Drungno kraujo kardioplegijos įvertinimas atliekant trijų vožtuvų korekcijos operacijas

Gintaras Turkevičius1, Stanislovas Stankevič2, Arimantas Grebelis3, Rasa Čypienė3, Palmyra Semėnienė31 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Anesteziologijos,intensyvios terapijos ir skausmo gydymo centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Ligoniai ir metodai 58 ligoniai (amžiaus vidurkis 66 metai), NYHA III–IV funkcinės klasės, suskirstyti į dvi grupes. Pirmoje grupėje (19 ligonių) taikyta pastovi retrogradinė drungno kraujo kardioplegija, antroje (39 ligoniai) – antegradinė frakcinė drungno kraujo kardioplegija. Aortos perspaudimo laikas 93 ± 5 min. Abiejų grupių ligoniams buvo vertinamas savaiminis širdies veiklos atsikūrimas po aortos atleidimo, EKG normalizavimosi laikas, trukmė nuo aortos atleidimo iki dirbtinės kraujo apytakos sustabdymo, adrenomimetikų poreikis pirmą pooperacinę parą, echoskopinis kairiojo skilvelio funkcijos įvertinimas prieš operaciją ir po jos. Rezultatai Išgyveno 54 ligoniai, mirė 4 (po 2 iš abiejų grupių). Vienas ligonis mirė nuo smegenų pažeidimo, du nuo dauginio organų nepakankamumo ir vienas nuo širdies silpnumo. Buvo geresni visų vertinamų tyrimų antros ligonių grupės rezultatai (1 lentelė). Išvados Trijų širdies vožtuvų korekcijos operacijose miokardo apsaugai tinkama naudoti tiek pastovi retrogradinė drungno kraujo kardioplegija, tiek frakcinė antegradinė drungno kraujo kardioplegija. Kiek geresni buvo antros ligonių grupės rezultatai. Pagrindiniai žodžiai: kardioplegija, vožtuvų korekcija Evaluation of tepid blood cardioplegia in three heart valve surgical correction Gintaras Turkevičius1, Stanislovas Stankevič2, Arimantas Grebelis3, Rasa Čypienė3, Palmyra Semėnienė31 Vilnius University Hospital „Santariškių klinikos“, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius2 Vilnius University Hospital „Santariškių klinikos“, Anesteziology,Intensive Care and Pain Management Center, Santariškių str. 2, LT-08661 Vilnius3 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 VilniusE-mail: [email protected] Objective Analysis of myocardial protection technique for triple valve surgery was performed. Patients and methods Fifty-eight NYHA III–IV F.cl patients, mean age 66 years, were the investigated. All the patients were divided into two groups. Continuous retrograde tepid blood cardioplegia was used in group I patients (19) and antegrade intermittent tepid blood cardioplegia in 39 patients (group II). Aorta cross-clamp time was 93 ± 5 min. After declamping the aorta, the following criteria were analysed: heart rhythm self-restoration, time to ECG normalization and time from declamping the aorta till weaning from CPB (reperfusion), epinephrine doses after surgery, left ventricle ejection fraction before and after procedure. Results Fifty-four patients survived and 4 patients died after surgery. The causes of death were: 1 – postoperative brain damage, 2 – multiorgan failure, 1 – severe heart failure. Postoperative heart function was better preserved in group II of the patients. Conclusions Both type of cardioplegia are suitable for triple valve surgery. A slight improvement of hemodynamic data was noted when intermittent tepid blood cardioplegia was used. Key words: cardioplegia, valve correction

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Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf.1577 ◽

2016 ◽

Vol 19 (3) ◽

pp. 123 ◽

Cited By ~ 7

Author(s):

Orhan Findik ◽

Ufuk Aydin ◽

Ozgur Baris ◽

Hakan Parlar ◽

Gokcen Atilboz Alagoz ◽

...

Keyword(s):

Acute Kidney Injury ◽

Regression Analysis ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Serum Albumin ◽

Replacement Therapy ◽

Kidney Injury ◽

Preoperative Serum ◽

Group I ◽

Group Ii

Background: Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels <3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL. Results: There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. Conclusion: Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

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COMPARATIVE STUDY BETWEEN THE EFFECT OF HISTAMINE RECEPTOR ANTAGONISTS OF TYPE II (FAMOTIDINE) AND PROTON PUMP INHIBITORS (OMEPRAZOLE) ON THE EFFICACY OF CALCIUM CARBONATE AS PHOSPHATE BINDER IN HAEMODIALYSIS PATIENT

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i8.12072 ◽

2017 ◽

Vol 9 (8) ◽

pp. 10

Author(s):

Hossam Aboelyazeed ◽

Sahar El-haggar ◽

Kamal Okasha

Keyword(s):

Calcium Carbonate ◽

Serum Calcium ◽

Phosphate Binder ◽

Renal Dialysis ◽

University Hospital ◽

Control Group ◽

Group Iii ◽

Group I ◽

Group Ii ◽

Pre Treatment

Objective: The purpose of this study was to compare the effect of famotidine versus omeprazole on the efficacy of calcium carbonate as a phosphate binder in the hemodialysis patient.Methods: From February 2014 to June 2014 a total number of 64 patients of both sexes were recruited from the department of renal dialysis, Tanta University Hospital, Egypt. Patients categorized into 3 groups. Group I (control group) consisted of 20 Patients (10) females and (10) males take calcium carbonate (caco3) (2.5–4 g/d) only, Group II consisted of 21 Patients (13) females and (8) males take the same dose of caco3 with famotidine 10 mg/d and Group III consisted of 23 Patients (8) females and (15) male take the same dose caco3 with omeprazole 20 mg/d.Results: All data are expressed as the mean±SD. Group II showed a significant increase (p<0.05) in serum phosphorus at 3rd mo with significant decreased (p<0.05) in serum calcium comparing with pre-treatment. Group III showed no significant change (p>0.05) in serum calcium, phosphorus and parathyroid hormone (PTH) comparing with pre-treatment. Both groups (II and III) showed a significant decrease in alkaline phosphatase (ALP) (p<0.05).Conclusion: Co-administration of famotidine with calcium carbonate aggravates hyperphosphatemia and this may increase the incidence of complications. The efficacy of calcium carbonate as a phosphate binder was not affected by co-administration of omeprazole.

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Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery

Perfusion ◽

10.1191/0267659103pf628oa ◽

2003 ◽

Vol 18 (1_suppl) ◽

pp. 55-60 ◽

Cited By ~ 20

Author(s):

S Eifert ◽

H Reichenspurner ◽

T Pfefferkorn ◽

B Baur ◽

C von Schlippenbach ◽

...

Keyword(s):

Cardiac Surgery ◽

Artery Bypass ◽

Bypass Graft ◽

Neurological Deficits ◽

Focal Neurological Deficit ◽

Group I ◽

Tenfold Increase ◽

Group Ii ◽

Magnet Resonance ◽

The Brain

Cerebral embolization of particles after cardiac surgery is frequently associated with neurological deficits. Aortic crossclamp manipulation seems to be the most significant cause of emboli release during cardiac surgery. The goal of this study was to demonstrate whether the use of an intra-aortic filter device has an effect on the magnet resonance imaging (MRI) and functional neurological outcome. Twenty-four patients undergoing cardiosurgical procedures using cardiopulmonary bypass (CPB) were selected: coronary artery bypass graft (CABG) surgery (n=17), aortic valve replacement (AVR) surgery (n= 4) or combined procedures (n=3). Patients were evaluated by diffusion weighted MRI of the brain, neurological examination and neuropsychological assessment regarding alertness as well as divided and selective attention before and five to seven days after surgery. The patients were divided into two groups. In group I, 12 patients received a filter through a modified 24 F arterial cannula immediately before the aortic crossclamp was released. Filters remained in the aorta until CPB was discontinued. Intraoperatively, bilateral middle cerebral artery transcranial Doppler (TCD) was monitored at baseline, at the beginning of CPB, at a timepoint when the aorta was crossclamped, when the filter was inserted and while the crossclamp was switched to partial clamping until the CPB was discontinued. TCD was used for detection of microembolic signals (MES). The captured material in the filter was examined histologically. Twelve patients served as controls without aortic filtration (group II). The MRI of the brain did not show any diffusion alterations in either group before or after surgery. No patient developed a focal neurological deficit or stroke. Intraoperative quantitative MES detection revealed a four to tenfold increase in patients of group I compared with group II (5 - 6 versus 0.5 - 1 MES/min) during the filter dwell time. There was no consistent pattern regarding the neurobehavioural sequelae. Filters showed arteriosclerotic debris in 75% of the patients. The use of the intra-aortic filter device did not show a positive effect on neurological, neuroradiographical and neuropsychological outcomes. The increase of the MES rate in group I patients may be due to microbubbles generated as microcavitations by the filter or the aortic filter cannula. The intra-aortic filter was able to capture atheromatous material in 75% of the patients.

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Effects of the dopamine agonist cabergoline in patients with prolactinoma intolerant or resistant to bromocriptine

Acta Endocrinologica ◽

10.1530/eje.0.1340454 ◽

1996 ◽

Vol 134 (4) ◽

pp. 454-456 ◽

Cited By ~ 54

Author(s):

Etienne Delgrange ◽

Dominique Maiter ◽

Julian Donckier

Keyword(s):

Internal Medicine ◽

Side Effects ◽

Dopamine Agonist ◽

Side Effect ◽

University Hospital ◽

The Third ◽

Group I ◽

Resistant Group ◽

Group Ii ◽

Long Acting

Delgrange E, Maiter D, Donckier J. Effects of the dopamine agonist cabergoline in patients with prolactinoma intolerant or resistant to bromocriptine. Eur J Endocrinol 1996;134:454–6. ISSN 0804–4643 Cabergoline is a new long-acting ergoline derivative used to treat hyperprolactinaemia. Its effect was assessed in 10 patients (eight women and two men) with prolactinoma who were intolerant (group I; N = 7) or resistant (group II; N = 3) to bromocriptine. In group I, no side effect was observed on cabergoline therapy; two patients became pregnant and normoprolactinaemia was achieved in the five others. In group II, cabergoline was active and well-tolerated in two out of the three patients: one woman had three consecutive pregnancies; in another patient normoprolactinaemia was restored and the tumour shrank by 60%; in the third patient cabergoline was discontinued because of side effects and inefficacy. Thus, cabergoline appears to be an alternative of choice as treatment of hyper-prolactinaemic patients who are intolerant or resistant to bromocriptine. Julian Donckier, Internal Medicine and Endocrinology, University Hospital UCL of Mont-Godinne, B-5530 Yvoir, Belgium

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Kairiosios širdies hipoplazijos sindromo pirmo chirurginio gydymo etapo pradinė patirtis

Lietuvos chirurgija ◽

10.15388/lietchirur.2007.3.2224 ◽

2007 ◽

Vol 5 (3) ◽

pp. 0-0

Author(s):

Virgilijus Tarutis ◽

Virgilijus Lebetkevičius ◽

Kęstutis Versockas ◽

Asta Bliūdžiūtė ◽

Žydrė Jurgelienė ◽

...

Keyword(s):

Cardiac Surgery ◽

Surgical Treatment ◽

Hypoplastic Left Heart Syndrome ◽

University Hospital ◽

Norwood Procedure ◽

Initial Experience ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Vilnius University ◽

Left Heart Syndrome

Virgilijus Tarutis1, Virgilijus Lebetkevičius1, Kęstutis versockas2, Asta Bliūdžiūtė2, Žydrė Jurgelienė2, Solveiga Umbrasaitė1, Rita Sudikienė3, Daina Liekienė1, Kęstutis Lankutis3, Vidmantas Jonas Žilinskas1, Vytautas Sirvydis11 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras3 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Kairiosiosios širdies hipoplazijos sindromas (KŠHS) yra viena sunkiiausių įgimtų širdies ydų. KŠHS turi 1 iš 4000–6000 naujagimių. Negydant mirštamumas pirmaisiais gyvenimo metais būna didesnis kaip 90%. Apžvelgiame pradinę KŠHS chirurginio gydymo patirtį. Ligoniai ir metodai Nuo 2005 m. iki dabar operuoti 9 naujagimiai, turintys KŠHS. 6 pacientai operuoti stabilizavus jų būklę, 3 operuoti nestabilios būklės esant kraujotakos nepakankamumui. 4 pacientams atlikta klasikinė Norwoodo operacija su modifikuota Blalocko ir Taussig jungtimi, likusiems 5 atlikta Norwoodo operacijos Sano modifikacija. Rezultatai Pirmas Norwoodo korekcijų etapas buvo sėkmingas 5 (55,6%) naujagimiams: 3 buvo padaryta modifikuota B-T jungtis, 2 – Sano jungtis. Išvada KŠHS chirurginis gydymas mūsų centre kol kas yra vadinamosios mokymosi kreivės laikotarpio. Norwoodo I etapo korekcijos rezultatai turėtų gerėti padidėjus operacijų skaičiui ir griežčiau atrenkant pacientus, atsižvelgiant į rizikos veiksnius. Pagrindiniai žodžiai: kairiosios širdies hipoplazijos sindromas, Norwoodo operacija Initial experience in first-stage surgical treatment of hypoplastic left heart syndrome Virgilijus Tarutis1, Virgilijus Lebetkevičius1, Kęstutis versockas2, Asta Bliūdžiūtė2, Žydrė Jurgelienė2, Solveiga Umbrasaitė1, Rita Sudikienė3, Daina Liekienė1, Kęstutis Lankutis3, Vidmantas Jonas Žilinskas1, Vytautas Sirvydis11 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“,Anesthesiology, Intensive Care and Pain Management Center3 Vilnius University Hospital „Santariškių klinikos“,Cardiac Surgery Centre Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective Hypoplastic left heart syndrome (HLHS) is one of the most complex congenital heart defects. The incidence of HLHS is 1 in 4000 to 6000 live births. The mortality rate exceeds 90% without treatment in the first year of life. We review the initial experience in the surgical treatment of HLHS at our Centre. Patients and methods There were 9 children operated on for HLHS from the year 2005 till now. Six of them went to operation in hemodinamically stable condition and three had a substantial insufficiency of systemic circulation. Four underwent Norwood I procedure with modified Blalock–Taussig shunt and five had Sano modification. Results The first-stage Norwood procedure was successful in five (55.6%) cases – three with B-T shunt and 2 with Sano. Conclusions Surgical treatment of HLHS remains in the learning curve period at our institution. We expect the rise of survival rate with the increase of case load and a more selective approach considering the risk factors. Key words: hypoplastic left heart syndrome, Norwood procedure

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Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation

American Journal of Surgical Research and Reviews ◽

10.28933/ajsrr-2021-04-0806 ◽

2021 ◽

pp. 21

Author(s):

Keyword(s):

Mitral Valve ◽

Blood Loss ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Wound Infections ◽

Operative Outcomes ◽

Group I ◽

Group Ii ◽

Operative Recovery

Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables. Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed. Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P <.01), shorter ICU stay 1.36 [1-6] vs 3.6 [2-8] days, p<.01. Length of hospital stay and chest tube stay were found to be shorter, respectively 6.9 [6-16] vs 7, 7 [7-13] and (1.38 [1-2] days vs 2.64 [2-4], P <.01). Wound infections were not found in both groups. Conclusion: Although the controversy interest of minimally invasive mitral valve surgery, it may be associated with less blood loss, faster post-operative recovery but increases operation time.

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Kairiojo skilvelio išstūmimo frakcijos įtakos mirštamumo prognozavimui po miokardo revaskulizacijos operacijų įvertinimas pagal EuroSCORE sistemą

Lietuvos chirurgija ◽

10.15388/lietchirur.2007.3.2194 ◽

2007 ◽

Vol 5 (3) ◽

pp. 0-0

Author(s):

Šarūnas Kinduris ◽

Giedrius Vanagas

Keyword(s):

Cardiac Surgery ◽

Ejection Fraction ◽

Risk Stratification ◽

Left Ventricular ◽

Mortality Prediction ◽

Left Ventricular Ejection ◽

Medicine Department ◽

Group Iii ◽

Group I ◽

Group Ii

Šarūnas Kinduris1,2, Giedrius Vanagas1,31 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika,Eivenių g. 2, LT-50009 Kaunas2 Kauno medicinos universiteto Biomedicininių tyrimų institutas,Eivenių g. 4, LT-50009 Kaunas3 Kauno medicinos universiteto Profilaktinės medicinos katedra,Eivenių g. 4, LT-50009 KaunasEl paštas: [email protected] Įvadas / tikslas Kardiochirurgijos operacijų rizikos įvertinimo EuroSCORE (European System for Cardiac Operative Risk Evaluation) sistema nuo 1999 metų naudojama Europos šalyse prognozuojant ankstyvąjį pooperacinį mirštamumą. Analizuojant EuroSCORE taikymo galimybes Lietuvoje paaiškėjo, kad ji nepasižymi nei didele prognozine verte, nei tikslumu. Darbo tikslas – įvertinti vieno iš EuroSCORE vertinimo sistemos rizikos veiksnių – kairiojo skilvelio išstūmimo frakcijos (KSIF) įtaką pooperacinio mirštamumo prognozavimui. Ligoniai ir metodai Atlikta retrospektyvioji duomenų analizė 1379 ligonių, sergančių išemine širdies liga. Jiems planine tvarka atlikta pirminė miokardo revaskulizacijos operacija Kauno medicinos universiteto klinikų Širdies, krūtinės ir angiochirurgijos klinikoje 2004 metų sausį – 2006 metų gruodį. Atsižvelgiant KSIF vertinimą pagal EuroSCORE sistemą ligoniai buvo suskirstyti į tris grupes: I grupę sudarė ligoniai, kuriems priešoperaciniu laikotarpiu KSIF nustatyta < 30%, II grupę – ligoniai, kuriems KSIF įvertinta 30–50%, ir III grupę – ligoniai, kurių KSIF buvo > 50%. Rezultatai Ligoniai pagal EuroSCORE sistemos KSIF vertinimą pasiskirstė taip: I grupę sudarė 167 ligoniai, II grupę – 906 ligoniai ir III grupę – 306 ligoniai. Šio tyrimo metu vertinant operacinę riziką pagal EuroSCORE sistemos metodiką išskirtinis dėmesys kreiptas į KSIF įtaką pooperaciniam mirštamumui, lyginant jį su prognozuojamu. Kadangi II grupės ligoniai pagal stebėtą ir prognozuotą mirštamumą pasiskirstė netolygiai, buvo sudaryti du pogrupiai: IIA (n = 218) – ligonių, kurių KSIF 30–39%, o IIB (n = 688) – ligonių, kurių KSIF 40–50%. Šių grupių ligonių mirštamumo skirtumai buvo statistiškai reikšmingi (p < 0,05). Išvados Ligoniai, kuriems yra kairiojo skilvelio disfunkcija (išstūmimo frakcija < 50%), galėtų būti skirstomi į tris grupes (40–50%, 30–39% ir < 30%) pagal operacijos riziką, atitinkamai peržiūrint balų skyrimą pagal EuroSCORE. Be to, apibūdinant kairiojo skilvelio kontrakciją tikslinga naudoti ir kitus jos vertinimo kriterijus (pvz., sienelių kontrakcijos indeksą). Pagrindiniai žodžiai: miokardo revaskulizacija, rizikos vertinimas, kairiojo skilvelio išstūmimo frakcija Evaluation of left ventricle ejection fraction impact on cardiac surgery risk stratification by EuroSCORE system Šarūnas Kinduris1,2, Giedrius Vanagas1,31 Hospital of Kaunas University of Medicine, Department of Cardiothoracic and Vascular Surgery,Eivenių str. 2, LT-50009 Kaunas, Lithuania2 Kaunas University of Medicine, Institute for Biomedical Research,Eivenių str. 4, LT-50009 Kaunas, Lithuania3 Kaunas University of Medicine, Department of Preventive Medicine,Eivenių str. 4, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Background / objective EuroSCORE as the cardiac surgery risk stratification system is well known in Europe since 1999. Previous validity and accuracy assessments in Lithuania showed mortality overprediction by the EuroSCORE system in our patients’ population. The aim of the article is to analyze the impact of LVEF on cardiac surgery postoperative mortality prediction by EuroSCORE. Patients and methods It was implemented retrospective analysis of qualitative and quantitative data on 1379 patients that underwent CABG surgery at Kaunas University of Medicine during January 2004 – December 2006. According to LVEF evaluation by EuroSCORE, all patients were grouped to 3 groups: group I with LVEF < 30%, group II LVEF 30–50% and group III LVEF > 50%. Results According to LVEF evaluation by EuroSCORE, group I comprised 167, group II 906 and group III 306 patients. According to mortality evaluation there were significant discrepancies between the observed and the predicted by EuroSCORE mortality among patients in group II. It was decided to divide group II into two subgroups: IIA 30–39% and IIB 40–50% in which mortality differed statistically significantly (p < 0.05). Conclusions Patients with LVEF lower than < 50% could be grouped into three groups (40–50%, 30–39% and < 30%). Also, it is important to review the scoring system according to these groups. It would be reasonable to make further analysis of mortality prediction by other ejection fraction parameters. Key words: coronary artery bypass grafting, risk stratification, mortality, left ventricular ejection fraction, predictive value

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The Role of Platelet Indices in Prediction of Pre-eclampsia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i230808 ◽

2021 ◽

pp. 69-77

Author(s):

Walaa Abdelghafar Elbasuony ◽

Hossam Abd el-mohsein Hodeib ◽

Adel Elshahat Eljejawy ◽

Karam Abd el-fattah Shaheen

Keyword(s):

Obstetric Care ◽

First Trimester ◽

Diagnostic Value ◽

University Hospital ◽

Distribution Width ◽

Platelet Indices ◽

Group I ◽

Gestational Week ◽

First Trimester Of Pregnancy ◽

Group Ii

Objective: The aim of this work is to investigate the diagnostic value of platelet count (PC), mean platelet volume (MPV), the PC to MPV ratio and platelet distribution width (PDW) for prediction of pre-eclampsia (PE). Subjects and Methods: This prospective cohort study included 100 pregnant women, in the ﬁrst trimester of pregnancy attending to University Hospital, Obstetric Outpatient Clinic, for routine obstetric care from January 2019 to December 2019. Routine obstetric follow-up consists of monthly visits until 32nd gestational week, bimonthly visits between 32nd and 36th gestational week, and weekly thereafter. Patients were classified into two groups: group I: 9 pre-eclamptic patients and group II: non pre-eclamptic 91 patients. CBC indices were measured at each planned visit Results: PC, PC/MPV were significantly decreased, MPV and PDW were significantly increased in group I than group II at the 2nd part of pregnancy. To predict pre-eclampsia, PC at cut-off ≤214, sensitivity was 77.78, specificity was 76.92. MPV at cut-off >9.7, sensitivity was 77.78, specificity was 100.00, PC-MPV at cut-off ≤26.89, sensitivity was 88.89, specificity was 78.02. PDW at cut-off >10.4, sensitivity was 88.89, specificity was 54.95. Conclusion: The increase in the MPV and PDW and the decrease in PC and PC/MPV were observed in preeclampsia. Thus, the platelet indices which are easily available, as well as economical, can also be used in the prediction and early diagnosis of preeclampsia.

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Impact of Gentamicin-Collagen Sponge (Collatamp) on the Incidence of Sternal Wound Infection in High-Risk Cardiac Surgery Patients: A Propensity Score Analysis

The Heart Surgery Forum ◽

10.1532/hsf98.20121032 ◽

2012 ◽

Vol 15 (5) ◽

pp. 257 ◽

Cited By ~ 6

Author(s):

Shahzad G. Raja ◽

Kareem Salhiyyah ◽

Muhammed Umar Rafiq ◽

Jeremy Felderhof ◽

Mohamed Amrani

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Propensity Score ◽

Wound Infection ◽

Wound Infection Rate ◽

Collagen Sponge ◽

Sternal Wound Infection ◽

Postoperative Wound ◽

Group I ◽

Group Ii

Objective: Local delivery of prophylactic antibiotic to the wound site with an implanted, reabsorbable, gentamicin-containing collagen sponge (Collatamp) is a strategy that has been claimed to prevent sternal wound infection after cardiac surgery. The purpose of this study was to review our experience with Collatamp in cardiac surgery patients deemed at high risk for sternal wound infection.Methods: From January 2007 to December 2010, Collatamp was used in 107 patients deemed at high risk for sternal wound infection. Applying the propensity score, we matched 97 patients with Collatamp (group I) with 97 patients who did not receive Collatamp (group II). All individuals received routine intravenous antimicrobial prophylaxis. Postoperative wound-infection rates as well as routine outcomes were compared. Information for the study was obtained from the cardiac surgical Patients Analysis and Tracking System (PATS) database and from hospital records.Results: The superficial sternal wound infection rate was 2.1% (2/97) in group I and 6.2% (6/97) in group II (P = .01). The rates of deep sternal wound infection rate were similar (2.1% versus 3.1%, P = .87). There was no mediastinitis in the study population. In addition, more patients in group II received an intra-aortic balloon pump (5.2% versus 2.1%, P = .04) and underwent hemofiltration (7.2% versus 3.1%, P = .02). No side effects were noted.Conclusion: Gentamicin-containing collagen sponge (Collatamp) is a useful adjunct to meticulous surgical technique and postoperative wound care in reducing the incidence of sternal wound infection in high-risk cardiac surgery patients. An adequately powered study is needed, however, to validate the safety and efficacy of this strategy.

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Triiodothyronine-predominant Graves' disease in childhood: detection and therapeutic implications

Acta Endocrinologica ◽

10.1530/eje-14-0959 ◽

2015 ◽

Vol 172 (6) ◽

pp. 715-723 ◽

Cited By ~ 10

Author(s):

Julie Harvengt ◽

Priscilla Boizeau ◽

Didier Chevenne ◽

Delphine Zenaty ◽

Anne Paulsen ◽

...

Keyword(s):

Pediatric Population ◽

Severe Disease ◽

Antithyroid Drug ◽

Rare Condition ◽

University Hospital ◽

Graves Disease ◽

Therapeutic Implications ◽

Group I ◽

Median Serum ◽

Group Ii

ObjectiveTo assess in a pediatric population, the clinical characteristics and management of triiodothyronine-predominant Graves' disease (T3-P-GD), a rare condition well known in adults, but not previously described in children.DesignWe conducted a university hospital-based observational study.MethodsAll patients with GD followed for more than 1 year between 2003 and 2013 (n=60) were included. T3-P-GD (group I) was defined as high free T3 (fT3) concentration (>8.0 pmol/l) associated with a normal free thyroxine (fT4) concentration and undetectable TSH more than 1 month after the initiation of antithyroid drug (ATD) treatment. Group II contained patients with classical GD without T3-P-GD.ResultsEight (13%) of the patients were found to have T3-P-GD, a median of 6.3 (3.0–10.5) months after initial diagnosis (n=4) or 2.8 (2.0–11.9) months after the first relapse after treatment discontinuation (n=4). At GD diagnosis, group I patients were more likely to be younger (6.8 (4.3–11.0) vs 10.7 (7.2–13.7) years) and had more severe disease than group II patients, with higher serum TSH receptor autoantibodies (TRAb) levels: 40 (31–69) vs 17 (8–25) IU/l, P<0.04, and with slightly higher serum fT4 (92 (64–99) vs 63 (44–83) pmol/l) and fT3 (31 (30–46) vs 25 (17–31) pmol/l) concentrations. During the 3 years following T3-P-GD diagnosis, a double dose of ATD was required and median serum fT4:fT3 ratio remained lower in group I than in group II.ConclusionSevere hyperthyroidism, with particularly high TRAb concentrations at diagnosis, may facilitate the identification of patients requiring regular serum fT3 determinations and potentially needing higher doses of ATD dosage during follow-up.

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