Atrioventricular nodal re-entrant tachycardia with QRS voltage and cycle length alternation and aberrant conduction due to two distinct antegrade slow pathways.

QRS voltage and cycle length alternation can be seen during supraventricular re-entrant tachycardias, especially in atrioventricular (AV) re-entrant tachycardia. We present a case of a 20-year-old man, in which AV nodal re-entrant tachycardia (AVNRT) shows alternation of QRS voltage and cycle length, as well as right bundle branch block aberration due to a re-entrant circuit using two distinct, beat-to-beat alternating slow AV nodal pathways antegradely and a single fast pathway retrogradely. Although more than one antegrade slow pathway exists, creation of a single lesion at the right posterior atrial septum using the conventional right-sided approach successfully eliminated AVNRT.     

Effectiveness of percutaneous metal stent placement in cholangiocarcinoma patients with midterm follow-up: Single center experience

Purpose

Patients with advanced cholangiocarcinoma present with high rate of local complications. The primary aim of this study is to report clinical course of advanced cholangiocarcinoma patients those who were presented with biliary obstruction and treated with percutaneous biliary stenting.

Material and methods

Patients with unresectable locally advanced or metastatic cholangiocarcinoma followed by our center for a period of 4 years were analyzed. For statistical analysis demographic and clinical characteristics of patients, primary biliary drainage method, metal stent occlusion rate, time to stent occlusion, and overall survival rates were recorded.

Results

A total of 34 eligible patients were analyzed. 27 patients had metal stent placement. These 27 patients formed the basis of this study. Median overall survival (OS) was 6.0 months. After metal stent deployment bilurubin levels were normalized within a mean of 10 days. During the follow-up period, 13 patients were experienced metal stent occlusion. Median TtSO was 10 weeks. Cytotoxic chemotherapy was administered to 14 (52%) patients. Patients without stent dysfunction had significantly higher rate of chemotherapy exposure rate (p = 0.021). Statistical analysis, however, failed to exhibit significant effect of stent dysfunction on OS.

Conclusion

In advanced cholangiocarcinoma, relief of bile duct obstruction is an important part of the initial patient management. This study therefore described the clinical value of percutaneous metal stent in cholangiocarcinoma patients and raises the question about patency of metal stent in cholangiocarcinoma whether we can expect success similar to the success achieved in pancreas carcinoma.     

Inter- and intraobserver reliability of the Crowe and Hartofilakidis classifications in the assessment of developmental dysplasia of the hip in adult patients

Background

The purpose of this study is to investigate the inter- and intraobserver reliability of Crowe and Hartofilakidis classifications in the assessment of developmental dysplasia of the hip in adult patients.

Materials and methods

Two consultant orthopedic surgeons classified 141 dysplastic hips on 103 standard anterior–posterior pelvis radiographs according to the Crowe and Hartofilakidis classifications. Assessments were performed in random order by each observer on two separate occasions, at least 4?weeks apart. Kappa statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer.

Results

At the first readings, interobserver reliability analysis revealed kappa coefficient of 0.71 for the Crowe classification and 0.54 for the Hartofilakidis classification. At the second reading, the kappa coefficient was 0.72 for the Crowe classification and 0.75 for the Hartofilakidis classification. Intraobserver reliability analysis revealed kappa coefficients of 0.71 for the Crowe and 0.80 for the Hartofilakidis classification for observer A, and 0.76 and 0.70 for observer B.

Conclusions

In conclusion, we have found substantial inter- and intraobserver agreement for Crowe classification and substantial to moderate agreement for Hartofilakidis classification in this study. Both classification systems assess the different aspects of developmental dysplasia of hip in adults. Each system has advantages and disadvantages. We suggest using both of these classifications together to increase the accuracy.     

Kyphectomy for congenital kyphosis due to meningomyelocele: a case treated with a modified approach to skin healing

This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135°-15° postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity.     

Behavior of Bromobutide in Paddy Water and Soil After Application

Behavior of the herbicide bromobutide, (RS)-2-bromo-N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, in paddy water and soil after application to paddy fields was investigated to evaluate the degradation to bromobutide-debromo, N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, and runoff of the herbicide. The respective maximum concentrations of bromobutide and the metabolite were 1,640–2,230 and 11.1–15.8 μg/L in the paddy water, and 2,210–4,140 μg/kg dry and 74–119 μg/kg dry in the paddy soil, respectively. The runoff ratios of the applied bromobutide from the paddy fields were calculated as 28 ± 16%. The respective mean values of the half-lives of bromobutide in the paddy water and the soil were 2.7 ± 0.34 days and 6.9 ± 2.6 days, respectively.     

Complete Lysis of Left Ventricular Giant Thrombus with Fibrinolytic Therapy in Clopidogrel Resistant Patient

Sixty-year-old woman admitted with dyspnea and cough. Three weeks ago she underwent primary stenting for acute anterior myocardial infarction and recieved antiplatelet therapy (clopidogrel). Echocardiography and left ventriculography revealed left ventricular segmental dysfunction at anterolateral-apical region but no thrombus. On last admission, despite the clopidogrel therapy, echocardiography showed giant-partly mobil thrombus obliterated half of the left ventricle. Slow infusion of thrombolytic therapy was given and complete lysis occurred with uneventful course. Disclosure of such a rapidly evolving giant left ventricular thrombus in the clopidogrel non-responder is a rare clinical problem with potentially catastrophic consequences. Slow infusion of thrombolytic therapy may be effective and life saving.     

The time course of recovery following mild thoracic trauma

PURPOSE: The purpose of this study was to determine when patients are able to return to their normal work or home activities. PATIENTS AND METHODS: Eighty cases, 35 females (44%) and 45 males (56%), presenting to our hospital between the years of 2003 and 2004 were prospectively evaluated. There were no hemopneumothorax or associated injury. The patients were randomized into two groups with respect to treatment modalities as the following: non-steroid anti-inflammatory (NSAIDs) and Tramadol treatment groups. In the follow-up, visual analog scale (VAS), and vital capacity were conducted on the days 0, 2, 7 and 30 and 6 months. The results were statistically analyzed. RESULTS: The mean age of the group receiving NSAIDs was 55.42 +/- 15.72, and for the group receiving tramadol treatment, it was 55.67 +/- 17.23. VAS result was 7.8 +/- 1.8 in those receiving NSAIDs treatment, while it was 8.2 +/- 1.6 in the other group. The vital capacity was 235.54 +/- 82 ml for the former group, and 232.43 +/- 89.44 for the latter. In their follow-up, particularly by the 7th day, significant improvement of VAS and vital capacity were observed (p < 0.01). Maximum improvement was achieved on the 30th day (p < 0.001). There was no change in the 6th month. CONCLUSION: Patients are able to return to their normal work or home activities after 7 days. Patients experienced steadily decreasing pain and improved vital capacity at each time point after injury. No difference in response was seen between the two medications. A significant improvement is observed by the 7th day after the trauma (p < 0.01). Optimal improvement was achieved on the 30th day (p < 0.001).     

Left ventricular apical aneurysm as a consequence of diffuse type congenital nonfamilial supravalvular aortic stenosis in a 30-year-old female

Congenital nonfamilial supravalvular aortic stenosis (SVAS) is relatively rare, its diffuse type being the least common. We present a 30-year-old woman with diffuse SVAS complicated with left ventricular apical aneurysm. We believe that subtle left ventricular myocardial ischemia or infarction and long-lasting severe pressure overload to the apical chamber caused LV apical aneurysm in our case. Acquired LV apical aneurysm secondary to supravalvular aortic stenosis, in the absence of atherosclerotic coronary artery disease and hypertrophic obstructive cardiomyopathy, has not been described before.     

Angiographic restenosis after myocardial bridge stenting

Data on restenosis after stent implantation in myocardial bridges (MB) are very limited. Six-month angiographic results for 12 symptomatic patients who underwent stent implantation for myocardial bridges were compared retrospectively with those of 39 patients who underwent direct stent implantation for de novo atherosclerotic lesions in the left anterior descending artery. Diameter stenosis decreased from 69 +/- 8% to 4 +/- 5% in the MB group and from 79 +/- 8% to 7 +/- 6% in the control group after stent deployment. Systolic narrowing was abolished in all patients with MB. In follow-up, quantitative angiography revealed late loss of 1.8 +/- 1.3 mm in the MB group and 0.9 +/- 0.9 mm in the control group (P = 0.025). The in-stent restenosis rate was also higher in the MB group compared to the control group (67% versus 28%; P = 0.037). Despite favorable immediate results, stent implantation in MBs may not be promising because of the higher in-stent restenosis rate compared to stenting in de novo atherosclerotic lesions.     

Comparison and evaluation of experimental mediastinitis models: precolonized foreign body implants and bacterial suspension inoculation seems promising

Background  

Post-sternotomy mediastinitis (PSM) is a devastating surgical complication affecting 1–3% of patients that undergo cardiac surgery. Staphylococcus aureus is one of the most commonly encountered bacterial pathogen cultured from mediastinal samples obtained from patients with PSM. A component of the membrane of the gram positive bacteria, lipoteichoic acid, stimulates the blood monocytes and macrophages to secrete cytokines, radicals and nitrogen species leading to oxido-inflammatory damage. This seems to be responsible for the high mortality rate in PSM. For the evaluation of the pathogenesis of infection or for the investigation of alternative treatment models in infection, no standard model of mediastinitis seems to be available. In this study, we evaluated four mediastinitis models in rats.