A cohort of the Marmara region which consitutes 1/4 of the population of Turkey w as surveyed for the third time in June 1997. A total of 760 adults (comprising 518 subjects of the original cohort and 212 persons newly enrolled) were examined. This report deseribes the data pertaining to cigarette smoking, relative weight, physical activity and prevalence of glucose intolerance and analyzes relevant changes incurred over the past 7 years. Adjustment for aging by 7 years was carried out for each parameter and gender by taking into account the weighted differences of mean values in various agegroupsin the initial survey. In the Marmara region during 1990 and 1997, the proportion of smokers rose . by one-quarter in women, while in men a minimal decline was noted. Body mass index rose in men by 0.86 kgfm2 - corresponding to about 2.5 kg - as contrasted to women who had no significant change, yet were previously known to be obese in general. In the assessment of physical activity, much harder to approach objectively, men and women appeared to have increased their activity by 20% and 14% though the reliability of this finding may be low. Utilized criteria for identifying diabetes were: persons known to be diabetic, a fasting glucose concentration in venous plasma of > 140, or a postprandial value > 200 mg/dl. The prevalence of diabetes in the entire cohort was 5% and 6.3% in men and women, that of glucose intolerance 1.2% and 3.3%, respectively. Theserates imply the continuation of a rising trend.

patients with mitral stenosis, transesophageal echocardiography (TEE) can be used to preoperative evaluation of mitral valve morphology and left atrial thrombosis. In addition to preoperative applications, TEE can be utilized intraoperatively during percutaneous balloon mitral valvuloplasty (PBMV), open mitral commissurotomy and mitral valve replacement surgery. Percutaneous balloon mitral valvuloplasty is an effective but rather expensive method for the treatment of rheumatic mitral stenosis. Closed mitral commissurotomy (CMC) was a blind procedure before transesophageal echocardiography (TEE) era. We assesed the utility of TEE guidance during closed mitral commissurotomy to enhance the efficacy and reduce the complications of surgery. 27 patients (19F, 8 M), 16 of them pure mitral stenosis, 9 patients w ith mil d aortic insufficiency w ere included in the study. M ean age of study group w as 36.2±7 .4 years. ı 7 patients were in normal sinus rhythm and ı O were in atrial fibrillation. Mitral valve areas were (MV A) measured by pressure half time (PHT) and planimetic (PLN) methods before, during and after the CMC procedure by using transthoracic and transesophageal echocardiography. During surgery, insanı information was obtained by using Vingmed CFM 800 multiplane probe. The succes of the procedure was determined by following parameters: mitral valve excursion, mitral commissural leakage, MV A disappearence of spontaneous echocontrast and decrease of mitral valvular gradient, mitral regurgitation and rupture of the chordae. The MV As detected by PHT and PLN method s using TEE probe were significantly increased from 1.06±017 cm2 to 2.4±0.3 cmı and from 1.01±0.09 cm2 to 2.21±0.19 cmı, respectively after the CMC procedure (p<0.05 and p<0.05). Intraoperative TEE contributes to the surgeon's performance allowing to monitor the valve area and detect the potential complications, earlier.

We examined the value of a new index (Stressrecovery Index (SRI)) combining information on the amount and kinetics of ST depression in the heart rate domain during exercise and recovery in identifying multivessel disease (MVD). 168 cases without previous myocardial infaretion underwent symptom-limited treadınili exercise testing and coronary angiography. At the end of each test, the lead exhibiting the greatest ST depression was selected for further analysis to calculate the SRI. The heart rate and corresponding ST segment values were plotted on a coordinate system, against x- and y-axes, respectively. The intersection points of the lines transversing each value at the axes were combined to form a line and the area subtended to baseline and limited by the ST trend against heart ra te during both exercise (A 1) and recovery (A2) w as calculated. The difference between A ı and A2 was defined as the SRI. Patients were divided into two groups according to the angiographic results: patients with MVD (group I, n=79) and patients without MVD (group II, n=89). The mean SRI of group I was significantly lower than that of group II (-21.1 ± 24, I I. O± 28 mm. beats.min-1.; p

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Cardioversion (CV) is the most effective therapeutic approach for reversion of atrial fibrillation (AF) to sinus rythm (SR). In addition to its being performed transthoracically, it may be performed via the intracardiac route. In this study we present the results of intracardiac cardioversion (ICC) in 29 patients. Mean age of the study group was 60±2 years and the mean AF duration was 36.9±7.2 months. We used Hewlett-Packard 43120A extemal defibrillator as the energy source for the first 15 patients, by means of a technique w e developed. For the remainder I 4, Yentak ECD cardioverter defibrillator was used. Reversion to SR was achieved in 72% of patients. Comparison of the success (n=2 I) and failure groups in regard to AF duration, left ventricular dimensions and ejection fraction revealed no statistical difference. Left atrial dimensions were significanıly higher in the failure group (p

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W e investigated the effects of flow characteristics in cardiopulmonary bypass on the endocrine system, and 22 patients were included in two groups according to the flow characteristics applied: pulsatile and nonpulsatile flow. The honnones studied were TSH, T3, T4, Free T3 free T4, ACTH, cortisol aldosterone, insuline and growth honnone; also glucose measurements were perfonned in the same periods. The honnon !eve! detections were made in all patients five times as in the preoperative period, after beginning of general anesthesia, at the 30th and 60th minutes of perfusion, and at 24th hour postoperatively. It was acertained that, in the perfusion period, T3 stayed at higher postoperatively. It was acertained that, in the perfusion period, T3 stayed at higher levels and FT3 diminished oppositely in the pulsatile group. There was not significant difference between the two groups in tenns of T4 and FT4. For ACTH, only in the 24th hour period, the mean !eve! of the pulsatile group was significantly high, and this was also true for cortisole in the same period; however, the difference was not statistically significant. For aldosterone, the mean levels were lower in the pulsatile group while the differences were not statistically significant. Mean !eve! of insulin was significantly lower in the pulsatile group by the 60th minutes of perfusion. The similar finding was also accurate for glucose in the perfusion period. The mean !eve! of growth honnone was significantly higher in the pulsatile group by the 60th minutes of perfusion. The lower level detections of insulin in the perfusion period of the pulsatile group was noticed and this could be related with the lower glucose levels and higher anti-insulinary bonnone levels.

In the third survey of a cohort of the Marmara region of Turkey in J un e 1997, a total of 531 subjects of the original cohort were followed up and 212 new Iy enrolled persons were subjected to physical examination and an ECG recording at rest. Rates of death, coronary heart disease (CHD) death, and new nonfatal coronary events (NCE) were studied in the original cohort whose median age at time of survery was 46 years both in men and women. NCE were defined to ineJude nonfatal myocardial infarction, acute myocardial ischemia, and newly developed stable angina with or without associated myocardial ischemia. During a mean of 7 years since the initial survey, the follow-up amounted to 5200 personyears, anda total of 35 deaths, 21 CHD deaths and 26 NCE were registered. Overall annual death rate was 6.7 per 1000 adults which w as slightly higher in women (7 .4 vs. 6.1 per 1000). A similar slight preponderance of females (4.5 vs. 3.6 per 1000) was noted in CHD death as well. NCE were observed at a rate of 6.5 per 1000 adults (7.1 in women vs. 6 per 1000 in men). Coronary death and event rates in the Marmara region appeared to be similar to those of the entire Turkish cohort studied in 1995 though female preponderance was confined to this region . Though most (13/1 7) of new coronary events in women consisted of new angina and/or new myocardial ischemia, most (8/15) of new events in men manifested as myocardial infarction.

Between J anuary 1993 and August 1997, 215 patients had been treated in the Ege Unviversity Medical Faculty, Department of Cardiovascular Surgery because of various aortic lesions. Aortic dissection was detected in 70 (32.6%) and aneurysm in 145 (67.4%) patients. Coronary angiography was perfonned to search for concomitant coronary artery disease in 118 (54.8%) of them. Concoınitant coronary artery disease was detected in 10 (14.3%) patients with aortic dissection and in 42 (28.9%) patients with aortic aneurysm. In the group of abdominal aortic aneursyın, concoınitant coronary artery disease was detected in 29 (82.8%) among 35 patients to whom coronary angiography was perfonned. Coronary artery bypass surgery (CABG) was performed in 9 patients who had aotic dissection and in 21 patients who had aortic aneurysm. PTCA was perfonned in 5 patients also. Eighteen (25.7%) patients who had dissection and 22 (15.2%) patients who had an aneurysm died. As a conclusion, the concomitant ineidence of coronary disease and cardiac mortality are considerable among patients with aortic disease and especially in those with abdominal aortic aneurysm. The preoperative determination of the severity of coronary artery disease and eventual revascularization by CABG or PTCA before or during aortic surgery, is crucial.

During the Turkish Risk Factor Survey plasma concentrations of apolipoprotein AI (apoAI) and apo B were included in the monitoring of coronary risk assessment in a cohort of the İstanbul adult population representatively sampled. In 338 adults aged 27 years or over (mean age 48±12) comprising 160 men and 178 women plasma apolipoprotein AI and apo B values were determined by utilizing radial immunodiffusion plates (Behring) containing antisera of immunized sheep, and the remaining lipid and lipoprotein fractions by enzyınatic technique utilizing a Retlotran apparatus. Obtained findings were evaluated after stratification for sex and age groups. Mean values in the population sample for apoAI were 13% tower in men than in women (127±33 and 145.5±38 mg/di, respectively). By contrast, mean levels of apoBin women (129±46 mg/di) were as high as in men (127±40 mg/di). These implied slightly low levels of apoAI and conspicuously high levels of apoB in both genders. A mild (by 13%) and persistent rise of mean apoAI concentrations was displayed in both genders between the age groups 30-39 and 60-69 years. A rise of similar magnitude was noted across the same age groups in the mean apoB levels in men, whereas in women the escalation reached 37%. Mean apoB values closely paraHel ed levels of LDL-cholesterol in both sex es at middle-age (30-59 years) but started to fall in women one decade later than the latter. It was concluded in this study (which analyzed for the first time levels of apoAI and apoB in Turkish adults after stratifying for sex and age) that adult inhabitants of the megalopolis İstanbul exhibited an ad verse constellation of plasma apolipoproteins.

The systolic approximation of the anterior leaflet of the mitral valve and hypertrophied, basal portion of the interventricular septum cause obstruction to the left ventricular outflow in hypertrophic obstructive cardiomyopathy. A new strategy for the management of hypertrophic obstructive cardiomyopathy was used in a 37-year-old female patient, resisıant to drug treatment with a mcan resting gradient of 22 mmHg. The first septal branch of left anterior descending artery was occluded w ith an injection of absolute alcohol. After induced septal infaretion the mean gradient in the left ventricular outflow was reduced to 3 mmHg. The functional class was reduced from III to I, and the basa! septal infaretion was documented by myocardial perfusion scintigraphy. This is the first published case in Turkey, who showed a very promising function al improvement.