B-type natriuretic peptide/ferritin ratio as a predictor of the risk of developing acute renal injury in acute decompensated heart failure.

OBJECTIVES: Acute decompensated heart failure (ADHF) is a clinical condition that requires urgent diagnosis and treatment. Patients present with pulmonary capillary wedge pressure, pulmonary arterial pressure, and venous pressure elevation. Along with the progressive deterioration observed in the clinical picture, impairment or deterioration of kidney function may also occur. In this study, we evaluated the B-type natriuretic peptide (BNP)/ferritin ratio as a predictor of the risk of developing acute renal injury (ARI) in ADHF. METHODS: A total of 157 patients with a diagnosis of ischemic dilated cardiomyopathy for more than 6 months that presented to our clinic with ADHF were included in this cohort study. After the treatment protocol was applied, the sample was divided into two groups as patients with and without ARI. The BNP and ferritin levels were examined along with the routine blood parameters (BNP), and the BNP, ferritin, and BNP/ferritin values were compared between the groups. RESULTS: ARI was present in 34.3% (n = 54) of the patients, who were also found to have higher BNP (892.76 vs. 817.54), lower ferritin (86.78 ± 57.2 vs. 105.46 ± 38.3), and higher BNP/ferritin (10.48 ± 2.14 vs. 7.89 ± 1.89). The multivariate logistic regression analysis revealed the BNP/ferritin ratio as an independent risk factor for ARI (odds ratio = 3.19; 95% CI, 1.92-6.54; P = 0.001). Using the receiver operating characteristic curve, a cutoff value of 9.32 for BNP/ferritin ratio had a sensitivity of 81.8% and a specificity of 93.5% (area under the curve 0.842, P < 0.001) for the prediction of ARI. CONCLUSION: The BNP/ferritin ratio is a new parameter that can be used to draw attention to the severity of the treatment and renal function in ADHF cases in emergency situations.

Left renal artery thrombosis in a 78-year-old patient with atrial fibrillation.

Renal artery thrombosis is a rare clinical condition. Often, there is a delay in diagnosis due to non-specific clinical complaints. We presented a woman with an elderly atrial fibrillation who developed thrombosis of the left renal artery. Despite the anticoagulant treatment given, patient did not benefit and the kidney was fully damaged.

Acumulación quilosa en el espacio mediastínico después de una revascularización miocárdica quirúrgica / Chylous accumulation in the mediastinal space following coronary artery bypass graft surgery

RESUMEN El quilomediastino como complicación de la cirugía cardiovascular tiene una incidencia de menos del 0,5% y es extremadamente raro después de los procedimientos intrapericárdicos. El origen de esta complicación es una lesión directa en los vasos linfáticos del mediastino anterior, en el área del timo o el conducto torácico, en la unión de las venas yugular izquierda y subclavia, que obstruye el drenaje del conducto torácico. En principio se prefiere el tratamiento conservador con suspensión de la vía oral y la administración parenteral de una dieta baja en grasas y triglicéridos de cadena media. Si el drenaje persiste después de 2 semanas de tratamiento conservador, debe considerarse la ligadura quirúrgica del ductus torácico como tratamiento de esta complicación. Se presenta un caso de un hombre que presentó acumulación mediastínica de líquido quiloso, tras una reintervención por sangrado en el segundo día del postoperatorio de una revascularización miocárdica quirúrgica.

ABSTRACT Chylomediastinum as a complication of cardiovascular surgery has a reported incidence of lower than 0,5% and is extremely rare following intrapericardial procedures. The origin of this complication is a direct injury to the anterior mediastinum lymphatics in the thymus area or the thoracic duct, at the junction of the left jugular and subclavian veins, obstructing thoracic duct drainage. Firstly, conservative treatment with low fat and medium chain triglyceride diet is prefered by cutting oral feding. If the drainage persists despite 2 weeks of conservative treatment, the surgical ligation of the ductus thoracicus may be considered for the management of this complication. We present the mediastinal chylous fluid accumulation in a male patient who underwent revision due to bleeding on postoperative second day after coronary artery bypass surgery.

Post-Traumatic Dorsalis Pedis Pseudo-aneurysm Caused by Crush Injury.

INTRODUCTION: This is the report of an unusual case of a dorsalis pedis artery pseudo-aneurysm resulting from trauma in a 61 year old farmer. REPORT: One year previously, the patient's right foot had been crushed under a tractor wheel. The patient complained of pain and pulsatile soaring swelling on his right foot which he noticed two months before presentation. Radiological examinations revealed a pseudo-aneurysm of the dorsalis pedis artery. Resection of the aneurysm was completed without complications. Pathological findings confirmed an aneurysm of traumatic rather than atherosclerotic aetiology. DISCUSSION: The patient remains under follow up without ischaemia. False aneurysms should be treated by surgical or endovascular intervention when they are detected.

The Effect of Aspirin as an Irreversible COX1 Inhibitor in Preventing Non-Valvular Atrial Fibrillation After Coronary Bypass Surgery.

BACKGROUND: We investigated whether the use of aspirin (irreversible COX1 inhibitor) in the preoperative period may prevent non-valvular atrial fibrillation, which is the most common rhythm problem in the postoperative period. Non-valvular atrial fibrillation after coronary surgery may lead to an increase in hospital costs due to excessive drug use and long-term hospitalization. METHODS: More than 1000 coronary artery bypass grafting operations were performed between January 2011 to and Nov 2018. The 572 patients were included in this study. Patients were divided into two groups as medication (n=292) and medication-free group (n=280). In the medication group, while patients received aspirin (300 mg daily) therapy (up to 5 days) before the operation, the other group did not receive any anti-aggregan treatment. The patients were followed up for the occurrence of atrial fibrillation from the early postoperative period up to 3 months. RESULTS: While non-valvular atrial fibrillation was developed in 16 patients (5,5 %) in medication group, this rate was 24,3 % with 68 patients in medication-free group 3 month after operation (P < .05). In addition to the intensive care unit and hospital stay, there was a significant difference between the groups in terms of hospital costs (P < .05). CONCLUSIONS: According to the results of our study, we found that the aspirin used in preoperative period may prevent non-valvular atrial fibrillation in the postoperative period. In relation to these results, we found that hospital stay and hospital expenses decreased.

Cierre quirúrgico de comunicación interauricular en pacientes mayores de 40 años de edad: Efecto sobre la función cardíaca y resultados clínicos generales / Surgical closure of atrial septal defect in patients aged 40 years and older: Effect on cardiac function and general clinical outcomes

RESUMEN Introducción: La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes en los pacientes adultos. Objetivos: Se evaluaron los resultados iniciales y a medio plazo del tratamiento quirúrgico de la CIA tipo ostium secundum en pacientes mayores de 40 años de edad en relación con la función cardíaca y los resultados clínicos. Método: Se estudiaron 32 pacientes, mayores de 40 años de edad, a quienes se les realizó corrección quirúrgica de una CIA tipo ostium secundum. Se compararon los parámetros ecocardiográficos, de función cardíaca y el estado clínico de todos los pacientes antes y después de la operación para evaluar la eficacia del tratamiento quirúrgico. Resultados: Los pacientes fueron seguidos durante un promedio de 2,2 años (rango 3 meses - 3,1 años). No hubo mortalidad en el postoperatorio. En el seguimiento temprano, no hubo ningún evento tromboembólico cerebrovascular y mejoraron las capacidades funcionales de los pacientes. No ocurrieron nuevas fibrilaciones auriculares. Los diámetros de la aurícula y el ventrículo derechos, y las presiones de la arteria pulmonar se redujeron significativamente, mientras que no se encontró variación en la fracción de eyección. La necesidad de tratamiento diurético se redujo después del tratamiento quirúrgico. No se detectó ningún cortocircuito intracardíaco residual durante el seguimiento. Conclusiones: El cierre quirúrgico de la CIA en pacientes adultos mayores de 40 años puede mejorar la función cardíaca medida por ecocardiografía y reducir los síntomas clínicos. Si no se utiliza ningún tratamiento en estos pacientes, los síntomas son escasos y rara vez se encuentran alteraciones en los parámetros hemodinámicos con peligro para la vida. Sin embargo, la reparación quirúrgica debe realizarse lo antes posible, especialmente cuando se detecta en pacientes adultos.

ABSTRACT Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases in adult patients. Objectives: We evaluated the early and mid-term results of surgical treatment of secundum atrial septal defects in patients with ≥ 40 years in terms of cardiac functions and clinical outcomes. Method: Thirty-two patients who had undergone surgical correction for secundum atrial septal defect at the age of 40 years an older were examined. Echocardiographic parameters, cardiac functions and clinical status of all patients were compared before and after the operation to evaluate the efficacy of surgical treatment. Results: The patients were followed for an average of 2,2 years (range 3 months - 3,1 years). There was no mortality in the postoperative period. In the early follow-up, there was no cerebrovascular thromboembolic event, functional capacities of the patients improved. No new atrial fibrillation occurred. Right atrial and ventricle diameters, and pulmonary artery pressures were significantly reduced, while ejection fractions did not change. The need for diuretic therapy was reduced after surgical treatment. No residual intracardiac shunt was detected during follow-up. Conclusions: Surgical closure of atrial septal defects in adult patients over the age of 40 can improve cardiac function by echocardiography and reduce clinical complaints. Even if no intervention is made in such patients, the current complaints are scarce and life-threatening problems are rarely seen in hemodynamic parameters. However, surgical repair should be performed as soon as possible, especially when detected in adult patients.

Extra-abdominal fibromatosis (desmoid tumor): a rare tumor of the lower extremity arising from the popliteal fossa.

Aggressive fibromatosis is a rare soft tissue tumor. Although it lacks metastatic potential, it can grow aggressively in a locally infiltrating pattern. The tumors frequently recur after surgical excision, which remains the treatment of choice. Optional combinations of radiotherapy and/or chemotherapy have been used postoperatively for recurrent disease and/or inoperable cases. A palpable mass was detected in the popliteal fossa of the right lower extremity in a 48-year-old man. Magnetic resonance imaging showed a contrast-enhancing noncalcified lesion initially felt to represent a vascular tumor. An invasive mass adherent to the surrounding tissue was visualized intraoperatively and extensively debulked. The patient's postoperative course was uneventful. Histologic examination of the surgical specimen was consistent with an extra-abdominal desmoid tumor. After appropriate recognition, wide local excision may be the most appropriate treatment for fibromatosis of the extremity. However, the rarity of this tumor and the difficulty inherent in distinguishing it from similar-appearing tumors are necessitating histologic confirmation of the diagnosis.

Intracardiac entrapped and pulmonary embolism developing during oral contraceptive therapy in a young woman.

We report a case of biatrial thrombus entrapped in a patent foramen ovale (PFO) in a 39-year-old woman under oral contraceptive therapy who was admitted to our hospital with multiple pulmonary embolism without paradoxical embolism. We present this case because of the relatively unusual thromboembolic disease.

Prevention of reperfusion injury of the spinal cord in aortic surgery: an experimental study.

PURPOSE: We designed an experimental study to show the effects of some agents in order to prevent reperfusion injury of the spinal cord. METHODS: Twenty rabbits were used and were divided into two groups in our study. Infrarenal abdominal aortic occlusion, between renal arteries and iliac bifurcations, was applied to the subjects in group 1 for only 30 min; in the group 2 subjects, on the other hand, intra-aortic diltiazem, N-acetylcysteine, and catalase combinations were applied after infrarenal abdominal aortic occlusion. The spinal cord functions of the subjects were assessed at the 48th hour after the operation according to Tarlov scoring, then cord tissue samples were taken for biochemical and histopathological studies. RESULTS: The group 2 subjects had better neurological functions than group 1 subjects (P < 0.01). In group 2; superoxide dismutase and glutathione peroxidase levels increased, while malondialdehyde and xanthine oxidase levels decreased as compared with group 1 (P < 0.05). A histopathological examination showed the group 2 samples to have fewer bleeding points and less neuron loss. CONCLUSIONS: We concluded that antioxidant agent combinations (diltiazem, N-acetylcysteine, and catalase) applied after ischemia might thus help protect the spinal cord against ischemia and reperfusion injury.

The effect of surgical treatment for secundum atrial septal defect in patients more than 30 years old.

BACKGROUND: We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect. METHODS: We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation. RESULTS: The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period. CONCLUSION: Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.

Effects of ascorbic Acid, alpha-tocopherol and allopurinol on ischemia-reperfusion injury in rabbit skeletal muscle: an experimental study.

PURPOSE: Ischemia reperfusion injury to skeletal muscle, following an acute arterial occlusion is important cause of morbidity and mortality. The aim of the present study was to determine and evaluate the effects of ascorbic acide, alpha-tocopherol and allopurinol on ischemia reperfusion injury in rabbit skeletal muscle. METHODS: Forty-eight New Zealand white rabbits, all male, weighing between 2.5 to 3.0 (mean 2.8) kg, were used in the study. They were separated into four groups. Group I was the control group without any drugs. The other groups were treatment groups (groups II, III, and IV). Group II rabbits administrated 50 mg/kg ascorbic acide and 100 mg/kg alpha-tocopherol 3 days prior to ischemia, group III rabbits received 50 mg/kg allopurinol 2 days prior to ischemia, and group IV rabbits were administrated both 50 mg/kg ascorbic acide, 100 mg/kg alpha-tocopherol 3 days prior to ischemia and 50 mg/kg allopurinol 2 days prior to ischemia. Two hours ischemia and 2 hours reperfusion were underwent to the treatment groups. At the end of the reperfusion periods, muscle samples were taken from rectus femoris muscle for determination of superoxide dismutase, catalase and glutathione peroxidase activities as antioxidant enzymes, and malondialdehyde as an indicator of lipid peroxidation and xanthine oxidase levels as source hydroxyl radical. Besides, histopathological changes (edema, inflammation, ring formation and splitting formation) were evaluated in the muscle specimens. RESULTS: In the treatment groups; superoxide dismutase (U/mgprotein), catalase (U/mgprotein), and glutathione peroxidase (U/mgprotein) levels increased, malondialdehyde (nmol/mgprotein) and xanthine oksidase (mU/mgprotein) levels decreased compared to control I ( p < 0.05). Increase of superoxide dismutase, catalase, and glutathione peroxidase levels were the highest and decrease of malondialdehyde and xanthine oxidase levels were the highest in group IV compared to groups II and III, but no significant as statistically. Also amount of cellular injury in group II, III, and IV were lower than group I. CONCLUSIONS: Antioxidant medication may help lowering ischemia reperfusion injury. In our study, all drug medications are shown to be able to have an effective role for preventing ischemia reperfusion injury. Moreover, ascorbic acide + alpha-tocopherol + allopurinol group (group IV) may have a beneficial effect to decrease the local and systemic damage due to ischemia-reperfusion injury.

Successful treatment of right ventricular thrombus with heparin and sodium warfarin therapy: a case report.

A 75-year-old woman came to our emergency clinic complaining of abdominal pain. Acute cholecystitis was diagnosed, and parenteral antibiotic therapy was initiated. Because of palpitation, she had a consultation with the cardiology clinic. Echocardiography showed a 2.7 x 2.2 cm mobile thrombus attached to the apex of the right ventricle. Since no thromboembolic complications were present, we decided to begin administering heparin and oral anticoagulant. After the administration of unfractionated heparin for 48 hours, the patient was shifted to low-molecular weight heparin because it is easier to use and requires no follow-up. The patient received low-molecular weight heparin in addition to sodium warfarin for 5 days. Administration of heparin was then stopped and treatment was continued with sodium warfarin. In the series of weekly echocardiography evaluations, a gradual reduction was noted in the apical mass, which was initially considered to be a thrombus, and 3 weeks later evaluation revealed that the thrombus in the right ventricle had disappeared completely. No thromboembolic complications were observed during the follow-up period.

Primary and secondary patency rates and complications of upper extremity arteriovenous fistulae created for hemodialysis.

The types of fistulae used and their complication rates are important for the hemodialysis patients. We aimed to compare retrospectively the primary and secondary patency rates and complications of upper extremity arteriovenous fistulae. Between 1984 and 2005, a total of 1,233 upper extremity arteriovenous fistulae were created in 920 patients. The mean age was 42 +/- 21 years. The fistulae were divided into the 3 groups; 588 radiocephalic, 205 brachiocephalic, and 127 were created by polytetrafluoroethylene graft. The fistulae types were evaluated with regard to their primary-secondary patency rates and complications. There was a significant difference with regard to development of thrombosis in radiocephalic group compared to other two groups, respectively, p = 0.0122, p = 0.0091. In brachiocephalic fistulae group, edema and steal phenomenon were statistically significant (p < 0.0001). The aneurysm formation was statistically significant in polytetrafluoroethylene fistulae graft group (p < 0.0001). During 6 months, 2 and 5 years period, while primary patency rate was higher in three fistulae types, in radiocephalic fistulae both primary and secondary fistulae patency rates were lower (p < 0.05). To create successful arteriovenous fistulae with long-term patency, appropriate veins of patients should be carefully preserved; thus initially a distal site should be preferred, and in case of failure the next fistulae should be created proximally. In case of failure of forearm fistulae, primary fistulae with autogenous veins should be tried at the upper arm first, and if this also fails, fistulae formation with synthetic grafts should be considered.

Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency.

BACKGROUND: The provision and maintenance of vascular access remains a major cost to end-stage renal failure programs. In addition, vascular access occlusion, results in significant morbidity in hemodialysis patients. Age, gender, diabetes mellitus, malignancy, smoking habits, administration of heparin per hemodialysis session, previous dialysis catheter insertion, number of hemodialysis sessions and location of the fistula may be associated with survival of the primary arteriovenous fistula. We examined the effects of various factors on fistulas in 412 chronic renal insufficiency patients. METHODS: From 1995 to 2004, 412 arteriovenous fistulas were created by the Department of Cardiovascular Surgery at the Medical Faculty of Atatürk University for hemodialysis. The mean age of the patients was 45 years (range 6 to 62 years). We evaluated the effects of various factors for patency rates in the patients who had primary arteriovenous fistulas. Primary patency was defined as the duration of fistula patency without revision. Twenty-eight patients (6.7%) with ischemic cardiac disease did not require surgical interference. Analyzed data were age, gender, smoking habits, diabetes mellitus, malignant neoplasm, previous dialysis catheter insertion, number of hemodialysis sessions, and fistula location. RESULTS: In 298 patients, where lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively, in the other 114 patients, where upper-arm fistulas were created, these rates were 84.0%, 72.2%, 53.3%, 39.8%, and 12.3%, respectively. There was no significantly difference between the upper-arm fistulas and the lower-arm fistulas statistically (p = 0.069). Factors affecting the primary patency of arteriovenous fistulas were diabetes mellitus (p = 0.0001), hemodialysis counts > or =3 per week (p < 0.0005), presence of malignancy (p < 0.0005), previous catheter insertion (p < 0.0007), and administration of heparin per hemodialysis session (p = 0.0008). CONCLUSION: While primary arteriovenous fistula patency was shortened in chronic renal insufficiency patients with diabetes mellitus, presence of malignancy, and previous catheter insertion, patency was longer in patients with heparin used for hemodialysis and hemodialysis count per week (> or =3).