Hybrid Repair of an Acute Type B Dissection with Subclavian‐to‐Subclavian Bypass and Stent‐Grafting

Abstract Hybrid repair of an acute type B aortic dissection with endovascular stenting and aortic arch debranching is an acceptable treatment in complicated type B dissection. We present the case of a 71‐year‐old man presenting with acute type B aortic dissection and concomitant aneurysm of the distal aortic arch, who underwent an uneventful hybrid procedure, which involved subclavian‐to‐subclavian bypass before endovascular stent‐graft placement to the aortic arch. (J Card Surg 2010;25:336‐339)     

Free-Floating Tumor Thrombus in the Left Atrium Associated with Non-Small Cell Lung Cancer

Abstract   A free-floating tumor thrombus in the left atrium is an unusual metastasis of non-small cell lung cancer. Surgical resection of free-floating tumor thrombus prior to adjuvant therapy relieves cardiac symptoms such as exertional dyspnea, and prevents life-threatening complications including systemic embolization, mitral obstruction, or sudden death.     

Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience.

BACKGROUND: Gastrointestinal (GI) complications are one of the serious complications of cardiac surgery. Although rarely seen, they cause major morbidity and mortality. The aim of the present study was to retrospectively analyze the risk factors acting on the GI complications seen after cardiac operations performed under cardiopulmonary bypass. METHOD: The present study was designed to retrospectively evaluate 13,544 patients who underwent cardiac surgery under cardiopulmonary bypass, between 1988 and 2004 in the authors' clinic. RESULTS: The overall mortality was 346 (2.55%) of 13,544 patients. GI complications developed in 128 patients (0.94%). Among those, 18 (14.1%) died because of GI complications, the most common of which was bleeding. Mesenteric ischemia had the highest case-fatality rate at 71.4%. Valve surgery, concomitant valve and coronary artery bypass grafting surgery, preoperative chronic renal dysfunction, postoperative acute renal failure, deep sternal infection, prolonged ventilation, need for intra-aortic balloon pump and ejection fraction less than 30% were found to be risk factors acting on GI complications. CONCLUSION: GI complications remain a significant concern after cardiac surgery under cardiopulmonary bypass. Higher-risk patients can be identified and treated prophylactically and in the postoperative period.     

Interrupted aortic arch associated with aortopulmonary window in a 20 year-old young adult

Interrupted aortic arch (IAA) and aortopulmonary window (APW) are rare but well-described congenital malformations. However, coexistence of these anomalies in young adults is an unusual event. Patients rarely reach adulthood without surgical correction in the neonatal period. The authors describe a 20-year-old patient, who presented with exertional dyspnea and was diagnosed as having IAA and concomitant APW. IAA just distal to the left subclavian artery and a large APW were demonstrated by chest multi-slice computed tomography angiography and cardiac catheterization.     

Biochemical and pathologic factors affecting technetium-99m-methoxyisobutylisonitrile imaging results in patients with primary hyperparathyroidism

Objective

Technetium 99 m methoxyisobutylisonitrile (Tc-99m MIBI) scintigraphy represents the most commonly utilized imaging modality for the detection of the diseased gland in patients with primary hyperparathyroidism (PHPT). In this study, we aimed to identify potential biological factors with an impact on MIBI sensitivity.

Methods

A total of 147 patients with surgically confirmed parathyroid adenomas were assessed retrospectively. Data including medical history, biochemical and hormonal measurements, cervical US, Tc-99m MIBI scans as well as pathology reports were retrieved and recorded.

Results

Of the 147 patients, there were a total of 77, 39, and 31 cases with a positive, negative, and suspicious parathyroid adenoma on Tc-99m MIBI scan, respectively. Serum calcium (Ca), parathyroid hormone (PTH) and 25 (OH) D levels were comparable among MIBI positive and negative patients [Ca: 11.5?±?0.9 vs 11.3?±?0.9 mg/dL (P?=?0.42); PTH: 216 (146–347) vs 194 (140–317) pg/mL (P?=?0.45); 25(OH)D: 8.4 (5.7–18.2) vs 10.0 (4.7–23.3) ng/mL (P?=?0.64), respectively]. P-glycoprotein (P-gp) staining was negative in both groups. Also, pathological examination of tissue preparations revealed no difference in terms of the volume of the adenomas, incidence of cystic adenomas, cell-type dominance (oxyphilic cell), percent fat, and Ki-67 ratio in MIBI positive and negative groups. The rate of hyalinization was 13% in MIBI positive and 28% in MIBI negative subjects, the difference being statistically significant (P?=?0.04).

Conclusion

Presence of hyalinization in parathyroid adenomas was found to be negatively correlated with MIBI scan results.

     

Does Primary Hyperparathyroidism Have an Association with Thyroid Papillary Cancer? A Retrospective Cohort Study

World Journal of Surgery - To investigate the relationship between primary hyperparathyroidism (pHPT) and papillary thyroid cancer (PTC). The perioperative findings of 275 patients with pHPT who...     

Dehydroepiandrosterone sulfate/free androgen index ratio predicts a favorable metabolic profile in patients with polycystic ovary syndrome

Potential effect of hyperandrogenemia on metabolic disturbances in polycystic ovary syndrome (PCOS) has always been a matter of interest. We analyzed the records of 125 patients with PCOS and 54 age-matched healthy women. All participants underwent biochemical and hormonal assessment and a 75?g oral glucose tolerance test was performed. PCOS and control groups were comparable in terms of age. Dehydroepiandrosterone sulfate/free androgen index (DHEAS/FAI) ratio was negatively correlated with body mass index (BMI) (p?<?.001), fasting glucose (p?=?.02), area under the curve (AUC) of glucose (p?=?.03), AUC of insulin (p?=?.001), homeostasis model assessment-estimated insulin resistance (HOMA-IR) (p?<?.001), and triglycerides (TG) (p?=?.009), and positively correlated with insulin sensitivity index (ISI) (p?<?.001) and high-density lipoprotein cholesterol (HDL-C) (p?<?.001) among PCOS patients. In logistic regression analysis, higher DHEAS/FAI ratio levels were associated with lower risk of low HDL-C [RR(95%CI); 0.97(0.95–0.98); p?<?.001] as well as atherogenic dyslipidemia (TG/HDL-C) [RR(95%CI); 0.97(0.94–0.99); p?=?.035] even after adjustment for BMI in the PCOS group. Androgens, DHEAS and FAI act differently on metabolic parameters. Our results demonstrate that high DHEA-S/FAI ratio levels are associated with a more favorable metabolic profile.     

Nephrocalcinosis in glucose-galactose malabsorption: nephrocalcinosis and proximal tubular dysfunction in a young infant with a novel mutation of SGLT1

We report an association of proximal renal tubular dysfunction in a 50-day-old girl with glucose-galactose malabsorption who was found to have nephrocalcinosis, but no sign of nephrolithiasis. A novel homozygous nonsense mutation at 267Arg →stop (CGA→TGA) in the Na⁺-dependent glucose transporter (SGLT1) was found in loop 5 connecting transmembrane segments 6 and 7, indicating the complete loss of glucose transport activity. This case indicates that hypercalcaemia, nephrocalcinosis and proximal tubular dysfunction may be seen in association with glucose-galactose malabsorption and that most of these abnormalities improve with a glucose-galactose-free diet.