Search

The pathological use of the Internet has surged during the pandemic, even though service provisions were negatively impacted. Telepsychiatry can be used as a solution to maintain psychiatric addiction services. This study examined the efficacy of online group dialectical behavioral therapy (DBT) for Internet addiction (IA), compared to cognitive behavioral therapy (CBT). Participants were divided into two arms for 8 weeks: the experimental arm received eight sessions of online DBT skill group training (n = 20), and the control arm received four sessions of online individual CBT (n = 20). All participants were required to complete a sociodemographic and Internet use survey, the Internet Addiction Test (IAT), and the University of Rhode Island Change Assessment (URICA). All participants completed the therapy. Of the 40 participants, six (15%) perceived the need for therapy and one (2.5%) participant had a history of seeking IA therapy. In the pre-post comparison, significant improvements were noted in the IAT and URICA scores as well as Internet use duration for both arms. No significant differences were observed across the arms and in the time-by-arm interaction. Online group DBT is a viable alternative to online CBT in an acute constrained setting, although further studies are required to scrutinize its long-term efficacy. Trial Registration: ISRCTN17273762.

BackgroundSubstance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial.MethodsA total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants’ usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes.Ethics and disseminationThe study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD.Trial registration numberUMIN000042186.

BACKGROUND AND AIM Anterior mediastinal masses which invade the great vessels and heart are rare. We report a case of a 76-year-old male presenting with a large invasive anterior mediastinal mass following recent cardiac surgery (coronary artery bypass grafting and aortic valve replacement via sternotomy). MATERIALS AND METHODS This is a case report study with clinical patient information retrieved from hospital electronic records. RESULTS Computed tomography scanning revealed a large heterogeneous 6.5 × 7.2 × 7.0 cm right anterior mediastinal mass. The mass directly propagated via the left innominate vein into the superior vena cava (SVC) and proximal right atrium. The patient underwent redo sternotomy with the aid of cardiopulmonary bypass and hypothermic circulatory arrest to remove the mass. The mass was sitting in the right pleural cavity and was adherent to the right lung and pericardium. Tumor material was removed from the right atrium, SVC and left innominate vein. The mass was excised en bloc along with a portion of the upper lobe of the right lung. DISCUSSION AND CONCLUSION Histology of the mass revealed the diagnosis of invasive type A thymoma with transvenous and transcardiac invasion. We advocate for surgeons to be aggressive in their operative resection of such tumours to ensure the best prognostic outlook for the patient.

We describe the intraoperative surgical management of tracheal bronchus encountered in a lung transplant recipient.

Background Important risk factors for long-term survival of lung transplant (LT) recipients are infection, acute graft rejection (AR) and chronic lung allograft dysfunction (CLAD). Socioeconomic deprivation (SED) is associated with increased graft failure rate after heart and kidney transplantation, but has not been investigated in LT recipients. The aim of this study was to evaluate an association between LT recipients' SED status and development of AR, CLAD, and long-term survival. Methods This was a retrospective cohort study. Over a 23 y period, 233 patients were identified from the Auckland City Hospital Lung Transplant Registry, Auckland, New Zealand. All patients were divided into two groups according to the 2013 New Zealand Deprivation Index Score. Results The incidence of AR in the higher SED group was 34.0/100 person-y (95% confidence interval [CI]: 24.7-46.7/100 person-y) and in the lower SED group 40.2/100 person-y (95% CI: 33.5-48.3/100 person-y) (P = 0.373). The incidence of CLAD in the higher SED group was 10.7/100 person-y (95% CI: 6.2-18.4/100 person-y) and 9.3 (6.9-12.5/100 person-y) in the lower SED group (P = 0.645). Mortality in the higher SED group was 12.9/100 person-y (95% CI: 9.2-17.9/100 person-y) and 12.4/100 person-y (95% CI: 10.0-15.3/100 person-y) in the lower SED group (P = 0.834). Conclusions SED status of LT recipients in New Zealand has no negative effect on development of AR, CLAD, and patients’ survival.

Background To evaluate our surgical results for Acute Ischaemic Ventricular Septal Defect and suggest practice guidelines. Methods Retrospective review of data from patient records between 1992 and 2006 for presentation, surgical approaches, morbidity and mortality, statistically analysed to derive guidelines for management. Results We had 36 patients with a mean age of 70.44(±6.34) years. Fourteen patients had inferior defects. Twenty-eight patients were in shock (22 on pre-operative IABP). Severe LV and RV dysfunction were present in 18 and 20 patients respectively. At surgery, 17 had infarct resection with patching while 18 had repair with infarct exclusion. Concomitant CABG was performed in 15. One patient was re-operated on for mitral valve replacement and one for recurrent VSD. Recurrent VSD was common (11 patients). Two of these patients underwent percutaneous device closure of whom one died. Prolonged ICU and hospital stay was normal. Early mortality was 52.78% (inferior defects—85.71% and anterior defects—31.82%). Inferior VSD (OR 7.7) and pre-operative shock (OR 6.7), predicted mortality. The subgroup of inferior VSD with shock had mortality equating that with medical management published in literature. Conclusions Acute Ischaemic VSD is a grim surgical disease marked by residual shunts and high mortality. Patients with inferior defects with shock should be offered surgery only under exceptional circumstances.

Traumatic aortic arch rupture is associated with a high mortality rate. Historically, the mainstay of treatment has been emergency open repair with cardiopulmonary bypass. This has had significant associated mortality and morbidity in a group of patients who often have multiple injuries. In recent times endoluminal stent graft (ESG) placement has become a treatment option as it is viewed as less invasive with favourable procedural and postoperative outcomes. We describe a case of complex aortic injury involving both the anterior and posterior aortic arch in a high-risk patient, treatedwith off-pump transposition of the arch vessels followed immediately by ESG placement to the mid ascending aorta (zone 0).

Purpose The purpose of this study is to describe the first experience of implanting a new left ventricular assist device in pediatric patients with end-stage heart failure. Description In two recent prospective, international, multicenter clinical trials, three children (aged ≤ 16 years) were implanted successfully with the VentrAssist (Ventracor Limited, Chatswood, Australia), a relatively small, novel, continuous flow, third-generation left ventricular assist device. Evaluation Despite the patients' disease severity (each child was in extremis at the time of implantation), VentrAssist (Ventracor Limited) implantation enabled each patient to be discharged home from the hospital. All patients survived for more than 1 year. One patient was successfully transplanted and another was bridged to an adequate degree of recovery; unfortunately, the third patient died on postoperative day 375 while waiting for a suitable donor heart. Consistent with the complications associated with left ventricular assist devices in adults, the main complications in these pediatric patients were infection and thromboembolism. Conclusions The VentrAssist may provide a major advancement in the management of larger children and adolescents with end-stage heart failure.

Background: Traumatic injury to the aorta and great vessels is a surgical emergency with survivors who reach hospital typically having suffered multiple injuries. There are several diagnostic and treatment options available, with new modalities emerging to challenge the gold standards. A review of recent trends in management of these injuries in Auckland, New Zealand was carried out and patient outcomes assessed. Methods: The charts of patients admitted to Auckland and Green Lane Hospital's cardiothoracic intensive care unit, with a diagnosis of injury to the thoracic aorta or great vessels since 1995 were retrospectively reviewed. Imaging techniques, injury types and treatment methods were analysed along with survival and neurological morbidity. Results: In the study period our unit operated on 29 cases of traumatic rupture of the thoracic aorta or great vessels. Digital subtraction angiography and more recently, multidetector computed tomography scanning have been used to diagnose the injury. Twenty-seven injuries were to the aorta and two to the innominate artery. The 30-day survival rate of those reaching the operating theatre was 90%. There was one case of postoperative hemiparesis and five cases of recurrent laryngeal nerve injury, but none of spinal cord ischaemic injury. Endoluminal stent grafting was carried out for one patient, without complication. Conclusions: Good survival rates exist for those who reach surgery for traumatic rupture of the aorta or great vessels. Multidetector computed tomography scanning is an alternative to digital subtraction angiography, potentially reducing treatment delay. In addition endoluminal grafting as opposed to open repair has been reported as a safe technique. The injury remains a surgical emergency requiring urgent diagnosis and transfer to an equipped cardiothoracic unit for definitive treatment.

The purpose of this study was to investigate whether broadening acceptance criteria for donor hearts and changing recipient demographics resulted in an increased perioperative morbidity and mortality in a heart transplant program.Donor and recipient data of 137 consecutive heart transplants performed from 1987 to 2001 were retrospectively analyzed and divided into three equal eras, each of 5 years: 1987 to 1991, 1992 to 1996, and 1997 to 2001. Multivariate analyses of recipient and donor demographics and operative factors were performed to identify the predictors of low cardiac output, intraaortic balloon pump utilization, 30-day mortality, and duration of intensive care and hospital stay.Significant increases in number of female recipients (p = 0.025), cardiopulmonary bypass (p0.001), recipient cross-clamp (p0.001), donor age (p = 0.009), donor ischemic times (p0.001), use of cardioplegia (p0.001) and the bicaval technique (p0.001), brain death to retrieval time (p = 0.006), and need for postoperative dialysis were observed for the three study periods, whereas length of intensive care and hospital stay decreased. Female donor (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0 to 5.7) was identified as a risk factor for low cardiac output. Female donor (OR, 3.7; 95% CI, 1.3 to 10.7), donor cardiac arrest (OR, 6.4; 95% CI, 1.6 to 25.9), and cardiopulmonary bypass time more than 2 hours (OR, 7.6; 95% CI, 2.1 to 28.1) were associated with increased intraaortic balloon pump utilization. Intensive care stay was prolonged by the biatrial technique (OR, 3.9; 95% CI, 1.3 to 11.9) and reduced by the use of cardioplegia (OR, 0.3; 95% CI, 0.1 to 0.9), longer cardiopulmonary bypass (OR, 0.2; 95% CI, 0.1 to 0.6) and aortic cross-clamp times (OR, 0.1; 95% CI, 0.03 to 0.6).Although a number of significant changes were observed during the study period, no donor, recipient, or operative factors influenced 30-day mortality. This study justifies our current donor and recipient selection policies.

Gorham's disease is a very rare disorder of uncertain aetiology, characterised by non-neoplastic proliferation of vascular or lymphatic channels within bone leading to resorption and replacement of osseous matrix with angiomatous tissue. Fewer than 200 cases have been reported in the literature. The complication of chylothorax is associated with a high morbidity and mortality. We present the case of a 17-year-old male with Gorham's disease of the sternum, clavicle and rib, complicated by bilateral chylothorax. Despite thoracic duct ligation and radiotherapy, the patient progressively deteriorated and died 36 weeks following initial presentation.

Controlled hypotension is critical to the accurate deployment of aortic endografts and safe balloon post-dilation. We describe the use of rapid ventricular pacing during 15 aortic stenting procedures. An immediate and sustained reduction in both phasic and mean blood pressure was achieved in all patients. This procedure has advantages over pharmacologic or other methods of blood pressure reduction.

Acute ischaemic ventricular septal defect (VSD) is a severe complication of acute myocardial infarction. We present the unusual case of a 66-year-old man with a haemodynamically stable acute posterior basal ischemic VSD, who was managed successfully with hybrid primary coronary artery bypass grafting followed by delayed percutaneous VSD closure, with an excellent intermediate-term outcome. We feel this management strategy should be considered in selected patients with acute posterior VSDs and stable clinical status.

Repair of cardiac wounds was considered impossible little over 100 years ago. Despite progress, penetrating cardiac injury remains a highly lethal form of trauma today. Cardiac tamponade and exsanguination are the greatest immediate and life-threatening risks. Clinical presentation is extremely variable and diagnosis may be highly deceptive. Unlike other forms of trauma, resuscitation is of limited value and urgent operative intervention is the only meaningful treatment. Refinements in cardiothoracic surgery and the simultaneous evolution of trauma care systems have both contributed to saving lives. However, mortality rates for this condition have changed little in the last century, due largely to the rising proportion of more lethal injuries caused by gunshot wounds.

Background. Orthotopic heart transplantation was done by the biatrial technique initially and the bicaval technique has become popular recently. Aims. This study aims to determine if bicaval technique is advantageous. Methods. Consecutive transplants performed between 1996 and 2001 were divided into two groups—37 patients done by bicaval and 38 by biatrial technique. Data accumulation was by retrospective study of patient charts. Results. Both groups had similar preoperative variables. There were no differences in low cardiac output (18.9% versus 26.3%, p = 0.62), intraaortic balloon pump insertion (16.2% versus 15.7%, p = 1.0), re-exploration (13.5% versus 18.4%, p = 0.79) and perioperative mortality (5.4% versus 7.9%, p = 1.0) in the bicaval versus biatrial groups. Temporary (13.5% versus 39.4%, p = 0.15) and permanent pacing (0 versus 3 patients) tended to be less frequent and central venous pressure measured at 1-week was lower in the bicaval group (mean 13.8 ± 6cm versus 14.9 ± 5.4cm, p = 0.42), but not attaining statistical significance. Severe tricuspid regurgitation was seen in one bicaval versus five biatrial patients at follow-up. Conclusions. Though bicaval group tended to require less pacing, had less tricuspid regurgitation and had lower central venous pressures, these did not attain statistical significance. There were otherwise no obvious differences in outcome. Short Abstract. Seventy five consecutive orthotopic heart transplantations done during the period 1996–2001 by bicaval or biatrial surgical technique were compared. There was no difference in low cardiac output, intraaortic balloon pump insertion and mortality but the bicaval patients tended to have less pacing and diuretic requirements and lower central venous pressures, though not attaining statistical significance.

Ossifying fibromyxoid tumor is usually a benign tumor. However some of these tumors with histologic and clinical evidence of malignancy have also been reported and little information is available regarding surgery for metastatic ossifying fibromyxoid tumor. We present a case involving extensive excision of a huge metastatic ossifying fibromyxoid tumor occupying the upper mediastinum and upper half of the right hemithorax.

Purpose To evaluate our surgical results for ischaemic Ventricular Septal Rupture and suggest practice guidelines. Methodology A retrospective review of data from patient records from 1992 to 2006 for presentation, surgical approaches, recurrence and mortality and analyzed for future management guidelines. Results We had 36 patients with a mean age of 70.44(+/− 6.34). 14 patients (38.9%) had an inferior/ posterior defect, 28 were in shock (22 on IABP). Severe LV and RV dysfunction were present in 18 and 20 patients respectively. Repair involved patches after infarctectomy (17) or infarct exclusion (18), using either continuous or interrupted suture. Concomitant CABG was performed in 15. 11 patients had residual shunts, 2 requiring device closure and one surgery. Prolonged ICU and hospital stay was the norm. Early mortality was 52.78% (inferior defects – 85.71%, anterior defects – 31.82%). On Univariate analysis Inferior VSD (OR 7.7; 95% CI 1.7, 33.3), Moderate to severe RV impairment (OR 5.0; 95% CI 0.92, 33.3), Pre op shock (OR 6.7; 95% CI 1.6, 33.3), Early presentation post MI and infarctectomy during repair (3.8; 95% CI 0.9, 15.4), predicted mortality. For subgroup of anterior VSD, only pre-op shock (OR11.1; 95% CI 1.0, 100) predicted a poor outcome. On multivariate analysis, Inferior defects and shock at presentation were the dominant predictors for early death. Repair without cardioplegia (OR5.2; 95% CI 0.48, 56.09) was the only risk factor for recurrence. Conclusions Acute ischaemic VSD is a grim surgical disease with high mortality. Inferior defects should be offered surgery only in exceptional circumstances due to uniformly poor outcome.