scholarly journals Aprotinin Reduces the Procalcitonin Rise Associated With Complex Cardiac Surgery and Cardiopulmonary Bypass

2013 ◽  
pp. 27-33
Author(s):  
P. MARUNA ◽  
A. A. KLEIN ◽  
J. KUNSTÝŘ ◽  
K. M. PLOCOVÁ ◽  
F. MLEJNSKÝ ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Serine Protease Inhibitor ◽  
Heparin Dose ◽  
Post Surgery ◽  
Thromboembolic Pulmonary Hypertension ◽  
Group A ◽  
Group B ◽  
Pulmonary Bypass ◽  
Pro Inflammatory Cytokines

Aprotinin, a nonspecific serine protease inhibitor, has been primarily used as a haemostatic drug in cardiac surgery with cardio-pulmonary bypass (CPB). This study investigated the effect of Aprotinin on the post-operative levels of procalcitonin (PCT) and a set of cytokines in patients undergoing pulmonary artery endarterectomy (PEA). We analyzed 60 patients with chronic thromboembolic pulmonary hypertension undergoing PEA. 30 patients (Group A) were treated with Aprotinin (2000000 IU prior anesthesia, then 2000000 IU in CPB prime and 50000 IU per hour continuously); a further 30 patients (Group B) received Tranexamic Acid (1 g before anesthesia, 1 g after full heparin dose and 2 g in CPB prime). PCT, TNFα, IL-1β, IL-6, and IL-8 arterial concentrations were measured from before until 72 hours after surgery. Aprotinin significantly affected early post-PEA plasma PCT. Patients treated with Aprotinin (Group A) had lower peak PCT levels compared to patients in Group B (1.52 ng/ml versus 2.18, p=0.024). Postoperative peak values of PCT and IL-6 correlated closely in both groups (r=0.78, r=0.83 respectively). Aprotinin attenuates the post-PEA increase of PCT in the same manner as other pro-inflammatory cytokines. Significant correlation between PCT and IL-6 post-surgery may be indicative of an indirect IL-6-mediated pathway of PCT alteration.

scholarly journals The effect of nano-hydroxyapatite/chitosan scaffolds on rat calvarial defects for bone regeneration

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanouil Chatzipetros ◽  
Spyros Damaskos ◽  
Konstantinos I. Tosios ◽  
Panos Christopoulos ◽  
Catherine Donta ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Mean Value ◽  
Parietal Bone ◽  
Female Rats ◽  
Sprague Dawley ◽  
Post Surgery ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Right

Abstract Background This study aims at determining the biological effect of 75/25 w/w nano-hydroxyapatite/chitosan (nHAp/CS) scaffolds on bone regeneration, in terms of fraction of bone regeneration (FBR), total number of osteocytes (Ost), and osteocyte cell density (CD), as well as its biodegradability. Methods Two critical-size defects (CSDs) were bilaterally trephined in the parietal bone of 36 adult Sprague-Dawley rats (18 males and 18 females); the left remained empty (group A), while the right CSD was filled with nHAp/CS scaffold (group B). Two female rats died postoperatively. Twelve, 11, and 11 rats were euthanized at 2, 4, and 8 weeks post-surgery, respectively. Subsequently, 34 specimens were resected containing both CSDs. Histological and histomorphometric analyses were performed to determine the FBR, calculated as [the sum of areas of newly formed bone in lateral and central regions of interest (ROIs)]/area of the original defect, as well as the Ost and the CD (Ost/mm2) in each ROI of both groups (A and B). Moreover, biodegradability of the nHAp/CS scaffolds was estimated via the surface area of the biomaterial (BmA) in the 2nd, 4th, and 8th week post-surgery. Results The FBR of group B increased significantly from 2nd to 8th week compared to group A (P = 0.009). Both the mean CD and the mean Ost values of group B increased compared to group A (P = 0.004 and P < 0.05 respectively). Moreover, the mean value of BmA decreased from 2nd to 8th week (P = 0.001). Conclusions Based on histological and histomorphometric results, we support that 75/25 w/w nHAp/CS scaffolds provide an effective space for new bone formation.

Abstract 1667: Early Childhood Mental Development After Transfusion-free Cardiac Surgery On Cardiopulmonary Bypass: A Multi-institutional Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tomohiko Ukai ◽  
Takenori Adachi ◽  
Atsusi Numaguchi ◽  
Daichi Fukumi ◽  
Toshiaki Yasuda ◽  
...  
Keyword(s):  
Early Childhood ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Brain Dysfunction ◽  
Hemoglobin Level ◽  
Mental Development ◽  
Blood Products ◽  
Surgical Closure ◽  
Group A ◽  
Group B

Background: The use of blood products is often necessary to prime the extracorporeal circuits for pediatric cardiac surgical patients. The use of blood products carries serious risks both in the acute and long-term aspects of patient care. However, excessive hemodilution during cardiopulmonary bypass (CPB) is associated with decreased oxygen carrying capacity, edema, and organ dysfunction. Especially, whether brain dysfunction after transfusion-free cardiac surgery on CPB occurred is unknown. Objective: This study aims to investigate whether excessive hemodilution affects child’s mental development. Methods: We studied 143 infants (24.2 +/− 15.8 months, 5 months ~ 3 years of age) had performed surgical closure of ventricular septal defect (VSD) in less than 12 months (4.8 +/− 2.6 months) of age in 7 children’s hospitals. Questionnaires mailed to the parents included the Tsumori-Inage Infant Developmental Scale estimating subjects’ behavioral developmental level as Developmental Quotients (DQ). The infants were divided into 3 groups; transfusion-free (Group A, n=52), transfusion during CPB (Group B, n=24) and transfusion after CPB (Group C, n=66). Results: Lower DQ was found for Group A (94.7 +/− 11.6) than Group B (103.5 +/− 16.0, p=0.008) and Group C (101.7 +/− 17.9, p=0.016). No correlation was found between DQ and minimum hemoglobin level during CPB (min-Hb) in Group A. The DQ was likely to be lower in the infants with below 6 g/dl (93.0 +/− 13.0) than with over 6 g/dl (98.7 +/− 8.3. p=0.10) of min-Hb. Conclusions: The results suggest that the infants after transfusion-free surgery of VSD on CPB delay in the mental development in their early childhood. Maintaining minimum hemoglobin level over 6 g/dl during CPB seems to prevent the mental development from delay.

Treatment of Canine Transmissible Venereal Tumour using Different Surgico-chemotherapeutic Protocols

2021 ◽  
Author(s):  
Nutan Punchkande ◽  
Rukmani Dewangan ◽  
Raju Sharda ◽  
D. Jolhe ◽  
Dhaleshwari Sahu ◽  
...  
Keyword(s):  
Biochemical Parameters ◽  
Histopathological Examination ◽  
Surgical Excision ◽  
Treatment Protocols ◽  
Post Surgery ◽  
Vincristine Sulphate ◽  
Group A ◽  
Group B ◽  
Canine Transmissible Venereal Tumour ◽  
Transmissible Venereal Tumour

Background: Canine transmissible venereal tumour (CTVT) also known as infectious sarcoma, venereal granuloma, transmissible lymphosarcoma or sticker tumour is usually transmitted through coitus and mainly affects the external genitalia of young sexually matured dogs. Surgery, chemotherapy, radiotherapy and immunotherapy are considered as effective treatment protocols. Therefore, depending upon the availability present study was designed to investigate the efficacy of different surgico-chemotherapeutic protocols for treatment of canine transmissible venereal tumour.Methods: The study was conducted during January 2018 to July 2018 at the Teaching Veterinary Clinical Complex (TVCC) and Department of Veterinary Surgery and Radiology, College of Veterinary Science and A.H., Anjora, Durg (C.G.) on 18 canines of various breed, irrespective of age, sex and divided into three groups consisting 6 animals in each group. Group A was treated with surgical excision of tumour only where as Group B and Group C were treated with surgical excision of tumour followed by administration of Doxorubicin (30mg/m2) BSA and Vincristine sulphate (0.025 mg/kg) intravenously alongwith DNS at 7th and 14th post-operative days respectively. Different physiological and haemato-biochemical parameters (Hb, PCV, TLC, TPC, DLC, serum glucose, TSP, SUN, SC, ALT, AST and ALP) were recorded preoperatively, postoperatively and after chemotherapy at 10th, 30th and 60th days intervals.Result: The present investigation showed transient changes in physiological and haemato-biochemical parameters before, post surgery and post chemotherapeutic management and was within normal range. Histopathological examination revealed confluent sheet of tumour cells arranged in large round oval or polyhedral shaped distributed in tight clusters or cords. Group A showed mild to moderated reoccurrence while Group B showed minimum reoccurrence. Group C showed no reoccurrence. Thus, surgery combined with vincristine therapy is most effective for treating dogs suffering with transmissible venereal tumour.

Comparison of early and late intravenous infusion of milrinone in children upto 1 year undergoing cardiac surgery.

2020 ◽  
Vol 7 (3) ◽  
pp. 67-72
Author(s):  
• Dr. Milind Pol ◽  
Dr. Kajalkumari Jain ◽  
Dr. Sunil Natha Mhaske
Keyword(s):  
Cardiac Surgery ◽  
Randomized Study ◽  
Central Venous Oxygen Saturation ◽  
Serum Lactate ◽  
Loading Dose ◽  
Low Cardiac Output Syndrome ◽  
Arterial Blood ◽  
Group A ◽  
Lactate Levels ◽  
Group B

Objective:  To compare the effects of early and late use of milrinone in children upto 1  year undergoing complex cardiac surgery. Study design:- prospective randomized study. Methods: A prospective study involved 30 children undergoing congenital corrective cardiac surgery,classified randomly into two groups. Group A: Milrinone infusion  was started without loading dose at  0.5mcg/kg/min at the beginning of CPB and continued postoperatively (0.5-0.75 mcg/kg/min) in the paediatric cardiac surgical ICU . Group B: Milrinone was started as a loading dose of 50mcg/kg over 10 min after aortic declamping and continued as infusion  postoperatively at 0.5-0.75 mcg/kg/min  in the pediatric cardiac surgical ICU.Data were collected at baseline, 1st ,6th  and  12th   postoperative hours in the ICU. Results: The inotropic supports and mechanical supports were needed more in group B than group A. The comparison of heart rate, CVP were insignificant between the two groups (P>0.05). The mean arterial blood pressure through the first 6 hours postoperatively was higher in group A than group B (P<0.05), but became insignificant through other timepoints. The urine output and central venous oxygen saturation were higher in group A than group B (P<0.05).The serum lactate levels were significantly higher in group B more than group A (P<0.05). Conclusion:Early use of milrinone, lead to easy weaning from Cardiopulmonary bypass, decreased requirement of pharmacological and mechanical support and decreased incidence of low cardiac output syndrome after pediatric cardiac surgery and there was no complications related to milrinone in our study patients.

Medical Diagnosis of Upper Urinary Calculi Based on Image Filtering in Ureteroscopic Lithotripsy

2019 ◽  
Vol 9 (2) ◽  
pp. 376-383
Author(s):  
Qiyi Hu ◽  
Hui Liang ◽  
Zhu Wang ◽  
Qiong Deng ◽  
Jianwen Zhang ◽  
...  
Keyword(s):  
Success Rate ◽  
Clearance Rate ◽  
Urinary Calculi ◽  
Operation Time ◽  
Ureteral Stent ◽  
Occurrence Rate ◽  
Post Surgery ◽  
Flexible Ureteroscope ◽  
Group A ◽  
Group B

Objective: Based on improved image processing techniques, we investigate the therapeutic effect and safety of a flexible ureteroscope applied in treatment of upper urinary calculi with and without preoperative ureteral stent, and analyzed their outcome based on CT and ultrasound medical imaging technology, as well as other clinical data. Methods: These identified patients were randomly divided into two groups, 89 patients suffering from upper urinary calculi in Group A were treated with flexible ureteroscopy lithotripsy and Holmium laser, without preoperative ureteral stent. On the other hand, another 114 patients in Group B received preoperative ureteral stent. In terms of measurement indicators, the total operation time, hospitalization time, hospital costs, success rate of operation, clearance rate of stone, occurrence rate of complications, and the probability of a second operation were recorded, respectively. In order to verify the effect of the operation, we performed Computed Tomography (CT), Nuclear Magnetic Resonance Imaging (MRI), Ultrasound Examination on the patient before and after the operation, and processed the image by downhill filtering algorithm and adaptive median filtering to ensure the validity and accuracy of the experiment. Results: By analyzing other clinical data such as medical images, it is known when making comparisons between two groups, there were no significant difference in terms of stone size, stone site, and success rate of operation (97.8%, 87/89 for group A; 100%, 114/144 for group B). In further, the operation time of group A was longer than that of group B (65.46 ± 10.17 min vs. 59.58 ± 9.25 min, P < 0 05), and the hospitalization time in group A was much shorter (6.53 ± 0.89 d vs. 10.16 ± 1.50 d, P < 0.01). The clearance rate of stone at 3-day post-surgery in group A was much lower than that of group B (36%, 32/89 vs. 51.7%, 59/114, P < 0.05). In addition, the clearance rate of stone at 1-month post-surgery (84.3%, 75/89 in group A vs. 85.1%, 97/114 in group B), and the occurrence rate of complications (21.3%, 19/89 in group A vs. 20.1%, 23/114 in group B) showed no significantly difference (P > 0.05). Besides, the probabilities of a second operation in group A and B were 14.6% (19/89) and 20.1% (23/114), respectively. And no significantly difference could be drawn according to statistical analysis. Conclusion: The application of flexible ureteroscope applied in treatment of upper urinary calculi without preoperative ureteral stent was economical, safe and effective.

scholarly journals Is Additional Cardiac Procedure A Catastrophic Risk During Bentall Operation? Long Term Results in A Tertiary Center

2021 ◽  
Vol 16 (5) ◽  
Author(s):  
Mehmet Ali Yesiltas
Keyword(s):  
Cardiac Surgery ◽  
Long Term Results ◽  
Mortality And Morbidity ◽  
Single Center Experience ◽  
Bentall Procedure ◽  
Cardiac Procedure ◽  
Tertiary Center ◽  
Surgical Data ◽  
Group A ◽  
Group B

The aim of this study was to assess the influences of concomitant cardiac surgery on the risk for mortality and morbidity after Bentall procedure. This retrospective study was a review of patients who underwent Bentall procedure from a single center experience over a 7-year period. Demographic features, surgical data, postoperative period and outcomes were analyzed. Patients with isolated Bentall surgery (Group A) were compared and concomitant cardiac surgery with Bentall procedure were compared (Group B).

scholarly journals COMPARISON OF INTRANASAL DEXMEDETOMIDINE V/S MIDAZOLAM AS A PREMEDICATION IN CHIDREN WITH CONGENITAL HEART DISEASE UNDERGOING CARDIAC SURGERY

2021 ◽  
Vol 9 (01) ◽  
pp. 814-822
Author(s):  
Sanjay Kumar Morwal ◽  
Ajit Singh ◽  
C.K. Vyas ◽  
Neelu Sharma
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Arterial Blood ◽  
Sedative Effects ◽  
Group A ◽  
Child Separation ◽  
Group B ◽  
Intranasal Midazolam

Background: The intranasal route is a reliable way to administer preanaesthetics and sedatives to children. The aim of present study was to compare the anxiolytic and sedative effects of intranasal dexemedetomidine and midazolam as a premedication in children with congenital heart disease undergoing cardiac surgery.. Patients and Methods: Fifty chidrens 2-12 years of age group of either sex with congenital heart disease undergoing cardiac surgery were randomly allocated into two groups. Group A-(n=25) - received intranasal dexmedetomidine as premedication.(0.1 µg/kg diluted in 2ml NS ) Group B- (n=25)- received intranasal midazolam as premedication. (0.2 mg/kg diluted in 2ml NS) Heart rate, mean arterial blood pressure and oxygen saturation were monitored upto30 minute after drug administration. The sedation score, anxiety score and child separation score were recorded until the child taken to the OR. The postoperative agitation score was also observed. Results and Conclusion: Premedication with intranasal dexmedetomidine attained significant and satisfactory sedation with better parental separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam in children with congenital heart disease undergoing cardiac surgery.

scholarly journals Efficacy of citrulline supplementation to decrease the risk of pulmonary hypertension after congenital heart disease surgery. A local experience.

2020 ◽  
Vol 77 (4) ◽  
pp. 249-253
Author(s):  
Silene Silvera Ruiz ◽  
Carola L Grosso ◽  
Margot Tablada ◽  
Marcelo Cabrera ◽  
Raquel Dodelson de Kremer ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Reference Level ◽  
Plasma Citrulline ◽  
Post Surgery ◽  
Group A ◽  
Group B

Pulmonary hypertension (PH) is a major cause of morbi-mortality among patients with congenital heart disease (CHD) and also a potentially severe complication after surgical repair. Oral citrulline, a precursor to NO synthesis, is safe and efficacious for decreasing the risk of postoperative PH. Objective: The aim of the present study was to investigate in pediatric patients the changes of plasma citrulline, arginine, homocysteine and nitric oxide (NO) metabolites and pulmonary artery pressures (PAP) pre-post cardiac surgery in order to describe our population status with regard to the risk of pulmonary hypertension and look for potential biomarkers for early detection and treatment. Main results/Discussion: 16 Argentine pediatric patients with CHD undergoing cardiopulmonary bypass were randomized in two groups: (A) with and (B) without perioperative citrulline supplementation. We found that plasma citrulline median levels before surgery were lower in both groups respect to referential values, probably due to the poor nutritional status of our patients; only group A surpassed post-surgery the minimum recommended level to avoid PH. Furthermore, none of the patients in group A showed mean PAP higher than 20 mmHg, whereas in group B, 67% of the measurements were ≥ than the reference level. Conclusions: We reaffirm that citrulline supplementation it is effective in reducing postoperative pulmonary hypertension and biomarkers could evidence patient status as a translational medicine application.

Effects of aspirin and desmopressin on platelet reactivity in patients undergoing cardiac surgery with extracorporeal circulation

2011 ◽  
Vol 105 (01) ◽  
pp. 113-121 ◽  
Author(s):  
Eliane Kmitta ◽  
Sami Kueri ◽  
Tomasz Zietak ◽  
Dietmar Trenk ◽  
Cornelius Keyl
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Extracorporeal Circulation ◽  
Platelet Reactivity ◽  
Therapy Group ◽  
Artery Bypass ◽  
Bleeding Tendency ◽  
Platelet Aggregometry ◽  
Group A ◽  
Group B

SummaryThe effect of desmopressin on platelet function in patients with continued antiplatelet therapy undergoing cardiac surgery is discussed controversially. We assessed platelet reactivity in 86 patients undergoing elective coronary artery bypass grafting (CABG) under extracorporeal circulation. Twenty-nine of these patients were without preoperative antiplatelet therapy (group A), while 57 were treated with acetylsalicylic acid (ASA) 100 mg qd up to the day of surgery. Out of this cohort, 24 patients received no desmopressin perioperatively (group B), whereas 33 patients were treated with desmopressin 0.4 μg/kg after administration of protamine due to increased bleeding tendency (group C). Multiple electrode platelet aggregometry with arachidonic acid as agonist showed a marked decrease of platelet reactivity in patients without antiplatelet therapy immediately after extracorporeal circulation compared to preoperative control (375 ± 227 vs. 749 ± 330 AU*min, p<0.001). Platelet reactivity recovered to preoperative controls in group A at 24 hours after protamine administration (662 ± 295 AU*min). Platelet reactivity in patients on ASA was not decreased further after extracorporeal circulation (group B: 197 ± 126 vs. 251 ± 203 AU*min, p=0.14; group C: 212 ± 100 vs. 245 ± 248 AU*min, p=0.43) and improved significantly within 24 hours. A statistically significant effect of desmopressin, however, could not be determined (group B: 392 ± 223 AU*min; group C: 439 ± 324 AU*min at 24 hours after protamine, p=0.63 for between-subjects contrast). Our data suggest that desmopressin does not affect platelet reactivity in patients on ASA undergoing CABG and is, therefore, not useful in this clinical setting.

scholarly journals Oxygenation failure after cardiac surgery: early re-intubation versus treatment by nasal continuous positive airway pressure (NCPAP) or non-invasive positive pressure ventilation (NPPV)

2016 ◽  
Vol 70 (2) ◽  
Author(s):  
Muhammed Kurt ◽  
Udo Boeken ◽  
Jens Litmathe ◽  
Peter Feindt ◽  
Emmeran Gams
Keyword(s):  
Cardiac Surgery ◽  
Respiratory Failure ◽  
Oxygen Transfer ◽  
Airway Pressure ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Positive Pressure ◽  
Non Invasive ◽  
Group A ◽  
Group B

Background: Due to an increasing incidence of respiratory failure after cardiac surgery we wanted to study whether nasal continuous positive airway pressure (NCPAP) may improve pulmonary oxygen transfer and may avoid reintubation after coronary operations. Additionally, we compared this protocol to non-invasive positive pressure ventilation (NPPV). Methods: For a period of 2 years we analyzed all patients that were extubated within 12 hours after coronary surgery, and in whom oxygen transfer (PaO2/FIO2) deteriorated without hypercapnia so that all these patients met predefined criteria for reintubation: group A=immediate reintubation (n=88), group B=NCPAP-treatment (n=173), group C=NPPV(n=18). Results: 25,4% of group B- and 22,2% of group C-patients were also intubated after a period of NCPAP or NPPV. All other patients of groups B and C could be weaned from these devices (B = 34.3 ± 5.9 hours; C = 26.4 ± 4.4 h; p&lt;0.05) and were well oxygenated by face mask at ambient pressure (Ratio PaO2/FIO2: B, 138 ± 13; C, 140 ± 13). In group A we found a higher mortality (7.95%) compared to group B (4.04%) and group C (5.55%). NCPAP-patients suffered more frequently from an impaired sternal wound healing (A = 4.5%, B = 8.6%; p&lt;0.05). Conclusions: We conclude that reintubation after cardiac operations should be avoided since NCPAP and NPPV are safe and effective to improve arterial oxygenation in most patients with non hypercapnic respiratory failure.

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