A Novel Risk Score to Predict One-Year Mortality in Patients Undergoing Complex High-Risk Indicated Percutaneous Coronary Intervention (CHIP-PCI).

Objective: To identify patients undergoing complex, high-risk indicated percutaneous coronary intervention (CHIP-PCI) and compare their outcomes with non-CHIP patients. We created a CHIP score to risk stratify these patients.

Background: Risk stratification of PCI patients remains difficult because most scoring systems reflect hemodynamic instability and predict early mortality.

Positive Effects of Heme Oxygenase Upregulation on Adiposity and Vascular Dysfunction: Gene Targeting vs. Pharmacologic Therapy.

Objective: Heme oxygenase (HO-1) plays a critical role in adipogenesis and it is important to understand its function in obesity. Many studies have shown that upregulation of HO-1 can affect the biologic parameters in obesity-mediated diabetes, hypertension and vascular endothelial cell function. Thus, we aimed to explore the hypothesis that upregulation of HO-1, using a pharmacologic approach as well as gene targeting, would improve both adiposity and endothelial cell dysfunction by direct targeting of endothelial cells.

Renal tumours with cavo-atrial extension: surgical management and outcome.

Surgery is the most effective treatment for the management of patients with renal cell carcinoma (RCC) and involvement of inferior vena cava (IVC). Data were accrued for 68 consecutive patients, who underwent surgical resection for RCC with IVC extension and required cardiothoracic surgical input from May 1993 to May 2005. The mean age of patients was 60.

A prospective clinical trial to evaluate the microbial barrier of a needleless connector.

Needleless connectors are being increasingly used for direct access to intravascular catheters. However, the potential for microbial contamination of these devices and subsequent infection risk is still widely debated. In this study the microbial contamination rate associated with three-way stopcock luers with standard caps attached was compared to those with Y-type extension set luers with Clearlink needleless connectors attached.

Glucose-insulin-potassium and tri-iodothyronine individually improve hemodynamic performance and are associated with reduced troponin I release after on-pump coronary artery bypass grafting.

Background: Both glucose-insulin-potassium (GIK) and tri-iodothyronine (T3) may improve cardiovascular performance after coronary artery surgery (CABG) but their effects have not been directly compared and the effects of combined treatment are unknown.

Methods And Results: In 2 consecutive randomized double-blind placebo-controlled trials, in patients undergoing first time isolated on-pump CABG between January 2000 and September 2004, 440 patients were recruited and randomized to either placebo (5% dextrose) (n=160), GIK (40% dextrose, K+ 100 mmol.L(-1), insulin 70 u.

Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: a prospective randomized trial.

Background: Aortic arch surgery has a high incidence of brain injury. This may in part be caused by a cerebral metabolic deficit observed after hypothermic circulatory arrest (HCA). We hypothesized that selective antegrade cerebral perfusion (SACP) would attenuate this phenomenon.

A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector.

The microbial contamination rate of luers of central venous catheters (CVCs) with either PosiFlow needleless connectors or standard caps attached was investigated. The efficacy of 70% (v/v) isopropyl alcohol, 0.5% (w/v) chlorhexidine in gluconate 70% (v/v) isopropyl alcohol and 10% (w/v) aqueous povidone-iodine to disinfect the intravenous connections was also assessed.

Failure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest.

Objectives: Although retrograde cerebral perfusion has become a popular adjunctive technique and may improve cerebral ischemic tolerance during hypothermic circulatory arrest, direct cerebral metabolic benefit has yet to be demonstrated in human subjects. We investigated the post-arrest metabolic phenomena with and without retrograde cerebral perfusion in patients.

Methods: In a prospective randomized trial, 42 patients undergoing aortic surgery requiring hypothermic circulatory arrest were allocated to receive hypothermic circulatory arrest alone (n = 21) or hypothermic circulatory arrest with additional retrograde cerebral perfusion (n = 21).

A central venous catheter coated with benzalkonium chloride for the prevention of catheter-related microbial colonization.

In an attempt to overcome infections associated with central venous catheters, a new antiseptic central venous catheter coated with benzalkonium chloride on the internal and external surfaces has been developed and evaluated in a clinical trial. Patients (235) randomly received either a triple-lumen central venous catheter coated with benzalkonium chloride (117) or a polyurethane non-antiseptic catheter (118). The incidence of microbial colonization of both catheters and retained antiseptic activity of the benzalkonium chloride device following removal were determined.

A novel serological test for the diagnosis of central venous catheter-associated sepsis.

Objectives: To determine the sensitivity and specificity of a novel antibody test for the diagnosis of intravascular catheter-related infections due to coagulase-negative staphylococci.

Methods: Sixty-seven patients diagnosed as having central venous catheter (CVC)-associated sepsis based on strict clinical criteria, including positive blood cultures, were compared to 67 patients with a CVC in situ who exhibited no evidence of sepsis. An ELISA serological test based on a novel short-chain lipoteichoic acid antigen isolated from coagulase-negative staphylococci (CNS) was used to determine the patient's serological response (IgG and IgM) to CVC sepsis caused by CNS.

Use of pulsed field gel electrophoresis to determine the source of microbial contamination of central venous catheters.

Microorganisms detected in situ on the distal tip of central venous catheters (CVC) within 90 min of insertion were investigated using pulsed-field gel electrophoresis to analyse genomic fragments obtained with the SmaI restriction enzyme. Thirty patients received a triple lumen CVC, which was inserted directly through the skin using the Seldinger technique. In a further 30 patients a triple lumen CVC was inserted through a Swan sheath, thereby avoiding direct contact of the CVC with the skin.

Novel approach to investigate a source of microbial contamination of central venous catheters.

The potential route of contamination by skin microorganisms onto the distal tip of central venous catheters during insertion was investigated. Thirty patients undergoing cardiac surgery who required a central venous catheter (CVC) as part of their clinical management were studied. Following catheter placement, the device insertion equipment and the skin at the insertion site were sampled for microorganisms.

Surgery of the thoracic aorta with hypothermic circulatory arrest: experience with retrograde perfusion via the superior vena cava and demonstration of cerebral perfusion.

Objective: Retrograde cerebral perfusion (RCP) via the superior vena cava has been described as an adjunctive technique to enhance the safety of hypothermic circulatory arrest (HCA), but perfusion of cerebral tissue in humans during RCP has not been demonstrated to date. We report our clinical experience with RCP and our attempt to demonstrate "true" perfusion of the brain.

Methods: Between April 1993 and June 1995, 49 thoracic aortic procedures were performed in 48 patients (male:female = 26:22) (emergency: elective = 25:24).

An audit programme for central venous catheter-associated infections.

Central venous catheters (CVC) are commonly associated with both localized and systemic infection. This paper describes an audit programme which was designed to review clinical practice associated with the insertion and subsequent care of CVC and their possible relationship to the development of infection. The programme was produced by a joint working group of the Hospital Infection Society and the Research Unit of the Royal College of Physicians and is subdivided into an audit of hospital practices and patient management associated with the use of CVC.

Retrograde cerebral perfusion: clinical experience in emergency and elective aortic operations.

We recently have used retrograde cerebral perfusion via the superior vena cava in association with hypothermic circulatory arrest as an adjunct to cerebral protection during aortic arch operations. Between April 1993 and March 1994, 23 patients (14 male; 9 female; median age, 64 years; age range, 25 to 76 years; 14 emergency, 9 elective) underwent operation on the ascending aorta, aortic arch, or both for acute dissection (11) or aneurysm (12). Aortic root replacement was performed in 13 patients (7 with arch replacement), ascending aortic replacement in 7 (4 with arch replacement), isolated aortic arch replacement in 2, and repair of sinus of Valsalva aneurysm in 1.

Guidelines for good practice in central venous catheterization. Hospital Infection Society and the Research Unit of the Royal College of Physicians.

Central venous catheters (CVC) are commonly used in clinical practice and are associated with several complications, including early and late onset infection. In these guidelines, an outline of good practice for the use of CVC and the prevention of associated infections is presented. Definitions of both localized and systemic catheter-related sepsis are given.

Infections and intravascular devices.

Complications associated with intravascular devices include infections mainly caused by Staphylococcus epidermis and S. aureus. The reported incidence of these infections varies.

Surgical manifestations and management of ascariasis in Kashmir.

Amongst 876 cases suffering from ascariasis 662 cases were managed conservatively and 214 cases were treated by surgery. Surgical complications were found to be more common in males in the age group of 6-10 years. Principal clinical features included pain abdomen (99.

Lidocaine accelerates neuroelectrical recovery after incomplete global ischemia in rabbits.

The use of high-dose lidocaine for cerebral protection during ischemia has produced varied results. Our study uses a new, single carotid artery preparation in the rabbit to produce incomplete global ischemia by graded carotid occlusion; specific electroencephalographic changes are used as the end point for the extent of blood flow reduction sustained during 20 minutes. We monitored arterial pressure, intracranial pressure, and internal carotid blood flow that were recorded with an electromagnetic flowmeter after surgical ligation of the opposite internal and the two vertebral arteries, and we studied the electroencephalogram and somatosensory-evoked potentials elicited by stimulation of the sciatic nerve.