Effects of Resistance Training on Vascular and Hemodynamic Responses in Patients With Coronary Artery Disease.

Purpose: The purpose of this study was to determine the impact of adjunctive resistance training (RT) in aerobically trained patients with coronary artery disease on systolic blood pressure (SBP), heart rate (HR), rating of perceived exertion (RPE; using the traditional 6-to-20 scale), and rate-pressure product (RPP) responses to lifting fixed submaximal workloads. Additionally, pretest and posttest RT measures of brachial artery reactivity were obtained.

Method: Fifteen patients with coronary artery disease (M = 66.

Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE Study.

Objectives: Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC-accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status.

Accreditation status and geographic location of outpatient vascular testing facilities among Medicare beneficiaries: the VALUE (Vascular Accreditation, Location & Utilization Evaluation) study.

Objective: There is limited information on the accreditation status and geographic distribution of vascular testing facilities in the US. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement to facilities regardless of accreditation status. The aims were to: (1) identify the proportion of Intersocietal Accreditation Commission (IAC) accredited vascular testing facilities in a 5% random national sample of Medicare beneficiaries receiving outpatient vascular testing services; (2) describe the geographic distribution of these facilities.

Prospective radial artery study following induction of reactive hyperemia looking at degree of diameter growth in healthy subjects.

Objectives: This "proof of concept" study sought to determine the magnitude of radial artery diameter change in 20 healthy subjects by induction of flow mediation dilatation (FMD) via reactive hyperemia.

Background: Transradial access in the cardiac catheterization laboratory is becoming more commonplace due to lower bleeding complications and increase in patient comfort. However, access to the radial artery can be challenging due to small vessel size.

Predictors of mortality after muscle flap advancement for deep sternal wound infections.

Background: Deep sternal wound infection is a devastating complication following median sternotomy, with mortality rates reported from 1.0 to 36 percent. Several studies have evaluated the risk factors for the development of a deep sternal wound infection, but the factors predicting survival after debridement and muscle flap advancement are not well known.

Predictors of mortality in trauma patients with intracranial hemorrhage on preinjury aspirin or clopidogrel.

Background: The mortality risk in elderly patients who sustained head trauma resulting in intracranial hemorrhage (ICH) while taking the antiplatelet agents aspirin (ASA) or clopidogrel or both (Plavix) was evaluated.

Methods: A retrospective review identified trauma patients, age 50 or greater, who had computed tomography (CT) evidence of ICH and were taking ASA, clopidogrel, or a combination of both. Patient demographics, type of medication, mechanism of injury, Glasgow Coma Score (GCS), grading of head CT scans, and outcomes were characterized.

Contemporary outcomes for carotid endarterectomy at a large community-based academic health center.

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated the efficacy of carotid endarterectomy (CEA), but these studies were published 15 and 11 years ago, respectively. We hypothesized that present clinical results of CEA have improved compared with those reported by NASCET/ACAS. Every patient having CEA from January 1999 through December 2003 was reviewed as part of a continuous quality-assurance program.

Improved organ procurement through implementation of evidence-based practice.

Michigan, like most other states in the nation, has a clear need for more organ donors for transplantation; at this time, there are more than 2,800 patients in the state awaiting organs. We have evaluated the effects of a process improvement program designed to increase the number of organ donors and the number of organs donated from appropriate trauma patients. In 2005, William Beaumont Hospital began working with the Michigan Hospital Association Keystone Center and more than 40 hospitals across Michigan to implement evidence-based practices in organ donation focused on 4 specific outcomes and process measures.

Treatment of trauma patients with intracranial hemorrhage on preinjury warfarin.

Background: Preinjury warfarin anticoagulation has been shown to increase the mortality of traumatic intracranial hemorrhage. We have evaluated the impact on patient mortality of the rapid triage of patients at risk for warfarin associated traumatic intracranial hemorrhage.

Methods: A "Coumadin Protocol" was implemented in January, 2001 in the Emergency Department that expedited triage of anticoagulated trauma patients to immediate physician evaluation.

Nurse driven protocol for head injured patients on warfarin.

The trauma quality improvement committee at our facility identified a significant number of patients on warfarin presenting to the emergency center after minor head trauma that subsequently expired from their intracranial hemorrhage prior to appropriate intervention. An analysis of this patient population identified multiple areas of delay. A collaborative effort between the emergency center nurses and the trauma service personnel resulted in a formal protocol to address each component of delay and expedite the process.

Positron-emission tomography as a prognostic tool for early-stage lung cancer.

Background: Positron-emission tomography (PET) shows tissue metabolic activity in the form of the standard uptake value (SUV). This study examines the prognostic value of the SUV for early-stage lung cancer.

Methods: A retrospective review of 187 patients undergoing PET for potential lung cancer.

Sentinel lymph node dissection for breast cancer: how many nodes are enough and which technique is optimal?

Background: Controversy exists in sentinel lymph node (SLN) mapping in breast cancer regarding the appropriate number of nodes to remove and the best technique for identification of the SLNs.

Methods: A retrospective chart review from January of 1999 to January of 2004 was performed for all patients undergoing a SLN biopsy examination who had at least 1 positive SLN.

Results: We identified 167 patients.

Rapid warfarin reversal in anticoagulated patients with traumatic intracranial hemorrhage reduces hemorrhage progression and mortality.

Background: A prospective cohort study at our institution demonstrated a 48% mortality rate in warfarin anticoagulated trauma patients sustaining intracranial hemorrhage (ICH) compared with a 10% mortality rate in nonanticoagulated patients. Forty percent of patients demonstrated progression of their ICH, despite anticoagulation reversal, with a resultant 65% mortality rate. Seventy-one percent of these patients initially presented with a Glasgow Coma Scale (GCS) score > or = 14 and a 'minor' ICH.

A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy.

Purpose: Spasm of the internal sphincter plays a role in hemorrhoidal disease and may be a source of anal pain after hemorrhoid surgery. We have evaluated the effects of topical diltiazem, a calcium channel blocker, in reducing pain after hemorrhoidectomy.

Methods: After hemorrhoidectomy, 18 patients were randomly assigned to receive 2 percent diltiazem ointment (n = 9) or a placebo ointment (n = 9).

Diagnosis of total internal carotid occlusions with duplex ultrasound and ultrasound contrast.

It remains a significant technical challenge for duplex ultrasound to accurately differentiate between total and near total internal carotid artery (ICA) occlusions. We have evaluated the efficacy of an ultrasound contrast agent combined with improved imaging techniques in patients with suspected carotid artery occlusions. Patients identified by conventional duplex ultrasound between January and August 2003 as having a possible ICA occlusion were eligible for study.

Safety and efficacy of superselective angioembolization in control of lower gastrointestinal hemorrhage.

Background: We evaluated the safety and efficacy of angioembolization to control lower gastrointestinal hemorrhage.

Methods: Retrospective chart review of patients undergoing angiography for lower gastrointestinal hemorrhage from January 2000 to December 2002.

Results: Seventy-seven patients with lower gastrointestinal hemorrhage underwent mesenteric angiography.

Spontaneous retroperitoneal hemorrhage.

Background: We evaluated patients with spontaneous retroperitoneal hemorrhage for reliable predictors of early diagnosis and improved outcomes.

Methods: A retrospective chart review was done to determine patient demographic and laboratory findings, presenting symptoms, time to diagnosis, anticoagulant and/or antiplatelet agent use, transfusions, and patient outcome.

Results: One hundred nineteen patients were identified; 14 (12%) died (mean age 77 +/- 9 years vs.

Epidural versus intravenous pain control in elderly patients with rib fractures.

Background: Epidural catheters are used in older patients with rib fractures to improve outcome. We reviewed the efficacy of epidural analgesia (EA) compared with intravenous narcotics (IVN) in this population.

Methods: Rib fracture patients >55 years old admitted to our level I trauma center from 1999 through 2002 were reviewed for demographics, Injury Severity Score (ISS), Abbreviated Injury Score for chest, length of stay, cardiopulmonary comorbidities, complications, and type of analgesia.

Effects of antiplatelet agents on outcomes for elderly patients with traumatic intracranial hemorrhage.

Background: Recent literature on elderly patients with traumatic intracranial hemorrhage receiving preinjury antiplatelet agents shows a mortality rate of 47%.

Methods: In a retrospective analysis, patients older than 50 years presenting to the hospital over the past 4 years with traumatic intracranial hemorrhage and the use of aspirin, clopidogrel, or a combination were compared with a control group that had hemorrhage but no antiplatelet medications. Patient demographics, mechanism of injury, and injury scores were recorded.

Duplex ultrasound recognition of spontaneous carotid dissection--a case report and review of the literature.

Spontaneous dissection of the internal carotid artery is an uncommon entity with a variable clinical presentation. A high index of suspicion is required to make the diagnosis, and prompt diagnosis and treatment with anticoagulation are essential for improved patient outcomes. Duplex ultrasound provides a safe and reliable imaging modality for early diagnosis and follow-up.

Management of blunt splenic injury in patients with concurrent infectious mononucleosis.

Selective nonoperative management is appropriate for most blunt splenic injuries in adults and children, but the efficacy of this approach is unknown when injury occurs in patients with concurrent infectious mononucleosis. We have reviewed our experience during the past 23 years with the selective nonoperative management of blunt splenic injury in these patients. Medical record review identified nine patients with blunt splenic injury and infectious mononucleosis from 1978 to 2001, representing 3.

Nitric oxide-releasing biopolymers inhibit thrombus formation in a sheep model of arteriovenous bridge grafts.

Objectives: Nitric oxide (NO), produced by normal vascular endothelial cells, reduces platelet aggregation and thrombus formation. NO-releasing biopolymers have the potential to prolong vascular graft and stent patency without adverse systemic vasodilation.

Methods: 5-mm polyurethane vascular grafts coated with a polymer containing the NO-donor dialkylhexanediamine diazeniumdiolate were implanted for 21 days in a sheep arteriovenous bridge-graft model.

Lysyl oxidase expression in a rat model of arterial balloon injury.

Objective: Traditional therapies for arteriosclerotic disease often fail as a result of an exaggerated fibroproliferative response (recurrent stenosis) at the site of the intervention. Lysyl oxidase, secreted by activated vascular smooth muscle cells and fibroblasts, catalyzes a key step in the cross-linking and stabilization of collagen and elastin in the vascular wall. We hypothesized that lysyl oxidase messenger RNA (mRNA) and protein expression are time-dependent and precede collagen accumulation and luminal narrowing after arterial balloon injury in the rat.

Gastrointestinal complications following infrarenal endovascular aneurysm repair.

Gastrointestinal complications are known to occur after open elective aortic aneurysm repair. This leads to increased morbidity, mortality, length of stay, and hospital costs. The authors hypothesize a change in the character and/or frequency of early postoperative gastrointestinal complications after endovascular aneurysm repair as compared to open abdominal aortic repair.

Open abdomen management of intra-abdominal sepsis.

Despite surgical advances, antimicrobial therapy, and intensive care, the morbidity and mortality of intra-abdominal sepsis remains high. The primary purpose of this study was to determine whether open abdomen management of intra-abdominal sepsis reduces intensive care unit (ICU) and hospital mortality. The records of 81 consecutive patients with open abdomen management for intra-abdominal sepsis admitted to the surgical ICU from January 1998 to April 2002 were retrospectively reviewed.