Renal cell carcinoma extended to the right atrium was operated by using cardiopulmonary bypass and deep hypothermic circulatory arrest. Hypothermic circulatory arrest provides bloodless surgical field for tumor thrombus removal and adequate visceral and brain protection. The surgical technique that we used in a patient was reported in light of the literature.

Graft spasm is a common problem in coronary artery bypass grafting (CABG). In this study, we aimed to investigate the interaction of levosimendan, a novel inodilator, with vasodilator agents that are clinically used for the treatment of graft spasm and with endogenous vasoconstrictors that are thought to play a role in graft vasospasm, in human internal mammary artery (IMA) and saphenous vein (SV). Isolated human IMA and SV segments derived from patients undergoing CABG were suspended in an organ bath. Responses to cumulative concentrations of noradrenaline (NA), serotonin (5-HT), papaverine, nitroglycerin (NG), and diltiazem were recorded before and after 10(-5) m levosimendan incubation (30 min). In addition, cumulative levosimendan responses were taken in vessels precontracted with NA or 5-HT. 10(-5) m levosimendan reduced NA Emax and sensitivity in IMA and SV, and 5-HT Emax responses in IMA. Moreover, levosimendan caused concentration-dependent relaxation in both grafts. Papaverine Emax or sensitivity was not altered by levosimendan neither in IMA nor in SV. Levosimendan diminished NG sensitivity in IMA and Emax responses in SV and decreased diltiazem Emax responses both in IMA and SV. Our results suggest that levosimendan may be used alone for prevention or treatment of graft spasm in IMA or in combination with papaverine in IMA and SV grafts. However, as concurrent administration with diltiazem or NG causes a reduction in relaxation in vitro, we suggest caution should be exercised when using levosimendan in combination with these agents.

Objective: AKI occurs in 5% to 42% of patients after cardiac surgery. The primary aim of this study was to investigate the effect of goal-directed fluid therapy in the perioperative period on the development of AKI in the early period in patients undergoing cardiac surgery.Methods: The study was designed prospectively at single academic center. Patients undergoing cardiac surgery were divided into two groups according to perioperative fluid management: Group Control (Group C, n=30): Fluid management was performed with traditional monitoring method. Group Study (Group S, n=30): It was performed with transesophageal doppler and transthoracic doppler fluid management. Clinical and hemodynamic data were recorded at preoperative (t0), postoperative 4th hour (t2), 24th hour (t3) and 48th hour (t4). Serum creatinine, GFR, Cystatin-C and KIM-1 values were measured as AKI indicators.Results: Postoperative fluid requirement was significantly lower in the study group (p=0.002). Postoperative total balance was significantly more negative in the study group than in the control group (p<0.0001). ERT requirement was significantly lower in the study group compared to the control group (intraoperative, p=0.02; postoperative, p=0.002). Cystatin-C was significantly lower in the study group at the postoperative 24th and 48th hours. (respectively, p<0.04, p<0.02). AKI development rates were similar between the groups (p>0.05).Conclusion: GDFT should be considered in the foreground because it shortens the length of hospital stay and reduces unnecessary fluid load in patients who are scheduled for major surgery. Cystatin-C can be used more prominently in the evaluation of AKI as a biomarker.