Objectives Contrast-induced acute kidney injury (CI-AKI) is a life-threatening complication that leads to comorbidities and prolonged hospital stay lengths in the setting of peripheral interventions. The presence of some CI-AKI risk factors has already been investigated. In this study, we evaluated the predictors of CI-AKI after carotid artery stenting. Methods A total of 389 patients with 50% to 99% carotid artery stenosis who underwent carotid artery stenting were included in this study. Patients were grouped according to CI-AKI status. Results CI-AKI developed in 26 (6.6%) patients. Age, baseline creatinine level, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were higher and estimated glomerular filtration rate, haemoglobin and lymphocyte count were lower in CI-AKI patients. In the multivariate regression analysis, the neutrophil-to-lymphocyte ratio triggered a 1.39- to 2.63-fold increase in the risk of CI-AKI onset ( p < 0.001). Conclusions The neutrophil-to-lymphocyte ratio may be a significant predictor of CI-AKI in patients with carotid artery stenting and higher neutrophil-to-lymphocyte ratio values may be independently associated with CI-AKI.

Bu çalışmada çeşitli nedenlerle çok kesitli bilgisayarlı tomografik anjiyografi incelemesi yapılan hastalarda koroner arter fistüllerinin sıklığı ile anatomik özellikleri araştırıldı. Ça lış ma pla nı: Ocak 2009-Temmuz 2015 tarihleri arasında kliniğimizde çok kesitli bilgisayarlı tomografik anjiyografi kullanılarak 26 hastada toplam 40 adet koroner arter fistülü retrospektif olarak incelendi. Etkilenen arterler ve fistüllerin yerleşim yerleri değerlendirildi. Bul gu lar: Fistüllerin 11'i (%27.5) sirkümfleks arterden, 10'u (%25) sol ön inen arterden, dördü (%10) diagonal arterden, üçü (%7.5) sol ana koroner arterden, üçü (%7.5) sağ ana koroner arterden, üçü (%7.5) septal arterden, üçü (%7.5) konus arterinden, biri (%2.5) obtus marjinal arterden, biri (%2.5) sol ön inen arter properden (dual LAD) ve biri (%2.5) ramus intermediustan köken almaktaydı. Konus arterlerinden biri doğrudan sağ koroner sinüsten köken almaktaydı. Fistüllerden 12'si (%30) pulmoner trunkusa, sekizi (%20) sol ventriküle, yedisi (%17.5) sağ ventriküle, beşi (%12.5) superior vena kavaya, üçü (%7.5) sağ ana pulmoner artere, ikisi (%5) sağ atriyuma, biri (%2.5) sol atriyuma, biri (%2.5) sağ internal torasik artere ve biri de (%2.5) sinüs koronariusa açılmaktaydı. So nuç: Konvansiyonel anjiyografiye kıyasla, çok kesitli bilgisayarlı tomografi anjiyografi koroner arter fistüllerinin daha yüksek oranda tespit edilebilmesine ve kalp anatomisinin ayrıntılı bir şekilde görüntülenebilmesine olanak sağlayan invaziv olmayan bir yöntemdir.

3 However, reintervention rates are higher than are those associated with composite graft implantation. In this report, we present the case of a patient who had undergone VSRR 2 years before his admission to our hospital with myocardial infarction and cardiogenic shock secondary to aortic pseudoaneurysm (APA) formation and left main coronary artery (LMCA) compression. Case ReportA 67-year-old man with a 6-hour history of dyspnea was admitted to our emergency department. Two years before, he had received a diagnosis of ascending aortic aneurysm and chronic aortic dissection and had undergone aortic root replacement. His aortic root had been 32 mm in diameter, and his ascending aorta 60 mm. From his operative report, we learned that a remodeling-type David operation had been performed: the coronary artery buttons had been displaced 1 cm, and a 32-mm Dacron prosthetic graft had been used.On physical examination, the patient had a blood pressure of 90/50 mmHg, a heart rate of 110 beats/min, and crackles in the bases of both lungs. His electrocardiogram revealed pathologic Q waves in leads V 1 through V 3 . His echocardiogram showed hypokinesia of the mid and apical segments of the anteroseptal and anterior left ventricular (LV) wall. His cardiac biomarkers were highly compatible with myocardial infarction.We performed emergency coronary angiography via the femoral artery. During selective cannulation of the LMCA, the left Judkins catheter entered a fistulous connection at the left sinus of Valsalva and thereby revealed a pseudoaneurysm (Fig. 1). The ostium of the LMCA was compressed beneath this structure, which resulted in severe arterial stenosis (Fig. 1). Flow was impaired distally in the left anterior descending and left circumflex coronary arteries. The right coronary artery was normal. We terminated the procedure and performed emergency computed tomography with 3-dimensional reconstruction; this showed an APA (2.2 × 1.1 cm in diameter) that originated adjacent to the ostium of the LMCA (Figs. 2-4).

ÖZETPosterior Reversibl Ensefalopati Sendromu (PRES) görme bozuklukları, mental durum bozukluğu ve nöbetler ile seyreden bir sendromdur. Bilgisayarlı tomografi (BT) ve magnetik rezonans (MR) görüntülemede oksipital, temporal ve pariyetal lobda ödem mevcuttur. Sıklıkla ani yükselen ve kompanse edilemeyen arter basıncına bağlı olarak; preeklampsi, böbrek yetmezliği, enfeksiyonlar ve immunosüpressif ilaçlar zemininde gelişir. PRES'in erken tanı ve tedavisi önemlidir. PRES medikal acillerden biridir ve özellikle erken tanı ve hızlı tedavi ile tamamen geri dönüşümlü bir sendromdur. Burada görme kaybı ile başvuran, preeklampsi zemininde gelişen ve MR ile tanısı konulan PRES sendromu olgusunu sunduk.Anahtar Kelimeler: posterior reversibl ensefalopati sendromu, gebelik, preeklampsi ABSTRACT Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by clinical symptoms such as visual disturbance, altered mental status, and seizures. It also presented with abnormal findings on computed tomography (CT) and magnetic resonance imaging (MRI) indicating cerebral edema in the occipital, temporal, and parietal lobes. It is often related with an acute increase in arterial blood pressure, and is associated with preeclampsia, renal failure, infections, and immunosuppressive agents. Early diagnosis and treatment of PRES is very important. PRES is a medical emergency and it is a fully reversible condition especially when diagnosed and treated immediately. Herein we report a case presented with blindness and diagnosed with MRI as PRES.