Facilitating technologies in minimally invasive aortic valve replacement: a propensity score analysis.

Objectives: Minimally invasive aortic valve replacement (MIAVR) can be technically demanding and may lead to prolonged operative time. We evaluated the intraoperative and postoperative patient outcomes following implementation of 2 facilitating technologies (FT) in MIAVR: the Cor-Knot titanium fastener and Custodiol-histidine-tryptophan-ketoglutarate solution.

Methods: A total of 299 patients underwent MIAVR from 2008 to 2016; 172 (57.

Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial).

Objectives: This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access.

Background: US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization.

Methods: We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization.

Chief's seminar: turning interns into clinicians.

Background: Recent changes in healthcare delivery have necessitated residency education reform. To adapt to these changes, graduate medical education can adopt a chief resident-led clinical curriculum. Chief residents are ideal clinical instructors, as they are recent graduates who have excelled in their residency programs.

Guidewire-induced coronary artery perforation and tamponade during PCI: in-hospital outcomes and impact on long-term survival.

Background: Guidewire-induced coronary perforation (CP) rate is reported to have increased.

Methods: We analyzed 23,399 PCIs and identified 73 patients complicated by CP, of which 31 were guidewire induced. Patients were divided into two groups: group A (guidewire-induced CP) and group B (non-guidewire induced CP).

Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis.

Aim: To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer (CC) or high grade dysplasia (HGD).

Methods: This is a single center (Lenox Hill Hospital) retrospective cohort and descriptive study of extensive ulcerative colitis (UC) for 20 years or more with a minimum of 3 surveillance colonoscopies and biopsies performed after the first 10 years of UC diagnosis. Data analyzed included: duration of UC, date of diagnosis of (CC) or (HGD), number of surveillance colonoscopies, and biopsies showing histological inflammation and its severity in each of 6 segments when endoscopic appearance is normal.

Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery.

Background: Since the advent of endovascular techniques for repair of descending thoracic aortic aneurysms (DTAAs), there has been a relative paucity of current data for open repairs. The purpose of this study was to assess the operative and long-term outcomes in a contemporary series of open repairs of DTAAs.

Methods: We conducted a retrospective review of 68 patients (63±14.

Outcomes of open surgical repair for chronic type B aortic dissections.

Objective: Open surgical repair (OSR) for chronic type B aortic dissection (CTBAD) has an associated morbidity and mortality. The role of thoracic endovascular aortic repair (TEVAR) in CTBAD has not been determined. We analyzed our contemporary experience of CTBAD undergoing OSR to identify high-risk patients who may be considered for TEVAR.

CT angiography-fluoroscopy fusion imaging for percutaneous transapical access.

Objectives: The aim of this proof-of-principle study is to validate the accuracy of fusion imaging for percutaneous transapical access (TA).

Background: Structural heart disease interventions, including TA, are commonly obtained under fluoroscopic guidance, which lacks important spatial information. Computed tomographic angiography (CTA)-fluoroscopy fusion imaging can provide the 3-dimensional information necessary for improved accuracy in planning and guidance of these interventions.

Potential costs of inappropriate use of proton pump inhibitors.

Background: Proton pump inhibitors (PPIs) are commonly overused in hospitalized patients. The objectives of this study were to determine the extent of their inappropriate initiation in patients with low risk for gastrointestinal hemorrhage, factors associated with their continuation on discharge and potential cost of this trend.

Methods: Retrospective examination of patients with low risk for gastrointestinal hemorrhage admitted to a tertiary-care teaching hospital over a 3-month period who received esomeprazole.

Focused renal sonography performed and interpreted by internal medicine residents.

Objectives: Intensivist-performed focused sonography, including renal sonography, is becoming accepted practice. Whether internal medicine residents can be trained to accurately rule out renal obstruction and identify sonographic findings of chronic kidney disease is unknown. The purpose of this study was to test the ability of residents to evaluate for this specific constellation of findings.

Somatosensory-evoked potential-guided intercostal artery reimplantation in thoracoabdominal aortic aneurysm surgery.

Objective: This study was undertaken to evaluate the use of somatosensory-evokedpotential (SSEP) monitoring on intercostal artery reimplantation (IAR) and spinal cord ischemia rates during thoracoabdominal ortic aneurysm repair.

Methods: Fifty-two patients had thoracoabdominal aortic aneurysm repair with IAR under SSEP guidance and 79 patients had repair with routine IAR without SSEP guidance from 1999 to 2010.

Results: No differences were observed between the two groups in age (63.

Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival.

Background: Cardiac tamponade constitutes the most severe clinical consequence of a coronary perforation (CP) during percutaneous coronary intervention (PCI).

Methods: We analyzed 23,399 PCIs and identified 73 patients complicated by CP (0.31%), of which 26 developed tamponade (0.

Palliative care training and associations with burnout in oncology fellows.

Background: Burnout among physicians can lead to decreased career satisfaction, physical and emotional exhaustion, and increased medical errors. In oncologists, high exposure to fatal illness is associated with burnout.

Methods: The Maslach Burnout Inventory, measuring Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was administered to second-year US oncology fellows.

Agreement between SPECT V/Q scan and CT angiography in patients with high clinical suspicion of PE.

Objective: To track agreement between single positron emission computed tomography (SPECT) V/Q and CT angiography in patients with high clinical suspicion of pulmonary embolism (PE). If significant agreement occurs, a case could be made for more frequent use of chest radiography followed by SPECT V/Q scanning given its lower risk profile.

Introduction: Diagnosis of PE can be difficult.

Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically III.

Doppler ultrasonography is a standard in diagnosis of deep vein thrombosis (DVT) but is often delayed. Clinician-performed focused vascular sonography (FVS) has proven to accurately diagnose DVT in the ambulatory and emergency room settings. Whether trained medical residents can perform quality FVS in the critically ill is unknown.

Elevated umbilical artery systolic/diastolic ratio in the absence of fetal growth restriction.

Purpose: To evaluate whether patients with isolated elevation of umbilical artery (UA) systolic/diastolic (S/D) ratio are at increased risk for adverse perinatal outcome.

Methods: This is a retrospective cohort study of 330 patients who underwent routine evaluation at our maternal fetal medicine center. We regularly perform UA S/D ratio analysis with every third trimester sonogram.

Is treatment with 6-mercaptopurine for colitis associated with the development of colorectal cancer?

Background: Patients with ulcerative colitis and Crohn's colitis have an increased risk of colon cancer influenced by the duration, extent, and severity of disease. Surveillance colonoscopy serves to detect cancer and precancerous dysplasia at the earliest possible time. Reduction of inflammation should theoretically reduce the development of cancer.

Mitral annular plane systolic excursion as a surrogate for left ventricular ejection fraction.

Background: Assessing left ventricular function is a common indication for echocardiography. It generally requires expert echocardiographer estimation and is somewhat subjective and prone to reader discordance. Mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement for left ventricular function.

Adequacy of low dose computed tomography in patients presenting with acute urinary colic.

Background And Purpose: Noncontrast abdominal/pelvic CT is the current imaging standard for patients who present with acute urinary colic. Conventional CT, however, exposes the patient to significant amounts of ionizing radiation, which is cumulative when additional CTs are used to monitor stone migration, outcomes, etc. We sought to maintain diagnostic adequacy while decreasing our patients' radiation exposure from CT by using a reduced tube current, an abbreviated scanning area, and the use of coronal reformatted images.

Teaching of pelvic organ prolapse quantification system among obstetrics/gynecology and urology residents in the United States.

Objectives: The objective of this study was to compare the Pelvic Organ Prolapse Quantification (POPQ) system teaching practices among obstetrics/gynecology (ob/gyn) and urology residents in the United States.

Methods: Anonymous Web-based survey was e-mailed to the residency program directors/coordinators of all urology and ob/gyn programs in the United States with a request to forward it to all their residents. Fisher exact and z tests for proportions and multivariate regression analysis examining factors associated with POPQ system use were used in the statistical analysis.

Troponin I as a prognostic marker of cardiac events in asymptomatic hemodialysis patients using a sensitive troponin I assay.

Elevated troponin T is known to be a prognostic marker for long-term cardiac events and mortality in asymptomatic end-stage renal disease patients. There are conflicting data in this regard with respect to troponin I (TnI). We recently showed a high incidence of elevated TnI levels in asymptomatic hemodialysis (HD) patients using a new generation sensitive TnI assay.

Intraoperative use of recombinant activated factor VII during complex aortic surgery.

Objective: Postoperative bleeding is a major cause of morbidity and mortality after complex aortic surgery. Intraoperative coagulopathy is a well-known culprit in this process. Recombinant activated factor VII is increasingly used for the postoperative management of such bleeding.