Performance of the Smeloff aortic valve beyond ten years.

The Smeloff aortic valve has remained unchanged in design and material since 1966. To assess the long-term performance of this prosthesis, we reviewed 394 consecutive patients undergoing elective aortic valve replacement. Concomitant coronary artery bypass grafting was performed in 26.4% of these patients. Follow-up was complete in 96%; maximum follow-up was 13.1 years (mean 4.3 years). The operative mortality was 7.4%. Actuarial survival rate, including operative mortality, was 66.3% +/- 2.8% at 5 years and 48.7% +/- 4.5% at 10 years. Thromboembolism for the entire group occurred at a rate of 3.8% per patient-year. Patients who underwent anticoagulation continuously had a rate of embolision of 1.8% per patient-year. All patients had a 5 year embolus-free rate of 91% +/- 2% and a 10 year embolus-free rate of 85% +/- 3%. Patients receiving anticoagulants had a 5 year embolus-free rate of 92% +/- 2% and a 10 year embolus-free rate of 89% +/- 3%. There was no mechanical failure or prosthetic thrombosis in 1,690 patient-years of follow-up. The Smeloff aortic valve has excellent long-term durability and thromboembolism is low in patients receiving anticoagulants.

Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results.

In the present climate of quality-assurance policies, rigorous requirements for informed consent, and a constantly changing patient population, a system of preoperative risk assignment and postoperative correlation was developed to monitor and evaluate surgical performance. Patients were categorized by operation, priority (emergent, urgent, elective), New York Heart Association Functional Class, and risk. Risk was assigned before operation using data from the Coronary Artery Surgery Study (CASS) and the recent literature. Data were collected by a full-time data manager and were stored and analyzed by computer. From January 1, 1984, to July 1, 1985, 1,303 patients underwent operation for acquired disease. This group included 913 patients undergoing isolated primary coronary artery bypass grafting (CABG). The comparison of predicted and observed results showed: (Table: see text). For patients undergoing isolated primary CABG, the elective group had an operative mortality of 0.6% (2/329); the urgent group, 1.1% (5/450); and the emergent group, 5.2% (7/134). Preoperative risk assignment is an effective method of quality assurance. Female sex and age older than 60 years, which predicted an operative mortality of 2 to 5% in the CASS study and other recent series, did not predict a similar risk in our series.

Association between the prevalence of infestation by Rhipicephalus sanguineus and Ctenocephalides felis felis and the presence of anti-Leishmania antibodies: A case-control study in dogs from a Brazilian endemic area.

The association between the prevalence of infestation by Rhipicephalus sanguineus and Ctenocephalides felis felis and the presence of anti-Leishmania antibodies has been evaluated in dogs located in a city of Brazil endemic for canine visceral leishmaniasis. Blood samples from 5556 domestic dogs domiciliated in the urban area of Belo Horizonte (Minas Gerais state) were submitted to enzyme linked immunosorbent (ELISA) and indirect immunofluorescent antibody (IFAT) assays, and 432 (7.8%) animals tested positive. Seropositive (n=200) and seronegative (n=200) dogs were randomly selected and examined for the presence of ticks and fleas, the results of which were expressed qualitatively as infested or non-infested, irrespective of the intensity of infestation. The prevalence of infestation by R. sanguineus was significantly greater (ρ=0.04) among seropositive dogs (38.5%) compared with their seronegative counterparts (29.0%). Similarly, the prevalence of infestation by C. felis felis was significantly greater (ρ<0.01) within the seropositive group (36.5%) than within the seronegative group (15.0%). Moreover, the probability of seropositivity for Leishmania was 53% higher in tick-infested dogs and 300% higher in flea-infested dogs in comparison with non-infested animals. Our data provide evidence of the vectorial capacity of these ectoparasites in transmitting Leishmania to the canine population, although further studies are needed to confirm or reject this hypothesis.

Measurement of quenching cross sections for laser-induced fluorescence of atomic arsenic.

The measurement of collisional quenching cross sections for the (4p)(2) (5s)(1) (4)P(1/2) state of atomic arsenic is reported. The arsenic (4)P(1/2) state was prepared by excitation from the (4p)(3) (4)S(3/2) ground state with 197.2-nm laser radiation. The fluorescence signal from the (4p)(2) (5s)(1) (4)P(1/2) ? (4p)(3) (2)D(1/2) transition was monitored at 249.3 nm. Quenching cross sections were obtained for hydrogen, methane, nitrogen, carbon monoxide, and ethylene.

Low-power resonant laser ablation of copper.

We emphasize two points: (l) the properties and mechanisms of very low-fluence ablation of copper surfaces and (2) the sensitivity and selectivity of resonant laser ablation (RLA). We present results for ablation of bulk copper and copper thin films; spot-size effects; the effects of surface-sample preparation and beam polarization; and an accurate measurement of material removal rates, typically ≤ 10(-3) Å at 35 mJ/cm(2). Velocity distributions were Maxwellian, with peak velocities ≈ 1-2 × 10(5) cm/s. In addition, we discuss the production of diffractionlike surface features, and the probable participation of nonthermal desorption mechanisms. RLA is shown to be a sensitive and useful diagnostic for studies of low-fluence laser-material interactions.

Speciation of arsenic oxides using laser desorption/ionization time-of-flight mass spectrometry.

Positive and negative ion mass spectra of arsenic trioxide (As2O3) and arsenic pentaoxide (As2O5) have been obtained by single-step laser desorption/ionization time-of-flight mass spectrometry. Pulsed UV radiation at 266 nm was used for the simultaneous desorption and ionization of the solid sample. High-mass cluster ions that are unique to the oxidation state of each oxide sample appear in the negative ion mass spectra. The As2O3 produces As3O5-, while the As2O5 yields As3O8-. The formation of unique negative cluster ions presents the capability for arsenic oxidation state speciation by laser desorption/ionization mass spectrometry. The ability of time-of-flight mass spectrometry to examine the relative amounts of each arsenic oxide present in a series of mixtures is discussed. Application of our speciation technique to a model incinerator sample is demonstrated.

Laser desorption/ionization time-of-flight mass spectrometry of nitrated polycyclic aromatic hydrocarbons.

Mass spectra of four nitrated polycyclic aromatic hydrocarbons (nitro-PAHs), 9-nitroanthracene, 1-nitropyrene, 2-nitro-9-fluorenone, and 2-nitrofluorene, have been investigated using single-step laser desorption/ionization time-of-flight mass spectrometry. Pulsed UV radiation at 266 or 213 nm was used for desorption and ionization of solid samples deposited on an aluminum probe. The positive molecular ion which was observed for each nitro-PAH was of greater relative intensity when 213 nm radiation was used. A strong [M - NO]+ peak was observed in all spectra, and an intense NO+ signal accompanied the [M - NO]+ signal when 213 nm was used but was only weakly present when 266 nm was used. Comparison of the various spectra suggests that nitro-PAHs undergo an excited state nitro-nitrite rearrangement, followed by loss of NO. Multiphoton ionization of the NO fragment appears to be the principal route of formation of NO+ during laser desorption/ionization when 213 nm radiation is used. The presence of the carbonyl group in 2-nitro-9-fluorenone leads to unique and prominent fragments involving losses of CO from the carbonyl bridge.