OBJECTIVE:A decrease in the left ventricular ejection fraction (≤40%) in the setting of ST-segment elevation myocardial infarction is a significant predictor of mortality in the young ST-segment elevation myocardial infarction population. In this study, we aimed to investigate the predictors of left ventricular ejection fraction reduction and evaluate the long-term mortality rates in young ST-segment elevation myocardial infarction patients with or without decreased left ventricular ejection fraction. METHODS: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial infarction patients aged 45 years or below who underwent primary percutaneous coronary intervention. Young ST-segment elevation myocardial infarction patients were divided into two groups according to their left ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were compared with each other. RESULTS: Statin use, white blood cell count, C-reactive protein, peak creatine kinase-MB, prolonged ischemia time, left anterior descending arteryrelated infarction, proximally/ostial located lesion, and no-reflow were independently associated with low left ventricular ejection fraction. Additionally, long-term mortality was considerably higher in the left ventricular ejection fraction ≤40% group than those in the left ventricular ejection fraction>40% group (18.1% versus 2.4%; p<0.001). CONCLUSIONS: In young ST-segment elevation myocardial infarction patients, lesion properties (left anterior descending lesion, proximally located lesion), no-reflow, and prolonged ischemia time appeared to be important determinants for the left ventricular ejection fraction decline, rather than coronary disease severity or demographic and hematological parameters. Statin use may be preventive in the development of left ventricular ejection fraction decline in young ST-segment elevation myocardial infarction patients.

Valvüler olmayan atriyal fibrilasyonlu hastalarda tromboembolik korunma için varfarine alternatif olarak yeni oral antikoagülanlar ortaya çıkmıştır. Yeni oral antikoagülanlar varfarine göre daha iyi uyum ve güvenlik marjına sahip olmakla birlikte, kullanımları konusunda dikkatli olmalıyız. Bu yazıda, rivaroksaban tedavisine bağlı bir spontan hemotoraks olgusu sunuldu. Araştırmamıza göre, rivaroksaban tedavisine sekonder ilk spontan hemotoraks olgusu budur.

ÖzetElli beş yaşında, koroner arter hastalığı nedeni ile prasugrel ve asetilsalisilik asit kullanmakta olan kadın hasta, senkop ve hipotansiyon ile acile servise getirildi. Ekokardiyografide paradoks septum ve sağ ventrikül-de genişleme saptanan, kontrastlı bilgisayarlı toraks tomografisinde bilateral ana pulmoner arterlerde ve dallarında yaygın trombüs görülen hastaya rt-PA uygulandı. Trombolitik bitiminde heparinize edilen hastanın tedavisine yirmi dördüncü saatte warfarin eklendi. Kanama komplikasyonu gelişmeyen hasta yedinci günde warfarin, klopidogrel, asetilsalisilikasit tedavileri altında taburcu edildi. Bu olgu, yeni kuşak antitrombotik olan presugrelin kanama riskinin yüksek olması, bu ilaç ile birlikte daha önce trombolitik kullanımının bildirilmemiş olması, sonuçta kanama komplikasyonu gelişmeden hastanın takip edilmesi açısından önemlidir.Anahtar Sözcükler: Masif pulmoner emboli, prasugrel, trombolitik tedavi. AbstractA 55-year-old female patient was admitted to emergency service for hypotension and syncope. The patient was under dual antiplatelet therapy, aspirin, and prasugrel for coronary artery disease. Echocardiography revealed dilated right heart chambers as well as paradoxical septal motion, suggesting a diagnosis of pulmonary embolism. Thorax computerized tomography with contrast enhancement was performed and revealed thrombi in both main pulmonary arteries and their branches. Thrombolytic treatment was provided. There were no bleeding complications, and patient was discharged from the hospital on the seventh day, taking warfarin, clopidogrel, and aspirin. The present case is important because thrombolytic treatment for a patient who is on prasugrel has not been reported in the literature previously, and it illustrates that such therapy can be administered safely, though prasugrel has been associated with an increased rate of bleeding complications. Key words: Massive pulmonary embolism, prasugrel, thrombolytic treatment.Masif pulmoner tromboemboli hızlı ve doğru tanı ve tedavi yaklaşımına rağmen mortal seyredebilen bir hastalıktır (1). Mortaliteye önemli katkısı olan durumlardan biri tedaviye sekonder kanama komplikasyonudur. Bu komplikasyon ileri yaş, yakın zamanda geçirilmiş travma ya da operasyon, komorbid hastalıklar ve bu hastalıkların tedavisi için kullanılmakta olan antiplatelet ajanlar gibi ilaçlardan kaynaklanabilir. Son yıllarda yeni aniplatelet ilaçların koroner arter hastalığında etkin kullanımı söz konusudur ve prasugrel bu ilaçlar içinde en yenilerden bir tanesidir. Literatüre bakıldığında prasugrel kullanırken trombolitik tedavi uygulanan bir olgu yoktur.

To Editor,Here, we report on a case of multiple hepatic metastases from rectal cancer that showed complete response to chemotherapy. A 46-year-old male patient was admitted to our hospital and diagnosed with rectal cancer and simultaneous multiple hepatic metastases. As the patient had wild-type KRAS mutation status, systemic chemotherapy by irinotecan with fluorouracil and folinic acid (FOLFIRI) plus cetuximab was begun via central venous port. After 3 courses of FOLFIRI plus cetuximab, abdominal computed tomography (CT) showed remarkable reduction in size of liver metastases. After completing 6 courses of the same regimen, both metastases and the primary tumor was not detected by Positron Emission Tomography-CT imaging. The radiologic complete response (CR) was also confirmed by other diagnostic modalities such as magnetic resonance imaging of the abdomen and pelvis and, rectosigmoidoscopy. Thereafter, primary tumor and hepatic metastatic sites were operated and the same chemotherapy regimen was continued for another 3 months.For the treatment of metastatic colorectal cancer (mCRC), recent advances in chemotherapy have been demonstrated to achieve a high response rate. Despite