Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy

AbstractA retrospective analysis of patients with hypertrophic obstructive cardiomyopathy treated by left ventricular myotomy and myectomy from 1972 to 1994 is reported. There were 158 patients (81 male and 77 female) with a mean age of 50.2 (±17.2) years (range 12 to 80 years). One hundred nine patients (69%) were 60 years of age or younger, and 49 patients (31%) were older than 60 years. The overall mean follow-up period was 6.1 (±4.8) years (range 0.1 to 19.3 years) and was 94% complete with a cumulative total of 956 patient-years. Preoperative exertional dyspnea was present in 84%, chest pain in 70%, presyncope in 54%, syncope in 31%, and cardiac arrest in 5% of patients. Preoperative cardiac catheterization was done in 150 patients, with mitral regurgitation detected in 104 patients (67%). The average maximal provocable left ventricular outflow tract gradient was 118 (±46) mm Hg (range 25 to 250 mm Hg). The average preoperative echocardiographic gradient at rest was 64 mm Hg, 20 mm Hg in the early postoperative period and 10 mm Hg in the late postoperative period. The mean septal thickness was 2.2 (±0.6) cm, 1.9 (±0.7) cm in the early postoperative period (p < 0.05 vs preoperative) and 1.7 (±0.5) cm in the late postoperative period (p < 0.05 vs preoperative). The overall 30-day operative mortality rate was 3.2% (5/158), and 0% for 109 patients 60 years of age or younger. Causes of death included myocardial infarction and left ventricular free wall rupture, myocardial failure from septal perforation, sepsis, cerebrovascular accident caused by thromboembolism, and delayed cardiac tamponade in one patient each. Concomitant coronary artery bypass grafting was performed in 22 patients (19.3% of patients ≥40 years of age) and mitral valve replacement in 5 patients (3.2%). One hundred nine patients (69%) are alive, 10 patients (6.3%) were lost to follow-up, and 39 patients died (24.7%, including operative deaths). Actuarial survivals at 1, 5, 10, and 15 years were 92.4% ±2.2%, 85.4% ±3.1%, 71.5% ±4.6%, and 46% ±9%, respectively. The overall linearized death rate for discharged patients was 1.9%/pt-yr, and for cardiac related deaths it was 1.7%/pt-yr. Thirty-nine (36%) of the 109 survivors received β-adrenergic blockers, and 30 (28%) received calcium channel blockers. Ninety-four patients had improvement in New York Heart Association functional class, 10 had improvement in symptoms but not in functional class, and 5 had no improvement in functional class or symptoms. Neither preoperative hemodynamic values nor routine echocardiographic measurements significantly correlated with quality of postoperative results. Left ventricular myotomy and myectomy is a safe and reproducibly effective operative treatment for medically refractory hypertrophic obstructive cardiomyopathy, especially for patients 60 years of age or younger. Improvement in functional class and symptoms can be expected in nearly all patients. The results of myotomy and myectomy serve as a standard for comparison with other interventions for medically refractory cardiomyopathy. (J THORAC CARDIOVASC SURG 1996;111:586-94

Holography and Cosmological Singularities

Certain null singularities in ten dimensional supergravity have natural holographic duals in terms of Matrix Theory and generalizations of the AdS/CFT correspondence. In many situations the holographic duals appear to be well defined in regions where the supergravity develops singularities. We describe some recent progress in this area.Comment: Anomaly equation corrected. References adde

LIMS Instrument Package (LIP) balloon experiment: Nimbus 7 satellite correlative temperature, ozone, water vapor, and nitric acid measurements

The Limb Infrared Monitor of the Stratosphere (LIMS) LIP balloon experiment was used to obtain correlative temperature, ozone, water vapor, and nitric acid data at altitudes between 10 and 36 kilometers. The performance of the LIMS sensor flown on the Nimbus 7 Satellite was assessed. The LIP consists of the modified electrochemical concentration cell ozonesonde, the ultraviolet absorption photometric of ozone, the water vapor infrared radiometer sonde, the chemical absorption filter instrument for nitric acid vapor, and the infrared radiometer for nitric acid vapor. The limb instrument package (LIP), its correlative sensors, and the resulting data obtained from an engineering and four correlative flights are described

Geometric phases and anholonomy for a class of chaotic classical systems

Berry's phase may be viewed as arising from the parallel transport of a quantal state around a loop in parameter space. In this Letter, the classical limit of this transport is obtained for a particular class of chaotic systems. It is shown that this ``classical parallel transport'' is anholonomic --- transport around a closed curve in parameter space does not bring a point in phase space back to itself --- and is intimately related to the Robbins-Berry classical two-form.Comment: Revtex, 11 pages, no figures

Impaired awareness of action-outcome contingency and causality during healthy ageing and following ventromedial prefrontal cortex lesions

Detecting causal relationships between actions and their outcomes is fundamental to guiding goal-directed behaviour. The ventromedial prefrontal cortex (vmPFC) has been extensively implicated in computing these environmental contingencies, via animal lesion models and human neuroimaging. However, whether the vmPFC is critical for contingency learning, and whether it can occur without subjective awareness of those contingencies, has not been established. To address this, we measured response adaption to contingency and subjective awareness of action-outcome relationships in individuals with vmPFC lesions and healthy elderly subjects. We showed that in both vmPFC damage and ageing, successful behavioural adaptation to variations in action-outcome contingencies was maintained, but subjective awareness of these contingencies was reduced. These results highlight two contexts where performance and awareness have been dissociated, and show that learning response-outcome contingencies to guide behaviour can occur without subjective awareness. Preserved responding in the vmPFC group suggests that this region is not critical for computing action-outcome contingencies to guide behaviour. In contrast, our findings highlight a critical role for the vmPFC in supporting awareness, or metacognitive ability, during learning. We further advance the hypothesis that responding to changing environmental contingencies, whilst simultaneously maintaining conscious awareness of those statistical regularities, is a form of dual-tasking that is impaired in ageing due to reduced prefrontal function.Recruitment and characterisation of individuals with brain lesions was made possible by the Cambridge Cognitive Neuroscience Research Panel at the MRC Cognition and Brain Sciences Unit, Cambridge. We acknowledge the contribution of Dr Sharon Erzinçlioğlu, Prof. Facundo Manes and Dr Tilak Das (consultant radiologist, Addenbroke’s Hospital) for their involvement in co-ordinating the panel, lesion tracing, and referral to the panel. This research was funded by a Wellcome Trust Senior Investigator Award (104631/Z/14/Z) to TWR. Work was completed at the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK, supported by a joint award from the Medical Research Council and Wellcome Trust (G00001354). CO is supported by a National Health and Medical Research Council Neil Hamilton Fairley Fellowship (GNT 1091310). MMV is supported by a Pinsent Darwin Scholarship in Mental Pathology and Angharad Dodds John Bursary in Mental Health and Neuropsychiatry

The Constitutionality of the American Legion Plan to Perpetuate Peace

The popularly named Universal Draft bill espoused by the American Legion was the occasion of extended hearings before the War Policies Commission in March, 1931. During those hearings many questions were raised concerning the powers of the Congress and of the President. The material of this article was incorporated in a memorandum prepared and filed in response to those questions by Mr. McNutt, Mr. O\u27Neil and Colonel Robbins, acting on behalf of the American Legion. Mr. McNutt and Mr. O\u27Neil are Past National Commanders of the Legion and are members of the Indiana and Nebraska bars, respectively. Colonel Robbins is Chairman of the National Defense Committee, former Assistant Secretary of War, and a member of the Iowa bar

The Constitutionality of the American Legion Plan to Perpetuate Peace

The popularly named Universal Draft bill espoused by the American Legion was the occasion of extended hearings before the War Policies Commission in March, 1931. During those hearings many questions were raised concerning the powers of the Congress and of the President. The material of this article was incorporated in a memorandum prepared and filed in response to those questions by Mr. McNutt, Mr. O\u27Neil and Colonel Robbins, acting on behalf of the American Legion. Mr. McNutt and Mr. O\u27Neil are Past National Commanders of the Legion and are members of the Indiana and Nebraska bars, respectively. Colonel Robbins is Chairman of the National Defense Committee, former Assistant Secretary of War, and a member of the Iowa bar

Work-related psychological health and psychological type among lead elders within the Newfrontiers network of churches in the United Kingdom

Building on a series of recent studies concerned with assessing work-related psychological health and psychological type among various groups of church leaders, this study reports new data provided by 134 Lead Elders within the Newfrontiers network of churches in the United Kingdom who completed the Francis Psychological Type Scales (FPTS) together with the two scales of the Francis Burnout Inventory (FBI) concerned with emotional exhaustion and satisfaction in ministry. Compared with other groups of church leaders, Lead Elders within the Newfrontiers network of churches reported lower levels of emotional exhaustion and higher levels of satisfaction in ministry. Compared with other groups of church leaders, there was a higher proportion of extraverts among Lead Elders within the Newfrontiers network of churches. There was only a weak association between psychological type and burnout