The study aimed to examine whether alpha-1-antitrypsin (AAT), an inhibitor of leukocyte esterase(LE), which damages the venous vessel wall, has a protective effect against chronic venous disease(CVD), and to examine the relationship between AAT levels and disease severity.Patients admitted with varicose vein disease and having reflux flow lasting longer than 0.5 s as determined by Doppler ultrasound were included. The informed consents were taken, and blood samples were obtained for complete blood count, C-reactive protein (CRP) level, and AAT level following anamnesis and physical examination. Clinical Etiologic Anatomic Pathologic (CEAP) classification was used to assess disease severity, and patients were divided into CEAP 1-5 groups accordingly.A total of 87 patients were included in the study. There was no statistically significant difference between the groups in body weight, red blood cell counts, platelet counts, or neutrophil counts (p = 0.117, p = 0.932, p = 0.177, and p = 0.177, respectively).CRP and AAT levels were higher in patients with a CEAP clinical score of 5 compared to the other groups (p = 0.018, and p = 0.020, respectively). AAT levels were similar in the CEAP 1-3 group and decreased in the CEAP-4 group but increased again in the CEAP-5 group. The AAT level was 1.62 ± 0.3 g/L in the CEAP-1 group, 1.61 ± 0.21 g/L in the CEAP-2 group, 1.61 ± 0.27 g/L in the CEAP-3 group, 1.48 ± 0.28 g/L in the CEAP-4 group, and 1.94 ± 0.39 g/L in the CEAP-5 group. CRP levels and platelet counts were observed to affect AAT levels (p = 0.10, p = 0.017, respectively).We believe that our hypothesis that low AAT levels play a role in the etiopathogenesis of CVD has been partially validated, at least in the CEAP-4 group. However, we believe that increased AAT levels in the CEAP-5 group may be a reactive increase in increased LE levels due to higher CRP levels of this group.
Our study aimed to examine the impacts of blood cardioplegia (BC) and del Nido cardioplegia (DNC) solutions - which we used in isolated coronary artery bypass grafting (CABG) - on early mortality and major adverse events (MAE).We retrospectively analyzed 329 consecutive patients who underwent CABG in our clinic between January 2016 and January 2020. Myocardial infarction, reoperation, cardiac tamponade, stroke, renal failure, extracorporeal membrane oxygenation requirement, and cardiopulmonary resuscitation were defined as MAE. The group in which DNC was used was Group D (181 [55%] patients), and the group in which BC was used was Group B (141 [45%] patients).No statistically significant difference was determined between the groups regarding age, weight, body surface area, gender, or European System for Cardiac Operative Risk Evaluation score (P=0.615, P=0.560, P=0.934, P=0.365, P=0.955, respectively). Although there was no statistically significant difference between the groups in terms of aortic cross-clamping time (P=0.712), cardiopulmonary bypass duration was longer in Group B (P=0.001). Even though the incidence of stroke was higher in Group B (P=0.030), no statistically significant difference was observed between the groups regarding total incidence of MAE, mortality, mechanical ventilation time, length of stay in the intensive care unit, or length of hospital stay (P=0.153, P=0.130, P=0.689, P=0.710, P=0.613, respectively).We found no significant difference in MAE, mortality, duration of mechanical ventilation, intensive care unit stay, or hospital stay between the DNC and BC groups. We believe that both solutions can be used safely for cardiac protection in the adult patient population.
Objective: There are various reasons for renal dysfunction after cardiac surgery; however, activation of the renin–angiotensin system has an important role following cardiac surgery. We investigated the effect of preoperative angiotensin-converting enzyme (ACE) inhibitors on renal functions after cardiovascular surgery. Material–methods: Three hundred sixty-six patients awaiting elective cardiac surgery were allocated to two groups, namely the treatment group, comprising the ACE inhibitor group (n = 186), and the control group, which was without ACE inhibitor (n = 180). The renal parameters [blood urea nitrogen, creatinine, creatinine clearance, and glomerular filtration rate (GFR)] and the need for dialysis were evaluated associated with renal functions between the two groups in the postoperative period. Results: After cardiac surgery, renal dysfunction requiring dialysis developed in 11 (3.8%) patients in the control group patients. There was no required dialysis in the treatment group (p < 0.05). As an indicator of renal dysfunction, the increase in creatinine and blood urea nitrogen levels and the decrease in GFR and creatinine clearance were higher in the control group (p < 0.05). The multivariate analysis indicated that therapy with ACE inhibitors was found to decrease the incidence of postoperative renal dysfunction (odds ratio, 1.07; 95% confidence interval, 0.45–2.50; p < 0.05). The other independent predictors were age, preoperative intra-aortic blood pump, hypertension, diabetes mellitus, and a left ventricular ejection fraction below 0.40. Conclusion: Preoperative therapy with ACE inhibitors has an influence on renal functions. This study demonstrates that administration of ACE inhibitors provides better renal protection after cardiac surgery.
Arteriovenous fistula (AVF) is the most important vascular access method for hemodialysis (HD). In this study, the relationship between AVF success and inflammation in patients who had HD due to end-stage renal failure (ESRF) was investigated.In the study, a total of 658 patients, who started HD for ESRF, were evaluated retrospectively. A total of 386 patients were included in this study. The demographic data and C-reactive protein, albumin and fibrinogen levels were investigated in patients with recognized success AVF.In total 311 patients with successful AVF and 75 unsuccessful AVFs were found. In unsuccessful AVF group the average low albumin level, high C-reactive protein and fibrinogen levels were found to be statistically meaningful when compared with successful AVF group (p < 0.001, p < 0.001, p < 0.001).As a result, we think that the evaluation of inflammation before creating AVF in HD patients is very important for increasing the success of AVF.
Amac: Bu calismada, gecici hemodiyaliz kateter girisimleri ve bunlarla iliskili komplikasyonlari incelemeyi amacladik. Hastalar ve Yontem: Klinigimizde Ocak 2006- Mayis 2013 tarihleri arasinda hemodiyaliz amacli bir ve/veya birden cok sayida gecici kateter takilan 782 hasta (488 erkek, 294 kadin, yaslari 11-91 arasinda, ortalama yas; 47±13), retrospektif olarak incelendi. 484 hastaya bir, 158 hastaya iki, 103 hastaya uc, 30 hastaya dort, 7 hastaya bes kez kateter yerlestirildi. 192 hastada bobrek yetmezligi tanisi yeni konulmustu. 254 hasta ise kronik bobrek yetmezligi hastasi olup daha onceden diyalize giren hastalardi. Hastalarimizin 486’sina sag internal juguler vene (IJV), 173’une sol IJV, 98’ine femoral vene, 25’ine subklaviyan vene kateter yerlestirildi. Bulgular: Hemodiyaliz kateterine bagli olarak gorulen en sik komplikasyon kateter disfonksiyonu idi. Dort hastamizda karotis arter ponksiyonuna bagli hematom gelisti. Hastalarimizda hemotoraks ve/veya pnomotoraks komplikasyonu gozlenmedi. Hastalarimizin 98’ine femoral ven yoluyla gecici kateter yerlestirildi. Bu femoral kateterlerden 22 ‘si kateterdeki bukulme ve tikanma nedeniyle ortalama dorduncu gunde, 27’si ise enfeksiyon nedeniyle ortalama 8.gunde cikarildi. Erken komplikasyon olarak 4 hastada boyunda hematom, 87 hastada kateter disfonksiyonu gelisti. Gec komplikasyon 59 hastada gelisti. Sonuc: Gecici hemodiyaliz kateter uygulamalarinda en sik gorulen sorun kateter disfonksiyonudur. Kateterlerin deneyimli kisiler tarafindan takilmasi ile islem basarisinin artacagi ve komplikasyon oranlarinin azaltacagi kanatindeyiz. Anahtar kelimeler: Hemodiyaliz, Gecici hemodiyaliz kateteri, Kronik bobrek yetmezligi
Artrial fibrillation is the most common arrhythmia that occurs after coronary bypass grafting operation with the rate of 30%. Atrial fibrillation is associated with hemodynamic instability, strokes, and prolonged hospital stay. Pericardial effusion is a risk factor for atrial fibrillation after cardiac surgery, and it occurs commonly in the posterior area during the post-operative period. The aim of this prospective study was to demonstrate the effectiveness of posterior pericardiotomy in reducing the incidence of atrial fibrillation. This prospective randomized study was carried out on 425 patients undergoing a coronary artery bypass grafting in our clinic between August 2009 and February 2011. There were 276 male patients and 149 female patients. These patients were randomly divided into two groups; posterior pericardial incision was performed in 213 patients (pericardiotomy group), while any pericardial incision was not performed in 212 patients (control group). Atrial fibrillation occurred more frequently in control group (62 patients, 14.6%), compared to the pericardiotomy group (14 patients, 3.1%; p < 0.0001). The incidences of early pericardial effusion, late pericardial effusion, and tamponade were also significantly higher in control group. Moreover, posterior pericardiotomy was associated with the decreases in the duration of stay in hospital and intensive care unit. In fact, the total hospital costs were lower in the pericardiotomy group. In conclusion, posterior pericardiotomy is an effective and safe technique that reduces early pericardial effusion, atrial fibrillation, length of stay in hospital, and hospital costs after the coronary artery bypasses grafting.
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