Mehmet Acipayam

The effects of cardiopulmonary bypass on androgen hormones in coronary artery bypass surgery.

The effects of testosterone on coronary vasomotor regulation have been described by several recent reports. Here we investigated changes in serum androgen levels during and after cardiopulmonary bypass (CPB) in patients who had undergone coronary artery bypass surgery. Serum luteinizing hormone, free testosterone and dihydroepiandrestenedione sulphate (DHEA sulphate) levels were evaluated in 38 male coronary artery bypass surgery patients using a chemical immunoassay technique. All hormone levels were corrected to account for haemodilution. Serum-free testosterone level decreased significantly during weaning from CPB (from 15.7 ± 4.2 nmol/l to 6.2 ± 2.8 nmol/l), and an even greater decrease was observed in the first post-operative day (5.4 ± 3.1 nmol/l). On the seventh post-operative day, free testosterone levels reached a normal value (11.8 ± 5.5 nmol/l), although they were still significantly lower compared with the pre-operative value. There were slight alterations in serum DHEA sulphate levels, although the only significant decrease occurred from the first to the seventh day post-operation (from 4.7 ± 2.2 μmol/l to 3.7 ± 1.8 μmol/l, respectively). Serum luteinizing hormone levels were decreased during weaning from CPB (from 4.8 ± 2.1 mIU/ml to 3.9 ± 1.8 mIU/ml), but increased rapidly to the pre-operative value (5.5 ± 2.5 mIU/ml) at the first post-operative day. These results show that CPB affects serum luteinizing hormone, free testosterone and dihydroepiandrestenedione sulphate levels. The free testosterone level decreases significantly both during and after CPB surgery.

Aspirin versus clopidogrel for synthetic graft patency after peripheral arterial bypass grafting.

Usually, aspirin used as an antiplatelet agent is thought to be sufficient to ensure graft patency after surgical bypass procedures. However, clopidogrel can also be considered as an alternative to aspirin. – 4 We have performed a preliminary fact-finding study in an attempt to compare the efficacies of aspirin and clopidogrel on long-term synthetic graft patency following peripheral arterial revascularisation. Seventy-six peripheral arterial bypass operations were performed in 54 patients using polytetrafluoroethylene synthetic grafts. Twelve aortafemoral bypass, 45 above-knee femoro-popliteal bypass, three ilio-femoral bypass, seven aorta-bi-femoral bypass (two cases in this latter group were aorta-bi-femoral plus femoro-popliteal bypass) were performed. Eight-mm ringless grafts in the aorta-femoral location and 6-mm full ringed grafts in the above-knee femoro-popliteal location were preferred. Twenty-eight patients who had 39 bypass procedures each received 300 mg single daily dose acetylsalicylic acid (Aspirin®, Bayer) and 26 patients who had 37 bypass procedures each received 75 mg single daily dose clopidogrel (Plavix®, Sanofi). Arterial examination consisted of peripheral arterial pulses and monthly evaluation of synthetic grafts and peripheral arteries using Doppler ultrasound. Early graft occlusion occurred in two patients within 30 days of operation and these were excluded from the study. Details of the patients, follow-up times, patency rates and complications are summarised in Table 1. The aspirin group was followed up for a mean of 11±4.0 months and the clopidogrel group for a mean of 7.2±3.9 months. Graft patency rate was 81% in the aspirin group and 84% in the clopidogrel group. The mean time to graft occlusion was 8.4±4.6 months in the aspirin group and 5.5±1.7 months in the clopidogrel group. The difference was not statistically significant. There were less unpleasant side effects in the clopidogrel group compared to the aspirin group. Nausea, vomiting, diarrhoea, rash and bleeding were observed in the aspirin group. Diarrhoea in one case and nausea and vomiting in one case were observed in the clopidogrel group. Graft occlusions occur as a result of thrombosis of the graft due to an insufficient peripheral arterial system and constriction at the proximal or distal arteries due to progression of the systemic atherosclerosis. Another pathology is intimal and neo-intimal hyperplasia in the suture line. Antiplatelet drugs as aspirin are used for the prevention of anastomotic neointimal fibrous hyperplasia. The effects of clopidogrel on ischaemic events were evaluated in the multicenter CAPRIE study and it was suggested that clopidogrel is more effective and safer than aspirin. However, in our study no clear difference was found between the efficacy of aspirin and clopidogrel. Although times of follow-up were not equal,

Analysis of Vascular Trauma in Terror-Related Civilian Attacks Within South-Eastern Turkey

ABS TRACT Objective: To evaluate the results of terror related vascular injuries and predictors of mortality caused by these injuries in South-Eastern Turkey. Material and Methods: Eighty-eight patients (82 men, 24.4 ± 8.1 years) who had vasculary trauma in terrorist attacks between January 2012-August 2015 in South-Eastern Turkey included in this retrospective study. Patients with traumatic amputations, extensive tissue losses, amputations after severe nerve damage and head injuries were excluded. Study patients were analyzed according to the mechanism and severity of injury, location of trauma, and surgical treatment options. Results: Forty-six (52.3%) patients had lower limb, 19 (21.6%) patients had upper limb, 13 (14.8%) patients had both upper and lower limb vascular injuries. Other vascular injuries involved neck (n=3; 3.4%), thorax (n=2; 2.3%), abdomino-pelvic (n=5; 5.7%) locations. Twenty-three (26.1%) of them were caused by bullets, 54 (61.4%) by shrapnel and 11 (12.5%) by bombs and explosions. Thirty-eight (43.2%) of these patients were in hypovolemic shock at admittance. Forty patients (45.5%) had isolated arterial, 42 (47.7%) patients had both artery and vein, 6 (6.8%) patients had isolated vein injuries. Autogenous grafts were used in 28 (31.8%) patients, and synthetic grafts were used in 10 (11.4%) patients. Vascular ligations were performed in 18 (20.5%) patients. Seven (8%) patients had acute renal injury and 28 (31.8%) patients had wound infections postoperatively. Overall in-hospital mortality rate was 18.2% (16 patients). Hypovolemic shock (p<0.0001), acute renal failure (p=0.002) and massive blood transfusion (p=0.007) were the main predictors of mortality. Conclusion: Vascular injuries in terror-related trauma victims require multidisiplinary urgent treatment of hypovolemic shock, preventive measures to avoid acute renal failure and immediate complex vascular surgery.

Comparative Results of the Two Methods of Port Catheter Application and Evaluation of Patient Comfort with Visual Analogue Scale

Objectives: To evaluate the two different methods of port catheterization and evaluation of patient comfort with an objective scale. Background: Port catheters are essential in long term drug administrations such as chemotherapy or intravenous alimentation. Methods: Forty-six patients were port-catheterized between 01.05.2013 31.10.2013 in our clinic. Group 1 (n=21) consisted of non-aided catheter procedures and Group 2 (n=25) consisted of ultrasonography aided catheter application procedures. The patients were asked to evaluate the in-procedural pain, the duration of the procedure, their comfort in the procedure and mark it on a visual analogue scale. The scale was a 10 cm length straight line on plain paper numbered 1 at one end and 10 at the other end representing minimum and maximum values. Results: The mean age of the patient population was 53.85 years (ranged between 13 and 80 years) and consisted of 25 (54.3%) males and 21 (45.7%) females. The catheter placement sites are as follows respectively (Group 1/Group 2): right internal jugular vein 20 / 22, left internal jugular vein 0 / 3 and right basilic vein 1 / 0. A statistically significant difference was found in the operation length, puncture count, pain score and comfort score data of the groups. Operation length, puncture count and pain score were lower and comfort score was higher in Group 2 (p values respectively 0,001; 0,003; 0,031; 0,047). Conclusion: Visually aided port catheterization is less risky and more comfortable for both the surgeon and

The Efficacy of Vitamin E in the Prevention of Lung Ischemia-Reperfusion Injury After Cardiopulmonary Bypass in Open Heart Surgery

Objective: The purpose of the study was to investigate the effects of vitamin E in the protection of the lung from potential ischemia-reperfusion injury during elective coronary artery bypass graft surgery. Material and Methods: This controlled randomized single-center study included patients who underwent elective coronary bypass grafting (CABG) operation. Forty-nine patients were randomly divided into 2 groups. Water soluble Vitamin E (100 mg) in tepid saline (n=25) or tepid saline alone (n=24) was administered via the jugular vein before the aortic cross clamping. Serum total antioxidant capacity (TAC) levels and serum malonedialdehyde levels (MDA) were measured. Pulmonary biopsies were obtained before the aortic cross clamping and 60 minutes after removing the cross clamp. Biopsies were examined histopathologically under electron microscopy. Results: Serum MDA levels at T1 (15 minutes after removal of the cross clamp) and T2 (30 minutes after removal of the cross clamp) were higher in the control group compared to the Vitamin group. Serum TAC levels at T1, T2 and T3 (60 minutes after removal of the cross clamp) were higher in the Vitamin E group compared to the control group. Histopathologic injury grade was lower in the Vitamin E group than in the control group. Conclusion: Vitamin E was found to be protective against reperfusion induced oxidative injury in the early operative period.