Effect of age on outcomes after left ventricular assist device placement.

The influence of age on outcomes after left ventricular assist device (LVAD) implantation is not well studied. To address this question, we assessed 222 patients who underwent LVAD placement and were divided into quartiles based on age (years): group 1, or=60. Eighty-four patients died on LVAD support. Six- and 12-month survivals for the four groups of LVAD patients were 67.7, 73.7, 49.8, and 38.2, and 49.4, 57.3, 42.7, and 26.2, respectively (all P<.01). Older patients showed a higher risk of infections, embolic strokes, and respiratory complications. They were the least likely to undergo reoperations postimplantation (56%, 53%, 50%, 46%, P=.06). After adjusting for baseline differences between the groups, there was a trend toward increasing mortality with age, which did not reach significance (odds ratio 1.93; 95% confidence interval 0.95 to 3.92 for the oldest quartile as compared with the youngest). In conclusion, these results suggest in the absence of other high risk factors, age alone should not be used as an independent contraindication for LVAD implantation.

Left internal mammary artery graft retransplantation from the recipient to the donor heart: a case report.

A case of heart transplantation with concomitant coronary artery bypass graft is reported. The patient was an alternate transplant list candidate with a history of bilateral below-knee amputation and 2 previous myocardial revascularization procedures. The previously used and patent left internal mammary artery graft was successfully removed and retransplanted from the recipient to the donor heart.

Efficacy of an in-feed formulation of ivermectin against somatic larvae of Strongyloides ransomi in pregnant swine.

OBJECTIVE: To confirm that ivermectin fed for 7 days to pregnant sows controls transmission of Strongyloides ransomi larvae to pigs via the colostrum or milk. ANIMALS: 24 mixed-breed sows. PROCEDURE: The sows were infected with 250,000 S ransomi larvae on 3 occasions (days 63, 64, or 65, days 71 or 73, and days 78, 79, or 80 of gestation). Eight sows received ivermectin at a dosage of 100 micrograms of ivermectin/kg of body weight/d from days 92 to 99 of gestation, and 8 sows were treated from days 103 to 110 of gestation; 8 remaining sows received unmedicated vehicle. Numbers of S ransomi larvae were counted in samples of colostrum or milk collected 1, 2, and 7 days after parturition. At 7 and 14 days after parturition, fecal samples were collected from each sow and from 4 pigs from each litter for determination of nematode egg counts; at the latter date, pigs were euthanatized and necropsied for worm counting. RESULTS: Pigs born to ivermectin-treated sows had significantly (P < 0.01) fewer adult S ransomi than did those born to control sows; efficacy was 100%. Treated sows had significantly (P < 0.05) fewer S ransomi larvae in colostrum/milk samples taken 1, 2, and 7 days after parturition than did control sows; efficacy was 100%, with the exception of 1 S ransomi larva found in a milk sample from 1 treated sow at 2 days after parturition. CONCLUSION AND CLINICAL RELEVANCE: Ivermectin fed to sows during the last third of gestation at a dosage of 100 micrograms/kg/d for 7 consecutive days is highly efficacious for control of transmission of infective S ransomi larvae to pigs via colostrum or milk.

Nursing care of a patient with lupus cerebritis.

Systemic lupus erythematosus (SLE) affects a large portion of the population, and over half of all SLE patients suffer from neurologic complications, referred to as lupus cerebritis. Through a patient case presentation, this article covers the pathophysiology, medication administration, and nursing considerations of a patient with lupus cerebritis.