Non-Occlusive Mesenteric Ischemia in Aortic Surgery: What You Need to Know.

Background: Nonocclusive mesenteric ischemia (NOMI), a subtype of acute mesenteric ischemia, is primarily caused by mesenteric arterial vasoconstriction and decreased vascular resistance, leading to impaired intestinal perfusion.Commonly observed after cardiac surgery, NOMI affects older patients with cardiovascular or systemic diseases, accounting for 20-30% of acute mesenteric ischemia cases with a mortality rate of ∼50%. This review explores NOMI's pathophysiology, clinical implications in aortic dissection, and the unmet needs in diagnosis and management, emphasizing its prognostic significance.

Wedge Episiotomy for Long Cemented Femoral Stem Removal and Reconstruction. A Case Report on One-Stage Revision for Failed Bipolar for Proximal Femur Giant Cell Tumor.

Introduction: Osteotomy around proximal femur provides excellent exposure and helps in revision of both cemented and uncemented femoral stem. Hereby, describing our case report on wedge episiotomy, a new surgical technique for removal of distal fitting cemented or uncemented femoral stem in conditions were extended trochanteric osteotomy (ETO) becomes inappropriate and episiotomy becomes inadequate.

Case Report: A 35-year-old lady presented with painful right hip and difficulty in walking.

Nature always sides with the hidden flaw: importance of the 'aortic team' approach.

Blunt thoracic aortic injuries (BTAI) are highly lethal, though their incidence is < 1%. The treatment options for BTAI have evolved over the years, where non-operative management is advised even in grade II injuries. In patients undergoing thoracic endovascular aortic repair, it is of vital importance that the left subclavian artery is revascularized.

Risk Prediction Models for Management of Patients following Acute Aortic Dissection.

Risk prediction of adverse outcomes post aortic dissection is dependet not only on the postdissection-associated clinical factors but on the very foundation of the risk factors that lead up to the dissection itself. There are various such risk factors existing prior to the dissection which impact the postdissection outcomes. In this paper, we review the literature to critically analyze various risk models, burdened by their significant limitations, that attempt to stratify risk prediction based on postdissection patient characteristics.

Malperfusion syndrome in acute type A aortic dissection: It's not what you know, it's what you can prove!

Organ malperfusion after type A aortic dissection represents a high-risk group for open surgical repair. This is particularly the case when mesenteric ischemia occurs. Central aortic repair should be considered for all presenting with malperfusion as many are due to dynamic obstruction.

Surgical and endovascular treatment of late postcoarctation repair aortic aneurysms: Results from an international multicenter study.

Objective: The formation of postaortic coarctation aneurysms (pCoAA) is well-described in the literature and carries a significant risk of rupture and death. Treatment strategies include open surgical, hybrid, and endovascular repair, depending on the clinical presentation, risk assessment, and anatomy. The aim of this study was to report the early and midterm results of open surgical and endovascular repair of pCoAA.

Does Balancing a Total Hip Arthroplasty Require a New Paradigm? Functional 3-Dimensional Balancing in Total Hip Arthroplasty.

Background: Traditional principles for successful outcomes in Total Hip Arthroplasty (THA) have relied largely on placing the socket in the native position and trying to restore static anatomical femoral parameters gauged on X-rays or intra-operative measurement. Stability is conventionally achieved by making appropriate changes during the time of trial reduction. Post-operative complications of dislocation and significant Limb Length Discrepancy (LLD) requiring foot wear modification represents opposite ends of the spectrum from a biomechanical perspective and these continue to be relatively high.

Exploring the Correlation and Protective Role of Diabetes Mellitus in Aortic Aneurysm Disease.

Diabetes mellitus is recognised as a significant risk factor for cardiovascular and peripheral vascular disease, as the abnormal metabolic state increases the risk for atherosclerosis, occlusive arterial disease and vascular dysfunction. There have been reports of potential association across the literature that illustrates a link between diabetes mellitus and aortic aneurysm, with the former having a protective role on the development of the latter. A thorough literature search was performed through electronic databases, to provide a comprehensive review of the study's reporting on the association of diabetes mellitus and aortic aneurysm, discussing the mechanisms that have been reported; furthemore, we reviewed the reports of the impact of oral hypoglycameic agents on aortic aneurysms.

Management of the penetrating atherosclerotic ulcer in the descending thoracic aorta.

Penetrating atherosclerotic ulcers present with an insidious onset with a reported mortality of 9%, varying across populations. With vast arrays of risk factors and potentially ominous complications, it is vital to efficiently provide optimum strategies for management. There exists controversy in the literature regarding management, especially for Type B penetrating atherosclerotic ulcers; the decision-making framework encompasses numerous factors in considerations for medical management versus invasive intervention and choice of endovascular versus open repair in the latter.

Is the Revision Rate Higher After Hip Arthroplasty in Teenage Patients? A Prospective Study with Long-Term Follow-Up of More Than 10 Years.

Background: Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are already proven good for end-stage arthritis in the older populations but it is challenging in young teenage patients. The primary aim was to assess Hip Disability and Osteoarthritis Outcome Score (HOSS), Harris Hip Score (HHS) and secondary aim for implant survival rate.

Materials And Methods: The details of 33 teenage patients (forty hips) who underwent HRA (21) and THA (19) at our institution (January 2002 to December 2013) with a mean follow-up period of 11.

Narrowing of the dark valve: aortic stenosis in alkaptonuria.

The commonest cardiac pathology in patients with alkaptonuria is aortic stenosis. Patients with alkaptonuria and aortic stenosis may remain asymptomatic until the 6th decade. Surgeons may have to deal with per-operative difficulties as alkaptonuria is a systemic disease.

Thoracic and abdominal aortic aneurysms: exploring their contrast and genetic associations.

Until recently thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) were correlated with atherosclerosis but following a range of cohort studies, a linkage proved unlikely. Instead, data from the Genome wide association study detected two common significantly correlated lncRNA loci: miRNA and the antisense non-coding RNA in the INK4 locus (ANRIL). lncRNAs are sometimes utilized by the body as transcription regulators and signaling molecules.

Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease.

With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown.

Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Study in Ankylosing Spondylitis.

Background: Uncemented total hip arthroplasty (THA) with large size femoral heads have shown greater advantage with good stability, range of motion and decreased dislocation rate in ankylosing spondylitis (AS). Meticulous planning is needed to address the unique surgical challenges in such patients with fused hip and spinal deformity.

Materials And Methods: Thirty fivefused hip joints in twenty-five AS patients who underwent uncemented THA (April 2014 to December 2016) were included in our prospective study and were followed up for a minimum period of 36 months.

Tale of Two sons - Nobelar and Excelar and the blurring edge between them.

Left main coronary artery disease (LMCAD) has low incidence but foreshadow a high prognostic risk merely due to the myocardial territory it supplies. Coronary artery bypass grafting (CABG) has been the standard of treatment for LMCAD. Recently, two major trials-NOBEL and EXCEL-with contradicting results have been published.

An Indian study: impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country.

Purpose: There is a paucity of evidence and guidelines to support clinical decisions in the present unprecedented time. We aimed to use the experience and consensus of the cardiac surgeons for clinical decisions until evidence-based guidelines are formed.

Methods: An electronic questionnaire was emailed to all the 1434 members of the Indian Association of Cardiovascular and Thoracic Surgery, starting from May 13, 2020, and the members were followed up with reminder emails.

International study on impact of COVID-19 on cardiac and thoracic aortic aneurysm surgery.

Background: The coronavirus disease-2019 (COVID-19) pandemic gripped every nation's health care system and provisions on all levels. In cardiac and aortic surgery, as it is with most specialities, elective surgeries were halted.

Aims Of The Study: We captured reflections, contingencies, and current practices across of high-volume centers in cardiac and aortic surgery globally.

Current status in decision making to treat acute type A dissection: limited versus extended repair.

Acute type A aortic dissection remains one of the most challenging conditions in aortic surgery. Despite the advancements in the field, the mortality rate still remains high. Though there is a general consensus that the ascending aorta should be replaced, the distal extension of the surgery still remains a controversy.

Hyalinizing Clear Cell Carcinoma: Base of Tongue.

Hyalinizing clear cell carcinoma (HCCC) is a low grade, rare neoplasm originating from the minor salivary glands. It usually follows an indolent course and the main treatment modality is surgery. The prognosis of these tumours are good, hence it needs to be differentiated from other carcinomas with clear cells.