Paragliding accidents--the spine is at risk. A study from a Swiss Trauma Centre.

In recent decades, paragliding-like other fashionable activities-has become a part of lifestyle and outdoor activities. The introduction of protective devices has helped to reduce the risk of severe injuries. However, it seems that the spine remains the paraglider's 'Achilles heel'. Better education, training, and the introduction of innovative back protectors are required to reduce the frequency and severity of paragliding injuries.

Short- and long-term mechanical cardiac assistance.

With the increase in high risk patients undergoing cardiac surgery and the substantial mortality among patients waiting for cardiac transplantation, the need for mechanical circulatory support is growing. Several devices are currently available, ranging from the intra-aortic balloon pump to fully implantable ventricular assist devices. Each system has its own features, and proper patient selection as well as the timing of implantation is sometimes difficult. Algorithms for stepwise management in subgroups of patients remain controversial and the concepts of weaning patients after myocardial recovery during mechanical circulatory support need further evaluation for their long-term effects. Future identification of valuable prognostic and risk factors may help in decision-making and allow for improved survival of these often very ill patients. In this report we review the concepts of mechanical circulatory support at our institution with emphasis on a detailed overview of technical features of extracorporeal life support.

[Challenging perioperative anticoagulation in a patient with Budd-Chiari syndrome and heparin-induced thrombocytopenia]. / Erschwerte perioperative Antikoagulation bei einem Patienten mit Budd-Chiari Syndrom und Heparin induzierter Thrombozytopenie.

We report on a patient suffering from Budd-Chiari disease who developed heparin-induced thrombocytopenia preoperatively. Dorsocranial liver resection and hepatoatrial anastomosis were performed with the extracorporeal circulation and perioperative anticoagulation was achieved with r-hirudin. Surprisingly, thrombus formation was observed in the venous reservoir although intraoperative anticoagulation values were within the targeted level. An additional bolus of hirudin and rinsing the reservoir allowed unproblematic discontinuation of the cardiopulmonary bypass.

Budd--Chiari syndrome and heparin-induced thrombocytopenia.

We report on a patient suffering from Budd--Chiari disease who developed heparin-induced thrombocytopenia preoperatively. Dorsocranial liver resection and hepatoatrial anastomosis were performed with the extracorporeal circulation and perioperative anticoagulation was achieved with r-hirudin. Surprisingly, thrombus formation was observed in the venous reservoir although ACT was 590 s and aPTT 55 s. An additional bolus of hirudin and rinsing the reservoir allowed unproblematic discontinuation of the cardiopulmonary bypass.

Thoracoabdominal aortic repair in a 190-kg patient: optimized perfusion with two oxygenators.

A 190-kg patient was referred because of an acute type B aortic dissection. Conservative management was initially performed but the 34-year-old patient was shown to have an increasing aortic diameter 2 months later and was scheduled for elective repair of the thoracoabdominal aorta. To anticipate potential difficulties with perfusion and oxygenation the cardiopulmonary bypass circuit was constructed with two parallel oxygenators, which allowed an adequate oxygen supply through all phases of the intervention and accelerated the estimated rewarming time.

[Effect of postoperative retransfusion of autologous blood products on hemostasis in heart surgery]. / Einfluss der postoperativen Retransfusion von autologen Blutprodukten auf die Hämostase in der Herzchirurgie.

In cardiac surgery a reduction of homologous blood products is mainly achieved by autologous blood salvage. Unprocessed retransfusion of autologous blood may induce changes in hemostasis. We assessed changes of activated clotting times (ACT) after retransfusion of unprocessed (1) oxygenator blood and (2) shed mediastinal blood. In 41 patients undergoing cardiac surgery (37 revascularization and 4 valve procedures) with a mean cardiopulmonary bypass time of 116.3 min, ACT was measured at the following time points: pre- and postoperatively, and before and after retransfusion of oxygenator blood and shed mediastinal blood. A significant prolongation of ACT values was only seen between pre- to postoperative blood (p < 0.003). Retransfusion of oxygenator blood changed ACT from 120 +/- 25 vs 116 +/- 17 sec and retransfusion of shed mediastinal blood showed a mean ACT of 118 +/- 14 vs 115 +/- 20 sec from before to after transfusion. There was a significant correlation between the ACT value in the unprocessed oxygenator blood and the ACT value measured in the patient after retransfusion (r = 0.41, p < 0.02). 6 patients receiving over 1 litre of unprocessed autologous blood (either from the oxygenator or the mediastinum) in less than 60 minutes showed a significant increase of ACT value after transfusion (p < 0.05). Hence, under normal conditions, retransfusion of unprocessed autologous blood will not significantly alter hemostasis measured by the ACT test in patients undergoing cardiac surgery.