Ali Sarıgül

Pre-operative Atorvastatin Therapy to Decrease the Systemic Inflammatory Response after Coronary Artery Bypass Grafting

The effect of pre-operative atorvastatin on systemic inflammatory response syndrome (SIRS), often seen after coronary artery bypass grafting (CABG) was evaluated in 40 patients undergoing elective CABG. Patients were divided into two groups: group I (pre-operative LDL cholesterol ≤ 100 mg/dl; n = 20) received 20 mg/day atorvastatin for at least 15 days pre-operatively; group II (pre-operative LDL cholesterol < 100 mg/dl; n = 20) did not receive antihyperlipidaemic agents. All patients underwent CABG with cardiopulmonary bypass. Blood samples were taken pre-operatively and 24 h post-operatively. There were no significant differences between the two groups in terms of demographic, pre-operative or operative parameters. At 24 h post-operatively, median high-sensitivity C-reactive protein and mean interleukin-6 levels were significantly lower in group I compared with group II. There were no other significant differences in postoperative parameters between the two groups, except for duration of stay in the intensive care unit, which was shorter in group I patients. In conclusion, pre-operative atorvastatin treatment in patients undergoing elective CABG decreased inflammation parameters and could be effective in preventing SIRS.

Atorvastatin pretreatment diminishes the levels of myocardial ischemia markers early after CABG operation: an observational study

BackgroundStatin pretreatment has been associated with a decrease in myocardial ischemia markers after various procedures and cardiovascular events. This study examined the potential beneficial effects of preoperative atorvastatin treatment among patients undergoing on-pump CABG operation.MethodsTwenty patients that had received atorvastatin treatment for at least 15 days prior to the operation and 20 patients who had not received any antihyperlipidemic agent prior to surgery were included in this study. CK-MB and troponin I levels were measured at baseline and 24 hours after the operation. Perioperative variables were also recorded.ResultsTwenty-four hours after the operation, troponin I and CK-MB levels were significantly lower in the atorvastatin group: for CK-MB levels, 12.9 ± 4.3 versus 18.7 ± 7.4 ng/ml, p = 0.004; for troponin I levels, 1.7 ± 0.3 versus 2.7 ± 0.7 ng/ml, p < 0.001. In addition, atorvastatin use was associated with a decrease in the duration of ICU stay.ConclusionsPreoperative atorvastatin treatment results in significant reductions in the levels of myocardial injury markers early after on-pump CABG operation, suggesting a reduction in perioperative ischemia in this group of patients. Further studies are needed to elucidate the mechanisms of these potential benefits of statin pretreatment.

Comparison of different dose regimens of enoxaparin in deep vein thrombosis therapy in pregnancy

IntroductionPregnant women have a higher risk of developing deep vein thrombosis (DVT) and consequent thrombogenic events, including pulmonary embolisms. Low-molecular-weight heparin (LMWH) products have been shown to successfully treat DVT with few significant side effects. The purpose of this study was to compare the effects of two dose regimens of enoxaparin (a LMWH) in the management of DVT in pregnancy.MethodsA total of 35 pregnant patients with DVT were enrolled in this study. As first-line anticoagulation therapy, patients were administered an intravenous unfractionated heparin infusion for 5 days, followed by a subcutaneous injection of enoxaparin 1 mg/kg twice a day until discharge. The enoxaparin therapy continued at home with 1 mg/kg twice a day for 18 patients (group I) and 1.5 mg/kg once a day for the other 17 patients (group II). Enoxaparin was discontinued 12–24 hours before delivery and restarted within 8-12 hours after delivery. Warfarin was given as adjuvant therapy along with enoxaparin in the post-partum period. Enoxaparin was discontinued when an international normalised ratio of 2 or above was reached. Differences between the two groups in terms of therapy response, complications and efficacy were recorded.ResultsThrombophilic disease was observed in three patients in each group. The iliac vein had the highest incidence of DVT in both groups. During therapy, two patients in group I were diagnosed with a mild haemorrhage; one patient (in group II) had abortion. There were no significant differences between groups in terms of recanalisation (measured by venous ultrasonography examination), post-thrombotic symptoms or safety parameters.ConclusionEnoxaparin can be used safely in DVT therapy during pregnancy. Our results indicate that therapy consisting of a single daily dose of 1.5 mg/kg enoxaparin is as effective as twice-daily administration.

THE EFFECT OF ILOPROST ON RENAL DYSFUNCTION AFTER RENAL I/R USING CYSTATIN C AND β2-MICROGLOBULIN MONITORING

The purpose of this study was to investigate the effect of iloprost, a cytoprotective prostacyclin analog, on renal injury during unilateral renal I/R in rats and to determine whether the levels of serum cystatin C (CyC) and &bgr;2-microglobulin (B2M), as markers of glomerular function, might denote this injury. Thirty-two Wistar rats were randomized into four groups (n = 8) as follows: control (sham laparotomy), renal I/R (60-min left renal ischemia and 120-min reperfusion), renal I/R + iloprost (20 ng kg−1 min−1 infusion during renal I/R period, i.v.), and control + iloprost. Blood and kidney tissue samples were obtained for biochemical and histological analysis from all rats. Serum urea, creatinine, CyC, and B2M levels were evaluated for biochemical analysis. Histopathological changes in renal structure were examined for histological analysis. Serum urea, creatinine, and CyC levels were significantly increased in the renal I/R group. Iloprost treatment decreased these three markers in the renal I/R + iloprost group. &bgr;2-Microglobulin levels were not significantly changed in any group. Histological analyses showed that renal I/R elicited significant renal injury, whereas iloprost significantly decreased I/R-induced renal injury. Serum CyC level is one of the good indicators of acute renal damage due to I/R produced by renal artery occlusion. In contrast, we have shown that there are no significant changes in the levels of serum B2M levels that would make it an accurate diagnostic tool for detecting acute changes in renal injury subject to renal I/R in rats.

Prevalence of and risk factors for early postoperative arrhythmia in children after cardiac surgery

The aims of this study were to (i) evaluate postoperative arrhythmias following congenital heart surgery, on 12‐lead electrocardiography and Holter monitoring; and (ii) analyze the association between the type of repair and postoperative arrhythmia.

The effect of coronary revascularization on new-onset complete atrioventricular block due to acute coronary syndrome.

BACKGROUND Coronary artery disease is one of the most common causes of complete atrioventricular block (AVB) in adults. In this study, we evaluated whether prompt revascularization of the coronary artery occlusion can ameliorate new-onset complete AVB due to acute coronary syndrome (ACS). METHODS Five patients (4 men and 1 woman) with a mean age of 69.8+/-7.1 years with diagnosed new-onset complete AVB and proven coronary artery disease were enrolled in the study. At the time of AVB diagnosis, 3 of the patients had acute myocardial infarction, and the other 2 patients had unstable angina pectoris. All patients underwent complete coronary bypass surgery after the diagnosis of complete AVB. A patient who underwent 2 coronary bypasses also underwent aortic valve replacement. RESULTS No mortality was observed in the study group. All but one of the patients converted back to sinus rhythm after a mean interval of 30+/-13.6 hours following revascularization procedures. Complete AVB persisted in 1 patient, and a permanent pacemaker was implanted. All patients were discharged uneventfully. The mean hospital stay was 11.4+/-4.5 days. All patients are still being followed up after surgery; at a mean follow-up of 27.4+/-0.9 months, there have been no further problems. CONCLUSION Coronary revascularization may ameliorate ACS-related new-onset complete AVB with an acceptable rate of successful reversion to sinus rhythm. An especially appropriate time for surgery, complete coronary revascularization, and management of myocardial protection during surgery might improve the results of coronary bypass procedures in these patients.

Post-Spinal a Rare Complication and Treatment: Tinnitus and Epidural Blood Patch

Dear Editor, Rare auditory symptoms such as tinnitus after spinal anaesthesia have been observed (1–4). It can be accompanied by headache (1, 4) and can become chronic and affect a patient’s quality of life. In this case, we aimed to present our clinical experience regarding the relief of symptoms by an epidural blood patch in a patient who developed headache and bilateral tinnitus following spinal anaesthesia. A 31-year-old female patient, who was 58 kg in weight and 169 cm in height, was scheduled for operation under spinal anaesthesia due to venous stasis. Informed written consent was obtained. The spinal space was accessed with a 25-G Quincke needle on the first try through the L4–5 interspinous space. On observing a clear cerebrospinal fluid leak, 12.5 mg of hyperbaric bupivacaine and 15 μg of fentanyl were intrathecally administered in a volume of approximately 3 mL. The patient was admitted to the hospital on the first postoperative day due to severe headache that started from the nape of the neck and that involved the entire head. The headache was accompanied by tinnitus (ringing in both ears and motor noise) and nausea–vomiting and was more prominent in the standing and sitting positions. The patient was chiefly discomforted by the tinnitus. The headache diminished while in the lying position, but the tinnitus did not subside. An intravenous access was established in the patient, and she was hydrated. An oral caffeinated analgesic and antiemetic were started. The headache alleviated on the second day of admission, but the tinnitus remained. The patient was unable to sleep and expressed that she was extremely discomforted by this. Given that it was accompanied by headache, we thought that the patient could benefit from an epidural blood patch. Following appropriate site cleaning, approximately 12 mL of the blood patch was epidurally administered by accessing the same space. The tinnitus in the left ear immediately improved following the injection, while it disappeared within approximately 12 h in the right ear. Additionally, the complaint of pain, which lost its severity with the medical treatment, completely disappeared. Aetiology regarding symptoms related to hearing following spinal anaesthesia is not very clear. One of the proposed hypotheses is the decrease in intra-labyrinth pressure. The cochlear duct provides an anatomical connection between the cochlea and the subarachnoid distance. The composition of the perilymph in the cochlea closely resembles the cerebrospinal fluid. One of the proposed views is that a decrease in cerebrospinal fluid pressure causes a decrease in intra-labyrinth pressure and that this causes functional inability in the ear in transmitting sounds (5). Symptoms could spontaneously subside; however, there are patients who became chronic. The relationship of chronic cases with spinal anaesthesia can only be revealed by obtaining a good medical history. These patients can benefit from an epidural blood patch (1, 2, 4). In a patient who developed tinnitus following spinal anaesthesia (4 years), it was learned, upon obtaining medical history by the ear, nose and throat specialist, that the complaint started 24 h after spinal anaesthesia, and the patient was directed to an anaesthetist. The tinnitus was successfully treated by administering 20 mL of an epidural blood patch to the patient (2). A patient with postspinal 8 years tinnitus complaint underwent epidural anaesthesia for another surgical operation. The tinnitus recovered by the epidural administration of 27 mL of bolus, followed by a local anaesthetic performed by continuous infusion (3). Due to the high rate of success and ease of application, an epidural blood patch is the accepted gold standard treatment in treating postspinal headache when conservative treatments have failed. It is a treatment whose major side effects are (usually temporary) rare, and it is safe and effective. Side effects are low back pain or radicular pain during injection, generally related to the administered volume (6). For evaluating these cases, the epidural administration of any application-blood, normal saline or local anaesthetics-appears to be effective in improving auditory symptoms. In conclusion, the accompaniment of nausea–vomiting and tinnitus with headache that develops after spinal anaesthesia negatively affects the quality of life. Therefore, we think that administering an epidural blood patch without delay in the presence of auditory symptoms accompanying headache will improve the comfort of patients.

Aortic valve replacement due to lactococcus lactis infective endocarditis

Infective endocarditis characterized by microbial infection of the endothelial surface of the heart,has an estimated annual incidence of 3 to 9 cases per 100.000 persons in industralized countries. Although common species causing infective endocarditis include streptococci, staphylococci, enterococci and fastidious gram negative coccobacilli, aortic valve replacement due to lactococcus lactis infective endocarditis seen in the literature, even if rarely. In this study we presented a 34 year old male patient underwent surgery, diagnosed with lactococcus lactis infective endocarditis.

The Potential Effect of Epidural Anesthesia on Mesenteric Injury after Supraceliac Aortic Clamping in a Rabbit Model

BACKGROUND Epidural anesthesia is known to increase blood flow by producing vasodilatation on mesenteric circulation. In this experimental study, we aim to examine the effect of epidural anesthesia on mesenteric ischemic-reperfusion (IR) injury induced by supracoeliac aortic occlusion in a rabbit model. METHODS Twenty-eight male white New Zealand rabbits were assigned into 4 separate groups, with 7 rabbits in each group: group I, control group; group II, IR-only group; group III, IR plus epidural anesthesia group; group IV, epidural anesthesia-only group. IR model was produced by clamping supraceliac aorta with an atraumatic vascular clamp for 60 min, followed by reperfusion for 120 min. An epidural catheter was placed via Th12-L1 intervertebral space by using open technique before aortic clamping in those assigned to epidural anesthesia. IR injury was assessed using blood markers interleukin-6 and IMA and tissue markers superoxide dismutase and malondialdehyde. Also histopathological examination was performed to evaluate the degree of injury. RESULTS All biochemical markers in group II were significantly elevated in comparison with the other 3 groups (p < 0.05). This was paralleled by a more severe histopathological injury in IR- only group (group II). The group receiving IR plus epidural anesthesia (group III) had lower biochemical marker levels as compared with the IR-only group (group II). CONCLUSIONS Mesenteric IR injury that can occur during abdominal aorta surgery can be reduced by epidural anesthesia, which is commonly used during or after major operations for pain control. Controlled clinical studies are required to evaluate these findings.