Racial variation in healthcare resource utilization and expenditures in knee/hip osteoarthritis patients: a retrospective analysis of a Medicaid population.

Background: Osteoarthritis (OA) is a leading cause of chronic pain and disability. Prior studies have documented racial disparities in the clinical management of OA. The objective of this study was to assess the racial variations in the economic burden of osteoarthritis within the Medicaid population.

Ernest Henry Starling (1866-1927) on the glomerular and tubular functions of the kidney.

Around the turn of the 20th century, Ernest Henry Starling (1866-1927) made many fundamental contributions to the understanding of human physiology. With a deep interest in how fluid balance is regulated, he naturally turned to explore the intricacies of kidney function. Early in his career he focused upon the process of glomerular filtration and was able to substantiate the view of Carl Ludwig that this process can be explained entirely upon the basis of hydrostatic and oncotic pressure gradients across the glomerular capillary wall and that the process can be regulated by alterations in the tone of the afferent and efferent arterioles.

Ernest Henry Starling (1866-1927) on the formation and reabsorption of lymph.

Ernest Henry Starling laid the groundwork for our modern understanding of how the interstitial fluid, which he referred to as 'lymph', is regulated. Together with his colleague, William Bayliss, he provided the crucial insight into how fluid is driven out of the capillary to form interstitial fluid. That was to measure (estimate) the capillary pressure in different parts of the circulation and to relate changes in these pressures to altered lymph formation.

The clinical quandary of left and right ventricular diastolic dysfunction and diastolic heart failure.

Diastolic heart failure is a common clinical entity that is indistinguishable from systolic heart failure without direct evaluation of left ventricular function. Diastolic heart failure is a clinical diagnosis in patients with signs and symptoms of heart failure but with preserved left ventricular function and normal ejection fraction, and is often seen in patients with a long-standing history of hypertension or infiltrative cardiac diseases. In contrast, diastolic dysfunction represents a mechanical malfunction of the relaxation of the left ventricular chamber that is primarily diagnosed by two-dimensional transthoracic echocardiography and usually does not present clinically as heart failure.

The prevalence and clinical relevance of sexual dysfunction in women and men with chronic heart failure.

Sexual dysfunction is a common problem of increasing incidence that is associated with multiple co-morbid conditions and chronic diseases. In heart failure, however, exact numbers are unknown, in part secondary to under-reporting and under-interrogating by health care providers. A gender-specific questionnaire was modified from established sexual dysfunction questionnaires to correspond to a non-randomized outpatient heart failure population, to assess the prevalence and demographic distribution of sexual dysfunction and potential treatments expectations.

Intermittent outpatient nesiritide infusion reduces hospital admissions in patients with advanced heart failure.

Recombinant B-type natriuretic peptide (BNP) is a therapeutic modality in patients with decompensated congestive heart failure. Retrospectively tested are the effects of intermittent outpatient nesiritide infusion on symptoms, hospital readmission rates, endogenous BNP, and renal function in patients with advanced heart failure. Twenty-four patients in heart failure in New York Heart Association (NYHA) classes III-IV received a 6- to 8-hour intermittent nesiritide outpatient infusion (0.

Percutaneous dilatational tracheostomy for emergent airway access.

The study objective of this article was to evaluate percutaneous dilatational tracheostomy (PDT) for emergent airway access. This is a case series of 9 patients who presented over a 58-month period. All patients were in severe respiratory difficulty where intubation by conventional means was unsuccessful.

Improved survival in women with BRCA-associated ovarian carcinoma.

Background: The objective of this study was to determine the clinical characteristics, treatment response, and frequency of p53 overexpression in Ashkenazi Jewish women with hereditary ovarian carcinoma.

Methods: Seventy-one Jewish women with epithelial ovarian carcinoma (EOC) were tested for the three BRCA founder mutations using single-strand conformation polymorphism analysis, heteroduplex analysis, and protein truncation testing. Clinical and histopathologic data were reviewed retrospectively.

Diagnosis of coronary pseudoaneurysm by Optison.

Intravenous contrast agents that traverse the pulmonary circulation have been used for endocardial border definition, myocardial perfusion, diagnosis of intracardiac thrombi, and in cardiovascular emergencies such as myocardial rupture. We report a patient who presented with a new inferior myocardial infarction and an extracardiac mass compressing the right atrium, in whom diagnosis of right coronary pseudoaneurysm was made on the basis of delayed appearance of Optison contrast into the pseudoaneurysm and was subsequently confirmed by angiography and surgery. Thus, we extend the diagnostic indication of myocardial contrast agents to patients with extracardiac masses.

Optical mapping of ventricular defibrillation in isolated swine right ventricles: demonstration of a postshock isoelectric window after near-threshold defibrillation shocks.

Background: Investigators who studied ventricular defibrillation by use of optical mapping techniques failed to observe an initial defibrillation event (isoelectric window or quiescent period) shown by electrode mapping studies. This discrepancy has important implications for the mechanisms of defibrillation. The purpose of the present study was to demonstrate an optical equivalent of an isoelectric window after a near-threshold defibrillation shock.

Comparing cardiac action potentials recorded with metal and glass microelectrodes.

Machine-pulled high-impedance glass capillary microelectrode is standard for transmembrane potential (TMP) recordings. However, it is fragile and difficult to impale, especially in beating myocardial tissues. We hypothesize that a high-impedance pure iridium metal electrode can be used as an alternative to the glass microelectrode for TMP recording.

Microdialysis update: optimizing the advantages.

Microdialysis was introduced in the early 1970s as a method to measure dynamic release of substances in the brain (see Tossman & Ungerstedt, 1986). The technique has been refined over the past three decades due to the development of new materials for dialysis membranes and commercial availability of smaller, more consistently fabricated probes. A typical microdialysis probe consists of rigid metal concentric tubing with a semipermeable region at the tip (Fig.

Characteristics of wave fronts during ventricular fibrillation in human hearts with dilated cardiomyopathy: role of increased fibrosis in the generation of reentry.

Objectives: We sought to evaluate the characteristics of wave fronts during ventricular fibrillation (VF) in human hearts with dilated cardiomyopathy (DCM) and to determine the role of increased fibrosis in the generation of reentry during VF.

Background: The role of increased fibrosis in reentry formation during human VF is unclear.

Methods: Five hearts from transplant recipients with DCM were supported by Langendorff perfusion and were mapped during VF.

Induction of meandering functional reentrant wave front in isolated human atrial tissues.

Background: The purpose of this study was to test the hypothesis that a single meandering functional reentrant wave front can result in rapid and irregular electrogram activity in human atrial tissues.

Methods And Results: The study used the explanted hearts of five human cardiac transplant recipients. Three right and two left atrial tissue samples, 3.