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Giant coronary artery aneurysms and myocardial fibrosis after Kawasaki disease may lead to devastating cardiovascular outcomes. We characterised the vascular and myocardial outcomes in five selected Kawasaki disease patients with a history of giant coronary artery aneurysms that completely regressed.
Methods:
Five patients were selected who had giant coronary artery aneurysm in early childhood that regressed when studied 12–33 years after Kawasaki disease onset. Coronary arteries were imaged by coronary CT angiography, and coronary artery calcium volume scores were determined. We used endocardial strain measurements from CT imaging to assess myocardial regional wall function. Calprotectin and galectin-3 (gal-3) as biomarkers of inflammation and myocardial fibrosis were measured by enzyme-linked immunosorbent assay.
Results:
The five selected patients with regressed giant coronary artery aneurysms had calcium scores of zero, normal levels of calprotectin and gal-3, and normal appearance of the coronary arteries by coronary computed tomography angiography. CT strain demonstrated normal peak systolic and diastolic strain patterns in four of five patients. In one patient with a myocardial infarction at the time of Kawasaki disease diagnosis at the age of 10 months, CT strain showed altered global longitudinal strain, reduced segmental peak strain, and reduced diastolic relaxation patterns in multiple left ventricle segments.
Conclusions:
These patients illustrate that regression of giant aneurysms after Kawasaki disease is possible with no detectable calcium, normal biomarkers of inflammation and fibrosis, and normal myocardial function. Individuals with regressed giant coronary artery aneurysm still require longitudinal surveillance to assess the durability of this favourable outcome.
Modern democracies, including the United States, rely upon three normative elements: (1) rights expressing the dignity of the citizen; (2) law expressing a commitment to public reason; (3) elections as the method of selecting representatives. In each dimension, citizens are to see a representation of themselves as popular sovereign. Morality and law are not matters to be resolved at the polls. Yet, popular opinion, supported by contemporary social sciences, tends to reduce democracy to the third element. On this view, the higher the voter turnout, the better the democracy. In an age in which we worry as much about majority, as minority, tyranny, this view is not credible. A mob at the polls is still a mob even if it is a majority. An exclusive focus on quantification represents a profound misunderstanding of the meaning of democracy. Democratic politics includes an interpretive practice across the moral and the legal dimensions. It relies as much on persuasion as on proof. Recovery of a vibrant democratic life requires a renewed appreciation of a public humanities, not as a pastime but as way of living.
For the thousands of children and teenagers who returned to Turkey with their parents during the mass exodus of 1984, the very concept of “return” was fraught. For many children, leaving West Germany in the 1980s was not a return or a remigration, but rather an immigration to a new country as emigrants from West Germany. The struggle of these archetypical “return children” was especially pronounced because they bore the burden of another label: “Almancı children,” or “Germanized children.” These children had particular difficulties reintegrating into the Turkish school system, and both the Turkish and West German media regularly emphasized the “liberal,” “democratic” education in Germany in contrast to an allegedly “authoritarian” education in Turkey. Although West German policymakers were initially relieved to export the burden of integrating these children to Turkey, they soon developed sympathy. Though twisted in the service of racism, this sympathy for the children’s plight compelled a rare relaxation of West German immigration policy. In 1989, just five years after kicking them out, Kohl’s government permitted the children to return once again – this time, not to their parents’ homeland but to the one that many considered their own: Germany.
This chapter addresses the nexus between racism and return migration in the early 1980s, which marked the peak of anti-Turkish racism. As the call “Turks out!” (Türken raus!) grew louder, policymakers debated passing a law that would, in critics’ view, “kick out” the Turks and violate their human rights. During this “racial reckoning,” West Germans, Turkish migrants, and observers in Turkey grappled with the nature of racism itself. Although West Germans silenced the language of “race” (Rasse) and “racism” (Rassismus) after Hitler, there was an explosion of public discourse about those terms. Ordinary Germans, moreover, wrote to their president expressing their concerns about migration, revealing both biological and cultural racism. The simultaneous rise in Holocaust memory culture (Erinnerungskultur) is crucial for understanding this racial reckoning. While many Germans warned against the mistreatment of Turks as an unseemly continuity to Nazism, the emphasis on the singularity of the Holocaust offered Germans a way to dismiss anti-Turkish sentiment. Turkish migrants fought against this structural and everyday racism with various methods of activism. Turks at home, including the government and media following the 1980 military coup, viewed these debates with self-interest, lambasting German racism in the context of the 1983 remigration law.
Migration destabilized family life, gender, and sexuality. Whereas most Turkish guest workers traveled alone during the formal recruitment period (1961–1973), West Germany’s subsequent policy of family reunification sparked the increased migration of spouses and children. This chapter shows that, although migrants developed strategies to maintain connections to home, separation anxieties and fears of abandonment loomed. The departure of able-bodied young workers strained local economies, upended gender roles, and separated loved ones, sparking tensions at home: were guest workers sending enough money home, communicating enough, and remaining faithful to spouses? In Germany, reports about sex between male guest workers and German women fueled Orientalist tropes about “foreigners,” perpetuated stereotypes about Turkish men’s propensity toward violence, and stoked fears about the transgression of national and racial borders. Women left behind worried that their husbands would commit adultery while abroad. Guest workers’ children were viewed simultaneously as victims and threats: some stayed behind in Turkey, others were brought to Germany, and thousands of “suitcase children” (Kofferkinder) repeatedly moved back and forth between the two countries with their bags perpetually packed. As physical estrangement evolved into emotional estrangement, the perceived abandonment of the family came to represent the abandonment of the nation.
The book begins in the Turkish beach town of Şarköy, home to a community of first- and second-generation return migrants who were interviewed for this book. These returnees are just some of the millions of people who have journeyed back and forth between Turkey and Germany for over 60 years. The introduction lays out the book’s four core arguments, which together reveal that Turkish-German migration history is far more dynamic than typically told. First, return migration was not an illusion or unrealized dream but rather a core component of all migrants’ lives, and migration was not a one-directional event but rather a transnational process of reciprocal exchange that fundamentally reshaped both countries’ politics, societies, economies, and cultures. Second, migration introduced new ambivalence into European identities: although Germans assailed Turks’ alleged inability to integrate, they had integrated enough to be criticized in Turkey as “Germanized Turks” (Almancı). Third, examining West German efforts to “kick out” the Turks in the 1980s exposes the reality of racism in the liberal, democratic Federal Republic of Germany. Finally, including Muslims and Turks in European history expands our idea of what “Europe” is and who “Europeans” are.
Challenging the myth of non-return, this chapter shows that, by the 1970s, many guest workers did want to return to Turkey. But instead of support, they encountered opposition from the Turkish government. In the 1970s, the link between return migration and financial investments dominated bilateral discussions between Turkey and West Germany. After the Oil Crisis, West Germany devised bilateral policies to promote remigration. Turkey, then mired in unemployment, hyperinflation, and debt, actively resisted those efforts. The Turkish government realized that guest workers played a significant role in mitigating the country’s economic crisis. To repay its foreign debt, Turkey needed guest workers’ remittance payments in high-performing Deutschmarks. If guest workers returned to Turkey, then that stream would dry up. Turkish officials thus strove to prevent mass return migration at all costs – even when it contradicted guest workers’ interests. These tensions also manifested in Turkey’s charging of exorbitant fees for citizens abroad who sought exemptions from mandatory military service, prompting young migrants to create an activist organization that critiqued this policy. The knowledge that they were unwanted in both countries widened the rift between the migrants and their home country, which disparaged them as “Germanized” yet relied on them as “remittance machines.”
This epilogue reexamines select themes – return migration and transnational lives, estrangement from “home,” racism, and the inclusion of Turks in European society – applying the arguments put forth in the previous chapters to more recent developments. After the fall of the Berlin Wall in 1989 and German reunification in 1990, there was an explosion of racist violence that recalled the racism of the 1980s and reverberated throughout Germany and Turkey. The 1983 remigration law had its own echoes in a 1990 GDR law that incentivized the departure of unemployed foreign contract workers. In the new millennium, paying unwanted foreigners to leave became standard practice for dealing with asylum seekers – in Germany and a united Europe. Over time, Germans transposed the call “Turks out!” onto a new Muslim enemy: Syrian asylum seekers. For its part, Turkey’s turn to authoritarianism under Recep Tayyip Erdoğan has strained Turkey’s relations with Germany and the diaspora. These developments come with profound implications – regarding citizenship, political participation, and national identity – for the approximately 3 million Turks who live in Germany today, and for the hundreds of thousands who have returned.
Historians have tended to view postwar labor migration, including the Turkish-German case, as a one-directional story whose consequences manifested within host country borders. This chapter complicates this narrative by arguing that Turkish migrants were mobile border crossers who traveled as tourists throughout Western Europe and took annual vacations to their homeland. These seasonal remigrations entailed a three-day car ride across Central Europe and the Balkans at the height of the Cold War. The drive traversed an international highway (Europastraße 5) extending from West Germany to Turkey through Austria, socialist Yugoslavia, and communist Bulgaria. Migrants’ unsavory travel experiences along the way underscored East/West divides, and they transmuted their disdain for the “East” onto their impoverished home villages. Moreover, the cars and “Western” consumer goods they transported reshaped their identities. Those in the homeland came to view the Almancı as superfluous spenders who were spending their money selfishly rather than for the good of their communities. Overall, the idea that a migrant could become German shows that those in the homeland could intervene from afar in debates about German identity amid rising racism: although many derided Turks as unable to integrate, they had integrated enough to face difficulties reintegrating into Turkey.