MANUALE DI TERAPIA INTENSIVA POSTCARDIOCHIRURGICA: Capitolo 14 - Problemi emocoagulativi

Sommario: Organizzazione dell'unità di terapia intensiva postoperatoria. Monitorizzazione dei parametri vitali nel cardiopatico operato. Farmaci più comunemente utilizzati in terapia intensiva. Approccio al cardiopatico operato. Disposizioni post-operatorie all'arrivo del paziente in terapia intensiva. Sindrome da bassa portata. Arresto cardiaco. Contropulsazione aortica. Peculiarità assistenziale del paziente sottoposto a trapianto. Ventilazione meccanica e complicanze respiratorie. Insufficienza renale acuta. Emodiafiltrazione artero-venosa continua. Equilibrio acido base. Insufficienza multiorgano. Problemi emocoagulativi. Complicanze infettive. Shock settico. Complicanze neurologiche. Supporto nutrizionale. Aspetti giuridici e etici dell'assistenz

Endocarditis caused by Lactococcus lactis subsp lactis in a patient with atrial myxoma: a case report

We report a case of subacute endocarditis in a 55-year-old patient affected by left atrial myxoma and with a severe mitral regurgitation. Lactococcus lactis subsp. lactis was isolated from blood cultures and infection was eliminated by treatment with amoxicillin-clavulanic acid. (c) 2006 Elsevier Inc. All rights reserved

Endocarditis caused by Lactobacillus jensenii in an immunocompetent patient

Lactobacilli are Gram-positive rod-shaped bacteria that inhabit the oral cavity, gastrointestinal tract, vagina and nasal cavity In this report, a rare case of Lactobacillus Jensenii endocarditis in a 47-year-old immunocompetent patient is described. Blood cultures and a replaced mitral valve were positive for L Jensenii as assessed by 16S rRNA gene sequencing Based on susceptibility tests the patient was successfully treated with a mixture of teicoplanin and meropenem antimicrobial therap

Intracardiac thrombus in a patient with autoimmune hemolytic anemia leading to a diagnosis of antiphospholipid syndrome.

We report a case of antiphospholipid syndrome (APS) which presented with clinical and laboratory signs of an autoimmune hemolytic anemia (AHA), in the absence of manifestations typically related to APS. The diagnosis of APS was made only after the occurrence of a sudden severe heart failure due to an intraventricular thrombus requiring a surgical approach. An accurate thrombophilic screening is warranted also in patients with apparently idiopathic AHA

Serum phospholipids are the main environmental determinants of activated factor VII levels in the most common FVII genotype.

BACKGROUND AND OBJECTIVE: Numerous studies have emphasized the role of triglyceride-rich lipoproteins and of Factor VII (FVII) polymorphisms in determining levels of FVII activity. DESIGN AND METHODS: This study was undertaken to evaluate the role of other lipid fractions and the interaction between lipids and FVII in subjects with recognised genotypes. Volunteer subjects (n=459) from 5 European countries were studied. Blood samples were drawn irrespective of the time of day or fasting status. Levels of FVII activity (FVIIc), activated FVII (FVIIa) and FVII antigen (FVIIAg) were evaluated with reference to a number of lipid parameters (HDL-, LDL- and total cholesterol, triglycerides, phospholipids, lipoprotein(a), and apoliproptein A1). The two most common FVII polymorphisms were analyzed in combination (353R/Q and 5'F7; alleles M1/M2 and A1/A2, respectively). RESULTS: Homozygotes for the A1 and M1 alleles (M11/A11) had significantly higher FVII levels. At multiple regression analysis the strongest predictor of FVIIa and FVIIc was the concentration of phospholipids. This interaction was confined to the A11M11 genotype subjects. INTERPRETATION AND CONCLUSIONS: These data indicate that lipids contribute mainly to FVIIa levels through their phospholipid content, and that the degree of this contribution is strictly dependent on FVII genotypes