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Background: Heart transplantation (HT) from donation after circulatory death (DCD) has yet to achieve wide clinical application despite the encouraging resultsreported recently. In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol., Methods: Our local abdominal DCD protocol was updated to allow DCD heart procurement, and was accepted by the institutional ethics committee. The main features of the protocol include: pre-mortem insertion of peripheral venoarterial extracorporeal membrane oxygenation cannulas; thoracoabdominal normothermic regional perfusion (NRP) by clamping the 3 aortic arch vessels to exclude cerebral circulation; and in-situ heart resuscitation. The retrieved hearts were directly transplanted into recipients located in an adjoining operating room., Results: The procurement warm ischemic time was 25 minutes for the first donor, and 26 minutes for the second donor. The cold ischemic time was 16 minutes for the first recipient and 17 minutes for the second recipient. The suture time was 30 minutes for the first recipient, and 53 minutes for the second recipient. Both recipients were easily weaned off cardiopulmonary bypass in sinus rhythm and inotropic support. Post-operative evaluation of cardiac function was excellent and the patients were subsequently discharged home., Conclusions: Transplantation of hearts from DCD donors is now a clinical reality.NRP is a useful tool for resuscitation, reperfusion, and preservation of transplanted hearts. It also offers the opportunity to assess the function and viability of organs before transplantation. However,due to ethical issues, some may object to ante-mortem intervention., (Copyright © 2019 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Background: Few studies have examined the prevalence of alcohol and drug use in individuals with multiple sclerosis (MS). The current study sought to examine the prevalence and associated demographic, disease-related, and psychological correlates of substance use in an East Coast United States outpatient MS sample., Methods: 157 individuals with MS completed questionnaires prior to, during or after their visit with an MS neurologist. These questionnaires included: the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), CAGE, CAGE-Adapted to Include Drugs (CAGE-AID), Patient Health Questionnaire-9 item (PHQ-9), Beck Depression Inventory-Second Edition (BDI-II) and Hospital Anxiety and Depression Scale-Anxiety (HADS-A)., Results: On the AUDIT-C, 40% of individuals with MS met or exceeded the cutoff for excessive alcohol use. They were more highly educated and younger than non-drinkers. Utilizing the CAGE, 6% of the sample met criteria for a lifetime history of excessive alcohol use and men endorsed higher rates of alcohol use than women. Only a small portion of the sample endorsed a history of drug use (CAGE-AID, 4%). Drug use was associated with greater disability and depression symptoms, but lower self-reported anxiety., Conclusions: Current alcohol use was prevalent in this sample, and excessive use was associated with men, younger age, and more education. Reported drug use was minimal and associated with greater disability, more self-reported depression, but fewer anxiety symptoms., (Copyright © 2013 Elsevier B.V. All rights reserved.)

We report the case of a 38-year-old man admitted at the emergency department for abdominal pain of abrupt onset. Computed tomographic examination revealed a spontaneous isolated dissection of the superior mesenteric artery and an anevrysm of the coeliac artery caused by the arcuate ligament. Outcome was favorable under conservative medical treatment and a three months follow-up was uneventful. This observation offers the opportunity to present recent insights concerning this pathology.

The occurrence of an acute myocardial infarction after non-penetrating chest trauma is an extremely rare complication. We report a case of dissection of the left anterior descending artery in a 43 year old man after being punched in the chest. Using data from a literature search relish revealed 76 cases; we review the characteristics of the pathology and its incidence. We also characterize its etiology, anatomy and path physiology. We then consider the diagnostic and therapeutic implications.

Objective: To assess efficiency of a nurse directed weight-based nomogram (NWN) for heparin dosage without training., Study Design: Prospective, comparative, before/after intervention study., Patients and Methods: In a university medical intensive care unit, 19 patients receiving unfractionned intravenous heparin, following standard medical prescriptions (SHT), were compared to 19 patients submitted to NWN (80 U kg(-1) bolus, starting infusion at 18 U kg(-1) h(-1) and secondary dosage adaptations following a specific nomogram)., Results: Dose of heparin bolus and starting dose infusion were significantly greater in NWN group than in the SHT group. The delay in achieving a predetermined therapeutic APTT level of at least 60 s was 6 (1-76) hours in the SHT group and 4 (3- 32) hours in the NWN group. The target APTT (60-85 s) was obtained after 13.5 (1-76) hours and 9.5 (3-32) hours in the two groups, respectively. Although reduction in delay seemed to favour anticoagulation dictated by the NWN protocol, the difference failed to reach statistical significance. Percentage of target APTT over total number of APTT values per patient was significantly higher in the NWN group (41 [0-87] vs. 31% [0-54]) in the SHT group. Strict observance of anticoagulation by using NWN tended to be better than that in SHT group., Conclusions: NWN protocol was easy to use without previous training. NWN was associated with the best anticoagulation state although its superiority was less evident than expected.

Objective: Our study was to assess the validity of SAPS II (New Simplified Acute Physiology Score) to predict the probability of in hospital mortality, in a cohort of patient admitted to a medical intensive care unit., Study Design: Prospective study., Patients and Methods: Out of 467 the 525 patients admitted were included. SAPS score and in hospital mortality prediction were calculated for each of them., Results: In this group, SAPS II offered a satisfactory discrimination power with an area under the curve of 0.843. However, calibration showed a lack of fit (chi 2 = 28.5, P < 0.001), with an overall under prediction of mortality (observed versus expected ratio of 1.12)., Conclusion: This SAPS II lower predicting accuracy in a specific population and for individual outcome prediction may reduce its interest in clinical decision-making.

Two-dimensional echocardiography provides adequate spatial orientation and anatomic definition. Eighteen consecutive patients undergoing myocardial biopsy had concomitant two-dimensional echocardiography during 22 biopsies of five to six samples each. The transducer was placed at the apex and in the subcostal area and four-chamber views were used. The bioptome was seen entering the right atrium and crossing the tricuspid valve to the right ventricle. The catheter was then manipulated under two-dimensional echocardiography and the tip's position was strictly adapted, using two different classic views before sampling. The success rate in visualizing the forceps and in defining the site of sampling was 100 percent, and no complication was noted. Radiation exposure was largely reduced. Two-dimensional echocardiography to guide endomyocardial biopsy may reduce the risk of perforation by a better anatomic definition of the sampling site. It permits sampling from different ventricular sites or from the same site during serial procedures for monitoring evolution or treatment.