Combined carotid endarterectomy and coronary artery bypass in a community hospital.

A study examining combined carotid endarterectomy and coronary artery bypass (CAB) outside the metropolitan or university hospital setting was performed. Over a 5-year period, 52 patients underwent carotid endarterectomy and CAB under a single anesthetic. Twenty-two patients (42%) had unstable angina and 23 (44%) had previous neurologic symptoms.

Review of radiation safety in the cardiac catheterization laboratory.

With the increasing use of coronary arteriography and interventional procedures, radiation exposure to patients and personnel working in cardiac catheterization laboratories has increased. Proper technique to minimize both patient and operator exposure is necessary. A practical approach to radiation safety in the cardiac catheterization laboratory is presented.

Attrition, burnout, job dissatisfaction and occupational therapy managers.

At a time when there is growing concern about the person-power shortages in occupational therapy, there is a need to address reasons why therapists leave the job market. Two job-related reasons for attrition are burnout and job dissatisfaction. The burnout phenomenon occurs as a result of personnel shortages, high-stress demands on therapists, the severity and complexity of client's problems, and the therapist's own ''worker personality.

Angioplasty of a large aortocoronary bypass graft utilizing a single oversized balloon catheter.

Angioplasty of large saphenous vein grafts may present problems because of unavailability of adequately sized balloon dilatation catheters. We report a case of successful PTCA of a left anterior descending graft by using a 5 mm balloon and a standard 8F guiding catheter.

Operative management of bilateral internal iliac artery aneurysms.

A case of bilateral internal iliac artery aneurysms in association with an infrarenal abdominal aortic aneurysm is presented. The implications of surgical repair of these lesions are considered, particularly with reference to interruption of pelvic blood flow. Reimplantation of the inferior mesenteric artery is recommended when internal iliac artery flow is compromised during aortic reconstruction.

External carotid endarterectomy under direct vision.

At the conclusion of standard carotid endarterectomy in 50 consecutive patients, we examined flow in the external carotid artery using a continuous-wave Doppler probe. In two patients (4 percent), flow was absent in the distal external carotid artery. In both patients, opening the external carotid artery through a separate incision revealed an obstructing intimal flap that was removed easily under direct vision, and external carotid endarterectomy was accomplished without interrupting flow through the internal carotid artery.

Automated three-part leukocyte differential counts in the preoperative evaluation of ambulatory surgery patients.

The clinical value of the Coulter S-Plus V three-part leukocyte differential cell count in the preoperative evaluation of 295 patients scheduled for ambulatory surgery was examined. Ninety-five percent of the specimens could be processed by the instrument without further review. Only 11 specimens had abnormal manual differential cell counts.

Operative approaches to the left atrium and mitral valve apparatus.

Traditional and alternative approaches to the mitral valve apparatus are presented. The median sternotomy and vertical left atriotomy approach affords adequate exposure in most cases. However, there are occasions when an alternative approach may be warranted.

Nonoperative management of unusual blunt traumatic rupture of the thoracic aorta.

A conservative nonoperative method of management was utilized in an atypical case of blunt traumatic rupture of the thoracic aorta. In unusual or complicated tears of the aortic arch, as described here, a delayed or expectant method of management may be justified.