Surgical management of active infective endocarditis during 1996-2006 in Tabriz, Northwestern Iran

Surgical treatment of active infective endocarditis [IE] requires not only homodynamic repair, but also, special emphasis on the eradication of the infection to prevent recurrence. This study was undertaken to examine the outcome of surgery for active infective endocarditis in a cohort of patients. One hundred and sixty-four consecutive patients underwent valve surgery for active IE in Madani heart centre [Tabriz, Iran] from 1996 to 2006. The patients with diagnosis of IE [according to Duke Criteria] were eligible for the study.The mean age of patients was 36.3 +/- 16 years, with 34.6 +/- 17.5 yrs for native valve endocarditis and 38.6 +/- 15.2 yrs for prosthetic valve endocarditis [p= 0.169]. Ninety-one [55.5%] of patients were males. The infected valve was native in 112 [68.3%] of patients and prosthetic in 52 [31.7%]. There was no predisposing heart disease in 61 [37%] of patients. The aortic valve was infected in 78[47.6%], the mitral valve in 69 [42.1%], and multiple valves in 17 [10.3%] of patients. Active culture-positive endocarditis was present in 81 [49.4%] whereas 83[50.6%] patients had culture-negative endocarditis. Staphylococcus aureus was the most common isolated microorganism. Ninety patients [54.8%] were in NYHA classes III and IV. Mechanical valves were implanted in 69 patients [42.1%] and bioprostheses in 95 [57.9%], including homograft in 19 [11.5%] cases. There were 16 [9%] operation-related deaths, but only 1 death in patients undergoing aortic homograft replacement. Reoperation was required in 18 [10.9%] cases.Based on multivariate logistic regression analysis, Staphylococcus aureus infection [p= 0.008], prosthetic valve endocarditis [p=0.01], paravalvular abscess [p=0.001] and left ventricular ejection fraction less than 40% [p=0.04] were independent predictors of hospital mortality.Surgery for infective endocarditis continues to be challenging and associated with high operation-related mortality and morbidity. Prosthetic valve endocarditis, impaired ventricular function, paravalvular abscess and Staphylococcus aureus infection associated with hospital mortality. Also we found that aortic valve replacement with an aortic homograft could be performed with acceptable hospital mortality and provided satisfactory results

Anesthesia for coronary artery bypass grafting with hypothermic cardiopulmonary bypass in a patient with a A2B negative Blood Group

A2B negative is one of rare subgroups of ABO blood group system. Herein, we report a 59-year-old male patient who was candidate for coronary artery bypass grafting surgery [CABG] due to coronary artery stenosis. The patient`s blood group was reported as AB negative in routine laboratory, and because of doubtful result, a complementary test confirmed his blood group as A2B negative. The consultant hematologist recommended reserving either negative A2B packed red blood cell [PRBC] or if unavailable O- blood group. After induction of anesthesia three units of patient's own blood were collected and replaced by colloid solution. The patient underwent CABG with hypothermic cardiopulmonary bypass. The collected autologous blood units were transfused at the end of operation. The patient received one unit of A2B- homologous PRBC in the postoperative period, and was discharged without any reaction to transfusion

Childhood status epilepticus: a study on its etiology, management and early outcome

Status epliepticus is a true medical urgency with high mortality. This study was surveyed etiology, management and early outcome of children with status epilepticus. Patients with status epilpeticus who admitted to emergency ward of Tabriz Children's Hospital between 1381 and 1384 were reviewed cross-sectional and analytical study on seizure type and etiology, its management and outcome at discharge from hospital. Among 123 patients with status epilepticus, 50 patients [40.7%] were afflicted with refractory status epilepticus and 73 patients [59.3%] had non - refractory status epilepticus. The most common etiologies in patients with status epilepticus in order of decreasing frequency were related to be prolonged febrile seizure [40.7%], remote symptomatic [28.4%], acute symptomatic [16.2%] and idiopathic [14.6%]. There was significant correlation between age and etiology [P=0.007]. The most common type of seizure was generalized seizure in 70.7% of patients. The median of duration of status epilepticus was 60 [37-146.25] minutes. In 28 patients [22.7%], diazepam with phenytoin or phenobarbital was used. In 40 patients [32.5%], diazepam with phenytoin and phenobarbital and in 50 patients [40.7%], midazolam were used. In 4 patients [3.25%], thiopental was used. Using midazolam, in 82% of patients with refractory status epilepticus lead to control of seizure. 85.9% of patients returned to their condition before status epilepticus. 8.26% of patients died, and in 5.7% of patients a new neurological sequel was established after status epilepticus. There was statistically significant correlation between patient's outcome and etiology of seizure [p=0.001]. The lowest rate of the mortality and morbidity was seen in prolonged febrile seizure [4%] and the most was in acute symptomatic [45%]. Prolonged febrile seizure was the most common etiology in status epilepticus. The highest mortality rate was seen in patients with acute symptomatic etiology. In most cases, intravenous midazolam infusion terminated the refractory status epilepticus