Prosthetic aortic graft cannulation: a simple technique to secure hemostasis.

Securing the arterial cannulation site in a prosthetic aortic graft with a standard pursestring suture may be difficult and can lead to troublesome bleeding. We describe a simple technique to secure the cannulation site that avoids these problems.

Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study.

Background: The prognosis in unselected community-dwelling patients with heart failure has not been widely studied.

Objective: To determine the short- and long-term mortality of patients after first hospitalizations for heart failure and to examine how age, sex, and comorbidities influence survival.

Methods: We used the Canadian Institute for Health Information database to construct a retrospective population-based cohort of 38 702 consecutive patients with first-time admissions for heart failure from April 1994 through March 1997 in Ontario, Canada.

Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure.

Background: Congestive heart failure (CHF) is an independent risk factor for mortality in the end-stage renal disease (ESRD) population. Nocturnal haemodialysis (NHD), a novel mode of renal replacement therapy, may be more effective than conventional haemodialysis in reducing intravascular volume or in removing uraemic toxins with vasoconstrictor or myocardial depressant actions, and may, therefore, improve the left ventricular (LV) systolic function of patients with coexisting cardiac and renal failure.

Methods: To test this hypothesis, we determined, in six patients (mean age+/-SD: 49.

Is hyperventilation-induced nystagmus more common in retrocochlear vestibular disease than in end-organ vestibular disease?

Hyperventilation-induced nystagmus (HVIN) has previously been shown by the senior author to be common in patients with both acoustic neuromas and following resection. The recurrent study's aim was to examine if HVIN was specific for retrocochlear pathology. To test this, the incidence of HVIN in 24 patients with confirmed acoustic neuroma was compared with its incidence in 38 patients with end-organ vestibular disease (defined as a greater than 25% reduction in caloric testing).

Rho and basic fibroblast growth factor involvement in centrosome redistribution and actin microfilament remodeling during early endothelial wound repair.

Objective: We have shown that centrosome redistribution to the front of the cell and actin microfilament remodeling occurs during the initiation of early porcine aortic endothelial wound repair even before cell migration. Because Ras homologous protein (Rho) induces actin microfilament polymerization, interacts with microtubules, and is believed to be activated by growth factors, we set forth to study the regulatory roles of basic fibroblast growth factor (bFGF) and Rho signaling on centrosome redistribution and actin microfilament remodeling in endothelial cells at an in vitro wound edge.

Study Design: With double immunofluorescent confocal microscopy, we studied the distribution of various cytoskeletal proteins in wounded porcine aortic endothelial cells in response to bFGF and exoenzyme C3 treatments.

N-acetylcysteine neither lowers plasma homocysteine concentrations nor improves brachial artery endothelial function in cardiac transplant recipients.

Background: N-acetylcysteine is a novel antioxidant that has been reported to reduce plasma homocysteine concentrations and improve endothelial function. Cardiac transplant recipients have a high incidence of coronary endothelial dysfunction and hyperhomocysteinemia, both of which may lead to the development of transplantation coronary artery disease. It was hypothesized that N-acetylcysteine would reduce plasma homocysteine concentrations and improve brachial endothelial function in cardiac transplant recipients.

Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis.

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for mortality in the dialysis population. LVH has been attributed to several factors, including hypertension, excess extracellular fluid (ECF) volume, anemia and uremia. Nocturnal hemodialysis is a novel renal replacement therapy that appears to improve blood pressure control.

Mycobacterium avium complex lung disease in immunocompetent patients: radiography-CT correlation.

This study aimed to describe and correlate the chest radiography and CT findings of Mycobacterium avium complex (MAC) lung disease in immunocompetent patients. 26 patients fulfilled The American Thoracic Society criteria for MAC lung disease and underwent chest radiography and CT within 6 weeks of positive cultures. All abnormalities and predominant lobar involvement were recorded and abnormalities on chest radiography were correlated with those on CT.

Aortic valve replacement with the Toronto SPV: long-term clinical and hemodynamic results.

Objective: Long-term durability and hemodynamics of stentless valves are unknown. Therefore, this study was undertaken to evaluate long-term clinical and echocardiographic outcome after aortic valve replacement with the Toronto stentless porcine valve (SPV) bioprosthesis at our institution.

Methods: Between 1991 and 1998, the Toronto SPV was implanted in 255 patients (mean age, 63+/-11 years, range 22-83 years, 181 males and 74 females).

Osmotic stress activates Rac and Cdc42 in neutrophils: role in hypertonicity-induced actin polymerization.

Hypertonicity inhibits a variety of neutrophil functions through poorly defined mechanisms. Our earlier studies suggest that osmotically induced actin polymerization and cytoskeleton remodeling is a key component in the hypertonic block of exocytosis and cell movement. To gain insight into the signaling mechanisms underlying the hyperosmotic F-actin response, we investigated whether hypertonicity stimulates Rac and Cdc42 and, if so, whether their activation contributes to the hypertonic rise in F-actin.

Pectoralis major myocutaneous pedicled flap in head and neck reconstruction: retrospective review of indications and results in 244 consecutive cases at the Toronto General Hospital.

The pectoralis major myocutaneous pedicled flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps for head and neck reconstruction, and several series of PMMPF procedures have been reported in the literature. Between 1983 and 1997, 244 reconstruction procedures using the PMMPF were carried out on 229 patients by the Otolaryngology-Head and Neck Surgery Department at the Toronto General Hospital. Pectoralis major myocutaneous pedicled flap reconstructions were completed after ablation of cancer in the following sites: oral cavity, 113; oropharynx/hypopharynx, 50; larynx, 59; and other, 21.

New challenge of hepatorenal syndrome: prevention and treatment.

Hepatorenal syndrome (HRS) remains one of the major therapeutic challenges in hepatology today. The pathogenesis is complex, but the final common pathway seems to be that sinusoidal portal hypertension, in the presence of severe hepatic decompensation, leads to splanchnic and systemic vasodilatation and decreased effective arterial blood volume. Renal vasoconstriction increases concomitantly, renal hemodynamics worsens, and renal failure occurs.

Brain natriuretic peptide: is it a predictor of cardiomyopathy in cirrhosis?

Subtle cardiac abnormalities have been described in patients with cirrhosis. Natriuretic peptide hormones have been reported to be sensitive markers of early cardiac disease. We postulate that plasma levels of N-terminal pro-atrial natriuretic peptide and brain natriuretic peptide could be used as markers of cardiac dysfunction in cirrhosis.

Protein-tyrosine phosphatase MEG2 is expressed by human neutrophils. Localization to the phagosome and activation by polyphosphoinositides.

Signaling pathways involving reversible tyrosine phosphorylation are essential for neutrophil antimicrobial responses. Using reverse transcriptase PCR, expression of the protein-tyrosine phosphatase MEG2 by peripheral neutrophilic polymorphonuclear leukocytes (PMN) was identified. Polyclonal antibodies against MEG2 were developed that confirmed expression of MEG2 protein by PMN.

Cardiopulmonary exercise performance in adult survivors of the Mustard procedure.

Most patients with the Mustard procedure are now adults. To date, however, there have been few reports on resting and exercise hemodynamics in a large population of adults with this circulation. The aim of this study is to describe such parameters in one of the largest and oldest populations of adults with the Mustard procedure.

Sperm swim-up techniques and DNA fragmentation.

Background: Swim-up techniques for sperm separation may have detrimental effects on sperm DNA. We wished to determine whether the normal swim-up method with centrifugation used in our laboratory, which involves a centrifugation step, was harmful to sperm compared with swim-up without centrifugation.

Methods: Semen samples were obtained from patients undergoing IVF or andrology assessment.

Morphologic responses of endothelium to shear stress: reorganization of the adherens junction.

Shear stresses induce marked morphologic responses from endothelium which include alterations to cell shape and orientation and changes to cytoskeletal organization. These morphologic changes necessitate remodeling of cell-cell adhesion complexes that are important to control of endothelial cell physiology. Reorganization of endothelial adherens junctions has been characterized, and there are some data that pertain to the signaling pathways that regulate this reorganization.

Why is erythropoietin made in the kidney? The kidney functions as a critmeter.

Erythropoietin is distinct among the hematopoietic growth factors because it is produced primarily in the kidneys rather than the bone marrow. The kidney functions as a critmeter in that it senses oxygen tension and extracellular volume. By regulating red cell mass through erythropoietin and plasma volume through excretion of salt and water, the kidney sets the hematocrit at a normal value of 45%.

Hemodynamic effects of simulated obstructive apneas in humans with and without heart failure.

Study Objectives: To determine whether generation of negative intrathoracic pressure during apnea would cause more pronounced and sustained reductions in cardiac output in patients with congestive heart failure (CHF) than in healthy subjects.

Design: Physiologic intervention study.

Setting: Cardiorespiratory physiology laboratory.

Nonresponse to first-line pharmacotherapy may predict relapse and recurrence of remitted geriatric depression.

The authors examined whether nonresponse to first-line pharmacotherapy was associated with an increased probability of relapse or recurrence following remission of an episode of geriatric depression. The study group consisted of 74 elderly patients whose index episode of nonpsychotic unipolar major depression had responded to antidepressant pharmacotherapy. In 6 of these patients, the depressive episode had not responded to first-line pharmacotherapy (8 weeks of nortriptyline, including 2 weeks of adjunctive lithium) but it had responded to second-line treatment (phenelzine with or without adjunctive lithium).

Middle mediastinal parathyroid: diagnosis and surgical approach.

We report two cases of middle mediastinal parathyroid ectopia associated with chronic renal disease. In both patients the diagnosis was delayed and prolonged due to the unusual location of the ectopic parathyroid tissue. The surgical approach was in error in 1 patient and corrected during the second procedure.

Angiotensin-converting enzyme inhibitors in adults after the Mustard procedure.

Angiotensin-converting enzyme inhibitors had no significant effect on cardiopulmonary exercise function in 14 patients who had undergone a Mustard operation for transposition of the great arteries. In some patients aerobic capacity improved and maximum systolic blood pressure decreased.