Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis

Background  

Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery.     

Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study

BACKGROUND: There are obvious advantages to increasing donor retention. However, for reasons of blood safety, certain donors may, in fact, be more desirable to retain than others. “Safe” donors are defined as those who provided a blood donation that was negative on all laboratory screening tests and who subsequently reported no behavioral risks in response to an anonymous survey. This study identifies the most important factors affecting the intention of “safe” donors to provide another donation. STUDY DESIGN AND METHODS: An anonymous survey asking about donation history, sexual history, injecting drug use, and recent donation experience was mailed to 50,162 randomly selected allogeneic donors (including directed donors) who gave blood from April through July or from October through December 1993 at one of the five United States blood centers participating in the Retrovirus Epidemiology Donor Study. Before mailing, questionnaires were coded to designate donors with nonreactive laboratory screening tests at their most recent donation. RESULTS: A total of 34,726 donors (69%) responded, with substantially higher response among repeat donors. According to reported intentions only, the vast majority of “safe” donors indicated a high likelihood of donating again within the next 12 months. Only 3.4 percent reported a low likelihood of donating again. A comparison of those likely to return and those unlikely to return reveals significant differences in demographics and in ratings of the donation experience. A higher proportion of those unlikely to return were first-time donors, minority-group donors, and donors with less education. The highest projected loss among “safe” donors was seen for those who gave a fair to poor assessment of their treatment by blood center staff or of their physical well-being during or after donating. CONCLUSION: These data suggest that efforts to improve donors' perceptions of their donation experience, as well as attention to the physical effects of blood donation, may aid in the retention of both repeat and first-time donors.     

Occurrence of tetrodotoxin and paralytic shellfish poison in the Taiwanese crab Lophozozymus pictor

Paralytic toxicity was detected by tetrodotoxin (TTX) bioassay in all 15 specimens of the xanthid crab Lophozozymus pictor collected from northern Taiwan in 1993. The average toxicity of crab specimens was 921 ± 231 (mean ± S.E.) mouse units. The toxin of crab was partially purified and then identified. It was found that the crab toxin contained TTX and gonyautoxin. The ratio of TTX to gonyautoxin for crab toxin was about 9:1.     

Reoperative Thyroid Surgery

Reoperative thyroid surgery is an uncommon operation associated with a high complication rate. We retrospectively reviewed the data of 115 patients to study the incidence of complications after reoperative thyroid surgery. There were 107 women and 8 men (13.4:1.0) with an average age of 42.8 years (range 18–80 years). The most frequent indication for reoperation was completion thyroidectomy for a carcinoma identified by permanent sections (50 patients, 43.5%). Reoperative surgery was performed on 13 (11.3%) patients with recurrent thyroid cancer. The remaining 52 patients underwent reoperation for recurrent thyrotoxicosis (12 patients, 10.4%), recurrent nodular goiter (28 patients, 24.3%) or recurrent multinodular goiter (12 patients, 10.4%). Seven patients with recurrent nodular goiter and one patient with recurrent thyrotoxicosis underwent total thyroidectomy for the presence of malignancies that were identified by frozen sections. Overall, the interval between the initial and reoperative procedures ranged from 1 day to 33 years (2335 ± 272 days). The length of hospital stay was 5.8 ± 0.5 days. The length of time needed for reoperative thyroid surgery was 122.0 ± 6.2 minutes. There was no 30-day perioperative mortality. The postoperative complications consisted of transient hypoparathyroidism in six patients (5.2%), permanent hypoparathyroidism in two patients (1.7%), transient RLN palsy in 3 patients (2.6%), and permanent recurrent laryngeal nerve palsy in two patients (1.7%). Reoperative thyroid surgery can be performed safely with little morbidity to the patient.     

The role of surgery in the management of unusual complications of transcatheter arterial embolization for hepatocellular carcinoma

Transcatheter arterial embolization (TAE) is accepted to be an effective treatment in both resectable and nonresectable hepatoma, which is very prevalent in Taiwan. Two hundred and twenty-five embolizations of TAE were performed in 137 patients in a 3-year period. Postembolization syndrome developed in the majority of patients. We analyzed these patients to study the nature and incidence of unusual complications and the surgical role in their managment. In our series, unusual complications, which were rarely reported in the literature, included 13 cases (5.8%) of gastroduodenal bleeding, 2 cases (0.9%) of duodenal perforation, 9 cases (4.0%) of acute pancreatitis with 1 case of gangrenous change, 24 cases (10.7%) of gallbladder infarction with 1 case of perforation, 4 cases (1.8%) of delayed formation of gallstones, 3 cases (1.3%) of hyperuricemia, and 2 cases (0.9%) of hepatoma rupture. Ischemic necrosis of the organs may be attributed to the inadvertent blockade of the gastroduodenal artery, gastric artery, cystic artery, and important collaterals. Inadequate superselectivity, the size of the tumor, regurgitation of embolus, anatomical variations, injury of vessel intima, or pseudoaneurysm formation resulting from previous embolization attempts made the avoidance of complications difficult with this technique. Most of the unusual complications could be managed by conservative treatment, but urgent operation was indicated in the cases of organ perforation. Elective operation was also needed for the delayed formation of gallstones with prominent symptoms. Awareness of the occurrence of these untoward sequelae makes us more careful in the evaluation and long-term follow-up of patients following TAE. Surgical intervention plays a selective but important role in the management of these unusual complications.

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Resumen La embolización arterial por cateterismo (EAC) es aceptada como tratamiento efectivo tanto en los hepatomas resecables como en los no resecables, tumores de alta incidencia en Taiwan. Doscientos veinticinco embolizaciones por EAC fueron realizadas en 137 pacientes en un período de 3 años; el síndrome de postembolización se desarrolló en la mayoría de los pacientes. Hemos analizado estos pacientes para estudiar la naturaleza y la incidencia de las complicaciones poco usuales y el papel de la cirugía en su manejo. Las complicaciones poco usuales observadas en nuestra serie, las cuales son raramente informadas en la literatura, incluyen 13 casos (5.8%) de hemorragia gastroduodenal, 2 casos (0.9%) de perforación duodenal, 9 casos (4.0%) de pancreatitis aguda con 1 caso de necrosis gangrenosa, 24 casos (10.7%) de infarto de la vesícula biliar con 1 caso de perforación, 4 casos (1.8%) de formación tardía de cálculos, 3 casos (1.3%) de hiperuricemia, y 2 casos (0.9%) de ruptura del hepatoma. La necrosis isquémica de los órganos puede ser atribuida a la oclusión inadvertida de la arteria gastroduodenal, la arteria gástrica, la arteria cística, y colaterales importantes. Superselectividad inadecuada, tamaño del tumor, regurgitación del émbolo, variaciones anatómicas, lesión de la íntima de la pared vascular, o formación de pseudoaneurismas como consecuencia de intentos previos de embolización hicieron difícil evitar las complicaciones con esta técnica. La mayoría de estas complicaciones poco usuales pudieron ser manejadas con tratamiento conservador, pero la operación de urgencia fue necesaria en casos de perforación de un órgano. La operación electiva también fue necesaria en los casos con formación tardía de cálculos biliares y síntomas prominentes. La toma de conciencia sobre la posibilidad de este tipo de secuelas nos ha hecho aún más cuidadosos en la evaluación y el seguimiento a largo plazo de los pacientes sometidos a EAC. La intervención quirúrgica juega un papel selectivo pero importante en el manejo de estas complicaciones poco usuales.

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Résumé L'embolisation par cathétérisme artériel occupe à Taiwan une place fiable dans le traitement de l'hépatome opérable ou de l'hépatome inopérable. Au cours d'une période de 3 ans 225 embolisations intra-artérielle ont été pratiquées chez 137 malades. Dans la majorité des cas l'embolisation a entrainé des phénomènes secondaires anormaux. Les auteurs font état de complications inhabituelles qui ont été rarement relatées dans la littérature: 13 cas (5.8%) d'hémorragie gastro-duodénale, 2 cas (0.9%) de perforation duodénale, 9 cas (4.0%) de pancréatite aigue dont une avec altérations gangréneuses, 24 cas (10.7%) d'infarcissement de la vésicule dont un avec perforation, 4 cas (1.8%) de formation retardée de calculs vésiculaires, 3 cas (1.3%) d'hyperuricémie, 2 cas (0.9%) de rupture de l'hématome. La nécrose ischémique des organes peut être attribuée à l'obstruction imprévue de l'artère gastro-duodénale, de l'artère gastrique, de l'artère cystique, et d'importantes collatérales. De multiples facteurs peuvent être invoqués pour expliquer les complications indésirables de l'embolisation: cathétérisme hypersélectif inadéquat, volume de la tumeur, régurgitation de l'embolus, blessure de l'intima artérielle, formation pseudoanévrysmale résultant de tentatives antérieures de cathétérisme artériel. La majorité d'entre elles peuvent être traitées médicalement mais l'intervention d'urgence s'impose quand une perforation viscérale est en cause. Il convient également de procéder à la cholécystectomie lorsque la lithiase vésiculaire entraîne des troubles importants. Connaître l'existence possible de ces accidents fâcheux doit rendre circonspect dans l'évaluation exacte de la valeur et le suivi à long terme de l'embolisation. De toute façon l'intervention chirurgicale est indispensable pour traiter certaines complications de l'embolisation.

     

Surgical management of hemangioblastomas of the spinal cord.

BACKGROUND AND PURPOSE: Intramedullary hemangioblastomas are relatively rare intraspinal tumors. Total removal of these tumors without causing significant neurological deficit remains a great challenge. This study analyzed the preoperative characteristics, management, and outcome in patients with successful total removal of spinal intramedullary hemangioblastomas. METHODS: Data from the medical records of patients with intraspinal hemangioblastomas treated from 1993 to 2003 were reviewed. The neurological function of these patients was graded and the preoperative data were recorded and correlated with clinical outcome. RESULTS: Ten patients with spinal intramedullary hemangioblastomas underwent microsurgical resection by the same neurosurgeon during the 10-year study period. They included 3 men and 7 women with age ranging from 20 to 49 years, with a mean age of 33 years. Five of the patients met the diagnostic criteria for von Hippel-Lindau disease. Preoperative neurological function was grade I in 6 patients, grade II in 3 patients and grade III in 1 patient. Immediate postoperative neurological function was worse in 3 cases, but all of these patients recovered their preoperative function within 3 weeks. At 3 months' follow-up, 9 patients had achieved functional grade I, and 1 patient with preoperative grade III function had improved to grade II. CONCLUSIONS: Detailed preoperative evaluation and skillful microsurgery are mandatory in successful total removal of intramedullary hemangioblastomas. The management of spinal hemangioblastomas associated with von Hippel-Lindau disease requires a cautious observation of clinical course and timely surgical intervention of symptomatic lesions to avoid possible neurological deficit.     

Effect of chronic renal failure on high-density lipoprotein kinetics

Plasma lipid and lipoprotein concentration and high density lipoprotein (HDL) kinetics were determined in control subjects and patients with chronic renal failure (CRF). Results demonstrated that plasma triglyceride (TG) concentration was significantly higher (P less than 0.001) in patients with CRF, associated with a significant increase in plasma VLDL-cholesterol (P less than 0.002) and a significant decrease (P less than 0.05) in plasma HDL-cholesterol concentration. The rate of removal of 125I-apoAI/HDL from plasma was slower (P less than 0.001) in the patients with CRF, resulting in an increase in the residence time of 125I-apoAI/HDL (P less than 0.001) and a decrease in the fractional catabolic rate (P less than 0.001). Since plasma apoAI concentration was lower in patients with CRF, total apoAI/HDL synthetic rate was also significantly (P less than 0.05) decreased. These data provide support for the view that low plasma HDL-cholesterol concentrations in patients with CRF are related to decreases in the synthetic rate of apoAI/HDL.