Minimally invasive monitoring of the central nervous system

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Daily atrial fibrillation issues: the view-point of a practicing surgeon

Atrial Fibrillation (AF) is encountered daily by the cardiac surgeon. How to deal with a patient with pre existing AF who is on anticoagulation taking into account urgency, type of anticoagulation and procedure planned are some of the daily considerations encountered. When to start anticoagulation and other pharmacotherapy after the occurrence of post-op atrial fibrillation and the use of ablative therapies in view of bleeding and other complications are daily judgement calls made by surgeons. Whom to offer combined interventions are decisions the surgeon faces daily. While guidelines help in broad strokes, there is little help for individual situations which is due to structural problems and absence of universal definitions resulting in the lack of granular data needed for practical individualized daily decision making

Global variation in the incidence of new-onset postoperative atrial fibrillation after cardiac and non-cardiac surgery: a systematic review

Aim: In the US, postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and a frequent complication after non-cardiac surgery, causing excess patient length of stay and costs. After a comprehensive review looking for validated statistically significant data sets, too few data, particularly from outside of the US and Europe, could be found to perform a conclusive analysis, but there is enough data for a well-informed, educated opinion.Methods: A systematic review analyzing 28 international and US studies of POAF hospital length of stay were identified; from this excess and % excess along with total patient length of stay were calculated, where excess patient length of stay is defined as the difference in post-operative stay between POAF and non-POAF patients in days. Geographic variabilities were calculated using chi-square analyses for US regions and international comparisons for a variety of surgical procedures with POAF.Results: Geographic variability analyses when corrected for total hospital stay showed a 325% longer excess patient length of stay (days) in the US vs. Europe (3.4 days vs. 0.8 days) for coronary artery bypass grafting (CABG). It also showed a 27.3% longer excess patient length of stay (days) in the US vs. Europe (4.2 days vs. 3.3 days) for lung resections. These were both statistically significant at P < 0.001.Conclusion: There appear to be substantial variations in POAF-related care practices worldwide. In all practice settings, POAF causes increased patient length of stay. Europeans appear to do better than the US in POAF patients’ length of stay for CABG but not for lung resections. POAF is a worldwide problem where international cooperation in research and development of best practice guidelines would be particularly fruitful

Growing PET positive nodule in a patient with histoplasmosis: case report

<p>Abstract</p> <p>Background</p> <p>Pulmonary histoplasmosis is a mycotic infection that often resembles pulmonary malignancy and continues to complicate the evaluation of pulmonary nodules.</p> <p>Case presentation</p> <p>We report a case of an immunocompetent patient who, despite adequate treatment for known histoplasmosis lung infection, presented with radiological and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) findings mimicking primary lung malignancy which eventually required surgical resection.</p> <p>Conclusion</p> <p>Histoplasmosis infection may radiologically resemble pulmonary malignancy, often causing a diagnostic dilemma. PET imaging is currently used for and considered accurate in the evaluation of pulmonary nodules. However, overlap in PET standardized uptake value (SUV) between granulomatous and malignant lesions decreases the accuracy of PET as a diagnostic modality. Future advances in PET imaging are needed to improve its accuracy in the evaluation of pulmonary nodules in areas where histoplasmosis is endemic.</p

Atrial fibrillation in mechanical circulatory support patients

Atrial fibrillation (AF) is known to be one of the most common arrhythmias noted in cardiac procedures and is frequently associated with heart failure. As frequent interventions for patients with heart failure involve implantation of mechanical circulatory assist devices (e.g., left ventricular assist devices), it is timely to review the role this arrhythmia has on adverse clinical outcomes. A comprehensive literature search was conducted for PubMed. Relevant medical subject heading (MeSH) terms used in the initial literature search include “Heart-Assist Devices”, “Extracorporeal Membrane Oxygenation”, “Atrial Fibrillation”, “Heart Failure”, “Mortality”, “Hospital Readmission”, “stroke”, “Postoperative Complications”. In this review, the relevant literature was highlighted to identify the incidence, clinical impacts, and management of AF surrounding mechanical circulatory support implantation. The incidence of AF in this mechanical circulatory support device population was similar to that of patients with other cardiac procedures (10%-40%). Moreover, in most studies, preoperative AF was not significantly associated with adverse outcomes. In contrast, however, it appears that postoperative atrial fibrillation may predispose patients to increased risk for thromboembolic events and adverse long-term outcomes

Optical monitoring and detection of spinal cord ischemia.

Spinal cord ischemia can lead to paralysis or paraparesis, but if detected early it may be amenable to treatment. Current methods use evoked potentials for detection of spinal cord ischemia, a decades old technology whose warning signs are indirect and significantly delayed from the onset of ischemia. Here we introduce and demonstrate a prototype fiber optic device that directly measures spinal cord blood flow and oxygenation. This technical advance in neurological monitoring promises a new standard of care for detection of spinal cord ischemia and the opportunity for early intervention. We demonstrate the probe in an adult Dorset sheep model. Both open and percutaneous approaches were evaluated during pharmacologic, physiological, and mechanical interventions designed to induce variations in spinal cord blood flow and oxygenation. The induced variations were rapidly and reproducibly detected, demonstrating direct measurement of spinal cord ischemia in real-time. In the future, this form of hemodynamic spinal cord diagnosis could significantly improve monitoring and management in a broad range of patients, including those undergoing thoracic and abdominal aortic revascularization, spine stabilization procedures for scoliosis and trauma, spinal cord tumor resection, and those requiring management of spinal cord injury in intensive care settings