Developing and sustaining community-academic partnerships: lessons from Downstate New York Healthy Start.

Partnering with communities is a critical aspect of contemporary health promotion. Linkages between universities and communities are particularly significant, given the prominence of academic institutions in channeling grants. This article describes the collaboration between a school of public health and several community-based organizations on a maternal and infant health grant project.

Prevalence and clinical course of pleural effusions at 30 days after coronary artery and cardiac surgery.

The present prospective study was designed to determine the prevalence of pleural effusion at approximately 28 days after cardiac surgery and their subsequent course. This consecutive case study included 389 patients; 312 had only coronary artery bypass graft surgery (CABG) surgery, 37 had both valve and CABG surgery, and 40 had only valve surgery. Chest radiographs were obtained approximately 28 days postoperatively.

Ventricular aneurysmectomy. A 25-year experience.

Objective: This study determined predictors of operative survival and improved long-term outcomes in patients undergoing ventricular aneurysmectomy.

Summary Background Data: Since the first successful repair of ventricular aneurysm in 1958, refined technique and improvement in perioperative care have been introduced to lower morbidity and mortality.

Methods: The authors reviewed their institutional experience from 1968 through 1993 in treating 523 patients who underwent ventricular aneurysmectomy.

Videothoracoscopy: improved technique and expanded indications.

Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favorable results. Application of this technology to our practice of thoracoscopy is the basis of this report. Videothoracoscopy has been performed in 39 patients for the following indications: chronic pleural effusion, interstitial lung disease, mediastinal lymphadenopathy in lung cancer, persistent air leak after decortication, mediastinal mass, recurrent spontaneous pneumothorax, hydropneumothorax with persistent air leak, and pleural-based mass.

Cloning and expression of the human myeloid cell nuclear differentiation antigen: regulation by interferon alpha.

The human myeloid cell nuclear differentiation antigen (MNDA) is a protein of 406 amino acids that is expressed specifically in granulocytes, monocytes and earlier stage cells of these lineages. Degenerate oligonucleotides that could encode regions of MNDA amino acid sequence were used to amplify the MNDA cDNA sequence using the polymerase chain reaction. The amplified cDNA product was sequenced to confirm that it encoded the MNDA protein.

Characterization of the human myeloid cell nuclear differentiation antigen: relationship to interferon-inducible proteins.

The human myeloid cell nuclear differentiation antigen (MNDA) is expressed specifically in cells of the granulocyte/monocyte lineage. The MNDA has been isolated by using a monoclonal antibody affinity matrix and reversed-phase high performance liquid chromatography. Its NH2-terminal sequence has been obtained, as well as additional sequence information derived from peptides produced by cyanogen bromide and SV8 protease cleavages.

Internal mammary artery graft at reoperation: risks, benefits, and methods of preservation.

To determine the effect of a prior internal mammary artery (IMA) graft on coronary artery bypass reoperation (CABR), we reviewed our experience with 410 consecutive patients: 313 received only saphenous vein grafts at initial coronary artery bypass grafting (CABG), and 97 received at least one IMA graft at CABG. Cardiac catheterization data before CABG were available in 110 patients (56 received only saphenous vein grafts, 54 received at least one IMA graft), allowing comparison of left ventricular function at CABG and CABR. Injury of the IMA graft occurred in 5 patients (1 death), but presence of an IMA graft was not an independent predictor of morbidity or mortality.

Lectin-binding proteins in nuclear preparations from rat liver and malignant tumors.

Lectin binding [concanavalin A, biotinylated ricinus communis agglutinin, and biotinylated succinylated wheat germ agglutinin (B-SWGA)] was used to detect the glycosylated proteins associated with a residual protein fraction [insoluble in 4% sodium dodecyl sulfate and termed the nuclear residual fraction (NRF)] or with nuclear matrix preparations from normal rat liver, azo dye (3'-MeDAB)-induced rat hepatoma, and Walker 256 transplantable carcinosarcoma. One- and two-dimensional gel electrophoresis were used with lectins, polyclonal antisera, and monoclonal antibody binding to characterize some of the glycoconjugates. Two polypeptide bands with approximate molecular weights of 95,000 and 55,000, shown previously to be present only in the induced tumor cells and the Walker 256 tumor, were reactive with lectins.

Efficacy of cefazolin, cefamandole, and gentamicin as prophylactic agents in cardiac surgery. Results of a prospective, randomized, double-blind trial in 1030 patients.

In an effort to develop an improved regimen of antibiotic prophylaxis in cardiac surgery, 1030 patients who were to have elective cardiothoracic surgery involving a median sternotomy were selected at random to receive cefamandole or cefazolin, with or without gentamicin, in a prospective double-blind study. Cefazolin was significantly less effective than cefamandole at both the sternal (1.8% vs.

Internal mammary artery grafts: technical factors influencing patency.

Eight hundred fourteen patients with internal mammary artery (IMA) coronary artery bypass grafts have been restudied 961 times with coronary arteriography, primarily to evaluate the patency of the grafts in the setting of symptomatic coronary occlusive disease. Their records were reviewed to assess graft patency as related to the technical aspects of coronary artery bypass surgery. Patency was evaluated using life-table analysis of the data.

Cryoprecipitate-topical thrombin glue. Initial experience in patients undergoing cardiac operations.

The use of fibrin glues as topical hemostatic agents is reported in the European literature. We have composed an analogous compound in our operating rooms using cryoprecipitate and topical thrombin (1000 units/ml) in equal volumes applied directly to the bleeding site. We have used cryoprecipitate-topical thrombin glue in 26 patients undergoing cardiac operations.

The fate of arm veins used for aorta-coronary bypass grafts.

Arm veins have been a common second choice conduit for those patients having insufficient saphenous veins for coronary bypass operations. To define the patency and durability of arm vein grafts, we reviewed our patients with one or more arm vein grafts used for coronary revascularization between 1974 and 1982. A total of 59 patients required at least one arm vein graft and 51 are presently alive.

Surgical procedures after percutaneous transluminal coronary angioplasty.

Since Gruentzig's introduction of percutaneous transluminal coronary angioplasty in 1974, there has been increasing clinical use of this technic. At St. Thomas Hospital in Nashville, 50 patients were selected for coronary angioplasty through December 1981.

Urgent operation for acquired ventricular septal defect.

Recent experience suggests that ventricular septal defect (VSD) secondary to myocardial infarction constitutes an indication for urgent operation. Acquired VSD at St. Thomas Hospital, Nashville, was reviewed to substantiate the obsolescence of protracted medical therapy designed to allow a late, technically less demanding, repair.

Pulmonary embolectomy.

During the past 10 years, 20 patients at St. Thomas Hospital had pulmonary embolectomy; there were 12 survivors. Ten patients had a pulmonary arteriogram prior to operation and, of these, there were 7 survivors.

Results of surgical management of acute left ventricular aneurysms.

Over an 8-year period, 20 patients underwent operative repair of ventricular aneurysms during the first 8 weeks after acute myocardial infarction. All patients with multivessel coronary occlusive disease underwent concomitant coronary artery bypass grafting. There was one hospital death, for an early mortality rate of 5%, and one late death during follow-up, which now extends over 8 years, for a predicted actuarial 5-year survival rate of 92%.

Air embolism and other accidents using pump oxygenators.

A surgery of 349 cardiac surgeons showed that during a six-year period, a pump oxygenator accident serious enough to cause patient injury or death occurred one per 1,000 procedures. A total of 264 deaths occurred as a direct results of an accident. Air embolism and disseminated intravascular coagulation were the two most common problems.

The cost of coronary bypass procedures.

We reviewed the financial records of 200 succesive patients who had coronary artery bypass surgery in the first three months of 1976. The average hospital bill was $7,690 and the average length of stay was 18 days. The highest bill was $28,329 (79 days) and the lowest was $6,126 (11 days).

Median sternotomy dehiscence.

Sternal dehiscence requiring reoperation occurred in 36 out of 4,531 patients who had a sternotomy incison within an eight-year period. Twisted sternal wire sutures were used for the first four years and a crimped steel plate fixation was used during the second four years with a marked and significant decrease in the incidence of dehiscence from 17 out of 1,000 patients to 3 out of 1,000 patients. Thirty-five of the 36 patients were men, and 4 required reoperation for bleeding.

The effectiveness of surgical treatment of acute aortic dissection.

Ten consecutive patients have undergone operative repair of acute aortic dissection at St. Thomas Hospital in the last three years. Two died.

Further evaluation of the surgical treatment of obstructive disease of the left main coronary artery.

A protocol for the operative management of two patient groups with left main coronary artery disease has been evaluated. The period prior to and during induction of anesthesia is managed without using aortic balloon counterpulsation. Of the 86 patients undergoing coronary artery bypass for left main coronary artery disease from 1970 to 1973, there was a surgical mortality of 8.

Ischemic cardiomyopathy: medical versus surgical treatment.

The natural history of patients with ischemic heart disease and depressed left ventricular function is dismal, and medical therapy has failed to alter its course. To assess the results of aorta-coronary bypass grafting in patients with coronary artery disease and decreased left ventricular ejection fraction (LVEF less than or equal to 0.3), we compared 70 medically treated patients to 46 patients having aorta-coronary bypass grafting.