Aortic valve repair with pericardial leaflet extension for aortic valve insufficiency

Background: This article presents our intermediate term results of pericardial leaflet extension used in various complex pathologies of the aortic valve leading to aortic regurgitation. Methods: Sixteen patients had aortic insufficiency/regurgitation with deficient leaflet tissues so that repair was performed with pericardial leaflet extension. The mean patient age was 26.6 years and 69% were male. Two patients (13%) were in NYHA class I, 12 patients (75%) were in class II and 2 patients (13%) were in class III preoperatively. Six patients (38%) had a bicuspid aortic valve and 10 patients (63%) had a tricuspid aortic valve. Eight patients (50%) had moderate and 8 patients (50%) had severe aortic insufficiency (AI) preoperatively. Two patients (13%) had associated cardiac procedures at the time of aortic repair. Results: There were no operative deaths but 3 patients died in the late postoperative period. Five patients underwent subsequent aortic valve replacement or a Ross procedure at re-operation. The most common finding during re-operation was thickening of the leaflet extension or rolling in of the edges of the leaflet extension. Freedom from aortic valve re-operation at five years postoperation was 68% (standard error 14). Late follow-up revealed that 9 patients (56%) were in NYHA class I and 7 patients (44%) were in class II. Ten (63%) patients had mild AI and 6 patients (37%) had moderate AI at most recent follow-up. Conclusions: Absence of hospital mortality, freedom from embolic events and echocardiography evidence of immediate competency of the valve are the reliable indicators of this surgical technique.     

Patient cytokine response in transfusion-associated sepsis.

Cytokine concentrations in plasma from patients transfused with packed erythrocytes contaminated with gram-negative bacilli were measured. Cytokine concentrations in posttransfusion plasma were significantly elevated. A difference in cytokine patterns between survivors and a nonsurvivor was observed.     

Altered skin temperature and electromyographic activity in the irritable bowel syndrome

A prospective study to determine the presence or absence of any difference in skin temperature and electromyographic (EMG) activity in 20 patients with irritable bowel syndrome (IBS) compared with 20 age- and sex-matched controls was conducted. A representative digital temperature and EMG activity during 4 phases, baseline, mental activity (arithmetic), unpleasant thoughts and audio biofeedback relaxation, were recorded using standard biofeedback equipment. Results showed the IBS group to have a significantly lower digital temperature and significantly higher EMG activity during the baseline and arithmetic phases. No difference was found in EMG activity for the unpleasant thought or audio biofeedback relaxation phases. Indeed, the IBS group were able to achieve a level of EMG activity during the audio feedback relaxation phase that approximated very closely that of the control group. These results provide further evidence suggestive of altered autonomic nervous system function in IBS patients and indicate that further studies should be undertaken to determine whether the reduction achieved in EMG activity post-relaxation is sustained, and if so, if it is associated with a corresponding improvement in symptoms.