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Background: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution. Methods: The majority of our patients were male, mean age 61.19 ± 13.33 years. Two patients had Marfan syndrome. Twenty-eight patients had bicuspid aortic valve. Thirty-four patients underwent aortic root replacement utilizing a composite valve/graft conduit; 23 had valve-sparing root replacements. The ascending aorta was replaced in 89 patients; 80 (89.9%) of these included a period of circulatory arrest at moderate hypothermia utilizing unilateral selective antegrade cerebral perfusion. Results: Thirty-day mortality was zero. Perioperative stroke occurred in 2 patients, both of whom completely recovered prior to discharge. No patients required re-exploration for bleeding. One patient developed a sternal wound infection. Fifteen patients required readmission to hospital within thirty days of discharge. Conclusion: Elective surgery for aneurysm of the proximal aorta is safe, reproducible, and is associated with outcomes that are superior to those seen in an acute aortic syndrome. It may be appropriate to offer surgery to younger patients with proximal aortic aneurysms at smaller diameters, even if their aortic dimensions do not yet meet traditional guidelines for surgical intervention.

The biochemical markers of a biliary etiology of acute pancreatitis (AP) include an ALT elevation of more than 3 times the upper range of normal (ULN) and a serum total bilirubin greater than 3 mg%.To analyze the frequency of normal LFTs (Bilirubin, ALP, ALT, and AST) in patients with biliary AP.In this prospective study data collected for other ongoing studies on AP in the division of Gastroenterology in the last 20 years were analyzed.Serum total Bilirubin, AST, ALT, and ALP levels in 269 patients with biliary AP out of 728 cases of AP of various etiologies were analyzed. The biliary etiology was confirmed on the basis of gallstones documented by transabdominal US or at surgery.We noted normal bilirubin, AST, ALT, and ALP levels in 14.5%, 12.3%, 11.2%, and 26.4% of cases of acute biliary pancreatitis respectively. When all the 4 laboratory tests were considered collectively, the incidence of normal values was 10.4%. We also noted an ALT elevation of3 x ULN in 16.7% of cases of biliary AP and 43.5% of cases had a T. Bilirubin level of less than 3 mg %.Almost 15 to 20% of patients with biliary AP manifest with normal LFTs. The clinician should not exclude a biliary etiology solely on the basis of normal LFTs.