Congenital cardiac surgery is one of the most challenging and fascinating branches of modern medicine which continues to
advance in areas and improving outcomes, post-operative and pre-operative care.
Patent Ductus Arteriosus was the first congenital heart lesion to be successfully corrected surgically. The landmark surgery was
performed by Dr. Robert E. Gross in 1938 and opened up the possibility of subsequent surgical correction of various other lesions,
which were considered to be untreatable previously. The first successful surgical closure of persistent ductus arteriosus (PDA)
was preceded by years of work and contributed by various surgeons, physicians, and anatomists, dating all the way back to
the 1st century. They are all worthy of recognition and praise.
This article covers the important events related to PDA lesions including its first identification, followed by its description
in various texts and sources over the course of time, failed attempts at surgical correction, and disputes regarding credits.
These contributions to the branch cannot be overstated and serves as an inspiration to cardiac surgeons all over the world
and to students, interns, and newly graduated doctors as well, who would one day like to be part of this fascinating branch.
A beautiful paper published by Eugene Braunwald
European Heart Journal, Volume 42, Issue 24, 21 June 2021, Pages 2327–2328, https://doi.org/10.1093/eurheartj/ehab264
From the cardiopulmonary bypass and first heart transplantation to transcatheter valve implantation and minimally invasive cardiac surgery, there were spent many decades. The cardiac surgery had modelled and evolved according to surgeons’ experience and clinical needs. Nowadays, the minimally invasive surgery and robotic surgery have won the first place in our operation rooms with the more and more emergent transcatheter valve procedure.
A beautiful paper published by Eugene Braunwald
European Heart Journal, Volume 42, Issue 24, 21 June 2021, Pages 2327–2328, https://doi.org/10.1093/eurheartj/ehab264
From the cardiopulmonary bypass and first heart transplantation to transcatheter valve implantation and minimally invasive cardiac surgery, there were spent many decades. The cardiac surgery had modelled and evolved according to surgeons’ experience and clinical needs. Nowadays, the minimally invasive surgery and robotic surgery have won the first place in our operation rooms with the more and more emergent transcatheter valve procedure.
As a result of the COVID-19 epidemic, there has been a renewed interest in Healthcare Inventions and the pursuit of revolutionary treatments. This is particularly true for the next crop of medical professionals and epidemiologists, who will be on the front lines of the next global health crisis. Like the Top 10 innovations that have made our lives easier and longer, these medical breakthroughs will undoubtedly usher in a new age of culturally transformational Healthcare Inventions.
A brief History of Coronary Artery Bypass Grafting (CABG)Abhijit Joshi
this presentation traces the early reports of angina, when it was thought to be a disease of the breast, goes on to describe the stepping stones leading to myocardial revascularisation.
Heberden meticulously described a symptom, but he did not understand the disease. Edward Jenner noticed thickened coronary arteries at autopsy of his colleague John Hunter who had died suddenly after an angina attack in 1793,2 but it took decades for a first remedy for angina pectoris and even longer for a true understanding of the underlying disease
A Stitch in Time: History and Future Directions for Congenital Heart SurgeryProvidence Health Care
On May 7, 2016, St. Paul's Hospital's Pacific Adult Congenital Heart Disease (PACH) Clinic invited patients and their families to learn more about navigating life as an adult with congenital heart disease. Over 150 participants attended the clinic.
Coronary Artery Bypass Grafting in Dextrocardia. Is There a Challenge?semualkaira
Dextrocardia with situs inversus is a rare congenital condition, even though known since 1606 when Fabricious first described it. The incidence of coronary artery disease in this group of patients is the same as in general population. First Coronary Artery Bypass Grafting (CABG) in patient with Dextrocardia was performed in 1980. Performing the procedure it is a very challenging task for the surgeon in the terms of planning, choice of conduits, and simultaneous presentation of other congenital conditions.
Coronary Artery Bypass Grafting in Dextrocardia. Is There a Challenge?semualkaira
Dextrocardia with situs inversus is a rare congenital condition, even though known since 1606 when Fabricious first described it. The incidence of coronary artery disease in this group of patients is the same as in general population. First Coronary Artery Bypass Grafting (CABG) in patient with Dextrocardia was performed in 1980
Wellens syndrome. Wellens syndrome (also referred to as LAD coronary T-wave syndrome) refers to an ECG pattern specific for critical stenosis of the proximal left anterior descending artery. The anomalies described occur in patients with recent anginal chest pain, and do not have chest pain when the ECG is recorded.
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
More Related Content
Similar to Surgical repair of patent ductus arteriosus history timeline
As a result of the COVID-19 epidemic, there has been a renewed interest in Healthcare Inventions and the pursuit of revolutionary treatments. This is particularly true for the next crop of medical professionals and epidemiologists, who will be on the front lines of the next global health crisis. Like the Top 10 innovations that have made our lives easier and longer, these medical breakthroughs will undoubtedly usher in a new age of culturally transformational Healthcare Inventions.
A brief History of Coronary Artery Bypass Grafting (CABG)Abhijit Joshi
this presentation traces the early reports of angina, when it was thought to be a disease of the breast, goes on to describe the stepping stones leading to myocardial revascularisation.
Heberden meticulously described a symptom, but he did not understand the disease. Edward Jenner noticed thickened coronary arteries at autopsy of his colleague John Hunter who had died suddenly after an angina attack in 1793,2 but it took decades for a first remedy for angina pectoris and even longer for a true understanding of the underlying disease
A Stitch in Time: History and Future Directions for Congenital Heart SurgeryProvidence Health Care
On May 7, 2016, St. Paul's Hospital's Pacific Adult Congenital Heart Disease (PACH) Clinic invited patients and their families to learn more about navigating life as an adult with congenital heart disease. Over 150 participants attended the clinic.
Coronary Artery Bypass Grafting in Dextrocardia. Is There a Challenge?semualkaira
Dextrocardia with situs inversus is a rare congenital condition, even though known since 1606 when Fabricious first described it. The incidence of coronary artery disease in this group of patients is the same as in general population. First Coronary Artery Bypass Grafting (CABG) in patient with Dextrocardia was performed in 1980. Performing the procedure it is a very challenging task for the surgeon in the terms of planning, choice of conduits, and simultaneous presentation of other congenital conditions.
Coronary Artery Bypass Grafting in Dextrocardia. Is There a Challenge?semualkaira
Dextrocardia with situs inversus is a rare congenital condition, even though known since 1606 when Fabricious first described it. The incidence of coronary artery disease in this group of patients is the same as in general population. First Coronary Artery Bypass Grafting (CABG) in patient with Dextrocardia was performed in 1980
Similar to Surgical repair of patent ductus arteriosus history timeline (20)
Wellens syndrome. Wellens syndrome (also referred to as LAD coronary T-wave syndrome) refers to an ECG pattern specific for critical stenosis of the proximal left anterior descending artery. The anomalies described occur in patients with recent anginal chest pain, and do not have chest pain when the ECG is recorded.
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
A post-splenectomy patient suffers from frequent infections due to capsulated bacteria like Streptococcus
pneumoniae, Hemophilus influenzae, and Neisseria meningitidis despite vaccination because of a lack of
memory B lymphocytes. Pacemaker implantation after splenectomy is less common. Our patient underwent
splenectomy for splenic rupture after a road traffic accident. He developed a complete heart block after
seven years, during which a dual-chamber pacemaker was implanted. However, he was operated on seven
times to treat the complication related to that pacemaker over a period of one year because of various
reasons, which have been shared in this case report. The clinical translation of this interesting observation
is that, though the pacemaker implantation procedure is a well-established procedure, the procedural
outcome is influenced by patient factors like the absence of a spleen, procedural factors like septic measures,
and device factors like the reuse of an already-used pacemaker or leads.
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...Ramachandra Barik
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...Ramachandra Barik
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Murshid and Elassal: Evolution of patent ductus arteriosus surgery
HEART VIEWS
Volume 22 / Issue 2 / April-June 2021
161
NORMAL ANATOMICAL CLOSURE
The process of closure of the arterial duct occurs
in two steps. Initially, medial smooth muscle contraction
produces increased wall thickness and shortening
and protrusion of the intimal cushions. This results in
functional closure 10–15 hours after birth in full‑term
infants. The second stage of the closure is due to
proliferation of connective tissue in the intima and
media. Atrophy of smooth muscle cells ultimately
transforms the muscular vessel into a non-contractile
ligament represented by a mass of dense elastic and
fibrous tissue known as ligamentum arteriosum.[2]
The
arterial duct is completely closed by 8 weeks of age in
88% of infants with a normal cardiovascular system.[3]
EVOLUTION OF SURGICAL
MANAGEMENT
129 AD
Patent ductus arteriosus is known from the ancient
times as Galen of Pergamon, a Greek anatomist and
physician at 129AD, who first discovered and described
multiple aspects of fetal circulation, including patent
ductus arteriosus and foramen ovale, although at the
time he did not fully understand the importance of this
feature.[4]
1564
The name DUCTUS ARTERIOSUS APERTUS
is generally traced to Leonardo Botallo (Leonardus
Botallus), the Italian anatomist and surgeon. Botallo
claimed, in his brief publication of 1564, “De catarrho
commentarius,” that he had discovered a “duct”, but the
opening he described connects the right and left atria.
He called it the “vena arteriarum nutria.” This opening
corresponds to the anatomic feature we now known as
the Foramen Ovale. Many years later, Botallo’s work,
Opera Omnia (1660) included an illustration of the
ductus arteriosus (“canalis à pulmonali arteria tendens
in aortam”). This illustration probably gave rise to the
assumption made by latter authors that Botallo had
discovered this anatomic structure.[5‑7]
1898
In 1898, George Alexander Gibson described the
classic “machinery murmur” associated with PDA.[8]
1907
The first person to come up with the idea of
possibility of surgical closure of the duct was John
Cummings Munro, a Professor of Surgery at Tuft’s,
Boston, based on studies postmortem. He described
and first proposed the idea of ductus ligation in an article
read before the Philadelphia Academy of Surgery on
May 6, 1907. He never had a case to try the suggested
procedure.[9]
1920s and early 1930s
The British surgeon Russell Claude Brock reported
that the famous American surgeon Evarts Ambrose
Graham (1883–1957) also planned surgical treatment
of the open ductus arteriosus in the early 1920s. He told
Dr. Brock that, in the early 1920s, he became convinced
that it was desirable and feasible to close the persistent
ductus arteriosus.
He subsequently met the Professor of pediatrics
at St. Louis Children’s Hospital, explained to him
his thoughts and plans, and requested if a patient
could be sent to him for the procedure. The pediatric
professor in response sent along a man aged 53 years,
presumably to prevent such an operation in a child,
because cardiac surgery in children did not yet exist at
that time. Graham commented that this action probably
delayed the introduction of this form of treatment by
about 15 years.[10]
Another known attempt to perform an operation
was done in London by Laurence O’Shaughnessy. The
procedure was never implemented because it was a
misdiagnosis. In fact, the patient had a pulmonary artery
stenosis and patent ductus arteriosus was transformed
into the ligament.[11]
1936
Maude Abbott, known for her 1936 Atlas of
Congenital Heart Disease, had systematically analyzed
the specimens of congenitally malformed hearts
held by the McGill Medical Museum in Montreal and
showed that endocarditis developed in more than 25%
of patients with a ductus arteriosus persistens if they
reached puberty.[12]
1937
John William Strieder attempted to close a ductus
at Massachusetts Memorial Hospital in Boston, on the
advice of the cardiologist Ashton Graybiel, on March 6,
1937. Strieder received referral of a 22‑year‑old woman
with an open ductus and bacterial endocarditis. Due to
short length of the duct, the planned procedure was
not performed and only partial closure was achieved.
There was immediate post-operative improvement of
the patient’s condition. The classical murmur of an open
duct was no longer audible. The patient however passed
away 4 days later. Postmortem findings indicated
extensive vegetation.[13]
1938
Dr. Robert E. Gross performed the first successful
correction of patent ductus arteriosus on a 7‑year‑old
girl, Lorraine Sweeney on August 26, 1938 at Brigham
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and Boston Children’s Hospital. He was the chief
resident at the time, with 33 years of age. It is worth
noting that Dr. Gross initially failed to secure permission
from his superior Dr. William Ladd (known for Ladd’s
Procedure, Ladd’s Bands) to perform this procedure.
He only was able to go ahead once Dr. Ladd left for
vacation, and his deputy gave Dr. Gross the necessary
go ahead to perform this procedure. Dr. Gross planned
to operate on two patients on the same day in case the
first surgery is unsuccessful. Once Dr. Ladd returned,
he was not pleased about the whole scenario and is
reported to have dismissed Dr. Gross in 1943, but
later reinstated him under public pressure.[14,15]
After
initial success, R. Gross reported his first four cases of
successful ductus ligation.[16]
1939
John C. Jones and Lewis T. Bullock, in LosAngeles,
tried in vain to obtain the permission of the relatives
of patients with a patent ductus for the operation.
Only after Bullock was able to report the successful
operation carried out by Gross, did he receive parental
consent. His first case was that of a 13‑year‑old boy who
underwent the operation on March 28, 1939. By April
10, 1940, this group was able to report ductus ligation
in 13 patients.[17]
Several reports and publications claim that the
German surgeon Emil Karl Frey (1888–1977) probably
closed a ductus before Gross. [18,19] Documentation
of this was no longer to be found after the World War
II. However, Frey himself wrote in his autobiography
“Rückschau und Umschau,” published in 1978, that even
though he performed the procedure on a 14‑year‑old boy
in 1939, he waited for more cases before reporting the
procedure, as he believed he needed more substantial
data. Before he could complete his objective, World War
II broke out, which affected his work. As Robert Gross
was the first to report about the successful ligation of
ductus arteriosus, the credit for the first procedure is
often attributed to him.[20]
1939
Oswald Tubbs (also known for Tubbs Dilator), on
December 5, 1939 successfully ligated a patient with
infected patent ductus at St. Bartholomew’s Hospital
in London. The causative organism was found to be
Haemophilus influenzae.[21]
1940
On January 27, 1940, Arthur S. W. Touroff ligated
an infected ductus at the New York Mount Sinai Hospital.
Shortlybefore,Grosshadregardedbacterialendocarditis
as a contraindication to the operation because surgical
manipulation might mobilize vegetations, leading to
embolism and severe bacteremia. Touroff, however,
believed that spontaneous pulmonary embolization
was already frequent in these patients and that it would
not be increased by manipulation. Touroff’s 29‑year‑old
patient, who had endarteritis caused by Streptococcus
viridans, was operated on through a left anterior
thoracotomy in the third intercostal space.[22]
1941
Dr. Robert E. Gross encountered the first fatal post-
operative complication in the form of Duct Transection
by the ligature. Two girls, a 15‑year‑old and a 5‑year‑old,
died postoperatively due to this complication and
prompted Dr. Gross to modify the operation and perform
surgical transection of the duct and closure of both ends.
Dr. Gross transected the ductus for the first time on
May 26, 1941. Across the Atlantic, Clarence Crafoord
a Swedish surgeon had also transected a ductus and
closed both ends in May 1941, most likely before
Dr. Gross, and was probably the first case.[23]
1966
Werner Porstmann was the first to close a ductus by
catheter technique. The first procedure was performed
on a 17‑year‑old patient in 1966 at the Charité Berlin,
in the then German Democratic Republic. Closure was
accomplished by implantation of an expandable plug
within the arterial duct. Although the required delivery
system was much too large to be of practical use in small
children, this report pointed to the possibility that repair
of congenital heart defects could be accomplished by
transcatheter techniques.[24]
1976
MichaelA. Heymann and colleagues demonstrated
the closure of patent ductus arteriosus in premature
infants using non-steriodial anti‑inflammatory drugs
(NSAIDS). They administeredAspirin and Indomethacin
to 18 premature infants and were able to demonstrate
positive result in majority of the infants.[25]
1979
Rashkind and colleagues in 1979 reported the
first successful catheter closure of a persistent arterial
duct in a child weighing only 3.5 kg by deploying a
double‑disc percutaneous device. In the following
decades many advances and refinement were done
to the catheter‑based closure of the ductus, and it still
remains the most commonly used technique except
cases of very large ductus arteriosus and very low-
birth-weight infants, where open surgical intervention
still remains the procedure of choice.[26]
1991
François Laborde in 1991 performed the first
video‑assisted thoracoscopic (VATS) PDA closure. In
Laborde’s series of 332 consecutive pediatric patients,
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mortality was zero, with minimal morbidity, making this
technique highly preferred among low‑birth‑weight
infants.[27]
1992
Cambier and colleagues. reported the first case
of successful transcatheter PDA coil embolization in
1992. This method was adapted from the technique
used in the preceding decade to embolize fistulae,
arteriovenous malformations, and other vascular
abnormalities. This technique immediately gained wide
popularity for its low cost, excellent safety, efficacy and
for its adaptability to a wide spectrum of patients ranging
from infancy to adulthood.[28]
Current treatment strategies include pharmacologic
closure, percutaneous closure in the catheterization
laboratory, video-assisted thoracoscopic (VATS)
hemoclip occlusion and conventional posterolateral
thoracotomy with ligation. Percutaneous closure is
effective in the treatment of children and adults with PDA.
Initial attempt at pharmacologic PDAclosure remains the
initial therapeutic modality at most centers.
DISCUSSION
Although many surgeons have claimed or presumed
to have performed surgical repairs before Dr. Robert E.
Gross, absence of specific dates and data regarding
such operations lead to an incomplete chronology of
events. But it is worth nothing that congenital heart
disease started to be considered as a treatable condition
when, in 1938, Robert Edward Gross first successfully
ligated a persistent ductus arteriosus. This event paved
the way to modern cardiac surgery.
On an interesting endnote, it is worth mentioning
that in 1939 Helen Brooke Taussig visited Gross after
his successful ductus operation in Boston. Taussig
asked Gross whether he could construct a ductus for
her, she disclosed to him that she thought creating a
surgical shunt will greatly benefit cyanotic children,
but Gross was not interested. Gross seemed to have
thought that the construction of such a shunt would lead
to pulmonary flooding. After Taussig had returned to
Baltimore, she approached Alfred Blalock. Eventually,
Taussig convinced Alfred Blalock for her operation, and
the Blalock‑Taussig shunt was constructed in the first
patient withTetralogy of Fallot on November 29, 1944.[29]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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