Are there independent predisposing factors for postoperative infections following open heart surgery?

Background: Nosocomial infections after cardiac surgery represent serious complications associated with substantial morbidity, mortality and economic burden. This study was undertaken to evaluate the frequency, characteristics, and risk factors of microbiologically documented nosocomial infections after cardiac surgery in a Cardio-Vascular Intensive Care Unit (CVICU).

Methods: All patients who underwent open heart surgery between May 2006 and March 2008 were enrolled in this prospective study.

The implication of vasa vasorum in surgical diseases of the aorta.

Vasa vasorum (VV) are microscopic vases that perfuse the vessel's wall; arteries and veins. Many recent researches support the opinion that VV have a significant role in aortic pathology. The VV, or 'the vessels of the vessels', form a network of microvessels that lie in the adventitia and penetrate the outer media of the host vessel wall.

Simultaneous endovascular stent-graft repair of descending thoracic and abdominal aortic pathologies. Report of four cases.

Four patients suffering from concomitant descending thoracic pathology and abdominal aortic aneurysms were treated with endovascular stent-grafts simultaneously. Graft deployment was successful and uneventful in all patients. Paraplegia was not observed.

Importance of perioperative monitoring of cerebral tissue saturation in elderly patients: an interesting case.

The authors describe the case of an elderly diabetic patient with a hip fracture who developed neurocognitive dysfunction and dysarthria preoperatively. Upon arrival in the operating room, the monitoring of cerebral oxygenation by near-infrared spectroscopy (NIRS) showed cerebral desaturation (44% on the left hemisphere and 46% on the right). Cerebral oximetry values were stabilized during the surgery after administration of crystalloid fluids and vasoconstrictive drugs and were ameliorated significantly after administration of two units of blood.

Endovascular management of an arteriovenous malformation using an occluder stent graft.

A 58-year-old woman presented with gangrene of the left upper arm stump caused by an arteriovenous malformation originating from the subclavian artery. She had been treated unsuccessfully in the past with repeated attempts of coil embolization and débridement, but finally she underwent arm amputation. A 14 mm diameter occlusion self-expandable stent was placed in the left subclavian artery via ipsilateral brachial artery access, with immediate and complete interruption of arterial supply to the vascular malformation.

Hybrid management of a false aneurysm complicating an arteriovenous graft in a patient with critical limb ischemia.

End-stage renal diabetic patients undergoing dialysis through an arteriovenous graft (AVG) often present with multiple graft complications which demand a combined therapeutic approach. We report a case of a male suffering from a pseudoaneurysm and venous outflow stenosis of his thigh AVG, as well as from critical limb ischemia caused by multiple significant stenoses of the femoropopliteal arterial segment. The patient was managed in a single session with a combination of classic open surgical and endovascular techniques in order to treat his aneurysm, salvage the AVG and to revascularize his leg.

Abdominal aortic endograft proximal collapse: Successful repair by endovascular means.

Infolding of an aortic endograft, usually characterized as endograft collapse, is a quite rare complication reported to occur mainly in thoracic aortic grafts. This report presents a case of an early proximal collapse of an endoprosthesis in an abdominal aortic aneurysm. The complication was diagnosed during the first month of follow-up and was not associated with any endoleak.

Spinal anesthesia: comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery.

This study was performed to compare the anesthetic efficacy and safety of three local anesthetic agents: racemic bupivacaine and its two isomers: ropivacaine and levobupivacaine, in patients undergoing lower abdominal surgery. One hundred-twenty patients, ASA I-III, were randomized to receive an intrathecal injection of one of three local anesthetic solutions. Group A (n = 40) received 3 ml of isobaric bupivacaine 5 mg/ml (15 mg).

Modified staged surgical approach to coexisting severe coronary artery disease and large abdominal aortic aneurysm.

Surgical management of coexisting severe coronary artery disease and large or symptomatic abdominal aortic aneurysm may be required in patients who are unsuitable candidates for minimally invasive interventions. Although several options have been proposed, the optimal timing to deal with both entities, in order to achieve the best outcome, is still debatable. This report presents a modified approach based on a two-stage treatment in a single anesthetic session.

Cardiac troponin I versus creatine kinase-MB in the detection of postoperative cardiac events after coronary artery bypass grafting surgery.

Aim: Several studies suggest that postoperarive concentrations of cardiac troponin-I (cTnI) may increase in patients undergoing aorto-coronary bypass grafting (CABG). The degree and pattern of release appears to be associated with perioperative myocardial damage.

Methods: This was a prospective observational study with serial sampling conducted at the Departments of Cardiothoracic Surgery and Anesthesiology, University Hospital of Ioannina, Ioannina, Greece.

Pancreatic injury after thoracoabdominal aortic occlusion in a porcine model.

Background: The aim of this study was to investigate pancreatic injury after 45 min of thoracoabdominal aortic occlusion in a porcine model.

Methods: Twenty-four pigs were used. Six pigs underwent sham operation and 18 intravascular balloon thoracoabdominal aortic occlusions for 45 min.

Knotting of an epidural catheter: a rare complication.

Knotting of an epidural catheter leading to entrapment is a rare complication of epidural catheterization. A lumbar epidural catheter inserted in a 28-year-old woman for caesarean section anesthesia and postoperative analgesia proved difficult to remove. After multiple attempts and placing the patient in the same position as when the catheter was initially inserted, the entrapped catheter was dislodged intact, revealing a double knot near its distal tip.

The effects of propofol or sevoflurane on free radical production after tourniquet induced ischaemia-reperfusion injury during knee arthroplasty.

Background: We studied the effects of anesthesia with propofol or sevoflurane on the production of free oxygen radicals during total knee arthroplasty performed with the use of an ischemic tourniquet by measuring the levels of malondialdehyde (MDA).

Methods: We studied two groups of patients (20 patients in each group) who underwent total knee arthroplasty. To maintain anesthesia we delivered 66% nitrous oxide plus sevoflurane or propofol.

Successful cardiac and cerebral resuscitation with extracorporeal circulation and mild hypothermia.

Extracorporeal circulation could be effective for cardiac resuscitation in patients who do not respond to ''Advanced cardiac life support'' (ACLS), but cannot guarantee brain survival. A case of successful cardiac and cerebral resuscitation with extracorporeal circulation and mild hypothermia, in a 48 year-old man with cardiac arrest due to cardiac tamponade, is reported. The good long term neurologic outcome of the patient is also described.

Lipid peroxidation and the use of emulsified propofol in laparoscopic surgery.

Background: Free radical-induced lipid peroxidation associated with a decrease of antioxidant capacity in plasma is observed after the deflation of the pneumoperitoneum in laparoscopic surgery. In this study, we evaluated the effect of the continuous administration of lipid peroxidation derivatives on emulsified propofol.

Methods: Two groups of 20 patients each who underwent laparoscopic surgery were studied prospectively.

Continuous propofol administration for suxamethonium-induced postoperative myalgia.

The effect of continuous propofol administration on creatine kinase and suxamethonium-induced postoperative myalgia was evaluated in 50 patients randomised into two groups of 25 patients each. Induction of anaesthesia was identical in all patients. Anaesthesia was maintained with 66% nitrous oxide in oxygen supplemented by either isoflurane 1% or continuous propofol.