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Background Postoperative pulmonary complications (PPCs) often occur after cardiac operations and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures occur to reduce PPCs. One device usually used for this reason is incentive spirometry (IS). The aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients. Methods This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room. Result The study findings showed a significant difference between the IS and control groups in the incidence of postoperative atelectasis. There were 8 patients (20.0%) in IS group and 17 patients (42.5%) in the control group (p = 0.03). Mechanical ventilation duration was significantly less in IS group. The median was four hours versus six hours in the control group (p p p Conclusion Preoperative incentive spirometry for two days along with the exercise of deep breathing, encouraged coughing, and early ambulation following CABG are in connection with prevention and decreased incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant. Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020—retrospectively registered.

Introduction Complications following Cardiopulmonary resuscitation (CPR) are rare and usually follows a vigorous CPR or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform CPR in pregnancy. One of this complication is diaphragmatic rupture with herniation of abdominal organs. Surgical intervention needs to be planned carefully in multidisciplinary team approach and requires fine surgical techniques for better outcome. There are few reported cases of diaphragmatic rupture after Cardiopulmonary resuscitation but none in pregnant woman. Case presentation We report a rare case of diaphragmatic rupture in a 29-year-old pregnant patient who experienced a full-blown diaphragmatic defect and herniation of the abdominal organs into the thoracic cavity, as a complication of CPR. Following careful assessment and diagnosis, the patient underwent urgent laparotomy with reduction of the contents and primary closure of the defect. One year follow up was satisfactory. To the best of our knowledge, this is the first reported case of diaphragmatic rupture with herniation of the abdominal organs following CPR in a pregnant woman in the literature. Conclusion The application of external cardiac massage through CPR is a life-saving procedure for the management of cardiac arrest. Common complications related to CPR include rib fractures, sternal fractures and haemothorax. Diaphragmatic rupture with herniation of the abdominal organs is a rare complication, having been reported only once in the literature (Sabzi F, Faraji R, Tanaffos 16:170–172, 2017); however, it represents a serious and life-threating event. Thus, careful evaluation of the patient by a multidisciplinary team and prompt intervention is recommended in order to improve outcomes.

Background Idiopathic pulmonary artery aneurysm is a rare anomaly with only a handful reports in the literature. It is often asymptomatic, while the first presentation could be severe hemoptysis or death. Surgical intervention needs to be planned carefully with a multidisciplinary team approach to secure optimal outcome. We hope to spread our experience with such cases and to encourage other surgeons worldwide to deal surgically with these cases when its indicated. Case presentation A 47 years old man presented to our institution after three episodes of hemoptysis, echo demonstrated good left ventricle (LV) systolic function, normal right ventricle (RV) size and function, Chest computed tomography (CT) revealed aneurysmal dilatation with pending rupture of the pulmonary artery trunk (4.5 cm), the left pulmonary artery (6 cm) and the right pulmonary artery (2.3 cm). The patient successfully underwent replacement of Pulmonary artery trunk, left pulmonary artery and right pulmonary artery by Wovex Prosthetic graft (28 mm). The patient discharged home on the eight postoperative day in good clinical condition . Conclusion With this case report we wish to emphasize the need for a careful multidisciplinary approach given the complex and rare nature of the reported pathology. Electronic supplementary material The online version of this article (10.1186/s13019-018-0791-9) contains supplementary material, which is available to authorized users.

Antegrade cannulation of peripheral veins is the usual practice. Blood stasis between a catheter and the wall of the vein or at its tip in addition to catheter-induced phlebitis may initiate a thrombosis. The use of retrograde ventriculojugular shunts against the direction of the blood flow with resultant decrease in the incidence of venous thrombosis encouraged us to compare retrograde versus conventional antegrade peripheral venous cannulation.Monocentric, nonblinded, prospective observational cohort of 40 intensive care unit patients receiving 2 peripheral venous catheters in upper limbs, 1 inserted in the direction of blood flow (antegrade cannula) and the other inserted in an opposite direction to blood flow (retrograde cannula). Daily ultrasound assessment of the angle between the catheter and the vascular wall was done to detect onset and progression of thrombus formation.The study included 40 patients, aged 46.7 ± 10.132 years. The incidence of thrombus formation was 100% in both techniques. The onset time of thrombus formation between the catheter and the wall of a vein was significantly longer with the retrograde catheters than with the antegrade catheters with median time (interquartile range [range]) 6 days (5-6.75 [4-8]) with 95% confidence interval (CI), 5.58-6.42 vs 3 days (3-4 [2-5]) with 95% CI (2.76-3.24), respectively, with a P value.001. The time needed by the recently detected thrombus to reach the catheter tip determined by ultrasound with or without catheter failure was significantly longer in the retrograde catheters than in the antegrade catheter with median time (interquartile range [range]) 9 days (8-9 [7-10]) with 95% CI, 8.76-9.24 vs 4 days (4-5 [3-6]) with 95% CI, 3.76-4.24, respectively, with a P value.001.Retrograde cannulation did not decrease the incidence of thrombus formation, but significantly increased the onset time until thrombus formation and prolonged the time needed by the newly formed thrombus to reach the catheter tip compared with conventional antegrade cannulation.

This is the first time the concept of total quality management in burn injuries is proposed. This is a prospective study done in 1997-2003. All burn admissions to King Fahd Hospital of the University, Division of Plastic Surgery, were included. Total number of cases is 240. Male patients constituted 141 (59.2%); female patients, 97 (40.8%), and 2 cases were not specified in forms. There were 114 children (0-18 years, 50.2%) and 113 adults (19-99 years, 49.8%). The source of admission was mainly emergency room (197, 82%) followed by outpatient department (27, 11.3%), and other hospitals in 16 (6.7%). The type of burn was mainly scald (16.3%), then flame (6.98%), electrical (6.5%), chemical (2.8%), friction (0.47%), and not specified in 33% of recorded cases. The most encountered body percentage burn was 1% to 10% and 11% to 20% in 36.7% and 25.9% of cases, respectively. Sixty-six cases (28.2%) were operated on. The reason for nonoperation was not indicated in 78.5% and refusal in 1.8%. The most frequent operation was split-thickness skin grafting followed by tangential excision + split-thickness skin grafting. Operations took mostly about 2 hours (53.8%). The region operated on was mainly upper limbs (42.6%), then head and neck (27.7%). The affected body part in electrical burns was upper limb, then the head. Preoperative photography was done in 17% and post operatively in 9.4% of recorded cases. Consultations were needed in 39.4% and responded to in 48 hours in 98.2% of them. Discharge was home in 80.9%, against medical advice in 7.5%, died in 7%, transferred in 4%, and other ward in 0.5%. No significant difference was observed between pediatric age groups and adults (>18 years old), also for electrical versus nonelectrical burns in relation to total hospital stay. Similar observations were made among various age groups with respect to total hospital stay. The clinicopathologic typing relation to age groups, nationality, and sex was found significant. Recommendations and the newly proposed zone of practice and concept of total quality management in burn injuries are included. Language: en

Background: The primary goal of cardiac surgery is not just a minimally acceptable outcome where the patient survives without life threatening complications, but a healthy productive long term survivor. There is no universally accepted technique for anesthesia management during cardiac surgery,Anesthetic protocols in cardiac surgery are investigated and analyzed in terms of their effect on post-operative mortality and incidence of myocardial infarction following cardiac surgery, needs for inotropic support, time to extubation, time on mechanical ventilation, and hospital length of stay. Fast–track tracheal extubation (within 6 hours after the surgery) after cardiac surgery has become a methods which is believed to facilitate this must be validated. One of these methods, is the use of intra-operative monitoring Modalities, such as (BIS) which is a value derived from electroencephalogram, and had been used as a measure of anesthesia effect. We performed this study in An-najah National University Hospital / Palestine to investigate the role of BIS monitoring on time to extubate and CCU length of stay after cardiopulmonary bypass surgery. Methods: In a randomized control study we used the bispectral index monitoring during cardiopulmonary bypass between 40-50 and in the CCU between 60-70 until extubation. 100 patients between the age of 30 and 75 years undergoing elective cardiopulmonary bypass surgery and patients undergoing elective valve replacement or repair, from 01/10/2015 to 01/04/2016 were assigned for this study, randomized to 50 patients each in the BIS group and the conventional group. Results: Extubation time data were available for 100 patients. The median time to extubate (320) minutes in the BIS group and (365) minutes in conventional group. The median CCU length of stay (24.1) hours in BIS group and (24.3) hours in conventional group. Regarding hospital length of stay, there was no difference in between the two groups, with median time of (5 days) in both groups. Conclusions: Data from this study suggested that the use of the BIS monitor during cardio pulmonary bypass does not confer an advantage in reducing time to extubation, CCU length of stay, or overall hospital length of stay.

We present a series of 40 cases who underwent reconstructive procedures using rectus abdominis myocutaneous units. The transplanted tissue comprised superior pedicle (26 cases), inferior pedicle (11 cases), and as free muscle flap (3 cases). The application fell into three groups i.e.; 1. breast and chest wall reconstruction; 2. groin, genital, and trochanteric area; and 3. leg and heel ulcer. The results show that surgical dissection of flaps is relatively easy and has a wide range of applications that can be used for different surgical reconstructive problems. Surgical dissection has a low incidence of complication for flap viability as well as for donor site.