Nejat Sariosmanoglu

A Multicentre Study of Abdominal Aorta Diameters in a Turkish Population

The aim of this study was to determine the normal values for aortic diameters and the prevalence of aortic dilatation in a mixed Turkish population. Between March 1998 and May 2000, patients who were undergoing abdominal ultrasonography examination for pathologies not involving the aorta, in three different cities, were enrolled into the study prospectively. The anterior posterior aortic diameters were measured at the subdiaphragmatic and aortic bifurcation levels using ultrasonography. A total of 596 patients were included (302 females, 294 males). The mean age was 48 ± 16 years (range, 6–88 years). The mean aortic diameter in the whole group was 19.0 ± 3.9 mm (10–45 mm) at the subdiaphragmatic level and 15.7 ± 3.6 mm (9–65 mm) at the aortic bifurcation level. The mean subdiaphragmatic aortic diameter was 18 ± 3 mm in females and 19 ± 4 mm in males. The mean aortic diameters at the bifurcation level was 15 ± 3 mm in females and 16 ± 4 mm in males. An aortic bifurcation diameter < 30 mm was encountered in 0.67% of the population. This ratio increased to 1.8% in patients over 55 years of age, regardless of sex. A subdiaphragmatic aorta diameter above 30 mm was observed in 1.2% of the population. In patients over the age of 55 years, this ratio increased to 2.7% (3.6% in males and 1.9% in females). In this national study, the subdiaphragmatic aortic diameters were similar to mean values reported in the world literature. The mean aortic bifurcation diameters were generally lower when compared with the literature, which may be due to difficulties in standardization of the measurements. Aneurysmal dilatation rates in this study also conform to those reported in studies conducted in other countries. Considering the significant number of patients with aneurysmal dilatation of the aorta in the elderly population, we believe it would be prudent to evaluate the aorta in all patients undergoing abdominal ultrasonographic examination.

Stroke and Myxoma

Cardiac myxoma was detected by transthoracic echocardiography in 8 patients (aged 11 to 64 years) who were admitted between 1991 and 1999 with stroke or transient ischemic attacks, representing 80% of the total myxoma cases treated in this period. All patients underwent surgery and the myxomas were successfully removed. There were no recurrences during a mean follow-up of 3.1 years. In the presence of unexplained transient ischemic attack, cerebral infarction, or syncope, this relatively rare cardiac lesion should be suspected and investigated by transthoracic echocardiography.

A new minimally invasive method of aortofemoral revascularization.

In recent years, minimal invasive surgical applications have been used in every field of surgery and became a routine application for some kinds of operations. Mini-laparotomy has been limited to abdominal incisions between 3 and 10 cm long. Four aortobifemoral and one aortofemoral bypass cases that were performed with mini-laparotomy incision between January 1997 and February 1998 are presented. In all cases, revascularization of lower extremities was performed successfully without enlarging the incision. The average operation time was shorter and the number of transfused blood units was significantly lower in that group when compared to the conventional laparotomy group of 12 cases. In all cases, bowel sounds appeared in 2 to 8 hours and at the end of 24 hours, oral nutrition was started. The mean discharge time from the hospital was 4.7 days. With the advantages of less operation time, optimal aortic exposure, ability in safe cross-clamping, less postoperative pain, less scar tissue occurrence, early resumption of intestinal functions, early mobilization and shorter hospitalization time, the mini-laparotomy technique is a safe reliable method for use in aortobifemoral bypass operations.

Effects on the Endocrine System of Pulsatile and Nonpulsatile Perfusion in Heart Surgery

The effects of cardiopulmonary bypass on the endocrine system were investigated in 10 patients who had pulsatile perfusion and in another 10 who had nonpulsatile perfusion during coronary bypass or valve replacement surgery. Measurements were made of thyroid-stimulating hormone, free and total triiodothyronine, free and total tetraiodothyronine, adrenocorticotropic hormone, cortisol, aldosterone, growth hormone, insulin, and glucose at 5 fixed time intervals up to 24 hours postoperatively. In the perfusion period, free and total triiodothyronine levels were less depressed in the pulsatile group. The mean level of growth hormone was significantly higher in the pulsatile group after 60 minutes of perfusion. The mean levels of insulin and glucose were significantly lower in the pulsatile group after 60 minutes of perfusion. Other changes were not statistically significant. We concluded that pulsatile perfusion was of benefit in stabilizing glucose and some hormone levels.

Use of Tunnelled Catheters in Haematological Malignancy Patients with Neutropenia

This prospective study analysed 83 patients (age 45 ± 17 years) with haematological neoplasms, implanted with 93 tunnelled catheters, who were neutropenic or developed neutropenia during treatment. Catheters were implanted in the right (n = 82) or left (n = 11) jugular vein by the same surgical team using the same technique. They remained in place for 124 ± 88 days: 29% were removed due to infection; 18% due to treatment termination and 2% due to mechanical problems. Seventeen patients died with catheters in place. At 30, 60, 90, 120 and 200 days mean catheter duration rates were 82%, 75%, 65%, 60% and 35%, respectively, and freedom from catheter removal due to infection was 92%, 88%, 80%, 77% and 67%, respectively. Patient diagnosis and history of previous catheter infection did not increase catheter infection risk, but patients undergoing stem cell transplantation had an increased infection risk. Tunnelled catheters can be used in high-risk patients with neutropenia. Systemic infections can be managed in most patients without catheter removal.

Surgical resection for successful treatment of invasive pulmonary aspergillosis : Report of 3 cases

We present 3 patients, 2 with recent heart transplants, complicated with invasive pulmonary aspergillosis (IPA), treated successfully with surgical resection. These patients demonstrate the role of surgery in management of IPA, and 2 heart transplant patients are of particular interest as surgical treatment of IPA after solid organ transplantation is seldom reported.

Postcardiotomy Extracorporeal Life Support

The need for postcardiotomy mechanical support is uncommon and likely to decline. A mixture of options is necessary to meet the diverse indications for cardiac support in a comprehensive heart failure program. Between January 1997 and December 2000, 29 adult, neonate, and infant cardiac surgical patients were supported on an extracorporeal life support system. Indications for cardiac assist included post-cardiotomy low cardiac output syndrome, and hyperacute rejection after cardiac transplantation. Data for analysis were collected prospectively. Survival on the life support system was 20/29 (69%) and 12 patients (41%) survived to discharge. The mean time to starting extracorporeal life support was longer in survivors than non-survivors. The extracorporeal life support system provides effective cardiopulmonary and end-organ support.

Traumatic Main Bronchial Disruption: Radiologic Evaluation and Surgical Management

A 23-year-old female suffered right main bronchial transsection as a result of blunt chest trauma. The lesion was suspected at plain radiography and clearly shown on three-dimensional helical computed tomography imaging. Urgent primary repair was performed successfully. This technique of diagnosis with its three-dimensional viewing capability, can be helpful in defining the location and extent of various injuries.

Pulmonary Arteriovenous Malformation Complicated by Cerebral Infarction

A 45-year-old epileptic female with fatigue, swollen legs, and numbness of the lower extremities, had radiological findings of increased density in the lower zone of the right lung and a pattern of chronic cerebral ischemia in the territory of the left internal carotid artery. A pulmonary arteriovenous malformation was demonstrated by angiography. A right lower lobectomy was performed successfully.

Aortobifemoral Bypass Surgery Using Mini-Laparotomy Technique

We describe 4 cases of aortobifemoral bypass performed using a mini-laparotomy incision (6 to 8 cm) between January 1997 and February 1998. Revascularization of the lower extremities was carried out successfully without the need to enlarge the incision. The mean aortic cross-clamp time was 12.7 ± 3.4 minutes and the mean duration of the operation was 93.7 ± 30.9 minutes. In all cases, bowel sounds appeared at 2 to 8 hours postoperatively and oral nutrition was started after 24 hours. The mean hospital stay was 4.7 days. With the advantages of short operation time, optimal aortic exposure, easy and safe aortic cross-clamping, limited postoperative pain and scar tissue, early mobilization and resumption of intestinal functions, and short hospitalization, we believe that the mini-laparotomy technique is safe and effective for aortobifemoral bypass operations.