Introduction of a handmade vacuum-assisted sponge drain for the treatment of anastomotic leakage after low anterior rectal resection

Purpose@#Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR. @*Methods@#All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up. @*Results@#Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up. @*Conclusion@#In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

Transseptal approach versus left atrial approach to mitral valve: a propensity score matching study

Background: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal [TS] and left atrial [LA] approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching

Methods: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach [163 patients] versus the LA approach [652 patients] on the outcomes was presented through odds ratio [OR] with 95% confidence intervals [CI]

Results: The mean age of the patients was 53.15 +/- 12.02 years in the TS group and 52.93 +/- 13.56 years in the LA group. Females comprised 119 [73.0%] patients in the TS group and 462 [70.9%] in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups [OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019]. Temporary pacemaker placement had no statistically significant difference between the two groups [p value= 0.418]. The TS patients had significantly longer pump [p value < 0.001] and cross-clamp [p value < 0.001] times. The mortality rate was 4.1% [27 patients] in the LA group and 6.1% [10 patients] in the TS group [p value = 0.274]

Conclusion: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality

Effects of mesenchymal stem cells with injectable scaffold on cardiac function in myocardial infarction in Rabbit

Bone marrow-derived mesenchymal cells can transdifferentiate into Cardiomyocyte cells and improve heart function after transplantation. Since biomaterials can improve the cell retention in the site, cell survival and differentiation, heart tissue engineering is now being explored as an applied solution to support cell-based therapies and increase their efficacy for myocardial diseases. Chitosan in combination with Glycerol Phosphate [GP] can produce a thermo sensitive material that in body temperature can form a jellylike material. The aim of this study was to evaluate the effects of a combination of autologous undifferentiated bone marrow mesenchymal stem cells [MSCs] and injectable scaffold on cardiac function improvement in rabbits after inducing myocardial infarction. The Left Anterior Descending [LAD] coronary artery was ligated by No. 6-0 poly amide suture material, and autologous MSCs with injectable scaffold were injected into the margins of the infarcted zone at the time of surgery. At 4 weeks after transplantation, the cardiac function and structure was detected using echocardiography. There was no significant difference among the three groups [MI only, MI Scaffold, and MI+Scaffold+MSCs] in the Echocardio-graphic parameters including, heart rate [HR], Ejection Fraction [EF], Fractional Shortening [FS], Left Ventricular Diameter [LVD] and Left Ventricular Parietal Wall Diameter [LVPW]. A combination of autologous undifferentiated bone marrow MSCs and injectable scaffold made of Chitosan+ Glycerol Phosphate in echocardiographic evaluation did not have a positive influence on achieving functional improvement

Relationship between serum magnesium level and arrythmias following postcoronary artery bypass grafting

Atrial and ventricular arrhythmias are among the most common complications after coronary artery bypass graft [CABG] surgery. It is known that cardiopulmonary bypass reduces serum magnesium level. In this study, we evaluated the relationship between total blood magnesium level [TMG] and the incidence of perioperative arrhythmias. TMG was measured in patients who were scheduled for CABG on three occasions: just before anesthesia, on intensive care unit [ICU] arrival and on the first morning after operation. Patients were evaluated for primary cardiac rhythm, serum creatinine, urine output in operating room and diuretic therapy. Supplemental magnesium [SMG] was also recorded in operating room and ICU. Patients were then evaluated for the rate and kind of arrhythmia occurring during the next 3 days. Mean TMG level in 170 cases was 2.2 [0.5], 2.6 [0.6] and 2.4 [0.6] mg/dl on three occasions respectively. 53 patients developed post-operative arrhythmia [31%] [Atrial Fibrillation [AF] [7.1%], Non-AF Supraventricular arrhythmia [14.7%] and Ventricular arrhythmia [16.5%]]. Although there was a significant difference between TMG on three occasions [P < 0.001], all values were within normal range. Although TMG was higher in arrhythmic patients compared to nonarrhythmics [2.26 vs. 2.14], both values were in normal range and there was no significant difference between two groups. This study shows that routine magnesium administration has no significant effect on serum magnesium level. We conclude that though routine regimen of magnesium administration has no effect on incidence of perioperative arrhythmia, it is probably necessary for maintaining normal magnesium level