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Background: The prevalence of rotator cuff repair continues to rise, with a noted transition from open to arthroscopic techniques in recent years. One reported advantage of arthroscopic repair is a lower infection rate. However, to date, the infection rates of these 2 techniques have not been directly compared with large samples at a single institution with fully integrated medical records., Purpose: To retrospectively compare postoperative infection rates between arthroscopic and open rotator cuff repair., Study Design: Cohort study; Level of evidence, 3., Methods: From January 2003 until May 2011, a total of 1556 patients underwent rotator cuff repair at a single institution. These patients were divided into an arthroscopic repair group and an open group. A Pearson chi-square test and Fisher exact test were used, with a subgroup analysis to segment the open repair group into mini-open and open procedures. The odds ratio and 95% CI of developing a postoperative infection was calculated for the 2 groups. A multiple-regressions model was then utilized to identify predictors of the presence of infection. Infection was defined as only those treated with surgical intervention, thus excluding superficial infections treated with antibiotics alone., Results: A total of 903 patients had an arthroscopic repair, while 653 had open repairs (600 mini-open, 53 open). There were 4 confirmed infections in the arthroscopic group and 16 in the open group (15 mini-open, 1 open), resulting in postoperative infection rates of 0.44% and 2.45%, respectively. Subgroup analysis of the mini-open and open groups demonstrated a postoperative infection rate of 2.50% and 1.89%, respectively. The open group had an odds ratio of 5.645 (95% CI, 1.9-17.0) to develop a postoperative infection compared with the arthroscopic group., Conclusion: Patients undergoing open rotator cuff repair had a significantly higher rate of postoperative infection compared with those undergoing arthroscopic rotator cuff repair., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Elemental mercury (Hg(0)) is a metal with a number of atypical properties, which has resulted in its use in myriad anthropogenic processes. However, these same properties have also led to severe local subsurface contamination at many places where it has been used. As such, we studied the influence of various parameters on Hg(II) sorption onto pyrite (pH, time, Hg(II) concentration), a potential subsurface reactive barrier. Batch sorption studies revealed that total Hg(II) removal increases with both pH and time. X-ray absorption spectroscopy analysis showed that a transformation in the coordination environment at low pH occurred during aging over 2 weeks, to form an ordered monolayer of monodentate Hg-Cl complexes on pyrite. In column studies packed with pure quartz sand, the transport of Hg(II) was significantly retarded by the presence of a thin pyrite-sand reactive barrier, although dissolved oxygen inhibited Hg(II) sorption onto pyrite in the column.

Many states are replacing microbiological water quality standards based on "fecal" or thermotolerant coliforms (ThCs) with new standards that employ Escherichia coli as the indicator organism. Implicit in these new standards are assumptions about the equivalence of E. coli enumeration tests and the E. coli levels that will provide protection equivalent to former ThC standards. To investigate these assumptions, E. coli levels in split samples (tests conducted on portions of the same grab sample) collected from small urban streams were determined using enzyme-specific media (Colilert, m-ColiBlue24, and nutrient agar with MUG) and compared to levels determined with conventional culture media (m-FC and m-TEC). Although levels observed with all tests were highly correlated, significantly fewer E. coli were enumerated with m-TEC than with enzyme-specific media (paired Student's t-test, alpha>99%). In addition, E. coli were found to comprise a larger fraction (84-104%, depending on the test) of the total presumptive ThC concentration than that suggested by the United States Environmental Protection Agency (63%). Both of these observations (1) the improvement in E. coli yields observed with enzyme-specific media, and (2) the greater proportion of ThC organisms that are E. coli, indicate that more water quality violations will occur when enzyme-specific media are used for testing than if conventional culture media are used.

Background: Few thrombolytic studies have assessed whether patient age is an indication for routine postlytic cardiac catheterization and revascularization or evaluated the impact of age on 1-year outcome differences after acute myocardial infarction., Methods and Results: A secondary analysis of 3339 patients enrolled in the TIMI II trial was performed to identify differences in clinical and coronary angiographic findings and 1-year cardiac event rates among 841 patients < 50 years old, 1639 patients 50 to 64 years old, and 859 patients 65 to 75 years old. Differences in 1-year clinical outcome were assessed among patients randomly assigned to an invasive or a conservative postlytic strategy within each age group. The percentages of patients with a prior history of myocardial infarction, angina, congestive heart failure, hypertension, or diabetes mellitus or an infarction complicated at the time of study entry by shock, pulmonary edema, hypotension, rales more than one third of lung fields, or atrial fibrillation as well as the percentage of female patients (all P < .001) increased with age. Fewer older patients (65 to 75 years) received early (ie, < or = within 2 hours after symptom onset) treatment with recombinant tissue-type plasminogen activator (rTPA), and fewer were eligible for random assignment to immediate or deferred beta-blocker therapy (P = .01). The location of the infarct-related artery and the percentage of patients with patent (ie, TIMI flow grade 2 or 3) or "complete" (ie, TIMI flow grade 3) infarct-related artery flow did not vary with age. The percentage of patients with multivessel disease was greatest in the older patients (P = .001). Cumulative 1-year mortality was low in the youngest patients (2.8%; 99% confidence interval [CI], 1.6% to 4.7%) regardless of whether the infarct location was anterior (3.7%) or nonanterior (1.6%). The highest 1-year mortality occurred in the older patients (13.6%; 99% CI, 10.9% to 16.9%), particularly when the infarct location was anterior (18%). The 42-day rates of reinfarction (P = .85), death (P = .95), or death or reinfarction (P = .99) were similar in patients assigned to the invasive or conservative postlytic treatment strategy, regardless of age group., Conclusions: Among patients with acute myocardial infarction treated with intravenous rTPA, heparin, and aspirin, there were age-related differences in time to treatment with thrombolytic therapy, use of beta-blockers, extent of coronary artery disease, and 1-year cardiac event rates. Routine use of cardiac catheterization and coronary revascularization does not improve immediate or 1-year outcome in terms of mortality or reinfarction compared with a more conservative strategy in young, middle-aged, or elderly patients similar to those enrolled in TIMI II.

Background: We report the results of the Heparin-Aspirin Reperfusion Trial, a collaborative study comparing early intravenous heparin with oral aspirin as adjunctive treatment when recombinant tissue plasminogen activator (rt-PA) is used for coronary thrombolysis during acute myocardial infarction., Methods: Two hundred five patients were randomly assigned to receive either immediate and then continuous intravenous heparin (starting with a 5000-unit bolus; n = 106) or immediate and then daily oral aspirin (80 mg; n = 99) together with rt-PA (100 mg intravenously over a six-hour period) initiated within six hours of the onset of symptoms. We evaluated the patency of the infarct-related artery by angiography 7 to 24 hours after beginning rt-PA infusion, the frequency of reocclusion of the artery by repeat angiography on day 7, and ischemic or hemorrhagic complications during the hospital stay., Results: At the time of the first angiogram, 82 percent of the infarct-related arteries in the patients assigned to heparin were patent, as compared with only 52 percent in the aspirin group (P less than 0.0001). Of the initially patent vessels, 88 percent remained patent after seven days in the heparin group, as compared with 95 percent in the aspirin group (P not significant). The numbers of hemorrhagic events (18 in the heparin and 15 in the aspirin group) and recurrent ischemic events (8 in the heparin and 2 in the aspirin group) were similar in the two groups., Conclusions: Coronary patency rates associated with rt-PA are higher with early concomitant systemic heparin treatment than with concomitant low-dose oral aspirin. This observation has important implications for clinical practice and should be considered in the design and interpretation of clinical trials involving coronary thrombolytic therapy.

The use of drafting film in creating pen and ink medical illustrations is generally superior to scratch board. Effects of scratch board may be duplicated with drafting film. In addition, the cost per page is lower, transfer time is saved, and the film is completely erasable without damage to the working surface.

201Thallium (201Tl) perfusion scintigraphy was performed in 22 patients with first acute transmural myocardial infarction within the initial 12 h after onset of symptoms. The size of the abnormally perfused area on 201Tl images was estimated by visual analysis and by a computer-assisted technique. 201Tl values for infarct size were compared to a biochemical estimate of infarct size using the cardiac specific esoenzyme creatine kinase-MB (CK-MB) and total creatine kinase (CK). Estimates of myocardial damage obtained from the visual and computer-assisted analysis of the 201Tl images showed a statistically significant correlation with the enzymatic estimates of infarct size. These results suggest that quantitative evaluation of 201Tl image defects may provide useful information regarding the degree of myocardial damage in the very early stages of acute infarction before biochemical estimates of infarct size are available, and that sequential imaging with 201Tl might provide an independent method of monitoring evolutionary changes in myocardial damage.

In summary, it should be stated that there is a basic philosophic difference concerning the importance and the treatment of cardiac arrhythmias in postoperative patients when compared to patients with myocardial infarctions. In the latter group the etiology for the arrhythmia is assumed, and very frequently correctly. In the former group of patients, the postoperative group, the etiology of the arrhythmia is often covert and difficult to come by. In patients with myocardial infarction treatment frequently is stereotyped and the effect of therapy often predictable. In the postoperative patient with a cardiac arrhythmia, be it tachycardia or an irregular pulse, the treatment may be as varied as the cause. Thus the thrust of our endeavor in the postoperative patient should be directed primarily toward determining the cause of the arrhythmia and thereafter administering correct therapy based on a reasonable diagnosis.

The impact of age on hospital mortality, incidence of major hemorrhagic events and transfusion requirements was examined in 756 patients with acute myocardial infarction enrolled in the Thrombolysis in Myocardial Infarction (TIMI) Phase I, open label studies and the TIMI Phase II pilot study. The mortality rate significantly increased with age and was 3.5%, 11.5% and 12% in patients less than 65, 65 to 69 and 70 to 76 years of age, respectively (p less than 0.001). Logistic regression analyses selected female gender, diabetes mellitus, extensive coronary artery disease, history of congestive heart failure, continuing chest pain immediately after recombinant tissue-type plasminogen activator (rt-PA) administration, low systolic blood pressure at the time of admission and advanced age as variables predictive of in-hospital death. The incidence of major hemorrhagic events among patients not undergoing cardiac surgery during hospitalization was 8.7%, 14.5% and 24.7% in patients aged less than 65, 65 to 69 and greater than or equal to 70 years, respectively (p less than 0.001). The majority of hemorrhages were secondary to cardiac catheterization or puncture wounds. Variables related to a major hemorrhagic event included protocol, age, rt-PA dose/kg body weight and elevated diastolic blood pressure on admission. Of five intracranial bleeding events, three occurred in patients greater than 65 years. Transfusion requirements significantly increased with age (p less than 0.001). Reperfusion status at 90 min in the TIMI Phase I and open label studies A to C was similar in the three age groups studied and ranged from 60% to 71%.(ABSTRACT TRUNCATED AT 250 WORDS)