Marios E Daskalopoulos

Ondasetron versus haloperidol for the treatment of postcardiotomy delirium: a prospective, randomized, double-blinded study

BackgroundTo investigate the controlling efficacy of ondasetron and haloperidol in regard to the postcardiotomy delirium.MethodsWe included in this prospective, randomized, double-blinded study 80 patients who developed delirium after heart surgery with the application of heart lung-machine. The patients were divided into two, equally-sized groups, which on detection of delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively. The statistical analysis compared the baseline and demographic characteristics of the two groups (age, gender, comorbidities, years of education, type of surgery etc.).ResultsBoth ondasetron and haloperidol had very good delirium controlling effects, without statistically significant differences.Discussion-ConclusionsOndasetron and haloperidol are efficient agents as far as the treatment of postcardiotomy delirium is concerned. As, in addition, ondasetron bares milder side-effects, we believe this could be the agent of choice in patients developing postcardiotomy delirium in the future.

New frontiers in aortic therapy: focus on deliberate hypotension during thoracic aortic endovascular interventions.

From the *Department of Surgery, AHEPA Hospital, Aristotle University, Thessaloniki, Greece, Department of Surgery, McMaster University, Hamilton, Ontario, Canada, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, Division of Cardiac Surgery, Bad Neustadt, Germany; and ‖Division of Vascular Surgery, Thriasseio General Hospital, Athens, Greece. Address reprint requests to John G. Augoustides, MD, FASE, FAHA, Perelman School of Medicine, University of Pennsylvania, Department of Anesthesiology and Critical Care, 680 Dulles, HUP, 3400 Spruce Street, Philadelphia, PA 19104. E-mail: viandoc@hotmail.com

Coronary artery surgery in a man with achondroplasia: a case report.

IntroductionAchondroplasia is a musculoskeletal disorder associated with short stature. Despite an estimated prevalence of 1:25,000 in the general population, there is little literature concerning the diagnostic and treatment challenges faced by doctors dealing with a heart operation on a patient with this condition.Case presentationWe present the case of a 41-year-old Caucasian man of Greek ethnicity with achondroplasia, who underwent bypass heart surgery.ConclusionsThe surgery was successful and did not present particular difficulties, showing that heart surgery can be safely performed on people with achondroplasia.

An alternate solution for the treatment of ascending aortic aneurysms: the wrapping technique

BackgroundThe aortic Dacron wrapping technique is a surgical technique used under certain circumstances in cases of ascending aorta dilatation. Herein, we are presenting our experience on the method performed on multimorbid patients who denied major aortic surgery.MethodsWe included in our series 7 patients (5 male-2 female) with mild to moderate ascending aortic dilatation, who were operated with the wrapping technique. One patient was submitted to biological aortic valve replacement during the same procedure. The number of conventionally operated patients during the same period (2 years) was 21.ResultsMortality during the 18-months follow-up control was 0%. One patient had to be operated with biological aortic valve replacement 18 months after the initial wrapping operation, although the diameter of her ascending aorta remained stable.ConclusionsThe Dacron wrapping technique is a method that can alternatively be used in multimorbid patients with mild to moderate ascending aortic dilatation without dissecting elements and has generally good results.

Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe?

ObjectiveThe aim of the present study was to evaluate the efficacy of autologous blood pleurodesis in the management of persistent air leak in spontaneous pneumothorax.Patients and methodsA number of 15 patients (10 male and 5 female) were included in this prospective study between March 2005 and December 2009. The duration of the air leak exceeded 7 days in all patients. The application of blood pleurodesis was used as the last preoperative conservative method of treatment in 12 patients. One patient refused surgery and two were ineligible for operation due to their comorbidities. A blood sample of 50 ml was obtained from the patients femoral vein and immediately introduced into the chest tube.ResultsA success rate of 27% was observed having the air leak sealed in 4 patients in less than 24 hours.ConclusionDespite our disappointingly poor outcome, the authors believe that the procedures safety, convenience and low cost establish it as a worth trying method of conservative treatment for patients with the aforementioned pathology for whom no other alternative than surgery would be a choice.

Classic and non-classic forms of mitral valve prolapse.

OBJECTIVE To investigate the significance of the established distinction between classic and non-classic forms of mitral valve prolapsed (MVP). METHODS We included in this prospective study all patients examined in our preventive cardiology outpatient clinics during the biannual period October 2004-October 2006. We examined in total 10.818 patients, 238 of whom (2.2%) were diagnosed for MVP. We noted relevant demographic and clinical data (gender, age of diagnosis, symptoms, need for hospitalization) and performed statistical comparisons between patients with the classic and those with the non-classic form. Follow-up controls were performed three years afterwards. RESULTS Patients with the classic form had an earlier age of first diagnosis, more prominent symptoms, and more frequently diagnosis for other disorders (atrial septal defect, ventricular septal defect, Marfan syndrome, Ehlers-Danlos syndrome) than the rest of the patients; however, there were no significant differences as far as certain major complications (stroke, death, submission to surgery) were concerned. CONCLUSION The classic form of mitral valve prolapse is more tightly associated with morbid complications, and a more frequent follow-up control in this group of patients may be useful.

Why are heart operations postponed

AimTo investigate the reasons that lead to postponement of cardiac operations, in order to elucidate the problem and help patients through modes of prevention.Methods-DesignWe retrospectively included in the study all patients submitted to elective adult heart surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule.Results94 out of a total of 575 patients (16.34%) scheduled for elective cardiac operation had their procedure postponed. The reasons were mainly organisatory (in 49 cases, 52.12%), which in order of significance were: unavailability in operating rooms, shortage in matching erythrocyte units and shortage in anaesthetic/nursing staff. The rest of the cases (45, 47.88%) were postponed due to medical reasons, which in order of significance were: febrile situations, including infections of the respiratory, gastrointestinal and urinary system, problems with the regulation of antiplatelet and antithrombotic drugs, neurological manifestations such as stroke and transient ischaemic attacks, exacerbation of asthma/chronic obstructive pulmonary disease, arrhythmias, renal problems and allergic reactions to drugs. Patients with advanced age and increased Euroscore values were most possible to have their heart operation postponed.ConclusionsHeart operations are postponed due to organisatory as well as medical reasons, the latter mainly affecting older, morbid patients who therefore require advanced preoperative care.

Avoiding cardiopulmonary bypass does not protect against neuropsychiatric complications in elderly patients

Coronary artery bypass grafting in octogenarians: outcome with and without extracorporeal circulation. On behalf of the northwest regional cardiac surgery audit steering group. Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England. Does off-pump coronary artery bypass reduce mortality, morbidity and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. G. Reduced strokes in the elderly: the benefits of untouched aorta off-pump coronary surgery. FG. Predictors of surgical mortality and discharge status after coronary artery bypass grafting in patients 80 years and older. We would like to contribute our opinion on an important related issue, not emphasized in the present study w1x; more specifically that of neuropsy-chiatric complications in the elderly after heart surgery. It has long been believed that, especially for elderly patients, avoiding cardiopulmonary bypass during heart surgical procedures really protects them against this category of complications (stroke, TIA, cognitive decline, postoperative delirium). However, multiple recent studies conclude to the result that off-pump operated patients either have a slight temporary benefit (over a three-or six-month period) or no benefit at all as far as their total neurocognitive performance status is concerned w2, 3x. In any case, mid-and long-term follow-up studies (until up to five or six years postoperatively) show no differences between on-and off-pump operated patients in this matter. Moreover, their total cognition performance tends to match that of the age-and gender-related general population in the long-term w2–4x. In conclusion, another reason for the avoidance of cardiopulmonary bypass in the elderly is hereby abolished.tive and cardiac outcomes 5 years after off-pump vs. on-pump coronary artery bypass graft surgery. We read with great interest the article by Saleh et al. w1x comparing outcomes following on-pump and off-pump coronary artery bypass grafting (CABG) in octogenarians. The authors deserve credit for publishing their experience and adding to the seemingly sparse literature on this topic. In this series, the 6.7% overall mortality rate and relatively low incidence of postoperative complications compare favorably with published literature and may be due to factors related to patient selection. In addition, their results suggest that overall outcomes after CABG surgery within octogenarians have improved in recent times and that surgical myocardial revascularization can be performed safely and with acceptable operative risk using either on-pump or off-pump strategy. Cardiac surgery among octogenarian and other elderly patients is being increasingly undertaken in recent years. Despite encouraging …

How many lobes do you see

Accessory fissures represent a variation of the normal lung anatomy. Incomplete development or even the absence of the major or minor fissures can lead to confusion in distinguishing adjacent lobes. This report aims to present a rare intraoperative finding of an anatomic malformation of the right lung in a 19-year old male patient with recurrent pneumothorax who underwent a surgical repair. An accessory fissure which was separating the superior segment of the lower lobe from the basal segments gave to the whole lung the unique image of a four-lobed one. A profound knowledge of the accessory fissures, even if they are incidentally discovered, is of pivotal importance for the thoracic surgeon and leads to optimal operative assessment and strategic planning.

Hemorrhagic Shock as a Sequela of Splenic Rupture in a Patient with Infectious Mononucleosis: Focus on the Potential Role of Salicylates

Despite the fact that the vast majority of splenic ruptures are traumatic, infectious mononucleosis has been incriminated as a major predisposing factor that affects the integrity of the spleen, thus causing atraumatic ruptures and life-threatening hemorrhages. Herein we present a case of a 23-year-old Caucasian male who underwent an emergency laparotomy for acute abdomen and hemorrhagic shock, caused by spontaneous splenic rupture secondary to infectious mononucleosis. The potential role of salicylates in the development of a hemorrhagic complication in a patient with infectious mononucleosis is discussed.