The Utility of Risk Scores in Postcardiotomy Extracorporeal Membrane Oxygenation.

BACKGROUND: The use of a venoarterial extracorporeal membrane oxygenation (ECMO) in the postcardiotomy shock setting (PC-ECMO) can be life-saving. Risk stratification for patients under PC-ECMO is currently challenging. The aim of this study was to assess the discriminatory ability of the different available risk scores for mortality in PC-ECMO patients. METHODS: Patients aged >18 years undergoing coronary artery bypass, valve surgery, or a combination of these procedures and implanted an ECMO for postcardiotomy shock between January 2017 and June 2022 in a single ELSO registered center were retrospectively included. The STS, Euroscore II, SAVE, modified SAVE, APACHE II, and VIS scores were compared for their discriminatory ability concerning weaning and 30-day survival. RESULTS: During the study period, 7342 patients underwent coronary bypass or valve surgery, of whom 109 patients with PC-ECMO were included in the analysis. The Euroscore II and STS scores were not associated significantly with 30-day mortality, whereas the SAVE, the modified SAVE, APACHE II, and VIS scores significantly predicted 30-day mortality. The SAVE and the modified SAVE scores showed moderate discrimination ability with AUCs of 0.672 and 0.695, while the APACHE and VIS scores had a satisfactory discriminatory ability with AUCs of 0.727 and 0.844, respectively. CONCLUSION: Currently used risk scores for PC-ECMO patients do not provide satisfactory predictions for weaning and survival. VIS at the 24th hour can be a valuable parameter for risk analysis and prospective studies can investigate novel PC-ECMO risk scoring systems.

Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios.

OBJECTIVES: Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. METHODS: Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. RESULTS: 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. CONCLUSIONS: Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.

Factors associated with excessive bleeding following elective on-pump coronary artery bypass grafting.

INTRODUCTION: Excessive bleeding following cardiac surgery is associated with worse outcomes. We aimed to analyze preoperative and operative factors associated with excessive bleeding in coronary artery bypass patients to better understand which patients are under increased risk. METHODS: The study was conducted as an observational study in a tertiary center for cardiac surgery by retrospective analysis of the hospital database. Patients were grouped according to chest tube output within the postoperative 24 h. Patients in the 4th percentile of chest tube output per kilogram were categorized as having excessive bleeding. Patients with excessive bleeding were compared with the other patients for preoperative and operative factors. Factors significant in univariate analysis were carried onto the multivariate analysis. RESULTS: Patients with excessive bleeding were more likely to be males (91.4% vs. 78.7%, p = .002), have lower body mass index (BMI) (27.4 vs. 29.2, p < .001), and low platelets (6.9% vs. 1.5%, p = .006). Cardiopulmonary bypass (101.8 vs. 110.9 min, p = .022) time was longer in the excessive bleeding group. Patients with excessive bleeding were more likely to have more than three vessels revascularized. Male sex, lower BMI, low platelets, and longer cardiopulmonary bypass time were independently associated with increased bleeding. CONCLUSION: Male sex, lower BMI, low platelet count, and longer cardiopulmonary bypass time are associated with extensive bleeding after elective coronary artery bypass surgery (CABG). Patients with higher bleeding risk should be identified preoperatively to account for adverse outcomes after CABG.

Long term results of minimally invasive treatment of pilonidal disease by platelet rich plasma.

BACKGROUND: Although, there are several treatment options for treatment of pilonidal disease, nowadays minimally invasive modalities are becoming more common. The aim of this study is to evaluate the results of platelet rich plasma application for pilonidal disease. METHODS: For this prospective cohort study, cases with pilonidal disease were evaluated. All cases that are eligible and accepted to be involved were included in the study. Platelet rich plasma was applied into the pilonidal sinus under local infiltration anesthesia. Healing of the disease and recurrence rates were recorded. RESULTS: The success rate of the application was 97.1% at the first month. With a median follow up of 60.2 months the recurrence rate was 8.2%. CONCLUSION: Platelet rich plasma can be safely used for treatment of pilonidal disease with high success and low recurrence rate.

The effect of fundus resection on weight loss and ghrelin levels in rats.

BACKGROUND: Ghrelin is a 28-amino acid peptide that is isolated mainly from the oxyntic glands of the stomach, especially fundus. Ghrelin administration, either centrally or peripherally, increases food intake and body weight in both rodents and humans. This study evaluates the effects of fundus resection and sclerosing agent injection on ghrelin level and weight loss. MATERIAL AND METHODS: Thirty rats were divided into three groups. In group 1, NaCl was injected into the submucosal space at the gastric fundus while in Group 2, a sclerosing agent was injected into the latter site. In group 3, gastric fundus was resected. Ghrelin levels and weight were recorded. RESULTS: In group 1, rats continued gaining weight and ghrelin levels stayed stable. In group 2, rats' weight and ghrelin levels stayed stable and in group 3, while weight stayed stable, ghrelin levels decreased significantly. CONCLUSION: In rats, the resection of fundus stabilizes weight gain and decreases ghrelin levels. However, in sclerotherapy, although weight gain was stabilized, there was no decrease in ghrelin levels. In humans, the effect of fundus resection on weight gain can usher in a new era of investigation (Tab. 2, Ref. 16).

Three complications of Pair (puncture, aspiration, injection, reaspiration) in one case: Recurrent hemobilia, cyst infection and pneumonia.

INTRODUCTION: With the appropriate indications, puncture, aspiration, injection and reaspiration (PAIR) is the most effective minimal invasive method used in the treatment of hydatic cysts. Hemobilia is the hemorrhagia in bile ducts in consequence of any reason. In literature there is no case with hemobilia because of PAIR. This is the first case with recurrent hemobilia, infection in cyst cavity and pneumonia because of PAIR. CASE: A 66 years old female patient was admitted to hospital with complaints of abdominal pain, hematemesis and melaena. She gave the history of PAIR for two hydatic cysts. At physical examination, there were jaundice, tenderness at right subcostal area and melaena at rectal digital examination. Hemobilia was detected by abdominal ultrasonography and magnetic resonance cholangiopancreaticography (MRCP). An endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy were performed. The patient was discharged after 6 days hospital stay. One day after the discharge the patient was admitted to hospital with the same complaints again. Performing ERCP and balloon extraction, the hematoma filling the common bile duct was removed. After the patient was hemodynamically stable for 3 days, she was discharged from the hospital. A week after that the patient was admitted to hospital with the clinical findings of infected hydatic cyst and pneumonia. The patient was treated medically with mechanical ventilation support for 8 days. CONCLUSION: It should not be underestimated that, there can be serious complications of PAIR like hemobilia. Therefore, PAIR should be performed only in centers having appropriate medical and surgical facilities.

Minimally invasive parathyroidectomy under local anesthesia.

BACKGROUND: More than 85% of primary hyperparathyroidism (PHPT) cases are due to solitary, benign parathyroid adenomas. Recently, the success rate of Tc99m sestamibi scintigraphy in localization has made minimally invasive parathyroidectomy (MIP) more prominent. MIP is as effective as conventional bilateral neck exploration. Moreover, it offers lower morbidity, cost effectiveness, and better cosmetics effects. AIM: We aimed to evaluate the success of MIP, which happens only under local anesthesia, in this study. MATERIALS AND METHODS: Total of 63 patients were operated for PHPT, of which 54 had solitary adenoma. Five patients underwent bilateral neck exploration under general anesthesia for thyroid nodules or unlocalizated adenomas. A total of 49 patients underwent MIP under local anesthesia without any sedation. During MIP, gamma probe was used for all patients. The patients were followed for parathyroid functions. RESULTS: The mean age of 49 patients with MIP (5 male, 44 female) was 59 years. The mean follow-up time was 16.4 (±10.1) months (range: 2-36 months). Of the 49 patients, 47 (96%) were totally cured. In 2 patients, the procedure was switched to conventional bilateral neck exploration. Temporary hypocalcaemia was noted in 4 patients. CONCLUSIONS: If the adenoma is localizated, MIP under only local anesthesia can be performed with a high success rate. Gamma probe-guided MIP under local anesthesia is an effective and safe method. It has the advantage of being minimally invasive and, therefore, it should be preferred over the conventional method.

A comparison of sutureless and antibacterial suture abdomen closure.

PURPOSE: This experimental study aimed at comparing the cyanoacrylate abdomen closure to the effectiveness of triclosan coated polidioxanone abdomen closure. METHODS: The abdomen layers were closed with 3/0 polidioxanone suture in the first group. In the second group, the layers were closed with triclosan coated polidioxanone suture in a single layer. The abdomen layers of rats in the third group were attached with cyanoacrylates without sutures. The rats were sacrificed on the 14th day and the adhesive level was recorded. The incision resistance strength was measured. The tissue was examined blindly in the terms of inflammatory cell infiltration, capillary proliferation, fibrosis and micro-abscess by the pathologist. RESULTS: No significant difference was determined between the 1st and 2nd groups in the terms of inflammatory cell infiltration, capillary proliferation, collagen deposition, fibroblast activity, adhesive and tissue distension strength. The fibrosis and adhesive rate of the 3rd group was significantly higher than the 1st and 2nd groups statistically. The tissue distension strength was lower than in the other groups and the differences between the groups were found to be significant (p < 0.05). No significant difference was determined between the groups in the term of micro-abscess. CONCLUSIONS: Antibacterial suture is not superior to the conventional suture. It is concluded that cyanoacrylate is not an appropriate molecule for abdomen closure (Tab. 1, Fig. 3, Ref. 17).

Hartmann colostomy with LigaSure.

PURPOSE: While LigaSure is commonly used for blood vessel closure, our aim was to research the effectiveness of using the latter tool for the purpose of closing intestines in rats. METHODS: Twenty Wistar albino rats were divided into two groups per 10 each. In Group 1, the sigmoid colon was cut from its middle and its distal was closed with 4/0 silk. In Group 2, on the other hand, the sigmoid colon was divided from the middle with LigaSure LS1200 probe and its distal was closed with LigaSure. In both groups, the proximal sigmoid colon was entered by means of colostomy with 4/0 silk to the left part of the abdomen. Operation durations, adhesion levels and explosion pressures were recorded. Tissue samples were taken for tissue hydroxyproline level. RESULTS: While the average duration of the operation was 25.7 minutes in Group 1, it was 18.8 minutes in Group 2 and the difference between them was significant in favour of LigaSure. (p<0.001). Stump explosion pressure was 181.4 (160-190) mmHg in average in the suture group (Group 1), and 173.3 (150-190) mmHg in the LigaSure group (Group 2) and the difference between them was not statistically significant. Tissue hydroxyproline level was 123.6 (13-232) in Group 1, and 123.3 (32-216) in Group 2 and no significant difference was determined between the groups. Adhesion level between the groups was also similar. CONCLUSIONS: This study experimentally shows that the duration of effective stump closure as part of Hartman colonostomy can be shortened with LigaSure (Tab. 1, Fig. 4, Ref. 12).

Micronuclear and sister chromatid exchange analyses in peripheral lymphocytes of patients with oral lichen planus--a pilot study.

OBJECTIVE: The purpose of this study was to determine the genetic instability of peripheral blood lymphocytes from patients diagnosed with oral lichen planus (OLP) by investigation of frequencies of micronuclei (MN) and sister chromatid exchange (SCE). MATERIALS AND METHODS: A total of 22 newly diagnosed and untreated patients with OLP of same severity scores and twenty healthy controls participated in this study. They were all non-smokers with no previous history or family history of cancer. The periodontal status, flow rate and buffering capacity of whole mouth saliva were recorded. SCE and MN analyses were performed on peripheral blood lymphocytes of OLP patients and healthy controls. RESULTS: The frequencies of MN (50.00 +/- 22.36) and SCE (6.89 +/- 1.48) in OLP patients were found to be significantly elevated compared with that in normal individuals (25.20 +/- 9.52 and 5.93 +/- 1.31; z = 3.946, P = 0.0001; z = 2.346, P = 0.019). There were no significant differences in the MN frequency and SCE between the two subgroups with reticular or erosive types of OLP. CONCLUSION: These pilot data indicate an increased genomic instability in peripheral blood lymphocytes of a cohort of Turkish patients diagnosed with oral lichen planus as compared with that of healthy individuals. As patients with OLP may have an increased or potential risk for oral malignancy, these assays could be used in translational research to monitor beneficial effects of interventions and long-term prognosis.