bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibrinolytic Compromise by Synthetic and Recombinant Thrombin Inhibitors: Implications in the Treatment of Thrombotic Disorders
Authors: Callas Demetra D. , Iqbal Omer , Hoppensteadt Debra , Fareed Jawed
Published: November 2007

Site-directed synthetic and recombinant antithrombin agents are widely used to prevent reocclusion during thrombolytic therapy in acute myocardial infarction and other vascular occlusive disorders. However, minimal studies have been conducted to examine the interactions between these anticoagulant and thrombolytic agents. Because of the structural homology of serine proteases, some of these newly developed antithrombin agents are also capable of inhibiting fibrinolytic enzymes, which may lead to fibrinolytic compromise during thrombolytic therapy. In addition, inhibition of thrombomodutin-bound thrombin may also result in fibrinolytic deficit. Several thrombin inhibitors were studied in in vitro systems to assess whether their inactivating properties extend to fibrinolytic and profibinolytic enzymes, such as kallikrein, plasmin, urokinase, streptokinase, and tissue plasminogen activator. The thrombin inhibitors studied included hirudin, hirulog-I, argatroban, D-MePhe-Pro-Arg-H, and Ac-D-Phe-Pro-boroArg-OH. Their activities were compared with those of aprotinin, which is currently used clinically as an antifibrinolytic agent. Although argatroban, hirulog-I, and hirudin exhibited minimal inhibition of the nonthrombin enzymes studied, the tripeptide derivatives showed variable inhibitory activities, with the boronic acid derivative being the most potent and universal inhibitor. The in vivo antifibrinolytic activities of these thrombin inhibitors were also studied in a rabbit model of jugular vein clot lysis. In agreement with the in vitro studies, argatroban, hirulog-I, and hirudin exhibited minimal antifibrinolytic activities, while Ac-D-Phe-Pro-boroArg-OH and D-MePhe-Pro-Arg-H showed marked inhibition of the thrombolytic process. The results of these studies indicate that newly developed thrombin inhibitors with a broader serine protease spectrum may exhibit fibrinolytic compromise resulting in diminishment of the expected thrombolytic outcome. Key Words: Thrombolysis—Fibrinolysis—Thrombin inhibitors—Argatroban—Hirudin—Hirulog-I—Aprotinin.
State-of-the-Art Review: Usefulness of Laboratory Techniques for Evaluating Antithrombotic Efficacy of New Therapeutic Strategies
Authors: Amiral Jean
Published: November 2007

New drugs and new therapeutic strategies are being introduced for the prevention and the management of cardiovascular and thromboembolic disorders. Extensive clinical studies and large-scale epidemiological investigations are conducted to demonstrate the efficacy of these therapeutic approaches. Laboratory assays are invaluable tools for this exploration. We discuss how the new understanding concerning the regulation of the coagulolytic equilibrium offers novel investigation tools. Parameters reflecting the activities of new drugs targeted to their impact site and presenting few side effects are available. In addition to global clotting methods and chromogenic substrate-based assays, introduction of immunoassays has allowed measurement of most of the molecular markers of hemostatic activation. We recommend use of a panel of markers exploring the endothelial damage, the blood cell involvement, the early coagulant pathways' activation (XIIa and VIIa), the thrombin-formation pathways, the fibrin formation, and the evaluation of the global fibrinolytic capacity. When related to the clinical end points, all these laboratory assays offer useful and reliable monitoring of new drugs. They contribute to the establishment of new therapeutic strategies. Key Words: Hemostasis—Activation—Antithrombotic—Therapy— Laboratory monitoring.
Postoperative Versus Preoperative Initiation of Deep-Vein Thrombosis Prophylaxis with a Low-Molecular-Weight Heparin (Nadroparin) in Elective Hip Replacement
Authors: Palareti Gualtiero , Borghi Battista , Coccheri Sergio , Leali Nicoletta , Golfieri Rita , Montebugnoli M. , Inghilleri Giovanni , Ronzio Alessandro , Barbui Tiziano , Pogliani Enrico Maria , Di Nino Gianfranco , Spotorno Lorenzo
Published: November 2007

The aim of this multicenter, randomized, dou ble-blind study performed in patients undergoing elective hip surgery was to compare the efficacy and safety of prophylaxis with low-molecular-weight heparin (LMWH) (Nadroparin, 7,500 anti-Xa IC units for the first 3 days and 10,000 from the fourth day on, s.c. o.i.d.) begun in one group shortly after surgery and in the other 12 h before operation, as is usually recommended. Preopera tive administration (drug or placebo) was the only differ ence between the two groups. Deep vein thrombosis (DVT) was detected by bilateral venography 10-15 days after surgery. The study investigated 179 patients (55 men), 40-80 years old, in seven Italian orthopedic cen ters. In 131 patients efficacy analysis was possible be cause of adequate bilateral venography. All 179 patients were evaluated for bleeding complications. The preva lence of thrombotic complications was similar in the two groups. Proximal DVT was found in 8.4% of patients (10.8% and 6.1% in the preop and postop groups, respec tively ; difference not statistically significant). Distal DVT was recorded in 30.5% of patients (30.8% and 30.3% in the pre- and postop groups, respectively). DVTs were more common in patients ≥65 years old (54.2% versus 28.4%, p < 0.05); no significant differences were detected in terms of other characteristics. No significant differ ences were recorded in the number or type of bleeding complications: major (nonfatal) bleeding episodes were reported in five patients (2.8%, two and three in the pre- and postop groups); minor bleeding was noted in 25 (13.9%, 14 and 11 in the pre- and postop groups). In con clusion, the present study suggests that a LMWH regi men started postoperatively is no less effective in pre venting DVT in elective hip replacement than the classi cal regimen started preoperatively. Surprisingly, postoperative commencement offered no significant ad vantage in terms of bleeding complications.
Antithrombin Concentrates in Heparin-Resistant Cardiopulmonary Bypass Patients
Authors: Irani Mehraboon S.
Published: November 2007

Antithrombin, a serine protease inhibitor, plays an important role in the regulation of the coagula tion cascade. It inhibits thrombin as well as factors Xa, IXa, XIa, and XIIa. Heparin markedly accelerates the rate at which antithrombin inhibits these enzymes. To prevent the formation of clots in the extracorporeal cir cuit, heparin is used during cardiopulmonary bypass sur gery (CPB). However, in a small proportion of patients, adequate anticoagulation, defined as an activated clotting time (ACT) of >400 s after an intravenous bolus of hep arin in a dose of 300 U/kg, is not achieved. Conventional treatment of heparin resistance includes fresh frozen plasma or large doses of heparin. Antithrombin concen trates were given to 12 patients who were considered to be heparin resistant at our institution. All patients had received >300 U/kg of heparin before antithrombin con centrates were infused. In all patients, the ACT pro longed to >400 s after concentrates were infused, and in nine of 12 cases to >600 s. Of these nine patients, six (67%) did not receive any allogeneic transfusions, whereas three (33%) required allogeneic blood transfu sions. In nine of 12 patients, no more heparin was given after infusing antithrombin concentrate. It appears that antithrombin concentrate, which is a fractionated, pas teurized plasma product, is a possible safer alternative to excessive heparin doses or fresh frozen plasma for CPB patients who are heparin resistant. Key Words: An tithrombin—Cardiopulmonary bypass—Heparin resis tance.
Clinical Study of TJ-137 Tsumura Kami-kihi-to in Patients with Idiopathic Thrombocytopenic Purpura (ITP)
Authors: Sakuragawa Nobuo , Yasunaga Kojiro , Nomura Takeo , Akatsuka Junichi , Kuramoto Atsushi , Matsuda Jyuzo , Nomura Shosaku
Published: November 2007

TJ-137 administered to patients with chronic ITP increased the platelet count "slightly" or more in 31.7% of the patients and showed a clinical effect in 40.9% with a rating of "modestly effective" or better. With a low incidence of adverse reactions, TJ-137 is ex pected to be a new drug for the treatment of ITP.
A Functional Protein S and Microlatex Immunoassay for Protein S and C4b-Binding Protein on the Automated Coagulation Laboratory (ACL) 300 Plus
Authors: Hirokawa Shinichiro , Mammen Eberhard F.
Published: November 2007

Protein S can be determined by functional or immunological assays. Electroimmunodiffusion (EID) or enzyme immunoassays (enzyme-linked immunosorbent assay; ELISA) are the commonly employed techniques for measuring protein S and C4b-binding protein (C4b- BP) immunologically. Procedures for these assays are time-consuming and labor-intensive. The introduction of microlatex immunoassays (LIATEST system; Diagnos tica Stago, Asnieres-Sur-Seine, France) has provided an alternative for rapid and reliable immunological determi nation. We have placed the microlatex immunoassay for total and free protein S (TPS, FPS) and C4b-BP, using the light-scattering mode, on the Automated Coagulation Laboratory (ACL) 300 Plus (Instrumentation Laboratory, Lexington, MA, U.S.A.). We also placed a functional activity assay of protein S (STACLOT protein S; Amer ican Bioproducts, Parsippany, NJ, U.S.A.) on the ACL 300 Plus. The performance characteristics for the assays yielded a within-run coefficient of variance (CV) of 2.5- 4.6% ( n = 13) for TPS, 4.0-4.8% ( n = 13) for FPS, 1.9- 3.0% ( n = 11) for C4b-BP, and 2.3-5.9% for protein S activity. The interrun CV was 2.1-5.7% ( n = 24), 3.7- 7.0% ( n = 12), 2.6-7.0% ( n = 16), and 4.0-8.4% ( n = 27), respectively. Analytical recovery was 94-109, 97-100, 91-103, and 99-103%, respectively. The normal ranges determined on plasmas from 30 healthy individuals were 113 ± 37 (mean ± 2 SD) for TPS, 106 ± 35 for FSP, 111 ± 22 for C4b-BP, and 107 ± 34 for protein S activity. The results for the microlatex immunoassay and either the EID or the ELISA methods showed excellent correla tions for FPS and C4b-BP; the correlations between LIATEST and either EID or ELISA for TPS were also relatively high. The functional activity of protein S cor related well with FPS. Microlatex immunoassays, using the light-scattering mode for TPS, FPS, or C4b-BP, and the functional assay of protein S can be adapted on the ACL 300 Plus system with a high accuracy and reproduc ibility and with considerable time saving.
Liver Cirrhosis Manifested by Dysfibrinogenemia
Authors: Wajima Takeshi
Published: November 2007

We report a case in which liver cirrhosis was manifested by dysfibrinogenemia before the diagnosis of liver cirrhosis was made. A patient developed gastrointestinal bleeding and hepatic encephalopathy although liver function tests, prothrombin time (PT), activated partial thromboplastin time (aPTT), bleeding time, fibrin (ogen) degradation products (FDP), and platelet counts were normal. However, thrombin time (TT) was prolonged. The gastrointestinal bleeding (GI bleeding) was successfully treated with cryoprecipitate and fresh frozen plasma (FFP). Key Words: Dysfibrinogenemia—Liver disease—Thrombin time.
Acquired Activated Protein C Resistance in Patients with Lupus Anticoagulant and Essential Thrombocythemia
Authors: Gabazza Esteban C. , Takeya Hiroyuki , Deguchi Hiroshi , Taguchi Osamu , Wada Hideo , Nishioka Junji , Hong Zhou  , Suzuki Koji
Published: November 2007

The prevalence of activated protein C (APC) resistance and the antigen levels of factor V were assessed in 37 patients with lupus anticoagulant (LA), 12 with essential thrombocythemia (ET), 17 with idiopathic thrombocytopenic purpura (ITP), and in 27 cases of thrombotic complications associated with diabetes mellitus and collagen vascular disease. Blood samples taken from 30 healthy normal subjects were also available for comparison. The mean APC ratio of patients with LA (2.9 ± 1.5), ET (2.7 ± 1.2), and secondary thrombosis (2.6 ± 0.9) were significantly lower than that of the healthy control group (3.5 ± 1.0). The APC ratio of ET patients with thrombosis (2.3 ± 0.6) was significantly lower than that measured in ET cases without thrombotic complication (3.9 ± 1.9). Patients positive for LA and with thrombotic complication (1.8 ± 1.4) presented lower APC ratios than those without thrombosis (3.3 ± 1.4). Among all patients, an APC ratio lower than 2 was found in 24 cases, of which 16 had thrombotic disease, but none of them presented the factor V:R506Q mutation. The antigen levels of factor V correlated significantly with APC ratio in all patients. The results of this investigation suggest that an acquired poor anticoagulant response to APC might explain, at least in part, the thrombophilia of patients with LA and ET and that associated with diabetes mellitus or collagen disease. Key Words: APC resistance—Lupus anticoagulant—Essential thrombocythemia.
Thrombosis and Hemostasis in Cardiology: Review of Pathophysiology and Clinical Practice (Part I)
Authors: Baker William F.
Published: November 2007

The adverse consequences of thrombosis are per haps nowhere more evident than in clinical cardiology. Throm bosis and hemostasis are primary issues in the management of patients with atrial fibrillation, prosthetic heart valves, severe left ventricular dysfunction, and coronary artery disease. Clini cal trials have defined a crucial role for anticoagulation with warfarin in patients with atrial fibrillation to reduce the inci dence of stroke. Anticoagulation with warfarin and aspirin in combination offers significant protection from systemic emboli in patients with mechanical prosthetic valves, without a sub stantial increased risk of hemorrhage. The risk of systemic emboli may also be reduced by anticoagulation in patients with severe left ventricular dysfunction. Disturbance of the normal balance of hemostasis is a major factor in the pathophysiology of coronary artery disease. Antiplatelet therapy, antithrombin agents, anticoagulants, and fibrinolytic agents have been used to prevent and treat acute coronary thrombosis and to prevent reocclusion following thrombolysis and interventional therapy. Guidelines are presented for antithrombotic therapy in the prac tice of clinical cardiology.
Genetic Counseling by Analysis of Intron 22 Inversions of the Factor VIII Gene
Authors: Yamazaki Etsuko , Mohri Hiroshi , Harano Hiroshi , Kanamori Heiwa , Inaba Hiroshi , Okubo Takao
Published: November 2007

Ten patients with severe hemophilia A and 10 with moderate and mild hemophilia A were studied. Five of 10 unrelated patients with severe hemophilia A had the distal telo meric int22h sequence, none had the proximal sequence, and one had a unique variant factor VIII gene rearrangement. Car rier detection was done in these six families. All mothers and two daughters of the patients were to be carriers. Six of the 15 at-risk female relatives were heterozygous for the rearranged and normal allele and were carriers. These results indicate that the rearrangement assay is very useful for carrier detection in families with severe hemophilia A. Key Words: Hemophilia A—Factor VIII gene rearrangement—Genetic counseling.
State-of-the-Art Review : Increased Activated Protein C: Protein C Inhibitor Complex and Decreased Protein C Inhibitor Levels in Patients with Chronic Renal Failure on Maintenance Hemodialysis
Authors: Takagi Mikio , Wada Hideo , Mukai Kenji , Minamikawa Kouzou , Wakita Yoshihiro , Deguchi Katsumi , Junji Nishioka , Hayashi Tatsuya , Suzuki Koji , Shiku Hiroshi
Published: November 2007

Hemostatic abnormalities were examined in 55 pa tients during maintenance hemodialysis (HD). Before HD, plasma protein C and protein S antigens were almost within the normal range, while plasma thrombin-antithrombin III complex (TAT III) and plasmin-plasmin inhibitor complex (PPIC) levels in HD patients were increased slightly, and plasminogen acti vator inhibitor 1 level was significantly increased, compared to that in normal volunteers. Plasma activated protein C (APC) and protein C inhibitor (PCI) complex and APC α1 antitrypsin (α1AT) complex were not detected in normal volunteers; how ever, plasma APC-PCI complex was increased in 36 of the patients and plasma APC-α1AT complex was increased in 25 patients. Plasma PCI levels in these patients before HD were significantly decreased. Plasma TAT, PPIC, and tissue type plasminogen activator levels were significantly higher before HD than after 1 hour HD and at the end of HD, while the changes in plasma protein C antigen, protein S antigen, PCI antigen, APC-PCI complex, and APC-α1AT complex were not significant after 1 hour of HD or at the end of HD compared to levels before HD. Plasma PCI levels were correlated with APC- PCI complex, suggesting that decreased PCI levels might be caused by the activation of protein C.
Combined Factor V and Factor VII Deficiency Due to an Independent Segregation of the Two Defects
Authors: Girolami Antonio , Zanon Ezio , Bertomoro Antonella , Gavasso Sabrina , Fadin Mariangela
Published: November 2007

A patient with combined factor V and factor VII deficiency is described together with a family study. The pro positus appeared to be double heterozygous for factor V and factor VII deficiency. Since the patient showed a parallel de crease of activity and antigen, he appeared to be double het erozygous for a true deficiency. The patient had inherited the factor V defect from the mother and the factor VII defect from the father. The parents of the propositus were not consanguin eous. Other family members were found to have isolated factor V or factor VII deficiency. This is the third family so far described with this peculiar combined defect but the first to be investigated by clotting and immunologic assays.
Current perspectives in the management of nausea and vomiting in oncology patients: The New Zealand experience
Authors: Hastie Bruce David
Published: November 2007

Background. Following the introduction of the 5HT3 (serotonin) receptor antagonists into New Zea land we wished to determine the current role that these and other antiemetic agents have in the preven tion and treatment of nausea and vomiting in oncol ogy patients.

Method. Surveys were posted to all medical and radiotherapy oncologists in New Zealand in July 1994 asking for their current approaches and recommen dations to preventing or treating many of the com mon causes of nausea and vomiting that oncology patients may experience.

Results. Surveys were posted to 32 oncologists, with replies received from 23 (72%). These results indicate that the 5HT3 antagonists ondansetron and granisetron are now used as primary therapy to prevent nausea and vomiting associated with highly emetogenic chemotherapy and radiotherapy regimes, and may be used either as single agents or in combi nation with a corticosteroid. In less emetogenic re gimes agents such as metoclopramide, prochlorpera zine, or domperidone are effective, and they may also be used in combination with a corticosteriod. When treating other causes of nausea and vom iting, antiemetic agents are usually only used if it is not possible to correct the underlying cause of these symptoms, if an antiemetic agent is required metoclo pramide, prochlorperazine, domperidone, or cycli zine are usually effective. Where nausea is caused by drugs such as nonsteroidal antiinflammatory agents (NSAIA) treatment options would include stopping the offending agent and changing to another agent if necessary, if this is not possible then agents such as metoclopramide or prochlorperazine are usually ef fective.

Conclusion. The 5HT3 receptor antagonists are used to control nausea and vomiting in chemo therapy and radiotherapy regimes with a moderate to high emetogenic potential. For chemotherapy and radiotherapy regimes with a lower emetogenic potential metoclopramide or domperidone are used to control nausea and vomiting. For other causes of nausea and vomiting that cannot be corrected by specific treatment strategies metoclopramide, dom peridone, prochlorperazine, or cyclizine are usually effective.
Stability of busulfan injection admixtures in 5 % dextrose injection and 0.9% sodium chloride injection
Authors: Xu Quanyun A. , Zhang Yan-ping , Trissel Lawrence A. , Martinez Juan F.
Published: November 2007

Objective. The purpose of this study was to deter mine the stability of busulfan injection at 0.5 and 0.1 mg/mL admixed in 5% dextrose injection and 0.9% sodium chloride injection in PVC and polyolefm bags over 24 hours at 23°C.

Methods. The busulfan injection was prepared by dissolving the bulk powder in a 1:2 mixture of N,N-dimethylacetamide and polyethylene glycol 400 to form a 6 mg/mL solution. The injection was filtered and admixed in the infusion solutions to yield busulfan concentrations of 0.5 and 0.1 mg/mL. Evaluations were performed initially and after 4, 8, and 24 hours of storage for physical and chemical stability. The admix tures were evaluated for physical stability using visual observation in normal light and using a high-intensity monodirectional light beam as well as measuring turbidity. The chemical stability was evaluated by using a stability-indicating HPLC analytical technique.

Results. No physical instabilities were observed. However, busulfan is chemically unstable. At 0.5 mg/mL, potency of at least 95% was retained through 4 hours and at least 90% was retained through 8 hours. After 24 hours, losses of 20% to 30% occurred. At 0.1 mg/mL, drug loss was more rapid. Potency of at least 90% was retained through 4 hours. Losses after 24 hours were about 30% to 40%.

Conclusions. Busulfan injection admixed in 5% dextrose injection or 0.9% sodium chloride injection is unstable. At a concentration of 0.5 mg/mL, ade quate drug delivery is provided within 8 hours of admixture. At the lower concentration of 0.1 mg/mL, adequate drug delivery is only provided for 4 hours.
Endothelium, lipoproteins and atherosclerotic vascular disease
Authors: Tanner Felix C , Tschudi Marcel R , Lüscher Thomas F
Published: November 2007

The endothelium modulates vascular tone by releasing nitric oxide, which is a potent vasodilator and inhibitor of platelet aggregation. Together with prostacyclin, the endogenous nitrate nitric oxide has an important protective role in preventing vasospasm and thrombus formation. In addition, the endothelium is a source of contracting factors such as endothelin-1, thromboxane A2 and endoperoxides. Due to its strategic anatomical position, the endothelium is a primary target for injurious stimuli and cardiovascular risk factors. Low density lipoproteins reduce endothelium-dependent relaxation and enhance endothelium- dependent contraction. The same pattern of endothelial dysfunction occurs in hypercholesterolaemia and atherosclerosis. These alterations of endothelial function may contribute to vasospasm, ischaemia and thrombus formation, which are common events in patients with atherosclerotic vascular disease.
Metalinguistic knowledge, language aptitude and language proficiency
Authors: Alderson J. Charles , Clapham Caroline , Steel David
Published: November 2007

This paper reports on an ESRC-funded study of the levels of knowledge about language of first-year undergraduate student learners of French and the relationship between this metalinguistic knowledge and language proficiency and aptitude. Tests of metalinguistic knowledge, language aptitude and French linguistic proficiency were administered to 509 students. The results show that levels of metalinguistic knowledge vary considerably. However, the relationship between metalinguistic knowledge and language proficiency is weak. Meta-linguistic knowledge and language proficiency appear to constitute two separate factors of linguistic ability. Moreover, there was no support for the belief that students with higher levels of metalinguistic knowledge perform better at French, or that they improve their French proficiency at higher rates than other students during university study. Whilst knowledge about language may be worthwhile in its own right, there is no evidence from this study to justify the teaching of metalinguistic knowledge as a means of improving students' linguistic proficiency.
Writing Orderly Geographies of Distant Places: the Regional Survey Movement and Latin America
Authors: Naylor Simon , Jones Gareth A. , Naylor Simon , Jones Gareth A.
Published: November 2007

Surveys of the boundaries, rivers and railways of Argentina have during the past cen tury extended a network of measurements around and over the country, covering it with a finer and larger mesh of surveyed lines and affording a general knowledge of the principal geographical features. 1
Production of Experimental Atrial Septal Defects
Authors: Brodie Thomas E. , Thompson Sandra L. , King Terry D. , Mills Noel L.
Published: November 2007

Atrial septal defects (ASDs) were successfully created by punch biopsy technique in 67 dogs. The technique is simple, effective and provides an ideal model for the study of ASDs, either for testing closure devices or physiological experiments. The position and size of the defects may be varied according to preference. Of 45 animals subjected to cardiac catheterization, 39 (87 percent) has a patent atrial septal defect.
Portal Hypoplasia: A Cause of An Unusual Portal-Systemic Venous Collateral Pathway
Authors: Lomonaco Anthony , Sokoloff Joel , Coel Marc N.
Published: November 2007

The diagnosis of portal vein hypoplasia can be made based upon the angiographic findings of a large portal-systemic shunt, nonopacification of intra- and extrahepatic portal veins, and a liver biopsy without cirrho sis.
Clinical Case Reports
Authors: Zisis Eleftherios G. , McCann William J. , Mahoney William D. , Schraft William C.
Published: November 2007

Two cases of abdominal aortic aneurysm associated with horseshoe kidney are presented and the litera ture is reviewed. Preoperative urog raphy is recommended in all but emergent cases. If the urogram is ab normal, aortography is indicated to confirm the diagnosis of horseshoe kidney and to determine the nature of the renal blood supply. If the renal blood supply arises from the aneu rysm or is from multiple small ves sels, resection may not be indicated because of the possibility of extreme operative difficulties. If the pelvis is split, extreme care must be taken to insure a watertight closure and to institute adequate drainage to avoid retroperitoneal inflammatory compli cations.
Spinal Cord Arteriovenous Malformations
Authors: Slade Walter
Published: November 2007

Spinal arteriovenous malformations (AVMs) are not as infrequent as is generally believed. They usually present with various neurologic symptoms and signs and there is usually a long period between the initial symptom and the definitive diagnosis and treatment. Advances, not diagnostic and thera peutic measures, make possible a more aggressive approach to the disease. The symptomotology, diagnosis, and treatment are reviewed and 504 cases from the literature are surveyed.
Cardiopulmonary Bypass Hemorrhage: Aggravation by Pre-Op Ingestion of Antiplatelet Agents
Authors: Bick R.L. , Fekete L.F.
Published: November 2007

A comparison between chest tube blood loss per total blood replacement and the ingestion of antiplatelet drugs before surgery was undertaken in 20 patients undergoing cardiopulmonary bypass (CPB) for coronary artery disease. Ten patients who had ingested antiplatelet agents and 10 patients denying the use of any agent known to interfere with hemostasis or platelet function were studied retrospectively. The average chest tube blood loss in the antiplatelet drug users was 1340 cc per 24 hours, and the average total blood replacement following bypass was 4.8 units. Chest tube blood loss in the non-antiplatelet drug group was 483 cc per 24 hours, and total blood replacement averaged 2.5 units.

This study illustrates that the ingestion of antiplatelet agents before CPB may accentuate the defects in hemostasis which are usually present during this procedure, and increased postoperative blood loss may result. In addi tion, this study emphasizes the importance of a careful drug history, espe cially concerning ingestion of antiplatelet agents, before cardiopulmonary bypass.
Noninvasive Estimation of Left Ventricular Function After Mitral and Aortic Valve Replacement With the Hancock Porcine Prosthesis
Authors: Bartall Haim Zeev , Desser Kenneth B. , Benchimol Alberto
Published: November 2007

Left ventricular function was noninvasively assessed by echocardiography, and left ventricular ejection time index (LVETI) was derived from external carotid pulse tracings in 25 patients before (B) and an average of 17 days after (A) Hancock porcine valve implantation. Fifteen patients had aortic valve replacement and 10 had mitral valve replacement; 4 had a combined procedure.

In the aortic and combined group, (n = 15) there were significant (P < 0.0025) changes of mean (± 1 SD) left ventricular end-systolic dimension (ESD), B = 5.1 ± 0.9, A = 4.3 ± 0.9 cm; end-diastolic dimension (EDD), B = 5.7 ± 1, A = 4.9 ± 0.9 cm; mean rate of circumferential fiber shortening (VCF), B = 0.37 ± 0.05, A = 0.75 ± 0.04 circumf/sec and LVETI, B = 0.45 ± 0.05, A = 0.39 ± 0.02 sec. In subgroups with preoperative aortic stenosis (n = 8), combined aortic stenosis and insufficiency (n = 3), and coexisting aortic and mitral disease (n = 4), there was a uniform reduction of ESD, EDD, and LVETI with an increase of VCF. In the isolated mitral valve replacement group (n = 10), the values were ESD (B = 4.6 ± 0.7, A = 4.4 ± 0.8 cm, P = not significant); EDD (B = 5.2 ± 0.6, A = 4.7 ± 0.8 cm, P < 0.0025); VCF (B = 0.36 ± 0.08, A = 0.7 ± 0.04 circumf/sec, P < 0.0025); and LVETI (B = 0.40 ± 0.03, A = 0.37 ± 0.03 sec P < 0.05). Patients with mitral stenosis (n = 2), mitral insufficiency (n = 3), and combined mitral stenosis and insufficiency (n = 5) all had a postoperative decrease in ESD, EDD, and LVETI with augmentation of VCF.

We concluded that (1) early noninvasive assessment of left ventricular function after Hancock valve implantation indicates a significant hemody namic improvement, and (2) echocardiography combined with external ca rotid arterial pulse tracing analysis is useful for the follow-up of patients who receive Hancock valves.
Mitral Valve Prolapse in Association With Mitral Valve Stenosis Echocardiographic And Angiographic Features
Authors: Reyns Philippe , Roper Philip , Desser Kenneth B. , Benchimol Alberto , Benchimol Alberto
Published: November 2007

Echocardiograms and left ventricular angiograms were systematically studied in 20 consecutive patients with hemodynamically proven mitral stenosis who were in sinus rhythm. "Definite" mitral valve prolapse was present on the echograms of 9 of 20 patients (45%), while "possible" mitral valve prolapse was noted on the echograms of 7 of 20 (35%). Of the 9 subjects with definite mitral valve prolapse, 4 had angiographic evidence of this diagnosis and an identical number had mitral regurgitation; 1 patient had both prolapse and mitral regurgitation. No subject with "possible" ultrasonic prolapse or normal systolic mitral valve motion had angiographic mitral valve prolapse. It is concluded that (1) signs of mitral valve prolapse are frequently encountered on the echocardiograms of patients with hemodyn amically proven mitral stenosis who are in sinus rhythm, and (2) when stringent criteria for the echographic diagnosis of prolapse are employed, approximately 50% of affected subjects have concomitant mitral insuffi ciency.
Transposition of Subclavian Artery For Vertebrobasillar TIA
Authors: Balaji Malur R. , O'Sullivan John A.
Published: November 2007

Proximal subclavian ulcerative athero matous lesion can present as vertebrobasillar TIA from atherothromboembolic phenom ena. Because it lacks hemodynamic signifi cance, prosthetic graft bypass may undergo thrombosis. Endarterectomy and trans position of the subclavian artery, which has had good results, is the procedure of choice in such cases.
Management of Complicated Carotid Endarterectomy
Authors: John Thomas , Kerstein Morris D.
Published: November 2007

Any neurologic deficit following carotid endarterectomy should be evalu ated early and rapidly by CT scan. If neither infarct nor hemorrhage is present, one should proceed to angiography and surgical correction.
Arterial Grafting with Polytetrafluoroethylene in the Pelvic Region
Authors: Polterauer P. , Kretschmer G. , Wagner O. , Piza F.
Published: November 2007

Since January 1977, polytetrafluoroethylene (PTFE)-Goretex has been used 82 times as aortoiliac substitute: 49 ilio-femoral, 17 ilio-profundal, 10 axillo-femoral, and 6 femoro-femoral cross-over bypasses were performed. In this group of patients 20% were diabetics, 85% were in a preoperative Stage III or IV according to Fontaine, with an average age of 66 years. Postoperative anticoagulation therapy was not used routinely. Each patient had noninva sive diagnostic procedures pre- and postoperatively (Figure 1).
Sartorius Transposition in Extra-Anatomical Bypass Grafts
Authors: Karl Tom R. , Hines George L.
Published: November 2007

A technique for obtaining tissue coverage of extra-anatomic femoral grafts has been developed using sartorius muscle rotated medially. The technique is suitable as a primary or secondary procedure.
Balloon Catheter Extraction of Pulmonary Emboli
Authors: Semb Bjarne K.H. , Storstein Liv , Lilleaasen Per
Published: November 2007

Two cases of massive pulmonary embolism were operated on with the aid of extracorporeal circulation. Considerable amounts of thrombotic material could be removed from the pulmonary artery ramifications by systematic clearing of the pulmonary artery branches by means of an inflatable balloon catheter.
Correlation Between Ultrasonic Doppler Arterial Scanning of the Extracranial Circulation and Cerebral Angiography
Authors: Alves Angelo M. , Sterensis Joseph B.
Published: November 2007

This study reviews 42 patients linked by the fact that they had undergone noninvasive cerebral vascular evaluation using Doppler techniques and had subsequently undergone cerebral angiography. The ultrasonic findings were reviewed and categorized as were the angiographic findings. The 2 sets of results are correlated and analyzed. The suggestion is made based on the data that Doppler techniques alone are highly reliable at diagnosing severely stenotic lesions and total occlusions of the carotid vessels. However, the Doppler technique alone appears inadequate at diagnosing atherosclerotic plaque formation with quite significant lesions not causing major hemody namic flow changes. A further modality is thought to be needed, and the paper ends with a prospective study already in progress analyzing a nonin vasive system utilizing both Doppler and real time imaging techniques.
Progress in the Management of Peripheral Vascular Disease
Authors: Blau Steven , Kerstein Morris D.
Published: November 2007

A search of the recent literature reveals a number of significant advances in peripheral vascular surgery. However, today's surgeon continues to find him self battling a disease process he does not understand with diagnostic tools which need improvement. The purpose of this paper is to outline progress in three areas; 1) diagnosis, 2) pathophysiology and 3) surgical therapy. The advances in diagnostic techniques have focused on three questions—(1) what is the nature of the vascular lesion so that an appropriate operation can be designed, (2) what is the status of the disease post-operatively, and (3) in the unreconstructable limb, what amputation may be successfully performed?

The second section deals with our increasing knowledge of the underlying disease—atherosclerosis—and its modification through pharmacology. The final section is devoted to improvements in surgical therapy, from pre operative management to the technical details of the operation and post operative care. Concurrently, new ideas in graft preparation and new graft developments are discussed.
Congenital Apical Left Ventricular Aneurysm
Authors: Sarnago Bullon F. , Pedrero A. Camacho , Duran E.
Published: November 2007

A case of congenital apical left ventricular aneurysm in a 35-year-old man with normal coronary arteries is reported. There was no myocardial infarction evident on electrocardiogram, no previous thoracic trauma, no sarcoidosis or pyogenic infection.
Surgical Treatment of Bilateral Subclavian Artery Aneurysms: The Combined Median Sternotomy and Cervical Approach
Authors: Garcia-Rinaldi R. , Gallagher M.W. , Lambert M.E. , Byrum M.S. , Rea J.E.
Published: November 2007

Surgical treatment of bilateral subclavian artery aneurysms can present a challenge to the surgeon. A simple method of aneurym exclusion and revas cularization of the upper extremities and posterior cerebral circulation is presented. This approach greatly simplifies the surgical management of this complex lesion.
Chylous Ascites Following Aortic Reconstruction
Authors: McKenna Robert , Stevick Clyde A.
Published: November 2007

Limited retroperitoneal and peritoneal lymph accumulations are undoubtedly common following abdominal aortic reconstruction. However, intractable and symptomatic chylous ascites is a fortunately uncommon occurrence in this setting, though probably not as rare as suggested by the presence of only six cases in the world literature. 1—6 A case of intractable chylous ascites following aorto-femoral reconstruction is presented with a review of the previous six cases in order to clarify the clinical presentation, course, and management aspects of post-operative chylous ascites, specifically in vascular patients with a synthetic graft in place.
Segmental Distribution of Vasa Vasorum to the Canine Abdominal Vena Cava: A Possible Correlation with its Embryogenesis
Authors: Uematsu T. , Takiguchi Y. , Nakashima M. , Shigei T.
Published: November 2007

The segment of the male canine abdominal vena cava (AVC) between the liver and the renal veins receives vasa vasorum from the right phrenicoabdom inal artery, while the infrarenal segment of AVC does from the right testicular artery. These facts were confirmed by both macroscopic observation with dye injection into the arteries and measurement of contractile responses of the segments in vivo by the method with intravascular cuffs. The segmental dis tribution of vasa vasorum from arteries of the right side may closely correlate with the embryogenesis of the vein.

An anomalous dog with totally inverted viscera, which we found during our study, exhibited another anomaly of AVC: It had the segment of AVC between the liver and the renal veins at the left side of the aorta and the infrarenal segment at the right. This anomaly shows that AVC is composed with at least two segments which is formed separately during its embryogenesis and may support our hypothesis.
Replantation Surgery and Microsurgical Technique
Authors: Cunningham Bruce L. , Shons Alan R.
Published: November 2007

The development of surgery using high magnification has allowed reconstructive surgeons to operate on the small blood vessels of the distal extremity which previously were beyond technical limits. Using this new technology reconstructive surgeons are able to replant amputated upper extremities with a high degree of survival and functional success.

The world's first successful clinical replantation was performed by Malt and McKhann1 in 1962. They replaced the arm of a 12 year old boy who had been amputated at the mid-humeral level. In 1965, Komatsu and Tamai2 used the surgical microscope to replant a thumb amputated at the metacarpophalangeal level.

This first successful microsurgical replantation was preceded by considerable ex perimental work. Jacobson and Suarez3 using an operating microscope reported a 100 percent patency rate in arteries 1.4 mm in diameter. Harry Buncke, a plastic surgeon continued development of the microsurgical technique, instruments, and sutures, that would result in successful replantation surgery. In 19634 Buncke successfully replanted a rabbit ear anastomosing an artery less than 1 mm. Next he replanted monkey digits5 and even performed a toe to hand transfer with primary arterial and venous anas tomoses.6
Arterial Thromboembolism of the Upper Extremity — A Late Complication of Traumatic Arterial Injury
Authors: Posteraro Robert H. , Magill H. Lynn , Sackler Jay P.
Published: November 2007

Arterial thrombosis of the upper extremity is an uncommon but well recognized result of recent arterial trauma. We describe an unusual case of upper extremity arterial thromboembolism which arose from a post-traumatic aneurysm ten years following the traumatic event. This report demonstrates the importance of inquiring about episodes of previous trauma in all cases of distal peripheral arterial embolism.
Angiographic Anatomy of the Lateral Femoral Circumflex Artery and Preliminary Experience With its Reconstruction During Profundoplasty
Authors: Adar Raphael , Bass Aryeh , Nussinovitz Moshe , Papa Moshe Z. , Schneiderman Jacob
Published: November 2007

The lateral femoral circumflex artery (LFCA) and its descending branch (DB) are important collaterals of the profunda femoris artery. The success of a profundoplasty may be enhanced by improving LFCA flow, while inadvertant compromise of the LFCA lumen may adversely affect the results of a profundo plasty.

The angiographic anatomy of the LFCA was studied in 200 limbs of patients undergoing aortography for leg ischemia. There were four major anatomic var iations of the LFCA and its DB in respect to their origin from the common and deep femoral arteries. Mean length of the LFCA was 2.5 cm and mean diameter 3.5 mm. Atherosclerotic changes, mainly at the orifice, were seen in 15% of LFCAs. The DB of the LFCA was an important collateral in 102 limbs, in 34 it was the main collateral in the thigh. Its diameter was 3 mm or more in 50% of limbs. These data show the anatomic basis for attempting adjunctive surgical procedures on the LFCA.

Preliminary results are reported of 36 profundoplasties during which a spe cific surgical maneuver was directed at the LFCA. Intraoperative blood flow measurements were performed to quantify the LFCA flow capacity and to com pare flow through the LFCA to distal profunda flow. The LFCA and its DB are important collaterals and should be given specific attention in selected cases.
The Alternative to the Saphenous Vein as an Arterial Graft
Authors: Limet R.
Published: November 2007

If God created the saphenous vein for the sake of vascular surgeons, He neglected to create all men equal in respect to the presence of saphenous veins for needed revascularizations. Therefore, the burden of finding alternatives to saphenous veins reverts to the humble ingenuity of man.
Aneurysm of the Aortic Sinuses of Valsalva: Hemodynamics and Long-Term Prognosis After Surgery
Authors: Drummer Eric M. , Hobbs Robert E. , Fitzgerald Rita , Moodie Douglas S.
Published: November 2007

Seventeen patients with sinus of Valsalva aneurysm are described. All of these patients have had late follow-up to assess prognosis. Twelve patients had congenital aneurysms and five were mycotic. There were 12 males and five females, ranging in age from 20 to 59 years of age (mean of 38 years). Symp toms of congestive heart failure, fatigue, and palpitations were common and were present from three days to seven years before diagnosis (mean of 13.8 months.) All patients had cardiac catheterization including aortography, and 16 had right heart catheterizations. Eleven patients (65%) had aneurysms which ruptured into another cardiac chamber, most frequently the right atrium (six patients). Eleven patients (65%) had aortic insufficiency, and it was moderate to severe in seven. New York Heart Association (NYHA) Functional Class at diag nosis was variable and did not correlate with degree of left-to-right shunt in patients with fistulas to the right heart. Functional Class seemed to correlate with the degree of aortic insufficiency.

Fourteen patients required surgery. The surgical procedure usually con sisted of repair of aneurysm and fistula when present, and aortic valve replace ment. There was one death prior to surgery and one operative death (operative mortality of 7%). Ten of the patients (66%) were in NYHA Functional Class I at late follow-up (range 2.5 to 13.1 years, mean 6.5 years). Long-term functional disability occurred more frequently in patients with moderate to severe aortic insufficiency at the time of diagnosis.

Patients with aneurysm of the sinus of Valsalva are a heterogenous popula tion. Functional Class at the time of diagnosis as well as long-term prognosis appears to be related to the presence and severity of aortic insufficiency at diagnosis. Catheterization with aortography and right heart catheterization are mandatory for accurate diagnosis. Surgical results are good with low operative mortality and improvement in long-term Functional Class.
Rupture of the Abdominal Aorta Due to External Inflammation
Authors: Kruse-Andersen Søren
Published: November 2007

Bacterial inflammation of the wall of the abdominal aorta leading to rupture or the formation of a "mycotic" pseudoaneurysm, has been described previ ously. An increasing number of such cases has been reported in connection with salmonella sepsis. A mycotic aneurysm or an aortic rupture has been observed together with lumbar osteomyelitis in a number of cases. In general, it has been assumed that the osteomyelitis developed secondarily, due to erosion and spreading of the infection from the aneurysm to the body of the lumbar verte bra, frequently L3. A case of erosive bacterial aortitis complicating osteomyeli tis in a 72 year-old woman suffering from diabetes mellitus and acute pyelonephritis is presented. She had a rupture of an otherwise normal abdomi nal aorta and simultaneous osteomyelitis. The pathological manifestation pre sumably occurred in the above order in this patient. Further, it throws some doubt as to the validity of earlier theories, as the lumbar osteomyelitis in some of these cases may have occurred primarily despite the fact that an aneurysmal dilatation of the aorta was present in the majority of cases.
Tanned Autologous Pericardial Valve as a Heart Valve Substitute
Authors: Kalke B.R. , Kole S.D. , Desai J.M. , Magotra Ratna
Published: November 2007

Evolution over the past 25 years has seen several designs of mechanical and tissue heart valves, each new model designed in an attempt to minimize the complications and to improve the flow characteristics. Thromboembolism is a major problem with mechanical valves necessitating life-long anticoagulant therapy. The tissue valves, on the other hand, do not need long-term anticoagu lation but their long-term durability has not yet been proved to be equal to that of the mechanical valves.
The Incidence and Pattern of Atherosclerosis in Africans
Authors: Ofoegbu Reginald O. , Guirguis Marcelle N.
Published: November 2007

Despite the very high incidence of arterial hypertension among Africans ath erosclerotic changes linked with prolonged hypertension is not commonly en countered and even then the coronary arteries are known to be spared. Since this seeming protection against atherosclerosis is said to be found among Afri can populations we carried out a study to ascertain the current presentation and pattern of atherosclerosis including fatty streaking of the intima in an indige nous African population. Our findings show that atheroma as a degenerative disease (not linked with hypertension), contrary to prevailing opinion, is not uncommon among Africans. However, the incidence and pattern of distribution of the lesion especially in the aorta show features which indicate interesting peculiarities in the population studied. We also found that although fatty streak ing of the intima was common and had its peak incidence in the third decade of life, comparatively fewer cases later progressed to atheroma formation.