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Biomedical subjects

Umit Ozyurda

Publications and source records attributed to Umit Ozyurda.

12 recordsLinked to original sources
PubMed2006

The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial.

OBJECTIVE: Acute renal failure remains a common and serious complication of cardiac surgery. In this randomized trial, we aimed to assess whether sodium nitroprusside (SNP) infusion during cardiopulmonary bypass (CPB) could prevent renal dysfunction after coronary artery bypass grafting (CABG) surgery. METHODS: Between October 2004 and May 2006, 240 consecutive patients with stable angina undergoing elective CABG for multi-vessel coronary artery disease were prospectively randomized into control (n=116, 72 men, mean age 61.3+/-9.7 years) or SNP groups (n=124, 81 men, 60.8+/-10.8 years). SNP group received SNP after initiation of rewarming period during CPB at a dose of 0.1mg/kg/h and the infusion was concluded by weaning from CPB. The anesthetic and CPB regimes were standardized. Blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), creatinine clearance (C(Cr)), urine output, serum cardiac specific troponin I (cTnI), creatine kinase cardiac isoenzyme (CKMB), and CPK were measured preoperatively and daily until day 5 after surgery. RESULTS: There were no differences in baseline levels of BUN, SCr, eGFR, C(Cr), cTnI, CKMB, CPK levels and EuroSCORES between the groups. Although the durations of cross clamp, CPB times, and postoperative cardiac enzymes were similar in both groups; in the control group, there was a significantly lower urine excretion during CPB (p=0.002) and the operation (p=0.041). Peak postoperative SCr levels were significantly (p=0.001) lower in the SNP group than in the control group (1.29+/-0.28 vs 1.42+/-0.34mg/dl). The incidence of >or=50%DeltaSCr was significantly higher in the control group when compared with the SNP group (35.3 vs 13.7%, p<0.001). Development of new C(Cr) less than 50ml/min postoperatively was significantly higher in the control group compared with the SNP group (14 vs 38%, p<0.001). CONCLUSION: SNP administration during rewarming period of non-pulsatile CPB in patients undergoing CABG surgery is associated with improved renal function compared with conventional medical treatment providing adequate preload and mean arterial pressures.

Acute Kidney Injury↗
PubMed2006

Autologous bone-marrow mononuclear cell implantation for patients with Rutherford grade II-III thromboangiitis obliterans.

BACKGROUND: This study investigated the efficacy and safety of autologous bone marrow-mononuclear cells (ABMMNC) implantation in patients with critical limb ischemia (CLI) due to thromboangiitis obliterans (Buerger's disease). METHODS: The study comprised 28 patients (25 men and 3 women) with a median age of 44 years (range, 25-54 years) who had thromboangiitis obliterans and unilateral critical limb ischemia, defined as ischemic rest pain in a limb with or without nonhealing ulcers. The patients received multiple injections of erythrocyte-depleted and volume-reduced ABMMNC into the gastrocnemius muscle, the intermetatarsal region, and the feet dorsum (n = 26) or forearm (n = 2) vs saline injections into the less ischemic contralateral limbs. The patients were nonresponders to previous Iloprost infusion and smoking cessation >or=6 months and were not candidates for nonsurgical or surgical revascularization. Primary end points were the total healing of the most important lesion while avoiding major or minor amputation, the relief of rest pain without the need for analgesics from baseline to 6 months' follow-up, and the safety and feasibility of the treatment. Secondary end points were the changes in ankle-brachial pressure index and peak walking time, the angiographic evidence of collateral vessel formation or remodeling, and the quality-of-life assessment. Two investigators blinded for treatment assignment performed image analyses. RESULTS: Unilateral intramuscular administration of ABMMNC was not associated with any complications. The mean follow-up time was 16.6 +/- 7.8 months (range, 7.6 to 33.8 months). Only one patient required toe amputation during follow-up. A change in the ankle-brachial pressure index >0.15 was achieved in 8 patients at 3 months and in 14 patients at 6 months compared with baseline values. At 6 months, patients demonstrated a significant improvement in rest pain scores (P < .0001), peak walking time (P < .0001), and quality of life (P < .0083). Total healing of the most important lesion was achieved in 15 patients (83%) with ischemic ulcers, and relief of rest pain without the need of narcotic analgesics improved in all patients. Digital subtraction angiography studies before and 6 months after the ABMMNC implantation showed vascular collateral networks had formed across the affected arteries in 22 patients (78.5%). CONCLUSIONS: ABMMNC implantation could be a safe alternative to achieve therapeutic angiogenesis in patients with thromboangiitis obliterans and critical limb ischemia refractory to other treatment modalities.

Adult↗
PubMed2006

Effect of posterior pericardial drainage on the incidence of pericardial effusion after ascending aortic surgery.

OBJECTIVE: Pericardial effusion and cardiac tamponade after ascending aortic surgery are higher than anticipated after cardiac surgery. We evaluated a thin closed-suction drain system to prevent posterior pericardial effusion in patients undergoing ascending aortic surgery. METHODS: One hundred forty patients who underwent ascending aortic surgery were prospectively randomized into group A and group B. In group A (n = 70) we used a 32F drain placed anteriorly overlying the heart and a 16F thin drain placed retrocardially. In group B (n = 70) only a 32F drain placed anteriorly was used. In group A we removed the large drain on the first postoperative day and continued drainage with the thin drain until the drainage was less than 50 mL in a 24-hour period. In group B we removed the drain after the first postoperative day when the drainage was less than 50 mL in an 8-hour period. Preoperative, perioperative, and postoperative parameters of the patients were compared. RESULTS: No significant posterior pericardial effusion and late cardiac tamponade developed in patients in group A. In group B 10 (14.3%) patients experienced significant posterior pericardial effusion and 4 (5.7%) patients experienced late cardiac tamponade; the incidence of significant pericardial effusion in group B was significantly higher (P = .001). Postoperative new-onset atrial fibrillation developed in 6 (10.4%) patients in group A and in 18 (32.7%) patients in group B (P = .03). CONCLUSIONS: We demonstrated that effective posterior drainage is important to prevent posterior pericardial effusion, and use of a thin drain placed retrocardially appears to be sufficient for these results.

Adult↗
PubMed2006

Regenerative medicine for cardiovascular disorders-new milestones: adult stem cells.

Cardiovascular disorders are the leading causes of mortality and morbidity in the developed world. Cell-based modalities have received considerable scientific attention over the last decade for their potential use in this clinical arena. This review was intended as a brief overview on the subject of therapeutic potential of adult stem cells in cardiovascular medicine with basic science findings and the current status of clinical applications. The historical perspective and basic concepts are reviewed and a description of current applications and potential adverse effects in cardiovascular medicine is given. Future improvements on cell-based therapies will likely provide remarkable improvement in survival and quality of life for millions of patients with cardiovascular disorders.

Adult↗
PubMed2004

Oral thyroid hormone pretreatment in left ventricular dysfunction.

OBJECTIVE: The aim of the present study was to determine whether pretreatment with oral thyroid hormone had beneficial effects in cardiac function and morbidity and mortality after cardiac operations. METHODS: Eighty patients undergoing coronary artery bypass grafting with a preoperative left ventricular ejection fraction (LVEF) less than 30% scheduled for elective coronary bypass grafting agreed to participate in this prospective, randomized trial. The triiodothyronine (T(3)) (Group I) and control groups (Group II) were equally divided. Patients randomized to the T(3) group received T(3) 125 microg/day orally for 7 days preoperatively and from the first postoperative day till the discharge. Outcome variables included perioperative hemodynamic data, inotropic requirements, morbidity and mortality. Hemodynamic data were collected before induction of anesthesia and following every 4 h. The thyroid profile was determined upon admission, after the induction of anesthesia, 5 min after the start of cardiopulmonary bypass (CPB) and after hourly intervals and after 24th hour, at 24h intervals till the 120th hour. RESULTS: There were 6 deaths, three in each group. Patients in the T(3) group demonstrated a higher cardiac index than patients in the placebo group in the entire post-CPB periods (P<0.01). Mean inotropic requirements remained lower in the T(3) group than in the placebo group (P<0.001). CONCLUSIONS: Although our study stresses the benefits of oral T(3) administration on the hemodynamic and prognostic parameters in patients with impaired left ventricular function and undergoing CABG weakly, it may warrant further much larger scaled studies that can reach statistical significance.

Administration, Oral↗
PubMed2004

Efficiency of L-arginine enriched cardioplegia and non-cardioplegic reperfusion in ischemic hearts.

OBJECTIVE: Endothelial dysfunction with decreased nitric oxide (NO) levels has been implicated on reperfusion injury. Although L-arginine has been shown to diminish reperfusion injury in in vitro studies, clinical studies were very limited. METHODS: Forty patients with acute myocardial ischemia undergoing CABG were randomized to a study and a control group. L-Arginine was added to cardioplegia solutions in study group. A non-cardioplegic warm blood solution with 8 mmol/l L-arginine infused for controlled reperfusion. Control patients received same protocol without L-arginine. Myocardial O2, lactate, nitrite and malondialdehyde extractions were measured in addition to calculation of CK-MB/CPK ratio and hemodynamic data. RESULTS: While there was no mortality in study group, one patient in control group died. Overall and nitrite (P=0.01) and lactate extractions (P=0.04) was higher in study and control groups, respectively. Myocardial O2 uptake was higher and malondialdehyde extraction was lower in study group. CK-MB/CPK ratio at postoperative sixth hour was also significantly lower in study group. Ninety percent of the study group had spontaneous return of the sinus rhythm, while 80% of the control patients required defibrillation (P<0.0001). In addition to significantly better hemodynamics, perioperative myocardial infarction incidence was lower (P=0.037), the length of intensive care unit (P=0.009) and hospital (0.014) stays were shorter in study group. CONCLUSIONS: Use of L-arginine for protection of acutely ischemic myocardium appears to be a safe technique. L-Arginine supplementation increased NO levels and attenuated free O2 radical mediated myocardial injury. Controlled reperfusion with l-arginine enriched non-cardioplegic blood could be a new therapeutic entity to diminish ischemia/reperfusion injury.

Adult↗
PubMed2004

Effect of carbon dioxide insufflation on free internal thoracic artery flows: is it a vasodilator?

BACKGROUND: This study was conceived to evaluate the effect of carbon dioxide insufflation on free internal thoracic artery flows. METHODS: We studied 56 consecutive patients who underwent coronary artery bypass grafting in which the left internal thoracic artery was anastomosed to the left anterior descending artery. The first 26 consecutive internal thoracic arteries were harvested as a pedicled graft (group 1), and the next 30 consecutive internal thoracic arteries were dissected by using the carbon dioxide insufflation technique (group 2). The internal thoracic artery harvesting was performed by 2 experienced surgeons by using the same instrumentation and technique. First, free flows of the internal thoracic arteries were registered after distal cutting of the vessel in both groups. After the first measurements, diluted papaverine was sprayed on the internal thoracic artery pedicle only in group 1, and then second measurements were registered after 15 minutes in both groups. Hemodynamic parameters were recorded with each measurement. RESULTS: The first free flow measurement was significantly higher in the carbon dioxide-insufflated internal thoracic arteries (group 2, 60 +/- 32 mL/min; group 1, 28 +/- 19 mL/min; P <.05). Although the second free flow measurement of the carbon dioxide-insufflated group was higher than in group 1, the difference was not statistically significant (68 +/- 46 mL/min vs 53 +/- 32 mL/min; P =.53). CONCLUSIONS: Carbon dioxide insufflation of the internal thoracic artery is an efficient technique to increase the flow and seems to be safe, simple, and reliable. When the internal thoracic artery is harvested in a carbon dioxide-insufflated fashion, arterial spasm and reduced early flow may be avoided, even without vasodilator agents such as papaverine.

Carbon Dioxide↗
PubMed2003

Surgery for cardiac hydatid disease: an Anatolian experience.

OBJECTIVE: The purpose of this study was to describe the clinical/pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit and other hospitals of Anatolia over a fifteen-years period. METHODS: Between 1984 and 2001, fifty cases of surgically treated cardiac hydatid disease were identified by systematic literature search from Anatolia. Twelve patients were operated at the Department of Cardiovascular Surgery, Ankara University within the same period. Overall thirty-nine patients were female (mean age 29.8+/-14 years). Sixty-three percent of patients were complaining of dyspnea at the time of referral to the hospital and 22% presented with signs of acute coronary syndrome. RESULTS: The most common cardiac location was the left ventricle (46.7%) followed by the interventricular septum, the right ventricle and atria. The most common procedure was controlled puncture and aspiration of the cyst content, its excision and closure of the resulting cavity, which were performed under cardiopulmonary bypass. Overall Anatolian operative mortality was 4.8% (3 patients). No late deaths but recurrence in one patient have occurred. CONCLUSION: In view of the lack of efficient alternative treatment options, we recommend surgical intervention even in asymptomatic patients in order to prevent the occurrence of lethal complications.

Adolescent↗
PubMed2003

[Alternative approaches in the end-stage heart failure].

Cardiac transplantation has emerged as the therapeutic procedure of choice for patients with end-stage heart disease but the availability of donor organs remains major limiting factor allowing only 1% of the candidates actually become transplant recipients. New therapeutic strategies are under intensive research for patients who do not meet patient selection criteria for transplantation or who suffer from donor organ shortage. Even though there are significant developments in the medical treatment of cardiac failure, the prognosis of this condition continues to be poor. The 20-40% of the candidates for cardiac transplantation die while they are included in the waiting list. Twenty percent mortality has been reported within the first year of transplantation with additional yearly mortality of 5% following the first year. Financial constraints, complications of immunosuppression and functional failure of the transplanted hearts are other limiting factors. This has brought up the necessity to search for alternative surgical treatment methods besides increasing the waiting periods of transplant candidates. The aim of this report is to summarize other currently available therapeutic alternatives for patients with end-stage cardiac disease.

Heart Failure↗
PubMedDate not supplied

Primary benign schwannoma of the heart.

We report herein a case of a 61-year-old woman who was found to have a mass adjacent to the left atrium. The tumor was resected giving least damage to the left atrium on cardiopulmonary bypass with a subsequent histological diagnosis of a schwannoma. Neurogenic tumors comprise 10% to 34% of mediastinal tumors. Nerve sheath tumors are more common in adults than in children, and these are equally malignant in children and adults. Nerve sheath tumors of the heart are extremely rare. Although there are many malignant cardiac neurilemomas reported, only a few cases of benign schwannomas have been reported. We describe a rare primary benign schwannoma of the left atrium.

Biomarkers, Tumor↗