Anesthetic approach to the patients with scleroderma at coronary artery surgery: two case reports

Scleroderma is a progressive connective tissue disease characterized by multiple-organ involvement. Altough the lesions are mostly seen in microvascular bed, in rare cases coronary and peripheral arteries are also affected. In this article, we report the problems and management strategies in two scleroderma patients at an intensive care unit after coronary artery bypass surgery

The Influence of Metabolic Syndrome on Acute Kidney Injury Occurrence after Coronary Artery Bypass Grafting

Background: Metabolic syndrome (MetS) is defined as a cluster of systemic abnormalities: hyperglycemia, dyslipidemia, abdominal obesity, and hypertension. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, DM, preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis of the aorta are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of MetS on AKI occurring after coronary artery bypass grafting (CABG)

A comparision of the sensitivity and specificity of the euroscore, Cleveland, and CABDEAL risk stratification systems in the Turkish population EuroSCORE, cleveland ve CABDEAL klinik risk sınıflama sistemlerinin Türk toplumu için duyarlılık ve özgüllüklerinin karşılaştırılmasi

Background: In this study, we aimed to compare three risk stratification systems to establish which of them is more suitable for predicting mortality and morbidity rates in the Turkish population. Methods: Our retrospective study included 501 consecutive patients (366 males, 135 females; mean age 63.4±19.4 years; range 44 to 83 years) who underwent coronary artery bypass graft (CABG) surgery between February 2005 and December 2006 in our clinic. The preoperative and intraoperative risk factors of the Cleveland, EuroSCORE, and CABDEAL risk stratification systems were analyzed for each patient, and the sensitivity and specificity of these three systems were compared in terms of mortality and morbidity. Results: In terms of mortality, the sensitivity and the specificity of the Cleveland system was found to be 61.5% and 90.4%, respectively while for the EuroSCORE system, the rates were 92.3% and 82.2%, respectively. For the CABDEAL system, the sensitivity and specificity were 92.3% and 44.9%, respectively. In terms of morbidity, the sensitivity and specificity of Cleveland system were 23.5% and 89.5%, respectively, while they were 41.2% and 81%, respectively for the EuroSCORE. The sensitivity and specificity of the CABDEAL system were 82.4% and 44.8%, respectively. Conclusion: The study results showed that the EuroSCORE system is more suitable for predicting the expected mortality rates while the CABDEAL system followed by the Cleveland system are more appropriate in for predicting the expected morbidity rates in the Turkish population with cardiac disease

Wpływ przedoperacyjnej wartości frakcji wyrzutowej lewej komory na wczesne i średnioterminowe wyniki operacji naprawczej u pacjentów z niedokrwienną niedomykalnością mitralną

Background: It has been well established that reduced left ventriclular ejection fraction (LVEF) has adverse impact on the outcome of patients undergoing ischaemic mitral valve repair. However, the exact value of LVEF which should be used for risk stratification, has not been well established. Aim: To asses which preoperative LVEF (pLVEF) value has the best predictive value in patients undergoing ischaemic mitral valve repair. Methods: A retrospective analysis of 105 patients with ischaemic mitral regurgitation (IMR) treated between January 2003 and June 2009 was conducted. Patients were divided into two groups according to their pLVEF value. The primary endpoints were early in-hospital and late follow-up deaths. Results: The pLVEF cut-off value was determined based on univariate analysis of parameters for primary end-points. The investigated parameters were: age, pLVEF, postoperative NYHA, postoperative mitral regurgitation and postoperative LVEF. The Cox proportional hazard regression analysis identified pLVEF (HR 1.5; 95% CI 1.4-5.0; p < 0.008) as the only independent predictor of the primary end-point. The pLVEF cut-off value of 40% was found to have the highest sensitivity of 76% and specificity of 70% in predicting death. Patients were divided into two groups using the cut-off value of pLVEF of 40%. The compromised group (pLVEF 40%) of 71 patients had inhospital death rates of three (9%) vs two (3%) (NS) and five year mortality of 18 (54%), eight (11%) (p < 0.001), respectively. Conclusions: In IMR surgery, a pLVEF value of 40% is an important prognostic marker for mid-term survival. Kardiol Pol 2010; 68, 11: 1226-1232Wstęp i cel: Celem niniejszego badania była ocena, czy przedoperacyjna wartość frakcji wyrzutowej lewej komory (LVEF) wpływa na rokowanie i wyniki leczenia chorych z niedokrwienną niedomykalnością zastawki mitralnej poddawanych operacji naprawczej. Metody: Przeprowadzono retrospektywną analizę danych 105 pacjentów z niedokrwienną niedomykalnością mitralną z okresu od stycznia 2003 do czerwca 2009 roku. Pacjentów podzielono na dwie grupy zależnie od przedoperacyjnej funkcji lewej komory (pLVEF): z zachowaną (UC) oraz upośledzoną (C) funkcją lewej komory, z uwzględnieniem wartości granicznej pLVEF. Głównymi punktami końcowymi były wczesna śmiertelność wewnątrzszpitalna i odległa śmiertelność w okresie obserwacji. Wyniki: Wartość graniczna pLVEF została określona na podstawie jednoczynnikowej analizy zmiennych dla głównych punktów końcowych. Do ocenianych parametrów należały: wiek, pLVEF, klasa NYHA po zabiegu, pooperacyjna niedomykalność mitralna i pooperacyjna LVEF. Analiza regresji na podstawie modelu proporcjonalnego hazardu Coxa wykazała, że jedynym niezależnym czynnikiem predykcyjnym głównego punktu końcowego była pLVEF (współczynnik narażenia - hazard ratio: 1,5; 95% przedział ufności 1,4-5,0; p < 0,008). Wartość odcięcia pLVEF równa 40% charakteryzowała się najwyższą czułością (76%) oraz specyficznością (70%). Podziału na grupy dokonano zależnie od pLVEF, za graniczną przyjmując wartość 40%. W grupie C (pLVEF 40%) liczącej 71 pacjentów zanotowano odpowiednio 3 (9%) i 2 (3%) przypadki zgonów wewnątrzszpitalnych, natomiast po 5 latach liczba zgonów w tych grupach wynosiła odpowiednio 18 (54%) i 8 (11%). Wnioski: U chorych operowanych z powodu niedokrwiennej niedomykalności mitralnej wartość pLVEF równa 40% stanowi ważny czynnik prognostyczny śmiertelności wewnątrzszpitalnej i średnioterminowej. Kardiol Pol 2010; 68, 11: 1226-123

Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial

We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18−44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero (“0”) was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENT What is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery. What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries. What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately