To compare the anatomical and physiological scoring systems and the outcomes of surgical management of penetrating cardiovascular trauma at a rural center.
Seventy-seven patients underwent emergency ...surgery at our center between January/2012 and October/2018 due to penetrating cardiovascular trauma. Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) were calculated. The validation of these risk scores to predict mortality was assessed by the area under the receiver operating characteristic curve analysis.
All trauma scores were correlated with mortality. As ISS, NISS, and TRISS values increased and RTS values decreased, the mortality rate increased. The area under the curve (AUC) in the receiver operating characteristic curve analysis was 0.943 for TRISS, 0.915 for RTS, 0.890 for ISS, and 0.896 for NISS (P<0.001 for each). Logistic regression analysis revealed that scores were correlated with mortality (P<0.001 for each). By investigating cardiac injuries alone, only TRISS and RTS results correlated with mortality for cardiac injuries (Mann-Whitney U test, P=0.003 and P=0.01, respectively). The AUC was only statistically significant for TRISS and RTS (AUC=0.929, P<0.05 for both). For vascular injuries, all the scores were significantly correlated with in-hospital mortality (Mann-Whitney U test, P<0.001 for each). TRISS had the highest AUC (AUC=0.946, P<0.001).
TRISS has the highest predictivity for in-hospital mortality in patients with penetrating cardiovascular trauma.
This paper presents a case study of a patient that underwent surgery for a ruptured abdominal aneurysm. The postoperative course was complicated by resistant hypertension and tachycardia. A ...suprarenal mass was detected in the computed tomography scan with radiological suspicion of pheochromocytoma. Few cases of pheochromocytoma coexisting with aneurysms have been reported. Management of cardiovascular stability is crucial in such cases. Despite the lack of evidence, pheochromocytomas might have a role in the etiology of aortic aneurysms.
Aim: Vascular surgery is an important part of the multidisciplinary approach to surgical treatments, and vascular surgeons are often called on intraoperatively to provide immediate assistance to ...their colleagues. Our aim was to describe the extent of assistance provided during emergency intraoperative consultations at a single tertiary academic centre. Material and Methods: We reviewed the records of patients who were consulted intraoperatively in our hospital over a period of approximately 4 years (January 1, 2017-December 31, 2020) and organized the data collected. Results: 40 emergency intraoperative consultations were identified. 55% of the patients were female, with an average age of 48.83 years. The most frequently consulted subspecialty was obstetrics and gynecology (32%). Index cases were elective/nonurgent (90%), most involving tumor resection (77.5%). The primary reason for vascular consultation was revascularization (37.5%). The primary blood vessel and anatomic field of intervention were categorized. Most cases (50%) included preservation of blood flow, including primary arterial repair (20%) and ligation of the bleeding vessels (20%) in the first choice. Postoperative mean length of stay was 13 days, with a 30-day mortality of 5.1%. Conclusion: Using a wide variety of skills and techniques, vascular surgeons strive to respond to urgent open surgical consultations in various anatomical sites. Our study provides evidence to the wide range of knowledge and skills required for modern vascular surgeons and the place of the subspecialty in the core services offered in a multidisciplinary approach.
Introduction: This study investigated the role of the neutrophil-lymphocyte ratio (NLR), the perioperative changes in NLR (delta-NLR), the platelet-lymphocyte ratio (PLR), and the platelet count in ...predicting acute kidney injury (AKI) following coronary artery bypass grafting (CABG) during hospital stay. Methods: The records of 396 patients with preoperative creatinine < 1.5 mg/dl undergoing isolated CABG between October 2015 and October 2019 were reviewed retrospectively. Diagnosis of AKI was based on the Kidney Disease Improving Global Outcomes definition. Demographic data, operative data, in-hospital mortality, preoperative NLR, PLR, and platelet counts were compared between patients with (AKI group) and without (non-AKI group) postoperative AKI. Additionally, NLR, delta-NLR, and PLR values were calculated daily for the first four postoperative days. A “subsequent AKI group” was formed for the first four postoperative days by excluding patients diagnosed with AKI. The daily and overall predictivity of the markers for AKI are investigated. Results: AKI was present in 86 patients during the postoperative period, while 310 patients had normal postoperative renal functions. NLR, delta-NLR, and PLR on the first four postoperative days (P<0.001 for all) were significantly associated with the development of AKI in subsequent days. Multivariate analysis identified postoperative NLR (odds ratio 1.17, 95% confidence interval 1.11-1.23; P<0.001) as an independent predictor of AKI. PLR lost its significant association with AKI at the values measured at discharge from hospital (P>0.05). Conclusion: NLR values measured on the first four days postoperatively are a useful tool in predicting AKI during hospital stay following CABG.
Sodium-glucose cotransporter 2 inhibitors have been shown to reduce the risk of cardiovascular disease in type 2 diabetes (T2DM) patients. The purpose of this study was to evaluate cardiovascular ...disease risk indirectly through Doppler ultrasonography (USG) of carotid artery vascular markers in T2DM patients using dapagliflozin.
One hundred forty-five patients presenting to our clinic between March 2016 and June 2018 and diagnosed with T2DM were included in the study. These were divided into two groups - a dapagliflozin group of 85 patients and a 60-member non-dapagliflozin control group. Common carotid artery end-diastolic velocity (EDV), peak systolic velocity (PSV), and resistive index (RI) parameters were evaluated using Doppler USG in both groups.
The mean duration of follow-up was 2.2 ± 0.4 years. Mean ages were 45 ± 14 years in the dapagliflozin group and 42 ± 15 in the control group. Mean HbA1c was 7.4 ± 1.6 in the dapagliflozin group and 7.3 ± 2.1 in the control group. Common carotid artery, PSV, and EDV parameters were higher (p = .012/p = .036), while RI was lower (p ˂ .001), in the dapagliflozin group than in the control group.
Vascular resistance was lower in the group using dapagliflozin for diabetes management.
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DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives: Endovascular aneurysm repair (EVAR) is a
widely used modality in the treatment of abdominal aortic aneurysms (AAA).
Siena EVAR and St.George Vascular Institute (SGVI) scores are risk ...scores to
predict possible EVAR related reinterventions. This study was aimed to validate
the risk scores and compare the predictivity of the scoring systems for
hospital cost-effectiveness in our population.Materials and Methods: 39 patients with unruptured
infrarenal AAA, including both elective and non-elective admissions which had a
follow-up period from at least 6 months are included in our study. Siena EVAR
score and SGVI score are calculated. The relation of the complications
(adjuncts at the index operation, reinterventions during follow up), costs
(index procedure and overall), aneurysm related mortality are compared among
the risk groups. Results: In our study, SGVI score had a predictivity
among high and low-risk groups involving reinterventions during follow up, cost
on index operation and mortality (P < 0.05). Siena EVAR score had no
significant predictivity (p > 0.05).
Conclusion: A high-risk value in SGVI score must warn
the surgeon to reassess the treatment option for AAA. If EVAR is indicated the health care providers
and assurance system can count on a higher cost on index operation, a higher
risk of reintervention and mortality during long term follow up.
Amaç: Endovasküler anevrizma onarımı (EVAR), abdominal aort
anevrizmalarının (AAA) tedavisinde yaygın olarak kullanılan bir yöntemdir.
Siena EVAR ve St.George Vasküler Enstitüsü (SGVI) puanları, EVAR ile ilgili
olası müdahaleleri öngörmek için kullanılan risk puanlarıdır. Bu çalışmada,
risk skorlarını doğrulamak ve skorlama sistemlerinin popülasyonumuzda hastane
maliyet etkinliği için öngörülerini karşılaştırmak amaçlandı.Gereç ve Yöntem: Çalışmamıza en az 6 ay takip süresine sahip
rüptüre olmayan infrarenal AAA'lı 39 hasta dahil edildi. Siena EVAR skoru ve
SGVI skoru hesaplandı. Risk grupları arasında komplikasyonların (ilk
operasyonundaki ek işlemler, takip sırasında girişim ihtiyacı), maliyet (ilk işlem
ve genel), anevrizmaya bağlı mortalite arasındaki ilişki karşılaştırıldı.Bulgular: Çalışmamızda SGVI skoru yüksek riskli ve düşük
riskli grupları arasında, takip sırasında girişim ihtiyacı, ilk işlem maliyeti
ve mortalite açısından anlamlı fark bulundu (P <0.05). Siena EVAR skorunun
anlamlı bir öngörücülüğü yoktu (p> 0.05).
Sonuç: SGVI skorundaki yüksek riskli bir değer, cerrahı AAA
için tedavi seçeneğini yeniden değerlendirmesi için uyarmalıdır. EVAR risk
gruplamasına göre, sağlık hizmeti sağlayıcıları ve sosyal güvence sistemi, ilk işleminlerde daha yüksek bir maliyet ve uzun
süreli takip sırasında daha yüksek oranda yeniden girişim ihtiyacı ve ölüm riskini hesaba katmalıdır .
Objectives: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) are hematological markers used as prognostic markers in cancer and thrombotic ...diseases. These markers’ association with intracardiac masses is unknown. Our goal is to determine the value of NLR, PLR, and MPV as prognostic markers in patients undergoing surgery for intracardiac masses. Materials and Methods: The study included primary and secondary heart tumors, intracardiac thrombi, and infectious diseases that cause a mass effect in the heart. The pathological examination, location, complications, and mortality are compared with the patients’ preoperative characteristics in the heart. The pathological examination, location, complications, and mortality are compared with the patients’ preoperative characteristics (NLR, PLR, and MPV). Results: The surviving patients were followed for 41 (20-75; minimum: 11-maximum: 120) months. NLR was found to be significantly higher in patients undergoing surgery for intracardiac thrombus, pulmonary embolism (PE), or impaired cardiac function (CF) (p=0.031, p=0.021, and p=0.046, respectively). Patients with masses in the left heart chambers and those with postoperative atrial fibrillation had significantly higher MPV values (p=0.001). The expected survival in the impaired CF group was significantly lower than in the normal CF group (35.91±13.00 months vs. 109.7±76.92 months, p=0.001). Conclusion: There was a link between CF impairment and the NLR. The presence or absence of PE, as well as significant differences in NLR between groups of impaired and normal CF, tumors, and thrombus, is thought to be influenced by the patients’ clinical condition. The preoperative relationship between the localization of the mass in the left heart and the development of postoperative atrial fibrillation and MPV is remarkable.
To assess the postoperative pain and midterm results of patients undergoing internal perivenous compression with internal compression therapy (ICT) for venous insufficiency at the saphenofemoral ...junction (SFJ).
Patients managed with ICT between April and October 2019 for grade 4 venous reflux at the SFJ were retrospectively evaluated. The venous clinical severity score (VCSS) was calculated preoperatively and 1, 3, and 6 months postoperatively. Postoperative pain was assessed with the visual analog scale (VAS). Control Doppler ultrasound imaging was performed 6 months postoperatively.
Forty-five patients 14 (31%) males and 31 (69%) females; mean age, 47 ± 13 years were included. The median preoperative VCSS was 7 (5-8.5). The median VCSS at 1, 3, and 6 months postoperatively was 6 (4-7.5), 4 (3-5.5), and 3 (2-4), respectively, and these values were significantly lower than the preoperative score (p = 0,001, p < 0.001, and p < 0.001, respectively). The postoperative VAS score was 0 in 6 patients (13%), 1 in 17 patients (38%), 2 in 6 patients (13%), 3 in 15 patients (33%), and 4 in 1 patient (2%). At 6 months, reflux was absent in 9 (20%), grade 1 in 20 (44%), and grade 2 in 16 (36%) patients. A vena saphena magna diameter of >6.7 mm predicted grade >1 reflux at 6 months 87.5%, with an area under the curve of 0.78 (p < 0.001). No complications occurred.
ICT alleviated symptoms and reduced reflux grade in patients with venous insufficiency at the SFJ. This therapy can be applied with satisfactory patient comfort.
Coronary artery perforations and dissections, associated with cardiac tamponade or acute vessel closure, are life-threatening complications of percutaneous coronary intervention. In some cases, ...subepicardial hematomas could occur and compress the vessel. A 59-year-old woman was admitted to our hospital with chest pain and was diagnosed with non-ST-elevation myocardial infarction. Coronary angiography showed the total occlusion of the diagonal artery. During the intervention, left main coronary artery dissection and intramural hematoma occurred as coronary complications. The left main coronary artery was stented; however, the extension of the hematoma through the ostium of the left anterior descending artery caused further complications. The patient underwent an urgent coronary artery bypass graft surgery and was discharged on the seventh postoperative day.
Introduction:
Intraluminal thrombolytic therapy is the first step treatment of thrombotic malfunction of tunneled hemodialysis catheters (THC). The factors that affect catheter restoration and also ...catheter survival following thrombolytic therapy are not well described. In this study, we aimed to reveal the predictors that affect the success of the procedure and also present post-restoration catheter patency after intraluminal thrombolytic administration.
Method:
This retrospective study included 62 patients with tunneled THC thrombosis treated with alteplase between 2017 and2020 in the study center. Age, comorbidities, the use of antiplatelet and anticoagulants, a history of catheter thrombosis, time on dialysis, the duration of the catheter were investigated as possible predictors of procedural success. The independent predictive factors for procedural success were evaluated by using backward stepwise likelihood ratio logistic regression analysis. Primaryand assisted patencieswere presented with Kaplan-Meier graphs.
Results:
Thrombolityc was administered to 62 patients 102 times. The median primary patency from the first thrombolytic administration to a second catheter thrombosis was 9 months (range 1-20 months). The overall median patency was 12 months (range 2-23 months). The overall procedural success rate was 79.4% (81/102).Multivariate analyses revealed that a history of prior catheter thrombosis was the only risk factor for procedural success (OR: 0.49; 95% CI: 0.26-0.91; p = 0.004). The need for a second dwell time among patients with prior history of thrombolysis was significantly higher compared to patients without a history of catheter thrombosis (12/26 patients, 46.2% and 6/55 patients, 10.9%; respectively; p = 0.001).
Conclusion:
The success of thrombolysis in subsequent de novo THC thrombosis decreases in patients who previously required intraluminal thrombolytic administration. Identifying patient subgroups with a high risk for THC thrombosis may be useful to investigate effective secondary prevention strategies.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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