A Comparative Study of the Early and Short-Term Outcomes of Aortic Replacement in Patients with Stanford type A Aortic Dissection and Ascending Aortic Aneurysm

Ascending aortic replacement is a challenging and complex surgery. The mortality, morbidity, and outcomes depend on the causes of the ascending aortic pathology and the type of operation. The research was conducted in a single-center, prospective, observational cohort study of patients undergoing ascending aortic replacement due to dissection or aneurysm. In the hospital, mortality, morbidity, and short-term outcomes were measured. A total of 85 patients were included in this study. Of them, 65.9% were male, and 34.1% were female. Thirty-three patients had Stanford type A aortic dissection (STAAD), whereas 52 had ascending aortic aneurysm (ASAA). Early mortality was (21.21% and 1.9%) for STAAD and ASAA, respectively, while the survival rate after one year was (75.8% and 96.15 %) for ascending dissection and aneurysm, respectively. The results of our study show higher early surgical mortality and morbidity and a lower short-term survival rate for STAAD surgery compared with ASAA surgery

Febrile seizures: mechanisms and relationship to epilepsy.

Studies of febrile seizures have been driven by two major enigmas: first, how these most common of human seizures are generated by fever has not been known. Second, epidemiological studies have linked prolonged febrile seizures with the development of temporal lobe epilepsy, yet whether long or recurrent febrile seizures cause temporal lobe epilepsy has remained unresolved. To investigate these questions, a model of prolonged (complex) febrile seizures was developed in immature rats and mice, permitting mechanistic examination of the potential causal relationships of fever and seizures, and of febrile seizures and limbic epilepsy. Although the model relied on hyperthermia, it was discovered that the hyperthermia-induced secretion of endogenous fever mediators including interleukin-1beta, which contributed to the generation of these 'febrile' seizures. In addition, prolonged experimental febrile seizures provoked epilepsy in a third of the animals. Investigations of the mechanisms of this epileptogenesis demonstrated that expression of specific ion (HCN) channels and of endocannabinoid signaling, may be involved. These may provide novel drug targets for intervention in the epileptogenic process

Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

Background: Primary hyperhidrosis is characterized by excessive sweating beyond physiological needs. It is a common disease (incidence 2.8%) that causes intense discomfort for patients. In the last decade, advantages of Single-Incision Thoracoscopic Sympathectomy have become clear, particularly in decreasing morbidity of sympathectomy. Patients and methods: From January 2010 to December 2012, 39 patients (29 females and 10 males) with primary palmar or axillary hyperhidrosis were treated by thoracoscopic sympathectomy. The age ranged from 18 to 40 years with a mean of 26.28 years. We used single incision thoracoscopic electrocoagulation through 10 mm incision for thoracic sympathetic chain (T2–T4). Results: The mean follow-up was 23.6 ± 14.2 months (range = 4–24 months). A total of 97.42% of patients were satisfied with the results. A total of 72.5% of patients had cure, one patient (2.5%) and another patient (2.5%) presented with recurrent axillary hyperhidrosis. The morbidity was 10.2% with no mortality. Percentage of compensatory sweating and gustatory sweating were 5.1% ( p = .353) and 2.5% ( p = .552), respectively. The result of sympathectomy in patients with both palmar and axillary hyperhidrosis was significantly better (17, 43.58%) compared to palmar type (14, 35.89%) or axillary type (7, 17.94%). Conclusion: Thoracoscopic sympathectomy is a simple, safe, and cost-effective therapy with good results and low complications

Tracheobronchial Foreign Bodies in Children: The Role of Emergency Rigid Bronchoscopy

Foreign body aspiration (FBA) is a common and lethal accident in the pediatric age group. It requires early recognition and treatment by rigid bronchoscopy to avoid fatal outcomes. Objective. The aim of this study was to study the pattern of FBA in the tracheobronchial tree as well as the success rate of rigid bronchoscopy in children admitted to a single center and to analyze the relationship of the type of foreign body (FB) with patients’ age, presentation, and complications. Methods. A retrospective cross-sectional study of FBA was conducted in children in the Sulaimani/Kurdistan region, Iraq, admitted to the emergency teaching hospital of the University of Sulaimani from January 2014 to March 2016. Result. Data of 83 patients between 6 months and 15 years old were studied. The most affected was the 1- to 5-year-old group. There was a slight female predominance (male to female ratio 0.93:1). The most common FB was sunflower seed (49.4%). History of choking was present in 92.8% of patients; 55.4% had normal air entry, and 37.3% had no added sound on chest auscultation. Normal chest X-ray (CXR) was found in 40% of patients. The most common site was the right bronchial tree (39.8%). Two patients needed mechanical ventilation; both of them died. There was a significant relationship between the type of FB ( P = .013, .000, respectively). Conclusion. Medical history is the most important factor for reaching the diagnosis; bronchoscopy is mandatory if choking was witnessed, even if examination and CXR are normal. Organic material causes more local reaction than nonorganic material

Infant with Life Threatening Thymic Carcinoma

Thymic epithelial neoplasms consist of thymomas, thymic carcinoids and thymic carcinomas. Carcinomas are malignant tumors of the thymus; they compromise only 4%-14% of thymic epithelial neoplasms. Thymic carcinoma cells do not resemble healthy cells but similar to cancer cells that originate from other parts of the body and grow more quickly when the tumor is found and more difficult to treat. Thymic carcinoma rarely occurs in children. We reported a case of undifferentiated thymic carcinoma in 11 months old female. After two courses of chemotherapy the patient developed increasing respiratory compression and unfortunately died because of respiratory failure

Experimental febrile seizures are precipitated by a hyperthermia-induced respiratory alkalosis

Febrile seizures are frequent during early childhood, and prolonged (complex) febrile seizures are associated with an increased susceptibility to temporal lobe epilepsy. The pathophysiological consequences of febrile seizures have been extensively studied in rat pups exposed to hyperthermia. The mechanisms that trigger these seizures are unknown, however. A rise in brain pH is known to enhance neuronal excitability. Here we show that hyperthermia causes respiratory alkalosis in the immature brain, with a threshold of 0.2–0.3 pH units for seizure induction. Suppressing alkalosis with 5% ambient CO(2) abolished seizures within 20 s. CO(2) also prevented two long-term effects of hyperthermic seizures in the hippocampus: the upregulation of the I(h) current and the upregulation of CB1 receptor expression. The effects of hyperthermia were closely mimicked by intraperitoneal injection of bicarbonate. Our work indicates a mechanism for triggering hyperthermic seizures and suggests new strategies in the research and therapy of fever-related epileptic syndromes