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Our ultrafiltration experience in open heart surgery patients with chronic renal failure

Aim: Open-heart surgery is common in patients with chronic renal failure due to coronary artery and valve diseases. Ultrafiltration can be performed intraoperatively to reduce excess volume and level of inflammatory cytokines. In this study, we aimed to investigate the results of our ultrafiltration applications in patients over 18 years of age, who were diagnosed with chronic renal failure and underwent open-heart surgery and compare the results with the literature. 

Materials and Methods: Sixty-two chronic renal failure patients over 18 years of age who underwent ultrafiltration during open-heart surgery in Bursa Yüksek İhtisas Hospital between April 2015 and September 2018 were evaluated. Demographic data, comorbidities, cardiopulmonary bypass, aortic cross-clamp and operation times, laboratory values, extubation times, intensive care unit and hospital stay and developing complications were investigated retrospectively.

Results: It was determined that 24 of the patients who underwent ultrafiltration during cardiopulmonary bypass were female and 38 were male. Thirty-five patients underwent open-heart surgery due to coronary artery disease and 27 patients due to valve pathologies. The mean age of our patients was 53.17 ± 16.1 years. The most common comorbidities were hypertension (56.45%) and diabetes mellitus (37.1%). Arterial blood gas findings after ultrafiltration revealed a significant increase in hemoglobin and hematocrit values compared to that before ultrafiltration (p <0.05). Postoperative complications included 3 (4.83%) pneumonia, 4 (6.45%) bleeding revisions, 4 (6.45%) arrhythmias, and 3 (4.83%) neurological complications. The number of cases resulting in mortality was 5 (8.1%).

Discussion: Ultrafiltration is routinely performed in open-heart surgery in patients diagnosed with advanced stage chronic kidney failure. It has positive effects on reducing mortality and morbidity. Our results are compatible with the values in the literature.

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The development of a scale to determine the effect of folkloric beliefs in the orthopedic and traumatology field

Aim: In Turkish society, there are general beliefs about treatment, but there is no scale to categorize these beliefs about treatment and measure the prevalence in society. Therefore, the aim of this study was to develop a general beliefs scale for the orthopedic and traumatology field. 

Materials and Methods: A scale comprising 25 items was applied to 698 individuals in face-to-face interviews and the data obtained were analyzed. The data were applied with confirmatory factor analysis from structural equivalence modeling. The 20th item was seen to disrupt the fit at this stage and was removed from the scale, leaving 24 items in 5 dimensions of “public beliefs about orthopedic treatment practices, beliefs related to treatment orientation, beliefs about fractures and nutrition, beliefs about infancy, and beliefs about orthopedic specialists”.

Results: The model created with confirmatory factor analysis was determined to show perfect fit. The determination of valid fit with confirmatory factor analysis indicated that structural validity was present. The Cronbach α value for the reliability of the scale was 0.886, indicating that the scale is very reliable.

Discussion: With reliability and validity confirmed, it was concluded the scale developed could be used to measure the effect of folkloric beliefs in the orthopedic and traumatology field.

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Reformate images in lung cancer: Are axial images enough in preoperative evaluation?

Aim: The T descriptor not only reflects a potentially different prognosis but may also change treatment. Unfortunately, due to workload and time constraints, many clinicians only evaluate axial plans preoperatively. Since the longest tumor axis is not always aligned with the axial, we assessed the longest measured dimension of the entire tumor on reconstructed computed tomography (CT) in the lung window setting.

Methods: The study included 57 out of 99 consecutive patients who underwent complete resection due to lung cancer between January 2008 and December 2012. Forty-two patients were excluded as the inoperable, and lesion was regressed after adjuvant chemotherapy. During the three years of follow-up, ten cases died.

Results: In the comparison differences between the tumor diameter in CT (p=0.02), the pathological tumor diameter (p=0.003) were found statistically significant. Localization was evaluated as incorrect in four cases. Other planes gave the most accurate results in determining the localization. In the best way, fissure invasion was detected in the sagittal plane, while the pleural invasion was discovered in the coronal plane but missed on axial. As for the lesion size was 8% more than the axial, and this difference was less in the others. Although axial is significantly different from other groups (p<0.01); because of this, the stage of only two patients changed.

Discussion: Reformat imaging provided more information about the tumor and hence the prognosis. Mainly, Thoracic wall, pleural invasions in centers without Magnetic Resonance Imaging or patients it cannot be used alternatively, and fissures were determined more precisely. 

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