The tangential K graft is a comfortable surgical technique aiming to increase cardiac surgeons' versatility in performing multiple arterial grafting using only two arterial conduits. One end of the free graft--either the right internal thoracic artery (RITA) or the radial artery (RA)--is attached to a marginal circumflex branch. Its other end is anastomosed end to side to a diagonal branch. After the left internal thoracic artery (LITA) is attached to the left anterior descending coronary artery, a wide-open side-to-side LITA to free RITA or RA anastomosis--resembling the letter K--is constructed.

TYPE THE WORDS “kidney transplantation” or “heart transplantation” or a similar combination into one of the more robust search engines on the World Wide Web and you will retrieve hundreds of thousands of different sites that refer to the specialty in some manner. Most international and national transplant associations have web sites, and a world of news, research, clinical cases, and statistical data are available on-line over the Internet. The aim of this study was to search international and national transplantation databases

BACKGROUND:The introduction of "fast-track" management into cardiac surgery has significantly shortened the intensive care unit (ICU) length of stay. Readmission to the ICU, traditionally used as a quality index, has not been investigated in these patients. The aim of this study was to assess the causes, risk factors, and outcomes associated with readmission to the ICU. METHODS:All patients undergoing open-heart surgery in a tertiary care, university-affiliated center were included in this prospective observational study. Preoperative and intraoperative data as well as ICU outcome were noted in all patients. RESULTS:Over the 27-month study period,1,613 patients were targeted for fast track management (discharge from ICU on the first postoperative day). The readmission rate was 3.29% (53 patients). Forty-three percent of readmissions occurred within 24 hours of discharge usually because of pulmonary problems (43%) or arrhythmias (13%). Readmission was associated with a prolonged ICU stay (105 +/- 180.0 versus 19.2 +/- 2.4 hours of initial ICU stay) and worse outcome: the only patients who died (6 of 53, 11.3%) were in this group. On multivariate analysis, a Bernstein-Parsonnet risk estimate more than 20 strongly predicted readmission (odds ratio, 3.08; 95% confidence interval, 1.43 to 6.69). CONCLUSIONS:Among a homogeneous group of patients targeted for fast-track management after cardiac surgery, readmission although uncommon is associated with a longer second ICU stay and significant mortality. The recognition of specific risk factors may allow for appropriate modification of the postoperative course.

The right coronary artery (RCA) appears either C-shaped or sigma-shaped during standard angiography. The purpose of the present investigation was to assess whether C-shaped RCAs are associated with more atherosclerotic disease than sigma-shaped RCAs. The study sample comprised 120 consecutive patients who underwent coronary catheterization and multivariate analysis was conducted using several systemic risk factors for atherosclerosis. The proportion of sigma-shaped RCAs found in a group whose angiograms showed little or no obstruction (70%) was significantly higher than that found in the group with significant obstruction (33%, p <0.001). In conclusion, a C-shaped RCA is associated with atherosclerosis.

Twenty-two patients were scanned using a newly released 16-slice CT seamier (Mx8000IDT, Philips) following CABG, using retrospective ECG gating. Excellent graft visualization of all 51 conduits - 46 arterial (28 in-situ left and right ITAs, 15 free right internal thoracic and radial arteries, and 3 in-situ right gastroepiploic arteries) and 5 vein grafts - was achieved. Sixty-nine of the 70 distal anastomoses were found patent. One vein graft was occluded. This new technology was found to be a promising non-invasive measure to evaluate patency of bypass conduits, including GEA where catheterization. is usually difficult. The ability to display the vessel's wall as well as its lumen might distinguish radial artery spasm from intimal hyperplasia. The superb resolution and increased scan length required to cover the entire ITA grafts - from origin to distal anastomoses - can easily be achieved in a single breath-hold owing to increased number of slices per rotation and shortening of the gantry rotation time.

THE OBJECTIVE of all scientific publications regardless of their type or size, is the international exchange of knowledge and new ideas. The United States, Germany, United Kingdom, Japan, and European countries are the leading contributors to medical science. In particular, the contribution of individual countries may depend on factors such as the language spoken and the population size. Organ transplantation in Israel is a therapeutic modality for end-stage organ diseases. The number of transplantations has increased since 1963. In the present study, we evaluated the contributions of Israel and of other nations in the field of organ transplantation according to their population size.

BackgroundHigh-quality postoperative imaging of bypass conduits is essential when evaluating different types of conduits, anastomoses, and surgical techniques. We investigated the potential value of the newest generation of multidetector-row computer tomographic scanners in assessing bypass grafts.MethodsFrom June to September 2002, 14 patients underwent scanning with a newly released 16-slice computed tomographic scanner (Mx8000 IDT; Philips Medical Systems) after coronary artery bypass grafting. Four patients had had minimally invasive direct coronary artery bypass grafting and 3, redo coronary artery revascularization. Contrast-enhanced computed tomographic angiography was performed using retrospective electrocardiographic gating. Scan length was 22 to 30 cm, and total scan time was 27 to 37 seconds.ResultsOf the 14 patients, 8 were scanned within 1 week after operation and 6, 1 month to 12 months postoperatively. Average heart rate during the scan was 82 beats per minute (range, 60 to 97 beats per minute), and all patients were able to hold their breath for the required time. Thirty conduits were studied: 26 arterial (18 in situ left and right internal mammary artery grafts, five free right internal mammary and radial artery grafts, and three in situ right gastroepiploic artery grafts) and four vein grafts. Excellent visualization of all 30 grafts was achieved. Thirty-four of the 35 distal anastomoses were patent; one vein graft was occluded.ConclusionsThis new technology is a promising noninvasive measure to evaluate patency of bypass conduits, including the gastroepiploic artery where catheterization is usually difficult. The ability to display the vessel wall as well as its lumen might distinguish radial artery spasm from intimal hyperplasia. The superb resolution and increased scan length required to cover the entire internal mammary artery grafts—from origin to distal anastomoses—can be achieved easily in a single breath-holding owing to the increased number of slices per rotation and shortening of the gantry rotation time.