Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery

In order to establish criteria for elective use of the intra-aortic balloon pump (IABP) in patients having cardiac surgery, we conducted a retrospective study of 43 patients who required counterpulsation, because of inability to be weaned from cardiopulmonary bypass, between May, 1972, and June, 1974. Patients in cardiogenic shock preoperatively were excluded. The 43 patients included 23 (Group A) who had severe preoperative left ventricular dysfunction with a mean cardiac index less than 1.8 L. per minute per square meter, ejection fraction less than 30 per cent, and end-diastolic pressure greater than 22 mm. Hg; 20 patients (Group B) had a combination of moderate cardiac dysfunction (cardiac index less than 2.2, ejection fraction less than 40, end-diastolic pressure less than 18) in the presence of acute infarction or severe aortic stenosis (gradient greater than 80 mm. Hg) with or without coronary disease. An inverse relationship was noted between survival and delay from completion of operation to the use of 1ABP. Thirty-two of 43 patients were weaned off bypass and were balloon assisted for 12 to 96 hours postoperatively; 25 patients were discharged (58 per cent). In Subgroup A, 14 of 23 (60 per cent) and, in Subgroup B, 9 of 20 (45 per cent) were long-term survivors. Based on these findings, 45 patients were operated upon between June, 1974, and December, 1975, with elective use of 1ABP and were assessed by serial hemodynamic studies. Sixteen had severe preoperative left ventricular dysfunction similar to Subgroup A and 29 had moderate dysfunction in combination with pathology similar to Subgroup B. Fifteen of these patients were hemodynamically unstable at time of arrival in the operating room; 1ABP was inserted under local anesthesia. Thirty-nine patients (87 per cent) were weaned off bypass and were hospital survivors. In Subgroup A, 13 of 16 (81 per cent) and, in Group B, 21 of 29 (72 per cent) were long-term survivors. Criteria for elective use of 1ABP in cardiac surgery should include severe preoperative left ventricular dysfunction or a combination of moderate dysfunction with coronary or valvular pathology. Elective 1ABP improves the survival with trivial iatrogenic morbidity.     

Stearoyl paratoluenesulfonate. A powerful acylating agent for lipid synthesis

The utility of the mixed carboxylic-sulfonic acid anhydride stearoyl p-toluenesulfonate as a powerful, mild acylating agent for lipid synthesis is shown by the synthesis of rac 1,2-distearoyl-3-iodopropane, lecithin and a spin-labeled choline derivative from the corresponding alcohols. The method constitutes a significant improvement of earlier acylating methods.     

Auditory attention in hyperactive children: Effects of stimulant medication on dichotic listening performance.

Administered dichotic digit tasks requiring free report and selective listening, respectively, to 20 6–16 yr old hyperactive children. Ss received methylphenidate before 2 experimental sessions and a placebo before 2 control sessions. The stimulant did not improve free-report performance significantly; rather it facilitated or impaired performance, depending on how it affected the order in which stimuli were reported. Similarly, medication had no effect on overall selective-listening performance, but it increased the difficulty of switching attention from one ear to the other. Results demonstrate that stimulants may act to maintain selective attention and to inhibit channel switching. Listening asymmetry, that is, right-ear superiority, was influenced by task variables but not by stimulant medication. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intermittent Occlusion System

A deformable cuff attached to a hydraulic activating mechanism provides a system suitable for intermittently occluding a collapsible tubular structure. When the apparatus in the system is constructed of materials such as silicon rubber and stainless steel, the system is chronically implantable. The system is designed so that it can be externally controlled after implantation.