Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

n/

Computational fluid dynamics of a novel perfusion strategy using direct perfusion of a left carotid-subclavian bypass during hybrid thoracic aortic repair

To mitigate the risk of perioperative neurological complications during frozen elephant trunk procedures, we aimed to computationally evaluate the effects of direct cerebral perfusion strategy through a left carotid-subclavian bypass on hemodynamics in a patient-specific thoracic aorta model

Aortic aneurysms, chronic kidney disease and metalloproteinases

Metalloproteinases (MPs) are proteolytic enzymes involved in extracellular matrix deposition, regulation of cellular signals of inflammation, proliferation, and apoptosis. Metalloproteinases are classified into three families: Matrix-MPs (MMPs), A-Disintegrin-and-Metalloprotease (ADAMs), and the A-Disintegrin-and-Metalloproteinase-with-Thrombospondin-1-like-Domains (ADAMTS). Previous studies showed that MPs are involved in the development of aortic aneurysms (AA) and, concomitantly, in the onset of chronic kidney disease (CKD). CKD has been, per se, associated with an increased risk for AA. The aim of this review is to examine the pathways that may associate MPs with CKD and AA. Several MMPs, such as MMP-2, -8, -9, and TIMP-1 have been shown to damage the AA wall and to have a toxic effect on renal tubular cells, leading to fibrosis. Similarly, ADAM10 and 17 have been shown to degrade collagen in the AA wall and to worsen kidney function via pro-inflammatory stimuli, the impairment of the Renin-Angiotensin-Aldosterone System, and the degradation of structural proteins. Moreover, MMP-2 and -9 inhibitors reduced aneurysm growth and albuminuria in experimental and human studies. It would be important, in the future, to expand research on MPs from both a prognostic, namely, to refine risk stratification in CKD patients, and a predictive perspective, likely to improve prognosis in response to targeted treatments

Linee Guida per il Giudizio di Plausibilit\ue0 e Congruit\ue0 delle Spese per Trattamenti Fisioterapici in Caso di Traumi Minori

Il documento \ue8 risultato della collaborazione tra l\u2019Associazione Medico-Giuridica M. GIOIA e la SIMFER (Societ\ue0 Italiana di Medicina Fisica e Riabilitazione), che hanno costituito un Gruppo di Studio congiunto per l\u2019elaborazione di un protocollo comune sulla valutazione della congruit\ue0 delle spese mediche per i trattamenti fisioterapici e riabilitativi

Repair of Penetrating Pericardial and Diaphragmatic Injury with Cormatrix® Patch in a Case of Suicide Attempt

Abstract The authors report the case of a suicide attempt. A 59-year-old man with self-inflicted penetrating chest trauma underwent emergency cardiothoracic surgery. Pre-operative computed tomography scan showed critical proximity between the blade and the right ventricle. Intraoperative findings showed a pericardial laceration and a huge diaphragmatic lesion with heart and abdominal organs integrity. The diaphragm muscle was repaired with a CorMatrix® patch, an acceptable alternative to the traditional synthetic mesh avoiding infection and repeated herniation

Hospital outcome analysis after different techniques of left internal mammary grafts harvesting

Background. Although accepted worldwide as the firstchoice conduit for myocardial revascularization (coronary artery bypass graft surgery), it is still questionable if left internal mammary arteries (LIMAs) do better as pedicled or skeletonized grafts. Recent reports have suggested that the skeletonized technique improves the outcomes.Methods. In all, 516 consecutive isolated coronary artery bypass graft surgery patients admitted between January 2003 and February 2007 were grouped according to the harvesting technique of LIMAs (387 pedicled versus 129 skeletonized). Intraoperative transit time flow results, hospital outcome, perioperative troponin I leakage, and echocardiographic results were analyzed. Maximum, mean, and minimum flows, pulsatility index, and graft flow reserve were stratified according to the type of surgery (on pump and off pump) and subgroups at risk (severe left ventricular hypertrophy).Results. The transit time flow results were unsatisfactory in 4 patients (0.8%), all 4 of whom underwent redo anastomosis. Maximum, mean, and minimum flows and pulsatility index values were comparable between skeletonized and pedicled LIMAs (p = not significant), for both on-pump and off-pump surgeries (p = not significant). Graft flow reserve was comparable between the two groups (p = not significant), as well as transit time flow results in severe ventricular hypertrophy. Troponin leakage, postoperative echocardiographic recovery, and hospital outcome were comparable between the two groups (p = not significant at all time points). Only superficial wound complications proved higher in the pedicled group (2.6% versus skeletonized group: 0%; p = 0.05).Conclusions. Pedicled LIMA carries a higher risk for minor wound complications. Neverthless, the two techniques showed similar in-vivo functional behavior and hospital outcome. Therefore, there is no reason to prefer one technique over the other