Diagnostic utility of superb microvascular imaging in depiction of corkscrew collaterals in Buerger's disease.

PURPOSE: To evaluate the corkscrew collaterals in Buerger's disease by superb microvascular imaging (SMI) and power Doppler ultrasonography (PDU). METHODS: We evaluated with SMI and PDU 14 patients with Buerger's disease in whom corkscrew collaterals had been identified on digital subtraction angiography (DSA). Corkscrew collaterals were classified on DSA and PDU based on their size and morphology. RESULTS: A total of 17 vascular regions of collateral vessel formation were assessed. Based on DSA classification, there were three cases of type I collaterals (arterial diameter of >2 mm with large helical pattern), seven cases of type III collaterals (arterial diameter of 1-1.5 mm with small helical pattern), and seven cases of type IV collaterals (arterial diameter of <1 mm with tiny helical pattern). On PDU, all type I collaterals on DSA appeared as "large snake" images, all type III collaterals on DSA appeared as "small snake" images, and all type IV collaterals on DSA appeared as dots. SMI imaging, both in color and monochrome mode, provided superior demonstration of the continuity of the vessel of large or small "snake" images. In cases appearing as dot pattern on PDU, color SMI was able to show continuity of the flow signal as a helical pattern. DISCUSSION: SMI is a promising new Doppler imaging technique that is superior to conventional power Doppler imaging in depiction and identification of corkscrew collaterals in Buerger's disease.

Relationship between hemodialysis patients' educational level and arteriovenous fistula patency.

OBJECTIVES: Vascular access is a lifeline for the patients who are in need of long-term hemodialysis. Native arteriovenous fistula is the most intensively preferred vascular access method owing to its longevity and convenience of use. Therefore, in this study, we aimed to determine whether there might be a relationship between hemodialysis patients' educational levels and arteriovenous fistula patency. METHODS: A total of 349 patients who were attending in a chronic hemodialysis program between June 2018 and September 2018 at Bursa Uludag University, Faculty of Medicine Dialysis Unit and in a private dialysis center in Istanbul were included in this study. The patients were grouped into two: those who have had arteriovenous fistula primary failure at least once and those who have never had arteriovenous fistula primary failure. Educational levels of the patients were classified according to Turkish National Education system (illiterate, primary school graduate, secondary school graduate, high school graduate, and university graduate). Mann-Whitney U and Chi-square tests were performed for statistical analyses. Risk factors were determined by applying backward binary logistic regression analysis. RESULTS: A total of 349 patients, 161 (46.1%) females and 188 (53.9%) males, were examined retrospectively. The median age of the patients was 64 years (range: 18-90 years). Educational level comparison revealed statistically significant difference in terms of fistula patency (p = 0.016). In particular, fistula patency was significantly lower in illiterate, primary, secondary, and high school graduates in comparison with university graduates (p = 0.001, p = 0.015, p = 0.003, and p = 0.018, respectively). When each group of educational level was analyzed separately in terms of fistula patency, it was observed that the higher the educational level was, the lower arteriovenous fistula primary failure rates were. CONCLUSIONS: In this study, we observed a lower rate of fistula patency in patients with a low level of education. Hence, we are of the opinion that the trainings delivered on arteriovenous fistula care in dialysis centers are required to be shaped in accordance with educational levels of patients.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection - does cyanoacrylate increase the severity of infection?

Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

A comparison of early clinical outcomes of off-pump and on-pump coronary artery bypass grafting surgery in elderly patients.

BACKGROUND: The reply of question of "which coronary artery bypass grafting (CABG) technique is superior in elderly patients, off-pump or on-pump CABG surgery?" is controversial. We aimed to compare the early clinical outcomes in elderly patients undergoing off-pump and on-pump CABG. METHODS: From January 2009 to January 2015, 344 elderly patients (aged 70 or older) underwent off-pump (n = 137) or on-pump (n = 207) CABG. Patients' medical records were retrospectively reviewed, and their baseline preoperative characteristics, operative data and postoperative outcomes were analyzed, thereby a comparison of early outcomes between off-pump and on-pump patients was performed. RESULTS: Mean age of patients was 74.4 ± 3.8 years. Both groups were statistically similar in terms of baseline preoperative characteristics. Number of distal bypass was significantly lower in off-pump group than in on-pump group. Postoperative length of intensive care unit and hospital stay were similar between two groups. Amounts of transfused blood products were significantly lower in off-pump CABG group. There were no significant differences in terms of postoperative complications and mortality between two groups. CONCLUSIONS: Our results did not reveal a significant benefit of either surgical technique with respect to early-term clinical outcomes in elderly CABG patients. Further investigations are needed to determine whether off-pump CABG is superior than on-pump CABG in elderly patients.

Investigation of chronic venous insufficiency in patients with sleep disorders due to restless legs syndrome.

BACKGROUND: We aimed to investigate of chronic venous insufficiency on patients with sleep disorder due to restless legs syndrome. METHOD: Five hundred forty-one cases on whom polysomnography was performed due to sleep disorder were evaluated retrospectively. Forty patients with restless legs syndrome were determined. They were examined by history, physical examination, and duplex ultrasonography in terms of chronic venous insufficiency. The sleep stage rates of both groups were compared (that the rate of total sleep time in polysomnography to sleep stages is expressed as minute and percentage has been defined as sleep stage rate). RESULT: Chronic venous insufficiency was identified in 20 out of 40 patients (group 1; female, 90%). In group 2, there were patients with only restless legs syndrome but with no chronic venous insufficiency (female, 80%). The mean ages of both groups were 56.4 ± 11.8 and 54.3 ± 14.7 years. Stage 1 sleep rate in group 1 was 5% ± 2.7 and in group 2 was 8% ± 3.8 (p = 0.006). Periodic limb movement index (polysomnography finding evaluating involuntary leg movements during sleep) was 11.4 ± 17.5 in group 1, and it was 29.4 ± 37.9 in group 2 (p = 0.006). CONCLUSION: We recommend that chronic venous insufficiency should be investigated in patients with primary restless legs syndrome diagnosis.

A comparison of off- and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular events.

OBJECTIVE: Our aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE) -free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG). METHODS: We retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217). RESULTS: OPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089-1.361; p = 0.001). CONCLUSION: OPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result.

Are the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men's?

OBJECTIVE:: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older) undergoing coronary artery bypass grafting surgery. METHODS:: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older) undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. RESULTS:: Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years). The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. CONCLUSION:: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery.

[Does the leukocyte count correlate with the severity of injury?]. / Kan lökosit degeri travmanin siddetini yansitir mi?

BACKGROUND: Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients. METHODS: 713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at presentation. RESULTS: Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS. CONCLUSIONS: The leukocyte count at presentation can be used as an adjunct in the evaluation of the severity of injury in blunt trauma patients.

Are the early postoperative outcomes of coronary artery bypass grafting surgery in elderly women worse compared to men's?

Abstract Objective: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older) undergoing coronary artery bypass grafting surgery. Methods: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older) undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. Results: Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years). The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. Conclusion: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery.