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Sungur MA, Zeren G, Yılmaz MF, Avcı İİ, Can F, Çetin T, Sungur A, Tezen O, Yücel E, Karagöz A, Okay T, Karabay CY. Endoscopic Thoracic Sympathectomy in the Treatment of Vasospastic Angina Resistant to Medical Therapy. Anatol J Cardiol 2024; 28:29-34. [PMID: 37842759 PMCID: PMC10796241 DOI: 10.14744/anatoljcardiol.2023.3484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND In this study, we aimed to investigate the clinical follow-up results of endoscopic thoracic sympathectomy (ETS) in the treatment of vasospastic angina (VSA) resistant to maximal medical therapy. METHODS A total of 80 patients with VSA who presented to our hospital between 2010 and 2022 were included in our study. Among them, 6 patients who did not respond to medical therapy underwent ETS. In-hospital and long-term clinical outcomes of patients who underwent ETS were recorded. RESULTS The median age of the patients with VSA was 57 [48-66] years, and 70% of the group were males. In the ETS group, compared to the non-ETS group, higher numbers of hospital admissions and coronary angiographies were observed before ETS (median 6 [5-6] versus 2 [1-3], P <.001; median 5 [3-6] versus 2 [1-3], P =.004, respectively). Additionally, while 2 patients (33.3%) in the ETS group had implantable cardioverter defib-rillator (ICD), only 2 patients (2.7%) in the non-ETS group had ICD (P =.027). Out of the 6 patients who underwent ETS, 2 were females, with a median age of 56 [45-63] years. Four patients underwent successful bilateral ETS, while 2 patients underwent unilateral ETS. During the follow-up period after ETS, only 3 patients experienced sporadic attacks (once in 28 months, twice in 41 months, and once in 9 years, respectively), while no attacks were observed in 3 patients during their median follow-up of 7 years. CONCLUSION It appears that ETS is effective in preventing VSA attacks without any major complications.
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Affiliation(s)
- Mustafa Azmi Sungur
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Gönül Zeren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Mehmet Fatih Yılmaz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - İlhan İlker Avcı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Fatma Can
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Tuğba Çetin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Aylin Sungur
- Department of Cardiology, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Ozan Tezen
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Enver Yücel
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Ali Karagöz
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
| | - Tamer Okay
- Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
| | - Can Yücel Karabay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, İstanbul, Türkiye
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Silav ZK, Sönmez C, Aydemir B, Yıldırım M, Okay T, Aker FV. Could cytology supplant frozen section for intraoperative evaluation of thoracic lesions? A single institutional experience in a developing country. Diagn Cytopathol 2023; 51:123-134. [PMID: 36181474 DOI: 10.1002/dc.25060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/16/2022] [Revised: 08/24/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The diagnostic performance of cytology was compared with the frozen results and its usability was evaluated as a rapid diagnosis method in intraoperative thoracic surgery in a single institution (Istanbul, Turkey). METHODS All 197 subsequent patient specimens (cases) from 158 patients who were sent to our department from the thoracic surgery clinic for an intraoperative diagnosis request between the years 2016 and 2021 were evaluated. Obtained results from frozen and cytology were compared with final paraffin section diagnoses. Lesions were grouped into three different groups as nonneoplastic, benign, and malignant neoplasms. RESULTS Diagnostic accuracy values of cytology and frozen sections in intraoperative consultation were 98.8% and 99.4%, respectively. Sensitivity values of cytology and frozen sections in intraoperative consultation were 96.3% and 98.7%, respectively. Specificity values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Negative predictive values of cytology and frozen sections in intraoperative consultation were 96.7% and 98.9%, respectively. Positive predictive values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Kappa statistics between cytology and frozen revealed a very high interrater reliability (Cohen's Kappa value: 0.911; p = .001; p < .01). The difficulty in distinguishing primary and metastatic carcinoma, which is mostly undecided in frozen sections and the definitive diagnosis is left to paraffin sections, seems also be a problem in the cytological examination. CONCLUSIONS Cytological diagnosis can be used in the evaluation of small biopsy specimens that require tissue preservation in intraoperative consultation, especially for immunohistochemical and advanced genetic studies.
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Affiliation(s)
- Zuhal Kuş Silav
- İstanbul Gelişim University, Occupational High School of Healthy Sciences, İstanbul, Turkey
| | - Cansu Sönmez
- Haydarpasa Numune Education and Research Hospital, Clinic of Pathology, Istanbul, Turkey
| | - Bülent Aydemir
- Siyami Ersek Chest, Heart and Vascular Surgery Education and Research Hospital, Clinic of Chest Surgery, Istanbul, Turkey
| | - Mehmet Yıldırım
- Siyami Ersek Chest, Heart and Vascular Surgery Education and Research Hospital, Clinic of Chest Surgery, Istanbul, Turkey
| | - Tamer Okay
- Siyami Ersek Chest, Heart and Vascular Surgery Education and Research Hospital, Clinic of Chest Surgery, Istanbul, Turkey
| | - Fügen Vardar Aker
- Haydarpasa Numune Education and Research Hospital, Clinic of Pathology, Istanbul, Turkey
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Dadaş E, Erdoğdu E, Toker A, Ersöz M, Okay T. Effectiveness of Video-Assisted Thoracoscopic Surgery in Undiagnosed Exudative Pleural Effusions. Turk Thorac J 2019; 20:188-191. [PMID: 30986175 DOI: 10.5152/turkthoracj.2018.18133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/01/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Undiagnosed pleural effusions mostly require histologic studies for a definite diagnosis. In addition, malignant pleural effusions responsible for a significant part of exudative pleurisy need palliative therapy The purpose of our study is to research the effectiveness of video-assisted thoracoscopic surgery in definitive diagnosis and palliative treatment of unexplained non-parapneumonic exudative pleural effusions. MATERIALS AND METHODS The study included 263 patients with non-parapneumonic exudative pleurisy, which could not be diagnosed by an initial clinical, radiological, biochemical, microbiological, and cytological investigation in three centers. All patients underwent video-assisted thoracoscopic surgery for definitive diagnosis between January 2002 and January 2018. Patients' data were retrospectively analyzed in terms of age, gender, symptoms, previously diagnosed cancers, computerized tomography of chest findings, histopathological diagnosis, cytological diagnosis, morbidity, mortality, and success rates of the procedure. Patient groups from the three centers were divided into three groups according to the center of the patient. The groups were compared statistically in terms of cytologic diagnosis rates. RESULTS The most common complaint was dysnea (66.5%). Of the 263 cases, 83 were previously diagnosed with cancer. The simple pleural effusion (66.5%) was the most frequent radiological finding. The success rate for definitive diagnosis was detected as 97%. Of all the cases, the rate of specific cytological diagnosis was detected to be 34%. The cytologic diagnosis rate was meaningfully lower in Group 1than in Groups2 and 3. The postoperative morbidity rate was detected as 9%. CONCLUSION Video-assisted thoracic surgery is not only a rapid and effective diagnostic method, but also a palliative therapeutic method. We think that it should be used immediately after initial diagnostic thoracentesis in undiagnosed exudative PEin the less experienced centers.
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Affiliation(s)
- Erdoğan Dadaş
- Department of Thoracic Surgery, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Eren Erdoğdu
- Department of Thoracic Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Miray Ersöz
- Department of Thoracic Surgery, University of Health Sciences İstanbul Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Tamer Okay
- Department of Thoracic Surgery, University of Health Sciences İstanbul Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Intepe OG, Yasaroglu M, Yardimci EH, Okay T. P3.04-040 A Rare Case of Intrathoracic Mass: Intrathoracic Desmoid Tumor. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Intepe OG, Yardimci EH, Guzey O, Okay T. P3.04-039 Solitary Fibrous Tumor of the Pleura Associated with Gynecomastia: A Case Report. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intepe OG, Yildirim M, Ustaalioglu R, Okay T. P1.06-002 Contralateral Axillary Lymph Node Metastasis of a Lung Cancer: A Case Report. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Hydatid disease rarely involves the aortic wall. We report a case of hydatidosis involving the ascending aorta and the left atrium. The patient underwent replacement of the ascending aorta with a prosthetic Dacron graft and left atrial cystectomy. At the 6-month follow-up, she was leading a normal life.
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Affiliation(s)
- Naz B Aydin
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Yildirim M, Ustaalioglu R, Erkan M, Ustaalioglu BBO, Demirbag H, Yasaroglu M, Dogusoy I, Okay T. The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences. Heart Surg Forum 2016; 19:E23-7. [DOI: 10.1532/hsf.1328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/13/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
Abstract
<strong>Background:</strong> Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. <br /><strong>Methods:</strong> We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. <br /><strong>Results:</strong> Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. <br /><strong>Conclusion:</strong> Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.
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Ustaalioğlu R, Yıldırım M, Coşgun H, Doğusoy I, İmamoğlu O, Yaşaroğlu M, Aydemir B, Okay T. Thoracic Traumas: A Single-Center Experience. Turk Thorac J 2015; 16:59-63. [PMID: 29404079 DOI: 10.5152/ttd.2015.4413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/22/2014] [Accepted: 11/19/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Trauma is currently among the most important health problems resulting in mortality. Approximately 25% of trauma-related deaths are associated with thoracic trauma. In the present study, morbidity and mortality rates and interventions performed in patients who had been treated as inpatients in Dr. Siyami Ersek Thoracic and Cardiovascular Surgery hospital after trauma were aimed to be evaluated. MATERIAL AND METHODS In our study, 404 patients who were treated as inpatients because of thoracic trauma between January 2005 and December 2008 were retrospectively evaluated. RESULTS The rates of blunt and penetrating trauma were 39.6% and 60.4%, respectively. In the study, 115 (28.4%) patients were noted to have pneumothorax, 99 (24.5%) had hemothorax, and 57 (14.1%) had hemopneumothorax. While tube thoracostomy was sufficient for treatment in approximately 80% of the patients, major surgical interventions were performed in 12.6% of the patients. Mortality rate was found to be 2.2%. CONCLUSION In patients with chest trauma, necessary interventions should be started at the time of the event, and the time from trauma to arriving at the emergency department should be made the best of. Mortality and morbidity rates in thoracic trauma cases may be reduced by timely interventions and effective intensive care monitoring.
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Affiliation(s)
| | - Mehmet Yıldırım
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
| | - Hatice Coşgun
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
| | - Ilgaz Doğusoy
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
| | - Oya İmamoğlu
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
| | - Murat Yaşaroğlu
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
| | - Bülent Aydemir
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
| | - Tamer Okay
- Clinic of Chest Surgery, Siyami Ersek Hospital, İstanbul, Turkey
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Abstract
OBJECTIVE The objective of this study was to evaluate and compare thoracoscopic sympathectomy and sympathicotomy at the third ganglia (T3) level for the treatment of primary palmar hyperhidrosis in terms of initial surgery results, complications, and patient satisfaction. MATERIALS AND METHODS Two groups of patient underwent T3 thoracoscopic sympathectomy and thoracoscopic sympathicotomy under general anesthesia using single-lung ventilation via a double-lumen endotracheal tube by the same surgical team for the treatment of severe primary palmar hyperhidrosis or a combination of levels for multiarea between 2008 and 2013. The groups were homogeneous for relevant demographic, physiological, and clinical data. All patients were examined preoperatively and were followed up at 6 months postoperatively. In both groups, patient's satisfaction was evaluated 6 months after surgery by a detailed interview and scored into three grades (1 = very satisfied, 2 = satisfied, and 3 = dissatisfied). RESULTS No operative mortality, major intraoperative complication, infections, and Horner syndrome were recorded. There was no treatment failure. The average time of operation was 50 minutes for Group A (sympathectomy) and 36 minutes for Group B (sympathicotomy). Compensatory sweating occurred in 40 patients (89% for Group A and 85.11% for Group B) with a different accumulation of the severity degree. The satisfaction rate was 91.11% for Group A and 93.61% for Group B. CONCLUSION There was no significant difference between thoracoscopic sympathectomy and sympathicotomy at the third ganglia (T3) level for the treatment of primary palmar hyperhidrosis in terms of initial surgery results, complications, and patient satisfaction. Neither surgical technique is better than the other one for palmar hyperhidrosis treatment. Development of severe compensatory sweating and postoperative pain are major determinant factors of patient dissatisfaction. Sympathicotomy should be preferred for palmar hyperhidrosis treatment, as it is much technically shorter, simpler to implement, and also easier to learn.
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Affiliation(s)
- Bülent Aydemir
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Oya Imamoglu
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tamer Okay
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muharrem Celik
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Aydemir B, Çelik S, İmamoğlu O, Çelik M, Okay T. Iatrogenic tracheal ruptures. J Cardiothorac Surg 2013. [PMCID: PMC3853701 DOI: 10.1186/1749-8090-8-s2-p3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
BACKGROUND Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause serious complications such as esophageal perforation. The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results of commonly used methods for their removal. METHODS We analyzed 20 years of records from Siyami Ersek Hospital, Istanbul and identified 512 cases of foreign objects enlodged in the esophagus. RESULTS In pediatric patients, the majority were aged between 2-5 years (34.4%), while in adult patients, the majority were above 55 years (38.7%). Coins were the most common foreign object detected in children (68.8%), whereas meat impaction was most common in adults (87.4%). The most common location of the foreign object was the cervical esophagus in children (78.2%), and the thoracic esophagus in adults (66.4%). In 30.8% of adults, there was esophageal or systemic disease. Objects were removed with a Magill clamp in 48.3% of children. Rigid endoscopy was the main treatment in adult patients. Perforation due to endoscopy developed in three patients. Surgical repair was performed on these patients but all died due to mediastinitis. CONCLUSION Underlying esophageal or systemic diseases may predispose adults to foreign object ingestion in the esophagus. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years.
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Affiliation(s)
- Sezai Celik
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
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Abstract
Background Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management. Case Report: A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient’s death was confirmed. Conclusions: We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.
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Affiliation(s)
- Bülent Aydemir
- Siyami Ersek Cardiothoracic Surgery Training Hospital, Istanbul, Turkey
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Celik S, Celik M, Aydemir B, Tanrıkulu H, Okay T, Tanrikulu N. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients. World J Surg Oncol 2012; 10:123. [PMID: 22742716 PMCID: PMC3499191 DOI: 10.1186/1477-7819-10-123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 02/20/2012] [Accepted: 06/02/2012] [Indexed: 01/31/2023] Open
Abstract
Background Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. Methods Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. Results Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively). Overall median survival was 10.41 ± 1.79 months. One- and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. Conclusion Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.
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Affiliation(s)
- Sezai Celik
- Department of Thoracic Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Braz L, Nicodemo A, Souza R, Santos N, Godoy N, Okay T, Amato V. Visceral leishmaniasis reactivation diagnosed by molecular technique in blood sample. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-Term Results of Lung Decortication in Patients with Trapped Lung Secondary to Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2012; 18:109-14. [DOI: 10.5761/atcs.oa.11.01715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND We aimed in this study to investigate and compare the diagnostic and therapeutic methods in tracheobronchial injuries. METHODS Nine cases (7 male, 2 female) operated between 2003 and 2008 because of tracheobronchial injury were included in the study. The cause of tracheobronchial injury was trauma in 7 cases and postintubation laceration in 2 cases. The cases were evaluated in terms of age, sex, type of trauma, clinical findings, localization of injury, performed diagnostic and therapeutic methods, and results. RESULTS The causes of tracheobronchial laceration were blunt trauma in 6 cases, penetrating trauma in 1 case and iatrogenic (postintubation) in 2 cases. Lacerations were in the trachea in 5 cases and at the bronchial level in 4 cases. Operations included right upper bilobectomy in 1 case, tracheal resection and end to end anastomosis in 1 case, end to end anastomosis in 3 cases, and primary repair in 4 cases. One case died during the operation and 1 case died postoperatively. CONCLUSION In tracheobronchial injuries, early diagnosis and treatment are very important. The most useful method is bronchoscopy for determining the type and localization of the injury. In treatment, primary repair should be preferred over anatomical resections whenever possible.
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Affiliation(s)
- Bülent Aydemir
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey.
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Aydemir B, Okay T, Imamoglu O, Sahin S, Dogusoy I. Preoperative Embolization in Mediastinal Castleman's Disease. Thorac Cardiovasc Surg 2010; 58:496-8. [DOI: 10.1055/s-0030-1250088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Celik S, Celik M, Aydemir B, Tunckaya C, Okay T, Dogusoy I. Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis. J Cardiothorac Surg 2010; 5:111. [PMID: 21078140 PMCID: PMC2996377 DOI: 10.1186/1749-8090-5-111] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [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: 07/20/2010] [Accepted: 11/15/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In this study we aimed to evaluate the long-term outcome of diaphragmatic plication for symptomatic unilateral diaphragm paralysis. METHODS Thirteen patients who underwent unilateral diaphragmatic plication (2 patients had right, 11 left plication) between January 2003 and December 2006 were evaluated. One patient died postoperatively due to sepsis. The remaining 12 patients [9 males, 3 females; mean age 60 (36-66) years] were reevaluated with chest radiography, flouroscopy or ultrasonography, pulmonary function tests, computed tomography (CT) or magnetic resonance imaging (MRI), and the MRC/ATS dyspnea score at an average of 5.4 (4-7) years after diaphragmatic plication. RESULTS The etiology of paralysis was trauma (9 patients), cardiac by pass surgery (3 patients), and idiopathic (1 patient). The principle symptom was progressive dyspnea with a mean duration of 32.9 (22-60) months before surgery. All patients had an elevated hemidiaphragm and paradoxical movement radiologically prior to surgery. There were partial atelectasis and reccurent infection of the lower lobe in the affected side on CT in 9 patients. Atelectasis was completely improved in 9 patients after plication. Preoperative spirometry showed a clear restrictive pattern. Mean preoperative FVC was 56.7 ± 11.6% and FEV1 65.3 ± 8.7%. FVC and FEV1 improved by 43.6 ± 30.6% (p < 0.001) and 27.3 ± 10.9% (p < 0.001) at late follow-up. MRC/ATS dyspnea scores improved 3 points in 11 patients and 1 point in 1 patient at long-term (p < 0.0001). Eight patients had returned to work at 3 months after surgery. CONCLUSIONS Diaphragmatic plication for unilateral diaphragm paralysis decreases lung compression, ensures remission of symptoms, and improves quality of life in long-term period.
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Affiliation(s)
- Sezai Celik
- Siyami Ersek Cardiothoracic Training Hospital, Thoracic Surgery Department, Istanbul, Turkey.
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Okay T, Aydemir B, Imamoglu OU. Does Ravitch legend turn back? Interact Cardiovasc Thorac Surg 2010; 11:227-8. [PMID: 20719909 DOI: 10.1510/icvts.2010.238220a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tamer Okay
- Dr. Siyami Ersek Thoracic Cardiovascular Surgery Training and Education Hospital, Istanbul, Turkey
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Okay T, Yasaroglu M, Yildirim M, Uncu OI, Aydemir B, Dogusoy I, Findikçioglu A. A new approach to pectus deformity in females. Interact Cardiovasc Thorac Surg 2007; 3:95-8. [PMID: 17670187 DOI: 10.1016/s1569-9293(03)00211-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
One of the most preferred procedures for correction of pectus deformities is the modified Ravitch procedure. The main aim is cosmetic for many patients, especially in females. Two types of skin incisions have been described for this operation in the literature: midsternal and transversal. Both incisions leave a skin scar on the sternum and result in unacceptable cosmetic results. As a way of concealing the ugly skin incision scar under the breasts after puberty, we describe and discuss the use of bilateral inframammarian separated skin incisions. We have used our method for correction of pectus deformity in 12 female cases in our clinic since 1991. Two 4-5 cm incisions were localized as 1/3 medially and 2/3 laterally below both breasts. With this incision we performed the modified Ravitch technique. In spite of technical difficulties of exposure, correction of the deformity was satisfactory in all patients. Only one patient had seroma and one had perioperative pneumothorax. The patients were followed up for from 3 months to 9 years. No recurrence was observed. Breast development and sensitivity was found to benormal at follow-up. The new approach was found to be effective and more cosmetically acceptable than the other approaches for correction of pectus excavatum in female patients.
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Affiliation(s)
- Tamer Okay
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Recep Peker cad. 27/1, Kiziltoprak-Kadikoy, Istanbul, Turkey.
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Abstract
Aspergilloma is a saprophytic infection which can colonize preexisting lung cavities. The most common underlying diseases are tuberculosis, sarcoidosis, cavitary lung cancer, etc. Although aspergilloma can also occur in operated hydatid cyst cavities, only a few cases have been reported in literature. A 32-year-old female patient underwent cystectomy for the diagnosis of perforated intraparenchymal giant hydatid cyst located in the right upper lobe, reaching down to the hilum. Capitonnage was not performed and it was observed that a residual cavity remained in the cystectomy area. The patient was discharged; however, during clinical and radiological follow-ups, it was found that the residual cyst cavity had expanded. As it was thought that one of the drainage bronchi in the cyst cavity could have opened, the patient was reoperated. During the operation, it was noted that purulent fluid and necrotic tissues were present in the cystic cavity. It was seen that the posterior upper lobe segment was consolidated and not ventilated. Contents of the cavity were removed and the posterior upper lobe segment was resected. Histopathological examination revealed that the tissue in the cavity was that of an aspergilloma, and that chronic organized pneumonia and diffuse interstitial fibrosis were present in the resected segment. Refraining from surgical obliteration (capitonnage) of cyst cavities in cases of giant hydatid cysts extending to the hilum can lead to opportunistic infections such as aspergilloma.
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Affiliation(s)
- B Aydemir
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Thoracic Surgery, Istanbul, Turkey.
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Tireli H, Karlikaya G, Tutkavul K, Akpinar A, Okay T. Myasthenia gravis: how to treat? Acta Myol 2004; 23:140-5. [PMID: 15938570] [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: 05/02/2023]
Abstract
Myasthenia Gravis is an acquired autoimmune disorder caused by a neuromuscular transmission defect which is clinically characterized by fluctuating weakness of voluntary muscles and fatigability. It can be diagnosed by clinical features, clinical, pharmacological and electrophysiological tests and serological evaluation. Treatment modalities include symptomatic treatment in the form of cholinesterase inhibitors and plasmapheresis and immunotherapy in the form of immunosuppressant medications, immunomodulating therapy and thymectomy. No single regimen is appropriate for all patients and up to now no mode of therapy has been proven to be clearly superior. The response to any form of treatment is difficult to assess because the severity of symptoms fluctuate. We retrospectively analyzed the clinical records of 33 myasthenia gravis patients which were managed at our clinic between 1995-2003. All patients were treated with anticholinesterase medications sometime during their treatment. Most patients recieved immunosupressant and/or immunomodulator therapy. Patients were referred for thymectomy when indicated. We evaluated the outcome with different treatment modalities, focusing on the role of thymectomy. We also investigated the possible correlations between clinicopathological features and clinical outcome. We conclude that as for the medical treatment of myasthenia gravis azathioprine plus steroid improves the outcome; and for the surgical treatment, early thymectomy should be performed in all generalize myasthenia patients.
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Affiliation(s)
- H Tireli
- Haydarpaşa Numune Education and Research Hospital, 2nd Department of Neurology, Istanbul, Turkey
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Okay T. [Progress in heart failure during the year 2001]. Anadolu Kardiyol Derg 2001; 1:301-6. [PMID: 12101842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- T Okay
- International Hospital, Istanbul
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Abstract
PURPOSE The purpose of this study was to assess the diagnostic role of a Tc-99m sestamibi gated SPECT technique in patients with left bundle branch block (LBBB) without known coronary artery disease. MATERIALS AND METHODS Twenty consecutive patients with constant complete LBBB were included. A same-day rest-stress protocol was used, and dipyridamole stress (14 patients) or treadmill exercise (6 patients) was applied. Electrocardiograph (ECG)-gated SPECT images were acquired 15 minutes after the administration of 0.31 mCi/kg Tc-99m sestamibi at peak stress. Regional myocardial perfusion was analyzed in relation to the cardiac cycle. RESULTS Eleven of 14 patients who underwent a dipyridamole stress test had hypoactivity in the left anterior descending (LAD) artery territory in the ungated (summed) stress-rest images (abnormality ratio, 78%). On the ungated images, the abnormality was completely reversible in one patient (9%), partially reversible in five patients (46%), irreversible in two patients (18%), and reverse perfusion was identified in three patients (27%). Abnormality ratios of end-systolic and end-diastolic data were 93% and 29%, respectively. Conversely, the ungated rest-stress and end-systolic images of all the patients who performed treadmill exercise were abnormal despite the presence of normal or nearly normal end-diastolic myocardial perfusion. The angiographic findings correlated best with those of end-diastolic images. In 13 patients without coronary artery disease, normal or nearly normal regional perfusion was observed on end-diastole, but four patients with abnormal end-diastolic perfusion, which involved the LAD territory in all but one, had substantial coronary artery disease. The number of the involved segments was similar on the end-systolic and ungated data. Most of these artifactual defects were localized to the anteroseptal, septal, and inferoseptal segments. CONCLUSIONS These preliminary data indicate that end-diastolic images can significantly reduce artifactual defects in patients with LBBB. The resolution of an LBBB pattern on end-diastolic data would significantly improve the diagnostic role of myocardial perfusion studies in these patients.
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Affiliation(s)
- S Inanir
- Department of Nuclear Medicine, Marmara University, School of Medicine, Istanbul, Turkey.
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Sabah I, Yalcin F, Okay T. Rupture of a presumed hydatid cyst of the interventricular septum diagnosed by transoesophageal echocardiography. Heart 1998; 79:420-1. [PMID: 9616357 PMCID: PMC1728658 DOI: 10.1136/hrt.79.4.420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- I Sabah
- Department of Cardiology, Acil Yardim Hospital, Balgat, Ankara, Turkey
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Okay T, Deligönül U, Sancaktar O, Kozan O. Contribution of mitral valve reserve capacity to sustained symptomatic improvement after balloon valvulotomy in mitral stenosis: implications for restenosis. J Am Coll Cardiol 1993; 22:1691-6. [PMID: 8227840 DOI: 10.1016/0735-1097(93)90597-t] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [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] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To explain the discrepancy between the symptomatic status of patients and the hemodynamically calculated mitral valve area during long-term follow-up after mitral balloon valvulotomy, mitral valve orifice variability after dobutamine infusion was investigated in two groups of patients. BACKGROUND A significant increase in aortic valve area with increased aortic transvalvular flow has been reported in patients with calcific aortic stenosis after aortic balloon valvulotomy. A similar phenomenon with regard to the mitral valve has not been studied in detail. METHODS Group 1 comprised 10 patients (mean age 33 +/- 9 years) with untreated mitral stenosis. Group 2 comprised 29 consecutive patients (mean age 32 +/- 7 years) who underwent successful percutaneous mitral balloon valvulotomy 13 +/- 2 months before the study. RESULTS After dobutamine infusion, heart rate and cardiac index increased significantly in both groups. The mean pulmonary artery pressure, mitral valve gradient and pulmonary capillary pressure remained unchanged in Group 2 but increased significantly in Group 1. The mean mitral valve area was significantly larger in Group 2 after dobutamine infusion than at baseline (1.9 +/- 0.5 vs. 2.4 +/- 0.6 cm2, p < 0.0001) but was unchanged in Group 1 (1.2 +/- 0.2 vs. 1.3 +/- 0.3 cm2, p = NS). The mean mitral valve area in seven patients in Group 2 (24%) was < or = 1.5 cm2 before dobutamine infusion (1.3 +/- 0.4 cm2), which was defined as restenosis. In five of these seven patients who had minimal or no symptoms, the mitral valve area increased significantly after dobutamine infusion (1.3 +/- 0.1 vs. 1.9 +/- 0.1 cm2). In the other two patients who were symptomatic, the mitral valve area did not change after dobutamine infusion. These two patients were identified as having "true" restenosis, and redilation of the mitral valve was performed in both. CONCLUSIONS In patients who underwent mitral balloon valvulotomy, increased mitral valve reserve capacity contributed to symptomatic improvement on long-term follow-up. Dobutamine infusion may be helpful in detecting clinically significant restenosis.
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Affiliation(s)
- T Okay
- Bayindir Medical Center, Ankara, Turkey
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Ambroise-Thomas P, Okay T. [Inter- and intra-cephalic variations in pathogenicity in Toxoplasma gondii. Clinical and epidemiologic consequences]. Bull Acad Natl Med 1993; 177:1411-9; discussion 1419-21. [PMID: 8193946] [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: 01/29/2023]
Abstract
Clinical and epidemiological studies, especially the ones conducted in HIV+ patients indicate that the pathogenicity of Toxoplasma gondii varies according to the strain considered. The differences observed among strains are represented by distinct genomic DNA patterns which could be experimentally evaluated by means of the RFLP (Restriction Fragment Length Polymorphism) and the RAPD (Random Amplified Polymorphic DNA). If on the one hand virulent strains present very similar genomic DNA patterns, on the other hand chronic strains are highly polymorphic. These differences may be, at least in part, due to the asexual (clonal) multiplication of virulent strains. The existence of an intraspecific pathogenicity variation and genetic heterogeneity was observed within a single strain either after attenuation (infection in Fischer or Wistar rats), or during reactivation (in immunodepressed animals). In a congenital model of toxoplasmosis, the differences are detected from one animal to another and sometimes, even from one organ to another in the same host. This finding do not seem to be related to the occurrence of mutations but rather to selective pressures, notably of immunological origin, exerted by the infected organism. A better understanding of these phenomena could result in significant therapeutic and prophylactic advances. Our first effort will be directed to the establishment of more precise diagnostic and predictive elements. The accomplishment of this step relies on the use of primers deriving from DNA sequences characteristic of virulence and which will be tested by PCR.
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Affiliation(s)
- P Ambroise-Thomas
- Département de Parasitologie-Mycologie Médicale et Moléculaire, Faculté de Médecine, Université Joseph Fourier, Grenoble
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Başaran Y, Başaran MM, Babacan KF, Ener B, Okay T, Gök H, Ozdemir M. Serum tumor necrosis factor levels in acute myocardial infarction and unstable angina pectoris. Angiology 1993; 44:332-7. [PMID: 8457086 DOI: 10.1177/000331979304400411] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Tumor necrosis factor (TNF) enhances leukocyte adherence to vascular endothelium and increases procoagulant activity in the endothelial cells. Thus it may be implicated in the pathogenesis of acute vascular occlusions. To study the role of TNF in the early stages of acute myocardial infarction (MI), the authors measured circulating TNF levels in the sera of patients with acute MI and unstable angina pectoris. Blood samples were obtained within six hours after onset of chest pain and stored at -70 degrees until tested. A sensitive sandwich enzyme-linked immunosorbent assay (ELISA) test was used for TNF measurement. C-reactive protein (CRP) levels were determined semiquantitatively. Immediate complications such as heart failure, arrhythmia, and shock were also noted. Twenty-four patients with electrocardiographically and biochemically confirmed acute MI and 14 patients with unstable angina pectoris were included in the study. TNF levels were serially assessed at the time of admission and at hours 6, 24, 48, 72, and 96 after onset of chest pain in 2 patients with acute MI. Detectable TNF was found in 13 sera of the acute MI group (range; 10-1510 pg/mL) and 4 sera of the angina pectoris group (range; 15-240 pg/mL). There was no correlation between the serum TNF levels and the occurrence of complications and the extent of myocardial damage. CRP response was unrelated to TNF levels. Contrary to previous reports, serial measurement of TNF revealed that peak values were reached within six hours and disappeared after twenty-four hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- Y Başaran
- Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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Ozkan M, Oztek I, Okay T, Basaran Y, Bayezid O, Ozdemir M, Yakut C. A case of arrhythmogenic right ventricular dysplasia associated with FANA positiveness--a case report. Angiology 1991; 42:849-53. [PMID: 1835322 DOI: 10.1177/000331979104201011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This is the case report of a forty-five-year-old woman who manifested clinical findings characteristic of arrhythmogenic right ventricular dysplasia (ARVD) except for fluorescent antinuclear antibody (FANA) positiveness. To the authors' knowledge, this is the first report of FANA positiveness associated with ARVD.
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Affiliation(s)
- M Ozkan
- Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Bayezid O, Ocal A, Işik O, Okay T, Yakut C. A case of cardiac hydatid cyst localized on the interventricular septum and causing pulmonary emboli. J Cardiovasc Surg (Torino) 1991; 32:324-6. [PMID: 2055928] [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: 12/30/2022]
Abstract
Cardiac hydatid cyst is rarely encountered. In this article, a case of hydatid cyst localized in multiple organs including the ventricular septum and causing pulmonary emboli is reported.
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Affiliation(s)
- O Bayezid
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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