Objectıve. The purpose of this study is to evaluate the effect of ethyl pyruvate (EP) on systemic inflammatory response and lung injury in an experimental rat model of ruptured abdominal aortic anurysm (RAAA). Methods. Anaesthetized 30 Sprague-Dawley male rats were randomized to sham (Sh n : 6) (Sh + EP n : 6) or shock and clamp (S/C) groups (S/C n : 9) (S/C + EP n : 9). In the S/C and S/C + EP groups, hemorrhagic shock, lower torso ischemia, and reperfusion were created, S/C group was given 1 mL saline and S/C + EP group was given 40 mg/kg EP. At the end of reperfusion process some biochemical and histological parameters were studied in serum and lung tissues. Results. An increase was observed in all parameters except interleukin-6 (IL-6) in the S/C group in comparison to the sham groups. In the S/C + EP group, serum myeloperoxydase (MPO), malondialdehyde (MDA), and tumor necrosis factor alpha (TNF-α) as well as lung MPO and MDA values decreased significantly (P < 0.016). In the lung tissues, histological injury scores and lung tissue wet/dry ratio were significantly decreased in the S/C + EP group as compared to the S/C group (P < 0.016). Conclusions. Ethyl pyruvate may reduce systemic inflammatory response and lung injury which resulted from shock and ischemia/reperfusion in an experimental model of RAAA.
Objective: To examine the biochemical and histopathological effects of ischemia/reperfusion (I/R) injury in a ruptured abdominal aortic aneurysm (RAAA) model in rats, and to investigate the potential protective role of resveratrol. Methods: Thirty-two male Sprague-Dawley rats were randomly assigned into four groups—control, I/R, sham (I/R + solvent/dimethyl sulfoxide), and I/R + resveratrol. The control group underwent midline laparotomy only. In the other groups, infrarenal vascular clamps were attached following 60-min shock to the abdominal aorta. Ischemia was applied for 60 min followed by reperfusion for 120 min. In the I/R + resveratrol group, intraperitoneal 10 mg/kg resveratrol was administered 15 min prior to ischemia and immediately before reperfusion. The I/R + dimethyl sulfoxide group received dimethyl sulfoxide, and the I/R group was given saline solution. All animals were sacrificed by exsanguination from the carotid artery at the end of the experiment. In addition to histopathological examination of the rat kidney tissues, malondialdehyde, glutathione, catalase, and nitric oxide levels were also investigated. Results: A decrease in glutathione, catalase and nitric oxide levels, together with increases in malondialdehyde levels, numbers of apoptotic renal tubular cells, caspase-3 levels, and tubular necrosis scores, were observed in the IR and I/R + dimethyl sulfoxide groups. In contrast, resveratrol increased glutathione, catalase and nitric oxide levels in renal tissues exposed to I/R, while reducing malondialdehyde levels, apoptotic renal tubular cell numbers, caspase-3 levels, and tubular necrosis scores. Conclusion: Our findings suggest that resveratrol can be effective against I/R-related acute kidney damage developing during RAAA surgery by reducing oxidative stress and apoptosis.
Chylothorax is rare as a sequela to cardiac surgery. Its prevalence in cardiothoracic procedures is 0.3% to 1.5%; after median sternotomy, it is still more unusual.1,2 It is more frequent in pediatric than in adult cardiothoracic surgery. 3-5Postoperative chylothorax is associated with high rates of morbidity and mortality. 6 It can cause metabolic disturbances, nutritional deficiencies, respiratory disorders, immunodeficiency and infections, prolonged hospitalization, and high treatment costs. 7,8 Chylothorax after coronary artery bypass grafting (CABG) is rare, but it occurs most often if the left internal mammary artery (LIMA) has been used as a graft. We describe 2 cases of chylothorax that developed in adults after CABG, both of which were treated successfully with medical therapy alone. Case Reports Patient 1A 60-year-old man was admitted to our institution after a sudden onset of chest pain that radiated to his left arm. Coronary angiographic results led our heart team to perform CABG.After a median sternotomy, the LIMA was harvested as a peduncle, the pleura was incised, and the saphenous vein was harvested. First, the reversed saphenous vein graft was anastomosed to the 2nd diagonal branch (D2). Then the LIMA was anastomosed to the left anterior descending coronary artery (LAD). After the proximal anastomosis, the patient was weaned from cardiopulmonary bypass.The operative and first postoperative days were eventless. On the 2nd postoperative day, pale pink discoloration of the pleural drainage fluid was noticed. Chylothorax was diagnosed when biochemical analysis of the pleural fluid revealed total cholesterol, 43 mg/dL; triglycerides, 398 mg/dL; glucose, 67 mg/dL; and total protein, 2.7 g/dL. Pleural drainage was 100 to 250 mL/d.From the outset, the patient was given nothing by mouth but received, via total parenteral nutrition (TPN), a low-fat diet rich in medium-chain fatty acids (MCFA) (total calorie intake, 1,800 kcal/d. In addition, intravenous somatostatin was started (infusion rate of 3.5 µg/kg/hr for the first 48 hr, increased to 5 µg/kg/hr for the next 48 hr, and then to 7 µg/kg/hr for the 3rd 48 hr). No side effects-such as hypersensitivity, hypotension, or hypoglycemia-were noted.On the 7th postoperative day, the patient's oral intake of a low-fat diet was started. The pleural drainage fluid decreased during the course of this conservative therapy. The chest tube was removed on postoperative day 13, after the drainage of fluid had ceased. Follow-up chest radiography yielded normal results. The patient was dis-
True extracranial carotid artery aneurysms (ECCAs) are uncommon. Atherosclerosis is the most common etiological factor. Neck pain, a pulsatile mass and murmur at auscultation are the most common symptoms. ECCAs may exhibit severe clinical manifestations due to complications. Cases of rupture can be fatal. There is a risk of distal embolization and stroke in thrombosed cases. We discuss two cases of enlarged ECCA treated surgically in the light of the most recent literature.
Ischemic wounds unresponsive to standard treatment in thromboangiitis obliterans are associated with amputation, morbidity, and mortality. In this study, hyperbaric oxygen therapy was added to standard treatment of 36 patients with thromboangiitis obliterans with ischemic ulcerated wounds in the extremities. Full recovery was observed in 52.7% of cases (25% at discharge, 27.7% during follow-up). Resting pain after treatment decreased significantly compared to pretreatment levels based on visual analog scale scores (7.1 ± 1.7 vs 2.2 ± 3.0, P = .0001). Mean wound area also decreased significantly after treatment (22.6 ± 17.5 vs 13.02 ± 16.5, P = .0001). The number of patients requiring no assistance during routine daily activities increased significantly (25% vs 55.5%, P = .001). All patients were at Fontaine stage IV before hyperbaric oxygen therapy. The number of patients at stage IIB increased significantly after treatment, while that of patients at stage IV decreased significantly (0% vs 47.2%, P = .0001, and 100% vs 47.2%, P = .0001, respectively). None of our patients was able to walk without pain before treatment; however, walking distance was significantly extended in 16 patients who were capable of walking (0 vs 190.6 ± 129.4 meters, P = .0001). In addition, 11.1% of patients underwent major amputation during follow-up.
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