Coronary-coronary bypass using vein graft on a beating heart in a patient with porcelain aorta

There is increased risk of systemic embolism during cardiopulmonary bypass in patients with a severely atherosclerotic ascending aorta. We report a coronary-coronary bypass in a 74-year-old man with a porcelain aorta. He underwent a proximal right coronary-distal right coronary artery bypass with a saphenous vein graft, combined with a pedicled arterial graft (left internal mammary artery) to the left anterior descending artery, in the presence of a beating heart without cardiopulmonary bypass. The patient survived without evidence of perioperative myocardial infarction or cerebrovascular accident. One year later, follow-up angiography showed graft patency with good distal run-off. Coronary-coronary bypass on a beating heart without cardiopulmonary bypass can be performed safely in a patient with porcelain aorta.     

Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients.

PURPOSE: To assess the safety and efficacy of ultrasound (US) guidance during retrograde popliteal artery catheterization (RPAC) and identify the risk factors for late hemostasis and complications. METHODS: A retrospective review was undertaken of consecutive patients who underwent grayscale US-guided RPAC during the last 8 years. Chart review identified 174 patients (150 men; mean age 61+/-10 years, range 37-84) with 247 iliofemoral lesions, which were treated via US-guided RPAC. Complications were classified as puncture-related versus angioplasty-related and major versus minor. Risk factors for complications and late hemostasis were evaluated with logistic and linear regression analyses, respectively. RESULTS: All 234 US-guided RPACs were technically successful. No arteriovenous fistula (AVF) or dissection/thrombosis of the popliteal artery was observed. The mean time to hemostasis was 6.9+/-2.3 minutes. The presence of femoral stenosis (versus occlusion) and use of large (6 to 7-F) sheaths were significant risk factors for late hemostasis. In 234 procedures, 15 (6.4%) complications developed; 10 (4.3%) were puncture-related (3 major, 7 minor) and 5 (2.1%) were angioplasty-related (3 major, 2 minor). Intra-arterial fibrinolysis was found to be the only significant risk factor for overall and puncture-related complications. CONCLUSIONS: Our results suggest that US-guided RPAC is at least as safe as other RPAC methods described in the literature. In contrast to generally held concerns, hemostasis is easy to obtain, and multiple punctures and the use of large sheaths appear safe. These results should be taken into consideration during the selection of an access site for endovascular treatment of superficial femoral artery and tandem iliofemoral lesions.     

The concept of crosstalk‐directed embryological target mining and its application to essential hypertension treatment failures

This review aims to introduce the novel concept of embryological target mining applied to interorgan crosstalk network genesis, and applies embryological target mining to multidrug‐resistant essential hypertension (a prototype, complex, undertreated, multiorgan systemic syndrome) to uncover new treatment targets and critique why existing strategies fail. Briefly, interorgan crosstalk pathways represent the next frontier for target mining in molecular medicine. This is because stereotyped stepwise organogenesis presents a unique opportunity to infer interorgan crosstalk pathways that may be crucial to discovering novel treatment targets. Insights gained from this review will be applied to patient management in a clinician‐directed fashion.     

Platelet-rich plasma with keratinocytes and fibroblasts enhance healing of full-thickness wounds

Advances in tissue engineering led to the development of various tissue-engineered skin substitutes (TESS) for the treatment of skin injuries. The majority of the autologous TESS required lengthy and costly cell expansion process to fabricate. In this study, we determine the possibility of using a low density of human skin cells suspended in platelet-rich plasma (PRP)-enriched medium to promote the healing of full-thickness skin wounds. To achieve this, full-thickness wounds of size 1.767 cm² were created at the dorsum part of nude mice and treated with keratinocytes (2 × 10⁴ cells/cm²) and fibroblasts (3 × 10⁴ cells/cm²) suspended in 10% PRP-enriched medium. Wound examination was conducted weekly and the animals were euthanized after 2 weeks. Gross examination showed that re-epithelialization was fastest in the PRP+cells group at both day 7 and 14, followed by the PRP group and NT group receiving no treatment. Only the PRP+cells group achieved complete wound closure by 2 weeks. Epidermal layer was presence in the central region of the wound of the PRP+cells and PRP groups but absence in the NT group. Comparison between the PRP+cells and PRP groups showed that the PRP+cells-treated wound was more mature as indicated by the presence of thinner epidermis with single cell layer thick basal keratinocytes and less cellular dermis. In summary, the combination of low cell density and diluted PRP creates a synergistic effect which expedites the healing of full-thickness wounds. This combination has the potential to be developed as a rapid wound therapy via the direct application of freshly harvested skin cells in diluted PRP.     

Effect of the preservation-to-surgery interval on corneal allograft survival in low-risk patients.

BACKGROUND AND OBJECTIVE: To investigate the role of the preservation-to-surgery interval on corneal allograft survival in low-risk patients. PATIENTS AND METHODS: Eighteen donor corneas obtained from an overseas eye bank were preserved and transported overseas in Optisol-GS solution (Chiron Vision, Irvine, CA) in Group 1. Thirty fresh, young, healthy, and unscreened donor corneas soaked in the same medium were used in Group 2. Average preservation-to-surgery time was more than 8 days in Group 1 and less than 30 hours in Group 2. Corneal allograft survival rates were determined by Kaplan-Meier estimates of the survivor functions. The log-rank test was used to determine statistical significance of the differences between groups. was 233.3 +/- 37.7 hours in Group 1 and 20.8 +/- 4.6 hours in Group 2 (P < .05 for the comparison of average times). There were significant differences between the groups with respect to donors' age and enucleation time, but there were no statistically significant differences between the groups in terms of graft diameter and recipient diameter or for corneal allograft survival in low-risk patients. The graft survival rate was 83.3% in Group 1 and 93.3% in Group 2 at the end of the follow-up period. CONCLUSIONS: Preservation-to-surgery time has no effect on corneal allograft survival in low-risk patients. However, prospective, randomized, long-term and large-scale clinical trials are necessary to confirm these findings.     

Effects of intravenous triiodothyronine during coronary artery bypass surgery

A prospective randomized and double-blind study was performed to evaluate whether perioperative triiodothyronine administration has any effect on cardiovascular performance after coronary artery bypass surgery. Sixty patients were assigned to 2 groups of 30 each. When crossclamping ended, group A received an intravenous bolus of triiodothyronine, followed by infusion for 6 hours. Group B received a placebo. Serum triiodothyronine levels and hemo-dynamic parameters were serially measured. Mean postoperative cardiac index was slightly, but not significantly, higher in group A, whereas systemic vascular resistance was significantly lower in group A. Compared with preoperative values, serum triiodothyronine levels dropped significantly in group B at the end of cardiopulmonary bypass and remained low 12 hours postoperatively, while levels rose significantly in group A. No significant differences were detected between the groups in the incidence of arrhythmia, the need for inotropic support, intensive care unit stay, mortality, and morbidity. Perioperative administration of triiodothyronine increased cardiac output slightly and decreased systemic vascular resistance, but it had no effect on operative outcome. Routine use after coronary surgery is thus not recommended.