Intratidal compliance of the lung and the total respiratory system.

The worldwide rising quantity of surgeries and the corresponding need of mechanical ventilation means a rising number of patients are at risk of suffering from post-operative pulmonary complications. To prevent this risk, individual mechanics of the lung should be considered when setting the parameters of mechanical ventilation. Intratidal compliance analysis based on transpulmonal pressure would provide an estimate for individual lung mechanics.

Highlights of a ten-year experience with the Ross procedure.

Background: A review of a 10-year experience with the Ross procedure as a root replacement by a single group of surgeons featuring specific highlights is presented. Highlights include our results from a subset of patients with endocarditis and their management and a comparison of outcomes in patients with aortic insufficiency based on technical changes made after 5 years' experience.

Methods: The total patient group was 191, with 148 male and 43 female participants with an age range from 1 day to 69 years.

Complex valvular procedures: ross, mitral, redos--time enough?

The possibility of a lengthy ischemic time is considered when evaluating complex valvular procedures. This consideration or even worry may influence the choice of valve replacement, repair offered, or actual acceptance of the case because of expected outcomes. With the use of an integrated, streamlined blood cardioplegic delivery, we believe these complex valvular procedures, even combined with revascularization, can be managed with good results.

International nursing education: Istanbul, Turkey.

To assist Turkish nurses in reaching educational standards and goals, an international neonatal program was developed that would incorporate a train-the-trainer module. The primary goal was to develop and teach a neonatal intensive care course while exposing identified trainers to content, theory, teaching strategies, and concepts. The expectations of the future trainers were to use the knowledge they obtained from the course to enable them to provide future neonatal intensive care courses and serve as experts in the field of neonatal nursing.

Acceptance and versatility of the Ross procedure.

During the 31 years since the initial Ross procedure, data have been collected that have been helpful in assessing long-term performance of the autograft. The ongoing study of the pulmonary autograft supports the use of the Ross procedure in young patients, in females of childbearing age, and in patients with congenital aortic stenosis and complex left ventricular outflow tract obstruction. We continue to see little or no thromboembolism despite no anticoagulation therapy.

Cardiopulmonary response to maximal exercise in young athletes following the Ross procedure.

Background: Aortic prosthetic devices offer limitations that make them less than optimal valve substitutes because the vast majority are innately obstructive, especially at increased levels of hemodynamic function. The present study is designed to demonstrate the hemodynamics of the pulmonary autograft in 11 conditioned athletes who have undergone the Ross (pulmonary autograft) procedure. Data was compared to a group of 13 age-matched "normal athletes.

Exercise-induced fragmentation hemolysis: a simple in vivo test to evaluate heart valve hemolysis.

Differentiating heart valve-related fragmentation hemolysis from other causes of hemolysis can occasionally be difficult, especially when findings on transthoracic or transesophageal echocardiography are minimal. We report a case in which the cause of hemolysis remained in doubt after thorough hematologic and cardiologic evaluations. The decision to reoperate on the valve was finally made, based on the result of exercise-induced increase in serum hemoglobin.

Management of aortic infective endocarditis by autograft valve replacement.

Follow up data is presented on the management of aortic infective endocarditis by root replacement using the pulmonary autograft. Twenty consecutive patients have been managed with this surgical procedure. Included are specific case discussions high-lighting advantages to the procedure as well as technical features consistent with surgery on an infected space.

Aortic infective endocarditis managed by the Ross procedure.

The excellent clinical results with homografts inserted for aortic endocarditis encouraged us to take this method one step further, believing that the placement of a pulmonary autograft which is totally viable and antibiotic-perfused would be an even better choice for valve replacement. We applied this technique in 13 consecutive patients with infective aortic endocarditis, achieving excellent early results. Our follow up extending to 30 months continues to show excellent results with 0% re-infection and 0% mortality.

Analysis of trauma intubations.

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery.

Estramustine phosphate--hormone, chemotherapeutic agent, or both?

Estramustine phosphate, a combination steroid and alkylating agent, has been used for treatment of cancer of the prostate since 1969. We treated 32 patients with Stages C and D prostate cancer with this compound. Using the National Prostatic Cancer Project criteria of response, no patient achieved complete or partial objective response.

Myocardial vs serum digoxin concentrations in infants and adults.

To establish whether there is a difference between infants and adults in the relationship of serum levels of digoxin to dosage or the ratio of myocardial to serum digoxin levels, the concentrations of digoxin in right atrial appendage (RAA) and serum were measured in 12 infants and 17 adults undergoing open heart surgery. Although the daily digoxin dose per weight for the infant was significantly greater than that for adults, there was no difference in the serum digoxin levels for the two groups. We found, however, a considerable difference in myocardial digoxin levels.