Platelet Functions in Cardiopulmonary Bypass Surgery

Background

Haemorrhage after Cardio Pulmonary Bypass (CPB) Surgery is a well recognised complication that leads to significant morbidity and mortality. The incidence varies between 5-25% depending upon the clinical situation. Several factors are implicated as causative but none have been precisely proved.

Methods

Our study was an attempt to evaluate the haemostatic defect with particular reference to platelet function abnormalities during cardio pulmonary bypass surgery, in order to reduce the morbidity and mortality associated with post CPB haemorrhage. Flow cytometric evaluation of different platelet glycoproteins like GPIb/IX, GPIIb/IIIa and GMP-140 was done.

Results

The marker expression showed deregulation during surgery which returned to base after bypass was terminated. In contrast, the cases with bleeding showed significant variation. P-Selectin (GMP 140) expression decreased progressively till 3^rd post-operative day showing lack of activation of platelets in cases of severe bleeding.

Conclusion

Longer duration of CPB initiates plasmin generation through heparin, which raises the PAI-1-tPA complex and thereby down regulating the functions of platelets. This suggests a link between duration of CPB, bleeding, platelet dysfunction and fibrinolysis. Hence serial estimations of the levels of GMP-140 and tPA can predict severe bleeding.Key Words: CardioPulmonary Bypass, Platelet dysfunction, flowcytometry, platelet glycoproteins, haemorrhage     

Simultaneous Correction of Aortic Coarctation and Partial Anomalous Pulmonary Venous Return

A 23-year-old asymptomatic woman with aortic coarctation and anomalous drainage of the right inferior and left pulmonary veins underwent correction. Coarctation repair was followed by anastomosis of the anomalous vertical vein to the left atrium under femoral-femoral bypass. A left thoracotomy offered excellent exposure for simultaneous repair of this unusual combination of vascular anomalies.     

Using information contained in the curriculum management information tool (CurrMIT) to capture opportunities for student learning and development

The purpose of this paper is to examine how West Virginia University Medical School used the AAMC Curriculum Management Information Tool (CurrMIT) to map the undergraduate medical school curriculum. Information gleaned from this analysis identified what students are expected to learn, how they learn and how they are assessed. Information about the curriculum was entered into CurrMIT, creating a comprehensive picture of the curricular landscape. Learning outcomes were parceled out according to a competence-based framework. In addition, learning methods and assessment measures were identified. A total of 639 learning outcomes were identified across several competences. A total of 13 learning methods and 13 assessment measures were also identified in the undergraduate curriculum. The results suggest that students are expected to acquire varied knowledge, skills and attitudes. Further, students are presented with diverse learning methods and assessment measures. The curriculum map ascertains whether the program's components, such as learning outcomes, learning approaches and assessment methods, are designed and linked to further students' learning. This analysis will lead to curricular improvements. The implications of this work can help faculty, students and other academic stakeholders shift tacit expectations of learning and development to a curricular reality and, in turn, help prepare future physicians for the changing field of medicine.