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This study investigated and compared the risk factors and outcomes of patients undergoing coronary artery bypass graft surgery with and without the occurrence of prolonged mechanical ventilation. Data in a cardiac surgery database were examined retrospectively. Data selected included any isolated coronary artery bypass graft surgery performed by the surgical group from August 2005 to June 2009. The resulting cohort included a total of 2933 patients which was comprised of 116 patients with a ventilation time of greater than 72 hours (prolonged ventilation) and 2817 patients with a ventilation time of 72 hours or less (no prolonged ventilation). Patients with a prolonged ventilation time were matched (1:3 ratio) to patients not requiring a prolonged ventilation time by year of surgery resulting in our study cohort of 464 patients. To generate the unadjusted risks of each factor, χ2and t test analysis were performed. Logistic regression analysis was then used to investigate the adjusted risk between cases and controls and each of the significant variables. χ2and t tests were conducted comparing cases and controls with the outcome variables. Patients undergoing coronary artery bypass graft that experienced a prolonged ventilation time (cases) were more likely female, had a New York Hospital Association functional class of III or IV, and had a longer perfusion time. There was no significant difference between cases and controls with diabetes, chronic obstructive pulmonary disease, left ventricular ejection fraction, or body mass index while controlling for all significant risk factors. Careful patient selection and preparation during preoperative evaluation may help identify patients at risk for prolonged mechanical ventilation and thus help prevent the added morbidity and mortality associated with it.

Follicular neoplasms of the thyroid are a frequent indication for surgery of the thyroid gland. We evaluated the use of frozen sections on intraoperative decision-making, possible avoidance of reoperative surgery, and histologic findings in a retrospective cohort. A database was created of all thyroid operations from 2001 to 2007. Data collected included age, gender, preoperative cytology, indication for surgery, surgeon, intraoperative decision-making, and histologic findings. Of the 723 thyroidectomies, 203 were performed for follicular neoplasms diagnosed by fine needle aspiration. Of these, 135 had cytology reports available within our electronic medical record; 44 per cent (59 of 135) of these patients had an intraoperative frozen section. Only two of 59 (3.4%) were positive for carcinoma, both of which were papillary carcinomas. One was interpreted as “suspicious” for carcinoma by the pathologist. In these three cases, the surgeon proceeded with total thyroidectomy at the time of initial surgery. The results of frozen section altered the operation in only three of 59 cases (5.1%). Intraoperative frozen section rarely impacts the conduct of thyroidectomy for follicular neoplasms.

This study was conducted to prospectively assess if there are any outcome differences between patients undergoing coronary artery bypass graft surgery with and without diabetes. This is an 11-year, prospective, hospitalization cohort study. Data were collected on 225 variables. A total of 8935 patients were available for our analysis (6023 nondiabetics, 319 diet-controlled diabetics, 1636 diabetics on oral medications, 957 insulin-controlled diabetics). Compared with nondiabetics, diet-treated diabetics possessed four significant comorbidities, diabetics treated with oral medications possessed 12 significant comorbidities, and insulin-treated diabetics possessed 13 significant comorbidities ( P < 0.05). There was no significant difference between diet-treated diabetics and nondiabetics for all outcomes. Diabetics treated with oral medications possessed a longer length of stay [relative risk (RR), 1.09; CI, 1.08–1.10], longer intensive care unit length of stay (RR, 1.56; CI, 1.12–2.00), and more intraoperative complications (RR, 1.42; CI, 1.12–1.66). Insulin-treated diabetics possessed more neurological complications (RR, 2.39; CI, 1.52–3.77), wound complications (RR, 2.42; CI, 1.19–4.95), and renal complications (RR, 2.43; CI, 1.70–3.49), longer length of stay (RR, 1.20; CI, 1.14–1.27), and longer intensive care unit length of stay (RR, 1.33; CI, 1.16–1.48). In diabetics undergoing coronary artery bypass graft surgery, as their diabetes progresses from diet treated with oral medications to insulin-dependent, this is associated with more comorbidities at surgical presentation and more morbidity after surgery.

Objective The purpose of this study was to demonstrate the feasibility of simple to complex endoscopic robotic mitral valve repair, using a lateral approach. Methods Data were retrospectively collected on 201 patients undergoing a lateral “ports only” endoscopic robotic mitral valve repair at three institutions. Techniques of aortic occlusion included the endoaortic balloon or a transthoracic clamp. The efficacy of the repair was measured intraoperatively by transesophageal echocardiogram. Results Two hundred one patients with a mean age of 55.2 ± 14.2 were intended to undergo elective robotic mitral valve surgery. One hundred eighty-six (92.5%) were scheduled for a repair procedure and 15 (7.5%) were scheduled for replacement. The repair was accomplished in 179 of 186 (96.2%) of patients. Eight patients (4.3%) required a conversion to sternotomy incision. Seven converted patients received a mitral valve repair and one received a replacement mitral valve. Mitral valve pathology included 10% isolated anterior leaflet involvement, 43% isolated posterior leaflet involvement, and 6% bileaflet pathology, and the remaining patients had dilated annulus, chordal rupture, or elongation. One hundred seventy-nine patients (96.2%) had regurgitation grade of 0 to 1 after repair. Two patients (1%) died. Other adverse events included reoperation for valve-related complications, 2 of 201 (1%); reoperation for cardiac-related complications, 3 of 201 (1.5%); and new onset of atrial fibrillation, 35 of 201 (17.4%). Conclusions A lateral endoscopic robotic approach to mitral valve repair is safe, feasible, and can be performed consistently with acceptable postoperative results. Further follow-up is required to determine the long-term efficacy of this approach to robotic mitral valve repair.

With the goals of creating a better match between medical students and general surgery programs and providing a program that is desirable to medical students who are interested in pursuing careers in surgery, a survey was designed to categorize student interests and to determine what factors are used in choosing a general surgery program. The survey focused on the reasons that surgical resident candidates select a program. Each statement was rated for importance on a 5-point scale, and then the top 10 statements were ranked in order of importance. The survey was distributed to 19 community hospitals, 23 university programs, and medical students interviewing for surgical residency. A total of 286 surveys were returned from 18 programs and medical students. The statements with the three highest ratings were “amount of operative exposure,” “diversity of operative cases,” and “perceived relationships among faculty and residents.” “Amount of operative exposure,” “diversity of operative cases,” and “ability to pursue fellowship training after residency” received the top rankings. There was a significant difference between men and women in the ratings of three statements. However, there was no difference with the ranking of the statements. There was also a significant difference between residents early and late in their training on ratings of five statements and on the ranking of two statements. The ratings of six statements were significantly different between community and university programs. A significant difference between types of program was also found with the rankings of four statements. There was a difference between small and large programs on two ratings of statements and one ranking. This data provides a useful resource for programs and candidates in preparing for candidate/residency selection.

We sought to assess predictors and outcomes of sternal wound complications in patients after coronary artery bypass grafting (CABG). A nested, case-control study from a 10-year hospitalization cohort with prospective data collection was conducted. Included in the cohort were patients age 18 and above undergoing CABG surgery between March 1997 and July 2003 (n = 7889). Patients who underwent any surgery other CABG were excluded. Cases were matched to controls 1:3 on year of surgery. Cases were CABG patients with sternal wound complications, which was defined as requiring antibiotics and/or topical treatment, requiring extra nursing care, dehiscence, or requiring surgical intervention (n = 89). Controls were CABG patients without sternal wound complications (n = 267). The study examined 29 risk factors and 10 outcome variables. Univariate analysis on the risk factors revealed 10 significant risk factors. Logistic regression analysis was conducted and the risk factors that significantly predicted sternal wound complications after CABG surgery included older age (odds ratio [OR] = 0.85, 95% confidence interval [CI] 0.808–0.892), previous CABG surgery (OR = 3.9, 95% CI 1.03–15.37), and in class three or four of the New York Heart Association functional class (OR = 2.8, 95% CI 1.27–6.12). There was a significant difference between CABG patients with and without sternal wound complications on nine outcome variables. Of the 29 predictors of post-CABG sternal wound infections being examined, 10 proved to be significant. Further analysis demonstrated only three variables that significantly predicted sternal wound complications. Older age, previous CABG surgery, and class three or four of the New York Heart Association functional class predispose CABG patients to sternal wound infections.

Our objective was to assess surgical outcomes between male and female patients undergoing off-pump coronary artery bypass grafting (CABG). The study was conducted from a 10-year hospitalization cohort (n = 11,230) in which the data were collected prospectively. Inclusion criteria included an off-pump CABG-only procedure. There were 526 men and 250 women included in the study. Fourteen potential confounding risk factors and 14 outcome variables were examined. Six potential risk factors were found to be significantly different between men and women. Men were younger (P = 0.014), had a larger body surface area (P < 0.001), a higher creatinine level (P < 0.001), required more grafts (P < 0.001), and were more likely to have a cerebrovascular history (P = 0.020) and a history of tobacco use (P ≤ 0.001). Logistic regression analysis showed that even after controlling for age, body surface area, creatinine level, number of grafts, and tobacco history, women had longer length of hospitalization (odds ratio, 1.97; 95% confidence interval, 1.28–3.04, P = 0.002) and more sternal wound complications than men (odds ratio, 1.07; 95% confidence interval, 1.01–2.11, P = 0.028) after off-pump CABG. Although not statistically different, women had lower operative mortality than men after off-pump CABG (0.8% [2 of 10] compared with 1.5% [8 of 10], respectively). Despite women requiring a longer hospitalization and having a greater incidence of sternal wound infections than men, there was no significant difference in mortality.

The objective of this study was to establish a complete computerized calculation of the Simplified Acute Physiology Score (SAPS) II within 24 hours after admission to a surgical intensive care unit (ICU) based only on routine data recorded with a patient data management system (PDMS) without any additional manual data entry. Score calculation programs were developed using SQL scripts (Structured Query Language) to retrospectively compute the SAPS II scores of 524 patients who stayed in ICU for at least 24 hours between April 1, 1999 and March 31, 2000 out of the PDMS database. The main outcome measure was survival status at ICU discharge. Score evaluation was modified in registering missing data as being not pathological and using surrogates of the Glasgow Coma Scale (GCS). Computerized score calculation was possible for all investigated patients. The 459 (87.6%) survivors had a median SAPS II of 28 (interquartile range (IQR) 13) whereas the 65 (12.4%) deceased patients had a median score of 43 (IQR 16; P a O 2/ FiO 2 ratio (34%), and neurological status (34%). Using neurological diagnoses and examinations as surrogates for the GCS, a pathological finding was seen in only 8.8% of all results. The discriminative power of the computerized SAPS II checked with a receiver operating characteristic (ROC) curve was 0.81 (95% confidence interval (CI): 0.74–0.87). The Hosmer-Lemeshow goodness-of-fit statistics showed good calibration (H=5.55, P=0.59, 7 degrees of freedom; C=5.55, P=0.68, 8 degrees of freedom). The technique used in this study for complete automatic data sampling of the SAPS II score seems to be suitable for predicting mortality rate during stay in a surgical ICU. The advantage of the described method is that no additional manual data recording is required for score calculation.

Compliance has been an overlooked area in occupational therapy practice and research. Compliance with progressive relaxation training for recurrent headache relief was determined for 10 children. A multiple baseline across subjects design was used. Baseline periods were assigned randomly and ranged from 7 to 25 days with treatment introduced in a time-staggered fashion. Subjects received a 6-week program that included weekly training sessions supplemented with daily home practice. Compliance was determined by the subject's correct recording of a password randomly placed on a cassette relaxation tape. Mean compliance across subjects was 84% (range: 36% to 100%). Noncompliance occurred 74% of the time when subjects reported being headache-free for that day. Eight of the subjects had a 2% to 30% (mean: 15%) increase in headache-free days. This study indicated that compliance with relaxation training does not result consistently in headache relief. Guidelines for the occupational therapist's assessment of patient compliance with treatment regimens are provided. Results and implications for future research also are discussed.

Headaches are one of the most common somatic complaints among adults and children. This study investigated the effects of thermal biofeedback-assisted relaxation training on adult and child tension, migraine, and mixed (migraine and tension) headache disorders. A multiple baseline design across three adult and four child participants was used and multiple outcomes were assessed including participants' records of headache duration and severity, medication intake, and downtime because of headaches. To corroborate participants' records of headache activity, family members independently recorded headache occurrences, and medication intake was corroborated by investigators' pill counts of headache medications. After treatment, reductions in headache duration and severity, downtime, and medication intake were noted for all participants, with four of seven participants headache-free at 1-year follow-up. The results are compared with previous studies and methodological issues are discussed, particularly the need to corroborate self-report measures in headache studies.

By standardization of both metallic and absorbent electrode material, an iontophoretic method has been developed which permits the detection of histamine in dilutions as high as 1:5,000,000 by the formation of wheals in the human skin.1 The method has been serviceable in the development of a procedure for assaying histamine in human, rabbit, and guinea pig blood. Thus, histamine can be assayed directly in the blood of rabbits killed by the intravenous administration of histamine. Only 0.1 cc. of blood is required.When histamine is administered by the galvanic current so that a wheal forms in the human skin, the positive pole is applied to force the positively charged histamine ions into the skin. It has now been found that if the negative pole be applied to the surface of the wheal formed by the scratch or by the iontophoretic method, sufficient histamine is transported out by this reversal of iontophoresis to form secondary wheals in new areas of the skin. In this way, histamine has been recovered from w...