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Background: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between postoperative deterioration of renal function and the use of HES 200 kD, 0.5 DS in the cardiac surgery setting., Methods: Retrospective analysis of daily collected data in 3124 patients who underwent coronary artery bypass and/or valvular surgery. Three groups were compared according to differences in fluid therapy: --GEL: gelatin was used as priming fluid of extracorporeal circulation (ECC) and for postoperative filling (n = 1276). --MIX: HES was used as priming fluid of ECC an gelatin was used for postoperative filling (n = 1008). --HES: HES was used as priming fluid of ECC and for postoperative filling (n = 840)., Main Results: There were no significant differences in postoperative serum creatinine concentrations between the 3 groups: GEL: 12,2 +/- 0,5 mg/l; MIX: 12,3 +/- 0.5 mg/l; HES: 12,3 +/- 0.6 mg/l. The need for postoperative extrarenal epuration was not significantly different between the 3 periods: GEL: 2,9%; MIX: 3,1%; HES: 3,8%., Conclusion: The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function.

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac tamponade but there was no evidence of pericardial effusion by transthoracic echocardiography. Thoracic-CT provided the diagnostic clue in revealing the extrapericardial nature (a major dilatation of the colonic transplant) of the tamponade. This diagnosis should be considered in case of acute cardiopulmonary distress occuring early or late after oesophagectomy.

We report the case of a massive tension-pneumoperitoneum developing immediately after starting mechanical ventilation (barotrauma). Careful analysis of CT-data provided meaningful informations in assessing the non surgical pulmonary source of pneumo peritoneum.

A four year child presented with an episode of malignant hyperthermia induced by reexposure to halothane. The episode was associated with early onset of a severe hypoglycemia and liver enzymatic perturbances. Etiology of these perturbances is hard to state precisely in this clinical context, but a hepatic toxicity of halothane and/or by dantrolene is considered.

Severe ketonuria developed during sedation with propofol in a 12 year old girl with brain injury. Deep sedation with propofol (5.1 mg/kg/h) was required because of agitation and severe intracranial hypertension; as a part of our management protocol, glucose intake was restricted to 5 Kcal/h. After 18 hours of propofol infusion there was intense ketonuria (8+ by Ketostix) without any evidence of metabolic acidosis (pH, HCO3- and anion gap were within normal values). At this time, indirect calorimetry (Deltatrac) confirmed that energy expenditure was principally based on fat consumption (70% of energy expenditure). Lowering the propofol infusion rate and increasing glucose intake reduced fat consumption to 39% within 8 hours: at this time, Ketostix was negative for ketone bodies. This case illustrates a potential risk of ketonuria during prolonged sedation with propofol (a 10% solution of intralipid), particularly if glucose intake is restricted. Monitoring urinary ketone bodies is recommended under these circumstances.

Severe acute hypercalcemia (4.03 mmol/l) developed in a 50 years old woman after head and intraabdominal trauma (and splenectomy). After failure to correct the calcium levels by intravenous saline, furosemide, steroids and calcitonin, two hemodialyses were performed; definitive control of hypercalcemia was obtained by intravenous (3-amino-1-hydroxypropylidene)-1.1-bisphosphonic acid (APD). APD is a new drug analog of pyrophosphate; its main property is to block bone resorption, irrespective of its stimulus. As suspected by clinical and laboratory data and confirmed by arteriographic findings, surgery and pathologic examination, the underlying pathology was a mild primary hyperparathyroidism which was acutely worsened (parathyroid crisis) in the course of the trauma. Definitive treatment consisted of the removal of the adenoma responsible of the hyperparathyroidism.

Postoperative changes in plasma lipid profile have been studied in six patients undergoing aortobifemoral bypass. The second day after surgery, significant changes were: decreased levels of high density lipoprotein (HDL) cholesterol (by 55%), non HDL cholesterol (by 60%) phospholipid (by 50%), pre-beta-lipoprotein (by 70%), beta-lipoprotein (by 50%), apolipoprotein A1 (by 60%) and apolipoprotein B (by 55%). The magnitude of these changes correlated positively with serum levels of transferrin and negatively with serum levels of C-reactive protein. Triglyceride levels also showed a significant decrease (by 60%) while free fatty acids increased by 70%. Changes in triglyceride levels were not correlated with serum transferrin and C-reactive protein but showed a significant negative correlation with insulin levels. Our results suggest that both inflammatory and endocrine mediators are likely implicated in the postoperative changes in lipid profile.

We report one case of severe accidental hypothermia; rectal temperature was 25 degrees C. Hypoxemia unmodified by 100 O2 inhalation in an ordinary face-mask was easily corrected using a face-mask CPAP; a ventilation-perfusion mismatching could be implicated in the cold induced hypoxemia. Active rewarming (1.5 degrees C/h) was pursued from 25 to 37 degrees C, using non aggressive methods: warming blankets and a Bennett heated humidifier inserted in the CPAP system. Even in severe hypothermia successful results may be obtained without resort to sophisticated methods.