The relationship between the surgeon and the intensivist in the surgical intensive care unit.

When a patient enters the intensive care unit, the admitting surgeon also enters a new environment. In some hospitals, the surgical intensive care unit (SICU) is "closed"--critical care providers manage care; in others the unit is "open," and the admitting surgeon is in charge. A third system is the "mixed" model of ICU administration; a collaborative approach.

A method for visualization of ventricular fibrillation: Design of a cooled fiberoptically coupled image intensified CCD data acquisition system incorporating wavelet shrinkage based adaptive filtering.

The measurement of cardiac transmembrane potential changes with voltage sensitive dyes is in increasing use. Detection of these very small fluorescent alterations using large multiplexed arrays, such as charge coupled device (CCD) cameras at high sampling rates, has proven challenging and usually requires significant averaging to improve the signal-to-noise ratio. To minimize the damage of living tissue stained with voltage sensitive dyes, excitation photon exposure must be limited, with the inevitable consequence of diminishing the fluorescence that is generated.

Reduction of leg wound infections following coronary artery bypass surgery.

Objective: To reduce the rate of infection at the saphenous vein harvest site after coronary artery bypass surgery, to identify predictors of infection and to determine the best method for leg wound closure.

Design: A randomized clinical trial was undertaken to determine the best technique for reducing the postoperative leg wound infection rate. Patients were allocated to one of four leg wound closure methods: staples, close immediately; staples, close after protamine administration; subcuticular sutures, close immediately; and subcuticular sutures, close after protamine.

Myocardial infarction complicated by ventricular septal rupture in a patient with polycythemia vera and minimal coronary ectasia.

Although it is known that patients with polycythemia vera (PV) are at increased risk of myocardial infarction (MI) secondary to thrombosis, ventricular septal rupture in this setting has never been reported. Ventricular septal rupture complicating a small anteroseptal MI is reported in a patient with PV and with only minimal ectasia of the left anterior descending coronary artery. Despite small infarct size these patients may be predisposed to myocardial hemorrhage, increasing the likelihood of myocardial rupture.

Spatiotemporal evolution of ventricular fibrillation.

Sudden cardiac death is the leading cause of death in the industrialized world, with the majority of such tragedies being due to ventricular fibrillation. Ventricular fibrillation is a frenzied and irregular disturbance of the heart rhythm that quickly renders the heart incapable of sustaining life. Rotors, electrophysiological structures that emit rotating spiral waves, occur in several systems that all share with the heart the functional properties of excitability and refractoriness.