Aim: The major part of tissue damage occurs upon reperfusion and is mediated by activated neutrophils that release oxygen free radicals. Following hind-limb ischemia/reperfusion, lung injury due to neutrophil infiltration and oxygen free radicals has been demonstrated. Previous studies have shown that this injury can be prevented pharmacologically. Iloprost is a long acting stable analog of prostacyclin. The aim of this study is to test the effect of iloprost in prevention of lung injury due to lower limb ischemia/reperfusion. Material and Methods: Through a midline laparotomy infrarenal abdominal aorta was approached and cross-clamped in 20 male Spraque-Dawley rats for 2 hours. At the time of declamping Group I animals (n=8) received iloprost (0,1µg/kg/min) and Group II animals (n=8) received normal saline (0,1ml/kg/min) continously for 4 hours. Third group was the sham group (n=4). The lung tissue assays were performed for measurement of lipid peroxidation end product malondealdehyde and also total glutathione. Lung tissues were also examined histopathologically under light microscopy. Results: The malondealdehyde levels in the iloprost group were significantly lower than the control group (p<0,05). The glutathione levels did not show any difference between the iloprost and the control groups (p>0,05). Histopathological examination revealed that the structure of the lung tissue was preserved in the iloprost group whereas lung tissue of the control group had evidence of injury. Conclusion: Our results suggest that iloprost reduces the production of oxygen free radicals and prevents lung injury due to lower limb ischemia reperfusion.

Background/aim: Bleeding in patients undergoing coronary artery bypass grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of significant morbidity and mortality. The aim of this study is to examine the perioperative hemostatic effects of tranexamic acid (TnX-A) and desmopressin acetate (Des) in these patients. Materials and methods: This clinical study was planned in a prospective and randomized manner. Fifty-four patients were enrolled and classified into 4 different groups. They were compared in terms of various bleeding and transfusion parameters.Results: No significant differences were observed between the groups in pre/intraoperative data apart from closure times. Plasmin/α-2 antiplasmin complex values in the TnX-A and control groups were significantly higher than those in the Des and TnX-A+Des groups at the end of postoperative drug infusion. Mean duration of closure times, first 3-h and total postoperative amounts of drainage, administered volumes of erythrocyte suspension/fresh frozen plasma, cost of blood products, length of intubation, length of stay in the intensive care unit, and time to discharge were also significantly higher in the Des and control groups.Conclusion: Des had no significant effect on bleeding control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A infusion alone in these patient groups had a positive effect on hemostasis-related data.

In-stent restenosis (ISR) remains a challenging problem, and its optimal management is still unknown. Although redilatation has predominantly been used, unusual complication such as coronary artery dissection may occur. This report describes successful surgical treatment of a severe coronary artey dissection in the left anterior descending coronary artery after attempting eximer laser angioplasty for in-stent restenosis. Key Words : In-stent restenosis, Coronary artery dissection, Surgical treatment.

Objectıve . The purpose of this study is to evaluate the effect of ethyl pyruvate (EP) on systemic inflammatory response and lung injury in an experimental rat model of ruptured abdominal aortic anurysm (RAAA). Methods . Anaesthetized 30 Sprague-Dawley male rats were randomized to sham (Shn:6) (Sh + EPn:6) or shock and clamp (S/C) groups (S/Cn:9) (S/C + EPn:9). In the S/C and S/C + EP groups, hemorrhagic shock, lower torso ischemia, and reperfusion were created, S/C group was given 1 mL saline and S/C + EP group was given 40 mg/kg EP. At the end of reperfusion process some biochemical and histological parameters were studied in serum and lung tissues. Results . An increase was observed in all parameters except interleukin-6 (IL-6) in the S/C group in comparison to the sham groups. In the S/C + EP group, serum myeloperoxydase (MPO), malondialdehyde (MDA), and tumor necrosis factor alpha (TNF- α ) as well as lung MPO and MDA values decreased significantly (P<0.016). In the lung tissues, histological injury scores and lung tissue wet/dry ratio were significantly decreased in the S/C + EP group as compared to the S/C group (P<0.016). Conclusions . Ethyl pyruvate may reduce systemic inflammatory response and lung injury which resulted from shock and ischemia/reperfusion in an experimental model of RAAA.

Chylothorax is a rare sequela to cardiac surgery, associated with high rates of morbidity and mortality. There are various medical and surgical options for its management. We describe 2 cases of chylothorax that developed after coronary artery bypass grafting and were managed successfully with medical therapy alone.Conservative treatment such as we describe aims to reduce chyle flow, to drain the pleural cavity in an effective manner, and to prevent chronic sequelae. Optimal conservative treatment, consisting of nothing by mouth and the administration of a pleurodetic agent, should be started immediately upon diagnosis. In most cases, it reduces the need for reoperation and long-term hospitalization. Prospective randomized controlled trials are nonetheless needed to confirm these assumptions.

Although transcatheter aortic valve implantation (TAVI) has been performed successfully in patients with aortic stenosis and a mechanical mitral valve, to the present authors' knowledge only one report has been made of this being achieved in a patient with a ball-cage-type mechanical mitral valve. In the present case, as the cage section of the mechanical valve was inclined towards the left ventricular outflow tract (LVOT), there was a risk of interaction between the prosthesis and mechanical valve during the TAVI procedure. The successful implementation is described of a self-expandable aortic prosthesis in a patient with a ball-cage-type mechanical valve inclined towards the LVOT.

The surgical treatment of surgically resectable gastric cancer in a patient with concomitant severe coronary artery disease is still controversial. In this article, we report a case of simultaneous gastrectomy and off-pump coronary artery bypass grafting for the treatment of gastric adenocarcinoma and severe ischemic heart disease.

A 17-year-old female patient with a history of surgery for primary femoral and metastatic lung osteosarcoma was admitted to our clinic with palpitations. Upon evaluation, a metastatic osteosarcoma in the left ventricle was diagnosed. Based on the collaborative decision of the oncology and cardiovascular surgery clinics, surgery was performed and the patient was discharged without any problems. According to the recommendation of the oncology clinic, chemotherapy was postponed for 6 months after surgery. Five months postoperatively, however, she had a recurrence with 2 tumors. Based on the collaborative decision, chemotherapy was initiated and in 2 months the size of the recurrent tumors had diminished. The patient is still under the care of the oncology and cardiovascular surgery clinics and continuing her chemotherapy regimen. Osteosarcomas have a high mortality. Metastatic tumors of the heart are not common. The location of the metastasis and the characteristics of the primary tumor determine the treatment modality. In some previously published reports, various treatment choices have been described. In the present case report, we present a rare case with metastatic cardiac osteosarcoma.

The use of left internal thoracic artery (LITA) as a bypass conduit is associated with the highest long term patency rate and greater life expectancy with respect to saphenous vein (SV) and radial artery grafts after coronary artery bypass grafting (CABG) (1). In this report, we presented a patient reoperated due to the failure of the LITA graft to the left anterior descending (LAD) artery and the pathologic examination of the LITA graft revealed eosinophilic periarteritis.

P>Objective: Bleeding and allogeneic transfusion remain constant problems in cardiac surgical procedures. In this study, we aimed to test the role of a routine thromboelastography (TEG)-based algorithm on bleeding and transfusions in patients undergoing elective coronary artery bypass grafting (CABG). Methods: Patients (n = 224) undergoing elective CABG with cardiopulmonary bypass were prospectively randomized into two groups according to transfusion strategy: in group 1 (clinician-directed transfusion, n = 110) need for blood transfusion was based on clinician's discretion and standard coagulation tests and in group 2 (TEG algorithm group, n = 114) kaolin-activated (k) TEG-based algorithm-guided perioperative transfusion management. Transfusion, blood loss, and outcome data were recorded. Results: There were no differences in consumption of packed cell units, blood loss, re-exploration for bleeding, and early clinical outcome between the groups. Patients in the TEG group had significantly lower median units of fresh frozen plasma and platelets compared with the other group (p = 0.001). The median number of total allogeneic units transfused (packed cells and blood products) was significantly reduced in the TEG group compared with the other group (median 2, range 1-3 units vs. median 3, range 2-4 units, respectively, p = 0.001). The need for tranexamic acid was significantly diminished in the TEG group compared with the other group (10.3% vs. 19%, respectively, p = 0.007). Conclusion: Our results show that routine use of a kTEG-guided algorithm reduces the consumption of blood products in patients undergoing elective CABG. Adopting such an algorithm into routine management of these patients may help to improve clinical outcome and reduce the potential risks of transfusion-related complications and total costs after CABG.(J Card Surg 2009;24:404-410).

Egitim, bireyin bir butun olarak gelismesi ve yasamdaki tum rollerini en verimli bicimde yerine getirebilmesi icin gerekli nitelikleri kazanmasinda buyuk rol almaktadir. Toplumumuzun bu gelismelere ayak uydurabilmesi icin egitim surecinde, Psikolojik Danismanlik ve Rehberlik alaninda yetismis uzmanlar onderliginde, sinif ogretmenlerinin ve diger ilgililerin isbirligi ile mesleki ve ozel yasamlarinda fizyolojik, duygusal ve toplumsal gereksinmelerini karsilayabilen ve saglikli iletisim kurabilen bireyler yetistirmek biz ogretmenlerin onemli bir hedefi haline gelmistir. Bu calisma, cinsiyet, yas, sinif ve okulun yer aldigi bolgelere gore cesitli degiskenleri acisindan belirlenmesi amaciyla nicel ve nitel karsilastirmali tanimlayici olarak incelenmistiir. Arastirmanin orneklemi Mart- Mayis 2007 tarihleri arasinda KKTC Milli Egitim Bakanligina bagli G. Magusa ilcesinde bulunan Ilkogretimde okuyan 200 ogrenciden olusmaktadir. Verilerin toplanmasinda, veri toplama araci olarak Holland'in ilgi Alanlari Envanteri kullanilmistir. Arastirmada elde edilen verilerin degerlendirilmesinde, SPPS istatistik paket programina islenerek aritmetik ortalama, standart sapma, capraz tablo, kay kare ve excel kullanilarak cozumlenmistir.

Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in patients undergoing hemodialysis. These catheters play an essential role in providing permanent access in patients in whom all other access options have been exhausted. However, they are prone to several complications like catheter thrombosis, catheter fibrin sheating and infection. Herein, we report two uncommon cases of stuck hemodialysis cuffed tunneled catheters causing stenosis and thrombosis in central veins which needed to be removed by median sternotomy.

Coronary endarterectomy is a controversial procedure that plays a particular role in the treatment of coronary artery disease. We retrospectively investigated the results for 548 patients who underwent coronary endarterectomy as an adjunctive therapy for coronary artery bypass graft surgery during the period between 1996 and 2004. We assessed short-term outcomes and identified risk factors for adverse outcomes. Mean patient age was 67.9 + 9.3 years and mean angina class was 2.7 + 0.3. The mean number of distal anastomoses was 3.8 + 1.1 patients (73.4%) had single and 151 (27.6%) multiple coronary artery endarterectomies. Of the 151 patients who underwent multiple endarterectomies, 97 (17.7%) had endarterectomies in 2 coronary arteries, 40 (7.2%) in 3 coronary arteries, 11 (2%) in 4 coronary arteries, 2 (0.36%) in 5 coronary arteries, and 1 (0.18%) in 6 coronary arteries. Postoperative mortality was 6.2% (34 patients). The predictors for early mortality were recent myocardial infarction and left ventricular dysfunction. Our results suggest that adjunctive coronary endarterectomy can be accomplished with acceptable results but with higher mortality rates than ordinary coronary artery bypass grafting. Adjunctive coronary endarterectomy should be considered as a last option for the surgical treatment of diffuse coronary disease.

Thromboelastography is an alternative method to conventional coagulation tests for the general evaluation of hemostatic system. Cardiac surgery with cardiopulmonary bypass is accomplished by complex alterations of hemostasis, including acquired dysfunction of platelets, consumption coagulopathy and increased fibrinolysis. Despite major advances in blood conservation methods and perioperative care of the patients, transfusion rates in cardiac surgery remain high. Thromboelastography has an ability to assess almost all components of haemostatic system globally. Currently, thromboelastography is used with standard coagulation tests to decrease the microvascular bleeding and homologous blood transfusion in cardiac surgery with cardiopulmonary bypass. In this review, we aimed to discuss thromboelastography technology and its usage in cardiac surgery.

BACKGROUND:Tricuspid valve replacement (TVR) is rarely performed and is associated with a high morbidity and mortality. We report our experience with TVR and related adverse events. METHODS:Between January 1996 and December 2007, 35 patients underwent TVR with mechanical (n = 33) or bioprosthetic (n = 2) valves. Twenty-nine patients underwent concomitant cardiac procedures. RESULTS:All patients completed follow-up (mean 47 months). Thirty-day mortality was 20 % (n = 7). Risk factors included perioperative low arterial blood pressure ( P = 0.000), New York Heart Association (NYHA) functional class III or IV ( P = 0.001), severe pulmonary hypertension (pulmonary arterial pressure greater than 60 mmHg) ( P = 0.000), hepatic dysfunction ( P = 0.000), ascites ( P = 0.003), and reoperation ( P = 0.015). Late mortality occurred in five patients. Valve-related complications included bleeding (n = 1) and stroke (n = 1). Kaplan-Meier estimates of 1-, 5- and 10-year survival (including early mortality) and event-free survival were 77.1 %, 60 %, and 54.3 % and 91.1 %, 80.6 %, and 55.9 %, respectively. Severe pulmonary hypertension was the only predictor of late mortality ( P = 0.001). Among survivors, the mean NYHA class improved from 2.8 to 1.1 ( P = 0.000). CONCLUSIONS:Although early outcome after TVR is suboptimal, long-term survival and functional improvement is satisfactory.

According to Cuceloglu (2002:195), general opinion is that; if individuals have good intentions and know how to speak to each other, there will be no arguments or If we look at same understanding from a different point of view, it is seen that outcome will be in conflict, are people who have bad intentions and who do not know manners. These expressions, might be pronouncing certain good intentions, yet they do not stand for reality. Because, as long as people live together, no matter how good intentions they have or how understanding they are, conflicts and infighting are inevitable. According to Oner (1996:191) people think that occurs when one ore more people cannot agree on a subject. In some conflict cases, discourses and behaviours of individuals in conflict are different from each other, or individuals perceive them in a different way. Conflicts generally happen when needs, instincts and desires of people counteract. These different needs, different instincts, different points of view and different perceptions cause conflicts. We all live through occasional conflicts for thinking in a different way. This is a part of being human. According to Tastan (2002:1) it will be best to mention two factors causing interpersonal conflicts in people's lives. The reason for young individuals having interpersonal conflicts is worry to achieve what they wish for themselves, and ways and diversity of relationships they have to pursue in order to get along with others. The assertive, self-sufficient, defensive attitude that emerges as a result when individuals act with urge of satisfying their own needs, causes conflicts both within individual and between individuals. (www.organizasyon.com) The outbreak reasons of interpersonal conflicts may originate from personal factors like cognition, perception, emotion, non-conscious needs, and communicative skills, or cultural factors, real differences, social and physical environments or quality of message given in communication process (Dokmen, 2004). Conflicts among individuals are naturally inevitable, as they differ from each other, in every aspect of these factors. Conflicts are a normal segment of daily life. Yet, to many, conflict is considered to be negative, as it causes disagreements, stress, social chaos and violence, and moreover, most significant indication of a good relationship is accepted to be absence of conflicts (Johnson, 1981). According to Johnson(1981), positive aspects of conflicts are; it helps individual in knowing themselves, enhancing their awareness about others' characteristics, noticing relationship problems that they need to solve, and encouraging change, increases energy and motivation for problem solving, making life more interesting, and help find small problems that are perceived as big issues. After all, it is obvious that conflict, can induce constructive results both for conflicting person, and person or group that conflict is about. It has been acknowledged for a long time that conflicts are inevitable features of relationships, and that their resolutions determine whether a relationship is functional or not. (Thomas, 1976). A conflict does not occur as a result of an object or a person, sometimes individual may have a conflict within. The conflicts within individual may occur in cases where two targets are equally attractive, or two internal needs or motivation oppose each other (Atkinson and others, 1999). When we look at interpersonal relationships, conflict is defined in several ways. In one instance, Maurer (1991) defines conflict as the unwanted result of inharmonious/clashing desires between two or more parties (Cited in : Sweeney, Carruthers, 1996). People in conflict, use certain conflict resolution styles. …

BACKGROUNDAcute kidney injury is one of the most serious complications after cardiac surgery. Genetic polymorphisms are reported to be associated with postoperative renal impairment. The aim of this study was to investigate the relationship between selected gene polymorphisms and acute kidney injury after cardiac surgery.METHODSTwo hundred forty-eight elective coronary artery bypass grafting procedure patients were enrolled in the study. Angiotensin-converting enzyme (ACE) II, ID, and DD, apolipoprotein E (APO E), and angiotensin II type 1 receptor (AGTR1) A1166C genotypes were detected by polymerase chain reaction. Plasma levels of ACE were analyzed by enzyme-linked immunosorbent assay. Acute kidney injury after cardiac surgery was graded according to the RIFLE (risk, injury, failure, loss, and end-stage kidney disease) classification.RESULTSIn our study, 21.8% of patients had acute renal impairment after cardiac surgery. Among the 54 patients with acute kidney injury, ACE D allele frequency was 0.620. The plasma levels of ACE were significantly higher in the D allele carriers (P = .018). Three of the 54 patients with acute kidney injury were APO E epsilon 4 allele carriers (P = .002). AGTR1 C allele carriers constituted 46% of all patients with postoperative acute kidney injury. There was no statistically significant difference between A allele homozygotes and C allele carriers with respect to postoperative renal dysfunction (P > .05).CONCLUSIONSThe present findings support the hypothesis that ACE I/D and APO E gene polymorphisms may play a role in the development of acute kidney injury after cardiac surgery. However, AGTR1 does not have a unique association with postoperative renal impairment.