Background: Surgical stress and pain result in activation of hypothalamus-pituitary-adrenal axis. The aim of this study was to establish the effects of postoperative pain and various modalities of analgesic administration on salivary and serum cortisol levels, as well as to establish the validity of salivary cortisol as a stress indicator in surgical patients. Methods: A randomized controlled trial involved 60 patients scheduled for elective abdominal aortic aneurysm surgery. Patients were randomly divided into two groups depending on the model of postoperative analgesia. The first group (MI - morphine intermittently) included patients given morphine doses 0.1 mg/kg/6h s.c. intermittently. The second group (MPCA - morphine patient-controlled analgesia) included patients who received morphine via the PCA system - intravenous administration of morphine adjusted to a dose of 1 mg per shot and a lockout interval of 6 minutes. Results: The intensity of pain did not significantly vary until the hour 10 post-surgery. However, in the period from hour 10 to hour 18 post-surgery, higher intensity of pain was reported in group MPCA (P < 0.05). Hemodynamic instability was more prevalent in the MI group (40.0% vs 6.7%, P = 0.0048). Serum cortisol levels were almost identical in both groups (MI 509.4 nmol/L vs MPCA 511.0 nmol/L, P = 0.1473). Higher values of salivary cortisol were recorded in group MPCA; however, the difference was not statistically significant (47.1 nmol/L vs 116.3 nmol/L, P = 0.0970). Conclusion: Our study confirmed that salivary cortisol is a more sensitive stress biomarker in surgical patients as compared to blood cortisol.

Papillary fibroelastoma is a rare primary benign cardiac tumor. The majority of patients are asymptomatic. Complications may result in embolic events, syncope, ventricular arrhythmias, and sudden death. In this study, we report on a series of papillary fibroelastomas documented in our institution. Medical history records from period between 2007 and 2022 were reviewed for all the patients diagnosed with cardiac papillary fibroelastomas treated surgically and confirmed histologically. Clinical, tumor, and demographic characteristics, echocardiography findings, and treatment modalities were analyzed. In a sixteen-year period, 12 cases of papillary fibroelastomas were documented. The percentage of female patients was 83.3%. The average age was 59.0 ± 11.2 years. Average diameter of tumor was 1.2 cm. The aortic valve was the most common origin site, with six cases (50%). In two cases (17%), the mitral valve was involved. There were single cases of tumor (8% each) found on the tricuspid valve, in the left atrium, in the left ventricle, and in the right ventricle. All patients were treated successfully by complete resection. PFEs are generally small and single tumors. Complete surgical resection of the tumor has a good prognosis and is a safe, efficient, and definitive treatment.

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Introduction. It is common practice in on-pump cardiac surgery to stop mechanical ventilation when extracorporeal circulation is started or to continue with low tidal volumes. The aim of this study was to investigate whether patients ventilated with low tidal volumes had a lower percentage of postoperative pulmonary complications compared to patients who were not ventilated during cardiopulmonary bypass. Material and Methods. This retrospective study included patients who underwent coronary artery bypass graft surgery over a period of 14 months. Patients with lung diseases and those with an ejection fraction < 30% were excluded from the study. Results. A total of 499 patients were included in the study. Of these, 398 were ventilated with low tidal volumes, while 101 patients were not ventilated during extracorporeal circulation. The groups did not differ in baseline characteristics, comorbidities, and intraoperative data. Pulmonary complications were equally prevalent in both groups (ventilated 16%, not ventilated 17.8%). The most frequent were the need for prolonged mechanical ventilation (ventilated 5.8%, not ventilated 5.9%), and pleural effusions (ventilated 4.8%, not ventilated 5.9%). The incidence of pneumonia was identical in both groups (2%). Other complications were less frequent. Duration of mechanical ventilation after surgery, stay in the intensive care unit, and in-hospital mortality did not differ significantly between the groups. Conclusion. Pulmonary complications after cardiac surgery are still common. The experience at our clinic showed that the choice of mechanical ventilation strategy during cardiopulmonary bypass does not affect postoperative pulmonary complications.