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Öğe Apolipoprotein E Genotype in Patients with Cerebrovascular Diseases and its Effect on the Disease Outcome(Taylor & Francis Ltd, 2009) Tamam, Yusuf; Tasdemir, Nebahat; Toprak, Recep; Tamam, Banu; Iltumur, KenanA total of 100 hospitalized stroke patients and 30 healthy controls were included in a study aiming to determine the predictive role of ApoE genotype polymorphism for stroke outcome in the Turkish population. The most frequent ApoE genotype was 3/3 reflecting Asian population polymorphic distribution. ApoE polymorphism in the Eastern Turkish population was found to be independent of stroke type, OSCP subtypes of infarction, localization of hemorrhage, severity of carotid artery stenosis, and resultant stroke outcome. Distinct polymorphic results in populations from nearby regions suggest a multifactorial pathogenesis and presence of very complex genetic factors in the development of stroke and stroke outcome.Öğe Coexisting subarachnoid hemorrhage and subdural hematoma mimicking acute anterolateral myocardial infarction(Churchill Livingstone Inc Medical Publishers, 2007) Iltumur, Kenan; Tamam, Yusuf; Karahan, Zulkuf; Guzel, Aslan; Altindag, RojhatIschemic electrocardiographic changes, elevations in cardiac-specific markers such as troponin and creatinine phosphokinase NIB, segmental wall motion abnormalities, and myocardial dysfunction may occur after central nervous system events such as subarachnoid hemorrhage, subdural hematoma, and ischemic stroke. The pathophysiology remains unclear, but a catecholamine-induced neurocardiogenic injury has been mentioned as a causative factor. We reported a case of coexisting subarachnoid hemorrhage and subdural hematoma with ischemic electrocardiography changes, increases in cardiac-specific enzymes, and a regional wall motion abnormality despite normal epicardial coronary arteries. It is very important to differentiate neurogenic stunned myocardium from myocardial dysfunction caused by coronary artery disease in patients with intracranial hemorrhages for appropriately managing the treatment of cases. (c) 2007 Elsevier Inc. All rights reserved.Öğe EFFECT OF LEVOSIMENDAN VERSUS DOBUTAMIN ON LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTIONS IN PATIENTS WITH DECOMPENSATED HEART FAILURE(Elsevier Ireland Ltd, 2010) Iltumur, Kenan; Kaplangoray, Mustafa; Toprak, Nizamettin[Abstract Not Available]Öğe Elevated plasma N-terminal pro-brain natriuretic peptide levels in acute ischemic stroke(Mosby-Elsevier, 2006) Iltumur, Kenan; Karabulut, Aziz; Apak, Ismail; Aluclu, Ufuk; Ariturk, Zuhal; Toprak, NizamettinBackground B-type natriuretic peptide (BNP) is a neurohormone secreted mainly in the cardiac ventricles in response to volume expansion and pressure overload. The aim of this study was to assess plasma N-terminal proBNP (NT-proBNP) changes in acute ischemic stroke (AIS). Methods The study group consisted of 57 (37 women aged 64 12 years) patients who had their first AIS and no history or signs of cardiovascular disease. An age-matched control group was also included (n = 57, 36 women aged 61 6 years). NT-proBNP, troponin I (TnI), and creatine kinase-MB were evaluated. A thorough cardiovascular and neurological investigation, including imaging techniques and lesion size determination, was also performed. Results The log NT-proBNP peak levels, TnI, and creatine kinase-MB levels were significantly higher in AIS compared with controls (7.25 +/- 1.77 vs 3.48 +/- 0.76 mu g/mL, P < .0001; 0.76 +/- 0.54 vs 0.5 +/- 0.0 ng/mL, P < .001; 57 +/- 37 vs 13 +/- 4 U/L, P < .001, respectively). The log NT-proBNP correlated positively with TnI (r = 0.29, P = .03) and heart rate (r = 0.41, P = .002), and negatively with left ventricular ejection fraction (r = -0.67, P < .0001). Patients with signs of marked myocardial ischemia and patients with insular cortex involvement had even higher NT-proBNP levels. After adjustment for relevant factors, the relation between the log NT-proBNP and AIS as well as insular cortex involvement was observed to be insignificant (P > .05 for both). Conclusions Our results show that NT-proBNP plasma levels are significantly elevated in AIS and might be of clinical importance as a supplementary tool for the assessment of cardiovascular function in patients with AIS.Öğe Evaluation of testosterone levels in men with metabolic syndrome(Turkish Soc Cardiology, 2005) Iltumur, Kenan; Karabulut, Aziz; Toprak, Gulten; Yokus, Beran; Toprak, NizamettinObjectives: Low plasma levels of testosterone in men are associated with increased risk for atherosclerosis. In this study, we assessed plasma testosterone levels in patients with metabolic syndrome (MS) and its relationship with MS parameters. Study design: The study consisted of 36 men (mean age 50.2 +/- 7.2 years) with a diagnosis of MS according to the NCEP (National Cholesterol Education Program) criteria. An age-matched control group comprising 39 healthy volunteers (mean age 48.3 +/- 8.1 years) was also included. Plasma testosterone levels were determined by electro-chemiluminescence immunoassay on the Roche Elecsys 2010 analyzer. Fasting blood samples were analyzed for glucose and insulin levels, and lipid profiles (total cholesterol, triglyceride, LDL, and HDL). In addition, HOMA (Homeostasis Model Assessment) index was calculated. Results: The mean plasma testosterone level was significantly lower in the patient group (3.6 +/- 0.8 vs 4.8 +/- 1.9 ng/ml, p=0.001). There was a significant correlation between the levels of testosterone and HDL cholesterol (r=0.25, p<0.05). Testosterone levels were inversely correlated with the following: body mass index (r=-0.41, p<0.001), waist circumference (r=-0.40, p<0.001), HOMA index (r=-0.31, p=0.008), insulin (r=-0.28, p<0.05), glucose (r=-0.29, p<0.05), triglyceride (r=-0.28, p<0.05), and very low density lipoprotein (r=-0.28, p<0.05). Multivariate analysis identified only body mass index as an independent correlate of testosterone (beta=-0.36, p=0.038). Conclusion: Our results show that plasma testosterone levels are significantly decreased in MS. This may be of clinical importance for the assessment of cardiovascular risks in male patients with MS.Öğe The incidence of congenital coronary artery anomalies in the Southeast Anatolia Region(Turkish Soc Cardiology, 2005) Karabulut, Aziz; Iltumur, Kenan; Gulsum, Samet; Toprak, NizamettinObjectives: We retrospectively reviewed patients who underwent routine coronary angiography in our catheterization laboratory in order to determine the incidence of congenital coronary artery anomalies in the Southeast Anatolia Region of Turkey. Study design: Catheterization reports of 5,018 patients who underwent coronary angiography from January 1998 to April 2005 were reviewed. Cineangiographies and records of patients in whom anomalous coronary arteries were detected were further analyzed. The anomalies were evaluated according to the recommendations of Serota et al. Patients were classified according to the origin of the anomalous coronary artery and accompanying coronary artery stenosis of greater than 50%. Results: Congenital coronary artery anomalies were documented in 19 patients (0.4%; 13 men, 6 women; mean age 48.2 years; range 32 to 74 years). The most frequent anomaly was that of the left circumflex artery in 11 patients (57.9%), all of which originated from the right coronary sinus. Six patients (31.6%) had an anomalous right coronary artery originating from the left coronary sinus. In two patients (10.5%), the left anterior descending and the left circumflex arteries originated from the right coronary sinus with separate ostia. Ten patients (52.6%) were found to have coronary artery disease including single-, two-, and three-vessel disease in seven patients (36.8%), two patients (10.5%), and one patient (5.3%), respectively. Atherosclerosis was present in the anomalous coronary artery in eight patients (42.1%). Conclusion: The incidence of congenital coronary artery anomalies shows geographical variations in individual populations. In our population, it is slightly lower than those reported in the literature. For appropriate and complete treatment, congenital coronary artery anomalies should be identified with their origin and course.Öğe POLYMORPHISM OF P53 GENE EXON 4 IN PATIENTS WITH CORONARY ARTERY DISEASE(John Wiley & Sons Inc, 2009) Tekes, Selahaddin; Cakir, Dilek; Yokus, Beran; Iltumur, Kenan; Simsek, Selda[Abstract Not Available]Öğe Pulmonary hypertension in patients with essential thrombocythemia and reactive thrombocytosis(Taylor & Francis Ltd, 2007) Altintas, Abdullah; Karahan, Zulkuf; Pasa, Semir; Cil, Timucin; Boyraz, Taylan; Iltumur, Kenan; Ayyildiz, OrhanIncreased incidence of pulmonary hypertension ( PH) has been reported in patients with chronic myeloproliferative disorders. The exact incidence of PH in essential thrombocythemia ( ET) is unknown. Most of the reported literature consists of case reports or small studies. We designed this study to asses the incidence of PH in patients with ET and reactive thrombocytosis. Previously or newly diagnosed 46 patients with ET, and 40 patients with reactive thrombocytosis secondary to iron deficiency anemia were found to be eligible for this study. Diagnosis of PH was established via transthoracic echocardiography. PH was found in 22 ( 47.8%) out of 46 patients with ET. Seven patients with PH were newly diagnosed ET, 5 patients with PH were in low, and the other patients with PH were in intermediate or high risk category. We found statistically significant difference in terms of platelet counts between ET patients with PH and without PH ( p = 0.027). None of the patients with reactive thrombocytosis had PH. In conclusion, PH appears to be common in patients with ET. Therefore, all patients with ET should be evaluated for PH. Larger and prospective studies are required to clarify the long-term impact of PH on the survival of these patients. Future studies are also needed to determine whether cytoreductive treatment and aspirin prevent the development of PH, and to determine the effects of cytoreductive treatments and aspirin on the prognosis of PH. The effect of PH on ET prognosis should also be determined in low risk ET patients.Öğe Simultaneous Occurrence of a Large Asymptomatic Prolapsing Left Atrial Myxoma with a Cutaneous Squamous Cell Carcinoma(Forum Multimedia Publishing, Llc, 2015) Iltumur, Kenan; Demir, Tolga; Ariturk, Zuhal; Toprak, Nizamettin; Oto, OztekinSynchronous myxoma of the heart and other malignancies are extremely rare. We report a case of a 64-year-old man who had a large left atrial myxoma that obstructed the mitral valve, as well as an unrelated, coexistent cutaneous squamous cell carcinoma in the sacral area. During the preoperative evaluation for non-cardiac surgery, the tumor was diagnosed coincidentally by echocardiographic examination. Echocardiography findings were consistent with a large left atrial myxoma originating from the posterior wall and prolapsing into the left ventricular cavity through the mitral valve, causing mitral stenosis. The mass was successfully completely excised. Histologic examination of the mass confirmed the diagnosis of cardiac myxoma. We report a casual echocardiographic finding of a left atrial myxoma that obstructed the mitral valve outflow tract, and an unrelated, synchronous cutaneous squamous cell carcinoma in the sacral area.
