Preoperative Saphenous Vein Mapping for Coronary Artery Bypass

Saphenous vein mapping by real-time duplex ultrasound scanning allows for the confirmation of the presence of patent vein and determination of the anatomical course of the vein prior to aortocoronary bypass procedures. This technique has proven to be of value in patients whose veins are not evident by physical examination and in those whose length of conduit may be limited by previous vein stripping or thrombophlebitis.     

Colonic ischemia after aortic reconstruction

Colonic ischemia after aortic reconstruction is rare, but when it occurs in its worst form it carries a 50% death rate. The etiology and pathogenesis of this condition demonstrate that in many instances it may be prevented. Early recognition, particularly of the transmural ischemic injury, is essential. Numerous techniques used during surgery for assessing the adequacy of colonic perfusion have been evaluated and found to be cumbersome and inaccurate in terms of predicting colonic ischemia. Recent experience with the use of the pulse oximeter appears promising in identifying patients with inadequate colonic perfusion who may then be candidates for reimplantation of the inferior mesenteric artery.     

A comparison of two cytotoxicity assays for the detection of metabolism-mediated toxicity in vitro: a study with cyclophosphamide

The cytotoxicity to V79 Chinese hamster fibroblasts of cyclophosphamide (CPA) metabolites, generated by rat-liver S9 fractions, has been compared in two assay systems with different endpoints of toxicity, namely, reduction of cloning efficiency and inhibition of cell growth. The two assay systems were found to be equally sensitive in detecting the metabolism-mediated cytotoxicity of CPA and gave similar ID50 values. Further studies confirmed the cytochrome P-450 enzyme requirement for the bioactivation of CPA to cytotoxic metabolites. CPA activation was mediated by phenobarbitone-inducible forms of cytochrome P-450, but not by beta-naphthoflavone-inducible forms.     

Atrial fibrillation with neonatal pulmonary lymphangiectasia

A female infant born at 28 weeks' gestation was found to have mild hydrops foetalis. Initial echocardiography showed a structurally normal heart. During the first week of life, episodic atrial tachycardia with 1:1 or 2:1 conduction was seen, requiring therapy with digoxin. The infant remained ventilator dependent, with a persistent, chylous pleural effusion which contained a preponderance of lymphocytes. Congenital pulmonary lymphangiectasia (CPL) was confirmed histologically. Worsening episodes of atrial tachycardia, including episodes of atrial fibrillation, were further investigated and a repeat echocardiogram revealed thickening of the entire right atrial wall. The cardiac findings of a thickened right atrial wall with the histological signs of myocarditis were thought to be the cause of paroxysms of atrial fibrillation, an extremely rare arrhythmia in the neonatal period. To the authors' knowledge there have been no previous reports of CPL in association with the cardiac abnormalities described herein.     

Classroom procedures for remediating behavior disorders

Numerous effective interventions for the control of behavior problems in the classroom have been developed. These have included relatively simple strategies such as providing contingent attention for appropriate behaviors and social reprimands or timeout for inappropriate behavior. Behavior control procedures have grown in sophistication to involve more complex systems such as token economies, skill straining strategies, peer interventions, and self-control procedures. Each technique has proved effective in improving classroom behavior, however, the combination of multiple techniques has had the most powerful effects on students. The ultimate goal of remediating complex behavior disorders such that appropriate behavior generalizes across new settings and events will require more comprehensive programs and continued analysis of new and promising practices.     

Postoperative gastric aspirations reduced by glycopyrrolate during upper abdominal surgery.

Glycopyrrolate is shown to reduce the incidence of large volumes (more than 40 ml) of postoperative gastric contents, but not the pH, after major abdominal operations and reduce the consequent risk of regurgitation. It should be preferred to atropine during these procedures.     

Obstructive jaundice. Causes and surgical interventions

Biliary obstruction can be caused by a number of conditions and can occur in persons of all ages. In every case, prompt diagnosis affords the best opportunity for surgical therapy. Accurate preoperative diagnosis can be difficult because benign and malignant causes may appear similar radiographically. Options in surgical management can be as simple as extraction of a solitary common duct stone or as extensive as pancreaticoduodenectomy or hepatectomy and liver transplantation. Because of the risk of infection with biliary surgery, prophylactic antibiotic treatment should be considered.