Early and late-phase events after valve replacement with the St. Jude Medical prosthesis in 1200 patients.

From May 1982 to August 1991, 1200 patients underwent valve replacement with the St. Jude Medical (St. Jude Medical, Inc., St. Paul, Minn.) valve: 615 men (51%) and 585 women, mean age 58 years. Preoperatively, 830 patients (69%) were in functional class III or IV. A total of 611 patients (51%) had the aortic valve replaced, 490 (41%) the mitral valve, 2 (0.2%) the tricuspid valve, and 97 (8%) multiple valves. There were 81 hospital deaths (6.8%). Risk factors included older age (p = 0.0001), female gender (p = 0.02), higher preoperative left ventricular end-diastolic pressure (p = 0.05), previous cardiac operation (p = 0.003), longer aortic crossclamp time (p = 0.0001), and longer cardiopulmonary bypass time (p = 0.0001). Follow-up was 98% complete (3153 patient-years). There were 152 late deaths; 32 (21%) were considered valve-related: six thromboembolism, four valve thrombosis, five anticoagulant-related hemorrhage, eight prosthetic valve endocarditis, one paravalvular leak, and seven sudden death. The 5-year actuarial survival was 75%. Risk factors for late death included older age (p = 0.03), lower preoperative ejection fraction (p = 0.005), longer aortic crossclamp time (p = 0.001), longer cardiopulmonary bypass time (p = 0.0001), previous cardiac operation (p = 0.02), and higher preoperative functional class (p = 0.0001). Actuarial freedom at 5 years from major thromboembolic events and anticoagulant-related hemorrhage was 97% and 95%, respectively. This value for valve thrombosis was 99%, for reoperation 96%, for prosthetic valve endocarditis 98%, and for paravalvular leak 96%. Actuarial freedom from all valve-related events and valve-related death at 5 years was 74% and 94%, respectively. We conclude that the low incidence of valve-related events and low mortality supports the continued use of the St. Jude Medical valve.

How certain drugs interfere negatively with the Jaffé reaction for creatinine.

Phenacemide and cephalothin may interfere either positively or negatively with the determination of creatinine by the Jaffé reaction, depending on the analytical system. The drug-picrate chromophores maximally absorb within the first minute of reaction (21 s for phenacemide, 45 s for cephalothin), after which the absorbances decrease. Thus, these drugs negatively interfere in analytical systems involving kinetic measurements when the time interval of measurement includes the period of decreasing absorbance.

Dental hygiene students and the developmentally disabled.

Dental hygiene students from Hudson Valley Community College were introduced to the subject of developmental disabilities during their senior year. Each student received three hours of lecture and spent one afternoon in the dental clinic of the O. D. Heck Developmental Center. The Personal Attribute Inventory was administered to the students before and after the program to determine attitudes about mental retardation. A determination was made as to whether the timing of the visit to the center, relative to the presentation of the lectures, made a difference in students' attitudes. No statistically significant difference in attitudes was found between the beginning and the end of the year, and there were no changes in attitudes attributable to the placement of the lectures vis-à-vis the site visit.

Sedation of the autistic patient for dental procedures.

It would be wrong to draw firm conclusions in this paper, because the methodology was highly subjective. However, the authors are of the opinion that certain conclusions can be drawn: Autistic individuals, even those with wildly aberrant behavior, can frequently receive dental treatment in a routine manner, if adequately sedated. Various sedative drugs may be effective. Combinations of drugs may be successful, where individual drugs have failed. The authors found the combination of Nisentil and Phenergan, supplemented with Vistaril when needed, to be especially effective. N2O-O2 analgesia appears to be beneficial, either alone or as an adjunct to other medications.