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Pubblicazioni recenti - cardiac surgery
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Trends in the Treatment of Pectus Excavatum in the Netherlands.
Eur J Pediatr Surg2020 May;():. doi: 10.1055/s-0040-1712182.
Zuidema Wietse P, van der Steeg Alida F W, Oosterhuis Jan W A, van Heurn Ernest,
Abstract
INTRODUCTION:
?Pectus excavatum (PE) is the most common deformity of the anterior chest wall and can be corrected surgically with different techniques. In the past years, medical literature suggests that the minimal invasive surgical correction of PE (MIRPE) has currently become the operation technique of choice in Europe, and the number of PE patients undergoing surgery has increased. The aim of this study was to evaluate trends in the number of patients operated on and the surgical techniques generally used in patients with PE in the Netherlands.
MATERIALS AND METHODS:
?From the registration by Statistics Netherlands, the numbers of live births and gender were obtained for the period 1980 to 2017. Furthermore, from the Dutch hospital registration performed by Kiwa Prismant systems, the number of total surgical procedures of PE patients from the period 1998 to 2017, and the numbers of open and MIRPE surgery were obtained over the period 2005 to 2013.
RESULTS:
?The birth rate in Netherlands has stayed more or less stable in the last two decades. The number of PE patients asking for correction, however, has increased. In addition, the percentage of thoracoscopic assisted correction has increased.
CONCLUSION:
?The increase in correction of PE is not due to an increased incidence but to an increase of patient wishes. The use of MIRPE is gaining popularity over time.
Georg Thieme Verlag KG Stuttgart · New York.
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Indocyanine Green-Coated Polycaprolactone Micelles for Fluorescence Imaging of Tumors.
ACS Appl Bio Mater2020 Apr;3(4):2344-2349. doi: 10.1021/acsabm.0c00091.
Luo Lijun, Yan Lesan, Amirshaghaghi Ahmad, Wei Yulong, You Tianyan, Singhal Sunil, Tsourkas Andrew, Cheng Zhiliang,
Abstract
Recently, near-infrared (NIR) fluorescent dyes such as indocyanine green (ICG) have received tremendous interest as contrast agents for use in fluorescence-guided, intraoperative cancer resection surgery. However, despite showing great promise, ICG has many shortcomings such as rapid clearance and poor tumor accumulation. To improve the selective accumulation of ICG within tumors, numerous groups have formulated ICG into nanoparticles, but these approaches can suffer from rapid leakage of ICG, use of materials that exhibit poor or incomplete excretion, or complex chemistries that are not easily amenable to scale up for clinical use. Here, we developed a simple one-step method to prepare ICG-based fluorescent micelles that are composed solely of unmodified ICG and polycaprolactone (PCL), two clinically used materials with well-characterized safety profiles. The ICG-PCL micelles are prepared via oil-in-water emulsions, and the resulting micelles exhibit a uniform size, good reproducibility, and high loading efficiency. In vivo fluorescence imaging demonstrated that the ICG-PCL micelles led to a significant improvement in the accumulation and retention of ICG, in four different tumor models, compared with free dye, making them an attractive option for image-guided surgery.
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Absence of the Left Main Artery with Separate Ostia of the Left Anterior Descending Artery and Circumflex from the Left Sinus Valsalva: A Case Report.
Am J Med Case Rep2020 ;8(5):134-136.
Francois Jonathan, Kariyanna Pramod Theetha, Jayarangaiah Amog, Matthew Tobin, McFarlane Isabel M,
Abstract
Coronary artery anomalies are diagnosed in approximately 1% of patients who undergo coronary angiography (CAG). Several anomalies are life threatening but are generally asymptomatic and clinically insignificant. Nonetheless, proper recognition and adequate visualization is necessary for proper medical management, especially in patients undergoing percutaneous coronary intervention or cardiac surgery. In this report, a 73-year-old female was admitted for NSTEMI. Coronary angiography revealed a stenotic right coronary artery and separate ostium of the left circumflex artery and left anterior descending artery from the left Valsalva sinus. The patient was treated with percutaneous coronary intervention of the RCA lesion.
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Delayed post-traumatic presentation of severe sternal osteomyelitis: A strong multidisciplinary effort and a novel reconstruction technique for a challenging case.
Trauma Case Rep2020 Jun;27():100305. doi: 10.1016/j.tcr.2020.100305.
Tamburrini Alessandro, Ahmed Hanad, Talbot Thomas, Harrison Oliver, Khan Mansoor, Tilley Simon, Alzetani Aiman,
Abstract
Sternal osteomyelitis is a morbid and challenging condition, which can rarely occur after trauma, with no established consensus over best therapeutic options. In this case, a 47-year-old man with history of intravenous drug use presented 11 weeks after a minor blunt chest trauma with a severe necrotizing osteomyelitis involving sternum, muscles, fascia and subcutaneous tissue and positive blood cultures for Methicillin Sensitive . Alongside tailored antibiotic therapy, extensive surgical debridement was performed, leaving a full thickness 3 × 4 cm sternal defect and a large skin defect. After 4 weeks of antibiotics and Vacuum-Assisted-Closure pump, a novel reconstruction technique was utilized, with full collaborations of thoracic surgeons, orthopaedic surgeons and plastic surgeons. An autologous tricortical iliac crest bone graft was harvested and shaped to fit the full-thickness sternal defect, while two titanium sigmoid-shaped clavicle plates were used for internal fixation of the autograft. The large skin defect was covered with a pedicled myocutaneous latissimus dorsi flap. Integrity and stability of the chest wall was fully restored, and infection was completely eradicated. No complications occurred and the patient was well at the 18 months follow-up. To the best of our knowledge, this is the first report on autologous iliac crest bone graft in the treatment of sternal osteomyelitis. In this case, it proved to be a viable therapeutic option, providing good long-term clinical and cosmetic results.
© 2020 The Authors.
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Intubation precautions in a pediatric patient with severe COVID-19.
J Pediatr Surg Case Rep2020 Jul;58():101495. doi: 10.1016/j.epsc.2020.101495.
Shaw Robert, Tighe Nathaniel, Odegard Kirsten C, Alexander Peta, Emani Sitaram, Yuki Koichi,
Abstract
We present the case of a child diagnosed with COVID-19 soon after open-heart surgery who required an urgent second surgery. The patient suffered from severe COVID-19 disease. The utility of preoperative COVID-19 testing, determination of recovery by an array of inflammatory markers and perioperative management are described.
© 2020 The Authors.
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Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach.
Cureus2020 Apr;12(4):e7779. doi: 10.7759/cureus.7779.
Finneran Megan M, Nardone Emilio, Marotta Dario A, Smith Glen B, Gordhan Ajeet,
Abstract
Ventriculoperitoneal shunt catheter migration is a rare but documented complication. The exact mechanism of this occurrence is not well understood. We report the case of an 81-year-old male who initially presented with symptoms consistent with normal pressure hydrocephalus. A ventriculoperitoneal shunt was placed uneventfully. Four months later, the patient presented complaining of a persistent headache despite multiple adjustments in the shunt setting. Shunt series radiographs demonstrated the distal catheter passing through the superior vena cava and looping into the right cardiac atrium and ventricle. Catheter retrieval was attempted from a proximal retroauricular incision but required a combination of snare technique by interventional radiology and, ultimately, surgical venotomy by a cardiothoracic surgeon. The distal catheter was replaced in the abdomen, and the patient had no further complications. This case is the first of its kind reported in the literature that includes a treatment team comprising neurosurgery, interventional radiology, and cardiothoracic surgery. We highlight the importance of a multidisciplinary approach to best address the migrated catheter.
Copyright © 2020, Finneran et al.
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A Unique Interplay of Multiple Predisposing Factors Culminating in a Catastrophic QT Prolongation.
Cureus2020 Apr;12(4):e7757. doi: 10.7759/cureus.7757.
Vyas Vrinda, Khan Alisha, Kanagalingam Gowthami, Bhatta Luna,
Abstract
Implantable cardioverter-defibrillators (ICDs) are used in patients without a reversible cause for long QT syndrome (LQTS) and secondary prevention in patients with LQTS-associated sudden cardiac arrest. We present a female patient with multiple reversible factors for QT prolongation, including the use of antidepressants, antidiarrheals, antiemetics, and antihistamines; chronic malabsorption from bariatric surgery; probable Gitelman syndrome and urinary losses of electrolytes, causing QT prolongation which leads to polymorphic ventricular tachycardia and a successfully resuscitated cardiac arrest. Our patient also had history suggestive of probable congenital LQTS with multiple childhood syncopal episodes and a history of seizures in first-degree relatives, further justifying the placement of an ICD. Also, this case gives us an opportunity to delve into the risks of catastrophic QT prolongation in the morbidly obese population undergoing bariatric surgery.
Copyright © 2020, Vyas et al.
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Safety and Feasibility of Performing Fenestrated Endovascular Abdominal Aneurysm Repair Using a Portable C-arm Without Fusion Technology: A Single-Center Experience.
Cureus2020 Apr;12(4):e7739. doi: 10.7759/cureus.7739.
Juneja Amandeep, Zia Saqib, Ayad Marco H, Singh Kuldeep, Dietch Jonathan, Schor Jonathan,
Abstract
Objective Most centers performing fenestrated endovascular aneurysm repair (F-EVAR) use hybrid rooms with fusion technology for mapping. We present our experience of successfully performing F-EVAR using C-arm without fusion technology. Methods During the period of January 2016 to October 2018, data were collected from a prospectively maintained F-EVAR database at our tertiary care institute. The primary endpoint was technical success, and the secondary outcomes measured were short- and midterm clinical success (both defined by the Society for Vascular Surgery reporting standards), blood loss, radiation dose, operative time, postoperative endoleaks, aneurysm rupture, endograft patency, and complications. Results We performed 11 F-EVARs during the study period in five (45.5%) males and six (54.5%) females, with a mean age of 75+8 years. All procedures were performed under general anesthesia using OEC 9900 Elite Mobile C-arm (GE Healthcare, Chicago, IL, USA) without the use of fusion technology. Three patients had planned preoperative open procedures for access due to prior cutdown or bypass. Technical success was achieved in all 11 (100%) cases. The mean length of stay was 5+2 days, and the mean follow-up was 7.5+6.5 months. The mean procedure time was 301+167 minutes, and the mean blood loss was 361+233 mL. Mean fluoroscopy time was 72+31 minutes, and the mean radiation exposure time was 2,160+930 mGy. No patients required intraoperative transfusion. Thirty-day (short term) clinical success was achieved in 10 (90.0%), cases whereas six-month (midterm) clinical success was achieved in 7 (77.7%) patients. Branch vessel patency was 11 (100%) at 30 days and 9 (81.8%) at six months, and primary endograft patency was 100% (11) at six months. We had no perioperative mortality or major adverse cardiac event at 30 days. Thirty-day postoperative morbidity included readmission for pulmonary edema from cardiac failure in one patient. Two patients had clinically insignificant silent cardiac enzyme elevation. Three patients had re-interventions performed during the mean follow-up period. Two patients developed renal stent thrombosis resulting in renal insufficiency, which is defined as an increase in creatinine concentration ?0.5 mg/dL, without the need for dialysis. One type II endoleak was identified postoperatively that required trans-lumbar embolization. No type I or III endoleaks were identified during the study period. Asymptomatic common femoral artery thrombosis was seen on follow-up imaging in one patient. Conclusions We conclude that F-EVAR can be safely performed using C-arm without the use of fusion technology. Its utility can be expanded to centers with appropriate skill set but no hybrid technology.
Copyright © 2020, Juneja et al.
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Comparison of Accuracy in Expert Clinical Examination versus Magnetic Resonance Imaging and Arthroscopic Exam in Diagnosis of Meniscal Tear.
Adv Orthop2020 ;2020():1895852. doi: 10.1155/2020/1895852.
Hashemi Seyed Ali, Ranjbar Mohammad Reza, Tahami Mohammad, Shahriarirad Reza, Erfani Amirhossein,
Abstract
Background:
Many clinical tests and diagnostic studies have been developed to increase the clinician's ability to accurately diagnose disorders of the knee. Torn menisci or ligamentous structures within the knee cause significant pain and disability and thus require expeditious management. This study was conducted to evaluate the accuracy of clinical examination in comparison with MRI examination and with the help of arthroscopic examination as the gold standard in the diagnosis of meniscal tears.
Method:
All of the arthroscopic surgery candidates, presenting symptoms of meniscal or cruciate ligament lesions, referring to Namazi and Chamran hospitals, Shiraz, Iran, were included in this study. Clinical examination (including McMurray test, Apley test, and 20 Thessaly test) was performed before the arthroscopy, and the results were recorded in special forms. Magnetic resonance imaging (MRI) results were also added. Then, arthroscopy was performed, declaring the definite diagnosis, and the results were compared to the results obtained from both tests and MRI. Statistical analysis was performed using SPSS software.
Results:
86 patients with a mean age of 27 years old, including 63 (73%) male and 23 (27%) female, were studied. 57 (66%), 19 (22%), and 10 (12%) injuries were caused by sports, twisting, or trauma, respectively. Arthroscopic results showed 32 meniscal tears, of which 28 (87%) and 4 (13%) were in medial and lateral menisci, respectively, including 10 bucket handle, 17 longitudinal, and 5 of other types (transverse, oblique, radial) of injuries. Comparing MRI results to arthroscopic results, we had 2 false-positive and 2 false-negative cases. 62 cases of McMurray test results were accurate; 15 and 9 cases were reported false positive and false negative, respectively. 60 cases of Apley test results were accurate; 16 and 10 cases were reported false positive and false negative, respectively. 78 cases of Thessaly test results were accurate; 5 and 3 cases were reported false positive and false negative, respectively. Comparing Thessaly test results to McMurray and Apley showed statistical significance ( < 0.05). Comparing Thessaly test results to MRI showed no statistical significance ( = 0.151), while comparing McMurray and Apley test results to MRI showed statistical significance ( < 0.01).
Conclusion:
Clinical examination, performed by an experienced examiner, can have equal or even more diagnostic accuracy compared to MRI to evaluate meniscal lesions. In this study, the Thessaly test has been approved as a reliable clinical test in the diagnosis of meniscal tears.
Copyright © 2020 Seyed Ali Hashemi et al.
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Cardiovascular Safety of Clonidine and Dexmedetomidine in Critically Ill Patients after Cardiac Surgery.
Crit Care Res Pract2020 ;2020():4750615. doi: 10.1155/2020/4750615.
Grest Angelina, Kurmann Judith, Müller Markus, Jeger Victor, Krüger Bernard, Spahn Donat R, Bettex Dominique, Rudiger Alain,
Abstract
Purpose:
The aim of this retrospective study was to assess the haemodynamic adverse effects of clonidine and dexmedetomidine in critically ill patients after cardiac surgery.
Methods:
2769 patients were screened during the 30-month study period. Heart rate (HR), mean arterial pressure (MAP), and norepinephrine requirements were assessed 3-hourly during the first 12 hours of the continuous drug infusion. Results are given as median (interquartile range) or numbers (percentages).
Results:
Patients receiving clonidine (?=?193) were younger (66 (57-73) vs 70 (63-77) years, =0.003) and had a lower SAPS II (35 (27-48) vs 41 (31-54), =0.008) compared with patients receiving dexmedetomidine (?=?141). At the start of the drug infusion, HR (90 (75-100) vs 90 (80-105) bpm, =0.028), MAP (70 (65-80) vs 70 (65-75) mmHg, =0.093), and norepinephrine (0.05 (0.00-0.11) vs 0.12 (0.03-0.19)?mcg/kg/min, < 0.001) were recorded in patients with clonidine and dexmedetomidine. Bradycardia (HR?
Conclusions:
Dexmedetomidine and the low-cost drug clonidine can both be used safely in selected patients after cardiac surgery.
Copyright © 2020 Angelina Grest et al.
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Perioperative Dexmedetomidine Fails to Improve Postoperative Analgesic Consumption and Postoperative Recovery in Patients Undergoing Lateral Thoracotomy for Thoracic Esophageal Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial.
Pain Res Manag2020 ;2020():4145893. doi: 10.1155/2020/4145893.
Mao Yu, Sun Xuemei, Si Li, Chen Lijian, Liu Xuesheng, Zhang Zhi, Gu Erwei,
Abstract
Objectives:
Dexmedetomidine is widely used as an adjunct to general anesthesia. In this study, we evaluated the effects of perioperative dexmedetomidine infusion on postoperative analgesia in patients undergoing lateral thoracotomy for thoracic esophageal cancer.
Methods:
A total of 62 patients undergoing lateral thoracotomy for thoracic esophageal cancer were randomized to receive adjuvant therapy with either dexmedetomidine (0.5?g/kg intravenous bolus injection for 10?min before induction of anesthesia, followed by continuous infusion of 0.2-0.4?g/kg/h until the end of surgery, and 0.06?g/kg/h for 5 days after surgery) or equal volumes of saline. Acute postoperative pain was treated with patient-controlled intravenous sufentanil and flurbiprofen axetil. The primary outcomes of this study were the numbers of analgesic requirements in the first postoperative 72?h.
Results:
Perioperative dexmedetomidine did not decrease the numbers of analgesic requirements in the first postoperative 72?h (dexmedetomidine group: 12.14?±?4.76, saline group: 10.89?±?5.66; =0.367). Likewise, the groups did not differ with respect to total postoperative analgesic requirements, postoperative pain, perioperative inflammation, blood cell count, incidence of adverse events, surgical recovery (assessed at postoperative days 2 and 5 using the surgical recovery scale), length of hospital stay, hospital cost, incidence of chronic pain, or quality of life. Notably, dexmedetomidine had beneficial effects on decreasing intraoperative opioid consumption and improving postoperative sleep quality. . Perioperative dexmedetomidine has limited analgesic benefits in lateral thoracotomy for esophageal cancer when added to an opioid-based multimodal anesthetic regimen but can reduce opioid consumption.
Copyright © 2020 Yu Mao et al.
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Cocaine-Induced Giant Bullous Emphysema.
Case Rep Med2020 ;2020():6410327. doi: 10.1155/2020/6410327.
Douedi Steven, Upadhyaya Vandan D, Patel Ishan, Mazahir Usman, Costanzo Eric, Hossain Mohammad A,
Abstract
Background:
Emphysematous bullae, defined as airspaces of greater than or equal to one centimeter in diameter, have a variety of etiologies such as tobacco use and alpha-1 antitrypsin being the most common. Emphysematous bullae have also been reported in patients using cocaine usually involving the lung periphery and sparing the central lung parenchyma. We present a case of a male with a history of cocaine abuse found to have a singular giant emphysematous bulla occupying >95% of the right hemithorax requiring video-assisted thoracic surgery (VATS) with a favorable outcome. . A 50-year-old male with a history of chronic cocaine abuse was found unresponsive in the field and given multiple doses of naloxone without any improvement in mental status. On presentation to the emergency department, chest X-ray as well as CT scan of the chest were performed which were suggestive of an extensive pneumothorax of the right lung requiring placement of a chest tube. The patient was subsequently intubated and underwent bronchoscopy with right chest VATS which found a giant bulla encasing the entire right pleural cavity. During the procedure, he underwent resection of the bullae and a partial right pleurodesis. After the procedure, patient's respiratory status significantly improved, and he was discharged in a stable condition.
Conclusion:
Cocaine use is a rare but identifiable factor that can cause giant bullous emphysema (GBE) resulting in severe complications and even death. The purpose of this case presentation is to support early identification and treatment of GBE using bullectomy with VATS, improving outcomes and decreasing morbidity and mortality.
Copyright © 2020 Steven Douedi et al.
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Surgical Management of an Empyema in a 3-Year-Old Child.
Case Rep Med2020 ;2020():5179292. doi: 10.1155/2020/5179292.
Kanakis Meletios A, Petsios Konstantinos Th, Giannopoulos Nicholas M, Bobos Dimitrios, Hatzianastasiou Sofia, Sianidou Lida C, Lioulias Achilleas,
Abstract
empyema in nonimmunocompromised children is rare. A case of surgical management of invasive aspergillosis in a previously healthy 3-year-old child is presented. The patient was initially admitted to a hospital with severe respiratory deterioration and clinical instability, originally attributed to sepsis. After surgical intervention and the diagnosis of invasive aspergillosis, intravenous therapy with voriconazole was initiated. During postoperative care, the patient's condition remained stable with mild functional respiratory deficits. The diagnosis and treatment of empyema remains challenging, especially in cases that the recognition of aspergillosis is delayed and urgent surgical management of the empyema is required due to rapid clinical deterioration of the patient. The early initiation, prolonged administration, and close monitoring of high-dose antifungal treatment are highly recommended.
Copyright © 2020 Meletios A. Kanakis et al.
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Cine-Computed Tomography for the Evaluation of Prosthetic Heart Valve Function.
Cardiology2020 May;():1-7. doi: 10.1159/000507182.
Hsu Charles, Bourganos Katerina, Zafar Mohammad A, Huber Steffen, Buntin Joelle, Ziganshin Bulat A, Mojibian Hamid, Elefteriades John A,
Abstract
BACKGROUND:
After aortic valve replacement (AVR), suspected prosthetic valve dysfunction (mechanical or biological) may arise based on echocardiographic transvalvular velocities and gradients, leading to reoperative surgical intervention being considered. Our experience has found that 4-dimensional (space and time) image reconstruction of ECG-gated computed tomography, termed cine-CT, may be helpful in such cases. We review and illustrate our experience.
METHODS:
Twenty-seven AVR patients operated previously by a single surgeon (who performs >100 AVRs/year) were referred for repeat evaluation of suspected aortic stenosis (AS) based on elevated transvalvular velocities and gradients. The patients were fully evaluated by cine-CT.
RESULTS:
In all but 2 cases, the cine-CT strikingly and visually confirmed normal leaflet function and excursion, with no valve thrombosis, restriction by pannus, or obstruction by clot. In only 2 cases did cine-CT reveal decreased mechanical valve leaflet excursion. Repeat surgery was required in only 1 case while all other patients continued clinically without cardiac events.
CONCLUSIONS:
Echocardiography is an extraordinarily useful tool for the evaluation of prosthetic valve function. Increased pressure recovery beyond the valve and other factors may occasionally lead to exaggerated gradients. Cine-CT is emerging as an extremely valuable tool for further evaluation of suspected prosthetic valve AS. Our experience has been extremely helpful, as is shown in the dramatically reassuring images.
© 2020 S. Karger AG, Basel.
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Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation.
Blood Purif2020 May;():1-11. doi: 10.1159/000508125.
Ronco Claudio, Bagshaw Sean M, Bellomo Rinaldo, Clark William R, Husain-Syed Faeq, Kellum John A, Ricci Zaccaria, Rimmelé Thomas, Reis Thiago, Ostermann Marlies,
Abstract
Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.
© 2020 S. Karger AG, Basel.
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Pulmonary vascular resistance as a potential marker of reactive pulmonary hypertension reduction following sildenafil therapy in patients disqualified from orthotopic heart transplantation.
Adv Med Sci2020 May;65(2):298-303. doi: S1896-1126(20)30015-8.
Dusza?ska Agata, Wasilewski Jaroslaw, Gierlotka Marek, Zakliczy?ski Michal,
Abstract
PURPOSE:
We sought to determine the predictors of restoration of heart transplantation (HTx) candidacy in patients with systolic heart failure (HF) and reactive fixed pulmonary hypertension (RFPH) defined as pulmonary vascular resistance (PVR) > 2.5 Wood units (WU), transpulmonary gradient (TPG) > 12 mmHg or ?2.5 WU with systolic arterial pressure ?85 mmHg during vasoreactivity test, following sildenafil therapy.
MATERIAL AND METHODS:
Between 2007 and 2018 1136 patients were evaluated at our department as candidates for HTx. Thirty-five of them, who presented with systolic HF and were not eligible for HTx due to RFPH, were included in the study (31 men aged 55.1 ± 7.4 years). In all the patients sildenafil was introduced and up-titrated to a maximal tolerated dose in addition to optimal medical therapy. Patients were assessed at 3-6 months intervals.
RESULTS:
During median 11 months (interquartile range 6-18 months) reduction of RFPH enabling qualification for HTx was observed in 62.9% patients. Higher baseline PVR (OR 0.32; 95% CI (0.14-0.74) p < 0.001), pulmonary artery systolic pressure (PASP) (OR 0.94, 95% CI (0.88-0.99) p = 0.05), mean artery pulmonary pressure (mPAP) (OR 0.87, 95% CI (0.77-0.98) p = 0.02) and TPG (OR 082, 95% CI (0.70-0.96) p = 0.003) were negative predictors of RFPH reduction with sildenafil therapy. In multivariable analysis, lower PVR (p = 0.02) was identified as an independent predictor of RFPH reduction following sildenafil therapy.
CONCLUSION:
Sildenafil therapy can support PH reduction in systolic HF patients uneligible for HTx due to RFPH. Lower baseline PVR was identified as an independent predictor of PH reversibility with sildenafil enabling restoration of HTx candidacy.
Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.
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Primary repair of esophageal perforation: Case report.
Int J Surg Case Rep2020 May;71():159-162. doi: S2210-2612(20)30218-2.
Abila Akello W, Nditika Mburu E, Kipkemoi Rono D, Ondigo Stephen, Khwa-Otsyula Barasa O,
Abstract
INTRODUCTION:
Mortality after esophageal perforation is high irrespective of the treatment modality. The rarity of traumatic esophageal perforations has made it difficult to conduct comprehensive studies that can answer pertinent questions with regard to management.
PRESENTATION OF CASE:
We report a case of through and through thoracic esophageal injury caused by an assailant's arrow in a young physically active male adult. Diagnosis was made on-table. He successfully underwent primary repair of the esophageal injury 16?h post injury via a left thoracotomy. Recurrent lung collapse and pleural effusion was managed with tube thoracostomy and chest physiotherapy.
DISCUSSION:
Esophageal perforations occur infrequently and may produce vague symptoms leading to diagnostic and therapeutic delays. High index of suspicion particularly in penetrating chest trauma followed by relevant investigations may reduce delay. Principles of management include treatment of contamination, wide local drainage, source control and nutritional support. Source control is achieved surgically or through endoluminal placement of stents. Surgical options include primary repair, creation of a controlled fistula by T-tube or esophageal exclusion.
CONCLUSION:
Primary repair of traumatic injury to a healthy esophagus is feasible for cases diagnosed early and without significant mediastinal contamination as in our case. Associated injuries are more likely in such cases to lead to increased morbidity and prolonged hospital stay and must be handled carefully.
Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Can we stop the long fusion at L5 for selected adult spinal deformity patients with less severe disability and less complex deformity?
Clin Neurol Neurosurg2020 May;194():105917. doi: S0303-8467(20)30260-2.
Taneichi Hiroshi, Inami Satoshi, Moridaira Hiroshi, Takeuchi Daisaku, Sorimachi Tsuyoshi, Ueda Haruki, Aoki Hiromichi, Iimura Takuya,
Abstract
OBJECTIVES:
It is controversial whether to stop the fusion at L5 or S1 in adult spinal deformity (ASD) surgery. Our hypothesis is that we can stop long fusion at L5 for selected patients with less severe disability and less complex deformity. Aim was to compare minimum 5-year outcomes between ASD patients with fusion to L5 versus S1.
PATIENTS AND METHODS:
Consecutive 40 patients (?50 years of age) with ASD underwent spinal fusion from lower thoracic spine to L5 or S1 between 2008 and 2011. 33 patients (82.5 %) had a minimum 5-year follow-up. Lower instrumented vertebra (LIV) was L5 in 12 patients (L5 group) and S1 in 21 (S1 group). Clinical and radiographical parameters were compared between L5 and S1 group.
RESULTS:
There were statistically significant differences between two groups (L5 vs S1) in %male (50 % vs 14 %), %type-N of SRS-Schwab classification (83 % vs 38 %), preop ODI (40.5 vs 56), correction loss of LL (11? vs 3?), final TK (32? vs 50?), correction loss of TK (-1? vs 17?), final improvement of PT (3? vs 10?), final improvement of PI-LL (26? vs 39?), PJK (8% vs 48 %), and revision surgery rate (50 % vs 14 %). Causes of revision surgery in L5 group were distal junctional failure in 5 patients and foraminal stenosis at L5-S1 in 1. All of them underwent additional spinal fusion to the sacrum. Whereas, causes of revision surgery in S1 group were rod fracture in 2 patients and proximal junctional failure in 1.
CONCLUSION:
Although fusion to L5 was conducted for selected ASD patients with less severe disability (better ODI) and less complex deformity (type N), 50 % of the patients required additional fusion to the pelvis. Decision making to stop the long fusion at L5 for ASD patients ?50 years of age should be made with careful considerations.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Experience from a Singapore tertiary hospital with restructuring a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic.
J Vasc Surg2020 May;():. doi: S0741-5214(20)31281-7.
Ng Jun Jie, Gan Tiffany R X, Niam Jen Yong, Menon Raj K, Ho Pei, Dharmaraj Rajesh B, Wong Julian C L, Choong Andrew M T L,
Abstract
Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on 23 January 2020. For two weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19. We also describe in detail, with relevant data, how our vascular surgery practice has changed due to these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function whilst reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compared it to preceding months. We discuss our operating room and personal protective equipment protocols when managing a COVID-19 patient and share how we continue surgical training amidst the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.
Copyright © 2020. Published by Elsevier Inc.
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