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    Reperfusion strategy after regional ischaemia: Simulation of emergency revascularization and effects of integrated cardioplegia on myocardial resuscitation
    (SAGE PUBLICATIONS LTD, 2004) Us, MH; Ogus, NT; Yildirim, T; Ogus, H; Ozkan, S; Ozturk, OY; Isik, O
    We induced ischaemia in the left anterior descending artery of 16 dogs while the heart was beating, followed by cardiopulmonary bypass (CPB), aortic cross clamping and blood cardioplegia. Half of the dogs received integrated blood cardioplegia and sudden uncontrolled reperfusion (group A) while the others received the same cardioplegia followed by pressure-controlled tepid initial reperfusion (group B). The effects on myocardial cell metabolism, oxidative stress and ultrastructure were recorded. The recovery period was significantly longer and cardiac output levels after CPB significantly lower in group A compared with group B. Group A showed a failure to uptake and utilize oxygen during the recovery period and significant lipid peroxidation. Marked tissue oedema was seen in group A but mitochondrial and organelle integrity was almost normal in both groups. We conclude that integrated cardioplegia could partially resuscitate the myocardium in this model, and pressure controlled reperfusion during the first 2 min is needed as an adjunct procedure.
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    Sternal cyanoacrylate gluing in mediastinitis - Effects on infection, stability and bone healing
    (EDIZIONI MINERVA MEDICA, 2002) Ogus, TN; Us, MH; Cicek, S; Ozkan, S; Ozturk, OY; Isic, O
    Background It is crucial to determine stability, histocompatibility and antibacterial properties of the cyanoacrylate used for sternal fixation. Methods. Clinical study: in 17 cases of mediastinitis, debridement and rewiring the sternum, was applied as the treatment method (Group I). Eighteen cases of mediastinitis were treated with the same method added sternal cyanoacrylate gluing (Group 11). A comparative study was done;, the follow-up period was 36.7 +/- 4 and 18.5 +/- 6.9 months in Group I and H, respectively. Animal study: in 10 rats, upper sternotomy was done and the sternal bone was contaminated. Direct wound closure was done in 4 rats (Group A), in 6 animals, wounds were dosed after applying cyanoacrylate in sternal split (Group B). in this prospective study, all rats alive were sacrificed at the 3rd and 8th weeks and sternums were examined histologically. Results. Clinical study: in Group 1, 6 patients required additional interventions due to recurrent sternal detachment and osteomyelitis (35.3%). In Group H neither osteomyelitis nor sternal detachment occurred, 3 patients required re-intervention related to cyanoacrylate histotoxicity. Hospital stay was higher in Group I than Group II (24.06 +/- 4.7 vs 14.16 +/- 3.98 days, respectively). Experimental study: all of the animals in Group A died of sepsis. In Group B all rats survived the procedure. At the 3rd week histologic evaluations showed that cyanoacrylate was not degraded, and no infection or foreign body reaction was observed. At the 8th week histologic examination showed that cyanoacrylate was completely degraded and replaced by connective tissue. Conclusions. Cyanoacrylate is effective in diminishing sternal wound complications and related cost and hospital stay of mediastinitis.