Beneficial effects of fibrin glue on esophageal perforation.
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Biomedical subjects
H Karagöz
Publications and source records attributed to H Karagöz.
Risk factors of reoperations for prosthetic heart valve dysfunction in the ten years 1984-1993.
From January 1984 to December 1993 a total of 154 patients (89 men and 85 women) required 160 reoperations for prosthetic heart valve dysfunction. Four patients required a second, two patients a third reoperation. Age was (mean +/- SD [range]) 38.8 +/- 10.2 (17 to 64) years. The primary operation was mitral valve replacement in 105 patients, aortic valve replacement in 20, and both aortic and mitral valve replacement in 29. The time interval between initial valve replacement and reoperation was 66.4 +/- 40 (3 to 288) months for the mechanical prostheses and 68.7 +/- 32 (24 to 140) months for bioprostheses; the difference was not statistically significant. Primary tissue failure was the most common cause of the reoperation for bioprostheses and valve thrombosis for mechanical prostheses. The hospital mortality rate was significantly higher in the replacement of mechanical prostheses (14/58 = 24.1% vs. 7/102 = 6.8%, p = 0.004). Low preoperative functional capacity and valve thrombosis were linked to higher mortality rates. It is discussed that monoleaflet mechanical valves yielded the highest operative mortality and that, excluding these, the risk of mortality in prosthetic valve reoperations today does not differ much from that in primary valve replacements.
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Comparison of the early results of coronary artery bypass grafting with and without extracorporeal circulation.
To compare the safety and efficacy of coronary artery bypass grafting without using extracorporeal circulation with standard cardiopulmonary bypass technique, based on certain early postoperative criteria, we designed a fully randomized and prospective study on two similar groups of 25 patients (off-pump and on-pump groups). The groups were compared for hemodynamic data (cardiac index, systemic vascular resistance, left- and right-ventricular stroke-work indices, inotropic and mechanical support needs) and enzyme levels (CK-MB and SGOT), as well as mortality, perioperative infarction rate, homologous transfusion requirements, and the symptomatology in the first follow-ups. There was no mortality or perioperative myocardial infarction in either group. Inotropic (25% vs. 4%) and mechanical (4% vs. 0) support requirements and homologous blood consumption (percentages of patients that needed no transfusion: 20% vs. 72%) were greater in the on-pump group. Results were otherwise similar. It is concluded that, in technically suitable cases, off-pump coronary artery bypass surgery is as safe and efficient as the standard on-pump technique and can be used in particular when cannulation, hypothermia, or cardiopulmonary bypass must be avoided. With these properties, this technique could take an important place in the cardiac surgeon's armamentarium.
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Complicated retinal migraine.
Retinal migraine is not uncommon, but permanent sequelae are rare. We describe the case of a 23-year-old woman who had suffered from retinal migraine for five years. After a typical migraine attack a left nasal quadranopsia persisted. Fluorescein angiography showed a branch retinal arterial occlusion. Other causes were ruled out by appropriate laboratory techniques. Her visual field defect has persisted for eleven months.
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Heparin need of the patients with cyanotic congenital heart disease during cardiopulmonary bypass. Comparison of cyanotic, acyanotic, rheumatic and atherosclerotic subjects.
Four groups of patients were studied. Group I: Congenital cyanotic heart disease (CCHD), consisting of 24 subjects aged 5 to 28 (1.4); 18 males and 4 females. Group II: Acyanotic congenital heart disease (ACHD), consisting of 34 patients aged 5 to 42 (20.1); 17 males and 17 females. Group III: Rheumatic heart disease (RHD), consisting of 30 patients aged 11-54 (42.4); 9 males and 21 females. Group IV: Atherosclerotic heart disease (AHD), consisting of 35 patients aged 36 to 65 (49.2); 33 males and 2 females. The haematocrit value (Hct) was the highest in the CCHD group. Total amount of heparin (mg/kg) used during cardiopulmonary bypass was 5.4 in CCHD, 4.66 in ACHD, 4.8 in RHD and 4.6 in AHD group. Mean protamine values was 4.02; 4; 4.03; and 4 respectively. Although the difference of Hct value was statistically different between CCHD and RHD group (p less than 0.001), heparin need was not (p less than 0.1). One-way analysis of variance (F test) showed no difference for heparin need between the four groups (F3.119 = 0.64). Prothrombin time (PT) and activated partial thromboplastin time (aPTT) showed a positive correlation (r = 0.36 and r = 0.25) with heparin need in CCHD group but no correlation was found in RHD group.
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