The intraoperative effect of pentoxifylline on the inflammatory process and leukocytes in cardiac surgery patients undergoing cardiopulmonary bypass

Background: Inflammation plays a pivotal role in the pathogenesis of organ dysfunction after cardiopulmonary bypass (CPB). The aim of this study was to investigate whether pentoxifylline (PTX) has effects on the inflammatory process and leukocytes in cardiac surgery patients undergoing CPB.

Material and methods: A double-blind, prospective, randomized, placebo-controlled study was undertaken to assess the effect of PTX on leukocyte counts, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) levels in 60 patients undergoing CPB for elective coronary artery bypass grafting. In 30 patients, 200 mg of PTX was added to 500 mL NaCl and perfused for 180 min after induction of anaesthesia and also 100 mg of PTX was added to the warm cardioplegic solution; another 30 patients received saline solution as placebo.

Results: All measurements were performed before PTX infusion (T0), after induction of anaesthesia (T1), 30 min after weaning from CPB (T2), and 6 hours (T3) and 24 hours postoperatively (T4). PTX did not change the percentage of eosinophils, basophils, neutrophils, monocytes, or lymphocytes, or CRP levels. In the control group, however, total leukocyte count and IL-6 level at T3 and T4 period were significantly higher than the study group. The progressive increment in TNF-α level observed at each period was also significantly prominent in the control group.

Conclusion: CPB-related whole body inflammatory response could be partially inhibited by intraoperative PTX administration. This effect of PTX would be helpful in preventing the well-known complications of CPB-induced systemic inflammation.

Surgical removal of a knotted and entrapped subclavian hemodialysis catheter guidewire

Many mechanical complications associated with insertion, maintenance, and removal of the hemodialysis catheters have been reported in the literature. A 47-year-old man was consulted to our hospital because of an entrapped hemodialysis catheter guidewire. Computed tomographic scan revealed that the right subclavian vein was perforated by the guidewire and the wire was knotted over itself, one loop inside the vein and two loops in the extravascular site. Guidewire is pulled out from a 3-cm incision over the wire loops lateral to the right sternocleidomastoid muscle. He was discharged home on postoperative day 2 without any complication. Our suggestion is that any abnormal resistance should be immediately evaluated for the presence of any potential knots using the most appropriate imaging technique.

Noninvasive evaluation of coronary artery bypass grafts and native coronary arteries: is 16-slice multidetector CT useful?

PURPOSE

To investigate the diagnostic accuracy and limitations of 16-slice multidetector computed tomography (MDCT) in the detection of significant ( > 50%) stenosis of coronary artery bypass grafts (CABG) and native coronary arteries.

MATERIALS AND METHODS

One hundred two patients with 236 grafts were investigated by 16-slice MDCT. Native coronary arteries were also investigated. The image quality was assessed in terms of artifact, and the evaluable segments were screened for the presence of occlusion and significant ( > 50%) stenosis. MDCT results were compared with conventional coronary angiography.

RESULTS

The evaluability of MDCT was 90.4% for CABG and 71.2% for native coronary arteries. The most frequent causes of nonevaluable segments were motion artifact in venous grafts, metallic clip artifact in arterial grafts, and severe calcification in native coronary arteries. MDCT correctly diagnosed all of the 46 occluded grafts. The sensitivity, specificity, and the positive and negative predictive value of MDCT for the detection of significant CABG stenoses were 91.4%, 98.5%, 84.2%, and 99.2%, respectively. Including nonevaluable segments in the analysis, overall sensitivity was 84.2%. For the evaluation of native coronary arteries, MDCT had a sensitivity of 82.1% and a specificity of 75.3%, but evaluability was only 71.2%, resulting in overall sensitivity of 62.1%.

CONCLUSION

Use of 16-slice MDCT angiography allows very accurate evaluation of CABG patency and has high diagnostic accuracy in detecting graft stenoses. But evaluation of native coronary artery stenosis is limited, particularly in patients with advanced coronary artery disease with severe calcification.