Zobrazení zdroje stránky Akhtarclements4699

This study aimed to identify the predictors and threshold of failure in neonatal acute respiratory distress syndrome.<br /><br /> Newborns with severe acute respiratory distress syndrome aged 0-28 days and gestational age ≥36 weeks were included in the study if their cases were managed with non-extra corporal membrane oxygenation (ECMO) treatments. Patients were divided into two groups according to whether they died before discharge. Predictors of non-ECMO treatment failure were sought, and the threshold of predictors was calculated.<br /><br /> A total of 103 patients were included in the study. A total of 77 (74.8%) survived hospitalization and were discharged, whereas 26 (25.2%) died. Receiver operating characteristic analysis of oxygen index, pH, base excess, and combinations of these indicators demonstrated the advantage of the combination of oxygen index and base excess over the others variables regarding their predictive ability. The area under the curve for the combination of oxygen index and base excess was 0.865. When the cut-off values of oxygen index and base excess were 30.0 and -7.4, respectively, the sensitivity and specificity for predicting death were 77.0% and 84.0%, respectively. The model with base excess added a net reclassification improvement of 0.090 to the model without base excess.<br /><br /> The combination of oxygen index and base excess can be used as a predictor of outcomes in neonates receiving non-extra corporal membrane oxygenation treatment for acute respiratory distress syndrome. In neonates with acute respiratory distress syndrome, if oxygen index &gt;30 and base excess &lt;-7.4, non-ECMO therapy is likely to lead to death.<br /><br />30 and base excess less then -7.4, non-ECMO therapy is likely to lead to death.<br /><br /> Previous studies suggest that patients with prior or current hematologic malignancy are at increased risk of intraoperative and postoperative complications when undergoing cardiac surgery. The aim of this review was to compare clinical outcomes of patients with a history of hematologic malignancy to those of similar patients with no known blood dyscrasia.<br /><br /> From January 1993 to June 2017, 37,839 patients underwent elective cardiac surgery at Mayo Clinic. We matched 612 patients (1.6%) with a history of hematologic malignancy to 612 controls, and compared operative details, early postoperative complications, and late survival.<br /><br /> The median age of matched patients with hematologic malignancy was 71 years (interquartile range [IQR], 62 to 77) and 71 years (IQR, 62 to 77) for patients without cancer. Patients with prior diagnosis of malignancy had lower hemoglobin levels, 12.8 (IQR, 11.5 to 13.8) vs 13.5 (IQR, 12.2 to 14.6; P &lt; .001), but similar platelet counts, 195 (IQR, 147 to 263) vs 203 (IQR, 170 to 245; P= .533). Patients with malignancy were at greater risk of receiving postoperative blood transfusions (47.4% vs 35.6%, P &lt; .001). However, reoperations for postoperative bleeding (4.7% vs 3.3%, P= .253) and stroke (1.3% vs 1.3%, P &gt; .999) were similar. Thirty-day mortality was 3.3% among patients with hematologic malignancy and 1.5% among matched controls (P= .061). Overall survival among patients with cancer was reduced (P &lt; .0001).<br /><br /> Although late survival is reduced in patients with hematologic malignancies, early outcomes are generally similar to those of matched controls. Therefore, surgery should not be withheld from patients with a diagnosis of hematologic malignancy who would benefit from cardiac procedures.<br /><br />Although late survival is reduced in patients with hematologic malignancies, early outcomes are generally similar to those of matched controls. Therefore, surgery should not be withheld from patients with a diagnosis of hematologic malignancy who would benefit from cardiac procedures.<br /><br /> Anomalous aortic origin of the left coronary artery (AAOCLA) with an extended trans-septal course behind the right ventricular outflow tract (RVOT) is a rare variant that poses challenges not addressed by current surgical techniques. We utilized a novel trans-conal approach in seven consecutive patients.<br /><br /> Retrospective review of a prospectively collected database for consecutive patients undergoing trans-conal unroofing of trans-septal AAOLCA. Surgical repair entails transection of the right ventricular outflow tract (RVOT), unroofing the septal course of the AAOLCA followed by RVOT extension with a rectangular strip of autologous pericardium. Preoperative characteristics, operative details, and postoperative course were abstracted.<br /><br /> All seven patients identified were symptomatic. Median age was 48 (range 12-62) years. AAOLCA with trans-septal course was confirmed by computed tomography angiography. Three patients had provocative testing demonstrating anterolateral ischemia. Four patients underwent cardiant early outcome. Multimodality provocative testing is critical to evaluate these lesions as individual studies may be misleading. IVUS with iFFR is clinically useful to confirm the hemodynamic significance of specific lesions.<br /><br /> Patients with chronic renal failure (CRF) on hemodialysis are at increased risk for developing infective endocarditis (IE). However, outcomes of surgical treatment for IE in these patients have not been well studied.<br /><br /> Between 1997 to 2017, 539 patients underwent surgery for IE. Of these patients, 125 were on hemodialysis for end-stage renal disease (ESRD) and 414 had no history of CRF. Primary endpoints compared in this study were short- and long-term survival.<br /><br /> Preoperatively, dialysis patients had higher incidences of diabetes (43% vs. 18%), hypertension (79% vs. 49%), congestive heart failure (63% vs. [https://www.selleckchem.com/products/s961.html https://www.selleckchem.com/products/s961.html] 48%), cardiogenic shock (13% vs. 5.3), and sepsis (29% vs. 18%), all p&lt;0.05. Postoperatively, they experienced higher rates of prolonged mechanical ventilation (54% vs. 22%), pneumonia (17% vs. 5.6%), sepsis (6.4% vs. 1.0%), cardiac arrest (7.2% vs. 1.7%), gastrointestinal events (14% vs. 5.1%), and operative mortality (14% vs. 5.8%), all p&lt;0.05. Five- and ten-year survival were significantly worse in the dialysis group at 29% and 16%, respectively, compared to 72% and 53% in non-CRF patients (p&lt;0.0001). ESRD was a risk factor for both short- (OR=2.0) and long-term mortality (HR=2.7). Rates of reoperation in dialysis patients were very low five- and ten-year incidences were 0% and 2.0%, respectively.<br /><br /> In ESRD patients with IE, poor postoperative outcomes emphasized the importance of prevention and raised the question of whether indications for surgery in the general population are appropriate for patients who are dialysis-dependent. Additionally, low rates of reoperation supported the use of bioprosthetic valves in these patients.<br /><br />In ESRD patients with IE, poor postoperative outcomes emphasized the importance of prevention and raised the question of whether indications for surgery in the general population are appropriate for patients who are dialysis-dependent. Additionally, low rates of reoperation supported the use of bioprosthetic valves in these patients.