5 research outputs found
An Extensive Warfarin-Induced Jejunal Hematoma
The most common adverse event associated with oral anticoagulation (OAC) is bleeding in general that is seen in 5 to 48% of patients and gastrointestinal bleeding (GIB) in particular which occurs in 2–4% of patients. Intramural hematoma (IMH) is a rare variant of GIB, occurring in 1 in every 2500 patients and is treated with OACs. IMHs are rarely fatal and the current data suggest conservative medical therapy and clinical follow-up for management of IMHs. GIB and intestinal IMH is becoming a more common clinical problem because of increasing number of patients taking OACs. This report describes a 91-year-old woman who was presented with abdominal discomfort for 2 days. The patient had been under anticoagulant therapy with warfarin because of atrial fibrillation. She was found to have an inappropriately prolonged international normalized ratio level of 8.1. IMH was confirmed with abdominal ultrasound and computed tomography (CT) scan. The patient was treated conservatively with fluid resuscitation, nasogastric decompression, bowel rest and reversal of anticoagulation. Follow-up CT scans, approximately one month after medical treatment, demonstrated complete resolution of the IMH. Intestinal IMH should be considered in the differential diagnosis of acute abdomen in any anti-coagulated patient with abdominal complaints
Early and late predictors of postoperative neurocognitive dysfunction in cardiac surgery = A posztoperatív neurokognitív diszfunkció korai és késői prediktorai szívsebészeti beavatkozás után
Background and purpose – Postoperative cognitive
dysfunction (POCD) is a multifactorial image characterized
by insufficiency in features such as the ability to perform
tasks requiring high brain functions. Cognitive dysfunction
such as memory loss and decreased concentration, confusion, and delirium are common conditions in some
patients in the early period after major surgical interventions such as cardiac surgery. POCD causes delays in
postoperative recovery, long return-to-work times, and
decreased quality of life. This study aims to demonstrate
POCD in early and late stages in patients undergoing
cardiac surgery through the Montreal Cognitive
Assessment (MoCA) and the Mini Mental Test (MMT).
In addition, we aim to determine predictive factors with
these neurocognitive tests.
Methods – MMT and MoCA tests were applied to the
patients included in the study before cardiac surgery, on
the sixth postoperative day and third month. Neuro -
cognitive dysfunction detected on the sixth postoperative
day was accepted as an early period, its detection in the
postoperative third month was accepted as a late period.
Results – 127 patients without neurocognitive dysfunction
in the preoperative period were included in the study. For
early neurocognitive impairment, age, mean platelet volume (MPV), New York Heart Association (NYHA) classification, x-clamp time, cardio-pulmonary bypass (CPB) time,
postoperative intensive care and hospital stay duration,
and an event of acute myocardial infarction (AMI) in the
preoperative period were determined as predictive factors.
In addition, in late-period of neurocognitive dysfunction
age, MPV, NYHA classification, x-clamp duration, CPB time,
postoperative intensive care and hospital stay duration
were shown as predictors of neurocognitive dysfunction. Conclusion – The results of our study support the literature findings showing that delirium is associated with a
decline in cognitive functions three months after cardiac
surgery. As a result, the lack of agreed diagnostic tests in
the definition of POCD makes it difficult to standardize
and interpret the research in this area. Therefore, a consensus to be reached in the diagnosis of POCD will ensure
the use and correct interpretation of neurophysiological
tests. In our study, advanced age and long hospital and
intensive care stays were shown as predictive factors for
both early and late neurocognitive dysfunctions.
Furthermore, smoking was shown as a predictive factor
only for late neurocognitive dysfunction. = Háttér és cél – A posztoperatív kognitív diszfunkció
(POCD) számos elemből összeálló állapot, amit a magasabb agyi funkciókat igénylő feladatok végrehajtásában
jelentkezô zavar jellemez. A nagy sebészeti beavatkozások, így például a szívsebészeti beavatkozások utáni korai
időszakban gyakran jelenik meg memóriazavarral,
csökkent koncentrációs készséggel, zavartsággal vagy
delíriummal jellemezhetô kognitív diszfunkció. A POCD
következtében elhúzódik a posztoperatív gyógyulás,
megnő a munkába való visszatéréshez szükséges időtartam és csökken a beteg életminôsége. Vizsgálatunk célja
az volt, hogy a Montreal Kognitív Felmérés (MoCA) és
a Mini Mentális Teszt (MMT) segítségével felmérjük, milyen
mértékben fordul elô POCD a szívsebészeti beavatkozá sok
utáni korai és késôi idôszakban. Célunk volt továbbá
annak megállapítása, hogy e neurokognitív tesztek
a POCD milyen prediktív faktorait képesek kiszûrni.
Módszerek – A vizsgálatba bevont betegekkel a szívsebészeti beavatkozás elôtt, a hatodik posztoperatív napon és
a harmadik posztoperatív hónapban végeztük el a két
tesztet. A hatodik posztoperatív napon detektált neurokognitív diszfunkciót korai, míg a harmadik posztoperatív
hónapban detektált neurokognitív diszfunkciót késôi
POCD-nek számítottuk.
Eredmények – A vizsgálatba 127 olyan beteget vontunk
be, akik a preoperatív periódusban nem rendelkeztek
neurokognitív diszfunkcióval. A korai neurokognitív diszfunkciót a következô tényezôk jelezték elôre: életkor, átlagos vérlemezke-térfogat (MPV), New York Heart Association
(NYHA-) osztályozás pontszáma, x-clamp-idô, cardiopulmonalis bypass (CPB) idôtartama, a posztoperatív intenzív
terápiás és kórházi ápolás idôtartama, akut myocardialis
infarktus (AMI) elôfordulása a preoperatív periódusban. A késôi neurokognitív diszfunkciót a követ kezô tényezôk
jelezték elôre: életkor, MPV, NYHA-klasszifikáció, x-clampidô, CPB-idôtartam, a posztoperatív inten zív terápiás és
kórházi ápolás idôtartama.
Következtetés – Eredményeink alátámasztják azt a szakirodalmi megállapítást, miszerint a delírium a szívsebészeti
beavatkozások utáni harmadik hónapban a kognitív
funkciók hanyatlásával jár együtt. Ebbôl az következik,
hogy a POCD definiálásához használható standard diagnosztikai tesztek hiánya megnehezíti a kutatási eredmények interpretálását ezen a szakterületen. A neurofiziológiai teszteket csak akkor lehet majd megfelelô módon
használni és interpretálni, ha kialakul a konszenzus
a POCD diagnózisa kapcsán. Eredményeink szerint
az elôrehaladott életkor, valamint a hosszú posztoperatív
intenzív terápiás és kórházi ápolási idô elôre jelzi mind
a korai, mind a késôi neurokognitív diszfunkciót; a dohányzás csak a késői neurokognitív diszfunkció kockázati
tényezője
Analysis of clinical outcomes of intra-aortic balloon pump during coronary artery bypass surgery
Aim: The mortality rate in coronary artery bypass surgery increases with advancing patient age. This study was conducted to analyse and compare older (above 65 years of age) with younger patients (below 65 years of age) who had undergone coronary artery bypass surgery and had an intra-aortic balloon pump (IABP) inserted, comparing hospital stay, clinical features, intensive care unit stay, postoperative complications, and morbidity and mortality rates. Methods: One hundred and ninety patients who had undergone coronary artery bypass surgery and required IABP support were enrolled in this study. Patients younger than 65 years of age were considered young, and the others were considered old. Ninety-two patients were young and 98 were old. The mortality rates, pre-operative clinical characteristics, postoperative complications, and duration of intensive care unit and hospital stays of the groups were compared. The risk factors for mortality and complications were analysed. Results: One hundred and thirty-eight of the patients were male, and the mean patient age was 62.7 +/- 9.9 years. The mortality rate was higher in the older patient group than the younger group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043)]. The cross-clamp time, mean ejection fraction, cardiopulmonary bypass time, and length of stay in the intensive care unit were similar among the groups (p > 0.05). Cardiopulmonary bypass time was the single independent risk factor for mortality in both groups. Conclusion: In this study, high mortality rates in the postoperative period were similar to prior studies regarding IABP support. The complication rates were higher in the older patient group. Prolonged cardiopulmonary bypass and advanced age were determined to be significant risk factors for mortality