A comparative review of in situ versus reversed vein grafts in the 1980s

In patients requiring an infrainguinal bypass who have an ipsilateral intact GSV, the choice between the reversed and in situ vein graft should be determined by the operative findings and the site of the distal anastomosis. When the ipsilateral GSV has either been removed or is of poor quality, ectopic autologous vein should be used in most circumstances and certainly for bypass to the infrapopliteal arteries. In reviewing the results of the two types of vein bypass to the popliteal artery, the results of two prospective, randomized studies and recent retrospective, nonrandomized reports suggest that there is no difference in patency rates between the two techniques. When performing a bypass to this level, the surgeon should not routinely use one method, but tailor the operative management to the individual patient. However, when the two bypass procedures to the infrapopliteal arteries were compared, the results of a prospective, randomized study and recent retrospective, nonrandomized reports furnish strong evidence that ISVGs provide better long term patency rates than RVGs. These results favoring use of distal ISVGs in nonrandomized reports are even more impressive, since the in situ technique was often preferentially chosen over the reversed vein method when only small diameter GSVs were available and when the bypass was performed to the distal tibial or pedal arteries. Many vascular surgeons agree with the conclusion that the ISVG is the bypass of choice for infrapopliteal bypass when an intact GSV is available. Although both the in situ and reversed vein techniques provide excellent long term patency rates for infrainguinal bypasses, and the vascular surgeon should be able to adapt this technique and approach for the individual patient, further randomized, prospective studies with extensive follow-up evaluation and a large number of patients are necessary to definitively resolve which technique provides optimal patency rates for arterial reconstruction of the lower extremity.     

High frequency oscillation in newborn infants with respiratory failure

Objective: To report ventilation strategies, survival and complications in 39 outborn infants treated with high frequency oscillatory ventilation (HFOV).
Methodology Data were collected prospectively between 1 May 1992 and 31 December 1993 on all infants treated with HFOV who had severe respiratory failure despite optimal conventional ventilation.
Results Twenty-eight out of 39 (72%) survived. Of the 15 infants with birthweights <1500g, eight survived. Best survival rates were for infants with pulmonary interstitial emphysema with air leak (4/5) and for infants of birthweight >1500g with hyaline membrane disease (8/8), and meconium aspiration syndrome (7/7). Three infants deteriorated while on HFOV and required extracorporeal membrane oxygenation. Complications were: (i) development of pulmonary interstitial emphysema (1); (ii) recurrence of pneumothorax (3); (iii) hypotension (2); and (iv) bronchopulmonary dysplasia (9). One of the eight infants weighing <1500g who received HFOV in the first week of life developed periventricular haemorrhage.
Conclusion The initial results of HFOV for severe respiratory failure were encouraging although a learning curve was encountered with its introduction.     

Sizing up HEDIS: experts take system's measure

NCQA's performance measurement system is well established in the industry. But is it really addressing the questions that matter? In this article, industry experts discuss how HEDIS has made its mark.     

Calming the IT seas. New alliance to guide health care toward technology standards

Thirty-five founding members have launched the National Alliance for Health Information Technology to develop voluntary interoperability standards for IT. In the process, the alliance hopes to encourage the health care industry to pick up the pace in adopting new technologies that will improve quality and operating performance.     

Fulminant ascending paralysis as a delayed sequela of diethylene glycol (Sterno) ingestion

The authors report a 57-year-old man who survived 18 days after swallowing an 8-oz. can of Sterno in a suicide attempt. Two days after ingestion, he developed confusion and acute renal failure requiring hemodialysis, followed on day 8 by a delayed but rapidly evolving ascending paralysis. Pathologic examination showed severe demyelination, with lesser axonal damage, of virtually all cranial and peripheral nerves sampled and sparing of central myelin. The diethylene glycol in the Sterno was considered responsible for this intoxication.