The aim of this study was to compare the mid and long term postoperative outcomes between the hemodialysis-dependent patients awaiting kidney transplantat who underwent open heart surgery in our department during the last five years, and those who did not receive a renal transplant, to determine the predictors of mortality, and assess the possible contribution of post heart surgery kidney transplantation to survival. The patients were separated into two groups: those who underwent a transplantation after open heart surgery were included in the Tp+ group, and those who did not in the Tp- group Between June 2008 and December 2012, 127 dialysis dependent patients awaiting kidney transplant and who underwent open heart surgery were separated into two groups. Those who underwent transplantation after open heart surgery were determined as Tp+ (n=33), and those who did not as Tp- (n=94). Both groups were compared with respect to preoperative paramaters including age, sex, diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), obesity, smoking, chronic obstructive pulmonary disease (COPD), peripheral vascular disease (PVD), left ventricle ejection fraction (EF), Euroscore; operative parameters including cross clamp time, perfusion time, number of grafts, use of internal mammary artery (IMA); postoperative parameters including revision, blood transfusion, ventilation time, use of inotropic agents, length of stay in the intensive care unit and hospital, and follow up findings. Problems encountered during follow up were recorded. Predictors of mortality were determined and the survival was calculated. Among the preoperative parameters, when compared with the Tp- group, the Tp+ group had significantly lower values in mean age, presence of DM, obesity, PVD, and Euroscore levels, and higher EF values. Assessment of postoperative values showed that blood transfusion requirement and length of hospital stay were significantly lower in the Tp+ group compared to the Tp- group, whereas the length of follow up was significantly higher in the Tp+ group. The use of inotropic agents was significantly higher in the Tp- group. A logistic regression analysis was made to determine the factors affecting mortality. Revision (p=0.013), blood transfusion (p=0.017), ventilation time (p=0.019), and length of stay in the intensive care unit (p=0.009) were found as predictors of mortality. Survival rates at years 1, 2 and 3 were 86.1%, 81%, 77.5% in the Tp- group, and 96.0%, 96.3%, 90.4% in the Tp+ group. Median survival rate was 41.35±2.02 in the Tp- group, and 49.64±1.59 in the Tp+ group which was significantly higher compared to the Tp- group (p=0.048). Chronic renal failure is among the perioperative risk factors for patients undergoing open heart surgery. Transplantation is still an important health issue due to insufficiency of available transplant organs. Patients with chronic renal failure are well known to have higher risks for coronary artery disease. A radical solution of the cardiovascular system problems prior to kidney transplantation seems to have a significant contribution to the post transplant survival.

Objective: To study the incidence of vascular disorders and to estimate their contribution to the severity and prognosis of Behcet's disease (BD). Subjects and methods. Ninety-five patients with evident BD, followed up at Research Institute of Rheumatology, Russian Academy of Medical Sciences, in the January 2006 to October 2009, were examined. Their mean age was 29,7 years; malefemale ratio was 3,7. The onset of the disease was chiefly at the age of 21-30 years in 36,8% of the patients. Vascular pathology was evaluated by the following techniques: vascular duplex scanning; brain magnetic resonance imaging in the mode of venosinusography, contrast-enhancement chest computed tomography, chest and abdominal angiography. The data were statistically processed by the programs Statistica 6.0 (Statsoft, USA) and EpiInfo 5.0 recommended by the WHO. Parametric and non-parametric statistical methods were used. Results. Vascular diseases were diagnosed in 26,3% of the patients. The venous bed was mainly involved (88%), the proportion of patients with arterial pathology was 12%. Vascular death occurred in 2 men aged 20 and 18 years due to pulmonary artery rupture aneurysm and brain sagittal sinus thrombosis. Assessment of an association of vascular disorders with other clinical manifestations of BD revealed their correlation with erythema nodosum and epididymitis. The risk for vascular events in erythema nodosum was 5 times greater (OR=5,03; 95% CI 1,54-17,41), the risk was higher in men than that in women (OR=7,11; 95% CI 1,83-30,02 versus OR=2,15; 95% CI 0,16-61,38). The male vascular risk is associated with epididymitis (OR=6,71; 95% CI 1,25-39,89). In erythema nodosum concurrent with epididymitis, the relative vascular risk was increased up to 21; 95% CI 2,15-503,94. Conclusion. Vascular disorders in BD were diagnosed in one fourth of the patients, mainly in young male patients. Severe thromboses with the development of chronic venous insignificance, Budd-Chiari syndrome, pulmonary and iliac artery aneurysms, and arterial thromboses were observed in male patients only. Vascular events were associated with erythema nodosum and epididymitis; in these concomitances, the vascular risk was substantially increased. Vascular death rates were 2,2%.

Interrupted aortic arch is one of the rarest anomalies among the congenital cardiac defects. Patients must be treated early in life, otherwise death is inevitable. Reports on adult patients with aortic interruption are very rare in the literature. In this report, we present a 21-year-old patient with type A interrupted aortic arch. The patient underwent successful anatomical reconstruction of the descending aorta.

Pituitary apoplexy usually results from ischemic or hemorrhagic changes due to preexisting adenomas of the pituitary gland. Rarely, it can occur after surgical procedures, mainly because of severe hemorrhage or hypotension. It is a serious condition and may lead to disastrous complications and even to death. We present a 60-year-old male patient in whom pituitary apoplexy developed due to protamine anaphylaxis during coronary artery bypass surgery.

Ein Hypophyseninfarkt kann ischämischer oder hämorrhagischer Genese sein und wird meistens durch Hypophysentumore ausgelöst. Dieser dramatische Zustand kommt selten nach chirurgischen Eingriffen vor allem bei Vorliegen schwerer Hämorrhagien oder einer längeren Hypotoniephase vor. Dieses Krankheitsbild stellt eine ernste Situation mit möglichen schweren Komplikationen und eventueller Todesfolge dar. Wir präsentieren einen 60-jährigen Patienten mit Entwicklung einer vollständigen Hypopyseninsuffizienz in Folge einer anaphylaktischen Reaktion auf Protamin während einer aortokoronaren Bypassoperation.

OBJECTIVE:The determination of postoperative course after cardiac surgery has always been a challenging issue. It is more sophisticated in the pediatric age group. The aim of this investigation was to identify whether increased concentrations of lactate in arterial blood has a predictive value for postoperative morbidity and mortality after heart surgery.METHODS:From May 2002 to June 2003, 60 infants operated on at the authors' institution were included in this prospective study. The patients were divided into 2 groups according to their respective postoperative serum lactate values. After the stabilization period in the intensive care unit (first 3 hours postoperatively), samples for serum lactate were obtained from arterial blood at 3 (t1), 6 (t2), and 12 hours (t3) postoperatively. The patients were subdivided into 2 groups according to their respective mean serum lactate values. A value of 4.8 mmol/L (3 times the normal upper limit) was chosen as a threshold for serum lactate. The patients with a mean value of greater than 4.8 mmol/L (group 1) were compared with the remaining group of patients (group 2). The relationship between serum mean lactate level and intraoperative and postoperative clinical variables was evaluated.RESULTS:Among the patients in this study, 26 (43.3%) had a serum mean lactate level more than 4.8 mmol/L and 34 (56.7%) had a level of 4.8 mmol/L or less. Age, aortic cross-clamping time, cardiopulmonary bypass time, and the lowest hematocrit during cardiopulmonary bypass were significant variables that influenced the postoperative serum mean lactate level. Six patients died in the postoperative period and 54 infants survived. The hospital mortality was significantly higher in group 1 than in group 2 (19.0% v 2.9%; p = 0.037, kappa = 0.179). Multivariate analysis revealed that serum mean lactate level correlated significantly with inotrope score, intubation time, and intensive care unit stay.CONCLUSIONS:Blood lactate concentration of 4.8 mmol/L or higher during the early postoperative hours identifies a group of patients with increased risk of postoperative morbidity and mortality.

Objective : The incremental surgical risk caused by mild or moderate renal dysfunction in patients undergoing surgery for an abdominal aortic aneurysm is not well defined. The aim of this study is to analyze the prognostic significance of mild or moderate renal dysfunction in 79 patients who have undergone repair of an infrarenal abdominal aortic aneurysm at our institution.Methods : The postoperative results of 35 non-dialysis-dependent patients (Group I) with renal dysfunction were included and compared with a group of 44 patients (Group II) with similar characteristics of age, gender and pre-operative risk factors. All operations were performed through a standard transperitoneal median laparotomy.Results : The mean operation and aortic cross-clamp times did not differ significantly between the two groups (234 +/- 15 min vs. 189 +/- 17min; p = 0.25 and 57 +/- 12 min. vs. 52 +/- 9 min.; p = 0.52). Early operative mortality was 5.71% in patients with renal dysfunction and did not differ significantly when compared with the other group of patients 4.5%; p = 0.083). Blood requirement was higher (p < 0.01) and the hospital stay was longer (p < 0.001) in group I. There were 18 patients in group I (51.4%) and three patients in group II (6.8%) in whom the pre-operative serum creatinine level increased above 2.5 mg/dI during the postoperative period. The postoperative increase of creatinine level differed significantly in patients with pre-operative renal dysfunction (p < 0.001). There were nine patients (25.7%) in group I and four patients (9.1%) in group II who required mechanical ventilation for more than 24 hours (p = 0.025). There was no significant difference between the two groups in terms of cardiac morbidity p = 0.234).Conclusion : Patients with even a mild or moderate degree of renal dysfunction require close monitoring and prolonged hospital care during the postoperative period. Although satisfactory early surgical outcomes may be expected in this particular group of patients, pulmonary and renal morbidity rates are higher than in patients with normal renal function.

La maladie de Behçet est une vascularite inflammatoire qui touche les artères et veines. L'atteinte vasculaire est une complication rare de cette maladie. Nous rapportons ici un cas de maladie de Behçet chez un patient qui a été hospitalisé plusieurs fois en raison des manifestations vasculaires.

BACKGROUND:Systemic inflammatory response and capillary leak syndrome, caused by extracorporeal circulation, have negative effects on the function of vital organs during the postoperative period. Modified ultrafiltration (MUF) has been developed as an alternative method to reduce the detrimental effects of cardiopulmonary bypass. The aim of this prospective, randomized study is to analyze the effects of MUF in a pediatric population undergoing congenital cardiac surgery.METHODS:Twenty-seven patients who underwent open-heart surgery at our institution were included in this prospective study. They were randomized into two groups as follows: Group I (n=14) of conventional ultrafiltration during bypass and Group II (n=13) receiving both conventional and modified ultrafiltration during and after the cessation of the bypass, respectively. The amount of prime volume, postoperative chest drain loss, transfusion requirements, hemodynamical parameters, duration of mechanical ventilatory support, and length of intensive care unit stay were compared between the two groups. During the postoperative period, the concentrations of hematological, biochemical and inflammatory parameters were also compared by analyzing the blood samples obtained at various time points.RESULTS:MUF resulted in a significant increase in hemoglobin, hematocrit and platelet levels, and significantly reduced the amount of chest tube output and transfused blood and blood products. MUF also shortened the duration of postoperative mechanical ventilatory support, length of the intensive care unit stay and improved postoperative hemodynamical parameters. During the early postoperative hours, IL-8 is significantly reduced in patients undergoing MUF, however, the concentrations of IL-8 were similar in both groups at the end of 24 h.CONCLUSIONS:MUF decreases the duration of mechanical ventilatory support, the length of intensive care unit stay, the need for blood transfusion and improves postoperative hemodynamics. It is associated with increased levels of hemoglobin, hematocrit and platelets. We can conclude that MUF attenuates the inflammatory response by decreasing the levels of inflammatory mediators.