Potential benefits and harms of offering ultrasound surveillance to men aged 65 years and older with a subaneurysmal (2.5-2.9 cm) infrarenal aorta

Objective

The objective of this review was to perform a rapid evidence summary to determine the prevalence of subaneurysmal aortic aneurysms, growth rates, and risk factors that modulate growth in average-risk men aged 65 years and older. Secondary objectives were to evaluate benefits and harms of lifelong ultrasound (US) surveillance and treatment outcomes for any large aneurysms that develop in the screened population.

Colonization of intravascular catheters in the intensive care unit

A prospective study of intravascular catheters (arterial, Swan-Ganz, and central venous) in two hospitals with similar intensive care units revealed an overall 25 percent colonization rate (more than 15 colony counts). Arterial catheters had the lowest colonization rate and central venous catheters had the highest. Arterial, Swan-Ganz, and central venous catheters are possible sources of nosocomial infections and septicemia. They should be inserted only when necessary. A critical review of our data and the literature suggests that future studies should examine the potential benefits of assiduous insertion technique, improved dressing care, intravascular delivery systems, and the choice of catheter.     

Failure rate with gastric partitioning for morbid obesity

One hundred twenty-two morbidly obese patients were selected for gastric partitioning from a multidisciplinary obesity clinic over a 4 year period. Initial early success was not a guarantee against cessation of weight loss or the regaining of lost weight. By emphasizing criteria for success and failure, both from our series and the literature, we showed an alarming increase in the failure rates for this procedure which is predicated on the fact that those lost to follow-up were probably failure patients. Numerous articles in the literature contain inadequate data because they refer to pounds rather than percentage of weight loss, they fail to consider revisions as failures, they do not provide 24 month follow-up data, and they do not take into account the possibility that those lost to follow-up are failure patients. The operation carries mortality and serious morbidity rates of 0 to 3 percent and 4 to 10 percent, respectively, with an average 28 percent weight loss at 24 months and a minimal failure rate of 50 percent. The alarming increase in the number of these procedures being carried out across the continent makes it mandatory for surgeons to accurately collect and register their data until the long-term effects and results are known. Gastric partitioning, although probably not experimental, is still developmental. The widespread use and possibly abuse of these operations may result in discreditation of the surgical approach to morbid obesity which would be unfortunate since it is the only practical method at this time for dealing with the problem.     

Surgical Treatment of Ventricular Tachycardia Guided by Ventricular Mapping in 23 Patients Without Coronary Artery Disease

Twenty-three patients with resistant ventricular tachycardia not related to coronary artery disease underwent surgical treatment guided by ventricular mapping. The patients were grouped according to radiological and anatomical findings. Group 1 (13 patients) had arrhythmogenic right ventricular dysplasia. Group 2 (3 patients) had left ventricular aneurysm. Group 3 (2 patients) had nonobstructive myocardiopathy. Group 4 (5 patients) had normal-appearing hearts.At operation all patients underwent ventricular mapping when in sinus rhythm and during ventricular tachycardia. The rationale of operation was ventriculotomy or cryosurgery at the site of origin of ventricular tachycardia or exclusion, resection, or undermining of arrhythmogenic areas where delayed potentials were observed.Four patients died during the perioperative period, 3 of low-output failure and 1 from bleeding. Ventricular tachycardia recurred immediately after operation in 4 patients, 3 of whom died during the perioperative period. Ventricular tachycardia recurred late in 5 patients. Three had only episodic, unsustained runs of tachycardia. Two were well controlled by drugs.All patients with ventricular tachycardia situated over the free wall of the ventricles had inducible ventricular tachycardia and had good surgical results. Three out of 5 patients with ventricular tachycardia situated in the septum had poor surgical results. Septal ventricular tachycardia needs a better surgical approach to the septum and a suitable surgical concept.     

The Clinical Outcome of Patellofemoral Arthroplasty vs Total Knee Arthroplasty in Patients Younger Than 55 Years

BackgroundPatellofemoral osteoarthritis affects 10% of patients older than 40 years and is commonly treated by patellofemoral joint arthroplasty (PFA) or a total knee arthroplasty (TKA). PFA is a more conservative approach with documented faster recovery. No study to date has compared both approaches with respect to patient-reported outcome measures in patients younger than 60 years.MethodsA retrospective case-matched cohort based on age, sex, body mass index, and side of 23 PFAs (in 19 patients) operated on by 2 surgeons and of 23 TKAs (23 patients) operated on by 6 surgeons was included in the study. All patients were younger than 55 years and operated on between March 2010 and September 2015. The Western Ontario and McMaster Osteoarthritic Index, Knee injury and Osteoarthritis Outcome scores, Tegner, and University of California, Los Angeles activity scores were compared between preoperative and minimum 2-year postoperative timepoints between groups.ResultsTKA and PFA were comparable on all patient-reported outcome measures at minimum 2-year follow-up; however, PFA patients exhibited statistically significantly larger improvement between 1 year postoperative and 2 years postoperative timepoints (P < .05). All patients improved between preoperative and postoperative timepoints (P < .05).ConclusionAlthough TKA performed better with respect to functional outcomes at the 1-year mark, at 2-year follow-up, PFA and TKA performed equally well. Our results allow us to conclude that in younger patients with isolated patellofemoral osteoarthritis who desire a more conservative, kinematic-preserving approach, PFA continues to be a practical treatment option yielding early outcomes that compare favorably with TKA.     

Radiolucent Retractor for Operative Coronary Angiography

A new retractor has been designed for sternal separation during cardiac operations. This retractor has the advantage of radiolucent blades that allow visualization of the entire heart by roentgenographic techniques without compromise of surgical exposure during the course of operation. The retractor also has swivel blades that provide excellent conformity to the sternal edges without pressure points, which tend to produce fractures.     

Comparing In Vivo Performance of Two Highly Cross-Linked Polyethylene Thermal Treatments: Remelting vs Annealing in Acetabular Liners

BackgroundThe introduction of highly cross-linked polyethylene (HXLPE) acetabular liners has greatly improved the wear performance of metal-on-PE bearing surfaces used in total hip arthroplasty. Changing the sterilization environment and adding thermal treatments, such as remelting or annealing, were introduced to limit on-shelf and in vivo oxidation of cross-linked liners. This study compares the wear properties of the remelted A-CLASS (MicroPort) HXLPE liner to a sequentially annealed HXLPE.MethodsThis retrospective study assessed linear and volumetric wear rates using Martell Hip Analysis Suite, and clinical performance through incidences of revision surgeries. A total of 80 remelted and 53 annealed liners were included in the wear analysis. All hips were reviewed for revisions.ResultsThere were no significant differences in steady-state linear or volumetric wear rates for remelted and annealed liners, 0.01 (?0.07 to 0.14) vs ?0.01 (?0.11 to 0.1) mm/y (P = .28) and ?1.03 (?30.99 to 45.43) vs ?1.31 (?32.23 to 23.70) mm³/y (P = .30), respectively. Both cohorts were below the 0.1 mm/y linear wear threshold. The wear rates for patients with femoral head sizes ≥36 mm were not significantly different than those with 32 and 28 mm femoral head sizes (P = .60). Similarly, wear rates for patients with an excessively vertical acetabular component (>50°) were not significantly different than those with standard acetabular component orientations (P = .97). No hips were revised due to liner-related complications.ConclusionThe wear rates of the A-CLASS remelted HXLPE acetabular liner wear rates were comparable to those of a sequentially annealed HXLPE. Further long-term studies are required to ensure acceptable resistance to fatigue and in vivo oxidation.     

A Simplified Cardiac Cannulation Technique

A technique for venous cannulation, left heart venting, and aortic root cannulation is described. It is simple and tidy and permits full mobility of the cannula with minimal manipulation and no blood loss.