Inclusion of soil organic carbon changes can reverse results of historical energy flux quantifications of Pampean agriculture.

The questions that guided this work were: 1) How do energy inputs, outputs, and energy indices evolve during the last four decades along the rainfall gradient of the Pampas, 2) How does present agrochemical and fertilizer use in Argentina resemble, or differ, from other main grain producing regions with large no-till surfaces?, and 3) How do energy fluxes vary when soil organic carbon (SOC) changes during the last four decades are included? Energy balances (outputs - inputs), energy efficiencies (outputs/inputs) and energy intensities (inputs/yield) were calculated. Inputs comprised agrochemicals and fertilizers, machinery used for soil tillage and fuel use and gathered from different information sources. Outputs included yield of main crops from national statistics. Calculations were performed for four areas along a rainfall gradient during the 1970-2015 period. Energy coefficients were collected from literature. Soil organic carbon changes of the upper soil profile meter were available from a previous publication. Total input averages per area were low although increased 62% after four decades, from 6.6 GJ ha-1 in the past up to 10.5 GJ ha-1 at present with no marked differences between areas. Agrochemicals comprised 49% of total energy input, a very large proportion compared to other regions mainly related to the large surface under no-tillage while fertilizer rates were low. Average energy outputs increased 51% with time and all energy balances were positive. Energy efficiencies had an optimum during 1995 of 4.8 decreasing afterwards down to 3.7. Energy intensities decreased and at present 14% less input energy was needed per t DM yield produced. Two areas gained SOC and one lost large amounts. Inclusion of SOC losses in energy quantifications turned all energy indices to negative values therefore providing a real scenario of what happened with energy fluxes after four decades of agriculture which otherwise would be ignored.

Postpartum ovarian veins thrombophlebitis.

Puerperal ovarian vein thrombophlebitis (POVT) is a rare postpartal complication. Its incidence is about 0.05%. POVT can follow a term pregnancy, a premature delivery, an abortion or an ectopic pregnancy. POVT usually presents as a syndrome consisting in lower abdominal pain and fever which does not respond to adequate antibiotics. We present a case report, in which the diagnosis was based upon computed tomography.

Improved exposure for complex left main coronary artery reconstruction.

Direct surgical repair of left main coronary artery (LMCA) stenosis by either the right (posterior) or left (anterior) approach can be difficult in case of complex, extensive atheromatous lesions. Complete transsection of both great vessels allows rotation of the heart, with its base facing the surgeon. Patch repair then becomes safe, precise and expedicious. The LMCA arteriotomy can easily be prolonged beyond its bifurcation as needed. Three consecutive patients were successfully operated. We suggest this approach to the surgeon concerned by restoration of a physiologic antegrade flow for his patient with complex atheromatous LMCA lesions.

Evaluation of membranous subaortic stenosis using biplane transesophageal echocardiography. Report of two cases.

A biplane transesophageal echocardiography was performed in two young adult patients with discrete subvalvular aortic stenosis. The combined information obtained in the transverse and in the longitudinal plane allows in these instances an accurate diagnosis and the choice of an optimal approach.

Pulmonary artery banding. Experience with 69 patients.

Between 1976 and 1985, 69 patients underwent pulmonary artery banding (PAB) at an average age of 2.2 months (mo) (range 2 days-18 mo) weighing 3.8 kg (2.1-10.7 kg), as part of their initial surgical therapy for massive left to right shunting. Only 10 patients (early in this series) had isolated ventricular septal defect (VSD). Seventeen patients did not survive PAB (25%), including 4 of 5 patients with Taussig-Bing heart (TBH) and only 4 of the 40 patients with VSD [either isolated or associated with coarctation or transposition (TGA)]. Forty-four patients underwent debanding (deB) and secondary cardiac repair at an average age of 22 mo (6-96) and weight of 9.4 kg (4.9-22.0): 9 patients died early and 1 late. Mean pulmonary artery pressure was 49 Torr (27-80) before banding and 24 before deB (6-65). PA stenosis from the band imposed further surgery in all but 15 patients. Thirty-four survivors to secondary repair were followed for an average 46 mo (1-120). Thirty were in NYHA classes I and II. Only 43% of patients with PAB had good medium term results. The presence of the band imposes close, complete follow-up. PAB is no longer recommended for isolated single VSD. It can still be beneficial in multiple, complicated, or medically compromised VSD as well as in very small neonates with atrioventricular septal defect and truncus arteriosus, and subsets of double outlet right ventricle and tricuspid atresia with high pulmonary flow not amenable to early complete repair. PAB in functional single ventricle allows safer delayed definitive repair. TBH and TGA+VSD are now repaired primarily (arterial switch).

Leaflet escape of a mitral Duromedics prosthesis. Case report.

This article reports a case of leaflet embolization of a mitral Edwards-Duromedics prosthesis. The patient had abrupt onset of acute pulmonary edema and was initially treated medically for 3 days. Fluoroscopy showed only one freely moving leaflet and the other was (incorrectly) assumed to be blocked in the closed position. The patient received IV thrombolysis for another 3 days and was finally operated. He died 8 days later from sepsis and the leaflet was recovered at autopsy in the abdominal aorta. Leaflet escape of a mitral Edwards-Duromedics prosthesis is a rare, potentially curable mode of valve failure. Correct interpretation of clinical signs and symptoms and of fluoroscopy should allow early diagnosis and surgical therapy.

Transaortic saphenous patch angioplasty for left main coronary artery stenosis. An alternative to coronary artery bypass.

We present two cases of isolated proximal left main coronary artery stenosis treated by direct transaortic angioplasty. In selected patients this technique offers a valuable alternative to CAB graft with the advantage of restoring unobstructed antegrade flow.

Spontaneous rupture of the esophagus after coronary artery bypass.

Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare but the most lethal perforation of the gastro-intestinal tract. A 62-year old male was successfully treated for this condition developing on the second post-operative day after coronary artery bypass. Two hours after extubation respiratory insufficiency and circulatory collapse necessitated reintubation and energetic resuscitation with prompt drainage of a massive pleural effusion. Left thoracotomy on post-operative day 17 confirmed the diagnosis and the esophagus was excluded by cervical esophagostomy and duodenostomy. After a six week recovery, reconstruction was achieved by total esophagectomy through a right thoracic incision and gastric bypass with cervical gastro-esophageal anastomosis. The patient left the hospital in good condition 112 days after the initial operation.

[Renal transplantation and Bourneville's tuberous sclerosis]. / Transplantation rénale et sclérose tubéreuse de Bourneville.

A kidney transplantation was performed in July 1981 on a 29 year old woman who presented the signs of tuberous sclerosis and suffered from chronic renal failure. The frequency and the genetic transmission of Bourneville's disease are explained. The signs of the disease are exposed with special emphasis on the renal lesions. Only the patients with minor neurological symptoms can survive. These patients are able to develop chronic renal failure. This occurs either when the kidneys are destructed by renal cysts or tumors, or when a bilateral nephrectomy must be performed for bleeding or tumoral compression. A kidney transplantation can give them an opportunity to live almost normally. When nephrectomy is not performed, a regularly follow-up is necessary because the unknown future of the renal lesions in place.

Poststernotomy arteriovenous fistula of internal mammary origin with pseudoaneurysmal subcutaneous extension.

We describe a very rare subcutaneous pseudoaneurysmal development of an internal mammary arteriovenous fistula supervening after sternal wire closure. The lesion underwent progressive thrombosis and was resected.

Thrombosis of the Saint Jude Medical valve prosthesis in the aortic position: a diagnostic and surgical emergency.

Three cases of prosthetic thrombosis with the SJM mechanical bileaflet pyrolitic valve in the aortic position occurred in a series of 355 patients operated on over a four-year period (October 1978-September 1982). Symptoms and signs of inadequate left ventricular flow (with various degrees of aortic regurgitation) were marked and developed rapidly. The patient is usually aware of muffling of the valve sounds. Auscultation is typical (muffled or abolished valve sounds; appearance of a systolo-diastolic murmur). Echocardiogram and carotidogram are suggestive. Adequately oriented fluoroscopy is diagnostic. Emergency prosthetic replacement is life-saving. Long term, well controlled, anticoagulation with coumadin is advocated.

Left-sided cervical aortic arch.

The authors report a case of cervical aortic arch. Left-sided cervical aortic arch is a very rare congenital anomaly which may or not be associated with clinical symptoms. Diagnosis, suspected on chest X-ray or clinical examination, must be confirmed by angiographic studies. A 17-year-old girl presenting an extensive aneurysm of a left-sided cervical aortic arch was successfully operated with the use of partial extracorporal bypass removing the aneurysm and restoring aortic arch continuity. Histological examination revealed mediacystic necrosis.

Aortico-left ventricular tunnel (ALVT). A diagnostic and surgical "must".

ALVT is a rare congenital lesion. The paravalvular tunnel causes a clinical picture of aortic regurgitation. An aortic regurgitant murmur is present since birth. The clinical diagnosis, often overlooked, is best confirmed by angiocardiography in the lateral view. Although 80% of reported cases present with congestive heart failure before age 1, our two cases were asymptomatic at age 13 and 8 respectively. Both were operated on the basis of progressive left ventricular (L.V.) overload and dilatation. Diagnosis was made at operation in case 1 and suspected by the surgeon in case 2. Case 1 necessitated implantation of a bioprosthetic valve and replacement of the prosthesis 3 years later for primary tissue failure. Case 2 could be handled more conservatively with obturation of the aortic orifice of the tunnel. The natural evolution of the lesion involves progressive aortic valve regurgitation both by annuloectasia and retraction of the valve cusps. The diagnosis of ALVT should be considered in any infant or child with an aortic regurgitation murmur. Surgical treatment should be undertaken before alteration of the valve and the aim should be preservation of native valve function.

[Coronary surgery in patients with poor ventricular function]. / La chirurgie coronarienne chez les patients avec mauvaise fonction ventriculaire.

The surgical indication of coronary by-pass surgery in patients with bad ventricular function is difficult. We analysed retrospectively 87 patients operated on between February 1982 and November 1983. We show the benefit of this surgery even in patients without angina pectoris.

Surgical treatment of echinococcal cyst of the right heart.

We report a rare case of hydatidosis of the right heart. Our young patient had know pulmonary hydatidosis and presented precordial chest pain, increasing dyspnea, cough and hemoptysis. Echocardiography, confirmed by angiocardiography delineated the right ventricular cyst. The operation was performed under extra corporal circulation (ECC), moderate hypothermia with cold cardioplegia. The echinococcal cyst was removed after local instillation of 0.5% silver nitrate solution. The postoperative course was uneventful.

Cardiocutaneous fistula after left ventricular aneurysm repair. Case report and review of the literature.

Cardio-cutaneous fistula is a rare late complication of LV aneurysm repair related to the use of Teflon strips to bolster the suture line. Since bleeding occurs in half of the cases and there is no tendency to spontaneous healing, operation should be advised and should involve complete removal of all foreign material with the aid of CPB. We suggest that foreign body intolerance might be the main factor in the development of the lesion and infection a consequence of fistulisation through the skin.

Cardiac tamponade as first manifestation of colonic cancer.

Metastatic cardiac tamponade was the presenting manifestation of a colonic carcinoma. The patient's condition improved after surgical treatment and shows no sign of recurrence of pericardial effusion after more than eight months of systemic chemotherapy. Metastatic pericardial effusions and their treatment are discussed.

Operative management of penetrating wounds of the chest. Experience with 41 patients on the island of Curaçao.

Of the 157 cases of chest injuries, 41 patients underwent thoracotomy. Thirty-three were male and 7 female with an average age of 27 years. Eighty-three percent had stabwounds and 17 percent gunshotwounds . On admission and on examination only seven thoracotomy patients were in a stable clinical condition. Hypotension and hemo- or pneumothorax were often present. Persisting hemorrhage from chest tubes drainage, cardiac tamponnade , and massive hemothorax were indications for immediate thoracotomy. Only few of the patients with an hemothorax have an hemorrhage from a major systemic vessel. Associated intraabdominal injuries were often found (17%). For exploration of the abdominal lesions a separate explorative laparotomy is indicated. The only patient who died in our series suffered from septicemia after multiple associated intra-abdominal wounds (mortality rate 2.4%). The overall complication rate was 19.7%. The average period of hospitalisation was 15.4 days.

Dynamic balance of learning disabled and nondisabled children.

This investigation assessed a difference in the dynamic balance abilities of 30 learning disabled and 30 nondisabled children of elementary-school age. Only distance traveled across the beam, a novel task, was significantly different between groups; no other effects were significant. Nondisabled subjects traveled further across the beam before losing balance than learning disabled children.