Purpose. Colorectal anastomotic leakage (CAL) is one of the most severe complications after colorectal surgery. This meta-analysis evaluates whether systemic or peritoneal inflammatory cytokines may contribute to early detection of CAL. Methods. Systematic literature search was performed in the acknowledged medical databases according to the PRISMA guidelines to identify studies evaluating systemic and peritoneal levels of TNF, IL-1β, IL-6, and IL-10 for early detection of CAL. Means and standard deviations of systemic and peritoneal cytokine levels were extracted, respectively, for patients with and without CAL. The meta-analysis of the mean differences was carried out for each postoperative day using Review Manager. Results. Seven articles were included. The meta-analysis was performed with 5 articles evaluating peritoneal cytokine levels. Peritoneal levels of IL-6 were significantly higher in patients with CAL compared to patients without CAL on postoperative days 1, 2, and 3 (P < 0.05). Similar results were found for peritoneal levels of TNF but on postoperative days 3, 4, and 5 (P < 0.05). The articles regarding systemic cytokine levels did not report any significant difference accordingly. Conclusion. Increased postoperative levels of peritoneal IL-6 and TNF are significantly associated with CAL and may contribute to its early detection.
A subgroup of patients with noncompaction cardiomyopathy (NCCM) is at increased risk of ventricular arrhythmias and sudden cardiac death (SCD). In selected patients with NCCM, implantable cardioverter-defibrillator (ICD) therapy could be advantageous for preventing SCD. Currently, there is no complete overview of outcome and complications after ICD therapy in patients with NCCM. This study sought to present an overview using pooled data of currently available studies. Embase, MEDLINE, Web of Science, and Cochrane databases were searched and returned 915 studies. After a thorough examination, 12 studies on outcome and complications after ICD therapy in patients with NCCM were included. There were 275 patients (mean age 38.6 years; 47% women) with NCCM and ICD implantation. Most of the patients received an ICD for primary prevention (66%). Pooled analysis demonstrates that the appropriate ICD intervention rate was 11.95 per 100 person-years and the inappropriate ICD intervention rate was 4.8 per 100 person-years. The cardiac mortality rate was 2.37 per 100 person-years. ICD-related complications occurred in 10% of the patients, including lead malfunction and revision (4%), lead displacement (3%), infection (2%), and pneumothorax (2%). Patients with NCCM who are at increased risk of SCD may significantly benefit from ICD therapy, with a high appropriate ICD therapy rate of 11.95 per 100 person-years and a low cardiac mortality rate of 2.37 per 100 person-years. Inappropriate therapy rate of 4.8 per 100 person-years and ICD-related complications were not infrequent and may lead to patient morbidity.
A 73-year-old woman with a history of hypertension was referred with pericardial effusion and suspected cardiac tamponade. She reported progressive dyspnoea and pain in the back and between the scapulae for several weeks. Except a dry cough and fever, she reported no other symptoms. Physical examination revealed a normal blood pressure without left-right difference. She was tachycardic and showed jugular venous distension. Oxygen saturation was 94% while on 2 L/min oxygen supply. Remaining physical examination was unremarkable. Electrocardiography showed atrial tachycardia at 125/min without signs of ischaemia. Laboratory tests identified elevated C-reactive protein (216 mg/L), elevated high-sensitive troponin T (471 ng/L), and low lactate levels. Echocardiography showed circumferential pericardial effusion up to 2.5 cm and a large mass in the pericardial space near anterior side of the left ventricle. Computed tomography showed no aortic dissection but revealed a large partially calcified mass in the pericardium ( Figure 1A). Cardiovascular magnetic resonance imaging showed an 8 Â 7 Â 6 cm mass in the pericardial space near the anterior interventricular groove suggestive of a giant coronary artery aneurysm (gCAA) almost completely filled with thrombus. No myocardial infarction was seen on late gadolinium
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