bluuebunny/crossref_metadata_2025 huggingface dataset:
The Demands of Peace and Reconciliation
Authors: Zaru Jean
Published: August 2008

Palestinians have been let down by the international communities and their political and legal institutions. Even ecumenical ecclesiastical institutions fail to recognize the injustices perpetrated on the Palestinian people, and to support them in their struggle to retain control of their lands and homes. Palestinian Christians are expected to speak out when the Bible is abused and used to support injustice and violence. However, it is hard to understand global Christianity's failure to support Palestinian human rights. Similarly, Christian pacifists, such as Quakers, are despised as acquiescent in the wrongs against which others fight. In a male-centred culture, women are expected to support and participate in the struggle. Often they are hurt and damaged. However, they are not allowed any part in community decision making structures. A patriarchal culture denies them responsibility for the future of the community in which they live. Multiple discrimination is inextricably intertwined. A stand against one form of discrimination must include involvement with the whole struggle for human rights.
Christianity and Feminism: The Marriage of Love and Reason
Authors: Pratton Marie
Published: August 2008

This article engages with Goldenberg's desire to abandon transcendence since it is the enemy of autonomy and to once more encounter corporeality as the site of immanence. The author is in agreement with Goldenberg but attempts to show that the negative outcomes associated with a reliance on transcendence are not necessary and have been produced by a false understanding on the part of Christianity.
Drawing Lines, Crossing Lines: Ethics and the Challenge of Disabled Embodiment
Authors: Scully Jackie Leach
Published: August 2008

ABSTRACT The advent of genetic technologies and of genetic explanations for biomedical phenomena has major implications for disability. They raise the fundamental question of our valuation of variations in human embodiment. In this paper I suggest that the lived experience of a specific embodiment affects the structures of imagination and interpretation that people use in moral perception and evaluation. As an example, I consider recent 'deaf designer baby' cases, suggesting that it is not possible to understand the ethics of the choices made without acknowledging significant differences in embodied experience. To understand embodiment fully means allowing the body itself to take us into unfamiliar territory, including experiences of limitation and difference. I argue that true justice for disabled people will demand insight into different lived experiences and an openness to what other corporeal modes have to teach us
Journey Towards the Goddess
Authors: Leonard Alison
Published: August 2008

'Journey Towards the Goddess' is a personal narrative tracing the writer's path from the space left by a Christian faith that has become irrelevant, through a series of earth-based, feminine-orientated experiences and brief spiritual encounters with non-human life forms and with the non-physical world, towards an openness to the divine feminine in its pre-Christian and post-Christian guises. Citing Quaker sources (the author is a convinced and practising Quaker) as well as Starhawk, the anthropologist Felicitas Goodman and feminist theologians such as Mary Condren and Beverly Wildung Harrison, she arrives at a conviction that goddess theology is not only valid but may be an essential component of a morally responsible spiritual outlook in the twenty-first century. The author is a poet and fic tion writer, and has also written two books that offer the non-judgmental life narrative as a way of spiritual understanding.
Pharmaceutical care in an inpatient pediatric hematopoietic stem cell transplant service
Authors: Prot-Labarthe Sonia , Therrien Roxane , Demanche Colette , Larocque Diane , Bussières Jean-François
Published: August 2008

Introduction. Hematopoietic stem cell transplant patients represent a population at high risk for drug-related problems. Our objective is to describe pharmacist interventions in a hematopoietic stem cell transplant pediatric unit.

Methods and Patients. The Hematopoietic Stem Cell Transplant Unit of the Centre Hospitalier Universitaire Sainte-Justine performs around 50 hematopoietic stem cell transplants per year. During a pharmaceutical care specialized residency program, a French pharmacist participated in certain clinical activities. Drug-related problems and clinical interventions were compiled over 31 nonconsecutive days using a tool developed by the Société Française de Pharmacie Clinique. Data concerning patients, drugs, intervention, documentation, approval (if needed), and estimated impact were compiled.

Results. During the 31-day period, 525 interventions were collected (16.9 ± 3.7 per day), targeting 29 patients. The main drug-related problems were adverse drug reactions (N = 125, 23.8%), untreated indication (N = 92, 17.5%) and failure to receive drug (N = 89, 17.0%). The pharmacist's interventions concerned mainly dose adjustment (N = 174, 33.1%) and drug monitoring (N = 132, 25.1%). Among the 324 (61.7%) interventions requiring a physician's approval, 302 (93.2%) were accepted without any change.

Conclusion. A pharmacist is able to perform clinically relevant interventions in a hematopoietic stem cell transplant unit, given the complexity of the pharmacotherapy. Our description of drug-related problems and interventions may help other pharmacists already working or developing pharmaceutical care in a hematopoietic stem cell transplant unit to compare their practice and it is one of the few reported in the literature. J Oncol Pharm Practice (2008) 14: 147—152.
Scale Coarseness as a Methodological Artifact
Authors: Aguinis Herman , Pierce Charles A. , Culpepper Steven A.
Published: August 2008

Scale coarseness is a pervasive yet ignored methodological artifact that attenuates observed correlation coefficients in relation to population coefficients. The authors describe how to disattenuate correlations that are biased by scale coarseness in primary-level as well as meta-analytic studies and derive the sampling error variance for the corrected correlation. Results of two Monte Carlo simulations reveal that the correction procedure is accurate and show the extent to which coarseness biases the correlation coefficient under various conditions (i.e., value of the population correlation, number of item scale points, and number of scale items). The authors also offer a Web-based computer program that disattenuates correlations at the primary-study level and computes the sampling error variance as well as confidence intervals for the corrected correlation. Using this program, which implements the correction in primary-level studies, and incorporating the suggested correction in meta-analytic reviews will lead to more accurate estimates of construct-level correlation coefficients.
Experimental Model of Lymphedema
Authors: Dominici C. , De Leo S. , Covarelli P. , Cordellini M. , Severini D. , Giusti D.
Published: August 2008

The authors describe a new exper imental model for lymphedema of rabbit ear. The method proved to be reliable and easily reproducible. The dilatation of lymph vessels after ex perimental provocation of lymphe dema permits study of the physio pathologic basis of lymphovenous shunts created by means of micro surgery and proves to be helpful for the microsurgeon's practice.
Hyperemia of the Glans Penis Following Penile Revascularization Treatment by Inferior Epigastric Artery Embolization—A Case Report
Authors: Rees J. Richard , Boren Scott R. , Carlin Bruce W.
Published: August 2008

Hyperemia of the glans penis is one of the complications of the Virag penile revascularization procedures. The authors present a patient with this complica tion who was treated successfully by embolization of the inferior epigastric artery to deep dorsal vein anastomosis.
Rapid Measurement of Compartment Pressure — A New Technique
Authors: Dierberg William J. , Brown O. William
Published: August 2008

Compartment syndrome requires early diagnosis and prompt treat ment to minimize permanent se quelae. The diagnosis is suspected and most often made on clinical grounds alone. Symptoms and find ings include: (1) pain out of propor tion to the severity of the injury and unrelieved by immobilization, (2) sensory deficit distal to the compart ment related to nerves that course through the compartment, (3) pain on passive stretching of muscles in the involved compartment, and (4) tenseness and tenderness to palpation over the compartment.

Frequently a clinical situation arises in which these criteria are con sidered invalid. The examination of a frightened, uncooperative child may be inadequate or unreliable. Simi larly, trauma patients who are intoxi cated or have head injuries may be difficult to examine. It may be impos sible to delineate neuropraxia from the compartment syndrome versus primary nerve injury (ie, brachial plexus injury). In these situations an objective measurement of the actual compartment pressure is essential. This paper describes a simple modifi cation of the standard needle-ma nometer method of measuring com partment pressure. By use of this modification, the pressure can be simply and rapidly measured with equipment available in most, if not all, hospital wards and emergency rooms.
Postinflammatory Aneurysm of the Subclavian Artery — A Case Report
Authors: Eldar Samuel , Steiner Zvi , Miselevich Ines , Boss Jochanan H. , Abrahamson Jack
Published: August 2008

A case of postinflammatory aneurysm of the subclavian artery is described. The etiology, pathogenesis, clinical presentation, diagnosis, and therapeutic im plications are discussed and the literature is reviewed. The condition may be quite asymptomatic or present with various local and remote manifestations, including Horner's syndrome. Arteriography usually confirms the diagnosis. Resection of the aneurysm and end-to-end anastomosis of the subclavian artery is recommended whenever feasible, particularly in young patients.
Management of Internal Mammary Artery Aneurysm to Superior Vena Cava Fistula—A Case Report
Authors: Tuma Martin A.
Published: August 2008

Internal mammary artery aneurysms with superior vena cava fistulas associ ated with an infected chest wall can be successfully managed in stages.
Ruptured Common Iliac Artery Aneurysm Presenting with Perianal Hematoma—A Case Report
Authors: Wilson N.M. , Collins R.E.C.
Published: August 2008

A case of ruptured common iliac artery aneurysm is reported. The patient presented with a perianal hematoma and had undergone repair of a leaking abdominal aortic aneurysm seven years previously. The presentation and man agement are discussed.
CSF-Shunt-Related Thrombophlebitis—Case Reports
Authors: Nguyen Jean-Paul , Goujon Colette , Monsuez Jean-Jacques , Keravel Yves
Published: August 2008

Two cases of left upper extremity thrombophlebitis following left cerebrospi nal fluid, (CSF) shunt implantation are reported. Signs and symptoms appeared in the early postoperative period (at days 5 and 15 respectively).

Thrombosis of the axillary vein was demonstrated by Doppler examination and phlebography. Both patients were given anticoagulant therapy with a favor able clinical outcome . No pulmonary embolism or catheter dysfunction occurred.

The patients remained free of any disability after a two and three-year follow-up, respectively, without relapsing thrombosis after discontinuation of therapy.

These 2 cases occurred in the only 2 adult-patients in whom a left CSF shunt was implanted. No thrombotic complications occurred among 153 patients with a right implantation of the device. Thus, the course of the catheter through the left brachiocephalic vein has to be taken into account in the pathogenicity of this complication.
Comparison of Cefuroxime and Cefazolin: Prophylaxis Against Infection in Arterial Reconstructive Surgery
Authors: Borrero Edgar , Rosenthal David
Published: August 2008

A prospective randomized study of 55 patients receiving prophylaxis with cefuroxime versus 55 patients receiving prophylaxis with cefazolin against post operative wound infection was conducted from August 1986, through January 1988. Two of the cefuroxime-treated patients and 8 of the cefazolin-treated patients developed postoperative wound infections (p<0.05). There were no graft infections. Cefuroxime represents an excellent alternative to the presently used cefazolin as prophylaxis against postoperative wound infections in arterial recon structive surgery.
Primary Aortoduodenal Fistula Masquerading as a Duodenal Tumor—Case Report
Authors: Wan Yee Lau  , Arthur Kwok Cheung Li
Published: August 2008

A sixty-eight-year-old man presented with two episodes of gastrointestinal bleeding in one week. Upper gastrointestinal barium study revealed a tumor in the third part of the duodenum. At operation, the "tumor" was found to be a laminated thrombus that protruded into the duodenal lumen from a primary aortoduodenal fistula. Duodenal repair and aneurysmectomy with Dacron graft replacement were done. The patient was well on follow-up four years after surgery.
Surgical Treatment of Congenital Coronary Artery Anomalies
Authors: Berki Turan , Turan Fikret , Okay Tugrul , Özdemir Mehmet , Yakut Cevat
Published: August 2008

Ten (0.28%) patients with anomalous origin of a coronary artery were detected from inspection of 3500 selected coronary arteriograms. In 1 patient the left main coronary artery (LMCA) originated from the pulmonary artery (PA). In 1 patient situs inversus totalis was present. This patient had a single coronary artery originating from the right coronary sinus. In 2 patients atrial septal defect (ASD) and aortic stenosis (AS) were additionally present. In 2 patients having an anomalously originated coronary artery, additional atherosclerotic coronary artery disease was present.

In 4 patients coronary artery bypass grafting (CABG) operations were per formed. In 2 other patients ASD closure and aortic valve replacement (AVR) were performed. One patient with anomalous LMCA originating from the right coro nary sinus refused operation. There was no mortality or morbidity. All of the patients are symptom free and are having an active life.
Hydroxyethyl Starch Effects on Rat Warm Renal Ischemia
Authors: Shih Scott T. , Oz Mehmet C. , D'Agati Vivette , McCleod Paul F. , King Thomas C. , Nowygrod Roman , Zikria Bashir
Published: August 2008

Fractions of hydroxyethyl starch (HES), 100,000-1,000,000 daltons, have been shown to reduce increased permeability changes in postcapillary venules associated with ischemia-reperfusion injury in canine myocardium and rat skel etal muscle. The authors studied the effect of intravenous administration of two fractions of the biodegradable HES, Fm (100,000-300,000 daltons) and FLm (300,000-1,000,000 daltons), in the prevention of acute renal failure in a rat warm renal ischemia model. A series of renal artery cross-clamp times was used to determine the threshold for irreversible damage (thirty minutes). After thirty minutes of warm renal ischemia, 2.5 cc of 6 % Fm or FLm solution, 5% human serum albumin, or 9% normal saline was administered. The effect of the solutions was evaluated by four criteria: (1) forty-eight hours' serum BUN/creatinine, (2) forty-eight hours' urine output, (3) percent of water content in the kidney, and (4) a histopathologic grading. There were no differences among the animals in any of the four groups in renal function at forty-eight hours, percent of water content of the kidneys, urine output, and extent of medullary and cortical injury. The authors attribute the lack of protective effect by the HES macromolecules to intrinsic properties of the kidney such as the extensive endothelial cell surface area of the well-vascularized kidney and the hypersensitivity of the kidney to hypoxic injury.
Abdominal Aortic Aneurysm with Periaortic Fibrosis and Ureteral Obstruction—Report of Two Cases
Authors: Vulpio Carlo , Venuto Vincenzo , Francesco Federico , Massari Massimo , Destito Carmelo , Borzone Augusto , Marin Alfredo Wiel , Castiglioni Giancarlo
Published: August 2008

Two cases of ureteral obstruction due to the retroperitoneal fibrosis associated with abdominal aortic aneurysm are described.

The clinical findings, etiology, diagnosis, and management are discussed. Preoperative diagnosis of abdominal aortic aneurysm with periaortic fibrosis and ureteral obstruction may be possible with the aid of intravenous urography, ultrasonography, and computed tomography.

Aortic replacement with synchronous ureterolysis is the treatment of choice; cortico steroids represent an alternative therapy where aortic replacement is too hazardous.
Surgical Treatment of Multivalvular Rheumatic Heart Disease
Authors: Berki Turan , Kisacikoglu Bülent , Mete Atalay , Irez Aysen , Bayezid Ömer , Yakut Cevat
Published: August 2008

Of 632 valvular heart disease patients 187 were operated on because of multivalvular rheumatic lesions. The operative mortality was 10.1% and late mortality 4.9%. Left ventricular dysfunction was the common cause in the early operative period. Prosthetic valve endocarditis and thromboembolism were the other common causes of mortality, 5.9% and 6.4% respectively. NYHA Class III-IV, pulmonary hypertension, ejection fraction less than 40%, aortic stenosis and elevated left ventricular end diastolic pressure were significant predictors of poor-prognosis. Tricuspid regurgitation due to right heart decompensation is also another grave sign. The type of the prosthetic valve or additional annuloplasties to double valve replacement did not influence the outcome.

Optimal timing of the operation is essential. Urgent operations should always be avoided if possible. Earlier surgical intervention, improved perioperative myocardial preservation, and alternate support methods, and improved surgical techniques may lower the operative mortality and morbidity.
The Predictive Value of Noninvasive Testing in Intermittent Claudication
Authors: Vasli Lars R. , Larsen Stig
Published: August 2008

Noninvasive tests may be used to aid in deciding the treatment of patients with vascular disease by providing hemodynamic information. The authors stud ied whether the information on the severity of the disease and the location of the diseased segment had any predictive value in regard to the results of nonoper ative treatment of patients with intermittent claudication.

Two hundred and one patients suffering from intermittent claudication and not recommended for operative treatment entered the study. They all had nonin vasive tests done, including segmental blood pressure measurements and femo ral velocity waveform analyses. After two years the mortality, surgical intervention rate, patient's subjective assessment, and changes in ankle-brachial index were recorded and analyzed.

Twenty-nine patients had died and 12 patients had been operated on during the follow-up. The severity of the disease influenced the mortality; the lower the ankle-brachial index, the higher the mortality. The patients' subjective feel ings of change in symptoms were not affected by the severity of the disease at the start.

The location of the disease, whether aortoiliac, femoropopliteal, or femorotibial, did not affect the progression of the disease, but it strongly influenced the patients' subjective assessment of the results of conservative treat ment. Patients with proximal disease were less satisfied with conservative treat ment and more often needed surgical intervention.

At the two-year follow-up, 53% of the patients felt better, 35% felt unchanged, and 12% felt worse. Patients' assessments of disease progression are good.
Results of Pulsatile Assist Device Usage In Extracorporeal Circulation
Authors: Isik Ömer , Balkanay Mehmet , Irez Aysen , Yakut Cevat
Published: August 2008

Some surgeons prefer pulsatile to nonpulsatile flow in extracorporeal circu lation. They believe that pulsatile flow is more physiologic, provides better tis sue perfusion, gives less damage to the blood elements and plasma proteins and causes less complement activation when compared with nonpulsatile perfusion.

In order to compare the pulsatile with nonpulsatile flow during extracorporeal circulation, the authors studied two different groups of patients, each consist ing of 20 coronary bypass candidates. The patients in the two groups had almost the same properties and were operated on under the same circumstances. In the first group extracorporeal circulation was established with a nonpulsatile roller pump. In the other group a pulsatile assist device was integrated into the arterial line of the extracorporeal circuit with the roller pump. Extracorporeal circula tion was maintained with pulsatile flow obtained by an intraaortic balloon pump pneumatic console. The patients in the two groups were selected to be similar in terms of sex, age, preoperative clinical characteristics and hemodynamic and angiographic findings. Thirty-two operative and early and late postoperative parameters were compared in these two groups. In conclusion, no superiority of pulsatile flow established with the pulsatile assist device over nonpulsatile flow during extracorporeal circulation was seen.
Relief of Migraine and Other Headache Following Surgical Treatment of Varicose Veins
Authors: Glass Gerard M. , Glass Brendan G.
Published: August 2008

Sixty-eight patients undergoing surgical treatment of varicose veins who also suffered from recurrent headache were studied. In 23 patients this symptom was classified as migraine and in 45 as other headaches. In each group four aspects of headache (frequency, severity, duration, and associated disturbances) were assessed by a self-administered questionnaire before and between twelve and eight een months after surgical treatment of varicose veins. In migraine there were reductions in scores for frequency, p < 0.01; severity, p < 0.01; duration, p < 0.01; associated disturbances, p<0.01; and in total score, p<0.01. In other headaches there were reductions in scores for frquency, p < 0.001; severity, p < 0.001; du ration, p < 0.001; associated disturbances, p < 0.01; and in total score, p < 0.001. Varicose veins and migraine are each associated with impaired regional blood flow. The results of the present study suggest that relief of recurrent headache following surgical treatment of varicose veins may be due to effects of improved blood rheology in the microcirculation on cerebral function.
Late Graft Occlusion: Thrombolytic Treatment
Authors: Pratesi Carlo , Michelagnoli Stefano , Pulli Raffaele , Credi Giovanni , Chiti Emiliano , Stefani Paolo , Bertini Domenico
Published: August 2008

The frequency of acute ischemic graft thrombosis is increasing owing to the larger number of graft implantations. The possibility of success depends on detection of the reasons for the thrombosis and the ability to repair it. In addition lytic therapy must be considered during diagnosis followed usually by an adjunctive procedure like surgery or percutaneous transluminal angioplasty. With this kind of approach physicians are able to delay the surgery, to get more information about the vascular bed, and so to choose the most proper surgical procedure.

At present the authors are using this protocol: 100,000 U bolus of urokinase and then 35,000 U/hour. During the application of this protocol certain laboratory parameters are monitored (fibrinogen, activated partial thromboplastin time, thrombin time, fibrinogen degradation products) in order to evaluate the coagulation system during therapy. Their protocol also includes serial controls by means of clinical examination, Doppler examination, and angiography. Angiography can be considered at the end of the therapy as a means of final evaluation and can detect those cases that need adjunctive therapy.

Their experience is based on treatment of 47 graft occlusions in 44 men and 3 women, in whom they used urokinase.

They divided the patients with late graft occlusions into two subgroups according to the occlusion level. The clinical results were good in 88.6°10 of cases in proximal and 75 ~Io of cases in distal occlusion. The overall lysis as determined by angiography was 85.707o in proximal and 41.7% in distal grafts.

The authors found a significant difference in the time limit for starting efficient therapy of a thrombosed graft versus an atherosclerotic artery. In therapy of an occluded graft they were able to achieve patency by starting the thrombolytic infusion within nine hundred sixty hours after the occlusion. In terms of the Winsor index before and after therapy they noticed that the improvement was less evident than could be imagined from looking at the arteriographic results because of the pathologic status of the artery below the graft.

In conclusion they recommend the technique of "low dose" catheter-directed therapy for its good results and its lack of significant systemic effects.
Treatment of Superficial Venous Incompetence with a Hemodynamic Technique on an Outpatient Basis: The SAVAS Technique
Authors: Belcaro G. , Christopoulos D.
Published: August 2008

Three techniques to treat venous incompetence on an outpatient basis were compared in 138 limbs [107 patients) with superficial venous incompetence. They were treated with the dentist's technique (DT) [Group A, 44 limbs], compres sion sclerotherapy (CS) [Group B, 45 limbs], or the SAVAS [ sectionnement en Ambulatoire des Varices Avec Sclerotherapie] technique [Group C, 49 limbs]. All patients were followed up (five years) with ambulatory venous pressure (AVP) measurements and color duplex scanning.

DT consisted of the sectioning under local anesthetic of incompetent veins. CS was done by injecting polidocanol 3% with compression applied for four weeks. The SAVAS was done with a combination of DT and CS with sectioning of the incompetent veins under local anesthetic and retrograde injection in the distal veins of polidocanol 3%. This type of retrograde injection perfuses only incompetent veins.

After five years there was a significantly lower refilling time (RT) with AVP in the SAVAS group (average of twenty seconds). RT was 12.5 seconds in group B and fifteen in A. The number of significantly incompetent residual veins was on the average 0.9 in the SAVAS group, significantly lower than in the other two groups. The average cost per treated limb was significantly lower is the SAVAS group.

In conclusion, after a five-year follow-up, the SAVAS technique was more effective, its hemodynamic value was superior to DT and CS, and its costs were lower.
Acute Mesenteric Ischemia: A Simple and Practical Approach
Authors: Samuels Louis E. , Gensler Todd W. , Kerstein Morris D.
Published: August 2008

The diagnosis and management of acute mesenteric ischemia (AMI) have evolved considerably since first described nearly 150 years ago. Angiography remains the gold standard for establishing a definitive diagnosis. Today, several therapeutic options—both percutaneous and surgical—are available for combatting AMI. Vasodilation, lytic, and balloon angioplastic procedures are percutaneous approaches that can be considered in a subset of patients in whom the clinical examination does not necessitate immediate laparotomy. When laparotomy is mandatory, embolectomy, thromboendarterectomy, and a variety of mesenteric revascularization procedures have enabled intestinal salvage. As a result, the morbidity and mortality of AMI have declined. The authors offer an algorithm that simplifies the approach to AMI, emphasizes rapid diagnosis and early intervention, and includes percutaneous therapy as an option to consider.
Celiac Steal Resulting in Chronic Intestinal Ischemia
Authors: Kupferschmid John P. , Dickson Christopher S. , Young Joseph C.
Published: August 2008

There is considerable controversy regarding the existence of celiac axis compression syndrome. Despite this, there is clearly a subset of patients with extrinsic compression of the celiac axis who have symptoms and who benefit from operative therapy. Clinical features that may help to identify those patients who are most likely to respond to surgical therapy have been studied; however, the authors present a patient who had a favorable surgical outcome despite lacking many of these clinical features. The patient had significant celiac steal. They suspect that the presence of celiac steal may be an important determinant of a successful surgical outcome.
Validity of Vascular Prostaglandin Assay Methods
Authors: Fillinger M.F. , Hull T.L. , Mirth C.A. , Reinitz E.R. , Schwartz R.A.
Published: August 2008

This study directly compares the three major methods of prostaglandin as say for explanted blood vessels in an effort to determine whether reliable assays can be performed on small, localized areas. Under general anesthesia, canine femoral arteries and veins (n =16) were excised after measurement of in vivo dimensions. Each vessel was divided into three segments. Vessel segments were (1) incubated as whole rings ("biopsy" method), (2) incubated with the luminal surface covered by a plexiglass well (well method), or (3) perfused with a pulsa tile pump at physiologic pressure, temperature, and flow rate for two fifteen minute cycles with a balanced salt solution (perfusion method). Perfusion seg ments were also tested by the well and biopsy methods after thirty minutes of ex vivo perfusion. Assays of stable metabolites for prostacyclin (Pc) and throm boxane A2 (Tx) were performed using commercially available radioimmuno assay techniques. Luminal perfusion was used as the "gold standard" for corre lation.

Mean values for Pc, Tx, and Pc/Tx ratio were compared for each method on both arteries and veins. In each case, the well method was statistically equiva lent to the perfusion method for the second fifteen-minute cycle, while the biop sy method was significantly different in several groups. Linear regression analysis revealed significant positive correlations between the well method and the per fusion method (r>0.74, P<0.01). The biopsy method did not correlate with the perfusion method in a significant manner (r 0.18 and 0.50, p<0.05).

Significant differences between the first and second perfusion cycle were seen in most cases. The wall method revealed trends toward decreased thromboxane production but no change in prostacyclin production for specimens after thirty minutes of perfusion.

Conclusions: (1) The well incubation method demonstrates a significant positive corre lation with luminal perfusion while allowing assay of small localized areas. (2) Luminal perfusion is a reproducible technique, but larger vessel areas and more complex appara tus are required. Significant variations in luminal prostaglandin synthesis occur with se quential perfusion cycles, and the mechanism for the decrease in prostacyclin/thromboxane synthetase level or differing mechanisms for prostacyclin and thromboxane synthesis. (3) The vessel biopsy method is not reliable for comparisons with luminal perfusion or as a means of measuring luminal prostaglandin production.
Surgical Outcome for "Normal" Coronary Ventricular Tachyarrhythmias
Authors: Yee Edward S.
Published: August 2008

Analyses of 75 surgically treated patients for potential life-threatening ven tricular tachyarrhythmias demonstrate a distinct subset of patients with "nor mal" coronary ventricular tachyarrhythmias. This subset of 10 patients (Group A) was compared with the remaining 65 patients (Group B), who had intra luminally obstructed and ischemic lesions. The etiologies for Group A patients included 4 hypertrophic cardiomyopathies, 4 dynamic intramyocardial muscle bridges, and 2 congenital aneurysms or diverticula. The localized arrhythmic foci for Group A were all preoperatively or intraoperatively determined as com pared with only 33 of 65 (51 %, p < 0.05) in Group B. While the specific types of surgical intervention for the two groups were seemingly identical (ie, revascu larization, endocardial resection, aneurysmectomy and reconstruction, and/or insertion of automatic internal cardiac defibrillators), the mortality rates were significantly different (mortality A vs B: early 0/10 vs 5/65, p < 0.05 and late 0/ 10 vs 4/60, p < 0.05). All Group A patients underwent repeated studies demon strating maintained ventricular function, in contrast to Group B patients, who exhibited severe ventricular impairment (7/60, p < 0.05).

In summary, "normal" coronary ventricular tachyarrhythmias are found in a distinctive subset of patients. Their different etiologies result in better out comes from direct operation, and hence, these patients should be managed with this important premise. Indirect or non-operative approaches should not be used in place of these potential cures.
Management of Infected Early Postoperative Lymph Leak in the Groin
Authors: Khalil Ismail M. , Sudarsky Laura A.
Published: August 2008

Lymph leak from a groin incision following vascular procedures on the fem oral vessels can be a difficult postoperative management problem. Eight pa tients (of 198 undergoing vascular reconstructions involving the femoral vessels) developed 9 lymph leaks (4.5%) through the groin skin incision in the first post operative week. Three patients (38%) had a synthetic prosthesis and 5 (62%) had autogenous saphenous vein grafts. Initially, the authors treated the patients with intravenous antibiotics, bed rest, and sterile occlusive dressings. The lym phorrhea persisted in all patients, and serial cultures of the draining lymph became positive within fourteen days postoperatively. Surgical management consisted of radical debridement of the wound and rotation of a muscle flap to cover the vascular repair. The wounds were left open to granulate, then split- thickness skin grafts were applied. During a follow-up period ranging from eighteen to thirty-six months, there was no evidence of graft infection, recurrent lymph leak, or limb loss.

Although the patient population is small, the authors feel that when a lymph collection in the groin leaks through the skin incision, the incidence of infection is high. Their surgical approach seems to yield a favorable outcome in control ling the lymph leak and preventing extension of infection to the vascular recon struction.
Catheter-Directed Thrombolytic Therapy in a Patient with Portal Venous Thrombosis Following Splenectomy—
Authors: Tanaka Koki , Ohno Takashi , Nishi Shunpei , Toda Riichiro , Taira Akira
Published: August 2008

A case of mesenteric venous thrombosis following splenectomy is presented. Her postoperative course was complicated. On the twentieth postoperative day, complete obstruction of the portal trunk was observed on portography. Cathe ter-directed thrombolytic therapy was started immediately. A total of 390 x 104 IU urokinase was given into the portal vein for eighteen days. After this ther apy, marked clinical improvement was noted and complete lysis of the thrombus was obtained. The portal system from trunk to intrahepatic branch was recana lized. This method had some benefits of efficacy, safety, and economy. To our knowledge, this is the first case of portal venous thrombosis to be successfully treated by catheter-directed thrombolytic therapy.
Triple-Ringed Cannula Spring Clip for Securing the Vein Grafts to the Blunted Cannulas in Coronary Artery Bypass Surgery
Authors: Olearchyk Andrew S.
Published: August 2008

The author describes the triple-ringed cannula spring clip or ringed clip designed for a quick, atraumatic and frugal securing of the vein grafts to the blunted infusion cannulas in coronary artery bypass surgery. It was found particularly useful when used in conjunction with the Shiley coronary cardioplegia adapter.
Carotid Endarterectomy in the Elderly Patient: Experience Over the Past 15 Years
Authors: Kashyap Ajaya , Deshmukh Narayan
Published: August 2008

The fastest growing population in the United States is greater than seventy-five years of age, and this is the population most prone to strokes. There has been some hesitation in performing carotid endarterectomy in the elderly. In this study, the authors attempted to evaluate short- and long-term effects of carotid endarterectomy in the elderly population and also compared these with those in younger patients. Results of 74 carotid endarterectomies in 68 patients more than seventy-five years of age performed by a single surgeon at Robert Packer Hospital/Guthrie Clinic in rural Pennsylvania over the past fifteen years were evaluated. These were compared with a similar number of surgeries done in younger patients by the same surgeon over the same time period. They found a 4% perioperative stroke rate and 4% perioperative mortality in the elderly patients compared with 4% perioperative stroke rate and 2.7% perioperative mortality in younger patients. Life table analysis done for elderly patients revealed a cumulative survival of 76.9% and a stroke-free survival of 70% at ten years. They found carotid endarterectomy as well tolerated in the elderly population as in the younger patients. The long-term benefits of carotid endarterectomy in the elderly in their setting have been excellent, and there is much to recommend this surgery in elderly patients with carotid artery stenosis.
The Concentration of Blood in Cardioplegia Determines Postoperative Conduction Disturbances
Authors: Gundry Steven R. , Sequeira Alejandro , McLauglin Joseph S.
Published: August 2008

Blood cardioplegia in conjunction with iced slush topical cooling has been shown by the authors' group and others to cause postoperative conduction disturbances in 50% of patients. Because this is significantly higher than crystalloid cardioplegia, they tested whether a lower concentration of blood in the cardioplegia mix might change the rheology of the solution and hence lower the conduction defects if cold sludging of red blood cells caused the defects. They compared 289 consecutive patients receiving 4:1 blood cardioplegia (BC) with 90 consecutive patients who received 2:1 blood cardioplegia for the presence of postoperative conduction defects.

The 4:1 BC caused conduction defects in 141/289 (49%) patients versus 8/90 2:1 BC patients (9%) (p=0.01). Perioperative heart block requiring pacing occurred in 67 patients with 4:1 BC (23%); no patients with 2:1 BC required pacing (p=0.001). Only 10 of 141 (7%) 4:1 BC patients had resolution of conduction defects prior to discharge, whereas all 2:1 patients but 1 resolved their defects within twelve hours of operation (p=0.05). There was no difference in patients' ages, grafts, ischemic time, or cardioplegia amount. Iced slush was used in all patients.

The authors conclude that the concentration of blood in cardioplegia solutions appears to have a direct effect on postoperative conduction disturbances; their group now routinely uses a 2:1 mixture. This concentration allows continued use of iced slush topical cooling.
Reduction of Homologous Transfusions in Open-Heart Surgery
Authors: Santoli Edoardo , Di Mattia Daniele G. , Castelli Piero , Condemi Annamaria , Guzzetti Stefano , Meraviglia Paola , Santoli Carmine
Published: August 2008

Use of homologous blood is relatively frequent in cardiac surgery and represents a potential risk for sensitivity or infective contamination.

A prospective study on 744 patients (operated on before September, 1986, and considered as the control group) revealed that the incidence of posttransfusion hepatitis was 12.7% (mean overall blood loss was 1270±115 mL; bank-blood-transfused patients comprised 91.9% of the group; and bank-blood-transfused units averaged 8.6/patient).

From September, 1986, to December, 1990, 924 patients underwent elective open-heart operations. Autotransfusion only was used in group A (400 patients). Aprotinin was added to autotransfusion in group B (192 patients). Aprotinin only was used in group C (332 patients). The bank blood requirement was reduced drastically in all groups. In group A, mean blood loss was 870±85 mL, and transfusions were required in 29.7% of patients with a mean bank blood unit/patient of 2.6 ± 1.8. In group B, mean blood loss was 425 ± 55 mL, and transfusions were required in 11.5% of patients, with a mean bank blood unit/patient of 1.8 ± 1.3. In group C, mean blood loss was 405 ± 45 mL, 31.9% of patients had bank blood transfusion, and mean bank blood unit/patient was 2.1±1.2.

The incidence of posttransfusion hepatitis was 4.2% in group A, whereas no infective complications were found in the other groups.

The basal mean hematocrit value in groups A and B was 42.1±2.7% and 41.4±2.0%, respectively, and preoperatively, after a blood withdrawal of 3 units, was, respectively, 34.8±1.9% and 33.8±1.1%. In group C the mean preoperative hematocrit value was 41.7 ±2.2%. Mean hematocrit values at discharge were similar in all three groups, ranging around 30%.

Platelet count dropped in group A after surgery (-41%) and increased in the postoperative period, never reaching the basal value. Patients receiving aprotinin (groups B and C) presented a lower postoperative platelet decrease (respectively -28.6% and - 26.1 %), with a discharge value lower than basal.

Autologous blood collection and aprotinin administration proved to be a well-tolerated and uncomplicated method. This represented the most important and effective blood-saving procedure in cardiac surgery, minimizing the bank blood requirement and minimizing or even eliminating posttransfusion complications.
The Microcirculation in Suction Blister Wounds on Upper and Lower Limbs in Healthy Volunteers
Authors: Kutlu Necmettin , Svedman Paul
Published: August 2008

Functional aspects of the microcirculation were studied in wounds deepithelialized by suction on the upper and lower limbs in healthy male volunteers (n: 8). Daily laser Doppler flowmetry (LDF) assessments for four days demonstrated a pronounced and lasting hyperemia in the deeper dermis of the lesions. The hyperemia was less pronounced in the lower limb wounds. On day 0 the LDF values were 144±47 PU (mean±SD, perfusion units) (upper limb) and 96±33 PU (lower limb) (p < 0.05). Intravital microscopy assessments based on the exposed superficial microvessel networks in the wounds also indicated stable conditions. The mean microvessel diameters on the day of infliction were 10±1 mn(upper limb) and 12±2 μm (lower limb) (NS), and the red cell velocity (RBC-V) was 0.62 ± 0.18 mm/s on the upper limb and 0.67±0.13 mm/s on the lower limb. There were no distinct differences in mean microvessel diameters or red cell velocities in comparisons on a day-to-day basis between wounds on the two sites. The latter finding contrasts with the differences in structural response on the two sites that have been described previously. Both the hyperemia and the stable circulatory conditions on the two sites should favor an even rate of drug resorption when the deepithelialized site is used for transdermal drug delivery.
Syphilitic Aneurysm of the Subclavian Artery: Case Report
Authors: Khoda J. , Sebbag G. , Lantsberg L.
Published: August 2008

The authors treated a patient who presented with an aneurysm of the subcla vian-axillary artery, which appeared to be of syphilitic origin. The authors re view the problems of diagnosis and treatment of these aneurysms. The management is surgical and consists in resection and reestablishment of arterial continuity.
Diagnostic Features, Surgical Treatment, and Postoperative Follow-up of the Aortic-Left Ventricular Tunnel
Authors: Balthazar Jacob José Luiz , da Silveira Luiz Carlos , Cecim Coelho Wilson Miguel , Spinola Machado Nilton Carlos , Coimbra Garzon Sérgio Aloisio , Nicolau José Carlos , Lorga Adalberto Menezes
Published: August 2008

This report of 3 cases of aortic-left ventricular tunnel describes the clinical features, cross-sectional echocardiographic and angiocardiographic studies, surgical technique, and postoperative follow-up.

Left ventricular hypertrophy was apparent in the electrocardiogram of each patient, and the chest x-rays showed marked cardiomegaly and dilatation of the ascending aorta.

The echocardiographic parasternal long-axis view and the parasternal short- axis view allowed the correct diagnosis of the aortic-left ventricular tunnel, and the Doppler study showed aortic valve regurgitation in all patients.

The left ventriculogram and aortogram in right anterior oblique view were very important for diagnosis and permitted visualization of the tunnel in all cases.

The surgical technique consisted of the closure of the aortic and ventricular ends of the tunnel with a reinforced patch repair to reestablish the attachment between the unsupported aortic annulus and the ventricular septum.

At the postoperative follow-up, the 3 patients have mild aortic valve regurgi tation that has not increased to the present.
Traumatic Pseudoaneurysms of Peripheral Arteries and Their Surgical Management
Authors: Yasar Tahsin , Inci Ilhan , Furtun Kamil , Özgen Gökalp
Published: August 2008

From 1977 through 1990, 60 patients who had traumatic pseudoaneurysms underwent surgical treatment at Dicle University, School of Medicine, Thoracic and Cardiovascular Surgery Department; 65% of the aneurysms were localized at lower extremities and 35% at upper extremities. The most frequent localiza tion was 40% at the superficial femoral artery. Etiology of the trauma was as follows: 67% shotgun injuries, 25% penetrating instrument injuries, 5% blunt trauma, and 3% iatrogenic.

In 31.7% end-to-end anastomosis, in 45% saphenous venous interposition, in 10% ligation, in 8.3% lateral suture, and in 3.3% artificial grafting were done as a surgical management.

Primary amputation was done in 1.7% of the patients; 93.3% of all the pa tients have recovered, and only 1 patient died (1.7%).
Computer Simulations of Ventricular Function: Surgical Implications for Repair and Reconstruction
Authors: Yee Edward S. , Kim Francis , Wilson James M.
Published: August 2008

Computer simulation technique has been developed to model the complex heterogeneous function of the left ventricle. The left ventricle was modeled as a series of twenty-five consecutive cylindrical shells in an elliptical configuration and then these were specifically and regionally modified. These techniques al lowed assessment of many salient features of clinical situations, such as (1) acute myocardial infarction with secondary loss of apical or anterior wall function, then (2) chronic changes with ventricular aneurysmal formation, and (3) sec ondary residual myocardial compensatory hypertrophy. These pathological de formations were then surgically operated by computer simulation to compare the reconstruction techniques of (1) direct apposition or primary closure versus (2) synthetic patch repair of the resected myocardium for these clinical condi tions. Computer simulation allowed a better understanding of the available data in relationship to surgical decision for ventricular reconstruction to achieve op timal function in each of these specific settings.

The current computer simulation models were used to demonstrate the com plex, dynamic function of the heterogeneous nature of the left ventricle and to allow further evaluations of various potential surgical reparative procedures. These models allow prediction for the best and worst potential outcome of func tion after surgical reconstruction.
Oxygen Free Radical (OFR) Generation During Cardiac Surgery Induces Lipid Peroxidation and Decreases Blood Cell Rheology
Authors: Belboul Ali , Krotkiewski Marcin , Al-Khaja Najib , Brzezinzka Zofia , El-Gatit Abdusalam , Liu Bo , Uchino Takashi , Roberts Donald
Published: August 2008

This study was done to find out whether free radical generation during car diac surgery results in increasing lipid peroxidation (LPO) in blood and to see whether this could partly explain reduction of blood cell rheology during cardiopulmonary bypass (CPB). Ten patients undergoing cardiac surgery using CPB were prospectively studied. Malondialdehyde (MDA) was measured as a marker of free-radical-induced LPO, and blood cell trauma was estimated by measuring blood cell rheology. During CPB, MDA increased, while blood cell rheology decreased significantly, especially after aortic declamping. There were significant correlations between LPO and blood cell rheology. It is concluded that free radicals generated during CPB lead to an increase of LPO, which is shown to be associated with a decrease of blood cell rheology.