Occult hepatitis C virus infection in patients with malignant lymphoproliferative disorders.

Despite the link between HCV and malignant lymphoproliferative disorders has been established, the association between occult hepatitis C virus infection and malignant lymphoproliferative disorders remains obscure. The present study intended to identify the possible association between occult HCV infection and malignant lymphoproliferative disorders. Newly diagnosed patients with LPDs were screened for the presence of HCV-RNA in both plasma and PBMCs. PBMCs of the subjects were also, examined by transmission and immuno-electron microscopy. LPD patients showed a high percentage of HCV infection (71.9%): OCI-HCV (37.5%) and HCV (34.38%). Meanwhile, 28.13% of LPD patients did not show any evidence of HCV infection. Ultrastructural examination of PBMCs revealed the presence of intracytoplasmic vacuoles enclosing viral like particles, which were less prominent in occult HCV patients. The possibility of occult HCV should be considered in patients with LPDs which can be helpful in the management of the treatment protocol in order to set up a balance between the control of the tumor progression and minimizing post chemotherapy complications related to HCV infection.

The accuracy of electrical cardiometry for the noninvasive determination of cardiac output before and after lung surgeries compared to transthoracic echocardiography.

Background: The anatomical changes associated with lung surgeries may decrease cardiac output and heart function. Therefore, monitoring of cardiac output (CO) is of significant value in these patients for clinical decision-making. Objective: This study is to evaluate the reliability of electrical cardiometry (EC) for the noninvasive continuous determination of CO after lobectomy or pneumonectomy compared to transthoracic echocardiography (TTE). Patients and Methods: This study was carried out on 60 patients, age ≥18 years scheduled for elective lung surgery (lobectomy or pneumonectomy). All patients underwent simultaneous measurement by EC using the ICON_ device and by TTE by measuring left ventricle outflow tract diameter (LVOT) and velocity time integral (VTI). Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), stroke volume index (SVI), CO, and cardiac index (CI) were measured 1 day before the surgery and 7 days after the surgery. Results: There was no significant difference between TTE and EC regarding preoperative and postoperative HR, SV, SVI, CO, and CI. There was a strong positive correlation between TTE and EC as regard preoperative and postoperative HR, SV, SVI, CO, and CI. Bland and Altman analysis showed low bias with accepted limits of agreement of HR, SV, SVI, CO, and CI. Postoperative readings showed a significant increase in HR and a significant decrease in SV and CO (either by TTE or EC), SBP, and DBP as compared to preoperative reading. Conclusion: Compared to the TTE, EC provides accurate and reliable CO, SV, and HR measurements before and even after lung surgeries.

Cardioprotective effects of propofol-dexmedetomidine in open-heart surgery: A prospective double-blind study.

Background: Myocardial protection in cardiac surgeries is a must and requires multimodal approaches in perioperative period to decrease and prevent the increase of myocardial oxygen demand and consumption that lead to postoperative cardiac complications including myocardial ischemia, dysfunction, and heart failure. Study Design: Prospective, controlled, randomized, double-blinded study. Aims: This study aims to study the effect of propofol-dexmedetomidine continuous infusion cardioprotection during open-heart surgery in adult patients. Materials and Methods: Sixty adult patients of both sexes aged from 30 to 60 years old belonging to the American Society of Anesthesiologists III or IV undergoing open-heart surgery were randomly divided into two equal groups: Group P (control group) received continuous infusion of propofol at a rate of 2 mg/kg/h and 50 cc 0.9% sodium chloride solution infused at a rate of 0.4 µg/kg/h (used as a placebo) and Group PD received continuous infusion of propofol at a rate of 2 mg/kg/h and dexmedetomidine 200 µg diluted in 50 cc 0.9% sodium chloride solution infused at a rate of 0.4 µg/kg/h. Infusion for all patients started immediately preoperative till skin closure. Hemodynamic measurements of heart rate (HR), invasive mean arterial pressure, and oxygen saturation were recorded at baseline before induction of anesthesia, immediately after intubation, at skin incision, at sternotomy and every 15 min in the 1st h then every 30 min during the prebypass period then every 15 min in the 1st h then every 30 min after weaning from CPB till the end of the surgery. Serum biomarkers; cardiac troponin (cTnI) and creatine kinase-myocardial bound (CK-MB) samples were measured basally (T1), 15 min after unclamping of the aorta (T2), immediate postoperative (T3), and 24 h postoperative (T4). Intraoperative data were also recorded including the number of coronary grafts, aortic cross-clamping duration, duration of cardiopulmonary bypass (CPB), duration of surgery, and rhythm of reperfusion. Fentanyl requirement, extubation time, and length of intensive care unit (ICU) stay were also recorded for every case. Results: There was no statistically significant differences as regard to demographic data between the studied two groups. HR and blood pressure recorded was lower in the PD group than the control group, and this difference was noted to be statistically significant. Furthermore, the PD group showed lower levels of myocardial enzymes (cTnI and CK-MB), decreased total fentanyl requirement, earlier postoperative extubation, and shorter ICU stay than the P(control) group. Conclusion: The use of propofol-dexmedetomidine in CPB surgeries offers more cardioprotective effects than the use of propofol alone.

High thoracic epidural decreases perioperative myocardial ischemia and improves left ventricle function in aortic valve replacement alone or in addition to cabg surgery even with increased left ventricle mass index.

Introduction: High thoracic epidural (HTE) may reduce perioperative tachyarrhythmias, respiratory complications and myocardial ischemia (MI) and it may increase coronary perfusion and myocardial oxygen balance through sympatholysis and pain control. The aim of this study is to investigate the benefit of HTE in patients undergoing aortic valve replacement (AVR) alone or in addition to coronary artery bypass graft (CABG). Methods: This prospective randomized controlled study was conducted on 80 patients (40 with increased left ventricular mass index (LVMI) and 40 with normal LVMI) who were equally randomised (n = 40) to receive either GA with HTE (HTE group) or GA alone (GA group). Heart rate (HR), mean arterial blood pressure (MAP) and the incidence of ischemic ECG changes were recorded. LV functions (preoperative and postoperative by transthoracic echocardiography and intraoperative by transoesophageal echocardiography) were measured preoperative, intraoperative and till 48 H postoperative. Results: There was no significant difference in the baseline values of all measurements. HR and MAP were lower, and LV functions were improved in HTE group intraoperatively and postoperatively. Ischemic ECG changes were significantly lower in HTE group; with 42.9% intraoperative risk reduction (95% CI: 0.195-0.943) and 46.6% postoperative risk reduction (95% CI 0.227-0.952) as compared to GA group. The risk of ischemia was significantly higher in patients with increased LVMI in GA group (2.25 times compared to normal LVMI patients with 95% CI: 1.195-4.236), but it wasn't increased in HTE group. LV functions were significantly improved from the induction to 48 H postoperative in HTE group as compared to GA group. Conclusion: HTE reduced the incidence of MI and improved the LV function, even with increased LVM, in patients undergoing AVR alone or in addition to CABG.

Blood transfusion and lung surgeries in pediatric age group: A single center retrospective study.

Background: Blood transfusion is not without harm, and recent studies suggest association between transfusion and poor outcome in critically ill patients. Although it is prescribed for many reasons based on the firm belief that blood transfusion improves oxygen carrying capacity, it carries notable adverse hazards. Importantly, lung surgeries are counted as moderate to high-risk operations and take a significant risk of blood loss. Aim: This study aims to reveal the association between blood transfusion and poor clinical outcomes and characterize the epidemiology of blood transfusion after pediatric chest surgery. Settings and Design: Retrospective cohort study, done throughout 3 years. Materials and Methods: A total of 248 patients who underwent open thoracotomy and lung surgery and aged ≤18 years were classified according to the need of intraoperative or postoperative blood transfusion into two groups: Group I (non-transfused = 130) and Group II (transfused = 118). Statistical Analysis: SPSS v25 was used for analysis. Results: Transfusion probability ranged between 42.8% and 50% according to type of surgery. As regard to postoperative variables, there was no significant difference between both groups regarding the duration of analgesia, allergic reactions, need of re-operation and in-hospital mortality. However, transfused group showed significant increase in duration of antibiotic, persistent postoperative fever, time to remove chest drains, ICU stays, hospital stay and pneumonia. Incidence of pneumonia had a relative risk 1.82 with transfused compared to non-transfused group. Conclusion: Transfusion group in pediatrics undergoing lung surgeries in our study was more prone to adverse outcomes such as pneumonia, delayed time to remove chest drains, prolonged ICU stay, and hospital stay.

Evaluation of local intra-pleural application of tranexamic acid on postoperative blood loss in lung decortication surgery, a prospective, randomized, double-blind, placebo-controlled study.

Background: During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding. Patients and Methods: A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay. Results: Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay. Conclusion: The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.

Successful percutaneous closure of post myocardial infarction left ventricular ruptured pseudoaneurysm after failed surgical repair.

Left ventricular pseudoaneurysms occur as a consequence of left ventricular free wall rupture contained by pericardium. This clinical situation is an uncommon but lethal complication of acute myocardial infarction. Surgery usually is the preferred therapeutic option but is associated with significant perioperative risk. We present a case of successful percutaneous closure of left ventricular ruptured pseudoaneurysm post myocardial infarction in a patient who failed two previous surgical repairs. .

Coronary fistula between the left anterior descending coronary artery and the pulmonary artery: Two case reports.

Coronary artery fistulae are rare congenital or acquired connections between the coronary vessels and the cardiac chambers or other vascular structures. We present two consecutive cases of coronary fistulae between the proximal left anterior descending artery (LAD) and the main pulmonary artery. Both cases where admitted with history of acute coronary syndromes and had multivessel coronary disease along with coronary pulmonary fistulae. The two cases were managed by coronary artery bypass grafting (CABG) and repair of the fistulae.

Repair of ascending aorta pseudoaneurysm without circulatory arrest in redo patient.

A pseudoaneurysm of the ascending aorta is an unusual and potentially fatal complication after aortic surgical operations. TEE and CT scan are the investigations of choice. Surgical treatment is mandatory. We describe the successful management of a pseudoaneurysm of the ascending aorta, with aorto-sternal-cutaneous fistula requiring right axillary and femoral artery cannulation with Remote Access Perfusion(R) aortic cannula (Estech(R), California, USA). Behaving like this we avoid hypotermic circulatory arrest, provide safe reentry and prevent an impending rupture.