Absence of paradoxical pulse in patients with cardiac tamponade and atrial septal defects.

Five patients with atrial septal defect and proved cardiac tamponade had neither paradoxical pulse nor the inspiratory reduction of left ventricular internal dimension associated with this sign. It is assumed that equilibration of flow across the atrial septal defect prevented paradoxical pulse. Patients with a large atrial septal defect and tamponade do not manifest a paradoxical pulse.     

A method for insertion of a stented xenograft valve in the atrioventricular position.

To facilitate the insertion of prosthetic valves, holders are available which keep the poppet out of the area of suture insertion or keep the open ends of the struts occluded. No such holders are available for use during insertion of xenograft valves, and it seems unlikely that one could be used, for danger of damage to the valve leaflets. To obviate this problem, we have brought the flexible struts together with a suture at the time of insertion. The struts assume their original open position upon cutting the suture.     

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.     

Immunohistochemical detection of carcinoma in radical prostatectomy specimens following hormone therapy

Following hormone therapy, residual carcinoma is frequently difficult to identify on HE-stained prostatectomy specimens. The aim of the present study was therefore to investigate whole-mounted specimens obtained by radical prostatectomy from patients who had undergone hormone therapy. Formalin-fixed and paraffin-embedded specimens were immunostained with prostate secretory cell markers including prostate-specific antigen (PSA), P504S (alpha-methylacyl-coenzyme A racemase, AMACR), P501S (prostein), and prostate-specific membrane antigen (PSMA). Residual carcinoma was detected in 250 histological slides of 42 patients in a total of 497 slides from 45 patients. In five of 250 slides (2%), carcinoma was not able to be recognized on HE-stained slides, but was found on the immunohistochemistry slides. PSMA had reacted positively beyond a moderate degree in carcinoma from all patients. PSA was positive for carcinoma in most of the patients, while negative or minimal staining was observed in a small number of patients. Carcinoma was positively reactive with P504S and P501S in most of the patients, but was negatively reactive in a few. The Gleason score for a pretreatment needle biopsy correlated with P504S staining of the prostatectomy specimens. P504S and P501S had limited ability to identify degenerated carcinoma. PSMA was the most useful marker to identify carcinoma after hormone therapy.