bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary artery bypass and carotid endarterectomy with mild hypothermia
Authors: Sadeghi Mohsen Mir-Mohammad , Sadeghi Amir Mir-Mohammad
Published: May 2013

The approach to treatment in patients with both coronary artery disease and major carotid disease is controversial. We analyzed our results of concomitant coronary artery bypass and carotid endarterectomy. Twenty-three patients aged 58 years or older underwent elective concomitant coronary artery bypass and carotid endarterectomy with mild hypothermia (32°C). Demographic characteristics and preoperative risk factors were recorded prospectively. Data were collected during a mean follow-up of 22 ± 9 months. The mean age of the patients was 71 ± 7 years. Twenty-one patients were in New York Heart Association class I to II, and 2 were in class III. Early mortality was 8.6%. There was no early postoperative stroke. Mean intensive care unit stay was 64.5 ± 30.5 h. One (4.3%) patient had a stroke one year later. One- and 2-year survival rates were estimated to be 86.9% and 73.9%, respectively. Although concomitant coronary and carotid artery surgery remains controversial, cooling to 32°C provided good results in this challenging group of patients managed by one team.
Syphilitic aortic aneurysm presenting with upper airway obstruction
Authors: Waikittipong Somchai
Published: May 2013

Syphilitic aortic aneurysms are uncommon today. A rare case of syphilitic aortic arch aneurysm with successful surgical treatment is reported. A 42-year-old man presented with upper airway obstruction. Chest radiography showed a superior mediastinal mass, and computed tomography revealed a large saccular aortic arch aneurysm that compressed the trachea. Dacron graft replacement of the aortic arch was successfully performed under circulatory arrest with antegrade cerebral perfusion.
Ischemic cardiomyopathy: midterm survival and its predictors
Authors: Pinto Nigel , Haluska Brian , Mundy Julie , Griffin Rayleene , Wood Annabelle , Shah Pallav
Published: May 2013

Background: the aim of the study was to analyze all-cause mortality and predictors of long-term survival after myocardial revascularization for ischemic cardiomyopathy.

Method: data of 101 patients (mean age, 63.86 years; age range, 30–85 years; 92% male), operated on with stable coronary artery disease and left ventricular ejection fraction <30% between April 2000 and June 2010, were analyzed.

Results: operative mortality was 1.9% (2/101). There was a significant improvement in left ventricular ejection fraction from 25.99% ± 3.8% preoperatively to 34% ± 12% postoperatively ( p < 0.0001). The mean duration of follow-up was 56.3 ± 33 months, and it was 97% complete (98/101). There were 18/96 (18.75%) late deaths. Overall actuarial survival at 1, 3, 5, and 10 years was 96%, 89%, 83% and 75%, respectively. Univariate predictors of late death were preoperative arrhythmia, cerebrovascular disease, peripheral vascular disease, and logistic EuroSCORE. Multivariate predictors of late death were cerebrovascular disease and preoperative arrhythmia.

Conclusion: our study suggests that myocardial revascularization for ischemic cardiomyopathy improves left ventricular ejection fraction and is associated with favorable long-term survival. Patients with cerebrovascular disease and preoperative arrhythmias had poorer outcomes.
Is there any further advantage of using more than one internal mammary artery? Literature review and analysis
Authors: Parissis Haralabos , Soo Alan W , Al-Alao Bassel
Published: May 2013

The use of the internal mammary artery reduces the incidence of late adverse effects and improves survival after coronary artery bypass grafting. Therefore, internal mammary artery grafts ought to be used in all patients undergoing coronary artery bypass grafting (level II evidence), although in the UK, only 95% of the patients receive an internal mammary artery graft. This is due to factors such as poor left ventricular function, old age, previous radiation to the thoracic cavity, or emergency surgery. As there are biological similarities between the left and right internal mammary artery, one can extrapolate that the use of 2 internal mammary artery grafts may provide additional benefits. Bilateral internal mammary artery grafting can be safely performed in most patients (level II evidence). The late survival in patients with bilateral internal mammary artery grafts is favorable. However, there is as yet no completed randomized trial on this subject. Thus the lack of robust data makes previous reports amenable to criticism. This review examines published data on bilateral internal mammary artery revascularization spanning the last 15 years, and addresses the advantages and disadvantages of arterial conduits in coronary surgery.
Effect of Warm Ischemia on Ultrastructure and Viability of Aortic Valve in Rats
Authors: Gang Chen , Yong Liu Wei , Qiang Yu Shi
Published: May 2013

Warm ischemia is one of the most important causes of valvular damage between the time of the donor's death and the time of organ harvesting and cooling. We used qualitative and quantitative methods to characterize warm ischemic injury through models of SD rat aortic valves to demonstrate the relationship between ultrastructural viability and changes with warm ischemic time. Aortic valves were harvested from 102 SD rats and divided into 6 ischemic times for study. Additionally, 432 photomicrographs of transmission electron microscopy were analyzed. The volume ratio of nucleus to plasma in cells and the ratio of extra-membrane area to volume of mitochondria were used to characterize the degree of valvular cell injury. Valvular cell culture and biochemical metabolism, including glucose degradation and 3H-TdR absorption rates, were adopted. The viability of cultured cells and 3H-TdR uptake were also inhibited with prolonged warm ischemic time.
Open Heart Surgery in Patients with Chronic Renal Failure
Authors: Boran Mediha , Göl M Kamil , Şener Erol , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

Coronary and valvular heart diseases are the main causes of mortality and morbidity among the long-term survivors of chronic renal failure. Despite the additional risk factors, open heart surgical procedures have recently been attempted with high rates of success in some patients with chronic renal failure. Forty-three patients with chronic renal failure that have undergone open heart surgery are included in this study. Ten of the patients were female and the mean age was 53.1 ± 11.2 (26 to 71). Twenty-five patients underwent aortocoronary bypass operations and 18 others underwent heart valve replacements. In this group of patients, 38 (88.3%) were in the compensated retention stage of chronic renal failure and 5 (11.7%) were in the end stage. The decompensated chronic renal failure patients were on regular hemodialysis and continued to receive hemodialysis in the preoperative and postoperative period. Sixteen patients of the compensated chronic renal failure group needed hemodialysis postoperatively. Early mortality rate was 7.8% (n = 3). Mean stay in the intensive care unit after the operation was 3.0 ± 3.3 days (2 to 22 days). In the long-term follow-up 3 patients underwent successful renal transplantations within 9 to 18 months after the cardiac operations. Two of these patients had valve replacements and 1 had concomitant valve replacement and coronary artery bypass grafting prior to renal transplantation. We conclude that coronary angiography, catheterization, myocardial revascularization, and valve replacements can be safely performed and should be considered if indicated in chronic renal failure patients.
A Modified Technique of Venoatrial Bypass in Bidirectional Glenn Shunt
Authors: Lal Manisha , Mahant Tek Singh
Published: May 2013

Clamping of the superior vena cava, while constructing a bidirectional Glenn shunt in patients with a single superior vena cava, may lead to an unacceptable rise in proximal venous pressure. Between January 1993 and March 1994, 7 patients underwent bidirectional Glenn shunt at our institution. Of these 7, 4 had a single superior vena cava and required venoatrial bypass. This was carried out with interposition of a roller pump. Central venous pressure was maintained at 13 to 30 mm Hg (mean 23.5 mm Hg) and arterial pressure at 60 to 74 mm Hg (mean 64 mm Hg). Postoperatively, no facial edema or neuropsychological disturbance was detected. This modified method is more effective than simple venoatrial bypass and less extensive than a cardiopulmonary bypass.
Endobronchial Lipoma Presenting as Destroyed Lung
Authors: Barthwal Madhu Sudan , Gupta Dheeraj , Singh Rana Sandeep , Kakkar Nandita
Published: May 2013

A 50-year-old man presented with recurrent infections and progressively increasing breathlessness of 5 years duration. Fiberoptic bronchoscopy revealed a smooth-rounded growth obstructing the left main bronchus. Computed tomography scan showed complete collapse of the left lung with extensive bronchiectasis. A pneumonectomy was performed.
Normothermic Cardiopulmonary Bypass
Authors: Feng William , Bert Arthur A , Singh Aran K
Published: May 2013

Normothermic cardiopuhnonary bypass avoids the detrimental systemic effects of hypothermia. It is a safe and effective technique of systemic perfusion during cardiopulmonaiy bypass. Myocardial preservation is not compromised when electromechanical quiescence is maintained. Cerebral protection is comparable to that of systemic hypothermia. Low vascular resistance is common and easily treated with higher perfusion flows or vasopressors during bypass and facilitates weaning from bypass. Duration of cardiopulmonary bypass is significantly shortened by the absence of systemic cooling and rewarming phases. Clinical outcomes of patients undergoing cardiac, surgery with normothermic bypass compare favorably with those receiving moderate hypothermia.
Cardiac Hemangioma Arising in the Epicardium
Authors: Joo Lee Cheol , Moon Soh Dong , Jai Tak Seung , Soo Kim Han , Il Choi Byung , Bum Lee Ki , Hyuck Lee Jae , Ryul Lee Heung
Published: May 2013

A 32-year-old housewife was treated for recurrent pericardial effusion with repeated pericardiocentesis and pleuropericardial window formation after a diagnosis of tuberculous pericarditis. The biopsied pericardium revealed nonspecific inflammation. In spite of continuing antituberculosis medication, she did not improve and the pericardial effusion increased with emerging signs of progressive right heart failure. A pericardiectomy was performed and multiple masses with a cobblestone appearance were found on the entire epicardium and the great vessels. The partially excised masses showed mesothelial hyperplasia and capillary hemangioma. The pericardial effusion continued and radiation therapy (2,000 cGy/2 weeks) was given with corticosteroid to control immune thrombocytopenic purpura. On the 87th postoperative day, a left posterolateral thoracotomy was performed to remove a large pleural hematoma which was compressing the left atrium and the left ventricle. We found extensive spread of the hemangioma into the pleural cavity along the intercostal vessels. The patient died 3 days later from massive uncontrollable hemorrhage.
Total Arterial Revascularization for a Patient with a Single Coronary Artery
Authors: Nabuchi Akihiro , Kawaguchi Goh , Ichihara Tetsuya , Takuma Shin , Fujisaki Hiroyuki , Hisamochi Kunikazu
Published: May 2013

A 52-year-old male patient with left main trunk disease and absent right coronary artery underwent successful coronary artery bypass grafting with in situ arterial conduits. Bilateral internal mammary arteries and the gastroepiploic artery were employed, with the inferior epigastric artery as a composite graft to the left internal mammary artery. The postoperative angiogram showed excellent patency of all 4 grafts and cardiac performance during exercise monitored by scintigram was found to be satisfactory.
Surgical Repair of Ventricular Septal Defect in 2085 Pediatric Patients
Authors: Wei Xu Zhi , Kang Su Zhao , Xiang Ding Weng
Published: May 2013

Of 5587 operations for congenital heart disease that we performed between January 1976 and December 1993, 2085 were for correction of ventricular septal defects. Paramembranous, muscular, and atrioventricular canal types were repaired through a right atrial incision, whereas subpulmonary and conus type defects were repaired through a pulmonary artery incision. Circulatory arrest under deep hypothermia was used for patients under 2 years of age or with body weight of less than 10 kg. There were 48 postoperative deaths. The overall mortality was 2.3% and it was related to the age and weight of the patients. The age at which surgical repair was undertaken depended on the position and size of the defect and the degree of intracardiac shunt. Patients with associated pulmonary hypertension underwent surgery before 2 years of age. Early repair of subpulmonary ventricular defects is recommended to prevent aortic insufficiency resulting from valve prolapse. The keys to successful repair were avoidance of a right ventricular incision, improvement of right ventricular function, and postoperative management of pulmonary hypertension. The operative mortality was reduced from 10.14% in the 1970s to 6.43% in the early 1980s by improvements in surgical procedure and postoperative management with a further reduction to 1.25% in recent years, which we attribute partly to the use of a hollow fiber membrane oxygenator.
Comparison of Enoximone with Dopamine after Protamine Reversal of Heparin
Authors: Katircioğlu Salih Fehmi , Küçüker Şeref , Yavaş Soner , Saritaş Zülifikar , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

This study compared the effects of enoximone with those of dopamine on myocardial function after protamine administration for the reversal of heparin. Twelve dogs were intubated and given 300 IU/kg heparin. A femoral artery cannula and two venous cannulae were inserted, and the animals were placed on hypothermic (28°C) cardiopulmonary bypass. The hearts were arrested for one hour with cold crystalloid cardioplegic solution and the animals were rewarmed to 36°C. After weaning from bypass, the heparin was neutralized with 4.5 mg/kg protamine sulfate. The dogs were divided into 3 groups: a control group (group C) received only protamine, another group (group D) received dopamine 10 μg/kg/min and protamine, and the third group (group E) received enoximone 10 μg/kg/min and protamine. Cardiac output was 1,320 ± 50 mL/min in group C, 1,420 ± 30 mL/min in group D, and 1,540 ± 10 mL/min in group E. We concluded that enoximone is an effective drug for relieving the adverse effects of protamine on the myocardium.
Minimally Invasive Coronary Artery Bypass Grafting
Authors: Wing Robert Tam Kien , Smith Christopher , Almeida Aubrey , Neng Lee Chuen
Published: May 2013

Minimally invasive coronary bypass surgery without the use of cardiopulmonary bypass has been introduced recently as a treatment for single or double coronary artery disease. Ten patients were operated on at this institute between September 1996 and January 1997. There was no operative mortality or perioperative myocardial infarction. The median hospital stay was 4 days (range 2 to 7 days). There was no reexploration for bleeding. The first 5 patients underwent postoperative coronary angiography prior to discharge. One showed a 70% stricture proximal to the anastomosis. Another patient had an occluded graft due to kinking and underwent reoperation. All patients were free of angina postoperatively. The minimally invasive technique facilitated early extubation, mobilization, and discharge from hospital. Long-term graft patency requires further evaluation by a randomized prospective trial.
Experience of the Arterial Switch Operation beyond Infancy
Authors: Benjacholamas Vichai , Sanpradit Meunmai , Kyokong Oranuch , Bunburapong Pavena , Lertsapcharoen Porntep , Chotivittayatarakorn Pairoj , Pothmanand Chotima , Thisyakorn Chule , Sueblinvong Viroj
Published: May 2013

The arterial switch operation in the neonatal period is the treatment of choice for complete transposition of the great arteries. Since 1995, we have performed the arterial switch operation with or without closure of a ventricular septal defect in 7 patients who presented beyond infancy. Their ages ranged from 21 to 60 months (mean age 40 months). Four patients had ventricular septal defects and 3 had an intact ventricular septum. Six underwent pulmonary artery banding before the operation and one had a subpulmonic membrane that acted as a pulmonary artery band. All patients survived the operation; two developed mild to moderate aortic regurgitation that decreased over time. Based on our experience and good results we conclude that the arterial switch operation is still the procedure of choice for such patients who present beyond the period of infancy.
Dynamic Cardiomyoplasty: First Successful Case in Korea
Authors: Yang Park Kook , Hyun Park Chul , Jae Lee Hyoen , Young Lim Chang , Kim Ju E , Hyung Kwon Jin , Hoon Ahn Tae , Suk Choi In , Dubrovski Igor , Chekanov Valeri S
Published: May 2013

Dynamic cardiomyoplasty occupies an important place among recent advances in treatment of heart failure. We report the first clinical dynamic cardiomyoplasty case in Korea. The patient was a 25-year-old male with viral cardiomyopathy and chronic active hepatitis. The preoperative echocardiogram showed a left ventricular ejection fraction of 30% and grade 2 mitral and tricuspid regurgitation with dilated left and right atria. The left latissimus dorsi muscle was mobilized to wrap the heart and a myocardial stimulator was connected and placed in the abdominal pocket. After a 10-week training period, the stimulation ratio was set at 1:4 and the stimulator functioned well. At the 8-month follow-up the left ventricular ejection fraction ranged between 30% and 35% and the patient was feeling much better with slightly increased activity.
Coronary Artery Neovascularization in Chronic Constrictive Pericarditis
Authors: Agarwala Manoj Kumar , Singh Mandeep , Juneia Rajnish , Grover Anil , Verma Jagmohan Singh
Published: May 2013

Neovascularity in the region of the left atrial appendage was demonstrated by coronary arteriography in a patient with tuberculous constrictive pericarditis. The presence of neovascularity may have been caused by the chronic nature of the constrictive pericarditis, which allowed time for tissue reaction and organization.
Ventricular Septal Defect following Triple Valve Replacement
Authors: Bapat Vinayak Nilkanth , Naik Ajay Madhukar , Lokhandwala Yash , Tendolkar Anil Gangadhar
Published: May 2013

We report an unusual case of ventricular septal defect following triple valve replacement. The defect was detected at follow-up 3 months after surgery. The site of the defect was subaortic and restrictive in nature. As it did not lead to hemodynamic deterioration, the patient was treated conservatively and she has remained asymptomatic.
Surgical Interruption of Patent Ductus Arteriosus in Children
Authors: Li Shu Sen , Xu Si An , Zheng You Ren , Zhao Xi Wu
Published: May 2013

From January 1981 to September 1996, 447 patients with patent ductus arteriosus (122 male and 325 female) aged from 0.75 to 14 years, underwent surgery in our institute. Systolic blood pressure was maintained below 90 mm Hg with sodium nitroprusside and a vertical incision was made under the left axilla through the third intercostal space. Simple ligation was performed when the ductus was less than 10 mm in diameter. In 313 patients with a patent ductus arteriosus of 10 mm diameter or greater, a Dacron cushion was placed under the ligature. There was no death or evidence of residual patency. We recommend careful control of systolic blood pressure during the whole procedure and the use of a cushion under the ligature when closing a large ductus.
Chordal Replacement in Tricuspid Valve Repair in Children
Authors: van Son Jacques AM , Hambsch Jörg , Black Michael D , Mohr Friedrich W
Published: May 2013

Congenital or traumatic tricuspid regurgitation in the pediatric population, although generally well tolerated initially, may lead ultimately to right atrial and ventricular dilation and dysfunction with dysrhythmias. In order to preserve right atrial and ventricular function and maintain sinus rhythm, it is our objective to repair the regurgitant tricuspid valve at an early stage. In 5 children (mean age 8.8 years) with congenital tricuspid regurgitation (2 with Ebstein's anomaly, 1 each with ventricular septal defect, tetralogy of Fallot, and partial agenesis of chordae), and in 1 child with traumatic tricuspid regurgitation, the shortened (n = 4), congenitally absent (n = 1), and ruptured (n = 1) chordae tendineae of the anterior or septal leaflets or both, were repaired with polytetrafluoroethylene artificial chordae. The tricuspid valve was successfully reconstructed in all 6 patients. De Vega's (n = 3) or Danielson's (n = 2) plication of the tricuspid valve annulus was performed in 5 patients. At a mean follow-up time of 15.7 months, tricuspid valve function was normal in 2 patients and the other 4 had mild residual tricuspid regurgitation. The mean diameter of the tricuspid annulus decreased from 36.7 mm preoperatively to 30.0 mm postoperatively, which is in the range for children with a normal tricuspid valve. In congenital or traumatic tricuspid regurgitation, chordal replacement using polytetrafluoroethylene artificial chordae is a useful adjunct to the armamentarium of tricuspid valve repair. Early repair avoids deterioration of right atrial and ventricular function and promotes maintenance of sinus rhythm.
Extracardiac Repair of Complex Unroofed Coronary Sinus
Authors: van Son Jacques AM , Hambsch Jörg , Mohr Friedrich W
Published: May 2013

A technique for conversion of an intra-atrial baffle repair to an extracardiac repair is described for complex unroofed coronary sinus syndrome (including a complete atrioventricular septal defect) with connection of the left superior caval vein to the roof of the left-sided atrium. The left superior caval vein was divided distally and anastomosed to the right superior caval vein in an end-to-side fashion. In addition, the baffle in the left-sided atrium connecting the pulmonary veins with the left atrioventricular valve orifice was removed and the atria were septated. This extracardiac repair technique avoids the various disadvantages of the intra-atrial baffle technique such as creation of a small left atrium with low compliance.
Minimally Invasive Technique for Closure of Atrial Septal Defect
Authors: van Son Jacques AM , Diegeler Anno , Sim Eugene KW , Autschbach Rüdiger , Mohr Friedrich W
Published: May 2013

Minimally invasive techniques for repair of extracardiac anomalies in congenital heart disease have evolved over the last 5 years and laid the foundation for the next phase: the repair of intracardiac defects. Fifteen patients (9 females and 6 males) with a median age of 9.8 years (range, 5.2 to 54 years) underwent closure of a secundum atrial septal defect through a small right anterior thoracotomy. The right external iliac artery was cannulated through a small groin incision and the atrial septal defect was repaired during hypothermic fibrillatory arrest for a mean period of 14 ± 5 minutes. The mean length of the thoracotomy was 4.9 ± 0.8 cm (range, 4.5 to 8.8 cm) while the mean length of the groin incision was 3.9 ± 0.5 cm (range, 2.9 to 5.3 cm). In the 3 youngest patients, the external iliac artery was cannulated with an 8F arterial cannula. Direct closure of the atrial septal defect was possible in all patients. The mean operative time was 109 ± 39 minutes. There was no perioperative or late mortality and no morbidity except for a tear in the right femoral artery of a 19-year-old girl. No residual atrial septal defect was observed in any of the patients. Although minimally invasive techniques for repair of intracardiac defects are not fully developed with regard to indications, the procedure described here provided secure closure of the defects with excellent cosmetic results.
Recombinant Tissue Plasminogen Activator Therapy for Pacemaker-Induced Thrombosis
Authors: Ilkay Erdoĝan , Karaca Ilgin , Serhatlioglu Selami , Aslan Nadi , Cihangiroglu Mutlu
Published: May 2013

A 50-year-old male who developed subclavian vein thrombosis following insertion of a demand pacemaker was treated with a short period of high-dose recombinant tissue plasminogen activator (100 mg over 3 hours). Total thrombolysis was achieved without complications.
Refractory Left Ventricular Failure Due to Large Left Ventricular Thrombus
Authors: Özerkan Filiz , Kayikçioĝlu Meral , Akilli Azem
Published: May 2013

Mural thrombi are common in patients with acute myocardial infarction and can cause refractory left ventricular failure as a rare complication. We report a case of large postinfarction ventricular thrombus resulting in left ventricular failure resistant to medical therapy. After echocardiographic diagnosis, thrombectomy and coronary bypass grafting were performed and the symptoms subsided.
Selection and Placement of Double-Lumen Tubes in Asian Patients
Authors: Mackey Sean , Brodsky Jay B , Alcantara Teresa M , Monje James , Nuevo Florian R
Published: May 2013

In the first part of the study performed at Stanford University, 30 Asian born and 163 non-Asian born patients matched by height and weight had left-sided double-lumen tubes selected on the basis of the width of each patient's trachea. In the second part of the study performed at the Philippines Lung Center and Santo Tomas University Hospital, left-sided double-lumen tubes were selected on the basis of the anesthesiologists' clinical experience for 22 patients and by tracheal width guidelines for 35 patients. When tubes were selected by tracheal width, there was no difference between those used for Asian and non-Asian patients of similar size. We concluded that measurement of tracheal width can be used to select the appropriate size of left-sided double-lumen tubes for all patients.
Tuberculous Lymphadenopathy Causing Dysphagia: Report of Two Cases
Authors: Alamoudi Omer S , Montaner Julio S , Evans Kenneth , FitzGerald J Mark
Published: May 2013

We report two cases of tuberculous lymphadenopathy causing dysphagia. The first patient was HIV positive and the second patient had immigrated recently from India. Culture in both patients grew Mycobacterium tuberculosis that was fully sensitive to first line drugs. Dysphagia may result from intrinsic or extrinsic involvement of the esophagus. Extrinsic involvement is more common and results from cervical and mediastinal lymph node enlargement (as in these 2 cases) that causes external compression on the wall of the esophagus. The dysphagia subsided completely after 4 weeks of antituberculous therapy in both cases.
Recovery of Left Ventricular Diastolic Function after Coronary Bypass Surgery
Authors: Kuralay Erkan , Demirkiliç Ufuk , Özal Ertugrul , Cingöz Faruk , Karaeren Hayrettin , Tatar Harun
Published: May 2013

Effects of myocardial revascularization in patients with preoperative left ventricular diastolic dysfunction have not been well characterized. The aim of this study was to evaluate the recovery of diastolic function following successful coronary artery bypass surgery. Forty-five patients with normal diastolic function were selected for comparison with 45 patients who had a pattern of diastolic dysfunction. Mitral flow peak velocity ratios and atrial filling fractions were measured by pulsed Doppler echocardiography 24 hours before surgery. Diastolic dysfunction was defined as a mitral flow peak velocity ratio of less than one. After coronary artery bypass graft surgery, patients who required hemodynamic support were excluded from further study. Group 1 consisted of 38 patients (mean age, 59 ± 9 years) with normal preoperative peak velocity ratios. Group 2 consisted of 33 patients (mean age, 52 ± 9) with preoperative diastolic dysfunction. In group 1, mitral flow peak velocity ratios decreased immediately after cardiopulmonary bypass and persisted for 24 hours, returning to normal at 72 hours. In group 2, peak velocity ratios decreased immediately after cardiopulmonary bypass and persisted for 10 days. Similar changes occurred in atrial filling fractions in the 2 groups. These findings indicate that recovery of left ventricular diastolic function is prolonged in patients with preoperative dysfunction, which may reflect the time required for reversal of the effects of chronic myocardial ischemia.
Establishment and First Audit of a New Perioperative Echocardiography Service
Authors: Morris Michael John , Klineberg Peter Lindsay , Chard Richard , Hanrahan Veronica , Harrison Ken , Larcos George , Mudaliar Yugan , Hanna William Meldrum , Paterson Hugh , Shaw David
Published: May 2013

Intraoperative echocardiography has become an integral service for cardiothoracic surgery. Establishing a service requires new ultrasound technologies and a dedicated team prepared to be trained in this new discipline. The establishment of a new perioperative service at Westmead Hospital, Australia is outlined. Early experience, current practice, teaching and research programs are presented and the first audit is reported.
Right Atrial Myxoma Originating from Tricuspid Septal Leaflet
Authors: Birincioğlu C Levent , Ulus A Tulga , Katircioğlu S Fehmi , Yamak Birol , Kale Arzum , Aydog Gülden , Taşdemir Oğuz
Published: May 2013

A unique case of right atrial myxoma originating from the septal leaflet of the tricuspid valve is described. The tumor was detected by echocardiography and resected along with part of the septal leaflet, followed by primary repair.
Traumatic Main Bronchial Disruption: Radiologic Evaluation and Surgical Management
Authors: Oto Öztekin , Açikel Ünal , Silistreli Erdem , Karabay Özalp , Tuzun Egemen , Gurgan Ugur , Catalyurek Hudai , Sariosmanoğlu Nejat
Published: May 2013

A 23-year-old female suffered right main bronchial transsection as a result of blunt chest trauma. The lesion was suspected at plain radiography and clearly shown on three-dimensional helical computed tomography imaging. Urgent primary repair was performed successfully. This technique of diagnosis with its three-dimensional viewing capability, can be helpful in defining the location and extent of various injuries.
Management of Cardiopulmonary Bypass during Minimally Invasive Cardiac Surgery
Authors: Bao Mei , Geng Jian Ying , Guo Bin
Published: May 2013

From December 1996 to December 1997, 58 patients underwent minimally invasive cardiac surgery in our institute. The operations comprised 10 for atrial septal defect, 26 for ventricular septal defect, 15 for mitral stenosis and insufficiency, 4 for aortic valve insufficiency, 2 for left atrial myxoma, and 1 for right ventricular myxoma. There were 21 men and 37 women with a mean age of 20 years (range, 5 to 46 years) and a mean weight of 35 kg (range, 15 to 68 kg). To establish cardiopulmonary bypass, femorofemoral and superior vena caval cannulation or femoral artery and two-stage cannulation was used. Normothermia with a beating heart or moderate hypothermia with aortic cross-clamping during cardiopulmonary bypass were employed. All patients resumed sinus rhythm spontaneously, except for one who was easily defibrillated. There were no deaths or neurologic complications and no problems with the cannulation sites. We concluded that these techniques of cardiopulmonary bypass were feasible and safe.
Beneficial Effects of Aminophylline on Ischemia-Reperfusion in Isolated Rabbit Heart
Authors: Ulus A Tulga , Gökçe Perran , Özgencil Eser , Yildiz Ülkü , Ibrişim Erdogan , Katircioğlu S Fehmi
Published: May 2013

Eighteen rabbit hearts were arrested for 3 hours with cardioplegic solution at 4°C, followed by reperfusion with oxygenated perfusion solution at 37°C for 2 hours. Six control hearts received no drug during arrest or reperfusion (group 1). Six hearts received 3 mg·L−1 aminophylline during the arrest period (group 2). Six hearts received 3 mg·L−1 aminophylline during the reperfusion period (group 3). Effects of aminophylline were evaluated in terms of the pressure-volume relationship, coronary flow, myocardial oxygen extraction, and lactate release before cardioplegic arrest and after 1 and 2 hours of reperfusion. End-diastolic pressure at constant volume after 2 hours of reperfusion was 19 ± 2.63 mm Hg in group 1, 14 ± 1.7 mm Hg in group 2, and 19 ± 2.55 mm Hg in group 3 (p < 0.05 for group 2 versus groups 1 and 3). End-systolic pressure at constant volume after 2 hours of reperfusion was 81 ± 3.55 mm Hg in group 1, 90 ± 2.95 mm Hg in group 2, and 84 ± 3.47 mm Hg in group 3 (p < 0.05 for group 2 versus groups 1 and 3). Oxygen extraction was significantly higher and release of lactate was significantly lower in group 2 compared to groups 1 and 3. The results indicate that aminophylline administration during cardioplegic arrest improved systolic and diastolic function and had a beneficial effect on metabolic recovery.
Penetrating Cardiac Injury Due to Ballpoint Pen
Authors: Hardikar Ashutosh A , Thakur Sanjeev S , Karmarkar Pushkaraj S , Ambike Vilas S , Kanetkar Ashok V , Golhar Keshaw B
Published: May 2013

Penetrating cardiac injury has the highest mortality and morbidity rates of any organ trauma. We describe a case of cardiac injury presenting with partial pericardial tamponade, which was caused by penetration of a ballpoint pen. The injury was diagnosed by chest radiography and successfully treated in a non-cardiac setup. Urgent investigation and surgical intervention are emphasized.
Effects of Ventilation on Lung Function after Normothermic Ischemia
Authors: Toker Alper , Bostanci Korkut , Yilmazbayhan Dilek , Dayioğlu Enver , Onursal Ertan
Published: May 2013

The effects of atelectasis and hyperinflation were compared on immediate postischemic lung function and architecture, following normothermic ischemia. Thirty Sprague-Dawley rats were divided into 3 groups; 2 groups were subjected to 60 minutes of normothermic ischemia. The lungs were atelectatic in 10 (group A), they were hyperinflated to a pressure of 10 cm H2O in 10 (group B), and 10 rats served as nonischemic controls (group C). After 5 minutes of reperfusion, left pneumonectomies were performed and the lungs were examined histopathologically. There were no statistically significant differences in pulmonary venous blood oxygen tension or pH in the 3 groups. There was a significant difference between the compliance data of groups A and B (p < 0.05) and a highly significant difference between the compliance data of groups A and C (p < 0.001). Alveolar edema, perivascular edema, peribronchiolar edema, vascular congestion, and intrapulmonary hemorrhage were more frequent and more severe in the atelectatic group than in the hyperinflated group. The results indicate that postischemic injury occurred at an early stage in atelectatic lungs before any change in blood gas values and that superior postischemic preservation was achieved in lungs maintained in a hyperinflated state.
Total Occlusion of Left Main Coronary Artery Trunk in a Young Man
Authors: Nabuchi Akihiro , Li Qing He , Zhu Zhan Lai
Published: May 2013

A 28-year-old male with total occlusion of the main trunk of the left coronary artery underwent successful coronary artery bypass surgery with bilateral internal mammary arteries. He did not have hypercholesterolemia and the ascending aorta, bilateral internal mammary arteries, and peripheral part of the left coronary artery were normal in character and size, which indicated that no systemic or inflammatory diseases caused the lesion. Smoking was the only risk factor identified.
Fuzzy stability of functional inequalities in matrix fuzzy normed spaces
Authors: Park Choonkil , Shin Dong Yun , Lee Jung Rye
Published: May 2013

Using the fixed point method, we prove the Hyers-Ulam stability of additive functional inequalities in matrix fuzzy normed spaces.

MSC:47L25, 47H10, 46S40, 39B82, 46L07, 39B52, 26E50.
Genetic characterization of a core collection of flax (Linum usitatissimum L.) suitable for association mapping studies and evidence of divergent selection between fiber and linseed types
Authors: Soto-Cerda Braulio J , Diederichsen Axel , Ragupathy Raja , Cloutier Sylvie
Published: May 2013

Background

Flax is valued for its fiber, seed oil and nutraceuticals. Recently, the fiber industry has invested in the development of products made from linseed stems, making it a dual purpose crop. Simultaneous targeting of genomic regions controlling stem fiber and seed quality traits could enable the development of dual purpose cultivars. However, the genetic diversity, population structure and linkage disequilibrium (LD) patterns necessary for association mapping (AM) have not yet been assessed in flax because genomic resources have only recently been developed. We characterized 407 globally distributed flax accessions using 448 microsatellite markers. The data was analyzed to assess the suitability of this core collection for AM. Genomic scans to identify candidate genes selected during the divergent breeding process of fiber flax and linseed were conducted using the whole genome shotgun sequence of flax.

Results

Combined genetic structure analysis assigned all accessions to two major groups with six sub-groups. Population differentiation was weak between the major groups (FST = 0.094) and for most of the pairwise comparisons among sub-groups. The molecular coancestry analysis indicated weak relatedness (mean = 0.287) for most individual pairs. Abundant genetic diversity was observed in the total panel (5.32 alleles per locus), and some sub-groups showed a high proportion of private alleles. The average genome-wide LD (r
2) was 0.036, with a relatively fast decay of 1.5 cM. Genomic scans between fiber flax and linseed identified candidate genes involved in cell-wall biogenesis/modification, xylem identity and fatty acid biosynthesis congruent with genes previously identified in flax and other plant species.

Conclusions

Based on the abundant genetic diversity, weak population structure and relatedness and relatively fast LD decay, we concluded that this core collection is suitable for AM studies targeting multiple agronomic and quality traits aiming at the improvement of flax as a true dual purpose crop. Our genomic scans provide the first insights into candidate regions affected by divergent selection in flax. In combination with AM, genomic scans have the ability to increase the power to detect loci influencing complex traits.
Low serum total nitrite and nitrate levels in severe leptospirosis
Authors: Kalugalage Thilini , Rodrigo Chaturaka , Vithanage Thamal , Somaratne Pranitha , De Silva H Janaka , Handunnetti Shiroma , Rajapakse Senaka
Published: May 2013

Background

The relationship between inducible nitric oxide synthatase activity and disease severity in leptospirosis is unclear. Nitric oxide is converted to nitrites and nitrates, thus nitrite and nitrate levels (NOx) in serum are considered surrogate markers for nitric oxide. NOx are excreted through the kidneys, and elimination is diminished in renal impairment. We assessed the correlation of NOx with disease severity in patients with leptospirosis, compared with healthy controls and non-leptospirosis fever patients.

Methods

All patients admitted over a two-month period to the National Hospital, Colombo, Sri Lanka with a clinical picture suggestive of leptospirosis were included. Leptospirosis was confirmed by the microscopic agglutination test (titre≥400). Severe leptospirosis was defined by the presence of two or more of the following criteria: jaundice (bilirubin> 51.3 μmol/l), oliguria (urine output < 400 ml/day), serum creatinine> 133 μmol/l or blood urea > 25.5 mmol/l, or the presence of organ dysfunction. Non-leptospirosis fever patients and healthy volunteers were used as control groups. NOx levels were measured using a modified Griess reaction.

Results

Forty patients were confirmed as having leptospirosis and 26 of them had severe disease. NOx levels were significantly higher in confirmed leptospirosis patients compared to healthy controls, MAT equivocal patients and non-leptospirosis fever patients (p<0.001). NOx concentrations were also significantly higher in patients with severe compared to mild leptospirosis (p<0.001). Once NOx levels were corrected for renal function, by using the ratio NOx/creatinine, NOx levels were actually significantly lower in patients with severe disease compared to other patients, and values were similar to those of healthy controls.

Conclusions

We postulate that high NOx levels may be protective against severe leptospirosis, and that finding low NOx levels (when corrected for renal function) in patients with leptospirosis may predict the development of severe disease and organ dysfunction.
Seroprevalence of Streptococcal Inhibitor of Complement (SIC) suggests association of streptococcal infection with chronic kidney disease
Authors: Karmarkar Mohan Ganesh , Hule Gouri Pandharinath , Hase Niwrutti Khandu , Mehta Preeti Rajeev , Walter Scott Robert , Sriprakash Kadaba Srinivasa
Published: May 2013

Background

Group A streptococcus (GAS) is an etiological agent for the immune mediated sequela post streptococcal glomerulonephritis (PSGN). In some populations PSGN is recognized as a risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). It was found that a significantly greater proportion of subjects with past history of PSGN than without the history exhibited seroreactions to streptococcal antigens called streptococcal inhibitor of complement (SIC) and to distantly related SIC (DRS). These antigens are expressed by major PSGN-associated GAS types. We therefore predicted that in populations such as India, which is endemic for streptococcal diseases and which has high prevalence of CKD and ESRD, greater proportions of CKD and ESRD patients exhibit seroreaction to SIC and DRS than healthy controls.

Methods

To test this we conducted a SIC and DRS seroprevalence study in subjects from Mumbai area. We recruited 100 CKD, 70 ESRD and 70 healthy individuals.

Results

Nineteen and 35.7% of CKD and ESRD subjects respectively were SIC antibody-positive, whereas only 7% of healthy cohort was seropositive to SIC. Furthermore, significantly greater proportion of the ESRD patients than the CKD patients is seropositive to SIC (p=0.02; odds ratio 2.37). No association was found between the renal diseases and DRS-antibody-positivity.

Conclusions

Past infection with SIC-positive GAS is a risk factor for CKD and ESRD in Mumbai population. Furthermore, SIC seropositivity is predictive of poor prognosis of CKD patients.
Characterization of a short isoform of the kidney protein podocin in human kidney
Authors: Völker Linus A , Schurek Eva-Maria , Rinschen Markus M , Tax Judit , Schutte Barbara A , Lamkemeyer Tobias , Ungrue Denise , Schermer Bernhard , Benzing Thomas , Höhne Martin
Published: May 2013

Background

Steroid resistant nephrotic syndrome is a severe hereditary disease often caused by mutations in the NPHS2 gene. This gene encodes the lipid binding protein podocin which localizes to the slit diaphragm of podocytes and is essential for the maintenance of an intact glomerular filtration barrier. Podocin is a hairpin-like membrane-associated protein that multimerizes to recruit lipids of the plasma membrane. Recent evidence suggested that podocin may exist in a canonical, well-studied large isoform and an ill-defined short isoform. Conclusive proof of the presence of this new podocin protein in the human system is still lacking.

Methods

We used database analyses to identify organisms for which an alternative splice variant has been annotated. Mass spectrometry was employed to prove the presence of the shorter isoform of podocin in human kidney lysates. Immunofluorescence, sucrose density gradient fractionation and PNGase-F assays were used to characterize this short isoform of human podocin.

Results

Mass spectrometry revealed the existence of the short isoform of human podocin on protein level. We cloned the coding sequence from a human kidney cDNA library and showed that the expressed short variant was retained in the endoplasmic reticulum while still associating with detergent-resistant membrane fractions in sucrose gradient density centrifugation. The protein is partially N-glycosylated which implies the presence of a transmembranous form of the short isoform.

Conclusions

A second isoform of human podocin is expressed in the kidney. This isoform lacks part of the PHB domain. It can be detected on protein level. Distinct subcellular localization suggests a physiological role for this isoform which may be different from the well-studied canonical variant. Possibly, the short isoform influences lipid and protein composition of the slit diaphragm complex by sequestration of lipid and protein interactors into the endoplasmic reticulum.
Evaluation of the cytotoxicity, mutagenicity and antimutagenicity of a natural antidepressant, Hypericum perforatum L. (St. John’s wort), on vegetal and animal test systems
Authors: Peron Ana Paula , Mariucci Rosinete Gonçalves , de Almeida Igor Vivian , Düsman Elisângela , Mantovani Mário Sérgio , Vicentini Veronica Elisa Pimenta
Published: May 2013

Background

St. John’s wort (Hypericum perforatum L.) is an herbaceous plant that is native to Europe, West Asia and North Africa and that is recognized and used worldwide for the treatment of mild and moderate depression. It also has been shown to be therapeutic for the treatment of burns, bruises and swelling and can be used for its wound healing, antiviral, antimicrobial, antioxidant, analgesic, hepato-protective and anxiolytic properties. The aim of this study was to evaluate the potential cytotoxic, mutagenic and antimutagenic action of H. Perforatum.

Methods

Meristematic cells were used as the test system for Allium cepa L., and bone marrow cells from Rattus norvegicus, ex vivo, were used to calculate the mitotic index and the percentage of chromosomal aberration. Statistical analysis was performed using the chi-square test.

Results

This medicinal plant had no cytotoxic potential in the vegetal test system evaluated. In the animal test system, none of the acute treatments, including intraperitoneal gavage and subchronic gavage, were cytotoxic or mutagenic. Moreover, this plant presented antimutagenic activity against the clastogenic action of cyclophosphamide, as confirmed in pre-treatment (76% reduction in damage), simultaneous treatment (95%) and post-treatment (97%).

Conclusions

Thus, the results of this study suggest that the administration of H. perforatum, especially by gavage similar to oral consumption used by humans, is safe and with beneficial antimutagenic potential.