Truncus Arteriosus With Patent Ductus Arteriosus and Normal Aortic Arch

In hearts with a common arterial trunk (truncus arteriosus), there is almost always an inverse development of the aortic arch and the ductus arteriosus. Truncus with a normal aortic arch and a patent ductus is a rare echocardiographic and surgical finding. In this report, we describe 2 neonates in whom truncus arteriosus with a normal aortic arch and a medium or large patent ductus was diagnosed by preoperative echocardiography (without catheterization) and confirmed intraoperatively.     

Intravenous Phenylephrine Preconditioning of Cardiac Grafts From Non–Heart-Beating Donors

Background. Hypoxia and warm ischemia produce severe injury to cardiac grafts harvested from non–heart-beating donors. To potentially improve recovery of such grafts, we studied the effects of intravenous phenylephrine preconditioning.Methods. Thirty-seven blood-perfused rabbit hearts were studied. Three groups of non–heart-beating donors underwent intravenous treatment with phenylephrine at 12.5 (n = 8), 25 (n = 7), or 50 μg/kg (n = 7) before initiation of apnea. Non–heart-beating controls (n = 8) received saline vehicle. Hypoxic cardiac arrest occurred after 6 to 12 minutes of apnea, followed by 20 minutes of warm in vivo ischemia. A 45-minute period of ex vivo reperfusion ensued. Nonischemic controls (n = 7) were perfused without antecedent hypoxia or ischemia.Results. Phenylephrine 25 μg/kg significantly delayed the onset of hypoxic cardiac arrest compared with saline controls (9.6 ± 0.5 versus 7.7 ± 0.4 minutes; p = 0.00001), yet improved recovery of left ventricular developed pressure compared with saline controls (57.1 ± 5.3 versus 41.0 ± 3.4 mm Hg; p = 0.04). Phenylephrine 25 μg/kg also yielded a trend toward less myocardial edema than saline vehicle (p = 0.09).Conclusions. Functional recovery of nonbeating cardiac grafts is improved by preconditioning. We provide evidence that the myocardium can be preconditioned with phenylephrine against hypoxic cardiac arrest.(Ann Thorac Surg 1997;63:1664–8)     

Aminoglycoside antibiotics. 7. Dihydrostreptomycin analogues

Dihydrostreptomycin analogues with structural variations in their guanidino groups were prepared. The analogue with a methyl group on the guanidine at C-1 was nearly as active as dihydrostreptomycin against bacteria. However, the 2-imidazolin-2-ylamino substituent at C-1 eliminated activity. No analogue with a substituent on the C-3 guanidino group was active.     

Evidence of Increased Class I MHC Expression on Human Peripheral Blood Lymphocytes during Acute Ethanol Intoxication

Certain ethanol-related diseases in humans have been linked to disorders of immunity. Although humoral and cellular immunity have been studied, the precise mechanisms whereby ethanol use leads to tissue damage remain unknown. In order to explore the hypothesis that ethanol may lead to alteration in expression of tissue Class I major histocompatibility antigen causing an autoimmune phenomenon, a population of acutely ethanol-intoxicated patients was studied. Measurement of Class I major histocompatibility antigen on peripheral blood lymphocytes in this population showed a highly significant (p less than 0.01) increase over controls. The role that this increased antigenicity may play in the evolution of clinical disease is discussed.     

Intraoperative Doppler flow studies: emphasis on colour mapping

Colour Doppler flow imaging (CD) is a well-established method of assessing valvular and congenital disease of the heart. The technique has proven useful intraoperatively in patients undergoing valve repair or replacement or intracardiac reconstruction. In 21 patients with various cardiac anomalies, colour Doppler flow imaging was used intraoperatively, before cardiac cannulation and again after cardiopulmonary bypass. Previously undisclosed features were demonstrated preoperatively in two patients and important residual defects after cardiopulmonary bypass in three others. Adequacy of valve replacement was confirmed in four patients and small leaks in ventricular septal defect patches were shown in another three. The procedure facilitated repair of complex cardiac fistulas in two patients. There were no apparent complications from CD. As intracardiac repairs become more complex, the role of intraoperative CD will expand.     

‘How Do You Remember You Ate…?’: A Delphi Technique Study to Identify Retrieval Categories From Fourth-Grade Children

Objective To develop and validate a consensus set of retrieval categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten during school lunch.Design A Delphi technique study was conducted using 10 psychologists. The subject matter consisted of responses transcribed from interviews conducted with 89 randomly selected fourth graders within 90 minutes of eating. Retrieval categories were evaluated for accuracy by comparing students’ self-reported lunch intake with observation.Statistical analyses For round 1, a centroid hierarchical cluster analysis was used to identify common sets of rating pairs to propose categories for reaching consensus. For rounds 2 and 3, percent of agreement was calculated. Accuracy was tabulated across meal items and student use by retrieval category.Results After round 3, we found that 23 “near-consensus”categories were used by at least eight raters. Six categories were used 60% of the time, 4 were used 20% of the time, and 5 were used 15% of the time. Less frequently used categories were combined with similar, more frequently used categories for a total of 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Of the 16 categories, 12 were used similarly by both accurate and inaccurate students. Where there were differences in accuracy by retrieval category, the more accurate students used “taste/smell/texture”and “visual”in deference to “order items consumed”and “oral cue still present.”Applications These categories provide insight into the broad range of retrieval categories that children use and provide direction for researchers to design and study specific cues to enhance the accuracy of children's self-reports of diet. J Am Diet Assoc. 1997;97:31–36.