WITHDRAWN: Subsegmental Thrombus in COVID-19 Pneumonia: Immuno-Thrombosis or Pulmonary Embolism? Data Analysis of Hospitalized Patients with Coronavirus Disease.

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Oxygen fraction adjustment according to body surface area during extracorporeal circulation.

BACKGROUND: The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery. METHODS: After approval from the Ethics Committee of the University of Acibadem, informed consent was given from 60 patients. FiO2 adjustment strategies applied to the patients in the groups were as follows: FiO2 levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5). RESULTS: Mean PaO2 was significantly higher in Group I than in Group II at T2 and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4 (P = .0001 for all).  CONCLUSION: Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.

Comparative effects of hemodilutional anemia and transfusion during cardiopulmonary bypass on acute kidney injury: a prospective randomized study.

AIM: Acute kidney injury after cardiopulmonary bypass has been associated with dilutional anemia during surgery. We aimed both to explore if this relation is modulated by blood transfusion and to understand the postoperative contribution of protein oxidation. METHODS: In this randomized prospective study, after ethics committee approval and informed consent, 30 patients undergoing first-time elective coronary artery bypass grafting (CABG) with hematocrit between 21% and 25% at any time during extracorporeal circulation (ECC) were randomly and equally allocated into two groups. Group I consisted of patients who received red blood cells (RBC) during ECC, while in Group II, patients did not receive any RBCs. Besides routine hemodynamic and biochemical parameters, markers of renal injury such as neutrophil gelatinase-associated lipocalin (NGAL), creatinine clearance, and protein oxidation parameters (advanced oxidative protein products [AOPP], total thiol [T-SH]) were determined in both groups. RESULTS: (1) Both cardiovascular parameters (MAP, HR) and the hospitalization period of the transfused group were not significantly different compared to the non-transfused group (P > .05); (2) While urine NGAL level (P < .05) increased and GFR (P < .01) decreased in the transfused group compared to the preoperative period, there were no significant changes in respective parameters of the non-transfused group compared to preoperative period; (3) AOPP concentrations did not change compared to postoperative periods in both groups (P > .05). However, T-SH concentration showed a transient increased at postoperative hour 6 (P < .001 vs preoperative period) but normalized at postoperative hour 24 (P > .05 versus preoperative period). CONCLUSION: These findings suggest that a hematocrit value over 21% during ECC is safe for renal functions. RBC transfusion just to increase hematocrit may be deleterious.

Utility of cerebral oxymetry for assessing cerebral arteriolar carbon dioxide reactivity during cardiopulmonary bypass.

BACKGROUND: Our study evaluated changes in cerebral arterial oxygen saturation (rSO2) during cardiopulmonary bypass (CPB) that were caused by changes in arterial carbon dioxide tension (PaCO2). METHODS: A group of 126 patients undergoing routine, elective, first-time coronary artery bypass graft surgery (CABG) was entered into a prospective study using bilateral near-infrared spectroscopy (NIRS) before anesthetic induction (T1), after anesthetic induction (T2), and continuing at 5-minute intervals during moderate hypothermic (32°C) CPB. Pump flows were set at 2.5 L/min/m(2) and adjusted to maintain mean arterial pressure (MAP) within 10 mmHg of the MAP recorded at the initial fifth minute of CPB (T3). Thirty-two patients were excluded from data collection because MAP could not be stabilized within the target range of 60-90 mmHg. In the remaining 94 patients, after obtaining steady state flow, MAP, and oxygenation, a trial period of hypocarbia (mean PaCO2 of 30 mmHg) was induced by increasing oxygenator fresh gas flow rate (FGFR) to 2.5 L/min/m(2) (T4). A reciprocal period was then measured at reduced FGFR (0.75 L/min/m(2)) (T5). RESULTS: After 20 minutes of a higher (2.75 L/min/m(2)) (FGFR), mean PaCO2 decreased from a baseline of 38 ± 4 mmHg to 30 ± 2 mmHg. This was associated with a parallel decrease (-10 ± 9%) in mixed cerebral oxygen saturation without alteration of mean arterial oxygen tension (PaO2), lactate, MAP, CPB flow, or other parameters implying increased cerebral oxygen extraction. CONCLUSION: Parallel changes in PaCO2 and rSO2 occur during CPB when other variables remain constant, and are due to the effects of carbon dioxide on cerebral arterioles. Cerebral oxygen saturation measured by NIRS may be a useful indirect measure of PaCO2 when continuous blood gas analysis is not possible during open-heart surgery. Cerebral oximetry values may be useful measurements for setting an optimum gas flow rate through the oxygenator.

Right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a patient with Behçet's disease: case report and review of the literature.

Behçet's disease is a multisystemic, chronic inflammatory disorder with diffuse clinical manifestations including the cardiovascular system. Endomyocardial fibrosis is a rarely seen complication of Behçet's disease leading to progressive heart failure. We report a case of right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a 26-year-old male Turkish patient with Behçet's disease, who had heart failure symptoms. In addition, the previously reported cases of endomyocardial fibrosis complicating Behçet's disease are reviewed in this article.

Stroke after coronary bypass surgery is mainly related to diffuse atherosclerotic disease.

OBJECTIVE: This study aims to investigate the risk factors for postoperative stroke and analysis of outcome after coronary bypass surgery with cardiopulmonary bypass. METHODS: Between 1999 and 2008, 3248 consecutive patients who underwent isolated coronary surgery with cardiopulmonary bypass were prospectively enrolled in the study. Demographic and perioperative data were analyzed. Postoperative stroke was defined as severe adverse neurological events including permanent deficits or cerebral lesions with radiological demonstration of cerebral infarction within the first postoperative month. RESULTS: In total, 32 patients (0.9%) were determined with stroke. Univariate risk factors for postoperative stroke were determined as preoperative unstable angina (P = .006), Canadian Class of Angina (CCA) ≥ 3 (P = .001), preoperative creatinin level >1.2 mg/dL (P = .001), left main coronary artery disease (P = .04), chronic obstructive lung disease (P = .04), peripheral arterial disease (P < .001), New York Heart Association (NYHA) Class ≥ 3 (P = .004), preoperative renal insufficiency (P = .001), age > 65 years (P = .04), preoperative hypothyroidism (P = .02), postoperative low cardiac output state (P < .001), severe coronary artery disease requiring distal anastomosis ≥ 4 (P = .05), non-elective operation (P = .02), and body mass index ≥ 25 (P = .02). Multivariate analysis revealed peripheral arterial disease (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.9-14.0; P = .001), severe coronary artery disease (OR, 3.1; 95% CI, 1.1-8.5; P = .02), and postoperative low cardiac output state (OR, 5.1; 95% CI, 1.4-18.2; P = .01) as the independent risk factors. CONCLUSIONS: Stroke after coronary bypass surgery with cardiopulmonary bypass is mainly related to diffuse atherosclerotic disease.

Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass.

Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB. Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5). Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0-T5 in all the functional microcirculatory parameters [%ΔTVDT0-T5(CCG): -10.86 ± 2.323 vs. %ΔTVDT0-T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0-T5(CCG): -12.91 ± 2.884 vs. %ΔPVDT0-T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0-T5(CCG): -2.345 ± 1.049 vs. %ΔPPVT0-T5(BCG): 1.482 ± 0.576, p < 0.01]. Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.

Endovascular treatment of occlusive abdominal aortic thrombosis.

We report the case of a 53-year-old woman with claudication in both legs. Her angiographic examination revealed thrombosis with a critical stenosis of distal abdominal aorta. The patient was treated successfully with endovascular stenting.

Efficiency of preoperative tranexamic Acid in coronary bypass surgery: an analysis correlated with preoperative clopidogrel use.

OBJECTIVE: This study evaluates the efficiency of prophylactic tranexamic acid in coronary bypass surgery with respect to preoperative clopidogrel use. METHODS: We analyzed data for 3754 consecutive patients who underwent isolated coronary bypass surgery with cardiopulmonary bypass between January 1999 and August 2008. The patients were placed into 4 groups according to the perioperative use of clopidogrel and tranexamic acid. Group 1 included patients administered neither of these medications (n = 3160, 84.2%); group 2 included patients who received tranexamic acid only (n = 444, 11.8%); group 3 included patients who received clopidogrel only (n = 113, 3.0%); and group 4 included patients who received both medications (n = 37, 1.0%). RESULTS: In patients who received tranexamic acid, we noted significant decreases in postoperative drainage (615 +/- 336 mL versus 458 +/- 289 mL, group 1 versus group 2 [P = .0001]; 740 +/- 399 mL versus 570 +/- 408 mL, group 3 versus group 4 [P = .03]) and the use of fresh frozen plasma (1.4 +/- 1.4 units/patient versus 0.2 +/- 0.7 units/patient, group 1 versus group 2 [P = .0001]; 2.2 +/- 1.7 units/patient versus 0.5 +/- 1.3 units/patient, group 3 versus group 4 [P = .0001]), irrespective of the use of clopidogrel. We found significant decreases in postoperative blood transfusion (0.59 +/- 1.1 units/patient versus 0.39 +/- 1.1 units/patient, group 1 versus group 2 [P = .0001]; 1.2 +/- 1.8 units/patient versus 0.7 +/- 1.1 units/patient, group 3 versus group 4 [P > .05]) and in the percentage of patients who received transfusions (31.3% versus 19.3%, group 1 versus group 2 [P = .0001]; 54.5% versus 37.8%, group 3 versus group 4 [P > .05]) only in the patients who did not receive clopidogrel. CONCLUSION: Prophylactic tranexamic acid reduces bleeding and the need for transfusion. This effect exists in patients using clopidogrel but is less prominent. Preoperative use may be beneficial in patients using clopidogrel without any need for delaying the surgical procedure.

Readmission to the intensive care unit after fast-track cardiac surgery: an analysis of risk factors and outcome according to the type of operation.

INTRODUCTION: In the present study, we investigated risk factors for intensive care unit (ICU) readmission after fasttrack cardiac surgery and analyzed outcome data according to the type of surgical procedure. METHODS: Between 1999 and 2008, we prospectively enrolled 4270 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) (CABG group, n = 3754), isolated valve surgery (valve group, n = 353), or combined CABG and valve surgery (CABG + valve group, n = 163) in the study. RESULTS: Ninety-eight patients (2.2%) were readmitted to the ICU. Of these patients, 73 were in the CABG group (1.9% of this group), 16 were in the valve group (4.5%), and 9 were in the CABG + valve group (5.5%). The main reason for ICU readmission in all groups was respiratory distress. A multivariate analysis showed that the independent risk factors for ICU readmission in the CABG group were an age >65 years (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.5-5.4; P = .001), peripheral arterial disease (OR, 2.7; 95% CI, 1.2-6.1; P = .016), and drainage >500 mL (OR, 2.5; 95% CI, 1.2-5.1; P = .009). The independent risk factors for the valve group included only preoperative congestive heart failure (OR, 3.9; 95% CI, 1.3-11.7; P = .01). No independent risk factor was defined for the CABG + valve group. Mortality was significantly higher among the readmitted patients in all groups. CONCLUSIONS: The risk factors for readmission after cardiac surgery with fast-track recovery may differ according to the type of operation. A strict control of volume balance and blood transfusion may further help prevent the occurrence of the most frequent cause of readmission, respiratory failure.

Endophlebectomy of the common femoral vein and endovascular iliac vein recanalization for chronic iliofemoral venous occlusion.

BACKGROUND: Chronic post-thrombotic occlusion of the iliofemoral veins causes significant morbidity, which can be alleviated if venous drainage is restored. We report our technique of surgical endophlebectomy and patchplasty of the common femoral vein (CFV) in conjunction with iliac vein stenting to restore venous flow from the infrainguinal venous system to the vena cava. METHODS: There were 157 patients who underwent CFV endophlebectomy combined with iliocaval recanalization. Questionnaires were completed both preoperatively and postoperatively to allow comparison. These included the Clinical, Etiology, Anatomy, and Pathophysiology clinical classification; the Venous Clinical Severity Score; the Villalta scale; the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms; and the 36-Item Short Form Health Survey quality of life questionnaire. RESULTS: Mean follow-up duration was 14.4 ± 2.9 months (range, 10-29 months). The mean preoperative Venous Clinical Severity Score was 15.3 ± 2.2, and this fell to 6.1 ± 1.8 after treatment (P < .001). The mean preoperative Villalta score dropped from 12.7 ± 2.6 to 6.3 ± 1.4 (P < .001). The quality of life and symptom severity scores were improved after 3 months by 17.2 points for quality of life (P < .001) and 20.5 points for symptom severity (P < .001). Primary patency was 81% (124/153) and secondary patency was 89.5% (137/153) at 12 months. Wound complications related to groin incision and lymphatic fistulas were observed in 22.8% (35/153) and 28.7% (44/153), respectively. CONCLUSIONS: The hybrid operation of CFV endophlebectomy in conjunction with iliac vein recanalization should be considered a safe and effective treatment option in patients with severe post-thrombotic syndrome and iliofemoral veno-occlusive disease.

Treatment of delayed retrograde dissection after endovascular stenting of thoracoabdominal aortic aneurysm: graft-to-endograft anastomosis.

INTRODUCTION: Endovascular treatment of thoracic aortic aneurysms may be associated with procedure-related early and late complications. REPORT: We describe the case of a 70-year-old man who developed acute retrograde dissection of the ascending aorta 30 days after endovascular stent grafting of a thoracoabdominal aortic aneurysm and prior revascularization of the left subclavian artery. The ascending aorta and aortic arch were successfully replaced with a Dacron graft; the distal part of the graft was partially anastomosed to the previously placed endograft. DISCUSSION: Surgical repair of dissections following a thoracic endovascular procedure is reliable with a graft-to-endograft anastomosis when native aortic tissue is not suitable.

Continuous arterial pressure waveform analysis accurately detects cardiac output in cardiac surgery: a prospective comparison with thermodilution, echocardiography, and magnetic resonance techniques.

OBJECTIVE: The aim of this study was to compare the accuracy of cardiac output (CO) measurements of noninvasive continuous arterial pressure waveform analysis, thermodilution technique and echocardiography with magnetic resonance (MRI) imaging. METHODS: Eleven patients who underwent coronary bypass surgery under cardiopulmonary bypass were prospectively enrolled in this study in 2008. Repeated arterial pressure based, thermodilution, echocardiography, and MRI cardiac output measurements were performed at the postoperative 24th hour. RESULTS: Mean CO values were 5.58 +/- 0.98, 5.97 +/- 0.8, 5.31 +/- 0.52, and 5.32 +/- 0.92 measured with MRI, echocardiography, arterial pressure waveform analysis, and thermodilution techniques, respectively. Bland-Altman analysis showed good overall agreement between the MRI vs arterial waveform analysis and MRI vs thermodilution; values for bias +/- SD were -0.27 +/- 1.06 (95% confidence interval [CI] [-2.3 to 1.8]; P = .42) and -0.26 +/- 0.89 (95% CI [-2.0 to 1.5]; P = .34), respectively. Poor agreement was defined between MRI and echocardiography: bias +/- SD, 0.39 +/- 1.28 (95% CI [-2.1 to 2.9]; P = .34). CONCLUSIONS: Arterial pressure-based and thermodilution CO measurement systems yielded results comparable to those obtained with cardiac MRI assessment after cardiac surgery. Arterial pressure wave-form analysis systems for CO measurement may be feasible, noninvasive methods for use in cardiac surgery.

Is it the patient or the physician who cannot tolerate anemia? A prospective analysis in 1854 non-transfused coronary artery surgery patients.

BACKGROUND AND OBJECTIVE: Low hematocrit level and transfusion may coexist during cardiopulmonary bypass and the actual impact of one on the outcome parameters may be counfounded or masked by the other. This study aims to determine the impact of the lowest hematocrit level during cardiopulmonary bypass on outcome parameters in non-transfused patients. METHODS: Two thousand six hundred and thirty-two consecutive patients who underwent isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass were evaluated prospectively:1854 (70.4%) patients who did not receive any red blood cells during hospital stay were included in the study. Perioperative data and outcome parameters were recorded. Outcomes were evaluated in 2 groups according to the lowest level of hematocrit (>21%: high hematocrit group, n = 1680, (91.6%) and < or = 21%: low hematocrit group, n = 174, (9.4%)) during cardiopulmonary bypass. RESULTS: Overall mean lowest hematocrit level of patients was 27.7 + or - 4.4% (19.7 + or - 1.9% in the low hematocrit group, 28.5 + or - 4.1% in the high hematocrit group). The comparison of outcome parameters regarding the time on ventilator, duration of intensive care unit stay, intensive care unit re-admission, hospital re-admission, reoperation for bleeding or tamponade, low cardiac output, postoperative atrial fibrillation, stroke, creatinine level at hospital discharge, new onset renal failure, mediastinitis, pulmonary complication and mortality rates were similar in both groups. CONCLUSIONS: Our findings suggest that a lowest hematocrit level of < or = 21% during cardiopulmonary bypass has no adverse impact on outcome after isolated coronary surgery in non-transfused patients.

The feasibility of robotic-assisted concomitant procedures during mitral valve operations.

BACKGROUND: In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations. METHODS: Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females; mean age 58.3 years; range, 34 to 78 years) who underwent robotic-assisted concomitant procedures during mitral valve surgery were retrospectively analyzed. Demographic characteristics of the patients, comorbidities, medical, and surgical histories, operative and laboratory results, electrocardiographic findings, postoperative intensive care unit and ward outcomes, and cardiac follow-up data were recorded. Atrial fibrillation-related medication use, stroke, or other thromboembolic events, and electrocardiographic reports in patients who underwent cryoablation were reviewed at three and 12 months after the operation. RESULTS: A total of 76 robotic-assisted concomitant procedures were performed during mitral valve repair (n=11) or replacement (n=23) in 34 patients. These procedures were cryoablation (n=29), tricuspid valve repair (n=6), tricuspid valve replacement (n=2), left atrial appendage ligation (n=32), atrial septal defect and patent foramen ovale closure (n=5), and left atrial thrombectomy (n=2). The mean preoperative EuroSCORE values were 5.1±2.5. The mean duration of cardiopulmonary bypass and cross-clamp was 156±69.4 min and 101±42 min, respectively. Normal sinus rhythm was restored in 85% of the patients (24/28) after cryoablation and two patients (5.8%) had permanent pacemaker within a year during follow-up. There was one (2.9%) mortality in the early postoperative period due to hemorrhage related to the posterior left ventricular wall rupture. No blood product was used in 82.4% of the patients. One patient had a transient cerebral event and symptoms regressed completely within two months. CONCLUSION: Technological improvements and growing experience can decrease the suspects related to prolonged operational duration during robotic-assisted cardiac surgery. Concomitant procedures in addition to mitral valve operations can be performed with low complication rates in centers with experience of robotic surgery.

Detection of TT virus (TTV) by three frequently-used PCR methods targeting different regions of viral genome in children with cryptogenic hepatitis, chronic B hepatitis and hbs carriers.

This study was designed so that three sensitive and widely-used polymerase chain reaction (PCR) methods for the detection of TT virus or Torque Teno virus (TTV) would be simultaneously applied to a large number of subjects to evaluate performances of the various PCR protocols with different genotype sensitivities. Sera were collected from 92 children admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Pediatric Gastroenterology Unit (17 cryptogenic chronic hepatitis, 17 asymptomatic HBs carriers, 18 chronic HBV patients and 40 healthy children). TTV DNA was detected via nested N22, nested 3'-UTR and 5'-UTR PCRs for all samples. Differences in TTV D N A detection prevalences were n o t statistically significantbetween the study groups with all TTV DNA and liver enzyme levels. A significant agreement between PCR methods that target UTR was observed. TTV detection rate increased with age, suggesting a non-parenteral, environmental exposure to the virus for the study population.

Hybrid synchronous treatment of two separate cardiovascular pathologies: Coronary artery bypass grafting and endovascular aortic replacement.

Coronary artery disease and abdominal aortic aneurysm may frequently be together, particularly in elderly patients. Treatment strategies should be tailored according to the needs and specific properties of each patient. Hybrid synchronous procedures may be a choice of therapy in these patients, as well as staged procedures. Herein, we present the first hybrid synchronous case of Turkey to treat two separate cardiovascular pathologies.

Correction of dilutional anemia induces renal dysfunction in diabetic patients undergoing coronary artery bypass grafting: a consequence of microcirculatory alterations?

BACKGROUND: In this study we aimed to evaluate the effects of dilutional anemia resulting from cardiopulmonary bypass (CPB) and its correction with red blood cell (RBC) transfusion on tissue oxygenation and renal function in diabetic patients undergoing coronary artery bypass grafting (CABG). METHOD: 70 diabetic patients who underwent elective CABG and whose hematocrit values had been between 24-28% at any time during CBP were prospectively randomized and equally allocated to two groups: patients who received RBC during CPB (group I, n = 35) vs. did not receive RBC during CPB (group II, n = 35). Besides routine hemodynamic and biochemical parameters, biomarkers of ischemia and renal injury such as ischemia modified albumin (IMA), protein oxidation parameters [advanced oxidative protein products (AOPP), total thiol (T-SH)], neutrophil gelatinase-associated lipocalin (NGAL) and estimated glomerular filtration rate (eGFR) were measured in both groups. RESULTS: In group I, T-SH, NGAL and urea levels were found to be significantly increased postoperatively compared to preoperative measurements (p < 0.05). Also, postoperatively, NGAL, creatinine, aspartate aminotransferase and AOPP levels were higher in group I than group II (p < 0.05). CONCLUSION: The correction of anemia with RBC transfusion in diabetic patients undergoing CABG could increase the risk of renal injury. Further studies verifying the effects of blood transfusions at the microcirculatory level are needed to optimize the efficacy of transfusions.

Endovascular treatment of traumatic thoracic aortic transection--role of timing: a case report.

Clinical management of traumatic thoracic aortic transection gains importance because of controversial approaches regarding diagnosis, treatment choices, and the timing of treatment modalities. We report on an emergency endovascular stent graft implacement for a patient with acute traumatic thoracic aortic transection and discuss the role of timing for this kind of procedure.

Evaluating Unscheduled Readmission to Emergency Department in the Early Period.

BACKGROUND: The readmission in the early period (RAEP) is defined as the admission of a patient to emergency department (ED) for the second time within 72 hours after discharge from the ED. AIMS: The aim of this study was to determine the disease, patient, doctor, and system related causes of RAEP. STUDY DESIGN: Descriptive study. METHODS: This study is a two-stage study that was conducted at Department of Emergency, Gazi University Faculty of Medicine. The causes of RAEP were defined as disease, patient, doctor, and system related causes. RESULTS: A total of 46,800 adult patients admitted to ED during the study period and 779 (1.66%) patients required RAEP. After the exclusion criteria, 429 of these patients were included the study. The most common reasons for RAEP were renal colic in 46 (10.7%) patients. It was detected that 60.4% of the causes of RAEP were related to disease, 20.0% were related to the doctor, 12.1% were related to the patient, and 7.5% were related to the hospital management system. CONCLUSION: This study revealed that there are patient-, doctor-, and system-related preventable reasons for RAEP and the patients requiring RAEP constitute the high risk group.