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Öğe Glucose-insulin-potassium therapy and its effects on signal-averaged electrocardiography in acute myocardial infarction(2000) Ulgen M.S.; Iltimur K.; Karadede A.; Alan S.; Toprak N.Low amplitude signals (LP) at the end of the QRS in patients with acute myocardial infarction (AMI) are related to fragmentation of the electrical impulse in ventricular myocardium and detected on signal-averaged electrocardiography. In this study, we investigated the use of glucose- insulin-potassium (GIK) solution and its effects on the SAECG in AMI. Methods: Seventy-two consecutive patients diagnosed with first Q-wave AMI were prospectively studied. Thrombolytic therapy was given to all patients unless contraindicated. The patients were randomly given glucose-insulin- potassium (GIK, n=34) solutions which consisted of 300 g of glucose, 50 units of insulin and 80 mEq of KCl in 1000 cc water placebo (saline, n.38). Ambulatory electrocardiographic examinations were performed in all patients between 24-48th hours. Sub-maximal exercise testing (if not contraindicated), signal-averaged electrocardiogram (SAECG) and echocardiographic records were obtained before discharge (6-9, mean 7 days). In postdischarge early period (in 30-40 days after index infarction) SAECG and echocardiography recordings were repeated. Results: There were no differences found between both groups in view of ages, number of risk factors, localization of infarction. In pre- discharge evaluations total filtered QRS duration (FQRS1: 103±7 msec vs 108±11 msec p<0.05), low-amplitude terminal signal duration (HFLA1: 25±8 msec vs 32±11 msec, p<0.01) and frequency of VLP1 (%20 vs %45 p<0.05) were found to be lower while root mean square voltage of the terminal 40 msec of the QRS (RMS-401: 45±18?V vs 36±20?V p<0.05), left ventricle ejection fraction (EF: 54±9 vs 48±8, p<0.05) to be higher in GIK when compared with the placebo group. In post discharge evaluations, FQRS2 (105±8 vs 110±10, p=0.05), HFLA2 (26±7 vs 34±10, p<0.01) and frequency of VLP2, (%25 vs %38, p>0.05) were found to be lower while RMS-402 (47±21 vs 33±19 p<0.05) and EF2 (59±10 vs 52±11, p<0.05) were higher in the GIK compared with the placebo group. The incidence of post-MI angina pectoris was significantly lower in the GIK-administered group (p<0.005) than in the placebo groups. The incidence of premature ventricular contraction was insignificantly lower in the GIK-administrated group (p>0.05). We concluded that using GIK solutions at the early stages of AMI may be beneficial on the SAECG, angina incidence, and left ventricular systolic performance in the pre-and postdischarge early period of AMI.Öğe The relation between infarction localization and late potentials(2001) Iltümür K.; Karabulut A.; Temamogullari A.V.; Karadede A.; Alan S.; Siddik Ulgen M.; Toprak N.OBJECTIVE: There are controversies about the relation between infarction localization and late potentials (LP) following acute myocardial infarction (AMI). To evaluate this issue 124 consecutive patients with first Q-wave AMI fulfilling the inclusion criteria were enrolled in this signal--averaged ECG (SAECG) study. METHODS: The patients were divided into three groups according to infarction localization: anterior (Group I n = 62; 50%), inferior (Group II: n = 42; 34%) and both inferior and right ventricular (RV) involvement (Group III n = 20; 16%). SAECG records were performed during the second week. LP results were evaluated as positive when at least two of the major criteria (QRS > 114 ms, LAS 40 > 38 ms, RMS < 20 V) were obtained. Tukey--Cramer multivariate analysis was performed. RESULTS: Positive LP results were obtained in 29% of group I, 35.7% of group II and 55% of group III patients. Patients with both inferior and RV involvement had a significantly higher positive LP results independent from left ventricular ejection fraction. CONCLUSION: Therefore, increased risk of arrhythmia in those patients with both inferior MI localization and RV involvement should be taken into consideration.Öğe The relation between ST segment elevation shape and low dose dobutamine stress echocardiography and clinical course in early period of anterior myocardial infarction(2001) Karadede A.A.; Temamo?ullari A.V.; Aydinalp Ö.; Ülgen M.S.; Alan S.; Iltümür K.; Toprak N.Although a relation between magnitude of ST segment elevation and myocardial damage was shown in early period of acute myocardial infarction, such a relation among shape of the ST segment elevation, myocardial damage and clinical course remains obscure. Sixty-two patients with acute anterior MI, in the first six hours of their first heart attack were enrolled for the study. Based on the precordial V3 derivation prior to thrombolytic treatment, the shape of the ST elevation was separated into three groups as concave (n=26), straight (n=24) or convex types (n= 12). The relation between the shape of the elevation recorded on admission and both results of low dose (5 and 10 ?g/kg/min) dobutamine stress echocardiography (LDSE) performed (n=53) in early period (the sixth day) of infarction and clinical course were investigated. Wall Motion Score Index (WMSI) was evaluated based on a 16-segmented scoring system of which nine segments were supplied by left anterior descending artery (LAD) and points were given for each segment from one (normal) to four (dyskinetic). Basal WMSI and response to LDSE were better in LAD region. Additionally both average akinetic segment number in infarct zone was higher and improvement in these segments were less in convex and straight groups (Concave 3,78±2 vs. 2,17±2.1 p<0.01; straight 5,15±2.7vs. 4,45±2,8, NS; convex 5,4±2,3 vs. 4,8±2,1 NS; basal vs. LDSE). Although only 13% (3/23) of the patients had no improvement in LDSE in Group A (p<0.05 v.s. group B and p<0.01 v.s. group C), 35% (7/20) of group B and 60% (6/10) of Group C patients were without improvement in LDSE. Although no relation was found between better left ventricular function (WMSI <2) and shape of the ST elevation in basal evaluation in multiple logistic regression analysis (p=0.06), an independent relation was found following LDSE (p=0.01, OR 4.5, %95CI 1.3-14.7). There was no in-hospital death in concave group whereas five patients died in either straight or convex group. Arrhythmia occurrence was lower in concave group during this period (p<0.05), and exercise capacities were lower. Conclusively, we suggested that there was an increased viability in infarct zone and decreased in-hospital mortality in patients with concave ST elevation on admission. This simple classification would be beneficial to estimate left ventricular functions at discharge.Öğe Successful treatment of Wilms' tumor with intracaval extension by preoperative chemotherapy: Report of two cases(2000) Dokucu A.I.; Öztürk H.; Söker M.; Alan S.; Bükte Y.; Özçelik C.; Zincircio?lu B.Two patients presenting with advanced Wilms' tumor extending to inferior vena cava anal right atrium, were successfully treated with chemotherapy and surgery. The first case presented with a right renal mass and intraatrial tumor extension. The original mass regressed 28 % in volume while the thrombus remained at the vena cava as it was before chemotherapy. Surgery was performed via laparotomy and sternotomy. The second case presented with bilateral Wilms' tumor and intracaval extension up to the right atrium. In this case, both renal masses and intracaval thrombus well regressed (up to 80 %) with chemotherapy. Surgical excision of the both masses and removal of intracaval thrombus were performed via laparotomy. The results obtained with preoperative chemotherapy as in these two patients mediates strongly against difficult surgery being undertaken as primary treatment for such patients.Öğe The value of late potential anaysis as a reperfusion criterion in acute myocardial infarction(2000) Iltümür K.; Kaymak H.; Ülgen M.S.; Temamoğullari A.V.; Karabulut A.; Karadede A.; Alan S.Various methods are available to evaluate reperfusion following thrombolytic treatment (TT) in Acute Myocardial Infarction (AMI). A few authors reported an inverse correlation between late potential (LP) positiveness and reperfusion in signal averaged ECG studies. Current prospective study was planned to investigate the value of LP analysis as a criterion of reperfusion following TT in AMI. METHODS:Ninety-two AMI patients (76 males and 16 females, with an average age of ± years) who were admitted to our clinics in the first twelve hours of pain initiation and were exposed AMI first time were enrolled. All patients had TT (TPA, n=31 or Streptokinase, n=61). Their clinical and labaratory parameters were recorded. RESULTS:Infarct related vessel was demonstrated angiographically in 69 patients (75%). Twenty-three (25%) had an occluded infarct related vessel. The LP incidence was quite low in cases with a patent infarct related vessel (7%) whereas it was higher in those with an occluded vessel (80%)(p<0.0001).Sensivity, specificity, positive and negative predictive values of LP analysis to put forward infarct related vessel patency were 95%, 80%, 92% and 87%, respectively. CONCLUSION: LP analysis with signal-averaged ECG might be used as a reperfusion criterion in AMI cases following TT.
