Acute mesenteric ischemia due to superior mesenteric artery embolism in a patient with permanent atrial fibrillation

Acute mesenteric ischemia (AMI) is an uncommon disorder with a high mortality rate. Reduction in mortality requires a high index of suspicion and prompt diagnosis. We describe a case of AMI in a 59-year old man with a history of permanent atrial fibrillation. Pathogenesis of AMI, clinical implications, diagnostic and therapeutic options are discussed

Intravenous anaesthesia for adenoidectomy in a 3-year-old child with Kartagener syndrome and sleep disordered breathing

Kartagener syndrome (KGS) is a rare inherited disorder characterized by situs inversus viscerum (including dextrocardia) and primary ciliary dyskinesia resulting in chronic respiratory tract infections, bronchiectasis and sinusitis. Possible anesthesiologic challenges are related to the respiratory system and increased susceptibility to infectious complications. There are several case reports of general anesthesia in these patients, but mainly in the adult population . Here, we report on a 3-year old female child with KGS, who underwent adenoidectomy because of sleep disordered breathing (SDB). Preoperative preparation consisted of intravenous antibiotics, steroids, as well as postural drainage and inhalations of bromhexine and salbutamol. Anesthesia was induced with propofol, fentanyl and vecuronium and maintained with a continuous infusion of propofol (150-200 gkg-1min-1) and supplemental doses of fentanyl. The child was ventilated with oxygen/air mixture (50%:50%) in the pressure-controlled mode of ventilation to keep end-tidal CO2 between 30 and 35 mmHg. During anesthesia the child’s hemodynamic and respiratory parameters were stable. Extubation, after thorough endotracheal and oral suction, was uneventful. After two hours in the post-anaesthesia care unit (PACU), the child was transferred to the ward. To the best of our knowledge, this is the youngest reported child with KGS and SDB that underwent intravenous general anesthesia. We also stress here the importance of comprehensive pre-anesthetic preparation, i.e. postural drainage, inhalations, bronchodilators, i.v. antibiotics and steroids. Furthermore, the condition of the respiratory system in the patient with KGS is seldom appropriate at the time of surgery, so the decision to anesthetize or not, should be made on an individual basis

Disturbed Fatty Acid Oxidation, Endoplasmic Reticulum Stress, and Apoptosis in Left Ventricle of Patients With Type 2 Diabetes

International audienceChronic heart failure is a common complication in patients with type 2 diabetes mellitus (T2DM). T2DM is associated with disturbed metabolism of fat, which can result in excessive accumulation of lipids in cardiac muscle. In the current study, we assessed mitochondrial oxidation of carbohydrates and fatty acids, lipid accumulation, endoplasmic reticulum (ER) stress, and apoptosis in diabetic left ventricle. Left ventricular myocardium from 37 patients (a group of patients with diabetes and a group of patients without diabetes [ejection fraction >50%]) undergoing coronary artery bypass graft surgery was obtained by subepicardial needle biopsy. The group with diabetes had a significantly decreased rate of mitochondrial respiration fueled by palmitoyl-carnitine that correlated with blood glucose dysregulation, while there was no difference in oxidation of pyruvate. Diabetic myocardium also had significantly decreased activity of hydroxyacyl-CoA dehydrogenase (HADHA) and accumulated more lipid droplets and ceramide. Also, markers of ER stress response (GRP78 and CHOP) and apoptosis (cleaved caspase-3) were elevated in diabetic myocardium. These results show that, even in the absence of contractile failure, diabetic heart exhibits a decreased mitochondrial capacity for β-oxidation, increased accumulation of intracellular lipids, ER stress, and greater degree of apoptosis. Lower efficiency of mitochondrial fatty acid oxidation may represent a potential target in combating negative effects of diabetes on the heart