Year in review in Intensive Care Medicine 2009: II. Neurology, cardiovascular, experimental, pharmacology and sedation, communication and teaching

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Alignment of the Cervix with the Vagina in Uterine Retroversion: A Possible Risk Factor in Uterine Prolapse

Multiple observational studies have found an association of uterine prolapse with uterine retroversion. Mechanisms proposed to explain this apparent association assume that the cervix of a retroverted uterus will usually insert at the apex of the vagina, with resultant alignment of the cervix with the vagina. The angle of the axis of the cervix with the axis of the vagina was measured by two readers on 323 sagittal pelvic MRI scans and sagittal reconstructions of pelvic CT scans performed for clinical purposes. One reader observed and recorded the anatomic relations of the uterus that differed by insertion site and version: 44 of 49 retroverted uteri (89.8%) inserted at the vaginal apex, and 13 of 274 anteverted uteri (4.7%) inserted at the vaginal apex. This difference was found to be statistically significant (p < 0.05) by the Chi square test. The urinary bladder, vaginal walls, and rectum were inferiorly related to anteriorly inserted anteverted uteri. Only the vaginal lumen and the rectum at a shallow oblique angle were inferiorly related to apically inserted retroverted uteri. Most retroverted uteri insert at the apex of the vagina. Apically inserted retroverted uteri appear to receive less support from adjacent structures than anteriorly inserted anteverted uteri

TAVI without surgical standby: Is history repeating itself? A word of caution

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Reoperative “off-pump” circumflex revascularization via left thoracotomy: how to prevent graft kinking

Reoperative circumflex revascularization can be performed through a left thoracotomy approach, with or without cardiopulmonary bypass. In such cases, establishing the appropriate length of coronary grafts connecting the descending thoracic aorta to one of the marginal branches of the circumflex coronary artery may be problematic. In fact, if these grafts are too long they may kink, whereas if left too short they may be injured by respiratory excursions of the left lower lobe of the lung. In this report we describe a technique that can prevent these potential complications

Redo left anterior descending artery grafting via left anterior small thoracotomy: an alternative approach

Reoperative left anterior descending artery (LAD) revascularization can be performed through a left anterior small thoracotomy (LAST approach) in patients requiring isolated LAD revascularization. If the left internal mammary artery has been previously used, however, the operation is generally performed either through a median sternotomy or through a full posterolateral thoracotomy for the necessity of connecting the vein graft to the ascending aorta or to the descending thoracic aorta, thus losing the advantages of a minimally invasive approach. In the case reported herein, we describe a technique in which reoperative revascularization of the LAD is accomplished through the LAST approach, using the stump of the left internal mammary artery as the inflow site of a saphenous vein coronary graft to the LAD

Exposure and mechanical stabilization in off-pump coronary artery bypass grafting via sternotomy

Although off-pump coronary artery bypass grafting (CABG) is gaining popularity, obtaining exposure and stabilization of coronary arteries located on the lateral and inferior wall of the heart may be problematic. The aim of this study is to describe strategies and techniques of coronary exposure and mechanical stabilization that may be used to achieve total myocardial revascularization of the beating heart