Does preoperative administration of allopurinol protect the lungs from ischemia-reperfusion injury occuring during cardiopulmonary bypass?

BACKGROUND: It is investigated whether preoperative allopurinol administration protects lung injury induced by cardiopulmonary bypass (CPB). METHODS: Sixty patients with coronary artery disease who need elective coronary artery bypass grafting operations by using CPB were taken into this study. They were divided into two groups; control and allopurinol. Allopurinol (300 mg/day) was administered to the latter group during the preoperative period of 5 days. Standard CPB procedures were used in all cases. Blood was sampled for TNF-alpha, IL-6, IL-8, IL-10 before anesthesia (T0), after anesthesia and before skin incision (T1), before CPB (T2), after aortic declamping (T3), at the end of CPB (T4), 6 hours after operation (T5), 12 hours after operation (T6), and 24 hours after operation (T7). Pulmonary function test (PFT) was performed before and following the 6th day of operation. RESULTS: TNF-alpha, IL-6, IL-8 increased in both groups at T3, T4, T5 and T6 compared to control (p<0.05). TNF-alpha, IL-6, and IL-8 levels were lower in group A at T3, T4, T5 and T6 (p<0.05). Creatinin phosphokinase (CK) levels were lower in group A at T6 (p<0.05). CK-MB levels were lower in group A than in group C (p<0.05). Pulmonary function test (PFT) did not yield any differences between the groups. CONCLUSIONS: Preoperative allopurinol administration decreases the inflammation and myocardial injury according to biochemical markers of ischemia reperfusion injury. However, this biochemical success does not rebound to PFT (Tab. 5, Ref. 15).

Primary cardiac myxomas: report of 28 cases and review the literature.

PURPOSE: Although primary cardiac tumors are rare, cardiac myxoma is the most common seen intracardiac tumor. This study summarizes our surgical experience with cardiac myxomas. METHODS: Twenty-eight cases of cardiac myxoma that were surgically treated in our center between January 1990 and March 2010 were retrospectively reviewed. In all patients the New York Heart Association (NYHA) functional classification was used to assess the functional status, and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were measured before and after surgery. RESULTS: Nineteen patients were female and 9 male. The mean age was 53.3 ± 12.7 years (range 4-73). The most common symptom was dyspnea (86%). Two patients presented with peripheral embolism. In preoperative assessment of functional status, 24 of the patients were in NYHA Class II, 2 of them were in Class I and the other 2 patients were in Class III. All patients were in NYHA class I in the early postoperative period up to long-term follow up. The mean preoperative CRP and ESR levels were 47.3 ± 14.6 mg/l (range 30-79) and 52.8 ± 21.4 mm/h (range 28-82), respectively. One month after surgery, CRP and ESR levels returned back to normal values. Postoperative CRP and ESR levels were 8.4 ± 2.6 mg/l (range 1-12) and 7.9 ± 4.8 mm/h (range 3-18), respectively. CONCLUSION: Myxomas should be considered in all patients with embolism. After surgical resection of cardiac myxomas, the functional status of patients improve and CRP and ESR levels become normal.

Successful surgical treatment of Nicolau's syndrome combined with intravenous iloprost.

A 4 year-old boy was admitted to our clinic with symptoms of pain and ecchymosis in his right leg and foot after injection of benzathine penicilline. There was a localized gangrenous area at the femoral injection site. Doppler ultrasonography showed no arterial flow in the femoral artery and clear evidence of acute thrombosis of the superficial femoral and popliteal veins. Femoral arterial and venous thrombectomy and fasciotomy were performed immediately. After surgery the boy was treated by Iloprost infusion and enoxaparine. One week later necrotic changes had regressed, fasciotomies were closed and only the distal phalanx of the third toe needed amputation. Early surgical intervention and standard management combined with Iloprost infusion may help in healing the lesions by increasing extremity perfusion and may prevent extremity loss.

Obstructing endobronchial malignant fibrous histiocytoma.

A 58-year-old male patient admitted with malignant fibrous histiocytoma of the left mainstem. Rareness and unusual presentation of malignant fibrous histiocytoma and surgical management for lung salvage made its reporting worthwhile. In this localization, prognostic characteristics are better than in the other localizations of lung and body.

Epidural emphysema associated with primary spontaneous pneumothorax.

A 21-year-old male patient was admitted with spontaneous pneumothorax, and no history of asthma. Closed drainage treatment was unsuccessful. Chest computed tomography demonstrated pneumomediastinum and subcutaneous emphysema with multiple air bubbles within the spinal canal between the levels Th3 and Th11. Resection of bullae on the upper lobe and partial pleurectomy were performed. Postoperative period was uneventful. Epidural emphysema was resolved spontaneously without neurologic symptoms and signs. Intraspinal air, or pneumorachis, associated with spontaneous pneumothorax and pneumomediastinum is an extremely rare condition. We discussed spontaneous pneumothorax and pneumomediastinum as well as epidural pneumatosis and reviewed reported cases in the literature.

Ruptured cardiac hydatid cyst masquerading as acute coronary syndrome: report of a case.

The case of a 40-year-old man hospitalized for investigation of a doubtful diagnosis of acute coronary syndrome is reported herein. Two-dimensional echocardiography and angiography showed a cardiac cyst localized in the left ventricular apex in close proximity to the left anterior descending coronary artery. Surgery performed with the aid of cardiopulmonary bypass revealed that the cyst had ruptured partially into the left ventricle and filled with thrombus. This case is of particular interest because of the rarity of cardiac localization of a hydatid cyst, and the conflict between the severity of the complications that occurred and the absence of correlated symptoms.

Pulmonary embolism due to cardiac hydatid disease: imaging findings of unusual complication of hydatid cyst.

We report two cases of primary cardiac hydatid cyst in which hydatid materials caused recurrent embolizations in pulmonary arteries and pulmonary parenchyma. Cardiac hydatid cysts may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation. The role of imaging techniques in diagnosis is discussed and the importance of dynamic enhanced CT, MR imaging, and enhanced MR angiography (MRA) is reported. Imaging findings were confirmed by surgery and pathology. Early diagnosis is essential because delayed treatment increases the morbidity and mortality rates.

An internal iliac artery aneurysm causing a colonic obstruction: report of a case.

An 80-year-old male patient presented with the chief complaints of a sudden onset of pain in the right lower quadrant and constipation of 3 days' duration. In computerized tomographic examination an aneurysm of right internal iliac artery and an abnormally enlarged descending colon were seen. During an emergency operation a small rupture in the subserosa of the rectosigmoid junction was found.