Surgical interference in cases of infective endocarditis [results and outcome]

Many patients with infective endocarditis [IE] present with serious and complicated courses that lead to significant morbidity and mortality. We followed up 39 cases of IE who were referred to surgery. Our patient population was comprised of 30 males and 9 females [aged between 7 and 52 years, mean 26.8 +/- 12.9 years]. Congenital heart disease was present in 7 of the patients while rheumatic heart disease was present in 32. The patients presented with congestive heart failure [CHF] in 26, and systemic embolization in 5. Blood cultures were positive in 30 [76.9%] of the patients, while vegetations were detected by 2-dimensional echocardiography in 28 patients [71.7%]. Elective surgery was performed in 36 patients and emergency operation for systemic arterial embolizalion and/or intractable CHF in 3 patients. Four patients required re-operation for post-operative bleeding. All patients were followed up for 6 months with no evidence of re-infection. Four patients died, 2 due to intracranial bleeding from the use of anticoagulation for the mechanical valve implanted, and 2 died due to septicaemia. The remaining patients resumed normal activity. The encouraging outcome of our study suggests that surgical intervention for IE, is a relatively safe procedure for patients with complicated IE, early diagnosis and early intervention are expected to improve the morbidity and mortality of patients with IE

Management of bronchial and lung injury in multiply injured patients with chest trauma

Pulmonary and/or bronchial injuries due to chest trauma are not uncommon and occur in about 0.25% of patients. .In this study, the pattern of injury is analyzed and the importance of careful clinical examination outlined. Diagnosis is confirmed by means of plain chest X-ray and bronchoscopy.Between 1998 and 2000, 600 patients with a chest trauma were admitted to our University Hospital.In only 32 of them [0.5%], a ruptured bronchus and lug injury following chest trauma was identified. All patients had sustained severe associated injuries]. In five patients presenting with an extended subcutaneous emphysema at the time of admission, an air leakage persisted after immediate tube thoracostomy, one patient showed continuous tracheal bleeding. Diagnosis was confirmed bronchoscopically and an emergency thoracotomy performed in all 32 patients.In 14 patients the main bronchus was sutured, in 2 patient a wedge resection became necessary, and in one patient with additional lung laceration a lobectomy was performed. Twenty eight of 32 patients have survived and show no sequelae 3 months after trauma, respectively.Multiply injured patients with chest trauma presenting with an extended subcutaneous emphysema and persistent air leakage after tube thoracostomy are at high risk of lesions of the tracheo-bronchial tree. Bronchoscopy will confirm the diagnosis

incidence and the Predictor factors of ARDS After open heart surgery

Severe respiratory insufficiency with the development of ARDS is an infrequent complication after open heart surgery and cardiopulmonary bypass.This retrospective study was done to determine the incidence and mortality of ARDS after open heart surgery and CPB, as well as to identify preoperative and perioperative predisposing factors of this complication.Of 578 patients who underwent open heart surgery and CPB between December 1999 and December 2000, 18 patients developed ARDS during the immediately postoperative period. Each patient was matched with four or five control subjects who had the same type of surgery but did not develop postoperative respiratory complications.The incidence of ARDS was 0.4%, with an ARDS mortality of 27%. In the ARDS group, 38% had previous cardiac surgery, as compared to 3.5% in the control group [p < 0.002]. During the postoperative period, ARDS patients received more blood products [4 +/- 5 vs 2 +/- 3; p < 0.01] and developed shock more frequently [31.5% vs 5%; p < 0.02] than patients in the control group. The analysis of risk factors and their effects was done including previous cardiac surgery, shock, and the number of transfusedblood products as significant independent predictors for ARDS, with odds ratios of 31.5[p = 0.015], 10.8 [p = 0.03], and 1.6 [p= 0.03], respectively.ARDS following cardiac surgery and CPB was a rare complication that earned a 27% mortality rate. Previous cardiac surgery, shock, and number of blood products received are important predicting factors for this complication. Abbreviation : ARDS o adult respiratory distress syndrome