Aortic valved homograft degeneration: surgical or transcatheter approach for repeat aortic valve replacement?

Objectives: Aortic valved allografts (homografts) have been used alternatively to mechanical or biological valve prostheses in expectation of better durability; however, homograft valves do degenerate, and redo procedures have proven challenging due to heavy wall calcification. The aim of the study was to compare the outcome of open surgical (SAVR) and transcatheter aortic valve replacement (TAVR) in degenerated homografts.

Methods: Between 1993 and 2022, 81 patients underwent repeat aortic valve procedures having previously received an aortic homograft.

Case Report: Incidental finding of an atresia of the inferior vena cava-a challenge for cardiac surgery.

Inferior vena cava atresia is a rare and usually asymptomatic condition. However, when these patients undergo cardiac surgery, it can present an unexpected and challenging situation for the surgeon. Specifically, adequate venous drainage during cardiopulmonary bypass (CPB) is a critical issue here and may require an extension of cannulation strategies.

Visceral and renal malperfusion syndromes in acute aortic dissection type A: the fate of the branch vessel.

Background: Malperfusion in acute aortic dissection is not uncommonly observed and associated with a highly significant increase in mortality and morbidity. Of the various malperfusion syndromes, visceral and renal involvement is the most challenging in terms of correct and timely diagnosis as well as the choice of management strategy. The aim of this study was to identify the pathology and associated fate of each visceral and renal vessel in acute type A dissections.

Bridging patients in cardiogenic shock with a paracorporeal pulsatile biventricular assist device to heart transplantation-a single-centre experience.

Objectives: We evaluated the outcome of patients in cardiogenic shock receiving a paracorporeal pulsatile biventricular assist device as a bridge to transplantation.

Methods: We performed a retrospective single-centre analysis of all patients who received a Berlin Heart Excor® at our institution between 2004 and 2019.

Results: A total of 97 patients (90 adults, 7 paediatric) were analysed.

Time is of the essence: where can we improve care in acute aortic dissection?

Objectives: In acute aortic dissection type A various components of the diagnostic and logistic pathways may affect the time to definitive treatment. This study aimed to characterize these components and to identify factors delaying the optimal management within our institutional referral network.

Methods: Between January 2017 and January 2020, 96 consecutive patients with classical aortic dissection type A were admitted (28%) or referred (72%) to our tertiary care centre and analysed retrospectively.

Routine Stent Bridging to the Supraaortic Vessels in Aortic Arch Replacement: 10-Year-Experience.

Background: The supraaortic vessel anastomosis stent bridging (SAVSTEB) technique simplifies the reattachment of the supraaortic vessels in aortic arch surgery; however, follow-up data are limited. The study aimed to investigate the stent-related performance and complications.

Methods: Between February 2009 and September 2020, 112 patients underwent total arch replacement with a tetrabranched graft and using the SAVSTEB technique.

Aortic Arch Hybrid Repair: Stent-Bridging of the Supra-Aortic Vessel Anastomoses (SAVSTEB).

The reattachment of the supra-aortic vessels during hybrid arch repair using a branched prosthesis is time consuming and sometimes technically challenging. Here, we describe the surgical technique of bridging the end-to-end anastomoses between the graft branches and the supra-aortic vessels by self-expanding covered stents to reduce suturing time, avoid anastomotic bleeding, enhance true lumen remodeling, and improve vessel alignment to the hybrid graft.

A multi-sensor RSS spatial sensing-based robust stochastic optimization algorithm for enhanced wireless tethering.

The reliability of wireless communication in a network of mobile wireless robot nodes depends on the received radio signal strength (RSS). When the robot nodes are deployed in hostile environments with ionizing radiations (such as in some scientific facilities), there is a possibility that some electronic components may fail randomly (due to radiation effects), which causes problems in wireless connectivity. The objective of this paper is to maximize robot mission capabilities by maximizing the wireless network capacity and to reduce the risk of communication failure.

[Effect of fasting on gastric mucosa thickness: experimental study in laboratory rats].

Background: It has been proven that damage to the gastric mucosa is the result of the combined effects of acidopeptic agents including infection with Helicobacter pylori and insufficient protective mechanisms of the mucosa. Thickness of gastric mucus is very important protective factor. We can hypothetically expect that fasting may cause changes in the thickness of gastric mucus layer, which may in certain circumstances contribute to the conditions for mucosal injury.

A gastric acid secretion model.

A theory of gastric acid production and self-protection is formulated mathematically and examined for clinical and experimental correlations, implications, and predictions using analytic and numerical techniques. In our model, gastric acid secretion in the stomach, as represented by an archetypal gastron, consists of two chambers, circulatory and luminal, connected by two different regions of ion exchange. The capillary circulation of the gastric mucosa is arranged in arterial-venous arcades which pass from the gastric glands up to the surface epithelial lining of the lumen; therefore the upstream region of the capillary chamber communicates with oxyntic cells, while the downstream region communicates with epithelial cells.

Prediction of survival of patients with primary biliary cirrhosis. Examination of the Mayo Clinic model on a group of patients with known endpoint.

Increasing use of liver transplantation and new treatment regimens necessitate an accurate estimate of prognosis in primary biliary cirrhosis. To test the usefulness of the Mayo model for this purpose, the R value of the model was calculated for a group of 28 patients after each patient encounter and plotted against time. The data were best described by two linear regressions.

The technique of abdominal pressure in total colonoscopy.

Total colonoscopy can be difficult. It is recognized that abdominal pressure can be helpful in the performance of colonoscopy by externally splinting the endoscope to prevent loop formation. Properly applied abdominal pressure can limit patient discomfort and shorten examination time.

Erythrocyte sedimentation as a measure of Crohn's disease activity: opposite trends in ileitis versus colitis.

To test our hypothesis that the erythrocytic sedimentation rate (ESR) correlates well with clinical activity in inflammatory disease of the colon, but not of the small bowel, we stratified 49 Crohn's disease patients according to their anatomic involvement and then measured the correlations between ESR and clinical activity within each of these anatomical subgroups. For 18 patients with Crohn's disease involving primarily the colon, there was a trend toward a direct correlation between clinical score and ESR (p = 0.15).

A multicenter, randomized, double-blind trial of somatostatin in the management of acute hemorrhage from esophageal varices.

A prospective, randomized, placebo-controlled, double-blind, multicenter clinical trial of intravenous somatostatin (Stilamin; Serono Laboratories, Inc., Randolph, MA) was performed in 102 patients with actively bleeding esophageal varices from August, 1985, to November, 1986. Patients had major hemorrhage indicated by hematemesis or melena and evidence of significant blood loss.

Mesenteric thrombosis following sclerotherapy during vasopressin infusion: mechanism and therapeutic implications.

In a series of 602 consecutive sclerotherapies, two cirrhotic patients who had received successful sclerotherapy for control of variceal bleeding while on vasopressin infusions developed mesenteric thrombosis. We found no other cases (in our institution or in literature review) where sclerotherapy or vasopressin infusion alone precipitated mesenteric thrombosis. During vasopressin infusion, there is portal stasis and an increased caudad flow of sclerosant.

Mechanism of erythrocyte aggregation and sedimentation.

Unstirred suspensions of erythrocytes form stable spherical aggregates of uniform size. The radius of the spheres depends upon the suspending medium and the hematocrit. Erythrocyte suspensions will undergo sedimentation only after these aggregates are formed.

Pseudodiverticula secondary to injection sclerotherapy.

The spectrum of complications encountered after injection sclerotherapy span esophageal, extraesophageal, and systemic sequelae of the sclerosing process. We report a case of pseudodiverticula secondary to sclerotherapy, a hitherto unreported complication of this modality.

Gastric polyps.

We suggest an approach to patients with gastric polyps, based on a study of 73 patients seen at this institution over a 5-year period. There were 40 cases of adenomatous and 20 cases of hamartomatous polyps. Differentiation between these two groups of polyps was not possible on the basis of clinical presentation, laboratory data, radiological, or endoscopic appearance.

Acute myelogenous leukemia in patients with ulcerative colitis.

Of approximately 400 patients with ulcerative colitis admitted to the Mount Sinai Hospital in New York City during 1970-1978, five developed acute myelogenous leukemia in the course of their illness. This association may be more than fortuitous.

The photochemical action spectrum of the microsomal ethanol oxidizing system.

The inhibition of the microsomal ethanol oxidizing system (MEOS) by carbon monoxide (CO) can be reversed by illumination with lights of differing wavelengths. The authors determined the efficiency of this reversal as a function of the illuminating light. Maximum efficiency was obtained in the wavelength band around 440-450 nm, which is near the absorption of the reduced cytochrome-P-450-carbon monoxide complex.