Background: To date, no validated biomarkers with high sensitivity and specificity have been established for diagnosis of pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). There is a need to develop simple and reliable noninvasive tests that can accurately identify patients with PE, even in small hospitals or clinics. The aim of this study was to investigate the value of mean platelet volume (MPV) and platelet distribution width (PDW) for predicting occurrence of PE in patients with DVT. Methods: Records of acute DVT patients were reviewed retrospectively. Group 1 consisted of 50 patients with acute DVT and group 2 consisted of 50 patients with acute DVT who developed PE during follow-up. The control group consisted of patients with uncomplicated primary varicose veins of the lower limbs. Venous peripheral blood samples for measurement of MPV, PDW, and platelet count were drawn on admission, before the treatment, and at the time of PE diagnosis. Results: MPV and PDW levels at the time of PE diagnosis were higher in group 2 than group 1 (P,0.001 and P=0.026, respectively). Receiver operating characteristics analysis revealed that a 5.2% increase in admission PDW during follow-up provided 70% sensitivity and 82% specificity (area under the curve, 0.80), and a 6.6% increase in admission MPV during follow-up provided 74% sensitivity and 83% specificity (area under the curve, 0.84) for prediction of PE occurrence in patients with DVT. PDW and MPV levels at the time of PE diagnosis were found to be independent risk factors for the occurrence of PE in patients with DVT. Conclusion: Serial measurements of MPV and PDW, and percent change in MPV and PDW appears to be a useful marker for predicting occurrence of acute PE in patients with a first episode of acute proximal DVT.

Delayed presentation of a thoracic aortic injury is an extremely rare complication after spine surgery. We report a case of delayed presentation of a thoracic aortic injury with a vertebral pedicle screw after posterior spinal surgery without periaortic hematoma, hemorrhage or pseudoaneurysm formation and review the relevant literature.

Background: Acute inferior ST-segment elevation myocardial infarction (STEMI) is associated with increased in-hospital morbidity and mortality particularly among patients with coexisting right ventricular (RV) involvement. High neutrophil to lymphocyte ratio (NLR) is an independent predictor of major adverse cardiac events and mortality in patients with myocardial infarction. This study evaluated the relationship between the NLR and RV dysfunction (RVD) in patients with inferior STEMI who underwent primary percutaneous coronary intervention (PCI). Methods: A total of 213 subjects with inferior STEMI were divided into two groups according to the presence of RVD. The groups were compared according to NLR and receiver operating characteristic (ROC) analysis was performed to access the predictability of NLR on having RVD. Results: The NLR was significantly higher in the group with RVD compared to that without RVD (p < 0.001). In ROC analysis, NLR > 3.5 predicted RVD with sensitivity of 83% and specificity of 55%. In a multivariate regression analysis, NLR remained an independent predictor of RVD (OR 1.55, p < 0.001

Background and aimIn our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis.Patients and methodsNinety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications.ResultsThe number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1–10) days.ConclusionLaparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases.

Red cell distribution width (RDW) and the neutrophil/lymphocyte ratio (NLR) are predictors of cardiovascular risk that have been shown to correlate with impaired reperfusion and increased morbidity and mortality in patients with an ST-segment elevation myocardial infarction (STEMI). We hypothesized that RDW and the NLR would be associated with failed thrombolysis. One hundred and two STEMI patients were included in the study; 32 had failed thrombolysis while the other 70 fulfilled the criteria for successful thrombolysis. Thrombolysis failure was defined as a need for rescue percutaneous coronary intervention (PCI), in-hospital mortality, unplanned PCI during hospitalization or complete occlusion of the culprit coronary artery on follow-up angiography. RDWs were compared between patients with failed or successful thrombolysis. There were no significant differences in the demographic or clinical baseline characteristics of the two groups. The mean RDW was significantly higher in the failed thrombolysis group than in the successful thrombolysis group (P = 0.028). The cutoff RDW value for failed thrombolysis was more than 14.3 fl with a sensitivity of 90.6% and a specificity of 61.4% (area under the curve, 0.774; 95% confidence interval, 0.680-0.851; P < 0.001) on receiver operating characteristics curve analysis. In addition, the prevalence of failed thrombolysis was significantly higher in patients with an RDW more than 14.3 fl than in those with an RDW of 14.3 fl or less (51.8 and 6.5%, respectively, P < 0.001 by multivariate analysis). The NLR was significantly higher in patients with an RDW more than 14.3 fl than in those with an RDW 14.3 fl or less (4 ± 2.5 and 2.8 ± 1.5, respectively, P = 0.007). RDW and the NLR may be used as adjunctive readily available factors for assessment of thrombolysis outcome upon admission.

ObjectivePostpericardiotomy syndrome (PPS), which is thought to be related to autoimmune phenomena, represents a common postoperative complication in cardiac surgery. Late pericardial effusions after cardiac surgery are usually related to PPS and can progress to cardiac tamponade. Preventive measures can reduce postoperative morbidity and mortality related to PPS. In a previous study, diclofenac was suggested to ameliorate autoimmune diseases. The aim of this study was to determine whether postoperative use of diclofenac is effective in preventing early PPS after cardiac surgery.MethodsA total of 100 patients who were administered oral diclofenac for postoperative analgesia after cardiac surgery and until hospital discharge were included in this retrospective study. As well, 100 patients undergoing cardiac surgery who were not administered nonsteroidal anti-inflammatory drugs were included as the control group. The existence and severity of pericardial effusion were determined by echocardiography. The existence and severity of pleural effusion were determined by chest X-ray.ResultsPPS incidence was significantly lower in patients who received diclofenac (20% vs 43%) (P<0.001). Patients given diclofenac had a significantly lower incidence of pericardial effusion (15% vs 30%) (P=0.01). Although not statistically significant, pericardial and pleural effusion was more severe in the control group than in the diclofenac group. The mean duration of diclofenac treatment was 5.11±0.47 days in patients with PPS and 5.27±0.61 days in patients who did not have PPS (P=0.07). Logistic regression analysis demonstrated that diclofenac administration (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18–0.65, P=0.001) was independently associated with PPS occurrence.ConclusionPostoperative administration of diclofenac may have a protective role against the development of PPS after cardiac surgery.

Objectives. Coronary collateral circulation (CCC) may limit the size of right ventricular (RV) infarcts but does not fully explain the relationship between CCC and clinical adverse events in patients with inferior STEMI. In this study, it was aimed to assess the relationship between preintervention angiographic evidence of CCC and clinical outcomes in patients with inferior STEMI who have undergone percutaneous coronary intervention. Methods. A total of 235 inferior STEMI patients who presented within the first 12 hours from the symptom onset were included. CCC to the right coronary artery (RCA) before angioplasty were angiographically assessed, establishing two groups: 147 (63%) patients without CCC and 88 (37%) with CCC according to presence of CCC. Results. RV infarction, complete atrioventricular block, VT/VF, cardiogenic shock, and in-hospital death were noted less frequently in patients with CCC than in those without CCC. Absence of CCC to RCA was found to be the independent predictor for in-hospital death among them (odds ratio 4.0, 95% CI 1.8–12.6; p = 0.03). Conclusion. Presence of angiographically detectable CCC was associated with better in-hospital outcomes including RV infarction, complete AV block, cardiogenic shock, and VT/VF in patients with inferior STEMI.

BACKGROUND The most important purpose of transplantation is to improve quality of life (QOL) together with increasing life expectancy. The aim of this study was to compare the QOL of both donors and kidney transplant recipients and a control group at the 3rd and 9th postoperative months by using the SF36 health survey, to investigate the changes in this 6-month period and to evaluate descriptive data and satisfaction of patients and donors. MATERIAL AND METHODS Forty-seven donors and 47 kidney transplant recipients who were operated on in Diyarbakir Gazi Yasargil Training and Research Hospital between August 2012 and March 2015 and had been followed up for at least 9 months and 47 healthy controls were enrolled in the study. RESULTS Physical functioning (PF) was higher at the 9th postoperative month compared to the 3rd month in the recipient group (p=0.028). Donors had higher PF (p=0.007) and functioning physical role (PR; p=0.01) compared to recipients. Recipients had lower PF (p=0.016), PR (p=0.004), and functional-emotional role (ER; p=0.03) at the 3rd month and had lower PR (p=0.002) at the 9th month postoperatively comparing to the control group. Donors had lower PF (p=0.007) and PR (p=0.01) at the 3rd month and had lower PR (p=0.035) at the 9th month postoperatively comparing to the control group. Donors and recipients had similar QOL at the 9th month. CONCLUSIONS During follow-up, we observed an increase in QOL (in some subgroups) at 9 months postoperatively. Donors and recipients had similar QOL (except for PR) with the control group at the 9th month. QOL was better in younger and male patients and educated persons. Donors did not show any regret regarding their donation.