Objective:This study aimed to assess the effect of new generation oral, direct factor Xa inhibitor rivaroxaban on intimal hyperplasia and smooth muscle cell proliferation at the carotid artery anastomosis site of rabbits.Methods:In total, 14 New Zealand male rabbits weighing 3–3.5 kg were randomized into two groups. Group A (7 rabbits) served as the control group and received no medication. Rivaroxaban was perorally administered to group B (7 rabbits) mg/kg/day for 28 days. Following anesthesia induction, carotid arteries were dissected through a right neck incision. following heparinization at 100 IU/kg, vertical full thickness arteriotomy was performed, then was repaired continuously with 8-0 polypropylene. At day 28, all rabbits were sacrificed and the anastomosed carotid artery segments were analyzed using light microcopy. Hematoxylin–eosin and Masson’s trichrome stained images were analyzed using a digital image analysis program, and lumen diameter, lumen area, intimal and medial thickness, and media areas were measured and results were compared.Results:In the serial sections, the average lumen diameter of group B was higher than that of group A (p=0.001). The lumen areas of group B were also higher than those of group A (p=0.004). The intimal thickness of group B was lower than that of group A (p=0.001). When the section series were evaluated for media thickness, the thickness of group B was lesser than that of group A; the difference was statistically significant (p=0.002).Conclusion:This study may imply a potential midterm benefit of rivaroxaban following arterial anastomosis by reducing intimal proliferation and restenosis.

BackgroundPatent ductus arteriosus is a common congenital cardiac condition. Its importance is mostly underestimated and accepted as an “easy” heart disease. Physiological consequences of pulmonary overflow may cause severe mortality in premature neonates. Accurate timing of surgical intervention is essential to decrease the mortality in very low birth weight premature infants. On-site surgery in the intensive care units (ICUs) results excellent surgical quality without jeopardizing the safety of the patients.MethodsWe have summarized the clinical and operative data of 26 premature neonates (<37 weeks of gestational age), which were operated for the diagnosis of PDA in the ICUs of Dokuz Eylül University. Thirteen low birth weight infants (<1000 gr) have been compared with remaining 13 neonates (>1000 gr).ResultsThere was no surgical mortality in both groups. Co-existing problems were observed in both groups, which did not affect surgical mortality and morbidity.ConclusionsSurgery in the ICU is a safe method for premature neonates with physiologically significant PDA. This technique should be the method of choice in experienced centers.

The hearing function of 50 children with bacterial meningitis was evaluated at the second and 10th days, and eight weeks after admission with auditory brain system responses (ABR) to investigate whether meningitis causes hearing loss. Normal values were obtained in all tests from both ears of 24 patients (48 per cent). Twelve patients (24 per cent) had temporary, and seven (14 per cent) patients had persistent mild degree hearing loss. Severe hearing loss was detected bilaterally in five (10 per cent) patients and unilaterally in two (four per cent) patients. Patients with other complications such as subdural effusion, convulsion, brain oedema and paralysis were found to have a higher incidence of hearing loss. We observed that patients treated with dexamethasone had 7.7 per cent persistent hearing loss, 11.6 per cent mild hearing loss, 34.6 per cent transient hearing loss, but in the group who did not receive dexamethasone there was 19.2 per cent persistent hearing loss, 15.3 per cent mild hearing loss and 11.6 per cent transient hearing loss. There were other signficant differences between the two groups in restoration of normal body temperature, the CSF/plasma glucose concentration ratio was elevated, CSF (cerebro-spinal fluid) protein concentration was decreased and the cell count in the CSF was decreased in the dexamethasone group, significantly more than the group who were not receiving dexamethasone. The hearing loss tended to be more frequent among younger children.

This study aims to assess the relation between late term arteriovenous fistula thrombosis and alteration in hemogram parameters before the occurrence of thrombosis in hemodialysis patients with end-stage renal failure. Materials and Methods: Data of three hemodialysis centers in our city were evaluated retrospectively. The results of hemogram values before thrombosis formation at first and third month in 14 re-operated patients between March-September 2017, owing to late term fistula thrombosis occurrence, who previously had a successful fistula access, were compared to 73 patients still having hemodailysis therapy via fistula access. Results: Statistically significant increments were measured in neutrophile to lympocyte ratio, red blood cell distribution width, mean platelet volume, platelet distribution width parameters in fistula thrombosis developed patients compared to their previous results three months before thrombosis formation and control group. No significant relation was found between thrombosis formation and other parameters in hemogram. Conclusion: Herein, it's determined that a profound examination of hemogram has a predictive value for late term fistula thrombosis in hemodialysis patients.

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Background Thrombocytopenia (platelet count below 150 x 103/μL) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non–heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors. Materials and Methods In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 103/μL on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis. Results A total of 501 patients were diagnosed as having non–heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 103 vs.117 x 103/μL; p < 0.001). Moderate-severe thrombocytopenia was associated with age ≥80 years odds (OR = 9.026, 95% CI: [1.757–46.363]; p = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867–5.114]; p < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638–14.889]; p = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923–64.023]; p = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046–1.420]; p = 0.011). Conclusion Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject.

Introduction: Ventricular septal defect (VSD) is the most common congenital heart anomaly. In surgical treatment, the transatrial approach is frequently utilized because of causing less right bundle block and ventricular scarring. However, some VSDs are obscured by the chordae tendineae or a pouch formation of the septal leaflet; therefore, alternative techniques are required. In such cases, tricuspid valve detachment (TVD) provides a complete visualization and ease to access to ventricular septal defects. In this study, we evaluated the results of the patients of whom we performed TVD. Patient and Method: Our study includes 50 patients who underwent TVD during the procedure with the diagnosis of perimembranous VSD. Patients were examined by transthoracic echocardiography (TTE) before and after operation and the valvular functions are evaluated. All patients were kept in follow up for 3 months after discharge. Results: The mean age of the patients was 27.56±34.81 months. At the end of the study, all patients were in New York Heart Association class I. There was no residual shunt through VSD. Except 4 patients with mild tricuspid regurgation (TR), the TTE has not revealed any TR in majority of patients. Conclusion: We suggest that, in appropriate patients, VSD closure can be performed safely with a TVD application thru an incision of the septal leaflet of the tricuspid valve without any adverse effect on function or growth at of the valve at midterm follow-up.

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