Kardiyak cerrahide miyokardiyal koruma açısından intermittant antegrad kardiyopleji ile antegrad/retrograd sürekli kardiyoplejinin karşılaştırılması

Amaç: Bu çalışmada kardiyak cerrahide miyokardiyal koruma açısından intermittant antegrad kardiyopleji ile antegrad/retrograd sürekli kardiyopleji karşılaştırıldı. Ça­lış­ma­pla­nı:­ Ekim 2010 - Ocak 2011 tarihleri arasında kliniğimizde kardiyak cerrahi ameliyatı uygulanan 106 hasta çalışmaya alındı. Hastalar, intermittant antegrad kardiyopleji uygulananlar (grup 1; 18 kadın, 14 erkek) ve antegrad/retrograd sürekli kardiyopleji uygulananlar (grup 2; 16 kadın, 58 erkek) olmak üzere iki gruba ayrıldı ve ameliyat sonrası elde edilen sonuçlar karşılaştırıldı. İşlem sürecinde troponin-I, kreatin kinaz-miyokard bandı (CK-MB) düzeyleri, kardiyopulmoner baypas (KPB) ve kros klemp süreleri, kardiyopleji toplam miktarları ve potasyum kullanımı değerlendirildi. Bul gu lar: Bulgularımıza göre, ortalama troponin-I ve CK-MB değerleri grup 1’de grup 2’den daha yüksekti. Ancak bu farklılık istatistiksel olarak anlamlı değildi. Grup 1’de troponin-I ve CK-MB değerleri kros-klemp ve KPB süresi ile korele iken, grup 2’de troponin-I ve CK-MB değerleri kros-klemp ve KPB süresi ile korele değildi. So­nuç:­ Troponin-I, CK-MB düzeyleri ile KPB ve kros-klemp zamanları arasında anterograd/retrograd sürekli kardiyopleji uygulanan grupta korelasyon bulunmadı. Buna göre, antegrad/ retrograd sürekli kardiyopleji ile efektif miyokardiyal koruma sağlandığında, troponin-I ve CK-MB değerleri etkilenmedi ve miyokardiyal koruma daha iyiydi. Anterograd/retrograd sürekli kardiyopleji daha iyi miyokardiyal koruma sağlasa da anterograd kardiyopleji sırasında aort basıncı istenen düzeylerde tutulabilmesi için monitörize edilmeli ve retrograd kardiyopleji sırasında da retrograd kanül doğru yerde tutulmalıdır. Anah­tar­söz­cük­ler: Kardiyopleji, koroner baypas cerrahi, miyokardiyal yaralanma, miyokardiyal koruma.Background:­ This study aims to compare intermittent antegrade cardioplegia and antegrade/retrograde continuous cardioplegia in terms of myocardial protection in cardiac surgery. Methods: Hundred six patients who underwent cardiac surgery in our clinic between October 2010 and January 2011 were included in the study. Patients were divided into two groups as patients who received intermittent antegrade cardioplegia (group 1; 18 females, 14 males) and who received antegrade/retrograde continuous cardioplegia (group 2; 16 females, 58 males), and postoperative results were compared. Troponin-I, creatine kinase-myocardial band (CK-MB) levels, durations of cardiopulmonary bypass (CPB) and cross-clamping, total amounts of cardioplegia, and potassium utilization during the process were evaluated. Results:­ According to our results, mean troponin-I and CK-MB levels were higher in group 1 than group 2. However, this difference was not statistically significant. While troponin-I and CK-MB values were correlated to durations of cross-clamping and CPB in group 1, troponin-I and CK-MB values were not correlated to durations of cross-clamping and CPB in group 2. Conclusion:­ No correlation was detected between troponin I, CK-MB levels, and durations of CPB and cross-clamping in the group which received anterograde/retrograde continuous cardioplegia. Therefore, troponin-I and CK-MB levels were not affected and myocardial protection was better once effective myocardial protection was obtained by antegrade/retrograde continuous cardioplegia. Although antegrade/retrograde continuous cardioplegia provides better myocardial protection, aortic pressure must be monitored to be kept between desired levels during antegrade cardioplegia, and the retrograde cannula must be kept in the appropriate place during retrograde cardioplegia

Effect of cigarette smoking on the washout time of sevoflurane anesthesia

<p>Abstract</p> <p>Background</p> <p>Cigarette smoking affects the pharmacodynamic and pharmacokinetic behavior of many drugs and causes deterioration of pulmonary mechanics. We have evaluated the effect of cigarette smoking on washout time after one minimum alveolar concentration-h (1 MAC-h) of sevoflurane anesthesia.</p> <p>Methods</p> <p>We investigated the washout time of sevoflurane in 30 non-smoking and 30 healthy cigarette smoking (≥20 cigarettes/day for>1 year) ASA I-II physical status patients, aged 18-63 years, who were candidates for otorhinolaryngologic elective surgery under 1MAC-h standardized sevoflurane anesthesia. At the end of the surgery, the sevoflurane vaporizer was turned off and the time taken for the sevoflurane concentration to decrease to MAC-awake (0.3) and 0.1 MAC levels were recorded. In addition, the ratio of the fractions of inspired concentration (Fi) and expired concentration of sevoflurane (Fexp) at 1 MAC and Fexp of sevoflurane at 0.1MAC were recorded. The patients were mechanically ventilated during the washout time.</p> <p>Results</p> <p>We found no difference between the 2 study groups with regard to washout time of sevoflurane. The times of 1MAC down to MAC-awake (106 ± 48 sec in non-smokers vs 97 ± 37 sec in smokers, <it>p </it>> 0.05) and down to 0.1MAC (491 ± 187 sec in non-smokers vs 409 ± 130 sec in smokers, <it>p </it>> 0.05) were similar. Similarly, there were no significant differences in the ratios of Fi/Fexp at 1MAC (1.18 in non-smokers vs. 1.19 in smokers, <it>p </it>> 0.05) and Fexp of sevoflurane at 0.1MAC (0.26 in non-smokers vs. 0.25 in smokers, <it>p </it>> 0.05).</p> <p>Conclusions</p> <p>Washout time of 1MAC-h sevoflurane anesthesia is not appear to be effected by cigarette smoking in patients without significant pulmonary disease.</p

The effect of combined hyperbaric oxygen and iloprost treatment on the prevention of spinal cord ischaemia-reperfusion injury: an experimental study

Bozok, Sahin/0000-0002-1256-5055; Durakoglugil, Emre/0000-0001-5268-4262WOS: 000325763500005PubMed: 23946499Hyperbaric oxygen (HBO) has been shown to be effective in preventing neurological injuries in animal models of ischaemia, whereas iloprost (IL) prevents ischaemia-related mitochondrial dysfunction and reduces infarction size after focal cerebral ischaemia in animal models. the aim of the present study was to investigate the effect of combined HBO and IL treatment on spinal cord ischaemia-reperfusion (IR) injury by neurological, histopathological and biochemical methods in an experimental study. Eighty New Zealand white male rabbits were randomly allocated into one of five study groups. the HBO group received a single session of HBO treatment and the IL group received an infusion of 25 ng/kg/min IL; the HBO + IL group received both HBO and IL and the control group received only 0.9% saline; the fifth group was the sham group. Levels of S100 beta protein, neuron-specific enolase (NSE) and nitric oxide (NO) were measured at onset, at the end of ischaemia period and at the 24th and 48th hour of reperfusion. Physical activity was assessed using Tarlov criteria 24, and the spinal cords of the sacrificed rabbits were evaluated histopathologically. Additionally, tissue malondialdehyde (MDA) and antioxidant enzyme activities [total superoxide dismutase (SOD); catalase (CAT) and glutathione peroxidase (GSH-Px) were assessed. Neurological scores in the HBO, IL and HBO + IL groups were statistically significantly better compared with the control group at the 24th (P = 0.001 for all) and 48th hour (P = 0.001 for all). Histopathological scores in the HBO, IL and HBO + IL groups were also significantly better compared with the control group (P = 0.003, 0.001 and 0.001, respectively). Whereas MDA, NSE, S100 beta protein and NO concentrations were significantly lower, CAT and GSH-PX levels were significantly higher in either sham or treatment groups compared with the control group. Since we demonstrated beneficial effects on spinal cord IR injury, we think that both HBO and IL, either alone or in combination, may be reasonable in the treatment of IR injury. Furthermore, there did not appear to be synergistic effects with combined treatment. More research is needed for practical application in humans, following thoracoabdominal aortic surgery

Diagnosis and management of carotid body tumor: a report of seven cases

Bozok, Sahin/0000-0002-1256-5055WOS: 000314377200038Paragangliomas are rare asymptomatic painless tumors, originating from paraganglionic bodies of autonomous nerve system of the embriological neural crest and increasing gradually. Despite their gradual developing nature, it is critical to reach early diagnosis and tailor surgical plan for carotid body tumors due to their potential of being malignant and local aggressive development, as well as invasion or pressure on the adjacent vascular and neural tissues. in this article, we present seven cases who were admitted with the complaints of pain and swelling in the neck and were diagnosed with carotid body tumor based on the further investigations and were surgically treated in the light of literature review and different surgical modalities were discussed

The Effects of a 'Transient Ischemic Attack Unit' on the Early Diagnosis and Treatment of Stroke and Other Vascular Events

Objective: Identifying the etiology and early treatment following a transient ischemic attack (TIA) or minor stroke may prevent patients from having a disabling ischemic stroke. The primary aim of this study was to increase awareness of the symptoms of TIA and minor ischemic stroke and provide early intervention via a TIA unit. In addition, the benefits provided by the TIA unit were analyzed in terms of prognosis and length of hospital stay. Materials and Methods: Before beginning the study, brochures and posters containing information about the symptoms of a TIA and minor ischemic stroke, along with the mobile phone number of a research fellow, were distributed in the clinics and hung on the main boards of the Ankara University Faculty of Medicine Hospitals. A presentation on the TIA unit was also given to the healthcare professionals of the hospitals. Afterward, 69 patients consecutively admitted with symptoms of a TIA or minor ischemic stroke [with a National Institutes of Health Stroke Scale (NIHSS) score of ≤5] between September 16, 2019, and September 15, 2020, were prospectively included in the study group. The hospital charts of 90 consecutive patients admitted with a TIA or minor ischemic stroke (with an NIHSS score of ≤5) were retrospectively evaluated as the control group from September 16, 2018, to September 15, 2019. The timing of the etiological diagnoses and treatments, the length of the hospital stay, and the prognoses of these two groups of patients, one comprising patients admitted before and the other comprising patients admitted after the TIA unit was established, were compared. Results: The two groups had no significant difference in vascular events and mortality. However, in the logistic regression analysis, the length of the hospital stay was significantly shorter in the study group (P = 0.015). Conclusion: A TIA and a minor stroke should be recognized quickly, and diagnostic tests should be performed as soon as possible to shorten the period of the hospital stay and reduce the costs and complications related to longer hospitalization

Kardiyak Cerrahi Uygulanan Diyabetik Hastalarda Taurin, Glikolize Hemoglobin ve C-Reaktif Protein İlişkisi

Amaç: Taurin, protein sentezinde kullanılmayan, methionin ve sistein sülfinik asit üzerinden karaciğerde sentezlenen bir aminoasittir. Antiinflamatuar ve hipoglisemik etkileri gösterilmiştir. Bu çalışmada, taurinin postoperatif düzeyi ve inflamasyona etkileri değerlendirilmiştir. Yöntem: Kalp cerrahisine alınan 34 hasta çalışmaya dâhil edilmiştir. Ameliyat sonrası 3. günde alınan kanda plazma taurin, C reaktif protein (Crp), HbA1c düzeyleri ölçülmüştür. Çalışmaya katılan tüm hastalar, Grup 1: HbA1c düzeylerine göre 6 ve daha düşük (glisemik kontrolü iyi olan) diyabetli hastalar ve Grup 2: HbA1c düzeyi 6’dan yüksek (glisemik kontrolü kötü olan) diyabetli hastalar olarak 2 gruba ayırılmıştır. Ameliyat sırasında verilen metil prednizolon dozu retrospektif olarak kaydedilmiştir. Normal yetişkin plazma taurin referans aralığı 45-130 mikromol/L olarak alınmıştır. Bulgular: Otuz dört hastanın yalnızca sekizinde normal plazma taurin düzeyleri saptanmış, diğer hastaların plazma taurin düzeyleri ise düşük bulunmuştur. Ortalama taurin düzeyi 34.30±34.81 mikromol/L’dir. Grup 1’de verilmiş olan metilprednizolon miktarı, Grup 2’de verilen metil prednizolon düzeyinden anlamlı olarak yüksek bulunmuştur (p0.05). Kan şekeri ve taurin değerlerinde de gruplar arasında anlamlı fark bulunmamıştır (p>0.05). Sonuç: Yirmi altı olgunun taurin plazma düzeyi düşüktür. Crp’nin gruplar arasında anlamlı olarak farklı bulunmamış olması inflamasyonun her 2 grupta eşit seviyelerde kontrol edilebildiğine işaret etmektedir. Grup 2’de, Grup 1 ile eşit antiinflamatuar kontrolün sağlanabildiği ve bu grupta verilen metil prednizolon düzeyinin anlamlı olarak daha düşük olduğu (Grup 2 için 8.36±1.04, Grup 1 için 9.78±1.68 mg/kg, p<0.006) görülmüştür. Bu durumda Grup 2’de daha yüksek olarak bulunan plazma taurin aminoasitinin antiinflamatuvar etkiye katkıda bulunmuş olabileceği düşünülebilir. Preoperatif taurin düzeylerini gösteren çalışmalar planlanmalıdır

Hipertrofik Non- Obstrüktif Kardiyomyopatili Olgu- da Gelişen İnfektif Endokardite Bağlı ICD Lead'i ile Üzerindeki Vejetasyonların İnflow Oklüzyon Tekni- ğiyle Başarılı Ekstirpasyonu

ICD lead'i benzeri intrakardiyak yabancı cisimlerdeki mikrobiyal infeksiyon tanımını da içeren infektif endokardit tanı ve tedavideki büyük ilerlemelere rağmen halen sağkalımı düşük yaşamı tehdit eden bir patolojidir. Bu çalışmada hipertrofik non-obstrüktif kardiyomyopatili olguda gelişen infektif endokardite bağlı ICD lead'i ile üzerindeki vejetasyonların inflow oklüzyon tekniğiyle başarılı ekstirpasyon yaklaşımımızı sunmayı amaçladık. Yüksek sağkalım oranı açısından kültürantibiyograma dayalı tüm duyarlı antibiyoterapiye rağmen lead endokarditinde cerrahi ekstirpasyon birincil seçenek olmayı sürdürmektedir. Özellikle inflow oklüzyon tekniğiyle, kardiyopulmoner by pass'ın da majör yan etkilerinden kaçınılarak uygulanacak açık cerrahi ekstirpasyonun güvenilirliği ve etkinliği bu olgu aracılığıyla kanıtlanmaktadırInfective endocarditis, including the microbial infections on ICD lead-like intracardiac foreign bodies, is a life-threatening pathology with poor survival in spite of all advances in diagnosis and treatment. In this study we aimed to present our successful extirpatıon of ICD lead and its vegetations with inflow occlusion technique developing in a hypertrophic non-obstructive cardiomyopathy case secondary to infective endocarditis. Surgical extirpation of the infected lead is still treatment of choice for better survival in lead endocarditis in spite of all susceptible antibiotherapy based on antibiogram. Particularly with inflow occlusion technique, one may avoid major side effects of cardiopulmonary bypass. Open surgical extirpation using this technique is a safe and effective method as proven with this cas