A rare presentation of mycotic cerebral aneurysm, subarachnoid haemorrhage, and mitral valve aneurysm in left-sided lnfective endocarditis: a case report and literature review.

Background: Infective endocarditis (IE) can present as a syndromic-like condition with multisystem involvement; this can make early diagnosis particularly challenging. Rarely, left-sided IE can lead to mitral valve aneurysm formation. Showering of septic emboli to the cerebral circulation may result in a mycotic aneurysm that can rupture, leading to haemorrhagic stroke, as in this case. Case summary: A 28-year-old male presented with a triad of subarachnoid haemorrhage (SAH) from mycotic cerebral aneurysm rupture, left-sided aortic and mitral valve IE causing severe regurgitation and aorto-mitral curtain fistula and mitral valve aneurysm formation. The SAH was the main initial presentation and was immediately treated with coiling by an interventional radiologist. However, the patient later developed heart failure due to severe aortic and mitral valve regurgitation that led to the diagnosis of IE. The patient underwent aortic and mitral valve replacements procedure10 days after SAH presentation. He then recovered satisfactorily from the operationa and successfully discharged home after completeing his course of intravenous antibiotics. Discussion: In this article, we shed some light on this unusual syndromic presentation, elaborate on the underlying mechanism, the ultimate importance of clinical examination, pitfalls in diagnosis, the important role of the heart team in IE, and finally the timing of surgery after SAH.

Is vacuum-assisted closure therapy the main culprit in right ventricular rupture after deep sternal wound infection?

Right ventricular rupture after deep sternal wound infection (DSWI) is a rare but fatal complication, and can occur with or without vacuum assisted closure (VAC) therapy. There is currently no strong evidence to suggest whether or not VAC therapy is a contributing factor to this complication. In total, 30 articles were retrieved and assessed through a systematic review strategy from 1953 to 2022. The keywords: 'vacuum assisted closure'; 'VAC'; 'negative pressure wound therapy'; 'deep sternal wound infection'; 'DSWI'; 'right ventricular rupture'; and 'cardiac rupture' were used in the search. Overall, 15 of the included articles satisfied the predefined eligibility criteria. Fatal right ventricular ruptures were reported in 18 (36%) out of 50 cases. In this article, the risk factors, mechanisms and management of right ventricular rupture are discussed. A novel view of the mechanism of VAC-associated right ventricular rupture is highlighted, with a focus on both pre- and intraoperative management.

Comparison of excursive occlusal force parameters in post-orthodontic and non-orthodontic subjects using T-Scan® III.

OBJECTIVE: Published studies indicate that orthodontically treated patients demonstrate increased posterior occlusal friction contributing to temporomandibular disorder (TMD) symptoms. This study investigated measured excursive movement occlusal contact parameters and their association with TMD symptoms between non- and post-orthodontic subjects. METHODS: Twenty-five post-orthodontic and 25 non-orthodontic subjects underwent T-Scan® computerized occlusal analysis to determine their disclusion time (DT), the excursive frictional contacts, and occlusal scheme. Each subject answered a TMD questionnaire to determine the presence or absence of TMD symptoms. Statistical analysis compared the within group and between group differences (p < 0.05). RESULTS: Statistically significant differences were observed in the disclusion time: DT = 2.69 s in the post-orthodontic and 1.36 s in the non-orthodontic group. In the non-orthodontic group, 72.7% working and 27.3% non-working side contacts were seen, while in the post-orthodontic group, (near equal) 54.7% working and 45.3% non-working side contacts were seen. Presence of canine guidance was seen in 60% of the non-orthodontic group and 24% in the post-orthodontic group. Seventy-two percent of the post orthodontics subjects presented with one or more TMD symptoms. CONCLUSION: Significantly longer disclusion time, higher posterior frictional contacts, and more TMD symptoms were observed in the post-orthodontic group, suggesting that orthodontic treatment increases posterior tooth friction. Computerized occlusal analysis is an objective diagnostic tool determining the quality of excursive movements following orthodontic treatment.

Evaluation of Stress Distribution on Implant-Retained Auricular Prostheses: The Finite Element Method.

PURPOSE: The purpose of this study was to evaluate stress distribution around two craniofacial implants in an auricular prosthesis according to the removal forces. Three attachment combinations were used to evaluate the stress distribution under removal forces of 45 and 90 degrees. MATERIALS AND METHODS: Three attachment designs were examined: (1) a Hader bar with three clips; (2) a Hader bar with one clip and two extracoronal resilient attachments (ERAs); and (3) a Hader bar with one clip and two Locators. The removal force was determined by means of an Instron universal testing machine with a crosshead speed of 10 mm/minute. All three designs were created in three dimensions using SolidWorks. The applied removal force and the models were then introduced to finite element software to analyze the stress distribution. RESULTS: The angle of removal force greatly affected the magnitude and direction of stress distribution on the implants. The magnitude of stress under the 45-degree removal force was higher than the stress at 90 degrees. The combination of the 1,000-g retention clip and 2,268-g retention Locator exhibited the highest stress on the implant flange when the removal force was applied at 45 degrees. CONCLUSION: The removal angle greatly influences the amount of force and stress on the implants. Prosthodontists are encouraged to inform patients to remove the prosthesis at 90 degrees and, if possible, use a low-retentive attachment to reduce stress.

Retrosternal goiter: the need for thoracic approach based on CT findings: surgeon's view.

BACKGROUND AND PURPOSE: The incidence of retrosternal goiter (RSG) varies from 2% to 26% of all thyroidectomies, depending on the defining criteria. There are no clear guidelines to identify patients that require an intrathoracic approach. So, we tried to correlate, between the size and/or anatomical site of the RSG based on preoperative CT findings and the surgical approaches used, aiming at defining those patients with RSG who are in need for thoracic approach. PATIENTS AND METHODS: Out of 1481 patients underwent thyroidectomy at the National Cancer Institute (NCI), Cairo University, between January 2000 and December 2009, only 73 (4.93%) of them had retrosternal extension. Demographic, clinical, operative, anatomical, and pathological data of patients with RSG were recorded and analyzed. RESULTS: The intraoperative extension of the goiter correlated with the extension seen in the CT in all except two patients. Laterality and longitudinal extension found in preoperative CT, correlated well with the surgical findings. The approach used was cervical in 66 cases (90.4%); combined approach in six patients (8.2%). Pure thoracic (full sternotomy) was used alone in one case (1.4%). Extension of the RSG down to or below the arch was associated with an increased risk of using a thoracic approach p<0.0001. CONCLUSION: Preoperative CT, can be used effectively to guide the indications for using a thoracic approach. Reaching the aortic arch or beyond and loss of fat planes in CT, recurrent and malignant disease, are significant risk factors for using a thoracic approach.

Abdominal aortic aneurysm: a review of the genetic basis.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a complex disease with a largely unknown pathophysiological background and a strong genetic component. Various studies have tried to link specific genetic variants with AAA. METHODS: Systematic review of the literature (1947-2009). RESULTS: A total of 249 studies were identified, 89 of which were eventually deemed relevant to this review. Genetic variants (polymorphisms) in a wide variety of genes, most of which encode proteolytic enzymes and inflammatory molecules, have been associated with AAA development and progression. CONCLUSION: The genetic basis of AAA remains unknown, and most results from ''candidate-gene'' association studies are contradictory. Further analyses in appropriately powered studies in large, phenotypically well-characterized populations, including genome-wide association studies, are necessary to elucidate the exact genetic contribution to the pathophysiology of AAA.