Is small volume, up to 2 red blood cell units transfusion required and redeemable in cardiac surgery? / Szükséges-e, kiváltható-e a kis volumenu vörösvértest-koncentrátum transzfúziója a szívmutétekben? Befolyásoló tényezok

Introduction: Low-volume (1-2 U) transfusion affects more than a quarter of cardiac surgical patients. This may increase the incidence of complications, mortality, and blood use, even in low-risk patients. Objective: By analyzing risk factors, we searched for measures to reduce the frequency of low-volume transfusions. Method: The risk factors for transfusion of up to 2 U red blood cells were examined in 1011 patients. We compared data from 276 (27.3%) patients who received low-volume transfusion (study group) with 448 (44.3%) patients who received no transfusion (control group). 287 patients (28,4%), who received more than 2 U red blood cells, were excluded. Multivariate logistic regression analysis of data was performed. Results: The factors affecting low-volume transfusion were female gender (OR= 2.048; p = 0.002), age (OR= 1.033; p = 0.002), body weight (OR= 0.954; p<0.001), preoperative hemoglobin value of <130 g/l (OR = 3.185; p<0.001), preoperative glomerular filtration rate <60 ml/min/1.73 m(2) (OR = 1.750; p = 0.026), off-pump coronary artery bypass surgery (OR = 0.371; p<0.001), combined procedures (OR = 2.432; p = 0.015), perioperative fluid balance (OR = 1.227; p = 0.005), intraoperative bleeding and preoperative clopidogrel treatment (OR = 1.002; p<0.001), postoperative bleeding >1200 ml/24 hours (OR= 2.438; p<0.005). Conclusion: Screening and treatment of preoperative anemia, decreasing operative hemodilution, increasing the number of minimally invasive and off-pump procedures as well as applying a surgical hemostasis protocol could be a solution to avoid low-volume transfusion in cardiac surgery.

The role of negative pressure wound therapy in the modern surgery / A negatív nyomású sebkezelés helye a modern sebészetben.

Összefoglaló. A negatív nyomású sebkezelés mai formájában történo, a mindennapos sebészi gyakorlatba történo bevezetése az 1990-es években történt meg. A kezelés célja a váladék elszívása mellett a mikrocirkuláció javítása és a seb granulációs folyamatainak serkentése. A modern sebkezelési szemlélettel a fenti módszert alkalmazhatjuk akut és krónikus sebgyógyulási zavarok esetében egyaránt, használatához azonban fontos a megfeleloen szakképzett személyzet és a jól kiválasztott beteg egyaránt. Összefoglalásunkban arra vállalkoztunk, hogy ismertetjük a negatív nyomású rendszer alkotórészeit, a sebkezelés ilyen formában történo muködését, bemutatjuk az eszközök különféle típusait, és meghatározzuk azon betegek körét, akik esetében a kezelés sikerrel alkalmazható. Kitérünk a sebkezelo rendszerek különféle technikai módozataira, bemutatjuk a kezelés pontos gyakorlatát, az indikációs lehetoségeket és a kontraindikáció helyzeteit, választ adunk a kezelés során felmerülo fontos kérdésekre, felhívjuk a figyelmet az esetlegesen fellépo szövodmények lehetoségeire, és közzétesszük azok elhárítási módjait. A negatív nyomású sebkezelésnek léteznek különleges formái (incizionális, endoluminalis és testüregen belül alkalmazott negatív nyomású sebkezelés), melyeket szintén részletesen bemutatunk, továbbá kitérünk az ambuláns betegkörben történo felhasználás részleteire. Cikkünk utolsó részében végül felhívjuk a figyelmet a negatív nyomású sebkezelés során jelentkezo speciális helyzetekre (antikoaguláns terápia módosítása, multirezisztens kórokozók és vizsgálatok elvégzése a negatív nyomású sebkezelés alatt). Orv Hetil. 2022; 163(7): 271-278. Summary. The introduction of negative pressure wound treatment in its current form into the daily surgical practice started in the 1990s. In addition to the suction of secretions, the aim of the treatment is to improve microcirculation and stimulate the granulation processes in the wound bed. Considering the modern wound management approach, the above method can be used to facilitate the wound healing process of both acute and chronic wounds. In the application of this method, it is important to emphasize the role of both the properly trained staff and the good patient selection. In our summary, we describe the components of the negative pressure system, the operation of wound care in this form, to present the different types of devices, and to identify the range of patients for whom the treatment can be used successfully. We cover the various technical methods of wound care systems, present the exact practice of treatment, the indications and contraindications, answer important questions that arise during treatment, draw attention to possible complications and discuss how to eliminate them. There are special forms of negative pressure wound care (incisional, endoluminal, and intracavitary negative pressure wound care), which are also presented in detail, as well as application of this treatment in outpatient care. Finally, we draw attention to some special issues that may arise during negative pressure wound treatment, e.g., modification of anticoagulant therapy and treatment of wounds contaminated by multidrug-resistant pathogens. Orv Hetil. 2022; 163(7): 271-278.

Iatrogenic ventricular septal defect: A rare complication of surgical reconstruction of mitral paravalvular dehiscence.

INTRODUCTION: Iatrogenic ventricular septal defect is a rare complication after the surgical replacement of cardiac valves. Small defects may have no hemodynamic significance or remain unremarked at the end of the surgical procedure. Understanding of the valvular anatomy alone is not always enough to avoid such complications, especially in the hands of young surgeons. PRESENTATION OF CASE: We present a case of iatrogenic ventricular septal defect that developed early after the surgical closure of a hemodynamically significant mitral paravalvular leak. Although the patient's critical state did not allow surgical intervention and he died, we think the lessons drawn from this case could be helpful to avoid such horrible complications in the future. DISCUSSION: This case documents a rare disastrous complication after imperfect surgical closure of a mitral paravalvular leak. Despite the unfortunate end, in reporting this case we try to direct the light to the possible mechanisms that led to the development of this injury focusing on the embryological and anatomical background. CONCLUSION: Understanding the anatomical and embryological structure of the cardiac fibrotic skeleton should keep cardiac surgeons more vigilent in detecting iatrogenic ventricle septal defects before the development of a devastating hemodynamic state.

Iodomalonic acid as an anti-inhibitor in the resorcinol inhibited Briggs-Rauscher reaction.

It was found that the inhibitory effect of resorcinol is less pronounced if it is added in a later stage of the Briggs-Rauscher reaction, which indicates that an accumulating intermediate--most probably iodomalonic acid--can suppress the inhibition. In fact, when iodomalonic acid was added to the reaction mixture, the inhibitory period was shortened considerably even at micromolar levels of the iodomalonic acid concentration. Moreover, iodomalonic acid can accelerate the rate of the reaction when applied in the same low concentrations, suggesting that it can be an autocatalytic intermediate of the Briggs-Rauscher reaction.

Reaction routes leading to CO2 and CO in the Briggs-Rauscher oscillator: analogies between the oscillatory BR and BZ reactions.

With Fenton-type experiments, it is shown that the intense CO2/CO evolution in the Briggs-Rauscher (BR) reaction is due to decarboxylation/decarbonylation of organic free radicals. The metal ion applied in the Fenton-type experiments was Fe2+ or Ti3+ or Mn2+ combined with H2O2 or S2O(8)(2-) as a peroxide, whereas the organic substrate was malonic acid (MA) or a 1:1 mixture of MA and iodomalonic acid (IMA). Experiments with a complete BR system applying MA or the MA/IMA mixture indicate that practically all CO2 and CO comes from IMA. The decarboxylation/decarbonylation mechanisms of various iodomalonyl radicals can be analogous to that of the bromomalonyl radicals studied already in the Belousov-Zhabotinsky (BZ) reaction. It is found that an intense CO2/CO evolution requires the simultaneous presence of H2O2, IO3-, Mn2+, and IMA. It is suggested that the critical first step of this complex reaction takes place in the coordination sphere of Mn2+. That first step can initiate a chain reaction where organic and hydroperoxyl radicals are the chain carriers. A chain reaction was already found in a BZ oscillator as well. Therefore, the analogies between the BR and BZ oscillators are due to the fact that in both mechanisms, free radicals and, in most cases, also transition-metal complexes play an important role.