Objective:To share our experience with the left distal radial approach for transradial coronary angiography and interventions. By performing the radial puncture in the fossa radialis or the so called anatomical “Snuffbox” we aimed to present the feasibility and complications of this new technique.Methods:Left distal radial artery was used as an access site in 54 patients admitted to our clinic for coronary angiography and intervention between May 25th and October 20th 2017. All of them had pulse in their left distal radial artery. In the laboratory, they had their left arm gently flexed at the shoulder so that the hand was placed over their right groin. The operator stood on the right side of the patient and performed coronary angiography and interventions. During the hospital stay, demographic features and complications were recorded.Results:Mean age of patients was 59.3 years and 80% were male. We used Judkins 6 French catheters for the procedures. Seventeen patients admitted with acute coronary syndrome. They all underwent successful left distal transradial coronary angiography and intervention. Primary angioplasty was performed in 10 patients. In total, 20 patients had coronary intervention. Left anterior descending artery was the artery requiring most intervention (11 patients). Two patients experienced brachial spasm requiring crossover to right femoral artery. There were no cases of radial artery occlusion, hematoma, or hand numbness. The radial sheath was removed at procedure termination. Hemostasis was achieved with manual compression.Conclusion:Left distal radial approach is safe and feasible as a new technique for coronary angiography and interventions.

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IntroductionExperimental and clinical studies demonstrated that the renin-angiotensin system (RAS) affects the pathogenesis of atherosclerosis and prognosis of coronary heart disease (CHD). The aim of this study was to investigate the genotype distribution and the allele frequencies of three RAS genes polymorphisms and their effects on premature CHD in a Turkish population. Materials and methodsOne-hundred and fifteen Turkish patients with premature CHD and 128 controls were included into the study. Angiotensin-converting enzyme (ACE), angiotensin II type 1 (AT 1 ) receptor and angiotensinogen (AGT) gene polymorphisms were analysed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). ResultsThe patients group showed an increased frequency of the ACE D allele compared with controls (65% vs. 35%, p=0.0001). There was a significant association between the DD genotype and premature CHD (ACE DD vs. ID and II; odds ratio [OR]=2.82 [CI 95% 1.33-2.91, p=0.002]). Also, we observed increased premature CHD risk associated with higher frequencies of the AGT MM genotype in patients when compared with controls (AGT MM vs. TT and MT, p=0.018]). We found a significant association between AT 1 -receptor AA genotype and decreased risk of premature CHD (AT1R AA vs. AC and CC, OR= 0.57 p=0.03]). ConclusionsWe demonstrated that increased premature CHD risk is associated with higher frequencies of the ACE DD and AGT MM genotypes. These findings indicate a synergistic contribution of ACE DD and AGT MM polymorphisms to the development of premature CHD. Also, our results suggest that family history, smoking, diabetes, hypertension, obesity and ACE DD genotype were independent risk factors for premature CHD.

Amaç: Kronik hepatit B virus infeksiyonu morbidite ve mortalitenin önemli bir nedenidir. Tenofovir disoproksil fumarat ve entekavir, hepatit B virus infeksiyonu tedavisinde ruhsatl› ilaçlard›r. Biz, kronik hepatit B nin tenofovir ve entekavir ile

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Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature.

Omega-3 PUFA caused significant regression of endometriotic implants. Vitamin D has not been as effective as omega-3 PUFA on endometriosis.