The choice of conduits in coronary artery bypass surgery.

Choosing appropriate bypass conduits is important in the consideration of long-term outcomes after surgical revascularization. When deciding on a grafting strategy, attention should be given to technical, anatomic, and angiographic determinants of conduit properties, as well as the clinical characteristics of the patient. The aim of the study was to present a current review of available choices of conduits in coronary artery bypass surgery. To date, only 4 conduits have proven to be effective: the saphenous vein (SVG), the internal mammary arteries (IMAs), the radial artery (RA), and the right gastroepiploic artery (RGEA). The IMA has unique biological properties that confer protection to intimal growth and atherosclerotic plaque formation, making it the conduit of choice for coronary artery bypass grafting. SVG exhibits a lower patency rate than those of IMAs. The RGEA allows revascularization of the inferior wall but is less commonly used, given that it is more prone to spasms.

The role of deep learning in diagnosing colorectal cancer.

Colon cancer is a major public health issue, affecting a growing number of individuals worldwide. Proper and early diagnosis of colon cancer is the necessary first step toward effective treatment and/or prevention of future disease relapse. Artificial intelligence and its subtypes, deep learning in particular, tend nowadays to have an expanding role in all fields of medicine, and diagnosing colon cancer is no exception. This report aims to summarize the entire application spectrum of deep learning in all diagnostic tests regarding colon cancer, from endoscopy and histologic examination to medical imaging and screening serologic tests.

Multifocal, biatrial, primary cardiac embryonal rhabdomyosarcoma.

Malignant primary cardiac tumors are rare, with atrial myxoma and rhabdomyosarcoma the common types in adult and pediatric populations respectively. Rhabdomyosarcomas are rare and are usually located in the atria; they present with symptomatology dependent on their location. A 63-year-old woman presented with the symptomatology of dyspnea, cough, and palpitations and was diagnosed with biatrial primary cardiac rhabdomyosarcoma, which required excision. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day. Postoperative cardiac functional tests revealed an ejection fraction of 60%, consistent with the preoperative value, and no mitral valve dysfunction. Biatrial rhabdomyosarcomas are extremely rare, with only 3 cases reported, including ours, reported in the literature, to the best of our knowledge. Transthoracic echocardiogram is useful in the diagnosis. They require surgical excision along with chemotherapy or radiotherapy. Their prognosis is poor, with a median survival of almost one year. Primary biatrial rhabdomyosarcoma is an extremely rare diagnosis that can present with symptomatology based on the location, size, and number of masses. There is no consensus on how to manage them due to the scarcity of cases, but they are managed as single rhabdomyosarcomas. The majority require surgical excision, with subsequent chemotherapy or radiotherapy. The prognosis is very poor, with the majority of the patients not surviving longer than one year.

Prevalence of stroke-related risk factors in Albania: a single-center experience.

Introduction: Stroke, a prominent global cause of mortality and disability, is broadly categorized into ischemic and hemorrhagic types. An epidemiological survey of stroke and its risk factors can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and evaluate stroke-associated risk factors in Albania. Material and methods: This was a single-center retrospective analysis conducted in Albania for the period from May 2015 to September 2021. Data were collected retrospectively through hospital records. Stroke was defined as sudden onset of a nonconvulsive and focal neurological deficit, and ischemic stroke was diagnosed using brain computed tomography (CT), magnetic resonance (MR) imaging, or both. We examined patient history characteristics encompassing demographics, stroke history, conventional vascular risk factors, and lifestyle-related risk factors. Results: The mean age of the 3860 patients was 74.6 ±10.4 years, and 73.5% were men. The prevalence of carotid stenosis, arrhythmia, obesity, and hypertension was significantly higher in males than in females (p < 0.001). Out of the 3860 patients in the study cohort, 641 (16.6%) subjects died, while 335 (8.7%) patients achieved complete recovery. Hemiparesis was observed in 386 (10%) patients and hemiplegia in 868 (22.4%) patients. Conclusions: Our analysis underscores the male predominance (2.2 : 1) in stroke cases. Carotid and vertebral artery stenosis is a significant factor, emphasizing the life-saving potential of early intervention. Social and economic factors in Albania pose challenges, demanding comprehensive strategies. Prospective trials are crucial to explore intervention efficacy, and timing, and address socioeconomic impacts on timely stroke management.

Perceval S, sutureless aortic valve: cost-consequence analysis.

Introduction: Sutureless aortic valve prostheses have the potential of shortening ischemic time. Aim: We conducted the present study to assess the clinical and economic impact of the biological, sutureless, self-expanding Perceval S valve since the effect of shortened operative times on hospital costs remains unclear. Material and methods: This is a retrospective analysis. From January 2018 to January 2019, 29 patients underwent isolated aortic valve replacement with the Crown PRT bioprosthetic Aortic Valve, whereas 35 patients underwent aortic valve replacement with Perceval S (auto-expanded, sutureless, bioprosthesis). Preoperative data, hospital outcome, and health care resource consumption were compared, using χ2 and t-test. Results: Aortic cross-clamp, cardiopulmonary bypass, and operation times were significantly shorter in the Perceval S group (p < 0.001). Patients in the sutureless group required blood transfusion less frequently (p = 0.03) and had a shorter intensive care unit (ICU) stay (p = 0.01). Hospital stay (p = 0.57) and pacemaker implantation were similar between groups. The reduction of aortic cross-clamp, extracorporeal circulation times, and ICU stay resulted in reduced resource consumption in the sutureless group. Conclusions: The use of the Perceval S valve is clinically safe and effective. A shorter procedural time in the sutureless group is associated with better clinical outcomes and reduced hospital costs.

Cold Reactive Proteins in Cardiovascular Surgery.

Background: According to the literature, Cryoglobins, Cold Agglutinins, Donath-Landsteiner antibodies, and Cryofibrinogen arethe 4 types of Cold-Reactive proteins described. Objective: The aim of the study was to show the role of these proteins cardiovascular surgery. Case presentation: A 57-year-old male patient with a history of myocardial infarction 6 years ago, heavy smoker until 1 year ago, with diabetes, was admitted to the hospital for a surgical confrontation of coronary disease. He reports that for1-month symptoms are deteriorating (NYHA III). The history of the patient does not include either hematopoietic system or connective tissue diseases or recent viral infection. Angiographic control showed total obstruction of the small branch. The patient underwent median sternotomy. Suspension of the left sternum. Mobilization of the left internal mammary artery. Concomitant reception of left great saphenous vein. Intubation of ascending aorta and right atrium - vena cava with acatheter of two steps. He was extubated at the 10th post-surgical hour. Smooth post-surgical progression, with no signs of brain, myocardial or renal failure. The patient was discharged on the 5th post-surgical day. Conclusion: Independently of the technique that is used, the systemic temperature must be maintained duringthe cardiopulmonary bypass above the temperature threshold activity of the cold-reactiveproteins.

Impact of obesity on outcome of patients undergoing off-pump coronary artery bypass grafting using aorta no-touch technique.

We prospectively examined 1359 adult patients undergoing isolated coronary revascularization with the Pi-circuit technique, consisting of beating heart, aorta no-touch, use of composite grafts, and off-pump arterial revascularization. Patients were divided into two groups based on body weight; Group A consisting of 295 (21.7%) obese patients [body mass index (BMI) > or =30 kg/m(2)] and Group B of 1064 (79.3%) non-obese patients (BMI <30 kg/m(2)). Advanced age and emergency surgery favored the non-obese group [63.0+/-10.4 vs. 65.3+/-9.6 years (P<0.0005) and 10.2% vs. 17.1% (P=0.004), with an increase in the number of octogenarians among them (1.7% Group A vs. 5.4% in Group B, P=0.11)]. The use of double internal mammary arteries (90.5% in Group A vs. 86.9% in Group B, P=0.109), the mean number of distal anastomoses (2.8+/-0.9 in Group A vs. 2.7+/-0.9 in Group B, P=0.5) and the number of sequential anastomoses performed (28.1% in Group A vs. 31% in Group B, P=0.3) were similar. No difference in morbidity rates was detected. All cause in-hospital mortality was comparable. Survival was similar in both groups also. Obesity is not a risk factor for morbidity and mortality in this group of patients.

Hierarchical analysis of anthropometric indices in the prediction of 5-year incidence of hypertension in apparently healthy adults: the ATTICA study.

OBJECTIVE: To evaluate the effect of anthropometric indices in the 5-year incidence of hypertension, in a sample of cardiovascular disease-free adults. METHODS: 1514 men and 1528 women (>18 years) without any clinical evidence of cardiovascular disease, living in Attica area, Greece, were enrolled in the ATTICA study from May 2001 to December 2002. In 2006, the 5-year follow-up was performed. Hypertension was defined as systolic/diastolic blood pressure measurements >140/90 mmHg or use of antihypertensive treatment. Weight, height, waist and hip circumferences, as well as body mass index (BMI) and waist-to-height and waist-to-hip ratios were tested in relation to the development of hypertension. RESULTS: During 2001-2006, 86 men and 102 women were diagnosed as having hypertension. Thus, annual incidence rate is 2.86 per 100 men and 2.68 per 100 women. From the anthropometric indices, waist, and hip circumferences, BMI, weight and waist-to-height ratio were associated with the development of hypertension. Particularly, for every 1cm difference in baseline measurements of waist a 2% higher risk of hypertension was observed; while abnormal waist at baseline examination was associated with 1.92-times (95% CI, 1.35-2.77) higher risk of hypertension, in both genders. Moreover, presence of obesity at baseline examination was associated with a 2.4-fold (95% CI, 1.62-3.79) of the risk of hypertension. All the aforementioned relationships were independent from age, sex, and various other confounders, while the model that contained waist had the best diagnostic ability, followed by BMI, hip circumference and weight. CONCLUSIONS: Among various anthropometric measurements that showed a significant association with hypertension incidence, waist circumference was the best predictor. The latter finding may lead to new pathophysiological mechanisms for the development of hypertension.

The emerging anti-inflammatory role of HDL-cholesterol, illustrated in cardiovascular disease free population; the ATTICA study.

OBJECTIVE: In this work we assessed the relationship between HDL-cholesterol levels and various inflammation markers status in a sample of cardiovascular disease free adult men and women from Greece. METHODS: The ATTICA study is a population-based cohort that has randomly enrolled 1128 men and 1154 women (aged >18 years old), stratified by age-gender, from the greater area of Athens, during 2001-2002. Adherence to Mediterranean diet was assessed through a diet-score that was based on a validated food-frequency questionnaire. In this study we assessed the relationship between HDL-cholesterol levels and inflammation markers (high sensitivity C-reactive protein, interleukin-6, homocysteine and amyloid-a), after taking into account the effect of several confounders. RESULTS: 46% of men and 40% of women had total serum cholesterol levels >200 mg/dl, while 21% of men and 7% of women had HDL-cholesterol levels <35 mg/dl. The mean value for HDL-cholesterol was 53+/-14 mg/dl in females and 44+/-14 mg/dl in males. HDL-cholesterol levels were inversely correlated to the hs-CRP levels (b=-0.028, P=0.001) and homocysteine levels (b=-0.039, P=0.036), after adjustment for sex, age, body mass index, physical activity status, smoking, total cholesterol levels, lipid lower agents, ethanol intake and diabetes mellitus; while no statistical significance was found between HDL-cholesterol levels and interleukin-6 and serum amyloid-a. CONCLUSIONS: In this work we evaluated the inverse relationship between HDL-cholesterol levels and inflammatory markers in a sample adult cardiovascular disease free population. This study among others illustrates the anti-inflammatory emerging role of HDL-cholesterol in reducing cardiovascular risk.

Predictors of early postoperative atrial fibrillation after off-pump myocardial revascularization.

OBJECTIVE: : We determined the incidence and the predisposing factors of atrial fibrillation (AF) after aorta nontouch coronary artery bypass grafting without extracorporeal circulation. METHODS: : From February 2001 to November 2005, 1359 patients (1159 men, 85.3%) of mean (±SD) age 64.8 (±9.8) years, who underwent off-pump coronary artery bypass grafting (OP-CAB), were prospectively enrolled. Demographics, perioperative data, and comorbidities were recorded in all patients. A 24-hour rhythm monitoring was performed in all patients until hospital discharge. RESULTS: : Among 1359 patients, 273 (20.1%) had development of atrial fibrillation in the early postoperative period. Patients with AF had higher mean (±SD) age, 68.3 (±8.8) years, compared with control subjects [63.9 (±9.9)] (P ≤ 0.0005). Univariate analysis showed that apart from age, history of arterial hypertension (P ≤ 0.02), chronic obstructive pulmonary disease (P ≤ 0.02), and the use of bilateral internal mammary arteries (P ≤ 0.01) were predisposing factors for the development of AF. Logistic regression analysis showed that age, history of arterial hypertension, and the use of bilateral internal mammary arteries were predisposing factors for early postoperative AF after OP-CAB. CONCLUSIONS: : Atrial fibrillation occurred in approximately 20% of patients undergoing OP-CAB, mainly in older patients with arterial hypertension who received bilateral internal mammary artery grafts.

Basic fibroblast growth factor changes in response to coronary angioplasty in patients with stable angina.

Basic fibroblast growth factor (bFGF) has been implicated in the pathogenesis of coronary atherosclerosis and in angiogenesis. We assessed the changes in serum bFGF before, immediately after, and 6 months after coronary angioplasty (PTCA). Using the ELISA methods we measured plasma bFGF in 28 patients who underwent PTCA, in 20 patients with coronary artery disease who underwent elective coronary angiography and in 28 healthy subjects. Before PTCA and coronary angiography, bFGF plasma levels were similar in both patient groups (4.4+/-1.0 vs. 3.3+/-0.5 pg/ml), but were significantly higher compared with those of the control group (0.8+/-0.1 pg/ml, P<0.05). By 24 h, 3 months and 6 months after PTCA, bFGF levels had decreased significantly in the PTCA group (3.2+/-0.6, 1.7+/-0.3 and 2.7+/-0.6 pg/ml, respectively, P<0.05). In conclusion, these findings show that bFGF levels are elevated in patients with coronary artery disease. Following PTCA, bFGF levels decreased significantly and remained stable for 6 months after the procedure. Thus, bFGF level may change in response to PTCA in patients with coronary artery disease and stable angina.