To obtain a model for the prediction of acute renal failure (ARF) after coronary surgery, 2009 consecutive patients were investigated. ARF was defined as a peak postoperative serum creatinine value exceeding the preoperative value by 50% or more or a need for dialysis. A postoperative increase in serum creatinine of less than 50% was associated with an early mortality (< or = 30 days postop.) of 0.4%. Sixteen per cent of the patients increased their serum creatinine by more than 50% and in this group there was a mortality of 1.3%. Twenty-five patients (1.2%) required postoperative haemodialysis because of ARF and of these 11 (44%) died early, whereas another 7 patients with chronic renal failure, requiring both pre- and postoperative haemodialysis, all survived. Peak postoperative serum creatinine and changes from the preoperative value were analyzed and related to clinical variables. Multivariate analysis indicated that high preoperative serum creatinine, high age and postoperative haemodynamic instability were the most important risk factors for developing renal failure. A logistic model including these risk factors versus the probability of developing ARF is presented.

The influence of systemic blood flow (pump flow) and arterial blood pressure on renal function was studied during hypothermic cardiopulmonary bypass (CPB) in 14 male patients where the pump flow rate was varied between 1.45 and 2.20 l.min-1 m-2. Renal blood flow (RBF) was measured in the left renal vein with retrograde thermodilution technique and urinary flow and circulatory variables were measured with an on-line computer set-up. During CPB the RBF comprised 12-13% of the systemic blood flow and was positively related to systemic blood pressure (r = 0.71; P < 0.001) and pump flow rate (r = 0.69; P < 0.001). These findings indicate that the renal autoregulation was not operative during the hypothermic CPB period. According to multiple regression analysis, RBF was primarily determined by the pump flow rate and systemic blood pressure was of secondary importance. Urinary flow increased during hypothermic CPB and became closely related to blood pressure and pump flow. According to multiple regression analysis, urinary flow was primarily determined by systemic blood pressure.

In a Swedish population, 361 patients with pernicious anemia were followed closely during a 7‐year period with regard to the occurrence of all forms of malignant neoplasia. In addition to an increased incidence of gastric neoplasia (0.6%/year), there seemed to be an increased incidence of pancreatic neoplasia (0.3%/year) in the series. With reference to age‐ and sex‐specific incidence rates in the general population, the number of malignant pancreatic tumors observed was significantly higher than expected (p<0.02, Poisson analysis). Pancreatic malignancy was the primary cause of death in 5 (4%) of 134 patients who died during follow‐up. Among 127 unselected patients with malignant pancreatic neoplasia, the prevalence of pernicious anemia was 3%. These findings indicate that there is a linkage between the two diseases which has not been previously recognized. Atrophic gastritis with hypergastrinemia may be the key to this linkage.

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The durability of CBAS Heparin Surface on EXCOR pumps retrieved after clinical use for varying periods of time was studied by analyzing samples for surface heparin density and bioactivity. The mean time of clinical use of the investigated 14 EXCOR pumps was 178 days (range, 15-461 days). Mean heparin density was 3.1 ± 0.6 μg/cm² (range, 2.2-4.8 μg/cm²), and the measured mean heparin bioactivity was 14 ± 5 ρmol/cm² (range: 7-27 ρmol/cm²). There was no detectable degradation or loss of function of CBAS Heparin Surface over time. Samples from the housing and the membrane of the EXCOR pump showed no significant difference in heparin bioactivity or density. The CBAS Heparin Surface stays on the surface and remains bioactive on the EXCOR pump at least up until 1 year. This is an important demonstration of coating durability and supports the mid-term and long-term clinical use as bridge-to-heart transplantation or to myocardial recovery.

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A combination of increased intrinsic heart rate, increased sensitivity to chronotropic actions of norepinephrine, and a decreased maximal coronary flow creates potential for a mismatch between perfusion and energy demands.