Antioxidant Actions of Thymoquinone, Silymarin, and Curcumin on Experimental Aortic Ischemia-Reperfusion Model in Wistar Albino Rats

ABSTRACT Introduction: Medical improvements are needed to prevent ischemia-reperfusion injury in thoracoabdominal aortic surgery. The aim of this study was to determine the antioxidant effects of thymoquinone, silymarin, and curcumin against ischemia-reperfusion injury associated with abdominal aorta. Methods: Twenty-five Wistar albino rats were included in the study. Sham, control, and treatment (thymoquinone, silymarin, and curcumin) groups were set in equal numbers. Ischemia-reperfusion was applied by clamping (120 minutes) and de-clamping (60 minutes) the infrarenal aorta of all groups, except the sham group. Before reperfusion, thymoquinone, silymarin, and curcumin were given intraperitoneally to the treatment groups. After reperfusion, blood samples were taken from the right ventricle. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in serum samples and histopathological examination was performed on the gastrocnemius muscle. Results: There was a significant difference in TOS and OSI values between the control and sham groups. Both values were found higher in the control group than in the sham group (P<0.05). OSI values were found to be lower in the thymoquinone group compared to the control group (P<0.05). All three parameters were found to be lower in the silymarin group than in the control group (P<0.05). TAS and TOS levels were found to be higher in the curcumin group than in the control group (P<0.05). There was no histopathological difference between the groups. Conclusion: Silymarin and thymoquinone administration decreases oxidative stress in experimental aortic ischemia-reperfusion injury. Antioxidant effect of curcumin was lower than silymarin and thymoquinone.

The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass

Abstract Introduction: Halting ventilation during cardiopulmonary bypass (CPB) is implemented to operate in a less bleeding setting. It sustains a better visualization of the operation area and helps to perform the operation much more comfortably. On the other hand, it may lead to a series of postoperative lung complications such as atelectasis and pleural effusion. In this study, we investigated the effects of low tidal volume ventilation on inflammatory cytokines during CPB. Methods: Twenty-eight patients undergoing cardiovascular surgery were included in the study. Operation standards and ventilation protocols were determined and patients were divided into two groups: patients ventilated with low tidal volume and non-ventilated patients. Plasma samples were taken from patients preoperatively, perioperatively from the coronary sinus and postoperatively after CPB. IL-6, IL-8, TNF-α and C5a levels in serum samples were studied with enzyme-linked immunosorbent assay (ELISA) kits. Results: C5a, IL-6, IL-8 and TNF-α were similar when compared to the low tidal volume ventilated and non-ventilated groups (P>0.05) Comparing the groups by variables, IL-6 levels were increased during CPB in both groups (P=0.021 and P=0.001), and IL-8 levels decreased in the ventilation group during CPB (P=0.018). Conclusion: Our findings suggest that low tidal volume ventilation may reduce the inflammatory response during CPB. Although the benefit of low tidal volume ventilation in CPB has been shown to decrease postoperative lung complications such as pleural effusion, atelectasis and pneumonia, we still lack more definitive and clear proofs of inflammatory cytokines encountered during CPB.

Antioxidant Actions of Thymoquinone, Silymarin, and Curcumin on Experimental Aortic Ischemia-Reperfusion Model in Wistar Albino Rats.

INTRODUCTION: Medical improvements are needed to prevent ischemia-reperfusion injury in thoracoabdominal aortic surgery. The aim of this study was to determine the antioxidant effects of thymoquinone, silymarin, and curcumin against ischemia-reperfusion injury associated with abdominal aorta. METHODS: Twenty-five Wistar albino rats were included in the study. Sham, control, and treatment (thymoquinone, silymarin, and curcumin) groups were set in equal numbers. Ischemia-reperfusion was applied by clamping (120 minutes) and de-clamping (60 minutes) the infrarenal aorta of all groups, except the sham group. Before reperfusion, thymoquinone, silymarin, and curcumin were given intraperitoneally to the treatment groups. After reperfusion, blood samples were taken from the right ventricle. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in serum samples and histopathological examination was performed on the gastrocnemius muscle. RESULTS: There was a significant difference in TOS and OSI values between the control and sham groups. Both values were found higher in the control group than in the sham group (P<0.05). OSI values were found to be lower in the thymoquinone group compared to the control group (P<0.05). All three parameters were found to be lower in the silymarin group than in the control group (P<0.05). TAS and TOS levels were found to be higher in the curcumin group than in the control group (P<0.05). There was no histopathological difference between the groups. CONCLUSION: Silymarin and thymoquinone administration decreases oxidative stress in experimental aortic ischemia-reperfusion injury. Antioxidant effect of curcumin was lower than silymarin and thymoquinone.

The Effect of Low Tidal Volume Ventilation on Inflammatory Cytokines During Cardiopulmonary Bypass.

INTRODUCTION: Halting ventilation during cardiopulmonary bypass (CPB) is implemented to operate in a less bleeding setting. It sustains a better visualization of the operation area and helps to perform the operation much more comfortably. On the other hand, it may lead to a series of postoperative lung complications such as atelectasis and pleural effusion. In this study, we investigated the effects of low tidal volume ventilation on inflammatory cytokines during CPB. METHODS: Twenty-eight patients undergoing cardiovascular surgery were included in the study. Operation standards and ventilation protocols were determined and patients were divided into two groups: patients ventilated with low tidal volume and non-ventilated patients. Plasma samples were taken from patients preoperatively, perioperatively from the coronary sinus and postoperatively after CPB. IL-6, IL-8, TNF-α and C5a levels in serum samples were studied with enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: C5a, IL-6, IL-8 and TNF-α levels were similar when compared to the low tidal in volume ventilated and non-ventilated groups (P>0.05). Comparing the groups by variables, IL-6 levels were increased during CPB in both groups (P=0.021 and P=0.001), and IL-8 levels decreased in the ventilation group during CPB (P=0.018). CONCLUSION: Our findings suggest that low tidal volume ventilation may reduce the inflammatory response during CPB. Although the benefit of low tidal volume ventilation in CPB has been shown to decrease postoperative lung complications such as pleural effusion, atelectasis and pneumonia, we still lack more definitive and clear proofs of inflammatory cytokines encountered during CPB.

Surgical Repair of Internal Carotid Artery Aneurysm: Case Report.

Extracranial carotid artery aneurysms are extremely rare aneurysms. Treatment options are conventional open surgery, endovascular surgery, and conservative treatment. Surgical treatment of such aneurysms is challenging and it is important to determine the treatment strategies wisely. There is still no definite association for treatment modalities. In this case report, we present open surgical treatment of a 58-year-old female patient with internal carotid artery aneurysm. The patient was admitted to our clinic with spontaneous pulsatile mass in the right jugular region. Computed tomography angiography shown right internal carotid artery aneurysm. Aneurysm cranial distance was enough to perform end to end anastomosis. Aneurysm was excised by preserving cranial nerves. No complications developed during the postoperative period.

Micro-RNA gene expressions during cardiopulmonary bypass.

INTRODUCTION: Cardiopulmonary bypass (CBP) is the most widely used method in cardiac surgery. During the CPB procedure, studies are conducted to maintain myocardial perfusion adequacy, reduce oxidative stress caused by immune reactions, and understand the longevity of the procedure. Recently, microRNAs (miRNAs) have come to the fore to understand the changes in the CPB. In vivo studies have shown that many different miRNAs regulate critical signaling molecules including cytokines, growth factors, transcription factors, proapoptotic, and antiapoptotic proteins. Our study aims to investigate the changes of miR-34a, miR-15a, and miR-320a gene expression in extracorporeal circulation. METHODS: Fifteen patients who underwent elective open-heart surgery were included in the study. Serum plasma samples were taken from the patients preoperatively, at the time of CPB, and at 24 h postoperatively. Gene expression of miR-34a, miR-15a, and miR-320a in plasma samples was studied. Differences in gene expression were compared. RESULTS: miR-15a gene expression increased during CPB compared with preoperative levels (p < .001). This increase was decreased after the operation (p < .05). miR-34a gene expression increased significantly during CPB (p < .01). Similar to the other two gene expressions, miR-320a gene expression was significantly increased during CPB (p < .01). CONCLUSIONS: miRNAs may play a key role in the initiation and maintenance of pathophysiological cascades during CPB. Our study showed the gene expression of miR-34a, miR-15a, and miR-320a in the CPB process. Our study will be a pioneer among future studies to investigate the molecular pathophysiology of the CPB process.

Unusual Hydatid Cysts: Cardiac and Pelvic-Ilio femoral Hydatid Cyst Case Reports and Literature Review.

INTRODUCTION: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. METHODS: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. CONCLUSION: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

Unusual hydatid cysts: cardiac and pelvic-ilio femoral hydatid cyst case reports and literature review

Abstract Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

Bioelectrical Impedance Analysis for Monitoring Fluid and Body Cell Mass Changes in Patients Undergoing Cardiopulmonary Bypass.

OBJECTIVE: To evaluate preoperative and postoperative body fluid distribution with a bioelectrical impedance analyzer in patients undergoing cardiopulmonary bypass. METHODS: Fifteen adult patients undergoing cardiopulmonary bypass were included in this study. Total body fluid changes, basal metabolism rates, body fat masses, lean body masses, and total cell masses were recorded. The patients' values were measured before anesthesia, after anesthesia, after sternotomy, at the 5th, 30th, and 60th minutes of cardiopulmonary bypass, and on the 1st, 3rd, and 5th postoperative days. All values were compared with preoperative values. RESULTS: Total body fluid changed significantly after cardiopulmonary bypass (P<0.01). Metabolic velocity significantly changed compared to preoperative measurements (P<0.05). Fat mass and lean body mass also changed significantly. Body mass index and phase angle did not change significantly (P>0.05). CONCLUSION: Changes in body fluids during and after cardiopulmonary bypass are inevitable. The increase in total body weight shows that this fluid load shifts to the extracellular space during bypass and the fluid load in this area passes into the intravascular area in the early postoperative period. This may cause edema and dysfunction in the major organs. Therefore, the fluid balance should be adjusted very carefully, especially during the bypass phase and the early postoperative period.

Bioelectrical impedance analysis for monitoring fluid and body cell mass changes in patients undergoing cardiopulmonary bypass

Abstract Objective: To evaluate preoperative and postoperative body fluid distribution with a bioelectrical impedance analyzer in patients undergoing cardiopulmonary bypass. Methods: Fifteen adult patients undergoing cardiopulmonary bypass were included in this study. Total body fluid changes, basal metabolism rates, body fat masses, lean body masses, and total cell masses were recorded. The patients' values were measured before anesthesia, after anesthesia, after sternotomy, at the 5th, 30th, and 60th minutes of cardiopulmonary bypass, and on the 1st, 3rd, and 5th postoperative days. All values were compared with preoperative values. Results: Total body fluid changed significantly after cardiopulmonary bypass (P<0.01). Metabolic velocity significantly changed compared to preoperative measurements (P<0.05). Fat mass and lean body mass also changed significantly. Body mass index and phase angle did not change significantly (P>0.05). Conclusion: Changes in body fluids during and after cardiopulmonary bypass are inevitable. The increase in total body weight shows that this fluid load shifts to the extracellular space during bypass and the fluid load in this area passes into the intravascular area in the early postoperative period. This may cause edema and dysfunction in the major organs. Therefore, the fluid balance should be adjusted very carefully, especially during the bypass phase and the early postoperative period.

Relationship Between Echocardiographically Evaluated Aortic Stiffness and Prolidase Activity in Aortic Tissue of Patients with Critical Coronary Artery Disease.

BACKGROUND AND AIMS: The aim of this study was to determine the relationship between echocardiographically evaluated aortic stiffness and prolidase activity in aortic tissue of patients with critical coronary occlusion. METHODS: Thirty six patients with coronary artery disease (CAD) scheduled for CABG and 30 control patients with no CAD proven angiographically were enrolled in this study. Plasma prolidase activities were quantified spectrophotometrically. During performance of the proximal anastomoses in the study group, a piece of aortic tissue was taken by punch and tissue prolidase activity was quantified spectrophotometrically and also evaluated pathologically by prolidase immunostaining. Eventually, the correlation of plasma prolidase activity, aortic tissue prolidase activity and aortic prolidase immunohistochemical staining with aortic stiffness was studied. RESULTS: The correlation of aortic stiffness with aortic tissue prolidase activity (rs = 0.364; p = 0.029) and aortic prolidase immunohistochemical staining (rs = 0.354; p = 0.034) was significant in the study group. However, the correlation of plasma prolidase activity with aortic stiffness was not statistically significant (rs = 0.083; p = 0.292). Linear regression analysis showed that the aortic stiffness ß index was significantly associated with aortic tissue prolidase activity (ß = 0.354; p = 0.034) and statin usage (ß = -0.334; 0.047) in the study group. Regression analysis revealed that ATPA and statin use were predictors of aortic stiffness, and API+ was found to be the predictor for ATPA (ß = 0.449; p = 0.006). CONCLUSION: Aortic tissue prolidase activity was more significant than plasma prolidase activity and aortic tissue prolidase immunohistochemical staining in the relationship with aortic stiffness in the critical CAD group.

Spondylolisthesis mimicking the progression of dissection in a case of chronic Stanford type B aortic dissection.

Aortic dissection is an acute lethal cardiovascular condition. A 67-year-old hypertensive woman was admitted to our Emergency Department with an abrupt onset of tearing pain in the interscapular area. A thoracic computed tomography scan with contrast showed chronic type B aortic dissection. The patient was transferred to intensive care and medical therapy was initiated. Upon spread of the pain to the lumbar area, the dissection was thought to have progressed. The patient, being hemodynamically stable, was examined using ultrasonography, and the dissection did not show any progression. In the neurological examination for the lumbar pain, the lumbar processus spinosus was found to be sensitive, and the sciatic nerve stretch test was positive at 30 degrees. Magnetic resonance imaging revealed spondylolisthesis and a centrally located disc herniation at the L3-4 level. No operation for the dissection was planned, but discectomy and fusion surgery was scheduled. Since the patient refused surgery, she was discharged with medical therapy. Our aim in this report was to emphasize the importance of spondylolisthesis mimicking the progression of dissection in the differential diagnosis of a chronic type B aortic dissection case.

Acute cardiac tamponade due to spontaneous bleeding in a child with haemophilia A.

In severe haemophilia A, patients, start from the first years of life, with spontaneous bleeding and require transfusion. However, cardiac tamponade due to spontaneous pericardial bleeding is rare. An 11-year-old boy receiving haemophilia A treatment was referred to the Department of Paediatric Haematology with pneumonia, fever, dyspnoea, and palpitation. In his PA chest radiograph, pneumonic infiltration in the right lung and enlargement in the pericardial area were found. On his echocardiograph, pericardial effusion reaching 3.9 cm and other findings of tamponade were detected. APTT was outside the measurable range. It was deranged to > 120 seconds. The patient received 1000 U of factor VIII intravenously. A pericardial window was made via left anterior mini thoracotomy due to fluid drained. In his control echocardiograph taken after one month, no pathology was found. At 50th day, the patient showed left pleural serohaemorrhagic effusion, which was treated with tube thoracostomy. In haemophilia A patients, either pericardiocentesis or subxiphoid pericardial drainage or pericardial window creation via thoracotomy may be applied, depending on the primary pathology. In paediatric cases, pericardial window creation via mini thoracotomy can be an alternative treatment of choice considering complications such as recurring bleeding and effusion during pericardiocentesis.

Penetrating cardiac trauma in children.

BACKGROUND: Penetrating cardiac traumas in children are dramatic and fatal. Many of the patients are admitted to hospital either in a state of shock or they are dead at presentation. In this study, we aimed to present our experience in penetrating cardiac trauma in children. METHODS: Seventeen pediatric cases of penetrating cardiac trauma were retrospectively evaluated. The effects on the results of the demographic characteristics of patients, etiology of penetrating trauma, time of presentation to the hospital, physical examination findings in the emergency department, diagnostic methods used, and the surgical techniques applied were evaluated. RESULTS: The male to female ratio of the 17 retrospectively evaluated cases was 16:1, with an age range of 3-15 years. The patients' mean age was 12.94+/-3.52 years. In all patients, the penetrating cardiac trauma was due to incisive/penetrating tools. The mean Ivatury physiologic index score was 8.23+/-0.78, whereas the mean cardiac injury organ scale score was 5.00+/-0.00. The hospital mortality rate was 5.9% due to the loss of one patient. CONCLUSION: Shock may develop in pediatric penetrating cardiac trauma in a short time due to hemorrhage and/or cardiac tamponade. The prime factors for patient survival are early diagnosis and emergency thoracotomy.

[Penetrating cardiac injuries: analysis of the mortality predictors]. / Penetran kalp yaralanmalari; mortalite belirleyicilerinin analizi.

BACKGROUND: Penetrating cardiac injuries are a dramatic and lethal form of trauma. Most of these patients reach the hospital already dead or in severe shock. The prognosis is determined by early diagnosis and operation. In this study, we discuss the effects of the etiology of trauma, the state of presentation in the emergency department, and the treatment approaches on the morbidity and mortality in penetrating cardiac trauma treated in our clinic. METHODS: Fifty-two patients treated due to penetrating cardiac injury were investigated retrospectively. Demographic characteristics, etiology of the injury, arrival time at the hospital, physical examination findings in the emergency room, diagnostic methods used, and surgical methods applied were determined along with the results. RESULTS: The male to female ratio was 48:4, and mean age was 27.86+/-13.73. The etiology was stab injury in 46, gun shot injury in four and iatrogenic trauma in two patients. Surgery was applied in emergency condition for all cases. Cardiac injury was repaired using primary repair technique. Hospital mortality was determined as 15.4% (8 patients). CONCLUSION: Penetrating cardiac injuries lead to shock in a very short period of time because of bleeding and/or pericardial tamponade. Early diagnosis and prompt thoracotomy are the fundamental factors affecting patient outcome after penetrating cardiac injury.

Arterial thrombosis and thalidomide.

Arterial emboli are largely a reflection of cardiac disease. Thalidomide is an antiangiogenic drug used in cancer therapy. Venous thrombosis incidence increased during treatment with thalidomide. We reported arterial thrombosis in two cases with multiple myeloma implemented in thalidomide treatment. Standard emergency intervention was applied. In the postoperative period, enoxiparine was given to all the patients. Warfarin treatment was started in the level of INR 2-2,5. ASA with a dose of 100 mg/day was added to the treatment. In conclusion, this side effect of the use of thalidomide should be taken into consideration while doing examinations with respect to the etiology in arterial thromboembolism and because of this vascular complication that threatens life; we suggest stopping the thalidomide treatment.

Effects of the diabetic patients' perceived social support on their quality-of-life.

AIM: The aim of this descriptive study was to determine effects of the diabetic patients' perceived social support on theirs life qualities. BACKGROUND: Type 2 diabetes and its treatment effects patients' quality of life. Quality-of-life is important for people with diabetes and their health care providers. Social support for diabetic adults has been shown to benefit disease management and adjustment. RESEARCH DESIGN: This research was conducted with 66 type 2 diabetic patients who came for control to the diabetes policlinic between May and June 2003 at diabetes polyclinic in Kocaeli State Hospital of Marmara Region in Turkey. Informed consent was obtained from patients. Data were collected by using the quality-of-life scale (SF-36), perceptional social support scale and the questionnaire prepared by the researchers. METHOD: For the analysis of data, Mann-Whitney U-test, Kruskal-Wallis test, Pearson and Spearman correlation analysis have been employed. RESULTS: Perceived social support and quality-of-life were increased together. Male patients' and retired patients' quality life score and perceived social support were high. Meanwhile when educational level was increased, perceived social support and quality-of-life were increased. The quality life scores and perceived social support scores were high in patients who living alone and used oral antidiabetic drugs. CONCLUSIONS: If perceived social support and quality-of-life were increased together, it means social support increases quality-of-life. That is why nurses must try to plan some strategies for increase social support of patients. RELEVANCE TO CLINICAL PRACTICE: Assessment of social support of type 2 diabetic patients may assist in determining individualized goals and strategies. Enhanced social support in diabetes self-management may subsequently improve metabolic control, self-management and psychosocial adjustment to diabetes.