Fersat Kolbakir

Comparison of histopathologic effects of carnitine and ascorbic acid on reperfusion injury

OBJECTIVEnReperfusion injury can be seen after acute arterial occlusion, acute myocardial infarctus and during open heart surgery and vascular surgery. Protective effects of ascorbic acid and carnitine on reperfusion damage were tested and compared using histopathologic examination on ischemia model in the rabbit hind limb.nnnMETHODSnFour groups (each containing ten animals) were used. In group I (G1), only anesthesia was administered and a biopsy was taken from the soleus muscle after 6 h. In group II (G2), group III (G3), and group IV (G4), after induction of anesthesia, arterial blood circulation of right posterior extremity was blocked by a tourniquet proximally. After four hours of ischemia, just before releasing of tourniquet, physiologic saline solution, sodium ascorbate (Redoxan) and L-carnitine (Carnitine) were administered intravenously to G2, G3 and G4, respectively. Following 2 h of reperfusion, biopsies were taken from soleus muscles. All of the biopsy slides were observed under the light microscope from the aspect of six different histopathologic criteria (loss of striation, nuclear centralisation, formation of ring and/or splitting, changing on diameters of muscle fibers, necrosis and minimal fibrosis) of ischemic muscle.nnnRESULTSnIschemic change criteria were seen less frequency in both vitamin C and carnitine groups compared to the control and placebo groups. However, this protective effect was statistically significant only for the aspect of segmental necrosis, centralization of nuclei and diameter change parameters in G3 and in G4. When G3 and G4 were compared, the differences on protective effects were significant only from the aspect of fibrosis (P<0.001) and changing on diameter of the fibers (P<0.001).nnnCONCLUSIONSnBoth sodium ascorbate and carnitine are effective on reducing the reperfusion injury in skeletal muscle. But when we compared these two agents to each other, we found that carnitine seems a little more protective on our experimental model.

Tracheoinnominate artery fistula following tracheostomy.

Tracheoinnominate artery fistula is a relatively rare but highly lethal complication occurring in patients with long-standing tracheostomies. Early evaluation of this problem and prompt aggressive therapy are necessary. When massive haemorrhage begins, immediate arterial compression, control of the airway and subsequent treatment of the injured artery may be lifesaving. Immediate surgical exploration through a median sternotomy is necessary to control the proximal and distal innominate artery. After the damaged artery has been excised, vascular reconstruction can be performed to preserve the connection between the proximal and distal ends of the innominate artery. A pedicled pericardial patch was successfully used for the tracheal reconstruction.

Primary Surgical Repair of Ventricular Septal Defect

Between January 1983 and December 2000, 78 patients underwent primary repair of a ventricular septal defect. There were 42 males (54%) and 36 females (46%) of whom 13 (17%) were under 1 year old, 50 (64%) were aged 1–10 years, 11 (14%) were aged 10–20 years, and 4 (5%) were over 20 years old. The ventricular septal defect was a perimembranous type in 60 patients (77%), subarterial (outlet) type in 10 (13%), and atrioventricular canal (inlet) type in 4 (5%). Operative repair was performed with a patch in all except 2 patients. Early postoperative complications included insignificant aortic regurgitation in 4 patients, persistent complete heart block in 1, and residual shunt in 4. There were 5 early deaths (6.4%) and 1 late death (1.8%) in 56 patients followed up. Early primary closure of ventricular septal defects, usually via a right atriotomy, can be performed with acceptable mortality and morbidity rates.

Thyroid hormone alterations during and after cardiopulmonary bypass

The haemodynamic effects of thyroid hormones are well known and include those on heart rate, contractility and myocardial oxygen consumption. Cardiopulmonary bypass produces various alterations in endocrine homoeostasis and may exert important haemodynamic effects postoperatively. The purpose of this prospective study was to determine the relation of cardiopulmonary bypass to changes in thyroid function. Blood samples were obtained from 20 patients preoperatively, at specific times before, during and after cardiopulmonary bypass. Total thyroxin (TT4), total triiodothyronine (TT3), free thyroxin (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone (TSH), thyroid-binding globulin (TBG) and albumin were measured by radioimmunoassay and competitive immunoassay. Values of TT4, TT3 and fT3 were significantly depressed up to 24 h after cardiopulmonary bypass (P < 0.05). TSH and fT4 levels remained within normal ranges at all sampling times. It is increasingly evident that cardiopulmonary bypass affects thyroid hormone metabolism, leading to a transient depression characterized by low levels of circulating TT4, TT3 and fT3.

Endothoracic Papaverine Application for Internal Thoracic Artery Harvest

This study compared the effects of different methods of papaverine application on free blood flow and harvesting time of the internal thoracic artery for coronary bypass grafting. Patients were randomly divided into 3 groups of 25 each: group 1 had papaverine injected into the endothoracic tissue around the internal thoracic artery before dissection, group 2 had papaverine injected into the periarterial tissues of the internal thoracic artery pedicle, and group 3 had intraluminal papaverine applied retrogradely into the internal thoracic artery. Mean blood flow was 56.3 ± 21.3, 21.1 ± 13.2, and 20.9 ± 9.1 mL · min−1 in groups 1, 2, and 3, respectively, immediately after harvesting. Flow in group 1 was significantly better than that in groups 2 and 3. Immediately before anastomosis, mean flow was 89.8 ± 19.1, 97.6 ± 35.4, and 95.9 ± 19.9 mL · min−1 in groups 1, 2, and 3, respectively, with no significant difference among groups. Internal thoracic artery harvesting times were shorter in group 1 than in groups 2 and 3. Administering papaverine into the endothoracic fascia of the internal thoracic artery bed prior to dissection is a reliable method that facilitates rapid harvesting of the graft without causing trauma and consequent spasm.

Left Subclavian Artery Aneurysm Rupture in Association with Aortic Coarctation

Aneurysms occurring in association with aortic coarctation are generally seen during the postoperative period and occur in a true or pseudoaneurysm form. Presumably, the stiff patch transmits additional tension to the adjacent elastic aortic wall, which thus bears the total burden of the pulse wave and dilates [1]. However, several cases have been reported in which an aneurysm developed in the absence of coarctation repair; these aneurysms are generally located in the ascending aorta [2]. Subclavian artery aneurysms (SAAs) are rare peripheral aneurysms and most are caused by atherosclerosis. They are rarely seen as complications of aortic coarctation and rarely result in aneurysm rupture [3, 4]. In the present issue, we have reported the clinical, operative, and imaging findings of a patient with left SAA rupture secondary to aortic isthmic coarctation.

Sutureless Vascular Anastomoses by Polydioxanone Connector

Usually a single end-to-end anastomosis on a middle-size vessel cannot be performed in less than twenty minutes with either separate or continuous suture technique. For easy and quick anastomoses the authors studied 12 dogs with a sutureless concept. With this method proximal and distal ends of a vessel were joined by means of a polydioxanone tube connector. The sutureless procedure took approximately five minutes to complete. Six months after the operation the anastomoses were examined and more than 41% of the vessels were found patent. The authors opinion is that, if polydioxanone tube is prepared more properly, the rate of patency will be higher than this.

Cor Triatriatum Dexter Echocardiographic Diagnosis and Successful Surgical Correction in an Infant

Cor triatriatum dexter is a very rare cardiac malformation in which the right atrium is subdivided into two distinct chambers. The authors report the case of a three-day-old infant boy with body weight of 2.8 kg, severely symptomatic, with highly obstructive cor triatriatum dexter and patent foramen ovale. The malformation was diagnosed by two-dimensional echocardiography and corrected successfully by surgery.

Rheumatic heart disease and coronary vasculitis in children.

UNLABELLEDnRheumatic fever is a systemic inflammatory disease which may also cause vasculitis in multiple organ systems.nnnCONCLUSIONnTwo children with rheumatic mitral valve disease and mitral valve replacement developed myocardial ischaemia due to coronary vasculitis. One of them had neurological findings that may be attributed to cerebral vasculitis.

Posttraumatic Pseudoaneurysm of the Anterior Tibial Artery

AbstractBackground: Posttraumatic pseudoaneurysm of the peripheral arteries infrequently occurs as a late complication of arterial injury. The pseudoaneurysmatic mass may cause ischemia of the extremity. It can be easily diagnosed by history and physical examination. The advisable surgical technique consists in reconstruction of the vessel by using a saphenous vein graft interposition.nn Case Study: A 25-year-old patient with posttraumatic pseudoaneurysm of the anterior tibial artery as a late complication of gunshot injury is presented which was successfully repaired in our clinic by using the reconstructive technique of saphenous vein graft interposition.