Impella 5.0: An intermediate strategy for bridging a patient from infected durable LVAD to cardiac transplant.

Cardiac transplant remains the gold-standard treatment for end-stage heart failure more than 50 years after the procedure was first pioneered. The number of transplant operations performed annually has been limited by the global imbalance of donor organs to recipients. This imbalance helped fuel the development of left ventricular assist devices (LVADs) first as a bridge to cardiac transplant and subsequently as destination therapy.

Precision and long-term stability of different estradiol immunoassays assessed in a multi-center quality control study.

Background: Because of the vast range of physiological relevant estradiol concentrations the requirements to be met by an estradiol assay are high. In the present study the performance of various commercially available estradiol assays was evaluated with regard to imprecision and long-term stability.

Methods: Precision and long-term stability of 7 commercially available estradiol immunoassays were assessed in a multi-centre quality control study based on the repeated measurement of liquid BIOREF estradiol control sera by 18 laboratories during a 14-month study period.

Factors contributing to recurrent carotid disease following carotid endarterectomy.

Background: Retrospective analysis was performed to assess the effect of gender, age, hypertension, diabetes, and smoking upon residual disease, recurrent disease, and progression of disease following carotid endarterectomy (CE). The effect of patch versus primary closure was also studied.

Methods: Postoperative duplex studies were performed following 323 CEs at months 1, 6, 12, and 24.

Allograft replacement of the aortic valve for active endocarditis.

Purpose: In the 50 months preceding March 1995, 35 adult patients underwent aortic valve replacement with a cryopreserved human aortic valve allograft. Nine of these patients had active endocarditis. The remaining 26 patients had aortic valve pathology without active infection.

Durability of emergency coronary artery bypass for complications of failed angioplasty.

Although emergency coronary artery bypass for complications of percutaneous transluminal coronary angioplasty (PTCA) has proved to be a relatively successful 'bail-out' procedure, little is known about the durability of revascularization under these potentially disastrous circumstances. The authors therefore retrospectively examined their results with this procedure. Emergency coronary artery bypass for complications of PTCA was performed in 112 patients between 1 January 1984 and 19 May 1992.

Clinical heparin coated cardiopulmonary bypass: reduction of systemic heparin requirements for redo cardiac surgery.

The authors compared blood loss, transfusion requirements, and heparin doses for reoperative cardiac surgery using either: a) a Duraflow (Baxter Corporation, Irvine, CA) heparin coated cardiopulmonary bypass (CPB) system or b) standard CPB. Twenty patients underwent redo cardiac surgery while supported with heparin coated CPB, and 17 patients underwent redo cardiac surgery with standard CPB. The following data are presented as mean +/- standard deviation.

Individual reference ranges of CA 15-3, MCA and CEA in recurrence of breast cancer.

The long-term intra-individual variation of the title tumour markers was studied in the group of 33 patients which developed no relapse. The average biological intra-individual CV was 11.2% for CA 15-3 and 14.

Early experience with homograft aortic root replacement for complex aortic pathology.

Background: Complex aortic valve and root pathology presents a serious operative challenge.

Methods: During the last 45 months 21 cryopreserved homograft root replacements have been performed in 19 patients. The ages of the patients ranged from 28 to 77 years; there were 15 men and four women.

Prophylaxis of heart transplant rejection with either antithymocyte globulin-, Minnesota antilymphocyte globulin-, or an OKT3-based protocol.

We compared an equine antithymocyte globulin (ATGAM)-based protocol with a Minnesota antilymphocyte globulin (MALG)-based protocol and a murine monoclonal CD-3 (OKT-)-based protocol in 3 groups of heart transplant (HT) recipients. Thirty-four recipients received a four-day course of ATGAM. Thirty HT recipients received a 14-day course of OKT3.

Acute repair of a full-thickness right ventricular defect with a composite myofascial pedicle flap.

A full-thickness defect of the right ventricle presented acutely after mediastinitis and sternal dehiscence. This developed 29 days after bilateral internal mammary artery harvest for coronary artery bypass grafting. The defect was managed successfully with a pedicled left rectus abdominis muscle flap using an attached island of the anterior rectus sheath for endocardial lining.

Intraesophageal balloon distention versus drug provocation in the evaluation of noncardiac chest pain.

Intraesophageal balloon distention (IEBD) has been advocated as an effective provocative test for the evaluation of chest pain and dysphagia. The normal esophageal response to intraesophageal balloon distention is to generate a sustained contraction proximal to the balloon while showing a distinctive absence of activity distal to the balloon. We evaluated intraesophageal balloon distention in 62 patients with noncardiac chest pain and compared the diagnostic results to those obtained by using a combination of acid infusion, edrophonium (80 micrograms/kg iv) and bethanechol (80 micrograms/kg sq).

Intraesophageal balloon distention in the manometric evaluation of chest pain.

Drug provocation is routinely used during esophageal manometry in the evaluation of chest pain of presumed esophageal origin. As significant side effects have been associated with the use of drugs in provocation, and these provocative tests are inadequately sensitive to exclude esophageal etiology as the cause of chest pain, alternative provocative tests have been sought. Intraesophageal balloon distention (IEBD) has recently been reintroduced as a method of pain provocation in the manometric evaluation of chest pain.

Manometric responses to balloon distention in patients with nonobstructive dysphagia.

The manometric responses to graded intraesophageal balloon distention were studied in 30 patients with symptoms of intermittent dysphagia but without evidence of structural narrowing on barium swallow or endoscopy, or both. These studies were compared with those performed in 10 normal volunteers. Using a manometric catheter with a balloon of reproducible dimension, balloon distention produced a sustained pressure proximal to the distended esophageal balloon in 28 of 30 (93%) patients and 9 of 10 (90%) normal volunteers.

Prospective evaluation of high-dose bethanechol in investigation of esophageal chest pain.

We compared the value of bethanechol 80 micrograms/kg subcutaneously, acid infusion with a 0.1 normal hydrochloric acid, and edrophonium 80 micrograms/kg intravenously as provocative agents to reproduce chest pain and manometric alterations in 72 patients with noncardiac chest pain. No patient developed typical chest pain and manometric alteration with acid infusion, while five (6.

Abdominal pain in hereditary angioedema: the role of acid hypersecretion.

Hereditary angioedema is a familial disorder characterized by recurrent episodes of soft tissue swelling and abdominal pain. Whereas most patients are successfully treated with androgenic steroids, some have abdominal pain unresponsive to therapy. To determine whether acid-peptic disease could account for the abdominal pain unresponsive to androgen therapy, we performed upper gastrointestinal endoscopy and determined basal acid output in 21 consecutive patients with hereditary angioedema and abdominal pain.

Extraesophageal manifestations of gastroesophageal reflux disease.

Gastroesophageal reflux is frequently viewed as a "nuisance" problem that affects a large number of individuals with variable frequency. When physicians conceptualize the complications of gastrointestinal reflux, they generally consider them a localized esophageal problem resulting in irritation of the esophagus, bleeding esophagitis, occasional stricture formation, and the development of Barrett's esophagus. However, attention has again been focused on the potential relationship between gastroesophageal reflux and pulmonary diseases (cough, asthma, recurrent pneumonia), chest pain, and hypopharyngeal or oral disease.

Intra-individual variation of serum thyroxin and triiodothyronine in pregnancy.

The mean concentrations of triiodothyronine (T3) and thyroxin (T4) in serum were increased in pregnancy, the increases for individuals remaining stable for week 16 to week 40 of gestation. For this period biological intra-individual variations of T3 and T4 in serum were estimated and compared with those of non-pregnant women. The average biological intra-individual CVs for T3 and T4 were of the same order for pregnant and non-pregnant women (6.

[Modification of the risk profile of obese essential hypertensive patients by the group "hypertension discussion" program].

The programme "Discussions on Hypertension" is a programme for group treatment of obese essential hypertensives in medical practices on the basis of behavioural therapy. A co-operation model was developed between the Department for General Medicine of the "Medizinische Hochschule Hannover", the Institute for Medical Psychology of the "Philipps-Universität Marburg" and the company Galenus Mannheim and was offered to doctors in general practice. The effects of the programme on the modifying of the risk profile for coronary heart disease was investigated in a controlled study in 137 patients by nine general practitioners.

Intraluminal shunting of operatively severed aortocoronary saphenous vein grafts.

Restoration of myocardial perfusion using plastic shunts in severed aortocoronary bypass grafts is described.

Prevention of pericardial adhesions with dextran 70.

Pericardial adhesions pose a major problem during reoperative cardiac surgical procedures. The purpose of this study was to determine the effect of intrapericardial dextran 70 on the formation of pericardial adhesions in an animal model. The data obtained revealed that intrapericardial dextran 70 reduced the incidence of experimental pericardial adhesions.

Venous prostheses: improved patency with external stents.

A uniformly successful prosthesis for replacement in the venous system has not been developed. This study assesses the effect of external stents on the patency of polytetrafluoroethylene (PTFE) grafts in the infrarenal vena cava. Under general anesthesia, 21 mongrel dogs underwent midline laparotomy.

The prevention of extra cardiac conduit obstruction: an experimental study.

Acquired right ventricular (RV) extracardiac conduit (ECC) obstruction was studied in an animal model. A 16 mm woven Dacron tube graft was inserted between the right ventricle (RV) and main pulmonary artery (PA) in 18 adult mongrel dogs followed by pulmonary artery occlusion with a Dacron tape. In 9 dogs, the RV anastomosis was maintained with a 16 mm Dacron covered polypropylene stent.

Prosthetic replacement for the thoracic vena cava: an experimental study.

The superior vena cava (SVC) and thoracic inferior vena cava (IVC) were replaced in 46 dogs with autologous vein, knitted Dacron, glutaraldehyde-fixed porcine pericardium, unsupported polytetrafluorethylene (PTFE), and externally stented PTFE. After 30 days, patency rates were determined by contrast venography and were 100%, 9%, 50%, 75%, and 100%, respectively. The patency rates of Dacron and glutaraldehyde-fixed pericardium are considered unacceptable when compared to autologous vein (p less than 0.