scholarly journals Characterization of morphology and function of the ‘neo-atria’ after a modified Mustard operation

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Mohamed Nagy ◽  
Hatem Hosny ◽  
Amr El Sawy ◽  
Ahmed Mahgoub ◽  
Magdi H Yacoub
Keyword(s):  
Contractile Function ◽  
Postoperative Recovery ◽  
Long Term Results ◽  
3D Segmentation ◽  
Mustard Operation ◽  
The Right ◽  
And Function ◽  
Atrial Systole

Background: There is a pressing need to improve early and long-term results of the Mustard operation. A modification of the operation was introduced at the Aswan Heart Centre for this purpose which relies on creating new functional atria rather than the two rigid channels in the classical Mustard operation.Objectives: To evaluate the morphology and function of the neo-atria, shortly after modified mustard operation for a ‘neglected’ patient with TGA, VSD and severe pulmonary hypertension.Methods: A 6-year-old with neglected TGA, VSD and pulmonary hypertension presented with severe cyanosis, clubbing and haemoconcentration (Hb 22 g/dL), underwent the modified Aswan-Mustard operation (MAM) with rapid smooth postoperative recovery. Repeated 2D echograms and multi-slice CT scans, followed by 3D segmentation, were performed after the operation. The size, shape, and morphology of the neo-atria were measured and measurements of the patterns of instantaneous filling and emptying of the right and left ventricles were quantified.Results: The neo-systemic venous atrium consisted of three components with a combined volume of 78 mL/m2, all of which contributed to the reservoir, conduit, and importantly contractile function of the neo-atrium. The pulmonary venous atrium consisted of two components with a combined volume of 66 mL/m2. These measurements were made at atrial end diastole. The volumes of the systemic venous and the pulmonary venous diminished to 51 and 54 mL/m2, respectively, at the end atrial systole - indicating relatively preserved contractile functions.

scholarly journals (M,β)-Stability of Positive Linear Systems

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Octavian Pastravanu ◽  
Mihaela-Hanako Matcovschi
Keyword(s):  
Linear System ◽  
Linear Systems ◽  
Transient Behavior ◽  
Short Term ◽  
Time Dynamics ◽  
The Right ◽  
Long Term Behavior ◽  
Stability Concept

The main purpose of this work is to show that the Perron-Frobenius eigenstructure of a positive linear system is involved not only in the characterization of long-term behavior (for which well-known results are available) but also in the characterization of short-term or transient behavior. We address the analysis of the short-term behavior by the help of the “(M,β)-stability” concept introduced in literature for general classes of dynamics. Our paper exploits this concept relative to Hölder vectorp-norms,1≤p≤∞, adequately weighted by scaling operators, focusing on positive linear systems. Given an asymptotically stable positive linear system, for each1≤p≤∞, we prove the existence of a scaling operator (built from the right and left Perron-Frobenius eigenvectors, with concrete expressions depending onp) that ensures the best possible values for the parametersMandβ, corresponding to an “ideal” short-term (transient) behavior. We provide results that cover both discrete- and continuous-time dynamics. Our analysis also captures the differences between the cases where the system dynamics is defined by matrices irreducible and reducible, respectively. The theoretical developments are applied to the practical study of the short-term behavior for two positive linear systems already discussed in literature by other authors.

scholarly journals Bachmann bundle impairment following linear ablation of left anterior wall: impact on left atrial function

2020 ◽  
Author(s):  
Yanjuan Zhang ◽  
Fengming Wu ◽  
Yu Gao ◽  
Nan Wu ◽  
Gang Yang ◽  
...  
Keyword(s):  
Contractile Function ◽  
Anterior Wall ◽  
Activation Time ◽  
Linear Ablation ◽  
Measured Activation ◽  
Mechanical Remodeling ◽  
Activation Times ◽  
And Function ◽  
Bachmann Bundle

Background: We aimed to evaluate the effect of Bachmann bundle (BB) impairment on electrical and mechanical function of the left atrium (LA), as well as the long-term clinical impact of such impairment. Design: We measured activation time in the five LA walls in 56 patients with atrial fibrillation. LA reservoir, conduit, and contractile function were also evaluated. Patients were divided into two groups based on ablation strategy: the circumferential pulmonary vein isolation (CPVI) group and CPVI with anterior wall linear ablation (LAWA) group. Patients in the CPVI+LAWA group were divided into two sub-groups based on ECG differences following ablation: the BB impairment group and intact BB group. LA activation time and function were then compared between the ablation strategy groups and the CPVI+LAWA subgroups. Results: Patients in the CPVI+LAWA group exhibited longer activation times in the anterior and lateral walls of the LA, poorer LA synchrony, and reduced LA contractile and reservoir function when compared with those in the CPVI group. In the BB impairment subgroup, we observed a discrepancy between electrical/mechanical remodeling. Among five walls, activation time was longest in this region. BB impairment was also associated with reduced LA function. Conclusion: Significant changes in LA function and conductibility were observed in patients with anterior wall ablation, especially those with iatrogenic BB impairment.

scholarly journals Multidisciplinary approach in the treatment of ossifying fibroma: Case report

2020 ◽  
Vol 9 (10) ◽  
pp. e3779108833
Author(s):  
Luara Teixeira Colombo ◽  
Laís Kawamata de Jesus ◽  
Ana Flávia Piquera Santos ◽  
Henrique Hadad ◽  
Everton Pontes Martins ◽  
...  
Keyword(s):  
Bone Lesion ◽  
Facial Asymmetry ◽  
Postoperative Recovery ◽  
Ossifying Fibroma ◽  
Clinical Report ◽  
Total Excision ◽  
Stomatognathic System ◽  
Slow Evolution ◽  
The Right ◽  
And Function

Ossifying fibroma is a type of fibro-bone lesion characterized by asymptomatic volumetric increase, of slow evolution, which can reach large dimensions resulting in facial asymmetry, causing tooth displacement and functional impairment of the stomatognathic system structures. The purpose of this article was to the clinical report a case of a female patient, seen at the University Clinic, with a complaint of a volumetric increase in the right mandibular region with an evolution of approximately 1 (one) year. Before the total excision of the lesion, an incisional biopsy was performed with the diagnosis of ossifying fibroma. Due to the proportions of the lesion, the patient presented dysphagia, which resulted in an anemic condition, requiring normalization of the condition prior to the total excision of the lesion. After 6 months of follow-up, the patient showed significant improvement in the shape and function of the operated region, in addition to the nutritional deficiency. The assessment of the patient's nutritional status is extremely important, should not be neglected, since malnutrition is directly linked to the evolution of the disease, and interferes with postoperative recovery.

Characterization of TAPE-Gelatin as a Potential Bioadhesive

2020 ◽  
Vol 833 ◽  
pp. 189-193
Author(s):  
Angelica Aira A. Ayalin ◽  
Bernell Merwyn S. Go ◽  
Gail Edselle S. Reyes ◽  
Terence Tumolva
Keyword(s):  
Inguinal Hernia ◽  
Production Cost ◽  
Long Term Results ◽  
Medical Field ◽  
Hernia Sac ◽  
New Class ◽  
New Material ◽  
Medical Adhesive

Bioadhesives have much potential in the medical field as an alternative to sutures in internal surgery. They are easier to use and have better long-term results. Improvement of a new class of adhesives, tannic acid-polyethylene glycol (TAPE), was done by mixing it with gelatin, since it was found that TAPE alone could not be applied to certain internal applications like in inguinal hernia. It failed to close a fresh inguinal hernia sac. Characterization tests were done on the new material, TAPE-gelatin, which proved to have a tissue adhesion strength of 0.41 MPa which is 5 times greater than fibrin glue, good blood biocompatibility with blood clotting index of 97.46%, burst pressure strength that can withstand 1000 mL that is 10 times more than the volume in the peritoneal cavity, and cheaper, with a production cost of Php28.50, than commercially available bioadhesives, which can reach up to Php2,000 – Php30,000 per application. With its desirable properties, cheaper production cost, and large potential for scalability, TAPE-gelatin as a new candidate for medical adhesive was established.

scholarly journals 13-year Follow-up of Treatment of Osteochondral Lesions with MACI

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004 ◽  
Author(s):  
Chris Kreulen ◽  
Trevor Shelton ◽  
Jacqueline Nguyen ◽  
Eric Giza ◽  
Martin Sullivan
Keyword(s):  
Social Functioning ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Sf 36 ◽  
Significant Difference ◽  
And Function

Category: Ankle, Arthroscopy, Hindfoot, Sports, Trauma Introduction/Purpose: Surgical management of osteochondral lesions of the talus (OLT) present an ongoing treatment challenge. Previously, matrix-induced autologous chondrocyte implantation (MACI) demonstrated improved pain and function at 7-years postoperative, providing evidence that MACI is a reliable method for treating cartilage. However, it is unknown the long- term results of MACI in OLT. The purpose of this study was to assess 13-year clinical follow-up data and the long-term success of this implant by comparing patient reported outcome measures (PROMs) pre-operatively, at 7-years post-operative, and at 13- years post-operative. Methods: A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. Of the 10 patients, 9 were available for 7-year and 13-year follow-up. Short Form Health Survey (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot evaluation were utilized at pre-operative, 7-year, a 13-year postoperative. For each patient, a paired t-test was used to compare 13-year post-operative PROMs to pre-operative PROMs. A single factor analysis of variance (ANOVA) determined whether PROMs were different between pre-operative, 7-year post- operative, and 13-year post-operative time intervals. When a significant difference was detected, a post-hoc Tukey’s determined which time periods were different. Results: SF-36 data at 13-years showed significant improvements in Physical Functioning (p=0.012), Lack of Bodily Pain (p=0.017), and Social Functioning (p=0.007) compared with preoperative data. There were no differences in other components of the SF-36 outcomes (p>0.05). Although the AOFAS was on average 12 points higher at 13-years postoperative, this was not statistically significant (p=0.173). As for comparing PROMs over time, 13-years post-operative PROMs were comparable to 7-years post- operative (Table 1). There were better PROMs for Physical Functioning, Bodily Pain, and Social Functioning at 7- and 13-years post-operative compared to pre-operative while Physical Role Functioning was also better at 7-years post-operative compared to pre-operative. Conclusion: This study shows MACI provides greater pain relief and function at 13-years post-operative with stable long-term follow-up. MACI should be considered for osteochondral lesions that fail initial microfracture.

Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

2019 ◽  
Vol 29 (8) ◽  
pp. 1036-1039
Author(s):  
Yoichi Kawahira ◽  
Kyoichi Nishigaki ◽  
Koji Kagisaki ◽  
Takuji Watanabe ◽  
Kazuki Tanimoto
Keyword(s):  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Systolic Pressure ◽  
Cardiac Repair ◽  
Long Term Results ◽  
Arterial Oxygen ◽  
The Right

AbstractBackground:In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.Methods:Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.Results:There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.Conclusion:Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

scholarly journals P1731ABO INCOMPATIBLE DONOR KIDNEY TRANSPLANTATION IN PORTUGAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natalia Silva ◽  
Catarina Isabel Ribeiro ◽  
Jorge Malheiro ◽  
Manuela Almeida ◽  
Sofia Pedroso ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Infectious Complications ◽  
Long Term Results ◽  
First Year ◽  
Donor Pool ◽  
Bk Polyomavirus ◽  
Effective Therapeutic Strategy ◽  
Immunosuppressive Protocol ◽  
And Function

Abstract Background and Aims ABO incompatiblitity was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Method The authors present a single center retrospective observational study, that include the analyse of 12 patients who underwent ABOi kidney transplantation between November 2014 and July 2019. All patients received Rituximab (375mg/m2) pre-operation and started Tacrolimus, Mycophenolate Mofetil and Prednisolone one week before surgery. Plasmapheresis was done to remove anti-A or B antibodies until their titles were <1:8 during the first post-operative week and <1:16 at the second. Results : A total of 12 patients were included in the study, 75,0% male with 43 years (IQR 31-50) The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (17%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%. Conclusion ABOi kidney transplantation has become a routine procedure. By this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. Immunosuppressive protocol of this Center can be considered safe.

Double Prosthetic Repair for Complex Incisional Hernia Repair: Long-term Results and Evolution of the Technique

2015 ◽  
Vol 81 (11) ◽  
pp. 1138-1143 ◽  
Author(s):  
Alfredo Moreno-Egea
Keyword(s):  
Hospital Stay ◽  
Average Length ◽  
Incisional Hernia Repair ◽  
Postoperative Recovery ◽  
Long Term Results ◽  
Abdominal Wall Defects ◽  
Type I ◽  
Prosthetic Repair ◽  
Group 2

No single approach has emerged as the best way to close complex incisional hernias. The aim of this report is to present the long-term results with a double prosthetic repair. In this prospective observational study over 12 years (Group 1, 8 years; Group 2, 4 years), the following data were collected: age, gender, previous surgery, comorbidities, situation and size of defect, hospital stay, postoperative complications, and recurrence. There were 53 lateral cases and 31 midline cases. About 88.6 per cent of the lateral defects were repaired without needing to approach the intraabdominal cavity (Type I), whereas in the patients with large medial defects this was only achieved in 6.5 per cent of the cases (93.5% required a Type II). The average length of the defects was 18 cm. Global morbidity was 18 per cent early, and 7 per cent late. The statistical analysis over time shows significant differences in the operative time, hospital stay, and consumption of analgesics ( P < 0.001). The recurrence rate has not varied despite the modifications to the technique (use of lighter meshes and fixation with tacks and glue). Complex abdominal wall defects can be corrected using the double prosthetic repair technique with low morbidity rates and with practically no long-term recurrence. The combination of two meshes reduces their density and the use of combined fixation (tacks + glue) improves postoperative recovery.

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