Two-vessel off-pump coronary artery bypass grafting by left thoracotomy in a complex redo case

Introduction: The left thoracotomy approach is an alternative technique for coronary revascularization to avoid complications associated with re-sternotomy, such as injury to patent grafts, right ventricle, aorta, during re-sternotomy. Situations such as calcification of the ascending aorta and previous mediastinitis favor the use of the left thoracotomy approach. Revascularization of the circumflex territory via a lateral thoracotomy has been reported previously. However, reports of revascularization of the LAD combined with circumflex artery territory via left thoracotomy approach are rare. We successfully performed an off-pump CABG by left thoracotomy in a complex redo case to revascularize the LAD and obtuse marginal branch (OM) in an 83 year-old-man who had CABG and AVR in the past with a heavily calcified ascending aorta. Case Report: 83-year-old caucasian male History of CABG 20 years ago, redo CABG in the following year due to graft failure, and an AVR with a mechanical valve 12 years ago, and multiple coronary interventions. Presented with unstable angina. Echo showed normal LV function Due to his history of early stent re-stenosis and location of the disease, he was considered not suitable for repeat PCI. CT Scan showed severe calcification of the ascending aorta (left), and mild disease on the descending aorta. Presented at Chest 2013. Chicago IL.October 26-31, 2013

Stroke from A Large Left Atrial Myxoma

A 36-year-old male involved in a car accident was found to have an embolic stroke due to a left atrial myxoma. Open heart surgery was delayed 4 weeks to decrease the risk of neurologic complications from the anticoagulation required for cardiopulmonary bypass. After resection of the myxoma, intraoperative transesophageal echocardiography found severe mitral regurgitation, which was repaired

Conceptual learning : the priority for higher education

The common sense notion of learning as the all-pervasive acquisition of new behaviour and knowledge, made vivid by experience, is an incomplete characterisation, because it assumes that the learning of behaviour and the learning of knowledge are indistinguishable, and that acquisition constitutes learning without reference to transfer. A psychological level of analysis is used to argue that conceptual learning should have priority in higher education

Outcomes of Surgical Treatment for Carcinoid Heart Disease: A Systematic Review and Meta-Analysis

Introduction and Objective: Carcinoid Heart Disease (CaHD) develops from vasoactive substances released by neuroendocrine tumors causing significant patient morbidity and mortality necessitating surgical intervention. We performed a systematic review and meta-analysis to elucidate granular perioperative details and long-term outcomes in these patients. Methods: Electronic search of Ovid, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed. Nine articles comprising 416 patients who received surgery were selected. Primary outcomes investigated included patient characteristics, surgical characteristics and survival data. Study-level data were extracted and pooled for meta-analysis. Results: Primary outcomes consisted of survival, length of stay and thirty-day mortality. Secondary outcomes included presence of right heart failure pre-operatively and type of valve replaced. Right heart failure was present in 48%. Moderate or severe regurgitation was present in 97% of tricuspid and 72% of pulmonary valves. 99% of tricuspid and 59% of pulmonary valves were replaced. Mean hospital length of stay was 16 days. Thirty-day mortality was 9%. Mean follow up was 25 months. Median survival was 3 years. Conclusion: Surgical treatment of CaHD can be performed with acceptable short-term outcomes. However, overall survival appears to suffer from ongoing effects of the primary disease. Surgery is often performed after patients have extensive right-sided heart involvement. Overall, onset and duration of symptoms of carcinoid heart disease should be closely monitored to properly identify and refer patients who would most benefit from valvular surgery

Academic boredom among students in higher education: a mixed-methods exploration of characteristics, contributors and consequences

Academic boredom contributes usually adversely towards student engagement, learning and overall performance across a diverse range of settings including universities. The formal study of academic boredom in higher education remains, however, a relatively underdeveloped field and one surprisingly neglected in the UK. Adopting contemporary perspectives rooted in Control-Value Theory, details of a mixed-methods exploration of academic boredom among 235 final year undergraduates attending a single university in England are presented. Quantitative data from the principal survey instrument employed included measurement using the BPS-UKHE, a revised boredom proneness scale developed for use across the sector. Qualitative data arose primarily from ten research interviews. Findings indicate that about half of all respondents reported experiencing the most common precursors of academic boredom at least occasionally (e.g. monotony, repetition, time slowing down, lack of desire for challenge, loss of concentration and motivation to learn, restlessness); traditional lectures with a perceived excess and inappropriate use of PowerPoint stimulating the actual onset of boredom more than other interactive forms of delivery. Coping strategies when bored included daydreaming, texting and turning to social media. Boredom also occurred during the completion of assignments used to assess modules. Quantitative and qualitative differences between those identified as more prone to boredom than others extended to self-study (fewer hours), attendance (good rather than excellent) and final degree outcome (lower marks and a lower proportion of first and upper second class degree awards). Findings are considered valuable empirically, as well as theoretically, leading to recommendations surrounding boredom mitigation which challenge cultural traditions and pedagogical norms

Explorations using computer simulation to comprehend thematic apperceptive measurement of motivation

The new theory of motivation by Atkinson and Birch (1970), based on conceptual analysis of a change in activity, has been programmed to allow computer simulation of effects of differences in motivation on the stream of operant behavior. Simulation of conditions that exist when people who differ in strength of achievement motive write imaginative stories in response to a sequence of pictures shows that construct validity does not require internal consistency as traditionally supposed. The theoretically deduced differences in total time spent imagining achieving (instead of something else) can postdict input differences in motive strength (i.e., construct validity) even when there is little or no internal consistency reliability as indicated by Cronbach's (1951) alpha computed from theoretically deduced time spent imagining achievement in response to particular pictures. This general point has already been amply documented in 25 years of productive empirical research using TAT n Achievement. Now a definitive theoretical refutation of the repeated psychometric criticism of the method is provided. Those who have been moved “to dispel fantasies about fantasy-based measures of achievement motivation” (Entwistle, 1972) are invited, instead, to examine the shallow theoretical foudation of our traditional myths of measurement.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45359/1/11031_2005_Article_BF00997578.pd

Chinese students in a UK business school: hearing the student voice in reflective teaching and learning practice.

This paper presents the outcomes of a study carried out in 2001-2002 with nine postgraduate students from China, enrolled on taught master's programmes in a UK university business school. The aims of the research were to explore the development of the students' orientations to learning during their year of study in the UK, and to explore how the researcher's interactions with the study group contributed to her professional reflections and influenced her academic practice. The main conclusions of the project were that participants' underlying approaches to learning did not change substantially over the year, owing to the culturally implicit nature of UK academic conventions and that they experienced high levels of emotional isolation and loneliness, which affected their academic confidence

Ayuda ventricular mec\ue1nica a corto y a largo plazos para favorecer la recuperaci\uf3n mioc\ue1rdica

Muchos pacientes tratados con dispositivos de ayuda ventricular pueden desconectarse de \ue9ste una vez que ha habido la recuperaci\uf3n del miocardio. En los pacientes con choque cardi\uf3geno agudo, es de importancia cr\uedtica la selecci\uf3n adecuada de los casos candidatos antes de la inserci\uf3n del dispositivo. Se puede retirar \ue9ste despu\ue9s de varios d\uedas o unas cuantas semanas. En los pacientes que experimentan insuficiencia cardiaca cr\uf3nica, es posible la desconexi\uf3n y la explantaci\uf3n del aparato en quienes tienen cardiomiopat\ueda dilatada idiop\ue1tica; sin embargo, parecen requerirse tratamiento en\ue9rgico con medicamentos para la insuficiencia cardiaca, b\ufasqueda activa de signos de recuperaci\uf3n y procedimiento met\uf3dico para la desconexi\uf3n a fin de lograr la explantaci\uf3n con buenos resultados en el mayor porcentaje posible de pacientes

Family Presence During Resuscitation in the ICU-Arguments for and Against

Presentation: 30:1