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Biomedical subjects

A Y Bozer

Publications and source records attributed to A Y Bozer.

At least 19 recordsLinked to original sources
PubMed1999

Diagnostic value of adenosine deaminase activity in pericardial fluids.

BACKGROUND: The activity of adenosine deaminase (ADA) was determined in serum and pericardial fluid of 70 patients (ages 21 to 71 years) with pericardial effusions of various etiologies and in 15 control subjects. METHODS: The patients were subdivided into five groups on the basis of definite diagnosis: 1) 24 patients with tuberculosis; 2) 22 with malignancies; 3) 12 with uremic pericarditis; 4) 12 with purulent pericarditis; 5) 15 control individuals without pericardial disease. The activity of ADA was determined at the same time in serum and cell-free pericardial fluid according to the method of Karker with minor modification. RESULTS: Mean (+/-SD) ADA activity in pericardial fluid was 66.92+/-4.12 IU/L in group 1; 27.50+/-6.02 in group 2; 28.65+/-4.73 in group 3; 53.05+/-11.14 in group 4; and 5.67+/-1.99 in group 5. Comparing the level achieved in group 1 with all others, the difference is significant at the p<0.001 level. When the cut-off value of 50 IU/L is used the sensitivity of the test for diagnosis of tuberculous effusion is 1, and the specificity is 0.83. Statistical analysis showed that there was no correlation between serum ADA activity and ADA activity in pericardial fluid. CONCLUSIONS: We recommend that determinations of ADA activity in pathologic pericardial fluids seem to be of great value in the early diagnosis of tuberculous pericardial effusions. Levels above 50 IU/L in effusions indicate probable tuberculosis.

Adenosine Deaminase↗
PubMed1996

Coarctation of the abdominal aorta with left renal artery and splenic artery aneurysms.

Both coarctation of the abdominal aorta, and splenic artery aneurysm reside in the hilus, a rare but extremely important pathological condition. Herein a 36-year-old woman hospitalized for uncontrolled hypertension is presented. Aortography demonstrated segmental abdominal aortic coarctation with left renal artery and splenic artery aneurysms. Medical control of hypertension was not possible and thoracoabdominal bypass with a prosthetic graft was undertaken. Left renal artery aneurysm was resected and aorto-renal saphenous vein bypass was performed. But splenic artery aneurysm was left in situ because it was asymptomatic and less than 2 cm in diameter. Postoperatively the patient was normotensive. Although the pathogenesis of such lesions remain unknown, it may be to congenital or related medial degeneration as demonstrated histologically.

Adult↗
PubMed1995

Coarctation of the aorta in infants and neonates: results and assessment of prognostic variables.

From 1984 until 1994, 75 consecutive patients younger than 12 months of age were operated on for coarctation of the aorta. We retrospectively analyzed predictive factors for morbidity and mortality, and also interaction between surgical procedures and recoarctation. Surgical procedures were as follows: resection with a traditional end-to-end (E-E) anastomosis in 55 patients (73.3%), prosthetic patch aortoplasty (PPA) in 12 patients (16%) and subclavian flap aortoplasty (SFA) in 8 patients (10.7%). Early mortality was 9.33% (7 patients). Logistic regression analysis proved that age at operation, associated anomalies of heart, type of coarctation, aortic arch hypoplasia and pulmonary banding were independent predictors of hospital death. Late mortality occurred in 7 patients (10.3%). Associated anomalies of heart were an independent prognostic factor for late mortality. Actuarial freedom from recoarctation at 1 year was 91% [confidence limits (CL): 82% to 97%] and 5 years were 74% (CL: 67% to 86%). Immediate postrepair gradient was equal after E-E anastomosis and other procedures. We conclude that the treatment of first choice in the management of coarctation of the aorta in infants is E-E anastomosis.

Aortic Coarctation↗
PubMed1994

Long-term experience with pericardiectomy: analysis of 105 consecutive patients.

A retrospective analysis of the records of 105 patients who underwent pericardiectomy from 1983 to 1993 was performed. Primarily, 40 patients (38%) had tuberculosis, 16 patients (15%) a malignancy, 12 patients (11.4%) uremia, and 11 patients (10.5%) had rheumatic disorders. Pericardiectomy was performed through midline sternotomy in all cases, 9 of them required cardiopulmonary bypass. On operation, the anterior pericardium was excised parallel to the phrenic nerves on both side. The early mortality rate was 10.5% (11 patients). Mean follow-up time was 5.8 +/- 2.1 years, ranging from 1 year to 11 years. Actuarial survival of the patients at 1 year and 5 years were 81.1% +/- 6.8% and 63.5% +/- 8.2%, respectively. We conclude that pericardiectomy using midline sternotomy with or without cardiopulmonary bypass can be performed safely and can lead to good functional results and long-term survival.

Adolescent↗
PubMed1992

Surgical treatment in tetralogy of Fallot diagnosed by echocardiography.

The purpose of this paper is to present the authors' 3-yr experience of echocardiographic examination of patients with the clinical diagnosis of tetralogy of Fallot, and their evaluation for surgical treatment without prior cardiac catheterization. Among the patients with the clinical diagnosis of tetralogy of Fallot 227 had a definite diagnosis made by M-mode, two-dimensional, Doppler and contrast echocardiography. For the diagnosis of tetralogy of Fallot, ventricular septal defect, pulmonary stenosis, and overriding of the aorta were considered to be fundamental. Ventricular septal defect could be seen easily in the subaortic region by two-dimensional echocardiography. However, in some patients whose ventricular septal defect was not seen clearly, peripheral vein contrast echocardiography was performed. The diameters of pulmonary artery, and main branches at a few millimeters distal to their origin were measured. These parameters were correlated with the aortic diameter for evaluation as to whether they were able to accept the total cardiac output. In patients whose left ventricular end-diastolic dimension was small, shunt operation was preferred. In 115 patients the pediatric cardiologist performing the echocardiography thought that cardiac catheterization was necessary. In these cases the reliability of echocardiography in detecting important cardiac abnormalities was evaluated. Detection of ventricular septal defect, presence of pulmonary valve, detection of stenosis on the pulmonary bifurcation and/or main branches revealed a high sensitivity. Two-hundred-and-one patients diagnosed by echocardiography underwent total correction. In all cases except one the preoperative diagnosis was confirmed by surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Right ventricular hydatid cyst causing recurrent pulmonary emboli.

A hydatid cyst of the heart is rare. Surgical treatment is the preferable method in the treatment of cardiac echinococcosis. A 27-year-old patient with right ventricular hydatid cyst causing recurrent pulmonary emboli and diagnosed by 2-dimensional echocardiography and treated surgically is presented.

Adult↗
PubMed1992

Mitral valve surgery in the presence of pulmonary hypertension.

Mitral valve surgery was performed in 59 patients with severe pulmonary hypertension (average systolic pulmonary artery pressure 77.1 +/- 18.6 mmHg; range 50-115 mmHg) between 1983 and 1990. Thirty-eight patients had been subjected to mitral valve replacement, 16 patients both mitral and aortic valve replacement, and 5 patients had open mitral commissurotomy, with an operative (30 day) mortality of 5.0%. These 3 deaths happened during the early postoperative period. Survivors were followed up for a period ranging from 6 months to 7 years with a mean of 36 months. Four late deaths (7.1%) occurred in patients with valve replacement. Actuarial survival was 93 +/- 3% at 5 years, and 90.7 +/- 4.4% at 7 years. Right ventricular catheterization was performed on 14 patients a mean of 38 months following operation. Systolic pulmonary artery pressure had decreased from a mean of 77.1 +/- 18.6 to 39.7 +/- 14.0 mmHg (p less than 0.001) and 90% of the survivors were in New York Heart Association Class 1 or II compared to 23.7% preoperatively. The clinical and hemodynamic findings in this series suggest that severe pulmonary hypertension is not a contraindication, and pulmonary hypertension decreases significantly after mitral valve surgery.

Adolescent↗
PubMed1991

Bronchoscopic removal of foreign bodies in children: retrospective analysis of 822 cases.

At the Department of Thoracic and Cardiovascular Surgery of Hacettepe University, a total number of 822 pediatric bronchoscopies were performed from 1984 through 1990 for suspected foreign body aspiration. Of the children 65.3% were boys and 34.7% were girls ranging in age from one month to 14 years. Definitive statement of foreign-body aspiration was obtained from 394 patients. Unilateral hyperaeration, atelectasis, and unilateral parenchymal infiltration were the most common radiological findings. In all endoscopic procedures, a pediatric rigid bronchoscope was used under general anesthesia and controlled ventilation. Foreign bodies were found in 77.7% of the 822 patients. In the rest of the children inflammatory disorders were confirmed. The foreign bodies most commonly found in 639 patients were sun-flower seeds (21.1%), beans (10.4%), water-melon seeds (10%), and hazelnuts (9.8%). In our presented series, the incidence of non-fatal complication was 1.8%, apart from these patients 5 of them (0.6%) died after the bronchoscopic procedures.

Adolescent↗
PubMed1991

Right atrial myxoma in an infant.

Cardiac myxomas are extremely rare in infancy. We report a case of right atrial myxoma in a 35-day-old male infant (with cyanosis and convulsions). Echocardiography was carried out and a diagnosis of right atrial myxoma was made. Open heart surgery was performed using cardiopulmonary bypass and a 2.5 X 3.0 cm mass was removed. The patient's postoperative course was uneventful. To our knowledge there is no previously reported case of right atrial myxoma in such a young infant which was operated on successfully.

Echocardiography↗
PubMed1990

De Vega's tricuspid annuloplasty: analysis of 195 patients.

In the years 1984-1989, 195 De Vega tricuspid annuloplasties were performed in association with mitral or mitral-aortic valve procedures. Preoperatively, 9 patients (4.6%) were in New York Heart Association functional class II, 124 (63.6%) were in class III, and the remaining 62 (31.8%) were in class IV. Tricuspid insufficiency was recognized by routine digital palpation of the tricuspid valve during the operation in 42 (21.5%) of the patients. Hospital mortality rate was 7.6% (15 patients). Late deaths occurred in 6 (3.0%) cases during a follow-up period of 3 to 72 months (mean 42 months). 8 patients (4.1%) required reoperation. Tricuspid annuloplasty failure was observed in 4 patients (2%). These valves were replaced with biological valves in three patients and with a mechanical valve in one patient. 112 of the survivors (64.3%) were evaluated by echocardiography and/or right ventriculography. Analysis of postoperative data showed that in 84 of the 112 patients (75%) tricuspid regurgitation disappeared completely after annuloplasty, 88% of surviving patients were in functional class I or II. For the series presented actuarial survival rate at 6 years was 79.1% +/- 14.4%. In the light of this study we recommend De Vega's annuloplasty as the method of choice for moderate to severe functional tricuspid insufficiency.

Adolescent↗
PubMed1990

Detection of right-sided endocarditis in children with congenital heart disease by two-dimensional echocardiography.

Right-sided endocarditis is rare in children. Since the clinical picture is nonspecific and the frequency of sterile blood cultures is high, the clinical and laboratory diagnosis is difficult. Recent reports suggest that echocardiography is a useful method to detect the presence of right-sided endocarditis. We studied 8 patients with congenital heart disease and right-sided endocarditis detected by two-dimensional echocardiography. All the patients were shown to have one or more vegetations in the two-dimensional echocardiographic examination. The 4 patients who did not respond to antibiotic therapy underwent elective cardiac surgery. One of these patients additionally had recurrent emboli to the lungs. Another of these 4 patients died during surgery due to myocardial failure. Apart from these 4 cases, urgent surgical intervention had to be carried out in 2 cases because of very large vegetative masses. Surgical confirmation of the diagnosis was available in all 6 cases. According to these results, we can conclude that two-dimensional echocardiography assumes a specific diagnostic role in cases with right-sided endocarditis.

Child↗
PubMed1989

The long-term follow up results of Kay-Shiley heart valve prostheses.

Three hundred and thirty six Kay-Shiley disc valves were implanted in 323 cases from 1968 to 1975 at the Hacettepe University Hospital, Ankara. Eight patients died during surgery. Of the 328 valve replacements followed postoperatively, 263 were in the mitral (80.2%), 26 in the aortic (8%) and 39 in the tricuspid position (11.9%). Three hundred and fifteen patients were evaluated in the early and late postoperative periods. In the early period 52 patients died (16.5%). The remaining cases were followed up for 1-16 years (3381 patient-years). Twenty eight patients remain alive at the time of this report (10.6%). The longest survivors are 2 of the mitral valve replacement cases. The actuarial survival estimates were 88 +/- 2.4% at 1 year, 60.3 +/- 3.4% at 5 years, 36.3 +/- 3.9% at 10 years for all cases. The incidence of thromboemboli was 4.2% per patient-year in the late period in both the overall and the isolated MVR groups. Valve failure due to thromboses was detected in 8 patients (3%). Six patients were reoperated on in the late period (2.3%).

Adolescent↗
PubMed1981

Hypertension because of an arteriovenous fistula between the right renal artery and the inferior vena cava secondary to a gunshot wound: a case report.

A case of a renovascular hypertension due to an arteriovenous fistula between the right renal artery and the IVC secondary to a gunshot wound 8 years previously is reported. The diagnosis was made initially by the clinical signs of a continuous bruit heard over the anterior abdomen and by the characteristic findings of diastolic hypertension. Diagnosis was confirmed by abdominal aortography. In the operation, the right renal artery was ligated and divided proximally between the aorta and the aneurysm and distally beyond the fistulous communication and a Gore-Tex graft was anastomosed between distal part of the renal artery and abdominal aorta. The result was confirmed by postoperative aortography and by disappearance of the preoperative physical findings. The present case, to our knowledge, is the sixth in the literature.

Abdominal Injuries↗
PubMed1974

Arterial embolism. An analysis of 115 surgical procedures.

Arterial embolus is usually a serious complication of rheumatic or atherosclerotic heart disease. One hundred-fifteen surgical procedures performed in 86 patients with arterial emboli in a 10 years' period in the Department of Adult Thoracic and Cardiovascular Surgery of our university are analyzed regarding the etiology, the treatment, and the results of this complication. Most of the patients were delayed cases showing mild to severe degrees of trophic, sensory and motor disturbances in the limbs without gangrene. These cases are also subjected to vascular surgery (removal of the embolus) as a chance to enable them to use their extremities in lieu of prosthese even when motor and sensory changes persist.

Adult↗