Kardiyak cerrahi ile iliþkili akut böbrek hasarý da (CSA-AKI), yaklaþýk %30 oranýnda olup, postoperatif geliþen AKI nedenleri arasýnda ikinci sýrada yer almaktadýr. AKI; artmýþ morbidite, mortalite ve hastanede kalýþ süresi ile iliþkilidir. CSA-AKI insidansý, AKI’nin tanýmlamasýna baðlý olarak deðiþmekte, RIFLE, AKIN ve en son “Kidney Disease: Improving Global Outcomes (KDIGO)” kriterlerleri tanýmlanmýþ ve günümüzde kullanýlmaktadýr.
CSA-AKI etyopatogenezinde; eksojen ve endojen toksinler, metabolik anomaliler, iskemi-reperfüzyon hasarý, inflamasyon ve oksidatif stres gibi birçok faktör yer almaktadýr. Birçok kez bu etyolojik nedenler tek baþlarýna deðil, perioperatif dönemde hemodinamik instabilite, mikrosirkülatuar disfonksiyon, kardiyopulmoner bypass sýrasýnda pompa akýmý ve perfüzyon basýncý, hipotermi, hemodilusyon ve transfüzyon gibi faktörler ayný anda bulunup hasar oluþturma riskini katlanarak arttýrmaktadýrlar.
Ayrýca preoperatif dönemde hasta ile iliþkili; CSA-AKI riskini arttýran birçok faktör belirtilmiþtir. Cerrahi yöntem ve hasta ile iliþkili faktörlerin etkileþimi bu hastalarda, renal fonksiyonlarýn azalmasýna yol açmaktadýr. Renal fonksiyonlarýn ölçümünde kullanýlan, idrar çýkýþý ve serum kreatinin deðerlerinin AKI tespitindeki sýnýrlýlýklarý nedeniyle, daha duyarlý parametrelere ihtiyaç duyulmaktadýr. Bu nedenle böbrek fonksiyonlarýnýn bir belirteci olduðu düþünülen, Sistatin C ilk olarak postoperatif AKI’nin erken tespiti için kullanýlmýþ, ancak henüz net kanýtlar bulunamamýþtýr. Son dönemde; Ýnterlökin-18 (IL-18), Nötrofil Gelatinaz ile Ýliþkili Lipokalin (NGAL), Ýnsulin-like Growth Factor-Binding Protein 7 (IGFBP7 ) ve Tissue Inhibitor of Metallproteinases 2(TIMP-2) gibi daha duyarlý ve erken dönemde tespit edilebilen biyobelirteçlerin; hem CSA-AKI, hem de genel olarak AKI’nin tespiti için kullanýlabileceðini belirten literatür verileri bulunmaktadýr.

Acute renal injury (CSA-AKI) associated with cardiac surgery is about 30% and is the second most common cause of AKI. AKI; increased morbidity, mortality and hospital stay. The incidence of CSA-AKI varies depending on the definition of AKI, RIFLE, AKIN and the latest Kidney Disease: Improving Global Outcomes (KDIGO) criteria are defined and is used today.
In the etiopathogenesis of CSA-AKI; exogenous and endogenous toxins, metabolic anomalies, ischemia-reperfusion injury, inflammation and oxidative stress. Many times these etiological factors, not alone, increase the risk of hemodynamic instability during perioperative period, microcirculatory dysfunction, pump flow during cardiopulmonary bypass and perfusion pressure, hypothermia, hemodilution and transfusion.
It is also associated with the patient preoperatively; There are several factors that increase the risk of CSA-AKI. The interaction of surgical method and patient-related factors leads to a decrease in renal function in these patients. More sensitive parameters are needed due to the limitations of urine output and serum creatinine levels used in the measurement of renal function. Therefore, Cystatin C, which is thought to be a marker of renal function, was initially used for early detection of post-operative AKI, but no clear evidence has yet been found. Recently; More sensitive and early detectable biomarkers such as Interleukin-18 (IL-18), Neutrophil Gelatinase-Associated Lipocalin (NGAL), Insulin-like Growth Factor-Binding Protein 7 (IGFBP7) and Tissue Inhibitor Metallproteinases 2 (TIMP-2); There are literature data indicating that both CSA-AKI and generally AKI can be used for detection.

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GÝRÝÞ ve AMAÇ: Bu çalýþmada konjenital kalp cerrahisi yapýlan pediyatrik hastalarda sepsis sýklýðý ve sepsis ile iliþkili risk faktörleri deðerlendirildi
YÖNTEM ve GEREÇLER: Bu çalýþmaya 289 hasta prospektif olarak alýndý. Hastalar, Society of Critical Care Medicine (SSCM) taný ölçütlerine göre Grup I'de, sepsis kriterlerini saðlayan 28 hasta ve Grup II'de sepsis tanýsý almayan 261 hasta olmak üzere iki gruba ayrýldý. Demografik bilgiler, operasyon tipi, kompleksite, preoperatif hastanede yatýþ süresi (> 5 gün) ve yoðun bakým ünitesinde (YBÜ) kalýþ, mekanik ventilasyon ihtiyacý(MV), pulmoner hipertansiyon öyküsü (PHT) ve acil cerrahi giriþim ihtiyacý, toplam kardiyopulmoner baypas(KPB) ve aortik kros klemp(AKK) süreleri kaydedildi. Postoperatif dönemde gecikmiþ sternum kapanmasý, mekanik ventilasyon süresi, reentübasyon ve reoperasyon ihtiyacý kaydedildi.
BULGULAR: Sepsis insidansý % 4.74 idi. Septik hastalarda mortalite oraný % 32 idi. Sepsis ile iliþkili faktörler genç yaþ, düþük vücut aðýrlýðý, preoperatif hastanede yatýþ süresi ve YBÜ kalýþ süresi, preoperatif MV, palyatif giriþimler, acil cerrahi, PHT öyküsü, uzun süreli MV, reentübasyon ve reoperasyon idi. Çok deðiþkenli analiz, reintubasyon ve entübasyon süresini sepsis için majör risk faktörü olarak tanýmlandý
TARTIÞMA ve SONUÇ: Pediatrik hastalarda sepsis gibi ciddi enfeksiyon problemleri, baðýþýklýk mekanizmalarýnýn yetersiz geliþmesi nedeniyle rastlanmaktadýr. Ameliyat için hastalarýn uygun preoperatif hazýrlýklarý, hastanede ve YBÜ'de kalma sürelerinin azaltýlmasý ve hastalarýn optimal bir süre için ekstübasyona tabi tutulmasýyla tekrar entübasyon gereksiniminin azaltýlmasý sepsis nedeniyle ölüm oranýný azaltacaktýr.

INTRODUCTION: This study aims to evaluate the incidence of sepsis and risk factors associated with sepsis in pediatric patients who underwent congenital heart surgery.
METHODS: 289patients were prospectively enrolled in this study. Patients were divided into two groups according to the Society of Critical Care Medicine (SSCM) diagnostic criteria as GroupI including 28 patients who fulfilled the criteria for sepsis and GroupII including 261 patients who were not diagnosed to have sepsis. Demographic information, type of operation, complexity, duration of preoperative hospitalization(>5 days) and intensive care unit(ICU) stay, requirements of mechanical ventilation(MV), history of pulmonary hypertension(PHT), and requirements of emergency surgery, total cardiopulmonary bypass(CPB) and aortic cross-clamp(ACC) times. During the postoperative period delayed sternal closure, duration of MV, the need for reintubation, and need for reoperation were also recorded.
RESULTS: The incidence of sepsis was %4.74. The mortality rate in septic patients was 32%. Factors associated with sepsis were younger age, low body weight, duration of preoperative hospitalization and ICU stay, preoperative requirement of MV, palliative and emergency surgery, history of PHT, prolonged MV, reintubation, and reoperation. Multivariate analysis identified reintubation and duration of MV as the major risk factors for sepsis
DISCUSSION AND CONCLUSION: Serious infectious problems, such as sepsis, are encountered due to inadequate development of immune resistance mechanisms in pediatric patients. Appropriate preoperative preparation of patients for surgery, reducing the length of stay in the hospital and in the ICU, and reducing the need for reintubation by extubation of the patients for an optimal period, would reduce the mortality rate due to sepsis.

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GÝRÝÞ ve AMAÇ: Giriþ: Çocuklarda santral venöz kateter ve arter kateteri takýlmasý damar çapý küçük olduðundan güçlükler içerir. Ultrasonografi ile kateterizasyon zaman ve malzeme tasarrufu ile birlikte giriþim baþarýsý artmýþ, komplikasyonlarda da azalma olmuþtur. Bu çalýþmanýn amacý çocuklara anatomik iþaret ve ultrasonografi eþliðinde santral venöz kateter ve arter takýlmasý yöntemlerini; zaman, malzeme, cerrahi, atriyal kateter takma yönlerinden karþýlaþtýlmasýdýr.
YÖNTEM ve GEREÇLER: Hastane etik komite onayý alýndýktan sonra, prospektif, vaka kontrollü, ard arda 1’er yýllýk sürelerde, 1.yýl anatomik iþaret (Grup A, n=151) ve ikinci yýl ultrasonografi (Grup B, n=151) yöntemleri kullanýlarak, 10 kg'ýn altý, santral venöz kateter ve/veya arter takýlan vakalar çalýþmaya dahil edildi.
BULGULAR: Grup A ve Grup B’de sýrasý ile tüm vakalarýn toplam santral venöz kateter takma süresi 78 saat, 37 saat, fark 41 saat idi (p<0,005). Grup A ve Grup B’de sýrasý ile tüm vakalarýn toplam arter kateteri takma süresi 96 saat, 63 saat, fark ise 33 saat idi (p<0,005). Kullanýlan toplam kateter sayýsý Grup A’da 203, Grup B’de 167 ve aradaki fark 36 bulundu. Kateterizasyon için cerrahi set kullanýmý 9 adet (Grup A: 8 set, Grup B: 1 set) idi (p<0.05). Toplam kateterizasyon süreleri (ameliyathane saatlik kullaným fiyatý olan 3.200 TL), kullanýlan kateter ve cerrahi set dikkate alýndýðýnda iki gruptaki ayný sayýdaki vakalar için 241.620 TL net iyileþtirme saðlandýðý görüldü.
TARTIÞMA ve SONUÇ: Ultrasonografi kýlavuzluðunda yapýlan santral venöz kateter ve arter kateteri yerleþtirilmesi, anatomik iþaret ile karþýlaþtýrýldýðýnda anlamlý derecede daha kýsa zamanda yapýldý. Ultrasonografi ile yapýlan kanülasyonlarda daha az malzeme kullanýldý. Hastane maliyetlerinde azalma saðlamasý nedeniyle özellikle düþük aðýrlýklý çocuk hastalarda ultrasonografi kullanýlmasý akla getirilmelidir.

INTRODUCTION: Insertion of a central venous catheter and an arterial catheter in children involves difficulties because the vessel diameter is small. With catheterization time and material saving by ultrasonography, the success of the procedure increased and the complications decreased. The aim of this study was to investigate the methods of insertion of central venous catheter and artery in the presence of anatomical signs and ultrasonography; time, material, surgery, atrial catheter insertion aspects of comparison.
METHODS: After obtaining hospital ethics committee approval, using prospective, case-controlled, first year anatomical signs (Group A, n = 151) and second year ultrasonography (Group B, n = 151) guidance methods in 1-year period catheter insertion into the superior vena cava and / or arteries in patients less than 10 kg, were included in the study.
RESULTS: In Group A and Group B, the total time of insertion of central venous catheter was 78 hours, 37 hours and 41 hours, respectively (p <0.005). In Group A and Group B, total arterial catheter insertion time was 96 hours, 63 hours and the difference was 33 hours, respectively (p <0.005). The total number of catheters used was 203 in Group A, 167 in Group B and 36 in Group B. The use of surgical set for catheterization was 9 (Group A: 8 sets, Group B: 1 set) (p <0.05). Total catheterization times (operating room hourly usage price is 3.200 TL), the catheter and surgical set used in the same number of cases in the two groups taken into account a net improvement of TL 241.620 was achieved.
DISCUSSION AND CONCLUSION: Ultrasonography guided central venous catheter and arterial catheter placement were performed in a significantly shorter time compared to the anatomical sign. Less material was used in the cannulations performed by ultrasonography. Due to the reduction in hospital costs, the use of ultrasonography should be considered in especially low-weighted children.

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GÝRÝÞ ve AMAÇ: Kalp cerrahisi geçiren pediyatrik hastalarda kan ve kan ürünleri transfüzyonu kaçýnýlmaz olabilmektedir. Çalýþmamýzda, bu hastalarda, kan ve kan ürünlerinin transfüzyonu ile iliþkili faktörlerin ve risklerin belirlenmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Preoperatif demografik veriler, kardiyopulmoner bypass (KPB) ve operasyon süresi, KPB giriþindeki, KPB sýrasýndaki ve ayrýlmadan sonraki, operasyon sonundaki hematokrit ve hemoglobin deðerleri kaydedildi. KPB sýrasýnda ulaþýlan en düþük vücut ýsýsý, intraoperatif dönemde kullanýlan kristalloid, kolloid, eritrosit süspansiyonu (ES), taze donmuþ plazma (TDP), trombosit süspansiyonu (TS), kriyopresipitat miktarý kaydedildi. Postoperatif dönemde; yoðun bakým ünitesinde (YBÜ) verilen kan ve kan ürünleri miktarý, YBÜ’nde ve hastanede kalýþ süreleri, mortalite kaydedildi.
BULGULAR: Çalýþmaya 83 çocuk dahil edildi. ES transfüzyonu RACHS1: 3 olan hastalarda, RACHS1: 2 olan hastalardan yüksekti (p=0,009). Yaþ ile postoperatif ES, intraoperatif ve postoperatif dönemdeki toplam ES ve toplam TDP transfüzyonu arasýnda negatif korelasyon saptandý. KPB süresi ile intraoperatif ES ve TDP, postoperatif ES, TDP, kriyopresipitat tüketimi, toplam ES ve toplam TDP tüketimi arasýnda pozitif korelasyon belirlendi. Siyanotik çocuklarýn intraoperatif ES ve TDP tüketimi asiyanotik çocuklardan yüksekti (ES p=0,002; TDP p=0,002). Postoperatif dönemde siyanotik çocuklarýn kriyopresipitat tüketimi yüksekti (p=0,026). 15 hastanýn eksitus olduðu belirlendi. Eksitus olan hastalarda postoperatif dönemdeki ES ve TDP (ES p=0,004, TDP p=0,003), toplam ES ve TDP miktarýnýn yüksek olduðu saptandý (toplam ES p=0,001, toplam TDP p=0,003).
TARTIÞMA ve SONUÇ: Açýk kalp cerrahisi geçiren çocuklarda intraoperatif ve postoperatif transfüzyon oranlarýnýn hastanýn yaþý, RACHS1 skoru, KPB süresi, vücut ýsýsý ve siyanoz ile iliþkili olduðu belirlenmiþtir. Eksitus olan hastalarda ES ve TDP transfüzyon miktarlarýnýn yüksek olduðu saptanmýþtýr.

INTRODUCTION: Transfusion of blood and blood products may be unavoidable in pediatric patients undergoing cardiac surgery. The aim of this study was to determine the factors and risks associated with transfusion in these patients.
METHODS: Preoperative demographic data, duration of cardiopulmonary bypass (CPB) and operation time were recorded. At the beginning of CPB, during the CPB and at the end of the operation hematocrit and hemoglobin values were recorded. The lowest body temperature during CPB, intraoperative crystalloid, colloid, blood, blood products consumptions were recorded. The consumption of blood and blood products, length of stay intensive care unit (ICU) and hospital, and mortality were recorded during the postoperative period.
RESULTS: 83 children were included in the study. Intraoperative erythrocyte transfusion was higher in patients with RACHS1: 3 than in patients with RACHS1: 2 (p=0.009). There was a negative correlation between age and postoperative erythrocyte, total erythrocyte and total fresh frozen plasma (FFP) transfusion. There was a positive correlation between CPB duration and intraoperative erythrocyte and FFP, postoperative erythrocyte, FFP, cryoprecipitate consumption, total erythrocyte and total FFP consumption. The intraoperative erythrocyte and FFP consumption, the postoperative cryoprecipitate consumption were higher in cyanotic children (Erythrocyte p=0.002; FFP p=0.002, cryoprecipitate p=0.026). 15 patients died. Postoperative erthrocyte and FFP, total erythrocyte and FFP consumption were higher in the patients who died (total erythrocyte p=0.001, total FFP p=0.003).
DISCUSSION AND CONCLUSION: Amount of transfusion were related to age, RACHS1, CPB duration, body temperature, cyanosis in children undergoing open heart surgery. Erthrocyte and FFP transfusions were higher in the patients who died.

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GÝRÝÞ ve AMAÇ: Nörolojik hasarlanma kalp cerrahisinin en ciddi komplikasyonlarýndan biridir. Bu yazýda açýk kalp cerrahisi yapýlan merkezimizde son iki yýlda postoperatif tip 1 nörolojik hasar geliþmiþ hastalarý deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastanemizde son 2 yýlda 2689 hastanýn açýk kalp cerrahisi geçirdiði saptandý. Bunlarýn içinde postoperatif dönemde aþikar nörolojik hasar geliþen 50 hasta tespit edildi. Bu hastalarýn verilerine elektronik veri tabanýndan ve arþivden dosya taramasý yapýlarak ulaþýldý.
BULGULAR: Verilerine ulaþýlan 50 hasta deðerlendirildi. Hastalarýn yaþ ortalamasý 60,4 ± 10,2 yýl olarak bulundu. Hastalarýn % 61,2’sine hipertansiyon, % 22,4’üne diyabet eþlik etmekteydi.Hastalara uygulanan prosedürler sýklýk sýrasýna göre %54 koroner baypas cerrahisi, %20 çoklu cerrahi prosedürler ve %14 aort cerrahisiydi. Ortalama KPB süresi 131,1 ± 58,6 dk idi. Buna göre serebrovasküler olay etyolojisinde %90 oranýnda embolinin neden olduðu iskemik inme gözlenirken, %10 hastada hipoperfüzyona baðlý inme görülmüþtür.SVO sonrasý kalýcý hasar %56 hastada bulundu. Mortalite ise 17 hastada (%34) mevcuttu.
TARTIÞMA ve SONUÇ: Araþtýrma sonucunda hastanemizde açýk kalp cerrahisi sonrasýnda aþikar nörolojik hasarlanma oraný %1,9 bulundu. Literatürde bununla ilgili olarak %0,5-5,4 gibi geniþ bir aralýk verilmiþtir. Hastalarýmýzdaki nörolojik hasarlanmanýn etyolojisinde daha çok intraoperatif embolik faktörlerin yer aldýðýný düþünmekteyiz.

INTRODUCTION: Neurological injury is one of the most serious complications of cardiac surgery. In this study, we aimed to evaluate patients who had postoperative type 1 neurological injury after open heart surgery in the last two years in our center.
METHODS: In our hospital, 2689 patients underwent open heart surgery in the last two years 50 patients with obvious neurological damage were detected postoperatively. The data of these patients were obtained from by electronic database and files scanning from the archive.
RESULTS: Fifty patients who achieved the data were evaluated. The mean age of the patients was 60,4 ± 10,2 years. 61,2% of the patients had hypertension and 22,4% had accompanied by diabetes. Procedures applied to the patients were 54% coronary bypass surgery, 20% multiple surgical procedures and 14% aortic surgery. The mean duration of CPB was 131,1 ± 58,6 min. Accordingly, in the etiology cerebrovascular event,while ischemic stroke caused by emboli was observed in 90%, hypoperfusion related stroke was observed in 10% patients. Permanent damage after SVO occurred in 56% of patients. Mortalite was observed in 17 patients(34%).
DISCUSSION AND CONCLUSION: In our study, the rate of obvious neurological injury after open heart surgery was 1,9% in our hospital. A large range of 0,5-5,4% is given in the literature. We think that intraoperative embolic factors are more involved in the etiology of neurological injury in our patients.

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GÝRÝÞ ve AMAÇ: Hastanemizde 15 yýllýk dönemde mitral kapak onarýmý-anuloplasti operasyonu yapýlan olgularda uygulanan farklý tekniklerin erken ve orta dönem sonuçlara etkisini saptamak.
YÖNTEM ve GEREÇLER: Mitral kapak onarýmý uygulanan 262 olgu retrospektif olarak hastane veri tabaný yardýmýyla, ameliyat ve poliklinik izlemleri toplanarak çalýþmaya alýndý. Davet yöntemiyle çaðrýlarak %91 hastaya ulaþýldý. Farklý onarým tekniklerinin (Kay, Wooler, Bayazýt büzme (uçkur) yöntemi, halka anuloplasti teknikleri, papiller adele onarýmý ve kordaplasti) erken ve orta dönemde klinik ve ekokardiyografik sonuçlara etkisi araþtýrýldý.
BULGULAR: Hastalarýn %67’si kadýn (n=177) ve yaþ ortalamasý 31,2±12 (5-64) olarak saptandý. Etiyolojik olarak olgularýn %74’ü romatizmal, %18’i endokardit ve %14’ünde dejeneratif kapak hastalýðý ön plandaydý. Postoperatif 3 olguda kanama, 1 olguda tamponad nedeniyle revizyon uygulanmýþtýr. Hastane mortalitesi 11 olgu ile %4,2 oranýnda görüldü.
Hastalar 1189 hasta yýlý takip edilmiþ olup; reoperasyon oraný %1,5/hasta yýlý, tromboemboli insidansý %2,3 (%0,5 /hasta yýlý) olarak bulunmuþtur, bir olguda antikoagulana baðlý kanama saptanmýþtýr (%0,08/hasta yýlý). Hastalarýn 5 yýl yaþam oranlarý %88±3 olarak bulunmuþtur. Mitral onarým yapýlan hastalarýn 8’inde gebelik ve baþarýlý doðum gerçekleþti.
Farklý mitral onarým tekniklerinin erken-orta dönem mortalite, reoperasyon, tromboemboli açýsýndan anlamlý farklýlýk oluþturmadýðý saptandý (p>0,05). Yine anuloplasti ringi kullanýlan ve kullanýlmayan olgularýn karþýlaþtýrýlmasýnda fark saptanmamýþtýr (p=0,092)

TARTIÞMA ve SONUÇ: Romatizmal hastalýk grubu ve doðurganlýk dönemindeki kapak hastalarýnda; mitral kapak onarýmý düþük hastane mortalitesi, iyi erken ve orta dönem sonuçlarýyla, özellikle akla gelmeli ve uygulanmalýdýr. Onarým tekniðinin mortalite ve morbidite üzerinde etkisi bulunmasa dahi, performans ve yaþam kalitesi konusunda ileri çalýþmalara gerek vardýr.

INTRODUCTION: To determine short and mid-term results of different techniques on patients who underwent mitral valve repair – annuloplasty surgery in a span of 15 years in our hospital.
METHODS: 262 patients who underwent mitral valve repair were included in the study. The effects of different repair techniques (Kay, Wooler, Bayazýt shir (drawstring), ring annuloplasty techniques, papillary muscle repair and cordaplasty), in early and medium period, on the clinical and echocardiographic results were investigated.
RESULTS: 67% of the patients were female (n = 177) and the mean age was 31.2±12 (5-64). Etiologically, 74% of the cases were rheumatic, 18% had endocarditis and 14% suffered from degenerative valvular disease. Hospital mortality rate was 4,2% with 11 cases.
The patients were followed up for 1189 patient years. The rate of reoperation was 1.5% / patient year, the incidence of thromboembolism was 2.3% (0.5% / patient year), and one patient had hemorrhage due to anticoagulant (0.08% / patient year). The 5-year survival rate of the patients were 88±3%. 8 patients who underwent mitral repair had successful pregnancies and gave birth.

DISCUSSION AND CONCLUSION: Different mitral repair techniques did not show any significant difference in terms of early-mid-term mortality, reoperation, and thromboembolism (p> 0.05). There was no difference in the comparison of patients with and without annuloplasty ring (p = 0,092).
Mitral valve repair, due to its good early and mid-term results, as well as low hospital mortality rates, should be considered and utilized on patients in rheumatic disease group and patients in the period of fertility.

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GÝRÝÞ ve AMAÇ: Kardiyak cerrahi, sonrasýnda birçok önemli komplikasyonun olduðu karmaþýk patofizyolojik durumlar içerir. En önemli komplikasyon olan böbrek yetmezliði artmýþ morbidite ve mortalitaden sorumludur.
YÖNTEM ve GEREÇLER: 2016-2018 yýllarý arasýnda hastanemizde yapýlan 2600 açýk kalp ameliyatý geçiren hastalarýn dosyalarý retrospektif olarak tarandý.
BULGULAR: 2600 açýk kalp ameliyatý geçiren hastalarýn 105 tanesinde, postoperatif renal yetmezlik geliþmiþtir.
TARTIÞMA ve SONUÇ: Renal yetmezlik; erkek cinsiyet, diabet ve periferik damar hastalýðý, önceden geçirilmiþ miyokard enfarktüsü, kötü ejeksiyon fraksiyonu (<%50), anemi, kontrast madde maruziyeti, nonsteroid antiiflamatuar (NSAÝ) ve antihipertansif ilaçlar, uzamýþ kardiyopulmoner baypas (KPB) süresi ile iliþkilidir.

INTRODUCTION: Cardiac surgery involves complicated pathophysiologic conditions, which are followed by many important complications. Renal failure, the most important complication, is responsible for increased morbidity and mortality.
METHODS: The files of the patients who underwent 2600 open heart surgeries in our hospital between 2016-2018 were retrospectively reviewed.
RESULTS: Postoperative renal failure developed in 105 of 2600 patients undergoing open heart surgery.
DISCUSSION AND CONCLUSION: Renal failure is associated; male sex, diabetes and peripheral vascular disease, previous myocardial infarction, poor ejection fraction (<50%), anemia, contrast agent exposure, nonsteroidal anti-inflammatory drugs (NSAIDs) and antihypertensive drugs, prolonged cardiopulmonary bypass (CPB).

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Santral venöz kateterizasyon, hastanede yatan hastalarda sýkça kullanýlan taný ve tedavide yardýmcý, malpozisyon, rüptür gibi komplikasyonlara sebep olabilen giriþimsel bir tekniktir. Yazimizda, koroner arter bypass greft cerrahisi preoperatif hazýrlýklarý yapýlan hastada, oldukça nadir gözlenen sol iç meme venine olan kateter malpozisyonunu deðerlendirmeyi amaçladýk. Sol iç meme venine olan bu beklen-medik kateterizasyon literatürde bildirilmiþ olmasýna raðmen, bu olgu, koroner arter hastasýnda in-traoperatif tespit edilen malpozisyonunun ilk raporu gibi görünmektedir.

Central venous catheterization is an interventional technique which is commonly used for helping diagnose ant treatment in hospitalized patients, also may lead to complications that malposition and rupture. In this article, we wanted to evaluate a very rare catheter malposition to left internal mammarian vein during coronary arteries bypass greft operation. Although unexpected catheterization into the left internal mammary vein has been reported in the literature. This case seems to be the first report to malposition detected intraoperatively in coronary artery disease

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17 yaþýnda erkek hasta traktörün göðsünün üzerinden geçmesi sonucu künt travma hikayesi ile hastanemize getirildi. Hasta perifer hastanede tek lümenli endotrakeal tüp ile entübe edilmiþ ve mekanik ventilasyon desteði verilmiþ. Göðüs sað ve sol tarafýna interkostal dren uygulanmýþ. Akciðer grafisinde yaygýn cilt altý amfizem, pnömomediastinum ve sol akciðerinde ekspansiyon kusuru vardý. Fiberoptik bronkoskopi yapýldý. Karina seviyesinde sað ana bronþun trakeadan komplet rüptüre olduðu görüldü. Hastaya acil torakotomi planlandý. Rüptür primer tamir edildi. Postop 7. gün sol akciðerde ekspansiyon kusuru vardý. Hasta tekrar opere edildi. Sol akciðer üst lobdaki nekrotik dokular ve hematom temizlendi. Bu olguda bronkoskopinin trakeobronþial yaralanmanýn teþhisinde en önemli prosedür olduðunu vurguladýk.

A 17-year-old male patient was admitted to our hospital with history of blunt trauma over chest (run over by a tractor). Patient was first attended at a peripheral hospital where he was intubated with single lumen endotracheal tube and given assisted mechanical ventilation. Intercostal drains were put on right and left side of chest. There were massive subcutaneous emphysema, pneumomediastinum and pneumothorax in left lung on chest X-ray. Fiber-optic bronchoscopy was performed. At the carina level, it was seen that the right main bronchus was completely ruptured from the trachea. Patient was planned for immediate thoracotomy. The rupture was repaired of a primary. On the seventh postoperative day, there was incomplet expansion of the left lung. The patient was reoperated. Necrotic tissues and hematoma in upper lobe of left lung were cleared. In this case, we emphasized that bronchoscopy is the most important procedure in the diagnosis of tracheobronchial injury.

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Amaç: Sepsis, enfeksiyona cevaben organ hasarýna ilerleyen ciddi bir týbbi durumdur. Dünyada önemli bir ölüm nedeni olarak, yoðun bakýmda araþtýrma ve tartýþma konusu olmaya devam etmektedir. Tedavi hýzlý tanýma, resüsitasyon, hemodinamik destek, enfeksiyon kaynaðýnýn kontrolünü ve erken antibiyotik tedavisini içerir. Hemodinamik destek; güçlü kanýtlarla noradrenalin ilk seçenektir.
Olgu sunumu: Seprik þoklu hastalar; Perfüzyon için gerekli olan doku, tansiyonun arteriyel deðerlerini saðlamak için yüksek dozda vazopressör ilaç kullanýyordu. Metilen mavisi ile muamele, yüksek ilaç dozlarýnýn azaltýlmasýnda faydalý olmuþtur.
Sonuç: Metilen mavisi birçok þok türünde kullanýlýr; Yan etkiler görünse de, septik þoktaki noradrenalin ek olarak kullanýlabilecek bir ajandýr. Maliyet çok önemli olduðunda; Daha uygun olan bu ilacýn hak ettiði önemi bulacaðýna inanýyoruz.

Background: Sepsis is a serious medical condition that progresses to organ damage in response to infection. As a major cause of death in the world, it continues to be the subject of research and discussion in intensive care. Treatment includes rapid recognition, resuscitation, hemodynamic support, control of the source of infection and early antibiotic therapy. Hemodynamic support; noradrenalin with strong evidence.
Case presentation: Patients with sepric shock; The tissue needed for perfusion was taking high-dose vasopressor medication to ensure arterial values of blood pressure. Treatment with methylene blue was beneficial in reducing high drug doses.
Conclusions: Methylene blue used in many types of shock; Although side effects are seen, noradrenaline in septic shock is an agent that can be a future competitor. When the cost is very important; We believe that this drug, which is more suitable, will find the deserved importance.

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