A Novel Calculation of Priming Volume and Required Packed Cell Transfusion to Maintain Optimal Haematocrit During Cardiopulmonary Bypass

Introduction: Hemodilution during cardiopulmonarybypass is an acceptable method to avoid the complications ofcontinuous flow at the microcirculatory level. Hemodilutionalanemia during cardiopulmonary bypass can lead to inadequateoxygen delivery and, which may result in ischemic organinjury to all the organs especially to the brain, kidney, lungs andliver. Study aimed to investigate the effectiveness of a novelformula for calculating priming volume (PV) and requiredpacked cell (PC) volume to maintain optimal hematocrit levelduring cardiopulmonary bypass.Material and methods: This Prospective interventional studywas done on 150 patients who underwent open-heart surgeriesin our Institute from January 2018 to December 2018. GroupA-75 patients: perfusionist’s old protocol for calculatingpriming volume and required packed cell volume calculationand the nadir hematocrit (Hct) during CPB and postoperativeoutcome monitored. Group B- 75 patients: customizednovel formula was applied for calculating PV and requiredPC volume and the nadir Hct during CPB and postoperativeoutcome monitored and both the groups compared.Results: In our study results showed that maintaining optimalHct of 25% (>20%) in adult and 30% (>25%) by using ournovel customized formula for calculating prime volume andrequired packed cell volume was significantly improvedthe nadir Hct from 19.16% to 21.8% as well as average Hctvalues from 19.7% to 23.4%. Complications of Hemodilutionwere significantly reduced in the study Group B. Mortalitywas reduced to 2.7% from 5.3%. Respiratory complicationlike reintubation rate and nonfatal noncardiogenic pulmonaryedema rates reduced from 34.7% to 17%. Coagulopathy withpostoperative blood products requirement reduced from 20%to 7%.Conclusion: Our Study showed that application of this novelformula is very useful and easy for both the perfusionists andthe surgeons in maintaining optimal Hct during CPB therebyimproving the postoperative results following open heartsurgeries.

Plasma cell granuloma of gingiva.

An exceedingly rare case of gingival plasma cell granuloma is reported in a 40-year old female patient. The case presented as an exophytic mass of gingiva, clinically resembling traumatic fibroma. Histopathologic findings revealed dense sheets of plasma cells infiltrate. Immunohistochemistry for kappa and lambda light chains showed polyclonal (benign) staining pattern confirming a diagnosis of plasma cell granuloma. It is important to recognise this peculiar lesion because of its highly unusual incidence in involving the periodontium. Clinical features are usually suggestive of traumatic fibroma (benign) but histopathologicaly in early stages it closely resembles plasmacytoma (malignant). This case highlights the need to biopsy unusual lesions to rule out potential neoplasms and also emphasizes the need to submit all the excised tissue for histological examination regardless of clinical impression and/or perceived surgical success. Only by such practice can rare lesion of this type be diagnosed and their incidence studied.

Tissue engineering: prospect for regenerating periodontal tissues.

New advancements in technological fields, continually has had a major impact on dental practice. The emergence of tissue engineering and biomimetic concepts has enhanced the predictability of existing therapy and also has radically recast approaches towards the dentoalveolar reconstruction. Tissue engineering in the simplest sense is a combination of material sciences and biology to repair tissues and organs which will unquestionably offer an exciting therapeutic alternative that have never been available before. This article is a brief introduction to the ever expanding field of tissue engineering and its possible implication in periodontal regeneration.