Traumatic lumbar artery pseudoaneurysm: the role of CT angiography in diagnosis and treatment.

Pseudoaneurysm of lumbar artery is a rare and late complication of penetrating trauma. We report the Doppler ultrasonography and multidetector computed tomography angiography findings and endovascular embolization treatment of a pseudoaneurysm of lumbar artery in a 14-year-old girl following a gunshot wound.

The effect of competitive flow on both the flow and the velocity in venous grafts in a bypass model.

OBJECTIVE: The term "competitive flow" defines the flow from a partially stenosed native artery that "competes" with the flow from a graft to perfuse the distal tissues. The purpose of our study is to investigate the effects of competitive flow at different degrees of stenosis at common carotid artery, in a rabbit model by measuring both the flow volume and velocity in the venous graft. METHODS: This prospective experimental study included 33 rabbits, which were divided into three groups: in Group 1, the common carotid arteries were ligated to form a total occlusion, in Group 2, the common carotid arteries were externally incompletely ligated to achieve 50% stenosis, and in Group 3, common carotid arteries were fully patent. The jugular vein was reversed and anastomosed to proximal and distal common carotid arteries using end to side anastomosis technique. Mean arterial pressure, the total flow and velocity were measured in native carotid arteries prior to surgery and in venous grafts 2 months after surgery using Doppler ultrasonography. Statistical analysis was performed using Chi-square test and Kruskal Wallis analysis of variances. RESULTS: There were no differences in graft mean velocity (Group 1--16.8+/- 6.7 cm/sec, Group 2--14.1+/- 6.1 cm/sec and Group 3--12.1+/- 6.7 cm/sec), and mean flow volume (Group 1--33.9+/- 11.5 mL/min, Group 2--29.0+/- 8.3 mL/min, and Group 3--24.4+/- 12.8 mL/min) between groups after surgery (p>0.05 for both). CONCLUSION: As it was the case in this rabbit model, the reduction of flow volume or velocity in lesser degrees of stenosis in the carotid artery venous bypass grafts is not significant in a statistical perspective. Although in short-term this effect did not create a difference for graft patencies between the groups, it may be important in long-term.

The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block.

OBJECTIVE: Noninvasive diagnostic methods do not supply sufficient data for patients with left bundle branch block (LBBB) accompanied with coronary artery diseases (CAD). Therefore, generally coronary angiography is required for these patients. Our aim was to evaluate the diagnostic value of multislice spiral computed tomographic (MSCT) coronary angiography to detect CAD in patients with LBBB. METHODS: Sixty one patients (31 males, 30 females, mean age: 56+/-13 years) with LBBB who have determined stenosis higher than 50% in quantitative coronary angiography were included in the cross-sectional study. The MSCT coronary angiography was applied to the patients with a 16-detector MSCT scanner that has an electrocardiographic synchronization unit. Each coronary artery was evaluated segmentally in the images acquired from MSCT coronary angiographies and any detected stenosis higher than 50% was recorded. RESULTS: The data of 793 coronary artery segments achieved from MSCT coronary angiographies of 61 patients (13 segments for each patient) were compared with the results of conventional coronary angiographies of the same patients. When all the segments evaluated were included in this comparison, the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of MSCT coronary angiography to detect stenosis higher than 50% were 91%, 67%, 97%, 85% and 92%, respectively. Also, it was observed that, MSCT coronary angiography has 80% sensitivity and 90% specificity to detect, at least, one segment coronary artery stenosis. CONCLUSION: The MSCT coronary angiography can be utilized as a noninvasive diagnostic method for patients with LBBB, in order to evaluate coronary artery disease.

Beneficial effect of methylprednisolone on cardiac myocytes in a rat model of severe brain injury.

Cardiac injury, occurred after traumatic brain injury (TBI), has been recognized for more than a century. Bcl-2 is a key regulatory component of the mitochondrial cell death pathway, and its overexpression is cytoprotective in many cell types. The therapeutic agents, which induce the expression of bcl-2 protein, might provide a new therapy to prevent cardiac myocyte damage following TBI. In this study, we investigated whether methylprednisolone sodium succinate (MPSS) influences the expression of bcl-2 in the heart. Wistar-Albino female rats underwent TBI (300 g/cm) generated by the weight-drop method, and were left untreated (n = 6) or treated with either MPSS (30 mg/kg) (n = 6) or vehicle (albumin solution) (n = 6). The heart was isolated from each animal with TBI. For comparison, the hearts were isolated from sham-operated (n = 6) and control rats (n = 6). The relative expression of bcl-2 mRNA in the heart was quantitated by real-time polymerase chain reaction. We also assessed lipid peroxidation in the heart tissue by determining the concentration of thiobarbituric acid-reactive substances (TBARs) as an indicator of tissue damage. The bcl-2 expression level was significantly higher in the hearts of MPSS-treated rats compared to that of other TBI groups (p < 0.0001). Moreover, TBI increased the lipid peroxidation in the heart, which was significantly reduced by the treatment with MPSS (p < 0.0001). These findings provide evidence for the efficacy of MPSS in protection of cardiac myocytes to achieve optimal heart donation after TBI in heart transplantation.

[Reexploration for bleeding and tamponade in intensive care unit following open heart surgery]. / Açik kalp ameliyatlari sonrasi kanama veya tamponad nedeniyle yogun bakimda yapilan reeksplorasyonlar.

OBJECTIVE: Following open-heart surgery some patients can need reexploration in the intensive care unit due to bleeding or pericardial tamponade. This study evaluates the impact of reexploration in the intensive care unit (ICU) on morbidity and mortality rates. METHODS: Between January 1990 and January 2002 overall 18,578 open heart surgery procedures were performed in our clinic and among them 570 (3%) patients required reexploration due to bleeding or pericardial tamponade. Reexplorations were done in the operating room (OR) in 385 (67.5%) patients and in the ICU in 185 (32.5%) patients. RESULTS: Among patients 383(67.2%) were male and 187(32.8%) were female. Mean age for reexploration in the OR group was 46.9+/-16.3 years, and in the ICU group was 48.2+/-15.7 years. The use of fresh frozen plasma and bank blood was significantly higher in the ICU group (p<0.0001). Fifty patients (27%) who were reexplored in ICU had intraaortic balloon pump (IABP) support (p<0.0001). Sixty-six patients (17.1%) died in OR group and 70 patients (37.8%) died in the ICU group (p<0.001). Following reexploration, 24 (6.2%) patients in the OR group and 17 (9.1%) patients in the ICU group had major infection (p>0.05). There was no statistically significant difference among groups in hospital stay time. CONCLUSION: Following open-heart surgery, especially among hemodynamically unstable patients, to avoid possible problems of transfer to the OR and time lost, explorations can be done in ICU. This practice does not increase morbidity and hospital stay.