It has been reported that changes in cytokine levels affect mitochondrial functions, levels of hypoxia-inducible factor α (HIF-1α), and tissue damage during sepsis. We aimed to investigate the effects of simvastatin pretreatment on mitochondrial enzyme activities, and on levels of ghrelin, HIF-1α, and thiobarbituric acid reactive substances (TBARS) in kidney tissue during sepsis. Rats were separated into four groups, namely, control, lipopolysaccharides (LPS) (20 mg/kg), simvastatin (20 mg/kg), and simvastatin + LPS. We measured the levels of mitochondrial enzyme activities and TBARS in the kidney using spectrophotometry. The histological structure of the kidney sections was examined after staining with hematoxylin and eosin. Tumor necrosis factor α (TNF-α), IL-10, HIF-1α, and ghrelin immunoreactivity were examined using proper antibodies. In tissue, TNF-α ( p < 0.01) and HIF-1α ( p < 0.05) levels were increased in the simvastatin + LPS and LPS groups. TBARS levels were higher in the LPS group than in the other groups ( p < 0.01), but they were similar in the simvastatin + LPS and control groups ( p > 0.05). Ghrelin immunoreactivity was lower in the LPS group ( p < 0.05) and higher in the simvastatin + LPS group than in the LPS group ( p < 0.01). We observed tubular damage in the sections of the LPS group. There were no differences in mitochondrial enzyme activities between the groups ( p > 0.05). We observed that pretreatment of simvastatin caused favorable changes on ghrelin and TBARS levels in rats with sepsis.
In some patients undergoing a valve-sparing reimplantation technique, a coronary ostium may be very close to one of the commissures. This condition jeopardizes the coronary ostium patency and valve reimplantation. The authors describe a simple and safe modification of the reimplantation technique, leaving the misplaced coronary ostium attached to the commissure.
Objective: To analyze our long-term experience with valve-sparing reimplantation technique in treating isolated root aneurysm, isolated aortic regurgitation, or both, as well as in aortic dissection. Methods: Between March 1998 and October 2018, 303 consecutive patients underwent valve-sparing reimplantation in our institution. The mean age of this cohort was 52.9±15 years. Time to event analysis was performed with the Kaplan-Meier method. Results: In-hospital mortality was 1% (n=3) of which 2 were admitted for acute aortic dissection. Two-hundred seventy-one patients were available for long-term analysis. Median follow-up was 5 years (IQR: 1.7-8.2). Thirty-nine patients (14.4%) died during follow-up setting survival at 10 years at 73+4.9%. Over the follow-up period, freedom from major bleeding, thromboembolic events and infective endocarditis at 10 years was 96.7%, 97.5% and 96% respectively. Seventeen patients required late aortic valve reoperation; freedom from valve reoperation was therefore 89.6+2.9% at 10 years and was not significantly different between groups. Conclusions: Our study shows that valve-sparing reimplantation is associated with low perioperative mortality, a remarkably low rate of valve-related complications and excellent long-term durability. Furthermore, we show that it can be equally performed in patients with severe isolated aortic regurgitation, and the durability of valve repair is similar regardless of the indication for surgery.
A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT)-Scan, positron emission tomography (PET)-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies.
Abstract: Surgical techniques for regurgitant aortic valve pathology have evolved significantly in the last 20 years as a result of deeper understanding of functional structure and physiopathology of the aortic valve and the development of a common anatomical and functional language among specialists. The introduction of the functional classification of aortic valve regurgitation facilitated the development of standard surgical approaches to treat this pathology. The principles of aortic valve repair include the restoration of normal anatomy and geometry of the functional aortic root with the aim to provide a long-term stabilisation of the aortic annulus. We report a review of our approach and surgical techniques to repair the aortic valve and aortic root based on our long experience in the field.
Abstract OBJECTIVES Our goal was to analyse the influence of preoperative aortic regurgitation (AR) on the necessity of cusp repair during valve-sparing reimplantation (VSR). We focused on patients with tricuspid aortic valves (TAV) and evaluated the impact of AR and cusp repair on long-term outcomes. METHODS From March 1998 to December 2018, a total of 512 consecutive patients underwent VSR at our institution; of these, 303 had a TAV. The mean age was 53 ± 15 years, and the median follow-up was 6.12 years. The rate and type of cusp repair were analysed based on preoperative AR. Time-to-event analysis was performed, as well as risk of death, reoperation and AR recurrence. RESULTS Cusp repair was necessary in 168 (55.4%) patients; the rate rose significantly as AR grade increased (P < 0.001). In-hospital mortality was 1% (n = 3). At 5 and 10 years, overall survival was 92 ± 2% and 75 ± 5%, respectively. Freedom from valve reoperation was 95 ± 2% and 90 ± 3%. Freedom from AR >2+ and AR >1+ at 10 years was 88 ± 4% and 70.4 ± 4.6%, respectively. Independent predictors of death included age, New York Heart Association functional class and type-A aortic dissection. Predictors of AR greater than mild included previous cardiac surgery and severe preoperative AR. CONCLUSION In patients with TAV receiving VSR, the necessity of cusp repair increased with the degree of preoperative AR. Preoperative AR and cusp repair do not impact long-term survival and aortic valve reoperation, but severe preoperative AR and multiple cusp repair increase the risk of recurrent moderate-to-severe AR. Overall, cusp repair seems to attenuate the negative impact of preoperative AR for at least 1 decade in a majority of patients.
