Current status of surgical treatment for pectus excavatum deformity

Pectus excavatum is the commonest anterior chest wall deformity which is the result of overgrowth and elon­gation of costal cartilages that push the normal sternum in. The deformity has serious pshychologic impact and limits the exercise tolerance of the patient, because of displacement of the heart within the left hemithorax. Repair of pectus excavatum is performed by the classical Ravich technique or the minimally invasive Nuss repair. The Ravich operation consists of resection of the deformed cartilages, bending the sternum in its normal position and maintenance of the sternum in the correct position by using a metal bar or a strong synthetic mesh. The Nuss procedure involves the thoracoscopic placement of a pre-formed curved metal bar behind the sternum which rises the sternum to the desired position. The selection of the technique depends on the age of the patient and the degree and symmetry of the deformity. The Nuss technique is suitable for children between 5 and 15 years old who have flexible chest wall and symmetric deformities, while the Ravich procedure is indicated in young adults and asymmetric forms. Indeed, the Nuss technique still undergoes modifications to become safer and simpler and further it needs expertise and special equipment

Sinotubular Junction Remodeling with Aortic Cusp repair. An alternative to Bentall operation for Ascending Aortic aneurysm with Aortic Valve Regurgitation.

We present a 72-year-old female patient with ascending aortic aneurysm and aortic valve regurgitation, who was referred for surgery. Preoperative echocardiography demonstrated a dilated sinutubular junction (STJ), preserved sinus dimensions and moderate to severe aortic valve insufficiency with central regurgitant jet. During surgery, comprehensive visual assessment of aortic cusp configuration revealed prolapse of the non-coronary cusp, which was repaired by appropriate techniques. Ascending aorta pathology was corrected with sinutubular junction remodelling (STJR). The combination of STJR and cusp repair is an excellent alternative to root replacement with no prosthesis-related long term complications

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery.

BACKGROUND Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients. METHODS A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment. RESULTS The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions. CONCLUSIONS This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions

Perioperative Application of Levosimendan Optimizes Postoperative Renal Function and Organ Perfusion in Patients with Severe Heart Failure.

Background: Renal dysfunction and impaired organ perfusion are common concerns following cardiac surgery. Levosimendan, a calcium sensitizer inotropic drug, is investigated in this study for its potential to improve postoperative renal function and organ perfusion in patients with low preoperative ejection fraction and severe myocardial dysfunction after cardiac surgery. Methods: A retrospective analysis was conducted on 314 patients with preoperative heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while 130 patients with similar characteristics received conventional treatment. Results: The perioperative administration of levosimendan resulted in a significantly lower need for renal replacement therapy (p < 0.001) and improvements in the serum creatinine levels, glomerular filtration rate, and creatinine clearance. Similarly, the C-reactive protein levels, blood pH, and lactic acid levels showed comparable improvements. Conclusions: The use of levosimendan was associated with a significant enhancement in postoperative renal function and a reduction in the need for renal replacement therapy. Furthermore, it resulted in a decrease in the extent of organ malperfusion. Postoperative inflammatory reactions and metabolic balance also exhibited improvements

Urban thoracic trauma: diagnosis and initial treatment of non-cardiac injuries in adults.

This comprehensive review aims to delineate the prevailing non-cardiac thoracic injuries occurring in urban environments following initial on-site treatment and subsequent admission to hospital emergency departments. Our study involved a rigorous search within the PubMed database, employing key phrases and their combinations, including "thoracic injury," "thoracic trauma," "haemothorax," "lung contusion," "traumatic pneumothorax," "rib fractures," and "flail chest." We focused on original research articles and reviews. Non-cardiac thoracic injuries exhibit a high prevalence, often affecting poly-trauma patients, and contributing to up to 35% of polytrauma-related fatalities. Furthermore, severe thoracic injuries can result in a substantial 5% mortality rate. This review provides insights into clinical entities such as lung contusion, traumatic haemothorax, pneumothorax, rib fractures, and sternal fractures. Thoracic injuries represent a frequent and significant clinical concern for emergency department physicians and thoracic surgeons, warranting thorough understanding and timely intervention

Assessing the knowledge of bronchial asthma among primary health care physicians in Crete: A pre- and post-test following an educational course

AIM: To assess the level of knowledge for bronchial asthma of the primary healthcare physicians serving a rural population on the island of Crete, both before and immediately after a one-day educational course. METHODS: Twenty-one primary health care physicians, randomly selected from a list of 14 Health Care Centres on the island of Crete were invited to participate in the study and attended an educational course. Nine of the 21 physicians were fully qualified general practitioners, while the remainder were non-specialized (NSs) physicians who had recently graduated from the University of Crete, Medical School. A questionnaire of 20 items based on current bronchial asthma clinical guidelines was used. Three scores, the mean total, knowledge subscore and attitudes subscore, were calculated for each group of physicians, both before and after the course. RESULTS: At baseline mean total score and knowledge and attitudes subscores were higher for non-specialized physicians than for the general practitioners, but the differences were not statistically significant (p > 0.05). The knowledge subscore was improved in both groups, however the difference was statistically significant only for the non-specialized physicians (t = 2.628, d.f. = 11, p < 0.05). The mean total score after the course was significantly higher for the non-specialized physicians in comparison to that of the general practitioners (t=-2.688, d.f. = 19, p < 0.05). CONCLUSIONS: This study adds to the information about the success of continuing medical education, and also demonstrates that the recent graduates in the studied population, could be educated with more positive results than the fully qualified practitioner

Συνήθειες μεσημεριανού ύπνου σε τυχαίο δείγμα αγροτών από τον νομό Ηλείας

Εισαγωγή: Μελέτες αναφέρουν ότι υπάρχει ικανό ποσοστό διαταραχών ύπνου σε επαγγελματίες αγρότες, με επιπτώσεις τόσο στην εργασία τους, όσο και στην καθημερινότητα τους . Σκοπός: Σκοπός της παρούσας εργασίας ήταν η διερεύνηση και η αποτύπωση των συνηθειών μεσημεριανού και βραδινού ύπνου, σε δείγμα αγροτών του Νομού Ηλείας, και η συσχέτιση αυτών, τόσο με κοινωνικούς παράγοντες όσο και με παράγοντες κινδύνου . Μεθοδολογία: Επιδημιολογική πιλοτική έρευνα η οποία διεξήχθη με την δειγματοληπτική μέθοδο της συστηματικής δειγματοληψίας. Η σύνθεση του δείγματος ήταν ενεργοί αγρότες και αγρότισσες, όλοι εγγεγραμμένοι σε καταλόγους των γραφείων των Τοπικών Οργανώσεων Εγγείων Βελτιώσεων (ΤΟΕΒ) του Νομού Ηλείας. Για τη διεξαγωγή της έρευνας χρησιμοποιήθηκε ερωτηματολόγιο, αποτελούμενο από 38 ερωτήσεις. Στο ερωτηματολόγιο απάντησαν, με προσωπική συνέντευξη, 179 άνδρες και 13 γυναίκες. Αποτελέσματα: Από το σύνολο των ενεργών αγροτών το 40.3% κοιμούνταν καθημερινά το μεσημέρι, το 50.3% για περισσότερο από 10 χρόνια, ενώ το 29.3% μόνο το καλοκαίρι. Η συνήθης διάρκεια του μεσημβρινού ύπνου σε ποσοστό 79.1%. ήταν δύο ωρών (2-4 μ.μ.). Η διάρκεια του καθημερινού νυκτερινού ύπνου ήταν λιγότερο από 5 ώρες στο 14.5% και από 5 έως 6 ώρες στο 46.9% του συνόλου. Λιγότερο από 5 ώρες κοιμούνταν οι γυναίκες σε ποσοστό 55%. Μέτρια υπνηλία απάντησαν ότι ένιωθαν την επομένη ημέρα του νυκτερινού ύπνου 8.4% των αντρών και 11.1% των γυναικών. Ασθενής θετική συσχέτιση μεταξύ ΒΜΙ και της κλίμακας Epworth παρατηρήθηκε στο δείγμα των ανδρών. Εμφανής υπήρξε η συσχέτιση του ροχαλητού των συμμετασχόντων σε σημαντικό βαθμό, τόσο με τον αριθμό των τσιγάρων που δήλωσαν ότι καπνίζουν, όσο και με την χρήση αλκοόλ. Συμπεράσματα. Μεγάλο ποσοστό του ερευνητικού δείγματος φαίνεται ότι εμφανίζει ανεπαρκή βραδινό ύπνο και αυξημένο ποσοστό διαταραχών του, πιθανότατα. Κρίνεται αναγκαίο αφενός να διεξαχθούν περαιτέρω έρευνες και μελέτες σε μεγαλύτερο ποσοστό συμμετεχόντων, και αφετέρου να διαγνωσθούν οι διαταραχές του ύπνου με εργαστηριακό έλεγχο. Επιβεβλημένες, δε, είναι οι παρεμβάσεις για την προαγωγή της υγείας του συγκεκριμένου πληθυσμού.Introduction: Previous reports provide evidence that there is a substantial percentage of sleep disorders in farmers with an impact both on their work and on their daily life as well. Aim: The aim of this study was to investigate and describe the sleeping habits using a sample from the agricultural population of the Elia region in South-Western Greece and to assess their association with social factors and the risk of developing sleep health problems as well. Methods: A total of 179 male and 13 female farmers were included in this study. The composition of the sample was recruited with a systematic sampling approach from the offices of the Local Land Improvement Organizations (TOEB) of the Elia region. To conduct this survey a questionnaire of 38 questions was applied as a tool. Information about demographics, socioeconomic, eating, and sleeping habits were included in the questionnaire. The severity of somnolence was measured with the Epworth scale. Results: From the total of active farmers, the 40.3% of male farmers slept every day at noon, 50.3% of them slept at noon for more than 10 years while 29.3% slept only during summer. The average duration of lunchtime nap in 79.1% of male farmers was between 2-4pm. Regarding the habits of sleep in male farmers, a 14.5% reported sleeping less than 5 hours while a 46.9% slept 5-6 hours a day. Respectively in female farmers, a 55% reported sleeping less than 5 hours. Moderate somnolence the following day was claimed by 8.4% of men and 11.1% of female farmers respectively. A weak positive correlation was observed in males between BMI and the Epworth scale. It has also been found that snoring significantly correlated with both the number of cigarettes and the use of alcohol. Conclusions: The results indicate that a substantial percentage of farmers appear to have insufficient sleep and this may be a factor contributing to an increased rate of sleep disorders. Further studies in farmers with concomitant laboratory testing are required in order to diagnose sleep disorders. In addition preventive interventions in this population may be necessary