Chronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.

Despite short-term follow-up and small patient series, the intramedullary Kirschner wire technique can be expected to achieve relief of pain and a decrease in major amputations in patients with Buerger's disease in whom medical and surgical therapy had failed. However, comparative studies with longer follow-up should be done to confirm the benefits of this new treatment.

Although technical refinements have improved the safety of cardiac operations, postoperative dysfunction of lung and other organs occurs frequently after cardiopulmonary bypass (CPB). The aim of the present study was to search the aetiopathogenesis of pulmonary complications due to CBP. Ten patients with stable coronary artery disease, undergoing coronary artery bypass grafting (CABG) surgery, were included in the study. Forty bronchoalveolar lavage (BAL) fluid samplings were performed in the 10 patients. Samples were obtained at the following time periods: (1) preoperatively; (2) at the end of the first hour after anaesthetic induction; (3) at the conclusion of 30 min of crossclamp on CPB; and (4) at the conclusion of 20 h after the end of CPB, postoperatively. Cell contents of bronchoalveolar lavage fluid, alveolar macrophage viability, eosinophil cationic protein (ECP) levels and myeloperoxidase (MPO) concentrations were analysed in each bronchoalveolar lavage fluids. While the percentage of preoperative macrophages was 85.90% and the percentage of preoperative neutrophils was 2.40%, they were 77.00% and 11.30% in the postoperative samples, respectively. Mean alveolar macrophage viability was 96.20% preoperatively and 90.40% in the postoperative period. Preoperative eosinophil cationic protein mean concentration was < 2 microg/l and mean response value (RV) was 28.80. Preoperative mean myeloperoxidase concentration was 7.66 ng/ml. Postoperative eosinophil cationic protein mean response value was 63.40 and mean myeloperoxidase concentration was 59.25 ng/ml. There were significant differences between third and final samples with regard to both neutrophil percentages (p = 0.028) and MPO levels (p = 0.005). While the preoperative mean PaO2 value was 89.39 mmHg and mean SaO2 value was 97.12%, they were calculated in the postoperative arterial blood specimens of patients, without inhaling O2, as 65.31 mmHg and 93.84%. These changes between blood gas analyses reflect the impairment of the lungs (p = 0.009 and p = 0.007, respectively). Neither alveolar macrophage viability nor ECP levels changed significantly between consecutive periods. However, when the results of the first and fourth samples were compared, we saw the cumulative effects of CPB, in that alveolar macrophages lost their viability and ECP mean RVs rose. These changes were statistically significant (p = 0.027 and p = 0.013, respectively). However, postoperative ECP levels were not like those found in a patient with asthma. Also, changes between alveolar macrophage percentages (p = 0.028), between neutrophil percentages (p = 0.036) and between MPO concentrations (p = 0.005) were statistically significant. Again, changes in neutrophil percentages between first and final samples correlated with changes in MPO levels between same periods (r = 0.657, p = 0.039).

No abstract

The purpose of this study was to evaluate angiogenesis after the use of intramedullary direct electrical current in rabbit tibia. Thirty-two New Zealand rabbits were divided into four groups: group 1, false electrode group; group 2, hole group; group 3, control group; and group 4, intramedullary electrical stimulation group. One-half of the rabbits in each group were evaluated angiographically, pathologically, and scintigraphically on day 7, and the rest were evaluated on day 21. Results proved that electrical stimulation was not capable of the induction of angiogenesis in the subjects killed on day 7 and day 21. Furthermore, we found some fibrotic changes secondary to electrical stimulation on day 7 ( P = 0.04) and day 21 ( P = 0.01). However, an increase in new capillary vessels occurred in the false electrode group ( P = 0.02). We found no useful effect of electrical stimulation in our study, a finding that is possibly due to our use of a method previously undocumented in the literature. We believe that this study can be the new baseline for further studies into the stimulation or inhibition of angiogenesis using intramedullary wire with or without electrical stimulation.

In this report we describe the surgical treatment of a 27-year-old patient with complete Cantrell's syndrome, i.e. multiple ventricular septal defect, left ventricular diverticulum, dextrorotation of the heart, an anterior diaphragmatic defect, and a midline supraumbilical abdominal wall defect with tetralogy of Fallot. Resection of the diverticulum was combined with correction of the tetralogy of Fallot and thoracoabdominal defects. The postoperative period was uncomplicated. We have have found only one previous report describing resection of the diverticulum combined with correction of Fallot's tetralogy and thoracoabdominal defects in an adult. One-stage repair of these complex anomalies is technically feasible and should be the treatment of choice.

BACKGROUND: This study was aimed to reveal whether there is a relationship between Raynaud Phenomenon (RP) and Helicobacter Pylori (HP). MATERIAL AND METHODS: Seventy-nine patients, who had been referred to outpatient clinic with Raynaud in the last 9 years were retrospectively screened. Of these, 29 patients with access to their data and who had HP screening tests were included in the study. RESULTS: HP direct antigen was found in feces in only one of 29 patients. When we compared the results of this study to the results of previous literature, it was observed that the patients admitted with RP symptoms by a gastroenterology outpatient clinic had a higher incidence for HP (+) scanning than the patients admitted with RP symptoms by a cardiovascular surgery policlinic (CVSOC). CONCLUSION: Although previous literature reports that HP leads to RP in the group of patients referred to other outpatient clinics, the same relation is very low in the Raynaud patient group in CVSOC. Patients admitted with RP in the CVSOC shouldn't be prescribed empirical antibiotic therapy for the eradication of HP. However, as the appropriate antibiotic regimen can resolve Raynaud symptoms in the presence of a HP(+) test, it makes this scanning rational for all symptomatic patients (Tab. 1, Fig. 1, Ref. 23).

AIM: To highlight the components of stripping operation of the great saphenous vein and to offer a proposal for guidelines. METHODS: 7789 admissions with venous insuffi ciency during the period, reaching seven and a half years were evaluated. Seventy-two admissions of nineteen patients were related to the recurrent symptoms due to previous incomplete stripping surgery. Doppler ultrasonography evaluations were made. The remained venous segment from the fi rst operation was excised in the second operation. RESULTS: Mean duration between two operations was 7.44 years. Preoperative clinics were changing between C2s and C5 according to CEAP classifi cation. Only nine patients could be persuaded to undergo the second operation. The remaining six patients rejected the second operation. CONCLUSION: While the patients who were operated on for the second time regained their health, others became the epitome of hopelessness and mistrust. They lost their confi dence in medicine and surgery. If a stripping operation is planned, it should be performed in full accordance with the surgical procedure of stripping as mentioned in the classical textbooks. Guidelines should contain expressions reminding of ethical issues. This will prevent the dereliction of the duty and the loss of money, labor, time, health, patients' confi dence in surgery (Tab. 1, Fig. 1, Ref. 18).