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IntroductionThe reliability of autocalibrated pressure waveform analysis by the FloTrac-Vigileo® (FTV) system for the determination of cardiac output in comparison with intermittent pulmonary arterial thermodilution (IPATD) is controversial. The present prospective comparison study was designed to determine the effects of variations in arterial blood pressure on the reliability of the FTV system in patients undergoing coronary artery bypass grafting (CABG).MethodsComparative measurements of cardiac output by FTV (derived from a femoral arterial line; software version 1.14) and IPATD were performed in 16 patients undergoing elective CABG in the period before institution of cardiopulmonary bypass. Measurements were performed after induction of anesthesia, after sternotomy, and during five time points during graft preparation. During graft preparation, arterial blood pressure was increased stepwise in intervals of 10 to 15 minutes by infusion of noradrenaline and lowered thereafter to baseline levels.ResultsMean arterial blood pressure was varied between 85 mmHg and 115 mmHg. IPATD cardiac output did not show significant changes during periods with increased arterial pressure either during sternotomy or after pharmacological manipulation. In contrast, FTV cardiac output paralleled changes in arterial blood pressure; i.e. increased significantly if blood pressure was raised and decreased upon return to baseline levels. Mean arterial blood pressure (MAP) and FTV cardiac output were closely correlated (r = 0.63 (95% confidence interval [CI]: 0.49 - 0.74), P < 0.0001) while no correlation between MAP and IPATD cardiac output was observed. Bland-Altman analyses for FTV versus IPATD cardiac output measurements revealed a bias of 0.4 l/min (8.5%) and limits of agreement from 2.1 to -1.3 l/min (42.2 to -25.3%).ConclusionsAcute variations in arterial blood pressure alter the reliability of the FlowTrac/Vigileo® device with the second-generation software. This finding may help to explain the variable results of studies comparing the FTV system with other cardiac output monitoring techniques, questions the usefulness of this device for hemodynamic monitoring of patients undergoing rapid changes in arterial blood pressure, and should be kept in mind when using vasopressors during FTV-guided hemodynamic optimization.

Obstructing colorectal carcinoma seems to be associated with high mortality rate, but long-term survival seems to be the same with non-obstructing carcinoma.

The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.

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Perforation of the liver hydatid cyst into hollow abdominal organs is an extremely rare complication. A case of two synchronous hydatid cysts in an old lady is presented. The patient had one multilobular cyst perforated into the right colon and another one uncomplicated located at the right ovary. She underwent partial cystectomy, omentoplasty, right hemicolectomy, and total hysterectomy, and had an uneventful recovery.

A 67-year-old male smoker presented with hemoptysis and recurrent pneumonia. Chest computed tomography showed an emphysematous cyst and air-fluid level cavities in the left lower lobe. A left lower lobectomy was performed. The intraoperative finding was intralobar sequestration. Histopathology revealed adenocarcinoma within the sequestrated lobe. Only 8 cases of lung cancer and sequestration have been reported since 1963.

BackgroundRenal injury is a serious complication after cardiac surgery and therefore, early detection and much more prediction of postoperative kidney injury is desirable. Neutrophil gelatinase-associated lipocalin (NGAL) is a predictive biomarker of acute kidney injury and may increase after cardiopulmonary bypass (CPB). However, time correlation of NGAL expression and severity of renal injury is still unclear. The aim of our study was to investigate CPB-related urine NGAL (uNGAL) secretion in correlation to postoperative renal function.MethodsData of NGAL expression along with clinical data of 81 patients (52 male and 29 female) were included in this study. Mean age of the patients was 66.8 ± 12.8 years. Urine NGAL was measured at seven time points (T0: baseline; T1: start CPB, T2: 40 min on CPB; T3: 80 min on CPB; T4: 120 min on CPB; Tp1: 15 min after CPB; Tp2: 4 h after admission to the intensive care unit) and renal function in the postoperative period was classified daily according to Acute Kidney Injury Network (Ronco et al, Int J Artif Organs 30(5): 373–6) criteria (AKIN).ResultsExpression of uNGAL increased at T4 (120 min on CPB) and post-CPB (Tp1 and Tp2; p < 0.01 vs. baseline) but there was no correlation between uNGAL level and duration of CPB nor between uNGAL expression and occurrence of postoperative kidney injury. The renal function over 10 days after surgery remained normal in 50 patients (AKIN level 0), 18 patients (22%) developed mild and insignificant renal injury (AKIN level 1), eight patients (10%) developed moderate renal failure (AKIN level 2), and five patients (6%) severe kidney failure (AKIN level 3). Twenty-four out of 31 patients developed renal failure within the first 48 h after surgery. However, there was no correlation between uNGAL expression and severity of acute renal failure.ConclusionAlthough uNGAL expression increased after CPB, the peak values neither predict acute postoperative kidney injury, nor severity of the injury.