The Society for Vascular Surgery: As I remember – An interview with Dr. Michael E. DeBakey

AbstractAs part of the activities to celebrate the first fifty years of the Society, the Celebration Committee decided to conduct a videotape interview of the two surviving founding members: Drs. Michael E. DeBakey and Harris B. Shumacker, Jr. Part of these two interviews will be shown at the 50th Annual Meeting in Chicago. The following transcript is from the interview with Dr. DeBakey conducted by Dr. F. William Blaisdell, Calvin B. Ernst, and James S. T. Yao

The Role of Organizational Culture on a Subculture of Feedback

Der zugehörige Aufsatz wurde nachträglich zurückgezogen und durch folgenden Titel ersetzt: Sylvia J. Hysong: The Role Of Organizational Culture On A Subculture Of Feedback [http://nbn-resolving.de/urn:nbn:de:kobv:83-opus4-54163]The article was replaced with the following article Sylvia J. Hysong: The Role Of Organizational Culture On A Subculture Of Feedback [http://nbn-resolving.de/urn:nbn:de:kobv:83-opus4-54163]Organizational culture has long been studied in relationship to organizational performance, though this relationship has not been established consistently. Martin (2002) suggested the simultaneous existence of a general culture, and multiple, context-specific subcultures in an organization. Are subcultures simply context-specific reflections of the larger organizational culture? Or do they serve as potential moderators of the relationship between the larger organizational culture and organizational performance? To explore this question, we employed ATLAS.ti 6.2 to conduct a content analysis of organizational culture at four United States Department of Veterans Affairs Medical Centers (VAMCs). Sites were selected purposely based on their performance on 15 clinical measures. At each facility we conducted one-hour telephone interviews of the facility director, the director of primary care, and one full-time primary care physician and nurse. Participants answered questions about the types of clinical performance information they receive, and seek out, the utility of such data, and how they use said information. Each site’s culture was highly distinct. However, despite these differences across sites, the mirror relationship between organizational culture and feedback subculture was present in all four sites, suggesting the subculture is a reflection of the parent culture

Ex vivo renal perfusion and autotransplantation in treatment of calculous disease or abdominal aortic aneurysm.

Two more indications are described for temporary ex vivo perfusion of kidneys with revascularization of these organs as autografts to orthotopic or heterotopic locations. One of the patients had staghorn calculi which were removed from a solitary kidney. The other patient had both kidneys autografted in the course of a surgical procedure on an extensive abdominal aortic aneurysm

The Government Contracts Reference Book: A Comprehensive Guide to the Language of Procurement

This book - first published in 1992 and now in its fifth edition - is intended to offer concise, comprehensive information to the practitioner of the art of government contracting. Looking up a key term, the reader can find a definition, followed by a summary of where the term is used in the statutes or regulations dealing with the procurement process. The book also includes references to literature where the term is more fully discussed. The book is not designed as a standalone encyclopedia: it is a first reference, pointing the user to additional sources as needed. The book makes it clear that government contracting is complex, and the rules cannot be gleaned from a single source such as the Federal Acquisition Regulation. They can only be learned from constant reading of reference materials and textbooks—not to mention decisions of the courts, boards of contract appeals, and the Government Accountability Office. Navigating the waters of government procurement is an arduous task, and this book is intended as an aid in that journey. The authors fully understand that it is impossible to make the book fully comprehensive. While this edition is (again) expanded, we know additional terms could be added. We welcome readers to let us know of terms that should be included in the next edition

Left ventricular assist device as bridge to heart transplantation - lessons learned with the MicroMed DeBakey axial blood flow pump

Objective: The MicroMed DeBakey left ventricular assist device (LVAD) axial blood flow pump was used as bridge to heart transplantation (HTx) in patients with terminal heart failure. The aim was to evaluate this novel mechanical circulatory support system in regard to overall outcome. Methods: Prospective study in 15 HTx candidates (mean age 40±7 years) with terminal heart failure and maximal medical treatment due to ischemic cardiomyopathy (CMP, n=5), dilated CMP (n=3), restrictive CMP (n=2), unclassified CMP (n=1), metabolic CMP (n=1), valvular CMP (n=1) and congenital CMP (n=2). All patients were implanted with a MicroMed DeBakey LVAD. A rescue procedure was necessary in eight critical patients, while seven underwent elective LVAD implantation. Procedures were performed via median sternotomy, in normotherm femoro-femoral CPB (mean duration 59±1 min). Oral Marcoumar© (INR 2.0-3.0) and Aspirin© (100 mg daily) were started as soon as possible. Patients were discharged into a specialized rehabilitation clinic from which it was possible to release them home after a few weeks. Results: Successful implantation and discharge from ICU (mean stay 10±7 days) was possible in 11 patients. Seven were transplanted (mean support 50.7 days) and one is awaiting HTx (support >310 days) in the comfort of his home (NYHA I). Survival was 100% among the transplanted patients. Of the seven elective implants, five, and of the eight rescue procedures three patients underwent successful HTx. Four patients died early, while three patients died late on pump support due to intracranial hemorrhage (n=2, 73 and 76 days) and chest infection (n=1, 124 days). All survivors were discharged from hospital, with significant decrease in NYHA class (mean 3.8-2.4 (n=11)). Treadmill testing showed increased exercise tolerance, from 35 to 71 W (n=4). Plasma BNP values (mean 950-162 ng/l (n=4)) and pulmonary resistance (mean 316-194.5 dyne s/cm5 (n=3)) decreased significantly during LVAD support. Conclusions: The MicroMed DeBakey LVAD is simple to implant; outpatient treatment is safe and efficient. Patients' condition and pulmonary resistances normalize within 6 weeks, making previously considered inoperable patients amenable for HTx. HTx can be performed in low-risk situation, allowing better donor-recipient matching and improving overall outcom

Rotary blood pump

A blood pump that comprises a pump housing having a blood flow path therethrough, a blood inlet, and a blood outlet; a stator mounted to the pump housing, the stator having a stator field winding for producing a stator magnetic field; a flow straightener located within the pump housing, and comprising a flow straightener hub and at least one flow straightener blade attached to the flow straightener hub; a rotor mounted within the pump housing for rotation in response to the stator magnetic field, the rotor comprising an inducer and an impeller; the inducer being located downstream of the flow straightener, and comprising an inducer hub and at least one inducer blade attached to the inducer hub; the impeller being located downstream of the inducer, and comprising an impeller hub and at least one impeller blade attached to the impeller hub; and preferably also comprising a diffuser downstream of the impeller, the diffuser comprising a diffuser hub and at least one diffuser blade. Blood flow stagnation and clot formation within the pump are minimized by, among other things, providing the inducer hub with a diameter greater than the diameter of the flow straightener hub; by optimizing the axial spacing between the flow straightener hub and the inducer hub, and between the impeller hub and the diffuser hub; by optimizing the inlet angle of the diffuser blades; and by providing fillets or curved transitions between the upstream end of the inducer hub and the shaft mounted therein, and between the impeller hub and the shaft mounted therein

Bezoar-induced Small Bowel Obstruction

Purpose: The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to in-vestigate the role of abdominal computed tomography (CT) in establishing the diagnosis. Methods: We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. Results: Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47 % (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel’s diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). Conclusion: A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications

Tricholithobezoar Causing Gastric Perforation

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. Trichobezoar is a rare condition seen almost exclusively in young women with trichotillomania and trichotillophagia. When not recognized, the trichobezoar continues to grow, which increases the risk of severe complications such as gastric ulceration and even perforation. Formation of a gallstone within the trichobezoar (tricholithobezoar) is an event that has not yet been described. We report the case of a 22-year-old woman admitted to the emergency room with signals and symptoms of an epigastric mass and perforative acute abdomen. Radiological study revealed bilateral pneumoperitoneum. Personal history revealed depressive syndrome, trichotillomania and trichophagia. With a diagnosis of visceral perforation, an urgent exploratory laparotomy was performed. This confirmed the diagnosis of gastric perforation due to a large trichobezoar with the formation of a gastrolith that was removed by anterior gastrotomy. Biochemical study of the gastric stone revealed that it was composed of bile salts. There were no complications. The patient was discharged on the 5th postoperative day and was referred for psychiatric treatment

Aortic dissection at the University hospital of the West Indies: A 20-year clinicopathological study of autopsy cases

<p>Abstract</p> <p>Background</p> <p>An autopsy study of aortic dissection (AD) at our institution was previously reported. In the approximately 20 years since then, however, many aspects of diagnosis and treatment of this disease have changed, with a fall in mortality reported in many centers around the world. An impression amongst our pathologists that, there might be an increase in the prevalence of AD in the autopsy service at our hospital, since that earlier report, led to this repeated study, in an attempt to validate that notion. We also sought to identify any changes in clinicopathological features between the two series or any occurring during this study period itself.</p> <p>Findings</p> <p>All cases of AD identified at autopsy, during the 20-year period since the conclusion of the last study, were collected and pertinent clinical and pathological data were analyzed and compared, both within the two decades of this study period and against the results of the last study.</p> <p>Fifty-six cases comprised this study group including 36 males and 20 females, with a mean age of 63.9 years. There were, more patients in the second decade (n = 33; 59%) compared with the first decade (n = 23; 41%). Hypertension as a risk factor was identified in 52 (93%) cases and rupture occurred in 49 (88%) cases. A clinical diagnosis of AD was considered prior to surgery or autopsy in 25 (45%) cases overall, more during the second decade. Surgery was attempted in 25% of all cases with an increase in the second decade compared with the first.</p> <p>Conclusions</p> <p>Compared with the earlier review, a variety of changes in the profile of patients with AD in the autopsy service has been noted, including a reversal in the female predominance seen previously. Other observations include an increase in cases where the correct clinical diagnosis was considered and in which surgical treatment was attempted, changes also evident when the second decade of the present study was compared with the earlier decade. Overall, there were many positive trends. However, areas that could still be improved include an increased index of suspicion for the diagnosis of AD and perhaps in the initiation of treatment, earlier, in those cases where the correct diagnosis was considered.</p