Serhat Hüseyin

A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

BackgroundWe aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations.MethodsOne hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively.ResultsThe VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group.ConclusionsTEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile.

Vascular complications of the intra-aortic balloon pump in patients undergoing open heart surgery: 10 years' experience.

BACKGROUND The most encountered complications with intra-aortic balloon pump (IABP) use are seen within the vascular system. The purpose of our study is to evaluate vascular complications of the sheathless IABP in patients undergoing open heart surgery. METHODS Between January 2002 and December 2011, a total of 148 patients undergoing open heart surgery and needed IABP support were included in the study. All vascular complications related with IABP were recorded. RESULTS Mean age of the patients was 64.4 ± 9.4 years. Total 104 (70.2%) were male and 44 (29.8%) were female. Total number of patients who had ischemic complications of the extremity was 13 (8.7%). The most used surgical treatment was embolectomy in five patients. Only one patient required an iliofemoral bypass. Above the knee amputation was performed in one patient. No balloon-related mortality occurred. CONCLUSION Incidence of vascular complications in IABP counterpulsation is still a problem despite improvements in catheter design and techniques. The presence of peripheral arterial disease and diabetes mellitus is important risk factors for ischemic complications.

A rare etiology of heart failure: traumatic arteriovenous fistula due to stab injury 17 years ago

BACKGROUND Although traumatic fistula is frequently encountered, high-output heart failure due to fistula is a very rare condition. Despite an indefinitive history of trauma, arteriovenous (AV) fistula may develop insidiously, and therefore identification of a shunt is highly important for treatment. CASE REPORT Here we report a 46-year-old male patient with heart failure due to traumatic femoral arteriovenous fistula developed following a penetrating stab injury 17 years ago. CONCLUSION Traumatic AV fistula is a curable cause of heart failure. Also, careful examination of the patient is as significant as radiological imaging methods.

Aortic Valve Regurgitation and Ventricular Septal Defect Diagnosed 5 Years after Penetrating Cardiac İnjury

Despite high mortality rates for penetrating heart injuries, developments in transport, diagnosis, and surgical interventions have increased survival rates. In some cases, life-threatening complications may be misdiagnosed or remain asymptomatic and lead to loss of life. Herein, we report a patient with aortic valve regurgitation because of noncoronary cusp perforation and ventricular septal defect that remained asymptomatic and diagnosed 5 years after a penetrating heart injury.

An experimental model of aortic surgery and the effect of Iloprost on lung injury

Abstract Objectives. Ischemia/reperfusion (I/R) damage of the lung is a frequently encountered complication following aortic surgery. The aim of the present study is to investigate the histopathological effects of Iloprost on pulmonary damage developed after I/R. Design. Twenty-four Sprague-Dawley rats were randomly divided into 3 groups. In the control group, aortas were not clamped. In the I/R group, aortas were occluded, and after 1 h of ischemia, clamps were removed. After 2 h of reperfusion period, lungs of the rats were extracted. In the I/R + Iloprost group after 1 h of ischemia, Iloprost infusion was initiated, and maintained for the duration of 2 h reperfusion period. For histopathological scoring, density of polymorphonuclear leucocytes, congestion, interstitial edema, and bleeding were semiquantitatively evaluated, and histopathological changes were scored. Results. In the I/R group, multifocal-marked histopathological changes in 5 (62.5%), and multifocal-moderate histopathological changes in 3 (37.5%) rats were detected. In the I/R + Iloprost group, multifocal-moderate histopathological changes in 4 (50%), and multifocal-mild changes in 4 (50%) rats were detected. Conclusions. In the experimental rat model, administration of Iloprost has been shown to have preventive effects for pulmonary damage occurring after I/R generated by infrarenal aortic occlusion.

Evaluation of Pericardial Fluid C-Type Natriuretic Peptide Levels in Patients Undergoing Coronary Bypass Surgery

Background Neurohumoral and hemodynamic mechanisms have an effect on cardiac activity. C‐type natriuretic peptide (CNP) is accessible in the cardiovascular system. The aim of this study was to determine whether CNP concentrations in pericardial fluid and blood are related to cardiac dysfunction in patients undergoing coronary artery bypass graft surgery. Materials and Methods In this study, 40 patients undergoing coronary artery bypass grafting were enrolled. The patients were separated into two groups according to left ventricular (LV) ejection fraction (EF): group 1 contained 28 patients with normal LV systolic function (LVEF ≥ 50%) and group 2 contained 12 patients with impaired LV systolic function (LVEF < 45%). Plasma and pericardial fluid samples were acquired during surgery to measure CNP levels. Results In group 1, CNP levels were detected to be 0.46 ± 0.10 ng/mL in plasma and 0.66 ± 0.8 ng/mL in pericardial liquid. In group 2, these levels were 0.51 ± 0.09 and 0.79 ± 0.12 ng/mL, respectively. CNP levels were determined to be significantly higher in patients with low EF compared with those with normal EF in pericardial fluid concentrations (p = 0.013). Conclusions CNP level in pericardial fluid is a more sensitive and proper marker of LV dysfunction than CNP levels in plasma. To the best of our knowledge, this study is the first to examine pericardial fluid CNP levels in patients undergoing coronary artery bypass surgery. It may have a valuable role in organizing cardiac remodeling and hypertrophy.

Avoiding Liver Injury with Papaverine and Ascorbic Acid Due toInfrarenal Cross-Clamping: an Experimental Study

Objective Ischemia-reperfusion injury after acute ischemia treatment is a serious condition with high mortality and morbidity. Ischemia-reperfusion injury may result in organ failure particularly in kidney, lung, liver, and heart. In our study, we investigated the effects of papaverine and vitamin C on ischemia-reperfusion injury developed in the rat liver after occlusion-reperfusion of rat aorta. Methods 32 Sprague-Dawley female rats were randomized into four groups (n=8). Ischemia was induced with infrarenal aortic cross-clamping for 60 minutes; then the clamp was removed and reperfusion was allowed for 120 minutes. While the control group and the ischemia-reperfusion group did not receive any supplementary agent, two other groups received vitamin C and papaverine hydrochloride (papaverine HCL). Liver tissues were evaluated under the light microscope. Histopathological examination was assessed by Suzukis criteria and results were compared between groups. Results In ischemia-reperfusion group, severe congestion, severe cytoplasmic vacuolization, and parenchymal necrosis over 60% (score 4) were observed. In vitamin C group, mild congestion, mild cytoplasmic vacuolization and parenchymal necrosis below 30% (score 2) were found. In papaverine group, moderate congestion, moderate cytoplasmic vacuolization and parenchymal necrosis below 60% (score 3) were observed. Conclusion An ischemia of 60 minutes induced on lower extremities causes damaging effects on hepatic tissue. Vitamin C and papaverine are helpful in reducing liver injury after acute ischemia reperfusion and may partially avoid related negative conditions.

A rare cause in etiology of left atrial mass: metastatic testicular germ cell tumor.

Although intracardiac metastasis of germ cell tumors is rare, it can be localized in the right or left heart by disseminating spread and give their cardiac symptoms depending on the location of metastatic mass. We present a 38-year-old male patient with a preliminary diagnosis of testicular tumor who was followed by the medical oncology clinic with cerebrovascular event and heart failure symptoms.

Comparison of early period results of blood use in open heart surgery

Background: Various adverse effects of homologous blood transfusion detected particularly in open heart surgery, in which it is frequently used, lead researchers to study on autologous blood use and to evaluate the patients blood better. Due to the complications of homologous blood transfusion, development of techniques that utilize less transfusion has become inevitable. We aimed to evaluate the effects of acute normovolemic hemodilution (ANH) in patients undergoing open heart surgery. Materials and Methods: In this study, 120 patients who underwent open heart surgery were included. Patients were grouped into three: Autologous transfusion group (Group 1), homologous transfusion group (Group 2), and those received autologous blood and homologous blood products (Group 3). Patient data regarding preoperative characteristics, biochemical parameters, drainage, extubation time, duration of stay at intensive care, atrial fibrillation (AF) development, and hospital stay were recorded. Results: A statistically significant difference (P < 0.005) was found in favor of autologous group (Group 1) with respect to gender, body surface area, European System for Cardiac Operative Risk Evaluation, smoking, hematocrit levels, platelet counts, urea, C-reactive protein levels, protamine use, postoperative drainage, frequency of AF development, intubation period, stay at intensive care and hospital stay, and amount of used blood products. Conclusion: The use of autologous blood rather than homologous transfusion is not only attenuates side effects and complications of transfusion but also positively affects postoperative recovery process. Therefore, ANH can be considered as an easy, effective, and cheap technique during open heart surgery.

Impact of Surgeon Experience During Carotid Endarterectomy Operation and Effects on Perioperative Outcomes

Objective We evaluated the effect of surgeon experience on complication and mortality rates of carotid endarterectomy operation. Methods Fifty-nine consecutive patients who underwent carotid endarterectomy between January 2013 and February 2016 were divided into two groups. Patients who had been operated by surgeons performing carotid endarterectomy for more than 10 years were allocated to group 1 (experienced surgeons; n=34). Group 2 (younger surgeons; n=25) consisted of patients operated by surgeons independently performing carotid endarterectomy for less than 2 years. Both groups were compared in respect of operative results and postoperative complications. Results No intergroup difference was found for laterality of the lesion or concomitant coronary artery disease. In group 1, signs of local nerve damage (n=2; 5.9%) were detected, whereas in group 2 no evidence of local nerve damage was observed. Surgeons in group 1 used local and general anesthesia in 3 (8.8%) and 31 (91.2%) patients, respectively, while surgeons in group 2 preferred to use local and general anesthesia in 1 (4%) and 24 (96%) patients, respectively. Postoperative stroke was observed in group 1 (n=2; 5.9%) and group 2 (n=2; 5.8%). Conclusion Younger surgeons perform carotid endarterectomy with similar techniques and have similar results compared to experienced surgeons. Younger surgeons rarely prefer using shunt during carotid endarterectomy. The experience and the skills gained by these surgeons during their training, under the supervision of experienced surgeons, will enable them to perform successful carotid endarterectomy operations independently after completion of their training period.