ABSTRACT
Objective: The differences in clinical outcomes in hospitalized patients with hematological disorders (HD) who developed either coronavirus disease 2019 (COVID-19) or seasonal influenza (SI) are not fully understood. To examine these differences, we retrospectively analyzed the baseline characteristics and clinical outcomes of hospitalized patients with HD admitted from 2016 to 2021.Patients and Methods: Patients with HD who developed COVID-19 (in the past 1 year) (n=21) or SI (in the past 5 years) (n=23) in the Department of Hematology/Oncology, Asahikawa Kosei General Hospital were evaluated.Results: The median ages of the patients with HD with either COVID-19 or SI were 80 and 68 years, respectively (P=0.03). The groups showed no significant differences in sex ratio, body mass index, or Eastern Cooperative Oncology Group performance status. In the COVID-19 and SI groups, the most common primary diseases were diffuse large B-cell lymphoma (43%) and multiple myeloma (39%), respectively. The median numbers of days of oxygen administration (8 vs. 0 days), quarantine (25 vs. 6 days), and hospitalization (72 vs. 21 days) were significantly higher in HD patients with COVID-19 than those in HD patients with SI (all P<0.001). The overall 90-day survival of patients with HD and COVID-19 was significantly shorter than that of patients with HD and SI (P=0.019). Moreover, patients with HD and COVID-19 had a higher risk of in-hospital mortality (43% vs. 9%; odds ratio, 7.50; 95% confidence interval, 1.26–82.4; P=0.01) compared to patients with HD and SI.Conclusion: Patients with HD and COVID-19 required longer periods of in-hospital medical and showed poorer survival than those with SI. During the COVID-19 pandemic, hematologists should closely monitor the condition of patients with COVID-19 to closely monitor their condition to prevent deaths.
ABSTRACT
We report a 5-year-old girl with a diagnosis of an anomalous origin of the left coronary artery from the pulmonary artery with an intramural aortic route. The left coronary artery entered the aortic wall running parallel to the aorta. With the aid of cardiopulmonary bypass, she underwent establishment of two coronary artery systems by intraaortic reconstruction (unroofing and anastomosis). Her postoperative course was uneventful. Postoperative cineangiogram demonstrated patency and prograde flow in the new coronary systems.
ABSTRACT
The activated clotting time (ACT) is used to assess adequacy of anticoagulation during cardiopulmonary bypass (CPB). However, ACT values during CPB do not correlate with heparin concentration and are affected by variations of such factors as hypothermia and hemodilution. ACT is also used to estimate protamine doses, because excess protamine may result in hypotension and an increase in bleeding after CPB. This study was designed to evaluate the effect of heparin and protamine administration that were administered based on whole blood heparin concentration using Hepcon/HMS (HC group) on the incidence of bleeding and blood transfusion after CPB. We treated 32 of adult cases and 36 pediatric cases. For the control group (NC group), an initial fixed dose of 300U/kg heparin was administered and if the ACT was less than 400s an additional fixed dose of 100U/kg heparin was administered. Heparin was neutralized with an initial fixed dose of protamine. For the HC group, the initial dose of heparin and the additional dose of heparin were based on an automated heparin dose response assay. The initial dose of protamine was based on the residual heparin concentration. The patients in the HC group received greater doses of heparin and lower doses of protamine than the patients in the NC group. In the pediatric HC group, the amount of TAT, FTC and D-dimer post CPB were smaller than those in the NC group. Operative time and closure time were similar the two groups. Operative bleeding, mediastinal chest tube drainage in the postoperative period were similar in the two groups. The volume of total blood transfusion was also comparable in the two groups. In conclusion, the monitoring of heparin concentration during CPB in children was effective for the maintenance of coagulation factors.