First but not last: Forearm!

Improved survival and higher diabetes rates in patients with end-stage renal disease have rendered vascular access an increasingly challenging issue. Autogenous conduits are recommended by the current guidelines for vascular access over other options.[1] in case of failing radiocephalic or brachiocephalic arteriovenous fistulas, humeral basilic vein transposition should be preferred over arteriovenous grafts. To preserve the proximal vasculature, assessment of forearm basilic vein transposition may reveal a promising option for arteriovenous fistulas

Hiperfibrinojenemiye bağlı retromboze prostetik mitral kapak

Thrombolytic therapy for prosthetic heart valve thrombosis is now frequently used as an alternative to high-risk surgery. Valve thrombosis may be due to some rare conditions except inadequate anticoagulation. We report a case who had rethrombosed prosthetic mitral valve. Hyperfibrinogenemia was the aetiology of the repeated prosthetic valve thrombosis. Thrombolytic therapy was used and thrombus dissolved without any complication.Trombolitik tedavi, prostetik kalp kapak trombozunun tedavisinde cerrahi tedaviye alternatif olarak sıklıkla kullanılmaktadır. Kapak trombozu, yetersiz antikoagülasyonun yanı sıra bazı nadir nedenler sonucu da gelişebilmektedir. Bu olgu sunumunda ikinci kez tromboze olan ve etiyoloji olarak hiperfibrinojenemi saptanan prostetik mitral kapaklı bir olgu sunulmuştur. Başarılı trombolitik tedavi ile herhangi bir komplikasyon görülmeden trombüs yok olmuştur

Koroner arter bypass cerrahisi sonrası gecikmiş mediastinitte yaklaşım: Olgu sunumu

In recent years coagulase negative staphylococci have been recognized as important pathogens after cardiac operations, especially in cases with implanted foreign materials. We experienced a case of delayed mediastinitis, who had two coronary bypass grafting operations. An interval is 40 months after second operation. A polytetrafluorothylene sheet which had been placed at the second operation around the right internal mammarian artery was explanted. Wound debritment and primary closure using a pectoral advancement flap was performed. For six months after repair, he was free from recurrence.Koagülaz negatif stafilokoklar son yıllarda açık kalp cerrahisi sonrasında özellikle yabancı cisim implante edilen olgularda önemli bir patojen olarak kabul edilmektedir. Kliniğimizde daha önce iki kez koroner arter bypass operasyonu geçiren bir olguda ikinci operasyondan 40 ay sonra koagülaz negatif stafilokokun etken olduğu gecikmiş mediastinit tespit edildi. Cerrahi girişimde sağ internal mammaryan arter çevresine önceki operasyonda konmuş olan polytetrafluoroethylene kılıf çıkarılarak debritman ve pektoral uzatma flebi ile rekonstrüksiyon uygulandı. Revizyon sonrası 6 aylık takipte rekürrens gözlenmedi

Cardiac involvement of hydatid disease: A case report

Human hydatidosis, caused by Echinococcus granulosis remains a considerable public health, economic, and social problem in many countries of the world. Cardiac involvement is rare in hydatid disease, but it carries a significant risk of potentially lethal complications. Cardiac hydatid cysts are mostly intramyocardial. Two patients with cardiac involvement of hydatid disease are presented: öne with hydatid cyst of the left ventricular posterior wall, and the other with ruptured left ventricular cyst associated with pulmonary arterial and pericardial cyst. Surgical excision under cardiopulmonary bypass was performed successfully in both patients.Human hydatidosis, caused by Echinococcus granulosis remains a considerable public health, economic, and social problem in many countries of the world. Cardiac involvement is rare in hydatid disease, but it carries a significant risk of potentially lethal complications. Cardiac hydatid cysts are mostly intramyocardial. Two patients with cardiac involvement of hydatid disease are presented: öne with hydatid cyst of the left ventricular posterior wall, and the other with ruptured left ventricular cyst associated with pulmonary arterial and pericardial cyst. Surgical excision under cardiopulmonary bypass was performed successfully in both patients

Surgical versus percutaneous tracheostomy after cardiac surgery

Aim: Elective tracheostomy after cardiac surgery is increasingly used in patients who require long-term mechanical ventilatory support. The aim of the present study is to compare percutaneous dilatational with surgical tracheostomy in cardiosurgical patients when both procedures were performed in cardiac surgery intensive care unit. Material and Methods: We retrospectively evaluated 63 patients who had surgical (n=24) or percutaneous dilatational (n=39) tracheostomy technique following cardiac surgery. Comparisons of the complications, oxygenation index, stomal closure time and time consumption of both technique is the main target. Results: Percutaneous dilatational tracheostomy was performed more quickly than surgical tracheostomy (p=0.0012). With regard to preoperative and postoperative oxygenation index, there was no significant difference between percutaneous dilatational tracheostomy and surgical tracheostomy groups (p=0.318 and p=0.9 respectively). When oxygenation indexes before and after tracheostomies compared within each group, we found also no statistical difference (p=0.77 and p=0.425 respectively). Overall complication rate for surgical tracheostomy and percutaneous dilatational tracheostomy were 25% and 12.8%, respectively. Wound infection in tracheostomy site was seen in 16.6% of the surgical tracheostomy, whereas no infection was found in percutaneous dilatational tracheostomy (p=0.018). Stomal closure times after decannulation in percutaneous dilatational tracheostomy group were shorter than in surgical tracheostomy group (p=0.0021). Conclusion: Percutaneous dilatational tracheostomy have some advantages relative to surgical tracheostomy including more rapid of performance and stomal closure and lower incidence of postoperative wound infection. Percutaneous dilatational tracheostomy as the procedure of choice for performing elective tracheostomy in the appropriately selected cardiosurgical patient requiring long-term mechanical ventilation.Amaç: Kalp cerrahisinden sonra elektif trakeostominin kullanımı, uzun süreli mekanik solunum desteği gerektiren hastalarda artmıştır. Çalışmanın amacı, kalp cerrahisi sonrasında kalp cerrahisi yoğun bakımında gerçekleştirilen perkütan dilatasyon trakeostomi(PDT) ve cerrahi trakeostominin (CT) karşılaştırılmasıdır. Yöntem ve Gereç: Kalp cerrahisi sonrasında 24 CT ile 39 PDT yapılan 63 hastanın sonuçları retrospektif olarak değerlendirildi. Her iki teknikteki komplikasyon oranlarını, oksijenizasyon indekslerinin, stomal kapanma sürelerinin ve işlem için harcanan sürenin karşılaştırılması yapıldı. Bulgular: Perkütan dilatasyon trakeostomi, CT oranla daha hızlı yapılmaktadır (p=0.0012). Preoperatif ve postoperatif oksijenizaston indekslerine bakıldığında PDT ve CT arasında anlamlı fark bulunmadı (p=0.318 ve p=0.9). Trakeostomi öncesi ve sonrası oksijenizasyon indeksleri grupların kendi içlerinde karşılaştırıldığında yine istatistiksel olarak anlamlı fark bulunmadı(p=0.77 ve p=0.425). Genel komplikasyon oranlarına bakıldığınde CT %25, PDT % 12.8 olarak bulundu. Trakeostomi yara yeri infeksiyonu CT'den sonra %16.6 olarak bulunurken, PDT grubunda infeksiyon tespit edilmedi (p=0.018). Dekanülasyondan sonra stomal kapanma süresi PDT grubunda CT oranla anlamlı olarak daha kısaydı (p=0.0021). Sonuç: Perkütan dilatasyon trakeostominin CT göre işlem süresinin daha kısa olması, stomal kapanma süresinin daha kısa olması ve postoperatif yara yeri infeksiyon oranını daha düşük olması gibi göreceli avantajları vardır. Bu nedenle PDT kalp cerrahisinden sonra uzun süreli mekanik solunum desteği gereken hastalarda elektif trakeostomi için tercih edilmesi gereken tekniktir