Redo left anterior descending artery grafting via left anterior small thoracotomy: an alternative approach.

Reoperative left anterior descending artery (LAD) revascularization can be performed through a left anterior small thoracotomy (LAST approach) in patients requiring isolated LAD revascularization. If the left internal mammary artery has been previously used, however, the operation is generally performed either through a median sternotomy or through a full posterolateral thoracotomy for the necessity of connecting the vein graft to the ascending aorta or to the descending thoracic aorta, thus losing the advantages of a minimally invasive approach. In the case reported herein, we describe a technique in which reoperative revascularization of the LAD is accomplished through the LAST approach, using the stump of the left internal mammary artery as the inflow site of a saphenous vein coronary graft to the LAD.

Acquired deafness: a multi-dimensional experience.

The aim of this study was to investigate the subjective experience of acquired deafness using quantitative (questionnaire) and qualitative (interview) methods. This paper presents findings from the questionnaire data. Eighty-seven people (of whom 38 had acquired a profound loss) participated in the study. The questionnaire contained items designed to examine both audiological and non-audiological aspects of deafened people's experiences. It also sought to measure the extent to which those aspects affect their quality of life. The questionnaire included three variables (i.e. reported frequency and impact of depression, and overall effect of deafness on one's life) as broad indicators of adjustment. Seventy-three respondents (including all but one of the profound group) completed the questionnaire. Factor analysis of the questionnaire data identified six major themes (with variance > 10%) underlying the personal experience of acquired deafness. Three themes--communicative deprivation, restriction, and malinteraction by hearing people--dealt with observable aspects of respondents' experience. Multiple regression found that these factor themes associated with biomedical variables. The remaining three themes dealt with less tangible aspects of the deafness experience. These themes--feelings of distress in interaction, feelings of abandonment and benefit from positive experiences--did not associate with biomedical variables. Finally, multiple regression indicates that respondents' factor scores predict the impact of deafness at least as strongly as their audiological and social characteristics.

The use of an open-ended questionnaire to identify positive aspects of acquired hearing loss.

The aim of this study was to identify the kinds of positive experiences associated with acquired hearing loss. An open-ended questionnaire was administered to consecutive patients seen in an audiological rehabilitation clinic. Seventy-nine respondents reported positive experiences encountered as a result of hearing loss. Positive questionnaire responses were grouped to themes corresponding to communicative experiences, psychological experiences, social experiences, and professional and technical support. The most commonly reported positive experiences were reduced disturbance by unwanted sounds (26), successful communication strategies (24), affinity for other hearing-impaired and disabled people (17), perceived self-development (13) and using hearing loss to self-advantage (10). Responses were independent of respondents' audiological and social characteristics.