Clinical outcomes and electrolyte balance factors in complex cardiac operations in adults; del nido versus custodiol cardioplegia solutions: A randomized controlled clinical trial

Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido (DN) and Custodiol cardioplegia solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol cardioplegia (CC) solution is gaining popularity for myocardial protection during cardiopulmonary bypass. Objectives: This study aimed to compare the effects of Custodiol with another cardioplegia solution, Del Nido, on myocardial protection during cardiopulmonary bypass. Methods: In a randomized controlled clinical trial, forty patients were randomly allocated to DN and Custodiol (CC) groups. Patients in both groups received a normal anesthesia protocol. For cardioplegia, in the DN group, the DN solution was administered every 90 minutes by the antegrade route. In the Custodiol group, the Custodiol solution was administered in the same way at the beginning of the cardioplegia. Demographic information, blood chemistry parameters and other related perioperative and postoperative clinical indices were recorded. Results: Frequency of female patients was 14/21 (66.66) in the DN and 12/19 (63.15) in the CC group (P = 0.816), age was 57.14 ± 12.48 years in the DN and 59.47 ± 11.96 years in the CC group (P = 0.551), weight was 70.95 ± 9.56 kilograms in the DN and 69.63 ± 7.64 kilograms in the CC group (P = 0.635), CPB time was103.19 ± 23.43 minutes in the DN versus 97.36 ± 16.7 minutes in the CC group (P = 0.376), and cross-clamp time was 73.76 ± 19.66 minutes in the DN and 83.95 ± 16.14 minutes in the CC group (P = 0.083). Blood chemistry and blood gas analysis revealed a similar trend between the two groups in these parameters (P > 0.05) except for higher sodium levels after cardioplegia (P = 0.016) and end of CPB (P = 0.002), potassium levels after cardioplegia (P = 0.029), and bicarbonate anions at the end of bypass (P = 0.03) in the custodiol group. Conclusions: In conclusion, CC and DN offer effective myocardial protection during cardiopulmonary bypass. It is recommended to restrict the use of CC in patients susceptible to electrolyte disturbances. © 2018, Author(s)

Arthroscopic ACL Avulsion Fixation With Adjustable Loop Length Cortical Endobutton

Various surgical management techniques have been introduced to treat anterior cruciate ligament avulsion fractures. There is disagreement among orthopedic surgeons about which fixation device to use during arthroscopy. Recently, there has been an increase in the use of arthroscopic techniques for fixation, and different devices such as sutures, screws, and fiber wires are being considered. The development of fiber wires has made it possible to use them in comminuted avulsions with satisfactory stability, whereas screws cannot be used in such cases. Sutures do not provide adequate stability for early range of motion compared to other methods. The article then goes on to describe a specific arthroscopic fixation technique that uses an adjustable loop cortical button to manage the avulsed fragment and provide stability

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution

The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly