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Untreated ventricular septal defect (VSD) is an important cause of congestive heart failure in early infancy. Growth is impaired in this population, and surgical closure is challenging because of congestion in the lungs, making infants prone to respiratory infection, and because of their poor nutritional status. The aim of this study is to share our experience with percutaneous VSD closure in patients under 1 year of age. Patients with hemodynamically significant left-to-right shunt, less than 1 year of age, and with VSD diameter ≤ 6 mm were retrospectively included in the study between December 2014 and January 2017. The median length of follow-up was 8.5 (4-14.2) months. Twelve patients from 2 to 12 months of age, with a median weight of 6.75 (5.4-8) kg, were included. The mean VSD diameter as measured by angiography from the left ventricle side was 4.7 ± 0.25 mm, and from the right ventricle side was 3.4 ± 1.1 mm. All were of a perimembranous type except three, which were muscular. All defects were closed with the Amplatzer Duct Occluder II (ADO II) or the ADO II-additional size. The mean fluoroscopy duration and total radiation dose were 22.6 ± 18.7 min and 1674 ± 851 cGy/min, respectively. No aortic regurgitation associated with device closure was seen in any of the patients. Complete atrioventricular block occurred in one patient 6 months after the procedure, and was treated with a permanent pacemaker. VSD closure is challenging, regardless of whether a surgical or percutaneous procedure is used. The risks are higher for children younger than 1 year with low body weight. Percutaneous closure, which carries similar risks but is less invasive than surgery, may be the preferred alternative in early infancy.

Introduction: We aimed to investigate the effects of cerium oxide, applied before the sevoflurane anesthesia, on lung tissue in rats with lower extremity ischemia-reperfusion (IR). Materials and Methods: A total of 30 rats were randomly divided into five groups as; control (C), IR, cerium oxide-IR (CO-IR), IR-sevoflurane (IRS), and cerium oxide-IRsevoflurane (CO-IRS). In the CO-IR group, 30 minutes after the injection of cerium oxide (0.5 mg/kg, intraperitoneal (i.p)), an atraumatic microvascular clamp was placed on the infrarenal abdominal aorta for 120 minutes. Then, the clamp was removed and reperfused for 120 minutes. Sevoflurane was applied in 100% oxygen at a rate of 2.3% at 4 L/min during IR. The blood samples were taken for biochemical analysis and the lung tissue samples were taken for histological analysis. Results: Neutrophil infiltration/aggregation was significantly higher in the IR group than in the C and CO-IRS groups. The alveolar wall thickness and total lung injury scores were significantly higher in the IR group than in the C, IRS, CO-IR and CO-IRS groups. Discussion: We determined that the administration of 0.5 mg/kg dose of cerium oxide with sevoflurane reduces the oxidative stress and corrects IR-related damage in lung tissue. Our results show that the administration of cerium oxide before IR and the administration of sevoflurane during IR have a protective effect in rats.

The presence of DM and increased BMI negatively correlated with AVF maturation. High intensity of CD309 expression on monocytes was observed in patients with successful AVF maturation.

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Objectives: To examine the effects of desflurane and cerium oxide (CO) on lung tissue following ischemia-reperfusion injury (IRI). Methods: Experiments were conducted in Gazi University Animal Laboratory, Ankara, Turkey. Thirty rats were divided into 5 groups: control (C), IRI, IRI-CO, IRI-desflurane (IRID), IRI-CO-desflurane (IRICOD). Cerium oxide was given intraperitoneally. Lower extremity IRI was induced. Desflurane was applied during IRI. Lung histopathological examinations and serum biochemical analyses were performed. Results: Serum nitric oxide (NO) and malondialdehyde (MDA) levels were higher in group IRI ( p =0.006) than in group C ( p =0.001). Serum MDA and NO levels were significantly lower in groups IRICO and IRICOD than in group IRI. Significantly greater alveolar wall thickening and neutrophil infiltration were recorded in group IRI than in group C. Co-administration of desflurane and CO significantly decreased alveolar wall thickening and neutrophil infiltration compared to group IRI. Total lung injury scores were significantly lower in groups IRID, IRICO, and IRICOD than in group IRI. Conclusion: Intraperitoneal CO with desflurane, reduced oxidative stress and corrected the damage in lung. Cerium oxide given before and desflurane given during IRI have been shown to have protective effects on lung damage in rats.

Stroke is a significant contributor to morbidity and mortality. The present study investigated how the systemic immune inflammation index (SII) could be used to predict the likelihood of developing carotid artery stenosis (CAS), which can be seen using carotid artery angiography (CAAG). This study comprised 418 individuals who underwent CAAG for CAS. SII was calculated by multiplying the platelet count by the neutrophil/lymphocyte ratio (NLR). The patients were divided into two groups: non-critical and critical CAS (stenosis below %70 and above ≥70%, respectively). Compared with the non-critical CAS, the critical CAS group had greater high sensitivity C-reactive protein levels (4.5 [3.1-5.7] vs 3.9 [2-5] [mg/L], P < .001), NLR (4.1 [2.9-7.5] vs 2.9 [1.8-3.7], P < .001), platelet/lymphocyte ratio (233 [110-297] vs 119 [96-197], P < .001), and SII (860 [608-2455] vs 604 [458-740], P < .001). Receiver Operating Characteristic Curve analysis demonstrated the best cutoff value of 672.3 for SII to predict the critical CAS with 71.2% sensitivity and 60.1% specificity. According to our study, an increase in SII is an independent predictor of the severity of CAS in patients undergoing CAAG.

Objective: Impaired sternal wound healing remains problematic after median sternotomy and can cause to significant morbidity after cardiac surgical procedures. Although some reconstruction systems exist for sternal closure, their use is limited by expense and practicality, and simple wire closure remains the most common technique to close the sternum. In this study, we aim to discuss the results of 6 cases that underwent surgery for sternal dehiscence(SD). Methods:We reviewed six patients with sternal dehiscence who underwent surgery in our department between April 2013 and May 2014. We have used a novel closure technique in six patients with sternal dehiscence and evaluated early-term results of sternal clips plus rewiring following failed sternal closure. Results:The mean age was 63 (range, 55 to 79 years). All patients were male. We have used a novel closure technique with sternal clips plus rewiring in all patients. We evaluated six patients with non-infectious SD. Sternal reconstruction using rigid fixation with clips improve bone healing and reduce early postoperative pain. All cases were discharged with successful treatment. Conclusions:We believe that this method of sternal closure guarantees better clinical outcomes rather than sternal wire closure. Additionally, SCD(sternal closure device) clips proved to be cost effective in cardiac surgery. J Clin Exp Invest 2014; 5 (4): 534-538Key words: Sternal dehiscence, closure technique, cardiac surgery ÖZET Amaç: Median sternotomi sonrası bozulmuş sternal yara iyileşmesi kardiak cerrahi sonrası önemli morbidite sebebi olabilir. Sternum kapatılması için bazı teknikler mevcut olmasına rağmen pratikte sınırlıdır ve sternumu basit tel tekniği ile kapatma uygulanan en yaygın tekniktir. Bu çalışmada sternal ayrılma nedeniyle cerrahi uygulanan 6 olgunun sonuçlarını tartışmayı hedefliyoruz. Sonuç: Sternumun bu yöntem ile kapatılmasının tel ile kapatılmasına göre daha etkin ve daha iyi klinik sonuçlar verdiğine inanıyoruz, ayrıca kalp cerrahisinde sternal kapama klipslerin kullanılması daha düşük maliyetli olduğu görülmüştür.