Transient cardiac standstill induced by adenosine in the management of intraoperative aneurysmal rupture: technical case report.

Objective And Importance: Intraoperative aneurysmal rupture represents a potentially catastrophic event. We describe the use of an intravenous adenosine bolus to induce transient cardiac asystole to control a severe intraoperative aneurysmal rupture. This treatment resulted in a brief period of severe hypotension, which enabled successful clipping of the aneurysm.

Incorporation of lean red meat into a National Cholesterol Education Program Step I diet: a long-term, randomized clinical trial in free-living persons with hypercholesterolemia.

Objective: Clinicians often recommend that intake of all meat, particularly red meat, be reduced in conjunction with a low-fat, low-cholesterol diet to reduce low-density lipoprotein (LDL) cholesterol. This study was designed to determine the long-term effects of lean red meat (beef, veal and pork) compared to lean white meat (poultry and fish) consumption on lipoprotein concentrations in free-living hypercholesterolemic subjects consuming a National Cholesterol Education Program (NCEP) Step I diet.

Methods: A randomized, crossover design was utilized.

Left ventricular assist device bridge therapy for acute myocardial infarction.

Background: Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock have a high mortality rate. Current treatment modalities remain suboptimal for these patients.

Methods: From April 1995 to March 1998, 7 patients were identified as having AMI associated with cardiogenic shock.

Use of gadolinium as an intraarterial contrast agent in digital subtraction angiography of the cervical carotid arteries and intracranial circulation. Technical note.

Patients with renal insufficiency or other contraindications to iodine-based contrast agents present a significant management dilemma when conventional arteriography is required. The authors describe the use of gadolinium as an alternative contrast agent for arterial digital subtraction (DS) angiography of the cervical carotid arteries (CAs) and intracranial circulation. Three patients with renal insufficiency presented with symptoms of ischemic cerebrovascular disease and inconclusive noninvasive imaging studies, which necessitated conventional angiography.

Temporary ECMO support following lung and heart-lung transplantation.

7 days) failure. Seven (78%) patients in the early group were weaned off ECMO and 5 (56%) survived to hospital discharge. In the late group, none of the patients could be weaned off ECMO, yielding 100% mortality.

Extracranial-intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy.

Objective: To examine the potential role of cerebral revascularization in the treatment of patients with symptomatic occlusive cerebrovascular disease refractory to medical therapy.

Methods: Twenty patients with symptomatic occlusive cerebrovascular disease underwent 22 extracranial-intracranial bypass procedures after failing maximal medical therapy. The average follow-up time was 3.

Single dose versus fractionated stereotactic radiotherapy for recurrent high-grade gliomas.

Purpose: To evaluate the efficacy of stereotactic radiotherapy (SRT) in patients with recurrent high-grade gliomas by comparing two different treatment regimens, single dose or fractionated radiotherapy.

Methods And Materials: Between April 1991 and January 1998, 71 patients with recurrent high-grade gliomas were treated with SRT. Forty-six patients (65%) were treated with single dose radiosurgery (SRS) and 25 patients (35 %) with fractionated stereotactic radiotherapy (FSRT).

Transcatheter closure of patent foramen ovale for hypoxemia during left ventricular assist device support.

A patent foramen ovale with right-to-left shunting was responsible, in part, for profound hypoxemia in a patient who required mechanical support with a left ventricular assist device for cardiogenic shock. The patent foramen ovale was detected with contrast transesophageal echocardiography, and the defect was closed successfully with a transcatheter septal defect closure device.

The fate of intracranial microaneurysms treated with bipolar electrocoagulation and parent vessel reinforcement.

Objective: Although direct clipping remains the treatment of choice for intracranial aneurysms, not all aneurysms can be clipped. This report reviews the results of bipolar coagulation followed by parent vessel reinforcement for the treatment of intracranial microaneurysms (maximal diameter of < or =3 mm), with immediate and delayed postoperative angiographic evaluation in all cases.

Methods: During a 1-year period, 20 intracranial microaneurysms in 12 patients were treated with bipolar electrocoagulation followed by reinforcement of the parent artery with muslin gauze.

The supination effect of tendon transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis or longus: a cadaveric study.

Flexor carpi ulnaris (FCU) transfer to the extensor carpi radialis brevis (ECRB) and/or the extensor carpi radialis longus (ECRL) has been commonly used to provide wrist extension. The ability of this wrist extension transfer to also provide forearm supination has been inferred but not formally investigated. This laboratory study investigated the forearm supination effect of FCU transfer to the ECRB and to the ECRL in a cadaveric model.

Pulmonary thromboembolectomy of donor lungs prior to lung transplantation.

Successful bilateral single-lung transplantation was performed after pulmonary thromboembolectomy of the donor lungs. The donor lungs were not thought to contain large amounts of pulmonary thromboemboli because they satisfied all the donor selection criteria. This case reinforces the need of not only meticulous inspection of the donor lungs prior to implantation but also the productive use of available donor organs.

Cadaveric modeling of the pronator teres rerouting tendon transfer.

The purpose of this study is to report the biomechanics of the supination effect of the pronator teres rerouting procedure and to determine the optimum insertion point for the transfer using a cadaveric model. Pronator teres rerouting procedures were performed on 5 fresh-frozen above-elbow cadaver specimens mounted in a forearm rotation mounting frame. The pronator teres was detached from its native insertion and tested at 6 insertions on the radius.

Radiographic incidence of multicentric malignant gliomas.

Background: Multicentric malignant gliomas are interesting yet uncommon clinical entities with an unknown rate of occurrence.

Methods: We reviewed the computed tomography (CT) and magnetic resonance (MR) images of 100 consecutive patients with malignant gliomas to determine the incidence of multicentricity in malignant glial neoplasms.

Results: Five patients had multiple lesions on their initial radiographic study (synchronous lesions) and in four patients multiplicity developed after initial diagnosis (metachronous lesions).

B cell lymphoproliferative disorders following hematopoietic stem cell transplantation: risk factors, treatment and outcome.

Twenty-six cases of B cell lymphoproliferative disorder (BLPD) were identified among 2395 patients following hematopoietic stem cell transplants (HSCT) for which an overall incidence of BLPD was 1.2%. The true incidence was probably higher, since 9/26 of the diagnoses were made at autopsy.

Painful conditions around the elbow.

This article discusses the origin and histology of conditions causing pain around the elbow as well as possible treatments. Specific conditions examined include epicondylitis and medial, posterior, and anterior musculotendinous injuries.

Patient selection criteria for the treatment of brain metastases with stereotactic radiosurgery.

In this study we evaluate prognostic factors that predict local-regional control and survival following stereotactic radiosurgery (SRS) in patients with brain metastasis and establish guidelines for patient selection. Our evaluation is based on 73 patients with brain metastasis treated with SRS at the University of Minnesota between March 1991 and November 1995. The ability of stereotactic radiosurgery to improve local control in patients with brain metastases is confirmed in our study in which only 6 of 62 patients failed locally after SRS, with an actuarial local progression-free survival of 80% at 2 years.

Surgical treatment of arthrogryposis of the elbow.

The purpose of this study was to analyze our results of surgical treatment of arthrogryposis of the elbow and to compare our tendon transfer results using range of motion (ROM) criteria versus functional use criteria. Eighteen tendon transfers for elbow flexion in 14 children with arthrogryposis with an average follow-up period of 4 years (range, 1-14 years) and 6 elbow capsulotomies with triceps lengthening in 6 children with arthrogryposis with an average follow-up period of 5 years (range, 2-9 years) were evaluated. Each child was assessed by a questionnaire regarding functional use of the upper extremity, physical examination of ROM and strength, and a videotaped activities of daily living evaluation.

A critical role for CD48 antigen in regulating alloengraftment and lymphohematopoietic recovery after bone marrow transplantation.

The binding of CD2, present on T cells, to its counterreceptor CD48 facilitates adhesion, signaling, alloantigen-induced cytokine production, and cytotoxic T-lymphocyte responses. Because these T-cell functions have been implicated in graft-versus-host disease (GVHD) pathogenesis, we have analyzed the effects of the CD2:CD48 pathway on GVHD mediated by CD4(+) and CD8(+) T cells infused into sublethally irradiated recipients. CD4(+) T-cell-mediated, and to a lesser extent, CD8(+) T-cell-mediated GVHD was inhibited by CD2 + 48 monoclonal antibody (MoAb) infusion.

Failure of clonidine to stimulate feeding in healthy humans.

The alpha2-adrenergic system is involved in the regulation of food intake in animals but its effects on feeding in humans are unknown. We hypothesized that clonidine administration would stimulate food intake in healthy human subjects. Ten men and 4 women, all physically and psychiatrically healthy, received clonidine 3 microg/kg or placebo, orally, in blinded, balanced, randomized order.

Genetic and immunological parameters governing in vivo susceptibility/resistance to retrovirally induced murine malignant histiocytosis.

Malignant histiocytosis sarcoma virus (MHSV) arose as a recombinant of c-Harvey-ras murine sarcoma virus (Ha-MuSV) and Friend mink cell focus-forming virus (F-MCFV). It is a defective acute transforming retrovirus that, along with Friend murine leukemia helper virus (F-MuLV), induces malignant histiocytosis (MH) in susceptible adult mice. We have assessed the in vivo susceptibility to MHSV in inbred homozygous, F1 hybrid, congenic, and recombinant inbred (RI) mice.