Haynes Dissing (veinplain46)

Conclusions We found that, when adjusted for comorbidities, complexity, and procedure type, there was no difference in outcomes in terms of surgical complications, reoperation, length of stay more than 5 days, and mortality. While these results suggest that our apprenticeship teaching model is safe for developing independent physicians, using new educational modalities such as simulation and resident-directed labs may be useful to attenuate potential.Innominate vein injury is a known potential complication of redo sternotomy but transection of the innominate vein after first time median sternotomy has not been previously described. A 71 year-old female suffered left innominate vein transection upon division of the sternum for coronary artery bypass grafting (CABG). Subsequent massive bleeding required digital compression of the transected vessel ends, open manual cardiac massage, institution of massive transfusion protocol, and pharmacologic support before gaining hemodynamic control by instituting cardiopulmonary bypass (CPB). Left innominate vein injury can occur with both first time and redo sternotomy.Background Bipolar radiofrequency (RF) clamps have been shown to be capable of reproducibly creating transmural lesions with a single ablation in animal models. Unfortunately, in clinical experience, the bipolar clamps have not been as effective, and often require multiple ablations to create conduction block. This study created a new experimental model using fresh, cardioplegically-arrested human hearts turned down for transplantation to evaluate the performance of a non-irrigated bipolar RF clamp. Methods Nine human hearts turned down for transplantation were harvested and the Cox-Maze IV lesion set was performed with a non-irrigated bipolar RF clamp. In the first seven hearts, a single ablation was performed for each lesion. In the last two hearts, a set of two successive ablations without unclamping were performed. The heart tissue was stained with 2,3,5-triphenyl-tetrazolium chloride. Each ablation lesion was cross-sectioned to assess lesion depth and transmurality. Results A single ablation with the bipolar RF clamp resulted in 89% (469/529) of the histologic sections and 65% (42/65) of the lesions being transmural. Of the non-transmural sections, 92% occurred in areas with epicardial fat. Performing two successive ablations without unclamping resulted in 100% of the cross-sections (201/201) and lesions (25/25) being transmural. NRL1049 Conclusions A single ablation failed to create a transmural lesion 35% of the time, and this was associated with the presence of epicardial fat. Two successive ablations without unclamping resulted in 100% lesion transmurality using the bipolar RF clamp.Covid-19 is a highly contagious viral infection caused by the SARS-CoV-2 virus. Its rapid spread and severe clinical presentation influences patient management in all specialties including thoracic surgery. We report three cases of Covid-19 occurring in patients shortly after thoracotomy and thoracoscopy procedures, illustrating the imminent threat of SARS-CoV-2 infection for thoracic surgery patients.Lysosomal storage disorders (LSDs) are diseases characterized by the accumulation of macromolecules in the late endocytic system and are caused by inherited defects in genes that encode mainly lysosomal enzymes or transmembrane lysosomal proteins. Niemann-Pick type C disease (NPCD), a LSD characterized by liver damage and progressive neurodegeneration that leads to early death, is caused by mutations in the genes encoding the NPC1 or NPC2 proteins. Both proteins are involved in the transport of cholesterol from the late endosomal compartment to the rest of the cell. Loss of function of these proteins causes primary cholesterol accumulation, and secondary accumulation of other lipids, such as sphingolipids, in lysosomes. Despite years of studying the genetic and molecular bases of NPCD and related-lysosomal disorders, the pathogenic mecha