Is there a relationship between Haller Index and cardiopulmonary function in children with pectus excavatum?

Background: This study aims to systematically examine the cardiopulmonary functions in children with pectus excavatum and to compare the obtained findings with the Haller Index. Methods: Between September 2017 and June 2018, medical records of a total of 31 patients (27 males, 4 females; mean age: 14.8±2.0 years; range, 9 to 18 years) with pectus excavatum were retrospectively analyzed. The patients were divided into Group 1 (<2.5), Group 2 (2.5 to 3.19), and Group 3 (>3.2) according to the Haller Index. All groups were systematically evaluated based on pulmonary function tests and echocardiography. Forced vital capacity, forced expiratory volume in 1 second, and the forced expiratory volume in 1 second/ forced vital capacity ratio were calculated. Left ventricular enddiastolic diameter, ejection fraction, mitral valve prolapses, and right ventricular cavity in the apical four-chamber position were evaluated with echocardiography. Results: Of the patients, 19.4% were in Group 1, 38.7% in Group 2, and 41.9% in Group 3. The mean Haller Index value was 3.09±0.64. According to pulmonary function test results, 16.1% of the patients had restrictive disease and 6.5% had obstructive disease. There was a negative correlation between the index and forced expiratory volume in 1 second and forced vital capacity, and there was a statistically significant decrease in these values, as the Haller Index increased (p<0.017). There was a significant difference in the ejection fraction among the groups (p<0.001) and, as the Haller Index increased, ejection fraction statistically significantly decreased. Conclusion: Our study results show a negative correlation between the severity of pectus excavatum and pulmonary dysfunction and, as the severity increases, left ventricular function may be affected by the deformity. As a result, there seems to be a significant relationship between the severity of the deformity and cardiopulmonary functions.

Is intraoperative embolization with n-butyl cyanoacrylate an alternative option in carotid body tumors surgery? A case report.

INTRODUCTION AND IMPORTANCE: The risk of intraoperative bleeding is relatively considerable because carotid body tumors (CBT) have rich vascular structures. Aim is to reduce intraoperative bleeding with preoperative embolization. We present a unique technique for the successful surgical removal of a challenging CBT using intraoperative direct percutaneous intratumoral n-butyl cyanoacrylate (n-BCA) embolization in a patient whose preoperative embolization failed and the operation could not be continued due to intraoperative bleeding. CLINICAL PRESENTATION: A 67-year-old female patient presented with 7 cm Shamblin class 3 CBT on her right neck. Due to the failure of the preoperative embolization, bleeding developed during the operation. In the case of Shamblin class 3 CBT, the primary concern was not the volume of bleeding, but the difficulty in seeing the dissection line due to hemorrhage. Intraoperative n-BCA straight embolization totally controlled the bleeding. The CBT was then readily removed. CLINICAL DISCUSSION: Effective management of intraoperative hemorrhage is essential to ensure successful progression of surgical procedures of CBT. Hemorrhage causes complete disappearance of the dissection line, which is already difficult to detect due to adventitia invasion. It is clear that another method is needed when preoperative embolization or covered stenting fails. n-BCA has been used in the endovenous treatment of varicose veins for a long time, but to the best of our knowledge, there is no other case of its use in intraoperative CBT embolization. CONCLUSION: Direct intraoperative embolization with n-BCA may be an alternative when other techniques are insufficient.

Incidence of chest wall deformity in 15,862 students in the province of Sivas, Türkiye.

Background: This study aims to investigate the prevalence of chest deformity in middle- and high-school students in Sivas province of Turkey, to identify the risk factors associated with the psychological and physical disorders caused by the deformity, and to facilitate early diagnosis and treatment guidance by increasing awareness of this problem. Methods: Between October 2011 and May 2012, a total of 15,862 students (8,508 males, 7,354 females; mean age: 15.9±1.3 years; range, 12 to 19 years) from public schools were included. A number of schools were randomly selected for study, and the students were screened by physical examination. A study protocol was developed in which patients with deformities were questioned about family history and symptoms. Results: Chest wall deformity was detected in a total of 250 students (1.6%). The prevalence rates of pectus carinatum and pectus excavatum in the children were 0.7% and 0.6%, respectively. The overall prevalence of chest wall deformity was 1.6%. Conclusion: Chest wall deformity is more common in boys and pectus carinatum is the most common deformity type. Chest wall deformity is more common in the 15-16 age group and female sex is a risk factor for psychological discomfort.

An easy way to remove a stuck hemodialysis catheter.

The replacement of tunneled hemodialysis catheters (CVCs) is a common procedure. In some cases, the CVC cannot be removed from the central vein because of tight adhesions to the surrounding fibrin sheath. A tight fibrin sheath leads to firm adherence between the catheter and the central veins or right atrial wall. Such stuck catheters cannot be removed from the central vein using standard methods. We present here a case demonstrating the successful removal of such a stuck CVC using the reverse Seldinger method.

Unusual mechanical complications of central venous catheterization.

OBJECTIVES: To present an unusual major mechanical complication of central venous catheterization (CVC).  Methods: Between January 2016 and January 2017, data of the patients who underwent CVC in Cumhuriyet University in Sivas, Turkey, were retrospectively reviewed. The patients who experienced an unusual mechanical catheter-related complication are included in this study. Other complications of central venous catheter placement, except mechanical catheter complications such as infection or thrombosis, were excluded from the study.  Results: A total of 236 consecutive patients who had undergone CVC were found. Nine patients (3.8%) were found to have unusual major mechanical catheter complications. Most noteworthy complications occurred when the catheter was placed in the arcus aorta, ductus thoracicus, pleural cavity, and abdominal cavity. The most common observation in patients with major complications was that CVC had been carried out in the absence of ultrasonic or fluoroscopic guidance owing to emergency situations. Conclusion: The use of CVC is associated with potential major complications occurring particularly during emergency situations. We believe that the use of radiological guidance during CVC could reduce unusual major mechanical complication rates even during an emergency situation.

Factors determining the complications in Nuss procedure.

BACKGROUND: This study aims to share our experiences in complications developing in patients who underwent Nuss procedure and the management of these complications. METHODS: In the study, files of 59 patients (50 males, 9 females; mean age 17.6±5.1 years; range, 2.5 to 33 years) who were applied Nuss procedure for pectus excavatum in our clinic between July 2007 and May 2016 were retrospectively assessed. Patients" age, gender, surgical method-complications and hospitalization durations were recorded. Fisher"s chisquare test and logistic regression analysis were used for data evaluation. RESULTS: Nuss procedure was performed in all patients without severe complications such as death, organ injury or massive hemorrhage. The most frequently observed postoperative earlyperiod complication was minimal pneumothorax (n=16, 27.1%), while bar dislocation was most frequently observed in the lateperiod (n=5, 8.3%). CONCLUSION: Being male and/or over 23 years of age were determined as risk factors for complication development after Nuss procedure. Still, being a minimally invasive and manageable approach with its success in correcting the deformity, short operation duration, and low complication rates, Nuss procedure can be safely performed in selected patients.

Statin pretreatment and risk of in-hospital atrial fibrillation among patients undergoing cardiac surgery: a collaborative meta-analysis of 11 randomized controlled trials.

AIMS: Statin pretreatment in patients undergoing cardiac surgery is understood to prevent postoperative atrial fibrillation (AF). However, this is based on observational and limited randomized trial evidence, resulting in uncertainty about any genuine anti-arrhythmic benefits of these agents in this setting. We therefore aimed to quantify precisely the association between statin pretreatment and postoperative AF among patients undergoing cardiac surgery. METHODS AND RESULTS: A detailed search of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012) was conducted, followed by a review of the reference lists of published studies and correspondence with trial investigators to obtain individual-participant data for meta-analysis. Evidence was combined across prospective, randomized clinical trials that compared the risk of postoperative AF among individuals randomized to statin pretreatment or placebo/control medication before elective cardiac surgery. Postoperative AF was defined as episodes of AF lasting ≥5 min. Overall, 1105 participants from 11 trials were included; of them, 552 received statin therapy preoperatively. Postoperative AF occurred in 19% of these participants when compared with 36% of those not treated with statins (odds ratio 0.41, 95% confidence interval 0.31-0.54, P < 0.00001, using a random-effects model). Atrial fibrillation prevention by statin pretreatment was consistent across different subgroups. CONCLUSION: Short-term statin pretreatment may reduce the risk of postoperative AF among patients undergoing cardiac surgery.

Comparison of trauma scores for predicting mortality and morbidity on trauma patients.

BACKGROUND: In this study, we compared the anatomical, and physiological scoring systems trauma revised injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), new injury severity score (NISS) to each other, to find out the most accurate and reliable trauma score for the risk classification of morbidity and mortality among the trauma patients. METHODS: This is a cross-sectional study, which included 633 patients who admitted to our University Hospital Emergency Department during an 8-month period due to trauma. All blunt and penetrating traumas (traffic accident, assault, etc.) patients above 16 years were included. RESULTS: Arrival time trauma scores (ISS, NISS, RTS, and TRISS) of the patients was calculated. Mean trauma score for the mortality prediction was calculated, and the p value was equal for all (p=0.001). Trauma scores were also analyzed for the hospitalization time in intensive care unit (ICU). While NISS, RTS, and TRISS values were significant (p=0.048, p=0.048, and p=0.017, respectively), ISS value was not significant (p=0.257) for predicting the ICU hospitalization time. Only TRISS was a good predictor for the mechanically ventilation time in ICU patients (p=0.01). CONCLUSION: In conclusion, we determined that the anatomical trauma scores (NISS, ISS) predicted the hospitalization and ICU necessities better, whereas TRISS, an anatomo-physiological trauma score, defined the ICU hospitalization and mechanically ventilation time better.

Efeito do levosimendan em pacientes com insuficiência cardíaca sistólica severa e agravamento da função renal / Effect of levosimendan in patients with severe systolic heart failure and worsening renal function

FUNDAMENTO: O levosimendan, um sensibilizador de cálcio, aumenta a sensibilidade do coração para o cálcio, aumentando assim a contratilidade miocárdica, sem aumento do cálcio intracelular. Recentemente foi demonstrado que o levosimendan era benéfico na melhoria da função renal. No entanto, fica por determinar que o efeito benéfico esteja relacionado em forma diferencial ao status renal durante o evento-índice. OBJETIVO: O objetivo do presente estudo foi determinar se o levosimendan pode melhorar o resultado renal em pacientes com insuficiência cardíaca aguda descompensada com e sem agravamento da função renal. MÉTODOS: Quarenta e cinco pacientes consecutivos que tiveram uma taxa de filtração glomerular reduzida e pelo menos dois dados consecutivos quanto à função renal, antes da administração de levosimendan, foram incluídos no estudo. Os pacientes foram classificados em dois grupos, com e sem agravamento da função renal com base no aumento da creatinina sérica > 0,3 mg/dL. RESULTADOS: Uma melhoria significativa foi observada na função renal em pacientes com agravamento da função renal (creatinina sérica de 1,4 ± 0,16 a 1,21 ± 0,23 mg/dL, p = 0,001 e taxa de filtração glomerular de 48,9 ± 15 a 59,3 ± 21,8 mL/min/m², p = 0,011), apesar de que não houve melhoria significativa em aqueles sem agravamento da função renal (creatinina sérica de 1,29 ± 0,33 a 1,37 ± 0,66 mg/dL, p = 0,240 e taxa de filtração glomerular de 53,7 ± 17,6 a 52,9 ± 21,4 mL/min/m², p = 0,850). CONCLUSÃO: O levosimendan parece proporcionar um efeito de realce renal em pacientes com severa insuficiência cardíaca sistólica descompensada aguda e agravamento da função renal. Considerar esse efeito diferencial poderia contribuir a obter resultados renais benéficos. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event. OBJECTIVE: The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function. METHODS: Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine >0.3 mg/dL. RESULTS: A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4±0.16 to 1.21±0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9±15 to 59.3±21.8 mL/min/m², p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29±0.33 to 1.37±0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7±17.6 to 52.9±21.4 mL/min/m², p=0.850). CONCLUSION: Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

Effect of levosimendan in patients with severe systolic heart failure and worsening renal function.

BACKGROUND: Levosimendan, a calcium sensitizer, increases the sensitivity of the heart to calcium, thus increasing myocardial contractility without a rise in intracellular calcium. It was recently shown that levosimendan is beneficial in improving renal function. However, it remains to be established that the beneficial effect is differentially related to renal status during index event. OBJECTIVE: The purpose of the current study was to determine whether levosimendan could improve renal outcome in acute decompensated heart failure patients with and without worsening renal function. METHODS: Forty-five consecutive patients who had a reduced glomerular filtration rate and had at least two consecutive data regarding renal function prior to administration of levosimendan were enrolled in the study. Patients were classified into two groups as those with and without worsening renal function based on an increase in serum creatinine >0.3 mg/dL. RESULTS: A significant improvement was noted in renal function in patients with worsening renal function (serum creatinine from 1.4 ± 0.16 to 1.21 ± 0.23 mg/dL, p=0.001 and glomerular filtration rate level from 48.9 ± 15 to 59.3 ± 21.8 mL/min/m², p=0.011), while there was no significant improvement in those without worsening renal function (serum creatinine from 1.29 ± 0.33 to 1.37 ± 0.66 mg/dL, p=0.240 and glomerular filtration rate level from 53.7 ± 17.6 to 52.9 ± 21.4 mL/min/m², p=0.850). CONCLUSION: Levosimendan appears to provide a renal-enhancing effect in patients with severe, acute decompensated systolic heart failure and worsening renal function. Consideration of this differential effect might help obtain beneficial renal outcomes.

Comparison of the antiangiogenic effects of heparin sodium, enoxaparin sodium, and tinzaparin sodium by using chorioallantoic membrane assay.

Unfractionated heparin (UFH) and low molecular weight heparins have been used as anticoagulation agents in cardiovascular clinics for decades. However, these molecules also have potent antiangiogenic effects. Whereas, angiogenesis may be the most crucial determinant of the prognosis of cardiovascular diseases, and except some special situation, antiangiogenic effect is not desirable in the most of the cardiovascular disease. In this study, we aimed to compare the antiangiogenic potency of UFH, enoxaparin, and tinzaparin. The antiangiogenic efficacies of UFH, enoxaparin, and tinzaparin were examined in vivo by using the chick chorioallantoic membrane (CAM) model. Twenty fertilized eggs were used for each studied drug. Drug solutions were prepared in 10 and 1 IU/10 µl concentrations. Decreases in the density of the capillaries were assessed and scored. All three drugs showed antiangiogenic effects on the chick CAM at the 10 IU/10 µl concentration. However, the antiangiogenic score of the UFH was significantly higher than that of enoxaparin and tinzaparin at 1 and 10 IU/10 µl concentrations. UFH had stronger and antiangiogenic potential than enoxaparin and tinzaparin. However, tinzaparin showed dose-dependent antiangiogenic effects. We think that an anticoagulant molecule with a less and dose-dependent antiangiogenic effect, as in the case of tinzaparin, may be more desirable in case of cardiovascular disease related with insufficient angiogenesis.

The antiangiogenic effects of levosimendan in a CAM assay.

BACKGROUND: There is a physiological balance between the stimulatory and inhibitory signals for blood vessel growth. In many symptomatic patients with peripheral artery disease, coronary artery disease, and ischemic chronic wounds, there is a pathological insufficiency of angiogenesis. Therefore, determining the angiogenic or antiangiogenic effects of molecules currently used in cardiovascular treatment is crucial. Although levosimendan is the most well studied calcium sensitizer in preclinical and clinical practice, to the best of our knowledge, there are no previous studies investigating its angiogenic or antiangiogenic effects. In the present study, we aimed to investigate the effects of levosimendan on angiogenesis. METHODS: The antiangiogenic efficacy of levosimendan was examined in vivo in the chick chorioallantoic membrane (CAM) model by using 20 fertilized eggs and drug solutions of 1 and 10 µmol/L concentrations. Decreases in the density of the capillaries were assessed and scored. RESULTS: Significant antiangiogenic effects were observed at 1 and 10 µmol/L concentrations of levosimendan. The antiangiogenic scores of levosimendan at 1 and 10 µmol/L concentrations were 0.6 and 1.10, respectively. The antiangiogenic score of bevacizumab, used as a positive control, was 0.95 at 1.0 µmol/L concentration. No significant difference was found between the antiangiogenic scores of levosimendan and bevacizumab (p=0.54). CONCLUSIONS: Our results indicate that levosimendan has antiangiogenic effects on the chorioallantoic membrane. However, these findings must be confirmed in future studies on humans.

The role of the CCR2 gene polymorphism in abdominal aortic aneurysms.

OBJECTIVE: Chronic inflammation play an important role on abdominal aortic aneurysms (AAA) formation. Chemokine receptor-2 (CCR2) is involved in regulation of the inflammatory response. However, relation between CCR2 polymorphism and AAA formation in human has not yet been investigated. In this study, we aimed to investigate the relationship between AAA and CCR2-V64I gene polymorphism. METHODS: In this study, 100 consecutive patients with AAA and 138 individuals with normal aortic diameter were included. CCR2-V64I gene polymorphism were analyzed by PCR-RFLP technique. Genotype distribution and allele frequencies of CCR2-V64I gene polymorphism in patients with AAA and healthy subjects were compared. RESULTS: CCR2 heterozygote V64I polymorphism and allele frequency were more frequently observed in the AAA group (p = 0.01, p = 0.004). Significant relationship was observed between CCR2 V64I polymorphism (OR:2.31, 95% CI:1.19-4.46, p = 0.01) and presence of AAA in multivariate regression analysis. CONCLUSION: The present study, showed us a relationship between CCR2-V64I polymorphism and AAA.

Association between ApoE4 allele and deep venous thrombosis: a pilot study.

INTRODUCTION: Deep vein thrombosis (DVT) is a multifactorial disease with genetic and acquired risk factors playing in concert in its pathogenesis. ApoE gene polymorphisms seem to have some impact among patients with cardiovascular disease; however, association between DVT and ApoE gene polymorphism has not been evaluated. MATERIALS AND METHODS: We aimed to search the relative frequencies ApoE alleles among patients with DVT and healthy participants. We enrolled 59 consecutive patients with DVT and 59 age- and sex-matched healthy controls. RESULTS: In the DVT group, E3/E4 gene polymorphism was detected in 20 patients (33.9%), in the control group E3/E4 polymorphism was detected in six patients (10.2%; P = .002). In the multivariable regression analysis, E3/E4 was independently associated with 1.31-fold increased risk of DVT (odds ratio [OR] 1.31; 95% confidence interval [CI], 1.30-10.48). CONCLUSION: It seems there is a relationship between ApoE3/E4 gene polymorphism and DVT in the Turkish population. However, this pilot study should be supported with large-scale studies.

Frequency of the mdr-1 C>T gene polymorphism in patients with COPD.

BACKGROUND AND AIM: The multi-drug resistant-1 (MDR-1) gene is located on human chromosome 7 and encodes a glycosylated membrane protein that is a member of the ATP-binding cassette transporters superfamily. The aim of the study was to reveal the role of the C3435T MDR-1 gene polymorphism in chronic obstructive pulmonary disease. METHOD: DNA samples from 41 patients with chronic obstructive pulmonary disease and 50 healthy control participants were used to compare MDR-1 gene profiles. Genotyping assays were performed using the StripAssay technique that is based on reverse-hybridization. RESULTS: The T allele polymorphism in the MDR-1 gene located at position 3435 in exon 26 was shown to correlate with chronic obstructive pulmonary disease. CONCLUSION: These preliminary results suggest that the T allele polymorphism of the MDR-1 gene is associated with chronic obstructive pulmonary disease.

eNOS G894T polymorphism and abdominal aortic aneurysms.

BACKGROUND: The genetic risk factors that contribute to the risk of developing abdominal aortic aneurysm (AAA) are poorly understood. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AAA. METHODS: eNOS gene polymorphism of 61 patients with AAA and 62 control participants were analyzed by polymerase chain reaction (PCR)-restriction technique. RESULTS: eNOS G894 homozygote T/T genotype polymorphism and 894T allele frequency in patients with AAA were significantly higher than those of the control participants (P = .01, P = .03). Among patients with AAA, the eNOS G894 T/T polymorphism and 894T allele frequency were associated with larger AAAs. CONCLUSION: The current study, in a small group of participants, showed a relationship between eNOS G894T polymorphism and AAA.

Frequency of the mdr-1 C>T gene polymorphism in patients with COPD

BACKGROUND AND AIM: The multi-drug resistant-1 (MDR-1) gene is located on human chromosome 7 and encodes a glycosylated membrane protein that is a member of the ATP-binding cassette transporters superfamily. The aim of the study was to reveal the role of the C3435T MDR-1 gene polymorphism in chronic obstructive pulmonary disease. METHOD: DNA samples from 41 patients with chronic obstructive pulmonary disease and 50 healthy control participants were used to compare MDR-1 gene profiles. Genotyping assays were performed using the StripAssay technique that is based on reverse-hybridization. RESULTS: The T allele polymorphism in the MDR-1 gene located at position 3435 in exon 26 was shown to correlate with chronic obstructive pulmonary disease. CONCLUSION: These preliminary results suggest that the T allele polymorphism of the MDR-1 gene is associated with chronic obstructive pulmonary disease.

Early thrombosis in bovine mesenteric vein grafts after infrainguinal reconstruction.

INTRODUCTION: Autologous vein grafts are still the gold standard in infrainguinal arterial bypass grafting procedures. However, due to the unavailability of suitable autologous vein grafts, heterogeneous grafts are usually preferred. In the present study, surgical outcomes with bovine mesenteric vein grafts (ProCol, Hancock Jaffe Laboratories, USA) in the infrainguinal location in patients with ischemic leg infection or necrosis are presented. METHODS: Seven patients who underwent infrainguinal arterial reconstructions with ProCol grafts were evaluated retrospectively. RESULTS: Graft thrombosis was seen in two patients on postoperative day 1 (28.5%). The shortest and the longest patency durations were six and 18 months, respectively. Aneurysmal dilation developed postoperatively in two grafts (28.5%) after 12 and 18 months, respectively. CONCLUSION: In cases where infection accompanies ischemia, and autologous veins are not available as graft materials, ProCol grafts can be used as temporary grafts in infrainguinal arterial reconstructions. The use of the graft is believed to be unacceptable for any indication other than infection due to its low short- and long-term patency rates and high risk of aneurysm formation in this location.