Aortabillentyű-beültetés antifoszfolipid szindrómában

Esetismertetés

Egy 44 éves férfi betegnél endokarditisz talaján kialakult súlyos aortabillentyű-elégtelenség tett szükségessé szívsebészeti beavatkozást. A kevesebb mint egy év alatt bekövetkezett többszöri trombotikus esemény felvetette antifoszfolipid szindróma lehetőségét. A lupus antikoaguláns pozitivitás és az említett klinikai kép ezt igazolta.

Megbeszélés

Betegünk fiatal életkora és a biológiai műbillentyű korlátozott élettartama ellenére biológiai műbillentyű beültetése mellett döntöttünk. Választásunkat azzal indokoljuk, hogy tanulmányok bizonyítják antifoszfolipid szindrómás betegeknél a mechanikus műbillentyűvel összefüggésbe hozható thromboembolia viszonylag gyakori előfordulását. A műtétet szövődménymentesen elvégeztük, aktivált parciális thromboplastin idővel kontrollált Na-heparin korai adása mellett állítottuk be az orális antikoaguláns terápiát 3,0 INR célértékkel a műtét utáni ötödik napra. A műtét során eltávolított billentyűből korokozó nem tenyészett ki. A kórszövettani vizsgálat abakteriális endokarditiszt véleményezett, nem kizárva a korábbi fertőzést. Biológiai műbillentyű implantáció után három hónapig ajánlott aszpirin vagy K-vitamin antagonista adása, betegünk esetében viszont élethosszig tartó antikoaguláns kezelés szükséges, tekintettel rendszerbetegségére.

Következtetés

Halmozódó tromboembóliás események kapcsán gondolni kell antifoszfolipid szindrómára, mely igazolása adott esetben meghatározhatja a választható műbillentyű fajtáját. Az ajánlások legtöbbször csak általánosságban fedik le a ritka társbetegségeket, ezért a kapcsolódó szakirodalom áttekintése is szükséges az optimális, betegre szabott döntéshez.

Radiological characterization of clay mixed red mud in particular as regards its leaching features

The reuse of industrial by-products such as red mud is of great importance. In the case of the building material industry the reuse of red mud requires a cautious attitude, since the enhanced radionuclide content of red mud can have an effect on human health. The natural radionuclide content of red mud from the Ajka red mud reservoir and the clay sample from a Hungarian brick factory were determined by gamma spectrometry. It was found that maximum 27.8% red mud content can be added to fulfil the conditions of the EU-BSS. The effect of heat treatment was investigated on a red mud-clay mixture and it was found that in the case of radon and thoron exhalation the applied heat reduced remarkably the exhalation capacities. The leaching features of red mud and different mixtures were studied according to the MSZ-21470-50 Hungarian standard, the British CEN/TS 14429 standard and the Tessier sequential extraction method. The Tessier method and the MSZ-21470-50 standard are suitable for the characterization of materials; however, they do not provide enough information for waste deposition purposes. To this end, we propose using the CEN/TS 14429 method, because it is easy to use, and gives detailed information about the material's behaviour under different pH conditions, however, further measurements are necessary.

Impact of the insulin and glucose content of the postoperative fluid on the outcome after pediatric cardiac surgery

INTRODUCTION

The aim of this study was to investigate the role of the insulin and glucose content of the maintenance fluid in influencing the outcomes of pediatric patients undergoing heart surgery.

METHODS

A total of 2063 consecutive pediatric patients undergoing cardiac surgery were screened between 2003 and 2008. A dextrose and an insulin propensity-matched group were constructed. In the dextrose model, 5% and 10% dextrose maintenance infusions were compared below 20 kg of weight.

RESULTS

A total of 171 and 298 pairs of patients were matched in the insulin and glucose model, respectively. Mortality was lower in the insulin group (12.9% vs. 7%, p = 0.049). The insulin group had longer intensive care unit (ICU) stay [days, 10.9 (5.8-18.4) vs. 13.7 (8.2-21), p = 0.003], hospital stay [days, 19.8 (13.6-26.6) vs. 22.7 (17.6-29.7), p < 0.01], duration of mechanical ventilation [hours, 67 (19-140) vs. 107 (45-176), p = 0.006], and the incidence of severe infections (18.1% vs. 28.7%, p = 0.01) and dialysis (11.7% vs. 24%, p = 0.001) was higher. In the dextrose model, the incidence of pulmonary complications (13.09% vs. 22.5%, p < 0.01), low cardiac output (17.11% vs. 30.9%, p < 0.01), and severe infections (10.07% vs. 20.5%, p < 0.01) was higher, and the duration of the hospital stay [days, 16.4 (13.1-21.6) vs. 18.1 (13.8-24.6), p < 0.01] was longer in the 10% dextrose group.

CONCLUSIONS

Insulin treatment appeared to decrease mortality, and lower glucose content was associated with lower occurrence of adverse events.

Down syndrome and postoperative complications after paediatric cardiac surgery: a propensity-matched analysis

OBJECTIVES

The incidence of congenital heart disease is ~50%, mostly related to endocardial cushion defects. The aim of our study was to investigate the postoperative complications that occur after paediatric cardiac surgery.

METHODS

Our perioperative data were analysed in paediatric patients with Down syndrome undergoing cardiac surgery. We retrospectively analysed the data from 2063 consecutive paediatric patients between January 2003 and December 2008. After excluding the patients who died or had missing data, the analysed database (before propensity matching) contained 129 Down patients and 1667 non-Down patients. After propensity matching, the study population comprised 222 patients and 111 patients had Down syndrome.

RESULTS

Before propensity matching, the occurrences of low output syndrome (21.2 vs 32.6%, P = 0.003), pulmonary complication (14 vs 28.7%, P < 0.001) and severe infection (11.9 vs 22.5%, P = 0.001) were higher in the Down group. Down patients were more likely to have prolonged mechanical ventilation [median (interquartile range) 22 (9-72) h vs 49 (24-117) h, P = 0.007]. The total intensive care unit length of stay [6.9 (4.2-12.4) days vs 8.3 (5.3-13.2) days, P = 0.04] and the total hospital length of stay [17.3 (13.3-23.2) days vs 18.3 (15.1-23.6) days, P = 0.05] of the Down patients were also longer. Mortality was similar in the two groups before (3.58 vs 3.88%, P = 0.86) and after (5.4 vs 4.5%, P = 1.00) propensity matching. After propensity matching, there was no difference in the occurrence of adverse events.

CONCLUSIONS

After propensity matching Down syndrome was not associated with increased mortality or complication rate following congenital cardiac surgery.