Endovascular treatment of recurring type A dissection after total aortic arch debranching.

Standard treatment method of the aortic arch pathologies is surgical replacement which requires cardiopulmonary bypass and deep hypothermic circulatory arrest. However, this approach is associated with major operative risks. Combination of debranching and thoracic endovascular aortic arch repair (TEVAR) has emerged as an alternative treatment modality in high-risk patients. This report describes successful staged hybrid treatment of a 50-year-old male patient with recurring type A dissection. It is concluded that staged debranching and TEVAR is a feasible option and provides aortic repair without increase of risk.

Ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii: risk factors, clinical features, and outcomes.

Acinetobacter baumannii is characterized by a rapid development of resistance to the commonly used antimicrobial agents. We investigated the risk factors, clinical features, and outcomes in ventilator-associated pneumonia (VAP) caused by extensive drug-resistant Acinetobacter baumannii (XDRAB). Clinical parameters and overall in-hospital mortality rates were compared between the VAP with and without XDRAB infection groups. This study showed that VAP caused by XDRAB was not associated with in-hospital mortality. However, it was related to high Simplified Acute Physiology Score II scores and increasing durations of hospital stays.

Spontaneous rectus sheath hematoma in patients on anticoagulation therapy.

BACKGROUND: This clinical study was conducted to present the clinical features, treatment and outcomes of rectus sheath hematoma (RSH), which is a complication of anticoagulation therapy that can present as acute abdomen. METHODS: Twenty-two spontaneous RSH cases who were on anticoagulation therapy were reviewed. Patient characteristics, anticoagulant therapy form and indications, clinical presentation, radiologic work-up, treatment modalities, recurrence, morbidity, and follow-up data were analyzed. RESULTS: The majority of the patients were female (64%), and the mean age was 60.6 years. All of the patients (100%) were receiving at least one form of anticoagulation therapy; most (72%) were on warfarin therapy. History of coughing was found in 45% of the cases. The most common presenting signs and symptoms were abdominal pain and mass (77%). International normalized ratio (INR) was >3.0 in all patients on warfarin therapy. The diagnosis was made by abdominopelvic ultrasonography (US) and computerized tomography (CT). CT showed 100% sensitivity. The majority of patients (87%) were treated conservatively. Three patients (13%) were operated and 2 patients (9%) died as a result of RSH. Two patients experienced recurrence in one year. CONCLUSION: RSH should be suspected in elderly, coughing patients on anticoagulation therapy, who present with clinical manifestations of acute abdomen. Early diagnosis can help to avoid increased morbidity or unnecessary surgical intervention.

Two stage EDTA anti-calcification method for bioprosthetic heart valve materials.

BACKGROUND: The aim of this study was to investigate the effect of two-stage EDTA treatment in diminishing calcific degeneration in bovine pericardial bioprosthetic heart valve material. MATERIAL/METHODS: Conventionally preserved pericardium specimens were divided into two groups. Group I (controls, n=18) pieces were first fixed in phosphate-buffered solution (PBS)+0.6% glutaraldehyde at +4 degrees C for 24 hours, then stored in PBS+0.2% glutaraldehyde at room temperature for 6 days. Group II (study group, n=18) pieces were treated with PBS containing 100 microg/ml ethylenediaminetetraacetic acid (EDTA) at +4 degrees C for 24 hours, then fixed in PBS+0.6% glutaraldehyde as was group I at +4 degrees C for 24 hours. After a second exposure to PBS containing 100 microg/ml EDTA at room temperature for 24 hours, they were stored in PBS+0.2% glutaraldehyde at room temperature for 4 days. Pericardial patches were inserted into the dorsal pouches of 18 juvenile male Wistar rats. After 7 weeks of implantation, all the pericardium pieces were harvested from sacrificed rats. The calcium content and biomechanical properties of the explanted tissues were evaluated and also examined histopathologically. RESULTS: The difference in the calcium content of the control and study groups was statistically significant. Biomechanical and histopathologic assessment also supported these findings. CONCLUSIONS: Application of two-stage EDTA was found to be useful in the attenuation of calcification in bioprosthetic heart valve materials with mildly increased durability. As calcification was reduced by approximately 50%, it can be considered for use with other agents as an adjuvant treatment.

N-acetylcysteine for preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass.

PURPOSE: To investigate the effect of N-acetylcysteine on preventing pump-induced oxidoinflammatory response during cardiopulmonary bypass (CPB). METHODS: Forty patients undergoing coronary artery bypass grafting (CABG) were randomly divided into a study group (n = 20), given 50 mg kg(-1) N-acetylcysteine intravenously for 3 days, and a control group (n = 20) given saline. Serum samples were collected for measurement of myeloperoxidase (MPO), malondialdehyde (MDA), interleukin-6, Alpha1-acid glycoprotein (AAGP), and C-reactive protein (CRP) during surgery and postoperatively. RESULTS: The MPO and MDA values showed a similar pattern during and after CPB in the study group, with significantly less variance than in the control group. Interleukin-6 showed similar patterns in the two groups, but the data from 30 min after the start of CPB and from 6 h post-CPB were significantly different. The AAGP and CRP values were both elevated during CPB in the two groups without a significant difference, but 6 and 24 h post-CPB, the values were significantly higher in the control group than in the study group. CONCLUSIONS: N-Acetylcysteine decreased pump-induced oxidoinflammatory response during CPB, suggesting that it could be a novel therapy for assisting in the prevention of CBP-induced oxidoinflammatory damage.