Comparison of endovenous laser ablation and cyanoacrylate embolization in the non-invasive treatment of superficial venous insufficiency in terms of patient satisfaction.

OBJECTIVE: Ablation with n-butyl cyanoacrylate is a clinically newer technique than endovenous laser ablation and other interventional techniques in the treatment of chronic venous insufficiency (CVI). The aim of this study was to compare the endovenous laser ablation (EVLA) and n-butyl cyanoacrylate (NBCA) interventional techniques in terms of benefit, effectiveness, and patient satisfaction. MATERIALS AND METHODS: The study was conducted at Yozgat City Hospital and Bozok University Research Hospital Cardiovascular Surgery clinics between November 2016 and February 2021. A total of 260 symptomatic patients with 130 randomized cases in each intervention group were included. NBCA patients constituted Group 1 and EVLA patients Group 2. The saphenous vein was evaluated by color Doppler ultrasonography (CDUS) of the lower extremity. Patients with saphenous veins over 5.5 mm in diameter and a saphenous-femoral reflux time of 2 s or longer were included in the study. The patients were asked about their satisfaction and symptoms in the first postoperative week during an outpatient clinic follow-up with CDUS investigation at the first and sixth months. RESULTS: Although vena saphenous magna (VSM) closure results were similar with the two methods, satisfaction rates were found to be higher with the NBCA procedure. CONCLUSION: Comparison of the new methods used in the treatment of CVI revealed similar VSM closure rates in the two methods, but the satisfaction rate was higher with the NBCA technique in this study.

A rare cause of dyspnea: Primary large B cell lymphoma causes giant cardiac mass.

Cardiac lymphoma (CL) is a rare and life-threatening clinical condition. Most cases are diagnosed late period. Although the definitive diagnosis is made by biopsy, a biopsy could not be performed in most cardiac masses due to the high mortality rate and therefore the exact incidence is not known. In this case report, we present a case of giant CL filling both the pericardial area and right heart cavities and treated with surgical resection in a previously healthy male patient who presented with symptoms of heart failure.

Remote patient monitoring after cardiac surgery: The utility of a novel telemedicine system.

OBJECTIVE: We examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web-based software. METHODS: From November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web-based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow-up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software. RESULTS: During a mean follow-up period of 78.9 ± 107.1 (10-395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life-threatening complications were found to have been diagnosed early using the Telemedicine System. CONCLUSION: Remote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.

Evaluation of Neurocognitive Abilities in Patients Undergoing Carotid Endarterectomy Surgery.

OBJECTIVE: To evaluate the differences in neurocognitive abilities between the preoperative and postoperative periods following carotid endarterectomy (CEA), due to carotid artery stenosis, and to evaluate the effectiveness of CEA on neurocognitive abilities in the future. MATERIAL AND METHODS: Thirty-eight cases of CEA surgery at Bozok University Faculty of Medicine Research Hospital between January 2015 and June 2020 were examined. Neurocognitive tests were performed on carotid endarterectomy patients one day before the operation and on the 2nd, 4th, and 30th postoperative days. The effect of CEA on cognitive results has been investigated. RESULTS: Of the patients, eight were female (21.1%), 30 were male (78.9%), and the mean age was 66 ± 4.09. Thirty-two (84.21%) of the patients were operated on under general anesthesia and six (15.78%) under regional anesthesia. A shunt was used in 19 patients. Right carotid endarterectomy was performed in 20 cases and left carotid endarterectomy in 18 cases. We used the primary closure technique in two of 38 cases and patches on 36 of them. We used Dacron in 21 cases, PTFE in 12 cases, and saphenous vein as a patch in three cases. In the WMS digit spam and recall scores, the postoperative period fell on the 2nd day, and then on the 4th and 30th day after the operation, there was a low level of increase over time. Compared with the preoperative period, the learning score was found to be the lowest on the 2nd day, lower on the 4th day compared with the preoperative period and improved compared with the preoperative period on the 30th day. There was no decrease in the verbal fluency test score results after the operation, on the contrary, it was observed minimally. The test score results cumulatively were decreased in the early postoperative periods compared with the preoperative period and increased on the 30th day compared with the preoperative period. CONCLUSION: The purpose of CEA in the past was the prevention of ischemic stroke and cerebrovascular disease (CVD) rather than neurocognitive recovery. Factors affecting neurocognition in CEA are multifactorial. Preservation and improvement of neurocognition are more important than any other period of history. By prioritizing cognitive abilities in the treatment of carotid stenosis, individualization of the treatment will help maximize the increase in cognitive abilities by providing optimum benefit to the patient of each factor.

Addition of Vitamin B Complex to Prime Solution in Cobalamin-Deficient Patients to Prevent Postoperative Delirium.

OBJECTIVE: In this study, we investigated whether the addition of vitamin B complex to prime solution for cardiopulmonary bypass (CPB) in cobalamin-deficient patients undergoing on-pump coronary artery bypass grafting (CABG) helps prevent the development of postoperative delirium (POD). MATERIALS AND METHODS: In the present study, 69 of 138 patients with serum vitamin B12 levels <200 pg/mL based on the blood sample taken within 1 week prior to on-pump CABG between January 2013 and December 2017 were enrolled. The control group included 69 patients. Vitamin B complex (25 mg vitamin B1, thiamine hydrochloride, 2.734 mg vitamin B2, riboflavin phosphate ester monosodium, 5 mg vitamin B6, pyridoxine hydrochloride, 15 mcg vitamin B12, 50 mg niacinamide, and 17.2 mg D-panthenol) was added to the prime solution for CPB in the study group. The Intensive Care Delirium Screening Checklist (ICDSC) was used for the diagnosis of POD, and the severity of delirium was assessed by using the Delirium Rating Scale-Revised-98 (DRS-R-98). RESULTS: Twenty-nine patients in the control group (42%) and 18 patients (26%) in the study group developed POD (P = .017), delirium severity scores were higher in the control group (16.5 ± 2.9 versus 15.03 ± 2.48, P = .034). Logistic regression analyses showed vitamin B complex was an independent protective factor for preventing the development of POD in patients undergoing on-pump CABG (odds ratio [OR]: 0.23, 95% confidence interval [95% CI]: 0.06-0.83, P = .025). CONCLUSION: On the basis of the results of our study, the addition of vitamin B complex to the prime solution for CPB decreases the incidence of POD in cobalamin-deficient patients undergoing on-pump CABG.

Treatment of Chylothorax with Pleurodesis (A Lesser Known Complication of Behçet's Disease): A Case Report.

Behçet's Disease (BD) is a multisystemic vasculitis which usually affects optical, genital, and oral mucosae and often reoccurs intermittently. Chylothorax is a very rare complication of BD which usually causes thrombosis in the major venous system. A 27-year-old man with a 10-year history of BD referred to our cardiovascular surgery department with symptoms of serious aches in the left arm, edema, and apparent veins on the left anterior chest wall. A total thrombosis of the left internal and external jugular veins and the left subclavian vein was observed. One month after a successful treatment and discharge, the patient returned to our clinic with symptoms of dyspnea and coughs. A chest radiograph showed a consolidated region. A milky liquid was aspirated through thoracocentesis from the left thorax, and its biochemical analysis helped us arrive at a diagnosis of chylothorax. The patient was hospitalized and administered corticosteroids and immunosuppressive therapy with a high-carbohydrate and low-fat dietary regimen for BD. Thereafter, a left thoracic drainage system was established. On the seventh day of hospitalization, due to a progressing cheilosis flow, a pleurodesis process was applied with talcum powder. However, the chylous drainage was continued and 60 mL of venous autologous blood was injected into the left thorax through a drainage tube. The treatment was successful, and the patient was discharged from the hospital uneventfully. At 1 month's follow-up, the chest radiograph was normal.

A simultaneous coronary artery bypass grafting on beating heart and right upper lobectomy in a patient with a lung adenocarcinoma.

A coexisting coronary heart disease may increase the operative mortality and morbidity rates of lung resection. A simultaneous or a two-stage procedure using myocardial revascularization prior to the pulmonary resection may reduce the postoperative morbidity and mortality. Herein, we present a 65-year-old male case of a lung adenocarcinoma in whom a simultaneous coronary artery bypass grafting on a beating heart and right upper lobectomy was performed.