Kerem Karaca

N-Acetylcysteine for Preventing Pump-Induced Oxidoinflammatory Response During Cardiopulmonary Bypass

PurposeTo investigate the effect of N-acetylcysteine on preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass (CPB).MethodsForty patients undergoing coronary artery bypass grafting (CABG) were randomly divided into a study group (n = 20), given 50 mg kg−1N-acetylcysteine intravenously for 3 days, and a control group (n = 20) given saline. Serum samples were collected for measurement of myeloperoxidase (MPO), malondialdehyde (MDA), interleukin-6, Α1-acid glycoprotein (AAGP), and C-reactive protein (CRP) during surgery and postoperatively.ResultsThe MPO and MDA values showed a similar pattern during and after CPB in the study group, with significantly less variance than in the control group. Interleukin-6 showed similar patterns in the two groups, but the data from 30 min after the start of CPB and from 6 h post-CPB were significantly different. The AAGP and CRP values were both elevated during CPB in the two groups without a significant difference, but 6 and 24 h post-CPB, the values were significantly higher in the control group than in the study group.ConclusionsN-Acetylcysteine decreased pump-induced oxidoinflammatory response during CPB, suggesting that it could be a novel therapy for assisting in the prevention of CBP-induced oxidoinflammatory damage.

Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques.

BACKGROUND Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. METHODS Eighty male patients with a mean age of 22.02 +/- 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). RESULTS The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. CONCLUSION Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.

Ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii: Risk factors, clinical features, and outcomes

Acinetobacter baumannii is characterized by a rapid development of resistance to the commonly used antimicrobial agents. We investigated the risk factors, clinical features, and outcomes in ventilator-associated pneumonia (VAP) caused by extensive drug-resistant Acinetobacter baumannii (XDRAB). Clinical parameters and overall in-hospital mortality rates were compared between the VAP with and without XDRAB infection groups. This study showed that VAP caused by XDRAB was not associated with in-hospital mortality. However, it was related to high Simplified Acute Physiology Score II scores and increasing durations of hospital stays.

Usefulness of elevated red cell distribution width for predicting systemic inflammatory response syndrome after extracorporeal circulation

Objectives: Cardiac surgical operations performed by using extracorporeal circulation (ECC) lead to a systemic inflammatory response (SIR). Sometimes SIR may turn into a severe state, the systemic inflammatory response syndrome (SIRS) that usually has a poor outcome with no specific clinical tools described for its prediction. Red cell distribution width (RDW) is a routine hematological parameter. It has been proposed as a marker of morbidity and mortality in various clinical conditions. We aimed to investigate the relationship between high RDW and SIRS which is triggered by ECC. Methods: Eleven hundred consecutive patients who underwent elective heart surgery with the use of ECC were retrospectively analyzed. A total of 19 patients fulfilled the described SIRS criteria and 20 consecutive patients were selected as the control group. RDW and other laboratory parameters, preoperative clinical status, operative data and postoperative data were compared between the SIRS and the control groups. Results: Baseline characteristics of the patient groups were similar. Significant mortality was found in the SIRS group; 18 (94.73%) patients and 2 (10%) patients in the control group (p<0.002). RDW was found to be significantly higher in the SIRS group vs the control group (15.02±2.03 vs 13.01±1.93, respectively, p<0.003). Multiple logistic regression analyses showed an association between high RDW levels and SIRS development (OR for RDW levels exceeding 13.5%; 95% confidence limits of 1.0-1.3; p<0.04). Total operation time and the need for inotropic support were also found to be significant against the SIRS group (p=0.049). Conclusion: Increased RDW was significantly associated with increased risk of SIRS after ECC. The results of this study suggest that paying attention to RDW might provide valuable clinical information for predicting SIRS development among patients who are candidates for open heart surgery, without incurring additional costs.

Endovascular treatment of recurring type A dissection after total aortic arch debranching

Standard treatment method of the aortic arch pathologies is surgical replacement which requires cardiopulmonary bypass and deep hypothermic circulatory arrest. However, this approach is associated with major operative risks. Combination of debranching and thoracic endovascular aortic arch repair (TEVAR) has emerged as an alternative treatment modality in high-risk patients. This report describes successful staged hybrid treatment of a 50-year-old male patient with recurring type A dissection. It is concluded that staged debranching and TEVAR is a feasible option and provides aortic repair without increase of risk.

Traumatic pulmonary valve hematoma; an unusual complication of pulmonary balloon valvuloplasty

characteristics of isolated congenital unilateral absence of a pulmonary artery. Pediatr Cardiol 2010; 31: 1186-90. [CrossRef] 8. Lee JH, Jung TE, Lee YH. Anomalous origin of left pulmonary artery from aorta with atrial septal defect. Pediatr Cardiol 2008; 29: 860-1. [CrossRef] 9. Prifti E, Bonacchi M, Murzi B, Crucean A, Leacche M, Bernabei M, et al. Anomalous origin of the right pulmonary artery from the ascending aorta. J Card Surg 2004; 19: 103-12. [CrossRef] 10. Yip AS, Chow WH, Lee DF, Cheung KL. Mitral valve prolapse causing severe mitral regurgitation in a patient with absent right pulmonary artery. Clin Cardiol 1995; 18: 424-5. [CrossRef]

A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma

Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumors. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass. The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl.

Ringed Reinforced Polytetrafluoroethylene Sheltered Saphenous Vein Graft for Femorofemoral Bypass in Critical Leg Ischemia with Limited Distal Run Off: Case Report

Femorofemoral bypass is an appropriate alternative method of treatment in patients with unilateral iliac arterial occlusive lesions when catheter-based intervention is not feasible and aorta-femoral bypass is contraindicated because of medical risk factors or previous surgical procedures. We aimed to demonstrate an alternative solution for femorofemoral bypass procedure by using an externally ringed polytetrafluoroethylene-sheltered saphenous vein graft in three patients in whom the small calibrated deep femoral arteries were their only chance for revascularization. This alternative technique could be performed in extremity salvaging operations in critical leg ischemia with limited distal run-off.