Objective The AvalonElite™ double lumen cannula (DLC) can provide effective cavopulmonary assistance (CPA) in a Fontan (TCPC) sheep model, but it requires strict alignment. The objective was to fabricate and test a newly designed paired umbrellas DLC without alignment requirement. Methods The paired membrane umbrellas were designed on the DLC to bracket infusion blood flow toward the pulmonary artery. Two umbrellas were attached, one 4 cm above and one 4 cm below infusion opening. Umbrellas were temporarily wrapped and glued to DLC body to facilitate insertion. A TCPC mock loop was used to test CPA performance and reliability with DLC rotation and displacement. The paired umbrella DLC was also tested in a TCPC adult sheep model (n=6). Results The bench test showed up to 4.5 l/min pumping flow and about 90% pumping flow efficiency at 360° rotation and 8 cm displacement of DLC. The TCPC model with compromised hemodynamics was successfully created in all 6 sheep. The CPA DLC with paired umbrellas was smoothly inserted into SVC and extracardiac conduit in all sheep. At 3.5–4.0 l/min pump flow, the sABP and CVP returned to normal baseline and remained stable throughout 90 min experiment, demonstrating effective CPA support. DLC Rotation and displacement did not affect performance. Autopsy revealed well opened and positioned paired umbrellas, and DLCs were easily removed from RJV. Conclusions Our DLC with paired umbrellas is easy to insert and remove. The paired umbrellas eliminated the strict alignment requirement and assured consistent CPA performance. (245 Words)
With the development of minimally invasive technology, minimally invasive surgery transforaminal lumbar interbody fusion has become an effective way to treat lumbar spinal stenosis. Lumbar spinal stenosis is one of the common diseases that cause backache or lumbago and sciatica. This article compares and analyzes the clinical efficacy of 60 patients with lumbar spinal stenosis surgery. It can be seen that the wound by MIS-TLIF is significantly less than that of traditional open surgery, and the postoperative recovery of MIS-TLIF is faster. So, MIS-TLIF is one of the concepts of minimally invasive surgery. The age distribution ranged from 56 to 78 years, with an average of 65.7 years. 31 cases were treated with MIS-TLIF (MIS-TLIF group), and 29 were treated with traditional posterior open surgery (TLIF group). The operation time, intraoperative blood loss, and postoperative drainage of the operation area were recorded. After statistical testing, the intraoperative blood loss, incision size, and postoperative drainage volume of the wound in the MIS-TLIF group were significantly less than those in the TLIF group. The results of JOA score, ODI score, and VAS score during the postoperative follow-up period were comparable to those of open surgery. Therefore, minimally invasive transforaminal lumbar interbody fusion is effective in treating lumbar spinal stenosis.
Rationale:Sliding inguinal hernias of the urinary bladder are protrusions of the bladder through the internal inguinal ring, most of which are insignificant and diagnosed intra-operatively. Large inguino-scrotal bladder hernias commonly present with lower urinary tract symptoms and may cause severe complications, including bladder incarceration or necrosis, bladder hemorrhage, obstructive or neurogenic bladder dysfunction, and even renal failure.Patient concerns:We describe and discuss the clinical findings and management of a 59-year-old man who complained of a decrease in scrotal size after voiding and 2-stage voiding requiring pressure to the scrotum.Diagnoses:The patient was diagnosed preoperatively as massive, bilateral, inguinoscrotal hernias, and a large, left-sided, sliding bladder hernia.Interventions:The patient underwent a timely open re-peritoneal inguinal herniorrhaphy using a mesh.Outcomes:The surgical outcomes were good, and no surgical site infection, chronic postoperative inguinal pain or recurrence were recorded during the follow-up.Lessons:Better knowledge of this rare condition of large inguino-scrotal sliding bladder hernia could help in making a correct diagnosis preoperatively and provide proper surgical management timely, so as to reduce delay in treatment and avoid potential complications.
Our goal is to develop a less invasive total cavopulmonary connection (TCPC) sheep model for testing total cavopulmonary assist (CPA) devices. Thirteen sheep underwent a right 4th intercostal lateral thoracotomy. In series I (n=6), a polytetrafluoroethylene (PTFE) extracardiac conduit (ECC) was connected to inferior vena cava (IVC) and superior vena cava (SVC) by end to side anastomosis. The SVC/IVC remained connected to right atrium (RA). A PTFE graft bridged ECC to right pulmonary artery (RPA). Clamps between SVC/IVC anastomoses and RA diverted total venous blood to pulmonary circulation. In series II (n=7), temporary bypasses between SVC/IVC to RA allowed SVC/IVC to be cut off from RA for better RPA exposure. The ECC-SVC/IVC were end-end anastomosed and ECC-RPA side-side anastomosed for total SVC/IVC to PA conversion. In each series, one sheep died of bleeding. In 5 sheep in series I and 6 sheep in series II, the TCPC model was successfully created with significantly increased central venous pressure and significantly decreased pulmonary artery pressure/arterial blood pressure. Our acute TCPC sheep model has a less traumatic right thoracotomy with no cardiopulmonary bypass and less blood loss with no blood transfusion, facilitating future long-term CPA device evaluation.
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