Atypical Abnormal Pulmonary Vein Drainage with Atrial Septal Defect: Surgical Treatment

Sinus venosus atrial septal defect (SV‐ASD) usually coexists with partial anomalous pulmonary vein connection (PAPVC). It is a difficult diagnosis in transthoracic echocardiography (TTE) due to eccentric position of defects. We present a rare case of atypical anatomical variation in PAPVC, which was never described before. Two right pulmonary veins drained into superior vena cava, which overrode SV‐ASD and interatrial septum, a third pulmonary vein into the right atrium. Complete diagnosis could not be set after TTE, nor transesophageal echocardiography, whereas angio‐CT was finally conclusive. This diagnostic approach allowed the surgical planning.     

A comparative study of angiogenic and cytokine responses after laparoscopic cholecystectomy performed with standard- and low-pressure pneumoperitoneum

Background  Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation. The purpose of the study was to access the influence of low-pressure CO₂ pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy. Methods  The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO₂ pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent assay (ELISA). Results  Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or by age, gender, or body mass index (BMI) of the patients. Conclusions  The results obtained in our study do not show any significant differences between studied operative procedures with regards to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences and implications.     

Aortic pulse wave velocity and carotid-femoral pulse wave velocity: similarities and discrepancies.

The objectives of this study were to determine the relationship between carotid-femoral (cfPWV) and aortic pulse wave velocity (aPWV) and to compare their modulators and association with coronary artery disease (CAD). We studied 107 consecutive patients (68 men) with a mean age of 60.49+/-8.31 years who had stable angina and had been referred for coronary angiography. cfPWV and aPWV were measured simultaneously during cardiac catheterization using the Complior device and aortic pressure waveform recordings, respectively. Based on the presence or absence of significant coronary artery stenosis (CAS) patients were subdivided into a CAS+ or CAS- group. The mean values of cfPWV and aPWV were 10.65+/-2.29 m/s and 8.78+/-2.24 m/s, respectively. They were significantly higher in the CAS+ (n=71) compared with the CAS- (n=36) group and predicted significant CAS independently of cardiovascular risk factors and mean or systolic aortic blood pressure. aPWV and cfPWV were significantly correlated (r=0.70; p<0.001) but the degree of correlation differed significantly (p<0.03) between the CAS+ (r=0.74, p<0.001) and CAS- group (r=0.46, p=0.003). Age and mean aortic blood pressure were independent predictors for aPWV as well as cfPWV. In the receiver operating characteristic (ROC) analysis, aPWV and cfPWV had similar accuracy in identification of significant CAS (AUC [area under the ROC curve]=0.76 and 0.69, respectively; p=0.13). However, neither cfPWV nor aPWV was effective at differentiating the extent of CAD. In conclusion, aPWV and cfPWV are highly correlated parameters with similar determinants and comparable accuracy in predicting significant CAS. The strength of correlation between these two indices differed significantly between subjects with and those without CAS.     

"Taurolin-Gel" and Taurolin-Trockengel" in treatment of osseous tissue inflammation]

The activity and principles of administration of Taurolin have been presented. That drug was used in 15 patients with chronic osteitis. Healing by first intention was obtained in 10 patients, necrosis of the skin occurred in 3 patients, recurrence of inflammation was found in one patient in whom accessory sequestroctomy was performed in the last case of osteitis and arteriosclerosis healing was obtained by second intention. The clinical observation of 15 patients has revealed: a) irritating influence of Taurolin on the soft tissue, b) increased phase of secretion of exudate since the 5 day after surgery, c) bactericidal influence of the drug. Sterilization of the focus occurred at 2 to 3 weeks after surgery. The use of Taurolin requires experience, complete abiding by the principles of use of this drug and equipment with a set of Charrier's drains. The authors are carrying on further observation of the use of Taurolin in the treatment of osteitis.     

Arthroscopic verification of meniscus repair]

The purpose of this study was to verify the arthroscopic meniscus repair by second-look arthroscopy. From November 2001 to October 2005, 28 meniscus (18 medial and 10 lateral) were repaired in 26 patients (two patients had both menisci in one knee repaired). There were 11 females and 15 males. The average age at surgery was 25.5 (range, 13 to 52 years of age). The indication for repair was a full-thickness, vertical tear > or = 8 mm. Meniscus repair was combined with partial meniscectomy of posterior horn because of horizontal tear in 3 cases. In 1 zone 14 meniscus were injured and in 2 zone--also 14 meniscus, according to Cooper's classification. All patients had anterior cruciate ligament rupture. The average time interval between the injury and the repair was 22 weeks (range, 2 weeks to 2 years). The inside-out suture was used in 18 repairs, all inside--3 repairs, outside-in--2 repairs and a mixed technique--5 repairs. Arthroscopic evaluation of meniscus repair was performed on average after 15 weeks (range, 2 months to 37 weeks) since the suture. That was done during the second stage of treatment--ACL reconstruction. There were 78.6% of completely healed repairs, 10.7% of incompletely healed and 10.7% were not healed.     

Difficulties in adaptation to pregnancy following natural conception or use of assisted reproduction techniques: a comparative study.

BACKGROUND: To evaluate the influence assisted reproduction techniques (ARTs) may have on women's adaptation to resulting pregnancies. METHODS: Retrospective assessment of how women adapt to their pregnancies following ART. A questionnaire was used that ranked their attitudes according to the 5-grade Likert scale. The study included 250 women who gave birth to their first child. Of these pregnancies, 125 had been obtained by means of ART; the remaining 125 were naturally conceived. RESULTS: Difficulties in adaptation to pregnancy were significantly more frequent in women whose pregnancies resulted from the use of ARTs than in those who had conceived naturally (p = 0.000005). The subjects in the first group were significantly older (p = 0.04), more affluent (p = 0.000005) and had more frequently interrupted their professional work than women in the latter group. The two groups did not differ with regard to frequency of hospitalisations. CONCLUSIONS: ART significantly increases difficulties in adaptation to resulting pregnancies. The main factors responsible for these difficulties are age, socio-economic conditions and interruption of professional activity.     

Mania caused by a diencephalic lesion.

We describe the case of a young male patient, SN, who suffered a MR-documented ischaemic lesion of both dorsomedial thalami and presented with a transient maniform syndrome. SN's neuropsychological, structural and functional imaging findings are compared with similar reported cases and are discussed in the framework of fronto-subcortical circuits and their proposed behavioural disorders. SN's mania was characterized by restlessness, mood elevation, a tendency for pleasurable activities, inflated self-esteem and loss of disease awareness. Other symptoms were sexual disinhibition, tactlessness, abnormal discourse, and reduced need for food and sleep. His neuropsychological assessment revealed an anterograde amnesia, and an impairment of frontal-executive functions. A SPECT-study showed diaschisis-related areas of hypoperfusion in both prefrontal regions which were interpreted as equivalents of SN's frontal-dysexecutive syndrome. In addition, there was a perfusion deficit in the right orbitofrontal cortex, which was taken as the imaging correlate of SN's secondary mania and personality disorder. These findings suggest that SN's mania and his other symptoms result from the twofold disruption of fronto-subcortical connections, namely of the right orbitofrontal loop which is concerned with mood regulation and socially appropriate behaviour, and of the dorsolateral prefrontal loop which mediates executive cognitive functions.