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      Gastrointestinal Emergencies in Cardiac Surgery

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          Abstract

          Objectives: The aim of this study is to retrospectively analyze risk factors, diagnosis and management of gastrointestinal (GI) complications following cardiac operations. Methods: Patients who developed GI complications after a cardiac operation were studied. Anesthesia protocols, techniques of cardiac surgery, potential risk factors, complications and medical and surgical interventions were reviewed and analyzed. Results: Out of 3,724 consecutive patients undergoing heart operations during an 8-year period, 33 patients developed GI complications. Eleven patients developed ischemic colitis, 8 cholecystitis, 6 GI bleeding, 4 liver failures, 3 pancreatitis and 1 esophageal hernia. Patients with GI complications had a lower mean ejection fraction compared to patients not developing these complications (45.1 vs. 49.7%, p < 0.01). Also, patients undergoing an urgent cardiac operation were significantly more likely (3.49 times more likely) to develop GI complications postoperatively. Of the 33 affected patients, 18 were treated conservatively and 15 underwent an emergency exploratory laparotomy. Overall mortality was 12% (4 patients). Conclusions: Intestinal ischemia and cholecystitis appear to be the most frequent GI complications associated with cardiac surgery. Risk factors include a low ejection fraction and an urgent cardiac operation. Early recognition and treatment of these complications may reduce mortality.

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          Most cited references 11

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          Off-pump bypass graft operation significantly reduces oxidative stress and inflammation.

          This study investigated whether off-pump coronary bypass graft operations on the beating heart under normothermic conditions reduces the systemic oxidative stress and inflammatory reaction seen in patients operated under cardiopulmonary bypass (CPB). A cardiac stabilizer (Octopus Tissue Stabilizer; Medtronic Inc, Minneapolis, MN) was used to perform the coronary anastomoses on the normothermic beating heart with or without CPB. Serial blood samples were taken at various intervals. Plasma was analyzed for several oxidative stress and inflammatory markers. Significant increases from prior anesthesia values of lipid hydroperoxides (190% at 4 hours), protein carbonyls (250% at 0.5 hours) and nitrotyrosine (510% at 0.5 hours) were seen in the CPB group, but they were abolished or significantly reduced in the off-pump group. Complement C3a and elastase levels were rapidly increased upon the institution of CPB, and this was followed by increases in IL-8, TNF-alpha, and sE-selectin. In contrast, the rise of these factors was blunted in patients operated without CPB. Off-pump coronary bypass graft operation on a beating heart significantly reduces oxidative stress and suppresses the inflammatory reaction associated with the use of CPB.
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            Vasoactive mediators and splanchnic perfusion.

            To provide an overview of the splanchnic hemodynamic response to circulatory shock. Previous studies performed in our own laboratory, as well as a computer-assisted search of the English language literature (MEDLINE, 1966 to 1991), followed by a selective review of pertinent articles. Studies were selected that demonstrated relevance to the splanchnic hemodynamic response to circulatory shock, either by investigating the pathophysiology or documenting the sequelae. Article selection included clinical studies as well as studies in appropriate animal models. Pertinent data were abstracted from the cited articles. The splanchnic hemodynamic response to circulatory shock is characterized by a selective vasoconstriction of the mesenteric vasculature mediated largely by the renin-angiotensin axis. This vasospasm, while providing a natural selective advantage to the organism in mild-to-moderate shock (preserving relative perfusion of the heart, kidneys, and brain), may, in more severe shock, cause consequent loss of the gut epithelial barrier, or even hemorrhagic gastritis, ischemic colitis, or ischemic hepatitis. From a physiologic standpoint, nonpulsatile cardiopulmonary bypass, a controlled form of circulatory shock, has been found experimentally to significantly increase circulating levels of angiotensin II, the hormone responsible for this selective splanchnic vasoconstriction. While angiotensin II has been viewed primarily as the mediator responsible for the increased total vascular resistance seen during (and after) cardiopulmonary bypass, it may also cause the disproportionate decrease in mesenteric perfusion, as measured in human subjects by intraluminal gastric tonometry and galactose clearance by the liver, as well as the consequent development of the multiple organ failure syndrome seen in 1% to 5% of patients after cardiac surgery.
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              Clinical improvement of HIV-associated psoriasis parallels a reduction of HIV viral load induced by effective antiretroviral therapy.

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2008
                August 2008
                31 March 2008
                : 111
                : 2
                : 94-101
                Affiliations
                Departments of aSurgery and bAnesthesiology, Aretaieio University Hospital, Athens Medical School, University of Athens and cDepartment of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
                Article
                119696 Cardiology 2008;111:94–101
                10.1159/000119696
                18376120
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 8, References: 19, Pages: 8
                Categories
                Original Research

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