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Multiligament injury and knee dislocation: Current approaches to surgical management

Multiligament injury of knee is usually the result of sports injury and trauma. Multiligament injury that caused by high-energy trauma often shows the coexistence with fracture and fracture-dislocation. It is vital to perform the surgical procedure in the correct order. Disruption of at least 2 of the 4 primary knee ligaments is called multiligament injury of knee. In most cases that also accompanied by knee dislocation, may seem reduced radiologically, but it is important to keep an eye open for the risk of vascular and nerve pathologies. Decision making in the multiligament injury of knee has some controversies, especially surgical versus conservative treatment, repair versus reconstruction of injured ligamentous structures, acute versus late surgery, and single versus two-staged surgery of injured ligaments. This review investigates the diagnosis and treatment of the multiligament injuries of knee. Possible complications, surgical tip and tricks were also shared with our clinical experiences.

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Protection from renal injury with popliteal artery micro-puncture and minimized radiographic contrast use with critical SFA lesions, low EGFR, and high creatinine levels

Aim: In recent years endovascular treatment of symptomatic peripheral arterial disease (PAD) provides many  advantages like fast application, fast recovery and low cost in many cases. And it is recommended as a primary  revascularization strategy in a wide range of many PAD patients rather than surgical treatment of symptomatic  peripheral arterial disease (PAD). However optimal methods of catheter-based treatment for renal insufiency  patients remain controversial. Material and Method: In Yeditepe University Faculty of Medicine Hospital between  2017-2018, we performed endovascular treatment with ipsilateral popliteal artery puncture of 18 patients. Pre-op  creatinin , EGFR and post-operative creatinin levels and puncture area complications were compared. Results:  Primary end-point was technical success with popliteal access without any post-operative complications and  low dosage contrast usage. Secondary end-point was 3 months follow-up stenosis degree. No punction area  complications were notted. None of patients had any hematoma, ecchymosis or pseudoaneurisyms in puncture  area. And after procedure none of patients had to have dialisysis treatment despite high level of kreatinin and  low EGFR values. In third month control follow-up patients were asymptomatic and no recurren vascular disease  was seen in doppler usg. Discussion: As a conclusion, balloon angioplasty performed with ipsilateral popliteal artery  micro-puncture with manually low dosage opaque use, allows the shortest way to access the target lesion  and it protects the kidney from opaque toxication with minimizing the amount of opaque usage for superficial  femoral artery lesions. Therefore, renal protection was ensured before and after the operation without dialysis  in diabetic patients with low EGFR and borderline high creatinine levels in the study group. Furthermore, the  incidence of complications is lower with popliteal artery micro-puncture than femoral artery puncture.

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Intraoperatively Taken and Used Autologous Blood Transfusion; A Cost-Effective and Beneficial Way of Blood Transfusion in Cardiac Surgery: A Retrospective Clinical Trial

Aim: In recent years autologous blood transfusion (ABT) seems to be more beneficial than allograft blood transfusion  in coronary artery bypass, major vascular surgery and other surgeries that have increased elective blood  transfusion risk. This current retrospective controlled study aimed to show that the intraoperatively taken and  transfused ABT (iABT) is practical, beneficial and cost-effective. Material and Method: Cardiac surgery patients  were investigated from January 2017 to November 2018. Fifty-eight patients’ clinical data were investigated.  During the process; the cross-clamp time and the extracorporeal perfusion time, volume of blood loss, blood  transfusions needed were investigated. During the intensive care unit hospitalization extubation, ICU hospitalization  time, the volume of blood loss, blood transfusions needed were examined. Also, total hospitalization time,  the total volume of blood loss, total blood transfusions required, 30 days of mortality and one year of mortality  were investigated. Results: Fifty-eight patients’ (23 female and 35 male) clinical data were investigated. ICU time  was significantly shorter than the patients who were not transfused with iABT (p<0.05). Intraoperative, ICU stay,  and total blood loss were significantly lower than who were not transfused with the iABT(p<0.05). Discussion:  This current study showed that the iABT is more beneficial than allograft blood and blood products transfusions.  The iABT is related to less blood loss in operation and during the ICU stay, causing decreased risk of complications.  According to less blood loss, fewer blood products transfusion is also a cost-effective benefit.

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