Ümit Halici

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery--a prospective, controlled, clinical study.

BackgroundAccording to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting.MethodsElectrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG) and heart valve replacement with moderate hypothermic (mean 28°C) cardiopulmonary bypass (CPB) were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia.ResultsIn all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement). No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB) or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms) and amplitude (mV) did not differ statistically before and after surgery in either group (p > 0.05).ConclusionsOur results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery).

Autogenous arterial radial-basilic forearm looped transposition

We describe the use of radial artery as a conduit for arteriovenous hemodialysis access in the forearm. The advantages of this type of fistula are use of autogenous material and its localization because forearm fistula is easily cannulated and is more convenient for the patient. This fistula may be an alternative solution in selected hemodialysis patients for the difficult access in whom superficial arm veins are exhausted and lower extremity access is unsuitable.

Dopaminin Koroner Arter Bypass Cerrahisi Operasyonlar×nda Kullan×lan únternal Torasik Arter Grefti Üzerine ún Vitro Etkileri

Amac: Bu cal×uman×n amac× dopaminin internal torasik arter (uTA) grefti uzerine etkilerini, invitro araut×rmakt×r. Gerec ve Yontemler: Aral×k 2003- Haziran 2005 tarihleri aras×nda kliniuimizde koroner arter bypass greft (CABG) operasyonu olan toplam 32 hasta (2’si kad×n 30’u erkek, ortalama yau; 59.256±8,.34, 37-75 yaular× aras×) cal×umaya al×nd×. un vitro organ banyosunda hastalar×n ITA’lar×ndan arta kalan parcac×klar uzerinde dopaminin oluuturduuu kas×c× ve gevuetici yan×tlar isometrik olarak kaydedildi. Bulgular: Dopamin 10-9 M-10-7 M konsantrasyon aral×u×nda fenilefrinle onceden kast×r×lm×u ITA’da hafif bir gevueme yan×t×, sonras×nda artan konsantrasyonlar×nda (>10-7 M) kas×lma yan×t× gercekleutirdiui gozlendi. Dopaminin gevuetici etkisinin k×smen L-NAME (nitrik oksit sentaz inhibitoru, 10-6 M), propranolol (10-6 M) ve cis-њ-flupentiksol (dopaminerjik reseptor antagonisti, 10-6 M) ile k×smen azald×u× fakat metoklopramidin (D2-dopaminerjik reseptor antagonisti) dopaminin kaynakl× gevuemeye etki yapmad×u× gozlendi. Dopaminin ITA’daki kas×c× etkisi k×smen fentolamin, prazosin ve yohimbin ile antagonize edildiui gozlendi. Sonuc: Sonuc olarak dopamin duuuk konsantrasyonlarda ITA’da vazodilatasyon yan×t×n× oluutururken daha yuksek konsantrasyonlarda ITA’da vasokonstriksiyon yan×t×n× oluuturmaktad×r. ћ-adrenerjik ve nitrik oksit arac×l× mekanizma (D1-dopaminerjik reseptor yoluyla) dopaminin duuuk konsantrasyonlar×nda ITA’da oluuturduuu gevuetici etkide rol alabilir. Dopaminin yuksek konsantrasyonlardaki ITA’da oluuturduuu kas×c× etki њ1- ve њ2-adrenerjik reseptorlerin aktivasyonu ile oluuturulmaktad×r.