A simple and safe technique of left ventricular venting.

Left ventricular venting has many physiologic and practical benefits. A venting technique is described that employs a simple, closed system which allows the perfusionist to monitor left ventricular distention. By monitoring the left ventricular volume the perfusionist can regulate the degree of negative pressure on the vent and thus reduce the chance of air entering the heart.

Applicability of noncardioplegic coronary bypass to high-risk patients. Selection of patients, technique, and clinical experience in 3000 patients.

Although some surgeons still prefer noncardioplegic coronary bypass, most surgeons are skeptical of its suitability for high-risk patients. We analyzed the first 3000 patients who had primary coronary bypass without cardioplegia since our program's inception. Patients with reoperations, valve operations, or carotid endarterectomies were excluded. Multivariate predictors of operative death included age, sex, left ventricular dysfunction, preoperative intraaortic balloon pumping, and urgency of operation. Eight hundred seventy-nine patients (29%) were more than 70 years of age; 795 (27%) were female; 290 (9.7%) had an ejection fraction less than 0.30, and another 77 (2.6%) had left ventricular aneurysms; 196 (6.5%) had an acute myocardial infarction, and another 397 (13%) had a myocardial infarction less than 1 week preoperatively; 917 (31%) had rest pain in the hospital (preinfarction angina). Only 790 (26%) had elective operations. The overall operative mortality rate was 1.47% (44/3000): The mortality rate for elective operations was 0.5% (4/790); urgent 1.7% (28/1687); emergency 2.3% (12/523). In patients with an ejection fraction less than 0.30 the mortality rate was 6.2% (18/290); with age more than 70 years, it was 3.9% (34 of 879); with acute myocardial infarction it was 3.1% (6/196); and with left ventricular aneurysmectomy it was 1.3% (1/77). Inotropic support after leaving the operating room was needed in 6.6% (199 patients), and 1% (30 patients) required new intraaortic balloon pumping postoperatively (two of these 30 patients died). These results provide reassurance that noncardioplegic coronary artery bypass grafting provides excellent myocardial protection and operating conditions for primary coronary bypass and is particularly suitable for high-risk patients.

Causes, location, and timing of relapse following rigid fixation after mandibular advancement.

The purpose of this study was to evaluate two different groups of patients who underwent bilateral sagittal split osteotomy for mandibular advancement. One group demonstrated no relapse, whereas a second group had documented relapse. The following questions were asked: 1) What factors contribute to relapse? 2) At what site in the mandible is movement seen? and 3) During what period does movement occur? A retrospective lateral cephalometric serial analysis was performed on 50 patients at multiple time intervals. Criteria for a candidate include 1) mandibular advancement surgery with rigid fixation, with or without genioplasty, 2) no maxillary surgery, and 3) relapse of 25% or more of the advancement. Of the 50 patients analyzed, 13 (26%) showed relapse of 25% or more and served as the relapse group. Twelve patients showed no relapse and served as the comparison group. Multiple-regression analysis for the relapse group showed that magnitude of advancement, increasing gonial arc and changing mandibular plane significantly accounted for 84.9% of the variance observed in relapse (P less than .001). Repeated-measures ANOVA showed that the majority of relapse occurred in the first 6 weeks after surgery (68%, P less than .05). Results of a paired t test showed that a significant change occurred in all the linear and angular measures except SN-AR-GO (P less than .05).

A lateral cephalometric analysis of nasal morphology following Le Fort I osteotomy applying photometric analysis techniques.

Fifty patients who had undergone Le Fort I maxillary osteotomies were studied. Cephalograms were available preoperatively and at least 6 months postoperatively. Soft-tissue analysis of the nasal profile was done employing three angles commonly used in the photometric analysis performed for rhinoplasty: nasal tip projection angle, columellar angle, and supratip break angle. Maxillary movement was assessed in two ways: 1) horizontal and vertical component vectors of A-point movement were calculated, and 2) maxillary rotation, defined as the change in the angle of a line drawn from the anterior nasal spine to the posterior nasal spine relative to the anterior cranial base, was calculated. The component vectors of A-point movement and maxillary rotation were then used as predictor variables for change in the soft-tissue angles in a multiple-regression analysis. A weak correlation was found between A-point movement in both the horizontal and vertical dimensions and the nasal tip projection angle. When A-point was moved in an anterior and superior direction, the nasal tip rotated up. The converse was true with movement in the posterior and inferior direction. Only A-point movement in the horizontal dimension had a significant relationship with columellar angle. When A-point was moved in an anterior direction, columellar angle increased. This study shows that prediction of the soft-tissue profile of the nose following maxillary surgery is difficult.

A method for analysis of the detergent-resistant cytoskeleton of cells within organs.

We describe a method for the preparation of the detergent-resistant cytoskeleton and nuclear matrix of cells within organs and tissues. Such cells were previously inaccessible to study because the three-dimensional organization of cells in organs prevented uniform distribution of the detergent throughout the multiple cell layers. We use the method presented here to compare the proteins present in the cytoskeleton, nuclear matrix and soluble fractions of cells from different histotypes. SDS-gel analysis demonstrates that soluble and nuclear matrix proteins differ greatly between histotypes while cytoskeletal proteins are relatively similar. Immunocytochemical analysis of tissue prepared using this procedure also demonstrates that the intracellular structure of cells within organs differs from that of in vitro cultured cells.