Ascending aorta insertion of the dual-chambered intraaortic balloon for counterpulsation during cardiac operations.

A patient with left ventricular power failure after aortocoronary saphenous vein bypass was successfully managed by intraaortic dual-chambered balloon counterpulsation through the ascending aorta. This insertion route reverses the orientation of the spherical distal chamber, which inflates early in diastole and partially occludes the aorta. This position achieved an effective augmentation pressure during left ventricular diastole and reduced arterial end-diastolic pressure considerably. The technique of insertion and events at operation and postoperatively are discussed.

Echocardiographic detection of left circumflex coronary artery to left superior vena cava fistula by use of Doppler color flow mapping.

We report the two-dimensional and Doppler color flow mapping echocardiographic findings in a neonate with left circumflex coronary arteriovenous fistula to a left superior vena cava. Doppler color flow mapping, in concert with detailed imaging, was essential to identify this rare fistula and to prepare for therapeutic intervention at initial cardiac catheterization.

Independent control of blood gas PO2 and PCO2 in a bubble oxygenator.

An in-vitro circuit simulating cardiopulmonary bypass has been used to evaluate the gas transfer characteristics, gaseous microemboli production and blood damage of the Bentley-10 Plus bubble oxygenator. This oxygenator incorporates a unique integral gas controller which proportions the gas flow between the gas sparger and heat exchange area. The results of the study indicate that maintenance of a gas flow which ensures adequate CO2 removal can be prevented from inducing over-oxygenation by the manipulation of the gas controller which variably proportions the flow of gas from the oxygenation-efficient conventional gas sparger to the less efficient heat exchange area. Independent control of PaO2 with maintenance of CO2 transfer was demonstrated. Reduction in gaseous microemboli production and red blood cell damage with the use of the gas controller was demonstrated.

Progressive idiopathic clitoral hypertrophy in a child: a previously undescribed type of female pseudohermaphroditism.

Progressive idiopathic masculinization of the clitoris was observed between the ages of 13 and 30 months in a healthy girl, otherwise normally developed except for a patent ductus arteriosus.

Pharmacokinetic characteristics of doxycycline accumulation in normal and severely diseased kidneys.

Intrarenal concentrations of doxycycline were measured in 48 normal canine kidneys during wide variations in urine pH and the systemic state of hydration of the experimental animals. The results were compared with the renal parenchymal levels achieved in 10 severely diseased human kidneys. Although the state of hydration, the urine pH, and renal disease all significantly influenced the urinary concentrations and rate of renal clearance of doxycycline, there was no detectable difference between concentrations in normal renal tissue and those in severely diseased kidneys. This result is in contradistinction of the findings for previously evaluated antibiotics. The levels of doxycycline measured in renal tissue averaged twice the concentration in serum without notable difference among levels in renal cortex, medulla, and papilla. Prospective clinical trials will be necessary for identification of any solid correlation between the remarkable characteristics of accumulation of doxycycline in diseased renal parenchymal tissue and the clinical, therapeutic importance of such an observation.

Analysis of low-speed rotational atherectomy for the reduction of platelet aggregation.

Platelet activation is an important determinant of acute outcomes of percutaneous intervention. The objective of this study was to assess the effect of rotational atherectomy on platelet activation in an in vitro model. Freshly collected heparinized porcine blood was exposed to a 2.0-mm Rotablator burr rotating at one of three speeds: 180,000, 140,000, or 0 rpm. The specimens were analyzed immediately for concentration and size of platelet aggregates and plasma-free hemoglobin. There were significantly more platelet aggregates of >20-microm diameter at higher speeds (7,434+/-2,193 at 180,000, vs. 2,269+/-627 at 140,000, vs. 633+/-258 aggregates/ml at 0 rpm; P < 0.001). Plasma-free hemoglobin, a simple measure of cell damage, decreased with decreasing rotational speed (429+/-168 mg/dl at 180,000, vs. 88+/-44 mg/dl at 140,000, vs. 9+/-9 mg/dl at 0 rpm; P < 0.0001). In vitro, platelet activation decreases with decreasing burr speed, suggesting that the use of the Rotablator system at its minimum approved speed (140,000 rpm) could prove clinically beneficial.