Identification of modifiable risk factors for acute kidney injury after cardiac surgery.

OBJECTIVES: Acute kidney injury (AKI) is a common problem after cardiac surgery and is associated with an increase in morbidity, mortality and duration of hospital stay. With this study we aimed to identify potential risk factors for cardiac surgery associated AKI (CS-AKI) in a single-centre population with a special focus on modifiable risk factors. METHODS: Retrospective single-centre cohort study of 565 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) with the use of cardiopulmonary bypass. AKI was defined by the AKIN classification. Known risk scores were applied when possible. RESULTS: Of the population, 14.7% were diagnosed with AKI. When considering baseline characteristics we found a significant difference in age, preoperative estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) stage and urgency of surgery between the CS-AKI group and the control population. Regarding the intraoperative characteristics, patients with CS-AKI had a significantly lower haematocrit and were more likely to receive a transfusion of packed cells. Postoperative administration of furosemide and packed cell transfusions were also associated with AKI. We found no differences in other characteristics (history of diabetes mellitus, history of congestive heart failure, sex, body mass index (BMI), history of cardiac surgery, low cardiac output and need for intra-aortic balloon pump (IABP), duration of cardiopulmonary bypass (CPB) and cross clamping). CONCLUSION: In our series we could identify intraoperative administration of packed cells and postoperative administration of furosemide or packed cells as potentially modifiable risk factors in the development of AKI.

Recommendations in the event of a suspected transfusion-related acute lung injury (TRALI).

The following recommendations, which aim at improving the clinical diagnosis ofTRALI and the laboratory investigations that can support it, were drawn up by a working group of the Superior Health Council. TRALI is a complication of blood transfusion that is both serious and underreported. Systematic reporting may help to develop preventive actions. Therefore, the Superior Health Council recommends that there should be a more stringent surveillance of patients who receive a blood component transfusion. The clinician should pay very close attention to any change in the patient's respiratory status (cf. dyspnoea and arterial desaturation), which should be notified systematically to the haemovigilance contact person in the hospital.

Post-traumatic severe fat embolism syndrome with uncommon CT findings.

Although the diagnosis of fat embolism syndrome is usually based on clinical findings, we describe ill-defined centrilobular and subpleural nodules in addition to ground-glass opacities and consolidation on a computed tomography scan of the chest in a trauma patient with fat embolism syndrome. The nodules presumably represent alveolar oedema, microhaemorrhage and an inflammatory response secondary to ischaemia and cytotoxic emboli in fat embolism syndrome. The literature of computed tomography findings in patients with fat embolism syndrome is reviewed and summarized.

Spontaneous dissection of three major coronary arteries subsequent to cystic medial necrosis.

This case report describes the devastating consequences of spontaneous coronary dissection in a 36-year-old female patient. Surgical revascularization was attempted, but diffuse myocardial infarction developed. The patient was bridged to heart transplantation but died secondary to multiple organ failure. To our knowledge, this is the only reported case of spontaneous dissection of the three main coronary arteries due to severe cystic medial necrosis.

Right-to-left flow through a patent foramen ovale in acute right ventricular infarction. Two case reports and a proposal for management.

Right-to-left shunting through a foramen ovale complicating acute right ventricular infarction and resulting in severe arterial hypoxemia has been described eight times before. Treatment strategies have often aimed at reducing the shunt. Four patients died. Less attention has been paid to attempts at revascularization and, despite a high incidence of atrioventricular conduction disturbances, to temporary dual-chamber pacing. We describe herein two patients with postcardiac surgical right ventricular infarction complicated by severe right-to-left interatrial shunting. Treatment strategy was aimed at improving right ventricular function, and right-to-left shunting ceased. All efforts should be directed at treating right ventricular dysfunction, which is the cause of the clinical picture, and not at reducing the shunt, which is a secondary phenomenon.

A 2,4-dichlorophenoxyacetic acid induced fatality.

This paper reports on a fatal intoxication by oral ingestion of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D). At admission, the victim was unconscious. His condition deteroriated rapidly with blood loss from his mouth and nose. Since the cause of this condition was not known, gastroscopy was performed and haemorrhagic mucosa was observed in the mouth, oesophagus and stomach. Gastric contents (removed by lavage), urine and blood were submitted for toxicological analysis. Unfortunately, within 3 h of admission (about 5 h following ingestion of the toxin) profound cardiogenic shock developed and the patient died. The identity of the toxic xenobiotic was revealed by gas chromatography-mass spectrometry. Analytical quantification of the herbicide was performed by acid extraction prior to gas chromatographic examination using electron capture detection. His blood level of 2,4-D was 192 mg l-1.

[Techniques of uvulopharyngoplasty for snoring]. / Techniques d'uvulopharyngoplastie pour ronflement.

Snoring is considered abnormal even in children. Breathing difficulties can modify the development of the face and provoke upper respiratory dysfunction. Some surgical techniques are presented.