Makale Arama

AIM:  In the present study, we aimed to evaluate the effect of blood pressure regulation on sleep quality in the hypertensive subjects and determine blood pressure parameters related with poor sleep quality.

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METHOD AND MATERIALS: Our study is a cross-sectional study including 90 hypertensive subjects at age between 35 and 65 years. The patients were performed 24-hour ambulatory blood pressure monitoring and divided into those with regulated blood pressure group and poor blood pressure control group. Sleep quality was checked before the ambulatory blood pressure monitoring by using Pittsburgh sleep quality test. Statistical analyses were performed with SPSS 13.0 packet program.

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MAIN FINDINGS: Global Pittsburgh sleep quality index (PSQI) scoring were similar in both groups and when components of the sleep quality were evaluated, daytime dysfunction was significantly higher in patients with poor blood pressure control compared to patienst with regulated blood pressure (1.0±0.9 versus 1.4±1.0, p=0.05; respectively ). Global PSQI score did not show significant correlation with arterial blood pressure leveles, pulse pressure, and systolic blood pressure levels. However, night diastolic pressure levels were weakly correlated with global PSQI scoring (r=0.16, p=0.04). Only diastolic non-dipper status was found as independent predictor of poor sleep quality as a result of logistic regression analysis (Odds: 3.21 (CI: 1.51-7.72), p=0.03).

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CONCLUSION: In the present study, sleep quality was markedly impaired in hypertensive patients and diastolic non-dipper was determined as an independent predictor of poor sleep quality. It seems important to assess sleep quality in patient with diastolic non-dipper at ambulatuary blood pressure evaluation, especially for detection of poor sleep status.    

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It is thought that magnesium deficiency may also play a role among etiological factors in patients with Essential Hypertension, and therefore, in this study we planned, the role of intracellular and extracellular changes in .1 ', 1g levels in essential hypertension was investigated by determining Mg levels in serum, erythrocyte and urine of patients with Essential Hypertension. The Mg level was found to be lower in all three materials in essential hypertensive patients who did not use antihypertensive drugs compared to healthy individuals, and the deficiency was found to be statistically significant (P <0.001). On the other hand, it was determined that there was no statistically significant difference (P> 0.05) between the values ​​found in healthy individuals and those found in patients with essential blood pressure taking antihypertensive drugs. In the light of current literature information, as seen in some patients with essential hypertension, an increase in aldosterone or aldosterone benri levels may lead to Mg deficiency. This deficiency can also lead to hyperexcitability in vascular smooth muscle as well as increased noradrenaline release at the neuroeffector junction.

Sildenafil, a phosphodiesterase inhibitor, decreases pulmonary arterial pressure by providing vasodilation in the pulmonary vascular bed. In this study, the effect of sildenafil use was investigated for prevention of pulmonary hypertensive crisis attacks in the postoperative period in patients with congenital heart defects. In our clinic, 9 patients with pulmonary hypertension and congenital heart defects were operated in between November 2005 and May 2006. Mean age of the patients were 9.6±8.1 (3-12) months and the mean body weights were 5.5±0.9 (4-7) kg. All patients were operated following median sternotomy by using extracorporeal circulation after aortic and bicaval cannulation. Medium hypothermia with cold blood cardioplegia was used. Sildenafil treatment was started in the early postoperative period by 0.5 mg/kg/day through the nasogastric tube. The dose was gradually increased up to 2 mg/kg/day and the treatment was maintained for one week. The results of the patients were evaluated retrospectively. Mean pulmonary arterial pressure in the preoperative period was 52.7±7.9 mmHg. Mean intubation times of the patients were 58.4±34.0 (20-100) hours, whereas intensive care unit stay and hospitalization periods were 2-7 (mean 4.8±2.0) and 6-12 (mean 10.11±2.8) days, respectively. During the study, neither mortality, nor important hypotension caused by sildenafil, was detected. Only a pulmonary hypertensive crisis attack was detected in 1 patient. One patient had consistent heart block and permanent pacemaker was implanted. Sildenafil is an effective choice of treatment for prevention of postoperative pulmonary hypertensive crisis in patients with congenital heart defects accompanied by pulmonary hypertension.

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.

İn this retropective study, patients with atherosclerotic risk factors and the related clinical diagnosis, angiographic scoring and regional distribution were investigated. A total of 630 patients (450 male, 180 female, mean age 56,2 ± 9.3) t hat underwent coronary angiography were enrolled. Patients were classified according to the clinical characteristic and Reardon’s modified severity scoring which is the indicator of the extend of coronary artery disease, was calculated. A parallel increase in coronary disease along with higher triglicehdes was observed, which was significantly different betvveen single and double vessel disease(p<0,05). The same correlation was apparent between HDL levels and the extent of the disease vvhich was remarkable in single and triple vessel disease group (p<0,05). Triglyceride levels varied as higher in males younger than 60 year of age vvhile smoking was lower in the same group (p<0,05). On the other hand hypertension was observed more frequently in elder patients (<60 year of age) (p<0,05). As a conclusion, ali risk factors other than smoking appeared to be higher than TEKHARF cohort, which were given for Central Anatolia region.

Background

Hypertension (HT) is a controllable and preventable public health problem that is a risk factor for many serious diseases, especially cardiovascular diseases. Hypertension, which can be silent and lethal, can not be diagnosed in many people. HT constitutes a significant part of the daily practice of the primary care physician. Today, the Family Medicine is a medical discipline constitutes the first level of the health system in Turkey.

Aim

In our study, the effectiveness of family medicine practice in the diagnosis of arterial hypertension was investigated.

Material and Method

We retrospectively reviewed the data of the patients aged 18 years and older who had access to their data in our family medicine department between 2017-2018. A total of seven questions, including personal information (age, gender and education level) and disease identification information (how many years were diagnosed with hypertension, baseline symptom, where and how the diagnosis of hypertension was first established) were retrospectively reviewed from the Family Medicine Information System.

Results

A total of 286 patients, 178 female and 108 male were detected. 9% of the participants were illiterate while 94.1% were literate . 59.8% of the illiterate patients were in primary education, 10.5% in high school and 16.8% in graduate education. 7.7% of the participants were diagnosed in the family medicine polyclinic, and the remaining 92.3% were diagnosed in secondary health care facilities and other places except family medicine. According to education level, 7.7% were diagnosed in family medicine and 92.3% were diagnosed in second-level health facilities and elsewhere except family medicine.

Conclusion

In our study; patients with arterial hypertension were diagnosed more frequently in secondary health care institutions regardless of their education level. Although the rate of diagnosis of arterial hypertension was increased from 1.5% to 16.3% in primary care after starting the practice of family medicine in Konya, we believe that the role of family medicine practice on the diagnosis of arterial hypertension should be increased even more.

 

 

Aim: To highlight the neurovascular complications of hemodialysis and discuss the therapeutic approaches with the relevant literature. Case Report: A 19- year old man on maintenance hemodialysis who admitted to our clinic with intracerebral hematoma is discussed. Conclusion: Neurovascular complications are being recognised as the major causes of mortality and morbidity in hemodialysis patients. Prevention of neurovascular complications of uremia and accelerated hypertension requires the cooperation of both the neurologists and nephrologists.

Multiple intracerebral hemorrhage represents 2 % of ali intracranial hemorrhages. Multiple intracerebral hemor- rhages have been known to occur most frequently in patients with coagulation defects, neoplasms, angiopathies or sinüs thrombosis. The finding of recurrent intracerebral hemorrhages is not unusual in patients with systemic arterial hypertension, but simultaneous occurence of multiple hemorrhages is rare in these patients. However, multiple spontaneous intracerebral hemorrhages vvithout an identifiable etiology were also reported in the literatüre. Here, we describe a hypertensive patient who developed multiple intracerebral hematomas. The patient had bilateral thalamic hematoma that extended the lentiform nucleus. There was apathy, loss of emotional concern, upvvard gaze palsy, tetraparesis and hypertensive retinopathy in the neurologic examination. Conditions other than hypertension that might cause intracerebral hemorrhage were excluded by laboratuary investigations.

Objective: The aim was to review the hormonal status, treatment and histopathological diagnosis of patients admitted to our endocrinology outpatient clinic with the diagnosis of adrenal incidentaloma.

Material and Methods:Between 2015-2018, 217 patients with adrenal incidentaloma who were admitted to the endocrinology outpatient clinic were included in the study. 1 mg overnight dexamethasone suppression test (DST), 24 hour urine free cortisol, 24-hour urine methanephrine and normetanephrine levels were evaluated in all patients.Patients who also have hypertension or hypokalemiawere screened for the plasma aldosterone/renin activity ratio. CT or MRI imaging properties of adrenal incidentalomas were screened.

Results: In the evaluation of cases; 180 (83%) of the masses were evaluated as non-functional and 37 (17%) as functional. Of the 37 patients evaluated as having functional adrenal mass; 10 (4.6%) pheochromocytoma, 5 (2.3%) Cushing's syndrome, 9 (4.1%) subclinical Cushing’s syndrome and 13 (6%) primary hyperaldesteronism were detected. In 180 patients who were evaluated as having non-functional adrenal mass; metastatic disease in 7 (3 non-small cell lung cancer, 1 breast cancer, 1 prostate carcinoma and 2 unknown primary cancer), myelolipoma in 4, ganglioneuroma in 1, hydatid cyst in 1, adrenocortical carcinoma in 2 patients were detected.

Conclusion: According to the results of this study, it is not uncommon for adrenal incidentalomas to be functional. It may be malignant in some cases. For this reason, adrenal incidentaloma is a condition that should be examined both in terms of
functionality and malignancy potential.

In this study, we evaluated the first open heart operations performed in our clinic. Between August 2005 and June 2011, a total of 550 patients (318 male, 232 female; mean age 58,35 years) underwent open heart surgery in our clinic. Preoperative mean ejection fraction was 36,8% (20 to 65). Diagnosis of patients were as follows: 397 cases had coronary aryery disease, 114 cases had valvular heart disease, 19 cases had congenital heart disease, 17 cases had aortic pathology and 3 cases had left atrial myxoma. Major comorbidities were hypertension, diabetes mellitus and chronic obstructive lung disease. Mean intensive care unit stay was 2,1 days (1-17), whereas mean hospital stay was 6,7 days (4- 23). Total complication rate was 28,54% with 157 cases. The most common postoperative complication was atrial fibrilation with 57 (10,36%) cases. Low cardiac output in 23 (4,18%) patients, wound infections in 16 (2,9%) patients, temporary neurologic disorder in 13 (2,36%) patients, renal failure in 10 (1,81%) patients and mechanical ventilation requirement in 6 (1,09%) patients were observed in hospitalization period. Reoperation was used in totally 45 (8,18%) cases due to hemorrhage (n=41) and sternal dehiscence (n=4). Total mortality rate was 5,63% with 31 cases. The most common cause of mortality was low cardiac output. This study demonstrated that open heart surgery has been performed successfully in a state hospital despite the all difficulties. We think that our mortality and morbidity rates are acceptable and similar to current literature.

Aim: In this study, it was aimed whether biochemical parameters, vital signs and neutrophil-lymphocyte ratio
(NLR) values could be used in determining the indication for intensive care hospitalization in COVID-19
patients.
Patients and Methods: This retrospective observational study was conducted in the emergency department
of a university hospital. Patients with positive SARS-CoV-2 PCR test who applied to our hospital on 1-31 July
2020 were included in the study. Laboratory results, demographic findings and clinical results of the patients
were collected electronically. The patients were divided into 3 groups as discharged, admitted to the service
or intensive care unit. The incidence and severity of symptoms, comorbidities, laboratory values, and NLR
values were compared between the groups.
Results: A total of 489 patients were included in the study. The mean age of the included patients was 48.69
+ 17.25 years, of which 260 (53.16%) were female. While 248 (50.9%) of these patients were discharged,
207 (42.3%) were taken to the service and 33 (6.7%) to the intensive care units. Age, heart rate, urea,
creatinine, CRP, D-dimer and NLR values of the patients admitted to the intensive care unit were higher
than the other groups, while oxygen saturation was statistically significantly lower in this group. Concomitant
systemic diseases such as Diabetes Mellitus, Essential Hypertension, Chronic Obstructive Pulmonary
Disease were more common in those hospitalized in the intensive care unit. In multivariable analysis, oxygen
saturation (OR:0.803) and neutrophil-lymphocyte ratio (OR:1.09) were found to be independent predictors of
the indication for hospitalization in the intensive care unit.
Conclusion: As a result of our study, we think that especially low oxygen saturation and high neutrophillymphocyte
ratio can be used in determining the indication for intensive care hospitalization in patients who
apply to the emergency department due to COVID-19.

Thirty-nine patients with mild to moderate hypertension were studied at Koşuyolu Heart and Research Hospital between March 1992 and September 1992. The patients were giyen increasing doses of enalapril to a maximum dose of 20 mglday and if necessary diuretic. Ambulatoly pressures were monitored at base line and at the end of 4 weeks of treatment in the case of responders. Total responder rate was 74%. Pre and post treatment mean arterial pressures were 148±9/95±4 and 136±5/87±4 mmHg, respectively (p<0.001). Between 2300-0700 hours these values were 138±5192±3 and 130±5/84±4 mmlig, respectively (p<0.01). Treatment was stopped in one case because of adverse drug effect. In summary enalapril is well tolerated and once daily administiration appeared to be ellective in mild to moderate hypertension

Transjuguler Intrahepatic Portosystemic Shunt (TIPSS) is a procedure that creates a shunt between portal and hepatic venous systems via transjugulary way placing a stent to hepatic parenchyme. In the current manuscript, we describe a patient with portal hypertension to whom a succesfull TIPSS operation was done in our hospital.

In this study: the effect of and tolerability to long actinz Verapamil SR 240 mg treatment on ',ordu, mild, moderate and malignant hypenension were in-vestigated.7'he drug was giyen orally once a day. If there was a necessity, a Jose o f 360 mg was used. At the end of Iliis study Verapamil SR 240 mg was found effective in most of thepaıients. Afier theVe-rapamil SR 240 mg treatınent, the patients diastolic blood pressure was ender 90 mın lig. Cardiac and ex-tracardiac tolercllıility to Verapamil SR 240 mg iher-apı. was excelknt. AV-block wasn't seen. In some of the patients, there were Side ellects such as headache, fiıtigue. flushing, nausea, vomiting and dizziness.

It is sometimes very difficult to distinguish between cardiovascular diseases and respiratory diseases, taking into account only physical examination findings. Symptoms of respiratory distress in premature babies may be due to congenital heart disease, congestive heart failure, hyaline membrane disease, aspiration syndrome, pneumonia, pneumothorax, lobar emphysema, pulmonary agenesis or hypoplasia and a metabolic disorder. Traditional radiology has often helped us clinically. From the wider ductus arteriosus to the fetus, the pressure of the pulmonary arterial system to the aorta is equal. Therefore, pulmonary hypertension is a feature of normal fetal circulation.

It is known that development of lacunar infarcts were seen due to involvement of lentikulositrial and talamoperforan arteries in hypertension and diabetes mellitus. In this study, we aimed to compare ADC (apparent diffusion coefficient) values of basal ganglia and talamus free of lacunar infarct in patients with diabetes mellitus and hypertension and individuals who have not any systemic diseases. Cranial MR imagings of 52 patients with hypertension, 8 patients with diabetes mellitus and 116 patients with a symptom like headache or vertigo but without any systemic disease were analyzed for ADC values at the levels of caudat nucleus, thalamus and lentiform nucleus. Results were evaluated for statistically. Statistically important difference was found between individuals without systemic disease and patients with diabetes mellitus for ADC values of left lentiform nucleus (p< 0.05). Statistically important difference was determined between hypertensive patients and healthy individuals for ADC values of both thalamus and lentiform nucleus (p<0.05). Even there is no distinct lacunar infarct, differences in ADC values of basal ganglia and thalamus in patients with diabetes mellitus and hypertension may represent microscopic chronic ischemia or developing lacunar infarct.

Aim: The aim of this study was to contribute to the data about the ischemic stroke epidemiology. Material and method: We analyzed 99 patients with ischemic stroke regarding the stroke risk factors. The patients and the controls were compared in respect to stroke risk factors. Results: Hypertension, atrial fibrillation, and cigarette smoking was statistically significant as a risk factor in the stroke group compared with the control group (P<0.05). Conclusion: Diabetes mellitus and dyslipidemia have not been found as significant risk factors in patients with stroke when compared with the control group (P>0.05).

The mean platelet volume (MPV); is a marker that gives information about platelet function, activity, and volume. Increased MPV indicates larger platelets which are more active and inclined to more adhesion and aggregation. In diabetics, increased adhesion and aggregation can lead to blockage in the microvascular system, diabetic complication, ischemia, and hypoxia. We compared MPV in patients with microalbuminuria (MA) and/or patients with/without hypertension (HT) who have type 2 diabetes mellitus (DM) as an indicator of complications. Eighty patients (aged 18-65) with/ without MA and/or HT with type 2 DM and 30 healthy subjects were included into the study and divided into 4 groups as Group 1: Type 2 DM without HT and MA, Group 2: Type 2 DM with HT and without MA, Group 3: Type 2 DM without HT and with MA, Group 4: Type 2 DM with HT and MA. The MPV’s of patients in Group 2, Group 3 and Group 4 were higher than controls (p=0.005,p<0.001, p<0.001, respectively), but not higher than Group 1. The mean MPV values in diabetic patients were significantly higher than the controls (p<0.001). Although higher MPV levels were found in diabetic patients compared to control, MPV levels are not useful in monitoring and predicting complications in type 2 DM patients.

Between 1989 and 1992 in University of Selçuk, Faculty of Medicine, Department of Surgery, 12 patients were diagnosed with portal hypertension. 14 surgical intervention (3 selective and 8 nonselective shunt, 1 eosophageal transsection and 2 Sugiura-Fwagawa procedure) were peıforıned ta these patients. Except 1 oesophageal transsection and 2 Sugiura-Futagawa operation, all operations were peıformed in elective conditions. Expect 2 cases underwent Sugiura-Futagawa operation, there were no operative mortality. Ir wasn't developed the recurrent hemorrhage in following 3 mounts to 2 years.

Aim: To determine the primary success rate and follow up results of renal artery stenting or balloon angioplasty in controlling renovascular hypertension and renal failure in patients with renal artery stenosis. Method: Before balloon angioplasty and stenting; renal angiography and Doppler ultrasonography findings were evaluated and also findings of MRA were estimated if present.The clinical estimation of the cases were made upon to renal functions, hypertension values and the changes of the number of medicines used. Results: Balloon expandable stents were placed in 32 renal arteries of 37 patients. Balloon angioplasty were used in 7 renal arteries of 37 patients (22 men, 15 women; mean age 50.24). There were hypertension in all of the patients. In 12 patients; there were disturbed renal functions. In order to determine the activity of the cure of the disease, the patients are followed by measuring blood pressures and serum creatinin levels before and after the stenting and balloon angioplasty. Stenosis rate was 30-100% (mean 74.15%).The lesions were ostial in 15 patients, truncal in 24 patients. Mean follow up time was 21.2 months (3-84 months). Hypertension was cured in 9 (24.33%) patients, improved in 19 (51.35%).patients In 9 (24.33%) patients there was no respond. In 12 patients with disturbed renal function, 8 (22.22%) patients showed improvement, 4 (11.10%) patients showed deterioration and 4 (11.10%) patients were stable. Conclusion: Revascularization of renal artery stenosis with stenting and balloon angioplasty is a simple, efficient and safe procedure. In patients with uncontrolled hypertension and progressive renal failure; revascularization of renal ar tery stenosis with stenting and baloon angioplasty pointed out impor tant clinical benefit.

It was reported that there is relationship between high brain natriuretic peptide (BNP) levels and mortality in chronic obstructive pulmonary disease (COPD). In this study, we investigated effect of NIV to the BNP and troponin. Fifty eight cases with COPD were enrolled to this study. The patients were divided into two groups as cases receiving NIV (n:41) and cases not receiving NIV (n:17). In both groups pretreatment and posttreatment pro BNP and troponin levels were measured. Initially, in NIV group both pro-BNP (2013.95 pg/ml) and troponin (0.17 ng/ml) levels were significantly higher than those of control group (328.9 pg/ml and 0.02 ng/ml, respectively) (p0.05). In conclusion, in severe COPD acute exacerbations that develop respiratory failure, both pro-BNP and troponin levels increase significantly. This increase suggests that in COPD exacerbations, depending on severity of exacerbation right ventricle load and pulmonary hypertension may be more prominent and myocardial injury may accompany this. In COPD exacerbations, NIV treatment could safely decrease the increased pro-BNP levels without increasing the myocardial injury.

Aim: Chest radiography and thoracic computed tomography (CT) play an important role in the diagnosis and
prognosis of sarcoidosis, a systemic granulomatous disease characterized by non-caseating granulomas.
Pulmonary hypertension, a rare complication of the disease, can be seen in all stages. There is a strong
correlation between pulmonary hypertension (PH) and an increase in the diameter of the main pulmonary
artery (MPAD). In this study, we aimed to evaluate MPAD with multislice computed tomography (CT)
examination for the early diagnosis of PH in patients with stag e II sarcoidosis.
Patients and Methods: We measured the diameter of the main pulmonary artery on thorax CT in patients
with stage II sarcoidosis, who were followed up in our hospital with a diagnosis of sarcoidosis between
January-2018 and December-2021, with hilar lymphadenopathy and parenchymal changes in their imaging,
and compared them with the control group, whose chest X-ray was normal and thorax CT scan was performed
with nonspecific symptoms. We evaluated the relationship between the pulmonary artery pressures obtained
by echocardiography and the diameter of the main pulmonary arte ry in patients with stage II sarcoidosis
Results: We found a significant correlation between the increase in MPAD and pulmonary artery pressure
measured by ECHO in patients with sarcoidosis compared to the control group, and the pulmonary artery
diameter measured by CT in this patient group.
Conclusion: We think that CT evaluation of pulmonary artery diameter in patients with sarcoidosis can guide
the development of PH and therefore of fer an opportunity for early intervention.

In this study, effects of angiotensin blockers (ARB) and diuretics combinations on central hemodynamics and arteriyel stiffness parameters were analyzed. In this retrospective study, hemodynamical parameters of patients using ARB, ARB + diuretics and healthy controls were analyzed for 24 hours with Mobil-O-Graph Arteriograph (I.E.M. GmbH, Stolberg, Germany). 44 patients on ARB, 81 cases on ARB + diuretics and 30 healthy control subjects without any hypertension or chronic illness were included. Mean age of patients on ARB, ARB+ diuretics and control group were 51.2±15.8, 56.3±13.8, 53.4±15.9 respectively. 24 hour mean pulse pressure was correlated with 24 hour central systolic blood pressure (SBP) (r=0.646, p=0.02), and 24 hour reflection size (r=0.498, p=0.022). 24 hour central SBP was correlated with 24 hour [email protected](r=0.590, p=0.005), cardiac output (r=0.630, p=0.005), peripheral resistance (r=0.451, p=0.030). 24 hour central diastolic BP (DBP) was correlated with 24 hour [email protected] (r=0.445, p=0.040), cardiac output (r=0.798, p

In this study, we looked the distribution and prognostic significance of ventricular arrhythmias (VA) in patients with essential hypertension. Fifty patients with essential hypertension were included. After physical and laboratory exa-mination, interventricular septum (IVS) and left ventricular posterior wall (LVPW) thickness were measured in M-mode echo to detect left ventricular hypertrophy (LVH). Patients were classified into 2 main group according to presence or absence of LVH. Halter monitoring was performed and VAs seen in Halter were defined according to Lawn clas-sification_ All of the patients were followed clinically at least 6 months by 2 monthly intervals. All types of VAs were more common in LVH group, but only Lawn IVA group VA was sig-nificantly higher occurence. There were no malign VA and sudden death while Lawn IA group VAs were more common in the two group of patients.

We investigated hypertension incidence among °at patients and the patients from the province in Konya. The first group included 1000 randomized out patients and the. second group included 2036 patients examined during health sereening studies in certain areas. We used World Health Organisation criterias for hypertension diagnosis. In first group hypertension incidence among patients under 45 years old was 22.5%, 46-60 years 44.5%, 61 years and over 60.3% and the mean 32.5%. In second group hypertension incidence among patients under 45 years oid was 14,2%, 46-60 years 42.2%, 61 years and over 44% and the mean 23,1%. The hypertension incidence increases gradually in older patients and most of them are mild cases, obesite and diabetes mellitus are important risk factors, cerebrovascular accident, cardiac and renal pathologies are the most common complications.

Idiopathic pulmonary arterial hypertension (IPAH) with an incidence of 1-2/million per-year. IPAH is a term used to define a variety of progressive conditions that have in common, increased pulmonary vascular resistance leading to right heart failure and death. Pulmonary arterial hypertension is presented with cyanosis, polyctemia and right heart failure. Increased prevelance of mortality is due to progression and late diagnosis of the disease. We present this case to alert physicians to keep in mind rare but serious disease IPAH in the differential diagnosis of polyctemia.

Effects of short-term perindopril therapy on cardiac function and left ventricular hypertrophy was assesed in patients with primer hypertension. The study population was consisted with 35 patients (mean age 485+ years, 15 female and 20 male). Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) decreased significantly (88 5 mmllg vs 107±6 mmlig, p<0.05). Left ventricular mass decreased significantly from 245±16 gr to 2370 gr (pc0.05). There were no change in systolic and diastolic left ventricular fiınctions by using Doppler and M-mode Echocardiography. There were no obvious side effects due to perindopril therapy.

The aim of this study is to report our surgical results in ventricular septal defects. Between 2001 and 2009, 92 patients with ventricular septal defect underwent surgical correction in our center were included in this study. Additional cardiac defects were pulmonary hypertension in 27 (29.3 %) patients, patent ductus arteriozus in 10 (10.8 %) patients, Down Syndrom in 7 (7.6 %) patients, and aortic regurtation 5 (5.4 %) patients. Defects were closed with Dacron patch using separately sutures. Early mortality was developed in 5 (5.4 %) patients. 65 patients were followed for 6.1 years. Residual VSD was detected in 3 patients and one of them underwent secondary operation. There was no complet atrioventriculary block. 1˚- 2˚ degree aortic and tricuspit regurtation were not operated and included in our follow up programme. We hope to perform surgery for ventricular septal defect with low mortality and morbidity as a new Middle Anatolian center.

IVe evaluated the medical records of 26 patients vvith kidney injuries resulting from multiple trauma at urological department. The patients vvere classified as minör and majör depending on the pathological sign. 65.4% of the patients had majör renal damage vvere as 34.6% of the patients had minör renal damage. From kidney injuries 76.8% was blunt injuries. 88.8% of majör kidney injuries vvere associated with multiple organ damage. Surgical treatment's vvere used for majör renal traumas wereas only conservative treatment vvere used in management of minör renal injuries. VVhile emergency interferances vvere reçuired only due to early complications of multiple trauma like hemorrage and urinoma, and late complications like htfdronephrosis, hypertension and arteriovenoous fistulas.

This study was carried out to find out the clinical affect, tolerance, side affect and metabolic affects of nitrendipine on 43 hypertensive patients. The pa-tients were divided tn to 3 groups as light, rnild and severe. In study group 11 patients had atherosciehot-ic heart disease, 3 had congestive heart failure and 13 had diabetes mellitus. Nitrendipine was giyen ta all patients 20 mg one dese daily in the morning. The patients were examined upon his application, in the firsth, the third and the sixth weeks. At the end of the six week treatment, the affect and the side affect of nitrendipine were evaluated. The success rate of nitrendipine in light hypertension was 86.66%, in mild hypertension was 81.81%, 64.70% in severe hypertension and considering the total 43 patients, the success was 76.74% in our study. While meaningful decrease in blood pressure in all hypertensive groups was observed at the end of six week treat►ent, meaningful increase in pulse rate was noticed in all except diabetic and the old pa-tients. The side affects such as particularly palpita-tion, headache and flushing, dizziness, feel of vomit-ing and exhoustion were noticed 44.18% of all groups. In conclusion, nitrendipine was proved to be ef-fectiw and reliable drug in all hypertensive patients.

The current study aimed to determine the in our country patients diagnosed peripheral arterial disease (PAD), the relationship with the atherosclerotic risk factors. A better understanding of the risk factors will make it possible to take precautions against the modifiable risk factors, and will facilitate the early diagnosis and implementation of effective therapy. The patients who had been diagnosed with PAD either clinically or by using ultrasonography underwent peripheral angiography for the arteries of the lower extremities. The patients were evaluated in terms of age, gender, and atherosclerotic risk factors. Of the 408 patients, 78.4% were males, and the mean age was 61.5±9.5 years. The patients had the following risk factors: hypertension (HT), 58.3%; diabetes mellitus (DM), 26.7%; a family history of CAD (Coronary artery disease), 15.9%; smokers, 48.2%; hypercholesterolemia, 49.7%. The extent of PAD observed during peripheral lower extremity angiography was associated with atherosclerotic risk factors. Particular attention should be focused on the co-morbidities of PAD. Non-invasive, as well as invasive tests, should be performed when indicated to decrease morbidity and mortality in patients at risk for PAD.

We investigated the serum selenium levels in 37 patients with acute myocardial infarction (Group I) and in 33 healthy people (Group II). The mean levels of selenium in both groups were 49.340.906 pgl L and 70.849±12.868 pgiL, respectively. There was significant difference between two groups (p<0.01). There was no relationship between selenium levels and sex, smoking and hypertension. The selenium levels showed decrease in patients older than sixty compared to those under sixty (p<0.05). In conclusion, we found that there was meaning relationship between serum selenium levels and cora onary artery disease. In order to describe the relation-ship we need prospective clinical and experimental studies with more detail.

Aim: In this study, it was aimed to investigate the kidney function, hypertension development and
proteinuria in individuals with only one kidney .
Patients and Methods: The study included 96 patients who had previously undergone nephrectomy with
the causes of nephrolithiasis and chronic pyelonephritis-induced nonfunctional kidney, RCC (Renal Cell
carcinoma), trauma, and donor nephrectomy among 17800 patients who applied to the Siirt State Hospital
Nephrology and Urology outpatient clinics between January 2016 and December 2019. The data of the
patients were obtained from patient files database retrospectiv ely.
Results: A total of 96 patients, 45 female and 51 male, were included in the study. 23 (24%) of the
patients had donor nephrectomy (DN), and 73 (76%) had nephrectomy (DE) due to nephrolithiasis, chronic
pyelonephritis, trauma, and renal cell cancer (RCC). The patients were divided into two groups as those
who underwent DN and DE due to other etiologies. Between DN and DE group, there was no statistically
significant difference in terms of mean age, distribution of gender, presence of HT before nephrectomy,
DM, presence of hematuria and new onset proteinuria (P> 0.05). Compared to the DN group, the frequency
of new onset in CKD and HT development was significantly higher DE group.
Conclusion: Nephrectomy is a risk factor for the development of CKD, proteinuria and hypertension.
Therefore, preventive measures should be taken in a timely manner to reduce the prevalence of
nephrectomies due to benign diseases.

Portal veins are the veins that carry the venous blood of the splacnic area in the abdomen to the liver (KC) sinusoids. Stomach, intestine, gallbladder, spleen, and pancreatic veins join the portal venous system. The largest vein of this system is the vena portal. It occurs by the union of the veria porta v.lialis (splenic vein) and the v. Mesenterica superior at the level of the L2 vertebra and the race of the pancreatic head. The v.porta, which has no valve inside, branches into the KC and opens to the sinusoids and central vein. Central hepatic veins unite and make v. Hepatic. Any reason that disrupts or prevents the blood flow in this system increases the blood pressure in the portal venous system and leads to portal hypertension (PH). To overcome the resistance of the sinusoidal system, the pressure in the portal system is normally 5-10 mm Hg higher than the venous pressure in other systems. With this increase in height, PH occurs. It is PH when the blood pressure in the portal venous system is higher than = 20 mm Hg (1) and, according to some authors, 10-12 mm Hg (17-20 cm water pressure) (2).

The assesment of the renal arteries is par-ticuhırlv inıporraın in the derection of a re-novaseuhır cause of hypertension. İi was in-,estigıred the ejfectivene•s of color doppler ultrasonography (CDU) in the detection 50 % or greater diameter reducing the srenosis in renal ar-ten, irr this study. The studv was done in the De-partment of Urology and Radiology, University of Ankara, Medical School between March 1993 and December 1994. The findings of color doppler ult-rasonography in 20 hypertensive patients were com-pared with the results of renal angiography. It was demonstrared 39 main and 4 accessories renal ar-teries irr these 20 pariems by angiography. An-giographv detnonstrared the stenosis in 5 main renal arte.ries and in. one accessory renal artery. It was derermined the occhısion in 4 tnain renal arteries. The maximum systolic velocity and th.e ratio of ma-ximum systolic velocitv in renal artery to that in ab-dominai aorta (RAR) were calculated with CDU in all patients. The average procedure time per pa-ıients with CDU was 42+4 (38 + 53) minutes. It was demonstrated 87,1% of the main arteries and only 1 (25%) of the accessory vessels by CDU. A nuıximum systolic velociry value of greater than 100 emisec and a RAI? value of 3.50 or greater were chosen as the criteria foı- SIC110SiS. The first criteria in the di-agnosis of renal artey stenosis was more useful. Ac-coı-ding rrı this crireria. we found 67 % sensitivity and 93% specifieity in diagnosing 6 renal artey ste-nosis with CD U. concluded, that CDU is not an ahernative to angiographv with the technology and criteria used, and the technology of CDU should be improved and the diagnostic criterias should be standardized to increase the effecriveness of CDU irr diagnosis of renal arterv stenosis.

It is a know that morbidity of cardiovascular disorders is high in diabetic patients. Besides obesity and hypertension, increased levels of triglycerides and very low density lipoprotein cholesterol were identıfied among high risk factors in the development of coronary arter disease in patients with abnormal oral glucose tolerance test. In this study, i1 is compared with risk factors and coronary heart disease among the patients with 60 abnormal glucose tolerance test and 60 type-II diabetes mellitus and 60 normal cases. Body muss index is found high in patients with' aıabetes melliıbıç and abnormal glucose tolerance les( It was higı- levels of systolic and diastolic blood pressuı e in patients with diabetes mellitus and abnormal glucose rolerance test. The level of triglycerids and totaı s holesterol and fasting blood sugaı were high in patıenıs with diabetes mellitus and abnormal glucose tolerance test, but it was low level of high density liport.teın cholesterol in both groups. It is identıfied mort ınactivelife standart regarding life style in both Finally these results suggested that the risk tactors of coronary artery disease increased in patients with abnormal glucose tolerance test lıke diabetes mellitus

Inguinal hernia operations are frequently performed at general surgery clinics. These procedures can be performed not only under general anesthesia but also with methods like spinal anesthesia, epidural anesthesia, and local anesthesia. Inguinal reparations can be successfully performed with local anesthesia especially on older patients, those with comorbidity and significant risk of anesthesia. An ample amount of studies in literature underline the fact that the results of hernia reparations performed under local anesthesia are no different than the results of hernia reparations done under general anesthesia. This report discusses the case of an 87-yearold male patient with comordid diseases like hypertension, diabetes mellitus, congestive heart failure, and chronic kidney failure as well as irreducible inguinal hernia who had to undergo emergency hernia reparation under local anesthesia. Although inguinal hernia reparation under local anesthesia has been comprehensively evaluated in literature, there is very limited information on the reparation of incarcerated inguinal hernias under local anesthesia. Consequently, we think that it is possible to use local anesthesia successfully to surgically treat incarcerated hernias with low risk of strangulation especially on senior and comorbid patients. However, we also believe that it would be of utmost significance to conduct a comparative study between emergency hernia operations performed under local anesthesia and general anesthesia in order to be able to recommend a safer solution on the subject.

Extra-adrenal pheocyroynwctomas generally occur in the retroperiotoneum and rarely seen any-where from the bladder to the base of the skull in as-socation with the svmphetetie nervous system and cause hverta►tion. We report 20 year-old female wit7i extra-adrenal pheocyromacytoma arising from left renal pedicle level review its diagnosis, treatment and follow-up.

High-density lipoproteins (HDL) have preventive effects from developing atherosclerosis (11, 13, 24). In order to investigate the effects of long-term drugs nifedipine and propranolol on HDL cholesterol concentrations in the treatment of CHD and hypertension, 20 patients who were given nifedipine, 20 patients who were given propranolol and 20 healthy controls were studied. Serum HDL cholesterol concentrations were lower in patients with coronary heart disease (CHD) than in the control group (P <0.05). There was a significant decrease in HDL cholesterol levels in the propranolol group (P <0.01), but no change in those given nifedipine. Total cholesterol values ​​did not differ significantly, and there was no change with drug intake. Total / HDL cholesterol ratio increased in those given propranolol, but did not change in those given nifedipia. We concluded that administration of propranolol for long-term treatment of KH and hypertension reduces IIDL cholesterol levels, but administration to nifedipine did not.

It was reported that cila:april, a new ACE in-hibitor, decreases arteial blood pressure, ine-reases regional flows by 25 %. in the kidney, 37 gf in the stomach, 57(. in the ileum and 37 % in the skin in spontaneously hyper tansive rats. 11-e evaluated the effects of treatment with ci-la:april (2.5 mg once a day) to kidneys in rats with renovasetilar hvertension that occurred partial renal artery SIC110SiS.

The Coronary heart disease and üs risk factors were investigated in Konya, which is placed in the central pan of Central Anatolia in Turkey. In 'his study 280 asymptomatic people, who are middle aged and over (.40), were selected randomize from Bozkır, a small town of Kon" ya, which shows a ho-mogen structure of population. All of the cases which were investigated, cardio-vascular system was examined. ECG and teleradiog-raphy were taken. In 54 cases (19.3%) hypertension, 11 cases (3.9%) hyperglisemia and 58 male cases (59.8%) smoking were found. Obesite was seen 17% of male and 27% of female. Ilypercholesterolarnia in 12% of cases and hypertrigliseridemia in 7.4% of cases were also seen. In 40 cases, coronary heart dis-ease was deterrnined. Incidence of hypefrtension was increasing with age, but the rale of cigarette-smoking was not changed. With the understanding of posiıive results of struggle -withreversible major risk factors periodic examinations in cases with high risk; furthermore investigation of risk factors medical and preventive treatment procedures were pointed out clearly as important issues which mut be followed by physidans.