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Purpose: In this study, the relationship between the plasma levels of melatonin and intercellular adhesion molecule-1 (ICAM-1), which plays role in several intercellular interactions including inflammatory and immune responses, and early neurocognitive functions associated with ischaemia-reperfusion injury during open heart surgery is examined. Methods: Forty patients who were to undergo elective coronary artery bypass grafting (CABG) were divided into two groups, those who underwent their operations at 8 AM (group I; n = 20) and those who underwent their operations at 1 PM (group II; n = 20). Blood samples were collected prior to surgery (S1), when the aortic cross clamp was removed (S2) and 4 (S3) and 24 h after the surgery (S4). Neuropsychiatric assessment was conducted one day before and seven days after surgery. Results: Melatonin levels measured during and after surgery were also significantly higher in Group 1. ICAM-1 levels were significantly lower in Group 1 at S2 and S3. Significant deterioration was observed in postoperative neurocognitive function compared with preoperative functions in Group 2 more than Group 1. Conclusion: We hypothesise that the greater preservation of neurocognitive functions in the morning patients is associated with elevated melatonin levels, which reduce the damage from ischaemia-reperfusion injury.

Bu çalışmada yeni süper elastik çıplak stentlerin vasküler biyoyararlanımının deneysel olarak araştırılması ve stent implante edilen damarların kan akışındaki orta dönem sonuçlarının ultrasonografik olarak izlenmesi amaçlandı. Metot: Çalışma adımlarının belirlenmesinden sonra stentler iki koyun ilyak arterlerine implante edildi. Ameliyat öncesi ve sonrası kan akışı ve lokal bulgular kaydedildi. Denekler anormal vücut değişiklikleri açısından periyodik olarak takip edildi ve stent implante edilen damarlar Doppler Ultrasonografi ile kontrol edildi. Denekler 6. ayda sakrifiye edildi ve iliak arterler histopatolojik olarak incelendi. Bulgular: Takip sırasında stent implante edilmiş damarlarda herhangi bir oklüzyon paterni gözlenmedi. Histopatolojik analiz, stent yüzeyinde yeterli yeniden endotelizasyona rağmen, her iki stent bölgesinin de belirgin neointimal hiperplazi olmadığını ortaya koydu. Makroskopik veya mikroskopik bulgularda oklüzif veya stenotik patern saptanmadı. Sonuç: Sonuçlarımız, yeni süper elastik çıplak stentlerin, orta dönem bulgularına göre yüksek açıklık oranları ile iyi vasküler biyoyararlılığa sahip olduğunu göstermiştir.

Aim: Chronic venous insufficiency (CVI) is a common disorder that occurs when the venous valves are not working sufficiently. The treatment strategies depend on ameliorating the function of the valves. The aim of this study was to evaluate the external application of N-Butyl Cyanoacrylate to improve venous valves' functions. Methods: Thirty patients with CVI who were admitted to the cardiovascular surgery clinic with CVI complaints and underwent extravenous N-Butyl Cyanoacrylate application (extravenous application to the area surrounding the malfunctioning venous valves) between January 2020 and June 2020 were included in this retrospective cohort study. Preoperative and postoperative (third and sixth month) venous Doppler ultrasound findings and complaints were noted, and the results were compared. Results: The diameter of the great saphenous vein was found to have decreased during the postoperative period (9.27 (1.95 mm) vs. 6.27 (2.16), P=0.001). Decremental saphenofemoral reflux durations were detected in postoperative ultrasound evaluations when compared with preoperative data (0.77(0.87) vs. 4.77(0.97) seconds). CVI complaints, including oedema, pigmentation and restless leg syndrome, improved within months after the operation. Conclusion: The external application of N-Butyl Cyanoacrylate gel seems effective for recovering venous valve function in the medium term.

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Background: Our aim of this study was to evaluate the cardiac symptoms, coronary angiographic results, and clinical outcomes of patients with confirmed COVID-19 and ST-segment elevation with myocardial infarction (STEMI) or myocardial ischemia. Material and methods: Thirty-seven patients, who already were confirmed with COVID-19 using reverse transcriptase-polymerase chain reaction (RT-PCR), were admitted to our hospital due to chest pain with STEMI. The median patient age was 66 years (range: 27-84 years). Female/male ratio was 22/15. We performed a second RT-PCR test in all patients. We investigated myocardial enzymes (creatine kinase myocardial band (CK-MB), cardiac troponin-I (c-TnI), and C-reactive protein (CRP), and liver enzymes (alanine amino transferase (ALT) and aspartate amino transferase (AST) also were measured. Blood d-dimer, thromboplastin time (PT), partial thromboplastin time (PTT), and fibrinogen were investigated. Transcutaneous oxygen saturation was monitored for each patient in the emergency department (ED). To evaluate myocardial wall abnormalities, transthoracic echocardiography was performed. Results: Coronary artery disorders requiring revascularization were detected in 25 patients (67.5%). There was no evidence of coronary artery disease in the remaining 12 patients. Out of 25, nine coronary artery disease patients had a history of coronary intervention (24.3%). All patients had high levels of myocardial enzyme release. Percutaneous coronary interventions (PCI) were performed in patients with culprit lesion(s). Success rate of PCI was 87.5% (N = 21). The median number of stent use was 2.9±0.7 (range: 1-4). Because PCI failed in four patients, we suggested elective coronary artery bypass grafting (CABG) surgery after medical treatment. Six patients required re-intervention owing to early stent thrombosis (30%). Seven patients died after PCI (33.3%). For patients with negative or positive RT-PCR test results, we performed thoracic computed tomography (CT), which is a sensitive diagnostic method for COVID-19. Interlobular septal and pleural thickening with patchy bronchiectasis in the bilateral or unilaterally lower and/or middle lobe(s) were the main pathologies in 24 patients. D-dimer, fibrinogen, and CRP levels were high in 11 PCI patients with bilaterally pulmonary involvement by COVID-19 (52.3%), while fibrin degradation products did not significantly change. For three patients with normal coronary arteries with a transient hypokinesia or hypokinesia as result of myocarditis, we decided to perform atypical Takotsubo cardiomyopathy. We medically treated using inodilator (levosimendan), diuretic, angiotensin-converting enzyme inhibitors and beta-blockers. To prevent the risk of thromboembolism, we also administered a heparin drip. The myocardial contractility of the apex did improve, and patients were discharged from the hospital, with the exception of one young female patient. She is following in the ICU with stabil hemodynamics. Conclusion: Chest pain with STEMI can develop in patients with confirmed COVID-19. Nearly one-third of patients had COVID-19 with chest pain and concomitant STEMI and normal coronary angiography (32.4%). Urgent PCI may be performed in hemodynamically unstable patients with high mortality. Complications, including sudden cardiac arrest, severe ventricular arrhythmia, and Takotsubo cardiomyopathy, related to COVID-19 patients with normal coronary arteries.

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