Fahri Adalı

Effect of IL-18 binding protein on hepatic ischemia-reperfusion injury induced by infrarenal aortic occlusion

Purpose Severe local and systemic tissue damage called ischemia/reperfusion (IR) injury occurs during the period of reperfusion. Free oxygen radicals and proinflammatory cytokines are responsible for reperfusion injury. IL-18 binding protein (IL-18BP) is a natural inhibitor of IL-18. The balance between IL-18 and IL-18BP has an important role in the inflammatory setting. The present study aimed to investigate whether IL-18BP had a protective role in remote organ hepatic IR injury. Methods Wistar-Albino rats were divided into three groups that contained seven rats. Group I (sham): Laparotomy and infrarenal abdominal aorta (AA) dissection were done but no clamping was done. Group II (I/R): The infrarenal AA was clamped by atraumatic microvascular clamp for 30 minutes and then was exposed to 90 minutes of reperfusion. Group III (IR + IL-18BP): 75 µg/kg of IL-18BP in 0.9% saline (1 mL) was administered 30 minutes before infrarenal AA dissection and clamping; 30 minutes of ischemia was applied and then was exposed to 90 minutes of reperfusion. Results Serum AST, ALT, and LDH levels were remarkably higher in IR group and returned to normal levels in treatment group. The proinflammatory cytokine levels had decreased in treatment group, and was statistically significant compared with the IR group. Serum levels of total oxidant status and oxidative stress index decreased and levels of total antioxidant status increased by IL-18BP. Conclusion This study suggested that IL-18BP has antioxidant, anti-inflammatory and hepatoprotective effects in cases of IR with infrarenal AA induced liver oxidative damage.

Effects of N-acetyl cysteine on renal functions evaluated by blood neutrophil gelatinase-associated lipocalin levels in geriatric patients undergoing coronary artery bypass grafting

Objective: Recent conflicting studies on the renal effects of N-acetyl cysteine (NAC) after cardiac surgery have been published. The aim of this study was to evaluate the renal effects of NAC using neutrophil gelatinase-associated lipocalin (NGAL) blood levels in elderly patients undergoing coronary artery bypass grafting (CABG). Methods: This randomized, double-blinded, placebo-controlled study was conducted among geriatric patients (>65 years) scheduled to undergo CABG. A total of 60 consecutive patients were randomly assigned to 2 groups. The first group received I.V. NAC (n=30) and the second group received placebo (n=30) at induction of anesthesia and then for 20 h. NGAL values were determined and conventional renal function tests were performed. Statistical analysis was performed using SPSS 17.0 (IL, Chicago, USA). A p value of <0.05 was considered statistically significant Results: Plasma creatinine levels at 24 h postoperatively were significantly higher in the placebo group than in the NAC group (1.41±0.63 vs. 1.13±0.35; p<0.05). The mean serum NGAL levels at 3 h postoperatively were higher in the placebo group than in the NAC group (104.94±30.51 vs. 87.82±25.18; p<0.05). NGAL levels were similar between the groups at all other measurement time points. Plasma creatinine levels of ≥1.5 mg/dL or >25% of the baseline value at any time during the study period were observed in 27% of patients in the NAC group and 37% of patients in the placebo group; the difference was statistically significant (p<0.05). Conclusion: In the present study, we found that I.V. NAC infusion in elderly patients undergoing CABG reduced the incidence of acute kidney injury as determined by blood NGAL and creatinine levels.

A rare para-anastomotic femoral artery aneurysm in a patient with history of femoro-popliteal bypass graft occlusion

Highlights • We report a rare complication of femoro-popliteal bypass grafting.• Open surgical repair using a biologic vascular graft (rather than a stent graft) may reduce the risk of postoperative infection.

Comparison of neutrophil:lymphocyte ratios following coronary artery bypass surgery with or without cardiopulmonary bypass.

Objective Coronary artery bypass graft (CABG) surgery may induce postoperative systemic changes in leukocyte counts, including leukocytosis, neutrophilia or lymphopenia. This retrospective clinical study investigated whether offpump coronary artery bypass (OPCAB) surgery working on the beating heart without extracorporeal circulation could favourably affect leukocyte counts, including neutrophil-tolymphocyte (N:L) ratio, after CABG. Methods In this study, 30 patients who underwent isolated CABG with cardiopulmonary bypass (CPB), and another 30 patients who underwent the same operation without CPB between May 2010 and May 2013, were screened from the computerised database of our hospital. Pre-operative, and first and fifth postoperative day differential counts of leukocytes with the N:L ratio of peripheral blood were obtained. Results A significant increase in total leukocyte and neutrophil counts and N:L ratio, and a decrease in lymphocyte counts were observed at all time points after surgery in both groups. N:L ratio was significantly higher in the CPB group compared with the OPCAB group on the first postoperative day (20.73 ± 13.85 vs 10.19 ± 4.55, p < 0.001), but this difference disappeared on the fifth postoperative day. Conclusion CPB results in transient but significant changes in leukocyte counts in the peripheral blood stream in terms of N:L ratio compared with the off-pump technique of CABG.

Nebivolol compared with metoprolol for erectile function in males undergoing coronary artery bypass graft

Objective: The aim of this study was to evaluate erectile function in males undergoing coronary artery bypass graft (CABG) while on two different adrenoceptor beta-blocker regimens, namely nebivolol and metoprolol. We hypothesize that the negative effects of cardiopulmonary bypass on erectile function may be possibly attenuated by preferring a vasodilating selective β1-blocker, nebivolol, to metoprolol as an anti-ischemic and antiarrhythmic agent in males undergoing CABG. Methods: This randomized, double-blind, prospective clinical study was conducted in patients scheduled for CABG surgery between February 2012 and June 2014. A total of 60 consecutive patients who met inclusion criteria were randomized and divided into the following two groups: N group, which received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks after surgery or M group, which received 50 mg of metoprolol orally for the same period. All patients were evaluated by the erectile function domain of the International Index of Erectile Function-5 (IIEF-5) at the time of admission (before starting the beta-blocker) and 3 months after surgery. Results: In the metoprolol group, the mean IIEF-5 score decreased significantly from a baseline of 15.2±5.8 to 12.9±5.8 (p<0.001), but in the nebivolol group, this difference was not significant (from a baseline 12.9±5.5 to 12.4±5.5, p=0.053). In all patients, the mean IIEF-5 score decreased significantly from a baseline of 14.0±5.7 to 12.6±5.6 (p<0.001). Conclusion: Although erectile function in males undergoing CABG surgery decreases when metoprolol is used, nebivolol exerts protective effects on erectile function against the disruptive effects of cardiopulmonary bypass in patients undergoing CABG.

Sağ Pulmoner Artere Erken Dönem Embolize Olmuş Atrial Septal Defekt Kapama Cihazının Tedavisi: İkinci Bir Girişim mi, Açık Cerrahi mi?

Atrial septal defektlerin perkutan transkateter yontem ile kapatilmasi, sternotomi ve kardiyopulmoner by-pass gerektirmemesi nedeni ile uygun vakalarda siklikla tercih edilir olmustur. Ancak, defekt kapama cihazinin kalp bosluklarindan birine yada vaskuler dolasima migrasyonu en korkulan komplikasyon olarak karsimiza cikabilmektedir. Sunulan yazida, perkutan yontemle basarili bir sekilde kapatildiktan 24 saat sonra sag pulmoner artere embolize olmus bir ASD kapama cihazinin cerrahi olarak cikarilmasi sunulmustur.

Effects of thymoquinone against cisplatin-induced cardiac injury in rats

PURPOSE T o investigate the possible protective effect of thymoquinone (TQ) in cisplatin (CP) induced myocardial injury. METHODS A total of 28 adult male Wistar-Albino rats were randomly and equally divided into four groups as follows: Group 1 (control), Group 2 (CP at 15 mg/kg dose), Group 3 (TQ 40 mg/kg/day for two days prior to CP injection and on third day, CP at 15 mg/kg dose was intraperitoneally administered and TQ treatment continued until fifth day) and Group 4 (TQ at 40mg/kg/day dose for five days). RESULTS There was a significant increment in CP group in terms of congestion, edema and pycnotic nuclei in myocardial fibers, comparing with other groups. TQ group exhibited significant increase in expression of antiapoptotic protein Bcl-2, comparing with CP group (p<0.05). In only CP administered group, expression of antiapoptotic protein Bcl-2 was lowest comparing with other groups. CONCLUSION Established data indicate that cisplatin is cardiotoxic and thymoquinone may be useful in treating CP-induced cardiac injury.

L-Carnitine Supplementation Reduces Short-Term Neutrophil-Lymphocyte Ratio in Patients Undergoing Coronary Artery Bypass Grafting.

This study aims to investigate whether preoperative L-carnitine supplementation affects the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing coronary artery bypass grafting surgery. The neutrophil-to-lymphocyte ratio is an inflammatory marker that has proven usefulness for predicting postoperative complications in coronary artery bypass surgery. A lot of studies concerning the role of L-carnitine in the immune system have been performed, contradictory results have been reported on its effects on absolute numbers of WBC subtypes. This randomized, double-blinded, placebo-controlled study was conducted among patients scheduled for coronary artery bypass grafting surgery between June 2012 and December 2013 in our cardiovascular surgery clinic. A total of 60 consecutive patients were randomized and divided into 2 groups. The first group received 2 g of L-carnitine in 1000 mL of 0.9% saline solution infused over 24 hours for each of the 3 preoperative days (L-carnitine group, n = 30), or only 1000 mL of 0.9% saline solution for the same time period (placebo group, n = 30). The basal values of leukocyte, neutrophil, lymphocyte counts, and neutrophil to lymphocyte ratio were similar in the 2 groups. After L-carnitine supplementation (just before surgery), leukocyte and neutrophil counts of the L-carnitine group were significantly lower than those of the placebo group (7.7 ± 1.5 versus 9.7 ± 2.6, P < 0.001 and 4.6 ± 1.3 versus 6.5 ± 2.2, P < 0.001). On postoperative day 1, lymphocyte counts were significantly higher in the L-carnitine group (1.1 ± 0.6 versus 0.8 ± 0.9, P < 0.001). Moreover, the increase in NLR was significantly lower in the L-carnitine group at postoperative day 1 (20.7 ± 13.8 versus 10.8 ± 4.1, P < 0.001). Preoperative L-carnitine supplementation may reduce neutrophil-lymphocyte ratio during the early postoperative period of coronary artery bypass grafting surgery.

Sol İnternal Torasik Arter Kullanılarak ve Kullanılmayarak Koroner Arter Bypass Cerrahisine Giden Yaşlı Hastalarda Komplikasyonların Karşılaştırılması

Introduction: This study aimed to compare postoperative complications in elderly patients who underwent coronary artery bypass grafting surgery with or without use of the left internal thoracic artery. Patients and Methods: In this retrospective clinical study, 40 patients over 75 years old undergoing coronary artery bypass grafting surgery between September 2011 and December 2013 in our clinic were included. Twenty of the patients underwent coronary surgery with LITA and the other 20 patients underwent without LITA. We compared the two groups on the basis of postoperative mechanical complications. Results: Postoperative pneumothorax was seen in 3 patients (15%, p=0.03) who had undergone coronary artery surgery with LITA. Sternal dehiscence was seen in one patient (5%, p=0.047) and sternal infection was seen in one other patient (5%, p=0.047) in whom LITA was used. None of these complications were seen in patients in whom LITA was not used. Conclusion: Postoperative complications such as pneumothorax, sternal dehiscence and sternal infection were more common in elderly patients in whom LITA was used. However, in consideration of the important superiorities of LITA, this graft cannot be easily abandoned. In conclusion, if the required measures are taken in the elderly without diabetes mellitus, osteoporosis, pre-operative pulmonary disease which would negatively affect the post-operative prognosis, complications related with LITA grafting would not be as serious as to refrain from using this graft in elderly patients.

Travmatik Torasik Aort Disseksiyonu Endovasküler Tamiri: Olgu sunumu

Travmatik torasik aort disseksiyonlari genellikle hayati tehdit eden ve maruz kalanlarin % 75 inin kaybedildigi ciddi yaralanmalardir. Acik cerrahi ile greft interpozisyonu geleneksel kabul gormus tedavidir. Ancak acil multitravmali hastalarda ek yaralanmalar nedeni ile uygulama alani azdir ve mortalite oranlarida yuksektir. Travmatik torasik aort yaralanmalarinda endovaskuler greftleme ile tamir, konvansiyonel acik cerrahiye gore dusuk mortaliteye sahip guvenli bir alternatiftir. Bu yazida endovaskuler stent greft ile tamir edilen travmatik torasik aort disseksiyonlu bir olguyu sunduk