Browsing by Author "Demirbag, R"

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A Case of Successful Six Consecutive Deliveries in a 41-Year Woman With Uhl's Anomaly
(Elsevier Ireland Ltd, 2003) Güler, N; Demirbag, R; Eryonucu, B; Gül, A
Uhl's anomaly, or parchment right ventricle is a myocardial disorder of unknown cause that mainly involves the right ventricle. Uhl's anomaly may represent a cause of right heart dilatation, failure, and premature sudden death due to ventricular arrhythmias. Although most of the cases of Uhl's anomaly end fatally in infancy or childhood, a limited number of cases have been reported in advanced ages. Also, in pregnant women, this situation increases the risk to both mother and baby and requires special management. This is the first report of six successful consecutive gestations and vaginal deliveries without special managements in a patient with Uhl's anomaly. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.
Clinical and Echocardiographic Predictors of Left Atrial Appendage Dysfunction in Patients With Mitral Stenosis in Sinus Rhythm
(Mosby, inc, 2004) Güler, N; Demirbag, R; Özkara, C; Eryonucu, B; Günes, A; Tuncer, M; Agirbash, M
Background: Mitral stenosis (MS) causes left atrial (LA) appendage (LAA) dysfunction resulting in reduced LAA flow velocities. Low LAA peak emptying velocity (PEV), determined by transesophageal echocardiography, is a risk for thrombus formation and systemic embolism. Objective: We sought to investigate various clinical and echocardiographic predictors of low LAA blood flow velocities. Methods: A total of 44 patients with newly diagnosed MS were classified into two groups on the basis of the presence of high (PEV greater than or equal to 46 cm/s) or low (PEV < 46 cm/s) LAA flow profile on Doppler transesophageal echocardiography. LAA flow velocities were measured to be 27.38 +/- 8.17 cm/s in patients with LAA dysfunction and 70.75 +/- 16.71 cm/s in high-flow profile (P < .0001). Simultaneous 12-lead electrocardiogram was used to measure P waves. Results: P maximum, P dispersion, and LA diameter were significantly higher in patients with low LAA PEV (n = 32) than in those with high LAA PEV (111.87 +/- 16.93 vs 96.66 +/- 14.97, P = .0084; 73.12 +/- 20.7 vs 49.16 +/- 9.96, P < .0001; 46.06 +/- 4.384 vs 38.08 +/- 7.42 mm, P = .004; respectively). Patients with MS and low LAA blood flow had smaller mitral valve area compared with those with high LAA blood flow velocity (1.48 +/- 0.431 vs 1.85 +/- 0.442 cm(2), P = .02). Male sex, spontaneous echocontrast, and thrombus were more frequent in patients with low LAA PEV (7 [21.87%] vs 5 [41.66%], P = .026; 21 [65.62%] vs 4 [33.3%], P = .088; 4 [12.5%] vs none; respectively). Mild MS was more frequent in patients with high blood flow velocity {6 [27.2%] vs 14 [63.6%], P = .03}. Conclusion: At linear regression analysis, only P-wave dispersion and LA diameter predicted the LAA mechanical dysfunction reflected as low LAA PEVs.
Intrapericardial Streptokinase for Purulent Pericarditis
(Springer, 2004) Ekim, H; Demirbag, R
Purpose. Purulent pericarditis has become a rare disease since the introduction of antibiotics into clinical practice. Standard management consists of antibiotics and surgical drainage. In this study we also instilled streptokinase to obliterate the loculations and fibrin strands in patients with purulent pericarditis. Methods. Between October 1997 and October 2002, we treated nine children with purulent pericarditis by pericardial drainage with streptokinase instillation and antibiotics. There were five boys and four girls aged between 3 and 13 years, with a mean age of 6.7 +/- 2.9 years. Results. Pericardiocentesis revealed purulent effusion of 180-650 ml in the pericardial space in all patients. Blood pressure increased and central venous pressure decreased after the pericardial empyema was evacuated in all patients. None of the patients had systemic bleeding, arrhythmias, or hypotension suggesting an anaphylactic reaction. Conclusion. We found intrapericardial streptokinase to be safe and effective for dissolving fibrin layers and removing loculations, resulting in complete pericardial drainage. Therefore, intrapericardial streptokinase should be instilled to prevent constrictive pericarditis.