Prevalence and Significance of Patient Prosthesis Mismatch Following Edwards SAPIEN XT and SAPIEN 3 Transcatheter Aortic Valve Replacement.

Background Severe patient prosthesis mismatch (sPPM) after surgical aortic valve replacement is associated with worse outcomes. Limited data exists on the impact of sPPM on outcomes after transcatheter aortic valve replacement (TAVR), especially regarding the newer generation valves. The aim of this study was to evaluate the incidence, determinants, and outcomes of sPPM in patients undergoing TAVR with Edwards SAPIEN XT (ES XT) and Edwards SAPIEN 3 (ES3) valves (Edwards Lifesciences, Irvine, CA, USA).

Low Risk of Hypertrophic Cardiomyopathy With Contemporary Management Strategies Implemented in Non-Referral Regional Community-Based Practices.

Major advances in diagnosis and treatment have emerged for hypertrophic cardiomyopathy (HCM), largely in major tertiary referral centers dedicated to this disease. Whether these therapeutic benefits are confined to patients in such highly selected cohorts, or can be implemented effectively in independent regional or community-based populations is not generally appreciated. We assessed management and clinical outcomes in a non-referral HCM center (n = 214 patients) in Eastern Pennsylvania.

Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease.

We report commissural fusion as a unique morphologic etiology of early bioprosthetic mitral valve failure in a woman with a history of rheumatic mitral stenosis. She had undergone mitral valve replacement with a 25-mm Edwards Magna Ease bovine pericardial bioprosthesis 3 years earlier and presented with progressive dyspnea. Transesophageal echocardiography revealed severe bioprosthetic stenosis due to commissural fusion.

Surgical treatment of an amniotic fluid embolism with cardiopulmonary collapse.

Amniotic fluid embolism is a rare but devastating condition associated with a very high rate of morbidity and mortality. The treatment has traditionally been aggressive supportive care. We report a case of a term pregnant woman with complete cardiovascular collapse secondary to a paradoxical amniotic fluid embolism.

Amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation.

Amniotic fluid embolism is a rare syndrome with potentially lethal outcomes. Complications include cardiorespiratory failure, disseminated intra-vascular coagulation, seizures, neurological deficits, and death. A 34-year-old woman had amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation.

Impact of aprotinin on adverse clinical outcomes and mortality up to 12 years in a registry of 3,337 patients.

Background: Recent studies have suggested increased renal complications and long-term mortality with aprotinin use in coronary artery bypass grafting (CABG) patients. However, these studies have been criticized for including multiple centers and different dosing strategies. We analyzed prospectively collected registry data from a single center hospital utilizing a full-dose aprotinin regimen to evaluate if aprotinin was associated with increased mortality and adverse outcomes compared with Amicar.

Impact of saphenous vein graft radiographic markers on clinical events and angiographic parameters.

Background: Use of saphenous vein graft (SVG) radiographic markers has been associated with shorter cardiac catheterization procedure times and reduced contrast agent volume for postoperative coronary artery bypass graft (CABG) catheterizations. Use of such markers is varied and often operator-dependent, as the effect of SVG markers has not been fully evaluated. The goal of the present analysis was to evaluate the association of SVG markers with clinical outcomes and graft patency.

A 20-year follow-up study on chronic respiratory effects of exposure to cotton dust.

In order to evaluate chronic effects of long-term exposure to cotton dust on respiratory health, and the role of dust and endotoxin, longitudinal changes in lung function and respiratory symptoms were observed prospectively from 1981 to 2001 in 447 cotton textile workers, along with 472 silk textile controls. The results from five surveys conducted over the 20-yr period are reported, including standardised questionnaires, pre- and post-shift spirometric measurements, work-area inhalable dust sample collections and airborne Gram-bacterial endotoxin analysis. Cotton workers had more persistent respiratory symptoms and greater annual declines in forced expiratory volume in one second (FEV1) and forced vital capacity as compared with silk workers.

Is chronic airway obstruction from cotton dust exposure reversible?

Background: Exposure to cotton dust is known to cause chronic airway obstruction, but there is little information on whether the obstructive impairment is reversible after the exposure stops.

Methods: Longitudinal changes in lung function were evaluated among 429 cotton textile workers and 449 silk workers in Shanghai, China, beginning in 1981. Both active and retired workers were tested every 4 to 6 years for 15 years.

Personal exposures to inorganic and organic dust in manual harvest of California citrus and table grapes.

The aim of this study was to determine characteristics of personal exposure to inorganic and organic dust during manual harvest operations of California citrus and table grapes. Personal exposures to inhalable dust and respirable dust were measured five times over a 4-month period of harvesting season. We analyzed components of the dust samples for mineralogy, respirable quartz, endotoxin, and total and culturable microorganisms.

Comparative analysis of risk-adjusted bypass surgery stratification models in a community hospital.

Background: Quality improvement in health care, which relies on appropriate strategies to evaluate and compare provider performance, has spawned the propagation of many public report cards or provider profiles for cardiac surgery. These risk-adjusted prediction models allow for the computation of a provider's expected outcome event rate compared with observed outcome events. The aim of this study was to assess the accuracy and reliability of 5 risk-adjusted predictive models for mortality in an independent population of patients in a community hospital who underwent coronary artery bypass graft surgery.

Respiratory symptoms and cotton dust exposure; results of a 15 year follow up observation.

Aims: To determine chronic effects of long term exposure to cotton dust and endotoxin on incidence of respiratory symptoms and the effect of cessation of exposure.

Methods: Respiratory health in 429 Chinese cotton textile workers (study group) and 449 silk textile workers (control group) was followed prospectively from 1981 to 1996. Byssinosis, chest tightness, and non-specific respiratory symptoms were assessed by means of identical standardised questionnaires at four time points.

Off the shelf or recalibrate? customizing a risk index for assessing mortality.

Background: Public "report cards" for cardiac surgery have been freely available from a variety of sources. These risk-adjusted indices serve as a means of benchmarking outcomes performances, allowing comparisons of outcomes between surgical programs, and quantifying quality improvement programs. We examined two alternative strategies for using previously developed risk-adjusted mortality models in a community hospital: (1) using the model "off the shelf" (OTS) and (2) recalibrating the existing model (RM) to fit the institution-specific population.

Splenic injury after intraoperative transesophageal echocardiography.

A 55-year-old woman underwent coronary artery bypass grafting and mitral valve repair using intraoperative transesophageal echocardiography (TEE). Postoperatively she had hemodynamic instability associated with an increase in abdominal size and a drop in hemoglobin. At laparotomy, a splenic hilar laceration was discovered, which was presumed to be associated with intraoperative TEE.

Exposure to airborne microorganisms in fiberboard and chipboard factories.

Microbiological air sampling was performed in one fiberboard factory and two chipboard factories located in south-eastern Poland. It was found that the levels of bacteria, fungi, dust and bacterial endotoxin in the air of examined facilities were high during initial stages of the production cycle (shredding of waste wood, storing of chips) and then sharply decreased during further stages of this cycle (forming and formatting of the boards). In the fiberboard factory, the concentration of airborne microorganisms at the initial stages of production cycle was 71.

Longitudinal changes in pulmonary function and respiratory symptoms in cotton textile workers. A 15-yr follow-up study.

To evaluate the chronic effects of exposure to cotton dust, a 15-yr follow-up study in cotton textile workers was performed in Shanghai, China from 1981 to 1996. Testing occurred four times during the 15-yr period. The achieved follow-up rates were 76-88% of the original 447 cotton textile workers, and 70-85% of the original 472 silk textile workers (as a control group).

Cotton dust and endotoxin exposure and long-term decline in lung function: results of a longitudinal study.

Background: To evaluate the relationship between long-term exposure to cotton dust and Gram-negative bacterial endotoxin on lung function, we conducted an 11-year follow-up study of cotton textile workers in Shanghai, China.

Methods: Workers at a nearby silk-thread manufacturing mill were used as a referent population. Ninety percent of the original cohort of 445 cotton and 467 silk textile workers--both active and retired--were identified for testing in the 11th year.

Personal exposure to dust, endotoxin and crystalline silica in California agriculture.

Aims: The aim of this study was to measure personal exposure to dust, endotoxin and crystalline silica during various agricultural operations in California over a period of one year.

Methods: Ten farms were randomly selected in Yolo and Solano counties and workers were invited to wear personal sampling equipment to measure inhalable and respirable dust levels during various operations. The samples were analysed for endotoxin using the Limulus Amebocyte Lysate assay and crystalline silica content using X-ray diffraction.

Organic dust exposures from work in dairy barns.

Environmental surveys were conducted in 85 barns, predominantly dairy, in central Wisconsin to characterize exposures to organic dusts and dust constituents from routine barn work. Environmental analytes included airborne dusts (total, inhalable inlet, and respirable), particle size distributions, endotoxins, total spore and bacteria counts, viable bacteria and fungi, histamine, cow urine antigen, mite antigen, ammonia, carbon dioxide, and hydrogen sulfide. The geometric mean (GM) concentration of airborne dusts include area total, 0.

Neutrophilic respiratory tract inflammation and peripheral blood neutrophilia after grain sorghum dust extract challenge.

Study Objective: To determine if inhalation of grain sorghum dust in the laboratory would cause neutrophilic upper and lower respiratory tract inflammation in human volunteers, as well as systemic signs of illness.

Design: Prospective.

Setting: University of Nebraska Medical Center.

The role of endotoxin in grain dust-induced lung disease.

To identify the role of endotoxin in grain dust-induced lung disease, we conducted a population-based, cross-sectional investigation among grain handlers and postal workers. The study subjects were selected by randomly sampling all grain facilities and post offices within 100 miles of Iowa City. Our study population consisted of 410 grain workers and 201 postal workers.

Determinants of longitudinal changes in spirometric function among swine confinement operators and farmers.

To assess whether working in a swine confinement facility causes an excess or accelerated decline in lung function, we conducted a population-based study to evaluate the determinants of longitudinal changes in airflow in a population of swine confinement operators. Spirometric measures of lung function were compared between swine confinement operators (N = 168) and neighborhood farmer control subjects (N = 127). Study subjects were randomly selected from a cohort of swine confinement operators in eastern Iowa.