In the last patient who presented with 2 nerve torsions, the foll

In the last patient who presented with 2 nerve torsions, the follow-up period after the last surgery is too short to allow evaluation.

CONCLUSION: Although not a frequent event, torsional nerve injury should be taken into consideration when dealing with peripheral

nerve injuries. Surgical exploration with detorsion or suture results in good recovery.”
“Objective: After univentricular Fontan conversion, systemic venous pressure serves as the sole driving force for transpulmonary blood flow. Consequently, systemic venous return is markedly altered and ventricular filling is subnormal. The mechanisms and time course of systemic adaptation to Fontan selleck chemical conversion are incompletely understood. We hypothesized that acute elevation in systemic venous pressure induces an adaptive response similar to conversion to a univentricular Fontan circulation.

Methods: Adjustable vessel occluders were placed around

the superior and inferior vena cavae in juvenile sheep. After 1-week recovery, occluders were tightened to acutely increase and maintain systemic venous pressure at 15 mm Hg (n = 6), simulating 1-stage Fontan conversion. Control animals (n 4) received identical surgery, but venous pressure was not manipulated.

Results: Cardiac index decreased significantly (3.9 +/- 1.0 mL/min/m(2) to 2.7 +/- 0.7 mL/min/m(2), P < .001) and then normalized to control at 2 weeks. Circulating blood volume increased (100 +/- 9.4 mL/kg vs 85.5 +/- 8.4 mL/kg, P = .034) as a persistent response. Cardiac reserve improved and was not different from control by week 3. Resting heart rate decreased in both groups. Oxygen extraction (arteriovenous oxygen difference) and neurohormonal mediators increased transiently and then normalized by week 2.

Conclusions: Adaptation to global elevation in systemic venous pressure to Fontan levels is

complete within 2 weeks. Increased blood volume and reduced heart rate are persistent responses. Increased oxygen extraction and neurohormonal Bay 11-7085 up-regulation are temporary responses that normalize with recovery of cardiac output. With improved physiologic understanding of systemic adaptation to Fontan conversion, approaches to single-ventricle palliation can be more objectively assessed and optimized. (J Thorac Cardiovasc Surg 2010;140:850-6)”
“BACKGROUND: The constrained working area in minimally invasive exposures of the spine may limit the capacity to effectively close the lumbar fascia, especially in patients with elevated body mass indexes. The working channel in these cases may have a diameter as narrow as 14 mm and a length up to 9 cm. Under these circumstances, the use of a conventional needle driver and a curved needle becomes suboptimal for closures of the fascia.

OBJECTIVE: To demonstrate the utility of an arthroscopic suture passer for closure of the lumbar fascia in such approaches.

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