The Role of Somatostatin Treatment in the Management of Chylous Fistula after Neck Dissection

Chylous fistula is a serious complication of neck dissection. The use of somatostatin after neck surgery, has been described in literature. Because of the absence of definitive guidelines, reporting of our experience in three cases may guide the surgeons to overcome this life threatening complication. We descibe three cases who underwent neck dissection. While two of them had high output (>1000 mL/day), one had a low output (250 mL/ day) chyle leakage, after neck dissection. After it was noticed in earlier days, conservative management was started immediately. While Somatostatin was started after the re-exploration in two, it was started due to the failure of conservative treatment for low output leakage in one. All of the chyleous fistulas were healed within less than two weeks. We think that somatostatin may be considered as an effective treatment in low output chyle fistulas which the leakage continues after conservative treatment; however in high output chyle fistulas, somatostatin should be used in patients due to lack of control of leakage after ligation of thoracic ductus in revision Somatostatin treatment was discussed in the light of the current literature

Aort Koarktasyonu Tanısıyla Cerrahi Düzeltme Uygulanan Hastalarda Rekoarktasyon Gelişimi Üzerine Etki Eden Faktörler

Amaç: Çalışmamızda, aort koarktasyonu (AK) tanısıyla opere edilmiş hastalarda rekoarktasyon gelişimi üzerine etki eden faktörler araştırılmış ve elde edilen sonuçlar ışığında, rekoarktasyon oranlarının azaltılmasına katkıda bulunulması hedeflenmiştir. Gereç ve Yöntem: Bu retrospektif çalşmaya, Hacettepe Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniği’nde 1977-2010 arasında AK tanısıyla cerrahi düzeltme yapılan 358 hastadan, verilerine tam olarak ulaşılabilen ve düzenli olarak takiplerine gelmiş olan 217 hasta dahil edildi. Rekoarktasyon gelişen olgularda cerrahi düzeltme esnasındaki yaş, vücut ağırlığı ve kullanılan cerrahi tekniklerin sonuçları karşılaştırıldı. Veriler istatistiksel olarak değerlendirildi. Kategorik değişkenler için tanımlayıcı istatistikler sayı (n) ve yüzde (%) olarak belirtildi. Sonuçlar ortalama±standart sapma ve/veya yüzde (frekans) cinsinden sunuldu. Alfa anlamlılık değeri <0,05 olarak kabul edildi. Bulgular: Hastaların 147’si (%67,7) erkek, 70’i (%32,3) kadındı. Doksan (%41,4) hasta basit koarktasyon, 127 (%58,6) hasta ise koarktasyon ve eşlik eden kompleks intrakardiyak anomaliler tanıları ile opere edildi. Otuz altı hastada (%16,5) rekoarktasyon tespit edildi. Rekoarktasyon tespit edilen 36 hastadan 21’i (%58,3) balon anjiyoplasti, 10’u (%27,7) cerrahi, 5’i stent implantasyonu (%13,8) ile tedavi edildi. Sonuç: Çalışmamızda vücut ağırlığı <3 kg ve yaşı <1 yaş olan hasta grubunda rekoarktasyon gelişimi istatistiksel olarak anlamlı bulunmuştur. Kullanılan cerrahi teknikler arasındaysa istatistiksel bir anlam tespit edilmemiştir. AK nedeni ile opere edilecek hasta gruplarında vücut ağırlığı <3 kg ve yaşı <1 yaş olan hasta gruplarının post operatif takiplerinde rekoarktasyon gelişimi açısından daha dikkatli olunması gerekmektedir

Assessment of electromechanically stimulated bone marrow stem cells seeded acellular cardiac patch in a rat myocardial infarct model

In this study, we evaluated cardiomyogenic differentiation of electromechanically stimulated rat bone marrow-derived stem cells (rt-BMSCs) on an acellular bovine pericardium (aBP) and we looked at the functioning of this engineered patch in a rat myocardial infarct (MI) model. aBP was prepared using a detergent-based decellularization procedure followed by rt-BMSCs seeding, and electrical, mechanical, or electromechanical stimulations (3 millisecond pulses of 5 V cm-1at 1 Hz, 5% stretching) to enhance cardiomyogenic differentiation. Furthermore, the electromechanically stimulated patch was applied to the MI region over 3 weeks. After this period, the retrieved patch and infarct region were evaluated for the presence of calcification, inflammatory reaction (CD68), patch to host tissue cell migration, and structural sarcomere protein expressions. In conjunction with any sign of calcification, a higher number of BrdU-labelled cells, and a low level of CD68 positive cells were observed in the infarct region under electromechanically stimulated conditions compared with static conditions. More importantly, MHC, SAC, Troponin T, and N-cad positive cells were observed in both infarct region, and retrieved engineered patch after 3 weeks. In a clear alignment with other results, our developed acellular patch promoted the expression of cardiomyogenic differentiation factors under electromechanical stimulation. Our engineered patch showed a successful integration with the host tissue followed by the cell migration to the infarct region

Pulmonary Thromboendarterectomy in Pediatric Patients: Report of Three Cases

Chronic thromboembolic pulmonary hypertension (CTEPH), which occurs due to impartial resolution of the pulmonary thrombus, is a rare type of pulmonary hypertension. However, most patients have an excellent long-term survival following pulmonary thromboendarterectomy (PTE). Pulmonary emboli and associated CTEPH is unusual in the pediatric population and is mostly reveals an underlying thrombophilic state. PTE is also recognized as the best therapeutic option in this subgroup of patients. In this case series, we report three young patients who had successfully undergone PTE due to pulmonary emboli and associated CTEPH.WoSScopu

Implantation Of Left Ventricular Epicardial Leads For Biventricular Resynchronization Through A Single-Port Video-Assisted Thoracoscopy

Cardiac resynchronization therapy is a promising therapeutic option for patients with end-stage heart failure. The preferred method for left ventricular lead implantation is the percutaneous access through the coronary sinus. However, this technique may impose certain technical difficulties due to suboptimal lead positioning. In such cases, a video-assisted thoracoscopic epicardial approach may be a good alternative. To date, video-assisted left ventricular epicardial lead implantation from two or three port incisions have been described. Herein, we present the first successful left ventricular epicardial lead implantation through a simplified single-port video-assisted thoracoscopy technique in Turkey.PubMedWo