Optimizing Venous Drainage Using an Ultrasonic Flow Probe on the Venous Line

The use of smaller cannulae for minimally invasive surgery techniques and/or aggressive miniaturization of the cardiopulmonary bypass (CPB) circuitry has necessitated the need to augment venous drainage to achieve adequate flow rates. Vacuum assisted venous drainage (VAVD) has become the dominant method to augment venous drainage. VAVD, however, has been associated with a number of known side effects including increased transmission of gaseous microemboli to the patient, venous line chatter, and increased arterial to venous shunts in the circuit. Historically, our practice has been to monitor the arterial output flow rate and to monitor VAVD by observing venous line chatter and changes in the venous reservoir level. In 2008 our pediatric cardiothoracic service began monitoring venous line flow rates by using a second ultrasonic flow probe placed on the venous line. After 12 months, our staff perfusionists reviewed the impact of monitoring venous line flow rates on VAVD and its known side effects on daily clinical practice. When monitoring venous line flow rates, empiric observation revealed that less overall vacuum pressure was needed for our CPB cases. This novel approach to monitoring venous drainage has aided us in providing optimal vacuum levels and therefore, may reduce some of the known side effects experienced with excessive VAVD

Storytelling for sustainable development

The use of stories in higher education crosses a number of sustainable development dimensions, including the relationships between humans and the environment, but also for healing and well-being purposes. Although ‘story’ is often used synonymously with the terms ‘narrative’ or ‘narrative inquiry’, others view the notion of ‘story’ as having a special structure and utility (as will be discussed below) (e.g. Gabriel, 2000; Denning, 2011). Moon (2010: i) explains that stories are omnipresent in daily life, and can include “narrative, case study, life history, myth, anecdote, legend, scenario, illustration or example, storytelling and/or critical incident” and can be “‘told’ in many ways – spoken, written, filmed, mimed, acted, presented as cartoons and/or as new media formats”. In relation to sustainable development, Okri (1996) describes the role of the story as being vital to maintaining collective health: "A people are as healthy and confident as the stories they tell themselves. Sick storytellers can make nations sick. Without stories we would go mad”. Similarly, Gersie (1992) argues that storytelling inherently considers our current concerns about the Earth and the future, as it formats our “understanding [of] the many ways in which we value and devalue our beautiful green and blue planet… [the] practical insight into approaches to our most persistent environmental difficulties.” (Gersie, 1992: 1). As such, storytelling in the context of sustainable development is recognised as having a deeply educational function, “passing on accumulated knowledge and traditions of culture” (Stevenson, 2002: 187) in ways which allow for a greater ‘stickiness’ because “stories allow a person to feel, and see, the information, as well as factually understand it … you ‘hear’ the information factually, visually and emotionally” (Neuhauser 1993: 4)

Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion

From July 2004 to June 2005, 19 patients with 25 discs underwent anterior cervical discectomy and interbody fusion (ACDF) in which polyetheretherketone (PEEK) cages were filled with freeze-dried cancellous allograft bone. This kind of bone graft was made from femoral condyle that was harvested during total knee arthroplasty. Patient age at surgery was 52.9 (28–68) years. All patients were followed up at least 1 year. We measured the height of the disc and segmental sagittal angulation by pre-operative and post-operative radiographs. CT scan of the cervical spine at 1 year was used to evaluate fusion rates. Odom's criteria were used to assess the clinical outcome. All interbody disc spaces achieved successful union at 1-year follow-up. The use of a PEEK cage was found to increase the height of the disc immediately after surgery (5.0 mm pre-operatively, 7.3 mm immediately post-operatively). The final disc height was 6.2 mm, and the collapse of the disc height was 1.1 mm. The segmental lordosis also increased after surgery (2.0° pre-operatively, 6.6° immediately post-operatively), but the mean loss of lordosis correction was 3.3° at final follow-up. Seventy-four percent of patients (14/19) exhibited excellent/good clinical outcomes. Analysis of the results indicated the cancellous allograft bone-filled PEEK cage used in ACDF is a good choice for patients with cervical disc disease, and avoids the complications of harvesting iliac autograft