The perils of opioid prescribing during pregnancy.

Chronic opioid therapy during pregnancy is perilous, but not simply because of neonatal effects: it is perilous because women are at particular risk for misprescription, misuse, dependence, overdose, and death. Opioids may be teratogens and should be avoided in the periconception period. Accidental childhood poisoning and purposeful teen experimentation are increased with opioid prescriptions in the home.

Teaching small groups in palliative care.

Small group learning (i.e., tutorial, seminar, or small problem-solving class) is uniquely suited to transformative change as the ultimate goal of education, and especially appropriate for use in teaching about palliative care.

Circulating endothelial microparticles in diabetes mellitus.

Background: Endothelial Microparticles (EMPs) are small vesicles shed from activated or apoptotic endothelial cells and involved in cellular cross-talk. Whether EMP immunophenotypes vary according to stimulus in Diabetes Mellitus (DM) is not known. We studied the cellular adhesion molecule (CAM) profile of circulating EMPs in patients with and without Diabetes Mellitus type 2, who were undergoing elective cardiac catheterization.

A novel model of blunt thoracic aortic injury: a mechanism confirmed?

Background: There is no consensus on the mechanism of traumatic injury to the thoracic aorta and no reproducible animal model. Advances in injury scene analysis suggest that lateral and oblique force vectors cause aortic injury. We hypothesized that the spectrum of aortic injury could be reproduced in an animal model by application of an obliquely directed load to the pressurized aorta.

Clinical ethics case consultation.

Nurses in the Pediatric ICU requested an ethics consultation asking "Is it fair to this child to continue painful experimental surgical procedures?"

A simple trick for repairing coronary pseudoaneurysm complicating a Bentall operation.

Coronary pseudoaneurysms are a known complication of the Bentall wrap-inclusion method of composite valve grafting. We describe two cases to illustrate a straightforward technique for repair and prevention of coronary pseudoaneurysm formation.

Desktop telemedicine in vascular surgery: some preliminary findings.

Objective: Surgical specialists have generally underutilized telemedicine technologies. This report describes the use of real-time interactive-video telemedicine to augment the care of vascular surgical patients in underserved rural areas within our region.

Materials And Methods: The telemedicine system at Fletcher-Allen Health Care (FAHC) and the University of Vermont in Burlington utilizes desktop video conferencing technology with terrestrial transmission at 384 kbps.

Left ventricular systolic torsion and early diastolic filling by echocardiography in normal humans.

This study describes a novel 2-dimensional echocardiographic technique to measure left ventricular (LV) systolic twist in humans and relates this measure to early ventricular filling. LV twist is the counterclockwise rotation of the left ventricle during systole when viewed from the apex. The effect of ventricular twist has been postulated to store potential energy, which ultimately aids in diastolic recoil, leading to ventricular suction.

Treatment of proctalgia fugax with topical nitroglycerin: report of a case.

Purpose: We report a single case of proctalgia fugax that responded to 0.3 percent nitroglycerin ointment.

Methods: Case report.

Use of the internal mammary artery graft in Northern New England. Northern New England Cardiovascular Disease Study Group.

Background: There is evidence that patients who receive an internal mammary artery graft (IMA) during coronary artery bypass surgery have increased long-term survival. However, an IMA is not used in all patients.

Methods And Results: We studied the use of IMA grafts among 7944 patients undergoing initial, isolated coronary artery bypass surgery in Maine, New Hampshire, and Vermont from 1992 to 1995.