Risk Factors Associated with In-Hospital Mortality for Patients with Acute Abdomen After Cardiac Surgery.

OBJECTIVES: Management of acute abdomen (AA) differs due to the heterogeneity of underlying pathophysiology. Complications of AA and its overall outcome after cardiac surgery are known to be associated with poor results. The aim of this retrospective analysis was to evaluate risk factors for AA in patients undergoing cardiac surgery. METHODS: Between December 2011 and December 2014, a total of 131 patients with AA after cardiac surgery were identified and retrospectively analyzed using our institutional database. Statistical analysis of risk factors concerning in-hospital mortality of mentioned patient cohort was performed using IBM SPSS Statistics. RESULTS: Overall in-hospital mortality was 54.2% (71/131). Analyzing in-hospital non-survivors (NS) versus in-hospital survivors (S) peripheral artery disease (28.2% vs. 11.7%; p = 0.03), the need for assist device therapy (33.8% vs. 16.7%; p = 0.03) and the requirement of hemodialysis (67.6% vs. 23.3%; p < 0.01) were significantly higher in NS. Furthermore, lactic acid values at onset of symptoms were shown to be significantly higher in NS (5.7 ± 5.7 mmol/L vs. 2.8 ± 2.9 mmol/L; p < 0.01). Assured diagnosis of mesenterial ischemia was strongly associated with worse outcome (odds ratio 10.800, 95% confidence interval 2.003-58.224; p = 0.006). CONCLUSION: In conclusion, in critically ill patients after performed cardiac surgery peripheral vascular disease, need for supportive hemodynamic assist device systems and occurrence of renal failure are risk factors associated with worsen outcome. Additionally, rise of lactic acid could potentially be associated with onset of intestinal malperfusion and should be taken into account in therapeutic decisions preventing fatal mesenterial ischemia.

Non-Cardiac Symptoms of Moderate to Severe Hypokalemia in a Patient with a Syncardia™ Total Artificial Heart.

The Syncardia™ total artificial heart (TAH) is an option for patients as a bridge to transplant in those who are not candidates for left ventricular assist devices (LVAD) due to right ventricular failure. Postoperative course is highly dependent on volume status and aggressive diuresis is often necessary. One complication from aggressive diuresis is hypokalemia; however, in these patients we tolerate a lower potassium level because cardiac arrhythmias are not a concern.  However, in two separate instances non-cardiac symptoms related to severe hypokalemia occurred. These symptoms included nystagmus in one patient and agitation, tremors, and having an "out-of-body" experience in the other patient. Both these patients had resolution of symptoms with potassium replacement.

Pump Thrombosis following HeartMate II Left Ventricular Assist Device Implantation in a Patient with Aspirin and Plavix Resistance.

Despite advances in pump technology, thromboembolic events and pump thrombosis are potentially life-threatening complications in patients with continuous flow ventricular assist devices. Here we describe a patient with pump thrombosis following LVAD HeartMate II implantation presenting with Aspirin and Plavix resistance and signs of acute hemolysis as manifested by high LDH, changing pump power, pulse index and reduced pump flows.

Expression of the RB protein, allelic imbalance of the RB gene and amplification of the CDK4 gene in metaplasias, dysplasias and carcinomas in Barrett's oesophagus.

In the present study, the role of allelic loss at the retinoblastoma gene (RB), expression of the retinoblastoma protein (pRb) and amplification at the CDK4 gene in the metaplasia--dysplasia--carcinoma sequence in Barrett's oesophagus (BO) was investigated. Samples of metaplastic specialised epithelium (SE; n = 28), low-grade dysplasia (LGD; n = 21), high-grade dysplasia (HGD; n = 19) and invasive adenocarcinoma (CA; n = 35) derived from 36 oesophagectomy specimens were included. Of the cases that were informative for the RB gene (n = 27), loss of heterozygosity (LOH) was found in none of the 22 SE, in none of the 14 LGD, in 1 of the 12 HGD (8.3%) and in 5 of the 27 CA (18.5%). Immunohistochemically, an enhanced expression of pRb protein in LGD, HGD and CA as compared with SE was found in most cases. In 4 carcinoma samples, however, a marked reduction (3 cases) or complete absence (1 case) of pRb protein expression was found. Two out of these 4 CA samples showed LOH in the RB gene whilst one case was heterozygous and one case was homozygous. In contrast to the positive controls used, CDK4 amplification was not detectable by means of differential PCR in any of the samples under investigation. The present study indicated that allelic loss of the RB gene occurs late in the metaplasia--dysplasia--carcinoma sequence in BO. Immunohistochemically determined loss of pRb protein expression may indicate LOH of the RB gene. CDK4 gene amplification does not seem to play a role in the development of oesophageal adenocarcinoma.