Pulmonary complications are the second most common after cardiac surgery with cardiopulmonary bypass (CPB). Atelectasis can result from intraoperative causes such as prolonged operation and anaesthesia time of more than 3-4 hours, use of a thoracic artery, use of cardiopulmonary bypass during surgery and failure to ventilate, and haemotransfusion of 4 or more units of packed red blood cells in the perioperative period. Impact of mechanical ventilation during cardiopulmonary bypass still unknown.
Methods: Prospective, randomised study at one centre. Adult patients undergoing cardiac surgery with a pump by sternotomy for coronary artery disease were included.
Patients were randomised into two groups – one group receiving mechanical ventilation and one group receiving no ventilation during cardiopulmonary bypass. The main endpoint was PaO2/FiO2 as a marker for the quality of ventilation and perfusion measured. Secondary endpoints were postoperative pulmonary complications such as atelectasis and prolonged mechanical ventilation of more than 72 hours.
Results 190 consecutive patients were included, 92 and 98 in each group. No significant difference was found in the PaO2/FiO2 ratio in the groups (p=0.6). A significant difference was found in the number of atelectasis during ultrasound investigation (USI) of the lungs with a p-value of 0.03 in the non-ventilated group.
Conclusion: On-pump cardiac surgery without mechanical ventilation can lead to atelectasis of the lungs.
Currently, the issue of chronic heart failure (CHF) is increasingly relevant in Kazakhstan, with a significantly higher mortality rate from the terminal stage of CHF, especially among patients in FC III-IV. Heart transplantation is considered the “gold” standard for surgical treatment of terminal CHF; however, endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. This study explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA (dd-cfDNA). The study involved 40 patients who had undergone heart transplantation. The results revealed that 60% of them had undergone repeat surgery, while 40% had undergone primary transplantation. The primary causes of terminal CHF included various cardiomyopathies, predominantly dilated and ischemic. The dd-cfDNA method shows promise in differentiating T-cell-mediated (ACR) and antibody-mediated (AMR) rejection, with distinct patterns of dd-cfDNA elevation. These differences have high clinical significance for diagnosis and treatment strategies. However, despite the prospects of using dd-cfDNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice. The study also raises important questions about the cost and accessibility of the method, requiring additional attention in the development of precision medicine methods in the field of heart transplantation.cardiacsurgeryres
Summary: Low back pain is common among people between the ages of 30 and 65, and herniated lumbar discs are one of the main causes of this condition. In most cases, the reduction in pain and clinical manifestations is associated with a decrease in the size of the hernia or its resorption, which is the natural process of reduction or complete disappearance of the hernia without the need for surgical intervention. Currently, there are several intensive physical therapy methods that influence the process of hernia resorption, making conservative treatment preferable.
Purpose: demonstration of the results of experience in the use of high-intensity physiotherapeutic methods of influencing the process of resorption of herniated intervertebral discs of the lumbar spine.
Materials and methods: At the Expert Neuro clinic, as part of a dissertation research from 2023 to 2024, 30 patients with a confirmed diagnosis of “herniated intervertebral discs of the lumbar spine” were analyzed based on the results of magnetic resonance imaging (MRI). The main group of patients received conservative treatment using modern high-intensity physiotherapy methods, the control group received classical methods of conservative treatment.
Results and discussion: According to MRI of the spine, 3 patients developed resorption of a herniated intervertebral disc. In all patients, radiculopathy symptoms improved after 1 month and low back pain symptoms improved after 2 to 3 months.
Conclusion: According to our clinical experience and relevant literature, sequestered disc herniations have a high rate of resorption. Pathophysiological processes of inflammation and regeneration are the main mechanisms of this phenomenon. Conservative management of such patients in the absence of definitive surgical indications should not be underestimated.