Abstract Background: Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Methods: This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients’ demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. Results: Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. Conclusions: Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.

Abstract Background: The genetic polymorphisms of the alpha-2A adrenergic receptor (ADRA2A), which plays a significant role in sedation, anxiety relief, and antinociception, particularly in dexmedetomidine, may differ in the degree of sedation. This study aimed to investigate the effect of the genetic polymorphisms of ADRA2A (rs11195418, rs1800544, rs2484516, rs1800545, rs553668, rs3750625) on the sedative effects of dexmedetomidine. Methods: A total of 131 patients aged 50 years or more from May 2018 to August 2019 were included in this study. The ADRA2A gene variants were evaluated using the TaqMan Assay. Dexmedetomidine diluted in normal saline to a concentration of 4 µg.mL-1 was infused at a dose of 2 µg.kg-1 to achieve procedural sedation (modified Ramsay sedation scale 4 [mRSS 4]). Results: A total of 131 patients were evaluated. The genetic polymorphisms (rs11195418) of the ADRA2A receptor gene demonstrated no variation in our participants. The ADRA2A receptor gene polymorphisms (rs1800544, rs2484516, rs1800545, rs553668, and rs3750625) exhibited no differences in total dexmedetomidine doses (p > 0.217), bispectral index at mRSS 4 (p > 0.620), and time to obtain mRSS 4 (p > 0.349). Conclusion: This study suggested that the genetic polymorphisms of ADRA2A did not affect the sedative efficacy of dexmedetomidine.

Abstract Background and objective Advances in surgical technique, postoperative management, and immunosuppressive therapy have led to a steady increase in the number of patients undergoing organ transplantation. This study aimed to compare the incidence of postoperative complications between young and elderly patients undergoing liver transplantation (LT) at a single university hospital. Method The medical records of 253 patients who underwent LT between January 2010 and July 2017 were retrospectively reviewed. The patients were divided into two groups: those younger than 65 years (group Y, n = 231) and those older than 65 years (group O, n = 22). Data on patient demographics, perioperative management, and postoperative complications were collected. Results The patients' baseline characteristics, including underlying diseases and the Model for End-Stage Liver Disease scores, were not different between groups. Preoperative laboratory findings were not significantly different between the two groups, except for hemoglobin level. The total amounts of infused fluid and packed red blood cells were higher in group O than in group Y. The postoperative plasma creatinine level was higher in group O than in group Y; however, the incidence of postoperative complications was not considerably different between the two groups. In addition, there was no difference in the survival rate after LT depending on age. Conclusion With the development of medical technology, LT in elderly patients is not an operation to be avoided, and the prognosis is expected to improve. Therefore, continuous efforts to understand the disease characteristics and physical differences in elderly patients who require LT are essential.

RESUMO OBJETIVO: Determinar os sinais de CT associados à perfuração estercoral e perfuração do câncer colorretal. MÉTODOS: De maio de 2003 a fevereiro de 2015, todos os pacientes cirurgicamente e patologicamente confirmados com perfuração estercoral (n = 8, idade média de 68,3 anos) ou perfuração de câncer de cólon (n = 11, idade média de 66,3 anos) foram revisados retrospectivamente por dois radiologistas certificados por placa cegados ao diagnóstico comprovado. Os seguintes achados CT foram avaliados e gravados para cada paciente: espessura da parede do cólon distal adjacente ao local da perfuração, padrão de espessamento e realce da parede do cólon, comprimento da parede intestinal espessada, presença de fecaloma, grau de dilatação do cólon proximal e inflamação pericolônica ou presença de abscesso pericolônico e número de linfonodos pericolônicos aumentados. Esses achados foram correlacionados com o diagnóstico patológico. RESULTADOS: A espessura média da parede colônica distal adjacente ao local de perfuração foi de 13,6 mm em pacientes com perfuração de câncer colorretal e 5,1 mm com perfuração estercoral, que foi estatisticamente diferente. Houve uma correlação significativa entre a perfuração do câncer colorretal e o espessamento da parede excêntrica (p < 0,01). Os achados de CT de espessamento de parede aprimorada em camadas (p < 0,01) e presença de fecaloma no cólon proximal (p < 0,01) foram achados significativos para perfuração estercoral. Os pacientes com câncer colorretal apresentaram mais linfonodos pericolônicos (média 2,27, p < 0,05). CONCLUSÃO: O fecaloma no cólon proximal e o espessamento da parede que aumenta a camada adjacente ao local da perfuração são provavelmente devidos à perfuração estereocálica. O espessamento da parede intestinal excêntrica na porção distal do local da perfuração com muitos gânglios linfáticos pericolônicos aumentados é provavelmente a perfuração do câncer colorretal.

SUMMARY OBJECTIVE: To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. MATERIALS AND METHODS: From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. RESULTS: The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). CONCLUSION: Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.

Resumo Justificativa e objetivo A previsão de perda sanguínea excessiva no pós-operatório é útil para o manejo em Unidade de Terapia Intensiva (UTI) após cirurgia cardíaca. O objetivo do presente estudo foi examinar a eficácia do sistema de classificação da Sociedade Internacional de Trombose e Hemostasia (International Society on Thrombosis and Hemostasis - ISTH) em pacientes submetidos à cirurgia cardíaca. Método Após obter a aprovação do Comitê de Pesquisa Institucional, os prontuários de pacientes submetidos à cirurgia cardíaca eletiva com circulação extracorpórea (CEC) entre março de 2010 e fevereiro de 2014 foram retrospectivamente revisados. O escore ISTH foi calculado na UTI e os pacientes foram alocados em dois grupos: grupo com coagulação intravascular disseminada (CID) manifesta e grupo com CID não manifesta. Para avaliar a correlação com a Perda Estimada de Sangue (PES), o teste t de Student e as análises de correlação foram usados. Resultados Dentre os 384 pacientes submetidos à cirurgia cardíaca, 70 com CID manifesta (n = 20) ou CID não manifesta (n = 50) foram incluídos. As médias dos escores CID na admissão na UTI foram 5,35 ± 0,59 (Grupo CID manifesta) e 2,66 ± 1,29 (Grupo CID não manifesta) e induzida CID manifesta em 29% (20/70). O grupo CID manifesta apresentou PES superior durante 24 horas (p = 0,006) e um tempo maior de intubação (p = 0,005). Conclusão Apesar da limitação do desenho retrospectivo, o uso do escore ISTH para o manejo de pacientes após cirurgia cardíaca parece ser útil para prever a perda sanguínea excessiva pós-CEC e o prolongamento da intubação traqueal.

Abstract Background and objective Prediction of postoperative excessive blood loss is useful for management of Intensive Care Unit after cardiac surgery. The aim of present study was to examine the effectiveness of International Society on Thrombosis and Hemostasis scoring system in patients with cardiac surgery. Method After obtaining approval from the institutional review board, the medical records of patients undergoing elective cardiac surgery using Cardio-Pulmonary Bypass between March 2010 and February 2014 were retrospectively reviewed. International Society on Thrombosis and Hemostasis score was calculated in intensive care unit and patients were divided with overt disseminated intravascular coagulation group and non-overt disseminated intravascular coagulation group. To evaluate correlation with estimated blood loss, student t-test and correlation analyses were used. Results Among 384 patients with cardiac surgery, 70 patients with overt disseminated intravascular coagulation group (n = 20) or non-overt disseminated intravascular coagulation group (n = 50) were enrolled. Mean disseminated intravascular coagulation scores at intensive care unit admission was 5.35 ± 0.59 (overt disseminated intravascular coagulation group) and 2.66 ± 1.29 (non-overt disseminated intravascular coagulation group) and overt disseminated intravascular coagulation was induced in 29% (20/70). Overt disseminated intravascular coagulation group had much more EBL for 24 h (p = 0.006) and maintained longer time of intubation time (p = 0.005). Conclusion In spite of limitation of retrospective design, management using International Society on Thrombosis and Hemostasis score in patients after cardiac surgery seems to be helpful for prediction of the post- cardio-pulmonary bypass excessive blood loss and prolonged tracheal intubation duration.

Justificativa e objetivo: O presente estudo teve como objetivo avaliar se a profundidade de inserção de cateter em veia subclávia (VSC) direita pode ser prevista de forma confiável pelas distâncias do local de inserção na VSC até a incisura clavicular ipsilateral (I-IC), passando diretamente pela parte superior do arco da VSC ou da clavícula (denominadas i-T-IC e i-C-IC, respectivamente). Método: No total, 70 cateterismos de VSC foram estudados. As distâncias I-IC, I-T-IC e I-C-IC de cada caso foram mensuradas após a inserção do cateter guiada por ultrassom. O comprimento do cateter entre o local de inserção e a incisura clavicular ipsilateral (L) foi calculado por meio de radiografia. Resultados: As diferenças em centímetros de L em relação às distâncias I-T-IC, I-C-IC e I-IC foram de 0,14±0,53; 2,19±1,17 e 0,45±0,68 respectivamente. A média de I-IC foi significativamente menor que L, enquanto a média de I-C-IC foi significativamente maior. A análise de regressão linear forneceu a seguinte fórmula: Comprimento previsto da inserção de cateter em VSC (cm) = -0,037 + 0,036 × Altura (cm) + 0,903 × I-T-IC (cm) (r2 ajustado = 0,64). Conclusão: A distância I-T-IC pode ser um preditivo confiável do comprimento de inserção ideal para canulação em VSC direita.

Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV) catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC), via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively). Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89). The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm) = -0.037 + 0.036 × Height (cm) + 0.903 × I-T-IC (cm) (adjusted r2 =0.64). Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

Introducción y objetivo: El presente estudio tuvo como objetivo evaluar si la profundidad de inserción de catéter en vena subclavia (VSC) derecha puede ser prevista de forma confiable por las distancias del lugar de inserción en la VSC hasta la incisión clavicular ipsilateral (denominada I-IC), pasando directamente por la parte superior del arco de la VSC o de la clavícula (denominadas I-T-IC y I-C-IC, respectivamente). Método: En total se estudiaron 70 cateterismos de VSC. Las distancias I-IC, I-T-IC e I-C-IC de cada caso fueron medidas después de la inserción del catéter guiada por ultrasonido. La extensión del catéter entre la región de inserción y la incisión clavicular ipsilateral, denominada L, fue calculada por medio de radiografía. Resultados: Las diferencias en centímetros de L con relación a las distancias I-I- IC, I-C-IC e I-IC fueron de 0,14±0,53, 2,19±1,17 y 0,45±0,68, respectivamente. La media de I-IC fue significativamente menor que L, mientras que la media de I-C-IC fue significativamente mayor. El análisis de regresión linear suministró la siguiente fórmula: Extensión prevista de la inserción de catéter en VSC (cm) = -0,037 + 0,036 × altura (cm) + 0,903 × I-T-IC (cm) (r2 ajustado = 0,64). Conclusión: La distancia I-T-IC puede ser un predictor confiable de la extensión de la inserción ideal para la canalización en la VSC derecha.