Serum uric acid level predicts new-onset atrial fibrillation after coronary artery bypass graft operation.

OBJECTIVE: To investigate the association between serum uric acid levels and the risk of incident atrial fibrillation in patients after coronary artery bypass graft (cABG) operation. PATIENTS AND METHODS: A total of 174 patients undergoing nonemergency coronary artery bypass graft operation were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We prospectively analyzed 174 patients (mean age: 59.8 years; 109 male and 65 female). The serum uric acid level was determined preoperatively. RESULTS: After a coronary artery bypass graft operation operation, 35 (20%) patients developed atrial fibrillation. Preoperative uric acid levels were significantly higher in patients who developed atrial fibrillation than in those who did not (7.8 ± 1.1 vs 5 ± 0.9). Using a cutpoint of 6.55, the preoperative level correlated with the appearance of atrial fibrillation with a sensitivity of 91.4% and specificity of 84.2%. CONCLUSIONS: Serum uric acid level can increase the sensitivity and specificity in predicting atrial fibrillation in patients after CABG operation.

Familial Takayasu arteritis in a mother and daughter. A report of two cases.

Takayasu arteritis (TA) is a chronic granulomatous panarteritis, predominantly affecting the aorta and its main branches. Infections, genetic factors as suggested by familial clustering, and autoimmunity may play a role in its pathogenesis. In this report, we describe familial TA in a mother and daughter with diverse clinical manifestations. In addition to being a familial form of vasculitis, both of our cases demonstrated amyloidosis, chronic renal disease thought to be due to ischemic nephropathy, and hypertensive nephrosclerosis.

Validity and reliability of VEINES-QOL/Sym questionnaire in chronic venous disorders.

AIM: The aim of this study was to translate the VEINES-QOL/Sym questionnaire into Turkish, which is used mainly in Western European countries, and to study its reliability and validity. METHODS: Standard "forward-backward" translation method was used to translate the questionnaire. The internal consistency was assessed with Cronbach's α, test-retest reliability was assessed with the intraclass correlation and Spearman-Brown coefficients. Validity was examined by correlation of VEINES-QOL/Sym with SF-36, Venous Clinical Severity (VCSS), and Venous Disability Scores (VDS). RESULTS: Out of 100 patients included (mean age 41.9 ± 12.5 years; 32% male, 68% female), 30 were given the questionnaire twice with 24-hour intervals for test-retest; a final completion rate of 99.2% was achieved. The Cronbach's α was 0.914. The Spearman-Brown coefficients and the intraclass correlation coefficients were 0.994, 0.988 and 0.966, 0.933 for VQOL and VSym scores, respectively. For the total quality of life and for several domains the correlations between VEINES-QOL/Sym and SF-36 were high, and significant. Inverse and significant correlations were observed with VCSS. CONCLUSION: Conclusively, the Turkish version of VEINSES-QOL/Sym questionnaire is reliable and valid; thus, it is highly recommended to use Turkish version of VEINSES-QOL/Sym to evaluate the quality of life and symptoms of patients with venous insufficiency in Turkey.

Comparative evaluation of As, Se and V removal technologies for the treatment of oil refinery wastewater.

In this study, a broad range of readily deployable metal removal technologies were tested on a US refinery's wastewater to determine vanadium, arsenic and selenium removal performance. The bench-scale treatability studies were designed and performed so that test conditions could be as uniform as possible given the different mechanisms of action and engineering applications of each technology. The experimental data show that both ferric precipitation and reactive filtration were able to remove As, Se and V more efficiently from the wastewater than other tested technologies. Additionally, granular ferric hydroxide (GFH) adsorption was also effective in both V and As removal. Although the thiol-SAMMS adsorbent was developed for mercury removal, it also demonstrated appreciable selenium removal. None of the tested membrane filtration technologies showed any significant metals removal. This was attributed to the dissolved form of the metals as well as the wastewater's fouling characteristics.

Intraosseous cavernous hemangioma of inferior turbinate: a rare case report.

Objectives. To investigate hemangiomas in the differential diagnosis of the nasal cavity neoplasms, even though it is an extremely rare mesenchymal tumor of the nasal cavity, and the world literature was reviewed. Case Report. A 57-year-old woman applied to our department with a 5-year history of left-sided nasal obstruction without history of epistaxis, nasal packaging, or facial trauma. Anterior rhinoscopic examination revealed a mass originating from inferior turbinate that completely obstructs the left nasal cavity. Paranasal computed tomography (CT) showed that the bony mass originated from the anterior part of the left inferior turbinate. Surrounding tissues were normal, and there was not any erosion or destruction. Mass was excised by the endoscopic approach. Histological diagnosis was reported as osseous cavernous hemangioma. Conclusion. Hemangiomas are a rare cause of intranasal masses. Its unusual site and masked presentation makes the differential diagnosis difficult. When a bony hard, well-shaped mass was seen in the nasal cavity, the possibility of intraosseous hemangioma must be remembered.

[Surgery of cardiac hydatid cysts. Experience of 39 years]. / Chirurgie des kystes hydatiques cardiaques. Trente-neuf ans d'expérience.

In some countries, Hydatidosis is a common public health problem but cardiac hydatid cysts are rarely observed. The evaluations of operative results and follow up of cardiac hydatid cases. Twenty-five consecutive unselected patients suffering from cardiac hydatidosis and operated on between 1967 and 2006 in Siyami Ersek Cardiothoracic and Vascular Surgery Center were retrospectively analyzed. In 10 of these patients the hydatid cyst was intracardiac, while in 13 patients cysts were extracavitary but located into the pericardium. In 2 patients the hydatid cyst was both intra and extracavitary. Mean age of the patients was 31+/-9.2. The female/male ratio was 17/8. The 12 patients with intracavitary and 2 patients wit extracavitary hydatid cysts were operated on with the aid of extracorporeal circulation. One patient died postoperatively. In one patient recurrence of the hydatidosis was observed. The majority of cases in previous publications were located in the left side of the heart. In our series, most were located in the right heart. In such cases clamping the pulmonary artery is mandatory to prevent pulmonary migration. Careful resection is important for prevention of recurrence.

Remifentanil versus propofol sedation for peribulbar anesthesia.

The short onset and offset of remifentanil may allow for accurate dosing of sedative effect with few side-effects and rapid recovery. In this study, remifentanil is compared with propofol for sedation intraocular pressure hemodynamics and oxygen saturation, in patients undergoing cataract surgery with peribulbar block. After ethical committee approval, fifty patients scheduled for one eye cataract surgery were enrolled into the prospective study. Remifentanil infusion was initialized at a rate of 0.04 microg/kg/min, 10 min before peribulbar anesthesia in Remifentanil group (Group R). In Propofol Group (Group P), propofol infusion of 2 mg/kg/h was reduced to 1mg/kg/h. Intraocular pressures of the contralateral eye were measured before and after peribulbar anesthesia and at the end of the operation. Sedation scores (1-5), hemodynamic parameters and saturation were assessed at 5 minute intervals. Heart rate, intraocular pressure, saturation and sedation scores were similar between groups. Intraocular pressures decreased within time in both groups. There were significant changes in mean blood pressure after 5th min between groups (P < 0.05). The infusion of remifentanil or propofol for sedation provided adequate sedation, hemodynamic stability without increasing intraocular pressure during surgery in patients undergoing cataract surgery with peribulbar anesthesia.

A case of metastatic spinal Ewing's sarcoma misdiagnosed as brucellosis and transverse myelitis.

An 11-year-old girl was admitted with back pain for 2 months, inability to walk for 15 days, and enuresis and encopresis for 2 days. She had been hospitalized with the diagnosis of brucellosis in another hospital. At presentation, she had paraplegia, sphincter dysfunction, and bilateral sensory loss below the T6 level, and was initially diagnosed with transverse myelitis caused by brucellosis. On the third day of hospitalization, however, agglutination test for brucella was negative, but it was positive for Salmonella. Therefore, transverse myelitis was considered to be due to salmonellosis. Thoracic spine magnetic resonance imaging showed an extradural, paraspinal mass at the level of T6-T7. The mass was totally extracted, and histopathological examination revealed Ewing's sarcoma. During follow-up, no improvement in paraplegia was noted and an enlarged presacral decubital ulcer developed. Aside from supportive care, local radiotherapy was applied. Unfortunately, the patient died from probable infection 9 months after the diagnosis. We emphasize that metastatic spinal Ewing's sarcoma may mimic brucellosis and transverse myelitis in childhood.

Gastrocystoplasty in pigs and effect of selective antral vagotomy on acid secretion of the reconstructed bladder.

INTRODUCTION: The aim of this study was to investigate the outcome of gastrocystoplasty and the effects of selective antral vagotomy (SAV) on the postprandial gastrin secretion from the antrum as well as on the acid secretion from the augmented bladder. MATERIALS AND METHODS: In this study on 12 male pigs, we applied subtotal cystectomy plus gastric augmentation plus SAV to the study group and the same procedure without SAV to the control group. The animals were followed up for 3 months with respect to feeding, weight, and urine output. The urine pH levels and the gastrin levels of the pigs in the two groups were then followed up and compared. RESULTS: The use of gastric segments in bladder reconstruction was found to be appropriate in terms of both gastric function and urinary system function. Nevertheless, regarding the effect of SAV, the differences between either the urinary pH levels or the gastrin levels of the pigs in the two groups were statistically significant. CONCLUSIONS: Although gastric segments in the bladder reconstruction were found to be appropriate in terms of both gastric function and urinary system function, SAV did not prevent postprandial gastrin secretion and the resulting increase of the urine acidity.

Supracondylar process of the humerus.

Four cases of supracondylar process of the humerus in three patients are presented. The main features of a supracondylar process as compared with an osteochondroma are reviewed. The three patients had pain and one had signs indicating median nerve compression. One had a supracondylar process together with an osteochondroma in the contralateral supracondylar region. One patient with a bilateral supracondylar process refused an operation. The other two patients underwent surgical treatment. The symptoms disappeared in the two patients who were operated.

Comparison of minithoracotomy with conventional sternotomy methods in valve surgery.

BACKGROUND: To determine the differences in the operative findings between the two groups of patients who had undergone either minithoracotomy or conventional sternotomy. METHODS: We compared 12 valve operations that were performed in our clinic with minithoracotomy (group I) between January 1997 and November 1999 with 13 valve operations that were performed with conventional median sternotomy (group II) in the same period in regard to preoperative, perioperative and postoperative variables, retrospectively. Preoperative variables were age, sex, bleeding time, clotting time, platelet count, and additional diseases like diabetes mellitus, hypertension, etc. Perioperative variables were extracorporeal circulation (ECC) time, cross-clamp (CC) time, and operation time. Postoperative variables were mechanical ventilation period, stay in the postoperative intensive care unit and hospital, mediastinal drainage amount, the amount of blood and blood products for transfusions, and costs. Group I consist of six mitral valve replacements (MVRs), three aortic valve replacements (AVRs), one aortic valve replacement combined with mitral valvuloplasty, and two tricuspid valve replacements (TVRs). Group II consist of nine MVRs and four AVRs. RESULTS: Statistical results are given with mean standard error (SEM) deviations. There were significant differences between the two groups in respect to operation time (in group I, mean operation time was 328 +/- SEM 22 minutes in group II, 271 +/- SEM 14 minutes (p < 0.04)); mediastinal drainage (in group I, mean drainage time was 283 +/- SEM 57 cc/m2, in group II, 490 +/- SEM 74 cc/m2 (p < 0.04)); and amounts of transfused blood and blood products (in group I, mean transfused blood products amount was 375 +/- SEM 115 cc/m2, in group II, 874 +/- SEM 184 cc/m2 (p < 0.03)). CONCLUSION: The operation times are apparently longer in the minithoracotomy group. On the other hand, less mediastinal drainage occurred and less blood and blood products transfusion needs were determined to exist in the minithoracotomy group.

Cardiac hydatid cysts with intracavitary expansion.

BACKGROUND: Hydatid cyst disease is a significant health problem for undeveloped and developing countries. Although cardiac involvement is rare, early diagnosis and treatment of this situation is important. METHODS: To investigate the long-term outcome of patients who underwent operation for cardiac hydatid cysts with intracavitary expansion, we reviewed 8 patients who had cardiac hydatidosis and who underwent operation in our institution between January 1988 and November 1999. All patients presented with intracavitary protrusion of the cysts. Seven patients were women. The mean age was 33 +/- 14.3 years with a range of 17 to 55 years. The cysts were located on the right ventricular outflow tract (2 patients), right midventricular part of the muscular septum, left atrial free wall and apical portions of the right (2), or left (2 patients) ventricle. Standard cardiopulmonary bypass and crystalloid antegrade cardioplegia with aortic cross-clamping were used in all patients. In one, with right ventricular hydatid cyst, we used cardiopulmonary bypass with femoral cannulation and total circulatory arrest at less than 18 degrees C systemic hypothermia. This patient, who was arrested because of pulmonary emboli could not be weaned from cardiopulmonary bypass and died. RESULTS: The cystic cavity was cleaned and closed with multiple pursestring sutures in 4 patients. In 2, cardiac and cystic cavities were united by partially resecting part of the cyst facing the cavity. In another patient, a left ventricular patch plasty was performed after removal of the cystic material in the left ventricle. Mebendazole was used postoperatively in all patients. Except for 1 patient who died, all were discharged without postoperative complications. The mean follow-up was 7.5 +/- 5 years. There was no late cardiac mortality or recurrence. CONCLUSIONS: Cardiac hydatid cysts with intracavitary expansion should be treated surgically without delay. Gentle handling of the heart during cardiopulmonary bypass minimizes operative risk. All patients should be investigated for systemic cysts.

An anatomopathologic study of membranous septum aneurysms and significance of their surgical treatment.

THE PURPOSE OF THE STUDY: We analyzed 14 patients with membranous septal aneurysms presenting with a left-to-right communication, by comparing the angiographic, operative and pathological findings. We decided to use medical treatment on two patients and operated on the rest (12 cases). BASIC METHODS: The mean age of the patients was 19+/-9 yr; nine were female, five were male. Cine-angiography of all patients revealed a saccular abnormality protruding into the right ventricle at the uppermost part of the interventricular septum, just below the aortic valve. The sac had the appearance of a glove finger, a cauliflower, a diverticulum, or it was dome-shaped on angiography. PRINCIPAL FINDINGS: Perioperative exploration revealed a perforated true aneurysmal sac in seven patients. In three patients, the perimembranous tissues were severely fibrotic, thickened or had more than one perforation. Two patients had a defect under the septal leaflet of the tricuspid valve at the postero-inferior part of the septum, hidden between the chordae of the valve. CONCLUSIONS: Defining the membranous septal abnormalities clearly is not always possible by cine-angiography. Echocardiography provides additional information. Pathological examination of the resected specimens showed almost total loss of elastic fibers and extensive accumulation of mucopolysaccharides.

Mobile right atrial hydatid cyst with multiorgan involvement.

A 25-year-old woman who had hydatid cysts in her lung was referred to our clinic for the hydatid cyst in her cardiac localization. Multiple hydatid cysts of different cardiac localizations were diagnosed by two-dimensional echocardiography, confirmed by computed tomography and magnetic resonance imaging, supported by enzyme-linked immunosorbent assay (ELISA) for echinococcosis. Surgical resection was performed for the right atrial cyst and pathology confirmed the diagnosis. Oral albendazole treatment was given postoperatively. Cathet. Cardiovasc. Intervent. 49:204-207, 2000.

The role of intraoperative antibiotic irrigation and postoperative antibiotic therapy for contaminated implantable prosthesis: in a rat model in vivo.

The aim of this study was to determine the usefulness of intraoperative antibiotic irrigation solution and long-term effective antibiotic therapy for the infected prostheses. Forty-five male Wistar albino rats were divided into three equal groups and a small piece of silicone prosthesis contaminated with Staphylococcus epidermidis was implanted into the scrotum. In the first group, the silicone pieces were irrigated with an antibiotic solution intraoperatively and antibiotic therapy was applied for 20 days postoperatively. The second group underwent only antibiotic therapy. In the third group (control) neither intraoperative irrigation nor postoperative antibiotic therapy was applied. Postoperative clinical infection was determined as follow-up. All implants were extracted 20 days after the implantation and cultured to observe the bacterial growth. In the first group, in 13 rats the cultures were negative and in two rats, the cultures revealed positive bacterial growth. In the second group, in four rats the cultures were negative, in five rats the cultures were positive and six rats revealed infectious findings. In the third group, 13 rats revealed infectious findings, and in the remaining two rats the cultures were positive. The differences between three groups are statistically significant (P < 0.05). We conclude that intraoperative antibiotic irrigation and postoperative antibiotic therapy are highly beneficial in the infected prosthesis surgery.

Swan-Ganz catheter entrapment in open heart surgery.

BACKGROUND AND AIM: Swan-Ganz catheterization is an important technique for monitoring perioperative and postoperative cardiac pressures during open heart surgery. However, although a rare condition, resistance may be encountered while removing the catheter postoperatively and its removal must be accomplished through surgery. METHODS: Between May 1988 and February 2000, we observed Swan-Ganz catheter entrapment complications in 10 cases subjected to open heart surgery. All the cases had valve replacement. Five cases were male, while five were female. The Swan-Ganz catheter was retained in the vena cava cannulation suture in four cases, in the right atriotomy in three cases, in a left atriotomy suture in one case, and looped around the right ventricular papillary muscle in one case. In the last case, it was looped around chordae tendinea between the tricuspid valve conal papillary muscle and septal leaflet. Although cardiopulmonary bypass equipment was prepared, it was not utilized in any of the cases. The catheter was released and removed by placing a pursestring suture on the vena cava cannulation site in four cases, by placing a matrix suture on the proximal and distal part of the left or right atrial suture line and a purse-string suture on the site of the entrapment in four cases, and by digital palpation from the right atrial appendage in two cases. RESULTS: All patients were taken to the intensive care unit postoperatively and to the wards the next day without complications. CONCLUSIONS: When performing open heart surgery, the surgeon should not leave the Swan-Ganz catheter in the suture while closing the right or left atriotomy or during venous cannulation. In addition, the catheter should be moved after suturing to ensure that there is no entrapment.

Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion.

Thirty-two patients with radiographic evidence of scaphoid nonunion were preoperatively evaluated by magnetic resonance imaging (MRI), then observed intraoperatively for punctate bleeding of the fragments. Although MRI and intraoperative findings matched in 19 patients, there was no correlation in 13 patients. While 7 of these latter patients showed normal MRI but no punctate bleeding during the operation, the remaining 6 had preoperative MRI of avascularity but punctate bleeding during the operation. After internal fixation and bone grafting, all but 1 of these 13 patients achieved union. We conclude that the diagnosis of avascular necrosis should only be made when both MRI and intraoperative findings indicate avascularity.