Early experience with the minimal extracorporeal circulation system (MECC) during thoracoabdominal aortic aneurysm repair.

AIM: The purpose of this report is to describe our early experience with a minimal extracorporeal circulation system (MECC), a compact closed heparin coated system consisting of a centrifugal pump and a membrane oxygenator, during thoracoabdominal aortic aneurysm (TAAA) repair. METHODS: Between January and December 2002 the MECC system was employed in seven consecutive patients (four TAAA type II, two TAAA type I and one TAAA type III according to the Crawford classification). In all patients distal aortic, selective renal and visceral perfusion was performed with this compact closed heparin coated system consisting of a centrifugal pump and a membrane oxygenator. RESULTS: The MECC system was used in all cases with no technical malfunctions. Six out seven patients were discharged from the unit. One patient developed paraplegia after TAAA repair and died on the third post-operative day from multi-organ failure. In this case the total spinal ischaemic time was 120 min and the distal aortic perfusion pressure was <50 mmHg. No cardiac, cerebral, renal, hepatic or bleeding complications were recorded in the remaining six patients. CONCLUSION: Our early experience with MECC during TAAA repair showed that it is feasible for distal aortic spinal and visceral selective perfusion. Further large clinical trials are required to determine the efficacy of this technique.

Phagocytic activity of bronchoalveolar lavage neutrophils in intensive care unit patients on mechanical ventilation.

In ventilator-dependent patients the management of clinically suspected nosocomial pneumonia is often difficult. A diagnosis of pneumonia is based upon findings including pulmonary infiltrate, fever, leukocytosis, or purulent secretions. By using bronchoscopic techniques, we can obtain bronchoalveolar lavage specimens (BAL) from the affected area of the lung. Neutrophils (PMN), which are important for lung defense, are found in increased numbers in BAL of these patients. We therefore ascertained the phagocytic activity of PMN against bacteria and fungi by microscopic examination. BAL specimens from ten mechanically ventilated patients were evaluated to assess the cellular counts using a Bürker hemocytometer, the differential cell counts by cytospin preparations (MGG stain), and the phagocytic activity of PMN and macrophages using the intracellular bacteria index (ICB) values. Microscopical examination of BAL cells and evaluation of ICB values (cut-off > 5%) were higher in four out of twelve patients and the quantitative assessment of bacteria in PMN cytoplasm on cytospin preparations was found to be useful for the diagnosis of pneumonia. In these patients, pneumonia was suspected (in one patient fungal pneumonia) on the basis of microscopical examination of BAL cells and ICB values and the findings were confirmed later by microbiological cultures. In conclusion, in patients on mechanical ventilation a rapid diagnosis of bacterial or fungal pneumonia can be made using BAL cytology and by ICB values, and this in turn allows appropriate therapy to be initiated at an early stage. However, further studies of neutrophil functions are required to improve our understanding of the increased incidence of pulmonary infections in these patients.

Comparison of A-mode ultrasound and computed tomography: detection of secretion in maxillary and frontal sinuses in ventilated patients.

OBJECTIVE: To study the accuracy of A-mode ultrasonography (A-MU) in detecting secretion in maxillary and frontal sinuses in critically ill, intubated patients undergoing mechanical ventilation. DESIGN: Open study in mechanically ventilated, comatose patients. SETTING: Medical-surgical intensive care unit in the General Hospital of Rovigo. PATIENTS: 50 consecutive, mechanically ventilated, critically ill patients. All patients were in a coma and needed cerebral computed tomography (CT) for a diagnosis. MEASUREMENTS AND RESULTS: The A-MU technique gave 100 images of maxillary and frontal sinuses. The images were read blindly and classified into five categories: definitely normal, definitely abnormal, probably normal, questionable, and probably abnormal. CT findings were considered to be the "gold standard". The specificity of echo images varied from 72 to 98% and the sensitivity from 63 to 86% for maxillary sinuses. For frontal sinuses, the specificity varied from 96 to 99% and the sensitivity from 14 to 57%. The area under the receiver-operating characteristic curve was found to be 0.89 and 0.76 for maxillary and frontal sinuses, respectively. CONCLUSIONS: The A-MU technique is an accurate tool for detecting secretion in the maxillary sinuses in intubated patients. More investigations are necessary in order to evaluate its usefulness in the frontal sinuses.

An unusual case of cytomegalovirus infection.

We describe the case of a nonimmunocompromised middle age man, who presented with a history of fever, nausea, disturbance of consciousness, peripheral eosinophilia and a bone marrow eosinophilic hyperplasia. A persistent unexplained eosinophilia was initially interpreted as a sign of the hypereosinophilic syndrome because all known causes of secondary eosinophilia had been excluded and there were evidence of multiorgan dysfunction. A cervical lymph node biopsy was remarkable for malignant T cell lymphoma according to the hypothesis that patients with the hypereosinophilic syndrome should be carefully examined for an underlying proliferation of clonal T cells. The patient died of CID after 3 months of hospitalization. At autopsy he was found to have a generalized CMV infection.

[Sensitization to Cw antigen]. / Primjer senzibilizacije s Cw antigenom.

This paper describes a patient who, after being subjected to repeated blood Transfusions, has developed antibodies to Antigen Cw.