HeartWare left ventricular assist device implantation through bilateral anterior thoracotomy

The HeartWare left ventricular assist device (LVAD) is a new addition to the family of second-generation continuous-flow LVADs. The miniaturized dimensions of the HeartWare LVAD provide the opportunity for its safe implantation through nonsternotomy incisions. We present our technique for HeartWare LVAD implantation through bilateral anterior thoracotomy incisions. This technique has proved to be safe and reproducible, with good clinical outcome.     

Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction after failed open surgery

BACKGROUND AND PURPOSE: Laparoscopic pyeloplasty has been accepted as a helpful option for the treatment of primary ureteropelvic junction (UPJ) obstruction. We report the results of laparoscopic pyeloplasty in cases with secondary UPJ obstruction after failed open pyeloplasty. PATIENTS AND METHODS: Between September 2003 and March 2006, 18 patients with secondary UPJ obstruction secondary to failed open surgery who had undergone laparoscopic pyeloplasty using different techniques were enrolled in this study. The mean age and male-to-female ratio were 29.8 years (range 5-65 years) and 14: 4, respectively. Pain, fever, duration of the operation, changes in renal function, and rate of complications were reviewed. RESULTS: The mean operation time and average hospital stay were 254 +/- 82 minutes and 7.2 days (range 3-12 days), respectively. The mean follow-up was 14.1 months (range 4-25.5 months). No intraoperative complication occurred. Flank pain, urinary-tract infection, and severe hydronephrosis decreased from 88.9% to 22.2%, 33.3% to 0, and 83.3% to 16.6%, respectively. After laparoscopic pyeloplasty, 100% of patients had improvement in renal function. The number of patients with >50% washout on the DTPA scan 10 and 20 minutes after furosemide injection were 0 and 2 before the operation and 5 and 12 after the operation (27.8% and 62.5% increment, respectively). CONCLUSION: Laparoscopic pyeloplasty can be used with acceptable success rate in secondary UPJ obstruction in patients with previous open pyeloplasty.     

Does pre-transplantation antireflux surgery eliminate post-renal transplantation pyelonephritis in children?

PURPOSE: Antireflux surgery for VUR before renal transplantation decreases the risk of post-kidney transplant UTI in pediatric patients with primary vesicoureteral reflux. We studied the risk of post-kidney transplant UTI in patients with or without surgical correction of VUR before transplantation compared to patients without VUR. MATERIALS AND METHODS: We compared 12 patients who had VUR corrected before transplantation (group 1) to 17 patients with VUR who did not undergo antireflux surgery before transplantation (group 2) and 36 patients undergoing renal transplantation without VUR (group 3). A total of 10 patients in group 1 (83.3%) and 10 in group 2 (58.8%) had high grade VUR. RESULTS: Eight patients in group 1 (66.7%), 6 in group 2 (35.3%) and 33 in group 3 (91.7%) remained free of febrile UTI during followup (p = 0.00). Among patients with high grade VUR 6 in group 1 and 1 in group 2 remained UTI-free (p = 0.02). A total of 33 patients in the control group (91.7%) remained free of febrile UTI, an incidence that was significantly lower compared to group 1 (p = 0.03) and group 2 (p = 0.00). Of the patients with high grade VUR 3 in group 1 (30%) and 4 in group 2 (40%) experienced recurrent febrile UTIs (p = 0.64). CONCLUSIONS: Even after surgical correction of VUR before transplantation the frequency of febrile UTI remained higher than that in kidney transplant recipients without VUR. In cases of high grade VUR reimplantation before renal transplantation decreased the rate of febrile UTI but it was still higher than the level of risk in the control group.     

Serotonin neuron transplants: electrophysiological unit activity of intrahippocampal raphe grafts in freely moving cats

Fetal serotonin (5HT)-containing neurons from the cat midbrain raphe were transplanted to the hippocampus of adult host cat brain. These neurons displayed spontaneous electrophysiological activity in freely moving cats, and showed the pacemaker-like discharge pattern characteristic of these cells. However, these neurons showed no significant change in activity across the sleep-waking cycle, nor were they responsive to sensory stimulation in the auditory and visual modalities. Grafted neurons were inhibited by 5HT agonists, but required higher doses than those in intact cats. These data are the first electrophysiological recordings of grafted 5HT neurons in freely moving animals, and question whether such tissue grafts can restore functional activity in the central 5HT system.     

Genomically Silent Refractory Gastric Cancer in a Young Patient Exhibits Overexpression of CXCL5

Gastric cancer is the third leading cause of cancer-related deaths, with more than one million new cases and approximately 841,000 deaths annually worldwide. We report a case of a young patient (25 years old) with an aggressive form of gastric cancer. The patient had previously been treated for Helicobacter pylori (H. pylori), which is a main risk factor for developing gastric cancer. Genetic testing showed an E-cadherin (CDH1) germline mutation of unknown significance. After eight cycles of chemotherapy, a positron emission tomography (PET) scan showed disease progression with an enlarging hypermetabolic right adnexal mass suspicious for metastatic disease. Tumor pathology demonstrated invasive and poorly differentiated gastric carcinoma. The analysis of the tumor biopsy indicated the very high expression of a chemokine, C-X-C motif chemokine 5 (CXCL5). The combination of H. pylori infection with an existence of a rare CDH1 mutation could have contributed to this aggressive gastric cancer.