Evaluation of Early Postoperative Period Results of Patients With Type 2 Diabetes Taking Oral Anti-Diabetics Or Insulin Medications, With Microalbuminuria and Normal Creatinine Levels After Coronary Artery Bypass.

BACKGROUND: Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. Diabetes mellitus also is one of the main risk factors for renal dysfunction in coronary artery bypass graft (CABG). In this study, we aimed to compare the early postoperative period results of type 2 diabetes patients taking oral antidiabetics (OAD) or insulin medications, with microalbuminuria and normal creatinine levels after CABG. METHODS: Eighty patients with type 2 diabetes and taking OAD or receiving insulin medication all with normal creatinine levels with microalbuminuria were included in this study. Preoperative creatinine values of the patients, albumin levels in spot urine, creatinine levels on the postoperative 3rd day, duration of ventilation, amount of drainage, length of stay in the intensive care unit, length of stay in the hospital, mediastinitis, and mortality rates were recorded. RESULTS: A statistically significant increase in creatinine was found in both taking OAD type 2 diabetes and insulin medication with microalbuminuria. When the two groups were compared with each other, the increase in creatinine levels of the patients using insulin was higher than the patients taking OAD. It also was statistically significant. CONCLUSION: According to the result of our study, it can be suggested that postoperative creatinine elevation is observed in patients with type 2 diabetes mellitus with microalbuminuria and with normal creatinine levels, either having insulin medication or not. The elevation is higher in patients having insulin medication, while other results are similar, except for impaired renal function.

The role of immature platelet count and immature platelet fraction in determining the need for transfusion in patients undergoing CABG.

BACKGROUND: Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), and to examine their relationship with postoperative bleeding and blood transfusion. METHODS: One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. All CABGs were performed by the same surgical team in a standardised method, utilising the on-pump technique. IPC, MPV and IPF were measured pre-operatively, after the completion of surgery, and at the postoperative first, third and fifth days. The primary outcome measure of this study was whether the need for transfusion was associated with IP, IPF, MPV and platelet count. RESULTS: There was a significant decrease of 7.77% in IPC on the day of the operation. Pre-operative IPC and IPF were correlated with postoperative drainage (p < 0.001), intraoperative blood transfusion (p < 0.001) and intensive care unit blood transfusion (p < 0.001). Pre-operative haemoglobin levels were significantly correlated with length of hospital stay. However, neither pre-operative IPC nor IPF were associated with length of hospital stay. Postoperative IPC was however associated with the length of hospital and intensive care unit stay (p = 0.008 and p = 0.009, respectively). CONCLUSIONS: Pre-operative IPC and IPF were significantly correlated with postoperative drainage and blood transfusion frequency. In patients undergoing CABG, these can be seen as serious guiding parameters in the estimation of postoperative bleeding.

Successful treatment of massive pulmonary embolism in a pregnant woman complicated with atypical hemolytic uremic syndrome.

The treatment of the massive pulmonary embolism concomitant hemodynamic instability in pregnancy is difficult and controversial and carries a high risk for both the baby and the mother. The catheter-directed thrombectomy with or without extracorporeal membrane oxygenation support may be a suitable management strategy in suitable cases but pregnancy-related complications may follow the treatment of pulmonary embolism and atypical hemolytic uremic syndrome should be considered in the differential diagnosis. We present a case of a 32-year-old patient who had a pulmonary embolism with shock in the 8th week of pregnancy complicated by atypical hemolytic uremic syndrome.

Ascending aorta mycotic aneurysm in a child secondary to subacute infective endocarditis on the basis of congenital aortic stenosis demonstrated by cardiac computerized tomography.

Infective endocarditis (IE) is rarely seen in children, and it can cause significant morbidity and mortality. Congenital heart disease is a predisposing cardiac condition for IE and has an increasing prevalence. A mycotic aortic aneurysm is a rare disease due to infection and it has been reported that it may be a result of IE. We present a 10-year-old boy who was referred to our cardiovascular surgery department due to severe aortic stenosis (AS). Transthoracic echocardiography revealed calcific severe AS and computerized tomography (CT) angiography was performed to better evaluate the ascending aorta. CT angiography demonstrated a saccular aneurysm of the ascending aorta. The underlying pathology was considered as chronic IE on top of congenital AS with an unknown number of cusps. Histologic findings supported our diagnosis and accompanied by a saccular aneurysm. The patient underwent a successful aortic root enlargement, mechanical aortic valve replacement, and ascending aorta repair surgery.

Effects of preoperative magnesium therapy on arrhythmias and myocardial ischemia during off-pump coronary surgery.

BACKGROUND: Heart manipulation during off-pump coronary artery bypass surgery may cause hemodynamic instability, and temporary coronary arterial occlusion may lead to myocardial ischemia. To reduce this, perioperative ß-blocking agents or calcium antagonists can be administrated. The effects of perioperative administration of magnesium on myocardial function were studied in patients undergoing coronary artery bypass grafting. OBJECTIVE: The aim of the study was to evaluate the effects of preoperative magnesium administration on perioperative hemodynamia, ventricular arrhythmias and myocardial protection. MATERIALS AND METHODS: We reviewed 2 groups of patients undergoing off-pump coronary artery bypass surgery - 24 patients (control group) that had not received preoperative intravenous infusion of magnesium and 23 patients (treatment group) that had received preoperative intravenous magnesium sulfate. RESULTS: The results demonstrated that it had reduced the heart rate, changes of ST segments, the need of ß-blocking agents and the use of intra-operative intra-aortic balloon pump and the inotropic usage. CONCLUSION: This treatment may provide hemodynamic optimization during off-pump coronary artery bypass.