Mutation analysis of the Vangl2 coding region revealed no common cause for Tetralogy of Fallot

Vangl2 (Van Gogh-like 2) protein acts via non-canonical Wnt signalling to regulate polarized cell movements during development of the proximal outflow tract in vertebrate embryos. Recently, it has been shown that mutations of the Vangl2 gene cause aortic arch defects that are characteristic of the loop-tail (Lp) mouse and they have also became a strong candidate for causing congenital outflow tract defects in humans. Thus, in this study Tetralogy of Fallot (ToF), which comprises a group of syndromes that constitutes the most frequent cause of congenital cardiac outflow abnormalities in humans, was analysed for mutations within all coding regions of the Vangl2 gene. Based on direct sequencing data from a combination of 20 patients with ToF and 22 healthy people, three polymorphisms have been identified in exon 6 and exon 7 which do not change the amino acid sequence. It was concluded, therefore, that there is no specific mutation responsible for the ToF phenotype in the Vangl2 gene.

Surgical Management of Giant Aneurysms Complicating Arteriovenous Fistulae

The creation of an arteriovenous fistula (AVF) is frequently used to achieve easier access for haemodialysis in patients with chronic renal insufficiency. The most frequent late complication of AVFs is aneurysm formation, which carries the risk of spontaneous rupture. This study reports on 18 patients with giant aneurysms that developed on antebrachial AVFs who were operated on over a period of 6 years. Colour duplex ultrasonographic examination of the upper extremity was performed in all but one patient in the preoperative period.

Surgical management included resection of the aneurysm and re-establishment of arterial continuity. There were no complications such as infection, ischaemic extremity loss, neurological sequelae or mortality. Colour duplex ultrasonographic examinations after 6 months were all normal. The mean follow-up period was 29.1 months (range 7 − 50 months). There were no additional vascular complications observed during follow-up. Early surgical intervention is the recommended treatment of choice for giant aneurysm complicating antebrachial AVF.

Aortic ruptured following lung resection in invasive aspergillosis

Invasive pulmonary aspergillosis, although rare in the general population, can prove to be an important cause of morbidity and mortality in immunosuppressed patients. In this paper we represent a case of aortic rupture for a fungal invasion of the aorta after a pulmonary resection procedure. Although a few cases are documented in the literature, we report our experience to make our colleagues aware of this complication.

A new closure technique for limited thoracotomy where the ribs are spread minimally

An alternative closure technique for limited thoracotomy incisions is described below. This technique consists of fixing the intercostal muscles with horizontal mattress sutures. Also the described technique can be applied where the ribs are spread minimally in such limited thoracotomy incisions.

The role of autologous blood injection on postoperative air leak at lung resections

BACKGROUND

The effects of autologous blood injection beneath the stapling lines on postoperative air leak after lung resections, especially in emphysematous lungs, were prospectively investigated.

METHODS

The study was carried out on 16 randomized patients. The mean age of the study group was 58 and the mean forced expiratory volume at one second (FEV1) at the spirometry was 2.05 L. In the control group, the mean age was 60 and the mean FEV1 was 1.97 L. All 16 cases were males and had a history of smoking. In the study group, 10-20 ml of autologous venous blood was drawn by the anesthesist and transferred to the operation team. The blood was gently injected underneath the staple line and ultimately 1 cm thickened layer of the lung was obtained. In the control group only staplers were applied.

RESULTS

There was no air leak at the end of the operation at the study group, whereas additional sutures which were pledgetted with Gore-tex patches were needed at four cases at the control group. There were minimal air leaks at three cases at the control group at the postoperative period, while there was no postoperative air leak problem at the study group. Thorax tubes were removed at the 3rd and the 3.9th days at the study and the control groups, respectively.

CONCLUSIONS

We believe this simple and cheap method could be used at least in some instances where additional staple reinforcement would be necessary. It may also be remembered when air leaks are encountered at suture holes after suturing the lung.

Cost-effectiveness of minimally invasive-intervention in aortofemoral revascularization

Minimally invasive surgical procedures have become popular recently because they offer several advantages over conventional operative techniques. A person undergoing a minimally invasive procedure usually experiences less pain, is discharged earlier from hospital, returns to work sooner and has a less obtrusive post-operative scar. Excluding highly technical techniques (e.g. laparoscopic surgery), operations performed using mini-laparotomy are usually more cost-effective than conventional procedures, largely because they are less expensive to perform. Our paper investigates cost-effectiveness and other parameters relating to minimally invasive aortofemoral revascularization procedures performed at our clinic. We compared 20 similar cases, half where revascularization was undertaken using mini-laparotomy and half where conventional laparotomy was selected. From our findings we conclude that mini-laparotomy is safe and reliable for aortobifemoral bypass procedures and has several advantages over traditional techniques; namely, shorter operating time, earlier resumption of intestinal function, shorter duration of in-patient stay and reduced costs.

Lung-volume reduction in parallel with coronary heart surgery: a case report

For patients with severe disabling emphysema, lung-volume reduction surgery has recently been introduced as an alternative to transplantation. Performing parenchyma resection from appropriate areas can improve pulmonary functions in selected patients having severe emphysema with a flattened diaphragm. We report the case of a patient, who urgently needed coronary revascularization and was otherwise inoperable because of severe chronic obstructive pulmonary disease (COPD). We carried out lung-volume reduction surgery at the same time as the coronary bypass.

Ligation of patent ductus arterious by the method of video-assisted thoracoscopic surgery and our other VATS experiences

In April and May 1996, two cases of PDA ligation were performed firstly in Turkey by the method of video assisted thoracoscopic surgery (VATS) in Dokuz Eylül Medical Faculty, Thoracic and Cardiovascular Surgery Department. There was not any complication in these patients in the postoperative period and they were discharged on the second day in symptom-free condition by the detection of closed ductus in their echocardiographic examination. Between February 1993 and October 1996, a total of 46 patients have undergone interventional application by VATS. While in six of these patients the procedure could not be manipulated because of massive pleural fibrosis, there was no mortality or morbidity among the patients, and they were discharged on average on the second day. The ratio of complications, such as bleeding, air leak, arrhythmia and empyema are so low in these operations, and hospital stay, with return to work time are shorter than with the open technique.

Cervical aortic arch. A case report

Cervical aortic arch is a rare type of aortic arch anomaly that is presumed to result from persistence of the third aortic arch and regression of the normal fourth arch. Most of the patients with this anomaly are asymptomatic, but symptoms of dysphagia and respiratory distress due to the compression by the vascular ring have been reported. Other findings such as a supraclavicular pulsatile mass, blood pressure discrepancies between the upper limbs, and loss of femoral or opposite-upper-limb pulses with compression of the cervical mass may also be present. In this article a twenty-two-year-old woman with symptomatic cervical aortic arch is presented. The patient had a left cervical pulsatile mass and elevated blood pressure on her right upper limb and was treated surgically with reanastomosis of the aorta.

Evaluation of some antioxidant enzymes in lung carcinoma tissue

This investigation was effected to determine the levels of the two antioxidant enzymes, superoxide dismutase (SOD) (EC 1.15.1.1) and catalase (CAT) (EC 1.11.1.6) in lung cancerous tissues and to compare with normal lung tissue in order to evaluate the antioxidant status in lung cancer. Fifteen lung carcinoma tissue samples and the normal counterparts from the same cases were homogenized and the cytosols obtained by ultracentrifugation (100,000 x g). SOD was assayed using a modification of the indirect nitroblue tetrazolium assay method, while CAT was measured by a spectrophotometric method. The data obtained are as follows: 1.42 +/- 0.24 U/mg protein (means +/- SEM) of SOD in lung cancer and 3.13 +/- 0.51 U/mg protein in normal lung tissue and 33.53 +/- 6.09 U/mg protein of CAT in lung cancer and 71.33 +/- 14.38 in normal lung tissue. The differences were found to be significant at the level of P < 0.01 for both enzymes. These low levels of the antioxidant enzymes in lung cancerous tissues can lead to elevated levels of reactive oxygen metabolites, resulting in damage to the key subcellular structures such as DNA, cell membranes, and other vital cellular components.

Amikacin administration in open heart surgery

Amikacin is usually administered to the patients during open heart surgery immediately after cardiopulmonary bypass (CPB) because the serum levels of this drug may decrease due to the volume overload and hemodilution caused by intravenously administered fluids (1.2-2 liters prime solution). We investigated whether this application of amikacin is necessary immediately after CPB. A total of ten patients from Dokuz Eylül University Hospital, Department of Thoracic and Cardiovascular Surgery, who were scheduled for open heart surgery were studied. Serum sodium, potassium, blood urea nitrogen and creatinine values of the patients were found to be within normal limits before the operation. Amikacin was administered to patients just before open heart surgery and 2 ml blood samples were collected from all patients 15 minutes after the drug administration, just before cardiopulmonary by-pass (CPB), at the 30th and 60th minutes of the CPB, after CPB and after the cessation of operation, 4 hours after drug administration. A significant decrease was observed between the values of 10 patients by ANOVA (p < 0.05). Serum amikacin values were found to be 9.80 +/- 0.96 micrograms/ml at the end of the operation, 4 hours after the drug administration. Since serum amikacin levels do not fall below the trough concentrations at the end of the fourth hour we conclude that it is unnecessary to repeat the dose at the end of the operation.