Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)

Background: International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents. Material and methods: A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). Trial registration: NCT02382770. Results: 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49–74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2–7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001). Conclusion: There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome

Multilayer fibroin/chitosan oligosaccharide lactate and pullulan immunomodulatory patch for treatment of hernia and prevention of intraperitoneal adhesion

This study aims to develop a novel intraperitoneal two- or three-layered patch with immunomodulatory property for treatment of hernia, regeneration of abdominal wall and prevention of intraperitoneal adhesions. Polypropylene (PP) mesh, middle layer, was intended to provide mechanical support whereas pullulan (PUL) hydrogel coating layer was designed to prevent intraperitoneal adhesions. Fibroin/chitosan oligosaccharide lactate (F/COS) layer electrospun on one side of pullulan was chosen for immunomodulation and abdominal wall regeneration. Physical and mechanical properties and regenerative capacity of intraperitoneal patches were determined. Immunomodulatory property of electrospun layer and whole patch was studied by determining nitric oxide amount produced by RAW 264.7 macrophages. 25 % (w/v) PUL hydrogel and F/COS with 90:10 (w/w) ratio yielded optimal results. Here, we report that fabricated intraperitoneal patches successfully prevented cell adhesion on one side and increased cell viability and proliferation on other side, along with immunomodulation, in vitro

Pulmonary artery aneurysm and coronary artery disease in a patient with previous cardiac surgery

Pulmonary artery aneurysms (PAA) are uncommon and the management of these conditions is not clear. Main PAA with high pulmonary pressure and right ventricular overload should be surgically managed because of the risk of rupture and dissection. However, isolated PAA, in the absence of left-to-right shunt or pulmonary hypertension, probably have a benign course and conservative treatment and close follow-up may be appropriate. The case of a 62-year-old patient with pulmonary artery aneurysm and coronary artery disease who had previous cardiac surgery is presented here. © Georg Thieme Verlag KG Stuttgart

Pulmonary artery aneurysm and coronary artary disease in a patient previous cardiac surgery

WOS: 000255365300011PubMed: 18365978Pulmonary artery aneurysms (PAA) are uncommon and the management of these conditions is not clear. Main PAA with high pulmonary pressure and right ventricular overload should be surgically managed because of the risk of rupture and dissection. However, isolated PAA, in the absence of left-to-right shunt or pulmonary hypertension, probably have a benign course and conservative treatment and close follow-up may be appropriate. The case of a 62-year-old patient with pulmonary artery aneurysm and coronary artery disease who had previous cardiac surgery is presented here

Clinical effects of leukofiltration and surface modification on post-cardiopulmonary bypass atrial fibrillation in different risk cohorts

PubMed: 18181517Objective. A manifestation of inflammatory injury to the heart, atrial fibrillation (AF), ranks among the most frequent and potentially life-threatening post-operative complications. Methods. In a prospective randomized study, 120 patients undergoing CABG were allocated into two groups (N = 60): Group 1- Polymethoxyethylacry late-coated circuits + Leukocyte filters (Terumo,USA); Group 2: Control:Uncoated circuits (Terumo,USA). Each group was further divided into three subgroups (N = 20) with respect to low (Euroscore 0-2), medium (3-5) and high (6+) risk patients. Results. Serum IL-2 levels were significantly lower in the study group at T4 and T5 (p < 0.01). C3a levels showed significant differences in the leukofiltrated group at T4 and T5 (p < 0.05). CPKMB levels demonstrated well-preserved myocardium in the leukofiltration group, post-operatively. AF incidence was 10% (2 patients) in the study and 35% (7 patients) in the control cohorts (p < 0.05). Phagocytic capacity on fibers in filtered patients was significantly lower. Conclusion: Leukofiltration and coating significantly reduce the incidence, ventricular rate, and duration of AF after CABG via modulation of systemic inflammatory response and platelet preservation in high risk groups. © 2007 Sage Publications

Posterior tibial nerve stimulation for faecal incontinence after partial spinal injury: Preliminary report

PubMed: 17510745Background: This study evaluated the possible effects of posterior tibial nerve stimulation in two patients with faecal incontinence due to partial spinal cord injury. Methods: Posterior tibial nerve stimulation was performed for 30 min, every other day for 4 weeks, and was then repeated every 2 months for three months. Clinical examination, anorectal physiological work-up, faecal incontinence severity index, and quality of life assessments were performed before and after the treatment. Results: After posterior tibial nerve stimulation, patients showed improvement in rectal sensory threshold, pudendal nerve terminal motor latency, Wexner faecal incontinence score, faecal incontinence severity index, faecal incontinence quality of life scales, resting pressure, and maximum squeeze pressure measurements. Conclusions: Posterior tibial nerve stimulation can be an effective method for the treatment of faecal incontinence caused by partial spinal cord injury. © 2007 Springer-Verlag

Right coronary system grafts: Alone or together with left system grafts - Angiographic results

Purpose: The aim of this study is to compare the long-term graft patency between patients who had sequential or individual right posterior descending artery (RPDA) anastomosis. Materials and Methods: Two hundred and forty-two patients underwent coronary artery bypass grafting (CABG) between June 1994 and December 2003. They were examined retrospectively with respect to coronary angiograghic data. [Group 1] Individually right system grafts in RPDA position (n=139). [Group 2] RPDA anastomosis sequentially with left system (n=103). Patency rates for posterior descending arteries in each group were separately calculated for each vessel quality category. Results: The mean interval from operation to angiography was 50.6±48.9 months in group 1 vs 57.5±39.2 months in group 2 respectively. The overall patency rate was 66.2% (92/139) in group 1 and 78.6% (81/103) in group 2 (p=0.04). When the RPDA has good run-off capacity, the patency rate was 69.1% in group 1 and 85.2% in group 2. Conclusion: When the RPDA has good run-off capacity, snake grafts show excellent results and right and left coronary systems could be anastomosed sequentially

Omentopexy in mediastinal infections: Case report Medi̇asti̇nal i̇nfeksi̇yonlarda omentum transpozi̇syonu tekni̇gi̇: Olgu sunumu

Omental transposition was performed on in two cases: a 43 year-old man with acute pericarditis who had no response to systemic antibiotics and pericardial tube drainage, and a 37 year-old woman who developed mediastinitis after mitral valve replacement. In this technique, the pedicled free omental graft was lied on contaminated area and the sternum reapproximated. There was no abdominal complication and both patients recovered rapidly and infection signs vanished completely

Experience with the Edwards MIRA mechanical bileaflet valve: In the aortic and mitral positions

The Edwards MIRA bileaflet mechanical prosthesis, a heart valve not yet available in the United States, is designed with a unique hinge mechanism, curved leaflets, and thin titanium housing. We performed this study to investigate its clinical performance and postoperative hemodynamic results. We implanted 58 Edwards MIRA prostheses in 51 patients in the aortic (n=18), mitral (n=26), and aortic and mitral (n=7) positions. Patients' ages ranged from 25 to 84 years (mean age, 53.7 ± 13.6). Operative mortality was 2% (n=1), and late mortality was 4% (n=2). Thromboembolic events were observed in 2 patients (valve thrombosis in 1 and a cerebrovascular event in 1). There were no complications related to anticoagulation. No signs of valvular dysfunction or paravalvular leakage were observed. Peak transvalvular gradients of the aortic prostheses ranged from 24.25 ± 5.32 mmHg for the 21-mm valve to 11 ± 1.41 mmHg for the 25-mm valve. The effective orifice area ranged from 1.99 ± 0.12 cm2 for the 21-mm valve to 2.44 ± 0.17 cm2 for the 25-mm valve. The mean transvalvular gradients of the mitral prostheses ranged from 5.85 ± 2.91 mmHg for the 27-mm valve to 4.5 ± 0 mmHg for the 31-mm valve. The effective orifice area ranged from 2.31 ± 0.03 cm2 for the 27-mm valve to 2.64 ± 0.05 cm2 for the 33-mm valve. These preliminary data suggest good hemodynamic function and a low rate of valve-related complications in the use of the Edwards MIRA mechanical prosthesis. © 2006 by the Texas Heart® Institute

St. Jude Medical and CarboMedics mechanical heart valves in the aortic position: Comparison of long-term results

We designed this study to compare long-term results of St. Jude Medical and CarboMedics mechanical heart valves in the aortic position. We retrospectively analyzed the results of 174 consecutive patients who received either a St. Jude (n=80) or a CarboMedics (n=94) mechanical aortic valve from March 1992 through October 2004. The follow-up rate was 97.7%. The mean follow-up duration for the St. Jude group was 79.3 ± 35.0 and for the CarboMedics group, 70.0 ± 34.3 months. The cumulative follow-up was 523.8 and 530.1 patient-years, respectively. The 30-day mortality rates for the St. Jude and CarboMedics patients were 1.3% and 3.2%, respectively. The actuarial survival rate for the St. Jude group at 138.0 ± 4.7 months was 75.9% ± 0.1% and for the CarboMedics group at 130.8 ± 4.8 months was 69.8% ± 0.1% (P=NS). There was no structural valve deterioration in either group. Freedom from thromboembolic events was 87.7% for the St. Jude group and 83.0% for the CarboMedics group (P=NS). Freedom from bleeding events for the St. Jude group was 93.6% and for the CarboMedics group, 89.7% (P=NS). The results obtained from this study indicate that standard St. Jude Medical and CarboMedics aortic valve prostheses offer similar excellent clinical performance. Definitive judgment must await trials that are extensive, randomized, and prospective. © 2006 by the Texas Heart® Institute