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Increasing, the colloid osmotic pressure (COP) of blood cardioplegia (BCP) may reduce myocardial edema and preserve cardiac function following cardiopulmonary bypass (CPB). The purpose of this study was to quantify the effects of albumin (ALB) supplementation on cardioplegia COP through an in vitro analysis. A self-contained cardioplegia delivery system administered supplemental ALB to four BCP ratios (1:1, 4:1, 8:1, and 20:1). In Group A, 25% ALB was combined with BCP at four delivery rates (0,13, 25, and 50 mL ALB/L BCP), with a delivery rate of 0 mL ALB/L BCP serving as the control for all groups. Twenty-five percent ALB was added to crystalloid to create carrier solutions containing 12.5, 25, or 50 g ALB/L in Group B, while Group C combined an ALB delivery rate of 50 mL ALB/L BCP with each of the three carrier solutions. Endpoints included initial and post-supplementation hematocrit, total serum protein (TSP), and COP. Without supplemental ALB, TSP was less affected with increasing blood to crystalloid ratios (1:1-81.7 ± 6.2%, 4:1-40.6 ± 5.1%, 8:1-20.6 ± 4.1%, 20:1-6.0 ± 5.7%). The TSP of 1:1 and 4:1 BCP increased (p < .0003 and p < .02) across all methods of supplementation, while 8:1 BCP was similarly increased (p < .008), except with 12.5 and 25 g ALB/L carrier solutions. The greatest change from baseline COP was seen with the lower blood to crystalloid ratios (1:1-64.3 ± 5.0% and 4:1-39.5 ± 10.5%). In higher ratios, the effects of dilution were less profound (14.6 ± 4.2 ± 4.2% and 20:1-6.0 ± 1.9%). COP of 1:1 BCP increased (p < .008) whenever ALB was added. In conclusion, TSP and COP of blood cardioplegic solutions is increased by supplemental albumin administration with quantitative enhancement dependent upon the dilutional effects of the blood to crystalloid ratio.

Bowel dysfunction, including constipation and faecal incontinence, is common, debilitating and associated with psychological problems, exacerbated by social stigma. It can usually be managed effectively with thorough symptom assessment, followed by a personalised treatment plan of conservative, evidence-based and non-invasive interventions, including biofeedback therapy. St Mark's Hospital in Northwest London provides a dedicated biofeedback service with a multidisciplinary, multimodal and behavioural approach. Bowel dysfunction is common in paediatric patients, including adolescents, who were an increasing proportion of St Mark's patients. Adolescence is a period of intense physical, psychological and social development, as young people are faced with hormonal, emotional and sexual pressures. St Mark's established an adolescent biofeedback service to provide dedicated treatment, education and support. This considered the impact of peer pressure, eating disorders and school life, as well as encouraging long-term co-ordinated transition to adult care. Clinicians used comfortable and comprehensible language, with new adolescent-friendly literature based on stages of development. Parental involvement was carefully considered and encouraged where appropriate. This clinic should improve bowel function and quality of life in younger patients, as well as reduce relapse in later life.