Although acute aortic dissections with bilateral carotid artery involvement are rare, they have serious morbidity and mortality rates. The most important strategy in cases with carotid involvement is to provide adequate cerebral perfusion during cardiopulmonary bypass. In this case, we presented, aortic dissection with bilateral carotid involvement was detected in the patient who was admitted to the emergency department with severe chest pain, vision loss, and left arm monoplegia, and the decision for surgery was made urgently. Selective cerebral perfusion was provided throughout the operation with direct bilateral carotid cannulation, in terms of being the fastest method and providing adequate cerebral flow. During the discharge period, full recovery was achieved in neurological deficits without any sequelae. We think that the technique we have applied in such a difficult and complicated case is the best strategy because it is fast and effective.

Background: This study aimed to investigate the incidence of postoperative atrial fibrillation (POAF) in patients undergoing off-pump versus on-pump coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods: A total of 3,197 consecutive patients (1,816 males, 1,381 females; mean age: 60.8 ± 9.8 years) with preoperative sinus rhythm who underwent CABG at a cardiovascular surgery clinic between November 2009 and March 2014 retrospectively were analyzed. Of the patients, 1,680 underwent on-pump and 1,517 underwent off-pump cardiac surgery. Data, including demographic characteristics, preoperative risk factors, preoperative medications, laboratory test results, postoperative data and complications, and mortality and morbidity rates, were recorded. Results: According to the multivariate analysis, the type of operation, number of anastomoses, right coronary artery or right coronary posterior descending artery graft, vasopressor therapy (epinephrine, norepinephrine), operation duration, age >60 years, hypertension, length of hospital stay >4 days, and obstructive sleep apnea syndrome (OSAS) were the independent predictors of POAF after CABG. Our study results suggest that on-pump CABG under CPB is correlated with POAF. Conclusion: We recommend using off-pump CABG in select cases to minimize the risk of POAF.

Objective: In this study, we investigated whether the addition of vitamin B complex to prime solution for cardiopulmonary bypass (CPB) in cobalamin-deficient patients undergoing on-pump coronary artery bypass grafting (CABG) helps prevent the development of postoperative delirium (POD). Materials and Methods: In the present study, 69 of 138 patients with serum vitamin B12 levels <200 pg/mL based on the blood sample taken within 1 week prior to on-pump CABG between January 2013 and December 2017 were enrolled. The control group included 69 patients. Vitamin B complex (25 mg vitamin B1, thiamine hydrochloride, 2.734 mg vitamin B2, riboflavin phosphate ester monosodium, 5 mg vitamin B6, pyridoxine hydrochloride, 15 mcg vitamin B12, 50 mg niacinamide, and 17.2 mg D-panthenol) was added to the prime solution for CPB in the study group. The Intensive Care Delirium Screening Checklist (ICDSC) was used for the diagnosis of POD, and the severity of delirium was assessed by using the Delirium Rating Scale-Revised-98 (DRS-R-98). Results: Twenty-nine patients in the control group (42%) and 18 patients (26%) in the study group developed POD (P = .017), delirium severity scores were higher in the control group (16.5 ± 2.9 versus 15.03 ± 2.48, P = .034). Logistic regression analyses showed vitamin B complex was an independent protective factor for preventing the development of POD in patients undergoing on-pump CABG (odds ratio [OR]: 0.23, 95% confidence interval [95% CI]: 0.06-0.83, P = .025). Conclusion: On the basis of the results of our study, the addition of vitamin B complex to the prime solution for CPB decreases the incidence of POD in cobalamin-deficient patients undergoing on-pump CABG.

N-acetylcysteine (NAC) is an antioxidant which works as a free radical scavenger and antiapoptotic agent. N-acetylcysteine-amide (NACA) is a modified form of NAC containing an amide group instead of a carboxyl group of NAC. Our study aims to investigate the effectiveness of these two substances on erythrocyte deformability and oxidative stress in muscle tissue. Materials and Methods. A total of 24 Wistar albino rats were used in our study. The animals were randomly divided into five groups as control (n: 6), ischemia (n: 6), NAC (n: 6), and NACA (n: 6). In the ischemia, NAC, and NACA groups, 120 min of ischemia and 120 min of reperfusion were achieved by placing nontraumatic vascular clamps across the abdominal aorta. The NAC and NACA groups were administered an injection 30 min before ischemia (100 mg/kg NAC; 100 mg/kg NACA; intravenous). Blood samples were taken from the animals at the end of the ischemic period. The lower extremity gastrocnemius muscle was isolated and stored at −80 degrees to assess the total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values and was analyzed. Results. The erythrocyte deformability index was found to be statistically significantly lower in rats treated with NAC and NACA before ischemia-reperfusion compared to the groups that received only ischemia-reperfusion. In addition, no statistically significant difference was found between the control group and the NAC and NACA groups. The groups receiving NAC and NACA before ischemia exhibited higher total antioxidative status and lower total oxidative status while the oxidative stress index was also lower. Conclusion. The results of our study demonstrated the protective effects of NAC and NACA on erythrocyte deformability and oxidative damage in skeletal muscle in lower extremity ischemia-reperfusion. NAC and NACA exhibited similar protective effects on oxidative damage and erythrocyte deformability.

How to cite/Atıf için: Atılgan K, Demirdaş E, Er CZ, Çiçekçioğlu F. Evaluation of deep vein thrombosis incidence with respect to age and gender in light of regional factors in central Anatolia: A population-based study.