WorldWideScience

Sample records for bypass surgery patients

  1. Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Temucin Noyan Ogus

    2010-01-01

    Full Text Available Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

  2. In situ saphenous vein bypass surgery in diabetic patients

    DEFF Research Database (Denmark)

    Jensen, L P; Schroeder, T V; Lorentzen, J E

    1992-01-01

    .005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic......From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry...... this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0...

  3. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  4. Lymphaticovenular bypass surgery for lymphedema management in breast cancer patients.

    Science.gov (United States)

    Chang, D W

    2012-12-01

    Historically, the reported incidence of upper extremity lymphedema in breast cancer survivors who have undergone axillary lymph node dissection has ranged from 9% to 41%. In the past 2 decades, sentinel lymph node biopsy has become popular as a way to minimize the morbidity associated with axillary dissection without compromising the cure rate for breast cancer patients. However, even with sentinel node biopsy, the postoperative incidence of upper limb lymphedema in breast cancer patients remains at 4-10%. Lymphedema occasionally emerges immediately after surgery but most often appears after a latent period. Obesity, postoperative seroma, and radiation therapy have been reported as major risk factors for upper extremity lymphedema, but the etiology of lymphedema is still not fully understood. Common symptoms of upper limb lymphedema are increased volume and weight of the affected limb and increased skin tension. The increased volume of the affected limb not only causes physical impairments in wearing clothes and in dexterity but also affects patients' emotional and mental status. Surgical management of lymphedema can be broadly categorized into physiologic methods and reductive techniques. Physiologic methods such as flap interposition, lymph node transfers, and lymphatic bypass procedures aim to decrease lymphedema by restoring lymphatic drainage. In contrast, reductive techniques such as direct excision or liposuction aim to remove fibrofatty tissue generated as a consequence of sustained lymphatic fluid stasis. Currently, microsurgical variations of lymphatic bypass, in which excess lymph trapped within the lymphedematous limb is redirected into other lymphatic basins or into the venous circulation, have gained popularity.

  5. Gastric bypass surgery

    Science.gov (United States)

    ... Roux-en-Y; Weight-loss surgery - gastric bypass; Obesity surgery - gastric bypass ... bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of ...

  6. Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F;

    2016-01-01

    BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 170 patients were...

  7. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary per

  8. Predicting the Glycemic Response to Gastric Bypass Surgery in Patients With Type 2 Diabetes

    OpenAIRE

    John B Dixon; Chuang, Lee-Ming; Chong, Keong; Chen, Shu-Chun; Lambert, Gavin W; Straznicky, Nora E.; Lambert, Elisabeth A.; Lee, Wei-Jei

    2012-01-01

    OBJECTIVE To find clinically meaningful preoperative predictors of diabetes remission and conversely inadequate glycemic control after gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes after bariatric surgery may help in patient selection. RESEARCH DESIGN AND METHODS Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1 year after gastric bypass. Remission was defi...

  9. Coronary artery bypass surgery in the diabetic patient.

    LENUS (Irish Health Repository)

    Maher, M

    2012-02-03

    Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61 +\\/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months--35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.

  10. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  11. Characteristics of morbidly obese patients before gastric bypass surgery.

    Science.gov (United States)

    de Zwaan, Martina; Mitchell, James E; Howell, L Michael; Monson, Nancy; Swan-Kremeier, Lorraine; Crosby, Ross D; Seim, Harold C

    2003-01-01

    The prevalence of binge eating disorder (BED) was assessed in a sample of 110 morbidly obese presurgery patients by means of self-report (Questionnaire on Eating and Weight Patterns [QEWP]). Subsequently, patients with (n = 19, 17.3%) and without BED (n = 91, 82.7%) were compared on several eating-related and general psychopathological instruments, as well as an obesity-specific health-related quality-of-life measure. Patients with BED exhibited higher scores than non-BED patients on most of the subscales of two questionnaires measuring eating behavior and attitudes towards eating, shape, and weight (Three Factor Eating Questionnaire [TFEQ], Eating Disorders Examination-questionnaire version [EDE-Q4]) with the exception of the respective restraint subscales. The two groups also differed significantly on the disease-specific quality-of-life measure (Impact of Quality of Life Questionnaire-Lite [IWQOL-Lite]). No differences were found for measures of severity of depressive symptoms (Inventory of Depressive Symptoms [IDS]) and impairment of self-esteem (Rosenberg Self-Esteem Questionnaire [RSE]). Our findings replicate the results of other studies comparing patients with and without BED in samples with different degrees of obesity and extend the results to an obesity-specific quality-of-life measure. Further research needs to investigate the short- and long-term impact of presurgery BED on surgery outcome, as well as the impact of surgery on binge eating and eating-related psychopathology.

  12. Awake off-pump coronary artery bypass surgery in 25 patients

    Institute of Scientific and Technical Information of China (English)

    GUO Huiming(郭惠明); Murali Chakravarthy; Vivek Jawali; K Jayaprakash; NV Shivananda

    2003-01-01

    Objectives To test the fea-sibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Results The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotony. There was no mortality. Mean length of stay in the intensive care tnit was 16.2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypassesin conscious patients without endotracheal general an esthesia.

  13. Undiagnosed phaeochromocytoma following infrainguinal bypass surgery

    DEFF Research Database (Denmark)

    Levi, N; Schroeder, T V

    1998-01-01

    We present a rare case of undiagnosed phaeochromocytoma following infrainguinal bypass surgery. The patient, a 59-year-old lady, had a one year history of hypertension following a first femoro-tibial bypass and presented as a cardiorespiratory emergency in the admission room following her...... contralateral femoro-tibial bypass. The patient recovered after some days in intensive care despite a delayed diagnosis....

  14. Your diet after gastric bypass surgery

    Science.gov (United States)

    Gastric bypass surgery - your diet; Obesity - diet after bypass; Weight loss - diet after bypass ... You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed the way your ...

  15. Psychologic distress of patients and their spouses after coronary artery bypass surgery.

    Science.gov (United States)

    Moore, S M

    1994-02-01

    The first 6 weeks of recovery from coronary artery bypass graft surgery is a source of stress for both patients and their spouses. Attempts by patients and spouses to manage the stress associated with this post-hospitalization recovery are associated with alterations in psychologic functioning. This study consisted of a secondary analysis of a larger study evaluating the effects of a homegoing family information intervention. The authors identify and compare the psychologic distress of patients and spouses 6 weeks after coronary artery bypass graft surgery. Patients and spouses were individually interviewed in their homes 6 weeks after surgery. They were asked about their psychologic functioning by using the Profile of Moods States. Results indicated that spouses experienced more psychologic distress than patients at 6 weeks after surgery. Younger spouses reported more anger than older spouses. These results support the need for discharge and home interventions to reduce the psychologic distress of spouses as well as patients. Younger spouses, in particular, may need targeted interventions. Additionally, the effect of gender on measures of psychologic distress needs further exploration.

  16. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... Names Minimally invasive direct coronary artery bypass; MIDCAB; Robot-assisted coronary artery bypass; RACAB; Keyhole heart surgery; ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  17. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    OpenAIRE

    de Feyter, Pim; Heuvel, P.; Unger, Felix; Beyar, R; Lindeboom, Wietze; de Valk, Vincent; Milo, S; Simon, Rudiger; Tyers, Frank; Regensburger, D.; Crean, Peter; Penn, Ian; McGovern, E; Cauwelaert, C.; Serruys, Patrick

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the relative merits of either technique in treatment of unstable angina. Methods and Results- Seven hundred fifty-five patients with stable angina were randomly assigned to coronary stenting (374) or ...

  18. Coronary artery bypass surgery in diabetic patients – risk factors for sternal wound infections

    Directory of Open Access Journals (Sweden)

    Lenz, Kristina

    2016-07-01

    Full Text Available The incidence of sternal wound infections (SWI after coronary artery bypass surgery (CABG as reported worldwide is low. However, it is associated with significant increase of postoperative mortality and treatment costs. The major risk factors discussed are diabetes mellitus and bilateral IMA harvesting of the internal mammary artery. This study analyses data of 590 patients receiving CABG concerning the risk factors for SWI. Sternal wound infections occur significantly more often in diabetic patients, one crucial and significant additional risk factor is obesity.

  19. Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Bougioukas Ioannis

    2010-08-01

    Full Text Available Abstract Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned.

  20. Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review.

    Science.gov (United States)

    Bougioukas, Ioannis; Mikroulis, Dimitrios; Danner, Bernhard; Lawal, Lukman; Eleftheriadis, Savvas; Bougioukas, George; Didilis, Vassilios

    2010-08-26

    Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was referred to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned.

  1. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly Patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Houlind, Kim; Kjeldsen, Bo Juul;

    2012-01-01

    Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially...... in elderly patients....

  2. [The peculiarties of nitric oxide synthesis in patients after coronary bypass surgery].

    Science.gov (United States)

    Bulanova, E L; Drapkina, O M; Kutepov, Iu S; Ivashkin, V T

    2007-01-01

    Nitric oxide (NO) participates in many physiological processes including those taking place in the cardiovascular system. The peculiarities of NO synthesis in patients after coronary bypass surgery were studied. The systems of NO generation responded in different ways. Changes in the levels of end-products of NO metabolism may be used as an additional prognostic criterion of the course of the postoperative period. The study found a direct correlation between the levels of end-products of NO metabolism and left ventricular ejection fraction as well as a reverse correlation between the level of end-products of NO metabolism and atherogenic lipids.

  3. Local anaesthetic toxicity after bilateral thoracic paravertebral block in patients undergoing coronary artery bypass surgery.

    Science.gov (United States)

    Ho, A M-H; Karmakar, M K; Ng, S K; Wan, S; Ng, C S H; Wong, R H L; Chan, S K C; Joynt, G M

    2016-09-01

    We conducted a small pilot observational study of the effects of bilateral thoracic paravertebral block (BTPB) as an adjunct to perioperative analgesia in coronary artery bypass surgery patients. The initial ropivacaine dose prior to induction of general anaesthesia was 3 mg/kg, which was followed at the end of the surgery by infusion of ropivacaine 0.25% 0.1 ml/kg/hour on each side (e.g. total 35 mg/hour for a 70 kg person). The BTPB did not eliminate the need for supplemental opioids after CABG in the eight patients studied. Moreover, in spite of boluses that were within the manufacturer's recommendation for epidural and major nerve blocks, and an infusion rate that was only slightly higher than what appeared to be safe for epidural infusion, potentially toxic total plasma ropivacaine concentrations were common. We also could not exclude the possibility that the high ropivacaine concentrations were contributing to postoperative mental state changes in the postoperative period. Also, one patient developed local anaesthetic toxicity after the bilateral paravertebral dose. As a result, the study was terminated early after four days. The question of whether paravertebral block confers benefits in cardiac surgery remains unanswered. However, we believe that the bolus dosage and the injection rate we used for BTPB were both too high, and caution other clinicians against the use of these doses. Future studies on the use of BTPB in cardiac surgery patients should include reduced ropivacaine doses injected over longer periods.

  4. Clinical outcome of patients with familial hypercholesterolemia and coronary artery disease undergoing partial ileal bypass surgery

    Directory of Open Access Journals (Sweden)

    Jaqueline Scholz Issa

    2000-07-01

    Full Text Available Familial hypercholesterolemia is characterized by high serum levels of total cholesterol and LDL-cholesterol. It may be homozygous or heterozygous. In homozygous patients, LDL-cholesterol levels range from 500 to 1000mg/dL and coronary artery disease is precocious, usually manifesting itself between the 2nd and 3rd decades of life. The diagnosis is often made by the presence of xanthoma tuberosum and tendinous xanthomas that appear between the 1st and 2nd decades of life. The use of high doses of statins or even unusual procedures (apheresis, partial ileal bypass surgery, liver transplantation, gene therapy, or both, is necessary for increasing survival and improving quality of life, because a reduction in cholesterol levels is essential for stabilizing the coronary artery disease and reducing xanthomas. We report our experience with 3 patients with xanthomatous familial hypercholesterolemia and coronary artery disease, who underwent partial ileal bypass surgery. Their follow-up over the years (approximately 8 years showed a mean 30% reduction in total cholesterol, with a significant reduction in the xanthomas and stabilization of the coronary artery disease.

  5. Physiotherapy for patients following coronary artery bypass graft (CABG) surgery: limited uptake of evidence into practice.

    Science.gov (United States)

    Filbay, Stephanie R; Hayes, Kate; Holland, Anne E

    2012-04-01

    The efficacy of physiotherapy techniques used for patients following uncomplicated coronary artery bypass surgery (CABG) is well documented. Previous research showed that some of this evidence was not rapidly adopted into practice by cardiothoracic physiotherapists; however, there has been no recent evaluation of the uptake of evidence. Our aim was to identify current physiotherapy interventions in use for patients following uncomplicated CABG surgery. A survey was sent to senior cardiothoracic physiotherapists from all Australian and New Zealand hospitals that perform CABG surgery. Fifty-four surveys were returned (response rate 88%). The most common treatments used were mobilisation (94% of hospitals), range of motion exercises (79%), deep breathing and/or cough (77%), cardiovascular exercise (42%), and incentive spirometry (40%). Respondents with a bachelor or diploma in physiotherapy were more likely to implement deep breathing exercises or coughing than those who obtained a postgraduate degree (p = 0.045). Respondents perceived personal experience as the most influential factor on postoperative treatment choices. Physiotherapists treating patients following uncomplicated CABG surgery continue to use interventions such as deep breathing exercises that are not supported by best available evidence. Standardised guidelines may be required to better match clinical practice with current literature.

  6. Efficacy of reiki on patients undergoing coronary artery bypass graft surgery.

    Science.gov (United States)

    Sharma, V G; Sanghvi, C; Mehta, Y; Trehan, N

    2000-07-01

    Reiki was administered to 50 patients out of 100 patients with normal left ventricular function scheduled for elective coronary artery bypass grafting. Blood components and inflammatory markers were estimated at various time points. Haemodynamic parameters, psychological analysis, intensive care unit stay,incidence of infection, chest tube drainage and mortality were recorded. Haemodynamic parameters and use of blood components were similar in both groups. Interleukin-6 were significantly lower in the preoperative period in the Reiki group, but showed similar trends in both the groups in the post-operative period. The psychological analysis assessed by World Health Organisation quality of life and General Health Questionnaire revealed that social relationships improve once patient is in his own surroundings and with his own people in both the groups. Psychological domain showed significant difference, six day after surgery in the Reiki group. This study concludes that Reiki is a time consuming process with no significant clinical benefit.

  7. Presurgical Weight Is Associated with Pain, Functional Impairment, and Anxiety among Gastric Bypass Surgery Patients

    Directory of Open Access Journals (Sweden)

    Sharlene Wedin

    2012-01-01

    Full Text Available Chronic pain and obesity are significant public health concerns in the United States associated with significant levels of health-care expenses and lost productivity. Previous research suggests that obesity is a risk factor for chronic pain, mainly due to excessive weight placed on the joints. However, the obesity-pain relationship appears to be complex and reciprocal. Little work to date has focused on the relationship between weight and pain among patients undergoing gastric bypass surgery for weight loss. Patients scheduled to undergo bariatric surgery for weight loss at a large southeastern academic medical center ( completed the Brief Pain Inventory (BPI, the Center for Epidemiological Studies 10-item Depression scale (CESD-10, and the Beck Anxiety Inventory (BAI. Higher presurgical weight was associated with higher pain-on-average ratings, higher functional impairment due to pain across the domains of physical activity, mood, walking ability, relationships, and enjoyment of life. Higher presurgical weight was associated with higher BAI scores, but weight was not related to depression. Findings suggest that bariatric surgery candidates report a moderate amount of pain prior to surgery and that presurgical weight is associated with higher pain, increased functional impairment due to pain, and increased anxiety. Anxiety was found to mediate the relationship between increased weight and pain.

  8. Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

    Directory of Open Access Journals (Sweden)

    Meredith L. Howard

    2016-06-01

    Full Text Available Background:Continuous infusion ketorolac is sometimes utilized for analgesia in postoperative coronary artery bypass graft (CABG patients despite contraindications for use. Limited literature surrounds this topic; therefore, this study was conducted to evaluate the safety of this practice. Methods: This retrospective cohort study evaluated the primary outcome of mortality and secondary outcomes of incidence of bleeding and myocardial infarction (MI. All patients who underwent isolated CABG surgeries and received continuous infusion ketorolac during the study period were included. An equal number of randomly selected isolated CABG patients served as control patients. Electronic medical records and the Society of Thoracic Surgeons (STS database were utilized to determine baseline characteristics and outcomes; Results: One hundred and seventy-eight patients met inclusion; 89 in each group. More patients in the control group underwent on-pump surgeries (78.6% vs. 29.2%, p = 0.01 and had higher STS risk scores (1.1% vs. 0.6%, p = 0.003. There was no difference in mortality between the ketorolac group and control group (2.2% vs. 3.3%, p = 0.605. Additionally, no patients experienced a MI and there was no difference in bleeding incidence (5.5% vs. 6.7%, p = 0.58; Conclusions: No association was found between continuous infusion ketorolac and increased risk of mortality, MI, or bleeding events in postoperative CABG patients. Considerations to differences in baseline characteristics must be made when interpreting results.

  9. Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, R.R.; Sawada, A.Y.; Fukuda, M.J.; Neves, F.H.; Carmona, M.J.; Auler, J.O.; Malbouisson, L.M.S., E-mail: malbouisson@hcnet.usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Pelosi, P. [Universita' degli Studi dell' Insubria, Varese (Italy). Dipt. Ambiente, Salute e Sicurezza; Rouby, J.-J. [University Pierre and Marie Curie, Paris (France). La Pitie Salpetriere Hospital. Dept. of Anesthesiology and Critical Care and Medicine

    2011-06-15

    Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated postoperative pulmonary alterations and their impact on blood oxygenation. Eighteen non-hypoxemic patients (15 men and 3 women) with normal cardiac function scheduled for CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at admission to the intensive care unit, and 12, 24, and 48 h after surgery. Pre- and postoperative volumetric thoracic CT scans were acquired under apnea conditions after a spontaneous expiration. Data were analyzed by the paired Student t-test and one-way repeated measures analysis of variance. Mean age was 63 {+-} 9 years. The PaO{sub 2}/FiO{sub 2} ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially improving 12 h after surgery. Compared to preoperative CT, there was a 31% postoperative reduction in pulmonary gas volume (P < 0.001) while tissue volume increased by 19% (P < 0.001). Non-aerated lung increased by 253 {+-} 97 g (P < 0.001), from 3 to 27%, after surgery and poorly aerated lung by 72 {+-} 68 g (P < 0.001), from 24 to 27%, while normally aerated lung was reduced by 147 {+-} 119 g (P < 0.001), from 72 to 46%. No correlations (Pearson) were observed between PaO{sub 2}/FiO{sub 2} ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. The data show that lung structure is profoundly modified after CABG with CPB. Taken together, multiple changes occurring in the lungs contribute to postoperative hypoxemia rather than atelectasis alone. (author)

  10. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian

    2007-01-01

    Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have addit...

  11. Bypass materials in vascular surgery

    Science.gov (United States)

    Eidt, Daniela; Roll, Stephanie; Kulp, Werner; Müller-Nordhorn, Jaqueline; Vauth, Christoph; Greiner, Wolfgang; Willich, Stefan N.; von der Schulenburg, Johann-Matthias

    2006-01-01

    a manual search. The for-mer included the following electronic resources: SOMED (SM78), Cochrane Library - Central (CCTR93), MEDLINE Alert (ME0A), MEDLINE (ME95), CATFILEplus (CATLINE) (CA66), ETHMED (ED93), GeroLit (GE79), HECLINET (HN69), AMED (CB85), CAB Abstracts (CV72), GLOBAL Health (AZ72), IPA (IA70), El-sevier BIOBASE (EB94), BIOSIS Previews (BA93), EMBASE (EM95), EMBASE Alert (EA08), SciSearch (IS90), Cochrane Library - CDSR (CDSR93), NHS-CRD-DARE (CDAR94), NHS-CRD-HTA (INAHTA), and NHS-EED (NHSEED). The present report included German and English literature published between the years 1999 and 2004. A list of the search parameters can be found in the appendix. No limits were placed on the target population, and the methodical quality of the included studies was determined using standardised checklists. Results The studies included in this health technology assessment compared the following bypass materials: autologous vein, human umbilical vein (HUV) and synthetic materials such as PTFE or Dacron®. Both the systematic reviews and the randomised controlled trials comparing autologous vein grafts to other bypass materials come to the conclusion that autologous vein is superior to all other materials. From a medical viewpoint, there are no clear differences between the various synthetic materials. To date, the subject of bypass materials in vascular surgery has not been addressed comprehensively from an economic point of view. Indeed, we were able to identify only one publication that compared the cost of various bypass materials. The remaining health economic studies did not compare costs, cost effectiveness, or quality of life associated with the use of various bypass materials. Discussion When deciding which bypass material to use, vascular surgeons take a number of medical considerations into account, including the bypass area, the availability of autologous vein, the amount of operation time available, and the health status of the patient. The studies

  12. Impairment of neuropsychological function in patients with hemodynamic cerebral ischemia and efficacy of bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sasoh, Masayuki [Iwate Medical Univ., Morioka (Japan). School of Medicine

    1999-08-01

    In order to evaluate the relation between neuropsychological functions and hemodynamic cerebral ischemia, the author analyzed neuropsychological examination and the cerebral blood flow and metabolism of patients before and after bypass surgery. Twenty-five patients were defined by clinical and laboratory criteria as suffering from hemodynamic cerebral ischemia. All patients had one or more episodes of focal cerebral ischemia due to unilateral internal carotid or middle cerebral artery occlusion. Computerized tomography scans either were normal or showed evidence of watershed infarction. Based on these criteria, superficial temporal artery-proximal middle cerebral artery anastomosis was performed. The baseline cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO{sub 2}) and cerebrovascular reserve capacity (CVRC) were studied using positron emission computerized tomography (PET) and the acetazolamide test. Neuropsychological evaluations including Hasegawa Dementia Scale-Revised, Mini-Mental State and Wechsler Adult Intelligence Scale-Revised (WAIS-R), and PET study were completed one month after the last ischemic event and 3-6 months after the operation. A significant negative correlation was observed between OEF and neuropsychological functions. Postoperative neuropsychological functions showed significant improvement. Significant correlations were observed for {delta}WAIS-R (preoperative WAIS-R postoperative WAIS-R) versus preoperative CMRO{sub 2} (r=0.52), for {delta}WAIS-R versus preoperative OEF (r=0.47). In view of these findings, the author concludes that elevation of OEF impairs neuropsychological functions and bypass surgery improves neuropsychological functions in patients with normal CMRO{sub 2} and elevated OEF. (author)

  13. Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery

    Science.gov (United States)

    do Egito, Julyana Galvão Tabosa; Abboud, Cely Saad; de Oliveira, Aline Pâmela Vieira; Máximo, Carlos Alberto Gonçalves; Montenegro, Carolina Moreira; Amato, Vivian Lerner; Bammann, Roberto; Farsky, Pedro Silvio

    2013-01-01

    ABSTRACT Objective: To evaluate the use of hyperbaric oxygen therapy as an adjunctive treatment in mediastinitis after coronary artery bypass surgery. Methods: This is a retrospective descriptive study, performed between October 2010 and February 2012. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite antibiotic therapy. Results: We identified 18 patients with mediastinitis during the study period. Thirty three microorganisms were isolated, and polymicrobial infection was present in 11 cases. Enterobacteriaceae were the most prevalent pathogens and six were multi-resistant agents. There was only 1 hospital death, 7 months after the oxygen therapy caused by sepsis, unrelated to hyperbaric oxygen therapy. This treatment was well-tolerated. Conclusion: The initial data showed favorable clinical outcomes. PMID:24136762

  14. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery.

    Science.gov (United States)

    Carmona, M J C; Malbouisson, L M S; Pereira, V A; Bertoline, M A; Omosako, C E K; Le Bihan, K B; Auler Jr, J O C; Santos, S R C J

    2005-05-01

    The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 +/- 8 years, mean weight 75.4 +/- 11.9 kg and mean body surface area 1.83 +/- 0.19 m(2)), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P < 0.01) and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3) to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05), while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6) vs 10.7 ml min(-1) kg(-1) (95% CI = 7.7-26.6; NS) after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

  15. Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Carmona M.J.C.

    2005-01-01

    Full Text Available The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB, resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body surface area 1.83 ± 0.19 m², receiving propranolol before surgery (80-240 mg a day and postoperatively (10 mg a day. Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9 to 10.6 h (95% CI = 8.2-14.7; P < 0.01 and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3 to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05, while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6 vs 10.7 ml min-1 kg-1 (95% CI = 7.7-26.6; NS after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

  16. A Numerical Multiscale Framework for Modeling Patient-Specific Coronary Artery Bypass Surgeries

    Science.gov (United States)

    Ramachandra, Abhay B.; Kahn, Andrew; Marsden, Alison

    2014-11-01

    Coronary artery bypass graft (CABG) surgery is performed to revascularize diseased coronary arteries, using arterial, venous or synthetic grafts. Vein grafts, used in more than 70% of procedures, have failure rates as high as 50% in less than 10 years. Hemodynamics is known to play a key role in the mechano-biological response of vein grafts, but current non-invasive imaging techniques cannot fully characterize the hemodynamic and biomechanical environment. We numerically compute hemodynamics and wall mechanics in patient-specific 3D CABG geometries using stabilized finite element methods. The 3D patient-specific domain is coupled to a 0D lumped parameter circulatory model and parameters are tuned to match patient-specific blood pressures, stroke volumes, heart rates and heuristic flow-split values. We quantify differences in hemodynamics between arterial and venous grafts and discuss possible correlations to graft failure. Extension to a deformable wall approximation will also be discussed. The quantification of wall mechanics and hemodynamics is a necessary step towards coupling continuum models in solid and fluid mechanics with the cellular and sub-cellular responses of grafts, which in turn, should lead to a more accurate prediction of the long term outcome of CABG surgeries, including predictions of growth and remodeling.

  17. Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension

    Directory of Open Access Journals (Sweden)

    Kumar Bhupesh

    2011-01-01

    Full Text Available Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

  18. Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, Alfredo E., E-mail: arodriguez@centroceci.com.ar

    2014-11-15

    Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

  19. Triage for coronary artery bypass graft surgery in Canada: Do patients agree on who should come first?

    Directory of Open Access Journals (Sweden)

    Chong Alice

    2007-07-01

    Full Text Available Abstract Background The extent to which clinical and non-clinical factors impact on the waiting-list prioritization preferences of patients in the queue is unknown. Using a series of hypothetical scenarios, the objective of this study was to examine the extent to which clinical and non-clinical factors impacted on how patients would prioritize others relative to themselves in the coronary artery bypass surgical queue. Methods Ninety-one consecutive eligible patients awaiting coronary artery bypass grafting surgery at Sunnybrook Health Sciences Centre (median waiting-time duration prior to survey of 8 weeks were given a self-administered survey consisting of nine scenarios in which clinical and non-clinical characteristic profiles of hypothetical patients (also awaiting coronary artery bypass surgery were varied. For each scenario, patients were asked where in the queue such hypothetical patients should be placed relative to themselves. Results The eligible response rate was 65% (59/91. Most respondents put themselves marginally ahead of a hypothetical patient with identical clinical and non-clinical characteristics as themselves. There was a strong tendency for respondents to place patients of higher clinical acuity ahead of themselves in the queue (P Conclusion While patient perceptions generally reaffirmed a bypass surgical triage process based on principals of equity and clinical acuity, the valuation of social independence may justify further debate with regard to the inclusion of non-clinical factors in waiting-list prioritization management systems in Canada, as elsewhere.

  20. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients.

    Science.gov (United States)

    Lakhani, Shilen V; Shah, Hiral N; Alexander, Kenneth; Finelli, Frederick C; Kirkpatrick, John R; Koch, Timothy R

    2008-05-01

    It has been proposed that thiamine deficiency after gastric bypass surgery in obese patients results from prolonged nausea and emesis. We hypothesized that thiamine deficiency is induced by altered gut ecology. This report includes 2 retrospective studies of obese patients who underwent Roux-en-Y gastric bypass surgery at our institution from 1999 to 2005. In the first study, 80 patients (52 women and 28 men) had measurement of whole-blood thiamine diphosphate level and serum folate level. In these 80 patients, 39 (49%) had thiamine diphosphate levels less than the lower limit of the reference range, and 28 (72%) of the 39 had folate levels higher than the upper limit of the reference range, an indicator of small intestinal bacterial overgrowth. In 41 patients with normal thiamine levels, only 14 (34%) had folate levels higher than the upper limit of the reference range (chi(2) test, P thiamine diphosphate levels less than the lower limit of the reference range and abnormal glucose-hydrogen breath tests, consistent with small intestinal bacterial overgrowth. Fifteen patients received oral thiamine supplements, but repeated thiamine levels remained low in all 15. Nine of these patients then received oral antibiotic therapy; repeated thiamine levels were found to be normal in all 9 patients. These results support the hypothesis that small intestinal bacterial overgrowth results from altered gut ecology and induces thiamine deficiency after gastric bypass surgery in obese patients.

  1. The Effects of Regular Physical Activity at Home on Patients' Quality of Life after Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Zeinab Amirian

    2013-04-01

    Full Text Available Introduction: Chronic diseases such as heart diseases have adverse effects on the physical, psychological, social performance, and overall quality of life of patients. This study aimed to determine the effect of regular physical activity at home on the quality of life in patients undergoing coronary artery bypass surgery. Methods: This Quasi-experimental study was carried out on patients who had undergone coronary artery bypass surgeries. 58 patients from Urmia Syedolshoheda hospital were selected randomly and then allocated into two intervention and control groups randomly. Data collected with using MacNew quality of life questionnaire. Patients in intervention group were trained with combined exercises at least three times a week and performed this exercises for 12 week at home. Data were analyzed using Chi-sqaure, Mann-Whitney and Wilcoxon testes. Results: Findings of the study showed promotion in quality of life domains in physical, emotional and social after performance of regular physical activity at home in intervention group (P=0.001. A significant difference was observed between patients quality of life after regular physical activity in intervention and the control groups (P=0.001. Conclusion: Regular physical activity at home has important effects on patients' promotion of quality of life after coronary artery bypass surgeries. Therefore, it is suggested that after CABG patients be trained with regular physical activity at home.

  2. Heart bypass surgery - discharge

    Science.gov (United States)

    ... Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. Philadelphia, PA: Elsevier ... Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 20th ed. Philadelphia, PA: Elsevier; ...

  3. Coronary angioplasty in patients 75 years and older; comparison with coronary bypass surgery.

    Science.gov (United States)

    Metzger, J P; Tabone, X; Georges, J L; Gueniche, C; Detienne, J P; Le Feuvre, C; Vacheron, A

    1994-02-01

    From November 1988 to May 1992, 108 patients (79 men, 29 women) 75 years or older (mean 78 +/- 3, range 75-90 years) underwent coronary angioplasty (group I: n = 62) or coronary bypass surgery (group II: n = 46). Group II patients were younger (76 +/- 2 vs 79 +/- 4, P = 0.002) and had a higher proportion of multivessel disease. The two groups were comparable with regard to the presence of unstable angina, left ventricular ejection fraction and Q wave infarction. In-hospital mortality was similar in the two groups (6.4% vs 4.3%). Complete revascularization (72% vs 47%, P < 0.05) and left anterior descending artery revascularization (100% vs 45%, P < 0.01) were more frequent in group II. Two-year infarction-free survival was similar (group I: 76 +/- 6%; group II: 79 +/- 6%) but recurrent class III or IV angina (36% vs 9%, P < 0.05) and repeat procedures (26% vs 0%, P < 0.05) were more frequent in group I.

  4. Lower leg electrical impedance after distal bypass surgery

    DEFF Research Database (Denmark)

    Belanger, G K; Bolbjerg, M L; Heegaard, N H;

    1998-01-01

    Electrical impedance was determined in 13 patients following distal bypass surgery to evaluate lower leg oedema as reflected by its circumference. Tissue injury was assessed by the plasma concentration of muscle enzymes. After surgery, the volume of the control lower leg increased from 1250 (816...... to be a useful method for the evaluation of lower leg oedema after distal bypass surgery....

  5. Effect of Cryotherapy on the severity of Thoracic Pain in Patients Undergoing Coronary Artery Bypass Grafting (CABG Surgery

    Directory of Open Access Journals (Sweden)

    Pishkar Mofrad Zahra

    2016-06-01

    Full Text Available Background and Objective: Patients experience severs pain after cardiac surgery due to incision of anatomical components of the chest wall. Given that the cryotherapy is one of the simplest and cheapest non-pharmacological methods of pain relief, the current study was conducted to determine the effect of cryotherapy on the severity of thoracic pain in patients undergoing coronary artery bypass grafting surgery. Materials and Method: This clinical trial study was conducted on 50 patients undergoing coronary artery bypass grafting surgery in one of the educational hospitals in Zahedan in 2015. Patients were selected conveniently and then were randomly allocated into two intervention and control groups (each group containing 25 patients. At first, pain of patients was measured in two groups after three cycles of deep breathing and coughing by using visual analogue scale. In intervention group, ice pack was used on the chest wound dressing of patients for 20 minutes alternatively at 5 minutes intervals in intervention group. Then, both groups received emotional support for 15 minutes and the pain score was measured again. Data were analyzed using Chi-square, independent t-test, Paired t-test, and analysis of covariance tests in SPSS 21. Results: The mean pain score before the intervention in the intervention and control groups were 60.16±13.45 and 58.64 ± 14.42, respectively. These values were changed after cryotherapy to 45.16 ± 15.25 in the intervention group and 58.60 ± 14.40 in the intervention group (P < 0.001. Conclusion: The use of cryotherapy can reduce severity of Thoracic Pain related to coughing and deep breathing in patients undergoing coronary artery bypass grafting surgery. Therefore, this method can be used as a non-pharmacological method of pain relief.

  6. Severe symptomatic hypocalcemia following total thyroidectomy in a patient with a history of Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Gross, Justin A; Olsen, Steven M; Koch, Cody A; Moore, Eric J

    2014-01-01

    Patients who undergo a Roux-en-Y gastric bypass (RYGB) procedure are at moderate risk for calcium and vitamin D deficiency. Those who subsequently undergo thyroid or parathyroid surgery are at high risk for developing severe symptomatic hypocalcemia if they are not monitored and adequately treated prophylactically. We describe the case of a morbidly obese 40-year-old man who had undergone RYGB surgery 6 months prior to the discovery of metastatic papillary thyroid carcinoma. He subsequently underwent total thyroidectomy with central and bilateral neck dissection. Following surgery, he developed severe symptomatic hypocalcemia, as his calcium level fell to a nadir of 6.0 mg/dl. He required aggressive oral and intravenous repletion therapy with calcium, vitamin D, and magnesium for 10 days before hospital discharge. Providers should institute careful preoperative screening, patient counseling, and prophylactic calcium and vitamin D therapy for all thyroid surgery patients who have previously undergone RYGB surgery to prevent the development of severe and life-threatening hypocalcemia. Only a few reports of patients have been published on the dangers of thyroid and parathyroid surgery in patients who have undergone bariatric surgery. We report a new case to add to the body of literature on this patient population. We also review calcium homeostasis and supplementation as they relate to this situation.

  7. The quantitative and qualitative responses of platelets in pediatric patients undergoing cardiopulmonary bypass surgery.

    Science.gov (United States)

    Ignjatovic, Vera; Than, Jenny; Summerhayes, Robyn; Newall, Fiona; Horton, Steve; Cochrane, Andrew; Monagle, Paul

    2012-01-01

    This prospective, single-center study aimed to evaluate the platelet response during cardiopulmonary bypass (CPB) surgery in a large cohort of children up to 6 years of age. Blood samples were drawn at four time points: after induction of anesthesia, after initiation of the CPB, before protamine, and immediately after chest closure. The study recruited 60 children requiring CPB for surgical repair of congenital heart defects. The platelet count decreased throughout CPB surgery, but during the same period, platelet activity increased. The more pronounced decrease in platelet count observed in children younger than 1 year compared with that of children 1 to 6 years of age was not associated with an age-specific change in platelet activity. The overall increase in platelet function observed in this study could provide a mechanism that compensates for the decrease in platelet count. This study provides a new foundation for future studies investigating requirements of platelet supplementation in the setting of pediatric CPB surgery.

  8. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  9. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Sambhunath Das

    2015-01-01

    Full Text Available Background: Postoperative cognitive decline (POCD after coronary artery bypass grafting (CABG is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07, digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09 and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008, digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008 and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02. The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

  10. Atypical complications of gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, Myrosia T. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States)]. E-mail: mmitchell@radiology.bsd.uchicago.edu; Pizzitola, Victor J. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Knuttinen, M-Grace [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Robinson, Tiffany [University of Chicago, Department of Internal Medicine, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Gasparaitis, Arunas E. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States)

    2005-03-01

    Although gastric bypass surgery continues to grow in popularity for weight loss and weight maintenance in the morbidly obese, there has been little attention given to the imaging of complications associated with these surgeries. The purpose of our study is to demonstrate the variety of gastric bypass surgery complications that can be identified radiographically, with attention to the more unusual complications. This study was performed with institutional Internal Review Board approval. We performed a 5-year retrospective review of all patients who had undergone gastric bypass surgery, had complications of the surgery, and had studies performed in our department to image these complications. These studies consisted of contrast fluoroscopy and CT. We identified the more common complications of anastomotic stenoses and anastomotic leaks. We also identified six unusual complications as follow: (1) internal herniation through the small bowel mesentery, (2) internal herniation through the transverse mesocolon, (3) external herniation through the abdominal wall incision, (4) enterocutaneous fistulas, (5) antiperistaltic construction of the Roux-en-Y, and (6) incorrect anstomoses of the Roux limbs resulting in a Roux-en-O configuration. Our findings show that a thorough understanding of expected postoperative bowel configuration is essential in the evaluation of these patients. In addition, fluoroscopic evaluation should assess not only anatomy, but also motility.

  11. Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Rong LIU; Youbin DENG; Xiaojun BI; Yani LIU; Li XIONG; Liuping CHEN

    2009-01-01

    The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echo-cardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months af-ter coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu-dinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs (-10.45±8.31)%, P0.05]. It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of re-gional systolic function. The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

  12. Effect of Modified Roux-en-Y Gastric Bypass Surgery on GLP-1, GIP in Patients with Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Shao-Wei Xiong

    2015-01-01

    Full Text Available The type 2 diabetes mellitus (T2DM is one of the most serious diseases that threaten public health. Modified gastric bypass surgery has been applied to the treatment of T2DM patients in the 1990s, but the therapeutic mechanism to this function is still unclear. The aim of this study was to further clarify the effect and the mechanism of modified gastric bypass surgery on glucose metabolism in patients with T2DM. In the study, the incretin indexes and blood glucose indexes were analyzed before surgery and 1 week and 1, 3, and 6 months after surgery. The results suggested that modified Roux-en-Y gastric bypass can promote GLP-1 secretion in patients with T2DM, while reducing the secretion of GIP. Thus it could effectively control blood glucose of patients with T2DM.

  13. Quality of life-associated factors among patients undergoing coronary artery bypass surgery as measured using the WHOQOL-BREF.

    Science.gov (United States)

    Najafi, Mahdi; Sheikhvatan, Mehrdad; Montazeri, Ali

    2009-01-01

    This was a study of the pre-operative factors that influence quality of life (QoL) in patients with coronary artery disease and the relationship between pre-operative QoL and early outcome after coronary artery bypass surgery (CABG). Using the WHOQOL-BREF questionnaire, 283 patients who underwent isolated coronary artery bypass surgery were interviewed and scores were obtained for the physical, psychological, social and environmental components. The study found that the independent physical component predictors for higher QoL included male gender and diabetes mellitus, while the independent psychological component predictors were male gender and high ejection fraction. Males, diabetics and patients with low education levels had higher social well-being than others. Among the postoperative complications, only respiratory failure was found to have a relationship with physical and psychological components. Women with coronary artery disease who were candidates for CABG had lower scores than the men in respect of all components of QoL. Furthermore, a lower pre-operative psychological score in patients undergoing CABG can influence postoperative complications, especially respiratory failure.

  14. Depression, C-reactive protein and length of post-operative hospital stay in coronary artery bypass graft surgery patients.

    Science.gov (United States)

    Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Ronaldson, Amy; Jahangiri, Marjan; Steptoe, Andrew

    2014-03-01

    This study aimed to explore the role of C-reactive protein (CRP) in mediating the association between greater pre-operative depression symptoms and longer post-operative length of stay in patients undergoing coronary artery bypass graft (CABG) surgery. We used a sample of 145 elective CABG patients and measured depression symptoms using the Beck Depression Inventory (BDI) prior to surgery and collected baseline measures of CRP. Participants were followed up during their in-hospital stay to measure early (1-3 days post-surgery) and persistent (4-8 days post-surgery) CRP responses to surgery. We found that compared with participants with low depression symptoms, those with elevated depression symptoms (BDI>10) prior to CABG were at increased odds of a hospital stay of greater than one week (OR 3.51, 95% CI 1.415-8.693, p=0.007) and that greater persistent CRP responses mediated this association. Further work is needed to explore the exact physiological pathways through which depression and CRP interact to affect recovery in CABG patients.

  15. Haemodynamics during maximal exercise after coronary bypass surgery

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M.F. Rousseau (Francois); J. Cosyns; R. Ponlot; L.A. Brasseur; J-M.R. Detry (Jean-Marie)

    1978-01-01

    textabstractFifty patients underwent an objective measurement of physical working capacity by means of a multistage test of maximally tolerated exertion before and after coronary bypass surgery; 29 patients also had haemodynamic measurements during maximal exercise before and after coronary bypass s

  16. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery

    NARCIS (Netherlands)

    Rouleau, Jean L.; Warnica, Wayne J.; Baillot, Richard; Block, Pierre J.; Chocron, Sidney; Johnstone, David; Myers, Martin G.; Calciu, Cristina-Dana; Dalle-Ave, Sonia; Martineau, Pierre; Mormont, Christine; van Gilst, Wiek H.

    2008-01-01

    Background-Early after coronary artery bypass surgery (CABG), activation of numerous neurohumoral and endogenous vasodilator systems occurs that could be influenced favorably by angiotensin-converting enzyme inhibitors. Methods and Results-The Ischemia Management with Accupril post -bypass Graft via

  17. Previous gastric bypass surgery complicating total thyroidectomy.

    Science.gov (United States)

    Alfonso, Bianca; Jacobson, Adam S; Alon, Eran E; Via, Michael A

    2015-03-01

    Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

  18. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

    DEFF Research Database (Denmark)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard;

    2009-01-01

    BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross-clampin...

  19. Bariatric bypasses contribute to loss of bone mineral density but reduce axial back pain in morbidly obese patients considering spine surgery

    Science.gov (United States)

    Epstein, Nancy E.

    2017-01-01

    Background: Many spine surgeons recommend stringent weight loss, including bariatric bypass procedures, prior to “elective” spine surgery (should not be for axial back pain alone) in morbidly obese patients (defined by a body mass index (BMI) of >40 mg/kg2 or >35 mg/kg2 with two or more major comorbidities) to reduce their greater risk for major perioperative complications. Although bypasses typically lead to marked weight reduction and even reduced axial back pain, they also promote unrecognized and often insufficiently treated vitamin D deficiency and loss of bone mineral density. Methods: Morbidly obese patients who are under consideration for “elective” spine operations (other than for back pain alone) are often told to lose weight. Some choose to undergo bariatric bypass procedures, but are unaware of the potential risks/complications of these procedures. Results: Within the first 2 years following most bariatric bypass procedures, patients experience not only marked loss of weight and muscle mass, but also significant vitamin D deficiency and loss of bone mineral density, increasing their susceptibility to fractures. Nevertheless, some patients also experience a sufficient reduction of axial back pain to avoid spinal surgery. Conclusions: Morbidly obese patients under consideration for “elective” spine surgery may undergo bariatric bypass procedures that lead to a significant reduction of vitamin D levels and loss of bone mineral density. However, potential benefits may include a sufficient reduction of axial back pain to avoid surgery in a select subset of patients altogether. PMID:28217392

  20. The Effect of Aromatherapy with Lavender Essential Oil on Anxiety and Stress in Patients Undergoing Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Rajai

    2016-09-01

    Full Text Available Background Depression and anxiety are among the most common mental disorders before and after surgery. Aromatherapy is a treatment that has grown substantially in recent years in comparison with other complementary and alternative medicines (CAM to relieve anxiety. Objectives This study investigated the effect of inhaling lavender essence on the physiological and psychological status of patients who are candidates for coronary artery bypass graft (CABG surgery. Methods This randomized clinical trial was performed on 60 patients who were undergoing CABG surgery at the hospitals of Artesh Jomhory Eslami (AJA University of Medical Sciences in Iran. Patients who met specific inclusion criteria were selected and randomly allocated into two groups: a control group that inhaled room air and an experimental group that inhaled from a piece of cotton impregnated with two drops of lavender essence. This intervention was done on the morning of surgery. To evaluate these measures, a Depression Anxiety Stress Scale (DASS questionnaire was filled out by the patient before and after the intervention. The data collected were analyzed using descriptive and analytic statistics. Results After the intervention, the study results showed statistically significant differences between the two study groups in heart rate (mean = 78.83, P = 0.02 and anxiety level (mean = 6.63, P = 0.02. However, the differences between the two groups were not significant regarding stress level (mean = 8.63, P = 0.55 and other physiological variables. Conclusions Inhalation aromatherapy is an effective method for reducing the heart rate and the level of anxiety in patients before CABG surgery. Given that the physiological and psychological health of patients are important responsibilities for nurses, aromatherapy can be considered a safe and effective relaxation method before invasive interventions. Learning this method is recommended for students and nurses.

  1. The Effects of Open Heart Surgery (Coronary Bypass on Depression and Social Adjustment of Hospitalized Heart Patients

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    Farah Naderi

    2009-01-01

    Full Text Available Problem statement: Post treatment preparation is critical period, as patients may have difficulties with psychosocial adjustment, especially related to dissatisfaction with side effects of medicine taking therapy and a lack of socialization skills/social competence. Different psychological issues arise for patients depending upon where they are in the medical treatment process. Approach: The current research was processed with the intention of examining and presenting the effects of open heart surgery (coronary bypass on male and female hospitalized heart patients' depression and social adjustment in Tehran Shahid Modarress Hospital; regarding age, sex, employment and marital status The research sample particularized 118 patients (42 female and 76 male whom were selected by simple random sampling procedure. To obtain data, Beck Depression Inventory (BDI and Social Adjustment Scale Self-Report (SAS-SR were implemented a couple weeks before and after surgery procedure as pretest and post test with one group. The research design was quasi-experimental. Results: Results were considered significant at p value less than to equal to 0.0001 (p≤0.0001 and revealed that: Heart surgery decreased social adjustment but had no significant impact on heart inpatients' depression. Conclusion: After treatment, it was common for patients to exhibit behavior problems, depression, poor social adaptation and/or noncompliance with the medical regimen. The psychosocial adaptation of surgery procedure can be promoted through support and counseling by one or all members of the surgery team caring for the patients and their families. This process must start during the first visit to the treatment center.

  2. Clinical effectiveness of centrifugal pump to produce pulsatile flow during cardiopulmonary bypass in patients undergoing cardiac surgery.

    Science.gov (United States)

    Gu, Y John; van Oeveren, Willem; Mungroop, Hubert E; Epema, Anne H; den Hamer, Inez J; Keizer, Jorrit J; Leuvenink, Ron P; Mariani, Massimo A; Rakhorst, Gerhard

    2011-02-01

    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate whether the Rotaflow centrifugal pump produces effective pulsatile flow during CPB and whether the pulsatile flow in this setting is clinically effective in adult patients undergoing cardiac surgery. Thirty-two patients undergoing CPB for elective coronary artery bypass grafting were randomly allocated to a pulsatile perfusion group (n = 16) or a nonpulsatile perfusion group (n = 16). All patients were perfused with the Rotaflow centrifugal pump. In the pulsatile group, the centrifugal pump was adjusted to the pulsatile mode (60 cycles/min) during aortic cross-clamping, whereas in the nonpulsatile group, the pump was kept in its nonpulsatile mode during the same period of time. Compared with the nonpulsatile group, the pulsatile group had a higher pulse pressure (P centrifugal pump is associated with a small gain of EEP and SHE, which does not seem to be clinically effective in adult cardiac surgical patients.

  3. Cardioprotection of Electroacupuncture for Enhanced Recovery after Surgery on Patients Undergoing Heart Valve Replacement with Cardiopulmonary Bypass: A Randomized Control Clinical Trial

    Directory of Open Access Journals (Sweden)

    Fangxiang Zhang

    2017-01-01

    Full Text Available We attempted to investigate cardioprotection of electroacupuncture (EA for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6, Ximen (PC4, Shenting (GV24, and Baihui (GV20 acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. This trial is registered with ChiCTR-IOC-16009123.

  4. Carotid intima-media thickness is reduced 12 months after gastric bypass surgery in obese patients with type 2 diabetes or impaired glucose tolerance

    DEFF Research Database (Denmark)

    Lundby-Christensen, Louise; Tarnow, Lise; Hansen, Dorte L

    2014-01-01

    AIM: To investigate whether Roux-en-Y gastric bypass surgery (RYGB) - an in vivo model for normalisation of hyperglycaemia - improves carotid intima-media thickness (IMT) in patients with type 2 diabetes (T2D)/impaired glucose tolerance (IGT) and normal glucose tolerance (NGT). METHODS: Observati......AIM: To investigate whether Roux-en-Y gastric bypass surgery (RYGB) - an in vivo model for normalisation of hyperglycaemia - improves carotid intima-media thickness (IMT) in patients with type 2 diabetes (T2D)/impaired glucose tolerance (IGT) and normal glucose tolerance (NGT). METHODS...

  5. Efficiency Biliopancreatic bypass surgery in bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Yu I Yashkov

    2008-06-01

    Full Text Available A clinical significance in the treatment of bulimia nervosa patients with morbid obesity had already been raised [10, 13], but we did not find publications on the effectiveness of bariatric surgery in these cases. There is also information about the possibility of applying the operation bilio-pancreatic bypass, effective in patients with morbid obesity with uncontrolled eating behavior for the treatment of patients with anorexia BILIM not suffering from morbid obesity. In this article the data of clinical observation of a small sample of patients. As a result, the treatment of these patients found that severe nervous BILIM can be seen as a latent form of morbid obesity. The choice of treatment should depend not only on the initial body weight of the patient, but also on the severity of the nervous BILIM. Unsuccessful attempts at organized-balanced, conservative treatment of patients with severe bulimia nervosa may be considered a variant of surgical treatment, while bilio-pancreatic bypass surgery is considered as the most preferred operation, compared with the installation of the gastric balloon and others. All candidates for surgical treatment of obesity must identify clinical signs of bulimia nervosa, as this may influence the choice of method of operation. Further study of the role of hyperinsulinemia, secretion of ghrelin, leptin, intestinal peptide may contribute to the elucidation of the true causes of bulimia nervosa, probably has a similar origin with morbid obesity.

  6. Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome

    Science.gov (United States)

    Naik, Rakesh; George, Gladdy; Karuppiah, Sathappan; Philip, Madhu Andrew

    2016-01-01

    Objectives of the Study: To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality. Methods: A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L. Blood lactate samples were collected intraoperatively and postoperatively in the ICU. Preoperative and intraoperative risk factors for hyperlactatemia were identified using the highest intraoperative value of lactate. The postoperative morbidity and mortality associated with hyperlactatemia was studied using the overall (intraoperative and postoperative values) peak lactate levels. Preoperative clinical data, perioperative events and postoperative morbidity and mortality were recorded. Results: Intraoperative peak blood lactate levels of 4.0 mmol/L or more were present in 158 patients (42.7%). Females had higher peak intra operative lactate levels (P = 0.011). There was significant correlation between CPB time (Pearson correlation coefficient r = 0.024; P = 0.003) and aortic cross clamp time (r = 0.02, P = 0.007) with peak intraoperative blood lactate levels. Patients with hyperlactatemia had significantly higher rate of postoperative morbidity like atrial fibrillation (19.9% vs. 5.3%; P = 0.004), prolonged requirement of inotropes (34% vs. 11.8%; P = 0.001), longer stay in the ICU (P = 0.013) and hospital (P = 0.001). Conclusions: Hyperlactatemia had significant association with post-operative morbidity. Detection of hyperlactatemia in the perioperative period should be considered as an indicator of inadequate tissue oxygen delivery and must be aggressively

  7. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Tully, Phillip J; Winefield, Helen R; Baker, Robert A

    2015-01-01

    BACKGROUND: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical...... conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level. METHODS: Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression...... and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring...

  8. Coronary stenting versus bypass surgery in heart failure patients with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    XUE Zeng-ming; WANG Xiao; CHEN Fang; ZHOU Yu-jie; L(0) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong; WU Xue-si; LI Wei-ju; MA Chang-sheng; NIE Shao-ping; DONG Jian-zeng; LIU Xiao-hui; KANG Jun-ping; L(O) Qiang; DU Xin

    2012-01-01

    Background The optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear.The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF.Methods From July 2003 through September 2005,a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥50%) underwent PCI (n=350) or CABG (n=570).We compared the groups with respect to the primary outcome of mortality,and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE),including death,myocardial infarction,stroke and repeat revascularization,at a median follow-up of 543 days.Results In-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs.2.5%,adjusted P=0.016).During follow-up,there was no significant difference in the two groups with regard to mortality rates (2.3% vs.3.5%,adjusted P=0.423).Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs.4.0%,adjusted P <0.001),mainly due to higher rate of repeat revascularization (adjusted P <0.001).Independent predictors of mortality were age,New York Heart Association (NYHA) class and chronic total occlusion.Conclusion Among patients with CAD and HFPEF,PCI was shown to be as good as CABG with respect to the mortality rate,although there was a higher rate of repeat revascularization in patients undergoing PCI.

  9. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    von Segesser Ludwig K

    2008-07-01

    Full Text Available Abstract Background Cardiopulmonary bypass (CPB with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. Methods Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6% selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 ± 7 years and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF was 27 ± 8%. The majority of them (88% suffered of tri-vessel coronary disease and 6 (24% had a left main stump disease. Nine patients (35% were on severe cardiac failure and seven among them (28% received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%. Results All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 ± 0.6 and the internal mammary artery was used in 23 patients (92%. The mean CPB time was 84 ± 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 ± 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 ± 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an

  10. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

  11. Epicardial ultrasound in coronary artery bypass surgery

    NARCIS (Netherlands)

    Budde, R.P.J.

    2005-01-01

    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeo

  12. The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole: the ERY-PAO Study

    NARCIS (Netherlands)

    Mitrov-Winkelmolen, Lieke; van Buul-Gast, Marie Christine W; Swank, Dingeman J.; Overdiek, Hans W P M; van Schaik, Ron H N; Touw, Daan J.

    2016-01-01

    Background Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic aci

  13. The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole : the ERY-PAO Study

    NARCIS (Netherlands)

    Mitrov-Winkelmolen, Lieke; van Buul-Gast, Marie-Christine W.; Swank, Dingeman J.; Overdiek, Hans W. P. M.; van Schaik, Ron H. N.; Touw, Daan J.

    2016-01-01

    Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic acid (ASA) and

  14. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-01-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  15. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-09-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  16. Current techniques and strategies for anesthesia in patients undergoing peripheral bypass surgery.

    Science.gov (United States)

    Bouman, E; Dortangs, E; Buhre, W; Gramke, H F

    2014-04-01

    Peripheral arterial disease is an illness with a high prevalence in Europe and North America. The disease is associated with a significant impact on quality of life. Despite advanced medical and endovascular treatments, surgery is often indicated to prevent the consequences of ischemic injury. Usually, these patients do have significant comorbidities resulting in an increased risk for anesthesia-related complications. While general anesthesia is commonly used for the majority of the patients, local and regional anesthesia (RA) offer several possible advantages such as stable cardiovascular hemodynamic perioperative course, improved postoperative pain relief and prevention of chronic postsurgical pain syndromes. This review will discuss perioperative management, available evidence regarding general anesthesia and various regional anesthetic techniques for peripheral vascular surgery, and the current advises regarding anticoagulants and RA. No definitive conclusions can be drawn from the existing literature with respect to superiority of general or neuraxial anesthesia or even RA. Maybe the profits lie in the combination of techniques, a strategy, to overcome the risks of one and use the benefits of the other technique. From circumstantial evidence, it is most likely that the experience of the anesthetic and surgical team is one of the major determinants of perioperative complications independent from the individual anesthesia technique.

  17. Comparison of costs of percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients with angina pectoris

    NARCIS (Netherlands)

    C. van Halem; F. van den Brink; P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); K.J. Meeter; E. Bos (Egbert); F.J. van Dalen (Frederik); M.J.B.M. van den Brand (Marcel)

    1990-01-01

    textabstractTo determine the costs of a procedure, the total costs of the department that provides the service must be considered and, in addition, the direct cost of the specific procedure. Applying this principle to the cost accounting of angioplasty and bypass surgery results in a direct, i.e. pr

  18. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

  19. Coronary bypass surgery in patients aged 70 years and over: Mortality, morbidity, & length of stay. Dar al-fouad experience

    Directory of Open Access Journals (Sweden)

    Ahmed Ghali

    2014-03-01

    This study supports the continued performance of coronary artery bypass grafting in patients 70 years. Advanced age alone should not deter a cardiac surgeon from offering such a potentially beneficial intervention.

  20. Influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    Shu-Tian Song; Ming Yang; Kun-Peng Li; Juan Xu; Chuan-Ming Bai; Ji-Wu Zhou

    2016-01-01

    Objective:To investigate and analyze the influence of recombinant human brain natriuretic peptide on myocardial enzymes, serum cardiac function indexes and oxygen metabolism of patients with open heart surgery with cardiopulmonary bypass.Methods:A total of 42 patients with open heart surgery with cardiopulmonary bypass during the period of June 2014 to January 2016 were randomly divided into the control group of 21 cases and the observation group of 21 cases. The control group was treated with routine postoperative treatment, and the observation group was treated with recombinant human brain natriuretic peptide on the basic treatment of control group, then the myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes of the two groups before the surgery and at 2 h, 12 h and 24 h after the surgery were respectively detected and compared.Results: There were no significant difference in myocardial enzymes, serum cardiac function indexes and oxygen metabolism indexes between two groups before the surgery (allP>0.05), while the myocardial enzymes and serum cardiac function indexes of the observation group at 2 h ,12 h and 24 h after the surgery were all significantly lower than those of control group, the oxygen metabolism indexes were significantly better than the levels of control group (allP<0.05).Conclusions:The recombinant human brain natriuretic peptide can effectively improve the myocardial enzymes, serum cardiac function indexes and oxygen metabolism state of patients with open heart surgery with cardiopulmonary bypass, and it has application value for the patients with the surgery is higher.

  1. Severe peripheral neuropathy following gastric bypass surgery for morbid obesity.

    OpenAIRE

    Maryniak, O.

    1984-01-01

    Severe weakness in the limbs developed in a young woman 3 1/2 months after successful gastric bypass surgery for morbid obesity. Electromyography confirmed the clinical impression of generalized axonal polyneuropathy. Vitamin B replacement therapy was started. The gastric bypass was not reversed, and the patient continued to lose weight while undergoing rehabilitation. After 10 months she had almost fully recovered. Her total weight loss was 76 kg. Neuropathy is an uncommon but serious compli...

  2. Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Ozan, Gonca; Kıbar, Kurtuluş; Erışır, Mine

    2016-01-01

    Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods. Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) were examined. Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period. Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed. PMID:28101295

  3. Pathophysiology and treatment of edema following femoropopliteal bypass surgery

    NARCIS (Netherlands)

    te Slaa, A.; Dolmans, D. E. J. G. J.; Ho, G. H.; Moll, F. L.; van der Laan, L.

    2012-01-01

    Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this e

  4. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera......This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...

  5. Vitamin deficiency after gastric bypass surgery: a review.

    Science.gov (United States)

    Matrana, Marc R; Davis, William E

    2009-10-01

    More than 60% of the adult US population now meets the criteria for being overweight or obese. Gastric bypass surgery has become a popular and effective way to combat this medical problem. Despite the success of these procedures, they are associated with many complications, including malnutrition, neurological compromise, and vitamin deficiency. Research has determined that even with multivitamin supplementation for life, a large percentage of bypass patients develop vitamin deficiencies. We present a case of beriberi after Roux-en-Y bypass that illustrates the importance of close follow up. A thorough review of vitamin deficiencies in this unique patient population is explored. Vitamin supplementation and treatment recommendations are compiled from the most up-to-date sources. Even patients on regular supplements should be closely monitored for vitamin deficiencies. Patient education regarding vitamin supplementation is vital; it should begin prior to surgery and continue throughout the postoperative period and beyond.

  6. Hemodynamic outcome of successful bypass surgery in patients with atherosclerotic cerebrovascular disease: a study with acetazolamide and {sup 99m}Tc-ECD SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Eo, Jae Seon; Oh, Chang Wan; Kim, Yu Kyeong; Park, Eun Kyung; Lee, Won Woo; Kim, Sang Eun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2006-12-15

    The aim of the study was to evaluate the hemodynamic changes after successful bypass surgery in patients with atherosclerotic stenosis in ICA using {sup 99m}Tc-ECD SPECT. Fourteen patients (M:F = 8:6, mean age; 60 {+-} 9 years) who underwent STA-MCA anastomosis for unilateral atherosclerotic cerebrovascular disease were enrolled. {sup 99m}Tc-ECD basal/acetazolamide perfusion SPECT studies were performed before, 10 days and 6 months after bypass surgery. Perfusion reserve was defined as the % changes after acetazolamide over rest image. Regional cerebral blood flow and perfusion reserve were compared preoperative, early-postoperative and late-postoperative scans. The mean resting perfusion and decrease in perfusion reserve in affected ICA territory on preoperative scan was 52.4 {+-} 3.5 and -7.9 {+-} 4.7%, respectively. The resting perfusion was significantly improved after surgery on early-postoperative scan (mean 53.7 {+-} 2.7) and late-postoperative scan (mean 53.3 {+-} 2.5) compared with preoperative images ({rho} < 0.05, respectively). Resting perfusion did not showed further improvement on late-postoperative scan compared with early-postoperative scan. The perfusion reserve was -3.7 {+-} 2.6% on early-postoperative scan, and -1.6 {+-} 2.3% on late-postoperative scan, which was significantly improved after surgery. Additionally, further improvement of perfusion reserved a observed on late-postoperative scan ({rho} < 0.05). While, in the unaffected ICA territory, on significant changes in the resting perfusion and perfusion reserve was observed. The improvement of resting perfusion and perfusion reserve in early-postoperative scan reflects the immediate restoration of the cerebral blood flow by bypass surgery. In contrasts, further improvement of perfusion reserve showing on late-postoperative scan may indicate a good collateral development after surgery, which may indicate good surgical outcome after surgery.

  7. Outcome of bypass surgery in patients with chronic ischemic left ventricular dysfunction. Predictive value of MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kloew, N.E. [The National Hospital, Oslo (Norway). Dept. of Radiology; Smith, H.J. [The National Hospital, Oslo (Norway). Dept. of Radiology; Gullestad, L. [The National Hospital, Oslo (Norway). Dept. of Cardiology; Seem, E. [The National Hospital, Oslo (Norway). Dept. of Cardiovascular Surgery; Endresen, K. [The National Hospital, Oslo (Norway). Dept. of Cardiology

    1997-01-01

    Purpose: To determine the preoperative findings of MR imaging of the left ventricle (LV) that could best predict the functional outcome of the LV after surgical revascularization. Material and Methods: Patients with angina pectoris, previous myocardial infarction, and dysfunction of the LV, and who had a preoperative cine MR, were re-evaluated after bypass surgery with MR in a study on the effects of revascularization after mean 22 months. Results: Angina pectoris was relieved in all patients except one, but the maximum workload during the exercise test was increased in only 3 patients. Coronary angiography showed that 37 of 45 (82%) of the distal anastomoses were open. The LV ejection fraction was the same before and after operation both at angiography and MR imaging. MR showed LV end-diastolic volume to be increased from 190{+-}50 ml to 250{+-}70 ml. Compared to angiography, MR provided additional information regarding myocardial wall thickness and function, and the size of myocardial infarction. Improvement in systolic wall thickening was seen in 65% of the segments that had had an end-diastolic wall thickness (EDWT) greater than 15 mm before operation, while only 4% of the segments with EDWT<6 mm improved. In the wall thickness range of 6-15 mm, MR was unable to predict the functional outcome of the LV. Conclusion: Preoperative MR findings of thick myocardial walls with poor function seem predictive of improved function after revascularization. When the LV wall thickness is less than 6 mm, no improvement should be expected. (orig.).

  8. Diabetes surgery in type 2 BMI 24-29 vs IMC 30-34 diabetic patients: is there differences among restrictive, malabsorptive and gastric bypass procedures?

    Science.gov (United States)

    Garciacaballero, M; Navarrete, S; Favretti, F; Celik, A; Del Castillo, D

    2013-03-01

    Diabetes mellitus (DM) is a public health problem with a prevalence of 345 million people worldwide that it may double by the year 2030 and have a high costs and mortality. Gastrointestinal surgery is accepted as a form of treatment that was already suggested for obese in 1987 by Pories, confirmed for obese patients by the metaanalysis of Buchwald and the direct comparison of gastric bypass with medical treatment in the study of Schauer that demonstrate a 4 fold greater resolution rate of DM with surgery. Improvement occurs immediately after surgery, before the patients lose weight in with BMI > 35; but there is doubt if the existent evidence is enough to extrapolate these results to patients with BMI < 35 and especially with BMI < 30, in spite that four reviews in patients with this BMI and DM2 demonstrated the same results when stomach, duodenum and part of jejunum is bypassed as happen gastric bypass (better results with this of one anastomosis than of two anastomosis, Roux-en-Y) BPD. For patients with a BMI between 30 and 35 restrictive techniques: LAGB and SGL are good but not better than the mixed: RYGB, BAGUA, or SG-DJB with remission from 60 to 100%, minor in the derivative: BPD and above on the IID with a 81% of remission. There are no differences in the metabolic control in comparison to the obese, It is progressively better with DJB, SDS, IID and BAGUA especially in patients who do not require insulin, have less time with disease, have normal C peptide levels, and not so much relation with the initial BMI that is only important to decide the degree of restriction. Although several mechanisms has been suggested for explaining these results such as caloric intake, hormonal changes, bypass of the anterior or early stimulation of posterior intestine, fundectomy, intestinal gluconeogenesis and others, new ones will appear in the near future.

  9. Diabetes surgery in type 2 BMI 24-29 vs IMC 30-34 diabetic patients: is there differences among restrictive, malabsorptive and gastric bypass procedures?

    Directory of Open Access Journals (Sweden)

    M. Garciacaballero

    Full Text Available Diabetes mellitus (DM is a public health problem with a prevalence of 345 million people worldwide that it may double by the year 2030 and have a high costs and mortality. Gastrointestinal surgery is accepted as a form of treatment that was already suggested for obese in 1987 by Pories, confirmed for obese patients by the meta-analysis of Buchwald and the direct comparison of gastric bypass with medical treatment in the study of Schauer that demonstrate a 4 fold greater resolution rate of DM with surgery. Improvement occurs immediately after surgery, before the patients lose weight in with BMI > 35; but there is doubt if the existent evidence is enough to extrapolate these results to patients with BMI < 35 and especially with BMI < 30, in spite that four reviews in patients with this BMI and DM2 demonstrated the same results when stomach, duodenum and part of jejunum is bypassed as happen gastric bypass (better results with this of one anastomosis than of two anastomosis, Rouxen-Y BPD. For patients with a BMI between 30 and 35 restrictive techniques: LAGB and SGL are good but not better than the mixed: RYGB, BAGUA, or SG-DJB with remission from 60 to 100%, minor in the derivative: BPD and above on the IID with a 81% of remission. There are no differences in the metabolic control in comparison to the obese, It is progressively better with DJB, SDS, IID and BAGUA especially in patients who do not require insulin, have less time with disease, have normal C peptide levels, and not so much relation with the initial BMI that is only important to decide the degree of restriction. Although several mechanisms has been suggesed for explaining these results such as caloric intake, hormonal changes, bypass of the anterior or early stimulation of posterior intestine, fundectomy, intestinal gluconeogenesis and others, new ones will appear in the near future.

  10. Methylation and Expression of Immune and Inflammatory Genes in the Offspring of Bariatric Bypass Surgery Patients

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    Frédéric Guénard

    2013-01-01

    Full Text Available Background. Maternal obesity, excess weight gain and overnutrition during pregnancy increase risks of obesity, type 2 diabetes mellitus, and cardiovascular disease in the offspring. Maternal biliopancreatic diversion is an effective treatment for severe obesity and is beneficial for offspring born after maternal surgery (AMS. These offspring exhibit lower severe obesity prevalence and improved cardiometabolic risk factors including inflammatory marker compared to siblings born before maternal surgery (BMS. Objective. To assess relationships between maternal bariatric surgery and the methylation/expression of genes involved in the immune and inflammatory pathways. Methods. A differential gene methylation analysis was conducted in a sibling cohort of 25 BMS and 25 AMS offspring from 20 mothers. Following differential gene expression analysis (23 BMS and 23 AMS, pathway analysis was conducted. Correlations between gene methylation/expression and circulating inflammatory markers were computed. Results. Five immune and inflammatory pathways with significant overrepresentation of both differential gene methylation and expression were identified. In the IL-8 pathway, gene methylation correlated with both gene expression and plasma C-reactive protein levels. Conclusion. These results suggest that improvements in cardiometabolic risk markers in AMS compared to BMS offspring may be mediated through differential methylation of genes involved in immune and inflammatory pathways.

  11. Prophylactic digitalization for coronary artery bypass surgery.

    Science.gov (United States)

    Johnson, L W; Dickstein, R A; Fruehan, C T; Kane, P; Potts, J L; Smulyan, H; Webb, W R; Eich, R H

    1976-05-01

    One hundred and twenty patients undergoing aortocoronary bypass procedures were randomly placed into control and digitalized groups. All were initially in normal sinus rhythm and without evidence of congestive heart failure. Supraventricular arrhythmias occurred in 17 of 66 controls and in only three of 54 digitalized patients (P less than 0.01). There was no evidence of digitals toxicity. Based on this evidence we recommend prophylactic digitalization for patients having aortocoronary bypass operations.

  12. Fibrin Adhesive: Clinical Application in Coronary Artery Bypass Graft Surgery

    Science.gov (United States)

    Fundaró, Pino; Velardi, Antonio R.; Santoli, Carmine

    1985-01-01

    Fibrin adhesive was used 72 times in a group of 67 patients undergoing elective coronary artery bypass graft surgery. The indications were prophylactic sealing of potential sources of bleeding, topical hemostasis (control of bleeding sites dangerous or difficult to suture), and fixation of the graft in the optimal position. The method of glue application under varying circumstances is described and the results are reported. This experience suggests that in some cases the glue expedites the operation and makes it safer. We conclude that the fibrin sealing represents a valid aid in coronary artery bypass graft surgery. PMID:15227018

  13. Gastric infarction following gastric bypass surgery

    Science.gov (United States)

    Do, Patrick H; Kang, Young S; Cahill, Peter

    2016-01-01

    Gastric infarction is an extremely rare occurrence owing to the stomach’s extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition. PMID:27200168

  14. Blood concentrations of cefuroxime in cardiopulmonary bypass surgery

    NARCIS (Netherlands)

    Bertholee, Daphne; ter Horst, Peter G. J.; Hijmering, Michel L.; Spanjersberg, Alexander J.; Hospes, Wobbe; Wilffert, Bob

    2013-01-01

    Objectives Patients with coronary artery bypass graft (CABG) surgery are at risk for severe postoperative infections. Prophylactic cefuroxime may help to reduce this risk, however sufficient concentrations, i.e. above the breakpoint (32 mg/L), are mandatory. The aim of this study is to evaluate the

  15. Effect of Roux-en-Y gastric bypass surgery on ventricular function and cardiac risk factors in obese patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Alireza Abdollahi Moghaddam

    2016-03-01

    Full Text Available Introduction: Weight gain and obesity are two important public health problems, which are associated with many diseases such as cardiovascular disorders. Various policies such as bariatric surgery have been proposed for the treatment of morbid obesity. Methods: PubMed and Scopus were searched thoroughly with the following search terms (roux-en-y gastric bypass surgery AND (ventricular function, OR cardiac risk factors OR heart AND (BMI OR body mass index to find the articles in which the effect of roux-en-Y gastric bypass (RYGB surgery had been evaluated in severely obese patients.Result: Out of 120 articles which were found in PubMed, and 28 records which were found in Scopus, only 18 articles fully met the inclusion criteria. Out of 2740 participants in the included studied, 1706 were patients with body mass index (BMI over 40 kg/m2 who had undergone RYGB surgery, and 1034 were control participants. Results of the studies showed that RYGB surgery could reduce BMI, and cardiac risk factors, and improve diastolic function, systolic and diastolic blood pressures, and aortic function, postoperatively.Discussion: Obesity is associated with increased risk of cardiovascular diseases, impaired cardiac function, and hypertension. It is shown that RYGB surgery reduces the serum level of biochemical markers of cardiac diseases. Cardiac structure, parasympathetic indices of autonomic function, coronary circulatory function, hypertension, epicardial fat thickness, and ventricular performance improve after bariatric surgery.Conclusions: It is concluded that RYGB surgery is an effective strategy to improve ventricular function and cardiac risk factors in morbid obese patients.

  16. Clinical evaluation of the Spiral Pump® after improvements to the original project in patients submitted to cardiac surgeries with cardiopulmonary bypass

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    Jarbas Jakson Dinkhuysen

    2014-09-01

    Full Text Available Objective: The objective of this paper is to present the results from Spiral Pump clinical trial after design modifications performed at its previous project. This pump applies axial end centrifugal hydraulic effects for blood pumping during cardiopulmonary bypass for patients under cardiac surgery. Methods: This study was performed in 52 patients (51% males, between 20 to 80 (67±14.4 years old weighing 53 to 102 (71.7±12.6 kg, mostly under myocardial revascularization surgery (34.6% and valvular surgery (32.8%. Besides the routine evaluation of the data observed in these cases, we monitored pump rotational speed, blood flow, cardiopulmonary bypass duration, urine free hemoglobin for blood cell trauma analysis (+ to 4+, lactate desidrogenase (UI/L, fibrinogen level (mg/dL and platelet count (nº/mm3. Results: Besides maintaining appropriate blood pressure and metabolic parameters it was also observed that the Free Hemoglobin levels remained normal, with a slight increase after 90 minutes of cardiopulmonary bypass. The Lactate Dehydrogenase showed an increase, with medians varying between 550-770 IU/L, whereas the decrease in Fibrinogen showed medians of 130-100 mg/dl. The number of platelets showed a slight decrease with the medians ranging from 240,000 to 200,000/mm3. No difficulty was observed during perfusion terminations, nor were there any immediate deaths, and all patients except one, were discharged in good condition. CONCLUSION: The Spiral Pump, as blood propeller during cardiopulmonary bypass, demonstrated to be reliable and safe, comprising in a good option as original and national product for this kind of application.

  17. The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC-GTN Study.

    Science.gov (United States)

    Hamarneh, Ashraf; Sivaraman, Vivek; Bulluck, Heerajnarain; Shanahan, Hilary; Kyle, Bonnie; Ramlall, Manish; Chung, Robin; Jarvis, Claire; Xenou, Maria; Ariti, Cono; Cordery, Roger; Yellon, Derek M; Hausenloy, Derek J

    2015-11-01

    Remote ischemic conditioning (RIC) using transient limb ischemia/reperfusion has been reported to reduce perioperative myocardial injury in patients undergoing coronary artery bypass grafting and/or valve surgery. The role of intravenous glyceryl trinitrate (GTN) therapy administered during cardiac surgery as a cardioprotective agent and whether it interferes with RIC cardioprotection is not clear and is investigated in the ERIC-GTN trial ( http://www.clinicaltrials.gov: NCT01864252). The ERIC-GTN trial is a single-site, double-blind, randomized, placebo-controlled study. Consenting adult patients (age > 18 years) undergoing elective coronary artery bypass grafting ± valve surgery with blood cardioplegia will be eligible for inclusion. Two hundred sixty patients will be randomized to 1 of 4 treatment groups following anesthetic induction: (1) RIC alone, a RIC protocol comprising three 5-minute cycles of simultaneous upper-arm and thigh cuff inflation/deflation followed by an intravenous (IV) placebo infusion; (2) GTN alone, a simulated sham RIC protocol followed by an IV GTN infusion; (3) RIC + GTN, a RIC protocol followed by an IV GTN infusion; and (4) neither RIC nor GTN, a sham RIC protocol followed by IV placebo infusion. The primary endpoint will be perioperative myocardial injury as quantified by the 72-hour area-under-the-curve serum high-sensitivity troponin T. The ERIC-GTN trial will determine whether intraoperative GTN therapy is cardioprotective during cardiac surgery and whether it affects RIC cardioprotection.

  18. Comparative study of on-pump and off-pump coronary bypass surgery in patients with triple-vessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 徐明; 史宏伟; 穆心伟; 陈振强; 邱志兵

    2004-01-01

    Background Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease.Methods A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n=150) or CABG with cardiopulmonary bypass (CCABG, n=150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P<0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group(P< 0.01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups.Results No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P<0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P<0.05). There were no significant differences between the two groups in mortality and other causes of morbidity (periopetative myocardial infarction, stroke, atrial fibrillation). Conclusions OPCAB can be applied to patients with triple-vessel coronary artery disease and can

  19. Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report

    Directory of Open Access Journals (Sweden)

    Carlos E Mendez

    2010-08-01

    Full Text Available Carlos E Mendez, Robert J Tanenberg, Walter PoriesDiabetes and Obesity Institute, East Carolina University, Greenville, NC, USAAbstract: Roux-en-Y gastric bypass surgery (RYGB reverses type 2 diabetes (DM2 in approximately 83% of patients with morbid or severe obesity. This procedure has been performed in small numbers of severely obese patients with type 1 diabetes (DM1, but the impact on glycemic control and insulin requirement in this population has not been widely described. We report three patients with DM1 and severe obesity that underwent RYGB. Weight, glycemic control, and insulin requirements before and one year after the procedure were compared. Significant weight loss was achieved by all three patients but insulin requirements decreased in only 2 patients. In contrast, glycemic control (A1C remained suboptimal in all three patients up to one year after the surgery. These findings suggest that RYGB leads to important weight loss and positively affects insulin sensitivity. However, reaching optimal glycemic control in patients with DM1 diabetes remains challenging due to persisting insulin deficiency.Keywords: gastric bypass, Roux-en-Y, obesity, diabetes, insulin

  20. Outcomes of off-pump versus on-pump coronary artery bypass graft surgery in patients with severely dilated left ventricle

    Science.gov (United States)

    Li, Sen; Gong, Wenhui; Qi, Quan; Yuan, Zezhe; Chen, Anqing; Liu, Jun; Cai, Junfeng; Zhou, Mi

    2016-01-01

    Background Currently, off-pump coronary artery bypass (OPCAB) grafting has been the standard procedure for surgical revascularization in patients with coronary artery disease (CAD). This study aimed to examine the safety and applicability of OPCAB compared with on-pump coronary artery bypass (ONCAB) in patients with severely dilated left ventricle. Methods A retrospective study of giant left ventricle patients [left ventricular end diastolic diameter (LVEDD) ≥ VE mm] undergoing coronary bypass grafting from 2009 through 2015 at a single center was conducted. Preoperative and intraoperative risk factors, and postoperative outcomes were analyzed. Survival analysis was carried to analyze survival rate during follow-up. Results A total of 24 patients underwent ONCAB, and 26 underwent OPCAB. Both groups had similar preoperative profiles. Two cases from each group died during in-hospital time. In comparison to OPCAB, there was longer operation and post-surgery intubation time and more renal dysfunction in ONCAB group (P0.05). Conclusions OPCAB is a safe and feasible alternative for CAD patients with giant left ventricle, offering a significant advantage over ONCAB with regards to renal function, operation duration and length of ventilation. PMID:27761444

  1. Off-pump coronary artery bypass grafting in patients with mirror-imaging dextrocardia.

    Science.gov (United States)

    Yuan, Xin; Sun, Hansong; Wang, Xianqiang

    2015-08-01

    Dextrocardia requires alterations in techniques during coronary artery bypass graft (CABG) surgery. We report two cases undergoing off-pump coronary artery bypass graft (OPCAB) surgery and discuss techniques for the operative management of these patients.

  2. The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial

    Directory of Open Access Journals (Sweden)

    Novikov Ilia

    2011-10-01

    Full Text Available Abstract Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients, and has been found to be cost-effective. This report describes a comprehensive and low cost educational intervention designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery. Methods/Design A controlled prospective intervention trial. The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel. This group received no additional treatment beyond usual care. The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006. This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment. The medical staff attended a one-hour seminar on cardiac rehabilitation. In addition, it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital. Both study groups were interviewed before surgery and one-year post surgery. A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs, as well as the structure and content of the cardiac rehabilitation programs attended. Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records. The effect of cardiac rehabilitation on one- and three-year mortality was assessed. Discussion We report a low cost yet comprehensive intervention designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation. Trial

  3. Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

    Directory of Open Access Journals (Sweden)

    Babak Amra

    2014-01-01

    Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

  4. Totally laparoscopic bypass surgery for aortoiliac occlusive disease in China

    Institute of Scientific and Technical Information of China (English)

    GUO Lian-rui; GU Yong-quan; QI Li-xing; TONG Zhu; WU Xin; GUO Jian-ming; ZHANG Jian

    2013-01-01

    Background Totally laparoscopic aortic surgery is still in its infancy in China.One of the factors preventing adoption of this technique is its steep learning curve.The objective of this study was to evaluate the feasibility and safety of laparoscopic surgery for aortoiliac occlusive disease (AIOD).Methods From November 2008 to November 2012,12 patients were treated for severe AIOD with a totally laparoscopic bypass surgery at our university hospital.The demographic data,operative data,postoperative recovery data,morbidity and mortality were analyzed and compared with those of conventional open approach.Results Twelve totally laparoscopic aortic surgery procedures,including two iliofemoral bypasses (IFB),three unilateral aortofemoral bypasses (UAFB),and seven aortobifemoral bypasses (ABFB),were performed.Conversion to open procedures was required in three patients.The mean operation time was 518 (range,325-840) minutes,mean blood loss was 962 (range,400-2500) ml,and mean aortic anastomosis time was 75 (range,40-150) minutes.Compared with conventional open approach for aortofemoral bypasses performed concomitantly during this period,laparoscopic patients required fewer narcotics and a shorter in-hospital stay and earlier recovery.Postoperative complications developed in four patients,including a single patient with transient left hydronephrosis,ischemic colonic fistula and pneumonia,residual aortic stenosis proximal to the anastomotic site,and asymptomatic partial left renal infarction.All patients recovered and were discharged on postoperative Days 7-14 except one patient that died of respiratory failure on Day 46.All grafts were patent with follow-up imaging performed by Duplex examination,with a mean follow-up time of 10.7 (range,2-61) months.Conclusion Totally laparoscopic bypass surgery is a feasible and safe procedure forAIOD,but attention needs to be paid to improve laparoscopic skills of vascular surgery in order to minimize morbidity during the learning

  5. Life-Threatening Hypocalcemia following Subtotal Parathyroidectomy in a Patient with Renal Failure and Previous Roux-en-Y Gastric Bypass Surgery

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    Betsy Palal

    2011-01-01

    Full Text Available Background. Roux-en-Y gastric bypass (RYGB can result in calcium and vitamin D deficiency. Parathyroid surgery carries the risk of immediate and long-term hypocalcemia. Methods and Results. We describe a 54-year-old woman with history of end-stage renal disease and gastric bypass surgery who developed calciphylaxis requiring a 3.5-gland parathyroidectomy. Seven weeks later, she presented with weakness, perioral numbness, leg cramps, a positive Chvostek's sign, hypotension, prolonged QT-interval, and serum calcium of 5.4 mg/dL. Oral and intravenous calcium, calcitriol, and high calcium bath hemodialysis were given. She required 18 days of intravenous calcium and an outpatient maintenance regimen of calcitriol 6 mcg/day, calcium carbonate 8 grams/day, calcium citrate 1.2 grams/day, and ergocalciferol 50,000 IU/week. Conclusion. The patient's life-threatening prolonged hypocalcemia and large requirements of calcium and calcitriol were due to a combination of malabsorption, hypoparathyroidism, and renal failure. Special considerations should be given to bariatric surgery patients undergoing neck exploration.

  6. Does vitamin C or its combination with vitamin E improve radial artery endothelium-dependent vasodilatation in patients awaiting coronary artery bypass surgery?

    OpenAIRE

    Uzun, Alper; Yener, Umit; Cicek, Omer Faruk; Yalcinkaya, Adnan; Diken, Adem; Ozkan, Turgut; Ulas, Mahmut; Yener, Ozlem; Turkvatan, Aysel

    2013-01-01

    Background We evaluated the vasodilatory effects of two antioxidants, vitamins C (ascorbic acid) and E (α-tocopherol), on radial artery and endothelium-dependent responses in patients awaiting coronary artery bypass surgery. Methods The study was performed in three groups. The first group took 2 g of vitamin C orally (n = 31, vitamin C group), the second group took 2 g of vitamin C with 600 mg of vitamin E orally (n = 31, vitamins C + E group), and the third group took no medication (n = 31, ...

  7. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  8. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET

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    Ünal Nermin

    2006-07-01

    Full Text Available Abstract Background We tested the hypothesis, that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques. Methods Thus far, 7 patients (60 ± 10 [SD] years undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal puncture. Mononuclear bone marrow cells were isolated by gradient centrifugation and resuspended in 2 ml volume of Hank's buffered salt solution. At the end of CABG surgery 10 injections of 0.2 ml each were applied to the core area and borderzones of the infarct. Global and regional perfusion and viability were evaluated by ECG-gated 99mTc-tetrofosmin myocardial single-photon emission computed tomograph (SPECT imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET in all study patients Results Non-viable segments indicating transmural defects were identified in 5 patients. Two patients were found to have non-transmural defects before surgery. Concomitant surgical revascularisation and bone marrow cell injection was performed in all patients without major complications. The median total injected mononuclear cell number was 7.0 × 107 (range: 0.8–20.4. At 3 months 99mTc-tetrofosmin SPECT and 18F-FDG-PET scanning showed in 5 patients (transmural defect n = 4; non-transmural defect n = 1 no change in myocardial viability and in two patients (transmural defect n = 1, non-transmural defect n = 1 enhanced myocardial viability by 75%. Overall, global and regional LV ejection fraction was not significantly increased after surgery compared with the preoperative value. Conclusion In CABG surgery patients with non-viable segments the concurrent use of intramyocardial cell transfer did not show any clear improvement in tissue viability or function by

  9. [Predictors of Efficacy of Radiofrequency Ablation of Pulmonary Veins Performed During Coronary Bypass Surgery in Patients With Ischemic Heart Disease and Paroxysmal Atrial Fibrillation].

    Science.gov (United States)

    Iskenderov, B G; Rakhmatullov, A F

    2015-01-01

    We performed simultaneous coronary artery bypass grafting (CABG) and radiofrequency ablation (RFA) ostia of pulmonary veins in 254 patients (147 men and 107 women) with ischemic heart disease and paroxysmal atrial fibrillation (AF). In-hospital mortality in patients with early recurrence of AF was 8.4%, in patients without recurrence of AF 1.9% (χ2 = 4.65; p = 0.03). The patients were followed-up during 12 months after operation. During follow-up 166 patients (69.5%) had no recurrence of AF without receiving antiarrhythmic drugs (AAP), 33 patients (13.8%) had recurrences of AF, and 40 patients (16.7%) receiving AAD had repeated rare paroxysms of AF. Main predictors of late AF recurrence were age > 65 years, AF duration > 5 years, preoperative atrial effective refractory period 50 mm, glomerular filtration rate heart due to CABG and RFA, use of β-blockers, angiotensin converting enzyme inhibitors and aldosterone antagonists were associated with the preservation of a stable sinus rhythm. The cardiovascular mortality during 12 months follow-up accounted for 2.1% and 1.2% in groups of patients with and without late recurrences of AF respectively (p > 0.05) to coronary artery bypass grafting surgery and RFA, taking drugs--β-blockers, angiotensin converting enzyme inhibitors and aldosterone antagonists--were associated with the preservation of a stable sinus rhythm.

  10. Severe scurvy after gastric bypass surgery and a poor postoperative diet

    DEFF Research Database (Denmark)

    Hansen, Esben P K; Metzsche, Carsten; Henningsen, Emil;

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at......-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. KEYWORDS: Scurvy; Gastric bypass surgery; Multiorgan dysfunction....

  11. Hospitalization before and after mini-gastric bypass surgery.

    Science.gov (United States)

    Rutledge, Robert

    2007-02-01

    The mini-gastric bypass (MGB) was developed to address some of the limitations of the Roux-en-Y gastric bypass ("RNY"). The RNY has recently been reported to increase the need for hospitalization for complications after RNY surgery. To determine the rates and indications for inpatient hospital use before and after MGB in comparison to similar rates in RNY. The study is a self reported retrospective study of patients from across the United States receiving MGB in Centers for Excellence in Laparoscopic Obesity Surgery ("CELOS") hospitals from 2000 to 2005. Complications and hospitalization in the year before and in the 1 to 5 years after MGB. 1069 patients who underwent MGB were selected for study. The rate of hospitalization in the year following MGB was 67% of the rate in the year preceding MGB (11% vs. 17%, P<0.001). The most common reasons for admission prior to MGB were general medical problems (38%) obstetric and Gynecological issues (36%), orthopedic problems (16%), gallbladder surgery (9%) and renal stones in 2%. The most common reasons for hospital admission after MGB were complications from surgery (29%), gallbladder surgery (20%), renal stones (14%), plastic surgery procedures (11%), appendectomy (9%), Gynecologic issues (9%) and orthopedic problems (6%). Thus while MGB complications made up a third of hospital readmissions following MGB surgery the over all hospitalization rates declined significantly. Previous studies have demonstrated that hospitalization after RNY gastric bypass increases remarkably (20% per year). The present study shows that hospitalization following MGB instead of rising, as reported with RNY, decreases by a third. The MGB has been shown to be a short, safe successful weight loss surgery in previous work. The present study supports the MGB as a low risk procedure that decreases the need for hospitalization.

  12. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G;

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 4...

  13. secondary Prevention of Coronary Events by Coronary Artery Bypass Surgery

    OpenAIRE

    2003-01-01

    Coronary artery bypass surgery has shown its superiority on other therapeutic options in specific but frequent indications such as left main lesions, multivessel disease with alteration of ventricular function, proximal lesions of the LAD, and multivessel diseases in diabetic patients. After reviewing the epidemiology of coronary artherosclerosis, we emphasize the efficacy of the surgical treatment compared to medical or interventional therapy for preventing ischemic events. The results deriv...

  14. Severe Scurvy After Gastric Bypass Surgery and a Poor Postoperative Diet

    OpenAIRE

    Hansen, Esben P.K.; Metzsche, Carsten; Henningsen, Emil; Toft, Palle

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. Keywords Scurv...

  15. Anesthesia for off-pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  16. Effects of a psychoeducation intervention on fear and anxiety about surgery: randomized trial in patients undergoing coronary artery bypass grafting.

    Science.gov (United States)

    Shahmansouri, Nazilla; Janghorbani, Mohsen; Salehi Omran, Abbas; Karimi, Abbas Ali; Noorbala, Ahmad Ali; Arjmandi, Akram; Nikfam, Sepideh

    2014-01-01

    The aim of this study was to examine the impact of a brief psychoeducation group intervention on fear and anxiety in patients undergoing the coronary artery bypass grafting (CABG). Sixty consecutive patients undergoing CABG for the first time were recruited for a clinical trial and randomized into two groups. The control group received routine care. The study group received a brief psychoeducation group intervention combined with routine care. The psychoeducation session consisted of a discussion of fear and anxiety in a psychotherapeutic atmosphere and relaxation techniques. Fear was scored with the Bypass Grafting Fear Scale (BGFS) and anxiety was scored with the Spielberger State Inventory (STAI) Questionnaire. The BGFS and the STAI were given to the patients the day after hospital admission and a day before the operation to measure fear and anxiety. Fear scores decreased in the psychoeducation group. Of the 29 patients treated with psychoeducation, the mean (SD) fear score decreased from 4.6 (1.7) at baseline to 2.8 (1.2) before the operation (p  .05). The mean difference in fear score before the operation was significantly lower in the psychoeducation group than the routine care group (mean difference -1.3; 95% CI, -2.1, -.2; p anxiety scores before the operation between the psychoeducation and routine care groups. In patients undergoing CABG, adding psychoeducation to routine care had a significant positive effect on fear but not on anxiety scores. A larger study of psychoeducation in these patients is warranted to assess the efficacy of this intervention in greater detail.

  17. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Jensen Beck, Søren; Houlind, Kim;

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  18. The Effect of Preoperative Melatonin on Nuclear Erythroid 2-Related Factor 2 Activation in Patients Undergoing Coronary Artery Bypass Grafting Surgery

    Directory of Open Access Journals (Sweden)

    Shaghayegh Haghjooy Javanmard

    2013-01-01

    Full Text Available During and after coronary artery bypass grafting (CABG, oxidative stress occurs. Finding an effective way to improveantioxidant response is important in CABG surgery. It has been shown that patients with coronary heart disease have a low Melatonin production rate. The present study aimed to investigate the effects ofMelatoninon nuclear erythroid 2-related factor 2(Nrf2 activity in patients undergoing CABG surgery. Thirty volunteers undergoing CABG were randomized to receive 10 mg oral Melatonin (Melatonin group, or placebo (placebo group, before sleeping for 1 month before surgery. The activatedNrf2 was measured twice by DNA-based ELISA method in the nuclear extract of peripheral blood mononuclear cells of patients before aortic clumps and 45 minutes after CABG operation. Melatonin administration was associated with a significantincrease in both plasma levels of Melatonin and Nrf2 concentration in Melatonin group compared to placebo group, respectively ( pmol/L, versus pmol/L, , . The findings of the present study provide preliminary data suggesting that Melatoninmay play a significant role in the potentiation of the antioxidant defense and attenuate cellular damages resulting from CABG surgery via theNrf2 pathway.

  19. Assessment of the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft surgery in a group of Iranian patients

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    Hamidreza Jamaati

    2015-01-01

    Full Text Available Background and Aims: Previous studies around the world indicated validity and accuracy of European System for Cardiac Operative Risk Evaluation (EuroSCORE risk scoring system we evaluated the EuroSCORE risk scoring system for patients undergoing coronary artery bypass graft (CABG surgery in a group of Iranian patients. Materials and Methods: In this cohort 2220 patients more than 18 years, who were performed CABG surgery in Massih Daneshvari Hospital, from January 2004 to March 2010 were recruited. Predicted mortality risk scores were calculated using logistic EuroSCORE and Acute Physiology and Chronic Health Evaluation II (APACHE II and compared with observed mortality. Calibration was measured by the Hosmer-Lemeshow (HL test and discrimination by using the receiver operating characteristic (ROC curve area. Results: Of the 2220 patients, in hospital deaths occurred in 270 patients (mortality rate of 12.2%. The accuracy of mortality prediction in the logistic EuroSCORE and APACHE II model was 89.1%; in the local EuroSCORE (logistic was 91.89%; and in the local EuroSCORE support vector machines (SVM was 98.6%. The area under curve for ROC curve, was 0.724 (95% confidence interval [CI]: 0.57-0.88 for logistic EuroSCORE; 0.836 (95% CI: 0.731-0.942 for local EuroSCORE (logistic; 0.978 (95% CI: 0.937-1 for Local EuroSCORE (SVM; and 0.832 (95% CI: 0.723-0.941 for APACHE II model. The HL test showed good calibration for the local EuroSCORE (SVM, APACHE II model and local EuroSCORE (logistic (P = 0.823, P = 0.748 and P = 0.06 respectively; but there was a significant difference between expected and observed mortality according to EuroSCORE model (P = 0.033. Conclusion: We detected logistic EuroSCORE risk model is not applicable on Iranian patients undergoing CABG surgery.

  20. Lower leg electrical impedance after distal bypass surgery

    DEFF Research Database (Denmark)

    Belanger, G K; Bolbjerg, M L; Heegaard, N H

    1998-01-01

    Electrical impedance was determined in 13 patients following distal bypass surgery to evaluate lower leg oedema as reflected by its circumference. Tissue injury was assessed by the plasma concentration of muscle enzymes. After surgery, the volume of the control lower leg increased from 1250 (816...... of troponin I (n = 8). In conclusion, tissue injury was reflected by increases in muscle enzymes in plasma. We found an inverse correlation between lower leg electrical impedance and volume, but the deviation in electrical impedance was approximately twice that of the leg volume. Electrical impedance appears...

  1. Comparing Alterations of Blood Glucose Level in type II Diabetic Patients Taking Metformin and Withhold of Metformin on the Morning of Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    M. Tarbiat

    2016-07-01

    Full Text Available Introduction & Objective: In the context effect of metformin in patients with acute coronary syndrome, available evidence supports cardiac effect. Yet, there is doubt about continuation or discontinuation of metformin before major surgery. The aim of the present study is to determine the efficacy of continuing metformin in plasma glucose, renal function index, arterial PH in type II diabetic patients after coronary artery bypass graft surgery. Materials & Methods: In this clinical-experimental study, 90 type II diabetic patients with ASA class II admitted for CABG surgery in Hamadan Ekbatan Hospital were enrolled in the study in 2014 and were randomly assigned to two groups , one group treated with insulin and continued metformin and the other group treated with insulin and discontinued metformin.In the beginning indicators such as age, sex, body mass index (BMI were compared which were not significantly different in the two groups. Then, other parameters such as blood glucose, BUN, Cr, arterial blood PH, cardiac arrhythmia and need for inotrope were compared. Used inotropes in this study included dopamine, dobutamine, epinephrine, norepinephrine, milrinon to achieve systolic blood presser pressure over 100mmHg. Results: Average plasma BUN after surgery and one day after surgery in the group who discontinued metformin significantly were higher compared with the metformin group, but no differences were observed in average plasma BUN in the 2nd and 3rd days after surgery in the two groups. During 3 days after surgery, average plasma creatinine was significantly lower in metformin group compared to non- metformin group. Although there was no difference between the two groups in pH parameter before surgery but in the metformin group, average pH was lower than non-metformin group after surgery. Before and 3 days after surgery mean blood glucose level was not significantly different between the two groups. During surgery, average need for inotrope in

  2. Performance, pain, and quality of life on use of central venous catheter for management of pericardial effusions in patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ghods K

    2016-10-01

    Full Text Available Kamran Ghods,1 Mohammad Reza Razavi,2 Mohammad Forozeshfard3 1Clinical Research Development Unit (CRDU, Department of Cardiovascular Surgery, Kowsar Hospital, 2Nursing Care Research Center, 3Cancer Research Center, Department of Anesthesiology, Semnan University of Medical Sciences, Semnan, Iran Abstract: Different pericardial catheters have been suggested as an effective alternative method for drainage of pericardial effusion. The aim of this study was to determine the performance, pain, and quality of life on use of central venous catheter (CVC for drainage of pericardial effusion in patients undergoing open heart surgery. Fifty-five patients who had developed pericardial effusion after an open heart surgery (2012–2015 were prospectively assessed. Triple-lumen central catheters were inserted under echocardiographic guidance. Clinical, procedural, complication, and outcome details were analyzed. Intensity of pain and quality of life of patients were assessed using the numerical rating scale and Short-Form Health Survey. CVC was inserted for 36 males and 19 females, all of whom had a mean age of 58.5±15 years, and the mean duration of the open heart surgery was 8±3.5 hours. The mean central venous pressure catheter life span was 14.6 days. No cases of recurrent effusion and complication were reported. The technical success rate of procedure was 100%. Intensity of pain and quality of life of patients had improved during follow-up. CVC insertion is a safe and effective technique for the management of pericardial effusion in patients after open heart surgery. Keywords: coronary artery bypass graft, pericardial effusion, central venous catheter

  3. Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial

    Science.gov (United States)

    Cardona, Saumeth; Pasquel, Francisco; Jacobs, Sol; Peng, Limin; Unigwe, Michael; Newton, Christopher A.; Smiley-Byrd, Dawn; Vellanki, Priyathama; Halkos, Michael; Puskas, John D.; Guyton, Robert A.; Thourani, Vinod H.

    2015-01-01

    OBJECTIVE The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial. RESEARCH DESIGN AND METHODS We randomized patients with diabetes (n = 152) and without diabetes (n = 150) with hyperglycemia to an intensive glucose target of 100–140 mg/dL (n = 151) or to a conservative target of 141–180 mg/dL (n = 151) after coronary artery bypass surgery (CABG) surgery. After the intensive care unit (ICU), patients received a single treatment regimen in the hospital and 90 days postdischarge. Primary outcome was differences in a composite of complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and major cardiovascular events. RESULTS Mean glucose in the ICU was 132 ± 14 mg/dL (interquartile range [IQR] 124–139) in the intensive and 154 ± 17 mg/dL (IQR 142–164) in the conservative group (P < 0.001). There were no significant differences in the composite of complications between intensive and conservative groups (42 vs. 52%, P = 0.08). We observed heterogeneity in treatment effect according to diabetes status, with no differences in complications among patients with diabetes treated with intensive or conservative regimens (49 vs. 48%, P = 0.87), but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen (34 vs. 55%, P = 0.008). CONCLUSIONS Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings. PMID:26180108

  4. Patient's Perception About Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Kelminda Maria Bulhões Mendonça

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: The diagnosis of coronary artery disease referred for heart surgery has an important psychological component. The purpose of this study was to access the difficulties experienced by individuals awaiting coronary artery bypass grafting and to determine strategies that facilitate adaptation to a new lifestyle, modified by the disease. METHODS: A qualitative, exploratory study involving patients admitted to a university teaching hospital in the city of Salvador, Bahia, Brazil, awaiting coronary artery bypass grafting. Semi-structured interviews were performed in accordance with a previously defined script based on the study objective. Each transcription was read in its entirety to verify the representativeness, homogeneity and pertinence of the data obtained (pre-analysis, followed by separation of categories of analysis. RESULTS: The descriptions of this study show that patients admitted to the completion of coronary artery bypass grafting experience a wide range of psychological difficulties, considering that surgery acquires interpretations that vary according to individuals' subjectivity. The patients recognized the benefit of being able to discuss their feelings as a means of diminishing their fear and anxiety. CONCLUSION: Helping patients find resources to confront more positively the daily hospitalization is an important aspect for the health care professionals who assist them. This goal can be achieved through modification of the biomedical model of care for a biopsychosocial view. The investment of time and attention is of fundamental importance and aims to overcome existing deficiencies that interfere with the outcome of patients after cardiac surgery.

  5. [VIABILITY OF MYOCAROIUM AS RISK FACTOR FOR MORTALITY IN EARLY AND LATE PERIOD AFTER BYPASS SURGERY OF CORONARY ARTERIES IN PATIENTS WITH CORONARY HEART DISEASE AND SEVERE LEFT VENTRICULAR DYSFUNCTION].

    Science.gov (United States)

    Todurov, B M; Zelenchuk, V; Kuzmich, I M; Ivanyuk, N B; Nikolaichuk, M V

    2015-06-01

    In coronary heart disease and low ejection fraction of the left ventricle (LV) in patients after coronary artery bypass surgery tend mortality and complication rate higher than preserved LV systolic function. Significant preoperative predictors of early mortality and remote in these patients, and the incidence of complications in the early postoperative period were reveald.

  6. Intra-aortic balloon pump use does not affect the renal function in patients undergoing off pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Muniraju Geetha

    2011-01-01

    Full Text Available Renal dysfunction is known to occur during cardiac surgery. A few factors such as perioperative hypotension, use of potential nephrotoxic therapeutic agents, radio opaque contrast media in the recent past, intra-aortic balloon pump (IABP and cardiopulmonary bypass have been blamed as the contributing factors to the causation of postoperative renal dysfunction in cardiac surgical patients. At times, in patients with renal failure and low cardiac output status, one may face the dilemma if the use of IABP is safe. We undertook this prospective observational study to determine the degree of possible renal injury when IABP is used by measuring serial values of serum creatinine and Cystatin C. Elective patients scheduled for off-pump coronary artery bypass surgery requiring preoperative use of IABP were included in this study. Cystatin C and serum creatinine levels were checked at fixed intervals after institution of IABP. Twenty-two patients were eligible for enrolment to the study. There was no significant change in the values of serum creatinine; from the basal value of 1.10 ± 0.233 to 0.98 ± 0.363 mg /dL (P value >0.05. Cystatin C levels significantly decreased from the basal level of 0.98 ± 0.29 to 0.89 ± 0.23 (P value <0.05. Contrary to the belief, Cystatin C, the early indicator of renal dysfunction decreases suggesting absence of renal injury after the use of IABP. Absence of elevation of cystatin C levels in our study suggests the lack of potential of the IABP to cause renal dysfunction in patients who received elective IABP therapy preoperatively.

  7. Effect of thoracic epidural anesthesia on oxygen delivery and utilization in cardiac surgical patients scheduled to undergo off-pump coronary artery bypass surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Suryaprakash Sharadaprasad

    2011-01-01

    Full Text Available To evaluate the effect of thoracic epidural anesthesia (TEA on tissue oxygen delivery and utilization in patients undergoing cardiac surgery. This prospective observational study was conducted in a tertiary referral heart hospital. A total of 25 patients undergoing elective off-pump coronary artery bypass surgery were enrolled in this study. All patients received thoracic epidural catheter in the most prominent inter-vertebral space between C7 and T3 on the day before operation. On the day of surgery, an arterial catheter and Swan Ganz catheter (capable of measuring cardiac index was inserted. After administering full dose of local anesthetic in the epidural space, serial hemodynamic and oxygen transport parameters were measured for 30 minute prior to administration of general anesthesia, with which the study was culminated. A significant decrease in oxygen delivery index with insignificant changes in oxygen extraction and consumption indices was observed. We conclude that TEA does not affect tissue oxygenation despite a decrease in arterial pressures and cardiac output.

  8. Intussusception after Laparoscopic Gastric Bypass Surgery: An Underrecognized Complication

    Directory of Open Access Journals (Sweden)

    Smit Singla

    2012-01-01

    Full Text Available Introduction. Intussusception after bariatric surgery is an uncommon complication that is now being frequently reported. Most people consider dysmotility to be the causative mechanism in the absence of obvious etiology. Material and Methods. A worldwide search identified literature describing intussusception after bariatric surgery. We also included our own patients and analyzed information regarding demographic profile, risk factors, presentation, diagnosis, and post treatment course. Results. Seventy one patients were identified between 1991 and 2011. Majority of the affected patients were females (=70, 98.6%; median time to presentation after gastric bypass surgery was 36 months. Most patients presented with abdominal pain, nausea and vomiting, but without obvious peritonitis. Sixty eight patients (96% required surgery; 48 (70.6% underwent revision of anastomosis, 16 (23.5% had reduction without resection, while 4 patients (5.9% had plication only. Amongst these, most patients (=51, 75% were found to have retrograde intussusception. Post-operatively, 9 patients presented with recurrence (range, 0.5–32 months. Five patients, who had earlier been treated without resection, eventually required revision of the anastomosis. There was no mortality noted. Conclusion. Intussusception after bariatric surgery is uncommon and its diagnosis is based on a combination of physicial, radiological and operative findings. An early surgical intervention reduces morbidity and prevents recurrence.

  9. Levels of vitamin C In the blood plasma patients treated with coronary artery bypass grafting increases significantly after surgery.

    Science.gov (United States)

    Kleszczewski, Tomasz; Modzelewska, Beata; Lisowska, Anna; Buzun, Leszek; Kleszczewska, Ewa

    2017-01-01

    One strong risk factor of coronary artery disease (CAD), which affects the levels of vitamin C in the blood is cigarette smoking. The supplementary effects of coronary artery bypass grafting (CABG) is smoking cessation by patients. Therefore, the aim of this study was to examine the level of vitamin C in the blood plasma one day before and one month after CABG. Human blood were collected from 20 patients (men); 1day before and 1 month after CABG. All patients were smoker and after CABG they declared their not smoking. The concentration of vitamin C in the blood plasma was assayed by FIA method with spectrophotometric detection. The mean value of the vitamin C concentration 1day before CABG was 12.36±2.84μmol/L (mean±SD), 1 month after CABG 40.07±10.95μmol/L (mean±SD). The average increase in the concentration of vitamin C was 3.27±0.73 times (mean±SD) and showed significant positive correlations (Pearson r=0.657, p=0.002). It should be consider incorporating the recommendations of preoperative smoking cessation for at least one month prior to CABG and/or additional supplementation. In addition it would be relevant to monitor the level of vitamin C in the patients' blood in the preoperative period.

  10. Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery.

    Science.gov (United States)

    Sevuk, Utkan; Kaya, Sedat; Ayaz, Firat; Aktas, Ulas

    2016-01-01

    Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

  11. Gene signatures of postoperative atrial fibrillation in atrial tissue after coronary artery bypass grafting surgery in patients receiving β-blockers.

    Science.gov (United States)

    Kertai, Miklos D; Qi, Wenjing; Li, Yi-Ju; Lombard, Frederick W; Liu, Yutao; Smith, Michael P; Stafford-Smith, Mark; Newman, Mark F; Milano, Carmelo A; Mathew, Joseph P; Podgoreanu, Mihai V

    2016-03-01

    Atrial tissue gene expression profiling may help to determine how differentially expressed genes in the human atrium before cardiopulmonary bypass (CPB) are related to subsequent biologic pathway activation patterns, and whether specific expression profiles are associated with an increased risk for postoperative atrial fibrillation (AF) or altered response to β-blocker (BB) therapy after coronary artery bypass grafting (CABG) surgery. Right atrial appendage (RAA) samples were collected from 45 patients who were receiving perioperative BB treatment, and underwent CABG surgery. The isolated RNA samples were used for microarray gene expression analysis, to identify probes that were expressed differently in patients with and without postoperative AF. Gene expression analysis was performed to identify probes that were expressed differently in patients with and without postoperative AF. Gene set enrichment analysis (GSEA) was performed to determine how sets of genes might be systematically altered in patients with postoperative AF. Of the 45 patients studied, genomic DNA from 42 patients was used for target sequencing of 66 candidate genes potentially associated with AF, and 2,144 single-nucleotide polymorphisms (SNPs) were identified. We then performed expression quantitative trait loci (eQTL) analysis to determine the correlation between SNPs identified in the genotyped patients, and RAA expression. Probes that met a false discovery rate<0.25 were selected for eQTL analysis. Of the 17,678 gene expression probes analyzed, 2 probes met our prespecified significance threshold of false discovery rate<0.25. The most significant probe corresponded to vesicular overexpressed in cancer - prosurvival protein 1 gene (VOPP1; 1.83 fold change; P=3.47×10(-7)), and was up-regulated in patients with postoperative AF, whereas the second most significant probe, which corresponded to the LOC389286 gene (0.49 fold change; P=1.54×10(-5)), was down-regulated in patients with

  12. Decline in Health-Related Quality of Life 6 Months After Coronary Artery Bypass Graft Surgery

    DEFF Research Database (Denmark)

    El Baz, Noha; Pedersen, Susanne S.; van Dijk, Jitse P;

    2013-01-01

    Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery.......Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery....

  13. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H. R.; Pol, Robert A.; Hulsebos, Robin G.; van Det, Rob J.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    BACKGROUND: To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. METHODS: Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inl

  14. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H.R.; Pol, Robert A.; Hulsebos, Robin G.; Det, van Rob J.; Palen, van der Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    Background To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. Methods Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inla

  15. Current status of coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin

    2009-01-01

    @@ Surgical revascularization for atherosclerotic heart disease, also called coronary artery bypass grafting (CABG), was first performed in 1962, and is one of the great achievements in medicine. Relief of angina, improvement of exercise tolerance, and the realization of survival benefit have been documented.1 CABG has been used in multi-vessel disease and left main stenosis for over 40 years.2 In the last two decades the mortality of CABG has decreased to less than 2% despite an aging population with increased risk factors. However, percutaneous coronary intervention (PCI), especially with drug-eluting stents, has been challenging CABG, While PCI has improved, CABG has also progressed with better peri-operative management, a higher use of arterial grafting, off-pump surgery, and improved techniques with minimally invasive surgical options.3,4

  16. In-Hospital and Long-Term Prognosis after Myocardial Infarction in Patients with Prior Coronary Artery Bypass Surgery; 19-Year Experience

    Directory of Open Access Journals (Sweden)

    Predrag M. Mitrovic

    2009-01-01

    Full Text Available To present a 19-year experience of the prognosis of patients with acute myocardial infarction (AMI and prior coronary artery bypass surgery (CABS, 748 patients with AMI after prior CABS (postbypass group and a control group of 1080 patients with AMI, but without prior CABS, were analyzed. All indexes of infarct size were lower in the postbypass group. There was more ventricular fibrillation in the postbypass group. In-hospital mortality was similar (p = 0.3675. In the follow-up period, postbypass patients had more heart failure, recurrent CABS, reinfarction, and unstable angina than did control patients. Cumulative survival was better in the control group than in the postbypass group (p = 0.0403. Multiple logistic regression model showed that previous angina (p = 0.0005, diabetes (p = 0.0058, and age (p = 0.0102 were independent predictor factors for survival. Use of digitalis and diuretics, together with previous angina, also influenced survival (p = 0.0092, as well as male gender, older patients, and diabetes together (p = 0.0420. Patients with AMI after prior CABS had smaller infarct, but more reinfarction, reoperation, heart failure, and angina. Previous angina, diabetes, and age, independently, as well as use of digitalis and diuretics together with angina, and male gender, older patients, and diabetes together, influenced a worse survival rate in these patients.

  17. Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery:a Meta-analysis of Randomized Controlled Trials

    Institute of Scientific and Technical Information of China (English)

    Yun-tai Yao; Li-huan Li

    2009-01-01

    Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting(CABG)surgery.Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardiurn in adult patients undergoing CABG surgery.Two authors independently extracted patients' perioperative data,including patients' baseline characteristics,surgical variables,and outcome data.For continuous variables,treatment effects were calculated as weighted mean difference(WMD)and 95% confidential interval(C0.For dichotomous data,treatment effects were calculated as odds ratio(OR)and 95% CI.Each outcome was tested for heterogeneity,and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity(Q test P<0.05).Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects.Publication bias was explored through visual inspection of funnel plots of the outcomes.Statistical significance was defined as P<0.05.Results Our search yielded 13 studies including 696 patients,and 402 patients were allocated into sevoflurane group and 294 into propofol group.There was no significant difference in postoperative mechanical ventilation time,inotropic support,mortality,myocardial infarction,and atrial fibrillation between the two groups(all P>0.05).Patients randomized into sevoflurane group had higher post-bypass cardiac index(WMD=0.39,95% CI:0.18 to 0.60,P=0.0003),lower troponin I level(WMD=-0.82,95% CI:-0.87 to-0.85,P=0.0002),lower incidence of myocardial ischemia(OR=0.37,95% CI:0.16 to 0.83,P=0.02),shorter ICU and hospital stay length(WMD=-10.99,95% CI:-12.97 to-9.01,P<0.00001;WMD=-0.78,95% CI:-1.00 to-0.56,P<0.00001,respectively).Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial

  18. Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    LU Jia-kai; ZHU Chen; JING He; WANG Yi-jun; QING En-ming

    2012-01-01

    Background For patients undergoing off-pump coronary artery bypass grafting (OPCABG),it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment.This study aimed to observe the clinical feasibility of artedal pressure-based cardiac output (APCO) for cardiac output (CO) monitoring and to evaluate the correlation between APCO and pulmonary artery catheter (PAC) for CO measurement for patients undergoing OPCABG intraoperatively.Methods Fifty patients of Amedcan Society of Anaesthesiologists (ASA) classification Ⅱ-Ⅲ,undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study.All patients were assigned to CO monitoring by PAC and APCO simultaneously.Patients with pacemaker,severe valvular heart disease,left ventdcular ejection fraction (EF) <40%,cardiac arrhythmias,peripheral vascular disease,application of intra-aortic balloon pump (IABP) and emergent diversion to cardiac pulmonary bypass were excluded.The radial artery wavaform was analyzed to estimate the stroke volume (SV) and heart rate (HR) continuously.CO was calculated as SV x HR; other derived parameters were cardiac index (CI),stroke volume index (SVI),systemic vascular resistance (SVR),and systemic vascular resistance index (SVRI).PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms.Continuous cardiac output (CCO),CI and other hemodynamic parameters were monitored at following 5 time points:immediate after anesthesia induction (baseline value),anastomosis of left intemal mammary artery to left anterior descending artery (LAD),anastomosis of left circumflex (LCX),anastomosis of posterior descending artery (PDA) and immediate after sternal closure.Results In the 50 patients,preoperative echocardiography measured left ventricular EF was (52.8±11.5)%,and 35 patients (70%) showed regional wall motion abnormalities.The correlation coefficient of CO

  19. Preoperative evaluation of basal free triiodothyronine in patients undergoing coronary artery bypass grafting surgery. Does it help?

    Directory of Open Access Journals (Sweden)

    Kaushal Kishore Tiwari

    2015-11-01

    Full Text Available noBackground & Objectives: The postoperative Low T3 syndrome has been considered as a possible source of reduced myocardial contractility, resulting in increased mortality after CABG. Effect of preoperative Low T3 has not been well studied in patients undergoing CABG surgery. Aim of our study is to evaluate effect of preoperative Low T3 syndrome in patients undergoing CABG surgery.Materials & Methods: Six hundred and six patients undergoing CABG were included in this prospective study. The impact of the base-line FT3 concentration and of preoperative low T3 syndrome on the risk of postoperative low cardiac output and hospital death was analyzed.Results: Fifteen patients (2.3% postoperatively and 159 (26.2% developed major complications. At univariate analysis a reduced EF, the presence of peripheral vascular disease, the NYHA class, the surgical urgency, the aortic cross-clamp time, the CPB time and the FT3 concentration at admission were significantly associated with low CO and higher mortality. At multivariate analysis, the CPB time, an emergency procedure, a reduced LVEF, and the fT3 concentration were independently related to the development of low CO. However, in multivariate analysis low EF, and the fT3 concentration were the only predictors of hospital death.Conclusion: We conclude that preoperative low EF and low T3 syndrome independently causes low cardiac output and higher mortality in patients undergoing CABG. Therefore, all patients undergoing CABG should be evaluated for low T3 syndrome and patients with low T3 syndrome should be considered at increased risk. Appropriate preoperative T3 replacement therapy could decrease the postoperative complications in patients undergoing CABG.JCMS Nepal. 2015; 11(2:1-7

  20. Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

    Institute of Scientific and Technical Information of China (English)

    Hasan Gungor; Cemil Zencir; Abraham Samuel Babu; Cagdas Akgullu; Ufuk Eryilmaz; Ali Zorlu; Mithat Selvi

    2014-01-01

    Background Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP).Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD).We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs.4 (13%),P=0.013).Preoperative hemoglobin level (OR:0.752; 95% CI,0.571-0.991,P=0.043),chronic obstructive pulmonary disease (OR:6.731; 95% CI,1.159-39.085,P=0.034) and poor CCC grade (OR:5.750; 95% CI,1.575-20.986,P=0.008) were associated with post-CABG in-hospital mortality.Poor CCC grade (OR:4.853; 95% CI,1.124-20.952,P=0.034) and preoperative hemoglobin level (OR:0.624; 95% CI,0.476-0.954,P=0.026) were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

  1. Aortic Valve Stenosis and Atrial Fibrillation Influence Plasma Fibulin-1 Levels in Patients Treated with Coronary Bypass Surgery

    DEFF Research Database (Denmark)

    Hansen, Maria Lyck; Dahl, Jordi S; Argraves, W Scott;

    2013-01-01

    Objectives: Aortic valve stenosis (AS) causes cardiac fibrosis and left ventricular hypertrophy, and over time heart failure can occur. To date, a reliable marker to predict progression of AS or the development of heart failure is still lacking. In this study, we addressed the hypothesis that fib......Objectives: Aortic valve stenosis (AS) causes cardiac fibrosis and left ventricular hypertrophy, and over time heart failure can occur. To date, a reliable marker to predict progression of AS or the development of heart failure is still lacking. In this study, we addressed the hypothesis...... that fibulin-1 levels reflect myocardial fibrosis. Methods: Patients undergoing heart surgery at the Odense University were investigated. By 2012 data on outcome were obtained. Results: In 293 patients, plasma fibulin-1 levels were measured. Patients with AS or atrial fibrillation (AF) had significantly higher...

  2. Heart bypass surgery - minimally invasive - discharge

    Science.gov (United States)

    ... invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  3. Alterations of hormonally active fibroblast growth factors after Roux-en-Y gastric bypass surgery

    NARCIS (Netherlands)

    P.L.M. Jansen; J. van Werven; E. Aarts; F. Berends; I. Janssen; J. Stoker; F.G. Schaap

    2011-01-01

    Thirty-five morbidly obese patients underwent Roux-en-Y gastric bypass surgery (RYGB). In addition to weight loss, these patients showed significant improvement of insulin resistance and a reduction of hepatic fat content. Three months after surgery, the serum bile salts were slightly but significan

  4. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Sharma Munish

    2010-01-01

    Full Text Available Perioperative Thoracic epidural analgesia (TEA is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB. We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index> 30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each. Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

  5. Computed tomography perfusion evaluation after extracranial-intracranial bypass surgery

    NARCIS (Netherlands)

    Vos, P.C.; Riordan, A.J.; Smit, E.J.; Jong, H.W. de; Zwan, A. van der; Velthuis, B.K.; Viergever, M.A.; Dankbaar, J.W.

    2015-01-01

    OBJECTIVE: Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obt

  6. Computed tomography perfusion evaluation after extracranial-intracranial bypass surgery

    NARCIS (Netherlands)

    Vos, Pieter C.; Riordan, Alan J.; Smit, Ewoud J.; de Jong, Hugo W. A. M.; van der Zwan, Albert; Velthuis, BK; Viergever, Max A.; Dankbaar, Jan Willem

    2015-01-01

    Objective: Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obt

  7. Clinical Effectiveness of Centrifugal Pump to Produce Pulsatile Flow During Cardiopulmonary Bypass in Patients Undergoing Cardiac Surgery

    NARCIS (Netherlands)

    Gu, Y. John; van Oeveren, Willem; Mungroop, Hubert E.; Epema, Anne H.; den Hamer, Inez J.; Keizer, Jorrit J.; Leuvenink, Ron P.; Mariani, Massimo A.; Rakhorst, Gerhard

    2011-01-01

    Although the centrifugal pump has been widely used as a nonpulsatile pump for cardiopulmonary bypass (CPB), little is known about its performance as a pulsatile pump for CPB, especially on its efficacy in producing hemodynamic energy and its clinical effectiveness. We performed a study to evaluate w

  8. Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

    OpenAIRE

    Elif Basagan-Mogo; Suna Goren; Gulsen Korfali; Gurkan Turker; Fatma Nur Kaya

    2010-01-01

    OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery. INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting ...

  9. Night Blindness and Vitamin A Deficiency following Jejunoilieal Bypass Surgery

    OpenAIRE

    Adams, Paul C; Canny, Christopher L.

    1989-01-01

    A 42-year-old man who developed severe night blindness 15 years following jejunoileal bypass surgery for morbid obesity is described. Ophthamological testing, including dark adaptation, electroretinography and serum vitamin A levels, confirmed a diagnosis of vitamin A deficiency. Oral vitamin A 25,000 iu/day for two months resulted in a full recovery of visual deficits. Nutritional vitamin A deficiency is discussed in the context of intestinal bypass surgery.

  10. Comparative study of graft flow between on-pump and off-pump coronary bypass surgery for patients with multivessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Xin Chen; Ming Xu; Zhibing Qiu; Yinshuo Jiang; Liming Wang; Liqiong Xiao

    2006-01-01

    Objective: To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods: The grafts flow was studied in 100 patients of OPCAB and compared with100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results: The mean number of the distal anastomosis was 3.78+ 1.11 in CCABG group, and 3.83 + 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 + 0.08, and 1.10+ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups.Conclusion: OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.

  11. The effect of continuous low dose methylprednisolone infusion on inflammatory parameters in patients undergoing coronary artery bypass graft surgery: a randomized-controlled clinical trial.

    Directory of Open Access Journals (Sweden)

    Abbas Ghiasi

    2015-02-01

    Full Text Available This trial was performed to determine if a continuous low-dose infusion of methylprednisolone is as effective as its bolus of high-dose in reducing inflammatory response. The study was single-center, double-blinded randomized clinical trial and performed in a surgical intensive care unit of an academic hospital. In this study, 72 consecutive patients undergoing elective coronary artery bypass grafting (CABG were assigned to receive either a methylprednisolone loading dose (1mg/kg followed by continuous infusion (2mg/Kg/24 hours for 1 day (low-dose regime or a single dose of methylprednisolone (15 mg/kg before cardiopulmonary bypass (high dose regime. Serum concentrations of IL-6 and C- reactive protein (CRP were measured preoperatively and 6, 24 and 48 hours after surgery, and serum creatinine was measured before the operation and 24, 48 and 72 hours postoperatively. The measurements were then compared between the groups to evaluate the efficacy of each regimen. The basic characteristics and measurements were not different between the study groups. There was no significant difference in IL-6 and CRP elevation (P=0.52 and P=0.46, respectively. Early outcomes such as the length of stay in the intensive care unit, intubation time, changes in serum creatinine and blood glucose levels, inotropic support, insulin requirements, and rate of infection were also similar in both groups. A continuous low dose infusion of methylprednisolone was as effective as a single high dose methylprednisolone in reducing the inflammatory response after CABG with extracorporeal circulation with no significant difference in the postoperative measurements and outcomes.

  12. Gastric bypass surgery reveals independency of obesity and diabetes melitus type 2

    DEFF Research Database (Denmark)

    Fenger, Mogens; Hansen, Dorte Lindqvist; Worm, Dorte

    2016-01-01

    BACKGROUND: Roux-en-Y gastric bypass surgery is widely applied to ameliorate morbid obesity, including diabetes in people with type 2 diabetes. The latter vanish a few days after surgery for many, but not in all patients before any weight reduction has occurred. The explanation for this change in...

  13. Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication

    Directory of Open Access Journals (Sweden)

    Kerstyn C. Zalesin

    2011-01-01

    Conclusion. Vitamin A deficiency is common after bariatric surgery and is associated with a low serum concentration of pre-albumin. This fat-soluble vitamin should be measured in patients who have undergone gastric bypass surgery and deficiency should be suspected in those with evidence of protein-calorie malnutrition.

  14. Revascularisation of patients with end-stage renal disease on chronic haemodialysis: bypass surgery versus PCI—analysis of routine statutory health insurance data

    Science.gov (United States)

    Möckel, Martin; Searle, Julia; Baberg, Henning Thomas; Dirschedl, Peter; Levenson, Benny; Malzahn, Jürgen; Mansky, Thomas; Günster, Christian; Jeschke, Elke

    2016-01-01

    Objectives We aimed to analyse the short-term and long-term outcome of patients with end-stage renal disease (ESRD) undergoing percutaneous intervention (PCI) as compared to coronary artery bypass surgery (CABG) to evaluate the optimal coronary revascularisation strategy. Design Retrospective analysis of routine statutory health insurance data between 2010 and 2012. Main outcome measures Primary outcome was adjusted all-cause mortality after 30 days and major adverse cardiovascular and cerebrovascular events at 1 year. Secondary outcomes were repeat revascularisation at 30 days and 1 year and bleeding events within 7 days. Results The total number of cases was n=4123 (PCI; n=3417), median age was 71 (IQR 62–77), 30.4% were women. The adjusted OR for death within 30 days was 0.59 (95% CI 0.43 to 0.81) for patients undergoing PCI versus CABG. At 1 year, the adjusted OR for major adverse cardiac and cerebrovascular events (MACCE) was 1.58 (1.32 to 1.89) for PCI versus CABG and 1.47 (1.23 to 1.75) for all-cause death. In the subgroup of patients with acute myocardial infarction (AMI), adjusted all-cause mortality at 30 days did not differ significantly between both groups (OR 0.75 (0.47 to 1.20)), whereas in patients without AMI the OR for 30-day mortality was 0.44 (0.28 to 0.68) for PCI versus CABG. At 1 year, the adjusted OR for MACCE in patients with AMI was 1.40 (1.06 to 1.85) for PCI versus CABG and 1.47 (1.08 to 1.99) for mortality. Conclusions In this cohort of unselected patients with ESRD undergoing revascularisation, the 1-year outcome was better for CABG in patients with and without AMI. The 30-day mortality was higher in non-AMI patients with CABG reflecting an early hazard with surgery. In cases where the patient's characteristics and risk profile make it difficult to decide on a revascularisation strategy, CABG could be the preferred option.

  15. Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Tonga Nfor

    2015-08-01

    Full Text Available Purpose: Previous studies comparing percutaneous coronary intervention (PCI with coronary artery bypass graft surgery (CABG in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83 vs. 13.6 ± 7.1% for CABG (n=187 (P=0.31. After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8. There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001. Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23. Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P 5%.

  16. Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

    Institute of Scientific and Technical Information of China (English)

    LIU Wei; ZHU Xiao-Ling; MA Chang-sheng; KANG Jun-ping; DU Xin; CHEN Fang; ZHOU Yu-jie; L(U) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong

    2011-01-01

    Background In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG)in the patients with CTO and multivessel disease.Methods From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.Results At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% Cl 1.219-3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.Conclusions Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

  17. A 16-slice multidetector computed tomography protocol for evaluation of the gastroepiploic artery grafts in patients after coronary artery bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Dorgelo, J.; Willems, T.P.; Ooijen, P.M.A. van; Oudkerk, M. [University Medical Center Groningen, Department of Radiology, Groningen (Netherlands); Panday, G.F.V.; Boonstra, P.W.; Zijlstra, F. [University Medical Center Groningen, Thoraxcenter, Groningen (Netherlands)

    2005-09-01

    Arterial coronary bypass grafts [internal mammary arteries and gastroepiploic artery (GEA)] are in widespread use for coronary surgery. Since selective catheterisation of the GEA graft to monitor patency, is often unsuccessful, a non-invasive protocol to visualise the GEA-graft from origin to anastomosis is presented using 16-slice multidetector computed tomography (MDCT). Twenty-six male patients (mean age 58.1{+-}6.7 years) with GEA grafts were scanned according to a protocol of an ECG-synchronised cardiac scan followed by a thoracoabdominal scan. To terminate the scan at the correct anatomical level, the lowest level of the GEA was coded based on the lumbar vertebrae level. Scores ranging from one (excellent) to four (bad) were assigned to evaluate visualisation quality of the grafts. GEA grafts were assessable in 62% of the thoracoabdominal scans and 69% of the cardiac scans. On average, the lowest part of the GEA corresponded with a level between L1 and L2, in two cases in the upper part of L3. Mean visualisation score in the thoracoabdominal scans and cardiac scans was good (respectively 1.4{+-}0.6 and 1.4{+-}1.0). Sixteen-slice MDCT is a promising alternative for catheterisation in evaluating patency of GEA grafts, using the presented protocol with thoracoabdominal scan including L3 for complete coverage of the GEA graft. (orig.)

  18. Hiatal hernia causing extrapericardial tamponade after coronary bypass surgery.

    Science.gov (United States)

    Papoulidis, Pavlos; Beatty, Jasmine Winter; Dandekar, Uday

    2014-10-01

    Cardiac tamponade is defined as compression of the heart due to accumulation of fluid in the pericardial sac, leading to raised pericardial pressures with haemodynamic compromise. We describe the case of a 76-year old female patient who underwent a routine off-pump coronary artery bypass graft operation and within 48 h developed classic signs of cardiac tamponade. The perioperative echocardiogram and operative findings at re-exploration revealed no clots or fluid collection. A giant hiatus hernia was found to be responsible for the tamponade through extrinsic compression. After insertion of a nasogastric tube and decompression of the stomach, there was a rapid improvement of the clinical picture. The remaining postoperative course was uneventful and the patient was discharged 5 days later, with referral to the general surgeon for further management. We conclude that, in cases of tamponade post-cardiac surgery, extrapericardial pathologies should be considered.

  19. Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval

    DEFF Research Database (Denmark)

    Nørgaard, Lone Nikoline; Gjerris, Anne Cathrine Roslev; Kirkegaard, Ida;

    2014-01-01

    OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton...... and early or late fetal growth in pregnancies conceived after gastric bypass surgery....

  20. Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Anil Karlekar

    2015-01-01

    Full Text Available Background: Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG surgery, as a component of multimodal analgesia (MMA technique. Methods: This open observational prospective study comprised of 100 adult patients (84 male, 16 female who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS. The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm 2 sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test. Results: The mean (standard deviation [SD] VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94 while on MMT; the same fell to 4.0 (1.279 and 3.40 (2.697 at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000. Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] - 6.38 [0.868] at 24 th h. After receiving the 2 nd dose of laser the VRS scores fell significantly (P = 0.000 and became 0 at 54 th h. No patients required 3 rd dose of the laser. No patient

  1. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

    NARCIS (Netherlands)

    Severdija, E.E.; Vranken, N.P.; Teerenstra, S.; Ganushchak, Y.M.; Weerwind, P.W.

    2015-01-01

    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A t

  2. Ex-situ liver surgery without veno-venous bypass

    Institute of Scientific and Technical Information of China (English)

    Ke-Ming Zhang; Xiong-Wei Hu; Jia-Hong Dong; Zhi-Xian Hong; Zhao-Hai Wang; Gao-Hua Li; Rui-Zhao Qi

    2012-01-01

    AIM:To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.METHODS:In 3 patients with liver tumor,the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation.It was impossible to resect the tumors by the routine hepatectomy,so the patients underwent ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.All surgical procedures were carried out or supervised by a senior surgeon.A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.We also compared our data with the 9 cases of Pichlmayr's group.RESULTS:Three patients with liver tumor were analysed.The first case was a 60-year-old female with a huge haemangioma located in S1,S4,S5,S6,S7 and S8 of liver; the second was a 64-year-old man with cholangiocarcinoma in S1,S2,S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1,S5,S7 and S8.The operation time for the three patients were 6.6,6.4 and 7.3 h,respectively.The anhepatic phases were 3.8,2.8 and 4.0 h.The volume of blood loss during operation were 1200,3100,2000 mL in the three patients,respectively.The survival periods without recurrence were 22 and 17 mo in the first two cases.As for the third case complicated with postoperative hepatic vein outflow obstruction,emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day,and finally died of liver and renal failure on the third day.Operation time (6.7 ± 0.47h vs 13.7 ± 2.6 h) and anhepatic phase (3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr's group and our series (P =0.78).CONCLUSION:Ex-situ liver resection and liver autotransplantation has shown a potential

  3. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone

    2011-01-01

    bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. Interestingly, however, it has been described that improvement...... of psoriasis is initiated immediately following surgery before any weight loss could have happened. We hypothesize that the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1) is responsible for this effect. The levels of GLP-1 have been shown to increase up to 20 times after gastric bypass...... surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis...

  4. Krukenberg tumor after gastric bypass for morbid obesity: Bariatric surgery and gastric cancer

    Directory of Open Access Journals (Sweden)

    Pablo Menéndez

    2013-06-01

    Full Text Available Gastric by-pass is one of the most performed surgical procedure in bariatric surgery. Neoplasm within gastric remnant is a slightly frequent complication (only six cases have been described but with important survival consequences. We present a case of a patient who developed an adenocarcinoma in excluded stomach, after three years of bariatric surgery; the tumor was incidentally discovered after a gynecological surgery for uterine myomas. Different diagnostic modalities for the excluded stomach were analyzed.

  5. Buprenorphine pharmacokinetic parameters during coronary artery bypass graft surgery.

    Science.gov (United States)

    Amani, A; Joseph, T; Balasaraswathi, K

    1997-10-01

    The pharmacokinetic parameters of buprenorphine (BN) after a single bolus dose of 10 microg/kg i.v. was investigated in 6 male patients whose age averaged 59+/-9.8 years and body weight of 65.8+/-5.7 kg undergoing coronary artery bypass graft surgery (CABG). The unbound BN plasma concentrations were detected using ultrafiltration and high performance liquid chromatography/electro-chemical detection (HPLC/ECD) method. During cardiopulmonary bypass (CPB) there was a fall in BN plasma concentrations, observations similar to reports on fentanyl, sufentanil and alfentanil. This is probably due to haemodilution, hypothermia and hydrophobic sequestration of drug on to the CPB tubing. After CPB the concentrations rose to values higher than during CPB, though it did not attain pre CPB concentrations. These variations were not statistically significant indicating that plasma levels were adequately stable during CPB. The plasma concentration time curves were biexponential and the pharmacokinetic parameters obtained were : distribution half-life 37.24+/-6.57 min, elimination half-life 482.69+/-79 min, clearance 1221.97+/-209.42 ml/min, and volume of distribution 736.46+/-71.25 L. BN in the dose used follows the pharmacokinetic pattern of other commonly used narcotics during CABG. The mean +/- SEM plasma BN concentration during CPB was 0.51+/-0.03 ng/ml which was adequate for the maintenance of analgesia and anaesthesia, as none of our patients expressed the signs and symptoms of awareness during surgery. Further, unlike the other narcotics muscle rigidity was absent. Thus BN is a safe and good alternative to other narcotics for patients undergoing CABG.

  6. Changes in left ventricular functions after coronary artery by-pass surgery

    Directory of Open Access Journals (Sweden)

    Habib Çil

    2010-09-01

    Full Text Available Objectives: The aim of this study was to evaluate the left ventricular functions with transthoracic echocardiography after coronary bypass surgery.Methods: Sixty-four patients who underwent coronary bypass surgery between January 2008 and March 2009 were retrospectively evaluated. The diagnosis, age and gender of the patients, presence of diabetes mellitus and/or hypertension, smoking, and left ventricle functions before and after surgery were recorded.Results: The mean age of the patients was 58 ± 6,2 years. Forty-four of 64 patients were male, and 20 were female. The lowest ejection fraction was measured in two patients as 30% preoperatively. The mean preoperative and postoperative left ventricle ejection fractions were 48 ± 5.4% and 58 ± 2.4% respectively. This difference was found statistically significant. The mortality rate of by-pass surgery was 4.68% (3 patients.Conclusion: The left ventricular functions were significantly recovered after coronary by-pass surgery.

  7. Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

    Directory of Open Access Journals (Sweden)

    Mingyi Chen

    2013-01-01

    Full Text Available Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

  8. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Salameh, Aida; Dhein, Stefan; Dähnert, Ingo; Klein, Norbert

    2016-01-01

    Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain. PMID:27879647

  9. Five-year Irish trial of CLI patients with TASC II type C/D lesions undergoing subintimal angioplasty or bypass surgery based on plaque echolucency.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2009-06-01

    To report a 5-year observational parallel group study comparing the effectiveness of subintimal angioplasty (SIA) to bypass grafting (BG) for treatment of TASC II type C\\/D lesions in the lower limb arteries of patients with critical limb ischemia (CLI).

  10. No Islet Cell Hyperfunction, but Altered Gut-Islet Regulation and Postprandial Hypoglycemia in Glucose-Tolerant Patients 3 Years After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Dirksen, Carsten; Eiken, Aleksander; Bojsen-Møller, Kirstine N

    2016-01-01

    Postprandial hyperinsulinemia characterizes Roux-en-Y gastric bypass (RYGB) and sometimes leads to reactive hypoglycemia. We prospectively evaluated changes in beta cell function in seven RYGB-operated patients with a median follow-up of 2.9 years with hyperglycemic clamps and oral glucose tolera...

  11. Roux-en-Y gastric bypass surgery of morbidly obese patients induces swift and persistent changes of the individual gut microbiota

    DEFF Research Database (Denmark)

    Palleja, Albert; Kashani, Alireza; Allin, Kristine Højgaard;

    2016-01-01

    BACKGROUND: Roux-en-Y gastric bypass (RYGB) is an effective means to achieve sustained weight loss for morbidly obese individuals. Besides rapid weight reduction, patients achieve major improvements of insulin sensitivity and glucose homeostasis. Dysbiosis of gut microbiota has been associated...

  12. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  13. Predicting Blood Transfusion Factors in Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    L. Kasraian

    2007-04-01

    Full Text Available Introduction & Objective: The ability to predict the use of blood components during bypass surgery will improve the blood banks ability to provide efficient service.Materials and Methods: This is a retrospective cross-sectional study that was carried out on patients that underwent CABG in Shiraz Namazi hospital in 2004. The sample size was 480 and we did systematic random sampling, and a questionnaire contained factors that effect on blood need was filling out. Independent t-test, multivariate logistic regression and Poason correlation were used for data analysis.Results: The average age of patients was 59.15±10.6 years, 69.2% were male and the mean Hct before surgery was 39.86±6.38% and after operation was 32.68±5.84% and the duration of surgery was 2 hours and 48 minutes. The average of pack cell was 5.76±1.52 unit and average of FFP was 2.82±7.72 unit. There was not significant correlation between ages, weighs, Hct before and after, sex and pack cell use (P> 0.05. The use of pack cell and FFP were more in urgent surgery in diabetic patients and vascular disease (P< 0.05.Conclusion: It seems that the rate of blood demanding in proportion to blood use is logical but the rate of blood usage is more than blood usage in other countries with considering of immunological and non-immunological complication of blood products, the heart surgeons must do special concern about the making decision for blood use.

  14. 腹腔镜胃旁路手术治疗2型糖尿病的围手术期护理%Perioperative nursing of patients with type Ⅱ diabetes mellitus treated by laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    穆丽茜; 尹建花; 周晓俊

    2012-01-01

    目的 探讨2型糖尿病患者行腹腔镜下胃旁路手术围手术期的护理方法.方法 对25例2型糖尿病行腹腔镜下胃旁路手术患者实施围手术期护理,并进行术后随访.结果 对25例患者按糖尿病诊断标准做葡萄糖耐量试验,空腹血糖、餐后2h血糖提示糖尿病病情明显好转.结论 针对性的围手术期护理对2型糖尿病腹腔镜胃旁路手术患者的康复具有积极的意义.%Objecyive To investigate the perioperative nursing of type Ⅱ diabetes mellitud treated by laparoscopic gastric bypass surgery.Methods Pefioperative nursing and follow up were performed for twenty five patients with type Ⅱ diabetes who were treated by laparoscopic gastric bypass surgery.Results The conditions of these patients were improved significantly by prompts of fasting blood glucose and 2h post-prandial blood glucose after glucose tolerance test was performed for every patient.Conclusions Pertinent perioperative nursing has proactive effect on recovery of patients with type diabetes mellitus and treated by laparoscopic gastric bypass.

  15. Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication

    OpenAIRE

    Zalesin, Kerstyn C.; Wendy M. Miller; Barry Franklin; Dharani Mudugal; Avdesh Rao Buragadda; Judith Boura; Katherine Nori-Janosz; David L. Chengelis; Krause, Kevin R.; McCullough, Peter A

    2010-01-01

    Introduction. Few data are available on vitamin A deficiency in the gastric bypass population. Methods. We performed a retrospective chart review of gastric bypass patients (n = 69, 74% female). The relationship between serum vitamin A concentration and markers of protein metabolism at 6-weeks and 1-year post-operative were assessed. Results. The average weight loss at 6-weeks and 1-year following surgery was 20.1 ± 9.1 kg and 44.1 ± 17.1 kg, respectively. At 6 weeks and 1 year after surgery,...

  16. Studies on cerebral hemodynamics by single photon emission computerized tomography, 2; Evaluation of the hemodynamics before and after bypass surgery in patients with cerebrovascular occlusive disease using sup 133 Xe inhalation and single photon emission computerized tomography

    Energy Technology Data Exchange (ETDEWEB)

    Imao, Yukinori (Gifu Univ. (Japan). Faculty of Medicine)

    1991-05-01

    Cerebral blood flow (CBF) was measured by using Xe-133 inhalation method before and after administration of Diamox (DM) to evaluate the hemodynamics in a total of 34 patietns with cerebrovascular occlusive disease. Hemodynamic changes after bypass surgery were also evaluated. According to CBF findings and DM reactivity, the patients were divided into 4 types: (1) normal findings in both CBF and DM reactivity, suggesting well-developed collateral circulation and normal cerebral perfusion pressure (CPP), (2) decrease in CBF, probably due to reduction in the metabolic demand, and normal DM reactivity, (3) normal CBF and decreased DM reactivity, suggesting moderate vasodilation due to reduced CPP, and (4) decreased CBF and impaired DM reactivity. One patient in the group of type 1 had transient hemiplegia after administration of DM. Retrograde ophthalmic flow or collateral flow via leptomeningeal anastomosis on angiograms was frequently associated with impairment of DM reactivity, suggesting reduction of CPP. CBF on the operation side was increased by bypass surgery. Most of the patients recovered from impaired DM reactivity after surgery. Of 13 patients having impaired DM reactivity, 9 had obviously increased cerebral blood volume (CBV) on the occluded side compared with the non-occluded side. In the remaining 4 patients, CBV did not increase on the occluded side. Impaired DM reactivity may not necessarily be caused by the compensative increase in CBV, i.e. vasodilation, due to reduced CPP. (N.K.) 57 refs.

  17. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal

    DEFF Research Database (Denmark)

    Goldfine, A B; Mun, E C; Devine, E

    2007-01-01

    are increased after GB and may promote excessive beta-cell function and/or growth. PATIENTS AND METHODS: We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia...... and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher...

  18. Activation of hemostasis after off-pump coronary artery bypass graft surgery

    NARCIS (Netherlands)

    Lo, B.

    2007-01-01

    The aim of this thesis was to study the activation of hemostasis and inflammation, in patients undergoing off-pump (OPCAB) and on-pump coronary artery bypass graft (CABG) surgery and the relationship of coagulation and inflammation to clinical outcome. We hypothesized that activation of hemostasis a

  19. The use of a Perma-Flow graft for coronary artery bypass surgery.

    Science.gov (United States)

    Schmid, C; Weyand, M; Kerber, S; Breithardt, G; Scheld, H H

    1996-01-01

    We report on our first clinical use of a Perma-Flow graft for coronary artery bypass surgery (CABG). It may well be that repeated successful use of this graft will offer a chance for revascularization to patients who might otherwise have been denied for lack of appropriate vessels.

  20. Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Flavia Baggio Nerbass

    2010-01-01

    Full Text Available INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0, during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3 using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m² were randomized into control (n = 20 and massage therapy (n = 20 groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006 and Day 2 (p=0.028 in addition, they reported a more effective sleep during all three days (p=0.019 when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

  1. Breast cancer biomarkers predict weight loss after gastric bypass surgery

    Directory of Open Access Journals (Sweden)

    Sauter Edward R

    2012-01-01

    Full Text Available Abstract Background Obesity has long been associated with postmenopausal breast cancer risk and more recently with premenopausal breast cancer risk. We previously observed that nipple aspirate fluid (n levels of prostate specific antigen (PSA were associated with obesity. Serum (s levels of adiponectin are lower in women with higher body mass index (BMI and with breast cancer. We conducted a prospective study of obese women who underwent gastric bypass surgery to determine: 1 change in n- and s-adiponectin and nPSA after surgery and 2 if biomarker change is related to change in BMI. Samples (30-s, 28-n and BMI were obtained from women 0, 3, 6 and 12 months after surgery. Findings There was a significant increase after surgery in pre- but not postmenopausal women at all time points in s-adiponectin and at 3 and 6 months in n-adiponectin. Low n-PSA and high s-adiponectin values were highly correlated with decrease in BMI from baseline. Conclusions Adiponectin increases locally in the breast and systemically in premenopausal women after gastric bypass. s-adiponectin in pre- and nPSA in postmenopausal women correlated with greater weight loss. This study provides preliminary evidence for biologic markers to predict weight loss after gastric bypass surgery.

  2. Assessment of long-term effects of aneurysms trapping and extracranial-intracranial bypass surgery in patients with complex cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    MAO Zhi-qi

    2012-02-01

    Full Text Available Objective To study the long-term effects of extracranial-intracranial (EC-IC bypass and aneurysms trapping in patients with complex cerebral aneurysms. Methods Seventeen patients with complex aneurysms, who underwent EC-IC bypass and aneurysms trapping from 2008 to 2009, were followed up. Clinical records were reviewed, modified Rankin Scale (mRS was recorded at admission, discharging, and follow-up point, and activities of daily living (ADL scale (Barthel Index at admission and follow-up point. Results Seventeen patients (11 males and 6 females were followed up. At admission mRS scores were 1.06 ± 0.87, Barthel index 91.10 ± 10.30. Superficial temporal artery-middle cerebral artery (STA-MCA was performed in 8 cases, extracarotid artery-great saphenous vein-middle cerebral artery (ECA-GSV-MCA in 5 cases, extracarotid artery-radial artery-middle cerebral artery (ECA-RA-MCA in 3 cases, occipital artery-posterior inferior cerebellar artery (OA-PICA in 1 case. Patients were followed up for 19-39 months (mean 28.67 months. At follow-up point, 2 patients (11.76% died, operation-related mortality was 5.88% (1/17, operation-related morbidity 5.88% (1/17, mRS scores 1.07 ± 1.16, Barthel index 96.40 ± 10.30. Conclusion Patients with complex aneurysms who were impossible to be treated with surgical clipping or endovascular intervention could be cured with extracranial-intracranial bypass and aneurysms trapping, and good follow-up results were acquired.

  3. Psychological characteristics and associations with weight outcomes two years after gastric bypass surgery

    DEFF Research Database (Denmark)

    Beck, Nina N; Mehlsen, Mimi; Støving, René Klinkby

    2012-01-01

    This study investigated symptoms of eating disorder, depression, and anxiety among Roux-en-Y gastric bypass patients two years after surgery, and the relationship between these characteristics and weight loss. Respondents completed assessment questionnaires including Eating Disorder Inventory-2...... (EDI-2), Harvard Anxiety and Depression Scale (HADS), and questions related specifically to binge eating. Forty-five patients (8 men, 37 women) out of 65 (67%) responded. Scores were significant higher on impulse regulation, interoceptive awareness, ineffectiveness, maturity fears and interpersonal...... that knowledge of the potential influence of eating disorder symptoms on outcomes after bariatric surgery is needed in order to optimize weight outcomes following surgery....

  4. The management of cardiopulmonary bypass in patients undergoing mitral valve replacement surgery with total video thoracoscope%全胸腔镜下二尖瓣置换的体外循环管理

    Institute of Scientific and Technical Information of China (English)

    周和平; 孙国成; 陈涛; 熊红燕; 冯建宇; 金振晓

    2011-01-01

    目的 总结全胸腔镜下二尖瓣置换手术的体外循环的管理方法.方法 85例二尖瓣病变患者,采用全胸腔镜下二尖瓣置换术,对体外循环建立方法、体外循环管理及手术后结果进行评价.结果 85例患者体外循环时间为90~155(120.7±17.4) min,升主动脉阻断时间40~90(51.2±9.1)min.所有患者手术过程顺利.术后均恢复良好,无严重并发症.结论 全胸腔镜下二尖瓣置换术的体外循环方法安全、可行.%Objective To summarize the management of cardiopulmonary bypass ( CPB ) in patients undergoing mitral valve replacement surgery with total video thoracoscope. Methods Eighty - five consecutive patients with mitral valve diseases undergoing mitral valve replacement surgery with total video thoracoscope were included. The methods of CPB setup and the precise management during surgery and the clinical results were evaluated. Results The CPB time of the patients was 90 - 155 ( 120.7 ± 17. 4 ) min and the aortic - clamping time was 40- 90(51.2±9.1 ) min. One patient had bleeding due to aortic purse string loose after CPB disconnection, which resulted in unstable hemodynamics and necessitated urgent treatment, then recovered uneventfully. All other patients recovered well without any severe complications. Conclusion The cardiopulmonary bypass of mitral valve replacement surgery with total vedio thoracoscope is safe and practical.

  5. Transient hyperperfusion after extracranial-intracranial bypass surgery on brain perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yu Kyeong; Oh, Chang Wan; Cho, Sang Soo; Lee, Eun Ju; Eo, Jae Seon; Lee, Won Woo; Kim, Sang Eun [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-07-01

    We designed this study to investigate the transient relative hyperperfusion and its clinical implication after STA (superficial temporal artery) to MCA (middle cerebral artery) bypass surgery in patients with ischemic cerebral stroke. In 25 patients, comprising of 11 moyamoya disease (MMD) and 14 atherosclerotic disease (ASD), STA-MCA anastomosis was performed to distal cortical branches of middle cerebral artery for revascularization. 99mTc-ECD brain perfusion SPECT was performed before, 3 days and then 10 days after bypass surgery. Each image was spatially normalized into the standard space and changes of brain perfusion in the entire internal carotid artery (ICA) territory were evaluated using standardized ROIs. In the overall analysis including all patients, the surgery effectively increased ICA territory perfusion on the 3rd and 10th day after bypass surgery in comparison with the preoperative one (p<0.01 and p=0.03). The 3rd day perfusion was significantly higher than the 10th day one (p<0.01), demonstrating transient relative hyperperfusion on the 3rd day compared with the 10th day. In MMD group, such transient increase of perfusion was most severe in the vicinity of the anastomosis site, and more definite than the ASD group. Three patients, 2 ASD and one MMD, showed temporary neurological deterioration (dysphasia or dysarthria) beginning within 3 days after surgery and resolving completely within 2 weeks after onset, without hemorrhage, infarction or other serious defects on CT scan. Their neurological changes correlated well with the focal perfusion changes confirmed by SPECT images on the 3rd and 10th postoperative day. Transient relative hyperperfusion was observed on postoperative 3rd day compared with the 10th day following STA-MCA bypass surgery. In some patients, such transient increase of focal perfusion seems to provoke temporary neurological deterioration.

  6. Iodine-123 IMP SPECT before and after by-pass surgery in a patient with occlusion of left anterior and middle cerebral arteries with basal abnormal telangiectasis (unilateral Moyamoya disease)

    Energy Technology Data Exchange (ETDEWEB)

    Honda, Norinari; Machida, Kikuo; Takishima, Teruo; Kaizu, Hiroyuki; Sugimoto, Eiichi

    1987-09-01

    A case of left anterior and middle cerebral arterial occlusion with angiographic features similar to Moyamoya disease was reported. IMP SPECT of the patient revealed the success of by-pass surgery clearly. The patient complained of transient right hemiparesis with aphasia 4 times. The cerebral arteriography disclosed occlusions of left anterior and middle cerebral arteries at their proximal portions. Right internal carotid and its branches were normal. I-123 IMP SPECT study showed hypoperfusion in left temporal lobe, basal ganglia with incomplete reperfusion on the delayed (4 hours after injection) SPECT images. After the superficial temporal-middle cerebral artery anastomosis, I-123 IMP SPECT showed improvement of the brain blood flow. I-123 IMP SPECT was very useful in detecting the ischemic areas and evaluating the revascularizing surgery in this case.

  7. On-pump versus off-pump coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

    Off pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized controlled trials . Co...

  8. Predictors of cognitive function in candidates for coronary artery bypass graft surgery.

    Science.gov (United States)

    Ernest, Christine S; Elliott, Peter C; Murphy, Barbara M; Le Grande, Michael R; Goble, Alan J; Higgins, Rosemary O; Worcester, Marian U C; Tatoulis, James

    2007-03-01

    Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.

  9. [Mesenteric traction syndrome during coronary artery bypass graft surgery].

    Science.gov (United States)

    Koyama, K; Kaneko, I; Mori, K

    1997-02-01

    Mesenteric traction syndrome (MTS) consists of decreased systemic vascular resistance, increased cardiac output, facial flushing and palmar erythema. Local production of PGI2 is thought to be the cause. We experienced a rare case of MTS that occurred during coronary artery bypass graft surgery (CABG). A 64-year-old man was scheduled for CABG for the treatment of angina pectoris. Hemodynamic variables were stable until 50 minutes after surgical incision. Blood pressure fell down suddenly from 110/50 to 70/40 mmHg, accompanied by obvious facial flushing and palmar erythema, when the surgeons were preparing the right gastroepiploic artery. Hemodynamic changes and cutaneous hyperemia returned to the baseline level in about 40 minutes. After this episode, the operation was performed uneventfully. The time sequence between the onset of the surgical procedure and the hemodynamic and cutaneous findings strongly suggest the release of PGI2 and MTS. In patients undergoing CABG with the gastroepiploic artery graft, pretreatment with NSAID might avoid sudden circulatory changes of MTS.

  10. Development of techniques for gastrojejunal bypass surgery in obese mice.

    Science.gov (United States)

    Lan, Zhu; Zassoko, Roman; Liu, Weihua; Garcia, Bertha; Sun, Hongtao; Wang, Rennian; Wang, Hao

    2010-05-01

    We have previously described a duodenojejunal bypass (DJB) surgical model in healthy C57BL/6 mice. However, our pilot study showed that the same surgical technique caused a high mortality rate in obese mice. In this study, to significantly improve animal survival rate following bariatric surgery and thereby providing a stable surgical model for the study of glucose homeostasis in obese mice, we have used modified techniques and developed the end-to-side gastrojejunal bypass (GJB) surgery in obese C57BL/6 with impaired glucose tolerance. The modification consisted of using the distal part of the jejunum for biliopancreatic diversion including: 1) ligation of the distal stomach at the level of the pylorus; 2) connection the jejunum to the anterior wall of stomach in an end-to-side fashion; and 3) diverting the biliopancreatic secretions through the blind limb into the distal jejunum through an end-to-side anastomosis. We found that by modifying the proximal end-to-end duodenojejunal anastomosis, described in our original model, to an end-to-side gastrojejunal anastomosis in these obese mice, we were able to significantly improve the postoperative mortality in this study. We have also demonstrated that performing the GJB surgery in obese mice resulted in significant weight loss, normalized blood glucose levels, and prevented acute pancreatitis. This newly developed GJB surgery in the obese mice offers a unique advantage to study the mechanisms of gastrointestinal surgery as treatment for type 2 diabetes.

  11. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review

    Institute of Scientific and Technical Information of China (English)

    Phillip J Tully; Robert A Baker

    2012-01-01

    Research to date indicates that the number of coronary artery bypass graft (CABG) surgery patients affected by depression (i.e., major, minor, dysthymia) approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsychological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.

  12. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J

    1997-01-01

    . In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...... antiplatelet therapy or vein graft diameter. Only 2 of the 20 intragraft platelet depositions occurred in areas where intra-operative vascular injury was suspected. In the composite graft and the PTFE grafts, diffuse activity was observed throughout the entire bypass. In conclusion, focal activity...

  13. Increased neutrophil priming and sensitization before commencing cardiopulmonary bypass in cardiac surgical patients

    NARCIS (Netherlands)

    Gu, YJ; Schoen, P; Tigchelaar, [No Value; Loef, BG; Ebels, T; Rankin, AJ; van Oeveren, W

    2002-01-01

    Background. Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative

  14. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT

    DEFF Research Database (Denmark)

    Frederiksen, Katrine Diemer; Hanson, Stine; Hansen, Stinus;

    2016-01-01

    Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral densit...... increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.......Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density...

  15. Vitamin a deficiency after gastric bypass surgery: an underreported postoperative complication.

    Science.gov (United States)

    Zalesin, Kerstyn C; Miller, Wendy M; Franklin, Barry; Mudugal, Dharani; Rao Buragadda, Avdesh; Boura, Judith; Nori-Janosz, Katherine; Chengelis, David L; Krause, Kevin R; McCullough, Peter A

    2011-01-01

    Introduction. Few data are available on vitamin A deficiency in the gastric bypass population. Methods. We performed a retrospective chart review of gastric bypass patients (n = 69, 74% female). The relationship between serum vitamin A concentration and markers of protein metabolism at 6-weeks and 1-year post-operative were assessed. Results. The average weight loss at 6-weeks and 1-year following surgery was 20.1 ± 9.1 kg and 44.1 ± 17.1 kg, respectively. At 6 weeks and 1 year after surgery, 35% and 18% of patients were vitamin A deficient, (Vitamin A directly correlated with pre-albumin levels at 6 weeks (r = 0.67, P vitamin A serum concentrations at these post-operative follow-ups. Vitamin A levels and markers of liver function testing were also unrelated. Conclusion. Vitamin A deficiency is common after bariatric surgery and is associated with a low serum concentration of pre-albumin. This fat-soluble vitamin should be measured in patients who have undergone gastric bypass surgery and deficiency should be suspected in those with evidence of protein-calorie malnutrition.

  16. Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery

    Directory of Open Access Journals (Sweden)

    Ricardo Antonio G. Barbosa

    2009-03-01

    Full Text Available PURPOSE: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10 or off-pump coronary artery bypass graft (group, n=10 coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 µg/mL. Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant. RESULTS: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 ± 117 vs. 216 ± 85 min, p = 0.04. Patients undergoing cardiopulmonary bypass had shorter biological (1.82 ± 0.5 vs. 3.67 ± 1.15h, p < 0.01 and terminal elimination (6.27 ± 1.29 vs. 10.5h ± 2.18, p < 0.01 half-life values, as well as higher total plasma clearance (28.36 ± 11.40 vs.18.29 ± 7.67 mL/kg/min, p = 0.03, compared to patients in the off-pump coronary artery bypass graft group. CONCLUSION: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

  17. Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

    Directory of Open Access Journals (Sweden)

    Elif Basagan-Mogo

    2010-01-01

    Full Text Available OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery. INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension. METHODS: Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg-1 (Group K or propofol 0.5 mg.kg-1 (Group P during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy. RESULTS: There were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01. CONCLUSION: There were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and

  18. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases.

    Science.gov (United States)

    Mannell, A; Becker, P J; Nissenbaum, M

    1988-03-01

    The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour less than or equal to 10 cm in length with mediastinal invasion (n = 81); group C, tumour greater than 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P less than 0.001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour greater than 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.

  19. 重度肥胖患者胃肠分流术后低氧血症机制的分析%Hypoxaemia following gastric bypass surgery in morbidly obese patients

    Institute of Scientific and Technical Information of China (English)

    李靖; GeorgeSMCowan; 等

    2001-01-01

    Objective To investigate the influence of morbidly obesity on arterial oxygen partial pressure (PaO2) following gastric bypass surgery. Methods Preoperative lung function and blood gas analysis before and 1 to 5 days after abdominal surgery were performed on 61 morbidly obese patients and 55 patients with normal body weight. Results PaO2 first five days in obese group post-operatively and first 2 days after the surgery in control group were significantly lower than preoperative values(P<0.05). PaO2 first two days after surgery in obese group was significantly correlated with maximal voluntary ventilation and waist-hip ratio (P<0.000 1). Conclusion Postoperative hypoxaemia in morbidly obese patients following gastric bypass surgery is more severe and lasted longer than that in patients with normal body weight after selective abdominal surgery.%目的 研究重度肥胖对胃肠分流术后动脉血氧分压的影响。方法 对61例进行胃肠分流术的重度肥胖患者及55例择期腹部手术的正常体重患者进行术前肺功能、术前及术后1~5 d的血气分析检测。结果 肥胖组术后1~5 d、对照组术后1~2 d的动脉血氧分压较术前显著下降(P<0.05);肥胖组术后1~2 d动脉血氧分压与其最大分钟通气量及腰臀比显著相关(P<0.000 1)。结论 重度肥胖者较正常体重患者在腹部手术后发生低氧血症的程度较严重且持续时间长。

  20. Preoperative β-cell function in patients with type 2 diabetes is important for the outcome of Roux-en-Y gastric bypass surgery

    DEFF Research Database (Denmark)

    Lund, Michael Taulo; Hansen, Merethe; Skaaby, Stinna

    2015-01-01

    INTRODUCTION: A major part of the patients with type 2 diabetes (T2DM) show remission after Roux-en-Y gastric bypass (RYGB). This is the result of increased postoperative insulin sensitivity and β-cell secretion. The aim of the present study was to elucidate the importance of the preoperative β...... DI, a restoration of first phase ISR and β-cell glucose sensitivity were seen only in T2DMhigh . Remission of type 2 diabetes was 71 and 38% in T2DMhigh and T2DMlow , respectively. Postoperative postprandial GLP-1 concentrations increased markedly, but did not differ between the groups. CONCLUSION......: Our findings emphasize the importance of the preoperative of β-cell function for remission of diabetes after RYGB. This article is protected by copyright. All rights reserved....

  1. PROPOSAL OF A REVISIONAL SURGERY TO TREAT NON-INSULINOMA HYPERINSULINEMIC HYPOGLICEMIA POSTGASTRIC BYPASS

    OpenAIRE

    SAMPAIO-NETO, José; BRANCO-FILHO,Alcides José; NASSIF, Luis Sérgio; NASSIF, André Thá; MASI, Flávia David João De; XIMENEZ,Daniele Rezende

    2015-01-01

    Background : Hyperinsulinemic hypoglicemia with severe neuroglycopenic symptoms has been identified as a late and rare complication in patients submitted to Roux-en-Y gastric bypass. However, the potential gravity of its manifestations requires effective treatment of this condition. The absence of treatment makes it necessary to develop more effective clinical or surgical methods. Aim : To present one surgical option to revisional surgery in the treatment of hyperinsulinemic hypoglicemia M...

  2. Use of Janke-Barron retractor for exposure of the arteries during bypass surgery.

    Science.gov (United States)

    Bridges, K G; Tomasello, D N; Hoffman, W S; MacVaugh, H

    1982-09-01

    The Janke-Barron heart support was used successfully on 1500 patients who required coronary artery bypass surgery to at least two vessels. The significant advantages it provided were improved exposure and access to all coronary arteries, elimination of damage caused by an assistant holding the heart, provision of a dryer operating field, and allowance for a smaller incision without compromising exposure of the heart.

  3. Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Toft, P; Tønnesen, Else Kirstine; Zülow, I

    1997-01-01

    Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open......-heart surgery and eight with abdominal surgery were studied. The adhesion molecules CD11a/CD18 (LFA-1_, CD11c/CD18 and CD44 and the activation molecules CD25, CD69, CD71 and MHCII were measured, using monoclonal antibodies and flow cytometry. Lymphocytopenia was observed during CPB and for some hours after both...... open-heart and abdominal surgery. The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p

  4. Comparison of TIVA and Desflurane Added to a Subanaesthetic Dose of Propofol in Patients Undergoing Coronary Artery Bypass Surgery: Evaluation of Haemodynamic and Stress Hormone Changes

    Directory of Open Access Journals (Sweden)

    Didem Onk

    2016-01-01

    Full Text Available Introduction. Increased levels of stress hormones are associated with mortality in patients undergoing coronary artery bypass grafting (CABG. Aim. To compare total intravenous anaesthesia (TIVA and desflurane added to a subanaesthetic dose of propofol. Material and Methods. Fifty patients were enrolled in this study. Fentanyl (3–5 mcg/kg/h was started in both groups. Patients were divided into two groups. The PD group (n=25 received 1 minimum alveolar concentration (MAC desflurane anaesthesia in addition to propofol infusion (2-3 mg/kg/h, while P group (n=25 received propofol infusion (5-6 mg/kg/h only. Biochemical data, cortisol, and insulin levels were measured preoperatively (T0, after initiation of CPB but before cross-clamping the aorta (T1, after removal of the cross-clamp (T2, and at the 24th postoperative hour (T3. Results. Systolic, diastolic, and mean arterial pressure levels were significantly higher in PD group than those in P group in T1 and T2 measurements (p≤0.05. CK-MB showed a significant decrease in group P (p≤0.05. When we compared both groups, cortisol levels were significantly higher in PD group than P group (p≤0.05. Conclusion. Stress and haemodynamic responses were better controlled using TIVA than desflurane inhalation added to a subanaesthetic dose of propofol in patients undergoing CABG.

  5. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ram Prasad Kaushal

    2015-01-01

    Full Text Available Introduction: The concerns for induction of anaesthesia in patients undergoing cardiac surgery include hemodynamic stability, attenuation of stress response and maintenance of balance between myocardial oxygen demand and supply. Various Intravenous anaesthetic agents like Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used for anesthetizing patients for cardiac surgeries. However, many authors have expressed concerns regarding induction with thiopentone, midazolam and ketamine. Hence, Propofol and Etomidate are preferred for induction in these patients. However, these two drugs have different characteristics. Etomidate is preferred for patients with poor left ventricular (LV function as it provides stable cardiovascular profile. But there are concerns about reduction in adrenal suppression and serum cortisol levels. Propofol, on the other hand may cause a reduction in systemic vascular resistance and subsequent hypotension. Thus, this study was conducted to compare induction with these two agents in cardiac surgeries. Methods: Baseline categorical and continuous variables were compared using Fisher′s exact test and student′s t test respectively. Hemodynamic variables were compared using student′s t test for independent samples. The primary outcome (serum cortisol and blood sugar of the study was compared using Wilcoxon Rank Sum test. The P value less than 0.05 was considered significant. Results: Etomidate provides more stable hemodynamic parameters as compared to Propofol. Propofol causes vasodilation and may result in drop of systematic BP. Etomidate can therefore be safely used for induction in patients with good LV function for CABG/MVR/AVR on CPB without serious cortisol suppression lasting more than twenty-four hours.

  6. Two Invasive Thymomas Incidentally Found during Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Navid Omidifar

    2016-01-01

    Full Text Available Thymoma, the most common neoplasm of the anterior mediastinum, is a rare tumor of thymic epithelium that can be locally invasive. We reported 2 cases of invasive thymoma incidentally found during routine coronary artery bypass graft (CABG surgery at Faghihee Hospital of Shiraz University of Medical Sciences of Iran in a period of about 6 months. The 2 patients were male and above 60 years old. They had no clinical symptoms and radiological evidence of mediastinal mass before detection of the tumor during operation. For both patients mass was completely excised and sent to the laboratory. The ultimate pathological diagnosis of both masses was invasive thymoma (stage 2. There are few reports in which thymomas were found incidentally during cardiac surgery. In spite of rare coincidence, due to being asymptomatic and possibly invasive, special attention to thymus gland during cardiac surgery or other mediastinal surgery and preoperative imaging studies seem to be reasonable approach.

  7. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J;

    1997-01-01

    of flow in the graft. Platelet deposition was assessed by gamma-camera images of thigh and crus obtained 4 and/or 24 h after surgery. Areas of focally increased activity were recorded and graded as moderate or intense. In the 24 vein bypasses, a median of two (range 0-5) areas of focally increased....... In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...... radioactivity were seen at the proximal anastomosis (n = 21), in the body of the graft (n = 20) or at the distal anastomosis (n = 9). The activity was moderate in 27 cases and intense in 23 cases. Scintigraphic evidence of focal platelet aggregation in vein grafts was not correlated with preoperative...

  8. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone;

    2011-01-01

    of psoriasis is initiated immediately following surgery before any weight loss could have happened. We hypothesize that the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1) is responsible for this effect. The levels of GLP-1 have been shown to increase up to 20 times after gastric bypass...... surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis......Psoriasis is a common inflammatory skin disease and obesity constitutes a risk factor for the disease. Obese patients with psoriasis are often more difficult to treat and are at increased risk for dyslipidemia, diabetes, hypertension and cardiovascular disease. Case reports suggest that gastric...

  9. Plummer-Vinson syndrome following gastric bypass surgery.

    Science.gov (United States)

    Sapthavee, Andrew; Kircher, Matthew L; Akst, Lee M

    2014-09-01

    Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.

  10. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  11. Incidence and risk factors for the development of anemia following gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Dimitrios; V; Avgerinos; Omar; H; Llaguna; Matthew; Seigerman; Amanda; J; Lefkowitz; I; Michael; Leitman

    2010-01-01

    AIM:To evaluate the incidence and risk factors for the development of anemia after RouxenY gastric bypass (RYGB).METHODS: A retrospective analysis of patients undergoing RYGB from January 2003 to November 2007 was performed. All patients had a preoperative body mass index > 40 kg/m2. A total of 206 patients were evaluated. All patients were given daily supplements of ferrous sulfate tablets for 2 wk following their operation. Hematological and metabolic indices were routinely evaluated following surgery. Pa...

  12. Pyoderma gangrenosum, acne and suppurative hidradenitis syndrome following bowel bypass surgery.

    Science.gov (United States)

    Marzano, Angelo V; Ishak, Rim S; Colombo, Antonella; Caroli, Francesco; Crosti, Carlo

    2012-01-01

    The clinical triad of pyoderma gangrenosum (PG), acne and suppurative hidradenitis (PASH) has recently been described as a new disease entity within the spectrum of autoinflammatory syndromes, which are an emerging group of inflammatory diseases distinct from autoimmune, allergic and infectious disorders. PASH syndrome is similar to PAPA (pyogenic arthritis, acne and PG), but it differs in lacking the associated arthritis and on a genetic basis. PAPA syndrome is caused by mutations in a gene involved in the regulation of innate immune responses, the PSTPIP1, while no mutations have been detected to date in patients with PASH syndrome. We report a young male patient who developed coexisting disseminated PG, typical suppurative hidradenitis and acneiform eruption on the face, after he had undergone bowel bypass surgery for obesity. The cutaneous manifestations associated with bowel bypass syndrome often mimic PG or other neutrophilic dermatoses, suggesting a pathogenesis related to neutrophil-mediated inflammation for this condition. This is the first report describing PASH syndrome after bariatric surgery, and we propose to include such neutrophilic dermatoses in the list of complications occurring after bowel bypass surgery. Extensive genetic studies may help to clarify the etiopathogenesis of PASH as well as of autoinflammatory diseases in general.

  13. Minimally invasive cardiac surgery-coronary artery bypass graft.

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  14. Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial: assessing and monitoring the antithrombotic effect of clopidogrel and aspirin versus aspirin alone in hypercoagulable patients: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rafiq Sulman

    2012-04-01

    Full Text Available Abstract Background Hypercoagulability, assessed by the thrombelastography (TEG assay, has in several observational studies been associated with an increased risk of post-procedural thromboembolic complications. We hypothesize that intensified antiplatelet therapy with clopidogrel and aspirin, as compared to aspirin alone, will improve saphenous vein graft patency in preoperatively TEG-Hypercoagulable coronary artery bypass surgery (CABG patients and reduce their risk for thromboembolic complications and death postoperatively. Methods/Design This is a prospective randomized clinical trial, with an open-label design with blinded evaluation of graft patency. TEG-Hypercoagulability is defined as a TEG maximum amplitude above 69 mm. Two hundred and fifty TEG-Hypercoagulable patients will be randomized to either an interventional group receiving clopidogrel 75 mg daily for three months (after initial oral bolus of 300 mg together with aspirin 75 mg or a control group receiving aspirin 75 mg daily alone. Monitoring of antiplatelet efficacy and on-treatment platelet reactivity to clopidogrel and aspirin will be conducted with Multiplate aggregometry. Graft patency will be assessed with Multislice computed tomography (MSCT at three months after surgery. Conclusions The present trial is the first randomized clinical trial to evaluate whether TEG-Hypercoagulable CABG patients will benefit from intensified antiplatelet therapy after surgery. Monitoring of platelet inhibition from instituted antithrombotic therapy will elucidate platelet resistance patterns after CABG surgery. The results could be helpful in redefining how clinicians can evaluate patients preoperatively for their postoperative thromboembolic risk and tailor individualized postoperative antiplatelet therapy. Trial registration Clinicaltrials.gov Identifier NCT01046942

  15. Ischemia monitoring in off-pump coronary artery bypass surgery using intravascular near-infrared spectroscopy

    Directory of Open Access Journals (Sweden)

    Zerkowski Hans-Reinhard

    2006-05-01

    Full Text Available Abstract Background In off-pump coronary artery bypass surgery, manipulations on the beating heart can lead to transient interruptions of myocardial oxygen supply, which can generate an accumulation of oxygen-dependent metabolites in coronary venous blood. The objective of this study was to evaluate the reliability of intravascular near-infrared spectroscopy as a monitoring method to detect possible ischemic events in off-pump coronary artery bypass procedures. Methods In 15 elective patients undergoing off-pump myocardial revascularization, intravascular near-infrared spectroscopic analysis of coronary venous blood was performed. NIR signals were transferred through a fiberoptic catheter for signal emission and collection. For data analysis and processing, a miniature spectrophotometer with multivariate statistical package was used. Signal acquisition and analysis were performed before and after revascularization. Spectroscopic data were compared with hemodynamic parameters, electrocardiogram, transesophageal echocardiography and laboratory findings. Results A conversion to extracorporeal circulation was not necessary. The mean number of grafts per patient was 3.1 ± 0.6. An intraoperative myocardial ischemia was not evident, as indicated by electrocardiogram and transesophageal echocardiography. Continuous spectroscopic analysis showed reproducible absorption spectra of coronary sinus blood. Due to uneventful intraoperative courses, clear ischemia-related changes could be detected in none of the patients. Conclusion Our initial results show that intravascular near-infrared spectroscopy can reliably be used for an online intraoperative ischemia monitoring in off-pump coronary artery bypass surgery. However, the method has to be further evaluated and standardized to determine the role of spectroscopy in off-pump coronary artery bypass surgery.

  16. 胃转流手术对代谢综合征患者体脂分布改变的影响%Impact of gastric bypass surgery on body fat distribution in patients with metabolic syndrome

    Institute of Scientific and Technical Information of China (English)

    王瑜; 陈自谦; 戴露倢; 刘斌; 王畅; 黄盛

    2012-01-01

    目的 探讨胃转流术后代谢综合征患者体脂分布的改变情况.方法 2009年7月至2010年2月间南京军区福州总院前瞻性入组收治26例胃癌合并代谢综合征病例,行胃转流手术.分别于术前和术后1、4、12、48周,检测体质量指数(BMI)、腰围、臀围和脂肪面积等体脂参数,以及胰岛素抵抗指数(HOMA-IR)等生化指标.结果 胃转流术后,26例代谢综合征患者肥胖、高血压、血脂紊乱及高血糖均获得了不同程度的好转.术后48周,26例患者HOMA-IR由术前的5.7±1.5降至3.4±1.0,BMI由术前的(27.1±3.8) kg/m2降至(22.6± 1.4) kg/m2(P<0.05).其中心性肥胖指标腰围由术前的(95.3±2.5) cm降至(75.3±1.1) cm,内脏脂肪面积由术前的(101.7±13.8) cm2降至(78.7±11.2) cm2(P<0.05);而外周性肥胖指标皮下脂肪面积未见下降(P>0.05).结论 胃转流术后体脂分布由中心性肥胖向外周性肥胖转变;胰岛素抵抗改善与中心性体脂参数下降有关.%Objective To evaluate the changes in body fat distribution after gastric bypass in gastric cancer patients with metabolic syndrome. Methods From July 2009 to February 2010, 26 patients with gastric cancer and concurrent metabolic syndrome were prospectively enrolled and underwent gastric bypass surgery at the Fuzhou General Hospital of Nanjing Military Command.Body mass index (BMI),waist circumference,hip circumference,insulin and insulin resistance index were measured before operation and at postoperative 1,4,12,24,48 weeks. Results After gastric bypass surgery,metabolic syndrome was improved including obesity,hypertension,disturbance of lipid and hyperglycemia.After 48 weeks postoperatively HOMA-IR decreased from 5.7±1.5 to 3.4±1.0 (P<0.05).BMI decreased from (27.1±3.8) kg/m2 to (22.6±1.4) kg/m2 (P<0.05).Indices for central obesity:waist circumference decreased from (95.3±2.5)cm to (75.3±1.1)cm,and visceral fat area decreased from (101.7±13.8) cm2 to (78.7±11.2) cm2

  17. Coronary artery surgery without cardiopulmonary bypass: usefulness of the surgical blower-humidifier.

    Science.gov (United States)

    Maddaus, M; Ali, I S; Birnbaum, P L; Panos, A L; Salerno, T A

    1992-12-01

    Coronary artery bypass surgery can be performed without cardiopulmonary bypass (CPB). Bleeding obscuring the operative field and hemodilution of shed blood with irrigating saline are some of the drawbacks of this technique. We report the use of a newly developed surgical blower-humidifier (custom made [Research Medical, Inc.]) for improved visualization and facilitation of coronary artery surgery without CPB.

  18. Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

    Directory of Open Access Journals (Sweden)

    Malheiros Suzana M. F.

    2001-01-01

    Full Text Available Coronary artery bypass surgery (CABG without cardiopulmonary bypass (CPB may potentially reduce the number of microembolic signals (MES associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.

  19. Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77

    Directory of Open Access Journals (Sweden)

    Radmehr H

    2001-08-01

    Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

  20. Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; GU Cheng-xiong; WEI Hua; LIU Rui; CHEN Chang-cheng; FANG Ying

    2005-01-01

    Background Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery.Methods From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejection fraction was 26%±9%. The mean left ventricular, end diastolic diameter was (57.5±7.1) mm. The ventricular preoperative and postoperative performances were compared. χ2 test and Student's t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.Results Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P<0.001). The mean left ventricular, end diastolic diameter decreased significantly (P<0.001). Conclusions Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.

  1. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience.

    Science.gov (United States)

    Craver, J M; Weintraub, W S; Jones, E L; Guyton, R A; Hatcher, C R

    1992-01-01

    Six hundred ninety-nine patients have required emergency coronary artery bypass after failed elective percutaneous coronary angioplasty during the decade September 1980 through December 1990. This represents 4% of 9860 patients having 12,146 elective percutaneous coronary angioplasty procedures during this interval. Emergency coronary artery bypass was required for acute refractory myocardial ischemia in 82%. Hospital mortality rate for all patients was 3.1%; 3.7% in patients with refractory myocardial ischemia but 0.8% in patients without refractory myocardial ischemia, p = 0.08. Postprocedural Q-wave myocardial infarctions were observed in 21% versus 2.4%, p less than 0.0001, and intra-aortic balloon pumping was required in 19% with versus 0.8% without refractory myocardial ischemia, p less than 0.0001. Multivessel disease, p = 0.004, age older than 65 years, p = 0.005, and refractory myocardial ischemia, p = 0.08, interacted to produce the highest risk of in-hospital death. Follow-up shows that there have been 28 additional late deaths, including 23 of cardiac causes for a 91% survival at 5 years. Freedom from both late death and Q-wave myocardial infarction at 5 years was 61%. In the group going to emergency coronary artery bypass with refractory myocardial ischemia, the late cardiac survival was 90%, and in those without ischemia, 92% at 5 years, p = not significant. The MI--free survival in the group with refractory ischemia, however, was 56% versus 83% in the group without ischemia, p less than 0.0001. Multivariate analysis showed the highest late event rates for patients with Q-wave myocardial infarction at the initial emergency coronary artery bypass, age older than 65 years, angina class III or IV, and prior coronary bypass surgery. In spite of a continuing high incidence of early acute myocardial infarction and an increasing operative mortality rate (7%) in the latest 3 years cohort of patients, excellent late survival and low subsequent cardiac event

  2. Intravenous zinc therapy for acquired zinc deficiency secondary to gastric bypass surgery: a case report.

    Science.gov (United States)

    Vick, Garrett; Mahmoudizad, Rod; Fiala, Katherine

    2015-01-01

    Zinc deficiency may result from either a congenitally inherited defect of zinc absorption or is acquired secondarily from a variety of factors affecting dietary zinc intake, absorption, or loss. We report a case of acquired zinc deficiency secondary to gastric bypass surgery that resulted in vulvar cutaneous manifestations of delayed onset, with failure to clear after oral supplementation with zinc. The patient experienced improvement of symptoms only after administration of intravenous zinc supplementation. Upon review of the current literature, it is thought that the patient's original suboptimal response to oral supplementation and improvement after receiving intravenous zinc were related to the intentional surgical alteration and bypass of the absorptive capacity of the duodenum and jejunum. With the current prevalence of obesity and availability of surgical weight loss therapies, it is important to be mindful of the resulting nutritional deficiencies, their clinical manifestations, and factors affecting the efficacy of therapeutic approaches as seen in this case.

  3. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristinn; Andreasen, Jan Jesper; Torp-Pedersen, Christian

    2015-01-01

    . Methods: All patients who underwent isolated CABG in 1996-2012 in Denmark were identified through nationwide administrative registers and included. The cumulative incidence of admission to a nursing home after CABG was estimated. A cause specific Cox-regression model was constructed to identify predictors......O5 Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: A nationwide cohort study Kristinn Thorsteinsson, Jan Jesper Andreasen, Christian Torp Pedersen, Kirsten Fonager, Rikke Nørmark Mortensen, Kristian Kragholm, Gunnar Gislason, Lars Køber....... Aalborg, Denmark Background: Data on nursing home admission in patients >80 years of age after isolated coronary artery bypass grafting (CABG) are scarce. Aim: The purpose of this study was to evaluate longevity and subsequent admission to nursing home stratified by age in a nationwide CABG cohort...

  4. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery

    OpenAIRE

    Abdul Jabbar AlHassany, Ali

    2014-01-01

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual f...

  5. Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Worm, Dorte; Madsbad, Sten; Kristiansen, Viggo B

    2015-01-01

    BACKGROUND: Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS: A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24...... decreased from before surgery to month 24 for both men (9.3 ± 0.05 vs. 8.3 ± 0.08 mmol/L, p anemia was present in 25.8 % of women and 22.1 % of men. Predictors of anemia in both sexes were baseline hemoglobin (p ... sexes (p anemia, which especially affected premenopausal women. More attention should...

  6. 腹腔镜下胃转流术治疗2型糖尿病患者的围术期护理%Perioperative nursing of type 2 diabetes patients suffered from laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    肖玲; 刘丽秀; 李淑娟; 姜涛

    2014-01-01

    Objective To explore perioperative nursing of type 2 diabetes patients suffered from laparoscopic gastric bypass surgery .Methods Sixteen patients with type 2 diabetes underwent laparoscopic gastric bypass surgery patients , with preoperative comprehensive assessment , psychological counseling , strict monitoring and control of blood sugar , reasonable diet guide; postoperative closely cardiopulmonary function , blood glucose monitoring , decompression care , a reasonable nutritional support , prevention of complications , while focusing on hospital discharge follow-up dietary guidance and health .Results Sixteen patients were operated smoothly, and diabetes-related indicators (C-peptide, glycated hemoglobin, fasting blood glucose, postprandial blood glucose , etc.) were reduced to normal after one month , three months, six months and twelve months.Varying degrees of diabetes-related complications ease or even cure .Conclusions To give careful perioperative care , reduce the incidence of postoperative complications , and promote rapid recovery after surgery is a strong guarantee for the smooth operation and rehabilitation of type 2 diabetes patients suffered from laparoscopic gastric bypass surgery .%目的:探讨2型糖尿病患者行腹腔镜下胃转流术的围术期护理。方法对16例2型糖尿病行腹腔镜下胃转流术的患者进行术前综合评估,给予心理疏导,严格监测并控制血糖,指导合理膳食;术后密切关注患者心肺功能,监测血糖,加强胃肠减压护理,给予合理的营养支持,观察、预防并发症的发生,同时注重出院饮食指导及健康随访。结果16例患者手术均顺利进行,术后1,3,6,12个月复查糖尿病相关指标(C-肽、糖化血红蛋白、空腹血糖、餐后血糖等)均降至正常;糖尿病相关并发症均有不同程度缓解甚至治愈。结论对2型糖尿病行腹腔镜下胃转流术患者给予精心围术期护理,减少术后

  7. Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

    DEFF Research Database (Denmark)

    Toft, P; Nielsen, C H; Tønnesen, E

    1998-01-01

    Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... surgery. The ability to respond with an oxidative burst was measured by means of flow cytometry using 123-dihydrorhodamine. The adhesion molecules CD11a/CD18, CD11c/CD18, CD44 were measured using monoclonal antibodies. Blood samples from eight patients undergoing open-heart surgery were taken before...... surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes...

  8. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia.

    Science.gov (United States)

    Bashein, G; Nessly, M L; Bledsoe, S W; Townes, B D; Davis, K B; Coppel, D B; Hornbein, T F

    1992-06-01

    After more than 30 yr of use, electroencephalographic (EEG) monitoring during cardiopulmonary bypass has not gained wide clinical acceptance. To assess its utility to predict central nervous system injury, two-channel recordings were made from 78 patients undergoing cardiopulmonary bypass and anesthetized with fentanyl/diazepam/enflurane. The perfusion regimen included the use of high pump flow, a bubble oxygenator, and no arterial tubing filter. Target values were 28-32 degrees C for the minimum rectal temperature, 60-80 mmHg for mean arterial pressure, and 20-25% for hematocrit. Eight descriptors of the Fourier power spectra of the EEG were calculated off-line, and outcome comparisons were made with the results from neuropsychological tests. Among 58 patients yielding complete data of acceptable quality, a statistically significant reduction in total power was observed from prebypass to postbypass, accompanied by an increase in the fractional power in the theta and beta frequency bands and in the spectral edge frequency. The shifts in total and theta power were weakly associated with short-term but not with long-term changes in neuropsychological scores. Nearly 40% of the patients' EEGs were corrupted with electrical noise at some time during bypass. In 15 patients selected for having high-quality recordings and no neuropsychological deficit, an extensive statistical analysis failed to reveal any consistent variation in the EEG descriptors with hypothermia. Under the conditions studied, it appears that for other than gross signal dropout, the strong background variability in the EEG makes it have little value for detecting harbingers of brain injury.

  9. Assessment of Surgical Complications in Morbid Obese Patients, The Candidates for 2 Methods of Laparoscopic Bariatric Surgery (Laparoscopic Gastric Bypass, Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Pazouki

    2015-11-01

    Full Text Available Background In 2005, obesity rate was declared 396 million worldwide, which has been doubled in the last 20 years (compared with 1985. Obesity has a strong correlation with a pool of comorbidities and consequences. Although many modules, including behavioural approach and medications have presented particular short-term unreliable methods to reduce and control the body weight in morbid obesity, only 5 - 10% of weight loss was achieved, which is usually regained overtime, compared with 50 - 75% success rate in bariatric surgery. Objectives This retrospective study tried to monitor weight loss after LRYGB and LSG in morbid obese patients referred to a known center in Tehran through a one-year follow up. Materials and Methods Participants were selected regarding the U.S. National Institute of Health (NIH guidelines, which indicates BMI > 40 kg/m2 alone, or BMI > 35 kg/m2 in addition to comorbidities and failure of non-surgical attempts to control their weight. They were visited at points of one, three, six, and 12 months postoperatively to collect information about weight loss, BMI, and complications in addition to percent excess weight loss (EWL%. The percentage of failure was computed to the proportion of patients who had EWL% < 25 to the total number of operated patients in a year. Results Significant decrease in BMI and weight were achieved in all postoperative visits (for all of them, P value < 0.0001, while no significant difference was found in which the parameters between two studied procedures were in this regard. Conclusions To sum up, LRYGB and LSG deserve an overall preference not only in current study, but also in the majority of performances up to now. Nevertheless it is urgent the relevant studies to confirm the preference or improve this kind of bariatric surgery in order to diminish complications as far as possible.

  10. Attachment anxiety predicts poor adherence to dietary recommendations : an indirect effect on weight change 1 year after gastric bypass surgery

    NARCIS (Netherlands)

    Hinnen, C.; Aarts, F.; Geenen, R.

    2014-01-01

    BACKGROUND: Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whe

  11. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols

    DEFF Research Database (Denmark)

    Houlind, Kim; Fenger-Grøn, Morten; Holme, Susanne J;

    2014-01-01

    OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol. METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-...

  12. Attachment Anxiety Predicts Poor Adherence to Dietary Recommendations : an Indirect Effect on Weight Change 1 Year After Gastric Bypass Surgery

    NARCIS (Netherlands)

    Aarts, Floor; Geenen, Rinie; Gerdes, Victor E. A.; van de Laar, Arnold; Brandjes, Dees P. M.; Hinnen, Chris

    2015-01-01

    Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whether attachm

  13. Attachment anxiety predicts poor adherence to dietary recommendations : an indirect effect on weight change one year after gastric bypass surgery

    NARCIS (Netherlands)

    Aarts, F.; Geenen, R.; Gerdes, V.E.A.; Van de Laar, A., A.; Brandjes, D.P.M.; Hinnen, C.

    2015-01-01

    BACKGROUND: Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whe

  14. Adherence to treatment after coronary bypass surgery: Psychological aspects

    Directory of Open Access Journals (Sweden)

    Maria V. Iakovleva

    2016-01-01

    Full Text Available Poor adherence to treatment is a problem of great importance and striking magnitude. Its consequences are increased health care costs and poor health outcomes. It defined the objective of this research, which is the study of psychological characteristics of patients with different degrees of adherence to rehabilitation treatment after coronary bypass surgery. Ninety male and female patients with CHD, aged 46---71, were examined. The study was carried out using the questionnaire of ways of coping and the technique for diagnosing the types of attitude toward the disease, and the study of medical history. The analysis of the types of attitude toward the disease revealed that adherent patients show higher values on the harmonious type; patients with poor adherence show higher values on the apathetic, as well as the melancholic type of attitude toward illness. This study shows that wide range of psychological characteristics is significant for the definition of adherence to treatment. It is essential to consider the patient’s personality and his characteristics, such as attitude toward the disease, because they influence the adherence and, therefore, the effectiveness of therapy in the postoperative period. La escasa adherencia a la terapia es un problema de gran importancia ampliamente extendido. Sus consecuencias son el aumento de costes del tratamiento y su baja eficacia. El objetivo de la investigación fue el estudio de las características psicológicas de pacientes con diferentes grados de adherencia al tratamiento de rehabilitación después de la cirugía de derivación coronaria. Se recogieron datos clínicos de 90 pacientes de ambos sexos con cardiopatía coronaria, sometidos a cirugía de derivación coronaria, con edades comprendidas entre 46-71 a˜nos. Los cuestionarios administrados fueron el cuestionario de estilos de afrontamiento y la técnica de diagnóstico de tipos de actitud hacia la enfermedad. Además se realizó un estudio

  15. Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.

    Science.gov (United States)

    Nys, Monique; Venneman, Ingrid; Deby-Dupont, Ginette; Preiser, Jean-Charles; Vanbelle, Sophie; Albert, Adelin; Camus, Gérard; Damas, Pierre; Larbuisson, Robert; Lamy, Maurice

    2007-05-01

    Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.

  16. Transient cortical blindness and successful recovery after coronary bypass surgery.

    Science.gov (United States)

    Tasdemir, Kutay; Evereklioglu, Cem; Kaya, Mehmet G

    2011-10-01

    Left ventricular injury has a bad prognosis, especially when a coronary artery is involved. After perforation of the left cardiac ventricle by a knife, a 19-year-old male patient presented with: (i) complete bilateral visual loss; (ii) left anterior descending (LAD) artery injury; (iii) severe systemic hypotension. Under emergency conditions and cardiopulmonary bypass, the LAD artery was revascularized by a saphenous vein graft. Bilateral blindness recovered within several days. Cerebral hypoxia as a result of severe systemic hypotension was the most likely underlying mechanism.

  17. Anterior ischemic optic neuropathy after conventional coronary artery bypass graft surgery

    Science.gov (United States)

    Dorecka, Mariola; Miniewicz-Kurkowska, Joanna; Romaniuk, Dorota; Gajdzik-Gajdecka, Urszula; Wójcik-Niklewska, Bogumiła

    2011-01-01

    Summary Background Perioperative optic neuropathy is a disease which can lead to serious, irreversible damage of vision. This complication could be the result of non-ocular surgery, for example, cardiac or spinal procedures. We present a case of anterior ischemic neuropathy (AION) which occurred following a conventional coronary artery bypass graft procedure. Case Report A 57-year-old man, 4 days after Conventional Coronary Artery Bypass Graft surgery as result of multi-vessel stabile coronary artery disease and history of anterolateral wall myocardial infarction, was admitted to the Eye Clinic due to significant loss of vision in his right eye. The patient had hypertension and was a heavy smoker. On admission, the slit lamp examination revealed a relative afferent pupillary defect in the right eye. The fundus examination showed optic disc edema with the presence of flame hemorrhages. Best corrected visual acuity (BCVA) was 0.02. The results of eye examination and fluorescein angiography confirmed the diagnosis of AION. Anti-aggregation and antithrombotic treatment was continued with steroids and vasodilators. After 7 days of this treatment we noticed the improvement of BCVA to 0.2. At 6-month follow-up, the vision was stable, and fundus examination revealed optic disc atrophy. Conclusions After cardiac surgical operations, such as coronary artery bypass graft procedures, anterior ischemic optic neuropathy may occur. In those cases, close cooperation between the various specialists is necessary. PMID:21629193

  18. Guillain-Barré Syndrome after Coronary Artery Bypass Graft Surgery: a Case Report.

    Science.gov (United States)

    Hekmat, Manouchehr; Ghaderi, Hamid; Foroughi, Mahnoosh; Mirjafari, S Adeleh

    2016-01-01

    Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery. Guillain-Barré syndrome following cardiac surgery is rare and only based on case reports, and we review all of the published cases. A 52-year-old man after 5 months suffering from chest pain was referred to our hospital and underwent coronary artery bypass graft for 3 vessel disease. The patient was discharged without complication on the 5th postoperative day. He presented Guillain-Barré syndrome after 12 months. He has not completely recovered weakness of upper extremities grade 4/5 with atrophy of both upper extremities remains after 18 months. This disorder is similar to classic GBS. It is important to be alert to de novo autoimmune neurological disorders after cardiac surgery. These disorders are similar to classic autoimmune disease and treated with standard therapies.

  19. Jejunoileal bypass: A surgery of the past and a review of its complications

    Institute of Scientific and Technical Information of China (English)

    Dushyant Singh; Alexandra S Laya; Wendell K Clarkston; Mark J Allen

    2009-01-01

    Jejunoileal bypass (JIB), popular in the 1960s and 1970s, had remarkable success in achieving weight loss by creating a surgical short bowel syndrome. Our patient had an unusual case of liver disease and provided no history of prior bariatric surgery. Later, it was recognized that he had a JIB in the 1970s, which was also responsible for the gamut of his illnesses. Patients with JIB are often not recognized, as they died of complications, or underwent reversal of their surgery or a liver-kidney transplant. Early identification with prompt reversal, and the recognition and treatment of the life-threatening consequences play a critical role in the management of such patients.

  20. Off-pump and on-pump coronary artery bypass surgery:time to move on

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ To the editor: Chen and colleagues,1 and the editorial staff of the Chinese Medical Journal, deserve much credit for carrying out and publishing a prospective comparative study of on-pump and off-pump coronary artery bypass (OPCAB) surgery in 300 patients with triple-vessel coronary artery disease. Although this study is limited by non-randomization and selection bias yet contrary to the previously published prospective, randomized studies by Van Dijk et al,2 and Ascione et al,3 the patient population of this study is more representative of current coronary artery surgery practices. Even more important is the conclusion that OPCAB can be applied to patients with triple-vessel coronary artery disease and "in experienced hands" can achieve similar completeness of revascularization and similar early surgical results.

  1. Moxifloxacin dosing in post-bariatric surgery patients

    NARCIS (Netherlands)

    Colin, Pieter; Eleveld, Douglas J.; Struys, Michel M. R. F.; T'Jollyn, Huybrecht; Van Bortel, Luc M.; Ruige, Johannes; De Waele, Jan; Van Bocxlaer, Jan; Boussery, Koen

    2014-01-01

    Introduction Given the ever increasing number of obese patients and obesity related bypass surgery, dosing recommendations in the post-bypass population are needed. Using a population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) simulations, we investigated whether adequate moxifloxacin

  2. Obstructive and enteropathic syndromes after jejunoileal bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Karasick, D.; Karasick, S.

    1981-05-15

    Small bowel bypass procedures for morbid obesity have been associated with many postoperative complications. With the use of the Scott procedure, the bypassed or excluded small bowel segment has recently been the focus of 2 syndromes - 'bypass enteritis' and 'defunctioned bowel syndrome'. We describe these postoperative complications and present their significant radiologic features.

  3. Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

    Energy Technology Data Exchange (ETDEWEB)

    Carucci, Laura R. [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)]. E-mail: lcarucci@vcu.edu; Turner, Mary Ann [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)

    2005-03-01

    Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies.

  4. Is the Preoperative Administration of Amiodarone or Metoprolol More Effective in Reducing Atrial Fibrillation: After Coronary Bypass Surgery?

    Science.gov (United States)

    Onk, Oruc Alper; Erkut, Bilgehan

    2015-10-01

    This study examined the influence of preoperative administration of amiodarone and metoprolol in preventing postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery.The study comprised 251 patients who underwent CABG surgery at our hospital between January 2012 and May 2014. The patients were randomly divided into 2 groups: amiodarone therapy group (n = 122 patients) and metoprolol therapy group (n = 129 patients).In the amiodarone group, the patients received amiodarone tablet orally 1 week before coronary bypass surgery and during the postoperative period. In the metoprolol group, the patients received metoprolol tablet orally 1 week before surgery and during the postoperative period. The AF development rate was retrospectively evaluated between the first 3 days and 4 weeks after surgery.AF developed in 14 patients in the amiodarone group and 16 patients in the metoprolol group 4 weeks after the operation (P = 0.612).No significant difference was observed between the groups in terms of intensive care unit and hospital stay. Furthermore, hospital charges were similar in both groups (P = 0.741).The results of the logistic regression analysis showed age, left ventricular ejection fraction, left atrial diameter, and aortic cross-clamping time to be predictors for postoperative AF.This study demonstrates that amiodarone and metoprolol have similar effects in prevention of AF after cardiac surgery. However, larger-scale studies need to be conducted to substantiate these findings.

  5. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    Science.gov (United States)

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  6. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; P<0.01). The primary end point did not show significant differences in graft patency between groups. Secondary end points occurred more frequently in the in situ group (P=0.03), with 7-year rates of 34±10% in the in situ and 25±12% in the Y grafting groups, driven largely by a higher incidence of repeat revascularization in the in situ group (14±4.5% versus 7.4±3.2% at 7 years; P=0.009). There were no significant differences in hospital mortality or morbidity or in late survival, myocardial infarction, or stroke between groups. Conclusions— Three-year systematic angiographic follow-up revealed no significant difference in graft patency between the 2 BITA configurations. However, compared with in situ configuration, the use of BITA in a Y grafting configuration results in lower rates of major adverse cardiovascular and cerebrovascular events at 7 years. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  7. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy;

    2016-01-01

    increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological...

  8. Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue

    Directory of Open Access Journals (Sweden)

    Hafiz Abdul Moiz Fakih

    2016-02-01

    Full Text Available Background: Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB. Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery. Case presentation: We describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications. Conclusion: Preoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease.

  9. Drug-eluting stents:is it the beginning of the end for coronary artery bypass surgery?

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ Myocardial revascularization therapy of coronary artery disease is one of the most important medical advances of the past 50 years.1 Coronary revascularization by either bypass surgery or coronary angioplasty relieves angina and may improve the prognosis in patients with coronary artery disease.2,3 Randomized comparisons reveal no difference in survival free from myocardial infarction (MI) between surgery and balloon angioplasty.4,5 Stenting significantly improved the long-term outcome, while surgery is still associated with fewer reinterventions during follow-up.6-10 However, subsequent improvements in both percutaneous and surgical techniques may now limit the validity of any conclusions that have been drawn from the earlier studies. In fact, the lines of demarcation for patients suited for bypass or angioplasty are becoming blurry with each passing day.

  10. Failure of cryopreserved saphenous vein allografts following coronary artery bypass surgery.

    Science.gov (United States)

    Sellke, F W; Stanford, W; Rossi, N P

    1991-01-01

    Internal mammary arteries and saphenous vein grafts are the most satisfactory conduits for coronary artery bypass. However, at times these conduits are not available, due to previous use or poor quality. This paper reports our experience with 6 patients who underwent coronary artery bypass operations using 10 cryopreserved saphenous veins and internal mammary arteries. Postoperative graft patency was assessed with ultra fast computed tomography or cardiac catheterization. At operation, venous graft patency was 100% (10/10), at 1-8 weeks was 60% (6/10), and at 6-30 months was 0% (0/9). Alternately, all seven internal mammary artery grafts were patent at 2 to 18 months following surgery. One patient died 6 months following operation. Poor graft patency may be related to destruction of the cellular components or fibrosis resulting from the cryopreservation process or from immunologic factors. Because of poor patency compared to autologous conduits, we conclude the use of cryopreserved saphenous veins for coronary artery bypass should be severely restricted.

  11. Matrix Metalloproteinase-9 Production following Cardiopulmonary Bypass Was Not Associated with Pulmonary Dysfunction after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Tso-Chou Lin

    2015-01-01

    Full Text Available Background. Cardiopulmonary bypass (CPB causes release of matrix metalloproteinase- (MMP- 9, contributing to pulmonary infiltration and dysfunction. The aims were to investigate MMP-9 production and associated perioperative variables and oxygenation following CPB. Methods. Thirty patients undergoing elective cardiac surgery were included. Arterial blood was sampled at 6 sequential points (before anesthesia induction, before CPB and at 2, 4, 6, and 24 h after beginning CPB for plasma MMP-9 concentrations by ELISA. The perioperative laboratory data and variables, including bypass time, PaO2/FiO2, and extubation time, were also recorded. Results. The plasma MMP-9 concentrations significantly elevated at 2–6 h after beginning CPB (P<0.001 and returned to the preanesthesia level at 24 h (P=0.23, with predominant neutrophil counts after surgery (P<0.001. The plasma MMP-9 levels at 4 and 6 h were not correlated with prolonged CPB time and displayed no association with postoperative PaO2/FiO2, regardless of reduced ratio from preoperative 342.9±81.2 to postoperative 207.3±121.3 mmHg (P<0.001. Conclusion. Elective cardiac surgery with CPB induced short-term elevation of plasma MMP-9 concentrations within 24 hours, however, without significant correlation with CPB time and postoperative pulmonary dysfunction, despite predominantly increased neutrophils and reduced oxygenation.

  12. Is there an association between urolithiasis and roux-en-y gastric bypass surgery?

    Directory of Open Access Journals (Sweden)

    Andre Costa-Matos

    2009-08-01

    Full Text Available Purpose: Several studies have documented high incidence of urinary lithiasis after jejunoileal by-pass. Roux-en-y gastric bypass surgery (RYGB is currently the most common bariatric procedure. Because of its difficult for absorption, RYGB has a potential risk to increase the incidence of lithiasis. This study was conducted in order to test the hypothesis that RYGB increases the incidence urolithiasis after 50% of excessive weight loss. Materials and Methods: We performed a retrospective cohort study to evaluate 58 patients who underwent RYGB at the Obesity Service at Santa Casa de Misericordia de Sao Paulo, between 2000 and 2005, with minimum follow-up of 10 and maximum of 72 months, after the procedure. Results: Forty-five (77.6% patients had ≥ 50% loss of weight excess. There was no difference between the frequency of urolithiasis before and after the procedure, and nephrolithiasis was observed after surgery in only one patient, however this had been detected before the procedure. Conclusion: In the period studied, RYGB does not seem to affect the incidence of urolithiasis after weight reduction. This may be due to its smaller malabsorptive component as compared with jejunoileal “by-pass”, thereby possibly not significantly influencing the oxalate metabolism.

  13. 腹腔镜胃旁路术治疗低BMI2型糖尿病患者效果观察%Laparoscopic gastric bypass surgery in treatment of patients with type 2 diabetes mellitus and low BMI

    Institute of Scientific and Technical Information of China (English)

    靳和平

    2016-01-01

    Objective To investigate the effect of laparoscopic gastric bypass surgery in the treatment of patients with type 2 diabetes mellitus and low BMI.Methods 50 patients with type 2 diabetes mellitus and low BMI undertaking laparoscopic gastric bypass surgery at our hospital were selected as study objects.The blood lipid,body mass index (BMI),fasting plasma glucose (FPG),meal 2 hours blood glucose (PBG),glycosylated hemoglobin (HbA 1 c),and quality of life were observed in the patients.Results 6 months after laparoscopic gastric bypass surgery,the total cholesterol level was (4.66 ± 0.39) mmol/L,triglyceride level (1.65 ± 0.24) mmol/L,low density lipoprotein level (2.63 ± 0.15) mmol/L,high density lipoprotein level (1.54 ± 0.32) mmol/L,BMI (20.67± 2.01) kg/m2,FPG (5.12 ± 0.31) mmol/L,PBG (5.82 ± 0.65) mmol/L,HbA1C (5.36 ± 0.47)%,physiological function (70.83 ± 4.58),physiological function (61.74 ± 4.35),bodily pain (70.23 ± 4.37),general health (75.46 ±4.28),energy (58.46 ± 4.35),social function (61.81 ± 4.71),emotional function (60.74 ± 4.49),and mental health (60.42 ± 4.82),which were all better than those before treatment in all the patients,with statistical differences (P<0.05).Conclusions Laparoscopic gastric bypass surgery in the treatment of patients with type 2 diabetes and low BMI has definite clinical efficacy and can significantly improve the patients' indicators and quality of life,so it can be regarded as medication or insulin therapy in patients with type 2 diabetes and worth for clinical application.%目的 探讨腹腔镜胃旁路术治疗低体重指数(BMI)2型糖尿病患者效果.方法 选取本院收治的50例实施腹腔镜胃旁路术治疗的低BMI 2型糖尿病患者为研究对象,观察患者血脂、BMI、空腹血浆葡萄糖(FPG)、餐后 2h 血糖PBG、糖化血红蛋白(HbA1C)及其生活质量.结果 实施腹腔镜胃旁路术后6个月,患者总胆固醇为(4.66±0.39) mmol/L、甘油三酯为(1.65±0.24) mmol

  14. Changes in adhesion molecule expression and oxidative burst activity of granulocytes and monocytes during open-heart surgery with cardiopulmonary bypass compared with abdominal surgery

    DEFF Research Database (Denmark)

    Toft, P; Nielsen, C H; Tønnesen, Else Kirstine

    1998-01-01

    Cardiac and major abdominal surgery are associated with granulocytosis in peripheral blood. The purpose of the present study was to describe the granulocyte and monocyte oxidative burst and the expression of adhesion molecules following cardiac surgery with cardiopulmonary bypass and abdominal...... surgery, 1, 5, 10 and 20 min after aortic clamping, and then 1, 5, 10 and 20 min and 1, 2 and 3 h after declamping. Samples from eight patients undergoing abdominal surgery were taken before surgery, at the end of surgery, and 2 and 3 h post-operatively. A decrease in number of granulocytes and monocytes...... burst of the granulocytes and monocytes decreased after declamping to 15% and 27% of initial values in vitro. Several hours after surgery, there was no significant difference between the two groups. These results can be explained by a granulocyte and monocyte refractory response developing subsequent...

  15. Posttraumatic growth in post-surgical coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

    Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

  16. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Stephen M McHugh

    2016-01-01

    Full Text Available Background and Aims: Tranexamic acid (TA is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05 between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.

  17. Five Vessel Coronary Arter Bypass Graft Surgery in a Case with Familial Hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Sureyya Talay

    2014-08-01

    Full Text Available We report a case of a rare and sypmtomatic familyal hypercholesterolemia case with an end-point of coronary artery bypass surgery at the age of 16. Patient was evaluated at the emergency department with chest pain and discomfort. Physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm for 108/ min. Arterial blood pressure was 90/60 mmHg. Lungs and heart were clear to auscultation. Patient was under treatment with a prior diagnosis of familial hypercholesterolemia (FH for one year by daily 40 mgs rosuvastatine. A coronary artery angiography was performed for chest pain. Multivessel coronary artery disease was diagnosed with a total occlusion of left anterior descending artery. Transthoracic echocardiography presented a left ventricular (LV ejection fraction 50%, LV diameters 44/26 mm, aneurysm formation at interatrial septum and mild dyskinesia of anterior wall. Thus, a five vessel emergent coronary artery graft bypass surgery was performed at this early age. FH is with a severe elevation in total cholesterol (TC and low density lipoprotein cholesterol (LDL in an autosomal dominant characteristic disorder that approximately occurs in 1 per 500 persons by its heterozygous form. FH is most certainly associated with premature coronary artery disease (CAD with catasthrophic early age results. [Cukurova Med J 2014; 39(4.000: 872-875

  18. Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

    Directory of Open Access Journals (Sweden)

    Dariush Shahsavari

    2014-07-01

    Full Text Available Acquired adult-onset zinc deficiency is occasionally reported in patients with malnutrition states, such as alcoholism, or malabsorptive states, such as post-bariatric surgery. The defining symptoms of hypozincemia include a classic triad of necrolytic dermatitis, diffuse alopecia, and diarrhea. We report a case of zinc deficiency in a 39-year-old man with history of gastric bypass surgery and alcoholism. For this patient, severe hypozincemia confirmed acrodermatitis, and zinc supplementation was met with gradual improvement.

  19. Off - Pump Coronary Artery Bypass Graft Surgery: A Safe Method For Complete Revascularization

    Directory of Open Access Journals (Sweden)

    Mirkhani S. H

    2002-07-01

    Full Text Available In recent years off-pump coronary artery bypass surgery (OPCAB has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG, we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery."nMaterials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB."nResults: Of 150 OPCAB cases, 146 (97.3 percent were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6. Total 595 distal grafts anastomosed to LAD (140 diagonals (140, right coronary artery (145, left circumflex (164. Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein."nConclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

  20. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; QI Dan-ni; GU Cheng-xiong

    2010-01-01

    @@ Currently coronary artery bypass grafting (CABG) is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft (CVBG), may be the proper therapeutic selection.1 The idea of myocardial revascularization by means of grafting the coronary venous system is more than a century old. However, few clinical trials and long-term outcome data have been presented. The use of venous arterialization has not been widely used. We report the use of a sequential saphenous vein graft from the aorta to middle cardiac vein in a patient with diffuse lesions in right coronary artery during off-pump coronary artery bypass surgery (OPCAB).

  1. Influence of Mechanical Cell Salvage on Red Blood Cell Aggregation, Deformability, and 2,3-Diphosphoglycerate in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass

    NARCIS (Netherlands)

    Gu, Y. John; Vermeijden, Wytze J.; de Vries, Adrianus J.; Hagenaars, J. Ans M.; Graaff, Reindert; van Oeveren, Willem

    2008-01-01

    Background. Mechanical cell salvage is increasingly used during cardiac surgery. Although this procedure is considered safe, it is unknown whether it affects the red blood cell (RBC) function, especially the RBC aggregation, deformability, and the contents of 2,3-diphosphoglycerate (2,3-DPG). This s

  2. Adult Moyamoya disease: 320-Multidetector row CT for evaluation of revascularization in STA–MCA bypasses surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Bing; Xu, Bing; Liu, Qi; Hao, Qiang; Lu, Jianping, E-mail: cjr.lujianping@vip.163.com

    2013-12-01

    Purpose: To evaluate the utility of 320-multidetector row whole-brain computed tomography perfusion (WBCTP) and whole-head subtracted dynamic angiography (WHSDCTA) for assessing the revascularization of blood flow after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery in adults with Moyamoya disease (MD) in the short and long term. Patients and methods: 320-multidetector row WBCTP and WHSDCTA were applied in 20 patients with MD before and after surgery (for an average of 3 days and 3 months). The bypass arteries were investigated using WHSDCTA and compared with DSA. The regions of interests (ROIs) in the surgical and mirror sides of the cerebral cortex were drawn on a Vitrea Workstation. Cerebral blood volume (CBV), time to peak (TTP), cerebral blood flow (CBF), mean transit time (MTT), and delay time were recorded. Preoperative and postoperative perfusion parameters in the MCA distribution were compared using the paired t-test. Results: WHSDCTA could clearly demonstrate 24 bypass arteries in 26 arteries for 20 patients, results which were in accordance with the results of digital subtraction angiography (DSA). When comparing preoperative values to those within 3 days after surgery, only TTP and delay time were significantly different (P < 0.05). Values of CBV, TTP, CBF, delay time, and MTT 3 months after surgery were significantly different (P < 0.05) from those of preoperative perfusion. Conclusion: These data suggest that 320-multidetector row WBCTP and WHSDCTA can be used to evaluate the revascularization of blood flow after STA–MCA bypass surgery in patients with MD in the short and long term.

  3. Endoscopic versus open radial artery harvest and mammario-radial versus aorto-radial grafting in patients undergoing coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Carranza, Christian L; Ballegaard, Martin; Werner, Mads U

    2014-01-01

    , it is unknown whether the endoscopic technique results in fewer complications or a graft patency comparable to open harvest. When the radial artery has been harvested, there are two ways to use the radial artery as a graft. One way is sewing it onto the aorta and another is sewing it onto the mammary artery......) mammario-radial open surgery group; and (4) aorto-radial open surgery group.The hand function will be assessed by a questionnaire, a clinical examination, the change in cutaneous sensibility, and the measurement of both sensory and motor nerve conduction velocity at 3 months postoperatively. All...... the postoperative complications will be registered, and we will evaluate muscular function, scar appearance, vascular supply to the hand, and the graft patency including the patency of the central radial artery anastomosis. A patency evaluation by multi-slice computer tomography will be done at one year...

  4. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristinn; Andreasen, Jan J; Mortensen, Rikke N;

    2016-01-01

    significant predictors for living in a nursing home 1 year postoperatively. CONCLUSIONS: The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk......OBJECTIVES: Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort. METHODS: All patients who...... underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan...

  5. Comparison of the centrifugal and roller pump in elective coronary artery bypass surgery--a prospective, randomized study with special emphasis upon platelet activation.

    Science.gov (United States)

    Andersen, Knut S; Nygreen, Else L; Grong, Ketil; Leirvaag, Beryl; Holmsen, Holm

    2003-12-01

    Objective--Evaluation of the centrifugal pump vs roller pump concerning effects upon platelet function, hemolysis and clinical outcome in elective coronary artery bypass surgery. Design--Thirty-four patients were randomized to centrifugal or roller pump. Platelet activation was studied by flow cytometry before, during and up to 3 days after bypass. Results--Duration of bypass, ischemic period, peripheral anastomoses, hospital stay and mortality did not differ. In roller pump patients, platelet aggregates increased by 250% between end of bypass and 3 h postoperatively (p centrifugal pump group, these changes were not significant. Hemolysis increased (20%) at end of bypass and 3 h postoperatively (p centrifugal pump patients, indicating higher susceptibility to postoperative thrombotic complications with the roller pump. Otherwise, there was no clinical evidence for superiority of the centrifugal pump.

  6. Nitrite exhaled breath condensate study in patients undergoing cardiopulmonary bypass cardiac surgery Estudo do nitrito do condensado do exalado pulmonar em pacientes submetidos à cirurgia cardíaca com CEC

    Directory of Open Access Journals (Sweden)

    Viviane dos Santos Augusto

    2011-03-01

    Full Text Available BACKGROUND: There is a relative lack of studies on postoperative changes in nitrite (NO2 - concentrations, a marker of injury, following cardiac surgery. In this context, investigations on how exhaled NO concentrations vary in the postoperative period of cardiac surgery will certainly contribute to new clinical findings. OBJECTIVE: The objective of this study was to compare the EBC NO levels in both the pre and postoperative (24 hours periods of cardiac surgery. METHODS: Twenty - eight individuals were divided into three groups: 1 control, 2 coronary artery bypass grafting, and 3 valve surgery. The nitrite (NO2 - levels were measured by chemiluminescence in blood samples and exhaled breath condensate (EBC. Data were analyzed by the Mann - Whitney and Wilcoxon tests. RESULTS: 1 Preoperatively, the EBC NO2 - levels from groups 2 and 3 patients were higher than control individuals; 2 The postoperative (24 hours NO2 - levels in the EBC from group 3 patients were lower compared with preoperative values; 3 The NO2 - levels in the plasma from group 2 patients were lower in the preoperative compared with the postoperative (24h values and; 4 Preoperatively, there was no difference between groups 2 and 3 in terms of plasma NO2 - concentrations. CONCLUSION: These data suggest that NO measurement in EBC is feasible in cardiac surgery patients.INTRODUÇÃO: Estudos mostrando alterações das concentrações de nitrito (NO2 - exalado, com biomarcador de lesão, são raros em pacientes submetidos à cirurgia cardíaca. Nesse contexto, o seu estudo no pré e pós - operatório de cirurgias cardíacas poderá contribuir para novos dados clínicos. OBJETIVO: O objetivo foi comparar os níveis de nitrito (NO2 - do condensado do exalado pulmonar (CEP no pré e pós - operatório de cirurgia cardíaca com circulação extracorpórea. MÉTODOS: Vinte e oito indivíduos foram alocados em três grupos: 1 controle, 2 revascularização do miocárdio e 3 corre

  7. Geographic Variability in Potentially Discretionary Red Blood Cell Transfusions After Coronary Artery Bypass Grafting Surgery

    Science.gov (United States)

    Likosky, Donald S.; Al-Attar, Paul M.; Malenka, David J.; Furnary, Anthony P.; Lehr, Eric J.; Paone, Gaetano; Kommareddi, Mallika; Helm, Robert; Jin, Ruyun; Maynard, Chuck; Hanson, Eric C.; Olmstead, Elaine M.; Mackenzie, Todd A.; Ross, Cathy S.; Zhang, Min

    2016-01-01

    We assessed regional differences in potentially discretionary [coronary artery bypass (CABG) surgery. Regional variation in overall RBC rates remained after risk adjustment, perhaps due to differences in regional practice environments. Objective A number of established regional quality improvement collaboratives have partnered to assess and improve care across their regions under the umbrella of the “Cardiac Surgery Quality IMPROVEment (IMPROVE) Network”. The first effort of the IMPROVE Network has been to assess regional differences in potentially discretionary [coronary artery bypass (CABG) surgery across 56 medical centers in four IMPROVE Network regions between January 2008 and June 2012. Each center submitted the most recent 200 patients who received 0, 1, or 2 units of RBC transfusion during the index admission. Patient and disease characteristics, intra-operative practices, and percentage of cases receiving RBC transfusions were collected. Region-specific transfusion rates were calculated, after adjusting for pre- and intra-operative factors among region-specific centers. Results There were small, but significant, differences in patient case mix across regions. RBC transfusions of 1 or 2 units occurred among 25.2% (2,826/11,200) of CABG procedures. Significant variation in use and number of RBCs existed across regions [None: 74.8% (min:max 70.0%, 84.1%), 1 unit: 9.7% (5.1%, 11.8%), 2 units: 15.5% (9.1%, 18.2%)], p<0.001. Variation in overall transfusion rates remained after adjustment (9.1% – 31.7%, p<0.001). Conclusions Delivery of small volumes of RBC transfusions was common, yet varied across geographic regions. These data suggest that differences in regional practice environments, including transfusion triggers and anemia management, may contribute to variability in RBC transfusion rates. PMID:25227699

  8. [Regional ventricular function at rest during exercise before and after bypass surgery (author's transl)].

    Science.gov (United States)

    Bussmann, W D; Mayer, V; Kober, G; Kaltenbach, M

    1978-06-01

    In 9 patients with coronary heart disease isovolumetric contractility indices and ejection phase parameters were measured simultaneously, using an angiographic catheter with a manometer at the tip (Millar). Regional wall motion at rest, after leg raising and during physical exercise (bicycle ergometer) was analyzed applying the hemiaxis method. Five weeks after aortocoronary bypass surgery the same examinations were repeated. Preoperatively left ventricular enddiastolic pressure (LVEDP) increased from 21 to 37 mm Hg following leg raising. The velocity mean of fiber shortening (Vcf) and of regional fiber shortening in the anterior wall decreased significantly.--All patients discontinued physical exercise due to angina pectoris. LVEDP increased from 21 to 39 mm Hg. Large hypokinetic and akinetic areas developed especially in the anterior wall. Velocity of fiber shortening of the anterior wall decreased from 1.43 to 0.76/s. Enddiastolic volume remained unchanged while endsystolic volume increased significantly. In six patients with patent grafts surgery had a beneficial effect. Comparing angiograms at rest no significant changes were found. After leg raising and physical exercise, however, marked improvement in ventricular function occurred, compared to the preoperative performance. All 6 patients were exercised without complaints at a load of 100 watts for 8 minutes. Velocity of fiber shortening in the anterior wall increased significantly from 0.76 to 2.56/s, mean Vcf from 1.11 to 2.12 circ/s, max dP/dt from 2302 to 4280 mm Hg/s and Vpm from 27.8 to 55.7/s. Functional improvement in individual wall segments amounted to 500% in the mean. Ejection fraction increased from 54 to 76%. Enddiastolic volume remained unchanged while endsystolic volume decreased from 67 to 33 ml/1.37 m2 (p less than 0.002). In three patients the bypass occluded or myocardial infarction occurred intraoperatively. Postoperative findings at rest and during exercise were unchanged as compared to

  9. Hypercoagulability in patients undergoing coronary artery bypass grafting: prevalence, patient characteristics and postoperative outcome

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Per Ingemar; Ostrowski, Sisse Rye;

    2012-01-01

    OBJECTIVESTo investigate the prevalence of preoperative hypercoagulability assessed by thromboelastography (TEG), to identify patient characteristics associated with hypercoagulability and to explore whether hypercoagulability is associated with a greater risk for myocardial infarction (MI), stroke...... and mortality 30 days after coronary artery bypass grafting (CABG) surgery.METHODSThis is a prospective, observational study of 200 consecutive CABG surgery patients. Hypercoagulability was defined as TEG maximum amplitude >69 mm.RESULTSEighty-seven out of 200 (43.5%) CABG patients were TEG......-hypercoagulability demonstrated a trend (P = 0.065).CONCLUSIONSHypercoagulability identified by TEG was preoperatively found in 43.5% of CABG patients, and the findings of this study support the notion that TEG-hypercoagulable patients have a higher risk for a combination of thromboembolic complications and death after surgery....

  10. Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

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    Kambiz Alizadeh

    2014-02-01

    Full Text Available Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.

  11. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher; Joe Boujaoude

    2008-01-01

    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  12. Amiodarone cost effectiveness in preventing atrial fibrillation after coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Zebis, Lars R; Christensen, Thomas D; Hjortdal, Vibeke E

    2008-01-01

    BACKGROUND: The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina. METHODS: This cost-effectiveness study...... was based on a randomized, controlled, double-blind trial (the RASCABG study) using avoidance of atrial fibrillation as the measure of benefit at the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. Two hundred and fifty eligible consecutively enrolled CABG...... of atrial fibrillation compared with 32 in the control group (p cost per patient was 7,639 euros in the amiodarone group and 7,814 euros in the placebo group (p

  13. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery

    DEFF Research Database (Denmark)

    Vorstrup, S; Brun, B; Lassen, N A

    1986-01-01

    and angiographical findings were operated. The majority of the patients had suffered a minor stroke with or without subsequent transient ischemic attacks. They were studied at least 6 weeks following the stroke. All patients had an occlusion of the relevant internal carotid artery. To identify preoperatively...

  14. Types of Heart Surgery

    Science.gov (United States)

    ... from the NHLBI on Twitter. Types of Heart Surgery Coronary Artery Bypass Grafting Coronary artery bypass grafting ( ... TAHs) might be used to treat these patients. Surgery To Place Ventricular Assist Devices or Total Artificial ...

  15. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

    Directory of Open Access Journals (Sweden)

    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  16. Trends in the treatment of coronary disease today. Selective use of PTCA and bypass surgery.

    Science.gov (United States)

    Jones, E L; Craver, J M; Guyton, R A; Bone, D K; Hatcher, C R

    1983-01-01

    Selection and treatment of patients with ischemic heart disease is presently undergoing an evolutionary trend. Percutaneous transluminal coronary angioplasty (PTCA) has been recommended as the initial procedure for many patients with coronary artery disease (CAD), thus possibly redefining candidates for coronary bypass surgery (CABS). Between October 1980 and June 1982, 777 patients having PTCA and 2068 patients having CABS were analyzed for differences in clinical presentation, complications, and early outcome. Patients having CABS were significantly older, had a higher incidence of hypertension (46% vs. 32%), more multivessel disease (80% vs. 12%), and poorer left ventricular function (nl. wall motion = 88% vs. 52%). The incidence of myocardial infarction in patients after PTCA was 1.0% (8/777). Emergency CAB was required in 5.3% of patients following PTCA. There were no deaths following the angioplasty procedure and 25 deaths in 2068 patients having CABS (hospital mortality rate = 1.2%). Since 1973, there has been a progressive decline in hospital mortality rate (now, less than 1%), postoperative infarction (now, 3%), requirement for inotropic drugs (now, 5%) and frequency of IABP (less than 1%). Increasing ability to achieve complete revascularization now means improved survival and freedom from angina with CAB surgery. PTCA and CAB are both procedures that may be used effectively for selected patients, depending on clinical presentation, extent of CAD, and left ventricular function (LVF). Careful patient selection affords the opportunity for use of PTCA in patients with single-vessel disease (SVD) and good LVF and CABS in patients with multivessel disease, regardless of LVF. Symptomatic patients with SVD and total vessel occlusion are not candidates for PTCA. Our data demonstrate that both PTCA and CABS may be accomplished with very low perioperative complications and hospital mortality. PMID:6222708

  17. Link Between Increased Satiety Gut Hormones and Reduced Food Reward After Gastric Bypass Surgery for Obesity

    Science.gov (United States)

    Miras, Alexander D.; Scholtz, Samantha; Jackson, Sabrina; Neff, Karl J.; Pénicaud, Luc; Geoghegan, Justin; Chhina, Navpreet; Durighel, Giuliana; Bell, Jimmy D.; Meillon, Sophie; le Roux, Carel W.

    2016-01-01

    Context: Roux-en-Y gastric bypass (RYGB) surgery is an effective long-term intervention for weight loss maintenance, reducing appetite, and also food reward, via unclear mechanisms. Objective: To investigate the role of elevated satiety gut hormones after RYGB, we examined food hedonic-reward responses after their acute post-prandial suppression. Design: These were randomized, placebo-controlled, double-blind, crossover experimental medicine studies. Patients: Two groups, more than 5 months after RYGB for obesity (n = 7–11), compared with nonobese controls (n = 10), or patients after gastric banding (BAND) surgery (n = 9) participated in the studies. Intervention: Studies were performed after acute administration of the somatostatin analog octreotide or saline. In one study, patients after RYGB, and nonobese controls, performed a behavioral progressive ratio task for chocolate sweets. In another study, patients after RYGB, and controls after BAND surgery, performed a functional magnetic resonance imaging food picture evaluation task. Main Outcome Measures: Octreotide increased both appetitive food reward (breakpoint) in the progressive ratio task (n = 9), and food appeal (n = 9) and reward system blood oxygen level-dependent signal (n = 7) in the functional magnetic resonance imaging task, in the RYGB group, but not in the control groups. Results: Octreotide suppressed postprandial plasma peptide YY, glucagon-like peptide-1, and fibroblast growth factor-19 after RYGB. The reduction in plasma peptide YY with octreotide positively correlated with the increase in brain reward system blood oxygen level-dependent signal in RYGB/BAND subjects, with a similar trend for glucagon-like peptide-1. Conclusions: Enhanced satiety gut hormone responses after RYGB may be a causative mechanism by which anatomical alterations of the gut in obesity surgery modify behavioral and brain reward responses to food. PMID:26580235

  18. [Psychoprophylaxis in patients after coronary artery bypass graft operations].

    Science.gov (United States)

    Rymaszewska, Joanna; Chładzińska-Kiejna, Sylwia; Górna, Renata; Kustrzycki, Wojciech

    2004-05-01

    The paper presented problems of quality of life and psychosocial functioning of patients following coronary artery bypass grafting operations. Possibilities of psychoprophylactic effects towards these patients and its efficacy were described.

  19. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  20. Enhanced insulin signaling in human skeletal muscle and adipose tissue following gastric bypass surgery

    DEFF Research Database (Denmark)

    Albers, Peter H; Bojsen-Møller, Kirstine N; Dirksen, Carsten

    2015-01-01

    12 months post-surgery. Adipose tissue from glucose tolerant subjects was the most responsive to RYGB compared to type 2 diabetic patients, whereas changes in skeletal muscle were largely similar in these two groups. In conclusion, an improved molecular insulin sensitive phenotype of skeletal muscle......Roux-en-Y gastric bypass (RYGB) leads to increased peripheral insulin sensitivity. The aim of this study was to investigate the effect of RYGB on expression and regulation of proteins involved in regulation of peripheral glucose metabolism. Skeletal muscle and adipose tissue biopsies from glucose...... tolerant and type 2 diabetic subjects at fasting and during a hyperinsulinemic-euglycemic clamp before as well as 1 week, 3 and 12 months after RYGB were analyzed for relevant insulin effector proteins/signaling components. Improvement in peripheral insulin sensitivity mainly occurred at 12 months post...

  1. Analysis of red blood cell aggregation in cardio-pulmonary bypass (CPB) surgery.

    Science.gov (United States)

    Graaff, R; Gu, Y J; Boonstra, P W; van Oeveren, W; Rakhorst, G

    2004-06-01

    Not much is known about red cell aggregation during cardio-pulmonary bypass surgery (CPB). Blood samples from 19 patients undergoing CPB were anticoagulated with EDTA. Hematocrit was adjusted to 40%. A red blood cell aggregometer (LORCA) measured changes in light reflection from each blood sample after cessation of the rotation, and calculated an aggregation index (AI). Reflection measurements were stored. Because LORCA software failed for 87 of 171 samples, we developed new software, and applied it to the stored reflection measurements. This software failed only in 7 out of 171 cases and showed that all LORCA failures occurred for AI CPB and recovered to 37.1 +/- 13.5 at day 1. It is concluded that the new software can be used to study decreased red cell aggregation during CPB.

  2. Gastrointestinal complications of bariatric Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sandrasegaran, Kumaresan; Rajesh, Arumugam; Lall, Chandana; Maglinte, Dean D. [Indiana University Medical Center, UH 0279, Department of Radiology, Indianapolis, IN (United States); Gomez, Gerardo A. [Wishard Memorial Hospital, Department of Surgery, Indianapolis (United States); Lappas, John C. [Wishard Memorial Hospital, Department of Radiology, Indianapolis (United States)

    2005-02-01

    Obesity is rapidly becoming the most important public health issue in USA and Europe. Roux-en-Y gastric bypass is now established as the gold standard for treating intractable morbid or super obesity. We reviewed the imaging findings following this surgery in 234 patients. In this pictorial essay we present the CT and upper gastrointestinal contrast study appearances of the expected postoperative anatomy as well as a range of abdominal complications. The complications are classified into leaks, fistula and obstruction. Postoperative gastric outlet and small bowel obstruction can be caused by anastomotic stenosis, mesocolic tunnel stenosis, adhesions, stomal ulcer, obturation, intussusception and internal or external hernia. Small bowel obstruction may be of a simple, closed loop and/or strangulating type. The radiologist should be able to diagnose the type and possible cause of obstruction. (orig.)

  3. A reduction of prothrombin conversion by cardiac surgery with cardiopulmonary bypass shifts the haemostatic balance towards bleeding.

    Science.gov (United States)

    Kremers, Romy M W; Bosch, Yvonne P J; Bloemen, Saartje; de Laat, Bas; Weerwind, Patrick W; Mochtar, Bas; Maessen, Jos G; Wagenvoord, Rob J; Al Dieri, Raed; Hemker, H Coenraad

    2016-08-30

    Cardiac surgery with cardiopulmonary bypass (CPB) is associated with blood loss and post-surgery thrombotic complications. The process of thrombin generation is disturbed during surgery with CPB because of haemodilution, coagulation factor consumption and heparin administration. We aimed to investigate the changes in thrombin generation during cardiac surgery and its underlying pro- and anticoagulant processes, and to explore the clinical consequences of these changes using in silico experimentation. Plasma was obtained from 29 patients undergoing surgery with CPB before heparinisation, after heparinisation, after haemodilution, and after protamine administration. Thrombin generation was measured and prothrombin conversion and thrombin inactivation were quantified. In silico experimentation was used to investigate the reaction of patients to the administration of procoagulant factors and/or anticoagulant factors. Surgery with CPB causes significant coagulation factor consumption and a reduction of thrombin generation. The total amount of prothrombin converted and the rate of prothrombin conversion decreased during surgery. As the surgery progressed, the relative contribution of α2-macroglobulin-dependent thrombin inhibition increased, at the expense of antithrombin-dependent inhibition. In silico restoration of post-surgical prothrombin conversion to pre-surgical levels increased thrombin generation excessively, whereas co-administration of antithrombin resulted in the normalisation of post-surgical thrombin generation. Thrombin generation is reduced during surgery with cardiopulmonary bypass because of a balance shift between prothrombin conversion and thrombin inactivation. According to in silico predictions of thrombin generation, this new balance increases the risk of thrombotic complications with prothrombin complex concentrate administration, but not if antithrombin is co-administered.

  4. Off-Pump Triple Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis: Case Presentation and a Brief Review of the Brazilian and the International Experiences

    Science.gov (United States)

    Karigyo, Carlos Junior Toshiyuki; Batalini, Felipe; Murakami, Alexandre Noboru; Teruya, Rogério Toshio; Gregori Júnior, Francisco

    2016-01-01

    A 76-year-old man with situs inversus totalis underwent a successful off-pump three-vessel coronary artery bypass surgery. The postoperative course was uneventful, and the patient was discharged 8 days later. At 9-month follow-up a coronary computed tomography angiography confirmed the viability of all of the grafts, and one year after the operation the patient remained asymptomatic. It comprises the fifth Brazilian case of a coronary surgery in a patient with situs inversus totalis and the first one of the country of a coronary artery bypass surgery without the use of the cardiopulmonary bypass in this condition. PMID:27556323

  5. Heart and Lungs Protection Technique for Cardiac Surgery with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Vladimir Pichugin

    2014-12-01

    Full Text Available Introduction: Cardioplegic cardiac arrest with subsequent ischemic-reperfusion injuries can lead to the development of inflammation of the myocardium, leucocyte activation, and release of cardiac enzymes. Flow reduction to the bronchial arteries, causing low-flow lung ischemia, leads to the development of a pulmonary regional inflammatory response. Hypoventilation during cardiopulmonary bypass (CPB is responsible for development of microatelectasis, hydrostatic pulmonary edema, poor compliance, and a higher incidence of infection. Based on these facts, prevention methods of these complications were developed. The aim of this study was to evaluate constant coronary perfusion (CCP and the “beating heart” in combination with pulmonary artery perfusion (PAP and “ventilated lungs” technique for heart and lung protection in cardiac surgery with CPB.Methods. After ethical approval and written informed consent, 80 patients undergoing cardiac surgery with normothermic CPB were randomized in three groups. In the first group (22 patients, the crystalloid cardioplegia without lung ventilation/perfusion techniques were used. In the second group (30 patients, the CCP and “beating heart” without lung ventilation/perfusion techniques were used. In the third group (28 patients, the CCP with PAP and lung ventilation techniques were used. Clinical, functional parameters, myocardial damage markers (CK MB level, oxygenation index, and lung compliance were investigated.Results. There were higher rates of spontaneous cardiac recovery and lower doses of inotrops in the second and third groups. Myocardial contractility function was better preserved in the second and third groups. The post-operative levels of CK-MB were lower than in control group.  Three hours after surgery CK-MB levels in the second and third  groups were lower by 38.1% and 33.3%, respectively. Eight hours after surgery, CK-MB levels were lower in the second and third groups by 45.9% and

  6. Comparison of the Postprocedural Quality of Life between Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Kaneez Fatima

    2016-01-01

    Full Text Available The treatment of choice between coronary artery bypass graft surgery (CABG and percutaneous coronary intervention (PCI has remained unclear. Considering quality of life (QOL increases life expectancy, we believe QOL should be important in determining the optimum treatment. Thus the objective of this review was to illustrate the comparative effects of CABG and PCI on postprocedural QOL. Methods. We searched PubMed (Medline and Embase from inception of the databases to May 2014 using “PCI versus CABG quality of life”, “Percutaneous Coronary intervention versus Coronary artery bypass graft surgery Quality of life”, “PCI versus CABG health status”, “Angioplasty versus CABG”, “Percutaneous coronary intervention versus coronary artery bypass surgery health status”, and different combinations of the above terms. 447 articles were found. After applying strict exclusion criteria, we included 13 studies in this review. Results. From the 9 studies that compared QOL scores at 6 months after procedure, 5 studies reported CABG to be superior. From the 10 studies that compared QOL among patients at 1 year after procedure, 9 reported CABG to be superior. Conclusion. It can be established that CABG is superior to PCI in improving patient’s QOL with respect to all scales used to determine quality of life.

  7. First autopsy analysis of a neovascularized arterial network induced by indirect bypass surgery for moyamoya disease: case report.

    Science.gov (United States)

    Mukawa, Maki; Nariai, Tadashi; Inaji, Motoki; Tamada, Natsumi; Maehara, Taketoshi; Matsushima, Yoshiharu; Ohno, Kikuo; Negi, Mariko; Kobayashi, Daisuke

    2016-05-01

    The object of this study was to analyze the pathology of collateral vessels newly induced by indirect bypass surgery for moyamoya disease (MMD). An autopsy analysis was conducted on a 39-year-old woman with MMD who had died of a brainstem infarction. The patient had undergone bilateral indirect bypass surgeries 22 years earlier. Sufficient revascularization via bilateral external carotid arterial systems was confirmed by cerebral angiography before her death. Macroscopic observation of the operative areas revealed countless meandering vessels on the internal surface of the dura mater connected with small vessels on the brain surface and in the subpial brain tissue. Notably, microscopic analysis of these vessels revealed the characteristic 3-layer structure of an arterial wall. This autopsy analysis was the first to confirm that indirect bypass surgery had induced the formation of a new arterial network (arteriogenesis) and that this network had been maintained for more than 20 years to compensate for the chronic cerebral ischemia caused by the MMD.

  8. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

    Science.gov (United States)

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

    2014-01-01

    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  9. Gastric bypass patients' goal-strategy-monitoring networks for long-term dietary management.

    Science.gov (United States)

    Lynch, Amanda; Bisogni, Carole A

    2014-10-01

    Following gastric bypass surgery, patients must make dramatic dietary changes, but little is known about patients' perspectives on long-term dietary management after this surgery. This grounded theory, qualitative study sought to advance conceptual understanding of food choice by examining how gastric bypass patients constructed personal food systems to guide food and eating behaviors 12 months post-surgery. Two in-depth interviews were conducted with each of 16 adults, purposively sampled from bariatric support groups. Using constant comparative analysis of verbatim interview transcripts, researchers identified participants' goal-strategy-monitoring networks representing how participants used specific food and eating behaviors towards their main goals of: Weight Management, Overall Health, Avoiding Negative Reactions to Eating, and Integrating Dietary Changes with Daily Life. Linked to each main goal was a hierarchy of intermediary goals, strategies, and tactics. Participants used monitoring behaviors to assess strategy effectiveness towards goal achievement. Individuals' Weight Management networks were compared to uncover similarities and differences among strategy use and monitoring methods among those who maintained weight loss and those who regained weight. The complex, multilevel goal-strategy-monitoring networks identified illustrate the "work" involved in constructing new personal food systems after surgery, as well as advance understanding of strategies as a component of people's personal food systems. These findings provide researchers and practitioners with insight into the long-term dietary issues that gastric bypass patients face and a potential method for representing how people relate deliberate dietary behaviors to their goals.

  10. Effect of lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass

    Science.gov (United States)

    Tsakiridis, Kosmas; Vretzkakis, Giorgos; Mikroulis, Dimitris; Mpakas, Andreas; Kesisis, Georgios; Arikas, Stamatis; Kolettas, Alexandros; Moschos, Giorgios; Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Tsiouda, Theodora; Siminelakis, Stavros; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    Background The establishment of Extracorporeal Circulation (EC) significantly contributed to improvement of cardiac surgery, but this is accompanied by harmful side-effects. The most important of them is systemic inflammatory response syndrome. Many efforts have been undertaken to minimize this problem but unfortunately without satisfied solution to date. Materials and methods Lornoxicam is a non steroid anti-inflammatory drug which temporally inhibits the cycloxygenase. In this clinical trial we study the effect of lornoxicam in lung inflammatory response after operations for cardiac surgery with cardiopulmonary bypass. In our study we conclude 14 volunteers patients with ischemic coronary disease undergoing coronary artery bypass grafting with EC. In seven of them 16 mg lornoxicam was administered iv before the anesthesia induction and before the connection in heart-lung machine. In control group (7 patients) we administered the same amount of normal saline. Results Both groups are equal regarding pro-operative and intra-operative parameters. The inflammatory markers were calculated by Elisa method. We measured the levels of cytokines (IL-6, IL-8, TNF-a), adhesion molecules (ICAM-1, e-Selectin, p-Selectin) and matrix metaloproteinase-3 (MMP-3) just after anesthesia induction, before and after cardiopulmonary bypass, just after the patients administration in ICU and after 8 and 24 hrs. In all patients we estimated the lung’s inflammatory reaction with lung biopsy taken at the begging and at the end of the operation. We calculated hemodynamics parameters: Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Pulmonary Vascular Resistance Index (PVRI), Left Ventricular Stroke Work Index (LVSWI), Right Ventricular Stroke Work Index (RVSWI), and the Pulmonary arterial pressure, and respiratory parameters too: alveolo-arterial oxygen difference D (A-a), intrapulmonary shunt (Qs/Qt) and pulmonary Compliance. IL-6 levels of lornoxicam group were statistical

  11. Headache and seizures after cervical epidural injection in a patient undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dheeraj Arora

    2012-01-01

    Full Text Available Epidural analgesia is widely used in cardiothoracic surgery. Most of the complications associated with epidural analgesia are related to the insertion techniques of epidural catheter. A 68-year-old obese patient posted for coronary artery bypass grafting surgery developed headache followed by seizures after insertion of the thoracic epidural catheter. Magnetic resonance imaging revealed air in the basal cisterns and in the left frontal region. The patient was managed conservatively and the symptoms subsided after 24 h. Later, the patient underwent coronary angioplasty.

  12. Genome-wide assessment for genetic variants associated with ventricular dysfunction after primary coronary artery bypass graft surgery.

    Directory of Open Access Journals (Sweden)

    Amanda A Fox

    Full Text Available BACKGROUND: Postoperative ventricular dysfunction (VnD occurs in 9-20% of coronary artery bypass graft (CABG surgical patients and is associated with increased postoperative morbidity and mortality. Understanding genetic causes of postoperative VnD should enhance patient risk stratification and improve treatment and prevention strategies. We aimed to determine if genetic variants associate with occurrence of in-hospital VnD after CABG surgery. METHODS: A genome-wide association study identified single nucleotide polymorphisms (SNPs associated with postoperative VnD in male subjects of European ancestry undergoing isolated primary CABG surgery with cardiopulmonary bypass. VnD was defined as the need for ≥2 inotropes or mechanical ventricular support after CABG surgery. Validated SNPs were assessed further in two replication CABG cohorts and meta-analysis was performed. RESULTS: Over 100 SNPs were associated with VnD (P2.1 of developing in-hospital VnD after CABG surgery. However, three genetic loci identified by meta-analysis were more modestly associated with development of postoperative VnD. Studies of larger cohorts to assess these loci as well as to define other genetic mechanisms and related biology that link genetic variants to postoperative ventricular dysfunction are warranted.

  13. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  14. Management of patients with hematological malignancies undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Deepak Borde

    2013-01-01

    Full Text Available The number of patients with a previously diagnosed malignancy who need cardiac surgery is increasing. Patients with hematological malignancies represent only 0.38% of all patients undergoing cardiac surgery. The literature in this subset of patients is limited to only a few retrospective case series, with limited number of patients undergoing emergency cardiac surgery. We describe three cases with hematological malignancies namely chronic myelogenous leukemia, acute promyelocytic leukemia and chronic lymphocytic leukemia presenting for coronary artery bypass grafting (CABG. Two patients were taken up for emergency CABG in view of ongoing ischemia, one of them was on preoperative intra-aortic balloon pump support. No mortality was observed. Two patients needed transfusion of blood products which was guided by thromboelastography. One patient developed superficial sternal wound infection requiring antibiotic therapy.

  15. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  16. Endotoxin release in cardiac surgery with cardiopulmonary bypass : pathophysiology and possible therapeutic strategies. An update

    NARCIS (Netherlands)

    Kats, Suzanne; Schonberger, Jacques P. A. M.; Brands, Ruud; Seinen, Willem; van Oeveren, Wim

    2011-01-01

    Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome

  17. COMPOUNDING PHARMACIES' POTENTIAL TO CREATE Graft Storage Solutions for Bypass Surgeries.

    Science.gov (United States)

    Guth, Michael A S

    2015-01-01

    Several studies have addressed the optimal storage conditions for vascular grafts during bypass surgery. These studies have repeatedly shown that placing vascular graft conduits in isotonic saline solutions, and to a lesser extent in heparinized autologous blood, leads to a profound decline in endothelial cell viability. Endothelial damage to vein grafts can occur at multiple points during a coronary artery bypass graft surgery procedure: graft harvesting, handling, flushing, storage, anastomosis, and arterialization (e.g., damage caused by exposure to arterial blood pressure). This damage to endothelial cells causes the release of pro-inflammatory chemical signals that trigger thrombosis, intimal hyperplasia, and accelerated graft atherosclerosis, all of which ultimately contribute to graft failure. Cardiothoracic surgeons performing coronary artery bypass graft surgery and vascular surgeons performing peripheral artery bypass graft surgery have attempted to overcome the damage to the vascular grafts by using buffers to maintain the physiological pH of the storage solution. However, the endothelial layers in the grafts would benefit from having proper oxygenation and antioxidants added to the storage solution. Compounding pharmacies can perform a vital role in ensuring the patency of the vascular grafts by creating compounded flushing and storage solutions that have an optimal mix of nitric oxide substrates, antioxidants, and other nutrients for the endothelium. Maintaining structural and functional viability of the endothelia in grafts by using an appropriate vessel storage medium would lead to improved long-term graft patency.

  18. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    1999-01-01

    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte filtratio

  19. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a nov...

  20. Oral bioavailability of moxifloxacin after Roux-en-Y gastric bypass surgery

    NARCIS (Netherlands)

    De Smet, Julie; Colin, Pieter; De Paepe, Peter; Ruige, Johannes; Batens, Helene; Van Nieuwenhove, Yves; Vogelaers, Dirk; Blot, Stijn; Van Bocxlaer, Jan; Van Bortel, Luc M.; Boussery, Koen

    2012-01-01

    Objectives: Roux-en-Y gastric bypass surgery is the most commonly performed procedure for the treatment of morbid obesity. This anatomical alteration may affect the absorption and consequently the bioavailability of oral drugs. This study aims to investigate the oral bioavailability of moxifloxacin

  1. Health related quality of life trajectories and predictors following coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Worcester Marian UC

    2006-08-01

    Full Text Available Abstract Background Many studies have demonstrated that health related quality of life (HRQoL improves, on average, after coronary artery bypass graft surgery (CABGS. However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. Methods 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36, Profile of Mood States (POMS and the Everyday Functioning Questionnaire (EFQ. These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. Results For both the physical component summary scale (PCS and the mental component summary scale (MCS of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers. A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. Conclusion It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of

  2. Health related quality of life trajectories and predictors following coronary artery bypass surgery

    Science.gov (United States)

    Le Grande, Michael R; Elliott, Peter C; Murphy, Barbara M; Worcester, Marian UC; Higgins, Rosemary O; Ernest, Christine S; Goble, Alan J

    2006-01-01

    Background Many studies have demonstrated that health related quality of life (HRQoL) improves, on average, after coronary artery bypass graft surgery (CABGS). However, this average improvement may not be realized for all patients, and it is possible that there are two or more distinctive groups with different, possibly non-linear, trajectories of change over time. Furthermore, little is known about the predictors that are associated with these possible HRQoL trajectories after CABGS. Methods 182 patients listed for elective CABGS at The Royal Melbourne Hospital completed a postal battery of questionnaires which included the Short-Form-36 (SF-36), Profile of Mood States (POMS) and the Everyday Functioning Questionnaire (EFQ). These data were collected on average a month before surgery, and at two months and six months after surgery. Socio-demographic and medical characteristics prior to surgery, as well as surgical and post-surgical complications and symptoms were also assessed. Growth curve and growth mixture modelling were used to identify trajectories of HRQoL. Results For both the physical component summary scale (PCS) and the mental component summary scale (MCS) of the SF-36, two groups of patients with distinct trajectories of HRQoL following surgery could be identified (improvers and non-improvers). A series of logistic regression analyses identified different predictors of group membership for PCS and MCS trajectories. For the PCS the most significant predictors of non-improver membership were lower scores on POMS vigor-activity and higher New York Heart Association dyspnoea class; for the MCS the most significant predictors of non-improver membership were higher scores on POMS depression-dejection and manual occupation. Conclusion It is incorrect to assume that HRQoL will improve in a linear fashion for all patients following CABGS. Nor was there support for a single response trajectory. It is important to identify characteristics of each patient, and

  3. Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention

    Science.gov (United States)

    Liu, Jiexin (Jason); Bellamy, Gail R.; McCormick, Melissa

    2007-01-01

    Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally. Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to…

  4. beta-blocker Therapy is Not Associated with Reductions in Angina or Cardiovascular Events After Coronary Artery Bypass Graft Surgery : Insights from the IMAGINE Trial

    NARCIS (Netherlands)

    Booij, Harmen G.; Damman, Kevin; Warnica, J. Wayne; Rouleau, Jean L.; van Gilst, Wiek H.; Westenbrink, B. Daan

    2015-01-01

    To evaluate whether beta-blockers were associated with a reduction in cardiovascular events or angina after Coronary Artery Bypass Graft (CABG) surgery, in otherwise stable low-risk patients during a mid-term follow-up. We performed a post-hoc analysis of the IMAGINE (Ischemia Management with Accupr

  5. Comparative effect of grape seed extract (Vitis vinifera and ascorbic acid in oxidative stress induced by on-pump coronary artery bypass surgery

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    Naser Safaei

    2017-01-01

    Full Text Available Background: This study aimed to test the beneficial effect of grape seed extract (GSE (Vitis vinifera and Vitamin C in oxidative stress and reperfusion injury induced by cardiopulmonary bypass (CPB in coronary artery bypass surgery. Patients and Methods: In this randomized trial, 87 patients undergoing elective and isolated coronary bypass surgery included. The patients were randomly assigned into three groups (n = 29 each: (1 Control group with no treatment, (2 GSE group who received the extract 24 h before operation, 100 mg every 6 h, orally, (3 Vitamin C group who received 25 mg/kg Vitamin C through CPB during surgery. Blood samples were taken from coronary sinus at (T1 just before aortic cross clamp; (T2 just before starting controlled aortic root reperfusion; and (T3 10 min after root reperfusion. Some clinical parameters and biochemical markers were compared among the groups. Results: There were significant differences in tracheal intubation times, sinus rhythm return, and left ventricular function between treatment groups compared with control (P 0.05 in all cases. Conclusions: In our patients, GSE and Vitamin C had antioxidative effects and reduced deleterious effects of CPB during coronary artery bypass grafting surgery.

  6. Comparative Effect of Grape Seed Extract (Vitis Vinifera) and Ascorbic Acid in Oxidative Stress Induced by On-pump Coronary Artery Bypass Surgery

    Science.gov (United States)

    Safaei, Naser; Babaei, Hossein; Azarfarin, Rasoul; Jodati, Ahmad-Reza; Yaghoubi, Alireza; Sheikhalizadeh, Mohammad-Ali

    2017-01-01

    Background: This study aimed to test the beneficial effect of grape seed extract (GSE) (Vitis vinifera) and Vitamin C in oxidative stress and reperfusion injury induced by cardiopulmonary bypass (CPB) in coronary artery bypass surgery. Patients and Methods: In this randomized trial, 87 patients undergoing elective and isolated coronary bypass surgery included. The patients were randomly assigned into three groups (n = 29 each): (1) Control group with no treatment, (2) GSE group who received the extract 24 h before operation, 100 mg every 6 h, orally, (3) Vitamin C group who received 25 mg/kg Vitamin C through CPB during surgery. Blood samples were taken from coronary sinus at (T1) just before aortic cross clamp; (T2) just before starting controlled aortic root reperfusion; and (T3) 10 min after root reperfusion. Some clinical parameters and biochemical markers were compared among the groups. Results: There were significant differences in tracheal intubation times, sinus rhythm return, and left ventricular function between treatment groups compared with control (P Vitamin C groups at T2 and T3 times. In reperfusion period, malondialdehyde level was increased in control group; however, it was significantly lower for the grape seed group (P = 0.04). The differences in the mean levels of superoxide dismutase and glutathione peroxidase among the three groups were not significant (P > 0.05 in all cases). Conclusions: In our patients, GSE and Vitamin C had antioxidative effects and reduced deleterious effects of CPB during coronary artery bypass grafting surgery. PMID:28074795

  7. 吸烟对冠状动脉旁路移植术后生存质量的影响%Influence of smoking on quality of life in patients after coronary artery bypass graft surgery

    Institute of Scientific and Technical Information of China (English)

    魏利娟; 高文根; 王鹏华

    2014-01-01

    目的:研究吸烟对冠状动脉旁路移植术(CABG)后早期生存质量的影响。方法随机入选2011年1月~2013年1月接受冠状动脉旁路移植术,并符合纳入标准的连续患者共120例。根据术前是否有吸烟史,分为吸烟组(60例)和未吸烟组(60例),分别在术后3、6、12个月向患者发放SF-36(short form-36)生存质量调查量表,对患者生存质量予以评定,分析吸烟对患者术后生存质量的影响。结果与未吸烟组比较,吸烟组患者冠状动脉旁路移植术后3、6、12个月躯体健康评分(PCS)和精神健康评分(MCS)以及生存质量总评分QOL均降低,差异有统计学意义(P<0.01)。结论与未吸烟组比较,吸烟组患者冠状动脉旁路移植术后早期生存质量降低,吸烟是影响冠状动脉旁路移植术后早期生存质量恢复不佳的危险因素。%Objective To assess the influence of smoking on early quality of life (QOL) in patients after coronary artery bypass graft (CABG) surgery.Methods The prospective study included 120 consecutive patients undergoing CABG between January 2011 and January 2013, who met inclusion criteria and completed short form-36 (SF-36) health status survey at 3 months, 6 months, 12 months after CABG. According to preoperative smoking history, divided into smoking group (60 cases) and non-smoking group (60 cases). Changes of quality of life and the influence of smoking on early quality of life in patients after CABG were analyzed.Results Compared with non-smoking, physical component summary (PCS) and mental component summary (MCS) and QOL total scores about smoking group of patients were lower at 3 months, 6 months, 12 months after CABG (P<0.01), the difference was statistically significant.Conclusion Compared with non-smoking, early QOL after CABG on smoking group of patients is reduced, smoking is risk factor to affect early QOL after CABG .

  8. Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications

    Institute of Scientific and Technical Information of China (English)

    Duk-hee CHUN; Seong-wan BAIK; So Yeon KIM; Jae Kwang SHIM; Jong Chan KIM; Young Lan KWAK

    2011-01-01

    Aim: To evaluate the clinical impact of reduced heparin responsiveness (HRreduced) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB),and to identify the predictors of HRreduced.Methods: A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis,150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥300 s,and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HRreduced).The relationships between the HSI and postoperative MI,cardiac enzyme levels and preoperative risk factors of HRreduced were investigated.Results: There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HRreduced patients. HRreduced occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.Conclusion: HRreduced was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients,which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HRreduced.

  9. The risk of arrhythmias following coronary artery bypass surgery: do smokers have a paradox effect?

    LENUS (Irish Health Repository)

    Al-Sarraf, Nael

    2010-11-01

    Smoking is reported to increase the risk of arrhythmias. However, there are limited data on its effects on arrhythmias following coronary artery bypass graft (CABG). This is a retrospective review of a prospective database of all CABG patients over an eight-year period. Our cohort (n=2813) was subdivided into: current (n=1169), former (n=837), and non-smokers (n=807). Predictors of arrhythmias following CABG in relation to smoking status were analysed. Atrial arrhythmias occurred in 942 patients (33%). Ventricular arrhythmias occurred in 48 patients (2%) and high-grade atrioventricular block occurred in five patients (0.2%). Arrhythmias were lower in current smokers than former and non-smokers (29% vs. 40% vs. 39%, respectively P<0.001). Logistic regression analysis showed 30% arrhythmia risk reduction in smokers compared to non-smokers [odds ratio (OR) 0.7, 95% confidence intervals (CI) 0.5-0.8] and this effect persisted after accounting for potential confounders while former smokers had the same risk as non-smokers (OR 1.04, CI 0.9-1.3). There were no significant differences in mortality. Smokers are less prone to develop arrhythmias following CABG. This paradox effect is lost in former smokers. This effect is possibly due to a lower state of hyper adrenergic stimulation observed in smokers than non-smokers following the stress of surgery.

  10. Low free triiodothyronine levels in mexican pediatric population with congenital heart disease after cardiac surgery undergoing cardiopulmonary bypass.

    Directory of Open Access Journals (Sweden)

    A Araujo Martínez

    2016-09-01

    Full Text Available BACKGROUND: Low free triiodothyronine level in patients undergoing heart surgery with cardiopulmonary bypass (CPB is well described in literature, but the prevalence in pediatric Mexican population is yet unknown. OBJECTIVE: To know the prevalence of postoperative low free triiodothyronine level and the associated complications after cardiopulmonary bypass exposure in pediatric population in Mexico. MATERIAL AND METHODS: A sample of free triiodothyronine (FT3 blood was obtained in the early postoperative period of patients undergoing CPB heart surgery. Postoperative low FT3 level (PLFT3 was defined as any blood value under 2.9 pg/mL. Logistical regression models were used for analysis of independent variables, adjusted for complexity score (RACHS-1 and Aristotle Comprehensive Complexity Score. RESULTS. PLFT3 was present in 35.7% of the patients (n=109. Correlation with PLFT3 the following variables were observed: prolonged CPB time (p=0.001 prolonged aortic cross clamp (p=0.002 level of complexity of the surgery as measured by Aristotle ≥3 (p=0.001 and RACHS-1 ≥3 (p=0.021. Associated complications were: postoperative arrhythmias (p=0.008 extended intubation period (p=0.008 and higher infection rate (p=0.002.

  11. Subarachnoid clonidine and trauma response in cardiac surgery with cardiopulmonary bypass

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    Claudia Gissi da Rocha Ferreira

    2014-12-01

    Full Text Available Background and objectives: The intense trauma response triggered by cardiopulmonary bypass can lead to increased morbidity and mortality. The present study evaluated whether clonidine, a drug of the class of α-2 agonists, administered by spinal route, without association with local anesthetics or opioids, reduces this response in cardiac surgery with cardiopulmonary bypass. Method: A total of 27 patients between 18 and 75 years old, divided by non-blinded fashion into a control group (15 and a clonidine group (12, were studied. All patients underwent identical technique of general anesthesia. Then, only the clonidine group received 1 μg kg−1 clonidine by spinal route. Levels of blood glucose, lactate and cortisol were measured at three consecutive times: T1, at the time of installation of invasive arterial pressure; T2, 10 min after the first dose for cardioplegia; and T3, at the time of skin suture; and troponin I values at T1 and T3. The variation of results between T2-T1, T3-T2, and T3-T1 was also evaluated. Results: There was a statistically significant difference only with respect to the variation in blood glucose in the clonidine group: T3-T2, p = 0.027 and T3-T1, p = 0.047. Conclusions: Spinal clonidine at a dose of 1 μg kg−1 did not decrease blood measurements of troponin, cortisol, or lactate. Blood glucose suffered a more moderate variation during the procedure in the clonidine group. This fact, already reported in the literature, requires further investigation to be clarified.

  12. Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission.

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    Tulika Arora

    Full Text Available Roux-en-Y gastric bypass (RYGB is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were subjected to global metabolomics and lipidomics analysis at pre-surgery and 4 and 42 days after RYGB. Metabolites and lipid species were compared between time points and between subjects who were in remission and not in remission from diabetes 2 years after surgery. We found that the variables that were most discriminatory between time points were decanoic acid and octanoic acid, which were elevated 42 days after surgery, and sphingomyelins (18:1/21:0 and 18:1/23:3, which were at their lowest level 42 days after surgery. Insulin levels were lower at 4 and 42 days after surgery compared with pre-surgery levels. At 4 days after surgery, insulin levels correlated positively with metabolites of branched chain and aromatic amino acid metabolism and negatively with triglycerides with long-chain fatty acids. Of the 14 subjects with diabetes prior to surgery, 7 were in remission 2 years after surgery. The subjects in remission displayed higher pre-surgery levels of tricarboxylic acid cycle intermediates and triglycerides with long-chain fatty acids compared with subjects not in remission. Thus, metabolic alterations are induced soon after surgery and subjects with diabetes remission differ in the metabolic profiles at pre- and early post-surgery time points compared to patients not in remission.

  13. Sobrevida em longo prazo de octogenários submetidos à cirurgia de revascularização miocárdica isolada Long-term survival of octogenarian patients submitted to isolated coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Fernando Pivatto Júnior

    2011-03-01

    Full Text Available INTRODUÇÃO: Um crescente número de pacientes octogenários tem sido submetido à cirurgia de revascularização miocárdica (CRM. Os resultados em curto prazo desse procedimento têm sido amplamente estudados, mas há poucos relatos nacionais até o presente momento sobre os seus desfechos em longo prazo. OBJETIVOS: Descrever a mortalidade hospitalar e a sobrevida em longo prazo de pacientes com idade 80 anos submetidos à CRM isolada. MÉTODOS: Estudo de coorte retrospectivo com 142 pacientes consecutivos de idade 80 anos submetidos à CRM isolada no período de janeiro/1996 a dezembro/2007. A idade média (±dp foi de 82,3±2,1 anos e 56,3% eram masculinos. A prevalência de hipertensão arterial sistêmica foi de 73,2%, infarto agudo do miocárdio prévio 30,3%, diabetes melito 26,8% e disfunção renal (creatinina ³ 2,0mg/ml 4,9%. A mediana do seguimento foi de 4,0 anos, havendo perda de 11,6% dos pacientes. A análise da sobrevida foi feita pela curva de Kaplan-Meier. RESULTADOS: A mortalidade hospitalar geral foi de 14,8% (IC95%: 8,8-20,8, observando-se uma redução desse percentual ao longo do período estudado (1996-1999: 25,9%, 2000-2003: 15,8% e 2004-2007: 8,6%. A média de sobrevida foi de 6,5 anos (IC95%: 5,5-7,5, sendo a taxa de sobrevida em 1, 3 e 5 anos de 83,3, 79,5 e 77,3%, respectivamente. CONCLUSÕES: A média de sobrevida foi de 6,5 anos, sendo a taxa em 5 anos de 77,3%, dados condizentes com a literatura internacional.INTRODUCTION: An increasing number of octogenarian patients is undergoing coronary artery bypass graft surgery (CABG. The short-term results of this procedure have been broadly studied, but there are few national reports on long-term outcomes. OBJECTIVES: To describe hospital mortality and long-term survival of patients aged > 80 years undergoing isolated CABG. METHODS: Retrospective cohort study with 142 consecutive patients aged > 80 years undergoing isolated CABG in the period between January/1996

  14. Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery.

    Science.gov (United States)

    2016-11-18

    Patients Waiting for Elective Isolated Coronary Artery Bypass Grafting (CABG); Patients Waiting for Aortic Valve Repair/Replacement for Moderate Aortic Stenosis or Severe Regurgitation; Patients Waiting for Mitral Valve Repair/Replacement for Moderate Stenosis or Severe Regurgitation; Patients Waiting for Combined Procedures. (CAGB and Valve)

  15. The effect of EC-IC bypass surgery on resting cerebral blood flow and cerebrovascular reserve capacity studied with stable Xe-CT and acetazolamide test

    Energy Technology Data Exchange (ETDEWEB)

    Yamashita, T.; Kashiwagi, S.; Nakano, S.; Takasago, T.; Abiko, S.; Shiroyama, Y.; Hayashi, M.; Ito, H. (Yamaguchi Univ. School of Medicine (Japan). Dept. of Neurosurgery)

    1991-06-01

    Cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were measured by stable xenon computerized tomography (Xe-CT) and acetazolamide test in 15 patients with cerebrovascular disease before and after extracranial-intracranial (EC-IC) bypass surgery for minor stroke, reversible ischemic neurological deficit or transient ischemic attack. All had angiographically shown occlusive lesions of the major arterial trunk. In the present series, global analysis showed that the bypass did not increase the resting rCBF, but did increase the rCRC. We divided the patients into four groups according to the preoperative resting rCBF and rCRC. All 3 patients with normal resting rCBF and reduced rCRC showed postoperative improvement of rCRC. Of 6 patients with reduced CBF and reduced CRC, three had postoperative increase in resting CBF and four had increased CRC. One of two patients with reduced CBF and normal CRC showed only an increase in CRC. We propose that reduced CRC or reduced CBF with reduced CRC are criteria for selection of candidates for bypass surgery. We conclude that Xe-CT with the Diamox test is a useful and simple method for evaluating cerebral hemodynamics. Preoperative grouping with a combination of preoperative resting rCBF and preoperative rCRC is useful for predicting the effect of EC-IC bypass surgery. (orig.).

  16. Transesophageal echocardiography guided cannulation for peripheral cardiopulmonary bypass during robotic cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Yao; GAO Chang-qing; WANG Gang; WANG Jia-li

    2012-01-01

    Background Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve.Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery.However,few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery.The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.Methods We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011,which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp.TEE was used to guide cannulation of the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO).The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.Results One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB.There were 67 female (51.9%) and 62 male (48.1%) patients,ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m2 (mean (1.71 ± 0.20) m2).Some 61 (47.3%) patients underwent mitral valve repair,27 (20.9%) mitral valve replacement,27 (20.9%) left atrial myxoma removal,and 14(10.9%) ventricular septal defect repair.Of the 129 patients,TEE guided cannulation of the IVC or SVC was successful in all patients (100%),and no puncture related complications occurred in all patients.Of the 129 patients,successful cannulation of the AAO was achieved in all patients (100%),and aortic

  17. Popliteo-pedal bypass surgery for critical limb ischemia.

    LENUS (Irish Health Repository)

    Good, D W

    2011-12-01

    Critical limb ischaemia due to distal arterial disease represents a significant challenge. Randomised controlled evidence suggests that open surgery may be superior to endovascular intervention but there is limited data on the specific clinical cohort with exclusively infra-popliteal disease.

  18. Acute Kidney Disease Due to Excessive Vitamin C Ingestion and Remote Roux-en-Y Gastric Bypass Surgery Superimposed on CKD.

    Science.gov (United States)

    Sunkara, Vasu; Pelkowski, Timothy D; Dreyfus, Darren; Satoskar, Anjali

    2015-10-01

    A 69-year-old woman presented with acute kidney failure of unknown cause that ultimately required dialysis. Kidney biopsy revealed the diagnosis of oxalate nephropathy. In retrospect, the patient had several risk factors for this entity, including excessive vitamin C intake, a remote history of Roux-en-Y gastric bypass for weight loss, and chronic kidney disease. This presentation of multiple risk factors for oxalate nephropathy is especially relevant to patients and physicians considering the increase in the United States of vitamin C supplementation use and gastric bypass surgery. It is important for physicians to maintain an awareness of this diagnosis and its risk factors.

  19. Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000

    Directory of Open Access Journals (Sweden)

    Hayden Robert

    2005-03-01

    Full Text Available Abstract Background In British Columbia, Canada, all necessary medical services are funded publicly. Concerned with growing wait lists in the mid-1990s, the provincial government started providing extra funding for coronary artery bypass grafting (CABG operations annually. Although aimed at improving access, it is not known whether supplementary funding changed the time that patients spent on wait lists for CABG. We sought to determine whether the period of registration on wait lists had an effect on time to isolated CABG and whether the period effect was similar across priority groups. Methods Using records from a population-based registry, we studied the wait-list time before and after supplementary funding became available. We compared the number of weeks from registration to surgery for equal proportions of patients in synthetic cohorts defined by five registration periods in the 1990s. Results Overall, 9,231 patients spent a total of 137,126 person-weeks on the wait lists. The time to surgery increased by the middle of the decade, and decreased toward the end of the decade. Relative to the 1991–92 registration period, the conditional weekly probabilities of undergoing surgery were 30% lower among patients registered on the wait lists in 1995–96, hazard ratio (HR = 0.70 (0.65–0.76, and 23% lower in 1997–98 patients, HR = 0.77 (0.71–0.83, while there were no differences with 1999–2000 patients, HR = 0.94 (0.88–1.02, after adjusting for priority group at registration, comorbidity, age and sex. We found that the effect of registration period was different across priority groups. Conclusion Our results provide evidence that time to CABG shortened after supplementary funding was provided on an annual basis to tertiary care hospitals within a single publicly funded health system. One plausible explanation is that these hospitals had capacity to increase the number of operations. At the same time, the effect was not uniform across

  20. Breath Hydrogen as a Biomarker for Glucose Malabsorption after Roux-en-Y Gastric Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Iman Andalib

    2015-01-01

    Full Text Available Objective. Abdominal symptoms are common after bariatric surgery, and these individuals commonly have upper gut bacterial overgrowth, a known cause of malabsorption. Breath hydrogen determination after oral glucose is a safe and inexpensive test for malabsorption. This study is designed to investigate breath hydrogen levels after oral glucose in symptomatic individuals who had undergone Roux-en-Y gastric bypass surgery. Methods. This is a retrospective study of individuals (n=63; 60 females; 3 males; mean age 49 years who had gastric bypass surgery and then glucose breath testing to evaluate abdominal symptoms. Results. Among 63 postoperative individuals, 51 (81% had a late rise (≥45 minutes in breath hydrogen or methane, supporting glucose malabsorption; 46 (90% of these 51 subjects also had an early rise (≤30 minutes in breath hydrogen or methane supporting upper gut bacterial overgrowth. Glucose malabsorption was more frequent in subjects with upper gut bacterial overgrowth compared to subjects with no evidence for bacterial overgrowth (P<0.001. Conclusion. These data support the presence of intestinal glucose malabsorption associated with upper gut bacterial overgrowth in individuals with abdominal symptoms after gastric bypass surgery. Breath hydrogen testing after oral glucose should be considered to evaluate potential malabsorption in symptomatic, postoperative individuals.

  1. Combined extracranial-intracranial bypass surgery with stent-assisted coil embolization for moyamoya disease with a ruptured wide-necked basilar trunk aneurysm: a case report.

    Science.gov (United States)

    Jiang, Hanqiang; Ni, Wei; Lei, Yu; Li, Yanjiang; Gu, Yuxiang

    2015-01-01

    A ruptured wide-necked basilar trunk aneurysm is uncommon in patients with moyamoya disease. The optimal treatment is unclear. We report a safe and beneficial treatment modality for moyamoya disease with aneurysms located in the posterior circulation. A 37-year-old man presenting with subarachnoid hemorrhage was admitted to our hospital. Emergent cerebral angiography demonstrated moyamoya disease associated with a wide-necked basilar trunk aneurysm. We performed bilateral extracranial-intracranial bypass surgeries prior to stent-assisted coil embolization of the aneurysm after the acute phase. No complication occurred and the patient was discharged with no neurological deficit. Follow-up digital subtraction angiography (DSA) performed 6 months after the surgery showed that all the anastomosises were patent and bilateral collateral vascular compensation was fully established with no recanalization of the basilar trunk aneurysm post embolization.We also found that high-flow bypass did not contribute to cerebral revascularization as imagined despite the good patency. Combined extracranial-intracranial bypass surgery with endovascular treatment proved to be an efficient therapeutic modality for moyamoya disease with aneurysms located in the posterior circulation. High-flow bypass surgery was not essential due to the inefficiency and the high risk of postoperative cerebral hyperperfusion syndrome.

  2. Prediction of Carotid Artery Stenosis in Candidates of Coronary Artery Bypasses Surgery by A Scoring System.

    Directory of Open Access Journals (Sweden)

    Sh. Shirani

    2007-05-01

    Full Text Available Background and Objective: Up to 9% of coronary ar-tery bypass grafting (CABG patients suffer from stroke after the surgery. Although post CABG stroke has multiple etiologies, stenosis of cervical carotid arteries is an important factor. Many studies have evaluated carotid artery stenosis in CABG. Carotid stenosis and its related factors and a new scoring sys-tem for selection of CABG patients for Doppler study are introduced. Materials and methods: 1721 consecutive cases of non-urgent CABG were evaluated for presence of significant carotid stenosis (> 50% stenosis. The asso-ciation of age, sex, hypertension, smoking, diabetes, dislipidemia and left main coronary stenosis with ca-rotid stenosis was evaluated. For introducing a scor-ing method, absence of each related factor was scored by 1 and its presence by 2. The score range for each patient was from 5 (none of related factors up to 10 (all of related factors. Results: 7% of patients suffered from significant stenosis. Female gender, age more than 55 years old, hypertension, diabetes, and stenosis of left main coronary artery were the related risk factors in uni-variate analysis. A step type analysis revealed patients with score 5 have 98.3% negative predictive value (NPV for significant stenosis with 96.2% sensitivity and 13.9% specificity. Patients with score 10 have 93.9% NPV for significant stenosis with 99.9% speci-ficity. Conclusion: This scoring system may help for better selection of patients for Doppler study before CABG.

  3. Sexual rehabilitation after myocardial infarction and coronary bypass surgery: Why do we not perform our job?

    Directory of Open Access Journals (Sweden)

    Đurović Aleksandar

    2010-01-01

    Full Text Available Background/Aim. There is a perception that in patients with heart diseases in Serbia sexual rehabilitation does not exist. Why do we not perform our job? A kind of resistance to sexual rehabilitation is common for heart disease patients. Prejudices regarding patients' sexuality, fear and limited knowledge are not rare among the members of medical staff. The aim of this study was to assess knowledge on sexual rehabilitation, inner sense during conversation on sexual rehabilitation and quality of sexual life in patients with myocardial infarction (MI and bypass surgery (BPS. Also, we wanted to assess an opinion of the medical staff members about that. Methods. We performed a prospective nonrandomized clinical study, which involved 40 participants: ten patients, six partners and twenty four medical staff members. All participants were tested by the self-created questionnaires. The main issues of observation were: knowledge about sexual rehabilitation, quality of sexual life and inner sense during conversation on sexual rehabilitation. The data were analyzed by the Shapiro-Wilk test, Kolmogorov Smirnov test, Mann Whitney Exact test and Fishers Exact test. Statistical significance was set up to p < 0.05. Results. There was a statistically significant difference among the participants regarding an attitude when sexual activity should be resumed after MI or BPS. The members of medical staff had a significantly different opinion about the most important team members responsible for sexual rehabilitation performance. There was a statistically significant difference (p = 0.01 in quality of patient's sexual life after MI or BPS (score: 14.2 ± 5.5 in relation to conditions before them (score: 21.3 ± 3.1. The members of medical staff had significantly (p = 0.05 worse inner sense (score: 3.8 ± 0.7 during and after fulfilling the questionnaires than the patients (score: 4.6 ± 0.5. Conclusion. Ignorance and prejudices are reasons why we do not perform our

  4. Early dumping syndrome is not a complication but a desirable feature of Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Laurenius, A; Engström, M

    2016-10-01

    Early dumping syndrome after gastric bypass surgery due to rapid delivery of hyperosmolar nutrients into the bowel causing intense symptoms is often described as a complication. Twelve patients, mean age 47 years, were interviewed approximately 9 years post-operation. The interviews were audiotaped and transcribed verbatim, followed by an inductive content analysis to reveal patients' experience of the dumping syndrome. The core category 'Dumping syndrome is a positive consequence of Roux-en-Y gastric bypass surgery and a tool to control food intake' was identified based on the following four sub-categories: (i) 'The multidimensional emergence and effects of dumping syndrome', (ii) 'Dumping syndrome as something positive although unpleasant', (iii) 'Developing coping mechanisms and ingenious strategies' and (iv) 'My own fault if I expose myself to dumping syndrome'. From the patients' perspective, dumping syndrome gives control over food intake; although the symptoms were unpleasant, patients considered dumping syndrome as a positive protection against over-consumption. Hence, healthcare professionals should not present dumping syndrome as a complication but rather as an aid to control eating behaviour and excessive food intake.

  5. Coronary artery bypass grafting in a patient with pseudothrombocytopenia: case report.

    Science.gov (United States)

    Kaplan, Mehmet; Düzyol, Cagri; Kemal Gur, Ali; Olsun, Adlan; Tosun, Remzi

    2008-01-01

    A 53-year-old female patient with coronary arterial disease who had been diagnosed with conventional coronary angiography was scheduled to undergo elective coronary artery bypass grafting surgery. Preoperative routine evaluations of the whole blood count revealed severe thrombocytopenia (6000/mm3). The patient received a consultation by the internal medicine clinic. With an initial diagnosis of pseudothrombocytopenia, the patient's operation was delayed, and she was referred to a hematology clinic for further diagnosis. The thrombocyte count in heparinized whole blood was in the normal range. A smear of a fresh, nonheparinized blood sample revealed thrombocytes in aggregations of 5 to 14, which confirmed the diagnosis. The patient underwent operation with cardiopulmonary bypass with normal heparinization, and no unexpected postoperative complications, including bleeding, occurred in the early postoperative period. She had an uneventful recovery and was discharged from the hospital on the seventh postoperative day. Later routine polyclinic control evaluations showed no complications. We think the possibility of pseudothrombocytopenia should be discussed with patients. With the correct diagnosis, such patients can be safely given the chance of operation with no more than the usual risks of coronary bypass surgery.

  6. Coronary artery bypass grafting in a patient with organophosphate poisoning.

    Science.gov (United States)

    Pieris, Rajeeva R; Fernando, Ravindra

    2015-08-30

    A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

  7. Ischemia-modified albumin use as a prognostic factor in coronary bypass surgery

    Directory of Open Access Journals (Sweden)

    Kanko Muhip

    2012-01-01

    Full Text Available Abstract Background Various types of markers have been used so far in order to reveal myocardial perfusion defect. However, these markers usually appear in the necrosis phase or in the late stage. Having been the focus of various investigations recently, ischemia-modified albumin (IMA is helpful in establishing diagnosis in the early stages of ischemia, before necrosis develops. Methods and Results 30 patients that underwent only coronary bypass surgery due to ischemic heart disease within a specific period of time have been included in the study. IMA levels were studied in the preoperative, intraoperative, and postoperative periods. The albumin cobalt binding assay was used for IMA determination. Hemodynamic parameters (atrial fibrillation, the need for inotropic support, ventricular arrhythmia of the patients in the postoperative stage were evaluated. Intraoperative measurement values (mean ± SD of IMA (0.67677 ± 0.09985 were statistically significantly higher than those in the preoperative (0.81516 ± 0.08894 and postoperative (0.70477 ± 0.07523 measurements. Considering atrial fibrillation and need for inotropics, a parallelism was detected with the levels of IMA. Conclusions IMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases.

  8. Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health-related quality of life as compared with patients who undergo CABG in a conventional-care plan

    NARCIS (Netherlands)

    El Baz, Noha; Middel, Berrie; van Dijk, Jitse P.; Boonstra, Piet W.; Reijneveld, Sijmen A.

    2009-01-01

    The aim of this study is to determine the difference between clinical pathway (CP) and conventional care in terms of health-related quality of life (HRQoL) domains, depression and anxiety, as well as to determine the relative contribution of CP towards an improved HRQoL after coronary artery bypass

  9. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass.

    Science.gov (United States)

    Ševerdija, Ervin E; Vranken, Nousjka P A; Teerenstra, Steven; Ganushchak, Yuri M; Weerwind, Patrick W

    2015-03-01

    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A total of 52 adult patients who underwent cardiac surgery using pulsatile CPB were included in this prospective explorative study. Cerebral tissue oxygen saturation (SctO2) was measured in both the left and right cerebral hemisphere. Intraoperative events, involving interventions performed by anesthesiologist, surgeon, and clinical perfusionist, were documented. Simultaneously, in-line hemodynamic parameters (partial oxygen pressure, partial carbon dioxide pressure, hematocrit, arterial blood pressure, and CPB flow rates) were recorded. Cerebral tissue saturation was affected by anesthetic induction (p retractor (p cardiac surgery. Future studies are needed to identify methods of mitigating periods of reduced cerebral saturation.

  10. 2型糖尿病患者胃旁路术治疗后脂联素水平的变化研究%Research on the Changes of Adiponectin after Gastric Bypass Surgery in Patients with Type 2 Diabetes

    Institute of Scientific and Technical Information of China (English)

    刘轶群; 熊静; 何红晖; 朱晒红; 莫朝晖

    2012-01-01

    Objective To investigate the changes of serum adiponectin levels before and after gastric bypass surgery in patients with type 2 diabetes mellitus (T2DM) and to explore its relationship with postoperative insulin resistance and diabetes improvement.Methods 33 T2DM patients were given laparoscopic Roux-en-Y gastric bypass surgery.Fasting serum adiponect in levels, body mass index (BMI), waist to hip ratio (WHR), fasting plasma glucose (FPG), 2 hours postprandial blood glucose (2 hPG), glycated hemoglobin (HbA1c), fasting insulin (FINS) and insulin resistance index (HOMA-IR) were detected before surgery and three months after surgery.Results (1) After gastric bypass surgery, levels of BMI, WHR, HbA1c, FPG, 2 hPG, TG were all decreased significantly (P <0.01), while the serum adiponectin level was significantly increased after surgery [ (1.60 ±0.09) μg/L vs (1.36 ±0.07) μg/L, P <0.01 ] .(2) Correlation analysis showed that the changes of serum adiponectin before and after surgery were negatively correlated with HOMA-IR and FINS (r values were-0.722, -0.713 , P <0.01; and -0.482, -0.505, P <0.01) .Conclusion The changes of adiponectin level after gastric bypass surgery among T2DM patients may relate to postoperative insulin resistance and diabetes improvement.%目的 观察2型糖尿病(T2DM)患者胃旁路术治疗前后血清脂联素水平的变化,探讨其与术后胰岛素抵抗、糖尿病改善的关系.方法 选取33例行腹腔镜下Roux-en-Y胃旁路术T2DM患者,检测其术前及术后3个月的空腹血清脂联素水平,并观察体质指数(BMI)、腰臀比(WHR)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)等的变化.结果 (1)术后T2DM患者BMI、WHR及HbA1c、FPG、2 hPG、TG水平较术前显著下降(P<0.01),而血清脂联素水平(1.60±0.09)μg/L则显著高于术前(1.36±0.07)μg/L,差异有统计学意义(P<0.01).(2)相关性分析显示,术前血

  11. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  12. Filtration of activated granulocytes during cardiopulmonary bypass surgery : A morphologic and immunologic study to characterize the trapped leukocytes

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    2000-01-01

    Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction, This

  13. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery.

    Science.gov (United States)

    AlHassany, Ali Abdul Jabbar

    2014-04-29

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual figures. B12 and folate deficiencies can produce a type of myelopathy similar to that produced by copper deficiency, and differentiation on the basis of laboratory tests, neurophysiology and improvement of symptoms after replacement therapy might be the hallmark of diagnosis. Combinations of vitamin deficiencies were previously reported, but no cases of combined vitamin A and copper deficiency could be found in the literature.

  14. Osteopontin in relation to Prognosis following Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Eftihia Sbarouni

    2016-01-01

    Full Text Available Cardiovascular events may occur even after complete revascularization in patients with coronary artery disease. We measured preoperative osteopontin (OPN levels in 131 consecutive patients (66.5±10 years old, 117 men and 14 women with left ventricular ejection fraction of 50.7±9.2% and low logistic EuroScore (3.5±3.2% undergoing elective Coronary Artery Bypass Grafting (CABG surgery. Patients were prospectively followed up for a median of 12 months (range 11–24. The primary study endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, need for repeat revascularization, and hospitalization for cardiovascular events. Pre-op OPN plasma levels were 77.9 (49.5, 150.9. Patients with prior acute myocardial infarction (AMI had significantly higher OPN levels compared to those without [131.5 (52.2, 219 versus 73.3 (45.1, 125, p=0.007]. OPN levels were positively related to EuroScore (r=0.2, p=0.031. Pre-op OPN levels did not differ between patients who had a major adverse event during follow-up compared to those with no event (p=0.209 and had no effect on the hazard of future adverse cardiac events [HR (95% CI: 1.48 (0.43–4.99, p=0.527]. The history of AMI was associated with increased risk of subsequent cardiovascular events at follow-up (p=0.02. OPN is associated with preoperative risk assessment prior to low-risk CABG but did not independently predict outcome.

  15. Pulmonary Perfusion and Ventilation During Cardiopulmonary Bypass Are Not Associated with Improved Postoperative Outcomes After Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Yiliam F Rodriguez-Blanco

    2016-11-01

    Full Text Available ObjectivesClinical trials of either pulmonary perfusion or ventilation during cardiopulmonary bypass are equivocal. We hypothesized that to achieve significant improvement in outcomes both interventions had to be concurrent.DesignRetrospective case-control studySettingsMajor academic tertiary referral medical centerParticipants274 consecutive patients who underwent open heart surgery with cardiopulmonary bypass 2009 - 2013.InterventionsThe outcomes of 86 patients who received pulmonary perfusion and ventilation during cardiopulmonary bypass were retrospectively compared to the control group of 188 patients.Measurements and Main ResultsRespiratory complications rates were similar in both groups (33.7% vs. 33.5%, as were the rates of postoperative pneumonia (4.7% vs. 4.3%, pleural effusions (13.9% vs. 12.2% and re-intubations (9.3% vs. 9.1%. Rates of adverse postoperative cardiac events including ventricular tachycardia (9.3% vs. 8.5% and atrial fibrillation (33.7% vs. 28.2% were equivalent in both groups. Incidence of sepsis (8.1% vs. 5.3%, postoperative stroke (2.3% vs. 2.1%, acute kidney injury (2.3% vs. 3.7% and renal failure (5.8% vs. 3.7% were likewise comparable. Despite similar transfusion requirements, coagulopathy (12.8% vs. 5.3%, p=0.031 and the need for mediastinal re-exploration (17.4% vs. 9.6%, p=0.0633 were observed more frequently in the pulmonary perfusion and ventilation group, but the difference did not reach the statistical significance. ICU and hospital stays, and the ICU readmission rates (7.0% vs. 8.0% were similar in both groups.ConclusionsSimultaneous pulmonary perfusion and ventilation during cardiopulmonary bypass were not associated with improved clinical outcomes.

  16. [Bone mineral density disminution post Roux-Y bypass surgery].

    Science.gov (United States)

    Papapietro, Karin; Massardo, Teresa; Riffo, Andrea; Díaz, Emma; Araya, A Verónica; Adjemian, Daniela; Montesinos, Gustavo; Castro, Gabriel

    2013-01-01

    Introducción: La cirugía bariátrica tiene complicaciones metabólicas importantes como la pérdida de masa ósea. Objetivo: Evaluar la densidad mineral ósea (DMO) posterior a by-pass gástrico en Y de Roux (BPYR) en pacientes con indicación de suplemento estándar de calcio y vitamina D. Método: En pacientes con BPYR por obesidad mórbida, 76 mujeres y 22 hombres de diversa edad, con instrucción nutricional, suplemento de calcio y vitamina D, se midió la DMO en columna lumbar y caderas con densitómetro radiológico de doble haz 2 a 3 años post-cirugía. Veinte mujeres fueron seguidas con DMO hasta 54 meses en promedio. Según criterios de Organización Mundial de la Salud (OMS), se comparó con población control joven y de su edad según sexo, evaluando osteopenia y osteoporosis. Resultados: Hubo correlación negativa de DMO con edad; positiva de DMO con índice de masa corporal y con exceso de peso preoperatorio. En mujeres menores de 45 años, se observó disminución de DMO en 26,8%, sin casos de osteoporosis y en 65,7% en las mayores de 45 años (p = 0,0011), correspondiendo a 45,7% de osteopenia y 20% de osteoporosis, predominantemente en columna lumbar. El subgrupo de mujeres con mayor seguimiento, presentó disminución progresiva de DMO, especialmente en cadera izquierda. En hombres se observó 36% de osteopenia y 14% de osteoporosis. Conclusión: Pacientes de ambos sexos y diversa edad, despues de un BPYR, presentaron osteopenia y osteoporosis, a pesar de suplemento precoz de calcio y vitamina D. Consideramos importante medir DMO seriada, individualizando terapias y controlando factores de riesgo.

  17. Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    Leonardo Leiria de Moura da Silva

    2013-06-01

    Full Text Available OBJECTIVE: To evaluate the impact of Cell Saver autologous blood transfusion system (CS on the use of packed red blood cells (pRBC in coronary artery bypass grafting (CABG surgery. METHODS: We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB, divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. RESULTS: There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008 between the groups without-CS (21/44 cases; 47.7% and with-CS (4/43 cases; 9.3%. There was also a statistically significant difference (P=0.000117 in the volumes of pRBC between the groups without-CS (198.651258.65ml and with-CS (35.061125.67ml. On the other hand, in the early postoperative period (up to 24h there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. CONCLUSION: Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

  18. Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Marc Licker

    2012-01-01

    Full Text Available A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

  19. Mild preoperative renal dysfunction as a predictor of longterm clinical outcome after coronary bypass surgery

    NARCIS (Netherlands)

    van de Wal, RMA; van Brussel, BL; Voors, AA; Smilde, TDJ; van Swieten, HA; van Gilst, WH; van Veldhuisen, DJ; Plokker, HWT

    2005-01-01

    Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of pr

  20. An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass.

    Science.gov (United States)

    Pernar, Luise I M; Lockridge, Ryan; McCormack, Colleen; Chen, Judy; Shikora, Scott A; Spector, David; Tavakkoli, Ali; Vernon, Ashley H; Robinson, Malcolm K

    2016-10-01

    Abdominal CT (abdCT) scans are frequently ordered for Roux-en-Y gastric bypass (RYGB) patients presenting to the emergency department (ED) with abdominal pain, but often do not reveal intra-abdominal pathology. We aimed to develop an algorithm for rational ordering of abdCTs. We retrospectively reviewed our institution's RYGB patients presenting acutely with abdominal pain, documenting clinical and laboratory data, and scan results. Associations of clinical parameters to abdCT results were examined for outcome predictors. Of 1643 RYGB patients who had surgery between 2005 and 2015, 355 underwent 387 abdCT scans. Based on abdCT, 48 (12 %) patients required surgery and 86 (22 %) another intervention. No clinical or laboratory parameter predicted imaging results. Imaging decisions for RYGB patients do not appear to be amenable to a simple algorithm, and patient work-up should be based on astute clinical judgment.

  1. Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass - The role of tissue injury by surgical incision

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; Boonstra, PW; Grandjean, JG; van Oeveren, W

    1999-01-01

    Study objectives: Complement activation is a trigger in inducing inflammation in patients who undergo coronary artery bypass grafting (CABG) and is usually thought to be induced by the use of cardiopulmonary bypass (CPB), In this study, we examined whether tissue injury caused by chest surgical inci

  2. [Perforated duodenal ulcer in a Roux-en-Y gastric bypass operated patient can be a diagnostic challenge].

    Science.gov (United States)

    Wied, Christian; Akralið, Guðny B; Lauritsen, Morten Laksáfoss; Naver, Lars Peter Skat

    2013-02-25

    Roux-en-Y gastric bypass (RYGBP) is an increasingly used procedure when treating morbid obesity. Due to the extensive gastrointestinal rearrangement, diagnostic evaluation of patients with gastric bypass and acute abdominal pain can be difficult. We present a case of a perforated duodenal ulcer in a RYGBP operated patient, where free abdominal fluid, but hardly any pneumoperitoneum was seen on a computed tomography. Free intraperitoneal fluid is an important finding and should give suspicion of the need for emergency surgery in RYGBP operated patients with abdominal pain.

  3. Visfatin level after laparoscopic Roux-en-Y gastric bypass surgery in patients with Type 2 diabetes%2型糖尿病患者行腹腔镜Roux-en-Y胃旁路手术后内脂素水平变化

    Institute of Scientific and Technical Information of China (English)

    刘轶群; 熊静; 何红晖; 朱晒红; 莫朝晖

    2013-01-01

    目的:观察2型糖尿病(Type 2 diabetes mellitus,T2DM)患者行腹腔镜下Roux-en-Y胃旁路手术后血清内脂素水平变化,并探讨其与术后胰岛素抵抗、糖尿病改善的关系.方法:33例T2DM患者行腹腔镜下Roux-en-Y胃旁路术,采用酶联免疫吸附实验检测其术前及术后3个月空腹血清内脂素水平,并同时检测空腹血糖(fasting plasm glucose,FPG)、糖化血红蛋白(human glycated hemoglobin Alc,HbAlc)、空腹胰岛素(fasting insulin,FINS)等.结果:腹腔镜Roux-en-Y胃旁路手术后,HbAlc,FINS,胰岛素抵抗指数均较术前下降,体质量指数[(24.53±0.62) kg/m2]较术前[(26.71±0.69) kg/m2]下降,且差异有统计学意义(P<0.001),血清内脂素水平[(9.79±0.64) ng/mL]也明显低于术前[(38.24±5.32) ng/mL],差异具有统计学意义(P<0.001).结论:T2DM患者腹腔镜Roux-en-Y胃旁路手术后内脂素水平变化可能与术后胰岛素抵抗、糖尿病改善有一定的关系.%Objective: To investigate the change in serum visfatin level after laparoscopic Roux-en-Y gastric bypass surgery in patients with Type 2 diabetes mellitus (T2DM) and to explore the relationship between visfatin insulin resistance and diabetes. Methods: Thirty-three patients with Type 2 diabetes were studied before and after the gastric bypass surgery. The level of fasting serum visfatin was measured by enzyme-linked immunosorbent assay. Fasting plasma glucose (FPG), glycated hemoglobin (HbAlc) and fasting insulin (FINS) were measured before and after the gastric bypass surgery. Results: Compared with before the operation, the indicators of HbAlc, FINS, and insulin resistance index (HOMA-IR) were decreased after the laparoscopic Roux-en-Y gastric bypass surgery. The body mass index (BMI) [(24.53 ± 0.62) kg/m2 vs (26.71 + 0.69) kg/m2] was decreased, with significant difference (P<0.00l). The serum visfatin level [(9.79 ± 0.64) ng/mL] was significantly lower than before the operation [(38.24 ± 5.32) ng

  4. Simultaneous modelling of operative mortality and long-term survival after coronary artery bypass surgery.

    Science.gov (United States)

    Ghahramani, M; Dean, C B; Spinelli, J J

    2001-07-15

    Typical analyses of lifetime data treat the time to death or failure as the response variable and use a variety of modelling strategies such as proportional hazards or fully parametric, to investigate the relationship between the response and covariates. In certain circumstances it may be more natural to view the distribution of the response variable as consisting of two or more parts since the survival curve appears segmented. This article addresses such a scenario and we propose a model for simultaneously investigating the effects of covariates over the two segments. The model is an analogue of that proposed by Lambert for zero-inflated Poisson regression. The application is central to the model development and is concerned with survival after coronary artery bypass surgery. Here operative mortality, defined as death within 30 days after surgery, and long-term mortality, are viewed as distinct outcomes. For the application considered, the survivor function displays much steeper descent during the first 30 days after surgery, that is, for operative mortality, than after this period. An investigation of the effects of covariates on operative and long-term mortality after coronary artery bypass surgery illustrates the usefulness of the proposed model.

  5. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;

    2008-01-01

    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...

  6. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA technique with paravertebral block (PVB technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG. TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

  7. Outcomes improvement following minimally invasive direct coronary artery bypass surgery.

    Science.gov (United States)

    Maglish, B L; Schwartz, J L; Matheny, R G

    1999-06-01

    The most progressive movement in the standardization of MIDCAB has occurred within the past 5 years. Standardization of care and continuous quality improvement are essential to improve outcomes and reduce costs for MIDCAB. At the authors' institution, perioperative clinical outcomes demonstrated no significant differences among a traditional single-vessel CABG and a MIDCAB in myocardial infarction rates, reoperations for bleeding, and cerebrovascular accidents. Differences were found in new-onset atrial fibrillation, extubation in the operating room, required transfusions, length of stay in the critical care unit, and overall length of hospital stay. Optimal perioperative critical care recovery may result from an evidence-based approach in the design and delivery of patient care. Standardized nursing interventions may be designed to improve efficiency and reduce inappropriate variations in perioperative care. Because MIDCAB is a palliative intervention for single-vessel CAD, multifactorial CRF management is a necessary adjunct for the achievement of optimal long-term outcomes. CRFs must be managed to maintain long-term arterial conduit patency rates (e.g., 20 y) and to prevent further progression of CAD in the native coronary arteries for MIDCAB patients. Nurse-managed, physician-directed CRF management programs are the avenue to provide such services. The reported clinical outcomes are appropriate variables to track for continuous quality improvement. These clinical outcomes are meaningful, measurable, and appropriate for evaluating the effectiveness of care but do not address quality of life, patient satisfaction, and efficacy of pain management. Nursing care must continue to evolve as more data become available.

  8. Intestinal Calcium Absorption Decreases Dramatically After Gastric Bypass Surgery Despite Optimization of Vitamin D Status.

    Science.gov (United States)

    Schafer, Anne L; Weaver, Connie M; Black, Dennis M; Wheeler, Amber L; Chang, Hanling; Szefc, Gina V; Stewart, Lygia; Rogers, Stanley J; Carter, Jonathan T; Posselt, Andrew M; Shoback, Dolores M; Sellmeyer, Deborah E

    2015-08-01

    Roux-en-Y gastric bypass (RYGB) surgery has negative effects on bone, mediated in part by effects on nutrient absorption. Not only can RYGB result in vitamin D malabsorption, but the bypassed duodenum and proximal jejunum are also the predominant sites of active, transcellular, 1,25(OH)2 D-mediated calcium (Ca) uptake. However, Ca absorption occurs throughout the intestine, and those who undergo RYGB might maintain sufficient Ca absorption, particularly if vitamin D status and Ca intake are robust. We determined the effects of RYGB on intestinal fractional Ca absorption (FCA) while maintaining ample 25OHD levels (goal ≥30 ng/mL) and Ca intake (1200 mg daily) in a prospective cohort of 33 obese adults (BMI 44.7 ± 7.4 kg/m(2)). FCA was measured preoperatively and 6 months postoperatively with a dual stable isotope method. Other measures included calciotropic hormones, bone turnover markers, and BMD by DXA and QCT. Mean 6-month weight loss was 32.5 ± 8.4 kg (25.8% ± 5.2% of preoperative weight). FCA decreased from 32.7% ± 14.0% preoperatively to 6.9% ± 3.8% postoperatively (p < 0.0001), despite median (interquartile range) 25OHD levels of 41.0 (33.1 to 48.5) and 36.5 (28.8 to 40.4) ng/mL, respectively. Consistent with the FCA decline, 24-hour urinary Ca decreased, PTH increased, and 1,25(OH)2 D increased (p ≤ 0.02). Bone turnover markers increased markedly, areal BMD decreased at the proximal femur, and volumetric BMD decreased at the spine (p < 0.001). Those with lower postoperative FCA had greater increases in serum CTx (ρ = -0.43, p = 0.01). Declines in FCA and BMD were not correlated over the 6 months. In conclusion, FCA decreased dramatically after RYGB, even with most 25OHD levels ≥30 ng/mL and with recommended Ca intake. RYGB patients may need high Ca intake to prevent perturbations in Ca homeostasis, although the approach to Ca supplementation needs further study. Decline in FCA could contribute to

  9. Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective

    NARCIS (Netherlands)

    R.L.J. Osnabrugge (Ruben); E.A. Magnuson (Elizabeth); P.W.J.C. Serruys (Patrick); C.A.M. Campos (Carlos); K.K. Wang (Kenneth); D. van Klaveren (David); V. Farooq (Vasim); M.S. Abdallah (Mouin S.); H. Li (Haiying); K.A. Vilain (Katherine A.); E.W. Steyerberg (Ewout); M-C. Morice (Marie-Claude); K.D. Dawkins (Keith D.); F.W. Mohr (Friedrich); Kappetein, A.P. (A. Pieter); D.J. Cohen (David J.)

    2015-01-01

    textabstractAims Recent cost-effectiveness analyses of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have been limited by a short time horizon or were restricted to the US healthcare perspective. We, therefore, used individual patient-level data from the SYNT

  10. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

    NARCIS (Netherlands)

    D.J. Cohen (David J.); B.A. van Hout (Ben); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); C.M. Miguel (Carlos); P. den Heijer (Peter); M.M. Vrakking (M. M.); K.K. Wang (Kenneth); E.M. Mahoney (Elizabeth M.); S. Audi (Salma); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractBACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in

  11. Regional myocardial shortening in relation to graft-reactive hyperemia and flow after coronary bypass surgery

    NARCIS (Netherlands)

    R.W. Brower (Ronald); P.W.J.C. Serruys (Patrick); E. Bos (Egbert); J. Nauta (Jan)

    1979-01-01

    textabstractExtent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was mani

  12. Cardiopulmonary bypass during cardiac surgery modulates systemic inflammation by affecting different steps of the leukocyte recruitment cascade.

    Directory of Open Access Journals (Sweden)

    Jan Rossaint

    Full Text Available BACKGROUND: It is known that the use of a cardiopulmonary bypass (CPB during cardiac surgery leads to leukocyte activation and may, among other causes, induce organ dysfunction due to increased leukocyte recruitment into different organs. Leukocyte extravasation occurs in a cascade-like fashion, including capturing, rolling, adhesion, and transmigration. However, the molecular mechanisms of increased leukocyte recruitment caused by CPB are not known. This clinical study was undertaken in order to investigate which steps of the leukocyte recruitment cascade are affected by the systemic inflammation during CPB. METHODS: We investigated the effects of CPB on the different steps of the leukocyte recruitment cascade in whole blood from healthy volunteers (n = 9 and patients undergoing cardiac surgery with the use of cardiopulmonary bypass (n = 7 or in off-pump coronary artery bypass-technique (OPCAB, n = 9 by using flow chamber experiments, transmigration assays, and biochemical analysis. RESULTS: CPB abrogated selectin-induced slow leukocyte rolling on E-selectin/ICAM-1 and P-selectin/ICAM-1. In contrast, chemokine-induced arrest and transmigration was significantly increased by CPB. Mechanistically, the abolishment of slow leukocyte rolling was due to disturbances in intracellular signaling with reduced phosphorylation of phospholipase C (PLC γ2, Akt, and p38 MAP kinase. Furthermore, CPB induced an elevated transmigration which was caused by upregulation of Mac-1 on neutrophils. CONCLUSION: These data suggest that CPB abrogates selectin-mediated slow leukocyte rolling by disturbing intracellular signaling, but that the clinically observed increased leukocyte recruitment caused by CPB is due to increased chemokine-induced arrest and transmigration. A better understanding of the underlying molecular mechanisms causing systemic inflammation after CPB may aid in the development of new therapeutic approaches.

  13. Glaukos iStent inject® Trabecular Micro-Bypass Implantation Associated with Cataract Surgery in Patients with Coexisting Cataract and Open-Angle Glaucoma or Ocular Hypertension: A Long-Term Study

    Science.gov (United States)

    Martinez-de-la-Casa, Jose Maria; Diaz-Valle, David; Morales-Fernandez, Laura; Fernandez-Perez, Cristina; Garcia-Feijoo, Julian

    2016-01-01

    Purpose. To evaluate the long-term efficacy and safety of the iStent inject device (Glaukos Corporation, Laguna Hills, CA) combined with phacoemulsification in patients with coexistent cataract and open-angle glaucoma or ocular hypertension (OHT). Methods. A prospective, uncontrolled, nonrandomized, interventional case series study was conducted in patients with both mild or moderate open-angle glaucoma or OHT and cataract. Patients underwent cataract surgery along with the implant of two iStent inject devices. Outcome measures were intraocular pressure (IOP), topical hypotensive medications required, and best-corrected visual acuity (BCVA). Results. 20 patients were enrolled. Mean follow-up was 47.4 ± 18.46 months. Mean baseline IOP was 19.95 ± 3.71 mmHg with medication and 26 ± 3.11 mmHg after washout. Mean end-follow-up IOP was 16.25 ± 1.99 mmHg, representing an IOP decrease of 36.92%, 9.74 ± 3.14 mmHg (P < 0.001), from baseline washout IOP. The mean number of medications was significantly reduced from 1.3 ± 0.66 to 0.75 ± 0.79 (P = 0.017). 45% of patients were medication-free by the end of follow-up. Mean log⁡MAR BCVA improved significantly from 0.42 ± 0.16 to 0.18 ± 0.16 (P < 0.001). No complications of surgery were observed. Conclusion. The iStent inject device combined with cataract surgery served to significantly reduce both IOP and medication use in the long term in patients with coexistent open-angle glaucoma or ocular hypertension (OHT) and cataract. PMID:27882243

  14. Glaukos iStent inject® Trabecular Micro-Bypass Implantation Associated with Cataract Surgery in Patients with Coexisting Cataract and Open-Angle Glaucoma or Ocular Hypertension: A Long-Term Study

    Directory of Open Access Journals (Sweden)

    Pedro Arriola-Villalobos

    2016-01-01

    Full Text Available Purpose. To evaluate the long-term efficacy and safety of the iStent inject device (Glaukos Corporation, Laguna Hills, CA combined with phacoemulsification in patients with coexistent cataract and open-angle glaucoma or ocular hypertension (OHT. Methods. A prospective, uncontrolled, nonrandomized, interventional case series study was conducted in patients with both mild or moderate open-angle glaucoma or OHT and cataract. Patients underwent cataract surgery along with the implant of two iStent inject devices. Outcome measures were intraocular pressure (IOP, topical hypotensive medications required, and best-corrected visual acuity (BCVA. Results. 20 patients were enrolled. Mean follow-up was 47.4±18.46 months. Mean baseline IOP was 19.95±3.71 mmHg with medication and 26±3.11 mmHg after washout. Mean end-follow-up IOP was 16.25±1.99 mmHg, representing an IOP decrease of 36.92%, 9.74±3.14 mmHg (P<0.001, from baseline washout IOP. The mean number of medications was significantly reduced from 1.3±0.66 to 0.75±0.79 (P=0.017. 45% of patients were medication-free by the end of follow-up. Mean log⁡MAR BCVA improved significantly from 0.42±0.16 to 0.18±0.16 (P<0.001. No complications of surgery were observed. Conclusion. The iStent inject device combined with cataract surgery served to significantly reduce both IOP and medication use in the long term in patients with coexistent open-angle glaucoma or ocular hypertension (OHT and cataract.

  15. The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system

    Science.gov (United States)

    Guru, Veena; Glasgow, Kevin W; Fremes, Stephen E; Austin, Peter C; Teoh, Kevin; Tu, Jack V

    2007-01-01

    BACKGROUND: The population-based results of off-pump coronary artery bypass surgery (OPCAB) in a public health care system have not been reported. OBJECTIVE: The study objective was to compare the one-year outcomes of OPCAB with those of the standard on-pump coronary artery bypass surgery (ONCAB) in the province of Ontario. METHODS: The present study was a retrospective, population-based study (n=15,172, with 1660 OPCAB patients) undertaken in fiscal years 2000 and 2001 using clinical and administrative data. Multivariate regression modelling for risk adjustment and propensity matching were used to compare OPCAB with ONCAB for one-year outcomes, including death, repeat revascularization and cardiac readmission. RESULTS: The rate of OPCAB was 11%, with institutional rates ranging from 3% to 51%. OPCAB patients were more likely to be female and older than 79 years of age, with peripheral vascular disease and higher socioeconomic status. OPCAB patients were less likely to have surgically significant coronary disease, poor left ventricular function, an urgent status, congestive heart failure and diabetes. The risk-adjusted one-year composite outcome was higher for OPCAB (11.8%, 95% CI 10.40% to 13.29%) than ONCAB (10.8%, 95% CI 10.23% to 11.27%); however, this difference was eliminated with propensity matching. OPCAB patients had shorter hospital lengths of stay and lower blood product transfusion rates than ONCAB patients. CONCLUSIONS: Despite the minimal use of OPCAB in Canada’s public health care system, outcome rates are similar to those of ONCAB. The benefits of OPCAB observed in randomized trials, including shorter hospital lengths of stay and lower transfusion rates, remained true in the investigators’ real-world experience. The results OPCAB were at least equivalent to those of ONCAB. PMID:17380221

  16. Outcomes following cardiac surgery in patients with preoperative renal dialysis.

    Science.gov (United States)

    Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W

    2014-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.

  17. EFFECT OF SIZE OF INTESTINAL DIVERSIONS IN OBESE PATIENTS WITH METABOLIC SYNDROME SUBMITTED TO GASTRIC BYPASS

    Science.gov (United States)

    RAMOS, Rafael Jacques; MOTTIN, Cláudio Corá; ALVES, Letícia Biscaino; BENZANO, Daniela; PADOIN, Alexandre Vontobel

    2016-01-01

    ABSTRACT Background: There is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries. Aim: To evaluate the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes. Methods: Was conducted a retrospective cohort study in diabetic obese patients (BMI≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into three groups according to the size of the intestinal loop: group 1, biliopancreatic limb 50 cm length and alimentary limb 100 cm length; group 2 , biliopancreatic limb 50 cm length and alimentary limb 150 cm length; and group 3, biliopancreatic limb 100 cm length and alimentary limb 150 cm length. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome was determined. Results: Sixty-three patients were evaluated, and they had a mean age of 44.7±9.4 years. All were diabetics, with 62 (98.4%) being hypertensive and 51 (82.2%) dyslipidemic. The three groups were homogeneous in relation to the variables. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of diabetes occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia. Conclusion: Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients. PMID:27683768

  18. Non-ischemic perfusion defects due to delayed arrival of contrast material on stress perfusion cardiac magnetic resonance imaging after coronary artery bypass graft surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeo Koon; Park, Eun Ah; Park, Sang Joon; Cheon, Gi Jeong; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-04-15

    Herein we report about the adenosine stress perfusion MR imaging findings of a 50-year-old man who exhibited two different perfusion defects resulting from two different mechanisms after a coronary artery bypass surgery. An invasive coronary angiography confirmed that one perfusion defect at the mid-anterior wall resulted from an ischemia due to graft stenosis. However, no stenosis was detected on the graft responsible for the mid-inferior wall showing the other perfusion defect. It was assumed that the perfusion defect at the mid-inferior wall resulted from delayed perfusion owing to the long pathway of the bypass graft. The semiquantitative analysis of corrected signal-time curves supported our speculation, demonstrating that the rest-to-stress ratio index of the maximal slope of the myocardial territory in question was similar to those of normal myocardium, whereas that of myocardium with the stenotic graft showed a typical ischemic pattern. A delayed perfusion during long graft pathway in a post-bypass graft patient can mimick a true perfusion defect on myocardial stress MR imaging. Radiologists should be aware of this knowledge to avoid misinterpretation of graft and myocardial status in post bypass surgery patients.

  19. Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2013-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

  20. Endovascular Repair of a Ruptured Aortic Extra-anatomic Bypass Pseudoaneurysm After Previous Coarctation Surgery.

    Science.gov (United States)

    Hörer, Tal; Toivola, Asko

    2015-01-01

    We present a short case of a total endovascular repair of a ruptured thoracic pseudoaneurysm after previous coarctation aortic conduit bypass surgery. A 67-year-old man with two previous coarctation repairs many years ago was admitted with chest pain, dyspnea, and hemoptysis. Computed tomography showed a rupture in the distal anastomosis of the thoracic extra-anatomic graft. Successful treatment was achieved by placement of an endovascular stent graft between the old graft and the native aorta and with a vascular plug occlusion of the native aorta.

  1. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    WANG Yun; YUE Yun; SUN Yong-hai; WU An-shi; WU Qi-wei; ZHANG Yong-qian; FENG Chun-sheng

    2005-01-01

    Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.Methods Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P>0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P>0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the

  2. Eating in mice with gastric bypass surgery causes exaggerated activation of brainstem anorexia circuit

    Science.gov (United States)

    Mumphrey, Michael B.; Hao, Zheng; Townsend, R. Leigh; Patterson, Laurel M.; Münzberg, Heike; Morrison, Christopher C.; Ye, Jianping; Berthoud, Hans-Rudolf

    2016-01-01

    Background/Objective Obesity and metabolic diseases are at an alarming level globally and increasingly affect children and adolescents. Gastric bypass and other bariatric surgeries have proven remarkably successful and are increasingly performed worldwide. Reduced desire to eat and changes in eating behavior and food choice account for most of the initial weight loss and diabetes remission after surgery, but the underlying mechanisms of altered gut-brain communication are unknown. Subjects/Methods To explore the potential involvement of a powerful brainstem anorexia pathway centered around the lateral parabrachial nucleus (lPBN) we measured meal-induced neuronal activation by means of c-Fos immunohistochemistry in a new high-fat diet-induced obese mouse model of Roux-en-Y gastric bypass (RYGB) at 10 and 40 days after RYGB or sham surgery. Results Voluntary ingestion of a meal 10 days after RYGB, but not after sham surgery, strongly and selectively activates calcitonin gene-related peptide neurons in the external lPBN as well as neurons in the nucleus tractus solitaries, area postrema, and medial amygdala. At 40 days after surgery, meal-induced activation in all these areas was greatly diminished and did not reach statistical significance. Conclusions The neural activation pattern and dynamics suggest a role of the brainstem anorexia pathway in the early effects of RYGB on meal size and food intake that may lead to adaptive neural and behavioral changes involved in the control of food intake and body weight at a lower level. However, selective inhibition of this pathway will be required for a more causal implication. PMID:26984418

  3. Effect of Roux-en-Y gastric bypass surgery on intestinal Akkermansia muciniphila

    Science.gov (United States)

    Yan, Ming; Song, Mao-Min; Bai, Ri-Xing; Cheng, Shi; Yan, Wen-Mao

    2016-01-01

    AIM: To investigated changes in intestinal Akkermansia muciniphila (A. muciniphila) and explored the mechanism underlying the therapeutic effects of Roux-en-Y gastric bypass (RYGB) surgery on type 2 diabetes in diabetic Goto-Kakizaki (GK) rats. METHODS: Male diabetic GK rats (n = 12) aged 8 wk were randomly assigned to the surgery group (GK-RYGB) or sham surgery group (GK-Sham) (n = 6 per group), and another 6 male Wistar rats aged 8 wk served as controls (WS-Sham). In the surgery group, RYGB surgery was conducted, and a sham operation was performed in both sham groups. Fasting blood glucose (FBG) levels before and after surgery, fasting levels of serum insulin and serum glucagon-like peptide-1 (GLP-1) and levels 30 min after intragastric injection of glucose, and the amount of A. muciniphila in the stool were determined. Insulin and GLP-1 were measured by enzyme-linked immunosorbent assay, and A. muciniphila were detected by fluorescence-based quantitative polymerase chain reaction. RESULTS: The FBG was improved, and serum GLP-1 and insulin increased significantly (P < 0.05) in the GK-RYGB group after surgery compared to levels before surgery and to levels in the GK-Sham group. Before surgery, the amounts of A. muciniphila in the GK-RYGB and GK-Sham groups were significantly lower than in the WS-Sham group (P < 0.05). After surgery, the amount of A. muciniphila in the GK-RYGB group increased markedly compared to that before surgery and to that in the GK-Sham and WS-Sham groups (P < 0.05). In addition, the A. muciniphila amount was positively related to GLP-1 (r = 0.86, P < 0.05). CONCLUSION: Our results demonstrated RYGB surgery may increase GLP-1 secretion, elevate serum insulin after intragastric injection of glucose, and improve insulin resistance in diabetic GK rats, thereby contributing to a significant reduction in blood glucose. The increased amount of A. muciniphila after RYGB surgery may be related to elevated GLP-1 secretion. PMID:27152136

  4. Multivariate Analysis of Factors Influencing Length of Hospital Stay after Coronary Artery Bypass Surgery in Tehran, Iran

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    Amin Torabipour

    2016-03-01

    Full Text Available Length of hospital stay (LOS is a key indicator for hospital management. Reducing hospital stay is a priority for all health systems. We aimed to determine the length of hospital stay following Coronary Artery Bypass Surgery (CABG based on its clinical and non-clinical factors. A cross-sectional study of 649 consecutive patients who underwent coronary artery bypass graft surgery was conducted in Imam Khomeini and Shariati university hospitals, Tehran, Iran. Data was analyzed by using non-parametric univariate tests and multiple linier regression models. Thirty seven independent variables including pre-operative, intra-operative and post-operative variables were analyzed. Finally, an appropriate model was constructed based on the associated factors. The results showed that 70.3% of the patients were male, and the mean age of the patients was 59.3 ± 10.4 years. The Mean (±SD and median of the LOS were 11.7 ± 7.1 and 9 days, respectively. Of 37 investigated variables, 24 qualitative and quantitative variables were significantly associated with length of stay (p<0.05. Multiple linear regression analysis showed that independent variables including age, medical insurance type, body mass index, and prior myocardial infarction; admission day, admission season, Cross-clamp time, pump usage, admission type, the number of laboratory tests and the number of specialty consultation had more effect on the hospital stay. We concluded that some significant factors influencing hospital stay after CABG were predictable and modifiable by hospital managers and decision makers to manage hospital beds.

  5. Significance of oxidative stress changes in type 2 diabetic patients after gastric bypass

    Directory of Open Access Journals (Sweden)

    Li SHI

    2011-08-01

    Full Text Available Objective To observe the changes in oxidative stress in type 2 diabetic(T2DM patients after gastric bypass,and investigate the mechanism of gastric bypass treatment for T2DM.Methods Thirty T2DM patients who underwent gastric bypass(T2DM group and thirty healthy subjects(control group were included in present study from Aug.2009 to Apr.2010.Values of fasting plasma glucose(FPG,2-hour postprandial plasma glucose(2hPG,glycosylated hemoglobin(HbA1c,fasting plasma insulin(FIns,superoxide dismutase(SOD,malondialdehyde(MDA and glutathione peroxidase(GSH-PX were determined in T2DM group before surgery and 1,3,6 months after surgery.All the parameters were determined once in control group.Results Compared with control group,MDA was significantly higher(3.6±1.3 vs 2.2±0.7μmol/L,P < 0.01,and SOD and GSH-PX were significantly lower(45.2±18.8 vs 87.6±20.4kU/L,P < 0.01;53.6±16.8 vs 78.9±15.6mmol/L,P < 0.01 in T2DM group.Compared with the preoperative values,the MDA decreased significantly(P < 0.05,and SOD and GSH-PX increased significantly(P < 0.01 in T2DM group 3 months after operation.Compared with preoperative values,FPG,2hPG and HbA1c decreased significantly(P < 0.01 in T2DM group one month after operation.Compared with the values one month after operation,2hPG and HbA1c decreased significantly(P < 0.01,P < 0.05 3 months after operation.Values of HOMA-IR decreased significantly from one month to six months after surgery(P < 0.01.Conclusions Oxidative stress can be improved markedly after gastric bypass in T2DM patients.It may be one of the mechanisms of suceessful treatment of T2DM with gastric bypass.

  6. 部分体外循环在胸降主动脉瘤手术中的应用%Use of partial cardiopulmonary bypass for surgery of descending thoracic aneurysm

    Institute of Scientific and Technical Information of China (English)

    刘建华; 刘海霞; 孙建全

    2008-01-01

    Objective To summarize the experience of use of partial cardiopulmonary bypass for surgery of descending thoracic aneurysm. Methods Thirty five patients were undertaken surgery of descending thoracic aneurysm using partial cardiopulmonary bypass and beating-heart technique in our hospital. The partial cardiopulmonary bypass includes left heart bypass (left atrial to femoral artery bypass), pulmonary artery to femoral artery bypass, femoral vein to femoral artery bypass. Results Only one patient died, the other thirty four patients experienced an uneventful recovery. There was no any complication related to partial cardiopulmonary bypass. Conclusion The use of partial cardiopulmonary bypass for surgery of descending thoracic aneurysm can reduce and avoid the complications of nervous system and urinary system effectively.%目的 总结胸降主动脉瘤手术中采用部分体外循环的管理经验.方法 回顾性分析35例胸主动脉瘤手术中采用心脏不停跳部分体外循环资料,包括左心转流(左房-股动脉转流)、肺动脉-股动脉转流、股静脉-股动脉转流.结果 全组患者1例死亡,余34例痊愈出院,未发生体外循环相关的并发症.结论 胸降主动脉瘤手术采用部分体外循环,能有效的减少和避免神经系统和泌尿系统等并发症的发生.

  7. Perioperative Changes of Plasma Endothelin-1 in Patients Undergoing Coronary Artery bypass Grafting and the Effect of Nitroglycerin

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 蒋英硕; 徐明; 陈振强; 郭子黄

    2002-01-01

    Objectioe To observe the dynamic changes of the plasma ET-1 and the effect of low dose nitroglycerin in patients with coronary artery bypass surgery. Methods Forty patravenous nitroglycerin 1 μg @ kg-1 @ rain-1 perioperatively. RIA was used to assay the plasma ET-1 lev-el. All the hemodynamie parameters were recorded by the Swan-Ganze catheter. Results The preoperative plasma ET-1 level in patients with coronary artery disease was significantly higher than the normal level. Five minutes after cardiopalmouary bypass in these patients the plasma ET-1 level was increased significantly until 6 to 8 h after operation. The increasing plasma ET-1 level in group B was less intense than that in group A. There was a positive correlation between the plasma ET-1 level and the mean pulmonary artery pressure in group A 2 and 8 h after operation. Conclusion In patients undergoing coronary artery bypass surgery, the increased plasma ET-1 level may be due to the influence of cardiopulmonary bypass partly. Low dose nitroglycerin is beneficial to these patients.

  8. L-Carnitine Supplementation Reduces Short-Term Neutrophil-Lymphocyte Ratio in Patients Undergoing Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Aldemir, Mustafa; Pektaş, Mehmet Bilgehan; Parlar, Ali İhsan; Akcı, Önder; Emren, Sadık Volkan; Tecer, Evren; Adalı, Fahri; Yüksel, Şeref; Darçın, Osman Tansel

    2015-07-01

    This study aims to investigate whether preoperative L-carnitine supplementation affects the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing coronary artery bypass grafting surgery. The neutrophil-to-lymphocyte ratio is an inflammatory marker that has proven usefulness for predicting postoperative complications in coronary artery bypass surgery. A lot of studies concerning the role of L-carnitine in the immune system have been performed, contradictory results have been reported on its effects on absolute numbers of WBC subtypes. This randomized, double-blinded, placebo-controlled study was conducted among patients scheduled for coronary artery bypass grafting surgery between June 2012 and December 2013 in our cardiovascular surgery clinic. A total of 60 consecutive patients were randomized and divided into 2 groups. The first group received 2 g of L-carnitine in 1000 mL of 0.9% saline solution infused over 24 hours for each of the 3 preoperative days (L-carnitine group, n = 30), or only 1000 mL of 0.9% saline solution for the same time period (placebo group, n = 30). The basal values of leukocyte, neutrophil, lymphocyte counts, and neutrophil to lymphocyte ratio were similar in the 2 groups. After L-carnitine supplementation (just before surgery), leukocyte and neutrophil counts of the L-carnitine group were significantly lower than those of the placebo group (7.7 ± 1.5 versus 9.7 ± 2.6, P carnitine group (1.1 ± 0.6 versus 0.8 ± 0.9, P carnitine group at postoperative day 1 (20.7 ± 13.8 versus 10.8 ± 4.1, P carnitine supplementation may reduce neutrophil-lymphocyte ratio during the early postoperative period of coronary artery bypass grafting surgery.

  9. Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    Chen Xin; Xu Ming; Jiang Yinshuo; Sui Kaihu; Qiu Zhibing; Wang Liming; Liu Peisheng

    2006-01-01

    Objectives To summarize our preliminary experience on off-pump coronary endarterectomy and bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3-year period, 53 patients (41 male) with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution.Patients' age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 (n=5) or 3 (n=32), and nearly half of them (26/53) had history of myocardial infarction. Most patients (n=50) had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% (mean 52%). At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery (LIMA) grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries,and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of completeness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay (mean duration = 9 days).Intra-operatively, 63 (90%) out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative myocardial infarctions but neither experienced significant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be performed safely in patients with diffuse coronary artery disease. This strategy may help to improve the completeness of myocardial revascularization.

  10. Increased post-operative cardiopulmonary fitness in gastric bypass patients is explained by weight loss

    DEFF Research Database (Denmark)

    Lund, M. T.; Hansen, M.; Wimmelmann, C. L.

    2016-01-01

    Roux-en-Y gastric bypass (RYGB) leads to a major weight loss in obese patients. However, given that most patients remain obese after the weight loss, regular exercise should be part of a healthier lifestyle. The primary aim of this study was to investigate the cardiopulmonary fitness in obese......-perceived physical fitness increased after RYGB. Self-reported low- and high-intensity physical activity did not change. With weight loss, self-rated fitness level increased and the limitations to perform exercise decreased in RYGB patients. Nevertheless, as shown by the lower absolute VO2max, RYGB patients do...... patients before and after RYGB. Thirty-four patients had body composition and cardiopulmonary fitness (VO2max) assessed and completed questionnaires regarding physical activity and function twice before RYGB (time points A and B) and 4 and 18 months after surgery (time points C and D). Weight loss was 37...

  11. Comparing Heparin-Coated and Non-Coated Oxygenators on Renal Functions in Coronary Artery Bypass Surgery

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    Bektaş Battaloğlu

    2011-04-01

    Full Text Available Background: Renal damage and subsequent acute renal failure is one of the most important complications in patients who had cardiac surgery. Multicenter studies with thousands of patients which exposed the risk factors for acute renal failure has been published especially in the last decade. This study is designed for evaluation of heparin-coated and non-coated oxygenators on the renal functions. Methods: This study has been performed prospectively with 50 patients who had undergone coronary bypass surgery in our clinic from March 2006 to September 2006. The patients have been divided into two groups as non-coated oxygenators (n = 25, Group 1 used and heparin-coated oxygenators (n = 25, Group 2 used. Blood samples were collected at the preoperative, and at 1st, 24th and 96th postoperative hours. The demographic data were similar in two groups. Results: There was no early mortality in both groups. Operative and postoperative parameters were similar in both groups. There were no statistical differences between the evaluated parameters like BUN, creatinine, sodium, potassium, calcium, chloride, phosphorus, urine protein, creatinine clearence, urine sodium, urine calcium and urine chloride tests at preoperative period in both groups. We did not detect renal dysfunction in any patients. There are no statistical differences in the creatinine clearance in preoperative and postoperative periods in both groups. In group one, creatinin levels were lower than group two at 24 hours after surgery and these differences were statistically important in two groups. We found no significant difference between two groups regarding the other parameters for renal function during the postoperative period. Conclusion: In this study, there were not any significant difference between coated and non-coated oxygenators’ effects over renal functions of patients whose renal functions were normal preoperatively.

  12. Early 24-hour blood pressure response to Roux-en-Y gastric bypass in obese patients

    DEFF Research Database (Denmark)

    Pedersen, Julie S; Borup, Christian; Damgaard, Morten

    2017-01-01

    Recently, it has been proposed, that the blood pressure (BP) lowering effect of gastric bypass surgery not only is explained by the obtained weight loss, but that the anatomical rearrangement of the gut after 'malabsorptive' surgical techniques, such as the laparoscopic Roux-en-Y gastric bypass...

  13. Cirugía bariátrica laparoscópica: bypass gástrico proximal Laparoscopic bariatric surgery: proximal gastric bypass

    Directory of Open Access Journals (Sweden)

    F. Rotellar

    2005-01-01

    Full Text Available El espectacular aumento en la prevalencia de la obesidad en nuestra sociedad y las importantes complicaciones y comorbilidades que origina ha despertado el interés de científicos y público en esta patología. El tratamiento quirúrgico es en la actualidad el único tratamiento eficaz y duradero para la obesidad mórbida y en muchos casos, mejora sensiblemente e incluso cura definitivamente complicaciones asociadas como es el caso de la diabetes o la hipertensión. De entre las diversas técnicas de cirugía bariátrica, parece imponerse definitvamente el by-pass gástrico (BPG, al ofrecer un excelente balance entre pérdida de peso (70% del exceso y riesgo quirúrgico y calidad de vida posterior. La posiblidad de realizar esta técnica mediante un abordaje laparoscópico ha mejorado su aceptación por parte de médicos y pacientes al tiempo que ha permitido disminuir morbimortalidad, estancia y costes. El BPG proximal se realiza en aquellos pacientes con un IMC The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (70% of the excess, surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg

  14. The effect of weight loss on the outcome after coronary artery bypass grafting in obese patients

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    Remez Kocz

    2012-01-01

    Full Text Available The role of body mass index (BMI in the setting of coronary artery bypass graft (CABG surgery has been a focus of past studies. However, the effects of postoperative weight loss in patients after CABG is yet to be known. We performed a retrospective study of 899 patients who underwent CABG at our institution. Perioperative patient information was collected from an onsite electronic record system. Patients were grouped into four BMI categories: normal controls, overweight, obese and morbidly obese. Based on the postoperative BMI changes, patients were then grouped into three categories: gainers, no change and losers. Statistical analyses were performed using analysis of variance and linear regression to establish an association among the data. Hazard ratios (HR and cumulative survival were obtained by the Cox-Mantel and Kaplan-Meier analyses, respectively. The normal controls exhibited a markedly higher mortality postoperatively, at 27.9%, especially when compared with the obese individuals (16.1%. Patients who lost weight faced a significantly increased risk of mortality than those who experienced no changes or gained weight after surgery. This trend was especially salient among the obese patients, who more than tripled their mortality risk (HR = 3.24 versus individuals who gained weight, and more than doubled their risk (HR = 2.87 versus those who had no changes. We conclude that obesity confers a survival advantage in the setting of the CABG surgery. Weight loss among all BMI categories of patients studied results in an adverse effect on postoperative survival.

  15. Nursing care for the patient after femoral popliteal bypass grafting

    Institute of Scientific and Technical Information of China (English)

    Guo Xiaohui

    2003-01-01

    Objective: To share my knowledge, regarding the nursing care for the patients after femoral popliteal bypass grafting, with my Chinese colleagues who have never been abroad. Methods: From August 1998 to September 2002, five patients (including 1 female and 4 male) were summarized retrospectively on postoperative care by assessment, nursing implementation and evaluation. Results: All patients were followed up for 3 to 6 months. The results were evaluated as follows: patient's condition and the function of the operated leg were improved. The leg pain was released. The peripheral pulses were present and strong. The color, temperature and sensation of the skin were normal. None of further complications was noted. Conclusion: For Nursing the patient after femoral popliteal bypass grafting, the nurses should focus their attention on the circulatory status of the operated leg, anticoagulant therapy and signs of bleeding from the graft site. Meanwhile, provide a quiet、comfortable and safety environment for the patient. Asall of these are the main points of the postoperative care. A good nursing careoffer to a patient not only can ease the patient's physical suffering, but alsocan avoid some complications occurring.

  16. 体外循环心脏瓣膜手术患者疾病不确定感状况及影响因素%The current status and influential factors of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    李亚洁; 谢文鸿; 李梅; 余艳; 林康兴; 潘永毅; 庄素华

    2014-01-01

    目的 调查体外循环心脏瓣膜手术患者疾病不确定感状况并探讨其影响因素,为制定有效干预措施提供参考.方法 采用自行设计的患者一般资料问卷、Mishel疾病不确定感量表、Connor-Davidson韧性量表、医学应对方式问卷对广东省4所“三甲”医院心血管外科的208例体外循环心脏瓣膜手术患者分别在术前1d、出院前1d进行调查.结果 体外循环心脏瓣膜手术患者术前1d疾病不确定感的总体均分为(99.09±11.41)分,92.3%的患者疾病不确定感水平处于中等.出院前1d疾病不确定感的总体均分为(90.33±10.32)分,91.8%的患者疾病不确定感水平处于中等.年龄、心脏瓣膜病类型、心脏瓣膜手术次数、乐观及屈服对疾病不确定感水平有显著正向影响,家庭平均月收入、自强、心理韧性总分及面对应对方式对患者疾病不确定感水平有显著负向影响.结论 体外循环心脏瓣膜手术患者疾病不确定感水平处于中等,年龄、家庭平均月收入、心脏瓣膜病类型、心脏瓣膜手术次数、心理韧性与应对方式是疾病不确定感水平的主要影响因素.%Objective To investigate the current status of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass and analyze its influential factor,and provide reference for effective intervention.Methods A total of 208 cardiac valvular surgery patients with cardiopulmonary bypass were recruited from 4 cardiovascular surgery in Guangdong and were investigated with the self-designed questionnaire,Mishel Uncertainty in Illness Scale (MUIS),Connor-Davidson Resilience Scale (CD-RISC),Medical Coping Modes Questionnaire (MCMQ),in the preoperative day and the day before discharge.The data were analyzed by single-factor and multiple-factor analysis.Results The average score of uncertainty in illness in cardiac valvular surgery patients with cardiopulmonary bypass was 99.09±11.41,and 92

  17. How Older Female Spouses Cope with Partners’ Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Suzanne Marnocha

    2013-01-01

    Full Text Available This research sought to better understand how older female spouses cope with a partner’s coronary artery bypass graft surgery and to explore coping’s relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse’s surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner’s surgery. Folkman and Lazarus’ ways of coping (WCQ scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses’ surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses.

  18. How older female spouses cope with partners' coronary artery bypass graft surgery.

    Science.gov (United States)

    Marnocha, Suzanne; Marnocha, Mark

    2013-01-01

    This research sought to better understand how older female spouses cope with a partner's coronary artery bypass graft surgery and to explore coping's relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse's surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner's surgery. Folkman and Lazarus' ways of coping (WCQ) scales yielded two factors in this sample-reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses' surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses.

  19. Extra-intracranial standard bypass in the elderly

    DEFF Research Database (Denmark)

    Sandow, Nora; von Weitzel-Mudersbach, Paul; Rosenbaum, Sverre;

    2013-01-01

    Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far......, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years....

  20. Quantitative Measurement of Cerebrovascular Reactivity by Blood Oxygen Level-Dependent MR Imaging in Patients with Intracranial Stenosis : Preoperative Cerebrovascular Reactivity Predicts the Effect of Extracranial-Intracranial Bypass Surgery

    NARCIS (Netherlands)

    Mandell, D. M.; Han, J. S.; Poublanc, J.; Crawley, A. P.; Fierstra, J.; Tymianski, M.; Fisher, J. A.; Mikulis, D. J.

    2011-01-01

    BACKGROUND AND PURPOSE: CVR is a measure of cerebral hemodynamic impairment. A recently validated technique quantifies CVR by using a precise CO2 vasodilatory stimulus and BOLD MR imaging. Our aim was to determine whether preoperative CO2 BOLD CVR predicts the hemodynamic effect of ECIC bypass surge

  1. Postoperative neuropsychological change and its underlying mechanism in patients undergoing coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    YIN Yi-qing; LUO Ai-lun; GUO Xiang-yang; LI Li-huan; HUANG Yu-guang

    2007-01-01

    Background The high incidence of neuropsychologic deficits after cardiac surgery, including cognitive dysfunction and mood status, has significantly influenced the prognosis, outcome of treatment and long-term quality of life of patients. With a circadian secretion pattern, melatonin and cortisol are capable of modulating the human physiological processes and neuropsychological status, whereas disorder of their secretion pattern may lead to many diseases. However, it is unclear whether neuroendocrine variations are related to the neuropsychologic status in patients undergoing coronary artery bypass grafting (CABG). Methods Forty male patients scheduled for CABG with hypothermic cardiopulmonary bypass (CPB) (n=20) or off-pump coronary artery bypass (OPCAB) (n=20) were studied. Blood samples were taken intraoperatively at specific time-points and every 3 hours within the first postoperative 24 hours to determine plasma concentrations of melatonin and cortisol. A neuropsychologic test battery including depression and anxiety was administered preoperatively and 7 to 10 days postoperatively. Statistical methods included the nonparametric analysis, multiple linear regression and cosinor analysis. Results The patients in the CPB group exhibited more severe neuropsychologic deficits and more anxious than those in the OPCAB group after surgery. In both groups, patients were more depressed postoperatively than preoperatively and recovered 3 months after surgery. Depression and anxiety were correlated with some factors of cognitive dysfunctions. In the postoperative 24 hours, 2 patients in the CPB group, and 6 patients in the OPCAB group showed a circadian rhythm of melatonin secretion. As for cortisol secretion, there were 3 patients in the CPB group and 7 in the OPCAB group respectively. Parameters of circadian rhythm of melatonin in the CPB group and those of secretion rhythm of cortisol in both groups were correlated with depression and some neuropsychologic tests

  2. Work Status and Return to the Workforce after Coronary Artery Bypass Grafting and/or Heart Valve Surgery: A One-Year-Follow Up Study

    Directory of Open Access Journals (Sweden)

    Kirsten Fonager

    2014-01-01

    Full Text Available Background. Several characteristics appear to be important for estimating the likelihood of reentering the workforce after surgery. The aim of the present study was to describe work status in a two-year time period around the time of cardiac surgery and estimate the probability of returning to the workforce. Methods. We included 681 patients undergoing coronary artery bypass grafting and/or heart valve procedures from 2003 to 2007 in the North Denmark Region. We linked hospital data to data in the DREAM database which holds information of everyone receiving social benefits. Results. At the time of surgery 17.3% were allocated disability pension and 2.3% were allocated a permanent part-time benefit. Being unemployed one year before surgery reduced the likelihood of return to the workforce (RR=0.74 (0.60–0.92 whereas unemployment at the time of surgery had no impact on return to the workforce (RR=0.96 (0.78–1.18. Sickness absence before surgery reduced the likelihood of return to the workforce. Conclusion. This study found the work status before surgery to be associated with the likelihood of return to the workforce within one year after surgery. Before surgery one-fifth of the population either was allocated disability pension or received a permanent part-time benefit.

  3. Mapping of Autogenous Saphenous Veins as an Imaging Adjunct to Peripheral MR Angiography in Patients with Peripheral Arterial Occlusive Disease and Peripheral Bypass Grafting: Prospective Comparison with Ultrasound and Intraoperative Findings

    OpenAIRE

    Ann-Marie Bintu Munda Jah-Kabba; Guido Matthias Kukuk; Dariusch Reza Hadizadeh; Frank Träber; Arne Koscielny; Mustapha Sundifu Kabba; Frauke Verrel; Hans Heinz Schild; Winfried Albert Willinek

    2014-01-01

    BACKGROUND: Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. METHODS: 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44-88 years) underwent periphera...

  4. 冠状动脉旁路移植术后ICU监护时间延长的危险因素%Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

    Institute of Scientific and Technical Information of China (English)

    袁忠祥; 刘健

    2011-01-01

    Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses for preoperative risk factors were performed. Prolonged length of ICU stay was defined as initial admission to ICU exceeding 72 h. Results The mean age of patients ( 322women and 996 men) was (67.4±9.4) years. Of 1318 patients undergoing isolated CABG from 1997 to 2009, 205 experienced prolonged length of ICU stay. The length of ICU stay was (40.1 ± 22.5 ) hours and ( 122.6 ± 48.7 ) hours separately.Overall in-hospital mortality was higher among these 205 patients ( 13.7% vs. 1.2%, P <0.05 ). The overall mortality was 3.1%. In univariate analyses, there were statistically significant differences with respect to the percentage of CPB, total bypass time, cross-clamp time, number of distal anastomoses, use of pressor agent, use of intro-aortic balloon pump,time of ventilation and hospital mortality. The significant risk factors were age, NYHA class Ⅲ/Ⅳ, left ventricular ejection fraction(LVEF) <0.40, renal failure, cerebrovascular and/or peripheral vascular disease, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, left main stenosi, three-vessels disease. The variables entered into the multivariate logistic regression were age, NYHA class Ⅲ/Ⅳ, LVEF <0.40, renal failure, chronic obstructive pulmonary disease, recent acute myocardial infarction, prior percutaneous coronary intervention, three-vessels disease. According to the outcome of multivariate logistic regression, we can conclude the model of probability forecast and create a new variable named Pre. The area under ROC curve of the new variable Pre was larger than other variables. Conclusion The main risk factors of prolonged ICU

  5. Factors Affecting the Quality and Quantity of Sleep in Coronary Artery Bypass Graft Patients

    Directory of Open Access Journals (Sweden)

    H Esmaily

    2008-10-01

    Full Text Available Introduction: Sleep disturbance is common in patients undergoing Coronary Artery Bypass Graft surgery and has been recognized for more than 30 years. New literature suggests the importance of sleep and rest for restoration, protection and promotion of function and wellbeing of these patients. Because of the importance of the role of nurses in diagnosis and treatment of sleep disorders, this study was conducted to determine possible effective factors on sleep quality and sleep quantity of patients after CABG. Methods: This longitudinal, descriptive and correlational study was conducted on 91 patients admitted to Imam Reza Hospital in Mashad City in 2005-2006. Subjects were selected according to inclusion and exclusion criteria. Data was collected by interview in three stages: 24 hours before surgery, as well as 6 weeks and 10 weeks after surgery. Subjective sleep quality was measured with PSQI and sleep quantity was measured with sleep log. The first two interviews were done at the hospital clinic and the last via telephone. Data was analyzed in SPSS using student T test, Pearson correlation coefficient and General Linear Model. Results: According to Univariable analysis, variables such as age (p=0.03, aorta clamp time (p=0.003, mechanical ventilation time (p=0.01, staying time in hospital (p=0.04 can affect sleep quantity 10 weeks after surgery. Previous history of sleep disorder (p=0.005, diabetes (p=0.02, use of diuretic drugs before surgery (p=0.04 and ACEI drugs after surgery (p=0.01 can affect sleep quality 10 weeks after surgery. Conclusion: Sleep disorder history (p=0.01, use of diuretic drugs before surgery (p=0.04 and sleep quantity 6 weeks after surgery (p=0.01 have been the most effective factors on sleep quality 10 weeks after surgery, whereas quality of life 10 weeks after surgery (p=0.04 has been the most effective factor on sleep quantity 10 weeks after surgery. There is therefore a necessity for presenting approaches in order to

  6. The Quality of life of patients with morbid obesity before and after gastric banding and gastric bypass

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    V Egiev

    2014-06-01

    Full Text Available In order to estimate the quality of life in bariatric surgery patients usually two scales are used: GIQLI (gastrointestinal Quality of life index and BAROS (Bariatric analysis and reporting outcome system. In our work we used the original estimation of the quality of life, based on the questionnaire GIQLI. This questionnaire consists of two parts: universal and specific. For the estimation of the level of morbid obesity two main scores are utilized: overweight and the Body Mass Index (BMI. We estimated the quality of life of patients with morbid obesity before the operation (25 patients, after gastric banding (25 patients and gastric bypass (25 patients. For the control group we show the answers for the same questionnaire of 26 volunteers without any chronic diseases, including morbid obesity. Gastric bypass was performed in patients with BMI more than 40 kg/m2, gastric banding was performed in patients with BMI less than 40 kg/m2. The median periods of supervising the patients after gastric bypass and gastric banding were 3±1,9 years and 4,3±1,7 years for each. After the surgery the percentage of reduction of the overweight was significantly higher in the patients after the gastric bypass. It means that the weight loss is more effective after gastric bypass than gastric banding. The index of the quality of life of the patients with the morbid obesity was much lower than in the control group (р<0,05. After the surgical treatment all the scores increased in the group of the patients being operated on, than in the group of the patients with obesity before the operations (р<0,05. While comparatively estimating the two operations we got practically the same results after gastric bypass and gastric banding. For gastric banding a very important index of the improvement of the quality of life is the level of the weight loss, but after the gastric bypass there were no such outcome.

  7. Off pump coronary artery bypass surgery for significant left ventricular dysfunction: safety, feasibility, and trends in methodology over time—an early experience

    Science.gov (United States)

    Sharoni, E; Song, H K; Peterson, R J; Guyton, R A; Puskas, J D

    2006-01-01

    Objective To examine the safety and applicability of off pump coronary artery bypass surgery (OPCAB) in patients with significant left ventricular dysfunction and to discuss the clinical implications for the surgical methods. Design Retrospective study. Setting Tertiary care university affiliated referral centre. Participants 353 consecutive patients with preoperative left ventricular ejection fraction ⩽ 35% who underwent coronary artery bypass over a three year period. Main outcome measures Postoperative morbidity and mortality. Methods 144 patients operated by OPCAB were compared with 209 patients operated by conventional coronary artery bypass. Multivariate and univariate analyses were performed on the pre‐ and postoperative variables to predict risk factors associated with hospital morbidity and mortality. Results Patients in the OPCAB group were more likely to be women and to have congestive heart failure, chronic obstructive pulmonary disease, hypertension, and diabetes; patients in the on pump group were more likely to have had a recent myocardial infarction and to have more severe angina pectoris and an urgent/emergent status. The groups did not differ significantly in length of stay, major postoperative complication rates, or mortality. Comparison of the impact of the procedures on surgical methods over time showed an increase in the use of OPCAB (13% to 67%), without any impact on morbidity or mortality. Conclusions OPCAB is feasible and applicable for patients with depressed left ventricular function. This high risk group can potentially benefit from the off pump approach. PMID:15994913

  8. The Effects of Thoracic Epidural Analgesia on Postoperative Pain and Myocardial Protection in Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Bestami Barış Çelik

    2015-03-01

    Full Text Available Aim: Thoracic epidural analgesia (TEA in cardiac surgery provides stable hemodynamics and postoperative analgesia by reducing stress response. The aim of this study was to investigate the effects of TEA in coronary artery bypass grafting (CABG on postoperative pain, myocardial protection, intensive care unit (ICU and hospital length of stay. Methods: After receiving approval from the hospital scientific committee and obtaining written informed consent from the participants, 40 patients, who were undergoing elective CABG, were included in the study. The patients were prospectively randomized into two groups as TEA group (n=20 and control group (n=20. Epidural catheters were placed one day before surgery at the T5-T6 level, levobupivacaine 2 µg/mL and fentanyl 5 mL/hr infusions were initiated in the ICU. Control group received intravenous infusion of fentanyl 8 µg/kg/hr. Infusions continued for 24 hours in both groups. Results: Time to extubation was shorter, postoperative hypertension was less frequent and pain scores were lower in TEA group than in control group (p<0.01. There was no difference in length of stay in the ICU, CK-MB and troponin I levels between the groups, however, length of hospital stay was shorter in TEA group. Conclusion: TEA with levobupivakain in CABG was found to provide stable hemodynamics, effective analgesia and to shorten length of hospital stay. (The Medical Bulletin of Haseki 2015; 53: 72-6

  9. Avaliação de uma escala de risco em pacientes submetidos à cirurgia de revascularização do miocárdio: análise de 400 casos Assessment of a risk scale in patients submitted to coronary artery bypass surgery: analysis of 400 cases

    Directory of Open Access Journals (Sweden)

    Hélcio Giffhorn

    2008-03-01

    ,61%. Foram registrados 22 óbitos (5,5%, sendo os de etiologia cardiovascular os mais freqüentes (40,9%. Em 370 pacientes (92,5% a avaliação pré-operatória teve como resultado um parâmetro BACKGROUND AND OBJECTIVES: The objective of this paper was to assess a risk scale based on a protocol developed at The Cleveland Clinic Foundation for the coronary artery bypass surgery using preoperative and perioperative parameters and the patient's physiological profile at the admission in the intensive care unit (ICU. METHODS: In the period between May,1999 and January,2002 part of the patients who underwent coronary artery bypass surgery in the cardiac service of the Hospital Universitário Cajuru of Pontifícia Universidade Católica do Paraná were included in the assessment of the operative risk scale, prospectively and consecutive. During the postoperative assessment a parameter 14. Morbidity was classified in major complications as well as less important complications. There were including all patients that it was possible to include all variables of the protocol. RESULTS: Four hundred patients who underwent surgery, with cardiopulmonary bypass or off-pump coronary bypass, were assessed. There was 22 deaths (5.5% and 124 patients with major complications (31%. The most common preoperative risk factors were the age between 65 and 74 in 111 cases (27.75%, weight below 65 kg in 106 (26.5%. Diabetes mellitus being treated in 89 cases (22.5%. The cardiopulmonary bypass time was above 160 minutes in 13 cases (6.95% and intra-aortic balloon pump was used in 11 (2.75%. During the analysis of the ICU admission physiology, the alveolar arterial gradient equal or above 250 mmHg was the parameter found in 334 patients (83.5%, arterial sodium bicarbonate at ICU below 21 mmol/L was identified in 265 patients (66.25%, and the marginal or inadequate cardiovascular performance was observed in 263 patients (65.75%. The major complications occurred in 124 patients (31% and the low output

  10. Does coronary artery bypass grafting improve quality of life in elderly patients?

    Science.gov (United States)

    Baig, Kamran; Harling, Leanne; Papanikitas, Joseph; Attaran, Saina; Ashrafian, Hutan; Casula, Roberto; Athanasiou, Thanos

    2013-09-01

    Traditional outcome measures such as long-term mortality may be of less value than symptomatic improvement in elderly patients undergoing coronary artery bypass grafting (CABG). In this systematic review, we analyse health-related quality of life (HRQOL) as a marker of outcome after CABG. We aimed to assess the role of HRQOL tools in making recommendations for elderly patients undergoing surgery, where symptomatic and quality-of-life improvement may often be the key indications for intervention. Twenty-three studies, encompassing 4793 patients were included. Overall, elderly patients underwent CABG at reasonably low risk. Our findings, therefore, support the conclusion that performing CABG in the elderly may be associated with significant improvements in HRQOL. In order to overcome previous methodological limitations, future work must clearly define and stringently follow-up this elderly population, to develop a more robust, sensitive and specialty-specific HRQOL tool.

  11. Roux-en-Y gastric bypass surgery is effective in fibroblast growth factor-21 deficient mice

    Directory of Open Access Journals (Sweden)

    Christopher D. Morrison

    2016-10-01

    Conclusions: FGF21 signaling is not a critical single factor for the beneficial metabolic effects of RYGB. This may open up the possibility to use FGF21 as adjuvant therapy in patients with ineffective bariatric surgeries.

  12. Comparison of the acute-phase response after laparoscopic versus open aortobifemoral bypass surgery: a substudy of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Krog AH

    2016-09-01

    Full Text Available Anne H Krog,1,2 Mehdi Sahba,3 Erik M Pettersen,4 Irene Sandven,5 Per M Thorsby,1,6 Jørgen J Jørgensen,1,2 Jon O Sundhagen,2 Syed SS Kazmi2 1Institute of Clinical Medicine, University of Oslo, 2Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, 3Department of Vascular Surgery, Østfold Central Hospital, Fredrikstad, 4Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand, 5Oslo Center for Biostatistics and Epidemiology (OCBE, 6Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway Purpose: Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population.Patients and methods: This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial. Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic (n=14 or an open surgical procedure (n=16. The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6, IL-8, and C-reactive protein (CRP at six different time points.Results: The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC, and after adjusting for the confounding effect of coronary heart disease (P=0.010. The differences in serum levels of IL-8 and CRP did not reach statistical significance.Conclusion: In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass

  13. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery.

    Science.gov (United States)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy; Bächler, Thomas; Bellmann-Sickert, Kathrin; Le Foll, Christelle; Sivertsen, Bjørn; Dalbøge, Louise S; Hartmann, Bolette; Beck-Sickinger, Annette G; Madsen, Andreas N; Jelsing, Jacob; Holst, Jens J; Lutz, Thomas A; Andrews, Zane B; Holst, Birgitte

    2016-09-01

    Neurotensin (NT) is a peptide expressed in the brain and in the gastrointestinal tract. Brain NT inhibits food intake, but the effects of peripheral NT are less investigated. In this study, peripheral NT decreased food intake in both mice and rats, which was abolished by a NT antagonist. Using c-Fos immunohistochemistry, we found that peripheral NT activated brainstem and hypothalamic regions. The anorexigenic effect of NT was preserved in vagotomized mice but lasted shorter than in sham-operated mice. This in combination with a strong increase in c-Fos activation in area postrema after ip administration indicates that NT acts both through the blood circulation and the vagus. To improve the pharmacokinetics of NT, we developed a pegylated NT peptide, which presumably prolonged the half-life, and thus, the effect on feeding was extended compared with native NT. On a molecular level, the pegylated NT peptide increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological antagonism of NT increased food intake transiently in RYGB rats. Taken together, our data suggest that NT is a metabolically active hormone, which contributes to the regulation of food intake.

  14. A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Antônio Sérgio Cordeiro da Rocha

    2012-03-01

    Full Text Available OBJETIVO: Analisar os resultados da cirurgia de revascularização miocárdica (CRVM isolada com circulação extracorpórea em pacientes com idade > 70 anos em comparação àqueles com 70 anos foi fator preditivo independente para maior letalidade operatória (P=0,004 e para RRH (P=0,002, sepse (P=0,002, complicações respiratórias (P 70 anos estão sob maior risco de morte e outras complicações no pós-operatório de CRVM em comparação aos pacientes mais jovens.OBJECTIVE: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG in patients >70 years-old in comparison to patients 70 years-old and G2 (age 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004, reexploration for bleeding (P=0.002, sepsis (P=0.002, respiratory complications (P 70 years-old were at increased risk of death and other complications in the CABG's postoperative period in comparison to younger patients.

  15. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  16. Peripheral intervention before bypass surgery in the elderly: feasible and effective, but is it necessary?

    Institute of Scientific and Technical Information of China (English)

    Sze-Piaw CHIN; Kui-Hian SIM

    2006-01-01

    @@ In this issue of the Journal of Geriatric Cardiology,Rigatelli and colleagues tackled the issue of concomitant noncoronary atherosclerosis among elderly patients undergoing cardiac surgery.1 Ilio-femoral disease, renal artery stenosis, carotid stenosis, and even disease of supra-aortic vessels may variously impact the patient's recovery from surgery. Also, the fact that involvement of two or more arterial beds are more common among the elderly makes this article all the more relevant at this time.

  17. Sustained postoperative anaemia is associated with an impaired outcome after coronary artery bypass graft surgery : insights from the IMAGINE trial

    NARCIS (Netherlands)

    Westenbrink, B. Daan; Kleijn, Lennaert; de Boer, Rudolf A.; Tijssen, Jan G.; Warnica, Wayne J.; Baillot, Richard; Rouleau, Jean L.; van Gilst, Wiek H.

    2011-01-01

    Objective To investigate the association between sustained postoperative anaemia and outcome after coronary artery bypass graft (CABG) surgery. Design Retrospective analysis of the IMAGINE trial, which tested the effect of the ACE inhibitor quinapril on cardiovascular events after CABG. Setting Thor

  18. Potential Effect of L-Carnitine on the Prevention of Myocardial Injury after Coronary Artery Bypass Graft Surgery

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    Farzaneh Dastan

    2015-10-01

    Full Text Available Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG surgery.Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery or a control group (n = 67. CK-MB (creatine kinase, muscle- brain subunits and troponin T (TnT levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively.Results: Our study included 134 patients (99 [73.8%] males at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group did not show any significant differences (p value=0.93 and 0.08, respectively. Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group, but the difference was not significant (p value = 0.28. TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34. Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels.

  19. Redux valvular surgery with coronary artery bypass graft in familial hypercholesterolemia

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    Ziadi Jalel

    2014-01-01

    Full Text Available Familial hypercholesterolemia (FH is a dominantly inherited disorder caused by mutation at the locus for the low-density lipoprotein (LDL receptor and is frequently associated with premature coronary artery disease and aortic valve involvement. The surgical treatment of these complications is accompanied by a high degree of risk, even in skillful hands. An intensive cholesterol-lowering therapy and LDL aphaeresis in association with surgery may be useful. The case of a 12-year-old girl, with a medical history of familial hypercholesterolemia is reported here, operated two years previously for valvular aortic stenosis; Ross intervention was done. She was readmitted for acute coronary syndrome. Three coronary artery bypass grafting was performed with saphenous veins with positive results.

  20. 2型糖尿病患者腹腔镜下胃旁路手术的护理干预效果评价%The effect of nursing intervention evaluation on type 2 diabetic patients after laparoscopic gastric bypass surgery

    Institute of Scientific and Technical Information of China (English)

    韩云红

    2014-01-01

    目的:探讨2型糖尿病(T2DM)患者腹腔镜下胃旁路手术治疗后护理干预效果。方法将80例腹腔镜下胃旁路手术治疗的T2DM患者分为对照组与观察组各40例,分别采用常规护理与个性化护理,比较两组护理前后各项指标(BMI、FPG、餐后2 h血糖、HbA1c及空腹C肽)、SAS及SDS评分、术后各项指标恢复所需时间。结果两组护理前后BMI、FPG、餐后2 h血糖、HbA1c及空腹C肽水平差异均有统计学意义(P<0.05),且两组护理后上述指标差异也均有统计学意义(P<0.05);两组护理前后SAS及SDS评分差异均有统计学意义(P<0.05),且护理后观察组上述评分显著小于对照组(P<0.05);观察组首次下床活动时间、首次排气时间及伤口拆线时间均显著短于对照组(P<0.05)。结论针对性护理干预在腹腔镜下胃旁路手术治疗T2DM患者护理中效果显著,值得在临床上推广应用。%Objective To investigate the effect of nursing interventions on type 2 diabetic ( T2DM ) patients after laparoscopic gastric bypass surgery treatment. Methods Eighty patients with T2DM cases of laparoscopic gastric bypass surgery in accordance with balloting were divided into control group and observation group, each of 40 cases, which were treated with routine care and personalized care respectively, the indicators (including BMI, FPG, 2 h postprandial blood glucose, HbA1c and fasting C-peptide), SAS and SDS scores, postoperative recovery time indicators were compared before and after treatment. Results BMI, FPG, 2 h postprandial blood glucose, HbA1c and fasting C-peptide levels were statistically significant differences between two groups before and after nursing ( P<0 . 05 ) , and these indicators were statistically significant difference between two groups after treatment ( P<0 . 05 ); SAS and SDS scores were statistically significant differences in two groups before and after nursing (P<0.05), and post-treatment observation

  1. Características clínico-demográficas de pacientes submetidos a cirurgia de revascularização do miocárdio e sua relação com a mortalidade Demographic and clinical characteristics of patients undergoing coronary artery bypass graft surgery and their relation to mortality

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    Eduardo Lafaiette de Oliveira

    2012-03-01

    Full Text Available OBJETIVO: Descrever as características clínicodemográficas e testar sua relação com a mortalidade hospitalar em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM. MÉTODOS: Estudo retrospectivo conduzido a partir dos prontuários de 655 pacientes submetidos à CRM, no período de maio de 2002 a abril de 2010. RESULTADOS: A mortalidade hospitalar foi de 12,1%. A mortalidade foi significativamente (P70 anos (OR=2,69; cirurgias em caráter de emergência (OR=15,43 e de urgência (OR=3,81; realização de CEC (OR=2,19 e reinternação na UTI (OR=4,33. CONCLUSÃO: Sexo, idade, tipo de cirurgia, reinternação na UTI, permanência na UTI, comorbidades e tempo de CEC influenciaram no desfecho óbito do paciente submetido à CRM. Dessa forma, tais aspectos devem ser considerados para diminuir o óbito hospitalar em pacientes submetidos a esse tipo de cirurgia.OBJECTIVE: To describe the demographic and clinical characteristics and to test their relation to mortality in patients undergoing to coronary artery bypass graft surgery (CABG. METHODS: It is a retrospective study developed from the medical records of 655 patients undergoing CABG from May 2002 to April 2010. RESULTS: Hospital mortality was 12.1%. Mortality was significantly (P70 years (OR=2.69, emergency surgery (OR=15.43 and urgency (OR=3.81, performance of CPB (OR=2.19 and re-admission to the ICU (OR=4.33. CONCLUSION: Variables such as gender, age, type of surgery, readmission to the ICU, ICU stay, comorbidities and time of CPB influence the outcome death in patients undergoing to CABG. Thus, such aspects should be considered to reduce hospital mortality in patients undergoing such surgery.

  2. The Effect of Using Peplau's Therapeutic Relationship Model on Anxiety of Coronary Artery Bypass Graft Surgery Candidates

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    Maghsoodi

    2014-08-01

    Full Text Available Background Anxiety is a one of the psychological aftereffect of cardiac surgery, which affects the outcome of treatment. One of the most effective ways to reduce anxiety is to train and establish a targeted relationship based on a functional model. Objectives The present study aimed to determine the effect of Peplau's therapeutic relationship model on anxiety of patients who were candidate for coronary artery bypass graft surgery (CABG. Patients and Methods In this clinical trial, 74 patients were enrolled according to eligibility criteria and were randomly allocated to intervention and control groups of 37 people. We evaluated anxiety of the patients using the Beck anxiety inventory before, immediately after, and two and four months after intervention. Based on Peplau's therapeutic relationship model, therapeutic communication sessions were conducted in four phases during seven sessions. Data analysis was performed with the statistical test of covariance analysis using SPSS version 16. Results The results of our study showed that after therapeutic communication, the mean score of anxiety decreased from 30.35 to 25.38 in the intervention group (P < 0.001, while the scores decreased from 33.22 to 31.46 in the control group. Furthermore, the mean score of anxiety in the intervention group decreased at two and four months after the intervention. Conclusions The findings showed a positive effect of therapeutic relationship based on Peplau's model on reducing anxiety of patients undergoing CABG. Therefore, health care teams, including nurses, should take advantage of appropriate communication with patients in their care procedures. In that regard, Peplau's communication model is recommended as a simple, low-cost, and efficient method.

  3. Changes in Glucose Homeostasis after Roux-en-Y Gastric Bypass Surgery for Obesity at Day Three, Two Months, and One Year after Surgery

    DEFF Research Database (Denmark)

    Falkén, Y; Hellström, P M; Holst, Jens Juul;

    2011-01-01

    Context: Endocrine effects of gastric bypass (GBP) surgery for obesity on glucose homeostasis are not fully understood. Main Objective: The main objective of the study was to assess the changes in plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), leptin, somatostatin, glucose...

  4. [Coronary artery bypass surgery: methods of performance monitoring and quality control].

    Science.gov (United States)

    Albert, A; Sergeant, P; Ennker, J

    2009-10-01

    The strength of coronary bypass operations depends on the preservation of their benefits regarding freedom of symptoms, quality of life and survival, over decades. Significant variability of the results of an operative intervention according to the hospital or the operating surgeon is considered a weakness in the procedure. The external quality insurance tries to reach a transparent service providing market through hospital ranking comparability. Widely available information and competition will promote the improvement of the whole quality. The structured dialog acts as a control instrument for the BQS (Federal Quality Insurance). It is launched in case of deviations from the standard references or statistically significant differences between the results of the operations in any hospital and the average notational results. In comparison to the external control the hospital internal control has greater ability to reach a medically useful statement regarding the results of the treatment and to correct the mistakes in time. An online information portal based on a departmental databank (DataWarehouse, DataMart) is an attractive solution for the physician in order to get transparently and timely informed about the variability in the performance.The individual surgeon significantly influences the short- and long-term treatment results. Accordingly, selection, targeted training and performance measurements are necessary.Strict risk management and failure analysis of individual cases are included in the methods of internal quality control aiming to identify and correct the inadequacies in the system and the course of treatment. According to the international as well as our own experience, at least 30% of the mortalities after bypass operations are avoidable. A functioning quality control is especially important in minimally invasive interventions because they are often technically more demanding in comparison to the conventional procedures. In the field of OPCAB surgery

  5. Laser Doppler flowmeter study on regional cerebral blood flow in early stage after standard superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease

    Institute of Scientific and Technical Information of China (English)

    GESANG Dun-zhu; ZHANG Dong; ZHAO Ji-zong; WANG Shuo; ZHAO Yuan-li; WANG Rong; SUN Jian-jun; MENG Ze

    2009-01-01

    Background Standard superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is an effective treatment for moyamoya disease, but recent evidence suggests that postoperative cerebral hyperperfusion can occur. In this study, the trendline of changes in regional cerebral blood flow (rCBF) after surgery were continually monitored near the site of anastomosis in order to investigate both the efficacy of the procedure for improving rCBF and the possible riskof hyperperfusion.Methods Standard STA-MCA bypass surgery was performed on 13 patients, rCBF was measured continually using laser Doppler flowmetry (LDF) until the 5th day after the operation with the LDF probe implanted adjacent to the area of the anastomosis. The trendline of rCBF changes postoperatively was recorded for the analysis performed using SPSS 13.0.Results The baseline LDF value of cortical rCBF was (84.68±14.39) perfusion unit (PU), which was linear relative to absolute perfusion volume before anastomosis and (88.90±11.26) PU immediately after anastomosis (P >0.05). The value changed significantly from before to after anastomosis (P 0.05).Conclusions STA-MCA anastomosis improves the cerebral blood supply significantly in the early stage after surgery,however, the risk of symptomatic hyperperfusion may exist, which may possibly occur on the 1st day and 5th day after surgery. A LDF is useful for postoperative monitoring for both the efficacy of bypass and possible risk of neurologic deterioration or bleeding from hyperperfusion.

  6. Hereditary spherocytosis in a patient undergoing coronary artery bypass grafting with cardiopulmonary bypass--a case report.

    Science.gov (United States)

    Spegar, J; Riha, H; Kotulak, T; Vanek, T

    2015-01-01

    Hereditary spherocytosis is a genetically determined abnormality of red blood cells. It is the most common cause of inherited haemolysis in Europe and North America within the Caucasian population. We document a patient who underwent an aortocoronary bypass procedure on cardiopulmonary bypass. In view of the uncertain tolerance of the abnormal red cells in hereditary spherocytosis to cardiopulmonary bypass, we reviewed the patient's chart and analyzed recorded values of these parameters: free plasma haemoglobin, renal parameters, cystatin C, bilirubin, liver tests, urine samples. From the results, we can see that slight haemolysis-elevated bilirubin in the blood sample and elevated bilirubin and urobilinogen in the urine sample occurred on the first postoperative day. The levels of these parameters slowly decreased during the next postoperative days. There was no real clinical effect of this haemolysis on renal functions.

  7. Simultaneous surgery in patients with both cardiac and noncardiac diseases

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    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  8. Differential pre-mRNA splicing regulates Nnat isoforms in the hypothalamus after gastric bypass surgery in mice.

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    William R Scott

    Full Text Available BACKGROUND: Neuronatin (NNAT is an endoplasmic reticulum proteolipid implicated in intracellular signalling. Nnat is highly-expressed in the hypothalamus, where it is acutely regulated by nutrients and leptin. Nnat pre-mRNA is differentially spliced to create Nnat-α and -β isoforms. Genetic variation of NNAT is associated with severe obesity. Currently, little is known about the long-term regulation of Nnat. METHODS: Expression of Nnat isoforms were examined in the hypothalamus of mice in response to acute fast/feed, chronic caloric restriction, diet-induced obesity and modified gastric bypass surgery. Nnat expression was assessed in the central nervous system and gastrointestinal tissues. RTqPCR was used to determine isoform-specific expression of Nnat mRNA. RESULTS: Hypothalamic expression of both Nnat isoforms was comparably decreased by overnight and 24-h fasting. Nnat expression was unaltered in diet-induced obesity, or subsequent switch to a calorie restricted diet. Nnat isoforms showed differential expression in the hypothalamus but not brainstem after bypass surgery. Hypothalamic Nnat-β expression was significantly reduced after bypass compared with sham surgery (P = 0.003, and was positively correlated with post-operative weight-loss (R(2 = 0.38, P = 0.01. In contrast, Nnat-α expression was not suppressed after bypass surgery (P = 0.19, and expression did not correlate with reduction in weight after surgery (R(2 = 0.06, P = 0.34. Hypothalamic expression of Nnat-β correlated weakly with circulating leptin, but neither isoform correlated with fasting gut hormone levels post- surgery. Nnat expression was detected in brainstem, brown-adipose tissue, stomach and small intestine. CONCLUSIONS: Nnat expression in hypothalamus is regulated by short-term nutrient availability, but unaltered by diet-induced obesity or calorie restriction. While Nnat isoforms in the hypothalamus are co-ordinately regulated by acute

  9. [Results of emergency coronary artery bypass surgery after failed coronary angioplasty].

    Science.gov (United States)

    Imazeki, T; Yokoyama, M; Murai, N; Kurimoto, Y; Sakurada, M; Simizu, Y

    1995-06-01

    In the past 7 years, 9 emergent or urgent coronary artery bypass operations after failed percutaneous transluminal angioplasty (PTCA) were performed among 947 (PTCA). Since the introduction of coronary perfusion catheter system for the support of coronary perfusion during PTCA we could reduce the number of emergent cases and these patients could be operated on semi-emergently and securely without endangering co-medical staffs in a hurry. It is also unnecessary to be on standby all the time when the PTCA is being undertaken. Two acute myocardial infarction cases died in the early phase of this study (operative mortality 22%) and none after the introduction of coronary perfusion system during PTCA.

  10. Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Thayssen, Per

    2007-01-01

    We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary...... preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional...

  11. Use of 24 h Esophageal pH Monitoring to Demonstrate Alkaline Reflux as a Complication of Gastric Bypass Surgery

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    J Patrick Shoenut

    1994-01-01

    Full Text Available A 35-year-old female who had previously undergone a gastric stapling procedure for morbid obesity presented with a persistent nocturnal cough that was treated over a three-year period as a gastric acid reflux complication of the bypass surgery. A barium swallow demonstrated gastroesophageal reflux, but the symptoms did not resolve after treatment with omeprazole and cisapride. Twenty-four hour esophageal pH monitoring subsequently found alkaline reflux in excess of 17% of the total time, with no acid reflux demonstrated. Surgical revision of the bypass Leaving the hiatus alone corrected the reflux complication and the symptoms resolved without further treatment. The diagnostic capability of pH monitoring is illustrated in a patient with an unusual surgical complication.

  12. A clinical research of mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation%中重度缺血性二尖瓣反流患者行二尖瓣置换同期冠状动脉旁路移植术的临床研究

    Institute of Scientific and Technical Information of China (English)

    郭志祥; 张成鑫; 汪欢; 葛圣林

    2015-01-01

    Objective To investigate the impact of combined coronary artery bypass grafting (CABG)and mitral valve replacement (MVR)in patients with moderate-to-severe ischemic mitral regurgitation (IMR).Methods From July 2010 to January 2013,16 pa-tients of coronary artery disease with moderate-to-severe IMR underwent mitral valve replacement combined with coronary artery bypass graft surgery.There were 8 male and 8 female patients,with a mean age of (63.4 ±7.6)years.Preoperative transthoracic echocardio-graphy showed moderate IMR in 2 cases,moderate to severe in 8 cases and severe in 6 cases.The data of preoperative transthoracic ech-ocardiography were compared with postoperative ones.Results Hospital mortality was 6.25%(1 case).Postoperative transthoracic echocardiography showed that there was no regurgitation in 10 cases,minimal in 5 cases,minimal to moderate in 1 case.LVEDD de-creased from (60 ±13)mm to (47 ±12)mm (P <0.05).Conclusions Mitral valve replacement combined with coronary artery by-pass graft is a safe and effective treatment for IMR,the short-term outcomes of which are satisfactory and there is a significant improve-ment of left ventricular function.%目的:探讨二尖瓣置换(mitral valve replacement,MVR)同期冠状动脉旁路移植术(coronary artery bypass grafting,CABG)治疗中重度缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)的效果。方法2010年7月—2013年1月,16例冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)合并中重度 IMR 的患者接受了 CABG 联合 MVR 术。其中男性8例,女性8例;平均年龄(63.4±7.6)岁。术前经胸超声心动图示中度二尖瓣反流2例,中重度8例,重度 6例。比较患者术前及术后经胸超声心动图资料。结果院内死亡1例。术后复查超声心动图示二尖瓣无反流10例,轻度反流5例,轻中度反流1 例。左心室舒张末内径(left ventricular end-diastolic diameter

  13. Central 5-HT Neurotransmission Modulates Weight Loss following Gastric Bypass Surgery in Obese Individuals

    DEFF Research Database (Denmark)

    Haahr, M. E.; Hansen, D. L.; Fisher, P. M.;

    2015-01-01

    The cerebral serotonin (5-HT) system shows distinct differences in obesity compared with the lean state. Here, it was investigated whether serotonergic neurotransmission in obesity is a stable trait or changes in association with weight loss induced by Roux-in-Y gastric bypass (RYGB) surgery....... In vivo cerebral 5-HT2A receptor and 5-HT transporter binding was determined by positron emission tomography in 21 obese [four men; body mass index (BMI), 40.1 ± 4.1 kg/m(2)] and 10 lean (three men; BMI, 24.6 ± 1.5 kg/m(2)) individuals. Fourteen obese individuals were re-examined after RYGB surgery. First......, it was confirmed that obese individuals have higher cerebral 5-HT2A receptor binding than lean individuals. Importantly, we found that higher presurgical 5-HT2A receptor binding predicted greater weight loss after RYGB and that the change in 5-HT2A receptor and 5-HT transporter binding correlated with weight loss...

  14. Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery and the SYNTAX score: A systematic review and meta-analysis

    Science.gov (United States)

    Bundhun, Pravesh Kumar; Yanamala, Chandra Mouli; Huang, Feng

    2017-01-01

    The SYNTAX [Synergy Between percutaneous coronary intervention (PCI) With Taxus and coronary artery bypass surgery (CABG)] score is a decision-making tool in interventional cardiology. However, several facts still remain to be addressed: What about PCI or CABG with a low versus a high score respectively? And what about PCI with a low score versus CABG with a high score? Electronic databases were carefully searched for relevant publications. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated and the analysis was carried out by RevMan 5.3. Eleven studies with a total number of 11,037 patients were included. In terms of clinical outcomes, this analysis showed PCI to have significantly favored patients with a low versus a high SYNTAX score. In patients who were re-vascularized by CABG, mortality and major adverse cardiac events were significantly lower with a low SYNTAX score. However, when PCI with a low SYNTAX score was compared with CABG with a high SYNTAX score, no significant difference in mortality and combined death/stroke/myocardial infarction were observed. In conclusion, the SYNTAX score might be considered useful in interventional cardiology. Nevertheless, the fact that it has limitations when compared to newer tools should also not be ignored. PMID:28252019

  15. Analysis of risk factors for postoperative atrial fibrillation in elderly patients with coronary heart disease after off-pump coronary artery bypass grafting surgery%老年冠心病患者非体外循环冠状动脉旁路移植术后心房颤动的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    权晓强; 程兆云; 赵健; 王圣; 孙俊杰; 李建强

    2015-01-01

    Objective To investigate certain risk factors for postoperative atrial fibrillation (AF) in elderly patients with coronary heart disease after off-pump coronary artery bypass grafting (OPCAB)surgery in order to provide a basis for the prevention and treatment of AF after OPCAB.Methods A total of 139 elderly patients with coronary heart disease who had undergone OPCAB surgery in our hospital were collected as research subjects and divided into the AF group and the nonAF group according to the occurrence of AF after operation.The patients' general information and clinical data were retrospectively analyzed.Risk factors for AF after OPCAB surgery in elderly patients with coronary heart disease were investigated.Results The incidence of AF after OPCAB was 15.8% in elderly patients with coronary heart disease.There were no statistical differences in gender,history of diabetes,history of myocardial infarction,preoperative β-blocker usage,number of coronary artery lesions,or operation time between the AF group and the non-AF group (P>0.05).The percentage of patients who were of older age (t=9.960) or had a left ventricular ejection fraction ≥40% (x2=4.942),a left atrial diameter ≥40 mm (x2 =4.491),a history of hypertension (x2 =12.357),dopamine medication after operation (x2 =8.511),or a bypass vessel count≥ 3 (x2 =5.385) was higher in the AF group than in the non-AF group (all P<0.05).Logistic regression analysis showed that age,history of hypertension,dopamine medication after operation,left atrial diameter and bypass vessel count were the risk factors for AF after OPCAB surgery in elderly patients with coronary heart disease (OR 3.080,2.435,2.465,3.593,and 1.921,respectively,P<0.05 for all).Conclusions The incidence of AF after OPCAB is high in elderly patients with coronary heart disease and is affected by many risk factors.These risk factors should be assessed before surgery so that appropriate prevention measures can be taken.%目的 探讨老年

  16. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....

  17. Assessing Patient bypass Behavior Using Taxi Trip Origin–Destination (OD Data

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    Gege Yang

    2016-09-01

    Full Text Available Many patients prefer to use the best hospitals even if there are one or more other hospitals closer to their homes; this behavior is called “hospital bypass behavior”. Because this behavior can be problematic in urban areas, it is important that it be reduced. In this paper, the taxi GPS data of Beijing and Suzhou were used to measure hospital bypass behavior. The “bypass behavior index” (BBI represents the bypass behavior for each hospital. The results indicated that the mean hospital bypass trip distance value ranges from 5.988 km to 9.754 km in Beijing and from 4.168 km to 10.283 km in Suzhou. In general, the bypass shares of both areas show a gradually increasing trend. The following hospitals exhibited significant patient bypass behavior: the 301 Hospital, Beijing Children’s Hospital, the Second Affiliated Hospital of Soochow University and the Suzhou Hospital of Traditional Chinese Medicine. The hospitals’ reputation, transport accessibility and spatial distribution were found to be the main factors affecting patient bypass behavior. Although the hospital bypass phenomena generally appeared to be more pronounced in Beijing, the bypass trip distances between hospitals were found to be more significant in Suzhou.

  18. Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

    DEFF Research Database (Denmark)

    Buggeskov, Katrine B; Sundskard, Martin M; Jonassen, Thomas;

    2016-01-01

    INTRODUCTION: Absence of pulmonary perfusion during cardiopulmonary bypass (CPB) may be associated with reduced postoperative oxygenation. Effects of active pulmonary artery perfusion were explored in patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery. METHODS: 90...... starting CPB and longitudinally in a mixed-effects model (MEM). Secondary outcomes were tracheal intubation time, serious adverse events, mortality, days alive outside the intensive care unit (ICU) and outside the hospital. RESULTS: 21 hours after starting CPB patients receiving pulmonary artery perfusion...... with normothermic oxygenated blood had a higher oxygenation index compared with no pulmonary perfusion (mean difference (MD) 0.94; 95% CI 0.05 to 1.83; p=0.04). The blood group had also a higher oxygenation index both longitudinally (MEM, p=0.009) and at 21 hours (MD 0.99; CI 0.29 to 1.69; p=0.007) compared...

  19. Roux-en-Y Gastric Bypass Surgery Increases Respiratory Quotient and Energy Expenditure during Food Intake.

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    Malin Werling

    Full Text Available The mechanisms determining long-term weight maintenance after Roux-en-Y gastric bypass (RYGB remain unclear. Cross sectional studies have suggested that enhanced energy expenditure (EE may play a significant role and the aim of this study was to reveal the impact of RYGB on each major component constituting total EE.Six obese female subjects, without other co-morbidities, were assessed before and at 10 days, 3 and 20 months after RYGB. Indirect calorimetry in a metabolic chamber was used to assess 24 h EE at each study visit. Other measurements included body composition by DEXA, gut hormone profiles and physical activity (PA using high sensitivity accelerometers.Median Body Mass Index decreased from 41.1 (range 39.1-44.8 at baseline to 28 kg/m2 (range 22.3-30.3 after 20 months (p<0.05. Lean tissue decreased from 55.9 (range 47.5-59.3 to 49.5 (range 41.1-54.9 kg and adipose tissue from 61 (range 56-64.6 to 27 (range 12-34.3 kg (both p<0.05. PA over 24 h did not change after surgery whereas 24 h EE and basal metabolic rate (BMR decreased. EE after a standard meal increased after surgery when adjusted for total tissue (p<0.05. After an initial drop, RQ (respiratory quotient had increased at 20 months, both as measured during 24 h and after food intake (p<0.05.RYGB surgery up-regulates RQ and EE after food intake resulting in an increased contribution to total EE over 24 h when corrected for total tissue.

  20. Abnormal Motion of the Interventricular Septum after Coronary Artery Bypass Graft Surgery: Comprehensive Evaluation with MR Imaging

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    Choi, Seong Hoon [University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan (Korea, Republic of); Choi, Sang Il; Chun, Eun Ju; Chang, Huk Jae; Park, Kay Hyun; Lim, Cheong [Seoul National University Bundang Hospital, Bundang (Korea, Republic of); Kim, Shin Jae [Ulsan University Hospital, Ulsan (Korea, Republic of); Kang, Joon Won; Lim, Tae Hwan [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2010-12-15

    To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. Eighteen patients (mean age, 58 {+-} 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non- ASM group (2.1{+-}5.3 mm vs. 14.9{+-}4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8{+-}4.5 mm vs. 2.1{+-}5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89{+-}5.41 vs. -15.41{+-}3.7, p < 0.05) Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium

  1. Endoscopic Saphenous harvesting with an Open CO2 System (ESOS trial for coronary artery bypass grafting surgery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Campanella Antonio

    2011-11-01

    Full Text Available Abstract Background In coronary artery bypass grafting surgery, arterial conduits are preferred because of more favourable long-term patency and outcome. Anyway the greater saphenous vein continues to be the most commonly used bypass conduit. Minimally invasive endoscopic saphenous vein harvesting is increasingly being investigated in order to reduce the morbidity associated with conventional open vein harvesting, includes postoperative leg wound complications, pain and patient satisfaction. However, to date the short and the long-term benefits of the endoscopic technique remain controversial. This study provides an interesting opportunity to address this gap in the literature. Methods/Design Endoscopic Saphenous harvesting with an Open CO2 System trial includes two parallel vein harvesting arms in coronary artery bypass grafting surgery. It is an interventional, single centre, prospective, randomized, safety/efficacy, cost/effectiveness study, in adult patients with elective planned and first isolated coronary artery disease. A simple size of 100 patients for each arm will be required to achieve 80% statistical power, with a significant level of 0.05, for detecting most of the formulated hypotheses. A six-weeks leg wound complications rate was assumed to be 20% in the conventional arm and less of 4% in the endoscopic arm. Previously quoted studies suggest a first-year vein-graft failure rate of about 20% with an annual occlusion rate of 1% to 2% in the first six years, with practically no difference between the endoscopic and conventional approaches. Similarly, the results on event-free survival rates for the two arms have barely a 2-3% gap. Assuming a 10% drop-out rate and a 5% cross-over rate, the goal is to enrol 230 patients from a single Italian cardiac surgery centre. Discussion The goal of this prospective randomized trial is to compare and to test improvement in wound healing, quality of life, safety/efficacy, cost-effectiveness, short

  2. Roux-en-Y胃肠转流术治疗胃癌合并2型糖尿病患者的应用价值%Application value of Roux-en-Y gastric bypass surgery in the treatment of gastric cancer patients with type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    郝英; 王波

    2016-01-01

    Objective To study the application valu e of Roux-en-Y gastric bypass surgery in the treatment of gastric cancer with type 2 diabetes, and to provide an important reference for the effective treatment of gastric cancer. Methods Forty gastric cancer patients with type 2 diabetes from April 2014 to September 2015 admitted in our hospital were select-ed in this research. Retrospective analysis of the clinical data of all patients including body mass index, glycosylated hemoglobin, fasting blood glucose, fasting insulin and fasting C-peptide inspection and insulin resistance index preopera-tive and postoperative 6 months were studied. Results The fasting blood glucose, glycosylated hemoglobin, postprandial 2 h blood glucose and insulin resistance index were significantly lower than that before the treatment, and fasting insulin, fast-ing C peptide, postprandial 2 h insulin, postprandial 2 h C peptide level were significantly higher than that of the preoper-ative. The difference of two groups of data had statistical significance (P0.05). Conclusion For the treatment of gastric cancer patients com-bined clinical type 2 diabetes, Roux-en-Y gastrointestinal bypass surgery can effectively improve islet β cell function, and control of blood sugar levels in patients after surgery, which is worth promoting.%目的:探析Roux-en-Y胃肠转流术治疗胃癌合并2型糖尿病的应用价值,旨在为临床有效治疗该病提供重要参考依据。方法选取我院2014年4月至2015年9月收治并已确诊的胃癌合并2型糖尿病患者40例为研究对象,对所有患者的临床资料进行回顾性分析,对比研究患者术前与术后6个月体质指数、糖化血红蛋白、空腹血糖、空腹胰岛素和空腹C肽的检查情况,并对胰岛素抵抗指数进行计算。结果所有患者术后6个月的空腹血糖、糖化血红蛋白、餐后2h血糖和胰岛素抵抗指数水平明显低于术前,而空腹胰岛素、空腹C肽、餐后2h

  3. Distribution of pathogens causing postoperative central venous catheter-related infections in patients undergoing cardiopulmonary bypass heart surgery and high risk factors%体外循环心脏直视术后中心静脉导管感染的病原菌分布与危险因素分析

    Institute of Scientific and Technical Information of China (English)

    杜守峰; 师文华; 孙君隽

    2015-01-01

    OBJECTIVE To explore the distribution of pathogens causing postoperative central venous catheter‐re‐lated infections in patients undergoing cardiopulmonary bypass heart surgery and analyze the high risk factors so as to provide guidance for the prevention of central venous catheter‐related infections .METHODS The clinical data of 137 patients who underwent the central venous catheter indwelling after the cardiopulmonary bypass heart surgery were retrospectively analyzed ;34 patients with infections were assigned as the infection group ,and 103 patients without infections were set as the non‐infection group ;the bacterial culture and the drug susceptibility testing were carried out for the infection group ,and the logistic regression analysis of the high risk factors for the central ve‐nous catheter‐related infections was performed .RESULTS Totally 34 strains of pathogens have been isolated from the 137 patients with the positive rate of 24 .82% ,including 17 (50 .00% ) strains of gram‐positive bacteria ,13 (38 .24% ) strains of gram‐negative bacteria ,and 4 (11 .76% ) strains of fungi .The drug susceptibility rates of the gram‐positive bacteria to teicoplanin and vancomycin were 100 .00% ;the drug susceptibility rate of the gram‐nega‐tive bacteria to meropenem was 100 .00% ;the drug susceptibility rate of the fungi to fluconazole was 66 .67% . There was significant difference in the catheter indwelling time ,time of cardiopulmonary bypass ,femoral venous puncture ,catheter connector ,or proportion of triple lumen catheter between the infection group and the non‐infec‐tion group (P<0 .05);the logistic regression analysis indicated that the time of cardiopulmonary bypass ,femoral venous puncture ,double lumen catheter indwelling ,and catheter indwelling time were the independent risk fac‐tors .CONCLUSION The excessively long time of cardiopulmonary bypass and catheter indwelling ,femoral venous puncture ,and double lumen catheter

  4. Predictors of Postoperative Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

    OpenAIRE

    Haghjoo, Majid; Basiri, Hossein; Salek, Mehrasa; Sadr-Ameli, Mohammad Ali; Kargar, Faranak; Raissi, Kamal; Omrani, Gholamreza; Tabatabaie, Mohammad Bagher; Sadeghi, Hassan Mirmohammad; Tabaie, Ali Sadeghpour; Baghaie, Ramin

    2008-01-01

    Objectives The present study was aimed to identify the preoperative, intraoperative, and postoperative predictors of AF in a pure cohort of the patients with coronary artery disease who underwent CABG surgery. Methods Between November 2005 and May 2006, 302 consecutive patients were included in this prospective study. All the relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in the included patients and they were also monitored for development of po...

  5. Improving Public Reporting and Data Validation for Complex Surgical Site Infections After Coronary Artery Bypass Graft Surgery and Hip Arthroplasty

    Science.gov (United States)

    Calderwood, Michael S.; Kleinman, Ken; Murphy, Michael V.; Platt, Richard; Huang, Susan S.

    2014-01-01

    Background  Deep and organ/space surgical site infections (D/OS SSI) cause significant morbidity, mortality, and costs. Rates are publicly reported and increasingly used as quality metrics affecting hospital payment. Lack of standardized surveillance methods threaten the accuracy of reported data and decrease confidence in comparisons based upon these data. Methods  We analyzed data from national validation studies that used Medicare claims to trigger chart review for SSI confirmation after coronary artery bypass graft surgery (CABG) and hip arthroplasty. We evaluated code performance (sensitivity and positive predictive value) to select diagnosis codes that best identified D/OS SSI. Codes were analyzed individually and in combination. Results  Analysis included 143 patients with D/OS SSI after CABG and 175 patients with D/OS SSI after hip arthroplasty. For CABG, 9 International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes identified 92% of D/OS SSI, with 1 D/OS SSI identified for every 4 cases with a diagnosis code. For hip arthroplasty, 6 ICD-9 diagnosis codes identified 99% of D/OS SSI, with 1 D/OS SSI identified for every 2 cases with a diagnosis code. Conclusions  This standardized and efficient approach for identifying D/OS SSI can be used by hospitals to improve case detection and public reporting. This method can also be used to identify potential D/OS SSI cases for review during hospital audits for data validation. PMID:25734174

  6. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Iannuccilli, J.D. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States)], E-mail: jiannuccilli@lifespan.org; Grand, D.; Murphy, B.L.; Evangelista, P. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States); Roye, G.D. [Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States); Mayo-Smith, W. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States)

    2009-04-15

    Aim: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Materials and methods: Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Results: Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign ({kappa} = 0.48-0.79), but agreement was relatively poor for all other signs. Conclusion: Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.

  7. Myocardial protection during off pump coronary artery bypass surgery: A comparison of inhalational anesthesia with sevoflurane or desflurane and total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Sharadaprasad Suryaprakash

    2013-01-01

    Full Text Available Aims and Objectives: The objective of the study was to evaluate the myocardial protective effect of volatile agents-sevoflurane and desflurane versus total intravenous anesthesia (TIVA with propofol in offpump coronary artery bypass surgery (OPCAB by measuring cardiac troponin-T (cTnT as a marker of myocardial cell death. Materials and Methods: The study was conducted on 139 patients scheduled to undergo elective OPCAB surgery. The patients were randomly allocated to receive anesthesia with sevoflurane, desflurane or TIVA with propofol. The cTnT levels were measured preoperatively, at arrival in postoperative intensive care unit, at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels at all time intervals were comparable in the three groups. Conclusion: The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.

  8. Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Elder dos Santos Cavalcante

    2014-11-01

    Full Text Available Background: Coronary artery bypass graft (CABG is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01. Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.

  9. Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass

    Science.gov (United States)

    Soller, Babs R.; Idwasi, Patrick O.; Balaguer, Jorge; Levin, Steven; Simsir, Sinan A.; Vander Salm, Thomas J.; Collette, Helen; Heard, Stephen O.

    2003-01-01

    OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and

  10. Transfusion practice in coronary artery bypass surgeri in Denmark: a multicenter audit

    DEFF Research Database (Denmark)

    Andreasen, Jan J.; Westen, Mikkel; Pallesen, Peter A.

    2007-01-01

    Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of alloge......Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use...... were discharged with a hemoglobin concentration >7 mmol/l, indicating inappropriate transfusions. The relative risk of receiving an allogeneic blood transfusion was 2.1 (95% CI: 1.6-2.7) in the hospital with the highest transfusion rate, after adjustment for patient-, drug-, and procedure......-related factors. Interesting differences in transfusion rates exists in Danish hospitals and these differences may reflect true variations in transfusion practices. Audits create a basis for educational efforts among surgeons and anesthesiologists to standardize transfusion practices....

  11. [Pathogenic variants of brain injuries and pharmalogic cerebroprotection performed on the model of brain condition during cardiovascular bypass surgery].

    Science.gov (United States)

    Tsygan, N V; Trashkov, A P

    2014-10-01

    Developed and approved a pathogenic grounded experimental model of brain condition during cardiovascular bypass surgery. Undertaken in Wistar rats research allowed to evaluate in detail effectiveness and safety of protracted cerebroprotective treatment. Advantages of this model are researches in laboratory animals with the aim to research condition of nerve tissue, not intensive procedures and consequently high reproducibility and possibility of complex evaluation of changes at every stage of research. Results of neurons, neuroglia and activation of neurotrophic mechanisms prove that simulation of brain condition during cardiovascular bypass surgery is accompanied with acute and delayed brain injuries. Use of Cytoflavin under pharmalogic cerebroprotection had prolonged multimodal and neuroprotactive effect, leading to improvement of neurotrophic protection from the first days.

  12. Effects of laparoscopic gastric bypass surgery in patients with type 2 diabetes and body mass index <28 kg/m2%腹腔镜下胃旁路术对体质指数<28 kg/m2的2型糖尿病患者的效果研究

    Institute of Scientific and Technical Information of China (English)

    郭妍; 李慧华; 刘超乾; 邹大进

    2014-01-01

    目的 探讨腹腔镜下胃旁路术对体质指数(BMI) <28 kg/m2的2型糖尿病(T2DM)患者的安全性及有效性.方法 回顾性分析2008年1月至2012年12月在第二军医大学附属长海医院接受胃旁路手术治疗的27例血糖控制不佳的非肥胖T2DM患者的术前资料,对其进行电话和(或)门诊随访,了解术后患者BMI、腰围、血糖、血压、血脂、术后并发症、饮食习惯及手术满意度等.两组之间比较采用t检验.结果 成功随访21例(77.8%),平均随访时间(2.7±1.1)年,无l例死亡,2例术后出现吻合口溃疡.术后空腹血糖(FPG)及糖化血红蛋白(HbAlc)较术前明显改善[FPG:(6.4±1.5)比(8.2±3.2)mmol/L,t=2.787,P<0.05;HbAlc:(6.6±1.2)%比(7.8±1.9)%,t=2.473,P<0.05].手术前后体重及BMI差异有统计学意义[分别为(65±12)比(77±10) kg,t=4.474,P<0.05;(22.8±4.6)比(25.1±2.3)kg/m2,t2.756,P<0.05],术后腰围较术前减小,差异有统计学意义[(83±8)比(93±12)cm,t =3.133,P<0.05].术后13例(61.9%)患者糖尿病缓解,5例(23.8%)疗效改善,无效者3例(14.3%).糖尿病缓解者与未缓解者相比,术前各项指标无统计学差异(均P >0.05).此外,胃旁路术后高血压缓解率为54.5% (6/11),血脂异常缓解率为66.7% (10/15),所有患者对手术平均满意度为(83±17)%.结论 腹腔镜下胃旁路术对于BMI<28 kg/m2的T2DM患者是较为安全和有效的,在减轻体重及改善血糖的同时还具有控制血压和调节血脂的作用.%Objective To explore the effect and safety of laparoscopic gastric bypass surgery in patients with type 2 diabetes mellitus and body mass index (BMI) < 28 kg/m2.Methods Twenty-seven consecutively selected diabetic patients with BMI < 28 kg/m2 underwent gastric bypass in a tertiary-care hospital from January,2008 to December,2012 were retrospectively studied and followed up with telephone interview.Postoperative changes in BMI,waist circumference,glycaemic control

  13. Asymptomatic liver segment herniation through a postoperative defect in the right hemidiaphragm following aortic bypass graft surgery

    Energy Technology Data Exchange (ETDEWEB)

    Benoit, Cyrille H. [Institute of Diagnostic Radiology, Department of Radiology, Zurich University Hospital, Zurich (Switzerland); Vogt, Paul R. [Clinic for Cardiovascular Surgery, Department of Surgery, Zurich University Hospital, Zurich (Switzerland); Hauser, Markus [Institute of Diagnostic Radiology, Department of Radiology, Zurich University Hospital, Zurich (Switzerland); Department of Radiology, The Norwegian Radium Hospital, Montebello, 0310, Oslo (Norway)

    2004-04-01

    We present a 16-year-old girl with asymptomatic liver segment herniation following aortic graft surgery for atypical coarctation of the aorta. The defect in the right hemidiaphragm was caused by the implantation of an ascending thoracic aorta to upper abdominal aortic bypass graft. The differential diagnosis of diaphragmatic defects as well as the role of various imaging modalities in establishing the diagnosis are discussed. (orig.)

  14. Sheep (Ovis aries) as a Model for Cardiovascular Surgery and Management before, during, and after Cardiopulmonary Bypass

    OpenAIRE

    DiVincenti, Louis; Westcott, Robin; Lee, Candice

    2014-01-01

    Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veteri...

  15. Sheep (Ovis aries) as a model for cardiovascular surgery and management before, during, and after cardiopulmonary bypass.

    Science.gov (United States)

    DiVincenti, Louis; Westcott, Robin; Lee, Candice

    2014-09-01

    Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veterinarians, technicians, and researchers developing and implementing protocols with this model.

  16. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial.

    Science.gov (United States)

    Marashi, Seyed Mojtaba; Saeedinia, Seyed Mostafa; Sadeghi, Mostafa; Movafegh, Ali; Marashi, Shaqayeq

    2015-12-01

    A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200 mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

  17. Gastric bypass surgery has a weight-loss independent effect on post-challenge serum glucose levels

    DEFF Research Database (Denmark)

    Hofsø, Dag; Birkeland, Kåre I; Holst, Jens J;

    2015-01-01

    BACKGROUND: Gastric bypass surgery seems to have an effect on glucose metabolism beyond what is mediated through weight reduction. The magnitude of this effect on fasting and post-challenge glucose levels remains unknown. RESULTS: Morbidly obese subjects without known diabetes performed a 75 g oral...... glucose tolerance test before and after either gastric bypass surgery (n = 64) or an intensive lifestyle intervention programme (n = 55), ClinicalTrials.gov identifier NCT00273104. The age-adjusted effects of the therapeutic procedures and percentage weight change on fasting and 2-h glucose levels at 1......-h glucose levels were significantly lower in the surgery group than in the lifestyle group, 4.7 (0.4) versus 5.4 (0.7) mmol/l and 3.4 (0.8) versus 6.0 (2.4) mmol/l, respectively (both p Gastric bypass and weight-loss had both independent glucose-lowering effects on 2-h glucose levels [B...

  18. Anesthetic management of robotically assisted totally endoscopic coronary artery bypass surgery (TECAB).

    Science.gov (United States)

    Deshpande, Seema P; Lehr, Eric; Odonkor, Patrick; Bonatti, Johannes O; Kalangie, Maudy; Zimrin, David A; Grigore, Alina M

    2013-06-01

    Over the last decade, TECAB has matured into a reproducible technique associated with low incidence of both mortality and morbidity, as well as superior quality of life, when compared with open CABG surgery. However, TECAB also is associated with important and specific challenges for the anesthesiology team, particularly with regard to the physiologic stresses of OLV, placement of special catheters, and induced capnothorax. As the technology supporting robotic surgery evolves and familiarity with, and confidence in, TECAB increases, the authors anticipate increasingly widespread use of these procedures in an increasingly fragile and problematic patient population who will require the support of a skilled and vigilant anesthesiology team.

  19. Anxiety, Self Efficacy Expectation and Social Support in Patients after Coronary Angioplasty and Coronary Bypass

    Directory of Open Access Journals (Sweden)

    T Dehdari

    2008-12-01

    Full Text Available "nBackground: Coronary artery bypass grafting surgery (CABG and precutaneous transluminal coronary intervention (PCI are safe and effective in the treatment of coronary artery disease. The aim of this study was to determine and compare anxi­ety, self efficacy expectation and perceived social support between CABG patients and PCI patients referral to receiving car­diac rehabilitation programs."nMethods: In this descriptive- analytical study 150 patients with CABG and PCI were selected. The Spilberger state trait anxi­ety inventory, general self efficacy scale and perceived social support scale three instruments for collecting data in the pre­sent study."nResults: PCI patients as compared to CABG patients experience higher anxiety (P= 0.02 and lower perceived social sup­port (P= 0.02. Self efficacy score in the PCI patients was higher than CABG patients (P= 0.01."nConclusion: It is necessary to be more considerate to psychological problems in the PCI patients.

  20. A rare cause of gastro-intestinal hemorrhage in a patient with a Roux-en-Y gastric bypass.

    Science.gov (United States)

    Cartabuke, Richard H; Mehta, Paresh P; El-Hayek, Kevin; Henderson, J Michael; Burke, Carol A

    2016-02-01

    This case illustrates a rare cause of gastro-intestinal bleeding following bariatric surgery. Though it is essential to rule out common causes of variceal formation accompanied by intermittent, profuse bleeding, there should be a high degree of suspicion of this rare etiology in patients who have previously undergone alteration of their anatomy, especially Roux-en-Y gastric bypass (RYGB). The case emphasizes the need for a multidisciplinary medical-surgical team in evaluating and treating patients who present with complex intra-abdominal pathology.

  1. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Z; Hansen, Peter R

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG). BACKGROUND: The benefit from post-operative clopidogrel in CABG......-treated MI patients is largely unknown. METHODS: All patients admitted with first-time MI between 2002 and 2006, treated with CABG within 180 days after admission, were identified by nationwide administrative registers. Clopidogrel treatment was determined by claimed prescriptions after discharge from...... surgery. Risk of death or recurrent MI, and of a combined end point of the 2, were assessed by cumulative incidence and Cox proportional hazards model. A propensity score-matched subgroup analysis was done. RESULTS: We included 3,545 patients, and of these, 957 (27.0%) were treated with clopidogrel after...

  2. Association of blood products administration during cardiopulmonary bypass and excessive post-operative bleeding in pediatric cardiac surgery.

    Science.gov (United States)

    Agarwal, Hemant S; Barrett, Sarah S; Barry, Kristen; Xu, Meng; Saville, Benjamin R; Donahue, Brian S; Harris, Zena L; Bichell, David P

    2015-03-01

    Our objectives were to study risk factors and post-operative outcomes associated with excessive post-operative bleeding in pediatric cardiac surgeries performed using cardiopulmonary bypass (CPB) support. A retrospective observational study was undertaken, and all consecutive pediatric heart surgeries over 1 year period were studied. Excessive post-operative bleeding was defined as 10 ml/kg/h of chest tube output for 1 h or 5 ml/kg/h for three consecutive hours in the first 12 h of pediatric cardiac intensive care unit (PCICU) stay. Risk factors including demographics, complexity of cardiac defect, CPB parameters, hematological studies, and post-operative morbidity and mortality were evaluated for excessive bleeding. 253 patients were studied, and 107 (42 %) met the criteria for excessive bleeding. Bayesian model averaging revealed that greater volume of blood products transfusion during CPB was significantly associated with excessive bleeding. Multiple logistic regression analysis of blood products transfusion revealed that increased volume of packed red blood cells (PRBCs) administration for CPB prime and during CPB was significantly associated with excessive bleeding (p = 0.028 and p = 0.0012, respectively). Proportional odds logistic regression revealed that excessive bleeding was associated with greater time to achieve negative fluid balance, prolonged mechanical ventilation, and duration of PCICU stay (p < 0.001) after adjusting for multiple parameters. A greater volume of blood products administration, especially PRBCs transfusion for CPB prime, and during the CPB period is associated with excessive post-operative bleeding. Excessive bleeding is associated with worse post-operative outcomes.

  3. Predictors of Ominous Outcome in Infants who Undergo Cardiac Surgery and Cardiopulmonary By-Pass: S100B Protein.

    Science.gov (United States)

    Varrica, Alessandro; Satriano, Angela; Tettamanti, Guido; Pelissero, Gabriele; Gavilanes, Antonio D W; Zimmermann, Luc J; Vles, Hans J S; Florio, Pasquale; Pluchinotta, Francesca R; Gazzolo, Diego

    2015-01-01

    S100B protein has been recently proposed as a consolidated marker of brain damage and death in adult, children and newborn patients. The present study evaluates whether the longitudinal measurement of S100B at different perioperative time-points may be a useful tool to identify the occurrence of perioperative early death in congenital heart disease (CHD) newborns. We conducted a case-control study in 88 CHD infants, without pre-existing neurological disorders or other co-morbidities, of whom 22 were complicated by perioperative death in the first week from surgery. Control group was composed by 66 uncomplicated CHD infants matched for age at surgical procedure. Blood samples were drawn at five predetermined timepoints before during and after surgery. In all CHD children, S100B levels showed a pattern characterized by a significant increase in protein's concentration from hospital admission up to 24-h after procedure reaching their maximum peak (P<0.01) during cardiopulmonary by-pass and at the end of the surgical procedure. Moreover, S100B concentrations in CHD death group were significantly higher (P<0.01) than controls at all monitoring time-points. The ROC curve analysis showed that S100B measured before surgical procedure was the best predictor of perioperative death, among a series of clinical and laboratory parameters, reaching at a cut-off of 0.1 µg/L a sensitivity of 100% and a specificity of 63.7%. The present data suggest that in CHD infants biochemical monitoring in the perioperative period is becoming possible and S100B can be included among a series of parameters for adverse outcome prediction.

  4. Effectiveness of Oral N-acetyl-cystein in Reduction of Pulmonary Complications in Smokers Undergoing Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    SJ Mir Hoseini

    2009-10-01

    Full Text Available Introduction: Up to 12% of patients undergoing coronary artery bypass graft have pulmonary complications. Smoking can cause a six-time increase in pulmonary complication after major surgery. The most common pulmonary changes after CABG are decrease in FRC, VC and atelectasis. In this study, the effect of oral N-acetyl-cystein in reduction of severity of hypoxemia and atelectasis in current smokers who smoked more than 10 packs/year and had undergone CABG was evaluated. Methods: In the study, 54 current smoker patients were selected randomly and allocated to two drug and placebo groups. In the study group, 300mg N-acetyl-cystein (ACC long containing vitamin C was prescribed two times a day from 4 days before operation up to 3 days after surgery and in control group, effervescent vitamin C tablet was prescribed as placebo. Patients with body mass index more than 35, NYHA class IV, those who needed intra aortic balloon pump and those who needed reoperation due to bleeding were excluded from the study. In all patients, spirometry was done in the preoperative visit and FEV1/FVC was determined. Induction and maintenance of anesthesia was similar in all patients. Arterial blood gas samples were obtained immediately after anesthesia induction and 4 to 6 hours after extubation. Chest X ray was taken before, 6 to 10 hours after extubation and 3rd postoperative day. Severity of atelectasis was also measured. Quantitative & qualitative data was analyzed by ANOVA and Chi-square tests, respectively. Pvalue<0.05 was considered as statistically significant. Results: Both groups were similar with respect to demographic data including ejection fraction, NYHA class, FEV1/FVC, cigarette smoking and Lima harvesting. The ratio of arterial oxygen pressure to fraction of inspiratory oxygen Pao2/FIo2 was not significantly different after induction but this difference was strongly significant (Pvalue<0.005 after extubation. Duration of mechanical ventilation was

  5. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW

    1998-01-01

    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  6. Comparison of New Technology Integrated and Nonintegrated Arterial Filters Used in Cardiopulmonary Bypass Surgery: A Randomized, Prospective, and Single Blind Study

    Directory of Open Access Journals (Sweden)

    Özgür Gürsu

    2013-01-01

    Full Text Available Background. Innovative cardiopulmonary bypass (CPB settings have been developed in order to integrate the concepts of “surface-coating,” “blood-filtration,” and “miniaturization.” Objectives. To compare integrated and nonintegrated arterial line filters in terms of peri- and postoperative clinical variables, inflammatory response, and transfusion needs. Material and Methods. Thirty-six patients who underwent coronary bypass surgery were randomized into integrated (Group In and nonintegrated arterial line filter (Group NIn groups. Arterial blood samples for the assessments of complete hemogram, biochemical screening, interleukin-6, interleukin-2R, and C-reactive protein were analyzed before and after surgery. Need for postoperative dialysis, inotropic therapy and transfusion, in addition to extubation time, total amount of drainage (mL, length of intensive care unit, and hospital stay, and mortality rates was also recorded for each patient. Results. Prime volume was significantly higher and mean intraoperative hematocrit value was lower in Group NIn, but need for erythrocyte transfusion was significantly higher in Group NIn. C-reactive protein values did not differ significantly except for postoperative second day's results, which were found significantly lower in Group In than in Group NIn. Conclusion. Intraoperative hematocrit levels were higher and need for postoperative erythrocyte transfusion was decreased in Group In.

  7. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients

    DEFF Research Database (Denmark)

    Jensen, Birte Østergaard; Hughes, Pia; Rasmussen, Lars S;

    2006-01-01

    Previous trials comparing coronary artery bypass grafting (CABG) with or without extracorporeal circulation have mainly enrolled selected patients at younger age and low risk. Patient-reported health-related quality of life has not been significantly different. We compared health-related quality...... of life in elderly moderate to high-risk patients randomized to either off-pump or on-pump surgery....

  8. Postoperative rescue closure of patent foramen ovale in the clinical setting of acute hypoxemic respiratory failure and stroke following coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    José L Díaz-Gómez

    2015-01-01

    Full Text Available We describe a case of intraoperative diagnosis and successful deferred percutaneous closure of a patent foramen ovale (PFO in the clinical setting of acute refractory hypoxemic respiratory failure and new-onset ischemic stroke in an elderly patient after coronary artery bypass graft. Perioperative morbidity (i.e. severe hypoxemia, worsening right ventricular dysfunction, and embolic stroke that is potentially related to intraoperatively diagnosed PFO during cardiac surgery can complicate management in the Intensive Care Unit and perhaps affect the patient′s outcome. Although the PFO closure can be challenging in the clinical setting of hypoxemic respiratory failure and stroke following cardiac surgery, it can be a reasonable perioperative option.

  9. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. J.; Seok, J. W.; Eo, J. S. [Seoul National University Hospital, Seoul (Korea, Republic of)] (and others)

    2005-07-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411{+-}121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8{+-}8.1% in diabetes and 0.3{+-}7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8{+-}8.0% in diabetes and 0.1{+-}7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by

  10. Urine and serum microRNA-1 as novel biomarkers for myocardial injury in open-heart surgeries with cardiopulmonary bypass.

    Science.gov (United States)

    Zhou, Xian; Mao, Anqiong; Wang, Xiaobin; Duan, Xiaoxia; Yao, Yi; Zhang, Chunxiang

    2013-01-01

    MicroRNA-1 (miR-1) is a cardio-specific/enriched microRNA. Our recent studies have revealed that serum and urine miR-1 could be a novel sensitive biomarker for acute myocardial infarction. Open-heart surgeries with cardiopulmonary bypass (CPB) are often accompanied with surgery injury and CPB-associated injury on the hearts. However, the association of miR-1 and these intra-operative and post-operative cardiac injures is unknown. The objective of this study was to test the hypothesis that urine and serum miR-1 might be a novel biomarker for myocardial injuries in open-heart surgeries with CPB. Serum and urine miR-1 levels in 20 patients with elective mitral valve surgery were measured at pre-surgery, pre-CPB, 60 min post-CBP, and 24h post-CBP. Serum cardiac troponin-I (cTnI) was used as a positive control biomarker for cardiac injury. Compared with these in pre-operative and pre-CPB groups, the levels of miR-1 in serum and urine from patients after open-heart surgeries and CPB were significant increased at all observed time points. A similar pattern of serum cTnI levels and their strong positive correlation with miR-1 levels were identified in these patients. The results suggest that serum and urine miR-1 may be a novel sensitive biomarker for myocardial injury in open-heart surgeries with CPB.

  11. Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2016-01-01

    Full Text Available Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF. Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE during cardiac surgery under hypothermic cardiopulmonary bypass (CPB. Methodology: Thirty-five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP, cardiac output (CO, SMABF, superior mesenteric artery (SMA diameter, superior mesentric artery blood flow over cardiac output (SMA/CO ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P 0.05 between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.

  12. Improvement of C peptide zero BMI 24-34 diabetic patients after tailored one anastomosis gastric bypass (BAGUA

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    M. Garcia-Caballero

    2013-01-01

    Full Text Available Background: Although bariatric surgery proved to be a very effective method in the treatment of patients in whose pancreas still produce insulin (type 2 diabetes, the accompanied metabolic syndrome and their diabetes complications, there is no information on the effect of this type of surgery in BMI24-34 patients when pancreas do not produce insulin at all (type 1, LADA and long term evolution type 2 diabetes among others. Patients and methods: We report preliminary data of a serie of 11 patients all with a C-peptide values below 0.0 ng/ml. They were followed for 6 to 60 months (mean 19 months after surgery. We studied the changes in glycemic control, evolution of the metabolic syndrome and diabetes complications after one anastomosis gastric bypass (BAGUA. Results: All values relative to glycemic control were improved HbA1c (from 8.9 ± 0.6 to 6.7 ± 0.2%, FPG (Fasting Plasma Glucose [from 222.36 ± 16.87 to 94 ± 5 (mg/dl] as well as the daily insulin requirement of rapid (from 40.6 ± 12.8 to 0 (U/d and long-lasting insulin (from 41.27 ± 7.3 U/day to 15.2 ± 3.3 U/day. It resolved 100% of the metabolic syndrome diseases as well as severe hypoglycaemia episodes present before surgery and improved some serious complications from diabetes like retinopathy, nephropathy, neuropathy, peripheral vasculopathy and cardiopathy. Conclusions: Tailored one anastomosis gastric bypass in BMI 24-34 C peptide zero diabetic patients eliminated the use of rapid insulin, reduced to only one injection per day long-lasting insulin and improved the glycemic control. After surgery disappear metabolic syndrome and severe hypoglycaemia episodes and improves significantly retinopathy, neuropathy, nephropathy, peripheral vasculopathy and cardiopathy.

  13. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Directory of Open Access Journals (Sweden)

    M. Cerci

    2013-01-01

    Full Text Available Introduction. Moderate obesity (BMI 30–35 kg/m2 affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM (56%, gastric bypass was performed; in cases with hypertension (64% and obstructive sleep apnea (OSA (12%, sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86% discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87% showed remission and 2 (13% improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.

  14. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Science.gov (United States)

    Cerci, M.; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. PMID:24454338

  15. Hearing Preservation CI Surgery and Hybrid Hearing : From Anatomical Aspects to Patient Satisfaction

    OpenAIRE

    Erixon, Elsa

    2014-01-01

    A common cause of profound deafness is hair cell dysfunction in the cochlea. Cochlear implants (CI) bypass the hair cells via an electrode and stimulate the cochlear nerve directly. Nowadays, it is possible to preserve residual hair cell function and hearing through flexible electrodes and a-traumatic CI surgery techniques; called hearing preservation CI surgery. This may suit partially deaf patients who can use natural low frequency hearing in combination with electric high frequency hearing...

  16. Postoperative pulmonary hypertensive crisis caused by inverted left atrial appendage after cardiopulmonary bypass surgery for congenital heart disease in a neonate.

    Science.gov (United States)

    Zhao, Qifeng; Hu, Xingti

    2013-09-01

    Postoperative pulmonary hypertensive crisis (PHC) caused by an inverted left atrial appendage (ILAA) is a rare complication following cardiac surgery. We present a case of 23 day-old male infant who developed postoperative PHC attacks after undergoing cardiopulmonary bypass (CPB) surgery for repair of the coactation of aorta. A hyperechogenic left atrial mass was detected via bedside transthoracic echocardiography (TTE), which was identified as an ILAA and corrected following repeat surgery. In this case, both the negative pressure in vent catheter and the long left atrial appendage (LAA) with a narrow base led to an irreversible ILAA. As in this neonate, ILAA had significant influence on the left atrial volume and caused PHC since the ILAA was located on the mitral valve orifice and interfered with the blood flow through the valve. Therefore, we recommend that the vent catheter should be turned off before removing to avoid this potential complication. Additionally, LAA should be carefully inspected after CPB surgery, and intra-operative and post-operative transoesophageal echocardiography (TEE) should be performed to detect ILAA intraoperatively so as to avoid the reoperation. When an ILAA is diagnosed postoperatively, whether conservative treatment or surgery will depend on the balance of benefit and risk for a particular patient.

  17. Effects of dexmedetomidine on hemodynamics and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass%右美托咪定对心肺转流心内直视手术患儿血流动力学及应激反应的影响

    Institute of Scientific and Technical Information of China (English)

    李晓松; 刘海涛; 任建军; 董振明

    2012-01-01

    Objective To evaluate the effects of dexmedetomidine infusion on hemodynamic and stress reaction in pediatric patients with congenital heart disease undergoing open heart surgery with cardiopulmonary bypass. Methods Thirty pediatric patients undergoing open heart surgery with cardiopulmonary bypass, ASA class D or 01, were randomly assigned to two groups: the group DEX (group D, n=15) and the group control (group C, n = 15). Patients In group D received an initial bolus dose of dexmedetomidine Cl. 0 礸/kg) over 10 minutes, immediately followed by a continuous infusion of 0. 5-1. 0 礸+kg -1穐-1 until the end of the operation. The same volume of normal saline was given in the control group. Hemodynamic parameters and concentrations of blood glucose, rartisol, norepinephrine and epinephrine were measured before injection(T0), 10 min and 15 min after administration Ti and T2), after incision (T3), after sternum saw (T4). after CPB(T6) and immediately after surgey(Ts). Results The values of HR, SBP. DBP and MAP decreased significantly at Ti-Ts in group D, and were significantly lower than those in group C, especially at T; (P<0. 05). In both groups, blood glucose,plasma cortisol, norepinephrine and epinephrine increased significantly at T4-T6. However, the values were lower in group D compared with those in group C(P <0.05). Conclusion Intraoperative dexmedetomidine infusion attenuated the hemodynamic and neuroendocrinal response to surgical trauma and cardiopulmonary bypass in pediatric patients undergoing corrective surgery for congenital heart disease%目的 观察右美托咪定连续输注对小儿先天性心脏病CPB心内直视手术期间的血流动力学及应激反应的影响.方法 CPB心内直视矫治手术患儿30例,ASAⅡ或Ⅲ级,随机均分为右美托咪定组(D组)和对照组(C组).D组接受初始剂量为1.0 μg/kg的右美托咪定(给药时间大于10 min),随后以0.5~1.0μg·kg-1·h-1的速度维持直至手术结束,C组则给予相

  18. Factors associated with extubation time in coronary artery bypass grafting patients

    Directory of Open Access Journals (Sweden)

    Abbas Rezaianzadeh

    2015-12-01

    Full Text Available Background and Objectives. Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis.Method. This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients’ information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software.Results. The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB, packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU.Conclusion. Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients’ prognosis.

  19. Gastroplastia redutora com bypass gastrojejunal em Y-de-Roux: conversão para bypass gastrointestinal distal por perda insuficiente de peso - experiência em 41 pacientes Gastric bypass Roux-en-Y gastrojejunostomy: conversion to distal gastrojejunoileostomy for weight loss failure - experience in 41 patients

    Directory of Open Access Journals (Sweden)

    José Carlos Pareja

    2005-12-01

    Full Text Available RACIONAL: O tratamento cirúrgico é a única modalidade efetiva de tratamento da obesidade mórbida. O insucesso do bypass gastrointestinal (percentagem de perda de excesso de peso inferior a 50% pode chegar a 10% dos pacientes operados a longo prazo (acima de 5, num ideal de 10 anos. OBJETIVOS: Avaliar os resultados, em termos de perda de peso, dos pacientes submetidos a reoperação com a finalidade de aumentar o componente disabsortivo. CASUÍSTICA E MÉTODOS: Estudaram-se 41 doentes, sendo 32 submetidos a reoperação por uma de três técnicas cirúrgicas (Fobi, Brolin e bypass gastrojejunoileal distal nas quais foi realizada diminuição da área absortiva do intestino delgado. RESULTADOS: Os doentes submetidos a bypass gastrojejunoileal distal apresentaram resultados superiores aos demais (69,7%. CONCLUSÃO: O emprego do bypass distal pode ser utilizado em casos selecionados com o intuito de melhorar os resultados em termos de perda de peso. É aconselhável a centralização desses procedimentos em serviços de referência com experiência na área específica de cirurgia bariátrica, para acompanhamento rigoroso desses doentes.BACKGROUND: Surgery is the only effective treatment for morbid obesity. Gastric bypass could fail in up to 10% of the patients (excess weight loss under 50%. AIMS: To evaluate the weight loss determined by reoperation performing disabsortive variation of gastric bypass. PATIENTS AND METHODS: The records of 41 patients, in whom 32 were submitted to reoperation by one of three surgical techniques (Fobi, Brolin, distal gastrojejunoileal bypass which consisted in increasing the disabsortive length of intestinal limb. RESULTS: The patients submitted to distal gastrojejunoileal bypass showed the best results (69,7%. CONCLUSION: The distal gastric bypass as a revisional procedure could be done in selected cases with the aim to improve the weight loss. It is advisable to refer these patients to selected centers (known as

  20. Management of gallstones and gallbladder disease in patients undergoing gastric bypass

    Institute of Scientific and Technical Information of China (English)

    Bernabé; M; Quesada; Gustavo; Kohan; Hernán; E; Roff; Carlos; M; Canullán; Luis; T; Chiappetta; Porras

    2010-01-01

    The appropriate management of gallstones and gallbladder disease in patients undergoing gastric bypass remains unknown.Several therapeutic modalities are used and include performing cholecystectomy on all patients at the time of gastric bypass,performing concomitant cholecystectomy only when patients have gallstones and performing cholecystectomy only in the presence of both symptoms and gallstones.Some groups administer ursodeoxycholic acid for gallstone prevention in the postoperative period.All treatment...

  1. The IGF-Axis and Diabetic Retinopathy Before and After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Brynskov, Troels; Laugesen, Caroline Schmidt; Floyd, Andrea Karen

    2016-01-01

    activation assay (bioactive IGF). Total IGF-I, IGF-II and IGF binding protein (IGFBP) 1 and 3 were determined by immunoassays. RESULTS: At baseline, 18 of 36 patients presented with DR. These patients had higher levels of bioactive IGF (p = 0.03) than patients without DR and this association was strengthened...... at the two postoperative visits (p ≤ 0.001). Total IGF-I showed no significant changes. HbA1c, glucose, HOMA-IR and lipids improved after surgery. Two patients did not complete the 12-month visit. CONCLUSIONS: In obese T2D patients, bioactive IGF is a potential biomarker for DR and levels tended to increase...

  2. Coronary Artery Bypass

    Science.gov (United States)

    ... to 3 days in the Intensive Care Unit (ICU). Life After Bypass After bypass surgery, your doctor will recommend that you join a cardiac rehabilitation program. These programs help you make lifestyle changes ...

  3. Roux-en-Y gastric bypass alleviates hypertension and is associated with an increase in mid-regional pro-atrial natriuretic peptide in morbid obese patients

    DEFF Research Database (Denmark)

    Bonfils, Peter K; Taskiran, Mustafa; Damgaard, Morten;

    2015-01-01

    OBJECTIVE: To examine 24-h blood pressure (24BP), systemic haemodynamics and the effect of sodium intake on 24BP in obese patients before and after gastric bypass surgery [laparoscopic Roux-en-Y gastric bypass (LRYGB)], and to determine whether weight loss from LRYGB might be related to an increase...... of high versus low sodium intake on 24BP was evaluated before and 12 months after LRYGB. RESULTS: Six weeks after LRYGB, the average weight loss was 20 kg, with a further 21 kg weight loss 1 year after surgery. In hypertensive patients, 24BP was significantly reduced at 6 weeks, but not 1 year after LRYGB...... in hypertensive patients and increased by 77% 1 year after the operation. In normotensive patients, preoperative concentrations were normal and increased only by 6%. High sodium intake induced plasma volume expansion, increased stroke volume and cardiac output, but no significant change in 24BP - neither before...

  4. Plasma cholecystokinin in obese patients before and after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio--no role in the increased risk of gallstone formation

    DEFF Research Database (Denmark)

    Sørensen, T I; Toftdahl, D B; Højgaard, L

    1994-01-01

    bypass surgery with either a 1:3 jejunoileal ratio (n = 14) or a 3:1 ratio (n = 15), and in unoperated obese patients (n = 7). Plasma CCK levels were determined during fasting and during 150 min following ingestion of a liquid test meal. RESULTS: There were no significant changes over time following......BACKGROUND AND AIM: Jejunoileal bypass surgery for obesity increases the risk of gallstone formation, and, contrary to expectations, the incidence is greater in patients with a long as compared to a short ileum left in continuity. Impaired gallbladder motility due to reduced cholecystokinin (CCK......) stimulation could be an explanation. The aim of this study was to investigate the CCK levels in such patients. SETTING: The randomized trial of bypass surgery named The Danish Obesity Project. DESIGN AND METHODS: We compared plasma levels of CCK in obese patients at three, nine or 15 months after jejunoileal...

  5. [The interconnection between cytokines and the factors of bactericidal action of neutrophiles in patients operated on under the conditions of cardiopulmonary bypass].

    Science.gov (United States)

    Novitskiĭ, V V; Chumakova, S P; Shipulin, V M; Urazova, O I; Evtushenko, O M; Perevozchikova, T V; Suslova, T E; Emel'ianova, T V

    2006-01-01

    The use of cardiopulmonary bypass (CPB) is associated with the development of a system inflammatory response. The subjects of the study were 48 patients with coronary heart disease (CHD), operated on under the condition of CPB. The following parameters were measured: the content of cation proteins and active oxygen forms in neutrophiles, the digesting capacity of these cells, and the serum levels of interleukins (IL)-1beta, 1ra, -4, -6, -8, and tumor necrosis factor-alpha (TNF-alpha). The measurements were made before performing coronary bypass surgery, and also 6 and 24 hours after surgery. The results showed that the levels of cytokines and the bactericidal activity of neutrophiles were elevated in CHD patients before surgery. The changes after surgery included an increased macrophageal digesting capacity with switching to oxygen-independent mechanisms, as well as increased levels of TNF-alpha, IL-1ra, and IL-1ra:IL-1beta. The changes were more prominent 6 hours after surgery. Oxygen-dependent killing was controlled mostly by IL-6 during the pre-operative period, and by this plus TNF-alpha 24 hours after surgery. The content of cation proteins in neutrophiles before surgery correlated with the concentrations of TNF-alpha and IL-8. These interconnections weakened 6 hours after surgery and became stronger 24 hours after it.

  6. The effect of pulsatile cardiopulmonary bypass on lung function in elderly patients

    NARCIS (Netherlands)

    Engels, Gerwin E.; Dodonov, Mikhail; Rakhorst, Gerhard; van Oeveren, Willem; Milano, Aldo D.; Gu, Y. John; Faggian, Giuseppe

    2014-01-01

    Purpose: Cardiopulmonary bypass is still a major cause of lung injury and delay in pulmonary recovery after cardiac surgery. Although it has been shown that pulsatile flow induced by intra-aortic balloon pumping is beneficial for preserving lung function, it is not clear if the same beneficial effec

  7. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study

    Directory of Open Access Journals (Sweden)

    Pértega-Díaz Sonia

    2009-07-01

    Full Text Available Abstract Background Heart surgery is associated with an occurrence of pulmonary complications. The aim of this study was to determine whether pre-surgery respiratory physiotherapy reduces the incidence of post-surgery pulmonary complications. Methods Observational study of 263 patients submitted to off-pump coronary artery bypass grafting (CABG surgery at the A Coruña University Hospital (Spain. 159 (60.5% patients received preoperative physiotherapy. The fact that patients received preoperative physiotherapy or not was related to whether they were admitted to the cardiac surgery unit or to an alternative unit due to a lack of beds. A physiotherapist provided a daily session involving incentive spirometry, deep breathing exercises, coughing and early ambulation. A logistic regression analysis was carried out in order to identify variables associated with pulmonary complications. Results Both groups of patients (those that received physiotherapy and those that did not were similar in age, sex, body mass index, creatinine, ejection fraction, number of affected vessels, O2 basal saturation, prevalence of diabetes, dyslipidemia, exposure to tobacco, age at smoking initiation, number of cigarettes/day and number of years as a smoker. The most frequent postoperative complications were hypoventilation (90.7%, pleural effusion (47.5% and atelectasis (24.7%. In the univariate analysis, prophylactic physiotherapy was associated with a lower incidence of atelectasis (17% compared to 36%, p = 0.01. After taking into account age, sex, ejection fraction and whether the patients received physiotherapy or not, we observed that receiving physiotherapy is the variable with an independent effect on predicting atelectasis. Conclusion Preoperative respiratory physiotherapy is related to a lower incidence of atelectasis.

  8. Incidence and Progression of Cardiac Surgery-associated Acute Kidney Injury and its Relationship with Bypass and Cross Clamp Time

    Science.gov (United States)

    Karim, Habib Md Reazaul; Yunus, Mohd; Saikia, Manuj Kumar; Kalita, Jyoti Prasad; Mandal, Mrinal

    2017-01-01

    Introduction: Cardiac surgery-associated kidney injury (CSA-AKI) is common but relatively less is known about its progression. The present study is aimed at evaluating the incidence and course of CSA-AKI and its relationship with the different durations of cardiopulmonary bypass (CPB) and cross clamp times. Materials and Methods: Occurrences of CSA-AKI are evaluated as per the Akin Kidney Injury Network (AKIN) criteria over the course of 5 postoperative day (POD) in 100 patients. The relationship of different durations of CPB and aortic cross clamp time with CSA-AKI is analyzed by Chi-squared test for trend and other appropriate tests using INSTAT software. Results: One hundred (43 male, 57 female; mean age of 37.01 ± 12.28 years, and baseline mean serum creatinine 0.99 ± 0.20 mg %) patients undergone mostly valve replacement, and congenital heart disease correction was evaluated. Nearly 49% suffered CSA-AKI (81.63% AKIN Class I) with maximum numbers on 2nd POD. Serum creatinine followed a falling trend 3rd POD onward except in 8.16% cases of CSA-AKI. Oliguria was absent even in AKIN Class II. The CPB time >70 min and cross clamp time >60 min increase CSA-AKI risk by an OR of 4.76 and 2.84, respectively (P < 0.05). Conclusion: CSA-AKI is very prevalent; mostly of AKIN Class I and increases with increasing CPB and cross clamp time. Urine output is not a reliable indicator of CSA-AKI. The AKIN Class II on the very 1st POD or increasing trend of serum creatinine beyond 3rd POD should alert for early intervention. PMID:28074790

  9. 盐酸戊乙奎醚对心肺转流患者肠损伤和炎性因子的影响%Effect of penehyclidine hydrochloride on gut injury and cytokines during cardiopulmonary bypass in patients undergoing open heart surgery

    Institute of Scientific and Technical Information of China (English)

    张丽丽; 孙莹杰; 张铁铮

    2011-01-01

    目的 探讨盐酸戊乙奎醚对心肺转流(CPB)患者肠损伤和炎性因子的影响.方法 40例ASA Ⅱ或Ⅲ级心瓣膜置换术患者,随机均分为盐酸戊乙奎醚组(P组)和对照组(C组),分别在CPB前10 min颈内静脉注射盐酸戊乙奎醚0.05 mg/kg或等容量生理盐水.分别于CPB前(T1)、主动脉开放10 min(T2)、停CPB即刻(T3)、术后2 h(T4)、6 h(T5)、18 h(T6)采取中心静脉血,应用ELISA法检测血清肠型脂肪酸结合蛋白(I-FABP)、白细胞介素-6 (IL-6)、白细胞介素-10(IL-10)浓度.结果 与T1时比较,T2~T6时两组I-FABP、IL-6和IL-10浓度均显著升高(P<0.05).T2、T4、T5时P组I-FABP浓度显著低于C组,T4、T5时IL-6浓度亦显著低于C组(P<0.05).结论 盐酸戊乙奎醚0.05 mg/kg可减轻患者肠损伤和炎性因子的释放.%Objective To observe the effect of penehyclidine hydrochloride on gut injury and cytokines during cardiopulmonary bypass in patients undergoing open heart surgery. Methods Forty patients undergoing heart valve replacement with cardiopulmonary bypass were randomly divided into two groups with 20 cases each: penehyclidine group(group P)and control group (group C) respectively. Patients in group P were injected PHC 0. 05 mg/kg before CPB 10 mins from the internal jugular vein, patients in group C were injected the same volume saline. Jugular vein blood was drawn at the following 6 time points: before CPB (T1), 10 min after aortic crossclamp release (T2), immediately at the end of CPB (T3), 2 h after operation(T4 ), 6 h after operation(T5 ), 18 h after operation(T6 ). The density of blood I-FABP was detected by enzyme-linked immunosorbent assay as well as cytokine levels (IL-6, IL-10). Results Comparing with T1 (beforeCPB), the concentration of blood I-FABP, IL-6 and IL-10 all increased significantly at T2 ,T3 ,T4 ,T5 ,T6 (P< 0. 05). In group P, the concentration of blood I-FABP was significantly lower atT2 ,T4 ,T5 than those in group C(P<0. 05). In group P, the

  10. Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery

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    Vazquez-Jimenez Jaime F

    2010-10-01

    Full Text Available Abstract Background A comprehensive evaluation of postoperative arrhythmias following surgery for congenital heart disease by continuous Holter monitoring has not been carried out. We aimed, firstly, to establish the time course of pre- and early postoperative arrhythmias by beat-to-beat analysis following cardiopulmonary bypass and, secondly, to examine which surgical procedures present risk factors for specific arrhythmias. Methods 494 consecutive patients, including 96 neonates, were studied wit