Racism as a clinical syndrome.

This paper examines the clinical effects of racism on its targets and, in particular, on its agents, the individuals who, wittingly or not, partake of the culture of racial privilege. It proposes a paradigm shift in regard to the clinical study of racism, and presents a structural model of racism, analogous to addiction as a disease, which holds that racism has an etiology and a clinical taxonomy that lends itself to differential diagnosis and treatment of those who manifest symptoms.

Aortic root replacement with the freestyle stentless porcine aortic root bioprosthesis.

BACKGROUND: Stentless porcine prosthetic valves offer several advantages over traditional valves. Among these are superior hemodynamics, laminar flow patterns, lack of need for anticoagulation and perhaps improved durability. METHODS: One hundred and twelve patients were operated on from September 17, 1992 to April 13, 1998 as part of a multi-center worldwide investigation. All patients received a total aortic root replacement. Patients were evaluated postoperatively at discharge, 3 to 6 months, and yearly by clinical exam and color flow Doppler echocardiography. RESULTS: There were 4 deaths either in the hospital or within 30 days after surgery for an operative mortality of 3.6%. No patients experienced structural valve deterioration, non-structural valve deterioration, paravalvular leak, unacceptable hemodynamic performance, or postoperative endocarditis. The linearized rates for survival and thromboembolic complications at 5 years were 82.8% and 90.5% respectively. Excellent hemodynamic function is demonstrated by very low gradients, large EOA, and an exceedingly low incidence of any aortic regurgitation. CONCLUSIONS: The Medtronic Freestyle aortic root bioprosthesis can be used safely to replace the aortic root for aortic valve and aortic root pathology. Root replacement allows optimal hemodynamic performance with no significant aortic regurgitation. Early and intermediate results are encouraging, but further follow-up is needed to determine valve durability.

Current treatment of traumatic aortic disruptions.

Eighteen patients with traumatic disruptions of the descending thoracic aorta were treated at the Wake Forest University Medical Center from 1979 through 1986. Their preoperative evaluation and operative management are presented, with emphasis being placed on methods for preventing complications related specifically to aortic cross-clamping. Two patients died, for an operative mortality of 11 per cent. One of the two patients had exsanguinating hemorrhage with profound shock on the way to the operating room; in the second patient, the aorta was occluded just beyond the disruption, and there had been no distal perfusion for several hours before operation. Four patients (22%), three of whom had not had a shunting procedure, had major neurologic complications relating to the spinal cord. Thus, shunting procedures during repair of descending aortic disruption appear to offer some protection from neurologic deficits.