The evaluation of arterial and venous grafts with intraoperative flowmeter techniques in coronary artery bypass grafting operations

Amaç: Çalışmada, koroner arter cerrahisinde kullanılan greftlerin intraoperatif Transit Time Akım Ölçüm (TTFM) Cihazı ile değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Koroner arter bypass greft (CABG) operasyonu uygulanan 59 hasta çalışmaya alındı. Sol internal mammaryan arter (LİMA) ve safen ven greft olarak çıkartılarak koroner bypass anastomozları gerçekleştirildi. Kardiyopulmoner bypasstan çıkıldıktan sonra Transit Time Flow Meter cihazı ile her bir greften geçen akım miktarı mililitre/dakika olarak, akım eğrisi eş zamanlı olarak ve greftin pulsatilite indeksi (PI) ve diyastolik doluş yüzdesi (%DF) otomatik olarak ölçüldü. Bulgular: Hastaların ortalama greft sayısı 3.25±0.8 idi. Toplam 187 greftte Transit Time Flow Ölçümü yapıldı. En yüksek ortalama akım 55.5 ml/dk ile aorta-RCA sistemde saptanırken en düşük ortalama akım ise 37.6 ml/dk ile aorta-diagonal sistemde ölçüldü. İki hastada toplam 2 greftte (%3.38) akımda yetersizlik saptandı. Sonuç: Transit Time Flow Ölçümü (TTFM), cerrahi esnasındaki teknik yetersizliklerin saptanmasında önemli katkıları olan bir yöntemdir. Perioperatif olarak greft yetersizliğinin saptanması ile küçük girişimlerle, genellikle hatanın düzeltilmesi ve yeterli greft akımının sağlanması mümkün olabilmektedir.Objective: The purpose of this study was to evaluate the coronary artery bypass grafts with Transit Time Flowmeter (TTFM). Material and Methods: Fifty-nine patients who were scheduled for coronary artery bypass graft (CABG) surgery were included in the study. Coronary artery bypass anastomoses were performed using the left internal mammary artery (LIMA) and saphenous vein. At the end of the cardiopulmonary bypass, graft flow (ml/min), pulsatility index (PI), flow curve and diastolic filling percentage (DF%) of each graft were assessed with TTFM. Results: Mean graft number of the patients was 3.25±0.8. We assessed the patency of a total of 187 grafts using TTFM. Highest mean flow was 55.5 ml/min in aorta-RCA grafts and lowest mean flow was 37.6 ml/min in aorta-diagonal grafts. Revision was required for two grafts (3.38%) in two patients based on inadequate TTFM findings. Conclusion: Transit time flowmeter is an important technique that provides the detection of technical errors during surgery. With the detection of graft failure intraoperatively, revision of the graft and restoration of blood flow could be performed

Comparison and evaluation of experimental mediastinitis models: precolonized foreign body implants and bacterial suspension inoculation seems promising

BACKGROUND: Post-sternotomy mediastinitis (PSM) is a devastating surgical complication affecting 1–3% of patients that undergo cardiac surgery. Staphylococcus aureus is one of the most commonly encountered bacterial pathogen cultured from mediastinal samples obtained from patients with PSM. A component of the membrane of the gram positive bacteria, lipoteichoic acid, stimulates the blood monocytes and macrophages to secrete cytokines, radicals and nitrogen species leading to oxido-inflammatory damage. This seems to be responsible for the high mortality rate in PSM. For the evaluation of the pathogenesis of infection or for the investigation of alternative treatment models in infection, no standard model of mediastinitis seems to be available. In this study, we evaluated four mediastinitis models in rats. METHODS: The rats were divided into four groups to form different infection models. Group A: A suspension of 1 × 10(7 )colony-forming units Staphylococcus aureus in 0,5 mL was inoculated from the right second intercostal space into the mediastinum. Group B: A hole was created in the right second intercostal space and a piece of stainless-steel implant with a length of 0.5 cm was inserted into the mediastinum and a suspension of 1 × 10(7 )cfu bacteria in 0,5 mL was administered via the tail vein. Group C: Precolonized stainless-steel implant was inserted into the mediastinum. Group D: Precolonized stainless-steel implant was inserted into the mediastinum and the bacteria suspension was also injected into the mediastinum. On the 10(th )day, rats were sacrificed and the extension of infection in the mediastenae was evaluated by quantitative cultures. Myeloperoxidase activity (MPO) and malondialdehyde (MDA) levels were determined in the sera to evaluate the neutrophil activation and assess the inflammatory oxidation. RESULTS: The degree of infection in group C and D were 83.3% and 100% respectively (P < 0.001). MDA levels were significantly higher in these two groups than the others (P < 0.001). CONCLUSION: Infected implants and high bacterial concentration administration were the two important components that played a significant role in the outcome of a successful infection in mediastinum in a rat model

Damar yaralanmaları ve cerrahi tedavi sonuçları

TEZ946Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2006.Kaynakça (s. 55-61) var.61 s. ; 30 cm.

Spontaneous Rupture of Splenic Artery Aneurysm: Case Report

Asemptomatik ancak rüptüre olduğunda oldukça ölümcül olabilen splenik arter anevrizmalarının acil durumlarda tedavisi önemli bir klinik antitedir. Bu yazıda; acil servise karın ağrısı, hipotansif atak ve nefes darlığı ile başvuran 60 yaşında bir kadın olgu sunuldu. Bilgisayarlı tomografi ve arteriyografi sonrası distal splenik arter hizasında rüptüre anevrizma tespit edildi. Batında yaygın sıvısı, sol hemitoraksta plevral sıvısı olan hipotansif hastaya, acil cerrahi müdahale ile anevrizma rezeksiyonusplenektomi uygulandı.The treatment of asymptomatic splenic artery aneurysms, which can be fatal when ruptured, is an important clinical entity in emergency situations. In this paper, a 60-year-old woman who admitted to emergency service with the abdominal pain, hypotensive attack and dyspnea was presented. Ruptured aneurysm was detected at the level of distal splenic artery on computerized tomography and arteriography. During emergency surgery, aneurysm resection and splenectomy were performed in the patient with a diffuse abdominal effusion, left hemithorax pleural effusion and hypotensio