Investigation of the effects of preoperative nutritional status scores on renal injury after cardiac surgery in elderly patients.

OBJECTIVE: Acute kidney injury (AKI) is a common complication after cardiac operations accompanied by cardiopulmonary bypass (CPB). Nutritional status is an important parameter that reflects the general health status of patients, and its prognostic importance has been shown in numerous diseases. For this reason, various scoring systems are used to show nutritional status, the most known of which are the controlling nutritional status (CONUT) score and the geriatric nutritional risk index (GNRI). In this current study, we aimed to investigate the prognostic values of the CONUT score and GNRI in predicting AKI after cardiac surgery. PATIENTS AND METHODS: Patients over sixty-five years of age who underwent cardiac surgery with CPB in our clinic between March 2019 and January 2021, were consecutively included in the study. The patients who did not develop AKI in the postoperative period were recorded as Group 1, whereas the patients who did develop were defined as Group 2. RESULTS: Postoperative AKI occurred in 126 (28.7%) patients (Group 2). The median age of the 313 patients included in Group 1 and 126 patients in Group 2 was 69 (67 to 81) and 71 (66 to 85) years, respectively (p = 0.033). The two groups were similar in terms of gender, body mass index, hypertension, smoking, and left ventricular ejection fraction rates. In Group 2, albumin and GNRI values were significantly lower (p = 0.019 and p < 0.001, respectively), whereas the CONUT score was significantly higher (p < 0.001). CONCLUSIONS: We showed the CONUT score and GNRI values calculated in the preoperative period in patients over 65 years of age as independent predictors of the development of AKI, after cardiac surgery.

The therapeutic effect of ALT-711 on erectile function in rats treated with high-level AGEs (advanced glycation end products) containing diet.

To investigate, if advanced glycation end products (AGEs) are involved in erectile dysfunction (ED) and also ALT-711, a cross-link breaker of AGEs, has the therapeutic potential against the development of ED in rats treated with high concentrated AGEs including food. For this purpose, 30 male Harlan Spraque-Dawley rats randomly were divided into three groups; (1) control rats treated with regular diet, (2) rats treated with high-level of AGE specific diet for 6 months, and (3) rats having AGE-diet treated with ALT-711 for the final 3 months of 6 months of AGE-diet period. Erectile response to cavernosal nerve stimulation (CNS), protein expression of neuronal nitric oxide synthase (nNOS) and levels of AGEs, Malondialdehyde (MDA), cyclic guanosine monophosphate (cGMP) were determined in penile tissues. Erectile responses to CNS and penile nNOS and cGMP content were significantly reduced, while AGEs and MDA were elevated in penises of Group-2. Treatment with ALT-711 reversed ED and depletion of both nNOS and cGMP. Additionally, ALT-711 treatment reduced penile tissue AGEs and MDA expression. In present study: rats without any co-morbidity such as diabetes mellitus (DM) and chronic renal failure (CRF) were treated with high-level AGEs containing food. Our results suggest that ALT-711 may be an interesting and promising approach in the treatment of AGEs-related ED.

Incidentally Detected Gastric Gastrointestinal Stromal Tumor during Living Donor Liver Transplant Surgery for Hepatocellular Carcinoma: The First Two Cases.

Coexistence of hepatocellular carcinoma and gastrointestinal stromal tumor is rare. In this case series, we aimed to present an unusual coincidence of a gastrointestinal stromal tumor and hepatocellular carcinoma in patients who underwent living donor liver transplantation for hepatocellular carcinoma who had an incidental gastric gastrointestinal tumor which was detected intraoperatively.

Effect of fibrin glue or suture on leakage in patients undergoing laparoscopic sleeve gastrectomy.

INTRODUCTION: Sleeve gastrectomy represents one of the most common surgical procedures used in bariatric surgery. The most feared complication following laparoscopic sleeve gastrectomy (LSG) is the leak that occurs at the staple line. One method to reduce the risk of leak is the use of reinforcement material at the suture line. In this study, the efficacy of sutures and fibrin glue in the prevention of staple leak has been compared retrospectively. METHODS: A total of 250 patients undergoing LSG between October 2011 and August 2015 at the Medical Faculty of Firat University were retrospectively assessed using the hospital database system records. RESULTS: There were 77 males (31%) and 173 (69%) females, with a mean age of 34 years (range: 16-65 years) and mean body mass index of 45 kg/m2. Staple line was sutured in 54 patients (22%). Neither suture nor fibrin glue was used for reinforcement of the staple line in 61 (24%) patients. Only fibrin glue was used for the reinforcement of the staple line in 135 (54%) patients. Postoperative leak occurred in eight patients (3.2%). Neither suture nor fibrin glue was used for reinforcement in 6 (9.8%) of these patients. One of them was in sutured staple line group and the other was in fibrin glue group (0.7%). One patient died due to leak and the consequent development of sepsis (0.4%). CONCLUSION: Despite some controversies, strong evidence exists on the effectiveness of fibrin glue in the prevention of leaks in patients undergoing LSG from this study.

The role of neutrophil to lymphocyte ratio as a predictor of diastolic dysfunction in hypertensive patients.

OBJECTIVE: Neutrophil to lymphocyte ratio (NLR) is a novel parameter for cardiovascular research area. The higher values of NLR have been found to be associated with worse clinical outcomes in atherosclerotic heart disease, heart failure, heart valve disease and other various cardiovascular disorders. Although the relationship between NLR and almost all cardiovascular disorders have been investigated, the association between NLR and diastolic dysfunction remains unclear. We herein evaluated the association between NLR and diastolic dysfunction. PATIENTS AND METHODS: The study population consisted of 41 hypertensive patients with any grade of diastolic dysfunction and 41 hypertensive patients without diastolic dysfunction determined by echocardiographic evaluation constituted the control group. RESULTS: Mean NLR value was found to be 2.07 ± 0.82 in the diastolic dysfunction group while the control group had a mean value of 1.69 ± 0.60 (p = 0.020). The patients with diastolic dysfunction had significantly higher values of NLR. When grades of diastolic dysfunction were evaluated, NLR was 1.80 ± 0.82, 2.32 ± 0.73 and 2.75 ± 0.45 in patients with grade 1, grade 2 and grade 3 diastolic dysfunction, respectively. The patients with higher grade of diastolic dysfunction had higher values of NLR (p = 0.001). None of the other hematologic parameters differed significantly in patients with diastolic dysfunction when compared to controls. CONCLUSIONS: Patients with diastolic dysfunction had higher values of NLR compared to subjects without diastolic dysfunction. Furthermore higher grades of diastolic dysfunction were associated with higher levels of NLR. Further studies are needed to search the possible use of NLR as a marker for prognostic stratification in diastolic dysfunction which is associated with worse cardiovascular outcomes.

Outcomes of left-lobe donor hepatectomy for living-donor liver transplantation: a single-center experience.

Living-donor liver transplantation (LDLT) is an excellent option for patients with end-stage liver disease in situations of donor shortage. The aims of this study were to evaluate our experience with left-lobe donor hepatectomy for LDLT and to grade postoperative complications using the 5-tier Clavien classification system. Data from medical records of 60 adult living liver donors (30 men, 30 women) who underwent left-lobe hepatectomy between November 2006 and April 2012 were reviewed. The median donor age was 31.7 ± 8.9 (range, 19-63) years. Sixteen complications were observed in 12/60 (20%) donors. Complications developed in 6/15 (40%) donors who underwent left hepatectomy and in 6/45 (13.3%) donors who underwent left lateral segmentectomy. Seven of 16 (43.7%) complications were Grade I and 2 (12.5%) were Grade II. Major complications consisted of 4 (25%) Grade IIIa and 3 (18.7%) Grade IIIb complications; no Grade IVb or V complications occurred. The most common complication was biliary, occurring in 7 (11.6%) donors and comprising 43.7% of all 16 complications. The mean duration of follow-up was 30 ± 7.1 (range, 2-58) months. No donor mortality occurred. Left-lobe donor hepatectomy for LDLT, which does not benefit the completely healthy donor, was performed safely and with low complication rates, but carries the risk of morbidity. Low morbidity rates following living-donor hepatectomy can be expected when surgical and clinical monitoring and follow-up are adequate and the surgeon has gained increased experience.

Acinetobacter infection in a liver transplantation intensive care unit.

OBJECTIVE: Despite the advances in surgical technique and postoperative care, infectious complications are associated with high mortality rates. Acinetobacter species are emerging as a leading worldwide nosocomial pathogen in intensive care unit (ICU) patients. This study was designed to evaluate the results of the patients who developed Acinetobacter infection in the ICU after liver transplantation. METHODS: We retrospectively analyzed 220 patients who had undergone liver transplantation between August 2011 and August 2012. Among the 55 positive culture results with clinical signs of infection, Acinetobacter was the single infectious agent for 10 of them, who were included in the study. RESULTS: The mean age of the patients was 43.1 ± 11.79 years with a male dominance (70%, n = 7). Eighty percent of the patients underwent living donor liver transplantations (n = 8). Mean Model for End-stage Liver Disease score was 28.5 ± 14.99. Graft dysfunction was present in 50% (n = 5), all of whom had a history of preoperative hospitalization (100%, n = 10). Forty percent (n = 4) of patients had a history of diabetes mellitus and 60% were subject to extended mechanical ventilation. Mean platelet count was 20.32 ± 8.1 × 10(9)/mL. The majority of the patients had multiple culture-positive sites (90%, n = 9). Positive culture results for Acinetobacter species included bloodstream (n = 8), drain fluid (n = 5), sputum (n = 3), paracenthesis material (n = 3), and catheter (n = 1). The mean period of postoperative positive culture results was 12.7 ± 9.5 days. Mortality was 90% (n = 9). CONCLUSION: Acinetobacter infections in the ICU after liver transplantation were asociated with a high mortality presenting with thrombocytopenia.

[Pneumothorax following preventive colonoscopy]. / Pneumothorax nach Vorsorgekoloskopie.

Pneumothorax represents an extremely rare but serious and potentially life-threatening complication of colonoscopy. Here we report an unusual case of contralateral pneumothorax accompanying a perforation of the splenic flexure after preventive colonoscopy in a young outpatient.

Therapy of regional lymphadenitis following BCG vaccination.

In this study we presented 92 cases with regional lymphadenitis (over 1 cm in diameter) which was caused by BCG vaccination generally performed a few days after birth. The patients were divided into four therapy groups. In group I, the lymphadenitis in 26 cases was excised totally by a surgical operation and they improved in a median period of four weeks (average: 4.4). No therapy was applied in 33 patients constituting group II and their periods of improvement were 28 weeks (average: 29.1). Sixteen cases in group III were given isoniazid (INH) 10 mg/kg for six months in addition to total surgical excision and their healing period was 4.5 weeks (average: 4). Seventeen cases in group IV were administered only INH for six months and the median improvement period was found to be 27 weeks (average: 28.2). The statistical differences in terms of the improvement periods between groups I and III, and groups II and IV were found to be insignificant (p greater than 0.05) but these differences were significant between groups I and II, groups I and IV, groups II and III, and groups III and IV (p less than 0.05). These results show that spontaneous healing is possible. Total excision is the best therapy for BCG lymphadenitis in suppurative forms and INH has no effect in shortening the therapy period.