The outcome of peripartum cardiomyopathy patients-single center experience.

OBJECTIVE: Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction. BACKGROUND: The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end-points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all-cause mortality. METHOD: Outpatient HF records between 2008 to 2021 were screened. Thirty-seven patients were defined as PPCM. Twenty-five patients had CMR evaluation at the time of diagnosis, and six patients were re-evaluated with CMR. RESULTS: The mean age was 30.5 ± 5.6 years, and the mean LVEF was 28.2% ± 6.7%. In 13(35.7%) patients, LVEF recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days. LVEF on CMR was 35.3 ± 10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub-endocardial and mid-wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non-compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9 ± 35.4, 86.4 ± 7.5, p = .003; 86.8 ± 34.6, 52.6 ± 7.6, p = .006), respectively. The median follow-up time was 2129 (IQR [911-2634]) days. The primary endpoint-free 1-year survival was 88.9% (event rate 11.1%), and 5-year survival was 75.7% (event rate 24.3%). CONCLUSION: In a retrospective cohort of PPCM patients, 35.7% of patients' LVEF recovered, and the primary end-point of free-5-year survival was 75%. Twenty-five patients were assessed with CMR; three of four met the Petersen CMR-derived LVNC at initial evaluation.

Characteristics and Outcomes of Psychiatric Inpatients With Severe Mental Illness and COVID-19: Experience From a COVID-19-Specific Acute Psychiatric Ward in Istanbul.

ABSTRACT: Recent studies indicated that psychiatric inpatients with severe mental illness (SMI) are at a greater risk of morbidity and mortality from COVID-19. However, there is still little data about the impact of comorbid COVID-19 infection on the course and outcome of acute exacerbations in this population. We conducted a prospective historically matched case control study. The sociodemographic and clinical characteristics of acute psychiatric inpatients with SMI and comorbid COVID-19 (n = 21) were compared with those of historically-matched non-COVID-19 controls with SMI (n = 42). The outcomes for acute inpatients with SMI and COVID-19 were also investigated. The new-onset SMI rate was relatively higher (23.8%) in the COVID-19 group, which has characteristics similar to those of the non-COVID-19 group except for working status (p < 0.05). The COVID-19 group had a high rate of relapse (47.6%) within 6 months of discharge. Our study suggests that patients with SMI who contracted SARS-CoV-2 may have a higher rate of new-onset mental disorder. Considering the high rate of relapse during the pandemic, chronically ill patients with SMI and COVID-19 should be closely monitored after discharge.

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown.

BACKGROUND: We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. METHODS: A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. RESULTS: The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. CONCLUSION: Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.

Surgical treatment of Ebstein anomaly in pediatric patients: A 10-year single-center study.

OBJECTIVE: We report the early and long-term results of the strategies and surgical methods used in our center to treat pediatric patients who underwent surgical intervention to correct Ebstein anomaly (EA) in our center. MATERIALS AND METHODS: In our study, a consecutive sample of 29 patients who underwent surgery for EA between February 2011 and February 2020 in our center were evaluated retrospectively. RESULTS: The 29 patients underwent a total of 40 operations. Univentricular repair was performed in 5 (17.2%), 1.5 ventricular repair in 5 (17.2%), and biventricular repair in the remaining 19 (65.5%) patients. Cone reconstruction (CR) was performed in eight (27.5%), non-Cone tricuspid valve (TV) repair technique in five (17.2%), ring annuloplasty in two (6.9%), and TV replacement in two patients (6.9%) who had undergone biventricular repair. In two patients (6.9%), only close an atrial septal defect. Two (6.9%) patients underwent a second operation for advanced tricuspid regurgitation (TR) in the early period. None of the 15 patients who underwent CR and TV plasty had moderate or advanced TR before discharge. Early mortality was seen in 1 (3.4%) patient. The mean follow-up period of the patients was 48.4±27.6 months. Three (10.7%) of the patients who were discharged after their first operation later underwent a second operation for TV regurgitation in the long term. No mortality was observed in any patient during long-term follow-up. CONCLUSION: Surgical treatment of EA is difficult, but its overall results are good. The anatomical repair rate is lower in neonatal and infant patients requiring surgery, but most of these patients underwent biventricular repair. Our long-term results demonstrated an acceptable survival rate, low mortality in the early postoperative period, and low incidence of re-intervention and morbidity.

Seroprevalence of coronavirus disease 2019 (COVID-19) among health care workers from three pandemic hospitals of Turkey.

COVID-19 is a global threat with an increasing number of infections. Research on IgG seroprevalence among health care workers (HCWs) is needed to re-evaluate health policies. This study was performed in three pandemic hospitals in Istanbul and Kocaeli. Different clusters of HCWs were screened for SARS-CoV-2 infection. Seropositivity rate among participants was evaluated by chemiluminescent microparticle immunoassay. We recruited 813 non-infected and 119 PCR-confirmed infected HCWs. Of the previously undiagnosed HCWs, 22 (2.7%) were seropositive. Seropositivity rates were highest for cleaning staff (6%), physicians (4%), nurses (2.2%) and radiology technicians (1%). Non-pandemic clinic (6.4%) and ICU (4.3%) had the highest prevalence. HCWs in "high risk" group had similar seropositivity rate with "no risk" group (2.9 vs 3.5 p = 0.7). These findings might lead to the re-evaluation of infection control and transmission dynamics in hospitals.

Cardiac resynchronization therapy in paediatric patients with congenital heart disease: single centre with 10 years of experience.

OBJECTIVES: In recent years, cardiac resynchronization therapy (CRT) has also started to be performed in the paediatric and CHD population. This study aimed to evaluate the efficacy of CRT in children with CHD. PATIENTS AND METHODS: Patients with CHD who underwent CRT treatment in our paediatric cardiology clinic between January, 2010 and January, 2020 were included in the study. Demographic findings, 12-lead electrocardiograms, echocardiograms, clinical characteristics, management strategies, and outcomes were reviewed systematically. RESULTS: The study population consisted of 18 CHD patients who had been treated with CRT for 10 years in our institution. The median age was 11 years (2.2-18 years) and the median weight was 39 kg (10-81 kg). Systemic ventricle was left ventricle in 13 patients, right ventricle in 4 patients, and 1 patient had single-ventricle physiology. CRT implantation indications were as follows: dysfunction after permanent pacemaker in 11 patients, dysfunction after left bundle branch block in 4 patients, and systemic ventricular dysfunction in 3 patients. CRT implantation techniques were epicardial (n = 13), hybrid (n = 4), and transvenous (n = 1) methods. QRS duration significantly decreased after CRT implantation (160 versus 124 m/second, p < 0.05). Median systemic ventricle ejection fraction (EF) significantly increased after the procedure (30 versus 50%, p < 0.05). Fourteen patients (78%) were responders, two patients (11%) were superresponders, and two patients (11%) were non-responders after the CRT treatment. One patient deceased during follow-up. Median follow-up duration was 40 months (6-117 months). CONCLUSION: When electromechanical dyssynchrony occurs in paediatric cases with CHD and developing heart failure, patients should be evaluated in terms of CRT to improve ventricular function. Alternative CRT therapy will be beneficial in these cases that do not improve clinically despite optimal medical treatment.

Adverse drug reactions associated with concurrent acute psychiatric treatment and Covid-19 drug therapy.

OBJECTIVE: Psychiatric patients are at increased risk of contamination, morbidity, and mortality associated with COVID-19, together with potentially more pronounced adverse effects. We present and discuss the adverse effects observed in an acute psychiatric clinic that has admitted COVID-19 patients during the first three months of the pandemic in Turkey. METHODS: The COVID-19 treatment schemes were formed in accordance with the national and regional guidelines at the time of admittance, which were mainly based on the use of hydroxychloroquine and other drugs. The sample consisted exclusively of inpatients, and all patients were enrolled in the study regardless of their specific diagnosis or treatment schemes. RESULTS: 4 out of 23 patients (17.4%) had experienced adverse effects, two of which had mild hepatic enzyme elevation and one had mild sinus bradycardia. Of note is that we haven't encountered any serious complications or life-threatening events during inpatient treatment. The most emphasised adverse effect in the literature, namely QTc prolongation and ECG changes, were not observed in our sample. The adverse effects were not found to be significantly associated with patient-related factors nor dose of antipsychotic medication. CONCLUSIONS: From our point of view, non-cardiac adverse effects should not be overlooked while treating comorbid psychiatric and COVID-19 patients.KEY POINTSAcute inpatient psychiatric treatment of patients who have comorbid COVID-19 is a complex situation requiring multidisciplinary action.Adverse drug reactions, which may or not result from the interaction of psychiatric and COVID-19 treatment, should be of concern for this patient group.While there is controversy over the benefits of some of the off-label COVID-19 medications, there should also be discussion over safety and concomitant medication use.In order to be adequately prepared for future escalations of COVID-19 pandemic, psychiatric services should thoroughly evaluate their initial experience with COVID-19, including from the point of drug effectiveness and safety.

The effects of Vasoactive-Ventilation-Renal score on pediatric heart surgery.

OBJECTIVE: The effects of Vasoactive-Ventilation-Renal (VVR) score on the evaluation of pediatric heart surgery results were investigated in this study. METHODS: This retrospective study included children younger than 18 years of age who were operated for congenital heart disease between was July 1st- December 31st 2018. Patients who needed ECMO support at the first postoperative 72 hours were not included in the study group. The postoperative initial, 24th and 48th-hour Vasoactive-Inotrope Score (VIS) and VVR scores of all patients were calculated in the intensive care unit (ICU). The effects of these scores on lengthy ICU duration (PCILOS, duration more than the upper 25th percentile) and to the hospital mortality (before 30 days) were evaluated. RESULTS: There were 340 patients in this study. The median age was 12 months (1 day-18 years), and the median weight was 7 kg (2.5 -82 kg). 18% of the patients had single ventricle physiology. Total correction was performed in 88% of the patients. Median RACHS 1 score was 2 (1-6). PCILOS was>112 hours and total mortality was 4%. The 0th hour VVR ICU c index=0.73 (CI: 0.70-0.77), mortality c index=0.77 (CI: 0.69-0.85). VVR at 24th hour ICU c index=0.75 (CI: 0.71-0.79), mortality c index=0.86 (CI: 0.81-0.91). VVR at 48th-hour ICU c index=0.87 (CI: 0.82-0.92), mortality c index=0.92 (CI: 0.87-0.97). The VVR score at 48th-hour was a strong indicator for the prediction of both LICU duration (odds ratio [OR]: -1.44; p=0.001) and hospital mortality (OR: -1.28; p=0.001). CONCLUSION: The postoperative VVR score can be a strong determinant for the prediction of early clinical results in congenital heart disease patients, which were considerably a heterogeneous group.

Short- and midterm outcomes of aortic arch reconstruction: Beating heart versus cardiac arrest.

OBJECTIVES: We aimed to compare the short- and midterm results of perfusion strategies used for arch reconstruction surgery. MATERIAL AND METHODS: One hundred and seventy-three consecutive patients who underwent aortic arch reconstruction surgery for transverse arcus hypoplasia between January 2011 and February 2020 were retrospectively analyzed. The patients were divided into two groups, as beating heart (BH) group and cardiac arrest (CA) group. RESULTS: The CA group comprised 60 (35%) patients and the remaining 113 (65%) patients were in the BH group. The median age of the patients was 30 (interquartile range: 18-95) days. The incidences of acute renal failure (ARF) and delayed sternal closure were higher in the CA group (p = .05, <.001, respectively). Balloon angioplasty was performed in 5 (2%) patients and reoperation was performed in 11 (6%) patients due to restenosis. There were no statistically significant differences between the two groups in terms of reoperation or reintervention rates (p = .44 and .34, respectively). CONCLUSIONS: Both strategies were associated with satisfactory midterm prevention of reintervention and reoperation. Given the lower incidence of ARF and delayed sternal closure in the postoperative period and similar midterm outcomes, we believe that the BH strategy is preferable.

Surgical Strategies and Results for Repair of Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals: Experience of a Single Tertiary Center.

OBJECTIVE: To evaluate surgical management and results of patients with pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). METHODS: We reviewed a consecutive series of patients with PA/VSD/MAPCAs between January 2012 and October 2018. Study patients were separated into Group A, efficient MAPCAs; Group B, hypoplastic MAPCAs; Group C, severe hypoplastic MAPCAs at all divisions; and Group D, distal stenosis at most MAPCAs divisions. RESULTS: Thirty-six patients were included in the study. Median age at operation time was 5.5 months (2-110 months), median weight was 8 kg (2.5-21 kg), and median number of MAPCAs was three (1-6). In Group A, 14 patients underwent single-stage total correction (TC); in Group B, 18 patients underwent unifocalization and central shunting; and in Group C, four patients had aortopulmonary window creation and collateral ligation. No patient was placed in Group D. Seventy percent of patients (n=25) had the TC operation. Early mortality was not seen in Group A, but the other two groups had a 13.6% mortality rate. At the follow-up, three patients had reintervention, two had new conduit replacement, and one had right ventricular outflow tract reconstruction. CONCLUSION: Evaluating patients with PA/VSD/MAPCAs in detail and subdividing them is quite useful in determining the appropriate surgical approach. With this strategy, TC can be achieved in most patients. Single-stage TC is better than other surgical methods due to its lower mortality and reintervention rates. Care should be taken in terms of early postoperative intensive care complications and reintervention indications during follow-ups.

Surgical strategies and results for repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: experience of a single tertiary center

Abstract Objective: To evaluate surgical management and results of patients with pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). Methods: We reviewed a consecutive series of patients with PA/VSD/MAPCAs between January 2012 and October 2018. Study patients were separated into Group A, efficient MAPCAs; Group B, hypoplastic MAPCAs; Group C, severe hypoplastic MAPCAs at all divisions; and Group D, distal stenosis at most MAPCAs divisions. Results: Thirty-six patients were included in the study. Median age at operation time was 5.5 months (2-110 months), median weight was 8 kg (2.5-21 kg), and median number of MAPCAs was three (1-6). In Group A, 14 patients underwent single-stage total correction (TC); in Group B, 18 patients underwent unifocalization and central shunting; and in Group C, four patients had aortopulmonary window creation and collateral ligation. No patient was placed in Group D. Seventy percent of patients (n=25) had the TC operation. Early mortality was not seen in Group A, but the other two groups had a 13.6% mortality rate. At the follow-up, three patients had reintervention, two had new conduit replacement, and one had right ventricular outflow tract reconstruction. Conclusion: Evaluating patients with PA/VSD/MAPCAs in detail and subdividing them is quite useful in determining the appropriate surgical approach. With this strategy, TC can be achieved in most patients. Single-stage TC is better than other surgical methods due to its lower mortality and reintervention rates. Care should be taken in terms of early postoperative intensive care complications and reintervention indications during follow-ups.

Oxidant-antioxidant levels in patients with bladder tumours.

PURPOSE: We have aimed to determine whether oxidants-antioxidants play a role in the etiopathogenesis of bladder tumour by measuring their levels in the serums of patients with bladder tumour. MATERIAL METHOD: Thirty patients with bladder tumour with superficial bladder tumour and 27 normal healthy volunteers were included in the study. Four cc of venous blood was taken from these patients and volunteers in the control group and centrifuged at 5000 rpm for 10 minutes and divided into serum and plasma. The activities of xanthine oxidase, glutathione reductase, glutathione-s transferase, reduced glutathione and superoxide dismutase enzymes in serum were then measured spectrophotometrically. FINDINGS: Antioxidant parameters (glutathione-s-transferase, reduced glutathione, superoxide dismutase and glutathione reductase) in the serum of patients with bladder tumours were found statistically significantly lower than control group (p < .05). On the other hand, xanthine oxidase which is an oxidant indicator, was found significantly higher in patients with bladder cancer than control group (p < .05). CONCLUSION: Oxidative stress is effective in the etiopathogenesis of bladder tumour. We, therefore, believe that antioxidants are protective against bladder tumours and will be effective in the treatment of bladder tumours.

Epicardial Pacemaker in Neonates and Infants: Is There a Relationship Between Patient Size, Device Size, and Wound Complication?

We aimed to investigate the complications after epicardial pacemaker (PM) implantation in neonates and infants and their relationship with factors such as device size and patient size. Between May 2010 and July 2018, 55 patients under 1 year of age who underwent epicardial PM placement were retrospectively evaluated. PM-related complications requiring rehospitalization were determined as wound site problems requiring surgical intervention, battery pocket infection, battery pocket dehiscence without infection, PM removal, relocation of the PM system, and replacement of the PM system with another system. The patients were divided into three groups: < 3 kg, 3-5 kg and > 5 kg. Fifty-five patients underwent PM implantation, 43 (78.2%) because of postoperative atrioventricular block (AVB), 10 (18.2%) because of congenital AVB, and two (3.6%) with diagnoses of c-TGA and AVB. Five (9%) patients incurred 18 complications. No statistically significant difference was observed in complication development between the groups (p > 0.05). Single- or dual-chamber device implantation did not affect complication development (p > 0.05). Despite the role of factors such as low weight, low age, and device volume in the development of wound complications, the relationship between these factors and complications is not statistically significant. Therefore, our results are encouraging in terms of the use of dual-chamber PMs instead of single-chamber ones in heart diseases in which AV synchronization is important.

Use of extracorporeal membrane oxygenation in postcardiotomy pediatric patients: parameters affecting survival.

AIM: We aimed to investigate the risk factors affecting survival after extracorporeal membrane oxygenation use in pediatric postcardiotomy patients. METHODS: One hundred thirty-three consecutive patients who underwent surgery for congenital heart disease who needed extracorporeal membrane oxygenation support were retrospectively analyzed. RESULTS: In all, 3,082 patients were operated, of which 140 patients (4.54% of the total number of operations) needed extracorporeal membrane oxygenation. Eighty (60.1%) patients were successfully weaned and 51 (38.3%) patients were discharged. Of the 50 patients discharged during the mean follow-up period of 34.8 (0-192.4) months, 6 (12%) patients died. The extracorporeal membrane oxygenation support was instituted in 29 (21.8%) patients for extracorporeal membrane oxygenation cardiopulmonary resuscitation, in 44 (33.1%) patients due to the inability to be separated from cardiopulmonary bypass, in 19 (14.3%) patients due to respiratory failure, and in 41 patients due to low cardiac output syndrome. Eighty patients (60.2%) were successfully weaned from extracorporeal membrane oxygenation support. The remaining 53 (39.8%) patients died on extracorporeal membrane oxygenation. Mortality was observed in 29 (21.8%) of the 80 patients in the successful weaning group, while the remaining 51 (38.3%) patients were discharged from the hospital. Multivariate analysis showed that double-ventricular physiology increased the rate of successful weaning (odds ratio: 3.4, 95% confidence interval lower: 1.5 and upper: 8, p = 0.004) and prolonged extracorporeal membrane oxygenation durations were a risk factor in successful weaning (odds ratio: 0.9, 95% confidence interval lower: 0.8 and upper: 0.9, p = 0.007). The parameters affecting mortality were the presence of syndrome (odds ratio: 3.8, 95% confidence interval lower: 1.0 and upper: 14.9, p = 0.05), single-ventricular physiology (odds ratio: 5.3, 95% confidence interval lower: 1.8 and upper: 15.3, p = 0.002), and the need for a second extracorporeal membrane oxygenation (odds ratio: 12.9, 95% confidence interval lower: 1.6 and upper: 104.2, p = 0.02). While 1-year survival was 15.2% and 3-year survival was 12.1% in patients with single-ventricular physiology, the respective survival rates were 43.9% and 40.8%. CONCLUSION: Parameters affecting mortality after extracorporeal membrane oxygenation support in pediatric postcardiotomy patient group were the presence of a syndrome, multiple runs of extracorporeal membrane oxygenation, and single-ventricular physiology. Timing of extracorporeal membrane oxygenation initiation, appropriate patient selection, appropriate reintervention or reoperation for patients with correctable pathology, the use of an appropriate cannulation strategy in single-ventricle patients, management of shunt flow, and appropriate interventions to reduce the incidence of complications play key roles in improving survival.

Levels of serum trace elements in patients with Peyronie.

Aim: The etiology of the disease of Peyronie is not certainly known. However, penile micro traumas are thought to be important in the pathogenesis of Peyronie's disease (PD) in genetically predisposed individuals. In this study, we aimed to determine the relationship of some trace element and heavy metals with PD.Material and methods: Thirty Peyronie patients and 26 healthy volunteers were included in the study. In individuals in both groups, levels of serum trace elements (Manganese [Mn], Cu, Cobalt (Co), zinc [Zn], Cd, and iron [Fe]) were determined separately by Atomic Absorption Spectrophotometer method in Yüzüncü Yil University Central Research Laboratory.Results: Mn, Cu, Zn, and Fe levels in Peyronie patients were statistically significantly lower when compared to the healthy control group (p < .05). Cd and Co levels were similar for both groups but not statistically significant (p > .05).Conclusions: The changes in trace element levels are related to the etiopathogenesis of PD. We think that our study is the first from this aspect.

Predictors of a complicated course after surgical repair of tetralogy of Fallot.

BACKGROUND: In this study, we aimed to evaluate the patient and surgical factors affecting prolonged hospital stay and major adverse events after surgical repair of tetralogy of Fallot and to identify the predictors of a complicated course after surgical repair. METHODS: A total of 170 consecutive patients (96 males, 74 females; median age 12 months; range, 1 to 192 months) who underwent surgical repair of tetralogy of Fallot between January 2015 and April 2018 were retrospectively reviewed. A mechanical ventilation duration of >24 h, an intensive care unit stay of >3 days, and a hospital stay of >7 days were considered as prolonged. Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, renal failure, diaphragmatic paralysis, neurological deficit, sudden circulatory arrest, need for extracorporeal membrane oxygenation, and death were considered as major adverse events. RESULTS: The median time to hospital discharge was 8.0 (range, 5.0 to 40.0) days. Higher preoperative hematocrit levels prolonged the length of hospital stay (odds ratio: 1.12, 95% confidence interval 1.1-1.2, p<0.001). A total of 28 major adverse events were observed in 17 patients (10%). Lower pulmonary artery annulus Z-score (odds ratio: 0.5, 95% confidence interval 0.3-0.9, p=0.01) and residual ventricular septal defects (odds ratio: 54.6, 95% confidence interval 1.6-1,874.2, p=0.03) were found to increase mortality. Residual ventricular septal defect was also a risk factor for major adverse events (odds ratio: 12.4, 95% confidence interval 1.5-99.9, p=0.02). CONCLUSION: Preoperative and operative factors such as high preoperative hematocrit, low preoperative oxygen saturation, low pulmonary annulus Z-score, Down syndrome, residual ventricular septal defects, and the use transannular patch were found to be associated with prolonged length of hospital stay, prolonged mechanical ventilation, prolonged intensive care unit stay, and increased development of major adverse events.

The Prolidase Activity, Oxidative Stress, and Nitric Oxide Levels of Bladder Tissues with or Without Tumor in Patients with Bladder Cancer.

This study was designed to evaluate the malondialdehyde (MDA), glutathione (GSH) and nitric oxide (NO) levels, and also prolidase, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) enzyme activities in malignant and benign cancers of bladder tissue. A total of 59 patients admitted to our clinic due to microscopic or macroscopic haematuria, were prospectively included in the study. Because of some reasons (no request to participate in the study, the inability to reach, other malignancies, alcohol consumption, metabolic disease), eight patients were excluded from study. Of the 51 patients, 25 were bladder tumor patients, and 26 were patients without cancers. The bladder tissue samples were obtained from all patients under anesthesia (spinal, epidural or general) for the measurement of MDA, GSH and NO levels, and prolidase, GSH-Px and SOD enzyme activities. Among the patients with bladder cancers, 7 patients were females and 18 patients were males, with an average age of 68.4 ± 2.49. Among patients without tumors, 6 patients were females and 20 patients were males, with an average age of 58 ± 2.05. In patients with bladder tumors, the oxidants (MDA, NO, prolidase) were higher, and the antioxidants (SOD, GSH, GSH-Px) were lower than those in patients without tumors. It was concluded that the oxygen free radicals play a role in the etiology of bladder cancers similar to many other tumors and inflammatory conditions. Therefore, we assume that antioxidants may provide benefits in the prevention and treatment of bladder cancer.

A Novel Experimental Method for Penile Augmentation Urethroplasty With a Combination of Buccal Mucosa and Amniotic Membrane in a Rabbit Model.

OBJECTIVE: To investigate the results of penile urethral reconstruction using amniotic membrane (AM) and buccal mucosa (BM) grafts, and the simultaneous use of both in a rabbit model. MATERIALS AND METHODS: A total of 28 male rabbits were divided into 4 groups according to grafting style: group 1 (AM), group 2 (BM), group 3 (BM + AM), and group 4 (sham). A standardized urethral defect was created in the 3 initial groups. The sham group underwent only a ventral vertical urethral incision and primary re-suturation. AM grafts were used in group 1, and BM grafts were used in groups 2 and 3. AM grafts were affixed to the BM grafts in group 3 as a covering tissue. Urethrography and endoscopy were performed after the 1st and 2nd months of grafting. The penises were subjected to histopathologic and immunohistochemical assessment for fibroblast growth factor and vascular endothelial growth factor expression. RESULTS: Dehiscence and fistula developed in group 1, whereas 2 fistulas were observed in group 2. No complications developed in group 3. Epithelization at urethras was observed at 4 weeks in all groups, but transformation to urothelial epithelialization occurred at 8 weeks. Marked amelioration and epithelial transformation were observed in group 3. The most prominent fibroblast growth factor expression was observed in group 3. Vascular endothelial growth factor expression was completely negative in group 3 at 8 weeks, indicating complete healing. CONCLUSION: The simultaneous use of AM and BM for ventral onlay penile urethroplasty provides better tissue healing and lower complication rates in comparison to BM alone. Further animal studies or clinical applications are needed.

Oxidative DNA Damage to Sperm Cells and Peripheral Blood Leukocytes in Infertile Men.

BACKGROUND Oxidative DNA damage is associated with male infertility. The aim of this study was to evaluate the oxidative DNA damage of sperm cells and blood leukocytes and to determine the levels of MDA and NO levels in seminal and blood plasma of idiopathic infertile men. MATERIAL AND METHODS The study enrolled 52 patients, including 30 infertile and 22 fertile men. MDA, NO, and 8-OHdG/106dG were estimated using spectrophotometry and high-pressure liquid chromatography (HPLC)-based methods in seminal and blood plasma. The association with the sperm parameters was assessed, particularly sperm counts and motility. RESULTS The mean sperm concentration and sperm motility of the fertile men were significantly higher than that of the infertile men. The mean MDA and NO concentration in the seminal and blood samples of the infertile men were higher than that of fertile men. Also, the mean numbers of sperm cells and leukocytes 8-OHdG/106dG of the infertile men were significantly higher than that of fertile men (p=0.04 and p<0.001, respectively). Sperm motility and sperm count were negatively correlated with leukocyte and sperm cell 8-OHdG/106dG ratio. However, progressive motility was significantly negatively correlated with sperm cell and leukocyte 8-OHdG/106dG ratio (R=-0.357, p=0.026; R=-0.388, p=0.024, respectively). CONCLUSIONS Oxidative stress is an important factor in male infertility. Therefore, biochemical detection of 8-OHdG/106dG in sperm cells and blood leukocytes may be an additional tool in the diagnosis of male infertility.