Monitoring considerations for port-access cardiac surgery.

Background: A method for monitoring patients was evaluated in a clinical trial of minimally invasive port-access cardiac surgery with closed chest endovascular cardiopulmonary bypass.

Methods And Results: Cardiopulmonary bypass was conducted in 25 patients through femoral cannulas. An endovascular pulmonary artery vent was placed in the main pulmonary artery through a jugular vein.

Closed-chest cardiopulmonary bypass and cardioplegia: basis for less invasive cardiac surgery.

Background: We developed a method of closed-chest cardiopulmonary bypass to arrest and protect the heart with cardioplegic solution. This method was used in 54 dogs and the results were retrospectively analyzed.

Methods: Bypass cannulas were placed in the right femoral vessels.

Port-access cardiac operations with cardioplegic arrest.

Background: A less invasive approach to cardiac surgery has been propelled by recent advances in video-assisted surgery. Previous obstacles to minimally invasive cardiac operations with cardioplegic arrest included limitations in operative exposure, inadequate perfusion technology, and inability to provide myocardial protection.

Methods: Port-access technology allows endovascular aortic occlusion, cardioplegia delivery, and left ventricular decompression.

Reading and language in 9- to 12-year olds prenatally exposed to cigarettes and marijuana.

Facets of reading and language were examined in 131 9- to 12-year-old children for whom prenatal exposure to marijuana and cigarettes had been ascertained. The subjects were from a low-risk, predominantly middle class sample who are participants in an ongoing longitudinal study. Discriminant Function Analysis revealed a dose-dependent association that remained after controlling for potential confounds, between prenatal cigarette exposure and lower language and lower reading scores, particularly on auditory-related aspects of this latter measure.

Extracorporeal circulation for port-access cardiac surgery.

Minimally invasive techniques for cardiac surgery are a new approach in performing some cardiac operations. Minimally invasive surgery may minimize patient discomfort, length of stay in the hospital and postoperative rehabilitation. These procedures utilize a small thoracotomy for direct visualization of the heart.

Nonsteroidal anti-inflammatory drugs and aspirin: a comparison of the antiplatelet effects.

Antiplatelet effects of common analgesics were assessed in vitro. The Streck Platelet Aggregation Test Kit (Omaha, NE) was used to measure percent platelet aggregation in response to sodium arachidonate, collagen, adenosine diphosphate, and ristocetin in patients on various analgesics. In comparison with the control group, the response to arachidonate and collagen of ibuprofen (86% vs.

Port-access cardiac surgery with cardiopulmonary bypass and cardioplegic arrest.

In the past decade, laparoscopic and thoracoscopiC technology have significantly and irreversibly altered the approach to many general and thoracic surgical diseases. With advances in laparoscopy and thoracoscopy, the concept of a minimally invasive approach to cardiac surgery has been realized.

Port-access bilateral internal mammary artery grafting for left main coronary artery disease: canine feasibility study.

Background: To extend the applications of minimal access cardiac surgery, an endovascular cardiopulmonary bypass (CPB) system that allows cardioplegia delivery and cardiac venting was used to perform bilateral internal mammary artery (IMA) bypass grafting in six dogs.

Methods: The left IMA (LIMA) was taken down thoracoscopically from three left lateral chest ports, followed by the right IMA (RIMA) from the right side. One left-sided port was extended medially 5 cm with or without rib resection, to expose the pericardium.

Initial postoperative serum lactate levels predict survival in children after open heart surgery.

Objective: To evaluate the relationship between postoperative serum lactate levels and outcome in children undergoing open heart surgery.

Design: Prospective, noninterventional study.

Setting: Pediatric intensive care unit (PICU) of a university hospital.

The Relationships between Phonological Sensitivity, Syntactic Processing, and Verbal Working Memory in the Reading Performance of Third-Grade Children.

The performance of 112 third-grade children was examined on tasks assessing phonological sensitivity, working memory, and syntactic processing. The children were also administered several measures of word recognition, pseudoword reading, and reading comprehension. A series of hierarchical regression analyses and commonality analyses indicated that phonological sensitivity remained a strong predictor of reading performance after variance in working memory and syntactic processing had been partialled out.

Delayed time response of the continuous cardiac output pulmonary artery catheter.

Previous studies of the accuracy of pulmonary artery catheters (PAC) which provide continuous cardiac output (CCO) monitoring have investigated the performance during steady-state conditions. We compared the response time to hemodynamic change using a CCO PAC and an ultrasonic flow probe (UFP). In five sheep, a CCO PAC was inserted, and an UFP for measurement of CCO was placed around the pulmonary artery via a left thoracotomy.

Echocardiographic monitoring of minimally invasive mitral valve surgery using an endoaortic clamp.

Background And Aims Of The Study: Twenty-four patients underwent minimally invasive mitral valve repair (n = 16) or mitral valve replacement (n = 8) using the Port-Access system. Intraoperative transesophageal echocardiography (TEE) was used in these patients to: (i) reassess valve pathology preoperatively; (ii) guide and continuously assess placement and position of the aortic endoclamp; (iii) measure aortic root diameters, aortic distensibility and aortic wall appearance prior to and after aortic endoclamping; (iv) evaluate the de-airing procedure; (v) evaluate the results of mitral valve repair; and (vi) guide weaning from cardiopulmonary bypass (CPB).

Methods And Results: Placement and positioning of the endoclamp was guided effectively in all but one patient who had acute retrograde aortic dissection with the onset of femoro-femoral bypass.

Port-access mitral valve replacement in dogs.

Objective: The objective was to assess mitral valve replacement in a minimally invasive fashion by means of port-access technology.

Methods: Fifteen dogs, 28 +/- 3 kg (mean +/- standard deviation), were studied with the port-access mitral valve replacement system (Heartport, Inc., Redwood City, Calif.

Clinicopathologic correlations in acute retinal necrosis caused by herpes simplex virus type 2.

The acute retinal necrosis syndrome is a rapidly progressive and potentially devastating disease. A case of acute retinal necrosis developed in an immunocompetent man, Presumably due to the stress, trauma, or immunomodulation related to a craniotomy for a parasellar craniopharyngioma. Vitrectomy and endoretinal biopsy were performed.

Viral infection as a cause of arthritis.

Rheumatic complaints secondary to viral infections are usually brief, self-limited and nondestructive. They may accompany almost any type of viral illness, and the arthritic presentation is nonspecific. These manifestations are protean, ranging from arthralgia to vasculitis.

Port-access coronary artery bypass with cardioplegic arrest: acute and chronic canine studies.

Background: Our goal is to perform minimally invasive coronary artery bypass grafting without sacrificing the benefits of myocardial protection with cardioplegia.

Methods: Twenty-three dogs underwent acute studies and 4 dogs underwent survival studies. The left internal mammary artery was taken down using a thoracoscope.

The development of phonological rules and visual strategies in average and poor spellers.

To investigate the development of phonological and visual skills used in spelling, 420 children between the ages of 6 and 16 completed the spelling dictation test of the Wide Range Achievement Test-Revised. The misspellings were scored for phonological as well as visual accuracy using a constrained (inclusion of position cues) and an unconstrained system. Poor spellers made fewer phonologically accurate and fewer visual matches than age-matched average spellers.

Port-access coronary artery bypass grafting: a proposed surgical method.

Minimally invasive surgical methods have been developed to provide patients the benefits of open operations with decreased pain and suffering. We have developed a system that allows the performance of cardiopulmonary bypass and myocardial protection with cardioplegic arrest without sternotomy or thoracotomy. In a canine model, we successfully used this system to anastomose the internal thoracic artery to the left anterior descending coronary artery in nine of 10 animals.

Minimally invasive cardiopulmonary bypass with cardioplegic arrest: a closed chest technique with equivalent myocardial protection.

Thoracoscopic cardiac surgery is presently under intense investigation. This study examined the feasibility and efficacy of closed chest cardiopulmonary bypass and cardioplegic arrest in comparison with standard open chest methods in a dog model. The minimally invasive closed chest group (n = 6) underwent percutaneous cardiopulmonary bypass and cardiac venting, as well as antegrade cardioplegic arrest through use of a specially designed percutaneous endovascular aortic occluder and cardioplegic solution delivery system.

Avascular necrosis of the lumbar spine.

Back pain is ubiquitous. Commonly, the etiology of the back pain remains elusive despite many costly tests. We report a patient with back pain who was found to have avascular necrosis (AVN) of the lumbar spine on the magnetic resonance imaging study despite normal x-rays.

Sulfite reductase structure at 1.6 A: evolution and catalysis for reduction of inorganic anions.

Fundamental chemical transformations for biogeochemical cycling of sulfur and nitrogen are catalyzed by sulfite and nitrite reductases. The crystallographic structure of Escherichia coli sulfite reductase hemoprotein (SiRHP), which catalyzes the concerted six-electron reductions of sulfite to sulfide and nitrite to ammonia, was solved with multiwavelength anomalous diffraction (MAD) of the native siroheme and Fe4S4 cluster cofactors, multiple isomorphous replacement, and selenomethionine sequence markers. Twofold symmetry within the 64-kilodalton polypeptide generates a distinctive three-domain alpha/beta fold that controls cofactor assembly and reactivity.