Congenital pancreas malformations: a clinical case report

OBJECTIVE: This study aimed to review the congenital malformation known as agenesis of the dorsal pancreas (ADP) and other pancreatic birth defects, based on a rare and exemplary clinical case of pancreatic malformations. The intent was to review the latest information published in the national and international literature on pancreatic birth defects, and to investigate the diversity of clinical presentations of ADP and other congenital pancreas abnormalities. The purpose was to identify which situations have therapeutic indication, the most appropriate time to institute treatment, and the currently available medical or surgical treatment of pancreatic congenital malformations. RESULTS: ADP is a very rare malformation that occurs during organogenesis. In the last decades, a large volume of embryological and genetic information has been obtained, helping to understand the causes of pancreatic malformations, which must be studied and understood as a whole. CONCLUSION: Pancreatic malformations are infrequently studied causes of acute and chronic pancreatic in adults. The possibility of pancreatic malformations should always be considered in patients with acute or chronic pancreatitis with no evident cause

Left ventricular aneurysms: early and long-term results of two types of repair

OBJECTIVE: Controversy still exists regarding the optimal surgical technique for postinfarction left ventricular (LV) aneurysm repair. We analyze the efficacy of two established techniques, linear vs. patch remodeling, for repair of dyskinetic LV aneurysms. METHODS: Between May 1988 and December 2001, 110 consecutive patients underwent repair of LV aneurysms. These represent 2.0% of a total group of 5429 patients who underwent isolated CABG during the period. Seventy-six (69.1%) patients were submitted to linear repair and 34 (30.9%) to patch remodelling. There were 94 (84.5%) men and 17 women, with a mean age of 59.2+/-9.2 years. Coronary surgery was performed in all patients (mean no. of grafts/patient, 2.7+/-0.8) and 14 (12.7%) had associated coronary endarterectomy. Forty-four (40.0%) patients had angina CCS class III/IV (linear 43.4%, patch 32.4%, NS) and the majority was in NYHA class I/II (88.2% in both groups). Left ventricular dysfunction (EF>40%) was present in 72 (65.5%) patients (linear 61.8%, patch 73.5%, NS). RESULTS: There was no perioperative mortality, and major morbidity was not significantly different between linear repair and patch repair groups. During a mean follow-up of 7.3+/-3.4 years (range 4-182 months) 14 patients (14.3%) had died, 12 (85.7%) of possible cardiac-related cause. Actual global survival rate was 85.7%. Actuarial survival rates at 5, 10 and 15 years were 91.3, 81.4 and 74%, respectively. There was no significant difference in late survival between the patch and the linear groups. At late follow-up the mean angina and NYHA class were, 1.3 (preoperative 2.4, P<0.001) and 1.5 (preoperative 1.7, NS), respectively, with no difference between the groups. There was no significant difference in hospital readmissions for cardiac causes (linear 22.8% and patch 37.0%). CONCLUSIONS: The technique of repair of postinfarction dyskinetic LV aneurysms should be adapted in each patient to the cavity size and shape, and the dimension of the scar. Both techniques achieved good results with respect to perioperative mortality, late functional status and surviva

Boger fluid flow through hyperbolic contraction microchannels

This paper was presented at the 3rd Micro and Nano Flows Conference (MNF2011), which was held at the Makedonia Palace Hotel, Thessaloniki in Greece. The conference was organised by Brunel University and supported by the Italian Union of Thermofluiddynamics, Aristotle University of Thessaloniki, University of Thessaly, IPEM, the Process Intensification Network, the Institution of Mechanical Engineers, the Heat Transfer Society, HEXAG - the Heat Exchange Action Group, and the Energy Institute.Boger fluids are characterized by their constant viscosity and elasticity and are very useful to study pure elastic flow behavior. In this paper we assess the potential of a microfluidic hyperbolic contraction as a device to measure the relaxation time of low viscosity polymer solutions, which are difficult to characterize in a conventional capillary break-up extensional rheometer. For this purpose we initially characterize the shear and extensional rheology of aqueous solutions of polyacrylamide (PAA) at different concentrations (400, 250, 125 and 50 ppm) with 1% (w/w) of NaCl, which result in low viscosity Boger fluids. Subsequently, flow visualizations of their flow through a microfluidic hyperbolic contraction were carried out in order to quantify the relation between their degree of elasticity and the vortex growth upstream of the microchannel.Fundação para a Ciência e a Tecnologia (FCT), COMPETE and FEDER through projects PTDC/ EQU-FTT/ 71800/2006, PTDC/EQUFTT/ 70727/2006, PTDC/EME-MFE/099109/ 2008, REEQ/928/EME/2005 and REEQ/298/EME/2005

Microchannels analogues for the study of viscoelastic fluid flows through porous media

This paper was presented at the 3rd Micro and Nano Flows Conference (MNF2011), which was held at the Makedonia Palace Hotel, Thessaloniki in Greece. The conference was organised by Brunel University and supported by the Italian Union of Thermofluiddynamics, Aristotle University of Thessaloniki, University of Thessaly, IPEM, the Process Intensification Network, the Institution of Mechanical Engineers, the Heat Transfer Society, HEXAG - the Heat Exchange Action Group, and the Energy Institute.This work studies the flow behavior and related pressure losses of viscoelastic polymer solutions in microchannels with two different sequences of contraction/expansion, disposed in a symmetric and an asymmetric arrangement, respectively. These microfluidic devices are proposed as simplified microchannel analogues for the flow of Newtonian and viscoelastic fluids through porous media. The results show that the symmetric configuration mimics the pressure gradient of these polymer solutions through a porous medium at low flow rates (below a critical Deborah number, Decr), while the asymmetric arrangement gives the asymptotic limit at high De values (above Decr) as a consequence of the intrinsic differences in the extensional rate profiles defined by each microgeometry.Fundação para a Ciência e a Tecnologia (FCT), COMPETE and FEDER through projects PTDC/ EQU-FTT/ 71800/ 2006, PTDC/EQUFTT/ 70727/ 2006, PTDC/ EME-MFE/ 99109/ 2008 and REEQ/ 262/ EME/ 2005

Hormona Paratiróideia Como Factor Predictivo de Hipocalcemia Após Tiroidectomia: Estudo Prospectivo em 100 Doentes

INTRODUCTION: Hypocalcemia is a frequent complication after total thyroidectomy and the main reason for prolonged hospitalization of these patients. MATERIAL AND METHODS: We studied prospectively 112 patients who underwent total or completation thyroidectomy between June 2012 and November 2013. Twelve patients with preoperative changes in parathyroid function were excluded. Parathyroid hormone and calcium levels were determined pre-operatively, immediately after surgery, on 1st day and on 14th day after surgery. RESULTS: Of the 100 patients enrolled, 60 have developed hypocalcaemia (60%) but only 14 patients had symptomatic hypocalcaemia. It mostly occurs 24 hours after surgery (76.7%). It was permanent in 3 patients and temporary in the others. In the 60 patients with hypocalcaemia, it has been found hypoparathyroidism in 19 patients immediately after surgery, in 14 patients on 1st day but only 3 had hypoparathyroidism (patients with permanent hypocalcaemia). Comparing the group of patients with and without hypocalcaemia we found a decrease of parathyroid hormone in both (immediately after surgery and on 1st day) but was more important in the hypocalcaemia group (p = 0.004 and p 19.4% determined on the 1st day (sensitivity = 82%; specificity = 63%). DISCUSSION: In our study there was a high incidence of hypocalcemia (60%), expressed predominantly 24 hours after surgery and conditioned, in these patients, a longer hospital stay. However, only 3 patients (3%) had permanent hypocalcemia. We still found a match in the oscillation of serum calcium levels and parathyroid hormone which identified the decrease in parathyroid hormone on the first day after surgery as a reliable predictor of hypocalcemia. CONCLUSION: Decrease of parathyroid hormone levels > 19.4% determined on 1st day is a good predictor of hypocalcemia after total / completation thyroidectomy, allowing to identify patients at higher risk of hypocalcemia, medicate them prophylactically and get early and safe discharges.info:eu-repo/semantics/publishedVersio

Coronary surgery in patients with diabetes mellitus: a risk-adjusted study on early outcome

OBJECTIVES: We aimed at determining the effect of diabetes mellitus (diabetes) on short-term mortality and morbidity in a cohort of patients with ischemic disease undergoing coronary artery bypass surgery (CABG) at our institution. MATERIAL AND METHODS: A total of 4567 patients undergoing isolated CABG in a 10-year period were studied. Diabetes mellitus was present in 22.6% of the cases but the percentage increased from 19.1% in the beginning to 27% in the end of the study period (p<0.0001 for the decade time-trend). Compared with non-diabetic patients, the group with diabetes was older (61.5+/-8.4 years vs 60.4+/-9.5 years), had a higher body mass index (26.4+/-2.2 vs 26.0+/-2.2), comprised more women (17.5% vs 10.1%), and had a greater incidence of peripheral vascular disease (13.3% vs 8.8%), cerebrovascular disease (8.3% vs 4.3%), renal failure (2.7% vs 1.1%), cardiomegaly (14.0% vs 10.9%), class III-IV angina (43.4% vs 39.0%), triple-vessel disease (80.9% vs 73.7%) and patients with left ventricular dysfunction (all p<0.05). Demographic and peri-procedural data were registered prospectively in a computerized institutional database. Multivariate logistic regression was performed to assess the influence of diabetes as an independent risk factor for in-hospital mortality and morbidity. RESULTS: The overall in-hospital mortality was 0.96% [n=44; diabetics: 1.0%, non-diabetics: 0.9% (p=0.74)]. The mortality of patients with diabetes decreased from 2.7% in the early period to 0.7% in the late period (p=0.03 for the time-trend). Postoperative in-hospital complications were comparable in the two groups in univariate analysis, with only cerebrovascular accident and prolonged length of stay being significantly higher in the diabetic patients (all p<0.05). In multivariate analysis, diabetes was not found to be an independent risk factor for in-hospital mortality (OR=0.61; 95% CI=0.28-1.30; p=0.19), but predicted the occurrence of mediastinitis (OR=1.80; 95% CI=1.01-3.22; p=0.049). CONCLUSIONS: Despite worse demographic and clinical characteristics, diabetic patients could be surgically revascularized with low mortality and morbidity, comparable with control patients. Hence, our data do not support diabetes as a risk factor for significantly adverse early outcome following CABG