Ali Vefa Özcan

Acute ST segment elevation myocardial infarction after sulbactam-ampicilllin induced anaphylactic shock in an adult with significant coronary artery disease: a case report.

Myocardial injury may complicate allergic reactions caused by several medications. We evaluated a case of a myocardial injury with transient ST segment elevation in a 72 year-old man presenting with collapse caused by sulbactam-ampicilllin assumption. The purpose of this report is to present this interesting case and revise the classification of Kounis syndrome.

Adhesion of hemocytes to desialylated prothoracic glands of Galleria mellonella (Lepidoptera) in the larval stage.

Summary Earlier work showed the existence of sialic acid (SA) in the prothoracic glands (PGs) of Galleria mellonella (Karaçali et al., 1997). In this paper we investigated the role of SA during the degeneration process of PGs. Neuraminidase-digested larval PGs were incubated within the hemolymph collected from same age larvae. Light and electron microscopic observations showed incomplete capsule formation by the accumulation of hemocytes around desialylated gland cells, but not in the control group. Desialylated larval PG cells were recognized as a foreign structure or non-self by hemocytes. The result indicates that SA acts as a mask for hemocytic receptors during the larval period under normal conditions. However, in the absence of SA, the glands start to degenerate. We provide an explanation for the role of SA in the recognition process of hemocytes that initiates the degeneration of PGs in pupal cells and show the functionality of SA in insects, confirming that SA is a universal molecule.

Comparison of simultaneous antegrade/vein graft cardioplegia with antegrade cardioplegia for myocardial protection.

Antegrade cardioplegic delivery via the aorta ensures distribution of cardioplegic solution through open arteries, but distribution may not be adequate beyond a stenotic coronary artery. This potential problem can be overcome by direct delivery of cardioplegia via a vein graft. The purpose of this study was to compare simultaneous antegrade/vein graft cardioplegia with antegrade cardioplegia during coronary artery bypass surgery. Twenty patients were divided into 2 groups. In group 1, intermittent antegrade cardioplegia was provided (n=10). In group 2, intermittent antegrade cardioplegia was supplemented by antegrade perfusion of vein grafts after distal anastomoses were completed (n=10). Data on enzyme release and hemodynamics were obtained preoperatively, before the induction of anesthesia, just before cross-clamping, immediately after aortic unclamping, and at 1, 6, 12, 24, and 48 h after unclamping. Enzyme release (creatinine phosphokinase-isoenzyme MB, cardiac troponin I, myoglobin) was similar in both groups (P > .05). Furthermore, no significant difference was noted in the incidence of postoperative low cardiac output syndrome, perioperative myocardial infarction, or ventricular arrhythmia (P > .05). In conclusion, both techniques permitted rapid postoperative recovery of myocardial function. Supplementation of antegrade perfusion of vein grafts with antegrade cold blood cardioplegia offered no advantage to study patients. However, hemostasis of a distal anastomosis may be controlled by this technique.

Exploring strategies to prevent post-lobectomy space: transient diaphragmatic paralysis using Botulinum Toxin Type A (BTX-A)

ObjectiveVarious techniques to reduce air space after pulmonary lobectomy especially for lung cancer have been an important concern in thoracic surgical practice. The aim of this study was to assess the effectiveness of Botulinum toxin A (BTX-A) injection into the diaphragm to reduce air space after right lower pulmonary lobectomy in an animal model.MethodsTwelve male New Zealand rabbits were randomly allocated into two groups. All animals underwent right lower lobectomy. Then, normal saline of 0,1 ml and 10 units of 0,1 ml Botulinum toxin type A were injected into the muscular part of the right hemidiaphragm in control (n = 6) and BTX-A groups (n = 6) respectively. Residual air space and diaphragmatic elevation were evaluated with chest X-ray pre- and postoperatively. Diaphragmatic elevation was measured as a distance in millimetre from the line connecting the 10th ribs to the midpoint of the right hemidiaphragm.ResultsThe mean diaphragmatic elevation in BTX-A and control groups were 7.0 ± 2.5 and 1.3 ± 1.2 millimetres respectively. Diaphragmatic elevations were significantly higher in BTX-A group (p = 0.0035).ConclusionIntraoperative Botulinum toxin type A injection may reduce postlobectomy spaces effectively via hemidiaphragmatic paralysis in rabbits. Further studies are needed to validate the safe use of Botulinum toxin type A in human beings.

Gene Polymorphisms and Febrile Neutropenia in Acute Leukemia—No Association with IL-4, CCR-5, IL-1RA, but the MBL-2, ACE, and TLR-4 Are Associated with the Disease in Turkish Patients: A Preliminary Study

AIMS The aim of this study was to investigate the mannose-binding lectin 2 (MBL-2), interleukin (IL)-4, Toll-like receptor 4 (TLR-4), angiotensin converting enzyme (ACE), chemokine receptor 5 (CCR-5), and IL-1 receptor antagonist (RA) gene polymorphisms (GPs) in acute leukemias (ALs) and to evaluate their roles in febrile neutropenia (FN) resulting from chemotherapy. METHODS The study included 60 AL patients hospitalized between the period of July 2001 and August 2006. Polymorphisms for the genes ACE(I/D), CCR-5, IL-1RA, MBL-2, TLR-4, and IL-4 were typed by polymerase chain reaction (PCR) and/or PCR-restriction fragment length polymerase. Genotype frequencies for these genes were compared in the patient and control groups. The relationships between the genotypes and the body distribution of infections, pathogens, the duration of neutropenia, and febrile episodes in AL patients were evaluated. RESULTS No significant differences in either the genotype distribution or the allelic frequencies of TLR-4, IL-4, CCR-5, IL-1RN GPs were observed between patients and healthy controls. The AB/BB genotype (53.3%) in the MBL-2 gene was found to be significantly higher in the AL patients compared with control groups. There were correlations between the presence of MBL-2, TLR-4, and ACE polymorphisms and clinical parameters due to FN. Overall, bacteremia was more common in MBL BB and ACE DD. Gram-positive bacteremia was more common in ACE for ID versus DD genotype. Gram-negative bacteremia was more common for both the MBL-2 AB/BB genotype and TLR-4 AG genotype. Median durations of febrile episodes were significantly shorter in ACE DD and MBL AB/BB. CONCLUSION Although TLR-4, ACE, and MBL-2 GPs have been extensively investigated in different clinical pictures, this is the first study to evaluate the role of these polymorphisms in the genetic etiopathogenesis of FN in patients with ALs. As a conclusion, TLR-4, ACE, and MBL-2 genes might play roles in the genetic etiopathogenesis of FN in patients with ALs.

Neuraminidase decreases in vitro adherence of slime-forming coagulase-negative staphylococci to biosynthetic ovine collagen vascular graft

Vascular prosthetic graft infection is a major complication of vascular surgery that starts with adhesion of the microorganism to the graft. Because slime-forming microorganisms are the major causative agents in graft infection, the goals of investigators in this study were (1) to investigate the bacterial adherence of slime-forming and non-slime-forming coagulase-negative staphylococci (CNS), and (2) to determine the role of neuraminidase (NANase) in bacterial adherence to the biosynthetic ovine collagen graft. Human plasma was instilled and incubated at 37°C in preparation for fibrin deposition of grafts. After 48 hours, incubation grafts were drained and inoculated with slime-forming and non-slime-forming CNS in tryptic soy broth in the presence and in the absence of neuraminidase. After 24 hours of incubation at 36°C, grafts were vortexed and cultured for colony count. Bacterial counts were expressed as total colony-forming units per longitudinal centimeter of the graft. Slime-forming CNS had greater affinity to the collagen graft compared with non-slime-forming CNS (P < .05). Adherence of slime-forming CNS was impaired by NANase treatment (P < .001). NANase treatment of patients with non-slime-forming CNS did not change adherence to the graft (P > .05). Results show that slime plays an important role in the pathogenesis of vascular graft infection. Adherence of slime-forming CNS can be decreased through the administration of NANase. This may have implications for the development of neuraminidase-embedded vascular grafts designed to reduce the occurrence of biomaterial-related infection.

Intramuscular Cavernous Hemangioma in Ankle: Treatment with Tendon Transfer: Case Report

of infancy and childhood.1 Typically, these lesions exhibit a period of rapid growth in the first 6 months of life. The proliferative phase is generally followed by spontaneous, gradual involution beginning at about 1 year of age and resolution continues by the age 7 of years in 95% of patients.2 The etiology is unclear but possibly congenital in origin. They are benign neoplasms demonstrating endothelial proliferation without malignant transformation in spite of their vascular nature.1 Hemangiomas can occur anywhere in the body. They commonly occur in the skin or subcutaneous tissues followed by the deep tissues, occasionally are intramuscular and rarely within bone. They are generally isolated lesions but in 30% of cases they are multiple and females are more commonly affected than males.3

30-year patency of a saphenous vein graft in coronary bypass graft surgery.

3 74-year-old man was admitted to our institute complaining of angina pectoris. Electrocardiograhy revealed sinus rhythm with left bundle branch block. e had a 30-year history of acetylsalicylic acid use. Thirty years previously, an anastomosis had been created etween the ascending aorta and the left anterior descendng artery (LAD) using a saphenous vein graft. Angiograhy showed significant lesions in the right coronary and ircumflex coronary arteries. The proximal LAD artery was ompletely occluded, but the previously performed aortoAD bypass was working perfectly (Fig 1A, Angiographic mage; B, diameters of vessels. 1 saphenous vein graft; 2 the proximal LAD; 3 the distal LAD; 4 6F Judkins atheter; * proximal anastomosis; ** distal anastomois). The right coronary artery and circumflex lesions were uccessfully treated with stents. The best predictor of the graft patency is the diameter f the vessel. For saphenous vein grafts performed to the AD, the 10-year patency is 90% for vessels exceeding 2.0