Unusual presentation of myocardial ischemia after arterial switch operation.

Ischemic changes and acute or subacute cardiac failure after arterial switch operation generally results from imperfect transfer of coronary arteries to the neoaorta. Peroperative and early postoperative myocardial ischemia is the main cause of death in these patients. We present an unusual cause of myocardial ischemia and cardiac failure after arterial switch: a congenital coronary artery fistula between the circumflex artery and the right ventricle. The symptoms imitate coronary translocation failure. In differential diagnosis of the coronary perfusion problems encountered after the arterial switch operation, coronary artery fistula should not be forgotten, although it is rare.     

Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation

OBJECTIVES: The purpose of this study was to investigate the effects of PEEP on oxygenation and airway pressures during PCV-OLV. DESIGN: Randomized, crossover, clinical study. SETTING: University hospital. PARTICIPANTS: Twenty-five patients undergoing thoracotomy. INTERVENTIONS: During the first 5 minutes of OLV, all patients were ventilated with VCV (PEEP: 0) (VCV-ZEEP). Afterward, ventilation was changed to PCV with PEEP: 0 (PCV-ZEEP) or PEEP: 4 cmH2O (PCV-PEEP) for 20 minutes. In the following 20 minutes, PCV-PEEP and PCV-ZEEP were applied in reverse sequence. MEASUREMENTS AND MAIN RESULTS: At the end of VCV-ZEEP airway pressures (peak airway pressure, plateau airway pressure, mean airway pressure, and pause airway pressure) were recorded. At the end of PCV-PEEP and PCV-ZEEP airway pressures, PaO2 and Qs/Qt were recorded. Ppeak and Pplat were significantly lower with PCV-PEEP compared with VCV-ZEEP (eg, Ppeak: 33.4+/-4.2, 28.3+/-4.1, and 28.9+/-3.7 cmH2O in VCV-ZEEP, PCV-ZEEP, and PCV-PEEP, respectively; p<0.05 for PCV-ZEEP v VCV-ZEEP and PCV-PEEP v VCV-ZEEP). PCV-PEEP was associated with an increased PaO2 (230.3+/-69.8 v 189.0+/-54.8 mmHg, p<0.05) and decreased Qs/Qt (33.4%+/-7.3% v 38.4%+/-5.7%, p<0.05) compared with PCV-ZEEP (mean+/-SD). Eighty-eight percent of the patients have benefited from PEEP. CONCLUSION: During OLV, PCV with a low level of PEEP leads to improved oxygenation with lower airway pressures.     

Decrease of CD4+CD25+ T cells in peripheral blood after liver transplantation: association with immunosuppression

CD25 (IL-2 receptor alpha-chain) marks a population of CD4-positive T cells with a suppressor phenotype. These CD4+CD25+ regulatory T cells can suppress both effector T cells and antigen-presenting cells and have been identified as a principle regulator of tolerance in experimental transplantation models. In the setting of human liver transplantation, however, little is known about the dynamics of these cells in relation to rejection, tolerance, and immunosuppression. In the current study we determined CD4+CD25+ T cell in blood of liver transplant recipients using flow cytometry and investigated a possible link with immunosuppressive therapies. Peripheral blood mononuclear cells (PBMC) of 27 liver transplant patients (pretransplantation and 12 months posttransplantation) and 16 healthy controls were included. We found that the percentages of CD25+ cells within the CD4 T-cell population was significantly reduced in more than two-thirds of patients 1 year after transplantation. Also the total percentage of CD4-positive T cells declined significantly within this period, making the absolute reduction of regulatory T cells after transplantation even more profound. Comparing PBMC samples of patients and healthy controls revealed an increased percentage of CD4+ T cells in the patients before transplantation, probably related to the chronic liver illness. The reduction in CD4+CD25+ T cells after transplantation was similar for different immunosuppression regiments. All patients, however, received calcineurin inhibitors, suggesting a possible suppressive effect of this therapy on regulatory T-cell levels in peripheral blood. Currently, assays for regulatory T-cell activity are used to further support this hypothesis.     

Treatment of intertrochanteric fractures in geriatric patients with a modified external fixator

Forty-two geriatric patients who had an intertrochanteric fracture were treated with a semicircular modification of the Ilizarov frame designed by Cattaneo and Catagni between January 1997 and September 2001. Twenty-five of the patients were female, 17 male. The average age of the patients was 77.5 years (range, 63-99). No intraoperative complication occurred. Deep pin-track infection was found in four patients and varus deformity was observed in two patients and shortening of less than 2 cm in 10 patients. Fixator removal was achieved in a mean time of 12 weeks (range, 10-18). No implant failure, refracture or stiffness of knee and hip joint movements was recorded. We concluded that the treatment of intertrochanteric fractures of the elderly patients with our modification provides significant advantages such as minimal operative and anaesthetic risks, no blood loss, early weight-bearing, short hospitalisation time and rapid union time.     

Goat semen cryopreservation with rainbow trout seminal plasma supplemented lecithin-based extenders

The objective of this study was to determine the optimum concentrations of rainbow trout seminal plasma (RTS) supplemented extenders for goat semen quality at post-thaw and after incubation. Five sexually mature Saanen goat (Capra aegagrus hircus) were used for semen collection. Pooled semen was diluted with soybean lecithin-based extender without RTS (control) or supplemented with different concentrations of RTS (1%, 2%, 4% or 8%), at a final concentration of 150 × 10⁶ spermatozoon/ml. Sperm motility, plasma membrane functional integrity (HOST), damaged acrosome (PSA-FITC), mitochondrial activity (rhodamine123) and DNA integrity (TUNEL) were evaluated. Spermatological parameters were evaluated at post-thaw and after 6 hr incubation. RTS8 group preserved sperm motility, acrosomal integrity, plasma membrane functional integrity and mitochondrial function better than the control group (p < .05). The study demonstrated that RTS supplemented lecithin-based extenders have useful effects on goat spermatozoa. In addition, the results of the current study represented the positive effect of using 8% RTS supplemented extender.     

A comparison of different hemorrhoidectomy procedures

OBJECTIVE: To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel (HS) and classical methods. METHODS: Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS (n=22), closed HS (n=22), Miligan Morgan (n=22), and Ferguson (n=21) hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time. RESULTS: Bleeding volume was significantly lower in Groups I-II (p<0.001). Operation time was significantly shorter in Group I (p<0.001). Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III (p<0.001) compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III (p<0.004). Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV (p<0.001). Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III (p<0.007) and similar in closed hemorrhoidectomy group. CONCLUSION: The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain.     

Mini-open technique for the achilles tenotomy in correction of idiopathic clubfoot: a report of 25 cases

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30 degrees ) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced.     

Ethnic differences in the soft tissue profiles of Turkish and European-American young adults with normal occlusions and well-balanced faces

The aim of this study was to evaluate soft tissue differences between Turkish and North American adults by comparing two sample populations with ideal occlusion and well-balanced faces. Lateral cephalometric radiographs of 117 Anatolian Turkish adults (65 female and 52 male, mean age: 23.9 ± 2.8 years) were compared with a sample of 116 adults of European-American ancestry (64 female and 52 male, mean age: 25.0 ± 6.8 years). The cephalometric analyses of Holdaway, Epker, and Legan and Burstone were performed using Dolphin Image Software 9.0. Thirty-two measurements (27 linear and 5 angular) were analysed. For statistical evaluation, independent samples t-tests were performed. Distinct differences were found between the two samples in facial convexity, upper lip position and length, lower lip position, chin prominence, and chin thickness. Vertical proportional findings were similar between groups. Ethnic differences were found between Turkish and North American adults in the soft tissue profile. It is appropriate to consider these differences during routine diagnosis and treatment planning of a Turkish patient or an American patient of European ancestry.     

Apoptosis in orbital fibroadipose tissue and its association with clinical features in Graves' ophthalmopathy

PURPOSE: To evaluate the rate of apoptosis in orbital fibroadipose tissue in Graves' ophthalmopathy (GO) patients and investigate its associations with disease characteristics. METHODS: Orbital tissue samples were obtained during decompression surgery from 25 GO patients. Disease activity was evaluated using the Clinical Activity Score, while the clinical features of GO were evaluated using the Total Eye Score (TES). Tissue samples of 12 patients without any thyroid or autoimmune disease were studied as controls. The rate of apoptosis was evaluated with a terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) assay, and ultrastructural features of apoptosis were evaluated with electron microscopy. RESULTS: The rate of apoptosis in orbital fibroadipose tissue was significantly higher in GO cases than in the control group (p < 0.001) and significantly correlated with TES (r: 0.545; p = 0.005). The rate of apoptosis was 7.9% +/- 6.5%, and 22.0% +/- 7.8% in type 1 and type 2 cases, respectively (p = 0.001). The rate of apoptosis was 21.6% +/- 7.5% in eyes showing dysthyroid optic neuropathy (DON) and 6.7% +/- 5.4% in eyes without DON (p = 0.005). CONCLUSIONS: The rate of apoptosis was high in the orbital fibroadipose tissue of GO cases and was related to the clinical features of the disease.