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Adrenomedullin attenuates aortic cross-clamping–induced myocardial injury in rats

BACKGROUND In this study we investigate the effects of adrenomedullin on myocardial injury after ischemia-reperfusion (I/R) after abdominal aortic surgery. METHODS Thirty-two Wistar rats were randomized into 4 groups (n = 8) as follows: control group (sham laparotomy), the aortic I/R group, aortic I/R plus adrenomedullin group (underwent aortic I/R periods, and received a bolus intravenous injection of .05 μg/kg/min adrenomedullin), and the control plus adrenomedullin group. RESULTS Biochemical analysis showed that aortic I/R significantly increased (P < .05) the plasma levels of troponin-I and tumor necrosis factor-α, and the myocardial tissue levels of malondialdehyde, superoxide dismutase, catalase, and angiotensin II, whereas aortic I/R plus adrenomedullin significantly decreased these same factors (P < .05). Aortic I/R significantly increased (P < .05) myocardial tissue levels of nitric oxide whereas aortic I/R plus adrenomedullin significantly increased the same factor (P < .05). CONCLUSIONS These results indicate that adrenomedullin has protective effects against myocardial injury induced by abdominal aortic I/R in rats.

The protective effect of adrenomedullin on renal injury, in a model of abdominal aorta cross-clamping.

Renal injury induced by aortic ischemia-reperfusion (IR) is an important factor in the development of postoperative acute renal failure following abdominal aortic surgery. The aim of this study was to examine the effect of adrenomedullin (AM) on kidney injury induced by infrarenal abdominal aortic IR in rats. Thirty-two Wistar Albino rats were randomized into four groups (eight per group) as follows: Control group, IR group (120-minute ischemia and 120-minute reperfusion), IR + AM group (a bolus intravenously of 0.05 µg/kg/min AM), and control + AM group. At the end of the experiment, blood and kidney tissue specimens were obtained for biochemical analysis. Immunohistological evaluation of the rat kidney tissues was also done. IR significantly increased (p < 0.05 vs control group) and AM significantly decreased (p < 0.05 vs. IR group) all of the biochemical parameters. Immunohistological evaluation showed that AM attenuated morphological changes as apoptosis associated with kidney injury. The results of this study indicate that AM attenuates both biochemically and immunohistopathologically kidney injury induced by aortic IR in rats.

Endothelin Receptor Antagonism by Tezosentan Attenuates Lung Injury Induced by Aortic Ischemia–Reperfusion

Tezosentan is a novel dual endothelin receptor antagonist. The purpose of this study was to examine the effect of tezosentan on lung injury induced by abdominal aortic ischemia-reperfusion (IR) in rats. Thirty-two Wistar-albino rats were randomized into four groups (eight per group) as follows: control group (sham laparotomy), aortic IR group (120 min ischemia and 120 min reperfusion), aortic IR + tezosentan group (a bolus intravenous injection of 10 mg/kg tezosentan before ischemia plus continuous intravenous infusion of 1 mg/kg/hr tezosentan during 120 min ischemia and 120 min reperfusion), and control + tezosentan. Blood and lung tissue samples were obtained for biochemical analysis. Protein concentrations in bronchoalveolar lavage fluid and lung wet/dry weight ratios were measured. A histological evaluation was also done. Aortic IR significantly increased (p < 0.05 vs. control group) and tezosentan significantly decreased (p < 0.05 vs. aortic IR group) the plasma level of tumor necrosis factor-alpha; lung tissue levels of malondialdehyde, catalase, and myleperoxidase; and protein concentration in bronchoalveolar lavage fluid and lung wet/dry weight ratio. Histological evaluation showed that tezosentan attenuated the morphological changes associated with lung injury. The results of this study indicate that tezosentan attenuates lung injury induced by aortic IR in rats. We propose that this protective effect of tezosentan is due to (1) reduced systemic inflammatory response, (2) reduced oxidative stress and lipid peroxidation in lung tissue, (3) reduced pulmonary microvascular leakage, and (4) inhibition of leukocyte infiltration into lung tissue.

Use of new oral anticoagulants secondary to Paget–Schroetter syndrome in a young sportsman: A case report

Introduction: The Paget–Schroetter syndrome or “effort thrombosis” is a deep venous thrombosis of subclavian-axillar vein at the costoclavicular junction . It affects predominately young and athletic people with an inherent anatomic variant at the costoclavicular junction that triggers the formation of a primary thrombosis. It is important to identify this syn-drome in order to prevent further complications, such as post-thrombotic syndrome, pulmonary embolism (PE), or even death. We present a clinical case in which a young professional basketball player developed a subclavian venous thrombosis and was managed with new oral anticoagulant.

Effect of Preoperetive Preparation for Early Extubation and Discharge of Intensive Care Unit

Aim: In coronary artery bypass surgery patients length of stay in intensive care unit (ICU) has an important role in complication rates and costs. For that reason, the discharging of the patients from the hospital in shorter period can be provided by taking measures prior to surgical intervention via previously known factors which may affect hospitalization stay. The aim of this study was to determine the role of perioperative risk factors in term of clinical outcomes based on the time of ICU discharge. Material and Method: In this retrospective study, we included 196 patients undergoing coronary artery bypass graft surgery in our clinic. The patients were divided into early (≤2 day) and late (>2 day) ICU discharge groups according to the duration of ICU stay. The preoperative and postoperative risk factors, the complications and the outcomes were evaluated. Results: Age, sex, hyperlipidemia, diabetes mellitus, previous myocardial infarction, renal failure, cerebrovascular accident, hypertension, level of hematocrit and creatinine were not significantly different between the two groups. Patients with hemodynamic instability, respiratory dysfunction, ejection fraction 2 day) compared to other group (p< 0.05). The shorter duration of intubation time was the most significant factor affecting early discharge according to late discharge group (7.8 ± 3.8 vs 17 ± 9.9 hours, p< 0.001). Discussion: Time of ICU discharge depends on especially to respiratory dysfunction and duration of intubation. Therefore, we assume that modification of preoperative risk factors for re spiratory may improve clinical outcomes in ICU.

Geç Dönem Gebelikte Mitral Kapak Trombozu: Olgu Sunumu.

Mekanik kalp kapagi olan gebe kadinlarda tromboembolik komplikasyon sikligi artmistir ve tromboembolik olaylar hem anne hem de fetus yasamini tehdit eden onemli komplikasyonlardir. Bundan dolayi, ideal antikoagulan tedavi mekanik kalp kapagi trombozunu engellemeli ve kendisi de teratojenik etkiye yol acmamalidir. Ama, gunumuzde mekanik kalp kapagi olan gebe kadinlarda ideal antikoagulan tedavi henuz belirsizligini korumaktadir. Bu olgu sunumunda, dusuk molekul agirlikli heparin ile antikoagulan tedavi altinda iken mekanik kapak trombozu olan 30 haftalik gebe bir kadin olguyu sunuyoruz.

Diabetes Mellitusun Koroner Arter Bypass Cerrahisinde Erken Dönem Morbidite ve Mortaliteye Etkisi

SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2006 Mart; 13(1) Diabetes Mellitusun Koroner Arter Bypass Cerrahisinde Erken Donem Morbidite ve Mortaliteye Etkisi Ilker Kiris, Şenol Gulmen, Ilker Tekin, Huseyin Okutan Ozet Gunumuzde, koroner arter bypass cerrahisi (KABC) uygulanan hastalarin % 20-30.u diyabetikdir. Bununla birlikte, diabetes mellitus (DM).un KABC sonrasi erken donem mortalite ve morbiditeye olan etkisi tartismalidir. Bu retrospektif calismanin amaci, DM.un KABC uygulanan hastalarda erken donem morbidite ve mortaliteyi anlamli derecede arttirip arttirmadigini arastirmaktir. Haziran 2003 ile Eylul 2005 tarihleri arasinda klinigimizde KABC uygulanan toplam 246 hasta calismaya alindi. Calismaya alinan hastalarin ortalama yasi 59.8 ± 9.75 olup 187.si erkek (% 76) ve 59.u kadin (% 23.9) idi. DM tanisi olan 79 (% 32.1) hasta DM grubunu, diger 167 (% 67.8) hasta da kontrol grubunu olusturdu. Gruplar, postoperatif erken donemde morbidite verileri ve mortalite orani acisindan birbiri ile karsilastirildi. Intra aortik balon pompasi, akut bobrek yetmezligi, multi organ yetmezligi, serebro vaskuler olay, yuzeyel yara yeri enfeksiyonu, sternal dehissens, mediastinit ve mediastinal kanama nedenli reoperasyon oranlari acisindan gruplar birbiri ile karsilastirildiginda istatistiksel olarak anlamli fark bulunmadi (p > 0.05). Mortalite oranlari DM grubunda % 3.7, kontrol grubunda ise %4.7 idi ve aradaki fark istatistiksel olarak anlamli degildi (p > 0.05). Yuzeyel yara yeri enfeksiyonu orani, insulin kullanan diyabetik hastalarda, hem oral antidiyabetik kullanan diyabetik hastalara hem de kontrol grubuna gore anlamli derecede daha yuksekti (p = 0.066). Sonuc olarak, bu calismada, DM.un KABC uygulanan hastalarda erken donem morbidite ve mortaliteyi anlamli derecede arttirmadigini bulduk. KABC, enfeksiyona karsi azami onlemler alinarak, diyabetik olan hastalarda da diyabetik olmayan hastalarda oldugu gibi guvenle uygulanabilir. Anahtar kelimeler: Diabetes mellitus, koroner arter bypass cerrahisi, morbidite, mortalite Abstract Effect of Diabetes Mellitus on Short-Term Morbidity and Mortality in Coronary Artery Bypass Surgery Currently, 15 % to 30 % of the patients that undergo coronary artery bypass grafting (CABG) are diabetics. However, the effect of diabetes mellitus (DM) on short-term morbidity and mortality after CABG iscontroversial. The aim of this retrospective study was to investigate whether DM increases short-term morbidity and mortality after CABG or not. Two-hundred-fourty-eight patients who underwent CABG operations in our clinic between June 2003 and September 2005 were included in the study. Mean age of the patients was 59.8 ± 9.75 and there were 187 male (% 76) and 59 female (% 23.9). Seventy-nine patients (%32.1) were diabetic (DM group) and 167 patients (% 67.8) were nondiabetic (control group). The groups were compared for morbidity data and mortality rates in the postoperative short-term. When the groups were compared for the incidence of intra aortic balloon pumping, acute renal failure, multi organ failure, cerebro vascular complications, superficial wound infection, sternal dehiscence, mediastinitis and reoperation due to mediastinal bleeding, there were no statisticaly significant difference (p > 0.05). Mortality rates in the DM group and the control group were % 3.7 and %4.7, respectively but there were no statisticaly significant difference (p > 0.05). The incidence of superficial wound infection were significantly higher in the patients with insulin-treated DM than both in the patients with oral antidiabetic-treated DM and in the nondiabetic patients (p = 0.066). In conclusion, in this study we found that DM does not significantly increase short-term morbidity and mortality in the patients who undergo CABG. Provided that strict measures are taken against infections, CABG can be performed in diabetic patients as safely as it is being performed in nondiabetic patients. Key words: diabetes mellitus, coronary artery bypass surgery, morbidity, mortality