Postoperative naproxen after coronary artery bypass surgery: a double-blind randomized controlled trial.

Objective: Non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used after coronary artery bypass surgery (CABG), yet their effects have seldom been evaluated in randomized controlled settings. The aim of this study was to examine the efficacy and safety of a commonly used NSAID, naproxen. We hypothesized that naproxen would reduce postoperative pain following CABG without increasing complications.

Tadalafil in the treatment of erectile dysfunction following bilateral nerve sparing radical retropubic prostatectomy: a randomized, double-blind, placebo controlled trial.

Purpose: We evaluated the efficacy and safety of tadalafil 20 mg, taken on demand, in men with erectile dysfunction following bilateral nerve sparing radical retropubic prostatectomy (BNSRRP).

Materials And Methods: This randomized, double-blind, placebo controlled multicenter study consisted of a 4-week treatment-free run-in period (baseline) followed by 12 weeks of treatment. A total of 303 men (mean age 60 years) with preoperative normal erectile function who had undergone a BNSRRP 12 to 48 months before study were randomized (2:1) to tadalafil (201) or placebo (102).

Safety of deliberate intraoperative and postoperative hypothermia for patients undergoing coronary artery surgery: a randomized trial.

Background: Hypothermia in the perioperative period is associated with adverse effects, particularly bleeding. Before termination of cardiopulmonary bypass, rewarming times and perfusion temperatures are often increased to avoid post-cardiopulmonary bypass hypothermia and the presumed complications. This practice may, however, also have adverse effects, particularly cerebral hyperthermia.

An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function.

Study Objectives: Preoperative renal dysfunction is a risk factor for adverse events in cardiac surgery. This study compared creatinine clearance (ClCr), estimated from the Cockroft and Gault formula, and plasma creatinine level as predictors of outcome after cardiac surgery.

Design: Prospective, observational.

Transcranial Doppler during suspected brain death in children: Potential limitation in patients with cardiac "shunt".

OBJECTIVES: We report a potential limitation of transcranial Doppler for assessing cerebral circulation during suspected brain death in children. DESIGN: Review of two case series identified during our clinical practice. PATIENTS: Eight children with suspected brain death and seven with intact-brain and cardiovascular anomalies.

Transcranial Doppler characteristics of different embolic materials during in vivo testing.

Purpose: The authors investigated whether ultrasonic characteristics of embolic signals could be used to differentiate embolic composition.

Materials And Methods: The authors analyzed high-intensity transient signals (HITS) from 3 patients with patent foramen ovale during the bubble contrast test and during total joint replacement surgery. In 3 anesthetized dogs, latex microspheres, fat particles, and air bubbles were injected into the internal carotid artery and HITS were identified in the cerebral circulation.

Financial incentives for cadaver organ donation: an ethical reappraisal.

A panel of ethicists, organ procurement organization executives, physicians, and surgeons was convened by the sponsorship of the American Society of Transplant Surgeons to determine whether an ethically acceptable pilot trial could be proposed to provide a financial incentive for a family to consent to the donation of organs from a deceased relative. An ethical methodology was developed that could be applied to any proposal for monetary compensation to elucidate its ethical acceptability. An inverse relationship between financial incentives for increasing the families' consent for cadaver donation that clearly would be ethically acceptable (e.

Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: a randomized trial.

Background: Neuropsychological deficits occur in 30% to 80% of patients undergoing heart surgery and are due in part to ischemic cerebral injury during cardiopulmonary bypass. We tested whether mild hypothermia, the most efficacious neuroprotective strategy found in laboratory studies, improved cognitive outcome in patients undergoing coronary artery surgery.

Methods And Results: Patients 60 years or older scheduled for coronary artery surgery were enrolled.

Organ donation: a statewide survey of trauma surgeons.

Purpose: Organ procurement organizations (OPOs) operate under the premise that Americans would donate organs and/or tissue if placed in appropriate circumstances. This study evaluated opinions of Pennsylvania trauma surgeons regarding OPOs and organ donation.

Methods: Ninety-six Pennsylvania trauma surgeons were surveyed and descriptive results calculated.

The cardiac anesthesia risk evaluation score: a clinically useful predictor of mortality and morbidity after cardiac surgery.

Background: The Cardiac Anesthesia Risk Evaluation (CARE) score is a simple risk classification for cardiac surgical patients. It is based on clinical judgment and three clinical variables: comorbid conditions categorized as controlled or uncontrolled, surgical complexity, and urgency of the procedure. This study compared the CARE score with the Parsonnet, Tuman, and Tu multifactorial risk indexes for prediction of mortality and morbidity after cardiac surgery.

Controlled non-heart-beating donor liver transplantation: a successful single center experience, with topic update.

Background: The critical shortage of transplantable organs necessitates utilization of unconventional donors. We describe a successful experience of controlled non-heart-beating donor (NHBD) liver transplantation.

Methods: Controlled NHBDs had catastrophic head injury, prognosis for no meaningful recovery, decision to withdraw life support, and subsequent consent for donation.

Circuits with surface modifying additive alter the haemodynamic response to cardiopulmonary bypass.

Objective: Blood contact with synthetic surfaces during cardiopulmonary bypass (CPB), inevitably results in the activation of a variety of interrelated pathways of inflammation and coagulation that may contribute to postoperative complications in cardiac surgery patients. The objective of this trial was to evaluate clinical events and complement activation related to the use of a novel biomaterial, into which a surface modifying additive had been incorporated into the polymer used to prepare the bypass circuit.

Methods: A prospective, double-blind trial was carried out with 34 patients randomized to surgery, with either a standard circuit or a circuit treated ('tip to tip') with the surface modifying additive.

Hematologic evaluation of cardiopulmonary bypass circuits prepared with a novel block copolymer.

Background: To decrease the complications associated with cardiopulmonary bypass, novel biomaterials have been introduced that may be less thrombogenic than standard synthetic surfaces.

Methods: Thirty-four patients undergoing coronary artery bypass grafting were randomized to bypass using either a control circuit or a circuit prepared "tip-to-tip" with a triblock-copolymer (polycaprolactone-polydimethylsiloxane-polycaprolactone).

Results: There was a progressive increase in thrombin generation in the control group during bypass, which was not seen in the test group.

Validation of a novel luminal flow velocimeter with video fluoroscopy and manometry in the human esophagus.

There is currently no ideal method for concurrently assessing intraluminal pressures and flows in humans with high temporal resolution. We have developed and assessed the performance of a novel fiber-optic laser-Doppler velocimeter, mounted in a multichannel manometric assembly. Velocimeter recordings were compared with concurrent fluoroscopy and manometry following 50 barium swallows in healthy subjects.

Profound hypoxemia during treatment of low cardiac output after cardiopulmonary bypass.

Purpose: To illustrate the multiple causes of hypoxemia to be considered following cardiopulmonary bypass and how therapy given to improve oxygen delivery may have contributed to a decrease in arterial oxygen saturation to life-threatening levels.

Clinical Features: A 61 yr old man with severe mitral regurgitation and chronic obstructive lung disease underwent surgery for mitral valve repair. A pulmonary artery catheter with the capacity to measure cardiac output and mixed venous oxygen saturation (SvO2) continuously was used.

Centralization of histocompatibility laboratories: impact on organ allocation efficiency and outcomes of cadaveric renal transplantation.

This project was undertaken to determine whether centralization of histocompatibility laboratory services for renal transplants performed within eastern Pennsylvania could improve the efficiency of allograft allocation and short-term allograft function. A nonconcurrent cohort study was performed comparing renal allografts transplanted between September 15, 1993, and September 14, 1994, to those transplanted between September 15, 1994, and September 14, 1995. All allografts were procured and allocated by the Delaware Valley Transplant Program, the organ procurement agency in eastern Pennsylvania.

Requesting organ donation: an interview study of donor and nondonor families.

Background: Approximately half of the families asked to consider donation of a relative's organs decline to give consent. Understanding the difference between stated public support of organ donation and actual behavior is key to decreasing the shortage of donor organs.

Objectives: To gain insight into the experiences of potential donor families and to define features of the donation-request process and other factors that are associated with consent for organ donation.