Introduction: Hyperglycemia is common in patients with and without diabetes mellitus (DM) following cardiac surgery. Intra-and postoperative hyperglycemia has been shown to be an independent risk factor for deep sternal wound infection (DSWI) after cardiac surgery. However, whether the preoperative chronic glycemic control is associated with the risk of DSWI remains controversial. Hemoglobin A1c (HbA1c) provides a measure of glucose control over the prior 2-3 months. The aim of this study was to evaluate the relationship between preoperative HbA1c levels and DSWI in patients with DM undergoing coronary artery bypass grafting (CABG). Patients and Methods:Records of patients who underwent elective on-pump CABG were retrospectively reviewed. A total of 180 patients with DM were included in the study. Patients were excluded if their blood glucose levels were not adequately controlled in the perioperative period. A total of 200 consecutive patients without DM were taken as controls.Results: Median HbA1c levels were signifi cantly higher in patients with DM [8.16 (7.2-10.4)] than in controls [5.49 (5-6)] (p< 0.001). There was no signifi cant difference in DSWI incidence between patients with DM and controls [5% (n= 9) vs. 2% (n= 4); P= 0.1]. Hospital (p= 0.01) and intensive care unit stays (p= 0.005) were signifi cantly longer in patients with DM. Conclusion:We found that DSWI was not associated with preoperative HbA1c levels in patients undergoing CABG. In addition, with adequate glycemic control in the perioperative period, our study demonstrated no signifi cant difference with regard to DSWI between patients with DM and controls.Key Words: Mediastinitis; coronary artery bypass grafting; hemoglobin A1c; diabetes mellitus; deep sternal wound infection Kalp Cerrahisi Yapılan Hastalarda Derin Sternal Yara İnfeksiyonları ile HbA1c Seviyeleri Arasındaki İlişki ÖZETGiriş: Kalp cerrahisi yapılan hastalarda, diabetes mellitus (DM)'lu hastalarda olduğu kadar diyabetik olmayan hastalarda da hiperglisemi ile sık karşılaşılır. Kalp cerrahisi sonrasında intraoperatif ve postoperatif hipergliseminin derin sternal yara infeksiyonu (DSYİ) için bağımsız risk faktörü olduğu gösterilmiştir. Ancak, preoperatif kronik glisemik kontrolün DSYİ ile ilişkisi tartışmalıdır. Hemoglobin A1c (HbA1c) geçmiş 2-3 aylık dönemdeki glukoz düzeyi hakkında bilgi verir. Bu çalışmanın amacı koroner baypas cerrahisi yapılan DM'li hastalarda, HbA1c seviyeleri ile DSYİ arasındaki ilişkiyi incelemektir. Hastalar ve Yöntem:Kliniğimizde kardiyopulmoner baypas altında koroner baypas operasyonu yapılmış olan hastaların kayıtları retrospektif olarak incelendi. DM'si olan ve perioperatif periyodda yeterli glisemik kontrol sağlanmış 180 hasta çalışmaya dahil edildi. DM'si olmayan koroner baypas cerrahisi yapılmış ardışık 200 hasta kontrol grubuna dahil edildi. Bulgular: Medyan HbA1c değerleri diyabetik hasta grubunda anlamlı olarak daha yüksekti [8.16 (7.2-10.4 vs 5.49 (5-6), p< 0.001]. DSYİ sıklığı bakımdan iki grup arasında istatistiksel olarak anlamlı b...

We present our patients who underwent carotico-subclavian bypass operation either for subclavian steal syndrome or for subclavian artery revascularization prior to thoracic endovascular aneursym repair procedures. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : We performed 16 carotico-subclavian bypass operations between August 2009-November 2013 in our department. Nine patients were operated for subclavian steal syndrome with subclavian artery occlusion and 7 patients were operated before thoracic endovascular stent grafting for type III aortic dissection or the thoracic aneursym necessitating left subclavian artery occlusion. Fourteen male (87.5%) and 2 female (12.5%) patients with their ages ranging between 55-74 (mean 66.3) years were operated. All operations were performed under general anesthesia with a supraclavicular incision. In 14 patients, 8-mm Dacron grafts were used and in 2 patients 8 mm polytetrafluoroethylene grafts were used. Anastomoses were done in end-to-side fashion. R Re es su ul lt ts s: : Radial artery pulses were palpable in all the patients after the operation, and their complaints like left arm pain or dizziness were resolved. Early 30-day morbidity was 6.2 % with one patient experiencing puffiness and pain at the left shoulder two weeks after the operation, due to seroma which was drained percutaneously under ultrasonography guidance after diagnosis. No perioperative stroke or minor cerebrovascular events were observed. One patient who had a native carotid artery tortuosity and cerebral artery aneurysm suffered from carotid-subclavian bypass graft thrombosis 2 days after the operation, with an early graft thrombosis rate of 6.2 %. No carotid-subclavian procedure related mortalities were observed. Patients to have thoracic endovascular aortic repair (TEVAR) procedures with a requirement of intentional left subclavian artery (LSA) coverage were primarily operated for carotico-subclavian graft interposition to provide LSA revascularization, and subsequently TEVAR procedure was performed. C Co on nc cl lu us si io on n: : Carotico-subclavian bypass is a safe procedure with good surgical results. K Ke ey y W Wo or rd ds s: : Carotico-subclavian bypass; subclavian steal syndrome; vertebrobasilar insufficiency Ö ÖZ ZE ET T A Am ma aç ç: : Subklaviyan çalma sendromu nedeniyle veya torasik endovasküler girişimlere ek olarak uyguladığımız karotis-subklaviyan baypas ameliyatı sonuçlarımızı sunmaktayız. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Ağustos 2009-Kasım 2013 tarihleri arasında kliniğimizde 16 hastada karotis-subklaviyan baypas ameliyatı yapıldı. Dokuz hastada subklaviyan arter stenozu sonucu subklaviyan çalma sendromu olması nedeniyle, 7 hastada da tip III aort diseksiyonu ve anevrizması sebebiyle torasik endovasküler stent greftleme prosedüründe sol subklaviyan arterin kapatılması gereksinimi sebebiyle karotis-subklaviyan baypas ameliyatı yaptık. Hastaların 2'si kadın (%12,5) ve 14'ü erkek (%87,5) idi ve yaşları 55-74 (ortalama 66,3) yıl arasında değişiyordu. Tü...

Introduction The purpose of this study was to evaluate the relationship between the correction rate in Cobb angle and the improvement in quality of life profile in terms of Scoliosis Research Society (SRS)-22 values. Patients and Methods Between January 2007 and December 2013, posterior instrumentation and fusion was performed to 30 patients with adolescent idiopathic scoliosis (AIS). Patients were grouped according to their improvement rate in Cobb angles after surgery. Patients with an improvement rate of > 80% were grouped as Group A; those with an improvement rate of > 60% and ≤ 80% as Group B and those with an improvement rate of ≤ 60% were grouped as Group C. The SRS-22 questionnaire of these three groups was calculated and their relationship with the improvement in Cobb angle was evaluated. Results No statistical difference was found among the three groups in terms of pain, appearance, function, spirit, satisfaction, and SRS-22 values (all p > 0.05). Conclusion The results of this study demonstrate that the degree of correction rate does not correlate with the degree of improvement in the SRS-22 questionnaire in patients with AIS that underwent posterior fusion and instrumentation.

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