Guy Dekoster

SMA circuits reduce platelet consumption and platelet factor release during cardiac surgery

BACKGROUND Platelet count and function are particularly damaged by cardiopulmonary bypass (CPB). This study evaluated the effects of a novel CPB circuit in terms of platelet count and activation, and postoperative need for blood products. METHODS One hundred patients undergoing coronary grafting were randomized in two groups: control group (n = 50) and test group (n = 50, surface modifying additives circuit, SMA group). Blood samples were taken before, during, and after CPB. Postoperative blood loss, number of transfused blood products, and postoperative variables were recorded. RESULTS The platelet count decreased less in the SMA group compared to the control group (end of CPB: respectively, 165 +/- 9 x 10(3)/mm3 vs 137 +/- 8 x 10(3)/mm3; p < 0.01). This was paralleled by a reduction in beta-thromboglobulin plasma levels in the SMA group. There was a trend to decreased blood loss in the SMA group, but the difference was significant only in patients taking aspirin preoperatively (p < 0.05). In the SMA group nearly 50% less fresh frozen plasma and platelet units were administered (p < 0.01). No operative deaths were observed. CONCLUSIONS The use of circuits with surface additives is clinically safe, preserves platelet levels, and attenuates platelet activation. This may lead to a reduced need for blood products.

Catamenial Pneumothorax : a Case Report and Review of the Literature

Abstract Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Treatment is medicosurgical: thoracoscopy for pleural abrasion and hormonotherapy to avoid recurrence.

Pseudoaneurysm of the High Extracranial Internal Carotid Artery: A Case Report and Literature Review

A case of pseudoaneurysm of the cervical internal carotid artery in a sixteen- year-old girl is reported. The enormous neck mass was initially misdiagnosed as a lymphomatous tumor; neck biopsy was compounded by a massive hemor rhage. The neck wound became secondarily infected, rendering the pseu doaneurysm mycotic. In the presence of infection any attempt of vascular reconstruction was pointless, so the internal carotid artery was doubly ligated. Recovery was uneventful, without neurologic deficit.

Extended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases.

Abstract Background : Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre’s investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. Methods : A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. Results : The mean age of the patients at surgery was 34 years (range, 9–63) and 78.9% were female. Mean length of follow up was 86 months (range, 24–163). The overall complication rate was 10.6% (1 episode of atrial fibrillation and a left recurrent laryngeal nerve palsy that resolved after the first postoperative month). There was no operative mortality. The mean hospital stay was 9.4 days (range, 5–23). The crude CR rate was 32% (n = 6). The Kaplan-Meier estimate of CR was 42% at 6 years. Age, gender, duration of symptoms, thymic histology, Osserman stage and the presence of thymoma were not identified as prognostic variables. The average daily dose of Medrol® and Mestinon® decreased significantly between the pre-operative period and the last follow-up (Medrol®, p = 0.0081; Mestinon®, p = 0.0013). Conclusions : Transsternal thymectomy for MG is safe and effective. It benefits patients with MG at all stages. Patients with thymoma are not associated with poorer remission rates. Complete responses are durable, as the CR rate remains stable over time.