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Article history: Received 20 November 2015 Accepted 22 November 2015 Available online 23 November 2015 artery dissection and rupture after successful TAVI procedure with axillary artery approach. The patient was admitted to our hospital because of severe and symptomatic aortic valve stenosis. The patient had hypertension, dyspnea and syncope on her history. On physical examination, the arterial blood pressure was 138/65 mmHg, the pulse was 86 bpm. There was a 4/6 systolic murmur on the right sternal border radiating to the right side of the neck. The peripheral arterial

WOS: 000469770400004, PubMed ID: 31144657, Background/Aims: Gastric cancers vary across countries and ethnic groups. They are the second most common type of cancer worldwide. Dietary and non-dietary factors as well as genetic and epigenetic alterations of many mechanisms are implicated in the development of gastric cancer. We aimed to determine the sequence of possible nucleotide changes, polymorphisms, and mutations, and to establish genotype and phenotype relation by performing whole DNA sequence analysis of the XRCC1 and ERCC1 genes belonging to base excision repair (BER) and nucleotide excision repair (NER) family of DNA repair genes in patients with gastric cancer. Materials and Methods: We included 50 patients of both sexes who had received diagnosis of gastric cancer and 50 healthy people who showed same demographic traits that forms the control group. We analyzed the ERCC1 and XRCC1 genes by DNA sequence analysis on both groups. After the analysis, we compared the genotype-phenotype relation. Results: Neither patients nor the control group has any nucleotide replacement in any exon of ERCC1 genes. We could not detect significant difference between patients and healthy groups when we correlated genotype contribution of mutations Arg194Trp, Arg208His, Arg399Gln detected in the XRCC1 gene and allele frequency. Conclusion: According to our study, the ERCC1 gene in Turkish population is not getting mutation in patients with gastric cancer and healthy individuals. Three mutations were detected in the XRCC1 gene, and these mutations were not associated with gastric cancer.

WOS: 000355193300029, PubMed ID: 26011220, Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

OBJECTIVES: There is growing evidence that practice on simulation models can improve technical skills in surgery. The aim of this study is to assess the effects of our tissue-based simulation model of vascular anastomosis on skill acquisition. METHODS: Five junior (Group I) and five senior (Group III) cardiovascular surgery residents, and five surgeons from different surgical departments (Group II) attended the study. A total of 180 vascular anastomoses on a bovine heart simulation model were performed in a 3-month period; each group performed 20 anastomoses per month (each participant in each group conducted four anastomoses per month). The anastomoses were evaluated according to criteria including, duration of the procedure, existence of anastomotic leak, additional suture requirements, matching between graft diameter and arteriotomy length, patency rates and inadvertent posterior wall injuries. Each practice was recorded with a video camera and eventually reviewed by three cardiovascular surgeons, who were blinded to groups. Results were compared for analysing the skill acquisition process in each group. RESULTS: The mean anastomosis time (Group I: 22.25±2.02, 18.10±0.78, 15.00; Group II: 17.05±1.39, 15.45±0.82, 13.00±0.79; Group III: 13.65±0.67, 11.45±1.14, 10.50±1.10) and additional suture requirements (Group I: 1.95±0.68, 1.30±0.80, 1.00±0.32; Group II: 1.80±0.41, 1.45±0.60, 1.45±0.60; Group III: 0.65±0.48, 0.40±0.50, 0.40±0.50) decreased gradually (P

Aim: To evaluate the relationship between pre-biopsy PSA levels, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), prostate volume and positive core numbers of histologically proved chronic prostatitis in the patients whom underwent transrectal ultrasound guided biopsy for elevated prostate specific antigen (PSA) levels. Material and Method: Between January 2012 and 2014, 152 patients underwent TRUS biopsy. Their medical records are examined retrospectively. The mean age of the patients were 62 (45-75). The pathologic specimens were evaluated for the number of cores with chronic prostatitis and percentage of prostatitis. Pre-biopsy levels of PSA, IPSS, maximum urinary flow rate, prostate volume are compared with the number positive cores for chronic prostatitis and their percentages. These variables also compared in the non-chronic prostatitis patients. Results: There was no statistically significant correlation between the positive number of cores for chronic prostatitis and age (P=0.5, r=0.055), a positive correlation was observed between IPSS (P

The transapical transcatheter approach for percutaneous interventions is performed in high-risk patients with peripheral vascular disease and when transseptal attempt failed. The apical access is traditionally performed through a left minithoracotomy at the fifth intercostal space under general anesthesia. But, there are some complications and risks like ventricular arrhythmias, ventricular tear and life-threatening surgical bleeding in the apical access even though it is a minimally invasive procedure [1]. Although new apical closure devices have been developed and tested in animals and humans, the apical closure remains a challenge in recent studies [2]. The cardiologists started to use the occluders to close the percutaneous apical accesses [3–11]. We report a case of a successful percutaneous closure of the apical access with a 4 mm ADO-II device after a standard transapical mitral paravalvular leak closure procedure without minithoracotomy with the computed tomography guidance. This case is the second from Turkey, so the first one was published recently in this journal [12]. In this second case, we used the CT guidance for optimal puncture of cardiac apex. A 44 year old female was admitted to our department with severe dyspnea (NHYA classes II–III). She had hemolytic anemia (hemoglobin level 8.0 g/dL, lactate dehydrogenase level was high). She had a history ofmitralmetallic prosthesis valve replacement in 1994. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and 9mm) of themitral valve prosthesis. Transesophageal echocardiography (TEE) showed two severe mitral paravalvular leaks (6 and

The aim of the study was to show the efficacy and results of aneurysm reconstruction that was developed for relieving the patients from pain and mass effects and to give an early hemodialysis option.Medical records were retrospectively screened over a period of 17 years to identify patients diagnosed with and surgically treated for aneurysm of an AV fistula. Twenty-eight patients were included in this study. The mean average age was 44 ± 3 years (31-60). Seventeen (60.7%) patients were female. Twenty-two (78.5%) patients had hypertension and 9 (32.1%) patients had diabetes mellitus. Aneurysm was examined by using ultrasonography to reveal the flow dynamics. The aneurysm was resected and an appropriate sized graft was interposed under local anesthesia. The same vein was dissected and anastomosed over the graft in an end-to-side fashion.Mean aneurysm diameter was 40 ± 12 mm. All aneurysm tissues and thrombotic materials were removed from the surgical field. Mean graft length was 37 ± 11 mm. Three (10.7%) patients need surgical revision because of postoperative bleeding. Dermal necrosis occurred in 1 (3.5%) patient. Infection was noted in 1 (3.5%) patient. Vascular access was started from the reconstructed venous area 2 or 4 days later in all patients. The patency rate was 100% in three years.Surgical reconstruction of the arteriovenous fistula aneurysm can be safely performed in hemodialysis patients with low complication rates. It gives early vascular access with high patency rates. All patients are relieved from pain and distended mass effect.Celem pracy było wykazanie skuteczności i efektów rekonstrukcji tętniaka przetoki tętniczo-żylnej przeprowadzonej celem wyeliminowania bólu, ograniczenia efektów masowych i umożliwienia wczesnej hemodializy.Przeanalizowano dokumentację medyczną obejmującą 17 lat, aby zidentyfikować pacjentów operowanych z powodu tętniaka przetoki tętniczo-żylnej. Do badania zakwalifikowano 28 pacjentów, w tym 17 kobiet (60,7%). Średnia wieku wynosiła 44 ± 3 lata (31–60 lat). Dwudziestu dwóch pacjentów (78,5%) miało nadciśnienie tętnicze, a 9 pacjentów (32,1%) cukrzycę. Tętniaki badano z wykorzystaniem ultrasonografii, aby ocenić dynamikę przepływu. Następnie tętniaki usunięto i w znieczuleniu miejscowym wstawiono odpowiednio dobrane przeszczepy. Tę samą żyłę ponad wszczepem poddano dysekcji i zespoleniu w sposób koniec do boku.Przeciętna średnica tętniaka wynosiła 40 ± 12 mm. Wszystkie tkanki tętniaka i materiały zakrzepowe usunięto z pola operacyjnego. Średnia długość przeszczepu wynosiła 37 ± 11 mm. Trzech pacjentów (10,7%) wymagało ponownej interwencji chirurgicznej z powodu krwawienia pooperacyjnego. Martwica skóry wystąpiła u 1 pacjenta (3,5%). Infekcję stwierdzono u 1 pacjenta (3,5%). U wszystkich badanych 2–4 dni później rozpoczęto dostęp naczyniowy ze zrekonstruowanego obszaru żylnego. Współczynnik drożności w ciągu 3 lat wynosił 100%.Chirurgiczną rekonstrukcję tętniaka przetoki tętniczo-żylnej można wykonywać u pacjentów poddanych hemodializie w sposób bezpieczny, przy niskim ryzyku powikłań. Umożliwia ona wczesny dostęp naczyniowy o wysokim współczynniku drożności. U wszystkich pacjentów wyeliminowano ból i powiększające się efekty masowe.

Aortic pseudoanevrizmalar kalp cerrahisinde karşılaşılabilecek en önemli komplikasyonlardan biridir. Son zamanlarda aortic pseudoanevrizmalara kontrastlı bilgisayarlı tomografi ile tanı konmaktadır. Bu test oldukça yüksek özgüllük ve hassasiyet değerlerine sahiptir. Geç dönem sternal apseler açık kalp cerrahisinden sonra nadiren gözlenmektedirler. Bilgisayarlı toraks tomografisinde subkutanöz dokudan başlayıp sternum medullasına kadar uzanan absenin aortik retrosternal dev bir pseudoanevrizma üzerine oturduğu saptandı. Bu makalede; üç yıl önce tip I aortic diseksiyon nedeni ile Bentall ameliyatı olan ve daha sonra sternal kitle yakınmasıyla kalp damar cerrahisi kliniğimize müracaat eden hasta sunulmaktadır., Aortic pseudoaneurysms are one of the most important complications to be encountered in cardiac surgery. Recently, the aortic pseudoaneurysms have been diagnosed by contrast enhanced computerized tomography. It has high specificity and sensitivity rates. Late postoperative sternal abscesses are rarely seen after open heartsurgery. Thorax computerized tomography scan revealed abscess extending from subcutaneous tissue to the medullar component of sternum, overlying retrosternal giant aortic pseudoaneurysms. This article presents the case of a patient, who had undergone Bentall procedure three years ago due to type I aortic dissection and laterpresented in our cardiovascular surgery department with a sternal mass.

Sternal intramedullary bleeding is an important contributor to postcardiac surgery hemorrhage. The aim of this study is to investigate the effects of bone wax, oxidized regenerated cellulose, and electrocoagulation on sternal intramedullary hemostatic control. Materials and methods: A total of 142 patients undergoing on-pump coronary bypass surgery were prospectively studied. The patients were randomized into 3 groups; bone wax concomitant with electrocauterization, oxidized regenerated cellulose concomitant with electrocauterization, and electrocauterization alone. The amount of postoperative hemorrhage was noted at the 1st, 2nd, 3rd, 6th, 12th and 24th hours. Rates of reexploration for hemorrhage and number of units of blood and its products used were also studied. Results: The mean age of the patients was 64.23 ± 5.81 years. There were 114 (79.7%) male patients. The patients were comparable regarding preoperative demographics except age and intraoperative variables. The amount of postoperative hemorrhage was lowest in the oxidized regenerated cellulose and highest in the electrocauterization alone group. The number of fresh frozen plasma and erythrocyte suspension used was also lowest in the oxidized regenerated cellulose group. Conclusion: To overcome hemorrhage originating from the sternal intramedullary space, oxidized regenerated cellulose use concomitant with electrocauterization is effective and can be safely used immediately before closing the chest in open heart surgery.

Severe aortic stenosis is associated with significant morbidity and mortality if untreated. The transcatheter aortic valve implantation(TAVI) is now feasable and effective gold standart treatment option in patients with severe aortic valve stenosis(AS) and associated with similar rate of major adverse events compared to the surgery. The relation between aortic stenosis and gastrointestinal angiodysplasia was known as Heyde’s Syndrome since 1958. High fluid shear stress through the narrowed valve is thought to be the underlying mechanism leads to the mechanical disruption of the large von Willebrand factor multimers. Aortic valve replacement either surgical or with TAVI seems to reduce gastrointestinal bleeding in approximately 80% in patients with Heyde syndrome in whom gastrointestinal bleeding is associated with intestinal angiodysplasia due to acquired von Willebrand’s disease (type 2A) and aortic valve stenosis. The patients especially with atrial fibrillation who need anticoagulant therapy may have bleeding risk despite aortic valve replacement. We report a case of patient presenting with a massive intestinal bleeding originating from intestinal angiodysplasia after percutaneous aortic valve replacement.

Here, we report a case of late device embolization to the abdominal aorta at the level of the superior mesenteric artery, approximately one month after percutaneous closure of an ASD.

We have read with great interest the article about the factors affecting the quality of anticoagulation with warfarin by Ciurus et al. [1]. The authors implicate the importance of predictors of controlling the anticoagulation. They aim to assess the quality of anticoagulant therapy in patients on warfarin and evaluate the factors affecting its deterioration. We thank the authors for their well-designed study. Regarding the current guidelines concerning anticoagulant therapy, we detected some contradictory and overlooked points that should be highlighted. We want to make some contributions to the report by Ciurus et al. [1] about the warfarin usage introduction update and education change according to current guidelines. Despite the presentation of new anticoagulants, vitamin K antagonists (VKA) still maintain their importance in clinical administration [2]. Unfortunately, this wide use of VKA is still associated with a wide spectrum of complications. Particular concerns have been raised regarding prevention of these complications. As one of them, the Ciurus et al. emphasized that maximizing the time in the optimum therapeutic range has great importance for avoiding adverse clinical outcomes [1]. To attain this goal, controlling the patient-specific factors such as adherence to the therapeutic plan, appropriate dosing, and reliable international normalized ratio (INR) control are very important. Among such patient-related factors, the feeding habit of the patients is a special issue. Many doctors and patients remember the wide VKA interaction food list containing dietary vitamin K. It has been a frequent practice to limit or alter dietary habits of the patients according to those food lists. But this clinical advice has been changed by the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines, 2012 [3]. It is suggested in the abovementioned document that limitations of diet deteriorate the therapeutic INR levels. Because most people have long-lasting dietary habits, which are very difficult to change, attempts to change any dietary habit may result in uncontrolled alterations of oral vitamin K intake, resulting in difficulties sustaining the therapeutic INR levels. The ACCP guidelines recommend that “A consistent intake of vitamin K-containing foods is advisable, but neither specific restrictions nor additions seem necessary in patients with stable anticoagulant control. Patients should be informed of possible changes in INR, in particular in response to the use of dietary supplements or herbs, or alcohol used chronically or ingested in large quantities.” The authors reported that, “The participants were informed about the diet limitations required in order to improve the effectiveness of the anticoagulant therapy.” Although this suggestion is valid for attaining a therapeutic level, it is very difficult to maintain this level in therapeutic doses. That is why we think the ACCP guidelines made a modification on warfarin use in 2012, which we cannot see in the previous guidelines from 2008 [4]. We also agree with the suggestion that the patient should be informed about the food and drug interactions but no suggestion should be made on limiting dietary intake, in order to maintain therapeutic INR levels.

Summary Background Proanthocyanidin is a bioflavonoid known to have protective effect against oxidative injury. We investigated the cardioprotective effect of proanthocyanidin. Material/Methods Thirty-two Rattus Norvegicus rats were categorized equally as the control group (CG), proanthocyanidin group (PCG), ischemia group (IG) and proanthocyanidin-treated group (PCT). Rats in CG and IG were fed standard rat food and PCG and PCT were fed standard rat food plus proanthocyanidin (100 mg/kg/day twice a day by oral gavage) for 3 weeks. In CG and PCG the myocardial samples were prepared immediately, and in IG and PCT hearts were placed in transport solution and kept at 4°C for 5 hours, then prepared for evaluation. Malondialdehyde (MDA) level, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities were measured. Results MDA levels were significantly higher in IG and PCT than in CG and PCG. The activity of SOD was significantly lower in IG and higher in PCG than in the other groups. The activity of GPx was significantly lower in IG than in the other groups. The activities of CAT were significantly lower in IG and PCT than in the other groups and were significantly lower in IG than PCT. Histopathologic evaluation revealed normal findings in CG and PCG. While ischemic injury was observed in IG, the content of muscle fibers was better preserved in PCT. Conclusions Proanthocyanidin may have a protective effect on myocardial ischemic injury.

Background : Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery. Methods : There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD. Results : There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality. Conclusion : The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.

The patients with cancers in the remnant stomachs after previous partial resections for benign diseases constitute a peculiar subset of the patients with gastric cancer. They are generally at advanced stages on admissions due to disregarding the symptoms related to cancer. Twenty six patients with cancer arising from the remnant stomach were analyzed. Clinicopathologic features such as age, gender, time interval between the initial operation and diagnosis of gastric remnant cancer, preoperative symptoms, surgical management, and tumor characteristics like size, location, histopathology, depth of invasion, lymph node involvement, presence of distant metastasis, and stages were documented. None of the cancers were diagnosed by routine surveillance and all the patients were symptomatic at the time of diagnosis. Twenty five patients were qualified for surgery. The resectability rate was 61% (n = 16). The ability to perform a curative resection and tumor location at the anastomotic site were determined as the factors significantly influencing survival (p

Gastrointestinal stromal tümörler, sindirim sisteminden (mide, ince barsak, mezenter, kolon, özofagus) kaynaklanan submukozal tümörlerdir. Gastrointestinal stromal tümörler en sık midede (%50-%70), ikinci sıklıkta ince barsakta (%20-%30) ve kalın barsakta ortaya çıkarlar (yaklaşık %10). Yaklaşık %50 oranında tanı konduğunda metastaz yapmış durumdadır ve en sık karaci¤er ve peritona metastaz yapar. Cerrahi, gastrointestinal stromal tümörler tanısını histolojik olarak doğrulamak için esas yöntemdir. Rezektabl gastrointestinal stromal tümörlerde cerrahi tedavideki temel hedef makroskopik olarak temiz cerrahi sınırlı rezeksiyon uygulamaktır. Bu olgu sunumunda kanlı dışkılama şikayeti ile başvuran bir hastada saptanan ince barsak gastrointestinal stromal tümörünün tanı ve tedavisini irdelemeyi amaçladık., Gastrointestinal stromal tumors are submucosal tumors that originate from the digestive tract (stomach, small intestine, mesentery, colon, esophagus). Gastrointestinal stromal tumors appear most frequently in the stomach (50%-70%), followed by the small intestine (20%-30%) and large intestine (nearly 10%). These tumors are metastatic at the time of diagnosis. Metastases are most frequently found in the liver and peritoneum. Surgery is the main met-hod to confirm the GIST diagnosis histologically. In resectable gastrointesti-nal stromal tumors, the main goal of the surgery is to provide a macroscopi-cally clean surgical margin. In this case report, we aimed to present the diag-nostic and therapeutic methods in a small intestine tumor patient with hema-tochezia

The most common synchronous cancer in gastric cancer patients is colorec-tal cancer, and vice versa. If there are suspicious complaints in the anamne-sis, the patients should be investigated carefully preoperatively. In this case report, we aimed to present the diagnostic and therapeutic methods in a pa-tient with synchronous colon and gastric cancer., Mide kanserli hastalarda en yaygın görülen senkron kanser kolorektal kanser ve kolorektal kanserli hastalarda da en sık görülen senkron kanser mide kanseridir. Anamnezde flüphe edilecek flikayetlerin varlığında preoperatif hastalar ayrıntılı tetkik edilmelidir. Bu sunumumuzda senkron mide ve kolon kanserli bir hastada tanı ve tedavi yöntemini irdelemeyi amaçladık

This retrospective study compared the immediate post-operative (first month) and mid-term (up to 5 years post-operation) results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene (PTFE) patch. There were no cases of early (in the first month) mortality in either group and the 3-month post-operative echocardiographical studies showed no evidence of calcification or aneurysm formation around the patch. Recurrent ventricular septal defects due to dehiscence of the patch occurred in the early follow-up period in four patients who had the PTFE patch but this was not statistically significant. Annual echocardiographical examination revealed some calcification in both groups. We conclude that although there are no significant differences between the two materials in outcome after ventricular septal defects closure, we prefer bovine pericardium because of its handling characteristics, elasticity and the lower risk of endocarditis.

Metilentetrahidrofolat reduktaz (MTHFR), homosisteini metionine donusturen folat metabolizmasinda temel enzimdir. Metilentetrahidrofolat reduktaz gen polimorfizmi hiperhosisteinemiden sorumlu olup, dogustan kalp defektleri, hiperkoagulasyon ve tekrarlayan abortuslara neden olur. Otuz yasindaki kadin hasta atriyal septal defekt tanisiyla klinigimize yonlendirildi. Hastanin tibbi oykusunde spontan abortus ile sonuclanan iki gebeligi, derin venoz tromboz ataklari, pulmoner emboli ve paradoks serebral emboli vardi. Genetik calisma sonucunda heterozigot MTHFR C677T mutayonu saptandi. Spontan abortus veya derin ven trombozu veya paradoks serebral emboli ile birlikte dogustan kalp hastaligi olan genc dogurgan kadin hastalarda MTHFR polimorfizminden suphelenmeyi onermekteyiz. Anah tar soz cuk ler: Atriyal septal defekt; derin ven trombozu; metilentetrahidrofolat reduktaz; spontan abortus; tromboembolizm. Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in the folate metabolism, where homocysteine converted to methionine. Methylenetetrahydrofolate reductase gene polymorphism is responsible for hyperhomocysteinemia resulting congenital heart defects, hypercoagulable states and recurrent abortion. A 30-yearold female was referred to our department with the diagnosis of atrial septal defect. In her medical history, she had two pregnancies with spontaneous abortus, deep venous thrombosis attacks, pulmonary thromboembolism and paradoxical cerebral embolus. The genetic workup revealed heterozygote MTHFR C677T mutation. We recommend suspecting MTHFR polymorphism in young fertile women with a history of spontaneous abortus or deep venous thrombosis or congenital heart disease with a paradoxical cerebral embolus.

Bu yazida uzun suredir psodoksantoma elastikum tanisiyla takip edilen ve sol internal meme arteri kullanilarak KABG cerrahisi uygulanan 49 yasinda erkek bir olgu sunuldu. Anah tar soz cuk ler: Koroner arter bypass greftleme; internal meme arteri; psodoksantoma elastikum. In this article, we present a 49-year-old male patient with longstanding pseudoxanthoma elasticum who underwent CABG surgery with left internal mammary artery.

We present here the fourth patient in the literature, over the age of 50 years old, with an abnormal right coronary artery arising from the pulmonary artery, who was successfully treated with surgery. Pre-operative computerised tomography (CT) angiography revealed an abnormal right coronary artery arising from the pulmonary artery. The right coronary artery was surgically transposed from the pulmonary artery to the ascending aorta with the aid of cardiopulmonary bypass. The patient had an uneventful postoperative course and the corrected anatomy was documented by postoperative CT angiography.

Hemoliz, mitral kapak tamirinin nadir, ancak ciddi bir komplikasyonudur. Mitral kapak tamiri oykusu olan her hastada ameliyat sonrasi erken veya gec donemde fonksiyonel kapasitede beklenmeyen bozulma olmasi halinde akla getirilmelidir. Eger hastadaki fonksiyonel bozulma reziduel mitral yetersizligin ciddiyeti ile uyumlu degilse, hemoliz her zaman dusunulmelidir. Bu yazida, mitral kapak tamiri sonrasinda intravaskuler hemoliz gelisen iki olgu sunuldu. Anah tar soz cuk ler: Hemoliz; mitral kalpak tamiri; mitral kapak replasmani. Hemolysis is a rare, but serious complication of mitral valve repair. It should be considered in every patient with the history of mitral valve repair and who has unexpected impairment in the functional capacity during early or late postoperative period. If the functional impairment is not consisted with the severity of patient residual mitral regurgitation, hemolysis should always be considered. In this article, we present two cases suffering from intravascular hemolysis after mitral valve repair.

DOI: 10.4328/JCAM.783 Received: 22.08.2011 Accepted: 17.12.2011 Printed: 01.01.2015 J Clin Anal Med 2015;6(1): 91-3 Corresponding Author: Mehmet Ali Sahin, GATA Kalp Damar Cerrahisi A.D. 06010 Etlik, Ankara, Turkiye. T.: +90 3123045243 F.: +90 3123045200 E-Mail: mali_irem@yahoo.com Ozet Infektif endokardit genis spektrumlu antibiyotiklerin yaygin sekilde kullanilmasina ragmen paravalvuler abse ve aorta-kaviter fistul olusmasina neden olabilir. Komplike infektif endokardit vakalarinda uygulanan kompleks cerrahi girisimler, cerrahi tekniklerdeki gelismelere paralel olarak daha kolay yapilabilir hale gelmesine ragmen mortalite hizlari halen yuksektir. Biz bu yazimizda infektif endokardit ve bunun sonucunda hemodinamik bozukluga neden olan aorta-kaviter fistul olgusunu sunduk. Olgumuzda aorta-kaviter fistul perikardiyal yama ile onarildi ve aortik pozisyonda mekanik kapak replasmani yapildi. Postoperatif donemde komplikasyon gelismeyen hasta 28. gunde antibiyotik tedavisinin tamamlanmasi sonrasinda taburcu edildi. Tedavi sekli ve gunumuzde uygulanan tedavi metodlari literatur esliginde tartisildi.

Gastrointestinal (GI) complications occur in less than 2% of patients undergoing open-heart surgery. Acute colonic pseudo-obstruction, known as Ogilvie's syndrome, is also a rare complication encountered in 0.046% of patients undergoing coronary artery bypass graft surgery. It is characterised by massive colonic dilatation without mechanical obstruction in patients with underlying medical or surgical conditions. In this report we describe a patient who suffered from acute renal failure requiring haemodialysis, and subsequently Ogilvie's syndrome, which was treated with high-dose neostigmine.

Taurine, the major intracellular free amino acid found in high concentrations in mammalian cells, is known to be an endogenous antioxidant and a membrane-stabilizing agent. It was hypothesized that taurine may be effective in reducing ischemia–reperfusion injury after lung transplantation and an experimental study was conducted in a rat model. The number of Sprague–Dawley rats used in the study was 35. Animals were randomized into five groups of 7 rats each, including control, donor I, donor II, ischemia–reperfusion injury, and treatment groups. All animals were exposed to the same experimental conditions in the preoperative period. Rats were fixed in a supine position after the induction. After the rats were shaved, a left pneumonectomy was performed following sternotomy in control, donor I, and donor II groups. The harvested grafts in donor I and donor II groups were transplanted to the rats of the ischemia–reperfusion group and treatment group, respectively. However, taurine was administered intraperitoneally for 3 days before the harvesting procedure in donor II. All harvested lungs were kept in a Euro-Collins solution at +4 °C for 24 h in a half-inflated manner. After harvesting and transplantation, lungs were sampled for histopathological and biochemical analysis. Malondialdehyde and superoxide dismutase, glutathione peroxidase, and catalase levels were lower in the treatment group than the other groups (p

Background: We aimed to highlight the use of a minimally invasive approach in uncomplicated congenital heart surgery. Patients and methods: We investigated retrospectively 32 children below 10 years of age who underwent elective closure of ostium secundum type ( n = 27), sinus venosus type ( n = 4) and ostium primum type ( n = 1) atrial septal defects through a limited skin incision and partial lower sternotomy between August 2001 and December 2008. All patients had cannulation through the same incision for cardiopulmonary bypass. Results: A pericardial patch was used to close the defect in 8 patients and direct suturing in 24. The mean time from the skin incision to cannulation was 56 ± 23 min. Total bypass time was 27 ± 12 min, and crossclamp time was 15 ± 8 min. Mean length of hospital stay was 4 ± 2 days. We did not encounter any complications or mortality. Conclusions: A minimally invasive approach, consisting of a limited skin incision and partial lower sternotomy, is a safe, reliable, and cosmetically advantageous method in uncomplicated congenital heart disease surgery, which can be performed widely, and may replace the standard approach without increasing mortality and morbidity.

Gastrointestinal stromal tumors and adenocancers are distinct neoplasms originating from different cell layers. Though adenocancers constitute the most common type of gastric tumors, synchronous development of a gastrointestinal stromal tumor is extremely rare. Case 1: A 63-year-old male patient underwent a radical total gastrectomy with D2 lymphadenectomy and Rouxen-Y reconstruction. Histopathologic and immunohistochemical examination of the specimen disclosed an advanced stage, intestinal type adenocancer intermixing with a distinct lesion of gastrointestinal stromal tumor. The early postoperative course was uneventful; however, recurrence was seen and he survived only 13 months. Case 2: A 60-year-old male patient underwent a distal subtotal gastrectomy with D2 lymphadenectomy, and reconstruction was provided with Billroth 2 procedure. Intraoperatively, a 0.5 cm vegetating lesion was detected on the gastric body and resected. Histopathologic and immunohistochemical examination disclosed an intestinal type adenocancer, and the incidental lesion was reported as gastrointestinal stromal tumor. His postoperative course was uneventful, and the patient is free of disease after one year. The conditions under which the synchronous tumors develop away from each other or collide are vague. Currently, the stage of the adenocancer and the size and mitotic manner of the gastrointestinal stromal tumors are the leading prognostic factors.

Their responsibilities within the Perfusionist heart surgery due to have an important place. Applied in open heart surgery with cardiopulmonary bypass support and the success of the operation affecting the patient's healing process is one of the criteria. Open heart surgery is applied in many centers have become today and in parallel significantly increased the number perfusionist. Such an important role and the patient's vital functions can influence directly the level of education perfusionist vary widely. U.S. and European countries compared with perfusionists perfusion education in Turkey with a standard and professional does not have a description. Made in these countries, and certain standards perfusionist definition put forward by the continuity of the quality of education is intended. Today in Turkey, based on perfusion education master apprentice relationship is working to improve knowledge and skills are at the beginning of the case. Quality and safe for the application of perfusion-trained regular or responsibilities of an academic who knows perfusions are needed.

Myxoma is the most common benign tumor of the heart, but it is very rare for it to originate from the left atrial appendage. Distinguishing between a mass, a thrombus, and a tumor in the body of the left atrium with preoperative transthoracic or transesophageal echocardiography is very difficult, even more so in patients with mitral valve disease and chronic atrial fibrillation. A 50-year-old male patient was admitted for surgery with the diagnosis of mitral stenosis and chronic atrial fibrillation. Transesophageal echocardiography demonstrated a mass attached to the wall of the left atrial appendage. Histopathological examination of the mass showed an image compatible with a myxoma. We hereby describe a case of a left atrial appendage myxoma mimicking a left atrial appendage thrombus.

The antiplatelet agents are prescribed in acute coronary syndromes, peripheric arterial diseases, MI, and noncardioembolic stroke to decrease the atherosclerotic events and often used with proton pump inhibitors. Current studies have demonstrated considerable interaction between clopidogrel and proton pump inhibitors. PPI can lessen the effect of clopidogrel owing to the elimination of the both drugs with the cytochrom P450 isoenzymes in Liver.

Background: Sternal dehiscence is a severe complication of open heart surgery. Reinforced wiring, a system of reinforced sternal closure, fixation of a rigid plate, and implantation of thermoreactive nitinol clips (TRC) are some surgical procedures used. The aim of this study was to evaluate the role of TRC for secondary sternal reconstruction.Methods: Of 1198 patients who underwent their operations via median sternotomy in 2 separate medical centers, sternal dehiscence was observed in 16 patients overall (1.33%). The mean (SD) age of the patients was 64.06 � 9.18 years (range, 40-77 years). Sternal dehiscence was diagnosed in all patients between the fifth and 30th postoperative days.Results: TRC were implanted in all of the patients who developed sternal dehiscence (16 patients). One patient developed severe respiratory failure, became ventilator dependent, and died from pneumonia on postoperative day 24. The other 15 patients were discharged without complications. Postoperative follow-up of the surviving patients revealed adequate and satisfactory sternal stability.Conclusion: Implantation of TRC is an effective and easy method for fixing the sternum and can be performed rapidly and securely.

Background: Carotid body tumors are infrequent neoplasms in daily practice. Diagnostic difficulties exist because of their slow growth and asymptomatic progress. The surgical treatment is complicated and difficult due to their proximity to vascular and neural structures. In this study we present the results of 12 patients operated for carotid body tumor that underwent preoperative percutaneous direct embolization. Patients and methods: The data of 12 patients, diagnosed with carotid body tumor and surgically treated at our department between 2000 and 2010, was retrospectively analyzed. Duplex ultrasound, computerized tomography and selective carotid angiography were the applied diagnostic tools. Two days before the planned surgery all patients underwent percutaneous direct embolization to achieve devascularization of the tumor. Afterwards, surgical excision of the mass under general anesthesia was performed in all cases. Results: Five tumors were classified as Shamblin type I (41.7%), and the others were type II (58.3%). All masses were removed sub-adventitially and no vascular reconstruction was necessary. There was no mortality and no permanent neural damage. Malfunction of the tongue was observed in only one case, which recovered completely in one month. There was one recurrence detected by Duplex ultrasound and angiography during the follow up period. Conclusions: Surgical excision is mandatory to be performed as soon as diagnosed in carotid body tumors. Preoperative direct percutaneous embolization of the mass helps to devascurize the tumor, enabling an optimal surgical procedure. The outcomes of such a combined intervention are excellent and neurovascular structure preservation decreases complication and morbidity rates.

OBJECTIVE Hypertrophied anomalous muscle bands (AMBs) in the right ventricular outflow tract (RVOT) may develop in the context of ventricular septal defects (VSDs) and limit persistent pulmonary overflow. In adult patients with a large VSD, persistent AMBs in the RVOT therefore can simulate the role of an externally placed pulmonary artery band. We termed such alterations natural internal bands (NIBs). Our goal was to establish the morphologic nature of the obstructive muscular lesions of the RVOT in patients with a large VSD. METHODS Patients who underwent operations for a large VSD in our center, which has a high volume of adult patients with congenital defects, were retrospectively reviewed, and the nature of the NIBs in these patients was documented. All patients underwent transthoracic echocardiography and cardiac catheterization evaluations preoperatively and at postoperative month 3. Histopathologic examination of the AMBs was performed. RESULTS Of 96 adult patients who underwent operations for a large isolated VSD (mean defect size, 16.9 ± 3.5 mm), 16 patients had a hemodynamically significant NIB. Two different patterns of obstruction were found. Ten of the 16 patients revealed an os infundibulum morphology, and 6 patients revealed systolic bulging of the conal septum. Four of the patients with os infundibulum also had classic tetralogy-type septal malalignment. The mean peak systolic gradient on the RVOT was 56.5 ± 17.2 mm Hg and 53.6 ± 12.3 mm Hg in the patients with os infundibulum and in the patients with systolic bulging of the conal septum, respectively. Surgical repair of the VSD was completed successfully in all patients. Resection of the os infundibulum was performed concomitantly in patients with os infundibulum. At the third postoperative month, the mean peak systolic gradient was 16.8 ± 3.5 mm Hg in patients with os infundibulum and 26 ± 5.9 mm Hg (range, 20-35 mm Hg) in patients with systolic septal bulging. CONCLUSIONS Some mechanisms in adult type VSDs are essential for protecting the pulmonary vasculature. We tried to review these protective mechanisms: hypertrophied AMBs and NIBs.

Sternal dehiscence after cardiac surgery occurs infrequently and can lead to mediastinitis and prolonged hospital stay and may even result in death. The most common treatment for mechanical sternal instability is rewiring with wound debridement. We present a case in which a modified titanium mesh plate fixation technique was used. A safe and easy to perform technique, this method can be an alternative option to wire closure in a sternum with fractures, instability or poor bone quality.

Herein we report an asphyctic preterm neonate with respiratory distress and prothrombotic risk factors that responded positively to rtPA treatment following 2 attacks of acute thrombosis.None declared.Bu yazıda solunum sıkıntısı ve asfiksi ile doğmuş, protrombotik risk faktörleri de olan bir prematüre bebekte iki tromboz atağının rekombinant doku plazminojen aktivatörü ile başarılı bir şekilde tedavi edildiği sunulmuş, ilacın etkinliği ve bu grup hastalarda dahi uygulanılabilirliği vurgulanmıştır.

Popliteal artery injuries are an important cause of amputation and morbidity. Existence of concomittant bone or other different pathologies and prolonged time of transport to the hospital leads to increased mortality. On the other hand, early surgical intervention, prevention of hypovolemic shock, systemic anticoagulation and fasciotomy in proper cases decrease morbidity and mortality. In both artery and vein injuries, vein ligation must be a non desirable choice, and when it is inevitable fasciotomy must be performed to prevent development of compartment syndrome.