One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions.

BACKGROUND: Minimally invasive procedures are demanding in terms of cardioprotection. In many leading centres Bretschneider HTK solution is used for mitral valve surgery. The study was designed to provide comparison of the del Nido and Bretschneider HTK protocol. METHODS: Patients who underwent minimally invasive mitral valve repair for primary mitral regurgitation and received single delivery of either del Nido (Group 1) or Bretschneider HTK cardioplegia (Group 2) were matched on basis of age, gender and length of the cross-clamp time. The groups were compared in terms of major adverse cardiac and cerebrovascular events (death, myocardial infarction, stroke), high sensitivity troponin T (hs-TnT) and creatine kinase- MB isoenzyme (CK-MB) release at 12 h and 24 h following the surgery, incidence of low cardiac output syndrome (LCOS), postoperative arrhythmia, transfusions and postoperative renal function. RESULTS: Case control matching selected 38 pairs of patients. None of patients died, nor suffered from myocardial infarction or stroke. Troponin values did not differ at 12 h (median: 281.0 pg/mL vs 313.0 pg/mL; p = .38) and 24 h (median: 261.0 pg/mL vs 299.0 pg/mL; p = .54), as well as CK-MB at 12 h (median: 25.0 ng/mL vs 29.0 ng/mL; p = .31) and 24 h (median: 11.0 ng/mL versus 9.6 ng/mL; p = .46). Difference in occurrence of LCOS was insignificant (2 vs 7; 5.2% vs 18.4%; p =.15). No difference was shown in incidence of postoperative arrhythmia, transfusions and renal function. CONCLUSIONS: Del Nido cardioplegia can be used safely as an alternative for Bretschneider HTK for minimally invasive mitral valve surgery.

Six-year single-centre experience in minimally invasive mitral valve repair - impact of the team learning curve on in-hospital clinical outcome.

INTRODUCTION: Minimally invasive mitral repair is less traumatic and more acceptable for the patient than traditional surgery. However, it is a challenging procedure that requires effort from all the personnel involved. AIM: To investigate the results of the minimally invasive mitral valve repair learning curve at the institution. MATERIAL AND METHODS: The indication for the surgery was severe mitral regurgitation. Patients with other valvular insufficiency, body mass index (BMI) > 30 kg/m2, ejection fraction (EF) < 45%, aortic dilatation, reoperation, pleural adhesions, coronary artery disease requiring invasive treatment, and pregnant women were disqualified. The patients were assigned to one of three groups regarding their surgery date - group 1 (2012-2013), group 2 (2014-2015) and group 3 (2016-2017). The primary endpoints were death, myocardial infarction, stroke, an reoperation for mitral dysfunction. The investigation was performed to determine preoperative parameters (EuroSCORE, age, sex, BMI, arrhythmias, EF), intraoperative parameters (procedure, cross-clamp, extracorporeal circulation), and postoperative parameters (chest revision, transfusion, drainage, ventilation time, pleurocentesis, hospitalization time). RESULTS: There were 173 patients in total. One patient from group 1 (0.6% overall) died. No myocardial infarction or stroke was observed in any of the three groups. Chest revision count (5 vs. 1 vs. 1; p = 0.0004), total drainage (797.20 vs. 517.92 vs. 449.69; p = 0.0018) and hospitalization time (7.89 vs. 7.18 vs. 6.73; p = 0.0005) were significantly different among the groups. The ventilation time, transfusion number and pleurocentesis count did not differ significantly. CONCLUSIONS: The procedure is safe and ensures optimal perioperative results. The number of complications is low and acceptable.

Surgical removal of entrapped guidewire fragment following direct circumflex artery angioplasty and stenting.

We present a case of a 64-year-old man with coronary artery disease, who underwent a percutaneous coronary intervention of the circumflex artery. As the guidewire was being withdrawn from the target vessel, it became entrapped by the structure of the previously implanted stent. Attempts to retrieve the foreign body were unsuccessful. Changes in electrocardiogram were observed during the procedure, and the level of cardiac biomarkers increased within the next 24-hours. The patient was admitted to the Cardiac Surgery Department. Remnants of the foreign body were removed under visual control using extracorporeal circulation, and coronary artery bypass grafting was performed. Treatment options and outcomes are discussed.

[Results of severe sepsis treatment--two years of experience in a single centre]. / Analiza leczenia chorych z ciezka sepsa w Oddziale Anestezjologii i Intensywnej Terapii Górnoslaskiego Centrum Medycznego.

BACKGROUND: Treatment of severe sepsis (SS) is a major challenge for an ITU, because of the high mortality. The severity of 55 is scored according to the number of organ systems that have failed. We analysed the results of treatment of SS in the ITU of the Upper Silesian Medical Centre, and compared them to previously reported data obtained from other centres. METHODS: Between 2008 and 2009, 45 SS cases were treated. Demographic data, laboratory tests and therapeutic routines were analysed. RESULTS: The overall mortality rate was 58%. There was a positive correlation between mortality, male gender and advanced age. The most common initial sources of infection were the respiratory system and abdominal cavities. Serious metabolic disturbance and central nervous system failure markedly affected prognosis. In 56% of cases, five or more organ systems were affected, DISCUSSION: Survival in SS is related to the number of affected organ systems. All patients were admitted in critical condition requiring respiratory and inotropic support. Despite strict application of the Surviving Sepsis Campaign (SSC) recommendations and a relatively short time from diagnosis to commencement of adequate treatment, the mortality rate was found to be higher than the European average, but comparable to that from the Polish registry. CONCLUSIONS: Advanced age, male gender and intraperitoneal pathology worsened the prognosis in SS. Mortality was directly related to the number of organ systems involved, and the number of coexistent diseases. An interdisciplinary approach during diagnosis and a reduced time to the start of intensive treatment are essential for survival. Ready access to updated databases on SS enables regular reviews of the results of treatment and improvement of algorithms.

Severe fungal infections in intensive therapy.

BACKGROUND: Identification of pathogens in severe fungal infections, by positive cultures, is usually difficult, delays appropriate therapy, and impairs treatment. Despite progress in biologic sciences, the diagnosis of candidiasis still poses a challenge. Early symptoms are not specific, and cultures are usually negative. Molecular methods are rarely used in clinical practice. Common empiric therapy of suspected fungal infection is based on examination, history, and analysis of risk factors. The aim of the study was to analyse fungal infections in ITU and to find factors which may help in their recognition. METHODS: In this retrospective study, the medical histories of ITU patients were analysed. Patients were divided into two groups: I - suspected and II - confirmed, fungal infections. The factors considered were: age, gender, suspected source of fungal infection, co-existing bacterial infection, Candida Score, laboratory tests taken on the day of fungal infection diagnosis (leukocyte count, platelets, and CRP), duration of hospitalisation, declarations of infection from departments, and results of treatment. RESULTS: Statistically significant differences between the groups were found in Candida Scores, duration of hospitalisation and departments of infection. The Candida Scores were higher among those patients in whom infections were already suspected. In this group, the duration of hospitalization was shorter, and infections frequently developed during hospitalisation in the ITU. CONCLUSION: The analysis of infections and Candida Scores helped to initiate prompt antifungal therapy and to reduce the duration of hospitalisation. Infection markers that were routinely used in the ITU were not specific, did not allow identification of patients with fungal infection.

[Reporting on data from cardiopulmonary resuscitation]. / Przydatnosc raportów czynnosci resuscytacyjnych w praktyce klinicznej.

BACKGROUND: In-hospital cardiac arrest is still associated with a high mortality rate, due to late recognition of life-threatening processes such as progressive hypotension, or cerebral ischemia.The aim of the study was to analyse some selected parameters influencing early results of in-hospital cardiopulmonary resuscitation. METHODS: We analysed cardiopulmonary resuscitation reports, prepared following in-hospital cardiac arrests, according to the Utstein templates. In each case, resuscitation was performed according to the recent ERC guidelines. RESULTS: Thirty-eight reports were analysed. 16% of cardiac arrests were caused by defibrillation-susceptible cardiac rhythms, and 84% were non-defibrillation-susceptible. Return of spontaneous circulation was achieved in 45% of cases: in 67% of defibrillation-susceptible cardiac rhythm arrests, and 40% of non-defibrillation-susceptible cardiac rhythm situations. CONCLUSION: The mechanism of cardiac arrest determines the early chance of survival in in-hospital cardiac arrest.

Is manual foot lenght measurement of comparable value to ultrasound femur and humerus measurement in anatomical studies for the assessment of foetal age?

Contemporary anatomical studies require reliable methods for determining foetal age. Menstrual age is often found to be inadequate. A combination of several anatomical features showing age-dependency may result both in exact age approximation and pathology detection. The authors compared the manual foot length measurements with the ultrasound femur and humerus length measurements of aborted foetuses in the calculation of foetal age. The correlation between femur length and foot length as well as humerus length and foot length were statistically significant. The expected value formulae for foot length are presented. The authors conclude that foetal age assessment based on foot length metering is reliable before the 7th calendar month of pregnancy and correlates with ultrasound measurements of the humerus and femur.

Digital analysis of the dynamics of the arterial supply to the human foetal kidneys.

Variations in the renal arteries in human individuals and foetuses have already been well studied. Contemporary trends in visualisation techniques focus on the evaluation of the dynamic parameters of blood flow in the vessels (speed, pulsatility, resistance). Most of these data have been obtained by the means of Doppler ultrasound (Fig. 1, 2). The authors have not found any anatomical database containing information about variability in the volume of the foetal renal arteries. The aim of the study is to design a database for variation in foetal renal artery volume in relation to foetal age and sex. The material consisted of digital images of the renal arteries filled with LBS-latex taken from 30 foetuses aged 12-19 Hbd. Digital analysis of the arteries was made with a unique form of software. The program is a 2D vector graphic editor using spliced functions of Bezier. Foetal age is estimated according to the last menstrual period and measurement of manual foot length and femur length (FL) as determined by ultrasound.

Growth dynamics of the renal and suprarenal arteries in human foetuses.

The kidneys and suprarenal cortex are of common embryonic origin. The suprarenal gland and kidney have a common pathway in angiogenesis. Each of the organs is of key importance for intrauterine and individual development, yet they vary greatly in growth dynamics throughout pregnancy. The authors compared the arterial supply of these organs quantitatively in respect to foetal age and sex.