Aneurysmal degeneration in the Omniflow II biosynthetic vascular graft.

Despite advances in endovascular treatments, femoropopliteal bypass is still the best option for the treatment of lower-extremity occlusive artery disease. Omniflow II biosynthetic vascular grafts are often chosen as bypass grafts when autologous vein grafting is not possible. A negative feature of this graft is the tendency towards late biodegeneration with possible formation of graft aneurysms. In this case report, we present a thrombosed non-anastomotic biosynthetic graft aneurysm, which caused only a pulsatile mass in the inguinal region, in a 62-year-old male patient who had undergone a femoropopliteal bypass operation three years earlier. Aneurysm formation in vascular grafts is multifactorial and can cause life-threatening consequences. Therefore, all patients with biosynthetic vascular grafts should remain under lifetime surveillance with duplex ultrasound for aneurysmal graft degeneration and graft thrombosis.

Factors affecting post-operative complications and mortality in surgical patients with and without COVID-19.

OBJECTIVE: The objective of the study was to evaluate the effect of COVID-19 on the outcomes of surgical patients and the factors associated with postoperative complications and mortality. METHODS: The study included hospitalized patients with similar demographic and clinical features, who underwent similar surgical operations with a positive polymerase chain reaction test for SARS CoV-2 before or within days following the surgery (COVID-19 group) and a control group was formed of patients who tested negative for COVID-19. The two groups were compared in terms of demographic, clinical, and laboratory data, the presence of pneumonia, complications, and 30-day post-operative mortality. RESULTS: The diagnosis for COVID-19 increased the risk of complications and mortality. Age, CRP, D-dimer, ASA Grade 3-4, > 2 comorbidities, and pneumonia were determined to be factors increasing the risk of complications. Age, CRP, > 2 comorbidities, emergency operations, and pneumonia were determined to increase the risk of mortality. CONCLUSION: As patients with peri/post-operative COVID-19 positivity might be at increased risk of postoperative complications and mortality, emergency surgery in infected cases should be delayed in appropriate cases.

OBJETIVO: Nos propusimos evaluar el efecto de la COVID-19 en los resultados de los pacientes quirúrgicos y los factores relacionados con las complicaciones postoperatorias y la mortalidad. MÉTODOS: Se incluyeron los pacientes hospitalizados sometidos a operaciones quirúrgicas similares con características demográficas y clínicas similares con una prueba de reacción en cadena de la polimerasa positiva para el CoV-2 del SARS antes/en los días siguientes a la cirugía (grupo COVID-19) y los controles negativos. Los dos grupos se compararon en términos demográficos, clínicos y de laboratorio de la presencia de neumonía, las complicaciones y la mortalidad a los 30 días del postoperatorio. RESULTADOS: El diagnóstico de COVID-19 aumentó el riesgo de complicaciones y mortalidad. La edad, la CRP, el Dímero D, el grado 3-4 de la ASA, tener más de 2 comorbilidades y neumonía se relacionaron con un mayor riesgo de complicaciones. Mientras que la edad, la PCR, tener más de dos comorbilidades, las operaciones de urgencia y la neumonía se relacionaron con un mayor riesgo de mortalidad. CONCLUSIONES: Los pacientes con COVID-19 pre/postoperatorio podrían tener un mayor riesgo de complicaciones postoperatorias y de mortalidad, por lo que las cirugías de urgencia en casos infectados podrían retrasarse en los casos adecuados.

Three Different Strategies for Repair of Symptomatic or Aneurysmatic Aberrant Right Subclavian Arteries.

INTRODUCTION: In this study, we aimed to present three different methods for symptomatic aberrant right subclavian artery (ARSA) surgery. METHODS: We identified 11 consecutive adult patients undergoing symptomatic and/or aneurysmal ARSA repair between January 2016 and December 2020. Symptoms were dysphagia (n=8) and dyspnea + dysphagia (n=3). Six patients had aneurysm formation of the ARSA (mean diameter of 4.2 cm [range 2.8 - 6.3]). All data were analyzed retrospectively. RESULTS: Median age of the patients (7 females/4 males) was 55 years (range 49 - 62). The first four patients (36.4%) underwent hybrid repair using thoracic endovascular aortic repair (TEVAR) and bilateral carotid-subclavian artery bypass (CScBp). Three patients (27.2%) were treated by open ARSA resection/ligation with left mini posterolateral thoracotomy (LMPLT) and right CScBp. And the last four patients (36.4%) underwent ARSA resection/ligation with LMPLT and ascending aorta-right subclavian artery bypass with upper mini sternotomy (UMS). Two of the four patients who underwent TEVAR + bilateral CScBp had continuing dysphagia cause of persistent esophageal compression. Brachial plexus injury developed in one of three patients who underwent LMPLT + right CScBp. Pleural effusion treated with thoracentesis alone was observed in one of four patients who underwent UMS + LMPLT. CONCLUSION: Among the symptomatic and/or aneurysmal ARSA treatment approaches, surgical and hybrid methods are used. There is still no consensus on how to manage these patients. In our study, we recommend the UMS + LMPLT method, since the risk of complications with anatomical bypass is less, and we have more successful surgical results.

Use of the derived isohemagglutinin parameter to predict patients with COVID-19 in need of an intensive care unit.

Predicting which patients will need the intensive care unit (ICU) due to severe COVID-19 is critical in terms of disease treatment. In this study, the use of the derived isohemagglutinin (dIH) parameter calculated from isohemagglutinin (IH) values and neutrophil to lymphocyte ratios for prediction of clinical care (CLC), ICU admission and mortality status was investigated for the morbidity and mortality of COVID-19. The data of approximately 21,500 patients admitted to the hospital with the suspicion of COVID-19 were scanned retrospectively. A total of 352 patients with IH results were divided into three groups according to CLC, ICU admission and mortality. Isohemagglutinin, hemogram and biochemistry test results, demographic characteristics, chronic diseases, length of stay, treatments, ICU admission and mortality records were reviewed for all patients. The relationship between test results, demographic characteristics, clinical status and mortality was investigated using statistical methods. The dIH values of patients with ICU admission and mortality were much lower than those of CLC patients [median (min-max): 3.34 (0.14-95.8) and 0.82 (0.05-42.3) vs. 0.18 (0.01-20.6) titers, p < 0.01, respectively]. In the ROC analysis for the power of dIH to discriminate ICU admission, the cutoff was ≤ 0.68 with sensitivity 88.9%, and specificity 79.6%. It was determined that a 1-unit increase in dIH values decreased the need for ICU by 2.09 times and the mortality of those receiving ICU treatment by 2.02 times. dIH values calculated in the early stages of the disease in patients with COVID-19 can be used to estimate the clinical progression associated with ICU admission and mortality.

Factors affecting the emotional reactions of patient relatives who receive news of death: a prospective observational study.

BACKGROUND: Reporting the death of relatives to a family member is a very stressful task for physicians. Grief reactions differ from person to person. METHODS: Demographic data of 100 patients who died after staying in ICU for more than three days were recorded. For each patient, one of the family members filled a form which contained their own age, gender, education level, marital status, number of children, degree of relationship, psychiatric treatment status, living in the same house as the patient, and whether they had ever visited the ICU before. Grief reactions were evaluated in five different categories: normal grief response, initial shock reaction, denial, feeling guilty and anger. RESULTS: When the death was reported, 55.0% of the relatives accepted this situation as normal, 19.0% felt guilty and 14.0% showed an initial shock reaction. The results showed that for a one-unit increase in the patient's age, the probability of the denial reaction among relatives was reduced by 746 times and the probability of feeling guilty was reduced by 698 times. CONCLUSION: The rate of denial and guilt in the grief reactions among patient relatives when given news of death in the intensive care unit increases with the decrease in patient age.

mir-221, mir-190b, mir-363-3p, mir-200c are involved in rat liver ischaemia-reperfusion injury through oxidative stress, apoptosis and endoplasmic reticulum stress.

AIM: In this study, it was aimed to investigate the relationship between expression levels of micro-RNAs, endoplasmic reticulum (ER) stress, apoptosis and oxidative stress markers in hepatic ischaemia-reperfusion (IR) injury. METHODS: Sixteen rats were randomised into two groups: Sham and IR groups. In the IR group, portal vein and hepatic artery were totally clamped with an atraumatic microvascular clamp and 60 minutes later unclamped and finally IR model was accomplished (60 minutes ischaemia and 60 minutes reperfusion). After sacrification, serum insulin-like growth factor-1 (IGF-1), tumour necrosis factor-α (TNF-α), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured. Liver tissue samples were evaluated histopathologically. The expression levels of IR1-alpha, Perk, Catalase, Gpx-1, Caspase-3, Bcl-2 genes and miR-33a, miR-221, miR-190b, miR-363-3p, miR-200c, miR-223, miR-133b were measured by quantitative real-time polymerase chain reaction method. RESULTS: Biochemical parameters of the IR group showed significantly higher changes compared with the Sham group (P < .01). Histological tissue damage was significantly prominent in the IR group. ER stress, oxidative stress and apoptosis gene expression levels were significantly higher in the IR group (P < .01). Expression levels of miR-221, miR-190b, miR-363-3p and miR-200c were increased in the IR group compared with the Sham group. No significant difference was found between the two groups in terms of miR-33a, miR-133b and miR-223 expression levels (P > .05). CONCLUSION: There is a strong need to enlighten the physiopathological and molecular mechanisms of liver IR injury and to find more specific biomarkers for IR damage, and miR-221, miR-190b, miR-363-3p and miR-200c maybe used as potential biomarkers of hepatic IR injury.

Abdominal wall blocks for emergency ileostomy operation in a patient with COVID-19 pneumonia: a case report.

The anesthesia method to be administered during emergency surgical procedures for COVID-19 (Coronavirus Disease 2019) pneumonia patients carries great importance for both patient and surgical team. Regional blocks are generally used to ensure postoperative analgesia after abdominal surgery with general anesthesia. In this case, involving a patient receiving anticoagulant treatment due to COVID-19 pneumonia with planned emergency operation, the aim was to present the anesthesia management with rectus sheath and transversus abdominis plane block combination for the ileostomy operation. Due to the administered blocks, the patient was not given general anesthesia. Hence, transmission was reduced by minimizing aerosol formation in terms of protecting health personnel and worsening of the patient's pneumonia was prevented. The case is discussed in terms of regional anesthesia techniques offering a good alternative in appropriate cases for both employee and patient safety in the present day, when the whole world is affected by the COVID-19 pandemic.

A combination of levosimendan and N-Acetylcysteine shows significant favorable efficacy on experimental liver ischemia/reperfusion injury.

BACKGROUND: Ischemia-reperfusion injury (IRI) is cellular damage that emerges from re-oxygenation of a hypoxic organ. In the present study, we aimed to examine the effects of a combination of levosimendan, an inotropic agent, and N-Acetylcysteine, the precursor of antioxidants and glutathione, in an experimental liver IRI model. METHODS: In this study, 38 rats were randomly divided into five groups. Before the ischemia, study arms were given physiological saline solution, N-Acetylcysteine (NAS), levosimendan or a combination of NAS+levosimendan in a predetermined amount and duration, and the infusion was continued until the end of this study. The hepatic pedicle was occluded using an atraumatic vein clamp, and 60 minutes of ischemia was achieved. The clamp was then opened and 60 minutes of reperfusion was ensured. Liver tissue samples were obtained after sacrifice, and tissue malondialdehyde (MDA) and myeloperoxidase (MPO) levels were determined. Serum Tumor Necrosis Factor (TNF)-α, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and MPO levels of blood samples were also measured. RESULTS: Among the histopathological changes in the liver tissue after IRI, differences between groups were statistically significant in the injury scoring system based on congestion, vacuolization and necrosis levels. Histopathological injury score, plasma MPO, AST, ALT, tissue MPO and tissue MDA values were statistically significantly lower in the treatment groups, prominently in the levosimendan and NAS combination group concerning liver histopathological damage. CONCLUSION: The use of a levosimendan plus NAS combination in liver IRI markedly suppressed inflammation and oxidative stress and significantly reduced liver ischemia-reperfusion injury and can be recommended for decreasing IRI instead of single agent use of levosimendan or NAS.

Assessment of severity and mortality of COVID-19 with anti-A1 and anti-B IgM isohaemagglutinins, a reflection of the innate immune status.

AIMS: The relationship between the innate immune system that creates the polysaccharide antibody response and COVID-19 is not fully understood. In this study, it was aimed to determine the predictive values of isohaemagglutinins in COVID-19 severity/mortality. METHODS: Approximately 15 440 patients diagnosed with COVID-19 were examined, and a total of 286 patients with anti-B and anti-A1 IgM isohaemagglutinins test results were randomly enrolled in the study. These patients were stratified into two groups according to anti-A1 (n: 138 blood type B or O) and anti-B (n: 148 blood type A) IgM isohaemagglutinins. Anti-A1 or/and anti-B IgM, biochemical parameters, symptoms, chronic diseases, hospitalisation status, intubation status, admission to intensive care unit (ICU) and exitus status were recorded and evaluated for all patients. RESULTS: Anti-A1 IgM and anti-B IgM were significantly lower in ICU patients (7.5 ± 9.9 vs 18.0 ± 20.4 and 5.5 ± 6.3 vs 19.3 ± 33.6 titres, respectively; P < .01) and in exitus patients (3.8 ± 3.6 vs 16.7 ± 18.7 and 3.5 ± 4.7 vs 16.9 ± 29.6 titres respectively; P < .01). In the ROC analysis performed to differentiate between exitus and discharge within groups, the sensitivity of anti-B IgM and anti-A1 IgM at cut-off ≤4 was 88.9% and 79.6%, specificity 66.0% and 73.4%, and AUC 0.831 and 0.861, respectively (P < .01). Anti-A1 IgM decreased the mortality risk 0.811 times per unit while anti-B IgM decreased 0.717 times (P < .01). CONCLUSION: Anti-B and anti-A1 isohaemagglutinins, which are an expression of the innate immune system, can be used to predict the severity and mortality of COVID-19 disease.

Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax.

The novel coronavirus identified as severe acute respiratory syndrome-coronavirus-2 causes acute respiratory distress syndrome (ARDS). Our aim in this study is to assess the incidence of life-threatening complications like pneumothorax, haemothorax, pneumomediastinum and subcutaneous emphysema, probable risk factors and effect on mortality in coronavirus disease-2019 (COVID-19) ARDS patients treated with mechanical ventilation (MV). Data from 96 adult patients admitted to the intensive care unit with COVID-19 ARDS diagnosis from 11 March to 31 July 2020 were retrospectively assessed. A total of 75 patients abiding by the study criteria were divided into two groups as the group developing ventilator-related barotrauma (BG) (N = 10) and the group not developing ventilator-related barotrauma (NBG) (N = 65). In 10 patients (13%), barotrauma findings occurred 22 ± 3.6 days after the onset of symptoms. The mortality rate was 40% in the BG-group, while it was 29% in the NBG-group with no statistical difference identified. The BG-group had longer intensive care admission duration, duration of time in prone position and total MV duration, with higher max positive end-expiratory pressure (PEEP) levels and lower min pO2/FiO2 levels. The peak lactate dehydrogenase levels in blood were higher by statistically significant level in the BG-group (P < 0.05). The contribution of MV to alveolar injury caused by infection in COVID-19 ARDS patients may cause more frequent barotrauma compared to classic ARDS and this situation significantly increases the MV and intensive care admission durations of patients. In terms of reducing mortality and morbidity in these patients, MV treatment should be carefully maintained within the framework of lung-protective strategies and the studies researching barotrauma pathophysiology should be increased.

The assessment of the effect of different intraabdominal pressures used for laparoscopic cholecystectomy surgery on optic nerve sheath diameter: a prospective observational cohort study

Background/aim: During laparoscopic cholecystectomy operations, increases in intraabdominal, intrathoracic, and intracranial pressures (ICP) can be seen after pneumoperitoneum created for surgical imaging. Orbital ultrasonography (USG), which has been developed in recent years, is a method that can evaluate the ICP by measuring the optic nerve sheath diameter (ONSD) from the eyeball. In our study, we aimed to evaluate whether different intraabdominal pressure values created during laparoscopic cholecystectomy operations correlate with ICP by measuring ONSD. Materials and methods: The study included a total of 90 patients with American Society of Anesthesiologists (ASA) physical status classification I (ASA I) and II (ASA II) and ages from 18 to 65 years with laparoscopic cholecystectomy planned. After the patients were intubated, at the 5th min, bilateral ONSD measurements were performed. The same measurements were performed at the 15th and 30th min after CO2 insufflation and additionally 10 min after CO2 was released at the end of the operation. During intrabdominal CO2 insufflation, patients with 10 mmHg pressure applied comprised Group 1, patients with 12 mmHg pressure applied comprised Group 2, and patients with 14 mmHg pressure applied comprised Group 3. Results: The study was completed with 89 patients, 51 female and 38 males. One patient was excluded from the study due to erroneous values. The variations in ONSD measured in the right-left eye before pneumoperitoneum and at the 15th and 30th min after abdominal CO2 insufflation were observed to be statistically significant (p < 0.01). In all three groups, the right and left eye ONSD values were not identified to be statistically significantly different (p > 0.01). A significant increase was observed in ONSD values in direct proportion to the increase in intraabdominal pressure in patients undergoing laparoscopic cholecystectomy surgery. Conclusion: USG-guided ONSD measurements appear be a guide to ensure optimization of intraabdominal pressures and safe anesthesia administration for patients, especially those at risk of ICP increase, during laparoscopic surgery.