Surgical management of iatrogenic femoral artery pseudoaneurysms: A 10-year experience.

BACKGROUND: Vascular complications of cardiac catheterization have increased in line with increasing number of percutaneous interventions. Open repair is the standard method of treatment for true and false aneurysms of femoral artery. We report results of patients operated due to femoral artery pseudoaneurysm after cardiac catheterization. METHODS: Data from 12,261 patients who underwent percutaneous intervention for cardiac catheterization between January 2003 and January 2013 were evaluated. Diagnosis of pseudoaneurysm was established mainly by doppler ultrasonography in patients with complaints of pain and hematoma at the intervention site. Pseudoaneurysms less than 2 cm in diameter were treated non-operatively and were followed up by regular ultrasonographic examination at the outpatient clinic. Pseudoaneurysms with a diameter of 2 cm or more underwent primary repair. All patients were followed up for one year. RESULTS: We detected 55 (0.44%) patients with femoral artery pseudoaneurysm and 42 of them were operated. The mean age was 60.7 ± 6.3 years. Thirty nine (94.5%) patients underwent elective surgery, three (5.5%) patients were operated on under emergency conditions. Operation was performed under local anesthesia in 32 patients, under local anesthesia and sedation in eight patients, and under general anesthesia in three patients. Location of the pseudoaneurysm was the superficial femoral artery in 29 (69%), the common femoral artery in nine (21.4%), and the deep femoral artery in four (9.6%) patients. No limb loss occurred, no patient died and no recurrence was detected during the follow up. CONCLUSIONS: Performing vascular reconstruction before the rupture of pseudoaneurysm is important in terms of morbidity and mortality. We concluded that surgical repair in pseudoaneurysms larger than 20 mm is safe and essential.

In vitro effects of lidocaine hydrochloride on coronary artery bypass grafts.

AIM: Coronary artery bypass grafting (CABG) is one of the most common procedures performed to improve blood supply to myocardium. The characteristics of grafts, mechanical stress and pharmacological agents have substantial influence on the short and long term graft patency. Lidocaine is among the most frequently used antiarrhythmic agents perioperatively. The aim of this study was to evaluate the in vitro effects of lidocaine on internal mammarian artery (IMA), radial artery (RA) and saphenous vein (SV) grafts. METHODS: Using standard tissue bath techniques, responses to increasing concentrations of lidocaine hydrochloride were obtained, in segments of IMA, RA and SV grafts. Twenty patients were enrolled in the study with a total number of 48 grafts (16 for IMA, RA and SV grafts each). In vitro lidocaine concentrations between 10(-9)M and 10(-3.5)M were studied to represent therapeutic plasma concentration of 1.5-5 mcg/mL. RESULTS: In IMA and RA grafts, lidocaine hydrochloride caused vasodilatation (40.5±1.9% and 39.1±2.6 % respectively) at concentrations between 10(-9) to 10(-7.5) M while causing a dose dependent vasoconstriction response at concentrations above 10(-7.5) M. In SV graft samples, lidocain hydrochloride caused vasodilatation (24.4±1.9 %) at concentrations between 10(-9) to 10(-7) M while causing dose dependent vasoconstriction at concentrations above 10(-7) M. For vasoconstriction effect, mean±SD values for E(max) were calculated as: 120.1±6.6% in IMA, 83.35±5.06% in RA, and 154.0±13.8% in SV. The vasoconstriction in the SV samples was higher than in the RA and IMA. The mean ±SD LogEC(50) values were -5.15±0.27, -5.76±0.11 and -5.56±0.19 for SV, IMA and RA grafts respectively.) There was a statiscally significant differences in the Log EC(50) values between SV, IMA and RA (P<0.005) CONCLUSION: Based on the results of our study, we conclude that, increasing doses of lidocaine in the perioperative period may cause vasospasm in IMA, RA and SV grafts. Thus, avoiding high doses may have a role in improving perioperative and long term mortality.

Immune reconstitution following rabbit antithymocyte globulin.

Depletional induction therapies are routinely used to prevent acute rejection and improve transplant outcome. The effects of depleting agents on T-cell subsets and subsequent T-cell reconstitution are incompletely defined. We used flow cytometry to examine the effects of rabbit antithymocyte globulin (rATG) on the peripheral T-cell repertoire of pediatric and adult renal transplant recipients. We found that while rATG effectively depleted CD45RA+CD27+ naïve and CD45RO+CD27+ central memory CD4+ T cells, it had little effect on CD45RO+CD27- CD4+ effector memory or CD45RA+CD31-, CD45RO+CD27+ and CD45RO+CD27- CD8+ T cell subsets. When we performed a kinetic analysis of CD31+ recent thymic emigrants and CD45RA+/RO+ T cells, we found evidence for both thymopoiesis and homeostatic proliferation contributing to immune reconstitution. We additionally examined the impact of rATG on peripheral CD4+Foxp3+ T cells. We found that in adults, administration of rATG-induced peripheral expansion and new thymic emigration of T cells with a Treg phenotype, while CD4+Foxp3+ T cells of thymic origin predominated in children, providing the first evidence that rATG induces Treg in vivo. Collectively our data indicate that rATG alters the balance of regulatory to memory effector T cells posttransplant, providing an explanation for how it positively impacts transplant outcome.

On the use of electrooculogram for efficient human computer interfaces.

The aim of this study is to present electrooculogram signals that can be used for human computer interface efficiently. Establishing an efficient alternative channel for communication without overt speech and hand movements is important to increase the quality of life for patients suffering from Amyotrophic Lateral Sclerosis or other illnesses that prevent correct limb and facial muscular responses. We have made several experiments to compare the P300-based BCI speller and EOG-based new system. A five-letter word can be written on average in 25 seconds and in 105 seconds with the EEG-based device. Giving message such as "clean-up" could be performed in 3 seconds with the new system. The new system is more efficient than P300-based BCI system in terms of accuracy, speed, applicability, and cost efficiency. Using EOG signals, it is possible to improve the communication abilities of those patients who can move their eyes.

A hybrid platform based on EOG and EEG signals to restore communication for patients afflicted with progressive motor neuron diseases.

An efficient alternative channel for communication without overt speech and hand movements is important to increase the quality of life for patients suffering from Amiotrophic Lateral Sclerosis or other illnesses that prevent correct limb and facial muscular responses. Often, such diseases leave the ocular movements preserved for a relatively long time. The aim of this study is to present a new approach for the hybrid system which is based on the recognition of electrooculogram (EOG) and electroencephalogram (EEG) measurements for efficient communication and control. As a first step we show that the EOG-based side of the system for communication and controls is useful for patients. The EOG side of the system has been equipped with an interface including a speller to notify of messages. A comparison of the performance of the EOG-based system has been made with a BCI system that uses P300 waveforms. As a next step, we plan to integrate EOG and EEG sides. The final goal of the project is to realize a unique noninvasive device able to offer the patient the partial restoration of communication and control abilities with EOG and EEG signals.

Late manifestation of a pseudoaneurysm in the descending thoracic aorta.

Rupture of the descending aorta following deceleration trauma is a catastrophic event because it has a high mortality. Prompt surgical treatment is generally considered to be mandatory. However, a few injured patients may leave the hospital with an undiagnosed aortic rupture which may give rise to a chronic pseudoaneurysm. In this report, a 28-year-old man is presented in whom a pseudoaneurysm of the descending thoracic aortic was diagnosed six months after a car accident.

Effects of electrical stimulation of autonomic nervous system on degranulation of von Ebner's gland acini.

In a series of studies to understand interactions between taste sensation and salivary gland function, we are pursuing experiments to determine the autonomic nervous system control of von Ebner's lingual salivary glands. Electrical stimulation of the glossopharyngeal nerve, which contains the parasympathetic nerve supply to von Ebner's glands, caused a reduction in secretory granules of the glands in the rat. This depletion of granules could be blocked by prior administration of the parasympathetic antagonist, atropine. In contrast, electrical stimulation of the sympathetic nerve supply was ineffective in causing granule depletion in von Ebner's gland, but produced almost total degranulation in the parotid gland of the same animals. It is concluded that parasympathetic nerves exert the principal control over von Ebner's gland, acinar degranulation in the rat; this is compared with autonomic control of other salivary glands that have a dual peripheral control by parasympathetic and sympathetic innervation.

Morphology of chorda tympani fiber receptive fields and proposed neural rearrangements during development.

The average number of fungiform papillae in receptive fields of single chorda tympani nerve fibers decreases during development in sheep, and a greater proportion of small receptive fields that are highly responsive to NaCl, compared with NH4Cl, is acquired. To learn whether there also are developmental differences in the number of taste buds within the papillae in mapped receptive fields, we studied the morphology of receptive fields and fungiform papillae, and also counted fibers in the chorda tympani nerve, in fetal, perinatal, and postnatal sheep. Whether defined as the number of fungiform papillae or as the number of taste buds within papillae, receptive fields of chorda fibers decrease developmentally. Initially, however, there is an increase, and subsequently a decrease, in the number of taste buds per field. The differences in field size cannot be attributed to developmental alterations in numbers of fungiform papillae because the total number of papillae on the tongue remains constant. The average number of taste buds per papilla, however, also increases and then decreases, and the increase in perinatal animals is accompanied by the appearance of large, multipored taste buds. Because there is a significant relation between fungiform papilla size and number of taste buds in the papilla, papilla size could be one regulating factor for taste bud number. Furthermore, the number of chorda tympani nerve fibers apparently increases up to perinatal stages and then decreases postnatally, providing another potential regulating factor for the number of taste buds.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic control of von Ebner's lingual salivary glands and implications for taste sensation.

To learn the nature of the autonomic control of the serous lingual salivary glands of von Ebner, parasympathetic and sympathetic agonists were injected into rats, and the extent of depletion of the secretory granules in gland acini was measured. Injection of the beta-adrenergic agonist isoproterenol caused a concentration-dependent reduction of the secretory granule content of the acinar cells. Injection of the beta-adrenergic antagonist propranolol, combined with isoproterenol, blocked the reduction in secretory granule content seen with isoproterenol alone. Injection of the parasympathetic agonist carbachol also produced a concentration-dependent reduction in granule content of the acini. This reduction was partially blocked by injection of atropine, and completely blocked by injection of atropine and propranolol. beta-Adrenergic and parasympathetic agonists alone did not cause total degranulation of the acini. However, this was achieved by injection of both agonists. It is concluded that protein secretion in von Ebner's glands is under both sympathetic and parasympathetic nervous control. It is hypothesized that the glands contain two sets of granules with different compositions, each under the control of either the parasympathetic or sympathetic nervous system. Because von Ebner's glands are closely associated with taste buds and because the glands supply the microenvironment of these taste buds the secretion of these glands may be very important in the mechanism of taste transduction.