[Show abstract][Hide abstract] ABSTRACT: Background: This study aims to compare intermittent antegrade cardioplegia and antegrade/retrograde continuous cardioplegia in terms of myocardial protection in cardiac surgery. Methods: Hundred six patients who underwent cardiac surgery in our clinic between October 2010 and January 2011 were included in the study. Patients were divided into two groups as patients who received intermittent antegrade cardioplegia (group 1; 18 females, 14 males) and who received antegrade/retrograde continuous cardioplegia (group 2; 16 females, 58 males), and postoperative results were compared. Troponin-I, creatine kinase-myocardial band (CK-MB) levels, durations of cardiopulmonary bypass (CPB) and cross-clamping, total amounts of cardioplegia, and potassium utilization during the process were evaluated. Results: According to our results, mean troponin-I and CK-MB levels were higher in group 1 than group 2. However, this difference was not statistically significant. While troponin-I and CK-MB values were correlated to durations of cross-clamping and CPB in group 1, troponin-I and CK-MB values were not correlated to durations of cross-clamping and CPB in group 2. Conclusion: No correlation was detected between troponin I, CK-MB levels, and durations of CPB and cross-clamping in the group which received anterograde/retrograde continuous cardioplegia. Therefore, troponin-I and CK-MB levels were not affected and myocardial protection was better once effective myocardial protection was obtained by 'antegrade/retrograde continuous cardioplegia. Although antegrade/retrograde continuous cardioplegia provides better myocardial protection, aortic pressure must be monitored to be kept between desired levels during antegrade cardioplegia, and the retrograde cannula must be kept in the appropriate place during retrograde cardioplegia.
Turkish Journal of Thoracic and Cardiovascular Surgery 01/2015; 23(1). DOI:10.5606/tgkdc.dergisi.2015.10182 · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
The aim of this study was to investigate the protective effects of methylprednisolone (Pn), which is a potent anti-inflammatory agent, and pheniramine maleate (Ph), which is an antihistaminic with some anti-inflammatory effects, on reperfusion injury in brain developing after ischemia of the left lower extremity of rats.
Twenty-eight randomly selected male Sprague-Dawley rats were divided into 4 groups: Group 1 was the control group, Group 2 was the sham group (I/R), Rats in Group 3 were subjected to I/R and given Ph, and rats in Group 4 were subjected to I/R and given Pn. A tourniquet was applied at the level of left groin region of subjects in the I/R group after induction of anesthesia. One h of ischemia was performed with no drug administration. In the Ph group, half of a total dose of 10 mg/kg Ph was administered intraperitoneally before ischemia and the remaining half before reperfusion. In the Pn group, subjects received a single dose of 50 mg/kg Pn intraperitoneally at the 30th min of ischemia. Brains of all subjects were removed after 24 h for examination.
Malondialdehyde (MDA) levels of the prefrontal cortex were significantly lower in the Ph group than in the I/R group (p<0.05). Superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzyme activities were found to be significantly higher in the Ph group than in the I/R group (p<0.05). Histological examination demonstrated that Ph had protective effects against I/R injury developing in the brain tissue.
Ph has a protective effect against ischemia/reperfusion injury created experimentally in rat brains.
[Show abstract][Hide abstract] ABSTRACT: Paragangliomas are rare asymptomatic painless tumors, originating from paraganglionic bodies of autonomous nerve system of the embriological neural crest and increasing gradually. Despite their gradual developing nature, it is critical to reach early diagnosis and tailor surgical plan for carotid body tumors due to their potential of being malignant and local aggressive development, as well as invasion or pressure on the adjacent vascular and neural tissues. In this article, we present seven cases who were admitted with the complaints of pain and swelling in the neck and were diagnosed with carotid body tumor based on the further investigations and were surgically treated in the light of literature review and different surgical modalities were discussed.
Turkish Journal of Thoracic and Cardiovascular Surgery 01/2013; 21(1):194-200. DOI:10.5606/tgkdc.dergisi.2013.6541 · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To compare the outcomes of vascular access (VA) procedures performed using physical examination (PE) alone to PE and ultrasound vein mapping for assessment of patients needing hemodialysis access. Methods: Comparative analysis of data obtained by retrospective review of records of 63 patients who underwent PE and vascular mapping (VM) using colored Doppler ultrasonography (CDUS) and 76 patients assessed by physical examination alone to schedule vascular access surgery. The parameters assessed to study the impact of these two different pre-operative assessment approaches included selection of surgical site, procedure, construction of arteriovenous fistulas (AVF) and grafts (AVG), negative surgical exploration rates and surgical outcomes (maturation and patency rates). Results: The rate of successfully constructed AVF increased significantly from 75% to 97% (P=.001) with pre-operative ultrasonographic vascular mapping. In 22 patients (34.9%) the access planned with physical examination was modified based on CDUS examination. In 12 patients, the surgical site for AVF creation and type of surgical procedure were modified based on the CDUS results. Permanent access placement rates were significantly higher in patients assessed with CDUS (P=.001). All patients who underwent vascular mapping had successful VA construction while the PE group had a 18.4% negative surgical exploration rate. When fistulas were assessed at six months, the patency rate was 80.7% for the physical examination (PE) group and 93.4% for the vascular mapping (VM) group. Conclusions: Pre-operative vascular mapping using CDUS significantly increases the success of AVF construction and patency.
The journal of vascular access 09/2012; 14(1). DOI:10.5301/jva.5000097 · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim. The aim of this paper was to evaluate our clinical experience and surgical results with oncologic procedures associated with major vascular resection and reconstruction on elective or emergent basis.
Methods. A retrospective study was performed on patients who underwent major vascular resection for malignancy in our hospital between January 2000 and January 2011. Data collection was organized for patient demographics, intraoperative findings, and postoperative outcome.
Results. Thirty-six patients were treated with 36 reconstructive procedures; 18 (50%) of them were major-vessel reconstruction, 11 (30.6%) of them were bypass procedures, and 7 (19.4%) of them were primary repair. Concomitant vascular interventions were performed electively as part of a planned oncologic procedure in 22 (61.1%) patients or emergently in 14 (38.8%) patients due to a vascular complication that occurred during tumor resection. Postoperative morbidity rate related to vascular intervention was 16.6% and mortality was observed in 2.8% of the patients due to pulmonary embolism.
Conclusion. The results reported herein support that the need for resection and reconstruction of a major vascular structure should not prohibit the resection of any given tumor. The study demonstrates that most major vascular reconstructions have a high degree of success, and do not result major complications.
Italian Journal of Vascular and Endovascular Surgery 09/2012; 19(3):171-176. · 0.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: We aimed to assess the suitability of right ventricular outflow tract (RVOT) fractional shortening for estimating low central venous pressure (CVP). To the best of our knowledge, there have been no similar studies in the English language literature. METHODS: In this cross-sectional study, the emergency physicians measured the RVOT fractional shortening on parasternal short-axis view. A receiver operating characteristic curve analysis was conducted to identify the threshold that maximized the sensitivity and specificity for discriminating normal and low CVPs by the RVOT fractional shortening value. The sensitivity, specificity, and the positive and the negative likelihood ratios of RVOT fractional shortening to truly estimate CVP were calculated. RESULTS: Fifty-eight consecutive patients had invasive CVP monitoring. Nine patients with high CVP and eight for other reasons were excluded. Forty-one patients were enrolled in the study, of whom 21 were in low CVP group and 20 were in normal CVP group. RVOT diastolic diameters, RVOT systolic diameters, and RVOT fractional shortening were lower in low CVP group and this difference was statistically significant (P<0.001). The cutoff value for RVOT fractional shortening to differentiate the low and normal CVPs using the highest sensitivity and specificity was 26.44%. Area under the receiver operating characteristic curve was 0.933 (0.810-0.987) with a P value of less than 0.001. The sensitivity and specificity of RVOT fractional shortening to truly estimate CVP were 95 (75-99) and 80% (58-94), respectively. CONCLUSION: In the hands of emergency physicians, a RVOT fractional shortening measurement is a good predictor of low CVP.
European Journal of Emergency Medicine 12/2011; 20(1). DOI:10.1097/MEJ.0b013e32834f835a · 1.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: According to the literature data, the prevalence of restenosis after carotid endarterectomy ranges between 6 and 36%. The etiological factor is intimal hyperplasia for early period, whereas it is atherosclerosis for late period. A 67-year-old male patient admitted to our clinic with a history of headache and minor stroke. His medical history was significant for right carotid endarterectomy 8 years ago. Recent Doppler ultrasound and digital substraction angiography revealed 75% stenosis and kinking corresponding to the segment distal to the endarterectomy region. Surgical endarterectomy is the treatment of choice in critical carotid stenosis. Endovascular therapy is primarily considered for patients if there is restenosis after carotid endarterectomy. However, the treatment modality is controversial in cases with concomitant carotid stenosis and kinking of internal carotid artery. We present our surgical approach to a case with significant stenosis and kinking of internal carotid artery. We performed a 6-mm-PTFE graft interposition between common and internal carotid artery and resection of the kinking segment.
[Show abstract][Hide abstract] ABSTRACT: To determine the incidence, short term survival and safety of delayed sternal closure following open-heart operation due to myocardial edema, non-surgical bleeding and malignant arrhythmia.
We retrospectively reviewed our medical records to identify the patients who underwent delayed sternal closure following open-heart operation and recorded morbidity, mortality postoperative complications of these patients. Among 2698 patients who underwent on- pump cardiac surgery, the sternum was left open in 46 (1.7%) patients, 31 men and 15 women, ranging in age from 2 to 73 years (mean 57.0+/-7.6 years). In 39 patients sternum was left opened following the initial operation and in 7 patients sternum was re-opened due to bleeding or hemodynamic instability after initial surgery. Statistical analysis was accomplished using Chi-square test, Mann Whitney U test and analysis of variances for repeated measurements.
The operative procedures were classified as elective in 24 (52.8%), emergency in 10 (22%), urgent in 7 (15.4%), and redo cardiac operations in 5 patients (11%). Bleeding (n=21), hemodynamic instability (n=16), arrest (n=5), and arrhythmia (n=4) were the reasons of delayed sternal closure. The patients had an open sternum for 3.48+/-0.35 days. Time to discharge was 21.5+/-1.6 days after operation and 17.6+/-1.6 days after sternal closure. Mortality within 30 days was 23.9% (7 patients died before closure and the remaining 4 after closure). Complications were mediastinitis (n=2), minor wound infection (n=3) and renal failure (n=5).
Delayed sternal closure is a safe and simple method for treating bleeding, arrhythmia and myocardial edema following on pump cardiac surgery. It is anticipated that as cardiac surgeons become more familiar with the technique of delayed sternal closure, the frequency of its use following on pump cardiac surgery may increase.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 04/2010; 10(2):163-7. DOI:10.5152/akd.2010.043 · 0.76 Impact Factor