Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery.

Objective: To evaluate the use of postoperative cardiac troponin T (cTnT) for the prediction of prolonged intensive care unit length of stay following cardiac surgery.

Design: Prospective, single-center, observational cohort study of patients following cardiac surgical procedures. The enrollment period was from October through December 2000.

Utility of B-type natriuretic peptide for the evaluation of intensive care unit shock.

Objectives: Among patients with congestive heart failure, B-type natriuretic peptide measurement is useful to estimate filling pressures and to prognosticate adverse outcome. However, among critically ill intensive care unit patients with shock, the utility of B-type natriuretic peptide to assess cardiac hemodynamics or prognosis has not been explored.

Design: Clinical investigation.

Evaluation of add-on testing in the clinical chemistry laboratory of a large academic medical center: operational considerations.

Context: Physicians frequently request that additional tests be performed on an existing specimen (add-ons). In our institution, add-ons comprise approximately 1% of the specimen volume and require a disproportionate number of employees. Not only are add-on tests time-consuming and expensive, but storing routine specimens for 7 days in anticipation of add-ons consumes valuable laboratory space.

How the clinical laboratory and the emergency department can work together to move patients through quickly.

The emergency departments (ED) at many medical centers are experiencing increased crowding and prolonged ED patient length of stay. During periods of heavy patient volume, the ED may go on divert status and be unable to care for new patients except for life-threatening illness. As part of a larger interdepartmental effort to improve ED operations, we implemented an ED satellite laboratory (kiosk) in the ED of Massachusetts General Hospital.

Reevaluation of myoglobin for acute chest pain evaluation: would false-positive results on "first-draw" specimens lead to increased hospital admissions?

Myoglobin is an early marker of cardiac injury, although positive results occur in the absence of cardiac myonecrosis. We studied data for 537 patients admitted to the emergency department with symptoms suggestive of myocardial injury who underwent testing for troponin I (TnI), creatine kinase isoenzyme (CK-MB), and myoglobin at the point of care. Physicians were blinded to the myoglobin results.

Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study.

Background & Aims: Cysts of the pancreas display a wide spectrum of histology, including inflammatory (pseudocysts), benign (serous), premalignant (mucinous), and malignant (mucinous) lesions. Endoscopic ultrasonography (EUS) may offer a diagnostic tool through the combination of imaging and guided, fine-needle aspiration (FNA). The purpose of this investigation was to determine the most accurate test for differentiating mucinous from nonmucinous cystic lesions.

Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery.

Study Design: The authors report on anterior vertebral reconstruction following tumor resection with use of fresh-frozen, cortical, long-segment allografts prepared from diaphyseal sections of long bones. A retrospective analysis of clinical outcomes is presented.

Objective: To analyze the results following the use of cortical allografts in the treatment of spine tumors.

Establishment of a central laboratory serum tumor marker service on a consolidated immunodiagnostic platform: development of practice standards, service improvements, and operational efficiency.

Background: Laboratory testing for serum tumor markers traditionally has been performed in low volume in most hospitals. Many markers are sent out to reference laboratories. Over the past decade, serum tumor marker testing in patient management has become more defined, resulting in increasing test volume and wider availability of assays on automated immunodiagnostic platforms.

Diastematomyelia presenting as progressive weakness in an adult after spinal fusion for adolescent idiopathic scoliosis.

Background Context: Diastematomyelia is uncommon and rarely presents in adulthood. This report draws attention to the fact that patients who underwent spinal fusion for deformity before the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) may have unrecognized spinal cord abnormalities. This should be considered if revision surgery is contemplated.

Managing utilization of new diagnostic tests.

In appropriate utilization of laboratory testing has been estimated to range from 10% to 50% of the volume encountered in hospital laboratories. Many strategies to control utilization of laboratory testing have been reported, including redesigning test requisitions, changing standing orders, the use of provider order entry, physician profiling, and educational initiatives. The major motivation to reduce utilization of unnecessary testing is financial, although other benefits also may be observed, such as reducing false-positive results stemming from testing patients in low prevalence populations, eliminating unnecessary follow-up procedures, avoiding iatrogenic anemia, and potentially lowering hospital length of stay resulting from the need to track down the significance of falsely abnormal tests.

Multicenter evaluation of the Roche NT-proBNP assay and comparison to the Biosite Triage BNP assay.

Background: Brain natriuretic peptides (BNPs) are useful in the assessment of heart failure, left ventricular dysfunction, and acute coronary syndromes.

Methods: We performed a multicenter evaluation of the automated Roche NT-proBNP assay and compared its performance to the Biosite Triage BNP assay.

Results: The N-terminal (1-76) pro brain natriuretic peptide (NT-proBNP) method is precise (CV View Article and Find Full Text PDF

Measurement of mercury levels in concentrated over-the-counter fish oil preparations: is fish oil healthier than fish?

Context: Fish consumption has been associated with a decreased risk of coronary artery disease. Recent studies have illustrated that the high mercury content in cold-water fish may negate the cardiovascular benefits of fish meals. Fish oils have similar antiatherogenic properties to fish, and similar studies should be performed to determine the level of mercury in fish oils.

Cardiac markers for myocardial infarction. A brief review.

Blood testing for biomarkers of myocardial injury plays an increasingly important role for the evaluation, diagnosis, and triage of patients with chest pain. The guidelines for the diagnosis of myocardial infarction (MI) have recently changed and prominently incorporate the results of cardiac marker testing in the clinical definition of MI. We review these updated guidelines for MI definition as it pertains to cardiac biomarker testing and further compare the differing biology and release kinetics of clinically relevant biomarkers.

Predictors of delay in presentation to the ED in patients with suspected acute coronary syndromes.

Delays in seeking medical attention for patients with acute coronary syndromes (ACS) preclude early application of life-saving treatment and diminish efficacy. Previous studies suggest 3-hour delays between onset of symptoms and ED arrival in patients with typical presentations of acute myocardial infarction (AMI). A prospective observational study was conducted in an urban ED measuring lag time (LT) among adults presenting within 48 hours of onset of symptoms suggestive of ACS.

Enhanced bioactivity of a poly(propylene fumarate) bone graft substitute by augmentation with nano-hydroxyapatite.

The bioactivity of a nano-hydroxyapatite-augmented, bioresorbable bone graft substitute made from the unsaturated polyester, poly(propylene fumarate), was analyzed by evaluating biocompatibility and osteointegration of implants placed into a rat tibial defect. Three groups of eight animals each were evaluated by grouting bone graft substitutes into 3-mm holes that were made into the anteromedial tibial metaphysis of rats. Thus, a total of 24 animals was included in this study.

Evaluation of a porous, biodegradable biopolymer scaffold for mandibular reconstruction.

Purpose: Bioresorbable bone graft substitutes could eliminate disadvantages associated with the use of autografts, allografts, and other synthetic materials. The authors investigated the osteoinductive capacity of a bioresorbable bone graft substitute made from the unsaturated polyester poly(propylene glycol-co-fumaric acid) (PPF) for mandibular reconstruction in a rat model. The eventual intention is to use this material either as a stand-alone bone graft substitute or as an extender to autograft harvested from mandibular reconstruction sites.

Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center. Impact on test turnaround time and patient emergency department length of stay.

Context: Emergency department (ED) overcrowding has reached crisis proportions in the United States. Many hospitals are seeking to identify process reengineering efforts to reduce crowding and ED patient length of stay (LOS).

Objectives: To investigate the impact of a point-of-care testing (POCT) satellite laboratory in the ED of a large academic medical center.

Comparison of glass K3EDTA versus plastic K2EDTA blood-drawing tubes for complete blood counts, reticulocyte counts, and white blood cell differentials.

Blood-drawing tubes made from plastic containing K2EDTA as an anticoagulant are gaining widespread use in clinical hematology. We compared complete blood count parameters, reticulocyte counts, white blood cell differentials, and flagging rates obtained with Becton Dickinson Vacutainer K3EDTA glass tubes and Vacutainer K2EDTA Plus plastic tubes and found only slight discrepancies in the results obtained with the two tube types. Although some parameter values obtained with K3EDTA glass tubes were significantly lower than those obtained with K2EDTA plastic tubes, many of these differences could be explained by the known effects of the liquid K3EDTA anticoagulant.

Effect of marathon running on total and free serum prostate-specific antigen concentrations.

Context: Prostate-specific antigen (PSA) is an important tumor marker for the most frequently diagnosed cancer in the United States. A major limitation of this marker is falsely elevated results in patients who are found not to have prostate cancer. The effects of vigorous physical exertion on PSA concentrations are controversial.

Composite resorbable polymer/hydroxylapatite composite screws for fixation of osteochondral osteotomies.

The aim of this study was to evaluate biomechanically the healing of an osteochondral fragment created in the distal sheep femur in response to fixation with a resorbable composite screw made of polylactide and hydroxylapatite. Pure poly(L-lactide) screws were used for comparison. At follow-up times of 4 or 8 weeks, specimens were examined with standard radiography, biomechanics, and histology.

Quantitative measures of osteoinductivity of a porous poly(propylene fumarate) bone graft extender.

Bioresorbable bone graft substitutes could alleviate disadvantages associated with the use of autografts, allografts, and other synthetic materials. However, little is known about the minimum autograft/extender ratio for a given material at which a sufficient osteoinductive effect is still seen. Therefore, we investigated a bioresorbable bone graft substitute made from the unsaturated polyester poly(propylene fumarate), PPF, at various mixing ratios with autograft.

Porous poly(propylene fumarate) foam coating of orthotopic cortical bone grafts for improved osteoconduction.

A porous biodegradable scaffold coating for perforated and demineralized cortical bone allografts could maintain immediate structural recovery and subsequently allow normal healing and remodeling by promoting bony ingrowth and avoiding accelerated graft resorption. This new type of osteoconductive surface modification should improve allograft incorporation by promoting new bone growth throughout the biodegradable scaffold, hence encasing the graft with the recipient's own bone. We investigated the feasibility of augmenting orthotopically transplanted cortical bone grafts with osteoconductive biodegradable polymeric scaffold coatings.

Composite poly(lactide)/hydroxylapatite screws for fixation of osteochondral osteotomies. A morphometric, histologic and radiographic study in sheep.

The aim of this study was to evaluate the healing of an osteochondral fragment created in the distal sheep femur in response to fixation with a biodegradable polylactide/hydroxylapatite composite screw. Poly(L-lactide) screws were used for comparison. At follow-up times of 4 and 8 weeks, the specimens were examined with standard radiography and computed tomography, as well as with macro- and micro-histomorphometry.