High volumes of intravenous fluid during cardiac surgery are associated with increased mortality.

INTRODUCTION: Positive fluid balance during abdominal surgery has been associated with increased morbidity. We hypothesized that administration of large volumes of intravenous fluids in cardiac surgery is associated with increased mortality. METHODS: Retrospective analysis of data on 1358 patients who underwent cardiac surgery from 2001 to 2005 at two major hospitals in Western New York. Patients were divided in to those who received intravenous fluids above the median volume (3.9 L) and those who received less than the median volume of intra-operative fluid. Acute Kidney Injury Network criteria based on serum creatinine were used to define Acute Kidney injury. RESULTS: Logistic regression and Cox-proportional models showed increased 90 day mortality (HR -2.8, 95% CI -1.16-7.01) in those patients who received greater than the median volume of intravenous during cardiac surgery. This was confirmed with propensity score analysis. Furthermore, the marginal effects analysis revealed that after about 4.0 liters of intravenous fluid, the survival probability falls significantly in cardiac surgery patients. CONCLUSIONS: Administration of large volumes of intra-operative intravenous fluid is independently associated with an increase in 90 day mortality in cardiac surgery.

Cytotoxicity evaluation of soft contact lens care solutions on human conjunctival fibroblasts.

PURPOSE: To determine whether different contact lens care solutions for soft lenses cause damage to human conjunctival cells. METHODS: Primary cultured human conjunctival fibroblasts were incubated with various concentrations of four different commercially available soft contact lens care solutions (OptiFree, Renu, SoloCare, Titmus) at concentrations of 5, 10 and 50 microl/ml medium. Toxicity was examined by determination of (1) the cell viability and mitochondrial activity with the colorimetric MTT test, and (2) the number of living cells with a cell analysis system (CASY 1) as compared with untreated cells. RESULTS: For all four soft contact lens care solutions at a concentration of 5 mul/ml medium, no significant decrease in mitochondrial activity of the human conjunctival fibroblasts was found by the MTT test. At 10 microl/ml, only OptiFree and Titmus reduced mitochondrial viability significantly. The greatest reduction in mitochondrial activity occurred with all of the four soft contact lens care solutions at a concentration of 50 microl/ml. No significant decrease in the number of living conjunctival fibroblasts was observed by CASY 1 even at higher concentrations of the four solutions investigated. CONCLUSION: This in vitro study demonstrates that the examined soft contact lens care solutions induce changes in mitochondria of human conjunctival cells only at higher doses as observed by the MTT test. However, this damage to the mitochondria did not lead to cell death as shown by the cell analysis system.

Discrimination between clinically relevant and nonrelevant Acanthamoeba strains isolated from contact lens- wearing keratitis patients in Austria.

Eighteen cases of Acanthamoeba-associated keratitis among contact lens wearers seen at the Department of Ophthalmology, Karl-Franzens-University, Graz, Austria, between 1996 and 1999 are reviewed. The amoebae were proven to be the causative agents in three patients. The aim of our study was to discriminate between clinically relevant and nonrelevant isolates and to assess the relatedness of the isolates to published strains. Altogether, 20 strains of free-living amoebae, including 15 Acanthamoeba strains, 3 Vahlkampfia strains, and 2 Hartmannella strains, were isolated from clinical specimens. The virulent Acanthamoeba strains were identified as A. polyphaga and two strains of A. hatchetti. To our knowledge this is the first determination of keratitis-causing Acanthamoeba strains in Austria. Clinically relevant isolates differed markedly from nonrelevant isolates with respect to their physiological properties. 18S ribosomal DNA sequence types were determined for the three physiologically most-divergent strains including one of the keratitis-causing strains. This highly virulent strain exhibited sequence type T6, a sequence type not previously associated with keratitis. Sequence data indicate that Acanthamoeba strains causing keratitis as well as nonpathogenic strains of Acanthamoeba in Austria are most closely related to published strains from other parts of the world. Moreover, the results of our study support the assumption that pathogenicity in Acanthamoeba is a distinct capability of certain strains and not dependent on appropriate conditions for the establishment of an infection.

Sclerotomy in uveal effusion syndrome.

PURPOSE: To report visual and anatomic outcomes after modified scleral surgery in patients with uveal effusion syndrome with retinal and choroidal detachment. METHODS: In five eyes of four patients with retinal and choroidal detachment and uveal effusion syndrome due to nanophthalmos, we performed pars plana full-thickness unsutured sclerotomies without sclerectomy. RESULTS: In all cases, uveal effusion with choroidal and retinal detachment resolved within 3 weeks, and all patients showed improved vision. The functional and anatomic results remained stable for over 2 years. CONCLUSIONS: Uveal effusion syndrome that is refractory to medical treatment (high-dose systemic corticosteroids) can be managed effectively by pars plana full-thickness unsutured sclerotomy without sclerectomy.