Inability of the activated partial thromboplastin time to predict heparin levels. Time to reassess guidelines for heparin assays.

Background: In treating venous thromboembolic disorders, patient outcomes appear to correlate with heparin levels. Due to pharmacokinetic and pharmacodynamic variations, a relationship between heparin dose and level cannot be reliably predicted in individual patients. Some patients have low heparin levels despite therapeutic activated partial thromboplastin times (aPTTs), which may increase their risk for recurrent thromboembolism.

Transesophageal echocardiographic identification of a retrograde dissection of the ascending aorta caused by inadvertent cannulation of the common carotid artery.

Retrograde aortic dissections can be a complication of vascular procedures. We describe a case of an inadvertent cannulation of the right common carotid artery during an attempt at inserting a pulmonary artery catheter. This resulted in dissection of the right common carotid, subclavian, and innominate arteries.

Peripheral vascular disease evaluated with reduced-dose gadolinium-enhanced MR angiography.

Purpose: To demonstrate the utility of low-dose gadolinium-enhanced magnetic resonance (MR) angiography of two consecutive anatomic areas for assessment of peripheral vascular disease.

Materials And Methods: Fifteen patients underwent gadolinium-enhanced MR angiography for evaluation of lower extremity peripheral vascular disease after conventional digital subtraction angiography (DSA). MR angiography was performed with three-dimensional coronal gradient-echo acquisitions before and during administration of gadopentetate dimeglumine.

A unique approach in the management of vena caval thrombosis in a patient with Klippel-Trénaunay syndrome.

Vena caval thrombosis has posed a surgical therapeutic challenge for many years. Historically, spiral vein grafts and synthetic materials used as prostheses have had variable results. The use of the stent may serve as a more promising alternative when used in the capacity to relieve caval obstruction.

Rectal adenocarcinoma in an HIV-infected haemophiliac: case report and review.

Colorectal adenocarcinoma, a relatively uncommon malignancy associated with HIV infection, is now being increasingly recognized. Most reports have been in homosexuals and intravenous drug users and there are no reports of its occurrence in haemophiliacs acquiring HIV via infused factor VIII and without other obvious risk factors or a family history. The present report describes the case of a young heterosexual haemophiliac with HIV infection and no other risk factors who developed rectal carcinoma.

Changing the infection control paradigm from off-line to real time: the experience at Millard Fillmore Health System.

In 1993, several departments at Millard Fillmore Health System joined efforts to initiate a new approach to infection control. The main emphasis of this program is to move infection control to a real-time mode to manage patient outcomes daily. The principal objective was to decrease the number of nosocomial infections by 10%, with a particular emphasis on surgical-site infections.

A multidisciplinary approach to the treatment of Paget-Schroetter syndrome.

To assess the results of thrombolytic therapy and surgical decompression of the thoracic outlet in the management of spontaneous axillary vein thrombosis (AVT), the records of 38 patients at New York University Medical Center (NYUMC) with AVT were reviewed. Excluded from this report were 20 patients who had AVT secondary to an underlying medical condition, a subclavian catheter, or a failed dialysis access graft. Of the 18 remaining patients with no underlying medical condition, all were found to have effort-related axillo-subclavian thrombosis, Paget-Schroetter syndrome.

Natural history and management of the asymptomatic, moderately stenotic internal carotid artery.

Purpose: Although it has been widely accepted as the evidence supporting prophylactic carotid endarterectomy, aspects of the Asymptomatic Carotid Atherosclerosis Study have left unease among clinicians who must decide which individuals without symptoms should undergo surgery. Additional confusion has been created by the fact that the several large randomized trials investigating the efficacy of carotid endarterectomy have classified and analyzed different categories of carotid stenosis. In an effort to provide more information on the natural history of asymptomatic, moderate carotid artery stenosis (50% to 79%), we have reviewed data on approximately 500 arteries.

Causes of the increased stroke rate after carotid endarterectomy in patients with previous strokes.

Patients who have sustained a preoperative stroke are at increased risk for perioperative stroke after carotid endarterectomy. At our institution this risk was recently shown to be increased two-to threefold. The purpose of this study was to investigate the reasons for the increased surgical risk in these patients.

A comparison of regional and general anesthesia in patients undergoing carotid endarterectomy.

Purpose: The optimal anesthetic for use during carotid endarterectomy is controversial. Advocates of regional anesthesia suggest that it may reduce the incidence of perioperative complications in addition to decreasing operative time and hospital costs. To determine whether the anesthetic method correlated with the outcome of the operation, a retrospective review of 3975 carotid operations performed over a 32-year period was performed.

The surgical management of carotid artery stenosis in patients with previous neck irradiation.

Background: A history of therapeutic irradiation to the neck complicates the management of carotid artery occlusive disease. Serious surgical concerns are raised regarding alternative incisions, difficult dissections, and adequate wound closure. Pathology may be typical atherosclerotic occlusive disease or radiation-induced arteritis.

Communication practices in the social construction of health in an AIDS kesidence.

Physical illness and well-being, while grounded in bodily and psychological experiences, are also constructed socially through communication practices. Significant symbols, rituals and myths, among other forms, converge to create shared meanings that help define the health/illness experience. This article first provides a conceptual framework for understanding how communication intertwines physical, psychological and collective worlds.

Perioperative morbidity and mortality in combined vs. staged approaches to carotid and coronary revascularization.

Between 1986 and 1994 we identified 57 patients who underwent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) during the same hospitalization. Simultaneous CABG and CEA was performed in 28 patients (mean age 70.5 years, 58% male).

Antibody facilitation of multiple sclerosis-like lesions in a nonhuman primate.

In the human disease multiple sclerosis (MS), the immune mechanisms responsible for selective destruction of central nervous system myelin are unknown. In the common marmoset Callithrix jacchus, a unique demyelinating form of experimental allergic encephalomyelitis resembling MS can be induced by immunization with whole myelin. Here we show that the MS-like lesion can be reproduced by immunization against the extracellular domain of a single myelin protein, myelin/oligodendrocyte glycoprotein (MOG).

Long-term follow-up of patients undergoing carotid endarterectomy in the presence of a contralateral occlusion.

Background: Patients with stenosis of one carotid artery and occlusion of the contralateral carotid artery (stenosis-occlusion) who are treated medically are at high risk for stroke. We have recently reported that carotid endarterectomy on the stenotic artery has a low perioperative risk in these patients. We now present follow-up data to define the long-term effectiveness of this operation.

Carotid endarterectomy in the presence of a contralateral occlusion: a review of 315 cases over a 27-year experience.

Recent data from the North American Symptomatic Carotid Endarterectomy Trial revealed a 14.3% perioperative risk of stroke or death with carotid endarterectomy contralateral to a carotid artery occlusion. Since last reporting on this topic in the mid-1980s, the authors have reviewed 180 patients with occlusion of one internal carotid artery (ICA) and who underwent endarterectomy of the stenotic contralateral ICA operated from 1965 to 1984 (group A) compared with 135 operated on from 1985 to 1991.

Lineage tracing demonstrates that blastomeres of early cleavage-stage human pre-embryos contribute to both trophectoderm and inner cell mass.

We injected a fluorescent lineage tracer (Texas Red-lysine-dextran) into individual blastomeres of donated human diploid 2- to 8-cell pre-embryos and cultured them to blastocysts. Once pre-embryos reached the expanded blastocyst stage, they were fixed and examined in a scanning confocal microscope to identify the location of fluorescent tracer. In successfully injected pre-embryos that developed to expanded blastocysts, we found that randomly injected blastomeres formed both trophectoderm (TE) and inner cell mass (ICM).

A comparative study of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery endarterectomy.

To determine whether the choice of material used for patch closure following carotid artery endarterectomy (CAE) affected the immediate operative results, the early follow-up results, or the incidence of early restenosis, a retrospective study of 275 consecutive carotid endarterectomies by two vascular surgeons was performed. Among 275 primary CAEs performed between July 1991 and August 1993, 159 (57.8%) were closed with saphenous vein (SV), 25 (9.

Is there detrimental gender bias in preoperative cardiac management of patients undergoing vascular surgery?

Background: To investigate the possibility of gender bias in the cardiac management of patients who undergo peripheral vascular surgery, we examined the hospital data and outcomes for 350 adult men and 128 women who underwent vascular surgery from September 1987 to December 1991.

Methods And Results: There were no significant differences between the two groups in age at operation, incidence of standard risk factors for myocardial infarction, or incidence or duration of episodes of perioperative silent ischemia. Nevertheless, a significantly lower percentage of women than men had undergone prior coronary bypass procedures (6.

Keeping the community spirit alive.

The concept of community is often romanticized as emerging magically or naturally among residents within a facility. But, the feeling of community evolves through the philosophy, decisions and everyday communication practices of administrators.

The cause of perioperative stroke after carotid endarterectomy.

Purpose: The purpose of this study was to examine the cause of perioperative stroke after carotid endarterectomy.

Methods: The records of 2365 patients undergoing 3062 carotid endarterectomies from 1965 through 1991 were reviewed. Sixty-six (2.