A New Artificial Chordae Implantation Method in Mitral Valve Surgery.

A novel method is described for artificial chordae replacement with expanded polytetrafluoroethylene suture in mitral valve repair procedures. The technique does not involve knots over or beneath the free edge of the mitral valve leaflets. Artificial chords suspend the exact free margin of leaflets as if it were a continuation of the free margin, such that the smooth zone of the coapting area can be preserved. This technique is simple, reproducible, and applicable to both anterior and posterior leaflets. Moreover, the length of the artificial chords can be adjusted rapidly and accurately at the first attempt.

Taurine attenuates lung ischemia-reperfusion injury after lung transplantation in rats.

PURPOSE: Taurine, the major intracellular free amino acid found in high concentrations in mammalian cells, is known to be an endogenous antioxidant and a membrane-stabilizing agent. It was hypothesized that taurine may be effective in reducing ischemia-reperfusion injury after lung transplantation and an experimental study was conducted in a rat model. METHODS: The number of Sprague-Dawley rats used in the study was 35. Animals were randomized into five groups of 7 rats each, including control, donor I, donor II, ischemia-reperfusion injury, and treatment groups. All animals were exposed to the same experimental conditions in the preoperative period. Rats were fixed in a supine position after the induction. After the rats were shaved, a left pneumonectomy was performed following sternotomy in control, donor I, and donor II groups. The harvested grafts in donor I and donor II groups were transplanted to the rats of the ischemia-reperfusion group and treatment group, respectively. However, taurine was administered intraperitoneally for 3 days before the harvesting procedure in donor II. All harvested lungs were kept in a Euro-Collins solution at +4 °C for 24 h in a half-inflated manner. After harvesting and transplantation, lungs were sampled for histopathological and biochemical analysis. RESULTS: Malondialdehyde and superoxide dismutase, glutathione peroxidase, and catalase levels were lower in the treatment group than the other groups (p < 0.05). Histopathological findings were better in treatment group than the ischemia-reperfusion group (p < 0.05). CONCLUSION: It was demonstrated that donor treatment with taurine resulted in preservation of transplanted lung tissue in respect to histopathological and biochemical findings.

[Effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits]. / Tavsan karotis arterlerinde yapilan anastomozlarda bosentanin intima hiperplazisi üzerine olan etkisi.

OBJECTIVES: We investigated the effect of bosentan on intimal hyperplasia of carotid artery anastomoses in rabbits. STUDY DESIGN: Eighteen New Zealand male rabbits were randomized into two groups, as drug (Group B) and non-drug (Group A). The right carotid artery of all the subjects was transected and anastomosed end-to-end with 10/0 polypropylene suture. The left carotid artery was left intact. Group B subjects received 30 mg/kg/day oral bosentan for 21 days, starting 3 days before the operation. Group A subjects did not receive any medication. After 28 days, the anastomoses site and the contralateral control site were removed, and samples were investigated histomorphometrically. RESULTS: Significant intimal hyperplasia was observed at all anastomoses compared to the non-anastomotic left side. Bosentan decreased significantly the intimal area [Group A: 48.3 µm(2) (37.1 µm(2)-65.7 µm(2)), Group B: 31.4 µm(2) (12.2 µm(2)-63.2 µm(2)), (p=0.04)] and intima/media area ratio [Group A: 0.49 (0.13-0.74), Group B: 0.22 (0.09-0.37), (p=0.024)] compared to the non-drug group. CONCLUSION: According to our investigation, bosentan decreased the intimal hyperplasia developed in a rabbit carotid artery model. Further investigations are needed to support the potential clinical utilization of bosentan after vascular interventions.

A neonatal thrombosis patient treated successfully with recombinant tissue plasminogen activator.

UNLABELLED: Herein we report an asphyctic preterm neonate with respiratory distress and prothrombotic risk factors that responded positively to rtPA treatment following 2 attacks of acute thrombosis. CONFLICT OF INTEREST: None declared.

Efficacy of thermoreactive nitinol clip implantation in reconstruction of sternal dehiscence.

BACKGROUND: Sternal dehiscence is a severe complication of open heart surgery. Reinforced wiring, a system of reinforced sternal closure, fixation of a rigid plate, and implantation of thermoreactive nitinol clips (TRC) are some surgical procedures used. The aim of this study was to evaluate the role of TRC for secondary sternal reconstruction. METHODS: Of 1198 patients who underwent their operations via median sternotomy in 2 separate medical centers, sternal dehiscence was observed in 16 patients overall (1.33%). The mean (SD) age of the patients was 64.06 ± 9.18 years (range, 40-77 years). Sternal dehiscence was diagnosed in all patients between the fifth and 30th postoperative days. RESULTS: TRC were implanted in all of the patients who developed sternal dehiscence (16 patients). One patient developed severe respiratory failure, became ventilator dependent, and died from pneumonia on postoperative day 24. The other 15 patients were discharged without complications. Postoperative follow-up of the surviving patients revealed adequate and satisfactory sternal stability. CONCLUSION: Implantation of TRC is an effective and easy method for fixing the sternum and can be performed rapidly and securely.

Proanthocyanidin prevents myocardial ischemic injury in adult rats.

BACKGROUND: Proanthocyanidin is a bioflavonoid known to have protective effect against oxidative injury. We investigated the cardioprotective effect of proanthocyanidin. MATERIAL/METHODS: Thirty-two Rattus Norvegicus rats were categorized equally as the control group (CG), proanthocyanidin group (PCG), ischemia group (IG) and proanthocyanidin-treated group (PCT). Rats in CG and IG were fed standard rat food and PCG and PCT were fed standard rat food plus proanthocyanidin (100 mg/kg/day twice a day by oral gavage) for 3 weeks. In CG and PCG the myocardial samples were prepared immediately, and in IG and PCT hearts were placed in transport solution and kept at 4°C for 5 hours, then prepared for evaluation. Malondialdehyde (MDA) level, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities were measured. RESULTS: MDA levels were significantly higher in IG and PCT than in CG and PCG. The activity of SOD was significantly lower in IG and higher in PCG than in the other groups. The activity of GPx was significantly lower in IG than in the other groups. The activities of CAT were significantly lower in IG and PCT than in the other groups and were significantly lower in IG than PCT. Histopathologic evaluation revealed normal findings in CG and PCG. While ischemic injury was observed in IG, the content of muscle fibers was better preserved in PCT. CONCLUSIONS: Proanthocyanidin may have a protective effect on myocardial ischemic injury.

Rosuvastatin, a new generation 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitor, reduces ischemia/reperfusion-induced spinal cord tissue injury in rats.

BACKGROUND: Severe neurological injury still represents one of the most devastating complications occurring after surgical repair of thoracoabdominal aneurysms. We aimed to investigate the role of rosuvastatin (RSV) against ischemia/reperfusion injury in an experimental model of spinal cord ischemia in rats. METHODS: Experimental groups included control group (n = 8), ischemia/reperfusion group (n = 8) undergoing aortic occlusion without pharmacologic treatment, and RSV-treated group (n = 8) receiving 10 mg/kg/day of RSV orally for 3 days before spinal cord ischemia. Spinal cord ischemia was induced by occlusion of the abdominal aorta between the left renal artery and aortic bifurcation for 45 minutes, followed by reperfusion. Neurological status was assessed before spinal ischemia and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels. RESULTS: Decreased spinal cord tissue malondialdehyde levels (p = .01) and increased tissue superoxide dismutase (p = .01) and glutathione peroxidase (p = .09) levels were observed in the RSV-treated group, as compared with the ischemia group. Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, RSV attenuated tissue necrosis. Total injury score in the RSV-treated group was significantly decreased, as compared with the ischemia group (p < .05). The Tarlov scores at 48 hours postoperatively were higher in the RSV group as compared with the ischemia group. CONCLUSION: RSV administration before spinal cord ischemia reduces spinal cord tissue injury by increasing antioxidant enzyme levels and may reduce the incidence of associated neurological dysfunction.

Cilostazol, a type III phosphodiesterase inhibitor, reduces ischemia/reperfusion-induced spinal cord injury.

BACKGROUND: Spinal cord injury is still a devastating complication after surgical repair of thoracoabdominal aortic pathologies. In this study, we investigated the protective effect of cilostazol, a type III phosphodiesterase inhibitor, against ischemia/reperfusion (I/R)-induced spinal cord injury in rats. METHODS: Twenty-four rats were assigned to 3 experimental study groups: the control group (sham operation, n = 8); the ischemia group (nontreated, n = 8), which underwent aortic occlusion without pharmacologic intervention; and the cilostazol-treated group (n = 8), which received 20 mg/kg cilostazol per day orally for 3 days before spinal ischemia. All animals underwent a 45-minute period of spinal cord ischemia via clamping of the abdominal aorta between the left renal artery and the aortic bifurcation; removal of the aortic clamp was followed by reperfusion. Neurologic status was assessed before spinal ischemia and at 48 hours after the operation. All animals were sacrificed at 48 hours after the operation. Spinal cords were harvested for histopathologic examination and biochemical analyses for the malondialdehyde (MDA) level and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. RESULTS: Tarlov scores at postoperative hour 48 tended to be higher in the cilostazol-treated group than in the nontreated ischemia group (mean ± SD, 3.66 ± 0.40 versus 2.32 ± 0.80; P = .08). Spinal cord tissue MDA levels (per gram protein) were lower in the cilostazol-treated group than in the nontreated ischemia group (0.27 ± 0.01 mmol/g versus 0.33 ± 0.04 mmol/g, P = .026), and the cilostazol-treated group had higher activities of tissue SOD (519.6 ± 56.3 U/g versus 438.9 ± 67.4 U/g, P = .016) and GSH-Px (4.07 ± 1.37 U/g versus 3.21 ± 1.02 U/g, P = .47) than the nontreated ischemia group. Histopathologic analyses demonstrated that cilostazol treatment attenuated I/R-induced cellular damage. CONCLUSION: Administration of cilostazol before spinal cord ischemia reduced neurologic injury and produced clinical improvement by attenuating oxidative stress in this rat spinal cord I/R model.

Natural internal banding in adult patients with a large ventricular septal defect and a preserved pulmonary vascular system.

OBJECTIVE: Hypertrophied anomalous muscle bands (AMBs) in the right ventricular outflow tract (RVOT) may develop in the context of ventricular septal defects (VSDs) and limit persistent pulmonary overflow. In adult patients with a large VSD, persistent AMBs in the RVOT therefore can simulate the role of an externally placed pulmonary artery band. We termed such alterations natural internal bands (NIBs). Our goal was to establish the morphologic nature of the obstructive muscular lesions of the RVOT in patients with a large VSD. METHODS: Patients who underwent operations for a large VSD in our center, which has a high volume of adult patients with congenital defects, were retrospectively reviewed, and the nature of the NIBs in these patients was documented. All patients underwent transthoracic echocardiography and cardiac catheterization evaluations preoperatively and at postoperative month 3. Histopathologic examination of the AMBs was performed. RESULTS: Of 96 adult patients who underwent operations for a large isolated VSD (mean defect size, 16.9 ± 3.5 mm), 16 patients had a hemodynamically significant NIB. Two different patterns of obstruction were found. Ten of the 16 patients revealed an os infundibulum morphology, and 6 patients revealed systolic bulging of the conal septum. Four of the patients with os infundibulum also had classic tetralogy-type septal malalignment. The mean peak systolic gradient on the RVOT was 56.5 ± 17.2 mm Hg and 53.6 ± 12.3 mm Hg in the patients with os infundibulum and in the patients with systolic bulging of the conal septum, respectively. Surgical repair of the VSD was completed successfully in all patients. Resection of the os infundibulum was performed concomitantly in patients with os infundibulum. At the third postoperative month, the mean peak systolic gradient was 16.8 ± 3.5 mm Hg in patients with os infundibulum and 26 ± 5.9 mm Hg (range, 20-35 mm Hg) in patients with systolic septal bulging. CONCLUSIONS: Some mechanisms in adult type VSDs are essential for protecting the pulmonary vasculature. We tried to review these protective mechanisms: hypertrophied AMBs and NIBs.

Protective effects of angiotensin II type-1 receptor blockade with olmesartan on spinal cord ischemia-reperfusion injury: an experimental study on rats.

BACKGROUND: Spinal cord injury is a major complication of thoracoabdominal aortic operations. We aimed to investigate neuroprotective role of olmesartan administered to rats before ischemia against ischemia-reperfusion (I-R) injury. METHODS: Twenty-four Wistar albino rats were randomly divided into three groups (n = 8 per group): group I (control group, the sham-operation group), group II (the I-R group undergoing aortic occlusion without pharmacologic treatment), and group III (olmesartan-treated group receiving 3 mg/kg/d olmesartan for 14 days before ischemia). Spinal cord ischemia was induced by infrarenal aortic clamping for 45 minutes, followed by reperfusion. Neurological status was assessed by using modified Tarlov score preoperatively and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels. RESULTS: The rats in the ischemia group had severe deficits including paraplegia after surgery, and they had a worse neurological status compared with the sham group (p < 0.05). The mean Tarlov scores in the ischemia and olmesartan-treated groups at 48 hours postoperatively were 1.6 +/- 0.4 and 2.2 +/- 0.9, respectively (p < 0.05). Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, olmesartan attenuated tissue necrosis. Decreased spinal cord tissue malondialdehyde (p = 0.047) and increased tissue superoxide dismutase (p = 0.001) and glutathione peroxidase (p = 0.009) levels were measured in the olmesartan-treated group compared with the ischemia group. CONCLUSION: Olmesartan may protect the spinal cord from I-R injury and reduce the incidence of associated neurological dysfunction after temporary aortic occlusion.

Comparison of the therapeutic efficacy of linezolid and vancomycin and correlation of serum and tissue malondialdehyde and myeloperoxidase in an experimental mediastinitis model.

BACKGROUND: We aimed to investigate the therapeutic efficacy of linezolid in an experimental mediastinitis model and to compare it with vancomycin, which is commonly used. The objective of this study was also to evaluate the role of the immune system in mediastinitis. MATERIALS AND METHODS: Fifty adult Wistar rats were randomly divided into five groups: an uncontaminated and contaminated untreated control groups; a group that received sefazolin prophylaxis; and two groups treated with vancomycin or linezolid. Median sternotomy without access to pleural spaces was performed on all rats. All groups, except the uncontaminated one, were inoculated with 0.5 mL 10(8) colony-forming units/mL methicillin-resistant Staphylococcus aureus in the mediastinal and sternal layers. Postoperatively, vancomycin and linezolid groups were given antibiotic treatment for 7 d, starting 24 h after the end of the procedure. After 7-d treatment tissue samples from the upper ends of the sternotomy line and mediastinum were obtained and evaluated microbiologically. Additionally, serum, heart, lung, liver, kidney, and mediastinal tissues samples were obtained to determine malondialdehyde (MDA) and myeloperoxidase (MPO). RESULTS: The study showed that either vancomycin or linezolid successfully reduced bacterial counts in mediastinum and sternotomy line. MDA and MPO levels were found to be decreased in the treated groups. There was a positive correlation between serum and tissues MDA and MPO in all of the groups. CONCLUSIONS: Our study showed that linezolid appears to be a promising option for treating mediastinitis due to methicillin-resistant S. aureus. Additionally, it was demonstrated that a wide inflammatory process occurred after mediastinitis.

Gastric remnant cancer: an old problem with novel concerns.

BACKGROUND AND AIMS: The patients with cancers in the remnant stomachs after previous partial resections for benign diseases constitute a peculiar subset of the patients with gastric cancer. They are generally at advanced stages on admissions due to disregarding the symptoms related to cancer. PATIENTS AND METHODS: Twenty six patients with cancer arising from the remnant stomach were analyzed. Clinicopathologic features such as age, gender, time interval between the initial operation and diagnosis of gastric remnant cancer, preoperative symptoms, surgical management, and tumor characteristics like size, location, histopathology, depth of invasion, lymph node involvement, presence of distant metastasis, and stages were documented. RESULTS: None of the cancers were diagnosed by routine surveillance and all the patients were symptomatic at the time of diagnosis. Twenty five patients were qualified for surgery. The resectability rate was 61% (n = 16). The ability to perform a curative resection and tumor location at the anastomotic site were determined as the factors significantly influencing survival (p < 0.05). CONCLUSION: Curative resection has to be the goal of surgical management in patients with gastric remnant cancer. Concerning clinician should be sceptical about a newly developing cancer in order to detect it in an early stage and enhance resectability.

[Pulsatile thoracal mass: a rare case of large left ventricular pseudoaneurysm]. / Pulsatil torakal kitle: Nadir görülen bir sol ventrikül psödoanevrizmasi.

Left ventricular pseudoaneurysms (LVPA) develop after myocardial infarction, trauma, infection and either valvular or ventricular surgery. We present here an unusual case of LVPA appearing like a pulsatile mass, which was easily seen from the chest wall. A 55-year-old woman was admitted to our clinic with a pulsatile mass and trill, easily seen on the anterior chest wall 6 weeks after coronary artery bypass graft (CABG) surgery and endoaneurysmorrhaphy operation. Contrast-enhanced tomography showed a soft tissue mass detected close to the subcutaneous fat tissue of the anterior chest wall located in the left hemithorax. Left ventriculography was consistent with a large pseudoaneurysm in the apical wall of the left ventricle. Cardiopulmonary bypass was established with femoral cannulation, and endoaneurysmorrhaphy and CABG x 1 operations were carried out. The patient was discharged home on postoperative day 15. Follow-up echocardiography showed successful repair and shrinkage of the aneurysm, and the patient remained asymptomatic without any clinical event during our follow-up. LVPA usually present with heart failure. However, some patients may have recurrent tachyarrhythmia, progressive dyspnea, nonspecific chest pain, or thromboembolism, or remain clinically silent. When a patient is seen after cardiac surgery with a pulsatile mass detected on the chest wall, LVPA should be considered in the differential diagnosis.

Distribution of nucleotide variants in the DNA sequence of ERCC1 and XRCC1 genes and the effect of phenotype in patients with gastric cancer.

BACKGROUND/AIMS: Gastric cancers vary across countries and ethnic groups. They are the second most common type of cancer worldwide. Dietary and non-dietary factors as well as genetic and epigenetic alterations of many mechanisms are implicated in the development of gastric cancer. We aimed to determine the sequence of possible nucleotide changes, polymorphisms, and mutations, and to establish genotype and phenotype relation by performing whole DNA sequence analysis of the XRCC1 and ERCC1 genes belonging to base excision repair (BER) and nucleotide excision repair (NER) family of DNA repair genes in patients with gastric cancer. MATERIALS AND METHODS: We included 50 patients of both sexes who had received diagnosis of gastric cancer and 50 healthy people who showed same demographic traits that forms the control group. We analyzed the ERCC1 and XRCC1 genes by DNA sequence analysis on both groups. After the analysis, we compared the genotype-phenotype relation. RESULTS: Neither patients nor the control group has any nucleotide replacement in any exon of ERCC1 genes. We could not detect significant difference between patients and healthy groups when we correlated genotype contribution of mutations Arg194Trp, Arg208His, Arg399Gln detected in the XRCC1 gene and allele frequency. CONCLUSION: According to our study, the ERCC1 gene in Turkish population is not getting mutation in patients with gastric cancer and healthy individuals. Three mutations were detected in the XRCC1 gene, and these mutations were not associated with gastric cancer.

Inflammatory Myofibroblastic Tumor Invading the Left Atrium: Report of a Rare Case.

Inflammatory myofibroblastic tumors (IMTs) of the lung are rare solid tumors and usually affect children and young adults. We describe an unusual form of an IMT of the left lower lobe invading the left atrium. A 9-year-old male patient with recurrent cough was referred for an evaluation of left-lung pneumonia. Transthoracic needle biopsy was performed, and the histopathological examination showed mixed inflammatory cells. Accordingly, an IMT was considered. Left lower lobectomy was performed. A portion of the tumor invading the left atrium was resected together with the intact atrial wall. The postoperative period was uneventful, and the patient was discharged on the sixth postoperative day.

Success of microvascular surgery; repair mesenteric injury and prevent short bowel syndrome: a case report.

BACKGROUND: Superior mesenteric injury is a rare entity but when it occurs, short bowel syndrome is one of the uninvited results of the emergency surgical procedures. CASE PRESENTATION: We present a 19-year-old boy with blunt abdominal trauma which caused serious mesenteric injury. Because ultrasound revealed free intraabdominal fluid, he underwent emergency laparotomy. Adequate vascularization of approximately 20 cm of proximal jejunal segment and approximately 20 cm of terminal ileum was observed. Nevertheless, the mesentery of the rest of the small intestine segments was ruptured completely. We performed an end-to-end anastomosis between a distal branch of the superior mesenteric artery in the mesentery of the ileal segment and a branch of the superior mesenteric artery using separate sutures of 7.0 monofilament polypropylene. The patient's gastrointestinal passage returned to normal on the postoperative day 2. He recovered without any complication and was discharged from hospital on the postoperative day seven. DISCUSSION: In this case report, we emphasize the importance of preservation of injured mesenteric artery due to abdominal trauma which could have resulted in short bowel syndrome.

[Superior vena cava syndrome caused by dialysis catheter]. / Diyaliz kateterinin neden oldugu vena kava süperior sendromu: Olgu sunumu.

The superior vena cava (SVC) syndrome is an uncommon complication due to permanent hemodialysis catheters. Herein we present a case with superior vena cava syndrome resulting from dialysis access catheter placed in the subclavian vein. The patient was admitted with typical signs and symptoms of superior vena cava syndrome. Angiography revealed obstruction of the superior vena cava with thrombosis. Surgical repair consisted of thrombectomy and patch repair of superior vena cava with autologous pericardium. The complaints and symptoms of the patient decreased dramatically following the operation. In view of this case, we do think that creating an early arteriovenous fistula should be kept in mind to minimize the use of dialysis catheter.

[Missed aortic transection following blunt trauma: a case report]. / Künt travmaya bagli farkedilmeyen aort transeksiyonu: olgu sunumu.

Missed vascular injuries following blunt traumas can lead to fatal clinical conditions that require an emergency intervention. Aortic transection (AT) is the most fatal complication of these missed vascular injuries. In this case report an AT that developed following a blunt trauma is presented. The patient was admitted with effort dyspnea and tachycardia. He had a history of blunt trauma three years ago. There was an enlargement of the upper mediastinum on X-ray studies. Thoracal magnetic resonance imaging and computed tomography revealed aneurysm of the descending aorta. Dacron graft interposition was performed as surgical treatment. The symptom and signs disappeared dramatically after the operation.

Inferior mesenteric artery aneurysm combined with renal artery stenosis in a patient with neurofibromatosis.

A case is reported of an inferior mesenteric artery aneurysm that starts approximately 1 cm from its origin and ends at the proximal portion of the bifurcation of the sigmoidal and left colic arteries accompanied with complete absence of the celiac axis and superior mesenteric arteries. Additionally, left renal artery stenosis existed. The diagnosis was made by digital subtraction arteriography and confirmed by magnetic resonance arteriogram. Disease involving the inferior mesenteric artery is extremely uncommon. This may be the first reported case of neurofibromatosis in combination with renal artery stenosis and inferior mesenteric artery aneurysm associated with celiac and superior mesenteric artery occlusion and treated surgically.