Surgical treatment of ventricular septal defect following myocardial infarction: a case report.

Ventricular septal defect after myocardial infarction is a rare but often life-threatening mechanical complication. The keys of management are a prompt diagnosis of ventricular septal defect and an aggressive approach to stabilize patient's hemodynamics. Invasive monitoring, judicious use of inotropes and vasodilators, and an intra-aortic balloon pump are recommended for the optimal support of patient's hemodynamics. The best results are achieved if optimally medically managed patients survive at least 4 weeks before elective surgery necessary for scar formation in a friable infarcted tissue. We report a case of acute myocardial infarction complicated by the rupture of ventricular septum. Instead of attempting an immediate surgical closure of ventricular septal defect, the postponed surgery was successfully performed 3 weeks after the occurrence of ventricular septal defect. Preoperatively, clinical and hemodynamic conditions of the patient were maintained stable with the support of an intra-aortic balloon pump and inotropes.

The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education.

OBJECTIVE: To determine whether 2-dimensional or 3-dimensional hepatic visualization is better for the medical students to be used while studying the clinical hepatic anatomy. MATERIAL AND METHODS: Twenty-nine patients who underwent surgical intervention due to focal hepatic pathology at the Department of General Surgery, University of Heidelberg, and at Clinics of Santariskes, Vilnius University Hospital were included in the retrospective cohort study. Before the surgical intervention, the computed tomography (CT) liver scan and 3-dimensional (3D) hepatic visualization were performed. A total of 58 2-dimensional and 3-dimensional digital liver images, mixed up in random sequence not to follow each other with a specially designed questionnaire, were presented to the students of Faculty of Medicine, Vilnius University. Their aim was to determine tumor-affected liver segments, to plan which liver segments should be resected, and to predict anatomical difficulties for liver resection. Results were compared with the data of real operation. RESULTS: The students achieved better results for tumor localization analyzing 3D liver images vs. CT scans. This was especially evident determining the localization of tumor in segments 5, 6, 7, and 8 (P<0.05). Furthermore, the results of proposed extent of liver resection have been found to be better with 3D visualization (mean+/-SD - 0.794+/-0.175) in comparison with CT scans (mean+/-SD - 0.670+/-0.200), (P<0.001). CONCLUSIONS: Computer-generated 3D visualizations of the liver images helped the medical students to determine the tumor localization and to plan the prospective liver resection operations more precisely comparing with 2D visualizations. Computer-generated 3D visualization should be used as a means of studying liver anatomy.

Morphometric study of age-related changes in the human intracardiac ganglia.

The present study was performed in order to determine morphological age-related changes of the human intracardiac ganglia. Paraffin sections of 40 ganglia from infants, adult and aged human hearts were stained with Picro-Mallory method. The ganglia area, nerve cell (with clearly visible nucleolus) area, neuron soma long axis length, perimeter, area of neuronal nuclei and neuron soma form factor were measured with the aid of computer images analyzing program "Sigma Scan Pro 5.0". Also, the neuronal density and the area occupied by nerve cells per ganglion section were calculated. The relative frequency of satellite cells, in close contact with nerve cell soma, was estimated. Based on the data of this study, we concluded that the area of ganglia, neurons and their nuclei increased with age. Neuronal packing density significantly decreased, but the area occupied by nerve cells within the ganglia decreased non-significantly. Satellite cells were more numerous nearby ganglion neurons from infant hearts. Shape factor of neurons was stable between the groups. In conclusion, the present study confirms significant differences in the morphology of the intrinsic cardiac ganglia with age.