Cevdet Ugur Kocogullari

Subxiphoid pericardiostomy in the management of pericardial effusions: case series analysis of 368 patients

Objective: To assess the effectiveness of subxiphoid pericardiostomy in the treatment and diagnosis of pericardial effusions. Methods: 368 patients who underwent subxiphoid pericardiostomy and tube drainage for cardiac tamponade, moderate to severe pericardial effusion, or suspicious bacterial aetiology were retrospectively analysed. Biopsies of the pericardium and fluid samples for diagnostic tests were obtained from each patient. Results: The mean age of the patients was 38.4 years, and the male to female ratio was 220:148. The pericardial effusion was classified by echocardiography as severe in 53% of the patients, moderate in 43%, and mild in 4%. The incidence of cardiac tamponade was 25%. Myocardial injury requiring sternotomy occurred as an operative complication in 0.8% of the patients and recurrent effusion necessitating further surgical intervention developed in 10% of patients. Histopathological examination and the polymerase chain reaction of specimens of pericardium and fluid were helpful for establishing a diagnosis in 90% of patients with malignancy and 92% of patients with tuberculous pericarditis. The overall 30 day mortality rate was 0.8%. Patients were followed up for at least one year. Pericardial constriction requiring pericardiectomy developed in 3% of the patients. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with subxiphoid pericardiostomy in both adults and children.

Control of acute postoperative pain by transcutaneous electrical nerve stimulation after open cardiac operations: a randomized placebo-controlled prospective study.

OBJECTIVE We investigated the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on pain during the first 24 hours after a cardiac surgical procedure. METHODS A total of 60 patients who had undergone median sternotomy (MS) for coronary artery bypass graft (n = 55) or valve repair surgery (n = 5) were randomized to receive TENS and pharmacologic analgesia, placebo TENS and pharmacologic analgesia, or pharmacologic analgesia alone (control group). For each group we recorded severity of pain, analgesic intake, and pulmonary complications. Pethidine HCL and metamizol sodium were administered for postsurgical analgesia. RESULTS Pain after MS was measured on a 10-point visual analogue scale (VAS). Mean scores in the TENS, placebo TENS, and control groups, respectively, were 5.70 +/- 1.78, 5.75 +/- 1.83, and 5.95 +/- 1.63 before treatment (P >.05); 2.40 +/- 1.18, 3.90 +/- 1.48, and 3.55 +/- 1.60 on the 12th hour of the intervention (P < .05); and 1.25 +/- 0.91, 2.30 +/- 1.34, and 2.15 +/- 1.13 on the 24th hour of the intervention (P < .05). The mean VAS scores decreased within each group (P < .05). However, the mean VAS scores decreased much more significantly in the TENS group (P < .05). Metamizol sodium intake was 1.05 +/- 0.39 g, 2.30 +/- 1.08 g, and 2.90 +/- 1.20 g and pethidine HCL intake was 17 +/- 16.25 mg, 57 +/- 21.54 mg, and 51.50 +/- 18.99 mg, respectively, in the TENS, placebo TENS, and control groups. Metamizol sodium and pethidine HCL intake was least in the TENS group (P < .05). Postoperative complications were observed in 6 (10%) of patients. The most frequent complication was atelectasia. CONCLUSIONS TENS was more effective than placebo TENS or control treatments in decreasing pain and limiting opioid and nonopioid medication intake during the first 24-hour period following MS.

Prevention of reperfusion injury of the spinal cord in aortic surgery: An experimental study

PurposeWe designed an experimental study to show the effects of some agents in order to prevent reperfusion injury of the spinal cord.MethodsTwenty rabbits were used and were divided into two groups in our study. Infrarenal abdominal aortic occlusion, between renal arteries and iliac bifurcations, was applied to the subjects in group 1 for only 30 min; in the group 2 subjects, on the other hand, intra-aortic diltiazem, N-acetylcysteine, and catalase combinations were applied after infrarenal abdominal aortic occlusion. The spinal cord functions of the subjects were assessed at the 48th hour after the operation according to Tarlov scoring, then cord tissue samples were taken for biochemical and histopathological studies.ResultsThe group 2 subjects had better neurological functions than group 1 subjects (P < 0.01). In group 2; superoxide dismutase and glutathione peroxidase levels increased, while malondialdehyde and xanthine oxidase levels decreased as compared with group 1 (P < 0.05). A histopathological examination showed the group 2 samples to have fewer bleeding points and less neuron loss.ConclusionsWe concluded that antioxidant agent combinations (diltiazem, N-acetylcysteine, and catalase) applied after ischemia might thus help protect the spinal cord against ischemia and reperfusion injury.

A Method for Locating Embedded Left Anterior Descending Coronary Arteries

Intraoperative detection of deeply embedded coronary arteries is difficult. This study describes an effective method to identify embedded coronary arteries by intraoperative cine angiography. Two embedded left anterior descending coronary arteries were successfully identified by intraoperative cine angiography. We believe that the intraoperative cineangiography is helpful for surgeons in this difficult situation.

Influence of intracoronary shunt on myocardial damage: a prospective randomized study.

OBJECTIVE We aimed to evaluate whether surgical intracoronary shunt protects myocardium in patients with moderate left ventricular dysfunction (MLVD). METHODS Thirty-nine patients consisted the shunt group and 43 patients consisted the shuntless group. Troponin I, CK, and CK-MB were measured preoperatively, and at 6 and 24h postoperatively. Cardiac enzymes, rate of postoperative atrial fibrillation (AF) and third month ejection fraction (EF) were compared between the groups. RESULTS There were no significant differences between the groups for preoperative troponin I, CK, CK-MB, and postoperative CK levels (at 6 and 24h). Postoperative troponin I and CK-MB levels were significantly lower in the shunt group (p<0.001). Although preoperative EF of the patients were not significantly different between groups, the third month EF were significantly increased in both groups, and this increment was significantly higher in the shunt group than the shuntless group. One patient (2.3%) died in the shuntless group whereas there was no death in the shunt group. CONCLUSION Intracoronary shunt has protective effects on myocardium in patients with moderate left ventricular dysfunction.

Effects of Ascorbic Acid, Alpha-Tocopherol and Allopurinol on Ischemia-Reperfusion Injury in Rabbit Skeletal Muscle: An Experimental Study

Purpose Ischemia reperfusion injury to skeletal muscle, following an acute arterial occlusion is important cause of morbidity and mortality. The aim of the present study was to determine and evaluate the effects of ascorbic acide, alpha-tocopherol and allopurinol on ischemia reperfusion injury in rabbit skeletal muscle. Methods Forty-eight New Zealand white rabbits, all male, weighing between 2.5 to 3.0 (mean 2.8) kg, were used in the study. They were separated into four groups. Group I was the control group without any drugs. The other groups were treatment groups (groups II, III, and IV). Group II rabbits administrated 50 mg/kg ascorbic acide and 100 mg/kg alpha-tocopherol 3 days prior to ischemia, group III rabbits received 50 mg/kg allopurinol 2 days prior to ischemia, and group IV rabbits were administrated both 50 mg/kg ascorbic acide, 100 mg/kg alpha-tocopherol 3 days prior to ischemia and 50 mg/kg allopurinol 2 days prior to ischemia. Two hours ischemia and 2 hours reperfusion were underwent to the treatment groups. At the end of the reperfusion periods, muscle samples were taken from rectus femoris muscle for determination of superoxide dismutase, catalase and glutathione peroxidase activities as antioxidant enzymes, and malondialdehyde as an indicator of lipid peroxidation and xanthine oxidase levels as source hydroxyl radical. Besides, histopathological changes (edema, inflammation, ring formation and splitting formation) were evaluated in the muscle specimens. Results In the treatment groups; superoxide dismutase (U/mgprotein), catalase (U/mgprotein), and glutathione peroxidase (U/mgprotein) levels increased, malondialdehyde (nmol/mgprotein) and xanthine oksidase (mU/mgprotein) levels decreased compared to control I (p < 0.05). Increase of superoxide dismutase, catalase, and glutathione peroxidase levels were the highest and decrease of malondialdehyde and xanthine oxidase levels were the highest in group IV compared to groups II and III, but no significant as statistically. Also amount of cellular injury in group II, III, and IV were lower than group I. Conclusions Antioxidant medication may help lowering ischemia reperfusion injury. In our study, all drug medications are shown to be able to have an effective role for preventing ischemia reperfusion injury. Moreover, ascorbic acide + alpha-tocopherol + allopurinol group (group IV) may have a beneficial effect to decrease the local and systemic damage due to ischemia-reperfusion injury.

Efficiency of postoperative statin treatment for preventing new-onset postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting: A prospective randomized study.

Objective: Recent studies have demonstrated that preoperative statin therapy reduces the incidence of postoperative atrial fibrillation (AF). The objective of this study was to assess the efficacy of statin therapy started in the early postoperative period for the prevention from new-onset AF after isolated coronary artery bypass grafting (CABG). Methods: This prospective and randomized study consisted of 60 consecutive patients who underwent elective isolated CABG. Patients were divided into two groups to examine the influence of statins: those with postoperative statin therapy (statin group, n=30) and those without it (non-statin group, n=30). Patient data were collected and analyzed prospectively. In the statin group, each extubated patient was given 40 mg of atorvastatin per day, starting from an average of 6 hours after the operation. Results: The overall incidence of postoperative AF was 30%. Postoperative AF occurred in 5 patients (16.7%) in the statin group. This was significantly lower compared with 13 patients (43.3%) in the non-statin group (p=0.049). According to the multivariate analysis, postoperative atorvastatin reduced the risk of postoperative AF by 49% [odds ratio (OR) 0.512, 95% confidence interval (CI) 0.005 to 0.517, p=0.012]. Also, age was an independent predictor of postoperative AF (OR 1.299, 95% CI 1.115 to 1.514, p=0.001). Conclusion: Postoperative statin therapy seems to reduce new-onset AF after isolated CABG in our study.

Repair of the inferior vena cava with autogenous peritoneo-fascial patch graft following abdominal trauma: a case report.

Abdominal vascular injuries are among the most challenging and lethal injuries in traumatized patients. Inferior vena cava is the most frequently injured vein during the blunt or penetrating trauma. The primary repair, end to end anastomosis, endovascular stenting, or graft interposition with autogenous or synthetic materials should be considered in selected cases. However, in cases the synthetic graft was preferred, intestinal contaminations due to small or large bowel perforation accompanying the trauma have been cited as a limiting factor for the use of such grafts as in the current case. However, a previous history of lower leg variceal surgery prevents the use of great saphenous vein as a graft. So in the present case, the authors report a patient with inferior vena cava injury repaired with autogenous peritoneo-fascial graft. The authors have used APF graft in traumatic inferior vena cava injury for the first time.

Advantages of autologous blood transfusion in off-pump coronary artery bypass.

BACKGROUND In this randomized controlled study, we investigated the effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery. METHODS Sixty patients who underwent surgery between February 2008 and August 2008 were randomized into 2 groups. The AHBT group (n = 30) consisted of patients who received autologous Hemobag blood transfusion, and the ABT group (n = 30) consisted of patients who received allogenic blood transfusion. All patients underwent OPCAB via sternotomy. The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit. RESULTS Intraoperative bleeding and fluid resuscitation were similar in the 2 groups (P > .05); however, there were significant decreases in postoperative blood loss, extubation period, postoperative white cell counts, sedimentation rate, incidence of atelectasis, C-reactive protein, and fever in the AHBT group compared with the ABT group (P < .05). The rate of atrial fibrillation in the AHBT group tended to be lower than in the ABT group. CONCLUSION Autologous blood transfusion in OPCAB may be beneficial in certain cardiac surgery patients; however, these beneficial effects require further study to be proved.

IABP-Related vascular complications: Who is responsible — the patient, the surgeon or the sheath? Part I: Sheath-related complications

IntroductionAn intra-aortic balloon pump (IABP) is frequently used as a mechanical support during the treatment of low cardiac output syndrome. The use of a sheath during IABP treatment can be associated with ischaemic complications in the extremities. The aim of our study was to determine the isolated role of sheaths in the development of vascular complications following IABP catheterisation.MethodsWe evaluated a total of 81 patients who had received an IABP for haemodynamic stability, between January 2003 and October 2007, following cardiovascular surgery. To eliminate surgical-related variables, only patients with IABPs and size 8.5 or 9 French catheters (inserted by experienced cardiovascular surgeons using the percutaneous Seldinger technique) were included in the study. To eliminate patient-related variables, patients with a known risk factor for either thrombosis, embolus or peripheral arterial disease were excluded from the study.ResultsThe patients were divided into two groups: Group 1 (sheathed catheter group; n=42), Group 2 (sheathless catheter group; n=39). Ischaemic complications were observed in a total of five patients. Four of these patients were from Group 1 and one was from Group 2.ConclusionSheathed catheterisation was found to increase the risk of vascular complications in patients who underwent IABP application. Therefore sheathless catheterisation is recommended for IABP application.