RESUMEN
BACKGROUND: Cerebral injury is a well-known complication after cardiac surgery with cardiopulmonary bypass (CPB), especially in adult patients. Specific biochemical markers like neuron-specific enolase (NSE) and S-100beta protein were developed previously for early detecting neuronal damage after CPB. Corticosteroids are shown to reduce multisystemic deleterious effects of cardiopulmonary bypass due to their anti-inflammatory characteristics. The aim of this study is to demonstrate the decrease of serum neuron-specific enolase levels in patients who received corticosteroids before CPB. METHODS: Thirty patients scheduled for elective coronary bypass surgery were included in the study. Patients were divided randomly into two groups as the control group (n = 15) who underwent a standard coronary bypass surgery without any additional medication and the study group (n = 15) who received 1 gm of methylprednisolone before CPB. Blood samples for analysis of serum NSE, interleukin-6 (IL-6), and IL-10 were drawn before CPB, 4 and 24 hours after the end of extracorporeal circulation. RESULTS: Serum cytokine and NSE levels were significantly increased after CPB above their normal range in both groups. In the study group, IL-6 and NSE levels were significantly reduced while IL-10 levels were much higher after CPB. High NSE levels significantly correlated with IL-6 levels in the control group. CONCLUSION: The lower levels of NSE in patients who received methylprednisolone may suggest that corticosteroids might be useful in decreasing possible neuronal damage during heart surgery. However, we were not able to demonstrate an adverse neurological outcome.
Asunto(s)
Puente de Arteria Coronaria , Metilprednisolona/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Fosfopiruvato Hidratasa/sangre , Premedicación , Biomarcadores/sangre , Lesiones Encefálicas/sangre , Lesiones Encefálicas/prevención & control , Femenino , Humanos , Interleucina-10/sangre , Interleucina-6/sangre , Masculino , Persona de Mediana EdadRESUMEN
Atrial myxomas are the most commonly encountered tumours of the heart and can present at different ages with different clinical symptoms. They are one of the curable tumours of the heart. Appropriate surgical treatment and surgery must be performed with great precautions in order to prevent fatal systemic embolizations. In this retrospective study we will present our experience of 14 years, between 1990 and 2004, in 27 patients who had been operated for cardiac myxomas. Diagnosis of the myxomas were made by echocardiography in all cases. Surgical approach to the tumour was biatrial in nine, left atrial in II, and transseptal in seven patients. Associated procedures included coronary artery bypass grafting in one, mitral valve repair with tricuspid annuloplasty in two patients, mitral valve replacement in one and bilateral femoral embolectomy in one patient. One hospital mortality occurred as a result of multiorgan failure in a patient with peripheral embolization. None of the patients required recurrent operation, however, mitral valve insufficiency was surgically corrected in one patient.
Asunto(s)
Atrios Cardíacos/cirugía , Neoplasias Cardíacas/cirugía , Mixoma/cirugía , Adolescente , Adulto , Anciano , Niño , Ecocardiografía , Embolia/etiología , Embolia/mortalidad , Femenino , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Mixoma/diagnóstico por imagen , Mixoma/mortalidad , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios RetrospectivosRESUMEN
Ter Haar Syndrome is one of the most deteriorating disorders defined in the medical era. Up to date only ten patients were reported. We present a living patient with Ter Haar Syndrome who has undergone successful mitral valve repair.
Asunto(s)
Enfermedades del Desarrollo Óseo , Anomalías Craneofaciales , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral/congénito , Insuficiencia de la Válvula Mitral/cirugía , Anomalías Múltiples , Insuficiencia de la Válvula Aórtica/congénito , Insuficiencia de la Válvula Aórtica/cirugía , Niño , Insuficiencia Cardíaca/congénito , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Síndrome , Insuficiencia de la Válvula Tricúspide/congénito , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
Antiphospholipid syndrome (APS) has been well defined in adults; however, primary nontraumatic arterial thrombosis owing to this entity is unusual in the pediatric population. The authors report a case of APS with lower extremity arterial thrombosis who had discolored feet since delivery.
Asunto(s)
Síndrome Antifosfolípido/diagnóstico , Anticuerpos Anticardiolipina/sangre , Anticoagulantes/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/congénito , Síndrome Antifosfolípido/tratamiento farmacológico , Síndrome Antifosfolípido/inmunología , Arteriopatías Oclusivas/tratamiento farmacológico , Arteriopatías Oclusivas/etiología , Aspirina/uso terapéutico , Preescolar , Circulación Colateral , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Inmunoglobulina G/sangre , Inmunosupresores/uso terapéutico , Claudicación Intermitente/etiología , Úlcera de la Pierna/etiología , Masculino , Prednisolona/uso terapéutico , Enfermedades Cutáneas Vasculares/congénito , Enfermedades Cutáneas Vasculares/etiología , Trombofilia/tratamiento farmacológico , Trombofilia/etiología , Warfarina/uso terapéuticoRESUMEN
PURPOSE: To clarify the factors that influence improvement and remission after thymectomy for patients with nonthymomatous myasthenia gravis (MG). METHODS: We retrospectively reviewed 204 patients with nonthymomatous MG who underwent thymectomy and anterior mediastinal dissection through a partial median sternotomy, between 1980 and 2001, and examined whether age, sex, preoperative classification, and duration of symptoms influenced their prognosis. RESULTS: There was no perioperative or hospital mortality. The mean follow-up period was 7.2 +/- 1.2 years, with early and late postoperative remission rates of 44.6% and 73%, respectively. Seven patients died; two from pneumonia and five from causes unrelated to MG. Preoperative treatment and classification, duration of symptoms, age, and sex did not seem to have a significant influence on remission, but the response to thymectomy was greater in patients with thymic hyperplasia. Remission and improvement rates were significantly better at the end of the first year, with the same status found at the last follow-up. CONCLUSION: Thymectomy is an effective and highly curative method of treatment for patients. with MG. It provides excellent symptomatic improvement, which is enhanced over the long term.