THE RELATIONSHIP BETWEEN CORONARY SLOW FLOW AND MYOCARDIAL ISCHAEMIA EVALUATED WITH TIMI FRAME COUNT AND MYOCARDIAL PERFUSION SCINTIGRAPHY ABSTRACT Aim: Coronary slow flow (CSF) is known as a form or early stage of common atherosclerotic disease. Myocardial perfusion scintigraphy (MPS) is a valuable technique in the diagnosis of coronary artery disease and prediction of prognosis. The aim of this study was to investigate the relationship between the myocardial defect score and ischaemia in patients with CSF. Method: A total of 169 patients who applied with the complaint of angina pectoris and underwent SPECT as a non-invasive test followed by coronary angiography were included in this retrospective study. 10 patient was excluded from the study for various reasons. The study population comprised 91 (58%) determined with CSF and no obstructive stricture in the coronary arteries and 68 (42%) with normal flow. The mean age of the patients was 56±12 years. The scores obtained from Quantitative Perfusion SPECT (QPS) and Quantitative Gated SPECT (QGS) software were used in the myocardial perfusion evaluation. The TIMI frame counts were compared with the myocardial defect and ischaemia scores. The TIMI frame count method was used in the determination of CSF. In patients with slow flow in the circumflex (Cx) coronary artery, the stress total perfusion defect Cx (sTPD-Cx) was found to be 0.1 (range, 0.0-1.3), and in those with normal flow, it was 0.0 (range, 0.0-0.28) (p=0.002). The stress score Cx (sscore-Cx) was found to be 1.0 (range, 0.0-3.0) in patients with slow flow and 0.0 (range, 0.0-2.0) in those with normal flow (p=0.031). A linear correlation was determined between the Cx TIMI frame count and the sTPD-Cx and sscore-Cx values (r=0.207, p=0.009; r=0.159, p=0.045). No relationship was found between slow flow and the defect and ischemia scores in other myocardial regions. Conclusion: In patients with slow flow in the Cx coronary artery, the sTPD-Cx and the sscore-Cx values were found to be significantly high. Although at a weak level, a linear correlation was found between the Cx TIMI frame count and the sTPD-Cx and the sscore-Cx values. Key Words: Coronary slow flow, TIMI frame count, myocardial perfusion scintigraphy

Amaç: Suriye’de 2011 tarihinde başlayan iç savaş, çok sayıda insanın ölümüne ve yaralanmasına neden olmuştur. Kafa yaralanmaları savaşta ve savaş dışı zamanlarda cerrahi acillerin en önemlilerindendir. Materyal ve method: 2014-2015 yılları arasında Suriye savaşında kurşun ve şarapnel gibi ateşli silah yaralanmalarına bağlı kafa travması nedeniyle başvuran toplam 75 hasta (58 erkek 17 kadin) retrospektif olarak değerlendirildi. İncelemeye nörolojik ve radyolojik incelemeleri yapılmış hastalar dahil edildi. Bulgular: Penetran ateşli silahla yaralı kafa travması nedeniyle hastanemize başvuran 75 hastadan 20’si (%26.67) ölmüştür. Beyin parankimal kanaması olanların ölüm oranı olmayanlara göre anlamlı düzeylerde bulunmuştur (p<0.001). Beyin ödemi olan hastaların ölüm oranı olmayanlara göre anlamlı düzeylerde bulunmuştur (p=0.003). Ayrıca ventriküler kanama ve subaraknoid kanaması olan hastalarda da ölüm oranı olmayanlara göre anlamlıya yakın düzeylerde yüksek bulunmuştur (ventriküler kanama için p=0.081, subaraknoid kanama için p=0.056). Sonuç: İleriye yönelik olarak ateşli silahla yaralı kafa travmalı hastalarda ilk müdahalede, gereklilik halinde cerrahi acil girişime karar verilmesi aşamasında ve komplikasyonların yönetiminde gerekli verileri oluşturmaktır.

Background: The aim of the current study was to investigate magnetic resonance imaging (MRI) findings in children who developed convulsions after COVID-19 infection. Materials and Methods: A retrospective screening was made of paediatric cases who presented at the COVID-19 pandemic clinic with suspected COVID-19 infection between March 2020 and June 2021 and were diagnosed with COVID-19 from a positive real-time polymerase chain reaction test (qRT-PCR). Non-contrast brain and diffusion MRI performed using a 3-Tesla device in all patients with convulsions. The demographic characteristics and brain MRI findings were recorded of cases with COVID-19 infection who developed convulsions. Results: Evaluation was made of 6 cases who were diagnosed with COVID-19 and developed convulsions during the disease course. There was a history of convulsions in 3 patients and recurrent convulsion attacks developed despite anticonvulsant therapy. In the other 3 cases developed convulsion, there was no history of convulsions, or additional disease. Non-contrast brain MRI was taken for etiology in all patients. In all the cases, no signal changes of acute pathologies were detected on diffusion MRI. Conclusion: COVID-19 infection can trigger convulsions even in patients with epilepsy and taking anticonvulsant therapy and may cause convulsions in previously healthy cases. Unlike in the adult patient population, COVID-19 infection was not seen to cause acute changes in brain MRI findings in the pediatric age group who developed convulsions due to COVID-19 infection.