Transplantation using hearts from primary pulmonary hypertensive donors for recipients with a high pulmonary vascular resistance

BACKGROUND: Transplantation for patients with a high pulmonary vascular resistance (PVR) carries an increased risk of mortality and right heart failure following heart transplantation and continues to be a major problem. We evaluated the use of hearts from patients who underwent heart and lung transplantation for primary pulmonary hypertension (PPH) as part of a domino procedure because these hearts have hypertrophied right ventricles used to increased pulmonary pressures, but could have a compromised left ventricle or irreversible damage of the right ventricle. METHODS: We reviewed 12 patients with PVR >4 Wood units who underwent orthotopic heart transplantation between 1989 and 1998 using hearts from donors with PPH as part of a domino procedure. RESULTS: We studied 10 men and 2 women, mean age 42.9 years. Mean PVR was 5.3 (range, 4-9) Wood units. Mean ischemia time was 85.3 minutes, and mean donor age was 32 years. Actuarial survival was 75% at 1 year and 75% at 5 years. In the early post-operative period, 3 patients had temporary arrhythmias, 2 required permanent pacemaker implantation, 1 had atrial fibrillation, and 1 had ventricular tachycardia that required defibrillator implantation. At a mean follow-up of 7.8 years, 2 patients had developed asymptomatic transplant coronary disease (both at 8.5 years after transplantation), 1 moderate and 1 very mild; the rest had none. Mean left ventricular ejection fraction at latest follow-up was 70.1% (range, 63%-78%). Right ventricular function assessed clinically and by echocardiography was adequate in the short and long term. CONCLUSIONS: Our results suggest that heart and lung recipients with PPH can provide useful donor hearts to patients with increased PVR and that these hearts function well in the intermediate and long term.     

Postprostatectomy orchitis: reduction in incidence using perioperative ceftriaxone and postoperative ciprofloxacin

Postoperative orchitis increases the morbidity and overall hospital stay after prostatectomy. A retrospective review of our initial series of 174 cases revealed an incidence of 6% which is similar to other studies. We reviewed our bacterial flora and antibiogram and subsequently started a prospective study combining peri-operative ceftriaxone and postoperative ciprofloxacin, which we compared to our previous series where we used perioperative ceftriaxone followed by postoperative gentamicin and ampicillin. There was an abolition of orchitis as a consequence and a significant reduction in the rate of wound infection. We conclude that a combination of ceftriaxone and ciprofloxacin is efficacious in reducing the rate of infective complications following prostatectomy. We recommend the use of these or similar drugs based on local microbial flora.     

The Anti-obesity Effect of Allium cepa L. leaves on High Fat Diet Induced Obesity in Male Wistar Rats

BackgroundOver the years, there has been research on the anti-obesity effect of the Allium cepa bulb, but a dearth of research was carried out on the leaves, which is consumed as vegetable salad and soup, hence this study was proposed.ObjectiveThis study aims at investigating the effect of A. cepa leaves on high fat diet (HFD) induced obesity in male Wistar rats.MethodsTwenty-eight male Wistar rats were divided into four groups with seven rats each. Apart from Group 1 (normal control which received normal pelleted diet), obesity was induced in 21 rats of Group 2 to 4 with HFD. Group 2, the obese control was administered with 100% HFD, while the diet for group 3 and 4 was supplemented with 10% and 20% A. cepa powdered leaves, respectively, for 28 days.ResultsIn the rats treated with 10% and 20% A. cepa, body weight, fat mass, blood glucose, total cholesterol, triglycerides, aspartate amino transferase, alanine amino transferase, creatinine and urea levels were reduced significantly (P < 0.05) in comparison with the obese control group. The liver of the rats treated with 10% and 20% A. cepa leaves revealed small and few amounts of fat deposits in comparison with the obese control group, which revealed numerous and large deposits of fat. The kidney of the rats treated with 10% and 20% A. cepa leaves showed moderate and mild inflammation, respectively, in comparison with the obese control group which showed acute inflammation. The leaves of A. cepa had antioxidant properties and the presence of volatile compounds with anti-obesity properties in A. cepa were identified using gas chromatography-mass spectrometry (GC-MS).ConclusionA. cepa leaves had weight-loss effect in that it decreased body weight, fat mass, glucose and lipid levels including fat deposits in the liver.     

Spontaneous ileal perforation complicating low anorectal malformation

Anorectal malformation is a common anomaly in neonates. Although colorectal perforations have been reported as a complication, ileal perforation is rarely encountered. This is a report of a 2-day-old boy presenting with a low anorectal malformation, complicated with ileal perforation, necessitating laparotomy and ileal repair. Anoplasty was done for the low anomaly. Early presentation and prompt treatment of anorectal malformations is important to prevent such potential life threatening complication.Key words: Ileal perforation, low anorectal anomaly, spontaneous     

Clinical Impact of Atrial Fibrillation in Patients With the HeartMate II Left Ventricular Assist Device

Background

Atrial fibrillation (AF) is common in patients with the HeartMate II (HMII) left ventricular assist device (LVAD), but the impact of AF on clinical outcomes is uncertain.

Objectives

This study sought to determine the effect of AF on outcomes in patients with the HMII LVAD.

Methods

Records of 106 patients who underwent HMII implantation at a single center were reviewed. The associations of paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF) with survival, heart failure (HF) hospitalization, bleeding, and thromboembolism were examined using Kaplan-Meier survival analysis and Cox proportional hazards regression.

Results

Mean age was 56.6 ± 11.4 years, 87.7% of the implants were intended as a bridge to transplantation, and median length of support was 217 days (range: 1 to 952 days). AF was present in 55 patients (51.9%); 36 patients (34.0%) had PAF and 19 (17.9%) had PeAF. Twenty-one patients (19.8%) died, and 18 (17.0%) were hospitalized for HF. There were 0.75 major bleeding events and 0.28 thromboembolic events per patient year of follow-up. PAF was not associated with increased mortality, HF hospitalization, bleeding, or thromboembolism. PeAF, however, was an independent predictor of the composite endpoint of death or HF hospitalization (hazard ratio: 3.54; 95% confidence interval: 1.52 to 8.25; p < 0.01). Although there was no increase in bleeding or thromboembolism, patients with AF had thromboembolic events at higher international normalized ratios (INRs).

Conclusions

Although PAF is not associated with worse outcomes in patients with the HMII LVAD, PeAF may be associated with increased mortality and HF hospitalization. Patients with AF also may have thromboembolic events at higher INR levels.     

Brainstem auditory evoked response in adolescents with acoustic mycotic neuroma due to environmental exposure to toxic molds

Indoor air contamination with toxic opportunistic molds is an emerging health risk worldwide. Some of the opportunistic molds include: Stachybotrys chartarum, Aspergillus species (A. fumigatus, A. flavus, A. niger, A. versicolor etc.), Cadosporium, Alternaria, Penicillium, Trichoderma, Fusarium graminearum etc. These molds flourish in homes that are moist and damp. Reports of floods are now evident in many parts of the world. With these global changes in climatic conditions that favor the opportunistic mode of living among these molds, some health authorities are beginning to feel concerned about the diversity and the extent to which opportunistic molds can cause adverse health effects in humans. Mycotoxicosis is the collective name for all the diseases caused by toxic molds. Frequently, we have cases of acoustic neuroma due to mycotoxicity in our Center. Mycotic neuroma probably has not been reported before and the application of brainstem auditory evoked response (BAER) techniques in acoustic mycotic neuroma have not been reported either. The aim of this study, therefore, was to report cases and measurements of acoustic mycotic neuroma in adolescents using the brainstem auditory evoked response. The patients' case history, clinical neurological and neurobehavioral questionnaires were assessed. Then, the BAERs were recorded between Cz and Ai, with a second channel, Cz-Ac. The case histories and the questionnaires were analyzed in conjunction with the outcome of the objective brainstem auditory evoked response measurements. The prevalent subjective findings in the patients were headaches, memory loss, hearing loss, lack of concentration, fatigue, sleep disturbance, facial swelling, rashes, nosebleeds, diarrhea, abdominal pains and respiratory difficulties. Objective BAER showed overall abnormalities in all the patients. Although the waveform abnormalities varied, 1-3 interpeak latencies were abnormal in all the patients. Overall results showed the presence of acoustic mycotic neuroma and confirmed the sensitivity and usefulness of BAER in screening acoustic mycotic neuroma and sensorineural auditory dysfunction.     

Does routine use of the radial artery increase complexity or morbidity of coronary bypass surgery?

BACKGROUND: Despite increasing data supporting its use, the uptake of radial artery coronary bypass grafting by most surgeons remains low. This may partly be from perceptions that it increases risk or complexity of coronary surgery. METHODS: Data on 151 patients who had radial grafts are compared with 179 concurrent nonrandomized controls that underwent conventional surgery using saphenous vein. Additionally, telephone interviews were conducted on 127 radial recipients to assess subjective outcome. RESULTS: Cardiopulmonary bypass and cross-clamp times were similar in both groups (72 versus 74 minutes and 20 versus 22 minutes). Morbidity was comparable (mortality 1% versus 2%; cerebral vascular accident 1% versus 2%; sternal infection 1% versus 2%; resternotomy 4% versus 6%). Of 127 patients contacted, 41 (32%) reported that they had experienced parasthesia, and 65 (51%) reported numbness related to radial harvest; of these, 75% reported their symptoms as resolved or resolving. Early angiography performed in 36 patients revealed a radial patency rate of 92%. CONCLUSIONS: Concerns about increased morbidity and mortality should not hinder adoption of radial artery grafting.