Cytokine response in lower extremity ischaemia/reperfusion.

We studied the local and systemic concentrations of pro-inflammatory cytokines produced during acute lower extremity ischaemia and following reperfusion in 19 patients undergoing thromboembolectomy of the femoral artery. Blood samples were taken from the femoral vein (local response) and radial artery (systemic response) in the ischaemic (baseline) phase, and 2, 12 and 24 h post-reperfusion. Associated lung injury was measured by the alveolar-arterial (A-a) oxygen gradient and post-reperfusion femoral vein plasma concentrations of creatinine kinase and lactic dehydrogenase were also measured. Local and systemic concentrations of interleukin (IL)-2 receptor and IL-6 (but not IL-1 beta) increased significantly after reperfusion. IL-8 concentration increased significantly in the radial artery. The high and progressively increasing concentration of IL-6 in the femoral vein suggests local production. The parallel increase in creatinine kinase concentration and A-a oxygen gradient indicates that IL-6 plays an important role in acute arterial occlusion and reperfusion injury.

A retrospective comparison of bovine pericardium and polytetrafluoroethylene patch for closure of ventricular septal defects.

This retrospective study compared the immediate post-operative (first month) and mid-term (up to 5 years post-operation) results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene (PTFE) patch. There were no cases of early (in the first month) mortality in either group and the 3-month post-operative echocardiographical studies showed no evidence of calcification or aneurysm formation around the patch. Recurrent ventricular septal defects due to dehiscence of the patch occurred in the early follow-up period in four patients who had the PTFE patch but this was not statistically significant. Annual echocardiographical examination revealed some calcification in both groups. We conclude that although there are no significant differences between the two materials in outcome after ventricular septal defects closure, we prefer bovine pericardium because of its handling characteristics, elasticity and the lower risk of endocarditis.

One-lung ventilation of a preterm newborn during esophageal atresia and tracheoesophageal fistula repair.

In this paper, we assessed the anesthesia management of a male, a 34-week gestation age newborn, weighing 1500 g, who has esophageal atresia and tracheoesophageal fistula localized just above the carina. Endotracheal intubation and intermittent positive pressure ventilation caused air leakage through the fistula into the stomach, causing abdominal distention. One-lung ventilation by left main bronchus intubation eliminated this problem.

[Clinical approach to trauma-related internal iliac artery pseudoaneurysms (two connected cases)]. / Travmaya bagli internal iliak arter pseudoanevrizmalarindaki klinik yaklasimimiz (iki olgu nedeniyle).

Penetrating injuries to abdomen and especially deep gluteal injuries causes vascular and non vascular injuries which necessitates emergency surgery. Surgical management of the penetrating injuries is very difficult, especially exploration of the gluteal region is very difficult. Management of the injury of iliac artery branches is extremely difficult. Two cases with penetrating injury to the gluteal region in 1998 and 2000 one was operated on urgently and the other was operated on electively. Coil embolization was tried to be performed for elective case but intervention was unsuccessful. In both cases internal iliac artery was ligated and aneurysm was repaired. There were no complications in postoperative period. In postoperative angiographic controls, aneurysm in the internal iliac artery was regressed and there were no vascular complications at this region such as hematoma. Penetrating injuries at gluteal region causes injury to the internal iliac artery branches which seriously necessitates emergency management, internal iliac artery ligation and repair.

The assessment of internal mammary artery grafts by colour Doppler in coronary artery surgery.

BACKGROUND: Various studies in progress on the flow and diameter parameters based assessment and suitability of internal mammary artery by preoperative colour Doppler examination in coronary artery surgery. Postoperative visualisation of these grafts is also in evolution. Due to its noninvasive approach, colour Doppler sonography is taking its place in the follow-up of coronary artery bypass procedure. The aim of this study was to show the effectiveness and feasibility of colour Doppler in the routine postoperative follow-up evaluation. METHODS: In GATA Haydarpasa Education Hospital, coronary artery bypass grafting was performed by anastomosing left internal mammary artery to left anterior descending artery and saphenous veins to remaining lesions of the coronary arteries in 36 male patients between the ages of 42 to 66 (mean 54.8) in 1995. Left internal mammary artery and unused right internal mammary artery were imaged by colour Doppler six to eight weeks after the operations in all cases. Coronary angiography was also performed in two cases 4 months postoperatively. RESULTS: Colour Doppler sonography findings showed that the diameter of left internal mammary artery was larger (p=0.03) and mean flow value was greater than intact right internal mammary artery (p=0.02). CONCLUSIONS: These results shows that colour Doppler sonography should be applied as a noninvasive method, in the follow-up of internal mammary artery grafts after coronary artery revascularisation.

Involvement of free radicals in the cardioprotective effect of defibrotide.

Ischemia followed by reperfusion has deleterious effects on myocardial tissue and a wide range of drugs have been investigated to modulate these changes. Defibrotide (polydeoxyribonucleotides from bovine lung), a drug with antithrombotic and fibrinolytic activities, has also proven to be cardioprotective against myocardial ischemia/reperfusion damage. However, the mechanism of this protective effect has not been clarified yet. The aim of this study was to determine whether this effect is due to protection against free radical induced changes. The experimental model in rabbits includes coronary artery ligation for 60 min followed by a reperfusion period of 45 min. In this model, free radical damage was estimated by different parameters of lipid peroxidation such as diene conjugation, carbonyl content, and thiobarbituric acid reactive substances, together with protein oxidation determinations. The results demonstrate that defibrotide prevents free radical induced changes after myocardial ischemia/reperfusion.

Protective effects of cilazapril against free radical injury in myocardial ischaemia-reperfusion.

Cilazapril is a prodrug which is rapidly hydrolysed to the pharmacologically active cilazaprilat following absorption to the bloodstream. In clinical pharmacological studies, administration of cilazapril resulted in potent, reversible, selective and competitive angiotensin converting enzyme inhibition. In this study, we have examined the protective effect of cilazapril on a myocardial ischaemia-reperfusion model by using different parameters of lipid peroxidation and protein oxidation. We have observed increased levels of diene conjugates, carbonyls and malondialdehyde as well as protein carbonyls after ischaemia-reperfusion, whereas protein sulphydryl groups were decreased. Our results clearly demonstrate that cilazapril, a non-sulphydryl, long-acting angiotensin converting enzyme inhibitor, has free-radical-scavenging potential in a model comparable to the clinical situation observed in humans.

Treatment of congenital venous avalvulosis using a surgically created autogenous vein valve.

A patient with venous valve hypoplasia resulting in chronic venous insufficiency is presented and a method of surgical correction by creation of an autogenous femoral vein valve described. A saphenous vein segment was opened posteriorly and inverted cephalad into the common femoral vein to construct a monocuspid vein valve. At 1 month after operation the patient experienced significant symptomatic improvement. The valve was patent and competent when assessed by Doppler venous examination but slight incompetence was shown by Valsalva's manoeuvre. This procedure appears to be a useful technique for the correction of deep vein reflux caused by venous valve aplasia and hypoplasia but requires further short- and long-term investigation.