OBJECTIVEAlthough many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic.MATERIALS AND METHODSLaboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality.RESULTSThere was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1.CONCLUSIONSIt is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.

Objectives: Inflammatory activity in the epicardial adipose tissue(EAT) is thought to have a role in coronary atherosclerosis. Factors mediating enhanced inflammatory activity in EAT have not been clarified yet. This study aims to investigate the relationship between macrophage infiltration and polarization in EAT and Netrin-1 expression.

OBJECTIVE: Electrical cardioversion (EC) is a short but painful procedure to restore sinus rhythm. The aim of this study is to compare the effect of fentanyl, remifentanil and alfentanil in association with propofol and midazolam for elective EC.PATIENTS AND METHODS: Ninety-nine patients older than 18-years, American Society of Anesthesiologists I/II/III grades undergoing elective EC were randomized into 3 groups. All patients received 2 mg midazolam and propofol (0.5 mg/kg). Group A received alfentanil (5 mu g/kg i.v. bolus), Group F received fentanyl (0.5 mu g/kg i.v. bolus) and Group R received remifentanil (0.25 mu g/kg i.v. bolus). Hemodynamics and respiratory variables [Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), SpO(2), respiratory rate (RR)], and Modified Aldrete recovery score (MARS) were assessed at six different time points (baseline, right after EC, and 3rd min, 5th min, 10th min, 30th min following EC). Also, induction times (time to reach RSS to 5) and recovery times (time to reach MARS to 8) were recorded. The incidence of respiratory depression, bradycardia, hypotension and adverse effects were also recorded.RESULTS: Hemodynamic variables were similar in all groups. SpO(2) values in Group R were significantly lower at 3rd min (p = 0.005). Induction and recovery times were longest in Group F. There were significant differences at 3rd, 5th and 10th minute MARS values between groups. The incidence of hypotension and bradycardia were similar in all groups (p > 0.05) but respiratory depression was higher in Group R (p = 0.047).CONCLUSIONS: Propofol alfentanil combination has more beneficial advantages in their rapid onset, early recovery time and less respiratory depression than remifentanil and fentanyl.

OBJECTIVEPolidocanol is the most frequently used sclerosant for sclerotherapy all around the world. Our experimental research aims to find out the angiogenic effects of Polidocanol.MATERIALS AND METHODSAngiogenic activity of polidocanol was examined in vivo in the chick chorioallantoic membrane (CAM) model, cell viability assay (human umbilical vein endothelial cells - HUVECs) and in vitro tube formation assay of HUVECs.RESULTSIn CAM assay, a significant decrease on CAM vessel growth was observed after the application of polidocanol solutions. Vessel growth inhibition was strongly dose-dependent. There was a cytotoxic effect on HUVECs in the presence of polidocanol observed with MTT assay (p < 0.05). In the tube formation assay, statistically significant decrease in tube formation was observed in polidocanol group. It was found that polidocanol had an anti-angiogenic effect (p < 0.05). The results provide evidence that polidocanol decreases angiogenesis and has a cytotoxic effect on ECs.CONCLUSIONSThese results provide evidence that Polidocanol (lauromacrogol 400) have strong anti-angiogenic effects in vitro and in vivo. Further researches needed to reveal early and long-term effects of polidocanol in the human vascular system and new treatment approach as an anti-angiogenic therapy.

OBJECTIVE Taurine is an abundant amino acid that is widely distributed in human and animal tissues. Pharmacodynamic studies show that taurine has hypotensive and myocardial protective effects. Studies in isolated tissue baths show that taurine relaxes precontracted arteries. This study aimed to show the effects of taurine on human internal mammary artery (IMA) in vitro and to explain the mechanisms of its effects. METHODS The response in the IMA was recorded isometrically by a force displacement transducer in isolated organ baths. Taurine (20, 40, 80 mM) was added to organ baths after precontraction with KCl (45 mM) or serotonin (5-HT, 30 µM). Taurine-induced relaxations were also tested in the presence of the cyclooxygenase inhibitor indomethacin (10 µM), the nitric oxide synthase inhibitor L-NAME (100 µM), the large conductance Ca2+-activated K+ channel inhibitor tetraethylammonium (TEA, 1 mM), the ATP-sensitive K+ channel inhibitor glibenclamide (GLI, 10 µM), the voltage-sensitive K+ channel inhibitor 4-aminopyridine (4-AP, 1 mM) and the inward rectifier K+ channel inhibitor barium chloride (BaCl2, 30 µM). RESULTS Taurine did not affect the resting tone of IMA. However, it produced relaxation in the 5-HT and KCl -precontracted preparations. The relaxation to IMA was not affected by GLI, 4-AP, BaCl2, indomethacin and L-NAME. But, TEA inhibited taurine -induced relaxations significantly (p < 0.05). CONCLUSIONS The preincubation of IMA with taurine antagonized KCl and 5-HT induced contractions in a concentration dependent manner, while it did not affect the resting tone. The relaxations to taurine were significantly antagonized by pretreatment with TEA. These results suggest that mechanism of vasodilator effect of taurine in IMA may be the activation of large conductance Ca2+-activated K+ channels.

OBJECTIVE:Pulmonary artery hypertension (PAH) is devastating disease that has very serious outcomes. Dysregulated angiogenesis is one of the main responsible courses in pathophysiology of disease. Our experimental research intends to find out and compare the angiogenic effects of medications used sildenafil, iloprost, and bosentan in the treatment of PAH.MATERIALS AND METHODS:This study was performed in Department of Biochemistry and Cancer and Stem Cell Research Laboratory of our institutes between August and October 2014. Angiogenic activity of sildenafil, iloprost, and bosentan were examined in vivo in chick chorioallantoic membrane (CAM) model and in vitro tube formation assay of human umbilical vein endothelial cells (HUVECs). Proliferative activity of these three agents was also determined through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on HUVECs.RESULTS:In CAM assay, when compared to the control and drug groups, treatment with sildenafil solutions resulted in a significant dose-dependent increase (budding, sprouting, extravasation) on CAM vessel growth. While there was no significant proliferative effect with iloprost and bosentan, presence of sildenafil caused a statistically significant proliferation on HUVECs following 24 and 48 h incubation (p < 0.05) compared to the control group. Comparing the tube length/area ratio values, there was statistically significant increase in sildenafil group with respect to the other 2 groups (p < 0.05). Iloprost and bosentan did not show a significant effect.CONCLUSIONS:The results provide evidence that sildenafil but not iloprost and bosentan induces angiogenesis in vitro and in vivo. Dysregulated angiogenesis, as an important pathophysiological part in the progression of PAH, may be triggered by the chronic ingestion of sildenafil in the long treatment period and may cause negative effects.

OBJECTIVE Many other organs and system can be affected in the course of Primary Raynaud's Phenomenon (RP). Simultaneously increased vasospasm in the pulmonary vascular bed may likely affect the pulmonary function. Therefore, we investigated the effect of Raynaud's phenomenon on the respiratory functions in this study. PATIENTS AND METHODS Between March 2014 and December 2014, 30 patients with the diagnosis of PRP more than two years and 32 age-sex matched healthy controls were enrolled into this study. Cold stimulation test (CST) was performed. Pulmonary function test were performed following 30 minutes after CST and spirometric measurements were calculated. RESULTS There were no statistically significant differences between two groups regarding their demographic and clinical data. Mean duration of symptoms from onset to present was 3.01 ± 1.05 years. Patients with Primary RP had significantly lower FVC and higher FEV1/FVC values compared to the control groups (p = 0.015 and p=0.045, respectively). CONCLUSIONS We found that statistically significant decrease of FVC values in patients with Primary RP compared to the healthy controls could be a impaired innervation of pulmonary system and a predictor of pulmonary vasospasm and/or pulmonary Raynaud's phenomenon, which may develop in future periods.

OBJECTIVE:Arteriovenous fistulas (AVFs) are commonly used during hemodialysis. Early failure of AVFs is quite common with incidence of 43% to 63%. In this study we aimed to describe a novel approach to AVF surgery for improving early patency rates.PATIENTS AND METHODS:Patients were divided into two groups according to use of probing and warm-wash-out technique. Group I consisted of 31 patients with additional probing technique. Group II consisted of 32 patients without additional maneuver. End-to-side anastomosis were used to all patients. Technical success was defined as having palpation of a thrill on fistula. Flow rates of draining vein was measured at 1st hour, 24th hour, 1st week and 3rd week of surgery.SURGICAL TECHNIQUE:Classical maneuvers were performed until end of the anastomosis. At this time, vein lumen was washed by low-dosed heparinized warm fluid, with assistance of a simple catheter.RESULTS:Technical success was similar in both groups at 1st hour and 24th hour, while there were significantly differences between groups at 1st week (p = 0.042) and 3rd week (p = 0.05) assessments. Flow rates were also measured significantly higher in Group I at 1st hour (p = 0.011) and 24th hour (p = 0.016). Flow rates were almost similar in two groups at 1st and 3rd weeks but overall success rate was higher in Group I comparing with Group II (96.8% vs. 81.3%, respectively, p = 0.05).CONCLUSIONS:Probing and warm-wash out technique will simply increase the surgical success and flow rate of draining vein.

OBJECTIVE: The role of nitrates and nitric oxide on platelet functions has obtained an increasing attention with respect to their potential effects on cardiovascular disorders. In this study we aimed to analyze the effect of sodium nitrite on platelet functions in human platelets.PATIENTS AND METHODS: This in vitro study was designed to show the effect of sodium nitrite on platelet functions in seven healthy volunteers. Blood samples were centrifuged to prepare platelet rich plasma and platelet poor plasma. Platelet rich plasma was diluted with the platelet poor plasma to have a final count of 300,000 +/- 25,000 platelets. Platelet rich plasma was incubated with six different increasing doses (from 10 mu M to 5 mM) of sodium nitrite for 1 hour at 37 degrees C. Then stimulating agents including collagen (3 mu g ml(-1)), adenosine diphosphate (10 mu M), and epinephrine (10 mu M) were added to the cuvette. Changes in light transmission were observed for 10 minutes. In addition spontaneous aggregation were performed in control group with all aggregating agents separately.RESULTS: Effect of sodium nitrite on agonist-induced platelet aggregation depends on the concentration of sodium nitrite. Compared with control group, agonist-induced platelet aggregations were significantly suppressed by sodium nitrite at the concentration of 5, 1.0 and 0.5 mM.CONCLUSIONS: Our results suggested that sodium nitrite has inhibitory effects in vitro on platelet aggregation in a dose-dependent manner.

OBJECTIVE:Opioid-induced hyperalgesia is well known complication of acute high dose and chronic opioid therapy. In this study, we evaluated development of opioid-induced hyperalgesia following intraoperative short-term use of µ-opioid agonist fentanyl after coronary artery bypass surgery.PATIENTS AND METHODS:100 patients undergoing elective coronary artery bypass graft surgery is divided into two groups. In group I (low dose), anesthesia was induced with propofol 1-2.5 mg/kg and fentanyl 2 mcg/kg, in group II (high dose) fentanyl 40-70 mcg/kg was used. In group I, propofol 5-10 mg/kg/h, fentanyl 1-3 mcg/kg/h, in group II fentanyl 5-10 mcg/kg/h was used for maintenance of anesthesia. The tactile and thermal thresholds were measured before surgery and in 1st, 3rd and 7th postoperative days by using Von Frey filaments and a thermal source, respectively.RESULTS:Tactile thresholds were significantly decreased at the first (6,08±0.21 and 3.76±0.13 g; p<0.001) and third (6.76±0.24 and 4.96±0.16 g; p<0.001) postoperative days compared to baseline preoperative values (7.72±0.26, and 7.60±0.21 g; p=816) in two groups. Postoperative 1st (13.45±0.33 and 10.05±0.24 sec; p<0.001) and 3rd day (14.77±0.28 and 13.17±0.26 sec; p<0.001) assessments showed a statistically significant thermal hyperalgesia compared to the preoperative baseline values (16.67±0.51 and 16.45±0.42 sec; p=0.997) in two groups. This decrease in both tactile and thermal thresholds returned to baseline control values at the 7th day of measurement.CONCLUSIONS:Our results showed that patients undergoing coronary artery bypass surgery receiving fentanyl anesthesia developed postoperative tactile allodynia and thermal hyperalgesia and this was more prominent in high dose group.

Background: This study aimed to determine whether there was any association between the intensity of intraoperative gaseous microembolic signals (GME), neuropsychological testing and clinical outcome in high-risk patients undergoing coronary artery surgery (CABG). Methods: Over a 6-month period, GME activity was monitored in 102 Euroscore 6+ patients during cardiopulmonary bypass (CPB) with a conventional 32-micron arterial filter by non-invasive, real-time ultrasonic device. Cognitive tests; line bisection, the Stroop test, finger tapping, and the Rey Auditory Verbal Learning Test were performed at baseline, postoperative one week and postoperative one month. Results: The distribution of GME activity showed that there were three groups of patients: >500 total emboli (n = 38); 250 to 500 emboli (n = 30) and <250 emboli (n = 34) at a detection level of 2% of the circuit diameter on the arterial side. Line bisection, the Stroop test and finger tapping were impaired significantly in >500 emboli patients versus control (<250 emboli) in postoperative week one, but resolved in one month. Conclusions: Correlation between intraoperative GME intensity and neurocognitive tests suggests that the level of GME might have a role in determining the psychological outcome after CABG with CPB.

BACKGROUNDCarotid body tumors are infrequent neoplasms in daily practice. Diagnostic difficulties exist because of their slow growth and asymptomatic progress. The surgical treatment is complicated and difficult due to their proximity to vascular and neural structures. In this study we present the results of 12 patients operated for carotid body tumor that underwent preoperative percutaneous direct embolization.PATIENTS AND METHODSThe data of 12 patients, diagnosed with carotid body tumor and surgically treated at our department between 2000 and 2010, was retrospectively analyzed. Duplex ultrasound, computerized tomography and selective carotid angiography were the applied diagnostic tools. Two days before the planned surgery all patients underwent percutaneous direct embolization to achieve devascularization of the tumor. Afterwards, surgical excision of the mass under general anesthesia was performed in all cases.RESULTSFive tumors were classified as Shamblin type I (41.7%), and the others were type II (58.3%). All masses were removed sub-adventitially and no vascular reconstruction was necessary. There was no mortality and no permanent neural damage. Malfunction of the tongue was observed in only one case, which recovered completely in one month. There was one recurrence detected by Duplex ultrasound and angiography during the follow up period.CONCLUSIONSSurgical excision is mandatory to be performed as soon as diagnosed in carotid body tumors. Preoperative direct percutaneous embolization of the mass helps to devascurize the tumor, enabling an optimal surgical procedure. The outcomes of such a combined intervention are excellent and neurovascular structure preservation decreases complication and morbidity rates.

Sternal dehiscence after cardiac surgery occurs infrequently and can lead to mediastinitis and prolonged hospital stay and may even result in death. The most common treatment for mechanical sternal instability is rewiring with wound debridement. We present a case in which a modified titanium mesh plate fixation technique was used. A safe and easy to perform technique, this method can be an alternative option to wire closure in a sternum with fractures, instability or poor bone quality.

ObjectivesThe small saphenous vein (SSV) lies in close relationship with sural nerve and is at risk of damage during surgery or vein ablation procedures on this vein. The aim of this study was to compare the effect of puncture site for SSV endovenous laser ablation (EVLA) on the rate of post-operative sural nerve injury.DesignRandomised controlled study.Patients and MethodsSixty patients with isolated SSV varicose veins (68 limbs) were randomised into two groups. All patients were treated with endovenous laser ablation procedures using radial fibres and a 1470 nm diode laser. In Group 1, SSVs were canulated from lateral malleolar part of the SSV. In Group 2, SSVs were canulated in the mid-calf. EVLA procedures were performed by using 12 W energy and 70 J cm−1 LEED (linear endovenous energy density). Local pain, ecchymosis, induration and paraesthesia in treated regions, vein diameter, treated vein length, tumescent anaesthesia volume, delivered energy were recorded. Follow-up visits were arranged on the 2nd post-operative day, 7th day, 1st, 2nd, 3rd and 6th months.ResultsThe mean SSV diameters at sapheno-popliteal junction (SPJ) and calf levels were Group 1 SPJ: 6.6 S.D. 1.2 mm, Calf: 5.1 S.D. 1.1 mm, and Group 2 SPJ: 6.8 S.D. 1.6 mm, Calf: 4.9 S.D. 1.3 mm. Adverse events after treatment were 1 patient with induration, 3 with ecchymosis and 6 minimal paraesthesia in Group 1 (malleolar) and 1 local pain, 4 minimal ecchymosis or induration and 1 paraesthesia in Group 2 (mid-calf). In Group 1 in two patients the paraesthesia lasted 2 months and then resolved spontaneously. In the remaining four patients’ paraesthesia resolved in less than 1 month without treatment. In Group 2 paraesthesia resolved spontaneously in two weeks. Induration, ecchymosis and local pain also resolved in less than 2 weeks in both groups. There was no recanalisation or reflux in the treated SSV of either group during the follow-up period.ConclusionTreatment of the SSV by endovenous laser ablation using a 1470 nm laser and a radial fibre is safe and effective. Puncturing the vein at mid-calf level causes less post-operative nerve injury without affecting the recanalisation rates.

Pneumoperitoneum developing after cardiopulmonary resuscitation may result either from visceral organ perforation or passage of mediastinal air via the diafragmatic hiatus of esophageus and aorta or directly through pleural and diafragmatic defects. A 77-year-old female patient was transferred to intensive care unit due to respiratory failure developing after coronary bypass surgery. Massive subcutaneous emphysema developed after tracheostomy. Tracheostomy cannula, therefore, was removed, and the patient was reintubated. Later acute cardiac arrest developed, and cardiopulmonary resuscitation was performed. Free air was detected below both diaphragms on chest radiograph. Conservative treatment was performed in the patient without peritoneal irritation signs or abdominal free fluid. Subdiaphragmatic free air completely disappeared after four days.

ObjectivesThe aim of this study is to compare efficacy, early postoperative morbidity and patient comfort of two laser wavelengths and fibre types in treatment of great saphenous vein (GSV) incompetence resulting in varicosities of the lower limb.DesignProspective randomised clinical trial.Materials and MethodsSixty patients (106 limbs) were randomised into two groups. They were treated with bare-tip fibres and a 980 nm laser in group 1 and radial fibres and 1470 nm laser in group 2 in order to ablate the GSV. Local pain, ecchymosis, induration and paraesthesia in treated regions, distance from skin, vein diameter, treated vein length, tumescent anaesthesia volume, delivered energy and patient satisfaction were recorded. Follow-up visits were planned on the 2nd postoperative day, 7th day, 1st, 2nd, 3rd and 6th months.ResultsMean GSV diameters at saphenofemoral junction and knee levels were 12.1 S.D. 4.3 mm and 8.2 S.D. 2.4 mm, and 11.8 S.D. 4.1 mm and 7.9 S.D. 2.6 mm respectively in groups 1 and 2. There were 14 patients with induration, 13 with ecchymosis and nine minimal paraesthesia in group 1 and no or minimal local pain, minimum ecchymosis or induration in group 2. Duration of pain and need for analgesia was also lower in group 2 (p < 0.05). There was significant difference on postoperative day 2, day 7 and 1st month control in favour of group 2 in venous clinical severity scores (VCSS).ConclusionTreatment of the GSV by endovenous laser ablation using a 1470 nm laser and a radial fibre resulted in less postoperative pain and better VCSS scores in the first month than treatment with a 980 nm laser and a bare-tip fibre.