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Understanding micro-seismicity is a critical question for earthquake hazard assessment. Since the devastating earthquakes of Izmit and Duzce in 1999, the seismicity along the submerged section of North Anatolian Fault within the Sea of Marmara (comprising the "Istanbul seismic gap") has been extensively studied in order to infer its mechanical behaviour (creeping vs locked). So far, the seismicity has been interpreted only in terms of being tectonic-driven, although the Main Marmara Fault (MMF) is known to strike across multiple hydrocarbon gas sources. Here, we show that a large number of the aftershocks that followed the M 5.1 earthquake of July, 25th 2011 in the western Sea of Marmara, occurred within a zone of gas overpressuring in the 1.5-5 km depth range, from where pressurized gas is expected to migrate along the MMF, up to the surface sediment layers. Hence, gas-related processes should also be considered for a complete interpretation of the micro-seismicity (~M < 3) within the Istanbul offshore domain.
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Purpose Acute lower extremity ischemia is still a main cause of mortality and morbidity in orthopedic traumatology and reconstructive surgery. In acute lower extremity ischemia, the skeletal muscles are the tissues that are the most vulnerable to ischemia. The aim of this study was to evaluate the effects of iloprost (IL) therapy on skeletal muscle contractile impairment and mitochondrial degeneration in an acute lower extremity ischemia-reperfusion rat model. Main Methods Forty Wistar albino rats were randomly divided into a control group and four experimental groups. Experimental groups were either subjected to 2 h of lower extremity ischemia followed by a 4-h reperfusion period or to 4 h of ischemia followed by an 8-h reperfusion period. Except for the animals in the control group, all animals received IL (1 ng/kg/min) or saline (1 ml/kg) by intraperitoneal infusion for 10 min immediately before reperfusion. At the end of the recording of skeletal muscle electrical activity and contractility, all rats were sacrificed by decapitation and muscle samples of lower extremity were immediately harvested for histopathologic analyses. Results After ischemia-reperfusion, a breakdown in the force-frequency curves of extensor digitorum longus muscle was observed, showing the diminished muscle contractility. However, IL significantly improved muscle contractility following injury induced by 2 h of ischemia followed by a 4-h reperfusion period. In addition, IL partially ameliorated mitochondrial degeneration in the muscle cells of ischemia groups. Conclusion This study indicates that immediate IL therapy repairs muscle damage especially after 2 h of ischemia and 4 h of reperfusion and therefore that IL improves contractile function.
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Iloprost/farmacología , Mitocondrias Musculares/efectos de los fármacos , Contracción Muscular/efectos de los fármacos , Músculo Esquelético/efectos de los fármacos , Daño por Reperfusión/tratamiento farmacológico , Potenciales de Acción/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Masculino , Mitocondrias Musculares/metabolismo , Mitocondrias Musculares/ultraestructura , Fuerza Muscular/efectos de los fármacos , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiopatología , Músculo Esquelético/ultraestructura , Ratas Wistar , Recuperación de la Función , Daño por Reperfusión/metabolismo , Daño por Reperfusión/patología , Daño por Reperfusión/fisiopatología , Factores de TiempoRESUMEN
OBJECTIVE: Amifositine is a phosphorylated thiol that holds its radioprotective actions by several indirect mechanisms. The purpose of this study was to evaluate histopathologically whether amifositine administration prior to irradiation would have a longterm protective effect on heart tissue in an experimental rat model. METHODS: Single dose of 18 Gy radiation and sham radiation exposure were used in related groups. A dose of 200 mg/kg of amifostine was injected intraperitoneally 30 min prior to radiation exposure. Analyses were performed 6 months after irradiation. RESULTS: Vascular damage and vasculitis were significantly decreased in amifositine treatment group. At the same time, significant thickening of the medial layer was accompanied by vascular damage in irradiated groups. The number and severity of myocyte necrosis were diminished with amifostine.Nevertheless, it could not prevent epicardial and myocardial fibrosis. Severe myocardial fibrosis was observed prominently in three regions, particularly on the apex, tips of papillary muscles and in sites adjacent to the atrioventricular valves. The anti-inflammatory effect of amifostine was not seen. CONCLUSION: The development of vascular damage and vasculitis were prevented by the use of amifostine. There was a correlation between vascular damage and fibrosis development. According to histopathological results, amifostine could be used as a protective agent against the side effects of radiotherapy (Tab. 4, Fig. 2, Ref. 22).
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Amifostina/farmacología , Cardiomiopatías/prevención & control , Traumatismos por Radiación/prevención & control , Protectores contra Radiación/farmacología , Animales , Cardiomiopatías/tratamiento farmacológico , Corazón/efectos de los fármacos , Masculino , Necrosis/prevención & control , Ratas , Vasculitis/prevención & controlRESUMEN
BACKGROUND: Pulmonary arterial hypertension (PAH) is a challenging disorder characterized by increasing pulmonary artery pressure, which is hard to treat. OBJECTIVE: This study was aimed to investigate the effects of bosentan, sildenafil and their combination. METHODS: Saline or MCT were applied to Wistar rats. By the development of PAH (4th week), MCT-given rats were treated orally with bosentan, sildenafil and combination of sildenafil and bosentan or placebo. ECHO examinations were performed. Tissues obtained from all of the rats were evaluated under an electron microscope. RESULTS: Left ventricular end diastolic diameter significantly increased in sildenafil and combined groups. Sildenafil group revealed a significant decrease in RV pressure and wall thickness. Examination of lung revealed a significant amount of connective tissue formation and increase in inflammatory cells in all the groups except controls in the interalveolar septum. Examination of PA revealed an increase in connective tissue volume, hypertrophic changes and expansions in granular endoplasmic reticulum cisternaes in smooth muscle cells in active groups rather than in the controls. Unlike the controls, the examination of the RV revealed an enlargement of the sarcoplasmic reticulum cisternaes in some cells, due to the calcium increase. CONCLUSION: Sildenafil and the combined therapy demonstrated to have more impact on pressure and the RV parameters in rats, with lower inflammatory findings in lung tissue (Fig. 6, Ref. 31).
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Antihipertensivos/farmacología , Hipertensión Pulmonar/tratamiento farmacológico , Pulmón/efectos de los fármacos , Monocrotalina/toxicidad , Inhibidores de Fosfodiesterasa 5/farmacología , Citrato de Sildenafil/farmacología , Sulfonamidas/farmacología , Animales , Bosentán , Quimioterapia Combinada , Hipertensión Pulmonar/inducido químicamente , Hipertensión Pulmonar/patología , Pulmón/patología , Masculino , Ratas , Ratas WistarRESUMEN
Introduction: Intraabdominal adhesions that develop because of prior abdominal or pelvic surgery may cause problems during surgery. Complications can include difficult intraabdominal entry; injury to the urinary bladder, uterus or small intestine; longer operation times, and increased blood loss. The goal of the present study was to evaluate the association between abdominal striae gravidarum and intraabdominal adhesions in the preoperative period in pregnant women with a history of cesarean section. Materials and Methods: The study included 247 pregnant women at ≥ 37 weeks of gestation admitted to the labor unit for delivery; all had undergone at least one previous cesarean section. Abdominal striae were assessed preoperatively using the Davey scoring system; the severity and intensity of adhesions were subsequently evaluated intraoperatively according to the modified Nair scoring system. Results: No striae were seen in 104 pregnant women; 41 had mild striae and 102 had severe striae. Overall, 113 cases had no adhesions (grade 0), 106 had grade 1-2 adhesions, and 28 had grade 3-4 adhesions. Among patients with grade 0 adhesions, 34 (13.7â%) had no striae, while 79 (31.9â%) had mild-to-severe striae (p < 0.001; sensitivity 55â%; specificity 67â%; positive predictive value 69â%; negative predictive value 52â%). Among women with grade 1-2 adhesions, 48 (19.4â%) had no striae, while 58 (23.4â%) had mild-to-severe striae. Finally, among women with grade 3-4 adhesions, 22 (8.9â%) had no striae, while 6 (2.4â%) had mild-to-severe striae (p < 0.001). A p-value < 0.05 was taken to indicate statistical significance. Conclusions: The abdominal adhesion score dropped as the abdominal striae gravidarum score rose during the preoperative period. Addition of this useful, easy-to-apply, inexpensive, adjunctive, observational, abdominal scoring method to the obstetrical work-up can provide important clues about the intraabdominal adhesion status of pregnant women scheduled for cesarean delivery because of previous cesarean section.
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The authors' aim was to detect the associated anomalies and their effect on the management of the fetuses with omphalocele and gastroschisis. Between the period of 2007-2013, the data of fetuses with abdominal wall defects were analyzed. Chromosomal abnormalities and associated morphologic anomalies diagnosed by ultrasonography and autopsy were evaluated. Of the. 61 fetuses, ten (20.4%) omphalocele cases and nine (75%) gastroschisis cases were isolated. Chromosomal abnormalities were found in seven fetuses with omphalocele cases. All fetuses with abnormal karyotypes had multiple additional anomalies. Termination rate was 65.3% for omphalocele group versus none in the gastroschisis group. To give better counseling about the prognosis and outcome of the fetuses with abdominal wall defects, detection of additional anomalies as well as type of the defect are essential tools even if the karyotype is normal.
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Anomalías Múltiples/diagnóstico por imagen , Aberraciones Cromosómicas/estadística & datos numéricos , Trastornos de los Cromosomas/genética , Gastrosquisis/diagnóstico por imagen , Hernia Umbilical/diagnóstico por imagen , Adulto , Trastornos de los Cromosomas/epidemiología , Femenino , Feto , Gastrosquisis/epidemiología , Gastrosquisis/genética , Hernia Umbilical/epidemiología , Hernia Umbilical/genética , Humanos , Cariotipo , Cariotipificación , Masculino , Embarazo , Pronóstico , Estudios Retrospectivos , Centros de Atención Terciaria , Ultrasonografía Prenatal , Adulto JovenRESUMEN
OBJECTIVES: Cardiac surgical operations performed by using extracorporeal circulation (ECC) lead to a systemic inflammatory response (SIR). Sometimes SIR may turn into a severe state, the systemic inflammatory response syndrome (SIRS) that usually has a poor outcome with no specific clinical tools described for its prediction. Red cell distribution width (RDW) is a routine hematological parameter. It has been proposed as a marker of morbidity and mortality in various clinical conditions. We aimed to investigate the relationship between high RDW and SIRS which is triggered by ECC. METHODS: Eleven hundred consecutive patients who underwent elective heart surgery with the use of ECC were retrospectively analyzed. A total of 19 patients fulfilled the described SIRS criteria and 20 consecutive patients were selected as the control group. RDW and other laboratory parameters, preoperative clinical status, operative data and postoperative data were compared between the SIRS and the control groups. RESULTS: Baseline characteristics of the patient groups were similar. Significant mortality was found in the SIRS group; 18 (94.73%) patients and 2 (10%) patients in the control group (p < 0.002). RDW was found to be significantly higher in the SIRS group vs the control group (15.02 ± 2.03 vs 13.01 ± 1.93, respectively, p < 0.003). Multiple logistic regression analyses showed an association between high RDW levels and SIRS development (OR for RDW levels exceeding 13.5%; 95% confidence limits of 1.0-1.3; p < 0.04). Total operation time and the need for inotropic support were also found to be significant against the SIRS group (p = 0.049). CONCLUSION: Increased RDW was significantly associated with increased risk of SIRS after ECC. The results of this study suggest that paying attention to RDW might provide valuable clinical information for predicting SIRS development among patients who are candidates for open heart surgery, without incurring additional costs.
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Índices de Eritrocitos , Eritrocitos/metabolismo , Circulación Extracorporea/efectos adversos , Síndrome de Respuesta Inflamatoria Sistémica/sangre , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos , Procedimientos Quirúrgicos Electivos , Eritrocitos/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Síndrome de Respuesta Inflamatoria Sistémica/mortalidadRESUMEN
The aim of our study was to evaluate the incidences and chromosomal abnormality detection rates of various indications for genetic amniocentesis. We retrospectively analysed 6,142 amniocentesis cases performed in a single centre between January 2007 and April 2013. We assessed the indications for prenatal diagnosis, fetal karyotypes, maternal ages, fetal ultrasound findings and maternal serum screening results. The most common indication for genetic amniocentesis was an abnormal maternal serum-screening test (36.6%), followed by advanced maternal age (28%), advanced maternal age and an abnormal maternal serum screening test (14.9%) and abnormal ultrasound findings (11.2%). The highest positive predictive values obtained from the indications included abnormal ultrasound findings and abnormal maternal serum screening test (12.9%) and advanced maternal age (12.2%). Although advanced maternal age and abnormal maternal serum screening tests were the most common indicators, their association with abnormal ultrasound findings should be identified to increase the efficacy of genetic amniocentesis.
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Amniocentesis/estadística & datos numéricos , Aberraciones Cromosómicas/estadística & datos numéricos , Femenino , Humanos , Embarazo , Estudios Retrospectivos , TurquíaRESUMEN
Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an extremely rare tumour. This case report describes the treatment and prognosis of a patient with PRMC during pregnancy. This is the third case of PRMC in a pregnant woman, worldwide. The patient was a 37-year-old woman presenting with a left mid-abdominal and pelvic semisolid, cystic mass at 29 weeks' gestation. At 30 weeks' gestation, she underwent an exploratory laparotomy, which revealed a solid tumour (22 × 13 × 11 cm) with an intact capsule extending from the inferior pole of the left kidney to the pelvic inlet in the left retroperitoneal area. The tumour had adhesions with the surrounding connective tissue and could be excised with its capsule intact. In conclusion, based on the limited information available, a PRMC with no visible dissemination excised with an intact capsule appears to have a good prognosis. Tumour excision may be adequate for treatment of PRMCs in the extragenital space and with no dissemination.
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Cistadenocarcinoma Mucinoso/cirugía , Complicaciones Neoplásicas del Embarazo/cirugía , Neoplasias Retroperitoneales/cirugía , Adulto , Femenino , Humanos , Tratamientos Conservadores del Órgano , EmbarazoRESUMEN
Ventriculomegaly (VM) is a marker of aneuploidy and warrants a detailed examination of fetal anatomy. Chromosomal abnormalities worsen the fetal and neonatal prognosis significantly and karyotyping of fetuses is critically important when accompanying anomalies are detected. Here, we report the genetic results of 140 fetuses with isolated and non-isolated VM detected during a second trimester ultrasound examination followed by invasive in utero diagnostic procedures for karyotyping. VM was diagnosed in seven (5%) fetuses with abnormal karyotype and the chromosomal abnormality incidence was higher in severe VM (6.8%) than mild (4.2%). Higher chromosomal abnormality rates were detected when VM was isolated (8.6%), rather than associated with any anomaly (3.8%). These results suggest that karyotype analysis should be offered to all patients with any degree of VM, regardless of its association with structural anomalies.
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Aberraciones Cromosómicas , Hidrocefalia/genética , Adolescente , Adulto , Amniocentesis , Femenino , Edad Gestacional , Humanos , Hidrocefalia/diagnóstico por imagen , Cariotipificación , Masculino , Embarazo , Estudios Retrospectivos , Ultrasonografía Prenatal , Adulto JovenRESUMEN
The aim of this study is to evaluate the frequency and types of associated anomalies with the results of ultrasonographic and postmortem examination and identify the necessity of prenatal karyotyping among fetuses with open neural tube defects (NTD). Fetuses diagnosed with NTDs between 2008 and 2012 were retrospectively analysed. A total of 167 fetuses that were prenatally karyotyped, terminated and examined at postmortem were evaluated. Associated anomalies were detected and classified by detailed ultrasonography and autopsy findings. In total, 57 fetuses (34.1%) had associated anomalies. Prenatal ultrasonography detected 73.1% of additional anomalies compared with autopsy. Three fetuses had chromosomal abnormalities with multiple additional anomalies. A complete anatomical survey and genetic evaluation is needed for the fetuses with NTDs. We found lower chromosomal abnormality rates but due to some factors specific to NTDs, ultrasonography may not be predictive as to whether the fetus is isolated or not. We still therefore also offer chromosome analysis in isolated cases.
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Aberraciones Cromosómicas , Defectos del Tubo Neural/genética , Adulto , Femenino , Humanos , Cariotipo , Defectos del Tubo Neural/diagnóstico por imagen , Embarazo , Estudios Retrospectivos , Ultrasonografía Prenatal , Adulto JovenRESUMEN
We developed a high quality reconstruction of May-June precipitation for the interior region of southwestern Turkey using regional tree-ring data calibrated with meteorological data from Burdur. In this study, three new climate sensitive black pine chronologies were built. In addition to new chronologies, four previously published black pine chronologies were used for the reconstruction. Two separate reconstructions were developed. The first reconstruction used all site chronologies over the common interval AD 1813-2004. The second reconstruction used four of the chronologies with a common interval AD 1692-2004. R² values of the reconstructions were 0.64 and 0.51 with RE values of 0.63 and 0.51, respectively. During the period AD 1692-1938, 41 dry and 48 wet events were found. Very dry years occurred in AD 1725, 1814, 1851, 1887, 1916, and 1923, while very wet years occurred in AD 1736, 1780, 1788, 1803, and 1892. The longest dry period was 16 years long between 1860 and 1875. We then explored relationships between the reconstructed rainfall patterns and major volcanic eruptions, and discovered that wetter than normal years occurred during or immediately after the years with the largest volcanic eruptions.
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Interpretación Estadística de Datos , Modelos Estadísticos , Lluvia , Estaciones del Año , Árboles/anatomía & histología , Árboles/crecimiento & desarrollo , Erupciones Volcánicas/estadística & datos numéricos , Simulación por Computador , Ecosistema , Estadística como Asunto , TurquíaRESUMEN
Present-day crust-mantle coupling in the Eastern Mediterranean and eastern Turkey is studied using the Global Positioning System (GPS) and seismic anisotropy data. The general trend of the shear wave fast-splitting directions in NE Turkey and Lesser Caucaus align well with the geodetic velocities in an absolute plate motion frame of reference pointing to an effective coupling in this part of the region of weak surface deformation. Farther south, underneath the Bitlis Suture, however, there are significant Pn delays with E-W anisotropy axes indicating significant lateral escape. Meanwhile, the GPS reveals very little surface deformation. This mismatch possibly suggests a decoupling along the suture. In the Aegean, the shear wave anisotropy and the Pn anisotropy directions agree with the extensional component of the right-lateral shear strains except under the Crete Basin and other parts of the southern Aegean Sea. This extensional direction matches perfectly also with the southward pulling force vectors across the Hellenic trench; however, the maximum right-lateral shear directions obtained from the GPS data in the Aegean do not match either of these anisotropies. Seismic anisotropy from Rayleigh waves sampled at 15 s, corresponding to the lower crust, match the maximum right-lateral maximum shear directions from the GPS indicating decoupling between the crust and the mantle. This decoupling most likely results from the lateral variations of the gravitational potential energies and the slab-pull forces.
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Planeta Tierra , Monitoreo del Ambiente/métodos , Sistemas de Información Geográfica , Geología/métodos , Anisotropía , Simulación por Computador , Conservación de los Recursos Naturales/métodos , Geografía , Región Mediterránea , Estrés Mecánico , TurquíaRESUMEN
BACKGROUND AND OBJECTIVE: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening KATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. METHODS: Twenty-one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs-Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n = 7) received no further treatment. In Group 2 (non-treated; n = 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n = 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. RESULTS: Tissue malondialdehyde levels were significantly lower in the levosimendan-treated group than in the non-treated group (P = 0.019). The tissue Na+-K+ ATPase activity was significantly decreased in the non-treated group than in the levosimendan-treated group (P = 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non-treated group than in the levosimendan-treated group (P = 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non-treated and levosimendan-treated groups. The severity of these findings was more extensive in the non-treated group. CONCLUSIONS: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.
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Cardiotónicos/uso terapéutico , Hidrazonas/uso terapéutico , Daño por Reperfusión Miocárdica/tratamiento farmacológico , Daño por Reperfusión Miocárdica/prevención & control , Piridazinas/uso terapéutico , Animales , Modelos Animales de Enfermedad , Masculino , Malondialdehído/metabolismo , Contracción Miocárdica , Miocardio/metabolismo , Peroxidasa/metabolismo , Ratas , Ratas Wistar , Simendán , ATPasa Intercambiadora de Sodio-Potasio/metabolismoRESUMEN
Post-sternotomy mediastinitis affects 1-3% of patients undergoing cardiac surgery and is lethal in 10-47% of these patients. We investigated the effect of an antioxidant/anti-inflammatory agent, caffeic acid phenethyl ester (CAPE), in the attenuation of inflammatory response induced by methicillin-resistant Staphylococcus aureus (MRSA) infection in a rat experimental mediastinitis model. Rats, divided into six equal groups, received MRSA precolonized stainless steel wire pieces implanted into their mediastinal spaces. Control group and CAPE control group received saline and CAPE 10 micromol/kg.day(-1 )respectively, where Group A received a single dose of teicoplanin 24 mg/kg i.m. for the first day and then 12 mg/kg.day(-1) . Group B received teicoplanin as in Group A plus CAPE 10 micromol/kg. day(-1 )intra-peritoneally. Group C received teicoplanin 60 mg/kg i.m. for the first day and then 30 mg/kg.day(-1 )and Group D received teicoplanin as in Group C plus CAPE 10 micromol/kg.day(-1) . By the end of 14 days rats were sacrificed and serum malondialdehyde (MDA), myeloperoxidase (MPO), nitric oxide (NO), urea and creatinine levels were evaluated. Mediastinal organ tissues were collected for histopathological analysis. Infection rates in all the drug-treated groups were lower than the control groups ( P=0.002) but statistical significance was attained only between the groups A and D ( P=0.018). In connective tissues and the peribronchial area polymorphonuclear leukocytic (PNL) infiltration in the treatment groups, although becoming very close, did not reach statistical significance (P =0.053, P=0.075, respectively). PNL infiltration especially in the peribronchial tissues of the Group B animals was found to be significantly less than the Control and CAPE Control groups with P values of 0.013 and 0.010, respectively. MDA and MPO levels were significantly lower in the treatment groups ( P<0.001 and P<0.001 respectively). Levels of the degradation products of NO were lower in treatment groups compared to two control groups (P=0.003, P= 0.005). NO levels in Group D were lowest among all treatment groups ( P=0.001). It has been demonstrated that although bacterial colonization can be controlled in mediastinitis, the inflammatory response persists. The combination of an antioxidant / anti-inflammatory agent, CAPE, added to standard antibiotic therapy might be effective in the treatment of post-sternotomy mediastinitis due to MRSA.
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Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Ácidos Cafeicos/uso terapéutico , Mediastinitis/tratamiento farmacológico , Alcohol Feniletílico/análogos & derivados , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/aislamiento & purificación , Teicoplanina/uso terapéutico , Animales , Antibacterianos/administración & dosificación , Antiinflamatorios/administración & dosificación , Antioxidantes/administración & dosificación , Antioxidantes/uso terapéutico , Ácidos Cafeicos/administración & dosificación , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Humanos , Mediastinitis/microbiología , Resistencia a la Meticilina , Osteomielitis/microbiología , Alcohol Feniletílico/administración & dosificación , Alcohol Feniletílico/uso terapéutico , Ratas , Ratas Sprague-Dawley , Infecciones Estafilocócicas/microbiología , Teicoplanina/administración & dosificaciónRESUMEN
AIM: The surgical management of the totally occluded abdominal aorta is highly complex and possible complications are more likely to be seen. We reviewed our experience to make a base for future endoluminal procedures. METHODS: Seventy-one patients with totally occluded abdominal aorta were operated between 1985 and 1998 in a main referral hospital of the social security organization and the results of vascular interventions were evaluated retrospectively. Juxtarenal aortic occlusion was seen in 52% of these patients. All the patients were operated using the transperitoneal approach and adequate dissection to control renal arteries. Limited thrombectomy through infrarenal aortotomy without transecting the aorta was done and continued with standard aortic graft insertion except for 1 patient with porcelain aorta. RESULTS: Follow-up was 76.9+/-41.9 (SD) months. Fourteen patients had concurrent femoro-distal bypass and 2 patients had concurrent renal bypass. Perioperative mortality was 5.6% and 26.5% of patients needed a second intervention during follow-up. Five-, 10- and 13-year survival and freedom from secondary operation was as follows: 84%, 56% and 44%, 81%, 54% and 42%. Cumulative primary and secondary graft patencies at 5- and 10-years were 68%, 63% and 92%, 92%, respectively. CONCLUSIONS: Surgical intervention is beneficial for patients with totally occluded aorta even if ischemic complaints are relatively mild and stable. Acceptable mortality rates and long-term results form a basis for future endovascular interventions.
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Aorta Abdominal/cirugía , Síndrome de Leriche/cirugía , Adulto , Anciano , Angiografía , Aorta Abdominal/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/métodos , Enfermedad Crónica , Supervivencia sin Enfermedad , Femenino , Humanos , Síndrome de Leriche/diagnóstico por imagen , Síndrome de Leriche/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación/métodos , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Electrocautery has a potential risk of serious pacemaker dysfunction in patients with implanted pacemaker. Here we present the safe and efficient use of ultrasonic scalpel (Harmonic scalpel) for the first time in a patient with implanted pacemaker undergoing open-heart reoperation.
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Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Bloqueo Cardíaco/terapia , Marcapaso Artificial , Reoperación , Cirugía Torácica , Terapia por Ultrasonido , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Cirugía Torácica/instrumentación , Cirugía Torácica/métodos , Terapia por Ultrasonido/instrumentación , Terapia por Ultrasonido/estadística & datos numéricos , UltrasonografíaRESUMEN
BACKGROUND AND AIM OF STUDY: Mitral valve repair is the standard reparative technique for degenerative mitral disease, but results of valve repair in rheumatic disease are also encouraging. The outcomes after mitral valve repair for rheumatic disease at young age was evaluated for suitability of repair. METHODS: A total of 319 patients (246 females, 73 males; mean age 31.3+/-0.5 years) underwent mitral valve repair for rheumatic mitral disease at the authors' institution between 1991 and 1998. Mean follow up was 51.9+/-1.2 months (range: 9-98 months), and was 88.7% complete. RESULTS: Preoperatively, 47.6% of patients were in NYHA classes III and IV. Mitral stenosis was present in 87.5%, insufficiency in 5.3%, and stenosis/insufficiency in 7.2%. Concomitant procedures were performed in 32% of patients who had associated cardiac lesions. The intraoperative mortality, reoperation and reoperation mortality rates were 0.9%, 6.7% and 0%, respectively. During follow up there were 10 late deaths (3.5%), six of which were cardiac disease-related (2.1%). Postoperatively, 98% of patients were in NYHA classes I and II. CONCLUSION: Valve repair in mitral disease is a standard technique, with low mortality, complication and reoperation rates, and good cardiac function and late survival. This approach is equally applicable to rheumatic mitral valve repair; hence, rheumatic mitral valves should also be repaired.
Asunto(s)
Válvula Mitral/cirugía , Cardiopatía Reumática/complicaciones , Cardiopatía Reumática/cirugía , Adolescente , Adulto , Factores de Edad , Gasto Cardíaco Bajo/etiología , Gasto Cardíaco Bajo/mortalidad , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/mortalidad , Estenosis de la Válvula Mitral/cirugía , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Recurrencia , Reoperación , Cardiopatía Reumática/mortalidad , Factores de Riesgo , Encuestas y Cuestionarios , Análisis de Supervivencia , Procedimientos Quirúrgicos Torácicos/métodos , Factores de Tiempo , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
BACKGROUND AND AIM OF THE STUDY: Despite having been used in many thousands of implants, few published data exist concerning the ATS valve. Clinical data from ATS valve implants are presented, and the first two cases of mitral valve thrombosis with the ATS valve reported. Published data are also reviewed comparatively. METHODS: Between September 1998 and July 2000, 240 ATS valve prostheses were implanted in 199 patients, of whom 88 (36.6%) had mitral (MVR), 70 (29.1%) aortic (AVR), and 41 (17.1%) double valve replacements (DVR). Additional procedures were performed in 31 patients (15.6%). Transvalvular gradients and effective orifice areas were measured by transthoracic echocardiography. Total cumulative follow up of all patients was 241.6 patient-years (pt-yr); mean (+/-SE) follow up was 1.25+/-0.51 years. RESULTS: There were six early deaths (3.0%). Overall and event-free survival rates during follow up were 98.96+/-0.73% and 97.90+/-1.22%, respectively. Anticoagulant-related hemorrhage occurred in one patient. The global incidence of hemorrhagic complications was 0.41 per 100 pt-yr. One patient with AVR was reoperated on for periprosthetic leakage in the first postoperative week. Valve thrombosis occurred in two patients with MVR at 12 and 14 months postoperatively. The incidence of valve thrombosis in MVR patients was 1.84 per 100 pt-yr (0.82 per 100 pt-yr overall). Hemolysis was seen only in one patient, echocardiographic examination revealing periprosthetic leakage. CONCLUSION: The short-term outcome in 240 implants showed the ATS valve to be safe, to have a low incidence of complications, and to provide excellent hemodynamic performance.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Adolescente , Adulto , Anticoagulantes/uso terapéutico , Válvula Aórtica/cirugía , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/mortalidad , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/terapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Hemodinámica/fisiología , Hemorragia/inducido químicamente , Hemorragia/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/mortalidad , Reoperación , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/mortalidad , Staphylococcus epidermidis , Tasa de Supervivencia , Trombosis/etiología , Trombosis/terapia , Factores de Tiempo , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
The validity of a Traumatic Stress Symptom Checklist (TSSC), which was developed as part of a Screening Instrument for Traumatic Stress in Earthquake Survivors (SITSES), was examined in 130 survivors of the recent earthquake in Turkey. Data were obtained on the TSSC, which consists of 17 DSM-IV posttraumatic stress disorder (PTSD) items and 6 symptoms of depression. The Clinician-Administered PTSD Scale and the Major Depressive Episode module of the Semistructured Clinical Interview for DSM-IV were used for comparison with the TSSC. The results indicated that the TSSC has high internal consistency and satisfactory sensitivity and specificity in predicting the diagnosis of PTSD and major depression. The SITSES appeared to be a useful instrument in screening earthquake survivors for PTSD, major depression, illness severity, and risk factors associated with traumatic stress responses.