Transdiagnostic symptom dynamics during psychotherapy.

Psychotherapy is an effective treatment for many common mental health problems, but the mechanisms of action and processes of change are unclear, perhaps driven by the focus on a single diagnosis which does not reflect the heterogeneous symptom experiences of many patients. The objective of this study was to better understand therapeutic change, by illustrating how symptoms evolve and interact during psychotherapy. Data from 113,608 patients from psychological therapy services who completed depression and anxiety symptom measures across three to six therapy sessions were analysed. A panel graphical vector-autoregression model was estimated in a model development sample (N = 68,165) and generalizability was tested in a confirmatory model, fitted to a separate (hold-out) sample of patients (N = 45,443). The model displayed an excellent fit and replicated in the confirmatory holdout sample. First, we found that nearly all symptoms were statistically related to each other (i.e. dense connectivity), indicating that no one symptom or association drives change. Second, the structure of symptom interrelations which emerged did not change across sessions. These findings provide a dynamic view of the process of symptom change during psychotherapy and give rise to several causal hypotheses relating to structure, mechanism, and process.

The role of transapical cannulation in the operative management of acute aortic dissection.

OBJECTIVES: The aim of the study was to investigate the usefulness of transapical cannulation as the routine cannulation site in patients with acute aortic dissection and to compare it with other cannulation methods. METHODS: Between January 2010 and December 2013, emergency surgery was performed in 111 consecutive patients with acute type A aortic dissection. Patients were divided into two groups: transapical cannulation group and other cannulation sites group (including femoral and axillary artery cannulation). Pre-, intra- and postoperative data were compared between these two groups of patients. RESULTS: Transapical cannulation was the most frequent cannulation site (78 patients, 70.3%), the femoral artery was selected in 24 patients (21.6%) and the axillary artery in 9 patients (8.1%). The mortality rate in the transapical group was 16.7% and 18.2% when other cannulation sites were chosen (p=0.85). No difference in postoperative stroke rate (6.4% vs 9.1%, p=0.62, transapical vs other cannulation sites group, respectively), myocardial infarction (6.4% vs 6.1%, p=0.94) and postoperative acute renal insufficiency incidence (9% vs 6.1%, p=0.61) was found. CONCLUSIONS: Routine transapical cannulation in patients with acute type A aortic dissection is a fast and safe way to establish cardiopulmonary bypass. There is no difference in major operative outcomes after transapical cannulation when compared to the other cannulation sites.

[Cardiac neoplasms: results of the surgical treatment between 2000. and 2008].

INTRODUCTION: The goal of this study was to show early and midterm results of surgical treatment of cardiac neoplasma. METHODS: Between 2000. and 2008., sixty-seven patients with a cardiac tumor or a subdiaphragmatic neoplasma with right atrial extension were operated in our institution. In 22 patients (32.8%), not only a simple extirpation of neoplasma, but an additional surgical procedure was done. RESULTS: A patient reoperated for a recurence of biatrial myxoma died early after operation (1.5% mortality rate). During follow-up period of 3.3 years, two patients (3.4%) out of 58 that were contacted died because of the neoplasma (Methastasis of adenocarcinoma, Carcinoma renis). CONCLUSION: Surgical treatment of cardic tumors resulted in low early mortality and an excellent survival rate after a follow-up period of 3.3 years.

Perfect angiographic patency of the arterial coronary-coronary conduit five years following surgery.

Five years ago, the left internal thoracic artery free segment was used as a coronary-coronary bypass over a single, distal lesion of the large left anterior descending coronary artery in a patient with triple vessel disease. The patient has recently been readmitted, complaining of chest discomfort. Although he was scheduled for percutaneous coronary intervention due to disease progression on the circumflex coronary artery, the perfect angiographic patency of the arterial coronary-coronary conduit has been confirmed.

The radial artery for coronary artery bypass grafting.

Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Previous long-term studies have shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularisation, compared with internal mammary artery grafts. Recently, the use of radial artery for CABG has enjoyed a revival, on the basis of the belief that it will help improving long-term results of coronary operations. The recent reports of encouraging mid-term and long-term patency rates of the radial artery, supports its continued use as a bypass conduit. In this paper, we review the current knowledge about the radial artery as a bypass graft, with special emphasis on the clinical results.

Foley catheter and deep hypothermic circulatory arrest to control bleeding in redo cardiac surgery.

Two cases with catastrophic hemorrhage in redo cardiac surgery are described. In the first one tearing of right ventricle with uncontrolled bleeding occurred during sternal reentry. In the second one, tearing of the right atria occurred while the patient was on cardiopulmonary bypass. In both cases we were able to control bleeding using Foley catheter, which enabled us to proceed to deep hypothermic circulatory arrest to repair heart chambers (due to dense adhesions it was impossible to manage it in any other way). We have found this combined technique to be extremely useful tool to control catastrophic hemorrhage during redo cardiac surgery.

Postcardiotomy assisted circulation with roller pump--early and late results.

The incidence of postcardiotomy myocardial failure (PMF) requiring mechanical circulatory support beyond IABP is reported to be 0.2% to 1.2%. From Dec. 1989 through Dec. 1995, 18 patients (0.3% of the total pump cases) were supported with roller pump type of LVAD. Assisted flow ranged from 3.5 up to 5 L/min with average support time of 35.5 hours. Six (33.3%) patients died while on LVAD. The causes of additional seven deaths (pts weaned of LVAD) were: myocardial failure (4), stroke (2) and intractable bleeding during removal of the LVAD (1). Overall, five patients (27.8%) were successfully discharged from the hospital. Two out of five long-term survivors died later, 6 months and 4 years postoperatively, both of cardiac causes. The actuarial survival rate of long-term survivors was 60% at 7 years, all of them being in NYHA functional class II. These results have proved efficiency of roller pump driven LVAD for short-term circulatory support in pts with PMF. Results are comparable to so far published data on postcardiotomy support with the same, as well as other types of more versatile and costly devices.

[Surgical revascularization of the myocardium]. / Hirurska revaskularizacija miokarda.

It has been 45 years ago when Longmire (1958.) used internal thoracic artery (ITA) for the first time in coronary artery bypass surgery (CABG). In this review, we are presenting novel surgical approaches in CABG surgery. We have also been summarized the best of knowledge, up to date, regarding histology, pharmacology and pathophysiology of conduits (VSM, ITA and alternative venous and arterial grafts) which have been used in CABG surgery, as well as factors influence on its short and long-term patency.

Tension-free left ITA graft -- the pericardial strip technique.

Emphysematous lung occupying the whole dome of the left pleural cavity and expanding well over the midline may occasionally present a significant problem for positioning of the left internal thoracic artery, although the graft has been mobilized up to its origin. To avoid an undue tension on it, we combined a well known technique of the pericardial incision with the pericardial strip technique, enabling the lung to expand freely.

[Assisted circulation II--systems for intermediate and long-term mechanical circulatory support]. / Asistirana cirkulacija II--sistemi za intermedijarnu i dugotrajnu mehanicku potporu cirkulacije.

The concept of artificial circulatory support has been established almost 200 years ago. It has only been within the last four decades that physicians and engineers have developed mechanical assist devices that can temporarily support the circulation until the native heart recovers from a reversible injury. In patients who do not regain native heart function, long-term circulatory support or permanent replace (biologically--heart transplant or permanent mechanical circulatory support) is indicated. In this paper we describe the devices (ABIOMED BSV 5000, Thoratec, HeartMate, Novacor and CardioWest TAH), that are in current clinical use for intermediate and long-term mechanical circulatory support.

Antiphospholipid syndrome in systemic connective tissue diseases.

Clinical manifestation and immunoserological features of secondary antiphospholipid syndrome (SAPS) were analyzed in this paper in 107 patients with systemic connective tissue diseases. In the group of patients with confirmed systemic lupus erythematosus (SLE), antiphospholipid antibodies (aPL) were positive in 43/93 (46.23%), while in 50/93 (53.76%) they were negative. Among aPL positive patients, 33/43 (76.74%) had clinical manifestations of SAPS, while 10 patients (23.26%) were without any clinical manifestations. The most frequent manifestations of SAPS associated with SLE were: arteriovenous thrombosis in 20/43 (46.51%), thrombocitopenia in 15/43 (34.88%) and autoimmune hemolytic anemia in 7/43 (16.27%). In our patients, rare manifestations of SAPS associated with SLE were recurrent fetal loss (1 case), livedo reticularis (1 case), transversal myelitis (2 cases), neuropathy (2 cases) and aseptic endocarditis (Libman-Sacks) (5 cases). Among 7 patients, with Sjögren's syndrome, clinically manifested SAPS was observed in 2, while in other 5 only increased aPL levels were found, as well as in patients with systemic vasculitis-3, MCTD-2 and Sy. Sjögren with vasculitis-1. One RA patient had thrombosis of v. cava inferior. In majority of patients with clinically present SAPS the levels of both examined immunoglobulin isotypes (IgG + IgM) were decreased-21/40 or 52.5%, while isolated increase of IgG was found in 14 (35%) and isolated increase of IgM in 5 (19.22%) patients. In three out of five patients with Libman-Sacks only LA test was positive. This investigation have shown that arterial and venous thromboses are the most common manifestations of SAPS in SLE. Every blood vessel may be involved (from arteriolae to the aorta and from postcapilar venules to the v. cava).

[Use of the ELISA immunoenzyme test and indirect immunofluorescence in the diagnosis of a toxoplasmosis epidemic]. / Primena imunoenzimskog testa ELISA i indirektne imunoflurescencije u dijagnozi epidemije toksoplazmoze.

Etiologic agent of lymphadenitis outbreak in one our military environment was detected by two serologic tests: ELISA (enzyme-linked immunosorbent assay) and indirect immunofluorescence test (IIF) both specific for IgM and IgG antibody detection in toxoplasmosis diagnosis. IgM-ELISA analysis of the first serum sample taken from a group of 79 soldiers with lymphadenitis was positive in 65 examinees (82.28%) and IgG-IIF technique in 52 (65.82%). In a group of 33 soldiers from the same unit with no signs of the disease IgM-ELISA test was positive in 12 (36.36%) and IgM-IIF in 9 (27.27%). In a group of 40 officers from the unit with the disease outbreak specific IgM antibodies were found by both tests only in the head cook. IgM antibodies were not found in a control group of 102 healthy soldiers from other units of the same garrison. Results of this investigation thermal injury showed variations in immune response to infection in dependence on trauma effect duration (in dependence on the phase). In the early posttraumatic phase organism is capable to react effectively to the inoculated infective agent and in the late posttraumatic phase this reaction is much less effective. Authors conclude that these results may influence upon the thermal injury management strategy in dependence on the trauma effect duration.