Mehmet Ali Şahin

Rosuvastatin, a new generation 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, reduces ischemia/reperfusion-induced spinal cord tissue injury in rats.

BACKGROUNDnSevere neurological injury still represents one of the most devastating complications occurring after surgical repair of thoracoabdominal aneurysms. We aimed to investigate the role of rosuvastatin (RSV) against ischemia/reperfusion injury in an experimental model of spinal cord ischemia in rats.nnnMETHODSnExperimental groups included control group (n = 8), ischemia/reperfusion group (n = 8) undergoing aortic occlusion without pharmacologic treatment, and RSV-treated group (n = 8) receiving 10 mg/kg/day of RSV orally for 3 days before spinal cord ischemia. Spinal cord ischemia was induced by occlusion of the abdominal aorta between the left renal artery and aortic bifurcation for 45 minutes, followed by reperfusion. Neurological status was assessed before spinal ischemia and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels.nnnRESULTSnDecreased spinal cord tissue malondialdehyde levels (p = .01) and increased tissue superoxide dismutase (p = .01) and glutathione peroxidase (p = .09) levels were observed in the RSV-treated group, as compared with the ischemia group. Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, RSV attenuated tissue necrosis. Total injury score in the RSV-treated group was significantly decreased, as compared with the ischemia group (p < .05). The Tarlov scores at 48 hours postoperatively were higher in the RSV group as compared with the ischemia group.nnnCONCLUSIONnRSV administration before spinal cord ischemia reduces spinal cord tissue injury by increasing antioxidant enzyme levels and may reduce the incidence of associated neurological dysfunction.

Protective Effects of Angiotensin II Type-1 Receptor Blockade With Olmesartan on Spinal Cord Ischemia-Reperfusion Injury: An Experimental Study on Rats

BACKGROUNDnSpinal cord injury is a major complication of thoracoabdominal aortic operations. We aimed to investigate neuroprotective role of olmesartan administered to rats before ischemia against ischemia-reperfusion (I-R) injury.nnnMETHODSnTwenty-four Wistar albino rats were randomly divided into three groups (n = 8 per group): group I (control group, the sham-operation group), group II (the I-R group undergoing aortic occlusion without pharmacologic treatment), and group III (olmesartan-treated group receiving 3 mg/kg/d olmesartan for 14 days before ischemia). Spinal cord ischemia was induced by infrarenal aortic clamping for 45 minutes, followed by reperfusion. Neurological status was assessed by using modified Tarlov score preoperatively and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels.nnnRESULTSnThe rats in the ischemia group had severe deficits including paraplegia after surgery, and they had a worse neurological status compared with the sham group (p < 0.05). The mean Tarlov scores in the ischemia and olmesartan-treated groups at 48 hours postoperatively were 1.6 +/- 0.4 and 2.2 +/- 0.9, respectively (p < 0.05). Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, olmesartan attenuated tissue necrosis. Decreased spinal cord tissue malondialdehyde (p = 0.047) and increased tissue superoxide dismutase (p = 0.001) and glutathione peroxidase (p = 0.009) levels were measured in the olmesartan-treated group compared with the ischemia group.nnnCONCLUSIONnOlmesartan may protect the spinal cord from I-R injury and reduce the incidence of associated neurological dysfunction after temporary aortic occlusion.

Abdominal aortic injury due to lumbar disc surgery: A case report.

Complications arising from lumbar intervertebral disc surgery are rare but fatal. Major vascular injury is one complication that may end in death unless it is diagnosed and treated immediately. Herein we report an abdominal aortic injury due to L3-L4 intervertebral disc surgery that was treated successfully and discuss it in light of current literature. Diagnosis and treatment of an abdominal aortic injury in a 31-year-old male patient operated on for L3-L4 intervertebral disc degeneration is discussed. Interestingly, in spite of abdominal aortic injury this particular patient was hemodynamically stable. The diagnosis was made 12 hours after disc surgery and laparotomy was performed immediately. As the injury in the aorta was large and had irregular margins, it could not be repaired with primary repair but an end-to-end anastomosis with partial resection was performed. In lumbar intervertebral disc hernia surgery, peroperative hemodynamic instability should raise suspicion of major vascular injury with high mortality and appropriate surgical treatment should be done as soon as possible. If there is any finding suggesting an intraoperative vascular injury, the patient should be kept under close monitoring in order not to delay diagnosis and treatment. It should not be forgotten that hemodynamic stability does not rule out major vascular injury.

Late presentation of missed aorta-caval fistula as arteriovenous malformation following lumbar disc surgery

Arteriovenous malformation in the abdomen following excision of lumbar intervertebral disc is the nightmare of the spinal surgeons [1–3]. A 56-year-old man was admitted to the emergency service with heart failure and atrial fibrillation symptoms. Abdominal computerized tomography with contrast and magnetic resonance angiography images were obtained. An aortacaval fistula that later grew into a giant arteriovenous malformation was discovered (Figs. 1 and 2). Then, he underwent consecutive repair procedures at the cardiovascular surgery department [2,4,5]. The patient’s medical history record shows he had a lumbar discectomy operation 4 months before the onset of his cardiac problems. This case emphasizes the importance of paying special attention to any overt hemorrhage that has originated from the disc space although it might have been controlled during surgery. References

Open heart surgery in a patient with liver transplantation

Coronary artery bypass operation was performed with the diagnosis of ischemic heart disease in a-58-year-old male patient in whom orthotopic liver transplantation had been performed 4 years ago. Coronary artery bypass grafting operation was performed using left internal mammarian artery and autogenous vein graft for three vessels. There were no complications in the pre- and post-operative periods. This patient as the first case in our hospital was presented with the literature review.