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Öğe APPLICATION OF ARGON PLASMA COAGULATION AT ENDOSCOPIC MANAGEMENT OF NON VARICEAL UPPER GASTROINTESTINAL BLEEDING CLINICAL RESULTS(Nobel Ilac, 2010) Tamer, Ali; Korkut, Esin; Korkmaz, UğurObjective The cum of this study was to compare the effectiveness and safety of argon plasma coagulation (APC) method that has recently been started to be used to epinephrine injection (sclerotherapy) in the endoscopic management of nonvariceal upper gastrointestinal bleeding (UGIB) Material and Method. Patients (8 female 3 male age 61 15 8) applied with nonvariceal UGIB and treated with APC endoscopically were allocated to the study Patients (20 female 10 male age 62 7 18 3) applied with nonvariceal UGIB and treated with sclerotherapy with endoscopic epinephrine (1/10000) were allocated as a control group Age of the patients gender complaints (hematemesis melena) during application drug use (acetyl salicylic acid warfarin nonsteroidal anti inflammatory drugs (NSAI)) hemoglobin (Hb) level during application and discharge endoscopic diagnosis number of blood transfusion and drug treatment methods were noted Results There was no difference between APC applied patients and the patients treated with sclerotherapy in respect to the age of the patients gender presence of hematemesis and melena complaints during application NSAI drug use acetyl salicylic acid and warfarin use Hb level during application and discharge number of blood transfusion length of hospital stay surgical and mortality rate (p>0 05) APC was applied endoscopically diagnosed as hemorrhagic erosive gastritis in addition to the patients applied for peptic ulcer Conclusion APC application is an effective method in endoscopic treatment of nonvariceal upper GI bleeding The ease of application of procedure in APC applied patients a noncontact and controllable depth of coagulation observation of the cessation of bleeding during application endoscopically applicability in patients with hemorrhagic erosive gastritis are the advantagesÖğe Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis(Professional Medical Publications, 2017) Nalbant, Ahmet; Aydın, Ayhan; Karacan, Alper; Önmez, Attila; Tamer, Ali; Cinemre, HakanBackground (sic) Objective: During the course of the autoimmune thyroid diseases, ultrasonography change parallel to histopathology. Vitamin D is associated with autoimmune diseases and thus can affect thyroid blood flow. Our aim was to investigate the relationship between vitamin D insufficiency/deficiency and thyroid hemodynamic indices in patients with Hashimoto thyroiditis. Methods: A total of 93 patients who presented to Sakarya University Endocrinology outpatient clinic from April to September 2016 and diagnosed with Hashimoto thyroiditis were included in this study. Clinical and serologic data, thyroid antibodies and 25(OH)D3 were evaluated. Mean peak systolic velocity(mPSV), mean end-diastolic velocity (EDV), mean resistive index (RI) flows of superior and inferior thyroid arteries were measured with B-mode Doppler ultrasonography. Results: Vitamin D insufficiency/deficiency was detected in 59 (63.4%). TPO Ab and TgAb levels were found higher in patients with vitamin D insufficiency/deficiency. In the normal vitamin D group, superior thyroid artery mPSV (32.21 +/- 6.73cm/s) and EDV(13.27 +/- 2.80 cm/s) were higher than in the low vitamin D group [mPSV (28.32 +/- 8.99cm/s) and EDV(10.67 +/- 3.68 cm/s)] (P=0.034, P=0.001, respectively). Inferior thyroid artery EDV value was higher in the normal compared to the low vitamin D group (0.032). RI measured in all arteries were higher in the vitamin D insufficient/deficient group compared to the Vitamin D normal group (p=0.001). Conclusion: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients.Öğe The effect of decreasing preload on valvular regurgitation in patients undergoing dialysis [Diyalize giren hastalarda önyük azalmasinin kapak yetersizliklerine etkisi](Turkiye Klinikleri, 2005) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Akdemir, Ramazan; Oğuzhan, Abdurrahman; Uyan, CihangirObjective: In chronic renal patients undergoing dialysis, calculations of left ventricular diameter and mass may be inordinately large and valve regurgitation may be develop to a high degree as a result of volume overload. In our study, we investigated the effect of ultrafiltration on left ventricular and atrial diameters, as well as on the collapsibility of the inferior vena cava and severity of valvular regurgitation present before dialysis. Material and Methods: A total of 30 patients, 16 male and 14 female, with a diagnosis of end-stage renal disease with hypervolemia and scheduled to undergo ultrafiltration in addition to hemodialysis were included in our study. Before and after ultrafiltration, left ventricular diastolic and systolic diameters, interventricular septum and posterior wall diastolic and systolic thicknesses, left atrial and aortic root diameters, and the severity of pericardial effusion, if present, were noted. Mitral, tricuspid, aortic and pulmonary valve functions were measured and, if regurgitation was present, its severity was staged in 4 categories. Inferior vena cava expiratory and inspiratory diameters were measured and a collapsibility index was calculated. Results: There was a significant decrease in left atrial and ventricular diastolic and systolic diameters after hemodialysis. Although the severity of mitral and tricuspid regurgitation decreased significantly, aortic and pulmonary regurgitation was not affected. A significant decrease in IVC expiratory and inspiratory diameters and an increase in collapsibility were noted. Conclusion: Dialysis causes significant changes in hemodynamic and echocardiographic parameters due to a decrease in intravascular fluid. In particular, a decrease in the presence and severity of valvular regurgitation occurs as a result of this procedure. Copyright © 2005 by Türkiye Klinikleri.Öğe Effect of reperfusion on P-wave duration and P-wave dispersion in acute myocardial infarction: Primary angioplasty versus thrombolytic therapy(2004) Akdemir, Ramazan; Özhan, Hakan; Gündüz, Hüseyin; Tamer, Ali; Yazıcı, Mehmet; Erbilen, Enver; Uyan, CihangirAtrial fibrillation is a common arrhythmia occurring in about 10-20% of patients with acute myocardial infarction. P-wave dispersion and P-wave duration have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P wave duration and dispersion in patients with acute anterior wall myocardial infarction. We have retrospectively evaluated 72 consecutive patients (24 women, 48 men; aged 58 ±12 years) experiencing a first acute anterior wall myocardial infarction (AMI). Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and on pach day of hospitalization. Maximum (P max) and minimum (P min) P wave durations and P wave dispersions (PWd) were calculated before and after treatment. There were no significant differences between the groups regarding age, gender, left ventricular ejection fraction (LVEF), left atrial diameter and volume, cardiovascular risk factors and duration from symptom onset to treatment. PWd and P wave durations were significantly reduced after PTCA (mean P max was 113±11 ms before and 95±17ms after the treatment [p=0.007]. Mean PWd was 46±12 ms before and 29±10 ms after the treatment (p=0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97±22 ms versus 114±16 ms and for PWd 31±13 ms versus 55±5 ms, respectively). Primary angioplasty reduces P max and P wave dispersion.Öğe Evaluation of right ventricular function in patients with thyroid dysfunction(Karger, 2006) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Seyfeli, Ergün; Kanat, Mustafa; Özhan, Hakan; Uyan, CihangirBackground: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. Patients and Methods: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. Results: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. Conclusions: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals. Copyright (c) 2006 S. Karger AG, Basel.Öğe A new effect of acetylsalicylic acid ? Significantly lower prevalence of nasal carriage of Staphylococcus aureus among patients receiving orally administered acetylsalicylic acid(Univ Chicago Press, 2006) Karabay, Oğuz; Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Uyan, CihangirWe aimed to evaluate effect of acetylsalicylic acid on the prevalence of nasal carriage of Staphylococcus aureus. Patients were orally administered a prophylactic dose of acetylsalicylic acid and then were compared with control subjects. The prevalence of nasal carriage of S. aureus was significantly lower among patients who received acetylsalicylic acid than among the control subjects (P < .001).Öğe Portal vein hemodynamics in patients with non-alcoholic fatty liver disease(Tohoku Univ Medical Press, 2008) Erdoğmuş, Beşir; Tamer, Ali; Büyükkaya, Ramazan; Yazıcı, Burhan; Büyükkaya, Ayla; Korkut, Esin; Korkmaz, UğurParalleling the rise in the incidence of obesity and diabetes worldwide, nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as one of the major causes of chronic liver disease. Doppler sonography is used as a diagnostic method in the non-invasive assessment of the hemodynamics of hepatic vascular flow in liver diseases. We investigated the effects of fatty infiltration in the liver on the Doppler flow hemodynamics of the portal vein. Doppler sonography of the liver and portal vein was performed in 60 subjects with NAFLD and 20 healthy volunteers (control). The patients were grouped into mild (grade 1), moderate (grade 2), and severe (grade 3) according to sonographic appearance of hepatosteatosis (n = 20 for each group). The vein pulsatility index (VPI), mean flow velocity (MFV), peak maximum velocity (V-max), and peak minimum velocity (V-min) of the portal vein were significantly lower in patients with NAFLD than those of the controls (p < 0.001). The VPI was 0.20 in the patients and 0.31 in the control. The MFV was 12.3 cm/sec in the patients and 16.5 cm/sec in the control group. The portal vein flow was found to be decreased as the grade of fatty infiltration increased for VPI (r = -0.946, p < 0.001),MFV(r=-0.951,p < 0.001). The alteration in Doppler waveform pattern of portal vein with fatty liver population suggests reduced vascular compliance in the liver.Öğe The relation between homocysteine and calcific aortic valve stenosis(Karger, 2005) Gündüz , Hüseyin; Arınç, Hüseyin; Tamer, Ali; Akdemir, Ramazan; Özhan, Hakan; Binak, Emrah; Uyan, CihangirBackground: In patients diagnosed with calcific aortic valve stenosis, cardiac risk factors are similar to those of coronary artery disease; homocysteine concentration is an independent risk factor for coronary artery disease. The aim of this study was to investigate the correlation between plasma homocysteine levels and aortic valve stenosis and the influence of homocysteine levels on the coexistence of coronary artery disease in patients with moderate to severe aortic valve stenosis. Methods: Fifty-eight patients who had been diagnosed with moderate to severe aortic stenosis formed the test group of this study, and 47 healthy subjects without coronary artery disease or aortic valve stenosis formed the control group. The patients with aortic stenosis were divided into two groups according to the presence or absence of coronary artery disease in their coronary angiograms. After 12 h fasting venous blood samples were collected and total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and homocysteine levels were measured and compared between the two groups. Measurements and Results: The mean blood homocysteine level was 10.8 +/- 3.3 mu mol/l in patients with aortic valve stenosis and 8.1 +/- 4.7 mu mol/l in the control group; the difference between these levels was statistically insignificant. The patients with aortic valve stenosis had significantly higher levels of total cholesterol and hypertension and were more likely to have a positive family history for coronary artery disease. When the two subgroups of patients with aortic valve stenosis were compared, mean blood homocysteine levels were 13.2 +/- 3.1 and 8.3 +/- 2.2 mu mol/l, respectively, showing significantly higher levels in the group with coronary artery disease. In this comparison patients with coronary artery disease were also found to have significantly higher levels of total cholesterol and LDL and they were more likely to be smokers. Conclusions: Although there was no relation between blood homocysteine levels and the existence of aortic valve stenosis, in cases with both coronary heart disease and aortic stenosis homocysteine levels were significantly higher than in the patients with pure aortic valve stenosis. Copyright (c) 2005 S. Karger AG, Basel.Öğe Relationship between P Wave Dispersion and Diastolic Dysfunction(2003) Gündüz, Hüseyin; Binak, Emre; Akdemir, Ramazan; Tamer, Ali; Ayarcan, Yasemin; Özkekelif, Mehmet; Uyan, CihangirDiastolic dysfunction of hypertrophic or ischemic left ventricle causes an increase in ventricular enddiastolic pressure and left atrial size. In this situation, continuity of sinus rhythm and atrial contractions are of great value for the maintenance of cardiac output. The aim of our study was to investigate the relationship between P wave dispersion, which is easily measured on the surface ECG and used in assessing the risk of atrial fibrillation, and left ventricular diastolic function. In our study, a total of 133 patients were included (73 patients with diastolic dysfunction assessed by transthorasic echocardiography and 60 patients without). P wave dispersions were calculated by measuring the P minimum and P maximum values on the surface ECG. The relation between P wave dispersion and presence of diastolic dysfunction, its etiology, severity and echocardiographic measurements were investigated. P dispersion was 53±9 ms in patients with diastolic dysfunction and 43±9 ms in the control group (p< 0.01). When the patients were grouped according to the stage of diastolic dysfunction, P dispersion was 48±7 ms in stage 1, 54±8 ms in stage 2 and 58±9 ms in stage 3. It was noted that as the severity of diastolic dysfunction increased, P dispersion also increased without reaching statistical significance (p> 0.05). When the etiology of diastolic dysfunction was considered, P dispersion was 53±8 ms in patients with ischemic heart disease, and 52±9 ms in patients with left ventricular hypertrophy and a significant difference was not present (p> 0.05). Hence, in patients with diastolic dysfunction, P dispersion increases but this increase is not related to the severity of diastolic dysfunction or its etiology. When clinical and echocardiographic parameters are taken into account, there was a weak but significant correlation only between P dispersion and left ventricular ejection fraction.Öğe The relationship between P wave dispersion and diastolic dysfunction(Texas Heart Inst, 2005) Gündüz , Hüseyin; Binak, Emre; Arınç, Hüseyin; Akdemir, Ramazan; Özhan, Hakan; Tamer, Ali; Uyan, CihangirWe investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and may be used in evaluating the risk of atrial fibrillation, and left ventricular diastolic function. There were 133 patients: 73 with diastolic dysfunction and 60 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and the presence, cause, severity, and echocardiographic measurements of diastolic dysfunction were investigated. P wave dispersion was 53 +/- 9 ms in patients with diastolic dysfunction and 43 9 ms in the control group (P < 0.01). When patients were grouped according to stage of diastolic dysfunction. P wave dispersion was 48 +/- 7 ms in stage 1, 54 +/- 8 ms in stage 2 and 58 +/- 9 ms in stage 3. As the severity of diastolic dysfunction increased, P wave dispersion increased but the difference did not reach statistical significance (P < 0.05). When the cause of diastolic dysfunction was considered, P wave dispersion was 53 +/- 8 ms in patients with ischemic heart disease and 52 +/- 9 ms in patients with left ventricular hypertrophy (P > 0.05). We conclude that P wave dispersion increases in diastolic dysfunction, but that this increase is not related to the severity or cause of diastolic dysfunction. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation only between P wave dispersion and left ventricular ejection fraction.Öğe The sedation in the endoscopic procedures(2006) Demiraran, Yavuz; Tamer, AliToday endoscopic examination is the best diagnostic method for the visualization of the upper and lower gastrointestinal system. In many countries endoscopic interventions have become better tolerated and more comfortable using sedoanalgesia and because it causes amnesia in patients repeated examinations are easier. Sedation during endoscopy is a conscious sedation that provides patient cooperation to verbal and and tactile stimuli. In gastroenterology sedation is applied in diagnostic and therapeutic endoscopic interventions for esophagus, stomach, duodenum and colon and during cholangiopancreaticography. The procedure of gastrointestinal endoscopy contains multiple standardized diagnostic and therapeutic procedures and has provided a perfect source for IV sedation studies. In gastrointestinal endoscopy sedation is applied safely by endoscopists that are experienced in sedation and analgesics. Especially in the pediatric group, in the presence of cardiac and pulmonary diseases and prolonged duration of the procedure, that the sedation is applied by anesthetists using standard maniterization is most appropriate.Öğe Spontaneous rupture of a coronary artery aneurysm - A case report and review of the literature(Japan Heart Journal, Second Dept Of Internal Med, 2004) Gündüz , Hüseyin; Akdemir, Ramazan; Binak, Emrah; Tamer, Ali; Uyan, CihangirCoronary artery aneurysm (CAA) is. a rare disorder, characterized by abnormal dilatation of a localized portion or diffuse segments of the coronary artery. CAA may cause angina, myocardial infarction, sudden death due to thrombosis, embolisation, or rupture. In this report, a 63 year old Turkish male patient is presented who had an acute non-Q wave myocardial infarction due to spontaneous rupture of the left circumflex artery aneurysm. An extremely rare clinical presentation of rupture of a left circumflex CAA is discussed.Öğe Use of tissue Doppler to assess right ventricle function in hemodialysis patients(Karger, 2005) Arınç, Hüseyin; Gündüz, Hüseyin; Tamer, Ali; Özhan, Hakan; Akdemir, Ramazan; Sağlam, Hayrettin; Uyan, CihangirAims: Although there are plenty of data about the differences in left ventricular tissue Doppler (TD) velocities by preload reduction, only a few studies regarding right ventricular function are found in the literature. We investigated the effect of intravascular volume reduction on right ventricular function by ultrafiltration in dialysis patients. Methods: 27 end-stage renal failure patients who were hypervolemic and undergoing hemodialysis were included in the study. TD studies of the right ventricle were performed before and 1 h after dialysis. These data were compared. Results: The mean age of the patients was 41 +/- 15 years and mean volume of ultrafiltration was 3.8 +/- 1.8 liters. Systolic, early and late diastolic lateral annular TD velocities before dialysis were 0.109 +/- 0.029, 0.088 +/- 0.039, 0.111 +/- 0.039 m/s, and after dialysis were 0.099 +/- 0.028, 0.078 +/- 0.036, 0.106 +/- 0.037 m/s, respectively ( p = 0.216, p = 0.112, p = 0.350). Myocardial early diastolic velocity decreased significantly ( p = 0.049) but systolic and late diastolic velocities did not change significantly ( p = 0.579, p = 0.146). Conclusion: Right ventricular systolic and diastolic velocities detected by TD were not or only minimally affected by preload reduction in hemodialysis patients and the TD early/late ratio is the most valuable variable that can predict right ventricular diastolic function. The right ventricular systolic and early diastolic TD velocities were positively correlated with left ventricle ejection fraction. Copyright (C) 2005 S. Karger AG, Basel.
