Twelve-hour canine heart preservation with a simple, portable hypothermic organ perfusion device.

BACKGROUND: Cardiac transplantation is limited to an ischemic time of around 6 hours by available preservation solution and technique. Complex organ preservation devices have been developed that extend this time to 24 hours or more, but are clinically impractical. This study evaluates a portable oxygen-driven organ perfusion device weighing approximately 13.5 kg. METHODS: Organs are perfused with the University of Wisconsin solution at low perfusion pressure using less than 400 L of oxygen per 12 hours. Left ventricular parameters were measured in anesthetized adult beagles to establish control values (n = 5). Hearts were procured after cardioplegia with 4 degrees C University of Wisconsin solution, weighed, then stored for 12 hours in University of Wisconsin solution at 4 degrees C. Hearts were perfused (n = 3) or nonperfused (n = 2) during storage. Organ temperature, partial pressure of oxygen in the aorta and right atrium, perfusion pressure, and aortic flow were recorded hourly in perfused hearts. After 12 hours, hearts were transplanted into littermates and left ventricular parameters measured after stabilization off bypass. RESULTS: Organ weight for both groups was unchanged. Nonperfused hearts required both pump and pharmacologic support with significantly depressed left ventricular function. Perfused hearts needed minimal pharmacologic support, with left ventricular end-diastolic pressure, cardiac output, and rate of change of left ventricular pressure showing no statistical difference from control. CONCLUSIONS: These findings confirm the potential for extended metabolic support for ischemia-intolerant organs in a small, lightweight, easily portable preservation system.

Metatarsocuneiform coalition.

This was clearly a case of an unusual anomaly. Clinically, this was a case of an osseous coalition of congenital origin. Since the patient eventually became asymptomatic, no further treatment was necessary. Unfortunately, the patient's parents were unavailable to be radiographed to test the hereditary nature of this disorder. The radiographs and fluoroscopy films were sent to a radiologist. The radiology report stated a total and complete coalition (osseous fusion) between the third metatarsal base and the third cuneiform, with no indication of a joint space present in the left foot scan. Since this pathology is more of an incidental finding and caused the patient no discomfort, surgical correction was not necessary. Certainly, more coalitions of this nature may exist without patient knowledge. This case demonstrates another pathology that the podiatric physician may need to address.

Blue nevus.

Dermal melanocytes are generally most numerous in the sacral, dorsal hand, and dorsal foot. There is also a slight rise that often occurs toward the axial line of the trunk. The practitioner needs to be aware and take necessary measures to properly diagnose the blue nevus from other forms of pigmented skin lesion. The authors believe that surgical excision with proper pathologic follow-up is the preferred treatment.

Subungual malignant melanoma mimicking a squamous cell carcinoma.

When a suspicious lower-extremity lesions is encountered, an appropriate biopsy should be performed. The lesion must then be excised with the proper margins and submitted for pathologic evaluation to ensure complete removal.

Anesthetic considerations in patients undergoing percutaneous radiofrequency interstitial tissue ablation.

Radiofrequency (RF) interstitial tissue ablation is a new, minimally invasive procedure for patients with liver cancer who are not candidates for conventional therapy. The percutaneous RF ablation therapy involves placing a needle electrode under ultrasound guidance into a selected portion of the tumor and heating the tissue between 90 degrees C and 100 degrees C. The ablation procedure can be done under monitored anesthesia care on an outpatient basis. The patient's ability to cooperate with regard to breathing is critical for accurate needle placement. Intravenous sedation must be meticulously titrated to maintain a delicate balance of patient cooperation and optimal comfort.

Tarsal tunnel syndrome: an endoscopic approach with 4- to 28-month follow-up.

The authors have used instrumentation developed by Smith & Nephew Dyonics, Inc., designed for endoscopic carpal tunnel release (ECTRA) in the endoscopic treatment of tarsal tunnel syndrome. This new technique reduces trauma to the patient and decreases scar formation over the release site. These appear advantageous over the open surgical technique. A retrospective study was conducted with a resultant 89% success rate.

Osteochondroma of the fibula.

A case presentation of osteochondroma of the distal fibula in a 15-year-old female is presented. Characteristics leading to the diagnosis and treatment of this particular recurrent tumor are discussed. Osteochondroma is the most common benign tumor of bone.

Endoscopic tarsal tunnel release: update 96.

Endoscopic tarsal tunnel release is another example of endoscopic surgery replacing an open technique. Endoscopy offers the surgeon an alternative procedure, presumably resulting in less patient trauma and faster recovery time. As with any emerging procedure, modifications are made in the procedure to help simplify the process and improve the end result. The endoscopic tarsal tunnel release procedure has undergone these modifications. The newer procedure is now less traumatic to the patient. A follow-up study of the modified technique is included.

Talar fracture/dislocation in the adolescent patient.

The authors report an 18-year-old patient who sustained a two-part injury involving his right ankle. The result of this traumatic episode was a fracture/dislocation of the talus. An interesting aspect of this injury is that the body of the talus dislocated laterally, distal to the fibular malleolus. Closed reduction was attempted and subsequent open reduction with internal fixation was performed. The patient was followed for 9 months, during which time a series of radiographs was taken. Nine months postoperatively, Hawkins sign was negative indicative of avascular necrosis. In review of the literature, no fractures with lateral dislocations of this nature were found.