A Retrospective Study of Deep Vein Insufficiency Treatment Device: ICT.

Objective: This study aimed to evaluate the efficacy and safety of a newly developed, leak closure Internal Compression Therapy (ICT) (Invamed, Ankara, Turkey) device during a single-session procedure in a group of patients with primary deep valve incompetence. Methods: There were 286 patients who were diagnosed with deep venous reflux by duplex scanning. They underwent valvular leak operations to treat primary deep venous insufficiency. Follow-up visits were on the third day, first month, sixth month and twelfth month. At each visit, duplex scanning and a clinical examination were performed. Successful treatment was defined as deep vein valves without reflux. Any patency or reflux over 1 sec was considered a failure. Results: The study enrolled 286 patients with deep venous insufficiency. Procedural technical success was 100%. At the one-year follow-up, the overall success, among all patients, was 92%. No significant morbidity or mortality related to the procedure were observed. All patients had major improvements in venous clinical severity score (VCSS) scores postoperatively. VCSS scores at pre-intervention, and at the twelfth month, were 20.7±5.9 and 3.9±0.9, respectively (p<0.001). Conclusion: After the twelve-month follow-up, the postprocedural outcomes indicate the ICT device is safe and effective.

Comparison of sharp dissection, electrocautery, and ultrasonic activated scalpel with regard to endothelial damage, preparation time, and postoperative bleeding during radial artery harvesting

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Comparison of ultrasound results following endovenous laser ablation and radiofrequency ablation in the treatment of varicose veins.

PURPOSE: Superficial venous insufficiency is a common problem associated with varicose veins. In addition to classical symptoms, it may result in skin changes, venous ulcers and has a great impact on patients' health-related quality of life. In the last decade, minimally invasive techniques such as endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have been developed as alternatives to surgery in an attempt to reduce morbidity and improve efficiency. The aim of this study is to evaluate the efficacy of EVLA and RF therapies in superficial venous insufficiency. MATERIAL AND METHODS: Fifty legs belonging to 50 patients with symptomatic primary venous insufficiency were treated. 25 saphenous veins treated with 1470 nmdiode laser, while 25, saphenous veins treated with bipolar Radiofrequency Induced Thermotherapy (RF). All patients underwent postoperative duplex scanning within 6 month after the procedure and followed clinically, to determine the severity of the venous disease. Complications and occlusion rates were recorded. RESULTS: Total occlusion rates in RF and EVLA groups were 100% and was 100%, respectively. There was no significant difference between groups (p=0,140). Major complications such as skin burns, deep venous thrombosis have not been detected for both groups. 2 patients treated with EVLA had erythema (8%) and 1 patient had a pain sensation (4%). 1 patient in the RF group had erythema (4%), 1 had pain (4%) and 1 had a burning sensation (4%). CONCLUSION: EVLA and RF therapies in saphenous vein insufficiency are effective, minimally invasive, safe, easy to use treatment modalities with good patient satisfaction and high occlusion rates. KEY WORDS: EVLA, Radiofrquency, Venous insufficiency.

Comparison of Sharp Dissection, Electrocautery, and Ultrasonic Activated Scalpel with Regard to Endothelial Damage, Preparation Time, and Postoperative Bleeding During Radial Artery Harvesting.

OBJECTIVE: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). METHODS: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. RESULTS: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. CONCLUSION: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Evaluation of the Isokinetic Calf Muscle Strength and the Range of Motion of Joint in C3 Chronic Venous Insufficiency.

PURPOSE: The present study aimed to compare the isokinetic muscle strength and range of motion (ROM) values of the ankle between patients diagnosed with C3 chronic venous insufficiency (group 1, n=57) and healthy individuals (group 2, n=30). MATERIALS AND METHODS: After identifying the venous refilling time (VRT) of all participants, the active ROM of the ankle joint and plantar flexion (PF) and dorsi-flexion (DF) muscle strength in the concentric/concentric mode at angular velocities of 60°/sec and 120°/sec were measured. RESULTS: No statistically significant differences were found between the demographic data of groups 1 and 2 (P>0.05). In total, 102 lower extremities were included in group 1 and 60 lower extremities in group 2. The VRT of the patients in group 1 was 15.5±5.6 seconds, the PF ROM of the ankle joint was 39.3°±9.5°, and the DF ROM of the ankle joint was 27°±8°; in group 2, the VRT, PF ROM, and DF ROM were 36±8.1 seconds, 41°±6.2°, and 27.2°±7.5°, respectively. Statistically significant differences were found between the two groups in terms of VRT (P<0.05); however, no statistically significant difference was observed in terms of ankle ROM (P>0.05). Statistically significant difference was found in terms of all parameters of isokinetic muscle strength measurements, such as peak torque, peak torque/body weight, total work done, and ratio (DF/PF) in group 1 (P=0.001). CONCLUSION: The lower extremity muscle strength of patients with chronic venous insufficiency was low, and this weakness was prominent particularly in the direction of PF.

A retrospective study of a new n-butyl-2-cyanoacrylate glue ablation catheter incorporated with application guiding light for the treatment of venous insufficiency: Twelve-month results.

Objective This study aims to present the early results of a retrospective study of the use of novel n-butyl-2-cyanoacrylate (VenaBlock)-based nontumescent endovenous ablation with a guiding light for the treatment of patients with varicose veins. Methods Patients with lower limb venous insufficiency were treated with n-butyl-2-cyanoacrylate (VenaBlock Venous Closure System) between April 2016 and July 2016. The study enrolled adults aged 21-70 years with symptomatic moderate to severe varicosities (C2-C4b) and great saphenous vein reflux lasting longer than 0.5 s with great saphenous vein diameter between 5.5 and 15 mm assessed in the standing position. No compression stockings were used after the procedure. Duplex ultrasound imaging and clinical follow-up were performed on the third day, first month, sixth month, and 12th month. Clinical, etiological, anatomical, pathophysiological classification; venous clinical severity score; and completed Aberdeen varicose vein questionnaire were recorded. Results Five hundred thirty-eight patients with great saphenous vein incompetency underwent n-butyl-2-cyanoacrylate ablation. The mean ablation length was 25.69 ± 4.8 cm, and the average amount of n-butyl-2-cyanoacrylate delivered was 0.87 ± 0.15 ml. The mean procedure time was 11.7 ± 4.9 min. Procedural success was 100%, and complete occlusion was observed after treatment and at the third-day follow-up. We observed ecchymosis in five patients (1.00%) at the entry site at the third-day follow-up. Phlebitis was encountered with six (1.20%) patients. No skin pigmentation, hematoma, paresthesia, deep vein thrombosis, or pulmonary embolism was observed. Kaplan-Meier analysis yielded an occlusion rate of 99.4% at the 12-month follow-up. All patients had significant improvement in venous clinical severity score and Aberdeen varicose vein questionnaire scores postoperatively ( p <0.0001). Venous clinical severity score scores decreased from 5.43 ± 0.87 to 0.6 ± 0.75. Aberdeen varicose vein questionnaire scores decreased from 18.32 ± 5.24 to 4.61 ± 1.42. Conclusions The procedure appears to be feasible, safe, and efficient in treating the great majority of incompetent great saphenous veins with this technique.

Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency.

Objective The aim of this study was to observe the change of the ankle joint range of motion, the muscle strength values measured with an isokinetic dynamometer, pain scores, quality of life scale, and venous return time in chronic venous insufficiency diagnosed patients by prospective follow-up after 12-week exercise program including isokinetic exercises. Methods The patient group of this study comprised 27 patients (23 female, 4 male) who were diagnosed with chronic venous insufficiency. An exercise program including isokinetic exercise for the calf muscle was given to patients three days per week for 12 weeks. At the end of 12 weeks, five of the patients left the study due to inadequate compliance with the exercise program. As a result, control data of 22 patients were included. Ankle joint range of active motion, isokinetic muscle strength, pain, quality of life, and photoplethysmography measurements were assessed before starting and after the exercise program. Results Evaluating changes of the starting and control data depending on time showed that all isokinetic muscle strength measurement parameters, range of motion, and overall quality of life values of patients improved. Venous return time values have also increased significantly ( p < 0.05). Conclusion In conclusion, increase in muscle strength has been provided with exercise therapy in patients with chronic venous insufficiency. It has been determined that the increase in muscle strength affected the venous pump and this ensured improvement in venous function and range of motion of the ankle. In addition, it has been detected that pain reduced and quality of life improved after the exercise program.

Quality of life in patients with chronic venous disease in Turkey: influence of different treatment modalities at 6-month follow-up.

PURPOSE: The main purpose of this study was to evaluate the influence of any of the four domains of the QoL score in CVD patients of classes C0-C4 and to analyze the correlation between the QoL and types of treatment modalities, and an additional aim of the present study was to compare QoL levels of patients with CVD and healthy participants and was to examine the factors associated with QoL in CVD patients. METHODS: The sample was composed of 501 patients with primary superficial venous reflux (28.5 % male and 71.5 % female) who answered 100 % of the questions in the World Health Organization Quality of Life (WHOQoL-BREF) questionnaire. After a clinical and duplex examination, the patients were categorized as C0-C4, according to the CEAP classification. The relationships between WHOQoL-BREF domains and gender, age, occupation, BMI, the clinical classes of the CEAP classification and four different treatment modalities according to guideline were analyzed. RESULTS: For the WHOQOL-BREF test battery, the patients with CVD had worse values, as compared with the control group participants. The differences were significant for the physical (77.81 ± 12.75 vs. 59.18 ± 12.90, p < 0.001), the psychological (74.78 ± 11.37 vs. 60.21 ± 14.70, p < 0.001), the social relationships (76.56 ± 13.56 vs. 63.07 ± 21.37, p < 0.001) and the environmental (70.27 ± 13.36 vs. 50.16 ± 11.39, p < 0.001) health scores. The patients with CVD had worse WHOQOL-BREF scores at initial, compared with the 6-month follow-up scores. CONCLUSION: This study shows that in spite of undergoing therapy, the subsequent QoL scores did not improve significantly, indicating that CVD continued to negatively affect the patient's life.

An evaluation of the lower extremity muscle strength of patients with chronic venous insufficiency.

OBJECTIVE: In this study, the aim was to evaluate the lower extremity muscle strength in patients with chronic venous insufficiency using an isokinetic dynamometer. METHODS: The study comprised a group of 36 lower extremities of 23 patients diagnosed with chronic venous insufficiency and a control group of 40 lower extremities of 20 patients who did not have chronic venous insufficiency. In the diagnosis and evaluation of chronic venous insufficiency, photoplethysmography was used to evaluate the venous return circulation time. Visual Analog Scale scoring was applied to define the level of pain of the patients. Muscle strength measurements were made in all the lower extremities by using an isokinetic dynamometer. RESULTS: A statistically significant difference was detected between the groups in terms of the muscle strength parameters in the ankle plantar flexion, and knee flexor and extensor muscles. However, no statistically significant difference was found between the groups in the ankle dorsiflexion muscle strength parameters. A significant difference was determined in the ratio of ankle dorsiflexion/plantar flexion muscle strength between the mild, moderate and severe venous insufficiency groups. A statistically considerable negative correlation was found between the Visual Analog Scale scores and the photoplethysmography results. According to the Visual Analog Scale results, as the degree of venous insufficiency increased, so did the level of pain. CONCLUSION: Impaired lower extremity muscle strength was observed in chronic venous insufficiency patients. Although the current study was consistent with literature in respect of impaired calf muscle strength, this finding was also seen in the thigh muscles. Furthermore, we concluded that if venous insufficiency becomes more severe, impaired calf muscle strength becomes more evident.

A fatal case of Behcet's disease with rare complications.

Behcet's disease BD may involve in any large or small artery, vein. We present a case of BD with multiple venous thromboses, cardiac and pulmonary involvements, and renal failure. A 22-year-old man admitted with progressive dyspnea and edema on his face and neck. He had the history of recurrent oral and genital ulcers, and pustular skin lesions for 4 years. Doppler ultrasonography revealed right internal jugular vein thrombosis. Transthoracic echocardiography showed a pericardial effusion, decreased left ventricular ejection fraction. While his symptoms were regressing moderately with a pulse cyclophosphamide, prednisolone, and low molecular weight heparin treatment, new thromboses occurred in vena cava inferior, and bilateral renal veins after the third and 7th dosages of pulse cyclophosphamide. Creatinine levels increased progressively, which required hemodialysis. However, he died after the second session of hemodialysis. Patients with BD should be followed up for new developing thrombosis even during an immunosuppressive treatment.

Quality of life in the elderly after coronary bypass surgery.

In addition to the clinical outcome, a patient's perspective and satisfaction with their health status have become important indicators. One of the most common measures to assess the quality of life is Short Form (SF)-36. The objective of the present study was to measure the functional status of elderly patients who had undergone coronary bypass surgery and to evaluate the impact of that surgery on their quality of life. The study involved 120 nonsmoking patients who underwent coronary bypass surgery between January 1, 2001 and January 1, 2003 at the Sevket Demirel Heart Center. Assessments were made using physical, clinical, and laboratory findings. We used the Turkish version of the Short Form (SF)-36 preoperatively and 18 months after surgery. The paired t test, two-tailed correlation, and variant analysis were used for statistical analysis. Of the 120 patients, 108 could be followed during the study period. Significant physical and mental improvements were seen in all areas, especially in the items of vitality and mental health. Females seemed to benefit from surgery more than males. Cardiac surgery substantially improved the quality of life of our patients. The findings allowed us to determine the patient's perspective of his or her outcome. With this knowledge, health care workers can provide information to the patient regarding functional limitations after cardiac surgery.

Efficiency of prostacyclin in the treatment of protamine-mediated right ventricular failure and acute pulmonary hypertension.

Protamine is used after cardiopulmonary bypass was stopped in order to reverse the anticoagulant effects of heparin administered during open-heart operations. Adverse hemodynamic responses to protamine are common, ranging from minor perturbations to cardiovascular collapse. The aim of the present study was to investigate whether a prostacyclin is effective in the treatment of protamine-mediated acute pulmonary hypertension and right ventricular failure in the perioperative period of isolated coronary artery bypass grafting (CABG) operations. In sixty-eight (1.78%) of 3800 patients who underwent isolated CABG, acute pulmonary hypertension and right ventricular failure developed during or following the protamine infusion. These 68 patients were included in the study and were randomized into two groups. Thirty-eight of the patients received prostaglandin I(2) (PGI(2)), norepinephrine and dopamine (PGI(2) group), whereas 30 patients received nitroglycerin, norepinephrine and dopamine (control group). Hemodynamic data were recorded before and after the above drug combinations. The mean value of left ventricle ejection fraction significantly increased (p < 0.05) and mean values of central venous pressure, pulmonary artery systolic and diastolic pressure, pulmonary capillary wedge pressure and pulmonary vascular resistance significantly decreased (p < 0.05) in the PGI(2) group. The mean value of pulmonary capillary wedge pressure significantly decreased (p < 0.05) and the mean value of central venous pressure significantly increased (p < 0.05) in the control group. In conclusion, prostacyclin (PGI(2)) is effective in the treatment of protamine-mediated acute pulmonary hypertension and right ventricular failure in the perioperative period in isolated CABG operations. This finding may be an important contribution to the treatment of severe protamine complications during open-heart operations.

Left atrial myxoma associated with acute myocardial infarction.

A 38-year-old male was admitted to our institution with left atrial myxoma complicated with acute myocardial infarction. The patient had no risk factor for coronary artery disease. A transthoracic echocardiographic study revealed the presence in the left atrium of an echogenic, mobile mass, compatible with myxoma. There were no endocrine hyperactivity, any other tumor and family history. Coronary angiography revealed normal coronary arteries and aorto-coronary bypass surgery was not required in this patient. The tumor was successfully removed surgically. In conclusion, there could be no other etiologic possibility identified and therefore left atrial tumor causing coronary embolization and MI was considered the most likely event in this patient.

Beneficial effect of the addition of nitroglycerin to the cardioplegic solution on lipid peroxidation during coronary artery bypass surgery.

The effects of the addition of a nitric oxide (NO) donor to the cardioplegic solution on reperfusion injury and lipid peroxidation (LPO) in coronary artery bypass grafting (CABG) are not known. Therefore, this work was conducted to determine the possible effects of nitroglycerin on LPO and reperfusion injury as a result of CABG. A prospective double-blind, placebo-controlled study was conducted in 30 consecutive patients with coronary artery disease who underwent CABG with cardiopulmonary bypass. The patients were randomly assigned to receive 3 microg/kg of nitroglycerin added to the cardioplegic solution (NTG group) or 3 microg/kg of placebo added to the cardioplegic solution (placebo group). MDA increased significantly in the placebo group compared to the NTG group during the ischemic (P < 0.01) and reperfusion periods (P < 0.01). The level of troponin I decreased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.001). The level of NO increased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.01). LPO was increased in response to CPB during CABG, together with simultaneous decreases in serum nitric oxide levels, whereas LPO was significantly decreased in response to CPB with nitroglycerin, together with simultaneous increases in the levels of serum nitric oxide.

Vascular wall damage in rats induced by organophosphorus insecticide methidathion.

We have examined the effect of subchronic methidathion (MD) administration on vascular wall damage. The experimental groups were: control group and rats treated with 5 mg/kg MD. The MD group was given MD by gavage for 5 days a week for 4 weeks at a dose level of 5 mg/kg per day by using corn oil as the vehicle. The levels of malondialdehyde (MDA) were determined in the vascular tissue. Histopathological examination was examined in the thoracic aortic tissue. The levels of MDA were increased in the MD group compared with the control group (P < 0.01). In the MD group, subchronic MD administration led to the irregulation, prominent breaks and fragmentation of the elastic fibers were located in the media of aortic wall. In conclusion, it is likely that subchronic MD administration caused vascular wall damage and, in addition, lipid peroxidation may be one of the molecular mechanisms involved in MD-induced vascular toxicity.

Vascular wall damage in rats induced by methidathion and ameliorating effect of vitamins E and C.

We examined the effect of subacute methidathion (MD) administration on vascular wall damage and evaluated the ameliorating effects of combination of vitamins E and C against MD toxicity. The experimental groups were: rats treated with corn oil (control group), rats treated with 5 mg/kg MD (MD), and rats treated with 5 mg/kg body weight MD plus vitamin E and vitamin C (MD+Vit). The groups were given MD by gavage on 5 days a week for 4 weeks at a daily dose 5 mg/kg (MD and MD+Vit) using corn oil as the vehicle. Vitamins E and C were injected at doses of 50 mg/kg intramuscularly and 20 mg/kg intraperitoneally, respectively, after the treatment with MD in the MD+Vit group. The levels of malondialdehyde (MDA) were determined in the aortic tissue. Histopathological examination was examined in the thoracic aortic tissue. MDA levels were higher in the MD group than the control group and lower in the MD+Vit group than MD group. MD administration led to irregulation, prominent breaks, and fragmentation of the elastic fibers but decrease in the irregulation and fragmantation of the elastic fibers with the combination of vitamins E and C in MD-treated rats. In conclusion, it is likely that subacute MD administration caused vascular wall damage, and that treatment with a combination of vitamins E and C after the administration of MD can reduce vascular wall damage caused by MD.

Cardiotoxicity in rats induced by methidathion and ameliorating effect of vitamins E and C.

We have examined the effect of subchronic methidathion (MD) administration on heart damage, and have evaluated possible ameliorating effects of a combination of vitamins E and C against MD toxicity. The experimental groups were: control group, rats treated with 5 mg/kg MD and rats treated with 5 mg/kg body weight MD plus vitamin E and vitamin C (MD+Vit). The groups were given MD by gavage 5 days a week for four weeks at a dose level of 5 mg/kg/day (MD and MD+Vit) by using corn oil as the vehicle. Vitamin E and vitamin C were injected at doses of 50 mg/kg i.m. and 20 mg/kg i.p., respectively, after the treatment with MD in the MD+ Vit group. The levels of malondialdehyde (MDA) were determined in the heart tissue, and the levels of cardiac troponin I (TnI) in serum. An autoanalyser was used to determine the serum activities of cholinesterase (ChE). Histopathological examination was carried out in the heart tissue. MDA significantly increased in the MD group as compared to controls (P <0.01). When MD was given concurrently with vitamins E and C, the increase in MDA was significantly less (P <0.01). ChE activity significantly decreased in the MD group as compared to controls (P <0.01). When MD was given concurrently with vitamins E and C, the decrease in ChE activity was significantly higher (P <0.05). The serum TnI levels significantly increased in the MD group as compared to controls (P <0.01). When MD was given concurrently with vitamins E and C, the increase in the serum TnI was significantly less (P <0.01). MD caused the diffuse loss of striation and myocytolysis of the cardiomyocytes, whereas the combination of vitamins E and C caused a significant decrease in these effects of MD. In conclusion, subchronic MD administration caused heart damage and, in addition, treatment with a combination of vitamins E and C after the administration of MD reduced heart damage caused by MD.

Role of endogenous adenosine in atrial fibrillation after coronary artery bypass graft.

BACKGROUND: Atrial fibrillation (AF) is the most common complication following coronary artery bypass graft (CABG). The mechanism of AF after CABG is not well defined; however, it is suggested that endogenous adenosine, released in response to tissue hypoxia, may play a mechanistic role in these arrhythmias. HYPOTHESIS: The purpose of this study was to examine whether intravenous theophylline, via adenosine A1 receptor antagonism, would correct or modify new-onset early (<48 h post CABG) atrial fibrillation in patients post CABG, and thereby implicate endogenous adenosine as an inciting agent. METHODS: A prospective double-blind, placebo-controlled study design was applied to 385 consecutive patients with coronary artery disease who had undergone CABG. Any patient who developed AF within 48 h of the operative procedure was randomly assigned to receive 5 mg/kg of intravenous theophylline (Group A) or matched intravenous placebo (Group B). The patients who converted to sinus rhythm within 15 min of drug administration were accepted as showing positive responses. RESULTS: Thirty patients comprised the study group. In Group A, 8 of the 15 patients (53%) converted from AF to sinus rhythm within 15 min of theophylline administration. One patient who converted to sinus rhythm 20 min after theophylline administration was accepted as showing a negative response. In the placebo-treated group, no patient converted to sinus rhythm within 15 min (p<0.007 compared with Group A). CONCLUSIONS: The mechanism of AF after CABG is not well defined and is probably multifactorial. However, this study demonstrated that antagonism of the adenosine A1 receptor can promptly convert many of these patients back to sinus rhythm, and thereby implicates endogenously released adenosine in a mechanistic role for inciting early (<48 h) post-CABG AF.

A case of mitral stenosis complicated with seronegative Brucella endocarditis.

Brucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve. A 30 year-old woman presented with complaints of chills and fever up to 38 degrees C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3 degrees C. On echocardiographic examination, the mitral valve area was 0.62 cm (2) and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced. Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation. The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints. In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated.