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    Assessment of Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Obese Subjects
    (Wiley, 2011) Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Ermis, Necip; Yagmur, Murat; Atas, Halil; Tasolar, Hakan
    Our aim was to evaluate whether atrial electromechanical delay measured by tissue Doppler imaging (TDI), which is an early predictor of atrial fibrillation (AF) development, is prolonged in obese subjects. A total of 40 obese and 40 normal-weight subjects with normal coronary angiograms were included in this study. P-wave dispersion (PWD) was calculated on the 12-lead electrocardiogram (ECG). Systolic and diastolic left ventricular (LV) functions, inter-and intra-atrial electromechanical delay were measured by TDI and conventional echocardiography. Inter-and intra-atrial electromechanical delay were significantly longer in the obese subjects compared with the controls (44.08 +/- 10.06 vs. 19.35 +/- 5.94 ms and 23.63 +/- 6.41 vs. 5.13 +/- 2.67 ms, P < 0.0001 for both, respectively). PWD was higher in obese subjects (53.40 +/- 5.49 vs. 35.95 +/- 5.93 ms, P < 0.0001). Left atrial (LA) diameter, LA volume index and LV diastolic parameters were significantly different between the groups. Interatrial electromechanical delay was correlated with PWD (r = 0.409, P = 0.009), high-sensitivity C-reactive protein (hsCRP) levels (r = 0.588, P < 0.0001). Interatrial electromechanical delay was positively correlated with LA diameter, LA volume index, and LV diastolic function parameters consisting of mitral early wave (E) deceleration time (DT) and isovolumetric relaxation time (IVRT; r = 0.323, P = 0.042; r = 0.387, P = 0.014; r = 0.339, P = 0.033; r = 0.325, P = 0.041; respectively) and, negatively correlated with mitral early (E) to late (A) wave ratio (E/A) (r = -0.380, P = 0.016) and myocardial early-to-late diastolic wave ratio (E-m/A(m)) (r = -0.326, P = 0.040). This study showed that atrial electromechanical delay is prolonged in obese subjects. Prolonged atrial electromechanical delay is due to provoked low-grade inflammation as well as LA enlargement and early LV diastolic dysfunction in obese subjects.
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    Multivessel Coronary Thrombosis in a Patient with Idiopathic Thrombocytopenic Purpura
    (Texas Heart Inst, 2012) Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Yagmur, Murat; Eyupkoca, Ferhat; Ermis, Necip; Akturk, Erdal
    A 49-year-old woman who had idiopathic thrombocytopenic purpura was admitted to our hospital with severe chest pain. Electrocardiography revealed inferolateral myocardial infarction. The patient underwent immediate coronary angiography, which revealed thrombi in the left coronary system. Percutaneous intervention was not indicated, because the thrombi had occluded the distal segments of multiple coronary arteries. Administration of tirofiban satisfactorily dissolved the thrombi. (Tex Heart Inst J 2012;39(6):881-3)
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    An Uncommon Presentation in Behcet's Disease: Recovered Descending-Colon Perforation with Conservative Medical Therapy: Case Report
    (Ortadogu Ad Pres & Publ Co, 2011) Demirel, Ulvi; Harputluoglu, Murat M.; Yagmur, Murat; Seckin, Yuksel; Isik, Burak; Aladag, Murat
    Behcet's disease is a multisystem disorder. Intestinal involvement is common in patients from the Far East, but is rare among those from the Middle East. The most frequent area of involvement is the ileocecal region. Although intestinal perforations of Behcet's disease are most frequently seen in the cecum, perforations of the sigmoid and descending colon have also been reported in the literature. A 45-year-old man with Behcet's disease admitted to our hospital with abdominal pain and active lower gastrointestinal bleeding. A colonoscopic examination revealed multiple perforated ulcers in the descending colon. He was followed-up conservatively, and no surgical intervention was required. Descending-colon perforation is a rare complication of Behcet's disease. Our patient recovered with conservative medical treatment, without surgery. Therefore, this case suggests that medical treatment with close follow-up may be useful in the management of intestinal perforations in Behcet's disease.