Why are thoracic operations postponed?

<p>Abstract</p> <p>Aim</p> <p>To investigate and present the reasons that cause the postponement of thoracic surgical operations.</p> <p>Methods</p> <p>We retrospectively included in the study all patients submitted to elective thoracic surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule.</p> <p>Results</p> <p>81 out of a total of 542 patients (14.9%) scheduled for elective thoracic operation had their procedure postponed. The reasons were mainly organisatory (in 42 cases, 51.85%), which in order of significance were: shortage in matching erythrocyte units, shortage in anaesthetic/nursing staff and unavailability in operating rooms. The rest of the cases (39, 48.1%) were postponed due to medical reasons, which in descending order of significance were: respiratory infections and exacerbations of COPD, cardiological problems, misregulation of antiplatelet/antithrombotic drugs and infections from other systems (gastrointestinal, urinary, etc.). Elderly male patients planned for major/oncologic surgery were most possible to have their operation postponed for medical reasons.</p> <p>Discussion-Conclusions</p> <p>Thoracic operations are postponed owed to organisatory as well as medical reasons, the latter mainly affecting elderly, morbid patients awaiting for major/oncologic surgery.</p

Remote preconditioning in normal and hypertrophic rat hearts

<p>Abstract</p> <p>Background</p> <p>The aim of our study was to investigate whether remote preconditioning (RPC) improves myocardial function after ischemia/reperfusion injury in both normal and hypertrophic isolated rat hearts. This is the first time in world literature that cardioprotection by RPC in hypertrophic myocardium is investigated.</p> <p>Methods</p> <p>Four groups of 7 male Wistar rats each, were used: Normal control, normal preconditioned, hypertrophic control and hypertrophic preconditioned groups. Moderate cardiac hypertrophy was induced by fludrocortisone acetate and salt administration for 30 days. Remote preconditioning of the rat heart was achieved by 20 minutes transient right hind limb ischemia and 10 minutes reperfusion of the anaesthetized animal. Isolated Langendorff-perfused animal hearts were then subjected to 30 minutes of global ischemia and reperfusion for 60 minutes. Contractile function and heart rhythm were monitored. Preconditioned groups were compared to control groups.</p> <p>Results</p> <p>Left ventricular developed pressure (LVDP) and the product LVDP × heart rate (HR) were significantly higher in the hypertrophic preconditioned group than the hypertrophic control group while left ventricular end diastolic pressure (LVEDP) and severe arrhythmia episodes did not differ. Variances between the normal heart groups were not significantly different except for the values of the LVEDP in the beginning of reperfusion.</p> <p>Conclusions</p> <p>Remote preconditioning seems to protect myocardial contractile function in hypertrophic myocardium, while it has no beneficial effect in normal myocardium.</p

Remote ischemic preconditioning in normal and hypertrophic myocardium

Background. The aim of our study was to investigate whether remote preconditioning (RPC) improves myocardial function after ischemia/reperfusion injury in both normal and hypertrophic isolated rat hearts. This is the first time in world literature that cardioprotection by remote preconditioning in hypertrophic myocardium is investigated. Methods. Four groups of 7 male Wistar rats each, were used: Normal control, normal preconditioned, hypertrophic control and hypertrophic preconditioned groups. Moderate cardiac hypertrophy was induced by fludrocortisone acetate and salt administration for 30 days. Remote preconditioning of the rat heart was achieved by 10 minutes transient right hind limb ischemia of the anaesthetized animal. Isolated Langendorff-perfused animal hearts were then subjected to 30 minutes of global ischemia and reperfusion for 60 minutes. Contractile function and heart rhythm were monitored. Preconditioned groups were compared to control groups. Results. Left ventricular developed pressure (LVDP) and the product LVDP x heart rate (HR) were significantly higher in the hypertrophic preconditioned group than the hypertrophic control group while left ventricular end diastolic pressure (LVEDP) and severe arrhythmia episodes did not differ. Variances between the normal heart groups were not significantly different except for the values of the LVEDP in the beginning of reperfusion. Conclusions. Remote preconditioning seems to protect myocardial contractile function in hypertrophic myocardium, while it has no beneficial effect in normal myocardium in rats.Σκοπός της εργασίας είναι να μελετηθεί κατά πόσον η προετοιμασία του μυοκαρδίου με παροδική ισχαιμία απομακρυσμένου οργάνου βελτιώνει την λειτουργικότητα της καρδιάς μετά από παρατεταμένη ισχαιμία/επαναιμάτωση σε φυσιολογικές ή υπερτροφικές απομονωμένες καρδιές αρουραίων. Είναι η πρώτη φορά στη διεθνή βιβλιογραφία που μελετάται η προστασία της καρδιάς με από απόσταση προετοιμασία υπερτροφικού μυοκαρδίου. Υλικό και μέθοδος. Χρησιμοποιήθηκαν 4 ομάδες από 7 αρουραίους η κάθε μία: ομάδα ελέγχου με φυσιολογικό μυοκάρδιο, ομάδα με ισχαιμική προετοιμασία-φυσιολογικό μυοκάρδιο, ομάδα ελέγχου με υπερτροφικό μυοκάρδιο και ομάδα με ισχαιμική προετοιμασία-υπερτροφικό μυοκάρδιο. Στα πειραματόζωα με μέτρια υπερτροφία της καρδιάς, αυτή προκλήθηκε με τη χορήγηση φθοριοϋδροκορτιζόνης και αλατιού από το στόμα για 30 ημέρες. Η προετοιμασία της καρδιάς με ισχαιμία απομακρυσμένου οργάνου επιτεύχθηκε με παροδική ισχαιμία του δεξιού κάτω άκρου του πειραματόζωου. Η αναισθητοποίηση των ζώων έγινε με ενδοπεριτοναϊκή έγχυση πεντοθάλης. Χρησιμοποιήθηκε η μέθοδος της απομονωμένης αναρτημένης καρδιάς που αρδεύεται κατά Langendorff. Οι καρδιές υποβλήθηκαν σε 30λεπτη καθολική ισχαιμία και στη συνέχεια σε επαναιμάτωση για 60 λεπτά. Μετρήθηκε η συσταλτική ικανότητα της καρδιάς (η αναπτυσσόμενη πίεση της αριστερής κοιλίας ΑΠ, η τελοδιαστολική πίεση της αριστερής κοιλίας ΔΠ και το παράγωγο ΑΠ επί τον αριθμό των σφύξεων ΑΣ) και παρακολουθήθηκε ο καρδιακός ρυθμός. Η σύγκριση έγινε μεταξύ των ομάδων με προετοιμασία και αυτών χωρίς προετοιμασία (χωριστά για τις φυσιολογικές και τις υπερτροφικές καρδιές). Αποτελέσματα. Η αναπτυσσόμενη πίεση της αριστερής κοιλίας (ΑΠ) και το παράγωγο ΑΠxΑΣ ήταν σημαντικά μεγαλύτερα στην ομάδα με υπερτροφία και προστασία της καρδιάς, ενώ η τελοδιαστολική πίεση και τα επεισόδια αρρυθμίας δεν διέφεραν. Στις ομάδες με φυσιολογικό μυοκάρδιο δεν υπήρχαν στατιστικά σημαντικές διαφορές, εκτός από τις τιμές της τελοδιαστολικής πίεσης στην αρχή της επαναιμάτωσης. Συμπεράσματα. Η προετοιμασία της καρδιάς με ισχαιμία άλλου οργάνου προστατεύει τη συσταλτική ικανότητα της υπερτροφικής καρδιάς, ενώ δεν πλεονεκτεί όταν το μυοκάρδιο είναι φυσιολογικό. Τα επεισόδια κοιλιακής αρρυθμίας είναι ελάχιστα και δεν διαφέρουν σε όλες τις ομάδες. Το αποτέλεσμα της έρευνας μπορεί να βρει εφαρμογή στον άνθρωπο καθώς το υπερτροφικό μυοκάρδιο απαντά σε πολλές παθολογικές κλινικές καταστάσεις, ενώ η προετοιμασία με ισχαιμία απομακρυσμένου οργάνου δεν επιβουλεύεται την ίδια την καρδιά

Experimental Cardiac Hypertrophy Induced by Oral Administration of Mineralocorticoid and Saline in Rats

We suggest a new, easily applicable way of myocardial hypertrophy induction in rats. Forty randomized age-matched male Wistar rats were divided into 2 groups of 20 each: a control group and an orally administered fludrocortisone/salt group. Myocardial hypertrophy was estimated by measuring body weight, heart-weight-to-body-weight ratio and ventricular free wall thickness. Moderate myocardial hypertrophy without heart failure was established in fludrocortisone/salt group in 4 weeks. Our method is effective and low cost, and it provides a model of hypertrophic heart

Why are heart operations postponed?

Aim: To investigate the reasons that lead to postponement of cardiac operations, in order to elucidate the problem and help patients through modes of prevention. Methods-Design: We retrospectively included in the study all patients submitted to elective adult heart surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule. Results: 94 out of a total of 575 patients (16.34%) scheduled for elective cardiac operation had their procedure postponed. The reasons were mainly organisatory (in 49 cases, 52.12%), which in order of significance were: unavailability in operating rooms, shortage in matching erythrocyte units and shortage in anaesthetic/nursing staff. The rest of the cases (45, 47.88%) were postponed due to medical reasons, which in order of significance were: febrile situations, including infections of the respiratory, gastrointestinal and urinary system, problems with the regulation of antiplatelet and antithrombotic drugs, neurological manifestations such as stroke and transient ischaemic attacks, exacerbation of asthma/chronic obstructive pulmonary disease, arrhythmias, renal problems and allergic reactions to drugs. Patients with advanced age and increased Euroscore values were most possible to have their heart operation postponed. Conclusions: Heart operations are postponed due to organisatory as well as medical reasons, the latter mainly affecting older, morbid patients who therefore require advanced preoperative care