Damage which occurs following spinal traumas is often irreversible. During recent years free oxygen radicals formed due to the pathological changes following neural tissue ischemia have been identified as being responsible for the ethio-pathogenesis of such damage. In our experimental study, model lesions are formed in spinal cords of rats by standard trauma. Malondialdehyde (MDA), a lipid peroxidation product, was measured in the spinal tissues distal to the trauma in order to examine indirectly the time-quantity relationship of free oxygen radicals in the area. For this study 60 rats in six groups, including one control group, were used to determine the formation of MDA. Under a surgical microscope, the spines of all rats were exposed by CS-Th6 laminectomy, and pressure was applied to the spinal cords of animals, except the members of the control group, at the level of C7 by a Ya~argil aneurysm clip. MDA was measured in spinal cord tissues in order to determine free oxygen radicals at the first and fifteenth minutes and at the first, second, and fourth hours. The statistical evaluation of the findings revealed a significant increase in MDA, starting from the 15th minute after the compression, reaching a maximum at 1 hour, and then decreasing. This observation may provide an important guide for studies on prevention of neural destruction.

16 (1993) 53-59 Lipid peroxidation in experimental spinal cord injury: time-level relationship

Background and Purpose- Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemic stroke. Methods- We identified clinical practice guidelines/consensus statements through searches of 4 electronic databases and hand-searching of websites/reference lists. Two reviewers independently assessed reports for eligibility. We extracted data on report characteristics and recommendations relating to etiologic workup in acute ischemic stroke and in cases of cryptogenic stroke. Quality was assessed using the AGREE II tool (Appraisal of Guidelines for Research & Evaluation). Recommendations were synthesized according to a published algorithm for diagnostic evaluation in cryptogenic stroke. Results- We retrieved 16 clinical practice guidelines and 7 consensus statements addressing acute stroke management (n=12), atrial fibrillation (n=5), imaging (n=5), and secondary prevention (n=1). Five reports were of overall high quality. For all patients, guidelines recommended routine brain imaging, noninvasive vascular imaging, a 12-lead ECG, and routine blood tests/laboratory investigations. Additionally, ECG monitoring (>24 hours) was recommended for patients with suspected embolic stroke and echocardiography for patients with suspected cardiac source. Three reports recommended investigations for rarer causes of stroke. None of the reports provided guidance on the extent of investigation needed before classifying a stroke as cryptogenic. Conclusions- While consensus exists surrounding standard etiologic workup, there is little agreement on more advanced investigations for rarer causes of acute ischemic stroke. This gap in guidance, and in the underpinning evidence, demonstrates missed opportunities to better understand and protect against ongoing stroke risk. Registration- URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019127822.

Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines.

We discuss our study on the effects of discontinuation of the usage of bone wax as a hemostatic agent in sternotomy incisions. In 1976, we abandoned use of bone wax because it was suspected of causing several cases of Mycobacterium fortuitum sternal osteomyelitis. In a retrospective study involving 400 patients, we found that this step did not increase postoperative bleeding as measured by drainage from the chest tube and by the need to return patients to the operating room because of bleeding. It also was observed that there was an appreciable simultaneous drop in pulmonary complications. To test our theory that the wax pressed into the bone marrow can embolize to the lung, radioactively tagged bone wax was pressed into the cut sternum in animal models, and a search was made for radioactive deposits in the peripheral lung tissue. Shortly after the application of the wax, there was evidence of large radioactive deposits in the lungs. It is probable that this embolization occurs also under clinical conditions and may play a role in pulmonary complications following open-heart operations.

The embolization of bone wax from sternotomy incisions

Cardiopulmonary Bypass: Principles and Management

Ischemic stroke is a multifactorial disorder, related to multiple genetic and environmental factors. Despite an increase in stroke risk when there is a positive family history (up to 75% in some trials), the exact contribution of genetics in the development of ischemic stroke in young patients is unknown. Genetic predisposition plays a different role depending on age and type of stroke. These genetic factors combine with conventional ones, like hypertension, diabetes and homocysteine levels; which at the same time interact with the environment in the development of atherosclerosis. Homocysteine has been considered anatherogenic factor in cardiovascular and cerebrovascular disease. We present the case of a previously healthy 49year old patient, who suffered a partial anterior circulation infarct with a score of 7 according to the NIHSS scale, and a heterocygotemethiltetrahydrofolate reductase gene mutation (C677T).

Evento cerebrovascular isquémico en el adulto joven (Ischemic stroke in a young adult)

Superoxide Dismutase'ın İzole Köpek Kalbinde İskemi ve Reperfüzyon Etkisiyle Oluşan Elektrofizyolojik Değişiklikler Üzerine Etkisi

Diagnosis of ischemic stroke: guidelines of turkish society of cerebrovascular diseases – 2015

Amaç: Bu çalışmada bone wax kullanımımın mortalite ve morbiditeye etkisi araştırıldı. Ça­lış­ma­ pla­nı:­ Ocak 2008 Mayıs 2009 tarihleri arasında kliniğimizde medyan sternotomi ve kardiyopulmoner baypas (KPB) altında kalp ameliyatı yapılan 191 hasta (118 erkek, 73 kadın; ort. yaş 50.1±2.9 yıl; dağılım 22-81 yıl) bu retrospektif çalışmaya dahil edildi. Hastalar bone wax kullanılanlar ve kullanılmayanlar olarak iki gruba ayrıldı. Gruplar kan ürünü gereksinimleri, resternotomi insidansı, sternum stabilizasyonu, yüzeyel yara enfeksiyonu, mediastinit ve erken mortalite açısından kıyaslandı. Bul gu lar: Her iki gruptaki hastaların demografik ve ameliyat özellikleri benzerdi. Koroner arter baypas greftleme (KABG) her iki grupta da en sık yapılan ameliyat olup, bunu mitral ve aort kapak cerrahisi ve Bental prosedürü takip etmekteydi. Cerrahi mortalite insidansı her iki grupta da birer hastaydı. Ameliyat sonrası yoğun bakıma alınan hastaların 12. ve 24. saatteki ortalama kanama miktarları, sırasıyla 1. grupta 484.9±112.0 mL ve 523.3±174.4 mL iken, 2. grupta 504.7±134.4 mL ve 577.6±181.1 mL idi. Bone wax grubunda hem 12. hem de 24. saatte ameliyat sonrası kanama miktarları daha az ise de, gruplar arasındaki fark istatistiksel olarak anlamlı değildi (12. saat için p=0.457, 24. saat için p=0.388). Toplam beş hasta reeksplore edildi; bunlardan ikisi 1. grupta, üçü de 2. gruptaydı. Kullanılan kan ürünleri açısından gruplar arasında istatistiksel fark yoktu. Toplam altı hastada sternotomi cilt kesisinde enfeksiyon gelişti, dört hastada antibiyotik tedavisi sonrası enfeksiyon tamamen iyileşti. Her iki gruptaki birer hastada enfeksiyonun dirençli olması ve sternum instabilitesinin gelişmesi nedeniyle, sternum revizyonu ve pektoral kas flepleme işlemi yapıldı. So­nuç:­Bone wax kullanımı ile ameliyat sonrası kanama ve ameliyat sonrası kan ürünü gereksinimi açısından anlamlı bir azalma görülmemiştir. Bununla birlikte, bone wax cerrahi enfeksiyon insidansını da artırmamaktadır. Anah tar söz cük ler: Kanama; kardiyak cerrahi; koroner arter baypas greftleme. Background:­In this study, we aimed to investigate the effects of bone wax use on mortality and morbidity. Methods: Our retrospective study included 191 patients (118 males, 73 females; mean age 50.1±2.9 years; range 22 to 81 years) who underwent cardiac surgery via median sternotomy and cardiopulmonary bypass (CPB) between January 2008 and May 2009 in our clinic. The patients were divided into two groups comprised of those who were administered bone wax, and those who were not. The groups were compared for blood product requirement, incidence of resternotomy, sternum stabilization, superficial wound infection, mediastinitis, and early mortality. Results:­The demographic and operative data of the patients in both groups were similar. Coronary artery bypass grafting (CABG) was the most commonly performed surgery, followed by mitral and aortic valve surgery and the Bentall procedure. The incidence of surgical mortality was one patient per group. The mean amount of bleeding at 12 and 24 hours after surgery were 484.9±112.0 mL and 523.3±174.4 mL in the first group and 504.7±134.4 mL and 577.6±181.1 mL in the second group, respectively. Although the amount of bleeding in the bone wax group at 12 and 24 hours following surgery was lower, the difference between the groups was not statistically significant (p=0.457 at 12 hours; p=0.388 at 24 hours). A total of five patients were re-explored two in the first group and three in the second group. There was no statistical difference between the groups in terms of the blood products used. Six patients experienced an infection of the sternotomy skin incision, and four of them fully recovered with antibiotic treatment. Sternal revision and the pectoralis major muscle flap procedure were performed on two patients, one in each group, due to resistant infection and sternal instability. Conclusion:­ There was no significant decrease in the postoperative bleeding and blood product requirement following the use of bone wax. In addition, it did not increase the incidence of surgical infection.

Bone wax use in open heart surgery: Is it safe?-Açık kalp cerrahisinde bone wax kullanımı: Güvenli mi?

Predictive Value of Mean Platelet Volume and Red Blood Cell Distribution in Chronic Brucellosis

ÖZET Bu çalışmada kardiyopulmoner by pass geçiren ol­ gularda yüksek doz aprotinin (Trasylol) 'in etkisi incelendi. Olgular 30 ar kişilik iki ayrı grup olarak ele alındı. Her iki grupta da standart anestezi, perfuzyon ve benzer cerrahi işlemler uygulandı. Kardiyopulmoner by pass sonrası trombosit sayılarındaki azalma her iki gruptu istatistiksel olarak önemli bir farklılık göstermedi. Ancak kardiyopulmoner by pass sonrası kanama zamanı aprotinin alan grupta nor­ malin biraz üzerinde iken almayan grupta normalin biraz üzerinde iken almayan grupta önemli bir yükseklik sap­ tandı. Aprotinin /adlanılan gruptaki toplam drenajın kul­ lanılmayan gruba oranla belirgin bir şekilde azaldığı gözlendi (385 ±78 mi ve 692 ±157 ınl p<0.01). Yine aprotinin gnıbunda diğer gnıba oranla post operatif dönemde banka kanı ve kan ürünleri oldukça az kul­ lanıldı.

Açık Kalp Cerrahisinde Ameliyat Sonrası Kanamaların ve Kan Kullanımının Yüksek Doz Aprotinin ile Azaltılması

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