Pulmonary hypertension secondary to pulmonary histiocytosis X is a progressive disease and has a poor prognosis. Despite conventional treatments (immunosuppresive agents, calcium channel blockers and continious O2 therapies) symptomatic improvement may not be seen. We found that single dose iloprost inhalation and oral sildenafil citrate treatment decreased pulmonary artery pressure in a patient with pulmonary hypertension secondary to histiocytosis X whose functional capacity was NYHA class IV. After one week of treatment period, functional capacity and six minutes walking test were improved with this combination. Combination of iloprost inhalation and oral sildenafil citrate might be an effective treatment options in pulmonary hypertension secondary to histiocytosis X.

In this retrospective study we aimed to analyse preoperative risk factors, mortality and morbidity figures, early and midterm results of coronary bypass surgery in patients 75 years of age or over and, additionally, compared results with the lower age group (below 75 years). This review included 142 patients, out of a total 4745 patients who underwent coronary bypass between July 1992 and August 2001 (Group 1). The study group was compared with a randomly selected control group of patients below 75 years of age (Group 2). Results: Group 1 consisted of patients with a mean age of 76,6±2,3 years, while it was 56±3,7 years for the Group 2. There was no significant difference between the groups concerning preoperative risk factors, left ventricular function parameters and coronary artery disease involvement. Hospital stay, low cardiac-output and incidence of atrial fibrillation were found to be high in group 1. Also, hospital mortality for group 1 (4,2%) was higher than group 2 (1,4%, p=0,2). Actuarial survival rates were 95,7% in a mean period of 58,5±2,7 months for group 1 and 97,1% in 72,4±3,6 months for group 2 (p=0,5). In conclusion, when compared with younger patients, coronary bypass seems to be linked with early problems but still can be performed with acceptable mortality and morbidity rates.

The association between ACE gene polymorphism and left ventricular hypertrophy has been studied in different populations with conflicting results. The aim of this study was to investigate this issue in Turkish patients with essential hypertension. One- hundred and seventeen hypertensive patients and 75 healthy controls were studied. Left ventricular mass indexes were examined by echocardiography and PCR technique was used to analyze ACE gene polymorphism. The distribution for DD, ID and II genotypes was not significantly different between patients (42%, 49% and 9%) versus controls (35%,53% and 12%). Allelic frequencies were also similar in both groups (66 vs 62% for D, and 34 vs 38% for I allele in patients vs controls respectively). The prevalence of LVH was 35% in hypertensive group and the genotypic distribution (DD, ID and II) was not significantly different between patients with and without LVH (41%, 57%, 2% vs 42%, 45%, 13%, respectively). The LVMI was not different among the carriers of the three genotypes; mean values were 113±37 g/m2 in DD; 110±36 g/m2 in ID; and 96±11 g/m2 in II patients (p=0.5). In conclusion, ACE gene polymorphism showed no association with either the occurrence of left ventricular hypertrophy or left ventricular mass in Turkish hypertensive patients.

Blood pressure (BP) was measured in 2389 subjects in the survey 2001/02 of the cohort of the Turkish Adult Risk Factor Study, and trends were studied after sex and age-group stratification. Comprised therein and similarly studied were 1782 identical men and women (mean age 52.2±12.4) followed up in the preceding 4 years. When age was kept constant, overall net mean BP in the male sample population declined by 3.8/2.3 mmHg and diastolic pressure in women by 1.5 mmHg. No significant difference was observed in systolic BP among women. These changes were accompanied by an increase of 0.6 kg/m2 in body mass index in both genders. The prevalence of hypertension, defined as being on antihypertensive medication, or displaying a blood pressure ?140 and/or ?90 mmHg, was 36% in men and 49% in women, indicating the existence of 12 million hypertensive Turkish adults. Forty-eight % of them were under drug treatment, and achieved rate of hypertension control rose to 28% as defined by keeping BP at normal levels. Thus antihypertensive treatment among Turks continued to become more widespread and effective. Among participants not subjected to antihypertensive medication, a net decline by approximately 2 mmHg was noted in systolic and diastolic pressures in men. In a logistic regression analysis for prevalent CHD, systolic BP proved to be again a determinant independent from age. We concluded that the trend of rising mean BP in Turkish adults observed in the 1990s seems to have halted in women and probably reversed in men. Though this positive development needs confirmation in the near future, it is believed that the more widespread use and effectiveness of antihypertensive drug treatment and the newly growing health-consciousness of the people are underlying it. Currently, each person out of every 3 men and 4 women using antihypertensive drugs keeps the BP under control.

P-wave dispersion (PWD), defined as the difference between maximum and minimum P-wave duration, has been reported as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The aim of the present study was to evaluate PWD in patients with AS. The study population consisted of two groups: Group I consisted of 98 patients with degenerative AS (76 men, 22 women; aged 63±8 years) and group II consisted of 98 age and sex matched healthy subjects without any cardiovascular disease. Twelve-lead electrocardiogram was recorded for each subject. The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum and minimum P-wave duration was calculated and this difference was defined as PWD. All patients and control subjects were also evaluated by echocardiography to measure the left atrial diameter, left ventricular ejection fraction, left ventricular wall thicknesses, maximum and mean aortic gradients. Patients were also evaluated for the presence of documented paroxysmal AF. Maximum P-wave duration (126 ms) and PWD of group I were found to be significantly higher than those of group II (108 ms). In addition, patients with paroxysmal AF (130 ms) had significantly higher PWD (121 ms) than those without paroxysmal AF. There was no significant difference between two groups regarding minimum P-wave duration. There was no significant correlation between echocardiographic variables and PWD. PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients with AS than in those without it. Further assessment of the clinical utility of PWD for the prediction of paroxysmal AF in patients with severe AS will require longer prospective studies.

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Heart failure is becoming a major public health problem, and is expected to be the prevailing cardiac disease of the next century. In the majority of patients, heart failure develops as a consequence of coronary atherosclerosis and myocardial infarction. Current therapeutic options for heart failure include medical therapy, of proven but limited benefit, and surgical options, which have either restricted applicability or unproven benefit. Necrosis of cardiomyocytes, and their subsequent replacement by fibrous scar, is an essentially irreversible process. Adult human cardiomyocytes have only a very limited ability to proliferate, and the myocardium has no myogenic stem cells capable of replacing the lost cardiomyocytes. Cell transplantation, gene therapy and nuclear transfer to repair injured myocardium are new approaches in the treatment of cardiovascular disease.