Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery

Sternal dehiscence is an untoward complication of cardiac surgery that leads to increased morbidity as well as length of hospital stay and costs. Although many different conventional and creative techniques have been described using both synthetic and biologic materials, the ideal method of sternal reconstruction is still controversial. In this case, we describe a simple and reproducible "fibula allograft sandwich technique" for the reconstruction of sternal nonunion in a cardiac surgery patient. This technique also facilitates the conventional wiring by creating bilateral landing zones for the wires at both sides of the sternum

Are perioperative near-infrared spectroscopy values correlated with clinical and biochemical parameters in cyanotic and acyanotic infants following corrective cardiac surgery?

WOS: 000371172200007PubMed ID: 26034194Background: Near-infrared spectroscopy (NIRS) is a useful non-invasive tool for monitoring infants undergoing cardiac surgery. In this study, we aimed to determine the NIRS values in cyanotic and acyanotic patients who underwent corrective cardiac surgery for congenital heart diseases. Methods: Thirty consecutive infants who were operated on with the diagnosis of ventricular septal defect (n=15) and tetralogy of Fallot (n=15) were evaluated retrospectively. A definitive repair of the underlying cardiac pathology was achieved in all cases. A total of six measurements of cerebral and renal NIRS were performed at different stages of the perioperative period. The laboratory data, mean urine output and serum lactate levels were evaluated along with NIRS values in each group. Results: The NIRS values differ in both groups, even after the corrective surgical procedure is performed. The recovery of renal NIRS values is delayed in the cyanotic patients. Conclusion: Even though definitive surgical repair is performed in cyanotic infants, recovery of the renal vasculature may be delayed by up to two days, which is suggestive of a vulnerable period for renal dysfunction

Progressive supra-aortic stenosis in a young adult with the findings of Singleton Merten Syndrome

Singleton Merten Syndrome is an autosomal dominant disorder of unknown origin. Patients often present with muscular weakness, failure to thrive, abnormal dentition, glaucoma, psoriatic skin lesions, aortic calcifi cation and musculoskeletal abnormalities. In this case, we present a young girl with a history of aortic root replacement, who had an unusual progressive supra-aortic stenosis managed with urgent surgery during the course of the syndrome. Cardiovascular involvement needs special attention, since it is the major cause of mortality along with rhythm disturbances in the course of Singleton Merten Syndrome

eComment. Combined surgical strategies for anomalous connection of coronary artery to pulmonary artery in adults

WOS: 000350199500030PubMed ID: 25605826We read with great interest the article by Gurbuz et al. [1]. We congratulate them on their successful effort in the surgical treatment of such a rare case, presenting with both carotid artery stenosis and coronary artery disease accompanied by an anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). In fact, the traditionally-named ALCAPA leads to a left-to-right shunting into pulmonary arteries, resulting in ventricular ischaemia [2]. Although the terminology defines an origin of left anterior descending artery (LAD) from pulmonary artery, the actual flow direction of the blood is from the coronary circulation to main pulmonary artery. This reversed coronary flow leads to a coronary steal phenomenon. In general, in such cases, re-establishment of a dual coronary circulation is the preferred treatment modality [2]. However, we would like to discuss some points about the surgical treatment strategy for the case presented by Gurbuz and colleagues. Coronary artery bypass grafting (CABG) for the revascularization of LAD with the left internal thoracic artery (LITA) will provide the antegrade flow to the distal segment of LAD; however the proximal part will still have the reversed flow pattern. The coronary steal phenomenon will possibly affect the septal or diagonal branches originating proximally to the lesion at the LAD. We would prefer the addition of a pulmonary arteriotomy to the CABG procedure in this case, in order to close the origin of the LAD simply with a pericardial patch, as reported by Tseng and colleagues [3]. In our opinion, this surgical strategy will provide both anatomical and physiological correction of the underlying pathology with prevention of the reversed flow from LAD to pulmonary artery as well as the distal perfusion by means of LITA-LAD anastomosis. In conclusion, in such congenital abnormalities related to the origin of the coronary arteries, the surgical strategy might be determined depending on both the anatomical and physiological effects of the disease

eComment. Evidence-based selection of conduits in coronary artery bypass grafting

WOS: 000350199500027PubMed ID: 25605825We read with great interest the article by Gaudino et al. [1]. They have performed coronary artery bypass grafting (CABG) with both internal thoracic arteries (ITA) in a 68-year old patient with a surgical history of aortic coarctation repair. However, there Figure 2: Postoperative angiographic control showing normal functioning left (A) and right (B) ITA grafts. CASE REPORT M. Gaudino et al. / Interactive CardioVascular and Thoracic Surgery 279 Downloaded from https://academic.oup.com/icvts/article-abstract/20/2/279/734665 by guest on 09 April 2020 are some issues we would like to discuss regarding the surgical strategy of the graft selection in this patient. The patient was reported to be hypertensive, both at admission and during the postoperative period. The authors performed a histopathological evaluation of the discarded ITA segments and markedly thickened endothelium was encountered. We wondered how they had decided that the discarded distal segment of the ITA with markedly thickened endothelium guaranteed an intact proximal arterial wall. The atherosclerotic involvement of the ITA may be segmental, hence distal ITA sampling may not accurately predict the degree of atherosclerosis at the proximal part of the graft [2]. Moreover, the same authors had published a review on the use of ITAs in patients with aortic coarctation recently [3]. In that paper, they reviewed 13 reports related to this topic and only one of them included an angiographic control at the long-term follow-up. The authors concluded that, ’a careful evaluation of the conduit is obviously paramount in the context that preoperative transthoracic Doppler ultrasound and selective LITA and RITA catheterization at the time of cardiac catheterization will provide with optimal preoperative planning’

Acute generalized exanthematous pustulosis associated with terbinafine: a case report

WOS: 000323527300010PubMed: 23432048A 27-year-old male patient who has used oral terbinafine for two weeks was admitted to our outpatient clinic for non-follicular millimetric pustules on erythematous and edematous different-sized plaques on his trunk and flexural areas. He was diagnosed with acute generalized exanthematous pustulosis (AGEP) because of terbinafine use in the light of history, clinical and histopathological findings. An AGEP is a rare and severe pustular reaction usually triggered by systemic drug intake. Approximately, 2.3% of the patients having oral terbinafine have been reported to develop cutaneous adverse effects. Although terbinafine is a commonly used medicine, it must be considered that it may cause severe adverse reactions

Implantation of looped epicardial cardioverter defibrillator coil on the surface of the right ventricular outflow tract

WOS: 000352494400017PubMed ID: 25683331BackgroundWe present the early results of looped epicardial cardioverter defibrillator coil implantation on the anterior surface of right ventricular outflow tract in infants and children. MethodsPatients with a surgical history of an epicardial implantable cardioverter defibrillator system between 2013 and 2014 were included in the study. Patient age, gender, body weight, indications for a cardioverter defibrillator system implantation, defibrillation threshold values, and defibrillation therapies were retrospectively evaluated. ResultsThere were eight patients with a mean age of 4.42.9 years and a mean body weight of 19.5 +/- 11.7kg. Five of the patients had been diagnosed with long QT syndrome, one patient had been diagnosed with genetic channelopathy and noncompaction of the left ventricle, and two patients had been diagnosed with univentricle physiology. The implantable cardioverter defibrillator system was composed of pace-sense leads, an abdominal active can, and a defibrillation coil placed below the pulmonary valve annulus on the anterior surface of the heart. The mean defibrillation threshold was 6.6 +/- 2.3 joules. There were four appropriate therapies in two patients in a mean follow-up of 9 +/- 6.5 months. ConclusionThe significantly low defibrillation thresholds with the defibrillation coils located below the pulmonary valve annulus are encouraging. However, a larger patient series will be necessary to evaluate the safety and reliability of this technique

Correlation between cerebral-renal near-infrared spectroscopy and ipsilateral renal perfusion parameters as clinical outcome predictors after open heart surgery in neonates and infants

The objective of this clinical study is to determine whether correlation exists among cerebral and renal near-infrared spectroscopy (NIRS) measurements, renal Doppler ultrasonography parameters (resistive index, peak systolic velocity), and early postoperative clinical outcomes following cardiac surgery in neonates and infants. Thirty-seven patients undergoing surgery for congenital heart defects with an age of less than 3 months, all of whom were in the high-risk group according to Aristotle Basic Complexity risk stratification score, were enrolled in our study. Cerebral, renal NIRS values and renal Doppler ultrasonography measurements were recorded for each patient at the 4th postoperative hour. The renal resistive indices were calculated for each case, and the patients were divided into two groups according to renal resistive index (RI) values. Group I included the patients with a RI of greater than 0.8 (n=25) and Group II included the patients with a RI of less than 0.8 (n=12). The postoperative outcome parameters were compared in between two groups. Group I (RI >0.8) had lower postoperative mean urine output than Group II (RI <0.8) (P=0.041). The lactate levels were significantly higher in Group I (P=0.049), as well. The postoperative intensive care unit and hospital stay of Group I was significantly higher than Group II (P=0.048). Both cerebral and renal NIRS values and the assessment of renal RI as well as peak systolic values can be used in order to predict the early clinical outcome in cardiac surgery patients in early infantile and neonatal period. © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc

Adakite-like parental melt generation by partial fusion of juvenile lower crust, Sakarya Zone, NE Turkey: A far-field response to break-off of the southern Neotethyan oceanic lithosphere

Ersoy, Yalcin E/0000-0002-8563-9561; KANDEMIR, RAIF/0000-0002-0344-9159WOS: 000471738200004The timing of major tectonic events and the driving mechanisms for magma generation during Late Cenozoic convergence and collision between Arabia and Eurasia still remain unknown. the Sakarya Zone (SZ) in northern Turkey is a critical member of this collisional assemblage. in the easternmost part of the SZ, we have recognized a Late Miocene volcanic suite termed the Cagirankaya volcanics which displays characteristic post-collisional geochemical features. Here, we report a new data set of zircon U-Pb ages, whole-rock major and trace element, as well as Sr-Nd isotope analyses for dacite and and esite samples from the cagirankaya volcanics. Zircon U-Pb ages for a selected dacitic sample average 5.16 +/- 0.11 Ma (mean square of weighted deviates. MSWD = 0.45, n = 35), confirming a late Miocene age of this volcanic episode. the high-K calc-alkaline andesites and dacites exhibit an adakite-like geochemical signature, and are characterized by high Sr (424 to 552 ppm), Sr/Y ratios (31-43), and low Mg# (42 to 46) values, along with low Y (12-14 ppm) and heavy rare earth element (HREE) concentrations, that resemble those in adakites formed by partial melting of hot oceanic slab during subduction. Isotopic compositions are near bulk Earth (Sr-87/Sr-86(t) = 0.70482 to 0.70489, epsilon(Nd)(t) = +1.08 to +133), which rules out a solely asthenospheric origin. Elevated Nb/Ta (14 to 17) and K2O/Na2O (0.6-1.0) imply a juvenile mafic lower crustal source composed of similar to 20% garnet-bearing amphibolite. Geochemical modeling suggests that adakite-like parental melts were generated in the absence of subduction and without large-scale delamination of lower continental crust. Instead, our findings suggest that Late Miocene adakite-like volcanic rocks in the SZ formed in a post-collisional intra-continental setting, which experienced far-field extension after the subducted slab of the southern Neotethyan branch became detached in the collision zone. Asthenospheric upwelling and underplating of basaltic magma provided the heat for partial melting of lower crustal amphibolite, forming minor amounts of adakite-like melts in the SZ. (C) 2019 Elsevier B.V. All rights reserved.Recep Tayyip Erdogan UniversityRecep Tayyip Erdogan University [FBA-2018-869]This work was financially supported by the Recep Tayyip Erdogan University with a grant #FBA-2018-869. We appreciate Serhat Kasai at the Isotopic Laboratory in the Middle East Technical University, Ankara, for the Sr-Nd isotopic analyses. Yilmaz Demir is thanked for his scientific and logistical supports in the field. We gratefully acknowledge the English editing efforts of the manuscript by Jacqueline O'Neill Ozcelik. We express our gratitude to Chief Editor Xian-Hu Li, and reviewers Paterno Castillo and Senel Ozdamar for constructive comments and excellent suggestions improving our manuscript Rize-Turkey

Retrospective evaluation of patients with herpes zoster followed up in our department between 1999-2010

WOS: 000313861400004Background and Design: Herpes zoster is a common viral disease of the nervous system. Although the annual incidence is 1.5-3/1000, this rate increases after 75 years of age. Seasonal factors are estimated to affect the incidence rate of the disease as well. The aim of this study was to investigate the clinical and demographic characteristics of patients diagnosed with herpes zoster and to explore the similarities and differences with other epidemiological studies from Turkey and the world. Materials and Methods: We retrospectively reviewed the records of 312 patients diagnosed with herpes zoster and followed up in the Duzce University Medical Faculty Dermatology Department between January 1999 and December 2010. Results: Herpes zoster patients comprised 0.56% of all patients who presented to our department. Their ages ranged from 6 months to 87 years (mean age: 49.6, median age: 53). The number of women and men was almost equal. Admissions were higher in January and December, with thoracic involvement being the most frequent one. Zoster was not a precursor of any occult malignancies. The most common associated systemic disease was cardiovascular disease. Pediatric cases comprised 7.4% of cases. Complications developed in 21.4% of patients. The most common complication was postherpetic neuralgia. Discussion: There are only a few studies from our country on the epidemiology of herpes zoster. We observed that our findings were more or less similar to the findings of the literature data. However, unlike in other studies, in our study, the most common associated systemic disease was cardiovascular disease. It is thought that this is because this kind of chronic stressor weakens humoral and cellular immunity We think that similar studies from different regions of our country are necessary to demonstrate the clinical and epidemiological characteristics of the disease more clearly. (Turkderm 2012; 46: 186-90