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

Vacutainer ve Enjektör ile Kan Alma Tekniğinin Hemoliz Oranına Etkisinin İncelenmesi

Objective: This study was conducted to determine hemolysis rates for venous blood samples drawn by injector and vacutainer holder and to assess the effect of the venipuncture technique on the process of hemolysis. Material and Method: This cross-sectional and analytical study was conducted with 128 patients who were admitted to the Cardiology and Angio clinics of a university hospital and met the inclusion criteria. One group of patients who were to have routine biochemical tests underwent venipuncture with an injector, and another group with a vacutainer. Results: The serum hemolysis level is not significantly different by gender. No significant correlation was found between blood serum hemolysis levels and age or Body Mass Index with blood drawn with an injector or with a vacutainer. While the serum hemolysis level was on average 0.11 g/dl in blood drawn with an injector, the level in blood drawn with a vacutainer was 0.06 g/dl; the difference was not statistically significant. Conclusion: This study revealed that there was no statistically significant difference between hemolysis rates in blood drawn with an injector or with a vacutainer. However, the hemolysis rates in blood drawn with an injector were almost twice the rates noted in blood drawn with a vacutainer, and this difference may be clinically significant. Amaç: Bu araştırma enjektör ve vacutainer kullanılarak alınan venöz kanlarda hemoliz oranını belirlemek ve kan alma tekniğinin hemoliz gelişimi üzerindeki etkisini değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntem: Kesitsel ve analitik tipte olan bu araştırma, bir üniversite hastanesinin Kardiyoloji ve Anjiyo kliniklerine yatışı yapılan ve araştırmaya dahil edilme kriterlerine uyan 128 hasta ile yürütülmüştür. Rutin biyokimyasal tetkikleri istenilen bir grup hastadan enjektörle, diğer gruptaki hastalardan vacutainer ile kan alınmıştır. Bulgular: Serum hemoliz düzeyi cinsiyetler arasında anlamlı olarak farklı değildir. Enjektör ve vacutainer ile alınan kan örneklerindeki serum hemoliz düzeyleri ile yaş ve Beden Kütle İndeksi arasında anlamlı korelasyon saptanmamıştır. Serum hemoliz düzeyi enjektör ile alınan kanlarda ortalama 0.11 g/dl iken vacutainer ile alınan kanlarda ortalama 0.06 g/dl olup bu fark istatistiksel olarak anlamlı bulunmamıştır. Sonuç: Bu araştırmada enjektör ve vacutainer ile alınan kan örneklerindeki hemoliz oranları istatistiksel olarak anlamlı farklılık göstermemiştir. Ancak enjektörle alınan kanlarda ortalama hemoliz oranı vacutainer ile alınan kanlardan neredeyse iki kat fazladır, bu fark klinik açıdan anlamlı olabilmektedir

Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors

Introduction: Preanalytical errors, along the process from the beginning of test requests to the admissions of the specimens to the laboratory, cause the rejection of samples. The aim of this study was to better explain the reasons of rejected samples, regarding to their rates in certain test groups in our laboratory. Materials and methods: This preliminary study was designed on the rejected samples in one-year period, based on the rates and types of inappropriateness. Test requests and blood samples of clinical chemistry, immunoassay, hematology, glycated hemoglobin, coagulation and erythrocyte sedimentation rate test units were evaluated. Types of inappropriateness were evaluated as follows: improperly labelled samples, hemolysed, clotted specimen, insufficient volume of specimen and total request errors. Results: A total of 5,183,582 test requests from 1,035,743 blood collection tubes were considered. The total rejection rate was 0.65 %. The rejection rate of coagulation group was significantly higher (2.28%) than the other test groups (P < 0.001) including insufficient volume of specimen error rate as 1.38%. Rejection rates of hemolysis, clotted specimen and insufficient volume of sample error were found to be 8%, 24% and 34%, respectively. Total request errors, particularly, for unintelligible requests were 32% of the total for inpatients. Conclusions: The errors were especially attributable to unintelligible requests of inappropriate test requests, improperly labelled samples for inpatients and blood drawing errors especially due to insufficient volume of specimens in a coagulation test group. Further studies should be performed after corrective and preventive actions to detect a possible decrease in rejecting sample

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

Do oral amino acid supplements facilitate the healing of rat lung injuries?

OBJECTIVES: Prolonged air leaks following lung injury cause extended hospital stays. This study investigated the effect of nutritional supplements containing arginine, glutamine and beta-hydroxy beta-methyl butyrate, which were theoretically proven to accelerate wound healing, on air leak and wound healing parameters in a rat lung injury model

Increased circulating urocortin-3 levels is associated with polycystic ovary syndrome

This study was aimed to compare serum urocortin-3 (UCN3) levels in women with polycystic ovary syndrome (PCOS) and healthy women, and establish what role UCN3 levels play in PCOS. Fifty-two patients with PCOS and 55 healthy women were included in the study, matched for age and body mass index. Fasting blood glucose (FBG), insulin, hs-CRP, UCN3 and free-testosterone levels of the all participants were measured. HOMA-IR was used to calculate the insulin resistance. Circulating UCN3 levels were significantly increased in women with PCOS than in control subjects (54.49 +/- 5.77 versus 51.28 +/- 5.86 pmol/l, p = 0.005). Serum insulin, hs-CRP and HOMA-IR levels were higher in women with PCOS than in control group. UCN3 levels positively correlated with hs-CRP in PCOS group (r = 0.391, p = 0.004). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curves were 0.732 (95% CI 0.634-0.830, p = 51.46 pmol/l, at which the sensitivity was 75% and specificity was 68%. Our results suggest that there is a potential link between PCOS and UCN3 levels. The results of this study support the presence of increased UCN3 levels for the association of inflammation with PCOS

Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors

Introduction: Preanalytical errors, along the process from the beginning of test requests to the admissions of the specimens to the laboratory, cause the rejection of samples. The aim of this study was to better explain the reasons of rejected samples, regarding to their rates in certain test groups in our laboratory. Materials and methods: This preliminary study was designed on the rejected samples in one-year period, based on the rates and types of inappropriateness. Test requests and blood samples of clinical chemistry, immunoassay, hematology, glycated hemoglobin, coagulation and erythrocyte sedimentation rate test units were evaluated. Types of inappropriateness were evaluated as follows: improperly labelled samples, hemolysed, clotted specimen, insufficient volume of specimen and total request errors. Results: A total of 5,183,582 test requests from 1,035,743 blood collection tubes were considered. The total rejection rate was 0.65 %. The rejection rate of coagulation group was significantly higher (2.28%) than the other test groups (P < 0.001) including insufficient volume of specimen error rate as 1.38%. Rejection rates of hemolysis, clotted specimen and insufficient volume of sample error were found to be 8%, 24% and 34%, respectively. Total request errors, particularly, for unintelligible requests were 32% of the total for inpatients. Conclusions: The errors were especially attributable to unintelligible requests of inappropriate test requests, improperly labelled samples for inpatients and blood drawing errors especially due to insufficient volume of specimens in a coagulation test group. Further studies should be performed after corrective and preventive actions to detect a possible decrease in rejecting sample