Locally deranged joint anatomy can predispose to septic arthritis which can be managed by surgical debridement. We present a case of manubriosternal subluxation/dislocation caused by kyphoscoliosis leading to manubriosternal septic arthritis.

The number of included patients is far too low to draw any conclusions but there were some interesting trends. For similar patient samples, colorectal surgeons seem to adopt a more conservative approach and have fewer recurrences than general surgeons. These differences are not reflected in the frequency or severity of postoperative incontinence.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that balloon aortic valvuloplasty is recommended as a bridge to aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis. Institutional practices, local and logistic factors can affect patient selection and management approaches to severe aortic stenosis, but having the facility to offer balloon aortic valvuloplasty (especially in the TAVI era) provides another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve surgery. The increased incidence of balloon aortic valvuloplasty mirrors the increase in the use of TAVI with a sharp increase in activity from 2006. Success rates for bridging from balloon aortic valvuloplasty to definite surgical intervention are in the range 26.3-74%, with AVR or TAVI occurring within 8 weeks to 7 months. Complications from balloon aortic valvuloplasty such as aortic regurgitation (AR) can be managed successfully. Up to 40% of patients selected by balloon aortic valvuloplasty to have TAVI or AVR do not have these procedures within 2 years. While most of these patients are excluded for objective clinical reasons such as terminal disease/malignancy or other persistent contraindication, some patients refuse definitive treatment and others die while on the waiting list. Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty only. Owing to the high mortality of patients in this cohort without destination therapy, delays to progression to TAVI or AVR should be avoided in selected patients. A discussion with the patient about expectations, mortality and morbidity risks with all management options will aid decision-making.

Our 5-year experience suggests that EVLA is a safe and effective alternative to conventional surgery for the treatment of varicose veins. Bilateral procedures were well tolerated by patients even under local anaesthesia.

In our experience EVLA can be safely performed for recurrent varicose vein disease. In our experience Redo EVLA is not more difficult than primary EVLA to perform.

According to objective sweat output measurements, thoracoscopic sympathectomy results in long-term control of palmar hyperhidrosis. This evaluation method is valuable in investigating recurrence of symptoms or compensatory hyperhidrosis after sympathectomy, providing a robust and objective criterion for planning intervention.

We evaluated the feasibility, tolerability, and efficacy of a strategy for transaxillary artery intra-aortic balloon pump placement for extended mechanical circulatory support of patients with post-cardiotomy shock as a bridge to recovery. Patients requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure were identified. Intra-aortic balloon pump was tunneled through a 6-mm Dacron graft anastomosed to the right axillary artery. The intra-aortic balloon pump catheter is advanced under fluoroscopic guidance into the descending thoracic aorta. Three patients were transferred from outside facilities, requiring prolonged intra-aortic balloon pump support for postcardiotomy heart failure. Patients included a 54-year-old woman with occluded grafts and left ventricular thrombus after coronary artery bypass grafting, ejection fraction (EF) of 23.4% on dobutamine infusion, intra-aortic balloon pump support for 39 days, max daily ambulated distance of 1250 feet, and discharged home on day 51 on milrinone infusion; a 63-year-old man with kinked left internal mammary artery to left anterior descending artery graft (surgically repaired), multiple failed extubations requiring tracheostomy, EF of 15% on epinephrine and milrinone, intra-aortic balloon pump support for 43 days, max daily ambulated distance of 400 feet, and discharged home on day 54; and a 66-year-old man after redo coronary artery bypass grafting + carotid endarterectomy, with failure to wean off cardiopulmonary bypass requiring veno-arterial extracorporeal membrane oxygenator, EF of 20% on epinephrine and norepinephrine, intra-aortic balloon pump support for 41 days, max daily ambulated distance of 2800 feet, and discharged home on day 91. There were no infection, thromboembolic, cerebrovascular, bleeding, or intra-aortic balloon pump malpositioning/migration complications. We found that transaxillary artery intra-aortic balloon pump is well tolerated by patients and allows early ambulation and aggressive physical therapy in patients needing extended support. Duration of intra-aortic balloon pump support was up to 43 days with no complications.

No abstract