Influence of ıschemic preconditioning and n-acetylcysteine on ınflammatory process in rat skeletal muscle ıschemia-reperfusion

OBJECTIVE: Skeletal muscle ischemia-reperfusion (I/R) injury is a complex process in which the inflammatory mechanisms play important role. Ischemic preconditioning (IPC) and reactive oxygen radical scavenger N-acetylcsyteine (NAC) have been shown to attenuate I/R injury. We aimed to investigate the effects of IPC and NAC on I/R induced inflammation and the influence of synchronous application. MATERIALS and METHODS: Thirty-five Sprague-Dawley rats were randomly assigned to five groups. In sham group, infrarenal aorta was isolated without induction of ischemia. In control group, ischemia was induced for 120 min, followed by reperfusion for 50 minutes. In IPC group, three cycles of 10 min ischemia, followed by 10 min reperfusion was formed preceding I/R. NAC group rats received an intravenous NAC (20 mg/kg) at the end of ischemic period and a maintenance dose of 20mg/kg/hr throughout the reperfusion. In IPC+NAC group, an equal amount of NAC was administered in an identical time period during IPC. Blood samples were obtained at the end of reperfusion for analysis of IL-1β, IL-6 and TNF-α level then rats were sacrificed. RESULTS: All serum cytokine levels which were analyzed in this study were found to be significantly increased in control group in comparison with sham group. Although cytokine levels in the study groups were moderately increased as compared with sham group, all of three groups had significantly reduced levels than control group. There were no significant differences between the study groups regarding the serum cytokine levels. CONCLUSION: These findings indicate that inflammation plays an essential role in skeletal muscle I/R injury. Our results suggested IPC and NAC exert beneficial effects on I/R induced inflammatory process in skeletal muscle. It was observed that there was no superiority of either of the measures over each other regarding the serum cytokine levels and concomitant use of them did not generate an additional benefit

Primary chondrosarcoma of the chest wall: a case report

Göğüs duvarında kondrosarkom tanısı alan bir olgu klinikopatolojik bulgularla sunulmaktadır. 48 yaşındaki kadın hasta göğüs ön duvarında ağrılı kitle şikayetiyle kliniğe başvurdu ve bu alanda 17x14x11 cm boyutlarında kitle saptandı. Kitle total olarak eksize edildi. Toraks duvarında oluşan defekt mersilen mesh ve metil metakrilat sandviç greft ile rekonstrukte edildi. Histolojik inceleme sonucu derece I kondrosarkom tanısı kondu. Göğüs duvarının primer malign tümörleri nadirdir, kondrosarkom göğüs duvarının en sık görülen primer malign tümörüdür.Tedavisinde geniş cerrahi eksizyon uygulanmaktadır.A case with chondrosarcoma of the chest wall is presented with clinicopathological findings. A 48-year-old woman, presenting with a painful anterior chest wall mass measuring 17x14x11 cm in size was admitted to the hospital. Complete surgical resection of the tumor was performed. The resulting defect of the chest wall was restored with mersilene mesh and methyl methacrylate sandwich graft. Histological examination showed grade I chondrosarcoma. Primary cartilaginous tumors of the chest wall are uncommon. Chondrosarcoma is the most common primary malignant tumor of the chest wall. The treatment for this tumor is wide excision

A 22 q11.2 deletion case with multiorgan failure

The 22q11.2 deletion syndrome is a genetic disorder seen inone out of every 4,000-6000 live births. The effects of the deletion can include a variety of physical findings, such as heart problems, cleft palate, facial dysmorphism, tymic hypoplasia, hypocalcemia, immune deficiency, developmental issues, including learning difficulties. The case was the second born child of 33 year old healthy mother by Caesarian section at 37 weeks of gestation. Birth weight of the baby girlwas 3400 g. She was referred to our unit on her first day due to respiratory distress. She had diffuse edema, cutis marmoratus and low set ears. Her oral orifice was small and the mouth was pulled downward on one side while crying. She was tachypneic, grunting. She had cyanosis, retractions, nasal flaring and hepatomegaly. Femoral pulses were weak. She had hypocalcemia, metabolic acidosis, hyperuricemia, hyperkalemia, abnormal renal function tests. Thymic shadow was absent on chest x-ray. Thrombocytopenia and giant thrombocytes were seen on peripheral blood smear. PTH level was normal. Interrupted aortic arch type-B was detected by echocardiographic examination and prostoglandin infusion was started. 22q11.2 deletion was detected by FISH examination. Interrupted aortic arch cases may be present with metabolic acidosis, edema, hepatomegaly and multiorgan failure during newborn period. 22q11 deletion should be considered in interrupted aortic arch cases with accompanying features such as characteristic facial appearance, thymic aplasia, hypocalcemia, giant thrombocytes and surgical team should be informed

Causes of reoperation after mitral carpentier ring annuloplasty: report of five cases

Mitral kapak tamiri, mitral yetmezliğinde tercih edilen bir tedavi yöntemidir. Bu çalışmada Carpentier ringi ile mitral anüloplasti yapılan olgularda reoperasyon nedenleri tartışılmıştır. Carpentier ringi ile mitral anüloplasti uygulanan ve geç dönemde reoperasyon uygulanan toplam 5 olgu çalışmaya alınmıştır. Olguların tümü kadın ve yaş ortalaması 44.611.2 (32-58) yıl olup, iki cerrahi prosedür arasında geçen ortalama süre 3228.4 aydır (7-78 ay). Olguların tümünde romatizmal kardit öyküsü mevcut olup, mitral rekonstrüksiyon öncesi dördünde orta-ileri derecede mitral yetmezliği, birinde ise ileri mitral darlığı olduğu saptanmıştır. Mitral rekonstrüksiyon sırasında ilave prosedür olarak bir olguya aort valv replasmanı, diğer dört olguya trikuspit anüloplasti uygulanmıştır. Reoperasyon endikasyonu üç olguda ileri derecede mitral yetmezliği, diğer ikisinde 3. derece mitral yetmezliği ile birlikte mitral darlığının varlığıdır. Olguların birinde reoperasyon ilk ameliyattaki prosedür ile ilgili iken, dördünde romatizmal hastalığın kronik bulgularının ilerlemesine bağlı idi. Tüm olgulara mekanik bileaflet mitral kapak protezi ile replasman uygulandı. Reoperasyonda ek olarak bir olguya aort kapak re-replasmanı, beş olgunun tümünün trikuspid kapağına anüloplasti uygulandı, ikisinde ring kullanıldı. Postoperatif erken dönemde bir olgu kaybedildi. Dört olgunun erken dönem takiplerinde mitral protez kapaklarının normal fonksiyonda olduğu, bir olguda minimal, üç olguda orta derecede trikuspid yetmezliği olduğu, tüm olgularınNYHAfonksiyonel sınıf I-II olduğu görüldü. Bu çalışma Carpentier ringi ile mitral rekonstrüksiyonu yapılan olgularda, geç dönemde reoperasyon nedeninin daha çok kapaktaki patolojinin progresyonu veya yetersiz cerrahi teknik ile ilgili olduğunu ve bu olguların reoperasyon sonrası erken dönem sonuçlarının iyi olduğunu düşündürmektedir.Mitral valve reconstruction is the treatment of choice in mitral regurgitation. In this study, the causes of reoperation following mitral reconstruction with Carpentier ring annuloplasty are discussed. : Five patients who underwent reoperation late after mitral ring annuloplasty with Carpentier ring were reviewed. Patients were all female, mean age was 44.6 11.2 (range 32 58 years) and the mean interval between the two procedures was 32 28.4 (range 7-78) months. All patients had history of rheumatic fever. Prior to mitral reconstruction, four patients had moderate to severe mitral regurgitation, one patient had severe mitral stenosis. Associated procedures were aortic valve replacement in one patient, tricuspid annuloplasty in four patients during mitral reconstruction. Indications for reoperation were severe mitral regurgitation in three patients and third degree regurgitation with mitral stenosis in two. The reasons for reoperation for the failed mitral reconstruction were procedure related in one patient and progression of the rheumatic disease in four patients. All patients underwent mitral valve replacement with mechanical bileaflet prosthesis. Associated procedures were aortic valve re-replacement in one patient, tricuspid annuloplasty in all five patients, ring was used in two. One patient died in hospital. In early follow-up, all four surviving patients were found to be in NYHA functional class I-II and have normally functioning mitral prosthesis. One patient had minimal, three patients had moderate tricuspid regurgitation. This study considered that the reason for reoperation for failed mitral reconstruction is mainly related with the progression of mitral valve pathology or inadequate surgical technique and early results of reoperation of these patients are good

Diltiazem added blood cardioplegia and myocardial protection

Amaç: Bu çalıışmanın amacı Ca++ antagonisti olan diltiazemin kardiyoplejik solüsyona eklenmesinin myokard korunmasındaki etkilerinin araıştırılmasıdır. Yöntem: Aortakoroner bypass operasyonu uygulanan 30 elektif hasta, kontrol ve çalıışma grubu olarak 15 er kiışilik 2 gruba ayrıldı. Kontrol grubunda yaış ortalaması (56.8±10.11), çalıışma grubunda ise (60.20±10.44) idi. Her iki grup arasında koroner lezyon, X- klemp, Kardiyopulmoner bypass (CPB) süreleri açısından fark saptanmadı. Kardiyopleji iki gruba da antegrad yoldan verildi. Hemodinamik ölçümler ve enzim tayinleri CPB öncesi ve sonrasında ayrı ayrı değerlendirildi. Bulgular: Kardiyoplejik solüsyona eklenen diltiazem ile hemodinamik parametrelerden CO ve CI deki 1. ve 6. saatlerdeki düışük bulundu(p<0,05).Buna rağmen, stroke volüm indeks ve sol ventriküler stroke work indeks de değiışiklik saptanmadı. CPK-MB düzeylerinde 6.- 12. ve 24. saatlerde diltiazem verilen grupta anlamlı düışme saptanmııştır(p<0,05). ıki grup arasında hastaların hemodinamisinde klinik olarak fark gözlenmemiıştir. Sonuç: Bu bulgular, kardiyoplejik solüsyona eklenen diltiazem ile hemodinamik parametrelerde bozulma olmadığı ve CPK-MB düzeylerinde anlamlı düışme saptanmıış olması, kalsiyum antagonistlerinden diltiazemin kardiyoplejik solüsyona eklenmesinin miyokardial koruma ve reperfüzyon hasarını önlemede önemli katkısı bulunduğunu göstermektedir.Objective: The aim of this prospective study was to demonstrate the effect of diltiazem, a calcium channel blocker, as an additive to cardioplegic solution in myocardial protection. Methods: Thirty patients who underwent coronary artery bypass grafting on an elective basis were divided into two groups: control group and diltiazem group (n=15, each). Diltiazem was added to the blood cardioplegic solution in the diltiazem group. Mean age was 56.8+10.11 years in the control group and 60.20+10.44 in the diltiazem group. There was no difference in the extent of coronary artery disease, cross-clamp time, cardiopulmonary bypass (CPB) time between the two groups. Cardioplegic solution was delivered antegradely. Hemodynamics and blood enzyme levels were measured before and following CPB. Results: In the diltiazem group, cardiac output and cardiac index was found to be lower in postoperative 1st and 6th hours (p<0.05). However, there was no difference in stroke volume index and left ventricular stroke work index values. Blood creatine kinase MB (CK-MB) isoenzyme levels were found to be lower in the diltiazem group in 6th, 12th, and 24th hours postoperatively (p<0.05). Patient hemodynamics did not differ clinically in either group. Conclusion: These results demonstrate the beneficial effects of diltiazem addition to blood cardioplegic solution on myocardial protection as evidenced by lower levels of CK-MB in the postoperative period

Effects of blood cardioplegia with deferroxamine on myocardial nitric oxide production and myocardial performance

Amaç: Bu çalişmada rutin kullanilan kan kardiyoplejisi ile deferoksaminli kan kardiyoplejisinin sol ventrikül fonksiyonlari üzerine etkileri, myokardiyal Nitrik Oksit (NO) düzeyleri ve hemodinamik parametreler karşilaştirilarak değerlendirildi. Yöntem: Aortakoroner bypass operasyonu olan 20 elektif hasta üzerinde çalişma yapildi. Hastalar kontrol ve çalişma grubu olarak 10 ar kişilik 2 gruba ayrildi. Kontrol grubunda yaş ortalamasi (61.30+2.12), çalişma grubunda ise (53.20±3.21) idi. Her iki grupta distal anastomoz , X- klemp, Kardiyopulmoner bypass (CPB) süreleri benzer değerlerdeydi (p>0.05). Kardiyopleji iki gruba da antegrad yoldan verildi. Kan örnekleri koroner sinüsten alinarak ölçümler yapildi. Hemodinamik parametreler CPB öncesi ve sonrasinda ayri ayri değerlendirildi. Bulgular: Çalişma grubunda NO düzeyleri tüm örneklemelerde yüksek bulundu ancak yalnizca CPB sonrasinda istatistiksel olarak anlamli idi. Myokard hasarinin bir göstergesi olan kreatin kinaz MB izoenzim (CK-MB) değerleri çalişma grubunda daha düşük düzeyde bulundu (p< 0.05). Her iki grup arasinda hemodinamik olarak bir farklilik gözlenmedi. Sonuç: Bu bulgular, deferroksaminli kan kardiyoplejisi kullanilan vakalarda endotel fonksiyonlarinin daha iyi korunduğunu ve myokard hasarinin daha az olduğunu göstermektedir. Deferroksaminli kan kardiyoplejisi açik kalp cerrahisinde aortik kross klemp esnasindaki myokard korunmasinda iyi bir seçenektirObjective: The effects of deferroxamine addition to routine blood cardioplegia on left ventricular function, myocardial nitric oxide (NO) production and hemodynamics were assessed. Methods: Twenty patients who underwent coronary artery bypass grafting (CABG) electively were studied in two groups, 10 in each. Ten patients in whom routine blood cardioplegia was used served as controls. In the other 10 patients (study group), blood cardioplegia with deferroxamine was used. Mean age was 61.30+2.12 in the control group, and 53.20±3.21 in the study group. The number of distal anastomoses, X-clamp and cardiopulmonary bypass (CPB) times were similar in two groups. Cardioplegia was delivered antegradely in both groups. Blood samples were taken from the coronary sinus. Hemodynamic measurements were done before and following CPB. Results: In the study group, myocardial NO levels were found to be higher at all sampling times, however, the difference was statistically significant only following CPB. Creatine kinase MB isoenzyme levels reflecting the degree of myocardial injury were measured lower in the study group postoperatively(p<0.05). There was no difference in hemodynamics between the two groups. Conclusions: These findings demonstrate that the addition of deferroxamine to blood cardioplegic solution maintains higher myocardial NO levels indicating better endothelial function and causes less myocardial injury. Blood cardioplegia with deferroxamine is a valuable alternative method of myocardial protection during aortic cross clamping in cardiac surgery

Effects of ıschemic preconditioning and postconditioning in a rat model of lower extremity ıschemia-reperfusion in early phase

PURPOSE: Ischemia-reperfusion injury is a major cause of morbidity and mortality in cardiovascular surgery. The aim of this study was to evaluate the protective effects of ischemic pre- and post conditioning and concomittant application of these two methods in a rat model of lower extremity ischemia-reperfusion (IR). MATERIALS and METHODS: Male Wistar-Albino rats (n=40) were divided into five groups. Sham group (n=8) underwent laparotomy but no ischemia. The infrarenal aorta was cross-clamped for 120 min. followed by 60 min. reperfusion in control (IR) (n=8) group. In ischemic post conditioning group (n=8) a period of ischemia for 5 min. followed by reperfusion for 5 min.repeated three times was formed at the beggining of repefusion. Three cycles of 10 min. of ischemia followed by 10 min of reperfusion was formed before IR in the ischemic preconditioning (n=8) group. In an other group synchronous application of pre- and post conditioning (n=8) was achieved. At the end of the reperfusion period, biopsy of the left gastrocnemius muscle was performed for determination of tissue malondialdehyte (MDA) and nitric oxide (NO) levels and blood samples were withdrawn for analysing serum cytokine (TNF-α, IL 1-β, IL-6) levels. RESULTS: Tissue MDA levels were observed to be lower as compared with the control group and it was significantly reduced in the post-conditioning group. TNF-α level was lowest in the post-conditioning group. Interleukin 1-β was found to be significantly lower in all groups as compared with the control group. In the preconditioning and synchronous pre- and postconditioning groups MDA levels were lower than the level in control group. CONCLUSION: Although the results were not statistically significant it was observed that there was a tendency towards reduced tissue injury in models of ischemic conditioning. These findings suugested that further studies are needed in order to clarify the effects of ischemic conditioning

Myokardiyal nitrik oksit ve kardiyak performans üzerine deferoksaminli kan kardiyoplejisinin etkileri

Objective: The effects of deferroxamine addition to routine blood cardioplegia on left ventricular function, myocardial nitric oxide (NO) production and hemodynamics were assessed. Methods: Twenty patients who underwent coronary artery bypass grafting (CABG) electively were studied in two groups, 10 in each. Ten patients in whom routine blood cardioplegia was used served as controls. In the other 10 patients (study group), blood cardioplegia with deferroxamine was used. Mean age was 61.30+2.12 in the control group, and 53.20;plusmn;3.21 in the study group. The number of distal anastomoses, X-clamp and cardiopulmonary bypass (CPB) times were similar in two groups. Cardioplegia was delivered antegradely in both groups. Blood samples were taken from the coronary sinus. Hemodynamic measurements were done before and following CPB. Results: In the study group, myocardial NO levels were found to be higher at all sampling times, however, the difference was statistically significant only following CPB. Creatine kinase MB isoenzyme levels reflecting the degree of myocardial injury were measured lower in the study group postoperatively(p;lt;0.05). There was no difference in hemodynamics between the two groups. Conclusions: These findings demonstrate that the addition of deferroxamine to blood cardioplegic solution maintains higher myocardial NO levels indicating better endothelial function and causes less myocardial injury. Blood cardioplegia with deferroxamine is a valuable alternative method of myocardial protection during aortic cross clamping in cardiac surgery.Amaç: Bu çalışmada rutin kullanılan kan kardiyoplejisi ile deferoksaminli kan kardiyoplejisinin sol ventrikül fonksiyonları üzerine etkileri, myokardiyal Nitrik Oksit (NO) düzeyleri ve hemodinamik parametreler karşılaştırılarak değerlendirildi. Yöntem: Aortakoroner bypass operasyonu olan 20 elektif hasta üzerinde çalışma yapıldı. Hastalar kontrol ve çalışma grubu olarak 10’ar kişilik 2 gruba ayrıldı. Kontrol grubunda yaş ortalaması (61.30+2.12), çalışma grubunda ise (53.20±3.21) idi. Her iki grupta distal anastomoz , X- klemp, Kardiyopulmoner bypass (CPB) süreleri benzer değerlerdeydi (p>0.05). Kardiyopleji iki gruba da antegrad yoldan verildi. Kan örnekleri koroner sinüsten alınarak ölçümler yapıldı. Hemodinamik parametreler CPB öncesi ve sonrasında ayrı ayrı değerlendirildi. Bulgular: Çalışma grubunda NO düzeyleri tüm örneklemelerde yüksek bulundu ancak yalnızca CPB sonrasında istatistiksel olarak anlamlı idi. Myokard hasarının bir göstergesi olan kreatin kinaz MB izoenzim (CK-MB) değerleri çalışma grubunda daha düşük düzeyde bulundu (p 0.05). Her iki grup arasında hemodinamik olarak bir farklılık gözlenmedi. Sonuç: Bu bulgular, deferroksaminli kan kardiyoplejisi kullanılan vakalarda endotel fonksiyonlarının daha iyi korunduğunu ve myokard hasarının daha az olduğunu göstermektedir. Deferroksaminli kan kardiyoplejisi açık kalp cerrahisinde aortik kross klemp esnasındaki myokard korunmasında iyi bir seçenektir