RESUMEN
OBJECTIVES: Our main objective was to investigate donor-transmitted epithelial cancers of all origins in comparison with breast cancers, with analysis of the carcinological outcome of recipients. Our secondary objective was to define medical check-up to be performed before any organ procurement from a donor with a history of breast cancer. METHODOLOGY: We performed a systematic review of the literature up to June 1st 2022 by including all original articles (including clinical cases) reporting cases of epithelial cancer transmitted from donor to recipient, followed by a meta-analysis of epidemiological and survival data. RESULTS: In total, we included 52 articles (31 clinical cases and 21 cohort studies), representing 91,388 donors, 236,142 recipients, and 2591 cases of transmitted cancer. The risk of transmitted cancer was significantly higher with a history of breast cancer compared with a history of other cancer (RR=9.48 P=0.0025). In clinical cases, the pre-donation check-up was specified in only 33.3% of publications. The time between transplantation and cancer occurrence was longer in cases of breast cancer transmission compared to other epithelial cancers: 1435.8 days versus 297.6 (P<0.001). CONCLUSION: Organ donation from a person previously treated for breast cancer or having a risk of occult breast cancer is possible in some situations but requires an adapted pre-donation assessment, the respect of good practice guidelines and an expert opinion in complex situations.
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Neoplasias de la Mama , Trasplante de Órganos , Obtención de Tejidos y Órganos , Humanos , Femenino , Neoplasias de la Mama/epidemiología , Donantes de TejidosRESUMEN
The COVID-19 pandemic strongly affected organ procurement and transplantation in France, despite the intense efforts of all participants in this domain. In 2020, the identification and procurement of deceased donors fell by 12% and 21% respectively, compared with the mean of the preceding 2 years. Similarly, the number of new registrations on the national waiting list declined by 12% and the number of transplants by 24%. The 3-month cumulative incidence of death or drop out for worsening condition of patients awaiting a liver transplant was significantly greater in 2020 compared to the previous 2 years. Continuous monitoring at the national level of early post-transplant outcomes showed no deterioration for any organ in 2020. At the end of 2020, less than 1% of transplant candidates and less than 1% of graft recipients - of any organ - had died of COVID-19.
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Intoxicación por Monóxido de Carbono , Triaje , Monóxido de Carbono , Carboxihemoglobina/análisis , Niño , Humanos , OximetríaRESUMEN
INTRODUCTION: Management of the perioperative hemorrhagic risk is of major interest in patients undergoing total arthroplasty of the lower limb. Anemia in the postoperative period of that increasingly performed surgery carries its own morbidity and mortality. Better anticipation of its occurrence could be done with a refined knowledge of bleeding kinetics. PATIENTS AND METHODS: We conducted a retrospective study in a single centre on 451 consecutive patients undergoing elective unilateral primary total hip or knee arthroplasty for osteoarthritis. Volume of total blood loss according to Mercuriali's formula and variations of haemoglobin levels were calculated between day 0 (D0) and postoperative day 8 (D8), and during subdivided periods between D0-D1, D1-D3 and D3-D8. Frequency and volume of autologous and homologous blood transfusions were also analyzed. Comparisons were done taking into account the use of intraoperative tranexemic acid (TA). RESULTS: Seventy to 75% of blood loss occurred between D0 and D1. Bleeding occurred mostly between the end of surgery and morning of D1, and tended to stop at D3. TA significantly reduced blood loss in the first 3days, mostly after knee prosthesis surgery. However, the bleeding kinetics were the same with or without TA. CONCLUSION: Loss of haemoglobin occurred mostly in the early postoperative period. To avoid transfusion delays, haemoglobin levels should be monitored regularly until the third postoperative day after total arthroplasty, especially when D1 haemoglobin is close to the transfusion threshold. Furthermore, our results support the routine use of TA.
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Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Pérdida de Sangre Quirúrgica/prevención & control , Hemorragia Posoperatoria/terapia , Anciano , Anestesia General/estadística & datos numéricos , Anestesia Raquidea/estadística & datos numéricos , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Pérdida de Sangre Quirúrgica/fisiopatología , Transfusión Sanguínea/estadística & datos numéricos , Transfusión de Sangre Autóloga/instrumentación , Femenino , Hemoglobinas/análisis , Humanos , Hipnóticos y Sedantes/uso terapéutico , Hierro/administración & dosificación , Hierro/uso terapéutico , Cetoprofeno/administración & dosificación , Cetoprofeno/uso terapéutico , Cinética , Masculino , Persona de Mediana Edad , Posicionamiento del Paciente , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Hemorragia Posoperatoria/tratamiento farmacológico , Hemorragia Posoperatoria/fisiopatología , Hemorragia Posoperatoria/prevención & control , Premedicación , Cuidados Preoperatorios , Estudios Retrospectivos , Simpatomiméticos/uso terapéutico , Factores de Tiempo , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/uso terapéuticoRESUMEN
Phaeochromocytoma is a catecholamine-secreting tumour that originates from the chromaffin cells in the adrenal medulla in 85% of the cases. Phaeochromocytoma typically presents with the classic signs and symptoms of paroxysmal hypertension, tachycardia, and episodic headache in young adults. However, it rarely may manifest as cardiogenic shock due to a catecholamine induced cardiomyopathy. We report the use of central extracorporeal life support (ECLS) in a young man admitted to our department because of cardiogenic shock caused by phaeochromocytoma.
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Neoplasias de las Glándulas Suprarrenales/diagnóstico , Apoyo Vital Cardíaco Avanzado , Feocromocitoma/diagnóstico , Choque Cardiogénico/complicaciones , Neoplasias de las Glándulas Suprarrenales/etiología , Neoplasias de las Glándulas Suprarrenales/cirugía , Antagonistas Adrenérgicos alfa/uso terapéutico , Hemodinámica/fisiología , Humanos , Laparoscopía , Imagen por Resonancia Magnética , Masculino , Feocromocitoma/etiología , Feocromocitoma/cirugía , Piperazinas/uso terapéutico , Tomografía de Emisión de Positrones , Choque Cardiogénico/terapia , Función Ventricular Izquierda , Adulto JovenAsunto(s)
Migración de Cuerpo Extraño/complicaciones , Insuficiencia Cardíaca/etiología , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas/efectos adversos , Enfermedad Aguda , Anciano , Falla de Equipo , Migración de Cuerpo Extraño/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico por imagen , Hemodinámica/fisiología , Humanos , Masculino , Ultrasonografía , Fibrilación Ventricular/etiologíaRESUMEN
BACKGROUND: Blood conservation strategies have been developed to diminish blood transfusion requirements in patients undergoing hip or knee replacement surgery. Tranexamic acid (TA) is an inexpensive antifibrinolytic agent that is little used in orthopaedic surgery due to the absence of standardised optimal administration regimens. HYPOTHESIS: Blood transfusion requirements and induced costs can be diminished by using TA according to a standardised administration protocol in a large cohort of patients. MATERIALS AND METHODS: A retrospective study in patients who underwent joint replacement surgery by a single surgeon compared two periods, 2007-2008 without TA and 2008-2009 with TA. The 451 included patients underwent primary unilateral hip (n=261) or knee (n=190) replacement for osteoarthritis. Standardised protocols were used for surgery and anaesthesia. TA was given intravenously in a dose of 1g (i.e., 15mg/kg) at incision and wound closure then at 6-hour intervals for 24 hours. Blood losses were estimated using the Mercuriali formula. Haemoglobin on D -1 and D 8 and the number and volume of autologous (from intra-operative blood salvage) and homologous blood transfusions were collected. The costs of TA, blood salvage systems, and homologous blood units were recorded. The two groups were compared using Student's test, Wilcoxon's test, and the Khi(2) test, and multivariate analyses were performed. Values of p less than 0.05 were considered significant. RESULTS: TA use was associated with a significant decrease in the homologous blood transfusion rate (from 4% to 0%) and with 38% and 68% reductions in the rate and volume of autologous blood transfusions, respectively, due to a 34% decrease in blood losses. After taking into account the additional cost of TA therapy, there was a 25% reduction in the cost of the blood conservation strategy. CONCLUSION: TA therapy abolished the need for homologous blood transfusion and induced no notable side effects. TA therapy decreased the amount of blood salvaged intra-operatively, allowing a more rational use of the blood salvage system and decreasing the cost of anaesthesia. LEVEL OF EVIDENCE: IV. Retrospective case-control.
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Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Rodilla/economía , Pérdida de Sangre Quirúrgica/prevención & control , Costos de Hospital/tendencias , Ácido Tranexámico/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Antifibrinolíticos/administración & dosificación , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Francia , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Recuperación de Sangre Operatoria/economía , Recuperación de Sangre Operatoria/métodos , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Rodilla/cirugía , Estudios RetrospectivosRESUMEN
We report the case of a 50-year-old patient admitted in ICU for a pulmonary embolism associated with a large thrombus in right heart cavities discovered during an assessment of faintness. Despite an excellent haemodynamic tolerance, there was a systolic and diastolic right ventricular failure and immediate threat to life. The treatment mainly relies on intravenous thrombolysis with excellent results both on thrombus lysis and on the right heart performance. Echocardiography proved to be an essential tool during the management of this patient to ensure the effectiveness and to monitor the whole procedure of thrombolysis.
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Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Angiografía Coronaria , Trombosis Coronaria/complicaciones , Ecocardiografía , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Activadores Plasminogénicos/uso terapéutico , Pronóstico , Embolia Pulmonar/complicaciones , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéuticoRESUMEN
Mobile ECMO support for remote cardiac or respiratory assistance (MESRCA and MESRRA) allows mobilization of the medical and paramedical team 24/7 in a very large geographical area. Mobility and autonomy require adapted devices. During many years, teams had to deal with non useful equipment. Recently, thanks to interest of medical world and laboratories, many materials especially suitable for this activity are developed. We describe our local experience and solutions we tented to fi nd to deal with material difficulties.
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Servicios Médicos de Urgencia/tendencias , Oxigenación por Membrana Extracorpórea/instrumentación , Reanimación Cardiopulmonar/instrumentación , Equipos y Suministros/estadística & datos numéricos , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Francia , Cardiopatías/terapia , Humanos , Transferencia de Pacientes , Insuficiencia Respiratoria/terapiaRESUMEN
Papillary muscle rupture is a classical, but not frequent life-threatening complication of myocardial infarction. The only treatment consists in mitral valve surgical replacement. It should be performed in a hospital with specialized critical care and a cardiac surgery unit. The problem we are talking about in this article is the transfer of very instable patients in a specialized center before surgery. We also discuss the interest of mobile unit of cardiac assistance to manage patients in hospital without cardiac surgery then to transfer them. We discuss also the initial management in the cardiac surgery and critical care unit.
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Circulación Asistida , Rotura Cardíaca Posinfarto/complicaciones , Músculos Papilares/lesiones , Transferencia de Pacientes , Cirugía Torácica/organización & administración , Ambulancias , Procedimientos Quirúrgicos Cardíacos , Ecocardiografía , Electrocardiografía , Rotura Cardíaca Posinfarto/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Infarto del Miocardio/complicaciones , Músculos Papilares/diagnóstico por imagen , Rotura , TúnezRESUMEN
Phaeochromocytoma and paraganglioma are chromaffine tumours secreting catecholamines. They are usually revealed by a paroxystic hypertensive crisis associated with headaches, palpitation and sweats. We reported a case of a young patient presenting a state of life threatening cardiogenic shock as unusual revelation of this tumour, requiring the implementation of an extracorporeal life support until myocardial recovery.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Neoplasias de las Glándulas Suprarrenales/metabolismo , Circulación Asistida , Catecolaminas/metabolismo , Paraganglios Cromafines/metabolismo , Paraganglioma/complicaciones , Choque Cardiogénico/terapia , Adolescente , Neoplasias de las Glándulas Suprarrenales/cirugía , Antagonistas de Dopamina , Electrocardiografía , Femenino , Hemodinámica/fisiología , Humanos , Complicaciones Intraoperatorias/diagnóstico por imagen , Complicaciones Intraoperatorias/terapia , Metoclopramida , Paraganglioma/metabolismo , Paraganglioma/cirugía , Feocromocitoma/complicaciones , Choque Cardiogénico/diagnóstico por imagen , Choque Cardiogénico/etiología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
OBJECTIVE: To define modalities of cardiac wound management with a special emphasis on the initial direction of the patient toward a surgical service, rapid diagnosis, and surgical treatment. METHOD: Sixteen patients with thoracic injury to the region of the heart treated between 1996 and 2006 were evaluated retrospectively. Pre-operative clinical data, echography, and CT results were collected; time elapsed between injury and treatment, type of surgical treatment, use of cardio-pulmonary bypass, morbidity and mortality were evaluated. RESULTS: There were 16 patients (12 men); age ranged from 18 to 80 with an average of 45.7 years. Nine patients had penetrating cardiac wounds, two had blunt trauma, and five suffered iatrogenic trauma. Cardio-pulmonary bypass was used in two cases. The mean time elapsed between trauma and surgical evaluation was 63 minutes (p=0.18). In all cases, surgery consisted of a myorraphy without coronary or valvular repair. Post-operative complications occurred in 4 patients (25%) and resulted in 2 deaths (12.5%). Complication and death were associated with a prolonged interval between injury and surgical management. CONCLUSION: Patients with cardiac wounds should be transported to the nearest surgical hospital. There are no benefits to cardio-pulmonary bypass in cardiac trauma.
Asunto(s)
Servicio de Cardiología en Hospital , Lesiones Cardíacas/cirugía , Traumatismo Múltiple/cirugía , Servicio de Cirugía en Hospital , Heridas no Penetrantes/cirugía , Heridas Penetrantes/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Puente Cardiopulmonar , Femenino , Lesiones Cardíacas/diagnóstico , Hospitales Generales , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Complicaciones Posoperatorias , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/diagnósticoRESUMEN
BACKGROUND: I.V. patient-controlled analgesia (PCA) with morphine is often used for postoperative analgesia after thoracic surgery, but the required doses may increase postoperative respiratory disorders. Adjunction of ketamine could reduce both doses and related respiratory side-effects. METHODS: The main objective of this prospective, randomized double-blinded study was to evaluate the influence of adding ketamine to PCA on morphine consumption and postoperative respiratory disorders. Consecutive patients undergoing lobectomy (n = 50) were randomly assigned to receive, during the postoperative period, either i.v. morphine 1 mg ml(-1) or morphine with ketamine 1 mg ml(-1) for each. Morphine consumption was evaluated by cumulative doses every 12 h for the three postoperative days. Postoperative respiratory disorders were assessed by spirometric evaluation and recording of nocturnal desaturation. RESULTS: The adjunction of ketamine resulted in a significant reduction in cumulative morphine consumption as early as the 36th postoperative hour [43 (SD 18) vs 32 (14) mg, P = 0.03] with a similar visual analogue scale. In the morphine group, the percentage of time with desaturation < 90% was higher during the three nights [1.80 (0.21-6.37) vs 0.02 (0-0.13), P < 0.001; 2.15 (0.35-8.65) vs 0.50 (0.01-1.30), P = 0.02; 2.46 (0.57-5.51) vs 0.55 (0.21-1.00), P = 0.02]. The decrease in forced expiratory volume in 1 s was less marked in the ketamine group at the first postoperative day [1.04 (0.68-1.22) litre vs 1.21 (1.10-0.70) litre, P = 0.039]. CONCLUSIONS: Adding small doses of ketamine to morphine in PCA devices decreases the morphine consumption and may improve respiratory disorders after thoracic surgery.
Asunto(s)
Analgesia Controlada por el Paciente/métodos , Analgésicos/farmacología , Ketamina/farmacología , Morfina/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Neumonectomía , Adulto , Anciano , Analgésicos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Anestesia General/métodos , Ritmo Circadiano , Método Doble Ciego , Esquema de Medicación , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Ketamina/administración & dosificación , Ketamina/efectos adversos , Masculino , Persona de Mediana Edad , Morfina/efectos adversos , Oxígeno/sangre , Trastornos Respiratorios/inducido químicamente , Trastornos Respiratorios/prevención & control , Espirometría , Capacidad Vital/efectos de los fármacosRESUMEN
OBJECTIVE: To compare the influence of thoracic epidural analgesia (TEA) with intravenous patient-controlled analgesia with morphine (PCA) on the early postoperative respiratory function after lobectomy. STUDY DESIGN: Prospective and comparative observational study. PATIENTS AND METHODS: Fourty-four patients scheduled for lobectomy (n=22 per group) were studied on the evolution of the postoperative respiratory function assessed by the forced vital capacity (FVC) and the forced expired volume (FEV(1)) during the first two postoperative days and the analysis of noctural arterial desaturation during the three first postoperative nights. RESULTS: The use of TEA resulted in fewer decrease both in FEV(1) (1.01+/-0.34 versus 1.31+/-0.51 l/s for Day 1, P=0.03; 1.13+/-0.37 versus 1.53+/-0.59 l/s for Day 2, P=0.01) and in FVC (1.23 [1.05-1.51] versus 1.57 [1.38-2.53] l for day 1, P=0.008; 1.33+/-0.43 versus 2.24+/-0.87 l for day 2, P<0.001). Moreover, the duration of arterial desaturation<90% were longer in the PCA group during the first (8.6 [0.8-28.2] versus 1.3 [0-2.6] min, P=0.02) and the second postoperative night (13.5 [3.5-54] versus 0.4 [0-2.6] min, P=0.025). CONCLUSION: The results of this study suggest that the use of TEA is associated with a better preservation of respiratory function assessed by spirometric data and noctural arterial desaturation recording after thoracic surgery for lobectomy.
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Analgesia Controlada por el Paciente , Anestesia Epidural , Pulmón/fisiopatología , Neumonectomía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morfina/administración & dosificación , Narcóticos/administración & dosificación , Pruebas de Función RespiratoriaRESUMEN
A 46-year-old woman was monitored by bispectral index monitoring (BIS) during redo aortic and mitral valve replacement. On release of the aortic cross clamp there was a sudden, severe, unexplained, and sustained fall in the BIS value. Postoperatively, a CT scan was consistent with multiple ischaemic lesions. The lesions were presumed to be due to air embolism. This case suggests that a sudden unexplained and persistent fall in BIS may indicate cerebral ischaemia.
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Isquemia Encefálica/diagnóstico , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Electroencefalografía/métodos , Complicaciones Intraoperatorias/diagnóstico , Monitoreo Intraoperatorio/métodos , Encéfalo/diagnóstico por imagen , Edema Encefálico/diagnóstico , Edema Encefálico/etiología , Isquemia Encefálica/complicaciones , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Embolia Aérea , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: To review the perioperative anaesthetic management of pulmonary arterial hypertension. DATA SOURCES: Extraction from Pubmed database of French and English articles on the perioperative anaesthetic management of pulmonary hypertension for 9 years. DATA SELECTION: The collected articles were reviewed and selected according their quality and originality. The more recent data were selected. DATA SYNTHESIS: Pulmonary arterial hypertension is classically divided in primary and secondary. Primary pulmonary hypertension (familial and sporadic) is relatively severe and rare. Muscularization of the terminal portion of the pulmonary vascular arterial tree, caused by smooth muscle cell hyperplasia is the first change. Pulmonary arterial hypertension linked with disorders of the respiratory system and hypoxemia or pulmonary venous hypertension including mitral valve disease and chronic left ventricular dysfunction are often associated with high morbidity and mortality. The main consequence of pulmonary hypertension development is the occurrence of right-sided circulatory failure. A better understanding of disease pathophysiology will contribute to the development of new therapies increasing then the prognosis of these patients. The management of primary pulmonary hypertension or secondary pulmonary arterial hypertension is a challenge for the anaesthesiologist because the risk of right ventricular failure is markedly increased.
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Cuidados Críticos/métodos , Hipertensión Pulmonar/terapia , Complicaciones Intraoperatorias/terapia , Anestesia/métodos , Anestésicos/farmacología , Manejo de Caso , Ecocardiografía Doppler , Insuficiencia Cardíaca/etiología , Humanos , Hipertensión Pulmonar/epidemiología , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Complicaciones Intraoperatorias/prevención & control , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/fisiopatología , Óxido Nítrico/fisiología , Oxígeno/administración & dosificación , Oxígeno/uso terapéutico , Medicación Preanestésica , Circulación Pulmonar/efectos de los fármacos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Respiración Artificial/métodos , Resistencia Vascular , Vasodilatadores/farmacología , Vasodilatadores/uso terapéutico , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/etiología , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
Whenever a catheter related infection is suspected, two main issues must be addressed: should the catheter be removed and should an empiric antibiotic treatment be prescribed? These questions are still under debate. Some differences are found between French and American guidelines. Main factors leading to decision about these questions are: severity of the sepsis, microorganisms involved and kind of patients we are dealing with.
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Cateterismo/efectos adversos , Infección Hospitalaria/terapia , Infección Hospitalaria/microbiología , Toma de Decisiones , Francia , Guías como Asunto , Humanos , Estados UnidosRESUMEN
BACKGROUND: Procalcitonin (PCT) blood concentrations are known to be an appropriate marker of severe systemic inflammatory response syndrome (SIRS) induced by coronary artery surgery with and without cardiopulmonary bypass. Pro-brain natriuretic peptide (N-BNP) is a newly described cardiac hormone considered to be an effective marker of severity and prognosis of acute coronary syndromes and congestive heart failure. We evaluated the perioperative time courses of PCT and N-BNP and investigated their role as early markers of severe SIRS (SIRS with cardiovascular dysfunction) induced by off-pump coronary artery bypass (OPCAB). METHODS: Sixty-three patients were prospectively included. The American College of Chest Physicians Classification was used to diagnose SIRS and organ system failure to define severe SIRS. Serum concentrations of PCT and N-BNP were determined before, during and after surgery. Receiver operating characteristic curves and cut-off values were used to assess the ability of these markers to predict postoperative severe SIRS. RESULTS: SIRS occurred in 25 (39%) patients. Nine of them (14%) showed severe SIRS. Significantly higher serum concentrations of N-BNP and PCT were found in patients with severe SIRS with peak concentrations respectively at 8887 pg ml(-1) (range 2940-29372 pg ml(-1)) for N-BNP and 9.50 ng ml(-1) (range 1-65 ng ml(-1)) for PCT. The area under the curve using N-BNP to detect postoperative severe SIRS was 0.799 before surgery (0.408 for PCT; P<0.01) and 0.824 at the end of surgery (0.762 for PCT; P<0.05). CONCLUSIONS: N-BNP may be an appropriate marker indicating the early development of non-infectious postoperative severe SIRS after OPCAB.
Asunto(s)
Puente de Arteria Coronaria , Proteínas del Tejido Nervioso/sangre , Fragmentos de Péptidos/sangre , Complicaciones Posoperatorias/diagnóstico , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Biomarcadores/sangre , Calcitonina/sangre , Péptido Relacionado con Gen de Calcitonina , Puente Cardiopulmonar , Humanos , Péptido Natriurético Encefálico , Complicaciones Posoperatorias/sangre , Estudios Prospectivos , Precursores de Proteínas/sangre , Curva ROC , Síndrome de Respuesta Inflamatoria Sistémica/sangreRESUMEN
OBJECTIVE: To compare N-terminal pro-brain natriuretic peptide (NT-pro-BNP), procalcitonin (PCT), and troponin I (Tn I) concentrations during and after coronary artery surgery in patients with or without cardiovascular complications. DESIGN AND SETTING: Prospective, comparative study of 12 months in the cardiovascular intensive care unit in a university hospital. PATIENTS: 60 adult patients undergoing coronary artery bypass grafting with the off-pump technique. MEASUREMENTS AND RESULTS: Plasma NT-pro-BNP, PCT, and Tn I levels were measured before and immediately after the end of operation and on PODs 1, and 2 and 3. We defined complicated postoperative course as myocardial infarction, cardiogenic shock, arrhythmias, congestive heart failure, and death occurring after the fourth postoperative hour. Receiver operating characteristic (ROC) curve cutoff values were used to assess the ability of the three markers to predict future cardiac events. The area under ROC curve (AUC) using NT-pro-BNP to detect a cardiovascular complicated course was 0.780 at the preoperative time and 0.850 at the end of surgery. A preoperative NT-pro-BNP value of 397 pg/ml had a sensitivity of 76%, specificity of 67%, and accuracy of 74% for predicting a subsequent cardiovascular complication. An immediate postoperative NT-pro-BNP value of 430 pg/ml had a sensitivity of 80%, specificity of 77%, and accuracy of 76%. Patients with preoperative NT-pro-BNP levels less than 275 pg/ml had an excellent postoperative prognosis. Other two markers were less appropriate. CONCLUSIONS: NT-pro-BNP levels measured before and immediately after off-pump coronary artery bypass seem to be predictive of postoperative cardiac events.
Asunto(s)
Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/sangre , Vasos Coronarios/cirugía , Proteínas del Tejido Nervioso/sangre , Fragmentos de Péptidos/sangre , Anciano , Calcitonina/sangre , Péptido Relacionado con Gen de Calcitonina , Enfermedad de la Arteria Coronaria/etiología , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/etiología , Pronóstico , Estudios Prospectivos , Precursores de Proteínas/sangre , Troponina I/sangreRESUMEN
A close association between human herpesvirus-8 (HHV-8) and Kaposi's sarcoma (KS) has been shown in transplant recipients, but donor-to-recipient transmission of HHV-8 is uncommon. Herein we report a case of a heart transplant recipient who had a fatal visceral KS in association with HHV-8 seroconversion at 18 months after transplantation with a donor having positive serology discovered after transplantation.