Outpatient Versus Inpatient Anterior Lumbar Spine Surgery: A Multisite, Comparative Analysis of Patient Safety Measures.

Background: The frequency and complexity of spinal surgery performed in an ambulatory surgery center (ASC) is increasing. However, safety and efficacy data of most spinal procedures adapted to the ASC are sparse and have focused on anterior cervical surgery. The purpose of this study was to compare the 90-day complication and readmission rates of anterior lumbar spine surgery performed in an ASC or inpatient setting.

Lead-Specific Features Predisposing to the Development of Tricuspid Regurgitation After Endocardial Lead Implantation.

Background: Endocardial lead in the right ventricle is recognized as a cause for tricuspid regurgitation (TR), but the mechanism remains elusive. We sought to evaluate lead-specific features on the development of TR after endocardial lead implantation.

Methods: This was a prospective single-center study.

The Influence of Collagen Impregnation of a Knitted Dacron Patch Used in Carotid Endarterectomy.

Background: In selected populations, carotid endarterectomy (CEA) reduces long-term stroke risk. Studies have shown increased risk of restenosis with use of a collagen-impregnated Dacron patch compared to a polytetrafluorethylene patch. There is concern that collagen impregnation may initiate thrombosis or promote restenosis due to platelet activation.

Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacement.

Background: Valve sparing root replacement (VSRR) and aortic valve repair (AVr) is an attractive treatment option compared with composite valve and root replacement (Bentall procedure) for patients with aortic root dilatation with or without aortic valve disease. While aortic valve preservation reduces the risk of valve-related complications, little is known about echocardiographic differences at follow-up between these 2 strategies.

Methods: Consecutive nonemergent patients undergoing VSRR and AVr (n=68) were compared with contemporary historical controls undergoing the Bentall procedure for aortic root pathology with or without mixed aortic valve disease (insufficiency or stenosis) (n=96).

An unusual case of cardiogenic shock: common cause from uncommon etiology.

Mechanical complications of an acute coronary syndrome can lead to hemodynamic instability out of proportion to the degree of left ventricular dysfunction. We present the case of a patient with cardiogenic shock secondary to severe mitral regurgitation in the setting of an acutely occluded obtuse marginal artery. Echocardiography and pathologic findings revealed an uncommon cause of anterolateral papillary muscle rupture.

Unusual cause of an ejection murmur: myxoma in the left ventricular outflow tract.

We present the case of a healthy, asymptomatic 50-year-old woman with a systolic ejection murmur who was found to have an obstructive left ventricular outflow tract mass. Transthoracic echocardiography revealed a large mobile mass attached to the basal anterior septum of the left ventricle. Surgical resection was performed and a benign left ventricular outflow tract myxoma was diagnosed.

Acute mitral regurgitation in suspected acute coronary syndrome: what is the cause?

Patients presenting with acute chest pain and suspected acute coronary syndrome (ACS) who have nonobstructive coronary disease on angiography, but new regional wall motion abnormalities are often diagnosed with takotsubo cardiomyopathy (TTC). The cause of TTC is often physical or emotional stress, and this clinical syndrome occurs more often in women than men. When hemodynamically significant mitral regurgitation (MR) accompanies TTC, the mechanism must be carefully elucidated, as systolic anterior motion (SAM) of the mitral valve can cause significant MR and left ventricular outflow tract (LVOT) obstruction.

The challenge of timing surgery in a complex case of endocarditis.

While the results of clinical trials are useful in guiding management of the "average" patient, physicians are often left to their own devices when confronted with cases that neither fulfil the entrance criteria for clinical trials nor conveniently match evidence-based guidelines. We present a teaching exercise, built around a complex case of endocarditis, in a branched self-assessment format that challenges the reader's clinical judgement. The case involves a woman aged 45 years with decompensated liver cirrhosis who presents with endocarditis complicated by heart failure and multiple systemic emboli.

Clinical comparative study: efficacy and tolerability of tolperisone and thiocolchicoside in acute low back pain and spinal muscle spasticity.

Study Design: We performed a multicentric, randomized, comparative clinical trial. Eligible patients were randomly assigned to receive 150 mg of Tolperisone thrice daily or 8 mg of Thiocolchicoside twice daily for 7 days.

Purpose: To assess the efficacy and tolerability of Tolperisone in comparison with Thiocolchicoside in the treatment of acute low back pain with spasm of spinal muscles.

Temporal trends and patterns of early clopidogrel use across the spectrum of acute coronary syndromes.

Background: Randomized trials have established efficacy of clopidogrel in various types of acute coronary syndromes (ACS). The objective of this study was to examine the temporal trends and patterns of early clopidogrel use (within the first 24 hours of hospitalization) across the spectrum of patients with ACS in Canada.

Methods: Using the multinational, prospective GRACE (Global Registry of Acute Coronary Events) and GRACE(2), we identified 11,177 patients who were admitted for ACS from January 2003 to December 2007 in Canada.

Carotid reconstruction in nonagenarians: is surgery a viable option?

Because of limited longevity and perceived increased perioperative risk, the optimal treatment of significant carotid stenosis in nonagenarians is controversial. This study was conducted to evaluate our results in this demographic group. A retrospective review was performed of carotid endarterectomies (CEAs) done in nonagenarians at Cedars-Sinai Medical Center between 1996 and 2006.

Access strategies for revision or explantation of the Charité lumbar artificial disc replacement.

Background: Several lumbar disc prostheses are being developed with the goal of preserving mobility in patients with degenerative disc disease. The disadvantage of lumbar artificial disc replacement (ADR) compared with anterior interbody fusion (ALIF) is the increased potential for displacement or component failure. Revision or removal of the device is complicated by adherence of the aorta, iliac vessels, and the ureter to the operative site.

Influence of crystallite size on acetone hydrogenation over copper catalysts.

Acetone hydrogenation was studied over a family of Cu/SiO2 catalysts as well as UHP Cu powder and a Cu chromite catalyst. Oxygen chemisorption via dissociative N2O adsorption was used to count surface Cu atoms and calculate crystallite sizes, and a microwave absorption technique was used to measure the electrical conductivity of these Cu particles. Under differential reaction conditions at 423 K and 1 atm, all catalysts exhibited deactivation on stream and activities were typically 10-20% of their initial values after 3-4 h on stream.

Treatment options for traumatic pseudoaneurysms of the paravisceral abdominal aorta.

Penetrating gunshot wounds (GSWs) to the abdominal aorta are frequently lethal. Alternative management options for treatment of traumatic pseudoaneurysms of the abdominal aorta are illustrated by three patient case histories. Patient A sustained two GSWs to the abdomen (midepigastrium, right subcostal region).

Current endovascular management of atherosclerotic renal artery stenosis.

The recent advances in stent technology and renal endovascular management have provided a technically reproducible method of percutaneously treating atherosclerotic renal artery stenosis (RAS). In many centers, this has resulted in endovascular management being the primary therapy for atherosclerotic RAS. Although still controversial, it appears that endovascular management of RAS by primay stent deployment provides better blood pressure control than that afforded by best medical management.

Endovascular management of iliac vein occlusive disease.

Iliac vein occlusive disease presents with either acute or chronic symptoms, both of which can be managed with endovascular techniques. This report summarizes our experience in a small cohort of patients undergoing percutaneous treatment of iliac vein occlusive disease. Six women and one man with occlusive lesions in the iliac veins are included in this report.

Basilic vein transposition fistula: a good option for maintaining hemodialysis access site options?

Purpose: The primary use of autogenous arteriovenous access for chronic hemodialysis is recommended by the National Kidney Foundation-Dialysis Outcomes Quality Initiative practice guidelines. We review the outcomes of basilic vein transposition (BVT) to assess its value as a primary upper arm arteriovenous access option.

Methods: A retrospective review of 56 patients undergoing BVT was performed.

Third generation anticonvulsants in bipolar disorder: a review of efficacy and summary of clinical recommendations.

Background: To review the literature on efficacy of third generation anticonvulsants for treatment of bipolar disorder and provide clinical recommendations.

Method: Open and controlled studies, case reports, and case series on the efficacy of lamotrigine, gabapentin, topiramate, tiagabine, and zonisamide were located through electronic searches of several databases, by manual search of proceedings of international meetings, and through contacting authors of recent reports.

Results: Lamotrigine is the best studied anticonvulsant and has efficacy in acute bipolar depression and in longer term treatment of bipolar depression as well as rapid-cycling bipolar II disorder but not in acute mania.