Fikret Maltepe

Hemostatic effects of Microporous Polysaccharide Hemosphere® in a rat model with severe femoral artery bleeding

An appropriate hemostatic dressing for prehospital use should lower mortality due to uncontrolled hemorrhage. In this study, the investigators explored the hemostatic effects of Microporous Polysaccharide Hemosphere® (MPH) applied in a rat model with severe femoral artery bleeding. Twelve rats were randomly assigned to MPH and control groups: The femoral artery of each rat was pierced to initiate bleeding. Then, 0.25 g MPH was poured into the bleeding site. A 200-g scale weight was placed over the bleeding site for 30 sec. At 30-sec intervals, the scale weight was removed, and hemostasis was assessed visually. After 30 sec, if the bleeding had ceased, the test was scored and checked as “passed at 30 sec.” If the bleeding had not stopped, the same procedures were repeated a maximum of 3 times. If hemostasis could not be achieved even after the third application, the test was scored as failed. The same sequence of procedures was repeated for the control group without use of MPH and with only standard compression. Application of MPH resulted in complete control of bleeding in 2 of 6, 4 of 6, and 6 of 6 rats at 30, 60, and 90 sec, respectively. In the control group, however, hemostasis could not be achieved in all 6 rats, even at 90 sec. The difference between the 2 groups was statistically significant (P=.007). Application of MPH and compression with a scale weight significantly decreased the time of hemostasis in the rat model with femoral arterial bleeding.

Multiple-Dose Activated Charcoal in an Accidental Vancomycin Overdose

BACKGROUND Multiple-dose activated charcoal may enhance the enterocapillary clearance of vancomycin. CASE REPORT A 17-day-old female neonate born with congenital meningomyelocele and Arnold-Chiari malformation was iatrogenically overdosed with a 500 mg intravenous bolus of vancomycin during a shunt operation. The Red Mans Syndrome developed within minutes, characterized by sudden hypotension, skin rash and cyanosis. Serum vancomycin level at one hour after the injection was 165.7 micrograms/mL, as measured by an enzyme immunoassay method (EMIT). Multiple dose activated charcoal, 1 g/kg, was first given five hours after injection, and continued every four hours for 12 doses. The half-life of vancomycin during charcoal administration was calculated to be 9.4 h or less than the reported 13.4-33.7 h half-life in normal neonates. The neonates renal function tests and brainstem auditory responses remained normal. CONCLUSIONS Gastrointestinal dialysis with multiple-dose activated charcoal without cathartics appeared to shorten the elimination half-life of vancomycin.

The effects of levosimendan and dobutamine in experimental bupivacaine-induced cardiotoxicity

BackgroundAccidental intravenous exposure to bupivacaine is highly cardiotoxic and may lead to death. Positive inotropic agents are usually utilized in resuscitative efforts. We have compared the efficacy of levosimendan, a novel inotropic agent, with dobutamine and their combination in a rat model of bupivacaine intoxication.MethodsTwenty-eight male Wistar albino rats weighing between 250-300 g were divided into these four groups: control (C), levosimendan (L), dobutamine (D) and dobutamine+levosimendan (D+L). Bupivacaine was administered at a dose of 3 mg/kg/min until cardiac arrest occurred or for 120 min. ECG, heart rate, blood pressure, arterial blood gases, and end tidal CO2 levels were monitored. Levosimendan was administered as a bolus of 12 μg/kg for 10 min and continued as an infusion at 0.3 μg/kg/min. Dobutamine was infused at a dose of 3 μg/kg/min. The time required for a 50% and 75% decrease in heart rate and blood pressure with a total time to cardiac arrest and bupivacaine dose for obtaining cardiac arrest were analyzed.ResultsTime periods for heart rate reductions of 50% and 75% were significantly longer in groups L (903, 1198 s), D (984, 1542 s) and L+D (1705, 3152 s) compared with the control group (345, 538 s p < 0.001). Median times to mean blood pressure reductions of 50% and 75% were 399 - 504 s in the control group, 1005 -1204 s in group L, 685 - 1009 s in group D and 1544- 2982 s in group L+D, and the difference was significant compared with the control group. Median time duration to asystole was 703 s in the control group compared with 1385 s in group L, 1789 s in group D and 3557 s in group L+D. Time to cardiac arrest was significantly higher in all 3 study groups. It was also significantly higher in the L+D group compared with both groups L and D separately.ConclusionA combination of dobutamine with levosimendan significantly increased survival times in this bupivacaine-induced toxicity rat model compared with the control, levosimendan, and dobutamine groups.

Ligation of patent ductus arteriosus in low birth weight premature infants: timing for intervention and effectiveness of bed-side surgery

BackgroundPatent ductus arteriosus is a common congenital cardiac condition. Its importance is mostly underestimated and accepted as an “easy” heart disease. Physiological consequences of pulmonary overflow may cause severe mortality in premature neonates. Accurate timing of surgical intervention is essential to decrease the mortality in very low birth weight premature infants. On-site surgery in the intensive care units (ICUs) results excellent surgical quality without jeopardizing the safety of the patients.MethodsWe have summarized the clinical and operative data of 26 premature neonates (<37 weeks of gestational age), which were operated for the diagnosis of PDA in the ICUs of Dokuz Eylül University. Thirteen low birth weight infants (<1000 gr) have been compared with remaining 13 neonates (>1000 gr).ResultsThere was no surgical mortality in both groups. Co-existing problems were observed in both groups, which did not affect surgical mortality and morbidity.ConclusionsSurgery in the ICU is a safe method for premature neonates with physiologically significant PDA. This technique should be the method of choice in experienced centers.

Long-Term Survival in a Young Adult with Total Artificial Heart: A Success Story

We presented here the result of a successful surgical treatment of 16 years old male diagnosed as dilated cardiomyopathy with the history of siblings’ early sudden death at the age of fifteen. The patient had to underwent total artificial heart implantation (TAH-T), (SynCardia) operation due to rapid biventricular detoriation and intracardiac trombus formation after his admittance to the ward. Due to lack of donor in the region he had to wait for long time with accurate anticoagulation and no serious complication during this long follow up period. He lived with TAH-T implantation both in the hospital and at home later was transplanted successfuly after 32 months. The patient is now activly working at a private company in NYHA Class 0 status. We have published this case due to its rarity in a young adult begins in childhood and longevity of the survival without any complication in TAH-T.