Factores relacionados con hemorragia mayor durante la cirugía cardíaca bajo circulación extracorpórea / Factors associated to heavy bleeding during heart surgery with cardiopulmonary bypass

OBJECTIVE: To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump. MATERIAL AND METHODS: A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at <0.05. RESULTS: The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p < 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage. CONCLUSIONS: Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.

Infarto agudo del miocardio y psicolecisto: informe de un caso / Myocardial infarction and acute Pyocholecystitis

Se informa el caso de un hombre de 43 años de edad, que cursó con abdomen agudo durante la etapa aguda del infarto del miocardio y a quien en la laparatomía exploradora se le encontró un piocolecisto, realizándose colecistectomía, sin presentar complicaciones abdominales o cardíacas postoperatorias. El motivo del presente informe es dar a conocer esta asociación poco frecuente en la que el reconocimiento temprano y manejo adecuado puede salvar una vida. Se hace énfasis en el hecho de que el cursar con un infarto miocárdico agudo no contraindica la cirugía abdominal