Selçuk Tıp Dergisi Arşiv

The prevelans of prediabetes is increasing over the world. It is estimated that more than 470 million people will have prediabetes by 2030. Prediabetes is defined as intermediate state between normal and diabetic glycaemic values and high risk categories for DM development. Insulin resistance and beta cell dysfuction start with prediabet before marked glucose changes. In observational studies it has been reported that the relationship was found between prediabetes and chronic renal disease, small fiber neuropathy, retinopathy, serebrovascular and cardiovascular disesase. In this review, it was evaluated that the definition of prediabetes and its microvascular and macrovascular complications.

Cerebral ischemia is defined as a reduction of cerebral blood flow in brain. Various experimental models of cerebral ischemia in humans has been developed to mimic closely the human ischemia. These experimental models have contributed the understanding of the pathophysiology of ischemic brain injury and may also allow the development of new neuroprotective strategies and new treatments. As a conclusion, the selected model in the experimental studies must be the most appropriate model that best reflect the clinical and laboratory findings in human cerebral ischemia.

The prevalence of type 2 diabetes mellitus is increasing worldwide. Although there are a number of treatments currently avaible to treat diabetes mellitus, glycemic control rates remain poor. Sodium Glucose Co-transporter (SGLT) 2 inhibitors are a novel class antihyperglycemic agent that act independently of insulin actions. The SGLT2 inhibitors increase urinary glucose excretion and lower plasma glucose. There are a lot of SGLT inhibitor molecules in a different phases of clinical trials is currently avaible. Initial clinical trials showed that this class of agents are well tolerated and can effectively control blood sugar levels with reduced weight gain without hypoglycemia. This manuscript reviews the role of the kidney in glucose hemostasis and the effects of inhibition of renal glucose reabsorbtion by SGLT2 inhibitors.

Diabetic nephropathy is one of the important microvascular complications of diabetes mellitus. Diabetic nephropathy develops as major complication of both type 1 and type 2 diabetes mellitus. At the same time, it is currently the leading cause of end-stage renal disease. Two of the main risk factors for diabetic nephropathy are hyperglycemia and arterial hypertension, but the genetic susceptibility in both type 1 and type 2 diabetes is of great importance. Contribute to the development of diabetic nephropathy other risk factors such as hyperglycemia, hypertension, obesity, hereditary diseases, smoking, and advanced age. The progression from normal albuminuria to microalbuminuria is accepted as the initial step in diabetic nephropathy, and then distinctive proteinuria, decreased glomerular filtration rate, and end-stage renal failure develops.

Saddle block is an ideal procedure that can provide sufficient anesthesia by protecting hemodynamic stability especially in elder patients with high cardiac risk. A 52 years old male patient with bladder tumor who was scheduled for transurethral bladder resection (TUR-B) had history of hypertension, diabetes mellitus and congestive heart failure. Echocardiography showed that LVEF was 20%; RVEF was 28% and there were insufficiency (MVI) of third degree, insufficiency (TVI) of second degree, biventricular global hypokinesia and remarkable dilatation on the right and left structures of the heart. The patient was considered as having ASA class IV. He had TUR-B under saddle block. In conclusion, we considered that saddle blockade was a more safe and efficient anesthetic procedure rather than neuroaxial blockade or general anesthesia for the highrisk patient who had bladder tumor.

The liver is the most frequently wounded organ in the abdominal traumas and the rate of mortality is still very high. We aimed to present a case that was treated with non-operative methods which led to hepatitis because of increase in intraparenchymal hematoma in the late period. Seventeen-year-old male patient who had liver laceration after blunt abdominal traumas was treated with embolectomy due to liver hematoma. In late period, liver parenchymal hematoma can be increased and patients can develop hepatitis because of increased hematoma pressure on intraparenchymal biliary tract and this situation can be effectively treated with non-surgical methods.

Large vessel vasculitis, although a part of the primary vasculitides, more branches of the aorta and is characterized by chronic granulomatous inflammation, and obliterative changes. Abdominal pain is rarely described as a clinical manifestation of Takayasu arteritis, although abdominal vascular involvement is common in this disease. Until now, at the medical literature, which is the first symptom of acute or chronic abdominal pain have been reported in thirteen cases with Takayasu’s arteritis. In our case, we aimed to present that the diagnosis of the large vessel vasculitis (Takayasu’s arteritis) at the 45 years old woman admitted to the emergency room with acute abdominal pain and her abdominal imaging method showed that organ infarction and widespread thrombosis with branches of the aorta.

The part of population over 80 years old has increased in the last decades. Older population constitiutes major part of patients with cardiovascular diseases. The mortality, the morbidity and the frequency of acute coronary syndromes rise as the age of patients increases. The data related with the benefit of primary coronary intervention for old aged population is limited.Here we present 97 year old patient who applied with inferior myocardial infarction at the second hour of his chest pain and underwent to primary percutaneous intervention successfully. We wanted to discuss the current literature pertinent with our case.

Vertebral artery dissection (VAD) among young people often diagnosed in an increasing cause of a stroke. Opalski syndrome which is due to a lesion of the lower medulla involving the corticospinal tract after the pyramidal decussation, results from an occlusion of the vertebral artery and in this syndrome ipsilateral hemiparesia is associated with symptoms of lateral medullary syndrome (Wallenberg syndrome). In this paper a case of spontaneous vertebral artery dissection caused by opalski syndrome will be discussed with literature.

Imaging Findings and Coil Embolization of A Coronary Artery Fistula

Antineutrophil cytoplasmic autoantibody (ANCA) associated small vessel vasculitis constitutes a group of life-threatening diseases and renal involvement is its most severe and common manifestation. Microscopic polyangiitis (MPA) is a rare form of such vasculitis in children characterized by pulmonary-renal syndrome with pauci-immune rapidly progressive glomerulonephritis. A 9-yearold boy was admitted to our hospital because of rash, arthralgia and dark urine. Urine analyses showed hematuria and proteinuria. Blood examination revealed anemia, renal failure and positive p-ANCA. A chest CT revealed diffuse infitration. The renal biopsy demonstrated crescentic glomerulonephritis, immunofluorescent examination was negative. He was diagnosed MPA. High-dose methylprednisolone and high-dose cyclophosphamide therapy improved all of the lung infltrates and renal function.

Coronary ectasia is localized or diffuse dilation of coronary arteries. There are limited data about the percutaneous coronary intervention (PCI) of ectatic coronary arteries with stenosis. Different stent systems such as carotid, bilier and venous graft have been used in these lesions. Post-dilation has been performed by peripheric balloon catheter, if necessary. In this case, we reported a patient with acute inferior myocardial infarction and ectatic right coronary artery who was treated with primary PCI using a renal stent.

Pericardial cysts and diverticula compose %7 of all mediastinal masses. Pericardial cysts and diverticula are generally present at right cardiophrenic sinus also within left cardiophrenic sinus, superıor mediastinum, aortic arch level and left hilum. Pericardial cysts and diverticula are lesions which resemble themselves in shape, localiaztion and symptoms. Radiography, CT and MRI has demonstrative importance in their diagnosis. We want to present similarities and differences of symptoms, diagnosis and treatment of pericardial cysts and diverticula which are important in differential diagnosis of mediastinal cystic lesions within these 3 cases.

Pericarditis is a common clinical entities. The recurrence rate of acute pericarditis is 15 % to 30 % inadulthood, whereas it is rare in children with cases, most of which are case reports. There are rare complications such as cardiac tamponade and constructive pericarditis. The majority of patients will have a benign clinical course. Generally, cases remain as idiopathic chronic inflammatory diseases and, in some cases associated with cardiac operations. Recurrent pericarditis in patients without rheumatic origin the use of colchicine has been a good response. Here we wanted to share the 8-year-old recurren pericarditis patient was kept under control with colchicine as a rare case of idiopatic with children.

In addition to the many research about organophosphate poisoning, the fact of acute myocardial infarction and respiratory failure that happen after organophosphate exposure is firstly reported. A 46 years old patient was taken into emergency with the plaint of dispne, chest pain and somnolence. By taking anamnesis, it is understood that these plaints are occured after eating cherry of which trees are disinfected with a pesticide (Dipterex SP 80 (%80 trichlorphon 0,0 dimethyl phosphonate). General situation was miserable, tachypnea and his consciosness was somnolence. The patient was immediately intubated and connected to the mechanical ventilator. There was sinus tachycardia in his electrocardiography and the elevation of pathologic Q and ST elevation in V1-4. Troponin was high in his blood test. With these indications, it was supposed that there was heart attack and respiratory failure depending on organophosphate poisoning on the patient. After the treatment of piralidoxime, acute myocardial infarction and respiratory failure, the patient was discharged from hospital for being angiography. Finally, acute myocardial infarction and respiratory failure which evolve out of organophosphate poisoning shouldn’t be ignored.

Coronary artery spasm is a special type of ischemic heart disease characterized by spontaneous episodes of chest pain accompanied by transitory ST segment elevations during the episodes. This syndrome may be associated with acute myocardial infarction, ventricular tachycardia or fibrillation, as well as with sudden death. Psychosocial stresses are also associated with an increased risk for acute myocardial infarction. We reported a 23 years old, male patient who applied to the emergency department for ongoing chest pain which had begun just after psychosocial trauma arising from heavy business tempo. He had neither ECG, nor cardiac enzym changes during admission, however acute MI with ST elevation occurred while following up period. There was no stenosis in coronary arteries on angiography. Given the typical symptoms, an ergonovine test was considered unnecessary. Administration of Ca-channel blocker and nitrates ameliorated his symptoms. The patient was prescribed a calcium channel blocker at discharge and has had no further chest pain. Finally, we thought that the cause of acute myocardial infarction for this young patient that occurred after vasospasm might be due to sympathetic hyperactivity and psychosocial stresses resulting from heavy work load conditions.

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare congenital heart disease in which left coronary artery leaves from the pulmonary artery. Patients are usually asymptomatic in neonatal period during the pulmonary artery pressure decreases up to a critical level. However, afterwards left ventricular failure and infarction were present. An asymptomatic newborn patient who was referred our clinic due to cardiac murmur was presented. Dilated cardiomyopathy and anomalous left coronary artery from pulmonary artery were diagnosed with echocardiography and during the cardiac catheterization ALCAPA syndrome was confirmed.

Single coronary artery is observed in approximately 2-4% of all coronary artery anomalies. In our case, 48 years old female patient had exercise-induced angina pectoris and fatigue. After her exercise electrocardiogram revealed ST depression during 9 mets, we demonstrated a single coronary artery as an extremely rare anomaly of coronary artery in which there was no original left main artery as well as right coronary artery, left anterior descending and circumflex arteries were originated from right sinus Valsalva. On medical treatment with beta blocker, her symptoms had recovered. This type of coronary anomalies is very infrequent and may be a reason of sudden death.