Determinants of early and late outcome for reoperations of the proximal aorta.

Background: The purpose of this study was to investigate the cause of ascending aorta and aortic arch reoperations and to identify determinants of early and late outcome.

Methods: Between January 1991 and March 2003 we repaired aneurysms of the proximal aorta in 597 patients. Of these patients, 104 had reoperations for replacement of the ascending aorta, aortic root, or transverse aortic arch.

Degradation of the apical sodium-dependent bile acid transporter by the ubiquitin-proteasome pathway in cholangiocytes.

To attenuate injury during cholestasis, adaptive changes in bile acid transporter expression in the liver provide alternative bile acid excretory pathways. Apical sodium-dependent bile acid transporter (ASBT) (SLC10A2), only expressed in the liver on the cholangiocyte apical membrane, is rapidly regulated in response to inflammation and bile acids. Here, we studied the mechanisms controlling ASBT protein levels in cholangiocytes to determine whether ASBT expression is regulated by ubiquitination and disposal through the proteasome.

Undiagnosed Takayasu's arteritis mimicking an acute aortic dissection.

Takayasu's arteritis (TA) is a vasculitis involving the aorta and its branches. We report a case of undiagnosed TA that presented to the Emergency Department with a chief complaint of chest pain and signs consistent with an aortic dissection.

Implications of silent strokes.

"Silent strokes" or "subclinical strokes" refer to incidental findings of strokes on neuroimaging studies, such as computed tomography or magnetic resonance imaging/diffusion-weighted imaging, that are asymptomatic. These include lacunar and other ischemic strokes and minor hemorrhages, particularly in "silent areas" of the brain, but also include leukoaraiosis due to small vessel pathology of a variety of origins. Clinicians need to appreciate their significance because with certain conditions, such as atrial fibrillation and significant carotid stenosis, follow-up of these patients shows an increased incidence of strokes, impaired cognitive function, and dementia.

Post-traumatic headaches.

Post-traumatic headaches are one of the most common and controversial secondary headache types. After mild head injury, up to 50% of people develop a post concussion syndrome, which has been controversial for over 135 years. Headache is estimated as present in 30% to 90% of patients after mild head injury.

Molding helmet therapy in the treatment of brachycephaly and plagiocephaly.

The purpose of this study was to compare the use of molding helmet therapy in the treatment of positional brachycephaly and posterior positional plagiocephaly. Four hundred twenty-eight children with positional brachycephaly or plagiocephaly were included in this study. In this group of patients, 132 (32%) were treated with positioning alone.

Patients with impending abdominal compartment syndrome do not respond to early volume loading.

Background: It is recommended that patients with impending abdominal compartment syndrome (ACS) should be volume loaded to insure the adequate preload. We evaluated our prospective resuscitation database to determine how patients who developed ACS differ from non-ACS patients in response to early volume loading.

Methods: Over 36 months, 152 consecutive high-risk patients were resuscitated by a standard intensive care unit (ICU) protocol that escalates interventions in nonresponders.

Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm.

Purpose: Delayed neurologic deficit has been recognized in recent years as a source of morbidity following thoracic and thoracoabdominal aortic repair. We wanted to find risk factors specifically significant for delayed neurologic deficit. In this initial study we looked at preoperative and operative risk factors.

Three-dimensional structures of the A, B, and C capsids of rhesus monkey rhadinovirus: insights into gammaherpesvirus capsid assembly, maturation, and DNA packaging.

Rhesus monkey rhadinovirus (RRV) exhibits high levels of sequence homology to human gammaherpesviruses, such as Kaposi's sarcoma-associated herpesvirus, and grows to high titers in cell cultures, making it a good model system for studying gammaherpesvirus capsid structure and assembly. We have purified RRV A, B, and C capsids, thus for the first time allowing direct structure comparisons by electron cryomicroscopy and three-dimensional reconstruction. The results show that the shells of these capsids are identical and are each composed of 12 pentons, 150 hexons, and 320 triplexes.

Elastography imaging of small animal oncology models: a feasibility study.

To test the feasibility of applying ultrasonic elastography on small animal oncology models, experiments were performed in vitro and in situ on murine mammary lesions induced exogenously by tumor cell line 66.3. In vitro studies involved three 1-week-old excised tumors embedded in a phantom block with ultrasonic properties similar to those of soft biologic tissues.

Mohr diagram interpretation of anisotropic diffusion indices in MRI.

Descriptions of diffusion anisotropy in MR Diffusion Tensor Imaging are often based on scalar indices such as surface-to-volume ratio, volume ratio, fractional anisotropy and rotational anisotropy. Recently, Mohr diagram was introduced to visualize the anisotropic diffusion information, but in a graphical form. Even though both scalar indices and the Mohr diagram are derived from the elements of the diffusion tensor, so far, the relationships between these measures and the key aspects of the Mohr diagram have not been established.

Computational study of enhanced excitability in Hermissenda: membrane conductances modulated by 5-HT.

Serotonin (5-HT) applied to the exposed but otherwise intact nervous system results in enhanced excitability of Hermissenda type-B photoreceptors. Several ion currents in the type-B photoreceptors are modulated by 5-HT, including the A-type K+ current (I(K,A)), sustained Ca2+ current (I(Ca,S)), Ca-dependent K+ current (I(K,Ca)), and a hyperpolarization-activated inward rectifier current (I(h)). In this study, we developed a computational model that reproduces physiological characteristics of type B photoreceptors, e.

Mechanical unloading increases caveolin expression in the failing human heart.

Objective: Implantation of a left ventricular assist device (LVAD) in the failing human heart initiates structural and functional changes termed reverse remodeling. Mechanical unloading improves cardiac adrenergic responsiveness and lipid metabolism, processes regulated by caveolar function. We tested the hypothesis that mechanical unloading alters the expression of caveolins and these changes are linked to altered expression of markers of reverse remodeling.

A loop technique for the safe, secure, and convenient fixation of subclavian central venous catheters to the chest wall.

Central venous catheters are placed frequently at our institution. Residents are taught the technique of subclavian line placement starting in their first year of training. Frequently the teaching stops once the line is in the vein.

Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure.

Background: Primary abdominal compartment syndrome (ACS) is a known complication of damage control. Recently secondary ACS has been reported in patients without abdominal injury who require aggressive resuscitation. The purpose of this study was to compare the epidemiology of primary and secondary ACS and develop early prediction models in a high-risk cohort who were treated in a similar fashion.

ST segment elevation pattern of acute myocardial infarction induced by acute pancreatitis.

The authors report the first emergent angiographic assessment of the coronaries with accompanying echocardiography in a 64-year-old man with dermatomyositis, who presented with ST segment elevation and cardiac specific enzyme derangements highly suggestive of myocardial infarction in the presence of acute pancreatitis. Both studies revealed no anatomical or functional evidence of obstructive coronary disease. Although the mechanism of electrocardiogram abnormalities found in acute pancreatitis remains to be elucidated fully, the authors propose a direct cardiac toxic effect by the pancreatic proteolytic enzymes to account for these changes and we recommend an angiographic approach as the first step to avoid the potentially lethal administration of thrombolytic therapy or potent anticoagulation.

Ethanol plus caffeine (caffeinol) for treatment of ischemic stroke: preclinical experience.

Background And Purpose: Ethanol and caffeine are 2 common psychoactive dietary components. We have recently shown that low-dose ethanol plus caffeine results in a 70% to 80% reduction of infarct volume after reversible common carotid/middle cerebral artery (CCA/MCA) occlusion in rats. The combination (caffeinol) was effective after either oral pretreatment or intravenous administration starting up to 2 hours after stroke onset.

Postoperative risk factors for delayed neurologic deficit after thoracic and thoracoabdominal aortic aneurysm repair: a case-control study.

Objective: Delayed neurologic deficit after thoracoabdominal or thoracic aortic repair is an unusual complication. We previously examined the preoperative risk factors associated with immediate neurologic deficit to consider their relationship to delayed neurologic deficit. In the current study we wanted to determine whether postoperative events influence the likelihood of delayed neurologic deficit, independent of preoperative risk factors.

Palliative and postoperative radiotherapy in biliary tract cancer.

Local failure is the primary limitation for cure in patients with BTC. whether or not they have been resected. The use of radiotherapy with or without chemotherapy in the postoperative setting is controversial, but some studies have reported improvement in 5-year survival.

Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation.

Background: The term secondary abdominal compartment syndrome (ACS) has been applied to describe trauma patients who develop ACS but do not have abdominal injuries. The purpose of this study was to describe major trauma victims who developed secondary ACS during standardized shock resuscitation.

Methods: Our prospective database for standardized shock resuscitation was reviewed to obtain before and after abdominal decompression shock related data for secondary ACS patients.