Innominate Artery Pseudoaneurysm Requiring Cartilage Tracheal Repair in a Child.

Mycotic aneurysms are rare but potentially catastrophic. We report a case of an innominate artery pseudoaneurysm in a 4-year-old patient that caused a tracheoinnominate fistula requiring tracheoplasty with a costal cartilage graft and a homograft iliac artery replacement of the diseased innominate artery, with a successful outcome.

Outcomes of surgery for acute type A dissection in octogenarians versus non-octogenarians: a systematic review and meta analysis.

INTRODUCTION: Acute Type A Aortic Dissection (ATAAD) is a cardiothoracic emergency that requires urgent intervention. Elderly status, particularly age over 80, is an independent risk factor for mortality and morbidity. The mid-term outcomes of this age group are also unknown. This systematic review and meta-analysis of observational studies was therefore performed to analyse short- and mid-term mortality and morbidity in octogenarians following surgery for ATAAD. METHODS: A systematic review was conducted for studies published since January 2000. The primary endpoint was short-term mortality, either reported as 30-day mortality or in-hospital mortality and medium-term (five year) survival. Secondary endpoints were rates of postoperative complications, namely stroke, acute renal failure (ARF), re-exploration and intensive care unit (ICU) length of stay (LOS). RESULTS: A total of 16 retrospective studies, with a total of 16, 641 patients were included in the systematic review and meta-analysis. Pooled analysis demonstrated that octogenarian cohorts are at significantly higher risk of short-term mortality than non-octogenarians (OR 1.93; 95% CI 1.33-2.81; P < 0.001). Actuarial survival was significantly lower in the octogenarian cohort, with a five-year survival in the octogenarian cohort of 54% compared to 76% in the non-octogenarian cohort (P < 0.001). There were no significant differences between the cohorts in terms of secondary outcomes: stroke, ARF, re-exploration or ICU LOS. CONCLUSION: Octogenarians are twice as likely to die in the short-term following surgery for ATAAD and demonstrate a significantly lower five-year actuarial survival. Patients and family members should be well informed of the risks of surgery and suitable octogenarians selected for surgery.

"The odds were stacked against me": a qualitative study of underrepresented minorities in surgical training.

BACKGROUND: The Royal Australasian College of Surgeons (RACS) is expected to provide surgical care to a diverse patient population across Australia and New Zealand (ANZ). To improve the quality-of-care individuals receive, the surgical workforce must reflect the population it serves. Achieving diversity within RACS will strengthen therapeutic relationships with patients and promote an inclusive culture. This study investigates the perspectives of underrepresented minority (URM) trainees to highlight barriers for the selection and completion of the RACS Surgical Education and Training (SET) program. METHODS: This qualitative study used online, semi-structured, in-depth interviews of URM trainees. Participants were recruited by self-identification and were invited to participate based on inclusion criterion. Interviews took place between August and October 2020, were transcribed and de-identified. Framework analysis was used to identify themes. FINDINGS: Eight participants from four surgical specialities were interviewed, six from Australia and two from New Zealand. There were six female and two male participants. The findings identified barriers that were grouped into eight broad areas: discouragement; structural racism, discrimination and unconscious bias; language barriers; policies and procedures; lack of role models; homophobia; sexual harassment and women in surgery. CONCLUSION: The findings offer guidance to RACS and the surgical community to explore new strategies to improve the experience of URM SET trainees. While on a small scale, the study draws directly on the URMs' experiences to inform strategies addressing equity, diversity and inclusion. The aim is to produce a diverse surgical workforce that better delivers healthcare services to a diverse population.

Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report.

INTRODUCTION: Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement. CASE PRESENTATION: A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting. CONCLUSION: We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.

Patient Safety During Chest Drain Insertion-A Survey of Current Practice.

OBJECTIVES: The aim of this study was to identify the degree of awareness of the current guidelines and common practices for pleural drain insertion. METHODS: A 10-item questionnaire was sent electronically to junior physicians from 4 different hospitals in the South Eastern Sydney and Illawarra Shoalhaven Local Health District. Participants were asked to give their level of experience and management practices for chest drain insertion. RESULTS: A total of 94 junior medical officers from 4 hospitals in the district completed the survey. More than 20% had never inserted a chest drain at the time; 72% had primarily learned from bedside teaching and peer learning, but 11% had no training at all. More than 50% of physicians felt that the biggest threat to the procedure was their own lack of confidence for drain insertion. Despite current guidelines, 25% insert chest drains routinely without the aid of ultrasound. A third of interviewees were aware of local guidelines but had not read them. Most physicians (86%) believe that formal standardized training should be available for junior physicians. CONCLUSIONS: Our findings demonstrate the ongoing need for improved procedural training in chest drain insertion, with emphasis on mandatory thoracic ultrasound. We consider it important to continue to raise concern and awareness that chest drain insertion is not a harmless procedure, and further physician procedural competence is required.

Programa E-Health ICOnnecta't: un ecosistema para fomentar el bienestar en cáncer a través de la propuesta europea ONCOMMUNP / E-Health ICOnnecta't program: An ecosystem to promote wellbing in cancer towards ONCOMMUN European proposal

INTRODUCCIÓN: A pesar de que los tratamientos psico-oncológicos han demostrado su efectividad en disminuir el malestar emocional y mejorar la calidad de vida de las personas con cáncer, aún existen numerosas barreras que limitan su acceso. La transformación a online de esta atención se plantea como una solución para aumentar la cobertura del servicio y mejorar su coste-utilidad. OBJETIVO: Crear un ecosistema digital de salud para reducir el impacto del cáncer, aumentando el bienestar y la calidad de vida del ciudadano con cáncer. MÉTODO: Programa dirigido a pacientes diagnosticadas de cáncer de mama en fase de supervivencia aguda. Es un programa de atención escalonada dividido en 4 niveles de intervención jerarquizados por complejidad: Nivel 1, cribado y monitorización psicosocial; Nivel 2, Campus: psicoeducación y educación sanitaria; Nivel 3, soporte psicosocial comunitario; y Nivel 4, tratamiento psicoterapéutico grupal. RESULTADOS: En 2019, 259 mujeres fueron incluidas en el programa (39,91% de los nuevos casos de cáncer de mama en los centros participantes). Solo el 3,47% (n = 9) requirió atención clínica especializada (Nivel 4). CONCLUSIÓN: El programa Iconnecta't adopta un modelo integrado de atención psicosocial en cáncer que se adecúa a las necesidades específicas de los supervivientes. Da solución a algunas de las barreras de la atención sanitaria tradicional, democratizando el acceso a los servicios mediante el uso de tecnologías de uso común en la mayoría de ciudadanos. En un futuro próximo se prevé la implementación progresiva a otras neoplasias, junto con un ensayo clínico controlado y aleatorizado que evaluará su eficacia

INTRODUCTION: Although psycho-oncological treatments have already demonstrated their effectiveness in reducing emotional distress and improving quality of life in people with cancer, there are still numerous barriers limiting their access. The digital transformation of care is proposed as a solution to increase service coverage and improve its cost-utility. AIM: Create a digital health ecosystem to reduce the impact of cancer, increasing users' well-being and quality of life. METHOD: The program is addressed to patients diagnosed with breast cancer in the acute survival phase. It is a stepped-care intervention divided into 4 levels ordered by complexity: Level 1, psychosocial screening and monitoring; Level 2, Campus: psychoeducation and health education; Level 3, psychosocial community support; and Level 4, psychotherapeutic group treatment. RESULTS: In 2019, 259 women were included in the program (39.91% of new breast cancer cases in participating centers), and only 3.47% (n = 9) required specialized clinical care (Level 4). CONCLUSIONS: The Iconnecta't program adopts an integrated model of psychosocial care in cancer that adapts to survivors' specific needs. It overcomes some of the barriers of traditional healthcare, democratizing service access through the use of common technologies among the vast majority of citizens. In the near future, progressive implementation to other cancer diagnoses is planned, together with a randomized controlled trial to evaluate its effectiveness

Simulation-based surgical education in cardiothoracic training.

Simulation has emerged as a feasible adjunct to surgical education and training for most specialties. It provides trainees with an immersive, realistic way to learn a variety of skills in a safe environment with the end goal of improving patient safety. There are three broad types of simulators: full mannequin simulators, part-task trainers or bench models and virtual reality systems. This review aims to describe the current use of simulation in cardiothoracic surgical education and training. We identified multiple procedures that can be simulated in cardiothoracic surgery using a combination of the above simulators, three-dimensional printing and computer-based simulation. All studies that assessed the efficacy of simulators showed that simulation enhances learning and trainee performance allowing for repetitive training until the acquisition of competence but further research into how it translates into the operating theatre is required. In Australia, cardiac surgery simulation is not yet part of the training curricula, but simulators are available for certain tasks and procedures.

Improving informed consent in cardiac surgery by enhancing preoperative education.

OBJECTIVE: To investigate the effect of enhancing preoperative education in improving recall and understanding of a surgical procedure and its application to the informed consent process in cardiac surgery. METHODS: Four electronic database searches were performed from January 2000 to August 2017. A total of 282 articles were identified from which 22 prospective studies assessing an intervention were selected according to predefined selection criteria. RESULTS: Most articles that used additional written information and all that used multimedia presentations to enhance informed consent showed that their intervention improved risk recall and patient's understanding of the procedure. A single randomised controlled trial in cardiac surgery showed that audiotaped consultations improved patient's knowledge of the operation. CONCLUSIONS: Patient recall and understanding of pre-operative information can significantly improve with a variety of educational tools. Procedure-specific forms with or without illustrations as well as interactive multimedia interventions enhance patient recall and understanding of information. In cardiac surgery patients, interventions need to meet patients' preferences, be repetitive on crucial points and consider the nature of the procedure.

Surgical Removal of an Unusual Massive Mediastinal Tumour Preceded by Interventional Embolisation.

Massive mediastinal tumours are rare in clinical practice and complete surgical resection may be associated with serious complications. Preoperative angiography and embolisation are valuable adjuncts in the management of giant tumours to decrease perioperative blood loss, provide a clear operative field and facilitate complete resection. We report the safe use of preoperative embolisation which facilitated excision via clamshell incision, of a highly vascular massive anterior mediastinal tumour with an unusual final diagnosis.

Systematic review of percutaneous interventions for malignant pericardial effusion.

The present systematic review assessed the safety and efficacy of percutaneous interventions for malignant pericardial effusion (MPE), with primary endpoint of recurrence of pericardial effusion. Electronic searches of six databases identified thirty-one studies, reporting outcomes following isolated pericardiocentesis (n=305), pericardiocentesis followed by extended catheter drainage (n=486), pericardial instillation of sclerosing agents (n=392) or percutaneous balloon pericardiotomy (PBP) (n=157). Isolated pericardiocentesis demonstrated a pooled recurrence rate of 38.3%. Pooled recurrence rates for extended catheter drainage, pericardial sclerosis and PBP were 12.1%, 10.8% and 10.3%, respectively. Procedure-related mortality ranged from 0.5-1.0% across the percutaneous interventions. Although isolated pericardiocentesis can safely deliver immediate symptomatic relief, subsequent catheter drainage or sclerotherapy are required to minimize recurrence. PBP has been shown to be highly effective and may be particularly useful in managing recurrent effusions. Ultimately, the choice of intervention must be based on the clinical status of patients, their underlying malignancy and the expertise available.

Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection.

A 63 year-old female was diagnosed with an adenoid cystic carcinoma causing near total tracheal lumen obstruction. The tumour was successfully resected using cardiopulmonary bypass via femoral vessels under local anaesthetic before induction to secure the airway and facilitate the operation.

Treatment of Intravenous Leiomyomatosis with Cardiac Extension following Incomplete Resection.

Aim. Intravenous leiomyomatosis (IVL) with cardiac extension (CE) is a rare variant of benign uterine leiomyoma. Incomplete resection has a recurrence rate of over 30%. Different hormonal treatments have been described following incomplete resection; however no standard therapy currently exists. We review the literature for medical treatments options following incomplete resection of IVL with CE. Methods. Electronic databases were searched for all studies reporting IVL with CE. These studies were then searched for reports of patients with inoperable or incomplete resection and any further medical treatments. Our database was searched for patients with medical therapy following incomplete resection of IVL with CE and their results were included. Results. All studies were either case reports or case series. Five literature reviews confirm that surgery is the only treatment to achieve cure. The uses of progesterone, estrogen modulation, gonadotropin-releasing hormone antagonism, and aromatase inhibition have been described following incomplete resection. Currently no studies have reviewed the outcomes of these treatments. Conclusions. Complete surgical resection is the only means of cure for IVL with CE, while multiple hormonal therapies have been used with varying results following incomplete resection. Aromatase inhibitors are the only reported treatment to prevent tumor progression or recurrence in patients with incompletely resected IVL with CE.

Ruptured left ventricular false aneurysm following acute myocardial infarction: case report and review of the literature.

False aneurysms of the left ventricle complicating acute myocardial infarction are rare. Given they are only contained by pericardial adhesions, they are prone to rupture and hence surgical repair is mandatory. We report a successful repair of a ruptured false aneurysm and then briefly review the current literature.

A case of Castleman's disease and adult necrotizing aortitis: a co-incidence or a significance?

We report a case of concomitant Castleman's disease and adult necrotizing aortitis, an association heretofore not reported. A brief discussion of the current state of our understanding of the pathogenesis of aortitis and possible link between these two entities is presented.

Materiales restauradores en odontopediatría. Revisión / Restorative materials in pediatric dentistry. review

El presente artículo es una revisión sobre la importancia de los diversos materiales dentales que de usan en odontopediatría, se realizó un exhaustiva revisión de artículos en las principales revistas de odontopediatría y en las bases de datos Pub Med, EBCO, HINARY, Imbiomed, Latindex, los cuales fueron distribuídos entre los autores para ser analizados y distribuídos por los mismos en múltiples reuniones como parte del Grupo de estudio de materiales dentales de la Sociedad peruana de Odontopediatr¡a.

This article is a review on the importance of the various dental materials that are used in pediatric dentistry, we performed an exhaustive review of articles in leading journals of pediatric dentristy and in the databases Pub Med, EBSCO, HINARI, IMBIOMED, Latindex, which were distributed among the authors to be analyzed and discussed by them and in multiple meetings as part of the study group of dental materials of the Peruvian Society of Pediatric Dentistry.

Effect of bovine lactoferrin on the minimum inhibitory concentrations of ampicillin and trimethoprim-sulfamethoxazole for clinical Shigella spp. strains.

Here, we determined the effect of bovine lactoferrin (bLF) on the minimum inhibitory concentration (MIC) of ampicillin and trimethoprim-sulfamethoxazole in Shigella . Using a microdilution method, the MIC was determined in the presence or absence of bovine lactoferrin (10 mg/mL) on 88 Shigella strains (56 Shigella flexneri , 15 Shigella boydii , 13 Shigella sonnei , and 4 Shigella dysenteriae ) previously isolated from peruvian children <2 years old. A fold change of 2 or more in MIC values was considered significant. For ampicillin, 67 (76%) strains were highly resistant; one-third of the strains (32%) showed a decrease in ampicillin MIC in the presence of LF. This was more typical of MIC values in less resistant strains. For 7 (8%) ampicillin-resistant strains, the decrease in the MIC resulted in the strains reaching the cutoff for susceptible in the presence of bLF. For trimethoprim-sulfamethoxazole, 93% of the isolates (n = 82) were highly resistant and only 4 isolates (5%) decreased their MIC in the presence of bLF. None of the trimethoprim-sulfamethoxazole resistant strains became susceptible in the presence of LF. The decrease in the MIC in the presence of bLF seems to depend on the mechanisms of action of each antibiotic. In vivo studies are needed to further evaluate bLF as a coadjuvant to antibiotic treatment of resistant Shigella.

The spatial distribution of acid phosphatase activity in ectomycorrhizal tissues depends on soil fertility and morphotype, and relates to host plant phosphorus uptake.

Acid phosphatase (ACP) enzymes are involved in the mobilization of soil phosphorus (P) and polyphosphate accumulated in the fungal tissues of ectomycorrhizal roots, thereby influencing the amounts of P that are stored in the fungus and transferred to the host plant. This study evaluated the effects of ectomycorrhizal morphotype and soil fertility on ACP activity in the extraradical mycelium (ACP(myc)), the mantle (ACP(mantle)) and the Hartig net region (ACP(Hartig)) of ectomycorrhizal Nothofagus obliqua seedlings. ACP activity was quantified in vivo using enzyme-labelled fluorescence-97 (ELF-97) substrate, confocal laser microscopy and digital image processing routines. There was a significant effect of ectomycorrhizal morphotype on ACP(myc), ACP(mantle) and ACP(Hartig), while soil fertility had a significant effect on ACP(myc) and ACP(Hartig). The relative contribution of the mantle and the Hartig net region to the ACP activity on the ectomycorrhizal root was significantly affected by ectomycorrhizal morphotype and soil fertility. A positive correlation between ACP(Hartig) and the shoot P concentration was found, providing evidence that ACP activity at the fungus:root interface is involved in P transfer from the fungus to the host. It is concluded that the spatial distribution of ACP in ectomycorrhizas varies as a function of soil fertility and colonizing fungus.