Deniz Demir

Mini-dose pump-prime aprotinin inhibited enhanced fibrinolytic activity and reduced blood loss and transfusion requirements after coronary artery bypass surgery.

Objectives: Low-dose aprotinin in the pump during cardiopulmonary bypass (CPB) has been shown to improve postoperative hemostasis and platelet preservation. This investigation was undertaken to evaluate the effects of mini-dose pump prime only aprotinin (70 mg) on the hemostatic parameters and blood transfusion requirements in patients undergoing on-pump coronary artery bypass surgery (CABG).Materials and Methods: We studied 86 patients who underwent CABG. Forty patients received mini-dose aprotinin (500.000 KIU [70 mg] in the pump), and a control group of 46 did not. D-dimer level, full blood count, postoperative blood loss, and transfusion requirements were analyzed before, after one hour operation and first day after operation.Results: Twenty-four-hour postoperative blood loss was significantly reduced in the aprotinin group (188± 51.5 ml vs. 818± 243.5 ml, [mean ± standard deviation] p < 0.01). Patients in the aprotinin group also received significantly less banked blood posoperatively than the control group (1.20 ± 0.52 vs. 3.33 ± 1.13 Units/per patient (p < 0.04). One hour after operation, and 24 hours after operation D-dimer level was significantly reduced in the aprotinin group (p < 0.008 and p < 0.017, respectively).Conclusions: Mini dose pump-prime aprotinin reduces postoperative blood loss, transfusion requirements and yet confers hemostatic improvement through reduced fibrinolysis in patients undergoing routine coronary artery bypass grafting.

An unusual cause of generalised seizure following cardiac surgery: with bolus cefazolin administration

Although some of the aetiological factors of seizure, such as cerebral microemboli, cerebral oedema, hypoperfusion, cerebral hypoxia and metabolic encephalopathy cannot be completely controlled during cardiac surgery, cautious management of all steps in the procedure may prevent the administrative causes of seizure. Cefazolin, which is known to be a proconvulsant agent, may be a suspected agent of seizure complications in patients with renal insufficiency. Surprisingly, intravenous bolus administration of cefazolin may also trigger seizure in patients with normal renal function. In this case report, a complication of generalised seizure after cardiac surgery with intravenous bolus administration of cefazolin is described, along with a brief review of the literature.

Mitral valve myxoma associated with intracranial tumor: a case report

Primary tumors of the heart are rare, and among them, cardiac myxoma is the most prevalent primary cardiac neoplasm in adult patients. Astrocytoma is the most common glioma and can occur in most parts of the brain and occasionally in the spinal cord. There is a little knowledge about coexistence of cardiac myxoma and astrocytoma in the literature. Cardiac myxoma associated with intracranial tumor is a very rare entity. We presented a case of cardiac myxoma originating mitral anterior valve associated with astrocytoma. The patient underwent the operation for intracranial tumor 2 months before cardiac surgery. Mitral valve myxoma was successfully treated with surgical resection without mitral valve replacement.

Surgical management of an inoperable giant pleomorphic rhabdomyosarcoma of the chest wall.

To the Editor: A 65-year-old men was referred to our hospital with a complaint of giant mass on the chest wall, which reached its present size to 3 cm in 5 months. On physical examination, the mass was firm, fixed, necrotized, and nontender (Figure 1). Metastatic lesions were detected in the lung. An incisional biopsy of the tumor confirmed the diagnosis of pleomorphic rhabdomyosarcoma, 2 months ago in another clinic. The patient was considered as inoperable because the lung was metastatic, and the mass excision was not performed. Serous leakage, observed in the incision area, was irritating for the patient. The patient brought to our clinic for the mass excision. The mass was totally excised. The size of the tumor was 16 16 15 cm, and the weight was 1750 g. The chest wall and the axillary skin defect were reconstructed with a latissimus dorsi muscle flap. The skin was primarily closed. After the operation, the patient has received chemotherapy in an oncological center. The postoperative course was uneventful, and no recurrence was found. The patient is still alive after 6 months follow-up and was satisfied from the operation. Surgical excision has not seemed to contribute to the improvement in survival after the mainstay of local disease control on chest wall rhabdomyosarcoma.1 The excision of giant tumors is usually not preferred because of its hardness, and it is useless for survival. Still, resection of giant mass can improve the patient’s condition and may provide a good quality of life.2 Rüstü Köse, MD Department of Plastic and Reconstructive Surgery Harran University Medical School Sanliurfa, Turkey