Sequential coronary artery bypass utilizing the internal mammary artery

Fifty consecutive patients underwent sequential bypass grafting of diseased coronary arteries using the left internal mammary artery (IMA) as a sequential bypass graft. There were no perioperative myocardial infarctions, and follow-up from 3 to 5 years revealed that all 50 patients are living and are free of angina. Technical aspects for use of the internal mammary artery as a sequential graft to two or more coronary arteries is technically a feasible procedure when certain guidelines are followed. We advise its use primarily for left anterior descending/diagonal connections and avoid its use when there is a wide angle between the latter vessels to avoid kinking. The distal end-to-side IMA anastomosis is always performed first to the most important coronary artery. With this approach if there is a problem with length or lie of the IMA graft, the sequential anastomosis to the lesser important coronary artery may be aborted. The side-to-side technique is used most often. Postoperative angiograms in 11 patients have revealed no evidence of stenosis, occlusion, or late ill effects.     

Studies on actively allergized cells: IV. Light and electron microscopic studies on the morphology of rosette-forming cells with special reference to plasma cells

A proportion of the plasma cells in lymph nodes of allergized guinea-pigs and mice were found to possess membrane-bound receptors for antigen when tested for rosette-formation at 4° by the suspension-centrifugation technique. This was shown by staining rosetted cells with pyronin-methyl green. Rosette-forming cells of the guinea-pig were further examined by staining with fluorescein-conjugated antigen (rabbit Fab′) and by electron microscopy. By these techniques it was found that many plasma cells which contain antigen-specific intracellular antibodies do not form rosettes, and that cells of the plasmacytic series represented in the rosetted population are limited to plasmablasts and immature plasma cells. The lack of rosette-forming mature plasma cells suggests that a loss of receptors from the cell-membrane occurs as an accompaniment to maturation.     

Effects of a coastal golf complex on water quality,periphyton, and seagrass

The objective of this study was to provide baseline information on the effects of a golf course complex on water quality, colonized periphyton, and seagrass meadows in adjacent freshwater, near-coastal, and wetland areas. The chemical and biological impacts of the recreational facility, which uses reclaimed municipal wastewater for irrigation, were limited usually to near-field areas and decreased seaward during the 2-year study. Concentrations of chromium, copper, and organochlorine pesticides were below detection in surface water, whereas mercury, lead, arsenic, and atrazine commonly occurred at all locations. Only mercury and lead exceeded water quality criteria. Concentrations of nutrients and chlorophyll a were greater in fairway ponds and some adjacent coastal areas relative to reference locations and Florida estuaries. Periphyton ash free dry weight and pigment concentrations statistically differed but not between reference and non-reference coastal areas. Biomass of Thalassia testudinum (turtle grass) was approximately 43% less in a meadow located adjacent to the golf complex (P < 0.05). The results of the study suggest that the effects of coastal golf courses on water quality may be primarily localized and limited to peripheral near-coastal areas. However, this preliminary conclusion needs additional supporting data.     

Genome-wide search for CLN2, the gene causing late-infantile neuronal ceroid-lipofuscinosis (LNCL)

The loci for the juvenile (CLN3) and infantile (CLN1) neuronal ceroid lipofuscinosis (NCL) types have been mapped by genetic linkage analysis to chromosome arms 16p and 1p, respectively. The late-infantile defect CLN2 has not yet been mapped, although linkage analysis with tightly linked markers excludes it from both the JNCL and INCL loci. We have initiated a genome-wide search for the LNCL gene, taking advantage of the large collection of highly polymorphic markers that has been developed through the Human Genome Initiative. The high degree of heterozygosity of these markers makes it feasible to carry out successful linkage analysis in small nuclear families, such as found in LNCL. Our current collection of LNCL pedigrees includes 19 US families and 11 Costa Rican families. To date, we have completed typing with over 50 markers on chromosomes 2, 9, 13, and 18–22. The results of this analysis formally exclude about 10% of the human genome as the location of the LNCL gene. © 1995 Wiley-Liss, Inc.     

Artrhoscopic Rotator Cuff Repair with Augmentation: The V‐sled Technique

Numerous techniques have been described for patch positioning in rotator cuff shoulder arthroscopic surgery. These techniques seem to be difficult challenges for the majority of arthroscopic surgeons, and because of that they are called “highly demanding” techniques. Without the use of dedicated instruments and cannulas, the authors propose a V‐sled technique that seems to be more reproducible, quicker and less difficult to perform for arthroscopic shoulder surgeons. The patient is placed in the lateral position. All arthroscopic procedures are performed without the use of cannulas. The standard posterior portal is used for the glenohumeral (GH) joint arthroscopy with fluid inflowing through the scope. After an accurate evaluation of the GH space, the scope is then introduced into the subacromial space. With the use of a spinal needle, a lateral portal is performed. The great tuberosity is prepared with a bur to place two 5.5 mm triple‐loaded radiolucent anchors. In addition, two free high strength sutures are passed through the muscle, respectively. The repair is performed using two high strength sutures from each anchor. The third wire from each anchor is retrieved out of the accessories portals used for the insertion of the anchors. In addition, two free high strength sutures are passed through the muscle, and the patch sizing is done using a measuring probe introduced through the lateral portal. Next, the patch is then prepared and is introduced into the subacromial space, and then the patch is stabilized, and the free sutures are tied.     

Epidemiology and prevalence of lean nonalcoholic fatty liver disease and associated cirrhosis,hepatocellular carcinoma,and cardiovascular outcomes in the United States: a population-based study and review of literature

Backgrounds

Nonalcoholic fatty liver disease (NAFLD) is linked to obesity and metabolic syndrome conditions. However, a subset of NAFLD patients express a normal or low body mass index (lean NAFLD [L-NAFLD]). Our aim is to compare the prevalence of L-NAFLD to the obesity-associated NAFLD in the United States by assessing prevalence, potential risk factors, liver-related complications, and coronary artery disease outcomes.

Methodology

A multicenter database (Explorys Inc.) of >70 million patients across the United States was screened. A cohort of patients with “nonalcoholic fatty liver” between 1999 and 2021 was identified. Two sub-cohorts of NAFLD patients were identified: those with a body mass index (BMI) < 25 kg/m² (L-NAFLD) and those with a BMI > 30 kg/m² (obesity-associated NAFLD). We excluded patients with age <18 and those who have viral hepatitis, hemochromatosis, Wilson's disease, biliary cirrhosis, alcoholic liver disease, cystic fibrosis, alpha-1-antitrypsin deficiency, and autoimmune hepatitis. Multivariate analysis was performed to adjust for confounders.

Results

68 892 260 individuals were screened. NAFLD prevalence was four per 100 000, and L-NAFLD prevalence was 0.6 per 100 000. Compared with those without, patients with L-NAFLD tended to be older (OR 2.16), females (OR 1.28), and smokers (OR 4.67) and of Asian race (OR 2.12). L-NAFLD patients were more likely to have acute coronary syndromes (OR 30.00) and metabolic syndrome (OR 2.31) despite the normal/low BMI. Esophageal varices and hepatocellular carcinoma risks were high in both cirrhosis patients.

Conclusion

This is the largest study to assess L-NAFLD prevalence in the United States. L-NAFLD are at a significantly higher risk for acute coronary syndromes, esophageal varices, and hepatocellular carcinoma.