ABSTRACT
The use of Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenator (ECMO) in patients suffering from Sickle cell disease (SCD) needs specific precautions. Whereas, no consensual protocols have been established to clarify therapeutic management. CASE REPORT A 7-year-old boy was admitted to the hospital for surgery of advanced endocarditis. Major dyspnea, hemodynamic distress and fever were noted on physical examination. Biological tests exploring anaemia revealed Haemoglobin (Hb) S levels of 39.1%. Echocardiography showed important right heart cavities dilation with multiple aortic vegetations. The child was accepted for emergent surgery. Ten minutes after anesthetic induction, serious hemodynamic distress was established. The patient was put on normothermic CPB when he received four packed red-blood-cell. After surgery, he was placed on ECMO support for 2 days than he succumbed. CONCLUSION Urgent cardiac surgery in patients suffering from SCD poses a major therapeutic dilemma. Multiplying case reports and encouraging prospective studies are necessary to define the right place of cardio-pulmonary assistance in treatment protocols for better management.
Subject(s)
Anemia, Sickle Cell/therapy , Cardiopulmonary Bypass/methods , Extracorporeal Membrane Oxygenation/methods , Oxygenators, Membrane , Anemia, Sickle Cell/physiopathology , Child , Echocardiography , Fatal Outcome , Humans , MaleSubject(s)
Endocarditis, Bacterial/diagnosis , Staphylococcal Infections/diagnosis , Substance Abuse, Intravenous/complications , Tricuspid Valve/microbiology , Adult , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/surgery , Humans , Male , Staphylococcal Infections/complications , Staphylococcal Infections/surgery , Staphylococcus aureus , Substance Abuse, Intravenous/microbiology , Tricuspid Valve/pathology , Tricuspid Valve/surgerySubject(s)
Aortic Diseases/etiology , Dandy-Walker Syndrome/surgery , Down Syndrome/surgery , Fistula/etiology , Postoperative Hemorrhage/etiology , Tracheal Diseases/etiology , Tracheostomy/adverse effects , Adolescent , Aortic Diseases/diagnosis , Dandy-Walker Syndrome/complications , Down Syndrome/complications , Fatal Outcome , Fistula/diagnosis , Humans , Male , Postoperative Hemorrhage/diagnosis , Tracheal Diseases/diagnosisABSTRACT
BACKGROUND: Coronary artery revascularization with cardiopulmonary bypass has been reported to carry several risks. AIM: Off-pump coronary artery bypass grafting has been proposed to result in a better outcome. The aim of this study is to assess the effect of off-pump cardiopulmonary bypass. METHODS: In a 7-year period, a total of 100 patients undergoing isolated first-time off-pump coronary artery bypass graft were studied. The mean ejection fractions was 48% and the EUROSCORE mean was 4.9. RESULTS: The average number of grafts was 1.55 per patient. The postoperative outcomes were simple for most patients with little use of inotropes after 24 hours (42%), few cases of atrial fibrillation (9.4%), and transfusion (27.3%). Time to extubation was less than 48 hours in most cases (94.7%) and hospital mortality rate was 10.5%. CONCLUSION: The beating heart bypass surgery allows good immediate results including multi-vessel disease and in patients at high risk.
Subject(s)
Coronary Artery Bypass, Off-Pump/statistics & numerical data , Aged , Cardiotonic Agents/therapeutic use , Drug Utilization , Humans , Postoperative ComplicationsABSTRACT
BACKGROUND: Hyperhidrosis is a benin affection representing a social and professional problems and occupational handicaps in young patient. Endoscopic thoracic sympathectomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. AIM: We describe the technique used in our institut and present results METHODS: From 1995 to 2002, 32 patients were operated on for hyperhidrosis. There were 17 mens and 15 women raging in age from 15 to 32 years The intervention consisting on destruction by electrocoagulation to the sympathetic trunk RESULTS: There was no major complication and the mean postoperative hospital stay was 2 days. The disappearance of the palmar sweating was immediately after operation. 7 patients complained of compensatory sweating CONCLUSION: Endoscopic thoracic sympathectomy for hyperhidrosis is a safe effect technique for treating palmar and axillary hyperhidrosis. Compensatry sweeting represent the major that necessite a preable information
