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Background This study was designed to compare the outcomes after total versus partial pericardiectomy clinically, echocardiographically, and hemodynamically. Methods Three hundred ninety-five patients undergoing pericardiectomy for constrictive pericarditis between January 1985 and December 2004 were studied. Age was 10 months to 71 years (mean, 25.1 ± 13.4 years). Three hundred thirty-eight patients (85.6%) underwent total pericardiectomy (group I), and 57 patients (14.4%) underwent partial pericardiectomy (group II). Results Operative and late mortality rates were 7.6% and 4.9%, respectively. Preoperative high right atrial pressure, hyperbilirubinemia, renal dysfunction, atrial fibrillation, pericardial calcification, thoracotomy approach, and partial pericardiectomy were significant risk factors for death. The risk of death was 4.5 times higher (95% confidence interval: 2.05 to 9.75) in patients undergoing partial pericardiectomy. At a mean follow-up of 17.9 ± 0.3 years (95% confidence interval: 17.3 to 18.6), actuarial survival was 83.8% ± 0.04% in group I and 73.9% ± 0.06% in group II ( p = 0.004). At their last follow-up, 96.3% survivors of group I and 79.1% survivors of group II were in New York Heart Association class I/II ( p Conclusions Total pericardiectomy is associated with lower perioperative and late mortality, and confers significant long-term advangage by providing superior hemodynamics that appear to be independent of the etiology of constrictive pericarditis.

The purpose of this study was to determine the pathohistology, morphometry, and risk factors for the development of intimal hyperplasia, calcification, and arteriosclerosis in the radial artery and to compare the morphometry of the distal and proximal radial arteries.A total of 190 proximal and distal radial artery specimens obtained from patients who underwent myocardial revascularization were exposed to histopathologic and morphometric analysis. The severity of disease was evaluated on the basis of the percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio.Sixty-two proximal (32.6%) and 22 distal (11.5%) radial artery segments were indicated as histologically normal. Morphometric analysis (Z test) revealed a lesser degree of intimal hyperplasia and luminal narrowing in the proximal segments compared with the distal segments (p0.001). The incidence of intimal hyperplasia, medial calcification, and arteriosclerosis in the distal radial arteries was 76.3%, 6.3%, and 5.78%, respectively. Using multivariate logistic regression, we have identified three significant predictors for intimal hyperplasia. Expressed as an odds ratio with a 95% confidence interval, these included (i) age greater than 50 years (1.052; 1.000-1.106, p = 0.052), (ii) smoking (14.073; 5.293-37.414, p = 0.000), and (iii) hypertension (2.777; 1.171-6.583, p = 0.020). Factors associated with an increased likelihood of medial calcification and arteriosclerosis included a history of smoking, diabetes, hypercholesterolemia, peripheral arterial disease, and chronic renal failure (p0.05).The great majority of radial artery conduits indicate preexisting intimal hyperplasia mostly affecting the distal portion. Therefore in cases of longer diseased segments of radial arteries, the discarded segments should be the distal end. Care should be taken when selecting radial artery as a conduit in myocardial revascularization, particularly in elderly males, diabetics, smokers, hypertensive patients, and in those with associated peripheral vascular disease.

Several techniques have been described for mobilising intra-abdominal testis (IAT) into the scrotum. Many are associated with significant morbidity. We hereby introduce our modification of the technique that is safe and reproducible. Surgical technique using a nylon tape to railroad instruments into the peritoneal cavity to minimise false passage and trauma is described in detail. Once the testis is delivered out of the scrotal wound, further division of restrictive bands to mobilise the testis is carried out laparoscopically. These steps are not previously described in the literature. A retrospective study of consecutive patients with IAT undergoing surgical intervention by a single surgeon over a period of 15 years has been included to demonstrate outcome. Twenty-five patients with unilateral IAT (10R, 15L) and 2 patients with bilateral IAT, a total of 29 IAT, underwent laparoscopic orchidopexy over the period 1997-2012. Median age of the patients was 3.0 years. One-stage testicular vessel preserving (VP) orchidopexy was performed in 20 testes, Fowler-Stephen (FS), vessel sacrificing orchidopexy (3 one-stage and 6 two-stage) was required in 9 testes. At follow-up, atrophy was detected in 1 (5.0 %) and 2 (22.2 %) patients of the VP and FS groups respectively. The railroading technique of transferring IAT into the scrotum via the inguinal canal under laparoscopic guidance minimises tissue trauma. It negates the need to create new tissue opening. It is reproducible with a testicular atrophy rate comparable to published literature.

Aims: The main aim of our study is to analyse Electron Beam Profiles like Flatness, Symmetry with 2D Array Detectors. The 2D Array can be used as an alternative device to measure the Electron beam profiles. Introduction: Flatness and symmetry of a radiation beam: The flatness of the beam is defined by the following formula: Flatness (%) = Dmax/Dmin × 100% (1) Where Dmax and Dmin are the maximum and minimum doses respectively within the area. Radiation field symmetry is defined as the maximum ratio of doses at two symmetric points relative to the central axis of the field. Symmetry (%) = [D(x, y)]/[D (-x,-y)] × 100% (2) Methods and Material: The beam symmetry is easily defined and is not very dependent on the depth of measurement. However, the flatness of the beam depends on the size and shape of the measurement phantom. However, 3% is sufficient measurement accuracy for a quick check. We measured the electron profiles of energies (4 MeV, 6 MeV, 8 MeV, 10 MeV, 12 MeV, 15 MeV and 18 MeV) from Elekta Synergy Linear accelerator for different electron applicators (6 × 6, 10 × 10, 14 × 14 and 20 × 20) at their depth of maximum dose (dm) respectively and Source-Surface-Distance (SSD) of 100 cm using PTW 729 2D array detectors. Results: We analyzed the variations in Flatness and Symmetry of electron energies obtained from 729 2D Array Detector and compared with the standard values obtained from the Radiation Field Analyzer (RFA) during Commissioning. Conclusions: We found that there is no significant variation in Flatness and symmetry obtained from the 729 2D Array detector as compared to the standard Flatness and symmetry obtained from the RFA .Thus we conclude that 729 2 D Array detector can be used for the routine measurement of electron beam profiles.

Plexiform neurofibroma (PNF) arises as a diffuse mass from nerve trunk and leads to overgrowth of cutis and subcutis structure. This is a case report of 20-year-old male, presented to our hospital with a giant ulcerated swelling over his left arm. Differential diagnosis of sarcoma, neurofibroma, hemangioma and angiolipoma was made but biopsy confirmed the diagnosis of plexiform neurofibroma. Isolated PNF with ulceration of overlying skin over arm is a rare presentation and here we are presenting it as a perusal of rare entity.

Magnetic changes induced by ball milling in Fe-50%Al alloy have been investigated using vibrating sample magnetometer (VSM). The mechanical alloying (MA) process induces a progressive dissolution of Al into Fe, resulted in the formation of an extended nanostructured Fe(Al) solid solution only after 5 hr of milling. The magnetic measurements show continuous decrease in saturation magnetization and increase in coercivity, retentivity and squareness ratio with increase in milling time. The systematic variation of the magnetic properties has been correlated with the evolution of microstructure, reduction in grain size and enhanced inter-granular exchange coupling.

Background: Data on the influence of surgical variables in mortality and morbidity of patients undergoing double valve replacement (DVR) surgery are scarce. Objective of this study was to identify preoperative, intra operative and post operative factors associated with mortality and morbidity of patients undergoing DVR surgery.Methods: Between 2010 and 2016, patients who underwent double (Mitral and Aortic) valve replacement at our institution were analyzed. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of deaths and the data was analyzed statistically.Results: There were 150 patients, 107 were male (71.3%) and 43 were female (28.6%) Present study revealed a high mortality rate among female patient undergoing DVR surgery than males, which is statically significant at p

Background: Management of patients with coronary artery disease (CAD) and low ejection fraction (EF) is challenging. The objective was to compare the effect of low EF to normal EF on clinical outcomes after off-pump coronary artery bypass graft (OPCABG) surgery.Methods: All patients who underwent CABG at VMMC and Safdarjung hospital, from June 2014 till December 2016 with LVEF≤35% (low EF) as well as LVEF>35% (high EF) were studied and their surgical results analyzed by collecting data retrospectively. Out of 203 total patients the LVEF was less than or equal to 35% in 41 (20.19 %) patients, more than 35% in162 (79.81 %) patients.Results: In LVEF≤35% there were 9 females and the mean age was 60.39±8.76 years, The mean ICU stay in hospital was of 8.73 days, mean ventilator support was 4.01 days, ionotropic support was 4.34 days, mean stay in hospital was of 28.54 days, hospital mortality was 8 (19.51%) in LVEF≤35 versus mean ICU stay in hospital was of 8.73 days, ventilator support was 4.01 days, ionotropic support 4.34 days, mean stay in hospital was of 20.33 days, hospital mortality was 13 (8.02%) in LVEF>35.These data make a survival rate of 80.49% for EF in LVEF≤35 versus 91.98% for EF in LVEF>35.Conclusions: CABG can be safely performed in low-EF patients with minimal postoperative morbidity and mortality in addition to encouraging home discharge rates.

Background: RSOV is associated with a dramatic onset of symptoms to a state of biventricular failure due to sudden volume overload. Controversies exist about RSOV repairs among various centers are the surgical approach (chamber involved, transaortic or both) and the closure technique (primary/ patch closure). There have been no clinical trials to show that one technique is superior to other. In the present study, we reviewed our 16 years’ experience with repair of RSOV through exclusive transaortic approach. Methods: 40 patients underwent RSOV repair through transaortic approach from January 2000 to December 2016. The mean age was 30.2 years. The origin of RSOV was right coronary sinus in 75% of cases and non-coronary sinus in 22.5% of cases. There was one giant calcified unruptured aneurysm arising from right coronary sinus. Right ventricle was most common chamber of rupture comprising 96.67% cases. All patients underwent transaortic repair of RSOV using dacron patch. VSD repair was done in 25% cases. Aortic valve replacement was done in 62.5% cases for moderate to severe AR. Results: There were 7.5% in hospital deaths with no late deaths. Inotropic and ventilatory support required for 3±1.6 days and 1.8±1.2 days respectively. The mean ICU stay and hospital stay was 3.5±1.6 days and 7.5±2.5 days respectively. None of the patient required permanent pacemaker implantation. The 37 survivors were followed up for 6.4±3.6 years; all had an improvement in functional NYHA class with superior results in those with no aortic regurgitation. 7.5% patients developed mild AR during follow up which medical management was done. Conclusions: Surgical treatment of ruptured sinus of Valsalva aneurysm using the transaortic patch technique has an acceptably low operative risk, lesser distortion of aortic valve and good long-term symptom-freedom survival. An early aggressive approach is recommended to prevent worsening of symptoms and more extensive disease.

Wear debris microparticle release associated with total joint arthroplasty may contribute to harmful inflammation, osteolysis and implant failure. We examined the role of different molecular signaling pathways in microparticle-mediated inflammation. Intraperitoneal inoculation of cobalt chrome (CoCr) in mice induced a robust innate type 2 response with increases in IL4, IL5, IL13, IL33, M2 macrophages, eosinophils and neutrophils compared to controls given vehicle only. Blockade of the SYK signaling pathway with the inhibitor BAY 61-3606 or the down stream BTK signaling pathway with Ibrutinib abrogated the CoCr-mediated innate type 2 inflammation. Further studies in CBA/Nxid mice, a genetic BTK loss of function mutant also showed decreases in type 2 inflammation, confirming a critical role for BTK in CoCr mediated sterile type 2 inflammation. Inoculation of JH−/−, B cell deficient mice, or depletion of T cells by anti-CD4 (GK1.5) antibody, had no impact on CoCr mediated type 2 inflammation. We further demonstrated that the major source of IL33 was macrophages and intra-peritoneal administration of recombinant IL33 rescued the CoCr mediated type 2 response after BTK blockade. These studies indicate that the type 2 immune response caused by solid particles is abrogated by blockade of BTK signaling pathways and that exogenous IL33 is sufficient to rescue this response. These studies elucidate the nature of wear debris-mediated type 2 sterile inflammation and provide potential targets for future therapy.

Cobalt chrome (CoCr) is a major component of orthopaedic implants and a source of metallic wear debris, which may contribute to harmful inflammation and implant failure. In this study we show that the presence of M2 macrophages (CD68+, CD206+, and CD163+) and tissue fibrosis is observed in human peri-prosthetic tissue samples obtained from patients undergoing revision joint arthroplasty. We further examined the molecular mechanisms that drive the sterile inflammatory response to CoCr microparticles in 2 clinically relevant murine articular models. Bilateral intra-articular knee injections of CoCr microparticles were given to C57BL/6 mice and innate immune cell infiltrates were examined in both acute (2 day) and chronic (2 week) models. At the acute time point, CoCr microparticles induce inflammation characterized by an innate type 2 response in synovial tissues with marked increases in neutrophils, eosinophils, and M2 macrophages. This response in articular tissues is dependent on both SYK and BTK signaling as pharmacologic blockade of either pathway abrogates the innate response. Studies in our chronic model demonstrates that repeated exposure of articular tissues to CoCr microparticles triggers an inflammatory response that is characterized by persistent innate cell infiltrates of neutrophils and macrophages, as well as the development of tissue fibrosis. Additionally we show that the innate response and generation of tissue fibrosis in our chronic model is independent of the Caspase-1 inflammasome. Taken together, our findings suggest that CoCr mediates a robust type 2 inflammation that leads to fibrosis and identifies novel potential targets for control of microparticle induced sterile inflammatory responses.

Background: Atrial septal defects (ASD) are one of the most common cardiac malformations. Being asymptomatic, diagnosis is not always made in childhood and may be delayed to adolescence or adulthood. The incidence of ASD in female is twice that of male, so greater emphasis has been placed on the cosmetic results of the operation.Methods: In this study, we retrospectively compare results 100 patients of ASD closure through a right anterolateral thoracotomy incision and median sternotomy incision. Between August 2011 to August 2016, out of total 100 patients with ostium secundum ASD, 50 patients operated by right anterolateral thoracotomy have mean age 16.74 yrs, mean weight 28.77 kg, mean Height 122.06 cm and 50 patients with midline sternotomy have mean age 17.07 year, mean weight 29.24 kg, mean height 122.20cm.Results: There was no mortality in both groups. Per operatively mean operating time, mean CPB time, mean cross clamp time in thoracotomy was 130.08±8.16min, 48.68±5.10min, 29.70±4.21 min while in sternotomy was 121.34±8.30 min, 45.62±4.10 min, 28.28±2.82 min respectively. When compared, there is significant increased duration in operating and CPB time in thoracotomy while cross clamp time was non-significant. Mean duration of ICU and Hospital stay in thoracotomy group was 1.78±0.58days and 6.74±1.77 days when compared to sternotomy group in which it was 2.40±0.495 days and 7.66±1.40 days which is significantly less when compared. Postoperatively and in follow up thoracotomy group have better cosmesis when compared.Conclusions: Surgical treatment of osteum secondum ASD using right anterolateral thoracotomy approach has low operative risk better cosmetic results and patient satisfaction.

In this paper, interactions of amine group (NH 2 ) with pristine Boron Nitride sheet (BN sheet) has been investigated using a density functional theory based ab-initio approach. Stability and electronic properties have been analysed at distinct positions of NH 2 on 2-D Boron Nitrite sheet. It has been observed that on placing the NH 2 group at the centre of the hexagon of the BN sheet, it becomes metallic. However, for other positions significant decrease in the band gap is observed which means that BN sheet is highly sensitive to amine group. Further, non equilibrium greens function (NEFG) has been utilized to validate the sensing of NH 2 by BN sheet on best suitable site in terms of current- voltage relationship.

Background: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. Materials and Methods: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm) were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. Results: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4%) patients. All patients were within the age group of 15-51 years (average 38 years) with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks). Conclusion: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.

Background Guidelines have been issued for the management of lung cancer patients in the United Kingdom. However, compliance with these national guidelines varies in different thoracic units in the country. We set out to evaluate our thoracic surgery practice and compliance with the national guidelines. Methods An initial audit in 2011 showed deficiencies in practice, thus another audit was conducted to check for improvements in guideline compliance. A retrospective study was carried out over a 12-month period from January 2013 to January 2014 and included all patients who underwent radical surgical resection for lung cancer. Data were collected from computerized records. Results Sixty-eight patients had radical surgery for lung cancer between January 2013 and January 2014. Four patients were excluded from the analysis due to incomplete records. Our results showed improvements in our practice compared to our initial audit. More patients underwent surgery within 4 weeks of computed tomography and positron-emission tomography scanning. An improvement was noticed in carbon monoxide transfer factor measurements. Areas for improvement include measurement of carbon monoxide transfer factor in all patients, a cardiology referral in patients at risk of cardiac complications, and the use of a global risk stratification model such as Thoracoscore. Conclusion Guideline-directed service delivery provision for lung cancer patients leads to improved outcomes. Our results show improvement in our practice compared to our initial audit. We aim to liaise with other thoracic surgery units to get feedback about their practice and any audits regarding adherence to the British Thoracic Society and National Institute for Health and Care Excellence guidelines.

Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics. However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance. We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward. Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.

We report the detection of ammonia gas through electronic and transport properties analysis of boron nitride sheet. The density functional theory (DFT) based ab initio approach has been used to calculate the electronic and transport properties of BN sheet in presence of ammonia gas. Analysis confirms that the band gap of the sheet increases due to presence of ammonia. Out of different positions, the bridge site is the most favorable position for adsorption of ammonia and the mechanism of interaction falls between weak electrostatic interaction and chemisorption. On relaxation, change in the bond angles of the ammonia molecule in various configurations has been reported with the distance between NH3 and the sheet. An increase in the transmission of electrons has been observed on increasing the bias voltage and I-V relationship. This confirms that, the current increases on applying the bias when ammonia is introduced while a very small current flows for pure BN sheet.

A 63-year old, male patient presented with prosthetic valve endocarditis and developed heparin-induced thrombocytopaenia (HIT) following heparin administration for continuous veno-venous haemofiltration. Use of cardiopulmonary bypass in patients suffering from heparin-induced thrombocytopaenia is difficult and challenging. We report a novel method that allows heparin use in patients diagnosed with HIT using Multiplate platelet analyser and iloprost. Platelet function analysis is complex, poorly standardized and time consuming. Multiplate platelet analyser represents a convenient, safe, reliable and rapid system that allows the assessment of platelet dysfunction. It allows objective demonstration of platelet inhibition before administration of heparin, allowing safe establishment of cardiopulmonary bypass in patients suffering from HIT.

Objectives A heart team approach has been recommended for managing patients with coronary artery disease. Although this seems to be a new concept, we have been developing such a practice for over 8 years. In this report, the enactment of the heart team decision is reviewed and possible improvement is discussed. Design Review of 1000 heart team decisions over a 1-year period for patients with coronary artery disease. These decisions were recorded contemporaneously at the time of the team discussion. Thereafter, patient9s notes were reviewed 6 months following the heart team meeting to assess whether the decision was enacted and, if not, what were the reasons for aberration. Results The heart team decision was enacted in 95.5% of patients. The reasons for aberration in the remaining 45 patients included patient9s choice (refusal), unrecognised comorbidities at the time of the heart team discussion, change in patient9s clinical condition requiring urgent intervention and death while awaiting procedure, among others. Conclusions The decision of a well set-up heartteam meeting is carried out for most patients. Aberration is uncommon and usually due to unknown factors at the time of the discussion. The heart team approach ensures that patients receive best available care (most likely evidence-based), and demonstrates transparency.

This paper describes the method for investigating the electrical properties of high solids via the study of thermal relaxation effects and offers an alternative scheme to the conventional bridge methods or the current voltage temperature measurements. For standard TSD experiment, this is comparable to a dielectric loss measurement, the low equivalent frequency and high sensitivity (ability to detect dipole concentration). The activation energies found by initial rise method are 0.31 ± 0.02 eV for pure and 0.43 ± 0.03 eV for malachite green sensitized PVK thermoelectrets. The peak current charges and activation energy associated with the peaks are affected by concentration of malachite green and have been explained in terms of formation of charge transfer complexes and molecular aggregates. The microscopic origin of a given current spectrum is explained by comparing the predictions of the general theories regarding the main polarization processes with the experimental data.

Nature of the interaction of electromagnetic radiation with matter depends upon the structure of the substance. When radiation passes through a sample, certain frequencies of the radiation are absorbed, leading to molecular vibrations. The frequencies of absorbed radiation are characteristic for a molecule providing insight into its structural framework. In the present study transmittance versus wavelength curves for PVK show an increasing trend from 300 nm wavelength and get saturated after 450 nm. However, for malachite green sensitized samples two sharp peaks at around 360 and 500 nm are observed. The characteristic absorption bands in the I.R. spectrum arise from the vibrations of pairs or small groups of atoms in the molecules.

Cobalt chrome (CoCr) is a major component of orthopaedic implants and a source of metallic wear debris, which may contribute to harmful inflammation and implant failure. Intra-peritoneal inoculation of CoCr induces a robust innate type 2 response with increases in M2 macrophages, eosinophils, and neutrophils and this response is dependent on Spleen tyrosine kinase (SYK) and Bruton’s tyrosine kinase (BTK) signaling, but not TLR, Caspase-1, or Cyclooxygenase signaling. We have also shown that this robust response is independent of T and B cell signaling. To examine this response in a more clinically relevant murine model, bilateral intra-articular knee injections of CoCr microparticles were given to C57BL/6 mice and changes in different innate immune cells were assessed from knee synovial cell isolates. Administration of the SYK inhibitor BAY 61-3606, or the BTK inhibitor Ibrutinib, abrogated innate immune cell recruitment and M2 macrophage polarization which is otherwise observed 2 days after inoculation with CoCr microparticles. The presence of M2 macrophages (CD68+, CD206+, and CD163+) is also observed in human peri-prosthetic tissue samples obtained from patients undergoing revision joint arthroplasty. Taken together, our findings suggest that BTK signaling is required for the type 2 inflammatory response to CoCr microparticles, providing a potential novel target for control of harmful inflammation leading to fibrosis and aseptic loosening.

The safety and efficacy of temporary pericardial pacing wires have been accepted and their use is common after cardiac operations. Complications related to pacing wire removal are unusual but it can be serious and even catastrophic. We report an unusual case of bleeding due the laceration and rent created in the saphenous vein graft wall by the metallic tip of the pacing wire at the time of pacing wire removal.

To evaluate the effect of audiotaping outpatient consultations on informed consent for cardiac surgery.Randomized controlled trial.Tertiary health care center in Scotland.Eighty-four patients who had first-time coronary artery surgery conducted by 1 surgeon from February 10, 2005, through March 15, 2006, whose consultations before surgery were audiotaped.Randomization to 3 trial arms. The control group (n = 29) received no tape. The generic group (n = 25) received a tape about coronary artery surgery, which we scripted to include information covering the domains described by the General Medical Council. The consultation group (n = 30) received a tape of their consultation interview. On admission to the hospital, patients were interviewed with the Knowledge Questionnaire, the Multidimensional Health Locus of Control, and the Hospital Anxiety and Depression Scale.The effect of audiotaping in improving the informed consent process for cardiac surgery.The mean knowledge score of patients in the consultation group was much higher than that of the control individuals (P.001). Patients in the consultation group reported a significantly greater sense of control with regard to their own health (P.001) and being less anxious and depressed overall.Providing an audiotaped recording of the consultation before cardiac surgery appears to improve patients' knowledge and perceptions of control of their health status and to reduce anxiety and depression.isrctn.org Identifier: ISRCTN20081026.

Interrupted aortic arch (IAA) is characterised by a lack of luminal continuity between the ascending and descending thoracic aorta. It represents a critical ductus dependent congenital heart disease, which without surgery is associated with high mortality in the neonatal period. Management remains challenging, although in recent years overall mortality appears to be improving. Long-term morbidity and need for repeated interventions are areas of concern. It is difficult to make generalised recommendations based on this literature review as complex associated anomalies often require individualised management strategy.

To determine current practice regarding the use of epicardial pacing wires by cardiothoracic surgeons in the U.K.

A 23-year-old man presented with a long history of dyspnea and wheezing thought to be due to asthma. Abnormal appearance of the left hemithorax was an incidental finding on a chest X-Ray. On further investigations he was found to have congenital Bochdalek hernia which was repaired surgically. All his respiratory symptoms resolved and he was able to discontinue treatment for asthma. We want to emphasise that late presentations can be misleading even to an astute clinician.

Background The purpose of this investigation was to determine the role of radionuclide studies in evaluating postoperative Fontan hemodynamics and to quantify its diagnostic accuracy. Methods One hundred five patients (105), aged 11 months to 35 years old, who had undergone univentricular repair, underwent first-pass and multigated acquisition scan 1 month to 10 years after univentricular repair. Forty-five patients with evidence of Fontan failure underwent radionuclide studies using Technetium-99 m as well as cardiac catheterization (group 1). The remaining sixty randomly selected patients with excellent functional status received radionuclide studies alone (group 2). The receiver operating characteristic curve analysis was done to quantify the diagnostic accuracy of the first-pass study. Results There was paradoxical filling of the right lung after femoral injection in all cases of tunnel or conduit obstruction. A first-pass transit time of 16 to 25 seconds (mean ± standard deviation [SD] = 18.82 ± 2.69) was always associated with Fontan failure and high right atrial pressure (range = 20 to 24 mm Hg, mean ± SD=22.02 ± 1.58). A first-pass transit time of 16 seconds was associated with a sensitivity of 100% and a specificity of 93.33%. The predictive accuracy of a positive or negative result was 91.8% and 100% respectively. The area measured under the receiver operating characteristic curve indicates that 99.41% (SE ± 0.0035) of the time, the value of first-pass time is higher for the Fontan failure group (group 1) compared to the normal group (group 2; p = 0.000). Conclusions Our data indicate that Fontan circuit can be reliably evaluated for both anatomic and functional flaws by radionuclide studies; radionuclide first-pass time may be used to predict the chances of Fontan failure postoperatively as well as its presence; and in the presence of atrial fibrillation with fast ventricular rate, analysis using first-pass radionuclide may be impossible and gated equilibrium radionuclide angiocardiography may be the preferred method. Inspection of the systemic ventricular time-activity curve is of crucial importance in this regard.

In this paper the well known notion of a cyclic contraction for anite family of non-empty subsets has been extended for G-metric space X.

Cardiac tumours are rare in occurrence. The authors report a patient who presented with a history of recurrent transient ischemic attacks and cerebrovascular accidents. During rehabilitation he was incidentally diagnosed with a large left ventricular mass which was excised successfully with good clinical outcome. On histopathology it was a papillary fibroelastoma.

I read with interest the recent article in European Journal of Cardio-Thoracic Surgery by Siepe and colleagues [1] where they have reviewed the work done in the field of stem cell research for myocardial regeneration. It is an excellent review paper. I would like to add a few points which unfortunately have not been addressed in this article. Despite significant advances in medical and surgical management of heart failure, the mortality and morbidity associated with it continues to be high. Cardiomyocyte apoptosis (programmed cell death) has been implicated in the development of end-stage heart failure [2]. Myocardial regeneration will be the ideal treatment for these failing hearts. It explains the hype created around cellular therapy, more appropriately called ‘Cellular Cardiomyoplasty’ by many investigators. In fact, while this issue is getting debated, some centres in South East Asian countries have started charging fees from patients for treatment with coronary artery bypass grafting and stem cell therapy as single procedure. It means not only are we stretching things too far but also the fact that it constitutes unethical practice. The evidence in support of stem cell therapy as means for myocardial regeneration is not flawless, to say the least. We do not know which cell type to inject; how to inject (delivery of cells); where to inject (centre of the scar vs periphery of scar); when to inject (immediately after myocardial infarction vs delayed injection); how much to inject (dosing) and safety, efficacy and long-term results. Recently the critical question of host immune response to implanted cells has started to receive attention from the researchers [3]. Recent studies on immune interactions of bone marrow mesenchymal stem cells have raised doubts over the concept of myocardial regeneration leading to functional recovery. Do they really form new functioning cardiomyocytes or is the improvement in ventricular function cytokine/chemokines mediated [4]? Very few engrafted cells express specific cardiac markers like connexion 43 and cardiac troponin I and only limited gap junctions are formed between grafted and native cells [4]. Even if they form new cardiomyocytes, the question of proper integration and communication with the host tissues remains unanswered.

Impact of ethnicity on outcome following cardiac surgery is controversial. Current risk stratification models do not include ethnicity as risk factor.

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