Plazma okside edilebilirlik testi koroner kalp cerrahisi geçiren hastalarda antioksidan durumu yansıtmayabilir

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Glutaraldehidin kazara epidural uygulanmasının ağır komplikasyonu

Epidural anestezi altında sol femoropopliteal bypass uygulanan hastaya ameliyat sonrası altıncı saatte epidural kateter yoluyla kazara 3 ml %3 glutaraldehid solüsyonu uygulandı. Glutaraldehid uygulamasını takiben hastada hipotansiyon, taşikardi, bulantı ve kusma gibi sistemik semptomlara ek olarak parapleji gelişti. Bir yıllık medikal tedavi ve rehabilitasyon programı sonunda nörolojik semptomlarda iyileşme olmadı.In a patient operated for left femoropopliteal bypass under epidural anesthesia, 3 ml of 3% glutaraldehyde solution was administered through the epidural catheter at the postoperative sixth hour accidentally. Following glutaraldehyde administration, the patient developed paraplegia in addition to systemic symptoms such as hypotension, tachycardia, nausea and vomiting. At the end of the first year, neurologic symptoms didn't improve despite medical treatment and rehabilitation program

A complication of venous cut-down: Migration of catheter that remained in the vein

Amiyotrofik lateral skleroz tanısıyla takip edilen, parenteral besleme ve tıbbi tedavi amacıyla sol kolda sefalik vene cut-down yaklaşımıyla santral kateterizasyon uygulanan 32 yaşındaki bir erkek hastada, gerekli tedavilerin tamamlanmasından sonra kateterin çekilmesi aşamasında kateter koparak büyük bir kısmı hastanın venöz yapıları içinde kaldı. Posterior-anterior akciğer grafisinde yeri bulunan kateter, subklaviyan venden yapılan venotomi ile çıkarıldı.A 32-year-old male patient who was followed-up with a diagnosis of amyotrophic lateral sclerosis was inserted a catheter into the left arm via cephalic vein cut-down in order to maintain parenteral nutrition and medical treatment. After the treatment, while the catheter was being removed, it was broken and a large part of it remained in the vessel. The catheter was located on a posteroanterior chest radiograph and removed by venotomy of the subclavian vein

Open heart surgery in dialysis-dependent patients with end stage renal failure

Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75%) and nine women(25%) totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76) years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3): 335-338Key words: Cardiac surgery, chronic renal failure, mortalit

Symptomatic huge pericardial cyst: a case report

Mediastinal kistler nadir gözlenen, konjenital, neoplastik ve inflamatuar kaynaklı patolojilerdir. Basit perikardiyal kistler tüm yaş gruplarında görülmekle beraber sıklıkla yetişkin yaş grubunda gözlenmektedir. Perikardiyal kistler tüm mediastinal kistler arasında %7 gibi bir oranda gözlenmektedir. Hastaların kliniği sıklıkla asemptomatik seyretmektedir. Semptomlar nadir gözlenmekle beraber %20-30 olguda semptomatik olup ağrı, nefes darlığı, taşipne ve öksürük en sık gözlenen semptomlardır. Kistin kardiyak basısına bağlı olarak hipotansiyon, aritmi, atrial fibrilasyon ya da ani kardiyak ölüm semptomlarda gözlenebilmektedir. X-ray, bilgisayarlı tomografi, ekokardiografi gibi tetkikler ile saptanmaktadır. Yazımızda 35 yaşında, medikal tedaviye dirençli hipotansiyon, aritmi ve nefes darlığı olan, sağ atriuma bası yapan perikardiyal kist olgusunu sunduk.Mediastinal cysts are uncommon and results from congenital, neoblastic or inflamatuar abnormalities. Pericardial cyst may occur in patients of all ages, but commonly present in adults. The overall incidence of pericardial cyst is 7% in mediastinal cysts. The clinical presentation is commonly asymtomatic. Pain, tachpnea, dsypne and cough is the most common symptoms. Tachycardie, hypotansion, arytmi and sudden death are usually because of cardiac compression by the cystic mass.They are commonly found incidentally upon chest radiography, computed tomography or echocardiograph. We present, herein, the case of a 35-year-old female with a symptoms of dsypne, hypotansion and atrial arrhythmia resistant to medical therapies with finding of a pericardial cyst compression to the lateral wall of the right atrium

The relationship between preoperative plasma total antioxidant capacity and ischemia-reperfusion injury in patients undergoing coronary artery bypass surgery

Amaç: Miyokardiyumda iskemi-reperfüzyon sırasında oluşan hasarın oksidatif stresten kaynaklandığı ileri sürülmektedir. Bu çalışmada bazal total antioksidan kapasite (TAOK) düzeyinin iskemi-reperfüzyon hasarına olan etkisi incelendi. Hastalar ve Yöntemler: Koroner bypass ameliyatı uygulanan 21 hastanın koroner sinüslerinden koroner bypass başlamadan önce (bazal durum), iskemi sonunda, çapraz klemp kaldırıldıktan beş dakika sonra (erken reperfüzyon) ve yan klemp kaldırıldıktan 15 dakika sonra (geç reperfüzyon) kan örnekleri alındı. Total antioksidan kapasite, lipid peroksit (LPO) ve laktat dehidrogenaz (LDH) düzeyleri ölçüldü. Hastalar bazal TAOK düzeyine göre iki gruba ayrıldı: TAOK değeri %60'dan düşük bulunan 10 olgu grup I'i (8 erkek, 2 kadın; ort. yaş 57), %60 veya üzeri olan 11 olgu grup II'yi (10 erkek, 1 kadın; ort. yaş 53) oluşturdu. Bulgular: Ameliyat süresince her iki grupta da LDH ve LPO düzeyleri ameliyat döneminde artarken, TAOK düzeylerinin baskılandığı görüldü. Grup I’de LDH ve LPO salınımı grup II’den fazla idi. Ameliyat öncesi ve ameliyat süresince TAOK düzeyleri grup I'de grup II'den anlamlı derecede düşük bulundu (ameliyat öncesi, iskemi ve erken reperfüzyon dönemleri için p<0.001, geç reperfüzyon dönemi için p<0.05). Bazal TAOK ile LPO arasında tüm evrelerde, LDH ile geç reperfüzyon döneminde negatif ilişki görüldü. Sonuç: Ameliyat öncesindeki düşük TAOK değerlerinin iskemi-reperfüzyon hasarı ve miyokard hasarının şiddetiyle ilişkili olduğu sonucuna varıldı.Objectives: Oxidative stress has been implicated in the occurrence of myocardial injury during ischemia-reperfusion. The aim of this study was to investigate the effect of basal total antioxidant capacity (TAOC) on ischemiareperfusion injury. Patients and Methods: Blood samples were taken from the coronary sinus of 21 patients prior to coronary bypass (basal), at the end of ischemia, five minutes after the removal of the cross clamp (early reperfusion), and 15 minutes after the removal of the lateral clamp (late reperfusion). The levels of TAOC, lipid peroxide (LPO), and lactate dehydrogenase (LDH) were determined. The patients were divided into two groups as follows: group I included 10 patients (8 males, 2 females, mean age 57 years) with TAOC &lt;%60 and group II included 11 patients (10 males, 1 female, mean age 53 years) with TAOC .%60. Results: The levels of LDH and LPO increased, while those of TAOC were suppressed in both groups throughout surgery. The levels of LDH and LPO were higher in group I than those of group II. The TOAC levels in group I were invariably and significantly lower than those of group II (for basal, ischemia, early reperfusion periods, p&lt;0.001; late reperfusion, p&lt;0.05). Inverse relationships were found between the basal TOAC and LPO at all the periods, and with LDH in the late reperfusion period. Conclusion: Our data suggest that basal TAOC values may be associated with ischemia-reperfusion injury and the degree of ensuing myocardial damage

Patient satisfaction with hemodialysis catheter in patients with chronic renal failure

Amaç: Kronik böbrek yetmezliği bulunan, renal transplant yapılamayan hastalar hemodiyaliz bağımlı olarak yaşamaktadır. Hemodiyalize giriş yolu olarak arteriovenöz şant (AV) altın standart yöntemlerdir. AV şant açılamayan ya da AV şant mevcut olup henüz olgunlaşmamış hastalarda hemodiyaliz'e girebilmek için hemodiyaliz kateterleri kullanılmaktadır. Hemodiyaliz kateterleri sıklıkla femoral, subklaviyan ve juguler venlere uygulanmakla beraber nadir olarak torakolomber yaklaşımla inferior vena kavaya da takılmaktadır. Çalışmamızda hemodiyaliz amacıyla kullanılan kateterlerin hasta memnuniyeti ve yaşam kalitesine etkilerini incelemeyi amaçladık. Yöntem: Kliniğimizde ocak 2011- mayıs 2012 yılları arasında hemodiyaliz amacıyla arteriyovenöz şant açılan ve katater takılan topla 139 hasta çalışmaya alındı. Hastalardan 91 erkek 48 kadın, yaş ortalaması 60,85 ±14,6 (min: 54, max:83) idi. Hastalar arasında demografik olarak anlamlı fark yoktu. Bu hastalar ile tek tek görülerek takılan kateter ve bölgelere göre menuniyet durumları araştırıldı. Bulgular: Takılan kataterlere bağlı olarak olguların %69.06'da herhangi bir şikayet gözlenmedi. En sık gözlenen şikayet ağrı olup olguların %17.9'da bu şikayet mevcut idi. Diğer şikayetler sırası ile %9.3 olguda görünümünden rahatsız olma ve %3.5 olguda yaşam kalitesinin olumsuz etkilenme olarak belirlendi. Komplikasyon olarak %10.7 oranında katater yeri enfeksiyonu ve %9.3 oranında katater oklüzyonu tespit edildi. Femoral bölgeye takılan kataterlerin enfeksiyon oranı %85 oranında tespit edildi. Sonuç: Kronik böbrek yetmezliği bulunan olgularda hemodiyaliz amacıyla katater takılacağı durumlarda öncelikli olarak juguler bölgenin tercih edilmesi gerektiği, juguler bölgenin uygun olmadığı durumlarda yüksek enfeksiyon oranları sebebiyle subklaviyan bölgenin ve en son seçenek olarak femoral bölgenin tercih edilmesi gerektiğini düşünüyoruz. Katater takılacak bölge ve oluşabilecek şikayetler hakkında hastaların bilgilendirilmesinin hasta memnuniyetini arttıracağı kanaatindeyizPurpose: Patients with chronic renal failure, for whom renal transplantation is not an option, depend on hemodialysis for life. An Arteriovenous shunt is the gold standart access site for hemodialysis. In patients without an AV shunt or with an immature shunt, a hemodialysis catheter is used. Subclavian, femoral and juguler veins are common sites for hemodiaylsis catheter. Patients may have different complaints with the catheter according to the insertion site. In our study, we aimed to investigate the impact of the site of the catheter on patients' comfort and social lives. Method: Between January 2011 and May 2012, 48 women and 91 men (139 patients) who underwent AV shunt operation in our clinic. The mean age of the patients was 60.85&plusmn;14.6(min:54, max:83) years. Every patient was interviewed individually about his comfort and satisfaction with the catheter.There were no statistically significant demographic differences among patients. Results: When insertion of a hemodialysis catheter is planned in patients with chronic renal failure, internal juguler vein is the optimum site and should be preferred in the first line. In cases which juguler vein is not available, subclavian vein is the next preferred site and he femoral vein, due to its high rates of infection, is the last place to choose for the insertion of a hemodialysis catheter. Conclusion: We believe that informing patients about the site of the catheter and the possible disadvantages will improve the patient satisfaction

The Role of Chlamydia pneumoniae in the Atherosclerotic Process of Patients under 50 Years of Age Who Underwent Coronary Artery Bypass Graft Surgery

ABSTRACT Background: To evaluate the presence of C. pneumoniae DNA in the tissues and C. pneumoniae DNA antibodies in the blood samples of patients who underwent CABG surgery. Material and Methods: Fifty-one patients &lt;50 years of age were included in the study, and analyzed in two groups according to the intimal thickness of aorta. C. pneumoniae DNA was evaluated in the tissues collected from the atrium, left internal thoracic artery and ascending aorta of patients. Results: Although, C. pneumoniae DNA was negative in the atrial and left internal thoracic artery tissues of all patients, it was positive in the tissues obtained from the ascending aortas of twelve patients. C. pneumoniae DNA positivity was significantly higher in patients with increased aortic intimal thickness compared to those without increased aortic thickness. Conclusion: The question whether C. pneumoniae is triggering atherosclerosis or is involved as a superinfection could not be clarified

Evaluation of treatment activity in patients with deep venous thrombosis

Amaç: Derin venöz sistemde trombüs oluşumu ve venöz akımın kesilmesi derin ven trombozu (DVT) olarak adlandırılmaktadır. Çalışmada DVT tanısı alan hastalarda tedavi sonuçlarını değerlendirmeyi amaçladık. Yöntem: Kliniğimizde kasım 2010 mayıs 2012 tarihleri arasında doppler ultrasonografi ile derin ven trombozu tanısı almış toplam 73 hasta çalışmaya alındı. Hastaların yaş ortalaması 55.205 ± 18.12 (Min: 22, Max: 84) idi. Hastalara standart DVT tedavisi uygulandı. Olgular tarafımızdan 6. ay'da doppler ultrasonografi ile venöz sistemleri tekrar değerlendirildi. Hastalar etyolojik faktörlere göre incelendi. Bulgular: Otuz hasta cerrahi sonrası yetersiz profilaksi, 9 hasta malignite, 34 hasta ise idiyopatik idi. 39 olguda sol alt ekstremite, 21 olguda sağ alt ekstremite ve 13 olguda ise her iki alt ekstremitede derin ven trombozu mevcuttu. 6 ay sonunda doppler ultrasonografi ile tüm hastaların tromboze ven segmenti değerlerdirildi. 54 olguda (%73) tromboza ait radyolojik bulgu kalmamış olup, 12 olguda (%16.4) rekanalize tromboze segment, 7 olguda (%8.5) ise trombozun devam ettiği görülmüştür. Sonuç: Derin ven trombozu tedavisi ve profilaksisinin yeterli yapılması rekürrensi azaltırken rekanalizasyon ve tromboz lizisini arttırmaktadır. Olguların mortalite ve morbiditesinin azalmasını sağlamaktadır.Purpose: Deep vein thrombosis (DVT) refers to thrombi formation and blood stasis in the deep veins of the extremities. This study was to determine the effectiveness of DVT treatment in our clinic. Method: All of 73 patients who diagnosed Deep Venous Thromboses with dupplex ultrasoun between december 2010 and may 2012, at our institution were enrolled in this study. The mean age of the patients was 55.205 &plusmn; 18.12 (Min: 22, Max: 84). Standart DVT treatment was applied. We re-evaluated the change in deep venous system using follow-up Dupplex ultrasonography after 6 months.The patients were observed according to etiology. Results: Etiologic factors were insufficient prophylaxis after surgery (30 patients), malignancy (9 patients) and idiopathic (34 patients). Deep venous thrombosis existed left lower extremity (n=39), right lower extremity (n=21) and bilateral lower extremity (n=13). Thrombosis vein segment of all patients were evaluated with duplex ultrasonography after 6 months. Radiologic findings of thrombosis disappeared in 54 patients (73%). Thrombosis segment were recanalization in 12 patients (16.4%). Thrombosis was not recovery in 7 patients (8.5%). Conclusion: If treatment and prophylaxis of deep venous thrombosis perform enough, recurrence decreases and recanalization and lysis of thrombosis increase. Eventually mortality and morbidity of cases decrease

The long outcome in patients with carotico-subclavian bypass surgery for subclavian steal syndrome

OBJECTIVE: In our study we aimed to evaluate long term outcome of carotico-subclavian bypass surgery in patients with subclavian steal syndrome. MATERIALS and METHODS: We evaluated the patients who underwent caroticosubclavian bypass surgery between the years 1999 and 2011 in our clinic. Total number of patients was 6 (5 female and 1 male). The mean age of the patients was 60.8±2.1 (48- 78). The patients presented with claducatio of upper extremities, headache, dizziness, and differences in arterial pressure between two arms. RESULTS: There were no complications after the carotico-subclavian bypass surgery. The differences in arterial pressure between the two arms disappeared together with the symptoms after the surgery. CONCLUSION: Carotico-subclavian bypass surgery is a procedure with low mortality and morbidity rates and good long term outcomes in patients with subclavian steal syndrome