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Ricardo G Marenchino, Alberto Domenech
A 78-year-old man with a Kommerell diverticulum and aberrant right subclavian artery was admitted for thoracic pain and severe malnutrition due to esophageal compression. We performed an atypical surgical procedure including extra-anatomical debranching and direct aortic repair, trying to avoid deep hypothermic circulatory arrest and shorten the cardiopulmonary bypass time.
February 2016: Aorta (Stamford, Conn.)
Sarah-Jayne Edmondson, Saina Attaran, Ulrich P Rosendahl
Wegner's granulomatosis (WG) is an autoimmune systemic vasculitis that results in necrotizing granulomas. We report a WG patient with a lung granuloma and aortic root dilatation, who underwent aortic root replacement on cardiopulmonary bypass (CPB). Intraoperatively, the patient suffered an aortic dissection, which was repaired immediately under deep hypothermic circulatory arrest (DHCA). Follow-up imaging showed complete granuloma resolution, despite absence of immunosuppressive therapy. Immune stimulation following CPB is well described; here, the opposite was observed and DHCA effects are discussed...
February 2016: Aorta (Stamford, Conn.)
Hiroya Kano, Hiroaki Takahashi, Takeshi Inoue, Hiroshi Tanaka, Yutaka Okita
INTRODUCTION: Intestinal fatty acid-binding protein (I-FABP) is increasingly employed as a highly specific marker of intestinal necrosis. However, the value of this marker associated with cardiovascular surgery with hypothermic circulatory arrest is unclear. The aim of this study was to measure serum I-FABP levels and provide the transition of I-FABP levels with hypothermic circulatory arrest to help in the management of intestinal perfusion. METHODS: From August 2011 to September 2013, 33 consecutive patients who had aortic arch surgery with hypothermic circulatory arrest or heart valve surgery performed were enrolled in the study...
October 19, 2016: Perfusion
Ramesh Singh, Katsuhiro Yamanaka, T Brett Reece
The extent and technique of resection for ascending aortopathies remains debated. The 2 main camps are divided into those who believe in the hemiarch resection utilizing hypothermic circulatory arrest and those who feel that the same goal can be accomplished with just an ascending aortic resection with an aortic cross clamp. While this debate continues to happen within groups and in some cases even in the same hospital, it certainly has not happened in the literature. There are no studies directly comparing the safety and efficacy of these 2 ideologies...
October 19, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Alexa Craig, Christine James, Janelle Bainter, Francis L Lucas, Scott Evans, John Glazer, Donna Dowling
BACKGROUND: The traumatic experiences of parents of babies treated with therapeutic hypothermia (TH) have been described. No research has assessed neonatal intensive care unit (NICU) nurse experience in providing care to hypothermic babies and emotional support to their parents. PURPOSE: To assess NICU nurse attitudes to the provision of TH with respect to perceptions about baby pain/sedation, need for nurse and parent education, decision making about initiation of TH, and barriers to best care...
October 18, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
B J Laan, S M van den Heiligenberg, M Hemelaar
BACKGROUND: Classical Meigs' syndrome consists of the triad of an ovarian fibroma, ascites and pleural effusion. A characteristic of the syndrome is that the excess fluid is resorbed after surgical resection of the tumour. CASE DESCRIPTION: A 49-year-old woman was admitted to accident and emergency department in a neglected, cachectic and hypothermic condition. A CT scan revealed an ovarian tumour, ascites and a right-sided pleural effusion. The level of the tumour marker CA-125 was also greatly elevated...
2016: Nederlands Tijdschrift Voor Geneeskunde
Nan Liu, Wei Zhang, Weiguo Ma, Wei Shang, Jun Zheng, Lizhong Sun
OBJECTIVES: To identify the risk factors for hypoxaemia following surgical repair of acute type A aortic dissection. METHODS: This was a retrospective study of patients treated between October 2013 and December 2014 at the Department of Cardiovascular Surgery, Anzhen Hospital, China. Univariable and multivariable analyses were performed on the clinical data of 160 patients with acute type A dissection and who underwent ascending aortic and arch replacement under deep hypothermic circulatory arrest...
October 17, 2016: Interactive Cardiovascular and Thoracic Surgery
Ahmer M Hameed, Henry C Pleass, Germaine Wong, Wayne J Hawthorne
BACKGROUND: The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation...
October 2016: Medicine (Baltimore)
Matthew S Mosca, George Justison, T Brett Reece
OBJECTIVE: The optimal strategy to deliver antegrade cerebral perfusion for cerebral protection during hypothermic circulatory arrest has not been established. The purpose of this review was to present our current clinical protocol utilizing selective antegrade cerebral perfusion during aortic arch surgery and to compare it to other published experience. CLINICAL PROTOCOL: Since 2013, our clinical protocol for aortic arch surgery has evolved to using selective antegrade cerebral perfusion via the innominate artery, moderate hypothermia, and ancillary strategies such as goal-directed perfusion (GDP)...
October 14, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
L Meng, N Matsuno, K Watanabe, M Furukori, H Obara, H Bochimoto, T Watanabe, H Fukukawa
BACKGROUND: The shortage of organ donors is a universal problem. Use of grafts from donors after cardiac death would greatly contribute to the expansion of the donor organ pool. The two major methods of preservation are cold storage and machine perfusion (MP) preservation, and each has its own advantages. Several studies have reported the relative merits of MP for the preservation for grafts from donors after cardiac death. In this study, we used scanning electron microscopy (SEM) to assess the damage to the liver between hypothermic and rewarming preservation conditions...
September 2016: Transplantation Proceedings
Maryse A Wiewel, Matthew B Harmon, Lonneke A van Vught, Brendon P Scicluna, Arie J Hoogendijk, Janneke Horn, Aeilko H Zwinderman, Olaf L Cremer, Marc J Bonten, Marcus J Schultz, Tom van der Poll, Nicole P Juffermans, W Joost Wiersinga
BACKGROUND: Hypothermia is associated with adverse outcome in patients with sepsis. The objective of this study was to characterize the host immune response in patients with hypothermic sepsis in order to determine if an excessive anti-inflammatory response could explain immunosuppression and adverse outcome. Markers of endothelial activation and integrity were also measured to explore potential alternative mechanisms of hypothermia. Finally we studied risk factors for hypothermia in an attempt to find new clues to the etiology of hypothermia in sepsis...
October 14, 2016: Critical Care: the Official Journal of the Critical Care Forum
John Kenny, SarahJane Cullen, Giles D Warrington
PURPOSE: Ice-mile swimming presents significant physiological challenges and potential safety issues but little data are available. We report on deep body temperature (BT), respiratory rate (RR) and swim performance in two swimmers completing an 'ice-mile' swim of one mile (1600m) in water temperature at less than 5°C. METHODS: Two male cold-water habituated swimmers completed a one-mile lake swim in water at 3.9°C. For comparative purposes, they completed an indoor one-mile swim in water at 28...
October 13, 2016: International Journal of Sports Physiology and Performance
Sam E Mason, James M Kinross, Jane Hendricks, Thanjakumar H Arulampalam
BACKGROUND: Surgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. Warming and humidifying carbon dioxide (CO2) used for peritoneal insufflation may protect against SSI by avoiding postoperative hypothermia (itself a risk factor for SSI). This study aimed to assess the impact of CO2 conditioning on postoperative hypothermia and SSI and to perform a cost-effectiveness analysis. METHODS: A retrospective cohort study of patients undergoing elective laparoscopic colorectal resection was performed at a single UK specialist centre...
October 12, 2016: Surgical Endoscopy
Utpal S Bhalala, Elumalai Appachi, Muhammad Ali Mumtaz
Many known risk factors for adverse cardiovascular and neurological outcomes in children with congenital heart defects (CHD) are not modifiable; however, the temperature and blood flow during cardiopulmonary bypass (CPB), are two risk factors, which may be altered in an attempt to improve long-term neurological outcomes. Deep hypothermic circulatory arrest, traditionally used for aortic arch repair, has been associated with short-term and long-term neurologic sequelae. Therefore, there is a rising interest in using moderate hypothermia with selective antegrade cerebral blood flow on CPB during aortic arch repair...
2016: Frontiers in Pediatrics
Anna Jarosz, Sylweriusz Kosiński, Tomasz Darocha, Peter Paal, Robert Gałązkowski, Hubert Hymczak, Rafał Drwiła
OBJECTIVES: When establishing the Severe Hypothermia Treatment Centre, certain problems and pitfalls regarding the qualification for extracorporeal rewarming were encountered. The authors shared their experience and opened a discussion with other centers that deal with severe, accidental hypothermia. DESIGN: Retrospective analysis of medical records of all patients examined by the hypothermia coordinator. SETTING: Patients consulted and treated by the Severe Hypothermia Treatment Centre...
May 13, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Thomas Minor, Katja Sutschet, Oliver Witzke, Andreas Paul, Anja Gallinat
BACKGROUND: Post-transplant function of suboptimal kidney grafts can be improved but not accurately predicted by hypothermic machine perfusion. Therefore, a new concept of ex situ pre-implantation machine perfusion with controlled rewarming up to subnormothermic temperatures was developed and evaluated. METHODS: Porcine kidneys (n= 6/ group) were retrieved before or 30 min after cardiac arrest of the donor and subjected to 18 hours of static cold storage. In some cases 90 min of machine controlled oxygenated rewarming (COR) was added thereafter...
October 8, 2016: European Journal of Clinical Investigation
Kai Oliver Jensen, Leonhard Held, Andrea Kraus, Frank Hildebrand, Philipp Mommsen, Ladislav Mica, Guido A Wanner, Peter Steiger, Rudolf M Moos, Hans-Peter Simmen, Kai Sprengel
BACKGROUND: Although under discussion, induced hypothermia (IH) is an established therapy for patients with cardiac arrest or traumatic brain injuries. The influences on coagulopathy and bleeding tendency in severely injured patients (SIP) with concomitant traumatic brain injury are most widely unclear. Therefore, the aim of this study was to quantify the effect of mild IH in SIP with concomitant severe traumatic brain injuries on transfusion rate and mortality. METHODS: In this retrospective multi-centre study, SIP from three European level-1 trauma centres with an ISS ≥16 between 2009 and 2011 were included...
October 6, 2016: European Journal of Medical Research
Myungsoo Jun, Noo Ri Lee, Won-Soo Lee
Alopecia areata (AA) affects anagen hair follicles, resulting in non-scarring hair loss. Since introduced by Huang et al., superficial cryotherapy has been accepted as a considerable primary therapeutic modality for AA. The aim of this study was to objectively clarify the therapeutic efficacy and safety of superficial hypothermic cryotherapy for treatment of AA. Medical records of 353 patients from 1993 to 2014 were retrospectively analyzed. According to the response to the superficial cryotherapy, patients were categorized into four groups: "marked", "partial", "poor" and "no recovery"...
October 6, 2016: Journal of Dermatology
Robert Anton Cesnjevar, Ariawan Purbojo, Frank Muench, Joerg Juengert, André Rueffer
Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve...
July 2016: Translational pediatrics
Jeffrey E Keenan, Ehsan Benrashid, Emily Kale, Alina Nicoara, Aatif M Husain, G Chad Hughes
Circulatory management during replacement of the aortic arch is complex and involves a period of circulatory arrest to provide a bloodless field during arch vessel anastomosis. To guard against ischemic brain injury, tissue metabolic demand is reduced by systemically cooling the patient prior to circulatory arrest. Neurophysiological intraoperative monitoring (NIOM) is often used during the course of these procedures to provide contemporaneous assessment of brain status to help direct circulatory management decisions and detect brain ischemia...
October 4, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
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