Emergency aorto-coronary venous bypass graft in cardiogenic shock

The mortality rate of shock complicating myocardial infarction is extremely high (80-100%) despite intensive medical management. Five patients with acute myocardial infarction and cardiogenic shock received an emergency aorto-coronary bypass graft, from three hours to five days after the onset of infarction and three to nine hours after the onset of shock. Selective coronary angiography was performed in all cases prior to operation. Four of the five patients survived and were discharged from hospital. Two cases with A-V dissociation and complete heart block reverted to normal sinus rhythm after the operation. This limited experience indicates that emergency aortocoronary bypass graft surgery can reduce mortality significantly in properly selected cases of cardiogenic shock.     

Immunoreactive endothelin in human plasma: marked elevations in patients in cardiogenic shock

Endothelin (ET) is a recently discovered, endothelium-derived peptide that may be the most potent vasoconstrictor yet identified. Although there is much interest in the possible systemic actions of circulating ET in vivo, there is no data on ET levels under physiological conditions, or in cardiovascular disease. We used a radioimmunoassay that was sufficiently sensitive to detect ET immunoreactivity (irET) in the SepPak-extracted plasma from 14 healthy volunteers in a range from 0.03 to 0.69 pg/ml (mean 0.26 +/- 0.236 pg/ml). ET levels were not significantly different from normal in 5 patients with stable congestive heart failure (0.46 +/- 0.36 pg/ml). However, irET was increased markedly in 6 patients in cardiogenic shock (3.65 +/- 1.14 pg/ml), and (less so) in 6 patients on chronic dialysis (1.05 +/- 0.41) and in 4 with pulmonary hypertension (1.52 +/- 0.45) (p less than 0.001). The present results suggest that circulating irET concentration is responsive to altered cardiovascular conditions, and therefore support a potential role for ET as a vasoactive hormone.     

Sheep blowfly strike risk and management in Great Britain: a survey of current practice

Abstract.  The methods used for the control of sheep blowfly strike (ovine cutaneous myiasis) and the farm management factors associated with strike prevalence were examined using data from questionnaire survey returns provided by 966 sheep farmers in Great Britain, based on the period between March 2003 and February 2004. Overall, 91% of participants treated prophylactically with insecticides against blowfly strike; 39% treated twice and 11% treated more than three times in the year. Insect growth regulators (IGRs) were the most commonly chosen product (40%), especially the IGR cyromazine. Only 12% of farmers opted to dip their sheep in organophosphate insecticide against fly strike and 2% of farmers reported applying inappropriate products against strike to their sheep, such as ivermectin or 'drenches'. Farmers worming their ewes more often were 0.8 times less likely to report blowfly strike, but those who wormed their lambs more often were 1.2 times more likely to report strike. Pure-breed flocks were 0.7 times less likely to record an outbreak of blowfly strike than cross-breed flocks. Strike was less likely in ewe flocks grazed at higher altitude; however, this relationship with altitude was not seen in lambs. The results show that insecticides remain the primary tool used by almost all farmers to prevent strike and that the type of insecticides used and means of application have altered dramatically over the past 15 years. However, the prevalence of strike has remained almost unchanged over this period. Clearly careful attention to the type and timing of insecticide application, in association with a detailed understanding of the husbandry factors that predispose sheep to higher strike risk, is essential to allow the optimal management of strike problems.     

Role of endothelins in septic,cardiogenic, and hemorrhagic shock

Shock is a condition where blood flow is inadequate for tissue needs. In all forms of shock, the concentrations of endothelins (ETs) are elevated, and they are especially high in septic shock. The rise in ETs plasma levels may initially have some positive homeostatic effects, for ETs can help restore normal vascular tone. However, high levels of ETs compromise the appropriate matching of flow to tissue needs and contribute to the pathophysiology of shock. Attempts at regulating the effects of ETs by the use of pharmacological blockers is made complicated by important interactions between the ETA and ETB receptors and potentially different effects on different tissues. We conclude that antagonism of ET receptors is unlikely to be helpful for cardiogenic or hemorrhagic shock. Furthermore, selective blockade is unlikely to be helpful. However, moderate doses of a mixed ET receptor antagonist may be of use for the management of septic patients.     

Organizing life cycle management in practice: challenges of a multinational manufacturing corporation

Purpose

The environmental life cycle management (LCM) literature proposes many factors considered critical in order to successfully conduct LCM. This study contrasts these vague and general factors proposed as critical to LCM in existing literature, with detailed accounts of LCM in practice.

Methods

A literature review of three related research fields, i.e., LCM, life cycle thinking, and sustainable supply chain management, is contrasted with a study of how LCM is enacted in practice in a large multinational manufacturing company recognized for its LCM work. A qualitative study, with mainly a managerial focus, is conducted based on interviews, workshops, part-time observations, and document studies.

Results and discussion

The literature review demonstrates that the three related research fields provide different accounts of LCM: all apply a holistic environmental perspective, but with different emphases and using largely different research methods. The empirical study shows that integration was a common topic at the studied company and that solutions were often sought in tools and processes. Middle management support proved important, and challenging, in these integration efforts. Challenges identified also included further integrating LCM into departments such as purchasing and sales.

Conclusions

The constant focus on integration at the studied company implies that LCM work is an ongoing effort. Several integration paths are identified: (1) inclusion of sustainability aspects in tools and processes, (2) finding ways to work around certain organizational levels, and (3) using networks and social interaction to create commitment and integration. Although the concept of LCM implies a holistic approach, LCM in practice reveals a lack of a comprehensive overview of LCM-related initiatives and of involved sustainability practitioners within the studied organization.

     

Endomyocardial biopsy: its history,techniques and current indications

Endomyocardial biopsy has found wide application as a diagnostic tool in the practice of cardiology and is of great clinical use in selected cardiac disorders. It is indispensable in the management of cardiac transplant recipients and has become increasingly valuable in the diagnosis of myocarditis and certain cardiomyopathies. Technical difficulties have been overcome, and the procedure is straightforward and of low risk in experienced hands. It is hoped that advances in endomyocardial biopsy will lead to a greater ability of physicians to diagnose and treat cardiac disease.     

Extracorporeal shock wave lithotripsy: the first 50 patients treated in Britain.

Fifty patients have been treated for upper tract urinary calculi by extracorporeal shock wave lithotripsy (ESWL) at the Devonshire Hospital lithotripter centre since November 1984. The average stay for an inpatient was 3 X 7 days. All patients suffered minimal postoperative discomfort and nearly all resumed normal activity within one day after discharge. Complications requiring auxiliary procedures were few. The procedure was found to be safe, cost effective, extremely well received by patients, and superior to all other methods of removing renal stones. This study confirms that treatment by ESWL is a specialised urological procedure that requires operators who are also trained in open, percutaneous, and ureteroscopic surgery and with a back up of a radiological team skilled in percutaneous renal puncture.     

Comparing sources and analysis of uncertainty in consequential and attributional life cycle assessment: review of current practice and recommendations

The International Journal of Life Cycle Assessment - Life cycle assessment (LCA) is intended as a quantitative decision support tool. However, the large amount of uncertainty characteristic of LCA...     

Cytokine medicines in clinical practice: current issues

Cytokine medicines have been licensed for the treatment of rheumatoid arthritis since 2000. The rheumatology community has accrued a large amount of experience in the use of these medications. This experience has led to the development of guidelines for their use that include ongoing vigilance for long term adverse events and efficacy using the Biologics Register. Delivery of these expensive therapies has prompted extensive system developments within rheumatology. The cytokine medicines have provided important tools to probe the pathogenesis of rheumatoid and other inflammatory diseases. Further cytokine medicines, in various stages of development, are on the horizon and continue to stimulate excitement within this fast expanding field.