Why are thoracic operations postponed?

AIM: To investigate and present the reasons that cause the postponement of thoracic surgical operations. METHODS: We retrospectively included in the study all patients submitted to elective thoracic surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule. RESULTS: 81 out of a total of 542 patients (14.9%) scheduled for elective thoracic operation had their procedure postponed. The reasons were mainly organisatory (in 42 cases, 51.85%), which in order of significance were: shortage in matching erythrocyte units, shortage in anaesthetic/nursing staff and unavailability in operating rooms. The rest of the cases (39, 48.1%) were postponed due to medical reasons, which in descending order of significance were: respiratory infections and exacerbations of COPD, cardiological problems, misregulation of antiplatelet/antithrombotic drugs and infections from other systems (gastrointestinal, urinary, etc.). Elderly male patients planned for major/oncologic surgery were most possible to have their operation postponed for medical reasons. DISCUSSION-CONCLUSIONS: Thoracic operations are postponed owed to organisatory as well as medical reasons, the latter mainly affecting elderly, morbid patients awaiting for major/oncologic surgery.

Helicobacter pylori infection and primary open-angle glaucoma: is there a connection?

Glaucoma, the most common form of which is primary open-angle glaucoma (POAG), is a neurodegenerative disease which is the second most common cause of blindness worldwide. Among the factors that have been implicated in the pathophysiology of this disease is infection with Helicobacter pylori. This alleged association has caused a great deal of scientific discussion during the past decade, as the establishment of such a correlation might lead to therapeutic applications for all glaucoma patients. In this review, we assess all relevant major studies and trials in an effort to elucidate the issue.

How many lobes do you see?

Accessory fissures represent a variation of the normal lung anatomy. Incomplete development or even the absence of the major or minor fissures can lead to confusion in distinguishing adjacent lobes. This report aims to present a rare intraoperative finding of an anatomic malformation of the right lung in a 19-year old male patient with recurrent pneumothorax who underwent a surgical repair. An accessory fissure which was separating the superior segment of the lower lobe from the basal segments gave to the whole lung the unique image of a four-lobed one. A profound knowledge of the accessory fissures, even if they are incidentally discovered, is of pivotal importance for the thoracic surgeon and leads to optimal operative assessment and strategic planning.

Why are heart operations postponed?

AIM: To investigate the reasons that lead to postponement of cardiac operations, in order to elucidate the problem and help patients through modes of prevention. METHODS-DESIGN: We retrospectively included in the study all patients submitted to elective adult heart surgery in our department during the 4-year period 2007-2010 and noted all cases of postponement after official inclusion in the operating schedule. RESULTS: 94 out of a total of 575 patients (16.34%) scheduled for elective cardiac operation had their procedure postponed. The reasons were mainly organisatory (in 49 cases, 52.12%), which in order of significance were: unavailability in operating rooms, shortage in matching erythrocyte units and shortage in anaesthetic/nursing staff. The rest of the cases (45, 47.88%) were postponed due to medical reasons, which in order of significance were: febrile situations, including infections of the respiratory, gastrointestinal and urinary system, problems with the regulation of antiplatelet and antithrombotic drugs, neurological manifestations such as stroke and transient ischaemic attacks, exacerbation of asthma/chronic obstructive pulmonary disease, arrhythmias, renal problems and allergic reactions to drugs. Patients with advanced age and increased Euroscore values were most possible to have their heart operation postponed. CONCLUSIONS: Heart operations are postponed due to organisatory as well as medical reasons, the latter mainly affecting older, morbid patients who therefore require advanced preoperative care.

Double auricles of the right atrium: a unique anatomic deformity.

BACKGROUND: Anatomic deviations, especially those detected during the course of an operation, are medically intriguing, as they raise concerns about their clinical significance and putative complications. CASE PRESENTATION: We present, to our knowledge, for the first time a case of an anatomic deviation in the form of a second right atrial auricle in a 70 year-old, coronary bypass-operated male Caucasian patient of Greek origin. No complications were noted intra-or postoperatively. CONCLUSIONS: A second right atrial auricle was found intraoperatively, without causing any clinical complications, or obstructing the normal course of a surgical procedure.

Poland's syndrome and recurrent pneumothorax: is there a connection?

AIM: To investigate the possible connection of Poland's syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. PATIENTS-METHODS: Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy) and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis) due to the recurrent state of their pneumothorax. RESULTS: The patients had good results with total expansion of the affected lung. CONCLUSIONS: Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases.

An alternate solution for the treatment of ascending aortic aneurysms: the wrapping technique.

BACKGROUND: The aortic Dacron wrapping technique is a surgical technique used under certain circumstances in cases of ascending aorta dilatation. Herein, we are presenting our experience on the method performed on multimorbid patients who denied major aortic surgery. METHODS: We included in our series 7 patients (5 male-2 female) with mild to moderate ascending aortic dilatation, who were operated with the wrapping technique. One patient was submitted to biological aortic valve replacement during the same procedure. The number of conventionally operated patients during the same period (2 years) was 21. RESULTS: Mortality during the 18-months follow-up control was 0%. One patient had to be operated with biological aortic valve replacement 18 months after the initial wrapping operation, although the diameter of her ascending aorta remained stable. CONCLUSIONS: The Dacron wrapping technique is a method that can alternatively be used in multimorbid patients with mild to moderate ascending aortic dilatation without dissecting elements and has generally good results.

Aggregation of LHCII Leads to a Redistribution of the Triplets over the Central Xanthophylls in LHCII.

We present laser flash-induced triplet-minus-singlet (TmS(flash)) and absorbance-detected-magnetic-resonance (TmS(ADMR)) measurements on the light-harvesting chlorophyll a/b pigment-protein complex (LHCII) from pea. We investigated the influence of LHCII aggregation on xanthophyll triplet formation. The effect of aggregation was previously studied using TmS(ADMR) [van der Vos et al. (1994) Biochim. Biophys. Acta 1208, 243-250] for LHCII from spinach, and it was concluded that aggregation leads to a large increase of the amount of intertrimer triplet transfer. However, a similar study on LHCII from pea with the use of TmS(flash) measurements [Barzda et al. (1998) Biochemistry 37, 546-561] showed much smaller effects. To resolve this apparent discrepancy and to compare the results of TmS(ADMR) and TmS(flash) measurements, we used both techniques to study LHCII from pea, applying an identical aggregation procedure in both cases. It appears that aggregation does not lead to an increase of intertrimer triplet transfer as thought before but to a redistribution of the triplets over the two central xanthophylls (mainly lutein) that are present in each monomeric subunit of LHCII. Moreover, it is argued that the TmS band at 525 nm is due to lutein instead of violaxanthin as was reported in earlier studies. It is concluded that aggregation leads to a change in chlorophyll-xanthophyll interactions, which might explain the large change in excited-state lifetime of chlorophyll a in LHCII upon aggregation. This change in lifetime is possibly related to the phenomenon of nonphotochemical quenching in green plants, which is an important protective regulatory mechanism, that lowers the probability of photoinhibition.