Aortic Annuloplasty: Focus on the Use of an External Teflon Ring.

Aortic annuloplasty has been clearly demonstrated to have a protective influence in aortic valve repair. Over the past 20 years, different annuloplasty concepts have been proposed by different groups. However, the most appropriate approach to enable long-term annular stability remains highly controversial. The aim of this article is to give a general overview of all types of aortic annuloplasty, particularly focusing on the use of an external Teflon ring, as proposed by our group. In this technique, external root dissection is performed in the same fashion as for reimplantation; the only difference is that it is necessary to go below the coronary ostia take-off. A series of pledgeted sutures (usually between 6 and 9 sutures) are placed at the level of the virtual basal ring. The external ring is made using a Teflon strip with a length of 8 to 9 cm, to reduce the annulus to a diameter of between 21 and 23 mm. The sub-annular sutures are then passed at the appropriate level through the Teflon strip and the strip is parachuted outside the aortic root base, passing under the coronary ostia. The two ends of the Teflon strip are tied at the level of the non-coronary sinus. Aortic annuloplasty is a crucial step to improve valve competence and stabilization. While several techniques offer good mid- to long-term results, annuloplasty with an external Teflon ring appears to be a simple and effective alternative to guarantee stable root diameters. Longer follow-up studies are needed to confirm the mid- to long-term results.

Giant Distal Anastomotic Pseudoaneurysm 35 Years after Bentall Operation Mimicking an "Elephant Trunk".

We present the case of a giant distal aortic pseudoaneurysm 35 years after a classic mechanical Bentall operation. Computed tomography and coronary angiography showed that this originated from the distal suture line. The proximal suture and coronary ostia appeared to be intact. At reoperation, we found a complete dehiscence of distal suture line: the graft was floating in the pseudoaneurysm, mimicking an "elephant trunk" procedure. This complication suggested a systematic and accurate follow-up of patients who underwent an original Bentall procedure.

[The completion Bentall procedure: aortic root and ascending aorta replacement after prior aortic valve replacement]. / "Completion Bentall": sostituzione della radice e dell'aorta ascendente in un paziente già portatore di protesi valvolare aortica.

We describe the case of a patient with an ascending aorta and aortic root aneurysm who underwent aortic valve replacement, 14 years earlier, with a mechanical prosthesis, which was normally functioning at time of reoperation. We describe the "completion Bentall" technique - a modified Bentall technique -, a procedure for prosthesis-sparing aortic root replacement. This technique simplifies the original procedure in reinterventions, reducing complication rates and aortic cross-clamping and cardiopulmonary bypass times, with a good surgical result.

Efficacy of Some Wearable Devices Compared with Spray-On Insect Repellents for the Yellow Fever Mosquito, Aedes aegypti (L.) (Diptera: Culicidae).

The current Zika health crisis in the Americas has created an intense interest in mosquito control methods and products. Mosquito vectors of Zika are of the genus Aedes, mainly the yellow fever mosquito, Aedes aegypti. L. The use of repellents to alter mosquito host seeking behavior is an effective method for the prevention of mosquito-borne diseases. A large number of different spray-on repellents and wearable repellent devices are commercially available. The efficacies of many repellents are unknown. This study focuses on the efficacy of eleven different repellents in reducing the number of Ae. aegypti female mosquitoes attracted to human bait. We performed attraction-inhibition assays using a taxis cage in a wind tunnel setting. One person was placed upwind of the taxis cage and the mosquito movement towards or away from the person was recorded. The person was treated with various spray-on repellents or equipped with different mosquito repellent devices. We found that the spray-on repellents containing N,N-Diethyl-meta-toluamide and p-menthane-3,8-diol had the highest efficacy in repelling mosquitoes compared to repellents with other ingredients. From the five wearable devices that we tested, only the one that releases Metofluthrin significantly reduced the numbers of attracted mosquitoes. The citronella candle had no effect. We conclude that many of the products that we tested that were marketed as repellents do not reduce mosquito attraction to humans.

Queratotomia radial: experiencia en el Hospital Nacional Cayetano Heredia / Radial keratotomy. Experience at the Hospital Nacional Cayetano Heredia

La queratotomia radial es un nuevo tratamiento quirurgico de la miopia simple. El proposito de este estudio ha sido evaluar los resultados de este procedimiento en el Hospital Nacional Cayetano Heredia desde agosto del 87 a diciembre del 89. La cirugia fue realizada en 44 ojos de 22 pacientes. 17 fueron femenino (77.3 por ciento) y cinco pacientes masculino (22.7 por ciento) la edad estuvo comprendida entre 20-39 años de edad. El promedio de la miopia pre-operatoria fue 3.9 +/- 1.8 dioptrias. La zona óptica fue 3mm en 31.8 por ciento y 3.5 mm en 68.2 por ciento de casos. El rango de la paquimetria central ultrasónica vario entre 0.41 a 0.63mm. El rango de la profundidad de las incisiones estuvo comprendido entre 0.44-0.64 mm. La agudeza visual postoperatorio a las 24 horas despues de la cirugia fue 20/20 a 20/40 en 68.2 por ciento de ojos; 20/50 a 20/70 en 11.4 por ciento de ojos; 20/100 a 20/200 en 20.4 por ciento. A los 30 dias postoperatorio la agudeza visual sin corrección fue 20/20 a 20/40 en 50 por ciento de ojos; 20/50 a 20/70 en 36.4 por ciento y 20/100 a 20/200 en 13.6 por ciento de ojos. La agudeza visual sin corrección a los 6 meses fue 20/20 a 20/40 en 43.2 por ciento; 20/50 a 20/70 en 38.6 por ciento y 20/100 a 20/200 en 18.2 por ciento de los ojos. Las complicaciones mas frecuentes en nuestra serie ha sido la hipo corrección. Se analiza cuidadosamente la miopia residual y podemos afirmar que la queratotomia radial disminuyó la miopia preoperatoria en todos los casos