Muhip Kanko

Protective antioxidant effects of carvedilol in a rat model of ischaemia- reperfusion injury

This study investigated the protective effects of carvedilol, a potent antioxidant, in a rat model of tourniquet-induced ischaemia-reperfusion injury of the hind limb. Thirty rats were divided equally into three groups: the control group (group 1) was only anaesthetized, without creating an ischaemia-reperfusion injury; group 2 was submitted to ischaemia (4 h), followed by a 2-h reperfusion period; and group 3 was pre-treated with carvedilol (2 mg/kg per day) for 10 days prior to ischaemia-reperfusion. Ischaemia-reperfusion produced a significant decrease in superoxide dismutase and glutathione peroxidase activities in the liver, lungs, muscle and serum compared with control treatment, and pre-treatment with carvedilol prevented these changes. Ischaemia-reperfusion caused a significant increase in malondialdehyde and nitric oxide (NO) levels in liver, lungs, muscle (except NO) and serum compared with control treatment, and carvedilol prevented these changes. In conclusion, it might be inferred that carvedilol could be used safely to prevent oxidative injury during reperfusion following ischaemia in humans.

Ischemia-modified albumin use as a prognostic factor in coronary bypass surgery

BackgroundVarious types of markers have been used so far in order to reveal myocardial perfusion defect. However, these markers usually appear in the necrosis phase or in the late stage. Having been the focus of various investigations recently, ischemia-modified albumin (IMA) is helpful in establishing diagnosis in the early stages of ischemia, before necrosis develops.Methods and Results30 patients that underwent only coronary bypass surgery due to ischemic heart disease within a specific period of time have been included in the study. IMA levels were studied in the preoperative, intraoperative, and postoperative periods. The albumin cobalt binding assay was used for IMA determination. Hemodynamic parameters (atrial fibrillation, the need for inotropic support, ventricular arrhythmia) of the patients in the postoperative stage were evaluated. Intraoperative measurement values (mean ± SD) of IMA (0.67677 ± 0.09985) were statistically significantly higher than those in the preoperative (0.81516 ± 0.08894) and postoperative (0.70477 ± 0.07523) measurements. Considering atrial fibrillation and need for inotropics, a parallelism was detected with the levels of IMA.ConclusionsIMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases.

Effect of sirolimus in the prevention of adhesions around intraabdominal prosthetic graft

BackgroundAdhesions due to the reactions caused by the grafts used in primary vascular operations can lead to various problems when a secondary operation is necessary. These problems include bleeding, injuries to neighboring organs, and complications occurring due to a prolonged operation. We investigated the effects of sirolimus, which has antiproliferative features, on vascular adhesions.MethodsThe abdominal aorta of rats was explored and abrasions applied. Following the fixation of a polytetrafluoroethylene (PTFE) graft on the abdominal aorta, sirolimus (rapamycin) is applied (in powdered form) onto the grafts of the study group. Eight weeks later a laparotomy was repeated and any adhesions were evaluated.ResultsIn the study group the adhesions were determined to be fewer in number and milder in severity. Severe cases of adhesion were determined in the control group.ConclusionsTherefore, sirolimus applied around the prosthesis in vascular operations was determined to be effective at preventing possible adhesions.

A low-cost and simple method to stop intraoperative leakage-type bleeding: use of the vancomycin-oxidized regenerated cellulose (ORC) sandwich.

Intraoperative bleeding may cause life-threatening complications in patients if such bleeding cannot be brought under control. Various materials are available for stopping such bleeding. However, there are some difficulties in the acquisition and application of these materials. The aim of this study was to investigate the efficiency of the low-cost and simple-to-prepare vancomycin–oxidized regenerated cellulose (ORC) sandwich in surgical bleeding control. Thirty New Zealand rabbits were used for this purpose. The animals were separated into three groups as group 1 (n = 10), control group; group 2 (n = 10), oxidized regenerated cellulose (ORC) group; and group 3 (n = 10), vancomycin-ORC sandwich group. Left thoracotomies were performed on the rabbits under general anesthesia, and bleeding was created in the parietal pleura. The amount of bleeding in the groups was measured and compared. The amount of bleeding in the group in which the vancomycin–ORC sandwich was used was found to be less, compared to the other two groups. According to these results, we conclude that the vancomycin–ORC sandwich can be used safely in the control of intraoperative leakage-type bleeding, as the vancomycin–ORC sandwich is a low-cost, easily applied, and easily acquired material.

Aortoesophageal Fistula Secondary to Thoracic Endovascular Aortic Repair of a Descending Aortic Aneurysm Rupture

PURPOSE We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture. CASE REPORT A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery. CONCLUSION AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.

Effect of clopidogrel on nitric oxide levels in an ischemia reperfusion model.

Ischemia and reperfusion injury is a pathologic process with serious consequences, arising due to interruption of arterial blood flow. Restored blood flow achieved after the ischemic period causes formation of oxygen radicals by activation of a variety of substances and systems. In this study, we investigated the effect of clopidogrel, an antithrombocyte agent, on tissue nitric oxide (NO) levels in an experimental ischemia reperfusion model. For this purpose, 6 hours of ischemia and 4 hours of subsequent reperfusion were applied to the right lower extremities of the subjects. Clopidogrel therapy was started in one of these groups 10 days before the process (study group). NO levels were measured in all groups in the muscle, lung, and liver tissues, and in plasma. Lung, plasma, and liver NO measurement values had statistically significant differences among the groups. There was no statistically significant difference in the measurements made on the muscle tissue. Clopidogrel, which has previously been reported to be suitable to be used as a preventive agent of ischemia reperfusion damage, has had a reducing effect on the NO levels in tissues in the ischemia reperfusion model created in our present study.

Aortic valve replacement for papillary fibroelastoma

Surgery is indicated for symptomatic patients with papillary fibroelastomas (PFE) on the aortic valve. The valve is commonly spared during tumor excision. Rarely, aortic valve replacement (AVR) is needed. We present a case requiring AVR for an aortic valve PFE and review the literature to determine the risk factors for failure of aortic valve‐sparing techniques in patients with PFE.

Spontaneous pseudoaneurysm of the superficial femoral artery in Behcet's disease-endovascular stent-graft treatment combined with percutaneous drainage: a case report.

Behcets disease is a rare multisystemic chronic autoimmune disorder characterized by a classic triad of urogenital ulcerations, chronic eye inflammation, and skin lesions. We report on a case of a spontaneous pseudoaneurysm of the superficial femoral artery caused by Behcets disease that was treated with an endovascular stent-graft followed by percutaneous drainage. We emphasize the use of percutaneous drainage of the pseudoaneurysm to decrease compression on the stent-graft and native vessel.

Clinical ventricular tachycardia and surgical epicardial ICD implantation in a patient with a Fontan operation for double-inlet left ventricle : online article - case report

The Fontan operation is the primary surgical technique used for palliation of patients with single-ventricle physiology. Arrhythmias are frequently observed and associated with morbidity and mortality in Fontan patients. The frequency of arrhythmias after the Fontan procedure increases over time and it was reported to reach 50% in a 20-year follow up. Atrial tachyarrhythmias, especially atrial tachycardia and sinus bradycardia, are most frequently observed in these patients. Ventricular arrhythmias are rarely observed. Generally, medical therapy, catheter ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation are options in the treatment of these arrhythmias. It may be difficult to implant either a pacemaker or an ICD in patients on whom the Fontan procedure has been performed. In conditions where access to the right ventricle is from the venous system, it is anatomically impossible. Where there is no functional right ventricle, device implantation can be performed with alternative methods other than the conventional transvenous approach. In this report, we discuss a middle-aged woman with a Fontan operation performed 14 years earlier, who presented with ventricular tachycardia (VT) and in whom an epicardial ICD was implanted. The literature on this issue is also reviewed.

Heat Shock Proteins and Myocardial Protection during Cardiopulmonary Bypass

This prospective randomized study investigated the effects of two different cardioplegia techniques on myocardial heat shock protein 70 (HSP70) mRNA levels. Patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass (CPB) were divided into two equal groups. All patients received the same anaesthesia. Myocardial preservation was achieved by delivering intermittent antegrade isothermic blood cardioplegia in one group and antegrade plus continuous retrograde isothermic blood cardioplegia in the other. Biopsies for measurement of HSP70 mRNA levels were taken from the right atria before surgical manipulation of the heart, and later from the same place following CPB. HSP70 mRNA levels were evaluated using quantitative real-time reverse transcription—polymerase chain reaction. Crossing-point values for HSP70 and β-actin were used to evaluate up-regulation. There was a significant increase in HSP70 mRNA levels in response to CPB in both groups, but no significant between-group difference in HSP70 up-regulation. Further investigation is required to evaluate the correlation between the level of HSP induction and the degree of myocardial protection in more heterogeneous groups of patients.