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    Clinical investigation: Thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome
    (Bmc, 2005) Iltumur, K; Olmez, G; Ariturk, Z; Taskesen, T; Toprak, N
    Introduction It is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event. Method Fifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction ( AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (< 5 min, 5 - 10 min and > 10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), triiodothyronine (T-3), free T-3, thyroxine (T-4), free T-4, troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group. Results The T-3 and free T-3 levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups ( P < 0.0001). On the other hand, there were no significant differences between T-4, free T-4 and TSH levels between the three groups ( P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T-3 and free T-3 levels in the cardiac arrest group ( P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T-3, free T-3, T-4 and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min ( P << 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively). Conclusion TFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state.
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    Öğe
    N-terminal proBNP plasma levels correlate with severity of mitral stenosis
    (I C R Publishers, 2005) Iltumur, K; Karabulut, A; Yokus, B; Yavuzkir, M; Taskesen, T; Toprak, N
    Background and aim of the study: Brain natriuretic peptide (BNP), a neurohormone, is secreted predominantly from the ventricular myocardium. Studies investigating BNP secretion in diseases affecting the right side of the heart are scarce. The relationship between N-terminal proBNP (NT-proBNP) and echocardiographic and clinical findings was studied in cases with isolated moderate to severe rheumatic mitral stenosis (MS), and in patients with previous mitral valve replacement (MVR). Methods: Thirty-two patients with MS (mean age 41.2 +/- 5.7 years), 20 with MVR (mean age 46.0 +/- 4.6 years) and 30 healthy individuals (mean age 40.3 +/- 4.9 years) were included in the study. In addition to NT-proBNP measurements, detailed transthoracic echocardiography was performed in all patients and healthy subjects. Results: Plasma levels of NT-proBNP were significantly higher in patients with MS than in those with MVR or in controls (99.8 +/- 12.7 versus 74.7 +/- 6.9 and 48.5 +/- 10.5 pg/ml, respectively; p < 0.0001 all groups). NT-proBNP levels showed a significantly greater increase in severe MS than in moderate MS (109.8 +/- 5.6 versus 88.3 +/- 7.6 pg/ml, p < 0.0001). NT-proBNP levels also were higher in MVR patients than in controls (74.7 +/- 6.9 versus 48.5 +/- 10.5 pg/ml; p < 0.0001). Although NT-proBNP levels did not correlate with left ventricular ejection fraction (LVEF) in patients with MS (r = -0.33; p > 0.05), there was a positive correlation with pulmonary artery pressure (r = 0.87; p < 0.001) and a negative correlation with mitral valve area (MVA) (r = -0.89; p < 0.0001). However, multivariate analysis identified only MVA as an independent correlate of NT-proBNP (P = -0.47; p = 0.02). Conclusion: In patients with rheumatic MS, NT-proBNP levels correlated positively with MS severity. Moreover, NT-proBNP levels increased significantly in patients with MS, but were significantly lower in those who underwent MVR.