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Chylothorax is a rare sequela to cardiac surgery, associated with high rates of morbidity and mortality. There are various medical and surgical options for its management. We describe 2 cases of chylothorax that developed after coronary artery bypass grafting and were managed successfully with medical therapy alone. Conservative treatment such as we describe aims to reduce chyle flow, to drain the pleural cavity in an effective manner, and to prevent chronic sequelae. Optimal conservative treatment, consisting of nothing by mouth and the administration of a pleurodetic agent, should be started immediately upon diagnosis. In most cases, it reduces the need for reoperation and long-term hospitalization. Prospective randomized controlled trials are nonetheless needed to confirm these assumptions.

Background. This retrospective study was designed to investigate the efficacy and safety of intermittent portal triad clamping (PTC) with low central venous pressure (CVP) in liver resections.Methods. Between January 2007 and August 2013, 115 patients underwent liver resection with intermittent PTC. The patients’ data were retrospectively analyzed.Results. There were 58 males and 57 females with a mean age of 55 years (±13.7). Cirrhosis was found in 23 patients. Resections were performed for malignant disease in 62.6% (n=72) and for benign disease in 37.4% (n=43). Major hepatectomy was performed in 26 patients (22.4%). Mean liver ischemia period was 27.1 min (±13.9). The mortality rate was 1.7% and the morbidity rate was 22.6%. Cumulative clamping time (t=3.61,P<0.001) and operation time (t=2.38,P<0.019) were significantly correlated with AST alterations (D-AST). Cumulative clamping time (t=5.16,P<0.001) was significantly correlated with D-ALT. Operation time (t=5.81,P<0.001) was significantly correlated with D-LDH.Conclusions. Intermittent PTC under low CVP was performed with low morbidity and mortality. Intermittent PTC can be safely applied up to 60 minutes in both normal and impaired livers.

WOS: 000384952700119 PubMed: 27687454 Study objective: To investigate the effects of dexmedetomidine on oxidative injury caused by ionizing radiation. Design: Randomized controlled experimental study. Setting: Department of radiation oncology and research laboratory of an academic hospital. Interventions: Twenty-eight rats were randomized to 4 groups (n = 7 per group). Group S rats were administered physiologic serum; group SR rats were administered physiologic serum and 10 Gy external ionizing radiation. Groups D100 and D200 were administered 100 and 200 mu g/kg dexmedetomidine intraperitoneally, respectively, 45 minutes before ionizing radiation. Measurements: Liver, kidney, lung, and thyroid tissue and serum levels of antioxidant enzymes (glutathione peroxidase [GPX], superoxide dismutase, and catalase) and oxidative metabolites (advanced oxidation protein products, malondialdehyde, and nitrate/nitrite, and serum ischemia-modified albumin) were measured 6 hours postprocedure. Main results: In group SR, IR decreased antioxidant enzyme levels and increased oxidative metabolite levels (P < .05). In plasma, antioxidant enzyme levels were higher and oxidative metabolite levels were lower in groups D100 and D200 than in group SR (P < .01). In tissues, hepatic and lung GPX levels were higher in groups D100 and D200 than in group SR (P < .001). Renal and thyroid GPX levels were higher in D200 than in group SR (P < .01). Thyroid superoxide dismutase levels were higher in groups D100 and D200 than in group SR (P < .01). Renal, lung, and thyroid catalase levels were higher in group D200 than in group SR (P < .01). Hepatic, renal, and lung advanced oxidation protein products and malondialdehyde levels were lower in groups D100 and D200 than in group SR (P < .01). Hepatic, renal, and lung nitrate/nitrite levels were lower in group D200 than in group SR (P < .05). Conclusions: Dexmedetomidine preserves the antioxidant enzyme levels and reduces toxic oxidant metabolites. Therefore, it can provide protection from oxidative injury caused by ionizing radiation. (C) 2016 Elsevier Inc. All rights reserved.

Iatrogenic vascular injury during lumbar spinal surgery is rare, but may lead to serious complications in unrecognized cases. Especially, injuries to aorta or its major branches may result in death unless diagnosed and treated immediately. We present a rare case of aortic injury with a scalpel in a 56-year-old male patient undergoing lumbar disk surgery. The vascular injury was successfully treated with open surgery. The post-operative period was uneventful and the patient was discharged in a healthy condition on the 8th day. This case once again reminds us that surgery is always open to complications and that early diagnosis and appropriate interventions are of paramount importance to overcome these complications.

Background. The aim of this study is to compare the effects of sevoflurane and propofol on one lung ventilation (OLV) induced ischemia-reperfusion injury (IRI) by determining the blood gas, ischemia-modified albumin (IMA), and malonyldialdehyde (MDA).Material and Methods. Forty-four patients undergoing thoracic surgery with OLV were randomized in two groups (sevoflurane Group S, propofol Group P). Anesthesia was inducted with thiopental and was maintained with 1–2.5% of sevoflurane within the 40/60% of O2/N2O mixture in Group S. In Group P anesthesia was inducted with propofol and was maintained with infusion of propofol and remifentanil. Hemodynamic records and blood samples were obtained before anesthesia induction (t1), 1 min before two lung ventilation (t2), 30 min after two lung ventilation (t3), and postoperative sixth hours (t4).Results. Heart rate att2andt3in Group P was significantly lower than that in Group S. While there were no significant differences in terms of pH and pCO2, pO2att2andt3in Group S was significantly lower than that in Group P. IMA levels att4in Group S were significantly lower than those in Group P.Conclusion. Sevoflurane may offer protection against IRI after OLV in thoracic surgery.

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects.Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1), 30 min after tourniquet inflation (t2), immediately before (t3), and 5 min (t4), 15 min (t5), 30 min (t6), 1 h (t7), 2 h (t8), and 6 h (t9) after tourniquet release.Results. MDA and IMA levels increased significantly compared with baseline values in Group S att2–t9andt2–t7. MDA levels in Group T and Group I were significantly lower than those in Group S att2–t8andt2–t9. IMA levels in Group T were significantly lower than those in Group S att2–t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I.Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy.Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient’s analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient’s demands from the pump, pump’s delivery, and additional analgesic requirement were also recorded.Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient’s demand and pump’s delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C.Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy.