Evaluation of the effect of enriched hydrogen saline solution on distant organ (lung) damage in skeletal muscle ischemia reperfusion in rats.

INTRODUCTION: Ischemia-reperfusion (IR) injury is a major concern that frequently occurs during vascular surgeries. Hydrogen-rich saline (HRS) solution exhibits antioxidant and anti-inflammatory properties. This study aimed to examine the effects of HRS applied before ischemia in the lungs of rats using a lower extremity IR model. MATERIAL AND METHODS: After approval was obtained from the ethics committee, 18 male Wistar albino rats weighing 250-280 g were randomly divided into three groups: control (C), IR and IR-HRS. In the IR and IR-HRS groups, an atraumatic microvascular clamp was used to clamp the infrarenal abdominal aorta, and skeletal muscle ischemia was induced. After 120 min, the clamp was removed, and reperfusion was achieved for 120 min. In the IR-HRS group, HRS was administered intraperitoneally 30 min before the procedure. Lung tissue samples were examined under a light microscope and stained with hematoxylin-eosin (H&E). Malondialdehyde (MDA) levels, total sulfhydryl (SH) levels, and histopathological parameters were evaluated in the tissue samples. RESULTS: MDA and total SH levels were significantly higher in the IR group than in the control group (p < 0.0001 and p = 0.001, respectively). MDA and total SH levels were significantly lower in the IR-HRS group than in the IR group (p < 0.0001 and p = 0.013, respectively). A histopathological examination revealed that neutrophil infiltration/aggregation, alveolar wall thickness, and total lung injury score were significantly higher in the IR group than in the control group (p < 0.0001, p = 0.001, and p < 0.0001, respectively). Similarly, alveolar wall thickness and total lung injury scores were significantly higher in the IR-HRS group than in the control group (p = 0.009 and p = 0.004, respectively). A statistically significant decrease was observed in neutrophil infiltration/aggregation and total lung injury scores in the IR-HRS group compared to those in the IR group (p = 0.023 and p = 0.022, respectively). CONCLUSION: HRS at a dose of 20 mg/kg, administered intraperitoneally 30 min before ischemia in rats, reduced lipid peroxidation and oxidative stress, while also reducing IR damage in lung histopathology. We believe that HRS administered to rats prior to IR exerts a lung-protective effect.

Assessment of Aspirin and Clopidogrel Resistance in Patients Undergoing Cardiovascular Surgery: A Single-Center Cross-Sectional Study

Objective: We aimed to investigate antiplatelet drug resistance utilizing light transmission-lumiaggregometry (LT-LA) and the Platelet Function Analyzer-100 (PFA-100) in patients undergoing cardiovascular surgery. Materials and Methods: The study included 60 patients diagnosed with stable coronary artery disease and peripheral vascular diseases that required surgery. Participants were divided into three groups: patients receiving aspirin (ASA) (n=21), patients receiving clopidogrel (CLO) (n=19), and patients receiving dual therapy (ASA+CLO) (n=20). Aggregation and secretion tests by LT-LA and closure time by the PFA-100 were used to measure antiplatelet drug resistance. Results: Based on the adenosine diphosphate (ADP)-induced aggregation test, 43% of patients were resistant to ASA, 22% to CLO, and 15% to dual therapy. Diabetes, hypertension, and hyperlipidemia were the most commonly identified comorbid disorders. In patients with comorbid risk factors, the median value of platelet aggregation response to ADP was significantly higher in the ASA group than in the CLO and dual therapy groups (p=0.0001). In patients receiving ASA monotherapy, the maximum amplitude of aggregation response to platelet agonists was ≥70% in 43% of patients for ADP and 28% for collagen by LT-LA. Elevated ADP (≥0.29 nmol) and collagen (≥0.41 nmol)-induced adenosine triphosphate release were found by LT-LA in 66% of patients utilizing an ADP agonist and 80% of patients using a collagen agonist undergoing ASA therapy. Closure times obtained with the PFA-100 were normal in 28% of patients using collagen-ADP cartridges and 62% of patients using collagen-epinephrine (CEPI) cartridges who received ASA. Recurrent thrombosis and bleeding were observed in 12 (20%) patients with cardiovascular disease. Three of these individuals (25%) showed ASA resistance with normal responses to ADP-induced aggregation (≥70%) and secretion (≥0.29 nmol), as well as normal CEPI closure times. Conclusion: Our findings suggest that antiplatelet drug monitoring by LT-LA and PFA-100 may be useful for high-risk and complicated cardiovascular patients.

Pericardiectomy after constrictive pericarditis associated with second dose of BNT162b2 vaccine: A case report.

Constrictive pericarditis is quite rare complication of messenger ribonucleic acid-based severe acute respiratory syndrome-Coronavirus 2 (SARS-CoV-2) vaccine. It is a severe clinical picture with clinical symptoms of right ventricular failure. Initial physical examination, laboratory work-up, and chest X-ray may yield non-specific findings. Echocardiography, computed tomography, and cardiac catheterization are other diagnostic tools. Surgery with pericardiectomy is the definitive treatment option. Herein, we report a case of pericardiectomy after constrictive pericarditis associated with the second dose of BNT162b2 vaccine.

Outcomes of endovascular treatment of thoracic aorta pathologies: 10-year single-center results.

PURPOSE Thoracic endovascular aortic repair (TEVAR) is a safe and effective treatment method for a variety of thoracic aortic pathologies. We aimed to investigate the mortality and complication outcomes and associated factors of TEVAR treatment in Turkey. METHODS In this single-centered retrospective study, patients with thoracic aorta pathologies treated with TEVAR at Gazi University School of Medicine, Department of Radiology, between January 2009 and January 2020 were included. Perioperative, early, and late mortality, complications, and technical success were the outcomes. RESULTS The sample comprised 58 patients with 68 TEVAR interventions. Eleven (16.2%) patients were female, the mean age was 60.1 ± 13.4 years. Emergent TEVAR was required in 20.7% of the patients. The main indications of TEVAR were intact descending aorta aneurysms in 37.9% of the sample, 31.0% Stanford type-B dissection, and 12.1% traumatic transections. The technical success rate of primary and secondary interventions was 98.3% and 100%, respectively. The mortality rate in the first 30 days was 8.6%. Seventeen (29.3%) cases had at least 1 complication related to TEVAR treatment. The most common complication was type-1A endoleak (10.3%). Having acute symptoms, stroke, and acute renal failure were significantly associated with mortality (P=.020, .049, and .009, respectively). CONCLUSION This study reported the outcomes of TEVAR treatment from a tertiary medical center in Turkey over a decade. Patients presenting with acute symptoms and who developed stroke and acute renal failure after the procedure should be carefully followed up as these factors were found to be associated with mortality.

Angiosarcoma at femoral artery puncture site; a diagnostic dilemma.

Femoral artery is the most common vascular access site used for angiographic interventions. Various complications such as hematoma, bleeding, dissection, arteriovenous fistula and pseudoaneurysm have been described following iatrogenic puncture. However, angiosarcoma formation at the access site is very uncommon and it poses a diagnostic dilemma due to its resemblance to organized hematoma. A 75-year-old patient who had undergone coronary angiography has suffered from an angiosarcoma and its vascular complications due to local invasion at the puncture site. Although the tumor was completely excised and flow was re-established, he was lost 17 months later because of multiple metastases and their complications. Presence of a persistent mass with vascular complaints should raise suspicion for this rare and aggressive type of tumor.

Assessment of the effects of levosimendan and thymoquinone on lung injury after myocardial ischemia reperfusion in rats.

AIM: The aim of this study was to investigate the effects of levosimendan and thymoquinone (TQ) on lung injury after myocardial ischemia/reperfusion (I/R). MATERIALS AND METHODS: Twenty-four Wistar albino rats were included in the study. The animals were randomly assigned to 1 of 4 experimental groups. In Group C (control group), left anterior descending artery was not occluded or reperfused. Myocardial I/R was induced by ligation of the left anterior descending artery for 30 min, followed by 2 h of reperfusion in the I/R, I/R-levosimendan (24 µg/kg) (IRL) group, and I/R-thymoquinone (0.2 mL/kg) (IRTQ) group. Tissue samples taken from the lungs of rats were histochemically stained with H&E and immunohistochemically stained with p53, Bcl 2, Bax, and caspase 3 primer antibodies. RESULTS: Increased expression of p53 and Bax was observed (4+), especially in the I/R group. In IRTQ and IRL groups, expression was also observed at various locations (2+, 3+). H&E staining revealed that that the lungs were severely damaged and the walls of the alveoli were too thick, the number of areas examined was increased during the evaluation. Caspase 3 expression was observed to be at an (1+, 2+) intensity that was usually weak and diffuse in multiple areas. Bcl 2 was not found to be expressed in any of the tissues. H&E staining revealed that that the lungs were severely damaged in the I/R group, with the walls of the channels and alveoli thickened and edematous, and also an intense inflammatory cell migration was observed. Immunohistochemical staining was more prominent in inflammatory areas and structures around the terminal bronchioles. CONCLUSION: The findings in our study have shown that administration of levosimendan and TQ during I/R increases expression of caspase 3, p53, and Bax in lung tissue and has a protective effect on lung as distant organ. We suggest that findings of this study be elucidated with further large-scale clinical studies.

Effects of alprostadil and iloprost on renal, lung, and skeletal muscle injury following hindlimb ischemia-reperfusion injury in rats.

OBJECTIVES: To evaluate the effects of alprostadil (prostaglandin [PGE1] analog) and iloprost (prostacyclin [PGI2] analog) on renal, lung, and skeletal muscle tissues after ischemia reperfusion (I/R) injury in an experimental rat model. MATERIALS AND METHODS: Wistar albino rats underwent 2 hours of ischemia via infrarenal aorta clamping with subsequent 2 hours of reperfusion. Alprostadil and iloprost were given starting simultaneously with the reperfusion period. Effects of agents on renal, lung, and skeletal muscle (gastrocnemius) tissue specimens were examined. RESULTS: Renal medullary congestion, cytoplasmic swelling, and mean tubular dilatation scores were significantly lower in the alprostadil-treated group than those found in the I/R-only group (P<0.0001, P=0.015, and P<0.01, respectively). Polymorphonuclear leukocyte infiltration, pulmonary partial destruction, consolidation, alveolar edema, and hemorrhage scores were significantly lower in alprostadil- and iloprost-treated groups (P=0.017 and P=0.001; P<0.01 and P<0.0001). Polymorphonuclear leukocyte infiltration scores in skeletal muscle tissue were significantly lower in the iloprost-treated group than the scores found in the nontreated I/R group (P<0.0001). CONCLUSION: Alprostadil and iloprost significantly reduce lung tissue I/R injury. Alprostadil has more prominent protective effects against renal I/R injury, while iloprost is superior in terms of protecting the skeletal muscle tissue against I/R injury.

Effects of VEGF and MSCs on vascular regeneration in a trauma model in rats.

In the human body, vascular injuries that are caused by trauma, vessel lumen stenosis, and occlusions are often irreversible and can lead to sequelae formation as the vessels cannot reproduce fast enough. To solve this problem, the blood flow must be returned to the region as fast as possible. The adipose tissue contains progenitor cells with angiogenic potential and can be used to resolve the issue. In the present study, mesenchymal stem cells (MSCs) derived from rat adipose tissue, vascular endothelial growth factor (VEGF), and their mixture were applied on the dorsum of a rat, which was traumatized and its contribution to vascular regeneration was reviewed. No application was made to the control group. The results showed that the percentage of necrotic area was significantly lower in the MSC group than that of all the other groups. When the VEGF group was compared to the VEGF + MSCs, the percentage of necrotic area was observed to be similiar. However, VEGF showed effects only when a large quantites of VEGF was applied to the flap area. VEGF could not fully respond to the needs, whereas MSCs can produce VEGF according to the needs of tissue. This makes them superior to stem cells.

Effects of adrenomedullin and vascular endothelial growth factor on ischemia/reperfusion injury in skeletal muscle in rats.

BACKGROUND: In this study we investigated the effects of adrenomedullin (AM) and vascular endothelial growth factor (VEGF) on skeletal muscle ischemia/reperfusion (I/R) injury in a rat model. MATERIALS AND METHODS: Thirty-six Wistar rats were randomized into six groups (n = 6). Laparotomy was performed in all groups under general anesthesia. Nothing else was done in Group S (Sham). The Group I/R underwent I/R performed by clamping and declamping of the infrarenal abdominal aorta for 120 min, respectively. Group VEGF and Group AM received intravenous infusion of VEGF (0.8 µg/kg) or AM (12 µg/kg) respectively, without I/R. Group I/R + VEGF and Group I/R + AM received intravenous infusion of VEGF (0.8 µg/kg) or AM (12 µg/kg) immediately after 2 h period of ischemia, respectively. At the end of reperfusion period, skeletal muscle samples of lower extremity were taken from all groups for biochemical and histopathologic examinations. RESULTS: Tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), nitric oxide (NO), and hypoxia inducible factor 1 alpha (HIF 1α) were found to be significantly higher in Group I/R than the levels in Group S (P < 0.05). Tissue levels of MDA, SOD, NO, and HIF 1α were significantly lower in Group I/R + AM compared with the levels in Group I/R (P < 0.05). In Group I/R + VEGF, tissue levels of MDA and NO were significantly lower than the levels in Group I/R (P < 0.05). No statistically significant difference was found in the tissue levels of catalase among the groups. Histologic examination revealed a larger central muscular necrosis than the peripheral necrosis, red blood cells in the lumens of capillary vessels, and a stronger atrophy and elliptical or round shape in muscle fibers in Group I/R. Terminal deoxynucleotidyl transferase mediated dUPT nick end labeling (TUNEL)-positive cell count was significantly lower in groups I/R + AM and I/R + VEGF than Group I/R (P < 0.0001, P < 0.0001, respectively). CONCLUSIONS: These results indicate that AM and VEGF have protective effects on I/R injury in skeletal muscle in a rat model.

Saphenous vein wrapping for the treatment of a perigraft seroma: report of a case.

A 61-year-old man who had undergone an iliofemoral bypass with an expanded polytetrafluoroethylene (PTFE) graft was readmitted to our hospital for the investigation and treatment of a possible complication of the surgery. A tender, pulsatile, bulging mass, about the size of an adult fist, was palpated around the left lower abdominal region. Diagnostic procedures showed a large low-density area around the PTFE graft and angiography revealed a patent graft with no anastomotic leakage. An operative inspection revealed the mass to be a large perigraft seroma. The PTFE graft was covered with a saphenous vein strip, a treatment that has not previously been mentioned in the literature. The success of this strategy was confirmed by clinical observations and diagnostic procedures including ultrasonography and computed tomography, with no sign of recurrence for 5 months.

Traditional single patch versus the "Australian" technique for repair of complete atrioventricular canal defects.

PURPOSE: A variety of operative techniques has been used to repair complete atrioventricular (AV) canal defects and satisfactory outcomes after single patch repairs have been reported. We report our comparative results of repairing complete AV canal defects between 1998 and 2006 using the traditional single patch and the "Australian" techniques. METHODS: Fourteen patients underwent traditional AV canal repair with the single patch technique (Group 1) and 11 patients underwent repair with the "Australian" technique (Group 2). All patients were examined with preoperative echocardiography and cardiac catheterization, and were followed up with echocardiography to evaluate AV valve and ventricular function. RESULTS: There were two early postoperative deaths in Group 1 and one in Group 2. One patient from each group had moderate left AV valve regurgitation postoperatively, but none from either group had left ventricular outflow obstruction. CONCLUSIONS: The "Australian" technique is a simpler method requiring shorter aortic cross-clamping and total bypass times with good clinical and functional results. The early postoperative results are as encouraging as those achieved by the traditional single patch technique; however, long-term follow-up results are required to establish the efficacy of this simplified technique.

The importance of transesophageal echocardiography in diagnosis of pericardial tamponade after cardiac surgery.

BACKGROUND AND AIM OF THE STUDY: Despite the fact that there is a simple and effective treatment for pericardial tamponade (PCT), delayed diagnosis can cause serious morbidities or even mortality. In this study, we discuss the management and the diagnostic procedures of PCT. MATERIALS AND METHODS: Sixty-two patients with suspected PCT were initially evaluated with transthoracic echocardiography (TTE) and then with transesophageal echocardiography (TEE). Forty-nine (79%) patients were chosen for surgery after TEE displayed a suspected PCT diagnosis. Patients with suspected PCT were divided into two groups: Early-phase PCT (symptoms developed within 72 hours) and late-phase PCT (symptoms developed after 72 hours). RESULTS: Thirty-five (56%) patients were in the early phase and 27 (44%) patients were in the late phase. In 13 out of 22 (59%) cases, from both early and late phases, TTE findings showed no PCT, but TEE findings showed a positive PCT diagnosis. All 13 of the cases where TEE was positive after a negative TTE were confirmed by surgery. Overall, the PCT diagnoses in 48 out of 49 patients were confirmed during surgery. DISCUSSION: The role of echocardiography in PCT diagnosis is shown to be extremely important in some clinical cases, such as in patients during the postoperative period after cardiac surgery. Furthermore, particularly when TTE does not provide complete imaging of the pericardial sac, TEE should be mandatory. We recommend that even patients with a negative diagnosis of PCT from TTE should undergo further evaluation with TEE.

Right-to-left shunt through a patent foramen ovale left open in the management of acute right heart failure after heart transplantation.

Severe pulmonary hypertension is a risk factor for mortality in heart transplantation due to elevated post-operative right heart failure. Various treatment modalities have been used in the management of pulmonary hypertension in the peri-operative period. We report a case of successful management of acute right heart failure after orthotopic heart transplantation by decompression of the right ventricle through the patent foramen ovale of the donor heart and inhalation of iloprost.

Iatrogenic major venous injuries incurred during cancer surgery.

PURPOSE: Iatrogenic operative injury to the major veins is associated with significant morbidity and mortality. This study was conducted to review the pattern, management, and outcome of iatrogenic major venous injuries incurred during cancer surgery. METHODS: We reviewed 24 patients with collective 30 venous injuries, evaluating clinical characteristics; operative and postoperative data, including location and type of venous injury, operative repair, blood loss, and transfusion requirements; and outcome. RESULTS: Thirty venous and 12 associated arterial injuries were identified. The two most common sites of venous trauma were the iliac and femoral veins with 10 (33.3%) and 9 (30.0%) injuries, respectively. Twenty-three (76.7%) of the venous injuries were repaired primarily or with end-to-end anastomosis, while the remaining injuries required interposition grafts, patch venoplasty, or venous ligation. Postoperative revision procedures were performed in 3 (12.5%) patients. Perioperative mortality was 16.7% and major complications developed in 11 (45.8%) patients. CONCLUSIONS: Serious complications can be minimized by immediate recognition and prompt repair of iatrogenic vascular injuries. Close collaboration with a vascular surgeon during resection of tumors in proximity to the vascular structures may be helpful in preventing iatrogenic vascular injuries. In hospitals where tumor resection procedures are frequently performed, a vascular surgeon must be readily available.

Emergency thoracotomy for blunt thoracic trauma.

OBJECTIVES: The indications for emergency thoracotomy are controversial for blunt trauma. The best results were seen in those patients who were stable enough to undergo thoracotomy in the operating theatre and survived the operation. METHODS: The hospital records of 29 patients who underwent emergency thoracotomy for blunt thoracic trauma were reviewed. RESULTS: Of 964 patients with thoracic trauma, 745 (77.3%) sustained blunt injury and 29 of these patients (3.9%) required emergency thoracotomy. Six patients underwent emergency department thoracotomy for blunt cardiac trauma and only one of them survived (16.7%). Of the 23 patients who had emergency thoracotomy at the operating theatre, 2 died in the early postoperative period due to pulmonary embolism (8.7%) and 21 of them survived (91.3%). CONCLUSION: The results of emergency department thoracotomy in our series were extremely poor compared with the results of other reports, mainly due to rapid deterioration of hemodynamic condition caused by severe cardiac injury. The outcome from emergency thoracotomy in the operating theatre was encouraging, due particularly to the patients' status being stable enough to be transferred to a fully equipped operating theatre. We emphasize the importance of emergency medicine education programmes on rapid diagnosis of traumatic injuries with early intervention, and adequate hemodynamic and respiratory support.