Tracking meaning evolution in the brain: Processing consequences of conventionalization.

Language users employ creative and innovative means to refer to novel concepts. One example is place-for-event metonymy as in "How many bands played at Woodstock?" where the place name is used to refer to an event. We capitalize on the observation that place-for-event metonymy can on the one hand result in the conventionalization of the event reading (as is the case for "Woodstock") but on the other hand can also be relatively short-lived as a function of the socio-cultural or historical impact of the respective event (e.

Isolated high lactate or low central venous oxygen saturation after cardiac surgery and association with outcome.

Objective: To determine if isolated abnormally low central venous oxygen saturation (ScvO2) or elevated lactate levels on admission to an intensive care unit (ICU) are associated with increased morbidity and length of stay (LOS) after cardiac surgery.

Design: Retrospective, observational.

Setting: Academic tertiary care hospital.

Predicting early death after cardiovascular surgery by using the Texas Heart Institute Risk Scoring Technique (THIRST).

Preoperative risk-prediction models are an important tool in contemporary surgical practice. We developed a risk-scoring technique for predicting in-hospital death for cardiovascular surgery patients. From our institutional database, we obtained data on 21,120 patients admitted from 1995 through 2007.

Heart failure due to a post-traumatic calcified pericardial hematoma.

Chest-wall trauma can produce bleeding into the pericardium and initiate a process of inflammation, calcification, and scarring that may eventually produce pericardial constriction. Herein, we present an unusual case of a man who experienced chest trauma at age 16 years, and developed heart failure 40 years later secondary to a large, calcified pericardial hematoma. During its prolonged genesis, the pericardial mass became deeply embedded in the myocardium and produced evidence of both constrictive and restrictive cardiomyopathy.

Outcomes and risk factors in 1,609 carotid endarterectomies.

Severe carotid stenosis is typically treated with carotid endarterectomy (CEA), but there is debate about the safety of this procedure in patients with occlusion of the contralateral artery, previous CEA in the same artery, and other risk factors. To evaluate the association of these factors with outcomes in standard CEA with Dacron patch angioplasty, we examined the records of 1,609 consecutive isolated CEAs performed at our institution over a 10-year period on 1,400 patients (851 men and 549 women; mean age, 69.5 yr) with symptomatic or high-grade asymptomatic carotid lesions.

Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement.

Objective: We sought to examine the relationship between the degree of prosthesis-patient mismatch and long-term survival after mechanical aortic valve replacement.

Methods: Prospectively collected long-term follow-up data from 469 consecutive patients who underwent aortic valve replacement between 1995 and 1998 were reviewed. The indexed effective orifice area was derived from the reference normal values of effective orifice area divided by the patient's body surface area.

C-ring mitral annuloplasty: 27-year follow-up.

We report the long-term follow-up of a patient with rheumatic mitral valve disease who underwent annuloplasty with a specially developed C-ring (the Cooley C-ring) for mitral valve repair in 1977. The repaired valve remained competent and unobstructed for 27 years before requiring replacement.

Combined endovascular and surgical treatment of infected carotid-carotid bypass graft.

Purpose: To present a complex case involving an infected carotid-carotid bypass graft that was successfully treated with a stent-graft and subsequent surgical removal of the infected graft.

Case Report: A 75-year-old woman presented with persistent purulent drainage of an infected and exposed carotid-carotid prosthetic bypass graft. Wound cultures revealed methicillin-resistant Staphylococcus aureus.

Myocardial thievery: the coronary-subclavian steal syndrome.

Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mammary artery coronary conduit, which produces myocardial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documentation of this phenomenon and its potentially catastrophic consequences in recent series suggests that the incidence of the problem has been underreported and that its clinical impact has been underestimated.

Concomitant brachiocephalic and coronary artery disease: outcome and decision analysis.

Background: In patients with coronary artery disease, concomitant brachiocephalic disease may affect outcome and influence decision making regarding operative staging, technique, and choice of conduit.

Methods: Eighty consecutive patients (mean age, 59.3 years; 60.

Brachiocephalic reconstruction II: operative and endovascular management of single-vessel disease.

Objective: Although the surgical management of brachiocephalic disease is well established, evolving endovascular techniques present new options for treatment. We explored the potential benefits and drawbacks of these interventions in terms of outcome.

Methods: From 1966 to 2004, 391 consecutive patients (43.

Brachiocephalic reconstruction I: operative and long-term results for complex disease.

Objectives: Complex brachiocephalic disease involves multiple vessels and is frequently associated with multisystem atherosclerosis. We reviewed surgical outcome and examined the impact of this problem on decision making regarding operative staging, technique, and choice of conduit.

Methods: Between 1966 and 2000, 157 consecutive patients (mean age, 54.

Iatrogenic left subclavian artery-to-left brachiocephalic vein fistula: successful repair without a sternotomy.

Subclavian vein catheterization can result in arteriovenous fistula formation--a rare complication that will eventually lead to heart failure if left untreated. The world medical literature describes several subclavian artery-to-subclavian vein fistulas and 2 subclavian artery-to-brachiocephalic vein fistulas, both on the right side. To our knowledge, there have been no reports of an iatrogenic left subclavian artery-to-left brachiocephalic vein fistula.

Aortic stent-graft infection due to a presumed aortoenteric fistula.

Purpose: To report a case of late stent-graft infection with aortoenteric fistula.

Case Report: A 76-year-old Colombian man received an AneuRx stent-graft for a 5.5-cm infrarenal AAA.

Perioperative care of the adult with congenital heart disease in a free-standing tertiary pediatric facility.

Adult patients with congenital heart disease are presenting more frequently for cardiac surgery. Frequently, pediatric congenital heart surgeons perform these procedures at pediatric hospitals. Between July 1995 and June 2000, a retrospective review of adult patients (> or = 18 years old) who had undergone cardiothoracic operations was performed.

Rare chronic gastric volvulus associated with left atrial and mediastinal compression.

We report a case of chronic gastric volvulus associated with left atrial compression in a 75-year-old woman who presented with chest pain, shortness of breath, and hypotension after elective hemiarthroplasty of the left hip. The patient's medical history included a paraesophageal hernia and gastric volvulus diagnosed in 1997 but left untreated. The present diagnosis of gastric volvulus was made on the basis of a chest radiograph and subsequent computed tomography.

Surgical treatment of coronary artery anomalies: report of a 37 1/2-year experience at the Texas Heart Institute.

The surgical treatment of coronary artery anomalies continues to evolve. The most common coronary artery anomalies requiring surgical intervention include coronary artery fistulae, anomalous pulmonary origins of the coronary arteries, and anomalous aortic origins of the coronary arteries. The choice of surgical intervention for each type of coronary anomaly depends on several anatomic, physiologic, and patient-dependent variables.

Coronary obstruction by a calcific pericardial ring.

We report the unique case of a 62-year-old man whose left anterior descending artery was intermittently obstructed by a heavily calcified pericardial ring. This is a rare case in which a coronary artery has been compressed because of constrictive pericarditis.

Interrupted aortic arch in an adult single-stage extra-anatomic repair.

Interrupted aortic arch is a rare congenital malformation of the aortic arch that occurs in 3 per million live births. Defined as a loss of luminal continuity between the ascending and descending portions of the aorta, this anomaly entails a very poor prognosis without surgical treatment. To our knowledge, the world medical literature contains only 12 reports of isolated interrupted aortic arch diagnosed in adults.

Hypercoagulable state leading to paraplegia in a middle-aged man.

A 37-year-old man presented with an unusual thrombotic disorder characterized by acute paraplegia and the absence of palpable pulses due to extensive arterial thrombosis of the aorta and its distal branches. The patient had an extremely complicated course that necessitated multiple revascularization procedures over a 1.5-year period.

Outcome after simultaneous abdominal aortic aneurysm repair and aortocoronary bypass.

Myocardial infarction remains the leading cause of early and late death after abdominal aortic aneurysm (AAA) repair. Myocardial revascularization is staged either before or concomitant with AAA resection, but results are far from uniform. We retrospectively analyzed our experience with patients who underwent concomitant AAA resection and aortocoronary bypass (ACB) to examine the factors affecting early morbidity/mortality and early results.

Suprarenal or supraceliac aortic clamping during repair of infrarenal abdominal aortic aneurysms.

Suprarenal or supraceliac aortic clamping during repair of infrarenal abdominal aortic aneurysms can be complicated by renal, hepatic, and intestinal ischemia. To determine whether suprarenal or supraceliac clamping increases morbidity and mortality we retrospectively reviewed our recent nonrandomized experience. Between January 1993 and December 1998, 716 patients underwent elective (n=682) or urgent (n=34) infrarenal abdominal aortic aneurysm repair.

The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass.

Objective: The aim of this study was to determine the effect of prophylactic immune suppression on the incidence and severity ofpostpericardiotomy syndrome (PPS) in children after cardiac surgery with cardiopulmonary bypass (CPB).

Background: Prophylactic suppression of the inflammatory response has an unknown effect on the incidence and severity of PPS in children undergoing surgery with CPB.

Methods: This randomized double-blind placebo controlled trial included two study groups.