Münacettin Ceviz

Subxiphoid pericardiostomy in the management of pericardial effusions: case series analysis of 368 patients

Objective: To assess the effectiveness of subxiphoid pericardiostomy in the treatment and diagnosis of pericardial effusions. Methods: 368 patients who underwent subxiphoid pericardiostomy and tube drainage for cardiac tamponade, moderate to severe pericardial effusion, or suspicious bacterial aetiology were retrospectively analysed. Biopsies of the pericardium and fluid samples for diagnostic tests were obtained from each patient. Results: The mean age of the patients was 38.4 years, and the male to female ratio was 220:148. The pericardial effusion was classified by echocardiography as severe in 53% of the patients, moderate in 43%, and mild in 4%. The incidence of cardiac tamponade was 25%. Myocardial injury requiring sternotomy occurred as an operative complication in 0.8% of the patients and recurrent effusion necessitating further surgical intervention developed in 10% of patients. Histopathological examination and the polymerase chain reaction of specimens of pericardium and fluid were helpful for establishing a diagnosis in 90% of patients with malignancy and 92% of patients with tuberculous pericarditis. The overall 30 day mortality rate was 0.8%. Patients were followed up for at least one year. Pericardial constriction requiring pericardiectomy developed in 3% of the patients. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with subxiphoid pericardiostomy in both adults and children.

Primary Arteriovenous Fistulas in the Forearm for Hemodialysis: Effect of Miscellaneous Factors in Fistula Patency

Background. The provision and maintenance of vascular access remains a major cost to end-stage renal failure programs. In addition, vascular access occlusion, results in significant morbidity in hemodialysis patients. Age, gender, diabetes mellitus, malignancy, smoking habits, administration of heparin per hemodialysis session, previous dialysis catheter insertion, number of hemodialysis sessions and location of the fistula may be associated with survival of the primary arteriovenous fistula. We examined the effects of various factors on fistulas in 412 chronic renal insufficiency patients. Methods. From 1995 to 2004, 412 arteriovenous fistulas were created by the Department of Cardiovascular Surgery at the Medical Faculty of Atatürk University for hemodialysis. The mean age of the patients was 45 years (range 6 to 62 years). We evaluated the effects of various factors for patency rates in the patients who had primary arteriovenous fistulas. Primary patency was defined as the duration of fistula patency without revision. Twenty-eight patients (6.7%) with ischemic cardiac disease did not require surgical interference. Analyzed data were age, gender, smoking habits, diabetes mellitus, malignant neoplasm, previous dialysis catheter insertion, number of hemodialysis sessions, and fistula location. Results. In 298 patients, where lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively, in the other 114 patients, where upper-arm fistulas were created, these rates were 84.0%, 72.2%, 53.3%, 39.8%, and 12.3%, respectively. There was no significantly difference between the upper-arm fistulas and the lower-arm fistulas statistically (p = 0.069). Factors affecting the primary patency of arteriovenous fistulas were diabetes mellitus (p = 0.0001), hemodialysis counts ≥3 per week (p < 0.0005), presence of malignancy (p < 0.0005), previous catheter insertion (p < 0.0007), and administration of heparin per hemodialysis session (p = 0.0008). Conclusion. While primary arteriovenous fistula patency was shortened in chronic renal insufficiency patients with diabetes mellitus, presence of malignancy, and previous catheter insertion, patency was longer in patients with heparin used for hemodialysis and hemodialysis count per week (≥3).

Management of Carotid Body Tumors and Familial Paragangliomas: Review of 30 Years' Experience

BACKGROUND Carotid body tumors (CBTs), especially familial paragangliomas, are rare benign neoplasms, accounting for <0.5% of all tumors; and they are the most common extra-adrenal paraganglioma. METHODS In this study, CBTs were clinically suspected in 31 patients but diagnosed by histopathology in 28 between 1977 and 2007 at our department. All but one was operated upon. The ages of the 30 surgically treated patients ranged 17-73 years. A mass in the neck was the common symptom in all patients. Two of the 28 patients with CBTs had a familial paraganglioma history of CBT. RESULTS Twenty-eight of these 30 surgically treated patients had confirmed CBT by histopathology; the diagnoses of other two patients were neurofibroma in one and tuberculosis lymphadenitis in one. These two patients were excluded from the study. CBTs were resected without a shunt procedure. UltraCision was used in five patients for tumor resection; the surgical results of these patients were excellent (easy dissection, minimal hemorrhage and time operation). Twenty patients underwent total resection, six had resection and saphenous vein interposition, one had partial resection, and one had carotid artery ligation with no resultant neurological deficit. One case of hypoglossal paralysis and one benign recurrence were detected. No mortality or malignant course was observed. CONCLUSION CBTs are infrequent neoplasms; their surgical treatment is highly dependent on the ability and experience of the surgeon. The diagnostic and therapeutic relevance reside in making a timely diagnosis to propose a surgical treatment aimed at preventing complications and neurological damage. Surgical resection is usually definitive therapy for these lesions.

Prevention of reperfusion injury of the spinal cord in aortic surgery: An experimental study

PurposeWe designed an experimental study to show the effects of some agents in order to prevent reperfusion injury of the spinal cord.MethodsTwenty rabbits were used and were divided into two groups in our study. Infrarenal abdominal aortic occlusion, between renal arteries and iliac bifurcations, was applied to the subjects in group 1 for only 30 min; in the group 2 subjects, on the other hand, intra-aortic diltiazem, N-acetylcysteine, and catalase combinations were applied after infrarenal abdominal aortic occlusion. The spinal cord functions of the subjects were assessed at the 48th hour after the operation according to Tarlov scoring, then cord tissue samples were taken for biochemical and histopathological studies.ResultsThe group 2 subjects had better neurological functions than group 1 subjects (P < 0.01). In group 2; superoxide dismutase and glutathione peroxidase levels increased, while malondialdehyde and xanthine oxidase levels decreased as compared with group 1 (P < 0.05). A histopathological examination showed the group 2 samples to have fewer bleeding points and less neuron loss.ConclusionsWe concluded that antioxidant agent combinations (diltiazem, N-acetylcysteine, and catalase) applied after ischemia might thus help protect the spinal cord against ischemia and reperfusion injury.

Arterial embolism caused by a ruptured hydatid cyst in the heart: report of a case.

Abstract.Cardiac hydatid cysts are extremely rare and, although patients may remain asymptomatic for many years or have only minor nonspecific symptoms, they are associated with life-threatening complications. We report the case of a 32-year-old woman with an acute arterial embolism caused by a ruptured hydatid cyst in the heart. An emergency operation revealed that the embolism originated from the left cardiac chamber caused by a cyst in the left ventricle. There were also three cystic lesions in the right lung. The patient underwent surgery to remove the hydatid cysts from the right lung on the 13th day after the first operation. Her postoperative course was uneventful and she was discharged from hospital on the 27th day after admission.

Left ventricular pseudoaneurysm after myocardial infarction.

In this report, a case of a left ventricular (LV) pseudoaneurysm due to a previous myocardial infarction, which was repaired successfully, is described. A 62-year-old man, with a history of acute anterior wall myocardial infarction 6 months previously, was admitted with the complaints of acute dyspnea and palpitation. Echocardiography revealed an LV aneurysm, and ventriculography showed ventricular dysfunction and an LV pseudoaneurysm. Coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery with a very thin lumen and insufficient retrograde filling. Under cardiopulmonary bypass and beating heart, the pseudoaneurysm was resected and the defect on the ventricular free wall was closed by the remodeling ventriculoplasty method of Dor. Histopathologic examination of the resected material confirmed the diagnosis of pseudoaneurysm. The postoperative course of our patient was uneventful. He was discharged on the ninth postoperative day.

Clinical experience with subxiphoid pericardiostomy in the management of pericardial effusions: a study of 240 cases.

We aimed to assess the effectiveness of subxiphoid pericardiostomy for treating patients with pericardial effusions (PE), and its contribution to defining the aetiology of these effusions. We undertook retrospective analysis of 240 PE patients who underwent subxiphoid pericardiostomy and tube drainage between 1990 and 2000. Echocardiography classified PE as severe in 132 patients, moderate in 99, and mild in nine. The main causes of PE were uraemic, idiopathic and undefined, tuberculous and non-tuberculous pericarditis, malignancy and trauma. Peri-operative myocardial injury requiring sternotomy, and recurrent effusion requiring further surgical intervention, occurred in three and 24 patients, respectively. Histopathological examination assisted the diagnosis in 94% of patients with malignancy, and 96% with tuberculous pericarditis. Overall 30-day mortality was 1.3% and pericardial constriction, requiring pericardiectomy, developed in seven cases. In conclusion, we believe that adults and children with PE can be safely, effectively and quickly managed with subxiphoid pericardiostomy, irrespective of its aetiology.

Pseudoaneurysm of the left coronary ostial anastomoses as a complication of the modified Bentall procedure diagnosed by echocardiography and multislice computed tomography.

We report the case of a patient with a pseudoaneurysm of the left coronary ostial anastomoses diagnosed 6 years after a Bentall procedure with coronary button anastomoses had been performed. Preoperatively, the pseudoaneurysm of the ascending aorta was diagnosed by transesophageal echocardiography and multislice tomography, and the diagnosis was confirmed by surgery. Intraoperatively, the dehiscence of the button anastomosis of the left coronary artery was determined. The operative technique for the repair of the left coronary anastomosis dehiscence was direct closure through a sternotomy using extracorporeal circulation. The patient was discharged on the twelfth day without problems. In conclusion, we demonstrated that the patient with a pseudoaneurysm after a conduit operation of the ascending aorta can be prediagnosed by using echocardiography and multislice tomography.

Involvement of the coronary artery in a patient with thromboangiitis obliterans. A case report

Abstract We report a case of coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and a saphenous vein graft in a 36-year-old man with Buergers disease. He was hospitalized in the coronary intensive care unit with a diagnosis of acute myocardial infarction. His coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery (LAD) and right coronary artery. Left ventricular dysfunction was detected by ventriculography. The patient had undergone bilateral sympathectomy of the lumbar branches for distal arterial occlusions due to thromboangiitis obliterans 12 years previously. Under cardiopulmonary bypass and aortic cross-clamping, we performed endarterectomy and a complex bypass procedure to LAD. Aorta-right coronary artery bypass was also applied. A histopathological study of an endarterectomy specimen showed characteristic features of thromboangiitis obliterans. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day.

Infected cardiac hydatid cyst

A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.