, mean duration of HD of 38+/-29 months) with the same Cuprophan membranes. All patients underwent a detailed echocardiographic evaluation during the interdialytic period. Twenty-four hours of Holter monitoring was performed starting from the onset of HD. Twelve lead electrocardiography (ECG) was obtained, and venous and arterial blood samples were drawn for serum electrolytes, pH, and arterial blood gas measurements before and after HD. Serum magnesium and potassium levels dropped after AHD (from 2.3+/-0.5 to 1.9+/-0.3 mEq/L and from 5+/-0.7 to 3.4 +/-0.4 mEq/L respectively, p < 0.001); on the other hand serum pH, bicarbonate, sodium, and calcium levels were normalized. Electrocardiographic evaluation revealed significant lengthening of the QTc interval (from 433+/-42 to 464+/-43 ms, p < 0.001), which was thought to be related to the decrease in serum magnesium and potassium levels. The frequencies of ventricular premature contractions (VPCs) were not different during AHD and the interdialytic period (8+/-9.1 to 6.5+/-11 contractions/h, p > 0.05). This was also true for supraventricular premature contractions (SVPCs) and supraventricular tachycardia (SVT). Nonsustained ventricular tachycardia was observed in 2 patients during HD and in 1 patient in the interdialytic period. No relation was established between the echocardiographic findings and the frequency of arrhythmia. In our ambulatory electrocardiographic study, the frequencies of VPCs and SVPCs observed during the interdialytic period were only positively correlated with age (r=0.54, p=0.013 and r=0.50, p=0.010, respectively). No relation was found between the frequency of arrhythmia and the gender of the patients; duration of HD; etiology of kidney disease; or serum Na, K, Ca, iCa, Mg, bicarbonate, or pH levels (p > 0.05). In conclusion, the application of AHD does not increase the frequency of arrhythmia in HD patients as had been shown in previous studies.

Bone marrow suppression and klebsiella pneumonia septicemia due to ticlopidine and successful treatment with filgrastim; a case report.

In this report we describe an elderly lady, who after 27 days of ticlopidine treatment developed severe pancytopenia and gram (-) septicemia. No clinical response was obtained with an eight days course of empirical broad spectrum antibiotics, after which granulocyte colony stimulating factor (G-CSF, filgrastim) added to her regimen. In a period of seven days her neutrophil count was normal and she had recovered from septicemia. Twelve weeks after discharge she is fine and her blood parameters are all normal.

Safety of single-site adenosine thallium-201 scintigraphy.

The diagnostic accuracy, safety and tolerance of adenosine thallium scintigraphy have been reported using a 2-site intravenous infusion with either a titrated or fixed-dose protocol. A single-site infusion would considerably simplify the test procedure, but its safety must be established before it can be recommended. Accordingly, 400 consecutive patients who had adenosine and thallium-201 administered through the same intravenous line were classified into 2 groups. Group I (n = 201) patients received a 7-minute titrated intravenous infusion of adenosine, with an initial dose of 50 micrograms/kg/min that increased at 1-minute intervals to a maximum of 140 micrograms/kg/min. Group II (n = 199) patients received a fixed dose of adenosine at 140 micrograms/kg/min for 6 minutes. Adenosine significantly (p < 0.001) increased heart rate and decreased systolic blood pressure by similar amounts in both groups. Adverse effects occurred more often (88 vs 71%, p < 0.001) and started earlier (2.8 vs 3.6 minutes, p < 0.001) in group II. There was no significant difference in the occurrence of second- and third-degree atrioventricular block between the 2 groups (4.0 vs 5.0%); however, chest pain, flushing and nausea were all more frequent in group II. Severe side effects were seldom seen in either group and occurred in 9 group I and 8 group II patients. Scintigraphic findings were similar in both groups. Transient perfusion defects were seen more often in patients with than without second- or third-degree atrioventricular block (42 vs 21%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Levels of IgE in the serum of patients with coronary arterial disease.

Because previous studies have shown that mast cells can be activated by IgE-mediated mechanisms to release potent mediators which affect coronary blood flow, we measured serum IgE levels in 156 patients with coronary arterial disease and in 53 healthy controls (27 men, 26 women, mean 54 years). Patients were classified into 3 groups according to well established criteria as having stable angina pectoris (28 men, 15 women, mean 58 years), unstable angina pectoris (37 men, 15 women, mean 57 years), and acute myocardial infarction (52 men, 9 women, mean 58 years). In every subject, serum IgE measurement, eosinophil count, and stool examination for parasites were performed. Every subject was interviewed concerning history of allergy, smoking habits and the other risk factors for coronary arterial disease. In a model including the factors that may affect the serum levels of IgE (namely, age, sex, cigarette smoking, parasites, and family and personal history of allergy), IgE levels were found to be significantly higher in the patients with unstable angina and acute myocardial infarction compared to the patients with stable angina pectoris and controls. These data indicate that IgE may play a role in the pathogenesis of unstable angina pectoris and acute myocardial infarction.

Quality of life in patients with rate responsive pacemakers: a randomized, cross-over study.

Eleven patients with rate responsive pacemakers (7 men, 4 women, mean age 41 years with a range of 23-60) were randomly assigned to a cross-over study in order to assess their overall exercise capacity and quality-of-life (QOL) scores. All of the pacemakers were implanted for complete AV block or sick sinus syndrome. The pacemakers were randomly programmed into VVI or rate responsive (VVIR) pacing modes for 3-week study periods in each mode. At the end of each period, an exercise test was performed and the QOL was evaluated by the "Hacettepe Quality-of-Life Questionnaire". All patients exercised longer in the VVIR mode (mean 10.54 +/- 0.73 min) than in the VVI mode (mean 7.81 +/- 0.62 min) (P less than 0.05). QOL scores were also found to be significantly higher in the VVIR mode (mean 173.81 +/- 16.22 points) compared to the VVI mode (mean 156.27 +/- 21.22 points) (P less than 0.01). In conclusion, our results suggest that VVIR pacing offers a better QOL in addition to an improved exercise capacity, compared to the single chamber nonrate modulated pacing (VVI).