Core content for venous and Lymphatic Medicine: 2022 revision.

The core content for a medical specialty outlines the scope of the discipline as well as the categories of knowledge considered essential to practice in the field. It provides a template for the development of curricula for medical school, graduate, and postgraduate education, as well as for creating certification standards. Venous and Lymphatic Medicine (VLM) is a specialty that has benefitted from contributions from specialists from several medical disciplines. Optimally, the societies, boards, and residency review committees representing these disciplines would uniformly recognize the scope of VLM to develop education and assessment standards to allow training and identification of qualified practitioners. In order to inform the standard setting bodies and other stakeholders of the current scope of VLM, a task force of VLM experts from cardiology, dermatology, emergency medicine, general surgery, interventional radiology, vascular medicine, and vascular surgery was formed to revise a 2014 consensus document defining the core content of the specialty of VLM.

Big five personality traits reflected in job applicants' social media postings.

Job applicants and incumbents often use social media for personal communications allowing for direct observation of their social communications "unfiltered" for employer consumption. As such, these data offer a glimpse of employees in settings free from the impression management pressures present during evaluations conducted for applicant screening and research purposes. This study investigated whether job applicants' (N=175) personality characteristics are reflected in the content of their social media postings. Participant self-reported social media content related to (a) photos and text-based references to alcohol and drug use and (b) criticisms of superiors and peers (so-called "badmouthing" behavior) were compared to traditional personality assessments. Results indicated that extraverted candidates were prone to postings related to alcohol and drugs. Those low in agreeableness were particularly likely to engage in online badmouthing behaviors. Evidence concerning the relationships between conscientiousness and the outcomes of interest was mixed.

Comparison of simultaneous electroencephalographic and mental status monitoring during carotid endarterectomy with regional anesthesia.

PURPOSE: This study examines the accuracy of intraoperative electroencephalographic (EEG) monitoring for the detection of cerebral ischemia by comparing EEG with simultaneous mental status evaluation (MSE) during carotid endarterectomy in awake patients. METHODS: Between 1994 and 1997, 208 consecutive carotid endarterectomies were prospectively evaluated for cerebral function during surgery with simultaneous MSE and EEG monitoring. Regional anesthesia (RA), which consisted of superficial cervical block, was chosen preferentially in 75% of the cases, with general anesthesia (GA) reserved for the patients who did not fulfill the criteria for RA. When available, 8-channel EEG monitoring was performed (59% with RA and 55% with GA). RESULTS: The EEG was a reliable predictor in comparison with MSE in most but not all cases of cerebral ischemia. Significant neurologic changes were noted using MSE in 4 of 89 patients (4.5%) that were not detected using EEG (false negative results). Conversely, 6 of 89 cases (6.7%) showed unilateral slowing without associated changes in MSE (false positive results). For the awake patients, 21 of 150 cases (14%) showed MSE changes that required a shunt. By contrast, 9 of 32 GA cases (28%) showed EEG changes that would have led to shunting (P = NS). In the RA group, there were no strokes versus 3 of 58 cases (5.2%) with strokes in the GA group. Two of 150 cases (0.1%) had transient ischemic attacks in the RA group. There was 1 myocardial infarction in the GA group; no deaths occurred in this series. CONCLUSION: EEG monitoring yielded a significant number of false positive (6.7%) and false negative (4.5%) results in the detection of neurologic deficits when compared with MSE in the awake patients. In this series, the preferential use of RA resulted in less shunt use and was possibly associated with a lower stroke rate.

Streptococcal toxic shock syndrome from a puncture wound to the foot.

Puncture wounds to the foot are a common occurrence. If treated properly, the majority will be resolved without major complications. Toxic shock syndrome and streptococcal toxic shock-like syndrome are devastating complications of some staphylococcal and streptococcal infections. This paper discusses the similarities and differences between the two toxic states, reviews the pathophysiology, and presents a case report of near-fatal streptococcal toxic shock-like syndrome secondary to a puncture wound of the foot.

Thrombolysis with prourokinase versus urokinase: an in vitro comparison.

PURPOSE: Despite advantages demonstrated in vitro, no single thrombolytic agent has been clearly shown to be superior to another in the clinical setting. Prourokinase has recently received attention as a new thrombolytic agent with higher fibrin specificity. The thrombolytic activity of prourokinase, however, remains ill defined. The purpose of this study was to evaluate thrombolysis with prourokinase in comparison to urokinase in vitro. METHODS: We used an in vitro parallel channel perfusion model that simulates catheter-directed thrombolysis in the peripheral arterial system. Radiolabeled thrombi were subjected to 90 minutes of endhole catheter-directed infusion with either prourokinase 5000 IU/ml, urokinase 5000 IU/ml; or 5% dextrose in water at 4 ml/hr. RESULTS: Prourokinase and urokinase were found to be equivalent with respect to thrombolytic effect. Percent lysis was maximal at 90 minutes in both the urokinase and prourokinase groups. Prourokinase and urokinase were found to be equally effective in restoring flow through thrombosed graft segments. CONCLUSION: Prourokinase appears to offer little benefit over urokinase with respect to thrombolytic activity in an in vitro model that closely resembles the clinical setting. If prourokinase is to be accepted as an alternative to urokinase, advantages must relate to differences in fibrin specificity.

Thrombus formation on polytetrafluoroethylene surfaces: the importance of von Willebrand factor.

The importance of von Willebrand factor (vWf) in the formation of platelet-fibrin thrombi on expanded polytetrafluoroethylene (ePTFE) surfaces was studied in an in vitro system, perfusing non-anticoagulated human blood over ePTFE grafts for 3 min at varying shear rates (100, 500 and 1500/s shear). Platelet (111In) and fibrin (125I) deposition was assessed on ePTFE surfaces in the presence and relative absence of vWf, achieved by use of polyclonal anti-vWf antibody (anti-vWf Ab). A total of 29 perfusions were performed. Increasing shear rate was associated with greater platelet deposition in the presence of vWf (p < 0.001). This shear-dependent rise in platelet deposition was not observed when vWf was blocked by anti-vWf Ab (P < 0.1), confirming the role of vWf in platelet deposition at high shear rates. Fibrin deposition increased with increasing shear rate in the presence of vWf (P < 0.01). Inhibiting vWf abolished the shear-dependent increase in fibrin deposition. These data suggest that vWf plays a critical role in platelet and fibrin thrombus formation on ePTFE surfaces. These effects are particularly important under conditions of high shear rate. These mechanisms may lead to the observed pathologic thrombus formation and platelet-dependent neointimal processes occurring at areas of high shear rate within the anastomotic regions of ePTFE grafts.

Development of a piezopolymer pressure sensor for a portable fetal heart rate monitor.

A piezopolymer pressure sensor has been developed for service in a portable fetal heart rate monitor, which will permit an expectant mother to perform the fetal nonstress test, a standard predelivery test, in her home. Several sensors are mounted in an array on a belt worn by the mother. The sensor design conforms to the distinctive features of the fetal heart tone, namely, the acoustic signature, frequency spectrum, signal amplitude, and localization. The components of a sensor serve to fulfill five functions: signal detection, acceleration cancellation, acoustical isolation, electrical shielding, and electrical isolation of the mother. A theoretical analysis of the sensor response yields a numerical value for the sensor sensitivity, which is compared to experiment in an in vitro sensor calibration. Finally, an in vivo test on patients within the last six weeks of term reveals that nonstress test recordings from the acoustic monitor compare well with those obtained from conventional ultrasound.

Comparison of washed blood and oxygenator whole blood as vehicles for sanguinous multidose cardioplegia.

The effects of washed blood or oxygenator-traumatized whole blood as vehicles for sanguinous cardioplegia were studied utilizing the isolated blood-perfused dog heart preparation. Hearts were subjected to 2 hr of potassium-induced arrest at 27 degrees C followed by 90 min of normothermic reperfusion. Washed blood cardioplegia (n = 7) contained blood washed thrice with saline while oxygenator blood cardioplegia (n = 6) contained whole blood which had been exposed to an extracorporeal circuit for 30 to 45 min. Cardioplegic solutions were administered at a perfusion pressure of 100 mm Hg every 15 min during arrest. While the arrest-reperfusion sequence caused minor variations in the mechanical, metabolic, and biochemical parameters tested, generally insignificant differences were found to exist between groups. Differences in coronary washout PCO2 appeared to be due to inherent differences between the two cardioplegic solutions. Thus, while washing blood may be thought to be beneficial and whole blood from the extracorporeal circuit may be theorized to have a deleterious effect on the myocardium, excellent recovery of mechanical function was observed with both cardioplegic solutions. The present study suggests that it is unnecessary to wash the sanguinous cardioplegic solution obtained from the cardiopulmonary circuit.

Myocardial protection utilizing calcium containing and calcium free perfusates.

The effects of the presence or absence of calcium in the cardioplegic perfusate were studied utilizing the isolated blood perfused dog heart preparation. Hearts were subjected to two hours of arrest at 27 degrees C followed by 90 minutes of normothermic reperfusion. Perfusates with or without 2.52 mM calcium chloride were delivered at 15 minute intervals during arrest at a perfusion pressure of 100 mm Hg. Both calcium and calcium free perfusates resulted in decreases in tissue calcium concentration measured at the end of arrest. Tissue magnesium concentrations did not change with either perfusate. Coronary vascular resistance was increased with early perfusions in the calcium perfused group relative to the calcium free group. Systolic and diastolic performance, high energy phosphate values, coronary blood flow and myocardial oxygen consumption were altered by the arrest-reperfusion sequence but no differences between calcium and calcium free groups were seen. Thus, no evidence for deleterious effects of calcium free perfusion was present after two hours of global cardiac arrest followed by reperfusion. The data indicate the absence of the calcium paradox under conditions simulating clinical cardioplegia and supports clinical data indicating that the addition of calcium to the cardioplegic solution is unnecessary.

Mechanism of myocardial protection during blood-potassium cardioplegia: a comparison of crystalloid red cell and methemoglobin solutions.

The mechanism of myocardial protection provided by red blood cells was studied with a preparation of isolated, blood-perfused dog heart. Myocardial function, metabolism, and high-energy phosphate stores were determined before and at the end of cardioplegic arrest and after reperfusion. Cardioplegic solutions containing NaCl, KCl, and dextran (crystalloid; C) were compared, at 27 degrees C, with an identical solution containing 20% washed red cells (R) and a third solution in which the red cells were treated with 0.02M NaNO2, resulting in methemoglobin (M) formation or red cells able to buffer pH but unable to transport oxygen. Solutions were delivered at 15 min intervals during 2 hr of arrest and coronary effluent pH, PCO2, and lactate were measured. Both R and M solutions prevented the increases in effluent PCO2 and decreases observed in pH with C. On the other hand, mechanical, metabolic, and high-energy phosphate determinations revealed that marked protection was provided by R but not by M or C. Thus, myocardial protection provided by R at 27 degrees C is not the result of buffering but appears to be primarily the result of oxygen delivery by the red cells to the myocardium.

The effect of secretin on colonic mucin secretion rate in the dog.

A method of quantitation of mucin using chondroitin sulfate A as a standard has been modified and applied to timed mucin collections from surgically created isolated colonic fistulas in 8 dogs. 25 experiments were conducted in which the effect of secretin was tested in 5. The mucin assay is precise and showed increased colonic mucin secretin in response to secretin. This model appears suitable for pharmacologic assessment of potential drugs for augmenting colonic mucin secretin in states of impaired colonic motility.

Colonic mucin secretion related to non-contractile motility in the dog.

In 8 dogs a colonic pouch with fistula was surgically created. Mucin secretion was measured by washing mucus out of the pouch and then, after a number of chemical steps, by determining the turbidity with spectrophotometry. The movement of tantalum particles insufflated into the canine rectum during periods of absence of contractions was correlated with mucus secretion in the pouch. Correlations were made after parenteral injection of secretin which increased movement of tantalum particles and production of mucin, and after injection of glucagon, which stopped movement of the particles and decreased mucin secretion in the pouch. Movement of tantalum was also observed when the particles were insufflated into the canine rectum on top of an applied layer of water-soluble jelly.

A minimum-interrupt digital interface for the Coulter S blood analyzer and IBM 1800 computer.

A computer interface for the fully automatic transfer of data from a Coulter model S blood analyzer to an IBM 1800 data acquisition and control system is described. The design objective was to eliminate manual handling of hematology data in order to enhance the reporting effectiveness of a computer-supported clinical pathology laboratory. Using integrated circuits and optical isolation techniques, the interface requires no modification of either the Coulter analyzer or the IBM computer. Successful operation of the interface has been demonstrated for over 4 years in two different hospitals.

The influence of fasting on opacification of the gallbladder during oral cholecystography using two consecutive doses in a canine model.

Oral cholecystography was performed in eight adult mongrel dogs. Contrast agents (Telepaque and/or Bilopaque) were administered in six different combinations, given as two consecutive doses with and without food. A combination of Bilopaque alone on both days and a combination of Telepaque with food on the first day and Bilopaque alone on the second day each proved to be the best method in 37.5% of the dogs. Telepaque with food on both consecutive days was the best method in 25% of the dogs. Among the eight combinations, two consecutive doses of Bilopaque alone or a combination of Telepaque with food on the first day and Bilopaque alone on the second day resulted in the most dense opacification of the gallbladder. Clinical implications of these results are discussed.

Use of substrate-coated barium sulfate tablets in the evaluation of digestive enzyme deficiency.

In vitro and in vivo studies determined the effect of digestive enzymes on substrate-coated barium sulfate tablets. Fragmentation of the barium tablet core was detected radiographically after enzymatic digestion of the substrate material occurred. Preliminary studies in humans suggest that such tablets may be used in the diagnosis of pancreatic exocrine insufficiency.

Non-contractile movement of tantalum powder in the canine rectum.

Caudad movement of trantalum particles in the rectum was observed in 5 recumbent anesthetized beagle bitches in the absence of muscular contractions as monitored by intrarectal balloons. The movement did not occur after injections of atropine or glucagon alone but did occur when a bisacodyl suppository was introduced in addition to the injection of glucagon. Along with direct observation of rectal mucosa, this strongly suggests the role of mucus as a carrier of the particles.