POINT OF CARE TESTING (POCT) DURING CARDIAC SURGERY OPERATIONS

Otvaranjem kardiokirurškog odjela u KBC-u Rijeka jasno je definirana potreba brzog dobivanja osnovnih laboratorijskih nalaza za uspješnost liječenja. Ovaj cilj ostvarili smo uvoðenjem organizacijskih promjena u laboratorijskoj službi i postavljanjem brzog mjernog ureðaja u operacijsku dvoranu, koji u vremenu od nekoliko minuta može izdati laboratorijske nalaze za osnovne hematološke i biokemijske parametre. U ovom radu prikazali smo kvalitetu ovakvog laboratorijskog rada, usporeðujuæi nalaze dobivene na aparatu u dvorani sa usporedno izvr¹enim nalazima u centralnome medicinsko- biokemijskom laboratoriju, dobivenim primjenom drugih aparata i drugih laboratorijskih metoda. Nalaz visoke korelacije izmeðu ovih mjerenja za razlièite analitièke parametare (Na, K, pH, pO2, pCO2, hemoglobin, hematokrit), naglasio je pouzdanost brze analize krvi na aparatu u dvorani i njezinu korisnost u odreðenim urgentnim stanjima.Faster laboratory data during cardiac surgery operations are necessary for more rapid treatment of the patient and fewer clinical complications. We implemented clinical chemistry analyzer in operation room in order to perform urgent laboratory tests (potassium, sodium, pH, pO2, pCO2, hemoglobin, hematocrit) during cardiac surgery operations. Successful implementation required a new organization of laboratory work and new set of skills and jobs for laboratory. Internal quality control, accuracy of results and compatibility with central laboratory results are checked daily and some off these results are reported in this work showing a high coefficient of correlation and accuracy of results, as well as accessibility and speed. Point-of care testing (POCT) or Ònearpatient Ó testing allows for diagnostic assays to be performed at the site of patient care delivery so that laboratory data are more readily available to clinicians. Cost-benefit analysis are still to be evaluated, but faster turnaround times can only lead to more rapid treatment of the patient. Point-of-care testing (POCT) has the potencial to expand further by increasing the accessibility, speed and accuracy of results

POINT OF CARE TESTING (POCT) DURING CARDIAC SURGERY OPERATIONS

Otvaranjem kardiokirurškog odjela u KBC-u Rijeka jasno je definirana potreba brzog dobivanja osnovnih laboratorijskih nalaza za uspješnost liječenja. Ovaj cilj ostvarili smo uvoðenjem organizacijskih promjena u laboratorijskoj službi i postavljanjem brzog mjernog ureðaja u operacijsku dvoranu, koji u vremenu od nekoliko minuta može izdati laboratorijske nalaze za osnovne hematološke i biokemijske parametre. U ovom radu prikazali smo kvalitetu ovakvog laboratorijskog rada, usporeðujuæi nalaze dobivene na aparatu u dvorani sa usporedno izvr¹enim nalazima u centralnome medicinsko- biokemijskom laboratoriju, dobivenim primjenom drugih aparata i drugih laboratorijskih metoda. Nalaz visoke korelacije izmeðu ovih mjerenja za razlièite analitièke parametare (Na, K, pH, pO2, pCO2, hemoglobin, hematokrit), naglasio je pouzdanost brze analize krvi na aparatu u dvorani i njezinu korisnost u odreðenim urgentnim stanjima.Faster laboratory data during cardiac surgery operations are necessary for more rapid treatment of the patient and fewer clinical complications. We implemented clinical chemistry analyzer in operation room in order to perform urgent laboratory tests (potassium, sodium, pH, pO2, pCO2, hemoglobin, hematocrit) during cardiac surgery operations. Successful implementation required a new organization of laboratory work and new set of skills and jobs for laboratory. Internal quality control, accuracy of results and compatibility with central laboratory results are checked daily and some off these results are reported in this work showing a high coefficient of correlation and accuracy of results, as well as accessibility and speed. Point-of care testing (POCT) or Ònearpatient Ó testing allows for diagnostic assays to be performed at the site of patient care delivery so that laboratory data are more readily available to clinicians. Cost-benefit analysis are still to be evaluated, but faster turnaround times can only lead to more rapid treatment of the patient. Point-of-care testing (POCT) has the potencial to expand further by increasing the accessibility, speed and accuracy of results

Abdominalne komplikacije u kardijalnoj kirurgiji : doktorska disertacija

Sažetak disertacije "Abdominalne komplikacije u kardijalnoj kirurgiji" nije dostupan

Abdominalne komplikacije u kardijalnoj kirurgiji : doktorska disertacija

Sažetak disertacije "Abdominalne komplikacije u kardijalnoj kirurgiji" nije dostupan

Apoptosis and cardiopulmonary bypass

The aim of this study was to ascertain the percentage of apoptotic myocytes in patients who underwent coronary artery bypass surgery. Apoptotic index (AI) obtained with in situ terminal deoxynucleotidyl transferase-labeled dUTP nick end labeling (TUNEL) method and Bak protein expression were compared. Twenty consecutive patients who underwent coronary artery bypass surgery, myocardial samples from the right atrium were taken in three stages: before cannulation (the first sample group), after declamping (the second sample group), and 20 minutes after reperfusion (the third sample group). The percentage of apoptotic cells was determined by TUNEL method. Expression of Bak protein was immunohistochemically analyzed. Intermittent ischemia and moderate hypothermia were used as methods of myocardial management during surgery. A statistical analysis was performed by using the Friedman ANOVA analysis of variances, the Kendall coefficient of concordance and the Wilcoxon matched pair test. In the first sample group mean value of Bak expression was 2.61 +/- 2.18, compared with AI 5.38 +/- 3.58, after declamping (the second sample group) the mean value of Bak expression was 4.31 +/- 2.68 while AI was 7.63 +/- 4.38 and after 20 minutes of reperfusion in the third sample group mean value of Bak expression was 8.89 +/- 4.45, while AI was 15.6 +/- 8.45. When compared by using Wilcoxon matched pair test two methods significantly correlated, p > 0.0001

Apoptosis and cardiopulmonary bypass

The aim of this study was to ascertain the percentage of apoptotic myocytes in patients who underwent coronary artery bypass surgery. Apoptotic index (AI) obtained with in situ terminal deoxynucleotidyl transferase-labeled dUTP nick end labeling (TUNEL) method and Bak protein expression were compared. Twenty consecutive patients who underwent coronary artery bypass surgery, myocardial samples from the right atrium were taken in three stages: before cannulation (the first sample group), after declamping (the second sample group), and 20 minutes after reperfusion (the third sample group). The percentage of apoptotic cells was determined by TUNEL method. Expression of Bak protein was immunohistochemically analyzed. Intermittent ischemia and moderate hypothermia were used as methods of myocardial management during surgery. A statistical analysis was performed by using the Friedman ANOVA analysis of variances, the Kendall coefficient of concordance and the Wilcoxon matched pair test. In the first sample group mean value of Bak expression was 2.61 +/- 2.18, compared with AI 5.38 +/- 3.58, after declamping (the second sample group) the mean value of Bak expression was 4.31 +/- 2.68 while AI was 7.63 +/- 4.38 and after 20 minutes of reperfusion in the third sample group mean value of Bak expression was 8.89 +/- 4.45, while AI was 15.6 +/- 8.45. When compared by using Wilcoxon matched pair test two methods significantly correlated, p > 0.0001

Pulmonary valve papillary fibroelastoma : a case report

We present a case of pulmonary valve fibroelastoma diagnosed by echocardiogram which was confirmed by surgical resection in a patient in whom elective coronary artery bypass surgery was performed. The patient had no clinical or constitutional symptoms suggesting the presence of an intracardiac tumor. Routine preoperative transthoracic echocardiography revealed a pulmonary valve tumor. Histopathological analysis resulted in a diagnosis of papillary fibroelastoma. Papillary fibroelastomas are rare and benign cardiac tumors.They usually arise from the cardiac valves. In the literature we found only a few cases, so it seems there is a need for further description of additional cases of pulmonary valve fibroelastoma

Metoclopramide improves gastric but not gallbladder emptying in cardiac surgery patients with early intragastric enteral feeding: randomized controlled trial.

Aim was to evaluate the effect of metoclopramide on gastric emptying in coronary artery bypass graft (CABG) surgery patients with early enteral nutrition and to evaluate the effect of metoclopramide on motility of the gallbladder in these patients. A prospective, randomized, placebo-controlled, double-blind study of 40 patients treated at cardiosurgical intensive care unit after CABG surgery. The patients were divided into two groups: metoclopramide group (20 patients ; age 60-/+9 years ; 85% male), and control group (20 patients ; age 59-/+8 years ; 70% male). In both groups, enteral feeding with isoosmotic enteral formula was initiated by nasogastric tube 18 hours after surgery. After 6 hours, feeding was stopped, and paracetamol solution (1, 000 mg) and 10 mg of metoclopramide IV or 2 ml of saline IV were concurrently administered. Blood samples were obtained 15 (t(+15)), 30 (t(+30)), 60 (t(+60)), and 120 (t(+120)) minutes after the administration of paracetamol. Paracetamol absorption was assessed from the plasma paracetamol concentration and the area under the curve (AUC) from 0 to 120 minutes. Sonographic measurement of gallbladder ejection fraction was also performed 15 (t(+15)), 30 (t(+30)), 60 (t(+60)), and 120 (t(+120)) minutes after the administration of paracetamol. The plasma paracetamol concentrations 15, 30, 60, and 120 minutes after the administration of paracetamol were significantly higher in metoclopramide group than in control group: (t(+15)) 5.4-/+2.7 vs 3.3-/+2.5 (Mann-Whitney U test ; P=0.017) ; (t(+30)) 6.7-/+2.4 vs 3.7-/+2.0 (P=0.006) ; (t(+60)) 7.7-/+2.5 vs 5.1-/+3.2 (P=0.008) ; (t(+120)) 8.5-/+2.2 vs 5.2-/+2.8 (P=0.005). The AUC value was 34% larger in the metoclopramide group vs control group (574-/+296 vs 429-/+309 ; P=0.027). There were no significant differences in gallbladder ejection fraction between groups (group metoclopramide vs control group: (t(0)-t(+15)) -2% vs -2% ; (t(+15)-t(+30)) 1% vs 4% ; (t(+30)-t(+60)) 0% vs -1% ; (t(+60)-t(+120)) 1% vs 3% ; P=NS). In CABG surgery patients with early enteral feeding, a single dose of intravenous metoclopramide effectively improves gastric emptying, but does not have any prokinetic effect on gallbladder motility

Metoclopramide improves gastric but not gallbladder emptying in cardiac surgery patients with early intragastric enteral feeding: randomized controlled trial.

Aim was to evaluate the effect of metoclopramide on gastric emptying in coronary artery bypass graft (CABG) surgery patients with early enteral nutrition and to evaluate the effect of metoclopramide on motility of the gallbladder in these patients. A prospective, randomized, placebo-controlled, double-blind study of 40 patients treated at cardiosurgical intensive care unit after CABG surgery. The patients were divided into two groups: metoclopramide group (20 patients ; age 60-/+9 years ; 85% male), and control group (20 patients ; age 59-/+8 years ; 70% male). In both groups, enteral feeding with isoosmotic enteral formula was initiated by nasogastric tube 18 hours after surgery. After 6 hours, feeding was stopped, and paracetamol solution (1, 000 mg) and 10 mg of metoclopramide IV or 2 ml of saline IV were concurrently administered. Blood samples were obtained 15 (t(+15)), 30 (t(+30)), 60 (t(+60)), and 120 (t(+120)) minutes after the administration of paracetamol. Paracetamol absorption was assessed from the plasma paracetamol concentration and the area under the curve (AUC) from 0 to 120 minutes. Sonographic measurement of gallbladder ejection fraction was also performed 15 (t(+15)), 30 (t(+30)), 60 (t(+60)), and 120 (t(+120)) minutes after the administration of paracetamol. The plasma paracetamol concentrations 15, 30, 60, and 120 minutes after the administration of paracetamol were significantly higher in metoclopramide group than in control group: (t(+15)) 5.4-/+2.7 vs 3.3-/+2.5 (Mann-Whitney U test ; P=0.017) ; (t(+30)) 6.7-/+2.4 vs 3.7-/+2.0 (P=0.006) ; (t(+60)) 7.7-/+2.5 vs 5.1-/+3.2 (P=0.008) ; (t(+120)) 8.5-/+2.2 vs 5.2-/+2.8 (P=0.005). The AUC value was 34% larger in the metoclopramide group vs control group (574-/+296 vs 429-/+309 ; P=0.027). There were no significant differences in gallbladder ejection fraction between groups (group metoclopramide vs control group: (t(0)-t(+15)) -2% vs -2% ; (t(+15)-t(+30)) 1% vs 4% ; (t(+30)-t(+60)) 0% vs -1% ; (t(+60)-t(+120)) 1% vs 3% ; P=NS). In CABG surgery patients with early enteral feeding, a single dose of intravenous metoclopramide effectively improves gastric emptying, but does not have any prokinetic effect on gallbladder motility

Heart embolization with the Kirschner wire without cardiac tamponade

The case of the heart embolization with the Kirschner wire that was used for shoulder trauma fixation, 2 years previously in a 67-year-old female, is reported. This case is unique; although embolization of foreign bodies to the heart is not a novel occurrence, heart embolization with non-broken Kirschner wire with a total length of 13.5 cm without cardiac tamponade was not described in medical literature so far