Long Term Outcomes Following Freestyle Stentless Aortic Bioprosthesis Implantation: An Australian Experience.

Background: The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results.

Methods: A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals.

Replacement of the aortic root with a composite valve-graft conduit: risk factor analysis in 246 consecutive patients.

Background: Composite valve-graft (CVG) replacement of the aortic root is a well-studied and recognised treatment for various aortic root conditions, including valvular disease with associated aortopathy. There have been few previous studies of the procedure in large numbers in an Australian setting.

Method: From January 2006 to June 2013, 246 successive patients underwent CVG root replacements at our institution.

Clinical utility of magnetic resonance imaging in the follow-up of chronic aortic type B dissection.

Several imaging modalities are utilised in the assessment of disease progression in chronic aortic dissection. We present the case of a 66 year-old male who underwent ascending aorta repair for Stanford type A aortic dissection. On follow-up the persisting dissection of the descending thoracic aorta was observed to regress on magnetic resonance imaging (MRI).

Outcomes of aortic arch replacement surgery after previous cardiac surgery.

Background: Aortic arch replacement is a potentially high-risk operation and in the re-operative setting has been found to be a risk factor for poor outcome, yet there is a dearth of published data specifically on this topic. The aim of the study was to review our unit's outcomes in this re-operative setting.

Method: Data were collated for all patients who underwent aortic arch replacement surgery after previous cardiac surgery from January 1988 to November 2011.

Outcomes of surgical aortic valve replacement in octogenarians.

Background: In the era of TAVI, there has been renewed interest in the outcomes of conventional AVR for high-risk patients. This study evaluates the short- and long-term outcomes of AVR in octogenarians.

Methods: A retrospective review was performed of all 117 patients aged ≥ 80 years who underwent AVR, (isolated AVR (n = 60) or AVR+CABG (n = 57),) from August 2005 to February 2011 at Royal Prince Alfred Hospital and Strathfield Hospital.

International retrieval of adults on extracorporeal membrane oxygenation support.

A retrieval service was established in New South Wales to provide mobile extracorporeal membrane oxygenation support to patients with severe, acute cardiac or respiratory failure. This service has also retrieved four adult patients from Nouméa, New Caledonia to Sydney on extracorporeal membrane oxygenation support, which are the first international retrievals of this type from Australia. We discuss our experience with these patients, three of whom survived to hospital discharge.

Evolution in the techniques and outcomes of aortic arch surgery: a 22 year single centre experience.

Background: Aortic arch replacement is a complicated and high risk procedure. There have been many advances over recent years. We review the changes in our unit's techniques and outcomes over the past 22 years.

Interlaboratory trial on the analysis of alkylphenols, alkylphenol ethoxylates, and bisphenol A in water samples according to ISO/CD 18857-2.

ISO/CD 18857-2 (International Organization for Standardization, Geneva) describes a new international standard method for the determination of octylphenol, nonylphenol, their mono- and diethyoxylates, and bisphenol A in nonfiltered samples of drinking, ground, surface, and wastewater. The method is based on the extraction of the analytes from an acidified water sample by solid phase extraction, solvent elution, derivatization, and determination by gas chromatography with mass spectrometric detection. For validation of this method, 14 laboratories from 4 different countries in Europe and Canada participated in an interlaboratory trial to determine the performance characteristics of the method, which are intended for publication in the corresponding standard.

Body dysmorphic disorder: more than meets the eye.

Body dysmorphic disorder is a relatively common yet long unrecognized problem affecting mainly adolescents and young adults of both sexes. It is an obsessive disease of such intensity that it interferes with daily activities. Patients typically focus on imagined major defects in the face, nose, skin or hair.

Haptoglobin elutes from human atherosclerotic coronary arteries--a potential marker of arterial pathology.

Background: Molecules which egress from atherosclerotic arteries may function as plasma markers of arterial pathology, but such egress has not been proven with living human coronary arteries. We hypothesised that proteins eluting from the arterial wall may discriminate between atherosclerotic and non-atherosclerotic coronary arteries.

Methods And Results: During cardiac bypass surgery, 155 sequential fractions of antegradely flushed coronary cardioplegia solution were collected by balloon-cuffed catheter from the coronary sinus in subjects with angiographically extensive (n=30) or minor (n=7) coronary disease.

Composite graft replacement of the aortic root after previous cardiac surgery: a 20-year experience.

Background: An aging population and prolonged survival of patients after cardiac operations has meant that composite aortic root replacement after previous cardiac operation is being performed with increasing frequency.

Methods: From January 1979 to July 1999, 32 patients underwent "reoperative" composite replacement of the aortic root at our institution. Previous operations were 16 aortic valve replacement, 9 coronary artery bypass grafting, 5 repair aortic dissection, and 7 others.

Video-assisted thoracoscopy.

Recent advances in video-imaging and minimally invasive surgical instrumentation have expanded the role of thoracoscopy in the diagnosis and treatment of intrathoracic conditions. This prospective study describes the use of video-assisted thoracoscopy (VAT) in 100 consecutive patients. There were 70 males and 30 females with a mean age of 54.

[Distribution pattern of chemicals in surface waters as a reflexion of entry pattern--heavy metals].

The concentrations of the heavy metals lead, cadmium and mercury were measured in surface water samples of an industrialized city and its surroundings. All but one value of Cd (particular) were less than 0.5 microgram l-1, 30% of the lead (particular) values were less than 0.

[Distribution pattern of chemicals in surface waters as a reflexion of entry pattern--volatile halogenated hydrocarbons].

The part gives some data about various light volatile halogenated hydrocarbons in surface waters of the industrialized city and its surroundings--the halogenated forms, chloroform and bromoform and the most used solvents trichloroethylene, tetrachloroethylene, tetrachloromethane and 1,1,2,2-tetrachloroethane. 80% of the concentrations of chloroform, tri- and tetrachloroethylene were in the range of less than 1 microgram l-1, 90% of bromoform, tetrachloromethane and 1,1,2,2-tetrachloroethane were found to amount less than 0.1 microgram l-1.

Human cranial bone structure and the healing of cranial bone grafts: a study using backscattered electron imaging and confocal microscopy.

This study explored the microstructure of human cranial bone at different ages, and the survival, remodelling and modelling of cranial bone grafts. A combination of reflection and fluorescence confocal optical microscopy and scanning electron microscopy in the backscattered electron imaging mode was employed to examine highly polished block faces of plastic-embedded bone fragments as harvested for grafting, or recovered after a period in situ as a graft. The methods enabled remarkably detailed information on bone content, maturation and turnover to be gleaned from tiny scraps of bone.

Acute myocardial ischaemia and cardiogenic shock after percutaneous transluminal coronary angioplasty; risk factors for and results of emergency coronary bypass.

Between 1 September, 1980 and 1 January, 1989, 4142 patients underwent percutaneous transluminal coronary angioplasty (PTCA). We retrospectively studied the 155 [3.7%; 119 males, mean age 53.

Björk-Shiley strut fracture and disc escape: literature review and a method of disc retrieval.

Embolization of a prosthetic valve poppet is a rare but life-threatening event. It was reported sporadically before the introduction of the Björk-Shiley 70-degree convexoconcave prosthesis in 1980. Since that time, there have been a large number of reported mechanical failures with disc escape.

Projection geometry and stress-reduction techniques in craniofacial surgery.

Since 1981, we have been able to modify the mathematical patterns of projection geometry to reshape the skull in craniofacial surgery. Unlike burring, morcellization, rotation, and plate switching, this technique actually changes the shape of individual sections of the skull by changing their radius of curvature. The technique is an adaptation of the principles used by engineers to build complex structures such as ships' hulls, airfoils, and domes.

The harvesting of cranial bone grafts: a guided osteotome.

A technique for in situ harvesting of the outer table of the skull using a "guided" osteotome is presented. While guards have been placed to control the depth of the blade, additional steps are advised to ensure the highest level of safety in clinical use: Before harvesting the graft, a full set of anteroposterior and lateral x-rays should be examined to determine which areas of the skull are thin and should be avoided. All areas with cranial sutures should be avoided because here the dura is more firmly attached to the inner table making perforation more dangerous.

A permanent tendon-to-bone suture technique in the distal phalanx.

This technique is used to place a permanent tendon-to-bone suture in the distal phalanx without increasing the amount of dissection beyond that needed for a Bunnell button repair. This technique has the advantage of greater strength without the problems of a percutaneous device that must be removed before full wound healing strength has developed.

A study of the pharmacologic control of blood flow to acute skin flaps using xenon washout. Part I.

This study was undertaken to understand the control mechanisms differentiating circulation to normal skin and acute skin flaps. The approach was to compare the effects of systemic vasoactive drugs on skin blood flow in rats in acute skin flaps and identical areas of control skin. With this model it was felt that systemic changes would affect both areas equally and any difference in response would be due to vascular control mechanisms unique to the flap.