The authors report a case of posterior sternoclavicular dislocation surgically reduced and stabilized with tenodesis, according to the Burrows technique completed by temporary wire fixation. The patient presented postoperative pericardiac tamponade appearing progressively from brachiocephalic blood vessels bleeding. Emergency drainage was surgically placed associated with removal of the material, thus curing the patient. This complication, although exceptional, formally contraindicates the use of wire fixation in surgery of the sternoclavicular joint.
We propose an arterial network model based on one-dimensional hemodynamic equations to study the behavior of different vascular surgical bypass grafts in the case of an arterial occlusive pathology: a stenosis of the Right Iliac artery. We investigate the performances of three different bypass grafts (Aorto-Femoral, Axillo-Femoral and cross-over Femoral) depending on the degree of obstruction of the stenosis. Numerical simulations show that all bypass grafts are efficient since we retrieve in each case the healthy hemodynamics downstream of the stenosed region while ensuring at the same time a global healthy circulation. We analyze in detail the behavior of the Axillo-Femoral bypass graft by performing hundreds of simulations where we vary the values of its Young's modulus [0.1-50 MPa] and radius [0.01-5 cm]. Our analysis shows that Young's modulus and radius of commercial bypass grafts are optimal in terms of hemodynamic considerations. Our numerical findings prove that this model approach can be used to optimize or plan patient-specific surgeries, to numerically assess the viability of bypass grafts and to perform parametric analysis and error propagation evaluations by running extensive simulations.
evidence of higher LTx morbidity-mortality with lungs providing by suicidal hanging. Methods: All lung transplantation performed at Foch hospital between January 2010 and July 2015 were analyzed outcomes of LTx to compare hanging donors (Hanging group) with donors having other cause of death (Control group). Results: During this period 299 LT were performed and divided in 2 groups: Hanging group (N= 20) and Control group (N= 279). Donor characteristics did not differ in age, sex, time on mechanical ventilation before retrieval, PO2/FIO2 ratio, smoking history, chest Xray or bronchial secretion. Recipient diagnoses did not differ significantly between the both groups. Primary graft dysfunction (PGD) at 72 hours was no statistically significant between Hanging group (PGD 0-1 70%, PGD 2 20% and PGD 3 10%) and Control group (PGD 0-1 61%, PGD 2 23% and PGD 3 16%) Median of post-operative mechanical ventilation duration (1 [range, 0-84] vs 1 [range, 0-435] days), intensive care unit stays (7 [range, 2-66] vs 7 [range, 2-91] days), and total hospital lengths of stay (31 [range, 20-84] vs 32 [range, 12-410] days) did not differ significantly between the two groups. The percentage predicted forced expiratory volume in 1 second at 6 months and 12 months were comparable in both groups (6 months, p= 0,94; 12 months, p= 0,05). No statistically significant differences were found on the survival between Hanging group and the Control group with respectively at 1 year (83% and 85%) and 2 years (75% and 80%) (p= 0,76). Conclusion: The LT outcomes are not different between hanging donors and the others cause of death. Hanging donors should be considered as conventional donors.
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