Autologous pericardium may be an alternative carotid patch material in patient with undergoing simultaneous carotid endarterectomy and coronary artery bypass grafting

Backround: Dacron, polytetrafluoroethylene, great saphenous vein, and bovine pericardium are the commonly used as patch materials. However, there is no study about autologous pericardial as a patch material in carotid endarterectomy surgery. We aimed to assess the results of the use of autologous pericardial patch in patients undergoing concomitant carotid endarterectomy and coronary artery by-pass graft surgery. Materials and Methods:: The study involved 30 patients who underwent concomitant carotid endarterectomy with patch angioplasty and coronary artery bypass grafting surgery from January 2016 to February 2020. Patchplasty is performed with autologous pericardium for 13 patients and dacron patch for 17 patients during carotid endarterectomy. Results: No statistical difference was found between the groups in terms of reoperation, arterial occlusion, restenosis, operation time, and neurological events. In the postoperative follow-up, it was determined that the amount of drainage from the area on which the carotid surgery was applied was less in the those in whom autologous pericardium was used compared to those in whom Dacron patch was used. (p=0.001) Conclusion: We concluded that the use of autologous pericardium as a carotid artery patch is a safe, feasible, and effective method in patients undergoing combined carotid artery and coronary bypass surgery

Thromboembolic Disease in Patients With Cancer and COVID-19: Risk Factors, Prevention and Practical Thromboprophylaxis Recommendations–State-of-the-Art.

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currentlyindicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARS-CoV2 remains unclear In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist

Prevention of dabigatran ınduced cytotoxicity by N-acetyl cysteine: An ın vitro study

946-952Dabigatran (DBG) is an oral direct thrombin inhibitor used for prevention of systemic embolism and venous thromboembolism. The major side effect of DBG is gastrointestinal upset. In the present study, we have investigated whether N-acetyl cysteine (NAC) showed a protective effect on dabigatran-induced cytotoxicity in the in vitro setting. The medium not containing DBG but containing NAC were served to assay the effect of NAC on cell proliferation and apoptosis. Comparing DAB and all other groups, the cell viability was the lowest in the D group. However, there was no statistically significant difference between the NAC I and DBG-NAC I group, while the difference was statistically significant compared to all other groups. The cells in the DBG group showed a degenerative and round-shaped morphology with nuclear condensation. In other dilutions, the cell morphology was healthy with a fibroblastic morphology. Based on our study results, NAC at high concentrations exerts cytoprotective effects against DBG, while moderate or low concentrations have no favorable effect on cell viability of NAC. Although using concomitant NAC at appropriate doses appears to be effective agent against dabigatran cytotoxicity in the current study, further experimental and clinical studies are needed to confirm our findings

Surgical Approaches to Symptomatic Arteriovenous Fistula Aneurysms: a Single-Center Experience

Arteriovenous fistulas (AVFs) created for hemodialysis accesses are prone to aneurysmal degeneration. Arteriovenous fistula aneurysms may lead to pain, aesthetic problems, infection, bleeding, and fistula thrombosis. The aim of this study is to report our surgical approaches and outcomes of AVF aneurysms. Medical records of a total of 21 patients (9 males, 12 females) with an AVF aneurysm who underwent surgery at Karabuk Training and Research Hospital, Department of Cardiovascular Surgery between January 2013 and March 2015 were retrospectively analyzed. The mean age was 59.7±13.5 years. Aneurysmectomy was performed on eight patients, while partial aneurysmectomy and polytetrafluoroethylene graft interposition were carried out in four patients. Three patients underwent aneurysmorrhaphy, whereas six patients underwent thrombectomy + aneurysmorrhaphy to the aneurysmatic segment. All patients were discharged without any event at the postoperative second day. They were scheduled for follow-up visits and assessed by Doppler ultrasound. Currently, surgical repair is the gold standard in the treatment of AVF aneurysms. Based on our experience, we recommend surgical interventions for selected patients to maintain AVF continuation. [Med-Science 2016; 5(2.000): 403-10

Immunoserologic Pepsin Detection in The Saliva as a Non-Invasive Rapid Diagnostic Test for Laryngopharyngeal Reflux

Background: The most common tool for the diagnosis of laryngopharyngeal reflux (LPR) is still 24-hours esophageal pH monitoring; there is lack of non-invasive, less expensive and accurate diagnostic tools for this frequent disease. Aims: To evaluate the accuracy of immunoserologic pepsin detection in the saliva for the diagnosis of LPR. Study Design: Cross-sectional study. Methods: A two channeled 24-hour esophageal pH monitoring catheter was placed in patients with a suspicion of LPR. During the 24-hour period, each patient gave one sample of sputum for the immunoserologic pepsin detection test. Pathologic gastroesophageal reflux (GER) findings, LPR findings, pH score in the proximal and distal probes when the sputum sample was given were recorded. The sensitivity, specificity, positive and negative predictive values of the pepsin detection test were analyzed and compared to pH monitoring scores. Results: The study group consisted of 20 patients who met the criteria. A positive pepsin detection test was elicited from 6 patients. The sensitivity and specificity of the pepsin detection test was 33% and 100%, respectively. A positive predictive value of 100% was recorded. When the pH results of the pepsin positive patients (PPP) and the rest of the study group in the proximal probe at the sample time were compared, the PPP had an apparent acidic pH value compared to the pepsin negative patients (pH: 3.26 for the PPP, pH: 6.81 for the pepsin negative patients). Conclusion: Pepsin detection in the saliva is a recent method and becoming increasingly popular. Because of the benefits and ease of application, a positive salivary pepsin test in a patient suspected of having LPR can be a cost effective, accurate and alternative diagnostic method. Increasing the daily number of sputum samples may increase the sensitivity of the test

Acetaminophen Mitigates Myocardial Injury Induced by Lower Extremity Ischemia-Reperfusion in Rat Model

WOS: 000441342700009PubMed: 30043918Objective: The injury-reducing effect of acetaminophen, an effective analgesic and antipyretic on ischemia-reperfusion continues to attract great attention. This study analyzed the protective effect of acetaminophen on myocardial injury induced by ischemia-reperfusion in an experimental animal model from lower extremity ischemia-reperfusion. Methods: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage. Results: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124). Conclusion: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion

First sign of native valve endocarditis in the COVID-19 pandemic: Acute arterial septic embolism in the lower extremity

he clinical manifestations of infective endocarditis are variable. Late diagnosis of the disease can lead to clinical catastrophe and even death. Although its symptomatology is broad, the initial diagnosis can sometimes be made after complications, particularly during COVID-19 pandemic days. It should be noted that during the pandemic period, patients with mild infective endocarditis symptoms may be confused with covid 19 infection symptoms. In this report, we aim to present that lower extremity ischemia was the first sign of infective endocarditis in a 77-year-old female patient with complaints of sudden onset of pain and coldness in the leg. The patient underwent an embolectomy and embolic material of 1x1.5 cm was removed from the left common femoral artery

An unexpected complication of robotic cardiac surgery: Pneumomediastinum

Pneumomediastinum is a rare entity that is defined as free air in the mediastinal space. A 26-year-old male patient was admitted with pneumomediastinum as an unexpected complication of robotic surgery. Diffuse subcutanous emphysema was observed suddenly on Postoperative Day 3 without respiratory distress. Air trapping into the mediastinum was seen on chest X-ray and computed tomography. The patient was followed in the intensive care unit for 7 days and managed conservatively. Subcutaneous emphysema reduced gradually. In conclusion, although it is a rare condition, pneumomediastinum should be kept in mind as a complication of robotic cardiac surgery. Keywords: Atrial septal defect, Cardiac surgery, Pneumomediastinum, Robotic surger

Acetaminophen Mitigates Myocardial Injury Induced by Lower Extremity Ischemia-Reperfusion in Rat Model

Abstract Objective: The injury-reducing effect of acetaminophen, an effective analgesic and antipyretic on ischemia-reperfusion continues to attract great attention. This study analyzed the protective effect of acetaminophen on myocardial injury induced by ischemia-reperfusion in an experimental animal model from lower extremity ischemia-reperfusion. Methods: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage. Results: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124). Conclusion: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion