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    An international multi-institutional analysis of operative morbidity in patients undergoing elective diverticulitis surgery
    (ASSOC MEDICA BRASILEIRA, 2022-01-01) Altinel, Yuksel; Cavallaro, Paul; Ricciardi, Rocco; Ozben, Volkan; Ozturk, Ersin; Bleday, Ron; Aytac, Erman; Bordeianou, Liliana; Stu, Members Turkish Diverticulitis
    OBJECTIVE: We investigated surgical complications of elective surgery for diverticulitis in international multi-institution to identify a prediction model for potential opportunities of quality improvement. METHODS: We identified 1225 patients who underwent elective surgery for diverticulitis between January 2010 and January 2018. The data were obtained from the National Surgical Quality Improvement Program and the Turkish Diverticulitis Study Group Collaborative, retrospectively. RESULTS: We observed that the presence of chronic obstructive pulmonary disease (OR: 3.2, 95\%CI 1.8???5.9, p<0.001) or abscess at the time of surgery (OR: 1.4, 95\%CI 1.2???1.7, p??0.001) is associated with a higher rate of minor complications, while comorbidities such as dyspnea (OR: 2.8, 95\%CI 1.6???4.9, p??0.001) and preoperative sepsis (OR: 4.1, 95\%CI 2.3???7.3, p??0.001) are associated with major complications. The centers had similar findings in minor and major complications (OR: 0.8, 95\%CI 0.5???1.4, p=0.395). The major independent predictors for complications were malnutrition (low albumin) (OR: 0.5, 95\%CI 0.4???0.6, p<0.001) and the American Society of Anesthesiology score (OR: 1.7, 95\%CI 1.2???2.4, p=0.002). CONCLUSION: Regarding the major and minor complications of diverticulitis of elective surgery, the malnutrition and higher American Society of Anesthesiology score showed higher impact among the quality improvement initiatives.
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    Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes
    (ELSEVIER SCIENCE BV, 2015-01-01) Karabulut, Ahmet; Cakmak, Mahmut
    Significant left main coronary artery (LMCA) stenosis is not rare and reported 3 to 10\% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES), extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion). However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI) with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI). In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.