Venovenous extracorporeal life support for patients after cardiotomy

Pulmonary edema and acute lung injury are common sequelae after cardiopulmonary bypass. Increased ventilatory support improves gas exchange, but may compromise ventricular function. From July 1994 to February 1997, nine patients were supported with veno-venous (V-V) extracorporeal life support (ECLS) for post cardiotomy respiratory failure. The mean age was 53 +/- 13 years (range: 37-80 years), and eight (89%) were men. Pre-operatively, five of nine (56%) were intubated, three (33%) were supported with an intra-aortic balloon pump, and five (56%) were on veno-arterial ECLS. Four patients were post left ventricular assist device (LVAD) implantation, one each after resection of an aortic aneurysm, mitral valve replacement and bypass grafting, aortic valve replacement, and pulmonary embolectomy and heart transplantation. Mean duration of support was 2 +/- 1 days (range: 1-4 days). Patients were intubated for a mean of 2 +/- 22 days (range: 4-71 days). One patient (11%) required mediastinal re-exploration secondary to bleeding, two patients underwent hemodialysis or ultrafiltration, and seven (77%) developed bacterial pneumonia. All patients were weaned from ECLS. Six patients (67%) survived to hospital discharge. Cause of death was multiple organ failure in two patients; one died from respiratory failure. V-V ECLS is a useful alternative to open sternotomy for ventilatory induced hemodynamic compromise post cardiotomy, especially in patients with LVADs.     

Durability of mitral valve repair for degenerative disease

BACKGROUND: Degenerative mitral valve disease is the most common cause of mitral regurgitation in the United States. Mitral valve repair is applicable in the majority of these patients and has become the procedure of choice. OBJECTIVE: This study was undertaken to identify factors influencing the durability of mitral valve repair. PATIENTS AND METHODS: Between 1985 and 1997, 1072 patients underwent primary isolated mitral valve repair for valvular regurgitation caused by degenerative disease. Repair durability was assessed by multivariable risk factor analysis of reoperation. It was supplemented by a search for valve-related risk factors for death before reoperation. Three hospital deaths occurred (0.3%); complete follow-up (4152 patient-years) was available in 1062 of 1069 hospital survivors (99.3%). RESULTS: At 10 years, freedom from reoperation was 93%. Among 30 patients who required reoperation for late mitral valve dysfunction, the repair failed in 16 (53%) as a result of progressive degenerative disease. Durability of repair was adversely affected by pathologic conditions other than posterior leaflet prolapse, use of chordal shortening, annuloplasty alone, and posterior leaflet resection without annuloplasty. Durability was greatest after quadrangular resection and annuloplasty for posterior leaflet prolapse and was enhanced by the use of intraoperative echocardiography. Death before reoperation was increased in patients having isolated anterior leaflet prolapse or valvular calcification and by use of chordal shortening or annuloplasty alone. CONCLUSIONS: Repair durability is greatest in patients with isolated posterior leaflet prolapse who have posterior leaflet resection and annuloplasty. Chordal shortening, annuloplasty alone, and leaflet resection without annuloplasty jeopardize late results.     

Tricuspid valve repair with the Cosgrove-Edwards Annuloplasty System

The technique of tricuspid valve repair with the Cosgrove-Edwards Annuloplasty System is described. This system provides a measured plication of the tricuspid valve annulus with a technique that is easily reproducible and permits physiologic motion of the tricuspid annulus.     

The thermal decomposition of 1,3,5 trinitro hexahydro 1,3,5 triazine (RDX)—part II: The effects of the products

The effect of products and 1,3,5 trinitrobenzene on the thermal decomposition of RDX in static system at 195°C has been studied. Formaldehyde, hydroxymethyl formamide, methylene diformamide, and 1,3,5, trinitrobenzene are all shown to enhance the reaction rate. Different initial steps in the mechanisms are indicated for the gaseous and solution phase decompositions.     

Temperature Profiling of Glass by FT-IR Emission Spectroscopy

Fourier transform infrared (FT-IR) spectroscopy is utilized to measure the wavelength and temperature-dependent radiative properties of two glass formulations. The information gained is then used with FT-IR measurements of radiance from hot glass to determine temperature gradient profiles through each glass thickness. Temperature profiling of clear Corning Pyrex and green-tinted PPG Solex are presented. The Solex was measured on-line, in situ during production at the industrial kiln. Since a temperature profile (not just bulk average) is obtained, the method offers a better understanding of process conditions for the glass industry.     

The kinetics of the autoxidation of polyunsaturated fatty acids

The kinetics of the autoxidation of a series of polyunsaturated fatty acids (PUFA) with increasing degrees of unsaturation and the mono-, di-and triglycerides of linoleate have been studied in homogeneous chlorobenzene solution at 37 C under 760 torr of oxygen. The autoxidations were initiated by thermal decomposition of azo initiators and followed by measuring the rate of oxygen uptake. The rate of chain initiation was determined by the induction period method using α-tocopherol as the chainbreaking antioxidant. The measured oxidizabilities of the PUFA are linearly dependent on the number of doubly allylic positions present in the molecule. Thus, the oxidizability of linoleate is 2.03×10⁻² M^−1/2 sec^−1/2, and the value for docosahexaenoate is five times greater, 10.15×10⁻² M^−1/2 sec^−1/2. The rate of autoxidation for all PUFA studied and for the mono- and diglyceride is proportional to the substrate concentration and to the square root of the rate of chain initiation, implying that the autoxidation of these compounds follows the usual kinetic rate law. The autoxidation of the triglyceride is more complex and does not appear to follow the same rate law at all substrate concentrations. This deviation from the usual kinetic rate expression may be due to lipid aggregation at low concentrations of the triglyceride.     

Plans and the development of listener skills.

Research on children's referential communication has focused primarily on the role of the speaker; the listener's role has remained largely unexplored. The development of listener skills during childhood and the effects of introducing a brief plan for effective listening on children's listener performances were investigated in this study. 24 children at each of 4 ages (4, 6, 8, and 10 yrs) played the role of listener in a referential communication game. The speaker was an adult confederate, who produced messages of varying informational adequacy. After 12 pretest trials on the communication game to assess baseline listener performance, half of the Ss were given a plan for effective listening. All Ss then participated in 12 additional trials. Significant development of listener skills was observed; older Ss asked more questions and chose more correct referents than younger Ss. The plan facilitated the performances of all but the 4-yr-olds. These findings suggest both the importance of the listener within the referential communication situation and the relevance of plans for efforts to facilitate the development of communication skills. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Synthesis of the hexaphosphates of myo-, scyllo-, neo- and D-inositol

Myoinositol hexaphosphate has been prepared by Posternak's method and purified from lower phosphate esters by ion-exchange chromatography. The product behaved differently from the natural hexaphosphate when used as a substrate for a plant phytase preparation. By modifying Posternak's original method it has been found possible to prepare a synthetic hexaphosphate which is hydrolysed at the same rate as its natural counterpart. The hexaphosphates of scyllo-, neo- and D-inositol have been prepared by the modified method and have been compared as substrates in phytase hydrolysis experiments.     

The influence of dose and dose rate on the incidence of neoplastic disease in RFM mice after neutron irradiation

The effect of circadian rhythm and alterations in posture on plasma aldosterone concentration was studied in 13 patients with primary aldosteronism (six adenoma, five idiopathic hyperplasia, two carcinoma) to define the regulatory mechanism in each of these pathologic subtypes. Blood samples for aldosterone, cortisol, renin, and potassium concentrations were obtained every 4 h during prolonged recumbency (32 h) and upright posture (16 h). During recumbency, aldosterone and cortisol followed a normal circadian pattern in patients with adenoma and hyperplasia, with peak values at 0400-0800 h and the nadir at 1600-2400 h. Normalized aldosterone and cortisol values correlated significantly in both groups (adenoma r=+0.66, P less than 0.001; hyperplasia r=+0.42, P less than 0.01). With upright posture, aldosterone levels declined parallel to the normal circadian fall in cortisol in patients with adenoma (r=+0.68, P less than 0.001); whereas aldosterone levels increased in patients with hyperplasia parallel to small increments in renin (r=+0.65, P less than 0.001) and potassium (r=+0.64, P less than 0.001). During the administration of dexamethasone, aldosterone no longer correlated with cortisol in patients with adenoma but continued to correlate with renin during upright studies in patients with hyperplasia (r=+0.77, P less than 0.01). Aldosterone circadian rhythm was abnormal in patients with carcinoma and no effect of posture was noted. Unilateral adrenalectomy restored the normal postural relationship in four patients with adenoma. These studies suggest that aldosterone secretion is under continuous ACTH control regardless of posture in patients with adenoma, whereas persistent adrenal responsiveness to small increments in renin and/or potassium mediate the postural increase in plasma aldosterone in patients with hyperplasia. True adrenal autonomy occurs only in patients with adrenal carcinoma and when ACTH is suppressed in those with adenoma.     

Planning With A Difference: A Reflection On Planning And Decision Making With Indigenous People In Broome,Western Australia

This paper stems from an intensive community action project undertaken in July 1995 by the authors with colleagues from the Department of Planning, Policy and Landscape (now Landscape, Environment and Planning), RMIT University, and an alliance of Aboriginal groups in the Shire of Broome, in northern Western Australia. This work focused on developing processes for inclusion of Aboriginal peoples' viewpoints in planning and decision making by the Broome Shire Council. This Broome project led the authors to consider a range of theoretical perspectives regarding communication and democracy originally presented in a paper given at the ACSP/AESOP conference in Toronto, Canada in July 1996.