Long-term survival with a stentless free-hand Batista pericardial aortic valve prosthesis: A case report.

INTRODUCTION: Stented bovine pericardial prosthetic valves are a good option for older patients, except when there is a fragile small aortic annulus, when, if there is no contraindication to anticoagulation, a mechanical prosthesis may be indicated. PRESENTATION OF CASE: We report a 72 year-old man who underwent coronary bypass grafting and aortic valve replacement with a stentless valve fashioned from bovine pericardium using the Batista technique. Despite early sternal infection and dehiscence, and renal and respiratory failure during 15 years follow-up, he remains alive and self-sufficient. Echocardiography demonstrates a well-functioning aortic valve. DISCUSSION: When Batista reported his first 60 patients, concerns were raised about the surgical feasibility of constructing the valve and its long-term durability. Our case perhaps addresses both concerns. CONCLUSION: Replacement of the aortic valve with a free-hand Batista pericardial valve is a feasible option in a suitable and carefully selected patient.

Interferences in the direct quantification of bisphenol S in paper by means of thermochemolysis.

This article analyses the interferences in the quantification of traces of bisphenol S in paper by applying the direct analytical method "analytical pyrolysis gas chromatography mass spectrometry" (Py-GC/MS) in conjunction with on-line derivatisation with tetramethylammonium hydroxide (TMAH). As the analytes are simultaneously analysed with the matrix, the interferences derive from the matrix. The investigated interferences are found in the analysis of paper samples, which include bisphenol S derivative compounds. As the free bisphenol S is the hydrolysis product of the bisphenol S derivative compounds, the detected amount of bisphenol S in the sample may be overestimated. It is found that the formation of free bisphenol S from the bisphenol S derivative compounds is enhanced in the presence of tetramethylammonium hydroxide (TMAH) under pyrolytic conditions. In order to avoid the formation of bisphenol S trimethylsulphonium hydroxide (TMSH) is introduced. Different parameters are optimised in the development of the quantification method with TMSH. The quantification method based on TMSH thermochemolysis has been validated in terms of reproducibility and accuracy.

Detection and quantification of traces of bisphenol A and bisphenol S in paper samples using analytical pyrolysis-GC/MS.

In this paper a simplified method based on analytical pyrolysis gas chromatography mass spectrometry (Py-GC/MS) for the detection and quantification of bisphenol A and bisphenol S in paper samples is presented. The method enables a direct analysis of the samples without tedious sample preparation. As the analytes are thermally desorbed, a solvent extraction is not needed. The method is applicable to small samples of ~120 µg. The limits of detection are below 1 mg kg(-1) for bisphenol A and for bisphenol S. The limits of quantification are about 1.3 mg kg(-1). Several validation characteristics of the method developed like standard error of calibration, limit of determination, linearity, and accuracy are given. To prove the accuracy of the method, interferences and matrix dependencies were also investigated. The influence of the pyrolysis crucibles, a special effect of analytical pyrolysis, was additionally investigated. It was found that the impact of the crucibles on the results is significant and one cause for matrix effects.

Giant gallstone: A case report.

INTRODUCTION: There is a high incidence of gallstones in the Chilean population. PRESENTATION OF CASE: We report on a 57-year-old man who complained of abdominal pain in the right upper quadrant. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large pear-shaped gallstone (16.8 cm long, and 7.8 cm at its widest point and 4.1 cm at its narrowest point). Its fresh weight (at operation) was 278.0 g and, after 4 years, its dry weight was 259.5 g. Emergency classical cholecystectomy was carried out successfully. DISCUSSION AND CONCLUSION: We have been unable to find a report of a larger gallstone in the English or Spanish language medical literature.

Cirugia de la fractura de cadera en pacientes centenarios / Surgery of the hip fracture in centenarians patients

La incidencia de fractura de cadera ha aumentado, por envejecimiento de la población e incremento de su prevalencia en áreas urbanas. Cuando se presenta en pacientes centenarios, resulta un desafío quirúrgico del cual poco se ha reportado. El objetivo del presente trabajo es estudiar una pequeña casuística de ellos. Pacientes y método: se definió como paciente centenario, quien al presentar fractura de cadera tuviera 99 años cumplidos. Ellos fueron operados si su daño orgánico cerebral era leve, si no estaban postrados y no portaban patologías limitantes de su rehabilitación o sobrevida a 1año. Se revisó retrospectivamente la casuística del Servicio de Traumatología, entre 01/04/1999 y 3 1/03/2006. Se comparó sobrevida con datos estadísticos de población centenaria general en periodo estudiado. Resultados: se efectuaron 8 operaciones a seis pacientes, todas mujeres, edad promedio 100.2 años (rango 99-102). La comorbilidad más frecuente fue hipertensión arterial (3 de 6 casos) e infección urinaria ( 3/6). No hubo diabetes mellitus. En todos se usó anestesia raquídea, la cirugía consistió en reducción más inserción de tornillo dinámico de cadera en 5 casos, placa de compresióndinámica en 2 y prótesis parcial en una paciente. El promedio de hospitalización postoperatoria total fue 13,1 días (rango 5- 25), 2 presentaron complicaciones, no hubo mortalidad hospitalaria. La sobrevida fue similar a población general de igual edad sin fractura. Los resultados obtenidos permiten concluir que es posible abordar en nuestro medio, el desafío ético que significa tratar quirúrgicamente fracturas de caderas en pacientes centenarios.

The incidence of hip fracture has increased, due to population aging and augmentation of prevalence in urban areas. Centenarian patients suffering from hip fracture are a surgical challenge, with limited reporting in medical literature. The purpose of this paper is to communicate the results of small groupof them. Patients and method: all patients older than 99 year old were considered as centenarians.They were operated only if they did not suffer from dementia, prostration or limiting severe diseases that could diminish one year survival or full rehabilitation. Their record and chinical folder were studied retrospectively from 01/04/1999 until 31/03/2006 and survival compared with general centenarian population during the same period. Results: six patients underwent 8 operations, all were female, mean age 100,2 years (range 99-102). Three of 6 suffered from hipertensión, 3/6 from urinary infection. No diabetes was found. Surgery was done under regional anaesthesia, in 5 operations a dynamic hip screw was implanted, dynamic compression plate in 2 and parcial prosthesis was used in other. The average total postoperative time in the hospital was 13,1 days (range 5-25), 2 patients suffered from postoperative complications. There were no intrahospital mortality and survival was similar to the general centenarian population with no hip fractures. In view of this results, it is nowadays reasonable to face the ethical challenge to operate hip fractures in centenarian patients.