Correction to: Hiatal hernia, mitral valve prolapse and defecatory disorders: An underlying rectal prolapse?

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Thrombosis of the left anterior descending artery due to compression from giant pseudoaneurysm late after a bentall operation.

BACKGROUND: A postoperative pseudoaneurysm may develop and gradually expand in the mediastinal space even late following Bentall operation for aortic root replacement, particularly in patients with dissection of the aorta. METHODS: A very large (148 mm) pseudoaneurysm originating of the right coronary ostium suture line was observed in a patient admitted with unstable angina 6 years after Bentall procedure for type A aortic dissection. Angiograms showed reduced flow in the right coronary and thrombotic subocclusion of the left anterior descending (LAD) coronary artery due to extrinsic compression from the expanding mediastinal mass. RESULTS: Reoperation was performed during femoro-femoral cardiopulmonary bypass and brief period of circulatory arrest to clamp the tubular graft. After closure of the detected right coronary ostium in the tubular graft double bypass, grafting to the right coronary and LAD arteries was required. Postoperative course was uneventful. CONCLUSIONS: Close long-term follow-up after a Bentall procedure is required to minimize the risk of developing a large pseudoaneurysmal mass, in particular, after dissection of the aorta

Effects of Two Commercial Diets on Several Reproductive Parameters in Bitches: Note One-From Estrous Cycle to Parturition

The close link between nutrition management and reproductive efficiency is well known, but there is very little data available concerning this topic in canine species. The present study aimed to compare the effect of two different diets upon the follicular period and gestation in bitches. Eighteen pluriparus medium and large size bitches were recruited and divided into control (CTR) and experimental (EX) groups and fed, respectively, with a commercial kibble diet and a specially formulated diet from two months before the expected onset of proestrus up to the end of the trial. It was possible to observe how the EX group had a better clinical presentation of the estrous phase, a higher number of ovarian follicles (p < 0.05), a lower percentage of fetal resorption (p < 0.05), and lower oxidative status, expressed by d-ROMs (p < 0.01), at the moment of pregnancy diagnosis compared to CTR group. Moreover, the EX group showed a lower fetal resorption rate and higher litter size (p < 0.05). These results highlight how a diet characterized by high protein and fat content and richer in essential fatty acids can improve reproductive performance in dogs

Effects of Two Commercial Diets on Several Reproductive Parameters in Bitches: Note Two-Lactation and Puppies' Performance

The study aimed to compare two diets, Control (CTR) and Experimental (EX) (mainly differing as regards their ingredients, energy, and protein contents) administered to medium and large-sized bitches from two months before the expected proestrus and up to 30 days after delivery on mothers’ weight, body condition score, litter size, milk quality, and puppies’ growth. No differences were found for body weight during pregnancy, even if the BCS after delivery was significantly (p < 0.01) higher in the EX group than in the CTR one. Concerning the size effect, the percentage of weight gain on the initial body weight was double in medium-sized dogs compared to large dogs (p < 0.01). The number of puppies per litter was significantly higher (p < 0.05) for the EX group compared to the CTR one. Concerning puppies’ weight, the CTR group showed a significantly (p < 0.01) higher body weight from the 21st day of life due to the significant (p < 0.01) higher daily weight gain during the suckling period. Considering the performance of bitches and puppies, both diets seem useful for these stages of their lives. In fact, after 30 days of lactation, all tested bitches showed a healthy status and both the percentage of newborns mortality and puppies’ growth kinetics fell into the normal physiological range for the species

Undifferentiated metastatic renal cell carcinoma presenting as a cutaneous nodular lesion|Bir kütanöz nodüler lezyon olarak ortaya çıkan farklılaşmamış metastatik renal hücreli karsinom

Cutaneous metastases may be the first sign of clinically silent visceral cancer. Approximately 30% of patients with primary renal cell carcinoma present with metastatic disease, and only 8% of them have skin metastases. We present the case of a 59-year-old male patient with a subcutaneous nodular on the upper chest extending to the jugular region. The lesion appeared skin colored and was not painful and 5 cm × 3.5 cm in diameter. The histological examination of the cutaneous biopsy showed an infiltration of undifferentiated epithelial cells positive to cytokeratins AE1/AE3, whereas they were negative to CK-20, CK5/6, cluster of differentiation 10, vimentin, thyroid transcription factor-1, S-100, human melanoma black-45, hepatocyte-specific antigen, carcinoembryonic antigen, and chromogranin A. A total-body computed tomography (CT) showed the presence of a tumoral lesion in the left kidney with multiple metastases in the lung, brain, and bones. According to the cutaneous biopsy and total-body CT, a final diagnosis of an undifferentiated renal carcinoma presenting as a subcutaneous metastasis was made. A chemotherapeutic treatment with gemcitabine and cisplatin resulted in the stabilization of the renal and metastatic lesions with an improvement in the quality of life of the patient. Considering that the prognosis of patients with cutaneous metastases is very poor, it is necessary to obtain an appropriate diagnosis in order to identify patients with treatable disease with the purpose of starting a therapeutic protocol

Aortic root surgery in Marfan syndrome: Bentall procedure with the composite mechanical valved conduit versus aortic valve reimplantation with Valsalva graft

Abstract OBJECTIVES: The aim of the study is to compare mid-term results of Bentall aortic root replacement with composite mechanical valved conduit and aortic valve reimplantation procedure using the Valsalva graft for the treatment of aortic root aneurysm in patients with Marfan syndrome. METHODS: We retrospectively compared data of 23 patients (mean age 38 + or - 14 years) who had undergone the Bentall procedure (group B) to those of 24 patients (mean age 36 + or - 12 years) who had undergone aortic valve reimplantation (group R) during a 14-year period. Follow-up (mean duration 65 + or - 44 months) was 100% complete. RESULTS: There were no operative deaths in either group. In group B, as compared with group R, preoperative aortic insufficiency (3.2 + or - 1.1/4 vs. 1.7 + or - 1.4/4, P < 0.001), ascending aorta diameter (55.8 + or - 4.9 vs. 44.1 + or - 8.7 mm, P = 0.001) were prevailing; cardiopulmonary bypass (107 + or - 51 vs. 145 + or - 32 min, P < 0.05) and aortic cross-clamp (77 + or - 17 vs. 116 + or - 30 min, P = 0.005) times were shorter. Eight-year survival and freedom from cardiac death and reoperation were 91 + or - 6, 96 + or - 4 and 100% in group B and 100, 100 and 91 + or - 6% in group R, respectively (P = NS for all comparisons). At follow-up, echocardiography showed significant improvement of left ventricular ejection fraction (0.60 + or - 0.10 vs. 0.52 + or - 0.09 preoperatively, P = 0.01) and end-systolic diameter (34 + or - 5 vs. 47 + or - 14 mm, P = 0.001) in group B and significant reduction of preoperative aortic insufficiency (0.7 + or - 1.0/4 vs. 1.7 + or - 1.4/4, P = 0.01) and aortic annulus (24 + or - 2.4 vs. 33 + or - 5 mm, P = 0.01) in group R. CONCLUSION: In Marfan patients, the Bentall procedure is associated with excellent mid-term outcome. The reimplantation technique, adopted for less dilated aortas, provides similarly satisfactory results. The Valsalva graft seems, with time, to allow a stable aortic valve function