ABSTRACT
OBJECTIVE: The objective of our study was to compare the standard protocol of anticoagulation to the Hepcon/HMS. METHOD: This study included forty-four patients who underwent coronary bypass grafting surgery (CABG), or biological aortic valve replacement (AVR). Unfractionated heparin (UH) was used for patients who underwent operations in the control group (n = 22) (300U/Kg of UH with a goal of an ACT of 400s). The heparin was antagonized dose/dose by protamine. For the patients who underwent operations in the HMS group (n = 22), the heparin and protamine doses were assessed by the Hepcon/HMS device. RESULTS: The sex ratio amounted to 1.93 (29 men and 15 women) and the mean age was 70 ± 11 years. The patients in the HMS group had a chest closure time that was significantly shorter than patients in the control group. The times were, respectively, 42 ± 15 minutes and 68 ± 27 minutes (p = 0.001). The protamine/heparin ratio was significantly lower in the HMS group (0.62 ± 0.13 vs. 1 ± 0.11) (p = 0.0001). The postoperative bleeding amounted to 804 ± 729 ml in the HMS group versus 1416 ± 1103 in the control group (p = 0.016). In multivariate linear regression analysis, only two independent factors were significantly associated with bleeding: the Hepcon/HMS (OR = 0.1-p = 0.03) and the preoperative hemoglobin rate (OR = 1.4 - p = 0.05). Postoperatively, within 72 hours, the red blood cell transfusion was 1.04 ± 1.5 units for the HMS group and 2.1 ± 1.87 units for the control group (p = 0.05). CONCLUSION: During cardiac surgery under CPB, heparin and protamine titration with the Hepcon/HMS device could predict a lower protamine dose and lower postoperative bleeding without higher thromboembolic events, and lower perioperative red blood cell transfusion with a shorter chest closure time.
Subject(s)
Anticoagulants/pharmacokinetics , Coronary Artery Bypass , Extracorporeal Circulation , Heparin/pharmacokinetics , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Aortic Valve/surgery , Hemorrhage/blood , Hemorrhage/therapy , Heparin/administration & dosage , Humans , Male , Postoperative Period , Protamines/blood , Time FactorsSubject(s)
Bacterial Infections/diagnosis , Tomography, X-Ray Computed , Ultrasonography, Doppler , Urachal Cyst/diagnosis , Adult , Bacterial Infections/surgery , Cooperative Behavior , Cystectomy , Diagnosis, Differential , Humans , Interdisciplinary Communication , Male , Urachal Cyst/surgery , Urachus/pathology , Urachus/surgeryABSTRACT
In France, the French National File Automated with Genetic fingerprints (FNAEG) is a bank automated by genetic data which is used in penal domain. It facilitates search of the authors of malpractices, or the missing people. Since 1998, it has enabled to resolve numerous criminal cases. An extension of the field of application has been observed. It is a confidential register which is subjected to numerous controls. Nevertheless, private character of the data and its functioning (criminal character of the refusal of taking, periods of answer, and problem of data's conservation) explain the important contesting of associations worried about the respect of personal freedoms.
Subject(s)
DNA Fingerprinting/ethics , Freedom , Security Measures , Confidentiality , France , Humans , RegistriesABSTRACT
In order to enhance the knowledge of the internal thoracic arteries of pig, sheep, and man, allowing to constitute a fundamental basis as for the current and later applications in the interventions in surgery of revascularization of the arteries of less than four millimetre of diameter, a biometric and histological comparative study of these arteries was carried out. Forty human corpses, 27 men and 13 women (mean age 75+/-6 years) were dissected, alike with three pigs respectively weighing 80 kg, 80 kg and 84 kg and four sheep weighing 70 kg each. The left and right internal thoracic arteries were harvested: exposure over the entire length and remote dissection before excision. At the same time their internal lengths and gauges were measured. The internal thoracic artery (ITA) of human has an average useful length of 18 cm and an average internal gauge close to 1.5 mm. ITA of the pig has an average length of 27 cm and an average internal gauge close to 2.8 mm. The ITA of the sheep has an average length of 18 cm with an average internal gauge close to 1 mm. The porcine Internal Thoracic Artery is an elastic artery like its human counterpart. Many elastic fibres and few smooth muscle cells are present in the media. On the other hand, the internal thoracic artery of the sheep has a mixed structure. Its media contains more smooth muscle cells than elastic fibres.
