Bekir Inan

Surgical treatment of lower limb ischemia in diabetic patients - long-term results.

Introduction Lower limb ischemia may cause nonhealing ulcers, infection, amputation and even mortality in diabetic patients. In this study, we review our data of ischemic lower limb revascularization procedures in diabetic patients and present the early, mid- and long-term results. Material and methods From March 2004 to September 2008, 83 patients with lower limb ischemia in Fontaine class III and IV underwent distal arterial bypass procedures. Saphenous vein grafts were used for below-knee arterial bypasses in all patients. In 16 (19%) patients femoropopliteal bypasses were performed with PTFE grafts. Short-term and long-term surgical results were evaluated. Results Ulcer recovery was determined in 36% of patients. Graft patency was 95% and 1 death (1%) occurred in short-term follow-up. In long-term follow-up the total effectiveness rate was 74%. Graft patency was 79% and 6 deaths (7%) occurred during the follow-up. Conclusions Lower limb ischemia is a serious event in patients with diabetes mellitus. The consequences may include increased mortality and morbidity in this particular patient population. However, distal arterial revascularizations are considerably effective procedures to avoid amputation, to eliminate symptoms, to promote ulcer recovery and to help the patient participate in social life with acceptable short, mid- and long-term follow-up results.

A giant right atrial villous myxoma with simultaneous pulmonary embolism

INTRODUCTION Primary cardiac tumors are rare and approximately three quarters of them are benign and up to half of the benign tumors are myxomas. Right atrial villous myxoma with pulmonary embolism is an unusual apparition. PRESENTATION OF CASE A 29 year-old male was admitted to our outpatient clinic with progressive exertional dyspnea, chest pain and intermittent feeling faint. A giant right atrial villous mobile mass was detected by means of transthoracic echocardiography. To exclude possible pulmonary embolism, chest computed tomography scan was performed and showed filling defects in the branch of the pulmonary artery. The mass was totally resected. DISCUSSION RA villous myxoma is a rare subtype in an unusual location with high potential of pulmonary embolism. Early surgery for villous myxoma has a great importance in order to reduce the risk of pulmonary embolism. CONCLUSION 3D TEE should be a sufficient technique for diagnosis and evoluation of shape, size and origin of the cardiac mass an adequate guide to surgical treatment.

Straight versus S-shaped sternotomy: a histologic study in the sheep model

IntroductionStraight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing.Materials and methodsWe enrolled 31 sheep, weighing 18–30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue.ResultsNo early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001).DiscussionOur work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure.

Single coronary artery anomaly causing ischemic mitral insufficiency

Single coronary artery anomaly is rarely seen, and although it can present with sudden death, chest pain, arrhythmia, myocardial infarction, or congestive heart failure, it can also be asymptomatic. We describe the case of a 58-year-old man with single coronary artery anomaly in whom the coronary artery stemmed from the left coronary sinus and caused ischemic mitral insufficiency due to left anterior descending artery stenosis. He underwent successful mitral valve repair and coronary bypass.

Ischaemic mitral regurgitation: The effects of ring annuloplasty and suture annuloplasty repair techniques on left ventricular re-remodeling

Objective: To examine the mid-term results of patients on whom a coronary revascularization as well as a mitral ring and suture annuloplasty have been performed due to coronary artery disease (CAD) and ischaemic mitral regurgitation (IMR). Methodology: Totally 73 patients on whom a revascularization and a mitral valve repair due to CAD and IMR had been performed in our clinic between 2000-2008 were included in the study. Patients were divided into two groups one of which included 38 patients (52.05%) on whom a coronary artery bypass graft (CABG) and a ring annuloplasty on the mitral valve had been performed (Group 1) and the other one 35 patients (47.95%) on whom only suture annuloplasty as well as a CABG had been performed (Group 2). The study was planned retrospectively and study data have been obtained by screening the hospital registries retrospectively. In the mid-term, patients were invited for a check and their intragroup and intergroup echocardiographic parameters and functional capacities were assessed statistically. Results: In pre-operational and post-operational intragroup assessment in terms of echocardiographic findings; although LVEDD, LVESD, EDV, PAP and the degree of recurrent MR have been decreased in both groups, the decrease in LVESD and PAP and the low degree of recurrent MR were statistically significant in Group 1 patients (p=0.047, p=0.023, p=0.01, respectively). When the mid-term intergroup echocardiograpic findings were assessed; PAP and recurrent MR have been determined statistically lower in Group 1 patients (p=0.005, p=0.08, respectively). The length of intensive care unit stay, length of hospitalization and length of detachment from respiratory support were statistically significantly longer in ring annuloplasty performed group (p=0.012, p=0.033, p=0.029, respectively). Conclusions: In moderate to severe IMR patients, a positive contribution can be provided to ventricular remodeling by a ring annuloplasty through a significant decrease in left ventricular diameter and a low recurrent MR and PAP.

Aortic stent infection in etiology of fever of unknown origin in a geriatric patient

Abstract Objective Aortic stent greft infections (ASGI) are associated with significant morbidity and mortality. ASGI may exist as a seldom cause of fever. Case report A 67 year-old male patient presented with fever, fatigue, chest pain and night sweats for a week. He had no infection sign except 3/6 systolic murmur. He admitted to the clinic with a prediagnosis of infective endocarditis. Combination therapy with ceftriaxon (2 g/day) + vancomycine (2 g/day) was administered. No vegetation was seen on neither transthoracic nor transesophageal ecocardiography. Methicillin-sensitive Staphylococcus aureus (MSSA) yielded in blood cultures. Antibiotherapy was changed to sulbactam-ampicilline (8 g/day). Then, we learned that the patient has an aortic stent placed due to aortic dissection. Contrast enhancement was detected in magnetic resonance imaging. Cardiovascular surgeons decided not to remove the stent because of increased mortality; therefore antimicrobial therapy was extended to 4 weeks. But soon after discharge from the hospital, the patient re-admitted with fever. Sulbactam-ampicilline was begun, and MSSA yielded in blood cultures again. Antibiotherapy was continued for an additional 6 weeks. No recurrent infection occurred during 6 months of follow-up. Conclusion ASGI could be one of the causes of fever of unknown origin (FUO). Despite the recommended treatment of ASGI being surgery, long-term conservative antimicrobial treatment may be performed successfully in patients with high surgical risk.

Aortic Dissection In Case with Chronic Kidney Disease

Aortic disection is an urgent clinical problem that rapid diagnosis and appropriate treatment is life-saving. Hypertension is one of the major risk factors. In this paper, a 56 years old female patient with hypertension and renal failure was presented. In this case after clinical suspicion, aortic dissection was diagnosed with imaging studies. Endovascular aortic repair was performed but after surgery, patient died because of possible hemorrhage complication. In aortic disection, diagnosis and treatment could be fast. In chronic kidney disease the prognosis of patients is adversely affected. Despite proper surgical intervention accompanying medical problems like chronic kidney disease have negative effects on survival.

Investigation of the Impact of Flaxseed (Linum Usitatissimum) on the Lower Extremity Ischemia/Reperfusion Injury in a Hypercholesterolemic Rat Model

Introduction: Ischemia is a condition in which the circulation fails to provide the oxygen and other metabolites required by the tissue, and to eliminate the waste products. Reperfusion is the recovery of blood flow and oxygen to a hypoxic tissue. The aim of this study is to investigate the effect of flaxseed (L. Usitatissimum) in a hyper cholesterolemic rat model of lower extremity ischemia-reperfusion injury.Material and method: 38 female Wistar rats weighing 200 to 250 grams were used in the study. The rats were assigned into 4 groups as follows: Group 1 (control, normal diet, n:8); Group 2 (40 mg/kg fed by body lignan complex, n:10), Group 3: (fed by 0.1% cholesterol containing diet, n:10), Group 4 (fed by 0.1% cholesterol containing diet+40 mg/kg body lignan complex, n:10). Ischemia was modeled by performing ligation of the left femoral artery using 6/0 prolene for two hours followed by two hours of perfusion and the blood flow was measured throughout the process in all groups by Doppler ultrasonography.Results: In Group 3, serum total cholesterol and triglyceride levels were higher compared to subjects in Group 1, Group 2 and Group 4 (p 0.05).Conclusion: The present study shows that flaxseed reduces the ischemia-reperfusion injury that occurs in femoral artery endothelium and gastrocnemius muscle following femoral artery occlusion-reperfusion in rats. The main findings in support of this conclusion include the significantly lower serum total cholesterol, LDL-cholesterol and triglyceride values in rats fed by flaxseed compared to hyper-cholesterolemic rats that were given flaxseed. In addition, assessment of the femoral artery endothelium and gastrocnemius muscle samples using the immunohistochemical method revealed significantly lower edema and neutrophil infiltration in rats fed by flaxseed.