Fast Curing Multifunctional Tissue Adhesives of Sericin-Based Polyurethane-Acrylates for Sternal Closure.

The use of wire cerclage after sternal closure is the standard method because of its rigidity and strength. Despite this, they have many disadvantages such as tissue trauma, operator-induced failures, and the risk of infection. To avoid complications during sternotomy and promote tissue regeneration, tissue adhesives should be used in post-surgical treatment. Here, we report a highly biocompatible, biomimetic, biodegradable, antibacterial, and UV-curable polyurethane-acrylate (PU-A) tissue adhesive for sternal closure as a supportive to wire cerclage. In the study, PU-As were synthesized with variable biocompatible monomers, such as silk sericin, polyethylene glycol, dopamine, and an aliphatic isocyanate 4,4'-methylenebis(cyclohexyl isocyanate). The highest adhesion strength was found to be 4322 kPa, and the ex vivo compressive test result was determined as 715 kPa. The adhesive was determined to be highly biocompatible (on L-929 cells), biodegradable, and antibacterial (on Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus bacteria). Finally, after opening the sternum of rats, the adhesive was applied to bond the bones and cured with UV for 5 min. According to the results, there was no visible inflammation in the adhesive groups, while some animals had high inflammation in the cyanoacrylate and wire cerclage groups. These results indicate that the adhesive may be suitable for sternal fixation by preventing the disadvantages of the steel wires and promoting tissue healing.

Is There Any Difference in Risk Factors between Male and Female Patients in New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting?

BACKGROUND: We aimed to investigate the risk factors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) in male and female patients without any history of AF, to identify the sex-specific risk factors, and to examine the effect of sex-specific risk factors on the overall population. METHODS: This retrospective study was conducted using the hospital database with 4,758 patients who underwent CABG surgery. Among them, 2,836 patients with complete data participated in this study. The female patients were divided into two groups as patients who developed new-onset AF after CABG and those who did not. The relationship between the patients' variables and risk factors of post-CABG AF was examined. RESULTS: The overall incidence of post CABG AF was 12.9% (386/2,836). Sex-specific incidence of AF was similar: 3.2% (91/690) and 12.9% (277/2146) in female and male patients, respectively (p = 0.849). Multiple analysis revealed the independent risk factors for male and female patients, respectively: mean age (odds ratio [OR] = 1.057, OR = 1,076), age over 65 years (OR = 2.156, OR = 2.736), the European System For Cardiac Operative Risk Evaluation Scores (EuroSCORE) (OR = 1.13, OR = 1.218), COPD (OR = 1.589, OR = 1.789), BUN level (OR = 1.026, OR = 1.019), mean cardiopulmonary bypass (CPB) time (OR = 1.007, OR = 1.010), prolonged CPB time (OR = 1.604, OR = 2.309), mean cross-clamp time (OR = 1.009, OR = 1.017), need of inotropic support (OR = 2.249, OR = 2.731), and mean mechanical ventilation time (VT) (OR = 1.026, OR = 1.027).Low left ventricular ejection fraction (LVEF) (OR = 1.419), left ventricular (LV) aneurysm repair (OR = 1.533), carotid artery disease (OR = 1.750), prolonged VT (OR = 1.729), and use of intra-aortic balloon pump (IABP) (OR = 2.436) were found to be the risk factors only for male AF patients.Unstable angina (OR = 1.969), right coronary artery (RCA) disease (OR = 2), prolonged cross-clamp time (OR = 2.152), and the number of grafts per operation (OR = 1.298) were found to be the risk factors only for female AF patients. CONCLUSION: This study suggests that predictors of AF in the overall population may be due to isolated patient groups. Multiple regression analysis and artificial intelligence modelling should be performed on large-scale, isolated groups to make strong AF prediction.

The effects of pulmonary hypertension on early outcomes inpatients undergoing coronary artery bypass surgery.

BACKGROUND/AIM: To investigate the effects of pulmonary hypertension on early clinical variables in patients undergoing coronary artery bypass grafting surgery. MATERIALS AND METHODS: The preoperative echocardiographic data of patients who underwent isolated coronary artery bypass surgery were evaluated retrospectively. A total of 1244 patients were included in the study. The patients were divided into two groups: one group consisted of patients with systolic pulmonary artery pressure (SPAP) values equal to or greater than 30 mmHg (Group 1, n = 184), while the other group consisted of patients with SPAP values below 30 mmHg (Group 2, n = 1060). RESULTS: Early mortality was similar in both groups (0% in Group 1 and 1.2% in Group 2; P > 0.05). Comparison of postoperative data indicated that Group 1 had a higher need for inotropic agent treatment, a longer average duration of ventilation, and a longer average duration of stay in the intensive care unit (P < 0.05). For the other variables, no significant differences were identified between patients with and without pulmonary hypertension (P > 0.05). CONCLUSION: Mild pulmonary hypertension (mean SPAP = 37.7 ± 8.4 mmHg) was not associated with a significant difference in the mortality of patients undergoing coronary artery bypass grafting. For patients undergoing this type of coronary bypass surgery, lower morbidity and mortality rates can be achieved through comprehensive preoperative examinations and effective perioperative medical procedures.

Left atrial volume and function in patients with white-coat hypertension assessed by real-time three-dimensional echocardiography.

BACKGROUND: White-coat hypertension (WCH) is a disease based on the disparity of a patient's blood pressure measurements between the physician's office and the patient's home environment. The aim of the present study is to evaluate the left atrial (LA) volume and functions in WCH. METHODS: In total, this study included 37 WCH (17 women, 20 men, mean age 48.4±5.7 years) and 30 healthy individuals (18 women, 20 men, mean age 47.9±7.5 years). All patients underwent real-time three-dimensional and comprehensive two-dimensional echocardiography (2DE) with tissue Doppler evaluation to estimate left atrial volumes and mechanical functions. RESULTS: LA diameters were significantly higher in the patients compared with the controls (37±2.8 vs. 35±3.1 mm, P=0.017). LA total systolic volume and LA maximal volume were significantly higher in the patients. (41.1±6.9 vs. 35.5±3.7 ml, P<0.001; 25.8±5.4 vs. 21.3±3.3 ml, P<0.001, respectively). LA volume before LA contraction and LA active stroke volume were significantly higher in the patients with WCH than in the normotensives (24.4±6.3 vs. 20.9±2 ml, P=0.002; 9.1±4.8 vs. 6.7±2.5 ml, P=0.007, respectively). Moreover, the LA expansion index was significantly higher in the patients with WCH than in the normotensives (178.7±53.6 vs. 155.3±36.3, P=0.037). However, the total emptying volume fraction of the LA was similar between the two groups. CONCLUSION: We showed that LA structural functions and volumes were increased in the WCH group. Although increased LA volume has been observed in many diseases, structural changes in LA may be accepted as an early sign for clinical cardiac remodeling in patients with WCH, suggesting the necessity of early intervention for preventing clinical cardiovascular disease.

Coronary Bypass Surgery in Patients with Pulmonary Hypertension: Assessment of Early and Long Term Results.

PURPOSE: We aimed to evaluate the effects of preoperative pulmonary hypertension (PH) on early and long term results in patients undergoing coronary bypass surgery and the effects of coronary bypass surgery on PH. METHODS: Among 2325 patients who underwent elective isolated coronary artery bypass surgery between March 2003 and March 2012, 287 patients with high preoperative pulmonary arterial pressure (PAP) ≥30 mmHg were examined. Patients' data were obtained by retrospective examination of our clinic's database. 69 patients who had complete parameters included in the study. RESULTS: There was no increase in the New York Heart Association (NYHA) functional classification 84% of cases. Preoperative and postoperative values of the mean ejection fraction and mean PAP of patients was respectively 45.28 ± 9.67 (25-65), 46.03 ±12.4 (20-65) (p = 0.447), 36.67 ± 6.81 (30-60) mmHg, 37.81 ± 10.07 (20-70) mmHg (p = 0.378). The late mortality of cases was 5.79%. In our study, during 33.9 ± 17 (9-100) months follow up period, life expectancy was calculated as 94.7 months. CONCLUSION: Preoperative evaluation of these patients for appropriate medical treatment at peroperative and postoperative period, coronary bypass can be performed with low morbidity and mortality rates. In the late period after surgical revascularization PH showed no significant change and had no adverse effect on quality of life.

Anomalous origin of the left coronary artery from the right coronary sinus.

Anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.

Interrupted inferior vena cava and partial anomalous pulmonary venous return with atrial septal defect in a 38-year-old adult: a case report.

We present a woman having congenital anomalies of the inferior vena cava and partial anomalous pulmonary venous return from the right lung with atrial septal defect in a 38-year-old. Congenital anomalies of inferior vena cava are rare. They are seen more often in young males. If there are not other anomalies, they are latent for a long time. Peripheral venous thrombosis, chronic venous insufficiency, dyspnea and fatigue are often the first symptoms of these anomalies. Surgical repair of atrial septal defect with partial anomalous pulmonary venous return include provision of durably unobstructed systemic and pulmonary venous pathways, closure of the atrial septal defect, and avoidance of arrhythmias. The diagnosis has been determined by compression ultrasonography with color doppler assessment, multidetector computed tomography angiography and echocardiography.

A comparison of different treatment managements in patients with acute deep vein thrombosis by the effects on enhancing venous outflow in the lower limb.

BACKGROUND: This study aimed at evaluating the benefits of the traditional management of acute deep vein thrombosis (DVT), subcutaneous (sc) administration of low-molecular-weight heparin (LMWH) one dose a day and bed rest, and LMWH with compression stocking and early ambulation compared with LMWH with pneumatic compression (PC) in patients with DVT. MATERIAL/METHODS: Forty-eight consecutive patients with DVT were separated evenly into four groups. Group A received intravenous unfractionated heparin, group B received sc injection of enoxaparin sodium and bed rest, group C received sc injection of enoxaparin sodium and thigh-length compression stockings, and group D received sc injection of enoxaparin sodium and PC for periods of up to 7 days. RESULTS: Comparing days 0 and 7, significant differences were determined in each group regarding differences in circumference of the two legs at the thigh and calf levels and the visual analogue scale (VAS) of pain, and in groups B, C, and D regarding the Lowenberg test for diseased and healthy legs (p<0.001). Between days 0 and 7, significant differences were found in the superficial femoral artery, superficial femoral vein, femoral vein, and the popliteal vein within groups A and D (p<0.05). CONCLUSIONS: Traditional management, sc administration of low-molecular-weight heparin, and pneumatic compression of patients with DVT led to a faster reduction of leg swelling and pain and to increased volume flow through the deep veins of the legs.

Mitral valvular cyst mimicking a solid mass: misdiagnosis with imaging modalities.

This report describes a mitral valvular cyst mimicking a solid mass in an 80-year-old patient. The diagnosis was based on histopathological evaluation of the resected material. This report emphasizes the possibility of misdiagnosis by echocardiographic and other imaging modalities of a mitral valvular mass in a patient without any clinical signs and symptoms.

Left atrial myxoma and concomitant atherosclerotic coronary artery disease.

Here we describe the case of a 71-year-old female patient who was admitted to our department with acute coronary syndrome. Trans-thoracic echocardiography evaluation to assess left ventricular functions incidentally detected a left atrial mass attached to the inter-atrial septum together with a left ventricular segmental wall motion abnormality due to acute anterior myocardial infarction. Coronary angiography revealed diffuse coronary artery disease. Because early surgery was not advised due to the high mortality risk, successful coronary angioplasty and stenting was performed in this emergecy situation. It may be informative to study the images from the echocardiography prior to angiography in this study as well as to determine the anticipated signs that may affect the treatment options for similar patients.

The role of adrenomedullin and brain natriuretic peptide levels in acute rheumatic fever in adults.

OBJECTIVE: Rheumatic fever, a multisystem disease following infection with group A beta-hemolytic streptococcus, is common among young (5-15 years) but can occur in adults as well. Recently, brain natriuretic peptide (BNP) has been validated as a marker of cardiac function and prognosis. Plasma adrenomedullin (ADM) levels are elevated in various pathological states including cardiovascular and inflammatory diseases. We aim to assess the relationship between ADM and BNP levels in adult patients with acute and convalescent rheumatic fever (ARF). METHODS: This case -controlled prospective study included 45 patients with ARF (mean age 21.04+/-1.91 years) and 30 age/gender-matched control subjects. Brain natriuretic peptide and adrenomedullin levels were studied in the acute and convalescent phase of ARF. Adrenomedullin was detected by enzyme immunoassay kit of peptides, while brain natriuretic peptide was measured by a commercially available instrument. The study was carried out between May 2006 and October 2006 in Atatürk University Medical Faculty Hospital. Statistical analysis was performed using Shapiro-Wilk, Mann Whitney U, Wilcoxon signed rank, Chi-square tests and Pearson correlation analysis. RESULTS: Plasma ADM and plasma BNP levels were significantly higher (p<0.05) in adults with ARF, regardless of whether they were in acute or convalescent phase of disease. Plasma ADM levels were 74.43+/-3.4 pmol/mL in acute phases, 59.35+/-1.45 pmol/mL in the convalescent phase, and 44.79+/-13.12 pmol/mL in control group. Plasma BNP levels were 197.51+/-47.41 pg/mL in the acute phase, 145.25+/-51.25 pg/mL in the convalescent phase, and 33.45+/-10.42 pg/mL in control group. The differences were statistically significant for all (p<0.05). Plasma ADM and BNP levels in the acute phase of disease showed significant negative correlation with the left ventricular ejection fraction (r=-0.56, p<0.05 and r=-0.61, p<0.05, respectively). CONCLUSION: In patients with acute and convalescent rheumatic fever, BNP and ADM levels were high compared to those of healthy subjects and this could be used as a complementary tool in the treatment and prognosis of ARF.