Off-pump versus on-pump coronary artery bypass grafting in acute coronary syndrome: a clinical analysis

<p>Abstract</p> <p>Background</p> <p>Although off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.</p> <p>Methods</p> <p>Between January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.</p> <p>Results</p> <p>OPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.</p> <p>Conclusions</p> <p>The patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.</p

Off-pump coronary artery surgery in a patient with essential thrombocythaemia: two life-threatening complications in the same patient

Essential thrombocythaemia (ET) is a rare chronic myeloproliferative disease characterised by persistent thrombocytosis. Cerebral, myocardial and peripheral thrombosis are frequently seen complications, but bleeding and venous thrombosis are more rare. Here, a case of essential thrombocythaemia complicated by cerebral and myocardial thrombosis is presented. The patient’s platelet count was 680×109/litre on admission. Electrocardiogram showed a slight ST elevation in leads V1 to V4. A coronary angiography was performed and it revealed a severe stenosis of the left anterior descending artery. The patient had a successful off-pump coronary artery bypass grafting surgery. After the operation the platelet count was 390×109/litre. The patient received hydroxyurea and aspirin treatment preoperatively and continued postoperatively. ET is a rare myeloproliferative disease; its complications are also rare, but the occurrence of two life-threatening complications in the same patient is rarer still. Further investigations are needed to determine the risk stratification for patients with ET undergoing cardiac surgery

The percentage of ALK-positive cells and the efficacy of first-line alectinib in advanced non-small cell lung cancer: is it a novel factor for stratification? (Turkish Oncology Group Study)

Introduction Alectinib is an effective second-generation ALK tyrosine kinase inhibitor (TKI) used in the first-line treatment of patients with advanced ALK-positive NSCLC. Recent studies demonstrated that the percentage of ALK-positive tumor cells in patient groups receiving crizotinib might affect outcomes. This study aimed to investigate whether the percentage of ALK-positive cells had a predictive effect in patients with advanced NSCLC who received first-line Alectinib as ALK-TKI. Materials and methods This retrospective study included patients with advanced-stage NSCLC who received alectinib as a first-line ALK-TKI and whose percentage of ALK-positive cells was determined by FISH at 27 different centers. Patients who received any ALK-TKI before alectinib were not included in the study. Patients were separated into two groups according to the median (40%) value of the percentage of ALK-positive cells (high-positive group >= 40% and low-positive group = 60%, the median PFS was 4.5, 17.1, and 26 months, respectively, and could not be reached in the >= 60% group. Conclusion Our study demonstrated that the efficacy of alectinib varies significantly across patient subgroups with different percentages of ALK-positive cells. If these findings are prospectively validated, the percentage of ALK-positive cells may be used as a stratification factor in randomized trials comparing different ALK-TKIs

Real-world data on efficacy and safety of first-line alectinib treatment in advanced-stage, ALK-positive non-small-cell lung cancer patients: A Turkish Oncology Group study

Aims: In this multicenter study, the authors aimed to determine the real-life efficacy and safety of first-line alectinib. Materials & methods: This retrospective trial included advanced-stage, ALK-positive non-small-cell lung cancer patients who were treated with first-line alectinib in terms of ALK-tyrosine kinase inhibitors, regardless of previous chemotherapy. The co-primary end points were progression-free survival both for all patients and for the treatment-naive population. The secondary end points were overall response rate, overall survival, rate of CNS progression and safety. Results & conclusion: A total of 274 patients (n = 177 for treatment-naive patients) were enrolled in the study. The median progression-free survival was 26 and 28.8 months for all patients and the treatment-naive group, respectively. The overall response rate, CNS progression rate and 1-year overall survival ratio were 77.9, 12.4 and 77%. Alectinib is a highly effective therapy with a favorable safety profile

Covid-19 Pandemi Raporu (20 Mart-20 Kasım 2020)

31 Aralık 2019 tarihinde Çin’de ortaya çıkan ve kısa sürede tüm dünyayı etkileyen SARS-Coronavirus-2 etkenine bağlı COVID-19’un Dünya Sağlık Örgütü tarafından pandemi ilan edildiği dönem ile eş zamanlı olarak, ülkemizde 11 Mart 2020’de ilk vaka bildirilmiştir. Hacettepe Üniversitesi Türkiye’nin salgınla mücadelesinde tüm birimlerindeki akademik ve idari personeli ile titiz bir süreç yürütmüş, öncü rolü ile Türkiye’de yürütülen mücadeleye birçok açıdan ciddi katkıda bulunmuştur.Türkiye Cumhuriyeti Sağlık Bakanlığı COVID-19 Bilimsel Danışma Kurulu’nda Hacettepe Üniversitesi Tıp Fakültesi’nden dört öğretim üyesi yer almıştır. Türkiye’de yürütülen aşı çalışmalarında İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı öncülük etmiştir. İlk COVID-19 hastamızı kabul ettiğimiz 21 Mart 2020 tarihinden itibaren de poliklinikler, yataklı servisler ve yoğun bakım ünitemizde yoğun bir şekilde mücadeleye devam etmekteyiz.Bu süreçte ülkemizde olduğu gibi bizde de çok sayıda sağlık çalışanımız COVID-19’a yakalandı, ülkemizde ciddi sayıda sağlık çalışanı kayıpları yaşadık. Yaşadığımız bu dönem bir yandan hekimler başta olmak üzere sağlık çalışanları için tarifi zor, hazin bir dönemdir, ancak diğer yandan da birbirimizi koruma, hastalıkla mücadele için dayanışma ve hoşgörünün her zamandan daha önemli olduğunu anladığımız bir dönemdir.Yüzyılda bir görülen bu salgının halen ülkemizde yoğun olarak yaşandığı ve tam olarak ne zaman sonlanacağının öngörülemediği bir dönemde tarihe not düşmek, geleceğe katkıda bulunmak adına hizmet ve eğitim fonksiyonlarını bir bütün halinde yürüten Hacettepe Üniversitesi Tıp Fakültesi İç Hastalıkları, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji, Göğüs Hastalıkları ve Kardiyoloji Anabilim Dalları olarak sekiz aylık dönemi bir rapor olarak sunmayı düşündük. Amacımız mücadele devam ederken, sınırlarımız dahilindeki bilgi birikimimiz ve tecrübelerimizi güncel bilgilerle birlikte derleyerek paylaşmak ve katkı sunmaktır.Üniversitemiz, Fakültemiz ve Hastane Yönetimleri ile bize destek olan araştırma görevlilerine, hemşirelerine ve tüm sağlık personeline, bu raporun hazırlanması ve düzenlenmesinde büyük emeği olan Prof. Dr. Ömrüm Uzun ve Prof. Dr. Mine Durusu Tanrıöver başta olmak üzere tüm öğretim elemanlarına ve de pandemi döneminin başından beri sosyal destek ve bu raporun basılması için kaynak sağlayan Hacettepe İç Hastalıkları Eğitim ve Sosyal Dayanışma Derneği’ne (kısa adıyla Hacettepe İç Hastalıkları Derneği) teşekkürü borç bilir, raporumuzun yararlı olmasını dileriz.Prof. Dr. Arzu Topeli İskitİç Hastalıkları (Yoğun Bakım Bilim Dalı) Anabilim Dalı BaşkanıHacettepe Üniversitesi Hastaneleri Pandemi Kurulu Yoğun Bakım SorumlusuProf. Dr. Serhat Ünalİnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı BaşkanıHacettepe Üniversitesi Erişkin ve Onkoloji Hastaneleri İnfeksiyon Kontrol Komitesi Başkanı ve Pandemi Kurulu İnfeksiyon Kontrol Sorumlus