Evaluation of pituitary function and metabolic parameters in patients with traumatic maxillofacial fractures.

PURPOSE: This study was designed to assess the pituitary functions of patients with traumatic maxillofacial fractures and compare the results with healthy controls. METHODS: Thirty patients (mean age, 38.14 ± 14.15 years; twenty-six male, four female) with a traumatic maxillofacial fracture at least 12 months ago (mean 27.5 ± 6.5 months) and thirty healthy controls (mean age, 42.77 ± 11.36 years; twenty-five male, five female) were included. None of the patients were unconscious following head trauma, and none required hospitalization in intensive care. Basal pituitary hormone levels of the patients were evaluated. All patients and controls had a glucagon stimulation test and an ACTH stimulation test to evaluate the hypothalamic-pituitary-adrenal axis and the GH-IGF-1 axis. RESULTS: Five of thirty patients (16.6%) had isolated growth hormone (GH) deficiency based on a glucagon stimulation test (GST). The mean peak GH level after GST in patients with hypopituitarism (0.54 ng/ml) was significantly lower than those without hypopituitarism (7.01 ng/ml) and healthy controls (11.70 ng/ml) (P < 0.001). No anterior pituitary hormone deficiency was found in the patients, except for GH. CONCLUSION: Our study is the first to evaluate the presence of hypopituitarism in patients with traumatic maxillofacial fractures. Preliminary findings suggest that hypopituitarism and GH deficiency pose significant risks to these patients, particularly during the chronic phase of their trauma. However, these findings need to be validated in larger scale prospective studies with more patients.

Comparison of the effectiveness of cyclosporine and tacrolimus in preventing acute rejection and their effects on kidney functions.

OBJECTIVE: The aim of this study is to compare the effects of cyclosporine (CsA) and tacrolimus (TAC) on preventing acute rejection and analyze the side-effect profiles of both agents, particularly on kidney functions. PATIENTS AND METHODS: In our study, 71 patients who underwent heart transplantation were included. For maintenance immunosuppression, 28 of these patients were treated with mycophenolate mofetil (MMF), steroid, and steroid CsA, and 43 of them were treated with MMF steroid and TAC. Endomyocardial biopsy results of the patients in the first month and the first year were compared. In the follow-ups, creatinine values and other parameters were recorded. RESULTS: Endomyocardial biopsy (EMB) performed at 1 month showed no rejection in 12 patients (42.9%) in the CsA group, grade 1R rejection in 15 patients (53.6%), and grade 2R rejection in one patient (3.6%). In the TAC group, rejection was not detected in 25 patients (58.1%), while grade 1R rejection was diagnosed in 17 patients (39.5%) and grade 2R rejection in 1 patient (2.3%) (p=0.4). In EMBs performed in the first year, 14 patients (51.9%) in the CsA group did not have rejection, 12 patients (44.4%) had grade 1R rejection, and one patient (3.7%) had grade 2R rejection. In the TAC group, grade 0R rejection was diagnosed in 23 patients (60.5%), grade 1R rejection in 15 patients (39.5%), and grade 2R rejection was not detected. Postoperative first-week creatinine values, which were found to be higher in the CsA group, were significant compared to the TAC group (p=0.028). CONCLUSIONS: TAC and CsA are drugs that help prevent acute rejection after heart transplantation and can be used safely in heart transplant recipients. Neither drug is superior to the other in preventing rejection. TAC may be preferred to CsA as it has fewer negative effects on kidney functions in the early postoperative period.

Thrombosis in Continuous Flow Left Ventricular Assist Devices: Our Clinical Experience With Medical and Surgical Management.

BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) such as the HeartMate II and HeartWare left ventricular assist device are important alternatives to heart transplantation. Thrombosis is a serious complication in both devices and we present our approach to treating thrombosis and analysis of predisposition factors. METHODS: Our center's CF-LVADs database was retrospectively reviewed for pump thrombosis between January 2011 and January 2015. The patients were grouped for pump thrombosis (n = 13) and nonpump thrombosis (n = 85). Patients with pump thrombosis were further divided by device type (n = 5 HeartMate II and n = 8 HeartWare left ventricular assist device). Predisposition factors for pump thrombosis, our treatment approach, and patient outcomes were evaluated. RESULTS: Pump thrombosis was diagnosed in 13 of 98 patients. The rate of pump thrombosis did not differ between the 37 HeartMate II and 61 HeartWare left ventricular assist device patients. High mean arterial blood pressure (P < .01) and noncompliance with the anticoagulation regimen (P = .04) were associated significantly with thrombosis. Twelve patients with stable hemodynamics were treated initially with intravenous tissue plasminogen activator and 1 patient who had end-organ damage underwent pump exchange. Two patients failed to respond to medical treatment and underwent pump exchange. Two patients with recurrent thrombosis were administered intracardiac tissue plasminogen activator. Five patients died after medical treatment and 4 deaths were due to cerebral hemorrhage. CONCLUSIONS: Avoiding increased mean arterial blood pressures and ensuring optimal anticoagulation may help to decrease pump thrombosis. In patients with pump thrombosis, thrombolytic therapy is an alternative that is less invasive than pump exchange, but carries the risk of hemorrhage and thromboembolism.

Outcomes and Readmissions After Continuous Flow Left Ventricular Assist Device: Heartmate II Versus Heartware Ventricular Assist Device.

INTRODUCTION: Donor organ shortage is still a problem for heart transplantation. Only 10% of patients in waiting list undergo heart transplantation. Over the last 5 years, 2 different continuous flow pumps, the HeartMate II and the HeartWare, have been successful clinically in the alternative treatment of patients with end-stage heart disease. METHODS: Fifty-five patients underwent left ventricular assist device implantation between 2011 and 2014. Patients were followed on pump support for complications and intraoperative outcomes. Potential device-related complications include infections, bleeding liver dysfunction, renal dysfunction, right ventricular failure, stroke, thromboembolism, gastrointestinal bleeding, and wound infection. RESULTS: The only preoperative significant difference between groups in the study was age; the Heartmate II group were significantly older than Heartware group. There were no differences in gender, body mass index, or body surface area. The Heartware has a better 1-year survival rate, although the difference was not significant. Patients with Heartmate II had a higher incidence of gastrointestinal bleeding and driveline infection. The Heartware group had a higher incidence of stroke and pump thrombosis. CONCLUSIONS: The Heartmate II and Heartware are comparable in most respects such as survival, intraoperative features, and major complications.

Pulmonary artery obstruction due to papillary fibroelastoma on the pulmonary valve: a rare cardiac tumor.

Papillary fibroelastomas (PFEs) are primary cardiac tumors. They are rare benign tumors that occur on the endocardium of the heart, especially on the heart valves. The majority of these benign tumors have been observed on the left side of the heart and involved the aortic and mitral valves; however, occurrence on the right side of the heart has been infrequently reported, with only a few cases documented on the pulmonary valve. Most patients with PFEs are asymptomatic and the tumors are usually found incidentally. The tumors have the potential to cause systemic or pulmonary embolism or obstructive phenomena. We present a rare case of a papillary fibroelastoma occurring on the pulmonary valve with clinical presentation due to pulmonary artery obstruction. The tumor was removed surgically.