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    Aspirin versus clopidogrel for synthetic graft patency after peripheral arterial bypass grafting
    (Taylor & Francis Inc, 2001) Duran, E; Canbaz, S; Ege, T; Acipayam, M
    [Abstract Not Available]
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    Assessment of digital ischaemia and evaluation of response to therapy by 99mTc sestamibi limb scintigraphy after local cooling of the hands in patients with vasospastic Raynaud's syndrome
    (Lippincott Williams & Wilkins, 2004) Sarikaya, A; Ege, T; Firat, MF; Duran, E
    Aim Cold induced arteriolar constriction in patients with vasospastic Raynaud's syndrome (VRS) produces temporary digital ischaemia. The aim of this study was to ascertain whether Tc-99m sestamibi scintigraphy is useful in the diagnosis and the monitoring of treatment in VRS. Methods Fifteen patients with VRS and 20 matched normal controls underwent examination. Twelve patients with VRS received therapy. For each patient one hand was immersed in iced water for 30s while the other hand served as a control. Ten minutes after cooling, Tc-99m sestamibi was injected and imaging was performed 60 min later. The per cent decrease of the perfusion (%DP) was calculated by semiquantitative analysis to determine the severity of hypoperfusion. Results In all patients with VRS, moderate or marked hypoperfusion were seen in (TC)-T-99m sestamibi images after exposure to the iced water, while there was minimal or mild hypoperfusion in the control groups. Values for %DP were 46.86 +/- 19.04 and 7.85 +/- 4.53 for the VRS group and normal subjects, respectively. The difference between both groups was statistically significant (P = 0.0000). In 12 treated patients with VRS, pre-treatment and post-treatment %DP values were 51.16 +/- 18.42 and 33.58 +/- 17.83, respectively, and a significant difference was seen between both values (P = 0.001). However, there was still a statistically significant difference between control subjects and post-therapy values (7.85 +/- 4.53 vs. 33.58 +/- 17.83, P = 0.0000). The +/- 95% confidence interval of DIP for control subjects was 5.7-10% (chi-squared, P = 0.000). When a DIP of 10% was used as a cut-off point, sensitivity, specificity and diagnostic accuracy were 100%, 70% and 83%, respectively, for the Tc-99m sestamibi scan. There was also a strong correlation between %DP and the duration of the disease (r = 0.80, P = 0.0003). Conclusion The results of this study indicate that a Tc-99m sestamibi scan is a valuable imaging method for the determination of digital ischaemia in vasospastic Raynaud's syndrome, and may play a role in evaluating the response to therapy. (C) 2004 Lippincott Williams Wilkins.
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    Atherosclerosis and peripheral neurological problems
    (Int Heart Journal Assoc, 2004) Canbaz, S; Turgut, N; Halici, U; Ege, T; Duran, E
    [Abstract Not Available]
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    Bilateral retrosternal dislocation and hypertrophy of medial clavicular heads with compression to brachiocephalic vein
    (Edizioni Minerva Medica, 2003) Ege, T; Canbaz, S; Pekindil, G; Duran, E
    A 36-year-old woman with effort dyspnea for 2 years, venous congestion of the left arm for 6 months and who did not have a history of a thoracic trauma was hospitalized. Posterior bilateral dislocation of the sternoclavicular joints and compression of the brachiocephalic vein were diagnosed and conformed by computed tomography (CT). The joint could not be reduced because of the old dislocation and destruction of the joint in the operation. The heads of the clavicles were resected and the vein compression was eliminated. Six weeks later, venous congestion disappeared and the brachiocephalic vein was patent.
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    Cytokine response in lower extremity ischaemia/reperfusion
    (Sage Publications Ltd, 2004) Ege, T; Us, MH; Sungun, M; Duran, E
    We studied the local and systemic concentrations of pro-inflammatory cytokines produced during acute lower extremity ischaemia and following reperfusion in 19 patients undergoing thromboembolectomy of the femoral artery. Blood samples were taken from the femoral vein (local response) and radial artery (systemic response) in the ischaemic (baseline) phase, and 2, 12 and 24 h post-reperfusion. Associated lung injury was measured by the alveolar-arterial (A-a) oxygen gradient and post-reperfusion femoral vein plasma concentrations of creatinine kinase and lactic dehydrogenase were also measured. Local and systemic concentrations of interleukin (IL)-2 receptor and IL-6 (but not IL-1beta) increased significantly after reperfusion. IL-8 concentration increased significantly in the radial artery. The high and progressively increasing concentration of IL-6 in the femoral vein suggests local production. The parallel increase in creatinine kinase concentration and A-a oxygen gradient indicates that IL-6 plays an important role in acute arterial occlusion and reperfusion injury.
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    Effect of obesity on risks after coronary artery bypass grafting
    (Mosby-Elsevier, 2004) Canbaz, S; Ege, T; Halici, U; Duran, E
    [Abstract Not Available]
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    Effect of pericardial fluid pro-inflammatory cytokines on hemodynamic parameters
    (Academic Press Ltd Elsevier Science Ltd, 2003) Ege, T; Canbaz, S; Yuksel, V; Duran, E
    We investigated the effects of pro-inflammatory cytokines of pericardial fluid on hemodynamic parameters in patients undergoing coronary artery surgery. Seventy-eight patients were included in the study and they were allocated to three groups: group I, stable angina pectoris (SAP, n = 15); group 2, unstable angina pectoris (USAP, n = 34); group 3, post-myocardial infarction (PMI, n = 29). Pericardial fluid and arterial blood samples were obtained from all patients and interleukin (IL)-1beta, IL-2 receptor, IL-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha) levels were measured. Pericardial IL-1beta concentration (pg/mL) was significantly higher in the USAP group (26.6 +/- 10.9) compared to the SAP (5.0 +/- 0.1) and PMI (5.8 +/- 1.0) groups. IL-2R, IL-6, IL-8 and TNF-a concentrations of pericardial fluid were significantly higher than serum in all groups; difference was more prominent in the PMI group compared to the SAP and the USAP groups. Serum IL-1beta concentrations (pg/mL) were significantly higher in the USAP group (21.8 +/- 3.4) compared to the SAP group (5.0 +/- 0.1) and the PMI group (5.4 +/- 11.6). Cardiac index (CI) before opening the pericardial sac was found to be lower in the USAP group (1.6 +/- 0.3 L/min/m(2)) compared to the SAP (2.2 +/- 0.5 L/min/m(2)) and the PMI (2.1 +/- 0.5 L/min/m(2)) groups (p = 0.028 and p = 0.011, respectively). In the USAP group, there was a relationship between reduction of CI and increase of IL-1beta levels in serum and pericardial fluid. (C) 2003 Elsevier Ltd. All rights reserved.
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    The effects of cardiopulmonary bypass on androgen hormones in coronary artery bypass surgery
    (Cambridge Med Publ, 2002) Canbaz, S; Ege, T; Sunar, H; Cikirikcioglu, M; Acipayam, M; Duran, E
    The effects of testosterone on coronary vasomotor regulation have been described by several recent reports. Here we investigated changes in serum androgen levels during and after cardiopulmonary bypass (CPB) in patients who had undergone coronary artery bypass surgery. Serum luteinizing hormone, free testosterone and dihydroepiandrestenedione sulphate (DHEA sulphate) levels were evaluated in 38 male coronary artery bypass surgery patients using a chemical immunoassay technique. All hormone levels were corrected to account for haemodilution. Serum-free testosterone level decreased significantly during weaning from CPB (from 15.7 +/- 4.2 nmol/l to 6.2 +/- 2.8 nmol/l), and an even greater decrease was observed in the first post-operative day (5.4 +/- 3.1 nmol/l). On the seventh post-operative day, free testosterone levels reached a normal value (11.8 +/- 5.5 nmol/l), although they were still significantly lower compared with the pre-operative value. There were slight alterations in serum DHEA sulphate levels, although the only significant decrease occurred from the first to the seventh day post-operation (from 4.7 +/- 2.2 pmol/l to 3.7 +/- 1.8 pmol/l, respectively). Serum luteinizing hormone levels were decreased during weaning from CPB (from 4.8 +/- 2.1 mIU/ml to 3.9 +/- 1.8 mIU/mI), but increased rapidly to the pre-operative value (5.5 +/- 2.5 mIU/ml) at the first post-operative day. These results show that CPB affects serum luteinizing hormone, free testosterone and dihydroepiandrestenedione sulphate levels. The free testosterone level decreases significantly both during and after CPB surgery.
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    The effects of intracoronary administration of vitamin E on myocardial ischemia-reperfusion injury during coronary artery surgery
    (Georg Thieme Verlag Kg, 2003) Canbaz, S; Duran, E; Ege, T; Sunar, H; Cikirikcioglu, M; Acipayam, M
    Background: Vitamin E has a strong antioxidant capacity, and has been used in several ischemia-reperfusion studies. The aim of this study was to investigate the effects of water-soluble vitamin E (alpha-tocopherol) on myocardial protection during coronary artery surgery. Methods: Water soluble vitamin E (100mg) in tepid saline (n = 14) or tepid saline alone (n = 16) was administered into the coronary arteries at the end of aortic cross-clamping. Cardiac troponin-1 (cTn-1), MB-isoenzyme of creatine kinase (CK-MB), myoglobin, blood gas, and lactate levels in systemic and coronary sinus blood and hemodynamic variables were assessed during and after the operation. Results: Eight hours after reperfusion, cTn-1 levels increased to 3.06 +/- 1.8 ng/ml and 6.97 +/- 3.9 ng/ml in the vitamin E group and control group, respectively (p = 0.01). Coronary sinus lactate concentration was 2.68 +/- 0.5 mmol/l in the vitamin E group and 4.01 +/- 1.5 mmol/l in the control group 60 minutes after reperfusion (p = 0.027). Conclusions: Administration of vitamin E into the coronary arteries before removal of the aortic cross-clamp can reduce myocardial cell injury and protect the myocardium from ischemia-reperfusion injury.
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    Evaluation of leg muscle perfusion by 99mTc sestamibi scintigraphy in patients with unileteral chronic venous insufficiency and acute deep venous thrombosis
    (Springer, 2004) Pekindil, G; Sarikaya, A; Ege, T; Salihoglu, S
    [Abstract Not Available]
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    False aneurysm of the radial artery with sharp injury of the brachial artery, median and ulnar nerves - An unusual presentation
    (Edizioni Minerva Medica, 2004) Canbaz, S; Ege, T; Eray, IC; Duran, E
    [Abstract Not Available]
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    The importance of aprotinin and pentoxifylline in preventing leukocyte sequestration and lung injury caused by protamine at the end of cardiopulmonary bypass surgery
    (Georg Thieme Verlag Kg, 2004) Ege, T; Arar, C; Canbaz, S; Cikirikcioglu, M; Sunar, H; Yuksel, V; Duran, E
    Background: Protamine has adverse effects on pulmonary gas exchange during the postoperative period. The objective of this study was to investigate the importance of aprotinin and pentoxifylline in preventing the leukocyte sequestration and lung injury caused by protamine administered after the termination of cardiopulmonary bypass (CPB). Methods: Participants (n = 39) were allocated into three groups at the termination of CPB: Group 1, (control group, n = 16); Group 2 (aprotinin group, n = 12), who received protamine + aprotinin (15 000 IU/kg); and Group 3 (Pentoxifylline group, n = 11), who received protamine + pentoxifylline (10 mg/kg). Leukocyte counts in pulmonary and radial arteries were determined after the termination of CPB and before any drug was given (t(1)), and 5 minutes (t(2)), 2 hours (t(3)), 6 hours (t(4)) and 12 hours (t(s)) after the administration of protamine. Alveolar-arterial O-2 gradient (A-aO(2)) and dynamic pulmonary compliance were measured at t(1), t(2) and t(3). Results: In the control group, an increase in pulmonary leukocyte sequestration was observed 5 minutes and 2 hours after protamine administration, after which this difference disappeared. No significant degree of pulmonary sequestration was detected in any measurements after protamine was administered in the aprotinin and pentoxifylline (PTX) groups. Dynamic lung compliance was 50.1, 45.2 and 47.2 ml/cm H2O in the control group, 49.2, 61.1 and 56.3 ml/ cm H2O in the aprotinin group, and 49.5, 54.5 and 50.4 ml/cm H2O in the PTX group. The A-aO(2) gradient was 212.2, 263.3 and 254.3 mmHg in the control group, 209.4, 257.1 and 217.3 mmHg in the aprotinin group, and 211.3, 260.8 and 219.2 mmHg in the PTX group. Conclusion: Aprotinin and PTX treatments have favourable effects on lung function by reducing protamine-induced leukocyte sequestration into lungs at the end of CPB.
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    Importance of internal mammary artery perfusion in cardiac ischemia and reperfusion
    (Sage Publications Ltd, 2003) Ege, T; Eskiocak, S; Yuksel, V; Taskiran, A; Duran, E
    Purpose: Our purpose was to investigate the changes in antioxidant defense systems due to internal mammary artery (IMA) perfusion during coronary artery bypass graft (CABG) operations in which proximal anastomoses were completed under partial bypass with the aid of a side-biting clamp. Material and Method: Twenty-five patients to be studied were divided into two groups according to the criterion of whether during proximal anastomoses left internal mammary artery (LIMA) perfusion was applied (n = 15, LIMA group) or not (n = 10, non-LIMA group). The erythrocyte catalase (CAT), superoxide dismutase (SOD), serum lipid peroxidation (LPO) products and whole blood reduced glutathione (GSH) levels were measured in the blood samples taken from the coronary sinus before cardiopulmonary bypass (CPB) (t(1)), before declamping (t(2)), at the 5th min after declamping (t(3)) at the 5th (t(4)) and 15th (t(5)) min after removing the side-biting clamp. Results: While erythrocyte CAT enzyme activity decreases in both groups after the basal measurements, no significant difference was detected between the groups. Although the GSH levels did not differ at t(1), t(2) and t(3), they were found to be higher in the LIMA group at t(4) (p = 0.006) and t(5) (p = 0.021). The erythrocyte SOD enzyme activity decreased after the basal measurements in both groups, but this reduction was less in the LIMA group at t(4) (p = 0.034) and t(5) (p = 0.018) compared to the other group. LPO products rose in both groups when reperfusion started after declamping. The levels of LPO products were significantly higher at t(4) and t(5) in the non-LIMA group than the other group (p = 0.011 and p = 0.008). Conclusion: If proximal anastomoses of coronary grafts are completed under partial bypass, permitting LIMA perfusion during this procedure will be beneficial to antioxidant defense systems.
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    The importance of intrapericardial drain selection in cardiac surgery
    (Elsevier, 2004) Ege, T; Tatli, E; Canbaz, S; Cikirikcioglu, M; Sunar, H; Ozalp, B; Duran, E
    Introduction: To explore the impact of intrapericardial and infracardiac drains on pericardial effusions in cardiac surgery. Materials and methods: Patients undergoing coronary artery bypass grafting were randomized into two groups. At the end of the intervention, an intrapericardial and infracardiac Blake drain was placed in patients in group 1 (n = 97), and an intrapericardial and infracardiac semirigid drain was placed in patients in group 2 (n = 105). In addition, a semirigid drain was placed into mediastinum in all cases. The amount of drainage was calculated at six different time points postoperatively: postoperative 0 to 2 h, postoperative 2 to 4 h, postoperative 4 to 6 h, postoperative 6 to 12 h, postoperative 12 to 24 h, and postoperative 24 to 48 h. The amount of pericardial effusion was estimated by transthoracic echocardiography after the drains were removed. Results: In all measurements, the amount of drainage from intrapericardial Blake drains was higher, the total amount of drainage being equal to 330.7 +/- 29.4 mL and 193.2 +/- 19.6 mL in the Blake drain and semirigid drain groups, respectively (p = 0.000) [mean +/- SD]. When the drains were removed, the volume of pericardial effusion was 3.86 +/- 0.76 mm in Blake drain group and 7.59 +/- 1.16 mm in semirigid drain group (p = 0.000). The incidence of postoperative atrial fibrillation was 11.3% in the group with Blake drains, and 23.8% in the group with semirigid drains (p = 0.016). Conclusion: The more effective drainage obtained with infracardiac Blake drains compared to semirigid drains helps to reduce the amount of postoperative pericardial effusion and the risk of atrial fibrillation.
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    The importance of pulmonary artery circulation during cardiopulmonary bypass
    (Cambridge Med Publ, 2003) Ege, T; Canbaz, S; Cikirikcioglu, M; Arar, C; Edis, M; Duran, E
    This study sought to determine changes in transpulmonary difference in blood cells and alveolar-arterial oxygen (A-aO(2)) gradient when pulmonary artery circulation was obstructed in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Eighteen patients were divided into group A (control group; X-clamp placed on aorta, n = 9) and group B (pulmonary ischaemia group; X-clamp placed on aorta and pulmonary artery, n = 9). Haematological parameters were compared before CPB and up to 90 min after declamping. A-aO(2) gradient differences were compared before and 2 h and 6 h after declamping. A transpulmonary increase in leucocyte levels normalized after 60 min in group A but remained higher in group B. A transpulmonary increase in neutrophils normalized after 60 min in group A and 90 min in group B. Increased lymphocyte levels normalized after 30 min in group A and 90 min in group B. A-aO(2), gradient was determined as: group A (294.8 +/- 74.3) and group B (321.2 +/- 73.3) before X-clamping; group A (132.7 +/- 22.7) and group B (236.6 +/- 41.5) 2 h after declamping; and group A (72.2 +/- 22.7) and group B (189.4 +/- 88.9) 6 h after declamping. When pulmonary artery circulation was obstructed during the X-clamping period, leucocyte, neutrophil and lymphocyte sequestration within both lungs increased, and an increased A-aO(2) gradient was observed because of tissue damage. To prevent post-operative complications, precautions to maintain normal pulmonary artery circulation are recommended.
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    Importance of pulmonary artery perfusion in cardiac surgery
    (W B Saunders Co-Elsevier Inc, 2004) Ege, T; Huseyin, G; Yalcin, O; Us, MH; Arar, C; Duran, E
    Objective: To investigate the importance of pulmonary artery perfusion in cardiac surgery. Design: Prospective randomized study. Setting: University hospital. Participants: Patients undergoing cardiac surgery. Interventions: Patients in whom the cross-clamp was applied only to the aorta were defined as group 1 (n = 11) and patients in whom the cross-clamp was applied to both the aorta and pulmonary artery were defined as group 2 (n = 11). Measurement and Results: Tissue samples obtained from the lower lobe of the left lung before CPB, 20 minutes after cross-clamping, and 20 minutes after declamping were examined under light and electron microscopes. Electron microscopic examination revealed changes in the blood-air barrier, epithelia[ cells, pneumocytes, and basal membrane were more prominent in group 2. Changes in the leukocyte, neutrophil, and lymphocyte counts of blood samples obtained from the right atrium and right superior pulmonary vein before CPB and 5, 30, 60, and 90 minutes after the removal of clamp were also investigated. The transpulmonary difference was statistically significant at 5 and 30 minutes after declamping in group 1. In group 2, transpulmonary differences continued to be significant at 5, 30, 60, and 90 minutes after declamping. There was no difference between groups in terms of PaO2/F1O2 ratio before CPB (group 1: 342.0 +/- 80.0 mmHg, group 2: 349.0 +/- 67.0 mmHg); however, a statistically significant difference was found between the groups 2 hours after declamping (group 1: 418.0 +/- 87.0 mmHg and group 2: 290.0 +/- 110.0 mmHg; p = 0.007). Conclusion: Pulmonary artery perfusion was found to be important in cardiac surgery. (C) 2004 Elsevier Inc. All rights reserved.