Totally endoscopic atrial septal repair in adults with computer-enhanced telemanipulation

AbstractObjectiveStandard surgical closure of an atrial septal defect via sternotomy is a safe and effective procedure with low morbidity and mortality. Considering that young female patients are frequently operated on for atrial septal defects, a minimally invasive procedure avoiding sternotomy is convincingly desirable and led to the approach through a right anterolateral minithoracotomy. The recent clinical introduction of robotically assisted surgery further reduced skin incisions and enabled totally endoscopic procedures through ports. This article reports on a first series of atrial septal defect closures of which the first case was operated on August 24, 1999, in a totally endoscopic closed chest technique using a computer-enhanced telemanipulation system.MethodsWe performed totally endoscopic atrial septal repair using the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif) in 10 consecutive adult patients. Median age was 45.5 ± 10.0 years, and preoperative New York Heart Association functional class was 1.8 ± 0.1. Left ventricular ejection fraction was normal in all patients and mean pulmonary artery pressure amounted to 35 ± 7 mm Hg. Shunt volume ranged from 24% to 70%. All patients displayed a fossa ovalis type of atrial septal defect; 2 of them multiperforated.ResultsNeither intraoperative nor postoperative complications occurred. Two patients had to be converted to minithoracotomy due to endoaortic balloon clamp failure. Length of operation was 262 ± 37 minutes, and cardiopulmonary bypass time was 161 ± 26 minutes. Intraoperative transesophageal echocardiography certified complete closure of the atrial septal defect in all patients. The totally endoscopic computer-enhanced technique yielded excellent cosmetic results.ConclusionTotally endoscopic atrial septal repair is a feasible and safe procedure with good clinical results and excellent cosmetic outcomes. It may be considered as perfect adjunct to interventional treatment options. Further studies with larger cohorts and randomized trials are necessary to document potential benefits. Evolution in robotic technology and refinement of procedural flow may shorten procedural time and decrease costs

Long-term assessment of coronary care unit patient profile and outcomes: analyses of the 12-years patient records

Background/aim: The aim of this study was to determine the patient profile, treatment, and outcomes of a coronary care unit (CCU) by retrospective screening of 12-year patient records

Mesenchymal Stem Cell Isolation from Pulp Tissue and Co-Culture with Cancer Cells to Study Their Interactions

Cancer as a multistep process and complicated disease is not only regulated by individual cell proliferation and growth but also controlled by tumor environment and cell-cell interactions. Identification of cancer and stem cell interactions, including changes in extracellular environment, physical interactions, and secreted factors, might enable the discovery of new therapy options. We combine known co-culture techniques to create a model system for mesenchymal stem cells (MSCs) and cancer cell interactions. In the current study, dental pulp stem cells (DPSCs) and PC-3 prostate cancer cell interactions were examined by direct and indirect co-culture techniques. Condition medium (CM) obtained from DPSCs and 0.4 mu m pore sized trans-well membranes were used to study paracrine activity. Co-culture of different cell types together was performed to study direct cell-cell interaction. The results revealed that CM increased cell proliferation and decreased apoptosis in prostate cancer cell cultures. Both CM and trans-well system increased cell migration capacity of PC-3 cells. Cells stained with different membrane dyes were seeded into the same culture vessels, and DPSCs participated in a self-organized structure with PC-3 cells under this direct co-culture condition. Overall, the results indicated that co-culture techniques could be useful for cancer and MSC interactions as a model system

Long-term assessment of coronary care unit patient profile and outcomes: analyses of the 12-years patient records

Background/aim: The aim of this study was to determine the patient profile, treatment, and outcomes of a coronary care unit (CCU) by retrospective screening of 12-year patient records

Diagnostic Value of Ultrasonography in Appendicitis

WOS: 000313027000010PubMed ID: 23356200Background. Clinical diagnosis of appendicitis is often difficult in atypical patients. Objectives. The authors aim to determine the diagnostic accuracy of ultrasonography (US) for acute appendicitis. Material and Methods. 121 consecutive patients with right lower abdomen pain were evaluated. Of them, 25 were excluded due to not having performed a preoperative US and 5 were obese (Body Mass Index > 30). A total of 91 patients were evaluated. The patients were assessed clinically and radiologically. Blood and urine analysis was carried out in all patients. US was performed with a Toshiba Fomio 8 brand machine with 3.75 and 8 MHz linear probes. Patients underwent an operation and an appendicectomy was done. Specimens were sent for histopathology to confirm appendicitis. Results. Ultrasound supported the diagnosis of acute appendicitis in 58 (63.7%) patients. In the US with positive findings, 55 patients (94.8%) had inflamed appendices on histopathology and 5 (8.6%) had normal appendices. The overall sensitivity of ultrasonography was 71.4% and specificity was 78.5%. Positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy of ultrasonography are 94.8%, 33.3%, and 72.5% respectively. Conclusions. All diagnostic tests are adjunctive to the clinician. US should be the first step in the care of patients with right lower abdominal pain after the physical examination (Adv Clin Exp Med 2012, 21, 5, 633-636)

Evaluation of neutrophil-to-lymphocyte ratio as a marker of inflammatory response in septic arthritis

Is neutrophil-to-lymphocyte ratio high in patients with septic arthritis? Septic arthritis may lead to higher rates of morbidity or even mortality if not diagnosed on time. This study was planned to answer the question that “Could neutrophil-to-lymphocyte ratio be utilized to help to diagnose septic arthritis?” The cohort of the study consisted of 39 patients diagnosed with septic arthritis. After ruling out the patients who did not meet the research’s inclusion criteria, the data of 26 patients were evaluated. The control group was collected from healthy volunteers who were admitted to the internal medicine outpatient clinic for a routine medical checkup at the same period (n = 26). Complete blood count (CBC) parameters, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratios of the septic arthritis and control groups were compared statistically. In comparison, neutrophil-to-lymphocyte ratios of the septic arthritis group were significantly higher than the control group. In conclusion, neutrophil-to-lymphocyte ratio can be utilized in the emergency department or in outpatient clinics to support the diagnosis of septic arthritis