Boxing: the preparticipation evaluation

Boxing is a controversial sport that has drawn public and physician criticism since its inception in 900 BC. The American Medical Association has recently taken a formal position to ban boxing because of the alleged dangers, including the possibility of the long-term effect of dementia pugilistica. Proponents of amateur boxing are working diligently to document this claim both as premature and false. They cite amateur boxing's purpose as one boxer's attempt to outpoint or outscore his opponent by utilization of superior strength and skill. Despite this medical and political controversy, thousands of primary care patients are boxing. This report offers the physician guidelines for the preparticipation evaluation. Specific disqualifying conditions are addressed.

[Role of intraoperative echo-Doppler color echocardiography in cardiac surgery. Preliminary study]

Intraoperative echocardiography with Doppler color flow imaging technique can provide the surgeon with an immediate and direct assessment of cardiac anatomy and function. To determine the utility of this recent technique, we have examined 15 patients pre, per, and postoperatively with Doppler color flow imaging. The intraoperative study was performed before and after cardiopulmonary bypass. A sterile transducer was placed directly on the epicardial surface of the heart, and multiple views were recorded. Intraoperative echocardiography with Doppler color flow imaging technique demonstrated excellent correlation with preoperative and postoperative findings, allowing an immediate evaluation of the surgical results. These preliminary results suggest that intraoperative Doppler color flow imaging technique is a valuable adjunct in heart surgery. It is particularly useful in valve repair, and in surgical repair of congenital heart disease.

Extensive aneurysm of the aortic arch and descending aorta. Extra-anatomical reconstruction and exclusion of the aneurysmal sac

A new technique for repair of extensive aneurysm reaching from the ascending aorta to the diaphragm is presented. The operation consists of the reconstruction of the aortic arch and descending aorta and the exclusion of the aneurysmal sac in a single operation. Two successful cases are presented.

ICMSF Methods Studies. XV. Comparison of Four Media and Methods for Enumerating Staphylococcus aureus in Powdered Milk

Four media were examined for their usefulness in enumerating Staphylococcus aureus inoculated (a) into milk that was then dried or (b) directly into dried milk powder. In all, seven strains of S. aureus were inoculated individually into each preparation and were enumerated after two periods of storage (18 to 19 d and 60 to 61 d). Fourteen laboratories from twelve countries participated in the comparison which found that direct plating on agar medium in 14-cm petri dishes may be as useful as enrichment followed by streaking. Plating on Baird-Parker medium or on Hauschild pork plasma fibrinogen medium and a MPN method using Giolitti and Cantoni's broth with Tween 80 were equally sensitive for enumerating S. aureus in dried milk powder. The use of Hauschild medium may eliminate the need for supplementary tests to confirm colonies as S. aureus , but in some cases was found to fail in some laboratories. Giolitti and Cantoni's broth without Tween 80 generally was less useful than the three other media for enumerating S. aureus . S. aureus inoculated into milk that was then dried survived longer than when inoculated into dried milk.

Comparative electrophysiological evaluation of atrial activation and sinoatrial node function following Senning and Mustard procedures: an experimental study

We compared several electrophysiological variables before and after Mustard and Senning procedures in 14 mongrel dogs and made the following three observations. First, after the Senning operation, the atrial activation in the areas of the anterior and middle internodal tracts is undamaged. After the Mustard procedure, however, conduction through the interatrial septum is practically abolished. Both techniques damage the area of the posterior internodal tract. On the whole, there is greater dispersion of atrial epicardial mapping with the Senning operation. Second, several degrees of depression in the sinus node automatism and intraatrial conduction were observed with both techniques. Third, atrioventricular block in various degrees was observed only after the Mustard procedure. The atrioventricular dissociation observed after the Senning operation was dependent on sinus pacemaker dysfunction only. We think that from the electrophysiological point of view, the Senning procedure is a valid alternative for repair of transposition of the great arteries.

Endoscopic sphincterotomy and gall stone removal

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Late embolization of disc occluder of a Beall mitral prosthesis with survival

A case of arterial embolization of a Beall mitral prosthesis disc (model 104) 5 1/2 years after implantation is presented. The patient was referred to use 3 days after the onset of acute symptoms and was immediately operated upon in pulmonary edema and cardiogenic shock. The migrated disc was removed from the abdominal aorta 26 days later, showing marked signs of wear. The postoperative course was complicated and the patient made a slow recovery. It is suggested that patients with models 103 and 104 Beall mitral prostheses be followed very closely and that electric valve substitution should be considered when first signs of prosthetic attrition are noted.

Traumatic ventricular septal defect: a case of early repair and review of the literature

We present a case of traumatic ventricular septal defect following a stab wound of the heart. The patient was operated on within the first 24 hours after being injured, because the hemodynamic situation had deteriorated; he is well 31 months postoperatively. From the literature reviewed, it is apparent that most of such lesions should be corrected early, since these patients are exposed to the continued risk of symptomatic cardiac dysfunction, and repair offers an excellent prognosis with minimal morbidity.

Cardiac echinococcosis: report of 3 cases and review of the literature

Three patients who underwent successful surgical treatment of cardiac hydatid disease are discussed. The nonspecificity of diagnostic measures and the importance of keeping this diagnosis in mind when faced with a patient coming from an area where hydatidosis is endemic are stressed. We propose the use of cardiopulmonary bypass in the surgical treatment of this problem.

Long-term evaluation of venous tissue in the construction of cardiac valves

We present the evolution of venous tissue, used as a mitral or tricuspid prosthesis or in the reconstruction of the right ventricular outlet tract, for periods of up to 18 months. A histological and hydrodynamic study is made of the valves after sacrificing the animals. The venous tissue showed fibrosis, structural disorganization, elastosis, elastorexis and, above all, intense calcification in heavy deposits. Since the venous tissue evolved toward fibrosis and calcification, its use is considered contraindicated.

Anoxic cardiac arrest: Its effect on myocardial mitochondrial metabolism

Forty eight healthy dogs are subjects to cardiopulmonary bypass and divide into two groups according to whether the perfusion is performed in normothermia or moderate hypothermia (30 degrees C). The effects on oxidative phosphorylation and mitochondrial respiration, produced by increasing periods of myocardial anoxia from aortic cross clamping, are studied. A clear correlation is found between the disturbances of mitochondrial metabolism and the future cardiac recovery. Hypothermia shows a protective effect on the anoxic myocardium. It is concluded that the period of absolute safety in cardiac anoxia, as far as mitochondrial function is concerned, is 15 minutes in normal thermic perfusion and 90 minutes in moderately hypothermic ones.

[Acut aortic insufficiency caused by rupture of a normal valve during labor]

We are presenting a case of a young woman with sudden onset of heart failure and several episodes of syncope, after a prolonged labor. The findings at physical examination suggested the diagnosis of acute aortic insufficiency, that was confirmed by cardiac catheterization. At surgery, the aortic valve showed a round perforation in the non coronary cusp. Pathological examination of the valve showed no significant abnormality. We conclude that the stress of labor was the cause of the rupture of a previously normal aortic valve.