Cardiac and Thoracic Surgery

SALI BERISHA Universally known as a leading researcher in the field of cardiology, Sali conducted a research program on hemodynamics, focusing on the dynamics of blood flow, that is why his scientific papers were adopted by universities throughout Europe. A clever polyglot (Albanian, English, German, Russian, French, Italian), he deepened heart transplants and their efficacy on patients' lives and lectured in different academic contexts, too. Opening new horizons in the scientific fields by means of research, e. g. experiencing new surgical techniques, and improving the Health System became the key goals of his medical career.

Introduction: Despite extensive evidence that shows clinical of superiority of MiECC, worldwide penetration remains low due to concerns regarding air handling and volume management in the context of a closed system. The purpose of this study is to thoroughly investigate perfusion safety and technical feasibility of performing all cardiac surgical procedures with modular (hybrid) MiECC, as experienced from the perfusionist's perspective. Methods: We retrospectively reviewed perfusion charts of consecutive adult patients undergoing all types of elective, urgent, and emergency cardiac surgery under modular MiECC. The primary outcome measure was perfusion safety and technical feasibility, as evidenced in the need for conversion from a closed to an open circuit. A systematic review of the literature was conducted aiming to ultimately clarify whether there are any safety issues regarding MiECC technology. Results: We challenged modular MiECC use in a series of 403 consecutive patients of whom a significant proportion (111/403; 28%) underwent complex surgery including reoperations (4%), emergency repair of acute type A aortic dissection and composite aortic surgery (1.7%). Technical success rate was 100%. Conversion to an open circuit was required in 18/396 patients (4.5%), excluding procedures performed under circulatory arrest. Open configuration accounted for 40% ± 21% of total procedural perfusion time and was related to significant hemodilution and increase in peak lactate levels. Systematic review revealed that safety of the procedure challenged originated from a single report, while no clinical adverse event related to MiECC was identified. Conclusions: Use of modular MiECC secures safety and ensures technical feasibility in all cardiac surgical procedures. It represents a type III active closed system, while its stand-by component is reserved for a small (<5%) proportion of procedures and for a partial procedural time. Thus, it eliminates any safety concern regarding air handling and volume management, while it overcomes any unexpected intraoperative scenario.

65 2011;20:35-67 Abstracts ciated procedures were performed in 12 (24%) patients: coronary bypass grafts (n = 6), mitral valve repair (n = 4), mitral valve replacement (n = 1) and repair of ventricular septal defect (n = 1). Average cross clamp time was 137 (76-279) min and average cardiopulmonary bypass time was 191 (103-355) minutes. All patients required urgent surgery. Operative mortality was 7 patients (14%) and causes of death included myocardial failure (n = 4) and massive haemorrhage (n = 2). Six patients (13.9%) died after hospital discharge during the 18 years follow-up period and re-operation was required in 2 patients. Actuarial survival at 17.7 years was 53.8% and freedom from re-operation was 74.1%. Conclusion: Aortic root infections present a difficult surgical challenge in the setting of septic, haemodynamically unstable and coagulopathic patients. The aortic homograft provides an excellent option for replacing the infected aortic root, as it is a compliant conduit with low risk of infection, good haemodynamics and avoids the need for post-operative warfarin.

Introduction: Pneumothorax is defined as the presence of air in the pleural cavity, ie, the space between the chest wall and the lung itself. Pneumothorax is classified ethiologically into spontaneous pneumothorax and traumatic pneumothorax. Spontaneous pneumothorax is further classified into primary and secondary. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. It can also be caused by iatrogenic injuries. Spontaneous pneumothorax is a significant health problem because of the high recurrence rate (this is so called recurrent pneumothorax). The aim of the study: the review of modern diagnosis and surgical management of pneumothorax Methodology: This is a review article. We used Medline and Pubmed databasis for retrieving the literature. Conclusion: Pneumothorax, either spontaneous or traumatic, demands urgent intervention in order to normalize lung function and save life of the patient.

Artikkel annab ülevaate narratiivteraapia teoreetilistest alustest ja selle meetodi kasutamisest seoses kehakuvandi  kujunemisega  teisme- ja noorukieas. See on kirjutatud sooviga aidata kaasa teooria ja praktika lõimimisele kliinilises ja rakenduslikus sotsiaaltöös. Ülevaade põhineb narratiivteraapia kasutamise juhistel ja kirjandusallikatel, ühtlasi on artiklis kirjeldatu ka minu doktoriõpingute teema.
Tutvustan analüüsi aluseks olevat teaduskirjandust ja materjale narratiivteraapia kohta, alustades selle poststrukturalistliku teraapiameetodi kõige üldisemast raamistikust ning liikudes kitsamate kehakuvandit puudutavate alateemadeni. Narratiivteraapia põhimõtteid saab kasutada nii töös inimestega, kellel on moonutatud arvamus oma välimusest (nn keha düsmorfiline häire) kui ka näiteks kaasasündinud rindkere moonutusega inimeste puhul: mõlemal juhul võib tulla kõne alla kas kirurgiline või mittekirurgiline korrektsioon. Jättes kõrvale meditsiinilised sekkumised, analüüsin oma uurimistöös nii kirjandusest pärinevaid kui ka teraapia eri osapooltelt (noorukid ise, nende pered, terapeudid ja arstid) kogutud andmeid selle kohta, kuidas narratiivteraapia soodustab positiivse kehakuvandi kujunemist teismelistel ja noorukitel, võttes arvesse ka teraapias osalevate noorte sotsiaalkultuurilist konteksti. Kuna narratiivteraapia põhimõtteid saab kasutada igasuguse nõustamise puhul, siis pakuvad artikli järeldused huvi lugejatele, kes soovivad rohkem teada saada sellest lähenemisviisist ja selle kasutamise võimalustest rakenduslikus sotsiaaltöös.

In this clinical study hyperbaric ropivacaine in spinal anaesthesia for lower limb and hip surgery was evaluated and results obtained were compared with those using hyperbaric bupivacaine. Methodology: Two hundred patients scheduled for lower limb and hip surgery were randomly divided into two groups of 100 patients each. These patients received a spinal injection of either 3ml (15mg) of 0.5% hyperbaric ropivacaine or 3ml (15mg) of 0.5% hyperbaric bupivacaine using 25G Quincke type spinal needle. The parameters studied were -onset and total duration of sensory block, onset and total duration of motor block, quality of intraoperative anaesthesia, hemodynamic alterations, and any intraoperative and postoperative complications. Results: The mean onset of sensory block (6±1.3min vs. 3±1.1min; p value<0.05) and motor block (13±1.6min vs. 9±1.3min; p value< 0.05) was significantly slower in ropivacaine group as compared to bupivacaine group. The total duration of sensory block was significantly shorter in ropivacaine group (160±12.9min) than in bupivacaine group (260±16.1min; p value <0.05). The mean duration of motor block was also shorter in ropivacaine group compared to bupivacaine group (126±9.2min vs. 174±12.6min; p value<0.05). Conclusion: The quality of anaesthesia was excellent in both the groups. In conclusion, a solution of ropivacaine (hyperbaric) can be used for spinal anaesthesia and is comparable with hyperbaric bupivacaine in terms of quality of block, but has shorter recovery profile.

Of oncological patients who have undergone chest radiation therapy, 20% develop radiationinduced constrictive pericarditis. The purpose of this study was to review our clinic's experience of such cases, focusing on survival and the functional outcome.

Thoracic anesthesia for non-cardiac surgery in children remains a niche practice with significant
physiologic and anatomic constraints that distinguish it from a similar practice in adults. Specialized
knowledge of one lung ventilation techniques, various regional anesthesia techniques, and multimodal
approaches to post procedure analgesia, is essential to ensure safety and high-quality care. This review
addresses airway management and acute postoperative pain topics in children undergoing non-cardiac
thoracic surgery.

There is enormous evidence that the initiation and growth of atherosclerosis is highly influenced by hemodynamic factors. In this study, hemodynamic factors in the following patient specific 3D carotid artery models were studied: i) normal, ii) stenosis (with plaque near to bifurcation of internal carotid artery (ICA)), and iii) surgical model (plaque with surgically fitted Palmaz–Schatz stent). The 3D model of the carotid artery was formed from CT image of a patient through a commercial software MIMICS. The geometrical measurement taken from the 3D model was used to form its CAD model using CATIA software. The CAD model was meshed in ANSYS ICEM CFD module. The inlet- and outlet- boundary conditions were defined and material properties were given in CFX-Pre module of ANSYS. Then the solver input file was given to CFX solver manager for performing computational fluid dynamics (CFD) on the model. The outputs of the CFD analysis were observed in CFD-Post. The wall shear stress and blood velocity were greater both at near the bifurcation and at bend of the carotid artery model. The abnormal model is characterized by high wall shear stress in the stenosed portion which indicates greater probability of growth of plaque. Disturbed flow patterns and oscillating velocity indicate that the vulnerability of plaque formation is high in such places. The hemodynamic values have come back near to normal values in the carotid model fitted with stent. The observed variations in hemodynamic factors in the carotid artery with plaque surgically fitted with stent were compared to its normal model. This information can be used to predict restenosis in future.

Background: Worldwide people of all ages are affected by the Noncommunicable Diseases (N.C.D.) and it
is a leading cause of death globally. According to the World Health Organization (WHO), 41 million people
die due to noncommunicable diseases which is equal to 71% of all death globally in which cardiovascular
diseases are the most common cause for death. The International Institute of Population Sciences stated that
from 1990 to 2016, the contribution rate of mortality of cardiovascular diseases is increased by 34.3% in India.
The more common leading cause of cardiovascular diseases are Coronary Artery Disease (CAD) and Stroke,
also WHO says in 2017, CAD is the leading cause of death and which is 15.6%. To treat these critical
conditions of coronary artery disease patients should undergo cardiac surgery which is known as Coronary
Artery Bypass Grafting Surgery (CABG). According to the A.H.A., Cardiac Rehabilitation is a
comprehensive exercise, education and behavioural modification program design to improve the physical and
emotional condition of patients with heart disease. Early mobilization includes an active range of motion,
thoracic mobility, bedside sitting, chair sitting, hall ambulation (chair sitting). With all these techniques, there
are mechanical devices available to improve oxygenation they known as positive pressure devices such as
Acapella, Flutter, Bubble-PEP, RC-Cornet. Bubble P.E.P. also used to prevent pulmonary complications in
postoperative open-heart surgery patient. On the other hand, the therapist-made bubble-PEP device which is
made from inexpensive and easily accessible materials consisting of a container (e.g. bottle) and tubing.
Therefore, the bubble P.E.P. is relatively cheaper and readily accessible.
Aim: To compare the effect of BBPEP Device and Acapella on Oxygenation and PEFR among patients with
open-heart surgery.
Objectives:
1. To compare the effect of BBPEP Device and Acapella on FiO2 and SpO2 among patients with openheart surgery.
2. To compare the effect of BBPEP Device and Acapella on PEFR among patients with open-heart
surgery.
Methodology: The study done on 54 samples. Samples were randomly divided into two groups, i.e. BBPEP
and Acapella group. Both the group received intervention from P.O.D. 1 to 3 twice a day. FiO2, SpO2 and
PEFR were taken pre- and post-treatment in every session. Data were collected and analysis was done.
Statistical analysis: normality was checked by using Kolomogrov-Smirnov Test. Data did not pass the
normality test, so a non-parametric test was used for data analysis.
Result: There was no significant difference between both groups.
Conclusion: The BBPEP and Acapella is equally effective in improving oxygenation and PEFR in the patient
who undergo open-heart surgery.
Keywords: BBPEP, Acapella, PEFR, FiO2, SpO2, Open Heart Surgery

In his dissertation, Ticchi specifically focuses on the life stories of shadows - youths with a chest wall deformity (pectus excavatum, carinatum, etc.). Especially he focused on the congenital condition pectus excavatum, which is the most typical deformity of the upper body. The deformity causes shame and could evoke suffering, ridicule, and depression. ‘In fact, as a consequence of the societal and virtual preference for sexually objectified bodies with bare, muscular torsos, the social and self-stigma of living with a congenital anomaly of the chest wall plays an important role,’ Ticchi says. According to Ticchi, the youths and their families are often in a situation where they are unable to get professional help and where they lack knowledge about both the surgical and the psychosocial treatment options. Nowadays, most chest wall deformities can be surgically treated. However, Ticchi’s dissertation suggests that clinical social work practice with a narrative therapy approach could be used as a liberating and supportive method to surgical treatment. Telling stories would help youths with the deformity to better understand the problems associated with their body image and to learn to live with it. Ticchi says that the purpose of his dissertation is to find out how the narrative therapy approach in the treatment of physical anomalies could offer psychosocial support in a society that glorifies body perfection. ‘Trained clinical social workers could use accordingly their scientific knowledge and skills to support families to face the crises when a yes-or-no question about surgical repair significantly interferes with their optimal decision-making due to the family’s distress, in a continued emphasis on shadows being seen as diagnostic categories upon which a treatment plan is executed for the remediation of the problem,’ Ticchi finds. In addition, thanks to trained clinical social workers, the families would be more informed about the causes, nature, cost, treatment, and results of chest wall deformities. By using a narrative therapy approach, Ticchi’s dissertation opened a new focus for social work, which is more oriented to problems than disciplines, and which advocates the interdisciplinarity of thoracic surgery with clinical social work practice. In his dissertation, Ticchi uses data collected from both literature and different parties of the interviews (shadows themselves, their families, and so on).

The public defence of 'Slender shadows of youths: A narrative therapy approach to explore life stories about social and self-stigma of chest wall deformities for clinical social work practice', the dissertation of Davide Ticchi, doctoral student of the School of Governance, Law, and Society of the Tallinn University, took place on Monday, 2 September. The supervisor of the doctoral dissertation is Merike Sisask, Professor of Social Health Care at Tallinn University. Opponents are Professor Diana DiNitto (University of Texas at Austin) and Meyer Children's Hospital Professor Antonio Messineo (University of Florence). The doctoral thesis is available in Tallinn University Digital Library: https://www.etera.ee/s/2QrzDhxdMo

Doxorubicin (DOX) is a broad spectrum anthracycline antibiotic used
to treat multiple cancers. The use of DOX is limited by significant
cardiotoxicity,  hepatotoxicity  and  nephrotoxicity.  Quercetin  is  a
dietary-flavonoid found in plants which prevents oxidant injury and
protects against lipid peroxidation. The objective of the present study
was to assess the possible protective role of quercetin on doxorubicin
induced  hepatic,  cardiac  and  renal  toxicity  in  male  Wistar  rats.
Doxorubicin  (10mg/kg  body  weight)  was  administered  twice  and
quercetin  (100mg/kg  body  weight)  was  administered  on  all  the  21
days of the experimental period. Body weight, heart weight, creatine
kinase in serum and heart, the activities of the antioxidant enzymes in
liver,  heart  and  kidney  were  decreased  in doxorubicin  administered
rats. Liver and kidney weight, liver marker enzymes in serum, liver
and  kidney,  lactate  dehyrogenase  in  serum,  liver,  heart  and  kidney,
urea and creatinine in serum, lipid peroxide content in liver, heart and
kidney were increased. All the biochemical parameters mentioned
above  were  restored  to  near  normal  levels  on  quercetin
administration with doxorubicin. Administration of doxorubicin in
rats  altered  the  biochemical  parameters  but,  did  not  cause  much
effect on the tissues such as liver, heart and kidney which is evident
with histological studies.

We describe  a 67-year-old  man with  a primary diagnosis  of  left  atrial  myxoma.  Preoperative coronary angiography revealed a significant three-vessel disease. The patient underwent surgery, comprising the complete resection of the left atrial mass concomitant with coronary artery bypass grafting. He had good recovery without any complications in the early and late follow-up. There was no residual tumor or recurrence. The histopathological examination of the mass confirmed the diagnosis of the left atrial myxoma. (Iranian Heart Journal 2015; 16(3): 54-56)

postoperative chylothorax eComment: Supradiaphragmatic ligation of the thoracic duct for prevention of http://icvts.ctsnetjournals.org/cgi/content/full/10/1/139 located on the World Wide Web at: The online version of this article, along with updated information and services, is 1569-9293. (ESCVS).

Chest wall invasion is seen in 5% to 8% of patients presenting with lung cancer. We report a case of complete resection of a 14 cm × 9 cm pT3N0M0 squamous cell carcinoma arising from the right lower lobe and invading the lower chest wall posteriorly, in a 75 years old male, via a hybrid thoracoscopic [video assisted thoracoscopic surgery (VATS)] approach. Following conventional VATS lobectomy, a targeted 10 cm
incision was performed to allow wide resection of the 7th to 10th ribs and 6th to 9th transverse processes, with the defect being subsequently reconstructed with a composite rigid prosthesis. The patient made an
uneventful recovery, and was discharged on the 3rd postoperative day; with later adjuvant chemotherapy. Thoracoscopic surgery is not currently widely adopted in patients with chest wall invasion, likely due to the technical difficulties. We briefly review the various techniques described in the current literature, whilst emphasising a role for such an approach in highly selected cases.

This study was aimed at determining major accessory fissures (MAF) and absence or incompleteness of lobar or major fissures (MF) during routine forensic autopsies. Prior to starting this prospective study, forms were prepared to collect data on pulmonary lobes and fissures. In this study, 420 lungs of 210 autopsy cases were examined for incompleteness and absence of MF and complete accessory fissures. Horizontal fissures were incomplete in 18 right lungs. Incomplete oblique fissures were noted in three right and two left lungs. Unidentified abnormal fissures were determined in one left lung and five right lungs. The most common fissural abnormality was less than half complete horizontal fissure. Four right lungs had four lobes and two left lungs had three lobes because of complete accessory fissures. The number of lobes in the left and right lungs and the morphological features of both incomplete MF and MAF were determined in detail and the variations
were photographed. It is concluded that, in addition to studies on computed tomography scans, autopsy series are useful for determining the variations of MF and MAF of the lungs in different populations.

The dependence of forearm rotations on the distal radius - ulna fractures has been studied using the variables like radial inclination, ulnar variance, dorsal/volar tilt which are varied in most of the fractures of distal end radius and ulna fractures.

Background: Previous studies have shown that the outcome of lung cancer patients who were admitted to the Intensive Care Unit (ICU), especially those requiring mechanical ventilation, is extremely poor. The present study was conducted in order to assess the outcome of a recent cohort of lung cancer patients admitted to the ICU with acute respiratory failure. Methods: A retrospective analysis of the medical records of 105 lung cancer patients who were admitted to the ICU between January 2008 and January 2011 was performed. Severity of illness on the first day of ICU admission was assessed using the acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) scoring systems. Associated organ failure was determined according to the Knaus criteria. Results: Eighty four (80%) patients were diagnosed with non-small cell lung cancer, 14 (13.3%) with small cell lung cancer, one patient with mesothelioma, and in the remaining 6 patients, the type of lung cancer could not be determined. Significant factors on admission were APACHE II and SOFA scores, poor performance status and severe comorbidity. During ICU stay, the main risk factors for poor outcome were the long term mechanical ventilation duration, use of vasopressors, more than two organ system failures and septic condition. The overall ICU, hospital and 6-month mortality rates were 44.7% (47/105), 56.1% (59/105) and 77.1% (81/105) respectively.

OBJECTIVES: The decision to proceed with surgical treatment for pectus excavatum (PE) is rarely clear-cut. Patients interested in treatment are referred for evaluation by numerous different specialists, but psychosocial counselling is currently not included in this process. Our objective was to assess whether PE patients would be interested in formal assistance with the decision-making process surrounding PE surgery using narrative therapy principles. METHODS: Ninety-seven untreated PE patients at 5 different institutions in 4 countries completed a questionnaire consisting of 13 questions , with 3 questions specifically evaluating interest in narrative therapy. RESULTS: Eighty-two percent of participants were interested in narrative therapy to assist with the decision-making process surrounding PE surgery. Individuals most interested in narrative therapy tend to be more interested in correction (P < 0.05) to improve the way they feel about their body (P < 0.05). CONCLUSIONS: The majority of PE patients are interested in narrative therapy to aid the decision-making process about treatment. We propose that narrative therapy should be offered to PE patients during the treatment evaluation process to address the psychosocial difficulties associated with PE and the surgical decision-making process overall. Future studies should assess the effectiveness of this interdisci-plinary model.

Regarding the second question, this is another key point. You are right, in the analysis of our data, three out of four female patients with recurrence had endometriosis, and in two of these, we were able to detect intraoperatively by inspection of the diaphragm the typical brown fenestration. These two patients underwent hormonal therapy.

Introduction: Pneumothorax is defined as the presence of air in the pleural cavity, ie, the space between the chest wall and the lung itself. Pneumothorax is classified ethiologically into spontaneous pneumothorax and traumatic pneumothorax. Spontaneous pneumothorax is further classified into primary and secondary. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. It can also be caused by iatrogenic injuries. Spontaneous pneumothorax is a significant health problem because of the high recurrence rate (this is so called recurrent pneumothorax).

The aim of the study: the review of modern diagnosis and surgical management of pneumothorax

Methodology: This is a review article. We used Medline and Pubmed databasis for retrieving the literature.

Conclusion: Pneumothorax, either spontaneous or traumatic, demands urgent intervention in order to normalize lung function and save life of the patient.

The Nuss procedure is a minimally invasive method for the correction of pectus excavatum, with several centers reporting its successful application. Complications related to the Nuss procedure are not uncommon and life-threatening complications have been reported. This study focuses on the incidence and management of complications in a series of 167 children and adults with funnel chest corrected by Nuss procedure. Guidelines and strategies to avoid the most common and typical complications are proposed. All patients with funnel chest, operated between April 2000 and 2006 were evaluated prospectively. Our surgical approach involved the submuscular insertion of the pectus bar under right-sided thoracoscopic control. The bar was secured in most cases with one stabilizer on the right side on the underlying rib to prevent bar displacement. Postoperative pain was primarily managed by epidural catheters. All data in the patient report forms was prospectively entered in a database. All complications were documented and classified into major or minor complication. A major complication was noted, if an organ injury occurred or if a significant surgical intervention became necessary. A minor complication was documented, if either an endoscopy or an evacuation of fluid or gas from the thorax by puncture were necessary. One hundred and sixty seven patients (136 males and 31 females) with a mean age of 16.3 (range 5–40 years) were included in this study. Major complications occurred in seven patients (4.2%) and consisted of one intraoperative heart perforation, one piercing of the liver with the trocar, bar infections (n = 2) and significant bar displacement (n = 3). Minor complications were seen in 122 patients (73.1%) and consisted of breakage of wires used to secure the lateral stabilizer plate (n = 48), pleural effusions (n = 28), intraoperative rupture of the intercostal muscle (n = 15), pericardial tears without clinical significance (n = 7) and lung atelectasia (n = 4). Major complications related to the Nuss procedure were rare but preventable and could mainly be attributed to the learning curve. Most minor complications can be avoided by changing the technique, e.g. fixation of the bar and the stabilizer onto the underlying rib, use of PDS cords instead of metal wires to fix the bar and the stabilizer, entrance into and exit of the thorax medial to the rim of the pectus excavatum, etc. Some complications are related to the technique, such as minor pleural effusion or remaining gas in the thorax. Clear guidelines in regard to the technique are presented to prevent the majority of complications and thereby shorten the learning curve.

Becker muscular dystrophy (BMD) has onset usually in childhood , frequently by 11 years. BMD can present in several ways such as waddling gait, exercise related cramps with or without myoglobinuria. Rarely cardiomyopathy might be the presenting feature. The evolution is variable. BMD is caused by dystrophin deficiency due to inframe deletions, mutations or duplications in dystrophin gene (Xp21.2) We review here the evolution and current therapy presenting a personal series of cases followed for over two decades, with multifactorial treatment regimen. Early treatment includes steroid treatment that has been analized and personalized for each case. Early treatment of cardiomyopathy with ACE inhibitors is recommended and referral for cardiac transplantation is appropriate in severe cases. Management includes multidisciplinary care with physiotherapy to reduce joint contractures and prolong walking. BMD is slowly progressive with phenotypic variability. Despite childhood onset, independent walking is never lost before the third decade. Personalized medicine is required to tailor treatment to individual cases.

The purpose of this investigation was to evaluate factors affecting the outcome following penetrating cardiac trauma in a developing country and to compare our results with others in developed countries. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, SBP, GCS, ISS, RTS, TRISS and mortality were performed. This study included 35 patients; all were males. Mortality rate was 22.8%. It was significant with low SBP (p =0.021), GCS ˂ 9 (p =0.02), non-presentation with tamponade (p = 0.023), low ISS (p =0.02), low RTS (p =0.007), low TRISS (p = 0.003), less blood transfusion (p =0.001) and longer time before entrance to OR (p= 0.019). Meanwhile, mortality were not significant with age (p =0.33), mechanism of injury (p =0.16), other associated injuries (p =0.16) or associated intra-abdominal injuries (p= 0.16). Rapid assessment and prompt surgical intervention may reduce mortality. Even in a developing country, mortality rates could reach those in developed countries depending on clinical skills and accessible technology tools.

Partial pulmonary venous return anomaly (PPVRA) is defined as one or more of the
pulmonary veins drain into the right atrium or a systemic vein such as superior vena cava (SVC),
inferior vena cava (IVC), azygos, hepatic or portal vein. Diagnosing of PPVRA is often clinical challenging. Onset clinical manifestation and progression of the disease vary significantly depending on
the amount of the intra-cardiac shunt. Signs or symptoms may include dyspnea, atrial arrhythmia,
right heart failure and pulmonary hypertension, transient ischemic attack (TIA), or stroke. In this
article, we aimed to present a 39-year-old female patient who underwent Warden Procedure with
the diagnosis of PPVDA.

Background: Papillomatosis presents, most frequently, as multiple lesions of the respiratory tract, which are usually considered benign. Malignant degeneration into squamous cell carcinoma is quite common, although curative approaches vary a lot in modern literature. Case report: We report a case of a 66-year-old male patient with the coexistence of multiple squamous cell papilloma and carcinoma in the upper trachea with severe airway obstruction that was diagnosed through bronchoscopy and treated by performing an urgent tracheostomy, followed by concurrent chemotherapy and radiotherapy. There was no evidence of recurrence after a 12-month follow-up period. Conclusion: This study underlines the diagnostic and therapeutic value of bronchoscopy as well as multimodality palliative treatment in such cases. To the best of our knowledge, this is the first study to describe an immediate treatment protocol with tracheostomy and concurrent chemotherapy/radiotherapy in a patient with squamous cell tracheal papilloma and carcinoma.

9:644-Interact CardioVasc Thorac Surg Nikolaos Barbetakis, Christos Asteriou, Ioannis Boukovinas and Christodoulos Tsilikas metastases from colorectal cancer eComment: The role of lymph node dissection in pulmonary resection for http://icvts.ctsnetjournals.org/cgi/content/full/9/4/644 located on the World Wide Web at: The online version of this article, along with updated information and services, is 1569-9293. (ESCVS).

Mediastinal thoracic duct cyst is a rare benign cystic disease. The lesion is generally in the post-erior or superior mediastinum, where the thoracic duct passes. We herein report an extremely rare case of surgically resected anterior mediastinal thoracic duct cyst. A thoracic duct cyst should be considered as an uncommon differential diagnosis of an anterior mediastinal lesion.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-...

Both the fetus and mother are under tremendous life threatening stress in case of an aortic dissection during pregnancy. We present case of a 25 years old diagnosed case of Marfan Syndrome primigravida at 29 weeks of gestation. The patient was referred from a clinic due to nausea, vomiting and dyspnea. Aortic dissection (AD) was evident upon Echocardiography. The patient was under observation when she suddenly developed jaw, chest and back pain. Her first degree relative (father) had died due to an AD at the age of 25. The patient was resuscitated and all possible medical efforts were taken along side an emergency cesarean section but the patient died soon after the delivery. Awareness needs to be raised in such medical cases and a clinical approach needs to be developed for critical care of pregnant patients. Proper surgical techniques and use of better medical technology are required to make and early diagnosis. Further studies/ case reports around the world would assert our findings and lead to better treatment options.

Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n 5 75) included patients operated on MiECC, while group B (n 5 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end-point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 6 25 vs. 122.2 6 33 min, P <0.001), peak troponin release (0.07 6 0.02 vs. 0.1 6 0.04 ng/mL, P < 0.01), peak creatinine levels (0.97 6 0.24 vs. 1.2 6 0.3 mg/dL, P < 0.001), duration of mechanical ventilation (14.1 6 7.2 vs. 36.9 6 59.8 h, P < 0.01) and ICU stay (2.1 6 0.7 vs. 4.4 6 6.4 days, P < 0.01). However, need for intraoperative blood transfusion showed a trend towards a gradual decrease as experience with MiECC system was accumulating (R 2 5 0.094, P 5 0.007). Subsequently, operational learning applied to postoperative hematocrit and hemoglobin levels (R 2 5 0.098, P 5 0.006). We identified that advantages of MiECC technology in terms of reduced hemodilution and improved end-organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology.

Giant pulmonary hamartoma though a benign lesion can grow up to large size occupying a major part of the hemithorax and can cause mechanical compression to the adjacent structures, It is a spot radiological diagnosis in Chest X ray owing to it s characteristic pocorn calcifications.So far only 15 cases of Giant Pulmonary hamartomas are reported in English Literature and hence the interest in publishing.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-...