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Oflaz H, Gunal I. Maximum loading of carpal bones during movements: a finite element study. Eur J Orthop Surg Traumatol 2018; 29:47-50. [DOI: 10.1007/s00590-018-2287-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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Onur ST, Emet S, Surmen S, Kara K, Kose M, Oflaz H, Onur I. A novel parameter for the diagnosis of acute pulmonary embolism: the T-wave peak-to-end interval. Eur Rev Med Pharmacol Sci 2016; 20:1566-1570. [PMID: 27160129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acute pulmonary embolism (APE) is a very common disease that must be diagnosed and treated quickly and accurately to reduce significant morbidity and mortality rates. Acute pulmonary embolism is associated with numerous electrocardiographic (ECG) changes including prolonged QT interval with global T-wave inversion. The aim of the study was to investigate the relationship between the T-wave peak-to-end interval and diagnosis of APE, which has never been investigated in the literature. PATIENTS AND METHODS Seventy-three patients who were suspected of having APE took part in the present study. The Local Ethics Committee of Istanbul University, Turkey, approved the study protocol. Forty-one of the patients were diagnosed as having APE using computed tomography. Surface ECGs were taken in the initial assessment at admission. The Tp-Te interval was identified as the interval from the peak of the T-wave to the end of the T-wave. The measurements of the Tp-Te interval were taken using precordial leads. All measurements were compared using appropriate statistical tests. Statistical analysis was performed using SPSS version 22.0. RESULTS We enrolled 73 patients to the study, 41 of which were diagnosed as having APE. Men comprised 54% of the APE group. The mean ages in the APE (+) and APE (-) groups were 59.5 ± 14.5 years and 61±9.2 years, respectively. There was a significant increase in Tp-Te results in V1 (p<0.01). The Tp-Te interval was 74.21 ± 20.81 in the APE (+) group, whereas it was 59.73 ± 12.82 in APE (-) group (p<0.01). CONCLUSIONS Acute pulmonary embolism (APE) is a mortal condition and as such, rapid and accurate diagnosis is very important. Surface ECG can be used to measure Tp-Te in patients admitted to the emergency room with suspected APE in the differential diagnosis as a fast and easily accessible tool.
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Affiliation(s)
- S T Onur
- Chest Disease, Yedikule Education and Research Hospital, Istanbul, Turkey.
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Elitok A, Ikitimur B, Onur I, Oz F, Emet S, Karaayvaz EB, Serbest NG, Sarikaya R, Kasali K, Bilge AK, Kaya MG, Mercanoglu F, Oflaz H. The relationship between T-wave peak-to end interval and ST segment recovery on intracoronary ECG during primary PCI. Eur Rev Med Pharmacol Sci 2015; 19:1086-1091. [PMID: 25855936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE T-wave peak to end interval (TPE) is a measure of repolarization dispersion, which has been reported as a major arrhythmogenic factor post acute myocardial infarction. The aim of our study was to investigate the changes in TPE in this patient population with regard to peri-procedural intracoronary ECG findings. PATIENTS AND METHODS Forty-four patients (34 male and mean age of 54.9 ± 10.9 years) with acute STEMI were included. Intracoronary ECG was performed during primary PCI. TPE indices were calculated before and after the procedure. Measurement of the intracoronary ST-segment was carried out before and just after coronary blood flow was established in the infarct related artery. Intracoronary ST-segment resolution (IC-STR) was defined as ≥ 1 mm compared to baseline. RESULTS There was no difference with respect to baseline characteristics when patients with IC-STR were compared with patients without IC-STR. TPE values decreased significantly after primary PCI in patients with IC-STR (80.9 ± 22.8 ms vs. 65.8 ± 14.4 ms; p < 0.001) whereas they did not change significantly after PCI in patients without IC-STR (79.2 ± 20.9 ms vs. 68.5 ± 16.3 ms; p = 0.18). CONCLUSIONS TPE measured from surface ECG recordings is significantly reduced in STEMI patients with successful reperfusion after primary PCI, as determined by IC-ECG recordings.
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Affiliation(s)
- A Elitok
- Department of Cardiology, Istanbul University, School of Medicine, Istanbul, Turkey.
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Köse M, Akpinar T, Özkök A, Açar G, Bakkaloglu O, Sumnu A, Erk O, Kayacan M, Oflaz H, Akkaya V, Demirel A. OP-095 Association of Genetic Polymorphisms with Endothelial Dysfunction in Chronic Heart Failure. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Turkmen K, Tufan F, Engin S, Akpinar T, Oflaz H, Ecder T. Author's reply. Indian J Nephrol 2014; 24:66. [PMID: 24574640 PMCID: PMC3927200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- K. Turkmen
- Department of Internal Medicine, Division of Nephrology, Selcuk University, Meram School of Medicine, Konya, Turkey,Address for correspondence: Dr. Kultigin Turkmen, Department of Nephrology, Selcuk University Meram School of Medicine, Turkey. E-mail:
| | - F. Tufan
- Department of Internal Medicine, Istanbul, Turkey
| | - S. Engin
- Istanbul University, Istanbul School of Medicine, Department of Medico-social, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey
| | - T. Akpinar
- Department of Internal Medicine, Istanbul, Turkey
| | - H. Oflaz
- Department of Cardiology, Istanbul, Turkey
| | - T. Ecder
- Department of Nephrology, Istanbul, Turkey
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Akpinar TS, Ozkok A, Kose M, Atas R, Sumnu A, Bakkaloglu OK, Erk O, Kayacan MS, Oflaz H, Akkaya VA, Demirel AS. Endothelial constitutive nitric oxide synthase, angiotensin converting enzyme, angiotensin II type 1 receptor gene polymorphisms and endothelial functions in healthy individuals. Eur Rev Med Pharmacol Sci 2014; 18:39-45. [PMID: 24452940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Endothelial dysfunction is recognized as an early and initiating event in the pathogenesis of coronary artery disease. Gene polymorphisms of endothelial constitutive nitric oxide synthase (ecNOS), angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) have been found to be associated with atherosclerosis. We aimed to investigate the possible effects of ecNOS, ACE and AT1R gene polymorphisms on endothelial functions in healthy population. MATERIALS AND METHODS In 255 healthy subjects (male/female: 119/136 mean age 35.1±2.3 years) ecNOS, ACE and AT1R gene polymorphisms were assessed by polymerase chain reaction (PCR). Endothelium dependent (EDD, flow-mediated) and endothelium independent vasodilation (EID) were measured by high resolution brachial artery ultrasound and 0.5 mg sublingual nitroglycerine respectively. RESULTS ecNOS and ACE genes had no significant effect on EDD and EID. However, subjects with AT1RAC+CC genotypes had lower EDD compared to subjects with AT1RAA genotype in females (19.4 ± 6.6% vs 21.5 ± 7.8%, p = 0.041). EDD and EID were significantly negatively associated with age, body mass index, serum creatinine, glucose, uric acid and hemoglobin levels. When the data on age, uric acid, BMI, glucose, creatinine, and hemoglobin were split into 3 as low-1/3, mid-1/3 and high 1/3, there was significant graded decrease in EDD and EID with these parameters. In multiple regression analysis, age and presence of AT1RAC+CC genotype retained as significant independent factors predicting endothelial functions. CONCLUSIONS Gene polymorphisms of endothelial constitutive nitric oxide synthase and angiotensin converting enzyme had no effect on endothelial functions. However, the presence of angiotensin II type 1 receptor polymorhism (AT1RAC+CC genotype) seemed to adversely affect the endothelial functions as reflected by impaired endothelium dependent and independent vasodilatation in healthy individuals.
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Affiliation(s)
- T S Akpinar
- Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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Sen F, Yildiz I, Basaran M, Ekenel M, Oz F, Kilic L, Toz B, Gurdal A, Camlica H, Bavbek S, Oflaz H. Impaired coronary flow reserve in metastatic cancer patients treated with sunitinib. J BUON 2013; 18:775-781. [PMID: 24065498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Hypertension is one of the major side effects of sunitinib, an angiogenesis inhibitor used in the treatment of metastatic renal cell carcinomas (mRCC) and gastrointestinal stromal tumors (GIST). Endothelial dysfunction, an early and reversible event in the pathogenesis of atherosclerosis, is suggested to be one of the possible underlying mechanisms of hypertension caused by angiogenesis inhibitors. Coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in mRCC and GIST patients under sunitinib treatment. METHODS Eighteen metastatic cancer patients (16 mRCC and 2 GIST) on sunitinib treatment and 27 healthy subjects were enrolled in this cross-sectional study. Thyroid stimulating hormone (TSH), lipid profile, creatinine, hemoglobin, glucose, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anthropometric and physical parameters of patients were recorded. CFR recordings were performed by the Vivid 7 echocardiography device. RESULTS CFR was significantly lower in patients when compared with controls (1.82±0.4 vs 2.71±0.8, respectively; p < 0.001). Impaired CFR was found in 13 (72%) patients whereas all controls had normal CFR values. CFR was inversely correlated with the duration of sunitinib treatment (r=-0.36, p =0.01), high sensitivite (hs) CRP (r = -0.574, p =0.01) and ESR (r = - 0.5, p = 0.02). CONCLUSION Our findings indicate that CFR is significantly impaired in cancer patients on sunitinib treatment. There is an inverse correlation between CFR and duration of sunitinib treatment and inflammation markers.
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Affiliation(s)
- F Sen
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
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Turkmen K, Tufan F, Selçuk E, Akpınar T, Oflaz H, Ecder T. Neutrophil-to-lymphocyte ratio, insulin resistance, and endothelial dysfunction in patients with autosomal dominant polycystic kidney disease. Indian J Nephrol 2013; 23:34-40. [PMID: 23580803 PMCID: PMC3621236 DOI: 10.4103/0971-4065.107195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Endothelial dysfunction (ED), insulin resistance (IR), and inflammation are risk factors for increased cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD). ADPKD patients may have increased carotid intima-media thickness (CIMT) and decreased coronary flow velocity reserve (CFVR). The neutrophil-to-lymphocyte ratio (NLR) was introduced as a marker to determine inflammation in various disorders. We aimed to investigate the relationship between NLR and IR, CFVR, CIMT, and the left ventricular mass index (LVMI) in normotensive ADPKD patients. Twentynine ADPKD patients (age 38.8 ± 10.2 years; 8 men and 21 women) and 19 healthy controls (age 33.8 ± 7.4 years; 8 men and 11 women) were included in this cross-sectional study. CFVR was calculated with echocardiography as the ratio of hyperemic to baseline diastolic peak coronary flow velocities. CIMT was measured in the distal common carotid artery by using a 10-MHz linear echocardiography probe. HOMA-IR was calculated NLR was calculated as the ratio of the neutrophil and lymphocyte counts. Age, sex, body mass index, and levels of glucose, creatinine, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, C-reactive protein (CRP), microalbuminuria, and creatinine clearance were similar between ADPKD patients and healthy subjects. NLR, CIMT, LVMI, and HOMA-IR were significantly higher and CFVR values were significantly lower in patients with ADPKD compared to that in healthy subjects. NLR showed positive correlation with CIMT, HOMA, insulin, glucose, and HDL cholesterol levels, while it was inversely correlated with CFVR and albumin level in all subjects. In patients with ADPKD, NLR showed positive correlation with HDL cholesterol level and inverse correlation with LVMI and albumin level. NLR that was found to be increased in patients with ADPKD may be a readily available marker of inflammation and ED.
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Affiliation(s)
- K Turkmen
- Department of Internal Medicine, Selcuk University, Meram School of Medicine, Division of Nephrology, Konya, Turkey
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Turkmen K, Tufan F, Alpay N, Kasıkcıoglu E, Oflaz H, Ecder SA, Ecder T. Insulin resistance and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease. Intern Med J 2012; 42:146-53. [DOI: 10.1111/j.1445-5994.2010.02404.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Akagun T, Caliskan Y, Alpay N, Ozkok A, Yazici H, Polat N, Guz G, Oflaz H, Turkmen A, Sukru Sever M. Long-Term Prognostic Value of Coronary Flow Velocity Reserve in Renal Transplant Recipients. Transplant Proc 2011; 43:2612-6. [DOI: 10.1016/j.transproceed.2011.05.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 05/02/2011] [Indexed: 12/31/2022]
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Sen F, Yildiz I, Oflaz H, Oz F, Kilic L, Gurdal A, Basaran M, Bavbek SE. Impaired coronary flow reserve in patients with metastatic cancer treated with sunitinib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
We have studied the biomechanical stability in vitro of three different Kirschner (K) wire configurations in three types of simulated scaphoid waist fractures. The fractures were created with a saw in Sawbones models. There were three fracture patterns: perpendicular to the long axis of the scaphoid model; and 30° and 20° oblique to that. Two 1.2 mm. K-wires were used in each scaphoid. The three configurations were: parallel; 20° oblique; and crossing. The oblique or crossing configurations of K-wires were the most stable depending on the fracture pattern.
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Affiliation(s)
- V Gokce
- Department of Orthopedics, State Hospital; the Departments of Biomechanics and Orthopedics, Dokuz Eylul University Hospital, Izmir, Turkey
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Abstract
BACKGROUND Functional and morphological changes of endothelium were risk factors for mortality attributed to atherosclerosis. Studies investigating early atherosclerotic alterations and the effect of the treatment of acromegaly on these alterations gave conflicting results. OBJECTIVE Surrogate markers of early atherosclerotic changes, i.e. brachial artery flow-mediated dilation (FMD) and carotid artery intima-media-thickness (IMT) in active and inactive acromegalic patients were compared with control subjects matched to patients for age, sex and cardiovascular risk factors to find out the direct effects of growth hormone (GH)/insulin-like growth factor-1 excess. METHODS In 14 active acromegalics and their 14 matched controls, 14 inactive acromegalics and their 14 matched controls, carotid artery IMT and FMD of brachial artery were measured. Inactive acromegalics were in remission for at least 1 year. RESULTS Active acromegalics had higher IMT than matched controls and inactive acromegalics (0.85 +/- 0.20 mm, 0.64 +/- 1.77 mm, 0.66 +/- 0.20 mm respectively; p < 0.005, p < 0.05) and IMT of inactive acromegalics was not different from their matched controls (0.61 +/- 0.12 mm). FMD was significantly lower in active acromegalics than in matched controls and inactive acromegalics (2.910 +/- 2.00 mm, 6.5 +/- 2.81 mm, 5.68 +/- 2.9 mm respectively; p < 0.005, p < 0.05). FMD of inactive acromegalics was not significantly different from their matched controls (7.96 +/- 3.12 mm). A significant inverse relationship was found between GH and FMD in active acromegalics (r = -0.659, p = 0.010). CONCLUSION In active acromegalics, early atherosclerotic changes are not only attributed to the high prevalence of risk factors, but also to the abnormal GH secretion itself.
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Affiliation(s)
- I Kartal
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Ekmekci A, Abaci N, Colak Ozbey N, Agayev A, Aksakal N, Oflaz H, Erginel-Unaltuna N, Erbil Y. Endothelial function and endothelial nitric oxide synthase intron 4a/b polymorphism in primary hyperparathyroidism. J Endocrinol Invest 2009; 32:611-6. [PMID: 19574729 DOI: 10.1007/bf03346518] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Patients with symptomatic primary hyperparathyroidism (pHT) have increased cardiovascular morbidity and mortality. Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism is associated with coronary artery disease and hypertension in various populations. Our aim is to evaluate endothelial function in patients with pHT during pre-operative hypercalcemic and post-operative normocalcemic periods and to determine whether intron 4a/b polymorphism of eNOS gene influences endothelial function. SUBJECTS AND METHODS Forty patients with pHT (age 48.48+/-11.64 yr) were examined pre-operatively and reexamined 5.8+/-1.9 months after parathyroidectomy. Forty-three healthy subjects (age 47.13+/-8.14 yr) were served as control group. Endothelial function was determined by flow-mediated dilation of brachial artery (FMD). eNOS4a/b polymorphism was detected by polymerase chain reaction. RESULTS FMD was significantly lower in patients pre-operatively compared with controls (8.48+/-1.78% vs 19.49+/-2.34%, p<0.001). FMD improved significantly after parathyroidectomy (16.19+/-2.16%, p<0.001 compared with pre-operative measurements), but was still significantly lower than controls (p<0.001). The distribution of eNOS4a/b genotype frequencies was not significantly different between patients and controls. Logistic regression analysis showed that increased serum calcium (>2.47 mmol/l) and PTH concentrations (>7.75 pmol/l) were significant independent predictors of lower FMD (<16.7%). ENOS4a/b polymorphism did not enter in this model. CONCLUSION Impaired endothelial function in patients with pHT improves after successful parathyroid surgery. No compelling data are evident to suggest that eNOS4a/b polymorphism modifies the endothelial function in patients with pHT.
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Affiliation(s)
- A Ekmekci
- Department of Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Göksel O, Tireli E, El H, Oflaz H, Dayioglu E. Coronary artery bypass grafting in a 12-year-old girl with familial hypercholesterolemia. Acta Chir Belg 2009; 109:117-8. [PMID: 19341213 DOI: 10.1080/00015458.2009.11680388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the case of a 12-year-old girl with familial hypercholesterolemia and coronary artery disease. She underwent triple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery grafting without adverse events. Pediatric patients with familial hypercholesterolemia may present with premature coronary atherosclerosis requiring coronary artery bypass grafting. In situ internal mammary artery grafts should be the graft of choice.
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Kadehci Z, Dagoglu N, Ucar A, Oflaz H, Dizdar Y, Altun M. Carotid vessel changes and risk factors in patients receiving radiotherapy for head and neck cancers. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
The aim of this study was to evaluate left atrial (LA) volume and its changes with the phases of atrial filling, and to examine the effect of exercise capacity on these parameters. Using two-dimensional echocardiography, LA volumes were measured in 30 male endurance runners and 30 age-matched sedentary men (controls). Maximal oxygen consumption (VO2max) was measured using a metabolic chart during exercise. LA reservoir, pump, and conduit functions, kinetic energy and force were calculated. We found that athletes had higher LA volume and volume index (except the conduit volume), LA passive emptying fraction, and LA total emptying fraction compared to control subjects. We observed positive correlations between: VO2max and LA passive emptying fraction (r=0.49, p<0.05); VO2max and LA active emptying fraction (r=0.54, p<0.05); VO2max and LA kinetic energy (r=0.61, p<0.05); and VO2max and LA force (r=0.57, p<0.05). These findings suggest that atrial function reflects exercise capacity in athletes.
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Affiliation(s)
- E Kasikcioglu
- Istanbul University, Istanbul Faculty of Medicine, Sports Medicine, Istanbul, Turkey.
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Oflaz H, Mercanoglu F, Karaman O, Kamali S, Erer B, Genchellac H, Pamukcu B, Umman S, Inanc M, Gul A. Impaired endothelium-dependent flow-mediated dilation in Behçet's disease: more prominent endothelial dysfunction in patients with vascular involvement. Int J Clin Pract 2005; 59:777-81. [PMID: 15963203 DOI: 10.1111/j.1742-1241.2005.00477.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Brachial artery endothelial dysfunction was shown previously in a small group of Behçet's disease (BD) patients. This study aimed to compare the endothelial function in BD patients with and without vascular involvement. The study group consisted of 25 BD patients with vascular involvement, 25 BD patients without any vascular disease and 46 healthy controls. Brachial artery flow-mediated (endothelium-dependent) dilation (FMD), nitroglycerine-induced dilation and carotid artery intima-media thickness were measured. FMD was impaired in patients with BD (10.41 +/- 3.85%) compared to healthy controls (14.41 +/- 3.39%, p < 0.001). FMD was significantly lower in BD patients with vascular involvement (8.80 +/- 3.63%) than those without any vascular disease (12.02 +/- 3.43%, p = 0.003). This study reveals that endothelial dysfunction documented by brachial artery FMD is a feature of BD, and it is more prominent in patients with vascular involvement.
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Affiliation(s)
- H Oflaz
- Department of Cardiology, Istanbul University, Istanbul, Turkey.
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Demirel S, Akkaya V, Cine N, Oflaz H, Yekeler E, Ozturk S, Cleophas TJ, Fici F. Genetic polymorphisms and endothelial dysfunction in patients with essential hypertension: a cross-sectional case-control study. Neth Heart J 2005; 13:126-131. [PMID: 25696471 PMCID: PMC2497295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Both in animal models and humans an association between endothelial constitutive nitric oxide synthase (ecNOS) gene polymorphism and the development of hypertension has been found. However, the relation between ecNOS polymorphism and endothelial function in patients with hypertension has not been systematically studied. Genes of the renin-angiotensin system include the angiotensin-converting enzyme (ACE) gene, and the angiotensin II type 1 receptor (ATIR) gene, and have been associated with essential hypertension. However, no consistent data are available about the relation between polymorphisms of these genes and the presence of endothelial dysfunction in such patients. OBJECTIVES To assess the presence of genetic polymorphisms and of endothelial dysfunction in patients with essential hypertension. To determine the effects of gene polymorphisms on endothelial dysfunction in these subjects. METHODS In 129 patients with essential hypertension and the same number of age-matched controls polymorphisms of the ecNOS gene, ACE gene, and AT1R gene were analysed by polymerase chain reactions. Endothelial function was assessed by maximal endothelial dependent vasodilation in response to reactive hyperaemia using high resolution ultrasound examinations of the brachial arteries. To assess correlation between genetic markers, endothelial function, and the presence of hypertension both univariate and multivariate analyses were used including Pearson's and Spearman's correlation coefficients, and multiple logistic regressions. RESULTS The size of endothelium-dependent vasodilation between patients and controls differed by 16% (p<0.02). However, the presence of genetic polymorphisms of the ecNOS, ACE, and AT1R genes did not significantly differ between patients and controls. Neither were there any statistically significant differences in endothelial function between various genotypes of the three genes. This was so for both the patients and the controls, although in all of these comparisons the controls overall displayed a slightly better endothelial function than the patients did. Multiple regression analysis with endothelial dysfunction as dependent and the presence of gene polymorphisms as independent variables did not reveal any significant correlation either. CONCLUSION A significant relation between endothelial dysfunction and essential hypertension was demonstrated. However, no relations between genetic markers and the presence of essential hypertension or between endothelial dysfunction and genetic markers were established. The failure of our study to demonstrate the latter may be due to confounders. Also, other genes may be more important in the pathogenesis of endothelial dysfunction and essential hypertension. The current study underscores that endothelial dysfunction and hypertension are not simple genetic disorders, and that they are, essentially, multicausal.
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Abstract
Aortic elastic properties are important determinants of left ventricular function. The aim of this study was to determine left ventricular diastolic function and aortic distensibility in endurance athletes. Thirty male runners and thirty age-matched healthy male controls took part in the study. All subjects underwent echocardiographic examination and cardiopulmonary exercise testing. Measurements included LV cavity dimension, standard and tissue Doppler parameters, and aortic diameter, 3 cm above aortic valve, at systole and diastole. Maximal oxygen uptake in athletes was higher than in controls. The aortic distensibility index was found to be higher in athletes compared with controls (5.37 +/- 1.50 vs. 3.37 +/- 1.48 cm (2) . dynes (-1) . 10 (-6), p < 0.001). While the aortic stiffness index in athletes was significantly lower than in controls (2.77 +/- 0.28 vs. 3.43 +/- 0.41, p < 0.001). Furthermore, transmitral early peak velocity (E) and late peak velocity (A), peak velocity of myocardial systolic wave (S (m)), early (E (m)) and atrial (A (m)) diastolic waves in athletes were higher than in controls. It seemed that the association of E (m) velocity with aortic distensibility was stronger than that of other LV parameters (coefficient = 0.74, p < 0.001) by using multiple linear regression. Increased aortic distensibility in endurance-trained athletes may cause better diastolic function as a physiological cardiovascular adaptation factor.
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Affiliation(s)
- E Kasikcioglu
- Department of Sports Medicine. Istanbul University, Istanbul Faculty of Medicine, Avcilar 34840, Istanbul.
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Mercanoglu F, Erdogan D, Oflaz H, Kücükkaya R, Selcukbiricik F, Gül A, Inanc M. Impaired brachial endothelial function in patients with primary anti-phospholipid syndrome. Int J Clin Pract 2004; 58:1003-7. [PMID: 15605661 DOI: 10.1111/j.1742-1241.2004.00162.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Although the precise pathophysiology of thrombosis is unknown in primary anti-phospholipid syndrome (PAPS), it is assumed that autoantibodies developed against endothelial cells and platelets might be one of the primary mechanisms. However, whether interaction between autoantibodies and endothelium leads to an impaired vasodilator response has not been investigated yet. In this study, we aimed to investigate the endothelial functions in patients with PAPS. Thirty-one patients with PAPS (22 female, nine male, mean age: 34.6+/-8.9 years) and 27 age- and sex-matched, healthy controls were included in the study. Brachial artery responses to reactive hyperaemia (endothelium-dependent dilatation) [EDD] and sublingual nitroglycerine (endothelium-independent dilatation) [EID] were measured by using high-resolution vascular ultrasound both in patients with PAPS and in the controls. The results were expressed as percentage of change in baseline values. Regarding cardiovascular risk factors, there was no significant difference between the two groups. EDD in patients with PAPS was significantly lower than those of controls (6.9+/-4.9 vs. 14.8+/-4.1%; p<0.0001). EID measurements were not significantly different between the groups. In the PAPS group, EDD in patients with arterial involvement (17 patients) was significantly lower than those of patients with venous involvement (12 patients) (4.6+/-3.9 vs. 7.4+/-4.1%; p = 0.02). This study showed that endothelial functions determined by using brachial artery ultrasound were impaired in patients with PAPS, and this was more prominent in the subgroup of patients with arterial involvement compared to patients with venous involvement.
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Affiliation(s)
- F Mercanoglu
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
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Oflaz H, Turkmen A, Kocaman O, Erdogan D, Meric M, Oncul A, Koylan N, Yilmaz E, Yilmaz C, Selcukbiricik F, Kasikcioglu E, Sever MS. Is there a relation between duration of cyclosporine usage and right and left ventricular function in renal transplant patients? Tissue Doppler Echocardiography study. Transplant Proc 2004; 36:1380-4. [PMID: 15251337 DOI: 10.1016/j.transproceed.2004.04.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Our aim was to investigate the effect of cyclosporine (CsA), which is commonly used in renal transplant patients and causes myocardial fibrosis and elevated arterial tension, on cardiac function. METHODS Sixty-six renal transplant patients (RTPs) and 25 healthy controls were included in the study. Renal transplantation patients were divided according to time of CsA exposure: group 1 (0 to 36 months); group 2 (36 to 72 months) and group 3 (> 72 months). Systolic peak velocity (Sm, mitral; St, tricuspid) and mitral early (e)/late (a) (Me/a) and tricuspid e/a (Te/a) waves of the right and the left ventricles were measured by pulse-wave (PW) Doppler used for tissue Doppler imaging of both ventricles as well as the ventricle free wall near to the lateral tricuspid and the posterior mitral leaflets. The measurements included conventional diastolic early (E) and late (A) waves and deceleration time (DT) of the E wave, isovolumetric relaxation time (IVRT) of both ventricles, as well as left ventricular systolic ejection fraction (EF). RESULTS There were no statistically significant differences between the groups with regard to demographic, clinical, and most biochemical characteristics. Left ventricular EF was normal in all groups; there were no statistically significant differences. IVRT and DT of left ventricle and right ventricle DT values were similar among RTPs. On the other hand, values were found to be increased in RTP groups compared with the control group. E/A ratio, Me/a Te/a of both ventricles were similar among RTPs. However, these values were found to be decreased in RTP groups compared with the control group. CONCLUSIONS Although left ventricular systolic functions were normal in all groups, there were statistically significant impairments of biventricular diastolic function parameters among renal transplant recipients compared with the control group.
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Affiliation(s)
- H Oflaz
- Department of Cardiology, Capa, Istanbul
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Mercanoglu F, Oflaz H, Turkmen A, Kocaman O, Bunyak B, Umman S, Yekeler E, Kasikcioglu E, Meric M, Demirel S, Kucuk M, Sever MS. Does the endothelial function change in renal transplant patients with longer duration of exposure and with higher cumulative doses of cyclosporine? Transplant Proc 2004; 36:1361-6. [PMID: 15251333 DOI: 10.1016/j.transproceed.2004.05.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Administration of cyclosporine (CsA) is one potential cause of endothelial dysfunction in renal transplant patients. We sought to investigate endothelial functional changes with respect to the cumulative dose and duration of exposure to CsA. METHODS Sixty-six renal recipients and 25 healthy controls were included in the study. The recipients were classified according to their time of CsA exposure: group 1 (0 to 36 months); group 2 (36 to 72 months); and group 3 (over 72 months). Endothelial function of the brachial artery was evaluated using high-resolution vascular ultrasound. Endothelium-dependent and -independent vasodilatation (EDD and EID, respectively) were assessed by assessing the responses to reactive hyperemia and using sublingual isosorbide dinitrate (ISDN), respectively. RESULTS There were no statistically significant differences between the groups with regard to their demographic, clinical, and most biochemical characteristics. Baseline measurements of the diameter of the brachial artery were similar in all groups. The values of mean brachial artery EDD and EID responses in groups 1, 2, and 3 were less than those in the control group (P < .05, P < .05, and P < .05, respectively). Mean brachial artery EDD and EID in group 1 were significantly impaired compared to groups 2 and 3 (for EDD: P < .05 and P < .05, respectively; for EID: P < .05 and P < .05, respectively). In contrast there was no difference between groups 2 and 3 with respect to these parameters. There were mild to moderate positive correlations between the cumulative doses of CsA and EDD and EID (r = .26 and r = .52, P < .05, respectively). CONCLUSION Endothelial dysfunction was more prominent in the first 36-month period than later despite the longer exposure to and higher cumulative doses of CsA. This finding may reflect an extended effect of the uremic state on endothelial function or more intense doses of CsA in early posttransplant period.
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Affiliation(s)
- F Mercanoglu
- Department of Cardiology, Nephrology, Capa, Istanbul, Turkey
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Oflaz H, Ozbey N, Mantar F, Genchellac H, Mercanoglu F, Sencer E, Molvalilar S, Orhan Y. Determination of endothelial function and early atherosclerotic changes in healthy obese women. Diabetes Nutr Metab 2003; 16:176-81. [PMID: 14635735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The aim of this study was to determine the associations between vascular endothelial function, intima-media thickness (IMT) of the common carotid artery and anthropometric/metabolic parameters in healthy obese women without obesity-related metabolic complications and age-matched healthy lean controls. Twenty-four obese [body mass index (BMI) > 30 kg/m2; age 31.4 +/- 7.4 yr] and 14 lean (BMI < 24 kg/m2; age 30.5 +/- 7.2 yr) women were studied. All of the subjects had normolipemia. Insulin resistance was calculated according to the homeostasis model assessment (HOMA) formula. Endothelial function was measured by flow-mediated dilation (FMD) of the brachial artery. IMT of the common carotid artery was calculated from high-resolution ultrasound imaging of the two common carotid arteries. Obese and lean women were matched with respect to age, smoking status, blood pressure, glucose, insulin concentrations and HOMA. IMT of common carotid artery was significantly higher (0.56 +/- 0.09 vs 0.45 +/- 0.06 mm, p < 0.001) and FMD (percentage of change from baseline) was significantly lower (13.3 +/- 6.5% vs 25.2 +/- 13.9%,p < 0.001) in the obese subjects. Lipid profile, blood pressure, indirect measurement of insulin resistance, leptin concentrations and anthropometric parameters did not predict the FMD or IMT in the obese and lean groups. It is concluded that even in healthy obese women with a normal metabolic profile, deterioration in endothelial function and early atherosclerotic changes are evident compared with healthy lean counterparts. Some undetermined factors in our study other than obesity-related well-known risk factors could be responsible for this observation.
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Affiliation(s)
- H Oflaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Türkmen A, Bunyak B, Oflaz H, Kücük M, Sahin S, Bugra Z, Umman B, Sever MS. Effect of calcineurin inhibitors on QT dispersion in renal transplant recipients. Transplant Proc 2002; 34:2996-8. [PMID: 12431681 DOI: 10.1016/s0041-1345(02)03512-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A Türkmen
- Department of Nephrology, Istanbul School of Medicine, Istanbul, Turkey
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Ozbey N, Sezgil A, Oflaz H, Umman B, Orhan Y, Sencer E, Molvalilar S. Left ventricular diastolic function abnormalities in hypopituitary patients with GH deficiency: evidence for a subclinical cardiomyopathy. J Endocrinol Invest 2002; 25:590-7. [PMID: 12150332 DOI: 10.1007/bf03345081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate cardiac performance, in particular diastolic function, in adult patients with adulthood onset GH deficiency. The study group was composed of 19 GH deficient adult hypopituitary patients with at-least 3 additional pituitary hormone deficits and 19 age, sex and BMI matched healthy controls. Mean duration of hypopituitarism was 108.6 +/- 77.0 months. None of the patients and controls presented with or had previous diagnosis of concomitant diseases that could affect cardiac function. All hormone deficiencies, except for GH, were appropriately replaced in the patients. Left ventricular function and geometry were evaluated by two-dimensional, M-mode and Doppler echocardiography. Body composition was evaluated by bioelectrical impedance analysis. Not significant differences were observed with respect to left heart dimensions and left ventricular systolic function between patients and controls. Nevertheless 2 of the left ventricular diastolic function parameters, deceleration time and isovolumetric relaxation time, were significantly prolonged in the patients compared with controls (247.88 +/- 70.65 vs 143.26 +/- 31.70 milliseconds (ms) and 122.31 +/- 18.24 vs 89.47 +/- 12.12 ms respectively, p<0.001). Duration of hypopituitarism was significantly correlated with percent body fat mass (r=0.6119, p<0.01) and percent lean body mass (r=-0.5949, p<0.01). It is concluded that in adults affected by hypopituitarism, GH deficiency predominantly impairs diastolic function while systolic function at rest is spared. This observation might indicate a preclinical stage of a cardiomyopathy.
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Affiliation(s)
- N Ozbey
- Department of Internal Medicine, Istanbul Faculty of Medicine, Capa, Turkey.
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