Abstract:Objective -This study was conducted to determine whether HbA1c is a predictor of short term mortality and morbidity after coronary artery bypass graft operation. Methods -The coronary artery bypass graft operation was performed on the patients between January 2009 and January 2013. Each patient's medical record was retrospectively reviewed. The patients who were included in the study were evaluated in groups of 60. One group was comprised of nondiabetic patients, whose HbA1c level is below 6% (the control group 0), the other included diabetic patients with the HbA1c level is between 6-6.9% (the group 1) and the last group, group 2, included those patients with HbA1c level is equal or greater than 7%. Pre, peri and post operation data was compared. The deaths that occured in the first 30 days were evaluated as mortality and complications as morbitity. Results -While mortality was not observed in the control group, one incident was observed in group 1 and 5 in group 2, which corresponds to 1.7% and 8.3% respectively. The mortality ratio in the group with patients whose HbA1c was greater or equal to 7% found statistically significant compared to the control group (P=0.02). The following parameters were observed in group 2 and were found statistically significant: the need for dialisis (25%, P<0.01), atrial fibrillation (33%, P=0.01), revision due to bleeding (10%, P=0.18), cerebrovascular event (16,7%, P=0.01), duration of mechanic ventilation (19.5±21.6, P=0.06), duration of hospital stay (approximately 9.91±5.35 days, P=0.01), infection in scar (53%, P<0.01), mediastenit (11%, P=0.01) and urinary tract infection (10%, P=0.01) Conclusion -We concluded that in those diabetic patients that elective coronart artery bypass graft is applied, highly reactive HbA1c levels (HbA1c ≥7), may indicate morbitity in the early stages of post operation.

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Papillary fibroelastomas (PFEs) are primary cardiac tumors. They are rare benign tumors that occur on the endocardium of the heart, especially on the heart valves. The majority of these benign tumors have been observed on the left side of the heart and involved the aortic and mitral valves; however, occurrence on the right side of the heart has been infrequently reported, with only a few cases documented on the pulmonary valve. Most patients with PFEs are asymptomatic and the tumors are usually found incidentally. The tumors have the potential to cause systemic or pulmonary embolism or obstructive phenomena. We present a rare case of a papillary fibroelastoma occurring on the pulmonary valve with clinical presentation due to pulmonary artery obstruction. The tumor was removed surgically.

Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95%. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.

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