Off pump coronary artery bypass (OPCAB) in critical left mainstem stenosis—Our experience

Background Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country. It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS) with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery (OPCAB) in patients with critical left main stem stenosis. Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively. 10 patients were high risk with a Euro score of ≥5. Results Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding. There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion to CPB. There was no operative mortality. Inotropes were used in ten cases. Conclusions OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may be managed by Beating heart On Pump (BHOP) technique.     

Disposition and hypoglycaemic action of glipizide in diabetic patients given a single dose of nifedipine

Summary Adrenaline, when administered in dental local anaesthetic solutions, significantly reduces the plasma potassium concentration in young healthy adults. This effect occurs within 10 min of extravascular injections into the maxillary buccal sulcus and may influence the choice of local anaesthetic solution for patients receiving kaliuretic diuretics.     

Liability for infectious diseases in day care: legal and practical considerations

A lawsuit directed by parents at a day care program following an outbreak of infectious disease would most likely be based on the legal theory of negligence--the failure to exercise due care as required by circumstances. In the determination of liability for infectious diseases in child day care, the element of causation is most critical. Did the day care facility's actions or failure to act cause the harm? Another important question is whether an infectious disease can be occupational and under what circumstances. Although worker's compensation laws initially had no provisions for occupational disease, now all states recognize responsibility for them. Awareness of potential problems with legal liability and establishment of procedures to minimize risk are important for day care providers, public health officials, clinicians, and parents.     

Factors affecting Adolescents' behavior and attitudes toward destructive rock lyrics

In a study of rock music preferences, listening/watching behavior, and views on destructive rock lyrics, 894 adolescents in grades 9 through 12 in rural, urban, suburban public, and metropolitan parochial schools were administered a questionnaire. Demographic information on parents was also collected. It was found that 17.5% of the students were fans of rock music with lyrics that promote homicide, suicide, or satanic practices (HSSR). Loglinear and multiple regression analyses were used to analyze the data. Parents' marital status, student sex, race, and school environment (urban, rural, suburban, etc.) were found to be significant predictors of HSSR status. As compared with non-HSSR fans, the HSSR fans were more likely to have parents who were “Never married” or “Remarried” and less likely to have parents in the “married” category. The HSSR fans were more likely to be male, white, and enrolled in urban schools but not parochial schools than expected; HSSR status also significantly predicted other music-related attitudes and behaviors. The HSSR fans reported liking both the sound and the lyrics of rock music more often than did non-HSSR fans, as did females and urban students. The HSSR fans more often felt that children under 10 years of age should be allowed to listen to HSSR lyrics, and they more frequently expressed the conviction that HSSR music does not affect adolescents' homicidal or self-destructive behavior. The HSSR fans and females reported more nearly complete knowledge of lyrics than did non-HSSR fans and males. The HSSR fans reported that they watch more MTV than did any other group except rural students.