[Heart wounds]

In our study, we aimed to present our cases with heart wounds and to determine the factors influencing mortality. We retrospectively evaluated 23 cases with cardiac injuries who were treated among years 1986-99 in our clinic. There were 4 female and 19 male cases, and the average age was 32 years (range 12-52). Heart wounds were caused by blunt trauma in 6 cases, and penetrating trauma in 17 cases. Penetrating heart wounds was caused by gunshot wounds in four patients and stab wounds in 13 patients. Our cases were underwent to rapid resuscitation and emergency surgery. Mortality rate was 17% with 3 cases. Blunt cardiac wounds was caused by motor vehicle accidents in all cases. Diagnosis with immediate echocardiography and efficient treatment was performed. Mortality rate was 33% with 2 cases. We think that emergent resuscitation and immediately surgical exploration in patients with penetrating heart wounds and immediate diagnosis by echocardiography and prompt treatment in patients with blunt heart injuries may improve overall survival.

Coronary artery bypass grafting nine months after pneumonectomy

We performed coronary artery bypass grafting on a 58-year-old man who only 9 months earlier had undergone right pneumonectomy for bronchial carcinoma. Although his preoperative pulmonary function had been poor, coronary artery bypass surgery was successful, and the patient was discharged on the 9th postoperative day Two years after surgery, he remained in New York Heart Association functional class I. We attribute this success to special management before, during, and after the operation. On the 32nd postoperative month, this patient died of multiple tumor metastases.

Prevalence of Helicobacter pylori in patients with primary hyperparathyroidism

Dyspeptic symptoms are common in patients with primary hyperparathyroidism (PHPT) and have been attributed to hypercalcemia; however, they may also become permanent after parathyroid surgery. We aimed to evaluate the prevalence of Helicobacter pylori in patients with PHPT and to see whether there is a relationship between dyspeptic complaints and H. pylori infection. Of 21 patients with PHPT, 18 patients had dyspeptic complaints. These 18 female patients with PHPT and dyspeptic symptoms were the study population, and 20 female volunteers with dyspeptic symptoms were the controls. An endoscopic examination was performed in all controls and in patients before parathyroid surgery. H. pylori was assessed by serological and histological evaluation. H. pylori was identified upon histological evaluation in 17 patients (94.4%) and serologically in 17 patients (94.4%). Active macroscopic and microscopic gastritis were found in 15 (83.3%) and in 17 (94.4%) of the patients, respectively. In the control group, H. pylori was identified histologically in 13 subjects (65%) and serologically in 17 subjects (85%). The prevalence of H. pylori assessed by histological examination was significantly (P < 0.05) different between patients and controls. There was a significant association between H. pylori infection identified by histology and/or serology and the presence of microscopic (r = 1; P < 0.001), as well as macroscopic (r = 0.54; P < 0.05), gastritis. In conclusion, this study showed that H. pylori infection was found frequently (85.7%) in patients with PHPT. In the management of PHPT with or without surgery, patients, especially those with dyspeptic symptoms, should be evaluated for H. pylori infection, which can be effectively eradicated by appropriate therapy.

Circulating IL-2 and IL-10 in chronic active hepatitis C with respect to the response to IFN treatment

BACKGROUND

The importance of circulating immunoregulatory cytokines in response to IFN treatment and the change of in vivo production of these cytokines during interferon (IFN) treatment are not well known. We aimed to determine whether pretreatment serum levels of IL-2 and IL-10 are predictive of the response to IFN treatment and to investigate if treatment response or nonresponse has any effect on the circulating levels of these cytokines.

PATIENTS AND METHODS

37 patients (18 responders and 19 non-responders) with chronic hepatitis C virus (HCV) infection who received IFN-alpha2b for 6 months were studied. Responders were defined by complete alanine aminotransferase (ALT) normalization and loss of HCV RNA as detected by bDNA assay while patients who had elevated ALT levels and positive HCV RNA after 6 months were considered as nonresponders.

RESULTS

Genotype distribution, ALT and HCV RNA levels were similar in responders and nonresponders. A significant number of patients with chronic hepatitis C (20/37 = 54%) had elevated IL-2 levels while IL-10 levels were not different from controls. No difference in baseline cytokine levels was observed between responders and non-responders. In the posttreatment serum samples some patients lost their detectable IL-2 or IL-10; some patients developed detectable cytokine levels after treatment irrespective of the treatment response.

CONCLUSION

These results suggest that active liver injury in chronic hepatitis C is associated with increased circulating Th1 cytokine IL-2 but not with Th2 cytokine IL-10 and that circulating levels of these cytokines do not predict the response to IFN treatment. There is no constant and regular change in circulating levels of these cytokines under IFN treatment with respect to treatment response.

Primary vascular echinococcosis: an uncommon cause of chronic iliofemoral arterial occlusion

We report the case of a 33-year-old woman who was admitted to our clinic with the diagnosis of chronic arterial occlusion of the right lower extremity. Preoperative angiography suggested an iliofemoral atherosclerotic occlusion. During surgery multiple hydatid cysts causing iliofemoral occlusion were found and excised. Arterial reconstruction was performed using an iliofemoral bypass technique with a polytetrafluoroethylene vascular graft. This case emphasizes that, in sheep-raising countries or in patients from such countries, primary vascular echinococcosis should be considered in the differential diagnosis of chronic arterial occlusion.

Platelet aggregation size and volume in chronic obstructive pulmonary disease

In this study the effect of hypoxia on thrombocytes was investigated in patients with a chronic obstructive pulmonary disease (COPD). 15 Hypoxic (group 1), 15 nonhypoxic (group 2) patients with COPD and 10 healthy persons (group 3) were included in the study. The differences in haemoglobin, hematocrit and PaCO2 values of group 1 and group 2 were insignificant, but there was a significant difference between group 3 and the other two groups. The differences in blood pH values in the above groups were insignificant, but the differences in FEV1, FVC and PaO2 values were significant. We found that thrombocyte aggregation increased significantly in group 1 and group 2. Also the platelet count decreased and mean platelet volume increased significantly in group 1. As a result, we think that in hypoxic patients with COPD, thrombocyte count decreases, volume and aggregation formation increases and oxygen plus antiaggregation therapy may have positive effects on the survival and life quality of these patients.

Comparative methods of repairing left ventricular aneurysms

Between 1 March 1992 and 31 June 1996, we enrolled 72 patients with left ventricular aneurysms in a prospective, nonrandomized study to compare--by study of cardiac indices, single-plane ejection fractions, and nuclear ventriculograms--the effects of classical aneurysmectomy (group 1, n = 36) with those of endoaneurysmorrhaphy (group 2, n = 36). Preoperative and postoperative cardiac index measurements were, respectively, 1.96 +/- 0.6 and 3.51 +/- 0.53 for group 1, and 1.96 +/- 0.31 and 3.43 +/- 0.41 for group 2. In this regard, there was not any significant difference between the groups preoperatively or postoperatively. Preoperative and postoperative multiple-gated acquisition measurements, were, respectively, 34.3 +/- 7.76 and 43.1 +/- 11.1 for group 1, and 37 +/- 3.88 and 66.5 +/- 5.2 for group 2. Although there was not any significant preoperative difference between the groups (P = 0.34), group 2 had significant postoperative improvement in left ventricular ejection fractions (P < 0.001). Preoperative and postoperative single-plane contrast ventriculographic ejection fractions were, respectively, 43.4 +/- 8.7 and 48.6 +/- 11.2 for group 1, and 43.8 +/- 5.5 and 60.8 +/- 15.1 for group 2. Again, there was not any significant difference between the 2 groups in preoperative left ventricular ejection fractions (P = 0.87), but the postoperative left ventricular ejection fractions of group 2 were significantly better than those of group 1 (P = 0.022). We conclude that left ventricular functional improvement with endoaneurysmorrhaphy is superior to that with classical aneurysmectomy.

The effects of hemodialysis on duodenal and gastric mucosal changes in uremic patients

From March 1992 to July 1992, 30 uremic patients (15 dialysed, 15 non-dialysed) and 15 non-uremic patients who had dyspeptic complaints were compared in terms of gastric and duodenal diseases. Gastritis and duodenitis graded as I, II and III were not found different in three groups (p > 0.05). Although the incidence of peptic ulcer disease is very high in both groups of uremic patients in comparison with the controls, there was no significant difference between two uremic groups (p > 0.05). Also the prevalence of gastritis determined histologically was not different in dialysed and non-dialysed uremic patients (p > 0.05). The incidence of the histologically proven gastritis was found higher in uremic patients than in non-uremic patients (p < 0.05). But, there were no significant differences among the three groups with regard to the rate of histologically proved duodenitis (p > 0.05). Gastrin levels, urea positivity, the incidence of gastritis and duodenitis and peptic ulcers did not differ in both uremic groups. However, these values were found significantly high in the uremic patients when compared to non-uremics. These findings showed serum gastrin levels, H.-pylori-infection, gastritis and duodenal disease in the uremic patients to be higher than those of the control group. Moreover, no effect of hemodialysis treatment on these results was observed.

Traumatic tricuspid insufficiency following blunt chest trauma

The insufficiency of the tricuspid valve developed due to blunt chest trauma is a rare and an insidiously progressing clinical incident. In this article we present a case which showed tricuspid insufficiency because of the rupture of the anterior papillary muscle due to trauma and which was treated surgically.

Circadian variation in circulating platelet aggregates

Acute coronary events are more likely to occur in the morning and it has recently been shown that platelet aggregability increases significantly then. To determine whether circulating platelet aggregates show such a circadian variation, we measured in vivo platelet aggregation in atherosclerotic patients and healthy subjects at three-hour intervals throughout a 24-hour period. We found a significant variation in circulating platelet aggregates, the highest being at 6 a.m. and the lowest at 9 a.m. We suggest that it may be important to consider the duration of action of anti-aggregating drugs and timing their administration with respect to circadian variation in circulating platelet aggregates.