Does low dose of aprotinin influence haemostatic profile in-patients under going mitral valve replacement?

Aprotinin [Trasylol], a non-specific serine protease inhibitor, is successful used to reduce excessive postoperative bleeding during cardiopulmonary bypass. The aim of our study was to verify the hypothesis whether aprotinin used during cardiopulmonary bypass procedure affects hemostatic parameters, which might be crucial for the elevated risk of thromboembolic complications. Patients and methods: Thirty patients undergoing open heart surgery for valve replacement were divided into two equal groups. Group 1[Aprotinin group, AP] [N = 15] a loading dose of 1,000,000 u was given over 20 minutes before sternotomy followed by a constant infusion of 500,000 U/h and 1,000.000 U was added to the priming. Group 2 [Control group] [N = 15] no antifibrinolytic medications were given to this group of patients. Anesthesia and cardiopulmonary bypass protocol were standard for all patients. Plasma level of [Hemoglobin, Hematocrit, Platelet], and Coagulation profile were measured. All blood samples were withdrawn in all patients at 6 times, before induction of anesthesia [basal], post CPB, at ICU arrival, after 6, 12 and 24 hours from ICU arrival. Postoperative, blood loss from the mediastinal chest tubes was collected and reported at 6, 12, and 24 hours from the time of arrival to ICU The percentage of patients received transfusion and the number of transfused units of packed red blood cells [PRBC], platelet and fresh frozen plasma were estimated and recorded at the end of CPB and at the time of discharge from the hospital. At the end of CPB, the thrombin time decreased in group I but this decrease was with in normal range [38-54 seconds] and elevated to exceed the normal range in group [2], This change in thrombin time returned gradually to the baseline value at the end of the study [24hours from ICU arrival] in groups [1], but still exceeded the normal range in group [2] till the end of the study. The fibrinogen level was decreased at the end of CPB in all the studied groups. It began to return to the baseline value in groups [1] at 12 and 24 hours from ICU arrival but the level still lower in group [2] till the end of the study. The D-dimer level was elevated at the end of CPB in all the studied groups and began to return to the normal value in groups [1] at 12 and 24 hours from ICU arrival but the level was markedly elevated and exceeded the normal value in group [2] till the end of the study. The amount of blood loss was significantly reduced [P < groups [1] when compared with group [2] at all the time of study. The amount of transfused [PRBC] units, FFP and Platelet were significantly decreased [P < 0.05] in group [1] when compared to control group. Low dose aprotinin during mitral valve replacement surgery decreased perioperative blood loses and the need for allogenic transfusion together with improvement the haemostatic profile

Immunological effects of parenteral nutrition on traumatized patients

Nutrition is one of the most important treatment for the traumatized patients, improving body protein and immune function, reducing rate of infection and shortening hospitalization. The aim of this work is to study the effect of early parenteral nutrition on the immunological and inflammatory variables. Thirty poly-traumatized patients with Injury Severity Score [ISS] 20-40 and within 6 hours after trauma were enrolled sequentially into a conventional [n = 15] and an parenleral [n = 15] groups. Conventional group was received intravenous regimen and hospital oral diet as soon as the bowel function returned. Parenteral nutrition plans were designed individually for the TPN group, based on their calculated caloric and protein requirement [25 k cal/kg] day. Laboratory investigations included blood sample for blood picture, serum total proteins, albumin, and C-reactive protein. Immunological parameters included interleukin 10 [IL-10], interleukin 6 [IL-6], immunoglobulins [IGA], CD4 and CD8 were determined by immunoassy kit. In the TPN group, the mean values of serum protein, 1st day was significantly increase [P < 0.01] versus 10th day, also the mean value of serum albumin was significantly increased on the 10th day. In relation to C-reactive protein CRP: The mean values for conventional and TPN groups, on the 1st day showed significantly decrease versus 10th day in both groups. There were no significant changes as regard [IL-10] and [IL-6] all studied times in the conventional group. While in the TPN, [IL-10] showed significantly decrease at 10th day. Also IL-6 showed significantly decrease on 1st day and 10th day. Concerning immunoglobulins [IGA]: In TPN group showed significantly increase in the 10th day. In the TPN group CD4 showed significantly increase between 1st day and 10th day. As regard CD8 in the TPN group show significantly decrease between 1st day and 10th day. In conclusion nutritional support of the traumatized patient is critically important to decrease the immunosuppression associated with injury