Objective: Extracorporeal circulation and its systems have been known to increase the inflammatory response and cause protein absorption in coronary bypass surgery. In this study, we aimed to compare the affinities of phosphorylcholinecoated and uncoated oxygenators on the cellular inflammatory response and protein absorption. Methods: Twenty patients undergoing elective coronary bypass were randomly allocated into two groups: Phosphorylcholine-coated oxygenators were used in 10 patients (Group 1) and uncoated oxygenators were used in the other 10 patients (Group 2) during surgery. Samples were obtained from blood and oxygenators at the induction of anesthesia, the beginning and end of cardiopulmonary bypass (CPB) and postoperative 1st day. Parameters related with white blood cells were studied with flow cytometry and electron microscopy in these samples. Results: White blood cell and neutrophil counts were increased while platelet counts were significantly decreased in both groups postoperatively. CD3+ T cell levels were significantly decreased at the end of CPB and on postoperative day 1. CD3+ CD25+ T cell levels were found to be significantly lower in Group 2 on the 1 st postoperative day. Electron microscopic evaluation demonstrated that phosphorylcholine-coated fibers were less likely to absorb blood components and proteins. Conclusion: Results of the current study have shown that phosphorylcholine-coated oxygenators were more likely to trigger a cellular immune response compared to the uncoated oxygenators.
BackgroundAortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures.MethodsEighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis.ResultsIn all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2±9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up.ConclusionTo conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.
Endovascular aneurysm repair (EVAR) is an adequate means for treating infrarenal abdominal aortic aneurysms (AAA). However, secondary interventions are required in approximately 15% to 20% of patients. The aim of this paper was to report our knowledge with stent grafts in secondary interventions after EVAR in a 73-year-old patient. One of the exceptional complications of EVAR are endoleaks which may lead to expansion of aneurysm and rupture if not repaired.
Traumatic cardiac wall rupture is a life-threatening emergency which develops as the result of a severe thoracic trauma. Making a prompt diagnosis in the emergency room and treating in a shortest time possible is of great importance for reducing mortality. In this study, a case brought to the emergency room after an in-vehicle traffic accident who was diagnosed with a cardiac wall rupture on examination is presented. The 37-year-old patient was admitted to the emergency room with the complaint of chest pain. On physical examination, the patient had tenderness on palpation of the sternum and right hemithotax. His measured vital parameters were a blood pressure of 90/60 mmHg and a heart rate of 120 bpm. Computed tomography of the thorax revealed minimal pneumothorax, extensive lung contusion and pericardial effusion. Echocardiography was suggestive of pericardial effusion and a 0.5 cm defect in the wall of the right ventricle. The defect was repaired by cardiovascular surgery team and the recovered patient was discharged after an 8 day follow up. The life threatening condition of cardiac wall rupture or pericardial tamponade should be kept in mind for every patient admitted to the emergency room with thoracic trauma displaying vital parameters of hypotension and tachycardia.
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