Penetrating Heart Injury Repaired with Peripheral Cannulation: Case Report.

Heart injuries usually occur due to penetrating or blunt traumas. High mortality rates are seen in heart injuries, owing to firearms and cutting/piercing tools. Factors such as the degree of injury, its localization, and the length of time to reach the hospital influence mortality rates. Despite the increase in imaging facilities and improvements in hospital transportation in today's conditions, high mortality rates are still observed, owing to causes such as sudden blood loss, cardiac arrest, or cardiac tamponade. The present study aimed to present the successful treatment of a 46-year-old male patient with injuries to the left atrium and posterior wall of the left ventricle due to a gunshot wound using the approach of median sternotomy and peripheral cannulation.

Atrioesophageal Fistula as a Complication of Radiofrequency Ablation for Atrial Fibrillation.

Atrioesophageal fistula (AEF) is an important complication of radiofrequency ablation (RFA). Delayed diagnosis is associated with increased morbidity and mortality. Despite the name "atrioesophageal fistula," fistulas functionally act esophageal to atrial, which accounts for the neurologic and infectious complications. This report presents the management of a 60-year-old male patient who was admitted to the emergency department (ED) with AEF-caused gastrointestinal bleeding. The patient was operated urgently, but he had serious comorbidities and died after the operation. The aim of this case was to evaluate patients who underwent RFA, within 10 days to two months, carefully in the ED and to know the possible complications.

The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery.

Background: During carotid arterial endarterectomy (CAE) surgery, an intraluminal shunt is used to prevent hypoperfusion, which can be caused by a cross-clamping cerebral ischemia. However, routine shunt use is not recommended. Various cerebral monitoring techniques are used to determine the need for shunt placement. In this study, retrospective analysis of data on the efficacy of cerebral oximetry in the decision of shunt use during elective CAE surveys was planned. Materials and Methods: We collected data on 68 patients operated under general anesthesia between December 2016 and December 2017. Patients were evaluated for near infrared spectrometry (NIRS) and stump pressure values and whether shunt was placed or not. Results: Eight (11.7%) patients were shunting. NIRS value after cross-clamping was lower in patients with shunt. Stump pressure values were below 40 mmHg. Conclusions: Cerebral monitoring in elective CAE operations has great importance in determining the necessity of using intraluminal shunt to reduce the complications that may occur.

Twelve-month efficacy and complications of cyanoacrylate embolization compared with radiofrequency ablation for incompetent great saphenous veins.

OBJECTIVE: In this study, the clinical results of radiofrequency ablation (RFA) and n-butyl-cyanoacrylate embolization (CAE) methods were compared in the treatment of incompetent great saphenous veins (GSVs). METHODS: We analyzed retrospectively 244 patients (128 patients in the RFA group, 116 patients in the CAE group) with incompetent GSVs who were treated with RFA and CAE according to the patients' choice between June 2013 and June 2016. All patients were thoroughly examined preoperatively and at 1, 3, 6, and 12 months after the operation, and the clinical results and the quality of life were evaluated. Color Doppler ultrasound (CDUS) results were compared between two groups after the operation and at 12 months. Complete vein occlusion was defined as the success of the treatment. RESULTS: There was no significant difference between patients treated with RFA or CAE in terms of demographic and clinical features. In CDUS after operation, total occlusion was detected in the saphenous vein in both groups. At the 12-month CDUS, complete occlusion of the GSV was observed in 99.5% of the CAE group and 96.6% of the RFA group (P = .072). Skin burn, which we consider a major complication, occurred only in one patient. No other major complications were seen in either group. Severe pain, ecchymosis, and sensitivity were the most common of the side effects, and these were significantly higher in RFA group than in CAE group. Severe pain occurred in 12.5% of the RFA patients and 4.3% of the CAE patients (P = .042), ecchymosis occurred in 20.3% of the RFA patients and 12% of the CAE patients (P = .044), and sensitivity occurred in 21.9% of the RFA patients and 12.1% of the CAE patients (P = .038), respectively. CONCLUSIONS: Based on the present data, our findings suggest that CAE is as effective as RFA ablation with similar rates of successful occlusion and can be associated with less pain and fewer complications than RFA; it also may yield better patient comfort. The current results should be verified with further randomized, controlled trials with longer term follow-up and larger patient groups.

Treatment of Aortic and Iliac Artery Aneurysms with Multilayer Flow Modulator: Single Centre Experiences.

OBJECTIVE: Presenting early and midterm results of aortic and iliac artery aneurysms treated with Multilayer Flow Modulators (MFM). METHODS: We retrospectively reviewed the medical records of 23 patients (19 males and 4 females) who are admitted to our clinic between April of 2014 and February of 2016, diagnosed with thoracoabdominal aortic aneurysm and/or iliac aneurysm, and treated using MFM. The patients were followed up for the development of potential clinical presentations for 12 months. RESULTS: MFM implantation was successfully completed in all the patients. During the process, two patients developed endoleak and so they were treated with postdilatation that was performed through balloon intervention, whereby the patients fully recovered. Although a short-term ischemic cerebrovascular event occurred in one of the patients 36 hours after the MFM, the patient recuperated without any noticeable neurological sequelae. Overall, three patients died after the procedure, one of whom died in hospital three days following the intervention due to acute renal failure, while the second one lost his life at the end of the first month due to the occlusion of superior mesenteric and celiac arteries. The third patient died at the end of the third month due to acute myocardial infarction. The rest of the patients developed no complications or had no mortality at their 12-month follow-ups. CONCLUSION: MFM can be preferred as an alternative approach in the treatment of aorta and iliac artery aneurysms including major lateral branches. The present results should be confirmed with additional future studies conducted with larger patient groups for longer periods.

Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery.

PURPOSE: To determine to what extent chronic obstructive pulmonary disease (COPD) affects mortality and morbidity rates in patients treated with off-pump coronary artery bypass graft (CABG). METHODS: A total of 321 patients treated with off-pump CABG were included in the present study. Of the 321 patients, 46 patients had COPD and they were designated as Group 1 and the remaining 275 patients did not have COPD and they were considered as Group 2. We compared the data obtained from the patients in both groups. RESULTS: While preoperative spirometry values and arterial blood gas oxygen saturation levels were significantly lower, the partial values of carbon dioxide were higher in Group 1. Likewise, extubation time, the amount of drainage and blood transfusion, inotropic support, prolonged intubation, pulmonary complications, the use of bronchodilators, and steroids were statistically higher in Group 1 when compared with Group 2. Overall, there was no marked difference between the two groups in terms of mortality incidence. CONCLUSION: We found similar morbidity and mortality rates among the patients with COPD and without COPD when they were treated with off-pump CABG. Therefore, the present results indicate that the presence of COPD is not associated with in-hospital mortality or severe morbidity post-CABG by off-pump approach.

Effectiveness, success rates, and complications of different thoracoscopic sympathectomy techniques in patients with palmar hyperhidrosis.

BACKGROUND: This study aims to investigate the effectiveness, success and complication rates of three different video-assisted thoracoscopic sympathectomy procedures performed for the treatment of primary focal hyperhidrosis; excision, cauterization and clipping. METHODS: We retrospectively evaluated the records of 60 patients (33 males, 27 females; mean age 25.1±6.4 years; range 16 to 43 years) with primary focal hyperhidrosis and treated with videoassisted thoracoscopic sympathectomy between January 2010 and December 2013. The patients were treated bilaterally at the same session: the sympathetic chain and ganglia were excised from the spinal cord segments of T2-T4 in 20 patients (group 1), cauterized in 20 patients (group 2), and clipped in 20 patients (group 3). The procedural success and complication rates were compared among the groups. RESULTS: Sympathectomy was successfully performed in all patients. The mean operation time was found to be significantly shorter in group 2 (42.5±7.1 min) and group 3 (36.9±7.8 min), compared to group 1 (51.1±8.4 min) (p<0.05). Compensatory hyperhidrosis developed in 17 patients (28.3%) and was comparable among all groups (p<0.05). CONCLUSION: Our study results suggest that excision, cauterization, and clipping are effective and reliable in the treatment of primary focal hyperhidrosis. Based on our experience, we believe that sympathectomy with video-assisted excision may be preferable for the treatment of primary focal hyperhidrosis.

The combined use of multilayer flow modulator stent and conventional stent grafts in complex thoracoabdominal aortic aneurysms and Type 3 dissections accompanying aneurysms.

BACKGROUND: In this study, we present early and mid-term results of the combined use of multilayer flow modulator stent and conventional stent grafts in aortic aneurysms and Type B aortic dissections. METHODS: The files and computerized data of 78 patients who underwent endovascular stent graft implantation due to an aortic aneurysm and dissection in our clinic between January 2015 and December 2016 were retrospectively analyzed. Among these patients, six male patients (mean age 69.5 years; range 63 to 77 years) who were treated with multilayer flow modulator stents in combination with conventional stent grafts were included. A successful intervention was defined as the placement of the stents into the aneurysmatic region without any complications. The patients were followed for the development of any clinical events during 12 months. RESULTS: The common symptoms observed in the half of the patients were abdominal pain and back pain. One patient had claudication during walking. In all patients, the interventions were successfully completed and no mortality was observed in any patient. One of the patients developed Type 1 endoleak during the procedure; however, it was completely corrected using the aortic stent graft extension. Creatinine levels were elevated (2.1 mg/dL) in one patient on the second day of the operation. The patient did not require dialysis and the kidney functions completely returned to normal on the seventh day. No intra- or postoperative complications developed. CONCLUSION: Multilayer flow modulator stents seem to be effective and safe in the treatment of aortic aneurysms with major side branches. The combined use of stents with different stent-graft devices increase the success rate and reduce the complication rate in complex aortic aneurysms.

Associations between coronary artery disease, aneurysm and ectasia.

AIM: Investigation the frequency and contribution of coronary artery aneurysm/ectasia in addition to their correlation with coronary artery disease (CAD). MATERIAL AND METHODS: We retrospectively evaluated the coronary angiography records of 6500 adult consecutive patients, and 418 of them were met inclusion criteria and used in the present study. The CAD was defined as the presence of angiographic coronary stenosis of > 50% of the luminal diameter in no less than one of the epicardial coronary arteries. Moreover, the prevalence and features of the coronary artery aneurysm/ectasia among the cases with and without CAD were compared. RESULTS: We observed coronary artery aneurysm (CAA) and ectasia (CAE) in 6.6% of the patients with significant CAD (+), and 6.1% of the patients with significant CAD (-) (p = 0.2). The percentage of coronary artery aneurysms was significantly higher in CAD (+) patients than in CAD (-) patients (0.8% vs. 0.4%, p = 0.015). The percentage of coronary artery ectasia showed no variation between CAD (+) patients and CAD (-) patients (5.8% vs. 5.7%, p = 0.47). The frequency of spotting aneurysm on a single coronary artery was higher than discerning aneurysm on two or three coronary arteries. CONCLUSIONS: Presence of CAA or CAE cases is often encountered in those who have undergone angiography procedures. Furthermore, CAA and CAE should not be considered as simple dilations of vessels. Further studies are needed to determine the effective procedures for the treatment and prognostic evaluations of the patients with CAA or CAE.

The effects of iloprost and alprostadil on ischemia-reperfusion injury in preventing inflammation, tissue degeneration, and apoptosis in rat skeletal muscle.

BACKGROUND/AIM: The protective effects of prostaglandin (PG) analogs on ischemia-reperfusion (I/R) have been well documented; however, comparative studies are lacking. The aim of the present study was to determine whether iloprost or alprostadil is more effective in preventing muscle I/R injury. MATERIALS AND METHODS: Thirty-two rats were divided into four groups (n = 8): sham, control, IL (I/R + iloprost), and AL (I/R + alprostadil). I/R was induced by a tourniquet in the hindlimb for 3 h/3 h. The IL and AL groups received iloprost (0.5 ng kg-1 min-1) and alprostadil (0.05 µg kg-1 min-1) during reperfusion, respectively. After 6 h, blood and muscles were collected for analyses. RESULTS: Serum TNF-α and IL-1ß levels were decreased in the IL and AL groups compared with the control group (P < 0.05), whereas IL-6 levels did not change significantly. Tissue malondialdehyde levels were significantly lower in the IL and AL groups (P < 0.05). Tissue catalase levels showed no difference. The histological damage scores and apoptosis scores were both significantly decreased in the IL and AL groups compared with the control group (P< 0.05). CONCLUSION: The present study indicated that iloprost and alprostadil attenuated I/R injury in skeletal muscle. However, no comparable difference was evident regarding the efficacies of either PG analog.

Role of gender in types and frequency of coronary artery aneurysm and ectasia.

This study aimed to evaluate the role of gender in types and frequency of coronary artery aneurysm and ectasia.We assessed retrospectively the angiography records of 6100 patients. At first, we mainly reviewed angiographic movies for the presence of coronary ectasia and/or aneurysm. Consequently, based on the number of the coronary artery involvement, the coronary ectasia and aneurysm were graded as mild if 1 coronary artery was involved and severe if 2 or more coronary arteries were involved. The location of ectasia and aneurysm was analyzed with respect to their isolated or combined location on various coronary arteries. The patients included in the present study were divided into 2 groups based on their gender as male and female. Then, we evaluated the impact of gender on severity and the location of the ectasia and aneurysm.The incidence of the aneurysm and ectasia was 3.5%. Among the patients with aneurysm and ectasia, 6.9% were male and 4.5% were female. Aneurysm and ectasia were evaluated together; their frequency was significantly higher in the male than female patients (P < 0.01). However, when their incidence was evaluated separately, coronary artery ectasia was markedly greater in male patients with regard to female patients (P < 0.01). Incidence of CAE presence on the RCA was significantly greater in males than females (2.7% vs 1.9%, P < 0.05).This study showed that incidence of CAE is more common in males than females. Particularly, frequency for the involvement of CAE on RCA and concurrently on 3 vessels is greater in male patients than female patients.

Protective effects of resveratrol in ischemia-reperfusion injury of skeletal muscle: A clinically relevant animal model for lower extremity ischemia.

Ischemia and reperfusion injury of the skeletal muscle is a common and serious condition observed in patients admitting to peripheral vascular surgery, interventional radiology and cardiology departments. Resveratrol (RVT) being a strong natural antioxidant is found in deal of red wine and Mediterranean diet. In the present study, male Spraque-Dawley rats were randomized into two groups of equal size. The first group was the control group, and these rats were administered with tap water with a gastric tube for fourteen consecutive days once daily. According to the same protocol, the rats in the second group were treated with tap water containing 20 mg/kg RVT. All the rats in the two groups were subjected to acute hind limb ischemia through clamping of the abdominal aorta for 120 min. Following this procedure, 60 minutes of reperfusion was applied by reestablishing blood flow in both iliac arteries. Ischemic damage in the skeletal muscle tissue was assessed by measuring myoglobin, lactate dehydrogenase, creatinine phosphokinase, aspartate transaminase enzymes in venous blood samples obtained at the end of the reperfusion period. Oxidative stress caused by reperfusion was determined by measuring MDA, carbonyl and protein sulphydryl levels in quadriceps muscle tissue retrieved at the end of the experiment. In Group II rats, all the measured ischemic enzymes and the markers of oxidative stress reflected robust anti-ischemic properties obtained by RVT administration. The data from both groups revealed statistically significant protection against acute skeletal muscle ischemia and reperfusion injury in Group II rats, compared to Group I. As a major dietary flavonoid RVT can protect the skeletal muscle tissue against global ischemia and reperfusion injury because of its strong antioxidant and cytoprotective properties.