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Burns are frequent lesions, often leading to serious functional or even life-threatening sequelae. Their care poses a problem in the countries of the South due to the lack of specialized centres. Through this study, we would like to share our experience. This was a descriptive retrospective study carried out over 36 months on 24 patients treated and followed up in the department for burn sequelae involving a limb. Functional results were classified as excellent, good, fairly good, fair and poor. Aesthetically, they have been categorized into satisfactory, unsatisfactory and poor. We recorded 1480 patients who underwent surgery, 24 of whom were operated on after burns. We noted a female predominance (sex ratio of 1.6) with an average age of 24.2 years (range 16-40). Domestic accidents (n=19) were the main circumstance of occurrence and there was a preponderance of thermal burns by flame (n=21). Twenty people were treated in the first year after burn with excellent, good and fair results in 10, 9 and 4 cases respectively. Burns can cause significant functional sequelae, the management of which requires specialized nursing staff. Training of caregivers oriented towards burn care without forgetting the related means remains a key element to minimizing the occurrence of these sequelae., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)

Background: Pulmonary vein cryoablation (PVC) is a new approach in the treatment of recurrent atrial fibrillation (AF). Computed tomography (CT) can be used to evaluate the left atrium anatomy and PVs dimensions to facilitate the procedure. In radiofrequency procedures, some anatomic variants such as common left (CLPV) or right (CRPV) PV were reported as factors associated with technical procedure difficulties and potential long-term complications. We hypothesized that the absence of CLPV as determined by CT would predict better AF-free survival after PVC., Methods and Results: We included 118 consecutive patients (mean age 56 ± 10 years; 77% males) with drug refractory paroxysmal (72%)/persistent (28%) AF, with more than 6 months follow-up, who underwent PVC. On CT scanning images performed within 1 month prior to ablation, we evaluated PV anatomic patterns: presence of CLPV or CRPV. Each patient was evaluated by 24-hour Holter monitoring within 1 and 3 months and all patients were periodically evaluated at 1, 3, and 6 months, and every 6 months thereafter. Patients were asked to record their 12-lead electrocardiogram whenever they experienced symptoms suggestive of AF. Recurrence was defined as AF that lasted at least 30 seconds. CLPV was present in 30 (25%) patients and no patients with CRPV were identified. At the end of the 13 months follow-up, patients with normal PVs had significantly better AF-free survival compared to patients with CLPV (67% vs 50%, P = 0.02). The difference was present in patients with paroxysmal AF (P = 0.008) but not in patients with persistent AF (P = 0.92)., Conclusion: In patients undergoing cryoballoon PV isolation for AF, the presence of normal PVs pattern is associated with better AF-free survival as compared to atypical PV anatomy with CLPV, particularly in patients with paroxysmal AF., (©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.)

Background: Systematic use of a 28mm balloon has been proposed for pulmonary vein cryoisolation in patients with atrial fibrillation., Objective: To assess the results of a dual balloon size strategy using a 23 or 28mm cryoballoon catheter for pulmonary vein isolation., Methods: A total of 118 patients (mean age 56 ± 10 years) with paroxysmal (n=85) or persistent atrial fibrillation (n=33) were enrolled. Patients with four pulmonary veins<20mm in diameter were isolated with a 23mm cryoballoon (n=29); patients with one pulmonary vein diameter ≥20mm were isolated with a 28mm cryoballoon (n=89)., Results: No significant difference in procedural variables was observed between the two groups. AF-free survival, after a mean follow-up of 19.9 ± 5 months, was similar in the two groups (69% vs 62%; p=0.57 and between patients with paroxysmal atrial fibrillation (68% vs 68%; p=0.91) or persistent AF (75% vs 48%; p=0.60). AF duration before the ablation procedure (p=0.005) was an independent predictor of AF recurrence. Phrenic nerve palsy rate was not statistically different in the two groups (4 [14%] vs 9 [10%]; p=0.73). The temperature in the right superior pulmonary vein (p=0.008) was an independent predictor of phrenic nerve palsy. Five patients developed left atrial flutter with the 28mm diameter balloon versus none with the 23mm balloon., Conclusions: A dual balloon size strategy was not associated with a lower AF-free survival or a higher procedure-related complication rate in patients in whom the 23mm balloon was used. Pulmonary vein isolation with a 23mm cryoballoon catheter appears to be an appropriate option in selected patients with small pulmonary vein diameters., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Aims: Although congestive heart failure (CHF) represents the most common cause of death in native valve infective endocarditis (IE), recent data on the outcome of IE complicated by CHF are lacking. We aimed to analyse the characteristics and prognosis of patients with left-sided native valve IE complicated by CHF and to evaluate the impact of early surgery on 1 year outcome., Methods and Results: Two hundred and fifty-nine consecutive patients with definite left-sided native valve IE according to the Duke criteria were included in this analysis. When compared with patients without CHF (n = 151), new heart murmur, high comorbidity index, aortic valve IE, and severe valve regurgitation were more frequently observed in CHF patients (n = 108, 41.6%). Mitral valve IE, embolic events and neurological events were less frequent in CHF patients. Congestive heart failure was independently predictive of in-hospital [OR 3.8 (1.7-9.0); P = 0.0013] and 1 year mortality [HR 1.8 (1.1-3.0); P = 0.007]. Early surgery was performed in 46% of CHF patients with a peri-operative mortality of 10%. In the CHF group, comorbidity index, Staphylococcus aureus IE, uncontrolled infection, and major neurological events were univariate predictors of 1 year mortality. Early surgery was independently associated with improved 1 year survival [HR 0.45 (0.22-0.93); P = 0.03]., Conclusion: Left-sided native valve IE complicated by CHF is more frequent in aortic IE and is associated with severe regurgitation. Congestive heart failure is an independent predictor of in-hospital and 1 year mortality. In CHF patients, early surgery is independently associated with reduced mortality and should be widely considered to improve outcome.

Background: The aim of this study was to describe a single unit experience for the treatment of acute infective endocarditis, for patients older than 75 years and to analyse the results of early surgery., Patients and Methods: From January 1991 to June 2006 348 consecutive patients with definite acute infective endocarditis, according to Duke criteria, were prospectively enrolled in our database. Among these, 75 patients older than 75 years (mean age 79.8+/-4 years) were analysed and compared to 273 younger patients., Results: The patients older than 75 years (group A, 75 patients) had a more severe clinical status than the younger patients (group B, 273 patients) with a comorbidity index amounting to 4.9+/-1.8 and 2.9+/-1.0 respectively (p=0.0001). Patients were treated medically (group A 53 pts vs group B 124 pts) or surgically (group A 22 pts vs group B 149 pts) (p=0.001). The in-hospital mortality rate for group A and B was comparable (16% vs 19%; p=0.3). Multivariate analysis identified for patients older than 75 years, severe sepsis (p=0.001, OR=12, CI [6-24]), and major neurological events (p=0.02, OR=3, CI [1.1-7.5]) as the two factors related to higher in-hospital mortality and surgery (p=0.006, OR=0.4, CI [0.2-0.7]) as the factor related to a lower in-hospital mortality. The overall survival of the older group at 36 months was 40.8+/-6.8%. Multivariate analysis for older patients identified comorbidity index (p=0.001) (HR 1.1, CI [1-1.2]), severe sepsis (p=0.0001) (HR 3.3, CI [2.2-5.2]), valvular prosthesis (p=0.0002) (HR 2.4, CI [1.5-4]) and major neurological event (p=0.04) (HR 1.7, CI [1-3]) as factors related to overall mortality and surgery (p=0.001) (HR 0.4, CI [0.3-0.6]) as a factor related to a better overall survival., Conclusion: The immediate results of treatment for endocarditis are comparable between elderly and younger patients. The long-term prognosis for the elderly patients is worse, mainly related to a higher comorbidity index. Surgery in elderly patients may be a reasonable option, and should be considered in selected elderly patients.

Aims: To analyse the risk of death according to the type of cerebrovascular complications (CVC) during infective endocarditis (IE) and to analyse the determinants of outcome in patients with IE and a CVC., Methods and Results: In two referral centres, 496 consecutive patients with definite IE were prospectively included. Cerebral CT scan was performed in 453 patients. During a mean 2.9 year follow-up, 139 (28%) patients died and CVC occurred in 109 (22%) patients. Stroke was an independent predictor of death, although no significant excess mortality was observed in patients with silent CVC or transient ischaemic attack (TIA). Among CVC patients, mortality was predicted by the presence of a mechanical prosthetic valve IE and a low Glasgow Coma Scale. When valvular surgery was performed in patients after CVC, neurologic exacerbation was rare [4 (6.3%) patients] and was observed only in patients with symptomatic stroke. Among CVC patients, survival was better in operated patients when compared with patients treated conservatively despite theoretical indication for surgery (P < 0.0001). However, the latter group had more comorbidities (P = 0.007) and a lower Glasgow Coma Scale (14.6 +/- 1 vs. 12 +/- 4, P < 0.0001)., Conclusion: Patients with silent CVC or TIA have a relatively good prognosis, whereas those with stroke have significant excess mortality particularly in case of mechanical prosthetic valve IE or impaired consciousness. Valvular surgery can be safely performed after silent CVC or TIA and may improve survival in selected patients with stroke.

Background: We studied a large cohort of adults with Staphylococcus aureus infective endocarditis to evaluate the predictors of outcome and to establish whether early surgery is associated with reduced mortality., Methods: The study prospectively enrolled 116 consecutive patients with definite S. aureus infective endocarditis, according to Duke criteria and examined by transthoracic and transesophageal echocardiography., Results: The in-hospital mortality rate was 26%, and the 36-month survival rate was 57% +/- 5%. Multivariate analyses identified comorbidity index, congestive heart failure, severe sepsis, prosthetic valve infective endocarditis, and major neurologic events as predictors of in-hospital mortality; severe sepsis and comorbidity index as predictors of overall mortality; and the comorbidity index as a predictor of late mortality. In unadjusted analyses, early surgery performed in 47% of patients was associated with lower in-hospital mortality (16% versus 34%; p = 0.034) and with better 36-month survival (77% +/- 6% versus 39% +/- 7%; p < 0.001). After adjustment of baseline variables related to mortality, early surgery remained associated with reduced overall mortality., Conclusions: Prognosis of S. aureus infective endocarditis remains poor, related to the comorbidities, presence of congestive heart failure, severe sepsis, major neurologic events, and prosthetic valve. Early surgery is independently associated with reduced overall mortality and should be considered in selected cases to improve the outcome.