bluuebunny/crossref_metadata_2025 huggingface dataset:
TPP and Intellectual Property: Growing Concerns
Authors: Palit Amitendu
Published: May 2013

Promoted as a high-quality twenty-first century trade agreement for the Asia-Pacific, the Trans-Pacific Partnership (TPP) has generated concerns over several WTO plus issues it is negotiating. This article examines the concerns on intellectual property rules with respect to patents and copyrights. While large emerging markets like China and India are not part of the TPP, growth of a rigid intellectual property regime as proposed by the TPP in the Asia-Pacific, will have several implications for them, particularly in innovations and production of generic pharmaceuticals, as discussed by the article.
The Universal Basic Income
Authors: Van Parijs Philippe
Published: May 2013

Utopian thinking consists of formulating proposals for radical reforms, justifying them on the basis of normative principles combined with the best possible scientific analysis of the root causes of the problems the proposals are meant to address, and subjecting these proposals to unindulgent critical scrutiny. Such utopian thinking is indispensable, and contributing to it is part of sociology’s core business. This article illustrates these claims by considering one particular utopian proposal: an unconditional basic income paid to every member of society on an individual basis, without means test or work requirement. It summarizes the main arguments that support this proposal, mentions a number of contexts in which it is being taken seriously, and sketches a number of ways in which sociological insights and research are crucially relevant to the discussion of the economic and political sustainability of an unconditional basic income.
Infotopia
Authors: Fung Archon
Published: May 2013

In Infotopia, citizens enjoy a wide range of information about the organizations upon which they rely for the satisfaction of their vital interests. The provision of that information is governed by principles of democratic transparency. Democratic transparency both extends and critiques current enthusiasms about transparency. It urges us to conceptualize information politically, as a resource to turn the behavior of large organizations in socially beneficial ways. Transparency efforts have targets, and we should think of those targets as large organizations: public and civic, but especially private and corporate. Democratic transparency consists of four principles. First, information about the operations and actions of large organizations that affect citizens’ interests should be rich, deep, and readily available to the public. Second, the amount of available information should be proportionate to the extent to which those organizations jeopardize citizens’ interests. Third, information should be organized and provided in ways that are accessible to individuals and groups that use that information. Finally, the social, political, and economic structures of society should be organized in ways that allow individuals and groups to take action based on Infotopia’s public disclosures.
Practical Anarchism
Authors: Benkler Yochai
Published: May 2013

The article considers several working anarchies in the networked environment, and whether they offer a model for improving on the persistent imperfections of markets and states. I explore whether these efforts of peer mutualism in fact offer a sufficient range of capabilities to present a meaningful degree of freedom to those who rely on the capabilities it affords, and whether these practices in fact remain sufficiently nonhierarchical to offer a meaningful space of noncoercive interactions. The real utopias I observe here are perfect on neither dimension. Internally, hierarchy and power reappear, to some extent and in some projects, although they are quite different than the hierarchy of government or corporate organization. Externally, there are some spectacular successes, some failures to thrive, and many ambiguous successes. In all, present experience supports neither triumphalism nor defeatism in the utopian project. Peer models do work, and they do provide a degree of freedom in the capabilities they provide. But there is no inexorable path to greater freedom through voluntary open collaboration. There is a good deal of uncertainty and muddling through. The last part of the article suggests a theory of freedom that supports the significance of even these obviously imperfect peer systems with incomplete coverage of necessary human capabilities, and explains why expanding the domain of mutualism improves freedom and well-being under conditions of persistent market imperfection and an inevitably fallible state. Peer mutualism doesn’t have to be perfect; it merely needs to offer a new dimension or sufficient diversity in how it instantiates capabilities and transmits power to offer us, who inhabit the systems that these peer systems perturb, a degree of freedom.
Making Direct Democracy Deliberative through Random Assemblies
Authors: Gastil John , Richards Robert
Published: May 2013

Direct-democratic processes have won popular support but fall far short of the standards of deliberative democracy. Initiative and referendum processes furnish citizens with insufficient information about policy problems, inadequate choices among policy solutions, flawed criteria for choosing among such solutions, and few opportunities for reflection on those choices prior to decision making. We suggest a way to make direct democracy more deliberative by grafting randomly selected citizen assemblies onto existing institutions and practices. After reviewing the problems that beset modern direct-democratic elections and the long history of randomly selected citizen assemblies, we propose five different varieties of randomly constituted citizen bodies—Priority Conferences, Design Panels, Citizens’ Assemblies, Citizens’ Initiative Reviews, and Policy Juries. After selecting members through stratified random sampling of citizens, each of these assemblies would operate at a different stage of the legislative process, from initial problem identification through approval of a finished ballot measure. Highly structured procedures guided by professional moderators and featuring expert testimony on policy and legal matters would help to ensure deliberative quality, and careful institutional designs would make each body politically powerful. In the end, these citizen bodies would be likely to address the deliberative deficit of direct democracy and better achieve the public’s desired policy objectives.
Myocardial Damage Induced by Uncontrolled Reoxygenation
Authors: Corno Antonio F , Milano Giuseppina , Samaja Michele , von Segesser Ludwig K
Published: May 2013

To evaluate myocardial impairment induced by uncontrolled reoxygenation, the effects of hypoxia-reoxygenation were compared with ischemia-reperfusion in isolated rat hearts. After stabilization, 2 groups (n = 8) of Langendorff-perfused rat hearts were exposed to 40 minutes of ischemia (10% of baseline flow) or hypoxia (10% of baseline oxygen content) followed by a sudden return to baseline conditions (reperfusion or reoxygenation). The O2 content was identical for the two groups during baseline conditions, O2 shortage, and O2 readmission. Metabolic (lactate production) and functional parameters (heart rate, peak systolic pressure, left ventricular developed pressure, maximal contraction and relaxation rates, end-diastolic pressure, coronary perfusion pressure) were recorded at the end of stabilization, after O2 deficiency, and after 2 minutes of reoxygenation. Systolic function was significantly depressed after ischemia (p < 0.0001) but completely recovered to baseline values after 2 minutes of reperfusion. In contrast, systolic function was less severely depressed after hypoxia but failed to return to baseline after 2 minutes of reoxygenation. Diastolic function, unchanged during ischemia-reperfusion, remained significantly impaired during hypoxia-reoxygenation.
Closure of Isolated Secundum Atrial Septal Defects in Infancy
Authors: Iyer Raju S , Hoschtitzky Andreas , Jacobs Jefferey , Elliott Martin , de Leval Marc , Stark Jaroslav
Published: May 2013

Between 1965 and 1995, 552 patients underwent closure of isolated secundum atrial septal defect, of whom 24 (4.3%) were infants with a mean age of 238.5 ± 13.8 days (range, 90 to 348 days). Mean weight was 6 ± 0.3 kg (range, 3.5 to 9 kg). Twenty-two had noted failure to thrive and 13 had chest infections. Direct closure was carried out in 20 and 4 underwent patch closure. There were 3 (12.5%) early deaths (intraoperatively, 5 hours, and 2 days postoperatively). Three patients had pulmonary hypertension with pulmonary arterial to systemic arterial pressure ratios of 0.74 to 0.83 preoperatively. Of 21 survivors, 13 were extubated within 24 hours and 8 within 72 hours of surgery. Mean hospital stay was 16.2 ± 8.2 days. There were 2 late deaths; one from pneumonia at 177 days postoperatively and another patient with a severe neuromuscular disorder who could not be extubated, died 328 days postoperatively. We concluded that some infants require early surgery and an atrial septal defect can be closed safely in infancy but the risk increases in patients with pulmonary vascular disease. The etiology of pulmonary vascular disease in such patients remains unclear.
Atypical Carcinoid Tumors of Lung: Clinicopathologic Study of Six Cases
Authors: Moghe Girish , Jambhekar Nirmala A , Deshpande Ramakant K , Hejmadi Rahul , Vyas Jitendra
Published: May 2013

This retrospective study of 6 cases of atypical carcinoid tumor was carried out to highlight their clinicopathological features and behavior. All patients were over 40 years of age and were treated by surgical excision of the tumor. Four tumors were central and 2 were peripherally located in the lung. Grossly, the tumors were large with spotted areas of necrosis. Microscopically, all tumors had a typical carcinoid pattern with spotted areas of necrosis and mitotic activity in the range of 2 to 5 per 10 high-power fields. On immunohistochemistry, the tumors were positive for neuron-specific enolase and cytokeratin. Follow-up ranging from 1 to 5 years was available in 4 patients; 2 are currently alive, 1 with local recurrence and distant metastasis one year postoperatively, the other with no disease after 5 years. Two patients died; one had a local recurrence at 2 years and the other had liver metastasis at 3 years.
Aorto-Left Ventricular Communication through Extracardiac Tunnel
Authors: Ipek Gökhan , Kirali Kaan , Tuncer Altuğ , Yakut Necmettin , Ömeroğlu Suat , Gürbüz Ali , Yakut Cevat
Published: May 2013

An asymptomatic 24-year-old man underwent surgical correction of an aorto-left ventricular tunnel. A 1-cm opening was found 1 cm above the commissure of the left and right coronary cusps, which communicated with the left ventricle. It was successfully closed by direct suture.
Mitral Valve Myxoma
Authors: Yavuz Senol , Celkan Adnan , Ata Yusuf , Mavi Mustafa , Türk Tamer , Eris Cüneyt , Özdemir İ Ayhan
Published: May 2013

A 65-year-old man had a 6 × 4 × 4 cm myxoma adhering to the posterior leaflet of the mitral valve. He underwent successful myxoma resection and mitral valve replacement.
Primary Pulmonary Leiomyosarcoma: A Rare Presentation
Authors: Naik Madhava Janardhan , Lim Chong Hee , Agasthian Thirugnanam
Published: May 2013

An unusual case of primary leiomyosarcoma presenting as a cystic mass is reported. An 86-year-old man underwent resection of a large cystic mass measuring 15 cm in diameter, arising from the left lower lobe of the lung. Histology of the resected specimen showed primary pulmonary leiomyosarcoma. The patient made a good recovery.
Pericardial Reinforcement for Hemostasis in Aortic Aneurysm Surgery
Authors: Srivastava Ashok K , Pandey Shantanu , Kapoor Aditya
Published: May 2013

Multiple anastomotic suture lines in aortic aneurysm surgery are prone to bleeding. To improve hemostasis, a 15-mm-wide strip of native pericardium was used to reinforce all anastomotic suture lines. This technique was used in 4 consecutive patients who underwent modified Bentall and elephant trunk procedures for extensive aortic aneurysm. The mean cardiopulmonary bypass time was 230 minutes and the mean aortic crossclamp time was 92 minutes. Mean blood loss through the mediastinal drainage tubes was 193 mL in the first 12 hours postoperatively and the mean blood requirement was 3 units. It was concluded that this technique markedly improved hemostasis in extensive aortic aneurysm surgery.
Duplex Pericardial Patch Aortoplasty
Authors: Erdinc Melih , Ocal Ahmet , Atalay Omer Sait , Ozturk Cuneyt , Sezer Husnu
Published: May 2013

A modification of the Nicks procedure to obtain a firm blood-tight aortoplasty is described. Autologous pericardium was used in a bilayer arrangement with a sandwich suture technique. It was found to be an easy and effective way of decreasing bleeding. It may also prevent true and false aneurysms.
Management Strategies for Complex Bronchopleural Fistula
Authors: Khan Junaid H , Rahman Sarah B , McElhinney Doff B , Harmon Adam L , Anthony James P , Hall Timothy S , Jablons David M
Published: May 2013

The management of complex bronchopleural fistula remains a major therapeutic challenge for the thoracic surgeon. Although the incidence of bronchopleural fistula following lung resection has decreased in recent years to 1% to 2%, when it occurs, it is associated with significant morbidity and mortality. Using illustrative cases, the epidemiology and pathophysiology of bronchopleural fistula are reviewed and operative strategies are discussed. Algorithms for the diagnosis and treatment are suggested on the basis of cases described in the literature. The best way to prevent a fistula is to rigorously follow the surgical techniques described, with minimal devascularization of the bronchus and prophylactic coverage of the stump in high-risk patients. Successful management of a fistula is combined with treatment of the associated empyema cavity. Definitive repair should be accomplished expeditiously, minimizing the number of procedures performed. When treatment is protracted, secondary complications are more likely and survival is adversely affected. The first step should be control of active infection and adequate drainage of the hemithorax, followed by timely repair of the bronchopleural fistula when possible and reinforcement of the stump with vascularized tissue. If a residual cavity is present it must also be obliterated with a pedicled muscle flap.
Angiotensin-Converting Enzyme Inhibition after Myocardial Infarction
Authors: Zhu Yi Zhun , Lee How Sung
Published: May 2013

Myocardial infarction was the underlying event in the majority of deaths from cardiovascular disease in Western countries in the past quarter-century. The introduction of angiotensin-converting enzyme inhibitors to the treatment of heart failure following myocardial infarction was a major advance in the last 10 years. However, the role of cardiac angiotensin-converting enzyme during postinfarction cardiac remodeling remains to be elucidated. Experimental studies demonstrated that angiotensin-converting enzyme inhibitors administered one week before myocardial infarction could limit infarct size, improve cardiac function, and prevent cardiac hypertrophy. Numerous large-scale clinical trials have shown that angiotensin-converting enzyme inhibitors are safe and can reduce mortality and the occurrence of severe left ventricular dysfunction after myocardial infarction. This review focuses on the effects of these inhibitors in experimental studies and in multicenter clinical trials.
Grafts for Left Main Trunk Lesion Using “MIDCAB Doughnut” on Beating Heart
Authors: Takahashi Masao , Watanabe Go , Furuta Hidetoshi , Doi Toshio , Tanaka Nobuyuki , Misaki Takuro
Published: May 2013

Successful beating heart multiple bypass grafting to the left anterior descending and circumflex artery for a left main trunk lesion was performed in 5 patients through a left thoracotomy using the “MIDCAB doughnut” for immobilization and hemostasis. After completion of left internal thoracic artery-to-left anterior descending artery grafting, a radial artery or saphenous vein graft was anastomosed safely to the obtuse marginal branch, without hemodynamic deterioration. Extending the left anterior small thoracotomy 3 or 4 cm laterally, the obtuse marginal branch could be approached easily without rotating the beating heart. The device achieved a still and stable operative field even for circumflex grafting. An inflow of the graft to the circumflex was placed at the left axillary artery to prevent blood flow shortage to the left coronary system. Mean perioperative blood flow was 29.5 ± 7.1 mL·min−1 in the internal thoracic artery grafts and 43 ± 8 mL·min−1 in the circumflex grafts. Postoperative angiography revealed patency of all grafts. The technique may extend the surgical indications for beating heart bypass surgery without cardiopulmonary bypass.
Stroke and Myxoma
Authors: Ugurlu Baran , Oto Öztekin , Okutan Hüseyin , Kutluk Kürşat , Silistreli Erdem , Sariosmanoğlu Nejat , Hazan Eyüp , Kargi Aydanur
Published: May 2013

Cardiac myxoma was detected by transthoracic echocardiography in 8 patients (aged 11 to 64 years) who were admitted between 1991 and 1999 with stroke or transient ischemic attacks, representing 80% of the total myxoma cases treated in this period. All patients underwent surgery and the myxomas were successfully removed. There were no recurrences during a mean follow-up of 3.1 years. In the presence of unexplained transient ischemic attack, cerebral infarction, or syncope, this relatively rare cardiac lesion should be suspected and investigated by transthoracic echocardiography.
Surgical Approach in Symptomatic Myocardial Bridge
Authors: Rahman Ali , Burma Oktay , Uyar Ihsan Sami , Karaca Ilgin , Ilkay Erdogan , Çekirdekçi Ahmet
Published: May 2013

Between 1996 and 1998, surgery was carried out in 4 patients with myocardial bridging who had angina refractory to medical therapy. Two patients were treated by supraarterial myotomy and 2 underwent coronary artery bypass grafting. One patient suffered a right ventricular perforation that was successfully repaired. Surgery is recommended for a grade-III myocardial bridge.
Biatrial Approach for Bicameral Myxoma with Mitral Regurgitation
Authors: Goel Pankaj , Sankar Nainar Madhu , Rajan Sethurathinam , Cherian Kotturathu Mammen
Published: May 2013

A 16-year-old girl presented with an episode of syncope. Two-dimensional echocardiography revealed masses in the left atrium and left ventricle with severe mitral regurgitation. She underwent removal of myxomas and mitral valve replacement using an extended biatrial approach.
Crossover Saphenous Vein Bypass in Deep Vein Thrombosis
Authors: Farsak Bora , Tok Mustafa , Ateş Şanser , Doğan Riza
Published: May 2013

Two women aged 48 and 32 years, suffering from deep vein thrombosis, were successfully treated with cross-femoral saphenous vein bypass grafts. A distal arteriovenous fistula was instituted in both cases and taken down one month postoperatively.
Mediastinal Hamartoma: Rare Presentation
Authors: Sharma Sanjeev , Furnary Anthony P , Floten H Storm
Published: May 2013

Hamartomas are benign mesenchymal tumors that occur most commonly within lung parenchyma. A rare case of mediastinal hamartoma in a 76-year-old man is described. The patient underwent successful excision of the 9.5 × 10.5 × 8-cm mass.
Functional Outcome in Model of Spinal Cord Ischemia: Use of Enoximone
Authors: Ulus A Tulga , Tütün Ufuk , Sürücü Selçuk , Apaydin Nusret , Gökçe Perran , Katircioğlu S Fehmi
Published: May 2013

Ten dogs underwent 60 minutes of aortic occlusion; 5 received enoximone 10 μg·kg−1·min−1 and the other 5 served as controls. Distal and proximal aortic pressures were measured during the procedure. Neurological status was assessed after 72 hours. Spinal cord specimens were taken for electron microscopy. During aortic occlusion, cerebrospinal fluid pressure was 17 ± 3 mm Hg in the control group and 14 ± 4 mm Hg in the enoximone group, while distal aortic pressure was 15 ± 4 mm Hg in the control group compared to 47 ± 6 mm Hg in the enoximone group (p < 0.001). Four dogs in the control group suffered paraplegia but there was no paraplegia in the enoximone group (p < 0.01). Electron microscopy scores indicated significantly less ultrastructural damage (p < 0.01) in the enoximone group (2.73 ± 0.79) than in the control group (7.67 ± 0.89). It was concluded that enoximone was effective in reducing the risk of spinal cord injury during aortic crossclamping.
Radial Artery Flows: Comparative Study
Authors: Palaniappan Manickam , Rajani Sundar , Soundaravalli Balakrishnan , Anil C Mathew , Krishnan Elayappan , Chandrasekar Padmanabhan , Muralidharan Srinivasan
Published: May 2013

Between December 1997 and February 1999, 150 patients who had the left radial artery as one of the conduits for coronary artery bypass graft surgery were randomly divided into 3 groups of 50 each. Group A received a left supraclavicular block with 20 mL of 1.5% lidocaine with adrenaline (1 in 200,000), and 10 mL of 0.25% bupivacaine. Group B received intravenous diltiazem at 0.5 to 1 μg·kg−1·min−1 after induction and during radial artery harvest. Group C received neither the block nor diltiazem. Radial artery blood flow was measured for 20 seconds and compared between the 3 groups. All patients received diltiazem by infusion in the postoperative period for 24 hours. Radial artery take-down was abandoned in one patient in group B. There was one in-hospital death. No ischemic complication of the hand was noted. There was a statistically significant difference in mean blood flow between group B (39.20 mL/20 sec) and group C (28.84 mL/20 sec). Group A flow (34.08 mL/20 sec) was also higher than group C, but this was not statistically significant. The results advocate the use of either supraclavicular block or intravenous diltiazem during radial artery harvest.
One-Stage Operations for Adult Cardiac Disease with Aortic Coarctation
Authors: Süzer Kaya , Tezcaner Tevfik , Yorgancioğlu Ali Cem , Çatav Zeki , Tokmakoğlu Hilmi , Günay İlhan
Published: May 2013

Three patients with aortic coarctation and additional cardiac disease underwent a one-stage operation through a median sternotomy. Ascending-to-descending aortic bypass was carried out with a prosthetic graft in all 3 cases. One patient also had triple coronary bypass grafting with internal thoracic artery. Another patient underwent single coronary bypass grafting and aortic valve replacement. Aortic remodeling and mitral valve ring annuloplasty were performed in the third patient. There were no postoperative complications and all patients became symptom-free.
Aortocaval Fistula Due to Abdominal Aortic Aneurysm Rupture
Authors: Bhat Mohammed Akbar , Neelakandhan Kurur Sankaran , Unnikrishnan Madathipat , Cherian Vijit Koshy , Attawar Sandeep , Lone Ghulam Nabi
Published: May 2013

Aortocaval fistula is a rare complication of rupture of an aortic aneurysm into the inferior vena cava. Prompt surgical repair is mandatory for salvage. Emergency surgery was performed in 2 cases of aortocaval fistula. The underlying etiology was polyarteritis nodosa in one patient and atherosclerosis in the other. Polyarteritis nodosa leading to abdominal aortic aneurysm with aortocaval fistula is reported for the first time.
Mechanical Circulatory Assist for Pulmonary Artery Obstruction
Authors: Misawa Yoshio , Fuse Katsuo , Oki Shin-Ichi
Published: May 2013

A 72-year-old woman underwent replacement of the ascending aorta because of acute aortic dissection. During surgery, the right pulmonary artery was injured. Direct suture closure led to pulmonary artery stenosis with elevated central venous pressure and recurrent ventricular fibrillation. Extracorporeal membrane oxygenation stabilized her hemodynamic condition. She was weaned from the device 6 days later. Pulmonary angiography revealed severe obstruction of the right pulmonary artery but she had no respiratory symptoms thereafter.
Results of Batista Procedure in Ischemic Dilated Cardiomyopathy
Authors: Zytowski Michael , Baumann Gert , Hotz Holger , Dushe Simon , Enzweiler Christian , Borges Adrian , Borak Viola , Redmann Klaus , Lunkenheimer Peter Paul , Konertz Wolfgang
Published: May 2013

From March 1995 to April 1998, 24 men and 5 women (mean age, 62.2 ± 10 years) underwent the Batista procedure for end-stage cardiac dysfunction due to ischemic dilated cardiomyopathy. Preoperatively, mean cardiac index was 1.9 ± 0.3 L·min−1·m−2, stroke index was 25 ± 5 mL·beat−1·m−2, ejection fraction was 20% ± 6%, and 22 (79%) patients were in New York Heart Association functional class IV. Associated procedures were coronary bypass (25), mitral valvuloplasty (15), aortic or mitral valve replacement (5), dynamic cardiomyoplasty (2), and aneurysmectomy (1). One patient (3.4%) died early and 3 (10.3%) died later. The 1- and 2-year actuarial survival was 87%. A left ventricular assist device was required in 2 patients during the follow-up period. Postoperatively, cardiac index was 2.9 ± 0.3 L·min−1·m−2, stroke index was 36 ± 5 mL·beat−1·m−2, and ejection fraction was 38% ± 10%. Left ventricular end-diastolic diameter decreased from 71 ± 8 mm to 55 ± 8 mm. Currently, 88% of survivors are in functional class I or II. It was concluded that the Batista procedure significantly improved objective and subjective parameters of cardiac performance during early and intermediate follow-up.
Left Subclavian Artery for Graft Inflow in Off-Pump Bypass
Authors: Isomura Tadashi , Suma Hisayoshi , Horii Taiko , Sato Toru , Kobashi Teisei , Kanemitsu Hideo
Published: May 2013

In coronary artery bypass grafting without cardiopulmonary bypass, a suitable alternative source of inflow to the free graft is required when the internal thoracic artery has already been used or the ascending aorta is severely atheromatous. Left subclavian artery was used for proximal inflow to a free radial artery graft in 1 patient and to saphenous vein grafts in 3. The free graft was anastomosed to the left subclavian artery through a small subclavian skin incision and the new pedicled graft was introduced into the pleural cavity. Through a left anterior small thoracotomy, the graft was anastomosed to the left anterior descending artery in 3 cases and to the circumflex artery in 1, without cardiopulmonary bypass. The postoperative course was uneventful and all grafts were patent. This technique may extend off-pump coronary artery bypass grafting to patients requiring reoperation and those with a diseased ascending aorta.
Assessment of Internal Mammary Artery Graft Patency: Angiography or Doppler?
Authors: Dubey Bharat , Bhan Anil , Choudhary Shiv Kumar , Sharma Sanjeev , Sharma Rajesh , Airan Balram , Venugopal Panangipalli
Published: May 2013

Angiography is the usual means of assessing the patency of grafted internal mammary artery. The feasibility of assessing patency by Doppler echocardiography was studied prospectively in 49 patients undergoing left internal mammary artery-to-left anterior descending coronary artery anastomosis. Postoperative angiographic findings were normal in 45 patients (92%), 2 had > 70% and 2 had < 50% narrowing of either the arterial pedicle or the graft. The left internal mammary artery could be visualized by Doppler echocardiography in 44 patients, 4 of whom had abnormal angiograms; there was an unobstructed flow pattern in 42 patients and an obstructed flow pattern in 2 (completely blocked internal mammary artery in one and > 70% narrowing of the graft in the other). Thallium scanning in patients with suboptimal angiographic results but unobstructed Doppler flow patterns showed no evidence of myocardial ischemia in the left anterior descending artery territory. Echocardiography is a sensitive noninvasive screening modality to diagnose critical narrowing of internal mammary artery grafts. It is suggested that angiography may be reserved for cases in which Doppler echocardiography fails to visualize the internal mammary artery or reveals an abnormal flow pattern.
Pulmonary Arteriovenous Malformation Complicated by Cerebral Infarction
Authors: Oto Öztekin , Metin Kivanç , Sariosmanoğlu Nejat , Hazan Eyüp , Silistreli Erdem
Published: May 2013

A 45-year-old epileptic female with fatigue, swollen legs, and numbness of the lower extremities, had radiological findings of increased density in the lower zone of the right lung and a pattern of chronic cerebral ischemia in the territory of the left internal carotid artery. A pulmonary arteriovenous malformation was demonstrated by angiography. A right lower lobectomy was performed successfully.
Pericardial and Pleural Effusion after Central Venous Line Insertion
Authors: Deviri Ehud , Avrutis Oleg , Friedman Shalom , Meshoulam Jack , Sibirsky Ohn , Blinder George , Borman Joseph B
Published: May 2013

A large volume of fluid collected in the pericardium and left pleural space following central venous catheter insertion for total parenteral nutrition in a 35-year-old man. This did not cause fatal hemodynamic compromise and was successfully diagnosed and treated.
Intracardiac Masses
Authors: Taşdemir Kutay , Emiroğullari Ö Naci , Ceyran Hakan , Aşik Ramazan , Yasim Alptekin
Published: May 2013

Between 1991 and 1998, 8 patients (mean age, 29.6 years) underwent surgery for an intracardiac mass. There were 2 hydatid cysts, 1 angiosarcoma, and 5 myxomas. One patient with myxoma underwent a Syme's amputation due to lower extremity ischemia caused by embolization. The patient with angiosarcoma died of cardiopulmonary failure on the 9th postoperative day. The surviving patients experienced no mortality, complications, or recurrence during follow-up of 0.5 to 5 years.
Successful Treatment of Candida Pericarditis following Sternotomy
Authors: Kok Va Kei , Chu Ming Yuan , Wong Ying Kit , Lee Fa Chieh
Published: May 2013

A 34-year-old man who was stabbed in the chest, underwent emergency sternotomy. Sternal dehiscence with pericardial tamponade developed by the 16th postoperative day. Pericardiotomy with drainage was performed and cultures of pericardial fluid yielded Candida tropicalis. The patient was treated successfully with fluconazole.
Traumatic Tracheal Tear Successfully Treated after Remote Area Retrieval
Authors: Endara Santiago A , Cook Steven P , Kang Dong , Bidstrup Benjamin P , Lopez Gary J
Published: May 2013

A 44-year-old man injured in a motor vehicle accident in rural Australia was resuscitated at a local hospital 9 hours later. Bronchoscopy revealed a large tracheal tear. After transfer to the regional cardiothoracic center, surgery was performed under cardiopulmonary bypass 18 hours after the injury was sustained. The patient required surgical tracheostomy as well as ventilatory and inotropic support. There were no postoperative complications and he was discharged after 27 days.
Innominate Artery Compression of Trachea: Treatable Airway Obstruction
Authors: Talwar Sachin , Sharma Rajesh , Agarwal Sandeep , Sharma Sanjeev , Bhan Anil , Kiran Usha , Venugopal Panangipalli
Published: May 2013

A case of innominate artery compression of the trachea is reported for its rarity. The features of this condition are briefly described.
Side-to-Side Anastomosis in Off-Pump Coronary Artery Bypass Grafting
Authors: Nabuchi Akihiro , Kurata Atsushi , Tsukuda Kazuhiko , Tajima Hidetoshi , Kim Kon-Il
Published: May 2013

A technique is described for side-to-side anastomosis as a functional end-to-side anastomosis, in which no direct contact with the vessel walls by surgical instruments is required during suturing, thus avoiding the possibility of damage to the graft.
Mitral Valve Repair with Autologous Pericardial Ring
Authors: Chotivatanapong Taweesak , Kasemsarn Choosak , Sungkahapong Vibhan , Chaiseri Pradistchai , Yosthasurodom Chaiwuth , Cholitkul Sireethorn
Published: May 2013

Between October 1997 and December 1999, 78 patients underwent mitral valve repair using an autologous pericardial ring for posterior annuloplasty. Five patients with congenital heart disease were excluded from the study, and 1 was lost to follow-up. The remaining patients comprised 45 males and 27 females, aged 17 to 74 years (mean, 43.8 years). Follow-up ranged from 3 to 30 months (mean, 17.6 months). Mitral valve repair was required for rheumatic disease (37), degenerative disease (26), infective endocarditis (4), and ischemic heart disease (5). Isolated valve repair was performed in 42 patients, associated operations were aortic valve replacement with autologous pericardium (5), aortic valve replacement (4), aortic valve repair (3), aortic valve replacement with pulmonary autograft (1), tricuspid valve repair (9), and coronary artery bypass (4). The most frequent surgical procedures were posterior annuloplasty, resection of secondary chordae, and suture annuloplasty (average repair procedures per patient was 4.4). There were 2 hospital deaths; one from acute respiratory failure and one from low cardiac output. Three patients needed mitral valve replacement. Use of an autologous pericardial ring is a safe alternative technique for mitral valve annuloplasty but long-term follow-up is mandatory.
Trend of Atherosclerosis Risk Factors in Children of Isfahan
Authors: Kelishadi Roya , Hashemipour Mahin , Sarraf-Zadegan Nizal , Amiri Masoud
Published: May 2013

The prevalence of major atherosclerosis risk factors in Iran was evaluated in 1993 and again in 1999 in 4500 randomly selected children aged 2 to 18 years. Serum lipid levels were significantly higher than standard values in both sexes and in all age groups in the 1993 and 1999 studies. The increase in serum lipid levels was most marked in teenagers. High-density lipoprotein cholesterol was significantly lower than standard values in both studies. There were no significant differences in blood pressure percentiles or the prevalence of hypertension compared to standard values in 1993 and 1999. No case of diabetes mellitus was found. Although the prevalence of obesity was low in these studies (0.2% in 1993, and 0.35% in 1999), a two-fold rise in overweight subjects was noted (4% in 1993, 8% in 1999; p < 0.05), especially in school-aged and adolescent girls. In view of these results and the increasing incidence of coronary artery disease among young people, special attention should be paid to primary prevention.
Right Mid-Ventricular Constriction Due to Constrictive Pericarditis
Authors: Çimen Serdar , Kaplan Mehmet , Demirtaş Murat , Türek Onur , Erdinler İzzet , Eren Mehmet , Gürkan Kadir , Tezel Tuna , Özler Azmi
Published: May 2013

A 16-year-old girl with atrial arrhythmia underwent excision of thickened pericardium with localized annular calcification over the proximal right ventricle. Sinus rhythm was restored postoperatively. Constrictive pericarditis and localized cardiac compression should be considered in the differential diagnosis of arrhythmias in young patients.
Heart Leiomyosarcoma Mimicking Pulmonary Thromboembolism
Authors: Hu Sheng Shou , Sun Cheng Chao , Zheng Zhe
Published: May 2013

A 34-year-old man was admitted with a putative diagnosis of pulmonary artery trunk thromboembolism. Magnetic resonance imaging and angiography showed a solid mass extending from the pulmonary trunk to the right pulmonary artery. During surgery, a tumor was found arising from the pulmonary valve annulus. The tumor was completely removed and pulmonary valvuloplasty was performed. The result was satisfactory. Histopathology showed the tumor to be a leiomyosarcoma.
Transaortic Excision of Left Ventricular Papillary Fibroelastoma
Authors: Bendre Suhas C , Baker Alec , Grehl Todd M
Published: May 2013

Transthoracic echocardiography in a 75-year-old woman with fatigue, dizziness, and left-sided weakness, demonstrated a 3.5 × 3-cm mass in the left ventricle, near the apex. The mass was excised via the aorta. Histology indicated a papillary fibroelastoma. Such tumors rarely arise from the ventricular endocardium.
Aprotinin for Open Cardiac Surgery in Cyanotic Heart Disease
Authors: Singh Rupinder , Vellaichamy Manimozhi , Gowda Nagaraj , Kumar Vasanth , Banakal Sanjay Kumar , Colin John , Kanchi Muralidhar
Published: May 2013

In a prospective randomized study, aprotinin was assessed in cyanotic children with tetralogy of Fallot undergoing total correction utilizing cardiopulmonary bypass. In group A (n = 25), 20,000 kallikrein inhibiting units of aprotinin per kilogram of body weight was administered before cardiopulmonary bypass and the same amount was added to the pump prime. In group B (n = 25), only a single dose of aprotinin was given before cardiopulmonary bypass. Blood loss and blood product requirements were compared with those in a control group of 25 patients who did not receive aprotinin. Blood loss and blood products used in groups A and B did not differ but the control group had significantly more bleeding and transfusion requirements. A single dose of aprotinin before cardiopulmonary bypass is recommended in cyanotic patients undergoing intracardiac repair.
Tricuspid Endocarditis and Paradoxical Embolism
Authors: Caleb Michael , Shankar Sriram , Agasthian Thirugnanam
Published: May 2013

A 32-year-old male heroin addict presented with pneumonia, septic shock, and disseminated intravascular coagulopathy. He was found to have tricuspid endocarditis with pulmonary and splenic septic emboli. A patent foramen ovale was detected during surgery, which was closed, vegetation was excised, and the tricuspid valve was repaired with autologous pericardium. Recovery was rapid.
Pulmonary Mucormycosis
Authors: Hong Yoon Joo , Lee Doo Yun , Park Young Sik
Published: May 2013

A 78-year-old diabetic man presented with consolidation in the middle and lower lobe of the right lung. An endobronchial mucoid mass was found to be obstructing the right middle lobe and right lower lobe bronchi. The patient was treated with intravenous amphotericin B followed by a right pneumonectomy. Histopathology of the resected specimen demonstrated broad nonseptate hyphae branching at right angles, characteristic of mucormycosis.
Postintubation Tracheal Rupture
Authors: Kutlu Ramazan , Kuzucu Akin , Soysal Ömer , Baysal Tamer , Karaman İbrahim , Akbulut Ahmet
Published: May 2013

Tracheal rupture following endotracheal intubation is an extremely rare emergency that needs expedient diagnosis and treatment. The clinical and radiological features of postintubation tracheal rupture in a 45-year-old woman who underwent vertebral stabilization are described. Primary suture closure was performed successfully via a cervical approach.
Volume Reduction Procedures in Giant Left Atrium
Authors: Erdoğan Hasan Basri , Ipek Gökhan , Kirali Kaan , Ömeroğlu Suat Nail , Güler Mustafa , Işik Ömer , Yakut Cevat
Published: May 2013

Partial left atrial resection was performed in 8 males and 12 females, aged 19 to 63 years, with giant left atrium and mitral valve disease. Preoperatively, 18 patients had atrial fibrillation, and 2 had normal sinus rhythm. Echocardiography revealed left atrial thrombosis in 3 patients and spontaneous echo contrast in 5. The lateral wall of the left atrium, the region between the pulmonary veins, the roof of the atrium, and the tissue parallel to the mitral annulus were resected. Resection was performed using the cardiac autotransplantation technique in 6 patients. The mitral valve was replaced in 9 patients and reconstructed in 11. Mean aortic crossclamp time was 101 ± 35 minutes and total perfusion time was 135 ± 26 minutes. Mean follow-up was 20.4 ± 1.1 months. There was no operative mortality. One patient (5%) died suddenly in the late postoperative period. Left atrial volume was reduced from 265.3 ± 125 mL to 83 ± 43 mL (p < 0.01). Left atrial diameter decreased from 8.02 ± 1.31 cm to 4.4 ± 1.23 cm (p < 0.01). Sinus rhythm was detected in 13 patients (65%) postoperatively. No left atrial thrombosis or spontaneous echo contrast were found during follow-up. Statistically significant reductions in cardiac size and improvements in functional capacity were observed.
Surgical Closure of Secundum Atrial Septal Defects: The Cutting Edge?
Authors: LeBlanc Jacques G , Russell Jennifer L , Potts James E , Deagle Margaret L , Sett Suvro S
Published: May 2013

Between January 1985 and November 1998, 270 patients (aged 2 to 220 months) underwent surgical closure of a secundum atrial septal defect. Cardiopulmonary bypass times ranged from 12 to 103 minutes, with aortic crossclamp times of 5 to 49 minutes. Use of blood products decreased from 2.7 units per patient in the first 5 years to 0.2 units in the last 4 years. Median intensive care unit and hospital stays were 2 days and 6 days, respectively. Complications included: bleeding in 6 patients (2%), which required reexploration in 3; air embolism in 1; and arrhythmias in 4. Postpericardiotomy syndrome occurred in 43 patients (16%), requiring drainage in 5. Follow-up (12 to 179 months) was available in 245 patients (91%). There were no early or late deaths. Most patients (94%) were in sinus rhythm, 8 had low atrial rhythm, 3 had first-degree atrioventricular block, and 1 had atrial flutter. Echocardiography in 207 patients (77%) demonstrated a residual shunt in 1 (0.5%), which was hemodynamically insignificant. Late reoperation was required in 4 patients for sternal nonunion. Surgical closure of secundum atrial septal defect remains the gold standard with which transcatheter closure should be compared, particularly with reference to morbidity and residual shunts.
Cardiac Paraganglioma
Authors: Apaydin Anil Z , Wu Derina , Griepp Randall B
Published: May 2013

A rare case of cardiac paraganglioma in a 69-year-old man with coexisting coronary artery disease is reported. Diagnostic, operative, and pathological findings are presented. Although difficult, excision is the treatment of choice. Follow-up is warranted because of potential recurrence, especially in cases of incomplete resection.
Congenital Intrapericardial Left Atrial Aneurysm
Authors: Dhaliwal Rajinder S , Puri Deepak , Sidhu Kuldip S
Published: May 2013

A 14-year-old boy with sudden onset of palpitations and dyspnea was found to have an intrapericardial left atrial aneurysm (15 × 12 cm). Left atrial aneurysmectomy was carried out under cardiopulmonary bypass. The patient has been symptom-free during a 1-year follow-up.
Resection of Congenital Intrapericardial Right Atrial Aneurysm
Authors: Beşoğul Yavuz , Tünerir Bülent , Kirdar Celal , Timuralp Bilgin , Aslan Recep
Published: May 2013

A 16-year-old male was investigated for exercise-induced dyspnea and paroxysmal palpitations. There was no prominent right heart border in a chest radiograph. A congenital intrapericardial right atrial aneurysm was diagnosed from 2-dimensional echocardiographic findings of a large echo-free space close to the right atrium, and confirmed by magnetic resonance imaging and surgical pathology. Successful repair was achieved on a beating heart with a brief period of on-pump support. Postoperatively, the symptoms disappeared completely.
Residual Aortopulmonary Window Closure with Amplatzer Septal Occluder
Authors: Alekyan Bagrat G , Boukharin Vitaly A , Podzolkov Vladimir P , Poursanov Manolis G
Published: May 2013

A 15-year-old female presented with fatigue and dyspnea on exertion due to a residual left-to-right shunt across an aortopulmonary window that had been surgically closed 11 years earlier. The residual opening was located distal to the coronary ostia, the semilunar valves, and the pulmonary artery bifurcation. An Amplatzer septal occluder was used to completely close the residual defect, thereby avoiding reoperation.
Flow Competition of Right Gastroepiploic Artery Graft
Authors: Lee Hyun Sung , Kwak Young Tae , Youn Young Nam , Park Hyung Dong , Chang Byung Chul
Published: May 2013

Right gastroepiploic artery is used as an in-situ arterial conduit in coronary revascularization, but flow competition has been reported. Between September 1998 and June 2000, 25 patients underwent coronary revascularization using right gastroepiploic artery. Coronary flow patterns were examined in 21 patients by postoperative angiography. Flow patterns were divided into 2 categories: right gastroepiploic artery-dependent (n = 16) and native coronary artery-dependent (n = 5). Flow competition was seen in 5 of the 21 patients (24%). The diameter of the right gastroepiploic artery was significantly larger in the right gastroepiploic artery-dependent group, whereas the diameter of the native coronary artery was larger in the native coronary artery-dependent group. Ten of 11 patients with 100% proximal coronary stenosis and all 3 who received a graft to the obtuse marginal branch showed a right gastroepiploic artery-dependent flow pattern. The flow pattern in the graft was determined by the size difference between the arterial conduit and the native coronary artery, the degree of proximal stenosis, and the site of the anastomosis. Further study is needed to evaluate the long-term results of coronary artery bypass grafting using right gastroepiploic artery.
Evolution of Surgical Strategies for Anomalous Left Coronary Artery
Authors: Mohanty Smruti Ranjan , Murthy Kona Samba , Roy Varghese , Cherian Kotturathu Mammen
Published: May 2013

Between 1980 and 2000, 18 patients aged 3 months to 60 years underwent repair of an anomalous left coronary artery from the pulmonary artery. Up to 1993, 8 patients were managed by subclavian artery turndown (4), coronary artery revascularization with ligation of the anomalous left coronary artery (3), or ligation of the anomalous left coronary artery alone (1). From 1994 to 1999, 6 patients underwent Takeuchi's repair. Great arterial wall tube interposition was used in the latest 4 patients. Concomitant mitral valve procedures were required in 4 patients. There were 3 early postoperative deaths (16.7%), and 1 patient who underwent subclavian artery turndown and mitral valve replacement died of bacterial endocarditis 3 months postoperatively. One patient had a tunnel leak at 6 months postoperatively, which was closed successfully; another developed significant right ventricular outflow obstruction and is awaiting surgery. Early two-coronary repair using the great arterial wall tube interposition technique looks promising.
Video-Assisted Thoracoscopic Surgical Closure of Patent Ductus Arteriosus: 300 Cases
Authors: Nezafati Mohammad Hassan , Hashemian Seyed Hassan , Mahmoodi Eftekhar , Hamedanchi Ali
Published: May 2013

From June 1997 to October 2000, 300 consecutive patients (mean age, 6 years) with patent ductus arteriosus recognized by echocardiography and/or cardiac catheterization underwent video-assisted thoracoscopic surgery. Under general anesthesia, three 5-mm holes were made in the left thoracic wall. A video camera and specialized surgical devices were introduced. The ductus was dissected and 2 titanium clips were applied for complete closure of the ductus. Exclusion criteria were: diameter of the ductus > 9 mm; complicated patent ductus arteriosus (aneurysm formation, endocarditis, or calcification); and pleural adhesion or a previous left-sided thoracic operation. All cases were reassessed immediately after the procedure, and followed up by echocardiography. No residual shunt was recorded. The procedure was changed to a thoracotomy in 3 adults due to inappropriately dilated canal (> 9 mm); 2 others developed transient recurrent laryngeal nerve dysfunction. Mean procedure time was 20 ± 2 minutes. All patients were discharged shortly after the procedure (at approximately 20 hours). The results indicate that video-assisted thoracoscopic surgery was superior to other techniques of ductal closure.