Elastic properties of ascending aorta are impaired in patients with beta-TM. Impaired functions of aorta may lead to deterioration of left ventricular function.

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Systemic thromboembolism is a serious major complication in patients with mitral stenosis. However, the pathogenesis of thromboembolism in mitral stenosis is not fully understood. Previous studies have demonstrated that platelet activation occurs in serum of patients with rheumatic mitral stenosis (MS). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation, in patients with MS. The study group consisted of 36 patients with MS who were in sinus rhythm. An age and gender matched control group was composed of 30 healthy volunteers. We measured serum MPV values in patients and control subjects. MPV was significantly higher among MS patients with sinus rhythm (SR) when compared with the control group (9.2+/-1.4 vs 8.1+/-0.9 fl respectively; p<0.001). We have shown that MPV was significantly elevated in patients with MS who were in SR compared to control subjects.

A b s t r a c tIntroduction: The mechanisms of circadian variation in cardiovascular events are not clear. Aim: Evaluation of the effect of Ramadan fasting on circadian variation of acute ST-elevation myocardial infarction (STEMI) in Turkish patients.Material and methods: This comparative cross-sectional study included 151 consecutive patients with acute STEMI. The time of onset of STEMI was determined by the attending physician on the basis of patients' self-reports. The patients were divided into two group based on the history of fasting. The standard hourly profile of the onset of STEMI was obtained over a 24-h period. Patients were then categorized into four 6-hour increments according to the time that the symptoms began (00:00-05:59; 06:00-11:59; 12:00-17:59 and 18:00-23:59 h).Results: In all study participants, the highest incidence of STEMI was between 12.00 and 18.00; the odds ratio was 2.77 (95% CI: 2.63-2.92, p < 0.001). In the non-fasting group, the highest incidence of STEMI occurred between 06:00 and 12:00 A.M. The highest incidence of AMI occurred between 12.00 A.M. and 18.00 in patients with fasting; the odds ratio was 2.70 (95% CI: 2.51-2.91, p < 0.001). There were significant differences between fasting and non-fasting groups regarding circadian variation of STEMI (p < 0.001).Conclusions: There are significant changes in the circadian variation of patients with STEMI in relation to Ramadan fasting.

SUMMARYBrucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve.A 30 year-old woman presented with complaints of chills and fever up to 38°C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3°C. On echocardiographic examination, the mitral valve area was 0.62 cm 2 and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced.Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation.The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints.In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated. (Jpn Heart J 2004; 45: 353-358)