Delayed presentation of a penetrating subclavian arterial injury: case report

Subklavian arter yaralanması lokalizasyonu nedeniyle oldukça nadir görülür. Yaralanma bazen çok rahatlıkla saptanabilirken, bazen de arteriyel yaralanmaya ait bariz bulgular saptanamaz. Elli sekiz yasında olan ve atesli silah yaralanması nedeniyle getirilen bayan olguda, basvurusu esnasında arter yaralanmasını düsündürecek bulgular saptanamadı. Olguda yaralanmayı düsündürecek tek bulgu travmanın lokalizasyonuydu. Indirekt bulgular nedeniyle hastanede gözlenen olgunun yapılan tetkiklerinde arteriyel yaralanma saptandı. Klinik takibinin yirminci saatinde genel durumu ve hemodinamik parametreleri aniden bozulan olgu cerrahi uygulanarak basarılı bir sekilde tedavi edildi. Subklavian bölgesinden yaralanmıs olgularda, damar yaralanmasının kesin bulguları olmasa da, yaralanma süphesi bulunan olguların hastane ortamında belirli bir süre gözlenmesi olası ölümcül komplikasyonları engelleyecektir.Subclavian artery injuries are quite rare. While the arterial injuries can be detected easily at times, the related symptoms may not be detected at all in some cases. Indirect evidences of arterial injury were detected in our fifty eight year old case brought in with firearm injury. Arterial injury was confirmed by the tests performed while the case was under observation in hospital due to indirect symptoms. Successful surgical therapy was performed on the patient whose condition had suddenly worsened in the 20 hour of the clinical follow-up.Acertain period of follow-up in the hospital setting of patients with injury in the subclavian area even when they show no initial signs will prevent possible lethal complications

Acute occlusion of internal carotid artery: thrombolysis and stent placement

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Efficiency of sirolimus in prevention of adhesions around vascular grafts

Background: Adhesions due to the reactions caused by the grafts used in the primary vascular operation can lead to various problems when a secondary operation is necessary. These problems include: bleeding, injuries to neighboring organs sand complications occurring due to a prolonged operation. We investigated the affects of sirolimus, which has antiproliferative effects on vascular adhesions. Methods: The abdominal aortae of rats were explored and abrasions inflicted. Following the fixation of a PTFE (Polytetra floroetilen) graft on the abdominal aorta, rapamycin (sirolimus) was applied (in powder form) on the grafts of the study group. Four weeks later a laparotomy was done and the adhesions developed were evaluated. Results: In the study group the adhesions were determined to be fewer in number and milder in severity. Severe adhesion were noted in the control group. Conclusions: Therefore, sirolimus applied around the prosthesis in vascular operations, was determined to be effective in preventing possible adhesions. Keywords: Sirolimus (Rapamycin), adhesion Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 285-28

Treatment of Candida sternal infection following cardiac surgery - a review of literature

WOS: 000458175000001PubMed: 30264627Background: Candida sternal wound infections (SWIs) following cardiac surgery are rare but are associated with a high mortality rate. Guidelines on this topic either propose no suggestions for management or offer recommendations based on a small number of reports. Methods: This paper presents a case of a Candida SWI and its successful treatment with debridement using a burr, negative pressure vacuum therapy (NPVT) and dermal grafting. To investigate different methods of treating Candida SWIs following cardiac surgery, a review was completed using the MEDLINE database. Reports without English abstracts and without defined outcomes of therapy for individual patients were excluded. Results: Seventy-seven cases of Candida SWIs following cardiac surgery were identified in 20 articles published since 1999, including our case. Treatment strategies are identified: omentum flap; muscle flap; debridement and secondary wound healing with or without NPVT; debridement and primary closure; incision and drainage; only medical therapy. Patients documented in the articles were classified based on the following outcomes: cured (n = 41 patients [including the present case]), relapse infection (n = 25 patients) and death (n = 11 patients). The various methods used to treat patients were analysed. Conclusions: Delayed closure reoperation with surgical debridement and NPVT have favourable outcomes. In the presence of widespread osteomyelitis, the use of omental flaps is advocated. Treatment with muscle flaps has a high rate of relapse. Debridement and secondary healing or conservative management with antifungals alone can be considered in the treatment of relapsing infection

Ischemia-modified albumin use as a prognostic factor in coronary bypass surgery

<p>Abstract</p> <p>Background</p> <p>Various types of markers have been used so far in order to reveal myocardial perfusion defect. However, these markers usually appear in the necrosis phase or in the late stage. Having been the focus of various investigations recently, ischemia-modified albumin (IMA) is helpful in establishing diagnosis in the early stages of ischemia, before necrosis develops.</p> <p>Methods and Results</p> <p>30 patients that underwent only coronary bypass surgery due to ischemic heart disease within a specific period of time have been included in the study. IMA levels were studied in the preoperative, intraoperative, and postoperative periods. The albumin cobalt binding assay was used for IMA determination. Hemodynamic parameters (atrial fibrillation, the need for inotropic support, ventricular arrhythmia) of the patients in the postoperative stage were evaluated. Intraoperative measurement values (mean ± SD) of IMA (0.67677 ± 0.09985) were statistically significantly higher than those in the preoperative (0.81516 ± 0.08894) and postoperative (0.70477 ± 0.07523) measurements. Considering atrial fibrillation and need for inotropics, a parallelism was detected with the levels of IMA.</p> <p>Conclusions</p> <p>IMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases.</p

36-month clinical outcomes of patients with venous thromboembolism: GARFIELD-VTE

Background: Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide.Methods: GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries.Findings: A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE +/- DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %).Interpretation: GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population