Use of a computerized intravenous insulin algorithm within a nurse-directed protocol for patients undergoing cardiovascular surgery.

Background: Several studies have shown the benefits of tight glycemic control in the intensive care unit. A large hospital became concerned about certain deficiencies in the management of glucose control in conjunction with cardiovascular surgery. A multidisciplinary steering committee was formed, which implemented a glycemic protocol, the subject of this study.

Liposarcoma of the posterior mediastinum in a child.

Liposarcoma is rare in children and rarely occurs in the posterior mediastinum in any age group. A massive intrathoracic tumor in a 17-year-old young man was a diagnostic dilemma; preoperative radiographic evaluation and biopsy led us to believe it was a teratoma. At operation, a poorly differentiated myxoid liposarcoma originating from the posterior mediastinum was found and excised.

Pulsed laser and thermal ablation of atherosclerotic plaque: morphometrically defined surface thrombogenicity in studies using an annular perfusion chamber.

Although clinical trials using laser and thermal angioplasty devices have been underway, the effects of pulsed laser and thermal ablation of atherosclerotic plaque on surface thrombogenicity are poorly understood. This study examined the changes in platelet adherence and thrombus formation on freshly harvested atherosclerotic aorta segments from Watanabe-heritable hyperlipidemic rabbits after ablation by two pulsed laser sources (308-nm xenon chloride excimer and 2,940-nm erbium:yttrium-aluminum-garnet [YAG] lasers) and a prototype catalytic hot-tip catheter. Specimens were placed in a modified Baumgartner annular chamber and perfused with citrated whole human blood, followed by quantitative morphometric analysis to determine the percent surface coverage by adherent platelets and thrombi in the treated and contiguous control areas.

In vivo human atherosclerotic plaque recognition by laser-excited fluorescence spectroscopy.

Arterial wall perforation and chronic restenosis represent important factors limiting the clinical application of laser angioplasty. Discrimination of normal and atherosclerotic vessels by laser-excited fluorescence spectroscopy may offer a means of targeting plaque ablation, thereby reducing the frequency of restenosis and transmural perforation. In this study, with use of a 325 nm low power helium-cadmium laser, in vivo endogenous surface fluorescence was excited through a flexible 200 microns optical fiber within a 0.

Balloon expandable stent implantation in stenotic right heart valved conduits.

Although valved conduits have been used successfully in severe forms of right ventricular-pulmonary artery discontinuity, progressive valved conduit stenosis is an important clinical problem. To determine the feasibility of reducing right heart valved conduit stenosis with a balloon expandable stent, a baboon model was used, in which the pulmonary artery was ligated and a right ventricular to pulmonary artery 14 mm bioprosthetic Dacron valved conduit implanted. In five baboons, at an average of 40 months after valved conduit implantation, fibrointimal stenosis at the valve site resulted in narrowing and a mean transconduit pressure gradient of 49 mm Hg (range 33 to 65).

Fluorescence-guided laser-assisted balloon angioplasty in patients with femoropopliteal occlusions.

In 12 patients (aged 64 +/- 10 years) with femoropopliteal occlusions (1-27 cm; average, 8.4 cm length) that could not be recanalized by standard guidewire-balloon angioplasty techniques, percutaneous laser-assisted balloon angioplasty was performed by use of a new fluorescence-guided dual-laser system. Plaque detection by 325-nm laser-excited fluorescence spectroscopy provided real-time feedback control to a 480-nm pulsed dye laser (2-microseconds pulses) for atheroma ablation.

A comparison of the open and closed methods in the initial treatment of sternal wound infections.

To determine the optimal initial treatment method for sternal wound infections, a retrospective review of 3,229 consecutive adult open heart operations was performed. There were 40 deep sternal wound infections (1.2%).

Platelet adherence and thrombus formation with flowing human blood on atherosclerotic plaque: reduced thrombogenicity of Watanabe-heritable hyperlipidemic rabbit aortic subendothelium.

Platelet adherence and aggregation are important in the development of ischemic sequelae in atherosclerosis. To directly examine platelet interaction with plaque, everted, deendothelialized aortic fibrous plaques from Watanabe-heritable hyperlipidemic rabbits were exposed to flowing human blood in an annular perfusion chamber. Morphometry was used to compare platelet adherence and thrombi on this surface with that observed when blood was perfused over normal New Zealand White (NZW) rabbit aortic subendothelium.

Early and late healing responses of normal canine artery to excimer laser irradiation.

Acute in vitro histologic studies have shown that the pulsed xenon chloride excimer laser causes precise microablation without the surrounding thermal tissue injury associated with frequently used continuous-wave lasers such as the argon, carbon dioxide, and neodymium:yttrium aluminum garnet lasers. However, the in vivo healing response of artery wall to excimer laser injury is not known. Accordingly, a xenon chloride excimer laser (308 nm, 40 nsec pulse width, 39 mJ/mm2/pulse) was transmitted via a 600 micron fused silica fiber to create 420 craters of varying depths (30 to 270 micron) in 21 normal canine femoral and carotid arteries.

Human arterial surface fluorescence: atherosclerotic plaque identification and effects of laser atheroma ablation.

In vivo plaque recognition may be important for safe and precise intra-arterial atheroma ablation during laser coronary angioplasty. This study examined the feasibility and sensitivity of utilizing quantitative fluorescence spectroscopy and video-enhanced fluorescence imaging for plaque identification in atherosclerotic human necropsy arterial wall before and after laser atheroma ablation. With wide-band (450 to 490 nm) blue light excitation, the 540 nm fluorescence intensity ratio of normal to diseased sites (n = 13) was 2.

Laser-induced fluorescence detection of atherosclerotic plaque with hematoporphyrin derivative used as an exogenous probe.

Clinical use of laser angioplasty is limited by the lack of an adequate guidance system. As a first step toward developing a reliable guidance system, laser-induced surface fluorescence and a fluorescent probe were used to differentiate plaque from normal arterial wall. The aortas from four normal New Zealand white rabbits and six atherosclerotic rabbits were studied in vitro.

Early detection and treatment of spinal epidural metastases: the role of myelography.

Spinal epidural metastases were detected in 75 of 140 cancer patients with back pain who were evaluated prospectively by clinical criteria, spine roentgenography, and bone scan. Fifty-five of the 75 patients with epidural metastases had no evidence of myelopathy when diagnosed. Of the patients diagnosed and treated while still ambulatory, more than 90% remained so.