Right ventricular laceration caused by sternal wire fracture following cardiac surgery: a case report.

Sternal dehiscence and sternal wire fractures are of significant concern for patients post cardiac surgery. Right ventricular laceration resulting from injury secondary to fractured sternal wires is a rare cause of life-threatening postoperative hemorrhage. A 68-year-old male presented for coronary artery bypass grafting (CABG). Postoperatively, he experienced an exacerbation of chronic obstructive pulmonary disease (COPD) which initially responded to medical treatment. While mobilizing, the patient experienced acute hemodynamic decompensation. Chest X-ray revealed a new left pleural effusion and a bedside echocardiogram revealed significant pericardial effusion. The patient was taken urgently for re-exploration with a diagnosis of cardiac tamponade. All sternal wires were found to be fractured and a right ventricular laceration was identified. The laceration was repaired primarily with sutures and the sternum was closed with reinforced sternal wires. The patient recovered well postoperatively and was discharged without further complication. Postoperative hemorrhage is a known complication of cardiac surgery but is rarely caused by laceration secondary to sternal wire fracture. Alternative sternal closure techniques should be considered in high-risk groups of patients. A high index of suspicion should be maintained for patients with sternal dehiscence. Furthermore, these patients should be monitored closely and definitive management implemented immediately when sternal wire fracture and resulting injury are suspected.

Central Serous Chorioretinopathy: Clinical Characteristics Associated with Visual Outcomes.

PURPOSE: Retrospective cohort study to identify clinical characteristics associated with poor visual acuity in central serous chorioretinopathy (CSC). MATERIALS AND METHODS: Charts of patients in a tertiary referral clinic diagnosed with CSC over a 13-year period were reviewed. Multivariate logistic regression analyses were performed to assess the relationship between several clinical characteristics and final visual acuity. RESULTS: Of 353 subjects with CSC, 258 had a minimum of 2 clinical assessments and adequate follow-up. Multivariate analysis showed that the followings were significantly associated with worse final visual acuity: older age at diagnosis, history of photodynamic therapy, choroidal neovascularization (CNV), hypertension, and either prostate cancer or benign prostatic hypertrophy. Diabetes mellitus was associated with better final visual acuity. In a subgroup analysis of 150 subjects with at least 1 year of follow-up, CNV, hypertension, and gastroesophageal reflux disease were significantly associated with worsening of visual acuity over the study period. Use of a psychiatric medication at presentation was protective. CONCLUSION: Poor visual outcomes in CSC are associated with older age at diagnosis, CNV, hypertension, and history of prostate disease. Several clinical characteristics that have been identified as risk factors for developing CSC also appear to be associated with worse visual outcomes.

Reduction of Cholesterol and Fasting Blood Sugar Levels by One Month Supplementation of Fresh Garlic in Diabetic Libyan Patients: A Double Blind, Baseline Controlled Study

Background: The therapeutic effects of fresh garlic remain controversial. The aim of this study is to investigate whether supplementation of fresh garlic could improve blood glucose and cholesterol profile in Libyan diabetic patients with moderate blood cholesterol.Methods:Forty-six diabetic patients were randomly assigned to either fresh garlic alone (≈2 grams/day), or fresh garlic in combination with glibenclamide taken on an empty stomach every morning for a month. Serum blood glucose, cholesterol and blood pressure were measured before starting treatment and after the end of the treatment period.Results: Fresh garlic alone was able to decrease the mean serum cholesterol levels by 26 mg/dl (84% of the original base values), while the combination of fresh garlic and glibenclamide produced a 28 mg/dl decrease in the mean serum cholesterol (85% of the original base values). Fresh garlic alone was able as well to decrease the mean blood glucose levels by 20 mg/dl (85% of the original base values), while the combination of fresh garlic and glibenclamide produced a 60 mg/dl decrease in the serum glucose levels (72% of the original base values). Neither treatment had a significant effect on the mean systolic or diastolic blood pressures after 30 days of treatment.Conclusion: Administration of fresh garlic every morning for a month significantly reduced the blood cholesterol and fasting blood glucose levels in diabetic patients. Thus administering dietary fresh garlic daily to diabetic patients might have cardio-protective effects on diabetic patients

Operative Myocardial Protection in Patients with Left Ventricular Hypertrophy: The Role of Systemic Hypothermia.

OBJECTIVES: Myocardial hypertrophy represents a great challenge in cardiac surgery. Several strategies have been described to protect the hypertrophied myocardium during cardiopulmonary bypass, and aortic clamping, yet the ideal strategy has not been identified. This study investigates the use of moderate systemic hypothermia (MSH) as an adjuvant method to protect the hypertrophied myocardium in patients undergoing aortic valve replacement (AVR). METHODS: Twenty eight patients undergoing AVR were divided into two groups, (Group I) received continuous cold 5-8 °C retrograde blood cardioplegia (CRBC) and their body temperature was cooled down to 23-26 °C. (Group II) also received CRBC but their body temperature was kept at 32-34 °C. RESULTS: No operative morality (30 days) was noted in both groups. Postoperative reduction in ejection fraction (EF) was seen in nine patients of group I and in twelve patients of group II (P < 0.05). The need for multiple inotropes was more in group II (eight patients) than in group I (two patients) (P < 0.001). IABP was needed in three patients of group II and non in group I (P < 0.01). CONCLUSION: Moderate systemic hypothermia might have a role in protecting hypertrophied myocardium in patients undergoing AVR.

Impact of endoscopic versus open saphenous vein harvest techniques on outcomes after coronary artery bypass grafting.

BACKGROUND: Endoscopic saphenous vein harvest (EVH) decreases leg wound infections and improves cosmesis after coronary artery bypass grafting (CABG). Recent data, however, suggest that EVH may be associated with reduced graft patency rates. The objective of this study is to assess the effect of EVH on short-term and midterm outcomes after CABG. METHODS: Data were prospectively collected on all first-time isolated CABG and combined valve/CABG with saphenous vein graft between 1998 and 2007 at a single center. Patients having traditional "open" vein harvest (OVH) were compared with patients having EVH. Multivariate models were used to examine the risk-adjusted impact of EVH on postoperative leg infection, composite in-hospital adverse events, and individual and composite midterm adverse events. RESULTS: The study included 5,825 patients, of whom 2,004 (34.4%) had EVH. Patients having EVH were more likely to have ejection fraction less than 50% (32.0% versus 29.3%, p = 0.04), recent myocardial infarction (24.2% versus 18.3%, p < 0.0001), and left main disease (26.0% versus 22.1%, p = 0.0009). Median follow-up was 2.6 years. After risk adjustment, EVH was associated with reduced rates of leg infection (odds ratio 0.48, p = 0.003) but had no association with either in-hospital (odds ratio 0.93, p = 0.56) or midterm adverse outcomes (hazard ratio 0.93, p = 0.22). Endoscopic saphenous vein harvest was associated with reduced readmission to hospital for unstable angina (odds ratio 0.74, p = 0.01). CONCLUSIONS: Endoscopic saphenous vein harvest is associated with a lower rate of leg infection and is not an independent predictor of in-hospital or midterm adverse outcomes. Endoscopic saphenous vein harvest is a safe alternative to OVH for patients undergoing CABG with saphenous vein.

Intraoperative precise localization of paravalvular mitral leak by a simple surgical maneuver.

Paravalvular leak after mitral valve replacement is a known surgical problem. Its management is controversial and challenging. The first and the most important step is to localize the leaking spot precisely. Echocardiogram is the standard technique that is used to localize the leak. The echocardiogram is accurate most of the time; however, in some occasions it does not easily provide the exact orientation of the leaking areas. A simple operative maneuver, which was used to allow the surgeon to localize the leak visually, and have accurate and solid repair, is described below.

A waveguide irradiation chamber for destruction of red palm weevils (Rhynchophorus ferrugineus) inside a block sample of a palm tree trunk.

A simple waveguide irradiation chamber at 2.45 GHz. was locally constructed for controlled laboratory experiments to assess the potentiality of using microwave heating for irradiation of weevils (RPW) inside healthy and infected palm tree trunks. The chamber consists of an aluminum rectangular waveguide with one of its broad sides removed for easy insertion of the block samples of the palm tree trunk. A rectangular aluminum plate, with the same dimensions as the removed wall section was made to slide-in and cover the tree block sample after its insertion in the waveguide to insure continuity of metallic walls. Temperature rise in the samples were monitored by thermocouples inserted through holes drilled at different positions along one of the waveguide side walls. Results showed that 100% mortality rate could be obtained with the RPW samples at distances not more than 2-3 cm from the leading edge of healthy tree block samples and 4-5 cm from leading edge of infected samples. Hot spots were observed at the leading edge of the tree samples due to high absorption of microwave at these regions.