C2 taa_c 4'2006 a.qxd

Rezumat Aspecte clinice aei chirurgicale în enterocolita ulceronecroticã Scopul lucrãrii este acela de a stabili dacã parametrii clinici şi radiologici pot determina prognosticul şi progresia patologiei, necesitatea realizãrii laparotomiei sau a drenajului peritoneal, precum şi mortalitatea în rândul pacienåilor trataåi chirurgical. Un numãr de 51 de pacienåi diagnosticaåi cu enterocolitã ulceronecroticã internaåi în clinica de chirurgie a Spitalului de Urgenåã pentru Copii "Grigore Alexandrescu" în perioada 2005-20011 au fost evaluaåi, fiind adunate informaåii cu privire la examenul clinic şi radiologic. Mortalitatea în rândul pacienåilor trataåi chirurgical este de 59.9%. Toåi pacienåii diagnosticaåi cu enterocolitã stagiul III au fost supuşi unei intervenåii chirurgicale, mortalitatea în rândul acestora fiind crescutã. S-a constat cã pentru pacienåilor la care simptomatologia a debutat mai târziu, patologia a fost mai severã şi prognosticul vital al acestor copii a fost unul prost. Cuvinte cheie: stadializare Bell, debutul simptomatologiei, examen radiologic Abstract Background: The purpose of the paper is to establish whether clinical and radiological parameters can predict the progression of the pathology, the necessity of performing laparotomy for patients with peritoneal drain and the mortality in surgically treated neonatal necrotizing enterocolitis patients. Material and Methods: A number of 51 cases with necrotizing enterocolitis from our institution were reviewed (from 2005 to 2011) and information on patient demographics and data about the clinical and radiological parameters was collected. Results: Of the 51 patients, 29 were (56.8%) males and 22 (43.2%) females. Age at presentation ranges between 1 and 87 days, with a mean 18.71 days. Birth weight varies between 400-4700g (mean 1979.6 g ± 1012.5). The mortality rate in our study was 45% (23 patients out of 51). Conclusions: The mortality rate in our series was 45%. Even though Bell stage III patients have clear indications for surgery, the procedure involves high fatality. Patients who undergo surgery are more likely to die than the ones who do not. We found that a later debut of symptoms should be an alarm sign for both the severity of the condition and for its outcome

Pre-revascularization coronary wedge pressure as marker of adverse long-term left ventricular remodelling in patients with acute ST-segment elevation myocardial infarction

Abstract The aim of this study was to investigate the relationship between coronary wedge pressure (CWP), measured as a marker of pre-procedural microvascular obstruction, and left ventricular remodelling in high-risk ST-segment elevation myocardial infarction (STEMI) patients. Pre-revascularization CWP was measured in 25 patients with high-risk anterior STEMI. Left ventricular volumes and ejection fraction were echocardiographically measured at discharge and at follow-up. A 20% increase in left ventricular volumes was used to define remodelling. Patients with CWP ≤ 38 mmHg were characterized by late ventricular remodelling. Patients with CWP > 38 mmHg developed a progressive remodelling process which was associated with a significant 60 months increase in left ventricular volumes (P = 0.01 for end-systolic volume and 0.03 for end-diastolic volume) and a significant decrease in left ventricular ejection fraction (P = 0.05). A significant increase in both left ventricular end-systolic (P = 0.009) and end-diastolic volume (P = 0.02) from baseline to 60 months follow-up was recorded in patients with extracted thrombus length ≥2 mm. Pre-revascularization elevated CWP was associated with increased left ventricular volumes and decreased ejection fraction at long-term follow-up. CWP was a predictor of severe left ventricular enlargement, besides extracted thrombus quantity

New Predictors of Early and Late Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Unprotected Left Main Coronary Artery Culprit Lesion

Objectives. The study evaluated the correlation between baseline SYNTAX Score, Residual SYNTAX Score, and SYNTAX Revascularization Index and long-term outcomes in ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) on an unprotected left main coronary artery lesion (UPLMCA). Background. Previous studies on primary PCI in UPLMCA have identified cardiogenic shock, TIMI 0/1 flow, and cardiac arrest, as prognostic factors of an unfavourable outcome, but the complexity of coronary artery disease and the extent of revascularization have not been thoroughly investigated in these high-risk patients. Methods. 30-day, 1-year, and long-term outcomes were analyzed in a cohort of retrospectively selected, 81 consecutive patients with STEMI, and primary PCI on UPLMCA. Results. Cardiogenic shock (p=0.001), age (p=0.008), baseline SYNTAX Score II (p=0.006), and SYNTAX Revascularization Index (p=0.046) were independent mortality predictors at one-year follow-up. Besides cardiogenic shock (HR 3.28, p<0.001), TIMI 0/1 flow (HR 2.17, p=0.021) and age (HR 1.03, p=0.006), baseline SYNTAX Score II (HR 1.06, p=0.006), residual SYNTAX Score (HR 1.03, p=0.041), and SYNTAX Revascularization Index (HR 0.9, p=0.011) were independent predictors of mortality at three years of follow-up. In patients with TIMI 0/1 flow, the presence of Rentrop collaterals was an independent predictor for long-term survival (HR 0.24; p=0.049). Conclusions. In this study, the complexity of coronary artery disease and the extent of revascularization represent independent mortality predictors at long-term follow-up