Purpose:Limb loss following lower extremity arterial injury is not uncommon and has serious implications on the patient’s life and functionality. This retrospective study was performed to analyze the results of lower extremity arterial injuries and to identify the risk factors associated with amputation.Methods:Between 2002 and 2009, retrospectively collected data on 140 patients with 173 lower extremity arterial injuries were analyzed.Results:There were 133 males (95%) and 7 females (5%). The mechanism of injuries was gunshot wounds in 56.4% of cases, stab wounds in 30%, and blunt trauma in 13.4%. Associated injuries included vein injury in 45% of cases, nerve injury in 16.4%, and bone fracture in 31.4%. The most frequently injured artery was superficial femoral artery (31.2%). More than 1 artery was injured in 18.6% of patients. Surgery was carried out, with a limb salvage rate of 90.4% and a survival of 97.1%. Amputation was performed in 75% of patients in whom only 1 artery was repaired, although all crural arteries were injured. Multivariate logistic regression analysis showed that significant risk factors of outcome were below-knee multiple arterial injuries (odds ratio [OR] 6.62, P < 0.001), associated 2-bone fractures (OR 2.71, P = 0.003), development of compartment syndrome (OR 1.94, P = 0.042), and great soft tissue disruption (OR 1.74, P = 0.010).Conclusions:Limb loss may be decreased by performing prophylactic fasciotomy more often and by repairing at least 2 crural arteries.

ObjectivesPostoperative pneumonia is a devastating complication after cardiac surgery that increases morbidity and mortality. The objective of this study was to identify potential risk factors for the development of nosocomial pneumonia post cardiac surgery by the way of logistic regression analysis.DesignData of the last 162 patients undergoing cardiac surgery before November 2009 were retrospectively collected and analysed.ResultsThe mean age of the patients was 65.57 ± 10.48 years and 83 (51%) were male. Postoperative pneumonia was diagnosed in 21 (13%) patients. The mean remaining time in the intensive care unit and mean length of hospitalisation were longer for patients with postoperative pneumonia. Pre-operative heart rate, previous diabetes mellitus, previous chronic obstructive pulmonary disease, postoperative urea, creatinine and potassium levels, extubation time, postoperative atrial fibrillation, and number of units of transfused packed red blood cells (pRBC) and fresh frozen plasma were associated with higher occurrence of postoperative pneumonia on univariate analysis.ConclusionsOn logistic regression analysis, pRBC transfusion, previous chronic obstructive pulmonary disease and postoperative atrial fibrillation remained as independent predictors for the development of postoperative pneumonia.

On-pump versus off-pump CABG is not significantly associated with AF development so long as the operating time does not extend over a certain time period. pRBC transfusion was the single risk factor that is amenable to intervention at the time of operation. Unneeded transfusion of pRBCs must be prohibited. Also, serious precautions must be taken against postoperative pneumonia to avoid postoperative AF occurrence.

Based on these results, it is estimated that measurement of irisin along with lactate may prove to be a useful parameter in monitoring the coronary bypass surgery and irisin may be a significant marker of hypothermia. Beside CK-MB, TnT and BNP, measurements of irisin concentration in open heart surgery may also be useful parameters for the panel of myocardium injury.

In patients with mixed mitral valve disease, MVR enhanced LV and LA remodeling resulting in better NYHA function. Preoperative NYHA, LVEF, and LVESd were significant predictors of postoperative LV function.