Elective Primary or Secondary Delayed Sternal Closure Improves Outcome in Severely Compromised Patients.

BACKGROUND: Delayed sternal closure (DSC) in patients with severely compromised preoperative hemodynamics can be helpful as the chest sometimes cannot be able to contain both lungs and heart. We report our experience to evaluate the midterm results of this strategy in an adult population. MATERIALS AND METHODS: From May 2009 till July 2015, 33 patients had DSC as first treatment of severe hemodynamic deterioration after cardiac surgery. Surgical procedures were valvular (9.27%) or coronary artery bypass grafting + others (24.73%). Stepwise logistic regression (SLR) showed that patients with lower ejection fraction, dilated right ventricle, and severe pulmonary hypertension were more likely to need DSC. Patients were divided in two groups: group A (n = 17), when the sternum was reopened before any hemodynamic collapse, or was never closed, and group B (n = 16), when the sternum was reopened after hemodynamic collapse. RESULTS: Inhospital mortality was 39% (n = 13), 18% in group A and 62% in group B (p < 0.0001). In 28 patients where the sternum was reopened, cardiac index increased from 1.7 (1.6, 1.9) L/m2 to 2.8 (2.4, 3) L/m2, p < 0.0001. The sternum was closed in 28 patients (85%), 94% in group A and 75% in group B (p = 0.13), after a median of 4 (2.5) days. SLR showed that only group B (p < 0.0001) was a risk factor for early death. Two-year survival was 48 ± 9%, higher in group A (71 ± 13) than in group B (25 ± 11), p < 0.0001. Cox's analysis showed that group B (p < 0.0001) and redo (p < 0.0001) were risk factors for lower survival. CONCLUSION: Elective DSC represents a useful strategy in severely compromised patients, entailing an improvement of hemodynamics and a higher survival.

An update of the blow flies (Diptera: Calliphoridae) of the Galápagos Islands, and first record of Chrysomya rufifacies (Macquart) from mainland Ecuador.

Seven species of Calliphoridae are reported from the Galápagos Islands, Ecuador: Lucilia pionia (Walker), L. setosa (James), L. deceptor (Curran), L. eximia (Wiedemann), Cochliomyia macellaria (Fabricius), Chrysomya albiceps (Wiedemann), and Chrysomya megacephala (Fabricius). Lucilia eximia is newly recorded from the islands. Lucilia sp. near pionia is recorded from the island of Española. The distribution and collection records of these species are discussed and listed, and a key to their identification is provided. Chrysomya rufifacies (Macquart) is reported for the first time from mainland Ecuador and the identification of this species is outlined.

An accidental but safe and effective use of Lucilia cuprina (Diptera: Calliphoridae) in maggot debridement therapy in Alexandria, Egypt.

The calliphorid fly, Lucilia cuprina (Wiedemann), is known to cause serious malign myiasis in animals, whereas its sibling species Lucilia sericata (Meigen) is commonly a carrion breeder and is used in maggot debridement therapy (MDT). The current study reports an accidental involvement of L. cuprina in MDT in Alexandria, Egypt, that has proved to be safe and effective. In November 2008, the laboratory colonies of L. sericata (the species regularly used in MDT) at the Faculty of Science, Alexandria University were renewed by Lucilia flies collected as third instar larvae on exposed rabbit carcasses. Flies from the new colonies were successfully used to heal the diabetic foot wounds of two patients at Alexandria Main University Hospital. Analysis of DNA sequences and adult and larval morphology then revealed that these flies were and still are L. cuprina. Breeding of this species in carrion in Alexandria is a new record. Despite the safety of this strain of L. cuprina in MDT, entomologists rearing blow flies for the purpose of wound debridement should regularly maintain high quality assurance of their species' identity to avoid possible clinical complications that may result from the introduction of an unexpected and invasive species to their laboratory colonies.

Revision of the Nearctic Calliphora Robineau-Desvoidy (Diptera: Calliphoridae).

The Nearctic species of Calliphora Robineau-Desvoidy are revised and all species are redescribed and/or diagnosed. Diagnostic characters to permit reliable identification of both sexes of Calliphora aldrichia (Shannon) and C. montana (Shannon) and detailed distributional records for both species are provided for the first time. A lectotype is designated for Calliphora loewi Enderlein, 1903. A revised key to the 13 species of Nearctic Calliphora is also included. The key is based on examination of over 1,000 specimens from across North America and the structure of the terminalia of both sexes of each species. Complete illustrations of the terminalia of both sexes are provided for all species, including those of eight poorly known species: Calliphora alaskensis (Shannon), C. aldrichia (Shannon), C. coloradensis Hough, C. grahami Aldrich, C. latifrons Hough, C. livida Hall, C. montana (Shannon) and C. terraenovae Macquart. The female terminalia of C. alaskensis, C. aldrichia, C. coloradensis, C. livida and C. montana are illustrated for the first time. Barcode data for all 13 species of Nearctic Calliphora are provided, several for the first time. Results support current species concepts but barcodes failed to distinguish C. aldrichia and C. montana.

Microalbuminuria and pegylated interferon in hepatitis-C patients.

To determine the relation between hepatitis C virus (HCV) genotype 4 and microalbuminuria in relation to hepatic histology and viremia in the absence of cryoglobulinemia and to examine the effect of treatment on microalbuminuria, we studied 400 HCV genotype-4-infected patients who were tested for microalbuminuria, albumin creatinine ratio (ACR), urea, creatinine and estimated glomerular filtration rate (eGFR). The parameters were measured again in the HCV patients after six months of treatment with pegylated interferon and ribavirin. Microalbuminuria was detected in 56 (14%) HCV-positive patients. There was a highly significant reduction in the microalbuminuria levels among the HCV-positive individuals after six months of therapy (P <0.001). Microalbuminuria was significantly associated with older age [Odds Ratio (OR): 1.1, 95% confidence interval (CI): 1.0-1.2, P = 0.01], elevated creatinine (OR: 0.09, 95% CI: 0.01- 0.7, P = 0.02), high modified Histological Activity Index score (OR: 1.5, 95% CI: 1.1-1.5, P = 0.004) and increased viral load (OR: 2.8, 95% CI: 1.1-6.6, P = 0.01). Sustained virological response (SRV) was achieved in 272 (86%) patients. The individuals with SVR had lower microalbuminuria post-treatment (P = 0.56). We conclude that HCV infection can be associated with microalbuminuria, which can be reduced by the use of a combination therapy of pegylated interferon-ribavirin.

First record of Lucilia bufonivora Moniez, 1876 (Diptera: Calliphoridae) from North America and key to North American species of the L. bufonivora species group.

The obligate anuran myiasis blow fly Lucilia bufonivora Moniez is reported from North America for the first time. The L. bufonivora species group is defined on the basis of the aedeagus and the history and biology of the North American species (L. bufonivora, L. elongata Shannon and L. silvarum (Meigen)) are discussed. A key is provided to separate the three North American species of this group. The North American species L. thatuna Shannon, a member of the L. sericata (Meigen) species group, is also treated because it is likely a parasite of anurans and is poorly known. The male abdominal sternites, aedeagus (L. elongata only), pregonites, postgonites, bacilliform sclerites, ejaculatory sclerites, and female ovipositors and spermathecae of L. elongata and L. thatuna are illustrated for the first time. 

Intraoperative coronary artery spasm after off-pump coronary surgery.

Coronary artery spasm is rare after coronary artery bypass surgery. We describe a case of intraoperative severe native coronary artery and graft spasm after successful off-pump coronary bypass surgery in a 55-year-old man, which was detected by suspicious electrocardiographic changes, and documented postoperatively by coronary angiography.