Widely Used Types and Clinical Applications of D-Dimer Assay.

D-dimers are formed by the breakdown of fibrinogen and fibrin during fibrinolysis. D-dimer analysis is critical for the diagnosis of deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. Modern assays for D-dimer are monoclonal antibody based. The enzyme-linked immunosorbent assay (ELISA) is the reference method for D-dimer analysis in the central clinical laboratory, but is time consuming to perform. Recently, a number of rapid, point-of-care D-dimer assays have been developed for acute care settings that utilize a variety of methodologies. In view of the diversity of D-dimer assays used in central laboratory and point-of-care settings, several caveats must be taken to assure the proper interpretation and clinical application of the results. These include consideration of preanalytical variables and interfering substances, as well as patient drug therapy and underlying disease. D-dimer assays should also be validated in clinical studies, have established cut-off values, and reported according to the reagent manufacturers recommendations.

One-and-a-half ventricular repair for isolated right ventricle metastatic tumor resection after lobectomy for lung cancer.

A 77-year-old woman presented with shortness of breath 1 year after a right upper lobectomy for lung cancer. She showed a possible intracardiac metastasis on positron emission tomography scan. There was no other evidence of recurrence. The large right ventricular mass was associated with the right ventricle free wall, the apex, the papillary muscle, and the chordae to the tricuspid valve. After mass resection of the right ventricle, a one-and-a-half ventricular repair was performed with tricuspid valve replacement and defect closure. The patient was discharged on postoperative day 14 without complications and has been well for the first 3 months after the surgery.

EEG asymmetry during aortic arch surgeries associated with selective preferential cerebral hypothermia.

Intraoperative EEG monitoring is increasingly used during aortic arch procedures for early detection of acute neurologic dysfunction. In those procedures involving cardiopulmonary bypass, increased neuroprotection may be gained by using hypothermic circulatory arrest and selective cerebral perfusion. Several techniques for cerebral perfusion exist; yet no studies have noted distinct EEG patterns associated with different techniques. In this study, we reviewed EEG records of six aortic arch procedures that used cannulation of the innominate artery to provide selective antegrade cerebral perfusion. In each case, a transient hemispheric asymmetry was noted within 2 minutes of the start of head cooling, consisting of enhanced suppression over the right compared with the left hemisphere, which was confirmed by power analysis. The EEG returned to baseline during passive-head rewarming in five cases, whereas a brief left-sided partial seizure occurred during rewarming in one case. These findings suggest that antegrade cerebral perfusion using cannulation of the innominate artery results in enhanced cooling of the right hemisphere as detected by intraoperative EEG monitoring. Characterization of this finding is necessary to prevent misinterpretation of ischemia by EEG.