Background/Objectives: Sulodexide (SDX) is a drug known for restoring the glycocalyx, thereby offering endothelial protection and regulating permeability. Additionally, it has antithrombotic and anti-inflammatory properties and has shown arterial vasodilatory effects. Endothelial cells play a crucial role in maintaining homeostasis, with their dysfunction being a key contributor to loss in vasodilatory response, especially in arterial pathologies. The aim of this study was to investigate the effects of SDX on stimulated vascular tonus in human arterial samples and to assess the function of the endothelial layer as a source of nitric oxide (NO). Methods: A total of 16 internal mammary artery remnants from coronary artery bypass graft surgeries were dissected into endothelium-intact and endothelium-denuded groups (n = 8 each). The arterial rings were equilibrated under tension, with their basal tonus recorded before and after phenylephrine stimulation. SDX’s impact on arterial contraction was assessed through cumulative dose–response curves. NO synthase inhibitor (Nω-nitro-L-arginine methyl ester) was used to assess SDX’s vasodilatory effect over the NO pathway. Results: SDX application resulted in concentration-dependent vasorelaxation in both endothelium-intact and endothelium-denuded groups at certain doses. However, the inhibitory effect of SDX was more pronounced in endothelium-intact rings at higher doses compared to endothelium-denuded rings (p < 0.05). Similar inhibition of contraction curves was achieved for both endothelium-intact and endothelium-denuded rings after L-NAME pre-incubation, suggesting a necessity for NO-related endothelial pathways. Conclusions: SDX exerts a concentration-dependent inhibition on arterial contraction, emphasizing the critical role of an intact endothelium and NO-mediated pathways in this process. This underscores SDX’s potential in treating endothelial dysfunction-related pathologies.

This study aimed to examine the impact of frailty on postoperative morbidity and mortality in patients undergoing cardiovascular surgery, questioning the adequacy of the preoperative American Society of Anesthesiologists (ASA) as the sole assessment tool. In a cohort of 76 patients undergoing cardiovascular interventions, we analyzed demographic data, Edmonton Frail Scale (EFS), ASA scores, Charlson Comorbidity Index values, surgery and hospitalization durations, intraoperative blood pressures, inotropic needs, erythrocyte transfusions, and pre/postoperative hemoglobin levels. Pearson chi-squared and Spearman tests were performed. Correlation of postoperative intensive care unit (ICU) stay, extubation time, ward stay, discharge status, morbidity rates, and ASA and EuroSCORE II results with EFS scores. The demographic profile indicated a mean age of 59.67 ± 13.02 years, with a majority of male patients (59.2%). Frailty status varied, with 48.7% non-frail, 26.3% vulnerable, 18.4% mildly frail, and 6.6% moderately frail. Surgical data revealed an average duration of 300.93 minutes and a mean ICU stay of 54.48 ± 101.16 hours. Statistical analysis showed significant differences in frailty levels based on initial morbidity (χ² = 10.612, P = .014) but not in ASA score distribution by morbidity status (χ² = 1.634, P = .442). A negative correlation was observed between EFS scores and hemoglobin levels, along with a positive correlation between the EuroSCORE II score and the duration of intubation, extubation, and ICU stay. Frailty significantly contributes to increased morbidity and necessitates evaluation alongside preoperative ASA scores to inform the need for prehabilitation. The ultimate goal extends beyond patient survival, aiming to ensure recovery while maintaining the quality of life and functional independence.

Chronic venous disease (CVD) is a proqgressive and underestimated condition related to a vicious circle established by venous reflux and endothelial inflammation, leading to vein dilation and histology distortion, including loss of media tone. Sulodexide (SDX) is a drug restoring the glycocalyx that demonstrated endothelial protection and permeability regulation, together with anti-thrombotic and anti-inflammatory roles. In the lab it also exhibited vein contractility function. The aim of the present study was to show the possible role of endothelium and nitric oxide pathway on SDX’s veno-contractile effect on human saphenous veins. The remnants of great saphenous vein (GSV) segments (n = 14) were harvested during coronary artery bypass graft surgery. They were dissected as endothelium-intact (n = 8) and denuded rings (n = 6). First, a viability test was carried out in bath with Krebs–Henseleit solution to investigate a control and basal tension value. After this, cumulative doses of SDX were applied to rings and contraction values were studied in endothelium-intact phenylephrine (PheE, 6 × 10⁻⁷ M) pre-contracted vein rings. Finally, endothelium-intact PheE pre-contacted vein rings were treated by nitric oxide synthase inhibitor Nω-nitro-L-arginine methyl ester (L-NAME, 10⁻⁴ M) for 10 min. Contraction protocol was applied, and contraction values were measured in cumulative doses of SDX. The same protocol was applied to endothelium-denuded vein rings to investigate the effect of SDX. Saphenous vein rings showed an increase in contraction to cumulative doses of SDX. In endothel-intact rings, KCL-induced contraction from 92.6% ± 0.3 to 112.9% ± 0.4 with cumulative SDX doses. However, SDX did not show any veno-contractile effect on endothel-denuded rings. In denuded rings contraction responses measured from 94.9% ± 0.3 to 85.2% ± 0.3 with increasing doses of SDX, indicating no significant change. Nitric oxide synthase inhibitor (L-NAME) prohibited the contraction response of the sulodexide in all dosages, indicating that the contractile function of SDX was mediated by endothelial derived nitric oxide. Results of endothel-intact and denuded rings with L-NAME showed a similar incline with denuded rings with SDX only. The results confirmed SDX’s veno-contractile effect in human samples, by means of nitric oxide synthase pathways involvement.

Objective: Testicular tumors, of which 95% are germ cell tumors, are generally solid tumors seen in men under the age of 35. Testicular tumors are primarily treated with orchiectomy. Following orchiectomy and chemotherapy, retroperitoneal lymph node dissection (RPLND) is an important surgical procedure in uro-oncology. In our study, we aimed to share our experiences by discussing our anesthesia management in RPLND operations conducted after chemotherapy at our hospital in light of current literature. Material and Methods: This study investigates cases of Retroperitoneal Lymph Node Dissection (RPLND) performed after chemotherapy at a tertiary education and research hospital between 2017 and 2023. After obtaining approval from the Ethics Committee (No: 2023/305), data including patients' ages, operation durations, perioperative blood gas and fraction of inspired oxygen (FiO₂) values, and the amount of fluid administered during the procedure were retrospectively reviewed from patient records and anesthesia monitoring forms. Patients with incomplete information were excluded from the study. Blood gas samples obtained immediately after anesthesia induction were compared with those taken upon admission to the intensive care unit. In our clinic, routine consultations with chest diseases and medical oncology are obtained prior to this procedure. Results: In our study, data from 34 out of 37 RPLND cases conducted over a four-year period were included. ASA III patients constituted 35% (n=12), while ASA II patients made up 65% (n=22), with an average age of 28 years (range: 17 to 47).The average anesthesia duration from the time patients entered the operating room to their admission to the ICU was recorded as 340.7 minutes, and the average extubation time from ICU admission was 125.6 minutes. While there were no significant changes in the average pH, pO₂, and pCO₂ values in blood gases of patients a significant increase in lactate levels was observed. It was noted that the perioperative (FiO₂) was maintained below 40% and the crystalloids administered in the first 2 hours were kept below 4 mL/kg/hour. All patients were discharged home after the operation. Conclusion: RPLND requires a multidisciplinary approach. Measures taken against perioperative hypoxia and hyperoxia, as well as fluid management, may be crucial in preventing major complications that can arise during both the intraoperative and postoperative periods.

Aim; Coronavirus disease 2019 (COVID-19) has led to a dramatic increase in critically ill patients requiring prolonged mechanical ventilation. Many of these patients require tracheostomies due to prolonged intubation times, respiratory failure, and the need for prolonged ventilatory support. Material and Method; A retrospective analysis was performed on critically ill COVID- 19 patients who were admitted to our ICU and required prolonged mechanical ventilation. Our primery outcome is presenting our experience for performing tracheostomy in COVID-19 patients. Ultrasound guided percutaneous tracheostomy was performed at the bedside in all patients. Results; All percutaneous tracheostomies were performed successfully without complications. The tracheostomy procedure was performed on an average of 14 days after intubation. The mean age of the patients was 71 years, and most had underlying comorbidities such as hypertension, diabetes mellitus, and obesity. Conclusion; Our experience with ultrasound-guided percutaneous tracheostomy in 17 COVİD 19 patients demonstrated that this method is a safe and effective approach in critically ill patients.

Aim: Tramadol is a weak centrally acting opioid analgesic with µ-opioid receptor agonist effects. It has been explored for its analgesic efficacy through various in-vitro and in-vivo studies. The skin, as the body’s largest organ and the protector barrier, is vulnerable to injuries and wounds that can cause significant challenges due to pain, economic burdens and psychological implications. Successful healing of wound involves complex processes and it is influenced by factors such as angiogenesis and nitric oxide levels. This study investigates the effects of tramadol on wound healing in experimental ischemic wound models in rats.Material and Methods: Two 6 mm ischemic wound models were created on the backs of 30 male Wistar Albino rats, with wound areas cut along the long edges and a sterile silicone material placed between the panniculus carnosus fascia and paraspinosus muscle. Rats were randomized into Tramadol, Control, and Sham groups. The wounds were imaged using a "SONY ILCE-7" camera on days 0, 3, 6, 10, and 14. Wound areas and healing percentages were calculated from the images and recorded for statistical purposes. After 14 days, the animals were sacrificed under general anesthesia for histopathological examination of tissue samples. CD31 and VEGF antibodies were used to evaluate the density and morphology of vascular structures.Results: Tramadol administration accelerated the healing of wound surface area. Significant differences were found between groups in terms of inflammation, and data recorded in CD34, CD31, and VEGF-stained preparations.Conclusion: The study found that tramadol positively contributes to wound healing in the acute phase of ischemic wounds by affecting various processes.