Brachial index does not reflect upper extremity functionality following surgery for vascular trauma

OBJECTIVES: Vascular injuries to the upper extremities requiring surgical repair are common after accidents. However, neither postoperative functionality nor hemodynamic status of the extremity are routinely described. We evaluated the postoperative functional and hemodynamic status of patients with vascular traumas in the upper extremities. METHODS: 26 patients who suffered penetrating vascular traumas in the upper extremities from November 2008 to December 2011 were retrospectively evaluated. Data on first approach, surgical technique employed and early postoperative outcomes were recorded. Further data on the post-discharge period, including clinical functional status of the arm, Doppler ultrasonography and brachial-brachial index were also evaluated. RESULTS: Average follow up was 33.5±10.8 months. Right (1.05±0.09) and left (1.04±0.08) brachial indexes were measured during follow up,. Doppler ultrasonography showed arterial occlusion in 4 patients (15%). Near-normal brachial-brachial indexes was observed in all four of these patients with occlusion of one of the upper extremity arteries, even though they exhibited limited arm function for daily work. CONCLUSIONS: Evaluation of the postoperative outcomes of this small series of patients with penetrating vascular traumas in the upper extremity revealed that 15% of them suffered occlusion of one artery of the upper extremity. Artery occlusion did not correlate with brachial-brachial Doppler index, probably due to rich collateral circulation, but occlusion was associated with an extremity that was dysfunctional for the purposes of daily work. The result of the brachial-brachial index does not therefore correlate with functionality

Influence of Blood Collection Systems on Coagulation Tests

OBJECTIVE: Coagulation tests are influenced by pre-analytic conditions such as blood collection systems. Change of glass collection tubes with plastic ones will cause alteration of the test results. The aim of this study was to compare three plastic blood collection tubes with a standard glass blood collection tube and each plastic collection tube with the other two for possible additional tube-to- tube differences. METHODS: A total of 284 blood samples were obtained from 42 patients receiving warfarin during their routine controls, besides 29 healthy volunteers. Subgroup analyses were done according to health status. RESULTS: Our study demonstrated that different blood collection tubes have a statistically significant influence on coagulation tests. The magnitude of the effect depends on the tube used. However most of the tests performed on samples obtained from any tube correlated significantly with results obtained from other tube samples. CONCLUSION: Although blood collection tubes with different brands or properties will have distinct effects on coagulation tests, the influence of these blood collection tubes may be relatively small to interfere with decision-making on dose prescription, therefore lack clinical importance. Correlations between the results showed that, one of these plastic blood collection tubes tested in our study, can be used interchangably for a wide variety of coagulation assays

Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery

Background: In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. Materials and methods: Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. Results: Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). Conclusion: Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response

Comparison of Myocardial Metabolism and Apoptosis in Patients Undergoing CABG Operation Performed Either with Fibrillation or Cardioplegia Method

Objective: Optimal myocardial protection during CABG operations is still debatable. In this study we comparedhemodynamic data, myocardial oxygen extraction, lactate production and presence of apoptosis in transmuralbiopsy specimens in operations performed either with intermittent aortic cross-clamping with fibrillation (IAC)or with cardioplegic cardiac arrest (CCA) method.Methods: Following Ethics Committee approval, consecutive patients with normal ventricular function andwithout any comorbid disease other than regulated hypertension and/or type-2 DM were included in the study(IAC group n=13, CCA group n=8). Hemodynamic data, serial CK-MB values and ECG changes at intermittenttime points were recorded till postoperative 24 hours. Myocardial oxygen extraction and lactate productionwere calculated from the blood samples withdrawn from the aortic root and the coronary sinus cannula beforetotal CPB, during cross-clamping and following removal of cross-clamp. Transmural biopsy specimens obtainedbefore total CPB and cessation of CPB were analyzed for apoptosis.Results: Demographic and intraoperative hemodynamic variables were similar. Pre ischemic and post ischemicmyocardial oxygen extraction and lactate production values were comparable in both groups. Seven patientsin IAC and one patient in CCA group needed low dose inotropic support during early postoperative period. Anyevidence of apopitosis was not found in both groups.Conclusion: This study shows that for low risk CABG procedures, IAC and CCA methods were not superior toeach other in protecting the myocardium from ischemic injury with respect to myocardial oxygen extraction,lactate production and presence of apoptosis.Keywords: cardiac surgery, myocardial protection, oxygen extraction, lactate production</p

The gender differences in the relaxation to levosimendan of human internal mammary artery

Purpose The mechanism of the vasorelaxation to levosimendan varies depending on the vascular bed and species studied. Here, we examined the vasorelaxation to levosimendan as well as its modification by various potassium channel antagonists in human internal mammary artery (IMA) obtained from male and female patients