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OBJECTIVES: Acute kidney injury (AKI) is a common problem after cardiac surgery and is associated with an increase in morbidity, mortality and duration of hospital stay. With this study we aimed to identify potential risk factors for cardiac surgery associated AKI (CS-AKI) in a single-centre population with a special focus on modifiable risk factors. METHODS: Retrospective single-centre cohort study of 565 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) with the use of cardiopulmonary bypass. AKI was defined by the AKIN classification. Known risk scores were applied when possible. RESULTS: Of the population, 14.7% were diagnosed with AKI. When considering baseline characteristics we found a significant difference in age, preoperative estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) stage and urgency of surgery between the CS-AKI group and the control population. Regarding the intraoperative characteristics, patients with CS-AKI had a significantly lower haematocrit and were more likely to receive a transfusion of packed cells. Postoperative administration of furosemide and packed cell transfusions were also associated with AKI. We found no differences in other characteristics (history of diabetes mellitus, history of congestive heart failure, sex, body mass index (BMI), history of cardiac surgery, low cardiac output and need for intra-aortic balloon pump (IABP), duration of cardiopulmonary bypass (CPB) and cross clamping). CONCLUSION: In our series we could identify intraoperative administration of packed cells and postoperative administration of furosemide or packed cells as potentially modifiable risk factors in the development of AKI.

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OBJECTIVE: While the efficacy and effectiveness of CBT protocols are well established, much less is known about the comparative contribution of the various techniques within CBT. The present study examined the relative efficacy, in comparison to a control condition, of two central techniques in CBT: thought records (TRs) and behavioral experiments (BEs). METHOD: A mixed within and between participants design was used to compare the efficacy of a single session TR and a single session BE intervention with a control intervention, in a non-clinical sample. Ninety one participants were randomly allocated to one of the three conditions. RESULTS: The overall pattern of results suggests that both TR and BE had a beneficial therapeutic impact in comparison to the control condition on beliefs, anxiety, behavior and a standardized measure of symptoms. There was evidence of a small advantage of the BE over the TR intervention in that the target belief changed earlier and change generalized to beliefs about others as well as the self. CONCLUSIONS: The findings confirm the utility of both TR and BE interventions and point to BEs as more useful in effecting belief change in that the change in the BE condition occurred sooner and generalized further.

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BACKGROUND: Skin lesions are the predominant clinical feature of the commonest form of mastocytosis. Mastocytosis is classified according to World Health Organization criteria. Determination of the levels of mast-cell mediators or their metabolites reflects the mast-cell burden. The extent of cutaneous mastocytosis can be assessed clinically using a scoring system (SCORing MAstocytosis; SCORMA Index) that we have developed. OBJECTIVE: Serum tryptase levels were compared with the SCORMA Index in a large group of paediatric and adult patients to investigate whether there was any correlation between the two. METHODS: The SCORMA Index in 64 patients (31 children and 33 adults) was compared with serum tryptase levels. The results of the first visit at which SCORMA and tryptase were evaluated were analysed. RESULTS: There was a positive correlation between the SCORMA Index and serum tryptase levels, indicating the value of the SCORMA Index in the assessment of mastocytosis with skin involvement. CONCLUSION: The results of this study showed that the SCORMA Index is a useful tool for evaluating the severity of cutaneous mastocytosis. The correlation between the SCORMA Index and serum tryptase levels underlines the benefit of the SCORMA Index as a clinical tool. Repeated SCORMA Index measurements can provide a rapid impression of changes in the clinical state of mastocytosis. This is particularly relevant in children, because taking blood samples from this group is much more difficult. The well-established methods for evaluation of disease severity may be expanded by the rapid SCORMA Index method.

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We examined the process, consequences and impact of writing a Do-Not-Resuscitate (DNR) order in a cohort of critically-ill ICU patients. Special emphasis was given to the DNR order including withholding renal replacement therapy. A DNR code was mainly written in the first week following ICU admission and more often given to medical, older and sicker patients. Patients never actively participated in the decision and in only half of the cases the DNR order was discussed with relatives. Mortality of all patients studied was 21% of whom 67% died with a DNR order. In our population, the final in-hospital mortality rate of DNR-coded patients was 100%, because the DNR status was ordered when the patients were already very sick. DNR-coded patients died after a longer mean length of ICU stay than patients without a code. Withholding renal replacement therapy was commonly added to the DNR order even if renal failure either was not present or never developed.

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BACKGROUND: Drotrecogin alpha activated (DrotAA) is licensed for treatment of patients with severe sepsis and organ failure. Among the latter, acute kidney injury (AKI), defined as the persistence of oligo-anuria following adequate resuscitation, is one of the most apprehended. We conducted a prospective, observational, and controlled study to test the hypothesis that DrotAA beneficially affected the evolution and outcome of AKI, complicating acute sepsis-induced cardiopulmonary failure. METHODS: Forty-six patients were studied. Thirty subjects received standard treatment for sepsis without DrotAA. In the remaining 16 patients, DrotAA was added as a continuous infusion of 24 microg/kg/h for 96 h. RESULTS: Mean age, causes of sepsis, and severity/organ failure scores were comparable between patients treated with or without DrotAA. Mortality at 28 days was high and comparable between both treatment groups (56% vs. 69%, DrotAA vs. no DrotAA; P=0.5). When oligo-anuria was present at the start of the study, it persisted during treatment in all patients, with no significant difference between groups. Both treatment groups presented with baseline mean daily fractional excretion of sodium values >2% that remained high during the observation period, regardless of whether DrotAA was given or not. Kidney histology showed a preserved renal architecture with tubular necrosis in all specimens. Similar glomerular, tubulo-interstitial, and vascular alterations were present in both treatment groups. CONCLUSION: In this small cohort of patients with severe sepsis who received adjuvant DrotAA treatment, no effect on urine output, tubular function, or mortality could be demonstrated.

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In this case we present a woman with arterial hypertension. Further examination showed an unilateral hydronephrosis caused by extrinsic compression. A tumoral mass, invading the caval inferior vein and the renal vein, is the very origin of the compression. This mass is a recidive of an endometrial stromal sarcoma for which she had a hysterectomy in 1984.

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Submucosal collagen provides strength to the intestinal wall. In order to assess the importance of collagen fibers for the developing strength of intestinal anastomoses we have sought to prevent postoperative collagen crosslinking by administration of lathyrogens. Rats, receiving both an ileal and a colonic anastomosis, were treated with either D-penicillamine or beta-aminopropionitrile from 1 day before operation. Animals were sacrificed 7 days postoperatively and bursting pressures, bursting sites, and anastomotic collagen (hydroxyproline) content and solubility were determined. D-Penicillamine, in a dose of 500 mg/kg/day and administered orally, had no effect at all. beta-Aminopropionitrile, in a dose of 625 mg/kg/day and given orally or intraperitoneally, significantly increased the acid solubility of anastomotic hydroxyproline in both ileum and colon without affecting total hydroxyproline content or concentration. Bursting pressures of the anastomotic segments were lowered, more significantly in colon than in ileum. Also, the bursting site was found more frequently in the anastomotic area in these animals. By inhibiting the formation of crosslinks in intestinal wounds with beta-aminopropionitrile, the anastomotic strength was reduced. These results demonstrate the importance of collagen in maintaining anastomotic integrity and at the same time emphasize that not only the quantity but also, and perhaps even more so, the quality of the collagen should be taken as an index of healing.

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In this paper, the subject of surface-area gain in tissue expansion is approached from three sides. With the help of a mathematical approach, the theoretical increase in surface area was calculated in relation to the specifications of the expanders. In an in vitro model, these mathematical data were confirmed to be reliable. To determine the real surface-area gain that takes place in vivo, measurements on pigs were performed. It appears that only about 35 percent of the mathematically expected increase in surface area takes place. Moreover, a clear difference was observed between the surface-area gain for the different shapes of tissue expanders.

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A technique suitable for continuous measurement of beat-to-beat cardiac output in conscious rabbits for relatively longer periods is described. The method consists, essentially, of implanting a specially constructed electromagnetic flow probe around either the pulmonary artery or the aorta during left thoracotomy (second intercostal space) in animals anesthetized with hypnorm. With care, the procedure is successful in a large proportion of the animals. Little postoperative care is required and the flow probe remains functional for several weeks up until the animals were killed to recover the probe for reimplantation. The cardiac output values (ml/min/kg) in conscious rabbits were: normal 183 +/- 9; unilateral renal hypertensive animals, 108 +/- 10 and bilateral renal hypertensive animals, 153 +/- 15. Isoprenaline increased, and propranolol decreased, the cardiac output in conscious normotensive rabbits.

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