The simulation of an ex utero intrapartum procedure to extracorporeal membrane oxygenation.

We report a case of using simulation to aid in the performance of ex utero intrapartum treatment (EXIT) procedure to extracorporeal membrane oxygenation (ECMO). A primigravid with a fetus who was diagnosed with hypoplastic left heart syndrome was scheduled for an EXIT to ECMO procedure to be done by members of her obstetrical and neonatal teams. It would be the first time any of the members of the 2 teams would work together.

Implementation of parameters in the expansion ratio of mesh skin grafts.

Expansion of a mesh skin graft depends on factors pertaining to the graft itself as well as on parameters of the meshing device. With regard to the graft, we examine the efficiency of graft handling and thickness of the skin graft. With regard to the parameters of the meshing apparatus, which determine the expansion ratio: (1) d equals the distance between the cutting blades, which will become the width of the mesh ribbons and is an underestimated parameter for expansion; and (2) L equals the length of cut, which determines proportionally the expansion ratio.

A review of skin meshers.

Before the widespread clinical acceptance of mesh skin grafting, expansion of full thickness skin had already been reported. The senior authors, who performed the first mesh skingrafts, have tried several variations of instruments starting with a flat block, later using a roller device with staggered cuts (Mesh Dermatome type I), and further a roller with continuous cuts and a grooved carrier (Mesh Dermatome II). Now interchangeable rollers for different expansions (Zimmer Skin Mesher) and several other genuine meshers are available.

Results of high dose intravenous urokinase for acute myocardial infarction.

To determine the outcome of patients after treatment with high-dose intravenous urokinase (3 million U) 102 patients were prospectively evaluated in the setting of acute myocardial infarction. The first 61 patients received intravenous urokinase as a continuous infusion and the last 41 patients were treated with an initial 1.5 million U intravenous bolus.

Prognostic implications and predictors of enhanced regional wall motion of the noninfarct zone after thrombolysis and angioplasty therapy of acute myocardial infarction. The TAMI Study Groups.

Although impairment of left ventricular function in acute myocardial infarction is closely related to extent of necrosis, function in the noninfarct zone also contributes to global performance and thus may be of prognostic importance. We evaluated left ventricular regional wall motion by the centerline chord method in 332 patients treated with intravenous tissue-type plasminogen activator (t-PA) in the multicenter Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) I trial. All patients had acute contrast ventriculograms of suitable quality for analysis, and 266 patients had paired acute and day 7 ventriculograms.

Clinical experience and predicting survival in coronary disease.

To study the accuracy with which long-term prognosis can be predicted in patients with coronary artery disease, prognostic predictions obtained from a large, diverse sample of practicing cardiologists were compared with predictions from a multivariable statistical model. Test samples of 10 patients each were selected from a large series of medically treated patients with significant coronary disease. Using detailed clinical summaries, 49 cardiologists each predicted the probability of 3-year survival and infarction-free survival for 10 patients.

A randomized controlled trial of intravenous tissue plasminogen activator and early intravenous heparin in acute myocardial infarction.

To evaluate the coronary thrombolytic efficacy of tissue plasminogen activator (t-PA) and early intravenous heparin, 134 patients with acute myocardial infarction were randomly assigned to combination therapy or t-PA only. At a median of 2.78 hours from symptom onset, 64 patients received both t-PA (1.

Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in treatment of acute myocardial infarction.

Purpose: Little attention has been paid to the importance of clinical factors associated with bleeding complications caused by the use of thrombolytic agents. The goal of our study was to examine clinical and hematologic factors associated with an increased risk of bleeding in a prospectively observed population that received intravenous tissue plasminogen activator for acute myocardial infarction.

Patients And Methods: Bleeding complications were evaluated in 386 consecutive patients treated with 150 mg of tissue plasminogen activator over six to eight hours for acute myocardial infarction.

Cephalosporin therapy in intraabdominal infections. A multicenter randomized, comparative study of cefotetan, moxalactam, and cefoxitin.

Three broad-spectrum cephalosporins (cefotetan, moxalactam, and cefoxitin) proved effective in this randomized, prospective trial for treatment of 303 surgical patients with moderately severe regional peritonitis.

Characteristics and outcome of patients in whom reperfusion with intravenous tissue-type plasminogen activator fails: results of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) I trial.

To examine the outcome of patients with persistent coronary artery occlusion despite treatment with intravenous tissue-type plasminogen activator (t-PA), the clinical course of 96 patients with persistent occlusion after 90 min of therapy was evaluated. All patients underwent cardiac catheterization 90 min after initiation of intravenous t-PA. Immediate coronary angioplasty (PTCA) was attempted when the infarct-related artery failed to reperfuse unless the vessel was technically unsuitable or the infarct was thought to be small.

Use of initial ST-segment deviation for prediction of final electrocardiographic size of acute myocardial infarcts.

The decision to administer thrombolytic therapy for limitation of acute myocardial infarction (AMI) size must occur when only the history, physical examination and 12-lead electrocardiogram of a patient are available. A method that could quickly assess the amount of jeopardized myocardium would greatly aid the physician. This study developed formulas from 68 anterior and 80 inferior AMI patients using the extent of initial ST-segment deviation (ST delta) to predict the final AMI size estimated by the Selvester QRS score in a population not receiving reperfusion therapy.

Comparison of two dose regimens of intravenous tissue plasminogen activator for acute myocardial infarction.

Two dosing schedules of intravenous tissue plasminogen activator (t-PA) for acute myocardial infarction were compared in a multicenter trial. At 2.95 +/- 1.

Quantitative analysis of right and left ventricular infarction in the presence of postinfarction ventricular septal defect.

To quantitate the amount of right and left ventricular infarction in patients dying with postinfarction ventricular septal defect (PIVSD), hearts from 54 patients with anterior or inferior myocardial infarction were studied at autopsy. Fifteen hearts had myocardial infarction with PIVSD and 39 hearts had infarction without PIVSD and were used as a comparison group. All infarcts were sized histologically and the percent of each ventricle infarcted was quantitated by computer-assisted planimetry.

Comprehensive rehabilitation after burn injury.

Comprehensive rehabilitation of patients after burn injury requires the organized application of sound, recognized principles. The basic concerns are the prevention of loss of joint motion, loss of muscle mass, and the prevention of anatomic deformities. Important considerations are starting the rehabilitative program as early as possible after injury and avoiding techniques that unduly immobilize the patient or parts of the body.

Identification of the optimal electrocardiographic leads for detecting acute epicardial injury in acute myocardial infarction.

Current coronary care electrocardiographic (ECG) monitoring techniques are aimed at detection of cardiac arrhythmias rather than myocardial ischemia. However, in patients with acute myocardial infarction (AMI) who undergo reperfusion therapy, monitoring ST-segment deviation could provide an early noninvasive indicator of coronary artery reocclusion. In this study, the admission 12-lead ECGs of patients with initial AMI were used to propose optimal lead locations for ST-segment monitoring.

Topical cerium nitrate prevents postburn immunosuppression.

Suppression of cell-mediated immunity (CMI) follows a major thermal injury and is associated with an increased incidence of serious infections. Adult female CF-1 mice received a 20% full-thickness steam burn and were then treated with various topical antimicrobial creams in an attempt to alter the course of postburn immunosuppression. Topical agents included cerium nitrate (CE), silver sulfadiazine (SSD), mafenide (SML), silver nitrate (AG), and a mixture of CE and SSD (CE-SSD).

Identification and antibiotic susceptibility of bacterial isolates from burned patients.

We retrieved bacterial blood isolates from 397 adult burned patients admitted over a 7-year period. Sixty-two patients (15.6 per cent) developed true-positive bacterial blood cultures (judged non-contaminants), and of these 30 (48.

Hydrocarbon contact injuries.

Cutaneous injury caused by exposure to gasoline and other hydrocarbons is a clinical entity with potentially life-threatening effects. We report four cases of such injury. One patient developed full-thickness skin loss following gasoline immersion, and another developed severe systemic complications following contact with a carburetor cleaning solvent.

Characterization of the immunosuppressive effect of burned tissue in an animal model.

The immunosuppressive effect of burned tissue was studied using a mouse burn model. To evaluate the immunologic status an in vivo measure of cell-mediated immunity (CMI) involving contact sensitization of mice by painting the skin with dinitrofluorobenzene was used; mice were challenged 5 days later by painting the ear with the same antigen. Ear swelling in response to antigenic challenge was used as a quantitative measure of CMI; diminution in ear swelling in treatment mice compared to sensitized, unburned control mice indicated the degree of immunosuppression.

Recovery of skeletal muscle after laceration and repair.

Few data are available regarding structural and functional recovery of lacerated skeletal muscle after repair. This study used the extensor digitorum longus muscle of rabbits to document recovery after laceration and repair and a healing period of 12 weeks. Completely lacerated muscles recovered approximately 50% of their ability to produce tension but were able to shorten to 80% of normal.