Giant pseudoaneurysm of the innominate artery late after surgical repair of type-A aortic dissection

A 49-year-old man was admitted to our department 6 months after emergent surgery for type-A acute aortic dissection. A chest computed tomography-scan revealed a huge aneurysm originating from the proximal aortic arch, strongly adherent to the upper part of the sternum. Extracorporeal circulation was instituted first, and chest was reopened in circulatory arrest. The mass was a giant pseudoaneurysm originating from a laceration at the base of the innominate artery. Due to tissue fragility and complete distortion of the origin of right carotid and subclavian arteries, we performed an extra-anatomic ascending aorta-to-right carotid artery bypass, followed by Teflon-reinforced suture of the proximal artery stumps. The postoperative course was uneventful.     

Clinical Use of a Cordless Laparoscopic Ultrasonic Device

Objective:

On April 25, 2012, the first laparoscopic cordless ultrasonic device (Sonicision, Covidien, Mansfield, Massachusetts) was used in a clinical setting. We describe our initial experience.

Methods:

The cordless device is assembled with a reusable battery and generator on a base hand-piece. It has a minimum and maximum power setting controlled by a single trigger for both coagulation and cutting. A laparoscopic radical nephrectomy was performed on a 56-year-old man with a 7-cm right renal mass. A laparoscopic pelvic lymphadenectomy was performed in a 51-year-old man with high-risk prostate cancer. Data on surgical team satisfaction, operative time, number of activations, and times the laparoscope was removed as a result of plume were collected.

Results:

The surgical technician successfully assembled the device at the beginning of the cases with verbal instructions from the surgeon. Operative time for nephrectomy was 77 minutes, with 143 total activations (minimum = 86, maximum = 57). The operative time for the pelvic lymphadenectomy was 27 minutes, with 38 total activations (minimum = 27, maximum = 11). One battery was used in each case. The laparoscope was removed twice during the nephrectomy and once during the lymphadenectomy. Surgical staff satisfaction survey results revealed easier and faster assembly, more space in the operating room, ergonomic handle, and comparable cutting/coagulation, weight, and plume generation with other devices (

Calsequestrin determines the functional size and stability of cardiac intracellular calcium stores: Mechanism for hereditary arrhythmia

Calsequestrin is a high-capacity Ca-binding protein expressed inside the sarcoplasmic reticulum (SR), an intracellular Ca release and storage organelle in muscle. Mutations in the cardiac calsequestrin gene (CSQ2) have been linked to arrhythmias and sudden death. We have used Ca-imaging and patch-clamp methods in combination with adenoviral gene transfer strategies to explore the function of CSQ2 in adult rat heart cells. By increasing or decreasing CSQ2 levels, we showed that CSQ2 not only determines the Ca storage capacity of the SR but also positively controls the amount of Ca released from this organelle during excitation-contraction coupling. CSQ2 controls Ca release by prolonging the duration of Ca fluxes through the SR Ca-release sites. In addition, the dynamics of functional restitution of Ca-release sites after Ca discharge were prolonged when CSQ2 levels were elevated and accelerated in the presence of lowered CSQ2 protein levels. Furthermore, profound disturbances in rhythmic Ca transients in myocytes undergoing periodic electrical stimulation were observed when CSQ2 levels were reduced. We conclude that CSQ2 is a key determinant of the functional size and stability of SR Ca stores in cardiac muscle. CSQ2 appears to exert its effects by influencing the local luminal Ca concentration-dependent gating of the Ca-release channels and by acting as both a reservoir and a sink for Ca in SR. The abnormal restitution of Ca-release channels in the presence of reduced CSQ2 levels provides a plausible explanation for ventricular arrhythmia associated with mutations of CSQ2.     

The additive prognostic value of restrictive pattern and dipyridamole-induced contractile reserve in idiopathic dilated cardiomyopathy

BACKGROUND: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM). AIMS: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM. METHODS: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile. RESULTS: Rest wall motion score index (WMSI) was 2.2+/-0.3 and decreased to 1.9+/-0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (deltaWMSI<0.15). CONCLUSION: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome.     

Does Senna Extract Promote Growth of Aberrant Crypt Foci and Malignant Tumors in Rat Colon?

Current evidence suggests that aberrant cryptfoci (ACF) can be used to evaluate agents for theirpotential colon carcinogenic activity. The aim of thepresent study was to determine whether senna pod extract (SE) itself induces ACF and tumors in the ratcolon or increases the development of ACF and tumorsinduced by azoxymethane (AOM). A daily administration ofSE 10 mg/kg by mouth for 13-28 weeks produced a weak laxative effect but did not itself causethe appearance of ACF or tumors. The numbers of ACF andtumors induced by AOM were, however, increased by a doseof SE (100 mg/kg) able to induce chronic diarrhea over three months. These resultssuggest that SE does not cause the appearance of ACF ortumors in the rat colon nor does it have a promotingeffect when given to rats at a dose that produceslaxation (10 mg/kg), whereas a diarrhogenic dose (100mg/kg) increases the appearance of tumors induced byAOM.