Expression of antiapoptotic survivin and aven genes in rat heart tissue after traumatic brain injury.

We have recently shown that experimental traumatic brain injury (TBI) results in ultrastructural damage in heart tissue. The aim of this study was to determine the two antiapoptotic signals "survivin" and "aven" in rat heart tissue following TBI, and comparing the effects of erythropoietin (EPO) and methylprednisolone (MPS). Thirty-six Wistar-Albino female rats weighing 190 to 230 g were randomly allocated into six groups: group 1 underwent head trauma with no treatment; group 2 and group 3, head trauma and intraperitoneally delivered EPO (1000 IU/kg) and MPS (30 mg/kg), respectively; group 4 (vehicle), head trauma and intraperitoneal albumin (0.4 mL/rat); groups 5 and 6, control and sham-operated groups, respectively. Three-hundred g-cm impact trauma was produced by the method of weight-drop. Real-time quantitative polymerase chain reactions were used to estimate survivin and aven gene expression at the total RNA level. Both survivin and aven were higher among the treatment than the trauma group (P = .0006, .0001 and P = .0038, .0033, respectively). Comparing survivin and aven between EPO and MPS treatment groups showed no significance (P = .3027, .2171, respectively). Also, both survivin and aven were significantly higher among the treatment than the vehicle, the control, or the sham-operated groups. These findings suggested that both EPO and MPS may play important roles in the expression of antiapoptotic survivin and aven genes in heart tissue after TBI.

Effect of erythropoietin on bcl-2 gene expression in rat cardiac myocytes after traumatic brain injury.

The purpose of this study was to investigate whether erythropoietin (EPO) has an effect on the expression of bcl-2 in rat cardiac myocytes following experimental isolated traumatic brain injury (TBI). Forty-eight Wistar-Albino female rats were randomly allocated into eight groups. Groups AC and BC were controls; groups AS and BS were sham-operated animals. Groups A1 and B1 underwent head trauma without treatment. Groups A2 and B2, head traumas plus EPO intraperitoneally (1000 IU/kg); groups A3 and B3, the vehicle groups, head traumas and intraperitoneal albumin (0.4 ml/rat). The method of weight drop was used to produce impact trauma at 24 hours after injury. Samples obtained from the left ventricle were assayed for lipid peroxidation and bcl-2 gene expression using real-time quantitative polymerase chain reactions. Lipid peroxidation in the heart tissue was determined by the concentration of thiobarbituric acid reactive substances (TBARs). The results showed that administration of EPO significantly reduced the increase in lipid peroxidation by-products after moderate or severe trauma. The bcl-2 expression was significantly higher in EPO (A2 and B2) compared to trauma groups (A1 and B1) suggesting a protective effect. These findings suggest that EPO may play an important role in the expression of bcl-2 and decrease in TBARs-the end product of lipid peroxidation in myocytes-after moderate or severe TBI.

Pott's disease after heart transplantation: a case report.

The incidence of tuberculosis among patients undergoing antirejection therapy is considerably higher than in the general population. Heart transplant recipients have been found to carry the highest risk of tuberculosis. There are no reported data about Pott's disease in heart transplant recipients. The authors present a case of Pott's disease seen after heart transplantation (HTx).

The importance of the time interval between diagnosis and operation in myasthenia gravis patients.

AIM: Complete remission rates in patients with myasthenia gravis (MG) using anticholine esterases, immunosuppressive drugs, and medical therapy methods like plasmapheresis are low. Because high levels of complete remission and advantages are reported after thymectomy this surgical method is widely used in patients with MG. METHODS: The preoperative status and the responses to thymectomy have been studied in 15 patients who had been diagnosed as MG and underwent thymectomy in Ankara Numune Education and Research Hospital. RESULTS: Patients who underwent thymectomy have shown a high proportion of clinical improvement (73%). We could not establish a direct relationship between the results and the patients' age, sex features and the pathological characteristics of the excisional biopsy specimens. The benefit rates for patients who had a short period of time between diagnosis and operation (87.5%) were higher (91%). CONCLUSIONS: Thymectomy because of its high benefit rate is an advantageous therapeutic tool. The chance of benefiting from thymectomy increases when the history of MG is short and the stage of the disease is early.

Repair of a ruptured posterior left ventricular pseudoaneurysm.

A 51 year old man with a large ruptured posterior left ventricular (LV) pseudoaneurysm (PsAn) was successfully surgically treated. Complete repair was performed by excision of the PsAn, leaving a cuff of fibrous tissue suitable to hold sutures and a Dacron patch reconstruction of the LV. On the 7th postoperative day, echocardiographic examination confirmed pericardial effusion (swinging heart). Media-stinal drainage tube was performed and the patient was discharged with a good recovery. The patient's preoperative LV ejection fraction (EF) increased from 42.7 to 52% after operation. We consider endoventricular circular patch plasty of ruptured posterior LV PsAn excellent because of the avoidance of thrombus and the effectiveness for improvement of LV function.

Management of military vascular injuries.

BACKGROUND: Vascular injuries caused by high-velocity military missiles during war present large and extensive defects of tissues and bones, are often associated with other injuries. In this study we will discuss the surgical strategy and results of military vascular injuries. METHODS: A retrospective review of records of 63 patients treated between January 1995 and December 1999 was undertaken. RESULTS: The mean age of the wounded was 22.3 years (range, 20 to 37 years). The mean time for evacuation from the place of injury to the hospital was 2.3 hours (range, 15 min to 10 hrs). There were 58 (76.3%) arterial and 18 (23.7) venous injuries. Vascular injuries concomitant with 28 (36.9%) bone fractures, six (7.9%) nerve injuries, nine (11.8%) hemopneumothorax and one (1.3%) abdominal injuries. The treatment of the injured arteries were 39 (51.3%) saphenous vein interposition grafting, 13 (17.1%) end to end anastomosis, 12 (15.7%) primary suture, seven (9.2%) synthetic graft replacement. Three patients (3.9%) died because of hypovolemic shock. Five patients underwent amputation (6.6%) and fasciotomy was performed after vascular repair in 11 cases (14.5%). CONCLUSIONS: At the military vascular injuries, the right timing, and also prompt treatment save the life of the patients and give better qualified living to the patient.

Multiple coronary artery aneurysms combined with abdominal aortic aneurysm.

Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of a normal adjacent segment or the diameter of the patients's largest coronary vessel by as much as 1.5 times. It is an uncommon pathology with a frequency of 1-4% in routine autopsies or coronary angiographies. Atherosclerosis plays an important role in the development of CAA, and it may be a predominant cause in the majority of patients. However, the timing of surgical intervention and the treatment options for CAA are still controversial. In this report, we present a patient who had multiple CAAs of all main coronary arteries and abdominal aortic aneurysm. Different treatment modalities and indications are also discussed.

A surgical approach on an emergency basis for removal of Wilms' tumor with intracardiac neoplastic extension.

Extension of Wilms' tumor through inferior vena cava into the heart two years after the completion of therapy, is a very rare clinical aspect. We successfully operated on a 7 year old girl who had a huge right atrial mass which filled the right ventricle and right ventricular out flow tract, on an emergency basis using cardiopulmonary bypass.