An Empirical Study on Using Visual Embellishments in Visualization.

In written and spoken communications, figures of speech (e.g., metaphors and synecdoche) are often used as an aid to help convey abstract or less tangible concepts. However, the benefits of using rhetorical illustrations or embellishments in visualization have so far been inconclusive. In this work, we report an empirical study to evaluate hypotheses that visual embellishments may aid memorization, visual search and concept comprehension. One major departure from related experiments in the literature is that we make use of a dual-task methodology in our experiment. This design offers an abstraction of typical situations where viewers do not have their full attention focused on visualization (e.g., in meetings and lectures). The secondary task introduces "divided attention", and makes the effects of visual embellishments more observable. In addition, it also serves as additional masking in memory-based trials. The results of this study show that visual embellishments can help participants better remember the information depicted in visualization. On the other hand, visual embellishments can have a negative impact on the speed of visual search. The results show a complex pattern as to the benefits of visual embellishments in helping participants grasp key concepts from visualization.

Ultra-low dose aprotinin decreases transfusion requirements and is cost effective in coronary operations.

BACKGROUND: The recommended dose of aprotinin has been shown to reduce blood loss and need for blood transfusions, but the cost precludes its routine use. This study was designed to determine whether a less expensive, ultra-low dose of aprotinin is effective when used in coronary artery bypass grafting with left internal mammary artery. METHODS: Patients (n = 202) were randomized to receive either placebo or aprotinin, 0.5 million KIU before incision and 0.5 million KIU during initiation of cardiopulmonary bypass. Differences in quantity of blood transfused were analyzed. Further groups were analyzed to account for the effect of aspirin. Multivariable analysis was performed to determine risk factors for transfusion. Direct costs of blood products and aprotinin were tabulated for each group. RESULTS: There was an important reduction in the proportion of patients transfused, and number of blood units transfused when aprotinin was given before coronary artery bypass grafting. These differences were even more important in patients on aspirin preoperatively. Independent predictors for increased number of transfusions were aspirin continued before operation, smaller body surface area, and the use of placebo instead of ultra-low dose aprotinin. There was no difference in morbidity between treatment groups. There was a reduction in direct costs associated with the use of aprotinin. CONCLUSIONS: These data support the routine use of aprotinin 1 million KIU in coronary artery bypass grafting with left internal mammary artery to reduce cost and transfusion requirements.

Modification of the Fontan procedure. Superior vena cava to left pulmonary artery connection and inferior vena cava to right pulmonary artery connection with adjustable atrial septal defect.

BACKGROUND: A modification of the Fontan procedure with unidirectional cavopulmonary connection is described in which the superior vena cava (SVC) is connected to the left pulmonary artery (PA) and the inferior vena cava (IVC) is connected to the right PA via a lateral tunnel with a snare-controlled, adjustable atrial septal defect (ASD). This allows matching of the SVC and IVC flows with the lung of appropriate size. The obligatory left Glenn shunt provides an adequate arterial oxygen saturation, and the elevation in SVC pressure is well tolerated. The adjustable ASD allows selective decompression of the IVC that maintains cardiac output and reduces fluid accumulation in the serous cavities. METHODS AND RESULTS: Since March 1992, we have performed this procedure in 18 patients. There were 17 children and 1 adult. Median age was 3 years and 9 months (range, 13 months to 36 years). Six patients had been staged with a previous bidirectional Glenn shunt. Preoperative cardiac catheterization revealed a PA pressure of 13 +/- 2 mm Hg and a transpulmonary gradient of 5 +/- 3 mm Hg. Ventricular function was satisfactory in all patients. At the completion of bypass, the pressures in the SVC and IVC were 16 +/- 4 mm Hg and 10 +/- 3 mm Hg, respectively (P < .01). The left atrial pressure was 6.0 +/- 3.0 mm Hg and the arterial O2 saturation on 100% oxygen was 93 +/- 3%. There was one death as a result of intractable atrial arrhythmias. The remaining 17 patients had a mean hospital stay of 9.7 days (6 to 18 days). The length of pleural drainage was 7 +/- 3 days. The ASD was adjusted in 11 patients before discharge. Oxygen saturation at discharge was 85.4 +/- 4%. Nine patients had repeat catheterization. The ASD was completely closed in 6 patients, an average of 2.5 months after surgery (range, 3 weeks to 5 months). After ASD closure, the arterial oxygen saturation was 96 +/- 3%, and the SVC and IVC pressures were both 13 +/- 3 mm Hg. CONCLUSIONS: The Fontan procedure with unidirectional cavopulmonary connection and adjustable ASD has several advantages that may reduce mortality and morbidity for the high-risk Fontan candidate.

Aortic implantation of anomalous left coronary artery. An improved surgical approach.

Anomalous origin of the left coronary artery from the pulmonary artery may present a technical challenge. Direct implantation of the anomalous left coronary artery into the aorta to provide a two coronary artery system is the preferred surgical approach. We describe a modification of this technique to allow anastomosis of the anomalous left coronary artery with the excised button of pulmonary artery from within the lumen of the aorta. We have used this procedure in six children and one adult with anomalous left coronary artery with favorable outcome. The potential benefits of this modified technique are (1) improved operative exposure, (2) ability to implant the anomalous left coronary artery in the appropriate sinus, (3) avoidance of aortic valve damage or distortion because of improved exposure, and (4) applicability to patients of all ages.

Aortic to right ventricular shunt for pulmonary atresia and intact ventricular septum.

Acute or chronic myocardial ischemia may develop in patients with pulmonary atresia with intact ventricular septum and right ventricular-dependent coronary circulation. In such cases an aorta to right ventricle shunt may be used to reverse this ischemia. This report summarizes our experience with the placement of an aortic to right ventricular shunt in 5 patients. The shunts were made of Gore-Tex and ranged from 4 mm to 8 mm. Associated procedures were bidirectional Glenn (n = 2) and Fontan (n = 2). All 5 patients survived the procedure with documented early graft patency and no evidence of ischemia.

Conversion of atriopulmonary to cavopulmonary anastomosis in management of late arrhythmias and atrial thrombosis.

The original atriopulmonary connection or "classic" Fontan operation is associated with several late complications such as arrhythmias, right atrial dilatation, and thromboembolism. This report describes our experience with 3 patients who presented with the acute onset of atrial arrhythmias and upon further evaluation were found to have significant hemodynamic lesions. After failing medical management, all 3 patients were treated successfully with surgical conversion of their atriopulmonary connection to a lateral tunnel cavopulmonary Fontan. The postoperative course of these patients was uneventful. However, long-term evaluation is needed to assess the efficacy of this technique in the prevention of postoperative morbidity.

Early and late results of mitral valve repair in children.

Mitral valve repair in children has the advantage of avoiding mitral valve replacement with its attendant need for anticoagulation and reoperation. Seventy-nine children between the ages of 2 months and 17 years (mean 4.9 years) underwent mitral valve repair between May 1982 and April 1993. There were five patients with mitral stenosis and 74 patients with mitral regurgitation, and 19 children were less than 2 years of age. Patients were divided into anatomic subgroups on the basis of the primary cardiac pathologic condition. Forty-three had severe mitral regurgitation, 21 had moderate mitral regurgitation, and 12 patients with primum atrial-septal defect and 2 patients with univentricular hearts had minimal to moderate mitral regurgitation. Associated cardiac anomalies were present in 68 patients and 85% of the patients required concomitant intracardiac procedures. The methods of mitral valve repair included annuloplasty in 68 (86%), repair of cleft leaflet in 41 (52%), chordal shortening in 9 (11%), triangular leaflet resection in 8 (10%), splitting of papillary muscles with resection of subvalvular apparatus in 7 (9%), and chordal substitution in 1 (1%). The technique of annuloplasty was modified to allow for annular growth. Follow-up was available from 1 to 10 years (mean 4 +/- 2.5 years). There were three early deaths (4%), all occurring as a result of low output cardiac failure in patients with minimal postoperative mitral regurgitation. Three late deaths (4%) occurred in patients with persistent moderate to severe mitral regurgitation and progressive cardiac failure and eight patients (10%) required either rerepair or replacement of the mitral valve. Actuarial survival was 94% at 1 year, 84% at 2 years, and 82% at 5 years, and actuarial freedom from reoperation was 89% at 8 years. All patients received postoperative echocardiography with 82% having minimal to no mitral regurgitation and 98% of long-term surviving patients being free of symptoms. We conclude that mitral valve repair can be done with low early and late mortality. The need for reoperation is relatively low and valve growth has occurred with the use of a modified annuloplasty.

Expression of major histocompatibility antigens and vascular adhesion molecules on human cardiac allografts preserved in University of Wisconsin solution.

The impact of cold storage of cardiac allografts on expression of major histocompatibility complex antigens and vascular adhesion molecules is not known. We obtained serial endomyocardial biopsy specimens at harvest, on implantation, and approximately 15 minutes after reperfusion from six consecutive human cardiac allografts stored in University of Wisconsin solution. Cold ischemia time was 187 +/- 45 minutes. A fourth endomyocardial biopsy specimen was obtained from the recipients of cardiac allografts 1 week after operation. Expression of major histocompatibility complex antigens and vascular adhesion molecules was studied by immunohistochemistry. The intensity was scored blindly by a semiquantitative method. On vascular endothelial cells, the expression of major histocompatibility complex class I and II antigens was strong; ICAM-1 expression was moderate, and expression of VCAM-1 and ELAM-1 was weak to absent. The expression of these antigens on vascular endothelial cells did not change in sequential biopsy specimens. The expression of major histocompatibility complex class I antigens on myocardial cells was weak and remained unchanged. Myocardial cells did not express major histocompatibility complex class II antigens, ICAM-1, VCAM-1, or ELAM-1 on serial examinations. During cold storage of cardiac allografts in University of Wisconsin solution, the expression of major histocompatibility complex antigens and vascular adhesion molecules on endothelial cells and myocardial cells remains unchanged.

Traumatic chylothorax: a case report.

A case of traumatic chylothorax following a motor vehicle accident is presented. This is a rare injury following thoracic trauma and is associated with a high mortality and morbidity. Mechanisms of injury to the thoracic duct are described. A management strategy is suggested, which initially entails a trial of conservative therapy of adequate drainage, total parenteral nutrition (TPN) and total gut rest. If significant chyle losses persist after 2 weeks, surgery is indicated, as immunological factors may complicate recovery. The recommended surgical technique is transthoracic duct ligation directly or at the hiatus.

"High-flow" priapism: treatment with superselective transcatheter embolization.

Hemodynamically, most cases of priapism occur as a result of venous outflow obstruction producing engorgement of the corpora cavernosa. In a small number of patients, however, the cause is uncontrolled arterial inflow, often from direct arterial trauma. The authors report two cases of arterial or "high-flow" priapism that were successfully treated with selective transcatheter embolization with autologous clot.

The stoichiometry and location of troponin I- and troponin C-like proteins in the myofibril of the bay scallop, Aequipecten irradians.

Localization and quantification studies were carried out on bay-scallop (Aequipecten irradians) striated-muscle troponin C- and troponin I-like proteins. Indirect immunofluorescence microscopy of scallop myofibrils stained with either rabbit anti-(scallop troponin I) or anti-(scallop troponin C) antibodies shows staining of all I-bands observed. The results of quantification studies using sodium dodecyl sulfate poly-acrylamide-gel electrophoresis of untreated scallop myofibrils, washed scallop myofibrils, and isolated scallop thin filaments indicate an actin/tropomyosin/troponin-C molar rationn of 7:1:1. The molar ratio for troponin I could not be determined in untreated myofibrils because of interfering bands; in washed myofibrils a value of 0.6 mol of troponin I/mol of tropomyosin was found. Purified scallop troponin C binds Ca2+ and interacts with scallop troponin I to relieve troponin I-induced inhibition of actomyosin ATPase. Although scallop troponin C is an acidic protein, it appears to be less acidic than troponin C from higher organisms. A calmodulin-like protein has been isolated from scallop striated muscle that activates bovine brain phosphodiesterase to the same extent as does brain calmodulin. Its amino acid composition and its electrophoretic mobility on alkaline 6 M-urea/polyacrylamide gels differs from that of scallop troponin C, and it appears not to be associated with thin filaments.

A singular dermatosis of Mongols.

A long-term, erythematous, follicular papular dermatosis affecting the presternal and interscapular skin was found to occur in subjects with Down's syndrome. One hundred seventy-four subjects (110 male and 64 female) were surveyed. The condition was seen in 46% of the males, with the highest incidence in patients who were between 20 and 40 years of age; the condition was rare in the females. Our findings suggest that this condition is much commoner than any other abnormal skin feature described in the literature on Down's syndrome.