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Aim: We sought to quantify the location and volume of thrombus in used hollow-fiber membrane oxygenators and correlate the volume of thrombus with patient demographics, flow characteristics and anticoagulation parameters. Methods: Hollow-fiber membrane oxygenators (Quadrox D, Maquet, Rastatt, Germany) were collected after clinical use in ECMO circuits and divided into sections. Each section was digitally imaged and analyzed using ImageJ software. The location and total volume (cm³) of thrombus was calculated for different sections. In an effort to predict thrombus formation, we correlated thrombus volume with possible aggravating and mitigating variables. Results: We collected 41 oxygenators from 27 patients. Twenty-seven (66%) were configured in the veno-venous mode and 14 (34%) in the veno-arterial mode. The median duration of use was 131 hours (interquartile range 61-214 hours). Eighteen (44%) were removed when the patient recovered, six (15%) were removed after withdrawal of care and seventeen (41%) were exchanged. The median volume of thrombus was 11.4 cm3 (interquartile range 2.2-44.5 cm³). Conclusions: A multivariable linear regression model suggested that the combination of median flow, configuration of ECMO and visible thrombus partially predicted internal thrombus volume (adjusted R²=0.39). [ABSTRACT FROM AUTHOR]

Background/aim: To investigate factors that affect colorectal polyp or colorectal cancer (CRC) detection amongst patients referred urgently to colorectal services for suspected bowel cancer., Patients and Methods: This was a prospective observational study at a UK colorectal centre (2017-2018). Logistic regression determined odds ratios for colorectal polyp or CRC according to age, gender, previous polyp or cancer, and the 6 NICE referral (NG12) categories., Results: A total of 605 patients were included in the study; median age 66 (IQR=54-76); 47.9% male. Nineteen (3.1%) patients had CRC and 64 (10.6%) had polyps. No individual variable increased the likelihood of CRC detection, but male patients had a higher likelihood of having either polyp or CRC (OR=1.72; 95%CI=1.07-2.80; p<0.05)., Conclusion: At the point of an urgent referral to a colorectal clinic, the likelihood of CRC detection appears to be unaffected by age, gender, or any individual referral criterion. However, overall disease detection may be more likely amongst male patients., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: Our goal was to present a case of emergent endovascular repair of a ruptured descending aortic aneurysm in an actively arresting patient., Patient: The patient was a 75-year-old woman with a known history of a 6.5-cm descending thoracic aortic aneurysm with acute onset of back pain and syncope. A computed tomographic angiogram revealed disruption of the descending thoracic aorta and a mediastinal hematoma. The patient was taken emergently to the operating room. During induction, the patient developed pulseless electrical activity arrest, and cardiopulmonary resuscitation was promptly initiated. The bilateral groins were prepped and draped, and an emergent cutdown was made to gain access to the femoral artery. Wire access of the aortic arch was obtained via a 6F micropuncture sheath, over which a 45- × 45- × 20-mm covered endograft was introduced. Using fluoroscopic guidance alone without angiography, the endograft was rapidly deployed proximally to the level of the distal aortic arch using calcification as a landmark (Fig. CC1-1). Immediately after deployment, the patient regained a pulse, and cardiopulmonary resuscitation was discontinued for a total of 30 minutes of continuous compressions. A right thoracotomy was then performed for evacuation of the hemothorax and ligation of the torn intercostal arteries. The patient was cooled to 35 degrees Celsius for 24 hours post-arrest and a lumbar drain was placed postoperatively. The patient thereafter regained all neurological and end-organ function and at the 6-month follow-up has had no progression of her aneurysm (Fig. CC1-1)., Conclusions: Rapid introduction and deployment of a descending thoracic aortic endograft for a ruptured descending aortic aneurysm is safe and effective in an arresting patient.

Background and Aim of the Study: There is clear evidence that mitral valve (MV) repair is superior to replacement for MV infective endocarditis (IE). Leaflet perforation is a common pathologic finding in MV IE, and leaflet patch repair with glutaraldehyde-treated autologous or bovine pericardium is the currently accepted method of MV repair. In the present study, fresh autologous pericardium (FAP) was used universally to treat leaflet perforation in MV IE, and the mid-term clinical and echocardiographic outcomes were determined., Methods: Between 2002 and 2009, a total of 20 patients with leaflet perforations from MV IE underwent patch repair with FAP. Follow up echocardiography was performed in a core laboratory., Results: There was one operative death (5%) secondary to sepsis, and three late deaths (15%). Late echocardiograms were available for review from 16 of the 19 patients (84%) who survived surgery. The mean time to follow up echocardiography was 793 +/- 663 days. The mitral regurgitation (MR) grade was mild or less in 14/16 patients (88%), moderate in one patient (6%), and severe in one patient (6%). The mean gradient was 4.8 +/- 2.7 mmHg, and the ejection fraction was preserved in all patients (63 +/- 4%). No expansion, retraction or calcification of the patches was observed. Freedom from reoperation, reinfection and thromboembolism was 100%., Conclusion: Fresh autologous pericardium for MV leaflet patch repair in IE is associated with good mid-term valve function. Given the association between late calcification and the glutaraldehyde treatment of bioprosthetic valves and this favorable experience, it is believed that FAP is an acceptable alternative for leaflet repair in MV IE.