Etiology and characteristics of large symptomatic pericardial effusion in a community hospital in the contemporary era

Hepatic dysfunction and adverse outcomes after total arch repair of acute type a aortic dissection: application of the MELD-XI score

Background

This study was aimed to investigate the incidence and outcomes of patients with postoperative hepatic dysfunction (PHD) after total arch repair of acute type A aortic dissection, and further explore the risk factors for severe adverse outcomes.

Methods

The clinical data of 227 patients with AAAD treated by modified triple-branched stent graft implantation from January 2020 to January 2021 were collected retrospectively. Including preoperative, surgical and postoperative data. Logistics regression was used to determine the independent risk factors of severe adverse outcomes in postoperative HD patients.

Results

In the early stage after operation, a total of 153 patients were complicated with PHD, accounting for 67.4%. The incidence of severe adverse outcomes in patients with PHD was 43.1%. We found that preoperative moderate/severe pericardial effusion [odds ratio (OR): 11.645, 95% confidence interval (CI): 1.144, 143.617, P = 0.045], preoperative imaging data suggest the celiac trunk involvement [OR: 6.136, 95% CI 1.019, 36.930, P = 0.048], CPB time > 180 min [OR: 4.855, 95% CI 1.218, 15.761, P = 0.034], decreased early postoperative serum albumin [OR: 0.935, 95% CI 0.856, 0.985, P = 0.026] were independent risk factors for severe adverse outcomes in patients with PHD.

Conclusions

PHD was associated with increased early mortality and morbidity. Preoperative moderate/severe pericardial effusion, preoperative celiac trunk involvement, cardiopulmonary bypass (CPB) time > 180 min and decreased early postoperative serum albumin were identified as independent risk factors for severe adverse outcomes in patients with PHD.

Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease and hypothyroidism is an organ-specific autoimmune disease. The two diseases may occur successively or simultaneously. The majority of previous studies observed that thyroid disease was more frequent in patients with SLE than in the general population, particularly those who had a higher incidence of anti-thyroid antibodies. However, there are no reported cases of SLE with hypothyroidism as the initial clinical manifestation, to the best of our knowledge. The present study reported on a case of SLE with this unusual initial clinical manifestation and reviewed the literature to estimate the prevalence of clinical hypothyroidism in patients with SLE (range, 3.0-21.4%). The case of the present study had no obvious facial erythema, photosensitivity or recurrent oral ulcers, and only had hypothyroidism as the initial clinical symptom, but the laboratory examination supported the diagnosis of SLE. The present study suggested that in the clinical diagnosis, attention should be paid to screening for connective tissue diseases when diagnosing hypothyroidism, and the importance of thyroid dysfunction should also be recognized in the treatment of SLE.

Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL  ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p = 0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.