Biomedical subjects
Publications and source records attributed to C Erol.
A 30-year-old pregnant woman was admitted to the Cardiology Research Center with syncope, dizziness, and fatigue on exertion. On ECG complete atrioventricular block was diagnosed. Permanent pacemaker implantation was performed with the guidance of ECG and two-dimensional echocardiography and without the use of fluoroscopy.
Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital abnormality diagnosed by coronary angiography. This is the first report of an echocardiographic diagnosis of a patient with this anomaly, as far as is known.
The triad of right superior vena cava connecting to the left atrium, persistent left superior vena cava draining into the right atrium (coronary sinus), and atrial septal defect is a rare malformation. Recently, we successfully corrected this anomaly in a 47-year-old man.
An isolated perfused rat heart preparation has been used in an attempt to define the mechanisms underlying the coronary vasoconstriction associated with the intraarterial infusion of cardioplegic solutions containing contaminant particles. Coronary infusion of commercially available intravenous solutions, compounded to create the St. Thomas' cardioplegic solution, resulted in a 40.3 +/- 1.9% decline in coronary flow rate at the end of a 20-minute period of infusion. Filtration of the solution through a 0.8 micron filter reduced this decline in flow rate to 23.4 +/- 2.3% of its control value. Inclusion of the 5HT2 receptor antagonist ketanserin (1.0 nanomoles/l), in the unfiltered cardioplegic solution, afforded the same protection as filtration. Inclusion of 5HT (0.1 micromole/l) in a filtered cardioplegic solution resulted in a reduction of coronary flow (49.7 +/- 1.9%) greater than that seen with the unfiltered solution. Studies with antagonists of the histamine receptor (mepyramine and cimetidine) and agonists and antagonists of adrenergic receptors suggested that, although involved in the control of vascular tone, these receptor systems are unlikely to be involved in the process of particle-induced vasoconstriction. Arguments are presented that 5 HT and its receptors may play a critical role and the hypothesis is advanced that particle-induced focal endothelial injury may be the primary lesion in a complex sequence of events leading to induction of transient vasoconstriction.
A patient with Behçet's disease who had pulmonary and cardiac involvement is described. The cardiac lesion was endocarditis in the right ventricle and a thrombus on this lesion which caused pulmonary emboli. The thrombus was excised completely and hemoptysis stopped. Pulmonary defects shown by pulmonary scintigraphy did not disappear with the therapies given to the patient. These abnormalities in Behçet's disease are very rare, echocardiographic examination can be useful in detecting them.
An unusual and new cross sectional echocardiographic feature, bulging of the inferior left ventricular wall during diastole, is described in a 35 year old woman with congenital total absence of the left pericardium. The diagnosis was made on the characteristic clinical, electrocardiographic, echocardiographic, and radiological findings.
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We have characterized an isolated rat heart preparation in which particles induce transient coronary vasoconstriction. Exploiting the fact that all commercially available intravenous solutions contain permissible levels of contaminant particles (usually 2 to 20 micron in diameter), we investigated whether these particles have any adverse effect upon coronary flow. A commercially available intravenous solution was modified to produce the St. Thomas' Hospital cardioplegic solution. Constant-pressure infusion of this solution over a 20 minute period caused a 46.2% +/- 5.1% reduction in coronary flow. This flow impairment could be limited to 13.3% +/- 3.5% by the incorporation of a 0.8 micron in-line filter. In hearts perfused with particle-containing solution followed by ultrafiltered solutions, the impairment of coronary flow was reversed within 1 minute. This quick reversal indicates that the particles were impairing flow not by physical occlusion of vessels but by triggering some form of transient vasoconstriction. In studies with filters of varying porosity (between 0.8 and 15.0 micron), the phenomenon was shown to be attributable to relatively small numbers of particles greater than 10.0 micron in diameter. In studies of myocardial protection, it was shown that the impairment of solution delivery and distribution caused by particles could severely reduce the protective properties of a chemical cardioplegic solution; hearts subjected to 180 minutes of hypothermic (20 degrees C) ischemic arrest with multidose (3 minutes every 30 minutes) cardioplegia recovered almost completely upon reperfusion if a filtered (0.8 micron) solution was used, but failed to recover when unfiltered, commercially prepared solutions were used. In an attempt to define the mechanisms underlying the particle-induced vasoconstriction, we conducted dose-response studies in which various vasoactive agents were used in an attempt to combat the effects of the particles. At their optimal concentrations, procaine (10.0 mmol/L), nifedipine (0.1 mumol/L), and adenosine triphosphate (1.0 mmol/L) completely prevented the problem; lidocaine and dipyridamole partially alleviated the effect; verapamil and isosorbide dinitrate were ineffective. These results indicate that several mechanisms acting at a small vessel level might contribute to the particle-induced vasoconstriction.
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Hereditary osteo-onychodysplasia, also known as the nail-patella syndrome (NPS), consists of a clinical tetrad of nail dysplasia, hypoplastic or absent patella, radial head dislocation, and iliac horns. Bilateral posterior iliac horns are observed only in NPS and present in >80% of patients. We describe the appearance, location, and structure of iliac horns by CT, MRI, and 3-dimensional CT reconstruction.
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