Tube occlusion from the external ostium after implantation of an aqueous shunt

Two patients had undergone double-plate Molteno shunt implantation. Both patients required surgical revision, the first at 41 months and the second at 8 months postoperatively, because of a failure of previously functioning tube shunts caused by blockage of the external ostium and intraluminal invasion of the tube by fibrous tissue. At the time of surgical revision, fibrous tissue extended down the lumen of the tube, occluding its external ostium. After excision of this tissue, both shunts became fully functional. When functioning aqueous shunts fail and there is no evidence of a bleb over the shunt reservoir or blockage of the internal ostium, ingrowth of fibrous tissue into the external ostium should be considered as a potential cause, especially if a ripcord or Latina suture has been left in place.     

Somatosensory evoked potential and histopathological investigations in ischaemia-induced brain damage: effects of trimetazidine in rats

We studied the protective effects of trimetazidine (TMZ) on brain damage by means of somatosensory evoked potentials (SEP) in rats. The TMZ group did not show any statistically significant difference from the control group with respect to SEPs. However, the percentage of cells with ischaemic cell damage in hippocampal regions was significantly smaller in the TMZ group than the control group. Trimetazidine reduced the number of damaged cells in the cerebral tissue during the ischaemia-reperfusion damage. It was suggested that higher doses of trimetazidine may further reduce the number of cells with ischaemic damage.     

Extended cervical mediastinoscopy in the diagnosis of anterior mediastinal masses

BACKGROUND: Although transthoracic needle biopsy (TNB) has been the preferred method for the diagnosis of anterior mediastinal masses, it has inherent limitations in accuracy. In particular, lymphoma and thymoma are diagnosed less reliably using needle biopsy. Videothoracoscopy has been advocated as an alternative method for diagnosis. Our goal was to assess the usefulness of extended cervical mediastinoscopy (ECM) in the diagnosis of anterior mediastinal masses. METHODS: The ECM technique was performed in 9 patients in whom TNB and Tru-cut biopsies had been inefficient for histologic diagnosis. All lesions were in the anterior mediastinum. Extended cervical mediastinoscopy was carried out using the same incision as in a standard cervical mediastinoscopy and dissection was performed behind the sternum as previously published. Mean operative time was 50 minutes (range 40 to 70 minutes) and mean hospital stay was 8 hours (range 5 to 36 hours). RESULTS: Diagnosis of lymphoma in 4 cases, thymoma in 3 cases, and thymic hyperplasia in 2 cases were obtained by ECM. In 1 of 2 patients with suspected thymoma who underwent resectional surgical procedures, final histologic diagnosis was non-small cell lung carcinoma. There was no surgical mortality or intraoperative complication. One patient had minimal pneumothorax requiring no intervention. CONCLUSIONS: We conclude that ECM in the diagnosis of anterior mediastinal masses is technically feasible and provides an alternative to the conventional approaches in patients with paraaortic or aortopulmonary masses.     

Bilateral elastofibroma dorsi

Elastofibroma dorsi was diagnosed in a 48-year-old woman with bilateral subscapular tumor masses diagnosed asynchronously in an interval of 4 months in spite of presence of another lesion at first admittance. She underwent subsequent resections of the lesions. They were diagnosed as elastofibroma. Reevaluation of the initial computerized tomography of thorax indicated an omitted small lesion with a 2-cm diameter and 25.2-day doubling time. Although the real neoplastic nature of elastofibroma is unknown, bilateral presence of the masses with different sizes and relatively short doubling times of the lesions must be kept in mind.     

Acute myocardial infarction after hydrochloric acid ingestion

We report a case of acute ST segment elevated myocardial infarction associated with hydrochloric acid ingestion. Severe systemic acidosis developed shortly after massive hydrochloric ingestion; it was complicated by the presence of acute myocardial infarction. A new complication of acid ingestion is presented and a possible mechanism is discussed.     

The effects of selective nitric oxide synthase blocker on survival, mesenteric blood flow and multiple organ failure induced by zymosan

BACKGROUND: Circulatory failure in multiple organ dysfunction syndromes (MODS) is characterized with systemic vasodilation, diminished blood flow to various vascular beds. The aim of this study was to investigate the effects of selective inhibition of nitric oxide on the mesenteric arterial blood flow (MABF), survival and organ injury of the liver, kidney, lung and spleen in zymosan-induced MODS. MATERIALS AND METHODS: Forty Swiss albino mice (20-40 g), 7 to 9 weeks old, were obtained. Animals were randomly divided into four groups. The first group were treated intraperitoneally (i.p) with vehicle (saline) and served as a sham group for aminoguanidine (AG) (n=10). The second group was treated with zymosan (500 mg/kg, suspended in saline solution, i.p). The mice in the third and fourth group received AG (15 mg/kg) 1 h and 6 h after zymosan or saline administration, respectively. Eighteen hours after the administration of zymosan, animals were assessed for MODS described subsequently. The signals from the flowmeter were also recorded on mesenteric arterial blood flow values. RESULTS: In zymosan-treated animals, the MABF was significantly lower than that of solvent (saline)-treated controls (ml min(-1), controls: 4.6 +/- 0.6; zymosan: 1.6 +/- 0.9, P <0.05). When animals were treated with AG, there were no significant differences in MABF values between AG group and solvent (saline)-treated control group. However AG prevented zymosan-induced mesenteric MABF decrease. Treatment with aminoguanidine also decreased mortality. CONCLUSION: AG is capable of inhibiting both the induction and the activity of the already iNOS; it remains a potential therapeutic agent in patients with MODS.     

In Vivo Study to Assess the Viability and Mass Effect of Fascia Injection in Comparison with Block Fascia Graft

Recently, fat injection has gained favor among plastic surgeons for soft tissue augmentation. However, fat injections lose 50% of their volume after 1 year. The profession is in need of an injectable bulking material that gives a long-lasting improvement. Using 30 male rats, this study investigated the stability of the size and structure of the injected fascia autograft and compared it with surgically transplanted fascia. The fascia graft was harvested from the back of the rat, big, and divided into two equal pieces. The first piece was minced into a paste and injected subcutaneously on the anterior surface of the right ear. The other piece was transplanted subcutaneously on the anterior surface of the left ear. The grafts were observed for any sign of resorption over 1 to 6 months.Grossly, injection and transplantation sites were palpable at the end of the observation periods. Microscopic examination showed that injected fascia maintains its histomorphologic structure.These findings indicate that the injected fascia graft is well tolerated, and the size of the graft remained stable. According to this study, fascia injection can result in bulking material that gives a long-lasting improvement, and can be a viable alternative to other methods.     

In vivo and in vitro effects of stellate ganglion blockade on radial and internal mammary arteries

OBJECTIVE: To investigate the effects of stellate ganglion blockade (SGB) on the internal mammary (IMA) and radial arteries (RA) in patients undergoing coronary artery bypass graft (CABG) surgery with in vivo and in vitro studies. DESIGN: Prospective, randomized trial. SETTING: University hospital. PARTICIPANTS: Thirty-seven patients undergoing CABG surgery. INTERVENTIONS: SGB was performed on 19 patients before anesthesia induction. Another group of 18 patients underwent surgery without SGB. Diameters of proximal RA, distal RA, and IMA were determined by Doppler ultrasonography before (T1) and after (T2) anesthesia induction. Control or blocked IMA and RA segments were obtained. Norepinephrine (NE) was applied to determine the contractile force of IMA and RA rings in a concentration-dependent manner. The maximal contractile response and the sensitivity of the vessels were compared. MEASUREMENTS AND MAIN RESULTS: The diameters of IMA and distal RA were statistically larger in the SGB group than those in the control group at T2. NE-induced maximum contraction was higher in the blocked RA rings than those in the control RA and blocked IMA rings. The sensitivity of IMA segments to NE was higher than that of RA segments in the SGB group. The control and blocked IMA segments showed similar sensitivity to NE. CONCLUSION: The present results show that SGB not only increases distal RA and IMA diameters but is also associated with in vitro differences, the mechanism of which remains to be elucidated. Therefore, SGB might be considered as an alternative to topical and systemic vasodilators for reducing vasospasm in patients undergoing CABG.     

Valve replacement surgery in patients with end-stage renal disease: long-term results

BACKGROUND: The life expectancy of patients with chronic renal failure who are dependent on dialysis is very poor. This study was undertaken to determine time-related outcomes in dialysis patients requiring cardiac valve replacement. METHODS: From 1994 to 2001, 29 end-stage renal disease (ESRD) patients on hemodialysis (HD) program underwent 30 valve replacement operations: 29 received mechanical valves (97%), and one received bioprosthetic valves. The sites of valve replacement were 11 aortic (36.7%), 18 mitral (60%), and one both aortic and mitral (3.3%). Mean age was 42.46 +/- 14.26 years (range 17-75 years). Follow-up was completed in 28 patients (96.5%). RESULTS: Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan-Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the follow-up period. All patients, except the one with bioprosthesis, used warfarin sodium for anticoagulation and none of them had bleeding. One of the patients had a major cerebrovascular accident (CVA) and another one had a minor CVA at the follow-up (6.7%). CONCLUSIONS: Life quality is better and life expectancy is longer after valve replacement in ESRD patients who have valvular disease. Also, longer life expectancy increases the probability for finding donors for kidney transplantation.