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https://www.readbyqxmd.com/read/28528537/intraoperative-mechanical-ventilation-state-of-the-art
#1
Lorenzo Ball, Federico Costantino, Giulia Orefice, Karthikka Chandrapatham, Paolo Pelosi
Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review is to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass...
May 19, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28528282/management-options-in-the-treatment-of-femoral-pseudoaneurysms-secondary-to-intravenous-drug-abuse-a-case-series
#2
James Rammell, Nisheeth Kansal, Vish Bhattacharya
INTRODUCTION: Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to the optimum management of these patients. Whilst emergency revascularisation options are available, excision and ligation of the femoral artery remains the most common operative intervention but risks leaving the patient with critical ischaemia or intermittent claudication. This case series reviewed the outcomes of 4 patients who underwent excision-ligation without revascularisation of an infected femoral pseudoaneurysm at a district general hospital...
May 5, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28528115/alcohol-and-other-substance-use-after-bariatric-surgery-prospective-evidence-from-a-u-s-multicenter-cohort-study
#3
Wendy C King, Jia-Yuh Chen, Anita P Courcoulas, Gregory F Dakin, Scott G Engel, David R Flum, Marcelo W Hinojosa, Melissa A Kalarchian, Samer G Mattar, James E Mitchell, Alfons Pomp, Walter J Pories, Kristine J Steffen, Gretchen E White, Bruce M Wolfe, Susan Z Yanovski
BACKGROUND: Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited. OBJECTIVE: To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes. SETTING: 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study...
March 31, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28528054/surgical-management-of-simultaneous-left-coronary-atresia-and-anomalous-right-coronary-artery-origin
#4
Shyam Sathanandam, T K Susheel Kumar, Umar Boston, Christopher J Knott-Craig
A 9-year-old child presented with syncope during exercise. He received a diagnosis of congenital atresia of the left main coronary artery by angiography. He underwent successful coronary artery bypass grafting. On the third postoperative day, he experienced acute, precordial chest pain. An urgent computed tomographic scan showed an unrecognized anomalous origin of the right coronary artery (RCA) with a 1.5-cm intramural course. He was taken back to the operating room to undergo unroofing of the RCA. This case highlights the difficulty involved in making two rare diagnoses that can cause the same exact symptoms in a patient and the surgical challenges associated with it...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28528047/sclerosing-aortic-and-coronary-arteritis-due-to-igg4-related-disease
#5
Mikael Barbu, Ulf Lindström, Claes Nordborg, Andreas Martinsson, Christian Dworeck, Anders Jeppsson
We present the case of a 55-year-old woman admitted for a coronary artery bypass operation because of three-vessel coronary artery disease based on angiographic findings and clinical symptoms. Unexpected intraoperative findings with diffuse tissue thickening of the ascending aorta and coronary arteries indicated an alternate pathogenesis rather than coronary artery atherosclerosis. Histopathologic findings and clinical evaluation could confirm IgG4-related disease (IgG4-RD). IgG4-RD is a newly recognized fibroinflammatory condition that can present in a variety of organs and is characterized by common histopathologic features...
June 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28527931/predictors-of-surgical-site-infection-after-open-lower-extremity-revascularization
#6
Frank M Davis, Danielle C Sutzko, Scott F Grey, M Ashraf Mansour, Krishna M Jain, Timothy J Nypaver, Greg Gaborek, Peter K Henke
OBJECTIVE: Surgical site infection (SSI) after open lower extremity bypass (LEB) is a serious complication leading to an increased rate of graft failure, hospital readmission, and health care costs. This study sought to identify predictors of SSI after LEB for arterial occlusive disease and also potential modifiable factors to improve outcomes. METHODS: Data from a statewide cardiovascular consortium of 35 hospitals were used to obtain demographic, procedural, and hospital risk factors for patients undergoing elective or urgent open LEB between January 2012 and June 2015...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28527930/outcomes-of-open-and-endovascular-lower-extremity-revascularization-in-active-smokers-with-advanced-peripheral-arterial-disease
#7
Samuel L Chen, Matthew D Whealon, Nii-Kabu Kabutey, Isabella J Kuo, Michael D Sgroi, Roy M Fujitani
OBJECTIVE: Concern over perioperative and long-term durability of lower extremity revascularizations among active smokers is a frequent deterrent for vascular surgeons to perform elective lower extremity revascularization. In this study, we examined perioperative outcomes of lower extremity endovascular (LEE) revascularization and open lower extremity bypass (LEB) in active smokers with intermittent claudication (IC) and critical limb ischemia (CLI). METHODS: Active smokers undergoing LEE or LEB from 2011 to 2014 were identified in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) targeted vascular data set...
June 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28527820/adventitial-cystic-disease-of-radial-artery-apropos-of-a-case-and-review-of-literature
#8
Álvaro Torres-Blanco, Luis Ariel Pepén-Moquete, Vicente Molina-Nácher, Francisco Gómez-Palonés
Adventitial cystic disease is an uncommon condition that is characterized by the collection of mucinous material that accumulates in the adventitial layer of the artery. Predominantly, this entity affects the popliteal artery, whereas it is extremely rare in the radial artery. We report a 72-year-old female patient that underwent surgical treatment of an adventitial cyst of the right radial artery. The involved arterial segment was resected, and reconstruction by means of the interposition of a saphenous vein graft was performed...
May 11, 2017: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
https://www.readbyqxmd.com/read/28527195/changes-in-sternal-perfusion-following-internal-mammary-artery-bypass-surgery
#9
Christian D Taeger, Konstantin Klein, Raymund E Horch, Michael Weyand, Justus P Beier
BACKROUND: Coronary bypass surgery using the internal mammary artery (IMA) is among the most commonly performed procedures in treatment of advanced coronary vessel disease. Further, bilateral harvesting of the IMA is associated with increased rates of sternal wound infections. OBJECTIVE: This study aimed to explore changes in sternal perfusion, following left internal mammary artery (LIMA) harvesting. METHODS: 60 patients were divided equally into intervention- and control cohorts and underwent assessment of oxygen saturation (sO2) and relative blood flow (RBF) by laser doppler flowmetry remission spectroscopy preoperatively, 24 h and 72 h postoperatively...
May 18, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/28527155/status-of-laparoscopic-sleeve-gastrectomy-in-china-a-national-survey
#10
Shibo Lin, Wei Guan, Pankaj Hans, Hui Liang
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a favorable bariatric procedure. This study evaluated the status of LSG in China. METHODS: During the 4(th) International Forum of Bariatric and Metabolic Surgery in May 2016, Nanjing China, an on-the-spot questionnaire was filled out by 105 attending surgeons with experience of LSG. The feedback data was collected and analyzed. RESULTS: For preoperative preparations, surgeons preferred blood glucose control with insulin (61...
May 19, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28527049/early-rise-in-postoperative-creatinine-for-identification-of-acute-kidney-injury-after-cardiac-surgery
#11
Keyvan Karkouti, Vivek Rao, Christopher T Chan, Duminda N Wijeysundera
PURPOSE: Acute kidney injury (AKI) is a potentially serious complication of cardiac surgery. Treatment strategies are unlikely to prove efficacious unless patients are identified and treated soon after the onset of injury. In this observational study, we determined and validated the ability of an early rise in postoperative serum creatinine to identify patients who suffer AKI during cardiac surgery. METHODS: The relationship between an early rise in creatinine (immediate postoperative / preoperative creatinine) and AKI (> 50% increase in creatinine by postoperative calendar days 1or 2) was determined by logistic regression modelling...
May 19, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28526778/nudges-in-a-post-truth-world
#12
Neil Levy
Nudges-policy proposals informed by work in behavioural economics and psychology that are designed to lead to better decision-making or better behaviour-are controversial. Critics allege that they bypass our deliberative capacities, thereby undermining autonomy and responsible agency. In this paper, I identify a kind of nudge I call a nudge to reason, which make us more responsive to genuine evidence. I argue that at least some nudges to reason do not bypass our deliberative capacities. Instead, use of these nudges should be seen as appeals to mechanisms partially constitutive of these capacities, and therefore as benign (so far as autonomy and responsible agency are concerned)...
May 19, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28526559/a-single-nucleotide-polymorphism-of-cyclin-dependent-kinase-inhibitor-1b-p27-kip1-associated-with-human-vein-graft-failure-affects-growth-of-human-venous-adventitial-cells-but-not-smooth-muscle-cells
#13
Richard D Kenagy, Shinsuke Kikuchi, Lihua Chen, Errol S Wijelath, Andrew B Stergachis, John Stamatoyannopoulos, Gale L Tang, Alexander W Clowes, Michael Sobel
BACKGROUND: Cyclin-dependent kinase inhibitor 1B (p27(Kip1)) is a cell-cycle inhibitor whose -838C>A single nucleotide polymorphism (rs36228499; hereafter called p27 SNP) has been associated with the clinical failure of peripheral vein grafts, but the functional effects of this SNP have not been demonstrated. METHODS: Human saphenous vein adventitial cells and intimal/medial smooth muscle cells (SMCs) were derived from explants obtained at the time of lower extremity bypass operations...
May 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28526433/risk-of-low-birth-weight-and-micronutrient-deficiencies-in-neonates-from-mothers-after-gastric-bypass-a-case-control-study
#14
Geraldine Gascoin, Maxime Gerard, Agnès Sallé, Guillaume Becouarn, Stephanie Rouleau, Loïc Sentilhes, Régis Coutant
BACKGROUND: An increased risk of small-for-gestational-age infants after maternal bariatric surgery has been shown. The risk of micronutrients deficiencies in these neonates is unclear. OBJECTIVE: To screen for micronutrients deficiencies in newborns of mothers with gastric bypass. SETTINGS: University hospital in Angers, France. METHODS: This study compared the clinical and cord blood biological characteristics of 56 newborns of mothers with prior Roux-en-Y gastric bypass (RYGB) and 56 newborns of nonobese healthy mothers after normal pregnancy (controls), followed between January 3, 2008 and October 31, 2012...
March 27, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28526092/transapical-aortic-perfusion-using-a-deep-hypothermic-procedure-to-prevent-dissecting-lung-injury-during-re-do-thoracoabdominal-aortic-aneurysm-surgery
#15
Yuya Kise, Yukio Kuniyoshi, Mizuki Ando, Hitoshi Inafuku, Takaaki Nagano, Satoshi Yamashiro
BACKGROUND: Avoiding various complications is a challenge during re-do thoracoabdominal aneurysm surgery. CASE PRESENTATION: A 56-year-old man had undergone surgery for type I aortic dissection four times. The residual thoracoabdominal aortic aneurysm that had severe adhesions to lung parenchyma was resected. Since the proximal anastomotic site was buried in lung parenchyma, deep hypothermia was essential to avoid lung dissection and to protect the spinal cord during the proximal anastomosis...
May 19, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28525670/hemoadsorption-treatment-of-patients-with-acute-infective-endocarditis-during-surgery-with-cardiopulmonary-bypass-a-case-series
#16
Karl Träger, Christian Skrabal, Guenther Fischer, Thomas Datzmann, Janpeter Schroeder, Daniel Fritzler, Jan Hartmann, Andreas Liebold, Helmut Reinelt
INTRODUCTION: Infective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function...
May 19, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28525631/primary-leiomyosarcoma-of-inferior-vena-cava-adjacent-to-hepatic-veins-complete-off-pump-resection-and-inferior-vena-cava-graft-reconstruction-with-application-of-external-skin-surface-cooling
#17
Michael Malyshev, Sergey Zotov, Anton Malyshev, Andrey Rostovykh
OBJECTIVES: Resection of a leiomyosarcoma of the inferior vena cava (IVC) requires venovenous bypass, especially if IVC clamping above the hepatic veins is planned. This report describes the application of external skin surface cooling for off-pump resection of a primary IVC leiomyosarcoma adjacent to the hepatic veins with graft IVC reconstruction in conditions of suprahepatic caval clamping and uninterrupted Pringle's manoeuvre. METHODS: A 62-year-old woman presented with IVC leiomyosarcoma adjacent to the hepatic veins...
May 19, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28525615/embolic-foreign-material-in-the-central-nervous-system-of-pediatric-autopsy-patients-with-instrumented-heart-disease
#18
Matthew Torre, Mirna Lechpammer, Vera Paulson, Sanjay Prabhu, Audrey C Marshall, Amy L Juraszek, Robert F Padera, Elizabeth A Bundock, Sara O Vargas, Rebecca D Folkerth
Upon detection of foreign-body embolization to the central nervous system (CNS) following a specific invasive cardiovascular procedure in 1 autopsied child, we undertook a quality assurance analysis to determine whether other patients had had similar events. Autopsies of all infants and children with history of cardiac catheterization, heart surgery on cardiopulmonary bypass, and/or extracorporeal membrane oxygenation over a 5-year period at a single tertiary care institution were reviewed for light-microscopic evidence of foreign material...
May 19, 2017: Journal of Neuropathology and Experimental Neurology
https://www.readbyqxmd.com/read/28525553/evaluation-of-conventional-and-frozen-elephant-trunk-techniques-on-spinal-cord-blood-flow-in-an-animal-model%C3%A2
#19
Sergey Leontyev, Maja-Theresa Dieterlen, Michelle Halling, Franziska Schlegel, Alexandro Hoyer, Susann Ossmann, Kerstin Klaeske, Christian D Etz, Friedrich W Mohr
OBJECTIVES: The treatment of patients with extensive thoracic aortic disease involving the arch and descending aorta is often performed using the frozen elephant trunk technique (FET). Spinal cord blood flow (SCBF) in cervical, thoracic and lumbar sections prior, during and after aortic arch surgery were compared in conventional elephant trunk (cET) and FET technique in a pig model. METHODS: German Landrace pigs (75-85 kg) underwent aortic arch surgery using the FET ( n  = 8) or cET ( n  = 8) techniques...
May 18, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28525506/haptoglobin-administration-in-cardiovascular-surgery-patients-its-association-with-the-risk-of-postoperative-acute-kidney-injury
#20
Kenta Kubota, Moritoki Egi, Satoshi Mizobuchi
BACKGROUND: Acute kidney injury (AKI) often occurs after cardiac surgery. During cardiac surgery, plasma free hemoglobin (fHb) would increase due to hemolysis. Since plasma fHb is thought to be nephrotoxic, haptoglobin, which is an fHb scavenger, may have the potential to prevent postoperative AKI (pAKI). However, there have been few studies in which the association of intraoperative administration of haptoglobin with the incidence of AKI after cardiac surgery was assessed. METHODS: This study was a retrospective observational study to assess the independent association of intraoperative administration of haptoglobin with the incidence pAKI in cardiac surgery patients...
June 2017: Anesthesia and Analgesia
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