Routine Use of Unilateral and Bilateral Radial Arteries for Coronary Artery Bypass Graft Surgery

AbstractObjectives. This study sought to evaluate the routine use of radial artery (RA) grafts in patients undergoing coronary artery revascularization.Background. Previous long-term studies have documented poor patency of saphenous vein grafts compared with internal thoracic artery (ITA) grafts.Methods. We performed a prospective review of 175 of 249 consecutive patients.Results. Fifty-four patients had bilateral RAs harvested. Mean number (±SD) of grafts/patient was 3.27 ± 0.93, with 2.76 ± 0.97 arterial grafts; a mean of 1.53 ± 0.68 grafts were performed with the RA. The operative mortality rate was 1.6%. No deaths were related to RA grafts, and there were no RA harvest site hematomas or infections. Transient dysesthesia 1 day to 4 weeks in duration occurred in the distribution of the lateral antebrachial cutaneous nerve in six extremities (2.6%). Elective cardiac catheterization in 60 patients at 12 weeks postoperatively demonstrated a 95.7% patency rate.Conclusions. Because of potential benefit of long-term patency associated with arterial grafts, minimal morbidity and mortality associated with use of the RA and excellent short-term patency rates, we cautiously recommend use of one or both RAs as additional conduits to be used concomitantly with the ITA for arterial revascularization of the coronary arteries

Fast-tracking in pediatric cardiac surgery - The current standing

Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity. With careful patient selection, fast-tracking can be performed in many patients undergoing surgery for congenital heart disease (CHD). In order to accomplish this safely, a multidisciplinary coordinated approach is necessary. This manuscript reviews currently used anesthetic techniques, patient selection, and available information about the safety and patient outcome associated with this approach

Parentesco reconfigurado no espaço da adoção Refiguring kinship in the space of adoption

Nesse artigo, inspiro-me em pesquisas realizadas na Suécia, Índia, Colômbia, Equador, Bolívia, Chile e Estados Unidos, entre 1995 e 2004, para enfocar o que Laurel Kendall descreve como "a plasticidade assim como a força do parentesco idiomático" no contexto da adoção transnacional. Tanto na Europa como na América do Norte, adoções transnacionais (que tendem a ser transraciais, dado que a maioria das crianças adotadas vem de regiões não-européias) complicam o projeto de "imitar a natureza", pois em muitas dessas adoções a "diferença" entre os pais adotivos e a criança é evidente. O adotado oriundo da Ásia, da África ou da América Latina que vive numa família euro-americana representa um paradoxo de pertencimento no contexto global onde o transnacionalismo, ao mesmo tempo, afirma e transgride as fronteiras da nação-estado.<br>In this article, I draw on research carried out in Sweden, India, Colombia, Ecuador, Bolivia, Chile, and the United States between 1995-2004 to focus on what Laurel Kendall describes as "the plasticity as well as the power of idiomatic kinship" in the context of transnational adoption. In both Europe and North America, transnational adoptions (which have tended to be cross-racial, in the sense that the majority of adopted children come from non-European regions of the globe) complicate the project of "imitating nature", since in many of these adoptions, the "difference" between adopted child and parent is obvious. The adoptee from Asia, Africa, or Latin America in an Euro-American home represents the ultimate paradox of belonging in a global context where transnationalism both affirms and breaches the borders of the nation-state

Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock

PURPOSE To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. METHODS We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. RESULTS Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) - 4.8 to 7.8]. Mean differences were 0.00 (99% CI - 0.06 to 0.05) for EQ-5D-5L index values, - 0.65 for EQ VAS (- 5.40 to 4.08), and - 0.14 for Mini MoCA (- 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. CONCLUSIONS Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out