Outcomes of Urgent Coronary Artery Bypass Graft Surgery Following Non-ST Elevation Myocardial Infarction

Background: Non-ST elevation myocardial infarction (NSTEMI) significantly reduces patient survival, a condition that is essential for the optimization of results and the restoration of effective vascular flow multivessel coronary artery disease, Emergency coronary artery bypass grafting (CABG) is frequently contemplated. In the aftermath of NSTEMI, the objective of this investigation is to assess the results of urgent CABG, to prioritize risk stratification through the use of the Global Registry of Acute Coronary Events (GRACE) score Methods: An analysis of 60 consecutive patients who underwent emergent CABG following NSTEMI was conducted retrospectively. Data on patients were obtained from a prospectively compiled database, and the GRACE score was implemented to evaluate the probability of mortality. Patients were divided into three risk categories: low (<10%), intermediate (10-19%), and high (?20%), based on their predicted mortality percentages. Results: Patients in the high-risk group (Group 3) exhibited significantly lower Euro Scores and ejection fractions (EF) than those in the low and intermediate groups, as demonstrated by the study. Additionally, the cross-clamp time was notably longer in Group 3, highlighting the urgency of intervention in this population The postoperative complications' overall incidence did not differ significantly between the groups. Even though Group 3 exhibited an increased in-hospital mortality rate. Conclusions: The findings underscore the importance of timely intervention and tailored management strategies for NSTEMI patients, more specifically, the individuals who have been classified as high-risk by the GRACE score. This study contributes to the growing body of literature supporting urgent CABG as a lifesaving procedure and emphasizes the need for further research to optimize outcomes in this vulnerable patient population. The results advocate for a multidisciplinary approach to enhance perioperative care and improve survival rates among NSTEMI patients undergoing CABG.

The Shared Airway: Tracheal Mass Excision

We report a case of successful airway management of a 26?year?old male patient who was posted for tracheal mass excision. The main challenge in such a case is to formulate a plan to provide maximum surgical access to the trachea for mass excision through an intraoral approach while ensuring adequate oxygenation and airway management. The patient presented with acute respiratory distress in the emergency ward. On computed tomography (CT), the patient was diagnosed with a polypoidal tracheal tumor occluding more than 90% of the tracheal lumen and 5.8 cm away from the carina. The case was successfully managed using a peripheral bypass for airway management. After the removal of the tumor, a tracheostomy tube was placed through the tracheotomy hole used for tumor excision. The whole process was uneventful.

Intraoperative Innovation Leading to a Modified Endotracheal Tube: A Case Report of Endobronchial Intubation of Total Laryngectomy Stoma

The post?total laryngectomy airway poses perioperative challenges to anesthesia management. While endobronchial intubation is a cited complication, a low?lying stoma may increase this risk. Furthermore, the stoma’s proximity to a median sternotomy increases surgical and airway management complexity. This report highlights a case of endobronchial intubation in a patient with a low?lying stoma who presented for coronary artery bypass graft. With a stoma at the upper border of the sternum, intraoperative innovation was required to prevent endobronchial intubation while remaining out of the surgical field. This innovation may be useful in urgent surgical situations.

Systemic Mastocytosis Successfully Managed using Cytosorb® During Cardiopulmonary Bypass for Aortic Valve Replacement

We describe the case of a 72?year?old male with a history of systemic mastocytosis scheduled for on?pump aortic valve replacement for severe aortic insufficiency. Anesthesia and peri?operative management included avoidance of histamine?releasing drugs, methylprednisolone and clemastin prophylaxis. Furthermore, a CytoSorb® cartridge has been added to the bypass circuit and hemoadsorption was performed throughout the entire cardiopulmonary bypass (CPB) duration. CytoSorb® is a hemoadsorption device designed to remove various cytokines and drugs from the blood. The use of CytoSorb® during CPB in our case was not associated with adverse events, and the patient did not present any allergic or anaphylactic reaction.

Relation Between Multiplication of Venous Carbon Dioxide Partial Pressure (PvCO2) and the Ratio of Gas Flow to Pump Flow (Ve/Q) with Hyperlactatemia During Cardiopulmonary Bypass

Background: The incidence of hyperlactatemia due to hypoperfusion during cardiopulmonary bypass (CPB) increases morbidity. Carbon dioxide production during CPB is one of the lactate production markers, in addition to other markers such as delivery oxygen (DO2), oxygen consumption (VO2), mixed vein oxygen saturation (SvO2), and oxygen extraction ratio (O2ER). Method: This observational analytic study was conducted on 40 adult cardiac surgery patients using a CPB machine. Initial lactate is taken when entering CPB and final lactate is examined 15 min after coming off bypass. The values of DO2, VO2, SvO2, VCO2, respiratory quotient (RQ), DO2/VCO2, PvCO2 × Ve/Q were calculated from the results of blood and venous gas analysis 1 h after entering CPB in the nadir of core temperature and lowest pump flow. Result: The multivariate test showed that the value of PvCO2 × Ve/Q was more effective than other oxygenation and carbon dioxide parameters in predicting an increase in the percentage of lactate. Each increase of 1 mmHg PvCO2 ×× Ve/Q can predict a final lactate increase of 29% from the initial lactate. The high PvCO2 × Ve/Q value is also the strongest correlation factor for the incidence of hyperlactatemia after CPB (final lactate >3 mmol/L). The cutoff value of this marker is >19.3 mmHg, which has a sensitivity of 100% and a specificity of 55.6% with a strong correlation value. Conclusion: The PvCO2 × Ve/Q value proved to be one of the significant markers in predicting hyperlactatemia during cardiac surgery using CPB.

Role of Prophylactic N-Acetylcysteine Supplementation on Postoperative Outcomes in Patients Undergoing Elective Double-Valve Replacement (Aortic and Mitral Valve)

Aims and Objectives: The incidence of postoperative liver dysfunction is high in patients undergoing double?valve replacement – mitral and aortic valve replacement (DVR). This study aims to evaluate N?acetylcysteine’s free radical scavenging property (NAC) to prevent postoperative liver dysfunction in these patients, thus affecting overall clinical outcomes. Methods: A single?center, prospective, randomized, double?blinded interventional study of 60 patients divided into two groups of 30 each. Group N received prophylactic intravenous NAC, and Group C received volume?matched 5% dextrose. Data comprised demographics, liver function tests (LFT), renal function tests (RFT), vasoactive?inotropic scores (VIS) score, and C?reactive protein (CRP) at various time intervals. Postoperative parameters such as ventilation duration, length of stay in ICU (LOS?ICU), length of hospital stay (LOHS), atrial fibrillation (AF), acute kidney injury (AKI) requiring hemodialysis, and mortality were noted. Statistical analysis was performed with the Student’s t?test and Chi?square test (SPSS 22 software). Results: All postoperative LFT parameters (total bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT), and alkaline phosphatase (ALP)) were significantly lower ( P < 0.05) at 24, 48, and 72 hours in Group N compared to Group C. RFT and VIS scores were lower in Group N; however, were not statistically significant except for Serum Creatinine at 48 hours ( P = 0.0478). Ventilation duration ( P = 0.0465) and LOS?ICU ( P = 0.0431) were significantly lower in Group N. Other outcomes like AF, LOHS, and mortality were lower in Group N but were not statistically significant. Conclusion: Our study showed that prophylactic administration of NAC in patients undergoing DVR is associated with a reduction in the incidence of postoperative liver dysfunction with a positive impact on postoperative outcomes.

The impact of pre-operative uric acid levels on post-operative renal outcomes in off-pump coronary artery bypass grafting patients

Background: Elevated pre-operative uric acid levels significantly impact post-operative renal outcomes in off-pump CABG patients, increasing the risk of acute kidney injury, as evidenced by higher serum creatinine and reduced urine output. Methods: This cross-sectional study was conducted in Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh from January 2021 to December 2022. Total 160 patients undergoing off pump CABG were divided into two groups, group A and group B, each containing 80 patients. In group A, uric acid level was <7 mg/dl for male and <6 mg/dl for female and in group B, it was >7 mg/dl and >6 mg/dL for female. Results: The demographic characteristics, pre-operative serum UA levels and serum creatinine levels between the two groups was not statistically significant. Group A had shorter operative times (mean 265.21�.33 minutes) compared to Group B (mean 327.04�.32 minutes), with more patients in Group-B undergoing longer surgeries (>360 minutes). Group-B also had more grafts (mean 4.4 vs 3.6), higher serum creatinine (1.91 vs 1.17 mg/dl), bilirubin (0.8 vs 0.7 mg/dl), and lower urine output (mean 47.52 vs 95.37 ml/hour), all statistically significant (p<0.001). Conclusions: This study concludes that there is significant impact of pre-operative uric acid levels on post-operative renal outcomes in off-pump CABG patients.

Skeletonized Left Internal Mammary Artery Harvesting is better than Pedicled Left Internal Mammary Artery Harvesting in the Context of Sternal Wound Complication Following Off-Pump Coronary Artery Bypass Grafting

Background: Off-pump coronary artery bypass grafting抯 most difficult complication is sternal wound. Left internal mammary artery harvesting affects sternal wound complications. It is unclear which left internal mammary artery harvesting method prevents sternal wound complications. Skeletonized and pedicled left internal mammary artery harvesting were compared for sternal wound complications during off-pump coronary artery bypass grafting. As a result, proper methodology might be supported as an attractive method to decrease the incidence of sternal wound complication. Material & Methods: This comparative cross-sectional study was conducted at the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University. Total 120 patients were enrolled after fulfilling the selection criteria and divided into two groups. Among them,60 patients of group A received skeletonized left internal mammary artery whereas 60 patients of group B received pedicled left internal mammary artery. After performing off-pump coronary artery bypass grafting postoperative ICU care was given to each patient as per ICU protocol. Statistical analysis was conducted using Statistical Package for Social Science (SPSS) version 26.0 for windows software. Comparisons between groups were made with Student抯 t-test, Chi-Square test and Fisher抯 exact test. Observations were recorded as statistically significant if ap-value ?0.05. Results: In this study 10 (8.33%) patients developed sternal wound complication. Among them2 (1.67%) patients in group A and 8 (6.66%) patients in group B developed sternal wound complication. Occurrence of sternal wound complication was more in group B than group A which was not statistically significant(p=0.35). The mean age of patients in Group A and Group B were 54.34�.55 years and 53.50�.70 years respectively. Age was not statistically significant between two groups (p=0.89). The gender difference among two groups were not also statistically significant(p=0.69). Mean BMI was 24.33�65 in group A and 24.55�45 in group B and findings were not statistically significant between groups (p=0.76). The differences between comorbidities (HTN, DM, dyslipidaemia, anaemia) of both groups were statistically insignificant (p>0.05). However, number of smokers was statistically significant between groups (p=0.03). Sternal wound complication was more in smoker patients in group B and this finding was statistically significant(p=0.04). Mean � SD number of bypass grafts used by group A was 2.76�79 and group B was 2.83 �65(P=0.69). Pre-operative parameters such as duration of operation and post-operative parameter like duration of mechanical ventilation, duration of chest drains, duration of central venous line and amount of postoperative mediastinal bleeding were found statistically not significant between groups (p>0.05). Comparison of postoperative laboratory parameters was statistically not significant between groups. Distribution of wound complications, duration of ICU and hospital stay between two groups were also not statistically significant (p>0.05). Conclusions: Occurrence of sternal wound complication was found less in skeletonized left internal mammary artery harvesting than pedicled left internal mammary artery harvesting after off-pump coronary bypass grafting in this study. But this finding was not statistically significant.

Protamine and Heparin Interactions: A Narrative Review

Protamine, first isolated from salmon fish sperm and now produced through recombinant biotechnology, is an antidote that neutralizes the anticoagulant properties of heparin. Protamine function is based on the capacity to dissociate the heparin–antithrombin III (AT III) complex (an important link that promotes blood fluidification by inhibiting coagulation), forming the inactive heparin–protamine complex. Protamine has itself dose?dependent anticoagulant properties: It interferes with coagulation factors and platelet function; it stimulates fibrinolysis; it can lead to thrombocytopenia and reduction in thrombin?related platelet aggregation; it decreases platelet response to thrombin receptor agonist in a dose?dependent manner. In this review, we will focus on protamine and its interaction with heparin. Notably, protamine is able to antagonize not only unfractionated heparin (UFH) but also low molecular weight heparins to various degrees. Protamine?allergic and anaphylactoid systemic reactions may affect up to 1 in 10 people and should be prevented and treated early.

Radiological and Surgical Findings in a Case of Gastric Necrosis with a Remote History of Gastric Bypass Surgery: A Case Report

We report the case of a 49-year-old man with necrotic perforation of the redundant stomach after gastric bypass surgery that was performed 15 years prior for morbid obesity. The patient underwent computed tomography of the abdomen and pelvis followed by urgent laparoscopy, which revealed significant bilious fluid in all quadrants of the abdomen and patchy necrosis of the remnant nonfunctional part of the stomach. The patient had partial gastrectomy; the necrotic part of the stomach was removed. The patient’s postoperative recovery was uneventful. Early and accurate diagnosis by radiologists is paramount in such cases with unusual presentation. During surgery, careful examination of the remnant stomach is recommended for patients with a history of gastric bypass surgery, particularly when a hollow viscus perforation is highly suspected. We also recommend that bariatric surgeons or acute care surgeons perform these surgeries

Use Of Cardiopulmonary Bypass With Deep Hypothermic Circulatory Arrest In The Management Of Ivc Tumor Thrombus

In recent years, there has been a signicant rise in the number of cases of renal cell carcinoma (RCC) that include venous extension to the inferior vena cava (IVC). This is mostly attributable to the development of several diagnostic techniques. Vascular invasion indicates an increased biological activity and poses a surgical difculty during treatment. Renal cell carcinoma accounts for around 3-4% of all solid neoplasms. 4-10% of patients with renal cell carcinoma exhibit the presence of IVC thrombus. Among such patients, extension to the right is observed in 1-3% of cases. Surgical resection is the established method used to treat such cases.

Impact of Posterior Pericardiotomy on Prevention of Post Operative Atrial Fibrillation in Patients Undergoing Coronary Bypass Surgery

Purpose: Coronary artery bypass grafting surgery (CABG) is a common surgical procedure used to treat coronary artery disease (CAD). Despite advancements in the surgical techniques and perioperative care, cardiac surgery patients remain at risk of developing complications, especially atrial fibrillation (AF), The present study aimed to investigate the impact of posterior pericardiotomy on the incidence of postoperative AF and other relevant complications following CABG. Methods: This study is a randomized controlled trial conducted at a single center. A total of 204 patients were randomly assigned to two groups: the pericardiotomy group and the non-pericardiotomy group (control group). The study assessed the incidence of postoperative atrial fibrillation within the first 7 days following CABG surgery. Results: Our findings revealed no statistically significant difference in the incidence of pericardial effusion and AF between the pericardiotomy and non-pericardiotomy groups. The lack of cardiopulmonary bypass (CPB) in the on-pump CABG method may have contributed to the absence of significant differences in pericardial effusion rates between the groups. Moreover, we found that posterior pericardiotomy did not significantly affect the intubation time, length of stay in the intensive care unit (ICU), and total hospital stay in either group. Our study differs from previous research that focused on off-pump CABG patients. Studies that utilized CPB reported a significant reduction in pericardial effusion and arrhythmias with posterior pericardiotomy. This discrepancy suggests that the use of CPB may play a crucial role in the occurrence of arrhythmias and subsequent complications. Conclusions: our study indicates that posterior pericardiotomy did not significantly influence the incidence of pericardial effusion and AF in on-pump CABG patients. Considering the differences in surgical techniques and patient populations, further research with larger sample sizes is warranted to provide more definitive insights into the role of posterior pericardiotomy in this specific setting. Comprehensive studies will be instrumental in guiding clinical decisions and establishing best practices for the prevention of postoperative pericardial effusion and arrhythmias in on-pump CABG patients.

Resultados cardiometabólicos de largo plazo tras cirugía bariátrica: control de comorbilidades, pérdida y reganancia de peso a los 5 años de seguimiento / Long-term cardiometabolic results after bariatric surgery: Control of comorbidities, weight loss and regain at 5 years of follow-up

Introducción. La cirugía bariátrica y metabólica (CBM) es efectiva en lograr pérdida de peso a corto plazo. Sin embargo, existe evidencia limitada en desenlaces clínicos y metabólicos a largo plazo. Métodos. Estudio longitudinal retrospectivo con pacientes llevados a baipás gástrico en Y de Roux (BGYR) o gastrectomía en manga (MG) por laparoscopia en Bogotá, D.C., Colombia, entre 2013 y 2021. El cambio de peso, control de comorbilidades y resultados metabólicos se recopilaron al inicio del estudio, 3, 6 y 12 meses después de cirugía, y anualmente hasta el quinto año. Las tasas de control de comorbilidades se evaluaron mediante la prueba Kaplan-Meier. Se utilizó un modelo de riesgos proporcionales de Cox para evaluar el efecto de covariables en la reganancia de peso. Resultados. De 1092 pacientes con CBM (71,4 % MG y 28,6 % BGYR), 67 % eran mujeres, con mediana de edad 48 años e índice de masa corporal de 35,5 Kg/m2. Después de cinco años de seguimiento, la tasa de control en diabetes mellitus fue 65,5 %, en hipertensión 56,6 % y en dislipidemia 43,6 %. La tasa de reganancia de peso fue 28 %, sin diferencias entre MG vs BGYR (p=0,482). El tiempo promedio hasta peso nadir fue 14 meses. La edad al momento de CBM fue el mejor predictor independiente de reganancia (HR=1,02, IC95% 1,01-1,04), pero con efecto clínico modesto. Conclusión. La CBM es segura y muestra beneficios a largo plazo en la pérdida de peso y control de comorbilidades en población colombiana.

Introduction. Bariatric and metabolic surgery (BMS) has shown its efficacy in achieving short-term weight loss. However, there is limited evidence regarding long-term clinical and metabolic outcomes. Methods. Retrospective longitudinal study with patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) interventions in Bogotá, Colombia, between 2013 and 2021. Weight change, comorbidity control, and metabolic outcomes were collected at the onset, 3-, 6-, and 12-month post-surgery, and annually up to the fifth year. Comorbidity control rates were assessed using the Kaplan-Meier test. A Cox proportional hazards model was used to evaluate the effect of covariates on weight regain. Results. Of 1092 patients with BMS (71.4% SG and 28.6% RYGB), 67% were women, with a median age of 48 years, BMI 35.5 kg/m2. After five years of follow-up, the control rate in diabetes mellitus was 65.5%, in hypertension 56.6%, and dyslipidemia 43.6%. The weight regain rate was 28% with no differences between SG vs RYGB (p=0.482). The mean time to nadir weight was 14 months. Age at the time of BMS was the best independent predictor of weight regain (HR=1.02, 95%CI: 1.01-1.04), but with a modest clinical effect. Conclusion. BMS is safe and shows long-term benefits in weight loss and control of comorbidities in Colombian population.

Incidence and Risk Factors for Postoperative Visual Loss after Cardiac Surgical Procedures: A Systematic Review

Postoperative visual loss (POVL) is an infrequent yet consequential complication that can follow cardiac surgical interventions. This systematic review aims to provide a comprehensive analysis of the incidence of POVL after cardiac surgery and to delineate the associated risk factors. A comprehensive search was conducted in major medical databases for relevant studies published up to September 2022. Eligible studies reporting on the incidence of POVL and identifying risk factors in patients undergoing cardiac surgery were included. Data extraction was performed independently by two reviewers. The pooled incidence rates and the identified risk factors were synthesized qualitatively. POVL after cardiac surgery has an overall incidence of 0.015%, that is, 15 cases per 100,000 cardiac surgical procedures. Risk factors for POVL include patient characteristics (advanced age, diabetes, hypertension, and preexisting ocular conditions), procedural factors (prolonged surgery duration, cardiopulmonary bypass time, and aortic cross?clamping), anesthetic considerations (hypotension, blood pressure fluctuations, and specific techniques), and postoperative complications (stroke, hypotension, and systemic hypoperfusion). Ischemic optic neuropathy (ION) is an uncommon complication, associated with factors like prolonged cardiopulmonary bypass, low hematocrit levels, excessive body weight gain, specific medications, hypothermia, anemia, raised intraocular pressure, and micro?embolization. Diabetic patients with severe postoperative anemia are at increased risk for anterior ischemic optic neuropathy (AION). Posterior ischemic optic neuropathy (PION) can occur with factors like hypertension, postoperative edema, prolonged mechanical ventilation, micro?embolization, inflammation, hemodilution, and hypothermia. While the overall incidence of POVL postcardiac surgery remains modest, its potential impact is substantial, necessitating meticulous consideration of modifiable risk factors. Notably, prolonged surgical duration, intraoperative hypotension, anemia, and reduced hematocrit levels remain salient contributors. Vigilance is indispensable to promptly detect this infrequent yet visually debilitating phenomenon in the context of postcardiac surgical care.

Resection Of Inflammatory Pseudotumor Of Trachea Using Cardiopulmonary Bypass

Primary tracheal tumors are exceptionally uncommon, and the majority of them are cancerous. An inflammatory pseudotumor is a noncancerous, tumor-like growth that is most likely caused by a reactive response. The primary morphological feature is the proliferation of spindle-shaped cells, specifically myoblasts and fibroblasts, accompanied by varying numbers and types of inflammatory cells. Cardiopulmonary bypass (CPB) creates a field without blood for heart surgery. The system utilizes an extracorporeal circuit to deliver physiological support by draining venous blood into a reservoir, oxygenating it, and returning it to the body through a pump. The collaboration between the surgeon, perfusionist, and anaesthesiologist is crucial for the effective utilization of CPB.

Correlation between Pre-Operative Myocardial Fibrosis and Early Post CABG Dysrhythmia

Background: Cardiac magnetic resonance (CMR) imaging combines the assessment of both the functional and structural aspects of the heart in order to identify the existence, timing, and intensity of ischemic heart disease by analyzing the function of the myocardium and the movement of the heart wall. This study aimed to investigate whether preoperative myocardial fibrosis, measured by CMR imaging, may be used to predict the incidence of rhythm disturbances in the early postoperative phase after coronary artery bypass grafting (CABG) surgery. Methods: Two groups of 92 patients who had CABG procedures performed were studied in this retrospective observational single site cohort study: There were 43 patients in Group A who had atrial or ventricular arrhythmia, and 49 patients in Group B who did not. Results: There was no correlation between arrhythmia and non-arrhythmia group and age, sex, body mass index, risk factor, CMR timing before surgery, cross clamp time, bypass time, left ventricular end-diastolic volume index (LV EDVI), LV end-systolic volume index (ESVI), stroke volume index (SVI), LV ejection fraction (EF) and territory of scar and were positive correlation between both groups and scar (P <0.001). Scar% was an independent predictor of occurrence of rhythm disturbance (P=0.002) while LV EDVI, LV EF, LV ESVI, SVI, and presence of scar were not. Group A had a statistically significantly lower LV-EF% and lower LV-SVI compared to Group B. Group A had a higher scar percentage compared with group B and this was statistically significant (P <0.001). Rhythm disturbance occurred more often in patients with a scar percentage >14.8% {P=0.0002 and area under ROC curve (AUC)=0.708}. Conclusions: CMR has evolved as a gold standard non-invasive imaging tool in cardiovascular medicine. Preoperative CMR imaging may be a promising tool for predicting postoperative cardiac arrhythmia after CABG. Our study showed that preoperative myocardial scarring >14.8%, as determined by CMR imaging, was predictive of early postoperative arrhythmia in patients undergoing CABG.

Usefulness and description of the intestinal bypass technique in children with short bowel syndrome: report of a Mexican cohort / Utilidad y descripción de la técnica de puenteo intestinal en niños con síndrome de intestino corto: reporte de una cohorte en México

Abstract Background: Short bowel syndrome (SBS) is one of the most frequent causes of intestinal failure, needing parenteral nutrition to maintain an energy-protein and water-electrolyte balance. At the Hospital Infantil de México Federico Gómez (HIMFG), the formation of two stomas is a technique used for intestinal rehabilitation, where the use of residue through the bypass technique (BT) helps to maintain gastrointestinal functionality, water-electrolyte, and nutritional stability. This study aimed to describe the technique of using intestinal residue through BT as a treatment strategy in intestinal rehabilitation and its effect on the biochemical and nutritional status of pediatric patients with SBS. Methods: An analytical and retrospective cross-sectional study was performed in patients hospitalized at HIMFG with SBS who underwent BT during their hospital stay between 2019 and 2020 and then followed up for 8 weeks. Results: A total of 10 patients were included in this study, with a mean age of 24 months; 50% were female. BT was able to reduce the inflammatory process in the liver caused by the continuous use of parenteral nutrition; enteral caloric intake increased from 25.32 kcal/kg/day to 72.94 kcal/kg/day, but it was insufficient to improve their nutritional status. Conclusions: BT is a safe and effective alternative in intestinal rehabilitation in patients with SBS to stimulate trophism and intestinal functionality, allowing a progression of enteral feeding and a decrease in the hepatic inflammatory process that occurs in these patients with prolonged parenteral nutrition.

Resumen Introducción: El síndrome de intestino corto (SIC) es una de las causas más frecuentes de insuficiencia intestinal que requiere del uso de nutrición parenteral para mantener un balance energético-proteico e hidroelectrolítico. En el Hospital Infantil de México Federico Gómez (HIMFG) la formación de dos estomas es una técnica empleada para la rehabilitación intestinal, donde con el aprovechamiento de residuo mediante la técnica de puenteo (TP) se ayuda a mantener la funcionalidad gastrointestinal, equilibrio hidro-electrolítico y estabilidad nutricional. El objetivo de este estudio fue describir la técnica del aprovechamiento de residuo intestinal mediante TP como estrategia de tratamiento en la rehabilitación intestinal y su efecto en el estado bioquímico y nutricional de pacientes pediátricos con SIC. Métodos: Se llevó a cabo un estudio transversal analítico y retrospectivo en pacientes hospitalizados en el HIMFG con SIC en quienes se realizó la TP durante su estancia intrahospitalaria entre 2019 y 2020. Resultados: Se incluyeron 10 pacientes en este estudio, con una edad promedio de 24 meses, y el 50% de sexo femenino. La TP logró disminuir el proceso inflamatorio hepático ocasionado por el uso continuo de nutrición parenteral; la ingesta calórica por vía enteral incrementó de 25.32 kcal/kg/día a 72.94 kcal/kg/día, pero fue insuficiente para mejorar el estado nutricional. Conclusiones: La TP es una alternativa segura y efectiva en la rehabilitación intestinal en pacientes con SIC para estimular el trofismo y funcionalidad intestinal, permitiendo una progresión de la alimentación enteral y disminución del proceso inflamatorio hepático que se presentan en estos pacientes con nutrición parenteral prolongada.

Assessment of Risk Prediction Using Edmonton Frail Scale and European System for Cardiac Operative Risk Evaluation II among Older Patients Undergoing Coronary Artery Bypass Graft Surgery in a Tertiary Care Hospital in India

Background: The risk assessment for outcomes of older people undergoing cardiac surgery employ scales such as the Euro?Score II, and STS (Society for Thoracic Surgeons), which use clinical and laboratory data. Some studies have suggested a lower accuracy in older patients. Frailty assessment, using functional parameters, has shown promise in this age group. The aim of this study is to compare the validity of risk prediction of Euro?score II, with the Edmonton Frail Scale (EFS), in older patients undergoing elective coronary artery bypass grafting (CABG). Methods: This was a prospective, observational study of a cohort of patients above 60 years scheduled for elective CABG in a single centre. The patients were graded on the Euro?Score II scale and the EFS scales. The primary outcome of 30th day mortality, and the secondary outcome of immediate post?operative complications during hospitalization were recorded. Results: A total of 487 patients were recruited. The mean age was 68 years. Male subjects comprised 81.1% of the study group. Classification of risk as per the EFS placed 76.3 % as low risk, 23.4% as intermediate, and none were considered to be high risk. The EuroScore II classification placed 86% in the intermediate and high risk groups. The AUC in the ROC (receiver operator curve) for the EFS was 0.793 and for the and EuroScoreII it was 0.752. The 30th day mortality threshold fit occurred at 5/6 score for both EuroScore II and EFS. Euroscore? II sensitivity/specificity was 66.7%/75.1% respectively. The EFS had a sensitivity of 66.7% and a specificity of 77.1%. The ROC curves for the secondary outcomes were not significant. Conclusion: Both scales are of modest value in predicting short?term mortality in older patients, and require further refinements for improving clinical decision?making in the individual patient.

Gastric pouch cancer after mini gastric bypass surgery: The first case report

Development of gastric cancer following bariatric surgery is very rare. Nearly all patients with cancer after mini gastric bypass/one anastomosis gastric bypass have carcinoma in their remnant stomach. This is the first case with the development of gastric cancer in the gastric pouch following mini gastric bypass surgery. Our case was a 32?year?old woman who was admitted to our department with oral intolerance 5 years after mini gastric bypass. In her endoscopic examination, an ulcerovegetan mass in the gastric pouch (Siewert type III) was detected. The pathological examination of the biopsies was reported as low differentiated adenocarcinoma. Clinical staging was performed using Positron emission tomographycomputed tomography (PET?CT) and endoscopic ultrasonography (T3N1M0). Following four cycles of neoadjuvant chemotherapy, en?bloc total gastrectomy, D2 lymph node dissection, and partial small intestine resection were performed. In pathological evaluation, no tumors were detected in the specimen and a total of 38 lymph nodes were dissected. This finding was accepted as a pathologic complete response. Signs and symptoms such as anemia, oral intolerance, and vomiting that develop after bariatric surgery can often be attributed to the surgical procedure performed, but it should be kept in mind that similar symptoms may also be associated with malignancy. In case of clinical suspicion, endoscopic examination and cross?sectional imaging should be performed.