Biomedical subjects

D Abrahamov

Publications and source records attributed to D Abrahamov.

4 recordsLinked to original sources

PubMed2002

Plasma vascular endothelial growth factor level is a predictor of the severity of postoperative capillary leak syndrome in neonates undergoing cardiopulmonary bypass.

Capillary leak syndrome (CLS), characterized by extravascular fluid accumulation and significant organ dysfunction, is a serious complication in children undergoing cardiopulmonary bypass (CPB). We examined the relationship between plasma vascular endothelial growth factor (VEGF) levels and severity of CLS. The kinetics of VEGF in the plasma of 11 neonates and 7 older children undergoing CPB were investigated, correlating plasma VEGF levels and CLS clinical presentation. The degree of postoperative CLS was quantified by measuring parameters of extracellular volume and end-organ dysfunction. A chest-wall soft-tissue-width index (CSTWI) was designed in order to standardize the extracellular fluid accumulation. Most CLS parameters were significantly more prominent in the neonatal patients. Low plasma VEFG levels (>35 pg/ml) were found in 3 neonatal control patients and all but, sample from the older group patient. The neonates had significantly higher preoperative VEGF plasma levels (684.4 +/- 559.1 pg/ml, P = 0.02), which decreased during the operation to levels below 35 pg/ml and increased again 24 h postoperatively to levels significantly higher than in the older patients (484 +/- 270.3 pg/ml, P = 0.001). Multilinear regression analysis found preoperative VEGF levels to independently correlate with CLS as represented by CSTWI (P < 0.01, r = 0.726). Both the occurrence of post-CPB CLS and plasma VEGF levels pre- and postoperatively were thus higher in neonates than in children. Plasma VEGF level is a predictor of the severity of postoperative CLS.

Capillary Leak Syndrome↗

PubMed2001

Hydroxyethylstarch versus human albumin for the treatment of severe ovarian hyperstimulation syndrome: a preliminary report.

OBJECTIVE: To compare the efficacy and safety of 6% hydroxyethylstarch and human albumin as colloid solutions for treatment of severe ovarian hyperstimulation syndrome (OHSS). DESIGN: Controlled cohort study. SETTING: Tertiary medical center. PATIENT(S): Sixteen patients with severe OHSS. INTERVENTION(S): Six percent hydroxyethylstarch (6 patients) and human albumin (10 patients). MAIN OUTCOME MEASURE(S): Urine output, number of abdominal and pleural drainage procedures, complications, duration of hospitalization, and perinatal outcome. RESULT(S): Patients who received 6% hydroxyethylstarch had higher urine output, needed fewer abdominal and pleural paracenteses, and had a shorter hospital stay than those who received human albumin. In each group, no adverse effects or congenital malformations were observed and the rates of miscarriage were similar. CONCLUSION(S): These results suggest that 6% hydroxyethylstarch may be superior to albumin as a colloid solution for the treatment of severe OHSS.

Adult↗

PubMed2001

Renal dysfunction after cardiac surgery.

OBJECTIVE: To assess the causes and outcomes of patients with postcardiac surgery renal dysfunction. PATIENTS AND METHODS: A large cardiovascular data- base including pre-, peri- and postoperative serum creatinine concentrations from 2214 consecutive cardiac surgery patients was analyzed. RESULTS: Sixty-nine patients developed postoperative renal dysfunction, defined as at least a 15 mL/min decline in the creatinine clearance rate resulting in a value of less than 40 mL/min. These patients were significantly older, and had a higher incidence of previous cardiac surgery, diabetes, obesity, peripheral vascular disease, hypertension and poor ventricular function. Postoperatively, these patients had a higher occurrence of low output syndrome and myocardial infarction. Stepwise logistic regression predictors of postoperative renal dysfunction included the following: postoperative low output syndrome; repeat cardiac surgery; being older than 65 years; having diabetes; having poor left ventricular function; and having had valve surgery. Preoperative renal dysfunction (defined as a creatinine clearance of less than 40 mL/min) was not found to be one of the predictors. The mean creatinine concentrations of patients with mild postoperative renal dysfunction (defined as a creatinine concentration of less than 200 mmol/L on the fourth or fifth postoperative day) decreased significantly at the fifth postoperative day, while that of patients with severe postoperative renal dysfunction rose to a mean of 300 mmol/L six months postoperatively. The incidence of late dialysis (defined as a need for dialysis after postoperative day 10) approached 30% among patients with severe postoperative renal dysfunction and only 2% among patients with mild postoperative renal dysfunction. The early mortality rate (during the first postoperative month) was similar in both groups and approached 30%. CONCLUSIONS: Patients who develop postoperative renal dysfunction have a high mortality rate. Postoperative low cardiac output is the most important cause of postoperative renal dysfunction and, therefore, should be avoided. Patients with creatinine concentrations of less than 200 mmol/L at postoperative day 4 or 5 will probably resume normal renal function. Patients with creatinine concentrations of more than 200 mmol/L at days 4 and 5 have a 30% chance of needing long term dialysis.

Age Distribution↗

PubMedDate not supplied

Clinical results of endarterectomy of the right and left anterior descending coronary arteries.

In this study, we examined the clinical outcome of coronary endarterectomy. From 1990 to 1998, 4839 patients underwent surgical revascularization. Coronary artery bypass graft surgery (CABG) was performed alone on 4516 patients, was combined with right coronary artery endarterectomy (RCA-E) in 242 patients, and was combined with left anterior descending coronary artery endarterectomy (LAD-E) in 81 patients. An analysis of preoperative variables revealed a higher proportion of males (90.7% vs 80.2%, p < 0.001), of patients with low ejection fraction (< 35%; 4.6% vs 1.7%, p < 0.001), and of three-vessel disease (47.9% vs 36%, p < 0.001) in the RCA-E versus the CABG patients. There was a higher proportion of unstable angina (51.9% vs 40.3%, p = 0.04) in the LAD-E patients. The 30-day mortality rate for CABG was 2% versus 2.5% for RCA-E and 3.7% for LAD-E (p = NS). Perioperative myocardial infarction (MI) rate for CABG was 3.4% versus 7.0% for RCA-E (p < 0.001) and 4.9% for LAD-E patients (p = NS). Postoperative low cardiac output syndrome was recorded in 11.5% of CABG, 18.6% of RCA-E (p = 0.01), and 11.1% of LAD-E (p = NS) patients. Predictors of postoperative bad outcome (death, MI, low cardiac output, cerebrovascular accident) were preoperative intra-aortic balloon pump, repeat operation, ejection fraction of < 35%, renal insufficiency, female gender, RCA-E, and age over 70. Protective factors included the use of internal mammary artery, multiple arterial grafts, and warm cardioplegia. Actuarial analysis at 6, 12, and 24 months showed late mortality rates of 0.8%, 1.3%, and 2.1% for CABG; 1.2%, 3.7%, and 3.7% for RCA-E; and 2.9%, 2.9%, and 2.9% for LAD-E, respectively. Late MI occurrence was 0.4%, 0.4%, and 0.7% for CABG; 1.5%, 1.5%, and 2.7% for RCA-E; and 0% for LAD-E, respectively. Multivariate analysis found renal insufficiency, ejection fraction of < 35%, repeat operation, female gender, New York Heart Association functional class IV, and diabetes to be predictors for late adverse events (recurrence of angina, MI, and cardiac death), and RCA-E was found to be a predictor of late MI. We conclude that the use of coronary endarterectomy to achieve complete revascularization in patients with diffuse distal coronary artery disease is a reasonable option, associated with a minimal addition in complication rates.

Cause of Death↗