Dysphagia associated with head and neck cancer
Margaret Walshe, Maggie-Lee Huckabee in Clinical Cases in Dysphagia, 2018
The patient reported that he was due for admission for elective cardiac thoracic surgery for an aortic valve replacement. Given the known history of silent aspiration, careful attention was paid to provide full and detailed handover to the speech and language therapy team at the cardiothoracic centre to ensure that the patient could be closely monitored during his postoperative recovery. The cardiac surgery was postponed in the first instance due to a further episode of pneumonia, and then due to a fall, which resulted in a fracture of the cervical spine. The spinal injury was managed at his local general hospital so, again, due diligence was required to provide accurate reports about swallowing status to the managing medical and speech and language therapy team. The patient was seen by the speech and language therapy team at the local hospital where thickened fluids were recommended in the absence of instrumental evaluation. This differing approach to dysphagia management may reflect the lack of experience of the local speech and language therapy team in managing HNC caseloads. Due to the cervical spine fracture, the patient required a neck brace for a number of months and he felt that the reduced mobility resulted in deterioration in swallowing function. All dysphagia rehabilitation exercises were discontinued. The cardiac surgery was undertaken almost six months later than initially scheduled. The postoperative course was complicated by a complete heart block requiring a pacemaker and a prolonged inpatient stay.
Deaths Following Cardiac Surgery and Invasive Interventions
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
This can occur 1–2 weeks after cardiac surgery, most often after CABG and mitral valve replacement. The most common symptoms are new/worsening pericardial effusions, pleuritic chest pain, and fever with raised inflammatory markers. Its features are identical to Dressler's syndrome following myocardial infarction. Surgical trauma and cardiopulmonary bypass trigger the systemic inflammatory response, with antiheart autoantigen release and the deposition of immune complexes in the pericardium thereby provoking the occurrence of PPS. Conservative treatment is associated with a higher recovery rate. Therapeutic options for the refractory cases are long-term oral corticoids or pericardiectomy. Cardiac tamponade or constriction develops in 0.1–6% of patients requiring surgery. Coronary artery and bypass graft occlusion, unstable angina and persistent pericardial pain have been described. The majority of patients respond to anti-inflammatory agents, and only a small proportion require pericardial drainage or pericardiectomy.
Cardiac CT and MRI: State of the Art
Phillip M. Boiselle, Charles S. White in New Techniques in Cardiothoracic Imaging, 2007
Cardiac MRI remains an important part of the imaging armamentarium because of its versatility and lack of ionizing radiation and iodinated contrast material (53). However, an adequate study requires that the patient remain in the magnet for some length of time. Acquisition of a diagnostic examination may be challenging in patients who are uncooperative or disoriented. However, if the patient is only mildly uncooperative, it is possible to obtain much useful information with fast imaging techniques, depending on the indication. Similar to MRI studies of other parts of the body, cardiac MRI is contraindicated in patients with a variety of foreign devices, including certain aneurysm clips, cochlear implants, and penile prostheses. MRI is also contraindicated in patients who have pacemakers or implantable cardioverter defibrillator (ICD) devices, although this limitation is being reconsidered. In general, MRI can be performed in patients who have prosthetic cardiac valves. Patients who have undergone recent cardiac surgery (coronary artery bypass graft or valve surgery) can probably be studied 1–2 weeks after the procedure, although this has not been documented conclusively.
Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery
Published in Disability and Rehabilitation, 2019
Isadora Salvador Rocco, Marcela Viceconte, Hayanne Osiro Pauletti, Bruna Caroline Matos-Garcia, Natasha Oliveira Marcondi, Caroline Bublitz, Douglas William Bolzan, Rita Simone Lopes Moreira, Michel Silva Reis, Nelson Américo Hossne, Walter José Gomes, Ross Arena, Solange Guizilini
Recent studies have utilised 6MWT while simultaneously performing mobile telemetric cardiopulmonary monitoring in order to investigate oxygen uptake (VO2) responses (a gold standard). During the 6MWT patients are encouraged to maintain a constant walking speed, allowing for the assessment of the VO2 transition from rest to exercise, otherwise known as VO2 on-kinetics [8]. VO2 on-kinetics is slower in individuals with pulmonary and cardiac diseases due to impaired supply of oxygen to the working muscles. The worse response to the increase in oxygen demand lead to lower exercise capacity with early symptoms of dyspnea and fatigue [9–11]. Thus, VO2 evaluation imply in better knowledge of cardiovascular and metabolic profile of patients. To the best of our knowledge, no study has evaluated the VO2 on-kinetics during the pre-operative in-hospital period in patients scheduled for cardiac surgery. We hypothesised that patients with slower VO2 on-kinetics during 6MWT could evolve with worse outcomes following cardiac surgery.
Effects of remote ischemic preconditioning on platelet activation and reactivity in patients undergoing cardiac surgery using cardiopulmonary bypass: a randomized controlled trial
Published in Platelets, 2022
Youn Joung Cho, Karam Nam, Sol Ji Yoo, Seohee Lee, Jinyoung Bae, Ji-Young Park, Hang-Rae Kim, Tae Kyong Kim, Yunseok Jeon
Eligible patients were adult patients (age >18 years) who were scheduled for cardiac surgery using CPB at Seoul National University Hospital. Cardiac surgery included cardiac valve surgery, aorta replacement, intracardiac mass excision, and combined surgical procedures, using CPB. Patients were excluded if they met any of the following criteria: preoperative left ventricular ejection fraction <30% or receipt of mechanical ventricular support; presence of peripheral vascular disease or poorly controlled diabetes; use of non-steroidal anti-inflammatory drugs within 3 days, intravenous heparin within 6 h, low-molecular-weight heparin within 24 h, or platelet inhibitors within 24 h prior to surgery; known thrombocytopenia or platelet dysfunction; end-stage renal disease or requirement for hemodialysis; active infectious disease; pregnancy; or refusal to participate (Figure 1).
Evaluation of platelet count and platelet function analyzer – 100 testing for prediction of platelet transfusion following coronary bypass surgery
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2020
Dejana Bogdanić, Nikolina Bogdanić, Nenad Karanović
Patients undergoing cardiac surgery are at increased risk for excessive bleeding and associated complications [1]. Efficient prevention and treatment of the cause of bleeding is an important issue [2]. Impaired platelet function is considered to be one of the most important factors leading to postoperative bleeding and patients often require platelet (PLT) transfusions because of a reduction in platelet count and function [3,4]. A high platelet red cell transfusion ratio seems to improve patient outcomes [5]. There is a lack of clinical evidence establishing the effectiveness of administering PLT units in cardiac surgery as well as the lack of consensus on the indication for a PLT transfusion [6]. The amount of red blood cell (RBC) unit, fresh frozen plasma (FFP) and bleeding volume was found to be significantly reduced in the viscoelastic haemostatic assays (VHA) – guide patients, whereas it was not found reduced in these patients for PLT transfusion requirements or mortality [7]. Transfusion algorithms that incorporate a test of platelet function have been the most successful in reducing PLT transfusions after surgery [8]. Identifying a method for assessing the effectiveness of PLT transfusion might yield clinical benefits and help to transfuse them at the right dose for the right patient.
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