Tocilizumab treatment in COVID-19 patients: therapy's side effects and effect on mortality.

OBJECTIVE: This study aimed to determine the effect of tocilizumab use on mortality and the potential side effects in COVID-19 patients. PATIENTS AND METHODS: The intensive care patients were divided into the tocilizumab group and the control group. Hemogram, biochemistry, acute phase reactant values, age, gender, comorbidity, and culture results were recorded on the 0th, 3rd, 7th, and 14th days. Factors affecting mortality between and within the groups and side effects were examined. RESULTS: 32.14% of the patients were female, and 67.85% were male. The tocilizumab group had high alanine aminotransferase and potassium on day 3. On day 7, low levels of platelet, glucose, international normalized ratio, prothrombin time, and active partial thromboplastin time levels were observed. Procalcitonin, C-reactive protein, and fibrinogen levels were low on days 3 and 7. The relationship between the tocilizumab treatment and mortality was statistically not significant, although the APACHE score was low. In the tocilizumab group, the presence of additional disease and reproduction in culture significantly increased mortality. CONCLUSIONS: Despite the risks of side effects, tocilizumab was used in COVID-19 treatment since it is an interleukin-6 blocker. Although the first publications stated that the treatment could decrease the mortality rate, later meta-analyses did not support these results. Our study also found that using tocilizumab did not make a difference in long-term mortality. We also observed that the known side effects were seen in short-term use.

Prognostic significance of the metastatic lymph node ratio compared to the TNM classification in stage III gastric cancer.

BACKGROUND: We aimed to evaluate a comparative analysis of the prognostic value of the metastatic lymph node ratio (LNR) and pN (TNM) in stage III gastric cancer. PATIENTS AND METHODS: A total of 159 stage III gastric cancer patients with curative gastrectomy were retrospectively analyzed. Cutoff values for LNR were designated according to 25%, 50% and 75% percentiles, 0.07, 0.20 and 0.44 respectively. The LNR was divided into four groups as 0 > LNR1 ≤ 0.07; 0.07 > LNR2 ≤0.20; 0.20 > LNR3 ≤0.44; 0.44 > LNR4 ≤1. RESULTS: The mean age of the patients was 61.1 ± 11.3 years. Male predominance was apparent (73.6%). The 1-year overall survival and recurrence rates were 73.6% and 33.6%, respectively. The univariate cox regression analysis demonstrated age and LNR were the main variables that affected overall survival (OS) (p < 0.05). Harvested lymph nodes less than 16 did not affect OS (p = 0.255). The results of the multivariate cox regression analysis revealed that only LNR was an independent prognostic factor (P < 0.001), while pN was not (p > 0.05). Similar results, as with overall survival, could not be revealed clearly for disease free survival (DFS). CONCLUSIONS: LNR was an independent significant prognostic factor and superior to pN staging in predicting OS but not for DFS in stage III gastric cancer patients. The high LNR levels in our research were found to be associated with poor survival rates. The percentile system we used to determine cutoff values may be considered as a reliable method. Similarly, LNR also provides a reliable prognostic parameter in future staging systems to help guide treatment algorithm plans.

Effects of co-administered melatonin, fructose and bisphenol A (BPA) on rat epididymis and sperm characteristics.

Consumption of fructose-rich food and exposure to endocrine disrupting chemicals continue to increase. High fructose consumption is associated with increased incidence of dyslipidemia, hypertension, hyperuricemia and insulin resistance. Bisphenol A (BPA) is an environmental contaminant that exhibits estrogen-like activity; it impairs reproductive organs, sperm production, spermatogenesis and fertility. We investigated the possible ameliorative effects of melatonin on rat epididymis and sperm characteristics following exposure to fructose and BPA. We used 42 adult male Sprague-Dawley rats divided into seven groups. Group 1, control group, was treated with 25 mg/kg sesame oil + 25 mg/kg 0.1% ethanol. Group 2 was treated with 10% aqueous fructose. Group 3 was treated with 25 mg/kg BPA. Group 4 was treated with 10% fructose and 25 mg/kg BPA. Group 5 was treated with 10% fructose and 20 mg/kg melatonin. Group 6 was treated with 25 mg/kg BPA and 20 mg/kg melatonin. Group 7 was treated with 10% fructose, 25 mg/kg BPA and 20 mg/kg melatonin. After 60 days, epididymal tissue was removed and analyzed using histochemistry and immunohistochemistry. Sperm were counted, and sperm motility and viability were investigated. Administration of BPA caused significant damage to both epididymal tissue and sperm quality; melatonin reduced the damage, but did not prevent it completely.

Effects of 2100 MHz radio frequency radiation on ductus epididymis tissue in rats.

PURPOSE: The use of mobile phones is widespread since the beginning of 1990s. A great debate exists about the possible damage that the Radio Frequency - RF radiation from mobile phones exerts on different organs. The objective of this study was to investigate the possible histopathological effects of 2100 MHz RF radiation on rat ductus epididymis tissue using a light microscopy and immunohistochemical method after one or two month exposure. MATERIALS AND METHODS: The study was performed on 36 adult Wistar albino rats. 2100 MHz RF radiation was used with a specific absorption rate (SAR) of 0.36 W/kg for 30 min/day, 6 days per week for one or two months. There were 3 groups (n = 6 for each group): one month RF exposed group, two months RF exposed group, and the control group. RESULTS: At the end of the study, the structural changes in ductus epididymis tissue were evaluated. In both 2100 MHz RF exposed groups, the rat ductus epididymis sperm were not observed in some channels, a reduction in sperm density in some of the channels drew an attention. The loss of connective tissue and edematous areas were observed in cross channel interstitial connective tissue. In addition, it was observed that vascularization was highly increased with respect to the control group in cross-channel interstitial connective tissue. CONCLUSION: 2100 MHz RF exposure resulted in some structural changes in the male genital ducts of rats (Tab. 1, Fig. 5, Ref 20).

Comparative investigation of the fetus and adult joint ligament in the knee and elbow with structural levels / Investigación comparativa del ligamento conjunto de rodilla y codo con niveles estructurales en fetos y adultos

The aim of this study was to examine and compare fetal and adult knee and elbow joint ligaments and determine histologically how these ligaments change over time. In addition, the images of fetal and adult joint ligaments were examined with magnetic resonance imaging (MRI). This study was conducted on 10 male fetus ranging from ages 14 to 17.5 weeks, two adult male cadavers obtained from Gazi University Faculty of Medicine Department of Anatomy and MR images of the knee and elbow regions of 10 male adults obtained from Atatürk Educational and Research Hospital between 2009 and 2011. In the present study, the sections taken from knee and elbow of ten 14­17.5 week old fetuses and the ligaments of tissue taken from the knee and elbow of two male cadavers using the same method of dissection were monitored. After monitoring tissue, microtome sections taken from paraffin-embedded structures were stained using the Masson-Trichrom and Orcein-Picroindigocarmine staining method. These sections were examined under a microscope and photographed. The images of 17 week old fetuses and the knee and elbow of the adults were obtained with MRI. The differences detected between adult and fetus ligaments consisted of fibroblast density and collagen thickness, density and waves. Although the fetus ligaments were not seen sufficiently with 1.5 Tesla (T) MR, they were seen very clearly with 3 T MR. Structural differences between adult and fetal ligaments revealed in histological and MRI images.

El objetivo del estudio fue examinar y comparar los ligamentos de la articulación de la rodilla y del codo en fetos y adultos y determinar histológicamente como estos ligamentos cambian con el tiempo. Además, las imágenes de los ligamentos de las articulaciones fetales y adultas se examinaron con imágenes de resonancia magnética (IRM). Fueron utilizados 10 fetos masculinos entre 14 y 17,5 semanas, y dos cadáveres adultos masculinos obtenidos del Departamento de Anatomía, Facultad de Medicina de la Universidad Gazi junto con las IRM de las regiones de la rodilla y del codo de 10 hombres adultos obtenidos de Atatürk Educativa y del Hospital de Investigación entre los años 2009 y 2011. Para las secciones de rodilla y codo de los diez fetos y de los cadáveres masculinos se utilizó el mismo método de disección. Después de procesar los tejidos e incluirlos en parafina, se obtuvieron cortes en micrótomo los cuales fueron posteriormente teñidos con Tricrómico de Masson y Orceína-picro-índigo Carmín. Las secciones fueron fotografiadas y examinadas bajo microscopio. Se obtuvieron IRM del codo y de la rodilla de los fetos y adultos. Las diferencias encontradas entre los ligamentos de adultos y fetos estaban en relación a la densidad de fibroblastos y espesor de colágeno. Aunque no fue posible observar los ligamentos fetales con 1,5 Tesla (T) MR, se observaron claramente con 3 T MR. Las diferencias estructurales entre los ligamentos fetales y adultos se observan tanto a nivel histológico y de resonancia magnética.

Antioxidative and therapeutic effects of spirulina on trichloroethylene induced cutaneous irritation balb/c mice.

OBJECTIVES: To evaluate the antioxidative and therapeutic effects of spirulina on the trichloroethylene induced cutaneous irritation balb/c mice. BACKGROUND: During recent years, an attention has been focused on the antioxidant potential of Spirulina species. METHODS: Balb/c mice were randomized into the four groups. At the end of the each application, the rats were sacrificed and dorsal skin was taken. Histopathologic and immunohistochemical evaluations were conducted, oxidative stress was assessed by the measurement of malondialdehyde (MDA) levels, superoxide dismutase (SOD) activities and nitric oxide (NO) production. RESULTS: There was a statistically significant decreased disruption in epidermal integrity, oedema in intercellular dermis, disorganization in collagen fibres and immunoreactivity in the pre acute dermatitis/ antioxidant and the post acute dermatitis/ treatment groups when compared to the acute dermatitis group (p<0.05). CONCLUSION: The results of the present study indicate the antioxidative and therapeutic effects of Spirulina on trichloroethylene induced cutaneous irritation balb/c mice (Tab. 2, Fig. 8, Ref. 33).

The protective effects of Ginkgo biloba extract (EGb-761) on radiation-induced dermatitis: an experimental study.

BACKGROUND: Irradiation of the skin induces production of free radicals, resulting in oxidative stress. EGb-761, an extract from the leaves of the Ginkgo biloba tree, has been reported to be an effective exogenous antioxidant based on its free-radical scavenger properties. AIM: To investigate the protective effect of G. biloba extract (EGb-761) on radiation-induced dermatitis in rats. METHODS: Forty male Wistar rats were divided equally into four groups: group 1 received sham radiotherapy (RT) without EGb-761, group 2 received sham RT with EGb-761, group 3 received RT without EGb-761, and group 4 received RT with EGb-761. Levels of malondialdehyde (MDA), nitric oxide (NOx) and glutathione (GSH) were measured. Dermatitis was assessed with a semiquantitative dermatitis item score. The intensity of staining and diffusion of expression for proliferating cellular nuclear antigen (PCNA) and transforming growth factor (TGF)-ß3 were also evaluated. RESULTS: The enhanced oxidative stress seen after RT was markedly diminished when EGb-761 was administered with RT; significantly lower mean MDA (P < 0.005) and higher mean GSH (P < 0.001) levels were seen in group 4 compared with group 3. Although there was a decrease in NOx levels, this was not significant. All (100%) of the animals in group 3 developed dermatitis, whereas only 13% of the animals in group 4 did so (P < 0.0001). There was a significant difference between group 1 and group 3 in PCNA and TGF-ß3 staining (P < 0.05), whereas no difference was seen between groups 3 and 4; however, the intensity of staining and diffusion of expression were lower in group 4 than in group 3. CONCLUSIONS: Prophylactic administration of EGb-761 seems to have a protective effect against radiation-induced dermatitis.

Hemolysis at different vacuum levels during vacuum-assisted venous drainage: a prospective randomized clinical trial.

BACKGROUND: There are several reports on the application of variable degrees of vacuum pressure to hardshell venous reservoirs. The aim of the current study was to compare the hemolytic effects of vacuum-assisted venous drainage (VAVD) at two different vacuum levels with the classical gravity siphon method. METHODS: A prospective, equally randomized (1: 1: 1), parallel group study was performed in elective coronary artery bypass grafting (CABG) operations. PATIENTS: (n = 162) were divided into three groups: gravity siphon (group 1, n = 55), VAVD at -40 mmHg (group 2, n = 55) and VAVD at -80 mmHg (group 3, n = 52). Hemolysis tests were performed at 2, 24 and 48 h following the operations. RESULTS: There were no deaths in this study. Plasma-free hemoglobin (PfHb) levels showed a difference at 2 h (p < 0.001) compared to 24 h (p = 0.02) between the groups. Haptoglobin (Hp) levels also revealed hemolysis in groups 2 and 3 at all sampling times. CONCLUSIONS: Constant negative suction at -80 mmHg during elective coronary bypass operations caused more hemolysis. We do not recommend a constant suction of -80 mmHg for VAVD.

The study of biochemical and histopathological effects of spirulina in rats with TNBS-induced colitis.

OBJECTIVES: To evaluate the beneficial effects of spirulina on the treatment of experimental colitis. BACKGROUND: Spirulina, a planktonic blue green algae from oascillateriaceae family, has anti-inflammatory, antioxidant, antitumor, anti-viral, and antimicrobial effects, rendering it a natural drug of prophylactic and therapeutic properties. The effects of spirulina on colitis are not known. METHODS: Wistar rats weighing 200-300 g were used. Experimental colitis was created during anesthesia using the trinitrobenzene sulfonic (TNBS) acid. The rats were randomly divided into the 3 groups. In the group 1 (sham; n = 8), saline was administered via oral gavage 7 days after 1 ml of rectal saline was administered. In the group 2 (experimental colitis + spirulina; n = 8), 2 g/kg spirulina was administered via oral gavage 7 days after the rectal 1 ml TNBS was administered. In group 3 (experimental colitis; n = 8), enema was administered via oral gavage 7 days after the rectal 1 ml TNBS was administered. Eight days after the instigation of TNBS colitis, the rats were sacrificed and blood and tissue samples were taken. Histopathologic and immunohistochemical evaluations were conducted, and malondialdehyde (MDA), advanced oxidation protein products (AOPP), catalase (CAT), total antioxidant status (TAS), and glutathione (GSH) levels were determined. RESULTS: Inflammation on mucosa and submucosa, hemorrhage, necrosis, cellular infiltration and crypt abscess formation, immunoreactivity and tissue MDA levels were decreased in the experimental colitis + spirulina group when compared to the experimental colitis group (p < 0.05). CONCLUSION: The results of the present study indicate the beneficial effects of spirulina on TNBS-induced inflammatory bowel disease (Tab. 6, Fig. 10, Ref. 40).

Examining the microanatomy of various fetal body parts using the orcein-picroindigocarmine staining method.

It is difficult to distinguish muscle, vessel, nerve, fascia, tendon and many other structures in fetal sections. The aim of the study reported here was to research the practicability of orcein-picroindigocarmine staining for distinguishing anatomic structures in histological sections containing complex structures. Histological serial sections of hand, foot, head and neck of four 18- to 20-week old fetuses were used. Bone matrix was stained bright blue, collagen fibers tones of green to blue, elastic fibers brown, cartilage matrix tones of pink, and chondroblasts blue. Muscles and erythrocytes were stained yellow to green, epidermis reddish brown, skin appendices including hair and nail stained light yellow to green.

The effect of taurine on renal ischemia/reperfusion injury.

Ischemia-reperfusion (I/R) injury is one of the most common causes of renal dysfunction. Taurine is an endogenous antioxidant and a membrane-stabilizing, intracellular, free beta-amino acid. It has been demonstrated to have protective effects against I/R injuries to tissues other than kidney. The aim of this study was to determine whether taurine has a beneficial role in renal I/R injury. Forty Wistar-Albino rats were allocated into four groups as follows: sham, taurine, I/R, and I/R+taurine. Taurine 7.5 mg/kg was given intra-peritoneally to rats in the groups taurine and I/R+taurine. Renal I/R was achieved by occluding the renal arteries bilaterally for 40 min, followed by 6 h of reperfusion. Immediately thereafter, blood was drawn and tissue samples were harvested to measure 1) serum levels of BUN and creatinine; 2) serum and/or tissue levels of malondialdehyde (MDA), glutathione (GSH), glucose 6-phosphate dehydrogenase (G-6PD), 6-phosphogluconate dehydrogenase (6-PGD) and glutathione reductase (GSH-red); 3) renal morphology; and 4) immunohistochemical staining for P-selectin. Taurine administration reduced I/R-induced increases in serum BUN and creatinine, and serum and tissue MDA levels (p<0.05). Additionally, taurine lessened the reductions in serum and tissue glutathione levels secondary to I/R (p<0.05). Taurine also attenuated histopathologic evidence of renal injury, and reduced I/R-induced P-selectin immunoreactivity (p<0.05). Overall, then, taurine administration appears to reduce the injurious effects of I/R on kidney.

Pai syndrome: an adult patient with bifid nose and frontal hairline marker.

OBJECTIVE: A 17-year-old previously unreported patient with Pai syndrome is described. The boy had median cleft of upper lip, a polypoid skin mass over the columella, a minimal cleft of the upper central incisors, frontal alopecia of the anterior hairline, and bifid nose. Magnetic resonance imaging showed pericallosal lipoma. No mental retardation was present, and a chromosomal study showed normal male 46, XY karyotype.

Occult spinal dysraphism and its association with hip dysplasia in females.

We examined the pelvic radiographs of two groups of patients (more than 12 years of age) from six medical centres. Hip dysplasia was considered to be present if Shenton's line was broken and more than one third of the femoral head was revealed to be uncovered in an antero-posterior radiograph of the pelvis. Patients with hip dysplasia due to teratological or neurological causes were excluded. There were 291 patients with treated or untreated hip dysplasia in the dysplastic group. The control group of 415 individuals was collected from consecutive outpatients (with a pre-set standardised female/male ratio) for whom an antero-posterior radiograph of the pelvis had been made in one of two medical centres and which did not disclose any abnormality of the hip joints. The aim of the study was to assess the co-existence of hip dysplasia and occult spinal dysraphism. Radiographs of all patients were examined, and any partial or complete defect of the posterior vertebral arch was recorded. In the dysplastic group, a defect was recorded in 23% (67/291) radiographs and in the control group in 12% (48/415). In both groups, L5 and S1 were the most commonly recorded sites with a defect. In the dysplastic group, a defect was recorded in 56/190 females and in the control group in 30/302 females. In males, there was no significant difference between the recorded findings in the two groups. In females with hip dysplasia, occult spinal dysraphism seems to be fairly common.

Histological and magnetic resonance imaging alterations after irradiation of meniscus using Holmium:YAG laser.

OBJECTIVE: The authors performed an experimental and a prospective clinical study to evaluate the histological and magnetic resonance imaging (MRI) alterations after irradiation of meniscus using holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and InfraTome Delivery Systems 30 degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). BACKGROUND DATA: Recently, some authors reported a few cases with articular cartilage damage or paraarticular osteonecrosis following arthroscopic knee surgery in which the laser was used to assist in the treatment of meniscal pathology. METHODS: Meniscus specimens in saline immersion were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 microm and pulse duration was 250 microsec. Power settings were 1-1.5 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 2, 3.5, and 6 K joules. Eight patients with meniscal problems underwent arthroscopic partial meniscectomy using Ho:YAG laser. Total laser energy used for these surgeries was 1.5-2.5 K joules. MRI was performed preoperatively and at 6 months postoperatively. RESULTS: At higher energy levels (more than 3 K joules), separation of the gap between the collagen fibers, and a three-dimensional dispersion in the striation were observed on electron microscopic evaluation of meniscus specimens. No patient had abnormal signals in MRI (a sign of articular cartilage damage or osteonecrosis) following arthroscopic laser surgery. CONCLUSION: When higher energy level is required, conventional instruments should be preferred in the treatment of meniscal lesions. Laser should be reserved for the posteriorly located and smaller meniscal lesions.

Paravalvular leakage after mitral valve replacement: is left atrial enlargement an additional indication for reoperation?

BACKGROUND AND AIM OF THE STUDY: Prostheses used to treat heart valve disease improve patient survival, but have certain disadvantages. Paravalvular leakage (PVL) is a rare complication after mitral valve replacement (MVR), and can impair cardiac function and reduce the patient's functional capacity, depending on the degree of periprosthetic regurgitation. METHODS: Between 1985 and July 1999, 2,502 patients underwent MVR with or without concomitant cardiac procedures. Of these patients, 33 (18 males, 15 females; mean age 39.8+/-15.3 years; range: 12-62 years) had PVL of differing degree. The interval between MVR and observation of PVL was 30.5+/-31.5 months (range: 1-126 months), and the period after diagnosis was 22.6+/-31.5 months (range: 2-114 months). Fourteen patients (42.4%) underwent reoperation (RO group), and 19 (57.6%) were followed medically (ME group). Indications for reoperation were reduction of functional capacity, echocardiographically proven serious mitral regurgitation, and hemolysis. RESULTS: Reoperative mortality was 3.0% (1/33), and late mortality 3.1% (1/32) for all patients. Cumulative survival after PVL was 90.2+/-6.7% at both five and ten years. Annular calcification (33.0%) and infective endocarditis (18.2%) were important predictive factors for development of PVL. Only one patient required second re-do surgery. Univariate and forward stepwise logistic regression analyses showed that there was no predictor for the development of severe PVL requiring a second reoperation. No difference was observed between left ventricular dimensions before and after periprosthetic regurgitation. The only significant finding between groups was an increase in left atrial diameter in RO patients after the development of PVL (p <0.05). CONCLUSION: Among patients undergoing MVR there are no clinical features to distinguish who will develop severe PVL during follow up. If PVL reduces the patient's functional capacity or causes serious hemolysis, or if severe PVL is evaluated echocardiographically, then reoperation must be performed. Mild or moderate mitral regurgitation without impairment of functional capacity may be followed medically. In asymptomatic patients, enlargement (>5%) of the left atrial diameter following development of moderate PVL may be a valuable criterion for deciding when to reoperate.

Different CABG methods in patients with chronic obstructive pulmonary disease.

BACKGROUND: Pulmonary dysfunction is still a major problem in coronary artery bypass grafting (CABG). The purpose of this randomized study was to determine the effect of different CABG techniques on pulmonary function. METHODS: Fifty eight patients with severe obstructive pulmonary disease had elective isolated coronary surgery. The surgical methods for the patients with chronic obstructive pulmonary disease (COPD) were standard CABG in 18 patients (group 1), beating heart surgery in 19 patients (group 2), and minimally invasive direct coronary artery bypass grafting (MIDCABG) in 21 patients (group 3). RESULTS: The earliest extubation time was from group 3 (p < 0.001). The average stay in the intensive care unit was significantly longer in group 1 (2.6 +/- 1.5 days) than in groups 2 (1.4 +/- 0.8 days) and 3 (1.1 +/- 0.8 days) (p < 0.05). The most prevalent respiratory morbidity was atelectasis that developed in 6 patients from group 1, in 2 patients from group 2, and in 3 patients from group 3. Forced expiratory volumes in 1 second (FEV1) obtained in the second postoperative month were significantly lower than preoperative values only in group 1 (p < 0.05). Forced vital capacity (FVC) values were significantly lower than the preoperative values in all three groups (p < 0.05). CONCLUSIONS: Off-pump bypass surgical procedures are more advantageous than on-pump methods for patients with COPD. These patients can be operated on using the beating heart technique or by using MIDCABG to prevent side effects of CPB on pulmonary function and effects of sternotomy.

Mechanical versus biological valve prosthesis in the mitral position: a 10-year follow up of St. Jude Medical and Biocor valves.

BACKGROUND AND AIM OF THE STUDY: During the past 30 years, the development of mechanical and biological valves has led to major improvements in patient survival. Here, we present long-term results obtained with both types of prosthesis. METHODS: At our institution, between 1985 and 1989, 158 patients received a Biocor porcine bioprosthesis, and 100 patients a St. Jude Medical (SJM) mechanical valve. Preoperatively, mean age, male:female ratio, NYHA functional class and pathology of mitral valve disease were similar in both groups. RESULTS: The 30-day mortality was 4.4% in the Biocor group and 4% in the SJM group, the major cause being congestive heart failure. Late mortality was 17.9% and 15.6% respectively in the two groups, but valve-related mortality was very low in both (1.3% versus 4.2%). Ten-year survival was similar in each group (77.8+/-3.4% versus 81.0+/-3.9%; p = 0.538). Ten-year freedom from anticoagulant-related hemorrhage was higher with Biocor prostheses (99.3+/-0.7% versus 90.9+/-3.1%; p = 0.007). Valve thrombosis was seen only in the SJM group, and structural valve degeneration (SVD) only in the Biocor group. Ten-year freedom from reoperation was lower in the Biocor group (84.9+/-3.2% versus 92.2+/-2.8%; p = 0.206). The significant causes of reoperation were SVD in the Biocor group and valve thrombosis in the SJM group. Freedom from prosthetic valve endocarditis was similar in both groups (96.3+/-1.6% versus 95.5+/-2.2%). CONCLUSION: As no difference was seen in survival and reoperation rates between patients receiving either bioprostheses or mechanical valves, the valve used will depend on the surgeon's choice and the type of patient, notably elderly patients who are intolerant of anticoagulation, and young women wishing to have children.

Midterm angiographic assessment of coronary artery bypass grafting without cardiopulmonary bypass.

BACKGROUND: Coronary bypass surgery that provides good long-term graft patency can be performed on the beating heart as a viable alternative to conventional coronary artery bypass grafting (CABG). METHODS: From September 1993 to December 1996, 696 patients underwent CABG on the beating heart at the Kosuyolu Heart and Research Hospital in Istanbul. Among them, 70 patients were chosen randomly for angiographic assessment of off-pump coronary artery bypass grafting. RESULTS: The interval from operation to angiography varied from 24 to 61 months (mean, 36.1+/-10.9 months). The patency rate of left internal mammary-left anterior descending artery anastomoses was 95.59% (patency achieved in 65 of 68 patients) and of vein grafts was 47.06% (patency achieved in 16 of 34 patients) (p < 0.0001). The patency rates of grafts anastomosed to the left anterior descending artery were significantly higher than the rates of the grafts anastomosed to the other coronary arteries (95.71% versus 45.45%, p < 0.0001). Multivariate analysis showed that graft type (p < 0.0001) and hyperlipidemia (p = 0.023) were significant predictors for graft occlusion. Left ventricular function improved significantly after CABG (p = 0.04). Reintervention (using percutaneous transluminal cardiac angioplasty) and reoperation rates were 0.97% and 1.4%, respectively. CONCLUSIONS: Off-pump coronary artery bypass grafting appears to produce midterm and long-term patency rates that are comparable to those of conventional techniques; that is especially true in cases of arterial conduits and of conduits anastomosed to the left anterior descending artery.