Surgical therapy of pulmonary artery aneurysms: a report of 2 cases

Pulmonary artery aneurysm is a rare condition that may be acquired rather than congenital. The natural history of pulmonary artery aneurysms is not defined yet, and management is still controversial. We present 2 cases of adult patients with pulmonary artery aneurysms who were treated surgically. We suggest replacement as the surgical strategy.     

Autogenous arteriovenous fistula options

The Fistula First Breakthrough Initiative (FFBI) shows that development of multidisciplinary teams with designated vascular access coordinators is the key to success in increasing the appropriate use of the arteriovenous fistula as access for hemodialysis. Since nephrologists should communicate expectations to surgeons regarding fistula placement and their ability to use the access repeatedly, current surgical techniques based on KDOQI guidelines and best practices are summarized in this review. These may serve also as bases for the education of the surgical community. Autogenous fistula options include primary native fistula creation in the forearm, arm and lower extremity which can be direct or based on transposed or translocated venous vessels. Optimizing autogenous options for hemodialysis requires vessel mapping and a surgeon's willingness to invest additional time and effort.     

Transfusion requirements in hip fractures: analysis of predictive factors

Background

The primary objective of this study was to identify factors which determine blood transfusion requirements in patients with hip fractures. Predicting a target population at a higher risk of requiring blood transfusion would enable a selective cross-matching policy and also help to establish the appropriate prophylactic measures.

Methods

It was a retrospective study including the time period between February 2003 and February 2005. All patients admitted with fracture neck of femur were included in the study. The following variables were noted perioperative Hb levels, type of fracture and surgery, age and gender and blood transfusion in the perioperative period.

Results

There were 238 female and 72 male patients. The mean age was 82.7 years; range 53–100. Out of a total of 310 patients, 49 patients required a postoperative blood transfusion. The mean preoperative Hb of patients who required transfusion was 11; S.D.1.49 while those who did not require a transfusion it was 12.5; S.D.1.42. There were 168 hemiarthroplasties and 142 DHS fixations. Patients undergoing a DHS had a mean preoperative Hb level of 12.1 and a mean postoperative Hb of 9.1. Transfusion was required in 33 (23%) patients. Patients having hemiarthroplasty had a mean preoperative Hb level of 12.4 and a mean postoperative Hb of 10. Transfusion was requried in 16 (9.5%) patients. The univariate analysis showed a significant relationship between postoperative transfusion and the preoperative Hb level (P = 0.0001) and the type of fracture (P = 0.001). However no relationship was found between transfusion and the age (P = 0.423) and the gender of the patient (P = 0.611). Preoperative Hb and type of fracture were found to be statistically significant on multivariate analysis as well.

Conclusions

The results of our study indicate that the most important factor in the prediction for blood transfusion in fracture neck of femur is the preoperative level of haemoglobin although the type of fracture is also important. Restrictive cross-matching for the high risk cases would improve costs in healthcare delivery and prevent unnecessary use of blood resources     

Mikulicz syndrome, an uncommon entity in Pakistan

A 38 years old woman presented with bilaterally symmetrical, painless swelling of the parotid, submandibular and sublingual glands. A fine needle aspiration biopsy revealed granulomatous histology with a few salivary ductal structures. On the basis of the histology, she was started on antituberculosis regimen until about 6 weeks later when she developed a skin rash on her shins, diagnosed as erythema nodosum co-existent with xerostomia. Her ESR was 38 mm and Mantoux test was negative. There was no lacrymal gland swelling and corneal tear film was normal on slit lamp examination. A diagnosis of sarcoidosis affecting the major salivary glands was made. The salivary glandular swelling, subsided within two weeks of treatment with oral prednisolone.     

Renal disease in AIDS: it is not always HIVAN

Human immunodeficiency virus (HIV) infection can cause a broad spectrum of clinical manifestations, ranging from an asymptomatic carrier state to severe immunodeficiency. The most common renal lesion, HIV-associated nephropathy (HIVAN), is a sclerosing glomerulopathy. However, potentially reversible causes of renal disease in HIV-infected patients should also be considered. We describe two cases of patients with acquired immune-deficiency syndrome (AIDS) who presented with rapidly progressive renal failure but were found to have reversible etiologies. The first case was found to have syphilis and the second, disseminated histoplasmosis; their renal injury resolved after initiation of a third-generation cephalosporin antibiotic and amphotericin B, respectively.     

Right brain is important for students' achievements in science

Relations between the hearing durations of right and left ears and points on the introductory examination for entrance to the Science School of Ataturk University in Erzurum were investigated in 31 male and 13 female students. The hearing duration of the left ear was significantly associated with the scores of the examination for the university entrance, the hearing duration for the right ear being not significantly related to the examination scores. The results suggest that the right brain would be beneficial for the students' achievements in science.