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Aydin S, Catak Z, Eren MN, Topal AE, Aydin S. Irisin in Coronary Bypass Surgery. Cardiovasc Hematol Disord Drug Targets 2019; 18:208-214. [PMID: 29749315 DOI: 10.2174/1871529x18666180511141151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/14/2018] [Accepted: 05/06/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In coronary bypass surgery, after cardiopulmonary bypass is initiated by arterial cannulation in the ascending aorta and venous cannulation through a single vein generally in the right atrium, the process of cooling the patient is started. OBJECTIVE There is a relation between cooling the patient and irisin, which is responsible for releasing heat. Therefore, the main objective of the present study is to explore how irisin concentrations and some other panel of myocardium injury in patients undergoing coronary artery bypass surgery. METHODS The blood samples collected before induction (T1), before bypass (T2), before (T3) and after (T4) removing the cross-clamp, upon admission to intensive care (T5), and at the postoperative 24 (T6) and 72 (T7) hours, and whether these concentrations are correlated with lactate levels classically used in monitoring this surgery. A total of biological samples, 23 from control individuals and 105 from bypass patients (14-16 samples for each timeframe) were analyzed to determine irisin, CK-MB, TnT and BNP levels by ELISA and lactate levels by lactate assay kit. Both lactate and irisin were seen to increase gradually from the time of induction to the removal of the cross-clamp. After the cross-clamp was removed and the patient was started to be warmed, both parameters began to decrease gradually and were restored to normal levels on the second and third post-operative days. The increase and decrease in irisin were found correlated with lactate levels. CK-MB, TnT and BNP alteration were similar to each other. RESULTS Based on these results, it is estimated that measurement of irisin along with lactate may prove to be a useful parameter in monitoring the coronary bypass surgery and irisin may be a significant marker of hypothermia. Beside CK-MB, TnT and BNP, measurements of irisin concentration in open heart surgery may also be useful parameters for the panel of myocardium injury.
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Affiliation(s)
- Suna Aydin
- Cardiovascular Surgery Department, Elazig Research and Education Hospital, Health Science University, 23119 Elazig, Turkey.,Department of Anatomy, School of Medicine, Firat University, 23119 Elazig, Turkey
| | - Zekiye Catak
- Department of Medical Biochemistry and Clinical Biochemistry, (Firat Hormones Research Group), Medical School, Firat University, 23119 Elazig, Turkey
| | - Mehmet Nesimi Eren
- Cardiovascular Surgery Department, School of Medicine, Dicle University, 21280 Diyarbakir, Turkey
| | - Askin Ender Topal
- Cardiovascular Surgery Department, School of Medicine, Dicle University, 21280 Diyarbakir, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry and Clinical Biochemistry, (Firat Hormones Research Group), Medical School, Firat University, 23119 Elazig, Turkey
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Aydin S, Kuloglu T, Aydin S, Yardim M, Azboy D, Temizturk Z, Kalkan AK, Eren MN. The effect of iloprost and sildenafil, alone and in combination, on myocardial ischaemia and nitric oxide and irisin levels. Cardiovasc J Afr 2017; 28:389-396. [PMID: 28906529 PMCID: PMC5885053 DOI: 10.5830/cvja-2017-025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/25/2017] [Indexed: 12/12/2022] Open
Abstract
Aim Insufficient oxygen supply to organs and tissues due to reduced arterial or venous blood flow results in ischaemia, during which, although ATP production stops, AMP and adenosine continue to be produced from ATP. The fate of irisin, which causes the production of heat instead of ATP during ischaemia, is unknown. Iloprost and sildenafil are two pharmaceutical agents that mediate the resumption of reperfusion (blood supply) via vasodilatation during ischaemic conditions. Our study aimed to explore the effects of iloprost and sildenafil on irisin levels in the heart, liver and kidney tissues and whether these pharmaceutical agents had any impact on serum irisin and nitric oxide levels in rats with induced experimental myocardial ischaemia. Methods The study included adult male Sprague-Dawley rats aged 10 months and weighing between 250 and 280 g. The animals were randomly allocated to eight groups, with five rats in each group. The groups were: sham (control), iloprost (ILO), sildenafil (SIL), ILO + SIL, myocardial ischaemia (MI), MI + ILO, MI + SIL and MI + ILO + SIL. The treatment protocols were implemented before inducing ischaemia, which was done by occluding the left coronary artery with a plastic ligature for 30 minutes. Following the reperfusion procedure, all rats were sacrificed after 24 hours, and their heart, liver and kidney tissues and blood samples were collected for analyses. An immunohistochemical method was used to measure the change in irisin levels, the ELISA method to quantify blood irisin levels, and Griess’ assay to determine nitric oxide (NO) levels in the serum and tissue. Myocardial ischaemia was confirmed based on the results of Masson’s trichrome staining, as well as levels of troponin and creatine kinase MB. Results Irisin levels in biological tissue and serum dropped statistically significantly in the ischaemic group (MI), but were restored with ILO and SIL administration. Individual SIL administration was more potently restorative than individual ILO administration or the combined administration of the two agents. NO level, on the other hand, showed the opposite tendency, reaching the highest level in the MI group, and falling with the use of pharmaceutical agents. Conclusions Individual or combined administration of ILO and SIL reduced myocardial ischaemia and NO levels, and increased irisin levels. Elevated levels of irisin obtained by drug administration could possibly contribute to accelerated wound recovery by local heat production. Sildenafil was more effective than iloprost in eliminating ischaemia and may be the first choice in offsetting the effects of ischaemia in the future.
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Affiliation(s)
- Suna Aydin
- Department of Cardiovascular Surgery, Elazig Education and Research Hospital, Health Science University, Elazig, Turkey; Department of Anatomy, School of Medicine, Firat University, Elazig, Turkey.
| | - Tuncay Kuloglu
- Department of Histology and Embryology, School of Medicine, Firat University, Elazig, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - Meltem Yardim
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - Davut Azboy
- Department of Cardiovascular Surgery, Elazig Education and Research Hospital, Health Science University, Elazig, Turkey
| | - Zeki Temizturk
- Department of Cardiovascular Surgery, Elazig Education and Research Hospital, Health Science University, Elazig, Turkey
| | - Ali Kemal Kalkan
- Department of Cardiology, Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Nesimi Eren
- Department of Cardiovascular Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey
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Aydin S, Eren MN, Yilmaz M, Kalayci M, Yardim M, Alatas OD, Kuloglu T, Balaban H, Cakmak T, Kobalt MA, Çelik A, Aydin S. Adropin as a potential marker of enzyme-positive acute coronary syndrome. Cardiovasc J Afr 2016; 28:40-47. [PMID: 27196807 PMCID: PMC5423434 DOI: 10.5830/cvja-2016-055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 04/17/2016] [Indexed: 11/08/2022] Open
Abstract
Aim Enzyme-positive acute coronary syndrome (EPACS) can cause injury to or death of the heart muscle owing to prolonged ischaemia. Recent research has indicated that in addition to liver and brain cells, cardiomyocytes also produce adropin. We hypothesised that adropin is released into the bloodstream during myocardial injury caused by acute coronary syndrome (ACS), so serum and saliva levels rise as the myocytes die. Therefore, it could be useful to investigate how ACS affects the timing and significance of adropin release in human subjects Methods Samples were taken over three days after admission, from 22 EPACS patients and 24 age- and gendermatched controls. The three major salivary glands (submandibular, sublingual and parotid) were immunohistochemically screened for adropin production, and serum and saliva adropin levels were measured by an enzyme-linked immunosorbent assay (ELISA). Salivary gland cells produce and secrete adropin locally. Results Serum adropin, troponin I, CK and CK-MB concentrations in the EPACS group became gradually higher than those in the control group up to six hours (p < 0.05), and troponin I continued to rise up to 12 hours after EPACS. The same relative increase in adropin level was observed in the saliva. Troponin I, CK and CK-MB levels started to decrease after 12 hours, while saliva and serum adropin levels started to decrease at six hours after EPACS. In samples taken four hours after EPACS, when the serum adropin value averaged 4.43 ng/ml, the receiver operating characteristic curve showed that the serum adropin concentration indicated EPACS with 91.7% sensitivity and 50% specificity, while when the cut-off adropin value in saliva was 4.12 ng/ml, the saliva adropin concentration indicated EPACS with 91.7% sensitivity and 57% specificity. Conclusion In addition to cardiac troponin and CK-MB assays, measurement of adropin level in saliva and serum samples is a potential marker for diagnosing EPACS.
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Affiliation(s)
- Suna Aydin
- Department of Anatomy - Cardiovascular Surgery, Elazig Education and Research Hospital, Elazig, Turkey.
| | - Mehmet Nesimi Eren
- Department of Cardiovascular Surgery, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Musa Yilmaz
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - Mehmet Kalayci
- Laboratory of Medical Biochemistry, Elazig Education and Research Hospital, Elazig, Turkey
| | - Meltem Yardim
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
| | - Omer Dogan Alatas
- Department of Emergency, Mugla Sitki Kocman University, Education and Research Hospital, Mugla 48000, Turkey
| | - Tuncay Kuloglu
- Department of Histology and Embryology, School of Medicine, Firat University, Elazig, Turkey
| | - Huseyin Balaban
- Department of Internal Medicine, 29 May State Hospital, Ankara, Turkey
| | - Tolga Cakmak
- Department of Cardiology, Ercis State Hospital, Van, Turkey
| | - Mehmet Ali Kobalt
- Department of Cardiology, School of Medicine, Firat University, Elazig, Turkey
| | - Ahmet Çelik
- Department of Cardiology, School of Medicine, Mersin University, Mersin, Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry (Firat Hormones Research Group), School of Medicine, Firat University, Elazig, Turkey
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Aydin S, Kuloglu T, Aydin S, Kalayci M, Yilmaz M, Çakmak T, Eren MN. Elevated adropin: a candidate diagnostic marker for myocardial infarction in conjunction with troponin-I. Peptides 2014; 58:91-7. [PMID: 24932661 DOI: 10.1016/j.peptides.2014.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 11/28/2022]
Abstract
Myocardial infarction (MI; "heart attack") can cause injury to or death of heart muscle tissue (myocardium) owing to prolonged ischemia and hypoxia. Troponins and CK-MB are released from heart muscle cells during MI. It has been demonstrated that energy expenditure is regulated by adropin expressed in the endocardium, myocardium, and epicardium. We hypothesized that adropin is released into the bloodstream during myocardial muscle injury caused by MI, so the serum level rises as myocytes die. Therefore, we examined the association between adropin expression and myocardial infarction in isoproterenol-induced myocardial infarction. Rats were randomly allocated to six groups. After treatment they were decapitated and their blood and tissues were collected for adropin measurement. Changes in adropin synthesis in rat heart, kidney and liver tissues in isoproterenol (ISO)-induced MI were demonstrated immunohistochemically. Serum adropin concentrations were measured by ELISA, and troponin-I, CK and CK-MB concentrations by autoanalysis. The results demonstrated that cardiac muscle cells, glomerular, peritubular and renal cortical interstitial cells, hepatocytes and liver sinusoidal cells all synthesize adropin, and synthesis increased 1-24 h after MI except in the liver cells. The findings elucidate the pathogenesis of MI, and the gradual increase in serum adropin could be a novel diagnostic marker and serve as an alternative to troponin-I measurement for diagnosing MI.
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Affiliation(s)
- Suna Aydin
- Department of Cardiovascular Surgery, Elazig Research and Education Hospital, Elazig 23100, Turkey; Firat University, School of Medicine, Department of Anatomy, Elazig 23119, Turkey
| | - Tuncay Kuloglu
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Suleyman Aydin
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormones Research Group), Elazig 23119, Turkey.
| | - Mehmet Kalayci
- Laboratory of Medical Biochemistry, Elazig Research and Education Hospital, Elazig 23100, Turkey; Department of Cardiology, Van Ercis State Hospital, Van, Turkey
| | - Musa Yilmaz
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormones Research Group), Elazig 23119, Turkey
| | - Tolga Çakmak
- Laboratory of Medical Biochemistry, Elazig Research and Education Hospital, Elazig 23100, Turkey; Department of Cardiology, Van Ercis State Hospital, Van, Turkey
| | - Mehmet Nesimi Eren
- Dicle University, School of Medicine, Department of Cardiovascular Surgery, Diyarbakir 21280, Turkey
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Aydin S, Aydin S, Kobat MA, Kalayci M, Eren MN, Yilmaz M, Kuloglu T, Gul E, Secen O, Alatas OD, Baydas A. Decreased saliva/serum irisin concentrations in the acute myocardial infarction promising for being a new candidate biomarker for diagnosis of this pathology. Peptides 2014; 56:141-5. [PMID: 24747283 DOI: 10.1016/j.peptides.2014.04.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 01/19/2023]
Abstract
Irisin is a muscle-secreted protein. Cardiac muscle produces more irisin than skeletal muscle in response to acute exercise, and is associated with myocardial infarction (MI) in an experimental model induced by isoproterenol in rats. The timing and significance of its release in patients with acute myocardial infarction (AMI) needs further investigation. We have studied the relationship between serum/saliva irisin concentration and AMI in humans. Serum and saliva samples were taken within 3 days of admission in 11 patients with AMI and in 14 matched controls. Salivary gland irisin was detected immunohistochemically, and serum and saliva levels were measured by ELISA. The three major paired salivary glands (submandibular, sublingual and parotid) produce and release irisin into saliva. Troponin-I, CK, CK-MB concentrations in the AMI group gradually increased from up to 12h, while saliva and serum irisin gradually decreased from up to 48 h, compared with the control group (P<0.05). After 12h, troponin-I, CK, CK-MB started to decrease, while saliva and serum irisin started to increase at 72 h. Serum irisin levels correlated with age, while troponin I, CK-MB, and CK were correlated and with saliva irisin in AMI patients. Besides cardiac troponin and CK-MB, irisin adds new diagnostic information in AMI patients, and the gradual decrease of saliva/serum irisin over 48 h could be a useful biomarker.
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Affiliation(s)
- Suna Aydin
- Department of Cardiovascular Surgery, Elazig Research and Education Hospital, Elazig 23100, Turkey; Firat University, School of Medicine, Department of Anatomy, Elazig 23119, Turkey
| | - Suleyman Aydin
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormones Research Group), Elazig 23119, Turkey.
| | - Mehmet Ali Kobat
- Department of Cardiology, Elazig Research and Education Hospital, Elazig 23100, Turkey
| | - Mehmet Kalayci
- Laboratory of Medical Biochemistry, Elazig Research and Education Hospital, Elazig 23100, Turkey
| | - Mehmet Nesimi Eren
- Dicle University, School of Medicine, Department of Cardiovascular Surgery, Diyarbakir 21280, Turkey
| | - Musa Yilmaz
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormones Research Group), Elazig 23119, Turkey
| | - Tuncay Kuloglu
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Evrim Gul
- Department of Emergency, Elazig Research and Education Hospital, Elazig 23100, Turkey
| | - Ozlem Secen
- Department of Cardiology, Elazig Research and Education Hospital, Elazig 23100, Turkey
| | - Omer Dogan Alatas
- Department of Emergency, Elazig Research and Education Hospital, Elazig 23100, Turkey
| | - Adil Baydas
- Department of Cardiology, Elazig Research and Education Hospital, Elazig 23100, Turkey
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Kuloglu T, Aydin S, Eren MN, Yilmaz M, Sahin I, Kalayci M, Sarman E, Kaya N, Yilmaz OF, Turk A, Aydin Y, Yalcin MH, Uras N, Gurel A, Ilhan S, Gul E, Aydin S. Irisin: a potentially candidate marker for myocardial infarction. Peptides 2014; 55:85-91. [PMID: 24576483 DOI: 10.1016/j.peptides.2014.02.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/06/2014] [Accepted: 02/07/2014] [Indexed: 12/30/2022]
Abstract
Myocardial infarction (MI) causes energy depletion through imbalance between coronary blood supply and myocardial demand. Irisin produced by the heart reduces ATP production by increasing heat generation. Energy depletion affects irisin concentration in circulation and cardiac tissues, suggesting an association with MI. We examined: (1) irisin expression immunohistochemically in rat heart, skeletal muscle, kidney and liver in isoproterenol (ISO)-induced MI, and (2) serum irisin concentration by ELISA. Rats were randomly allocated into 6 groups (n=6), (i) control, (ii) ISO (1h), (iii) ISO (2h), (iv) ISO (4h), (v) ISO (6h), and (vi) ISO (24h), 200mg ISO in each case. Rats were decapitated and the blood and tissues collected for irisin analysis. Blood was centrifuged at 1792 g for 5 min. Tissues were washed with saline and fixed in 10% formalin for histology. Serum irisin levels gradually decreased from 1h to 24h in MI rats compared with controls, the minimum being at 2h, increasing again after 6h. Cardiac muscle cells, glomerular, peritubular renal cortical interstitial cells, hepatocytes and liver sinusoidal cells and perimysium, endomysium and nucleoi of skeletal muscle were irisin positive, but its synthesis decreased 1-4h after MI. At all time-points, irisin increased near myocardial connective tissue, with production in skeletal muscle, liver and kidney recovering after 6h, although slower than controls. Unique insight into the pathogenesis of MI is shown, and the gradually decrease of serum irisin might be a diagnostic marker for MI.
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Affiliation(s)
- Tuncay Kuloglu
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Suna Aydin
- Department of Cardiovascular Surgery, Elazig Research and Education Hospital, Elazig 23100, Turkey; Firat University, School of Medicine, Department of Anatomy, Elazig 23119, Turkey
| | - Mehmet Nesimi Eren
- Dicle University, School of Medicine, Department of Cardiovascular Surgery, Diyarbakir 21280, Turkey
| | - Musa Yilmaz
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey
| | - Ibrahim Sahin
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey; Erzincan University, School of Medicine, Department of Histology and Embryology, Erzincan 24030, Turkey
| | - Mehmet Kalayci
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey
| | - Emine Sarman
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Nalan Kaya
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Osman Fatih Yilmaz
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Ahmet Turk
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Yalcin Aydin
- Ankara University, Faculty of Veterinary Medicine, Veterinary Medicine Student, Ankara 06110, Turkey
| | - Mehmet Hanifi Yalcin
- Firat University, Faculty of Veterinary Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Nimet Uras
- Firat University, School of Medicine, Medical School Student, Elazig 23119, Turkey
| | - Ali Gurel
- Firat University, School of Medicine, Department of Internal Medicine, Elazig 23119, Turkey
| | - Selcuk Ilhan
- Firat University, School of Medicine, Department of Medical Pharmacy, Elazig 23119, Turkey
| | - Evrim Gul
- Department of Emergency, Elazig education and Research Hospital, Elazig 23100, Turkey
| | - Suleyman Aydin
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey.
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Aydin S, Kuloglu T, Aydin S, Eren MN, Celik A, Yilmaz M, Kalayci M, Sahin İ, Gungor O, Gurel A, Ogeturk M, Dabak O. Cardiac, skeletal muscle and serum irisin responses to with or without water exercise in young and old male rats: cardiac muscle produces more irisin than skeletal muscle. Peptides 2014; 52:68-73. [PMID: 24345335 DOI: 10.1016/j.peptides.2013.11.024] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Irisin converts white adipose tissue (WAT) into brown adipose tissue (BAT), as regulated by energy expenditure. The relationship between irisin concentrations after exercise in rats compared humans after exercise remains controversial. We therefore: (1) measured irisin expression in cardiac and skeletal muscle, liver, kidney, peripheral nerve sheath and skin tissues, as also serum irisin level in 10 week-old rats without exercise, and (2) measured tissue supernatant irisin levels in cardiac and skeletal muscle, and in response to exercise in young and old rats to establishing which tissues produced most irisin. Young (12 months) and old rats (24 months) with or without 10min exercise (water floating) and healthy 10 week-old Sprague-Dawley rats without exercise were used. Irisin was absent from sections of skeletal muscle of unexercised rats, the only part being stained being the perimysium. In contrast, cardiac muscle tissue, peripheral myelin sheath, liver, kidneys, and skin dermis and hypodermis were strongly immunoreactivity. No irisin was seen in skeletal muscle of unexercised young and old rats, but a slight amount was detected after exercise. Strong immunoreactivity occurred in cardiac muscle of young and old rats with or without exercise, notably in pericardial connective tissue. Serum irisin increased after exercise, being higher in younger than older rats. Irisin in tissue supernatants (cardiac and skeletal muscle) was high with or without exercise. High supernatant irisin could come from connective tissues around skeletal muscle, especially nerve sheaths located within it. Skeletal muscle is probably not a main irisin source.
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Affiliation(s)
- Suna Aydin
- Department of Cardiovascular Surgery, Elazig Research and Education Hospital, Elazig 23100, Turkey; Firat University, School of Medicine, Department of Anatomy, Elazig 23119, Turkey
| | - Tuncay Kuloglu
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
| | - Suleyman Aydin
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey.
| | - Mehmet Nesimi Eren
- Dicle University, School of Medicine, Department of Cardiovascular Surgery, Diyarbakir 21280, Turkey
| | - Ahmet Celik
- Mersin University, School of Medicine, Department of Cardiology, Mersin 33070, Turkey
| | - Musa Yilmaz
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey
| | - Mehmet Kalayci
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey
| | - İbrahim Sahin
- Firat University, School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Elazig 23119, Turkey; Erzincan University, School of Medicine, Department of Histology and Embryology, Erzincan 24030, Turkey
| | - Orhan Gungor
- Department of Cardiovascular Surgery, Elazig Research and Education Hospital, Elazig 23100, Turkey
| | - Ali Gurel
- Firat University, School of Medicine, Department of Internal Medicine, Elazig 23119, Turkey
| | - Murat Ogeturk
- Firat University, School of Medicine, Department of Anatomy, Elazig 23119, Turkey
| | - Ozlem Dabak
- Firat University, School of Medicine, Department of Histology and Embryology, Elazig 23119, Turkey
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Aydin S, Aydin S, Eren MN, Sahin İ, Yilmaz M, Kalayci M, Gungor O. The cardiovascular system and the biochemistry of grafts used in heart surgery. Springerplus 2013; 2:612. [PMID: 24324924 PMCID: PMC3855918 DOI: 10.1186/2193-1801-2-612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/13/2013] [Indexed: 11/15/2022]
Abstract
Blood is pumped into the cardiac muscle through arteries called the coronary arteries. Over time, the accumulation of cholesterol, coagulation factors, and cells on the walls of these arteries causes the walls to thicken and lose their elasticity, resulting in the development of atherosclerosis. When the blood supply of the heart is diminished by atherosclerosis, it can be restored by bypass surgery, in which atherosclerosis-free vein and/or artery grafts taken from another area of the body are used to replace the atherosclerotic vessels. These biological grafts used in surgery differ in biochemical composition and long-term patency. Although the great saphenous vein (GSV) has been the most popular graft material in revascularization for years, it has recently been superseded by the internal mammarian artery (IMA), which has a lower incidence of recurrence of atherosclerosis. The aim of the present review is briefly to address the structure of the cardiovascular system and blood vessels, and then, in the light recent data, to present the biochemical compositions and individual advantages of the graft materials used to restore an impaired blood supply to the heart.
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Affiliation(s)
- Suna Aydin
- />Elazig Research and Education Hospital, Clinic of Cardiovascular Surgery, 23119 Elazig, Turkey
- />School of Medicine, Department of Anatomy, Firat University, 23119 Elazig, Turkey
| | - Suleyman Aydin
- />School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Firat University, 23119 Elazig, Turkey
| | - Mehmet Nesimi Eren
- />School of Medicine, Department of Cardiovascular Surgery, Dicle University, 21280 Diyarbakir, Turkey
| | - İbrahim Sahin
- />School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Firat University, 23119 Elazig, Turkey
- />School of Medicine, Department of Histology & Embryology, Erzincan University, 24030 Erzincan, Turkey
| | - Musa Yilmaz
- />School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Firat University, 23119 Elazig, Turkey
| | - Mehmet Kalayci
- />School of Medicine, Department of Medical Biochemistry (Firat Hormone Research Groups), Firat University, 23119 Elazig, Turkey
| | - Orhan Gungor
- />Elazig Research and Education Hospital, Clinic of Cardiovascular Surgery, 23119 Elazig, Turkey
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Yavuz C, Demirtas S, Caliskan A, Ertas F, Kaya H, Aydin M, Benli ED, Celik Y, Eren MN. The predictors of poor outcomes in patients with femoral artery injuries. Eur Rev Med Pharmacol Sci 2013; 17:1901-1908. [PMID: 23877855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries. PATIENTS AND METHODS The study included 158 patients aged 2-82 (mean age 28.4 ± 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded. RESULTS Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.41-87.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively. CONCLUSIONS The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.
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Affiliation(s)
- C Yavuz
- Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
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Abstract
Objectives Postoperative pneumonia is a devastating complication after cardiac surgery that increases morbidity and mortality. The objective of this study was to identify potential risk factors for the development of nosocomial pneumonia post cardiac surgery by the way of logistic regression analysis. Design Data of the last 162 patients undergoing cardiac surgery before November 2009 were retrospectively collected and analysed. Results The mean age of the patients was 65.57 ± 10.48 years and 83 (51%) were male. Postoperative pneumonia was diagnosed in 21 (13%) patients. The mean remaining time in the intensive care unit and mean length of hospitalisation were longer for patients with postoperative pneumonia. Pre-operative heart rate, previous diabetes mellitus, previous chronic obstructive pulmonary disease, postoperative urea, creatinine and potassium levels, extubation time, postoperative atrial fibrillation, and number of units of transfused packed red blood cells (pRBC) and fresh frozen plasma were associated with higher occurrence of postoperative pneumonia on univariate analysis. Conclusions On logistic regression analysis, pRBC transfusion, previous chronic obstructive pulmonary disease and postoperative atrial fibrillation remained as independent predictors for the development of postoperative pneumonia.
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Affiliation(s)
- A E Topal
- Cardiovascular Surgery Department, Dicle University Medical Faculty, Diyarbakir,Turkey.
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Aydin S, Eren MN, Aydin S, Ozercan IH, Dagli AF. The bioactive peptides salusins and apelin-36 are produced in human arterial and venous tissues and the changes of their levels during cardiopulmonary bypass. Peptides 2012; 37:233-9. [PMID: 22884920 DOI: 10.1016/j.peptides.2012.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
Abstract
This study aimed to examine the effects of CPB on salusin-α, salusin-β and apelin-36 bioactive peptides in people who are planned to undergo coronary artery bypass graft (CABG) operation due to coronary artery disease and to explore whether these peptides are produced in human aortic, saphenous and arterial tissues. The study included age and BMI matched 15 patients who underwent CABG operation by CPB. In order to determine salusin-α, salusin-β and apelin-36 levels, venous blood samples were collected before induction of anesthesia (T1), before CPB (T2), 5 min before the removal of cross-clamp (T3), 5 min after the removal of cross-clamp (T4), upon arrival in the intensive care (T5), at postoperative 24th hour (T6) and 72nd hour (T7). Salusin and apelin expressions of the tissues were shown by immunohistochemical method. Peptide amounts of sera and tissues were measured using ELISA. Salusins production by vessels occurs in fibroblast cells of the media in the aorta and smooth muscle cells of the media in the LIMA and saphena. Apelin is produced by endothelial cells of the intima and fibroblast cells of the media in the aorta and by smooth muscle cells of the media in the LIMA and saphena. Changes in the levels of salusin-β and apelin-36 were significant during CPB. Salusin-α, salusin-β and apelin-36 are locally synthesized in the arteries and veins. Salusins and apelin-36 might be important markers in the CPB, and also that salusin-β was more specific in comparison to salusin-α.
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Affiliation(s)
- Suna Aydin
- Department of Cardiovascular Surgery, Elazig State Hospital, Elazig, Turkey.
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Topal AE, Eren MN, Celik Y. Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management. Vasc Health Risk Manag 2010; 6:1103-10. [PMID: 21191430 PMCID: PMC3004513 DOI: 10.2147/vhrm.s15316] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Limb loss following lower extremity arterial injury is not uncommon and has serious implications on the patient's life and functionality. This retrospective study was performed to analyze the results of lower extremity arterial injuries and to identify the risk factors associated with amputation. METHODS Between 2002 and 2009, retrospectively collected data on 140 patients with 173 lower extremity arterial injuries were analyzed. RESULTS There were 133 males (95%) and 7 females (5%). The mechanism of injuries was gunshot wounds in 56.4% of cases, stab wounds in 30%, and blunt trauma in 13.4%. Associated injuries included vein injury in 45% of cases, nerve injury in 16.4%, and bone fracture in 31.4%. The most frequently injured artery was superficial femoral artery (31.2%). More than 1 artery was injured in 18.6% of patients. Surgery was carried out, with a limb salvage rate of 90.4% and a survival of 97.1%. Amputation was performed in 75% of patients in whom only 1 artery was repaired, although all crural arteries were injured. Multivariate logistic regression analysis showed that significant risk factors of outcome were below-knee multiple arterial injuries (odds ratio [OR] 6.62, P < 0.001), associated 2-bone fractures (OR 2.71, P = 0.003), development of compartment syndrome (OR 1.94, P = 0.042), and great soft tissue disruption (OR 1.74, P = 0.010). CONCLUSIONS Limb loss may be decreased by performing prophylactic fasciotomy more often and by repairing at least 2 crural arteries.
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Affiliation(s)
- Aşkin Ender Topal
- Cardiovascular Surgery Department, Dicle University Medicine Faculty, Diyarbakir, Turkey.
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Topal AE, Eren MN. Gradually increasing predominance of self-mutilation in upper extremity arterial injuries: less morbidity but with high threat to society. ULUS TRAVMA ACIL CER 2010; 16:527-531. [PMID: 21153946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Although vascular trauma of the upper extremity is increasingly more common, mortality and morbidity rates remain low, at between 0-8%. Self-mutilation has become evident in recent years. We planned this study to compare the results of self-mutilation with other penetrating trauma in upper extremity vascular injuries and also to emphasize the dangers of self-mutilation for society. METHODS Data of 249 patients with penetrating vascular injury of the upper extremity were retrospectively analyzed. There were 214 male (86%) and 35 female (14%) patients, with a mean age of 24.76 ± 11.28 years (range: 2-69 years). Of these, 129 (52%) were self-mutilators. RESULTS The ulnar artery was the most frequently affected (n=140, 56%). There was no mortality or limb loss. However, eight (3.21%) patients, who had penetrating trauma, had restriction in finger motions. Male predominance, substance abuse and associated nerve injury were significantly more common among self-mutilators (p values <0.001, <0.001 and 0.005, respectively), whereas brachial artery injury, vein graft interposition and fasciotomy rates were higher among the penetrating trauma group (p<0.001 for all). CONCLUSION The form of and reason for injuries and presence of substance abuse in case of self-mutilation must be investigated cautiously, and the immediate commencement of psychiatric treatment must be provided to the self-mutilators.
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Affiliation(s)
- Aşkın Ender Topal
- Department of Cardiovascular Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey.
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Göz M, Cakir O, Eren MN. Penetrating cardiac trauma in children. ULUS TRAVMA ACIL CER 2010; 16:220-224. [PMID: 20517746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Penetrating cardiac traumas in children are dramatic and fatal. Many of the patients are admitted to hospital either in a state of shock or they are dead at presentation. In this study, we aimed to present our experience in penetrating cardiac trauma in children. METHODS Seventeen pediatric cases of penetrating cardiac trauma were retrospectively evaluated. The effects on the results of the demographic characteristics of patients, etiology of penetrating trauma, time of presentation to the hospital, physical examination findings in the emergency department, diagnostic methods used, and the surgical techniques applied were evaluated. RESULTS The male to female ratio of the 17 retrospectively evaluated cases was 16:1, with an age range of 3-15 years. The patients' mean age was 12.94+/-3.52 years. In all patients, the penetrating cardiac trauma was due to incisive/penetrating tools. The mean Ivatury physiologic index score was 8.23+/-0.78, whereas the mean cardiac injury organ scale score was 5.00+/-0.00. The hospital mortality rate was 5.9% due to the loss of one patient. CONCLUSION Shock may develop in pediatric penetrating cardiac trauma in a short time due to hemorrhage and/or cardiac tamponade. The prime factors for patient survival are early diagnosis and emergency thoracotomy.
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Affiliation(s)
- Mustafa Göz
- Department of Cardiovascular Surgery, Harran University Faculty of Medicine, Sanliurfa, Turkey.
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Topal AE, Eren MN, Celik Y. Left Ventricle and Left Atrium Remodeling after Mitral Valve Replacement in Case of Mixed Mitral Valve Disease of Rheumatic Origin. J Card Surg 2010; 25:367-72. [DOI: 10.1111/j.1540-8191.2010.01062.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Göz M, Cakir O, Eren MN. [Penetrating cardiac injuries: analysis of the mortality predictors]. ULUS TRAVMA ACIL CER 2009; 15:362-366. [PMID: 19669966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Penetrating cardiac injuries are a dramatic and lethal form of trauma. Most of these patients reach the hospital already dead or in severe shock. The prognosis is determined by early diagnosis and operation. In this study, we discuss the effects of the etiology of trauma, the state of presentation in the emergency department, and the treatment approaches on the morbidity and mortality in penetrating cardiac trauma treated in our clinic. METHODS Fifty-two patients treated due to penetrating cardiac injury were investigated retrospectively. Demographic characteristics, etiology of the injury, arrival time at the hospital, physical examination findings in the emergency room, diagnostic methods used, and surgical methods applied were determined along with the results. RESULTS The male to female ratio was 48:4, and mean age was 27.86+/-13.73. The etiology was stab injury in 46, gun shot injury in four and iatrogenic trauma in two patients. Surgery was applied in emergency condition for all cases. Cardiac injury was repaired using primary repair technique. Hospital mortality was determined as 15.4% (8 patients). CONCLUSION Penetrating cardiac injuries lead to shock in a very short period of time because of bleeding and/or pericardial tamponade. Early diagnosis and prompt thoracotomy are the fundamental factors affecting patient outcome after penetrating cardiac injury.
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Affiliation(s)
- Mustafa Göz
- Department of Cardiovascular Surgery, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
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Abstract
Esophageal foreign bodies (FBs) in children are a commonly seen complaint that can cause severe morbidity. Different methods are used for their extraction. We reviewed our cases and described direct extraction technique. The specifications of 1116 children with esophageal FBs between 1990 and 2000 were evaluated. All FB cases were considered emergencies and intervention was performed in the operating theater. Patients with coins were only sedated and relaxed while the FB was removed under direct vision by McGill forceps. Other FBs were removed under general anesthesia by rigid esophagoscope. There were 1035 coins in 1007 patients and 112 other FBs in 109 children. Mean age was 4.2 years, ranging from 1 month to 15 years. Immediate interventions were performed in 16 (1.4%) patients. Reasons included respiratory distress from pressure in eight (five coins, three toy pieces), increased rupture risk after 4 days in three (all coins) and esophageal rupture in five patients. Four (0.3%) perforations occurred during intervention; two (0.02%, 2/1116) arose from coin extraction, and another two (1.8%, 2/109) were caused by esophagoscopic removal. The success rate for esophagoscopic removal was 95.4% (105/109). Three (0.2%) of 1116 patients underwent surgery to remove FBs. All were esophagoscopy patients, thus the surgery ratio for esophagoscopic removal was 2.7% (3/109). If an FB is diagnosed quickly and removed few problems arise. Esophageal coins can be successfully extracted under direct vision.
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Affiliation(s)
- Akin Eraslan Balci
- Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, 21280 Diyarbakir, Turkey.
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Balci AE, Kazez A, Eren S, Ayan E, Ozalp K, Eren MN. Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg 2004; 26:387-92. [PMID: 15296902 DOI: 10.1016/j.ejcts.2004.04.024] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 04/11/2004] [Accepted: 04/21/2004] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Thoracic injuries are uncommon in children and few report present on blunt ones. METHODS Between 1994 and 2003, 137 children with blunt thoracic injury were reviewed. RESULTS The mean age of children was 6.9+/-7.3 (1-16) years. Etiology was falls in 46.7%, traffical accidents in 51% and abuse in 2.2%. Average height in fallen-down cases was 6.4+/-2 (range: 3-11) m. Calculated mean kinetic energy transfer to body was 1923+/-1056 J. When first seen, 70% (82/117) of the patients had vital signs that were within normal limits. Forty-two (35.9%) children had isolated thoracic injury. Associated injuries were present in 75 (64.1%) children. Head injury was the most common associated injury present in 33 (28.2%). Pulmonary contusion was the most common thoracic injury with 68 (49.6%). Seventeen (12.4%) required surgery, 11 (8%) of them were thoracic (4 for diaphragmatic tear, 2 for flail chest, 2 for tracheobronchial injuries, 2 for laceration, 1 for esophageal rupture). Surgical group had higher ISS (26.8 vs 36.2, P = 0.001). Fifteen were lost (10.9%): There were lethal injuries in 7; chest tube treatment in 3; intensive care unit management in 2; mechanical support in 2 and observation in 1 patient. No death occurred for operations. Mortality rate was the lowest at injuries to chest alone and the highest for multi-system injuries (P < 0.05). The hospital length of stay for averaged 13.4+/-8.8 (range: 4-49) days. CONCLUSION Associated injury is the most important mortality factor. Thoracic operations can be performed with minimal morbidity and without mortality in children with blunt thoracic trauma.
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Affiliation(s)
- Akin Eraslan Balci
- Department of Thoracic Surgery, Firat University School of Medicine, Elazig 23100, Turkey.
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Affiliation(s)
- Mehmet Nesimi Eren
- Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey
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Ulkü R, Eren MN, Eren S, Onat S, Yavuz C. [Tracheobronchial injuries]. ULUS TRAVMA ACIL CER 2003; 9:281-4. [PMID: 14569485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Tracheobronchial injuries are among the least common sort of thoracic traumas. This injury can be life threatening. However, successful diagnosis and treatment can prevent devastating acute or delayed complications. The aim of this study was to review the authors' surgical experience in tracheobronchial injuries. METHODS We reviewed our records of 29 patients with tracheobronchial injuries from January 1979 to December 2000. The median age was 22.7. Twenty-seven patients were male and two were females. RESULTS The causes of traumas were penetrating injury in seventeen, blunt injury in eleven patients and animal bite in one. In sixteen patients cervical trachea, in nine main stem bronchus, in 3 lobar bronchus and in one patient mediastinal trachea were found to be injured. In seven of twenty-nine patients there were combined tracheal and esophageal injuries. Surgical approach was made by oblique incision, collar incisions and thoracotomy. In general we preferred primary repair. The overall mortality rate was 24%. CONCLUSION In our opinion, the number of complications and mortality can be diminished by early recognition of the injuries and treatment.
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Affiliation(s)
- Refik Ulkü
- Dicle University, Medical Faculty, Department of Thoracic Surgery, Diyarbakir, Turkey.
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Abstract
OBJECTIVES Destroyed lung introduces irreversible changes in lung parenchyma. This condition is uncommon in children. Operative intervention is essential for children in this state. We demonstrate our experience with this condition and report on the respective long-term results. METHOD Seventeen children who underwent pneumonectomy for destroyed lung during a 15-year period were retrospectively analyzed. Long-term results were detected in 13 patients. RESULTS Seventeen children underwent pneumonectomy. Five children were female (29.4%), and 12 children were male (70.5%). The median age of the study group children was 9.1 years (3-16 years). Sputum was the most common presenting symptom (n = 13, 76.4%). Bronchiectasis (n = 11), tuberculosis (n = 4), and necrotizing lung disease (n = 2) were the main underlying conditions. Destroyed lung was detected on the left side in 14 children (82.4%) and on the right side in 3 children (17.6%). Main bronchial stenosis was found in 4 children and mucosal thickening or congestion in 5 children. The median length of hospital stay was 15.5 days. The mortality rate was 11.7% (n = 2), and the morbidity rate was 23.5% (n = 4). Follow-up information was available for 13 patients, and this ranged from 1 year to 12 years (median 5.2 years). The respiratory capacity and scoliosis level of the patients were examined. CONCLUSIONS Although pneumonectomy is considered a difficult procedure in children, its use for destroyed lung resolves complications and improves a patient's quality of life. In time, the remaining lung expands to compensate for the loss of the removed lung. Children grew and developed normally after pneumonectomy. Patients tend not to have major skeletal deformation as the result of pneumonectomy in the short term.
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Affiliation(s)
- Sevval Eren
- Department of Thoracic and Cardiovascular Surgery, Dicle University School of Medicine, 21100 Diyarbakir, Turkey.
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Abstract
BACKGROUND Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience. METHODS Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity. RESULTS Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient. CONCLUSIONS Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time.
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Affiliation(s)
- Akin Eraslan Balci
- Department of Thoracic & Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
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Abstract
Hospital records of 1160 children <or=15 years old referred for suspected foreign body aspiration were reviewed. Bronchoscopy under general anaesthesia was performed on all patients. Foreign bodies were successfully removed in 1068 (92%) children. The majority, 885 (76.3%), presented with a definite history of foreign body aspiration. Bronchoscopy was negative in 85 (7.3%) children. Watermelon seeds, found in 414 (38.7%) children, were the most commonly aspirated foreign bodies. Open surgical procedures were required for 21 (1.8%) children. Bronchial rupture related to bronchoscopy occurred in four children, two of whom died post-operatively. The overall mortality rate was 0.8%.
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Affiliation(s)
- Sevval Eren
- Departments of Thoracic & Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
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Abstract
OBJECTIVE Progression of empyema, with the development of fibrinous adhesions and loculations, makes simple drainage difficult or impossible. The appropriate management remains controversial. Intrapleural fibrinolytic treatment to facilitate drainage of loculated empyema instead of open thoracotomy has been advocated recently. The aim of this study was to evaluate the effectiveness of the intrapleural fibrinolytic application. METHODS In our clinic we used urokinase in 28 patients and performed thoracotomy and decortication in another 43. The two groups of patients had similar characteristics. Mean age was 10.2 (range: 3-14 years). All had undergone medical treatment and tube thoracostomy. Empyema severity score (ESS) was measured in all. RESULTS Fibrinolytic treatment, and thoracotomy and decortication had complete response rates of 67.8 and 100%, respectively. Treatment was ineffective in six (21.4%) out of 28 patients who underwent urokinase instillation; they recovered after thoracotomy. In three (10.7%) patients, partial resolution was observed. One patient died of sepsis and pleural hemorrhage. Mean hospital stay after urokinase was 10.7 (range: 6-17) days. In the thoracotomy group, all patients recovered completely. No deaths occurred. Postoperative complications were incisional infection in two patients, atelectasis in one and reoperation after hemorrhage in one. Mean hospital stay after surgery was 9.5 (5-19) days. The ESS of cases operated on was lower postoperatively (0.3 versus 0.8). CONCLUSION Continued conservative therapy risks morbidity and mortality. Thoracotomy-decortication can be used successfully and must remain the preferred method in the treatment of multiloculated pediatric empyema.
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Affiliation(s)
- Akin Eraslan Balci
- Department of Thoracic & Cardiovascular Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
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Ulkü R, Eren S, Balci A, Ozçelik C, Eren MN. [Penetrating heart wounds. An analysis of 29 cases]. Ulus Travma Derg 2001; 7:172-5. [PMID: 11705219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Twenty-nine cases, penetrating wounds to the heart, who were operated in the thoracic and cardiovascular surgery department of our University during January 1995-August 2000 were reevaluated. Twenty nine patients were men and the mean age was 22.6 (min 12, max 45). The cause of injury was stab wounds in 28 cases and gunshot wounds in 1 case. Besides the clinical findings; teleradiography, echocardiography were valuable for the diagnosis. Surgery was applied in emergent conditions for all cases. Interventions were performed 28 anterolateral thoracotomy, 1 bilaterally anterolateral thoracotomy and additionally 4 laparatomy were performed. The most frequent side of injury was right ventricule. Our mortality ratio was 17.2%, morbidity ratio 17.2%. We think that fast transportation, urgent diagnostic study and immediate surgical intervention important parameters which decrease of the mortality.
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Affiliation(s)
- R Ulkü
- Dicle Universitesi Tip Fakültesi Göğüs Kalp ve Damar Cerrahisi ABD Diyarbakir
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