The interaction between myocardial depressant factors in endotoxemic cardiac dysfunction: role of TNF-alpha in TLR4-mediated ICAM-1 expression.

Unlabelled: Multiple pro-inflammatory mediators contribute to cardiac dysfunction caused by bacterial lipopolysaccharide (LPS). The rapid TNF-alpha response is likely involved in the induction of down-stream myocardial depressant factors. Studies by our laboratory and others indicate an important role for ICAM-1 in endotoxemic cardiac dysfunction through leukocyte-independent mechanisms.

Viscosupplementation: managed care issues for osteoarthritis of the knee.

Background: Osteoarthritis (OA) affects an estimated 49 million adults in North America, or nearly 1 of every 6 adults. More than 8 million North Americans have limited mobility to some extent because of OA. By 2030, an estimated 71 million North Americans will be diagnosed with OA, an increase of 45% over current figures.

Pantoea agglomerans liver abscess presenting with a painful thigh.

This case highlights that an acute myositis leading to rhabdomyolysis may occur as a rare complication of hepatic abscess and shows the benefit of early recognition of this possible association. A 70-year-old man presented with fever and lower limb myalgia, with laboratory evidence of acute renal failure secondary to rhabdomyolysis. Blood cultures revealed Pantoea agglomerans, which led to identification of a hepatic abscess on computed tomography scan.

[Screening colonoscopy among first degree relatives of patients with colorectal carcinoma].

Background: First degree relatives of patients with colorectal carcinoma are at a higher risk of having the disease than the general population. Therefore, they should be subjected to screening colonoscopy.

Aim: To assess the effectiveness of colonoscopy among first degree relatives of patients with colorectal carcinoma.

Topical application of bacitracin ointment is associated with decreased risk of mediastinitis after median sternotomy.

Background: The diagnosis of mediastinitis after open-heart surgery is infrequent but dreaded as it carries a high morbidity and mortality. The purpose of this study was to investigate the impact that topical antibacterials would have on the postoperative mediastinitis rate.

Methods: Data were collected from 2455 consecutive patients who underwent sternotomy and cardiopulmonary bypass for both valvar and ischemic heart disease.

The economic impact of insomnia in managed care: a clearer picture emerges.

An important question for managed care organizations is whether insomnia is associated with increased consumption of healthcare resources. Even though a large number of adults complain of insomnia, few actually receive a diagnostic code for the condition. Consequently, it has been challenging to consistently measure both direct medical costs and indirect costs attributable to insomnia.

Evaluation of web-based learning tools: lessons learned from the thoracic surgery directors association curriculum project three-year experience.

Background: In 2001 the Thoracic Surgery Directors Association implemented a web-based curriculum for prematriculated TS residents containing 75 learning modules organized into 13 sections Each module contains an audio/video presentation, a summary, frequently asked questions, references, a self-assessment, and a critique. Curriculum content was provided as a randomized prospective trial one year prior to matriculation to residents matching into a TS program from 2001 to 2004.

Methods: Over 3 years the utilization and impact of this curriculum was evaluated by 8 different methods including resident surveys, faculty surveys, web tracking, examination scores, and individual online learning module critiques.

Profound hypothermia with alpha-stat pH management during open-heart surgery is associated with choreoathetosis.

A retrospective chart review was conducted to examine risk factors associated with the occurrence of choreoathetosis, a rare but significant complication of open-heart surgery in children. Ten children were identified as having developed choreoathetosis after cardiac surgery. Their charts were reviewed and compared with 33 age- and diagnosis-matched controls who underwent open-heart surgery during the same time period.

Signaling for myocardial depression in hemorrhagic shock: roles of Toll-like receptor 4 and p55 TNF-alpha receptor.

Hemorrhagic shock causes myocardial contractile depression. Although this myocardial disorder is associated with increased expression of tumor necrosis factor-alpha (TNF-alpha), the role of TNF-alpha as a myocardial depressant factor in hemorrhagic shock remains to be determined. Moreover, it is unclear which TNF-alpha receptor mediates the myocardial depressive effects of TNF-alpha.

[Atypical presentation of a colorectal carcinoma].

We report a 67 years old male with a history of pulmonary tuberculosis at the age of 15, that consults for malaise, weight loss and productive cough. Chest X ray examination showed a left pleural effusion. A pleural tap obtained a sterile exudate.

Successful implementation of a novel internet hybrid surgery curriculum: the early phase outcome of thoracic surgery prerequisite curriculum e-learning project.

Background: The internet CD-ROM thoracic surgery (TS) e-learning system was implemented in 2001 as a prospective randomized trial testing resident acceptance and educational impact of a unique web-based curriculum system on prematriculated TS residents. The Prerequisite Curriculum (PRC) contains 75 segments organized with textbook and case-based navigational systems.

Methods: Web-based technology tracked the PRC use for each resident.

[Hereditary nonpolyposis colorectal cancer: surgical treatment and pedigree analysis].

Background: Hereditary nonpolyposis colorectal cancer (HNPCC) accounts for 3 to 5% of all colorectal cancer (CC). It is an autosomal dominant syndrome with 80% of penetrance for this disease.

Aim: To analyze the pedigree and surgical treatment of HNPCC.

Prescription-filling rates for key medications in Veterans Affairs patients after coronary artery bypass grafting.

Purpose: The six-month prescription-filling rates for key secondary-prevention drugs in Department of Veterans Affairs (VA) patients who had undergone coronary artery bypass grafting (CABG) were studied.

Methods: Patient records for elective CABG from April 2000 through March 2002 (divided into four six-month periods) were analyzed. The study population included 8925 CABG-only patients surviving to hospital discharge.

Formularies, therapeutics, and outcomes: new opportunities.

The increasing prominence of drug therapies in health care and their rapidly rising costs have led to a dramatic escalation of interest in the use of outcomes data for therapeutics and formulary decisions. The expanded use of formulary submission dossiers, effectiveness data, health outcomes analysis, and pharmacoeconomic modeling has created an urgent need for outcomes research to investigate topics especially relevant for health plan drug therapy coverage decisions. This article examines the evolving use of outcomes data on drug formulary and other therapeutic decisions, and outlines several priority areas for outcomes research.

Inferior vena cava thrombus removal using hypothermic circulatory arrest in two patients with osteosarcoma.

In this case report, the technique of deep hypothermia and circulatory arrest (DHCA) is used to successfully extract extensive symptomatic tumor thrombus from the inferior vena cava (IVC) in two patients with osteosarcoma. This is the first description of the use of this modality for treatment of osteosarcoma involving the IVC. Osteosarcoma and the use of DHCA are discussed.

Coordinated activation of Hsp70 chaperones.

Hsp70s are a ubiquitous family of molecular chaperones involved in many cellular processes. Two Hsp70s, Lhs1p and Kar2p, are required for protein biogenesis in the yeast endoplasmic reticulum. Here, we found that Lhs1p and Kar2p specifically interacted to couple, and coordinately regulate, their respective activities.

The Ross procedure in adults: intermediate-term results.

Background: The durability of the Ross procedure may be optimized by appropriate geometric matching of the aortic and pulmonary artery roots. We employed a surgical strategy to standardize the operation in order to avoid more readily a geometric mismatch.

Methods: The Ross procedure was performed as a root replacement.

Hidden risks for pneumonia in Malawi.

Domestic smoke exposure and early HIV infection are critical but unseen risk factors for pneumonia. This paper reviews how recent research in Malawi and elsewhere contributes to an understanding of the possible immunological mechanisms underlying these risks.

Human aortic valve calcification is associated with an osteoblast phenotype.

Background: Calcific aortic stenosis is the third most common cardiovascular disease in the United States. We hypothesized that the mechanism for aortic valve calcification is similar to skeletal bone formation and that this process is mediated by an osteoblast-like phenotype.

Methods And Results: To test this hypothesis, we examined calcified human aortic valves replaced at surgery (n=22) and normal human valves (n=20) removed at time of cardiac transplantation.

Myocardial functional recovery after fibroblast growth factor 2 gene therapy as assessed by echocardiography and magnetic resonance imaging.

Background: Although it has been shown that gene therapy is capable of inducing neovascularization in ischemic myocardium, the functional significance of such therapeutic angiogenesis remains less certain. The purpose of this study was to investigate whether an experimental link could be made between the ability of a novel fibroblast growth factor 2 (FGF2) gene formulation to promote neovascularization, and its ability to restore myocardial function.

Methods: Fibroblast growth factor 2 gene was delivered by means of an adenovirus vector formulated in a collagen-based matrix to provide localized and sustained gene activity.

Functional comparison of transmyocardial revascularization by mechanical and laser means.

Background: As a result of the clinical benefit observed in angina patients treated by transmyocardial revascularization (TMR) with a laser, interest in mechanical TMR has been renewed. Although the injury induced by mechanical TMR is similar to laser TMR, the resultant impact on myocardial contractility is unknown. The purpose of this study was to determine whether mechanical TMR improves ventricular function as compared with laser TMR in chronically ischemic myocardium.

Showing outcomes and proving value brings success.

Today's pharmacoeconomics have shown how critical it is to find value in formulary drug products. For Regence BlueShield, Seattle, this means outcomes; making sure a drug truly works better than well-established alternatives, not just placebos. In 1998, Regence adopted formulary submission guidelines that have proven a solid success, and have been adopted by the Academy of Managed Care Pharmacy, Alexandria, Virginia, for evaluation nationwide.