Use of a Javid™ shunt in the management of axillary artery injury as a complication of fracture of the surgical neck of the humerus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Axillary artery injury is a rare but severe complication of fractures of the surgical neck of the humerus.</p> <p>Case presentation</p> <p>We present a case of axillary artery pseudoaneurysm secondary to such a fracture, in a 82-year-old white woman, presenting 10 weeks after the initial injury, successfully treated with subclavian to brachial reversed vein bypass together with simultaneous open reduction and internal fixation of the fracture. We discuss the use of a Javid™ shunt during combined upper limb revascularisation and open reduction and internal fixation of the fractured humerus.</p> <p>Conclusion</p> <p>This case highlights the usefulness of a Javid™ shunt, over other forms of vascular shunts, in prompt restoration of blood flow to effect limb salvage. It can be considered as a temporary measure whilst awaiting definitive revascularisation which can be performed following fracture fixation.</p

Effects of alprostadil and iloprost on renal, lung, and skeletal muscle injury following hindlimb ischemia&ndash;reperfusion injury in rats

Dilek Erer,1,* Abdullah &Ouml;zer,1,* H&uuml;seyin Demirtaş,1 İpek Işık G&ouml;n&uuml;l,2 Halil Kara,3 Hande Arpacı,4 Faruk Metin &Ccedil;omu,5 G&uuml;rsel Levent Oktar,1 Mustafa Arslan,6 Ayşeg&uuml;l K&uuml;&ccedil;&uuml;k7 1Department of Cardiovascular Surgery, 2Department of Pathology, Gazi University Medical Faculty, 3Department of Pharmacology, Yıldırım Beyazıt University Medical Faculty, 4Department of Oral and Maxillofacial Surgery, Ankara University Faculty of Dentistry, Besevler, Ankara, 5Department of Physiology, Kırıkkale University Medical Faculty, Kırıkkale, 6Department of Anesthesiology and Reanimation, Gazi University Medical Faculty, Ankara, 7Department of Physiology, Dumlupınar University Medical Faculty, K&uuml;tahya, Turkey *These authors contributed equally to this work Objectives: To evaluate the effects of alprostadil (prostaglandin [PGE1] analog) and iloprost (prostacyclin [PGI2] analog) on renal, lung, and skeletal muscle tissues after ischemia reperfusion (I/R) injury in an experimental rat model.Materials and methods: Wistar albino rats underwent 2 hours of ischemia via infrarenal aorta clamping with subsequent 2 hours of reperfusion. Alprostadil and iloprost were given starting simultaneously with the reperfusion period. Effects of agents on renal, lung, and skeletal muscle (gastrocnemius) tissue specimens were examined.Results: Renal medullary congestion, cytoplasmic swelling, and mean tubular dilatation scores were significantly lower in the alprostadil-treated group than those found in the I/R-only group (P&lt;0.0001, P=0.015, and P&lt;0.01, respectively). Polymorphonuclear leukocyte infiltration, pulmonary partial destruction, consolidation, alveolar edema, and hemorrhage scores were significantly lower in alprostadil- and iloprost-treated groups (P=0.017 and P=0.001; P&lt;0.01 and P&lt;0.0001). Polymorphonuclear leukocyte infiltration scores in skeletal muscle tissue were significantly lower in the iloprost-treated group than the scores found in the nontreated I/R group (P&lt;0.0001).Conclusion: Alprostadil and iloprost significantly reduce lung tissue I/R injury. Alprostadil has more prominent protective effects against renal I/R injury, while iloprost is superior in terms of protecting the skeletal muscle tissue against I/R injury. Keywords: alprostadil, iloprost, ischemia reperfusion injury, rat, renal, lung, skeletal muscl

Assessment of the effects of levosimendan and thymoquinone on lung injury after myocardial ischemia reperfusion in rats

Şaban Cem Sezen,1 Aysegul Kucuk,2 Abdullah &Ouml;zer,3 Yiğit Kılı&ccedil;,4 Barış Mardin,3 Metin Alkan,5 Fatmanur Duruk Erkent,5 Mustafa Arslan,5 Yusuf &Uuml;nal,5 G&uuml;rsel Levent Oktar,3 Murat Tosun6 1Department of Histology and Embryology, Kirikkale University Medical Faculty, Kirikkale, Turkey; 2Department of Physiology, Dumlupinar University Medical Faculty, Kutahya, Turkey; 3Department of Cardiovascular Surgery, Gazi University Medical Faculty, Ankara, Turkey; 4Pediatric Cardiovascular Surgery Clinic, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 5Department of Anaesthesiology and Reanimation, Gazi University Medical Faculty, Ankara, Turkey; 6Department of Histology and Embryology, Afyon Kocatepe University Medical Faculty, Afyonkarahisar, Turkey Aim: The aim of this study was to investigate the effects of levosimendan and thymoquinone (TQ) on lung injury after myocardial ischemia/reperfusion (I/R). Materials and methods: Twenty-four Wistar albino rats were included in the study. The animals were randomly assigned to 1 of 4 experimental groups. In Group C (control group), left anterior descending artery was not occluded or reperfused. Myocardial I/R was induced by ligation of the left anterior descending artery for 30 min, followed by 2 h of reperfusion in the I/R, I/R-levosimendan (24 &mu;g/kg) (IRL) group, and I/R-thymoquinone (0.2 mL/kg) (IRTQ) group. Tissue samples taken from the lungs of rats were histochemically stained with H&amp;E and immunohistochemically stained with p53, Bcl 2, Bax, and caspase 3 primer antibodies. Results: Increased expression of p53 and Bax was observed (4+), especially in the I/R group. In IRTQ and IRL groups, expression was also observed at various locations (2+, 3+). H&amp;E staining revealed that that the lungs were severely damaged and the walls of the alveoli were too thick, the number of areas examined was increased during the evaluation. Caspase 3 expression was observed to be at an (1+, 2+) intensity that was usually weak and diffuse in multiple areas. Bcl 2 was not found to be expressed in any of the tissues. H&amp;E staining revealed that that the lungs were severely damaged in the I/R group, with the walls of the channels and alveoli thickened and edematous, and also an intense inflammatory cell migration was observed. Immunohistochemical staining was more prominent in inflammatory areas and structures around the terminal bronchioles. Conclusion: The findings in our study have shown that administration of levosimendan and TQ during I/R increases expression of caspase 3, p53, and Bax in lung tissue and has a protective effect on lung as distant organ. We suggest that findings of this study be elucidated with further large-scale clinical studies. Keywords: ischemia reperfusion, levosimendan, thymoquinone, lung, caspase 3, p5