Asymptomatic thoracic stentgraft collapse treated conservatively

W pracy przedstawiono przypadek 58-letniego mężczyzny przyjętego do szpitala z ostrym rozwarstwieniem aorty (typ B według klasyfikacji Stanforda), który zaopatrzono stentgraftem piersiowym Cook Zenith. Trzy miesiące po zabiegu, podczas pierwszej rutynowej kontroli, przeprowadzono badanie angiografii tomografii komputerowej (CTA), w którym wykazano proksymalne zamknięcie się stentgraftu. Próba ponownego otwarcia protezy okazała się nieskuteczna. Pacjenta poinformowano o potrzebie przeprowadzenia zabiegu kardiochirurgicznego oraz o ewentualnym związanym z nim ryzyku. Chory odmówił poddania się operacji. Do tej pory, 3 lata po zdiagnozowaniu zamkniętego stentgraftu, u pacjenta nie występują żadne objawy. W systematycznie przeprowadzanych co 6–9 miesięcy kontrolnych badaniach CTA nie stwierdza się dalszego poszerzania aorty piersiowej. Acta Angiol 2010; 16, 3: 138–143We describe a case of 58-year-old male with complicated acute type B aortic dissection that was treated with a Cook Zenith thoracic stentgraft. Three months after the procedure, the first routine follow-up computed tomography angiography (CTA) revealed proximal collapse of the stentgraft. An attempt to reopen the endograft from the distal part in a retrograde manner followed by second device implantation failed. After the patient was informed about the need for an open surgical procedure and its related risk, he refused to be operated upon. Up to now, 3 years after diagnosis of stentgraft collapse, he has remained asymptomatic and in serial follow-up CTA scans carried out every 6 to 9 months no further thoracic aortic dilatation has been noted. Acta Angiol 2010; 16, 3: 138–14

The COVID-19 drive-through point — screening and testing — first in Poland complex centre experience

Introduction: Rapid widespread of the SARS-CoV-2 virus in early 2020 caused global chaos. In the initial period, a lack of knowledge of epidemiology and viral contamination, as well as no availability of either causal treatment or preventive vaccination, resulted in mass testing of symptomatic individuals as the priority for protection. This study aimed to evaluate the effectiveness and safety of the first COVID-19 (coronavirus disease) drive-through testing model in the Greater Poland Region. Material and methods: The authors demonstrate step-by-step the creation and development of the Centre of Medical Simulation Poznan University of Medical Sciences (PUMS) COVID-19 drive-through testing point for 3.5 million inhabitants in the Greater Poland Region during the 1st through 4th coronavirus pandemic waves. For staff education, low and high-fidelity simulation techniques were used. Additionally, the number of tests performed at the swab point and the efficiency of the developed testing model were evaluated and assessed in all pandemic waves. Results: PUMS POST (point of screening and testing) activity lasted 24 months. Improvement of staff skills developed through simulation training increased the median number of 91 patients tested each day (with a median of 25 tests per hour) during the 1st wave to a maximum of 260 patients tested each day (135 tests per hour) during the 4th wave when the new drive-through POST system was employed (p < 0.001). Conclusion: The present study supported the previous preliminary reports that drive-through systems developed during the COVID-19 pandemic proved to be efficient and safe for mass population testing. Moreover, the Medical Simulation Centre confirmed the effectiveness of staff skills improvement

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

BackgroundAccording to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.ObjectivesThe aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.MethodsAll octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.ResultsOctogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).ConclusionOn the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians

Re-hybrid thoracic stent graft implantation with total aortic arch debranching in urgent procedure: case report

INTRODUCTION: Implementation of emergency endovascular aortic repair provides an opportunity to treat complicated acute aortic syndromes involving descending aorta. CASE REPORT: A 40-year-old man with a history of aortic coarctation surgical repair as a child and an anastomosis aneurysm repair with a double endovascular stent graft implantation with hemi-arch transposition was urgently admitted with intensifying shortness of breath and hoarseness. A computed tomography study confirmed a blood leak into an aneurysm sac in proximal landing zones of implanted stent grafts (Type I endoleak). Therefore, he qualified for hybrid surgery. First, the ascending aorta brachiocephalic trunk was anastomosed with a 12 mm vascular prosthesis from an upper mini-sternotomy. In the next step, normothermic extracorporeal circulation was necessary to prevent cerebral circulation. Finally, a GORE stent graft (Gore Medical, Flagstaff, AZ, USA) was implanted with a proximal landing zone directly behind the anastomosis site of the vascular prosthesis and ascending aorta. The hospital course was uncomplicated, and the patient was discharged home 5 days after the procedure. CONCLUSIONS: Complicated aortic pathologies requiring emergent interventions can be treated by a hybrid approach utilizing multistep surgical and endovascular techniques achieving optimal results

RECENT RESEARCH IN VLSI, MEMS AND POWER DEVICES WITH PRACTICAL APPLICATION TO THE ITER AND DREAM PROJECTS

Several MEMS (Micro Electro-Mechanical Systems) devices have been analysed and simulated. The new proposed model of SiC MPS (Merged PIN-Schottky) diodes is in full agreement with the real MPS devices. The real size DLL (Dynamic Lattice Liquid) simulator as well as the research on modelling and simulation of modern VLSI devices with practical applications have been presented. In the basis of experience in the field of ATCA (Advanced Telecommunications Computing Architecture) based systems a proof-of-concept DAQ (data acquisition) system for ITER (International Thermonuclear Experimental Reactor) have been proposed

Mean platelet volume-to-platelet count ratio after elective cardiac surgical procedures is superior in reflecting platelets metabolic hyperactivity compared to other routine morphological platelet indices: A preliminary report

Background: Excessive metabolic excitation of platelets after cardiac procedures may be related to some adverse events but assessment of their metabolic activity is not routine. The purpose of this study was to evaluate which of the basic platelet morphological parameters best reflects their metabolic status. Methods: The blood samples of 22cardiac surgical patients (mean age of 62.3 ± 10.3 years) were taken before surgery (BS), and 1, 24 and 48 hours after the operation. Correlations between morphological platelet parameters (platelet count [PLT], mean platelet volume [MPV], platelet distribution width [PDW] and MPV/PLT) and their metabolic activity (total concentration of malondialdehyde [MDA] and MDA/PLT) were estimated. Results: Significant decline in PLT after operation (from 223 ± 44 × 1012/L to 166 ± 57 × 1012/L) was accompanied by marked increase in MPV (from 8.4 ± 0.9 fL to 9.1 ± 1.2 fL) and no change of PDW. Consequently, MPV/PLT index increased significantly after procedures from (median with IQR) 0.038 (0.030–0.043) to 0.053 (0.043–0.078). Simultaneously, a significant increase in total platelet MDA content and MDA/PLT was noted reaching peak levels soon after operation. The strongest correlation was observed between MPV/PLT and MDA/PLT (r = 0.56; p < 0.001), although the others were also found to be significant (MDA/PLT vs. MPV; r = 0.35; MDA/PLT vs. PDW; r = 0.34). Conclusions: Among basic morphological parameters and indices, the MPV-to-PLT ratio reflects the best metabolic status of platelets in cardiac surgical patients