Objective:Combined sedation with propofol and benzodiazepines, known as balanced propofol sedation (BPS), was developed to increase patient comfort during endoscopy. However, the effects of BPS on P-wave dispersion (Pwd), QT interval, and corrected QT (QTc) interval after endoscopy have not been investigated.Methods:The study population consisted of 40 patients with BPS and 42 without sedation who were scheduled to undergo upper endoscopy in this cross-sectional prospective study. Patients with hypertension, diabetes mellitus, renal failure, chronic obstructive pulmonary disease, coronary artery disease, or valvular heart disease and those on medications that interfere with cardiac conduction times were excluded. Electrocardiograms (ECGs) was recorded in all patients pre-endoscopy and 10 min post-endoscopy. QT, QT dispersion (QTd), and Pwd were defined from 12-lead ECG. The QTc interval was calculated using Bazett’s formula. All analyses were performed using SPSS 15.0.Results:Post-endoscopy P max duration and Pwd were prolonged compared with baseline values (86±13 ms vs. 92±10 ms and 29±12 ms vs. 33±12 ms, respectively; p<0.05). Post-endoscopy QTc and QTd were decreased compared with baseline values, but these decreases were not statistically significant (431±25 ms vs. 416±30 ms and 62±28 ms vs. 43±22 ms, respectively; p>0.05).Conclusion:The present study showed that P-wave duration and Pwd values increased after endoscopy with a combination of midazolam and propofol sedation. Physicians should be made aware of the potential effects of BPS in terms on P-wave duration and Pwd values.

Background: Cardiovascular death is decreasing in the general population; however, it appears in still higher rates and even increases gradually in hemodialysis (HD) patients. This situation has led to a debate about cardiovascular adverse effects of HD which lead to significant changes in cardiac and hemodynamic events. It is known that troponins are often elevated in HD patients, and high levels of troponin are associated with increased mortality. Therefore, it is difficult to interpret the value of elevations in chronic kidney disease patients. Methods: Echocardiographic and biochemical parameters of 41 patients treated with HD were evaluated before and after a HD session. Results: HD led to an increased heart rate, and tissue Doppler imaging parameters such as early diastolic mitral peak velocity (E)/early diastolic myocardial peak velocity (é) and septal é decreased significantly after HD. HD caused an increase in troponin I, myoglobin and cardiac creatine kinase (CK MB) levels (p = 0.019, p < 0.001 and p = 0.018, respectively). A decrease in the left ventricular peak systolic myocardial (LV S') velocity (p = 0.011) was detected in patients with increased levels of cardiac damage markers (group 2) compared to those without increased levels of cardiac damage markers (group 1) in HD. Conclusion: A decrease in LV S' velocity was found to be an independent predictor of an increase of myocardial injury enzymes in HD (odds ratio = 1.099; p = 0.039). We concluded that HD may lead to significant acute stress upon the myocardium.

Arteriovenous fistula presents rarely with ascites. Diagnosis, with an elusive clinical presentation, is often incidental or delayed. A 35-year-old woman presented with ascites and cardiac decompensation. Contrast enhanced computed tomography revealed arteriovenous fistula between the left common iliac artery aneurysm and the left common iliac vein. The patient underwent endovascular treatment with arterial access was performed, with implantation of a stent graft in the iliac artery to cover the fistulous communication. At follow-up 1 month later, she was asymptomatic without ascites. Arteriovenous fistula should be considered in the differential diagnosis of patients with ascites and cardiac decompensation. The endovascular treatment of the arteriovenous fistula should be considered as a first line option. Keywords: Arteriovenous fistula, ascites, heart failure, endovascular procedures INTRODUCTIONAbdominal arteriovenous (AV) fistulas are rare clinical abnormalities with a rupture of an aortic or iliac aneurysm into the inferior vena cava, the iliac or renal veins (1). Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, with an elusive clinical presentation, is often incidental or delayed (1). Clinical presentation with ascites is rare in iliac AV fistulas (2).Surgery is the traditional treatment for this condition, consisting of fistula closure and aneurysm repair, usually with an aortic or aortoiliac graft (3). Endovascular repair of such fistulas is a growing trend in vascular surgery (4). This is a case of a percutaneous endovascular exclusion of an ilio-iliac AV fistula in a 35-year-old female presenting with ascites and swelling in the legs. CASE PRESENTATIONA 35-year-old woman was referred to our out-patients clinic with ascites. She has a five months history of increased abdominal girth and breath shortness. Her complaints started and increased gradually after lumbar discectomy five month prior to admission. Physical examination revealed a blood pressure, 100/70 mm Hg; heart rate, 86 beats/min; respiratory rate, 24 breaths/min; and temperature, 36°C. Skin and sclerae were anicteric. The lungs had bilateral basal crepitations without evidence of pleural effusion. Grade 3/6 holosystolic murmur was best heard at the left midsternal border. The abdomen was massive distended with a fluid wave and shifting dullness consistent with ascites. Examination over the left lower quadrant in the abdomen revealed a thrill and bruit. Bilateral asymmetrical lower extremity edema to the ankle was noted. 2014; 25 (Suppl.- Turk J Gastroenterol 211Initial laboratory examination showed moderate bilirubin elevation with total bilirubin 1.9 mg/dL and conjugated bilirubin 0.4 mg/dL. Electrocardiogram showed normal sinus rhythm. Chest radiograph showed cardiomegaly. Abdominal ultrasonography showed advanced ascites. By color doppler ultrasonography, portal vein diameter was measured 10 mm at its midpoint. Portal ...