Non-steroid anti-inflammatory drugs reduce the efficacy of autologous blood pleurodesis.

BACKGROUND: This study aims to perform autologous blood pleurodesis in an animal model and investigate the effects of paracetamol and diclofenac on autologous blood pleurodesis. METHODS: We divided 42 female Wistar albino rats (aged three months; average weight 275±25 g) into three major groups of 14. Each major group was further divided into two subgroups of seven rats to be sacrificed at seven days for early changes and 21 days for late changes. We performed autologous blood pleurodesis in all rats at a dose of 3 mL/kg. Group C (control group) was administered saline, group P was administered paracetamol, and group D was administered diclofenac for the postoperative five consecutive days as a single dose intraperitoneally. We sacrificed the rats at the designated dates and removed the thoracic cages en bloc. RESULTS: According to macroscopical and microscopical evaluation of the specimens, paracetamol led to a similar degree of adhesions with saline, whereas diclofenac significantly reduced the intensity of the desired adhesions between the two pleural sheets (p=0.05). CONCLUSION: Using anti-inflammatory analgesics following autologous blood pleurodesis may lead to unsuccessful outcome of the procedure.

Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients.

OBJECTIVE: Acute mesenteric ischemia (AMI) is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. METHODS: From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. RESULTS: The study included 6013 patients, of which 52 (0.86%) patients suffered from AMI, 35 (67%) of whom died. The control group (150 patients) was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB). Preoperative parameters including age (P = 0.03), renal insufficiency (P = 0.004), peripheral vascular disease (P = 0.04), preoperative inotropic support (P < 0.001), poor left ventricular ejection fraction (P = 0.002), cardiogenic shock (P = 0.003), and preoperative intra-aortic balloon pump (IABP) support (P = 0.05) revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (P < 0.001), dialysis (P = 0.04), inotropic support (P = 0.007), prolonged ventilator time (P < 0.001), and IABP support (P = 0.007) appeared significantly higher in the AMI group than the control group. CONCLUSIONS: Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.

Cavitary lung cancer presenting as subcutaneous emphysema on the contralateral side.

Bronchocutaneous fistula is an extremely rare complication of lung cancer and is frequently seen following biopsy or radiotherapy. A 67-year old male patient was administered to our hospital due to sudden onset of shortness of breath and subcutaneous emphysema on the right side. Chest computed tomography revealed a cavitary lesion in the left upper lobe in connection with the subcutaneous emphysema on the right side through sternum and anterior chest wall. The pathological examination of the biopsy performed during tube insertion revealed a well-differentiated squamous cell carcinoma of the lung. The patient was referred for adjuvant therapy to local oncology hospital. He passed away 9 months following diagnosis.

An adult case of giant bronchogenic cyst mimicking tension pneumothorax.

Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.

Inhibitory effects of ticlopidine and clopidogrel on the intimal hyperplastic response after arterial injury.

OBJECTIVE: The purpose of this study was to compare the effects of ticlopidine and clopidogrel on the development of neointimal hyperplasia after experimental arterial injury. METHODS: This experimental, prospective, randomized controlled study was performed on twenty-seven rabbits, which were divided into three groups, each of which contained nine subjects. Following the development of a balloon catheter injury in the iliac artery, no drugs were administered to Group 1 (control). Group 2 was given ticlopidine, while Group 3 was given clopidogrel. At the end of the 21-day experimental period, arterial sections were evaluated histomorphologically and immunohistochemically with staining using antibodies against platelet derived growth factor beta and basic fibroblast growth factor. Statistical analyses were performed using Chi-Square, Mann Whitney U and one-way ANOVA tests. RESULTS: At the end of study period, ticlopidine and clopidogrel strongly reduced the development of intimal hyperplasia after arterial injury (54.1%, p<0.001, 53.2%, p<0.001, respectively). No significant difference was observed in terms of intimal and medial areas between the drug-treated groups. Expressions of the basic fibroblast growth factor and platelet derived growth factor beta were significantly lower in the intima of drug treated groups with respect to the control group (p<0.05). CONCLUSION: The results of our study suggest that ticlopidine and clopidogrel, which are widely used in antiplatelet treatment in clinics, can similarly prevent the development of intimal hyperplasia after experimental arterial injury.

Histological results of sclerotherapy, phototherapy, and pulsed 980-nm laser irradiation of the dorsal rabbit ear vein.

OBJECTIVE: To compare the histological changes occurring after three different treatment modalities for telangiectasias. MATERIALS AND METHODS: Thirty 16-week-old New Zealand white rabbits weighing 2.4-3.1 kg were enrolled in the study. The rabbits were divided into three groups. The group 1 received sclerotherapy, he group 2 received phototherapy, and group 3 received high-power diode laser treatments. All animals were treated on the right dorsal marginal ear vein. Biopsies were taken on days 1, 2, 7, and 30 post-treatment, and histopathogical evaluation was performed. RESULTS: Clinical and histological thrombosis occurred between days 1 and 7 in all groups. Superficial necrosis, neutrophil infiltration, and recanalization were mostly seen in group 3, whereas thrombosis was prominent in groups 1 and 2. CONCLUSIONS: All of the methods tested appear to have similar mechanisms of action, but had differing clinical and histological results. Phototherapy and laser treatment are non-invasive and do not require an exact, pinpoint technique, in contrast to sclerotherapy. However, sclerotherapy and phototherapy showed better results, especially with regard to recanalization.

Intracoronary shunt versus bulldog clamp in off-pump bypass surgery. Endothelial trauma: shunt versus clamp.

BACKGROUND: During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model. METHODS: Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted. RESULTS: Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades. CONCLUSION: The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.

Sternal closure reinforced with rib heads: a novel technique for prevention and treatment of sternal dehiscence.

BACKGROUND: When a sternotomy cannot be performed at the midline and/or there is infection at the operation site, sternotomy revision can cause problems that increase the mortality and morbidity of the patients. There is no agreement on the best treatment method. In this paper we present a modified wiring technique. METHODS: This technique consisted of wrapping wires twice around each rib head and placing standard circumferential wire sutures, thus providing full stability by decreasing the load on the sternum using only steel wires. The study group included 23 patients with sternal dehiscence because of inappropriate sternotomy (n = 10) and/or mediastinitis (n = 13). Two mediastinal tubes were placed for irrigation in 13 patients with mediastinitis and/or wound infection, and mobilization and interposition of omentum as an axial graft was performed in 2 patients. Irrigation and antibiotherapy were continued for 4 to 6 weeks. RESULTS: Complete wound healing was obtained in all patients. Twenty-two patients treated with this technique survived. One patient died on postoperative 42nd day because of renal insufficiency and multi-organ failure. CONCLUSION: Early and aggressive debridement of infected and necrotic tissue, irrigation, and antibiotics are necessary for successful treatment, but we believe that the most important factor is full stabilization of the sternal tissue with minimal use of foreign stabilization material. Despite the limited number of cases, we suggest that our stabilization technique seems to be successful in achieving full stabilization even in infected and fragile sternal bony tissue in patients with sternal dehiscence and/or inappropriate sternotomy.

Giant size abdominal aortic aneurysm repair using open proximal anastomosis under hypothermic circulatory arrest: a report of two cases.

Hypothermic total circulatory arrest and open proximal anastomosis techniques are not commonly used in abdominal or juxtarenal abdominal aortic aneurysm repair. Proximal aortic clamping is usually adequate for surgical repair of abdominal aortic pathologies. We present two cases of giant-sized abdominal aortic aneurysms, one was juxtarenal and one was a Crawford type IV thoracoabdominal aneurysm, that were repaired by using open proximal anastomosis under hypothermic total circulatory arrest and a transabdominal approach. This technique may be useful for both thoracoabdominal and large abdominal aortic aneurysms because it offers the opportunity to not clamp the aorta and operate in bloodless surgical field.

Treatment modalities in hypertrophic obstructive cardiomyopathy: surgical myectomy versus percutaneous septal ablation.

BACKGROUND: The aim of this study was to compare the results of percutaneous septal myocardial ablation (PSMA) and surgical myectomy (SM) for decreasing the left ventricular outflow tract (LVOT) gradient, septal thickness, ventricular dimensions, and mitral regurgitation (MR) in patients with symptomatic hypertrophic obstructive cardiomyopathy. METHODS: We treated 40 patients (mean age, 24.4 +/- 6.8 years; 34 male and 6 female patients) between June 2002 and April 2006. Twenty-four patients underwent SM, and 16 patients underwent PSMA. All patients were symptomatic despite maximal medical treatment and had an LVOT gradient higher than 65 mm Hg. Their echocardiographic data were recorded before and after the procedure and then compared. The patients were followed up postoperatively for a mean of 13 months. RESULTS: There was no mortality in either group. One year after the procedure, the LVOT gradients for the 2 groups were not statistically different. During the follow-up, moderate MR was found in 4 patients (25%) in the ablation group and in 2 patients (8.3%) in the myectomy group. Exercise capacity and New York Heart Association class improved after PSMA, whereas postoperative MR severity and effort capacity were better in the surgical group. CONCLUSION: The 2 approaches yielded similar results with regard to reducing the LVOT gradient. We conclude that SM is preferable to PSMA in cases with MR.