Sheathless insertion of the percutaneous intraaortic balloon pump: an alternate method.

A technique is described that allows insertion of a standard percutaneous intraaortic balloon without use of the larger 12F sheath. Standard 9.5-cm.

The neonate with congenital heart disease: diagnosis and management.

In the neonate cyanotic lesions as well as acyanotic lesions (left to right shunts and critical obstructions) manifest in several ways and identification of such lesions is critical in this age group. Evaluation of various presenting signs and symptoms along with various investigational modalities available which includes oxygen saturation, echocardiography along with conventional electrocardiography and chest roentgenography and the newer axial views of cineangiocardiography have made it possible to arrive at a precise diagnosis in defining all of the intra and extracardiac anomalies. This allows one to make full assessment of the presenting problem and offer appropriate management.

Hemopump support for the failing heart.

Under fluoroscopy, the hemopump is passed through the aortic valve into the left ventricle through a Gortex (WF Gore, Denver, CO) chimney sewn to a surgically exposed femoral artery. The system aspirates the left ventricular blood and actively pumps it into the aorta. Five patients (four men, one woman), aged 47-71 years (mean, 62 years), were candidates for hemopump support because of refractory cardiogenic shock.

Correction of total anomalous pulmonary venous connection below the diaphragm.

Six infants with total anomalous pulmonary venous connection below the diaphragm had correction by modification of conventional surgical technique. Catheterization revealed the confluence of the pulmonary veins draining into a descending vein below the diaphragm. Symptoms of pulmonary venous hypertension and low cardiac output were typical.

Use of a double-lumen pressure monitoring catheter to facilitate pulmonary artery banding.

Pulmonary artery banding is facilitated by simultaneously measuring the pressure above and below the band. This can be accomplished with a commercially available double-lumen central venous pressure monitoring catheter. This catheter is inserted through the outflow tract of the right ventricle and positioned so that the band will be between the two lumens.

Disrupted coronary artery caused by angioplasty: supportive and surgical considerations.

Of 2,859 patients having percutaneous transluminal coronary angioplasty, 201 (7%) underwent emergency coronary artery bypass grafting. Two categories of patients were reviewed. Group 1 consisted of 126 patients of 2,304 who had immediate coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty.

A reliable method for monitoring the microvascular patency of free jejunal transfers in reconstructing the pharynx and cervical esophagus.

Reconstruction of the pharynx and esophagus with revascularized segments of jejunum remains a time-proven entity. Most thromboses and subsequent flap failures have occurred within the first 24 hours after revascularization of the flap. What would therefore be desirable is a safe, proven monitoring system to assess the patency of the microvascular anastomoses and subsequent viability of the transferred bowel segment.

A versatile retractor for use in harvesting the internal mammary artery and performing standard cardiac operations.

A versatile retractor is described that can be used to harvest either mammary artery without disturbing the operative field and can be converted to a standard sternotomy retractor. It uses the principle of elevating the cut sternal edge and applying external pressure to the area of the costochrondal junction to rotate the mammary pedicle into view. We have used this retractor and found it to be very efficient in exposing the mammary pedicle while being atraumatic to the sternum.

Permanent left ventricular assistance for outpatients through surgical implantation of a modified intra-aortic balloon pump.

There is a large population of patients in end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. In 2 such patients, we provided permanent left ventricular assistance on an outpatient basis by surgically implanting a modified intra-aortic balloon pump. A Dacron-velour graft to the common iliac artery served as a covering for the extravascular portion of the balloon's pneumatic tubing, which was stabilized by routing it through the iliac crest.

Percutaneous cardiopulmonary bypass: application and indication for use.

Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB.

Comparison of combination nifedipine-propranolol and diltiazem-propranolol with high dose diltiazem monotherapy for stable angina pectoris.

Patients with chronic stable angina are frequently treated with calcium antagonist-beta-blocker combination drug therapy. However, there is a paucity of data comparing such combination therapies with each other and with high dose calcium antagonist monotherapy. Nineteen patients with chronic stable angina pectoris were studied using a prospective, randomized, Latin-square crossover protocol in an effort to determine the differential effects of nifedipine-propranolol combination therapy, diltiazem-propranolol combination therapy and high dose diltiazem monotherapy on exercise treadmill performance.

Adrenal cortical nodule mimicking small round cell malignancy on fine needle aspiration.

The cases of two elderly female patients with benign adrenal cortical nodules that mimicked small round cell malignancies by fine needle aspiration cytology are reported. Electron microscopic examination of part of the aspirate revealed the cells to be aggregates of bare nuclei of broken adrenal cortical cells, leading to a correct diagnosis.

Clinical experience with the CO2 laser during carpal tunnel decompression.

Scar tissue formation along the cut edges of the transverse carpal ligament has been found to be among the primary causes for persistent median nerve compression following carpal tunnel release with the steel scalpel. Since laser surgery has been shown to be effective in reducing incisional inflammatory reactions, hypertrophic scarring, and postoperative pain and edema, in achieving better hemostasis, the application of the carbon dioxide laser may be a more efficient surgical tool than the steel scalpel for carpal tunnel release. In 46 cases of carpal tunnel syndrome, the carbon dioxide laser was utilized to vaporize the transverse carpal ligament and seal its edges.

Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up.

In 1975, 80 patients undergoing revascularization were prospectively randomized to receive either a greater saphenous vein (SV) graft (41 patients, Group 1) or a left internal mammary artery (LIMA) graft (39 patients, Group 2) to the left anterior descending coronary artery (LAD). All patients were completely revascularized. The average number of grafts per patient in both groups was 3.

Malignant peripheral nerve sheath tumor and pheochromocytoma. A composite tumor of the adrenal.

An adrenal composite tumor of pheochromocytoma and malignant peripheral nerve sheath tumor (PNST) is described in a 39-year-old woman in whom PNST component appeared to have undergone further malignant degeneration, resulting in a highly anaplastic sarcoma with rapidly progressive clinical course.

The relationship between relapse and involvement in alcoholics anonymous.

Recovering alcoholic members (N = 59) of Alcoholics Anonymous (A.A.) were asked to complete a questionnaire to assess the occurrence of relapse and its correlation to their level of involvement in the A.

Postnatal evolution of the human pineal gland. An immunohistochemical study.

Pineal glands from 16 infants ranging from 38 weeks gestation to 3 years of age were fixed in buffered formalin; Paraffin sections were stained for neuron-specific enolase, glial fibrillary acidic protein, and S-100 protein (S-100) using the peroxidase-antiperoxidase method and hematoxylin and eosin, Masson-Fontana, and Bodian stains. The pineal glands of neonates consisted of cords of closely packed, dark, nucleated cells (type I) with intervening loosely arranged, large, clear cells (type II). The type I cells were frequently pigmented and occasionally exhibited rosette formation.

Laboratory suggestion. Interpretation of plasma protamine paracoagulation test.

The reliability of the plasma protamine paracoagulation test has been questioned because of the controversy surrounding its interpretation and because of false positives reported with high frequency in some series. To minimize the frequency of false positives, it is recommended that when the test is done at room temperature, clot or fibrin strand formation be considered a positive result and precipitates be considered negative. Use of the wire hook to distinguish fibrin strands from precipitates is suggested.