Pediatric near-drowning events: do they warrant trauma team activation?

Background: The purpose of this study was to determine the incidence of traumatic injuries, factors associated with mortality, and need for pediatric trauma surgery involvement for drowning and near-drowning events in children.

Materials And Methods: An institutional review board-approved, retrospective chart review was performed at three American College of Surgeons-verified Pediatric Trauma Centers (2011-2014). Patients with International Classification of Diseases, Ninth Revision, codes or E-codes for fatal-nonfatal drowning, fall into water, accidental drowning, or submersion were included.

Surgical management for complications of pediatric lung injury.

The etiologies of pediatric lung injury requiring surgical intervention can be infectious, traumatic, congenital, or iatrogenic. Childhood pneumonia is a significant global health problem affecting 150 million children worldwide. Sequelae of pulmonary infections potentially requiring surgery include bronchiectasis, lung abscess, pneumatocele, and empyema.

Blunt intraabdominal arterial injury in pediatric trauma patients: injury distribution and markers of outcome.

Background: The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome.

Methods: The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004.

Melagatran for thromboprophylaxis after mechanical valve implantation: results in a heterotopic porcine model.

Objective: Melagatran, the active form of ximelagatran, is a novel, direct thrombin inhibitor that does not have a narrow therapeutic window regarding hemorrhagic and thromboembolic events. We aimed to determine whether melagatran would be effective in preventing thrombus formation on heterotopically placed mechanical heart valves.

Methods: A graft containing a bileaflet mechanical heart valve was implanted in the descending thoracic aorta of domestic swine.

Pheochromocytoma and paraganglioma in children: a review of medical and surgical management at a tertiary care center.

Objective: The aim of this study was to review our institutional experience managing pheochromocytomas and paragangliomas in children.

Methods: A retrospective chart review of the Mayo Clinic database from 1975 to 2005 identified 30 patients < 18 years of age with histologically confirmed pheochromocytoma or paraganglioma.

Results: There were 12 patients with pheochromocytomas and 18 with paragangliomas.

Bilateral staged versus bilateral simultaneous thoracotomy in the pediatric population.

Aim: The aim of the study was to evaluate the safety and outcomes of simultaneous bilateral thoracotomy in pediatric patients compared with traditional bilateral staged thoracotomy.

Methods: This is a retrospective review of 30 consecutive patients 18 years or younger undergoing either bilateral staged or bilateral simultaneous thoracotomy between March 1994 and July 2004. Follow-up (mean, 47 months) was available for all patients.

Irrigated radiofrequency ablation with transmurality feedback reliably produces Cox maze lesions in vivo.

Background: Irrigated bipolar radiofrequency ablation has been used to replicate Cox maze surgical scars in pig hearts ex vivo. Impedance monitoring accurately predicted complete transmurality for all lesions. This study aimed to assess the feasibility and reliability of irrigated radiofrequency ablation and impedance monitoring to produce electrically isolating Cox maze lesions in vivo.

Prolonged exposure of canine coronary arteries to a nitric oxide donor desensitizes soluble guanylate cyclase.

Background: This study investigated the role of soluble guanylate cyclase desensitization in the development of tolerance to organic nitrates.

Materials And Methods: In organ baths, canine coronary arteries were exposed to either sodium nitroprusside (SNP) (experimental group) or papaverine (control group) at various concentrations (10(-9), 10(-7), or 10(-5) M) for 3 h. Arteries were then compared for response to vascular agonists and for inducible cyclic guanine monophosphate (cGMP) formation.

Safety and biocompatibility of the Myosplint system--a passive implantable device that alters ventricular geometry for the treatment of heart failure.

A passive implantable device developed for the treatment of heart failure, the Myosplint System, has demonstrated therapeutic efficacy in a canine model of pacing induced heart failure. The current study sought to demonstrate chronic device safety and biocompatibility, in vivo, in a normal porcine model. Two devices were implanted into each normal, beating heart of 6 juvenile and 15 adult pigs without cardiopulmonary bypass.

Endothelium-dependent vasodilation during acute rejection in dogs.

Background: Acute rejection, which is a major cause of death after cardiac transplantation, is associated with increased coronary artery resistance and decreased coronary blood flow, leading to congestive heart failure.

Materials And Methods: To examine the contribution of endothelium-derived vasoactive factors on coronary artery tone during acute rejection, dogs underwent orthotopic heart transplantation without immunosuppression. Plasma levels of endothelin, a potent endogenous vasoconstrictor peptide, and atrial natriuretic peptide, an endogenous coronary vasodilator of cardiac origin, were measured daily by radioimmunoassay until sacrifice.

Hirudin (desulfated, 54-65) contracts canine coronary arteries: extracellular calcium influx mediates hirudin-induced contractions.

Objective: Although the anticoagulatory properties of hirudin are well known, its direct vasoactive effects have not been investigated extensively. Hirudin stimulates nitric oxide and prostacyclin production in noncoronary vascular beds, but its actions on coronary arteries are unknown.

Materials And Methods: Five-millimeter segments of canine left circumflex coronary arteries were obtained for organ chamber experiments.

Nitric oxide and prostacyclin in ultrasonic vasodilatation of the canine internal mammary artery.

Background: Investigators recently demonstrated increased free blood flow from radial artery free grafts harvested using ultrasonic technology. We investigated the mechanism underlying this phenomenon.

Methods: Canine internal mammary artery segments (with and without intact endothelium) were precontracted with norepinephrine and sonicated 3 seconds in organ chambers with ultrasonic coagulating shears (Harmonic Scalpel; Ethicon Endo-Surgery, Cincinnati, OH) functioning at level 2.

Irrigated bipolar radiofrequency ablation with transmurality feedback for the surgical Cox-Maze procedure.

Background: Nonirrigated radiofrequency ablation (RFA) has been used to replicate the surgical scars of the Cox-Maze procedure. This study aimed to demonstrate that an irrigated, bipolar RFA energy source could also effectively replicate Cox-Maze lesions with impedance monitoring to predict the transmurality of ablated tissue.

Methods: A complete Cox-Maze lesion pattern was created ex vivo on fresh porcine atria using an irrigated, bipolar RFA system.

A novel antioxidant, EPC-K1, stimulates endothelial nitric oxide production and scavenges hydroxyl radicals.

EPC-K1, a hydroxyl radical scavenger synthesized by phosphate linkage of vitamin E and vitamin C, prevents myocardial reperfusion injury in vivo; however, the direct effects of EPC-K1 on coronary arteries are unknown. These experiments were undertaken to define possible mechanisms through which EPC-K1 imparts its protective action on the coronary vasculature. EPC-K1 (10(-5) to 10(-1) mg/ml) induced concentration-dependent relaxation in contracted canine coronary artery segments with endothelium, but no change in tension of arterial segments without endothelium (p<0.

Evaluation of a novel 2 mm internal diameter stainless steel saphenous vein to coronary artery connector: laboratory studies of on-pump and off-pump revascularization.

Objective: A second generation, 'easy-load', 2 mm internal diameter (ID), stainless steel, distal anastomotic device has been developed, and design improvements facilitate rapid connector loading with minimal magnification. The reduced size should allow application to most distal coronary vessels currently grafted. This technology may be useful in off-pump and minimally invasive surgical approaches to coronary revascularization.

Trends in the surgical management of ischemic mitral regurgitation.

The surgical approach to ischemic mitral regurgitation (IMR) remains a topic of considerable controversy. Will coronary artery bypass alone suffice, or should the valve be intervened upon? The poor late survival of patients with IMR is well recognized, but it remains unknown if this can be altered by addressing the valve directly. And if surgery is undertaken, should the valve be repaired or replaced? The underlying mechanisms of IMR remain incompletely understood, and although current theory focuses on the role of alterations in ventricular geometry in its pathogenesis, IMR is most often addressed by annuloplasty alone.

Gene transfer to coronary artery bypass conduits.

Background: Gene therapy is a rational approach to prevention of stenosis in saphenous vein grafts used as conduits for coronary artery bypass grafting. To explore this possibility we developed methods for adenoviral-mediated gene transfer to canine saphenous veins.

Methods: During a single procedure, autogenous canine saphenous vein segments were transduced ex vivo and used as coronary artery bypass grafts.