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Aim: In this study on physicians who graduated at 2000 and after, contribution of the pathology education they received in medical faculties to their active professional lives, its adequacy and necessity, and their opinions and suggestions were examined.Methods: An open-ended, multiple choice and Likert scale format digital questionnaire consisting of 12 questions was filled by the consenting physicians who graduated in 2000 and later.Results: Total 107 physicians (39 (36.4%) clinical, 38 (35.5%) surgical sciences and 30 (28%) general practitioners) participated in the study. Forty-one physicians (38%) took the pathology course only in the third year. Didactic training was most frequently accompanied by microscopy (n = 94, 87.9%) training. Sixty-six (61.68%) physicians additionally received macroscopy training. Pathology education was very useful and beneficial for their current professional life for 75% physicians and was very sufficient and quite sufficient in 45% physicians. There was a statistically significant relationship between the benefit of pathology in professional life and the adequacy of the education received (p = 0.01). The usability of the knowledge (n = 89, 83.2%), the educational methods (n = 78, 72.9%), and the characteristics of the educator (n = 75, 70.1%) were rated as the most important factors for its benefit in active professional life. Case discussions (n= 79, 72.9%), macroscopy (n = 65, 60.7%), and microscopy laboratory study (n= 62, 57.9%), problem-based learning (PBL) (n = 61, 57.0%), and observation in hospital laboratory ( n= 51, 47.6%) are recommended besides objective structured practical exam (OSPE) (n = 85, 79.4%) andobjective structured clinical exam (OSCE) (n = 76, 71.0%). Conclusions: Pathology education will be helpful in active professional life if the curriculum is usable, integrated with the clinic and delivered with diversified up-to-date learning methods. The benefit of pathology education increases in parallel to its adequacy. Also, surgical and internal sciences physicians benefit more than practitioners. It would be appropriate to set up-to-date standards on the years, duration, content and method of pathology education., Amaç: Bu çalışmada, 2000 yılı ve sonrasında mezun olmuş hekimlerin tıp fakültelerinde aldıkları patoloji eğitiminin aktif meslek yaşamlarında katkısı, aldıkları eğitiminin yeterliliği ve gerekliliği ile ilgili görüşleri ve önerileri incelenmiştir.Yöntem: 2000 ve sonrasında mezun olmuş hekimlerden onam verenler tarafından açık uçlu, çoktan çok seçmeli ve Likert skalası formatında toplam 12 soruluk bir dijital anket doldurulmuştur.Bulgular: Çalışmaya 107 hekim katılmış olup 39’u (%36.4) dahili, 38’i (%35.5) cerrahi bilimler hekimi ve 30’u (%28) pratisyen hekimdir. Kırk bir hekim (%38) patoloji dersini sadece 3. sınıfta almıştır. Didaktik eğitime sıklıkla mikroskopi eğitimi eşlik etmiştir (n=94, %87.9). Altmış altı (%62) hekim ek olarak makroskopi eğitimi almıştır. Hekimlerin %75’i patoloji eğitiminin şimdiki meslek hayatları için çok yararlı ve oldukça yararlı olduğunu ve %45’i aldıkları eğitimin çok yeterli ve oldukça yeterli olduğunu belirtmiştir. Patolojinin meslek hayatındaki yararı ile alınan eğitimin yeterliliği arasında istatistiksel anlamlı ilişki vardır (p=0.01). Hekimler, bilgilerin kullanılabilir olmasını (n=89, %83.2), eğitim yöntemlerini (n=78, %72.9) ve eğitimcinin özelliklerini (n=75, %70.1) önemli bulmuş ve olgu tartışmaları (n=79, %72.9), makroskopi (n=65, %60.7) ve mikroskopi çalışması (n=62, %57.9), probleme dayalı öğrenme (PDÖ) (n=61, %57.0) ve hastane laboratuvarında gözlem (n=51, %47.6) yapılmasını önermiştir. Değerlendirmelerin objektif yapılandırılmış pratik sınavı (OSPE) (n=85, %79.4) ve objektif yapılandırılmış klinik sınavı (OSCE) (n=76, %71.0) ile yapılması önerilmiştir.Sonuç: Patoloji eğitimi, müfredatının kullanılabilir olması, klinik ile entegre edilmesi ve çeşitlendirilmiş güncel öğrenme yöntemleri ile verilmesi halinde aktif meslek hayatında işe yarayacaktır. Patoloji eğitiminin yeterliliği arttıkça yararı da artmakta olup dahili ve cerrahi bilimler alanlarında çalışan hekimler pratisyen hekimlere göre daha fazla yarar görmektedir. Patoloji eğitiminin hangi yıllarda verileceği, süresi, içeriği ve yöntemi konusunda da güncel standartlar belirlenmesi uygun olacaktır.

Human adipose tissue is involved in fat storage and also plays a role in the immune response. Curcumin (CUR), a natural polyphenol is suggested to supress adipocyte differentiation in the early stage by inhibiting secretion of some regulators and the inflammatory cytokines and by activating the secretion of antiinflammatory cytokines. Our aim in this research was to examine the molecular pathways of the inhibitory effects of different doses of curcumin (0.5 µM, 5 µM, 10 µM, 20 µM, 50 µM) on the preadipocyte-adipocyte differentiation and the anti-inflammatory effect of curcumin for preventing adipocyte related oxidative and inflammatory status. Differentiation of cells was performed using Oil red O, mRNA expression levels of adiponectin, CCAAT/enhancer binding proteinα (C/EBPα), cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), leptin, Nuclear Factor kappa B1 (NFκB1), peroxisome proliferator-activated receptor gamma (PPARγ), sirtuin-1 (SIRT-1), tumor necrosis factor-α (TNF-α), transient receptor potential vanilloid receptor1 (TRPV1), uncoupling protein2 (UCP2), vasculer endothelial growth factor-A (VEGF-A), vascular endothelial growth factor receptor I (VEGF-RI), VEGF-RII were evaluated in preadipocytes and adipocytes. Curcumin suppressed the differentiation of preadipocyte to adipocytes, decreased the release of proinflammatory cytokines, but it did this by regulating C/EBPα and PPARγ gene expressions outside the NF-κB pathway. Curcumin effectively suppressed adipogenic transcription factors and also adipocyte differentiation at all doses between 0.5–50 µM, but showed its anti-inflammatory effect especially in the application of curcumin of 50 µM.

Background Inflammation related hypertension is reported in obesity due to synthesis of angiotensin-II (Ang-II) and proinflammatory compounds in obese adipose tissue. Mast cell chymase (MC) also stimulate Ang-II synthesis, and activate transforming growth factor beta-1 (TGF-β1) and matrix metalloproteinase-9 (MMP-9). The aim of our study is to evaluate the relation of serum chymase levels, a serine protease enzyme secreted from mast cells, in obese patients with hypertension and cytokines that lead to cell damage. Materials and methods Three study groups are composed of individuals aged between 19 and 63 with following characteristics; (1) control (n = 30): healthy subjects with body mass index (BMI) 30; (3) obese + HT (n = 20): patients BMI >30 and hypertension. Serum Ang-II, MC, TGF-β1 and MMP-9 are determined by commercial ELISA. Angiotensin converting enzyme (ACE) activity is determined with enzymatic colorimetric assay. Results Serum chymase levels did not vary between groups. Chymase levels showed significant negative correlation with ACE activity (r = −0.278, p = 0.013) and positive correlation with Ang-II levels (r = 0.251, p = 0.024). No correlation was evident between chymase levels and hsCRP, TGF-β1 and MMP-9. Conclusion Serum chymase, Ang-II, TGF-β1 and MMP-9 levels did not change in obese and hypertensive-obese patients despite evident hyperinsulinemia, increased insulin resistance and elevated hsCRP levels.

This study investigated the effects of curcumin and capsaicin on testicular and hepatic oxidant–antioxidant status in rats fed a high-fat diet (HFD). Male Sprague–Dawley rats were divided into 5 groups (8 rats per group). The control group was fed a normal control diet (standard laboratory chow), the HFD group was fed HFD (60% of total calories from fat), the HFD+CUR group received HFD supplemented with curcumin (1.5 g curcumin/kg HFD), the HFD+CAP group was given HFD supplemented with capsaicin (0.15 g capsaicin/kg HFD), and the HFD+CUR+CAP group received HFD supplemented with curcumin and capsaicin for 16 weeks. Hepatic and testicular thiobarbituric acid reactive substances (TBARS), reactive oxygen species (ROS), glutathione (GSH) levels, glutathione transferase activity, and Cu-Zn superoxide dismutase, glutathione peroxidase, and catalase protein expression and enzyme activities were measured. Protein expression was determined by Western blotting. GSH levels and antioxidant enzyme activities were measured with colorimetric methods. HFD slightly increased hepatic and testicular oxidative stress parameters. GSH levels did not change between groups. TBARS and ROS levels were significantly reduced in the HFD+CUR+CAP group compared with the HFD group. Liver and testis antioxidant enzyme activities and expression increased significantly with combined capsaicin and curcumin treatment. Curcumin and capsaicin treatment attenuated testicular and hepatic oxidative stress and enhanced the antioxidant defense system. The combination of capsaicin and curcumin with HFD seems to have some remarkable and beneficial effects on testicular oxidative damage in the fatty liver rat model.

Background The aim of this study is to present early and mid results associated with the treatment of dilatation of the ascending aorta using the wrapping technique. Methods A total of 54 patients (16 males, 38 females; mean age 56.9±12.7 years; range 21 to 77 years) who were subjected to the wrapping technique due to dilatation of the ascending aorta between January 2010 and Fabruary 2017 were retrospectively analyzed. The Dacron grafts were used in all patients. Wrapping was performed in all patients in combination with the other cardiac surgical procedures. Wrapping was performed with aortoplasty in 32 patients and as an isolated procedure in 22 patients. Preoperative clinical findings, concomitant cardiac procedures, intraoperative parameters, postoperative early and long-term outcomes were evaluated. The ascending aorta and descending aorta diameters, ejection fraction, left ventricle end-diastolic and end-systolic diameters were measured using a computed tomography scan and/or transthoracic echocardiography after surgery, and was compared with the preoperative values. Results The median follow-up was 3.8 (range, 1 to 7) years. No intraoperative complication associated with the wrapping procedure was reported in any of the patients. One patient died during the early postoperative period. Relapse-free intra-arterial fibrinolysis was used to correct postoperative cerebral infarct in one patient without any sequelae. Revision surgery was required in two patients due to bleeding and in another two patients due to sternal dehiscence. A postoperative decrease in the aortic diameter and an increase in the ejection fraction were found to be statistically significant. Findings such as sinus of Valsalva and distal aortic dilation, rupture, pseudoaneurysm, and graft mobilization were not observed during follow-up. Conclusion Our study results show that the wrapping techniques may be safely performed in patients with moderate dilatation of the aorta who do not require replacement of the ascending aorta.

BACKGROUND: This study aims to evaluate the effects of graft dysfunction detected by intraoperative transit-time flow measurement on the outcomes of on-pump coronary artery bypass graft surgery. METHODS: A total of 1,240 patients (856 males, 384 females; mean age 57.4±12.1 years; range, 47 to 74 years), who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy performed by the same surgical team, were reviewed retrospectively. With the introduction of transit-time flow measurement into practice at our clinic in 2006, all patients regularly underwent transit-time flow measurement during surgery in order to evaluate the graft patency. Interpretation of the data obtained using the transit-time flow measurement in patients who underwent surgery has directed our decision as to whether to perform graft revision. Patients were evaluated for early- and late-period mortality/ morbidity, perioperative and postoperative myocardial infarction, and intraaortic balloon requirement. RESULTS: A total of 3,596 grafts in the perioperative period was evaluated using transit-time flow measurement. Anastomosis/graft revision, new anastomosis/patch plasty to distal native artery or free left internal mammary artery graft was performed in 146 grafts of 143 patients in whom transittime flow measurement showed insufficient patency. Four of six patients who developed peri/postoperative myocardial infarction were found to have perioperative hypotension, ST elevation, and wall motion abnormality on transesophageal echocardiography before closure of the sternum. The flow was corrected by extending the short length of the grafts with insufficient flow after transit-time flow measurement and it was recorded that transit-time flow measurements were at normal values at these four grafts. Two patients developed acute myocardial infarction in the postoperative period and stent was applied in one vessel of each patient; however, one of these patients died. Sixteen patients were inserted intraaortic balloon pump, four of which being in the preoperative period. Revision surgery was performed due to bleeding in 56 patients and sternal infection in 12 patients. Of all patients, 28 (2.3%) died in the early postoperative period. CONCLUSION: We believe that transit-time flow measurement may be an important tool in evaluating graft function and contribute to eliminate the causes of graft failure during surgery.

üksek yağlı diyetin (YYD) neden olduğu oksidatif stresin testis fonksiyonlarını olumsuz yönde etkilediği bilinmektedir. Zerdeçal baharatının aktif bileşeni olan kurkuminin oksidan-antioksidan denge üzerine olumlu etkileri olduğu gösterilmiştir. Bu çalışmanın amacı; YYD birlikte alınan kurkuminin testiste oksidan-antioksidan denge üzerine olan etkisini incelemektir. Gereç ve Yöntem: Sprague-Dawley erkek sıçanlar dört gruba ayrılmış ve 16 hafta süreyle beslenmiştir. Birinci gruba kalorisinin %10’unun yağdan karşılandığı normal diyet, ikinci gruba kalorisinin %60’ının yağdan karşılandığı YYD, üçüncü gruba YYD’e karıştırılmış kurkumin (1g/kg yem) ve dördüncü gruba sadece normal diyet+kurkumin (1g/kg yem) verilmiştir. Deney süresi sonunda testis dokusu homojenize edilerek postmitokondriyal ve mitokondriyal fraksiyonlara ayrılmış; testiste reaktif oksijen türleri (ROS) düzeyleri florometrik yöntemle, malondialdehit (MDA) ve glutatyon (GSH) düzeyleri ile glutatyon peroksidaz (GPx), süperoksit dismütaz (SOD) ve glutatyon transferaz (GST) aktiviteleri spektrofotometrik yöntemlerle ölçülmüştür. Bulgular: YYD uygulaması, testiste postmitokondriyal ve mitokondriyal MDA düzeylerini arttırmış; sitozolik GSH düzeylerini ise azaltmıştır. YYD+Kurkumin uygulaması YYD’e bağlı artış gösteren MDA düzeylerini düşürmüş; GSH düzeyini ve GST aktivitesini ise arttırmıştır. Ancak sadece kurkumin uygulaması oksidan-antioksidan göstergeleri etkilememiştir. ROS düzeyleri ile SOD ve GPx aktiviteleri ise gruplar arasında anlamlı değişim göstermemiştir. Sonuç: Bulgularımız, YYD ile birlikte alınan kurkuminin testiküler oksidan-antioksidan dengeyi koruyucu olabileceğini göstermektedir. Ancak bu etkinin moleküler mekanizmalarının incelenmesi için ileri çalışmalar yapılması gerekmektedir., Objective: High fat diet (HFD) induced oxidative stress is known to adversely affect testicular functions. Curcumin, which is an active ingredient of turmeric spice, has been shown to reduce lipid peroxidation and stimulate cellular antioxidant enzymes. The aim of this study is to investigate the effect of dietary curcumin on the testicular oxidant-antioxidant status in rats fed on a HFD. Material and Method: Male Sprague-Dawley rats were divided into four groups. Group 1 was fed with a control diet (10% of total calories from fat). Group 2 was fed with a HFD (60% of total calories from fat). Groups 3 and 4 received a HFD and a control diet with curcumin (1g/kg diet; w/w) respectively for 16 weeks. The testis tissue was homogenized and divided into postmitochondrial and mitochondrial fractions and the reactive oxygen species (ROS) levels were measured with the fluorometric method. The malondialdehyde (MDA) and glutathione (GSH) levels and glutathione peroxidase (GPx), superoxide dismutase (SOD) and glutathione transferase (GST) activities were measured with spectrophotometric methods. Results: HFD supplementation increased postmitochondrial and mitochondrial MDA levels and decreased cytosolic GSH levels in testis. MDA levels decreased with curcumin supplementation. Moreover, GSH levels and GST activity increased. However, curcumin supplementation alone did not affect oxidant-antioxidant status. ROS levels, SOD and GPx activities did not change significantly between the groups. Conclusion: Our data has shown that curcumin supplementation with HFD may prevent testicular oxidant damage. However, further studies are needed to investigate the underlying molecular mechanisms.

Objective: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Abbasoglu, Semra/0000-0003-3467-9763; Oner-Iyidogan, Yildiz/0000-0001-6956-8794; Tuncdemir, Matem/0000-0002-5300-4449; KOCAK, Hikmet/0000-0003-1720-9102 WOS:000484049900002 PubMed ID: 30993920 Background. Apoptosis plays a major role in fatty liver disease. High-fat diets are related to the onset of fatty liver disease and hepatic oxidant-antioxidant imbalance. Curcumin and capsaicin are somewhat beneficial in reducing hepatic triglycerides; this is most likely because they are known to downregulate reactive oxygen species (ROS) and apoptosis. Objectives. The aim of this study was to investigate the effects of curcumin and capsaicin on apoptosis through the oxidative effect in an animal model of fatty liver disease. Material and methods. Male Sprague-Dawley rats were fed a normal control diet, a high-fat diet (HFD; 60% of total calories from fat), a HFD+curcumin (1.5 g curcumin/kg HFD), a HFD+capsaicin (0.15 g capsaicin/kg HFD), or a HFD+curcumin+capsaicin (1.5 g curcumin and 0.15 g capsaicin/kg HFD). Liver lysate levels of BAX, Bcl-2 and caspase-3 were determined via immunoblotting. Caspase-3 activity was measured with a colorimetric caspase-3 measurement kit. Total antioxidant status (TAS) and total oxidant status (TOS) were assayed using commercial kits. The generation of hepatic ROS was measured with fluorimetry. Fragmentation of DNA was detected using the TUNEL method. Results. High-fat diet caused increased expression of BAX and caspase-3, as well as increased TOS and caspase-3 activity, but decreased expression of Bcl-2. HFD+curcumin+capsaicin caused decreased BAX, caspase-3, TOS, and ROS levels as compared to HFD, but increased TAS and Bcl-2. A HFD +curcumin+capsaicin also decreased the number of TUNEL-positive cells. Conclusions. These results suggest that supplementation with curcumin and capsaicin balances the hepatic oxidant-antioxidant status and may have a protective role in the apoptotic process in an HFD-induced fatty liver model. Research Fund of Istanbul University, TurkeyIstanbul University [55331, BEK-2017-24926] This work was supported by the Research Fund of Istanbul University, Turkey, project No. 55331 and BEK-2017-24926.

Effects of curcumin (turmeric) and capsaicin (red pepper) on hepatic fat accumulation and fetuin-A expression in rats fed high-fat diet (HFD) is aimed to be investigated. Male Sprague-Dawley rats received HFD (60% of total calories from fat) and 0.15 g capsaicin/kg HFD and/or 1.5 g curcumin/kg HFD for 16 weeks. Hepatic AMPK, p-AMPK and fetuin-A expressions were determined by western blotting, liver lipid levels were measured with colorimetric methods and serum fetuin-A, insulin, leptin and adiponectin levels were detected using commercial ELISA kits. HFD increased hepatic lipid levels, fetuin-A expression and serum leptin, insülin and fetuin-A levels. Curcumin and capsaicin treatments significantly reduced hepatic fat accumulation and leptin levels; liver fetuin-A expression was decreased significantly by the curcumin treatment. Curcumin and capsaicin treatments attenuated hepatic fat accumulation and increased leptin levels related to inflammation. The suppression of hepatic fetuin-A expression is observed to be especially sensitive to curcumin.

Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74) underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90%) were in NYHA class III; 34 (85%) patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

Objective: The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. Methods: Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). Results: Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). Conclusion: The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

High fat diet (HFD) is associated with oxidative stress induced fatty liver. Curcumin, an extract of Curcuma longa, has been shown to possess potent antioxidant and hypolipidemic properties. In this study, we investigated the effect of curcumin treatment on hepatic heme oxygenase-1 (HO-1) expression along with pro-oxidant–antioxidant status and lipid accumulation in rats fed an HFD. Male Sprague–Dawley rats were distributed among 4 groups: Group 1, which was fed the control diet (10% of total calories from fat); Group 2, which was fed the HFD (60% of total calories from fat); and groups 3 and 4, which received the HFD supplemented with curcumin and the control diet supplemented with curcumin (1 g/kg diet; w/w), respectively, for 16 weeks. HFD caused increases in hepatic lipid levels, production of reactive oxygen species, and lipid peroxidation. Further, HO-1 expression was significantly decreased. Histopathological examination showed hepatic fat accumulation and slight fibrotic changes. Curcumin treatment reduced hepatic lipids and oxidative stress parameters, and HO-1 expression was significantly increased. These findings suggest that increased HO-1 expression, along with suppressed oxidative stress as well as reduced hepatic fat accumulation and fibrotic changes, contribute to the beneficial effects of curcumin in attenuating the pathogenesis of fatty liver induced metabolic diseases.

Objective In the present study, we aimed to retrospectively investigate the early and late results of different surgical treatment techniques applied in different age groups with coarctation of the aorta (CoA). Materials and methods Between January 2007 and February 2017, 26 patients (12 males, 14 females; mean age: 12.2±12.4 years; range: 29 days-34 years) who underwent surgery with the diagnosis of CoA were evaluated. Overall, 11 of these patients (42.3%) were in the infantile period, whereas 15 patients (57.7%) aged between 6 and 34 years. Resection and end-to-end anastomosis were performed in 13 patients (50%). Bypass grafting was performed in six patients (23.1%), and patch plasty was performed in seven patients (26.9%). Results A patient (3.8%) who was operated on during the infantile period died early, whereas another patient (3.8%) died 2 years after the surgery. Recoarctation was detected in two patients. A patient underwent balloon dilatation, whereas another patient underwent balloon dilatation and stenting. In patients who underwent re-section and end-to-end anastomosis based on postoperative echocardiography results during follow-up, a lower statistically significant gradient was observed compared with the preoperative period. Despite the decrease in the left ventricular systolic diameter (LVSD) and the increase in the ejection fraction (EF) the decrease in LVSD and increase in EF were not statistically significant. In patients who underwent patch plasty or graft interposition, the low values of the gradient and left ventricular diastolic diameter in the postoperative follow-up were statistically significant. However, the decrease in LVSD and increase in EF were not statistically significant. Conclusions Our clinical experience suggests that repairing with resection and end-to-end anastomosis is a more appropriate treatment option during the infancy, whereas patch plasty or bypass grafting may be preferred in advanced ages.

Objective Inflammation and loss of appetite is the most common problem in patients with chronic kidney disease (CKD). This comparative cross-sectional study aimed to characterize the changes in circulating levels of ghrelin, obestatin, leptin, all of which have an effect on food intake, and proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) in patients with CKD who were undergoing different treatments. Design and Setting Study participants included 36 patients who had undergone hemodialysis (body mass index [BMI]: 22.3 ± 4.17 kg/m 2 ); 41 who had undergone peritoneal dialysis (BMI: 23.5 ± 3.10 kg/m 2 ), 30 with early stage CKD (BMI: 24.4 ± 3.32 kg/m 2 ), and 31 healthy subjects (24.3 ± 2.14 kg/m 2 ). The patients with CKD were kept under a standard diet with restricted salt, potassium, and protein intake. Intervention Levels of leptin, acylated ghrelin, obestatin, TNF-α, and IL-6 were measured by commercially available enzyme-linked immunosorbent assay kits. Total nitrite/nitrate was analyzed using colorimetric assay kit. Results Significantly high leptin levels, accompanied by low acylated ghrelin levels, were observed in patients with CKD. Maintenance dialysis did not affect these levels. TNF-α and IL-6 levels were significantly higher in CKD patients than in healthy subjects, the highest being in dialysis patients. Obestatin levels were relatively low in patients who had undergone hemodialysis. Conclusion Low acyl-ghrelin levels, accompanied with high levels of TNF-α and IL-6 may be involved in the loss of appetite and poor nutritional status in CKD patients.

Thromboangiitis obliterans (TAO) is very frequent in eastern Anatolia. In a ten-year period 204 Buerger’s disease patients were diagnosed in Ataturk University Research Hospital. The patients were 18 to 45 years old (mean 28.4 years). Of these patients 185 were chronic smokers, 124 were from a lower socioeconomic level, and 137 were living in a cold climate. Cryoglobulin was positive in 48 patients.

Background: It has been reported that estrogen deficiency after menopause might cause a decrement in nitric oxide (NO) bioavailability by increasing the level of asymmetric dimethylarginine (ADMA), a major endogenous nitric oxide synthase inhibitor, thus leading to abnormalities in endothelial function. Because NO plays an important role on feeding behavior, ADMA may be involved in the pathogenesis of obesity, too. This cross‐sectional study aimed to evaluate the relations of ADMA and NO with the obesity‐linked peptides, such as ghrelin, leptin, and adiponectin in postmenopausal women free of hormone replacement therapy. Methods: Adiponectin, ghrelin, leptin, ADMA, and NO(x) (total nitrite/nitrate) were measured in 22 obese (BMI: 30–47 kg/m(2)) and 19 normal weight (BMI: 21.5–26 kg/m(2)) postmenopausal women.Anthropometric measurements (height, weight, BMI, waist, and hip circumferences) were recorded. Statistics were made by the Mann–Whitney U‐test. Results: Ghrelin and adiponectin levels were significantly lower (P

Objectif Les tumeurs du corpuscule carotide (TCCs), en particulier les paragangliomes familiaux, sont de rares tumeurs benignes representant moins de 0,5% de toutes les tumeurs. Ils sont les plus frequents des paragangliomes extra surrenaliens. Methodes Dans cette etude, les TCCs etaient suspectes cliniquement chez 31 patients mais diagnostiques en histopathologie chez 28 d'entre eux entre 1977 et 2007 dans notre institution. Tous sauf un ont ete operes. L'âge des 30 patients traites chirurgicalement variait de 17 a 73 ans. Une masse cervicale etait le symptome commun a tous les patients. Deux parmi 28 patients ayant une TCC avaient un antecedent familial de TCC. Resultats 28 des 30 patients operes ont eu confirmation du diagnostic de TCC par l'histopathologie. Les diagnostics chez les deux autres patients etaient un neurofibrome pour l'un et une adenopathie tuberculeuse pour l'autre. Ces deux patients ont ete exclus de l'etude. Les TCCs ont ete reseques sans mise en place de shunt. L'UltraCision a ete utilisee pour la resection tumorale chez cinq patients ; les resultats chirurgicaux de ces patients etaient excellents (dissection facile, hemorragie et duree d'intervention minimes). Vingt patients ont eu une resection totale, 6 ont eu une resection avec greffe veineuse saphene, un a eu une resection partielle et un a eu une ligature de l'artere carotide sans sequelle neurologique. Un cas de paralysie de l'hypoglosse et une recidive benigne ont ete observes. Il n'y a eu aucun deces ni transformation tumorale. Conclusion Les TCCs sont de rares tumeurs ; leur traitement chirurgical depend considerablement des capacites et de l'experience du chirurgien. La discussion diagnostique et therapeutique reside en l'etablissement d'un diagnostic assez rapide pour proposer un traitement chirurgical visant a prevenir les complications et les sequelles neurologiques. La resection chirurgicale est habituellement curatrice pour ces lesions.

Carotid body tumors (CBTs), especially familial paragangliomas, are rare benign neoplasms, accounting for0.5% of all tumors; and they are the most common extra-adrenal paraganglioma.In this study, CBTs were clinically suspected in 31 patients but diagnosed by histopathology in 28 between 1977 and 2007 at our department. All but one was operated upon. The ages of the 30 surgically treated patients ranged 17-73 years. A mass in the neck was the common symptom in all patients. Two of the 28 patients with CBTs had a familial paraganglioma history of CBT.Twenty-eight of these 30 surgically treated patients had confirmed CBT by histopathology; the diagnoses of other two patients were neurofibroma in one and tuberculosis lymphadenitis in one. These two patients were excluded from the study. CBTs were resected without a shunt procedure. UltraCision was used in five patients for tumor resection; the surgical results of these patients were excellent (easy dissection, minimal hemorrhage and time operation). Twenty patients underwent total resection, six had resection and saphenous vein interposition, one had partial resection, and one had carotid artery ligation with no resultant neurological deficit. One case of hypoglossal paralysis and one benign recurrence were detected. No mortality or malignant course was observed.CBTs are infrequent neoplasms; their surgical treatment is highly dependent on the ability and experience of the surgeon. The diagnostic and therapeutic relevance reside in making a timely diagnosis to propose a surgical treatment aimed at preventing complications and neurological damage. Surgical resection is usually definitive therapy for these lesions.

Antecedentes Los tumores del cuerpo carotideo (TCC), especialmente los paragangliomas familiares, son neoplasias benignas poco frecuentes, que representan Metodos En este estudio, se sospecho clinicamente de la existencia de TCC en 31 pacientes, pero se realizo el diagnostico histopatologico en 28 de ellos entre 1977 y 2007 en nuestro departamento. Todos los pacientes fueron intervenidos excepto uno. La edad de los 30 pacientes tratados quirurgicamente oscilo entre los 17 y los 73 anos. El sintoma comun a todos los pacientes fue una masa en el cuello. Dos de los 28 pacientes con TCC tenian antecedentes de paragangliomas familiares. Resultados El TCC se confirmo mediante histopatologia en 28 de estos 30 pacientes tratados quirurgicamente; el diagnostico de los otros 2 fue neurofibroma en uno y linfadenitis tuberculosa en el otro. Estos 2 pacientes fueron excluidos del estudio. Los TCC se resecaron sin colocar ninguna derivacion temporal. Se utilizo un bisturi UltraCision en 5 pacientes para la reseccion tumoral; los resultados quirurgicos fueron excelentes (facil diseccion, minima hemorragia y tiempo de intervencion). Veinte pacientes fueron sometidos a reseccion total, en 6 se realizo la reseccion junto con la interposicion de vena safena, en uno se realizo la reseccion parcial, y en uno la ligadura de la arteria carotida sin deficit neurologico resultante. Se detecto un caso de paralisis hipoglosa y una recurrencia benigna. No se observo mortalidad ni malignizacion. Conclusion Los TCC son neoplasias muy poco frecuentes; su tratamiento quirurgico depende en gran medida de la habilidad y experiencia del cirujano. La importancia diagnostica y terapeutica reside en realizar un diagnostico precoz para proponer un tratamiento quirurgico destinado a prevenir complicaciones y lesiones neurologicas. La reseccion quirurgica suele ser el tratamiento definitivo para estas lesiones.

We designed an experimental study to show the effects of some agents in order to prevent reperfusion injury of the spinal cord.Twenty rabbits were used and were divided into two groups in our study. Infrarenal abdominal aortic occlusion, between renal arteries and iliac bifurcations, was applied to the subjects in group 1 for only 30 min; in the group 2 subjects, on the other hand, intra-aortic diltiazem, N-acetylcysteine, and catalase combinations were applied after infrarenal abdominal aortic occlusion. The spinal cord functions of the subjects were assessed at the 48th hour after the operation according to Tarlov scoring, then cord tissue samples were taken for biochemical and histopathological studies.The group 2 subjects had better neurological functions than group 1 subjects (P0.01). In group 2; superoxide dismutase and glutathione peroxidase levels increased, while malondialdehyde and xanthine oxidase levels decreased as compared with group 1 (P0.05). A histopathological examination showed the group 2 samples to have fewer bleeding points and less neuron loss.We concluded that antioxidant agent combinations (diltiazem, N-acetylcysteine, and catalase) applied after ischemia might thus help protect the spinal cord against ischemia and reperfusion injury.

Purpose: Ischemia reperfusion injury to skeletal muscle, following an acute arterial occlusion is important cause of morbidity and mortality. The aim of the present study was to determine and evaluate the effects of ascorbic acide, alpha-tocopherol and allopurinol on ischemia reperfusion injury in rabbit skeletal muscle. Methods: Forty-eight New Zealand white rabbits, all male, weighing between 2.5 to 3.0 (mean 2.8) kg, were used in the study. They were separated into four groups. Group I was the control group without any drugs. The other groups were treatment groups (groups II, III, and IV). Group II rabbits administrated 50 mg/kg ascorbic acide and 100 mg/kg alpha-tocopherol 3 days prior to ischemia, group III rabbits received 50 mg/kg allopurinol 2 days prior to ischemia, and group IV rabbits were administrated both 50 mg/kg ascorbic acide, 100 mg/kg alpha-tocopherol 3 days prior to ischemia and 50 mg/kg allopurinol 2 days prior to ischemia. Two hours ischemia and 2 hours reperfusion were underwent to the treatment groups. At the end of the reperfusion periods, muscle samples were taken from rectus femoris muscle for determination of superoxide dismutase, catalase and glutathione peroxidase activities as antioxidant enzymes, and malondialdehyde as an indicator of lipid peroxidation and xanthine oxidase levels as source hydroxyl radical. Besides, histopathological changes (edema, inflammation, ring formation and splitting formation) were evaluated in the muscle specimens. Results: In the treatment groups; superoxide dismutase (U/mgprotein), catalase (U/mgprotein), and glutathione peroxidise (U/mgprotein) levels increased, malondialdehyde (nmol/mgprotein) and xanthine oksidase (mU/mgprotein) levels decreased compared to control I (p < 0.05). Increase of superoxide dismutase, catalase, and glutathione peroxidase levels were the highest and decrease of malondialdehyde and xanthine oxidase levels were the highest in group IV compared to groups II and III, but no significant as statistically. Also amount of cellular injury in group II, III, and IV were lower than group I. Conclusions: Antioxidant medication may help lowering ischemia reperfusion injury. In our study, all drug medications are shown to be able to have an effective role for preventing ischemia reperfusion injury. Moreover, ascorbic acide + alphatocopherol + allopurinol group (group IV) may have a benefi cial effect to decrease the local and systemic damage due to ischemia-reperfusion injury.

The objective of this study was to trigger the formation of rat abdominal aortic aneurysm by applying calcium chloride periarterially and then to detect the degree of prevention of aneurysm occurrence by oral introduction of indomethacin in some of the rats. Thirty-one rats were divided into three groups. The infrarenal aorta above the iliac bifurcation of rats was treated with sodium chloride in group 1 (control, n = 7), calcium chloride in group 2 (n = 12), and calcium chloride-indomethacin in group 3 (n = 12) periarterially. The rats of each group were randomly selected at the end of the first, second, and third weeks postoperatively; and vessel diameters of abdominal aortas were measured by digital photography using a micrometer. Aneurysmal development was not observed in any of the rats in the control group. None of the comparisons was statistically significant (p > 0.05). Aneurysmal development was observed in all of the rats in the calcium chloride group. Results from the first, second, and third weeks postoperatively were statistically significant (p < 0.05). A middle aneurysmal development was observed in all rats in the calcium chloride-indomethacin group. Only results from the second and third weeks postoperatively were statistically significant (p < 0.05). Measurements in groups 2 and 3 were statistically significant when compared to group 1 (p < 0.001). However, the mean increase in the indomethacin-treated group (group 3) was only 26.1%. The macroscopic appearance of the control group and an aneurysm induced by calcium-chloride application are shown.

Objectives: The assessment of renal function is particularly important in patients with spinal cord injury (SCI). Creatinine (Cr) is known to be unsuitable as a marker of renal function in SCI because of muscle wasting. Although cystatin C (cys-C) is more reliable than Cr, its expression may be affected by oxidative stress accompanying SCI. The aim of the study was to estimate the cys-C levels in SCI patients with normal functioning kidneys. The prooxidant/antioxidant state in plasma of the patients and controls was measured, and any correlations between these parameters and cys-C were determined. Design and methods: Blood samples from 41 chronic SCI patients and 13 controls were obtained. Serum Cr was assayed by the Cobas Integra 400 autoanalyzer and cys-C by particle-enhanced immunoturbidimetry. Heparinized plasma was used for biochemical determinations of vitamin E, total antioxidant status (TAS) and malondialdehyde (MDA). Results: Cr, TAS and MDA levels were significantly lower in SCI patients compared to the controls ( P = 0.007, P = 0.019, P = 0.000, respectively), whereas no difference was seen in cys-C and vit E concentrations. Body mass indices (BMI) of SCI patients were less than those of the controls ( P = 0.03). No correlation existed between cys-C and MDA in SCI patients and controls. Cys-C levels were independent from the body mass indices of subjects. Conclusion: In our study, although BMI and MDA were both affected in SCI patients, cys-C levels were unchanged. Therefore, the measurement of cys-C appeared to be of value for the follow-up of renal function in SCI. The low MDA levels observed in these patients suggest that various adaptation mechanisms may be relevant for subjects undergoing prolonged stress situations.

Objective: To assess the effectiveness of subxiphoid pericardiostomy in the treatment and diagnosis of pericardial effusions. Methods: 368 patients who underwent subxiphoid pericardiostomy and tube drainage for cardiac tamponade, moderate to severe pericardial effusion, or suspicious bacterial aetiology were retrospectively analysed. Biopsies of the pericardium and fluid samples for diagnostic tests were obtained from each patient. Results: The mean age of the patients was 38.4 years, and the male to female ratio was 220:148. The pericardial effusion was classified by echocardiography as severe in 53% of the patients, moderate in 43%, and mild in 4%. The incidence of cardiac tamponade was 25%. Myocardial injury requiring sternotomy occurred as an operative complication in 0.8% of the patients and recurrent effusion necessitating further surgical intervention developed in 10% of patients. Histopathological examination and the polymerase chain reaction of specimens of pericardium and fluid were helpful for establishing a diagnosis in 90% of patients with malignancy and 92% of patients with tuberculous pericarditis. The overall 30 day mortality rate was 0.8%. Patients were followed up for at least one year. Pericardial constriction requiring pericardiectomy developed in 3% of the patients. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with subxiphoid pericardiostomy in both adults and children.

Serum cystatin-C (cys-C), creatinine (Cr), C-reactive protein (CRP) and amyloid A have been shown to provide useful information for renal function following transplantation. In this study, we wanted to evaluate the impact of these parameters as markers of the glomerular filtration rate (GFR) on the third and seventh days of the post-transplantation period. Cys-C was determined by the particle-enhanced immunoturbidimetric assay, and serum amyloid A (SAA) by the sandwich-enzyme immunoassay kit. Cr and CRP concentrations were measured by the Cobas Integra 400 autoanalyser. The patients (n=35) were followed with daily repetitive measurements of serum Cr and urine output per hour, and with Doppler ultrasonography against the risk of rejection. Statistical evaluations were made using the ANOVA and Pearson’s test. Serum cys-C and Cr levels on both the 3rd and 7th days after transplantation were lower than those of pretransplantation values (P

Background: Isoprostanes are prostaglandin-like end products of arachidonic acid peroxidation that are produced by a free radical-catalyzed mechanism. Considering its free radical-dependent formation and potent contractor effect, it is postulated that isoprostane 8-iso PGF2α may play an important role in oxidative stress-related smooth muscle dysfunction. These substances may also influence bladder activity directly by effects on the smooth muscle. The present study was designed to measure traditional biochemical parameters (MDA, TAS, vitamin E) in plasma and 8-iso PGF2α concentrations in urine of patients with spinal cord injury and to evaluate the relation of urinary isoprostane concentrations to the bladder function. Methods: All spinal cord patients underwent urodynamic evaluations. The biochemical tests were performed in both hyperreflexic bladder group (n=23) and areflexic bladder group (n=10), and the findings were compared to those of the patients with normally functioning bladder (controls, n=19). Results: Urine 8-iso PGF2α concentrations were significantly increased in hyperreflexic group (median value 0.89 pg/mg creatinine) compared to both control (0.52 pg/mg creatinine) and areflexic groups (p

We aimed to assess the effectiveness of subxiphoid pericardiostomy for treating patients with pericardial effusions (PE), and its contribution to defining the aetiology of these effusions. We undertook retrospective analysis of 240 PE patients who underwent subxiphoid pericardiostomy and tube drainage between 1990 and 2000. Echocardiography classified PE as severe in 132 patients, moderate in 99, and mild in nine. The main causes of PE were uraemic, idiopathic and undefined, tuberculous and non-tuberculous pericarditis, malignancy and trauma. Peri-operative myocardial injury requiring sternotomy, and recurrent effusion requiring further surgical intervention, occurred in three and 24 patients, respectively. Histopathological examination assisted the diagnosis in 94% of patients with malignancy, and 96% with tuberculous pericarditis. Overall 30-day mortality was 1.3% and pericardial constriction, requiring pericardiectomy, developed in seven cases. In conclusion, we believe that adults and children with PE can be safely, effectively and quickly managed with subxiphoid pericardiostomy, irrespective of its aetiology.

Objectives The purpose of this study was to investigate the diagnostic value of some osteoblastic/osteoclastic biochemical markers and serum prolidase I activity in breast cancer (BC). Design and methods Serum bone gla protein (BGP), prolidase I activity, urinary deoxypyridinoline (Dpy) and calcium excretions were measured, in metastatic and nonmetastatic BC patients, and in 52 healthy women. Results In patients with metastases, bone turnover markers were found to be significantly higher than those in the control group and in patients without metastases. Serum prolidase activity in patients with and without metastases was also significantly higher than those in the control group, but there was no difference between the two patient groups. Conclusions Bone turnover has been suggested to be accelerated in BC patients with the more pronounced osteolytic activation, especially in metastatic state. Serum prolidase in premenopausal period appears to be valuable in discriminating cancer patients from controls. BGP and to a lesser degree of Dpy, may be useful markers for predicting the metastatic bone involvement, as well as for the more cost effective management of BC patients and monitoring the effects of antiresorptive therapy of malignant osteolysis before any metastasis could be detected by other invasive techniques.

Carotid body tumors arise from the embryonic neural crest. These tumors are mostly benign, and they rarely show character. Bifurcation of the carotid body cells originates from a common carotid paraganglion; a tumoral mass lateral to the carotid bifurcation is usually found in the neck. A pathologic feature of these tumors is that they have a tendency to wrap because they are not treated with the external and internal carotid arteries. In our clinic, we operated on a patient who had been diagnosed with carotid body tumor. After removal of the internal carotid artery, the mass flow due to a decrease in the light of literature used to evaluate the importance of flowmetry carotid surgery.

Objective : using a rabbit vascular graft model we investigated the use of fibrin glue (FG), gelatin-resorcinol-formaldehyde (GRF), and collagen (C) as a means of reducing suture hole bleeding. Materials and methods : twenty-eight rabbits were divided into four groups: fibrin glue, gelatin-resorcinol-formaldehyde, collagen and control. A 1 cm incision was made in the abdominal aortic wall of each animal. Incisions were covered with a polytetrafluoroethylene patch sutured with a 7-0 polypropylene. Fibrin Glue, GRF, and C were applied to cover suture holes in the groups 1, 2 and 3, respectively, but nothing in controls (group 4). The fibrin clot was allowed to achieve strength for 3 minutes before the clamps were reopened. After reopening the clamps, blood was collected from the surgical site using a syringe for a total of 2 min. Results : mean blood loss was significantly lower in the FG, GRF, and C compared with control group (p=0.0022, p=0.0022, and p=0.0017, respectively). The volume of blood lost and the time of haemostasis in the group 1 (FG) was less than those in groups 2 and 3 (GRF and C, respectively) (p=0.001). The haemostasis (defined 2 min later) was achieved only in group 1 (FG) (p=0.00067). Conclusions : FG, GRF and C all reduce blood loss. Fibrin glue containing factor XIII was the most effective.

Aim: In this study, surgical closure of ostium secundum type atrial septal defects was to evaluate early and long-term results. Material and Method: Department of Cardiovascular Surgery between January 1997-March 2010 due to ostium secundum type atrial septal defects and surgical treatment applied data from 173 patients were evaluated. Mean age 25.16 ± 18.10 (3 -76 years), respectively. Primary defects, was repaired surgically with pericardial patch or synthetic patch. 173 patients, on average, 10 days after the operation in the short term and the long-term average of 161 patients received 44 months after the clinical, radiological, echocardiography and ECG findings were evaluated. Results: 75.72% of the cases to in the fossa ovalis, 10.9% and 5.8% when the superior caval ‘When the inferior caval defect was detected. The average diameter of 121 patients the defect was closed with pericardial patch 20.43 mm, 17.25 mm in 4 cases closed with synthetic patch and closed in 48 patients with primary repair method was found to be 17.60 mm. Preopertif of teleradyogram cardiothoracic ratio 54% on average in the early period were 56% and 53% in the long term. Preoperative ejection fraction 67.50%, 68.73%, respectively, early and long-term, 69.86%, respectively. Mean preoperative pulmonary artery pressure 43.94 mmHg, 37.06 mmHg and 28.06 mmHg, respectively, early and was found to be in the long term. Right atrial diameter echocardigraphy preoperative, early and long-term, respectively, 44.24 mm, 41.58 mm and 37.89 mm, respectively. None of the patients in hospital mortality was observed. Discussion: Early surgical closure of ostium secundum ASD and believe that the long-term efficient and reliable method.

Carotid body tumors were diagnosed in 19 patients (13 females and 6 males) between 1977 and 2000. All but one were operated upon. The ages of the 18 surgically treated patients ranged from 17 to 65 years. Carotid body tumor was confirmed in 16 cases; the diagnosis was neurofibroma in 1 and tuberculosis lymphadenitis in 1. The carotid body tumors were resected without a shunt procedure. Eight patients underwent total resection, 6 had resection and saphenous vein interposition, 1 had partial resection, and 1 had carotid artery ligation with no resultant neurological deficit. One case of hypoglossal paralysis and one benign ipsilateral recurrence were detected. Contralateral recurrence was detected in 1 patient 4 years postoperatively. No mortality or malignant course was observed.

We studied the effect of aminoguanidine (AG), an inhibitor of advanced glycation product formation, on diabetes-induced oxidative damage. Renal cortex Na(+),K(+)- ATPase was chosen for study as a potential cellular target of oxygen radicals. In this study, the enzyme activity was reduced while malondialdehyde (MDA) and carbonyl levels were enhanced but sulphydryl (SH) level remained unchanged in the renal cortex in diabetic animals. Treatment of diabetic rats with AG had no significant effect on diabetes-induced impairments of enzyme activity and MDA but the carbonyl level readjusted to control level in the kidney. These results show that AG treatment at that dose did not exhibit profound antioxidant properties even if carbonyl stress was ameliorated by this treatment.

Background: Mediastinal infection is one of the most serious complications that occurs following open-heart surgery by sternotomy. In the present study, omentoplasty was initially and aggressively used to treat the infection and prevent the recurrence caused by bones in cases of mediastinitis following open-heart surgery at our clinic.Methods: Among the 3656 patients who underwent surgery at our department of cardiovascular surgery between January 1996 and December 2012, omentoplasty as a treatment for mediastinitis was applied to 19 (0.51%) patients (of which 13 were males) following sternotomy. The cases were revised on the 15th day following the first surgery and/or when there was a suspicion of mediastinal infection. The necrotic skin, subcutaneous tissue, and bone tissue were resected, and all the affected sternal tissues were removed until healthy hemorrhagic areas were reached. Results: The average age of the patients was between 49 and 81 years (mean: 65.7 ± 10.5 years). The mean age of the men was 66.08 ± 12.7 years (age range: 49-81 years) and that of the women was 63.2 ± 6.8 years (age range: 55-71 years). The male to female ratio was 2:1, and in both the male and female groups, the approximate age ranged from 55 and 70 years. In the intraoperative cultures received from wound cases, the most common agent of infection was methicillin-resistant coagulase-negative staphylococci. Purulent leaks from eight patients stopped in approximately 4 days. Purulent leaks from the other 11 patients continued until the 6th day, and thus, medical dressing also continued, after which the leaks stopped on the 15th day. The approximate postoperative hospital stay was 32 days (range: 13-63 days). Conclusion: Omentoplasty in heart surgery can be considered an effective method when used to control infection and treat secondary poststernotomy mediastinitis.

Severe steroidogenic and spermatogenic alterations are reported in association with diabetic manifestations in humans and experimental animals. This study was planned to determine whether oxidative stress is involved in diabetes-induced alterations in the testes. Diabetes was induced in male rats by injection of 50 mg/kg of streptozotocin (STZ). Ten weeks after injection of STZ, levels of selenium and activities of selenium dependent-glutathione peroxidase (GPx) and phospholipid hydroperoxide glutathione peroxidase (PHGPx) were measured in rat testis. Lipid and protein oxidations were evaluated as measurements of testis malondialdehyde (MDA) and protein carbonyl levels, respectively. Testis sulfydryl (SH) levels were also determined. The control levels of GPx and PHGPx activities were found to be 46.5 +/- 6.2 and 108.8 +/- 19.8 nmol GSH/mg protein/min, respectively. Diabetes caused an increase in testis GPx (65.0 +/- 21.1) and PHGPx (155.9 +/- 43.1) activities but did not affect the levels of selenium or SH. However, the testis MDA and protein carbonyl levels as markers of lipid and protein oxidation, respectively, did not increase in the diabetic group. Aminoguanidine (AG) treatment of diabetic rats returned the testis PHGPx activity (136.5 +/- 24.9) to the control level but did not change the value of GPx activity (69.2 +/- 17.4) compared with diabetic group. MDA and protein carbonyl levels in testis were not affected by AG treatment of diabetic rats, but interestingly AG caused SH levels to increase. The results indicate that reactive oxygen radicals were not involved in possible testicular complications of diabetes because diabetes-induced activations of GPx and PHGPx provided protection against oxidative stress, which was reported to be related to some diabetic complications.

To understand the increased susceptibility of the development of serious complications to hypoosmotic hyponatremia in young females, we examined the resistance of blood brain barrier (BBB) permeability to water along with the synaptosomal Na(+),K(+)ATPase activity in both sexes of rats during acute water intoxication. Four groups of rats were used: Group I and II were normal female and male rats injected with only Evans-blue. Group III and IV were water intoxicated female and male rats respectively. BBB permeability in female rats was found to be increased following acute water intoxication. In contrast, synaptosomal Na(+),K(+)ATPase activities in both water intoxicated male and female rats were found significantly lower than those in control rats. But inhibition in enzyme activity in synaptosomes from water intoxicated female rats was more pronounced than those of corresponding male rats. Our results concluded that female sex steroids may be responsible for the highly significant decrease in synaptosomal Na(+),K(+)ATPase activity and increased BBB permeability in female rats following water intoxication.

Atypical cardiac myxomas are rare occurrences and may present with a variety of clinical manifestations depending on the location and morphology. A 46-year-old woman had a 4 x 3 x 2-cm myxoma originating from the superior wall of the left atrium, found by echocardiography and multislice tomography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a narrow-base stalk originating from the right wall of the left atrium in between the right upper and lower pulmonary vein. The patient recovered without complication and was discharged 6 days after the operation. At 1-year follow-up, echocardiography revealed normal cardiac function without reccurence in terms of mass. Although up to 80% of myxomas are localized in the left atrium, of which 75% involve in the interatrial septum, it should not be forgotten that myxomas can appear in an atypical localization, as occurred in our case.

Objectives Brachial plexus injury is a rare complication after median sternotomy. We investigated that injury to the brachial plexus was retrospectively assessed in the results of three patients who underwent median sternotomy for open heart surgery. Materials and methods All patients were placed in the hands-up position after right internal jugular vein cannulation, and the internal mammary artery was prepared for all of those. Nerve conduction measurements and electromyography were performed besides neurological examination. Results Brachial plexus injury was detected in three cases (0.5%) of 575 patients who underwent coronary artery bypass grafting with median sternotomy. The main symptoms were continuous pain, and motor and sensory disturbances at the affected upper extremity (left arm in all cases). The common feature was that in all cases the left internal mammary artery was harvested. While the symptoms were relieved in two patients about six months after the operation, the other one had intractable pain and paresthesia. Conclusion The most important measure is careful sternal retraction and use of the hands-up position for the low incidence and benign course of brachial plexus problems. Inappropriate sternal retraction during preparation of internal mammary artery should be avoided.

A divided left atrium because of cor triatriatum is a relatively rare cardiac anomaly requiring corrective surgery. Although association of cor triatriatum with different congenital heart diseases had been reported, to our knowledge, its association with severe valvular pulmonary stenosis and patent ductus arteriozus had not been reported previously. In this paper, an asymptomatic case with cor triatriatum, severe valvular pulmonary stenosis and patent ductus arteriosus is defined.

Primary cardiac osteosarcomas are uncommon tumors. Their growth pattern is aggressive and the prognosis is poor. A 34-year-old, 7-month pregnant woman with a primary cardiac osteosarcoma associated with the anterior mitral leaflet and connected to the interatrial septum, causing nearly subtotal obstruction of the mitral valve, presented with a clinical picture of heart failure. Transthoracic echocardiography demonstrated an abnormal mass located in the mitral anterior leaflet, prolapsing into the left ventricle. Radical resection of the mass and replacement of the mitral valve were performed under cardiopulmonary bypass. Histopathology showed a low-grade osteosarcoma. The postoperative course was uneventful, and the patient was discharged on the 16th day after surgery. She gave birth after 2 months to a healthy baby after the successful operation. She and her baby did not have any problem during 3 months of follow-up.

The aim of this study was to investigate the brain cortex Na(+)-K+ ATPase activity in rats made diabetic by streptozotocin and epileptic by pentylenetetrazol. Streptozotocin diabetic rats showed a significant decrease in brain cortex Na(+)-K+ ATPase activity whereas the pentylenetetrazol treatment caused no significant change in enzyme activity. On the other hand, no brain cortex Na(+)-K+ ATPase activity could be detected in all the diabetic rats treated with pentylenetetrazol. Our results concluded that reduced Na(+)-K+ ATPase activity in streptozotocin diabetic rats may contribute to the pathogenesis of metabolic complications of the central nervous system, and that the undetectable enzyme activity in diabetic convulsing rats may result from considerable damage or necrosis of brain tissue during pentylenetetrazol seizures.

The effects of curcumin on mast cell chymase activity in fatty liver and serum fetuin-A levels in rats fed a high-fat diet (HFD) were investigated. Male Sprague-Dawley rats received HFD (60% of total calories from fat) and 1 g curcumin/kg HFD for 16 weeks. Hepatic chymase activity was determined using spectrophotometric analysis while liver lipid levels were measured using colorimetric methods and serum fetuin-A, insulin, leptin, and adiponectin levels were detected using commercial enzyme-linked immunosorbent assay kits. Hepatic fat accumulation and fibrotic changes were ameliorated with curcumin treatment. Curcumin significantly reduced hepatic lipids, chymase activity, and serum fetuin-A levels. Decreased serum leptin and augmented adiponectin levels were also observed. These findings suggest that curcumin attenuated hepatic fat accumulation and regulated adipokine levels. The reduction of liver chymase activity and serum fetuin-A levels may also contribute to the beneficial effects of curcumin in fatty liver disease induced inflammatory status. Practical applications Curcumin (diferuloylmethane), which is extracted from the dried root of the rhizome Curcuma longa, is a popular dietary spice (turmeric) in Asia and used in curry. Turmeric is widely used as food component, flavoring agent, and colorant. This research revealed that dietary curcumin treatment reduces hepatic fat accumulation, ameliorates liver damage, and inflammation related to fat storage. Therefore, curcumin may be a potential protective agent in the prevention of fatty liver disease and the anti-inflammatory capacity of curcumin may reveal a beneficial application in medicine and also food technology.

Cardiac hydatid cysts are extremely rare and, although patients may remain asymptomatic for many years or have only minor nonspecific symptoms, they are associated with life-threatening complications. We report the case of a 32-year-old woman with an acute arterial embolism caused by a ruptured hydatid cyst in the heart. An emergency operation revealed that the embolism originated from the left cardiac chamber caused by a cyst in the left ventricle. There were also three cystic lesions in the right lung. The patient underwent surgery to remove the hydatid cysts from the right lung on the 13th day after the first operation. Her postoperative course was uneventful and she was discharged from hospital on the 27th day after admission.

We report a case of coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and a saphenous vein graft in a 36-year-old man with Buerger's disease. He was hospitalized in the coronary intensive care unit with a diagnosis of acute myocardial infarction. His coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery (LAD) and right coronary artery. Left ventricular dysfunction was detected by ventriculography. The patient had undergone bilateral sympathectomy of the lumbar branches for distal arterial occlusions due to thromboangiitis obliterans 12 years previously. Under cardiopulmonary bypass and aortic cross-clamping, we performed endarterectomy and a complex bypass procedure to LAD. Aorta-right coronary artery bypass was also applied. A histopathological study of an endarterectomy specimen showed characteristic features of thromboangiitis obliterans. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day.

Background: Na+,K+-ATPase is known to be responsible for the ionic homeostasis in excitable tissues. The energy cost of Na+,K+-ATPase activity is increased in the active brain, so it would be important to ascertain whether defects in brain metabolism in aging are associated with changes in the properties of Na+,K+-ATPase. Objective: The aim of this study was to investigate the influence of age on the Na+,K+-ATPase activity in developing rat brains from the age of 1 day to 24–28 months. Methods: Crude microsomal preparations were obtained from the brains of newborn (n = 8), 18-day-old (n = 8), 4- to 5-month-old (n = 12), and 24- to 28-month-old (n = 14) rats. Then the ATPase activity was measured and expressed as micromoles of inorganic phosphorus released per milligram of protein per hour. Results: The increased tendency in brain Na+,K+-ATPase activity from newborn to 18 days of age suggested that the Na pump is mature soon after birth. No significant differences could be detected in the enzyme activity between newborn and adult rats. In contrast, the Na+,K+-ATPase activity in aged rat brains was found to be significantly lower than in the other age groups of rats tested (p < 0.001). Conclusion: Our results suggest that aging-induced inhibitions in the brain Na+,K+-ATPase activity may be implicated in the depression of neuronal excitability and in the age-related impairments of cognitive functions.

The authors researched the association between plasma atrial natriuretic peptide (ANP) levels and atrial pressure changes and cardiac nerves in 14 dogs. The dogs were divided into two groups, each group containing 7 dogs. In the second group, cardiac denervation was performed. Left atrial pressure was in creased by creating partial mitral obstruction in both groups. In the second stage, after atrial pressures were decreased to previous values, the dogs were bled. Eventually, atrial pressures were decreased below the normal value. Plasma ANP levels and right and left atrial pressures were determined in all stages. It was concluded that ANP was released from the atria by a direct effect of stretching of the atrial wall and that there was no specific effect of cardiac nerves on ANP release.