Baseline cerebral oximetry values in cardiac and vascular surgery patients: a prospective observational study

<p>Abstract</p> <p>Aim</p> <p>This study was conducted to evaluate baseline INVOS values and identify factors influencing preoperative baseline INVOS values in carotid endarterectomy and cardiac surgery patients.</p> <p>Methods</p> <p>This is a prospective observational study on 157 patients (100 cardiac surgery patients, 57 carotid endarterectomy patients). Data were collected on factors potentially related to baseline INVOS values. Data were analyzed with student's t-test, Chi-square, Pearson's correlation or Linear Regression as appropriate.</p> <p>Results</p> <p>100 cardiac surgery patients and 57 carotid surgery patients enrolled. Compared to cardiac surgery, carotid endarterectomy patients were older (71.05 ± 8.69 vs. 65.72 ± 11.04, P < 0.001), with higher baseline INVOS (P < 0.007) and greater stroke frequency (P < 0.002). Diabetes and high cholesterol were more common in cardiac surgery patients. Right side INVOS values were strongly correlated with left-side values in carotid (r = 0.772, P < 0.0001) and cardiac surgery patients (r = 0.697, P < 0.0001). Diabetes and high cholesterol were associated with significantly (P < 0.001) lower INVOS and smoking was associated with higher INVOS values in carotid, but not in cardiac surgery patients. Age, sex, CVA history, Hypertension, CAD, Asthma, carotid stenosis side and surgery side were not related to INVOS. Multivariate analysis showed that diabetes is strongly associated with lower baseline INVOS values bilaterally (P < 0.001) and explained 36.4% of observed baseline INVOS variability in carotid (but not cardiac) surgery.</p> <p>Conclusion</p> <p>Compared to cardiac surgery, carotid endarterectomy patients are older, with higher baseline INVOS values and greater stroke frequency. Diabetes and high cholesterol are associated with lower baseline INVOS values in carotid surgery. Right and left side INVOS values are strongly correlated in both patient groups.</p

Ultrasonographic computer-assisted analysis of atheromatic carotid plaques.

ΣΚΟΠΟΣ ΤΗΣ ΠΑΡΟΥΣΑΣ ΚΛΙΝΙΚΗΣ ΠΡΟΟΠΤΙΚΗΣ ΜΕΛΕΤΗΣ ΕΙΝΑΙ ΝΑ ΔΙΕΡΕΥΝΗΣΕΙ ΤΗΝ ΣΧΕΣΗ ΜΕΤΑΞΥ ΤΗΣ ΗΧΟΓΕΝΕΙΑΣ ΤΗΣ ΑΘΗΡΩΜΑΤΙΚΗΣ ΠΛΑΚΑΣ ΤΩΝ ΚΑΡΩΤΙΔΩΝ ΟΠΩΣ ΕΚΤΙΜΑΤΑΙ ΜΕ ΗΛΕΚΤΡΟΝΙΚΟ ΥΠΟΛΟΓΙΣΤΗ ΚΑΙ ΤΗΣ ΥΠΑΡΞΗΣ ΑΦ'ΕΝΟΣ ΣΥΜΠΤΩΜΑΤΩΝ ΕΓΚΕΦΑΛΙΚΗΣ ΙΣΧΑΙΜΙΑΣ ΚΑΙ ΑΦ'ΈΤΕΡΟΥ ΙΣΧΑΙΜΙΚΩΝ ΕΚΦΡΑΓΜΑΤΩΝ.ΕΞΕΤΑΣΘΗΚΑΝ 31 ΑΣΘΕΝΕΙΣ ΜΕ 43 ΑΘΗΡΩΜΑΤΙΚΕΣ ΠΛΑΚΕΣ ΤΩΝ ΚΑΡΩΤΙΔΩΝ ΟΙ ΟΠΟΙΕΣ ΠΡΟΚΑΛΟΥΣΑΝ ΣΤΕΝΩΣΗ >50%,ΟΙ ΥΠΕΡΗΧΟΓΡΑΦΙΚΕΣ ΕΙΚΟΝΕΣ ΤΩΝ ΑΘΗΡΩΜΑΤΙΚΩΝ ΠΛΑΚΩΝ ΜΕΤΑΦΕΡΘΗΚΑΝ ΣΕ ΗΛΕΚΤΡΟΝΙΚΟ ΥΠΟΛΟΓΙΣΤΗ ΟΠΟΥ ΔΗΜΙΟΥΡΓΗΘΗΚΕ ΕΝΑ ΙΣΤΟΓΡΑΜΜΑ ΓΙΑ ΚΑΘΕ ΠΛΑΚΑ,Η ΔΙΑΜΕΣΟΣ ΤΙΜΗ ΤΟΥ ΟΠΟΙΟΥ (GMS) ΑΠΟΤΕΛΕΣΕ ΤΟ ΜΕΤΡΟ ΤΗΣ ΗΧΟΓΕΝΕΙΑΣ ΑΥΤΗΣ.ΔΕΚΑ ΕΞΙ ΠΛΑΚΕΣ ΗΤΑΝ ΣΥΜΠΤΩΜΑΤΙΚΕΣ ΚΑΙ 27 ΑΣΥΜΠΤΩΝΑΤΙΚΕΣ ΕΝΝΕΑ ΠΛΑΚΕΣ ΣΧΕΤΙΖΟΝΤΑΝ ΜΕ ΕΜΦΡΑΤΙΚΟ ΚΑΙ 34 ΟΧΙ ΑΠΟ ΤΙΣ 26 ΠΛΑΚΕΣ ΜΕ GMS>30 (YΠΕΡΗΧΟΙΚΕΣ)ΜΟΝΟ 4 ΣΧΕΤΙΖΟΝΤΑΝ ΜΕ ΣΥΜΠΤΩΜΑ ΕΝΩ ΑΠΟ ΤΙΣ 17 ΜΕ GMS30 ΔΕΝ ΣΧΕΤΙΖΟΝΤΑΝ ΜΕ ΕΜΦΡΑΚΤΟ ΚΑΙ 7/17 ΜE GNS30 (ECHOGENIC)WERE RELATED TO SYMPTOMS WHILE 12 OF 17 WITH GSM30(2/26)(P<0,02).THIS STUDY HAS SHOWN THAT BY COMPUTERIZED MEASUREMENT OF PLAQUE ECHOGENICITY, IT IS POSSIBLE TO INDENTIFY CAROTID PLAQUES AT HIGH RISK FOR DEVELOPMENT OF CEREBROVASCULAR DISEASE AND CEREBRAL INFARCTION.THIS METHOD CAN BE USED TO IMPROVE CRITERIA OF PATIENTS SELECTION FOR CAROTID ENDARTERECTOMY

Prevalence of Hemorrhagic Complications in Hospitalized Patients with Pulmonary Embolism

Background: The prevalence of anticoagulant therapy-associated hemorrhagic complications in hospitalized patients with pulmonary embolism (PE) has been scarcely investigated. Aim: To evaluate the prevalence of hemorrhages in hospitalized PE patients. Methods: The Information System &ldquo;ASKLIPIOS&trade; HOSPITAL&rdquo; implemented in the Respiratory Medicine Department, University of Thessaly, was used to collect demographic, clinical and outcome data from January 2013 to April 2021. Results: 326 patients were included. Males outnumbered females. The population&rsquo;s mean age was 68.7 &plusmn; 17.0 years. The majority received low molecular weight heparin (LMWH). Only 5% received direct oral anticoagulants. 15% of the population were complicated with hemorrhage, of whom 18.4% experienced a major event. Major hemorrhages were fewer than minor (29.8% vs. 70.2%, p = 0.001). Nadroparin related to 83.3% of the major events. Hematuria was the most common hemorrhagic event. 22% of patients with major events received a transfusion, and 11% were admitted to intensive care unit (ICU). The events lasted for 3 &plusmn; 2 days. No death was recorded. Conclusions: 1/5 of the patients hospitalized for PE complicated with hemorrhage without a fatal outcome. The hemorrhages were mainly minor and lasted for 3 &plusmn; 2 days. Among LMWHs, nadroparin was related to a higher percentage of hemorrhages

Superiority of early relative to late ischemic preconditioning in spinal cord protection after descending thoracic aortic occlusion

ObjectiveWe previously showed that ischemic preconditioning significantly reduced spinal cord injury caused by 35-minute aortic occlusion. In this study we investigated the effect of ischemic preconditioning on spinal cord injury after 45-minute aortic occlusion.MethodsThirty-two pigs were divided as follows: group 1 (n = 6) underwent sham operation, group 2 (n = 6) underwent 20 minutes of aortic occlusion, group 3 (n = 6) underwent 45 minutes of occlusion, group 4 (n = 6) underwent 20 minutes of occlusion and 48 hours later underwent an additional 45 minutes, and group 5 (n = 8) underwent 20 minutes of occlusion and 80 minutes later underwent an additional 45 minutes. Aortic occlusion was accomplished with two balloon occlusion catheters placed fluoroscopically after the origin of the left subclavian artery and at the aortic bifurcation. Neurologic evaluation was by Tarlov score. The lower thoracic and lumbar spinal cords were harvested at 120 hours and examined histologically with hematoxylin-eosin staining. The number of neurons was counted, and the inflammation was scored (0-4). Statistical analysis was by Kruskal-Wallis and 1-way analysis of variance tests.ResultsGroup 5 (early ischemic preconditioning) had better Tarlov scores than group 3 (P < .001) and group 4 (late ischemic preconditioning, P < .001). The histologic changes were proportional to the Tarlov scores, with the least histologic damage in the animals of group 5 relative to group 3 (number of neurons P < .001, inflammation P = .004) and group 4 (number of neurons P < .001, inflammation P = .006).ConclusionEarly ischemic preconditioning is superior to late ischemic preconditioning in reducing spinal cord injury caused by the extreme ischemia of 45 minutes of descending thoracic aortic occlusion

Venous Thromboembolism Risk and Prophylaxis in the Acute Care Hospital Setting (ENDORSE Survey) Findings in Surgical Patients

Objective: To evaluate venous thromboembolism (VTE) risk in patients who underwent a major operation, including the use of, and factors influencing, American College of Chest Physicians-recommended types of VTE prophylaxis