Endovascular treatment of symptomatic true-lumen collapse of the downstream aorta after open surgery for acute aortic dissection type A.

AIM: The aim of the present study was to evaluate the outcome of endovascular treatment of true-lumen collapse (TLC) of the downstream aorta after open surgery for acute aortic dissection type A (AADA). METHODS: Retrospective, observational study with follow-up of 16 ± 7.6 months. From April 2010 to January 2012, 89 AADA-patients underwent aortic surgery. Out of these, computed tomography revealed a TLC of the downstream aorta in 13 patients (14.6%). They all received additional thoracic endovascular aortic repair (TEVAR) in consequence of malperfusion syndromes. RESULTS: In all 13 TLC-patients, dissection after AADA-surgery extended from the aortic arch to the abdominal aorta and malperfusion syndromes occurred. Remodeling of the true-lumen was achieved by TEVAR with complemental stent disposal in abdominal and iliac arteries in all cases. One patient died on the third postoperative day due to intracerebral hemorrhage. Another patient, who presented under severe cardiogenic shock died despite AADA-surgery and TEVAR-treatment. Thirty-day mortality was 15.4% in TLC-patients (N = 2/13). In the follow-up period, 3 patients required additional aortic stents after the emergency TEVAR procedures. After 20 weeks, a third patient died secondary to malperfusion due to false-lumen recanalization. Therefore, late mortality was 23.1%. CONCLUSION: After proximal aortic repair for AADA, early postoperative computed tomography should be demanded in all patients to exclude a TLC of the descending aorta. Mortality is still substantial in these patients despite instant TEVAR application. Thus, in case of TLC and malperfusion syndrome of the downstream aorta, TEVAR should be performed early to alleviate or even prevent ischemic injury.

Intensive care management of acute liver failure.

Acute liver failure represents one of the most challenging conditions in intensive care treatment. In most cases there is no causal medical therapy available for survive making the intensive care treatment as the most important management tool, as bridge to transplant or still the recovery of the liver! These patients frequently develop multi-organ failure, placing them at risk of hemodynamic disorder, cerebral edema, coagulopathy and various renal and metabolic complications.

Analysis of research studying the effects of polychlorinated biphenyls and related chemicals on neurobehavioral development in children.

During the past 25 y numerous studies have been performed in infants and children to determine whether environmental exposure to polychlorinated biphenyls (PCBs), dibenzo-p-dioxins, dibenzofurans (PCDFs) and dichlorodiphenyl trichloroethane is causally associated with neurobehavioral effects. In addition, 1 episode of poisoning with PCDFs occurred in Taiwan in 1978. This poisoning outbreak is referred to as Yu-Cheng, oil disease, since the PCDFs and PCBs had accidentally contaminated cooking oil. In the aggregate the studies reviewed here show no conclusive evidence that environmental exposure to these chemicals affect the neurobehavioral development of infants and children.

Has perchlorate in drinking water increased the rate of congenital hypothyroidism?

Perchlorate, known to inhibit the human thyroid at doses above 200 mg/day, was detected in the drinking-water supplies of seven counties in California and Nevada at levels of 4 to 16 micrograms/L in 1997. The data from the neonatal screening programs of the state health departments in these two states were analyzed for any increased incidence of congenital hypothyroidism in those counties. County-specific, ethnicity-specific data for Nevada and California were obtained for 1996 and 1997. Within these seven counties, nearly 700,000 newborns had been screened. In all, 249 cases were identified, where 243 were expected, for an overall risk ratio of 1.0 (95% confidence interval, 0.9 to 1.2). The risk ratios for the individual counties ranged between 0.6 and 1.1. These data in this ecological analysis do not indicate an increase in the incidence of congenital hypothyroidism with the reported perchlorate levels.

Mortality in male and female capacitor workers exposed to polychlorinated biphenyls.

A mortality study was conducted in workers with at least 90 days' exposure to polychlorinated biphenyls (PCBs) between 1946 and 1977. Vital status was established for 98.7% of the 7075 workers studied. In hourly male workers, the mortality from all cancers was significantly below expected (standardized mortality ratio [SMR] = 81; 95% confidence interval [CI], = 68 to 97) and comparable to expected (SMR = 110; 95% CI, 93 to 129) in hourly female workers. No significant elevations in mortality for any site-specific cause were found in the hourly cohort. All-cancer mortality was significantly below expected in salaried males (SMR = 69; 95% CI, 52 to 90) and comparable to expected in salaried females (SMR = 75; 95% CI, 45 to 118). No significant elevations were seen in the most highly exposed workers, nor did SMRs increase with length of cumulative employment and latency. None of the previously reported specific excesses in cancer mortality were seen. This is the largest cohort of male and female workers exposed to PCBs. The lack of any significant elevations in the site-specific cancer mortality of the production workers adds important information about human health effects of PCBs.

Calcium intake and blood pressure in blacks and whites.

This study focuses on 1790 residents of Erie County, New York, over age 19, who participated in a study of blood pressure in 1986. Subjects were selected using a highly stratified sampling procedure to obtain a sample that included approximately equal numbers of blacks and whites in three educational strata (less than 12 years, 12 years, and more than 12 years of education). Calcium intake was estimated using questions regarding usual frequency of intake of foods high in calcium and of calcium-containing supplements and antacids. Calcium intake by normotensives tended to be higher than intake by hypertensives; differences were significant for females but not for males. Calcium intake was significantly inversely associated with systolic blood pressure for black females and diastolic blood pressure in black and white females after control for age, education, body mass index, smoking, and alcohol. For other sex-race groups, there was generally a trend (although not significant) toward decreased blood pressure with increased calcium intake. Diastolic blood pressure was inversely associated with calcium from milk and yogurt (but not cheese) for white females. A similar association (although not significant) was found for black females; no association was found for males. No differences were found between blacks and whites in response to calcium. This cross-sectional study provides some additional evidence of a protective effect of calcium intake on blood pressure in both black and white females.

An assessment of rural hospital trustees' health care knowledge base.

Rural hospital trustees are usually volunteers who serve important roles in the governance of a hospital and, therefore, in defining health care policy in their communities. Because most trustees are not health professionals, their orientation to the hospital and continuing education about the hospital present a special challenge to administrators. One hundred and three trustees from 10 rural hospitals in western New York were surveyed to better understand their demographics, their knowledge base regarding the hospital, and their roles as trustees. Sixty-six percent of the respondents were male and the average age of the sample was 48 years. Trustees had served an average of six years and spent seven hours per month on hospital business. Eighty-three percent recalled receiving some orientation. Answers about average hospital census, length of stay, payor type, and hospital services were correct less than 50 percent of the time. Trustees were aware that recent quality assurance guidelines increased their liability and half believed it was their most important activity. We conclude that greater effort should be applied to the orientation and continuing education of hospital trustees. Given the significant time commitment already asked of trustees, this education should be woven into the hospital governance routine.

Endometrial sampling: analysis of 310 procedures performed by family physicians.

Endometrial sampling has become an accepted office procedure. Safety and clinical usefulness have been well established but not specifically studied in family practices. To address the safety and clinical usefulness of endometrial sampling, a chart review of 310 endometrial sampling procedures performed by practicing family physicians was undertaken. Cases were identified by billing records and chart auditing to assure complete recording of all procedures performed by study practitioners since the beginning of their practices. A prestudy survey revealed that 26% of rural family physicians and none of the urban family physicians in western New York were doing endometrial sampling. Practitioners were doing an average of 1.2 per month. Of the 310 procedures 14.5% were unsuccessful because of cervical stenosis or inadequate sample. There were no reported complications, and three cases of endometrial carcinoma were discovered. Endometrial sampling is safe and clinically useful when performed by family physicians.