Aortic root surgery with circulatory arrest: Predictors of prolonged postoperative hospital stay

Objective

Little is known about the outcomes of aortic root operations that involve inducing hypothermic circulatory arrest for relatively extensive proximal aortic surgery. We attempted to identify predictors of postoperative hospital length of stay (LOS) and factors that affect postoperative recovery.

Impact of transfusion policy on acute coronary syndrome after major vascular reconstruction

Objectives

To investigate the impact of a restrictive transfusion approach, as indicated by accepting a perioperative hemoglobin (Hb) level as low as 8 g/dL, on the incidence of acute coronary syndrome (ACS) and mortality after major vascular reconstruction.

Methods

Using a case-control design, 45 patients who underwent vascular reconstruction and developed postoperative ACS were compared with 135 patients treated with similar procedures who did not suffer ACS postoperatively.

Results

A history of CAD was more often present in the ACS group (16% vs 56%) and was an independent predictor of ACS (odds ratio [OR] = 6.62; confidence interval [CI], 3.16-13.88; P < .001) and postoperative death (OR = 5.08; CI, 2.0-12.85; P = .001). Postoperative (Hb) levels as low as 8 g/dL were well tolerated and had no impact on the occurrence of ACS (OR = .61; CI, 0.29-1.26; P = .181) or death (OR = 1.33; CI, 0.52-3.43; P = .547). The presence of CAD for a given Hb level did not increase the odds of either ACS (OR = 3.43; CI, .75-15.6; P = .112) or death (OR = 2.02; CI, .5-19.55; P = .543).

Conclusions

A restrictive transfusion policy is justified in patients undergoing major vascular reconstruction, even in the presence of appropriately managed cad.     

Nevoid basal cell carcinoma syndrome: a review of the literature and a report of a case

The purpose of this paper is to report the development of multiple odontogenic keratocysts (OKCs) in a 15-year-old female with nevoid basal cell carcinoma syndrome (NBCCS) and review the literature pertinent to NBCCS. Although more than 100 abnormalities have been reported in NBCCS, the development of OKCs is one of its principle features. In view of this, the patient was subjected to further medical, dermatological and radiographic investigation. Multiple basal cell naevi and skeletal anomalies associated with NBCCS were found. Because of the autosomal dominant inheritance of this syndrome, the patient's family was then investigated. The patient's father was found to have multiple OKCs. The report highlights the need for vigilance in considering the diagnosis of NBCCS in all cases of OKCs, particularly those affecting young patients.