A rare complication after coronary bypass surgery: Incisional pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a non-infectious, necrotizing, destructive skin disease which is rarely seen after cardiac surgery. This report presents a PG case after coronary bypass surgery.

The relationship between aortic calcification on chest radiograph and neurocognitive impairment after coronary artery bypass grafting.

BACKGROUND: In this study, we aimed to investigate the possible relationship between aortic calcification as detected by preoperative chest radiography and postoperative neurocognitive impairment in patients undergoing coronary artery bypass grafting. METHODS: A total of 124 patients (101 males, 23 females; mean age: 59.9±8.8 years; range, 34 to 84 years) who underwent coronary artery bypass grafting in our clinic between January 2019 and July 2019 were included. Of these patients, 35 whose preoperative chest radiography revealed aortic calcification in the aortic knuckle were included as the patient group. The control group consisted of 89 patients without aortic calcification. The patients with aortic calcification underwent additional imaging with thoracic computed tomography angiography and ascending aorta and aortic arch calcium scores were calculated. Neurocognitive dysfunction was assessed using the Standardized Mini-Mental State Examination. Postoperative delirium was evaluated by confusion assessment method in the intensive care unit. Both groups were compared for demographic, operative and postoperative data. RESULTS: Of all patients included in the study, the overall cerebrovascular event incidence was 3.2%. Although not statistically significant, the number of patients with neurocognitive decline was higher in the patient group than the control group (48.6% vs. 34.8%, respectively; p=0.157). Both Standardized Mini-Mental State Examination score decline and percentage decline were significantly higher in the patients with high aortic arch calcium scores (>2,250 AU). Carotid artery stenosis was 3.2 times higher in the patient group. In the patients with carotid artery stenosis, the aortic arch calcium scores were also higher (p=0.042). CONCLUSION: Aortic calcification detectable on chest radiography with high calcium scores may be associated with neurocognitive impairment and carotid artery stenosis in patients undergoing coronary artery bypass grafting.

Transposition of brachiobasilic arteriovenous fistulas: One-stage or two-stage technique and factors affecting the early maturation.

The brachiobasilic transposition (BBT) arteriovenous fistula (AVF) is a valuable option especially for dialysis patients with previously failed vascular access. We aim to report factors affecting the maturation of BBT-AVF created with either one-stage or two-stage technique. BBT-AVF procedures between January 2015 and May 2019 by a dedicated vascular access team were investigated retrospectively. A total of 122 patients (63 males, 59 females), with 6 to 12 weeks of follow-up after the BBT-AVF procedure were included in the study. Patients of one-stage and two-stage techniques were compared for maturation rates. Patients with successful and failed maturation were compared for baseline characteristics and anatomic factors. Of 122 BBT-AVF procedures, 54 were created with the one-stage and 68 were created with the two-stage technique. The mean age of the patients was 58.2 ± 13.8, the mean brachial artery and basilic vein diameters were 3.91 ± 1.02 mm, and 3.39 ± 1.16 mm. Of 122 included patients, 88 (72.1%) had mature AVFs at follow-up. The AVF maturation rates were similar between the one- and two-stage groups (70.4% vs 73.5%; P = .699). Lower age (62.8 ± 12.5 vs 56.5 ± 13.9; P = .023) and greater brachial artery diameter (3.09 ± 0.84 mm vs 4.23 ± 1.76 mm; P < .048) were the only factors affecting the AVF maturation in univariate analysis. Gender, extremity side, diabetes mellitus, hypertension, and targeted vein diameter were not found to affect the AVF maturation (P = .301, P = .084, P = .134, P = .858, P = .127). Target artery diameter (P = .049) was the only significant factor affecting BBT-AVF maturation in multivariate analysis. One-stage and two-stage BBT-AVFs are similar in terms of maturation rates. Targeted artery diameter was the only factor important in BBT-AVF maturation in our study group. The two-stage technique can be preferred considering smaller incision size and lower complication rate in patients with suitable anatomy.

An Alternative Technique for Ascending and Arcus Aorta Repair in Case of Vascular Diameter Mismatch.

Complicated Type A intramural hematoma involving the arcus aorta requires emergency correction of the aortic arch. Surgical options include reimplantation of the brachiocephalic vessels as an island to a vascular graft, debranching aortic arch surgery, and Kazui technique. This report describes a modified technique for aortic arch repair in a patient with vascular diameter mismatch between the ascending and descending aorta, as well as an intimal tear between the brachiocephalic vessels.

Ultrasonography-guided foam sclerotherapy in patients with small saphenous vein insufficiency.

PURPOSE: Chronic venous insufficiency is an important health problem; small saphenous vein (SSV) insufficiency is one of the leading causes and may affect up to 20% of adults. In addition to conventional treatment methods, endovenous treatment techniques have become popular in treatment of varicose veins. Herein, we report the outcomes of ultrasound-guided foam sclerotherapy (UGFS) in patients with symptomatic SSV insufficiency. METHODS: From January 2014 to June 2018, patients with primary SSV insufficiency treated with UGFS were followed to assess the effectiveness and safety of the procedure. A total of 31 lower limbs of 30 patients (18 females and 12 males), who attended control visits at 1 week, 1, 3, and 6 months, and yearly, after undergoing UGFS, were included in the study. The clinical results, occlusion rates, and the patients' preprocedure and postprocedure Venous Clinical Severity Scores were recorded. RESULTS: The records show that, during the procedure, severe pain occurred at the time of injection in one patient (3%), vasovagal syncope in one patient (3%), hyperpigmentation in five patients (16%), and phlebitis in three patients (9%). It was also recorded that during follow-up 24 legs (78%) showed complete thrombosis and 7 legs (22%) had partial thrombosis. The mean Venous Clinical Severity Score for the patients before UGFS was 8.58 ± 3.78, and 7.25 ± 3.17 after the procedure. No major complications, including sural nerve injury and deep venous thrombosis, were seen during the follow-up period. CONCLUSIONS: The results of this study show that UGFS is a simple, safe, and effective procedure for treatment in patients with symptomatic SSV insufficiency with acceptable side effects.

The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study.

BACKGROUND: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. AIMS: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. STUDY DESIGN: Cross-sectional study. METHODS: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal's algorithm. Awareness was evaluated based on the patients' knowledge of the effect of warfarin and food-drug interactions with simple questions developed based on a literature review. RESULTS: The Turkey-wide time in therapeutic range was reported as 49.5%±22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p>0.001). The highest rate was reported in the Marmara region (54.99%±20.91) and the lowest was in the South-eastern Anatolia region (41.95±24.15) (p>0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p>0.001). CONCLUSION: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey.

Nonthermal, Nontumescent Endovenous Treatment of Varicose Veins.

BACKGROUND: Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. A new technique for venous insufficiency is non-thermal ablation with vein sealing system which comprises the endovenous delivery of cyanoacrylate tissue adhesive to the vein causing fibrosis. METHODS: This is a single-center prospective study of treatment of great saphenous vein incompetence in 62 patients with vein sealing system (Biolas VariClose® FG Group, Turkey). All cases were implemented under local anesthesia. Tumescent anesthesia was not required. Patients were not given any nonsteroidal anti-inflammatory drug postoperatively; advised to wear elastic bandages for 1 day; and compression stockings were not offered. RESULTS: Treatment success was defined as complete occlusion of treated vein or recanalized segment shorter than 5 cm. Subtotal recanalization was defined as great saphenous vein flow containing 5-10 cm segment of treated vein. A recanalized great saphenous vein or treatment failure was defined as an open part of the treated vein segment more than 10 cm in length. At 1 week and 1 month control, duplex scans showed total occlusion for all patients (100%), total occlusion for 58 patients (93.5%), and subtotal occlusion for 4 patients (6.5%) at third month. At the end of 6 months, total occlusion 56 patients (90.3%) and subtotal occlusion for 2 patients (3.2%). For 4 (6.5%) patients, no occlusion was observed, and the diameter was >11 mm. Embolization of great saphenous vein with cyanoacrylate has been performed since the beginning of this decade. Combined chemical and physical mechanism of action results in permanent vein closure. In a recently published study, a 24-month occlusion rate of 92% was demonstrated. The most commonly reported complications of cyanoacrylate use for the treatment of varicose vein disease, so far, include ecchymosis and phlebitis. Almeida et al. reported that phlebitis is the most frequent side effect at a rate of 16%. In our study, phlebitis rate was not as high as reported. It may be caused due to shorter time of follow-up in the hospital. CONCLUSION: Endovenous ablation of incompetent great saphenous vein with cyanoacrylate-based glue is feasible. Operation time is short, and tumescent anesthesia is unnecessary as postprocedure compression stockings. Lack of significant side effects and an yearly success rate of 100% are benefits of the system.

Comparison of Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement to Improve Quality of Life in Patients >70 Years of Age with Severe Aortic Stenosis.

OBJECTIVE: Transcatheter aortic valve implantation has recently been used in the treatment of severe aortic valve stenosis, particularly in patients with high mortality and morbidity rates for open surgery. The purpose of this study was to compare quality of life in patients over 70 years of age undergoing surgical or transcatheter aortic valve implantation, before the procedure and in the early post-procedural period. METHODS: Seventy-nine patients were included in the study, 38 (48.1%) male and 41 (51.9%) female. Mean age of patients was 74.3±5.2 (70-91) years. The surgical aortic valve replacement group consisted of 51 (64.6%) patients and the transcatheter aortic valve replacement group of 28 (35.4%). Quality of life data before the procedure and at the 3rd month postoperatively in patients aged 70 years and older undergoing surgical or transcatheter aortic valve implantation were assessed using the 36-item Short Form Health Survey form. RESULTS: Positive increases in physical task difficulty (13.2±9.8vs. 5.1±7.3) (P=0.001), emotional task difficulty (14.4±11.9 vs.8.5±6.4) (P=0.035), and mental health (0.4±10.4 vs. 9.6±15.1) (P=0.001; P<0.01) scores in patients undergoing transcatheter aortic valve replacement were significantly higher compared to the surgical aortic valve replacement group. No statistically significant difference was determined between the groups in terms of pain, vitality, social function, physical function or general health scores in the preoperative and postoperative periods. CONCLUSION: The positive increase in quality of life parameters in the transcatheter aortic valve implantation group at the 3rd month postoperatively was significantly higher compared to the surgical aortic valve replacement group.

Abdominal oxygen saturation for monitoring return of spontaneous circulation in out-of-hospital cardiac arrest using near infrared spectrophometry.

AIM: We used near-infrared spectrophotometry to assess the initial and final abdominal and cerebral saturations during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest to determine if there is a correlation between increase in these saturation values and return of spontaneous circulation. MATERIALS AND METHODS: We evaluated 34 patients with out-of-hospital cardiac arrest without witnesses brought to our emergency department. Abdominal and cerebral saturations were measured using near-infrared spectrophotometry from the start of CPR. Cardiopulmonary resuscitation was performed for a maximum of 30 minutes. The effect of abdominal saturations in patients with or without spontaneous circulation restored through CPR was then assessed. RESULTS: Thirty-four patients (17 males + females) with a mean age of 63.06 ± 11.66 years were included in the study. A significant correlation was determined between increase in abdominal saturations measured at the start and end of CPR and the return of spontaneous circulation (P < .001). A good positive correlation was also identified between abdominal saturation and return of spontaneous circulation. CONCLUSION: Patients with increased abdominal and cerebral saturation values have a higher survival rate after appropriate CPR. This noninvasive measurement system and monitoring of patients during CPR may be a good method of predicting return of spontaneous circulation and assessing abdominal perfusion.

Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery.

OBJECTIVE: This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery. METHODS: Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn't receive diltiazem infusion. RESULTS: Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters. CONCLUSION: We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations.

Management of coronary artery disease in Kyrgyzstan: a comparison with Turkey and europe according to European Action on Primary and secondary prevention by intervention to reduce events III results.

OBJECTIVES: The European Action on Primary and Secondary Prevention by Intervention to Reduce Events (EUROASPIRE III) Study in coronary artery disease had been undertaken between the years of 2006 and 2007, with the participation of 22 countries in Europe including Turkey (76 centers). In this study, the situation in the management of coronary artery disease in Kyrgyzstan was compared with EUROASPIRE III findings of Turkey and Europe. STUDY DESIGN: The results of 1067 patients with stable coronary artery disease admitted to 22 centers in Kyrgyzstan were studied retrospectively and compared with the European and Turkish findings in EUROASPIRE III. During the study, the patients were interviewed and examined in the first year after the initial coronary event and/or intervention. RESULTS: The gender distribution of the 1067 patients in the study was 658 female (61.7%) and 409 male (38.3%), and the average age was 68 ± 14 years. The ratio of young patients (<50 years) in Kyrgyzstan and Turkey were higher compared with the other European countries (Kyrgyzstan 28.2%, Turkey 20% and Europe 12.7%). The number of patients followed after the coronary event in Kyrgyzstan was 524 (49.1%). Although there was not a big difference of the classical risk factors between Turkey and Europe, in Kyrgyzstan, smoking (75%), hypertension (84%), dyslipidemia (86.5%), and diabetes (74.4%) were much higher when compared to the other countries. The biggest difference between Kyrgyzstan and the other countries in EUROASPIRE III study including Turkey, was the infrequency of medical (78% vs. 95%) and interventional treatment (1.9% vs. 57%). Also, smoking cessation (27.4% vs.70.8% in Europe), physical activity (17.5% vs. 59.1% in Europe), and weight loss (37.2% vs. 58.2% in Europe) ratios after the coronary event were found to be much lower in Kyrgyzstan than in EUROASPIRE III study. CONCLUSION: When compared to the results of EUROASPIRE III study of Turkey and Europe; the Kyrgyzstan results were found to be behind for the prevention, follow-up and treatment goals set by the guidelines.

[The prevalence of chronic bronchitis in adults living in the center of Gumushane]. / Gümüshane il merkezinde yasayan eriskinlerde kronik bronsit prevalansi

INTRODUCTION: Chronic bronchitis and emphysema are major components of chronic obstructive pulmonary diseases (COPD). The aim of this study was to determine the prevalence of chronic bronchitis 20 years and over living in the center of Gumushane and to analyze the risk factors. MATERIALS AND METHODS: The study is targeted to reach 373 people who represent the center of Gumushane, 368 (98.6%) people have been reached. Participants were filled modified version of the questionnaire created by the Medical Research Council by face-to-face interview technique. RESULTS: The prevalence of chronic bronchitis was 14.1%. The average age was in the chronic bronchitis group and non-chronic bronchitis group was respectively 43.2 ± 12.9, 39.3 ± 11.6, and the differance was statistically significant (p< 0.05). Considering the relationship between cigarette smoking with chronic bronchitis, it was more frequent in smokers than non-smokers (p< 0.001, OR 4.74, 95% CI 2.47-9.17). Chronic bronchitis was observed in passive smokers than in non-smokers (p= 0.004, OR 2.86, 95% CI 1.36-6.03). Occupational exposure to dust, fumes and history of childhood pulmonary diseases were increased chronic bronchitis prevalence (respectively, p< 0.001, OR 9.53, 95% CI 4.56-19.94; p< 0.001, OR 12.14, 95% CI 5.87-25.12). Male gender, low income level and to warm up with stove were found statistically significant by univariate logistic regression analysis but these risk factors were not statistically significant in the multivariate analysis. Educational level was not found statistically significant in both analysis (p> 0.05). CONCLUSION: The prevalence of chronic bronchitis was 14.1% in 20 years and older adults living in the center of Gumushane. Old age (especially over the age of 50), active or passive smoking, occupational history of dust, fumes and history of childhood pulmonary diseases were found to be risk factors for chronic bronchitis.

An unusual clinical state: true ulnar artery aneurysm in a five-year old girl.

We report the case of a 5-year old girl, who presented with a true ulnar artery aneurysm, and the aetiology, clinical presentation and treatment of the disease.

Behcet's disease with aneurysm of internal iliac artery and percutaneous treatment.

Behçet's disease (BD), described in 1937 by Hulusi Behçet, is a multisystemic inflammatory disorder. In this paper, we report a large pseudoaneurysm of the internal iliac artery in a patient who had BD, and was admitted to emergency service complaining of leg pain and the percutaneous treatment of the pathology which followed.

Endovenous ablation with a 940 nm laser for the treatment of great saphenous vein insufficiency: short- to mid-term results.

PURPOSE: We aimed to present the short- to mid-term results of endovenous laser ablation (EVLA) procedures that were used to treat great saphenous vein (GSV) insufficiency. MATERIALS AND METHODS: This prospective study was conducted between December 2009 and January 2011. A total of 112 incompetent GSVs were treated using EVLA with a 940 nm wavelength laser. Ninety patients were treated for varicose veins with saphenous reflux, including 36 females (40%) and 54 males (60%). These patients' ages ranged from 17 to 79 years (median, 48 years). After the EVLA, the patients were monitored using duplex ultrasonography and were assessed clinically at 1 week and 1, 3, 6, and 12 months after the surgery. The patients were scheduled for a three-day examination after the EVLA to assess the level of pain that each patient was experiencing in each limb. RESULTS: At the end of a one-year follow-up period, the postprocedural duplex scans revealed a total occlusion of the treated GSVs in 88 (97%) patients and a sub-total occlusion in two (2%) patients. The average modified clinical, etiological, anatomical, and pathological score was significantly decreased at 12 months. The following complications were observed in the present study: hypoesthesia (11%), swelling and induration (5%), skin pigmentation (5%), deep vein thrombosis (1%), erythema (1%), and bleeding (1%). The mean visual analog pain score for the entire procedure was 3.14±1.06. CONCLUSION: Our short- and mid-term results of the EVLA procedure were satisfactory, and the results of this study reaffirmed the safety and effectiveness of an EVLA using a 940 nm wavelength for the treatment of GSV insufficiency.

Combination technique of tumescent anesthesia during endovenous laser therapy of saphenous vein insufficiency.

OBJECTIVE: This study aimed at evaluating the efficiency of applying tumescent anesthesia before an ablation procedure and continuously during endovenous laser treatment (EVLT) (combined tumescent technique) of saphenous vein insufficiency to reduce the patients pain and discomfort. METHODS: Twenty-five patients with 31 duplex-confirmed great saphenous vein insufficiency underwent endovenous laser (940 nm) varicose vein treatment between December 2009 and April 2010. The patients were randomized in two groups. In group A (15 patients) tumescent anesthesia was used before the ablation procedure and in group B (10 patients) tumescent anesthesia was used before and continuously during the procedure. Patients were scheduled for a three-day examination after EVLT to assess the level of pain experienced. RESULTS: According to the statistic analysis we observed that the mean level of pain score for the patients given classical tumescent anesthesia showed a higher level (P=0.003) compared with the patients given tumescent anesthesia in the combined procedure. CONCLUSION: Combination technique of administering tumescent anesthesia before ablation and continuously during the EVLT procedure may be an alternative way to reduce the patient's peroperative pain and discomfort.