Tolga Demir

Aneurysm of the kinked extracranial internal carotid artery case report and review of the literature.

Aneurysms at the extracranial portion of the internal carotid artery are rare disorders. In the largest series, McCollum reported only 37 cases over a 21 year period (1) and Moreau reported 35 cases over a 24 year period (2). This uncommon but interesting vascular disorder usually presents as a parapharyngeal pulsatile mass. It can be partially or completely thrombosed and can thereby cause embolization or compression of neuronal vasculature. Ruptures and ischaemic events are other complications. Therefore the mortality rate in nonoperated patients is very high. The major etiologic factor is atherosclerosis. Sometimes, trauma may be another cause. Surgery is recommended for symptomatic aneurysms in patients at all ages. The aim of this paper is to report the symptoms and clinical findings of a patient with a kinked extracranial internal carotid artery with aneurysm and to review the literature.

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.

Five-Year Follow-Up of a Patient with Bilateral Carotid Body Tumors after Unilateral Surgical Resection

BACKGROUND Carotid body tumors are rare, highly vascularized neoplasms that arise from the paraganglia located at the carotid bifurcation. Surgery is the only curative treatment. However, treatment of bilateral carotid body tumors represents a special challenge due to potential neurovascular complications. CASE REPORT We present the therapeutic management of a 34-year-old woman with bilateral carotid body tumors. The patient underwent surgical resection of the largest tumor. It was not possible to resect the tumor without sacrificing the ipsilateral vagal nerve. Due to unilateral vagal palsy, we decide to withhold all invasive therapy and to observe contralateral tumor growth with serial imaging studies. The patient is free of disease progression 5 years later. CONCLUSIONS Treatment of bilateral CBTs should focus on preservation of the quality of life rather than on cure of the disease. In patients with previous contralateral vagal palsies, the choice between surgery and watchful waiting is a balance between the natural potential morbidity and the predictable surgical morbidity. Therefore, to avoid bilateral cranial nerve deficits, these patients may be observed until tumor growth is determined, and, if needed, treated by radiation therapy.

Simultaneous Occurrence of a Large Asymptomatic Prolapsing Left Atrial Myxoma with a Cutaneous Squamous Cell Carcinoma

Synchronous myxoma of the heart and other malignancies are extremely rare. We report a case of a 64-year-old man who had a large left atrial myxoma that obstructed the mitral valve, as well as an unrelated, coexistent cutaneous squamous cell carcinoma in the sacral area. During the preoperative evaluation for non-cardiac surgery, the tumor was diagnosed coincidentally by echocardiographic examination. Echocardiography findings were consistent with a large left atrial myxoma originating from the posterior wall and prolapsing into the left ventricular cavity through the mitral valve, causing mitral stenosis. The mass was successfully completely excised. Histologic examination of the mass confirmed the diagnosis of cardiac myxoma. We report a casual echocardiographic finding of a left atrial myxoma that obstructed the mitral valve outflow tract, and an unrelated, synchronous cutaneous squamous cell carcinoma in the sacral area.

Aspergillus flavus endocarditis of the native mitral valve in a bone marrow transplant patient.

Patient: Male, 36 Final Diagnosis: Aspergillus flavus endocarditis Symptoms: Malaise • fatigue and dyspnea Medication: — Clinical Procedure: Mitral vale replacemnet Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis due to Aspergillus species is an uncommon infection with a high mortality rate. It mostly occurs after the implantation of prosthetic heart valves. Parenteral nutrition, immunosuppression, broad-spectrum antibiotic regimens, and illegal intravenous drug use are the risk factors for developing infection. Case Report: We report a case of Aspergillus flavus native mitral valve endocarditis in a patient who had allogeneic stem cell transplantation in the past due to myelodysplastic syndrome. Conclusions: Although it is rare and there is limited experience available with the diagnosis and treatment, early recognition and therapeutic intervention with systemic antifungal therapy and aggressive surgical intervention are critical to prevent further complications that may eventually lead to death. In addition, better novel diagnostic tools are needed to facilitate more accurate identification of patients with invasive Aspergillus and to permit earlier initiation of antifungal treatment.

Pinball-Like Free-Floating Left Atrial Ball Thrombus Presenting with Hemiplegia: A Challenging Treatment Decision.

We describe a case of a patient with a history of chronic atrial fibrillation who presented with sudden onset of left hemiplegia. Nine months earlier the longstanding warfarin therapy had been suspended due to a hemorrhagic stroke. Transthoracic echocardiography revealed a large free-floating highly mobile mass in the left atrium and severe mitral valve regurgitation. Due to the potential risk of an embolic event or a hemodynamic collapse, a decision to carry out an emergency operation was made irrespective of the neurological condition of the patient. Unfortunately, the patient died on the 18th postoperative day after a freshly occurring hemorrhagic stroke.

Endovascular Treatment of Abdominal Aortic Aneurysm in a 26-Year-Old Man. A Case Report and 10-Year Follow-up

We present endovascular treatment of abdominal aortic aneurysm in a 26-year-old man with a 10-year follow-up. A young patient presenting with an abdominal aortic aneurysm is extremely rare, and data describing this population are limited. Open aneurysm repair (OAR) is the treatment of choice in these patients. However, since its introduction, endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. The long-term durability and late complications after EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. Our good long-term outcome will help to support the use of EVAR as a reasonable alternative to OAR in young patients with suitable anatomic findings.

Innominate Artery as an Alternative Site for Proximal Anastomoses in Patients With a Severely Calcified Aorta

Atheromatous plaques of the ascending aorta are one of the most important risk factors for postoperative mortality and morbidity in coronary artery bypass grafting (CABG). We have retrospectively analyzed the results of proximal anastomoses constructed on the innominate artery in patients with calcific atheromatous plaques (CAP) in their ascending aorta detected intraoperatively.

Epicardial permanent pacemaker implantation via coronary sinus in a patient with mechanical tricuspid valve prosthesis

received: 23.01.2016 accepted: 20.02.2016 1Kolan International Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey 2Medipol University Hospital, Department of Cardiology, Istanbul, Turkey 3Kolan International Hospital, Department of Anesthesiology, Istanbul, Turkey yazışma adresi: Tolga Demir, Kolan International Hospital, Department of Cardiovascular Surgery, Istanbul e-mail: dr.tolgademir@gmail.com ıNTroDuCTıoN

The Effects of Some Drinks on Saliva pH

Objectives: The purpose of this study is to evaluate the effects of some drinks on saliva pH. Methods: Systemic and periodontally healthy individuals aged 18-23 years were included in the study. Individuals saliva pHs were measured three hours after breakfast. Three groups were set up to measure after 1 minute, 10 minutes and 30 minutes after drinks were drunk and the effects of Turkish coffee, cola, ayran and green tea on saliva pH were investigated. Results: The most pronounced pH changes occurred in the first group. The lowest pH values were reached when cola was consumed while the highest pH values were reached when green tea was consumed. Within the pH measurement time period, the drink group with the least tendency of pH value change was green tea. Conclusion: In order to prevent tooth decay, there is a need to raise awareness about conscious and controlled consumption of beverages that may lead to significant reductions in salivary pH.