A novel approach for repair of right sided congenital diaphragmatic hernia and hepatopulmonary fusion.

Right sided congenital diaphragmatic hernia (CDH) associated with hepatopulmonary fusion (HPF) is a rare congenital anomaly in which the herniated liver is fused with lung parenchyma. We discuss the case of an infant with right-sided CDH and HPF found on index operation for repair of right-sided CDH. Due to the high incidence of vascular anomalies associated with HPF the decision was made to close the patient and get further imaging to characterize the HPF before returning to the operating room for definitive repair.

The efficacy and safety of a pharmacologic protocol for maintaining coronary artery bypass patients at a higher mean arterial pressure during cardiopulmonary bypass. 1998.

A recent randomized trial of higher versus lower mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) showed that higher MAP on CPB was associated with a lower incidence of overall cardiac and neurologic morbidity and mortality in coronary artery bypass graft surgery (CABG) patients. Cardiopulmonary bypass MAP was controlled pharmacologically while CPB flow was held constant for any given period. The objective of the present study was to assess the efficacy and safety of this pharmacologic protocol.

Joint associations of 61 genetic variants in the nicotinic acetylcholine receptor genes with subclinical atherosclerosis in American Indians: a gene-family analysis.

Background: Atherosclerosis is the underlying cause of cardiovascular disease, the leading cause of morbidity and mortality in all American populations, including American Indians. Genetic factors play an important role in the pathogenesis of atherosclerosis. Although a single-nucleotide polymorphism (SNP) may explain only a small portion of variability in disease, the joint effect of multiple variants in a pathway on disease susceptibility could be large.

Sham feeding in rats with chronic, reversible gastric fistulas.

Sham feeding occurs when ingested food is prevented from accumulating in the stomach and small intestine by surgical intervention. Sham feeding permits the investigation of the orosensory controls of meal size in the absence of postingestive controls. This unit details preoperative preparation, surgery, postoperative care and maintenance, and test procedures for the simplest and most widely used method, which involves implantation of a gastric cannula in a rat to provide a chronic, reversible gastric fistula.

Hepatitis C and B-cell lymphoma.

Hepatitis C virus (HCV) infection is a major public health problem worldwide. HCV, a lymphotropic and hepatotropic virus, is clearly associated with cirrhosis, end-stage liver disease, autoimmune phenomena, hepatocellular carcinoma, and essential mixed cryoglobulinemia. Recently, there have been increasing reports of B-cell lymphomas in patients with HCV infection, and epidemiologic data from several sources have demonstrated high rates of HCV seroprevalence in patients with B-cell malignancies.

Urologic issues during pregnancy.

Pregnancy induces a variety of physiologic changes in the urinary tract. When such changes become accentuated the physiologic becomes the pathologic and symptoms arise, at times of significance enough to threaten the well being of mother and/or fetus. This article intends to describe the basis for urinary physiology and its pathologic counterparts during pregnancy.

Isolated hypogonadotropic hypogonadism in a man with a history of head trauma during childhood.

Objective: To report a case of isolated hypogonadotropic hypogonadism as a delayed consequence of major head injury.

Methods: We present the relevant history, findings on physical examination, and results of laboratory evaluation, and supportive data from appropriate reports in the literature are reviewed.

Results: A 37-year-old man with progressive loss of libido, impotence, and gradual loss of facial and axillary hair had sustained severe trauma to the head (sufficient to cause blindness in one eye) in a fall from a tree at 7 years of age.

Involvement of interleukin-1 and the interleukin-1 receptor antagonist in in vitro embryo development among women undergoing in vitro fertilization-embryo transfer.

Purpose: To examine the roles of Interleukin-1 (IL-1) and IL-1 receptor antagonist (IL-1ra), in in vitro embryo development and subsequent pregnancy outcome.

Methods: Maternal serum utilized to supplement embryo growth in IVF cycles was analyzed for the presence of IL-1 cytokines.

Results: The maternal serum that was utilized to supplement the embryo media was found to have measurable amounts of IL-1beta and IL-1ra.

Between a rock and a hard place with E/M coding: dilemmas of compliance and practice financial viability.

Compliance with HCFA's Evaluation and Management (E/M) documentation guidelines presents a tremendous challenge to physicians and their staffs due to the complexity of the guidelines. All too frequently, physicians and staff undercode the services actually provided to prevent additional scrutiny and fraud and abuse charges. This results in significant lost revenue for the practice.

High grade dysplasia: surveillance, mucosal ablation, or resection?

Barrett's esophagus is a common premalignant condition that results from chronic gastroesophageal reflux. High grade dysplasia in the metaplastic esophagus is thought to be the last step in the metaplasia-to-carcinoma sequence that characterizes this disease. The management of high grade dysplasia in Barrett's esophagus is controversial.

An appraisal of echocardiography as an epidemiological tool. The Strong Heart Study.

Purpose: Despite the prognostic importance of left ventricular (LV) mass (LVM) by M-mode echocardiography, concern exists about bias introduced by missing data. The American Society of Echocardiography has made recommendations for linear measurements of LV wall thickness and internal dimension used to calculate LVM, but it is unknown whether their substitution for suboptimal M-modes improves measurement yield and reduces bias.

Methods: LVM measurement yield and associations of missing data with risk factors were assessed in 3487 American Indian participants in Strong Heart Study (SHS) Phase II and compared to data from other large-scale studies.

Effect of hormonal manipulation on mRNA expression of antioxidant enzymes in the rat testis.

Purpose: We evaluated the effects of ethane dimethane sulfonate, an agent that selectively destroys Leydig cells, and hypophysectomy on CuZn superoxide dismutase, catalase and glutathione peroxidase mRNA levels in the testis.

Materials And Methods: A total of 18, 60-day-old adult rats were injected with ethane dimethane sulfonate (75 mg./kg.

Coexistence of primary bone tumours: report of 4 cases of collision tumours.

Objective: To report, in 4 patients, the occurrence of 2 different primary tumours in proximity in the same bone. Three patients had osteosarcomas, and 1 had a giant cell tumour; all had coincident metaphyseal fibrous defect.

Methods: Four patients (2 women, 1 man and 1 boy; 18, 25, 24 and 10 years of age, respectively) presented with progressive pain in the knee and distal thigh.

Differential effects of direct antagonism of AII compared to ACE inhibitors on serum potassium levels and azotemia in patients with severe congestive heart failure.

OBJECTIVES. The present study was undertaken to determine if direct blockade of angiotensin II receptors by losartan potassium as compared to ACE inhibition might result in greater tolerability in patients with congestive heart failure in whom ACE inhibition resulted in hyperkalemia and azotemia. BACKGROUND.

Mechanism of microwave thermotherapy.

Possible mechanisms by which transurethral microwave thermotherapy creates an improvement in vodiing parameters are reviewed. The therapy creates coagulation necrosis in the hyperplastic adenoma, and thus has the potential to create volume reduction, change in the periurethral tissue, and changes in efferent neuromuscular elements and sensory neural elements. Evidence is presented that suggests that several of these mechanisms are likely important, and there is not a singular mechanism of action.

True bursal pigmented villonodular synovitis.

We describe two cases of pigmented villonodular synovitis affecting true bursae. This study was also designed to discuss the term "pigmented villonodular bursitis", not confined to true synovial bursae, sometimes creating misunderstanding.

Prognostic significance of nonsustained ventricular tachycardia after revascularization.

Introduction: Two randomized trials (Multicenter Automatic Defibrillator Implantation Trial [MADIT] and Multicenter Unsustained Tachycardia Trial [MUSTT]) suggest that implantable cardioverter defibrillator (ICD) placement is associated with improved survival in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia (VT) who also have inducible sustained VT. However, neither study directly addresses the management of such patients who develop nonsustained VT early after revascularization.

Methods And Results: We evaluated 109 consecutive patients who underwent electrophysiologic testing to evaluate nonsustained VT, which occurred 5 +/- 4 days following revascularization.

Functional residual capacity (FRC) does not predict response to surfactant in preterm infants.

We tested the hypothesis that the initial functional residual capacity (FRC) of preterm infants with hyaline membrane disease (HMD) could predict the response to surfactant replacement (Survanta, 4 mL/kg/dose), with a better initial FRC being correlated with a greater improvement in PaO2, a/A PO2 ratio, and FRC. Thirty-four preterm infants were studied on 41 occasions. FRC and arterial blood gases were measured immediately prior to treatment.

Quantifying mammary duct carcinoma in situ: a wild-goose chase?

Duct carcinoma in situ (DCIS) is a malignant neoplasm of the breast that is limited to the glandular component. The introduction of mammographic screening allows for earlier detection of carcinoma, at the stage of DCIS, before it invades the surrounding stroma. Although DCIS has been studied extensively, its quantification remains a dilemma.