Excessive bleeding after cardiopulmonary bypass (CPB) is risk factor for adverse outcomes after elective cardiac surgery (ECS). Although many different point-of-care devices to diagnose hemostatic disturbances after CPB are available, the best test is still unclear. The study aim was to compare the accuracy of hemostatic disorder detection between two point-of-care devices. We enrolled 148 patients (105 male and 43 female) undergoing ECS in a prospective observational study. Rotational thromboelastometry (TEM, with InTEM test), and Activated coagulation time (ACT) measurement were performed 15 min after protamine administration. The cohort group was divided into two subgroups according to occurrence of excessive postoperative bleeding. Endpoints were defined in two ways: as total amount of chest tube output (CTO) and blood product transfusion requirements. Total amount of CTO value of 1507,50 mL presented 75th percentile of distribution, thus cut-off value for bleeder category. InTEM parameters, but not ACT, correlated significantly with CTO. InTEM parameters with the strongest correlation to CTO were tested for accuracy in predicting excessive postoperative bleeding using ROC analysis. InTEM A 10 value of 38 mm, InTEM A 20 value of 49 mm and InTEM A 30 value of 51 mm delineated bleeding tendency. Patients with total amount of CTO exceeding 75th percentile were more frequently transfused with fresh frozen plasma (51.4% vs. 9.9%, p < 0.001), fibrinogen concentrate (21.6% vs. 2.7%, p = 0.001) and platelet concentrate (13.5% vs. 0.9%, p = 0.004). Our study showed that InTEM test, but not ACT is useful in prediction of bleeding tendency after protamine administration following weaning from CPB. InTEM test could be used as a first line test in screening of possible hemostatic disorder following protamine administration.

Coronary artery disease remains the dominant cause of mortality in developed countries. While platelets have been recognized to play a pivotal role in atherothrombosis, the ideal antiplatelet regime after coronary artery surgery remains elusive. The evolution of CABG has presently moved beyond technical improvements to involve modulation of pharmacologic management designed to improve patient outcomes. The aim of this trial will be to test the hypothesis that the addition of clopidogrel to patients with documented postoperative aspirin resistance will reduce the incidence of major cardiovascular events. Patients scheduled for isolated coronary artery surgery will be eligible for the study. Patients in whom postoperative multiple electrode aggregometry documents aspirin resistance will be randomized into two groups. The control group will receive 300 mg of aspirin. The dual antiplatelet group will receive 75 mg of clopidogrel in addition to 300 mg of aspirin. Patients will be followed for 6 months. Major adverse cardiac and cerebrovascular events (death from any cause, myocardial infarction, stroke, hospitalization due to cardiovascular pathology) as well as bleeding events will be recorded. This will be the first trial that will specifically address the issue of dual antiplatelet therapy in patients undergoing coronary artery surgery who have been found to be aspirin resistant. In the event that the addition of clopidogrel proves to be beneficial in this subset of surgical patients, this study could significantly impact their future antiplatelet management. This randomized controlled trial has been registered at the ClinicalTrials.gov website (Identifier NCT01159639).

Background and Objectives: Sore throat is a common symptom that, due to its heterogeneous etiology and diverse clinical presentation, poses challenges for both accurate diagnosis and etiological treatment, making symptomatic therapy essential. Our review aims to provide an overview of the literature on locally applied flurbiprofen in the treatment of sore throat of both infectious and non-infectious etiologies. Materials and Methods: The database PubMed was searched for studies evaluating the effect of flurbiprofen on sore throat in the last ten years (28 August 2025), and 15 studies were selected for the analysis based on the predefined inclusion and exclusion criteria. We analyzed the effect of flurbiprofen in acute pharyngitis on relief of pain, difficulty swallowing, throat swelling, the Qualities of Sore Throat Index, overall satisfaction scores and Upper Respiratory Tract Infection Questionnaire, stratified by single or multiple doses and concomitant antibiotics. Efficacy in postoperative sore throat treatment and safety profile were also analyzed. The results are demonstrated in tables and forest plots. Results: Topical flurbiprofen is shown to be effective in pain relief, relief of difficult swallowing and throat swelling in acute pharyngitis in both single and multiple doses, regardless of the formulations. The same effect is noted when analyzed by the Qualities of Sore Throat Index questionnaire and overall satisfaction scores. The data shows that flurbiprofen reduces related upper respiratory tract infection symptoms. It is also shown to be effective in reducing the incidence and severity of postoperative sore throat. No serious adverse effects were reported in the included studies. Conclusions: Topical flurbiprofen seems to be an effective and safe symptomatic treatment option for sore throat in both infectious and non-infectious etiologies.

Introduction: The aim of this study was to compare long-term postoperative nasal airflow and symptom improvement using both subjective and objective nasal patency outcomes after three common different types of surgical interventions in patients with nasal obstruction, aimed at reducing nasal obstruction. Methods: This is a single-center prospective cohort study on 105 patients performed in a tertiary rhinology center, who underwent one of three interventions: septoplasty with radiofrequency turbinate reduction, septoplasty with turbinectomy, or septoplasty with valvuloplasty, aimed at improving nasal patency. Results: All three groups showed statically significant postoperative improvement of the Nasal Obstruction Symptom Evaluation scale (NOSE) and Peak Nasal Inspiratory Flow measurement (PNIF) values that increased in time, with a markedly increased effect sustained during the six months of follow-up compared to baseline measurements (p = 0.001, Friedman’s two-way test). Intergroup analysis showed that septoplasty combined with radiofrequency turbinate reduction showed superior nasal patency results after three months (p = 0.001, Kruskal–Wallis test); however, all three groups had a similar result at the six-month follow-up. Conclusions: All surgical techniques in patients with anatomic nasal obstruction led to favorable postoperative subjective and objective nasal patency outcomes. However, the impact of any specific additional procedure alongside septoplasty may be limited in long-term follow-up.

Background: Native aortic valve thrombosis (NAVT) is an uncommon cause of coronary embolism and myocardial infarction. In patients with severe aortic valve disease treated surgically, a post-operative communication between the left ventricle and right atrium (i.e. acquired Gerbode defect) is a rare complication. Case summary: We report the case of a 67-year-old man with suspected NAVT presenting with myocardial infarction and a post-operative acquired Gerbode defect. Coronary angiography showed a floating thrombus in the left main coronary artery without significant culprit-vessel atherosclerotic disease, suggesting coronary embolism. Multiple aspiration thrombectomies and glycoprotein IIb/IIIa inhibitor therapy were performed. Recurrent chest pain prompted repeat coronary angiography, which confirmed thrombus recurrence and resolution after repeat treatment. Intravascular ultrasound excluded significant culprit-vessel atherosclerotic disease. Aspirated material revealed a subacute thrombus with microcalcifications on histopathological examination. Echocardiography showed severe calcific aortic stenosis, a likely predisposing factor for NAVT. Atrial fibrillation had not been documented during the embolic event or previously and was only detected later during hospitalization, prompting initiation of anticoagulation (CHA2DS2-VASc score 3). Consequently, dual antiplatelet therapy was replaced with apixaban and ticagrelor until surgery. After clinical stabilization, the patient underwent surgical aortic valve replacement. No left atrial appendage thrombus was found intra-operatively after 3 months of anticoagulation. Post-operatively, multimodal imaging identified and quantified an acquired Gerbode defect. Given its haemodynamic insignificance, a conservative approach was adopted. Discussion: This case highlights underreported complications of severe aortic stenosis and its treatment, emphasizing the importance of multimodal imaging in the diagnosis of NAVT and post-operative Gerbode defect.