Foreign Body Aspiration

Tracheobronchial aspiration of foreign body in the system, manifesting during childhood is a common cause of respiratory problems. The most frequently seen between 1-3 years. Foreign bodies in children aged 1-3 years aspirasyonlarının indicated that 7% of fatal accidents. Early diagnosis and treatment is essential in order to prevent serious complications. Weather roads settled foreign bodies, air obstruction can cause death as a result of the way full.


Aspirasyonlarının foreign body to see a higher incidence in children between 6 months-3 years of age, children's tendencies to bring the objects in their mouths, playing games, running, crying presence of objects in their mouth, swallowing and airway cleaning mechanisms that have immature neuromuscular, a complete lack of development of teeth and jaw, larynx, and epiglottisin Not to have been due to the anatomical shape of the adult.


Herbal and chemical pneumonia in children with aspirated material usually gives an early finding. Diagnosis can be delayed reaction açmadıklarından over metallic objects. School-age children, aspiration of plastic materials, beads, rubber parts, beads, plastic toys may be parts.

About Coronary Artery Disease

Coronary Artery Disease

Coronary artery disease, often early in life, coronary arterial fatty streaks and tied in bed later in the process of atherosclerosis in coronary blood flow and myocardial ischemia caused by a pathological process. CV is all over the world are known to be one of the most important causes of morbidity and mortality. CAD, the most important public health problem in developed countries, but in recent years, the frequency is increasing in developing countries. Official data and TARF (in Turkish adults and Risk Factors for Heart Disease) study data were evaluated with the time in our country 45% of all deaths from cardiovascular disease, heart disease, 36%, 32% were the result of coronary heart disease. The prevalence of coronary heart disease in our society, increasing with age and affects about 5% of people over the age of 60. The number of coronary artery disease in 2010, 3.4 million people in our country is expected to arrive. Coronary artery disease is the most important mechanisms underlying atherosclerosis.


A number of hypotheses have been proposed to explain how atherosclerosis occurs. Those which are most of them in the 'injury response' hypothesis. Normal arterial structure consists of three layers. Most of the inside of blood vessel wall with a semi-permeable barrier, the endocrine and paracrine function, as well as a single layer of the intima is lined by endothelial cells. Middle layer of the vessel elasticity

media, which creates a layer composed of smooth muscle. Adventisia located in the outermost layer. The most important step in the hypothesis of recurrent damage to endothelial damage response. Endothelium; vasoactive substances secretion and the regulation of vascular flat muscles contraction and relaxation, coagulation regulation, leukocyte adhesion, solid and liquid substances acts as a barrier. In addition, by inhibiting the adhesion of blood cells, by dilating blood vessels and vascular protective effect by inhibiting the proliferation of vascular smooth muscle. Developed in the presence of proatherogenic factors in this protective function is lost due to endothelial dysfunction and atherosclerosis begins. Endothelial dysfunction as a result of low-density lipoprotein (LDL) and oxidized to cross the endothelium-subintimal is a comfortable distance. Macrophages and oxidized LDL receptors are. Phagocytosis by macrophages and foam cells, composed of lipids. In the early stages of atherosclerosis, lipid, mostly as a cell within the foam cells. As you continue to proatherogenic factors, both circulating LDL is directly connected to the intimal proteoglycans, as well as foam cells mainly because of the fragmentation of the released cholesterol esters in lipid begins to accumulate outside the cell. As a result of the intimal layer of connective tissue, cholesterol and cell breakdown products of lipid-filled core. The age of the lesion progresses, the media layer of smooth muscle cells migration and proliferation of these cells and fibrous connective tissue proteins to produce a title with the atherosclerotic plaque covered above, consists of mature atherosclerotic plaque. Meanwhile, the central part of the plate are starved of oxygen and begins to develop necrosis. A plaque with focal or massive calcifications may occur. However, sometimes fibrous plaque build up in the title fissures and ulcers, and smooth muscle cells, blood circulation is in contact with oil. As a result, an intense thrombogenic reaction begins. Narrowing of the lumen and gradually increases as a result of repeated attacks. As a result of complete occlusion of the coronary artery, myocardial infarction and sudden death may occur if there is such a sufficient. As a result of rupture of the fibrous plaque next to the title of their lipid components in the circulation through the cholesterol plaque can cause embolisms.


Histological, immunohistochemical, and electron microscopy methods, using extremely detailed morphological studies were performed on recordings. American Heart Association, the morphology of plaques dedicated to the 8 type:


Type 1 lesions: That intensive lipid-laden macrophages, the initial lesion.



Type 2 lesions: the number of macrophages was increased, and stratification. Other than macrophages, smooth muscle cells, as well as inside, outside the cell lipid droplets There. If the Type 2 lesion sensitive regions develops fast growing up (type 2a lesion), less-sensitive regions are formed more slowly than the development of Type 2 lesions (lesion Tip2b).


Type 3 lesions: The most important distinguishing feature of type 2 according to the lesion is small lipid deposits. Under this lipid macrophages and T cells, the lesion accumulates in the deepest place. Endothelial dysfunction begins to develop during this period.


Type 4 lesion: Classically defined as atherosclerotic plaque or atheroma. During this period, limited to the intimal intensive lipid available. This is called a lipid core. At this stage in order to protect the actual volume of artery lumen reconstruction begins. However, with the viewing of these lesions is difficult coronary angiography.


Type 5 lesions: the lesions are characterized by an increase of fibrous tissue covering the lipid core. Developing fibrous tissue, proliferating and secreting collagen and proteoglycans, matrix proteins, such as smooth muscle cells are generated. This so called fibroatheroma circuit or Type 5 lesions.


Type 6 lesions: the Type 4 and Type 5 lesions, fissures, hematoma, or thrombus formation occurs with. Clinical symptoms, mortality and morbidity in the most watched type. Type 6 is also called lesions, complicated lesions.


Type 7 lesions: lipid core, or any part of the lesion occurs with the development of calcification.


Lesion type 8: Lipid burden is less fibrotic plaques.

Coronary Artery Imaging Methods

Conventional Coronary Angiography

Usually the femoral artery access site of coronary arteries using the arterial catheter to send and display of various aspects of the coronary arteries under fluoroscopy with contrast medium is provided. It is accepted that the gold standard method of assessing coronary artery lumen. Also, if necessary, therapeutic interventions such as balloon dilation and stent placement can be made ​​of operations. Complication rate of about 0.08%, 0.15% mortality and morbidity rate of 1.5% is present in some complications may require emergency surgery. Interferential process in situations that require the patient's dose may be increased up to 3 times compared to angiography in diagnostic.


Intracoronary Ultrasound

Thanks to advancing technology by developing small-scale intravascular ultrasound transducers in clinical use has found. Ranging from 2.9 to 3.5 French in diameter, 20-40 MHz transducers with the lumen of the coronary arteries, artery wall, plaque size and morphology can be analyzed. High degree of invasiveness, cost of excess, the process and the need for coronary catheterization to evaluate only the proximal limits the availability of this method.


Electron Beam Tomography


Electron beam tomography (EBT) of hard X-ray source and detector fixed structure consists of tungsten. In 1979, was found by Boyd et al. Old IT equipment is one of the most important factors limiting the speed of the tube rotates around the patient, the rotation of the cables were connected to the tube and detectors. Unlike other IT devices in EDT have mechanical moving parts. Produced under the tungsten targets in an electron beam directed at the patient. Fan-shaped x-rays through the patient's body, the patient placed on a 210 ° angle, more than 3,000 collected by the detector. EBT in a period of 40-60 units from 1.5 to 3 mm to 100 milliseconds, it is possible to take cross-sections. All transactions are made ​​during breath-holding only one patient. In addition, motion artifact can be minimized by using EBT with the ECG trigger. The earliest CT evaluation of the coronary artery was done with the 1980 EBT


Coronary Magnetic Resonance Imaging


Coronary magnetic resonance imaging (MRI) in selected patient populations, the detection of coronary artery anomalies, and to be characterized, the evaluation of coronary artery aneurysms and bypass-graft patency in order to evaluate the clinical use today, has taken place. Long examination time, the disadvantages such as low spatial resolution, as well as the most important advantage is the absence of radiation. The sensitivity of MR imaging in detecting coronary stenosis 65-86%, the specificity ranged from 88-97%



MSCT Coronary Angiography


Computerized tomography (CT) is the first intellectual father Alan Cormack was the first clinical applications in 1967 by Hounsfield Godsfrey. Initial CT device, the elapsed time for 5 minutes going through the formation of a cross sectional view. Several generations of technology with the development of IT equipment is manufactured in the late 1980s by Kalender et al Spiral CT has been used clinically. Spiral CT gantry rotation rate, has been an important factor in the development of MSCT. IRs in the 1990s had been used in the first detector is a 2 in the years following the z-axis detector has been introduced more and more. MSCT with the z-axis, multi-detector system; more volume than thin slices can be scanned during a single gantry rotation, has been helping to deliver fast and high-quality images. Emerging technology, MSCT, CAD has been used for diagnostic purposes. With MSCT calcium scoring, CT angiography, and ventricular function analysis can be made. Coronary artery calcium scoring can be classified with the risk of coronary artery disease. In addition, the anatomy of the coronary artery, MSCT can be performed with the assessment of calcified plaques.