Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach

Rectus sheath hematoma (RSH) is an uncommon clinical event usually associated with trauma or coagulation disorders. It can also occur spontaneously. RSH usually runs a benign course but it can present with hypovolemic shock. When conservative management fails, surgical exploration becomes mandatory. We propose a technique of emergency ligation of the inferior epigastric artery. This is a simple approach as this artery originates at the posterior rectus sheath above the inguinal ligament. This safe technique provides immediate hemodynamic stabilization

Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies

Anticoagulation strategies in Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) is an advanced system of short-term mechanical cardiorespiratory support indicated for patients with life-threatening cardiac and/or respiratory failure. The circuit includes the centrifugal pump, the oxygenator, and a closed circuit of cardiopulmonary bypass tubing. Due to the contact of the blood with the artificial surfaces, the use of anticoagulation is mandatory to avoid the formation of clots, reducing the risk of embolism while at the same time minimizing the inflammatory reaction created by the exposure of the blood to the surface of the circuit. Anticoagulants mainly include heparin and its derivatives that differ in molecular weight as well as novel agents that inhibit thrombin formation. Anticoagulation is monitored through various plasma-based laboratory tests and clinical evaluations. Management of anticoagulation in ECMO requires a multidisciplinary approach, involving intensivists, perfusionists, hematologists, and other healthcare professionals, to ensure optimal patient outcomes. While there have been several small studies that have attempted to evaluate the safety and efficacy of various anticoagulation strategies, institutions currently use a variety of independently developed approaches due to a lack of published accepted guidelines based on solid clinical evidence

Study on the transformation of haematopoietic stem cells to cardiomyocytes in long term liquid culture

The aim of the study is to investigate the ability of bone marrow mesenchymal stem cells to differentiate toward cardiomyocytes in ligand culture. Bone marrow samples were aspirated from 30 patients undergoing open heart surgery. Mesenchymal stem cells were isolated and expanded in culture. Second passaged cells were treated with 10μΜ 5-azacytidine. Immunophenotype was detected with flow cytometry. Morphology was analyzed with contrast and electron microscopy. Vimentin and myosin heavy chain production were analyzed by immunohistochemistry. Expression of α-cardiac actin, b-myosin heavy chain and troponin-T was also analyzed with molecular studies. In treated cells, multiple myofilaments were detected that were positive immunohistochemically to myosin heavy chain. All studied genes were also expressed. In untreated cells not expanded in culture, all myocardial markers were negative.Σκοπός της παρούσας μελέτης αποτελεί η διερεύνηση της ικανότητας των αρχέγονων μεσεγχυματικών κυττάρων του μυελού των οστών να μετατρέπονται σε μυοκαρδιακά κύτταρα του μυελού των οστών να μετατρέπονται σε μυοκαρδιακά κύτταρα σε σύστημα υγρής καλλιέργειας. Δείγματα μυελού ελήφθησαν από 30 ασθενείς οι οποίοι υποβλήθηκαν σε χειρουργική επέμβαση ανοικτής καρδιάς. Τα μεσεγχυματικά βλαστικά κύτταρα απομονώθηκαν και τοποθετήθηκαν σε καλλιέργεια. Μετά τη δεύτερη ανακαλλιέργεια έγινε επίδραση 10μ.Μ 5-αζακυτιδίνης. Ο ανοσοφαινότυπος προσδιορίστηκε με κυτταρομετρία ροής. Η μελέτη της μορφολογίας διενεργήθηκε με το ανάστροφο καθώς και με το ηλεκτρονικό μικροσκόπιο. Πραγματοποιήθηκε ανοσοϊστοχημικός έλεγχος της βιμεντίνης και της βαριάς αλύσου της μυοσίνης. Μελετήθηκε παράλληλα η έκφραση των γονιδίων της α-καρδιακής ακτίνης και της β-βαριάς αλύσου της μυοσίνης και της τροπονίνης-Τ. Στα κύτταρα που υποβλήθηκαν στην επίδραση ανιχνεύτηκαν πολυάριθμα ινίδια, τα οποία ήταν θετικά με ανοσοϊστοχημεία στη βαριά άλυσο μυοσίνης. Παράλληλα διαπιστώθηκε έκφραση των υπό μελέτη γονιδίων. Αντίθετα, σε κύτταρα πολύ δεν υποβλήθηκαν σε καλλιέργεια, δε διαπιστώθηκε έκφραση μυοκαρδιακών δεικτών