Tepid blood cardioplegia versus cold crystaloid cardioplegia for myocaridal protection

The tepid blood cardioplegia 29°C was recently introduced. It reduce anaerobic myocardial lactate and acid release without inhibiting rnyocardial activity. The aim of this study is to compare tepid blood cardioplegia versus cold crystalloid cardioplegia for rnyocardial protection. 40 patients undergoing double valve replacement, 20 patients receive intermittent antegrade cold crystalloid and 20 patients receive tepid cardioplegia. Data collection included Aortic cross clamp time, bypass time, spontaneous recovery or the use of defibrillator, number of DC shock used and need for inotropic support. Measuring cardiac enzymes [CK-MB], the myoglobin and cardiac troponin was done. There was significant difference between two groups as regard to the behaviour of myocardial activity at end of cardiopulmonary bypass in all parameters [P <0.001]. So we conclude that tepid blood cardioplegia is safe, efficacious method of rnyocardial protection when compared with cold crystallod cardioplegia

Pulmonary resection for massive hemoptysis of benign lesion

To assess the outcome of pulmonary resection in the management of massive hemoptysis caused by benign lung diseases. A longitudinal cohort study of 53 consecutive patients who presented with hemophsis and were treated with either emergency [group 1] or elective [group2] pulmonary resection from January 2001 to December 2003. Fifty-three patients were studied, 27 in group 1 and 26 in group 2. The mean age of the patients was 47.2 years [range, 29-70 years]. Urgent examination with a combination of rigid and flexible fiberoptic bronchoscope localized the bleeding site in 45 patients [85%] age >50 years, hypertension, hemoglobin on admission<10 g/dl, cause of hemoptysis, and a prior attack of hemoptysis were the predictors for the need of emergency surgery. The overall hospital mortality rate was 4% [2/53]. Postoperative complications occurred in 13 patients [25%]. Complications were more common in patients who received blood transfusion than non-transfused patients [9/23 and 4/30, respectively; P=0.03]. Patients with tuberculosis as the cause of massive hemoptysis had more complications 5/8 in comparison to all other patients [P=0.02]. The mean follow-up was 18 months [range, 12-24 months] for all patients who survived. Hemoptysis recurred in four patients [8%] and all from group I [P=0.02]. Immediate pulmonary resection for massive hemoptysis is effective in case of life-threarening bleeding that is not controlled by conservative measures. Elderly patients with a prior history of hemoptysis and/or hypertension and bleeding due to a fungus ball, necrotizing pneumonia, tuberculosis or lung abscess should be considered for early operation in an attempt to reduce morbidity and mortality