Semih Barlas

Influence of methylprednisolone on levels of neuron-specific enolase in cardiac surgery: a corticosteroid derivative to decrease possible neuronal damage.

Abstract  Background: Cerebral injury is a well‐known complication after cardiac surgery with cardiopulmonary bypass (CPB), especially in adult patients. Specific biochemical markers like neuron‐specific enolase (NSE) and S‐100β protein were developed previously for early detecting neuronal damage after CPB. Corticosteroids are shown to reduce multisystemic deleterious effects of cardiopulmonary bypass due to their anti‐inflammatory characteristics. The aim of this study is to demonstrate the decrease of serum neuron‐specific enolase levels in patients who received corticosteroids before CPB. Methods: Thirty patients scheduled for elective coronary bypass surgery were included in the study. Patients were divided randomly into two groups as the control group (n = 15) who underwent a standard coronary bypass surgery without any additional medication and the study group (n = 15) who received 1 gm of methylprednisolone before CPB. Blood samples for analysis of serum NSE, interleukin‐6 (IL‐6), and IL‐10 were drawn before CPB, 4 and 24 hours after the end of extracorporeal circulation. Results: Serum cytokine and NSE levels were significantly increased after CPB above their normal range in both groups. In the study group, IL‐6 and NSE levels were significantly reduced while IL‐10 levels were much higher after CPB. High NSE levels significantly correlated with IL‐6 levels in the control group. Conclusion: The lower levels of NSE in patients who received methylprednisolone may suggest that corticosteroids might be useful in decreasing possible neuronal damage during heart surgery. However, we were not able to demonstrate an adverse neurological outcome.

Results of surgical treatment for nonthymomatous myasthenia gravis.

AbstractPurpose. To clarify the factors that influence improvement and remission after thymectomy for patients with nonthymomatous myasthenia gravis (MG). Methods. We retrospectively reviewed 204 patients with nonthymomatous MG who underwent thymectomy and anterior mediastinal dissection through a partial median sternotomy, between 1980 and 2001, and examined whether age, sex, preoperative classification, and duration of symptoms influenced their prognosis. Results. There was no perioperative or hospital mortality. The mean follow-up period was 7.2 ± 1.2 years, with early and late postoperative remission rates of 44.6% and 73%, respectively. Seven patients died; two from pneumonia and five from causes unrelated to MG. Preoperative treatment and classification, duration of symptoms, age, and sex did not seem to have a significant influence on remission, but the response to thymectomy was greater in patients with thymic hyperplasia. Remission and improvement rates were significantly better at the end of the first year, with the same status found at the last follow-up. Conclusion. Thymectomy is an effective and highly curative method of treatment for patients. with MG. It provides excellent symptomatic improvement, which is enhanced over the long term.

Thymoma: surgical results of 73 cases.

Abstract Purpose : Thymomas are uncommon tumours; they represent a broad spectrum of morphological and clinical behaviour. The purpose of this study is to identify the factors that influence survival. Method : Seventy-three patients with thymoma who underwent thymectomy between 1980 and 2002 were reviewed. Prognostic factors assessed were: age, sex, presenting symptoms, histological features, stage at diagnosis and extent of surgical resection. Results : Complete resection was achieved in 67 patients and incomplete in 6. Survival rates of patients in the 1st or 2nd stages were 100% and 92.8% for 10 years, respectively. A high incidence of myasthenia gravis (MG) associated thymomas (80.8%) was found. These patients had better survival rates when compared to non-myasthenic patients. However the mortality rate for malign thymomas was high (65.7%) due to tumoral invasion. The histological types of thymoma did not influence the survival rate. Conclusions : The association of MG with thymoma enables earlier detection of tumour, thus higher survival rates were achieved in these patients. Survival was also related to the stage of the tumour at diagnosis and the completeness of resection.

Effects of Oxygenator and Pumping Devices on Blood Parameters in Open Heart Surgery

Despite the recent technological advances in open heart surgery, an oxygenator being absolutely harmless to blood cells and providing excellent perfusion to organ tissues, especially the brain, via an extra corporeal pump is yet to be developed.

Oxygen Supply during Cardiopulmonary Bypass (CPB) in Cyanotic Patients

Today, repair of congenital heart defects has become a routine operation with low mortality and morbidity in many subgroups of anomalies1. The knowledge that the ventricular myocardium continues to develop and conditions itself according to the loads present and that this mechanism can influence the long-term outcome in many cardiac anomalies, stress the operations towards infantile and neonatal age groups2,3. This, in turn, stresses the importance of the possible damage to the other organs and systems still developing at the time of cardiopulmonary bypass (CPB). While myocardial protection attempted by lowering the energy demands through topical cold and chemical cardioplegia1,4,5, the protection of other systems, including central nervous system (CNS), remains dependent on the oxygenation and the local wash out of metabolites by means of CPB.

The Efficacy of Pulse Oxymetry in the Postoperative Respiratory Management of Cardiac Patients

Today, early postoperative respiratory support is routine for patients with prolonged general anesthesia, especially after cardiopulmonary bypass. The adequacy of respiration during this period is evaluated by serial blood gas samplings and the appropriate changes according to the patients’ status are made on this basis.

Ten-year Follow-up of Femoropopliteal Bypass Grafts: Comparative Review of Late Patency Rates of PTFE and Saphenous Vein Grafts for Lower Extremity Ischemia

Between January, 1987 and June 1988, 335 femoropopliteal bypass (FPBP) operations were performed on 308 patients who had limb ischemia caused by femoropopliteal occlusion. The greater saphenous vein graft (SVG) was used whenever possible (165) and polytetrafluoroethylene (PTFE) prosthesis was used in 165. In addition, 4 Dacron grafts and 1 umbilical vein graft were used in 5 operations but were excluded from comparison in this study. The two groups did not differ significantly regarding stage of peripheral ischemia, preoperative indication, distal popliteal anastomotic site, and number of patent runoff ves sels. Overall cumulative patency rates according to occlusive criteria alone were calculated by the life table method. Graft occlusion was determined by angiog raphy, Doppler assessment, loss of previously palpable pulses, or return of symp toms. Diabetes mellitus was associated with a significantly lower patency rate. It is concluded from this study that the saphenous vein is superior to PTFE as femoropopliteal bypass.