Cost-effectiveness of intraoperative transesophageal echocardiography in cardiac valve surgery

Being a unique diagnostic technique, transesophageai echocardiography [TEE] has influenced many different aspects of cardiac surgery including valve repair surgery. The cost-effectiveness of this method however is questioned considering the conditions of every region and country. In this study we aimed at answering the question if utilizing TEE throughout valve repair surgery could be cost-effective. Twenty four patients were studied within two groups of case "valve repair operation plus intra-operative TEE [10-TEE]" and control [valve replacement operation]. Variables including age, gender, left ventricle ejection fraction [LVEF], re-operation, intensive care unit [ICU] stay, hospital stay and cost were studied and compared. There was no significant difference regarding age, gender and LVEF between two groups [p=0.559, p=0.413, and p=0.408, respectively] ICU stay in repair group was less than replacement group [p=0.009]. Hospital stay difference however was not statistically significant [p=0.928]. The cost of valve repair under 10-TEE monitoring was significantly less than valve replacement [p=0.00l]. 10-TEE not only would assist surgeons by increasing their interest toward valve repair operation instead of replacing impaired cardiac valves but also consequently decrease hospital costs. It is also advised for the cardiac anesthesiologists to use 10-TEE routinely in the valve repair operations provided that there are no contraindications

Epidemiologic and etiologic evaluation of acquired urinary tract infections in cardiac surgery ICU patients

Urinary tract infections [UTI] are the most common acquired infections in hospitalized patients. The most common nosocomial infections in hospitals occur in intensive care units. Occurrence of UTI in severely compromised patients significantly increases the hospitalization period and treatment costs. The aim of the present study was the epidemiologic and etiologic evaluation of acquired UTI in cardiac surgery ICU patients. In this descriptive cross-sectional study, 500 patients in the cardiac surgery ICU in Tabriz Madani hospital were evaluated for a period of 1 year. The acquired UTI was diagnosed by the positive urine culture result [number of microorganisms<105/mL] 48 hours after hospitalization or 48 hours after discharge from ICU. In patients with positive culture results, anti-bactrial sensitivity test was carried out by modified Kriby-Bauer method in relation to Amikacin, Gentamicin, Co-Trimoxazole, Ciprofloxacin and Ceftazidime. A total of 500 patients, 309 males and 191 females, with a mean age of 48.95 +/- 22.83 years were included in the study. All the patients had urinary catheters. Acquired UTI diagnosed in 8 subjects [1.6%], 7 males and 1 female, with a mean age of 62.88 years [mean standard error=40.7; age range=41-78 years]. All the subjects were married. From each patient one microorganism was isolated: Enterobacter aerogenes [37.5%]; Candida albicans [25%]; Escherichia coli [25%] and Klebsiella pneumoniae [12.5%]. Antimicrobial sensitivity test revealed only one case of E coli resistant to Co-Trimoxazole. The results of the present study showed a low prevalence of acquired UTI in the ICU under study. Although the microorganisms isolated were similar to those reported in other studies, a low rate of resistance to commonly used antibiotics was observed

Blue color vision as a rare sign of digitalis toxicity

We report a 73-year-old woman who had taken an amount of 0.25 mg/day of digoxin for an unknown period of time because of chronic congestive heart failure and chronic atrial fibrillation. She was admitted due to nausea, vomiting, abdominal pain, atrial fibrillation with a slow ventricular rate and with a short corrected Q-T interval in an electrocardiogram of 345 milliseconds, high serum digoxin level of 4.2 nmol/L, and interestingly color vision disturbances: blue colored vision. After discontinuation of the digitalis treatment, all signs of digitalis toxicity, including blue color vision, disappeared within five days

effect of acute normovlumic hemodilution in reducing allogenic red blood cell transfusion during and after cardiac surgery

In this study, effect of acute normovlumic hemodilution [ANH] to reduce consumption rate of allogenic blood transfusion was compared with the traditional protocol during and after cardiac surgery. One thousand patients who underwent elective cardiac surgery [CABG, valve surgery were entered into study. In ANH group [n=500/ blood obtained from patients by using a new formula and re-transfused the collected blood at the end of operation. Total amount of a2logenzc packed red blood cell [PRBC] and fresh frozen plasma PFP] transfusion in ANH group was compared with 500patients that had been operated one year ago in our hospital [Historical Control]. Considering the patients baseline hematocrit values A M technique was used in 59% of patients in ANH group, and 12% in control group. In ANH group fewer patients during operation transfused with PRBC and FFP than control group [23.2% vs. 71.4%; p = 0.001 and 3 1.2% vs 77.4%; p = 0.008, respectively. Significantly lower mean PRBCs units transfused in ANH group comparing with control group [1.1 +/- 0.5 vs. 2.4 +/- 1.3 units; p = 0.006]. After surgery PRBCs and FFP transfusion were lower in ANH group than control group. Mean postoperative bleeding was not significantly different in the two groups [884 +/- 304 ml vs 790 +/- 291 ml; p = 0.312]. The incidence of postoperative complications, ICU stay and in-hospital mortality between the two groups were not significantly different [p > 0.05]. In this stu4, using the A M significantly reduce consumption of allogeneic red blood cell and FFP in cardiac surgery patients