Yetmiş beş yaş üstü kadınlarda izole koroner artery baypas greft cerrahisi riski erkeklere göre gerçekten yüksek midir ?

Amaç: Bu çalışmada izole koroner arter baypas greft (KABG) cerrahisi yapılan 75 yaş üzeri kadın ve erkek hastalardaki muhtemel farklılıklar araştırıldı ve risk faktörleri belirlendi.Ça­lış­ma­pla­nı:­Ocak 2004 - Ocak 2012 tarihleri arasında kardiyopulmoner baypas ile izole koroner baypas greft (KABG) cerrahisi uygulanmış olan toplam 174 hasta (121 erkek, 53 kadın; ort. yaş 77.1 yıl; dağılım 75-97 yıl) retrospektif olarak incelendi. Hastalar cinsiyetlerine göre iki gruba ayrıldı: Grup 1 erkek hastalardan, grup 2 ise kadın hastalardan oluşuyordu. Her iki grubun ameliyat öncesi risk faktörleri, ameliyat sırası ve sonrası verileri ve erken dönem mortalite oranları karşılaştırıldı.Bul gu lar: Diyabetes mellitus insidansı ve EuroSCORE değerleri kadınlarda daha yüksek iken, sigara içme oranı erkeklerde daha yüksek idi (sırasıyla p=0.012; p<0.01; p<0.01). Hasta başına düşen greft sayısı ve mediastinal drenaj hacmi erkeklerde daha yüksek iken, yoğun bakımda kalış süresi kadınlarda daha uzundu (sırasıyla, p=0.039; p=0.041; p<0.01). Sol internal mammaryan arter greft kullanımı, inotropik ilaç gereksinimi, intraaortik balon pompası desteği, nörolojik komplikasyonlar, atriyal fibrilasyon insidansı ve hastanede kalış süresi iki grupta da benzerdi. Grupların mortalite oranları arasında anlamlı bir fark bulunmadı [grup 1, 1.7% (n=2); grup 2, 3.8% (n=2)].So nuç: Yetmiş beş yaş üzeri kadın hastalarda, aynı yaş grubu erkeklere kıyasla, diyabetes mellitus insidansı, EuroSCORE değeri ve yoğun bakım ünitesinde kalış süresi daha yüksek olmasına rağmen, KABG cerrahisi benzer mortalite oranları ile yapılabilmektedir.Background: This study aims to investigate the possible differences of male and female patients aged above 75 years undergoing isolated coronary artery bypass graft surgery (CABG) and to define the risk factors. Methods: Between January 2004 and January 2012, a total of 174 isolated on-pump CABG patients (121 males, 53 females; mean age 77.1 years; range 75 to 97 years) using cardiopulmonary bypass were retrospectively analyzed. The patients were divided into two groups according to their sex: Group 1 consisted of male patients, while group 2 consisted of female patients. Preoperative risk factors, intraoperative and postoperative data and early mortality rates of both groups were compared. Results: The incidence of diabetes mellitus and EuroSCORE values were higher in females, while smoking rates were higher in males (p=0.012; p&lt;0.01; p&lt;0.01, respectively). The number of graft per patient and mediastinal drainage volume were higher in males, whereas the length of intensive care unit stay was longer in females (p=0.039; p=0.041; p&lt;0.01, respectively). The left internal mammary artery graft utilization, need for inotropic support, intra-aortic balloon pump support, neurological complications, the incidence of atrial fibrillation and length of hospital stay were similar in both groups. There was no significant difference in the mortality rates between the groups [group 1, 1.7% (n=2); group 2, 3.8% (n=2)]. Conclusion: Although women aged above 75 years may have a higher incidence of diabetes mellitus, EuroSCORE values and length of intensive care unit stay compared to age-matched men, CABG operations can be done with similar mortality rates

Güneydoğu Türkiye'de terör saldırılarında sivillerdeki vasküler yaralanmaların analizi

Türkiye'nin Güneydoğusu'nda meydana gelen teröre bağlı vasküler yaralanmalar ve mor-- talite göstergelerini incelemek. Gereç ve Yöntemler. Ocak 2012--Ağustos 2015 arasında teröre bağlı vasküler yaralanması olan 88 hasta (82 erkek, yaş 24418.1) bu retrospektif çalışmaya alındı. Travmatik amputasyon, yaygın doku kaybı, ciddi sinir hasarina bağlı amputasyon ve baş yaralanması olan hastalar çalışmaya alınmadı. Hastalar yaralanmanın ciddiyeti ve mekanizması, travma lokalizasyonu ve cerrahi tedavi şekillerine göre değerlendirildi. Bulgular: Kırkaltı (%52.3) hastada alt ekstremite, 19 (%21.6) hastada üst ekstremite, 13 (%14.8) hastada alt ve üst ekstremitede vasküler yaralanma vardı. Ayrıca boyun (n=3; %3.4), toraks (n=2; %2.3), abdomino--pelvik (n=5; %5.7) yaralanmalar da vardı. Yaralanmaların 23'ü (%26.1) mermi, 54'ü (%61.4) şarapnel, 11'i (%12.5) patlama sebebiyle meydana gelmişti. Hataların 38'i (%43.2) hastaneye geldiklerinde hipovolemik şoktaydı. Kırk (%45.5) hastada izole arter, 42 (%47.7) hastada arter ve ven, (%6.8) hastada sadece ven yaralanması vardı. Yirmisekiz (%31.8) hastada otojen greft, 10 (%11.4) hastada sentetik greft kullanıldı. Onsekiz (%20.5) hastada vasküler ligasyon yapıldı. Yedi (%8) hastada postoepratif akut böbrek hasarı gelişti. Yirmisekiz (%31.8) hastada yara enfeksiyonu gelişti. Çalışmamızda erken dönem mortalite oranı %18.2 (16 hasta)'dir. Hipovolemik şok (p<0.0001), akut böbrek yetmezliği (p=0.002) ve masif kan transfüzyonu (p=0.007) mortalite prediktörleridir. Sonuç: Teröre bağlı bağlı vasküler yaralanmalarda multi--disipliner yaklaşımla hipovolemik şok tedavi edilmeli, akut renal yetmezlik engellenmeli ve acil kompleks vasküler cerrahi girişimler planlanmalıdır.To evaluate the results of terror related vascular injuries and predictors of mor-- tality caused by these injuries in South--Eastern Turkey. Material and Methods: Eighty--eight patients (82 men, 24.4 8.1 years) who had vasculary trauma in terrorist attacks between ]anuary 2012--August 2015 in South--Eastern Turkey included in this retrospective study. Patients with traumatic amputations, ex-- tensive tissue losses, amputations after severe nerve damage and head injuries were excluded. Study pa-- tients were analyzed according to the mechanism and severity of injury, location of trauma, and surgical treatment options. Results: Forty-six (52.3%) patients had lower limb, 19 (21 .6%) patients had upper limb, 13 (14.8%) patients had both upper and lower limb vascular injuries. Other vascular injuries involved neck (n=3; 3.4%), thorax (n=2; 2.3%), abdomino--pelvic (n=5; 5.7%) locations. Twenty--three (26.1%) of them were caused by bullets, 54 (61.4%) by shrapnel and 11 (12.5%) by bombs and explosions. Thirty--eight (43.2%) of these patients were in hypovolemic shock at admittance. Forty patients (45.5%) had isolated arterial, 42 (47.7%) patients had both artery and vein, (6.8%) patients had isolated vein injuries. Auto-- genous grafts were used in 28 (31.8%) patients, and synthetic grafts were used in 10 (11.4%) patients. Vas-- cular ligations were performed in 18 (20.5%) patients. Seven (8%) patients had acute renal injury and 28 (31.8%) patients had wound infections postoperatively. Overall in--hospital mortality rate was 18.2% (16 patients). Hypovolemic shock (p&lt;0.0001), acute renal failure (p=0.002) and massive blood transfusion (p=0.007) were the main predictors of mortality. Conclusion: Vascular injuries in terror--related trauma victims require multidisiplinary urgent treatment of hypovolemic shock, preventive measures to avoid acute renal failure and immediate complex vascular surgery

A comparison of axillary blockage and local anesthesia techniques on autologous arteriovenous fistula flow rates and patient comfort in chronic hemodialysis patients

Amaç: Bu çalışmada, aksiller sinir bloku ve lokal anestezi tekniklerinin arteriyovenöz fistül (AVF) akım hızı, açıklık oranları, ameliyat sonrası erken dönem ağrı üzerine etkileri karşılaştırıldı. Çalışma planı: Bu prospektif çalışmaya Haziran 2007 - Ağustos 2009 tarihleri arasında, brakiyal arter-sefalik ven AVF ameliyatı yapılması planlanan 30 hasta alındı. Grup 1 aksiller sinir bloku (n=15), grup 2 lokal anestezi uygulanan hastalardan (n=15) oluşuyordu. Grup 1 ve grup 2 hastaların yaş ortalaması, sırasıyla 57.8±14.0 ve 54.9±16.5 idi. Her iki grupta da hipertansiyon öyküsü olan iki hasta vardı. Hastaların ağrı skoru, görsel analog ölçeği (GAÖ) (0-10 cm) ile ameliyat sonrası 2, 6. ve 24. saatlerde değerlendirildi. Arteriyovenöz fistül açıklığı ve akım hızı, takip sırasında 10. ayda Doppler ultrasonografi (USG) ile değerlendirildi. Bulgular: Ameliyat sonrası 2, 6. ve 24. saatteki ağrı skorları ortalamaları grup 1’de sırasıyla 1.2±0.5, 2.8±0.7 ve 1.9±0.4 ve grup 2’de sırasıyla 3±1.3, 3±0.7 ve 2±0.5 (p=0.000; p=0.480; p=0.497) olarak saptandı. Ameliyat sonrası 10. ay kontrolünde grup 1’de Doppler USG ile saptanan ortalama akım hızı 966.1±206.1 ml/dk., grup 2’de 871.6±338.3 ml/dk. idi (p=0.513). Grup 1 ve grup 2’de tüm AVF’ler açıktı. Grup 2’de üç hastada çalma “steal” sendromu gelişirken grup 1’de herhangi bir komplikasyon saptanmadı (p=0.68). Grup 1’de bir hastada aynı ekstremitede 24 saat süren motor blok gelişti ve takiplerinde spontan olarak blok geri döndü. Sonuç: Arteriyovenöz fistül ameliyatları sırasında aksiller blokun, önemli bir komplikasyon olmadan gerçekleştirilebilecek etkili, güvenli ve AVF fistül akımını olumlu yönde ve uzun vadeli etkileyen bir anestezi yöntemi olduğu kanısındayız.Background: In this article, we aim to compare the effects of axillary nerve block and local anesthesia techniques on the flow rate and patency of arteriovenous fistulas (AVF) and postoperative early-stage pain. Methods: This prospective study included 30 patients who were scheduled for brachial artery-cephalic vein AVF construction operation between the dates June 2007 and August 2009. Group 1 (n=15) consisted of axillary nerve block, group 2 (n=15) consisted of local anesthesia administered patients. The mean age of group 1 and group 2 patients were 57.8&plusmn;14.0 and 54.9&plusmn;16.5 respectively. There were two patients with hypertension history in both groups. Pain scores were evaluated with visual analog scale (VAS) (0-10 cm) at 2, 6th and 24th hour after the operation. Arteriovenous fistulas patency and flow rates were measured by Doppler ultrasonography (USG) at 10th months during follow-up. Results: Postoperative pain scores of 2, 6th and 24th hour in group 1 were 1.2&plusmn;0.5, 2.8&plusmn;0.7 and 1.9&plusmn;0.4 respectively; the same values for group 2 were 3&plusmn;1.3, 3&plusmn;0.7 and 2&plusmn;0.5 (p=0.000; p=0.480; p=0.497). The mean flow rates measured with Doppler USG after 10 months were 966.1&plusmn;206.1 ml/min in group 1 and 871.6&plusmn;338.3 ml/min in group 2 (p=0.513). All the AVF were patent in group 1 and group 2. Steal syndrome arised in three patients in group 2 and none in group 1 (p=0.68). There was one patient complicated with motor blockade on the same extremity, who spontaneously recovered after 24 hours in group 1. Conclusion: We conclude that axillary blockage is an effective and safe technique in AVF construction operations which has also a positive long-term effect on AVF flow rates without any critical complication

Czy leczenie ozonem (O3) jest skuteczne w przypadku zanikowego zapalenia błony śluzowej nosa? Badanie eksperymentalne na zwierzętach doświadczalnych

Wprowadzenie: Zanikowe zapalenie błony śluzowej nosa (atrophic rhinitis; AR) jest chorobą charakteryzującą się zanikiem (atrofią) błony śluzowej, błony podśluzowej oraz tkanki kostnej, a także nadmiernym powiększaniem się jam nosa z nieznanej przyczyny. Dotychczas nie udało się poznać skutecznej metody leczenia tej choroby, a terapia czynnościowej utraty atroficznych komórek w AR wciąż pozostaje przedmiotem badań. Wykazano, że terapia ozonem (O3) zwiększa metabolizm komórkowy, angiogenezę, aktywność fibroblastów i syntezę kolagenu. Cel: Ustalenie, czy leczenie ozonem wpływa na histopatologiczny obraz choroby w doświadczalnie wywoływanym modelu AR. Materiał i metody: Do badania włączono 12 szczurów-albinosów rasy Wistar Hannover. Zanikowe zapalenie błony śluzowej nosa u zwierzęcia indukowano poprzez podawanie do obu jam nosa przez 21 dni toksyny bakteryjnej Pasteurella multocida, rozcieńczonej roztworem soli fizjologicznej. Wszystkie zwierzęta objęte badaniem podzielono na dwie grupy – kontrolną i badaną. Grupie badanej podawano doodbytniczo gaz ozonowy (60 μg/ml) przez 21 dni. Po 2 tygodniach szczury poddano dekapitacji, usunięto w całości jamę nosową, a parametry zanikowego zapalenia błony śluzowej nosa (hiperplazję komórek nabłonka, utratę komórek kubkowych, utratę rzęsek, naciek zapalny i ektazję naczyniową) oceniano na podstawie badania histopatologicznego pod mikroskopem świetlnym, po czym poddano analizie statystycznej. Wyniki: Częstość występowania ektazji naczyniowej była istotnie niższa w grupie poddanej leczeniu ozonem w porównaniu z grupą kontrolną (p <0,05). Nie stwierdzono istotnych różnic pomiędzy grupami w odniesieniu do pozostałych parametrów histopatologicznych. Wnioski: Leczenie ozonem wywołało umiarkowany efekt na poziomie histopatologicznym. Autorzy doszli do wniosku, że terapia ozonem nie ma wpływu, lub ma bardzo ograniczony, na zanikowe zapalenie błony śluzowej nosa

Is Ozone (O3) Treatment Effective in Atrophic Rhinitis? Experimental Animal Study

Introduction: Atrophic rhinitis (AR) is a disease characterized by atrophy of the mucosa, submucosa, bone tissue due to an unknown cause and excessive nasal cavity enlargement. The disease still has no complete treatment, and the treatment of functional loss of atrophic cells in AR is still a matter to be investigated. Ozone (O3) therapy has been shown to enhance cell metabolism, angiogenesis, fibroblast activity and collagen synthesis. Aim: To determine whether ozone treatment affects the disease histopathologically, in experimentally created AR. Material - Method: Twelve Wistar Hanover strain albino male rats were included in the study. Atrophic rhinitis was induced in animals by administering Pasteurella multocida toxin diluted with saline for 21 days to both nasal cavities. A total of 12 animals included in the study were divided into 2 groups as control and study. Ozone gas (60 μg/mL) was administered rectally to the study group for 21 days. After 2 weeks, the rats were decapitated, the nasal cavities were removed as a block, and atrophic rhinitis parameters (epithelial hyperplasia, goblet cell loss, cilia loss, inflammatory infiltration and vascular ectasia) were evaluated under light microscopy by histopathological examination and statistically interpreted. Result: The incidence of vascular ectasia was significantly lower in the ozone group compared to the control group (p<0.05). There was no significant difference between the groups regarding other histopathologic findings. Conclusion: Ozone treatment was moderate at the histopathological level. We concluded that ozone therapy has no or very limited effect on atrophic rhinitis