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Demirhan S, Polat O, Mert M. THE RELATIONSHIP BETWEEN TSH LEVELS, THYROID AUTOANTIBODIES AND ATHEROGENIC INDEX OF PLASMA, AST TO PLATELET RATIO INDEX SCORE, AND FIBROSIS 4 INDEX IN PATIENTS WITH HYPOTHYROIDISM. Acta Endocrinol (Buchar) 2023; 19:333-338. [PMID: 38356973 PMCID: PMC10863957 DOI: 10.4183/aeb.2023.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Context Thyroid hormones have metabolic effects such as relationship between hypothyroidism and atherosclerosis. Objective Evaluate the effects of hypothyroidism on Non-Alcoholic Fatty Liver Disease and atherosclerosis by using AIP, APRI score, FIB-4 indices. Material and Methods 1370 patients with hypothyroidism who applied to the Endocrinology and Metabolism outpatient clinic between 01.01.2017-30.12.2021 were included the study. Pregnants, patients with a history of thyroid carcinoma, cardiovascular and liver diseases were excluded. TSH, fT4, Anti TPO, Anti TG, thrombocyte, ALT, AST, HDL, Triglyceride values of the cases were analyzed and atherogenic index of plasma (AIP), AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) indices were calculated. Results 1170 (85.4%) of the cases were female.The age of those who had high risk of AIP was found to be higher than those with low and moderate risk (p=0.001; p=0.003; p<0.01). The ages of those who had low-risk FIB-4 Index were found to be lower than those with moderate risk and high risk (p=0.001; p=0.001; p<0.01). A positive relationship was detected between APRI and FIB-4 (r=0.681; p=0.001; p<0.01).AIP increased as TSH increased in hypothyroid patients. No significant correlations were detected between TSH, APRI, and the FIB-4 Index. No significant differences were detected between AIP, APRI, FIB-4, and thyroid autoantibodies. Conclusion In hypothyroid patients, the AIP index increased with age and the increase in TSH. A strong relationship was detected between AIP and TSH . For this reason, we think that keeping TSH within the normal range with regular follow-ups and treatment in patients with hypothyroidism will reduce the risk of atherosclerosis.
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Affiliation(s)
- S. Demirhan
- University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Family Medicine
| | - O. Polat
- University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Family Medicine
| | - M. Mert
- University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Department of Endocrinology and Metabolism, Istanbul, Turkey
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Leavens J, Young PM, Mert M, Sawcer D, Ahronowitz I. Clinical presentation of verruca vulgaris in HIV. Dermatol Online J 2022; 28. [DOI: 10.5070/d328157055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/08/2022] Open
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Piskinpasa H, Ciftci Dogansen S, Kusku Cabuk F, Guzey D, Sahbaz NA, Akdeniz YS, Mert M. BILATERAL ADRENAL AND TESTICULAR MASS IN A PATIENT WITH CONGENITAL ADRENAL HYPERPLASIA. Acta Endocrinol (Buchar) 2019; -5:113-117. [PMID: 31149069 DOI: 10.4183/aeb.2019.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Congenital adrenal hyperplasia (CAH) autosomal recessive disorders characterized by impaired adrenal steroid hormone synthesis. The most common form is 21-hydroxylase deficiency (21OHD). Testicular adrenal rest tumors (TARTs) are benign intratesticular masses that occur in male patients with CAH. TARTs are quite common in patients with 21OHD who were diagnosed late. Case report A 41-year-old male patient with CAH secondary to 21OHD. The patient was referred to our endocrinology department from the andrology clinic for bilateral adrenal masses. Bilateral orchiectomy had been performed due to bilateral testicular masses and azoospermia two years ago. The pathology was reported as Leydig cell tumor. In hormonal assessment, baseline cortisol levels were low, 17-hydroxyprogesterone levels with baseline and after cosyntropin stimulation test were high. As a result of clinic and laboratory assessment, the patient was diagnosed with simple virilising CAH due to 21OHD and adrenal insufficiency. Then, prednisolone replacement was initiated. Bilateral orchiectomy tissue blocks of the patient were re-assessed and were considered TART. Magnetic resonance imaging revealed bilateral adrenal masses with 88x55 mm on the right and 41x22 mm on the left. Laparoscopic right adrenalectomy was applied and pathology was reported as myelolipoma. Follow-up of the mass on the left adrenal gland is ongoing. The patient is monitored under prednisolone and testosterone replacement therapy. Early diagnosis of CAH is very important because of the complications it causes. It should be considered especially for bilateral testicular and/or adrenal masses. Both fertility and adrenal glands can be protected with an early diagnosis and an early glucocorticoid replacement.
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Affiliation(s)
- H Piskinpasa
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
| | - S Ciftci Dogansen
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
| | - F Kusku Cabuk
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of Pathology, Istanbul, Turkey
| | - D Guzey
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of General Surgery, Istanbul, Turkey
| | - N A Sahbaz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of General Surgery, Istanbul, Turkey
| | - Y S Akdeniz
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
| | - M Mert
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital - Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
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Saribal D, Hocaoglu-Emre FS, Erdogan S, Bahtiyar N, Caglar Okur S, Mert M. Inflammatory cytokines IL-6 and TNF-α in patients with hip fracture. Osteoporos Int 2019; 30:1025-1031. [PMID: 30701344 DOI: 10.1007/s00198-019-04874-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/22/2019] [Indexed: 12/24/2022]
Abstract
UNLABELLED Mortality and remaining bedridden following the hip fracture surgery are not rare. We tried to measure the levels of inflammatory markers tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) following the hip fracture surgery and compare their levels with controls. We aimed to show a relationship between the levels of these markers and post-operative mortality and walking capability. INTRODUCTION Osteoporosis is a condition, causing the hip fractures in the elderly. Hip fractures have a high rate of overall mortality up to 30% following the incident. Cytokines such as IL-6 and TNF-α are suggested to play a role in bone resorption and, thus, in the etiology of osteoporosis. METHODS Plasma levels of IL-6 and TNF-α were measured pre-operatively and on the first and second days after the surgery in 40 Turkish hip fracture patients. The levels of these cytokines were compared with 40 Turkish age-matched healthy controls. The levels of these cytokines were compared between the deceased and surviving patients, as well as the existence of walking capability following the surgery. RESULTS Significantly higher IL-6 levels were shown on the first and second days after the surgery (p = 0.005; p = 0.01, respectively). The overall death rate of our study group within the 2-year follow-up time was found to be 35%. No statistical significance was found in the means of 2-year follow-up mortality between the patients. Presence of walking capability did not differ between the patients, as well. CONCLUSION We demonstrated an association between IL-6 levels and hip fracture in our study group following the surgery. We also suggest that TNF-α and IL-6 levels are not related to the occurrence of death and walking capability after the surgery. However, these findings need further functional and clinical confirmation.
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Affiliation(s)
- D Saribal
- Department of Biophysics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - F S Hocaoglu-Emre
- Department of Nutrition and Dietetics, Beykent University, Istanbul, Turkey.
| | - S Erdogan
- Department of Orthopedic Surgery, Istanbul Metin Sabanci Baltalimanı Training and Research Hospital for Bone Diseases, Istanbul, Turkey
| | - N Bahtiyar
- Department of Biophysics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - S Caglar Okur
- Department of Physical Treatment and Rehabilitation, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - M Mert
- Department of Orthopedic Surgery, Yeniyuzyil University Medical School, Istanbul, Turkey
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Ucpunar H, Tas SK, Camurcu Y, Sofu H, Mert M, Bayhan AI. The effects of residual hip deformity on coronal alignment of the lower extremity in patients with unilateral slipped capital femoral epiphysis. J Child Orthop 2018; 12:599-605. [PMID: 30607207 PMCID: PMC6293324 DOI: 10.1302/1863-2548.12.180137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of our explorative study was to compare the differences in the coronal alignments of the hip, knee and ankle on the slip side and non-slip sides in patients with slipped capital femoral epiphysis (SCFE). METHODS The study group consisted of 28 patients. On the full-length standing radiographs, measurements of articulo-trochanteric distance (ATD), neck-shaft angle (NSA), femoral offset, hip-knee-ankle axis, femur-tibial angle, mechanical axis deviation ratio (MAD-r), anatomical medial proximal femoral angle (aMPFA), mechanical lateral proximal femoral angle (mLPFA), anatomical lateral distal femoral angle (aLDFA), mechanical lateral distal femoral angle (mLDFA), knee joint line congruency angle, mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal tibial angle (mLDTA), ankle joint line orientation angle (AJOA), and leg length discrepancy (LLD) were performed. The data from the slip side were compared with those from the non-slip side. RESULTS At skeletal maturity, there were significant differences between the slip side and non-slip side in ATD (p <0.001), NSA (p <0.001), MAD-r (p <0.001), aMPFA (p <0.001), aLDFA (p = 0.03), mLDFA (p = 0.04), mLDTA (p = 0.02), AJOA (p <0.001) and LLD (p<0.001). CONCLUSION Residual deformity in the proximal femur after epiphyseal slip and premature epiphysiodesis could cause changes in the coronal alignment of the lower extremity. We can add lower extremity alignment examination to follow-up protocol to rule out secondary problems in patients with SCFE. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- H. Ucpunar
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey, Correspondence should be sent to H. Ucpunar, MD, Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Basbaglar Mahallesi, 24030 Erzincan, Turkey. E-mail:
| | - S. K. Tas
- Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - Y. Camurcu
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - H. Sofu
- Department of Orthopaedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - M. Mert
- Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
| | - A. I. Bayhan
- Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Education and Research Hospital, Istanbul, Turkey
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Mert M, Cetin G, Turkoglu H, Ozkara A, Akcevin A, Saltik L, Paker T, Gunay I. Early Results of Valved Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction. Int J Artif Organs 2018; 28:251-5. [PMID: 15818548 DOI: 10.1177/039139880502800310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/16/2022]
Abstract
Objective Many congenital cardiac anomalies present with accompanying severe right ventricular outflow tract (RVOT) obstruction or interruption requiring surgical correction. RVOT reconstruction by means of a conduit is often necessary in the majority of these patients in the early years of life and there are several proposed conduits for this purpose. Methods Fourteen patients with different congenital cardiac pathologies underwent RVOT reconstruction with the newly developed bovine valved jugular vein conduit (The Contegra conduit). The function of the conduit is observed by echocardiographic examinations at the hospital discharge and at follow-up visits with special attention to the function of the venous valve and to any gradient on the RVOT. Results There were two perioperative mortalities. All the surviving patients are followed for a mean period of 8.07 months (range 2 to 33 months). The function of the venous valve was determined, in 4 patients (33.33%) as without regurgitation, in 7 patients (58.3%) as mild regurgitation and in 1 patient (8.33%) as mild-to-moderate regurgitation. The reconstructed RVOT was free of any significant gradient at the hospital discharge (mean 10.83 ±10.18 mmHg) and at the follow-ups (mean 12.916 ±12.33 mmHg). There was not a trend towards an increase in the gradients following discharge. Conclusion The early results of the Contegra valved conduit are very satisfactory. This graft can be a good alternative for RVOT reconstruction, particularly in the neonatal and infant patient group. These patients can be managed by homograft replacement of their conduit in later years.
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Affiliation(s)
- M Mert
- Istanbul University, Institute of Cardiology, Department of Cardiovascular Surgery, Instanbul, Turkey.
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Karatepe O, Eken I, Acet E, Unal O, Mert M, Koc B, Karahan S, Filizcan U, Ugurlucan M, Aksoy M. Vacuum Assisted Closure Improves the Quality of Life in Patients with Diabetic Foot. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2011.11680757] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- O. Karatepe
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - I. Eken
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - E. Acet
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - O. Unal
- Department of Vascular Surgery, Istanbul University, Faculty of Medicine
| | - M. Mert
- Department of Endocrinology, Istanbul University, Faculty of Medicine
| | - B. Koc
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - S. Karahan
- Department of General Surgery, Istanbul University, Faculty of Medicine
| | - U. Filizcan
- Okmeydani Training and Research Hospital; Department of Cardiovascular Surgery, Istanbul University, Faculty of Medicine
| | - M. Ugurlucan
- Maltepe University Medical Faculty; Department of Cardiovascular Surgery, Istanbul University, Faculty of Medicine
| | - M. Aksoy
- Duzce Ataturk State Hospital; Department of General Surgery, Istanbul University, Faculty of Medicine
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Tanriverdi F, Dokmetas HS, Kebapcı N, Kilicli F, Atmaca H, Yarman S, Ertorer ME, Erturk E, Bayram F, Tugrul A, Culha C, Cakir M, Mert M, Aydin H, Taskale M, Ersoz N, Canturk Z, Anaforoglu I, Ozkaya M, Oruk G, Hekimsoy Z, Kelestimur F, Erbas T. Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database. Endocrine 2014; 47:198-205. [PMID: 24366641 DOI: 10.1007/s12020-013-0127-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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] [Received: 09/23/2013] [Accepted: 11/13/2013] [Indexed: 02/02/2023]
Abstract
Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries.
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Affiliation(s)
- F Tanriverdi
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey,
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Coskun U, Bostan C, Baskurt M, Ökçun B, Yildiz A, Yildiz C, Çetinkal G, Arat A, Ersanli M, Çetin G, Mert M, Gurmen A. OP-247 CASE REPORT: UNCOMMON CAUSE OF ANGINA PECTORIS, VERTIGO AND SYNCOPE ATTACKS; CORONARY SUBCLAVIAN STEAL SYNDROME. Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70162-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karatepe O, Eken I, Acet E, Unal O, Mert M, Koc B, Karahan S, Filizcan U, Ugurlucan M, Aksoy M. Vacuum assisted closure improves the quality of life in patients with diabetic foot. Acta Chir Belg 2011; 111:298-302. [PMID: 22191131] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diabetes Mellitus (DM) is the most common endocrine disease worldwide. One of the most important chronic complications of this disease is the development of diabetic foot. The management of diabetic foot wounds is quite important with respect to public health. AIMS To determine the effect of Vacuum Assisted Closure (VAC) therapy on the quality of life in the treatment of diabetic foot ulcers and compare it with standart wound care. METHODS Between May 2007 to December 2008, 67 consecutive patients with diabetic foot ulcers were randomly assigned to VAC therapy (Group 1, n : 30) or standart wound care (Group 2, n : 37). The SF-36 questionnaire was administered the day before and in the month following wound healing. Global analyses of the 8 domains and 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS) were performed. Clinical measures included standard antidiabetic treatment, daily wound care including antiseptic bath, debridement, toe removal for gangrene when necessary, and wound care with conventional methods or VAC. Healing time was calculated as the time from hospital admission to the time of re-epithelization. RESULTS There were no differences in the mean age, ulcer size and pulse status of the patients in both groups. Healing time in the VAC group was significantly reduced (p < 0.05). All 8 domains of SF-36 and MCS and PCS scores improved remarkably after VAC therapy. CONCLUSION Vacuum Assisted Closure therapy was found to be effective in the treatment of chronic diabetic ulcers. The improvement of quality of life demonstrates a clear-cut indication in this particular group of patients.
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Affiliation(s)
- O Karatepe
- Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Karabay C, Kocabay G, Kalayci A, Zehir R, Mert M, Kirma C. Snake-like thrombus in the right atrium causing pulmonary embolism. Cardiovasc J Afr 2011; 22:206-7. [DOI: 10.5830/cvja-2010-060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 07/29/2010] [Indexed: 11/06/2022] Open
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Kocabay G, Sirma D, Mert M, Tigen K. Isolated tricuspid valve prolapsed: identification using two- and three-dimensional echocardiography and transoesophageal echocardiography. Cardiovasc J Afr 2011; 22:272-3. [PMID: 21709929 DOI: 10.5830/cvja-2011-006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 02/16/2011] [Indexed: 11/06/2022] Open
Abstract
We present a case of isolated prolapse of the tricuspid anterior leaflet in an asymptomatic 34-year-old man who was referred to our hospital for a routine check up. We performed two-and three-dimensional transoesophageal echocardiography (TEE). We found three-dimensional TEE a useful, non-invasive tool that can provide additional information to two-dimensional echocardiography in the assessment of tricuspid valve prolapse.
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Affiliation(s)
- G Kocabay
- Kartal Kosuyolu Heart and Research Hospital, Department of Cardiology, Kartal, Istanbul, Turkey.
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Karabay CY, Kocabay G, Kalayci A, Tanboga H, Mert M, Kirma C. Cardiogenic shock due to dynamic left ventricular outflow tract obstruction of acute myocardial infarction: an under-diagnosed complication. Cardiovasc J Afr 2011; 22:205-6. [PMID: 21264440 DOI: 10.5830/cvja-2010-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 06/30/2010] [Indexed: 11/06/2022] Open
Abstract
We report on a patient who developed cardiogenic shock caused by dynamic left ventricular outflow tract (LVOT) obstruction following percutaneous coronary intervention for anteroseptal acute myocardial infarction.
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Affiliation(s)
- C Y Karabay
- Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Abstract
BACKGROUND Morgagni hernia is a rare diaphragmatic hernia occurring secondary to potential anterior medial defects in the diaphragm. The association of the defect with congenital cardiac pathologies and Down syndrome has already been reported. The defect is repaired usually by transabdominal or transthoracic approaches. Transsternal repair of the hernia is preferred in patients undergoing concomitant open heart surgery. CASE An eight-month old child with Down syndrome and congenital hypothyroidism underwent concomitant repair of Morgagni hernia and closure of his ventricular septal defect under cardiopulmonary bypass. The hernia was repaired by the sternotomy approach, without opening the hernia content, before the correction of the cardiac pathology. COMMENT As Morgagni hernia can accompany some congenital cardiac anomalies, cardiac surgeons should be familiar with the transsternal approach to the defect which is as effective as other surgical approaches.
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Affiliation(s)
- M Mert
- Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey.
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Ozkara A, Mert M, Cetin G, Saltik L, Sarioglu T. Right ventricular outflow tract reconstruction for tetralogy of fallot with abnormal coronary artery: experience with 35 patients. J Card Surg 2006; 21:131-6. [PMID: 16492269 DOI: 10.1111/j.1540-8191.2006.00192.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/28/2022]
Abstract
BACKGROUND An abnormal coronary artery crossing the right ventricle outflow tract (RVOT) complicates complete repair of tetralogy of Fallot (TOF). We have evaluated surgical options for RVOT reconstruction for this group of patients. METHODS Between 1984 and 2002, 35 TOF patients with abnormality of coronary arteries underwent total correction. Age of these patients ranged from 1 to 14 years (mean 5.8 +/- 2.8 years). All patients were diagnosed by echocardiography and 25 patients had cardiac catheterization. All the abnormal coronary arteries were spared at the operation. In 24 patients a transannular patch was applied for RVOT reconstruction. In three patients with an adequate pulmonary annulus, oblique ventriculotomy incisions, and in two patients, transatrial approaches were performed. "Two-patch" technique was chosen for two patients. In four patients placement of an extracardiac conduit was necessary. RESULTS Mortality was observed in four patients, in two of them due to suspected myocardial ischemia. None of the surviving patients needed reoperation. All of them were in NYHA class I. The follow-up period for patients without extracardiac conduit was between 14 and 96 months (mean 50.2 months) and for the patients with extracardiac conduit ranged 36 to 98 months (63.5 months). The mean gradients measured by echocardiography were, respectively, 5 mmHg (range 0 to 35 mmHg) and 23.75 mmHg (range 20 to 25 mmHg). CONCLUSIONS Definitive repair of TOF patients with abnormal coronary arteries can be performed in early childhood, but care should be taken to leave at least 1 cm of myocardium between the sutureline and the abnormal coronary artery. Detailed evaluation of the patients preoperatively is mandatory to identify the strategy and timing of the operation.
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Affiliation(s)
- A Ozkara
- Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Turkey.
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Mert M, Bakay C. Early and mid-term angiographic assessment of internal thoracic artery grafts anastomosed to non-stenotic left anterior descending coronary arteries. Thorac Cardiovasc Surg 2004; 52:65-9. [PMID: 15103577 DOI: 10.1055/s-2004-817805] [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: 10/26/2022]
Abstract
BACKGROUND Mild to moderately stenotic coronary arteries present a major problem as the progression of atherosclerosis is unpredictable. In addition, residual flow from the native coronary artery has been proposed as a mechanism that reduces blood flow in bypass grafts resulting in failure of the graft. PATIENTS AND METHODS The internal thoracic artery was anastomosed to the left anterior descending coronary artery for different reasons in three patients who underwent coronary arterial surgery, with stenosis of this coronary artery changing from none to 30%. Patients were monitored by coronary arteriography at different intervals postoperatively (from 6 days to 25 months) to assess the patency of the internal thoracic artery graft. RESULTS Internal thoracic artery grafts were found to be patent in all coronary arteriographies during the follow-up period. Twenty-five months after surgery, one patient showed total occlusion of the native coronary artery which was previously normal. CONCLUSIONS Competitive flow from the native coronary artery does not seem to influence internal thoracic artery patency when grafted to a normal or mildly stenotic left anterior descending coronary artery. This information could be of help in some patients undergoing coronary artery bypass surgery with non-critical stenosis of this coronary artery. If the non-critical lesion is located proximally and if the patient has additional risk factors for coronary artery disease progression, prophylactic grafting of the left anterior descending coronary artery to the internal thoracic artery should be considered to prevent any future cardiac event, keeping in mind that this procedure may accelerate the progression of the native coronary artery disease.
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Affiliation(s)
- M Mert
- Istanbul University, Institute of Cardiology, Department of Cardiovascular Surgery, Istanbul, Turkey.
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Mert M, Erdem CC, Babalik E, Bakay C. Mid-to-long-term Patency Comparison of the Right Internal Thoracic Artery Grafts on the Left Anterior Descending and on the Right Coronary Arteries. Thorac Cardiovasc Surg 2003; 51:180-4. [PMID: 14502453 DOI: 10.1055/s-2003-42257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
BACKGROUND The excellent results obtained from internal thoracic artery for myocardial revascularization have led surgeons to simultaneous use of other arterial conduits, particularly the right internal thoracic artery. However, some controversy still exists regarding the optimal target coronary artery for this graft; different strategies have been proposed for bilateral internal thoracic artery grafting. PATIENTS AND METHODS 59 patients with right internal thoracic artery grafts were monitored using coronary arteriography in order to compare the patency of this graft on the left anterior descending and the right coronary arteries. The right internal thoracic artery was grafted to left anterior descending artery in 39 patients (group 1) and to right coronary artery in 20 patients (group 2). RESULTS The mean period of follow-up was 64.07 months (range: 37 to 185 months). Overall, 8 of the 59 grafts (13.6%) were occluded at the arteriography. In group 1, 1 of 39 (2.6%) grafts and in group 2, 7 of 20 (35%) grafts are found to be occluded. These results are considered statistically significant (p < 0.001). COMMENT The results show that the patency of the right internal thoracic artery is significantly better on the left anterior descending artery than on the right coronary artery in the mid-to-long term, and patency does not differ from the left internal thoracic artery on the left anterior descending artery.
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Affiliation(s)
- M Mert
- Department of Cardiovascular Surgery, Istanbul University, Institute of Cardiology, Turkey.
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Abstract
Radiation-induced heart disease must be considered in any patient with cardiac symptomatology who had prior mediastinal irradiation. Radiation can affect all the structures in the heart, including the pericardium, the myocardium, the valves and the conduction system. In addition to these pathologies, coronary artery disease following mediastinal radiotherapy is the most actual cardiac pathology as it may cause cardiac emergencies requiring interventional cardiological or surgical interventions. Case A 36-year-old man was admitted to the clinic with unstable angina pectoris of one month duration. The patient had no coronary artery disease risk factor. The history of the patient revealed that he had mediastinal radiotherapy due to Hodgkin's disease at 10-year of age. Coronary arteriography showed total occlusion of the left anterior descending artery and 70% stenosis of the proximal right coronary artery. Both arteries are dilated with placement of two stents. Control coronary arteriography at the end of the first year showed patency of both stents and the patient is free of symptoms. Previous radiotherapy to the mediastinum should be considered as a risk factor for the development of premature coronary artery disease. Percutaneous transluminal coronary angioplasty with stent placement or surgical revascularization are the preferred methods of treatment. Preoperative assessment of internal thoracic arteries should be considered prior to surgery. As the radiation therapy is currently the standard treatment for a number of mediastinal malignancies, routine screening of these patients and optimal cardiac prevention during radiotherapy are the only ways to minimize the incidence of radiation-induced heart disease.
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Affiliation(s)
- M Mert
- Istanbul University, Institute of Cardiology, Istanbul, Turkey.
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Keskin S, Seven A, Mert M, Akalp F, Yurdakul F, Candan G. Could L-carnitine be an acute energy inducer in catabolic conditions? Dev Med Child Neurol 1997; 39:174-7. [PMID: 9112966 DOI: 10.1111/j.1469-8749.1997.tb07406.x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Serum free carnitine levels in five children (aged between 2.5 months and 4 years) with the findings of septic shock without disseminated intravascular coagulopathy and seven children (aged between 1.5 and 6.5 years) with the first attack of idiopathic status epilepticus were compared with those of eight healthy children (aged between 2.5 months and 5 years). Serum free carnitine levels showed a statistically significant decrease in the sepsis (mean 51.5 +/- 19 mg/L) and status epilepticus groups (mean 4.1 +/- 12.4 mg/L) (P = 0.006 and P = 0.001, respectively) when compared with the controls (mean 90.8 +/- 17.2 mg/L).
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Affiliation(s)
- S Keskin
- Pediatrics Department, Cerrahpasa University, Istanbul, Turkey
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