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Objectives Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated. Methods In this retrospective study, treatment and clinical outcomes of patients’ who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed. Results A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation. Conclusion Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

Objectives: An exaggerated inflammatory immune response is observed in cases of COVİD 19. This study aims to evaluate the effects of vitamin C, as a significant modulator of inflammation, on the inflammatory parameters and mortality in patients followed up in the intensive care unit (ICU) during the pandemic. Methods: This single-center retrospective study included 160 adult patients with confirmed positive nasopharyngeal smear COVID-19 PCR test results, who were followed up in the ICU between 01 March and 01 August 2020. Hospital files were scanned and patients given and not given vitamin C were assigned, to Group 1 and Group 2, respectively. The Acute Physiology and Chronic Health Evaluation (APACHE II) scores, the data entries on demographics, ventilation, laboratory tests, duration of ICU stay, discharge, and mortality were compared. Interventions with antiviral and antibacterial agents. steroids, cytokine apheresis, and renal replacement therapy were evaluated. Results: Vitamin C treatment was started in patients with raised neutrophil/lymphocyte ratio (NLR) at admission to ICU, who made up 20% of the total 160 ICU patients. Mortality incidence was higher among patients with raised NLR. Vitamin C at the doses used did not affect the inflammatory parameters, length of stay or mortality, and 37.5% of the patients recovered and were discharged from the ICU. Conclusions: We think that vitamin C treatment will have positive effects on the initiation of COVID-19 and that the time of intiation of the therapy and the optimal doses used should be determined with prospective studies.

As the industry made progress, human labor force gained importance as an element of work life. The science of ergonomics came into being in order to take necessary precautions by determining the convenience of human motions with anatomy and risks and possible dangers during work. Through the methods of risk assessment, risks and possible dangers are determined to create a healthy environment for workers. Through REBA and RULA risk assessment methods, worker motions and postures are studied to determine convenience by calculating risk scores related to worker motions. The aim of REBA and RULA risk assessment methods is to study whether or not the worker is functioning in accordance with his/her skills and to prevent labor accidents and occupational diseases with the help of the data obtained. In this study, REBA and RULA risk scores are tried to be calculated by studying the motions of apparel workshop employees working in the fabric cutting, quality, packaging, ironing and stain removal sections. According to the analysis obtained, REBA score for the fabric cutting employee is 6, RULA score for the sewing machine operator is 4, REBA score for the quality control employee is 4, REBA score for the stain removal employee is 3, REBA score for the ironing employee is 6 and REBA score for the packaging employee is 5. According to the scores obtained through the use of REBA and RULA risk assessment method, the motions and postures of employees are determined to be at dangerous levels. Among the primary precautions needed to be taken to prevent the risks can be having the employee work at different tasks within certain intervals, monitoring the health, providing occupational health and safety educational programs

Objective To evaluate the 6 months efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins (GSVs) in comparison with radiofrequency ablation (RFA). Methods In this multicenter, retrospective, clinical trial, 398 symptomatic subjects with incompetent GSVs were assigned to either cyanoacrylate closure or RFA. The primary endpoint, complete closure of the target GSV, was determined using duplex ultrasound examination starting from one-, three-, and six-month visits. Results All patients were followed for 6 months and there was no difference between the groups in terms of mean follow-up time. Hospital stay and return to work/activity were shorter in the cyanoacrylate ablation (CAA) group, and these differences between the groups were statistically significant. Ecchymosis was observed higher in the RFA group and was statistically significant. Conclusions In this study, in which we examined the CAA and RFA methods, we found that both methods were effective and reliable; however, we found that patients in the CAA group had a more comfortable postoperative period and returned to work earlier.

Workplaces are divided into three as very dangerous, dangerous and less dangerous according to the principle of the work done. When occupational accidents and diseases are mentioned, construction sites and mines are considered. However, although the probability of occupational accidents and diseases is low, most working areas throughout the country are offices. In the offices, there are obligations that the employer must fulfill according to the law numbered 6331. Employees in offices that accommodate employees from all levels of the public and private sector are likely to be exposed to risk factors. Office workers are most exposed to physical, psychosocial and ergonomic risk factors. The employer is likely to prevent work accidents and occupational diseases by providing a healthy and safe working environment for its employees. In this study, a questionnaire consisting of 28 questions was applied to examine the perception levels of physical, psychosocial and ergonomic risk factors for 246 office workers in public and private sector institutions in Samsun. The answers to the questionnaire questions were analyzed with the program "IBM SPSS Statistics 22.0" and the value of "Cronbach Alpha (α)" was found to be 0.667. The fact that α value is in the range of 0.6

Objectives: The coronary endarterectomy combined with coronary artery bypass grafting (CABG) is an useful but still controversial surgical technique in diffuse coronary artery disease. The aim of this study was to analyze the operative and early postoperative outcomes of the patients who underwent CABG with and without coronary endarterectomy. Methods: This retrospective study included a total of 312 consequtive patients undergoing on-pump CABG from December 2018 to December 2020 in the Department of Cardiovascular Surgery, Bursa Yüksek İhtisas Training and Research Hospital. Patients were divided into 2 groups as those who underwent coronary endarterectomy combined with on-pump CABG (Group 1, n = 48) and those who underwent isolated on-pump CABG (Group 2, n = 264). Peroperative variables were obtained from our hospital's computerized database and retrospectively analyzed. Results: Previous percutaneus coronary intervention rate and the number of patients with diabetes mellitus was significantly higher in the endarterectomy group. The demographics and characteristics of the patients were similar between the two groups. The median number of distal anastomoses was 4 (2-5) in Group 1 and 2 (1-5) in Group 2. Median cross-clamp duration and perfusion times in Group 1 were longer than Group 2 (82 min vs. 63 min; p < 0.001 and 120 min vs. 95 min; p = 0.003, respectively). A total of 54 coronary endarterectomy practices were performed on 48 patients, and the LAD artery (73%) was the most endarterectomized vessel. In Group 1, postoperative 24 hours high-sensitive troponin I levels were significantly higher than in Group 2 (p < 0.001). There was no significant difference between the groups in terms of operative mortality, low cardiac output rates and perioperative myocardial infarction rates. Postoperative atrial fibrillation was significantly higher in Group 1 (p = 0.023). Conclusions: Although coronary endarterectomy is a complex procedure, in patients with diffuse coronary artery disease, it is an essential and sometimes mandotary method in order to achieve complete revacularization and can be performed safely with acceptable operative and early postoperative outcomes.

Objective: To investigate the relationship between prognostic nutritional index (PNI) and carotid artery stenosis (CAS). Material and Methods: This retrospective observational study included patients undergoing carotid endarterectomy (CEA) and patients with non-critical CAS who received medical treatment. All data retrieved retrospectively from the hospital medical files. The values acquired from the patients during acceptance to the hospital were used in the calculation of PNI. Results: There were 82 patients (68.3 % male, mean age: 70.5±8.9 years) in surgical group, and 79 patients (72.2% male, mean age: 62.0±9.1 years) were recorded in medical group. We detected statistically difference in surgical group in terms of higher BUN (p

Peripheral artery disease (PAD) is a common disease among women and is expected to increase in the coming years. Diagnostic and therapeutic management of PAD in women is difficult due to their gender-related differences, comorbid factors, atypical symptoms, more functional disorders, the presence of advanced disease, being older age of the disease onset, smaller vessel diameter, and psychosocial factors. Especially due to the high prevalence of asymptomatic disease, late admission status and further disease on admission affect the success of the treatment negatively. By focusing more on PAD in women and more clinical studies, gender-specific differences can be identified. Hereby, there is a need to develop appropriate strategies to improve women's overall quality of life. In this review, we aimed to draw attention to the female gender with PAD, which is increasingly occurring.

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction. Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated. Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p < 0.001; respectively. MPV and RDW levels were different in all four groups (p < 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p < 0.001). Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups.

BACKGROUND: In this study, we aimed to investigate the effects of thiol-disulfide homeostasis in patients undergoing on-pump coronary artery bypass grafting. METHODS: Between January 2018 and October 2018, a total of 51 patients (43 males, 8 females; mean age 61.8±8.7 years; range, 38 to 78 years) who underwent isolated on-pump coronary artery bypass grafting were included. Thiol-disulfide homeostasis parameters were studied in the preoperative period (T1), 30 min after the removal of cross-clamp (T2), and postoperative sixth h (T3). Hemodynamic parameters such as atrial fibrillation and inotropic support requirement of the patients were evaluated in the postoperative period. RESULTS: There were significant differences in the measured thiol-disulfide homeostasis parameters at different time points of surgery (p

Objectives: We aim to evaluate the relationship between serum lipid indices and carotid artery stenosis (CAS). Methods: This retrospective observational study included patients who underwent carotid endarterectomy (CEA) and unoperated patients who have CAS less than 50%. CAS was diagnosed with history and physical examination followed by doppler ultrasonography, coronary and carotid angiography. All data retrieved retrospectively from the hospital medical files. Non-high-density lipoprotein-cholesterol (non-HDL-C) level was calculated by removing HDL-C from total cholesterol. In addition, low-density lipoprotein-cholesterol (LDL-C)/HDL-C ratio, non-HDL-C/HDL-C ratio, and triglyceride (TG)/HDL-C ratio were assessed. Results: CEA group (77.5% male, mean age: 71.35 ± 8.35 years) included 40 patients who underwent CEA, and there were 32 patients who have less than 50% CAS in unoperated group (68.8% male, mean age: 63.94 ± 9.92 years). The development of CAS was not significantly correlated with LDL-C/HDL-C ratio (p = 0.119), non-HDL-C/HDL-C ratio (p = 0.227) and TG/HDL-C ratio (p = 0.768). Advanced age and presence of coronary artery disease were identified as an independent predictor of the development of CAS. For predicting development of CAS, there were 50.0% sensitivity and 65.6% specificity for LDL-C/HDL-C ratio and non-HDL-C/ HDL-C ratio (area under the curve [AUC]: 0.592, log rank p = 0.183, AUC: 0.583, log rank p = 0.227, respectively). Conclusions: We found that lipid ratios were not an independent predictors of the development of CAS. But, we think that AUC values which were above 0.5 for lipid ratios are may be important development of CAS.

Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.

Aim: To investigate the relationship between fibrinogen to albumin ratio (FAR) and carotid artery stenosis (CAS). Material and Methods: This study included patients who underwent carotid endarterctomy (CEA) as CEA group and unoperated patients who have CAS less than 50% as non-surgical group. CAS was diagnosed with history and physical examination followed by doppler ultrasonography and carotid angiography. All data retrieved retrospectively from the hospital medical files. Hematologic parameters were measured and recorded. In addition, FAR was calculated.Results: Fifty patients were included in CEA group (70.0 % male, mean age: 71.0 ± 7.7 years) and 60 patients were invluded in non-surgical group (70.0 % male, mean age: 63.9 ± 8.0 years). In logistic regression analysis advanced age, presence of coronary artery disease and FAR were identified as an independent predictor of the development of CAS. In Receiver operating characteristic (ROC) curve analysis, for predicting development of CAS, there were 68.0% sensitivity and 65.0% specificity for FAR (area under the curve [AUC]: 0.669, 95% CI: 0.566-0.771, log rank p = 0.002). Conclusion: We found that FAR were identified as an independent predictor of the development of CAS. FAR could be a potential marker on carotid atherosclerosis in patients. But there is a need large studies including all cardiovascular diseases.

Objective: Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods: In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results: We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P

Aim: Our aim was to evaluate the two-year results of radiofrequency ablation (RFA) in the treatment of great saphenous vein (GSV) insufficiency.Methods: A total number of 217 patients who underwent RFA (52.5 % male, mean age 42.7±11.4) were included in the study. RFA was performed in patients with great saphenous vein valvular incompetence and saphenofemoral junction incompetence. Occlusion status was recorded by ultrasonography. Venous clinical severity score (VCSS) was calculated pre- and post-intervention.Results: The mean follow-up period of the patients was 22.2 ± 5.1 months. Cumulative survival rate (Kaplan–Meier) of 24-month follow-up was 84.3%. Complete occlusion rate for GSV was 100%, 98.6% ,97.6%, 97.6% and 97.6% for 1, 6, 12, 18 and 24 months follow up, respectively. VCSS was significantly different before RFA and 4 weeks after RFA (p < 0.001). No major complications were observed in the study.Conclusion: In the treatment of GSV insufficiency, RFA is a safely applied method with high occlusion rates and obvious VCSS score decrease., Amaç: Çalışmamızda büyük safen ven (GSV) yetmezliğinin tedavisinde radyofrekans ablasyonun (RFA) iki yıllık sonuçlarını değerlendirmeyi amaçladık.Yöntemler: Çalışmaya RFA uygulanan toplam 217 hasta (%52,5 erkek, ortalama yaş 42.7 ± 11.4) dahil edildi. RFA işlemi büyük safen vende kapak yetersizliği ve safenofemoral bileşkede venöz reflü olan hastalara uygulandı. Oklüzyon takibi doppler ultrasonografi ile yapıldı. Müdahale öncesi ve sonrası Venous clinical severity score (VCSS) kayıt altına alındı.Bulgular: Hastalar ortalama 22.2 ± 5,1 ay takip edildi. 24 aylık takipte kümülatif sağkalım oranı (Kaplan-Meier) %84,3 idi. GSV için tam oklüzyon oranı 1, 6, 12, 18 ve 24 aylıktakiplerde sırasıyla % 100,% 98.6,% 97.6,% 97.6 ve% 97.6 idi. RFA işleminden önce ve RFA uygulandıktan 4 hafta sonra hesaplanan VCSS değerleri anlamlı ölçüde farklıydı (p

Introduction: Low hematocrit level is a hematological problem that is frequently encountered in the preoperative evaluation of patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to investigate the effect of preoperative hematocrit level on the first 30-day outcomes in patients undergoing CABG surgery. Methods: Ninety-four patients undergoing isolated CABG were included in the study. The patients were divided into two groups as patients with preoperative low hematocrit levels (

Polidocanol is a sclerogenic agent commonly used for the treatment of varicose veins. Common complications such as hyperpigmentation, telangiectasia matting on skin may be observed in relation with foam sclerotherapy. Complications such as deep vein thrombosis, stroke and tissue necrosis are rarely seen. Fatal complications such as anaphylaxis are seen very uncommonly. A 50-year-old female patient underwent polidocanol foam sclerotherapy for left leg reticular varicosity (CEAP 2-3). Our patient has experienced biphasic anaphylaxis, which was observed as two attacks following the foam sclerotherapy. Biphasic anaphylaxis complication after the foam sclerotherapy is not known, this presentation may even be the first condition experienced ever.

OBJECTIVE To investigate the effect of ischemia-modified albumin (IMA) during cardiopulmonary bypass (CPB). STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Department of Cardiovascular Surgery, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January and April 2018. METHODOLOGY Patients, who underwent on-pump coronary bypass surgery, were inducted. IMA levels were measured in the preoperative period (IMA-T1), 30 minutes after removal of aortic X-clamp (IMA-T2) (ischemic period) and 6th hours (IMA-T3) after surgery. The groups were formed according to the average value of IMA-T2 levels measured in the ischemic period. Those with a value above the mean (0.76 U/mL) were grouped as group 1 and those below the mean were grouped as group 2. Postoperative data of the patients were recorded. RESULTS There were significant differences between measured IMA levels in different periods of on-pump CABG (p

Introduction: Rhythm problems are the most observed complications following coronary artery bypass grafting (CABG), the most common being postoperative atrial fibrillation (PoAF), with an incidence reaching 50% of the patients. In this study, we aimed to investigate the predictive importance of prognostic nutritional index (PNI) and visceral adiposity index (VAI) in predicting PoAF, which occurs after CABG accompanied by cardiopulmonary bypass. Methods: Patients who underwent isolated CABG with cardiopulmonary bypass between June 15 and October 15, 2019, were prospectively included in the study. Patients who did not develop in-hospital PoAF were identified as Group 1, and those who did constituted Group 2. Results: PoAF developed in 55 (27.6%) patients (Group 2). The mean age of the 144 patients included in Group 1 and 55 patients in Group 2 were 56.9±8.7 and 64.3±10.2 years, respectively (P

Background: Postoperative atrial fibrillation (POAF) is a leading arrhythmia with high incidence and serious clinical implications after cardiac surgery. Cardiac surgery is associated with systemic inflammatory response including increase in cytokines and activation of endothelial and leukocyte responses. Aim This systematic review and meta-analysis aimed to determine the strength of evidence for evaluating the association of inflammatory markers, such as C-reactive protein (CRP) and interleukins (IL), with POAF following isolated coronary artery bypass grafting (CABG), isolated valvular surgery, or a combination of these procedures. Methods: We conducted a meta-analysis of studies evaluating measured baseline (from one week before surgical procedures) and postoperative levels (until one week after surgical procedures) of inflammatory markers in patients with POAF. A comprehensive search was performed in electronic medical databases (Medline/PubMed, Web of Science, Embase, Science Direct, and Google Scholar) from their inception through May 2017 to identify relevant studies. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. Results: A literature search of all major databases retrieved 1014 studies. After screening, 42 studies were analysed including a total of 8398 patients. Pooled analysis showed baseline levels of CRP (standard mean difference [SMD] 0.457 mg/L, p < 0.001), baseline levels of IL-6 (SMD 0.398 pg/mL, p < 0.001), postoperative levels of CRP (SMD 0.576 mg/L, p < 0.001), postoperative levels of IL-6 (SMD 1.66 pg/mL, p < 0.001), postoperative levels of IL-8 (SMD 0.839 pg/mL, p < 0.001), and postoperative levels of IL-10 (SMD 0.590 pg/mL, p < 0.001) to be relevant inflammatory parameters significantly associated with POAF. Conclusions: Perioperative inflammation is proposed to be involved in the pathogenesis of POAF. Therefore, perioperative assessment of CRP, IL-6, IL-8, and IL-10 can help clinicians in terms of predicting and monitoring for POAF.

Objective The aim of this study was to evaluate the relationship between red blood cell distribution width (RDW) and mean platelet volume (MPV) with development of postoperative atrial fibrillation (PoAF) after off-pump coronary artery bypass grafting (CABG). Background The RDW and MPV have been associated with some cardiovascular disorders. Methods A total of 93 patients who underwent off-pump CABG were included in this study. The patients were divided into two groups as developing and nondeveloping PoAF groups in the postoperative period. We measured whether RDW and MPV levels are a predictive value for development PoAF. Results There were 24 patients with PoAF enrolled (mean age: 66 ± 7.8 years) and 69 patients without PoAF (mean age: 56.26 ± 11.53 years). The PoAF was significantly correlated with age (p = 0.004), hematocrit (p: 0.010), RDW (p = 0.007) and creatinine (p = 0.006). Only advanced age (p = 0.012) was identified as an independent predictor of PoAF. For predicting PoAF, there was 79.2 % sensitivity and 65.2 % specificity for RDW (p = 0.001) and 62.5 % sensitivity and 55.1 % specificity for MPV (p = 0.062). Conclusions We found that RDW levels and MPV were not an independent predictor of the development of PoAF. However, elevated RDW levels and MPV may be one of the predictive values for PoAF development (Tab. 3, Fig. 2, Ref. 27).

BACKGROUND Atrial fibrillation (AF) is one of the most critical and frequent arrhythmias precipitating morbidities and mortalities. The complete blood count (CBC) test is an important blood test in clinical practice and is routinely used in the workup of cardiovascular diseases. This systematic review with meta-analysis aimed to determine the strength of evidence for evaluating the association of hematological parameters in the CBC test with new-onset and recurrent AF. MATERIAL AND METHODS We conducted a meta-analysis of observational studies evaluating hematologic parameters in patients with new-onset AF and recurrent AF. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. RESULTS The literature search of all major databases retrieved 2150 studies. After screening, 70 studies were analyzed in the meta-analysis on new-onset AF and 23 studies on recurrent AF. Pooled analysis on new-onset AF showed platelet count (PC) (weighted mean difference (WMD)=WMD of -26.39×10^9/L and p

Objectives: The aim of the present study was to compare preoperative / postoperative ventricular functions of patients with ventricular dysfunction who were planned for coronary artery bypass grafting (CABG) using echocardiography and angiography, and to evaluate whether there was a significant improvement in ventricular function. Methods: This prospective study included 30 patients with poor ventricular function who had undergone CABG at the Cardiovascular Surgery Clinics of Bursa Yüksek Ihtisas Hospital. The patients' ventricular functions were compared preoperatively and postoperatively at the 2nd, 6th and 12th months. Results: Of the patients, 28 were males, and the mean age was 60.1 ± 8 years (range 39-71). In these cases, functional capacity improved within the early postoperative period, and global ventricular functions improved within the postoperative first year. The improvement in ejection fraction results was statistically significant at 6 months and 12 months (p < 0.05). A significant decrease was observed in left ventricular enddiastolic pressures within one year (p < 0.001). For the performance score, improvement was significant from the 2nd month (p < 0.05). Conclusions: Our findings show that CABG improves ventricular function in terms of EF, PS, LVEDP and NYHA classification. In conclusion, we consider that CABG is a significantly effective option in patients with poor ventricular function.

Objectives: To investigate whether mitral valve repair (MVR) at the time of coronary artery bypass grafting (CABG) in patients with ischemic moderate mitral regurgitation (MR) and coronary artery disease could improve short- and mid-term postoperative outcomes. Methods: Between March 2013 and December 2015, 90 patients with moderate ischemic MR underwent first-time CABG in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey. Out of 90 patients, 44 (48.9%) underwent combined CABG+MVR. The remaining 46 (51.1%) underwent CABG alone. Ventricular functions and effort capacities of patients in both groups were evaluated echocardiographically and clinically in the preoperative period, and in the first postoperative year. Results: Postoperative regurgitant volume changes according to preoperative values were -24.76±19 ml/beat in the combined CABG+MVR group, and -8.70±7.2 ml/beat in the CABG alone group ( p =0.001). The change of vena contracta width was -3.40±0.2 mm in the combined CABG+MVR group whereas in the CABG alone -1.45±0.7 mm ( p =0.019). The changes of left ventricular end-systolic volume index were -30.77±25.9 ml/m 2 in the combined CABG+MVR group and -15.6±9.4 ml/m 2 in the CABG alone group ( p =0.096). Ejection fraction changes in the combined CABG+MVR group was +1.51±5.3% and in the CABG alone group was +1.15±4.3%. No statistically significant difference was found between both groups ( p =0.604). Preoperative New York Heart Association class values in the combined CABG+MVR group was 2.18±0.45, and in the CABG alone group was 2.13±0.54. Conclusions: Moderate MR in patients undergoing CABG affects the outcome adversely and it does not reliably improve after CABG alone. Therefore, patients with ischemic moderate MR should undergo simultaneous MVR at the time of CABG. Saudi Med J 2016; Vol. 37 (8): 853-859 doi:10.15537/smj.2016.8.14795 How to cite this article: Toktas F, Yavuz S, Ozsin KK, Sanri US. Mitral valve repair for ischemic moderate mitral regurgitation in patients undergoing coronary artery bypass grafting. Saudi Med J 2016; 37(8): 853-859. doi: 10.15537/smj.2016.8.14795.

Background:Although psoriatic arthritis (PsA) may be seen at any decades, juvenil onset PsA is relatively rare. Moreover, there were no more data about clinical features, treatments, and course in juvenile PsA when they reached to adult age.Objectives:The objective of this study was to assess and compare demographic and clinical features for juvenile onset PsA and adult onset PsA.Methods:PsART-ID is a multicenter, international database, investigating the disease characteristic in real life (1). Briefly, demographic data, PsA subtypes, uveitis, enthesitis, dactylitis, Co-morbidities, disease activity scores (TJC, SJC, VAS-pain, VAS patients and physician global assessments, VAS-fatigue, BASDAI), and functional status (HAQ-DI, BASFI) were recorded. Psoriasis and PsA starting age were noted, as well. Patients were classified as juvenile PsA or juvenile PsO (under 18 years old). Results were compared regarding to juvenile versus adult onset age.Results:Overall, 1644 PsA patients were included to study, 301/1644 (18.3%) patients had juvenile onset psoriasis. Of 39/1644 (2.4%) patients had juvenile onset PsA, as well. As expected, juvenile onset PsA patients were younger, however PsA disease duration were longer than adult onset PsA patients. There were no any difference between demographic and clinical data, except BMI and enthesitis were less frequently at the juvenile onset PsA groups. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used more frequently bDMARDs.Table.Comparison of demographic and clinical characteristics of juvenile and adult-onset psoriatic arthritisJuvenile onsetAdult onsetpN (%)39 (2.4)1605 (97.6)Female Sex n (%)24 (61.5)1006 (62.7)0.884PsA beginning age mean (SD)13.3 ± 3.8542.3 ± 12.9Current age mean (SD)26.6 ±10.747.3 ±13.07Duration of psoriasis (years)17.10 ± 11.2614.75 ± 11.780.124Duration of psoriatic arthritis (years)13.5 ±115.06 ± 6.7Cigarette smoking (ever) n (%)15/38641/14940.72Education duration/year (mean,SD)10.09 ± 3.679.52 ± 4.810.464BMI (kg/m2) (mean, SD)24.5 ±5.128.3 ± 5.21Family history of PsO/PsA n (%)15 (38.5)559 (34.9)0.642Nail involvement n (%)18 (46.2)762 (47.5)0.864Dactilitis n (%)9 (23.7)367 (24)0.958Entesitis n (%)3 (7.9)384 (25.7)0.013Uveitis n (%)-13 (4.3)0.713Axial involvement (%)15 (38.5)464 (29)0.199Methotrexate36 (92.3)1348 (84)0.162Sulfasalazine17 (43.6)612 (38.1)0.488Leflunomide14 (35.9)379 (23.6)0.076Biologic DMARDs102 (33.9)358 (26.8)0.013Conclusion:Although psoriasis may be seen frequently in the juvenile age, juvenile onset PsA was not so frequent in our PsA cohort. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used bDMARDs more frequently.References:[1]Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.Disclosure of Interests:Serpil ERGULU EŞMEN: None declared, Ozun Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Sule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Mehmet Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Background:Studies indicate that patients with rheumatoid arthritis (RA) are at increased risk of developing several comorbid disorders. Comorbidities affect treatment decisions, the effectiveness of the treatment, quality of life, RA prognosis, and survival rate [1].Objectives:The aim of thisstudyto investigate the impact of comorbidity on the first TNF inhibitor treatment persistence in RA.Methods:In the TURKBIO database, patients with an ICD 10-diagnosis of RA (M05 or M06) who started TNF inhibitor therapy between January 2011 and June 2019 were enrolled. Demographic and clinical characteristics, acute phase reactants, disease activity scores (DAS 28 CRP, HAQ, CDAI, VAS global), initial comorbidities and numbers, drug persistence, were evaluated. Kaplan-Meier plots and Cox proportional hazard regression analyses were performed.Results:A total of 1172 patients >18 years of age treated with TNF-α inhibitors were included in the study. The most prevalent comorbidities were: hypertension in 262 patients (32.6%), obesity in 254 (32.6%), osteoporosis in 178 (22.3%), chronic lung disease in 143 (17.9%) and depression in 126 (15.8%). The baseline characteristics are summarised in Table 1. The presence of comorbidity did not affect the survival rate of the first TNF inhibitor therapy in the RA patients (p: 0.65). Comorbidities had no effect on DAS28 CRP (> 1.2 reduction) responses at 6 and 12 months of treatment (p: 0.18, p: 0.83, respectively). As the mean disease duration increases, the persistence of the first TNF inhibitor decreases by 5%.Conclusion:This study demonstrated the increasing burden of comorbidities in RA. However, it suggested that the presence and number of comorbidities did not influence the rate of persistence in the first TNF inhibitor drug and the response to treatment.References:[1] Gabriel, S.E. and K. Michaud,Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases.Arthritis research & therapy, 2009.11(3): p. 229.Disclosure of Interests:None declared

Aim: It has been shown in many experimental animal studies that increased myocardial tension and ventricular filling after cardiac pericardiectomy leads to increased myocardial protein synthesis and increased left ventricular muscle mass. In this study, we aimed to show left ventricular muscle mass changes, left ventricular end-systolic-end-diastolic volume changes, significant changes in systolic-diastolic blood pressure and wall stress after pericardiectomy performed in patients with normal ejection fraction undergoing coronary artery bypass graft (CABG) operation.Material and Methods: Echocardiographic ventricular mass, end-diastolic volumes, end-systolic volumes, ejection fraction values were measured in the preoperative 1st day, postoperative 6th weeks and post operative 6th months in our 32 patients with normal ejection fraction who underwent elective coronary artery bypass operation in our clinic. Results: According to the preoperative values, echocardiographic evaluations showed that left ventricular muscle mass index (LVMMI) increased 15% at 6 weeks, %18 at 6 month after CABG operation ( p 0,05). The mean left ventricular end diastolic volume index (LVEDVI) was 55 ±8 ml/m2 preoperatively , 67 ±10 ml/m2 at the 6th week and 70 ±12 ml/m2 at 6th month; this increase was significant respectively (p0.05). This enlargement occurred with no changes in systolic and diastolic blood pressure and did not lead to significant changes in end-systolic volume and end-systolic circumferential wall stress.Conclusion: In conclusion, in patients undergoing coronary artery bypass graft surgery, pericardiectomy may lead to a partial increase in left ventricular end-diastolic volume and left ventricular muscle mass with better left ventricular filling.

Objectives Corticosteroids (CS) are accepted as the standard first-line treatment for giant cell arteritis (GCA). However, controlled trials of tocilizumab and abatacept demonstrated relapse rates of up to 70%–80% in patients on CS-only protocols in 12–24 months. Though level of evidence is low and not suggested by guidelines (except for methotrexate), conventional immunosuppressives (ISs) are also commonly used. We aimed to assess the relapse rates in patients with GCA in routine practice, retrospectively. Methods We assembled a retrospective cohort of patients with GCA from Turkey. All data was abstracted from records. Relapse was defined as any new manifestation or increased acute-phase response leading to the change of the CS dose or use of a new therapeutic agent by the treating physician. Results The study included 156 (F/M: 95/61) patients with GCA (table 1). The mean age at disease onset was 67.8±9.1 years. Polimyalgia Rheumatica was also present in 48 (30,8%) patients. Diagnosis was proven histopathologically in 99 patients.All patients received 1 mg/kg/day CS for remission induction, additional CS pulses were given to 36 (23.1%) patients. Conventional ISs including methotrexate and azathioprine were used in 89 (56.1%) and 26 (16.6%) patients respectively, while 10 (6.4%) patients received biologic treatments (8 tocilizumab,2 etanercept). Fourty-four (28.2%) patients used only CS during follow-up. Follow-up of at least 6 months was available for 132 patients, and median follow-up duration was 35 (6–268) months. Relapses occurred in 27 (20.5%) patients during follow-up. Mortality rate was 7.5% (n=10) during follow-up. VDI score was 2.4±1.7. Main causes of damage were related to CS treatments such as cataract, osteoporosis and diabetes mellitus. Conclusions In this first multi-centre series of GCA from Turkey, we observed that only one fifth of patients had relapses during a mean follow-up of 35 months. This lower relapse frequency suggests a different clinical spectrum in routine practice compared to patients included in controlled trials. Our results also suggest that there is a clear need for a steroid sparing agent in patients with GCA, that is a older aged population prone to CS side effects. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) has a genetic background, approximately 40% of patients having a family history of psoriasis or PsA in first-degree relatives, which may impact the disease features. Objectives The aim of this study was to evaluate the effects of family history of psoriasis or PsA on the disease phenotypes. Methods The demographic and clinical data were retrieved from the longitudinal, multicenter PsArt-ID (Psoriatic Arthritis-International Database). Family history of psoriasis and PsA were investigated for 1st and 2nd degree relatives separately. The effect of the family history of psoriasis and/or PsA on disease phenotypes and severity were analysed, calculating the relative risks (RR). Results 1393 patients had the data for family history, 444 (31.9%) of whom was positive for psoriasis and/or PsA. The majority of the family history was only psoriasis (333/444; 75%) and 58.5% (260/444) of the patients had first-degree relatives affected. There was no differences in maternal or parental transmission rates however women had more psoriasis and/or PsA in their family (67.3% vs 32.7% p: 0.028). Patients with a family history had an earlier onset of age for psoriasis (29±14.8 vs 31±14.9 p: 0.007), more frequent nail involvement (50.7% vs 29.6% p: 0.032), more frequent enthesitis (28.2% vs 17.7% p Conclusions The family history of psoriasis and PsA has impacts on skin phenotypes, musculoskeletal features and the disease severity. The differences between family history of psoriasis and PsA and pustular vs plaque phenotypes may point out to a different genetic background and pathogenic mechanisms in these subsets. Disclosure of Interest None declared

Background The environmental and genetic factors play a crucial role in the pathogenesis of psoriatic arthritis (PsA) which may cause a difference in disease characteristics for patients from different geographical regions. Objectives The aim of the study was to explore the disease characteristics, treatment choices and comorbidities in patients with PsA in different countries to see the impact of geographic factors. Methods PsArt-ID (Psoriatic Arthritis- International Database) is a prospective, multicentre registry in PsA, which was initially developed in Turkey in 2014, with participation of Canada since 2015 and Italy since 2017. Patients with PsA are consecutively registered to this registry with the aim of investigating the real-life data. Patient characteristics across Turkey (n=1283) and Canada (n=119) are compared for this analysis. Results Canadian patients were older at the time of recruitment (Table). They also were more frequently smokers, had higher duration of education and higher BMI than patients in Turkey. Patients in Canada had more frequent polyarthritis (66.7% vs 39.6%, p Conclusions Geographical differences have impacts on the disease features in PsA, which may be due to genetic, environmental and cultural differences. The treatments are comparable suggesting a similar approach by the physicians. Disclosure of Interest None declared

Background A multicenter antiphospholipid antibody (aPL) clinical database was created in 2016 with the pariticipation of six rheumatology centres around the country. The purpose has been to better define aPL-related clinical manifestations and management strategies; and also to establish a resource for future clinical studies. Objectives In this first analysis, we compared the clinical and laboratory features of aPL-positive patients with and without systemic lupus erythematosus (SLE). Methods The demographic, clinical, laboratory, treatment characteristics of the aPL-positive patients with/without other systemic autoimmune diseases (SAID) are recorded at enrollment according to a predefined protocol. The inclusion criteria are positive aPL (lupus anticoagulant test [LA], anticardiolipin antibody [aCL], and/or anti β2-glycoprotein-I antibody [aβ2GPI]) based on the Updated Sapporo Antiphospholipid Syndrome (APS) Classification Criteria at least twice within one year prior to enrolment.1,2 For the purpose of this analysis, we only included aPL-positive patients without other autoimmune diseases (primary aPL/APS) and aPL-positive SLE patients (SLE aPL/APS). Results As of January 2018, 105 aPL-positive patients were recruited (mean age: 42.6±10.1 [min-max: 19–70]; 83 [79%] female; and 67 [64%] with another SAID). Ten patients were excluded from the analysis due to their SAID history other than SLE. Of the remaining 95 patients, 38 (40%) had primary aPL/APS; 57 (60%) fulfilled the ACR SLE Classification Criteria; 42 (44%) had thrombotic APS (TAPS) (8 arterial, 24 venous, and 8 both); 21 (22%) had obstetric APS (OAPS); 22 (23%) had both TAPS and OAPS (7 arterial, 14 venous, and 1 both); and 10 (11%) had no TAPS/OAPS. Fifty percent of the patients had history of at least one non-criteria aPL-manifestation. Demographics, clinical and laboratory manifestations, and medications were similar between primary aPL/APS and SLE aPL/APS patients except increased frequency of autoimmune hemolytic anaemia, aCL IgG, and hydroxychloroquine use in SLE aPL/APS patients (table 1). Conclusions The analysis of our multicenter aPL database demonstrates that the frequencies of thrombosis and pregnancy morbidity are similar between aPL-positive patients with or without SLE. Half of the patients in both groups had history of at least one “non-criteria” aPL-manifestation; only autoimmune hemolytic anaemia was more frequent in aPL-positive patients with SLE. References [1] Schreiber K, Sciascia S, de Groot PG, Devreese K, Jacobsen S, Ruiz-Irastorza G, et al. Antiphospholipid syndrome. Nat Rev Dis Primers2018;4:17103. [2] Gomez-Puerta JA, Cervera R. Diagnosis and classification of the antiphospholipid syndrome. J Autoimmun2014;48–49:20–5. Disclosure of Interest None declared

Objectives. The aim of this study was to emphasize the importance of surgical intervention perfotmed before development of arteriovenous fistula (AVF) aneurysm complications. Methods. The patients were categorized into two groups: Patients undergoing elective surgery for autogenous AVF aneurysm were defined as elective group (Group 1), whereas those who underwent emergency surgery due to ruptured aneurysmal fistulas were defined as emergency group (Group 2). All elective cases were evaluated by doppler ultrasonography before surgery. All patients had temporary hemodialysis catheters. In the patients with salvaged fistulas, the fistulas was rested for 1 week. A new fistula was created in patients with not salvaged fistula. Results. A total of 31 patients (54.8% male, mean age: 41.2 ± 14.7 years) were in Group 1 and 7 patients (57.1% male, mean age: 53 ± 9.4 years) were in Group 2. Significant difference was observed between two groups in terms of fistula preservation. Salvaged fistulas were significantly higher in the Group 1 than Group 2 (p = 0.003). In Kaplan-Meier curves, cumulative primary AVF patency rates at 1, 3 and 6 months were 96.3%, 81.5%, and 77.8% in Group 1 and 66.7%, 66.7%, and 66.7% in Group 2, respectively (log-rank; p = 0.536). Conclusions. Consultation of these cases with a cardiovascular surgeon before they reach the rupture stage is an important condition for both the patency of the fistula and the vital risk of the patient.

Background: This study aims to evaluate the patency rates and long-term outcomes of femoro-popliteal bypass procedures with Omniflow II biosynthetic vascular grafts in patients with occlusive vascular disease. Methods: This retrospective, observational, clinical study included a total of 93 patients (61 males, 32 females; mean age 56.9±7.4 years; range, 43 to 83 years) who underwent femoro-popliteal bypass in which Omniflow II biosynthetic vascular grafts were used due to peripheral arterial disease. The patients were divided into two groups: 62 patients undergoing femoro-popliteal above-knee bypass and 31 patients undergoing the femoro-popliteal belowknee bypass. We evaluated preoperative clinical characteristics, postoperative graft patency rates, and other clinical results. Results: The mean follow-up was 44.9±18.8 months in the femoropopliteal above-knee bypass group and 47.3±22.3 months in the femoro-popliteal below-knee bypass group (p=0.302). The cumulative primary graft patency rates of the femoro-popliteal above-knee bypass and femoro-popliteal below-knee bypass groups at three, four, and five years were 98%, 95% and 78% and 86%, 75% and 45%, respectively (log-rank; p=0.312). The cumulative assisted graft patency rates of the femoro-popliteal above-knee bypass and femoro-popliteal below-knee bypass groups at five years were 87.9% and 65.3%, respectively (log-rank; p=0.530). Conclusion: The Omniflow II biosynthetic vascular graft is suitable for above-and below-knee femoro-popliteal bypass procedures. These grafts may be prefered due to high patency rates, low incidence of aneursym formations, and infections. ©2018 All right reserved by the Turkish Society of Cardiovascular Surgery.

Background: New postoperative atrial fibrillation (POAF) is one of the most critical and common complications after cardiovascular surgery precipitating early and late morbidities. Complete blood count (CBC) is an imperative blood test in clinical practice, routinely used in the examination of cardiovascular diseases. Aim: This systematic review with meta-analysis aimed to determine the strength of evidence for evaluating the association of haematological indices in CBC tests with atrial fibrillation following isolated coronary artery bypass graft (CABG), isolated valvular surgery, or a combination of these treatments. Methods: We conducted a meta-analysis of studies evaluating pre- and postoperative haematological indices in patients with POAF. A comprehensive subgroup analysis was performed to explore potential sources of heterogeneity. Results: A literature search of all major databases retrieved 732 studies. After screening, 22 studies were analysed including a total of 6098 patients. Pooled analysis showed preoperative platelet count (PC) (weighted mean difference [WMD] = –7.07 × 109/L and p < 0.001), preoperative mean platelet volume (MPV) (WMD = 0.53 FL and p < 0.001), preoperative white blood cell count (WBC) (WMD = 0.130 × 109/L and p < 0.001), preoperative neutrophil-to-lymphocyte ratio (NLR) (WMD = 0.33 and p < 0.001), preoperative red blood cell distribution width (RDW) (WMD = 0.36% and p < 0.001), postoperative WBC (WMD = 1.36 × 109/L and p < 0.001), and postoperative NLR (WMD = 0.74 and p < 0.001) as associated factors with POAF. Conclusions: Haematological indices may predict the risk of POAF before surgery. These easily-performed tests should definitely be taken into account in patients undergoing isolated CABG, valvular surgery, or combined procedures.

OZ Amac: Bu calismada koroner arter baypas greftleme (KABG)’nin aortik fonksiyonlar uzerindeki etkisi incelendi. Ca­lis­ma­ pla­ni:­ Ayni cerrahi ekip tarafindan kardiyopulmoner baypas ile KABG ameliyati yapilan cokdamar koroner arter hastaligi (KAH) olan ardisik 32 hasta (ort. yas 61.6±9.4 yil) calismaya alindi. Hastaligin siddeti Gensini skor indeksi ile hesaplandi. Aortik kesit uyumu, aortik esneklik ve aortik sertlesme gibi aortik fonksiyon indeksleri ekokardiyografi ile ameliyat oncesi donemde ve ameliyat sonrasi ucuncu ve altinci aylarda hesaplandi. Bul gu lar: Aortik fonksiyonlar yuksek Gensini skoru (ortalama 98.3±38.1) ile ciddi veya yaygin KAH’si olan hastalarda ameliyat sonrasi donemde iyilesti. Aortik kesit uyumu ameliyat oncesi 2.62±1.5 cm2/mmHg’den ameliyat sonrasi ucuncu ayda 3.52±1.6 cm2/mmH’ye (p=0.21) ve altinci ayda 3.79±1.5 cm2/mmHg’ye (p

Objectives . Myxomas are the most common benign primary heart tumors. They have serious complications including intracardiac blood flow obstruction and embolic events. The aim of the study was to assess our experiences related to patients undergoing surgical resection for cardiac myxomas. Methods. The medical records of 39 patients, aged 16 to 76 years (mean, 47.5 years), who were operated on for primary cardiac myxomas between January 1994 and December 2016 at our clinic were retrospectively evaluated. Demographic, clinical, operative and postoperative data were obtained from these hospital medical records. Cardiac myxomas were diagnosed by transthoracic echocardiography. Preoperative coronary angiography was performed in patients over 40 years of age and those with symptoms of coronary disease. In routine follow-up after discharge the patients were checked by echocardiography. Long-term cumulative survival was analyzed using the Kaplan-Meier method. Results . There was no in-hospital mortality. The majority (61.5%) of patients were female. The most common encountered localization of myxoma was the left atrium (76.9%), and the classic posterior approach from interatrial groove was preferred in 32 (82.1%) patients. Mean follow-up was 6.05 ± 3.75 years (range, 1-10 years). Five (12.8%) patients were lost on long-term follow-up. Kaplan-Meier curves, cumulative proportion surviving of patients at 1-, 2-, 5-, and 10-year were 97.4%, 91.7%, 84.7%, and 84.7%, respectively. No hospital mortality was observed in any of the patients. There was no recurrence in our series. Conclusions . Myxoma is the disease that can lead to complications such as embolic events and intracardiac blood flow obstruction. It can be excised with a low rate of morbidity and mortality. S urgical resection should be performed promptly after diagnosis in order to prevent potential complications.

OBJECTIVES: In the present study, we aimed to deterimine the dose-related effects of ticagrelor, the first reversible inhibitor of the P2Y(12) receptor, found in smooth muscle cells as well as platelets, during neointimal hyperplasia in a rabbit carotid anastomosis model. METHODS: This study was an experimental, prospective, randomized controlled study including 20 New Zealand white female rabbits (6-months old; weighing 2300 +/- 300 g). Under general anaesthesia, the rabbits underwent transection of the right carotid artery and subsequent anastomosis of both ends. The study animals were divided into the following 4 groups: T1 (ticagrelor 5 mg/kg, orally, daily), T2 (ticagrelor 10 mg/kg, orally, daily), T3 (ticagrelor 20 mg/kg, orally, daily) and control (no ticagrelor treatment). The single oral doses were administered in phosphate-buffered saline. The control group received sterile phosphate-buffered saline (2 ml/kg/day, orally) for 3 weeks postoperatively. At the end of the study, the animals were killed, and the anastomosed segment of the right carotid artery and part of the left carotid artery were excised from each animal. Antibodies against transforming growth factor-beta were used in staining of arterial sections, which was followed by histomorphological and immunohistochemical studies. RESULTS: The median intimal thickness (2.0 +/- 0.14 m left vs 73.4 +/- 35.8 m anastomosed right arteries; P

Background: Isolated right atrial rupture is a very rare catastrophic complication of cardiopulmonary resuscitation. Objective: We described a rare case of right atrial rupture after external cardiac massage. Methods: We reported the case of a 62-year-old male patient who developed excessive bleeding following external cardiac massage for sudden cardiac arrest in the intensive care unit after coronary artery bypass grafting. Results: This man underwent successful emergency repair of the tear of the right atrium without using cardiopulmonary bypass. Conclusion: Right atrial rupture can occur after external cardiac massage. An emergency repair is needed.

Tup torakostomisi, kardiyovaskuler cerrahi kliniklerinde rutin olarak kullanilan bir girisimdir. Tup torakostomisi bircok durumda hayat kurtarici bir islem olmakla birlikte, mortaliteye neden olabilecek ciddi komplikasyonlari vardir. Klinigimizde koroner arter baypas greft (KABG) ameliyati yapilmis 71 yasinda erkek bir hastada, ameliyat sonrasi apikal gogus tupu yerlestirilmesinin alisilmadik bir komplikasyonu olarak cikan aort perforasyonu gelisti. Bu komplikasyon basarili bir sekilde tedavi edilerek, hasta tam sifa ile taburcu edildi. Ozellikle torakarli tup torakostomisi uygulanan hastalarda bu nadir ancak olumcul komplikasyonun gelisebilecegi akilda tutulmalidir. Keza, ameliyat sonrasi donemde bu hastalarda mediastinal yer degisikligi olup olmadigina dikkat edilmelidir. Anah tar soz cuk ler: Aort rupturu; gogus tupu; torakostomi. Tube thoracostomy is a routine intervention which is used in cardiovascular surgery clinics. Although it is a life-saving intervention in most cases, it has serious complications leading to mortality. We encountered an ascending aortic perforation, an unusual complication following apical chest tube insertion, in a 71-year-old male patient who underwent coronary artery bypass graft (CABG) surgery in our clinic. This complication was managed successfully and the patient was discharged with a complete recovery. This rare but fatal complication should be considered for the patients undergoing tube thoracostomy, particularly with a toracar. It should also be noticed whether the patients have mediastinal shift in postoperative period.

Background: Pulmonary hypertension development in pure severe aortic stenosis is a situation that affects mortality and morbidity. Material and Methods: Data from files of 31 patients with systolic pulmonary artery pressure over 50 mm Hg and with pure severe aortic stenosis, and underwent aortic valve replacement in our clinic were examined retrospectively. Results: Preoperative effort capacities of the patients were evaluated as follows according to NYHA; 4 patients class 1-2, 16 patients class 3, and 11 patients class 4. Twenty-five metal, and 6 biologic aortic valves were used. Postoperative hospital mortality was recorded as 12% with 4 patients. Patients were reevaluated on the postoperative 2nd and 12th months. Pulmonary arterial pressure of the patients was measured using echocardiography. Preoperative average pulmonary artery systolic pressure was measured as 55 ± 3 mmHg. The average pressure was measured as 41 ± 3 mmHg on the 2nd, and as 37.8 ± 4 mmHg on the 12th month. The effort capacity evaluation in the postoperative 2nd month was as follows: 11 patients class 1-2, 12 patients class 3, and 4 patients class 4. The effort capacity evaluation conducted in the 12th month was: 14 patients were class 1-2, 10 patients were class 3, and 2 patients were class 4. During the follow-up 1 year, survival rate of the patients was determined as 83.8% average, 5 year survival rate was determined as 61.5%. Conclusion: We believe that AVR may be performed in severe aortic stenosis cases with high pulmonary pressure with acceptable ortality, leading to a better quality and longer life.

Objective: The aim of this study is to investigate the effectiveness of unipolar radiofrequency ablation in patients with persistent atrial fibrillation undergoing mitral valve replacement. Method: Our study consists of 22 patients, who performed mitral valve replacement with associated left atrial ablation in our clinic between January 2010 and January 2012. Postoperative early and mid-term follow-up of the patients were retrospectively evaluated with 12-lead electrocardiographic recordings. The patients were followed up during 6- month period. Results: After cardiopulmonary bypass, 14 63.6% patients maintained normal sinus rhythm, 8 patients including one patient with a temporary pace support has AF on time received to the intensive care unit. In the early period, one patient died due to low flow, and prolonged intubation. At the end of the first month, 15 71.4 % patients were in sinus rhythm, and 6 patients 28.6% were with atrial fibrillation persisted. Followed by the tenth postoperative atrial fibrillation in a patient was implanted permanent pace. At followup 6th month, there was recurrent atrial fibrillation.Conclusion: The success achieved with the unipolar radiofrequency left atrial ablation was found to be consistent with the findings of the literature. In our study, patient age and pulmonary hypertension was evaluated as predictive of ongoing postoperative AF., Amaç: Bu çalışmanın amacı mtiral kapak replasmanı uygulanan persistan atriyal fibrilasyonlu AF hastalarda unipolar radyofrekans ablasyon etkinliğinin araştırılmasıdır. Yöntem: Çalışmamıza, Ocak 2010- Ocak 2012 tarihleri arasında kliniğimizde mitral kapak replasmanı uygulanan ve beraberinde sol atriyal ablasyon uygulanan 22 hasta dahil edildi. Hastaların postoperatif ve orta dönem kontrol 12 derivasyonlu EKG kayıtları geriye dönük olarak değerlendirildi. Hastaların operasyon sonrası 6 ay boyunca takip edilmesi planlandı. Bulgular: Kardiyopulmoner bypass çıkışında 14 %63,6 hastada normal sinüs ritmi sağlandı, 1 hasta geçici pace desteğinde olmak üzere 8 36,3 hasta AF ile yoğun bakıma alındı. Erken dönemde 1 hasta düşük debi ve uzamış entübasyon nedeniyle kaybedildi. 1.ay sonunda 15 hasta %71,4 sinüs ritminde, 6 hastada % 28,6 atriyal fibrilasyon devam etmekteydi. Atriyal fibrilasyon ile takip edilen bir hastaya postoperatif 10. ayında kalıcı pace implante edildi. 6.ay sonunda tekrarlayan atriyal fibrilasyon olmadı. Sonuç: Sol atriyal unipolar radyofrekans ablasyon tedavisinde elde edilen başarı literatür bulguları ile uyumlu olarak bulundu. Çalışmamız sonucunda, hasta yaşı ve pulmoner hipertansiyon postoperatif devam eden AF için prediktif olarak değerlendirilmiştir.

Objective. Chronic inflammation might favour platelet hyperactivity, which leads to inter-individual variability in antiplatelet resistance. The aim of this study was to test the hypothesis that there is a relationship between some hematological parameters reported as measures of systemic inflammation, the atherogenic index of plasma (AIP), and antiplatelet responsiveness. Methods. This retrospective study included patients receiving aspirin (100 mg) and clopidogrel (75 mg) daily before and after stenting. Platelet inhibition was assessed using the VerifyNow P2Y12 point-of-care test. Resistance to antiplatelet therapy was defined as P2Y12 reactivity exceeding 240 units (for clopidogrel) or aspirin reaction units exceeding 550 units (for aspirin). The AIP was calculated as the logarithm of triglyceride/high density lipoprotein cholesterol. The white blood cell (WBC), platelet (P), neutrophil (N), and lymphocyte (L) counts, red cell distribution width (RDW), hemoglobin (Hb), plateletcrit, mean platelet volume (MPV), platelet distribution width, and N/L and P/L ratios were evaluated. Results. Of 232 patients (73% male; median age, 63 years; range, 38-87 years), 52 (22%) were aspirin resistant and 82 (35%) were clopidogrel resistant; 7.7% were both aspirin and clopidogrel resistant. Median RDW levels were significantly higher (14.4% [interquartile range (IQR) 3] vs. 13.9% [IQR 1.3]; p=0.01) and Hb levels significantly lower (12.0±1.6 g/dL vs. 13.2±1.7 g/dL; p0.05). Multivariate logistic regression showed that Hb (odds ratio [OR]=0.73; 95% confidence interval [CI], 0.60-0.88; p=0.001) and RDW (OR=1.26; 95% CI, 1.02-1.55; p=0.02) were independent predictors of clopidogrel resistance. Conclusion. Both RDW and Hb were independent variables associated with clopidogrel resistance, but antiplatelet resistance cannot be predicted based on other hematological parameters or AIP.

Objective. The total antioxidant capacity (TAC) of a sample can be measured with a ferric reducing antioxidant power (FRAP) assay. There are commercially available kits for FRAP assays, however they are more expensive than in-house kits. We aimed to evaluate a FRAP direct measurement method under our laboratory conditions using a microplate reader and establish reference values to use in future research projects. Methods. An in-house microplate adaptation of the FRAP method was evaluated. Reference values of FRAP were established for one hundred and twenty subjects aged between 25-55 years. FRAP levels were estimated in 30 serum samples with high glucose concentration, 44 hyperbiluribinemic neonatals and 16 patients receiving renal replacement therapy (RRT). Results. The mean FRAP level was 890±235 µmol/L. The median TAC level was 904 µmol/L. This method was found to be linear up to at least 2000 µmol/L. The intra- and inter-assay coefficients of variation were 2.7-6.7% and 5.3-10.1%, respectively. The mean FRAP level was lower than normal in diabetes and RRT patients and higher in hyperbiluribinemic neonatals (687±209 µmol/L, 609±250 µmol/L and 945±187 µmol/L, respectively). Conclusions. Our reference values give comparable results with the literature. This method is simple, reliable, and inexpensive. It could be used for studies of oxidative stress-related diseases.

Objective. The widespread use of percutaneous coronary intervention (PCI) has resulted in an increasing number of patients who have undergone prior PCI being referred for coronary artery bypass grafting (CABG). The aim of this study was to determine the association between previous PCI and early and midterm outcomes after CABG. Methods. A total of 54 patients undergoing elective CABG (group 1) between January 2008 and January 2009 were compared to 46 patients who had a history of bare metal stent implantation before CABG (group 2). Mean follow-up was 12 months. Results. The average time interval to CABG following initial PCI was 18.5 months. There was no significant difference in demographic features and risk factors between the two groups (p>0.05). There were also no significant differences in intraoperative and postoperative data, and no significant differences for in-hospital mortality, cardiac mortality and total mortality and in the number of rehospitalizations for cardiac or for all-cause reasons (p>0.05). Conclusion. In this study, previous PCI did not significantly influence the outcomes of CABG in a 12-month follow-up period.

Objective. Off-pump coronary artery bypass grafting (CABG) with median sternotomy have been shown to be beneficial and associated with reduced myocardial injury. However, there is still a risk for ischemic myocardial injury that results from the normothermic and metabolically active myocardium during the occlusion of the target coronary artery. We aimed to evaluate the efficacy of trimetazidine in prevention of myocardial tissue injury in patients undergoing off-pump CABG by measuring serum levels of cardiac troponin I (cTnI). Methods. Thirty patients undergoing first-time elective off-pump CABG were randomly assigned to two groups: 15 patients received trimetazidine 60 mg orally per day (trimetazidine group) for three weeks and 15 patients received placebo (control group). As a parameter of myocardial injury, we measured cTnI levels. Blood samples were taken sequentially from the patients before surgery (t1), 30 minutes after the last distal anastomosis (t2), at postoperative 12 th hour (t3) and at postoperative 24 th hour (t4). cTnI measurements were made by direct chemiluminometric technology. Results. Baseline and operative characteristics of patients are similar. All preoperative serum cTnI concentrations were within the normal range and rose with the beginning of the operation which reached to its peak value at t3 in the control group and t4 in trimetazidine group. When the increase in the serum cTnI concentrations of trimetazidine group and control group were compared there was a slight numerical increase in cTnI levels in all measurements after reperfusion but reached to statistical significance only at t3 (mean: 0.40 ng/ml; mean rank: 12.20; range: 0.05-1.66 vs. mean: 0.20 ng/ml; mean rank: 18.80; range: 0.11-0.30; p =0.041). Conclusion. Preoperative treatment with trimetazidine might reduce postoperative myocardial injury in patients undergoing first time isolated off-pump CABG, but larger randomized placebo controlled trials are still for recommendation of routine pretreatment with trimetazidine.