Background: Early mobilization of patients in the postoperative period after open heart surgeries, significantly decreases the risk of complications, accelerates the restoration of functional capacity, shortens the length of hospital stay, and reduces treatment costs
Materials and methods: Open heart surgeries were performed on 60 patients at Ankara "Bayındır" Hospital, Central Clinical Hospital, and Baku Health Center were included in the study. Patients were divided into two groups. 30 of them underwent the procedure with the use of multi-component balanced general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization under high thoracic epidural anesthesia, with the administration of ropivacaine prior to induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects.
Results: Thirty of them underwent the procedure with the use of multi-component general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization of the high epidural space with the administration of ropivacaine before induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects.
Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings.
Diagnosing malignant pancreatic neoplasms presents a challenging task fraught with the possibility of diagnostic errors due to similarities with other pathologies such as pancreatitis, neuroendocrine tumors, and cystic formations. The key diagnostic method is contrast-enhanced multi-detector computed tomography, yet even this method has certain limitations that may affect diagnostic accuracy.Through the analysis of clinical cases, typical errors accompanied by visual characteristics that can be misleading in differential diagnosis have been identified. Hypodensity and tissue structure alterations, changes in ducts, or mass effect may be common features of both cancer and pancreatitis. Comparing visual signs with the clinical picture and employing additional methods aids in reaching a more precise diagnosis.It is important to note that rare pathologies such as serous oligocystic adenoma and intraductal papillary mucinous neoplasm may also pose additional challenges for accurate diagnosis due to their unusual characteristics on computed tomography scans.The conclusions of the study underscore the importance of a multimodal approach to diagnosing malignant pancreatic neoplasms, including the use of various imaging methods to ensure an accurate diagnosis and the selection of the most appropriate treatment strategy
Introduction. Renal transplantation is the best treatment option for end-stage renal disease, but organ demand continues to overweight organ supply. The transplantation of kidneys from donors with small renal masses represent a potential avenue to expand the donor pool. We represent the clinical case of kidney transplantation from living related donor with small renal mass and performed literature review of results of these cases.
Methods. Саse presentation of kidney transplantation from living related donor with incidental finding of small renal mass. Mass was excised and subsequently kidney was engrafted successfully. Up to date both patients are under follow up during 8 months and any signs of recurrence were seen.
Results. Donor kidney was procuredby laparosopic hand-assissted technique. Intraoperatively small renal mass was encountered whereas during preop evaluation renal cyst was diagnosed. Renal mass was excised fully and defect was closed with interruptive suture. Histological evaluation has revealed highly differentiated renal cell carcinoma. Postoperative period was uneventful. Patient was discharged with good graft function.
Conclusion. Careful use of kidneys from donors with single renal masses is feasible and safe, with an overall recurrence rate of less than 1.5%. The use of such kidneys could help alleviate the organ shortage crisis.
Background. Bilirubin is a byproduct of the breakdown of erythrocytes. Bilirubin levels can potentially serve as a biomarker for cardiovascular risk assessment. In this study, we would be investigating most recent manuscripts, published in the last 5 years, that studied association of serum bilirubin level to atherosclerosis progression to elicit how strongly low level of total bilirubin can prognose the disease progression.
Methods. Using Pubmed search engine, all articles that included
Keywords
Total Bilirubin Level, Atherosclerosis, Meta-Analysis
Background. Non-alcoholic fatty liver disease and type 2 diabetes mellitus or impaired glucose tolerance are common diseases with a high risk of developing cardiovascular diseases, the leading cause of disability and death. Our aim is to develop new methods for screening, prevention, and treatment of cardiovascular diseases in patients with non-alcoholic fatty liver disease, type 2 diabetes mellitus, and impaired glucose tolerance.
Methods and methods. This study is single-center, open-label, uncontrolled, diagnostic study. Between 2023 and February 2024, 216 patients with cardiovascular diseases and concomitant non-alcoholic fatty liver disease, type 2 diabetes, and impaired glucose tolerance were selected at Heart Center “University Medical Center” Corporate Fund.
Results. All examined patients with cardiovascular diseases and concomitant non-alcoholic fatty liver disease showed increased liver enzyme activity. Blood lipid profile indicators were significantly higher than optimal levels for patients with cardiovascular diseases. There was also a significant increase in liver enzymes, C-reactive protein, triglycerides, and lipoproteins in patients with cardiovascular diseases and non-alcoholic fatty liver disease combined with type 2 diabetes and impaired glucose tolerance.
Conclusion. Liver enzyme activity, C-reactive protein, glucose, and lipid profile analysis showed significant increases in these indicators in patients with cardiovascular diseases and non-alcoholic fatty liver disease, especially in the presence of type 2 diabetes and impaired glucose tolerance. All examined patients showed increased liver enzyme activity and lipid levels, indicating the impact of these diseases on the liver and metabolism.
Background. Bile duct injury is a potentially life-threatening condition characterized by high morbidity and mortality, which occurs as a result of erroneous manipulation during surgical intervention, such as incorrect identification of the ducts, improper clipping, or thermal injury. The aim of the study is to investigate the effectiveness of laparoscopic hepaticojejunostomy in patients with post-cholecystectomy bile duct injuries and compare it with traditional open techniques. Materials and
Methods. A retrospective analysis of the results of laparoscopic and open hepaticojejunostomy in patients with bile duct injuries from 2017 to 2023 was conducted.
Results. Laparoscopic surgery was performed on 28 patients, while open surgery was performed on 57 patients. Statistically significant differences were noted in the presence of external biliary fistula, diameter of the anastomosis, duration of the operation, postoperative complications, and postoperative period. There were no significant differences in the frequency of intraoperative complications.
Conclusion. The laparoscopic approach in treating bile duct strictures classified as Strasberg E1 - E2 is safe and effective.
Keywords
Bile duct injury, cholecystectomy, laparoscopic hepaticoejunostomy, hepaticoejunoanastomosis
The current treatment algorithm for patients with non-valvular atrial fibrillation (AF) includes anticoagulation to prevent stroke and systemic embolism, improvement of AF symptom control by heart rate reduction or restoration and maintenance of sinus rhythm, and treatment of cardiovascular and other comorbidities. The evaluation of patients with AF should be structured and include assessment of stroke risk, symptom severity, severity of the AF burden (type of arrhythmia, number and duration of episodes, etc.) and predisposing condition. The use of the CHA2DS2-VASc (risk of stroke), HAS-BLED (risk of bleeding), EHRA (severity of AF symptoms), and 2MACE (risk of cardiovascular outcomes) scales is important to help assess the likelihood of adverse outcomes and select the optimal treatment to protect not only against stroke but also against cardiovascular events. It should be noted that the HAS-BLED scale is primarily necessary for identification of bleeding risk factors, the modification of which allows to increase the safety of anticoagulant therapy, and a high index value according to this scale can’t serve as a reason to refuse anticoagulation in a patient with AF. New scales of stroke and hemorrhagic complications risk assessment in patients with AF on the basis of clinical parameters and laboratory biomarkers have been proposed, but their possible advantages over the existing indices need to be confirmed in special studies.
