A Case Report of Modified Cabrol Technique in a 60-Year-Old Male with Coronary Origin Anatomical Variant.

Introduction: Reconstruction surgery of the proximal aorta in most cases involves the use of an aortic conduit, followed by reimplantation of the coronary ostia. Although uncommon, the origin of the coronary arteries in certain anatomical variants poses additional difficulties when performing surgery on the aortic root and requires a different treatment rationale. Case report: We hereby present the case of a 60-year-old patient with multiple cardiovascular risk factors (smoking, arterial hypertension and dyslipidemia), suffering from severe degenerative stenosis of a bicuspid aortic valve, associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. The patient presented with severe degenerative bicuspid aortic valve stenosis associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. Following the preoperative assessment, it was decided that the best course of action was to perform surgery on the aortic valve and ascending aorta. During the surgery, the origin of the right and left coronary ostia were found at the level of the left coronary cusp, both forming a common coronary button. Due to this particular anatomical variant, it was decided to reimplant them as a common button onto the main conduit by means of an interposed No.10 PTFE (Polytetrafluoroethylene) vascular prosthesis. Conclusion: A rare case of aortic root surgery associated with coronary ostia origin variant "shotgun barrel", which required a different method of reimplantation: modified Cabrol technique.

Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report.

We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis.

Noninvasive continuous cardiac output by the Nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output.

BACKGROUND: The Nexfin uses an uncalibrated pulse contour method for the continuous measurement of cardiac output (CO) in a totally noninvasive manner. Since the accuracy of pulse contour methods and their ability to track changes in CO have been repeatedly questioned, we have compared the CO measured by the Nexfin (NAPCO) with the CO measured by the pulmonary artery catheter (PACCO) in cardiosurgical patients before and after preload-modifying maneuvers. METHODS: Twenty-eight patients who underwent on-pump cardiac surgery, of whom 18 were receiving vasopressor and/or inotropic therapy, were studied during the first postoperative hours. Preload modification, in the form of either a fluid challenge or a passive leg raising maneuver, was done whenever clinically indicated, with PACCO and NAPCO being simultaneously measured before and after each intervention. RESULTS: A fluid challenge was administered to 22 patients, and the passive leg raising maneuver was performed in 6 patients. These interventions were repeated in 19 patients producing a total of 47 pairs of measurements. At baseline, mean (±SD) CO was 4.9 ± 1.1 and 5.0 ± 1.4 L·min(-1), for the PACCO and NAPCO, respectively, bias 0.1 ± 1.0, 95% prediction interval -2.5 to 2.4 L·min(-1), and 39% of error. After preload modification, the mean CO was 5.6 ± 1.3 and 5.6± 1.5 L·min(-1) for the PACCO and NAPCO, respectively, bias -0.0 ± 1.1, 95% prediction interval -2.6 to 2.7 L·min(-1), and 38% of error. The correlation coefficients (r) between the PACCO and NAPCO before and after preload modification were 0.71 (95% confidence interval [95% CI], 0.53-0.82) and 0.70 (95% CI, 0.52-0.82), respectively. Preload modification induced similar absolute changes in PACCO and NAPCO (r = 0.9, P < 0.0001). A 4-quadrant scatter plot showed a concordance rate of 100% (95% CI, 80.5%-100%) between the changes in NAPCO and PACCO. Polar plot analysis demonstrated a small polar angle and radial limits of agreement well below the 30° benchmark. The area under a receiver operating characteristic curve, testing the ability of Nexfin to detect an increase of ≥15% in PACCO, was 0.974 (95% CI, 0.93-0.99). CONCLUSIONS: Although the Nexfin has limited accuracy when compared with the pulmonary artery catheter, it can reliably track preload-induced changes in CO in stable patients after cardiac surgery in the presence of moderate vasopressor and inotropic therapy. This ability, combined with its total noninvasiveness, fast installation, and ease of use, make the Nexfin a suitable monitor for the perioperative continuous measurement of CO. The reliability of this monitor in tracking the CO when significant changes in peripheral resistance take place still needs to be established.

Operational Limits of the Bulk Hybrid Liquid Membranes Based on Dispersion Systems.

Liquid membranes usually have three main constructive variants: bulk liquid membranes (BLM), supported liquid membranes (SLM) and emulsion liquid membranes (ELM). Designing hybrid variants is very topical, with the main purpose of increasing the flow of substance through the membrane but also of improving the selectivity. This paper presents the operational limits of some kind of hybrid membrane constituted as a bulk liquid membrane (BLM), but which works by dispersing the aqueous source (SP) and receiving (RP) phases, with the membrane itself being a dispersion of nanoparticles in an organic solvent (NP-OSM). The approached operational parameters were the volume of phases of the hybrid membrane system, the thickness of the liquid membrane, the working temperature, the flow of aqueous phases, the droplet size of the aqueous phases dispersed across the membrane, the nature and concentration of nanoparticles in the membrane, the pH difference between the aqueous phases, the nature of the organic solvent, the salt concentration in the aqueous phases and the nature of transported chemical species. For this study, silver ion (SI) and p-nitrophenol (PNP) were chosen as transportable chemical species, the n-aliphatic alcohols (C6…C12) as membrane organic solvents, 10-undecenoic acid (UDAc) and 10-undecylenic alcohol (UDAl) as carriers and magnetic iron oxides as nanoparticles dispersed in the membrane phase. Under the experimentally established operating conditions, separation efficiencies of over 90% were obtained for both ionic and molecular chemical species (silver ions and p-nitrophenol). The results showed the possibility of increasing the flow of transported chemical species by almost 10 times for the silver ion and approximately 100 times for p-nitrophenol, through the appropriate choice of operational parameters, but they also exposed their limits in relation to the stability of the membrane system.

Characterization and classification of Romanian acacia honey based on its physicochemical parameters and chemometrics.

Three groups of Romanian acacia honey, i.e., pure, directly adulterated (by mixing the pure honey with three sugar syrups), and indirectly adulterated (by feeding the bees with the same syrups), were characterized and discriminated based on their physicochemical parameters. Moisture, ash, 5-hydroxymethylfurfural (HMF), reducing sugars (fructose and glucose), and sucrose contents, free acidity, diastase activity, ratio between stable carbon isotopes of honey and its proteins (δ13CH and δ13CP) were evaluated. Adulteration led to a significant increase in sucrose content, HMF level, and Δδ13C = δ13CH‒δ13CP as well a decrease in reducing sugar content and diastase activity. Principal component analysis (PCA) and linear discriminant analysis (LDA) were applied to experimental data in order to distinguish between pure and adulterated honey. The most relevant discriminative parameters were diastase activity, HMF, sucrose, and reducing sugar contents. Posterior classification probabilities and classification functions obtained by LDA revealed that 100% of honey samples were correctly assigned to their original group.