Post-infarction pseudoaneurysm of the left ventricle as a cause of heart failure. Presentation of a surgically treated case

Pseudoaneurysm of the left ventricle is an unusual complication of myocardial infarction. Surgical resection is justified by the high risk of rupture. Patients may be asymptomatic, more often a clinical state of chronic heart failure is present. We report on a patient who successfully underwent urgent resection of a large pseudoaneurysm which was the cause of acute heart failure.     

Regenerative medicine as applied to general surgery

The present review illustrates the state of the art of regenerative medicine (RM) as applied to surgical diseases and demonstrates that this field has the potential to address some of the unmet needs in surgery. RM is a multidisciplinary field whose purpose is to regenerate in vivo or ex vivo human cells, tissues, or organs to restore or establish normal function through exploitation of the potential to regenerate, which is intrinsic to human cells, tissues, and organs. RM uses cells and/or specially designed biomaterials to reach its goals and RM-based therapies are already in use in several clinical trials in most fields of surgery. The main challenges for investigators are threefold: Creation of an appropriate microenvironment ex vivo that is able to sustain cell physiology and function in order to generate the desired cells or body parts; identification and appropriate manipulation of cells that have the potential to generate parenchymal, stromal and vascular components on demand, both in vivo and ex vivo; and production of smart materials that are able to drive cell fate.     

Analysis of Unconfined Compressive Strength of Rammed Earth Mixes Based on Artificial Neural Network and Statistical Analysis

Earth materials have been used in construction as safe, healthy and environmentally sustainable. It is often challenging to develop an optimum soil mix because of the significant variations in soil properties from one soil to another. The current study analyzed the soil properties, including the grain size distribution, Atterberg limits, compaction characteristics, etc., using multilinear regression (MLR) and artificial neural networks (ANN). Data collected from previous studies (i.e., 488 cases) for stabilized (with either cement or lime) and unstabilized soils were considered and analyzed. Missing data were estimated by correlations reported in previous studies. Then, different ANNs were designed (trained and validated) using Levenberg-Marquardt (L-M) algorithms. Using the MLR, several models were developed to estimate the compressive strength of both unstabilized and stabilized soils with a Pearson Coefficient of Correlation (R²) equal to 0.2227 and 0.766, respectively. On the other hand, developed ANNs gave a higher value for R² than MLR (with the highest value achieved at 0.9883). Thereafter, an experimental program was carried out to validate the results achieved in this study. Finally, a sensitivity analysis was carried out using the resulting networks to assess the effect of different soil properties on the unconfined compressive strength (UCS). Moreover, suitable recommendations for earth materials mixes were presented.     

Video Assisted Coronary Bypass Surgery

An alternative way to revascularize coronary vessels is described, using arterial conduits without extracorporeal circulation. The heart is exposed via a small thoracotomy over the fifth left intercostal space. A thoracoscope is introduced into the thorax, to assist in the harvesting of the left internal mammary artery (LIMA). In selected patients with two or three vessel disease, the same procedure can be achieved on the right side, harvesting the right internal mammary artery to revascularize the right coronary artery. The gastroepiploic artery can be easily reached and used to revascularize the posterior descending artery, through a mini-subxiphoid median laparotomy. This technique was used to revascularize 30 patients from April 1994 to June 1995. All received a LIMA graft to the left anterior descending artery, and two had a free radial artery graft from the LIMA, sequentially bypassing the diagonal and obtuse marginal branches. There was neither perioperative mortality nor morbidity myocardial infarction. Fifteen patients were restudied angiographically before discharge. Average hospital stay was 43 ± 11 hours.     

Early and long-term outcome in patients undergoing aortic root replacement with composite graft according to the Bentall's technique.

OBJECTIVE: The aims of this study were: (i) to evaluate the early and long-term outcome in patients undergoing aortic root replacement (ARR) with a composite graft; (ii) to identify the predictors for poor overall survival in this pool of patients. MATERIAL AND METHODS: Between January 1989 and December 2000, 212 patients underwent ARR with a CG. Mean age was 56+/-14 years, ranging from 16 to 77. Annuloaortic ectasia was the most frequent cause of aortic disease in this series, 81 (38%) patients, followed by atherosclerotic aneurysm 57 (27%) and type A acute aortic dissection 52 (24.5%). Marfan's syndrome was present in 37 (17.5%) patients. Duration of follow-up ranged from 1 to 120 months, mean 59+/-35 months. RESULTS: The overall hospital mortality was 16 (7.5%) patients. Eight of them had aortic dissection and four Marfan syndrome. The most frequently found complication resulted to be renal failure in 22 (10%) patients and low cardiac output in 15 (7%) patients. The incidence of perioperative myocardial infarction, neurological complications, respiratory complications, renal failure and coagulopathy incidence were significantly higher in patients with cardiopulmonary bypass (CPB) time >170 min, CA >40 min, and total aortic arch replacement. The actuarial survival at 1, 3 and 5 years resulted to be 91.8, 86 and 81.5%, instead the actuarial survival without re-operation resulted to be 89, 82 and 78%. The actuarial survival in patients with aortic dissection was significantly lower versus non-dissection (P=0.022). The multivariate analysis revealed the aortic dissection (P=0.03), age >65 years (P=0.014), associated coronary artery disease (P=0.002), NYHA functional class>/=3 (P=0.027), LVEF <35% (P=0.002) and total arch reconstruction (P=0.003) as strong predictors for poor overall survival in patients undergoing ARR. CONCLUSIONS: The ARR with a CG offers acceptable early and long-term outcome. The predictors for poor overall survival in patients undergoing ARR seems to be preoperative aortic dissection extended into the aortic arch, older age, depressed left ventricular function and associated coronary artery disease.     

The transcallosal approach for lesions affecting the lateral and third ventricles

Summary The study was carried out on a series of 42 patients who underwent surgery through a midline approach. Lesions were in the anterior part of the third ventricle in 32 cases, in the frontal horns in 6, in the trigone in 3, and in both lateral and thrid ventricles in 1 case. The third ventricle was approached through Monro's foramen in 22 cases and through an interfornicial route in 9 cases.Surgical mortality occurred in 2 cases (5%). Permanent morbidity occurred in another 2 cases (5%): it consisted of slight intellectual deterioration in one case and slight fixed pyramidal signs in the other. Transient mutism was the most frequently observed post-operative complication.Thirty-one patients were reviewed and submitted to neuropsy-chological tests in the late postoperative period to investigate the presence of intellectual deterioration or disturbances in the interhemispheric transfer of motor, somataesthetic and visual information. All patients showed only the presence of short-term memory disturbance. Furthermore, 12 patients tested before surgery also showed the presence of short-term memory deficits in the preoperative period.We conclude that a midline approach is the most direct and safe route to the third ventricle as well as to the frontal horns and trigone.     

Early postoperative angiographic findings after carotid endarterectomy

Summary This report reviews the early postoperative evaluation of 70 patients who underwent carotid bifurcation endarterectomy within our department (before patients' releasing). Angiography was performed by femoral catheterization or the retrograde brachial route; three times only digital venous techniques were employed. No complications due to radiological procedures occurred. Postoperative angiographic findings include asymptomatic occlusion of ICA, occlusion of ECA, the presence of mural thrombi, diffuse surface roughness, intimal flaps and kink of ICA. Dilatation of the arteriotomized segment was detected with a high rate of frequency. Postoperative vascular changes are then analyzed in relation to surgical techniques, to early postoperative clinical course and to the occurrence of late re-stenoses.