Dissected Aorta Repair Through Stent Implantation trial: Canadian results

Objectives

We describe the Canadian results of the Ascyrus Medical Dissection Stent (AMDS), a novel partially uncovered aortic arch hybrid graft implanted antegrade during hypothermic circulatory arrest to promote true lumen expansion and enhance aortic remodeling.

Bailed out by TEVAR in a horrendous bleeding aortic arch cannulation site

BackgroundThoracic Endovascular Aortic Repair [TEVAR] is used as a gold standard treatment for aortic disease such as Type B dissection, proximal descending thoracic aortic disruption and descending thoracic aortic fistulas. There was never a report, before this one, of TEVAR utilization for uncontrolled bleeding on the aortic arch cannulation site.Case presentationThis case report is of a 72-year-old female patient who presented to our facility with a day history of anterior sharp pain and dyspnea. Clinical examination revealed a frail patient in distress with tachycardia, tachypnea and elevated blood pressure. The patient had an early diastolic murmur of aortic valve insufficiency. Blood investigations were all normal. Radiological investigations (chest X-ray and Computed Tomography scan) showed prominent ascending aorta, widening mediastinum and dissection affecting the ascending aorta and the root. The patient was optimized in ICU and underwent composite ascending aortic replacement with a stentless composite valve and Dacron graft. The aortic arch cannula site bled uncontrollably and was controlled with a TEVAR stent bypass, as a staged hybrid procedure.DiscussionThe patient had a bovine arch type B configuration, which ensured that the left common carotid artery was not occluded, when deploying the TEVAR stent. However, due to inadequate landing zone three, the left subclavian artery was over-stented and further intentionally occluded with an endovascular occluder to prevent steal phenomenon.ConclusionTEVAR was a real bailout procedure in such situation. Its indication, as in this case report was never reported before; hence, it was an interesting case to write-on.     

Muscle functional MRI analysis of trunk muscle recruitment during extension exercises in asymptomatic individuals

The present study examined the activity levels of the thoracic and lumbar extensor muscles during different extension exercise modalities in healthy individuals. Therefore, 14 subjects performed four different types of extension exercises in prone position: dynamic trunk extension, dynamic–static trunk extension, dynamic leg extension, and dynamic–static leg extension. Pre‐ and post‐exercise muscle functional magnetic resonance imaging scans from the latissimus dorsi, the thoracic and lumbar parts of the longissimus, iliocostalis, and multifidus were performed. Differences in water relaxation values (T2‐relaxation) before and after exercise were calculated (T2‐shift) as a measure of muscle activity and compared between extension modalities. Linear mixed‐model analysis revealed higher lumbar extensor activity during trunk extension compared with leg extension (T2‐shift of 5.01 ms and 3.55 ms, respectively) and during the dynamic–static exercise performance compared with the dynamic exercise performance (T2‐shift of 4.77 ms and 3.55 ms, respectively). No significant differences in the thoracic extensor activity between the exercises could be demonstrated. During all extension exercises, the latissimus dorsi was the least activated compared with the paraspinal muscles. While all extension exercises are equivalent effective to train the thoracic muscles, trunk extension exercises performed in a dynamic–static way are the most appropriate to enhance lumbar muscle strength.     

Paraaortic dissection in “total mesopancreas excision” and “mesopancreas-first resection” pancreaticoduodenectomies for pancreatic cancer: Useless,optional, or necessary?A systematic review

The mesopancreas does not have well-defined boundaries but is continuous and connected through its components with the paraaortic area. The mesopancreatic resection margin has been indicated as the primary site for R1 resection after PD in pancreatic head cancer and total mesopancreas excision has been proposed to achieve adequate retropancreatic margin clearance and to minimize the likelihood of R1 resection. However, the anatomy of the mesopancreas requires extended dissection of the paraaortic area to maximize posterior clearance. The artery-first surgical approach has been developed to increase local radicality at the mesopancreatic resection margin. During PD, the artery-first approach begins with dissection of the connective tissues around the SMA. However, the concept of the mesopancreas as a boundless structure that includes circumferential tissues around the SMA, SMV, and paraaortic tissue highlights the need to shift from artery-first PD to mesopancreas-first PD to reduce the risk of R1 resection. From this perspective the “artery-first” approach, which allows for the avoidance of R2 resection risk, should be integrated into the “mesopancreas-first” approach to improve the R0 resection rate.In total mesopancreas excision and mesopancreas-first pancreaticoduodenectomies, the inclusion of the paraaortic area and circumferential area around the SMA in the resection field is necessary to control the tumour spread along the mesopancreatic resection margin rather than to control or stage the spread in the nodal basin.     

Sensitivity to change and responsiveness of the Segmental Assessment of Trunk Control (SATCo) in children with spinal cord injury

Purpose: The purpose of this study was to assess the sensitivity and responsiveness of the Segmental Assessment of Trunk Control (SATCo) for evaluating trunk control in children with spinal cord injury (SCI) receiving activity-based locomotor training (AB-LT).

Methods: Prospective study of nine outcomes for consecutively enrolled children in outpatient AB-LT. To evaluate sensitivity to change, linear-mixed models were constructed and adjusted for covariates: age at and time since SCI. To evaluate responsiveness, standardized response means and 95% confidence intervals were estimated per outcome.

Results: SATCo scores increased significantly (p < 0.05) regardless of chronicity, initial score, and injury level. The SATCo was the most responsive measure and the only outcome demonstrating a large effect size after 3 months of therapy.

Conclusions: Children with SCI receiving AB-LT improved trunk control regardless of chronicity, initial impairment, or prior experience. SATCo sensitivity and responsiveness support its usefulness in measuring trunk control in children with SCI.     

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma： a case report

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.     

Interactive design of patient-oriented video-games for rehabilitation: concept and application

Purpose: Serious video-games are innovative tools used to train the motor skills of subjects affected by neurological disorders. They are often developed to train a specific type of patients and the rules of the game are standardly defined. A system that allows the therapist to design highly patient-oriented video-games, without specific informatics skills, is proposed.

Method: The system consists of one personal computer, two screens, a Kinect? sensor and a specific software developed here for the design of the video-games. It was tested with the collaboration of three therapists and six patients, and two questionnaires were filled in by each patient to evaluate the appreciation of the rehabilitative sessions.

Results: The therapists learned easily how to use the system, and no serious difficulties were encountered by the patients. The questionnaires showed an overall good satisfaction by the patients and highlighted the key-role of the therapist in involving the patients during the rehabilitative session.

Conclusions: It was found that the proposed system is effective for developing patient-oriented video-games for rehabilitation. The two main advantages are that the therapist is allowed to (i) develop personalized video-games without informatics skills and (ii) adapt the game settings to patients affected by different pathologies.

• Implications for rehabilitation

• Virtual reality and serious video games offer the opportunity to transform the traditional therapy into a more pleasant experience, allowing patients to train their motor and cognitive skills.

• Both the therapists and the patients should be involved in the development of rehabilitative solutions to be highly patient-oriented.

• A system for the design of rehabilitative games by the therapist is described and the feedback of three therapists and six patients is reported.