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Öğe Assessment of Left Ventricular Myocardial Performance by Tissue Doppler Echocardiography in Patients with Polycythemia Vera(WILEY-BLACKWELL, 2011) Kayrak, Mehmet; Acar, Kadir; Gul, Enes Elvin; Baglicaklioglu, Murat; Kaya, Zeynettin; Sonmez, Osman; Aydogdu, IsmetAims: The aim of this study was to evaluate myocardial performance index (MPI) which reflects the combined systolic and diastolic performance of the ventricles by tissue Doppler imaging (TDI) in patients with polycythemia vera (PV). Method and Materials: Twenty-eight patients with PV (17 men; mean age 60 +/- 9 years) and 30 age-matched healthy subjects were prospectively evaluated. The diagnosis of PV was performed according to the World Health Organization (WHO) criteria. Left ventricular (LV) systolic and diastolic functions were assessed by conventional echocardiography and TDI. MPI of both the LV and right ventricles (RV) were measured by TDI method. Results: The LV MPI was significantly higher in PV group than in the controls (0.61 +/- 0.16 vs. 0.49 +/- 0.05; P = 0.001). Also, the RV MPI was impaired in patients with PV compared to the control subjects (0.51 +/- 0.11 vs. 0.43 +/- 0.09; P = 0.005). RV late A filling velocity (Am) and RV isovolumetric relaxation time were significantly higher in the PV group compared to healthy subjects (P = 0.03 and 0.05, respectively). In logistic regression models, PV was determined as an independent predictor of impaired MPI (odds ratio: 3.7; CI 95%, 1.2-7.5). In addition, pulmonary arterial pressure was significantly elevated in patients with PV compared to the controls (P = 0.02). Conclusion: This study demonstrated that biventricular MPI is impaired in patients with PV. (Echocardiography 2011;28:948-954)Öğe The association between myocardial iron load and ventricular repolarization parameters in asymptomatic beta-thalassemia patients(2012) Kayrak, Mehmet; Acar, Kadir; Gül, Enes Elvin; Özbek, Orhan; Abdulhalikov, Turyan; Sönmez, Osman; Alibaşiç, HayruddinPrevious studies have demonstrated impaired ventricular repolarization in patients with ?-TM. However, the effect of iron overload with cardiac T 2 * magnetic resonance imaging (MRI) on cardiac repolarization remains unclear yet. We aimed to examine relationship between repolarization parameters and iron loading using cardiac T 2 * MRI in asymptomatic ?-TM patients. Twenty-two ?-TM patients and 22 age- and gender-matched healthy controls were enrolled to the study. From the 12-lead surface electrocardiography, regional and transmyocardial repolarization parameters were evaluated manually by two experienced cardiologists. All patients were also undergone MRI for cardiac T 2 * evaluation. Cardiac T 2 * score <20msec was considered as iron overload status. Of the QT parameters, QT duration, corrected QT interval, and QT peak duration were significantly longer in the ?-TM group compared to the healthy controls. T p - T e and T p - T e dispersions were also significantly prolonged in ?-TM group compared to healthy controls. (T p - T e) / QT was similar between groups. There was no correlation between repolarization parameters and cardiac T 2 * MRI values. In conclusion, although repolarization parameters were prolonged in asymptomatic ?-TM patients compared with control, we could not find any relation between ECG findings and cardiac iron load. Copyright © 2012 Mehmet Kayrak et al.Öğe Does Smoking Amplify the Risk of Acute Myocardial Infarction Related with Pregnancy in Factor V Leiden Carriers?(AKAD DOKTORLAR YAYINEVI, 2009) Yazici, Mehmet; Acar, Kadir; Kayrak, Mehmet; Ayhan, S. Selim; Dogan, Umuttan; Ulgen, Mehmet S.[Abstract not Available]Öğe Electrocardiographic Findings in Patients with Polycythemia Vera(IVYSPRING INT PUBL, 2012) Kayrak, Mehmet; Acar, Kadir; Gul, Enes Elvin; Abdulhalikov, Turyan; Baglicaklioglu, Murat; Sonmez, Osman; Kaya, ZeynettinBackground: The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV. Method and materials: Sixty patients with PV (34 male, mean age 58 +/- 11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (T-peak-T-end interval (T-p-T-e) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads. Results: QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (p<0.01 and p<0.01, respectively). The T-p-T-e was longer and the T-p-T-e/QT ratio was significantly higher in the PV group compared to the controls. P-wave analyses showed that all P-wave parameters including Pmax, Pmin, P dispersion, and Pi were significantly prolonged in PV patients compared to the controls. The increase of both T-p-T-e and P max in the PV group was independent of age, BMI, diabetes and hypertension, gender, systolic blood pressure, hemoglobin, hematocrit, left atrial dimension, left ventricular end-diastolic diameter and early deceleration time in a univariate analysis of co-variance model (F= 11.097, p= 0.001 and F= 31.537, p= 0.0001, respectively). Conclusion: The present study demonstrated that PV may be associated with electrocardiographic abnormalities of both atrium and ventricle.Öğe Haemostatic Role and Histopathological Effects of a New Haemostatic Agent in A Rat Bladder Haemorrhage Model: An Experimental Trial(WILEY-BLACKWELL, 2010) Kılıç, Özcan; Gönen, Murat; Acar, Kadir; Yurdakul, Talat; Avunduk, Mustafa Cihat; Esen, Hacı Hasan; Öz, MehmetOBJECTIVE To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper (R) (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds. MATERIALS AND METHODS In all, 20 male Sprague-Dawley rats were divided into two equal groups. In both groups, the mucosa was damaged on the posterior wall (PW) of the bladder. The liquid form of ABS was applied to the bleeding area of one group (group 1) and 0.9% NaCl to the bleeding area of the other group (group 2, controls). The solutions were applied drop by drop with a 2 mL injector until the bleeding stopped and the bleeding times recorded. For histopathological examination, two tissue samples were taken from all rats in each group; one from the damaged mucosa in the PW and one from undamaged mucosa in the lateral wall (LW). Two sections were prepared from all samples. One section was stained with haematoxylin and eosin (H&E), and the rest was used for immunohistochemical staining for fibronectin. RESULTS The mean bleeding times were 65 s and 147 s for groups 1 and 2, respectively (P < 0.001). In the pathological specimens stained with H&E, fibrosis and other studied pathological features were similar in the LW samples in groups 1 and 2. Similarly, there were no differences between the PW samples of groups 1 and 2. In the pathological specimens stained for fibronectin, the number of attenuated cells was similar in the LWs of group 1 and 2 (P = 0.21) as well as in the PWs of each group (P = 0.066). CONCLUSIONS ABS decreased bleeding time and did not increase fibrotic reactions in rat bladder tissue.Öğe Hepatitis B reactivation with fulminant hepatitis during rituximab chemotherapy in a patient with follicular lymphoma(2010) Acar, Kadir; Göktepe, Mevlüt Hakan; Polat, İlker; Atalay, HüseyinA 52-year-old man was diagnosed Follicular lymphoma with autoimmune hemolytic anemia. At time of diagnosis his HBs Ag was (+), Anti-HBs (-), and HBV DNA was negative. Chemotherapy was interrupted after tree cycles of R-CVP due to elevated liver enzyme. At that time HBV DNA became positive. Lamivudine therapy was started, whereas patient died due to fulminant hepatic failure. The high morbidity and mortality of this complication is one of the major obstacles to completing the standard treatment for lymphoma in HBV carriers. Thus, preventive therapy with nucleoside or nucleotide analogs should be started before the chemotherapy to prevent HBV reactivation.Öğe Pericardial Hemorrhage Due to Acetylsalicylic Acid in a Patient With Essential Thrombocythemia(SAGE PUBLICATIONS INC, 2009) Kayrak, Mehmet; Acar, Kadir; Yazici, Mehmet; Kaya, Coskun; Ayhan, S. Selim; Gok, HasanEssential thrombocythemia is a clonal myeloproliferative disorder that Causes thrombocytosis. Essential thrombocythemia is characterized by increased incidence of thrombosis with arterial event more than venous events and hemorrhagic complications. Acetylsalicylic acid enhances both minor and major bleedings. The authors describe pericardial hemorrhage, which is related to the use of low-dose acetylsalicylic acid in a patient with essential thrombocythemia. The patient was Successfully managed with clopidogrel therapy during the 16 Months follow-up without recurrent thrombotic or hemorrhagic events.Öğe Prediction of Atrial and ventricular Arrhytmias by Twelve-lead Electrocardiography in Patients with Polycythemia Vera(ELSEVIER IRELAND LTD, 2011) Kayrak, Mehmet; Acar, Kadir; Gül, Enes Elvin; Bağlıcaklıoğlu, Murat; Kaya, Zeynettin; Abdulhalikov, Turyan; Arı, Hatem[Abstract not Available]Öğe Relationship between color M-mode echocardiography flow propagation and cardiac iron load on MRI in patients with thalassemia major(TURKISH SOC RADIOLOGY, 2012) Ozbek, Orhan; Acar, Kadir; Kayrak, Mehmet; Ozbek, Seda; Gul, Enes Elvin; Ucar, Ramazan; Paksoy, YahyaPURPOSE Myocardial iron overload remains an important problem and results in cardiac dysfunction in patients with thalassemia major (TM). The ratio of color M-mode flow propagation velocity to early diastolic transmitral flow velocity (E/Vp) in echocardiography is a marker of increased left ventricular filling pressure, which is independent of preload, afterload, and heart rate. We examined the relationship between E/Vp and iron loading in patients with TM using cardiac magnetic resonance imaging (MRI). MATERIALS AND METHODS Twenty-one TM patients and 21 age-matched healthy controls were enrolled in the study. Transmitral flow, pulmonary vein velocities, and Vp were obtained by two blinded echocardiographers. Left ventricular isovolumetric relaxation time (IVRT) was measured in the apical long axis by echocardiography. All patients also underwent MRI for cardiac T2* evaluation of iron overload. An increased E/Vp was defined as >1.5. RESULTS The E/Vp ratio was increased in TM patients compared with control subjects (1.7+/-0.4 and 1.2+/-0.2, P < 0.01, respectively). There was no correlation between E/Vp and cardiac T2* value. E/Vp was significantly correlated with IVRT (r=0.51, P = 0.02). In addition, the cardiac T2* value was comparable in patients with an E/Vp >1.5 and E/Vp <= 1.5 (21.1+/-9.8 ms vs. 22.3+/-8.0 ms, P = 0.80, respectively). CONCLUSION E/Vp may be a marker of diastolic abnormality that is independent from myocardial iron load in TM patients with preserved left ventricular function.Öğe Safety profiles of total dose infusion of low-molecular-weight iron dextran and high-dose iron sucrose in renal patients(WILEY, 2011) Atalay, Huseyin; Solak, Yalcin; Acar, Kadir; Govec, Nilgun; Turk, SuleymanIron sucrose and low-molecular-weight iron dextran (LMW-ID), two commonly used iron solutions, have been compared in terms of allergic adverse event profiles to date. However, the safety of total dose infusion of LMW-ID has been investigated by only one study in chronic kidney disease (CKD) (not dialysis) patients. Thus, we aimed to compare adverse event profiles of total and high-dose LMW-ID and iron sucrose infusions in a heterogenous renal patient group comprising CKD, hemodialysis, and peritoneal dialysis. In this retrospective chart review study, we included 110 predialysis CKD, 101 peritoneal dialysis, and 118 hemodialysis patients. We included a total of 329 patients who were administered parenteral iron sucrose or LMW-ID between September 2006 and April 2010. Adverse events were determined both by medical and nursing follow-up notes. Laboratory data and clinical characteristics were collected from patient charts. Adverse event rates were compared between iron sucrose and LMW-ID infusions. In a total of 329 patients, 530 infusions (3470 ampules) were administered. We detected adverse reaction in only 1 patient. This adverse reaction, which manifested as generalized pruritus, occurred in a patient who received 500 mg of iron sucrose infusion. There were neither anaphylactic reactions nor deaths associated with infusion of either preparation. We did not observe any other adverse event related to administration of 500 and 1000 mg of iron sucrose at single infusion. The results of this study showed comparable safety of total dose LMW-ID and high-dose iron sucrose in a heterogenous group of renal patients.Öğe Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study(SPRINGER, 2013) Ozbek, Orhan; Acar, Kadir; Koc, Osman; Saritas, Kadir; Toy, Hatice; Solak, Yalcin; Ozbek, SedaRenal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.Öğe Soluble platelet glycoprotein V in distinct disease states of pathological thrombopoiesis(NATL MED ASSOC, 2008) Acar, Kadir; Aksu, Salih; Beyazit, Yavuz; Haznedaroglu, Ibrahim C.; Koca, Ebru; Cetiner, Deniz; Sayinalp, NilguenQuantitative platelet disorders (i.e., thrombocytosis or thrombocytopenia) may also be associated with qualitative platelet alterations. Clonal thrombocythemia (CT), reactive thrombocytosis (RT), immune thrombocytopenic purpura (ITP), and thrombocytopenia of aplastic pancytopenia (AA) or infiltrative bone marrow disorders represent the major classes of pathological thrombopoiesis. Glycoprotein V may serve as an in vivo marker of platelet activation in thrombotic and hemorrhagic states. The aim of this study was to assess circulating plasma soluble platelet glycoprotein V (sGPV) concentrations in distinct disease states of pathological thrombopoiesis. The whole study group comprised 20 patients with thrombocytopenia, 32 patients with thrombocytosis and 14 healthy adults as the control group. sGPV was significantly increased in the group of thrombocytosis patients in comparison to the thrombocytopenic group and the healthy control groups. When sGPV levels were corrected according to platelet number (sGPV/tr), this ratio was very high in patients with thrombocytopenia compared to patients with thrombocytosis and the control group. Our results suggest that there is an ongoing platelet activation associated with thrombocytosis regardless of its origin is either CT or RT. Therefore, glycoprotein V system may serve to activate residual platelets in thrombocytopenia regardless of its origin is either ITP or AA.Öğe Splenic artery embolization with Ankaferd blood stopper in a sheep model(AVES, 2016) Koc, Osman; Acar, Kadir; Ozbek, Orhan; Guler, Ibrahim; Saritas, Kadir; Erdem, Tuba Bera; Solak, YalcinPURPOSE Splenic artery embolization is a minimally invasive therapeutic procedure utilized in a number of disorders. Ankaferd blood stopper (ABS) is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We aimed to investigate the safety and efficiency of ABS for splenic artery embolization in a sheep model. METHODS Seven adult female sheep were included in the study. Selective celiac angiography was performed using a 5F diagnostic catheter and then a 2.7F hydrophilic coating microcatheter was advanced coaxially to the distal part of the main splenic artery. Under fluoroscopic guidance, 6 mL mixture composed of half-and-half ABS and contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration and stagnation of the flow. Control celiac angiograms were obtained immediately after the embolization. After the procedure, the animals were observed for one day and then sacrificed with intravenous sodium thiopental. RESULTS Technical success rate was 100%. None of the animals died or experienced a major systemic adverse event during the procedure. All of the spleens appeared dark on macroscopic examination due to excessive thrombosis. Microscopically, the majority of the splenic sinusoids (90%-95%) were necrotic. CONCLUSION In our study, splenic artery embolization by ABS was found to be safe and effective in the short-term. Further studies are needed to better understand the embolizing potential of this novel hemostatic agent.Öğe Successful pericardiocentesis for cardiac tamponade in a patient with thrombocytopenic acute lymphocytic leukemia(2012) Sönmez, Osman; Gül, Enes Elvin; Soylu, Ahmet; Acar, Kadir; Almaz, EmineLenfomaların klinik belirtisi olarak kardiyak tamponadların (KT) görülme sıklığı çok nadirdir. Perikardın lösemik infiltrasyonunun post-mortem dönemde sık görülmesine rağmen klinik olarak kardiyak tamponadların görülmesi nadirdir. Biz lösemide gelişen kardiyak tamponad vakasını sunmak istiyoruz. Tekrarlayan ve refraktör akut lenfositik lösemiden (ALL) dolayı kemoterapi alan hastanın kardiyak tamponadı ve ciddi trombositopenisi mevcuttu. On beş gün başarılı bir şekilde ibuprofen-kolşisin tedavisi gören hastada acil ve zorunlu perikardiyosentez sonrası herhangi bir kanama komplikasyonu gelişmeden perikardiyal effüzyonun tamamen rezolüsyonunu gözlemledik. Ağır trombositopeni gibi kritik durumlara rağmen acil perikardiyosentezin hayat kurtarıcı olması bu olgunun heyecan verici özelliğidir.Öğe Thrombopoietic Cytokines and Platelet Count in Multiple Myeloma(FERRATA STORTI FOUNDATION, 2009) Özkurt, Zübeyde Nur; Yağcı, Münci; Acar, Kadir; Sucak, Gülsan Türköz; Haznedar, Rauf[Abstract not Available]
