bluuebunny/crossref_metadata_2025 huggingface dataset:
Review : Purine nucleoside analogues: Fludarabine, pentostatin, and cladribine
Authors: Kolesar Jill M. , Morris Ashley K. , Kuhn John G.
Published: November 2007

Purpose. An introductory template for an extensive discussion of the pharmacology, pharmacokinetics, clinical use and adverse effects of the currently ap proved adenosine analogues: fludarabine, pentostatin, and cladribine is profiled. This is part one of a three-part series.

Data Sources. We reviewed the literature through a MEDLINE search from 1986 to 1996. Relevant articles cited in literature obtained by MEDLINE searching were also considered. We searched the following terms: fludarabine, cladribine, pentostatin, apoptosis and adenosine ana logues. The search was restricted to the English language. We have incorporated pricing information from our prac tice sites as well as the average wholesale price for the purpose of cost comparison.

Data Extraction. We have reviewed the current literature with regard to the chemistry, mechanisms of action and pharmacology, pharmacokinetics, clinical use, adverse effects, drug interactions, indications, formulation, dosage, administration, pharmaceutical issues and a cost comparison of the currently approved adenosine ana logues, fludarabine, pentostatin, and cladribine.

Data Synthesis. The adenosine analogues are struc turally similar agents used in the management of hemato logical malignancies. Fludarabine and cladribine exhibit significant activity in CLL (chronic lymphocytic leukemia) and NHL (non-Hodgkin's lymphoma) and pentostatin and cladribine are both active in the treatment of hairy cell leukemia. There are no comparative clinical trials between the agents and we have provided comparisons based on pharmacology, clinical experience, adverse effects and cost as well as reviewing the clinical use of these agents.

Conclusion. The adenosine analogues, fludarabine, pentostatin, and cladribine, represent an important ad vance in the treatment of indolent lymphoid malignancies. Although response rates for fludarabine and cladribine in chronic lymphocytic leukemia and for pentostatin and cladribine in hairy cell leuemia are improved over standard therapy, the true clinical impact of these agents has not yet been realized. Additional studies in larger populations of both previously treated and untreated patients, as well as comparative trials between the deoxyadenosine analogues themselves need to be carried out. Moreover, combination chemotherapy trials with deoxyadenosine analogues and other cytotoxic agents need to be performed to determine the efficacy and toxicity of these combinations in various lymphoid malignancies.
Purine nucleoside analogues: fludarabine, pentostatin, and cladribine
Authors: Kolesar Jill M. , Morris Ashley K. , Kuhn John G.
Published: November 2007

Purpose. The primary objective of this article is to continue the discussion of the pharmacology, phar macokinetics, clinical use, and adverse effects of the currently approved adenosine analogues, focusing on pentostatin. This is part two of a three part series.

Data Sources. We reviewed the literature through a MEDLINE search from 1986 to 1996. Rele vant articles cited in the literature obtained by MED LINE searching also were considered. We searched the following terms: fludarabine, cladribine, pentosta tin, apoptosis, and adenosine analogues. The search was restricted to the English language.

Data Extraction. We have reviewed the current literature in regard to the chemistry, mechanisms of action and pharmacology, pharmacokinetics, clinical use, adverse effects, drug interactions, indications, formulation, dosage, administration, and pharmaceu tical issues of the currently approved adenosoine analogues, focusing on pentostatin.

Data Synthesis. The adenosine analogues are structurally similar agents used in the management of hematological malignancies. Pentostatin and cladrib ine are both active agents in the treatment of hairy cell leukemia. There are no comparative clinical trials between the agents, and we have provided compari sons based on pharmacology, clinical experience, adverse effects, and cost.
Standardizing the expression and nomenclature of cancer treatment regimens
Authors: Kohler David R. , Montello Michael J. , Green Laurence , Huntley Carl , High Joseph L. , Fallavollita Alfred , Goldspiel Barry R.
Published: November 2007

Guidelines for describing cancer chemotherapy regi mens in all aspects of drug development, including treatment protocols, order forms, and product labels, are proposed.

To complement the approaches to reducing medication errors that have been recommended by the American Society of Health-System Pharmacists and others, pharmacists at the National Institutes of Health and the National Cancer Institute, with the input of oncology pharmacists from diverse areas of practice, developed guidelines for expressing chemo therapy dosage schedules and treatment regimens. The guidelines present standards that are broadly applicable and can be adopted by other institutions. Clear and unambiguous expression of all medication orders and consistency of treatment descriptions are suggested. Written treatment plans and orders should contain enough information to allow health care providers from diverse disciplines to compare them with published treatment descriptions and investiga tional protocols and must therefore include planned dosages and schedules expressed in patient-specific units. In general, drug dosages should be expressed as the amount of drug administered from a single con tainer. When ordering drugs that are part of complex or combination-drug regimens, prescribers should write as many of the orders at one time as is possible so that continuity might be preserved.

Standard rules are proposed for describing che motherapy regimens.
Urinary excretion of paclitaxel and metabolites in a large series study
Authors: Panday Vinodh R Nannan , Rosing Hilde , Huizing Manon T , Koopman Francesca J , van Warmerdam Laurence JC , ten Bokkel Huinink Wim W , Beijnen Jos H
Published: November 2007

Objective. Paclitaxel is an antineoplastic agent with significant activity against several tumour types. The major portion of the drug disposition (80-90%) in volves metabolism and biliary excretion. The purpose of this study was to investigate the relationships between the mean urinary paclitaxel excretion frac tion and the administered dose, creatinine clearance, or the measured paclitaxel area under the plasma concentration versus time curve.

Design. The design used was a retrospective convenience sample study.

Setting. The setting for this study was a hospi talised care center.

Patients. A total of 103 24-hour urine collections from 60 patients treated with paclitaxel were used to investigate these relationships.

Results. In this large series study, the paclitaxel urinary fraction was 5 ± 3% (mean ± SD) as a fraction of the administered paclitaxel dose. No correlations were found between the paclitaxel urinary excretion fraction and the administered dose, creatinine clear ance, and plasma concentration-time curve. In addi tion, the paclitaxel metabolites 6α-hydroxypaclitaxel, 3'- p-hydroxypaclitaxel and some unidentified com pounds were detected in the 24-hour urine samples of two patients, of whom one had a mild impaired renal function.

Conclusions. Considering the low urinary ex cretion of paclitaxel, it is anticipated that patients with renal dysfunction require no dose adjustments. Metabolites were found in the urine.
Psychological consequences associated with intensive care treatment
Authors: Carr James
Published: November 2007

Intensive Care Unit (ICU) treatment involves a range of physical and psychological stressors including serious illness, invasive medical procedures, and prolonged incapacity. In addition to physical health problems, those that survive ICU often experience long term psychological difficulties such as cognitive impairment, depression, anxiety, and post-traumatic stress disorder. This review will first consider the types of psychological problems that can occur both during ICU treatment and following discharge and some of the factors involved in their development. Second, consideration is given to medical and psychological intervention strategies that can be provided both during treatment and in follow-up.
Angioscopic Preparation of the Saphenous Vein for in situ Grafting in the Treatment of Chronic Lower Extremity Ischemia
Authors: Bhirangi Kiran , Lynch James C. , Stahler Christopher , Brinton Milton H. , Kraiss Larry W.
Published: November 2007

The purpose of this study is to evaluate the angioscopic method of preparation of the saphenous vein for in situ grafting as compared with the standard open vein preparation. Nineteen consecutive cases performed after adoption of a semiclosed angioscopic technique were compared with 20 consecutive cases performed with the conventional technique of vein preparation. Wound complications occurred less frequently in the angioscopy group (37% vs 78%, p=0.02). By univariate analysis, wound healing problems were associated with low preoperative ankle-brachial index (p=0.07), tissue loss (p=0.05), and use of a long, continuous leg incision (p=0.01). Logistic regression analysis identified low preoperative ankle-brachial index (p=0.03), diabetes (p=0.05), and a long, continuous leg incision (p=0.06) as independent predictors of wound compli cations. Patients with wound complications had significantly longer hospital stays (9 ±8 vs 4 ±3 days, p<0.01). This initial experience suggests that angioscopic preparation of the saphenous vein results in fewer wound complications and should result in shorter hospital stays compared to conventional methods of vein preparation. The long-term effect of angioscopically assisted vein preparation remains to be determined.
Combined Carotid Endarterectomy and Vertebral Transposition or Bypass for Cerebral and Vertebrobasilar Insufficiency
Authors: Sottiurai V.S. , Lyons R. , Omlie W. , Roberts R. , Smith B. , Ross C. , Cooper M. , Gonzales J.
Published: November 2007

The purpose of this report is to determine the indication for a combined carotid endarterectomy and vertebral transposition or bypass in patients who have transient ischemic attack (TIA) or stroke and intractable vertebral ischemic symptoms of dizziness and syncope. A retrospective review was made on 49 patients with the combined symptoms of generalized global ischemia, TIA, amaurosis fugax or stroke, and vertebral basilar insufficiency manifested as syncope, intractable dizziness, and unsteady gait. Diagnostic studies employed were carotid duplex scan, computed tomography (CT) or magnetic resonance imaging (MRI) brain scan, xenon blood flow study, transcranial Doppler analysis, electronystagmography, electroencephalography, and cardiac arrhythmia evaluation. Twenty-one of 49 patients (43%) with internal carotid occlusion underwent carotid endarterectomy plus vein patch or internal carotid to external carotid onlay patch angioplasty and proximal vertebral to common carotid artery transposition (n: 19), or bypass (n:2). Twenty-seven of 49 patients (57%) received carotid endarterec tomy and vertebral transposition (n:27) or bypass (n:2) for carotid and vertebral stenosis. There was no operative mortality, stroke, or neurologic deficit following the carotid and vertebral operations in the 49 patients. Six patients had transient palpebral ptosis. Postoperative cerebral angiogram or magnetic resonance angiogram showed patent vertebral arteries. All 49 patients have resolution of TIA, dizziness, syncope, and unsteady gait. Combined carotid endarterectomy and vertebral transposition or bypass should be considered in patients with solitary, dominant, or bilateral vertebral artery critical stenosis whose symptoms are unrelated to vestibular, cardiac, or seizure disorders and lateralized TIA or stroke.
Femoroaxillary Bypass for Cerebral Ischemia
Authors: Sharp William J. , Nowak Lisa , Hoballah Jamal J. , Kresowik Timothy F. , Corson John D.
Published: November 2007

The case of a 69-year-old woman with a complicated history of intrathoracic aortic arch and arch vessel reconstruction is reported. She presented with occlusion of multiple arch vessels and symptoms of cerebral ischemia. A remote femoral inflow route was used for revascularization of the arch vessels owing to the hostile nature of the arch reoperative field.
Anomalous Coronary Artery Origin and Bicuspid Aortic Valve
Authors: Schang Steven J. , Pepine Carl J. , Bemiller Carl R.
Published: November 2007

A patient presenting with signs and symptoms suggesting myocardial ischemia was found to have anomalous origin of his right coronary artery from the left aortic sinus of valsalva associated with a bicuspid aortic valve. Abnormal left ventricular function with anaerobic myocardial metabolism was documented in the absence of significant coronary artery disease or aortic obstruction. The possible relationship of these findings to the coronary artery anomaly and bicuspid aortic valve is considered. The necessity of identifica tion of the origin of the coronary arteries is re-emphasized in the evaluation of patients with bicuspid aortic valves coming to cardiac catheterization.

Anomalous origin of a coronary artery is a rare occurrence. The association of this anomaly with a bicuspid aortic valve has not been emphasized and the possible clinical consequences of this combination of malformations have not been described. We recently evaluated a patient with anomalous origin of right coronary artery from the left coronary ostium and a bicuspid aortic valve. A description of these findings follows.
Jugular Venous Pulse Recording in a Patient Without a Tricuspid Valve
Authors: Kleid Jack J. , Agnostopolous Constantine , Cagin Norman A. , Levitt Barrie
Published: November 2007

The unusual contour of the jugular venous pulse tracing (JVPT) in a pa tient whose tricuspid valve was excised is described. The appearance of an early positive systolic wave (SW) followed by a prominent "V" wave and a delayed deep "Y" descent were noted.
Embolization To Diminish High Output Failure Secondary To Systemic Angiomatosis (Ullman's Syndrome)
Authors: Coel Marc N. , Alksne John F.
Published: November 2007

Embolization of multiple arteriove nous malformations was performed to alleviate high-output cardiac failure. The malformations were diagnosed as systemic angiomatosis, also known as Ullmann's syndrome. The resulting reduced cardiac output and improved emotional outlook lasted 2 years.
External Iliac "Steal Syndrome" Leading To a Defect in Penile Erection and Impotence: a Case Report
Authors: Metz Peter , Mathiesen Frits R.
Published: November 2007

A 39-year-old man with intermittent claudication due to occlusion of the aor tic bifurcation complained of sexual dysfunction. He had an almost normal ability to achieve erection, but experi enced disappearence of the erection and gluteal pain when he tried to move dur ing sexual intercourse. The patient was implanted with a bifurcation graft pro- thesis and regained complete erective potency. It is stressed that patients like this with sexual dysfunction, even those without intermittent claudication, should be examined for bruits and re duced pulses in the groins, and if nec essary they should be referred to an appropriate vascular department.
Lung Scan Abnormality Heralding a Left Atrial Myxoma: Case Report of an Unusual Presentation
Authors: Ellis Joseph G. , Houseworth John H. , Medendorp Debra
Published: November 2007

A large atrial myxoma was found in a patient whose initial complaints were related to obstructed perfusion of the right upper lobe. The tumor had blocked the right superior pulmonary vein.
The Physiologic Basis for the Extra-Anatomic Bypass
Authors: Shin Choon S. , Chaudhry Abdul G.
Published: November 2007

The effect of different factors on the hemodynamics of extra-anatomic by pass was studied in 12 adult mongrel dogs in an attempt to find a physiologic basis for such bypass operations. It was observed that increased demand of flow following the extra-anatomic bypass graft is met by increasing inflow in the do nor artery proximal to the anastomosis. In the absence of any restriction of in flow, no steal was observed even when the graft flow was increased to 10 times the normal by a fistula on the recipient side. Hypotension per se also failed to produce vascular steal. The graft flow was not affected by changes in the outflow of the donor artery. However, the most significant finding was that once the inflow into the donor artery was restricted down to a critical point, it led to vascular steal. The blood flow measurements 4 weeks after bypass showed an increased flow in all the vessels.
The Role of Autotransplantation in the Treatment of Severe Arteriorenal Hypertension: Ten Case Reports
Authors: Hadjiyannakis E.J.
Published: November 2007

This report summarizes our experience with 10 kidney autotransplanta tions performed from November 1972 to October 1978 in 9 patients with extended stenosis of renal arteries following fibromuscular hyperplasia. One of the cases involved a 5-year-old girl with a single kidney. Five of the 9 patients had presented with obviously decreased renal function.

There were no deaths. In the first patient the graft was removed after 10 months and a successful allotransplantation was performed with a mother donor, 5 years ago. In 2 of the 9 patients single kidney aortorenal bypass had been unsuccessfully performed elsewhere.

All the patients now have a normal blood pressure without having to take any antihypertensive agents, 3 to 70 months after the autotransplantation.
Use of Ultrasound Technique in Diagnosis and Therapy of Congenital Arteriovenous Fistulas
Authors: Stella A. , Pedrini L.D. , Curti T.
Published: November 2007

Twenty-four patients suffering from congenital arteriovenous fistulas were studied by means of angiography and Doppler ultrasound technique. Some common aspects were found in the ultrasound recording on the artery, vein, and fistula's area; typical findings can be analyzed and plotted by means of the sonographic test. Doppler probe was used during and after surgery as complementary to surgical angiography, due to its repeatibility and harm lessness. Doppler ultrasound technique may be very useful for periodical follow-ups which are essential in these patients because of the possibility of frequent recurrences.
Dilation with the Gruntzig Balloon Catheter for Peripheral Arterial Disease: Initial Experience in a Community Hospital
Authors: Calvin James W. , Sommer Daniel G. , Brown Michael J.
Published: November 2007

Intraluminal dilation using the Gruntzig catheter is a definitive procedure to correct obstructive arterial disease. Eleven procedures in 8 patients are reported. Six patients had progressive claudication and/or night pain, and 2 had advanced pre-gangrenous changes. Iliac, femoral, and/or trifurcation dilation of single or multiple lesions was successful in 9 (82%) extremities with documentation of widening of the arterial lumen. Clinical improvement was sustained for the short term followup (3-11 months, mean 7 months) except in 1 case where there was symptomatic relief for only 6 months. There were 2 technical failures (18%) in 1 patient due to bilateral calcific lesions. In some cases, the procedure should be performed in the operating room for immediate standby readiness of the surgical team and equipment. With this precaution in mind, the advantages of simplicity and repeatability suggest wider use of Gruntzig dilation.
Giant Hemangioma with Coagulopathy
Authors: Pen J. , Mahler C. , Parizel G. , Hermans C.
Published: November 2007

The association of giant hemangioma with an increased tendency to bleed was first recognized in 1940 by Kasabach and Merritt.1

Since then 132 additional cases have been published. Most of them show a combination of benign hemangioma, thrombocytopenia, and hemorrhagic diathesis.

The purpose of this paper is to present a patient with a truly giant heman gioma, associated with a bleeding tendency. A review of the relevant literature is given.
The Influence of the Smooth Muscle of the Tibial Artery on Local Arterial Pressure-Flow Relation
Authors: Bardou A.L. , Levy B.I. , Tedgui A. , Bazire J.M. , Saumont R.
Published: November 2007

Arterial smooth muscle response to direct electrical stimulation or stimulation of sciatic nerve, has been studied on the tibial artery of the dog. A segment of this artery was catheterized in two points separated by about 5 cm. Response of this segment to stimulation has been studied at constant arterial volume and at constant arterial flow-rate.

At constant arterial volume, initial pressure was adjusted between 25 to 120 mm Hg. Direct electrical stimulation was always followed by an important arterial pressure increase (158 to 183 mm Hg). Stimulation of the sciatic nerve also provoked an important increase of pressure (150 to 177 mm Hg).

At constant perfusion flow-rate, the pressure of the arterial segment was adjusted from 50 to 250 mm Hg (flow-rates included between 10 to 20 ml/min.). Direct stimulation was followed by a maximal vaso-constriction. Initial pressures of 50, 100, 150, 200 or 250 mm Hg all yielded very similar values (217 ± 17 mm Hg). Stimulation of the sciatic nerve produced an increase of pressure to 272 ± 17 mm Hg with a different response chronology.

These results show that, on tibial artery (generally considered as musculoelastic), smooth vascular muscle may considerably modify the hemo-dynamic conditions.
The Anterior Extraperitoneal Approach—Its Application to Pelvic Vascular Surgery
Authors: Jacob Jackie E.
Published: November 2007

Use of the midline or parmedian incision in the extraperitoneal approach to structures in the pelvis and posterior abdominal wall is recommended for ease, better exposure and flexibility. Two cases are presented involving ar teriosclerotic occlusive disease of the external iliac artery, where a relatively minor procedure may render the patient asymptomatic at least for the im mediate and near future.
Surgical Resection of Neoplastic Thrombosis in the Inferior Vena Cava by Neoplasms of Renal-Adrenal Tract
Authors: Vaislic C. , Puel P. , Grondin P. , Vargas A.
Published: November 2007

Renal cell carcinoma extends to the inferior vena cava in six percent of the patients.5 Ten percent to twenty-two percent of these renal cell carcinoma are found to invade the right atrium.4 Although earlier reports attached a poor prognosis to renal carcinoma,10 it has been suggested recently that extended survival can be achieved following complete surgical extirpation. Therefore radical nephrectomy and thrombus removal represent the only possibility of survival in these patients. The classically elevated mortality of this procedure has been drastically transformed in our experience by the use of cardiopulmo nary by-pass and deep hypothermic circulatory arrest technique. We have had no operative deaths with carcinogenic tumor removal.
Salvage of Apparently Occluded Femoropopliteal Autogenous Vein Graft (Case Report)
Authors: Hans Sachinder S.
Published: November 2007

Femoropopliteal vein graft was salvaged by patch angioplasty at two sites. The graft was presumed to be occluded as it could not be visualized on delayed arteriograms. In patients who need secondary revascularization after a failed femoropopliteal graft, direct palpation of the graft and corrective surgery if indicated may help in salvage of the graft in a very small number of cases.
The Versatility of Gore Tex® Grafts for Extra-Anatomic Bypass
Authors: Garcia-Rinaldi Raul , Revuelta Jose M. , Vaughan G. Dennis , Johnston Robert H. , Bonnington Lucy
Published: November 2007

Fifty six patients underwent fifty nine complex extra-anatomic revascular ization procedures using Gore Tex®. Nine grafts (15%) occluded. We opted not to revise 2 grafts and other two grafts thrombectomized ultimately failed. Five grafts were declotted and have remained patent.

The other patients have patent grafts or died of their primary illness with patent grafts (overall patency 93%). The surviving patients have been followed for an average period of 27.7 months (0.5-56 mo.).

Based on this experience we conclude that Gore Tex®, is a suitable conduit for complex extra-anatomic bypass in patients whose condition contraindicates direct vascular reconstruction.
The Value of the Intraoperative OPG Monitoring in Carotidendarterectomy
Authors: AbuRahma Ali F. , Lawton William E. , Ferrell Phyllis , Osborne Linda
Published: November 2007

One of the most important aspects of carotidendarterectomy is to maintain adequate cerebral blood flow during carotid clamping. Various methods have been reported to assess the cerebral circulation during carotidendarterectomy; e.g. electroencephalogram, stump pressure measurement, etc. The purpose of this paper is to analyze the value of the intraoperative OPG monitoring during carotidendarterectomy with emphasis on its value during carotid shunting. Using the Zira-OPG, 15 patients who underwent carotidendarterectomy were studied. Baseline OPG was done in the operating room after anesthesia. Serial recordings were obtained during sequential clamping of the common, internal and external carotid arteries. Another OPG was obtained during ca rotid shunting and every three minutes until the shunt was removed and after completion of the procedure. The pulse delay information obtained was used as indicator of what the expected delays would be in the event of shunt occlusion. The test was valid and helpful in eight and invalid and useless in the other seven patients. We concluded that this method was only helpful in 53% of the cases.
Intraoperative Arteriography Following Arterial Reconstruction with Saphenous Vein (A Simplified Technique)
Authors: Singh Hans Sachinder , Mittal Vijay K.
Published: November 2007

Immediate graft failure following femoropopliteal and femoro-infrapopliteal bypass is due to technical errors which can most definitively be recognized by intraoperative arteriography. A simplified technique of intraoperative arteriog raphy following arterial reconstruction with saphenous vein has been described and results discussed.
The Surgical Anatomy of the Colorectal Intramural Blood Supply
Authors: Al-Fallouji M.A.R.
Published: November 2007

An experimental angiology study of 12 surgical colorectal specimens resected from 12 patients with colorectal malignancies in a prefixed state (panoramic view) and after fixation (cross-sectional views taken at 5 different segmental levels) was conducted in Newmarket General Hospital over a 6 month period. The angiology films were analysed quantitatively in order to study the surgical anatomy of the intramural blood supply with the aim of determining whether the arteriolar anastomotic pattern was variable, possibly making one part more suitable for anastomosis than others.

The results revealed no difference in intramural vasculature at different lev els and the selection of any segment for colorectal anastomosis should be gov erned, so far as the blood supply is concerned, by the adequacy of the extramural circulation.
The Recurrence of Varicose Veins After Surgery
Authors: Kutz Charles M.
Published: November 2007

After having performed at least two thousand varicose vein operations, I have come to the conclusion that despite careful preoperative diagnosis and meticulous surgery, there are some patients who develop recurrences.

Barlow in 1948 1 stated that varicose veins is a progressive degenerative dis ease. Surgical treatment is directed at eliminating all discernable varicosities. However, since the disease is naturally progressive, some degree of recurrence is inevitable. Therefore, all patients should be followed ad infinitum.
Cold Blood Potassium Cardioplegia: A Five-Year Experience With 400 Consecutive Patients
Authors: Morishita Yasuo , Taira Akira
Published: November 2007

The purpose of this study is clinically to evaluate the efficacy of cold blood potassium cardioplegia (BPC) during ischemia. Four hundred patients, includ ing 141 congenital heart diseases (Group I), 220 acquired valve-heart diseases (Group II) and 39 other acquired cardio-vascular diseases (Group III), were operated on using cold BPC. In Group I, the hospital death occurred in 12 patients and the late death in four. There were 21 hospital and five late deaths in Group II. In Group III, the hospital and late deaths occurred in four and in one, respectively. In a total of 400 patients, overall cardiac-related hospital mor tality was 5.5%, which is within the established ones reported by others. Fur thermore, in valve-heart surgery, there was no close relationship between the length of aortic occlusion or poor ventricular function (less than 0.4 of ejection fraction), and cardiac-related hospital death. Therefore, we conclude that cold BPC provides excellent myocardial protection.
Arterial Abnormalities of the Lower Extremities: The Embryological Link
Authors: Kim Maurice , Dany François , Hammel Jean , Brutus Paul
Published: November 2007

This study is a review of the main aspects of arterial pathology of the lower extremities. It appears that some coincidences can be correlated with abnormal ities of embryonic development. Many diseases of lower arteries, such as per sistent sciatic artery, trapped popliteal artery, Leriche Fontaine aneurysmal dystrophy and hypoplasia of the tibial vessels, can be explained by an embyrolo gic link.

These possible mechanisms, rare in the upper arteries, can also be found in anomalies of the renovascular system.

It seems necessary to take into account this problem, first to avoid associated lesions of the same type on the contraolateral limb and in order to obtain a better surgical correction.
Peripheral Embolization Following Gunshot Wound on the Abdominal Aorta: A Case Report
Authors: Viana Rui , Palma Osvaldo , Blanco Dirceu H. , Silvestre José Manoel S.
Published: November 2007

We will describe a case of a gunshot wound of the abdominal aorta, in which occurred embolization of the bullet that lodged in the left femoral artery. What led us to describe this case was the rarity of this event, the high morbidity and mortality of such wounds and the surgical technique employed.
Sack-Barabas Syndrome (Ehlers-Danlos IV Type) (Clinic and Histopathologic Ultrastructural Correlations)
Authors: Stella A. , Gessaroli M. , Cifiello B.I. , Mirelli M. , Loperfido V. , Riva R. , Guizzardi S.
Published: November 2007

The patient that led the authors to make some physiopathological reflections on the Ehlers-Danlos syndrome (EDS) was a young 30 year old suffering from a poly-aneurismatic syndrome, identifiable as EDS type IV.

After a surgical treatment on the abdominal aortic aneurysm and an aorto bis-iliac by-pass, a specimen of the aortic wall was the subject of an ultrastruc tural study.

In particular, correlations between the histopathological alterations were sought.

Particular reference was made to the collagen and the clinical vascular mani festations found not only in this patient but also repeatedly in other patients suffering from this type of EDS.
Selective Management of Clotted Femoro-Popliteal Bypass Grafts
Authors: Vo Nghia M.
Published: November 2007

From 1982 to 1984 eleven patients with thrombosed PTFE femoro popliteal bypass grafts were treated by thrombectomy with a high incidence of rethrom bosis (1.4 occlusion per patient) resulting in four amputations. Since 1984 a selective surgical approach was instituted depending upon angiographic evi dence of inflow problems, intimal hyperplasia or distal progression of athero sclerosis. No amputation and only one episode of rethrombosis occurred in a group of nine patients. We concluded that the natural history of thrombectomy for failed F-P bypasses is rethrombosis and that a selective approach should be individualized for each patient.
Axillofemoral Bypass Graft: The Outcome of 66 Procedures
Authors: Harvey Benson , Fanning William J. , Smead William L. , Vaccaro Patrick S.
Published: November 2007

Sixty-six axillofemoral bypasses have been performed since 1978. The indi cations for operation were limb salvage in 62%, claudication in 24%, and in traabdominal sepsis in 14%. Three-year patency by Life-Table analysis was 88.8% for the entire group. Patients operated upon because of claudication had 100% patency at three years and fared better than the other groups. Periopera tive mortality was 15% in all patients, but only 7% in those operated upon electively. Limb salvage at two years was 64%. Although concomitant lower extremity bypass improved the patency of the axillofemoral graft, it failed to improve the limb salvage rate. Axillofemoral bypass can be successfully per formed in selected patients with a low incidence of reoperation.
Popliteal Artery Entrapment. Analysis of the Literature and Report of Personal Experience
Authors: Cavallaro Antonino , Di Marzo Luca , Gallo Pietro , Cisternino Silvestro , Mingoli Andrea
Published: November 2007

A review has been made of 210 cases of popliteal artery entrapment syn drome, submitted to direct surgical therapy, from 1959 (first case reported by Hamming) through 1983. A personal experience of 14 operative procedures on 14 limbs of 11 patients is reported.

Eighteen anatomical variants producing entrapment have been identified; however, in more than 80% of the cases, the medial gastrocnemius was involved. About two-thirds of the patients were operated on with an already occluded popliteal artery, and this implied the need for some kind of reconstructive pro cedure. No reliable data on the true incidence of the disease are yet available; however, it is certainly higher than previously suspected, as witnessed by the growing number of reported cases. Extensive screening procedures could allow identification of probable cases, but a reliable diagnosis cannot be made without angiography. Surgery should be performed as a preventive measure or in case of embolic lesions such as stenosis or aneurysm. If the artery is already oc cluded, an efficient collateral network may develop and surgery should be lim ited to patients not improving with time or at risk of limb loss.
The Substitute Valve Operation on the Popliteal Vein in the Treatment of Deep Venous Incompetence of the Lower Extremity
Authors: Sun Jian-Min , Zhang Pei-Hua
Published: November 2007

Sixty patients (62 limbs) with chronic incompetence of the deep veins of the lower extremity underwent the "substitute value" operation on the popliteal vein. The results after this operation were assessed clinically, phlebographically, and objectively, by venous pressure measurements, before, and three weeks and one and two years after, operation. The two-year follow-up of the 60 operated patients demonstrated clinical improvement associated with significant reduc tion in the ambulatory venous pressure (AVP) and prolongation of the refilling time (RT). The patients selected for this operation had had either a primary incompetence or a postthrombotic valve incompetence with completely recana lized deep veins. On the basis of their experience and the excellent results, the authors consider this operation the method of choice for eliminating deep ve nous insufficiency.
Healing and Long-Term Viability of Grafts in the Venae Cavae Reconstruction
Authors: Motta G. , Ratto G.B. , Sacco A. , Ogata T. , Masuda H. , Kikuchi K. , Takagi K. , Tanaka S. , Yoshizu H. , Senoo A.
Published: November 2007

The need for superior vena cava (SVC) or inferior vena cava (IVC) recon struction is not uncommon: lung cancer, mediastinal tumors, or retroperitoneal neoplasms are the most frequent indications for caval replacement. Since auto genous veins, which represent the most satisfactory venous substitute, have not been applicable to caval replacement, because of the lack of suitable length and caliber, many types of materials have been tested in the venous system. The present study was planned to compare the potential of expanded polytetrafluoroethylene (e-PTFE) and glutaraldehyde-tanned human umbilical vein (HUV) grafts as caval substitutes.

Patch (4 x 5 cm) reconstruction of the SVC was carried out in 10 dogs, tubu lar (3 x 10 mm) reconstruction of the SVC in 5 dogs, and patch (1 x 2 cm) recon struction of the IVC in 8 dogs. In the patch reconstruction groups, HUV grafts were used in half of the cases and 30 μm pore sizes e-PTFE grafts in the other half, while in the tubular SVC replacement group, only e-PTFE grafts were employed. The grafts were removed fifteen to thirty days after IVC patch re construction, thirty to two hundred seventy days after SVC patch reconstruc tion, and thirty-three to forty-one months after SVC tubular replacement. In every instance, specimens were obtained for light microscopy (LM) and scan ning electron microscopy (SEM).

HUV patches implanted in the SVC showed hemorrhagic foci at their central portion and marked constriction at the anastomotic regions. On the contrary, the inner surface of e-PTFE patch grafts was covered with a uniform and glis tening neointima. By LM, e-PTFE patches showed a smooth and regular lumi nal surface, while the inner surface of HUV patches was irregular, with hemorrhagic areas in the underlying layers. By SEM, e-PTFE patches revealed a more rapid and orderly endothelialization of their inner surface than HUV patches did. Tubular SVC reconstruction showed the good long-term viability of the e-PTFE neointima (as long as forty-one months after grafting). Only spotty areas revealed neointima alterations, such as fibrinoid degeneration, fo cal necrosis, or minor thrombotic foci. In the IVC patch reconstruction model, HUV grafts showed an exuberant fibrin deposition on their inner surface and delayed endothelialization patterns, as compared with e-PTFE grafts. Since rapid healing with rapid endothelialization is accepted as the most important factor providing the graft luminal surface with the best antithrombotic proper ties, the present study demonstrated that e-PTFE is a more suitable material than HUV for SVC and IVC reconstruction.
Reversed "C" Bypass for Multiple Extremity Ischemia—A Case Report
Authors: Borrero Edgar , Swersky Robert
Published: November 2007

Extraanatomic bypass has been utilized increasingly in both elective and emergency situations over the last ten years. The three major indications are: (1) a poor-risk patient, (2) an alternative to direct primary or secondary recon struction, and (3) a need to bypass an infected area. In some patients, it may be necessary to perform more than one extraanatomic bypass for symptomatic relief or limb salvage.
Advantages and Disadvantages of Polytetrafluoroethylene (PTFE) Grafts for Portacaval Shunting
Authors: Rypins Eric B. , Conroy Robert M. , Sarfeh I. James
Published: November 2007

The authors report the largest published experience with PTFE H-grafts in the portacaval position. Cumulative late patency of 8- and 10-mm grafts has been 97%, but acute perioperative thromboses have occurred in 15%. Pe rioperative thromboses are currently managed nonoperatively by using angio graphic intervention. Comparing their long-term results with those of dacron grafts in the portal system, the authors conclude that PTFE is a superior pros thetic conduit.
Surgical Techniques from Intraoperative Angiographic and Velocimetric Controls in 43 Consecutive Carotid Bifurcation Endarterectomies
Authors: Tiberio Giorgio , Giulini Stefano Maria , Floriani Marco , Bonardelli Stefano , Portolani Nazario
Published: November 2007

From January to November, 1985, 43 carotid bifurcation endarterectomies (CE) were performed with intraoperative functional (Doppler spectrum analy sis) and morphologic (angiography) controls.

In the first 20 cases, after thromboendarterectomy and direct suture, Dop pler showed absence of or no significant variations of frequency in 17 cases, a frequency increase corresponding to a less than 45% diameter reduction steno sis at the apex of the suture in 2 cases, and no flow in the internal carotid artery (ICA) in 1 case. Angiography confirmed the thrombosis in the above mentioned case and showed 3 less than 50% stenoses at the distal end of the arteriotomy: 2 already recognized by Doppler in small-size ICAs and 1 in a medium-size ICA without significant changes of flow. The reason for thrombosis was a distal intimal flap, which was successfully removed; the 2 stenoses in which Doppler and angiography agreed were corrected by patch angioplasty. In the last 23 cases, patch angioplasty was performed routinely in small-size ICAs (6 cases); in 1 case, first treated by a direct suture, Doppler and angiography showed a medium-grade stenosis, immediately corrected; in 1 case both techniques showed a 50% stenosis in a common carotid artery, immediately corrected. The execution of intraoperative angiography in this group of patients al lowed the authors to define the indication for the use of patch angioplasty, never previously employed. Nevertheless, the authors state that, on account of loss of time, costs, and exposure to radiations, intraoperative angiography must be reserved for those cases selected by Doppler spectrum analysis. This method seems to be highly sensitive in recognizing significant technical defects that could lead to an immediate or late failure.
Pancreaticorenal Composite Transplantation: A New Method to Improve Venous Hemodynamics
Authors: Gänger K.H. , Mettler D. , Höflin F. , Ruchti Ch. , Böss H.P. , Schilt W.
Published: November 2007

A new method of pancreaticore nal composite transplantation in a porcine model is presented aiming at reducing the risk of vascular throm bosis, which is still a frequent compli cation in pancreatic transplantation. In 14 technically successful duodeno pancreaticorenal allotransplantations (DPRTx) with joint venous drainage of pancreas and kidney and urinary drainage of the exocrine pancreas, euglycemia could be maintained in the substitutive transplant group (sDPRTx) and significant exocrine function (p = 0.222) in the auxiliary (aDPRTx) and substitutive trans plant group for up to four weeks. Pancreaticorenal composite trans plantation thus proved to be a prom ising new method combining hemo dynamic improvement in the pancre atic graft and gaining a kidney at the same time.
Acute Acalculous Cholecystitis Following Cardiovascular Surgery—Case Histories
Authors: Todd George J.
Published: November 2007

Acute acalculous cholecystitis has been recognized with increasing frequency in recent years. The condition has been associated with trauma, burns, total parenteral nutrition, and unrelated surgical procedures. This report describes 3 patients who developed a particularly fulminant form of the disease following cardiovascular surgical procedures. Rapid deterioration and signs of impending cardiovascular collapse were characteristic of these patients; emergency sur gery was needed in each case. Tube cholecystostomy was performed in each case with no mortality. No patient required subsequent cholecystectomy during a mean follow-up of 4.3 years. It is concluded that the patient with cardiovascular disease may develop a more fulminant form of acute acalculous cholecystitis owing to the underlying vascular disease. Awareness of this condition and early surgical intervention with performance of tube cholecystostomy will decrease the mortality of this lethal process.
Surgical Evaluation of Percutaneous Transluminal Balloon Angioplasty and Valvuloplasty in Congenital Cardiovascular Anomalies
Authors: Walls Joseph T. , Lababidi Zuhdi , Curtis Jack J.
Published: November 2007

Percutaneous transluminal bal loon angioplasty and valvuloplasty procedures for treatment of congeni tal cardiovascular anomalies were performed in 109 consecutive pa tients. Forty-two patients had balloon pulmonary valvuloplasty: the mean peak systolic gradient was reduced from 80 ± 35 mmHg to 23 ± 15 mmHg (p < 0.01). Thirty-seven pa tients had balloon aortic valvulo plasty : the mean gradient was re duced from 105 ± 43 mmHg to 28 ± 15 mmHg (p < 0.01). Thirty pa tients had balloon aortic coarctation angioplasty: the mean gradient was reduced from 47 ± 3.9 mmHg to 9.2 ± 1.3 mmHg (p < 0.01). Follow-ups of percutaneous balloon pulmonary valvuloplasty results in 15 patients (mean of 9.1 ± 1.2 months), of per cutaneous balloon aortic valvulo plasty in 17 patients (mean of 11.6 ± 1.9 months), and of percutaneous balloon aortic coarctation angio plasty in 14 patients (mean of 13 ± 4 months) revealed that gradients re mained significantly reduced (p < 0.01) in all groups. Elective op eration was performed upon 14 pa tients following percutaneous transluminal balloon procedures, and pulmonary valves were noted to be opened by commissural splitting, cusp tear, or cusp avulsion from the annulus. Aortic valves had commis sural splitting, and coarctation sites had intimal tears. No deaths oc curred. Percutaneous transluminal balloon valvuloplasty and angioplasty can aid in palliating selected congeni tal cardiovascular anomalies and de lay the time within which operative treatment is required.
Quadricuspid Aortic Valve with Significant Regurgitation Treated by Aortic Valve Replacement — Case Report
Authors: Morishita Yasuo , Ishizaki Naoki , Hashiguchi Masahiko , Fukuda Shigeru , Moriyama Yukinori , Kawashima Sumihiro , Taira Akira
Published: November 2007

A case of quadricuspid aortic valve with aortic regurgitation is reported. This cardiac malformation is very rare and usually diagnosed at aortic valve surgery or at autopsy. The case presented here was preoperatively diagnosed by echocardiography, and aortic valve replacement was performed successfully.
Traumatic Arteriovenous Fistula of the Scalp-Case Reports
Authors: Upendra Mohan Chowdhary
Published: November 2007

The author describes 2 cases of traumatic arteriovenous (AV) fistulae of the scalp. In both patients the appearance of the pulsatile swelling occurred some time after the initial scalp injury. In spite of intense vascularity of the scalp, such fistulae are rare. The author describes the angiographic appearance and the complete excision of both AV fistulae.
Transient Division of the Left Renal Vein as Adjunct to Perirenal Aortic Surgery
Authors: Esato Kensuke , Takenaka Hiroaki , Fujioka Kentaro , Akimoto Fumikazu , Nakamura Takashi , Ohhara Masaki
Published: November 2007

In perirenal aortic surgery, a transient division of the left renal vein may be necessary in order to expose the perirenal aorta. Perirenal aortic surgery was performed on 4 patients with infrarenal abdominal aortic aneurysms and 1 pa tient with Leriche's syndrome by transection and reanastomosis of the left renal vein. All but 1 of the cases had uneventful postoperative recovery. One of the patients died of septicemia and disseminated intravascular coagulation (DIC) on the fifty-first postoperative day; however, septicemia and DIC were not attrib uted to transient division of the left renal vein.

In all of these cases, the renal function stabilized, and no permanent kidney damage relating to the transient division of the left renal vein could be found.

Although there have been several reports that ligation and division of the left renal vein are a reasonably safe and acceptable procedure for perirenal aortic surgery, the resuturing of the divided left renal vein is recommended. Although this maneuver is simple, it is impossible to determine the adequacy of collateral venous circulation of the left kidney without extensive dissection.