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Background Sternal closure by absorbable suture material is an established method for chest closure in pediatric cardiac surgery. However, the formation of granuloma around knotted suture material is frequently observed and has potential for prolonged wound healing and infection, particularly in newborns and infants. This retrospective study analyses the suitability and reliability of a novel absorbable, self-locking, multi-anchor knotless suture with antibacterial technology for sternal closure in pediatric cardiac surgery. Methods The applied material (STRATAFIXTM Symmetric PDS Plus, Ethicon) presents a poly-dioxanon PDS suture with a self-locking, multi anchor design, which enables a sternal closure in a continuous knotless suture technique. All children undergoing knotless closure after standard median sternotomy were examined for the occurrence of sternal wound infection or sternal instability by applying the screening criteria of the Centers for Disease Control and Prevention at hospital discharge, at 30 and 60 days. Results In 130 cases, the new knotless sternal closure was used. Patients` mean age was 19.0±31.9 months (range: 0 to 142 months), mean bodyweight 7.8±6.6 kg (range: 2.4 to 35 kg). Delayed sternal closure occurred in 23 cases with a mean closure time after 2.9±2.6 days. One superficial incisional sternal site infection but no cases of deep sternal site infection or sternal instability were observed. Conclusions The application of the absorbable, knotless suture technique provides excellent results regarding the rate of sternal wound infection and improved healing after median sternotomy in pediatric patients.

Objective To determine the outcome of Stanford type B aortic dissection in patients with Marfan syndrome and to evaluate aortic diameters at time of dissection as well as the impact of previous aortic root replacement. Methods Analysis of all patients with Marfan syndrome fulfilling Ghent criteria seen at this institution since 1995 until 2022. Results Thirty-six (19%) out of 188 patients with Marfan syndrome suffered from Stanford type B aortic dissection during the study period. Mean aortic diameter at time of dissection was 39.0 mm (95% CI: 35.6-42.3). Mean pre-dissection diameter (available in 25% of patients) was 32.1 mm (95% CI: 28.0-36.3) and mean expansion was 19% (95% CI: 11.9-26.2). There was no correlation between age and diameter at time of dissection ( Conclusions Stanford type B dissection in patients with Marfan syndrome occurs far below accepted thresholds for intervention. Risk for type B dissection is present throughout lifetime and two third of patients need an intervention after dissection. There is no difference in freedom from type B dissection between a Bentall procedure and a valve-sparing root replacement.

OBJECTIVES The aim of this study was to explore sex and gender differences regarding aortic events in Marfan patients. METHODS We analysed all data from our connective tissue disorder database. Only patients with Marfan syndrome were included. For analysis, patients were divided by sex. Female patients were further divided into 2 subgroups: with versus without children. Aortic events were defined as Stanford type A aortic dissection (TAAD) or type B aortic dissection (TBAD) or any aortic intervention. RESULTS A population of 183 Marfan patients was analysed for the purpose of this study. One hundred four (57%) were male and 79 (43%) were female patients. Thirty-seven (47%) of the 79 female patients had at least 1 child. Male patients had a significantly higher probability of experiencing an aortic event (P = 0.015) compared to female patients. However, there was no increased probability for recurrent events in male patients compared to female patients (P = 0.063). Follow-up revealed no sex and gender differences in the occurrence of Stanford TAAD or TBAD between male and female patients (P = 0.324/P = 0.534). While 11% of women with children suffered from peripartum aortic events, 24% experienced Stanford TAAD unrelated to pregnancy. CONCLUSIONS Male patients have a higher risk of aortic events than female patients. The majority of women were not aware of their Marfan syndrome diagnosis before conceiving. One out of 10 women suffered from peripartum Stanford TAAD or TBAD. Twice as many female patients with children suffered from aortic dissection unrelated to childbirth. There were no sex and gender differences affecting mortality in Marfan patients.

OBJECTIVE The aim of the present comprehensive review was to present an overview of the clinical presentation and treatment options for external (EJVAs) and internal jugular vein aneurysms (IJVAs) to help clinicians in evidence-based decision making. METHODS A systematic literature search was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and included MEDLINE, Embase, Cochrane Library, Scopus, WHO (World Health Organization) trial register, ClinicalTrials.gov, and the LIVIVO search portal. The inclusion criteria were studies of patients who had presented with IJVAs or EJVAs. The exclusion criteria were animal and cadaver studies and reports on interventions using the healthy jugular vein for access only (ie, catheterization). Analysis of the pooled data from all eligible case reports was performed. RESULTS From 1840 identified reports, 196 studies were eligible. A total of 256 patients with JVAs were reported, with 183 IJVAs and 73 EJVAs. IJVAs were reported to occur in 66% on the right side compared with the left side (P��= .011). The patients with IJVAs were mostly children (median age, 12��years; interquartile range, 5.8-45.2��years). The patients with EJVAs were young adults (median age, 30��years; interquartile range, 11.0-46.5��years). EJVAs were more frequently reported in women and IJVAs in men (P��= .008). Most of the patients were asymptomatic. Pulmonary embolization in association with thrombosed EJVAs was only reported for one patient. A report of the outcomes after surgery and conservative management was missing for ���50% of the patients. No relevant complications were reported after ligation of the EJVA without reconstruction. Intracranial hypertension after ligation of the right-sided IJVA was reported in three children; in one of them, a pontine infarction was observed. CONCLUSIONS JVAs are a disease of the younger population but can occur at any age. It seems to be safe to observe patients with nonthrombosed JVAs. However, in the presence of thrombus or pulmonary embolization, surgical treatment should be considered. A reconstruction technique of the IJVA with venous patency preservation should be preferred.

Zusammenfassung. Der Roux-Y-Magenbypass (RYGBP) stellt weltweit die am häufigsten durchgeführte bariatrische Operation dar – innere Hernien zählen zu den wichtigsten Langzeitkomplikationen. Unser Bericht einer 30-jährigen Patientin beschreibt erstmalig einen Fall einer ischämisch bedingten Dünndarmstenose nach RYGBP. Bei der Erstvorstellung wurden eine Petersen- und eine Brolin-Hernie diagnostiziert und laparoskopisch erfolgreich verschlossen. Der minderperfundierte Dünndarmanteil erholte sich in der Folge gut. Die Zweitvorstellung folgte eine Woche darauf bei postprandialem Erbrechen aufgrund postischämischer Dünndarmstenosen. Diese wurden mittels Ballondilatation erfolgreich behandelt.

Gastric Bypass: Weight Loss with Complications Abstract. Roux-en-Y gastric bypass (RYGBP) is the most often performed bariatric operation worldwide with internal hernia as one of the main long-term complications. To our knowledge, we report the first case of post-ischemic small-bowel strictures observed after a successful operation of an internal hernia after RYGBP. During emergency surgery a Petersen and a Brolin hernia were diagnosed and repaired. The initially ischemic small intestine was recovered. However, a week later the patient presented herself again due to ischemia-induced small-bowel strictures. These were treated successfully by endoscopic balloon dilatation.Zusammenfassung. Der Roux-Y-Magenbypass (RYGBP) stellt weltweit die am häufigsten durchgeführte bariatrische Operation dar – innere Hernien zählen zu den wichtigsten Langzeitkomplikationen. Unser Bericht einer 30-jährigen Patientin beschreibt erstmalig einen Fall einer ischämisch bedingten Dünndarmstenose nach RYGBP. Bei der Erstvorstellung wurden eine Petersen- und eine Brolin-Hernie diagnostiziert und laparoskopisch erfolgreich verschlossen. Der minderperfundierte Dünndarmanteil erholte sich in der Folge gut. Die Zweitvorstellung folgte eine Woche darauf bei postprandialem Erbrechen aufgrund postischämischer Dünndarmstenosen. Diese wurden mittels Ballondilatation erfolgreich behandelt.

This work is part of a well-established strand of study about quality of life (QoL) and the different methodologies for its quantitative evaluation. The study focuses on a specific dimension of QoL, that of the eudaimonic well-being (EuWB), with two main objectives. On the one hand, we try to clarify how EuWB can be framed in the systematizations of QoL proposed in the literature. Its relation to the concept of subjective well-being is discussed, and the need to distinguish such approach from the so-called hedonic dimension of QoL is highlighted. On the other hand, the paper aims to investigate the link between the perception of EuWB and individual socio-demographic characteristics through a quantitative analysis based on the results of a survey. The survey carried out in Central Italy in 2010, involved a sample of 1,134 individuals, which are classified according to their perception of EuWB. An analysis of the socio-demographic characteristics within the EuWB groups is then performed in order to investigate the association between these variables and the perception of EuWB. Results are discussed with respect to the evidences from similar surveys found in the literature. The analysis confirms the influence of some variables on the perception of EuWB, yet it underlines the difficulty in comparing different studies on QoL without clarifying to which of the different declensions of this concept the survey methodology refers to.

Wolfram syndrome (WS) is a rare, autosomic recessive genetic disorder. The mortality rate of WS is about 65% before 35 years of age. It presents diagnostic challenges in the clinical practice due to its incomplete characterization. This report represents the first case of undiagnosed Wolfram syndrome in a patient over 53 years old.A 53-year-old white woman developed a respiratory complication necessitating extended ICU care and respiratory rehabilitation. This respiratory complication proved to be a consequence of undiagnosed WS.The report discusses the clinical elements that suggested the diagnosis, the problems related to the ICU management of this patient, in particular the weaning difficulties, and the need for rehabilitation. Finally, the report considers the ethical aspect of timely diagnosis on the course and outcome of WS.