Clinical course of abdominal aortic aneurysms in Behçet disease: a retrospective analysis.

Arterial aneurysms are rare manifestations of Behçet Disease (BD) with high morbidity and mortality. This study aimed to investigate the clinical course of BD patients with abdominal aortic aneurysms (AAA). We retrospectively searched charts of BD patients, followed up between 1988 and 2011, to identify those with AAA with at least 6-month clinical and radiological follow-up data. Chart review revealed 12 patients (11 males) with AAA amongst 1224 patients; follow-up data from 11 patients were available. The most common symptoms were lower back and abdominal pain. The only pre-treatment complication was a spontaneous rupture. All but one patient received corticosteroid and cyclophosphamide pulses for the induction, and corticosteroid and azathioprine for the maintenance treatment; one patient received only the maintenance treatment. Two patients had surgical graft interposition, without postoperative complications. Seven patients had endovascular stenting; five of them (71.4%) showed radiological regression after 32.5 (13.4-53.8) months, while four (57%) had clinical improvement after 11.8 (0.2-29.4) months. However, one non-responsive patient developed stent infection and exsanguinated during percutaneous drainage, and one patient developed femoral artery pseudo-aneurysm at the catheter insertion site. Another patient developed a new aneurysm under the maintenance treatment. Medical treatment alone yielded radiological regression in one of two patients. Current immunosuppressive, surgical or endovascular approaches can provide clinical and radiological improvements lately in BD patients with AAA. Furthermore, complication rates seem to be high with interventional approaches. These findings suggest an unmet need for safer alternative treatments.

The management of mesenteric vein thrombosis: a single institution's experience.

BACKGROUND: Mesenteric vein thrombosis occurs rarely and is responsible for approximately 5-15% of all cases of acute mesenteric ischemia. The aim of this report was to discuss the management of mesenteric vein thrombosis based on our experience with 34 patients. METHODS: In the present study, 34 patients who were admitted to our emergency surgery department between January 2007 and January 2010 with a diagnosis of acute mesenteric vein thrombosis were assessed retrospectively. Patients with peritoneal signs first underwent diagnostic laparoscopy to rule out perforation or bowel gangrene. We performed a second-look laparoscopy within 72 hours of the first operation. All patients were administered 100 mg/kg of the anticoagulant enoxaparin twice daily. In the 6th and 12th months of follow up, CT angiography was performed to evaluate recanalization of the veins. RESULTS: CT angiography revealed superior mesenteric vein thrombosis in 25 (73%) patients, portal vein thrombosis in 24 (70%) patients, and splenic vein thrombosis in 12 (35%) patients. Eleven patients with peritoneal signs underwent diagnostic laparoscopy; eight of the patients underwent small bowel resection, anastomosis, and trocar insertion. During second-look laparoscopy, small bowel ischemia was found in two patients and re-resection was performed. CONCLUSION: Early diagnosis with CT angiography, surgical and non-surgical blood flow restoration, proper anticoagulation, and supportive intensive care are the cornerstones of successful treatment of mesenteric vein thrombosis.

A novel adaptive state-of-charge balancing control scheme for cascaded H-bridge multilevel converter based battery storage systems.

Variations in state-of-charges (SOCs) of batteries in a cascaded H-bridge multilevel converter (CHB-MLC) based battery storage system (BSS) could lead to undesired efficiency and performance drops, even failure of the whole system. Hence, SOC balancing is crucial for BSSs. Avoiding over-modulation region, ensuring zero common-mode voltage and reaching balanced SOC condition as quickly as possible are the key points to consider while performing SOC balancing. In this paper, a gain-scheduling based adaptive SOC balancing method is proposed for single-phase CHB-MLC based BSSs. In the proposed method, gains of the proportional controllers are updated at each sampling time based on the mathematical relationship between instantaneous SOCs and voltage reference of the CHB-MLC. Performance of the proposed method is validated through a Monte Carlo simulation based numerical analysis and experimental studies on a single-phase three-module CHB-MLC based BSS. Results reveal that the proposed method achieves SOC balancing at least two times faster than the traditional constant gain methods while avoiding over-modulation region and having zero common-mode voltage.

Is emergency gastrointestinal system tumor surgery safe under treatment of antitrombotics?

BACKGROUND: The use of antitrombotic (antiaggregant and anticoagulant) drugs is increasing all over the world and in our coun-try. About 12.6% of patients who underwent gastrointestinal tumor surgery receive antitrombotic therapy for various reasons, and in this study, we aimed to demonstrate the safe feasibility of elective or emergency gastrointestinal tumor surgery with the correct perioperative antitrombotic therapy management. METHODS: The patients who were planned for gastrointestinal tumor surgery under antitrombotic treatment were analyzed in three groups as those whose pre-operative treatment management treatment was discontinued, those who underwent bridging treat-ment, and those whose treatment continued. Anti-embolic stockings or intermittent pneumatic compression devices were applied to all patients preoperatively and postoperatively as mechanical prophylaxis. Post-operative complications, especially post-operative bleeding and thrombosis, were evaluated using the Clavien-Dindo post-operative complication classification. RESULTS: When patients who were under antithrombotic therapy, whose therapy was discontinued, and who underwent surgery under bridging therapy, no significant difference was found between the three groups in terms of bleeding complications. CONCLUSION: In tertiary centers with high clinical experience, elective and emergency gastrointestinal system tumour surgery can be safely performed under antitrombotic therapy without increasing the thromboembolic risk.

Femoral artery aneurysm developed on intimal sarcoma: Case report.

Intimal angiosarcoma is a rare vascular malignancy, and diagnosis is very difficult due to nonspecific symptoms. There are controversial points regarding the diagnosis, treatment and follow-up of intimal angiosarcomas. The purpose of this case report was to evaluate the diagnosis and treatment process of a patient diagnosed with femoral artery intimal angiosarcoma. Furthermore, in line with previous studies, it was aimed to illuminate controversial points. A 33-year-old male patient, who had been operated on due to ruptured femoral artery aneurysm, was diagnosed with intimal angiosarcoma with the pathology result. Recurrence was observed during clinical follow-up, and the patient was treated with chemotherapy and radiotherapy. Since there was no response to treatment, the patient underwent aggressive surgery including the surrounding tissues. No recurrence or metastasis was observed in the patient's 10th month follow-up. Although intimal angiosarcoma is rare, it should be considered in differential diagnosis when femoral artery aneurysm is detected. The most important step in treatment is aggressive surgery, but adding chemo-radiotherapy to the treatment should be considered.

Long-term efficacy and safety of once-daily enoxaparin plus warfarin for the outpatient ambulatory treatment of lower-limb deep vein thrombosis in the TROMBOTEK trial.

OBJECTIVE: The present study was designed to evaluate the long-term efficacy and safety of once-daily enoxaparin plus warfarin for the outpatient ambulatory treatment of lower-limb deep venous thrombosis (DVT). METHODS: A total of 246 patients, comprising 128 men (mean age, 54.28±16.48 years) and 118 women (mean age, 50.11±16.47 years) with symptomatic lower extremity DVT, were included in this open-label, single-arm, multicenter, phase IV clinical trial conducted at 14 centers in Turkey. All patients were administered subcutaneous enoxaparin (1.5 mg/kg, once-daily) until international normalized ratio (INR) levels reached to 2 to 3, followed by oral warfarin (5 mg/d) for at least 3 months and elastic compression stockings (30-40 mm Hg). Clinical signs (leg circumference), symptoms (edema, pain, tenderness), recanalization rates upon duplex ultrasound examination, laboratory findings (D-dimer and INR levels), and postthrombotic syndrome status with CEAP classification were the efficacy parameters evaluated every 3 months during 18 months of follow-up. Safety end points included minor and major bleeding as well as serious adverse events. RESULTS: Ambulatory treatment with enoxaparin plus warfarin significantly reduced physical symptoms, including tenderness, edema, pain (P<.001), and the circumference of the affected leg (P<.001). The leg circumference difference in almost all patients was <1.5 cm at the end of 18 months (P<.001). Recanalization rates for occluded iliofemoral vein were 76.1% at 3 months and 86.5% at 18 months (P<.001). An early and significant decrease obtained in D-dimer levels on day 10 continued to decline significantly until month 6 and remained unchanged afterwards (P<.001). Of four patients diagnosed with major bleeding during oral anticoagulant use, three recovered with conservative treatment (reduction in hemoglobin levels in 2 developed at visit 2 [day 10] and intracranial bleeding in 1 developed at visit 3 [day 30]), and one patient required a hysterectomy after menorrhagia developed at visit 7 (month 18). Two of the 65 (9.9%) adverse events documented were serious adverse events, but none of the serious adverse events leading to death were related to the study medications. CONCLUSION: Ambulatory treatment with enoxaparin plus warfarin seems to be effective in symptomatic healing and in clinical improvement by reducing thrombus formation and organization at all levels of lower extremity venous system with DVT, without a significant major bleeding risk. Therefore, the results of our conventional conservative treatment are in line with 1A level evidence reported in the recent American College of Chest Physicians guideline.

[Venous thromboembolism prophylaxis methods in trauma and emergency surgery intensive care unit patients: low molecular weight heparin versus elastic stockings + intermittent pneumatic compression]. / Travma ve acil cerrahi yogun bakim hastalarinda venöz tromboemboli profilaksisi: Düsük molekül agirlikli heparin ile elastik çorap + aralikli pnömotik kompresyonun karsilastirilmasi.

BACKGROUND: We aimed to evaluate the efficacy and safety of low molecular weight heparin (LMWH) compared to elastic stockings in combination with intermittent pneumatic compression (ES+IPC) in venous thromboembolism (VTE) prophylaxis in the intensive care unit (ICU) of trauma and emergency surgery. METHODS: From June 2005 to June 2007, 259 patients who were on mechanic ventilation in the ICU were assigned to two groups as either LMWH (152 patients) or ES+IPC (94 patients). Color flow Doppler sonography was performed on the 3rd and 7th days. RESULTS: Deep venous thrombosis was determined in 3 (2%) of the LMWH group and in 1 (1%) in the ES+IPC group. Minor bleeding was seen in 15 patients. The frequency of VTE was 1.5%. Two patients suffered from fatal pulmonary embolism (PE) among a total of 4 patients with PE. CONCLUSION: We believe that the protocol applied for VTE prophylaxis in the Emergency Surgery Department of Istanbul Medical Faculty is effective and safe in this group with such high mortality and morbidity.

Femoral artery occlusion secondary to a spontaneously "migrated" hip prosthesis: case report.

A 77-year-old male patient was admitted to the hospital with a worsening acute ischemia of the left lower extremity. The patient, who had a coxarthrosis and was being followed by the orthopedic clinic, had undergone a total hip prosthesis, with a revision performed at the sixth month of its placement. The physical examination revealed the absence of the femoral, popliteal and distal pulses of the left lower extremity. The left hip movements were painful and limited in external rotation posture. Doppler ultrasonography showed an acute occlusion of the left common femoral artery due to the dislocated hip prosthesis, and right-to-left femorofemoral expanded polytetrafluoroethylene graft bypass was carried out. After successful surgery and an uneventful postoperative period with palpable femoral and popliteal pulses, the patient was put on low molecular weight heparin and referred to orthopedics once the ischemia had subsided with the intervention. Case reports regarding occlusions due to migration of total hip prosthesis are rare in the literature. The emphasis of this case report is to describe one such case.

Recommendations for Trauma and Emergency General Surgery Practice During COVID-19 Pandemic.

COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.

The role of the ankle brachial pressure index in the diagnosis of peripheral arterial injury.

BACKGROUND: Angiography is the "gold standard" diagnostic tool for patients presenting soft signs of arterial injury. To reduce the number of unnecessary angiographies, we aimed to evaluate the role of the ankle brachial pressure index (ABPI) in the diagnosis of peripheral arterial injury in extremity trauma with soft signs. METHODS: The data of 1772 patients with the suspicion of peripheral arterial injury was recorded prospectively. Two hundred eighty-three patients (16%) with any hard sign underwent immediate surgery. ABPI was calculated in 1489 patients with soft signs. Patients with ABPI <1 were evaluated by duplex ultrasonography and/or angiography, and if arterial injury was detected, the patients underwent surgery. Patients with an ABPI > or =1 were followed up conservatively. RESULTS: 1343 (90%) patients had ABPI > or =1; seven (0.5%) of them developed symptoms and signs of arterial injury and healed without morbidity. One hundred forty-six (10%) patients had ABPI <1; with DUS/angiography, arterial injury was detected in 39 of them (26.7%), and they underwent surgery. The sensitivity of ABPI <1 was 84.8%; specificity 92.6%; positive predictive value 26.7%; negative predictive value 99.5%; and overall accuracy 92.3%. CONCLUSION: ABPI excludes arterial injury in 99.5% of patients with soft signs of arterial injury and avoids unnecessary examinations in 90% of patients. In the management of extremities with soft signs, ABPI measurement should be the first-line diagnostic choice.

Planned second-look laparoscopy in the management of acute mesenteric ischemia.

AIM: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI). METHODS: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS: The average time of admission to the hospital after the initiation of symptoms was 3 d (range, 5 h-9 d). In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% (n = 6). CONCLUSION: Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

Serious lower extremity venous injury management with ligation: prospective overview of 63 patients.

Management of lower extremity venous trauma using repair or ligation has been an area of controversy during the past decades. However, in unstable patients or if primary repair is technically impossible as a result of extensive disruption of the vein, ligation is recommended. This study investigated the effects of venous ligation on major veins in the lower extremities when primary repair is impossible as a result of extensive laceration of the vein. Between January 2001 and April 2004, 63 patients with Grade III and IV venous injuries were observed prospectively. Compression ultrasonography was performed postoperatively on the fifth day, once before discharge, and at the 3-month visit to assess deep vein thrombosis (DVT) and the patency of arterial repair. If DVT was present, the patient was given an oral anticoagulant (warfarin Na) for 3 months (international normalized ratio, 2.0-3.0), and Class II compression stockings (Sigvaris-212, Ganzoni, Switzerland) were used for 1 year. Follow-up visits occurred at 1, 3, 6, and 12 months and at 6-month intervals thereafter. Combined arterial and venous injuries were present in 50 (79.4%) patients and pure venous injuries were present in 13 (20.6%) patients. DVT developed in 49 patients (77.7%; postoperative n = 37 [58.7%], late n = 12 [19%]). Three arterial restenoses (4.7%) and one pseudoaneurysm (1.6%) of the superficial femoral artery developed. Five early (prophylactic) and two late (compartment syndrome) fasciotomies were performed. Postoperative edema was seen in 56 (88.8%) patients and wound infection was seen in 19 patients (30.1%; n=18 superficial, n=1 deep). Two amputations (3.2%) were performed. One patient (1.7%) died as a result of irreversible shock. After a median of 18 months, 25 patients were classified with Clinical Etiology, Anatomy, Pathology classification: 10 legs C-0, seven legs C-2, and eight legs C-3. No severe postthrombophlebitic syndrome was observed. Early leg swelling after venous ligation was the most common morbidity. We observed no significant sequelae of chronic venous insufficiency, and venous ligation had no detrimental effect on associated arterial repair. In cases of DVT, anticoagulation with low-molecular-weight heparin and oral anticoagulants should begin immediately and continue for 3 months along with compression stocking support for 1 year.

Rupture of abdominal aortic aneurysm into sigmoid colon: a case report.

Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.

The effects of compression garments and electrostimulation on athletes' muscle soreness and recovery.

In this study, we explained the effects of compression garment and electrostimulation on athletes' recovery period by evaluating blood lactate and isokinetic peak torque parameters. Twenty volunteers (15.55± 0.51 yr) were included to study. At recovery period, blood samples was taken for lactate values at 0th, 3rd, 5th, 15th, 30th min. The isokinetic strength test was performed on right ankle at 15th min and on the left ankle at 30th min. The same protocol was performed for compression garment on 2 weeks and for electrostimulation on third weeks and results were compared. There wasn't any significant difference on blood lactate levels within groups. At women; there was not any significant difference on isokinetic peak torques within two groups. but at electro-stimulation usage we found significant increases on right plantar flexion (P<0.1), right dorsal flexion (RDF) (P<0.1) and left plantar flexion (LPF) (P<0.1) values compared to control measurements. At men; with compression garment usage, there was significant increase on LPF values compared to control measurements. At electrostimulation usage, we found significant increases on RDF (P<0.1) and left dorsal flexion (P<0.1) values compared to control measurements. During recovery, there is not any beneficial effect seen on blood lactate level within two groups. When compared to passive rest, compression garments and electrostimulation interventions effects on force generation capacity at recovery are statically significant. Also in terms of force generation capacity; usage of electrostimulation during 15 min and compression garments during 30 min were statically more significant.

Intermittent pneumatic compression in the prevention of venous thromboembolism in high-risk trauma and surgical ICU patients.

BACKGROUND: Our aim was to evaluate the efficacy and safety of intermittent pneumatic compression methods (IPC) in the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in high-risk patients followed in our intensive care unit (ICU) for whom anticoagulation is contraindicated due to high risk of bleeding. MATERIALS AND METHODS: This prospective study was conducted between October 2001 and June 2002 at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty. Thirty eight surgical ICU patients who used IPC devices for prophylaxis of venous thromboembolisim were evaluated retrospectively. RESULTS: There were 27 male (71%) and 11 female patients (29%) with a mean age of 49.69 +/- 18.61 years. Their diagnoses were as follows; 21 multi-trauma, 11 major abdominal surgery, 11 severe gastrointestinal bleeding. None of the patients had manifested DVT by venous duplex scans. A leg swelling was present in one patient without evidence of DVT by duplex scans. Symptomatic and fatal pulmonary embolism were not detected. Asymptomatic pulmonary embolism was detected by spiral thorax CT examination in one patient (2.6%). CONCLUSIONS: IPC seems to be an effective and a safe modality in preventing both DVT and PE in high-risk ICU patients with severe trauma and for those undergoing major surgery.

Gene expression levels of elastin and fibulin-5 according to differences between carotid plaque regions.

AIM: The purpose of this study was to investigate the gene expression levels of elastin and fibulin-5 according to differences between carotid plaque regions and to correlate it with clinical features of plaque destabilization. MATERIALS AND METHODS: The study included 44 endarterectomy specimens available from operated symptomatic carotid artery stenoses. The specimens were separated according to anatomic location: internal carotid artery (ICA), external carotid artery (ECA) and common carotid artery (CCA), and then stored in liquid nitrogen. The amounts of cDNA for elastin and fibulin-5 were determined by Quantitative real-time PCR (Q-RT-PCR). Target gene copy numbers were normalized using hypoxanthine-guanine phosphoribosyltransferase (HPRT1) gene. The delta-delta CT method was applied for relative quantification. RESULTS: Q-RT-PCR data showed that relative fibulin-5 gene expression was increased in ICA plaque regions when compared to CCA regions but not reaching significance (p=0.061). At the same time, no differences were observed in elastin mRNA level between different anatomic plaque regions (p>0.05). Moreover, elastin and fibulin-5 mRNA expression and clinical parameters were compared in ICA plaques versus CCA and ECA regions, respectively. Up-regulation of elastin and fibulin-5 mRNA levels in ICA were strongly correlated with family history of cardiovascular disease when compared to CCA (p<0.05). Up-regulation of fibulin-5 in ICA was significantly associated with diabetes, and elevated triglycerides and very low density lipoprotein (VLDL) when compared to ECA (p<0.05). CONCLUSION: The clinical significance is the differences between the proximal and distal regions of the lesion, associated with the ICA, CCA and ECA respectively, with increased fibulin-5 in the ICA region.

The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.

[Color flow duplex ultrasonography is an effective alternative method]. / Renkli Doppler Ultrasonografi, Psödoanevrizmalarda Tanisinda Oldugu Kadar Tedavisinde De Etkin Bir Seçenektir.

Increasing use of percutaneous interventional cardiac and peripheral arterial procedures has resulted in high incidence of femoral pseudoaneurysms. This case report presents a 68 year-old male with a femoral pseudoaneurysms after percutaneous iliac transluminal angioplasty, who was treated with ultrasound guided compression successfully. Although surgical procedures are widely performed in Turkey, it should be kept in mind that compression therapy is effective and may present as an initial step in the management of femoral pseudoaneurysms.

The late outcomes of vena cava filters in the prevention of pulmonary embolism.

BACKGROUND: Pulmonary embolism (PE) is the most serious complication of deep venous thrombosis (DVT) resulting in high morbidity and mortality rate. The purpose of this study is to evaluate the long-term results of vena cava filters (VCFs) placement for prevention of PE in high- risk patients. METHODS: Between June 1999 and March 2002, at the Trauma and Surgical Emergency Service of Istanbul Medical Faculty, 15 high-risk patients who underwent placement of filters were evaluated. RESULTS: There were eleven males (73%) and four females (27%) with mean age of 50 years (range 14 to 76). Eleven of VCFs were placed for prophylactic and four for therapeutic purposes. The indications of VCFs placement are as follows: Spinal cord injury with life-long paraplegia in eight and quadriplegia in two patients, venous thromboembolism while on anticoagulation in two patients, contraindications to anticoagulation in three patients. The mean duration of follow-up was 17 months (range 3-32 months). No patients developed DVT and recurrent DVT. No patients clinically had signs or symptoms of PE. There was one insertion site thrombosis that related to VCF complications, which resolved with medical therapy. Four patients died during the study period. Medical records revealed no evidence of PE. CONCLUSION: Although VCF placement seems to prevent PE in high- risk patients, prospective randomized trials with larger patient groups and longer-term follow up period are necessary to evaluate efficacy and safety of VCF in prevention of PE before making definitive conclusion.

[Venous thromboembolism prophylaxis with low molecular weight heparins in polytraumatized patients in intensive care unit (extended serie)]. / Politravmatize yogun bakim hastalarinda düsük molekül agirlikli heparin ile venöz tromboembolizm profilaksisi (genisletilmis seri).

BACKGROUND: In our study we aimed to evaluate, retrospectively, the bleeding and the Venousthrombo Emblism (VTE) complications in trauma patients in Intensive Care Unit (ICU) under the prophylaxis of enoxaparin sodium. The results will guide us to establish a protocol for use of Enoxaparin Sodium in trauma patients. In trauma patients, Low Molecular Weight Heparine (LMWH) has better efficiency than unfractionned heparin and intermittant pneumatic compression for VTE prophylaxis. METHODS: 457 polytraumatized patients treated in ICU are included to the study group. All patients received 40 mg/day of Enoxaparin Sodium. Severity of trauma was assessed with Apache II Scoring System and bleeding diagnosed by observing a sudden drop of 2 g/dl in hemoglobin concentration and pulmonary embolism was diagnosed by a sudden change in blood gases and deterioration of the clinical outlook which was confirmed by a spiral CT scan. Statistical correlation was made by Pearson's correlation test. RESULTS: Mean Apache II score was 13.8 with a total mortality of 41%. 42 patients (9,2%) had bleeding due to Enoxiparine Sodium prophylaxis. 12 patients (2,6%) had pulmonary embolism and 8 of them (1,7%) had died. CONCLUSION: Verified by the literature and our study, LMWH prophylaxis significantly reduces the Pulmoner Embolism (PE) incidence in polytraumatized patients (p<0,05). On the other hand, the bleeding risk has slightly increased without showing any significance (p>0.05). Prophylaxis with LMWH is safe and efficient in polytraumatized ICU patients.