Coronary artery bypass graft operations can be performed safely in obese patients.

OBJECTIVES: Obesity is a major public health problem with an increasing prevalence. Although coronary artery bypass grafting (CABG) operations are now performed with low morbidity and mortality rates, obesity is still assumed to be an important risk factor for morbidity and mortality at these operations but there is no precise approach to define it as a risk factor. The aim of this study is to evaluate the effects of obesity on the clinical outcome of the CABG operations. METHODS: A total of 1206 patients, who underwent isolated CABG operation under cardiopulmonary bypass were evaluated retrospectively. The patients were divided into three groups. Group I was normal weight, with body mass index (BMI) of 18-24.9 kg/m(2), group II was overweight, with a BMI of 25-29.9 kg/m(2), and group III was obese, with a BMI of >30 kg/m(2). The clinical data of three groups were evaluated in aspects of postoperative morbidity and mortality. RESULTS: Except for the superficial wound infections, there were no differences in postoperative mortality and morbidity rates between the three groups. Obesity was not found to be an important risk factor for postoperative morbidity and mortality. CONCLUSIONS: Despite the perception that obesity increases the risk of mortality and morbidity in CABG operations, the clinical outcome of these patients are not so different from other patients. We may say that obese patients can be safely operated.

The effects of moderate-dose steroid therapy in sepsis: A placebo-controlled, randomized study.

BACKGROUND: Despite the new developments in sepsis treatment, mortality rate is still high. In this study, we aimed to investigate endocrinologic changes and the effects of moderate dosage steroid treatment in patients with sepsis. METHODS: Fifty-five patients were included in the study. Basal hormonal evaluation and adrenocorticotropin hormone (ACTH) stimulation test were performed within 24 h in all patients. Both groups received standard treatment for sepsis. However, one group (steroid group) was also given intravenous prednisolone (20 mg/day). All-cause mortality was assessed during the first 28 days. RESULTS: Analysis of the findings revealed a 59.3% mortality rate in steroid group compared with a 53.6% mortality rate in placebo group (p = 0.787). Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, and peak cortisol and ACTH levels were significant factors related to mortality. The incidence of adrenal insufficiency (AI) was 10.9% and relative adrenal insufficiency (RAI) 36.4%. It was also found that steroid treatment did not have any effects on the mortality of patients with AI and RAI (p = 0.075 and p = 0.999, respectively). CONCLUSIONS: Moderate-dose steroid therapy has no effect on mortality. Higher basal cortisol and peak cortisol levels were found more reliable mortality indicators compared to RAI. In addition, the study revealed that ACTH level was a significant indicator of mortality.