Search

Table of Contents Abstract Introduction Material and methods Results Discussion References Abstract Cold agglutinins (CA) represent IgM antibodies, which reversible interact with antigens on autologous erythrocytes at low temperatures. Most [...]

Abstract Cold agglutinins (CA) represent IgM antibodies, which reversible interact with antigens on autologous erythrocytes at low temperatures. Most patients with CA remain asymptomatic, but in patients with high-titer and [...]

Supplemental Digital Content is available in the text

Objective Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure and is associated with increased morbidity and in-hospital mortality. Some recent studies identified female sex as a risk factor of CIN. The aim of this study was to determine the relative impact of female sex on the development and clinical outcome of CIN in patients with preexisting renal impairment after transapical transcatheter aortic valve implantation (TAVI).Methods From February 2008 to February 2011, a total of 55 TAVI patients [82.4 (6.5) years] with preprocedural serum creatinine level of greater than 1.1 mg/dL were retrospectively investigated. The incidence of postprocedural CIN, lengths of intensive care unit and hospital stay, and short-term mortality among men and women were compared. Contrast-induced nephropathy was defined as a creatinine increase of greater than 0.5 mg/dL or greater than 25% from baseline within 3 days after contrast medium (CM) exposure.Results The women had significantly lower body surface area [1.8 (0.18) vs 1.95 (0.17) m2; P= 0.002), lower hemoglobin levels [11.5 (1.3) vs 12.7 (1.6) g/dL, P< 0.001], and lower estimated glomerular filtration rate [34.2 (9.7) vs 49.4 (12.3) mL/min per 1.73 m2, P= 0.002]. The amount of CM given was significantly higher in the women relative to body surface area [67.3 (42.5) vs 48.3 (16.6) mL/m2, P= 0.043]. The women received a higher number of blood cell transfusion units [4.4 (3.4) vs 2.1 (2.7) U, P= 0.006]. The frequency of CIN within 72 hours after CM exposure was significantly higher in the women (62.1% vs 26.9%, P= 0.009). A total of 31% of the women (n = 9) versus 7.7% of the men (n = 2) needed hemodialysis (P= 0.031). Analysis of the postoperative morbidity in terms of length of intensive care unit and hospital stay revealed no significant difference between the two groups. Mortality results reached a significant difference at 60 days, with 31% (n = 9) mortality in the women compared with 7.7% (n = 2) in the men (P= 0.031).Conclusions Women with preexisting renal impairment are at higher risk than men for CIN, with resultant higher early mortality after transapical TAVI.

Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation (AF). A prospective cohort study was performed containing 149 patients (n=73 statin group vs. n=76 control group) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF. Measured outcomes were freedom from AF in the intensive care unit, discharge and at three and six months follow-up and perioperative markers of inflammation (white blood cell count, C-reactive protein). Independent predictors for freedom from AF were assessed. Groups did not differ with respect to EuroSCORE, New York Heart Association class, left atrial size, anti-arrhythmic drug therapy or aortic cross-clamp time. Statin therapy had no impact on postoperative inflammatory markers. Freedom from AF was more frequent in the statin group at discharge (P=0.07) and after three and six months (P<0.05). Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months (P<0.05). Importantly, statin-pretreatment was independently predictive for freedom from AF at discharge [odds ratio (OR): 3.21; 95% confidence interval (CI): 1.2-8.55; P=0.02] and at three months (OR: 2.91; 95% CI: 1.14-7.45; P=0.026). Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients.

Pneumomediastinum or mediastinal emphysema is a known complication of traumatic injury or disease whereas spontaneous pneumomediastinum remains a rare clinical entity. We present the case of a young woman with a diagnosis of spontaneous pneumomediastinum combined with cervical emphysema without any precipitating factors or disease.

Supplemental Digital Content is available in the text.

In the presented case, a screw-in pacemaker lead migrated through the right ventricle, pericardium, left hemidiaphragm, and the left liver lobe into the epigastric region. The rarity of the case is based upon the multiorgan perforation without development of relevant pericardial effusion or intra-abdominal bleeding. Lead extraction was performed uneventfully.

Severe myocardial dysfunction after blunt head injury is a rare but potentially lethal complication. We describe remarkable myocardial recovery after severe hemodynamic deterioration in a young man with brain injury, due to extracorporeal membrane oxygenation support. Because of the severity of brain damage, the patient succumbed after diagnosis of brain death. Postmortem histopathological examination of the heart showed severe myocardial necrosis.