bluuebunny/crossref_metadata_2025 huggingface dataset:
Laser Doppler Blood Flow Monitoring in Reconstructive Vascular Surgery: Case Studies
Authors: Svensson Henry , Bergqvist David , Takolander Rabbe
Published: November 2007

Laser Doppler flowmetric (LDF) measurements were performed preopera tively and postoperatively in patients undergoing arterial reconstruction in the lower limb, and intraoperatively in patients undergoing abdominal aortic re construction.

In 21 instances of successful arterial reconstruction in the lower limb, post operative LDF values from the skin of the foot were significantly higher than those obtained preoperatively. In 4 instances, depressed LDF values immedi ately after surgery clearly heralded thrombotic complications.

In 5 patients operated upon for occlusive disease of the aorta, LDF values from the skin of one foot were significantly higher at the end of surgery than those obtained when surgery was started. In 2 cases of aneurysm, LDF values decreased but distal pulses were normal. In 2 of these 7 patients, intraoperative embolization was instantly detected. In 1 case of severe microembolization from an aortic aneurysm, a low and unchanged LDF value was recorded throughout the reconstructive procedure, indicating thrombosis of the microvasculature.

These observations indicate that laser Doppler flowmetry is useful in recon structive vascular surgery to determine the patency of reconstructed vessels and also to detect thromboembolic complications during and after operation.
Vascular Surgery in Senescence Carotid Endarterectomy in Patients over 70 Years
Authors: Madsen Poul Vasehus , Schroeder Torben , Engell Hans Christian
Published: November 2007

In order to evaluate the immediate and long-term results of carotid endar terectomy in patients over seventy years of age, 54 patients undergoing a total of 59 surgical procedures were followed for a mean time of forty-three months. There was no operative mortality. Perioperative central neurological complica tions developed in 18 patients (33%), 9 (17%) of whom suffered permanent neurological deficits. During the follow-up period we found an annual stroke rate of 5% according to life table arialysis. The five-year survival rate was 67%. At termination of follow-up or before death, 85% of the patients lived indepen dently in their own homes. Compared with younger age groups, carotid endar terectomy in senescence yielded poorer results in terms of immediate and late neurological status. The old patients had, however, the same life expectancy as a contemporary age- and sex-matched population and had to a remarkable degree been able to maintain an independent life.
Abdominal Aortic Aneurysm and Horseshoe Kidney: Evaluation and Surgical Management— A Case Report
Authors: Harman P. Kent , McCullough James L. , Johnson Alan M. , Mentzer Robert M.
Published: November 2007

This report describes the successful repair of a ruptured abdominal aortic aneurysm (AAA) associated with a horseshoe kidney (HK). The operative man agement of this problem is discussed. The preoperative evaluation of patients in whom an AAA and HK are known to coexist, the indications for elective aneu rysm resection, and the operative management of this problem are examined.
Primary Angiosarcoma of the Heart. A Case Report and Review of the English Literature
Authors: Allam Charles , Shikhani Alain , Slim Michel S. , Takla Lama J. , Malouf Joe F.
Published: November 2007

Primary angiosarcoma of the heart is a rare tumor. In view of its variable clinical picture, the diagnosis is delayed and often difficult to establish without an open biopsy.

In the majority of cases the tumor originates from the right atrium, metasta sizes early to distant sites, and carries a rapidly fatal outcome. The clinicopath ologic features and the methods of diagnosis for this highly malignant neoplasm are reviewed and a new case is reported.
Hemodynamic Study After Mechanical Dilatation of Femoral Arteriovenous Fistulas Constructed in Dogs
Authors: Rodriguez-Moran Manuel , Fernandez-Temprano José M. , Lozano Francisco , Cuadrado-Idoyaga Fernando , Serrano Eduardo , Gomez-Alonso Alberto
Published: November 2007

Perioperative blood flow, blood flow velocity, arterial diameter, and venous diameter are factors with known influence in survival with arteriovenous fistu las (AVF).

Twenty-four femoral AVFs were constructed in 12 dogs. The fistulas were randomly divided, and in half of them the vein and the artery were mechani cally dilated (in an extension of 23 cm) with a Fogarty or Foley catheter.

After dilatation, perioperative blood flow, blood flow velocity, and arterial diameter were greater in the dilated group when compared to the nondilated group (p < 0.005, p < 0.005, p < 0.025 respectively). In the dogs reoperated at day 30, similar results were observed and also venous diameter was greater in the dilated fistulas (p < 0.05).

In conclusion, simple mechanical dilatation of a long venous and arterial segment improved most of the factors that have influence in AVF patency and improved the maturation of the AVF vein. We believe that it would be useful for the construction of arteriovenous fistulas in uremic patients.
Arterial Injuries Associated with Fractures in Civilian Practice
Authors: Wali Hassan T. , Molokhia Farouk A. , El-Amrawy Ahamed , El-Henawi Moustafa , Hamza Mohamed , Naga Rafat , Salem Mohamed
Published: November 2007

Sixty-two patients with arterial trauma and fractures or dislocations are re ported, half of the cases acute. The average age was 26.4 years, and 92% were males. Car accidents, blunt trauma, and bullets were the common injury agents. Thrombosis, pulsating hematoma, and complete transection were the main acute arterial lesions, and false aneurysms, chronic occlusions, and trau matic AV fistulas were the main chronic lesions. Fractures of the lower limb (64.5%) were more common than those of the upper limbs (25.8%), and hence, so were arterial lesions. Arterial reconstruction was made in every case, and venous repair was needed in 51.6% of cases. Reduction and casting was done in (51.6%) of cases, and internal fixation was needed in 40.3%. The amputation rate was 8.1%, and the mortality rate was 1.6%.
New Device to Avoid Life-Threatening Complications of Subclavian Vein Puncture
Authors: Rao G.
Published: November 2007

Because of improvement of the leads, the use of dual-chamber pacing is increasing. Usually, two leads are required, and these are introduced through the cephalic vein. However, some physicians prefer puncture of the subclavian vein for insertion of leads. But two major complications have been reported with this technique: major air embolus and massive hemorrhage. The author describes a new apparatus designed to avoid these complications.
Tactics on Investigation of the Venous Dynamics and Their Validation Before and After Operations in the Deep Veins of the Lower Limb
Authors: Psathakis Nikolaos D. , Psathakis Dimitrios N.
Published: November 2007

Investigation of the deep venous system of the lower limb must mainly aim to elucidate its capabilities. Because deep venous incompetence is necessarily con nected with a popliteal reflux accounted for by valvular incompetence of the popliteal vein, its presence must be clarified. An isolated valvular incompetence of the femoral vein without popliteal incompetence is of no clinical significance and should be disregarded. Only patients with popliteal reflux detected by Dop pler ultrasound require a further examination by venous pressure measure ments and by phlebography. An operation in the deep veins is admissible only when a popliteal reflux > 40%, and ambulatory venous pressure > 60 mmHg, a refilling time < 15 sec, a venous insufficiency > 20%, and a patency or recanalization of the deep venous > 70% have been confirmed. A correlation between venous pressure and Doppler recordings has been done.
Determinants of Gastrointestinal Complications in Aortic Surgery
Authors: Sheng F.C. , Burns R. , Baker J.D. , Machleder H.I. , Quinones-Baldrich W. , Moore W. , Busuttil R.W.
Published: November 2007

Gastrointestinal complications after aortic surgery are unusual; conse quently, their natural history has not been adequately defined. The authors reviewed 505 cases of aortic reconstruction done over a fourteen-year period in order to assess the clinical significance of postoperative gastrointestinal compli cations on outcome and to determine if there were preoperative or operative predictive factors for the development of such complications. There were 37 cases of gastrointestinal complications (7.3%). No significant difference was found between the complication rates after aneurysm resection versus aortic bypass for occlusive disease. Overall, the complication rates were: small bowel obstruction, 2.2%; gastrointestinal hemorrhage, 1.6%; small bowel ischemia, 1.2%; and colon ischemia, abdominal abscess, local trauma, pancreatitis, aor toenteric fistula and jaundice, each < 1%. More than one half of the complica tions occurred during the same hospitalization. Forty-three percent (16/37) were treated surgically, and these had a mortality of 44% (7/16) as opposed to 10% (2/21) for those with complications not requiring operation. Overall mor tality as a direct result of gastrointestinal complications was 24% (9/37) versus less than 5% for those patients not having such complications. Significant corre lation for gastrointestinal complications occurred with: emergency operation, and postoperatively, positive urine and blood culture, steroid administration, white blood cell count greater than 12,000, and creatinine greater than 1.5 (p < 0.05). When patients aged sixty or older were analyzed separately, signifi cant correlation was also found with ruptured aorta, emergency operation, inci dental GI operation, preoperative adhesions and postoperative fever (p < 0.05). Analysis by computerized logistic regression in this group showed that ruptured aorta, incidental GI operation, increased duration of surgery, higher age, and the use of bifurcation grafts were all of significance synergistically in the predic tion of gastrointestinal complications. The authors conclude the following: (1) The incidence of gastrointestinal complications after aortic surgery is low, but when these occur, the mortality is fivefold greater. (2) The occurrence of gastro intestinal complications may be predictable preoperatively in selected patients. (3) Those complications requiring operative intervention have a higher mortal ity.
Early and Late Results in the Surgical Treatment of Phlegmasia Cerulea Dolens
Authors: Alemany José , Marsal Teresa
Published: November 2007

A series of 408 patients with acute thrombosis in the iliofemoral area was operated on over the last fourteen years. The operative indication and prognosis depend on localizing the origin and duration of the thrombus. We differentiate among three type of thrombosis: iliofemoral, sapheno-femoro-iliac, and femo roiliac.

The duration of the thrombi varied from three to thirty days. In the first and second type, there is a great danger of pulmonary embolism. In such cases, operative treatment is indicated. In the third type of thrombosis, the confluent point is ascendingly obliterated. There is little danger of pulmonary embolism, for the peripheral pressure is not raised. Intraoperative prophylaxis for embo lism by means of a balloon catheter placed contralaterally is not necessary. Of this group, 284 patients were followed up over a period of one to fourteen years. Good results were seen following thrombectomy of type I and II throm bosis. The third type of thrombosis showed worse results.

In type I and II thrombosis, fibrinolysis can easily cause pulmonary embo lism, for the peripheral venous pressure is high, but in thrombosis of the third type, the danger of pulmonary embolism is relatively small. The results of fi brinolysis in this ascending type are better than the results of surgery.
Femoral Nerve Paralysis and Prolonged Survival After Ruptured Abdominal Aortic Aneurysm—A Case Report
Authors: Nevelsteen A. , Duponcelle E. , Suy R.
Published: November 2007

The authors describe a patient who survived an unrecognized rupturing ab dominal aortic aneurysm for two months, the only symptoms being a combined left femoral and obturator neuropathy. After reviewing the literature, the au thors conclude that a rupturing aneurysm can present with only mild transitory or atypical symptoms, which, if not recognized, cause an unwarranted delay in diagnosis and operative treatment. Furthermore it is recommended that retro peritoneal hemorrhage from a ruptured aneurysm be included in the diagnostic checkup of patients with femoral neuropathy.
Chronic Intake of a Hydrogenated Ergot Alkaloid Causing Peripheral Vascular Ischemia—A Case Report
Authors: Hubens G. , Cham B. , Welch W.
Published: November 2007

Ergotism is known to cause peripheral vascular ischemia. This case report describes the occurrence of peripheral gangrene in a thirty seven year old woman who had been taking a hydrogenated ergot alkaloid, ergoloid mesylates, 3 x 25 dr./24h, for nine years. Negative results from exhaustive clinical, labora tory and technical investigations and the disappearance of symptoms after with drawal of the drug compel the conclusion that chronic intake of ergoloid mesylates led to the vascular problems presented by the patient. Six months after the second amputation of necrotic toes the patient was painfree and showed no signs of recurring ischemia. The amputation would have healed sat isfactorily.
Restenosis After Carotid Endarterectomy
Authors: Buche M. , Schoevaerdts J.C. , Jaumin P. , Ponlot R. , Chalant Ch. H.
Published: November 2007

Fifty endarterectomies of the internal carotid artery have been performed on 43 patients from March, 1984, to December, 1985. There were no perioperative or hospital deaths. The permeability of the operated vessel was confirmed by Doppler or angiography in every case.

All patients received aspirin 100 mg/day and dipyridamole 400 mg/day post operatively and all were examined for follow-up. Routine Doppler examination of the carotid artery was performed at frequent intervals.

At long-term follow-up, 4 patients had died. None of these deaths could be linked to a neurologic deficit. Three restenoses due to intimal hyperplasia were discovered at follow-up between the eighth and twelfth months. The three re stenoses were successfully reoperated.

Because the risk of carotid artery restenosis appears to be real, routine fol low-up with Doppler examination is required. Suspicion of restenosis is an indi cation for control angiography. If restenosis is severe, a reoperation is warranted.
Rupture of Abdominal Aneurysm in Renal Transplant Patient—A Case Report
Authors: Defraigne J.O. , Limet R.
Published: November 2007

Aortic aneurysm rupture in a kidney transplant patient was successfully managed by implantation of an axillary-femoral bypass graft prior to aortic aneurysmectomy. Renal function remained intact during and after the proce dure.
Nonocclusive Mesenteric Ischemia Associated with Hepatic Portal Venous Gas—A Case Report
Authors: Vo Nghia M. , Watson Scott , Stanton Paul E.
Published: November 2007

Gas within the hepatic portal venous system and the bowel wall as shown on abdominal films prompted exploratory laparotomy in a patient who showed no localizing abdominal symptoms or signs. The small bowel was pale but not ne crotic, and the mesenteric vessels were widely patent. Pathologic diagnosis of the resected bowel showed focal mucosal necrosis. This was most likely related to digoxin-induced nonocclusive mesenteric ischemia.
Ulcerated Below-the-Knee Stump
Authors: Teplitz Glenn A. , Kerstein Morris D.
Published: November 2007

Ulcerative lesions appearing on a below-the-knee (BK) stump often delay permanent prosthesis fitting and rehabilitation or prevent the user of a perma nent prosthesis from resuming the ambulatory state. Seventeen patients (11 men, 6 women), with an average age of 61.4 (range 52 to 71) years, had under gone BK amputation for vascular disease (rest pain or gangrene, or both, with ankle:brachial index ratios < 0.15); 5 patients (3 men, 2 women) had diabetes controlled with insulin. All patients had a history of smoking with associated cardiovascular disease determined by physical examination or electrocardio gram, or both. Fourteen patients did not have initial healing after their BK amputation; the other 3 had a BK amputation in the distant past (twelve, eight een, and twenty months previously) and a nonhealing ulcer. All patients were referred for revision to an above-the-knee (AK) amputation; none came to AK amputation. All patients were treated with intravenous cephalosporins, de bridement, whirlpool, fine mesh gauze dressings, and a softstem air splint. The air splint prosthesis allowed proprioception, balance, gait, and total contact compression at 25 mm Hg when ambulatory. All wounds healed in fourteen to twenty-four days, allowing return to the permanent prosthesis in 3 patients and early measurement and fitting (no delay) of the remaining 14 patients for a permanent prosthesis. The softstem air splint temporary prosthesis represents an adjunctive measure in management of a nonhealing lesion on the stump of a BK amputee. It can facilitate rehabilitation via maintenance of gait, pro prioception, balance, and shape.
Chemodectoma of the Vagus Nerve—A Case Report
Authors: Tawfik Omar M.
Published: November 2007

Chemodectomas are tumors of the "paraganglion" system. They arise in many different parts of the body.

This is a report of a chemodectoma that arose within the sheath of the vagus nerve and was successfully excised. The different locations where chemodecto mas have been reported in the literature are listed.
"Therapeutic" Lymphangiography — A New Solution to Post-Bypass Lymphorrhea — A Case Report
Authors: Perler Bruce A. , Kinnison Malonnie
Published: November 2007

A sixty-eight-year-old man developed a groin lymphocele following an aorto- femoral bypass graft. Despite four weeks of conservative therapy, lymphorrhea persisted. A lymphangiogram, performed to accurately identify the site of leak age, resulted in cessation of the lymphatic leak. To our knowledge, this is the first report of lymphangiography as a therapeutic tool in the management of lymphorrhea following vascular reconstruction.
Residual Aorto-Caval Fistula: Treatment by Embolotherapy—A Case Report
Authors: Boyarsky Andrew H. , Sabado Mario F. , Sheka Kedambady P. , Gordon David H. , Herz Burton L.
Published: November 2007

This case report demonstrates a residual aorto-caval fistula (ACF) after repair of an ACF secondary to a ruptured abdominal aortic aneurysm. The authors were able to make the diagnosis with the appearance of the classic clinical signs of an ACF. They report the first known treatment of this complication via em bolotherapy utilizing mini and maxi coils introduced through the percutaneous route.
A Clamp for Carotid Artery Surgery with Internal Bypass Shunt
Authors: Furui Tomoo
Published: November 2007

A new clamp substituting for the surgical tourniquet in extracranial carotid surgery with use of an internal shunt is described. The clamp offers better exposure of the operative field and promises quick holding of the internal shunt without fear of injury to the arterial wall, even when the distal and deep inter nal carotid artery must be secured.
Penile Vascular Etiology of Primary Impotence
Authors: Jevtich Milorad J. , Dholakia Satish , Khawand Nabil
Published: November 2007

The etiology of primary impotence has long been considered to be mostly psychogenic. On the basis of their study of 400 impotent men, the authors found conversely that a subgroup of 24 patients (6%) with primary erectile dysfunc tion had an organic etiology responsible for the disorder. Of these, 20 (83.3%) were found to have penile arterial insufficiency, either alone or associated with hormonal or neural deficiencies; the remaining 4 patients had hormonal defi ciencies alone. Detected lesions of the penile arteries were subtle and mostly congenital. The authors recommend that a complete urologic and vascular work-up be performed prior to attempting a lengthy psychosexual therapy, be cause modern urologic and vascular therapy does offer definite cure to these patients.
Ischemic Colitis Preceding Ruptured Aortic Aneurysm— A Case Report
Authors: Mittal Ram K.
Published: November 2007

Ischemic colitis following repair of a ruptured abdominal aortic aneurysm is a well-known and invariably fatal complication. Sometimes, obvious colon is chemia can be recognized at the end of the operation. Frequently, the diagnosis becomes obvious within the first week after the operation. The author treated a patient in whom colon ischemia preceded the rupture of aortic aneurysm. To his knowledge this has not been previously reported.
Argon Laser-Assisted Peripheral Angioplasty
Authors: Diethrich Edward B. , Timbadia Ela , Bahadir Ilhan , Coburn Kathy , Zenzen Sharon
Published: November 2007

Pioneered several years ago by cardiologists and interventional radiologists, laser-assisted angioplasty for the ablation of occlusive atherosclerotic lesions in the peripheral and coronary circulations is now entering the domain of the vas cular surgeon, who has the ability to progress beyond the limitations of the percutaneous approach.

In the initial 38 patients undergoing 51 lower extremity laser angioplasty/ balloon dilatation procedures for peripheral vascular occlusive disease, pedal pulses were restored in 32 (63%) limbs. The tandem procedure failed in 16 (31%); however, when improvement was assessed objectively by postoperative ankle/arm index evaluation, a positive outcome was achieved in 72 % of the patients. Three (6%) patients required femoral-popliteal bypass after balloon- related arterial dissection was identified.

Although laser angioplasty can successfully open occluded arteries, new in traoperative angiographic equipment compatible with laser angioplasty and a variety of incrementally sized laser probes will facilitate refinement of the tech nology and enhance its application.
Minimizing Time for Shunt Insertion During Carotid Endarterectomy—Case Report
Authors: Vaccaro Patrick S.
Published: November 2007

A left carotid endarterectomy was performed under regional anesthesia in a patient who had recovered from a stroke that involved the right cerebral hemis phere. Arch angiography showed total occlusion of the right internal carotid artery with high-grade stenosis and a large ulceration of the left internal carotid artery. To minimize ischemic time, a modification of the standard procedure for insertion of the Pruitt-Inahara shunt was used successfully.
Pseudo-obstruction — A New Venous Disorder — Case Reports
Authors: van Bemmelen Shalom P. , Spaas J.A.J.
Published: November 2007

Three patients are described who had no prior thrombosis or varicosities but who suffered from venous complaints, such as edema and pain in the lower extremity after standing. Although they all presented with a severe decrease in their maximal venous outflow on the affected side, no obstruction or hypoplasia was found on phlebograms. Other forms of obstruction and artifacts were ruled out. Normal function of the calf muscle pump and valves was present. An expla nation for this phenomenon is postulated. The altered histology of the vein wall supports the hypothesis that a change in elastic properties of the venous wall is present in these patients.
An Unusual Vascular Complication Following Partial Nephrectomy: Case Report
Authors: Onursal Ertan , Bedirhan Mehmet Ali , Sonmez Bingur , Kargi Aydin , Yagan Naci , Barlas Cemil
Published: November 2007

Development of a fistula between the main renal vessels after nephrectomy has heretofore been a rare occurrence, but its increasing frequency would seem to result from increased interest in detection of this fistula. The authors present a rare case of arteriovenous fistula following partial nephrectomy. Renal hyper tension following nephrectomy, also quite rare, developed in this case.
Changes in Paracardiac Lymph Nodes in Portal Hypertension
Authors: Aboul-Enein A. , Arafa Sobhy
Published: November 2007

Because of their proximity to the coronary vein and thoracic duct, the para cardiac lymph nodes are liable to develop both venous and lymphatic conges tion. The authors studied morphologic changes in the paracardiac lymph nodes in patients with portal hypertension.

Paracardiac lymph nodes were obtained during surgery from 40 volunteer patients with esophageal varices due to schistosomal portal hypertension (29 nonbleeders, 11 bleeders). Paracardiac lymph nodes from 10 volunteer patients having surgery for correction of incisional hernia served as controls.

The main histologic difference found in this study was the lower incidence of necrosis in nonbleeders. This indicates the possible role played by inadequate lymphatic drainage of the excessive lymph produced by the congested varices- bearing area in the bleeder.
Patent Ductus Arteriosus in Arabs
Authors: Raffa Hassan
Published: November 2007

Two hundred patients with patent ductus arteriosus (PDA) underwent sur gery for either triple ligation and transfixation (183 patients = 91.5%) or divi sion and suture (18 patients = 8.5%). The patent ductus arteriosus was an isolated lesion in 163 patients (81.5%) and combined with other cardiac anoma lies in 37 patients (18.5%). Advanced pulmonary hypertension (> 50 mmHg), even in the pediatric age group, was seen in 70 patients (35%).

Familial PDA occurred in 6 patients, and 38 patients were born at a high- altitude area (> 4000 feet).

Recanalization occurred in only 1 patient (0.5%) owing to initial faulty tech nique using umbilical tape instead of strong silk for ligation of the PDA. Only 2 patients with complex congenital anomalies died (mortality rate of 1%).

The peculiarities, presentation forms, and surgical results in Arab patients with PDA are discussed in this paper.
Experimental Surgical Aneurysms in the Rat
Authors: Valentine Jimmie L. , Patil Angelo A. , Yamanashi William S. , Hill Deborah L. , LePage James R.
Published: November 2007

Three different surgical methods were used to create experimental models of aneurysms in rats. The first model was an autogeneous side-to-side anastomosis of the inferior vena cava to the abdominal aorta. This model proved to be ac ceptable for acute preparations but was not amenable to survival surgery since occlusion of the venous circulation occurred. The second model developed was a renal vein aneurysm that was created in either of two ways: (1) the left renal vein was ligated at its juncture with the inferior vena cava and a partial ne phrectomy performed, or (2) the left renal vein was ligated in the same manner, as well as the inferior suprarenal artery. With either technique, the aneurysm developed within five to ten minutes. This model was technically satisfactory but also occluded the venous circulation as the first method had. The third model developed was a heterogeneous aorta of a donor animal grafted to the abdominal aorta of a recipient animal. This model proved to be best for survival surgery and gave patent aneurysms up to one week following surgery.
Navigation Through Locks in Transvenous Pacing
Authors: Rao Gopal
Published: November 2007

This paper describes a method of achieving transvenous pacing when the conventional method is not feasible or has failed.
Carotid Endarterectomy Under Local Anesthesia: The Safer Alternative?
Authors: Schwartz Robert A. , Peterson Gary J. , Stern John A. , Naunheim Keith S.
Published: November 2007

Carotid endarterectomy can be successfully accomplished using either local or general anesthesia. The purpose of this study was to attempt to discern any differences in perioperative morbidity associated with the two anesthetic tech niques. A retrospective review was undertaken of 324 consecutive carotid en darterectomies performed by fifteen surgeons between 1979 and 1985. There were no significant differences in preoperative cardiac, pulmonary, or renal risk factors between the two anesthetic groups. Postoperative fever (p < 0.005), pulmonary complications (p < 0.05), and neurologic morbidity (p < 0.05) oc curred significantly more frequently in the general anesthesia group. The dura tion of postoperative hospitalization was shorter (p < 0.0005) in the local anes thetic cohort (3.1 ± 2.3 days) than in the general anesthetic group (5.1 ± 8.07 days). Local anesthesia for carotid endarterectomy appeared to result in less morbidity and shorter hospitalization when compared with general anesthesia. There did not appear to be any cerebral protective effect of general anesthesia during carotid endarterectomy.
Incomplete Hemisphere Ischemic Model in the Dog Produced by Electrocoagulating Several Major Intracranial Arteries
Authors: Weigou Jiang , Shaoqing Li
Published: November 2007

An obstacle in stroke research is lack of a suitable animal model; therefore, there is an apparent need for an experimental model of ischemia that resembles as closely as possible what is observed in human beings. The authors used soma tosensory evoked potentials (SEPs) and histologic examination to evaluate the practicability and reliability of an incomplete ischemic model of the brain in dog after observing the circle of Willis of dog. Incomplete cerebral hemisphere is chemia was produced by electrocoagulating various vessels from the circle of Willis. After occlusion, there was a precipitous decrease in the amplitude of cerebral cortical components. The majority of neurons at the sixth hour after occlusion became swollen and some were shrunken.

This study shows that the model is a useful one that has the advantages of high rates of successful ischemia and prediction of its size and location, and it is suitable for intracranial microvasosurgical and pathophysiological research in cerebral ischemia.
Transthoracic Axillary Sympathectomy as a Treatment for Palmar Hyperhydrosis: An Eleven-Year Experience
Authors: Rivkind Avraham I. , Berlatzky Yaacov , Anner Haim , Admon Dan , Romanoff Henry
Published: November 2007

The authors performed 134 transthoracic axillary sympathectomies on 68 patients suffering from primary hyperhydrosis. In the benign condition, hy perhydrosis may cause considerable psychological, social, and occupational dis turbances. Their eleven years of experience with this approach is discussed. The postoperative course and results were devoid of severe complications. They rec ommend, therefore, the axillary approach for thoracic sympathectomy in cases of hyperhydrosis of the upper limbs.
Acute Abdominal Conditions Induced by Anticoagulant Therapy—Case Reports
Authors: Stanton Paul E. , Watson Scott , Laucirica Rodolfo , Vo Nghia N. , Yee Edward S.
Published: November 2007

Hemorrhage after oral anticoagu lant administration is a well-recog nized hazard of therapy, and hemorrhagic complications may oc cur in 10-40% of patients. Usually these complications are minor, but se rious bleeding has been reported in from 2-10% of patients on prolonged anticoagulant therapy.

Some hemorrhagic complications may be manifested as an acute ab dominal process that may result in unnecessary surgery. The process is most commonly seen in the form of intestinal obstruction produced by hemorrhage into the bowel wall, ad jacent mesentery, or retroperitoneal structures.

The authors present 7 cases of se rious abdominal anticoagulant com plications and review the Western literature on this perplexing prob lem.
Spontaneous Aneurysmal Enteric Fistulae—Report of Two Chinese Patients Successfully Treated by Surgery
Authors: Siu K.F. , Wong J.
Published: November 2007

Two Chinese patients with spontaneous aneurysmal enteric fistulae are re ported, one with an aortoduodenal fistula, the other with an iliac-ileal fistula. The first patient presented with the classic symptoms of upper gastrointestinal bleeding and a pulsatile abdominal mass. The latter had more ill-defined gastro intestinal symptoms, mainly abdominal distension and diarrhea without mas sive bleeding. Both patients were successfully treated by surgery.
Observations of Early Atherogenesis with Calcification Following Aortic Deendothelialization in Rabbits Maintained on a Normal Diet
Authors: Hoover Eddie , Gross Andrew , Webb Hueldine , Fani Kazam , Debons Albert
Published: November 2007

The factors initiating atherosclerosis in the rabbit model are largely un known, especially when the animals are maintained on a normal diet. The au thors studied regeneration of rabbit aortic intima after balloon deendothelial ization. Eighteen male rabbits were divided into three groups of 6 and under went removal of the thoraco-abdominal aortic endothelium by standard balloon techniques. Animals were sacrificed after four hours (Group I), three days (Group II), and six weeks (Group III). All specimens were evaluated by light (LM) and electron microscopy. Group I showed a gross mural thrombus by LM and complete deendothelialization with a complete layer of platelet deposition. Group II showed disappearance of platelets and reduction in the size of the thrombus. Early myofibroblast (MF) proliferation was seen. Group III showed a well-formed plaque and several layers of MF partially covered with endothe lium. The media was calcified, and there were no foam cells present as are commonly seen in hypercholesterolemic animals. Conclusions: (1) Maintenance of the endothelium is important in preventing atherogenesis. (2) Plaque forma tion occurs early following intimal disruption despite normal calcium metabo lism and a cholesterol-poor diet. (3) Complete endothelial recovery may be in hibited by early plaque formation thus creating a surface conducive to further atherogenesis. This would suggest the possibility of modulating the neointima by the administration of antithromboxane compounds or prostacyclin ana logues.
The DRG Prospective Payment System, Age, Resource Consumption, and Outcome for Peripheral Vascular Surgical Patients
Authors: Munoz Eric , Borrero Edgar , Goldstein Jonathan , Mulloy Katherine , Chang John , Wise Leslie
Published: November 2007

The federal Medicare DRG pro spective payment system as entered its sixth year, with no major adverse effect so far on American health care regarding either access to or quality of surgical care. The authors ana lyzed hospital resourc consumption and outcome by age for peripheral vascular surgical patients from Ja nuay 1, 1985, through March 31, 1986, at a large academic medical center using the DRG format. Total costs (exclusive of MD fees) for the 211 peripheral vascular surgical pa tients studied were $2,933,623. Mean hospital cost per patient, hospital length of stay, percent of outliers, and mortality were higher for pa tients seventy-five years of age and over as compared with younger pa tients. DRG case-mix index and the number of procedures per patient was also higher for these older pa tients.

This study demonstrated that un der prospective payment systems (ie, DRG reimbursement) financial risk was higher for patients seventy-five years of age and over, as were hospi tal length of stay, the number of pro cedures per patient, and mortality. These data suggest that current DRG reimbursement may provide finan cial disincentives to treat elderly pe ripheral vascular surgical patients. As government continues to decrease DRG hospital payment for these pa tients relative to hospital costs, both their access to and quality of surgical care could be jeopardized in the fu ture.
Laser-Assisted Anastomoses of the Trachea and Carotid Artery in Dogs
Authors: Moosdorf Rainer , Scheld Hans H. , Stertmann W.A. , Fitz Hartmut , Borner Ulf , Hehrlein Friedrich W.
Published: November 2007

Anastomoses or reconstructions at the trachea are known to be related to a high risk of complications. Simi larly, anastomoses at smaller vessels have often occasioned discussion con cerning new techniques and different suturing materials. Low-dose laser energy seems to offer a new chance of tissue welding in these areas. In 10 Beagle dogs tracheal anastomoses were performed with an argon laser system, stabilized only by three single sutures for readaptation of the stumps. In 5 dogs even these three su tures were removed immediately af ter the tissue welding was finished. The anastomoses were monitored by bronchoscopy after an interval of six weeks and were removed after twelve weeks for pathologic investigations.

In another 5 dogs carotid arteries were transected and reanastomosed with a similar technique. Readapta tion was achieved by four single su tures at equal distance, which were left in situ. Patency was monitored by Doppler ultrasound and by angiogra phy, and again after an interval of four to six weeks the anastomotic seg ments were resected and examined pathologically.

All animals showed an uneventful postoperative course. None of the tracheal anastomoses showed any signs of functional impairment, air leakage, or infection. Bronchoscopy revealed no significant luminal nar rowing. These findings were con firmed after resection. Histology showed regular wound healing and especially normal reconstruction of the ciliated endothelium of the tra chea. Similarly all carotid anasto moses were patent in Doppler ultrasound and angiographic con trols. Neither angiography nor direct inspection after resection revealed signs of aneurysm formation. Micro scopic investigations showed a smooth endothelial passage between the two anastomosed segments and regular wound healing of the arterial wall. There were no signs of excessive scar formation or intimal hyperpla sia.

The results underline the applica bility of laser energy for the perform ance of anastomoses at the tracheobronchial tree, as well as at smaller vessels. Clinical application has to be preceded by further investi gations and some technical improve ments, but still the technique shall prove to be an alternative to conven tional suturing techniques for se lected cases in the near future.
Predictive Value of Transcutaneous Oxygen Tension Measurement in the Indication for Spinal Cord Stimulation in Patients with Peripheral Vascular Disease: Preliminary Results
Authors: Sciacca Vincenzo , Mingoli Andrea , di Marzo Luca , Maggiore Claudia , Fiume Dario , Cavallaro Antonino
Published: November 2007

Thirteen patients (12 males, 1 fe male, mean age 60.5 years) affected by peripheral vascular disease (21 lower limbs: 9 with intermittent clau dication and 12 with rest pain and/or necrosis smaller than 3 cm2) have been studied by means of transcuta neous oxygen tension (TcpO2) mea surements. They had been submitted to spinal cord stimulation (SCS) de vice implant from one day to twenty- two months previously. In 8 patients (15 limbs) implanted from one day to twenty-two months, the TcpO2 index was calculated to evaluate the neuro- stimulator effect on peripheral blood circulation. In 5 patients (6 limbs) studied before definitive implanta tion, preoperative and postoperative TcpO2 measurements were able to predict the SCS efficacy during the temporary trial period: when TcpO2 did not increase immediately (4 limbs), no result was achieved (am putation) ; a TcpO2 increase corre sponded to relief of symptoms (2 limbs).

On the basis of this preliminary report, TcpO2 measurement could be useful for predicting SCS efficacy in vascular patients; the possibility of dividing the patients into responders and nonresponders to SCS by TcpO2 measurement represents an impor tant achievement in determining the indication for SCS implant.
Angiographic and Duplex Scanning Assessment of Biografts in Femorodistal Reconstructions
Authors: Huk I. , Gritzmann N. , Karnel F. , Jantsch H. , Kretschmer G. , Polterauer P. , Wagner O.
Published: November 2007

Morphologic and hemodynamic changes in 32 long-standing human umbilical vein (HUV) grafts due to biodegradation (segmental dilatation, aneurysmal degeneration, and peri prosthetic tissue reaction) were inves tigated by use of duplex sonography (DS) and intravenous digital subtrac tion angiogaphy (DSA) techniques. The follow-up time ranged from nineteen to eighty-four months with a median of fifty months. Patients were divided into three groups, namely, with biografts patent for less than two years, for three to four years, and for five years or longer. Maxi mum diameter was measured for each group and yielded the following median values: 5.9, 8.9, and 11.2 mm respectively. Sonographic measure ments of internal diameter in HUV grafts showed an increase in 85% of all cases; in the last two groups a biodegradation of the grafts' inner surface was commonly observed. Three true aneurysms were seen in the third group. Segmental dilatation and wrinkling effect occurred in both the second and third groups, but no degeneration was seen in the first group. In 1 case a seroma was de tected as a sign of late periprosthetic tissue reaction.

Despite the high incidence of late morphologic changes of the biograft an acceptable patency rate was achieved, although late aneurysmal degeneration of the HUV grafts seems to be a limiting factor in a younger group of patients. With ei ther technique, morphologic changes of the biografts could be observed.
Retrieval of Adherent, Centrally Embolized Foreign Bodies: Common and Advanced Methods
Authors: Grabenwoeger Florian , Dock Wolfgang , Pinterits Fritz , Metz Viktor
Published: November 2007

Percutaneous removal of centrally embolized foreign bodies left in situ is of utmost importance because of the high mortality. With the usual meth ods, however, removal is possible only if one end of the embolizate is freely accessible. In this report the authors present the common tech niques and a new method permitting the shifting of fixed foreign bodies into a position where they may be grasped and removed by snare or Dormia basket.
Cyclooxygenase Activity in the Thoracoabdominal Aorta After 24 Hours of Intraaortic Balloon Counterpulsation: An Assessment of the Effects of Localized Mechanical Trauma
Authors: Hoover Eddie L. , Kharma Bassam , Ross Margery , Webb Hueldine , Fani Kazam , DiMaio Frank , Ketosugbo Anukware , Hsu Hwei-Kang
Published: November 2007

Using a canine model, the authors evaluated the effects of twenty-four hours of intraaortic balloon counterpulsation (IABCP) on the morphology of the thoracoabdominal aorta and its spontaneous and arachidonate stimulated pro duction of prostacyclin (PGI2). The treated group was counter-pulsed at a 1:1 ratio with a 40 cc balloon. The control group had the balloon inserted and left deflated across the thoracoabdominal aorta.

There were no differences between the IABCP or sham groups in prostanoid production either in the thoracic or abdominal aorta. Baseline PGI2 production in the control versus treated group of thoracic aortas was 1880 ± 1140 pg/cm2/ min vs 1992 ± 1125. The stimulated response in the control group, 9180 ± 1198, was statistically different from baseline (P < .001). The stimulated in crease in the IABCP group, 6269 ± 5240, relative to baseline was also signifi cant (P < .01). There were no significant differences, either between or within groups in the abdominal aortas. Poststimulation values (30 min) were signifi cantly below baseline in each group in each section of the aorta (P < .05). Light microscopy showed a statistically significant difference in endothelial preserva tion between the control and the balloon group, 66 ± 25% vs 19 ± 17% (P < 0.05) .

The authors conclude that IABCP results in severe endothelial destruction but that spontaneous and stimulated PGI2 production is unimpaired. It remains to be determined whether the aorta may sustain long-term damage due to the repair process after IABCP.
Origin of Seeded Endothelial Cells
Authors: Vo Nghia M. , Arbogast Loretta H. , Mashburn Rebecca
Published: November 2007

This study proposes to evaluate the effectiveness of porcine endothelial cell seeding on the patency rate and the cellular lining of healed grafts. Nonseeded grafts were implanted in a series of 8 dogs while porcine endothelial cell-seeded grafts were used in 15 animals. Aspirin (325 mg) was given daily to all animals. The thirty-two-day patency rate was 25% (2/8) versus 67% (10/15) respectively for the control and seeded grafts (p < .01). All patent grafts were lined with an endothelial surface. Cultures of the thirty-two-day old seeded grafts grew a combination of canine and porcine cells at a ratio of 5/1. The authors conclude that allograft cell seeding increases the patency rate of vena cava grafts and may stimulate growth of host canine cells. No clinical adverse reactions were noted with allograft cell seeding in the present study.
Intravascular Leiomyosarcoma in Varicose Veins —
Authors: Sayers R.D. , Baker A.R. , MacKay E.H. , Barrie W.W.
Published: November 2007

Leiomyosarcoma is a malignant tumor of smooth muscle. This is a report of a case of an intravascular leiomyosarcoma of the long saphenous vein that was initially misdiagnosed as thrombophlebitis. This is only the second report of its kind in the literature.
Vascular Spasm During Heparin-Dihydroergotamine Prophylaxis in a Quadriplegic Patient: Case History
Authors: McDowell Gregory , Blatman Robert , Stamp Warren , Joob Axel , Tegtmeyer Charles , Kron Irving L.
Published: November 2007

Lower extremity ischemia occurred in a quadriplegic patient following dihy droergotamine-heparin prophylaxis. Ergotamine should be used with caution in paralyzed patients.
Degenerative Dacron Graft Changes: Is There A Biological Component in This Textile Defect ? — A Case Report
Authors: Cardia Giuseppe , Regina Guido
Published: November 2007

A false aneurysm occurring six years after insertion of a woven femoropopli teal dacron graft into a patient is discussed. The lesion clearly appeared during an anticoagulation overdosage. The authors propose, therefore, that an excess of anticoagulants may have an effect on the repair of a simple, accidental, da cron fiber rupture and thus contribute to the appearance and enlargement of an initially microscopic hole.

This suggests that, at least in some of the degenerative dacron graft changes, the interreaction between the host and plastic material may play a determinant role.
Coronary Artery Bypass Surgery in Chinese Septuagenarians
Authors: Chen Thay-Hsiung
Published: November 2007

Arteriosclerosis has been well known to be intimately connected with the human aging process, and thus the prevalence of coronary artery disease in creases with the advance of age.

On the other hand, senility seems to cause extra surgical risk when a patient undergoes a major operation such as coronary artery revascularization. In the past, physicians, and perhaps patients too, took a conservative attitude toward coronary artery bypass surgery for aged patients. But in the author's experience with 38 patients aged seventy years or more, there were 3 deaths (7.9%), a mortality rate not significantly different from that (4.9%) of another group of 264 patients aged less than seventy years. Thus, the author concludes that cur rently coronary artery bypass surgery can be safely performed upon Chinese septuagenarians with limited surgical risks and satisfactory consequences.