Cardiac output by femoral arterial thermodilution-calibrated pulse contour analysis during liver transplantation: comparison with pulmonary artery thermodilution

PURPOSE: The continuous monitoring of the cardiac output during liver transplantation (LT) is an essential part of the intraoperative management of the patient's hemodynamics. To verify the accuracy of a new method based on femoral artery thermodilution-calibrated pulse contour analysis (PCCO) during LT, we compared the technique with the results of an intermittent pulmonary artery thermodilution method (ICO). METHOD: A prospective study included 314 paired cardiac output measurements at 10 sampling times in 35 patients undergoing LT. After initial calibration of the pulse contour analysis, no further recalibrations were performed. Bland and Altman's statistical method, one-way ANOVA, and one sample t tests were used for the analysis of the data. A P<.05 was considered significant. RESULTS: There was a small bias 0.18 L x min(-1) (6.29% from the ICO) for the whole sample of paired measurements, associated with 95% limits of agreement of +/-4.72 (68.89%) L x min(-1). The additional analysis showed comparable biases and limits of agreement for any single time in the study period. The difference PCCO-ICO showed a negative sign for ICO >10 L x min(-1) (P<.001) and a positive sign for ICO <5 L x min(-1) (P<.001). It was greater during infusion of a vasoactive drug (P<.001). CONCLUSION: The pulse contour analysis was found to be an unsatisfactory substitute for intermittent thermodilution measurement of cardiac output during the LT.     

Idebenone treatment in paediatric and adult patients with Friedreich ataxia: Long-term follow-up

BACKGROUND: Antioxidant therapy is a new therapeutical approach for patients with Friedreich ataxia. AIMS: To assess the effectiveness of long-term idebenone treatment in Friedreich ataxia patients. METHODS: An open-labelled prospective study. Ten paediatric patients (age range 8-18 years) and 14 adults (age range 18-46 years) with genetic diagnosis of Friedreich ataxia were treated with idebenone (5-20mg/kg/day) for 3-5 years. Neurological evolution was evaluated using the International Cooperative Ataxia Rating Scale (ICARS), and cardiological outcomes using echocardiography. RESULTS: In paediatric patients, no significant differences were observed in ICARS scores and echocardiographic measurements when comparing baseline status and after 5 years of follow-up. Concerning adult cases, ICARS scores showed a significant increase in neurological dysfunctions during 3 years of therapy (Wilcoxon test, p=0.005), while echocardiographic measurements remained unchanged. CONCLUSIONS: Our results indicate that longer-term idebenone treatment prevented progression of cardiomyopathy in both paediatric and adult patients, whereas its stabilizing effect on neurological dysfunction was present only in the paediatric population, mainly before puberty. This suggests that the age at which idebenone treatment is initiated may be an important factor in the effectiveness of the therapy.     

Apoptosis in the cryptorchidism. Role of the FAS protein in it's modulation

The cellular degeneration, present at the criptorchidism leads to a malfunction in the spermatogenosis and it's due to cellular apoptosis (programed cellular death). This process is turned on and modulated by different ways. One of then is mediated by Ag-Ac reactions and a protein called FAS seems to have an important role in it's modulation. We studied the relation between FAS an the increased apoptosis in undescended testics. Testicular biopsies were done in criptorchid patients during orchidopexy and FAS was measured by immune-techniques. Our results seem to dismiss FAS as a modulation apoptosis factor in the cryptorchidism.     

Accurate topographical diagnosis of urinary tract infection in male patients with (111)indium-labelled leukocyte scintigraphy

Background: Although the clinical diagnosis of urinary tract infection (UTI) is straightforward, the precise localization of the urogenital organ affected by the infection is often difficult to establish. Methods: To evaluate this, we prospectively studied 20 males with a clinical diagnosis of acute pyelonephritis (APN), acute prostatitis (AP) and febrile UTI (FUTI), as well as seven control females with APN. (111)Indium-labelled leukocyte scintigraphy (ILS) was performed during the febrile episode and repeated when patients were free of symptoms. Results: ILS showed an abnormal uptake in a urinary organ in every case. All patients with AP showed uptake in the pelvic area. Four male patients presented AP, one of them had uptake in the lumbar area, one in the lumbar and pelvic area, and two in the area of the prostate only. Six out of seven patients with FUTI presented uptake in the pelvic area. All female patients showed kidney uptake. After the clinical resolution of the UTI, no residual uptake was found in any case except for one. Conclusions: These results suggest that ILS is very useful in localizing the affected organ in febrile UTI. Most male patients with a febrile UTI presented a prostatic involvement, suggesting that many cases of APN or FUTI in males may actually be cases of AP not recognized by standard clinical evaluation.     

Intra-operative Pneumothorax Complicating Laparoscopic Roux-en-Y Gastric Bypass

Background: Intra-operative pneumothorax (PTX) is an infrequent complication of laparoscopic surgery. Most cases are attributed to CO₂ diffusion across congenital diaphragmatic defects and resolve spontaneously. We report a case of PTX during a laparoscopic Roux-en-Y gastric bypass (LRYGBP). When applied to this specific patient population, the current literature recommendations for the management of intra-operative PTX are questioned. Material and Methods: A retrospective chart review of 400 consecutive LRYGBP procedures performed over a 30-month period revealed 1 case of PTX (0.025%). Results: A bulging left diaphragm, hypotension, bradycardia, decreased pO₂, and elevated EtCO₂ and airway pressures, were noted early in the case. She initially responded to conservative management but required multiple subsequent hospital admissions for pulmonary complications. Conclusions: Pneumoperitoneum-induced PTX during laparoscopic bariatric surgery is a rare complication. Its treatment must be based on the potential underlying cause, with consideration of these patients' often delicate pulmonary status. In stable patients, where the PTX is attributed to diaphragmatic or hiatal dissection, expectant treatment is appropriate. In all other situations, however, we believe that tube thoracostomy is indicated. An algorithm for treatment of PTX in laparoscopic bariatric surgery is proposed. It follows the dictum of maintaining extreme vigilance and a low threshold for aggressive intervention in this group of patients.     

Intraosseous hemangioma of the lateral orbital wall

PURPOSE: To report the clinical and radiologic features of two patients with intraosseous orbital hemangiomas of the lateral wall. METHODS: Case reports and literature review. RESULTS: The first patient presented with an indolent mass over the lateral orbital rim. Intraosseous hemangioma was not considered in the differential diagnosis. A biopsy specimen was taken from the tumor, which caused significant bleeding. After biopsy, an orbital CT scan revealed a lesion involving the left lateral orbital rim and soft tissue of the temporal fossa. The rim was grossly enlarged, with several cavities of different sizes. The tumor of the second patient was located more posteriorly and extended into the roof. The patient complained of parietal headache, epiphora, and local pain. A CT scan revealed a round, lytic lesion involving the greater sphenoid wing and frontal bone. The tumor was approached through a coronal flap and resected en bloc without problems. CONCLUSIONS: The diagnosis of intraosseous hemangioma can be difficult, especially when tumors are located in the anterior part of the lateral wall. In this location, intraosseous hemangiomas tend to induce few symptoms and thus have a higher likelihood of biopsy being performed before a correct diagnosis. A CT scan with bone windows can play a beneficial role in the evaluation of lytic bone lesions in intraosseous hemangioma.