bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Reoperations without the Use of Cardiopulmonary Bypass
Authors: Iscan H. Z. , Kandemir O. , Gol M. K. , Saritas A. , Tasdemir O.
Published: September 2022

Background:

Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity.

Materials and methods:

Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3 ± 5 and 57.4 ± 7.3 years, respectively.

Results:

Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively.

Conclusion:

Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.
Abdominal Aortic Aneurysm Rupture; after Coronary Artery Bypass Grafting
Authors: Ngaage Dumbor L. , Sulaiman Mamdouh S. , Mavor Andrew , Kaul Pankaj
Published: September 2022

Abdominal aortic aneurysm (AAA) rupture following cardiac surgery is usually fatal. The pathogenesis of this complication is not clearly elucidated and the optimal management of the combined pathology is controversial. We report the successful management of a 77-year old man who developed a AAA rupture in the early postoperative period after coronary artery bypass grafting. The factors that predispose cardiac surgery patients with concomitant AAA to increased risk of rupture are discussed.
Management of Infected Grafts and Mycotic Aneurysms of the Aorta Using Cryopreserved Homografts
Authors: Arbatli Harun , DeGeest Raphaël , Demirsoy Ergun , Wellens Francis , Degrieck Ivan , VanPraet Frank , Korkut Ali Kubilay , Vanermen Hugo
Published: September 2022

Objective:

To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of the aorta with cryopreserved homografts.

Materials and methods:

Between April 1994 and May 2002, 15 cryopreserved aortic homografts were used in 13 patients in the thoracic and abdominal aortic position with supplementary omental or pectoral muscle wrapping for infected grafts (n = 11), and mycotic aneurysms (n = 2) (mean age: 57.5).

Results:

One patient died due to multiorgan failure and the other due to cerebral hemorrhagia postoperatively (15.38%). Another patient died four months after the operation due to septic arthritis, and coronary heart disease. Ten patients are still alive without evidence of infection (76.92%) during a follow up of 44±23.03 (range 4–71) months.

Conclusion:

The use of cryopreserved homografts with supplementary omentum and/or muscle flap coverage, assures an anatomical reconstruction with good results in this difficult group of patients.
Natural History of the Ectatic Aorta
Authors: Basnyat P. S. , Aiono S. , Warsi A. A. , Magee T. R. , Galland R. B. , Lewis M. H.
Published: September 2022

Objectives

To define the natural history of ectatic abdominal aortas and to assess the clinical need for follow-up.

Design

Abdominal aortas were considered ectatic if they were diffusely and irregularly dilated with a diameter less than 3 cm. Ectatic aortas were identified either by AAA screening or as incidental findings. Patients who had only one scan were excluded from the study. Clinical data were analysed.

Setting

Two district general hospitals in Wales and England.

Subjects

116 patients (90 men).

Results

The median age of patients was 71 years (range 48–90). Co-existing risk factors included hypertension (75), IHD (22), PVD (8), diabetes (3), COAD (14), stroke (5), popliteal aneurysm (1), malignant disease (3) and 4 had a family history of AAA. The median follow-up was 24 months (range 5–72). The median and maximum growth rate of the ectatic aortas were 0.65 and 14.4 mm/year respectively. In three patients the expansion rate was more than 5 mm/year. In 22 patients the ectatic aorta became aneurysmal, reaching a diameter greater than 3 cm. There were no ruptures and no elective repairs. Two deaths occurred due to IHD.

Conclusions:

This study demonstrates that if ectatic aortas do expand they do so very slowly. However, 22 of the 116 (19%) became aneurysmal in a follow-up of twp years. Once identified ectatic aortas should be scanned at intervals of three years.
The Quality of Care for Patients with Abdominal Aortic Aneurysms
Authors: Dimick Justin B. , Upchurch Gilbert R.
Published: September 2022

Abdominal aortic aneurysm (AAA) repair is a complex surgical procedure and is commonly performed in a variety of practice settings across the United States. The quality of surgical care is neither ideal nor uniform across medical centers with documented variation in both utilization and outcomes. Recent data document that screening, though effective in reducing AAA-related deaths, may have only small contributions to population mortality. Large randomized trials have provided evidence regarding the timing of AAA repair and provide strong evidence for the development of appropriateness criteria. In general, lower mortality rates have been consistently associated with higher provider volume (surgeon and hospital) and specialization in vascular surgery. Current health policy initiatives suggest referral of several complex procedures to high volume centers based on minimum volume standards. Processes of care of high-volume providers and vascular surgeons should be studied and used to guide quality improvement efforts for lower volume providers and surgeons of other specialties performing AAA repair.
Clinical Outcome of Aortic Valve Replacement in the Elderly
Authors: Chiappini Bruno , Bergonzini Marcello , Gallieri Simona , Pacini Davide , Pierangeli Angelo , Bartolomeo Roberto Di , Marinelli Giuseppe
Published: September 2022

Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70–74 years old; in Group 2 patients aged 75–79 years old; and in Group 3 patients aged 80 years old or older.

An isolated AVR was performed in 289 patients (63%), concomitant coronary artery bypass graft (CABG) in 168 patients (36.6%), an isolated ventricular septal defect (VSD) closure in one patient (0.2%) and an isolated atrial septal defect (ASD) closure in one patient (0.2%). The overall perioperative mortality rate was 7% (32 patients), without significant differences among the three groups ( P= 0.88).

Our study confirms the good outcome of aortic valve replacement in elderly patients even in octagenarians and only concomitant CABG procedures increase the operative risk, reducing long-term survival ( P < 0.05).
Intermittent Warm Blood Cardioplegia Induces the Expression of Heat Shock Protein-72 by Ischemic Myocardial Preconditioning
Authors: Chello M. , Mastroroberto P. , Patti G. , D'Ambrosio A. , Sciascio G. Di , Covino E.
Published: September 2022

Objective:

Recent studies have demonstrated that the induction of heat shock protein-72 (HSP72) by different stimuli preserves the heart function after cardioplegic arrest. Based on these findings, we investigated whether intermittent warm blood cardioplegia would induce changes in the myocardial expression of HSP72.

Methods:

Forty patients scheduled for aortocoronary bypass were randomly assigned to receive either cold or warm intermittent blood cardioplegia. In all patients HSP72 and HSP72 mRNA were assayed in biopsies from the right atrium at baseline, and during the reperfusion period. Plasma CK-MB and troponin-T, and myocardial oxygen extraction and lactate release were also measured.

Results:

In both groups, myocardial expression of HSP72 increased throughout the reperfusion period, but the values of HSP72 band lengths were significantly higher in the warm group. Correspondingly, HSP72 mRNA levels increased progressively in both groups, with significant difference between groups observed in biopsies at the reperfusion. Warm blood cardioplegia was associated with lower levels of CK-MB and troponin-T. Myocardial oxygen extraction and lactate release were higher during intermittent warm cardioplegia, indicating a more profound ischemic anaerobic metabolism in the warm group.

Conclusions:

Intermittent warm blood cardioplegia induces an increased expression of HSP72 and it is associated with a better myocardial protection, by a mechanism involving a variant of the classical ischemic preconditioning model.
Evolving Techniques for Endoscopic Radial Artery Harvesting
Authors: Casula Roberto P. , Kumar Pankaj , Ashrafian Hutan , Athanasiou Thanos
Published: September 2022

The role of radial artery as an arterial conduit for myocardial revascularisation is well established. Minimally invasive approaches for the harvesting of conduits are desirable for clinical and cosmetic reasons. We report our experience with two techniques of endoscopic radial artery harvesting. The techniques are illustrated and their relative advantages discussed.
Current Status of Carotid Imaging by MRA
Authors: Rapp Joseph H. , Saloner David
Published: September 2022

Magnetic resonance imaging of the lumen of the carotid artery, or magnetic resonance angiography (MRA) of the carotid, has gone through a long evolutionary period to become a routine imaging modality in many centers. Further improvements are becoming available. There are better gradients available for scanners, high resolution neck surface coils allow improved signal to noise ratios, and contrast agents which have a longer intravascular dwell time are about to be introduced. Thus, further evolution of this modality will result in continued improvement in our ability to define the vascular lumenal edge and give the added advantage of in vivo plaque imaging. At present, these newer developments are available only in research centers. Published by Elsevier Ltd on behalf of The International Society for Cardiovascular Surgery.
Routine β-Blockade in Vascular Surgery
Authors: Torella Francesco , de Cossart Linda , Dimitri Sameh K. , Edwards Paul R.
Published: September 2022

We have evaluated the safety and efficacy of routine β-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease.

From 1 December 2001 to 31 May 2002, patients received perioperative β-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. The main outcome measure was the occurrence of cardiac complications.

Fifty-three patients underwent surgery in the first period and 54 in the second. After introduction of routine β-blockade, only one patient suffered cardiac complications compared to 10 in the first period ( P = 0.01). There were eight deaths in the first and two in the second period ( P = 0.052). On multivariate analysis, treatment with β-blockers was the only variable significantly associated with a decrease in cardiac morbidity (OR = 0.12; 95% Cl = 0.002–0.66; P = 0.014). Two patients suffered bronchospasm leading to discontinuation of atenolol. Routine perioperative β-blockade was safe and reduced the occurrence of cardiac complications after vascular surgery.
Norepinephrine-Induced Delayed Cardioprotection against Stunning is at the Expense of a Higher Postishemic Arrhythmia Rate
Authors: Marktanner Ralph , Nacke Peter , Feindt Peter , Hohlfeld Thomas , Gams Emmeran
Published: September 2022

Objective

α1-adrenoceptor activation confers myocardial protection from ischemic injury. We tested whether norepinephrine mediates delayed cardioprotection against stunning and whether this alters postischemic arrhythmias.

Methods

New Zealand White rabbits were assigned to three groups: Control-group ( n = 7): no drugs. Norepinephrine-group ( n = 7): 75 μg norepinephrine/kg bodyweight (bw). Norepinephrine/prazosin-group ( n = 7):75 μg norepinephrine and 15 μg prazosin/kg bw. After 24 h, hearts were excised, perfused with buffer and subjected to 20 min of ischemia followed by 120 min of reperfusion.

Results

(a) Developed pressures (dP) ( Psyst– Pdiast) at the end of reperfusion: C: 51.2 ± 5.0%, NE: 71.7 ± 5.1% ( p < 0.05 vs. C), NEP: 50.7 ± 5.0%. (b) Ventricular extra beats (vebs) were detected throughout the experiments. C: 0.41 ± 0.15 vebs/min, NE: 1.06 ± 0.18 vebs/min ( p < 0.05 vs. C), NEP: 1.17 ± 0.3 vebs/min.

Conclusion

Norepinephrine confers delayed preconditioning against myocardial stunning via an α1-adrenoceptor mediated pathway. Norepinephrine-mediated preconditioning involves a beneficial effect towards stunning, but at the expense of a higher rate of postischemic ventricular arrhythmia.
Prospective Clinical and Biological Comparison of Three Blood Cardioplegia Techniques in Low-Risk CABG Patients: Better is Worse than Good Enough
Authors: Baron Olivier , Roussel Jean-Christian , Delaroche Odile , Péron Stéphanie , Duveau Daniel
Published: September 2022

Objective

Three myocardial protection techniques were evaluated in a prospective, randomised trial during coronary artery bypass grafts in 69 patients.

Material and method

Twenty seven patients received intermittent hyperkalaemic undiluted warm blood anterograde cardioplegia (AC), 21 received continuous hyperkalaemic undiluted warm blood retrograde cardioplegia (RC) and 21 received intermittent, hyperkalaemic, diluted cold blood (15 °C), anterograde cardioplegia (CC). Assessment criteria were clinical, laboratory and haemodynamic.

Results

Groups were homogeneous in terms of age, sex, cardiovascular risk factors, severity of coronary disease, preoperative ejection fraction, and number of bypass grafts performed. The oxygen extraction coefficient, and lactate and troponin production in the coronary sinus on aortic unclamping was not significantly different between the three groups. The base excess was −0.19 ± 0.13 in the RC group, −0.18 ± 0.52 in the AC group and −2.67 ± 0.59 in the CC group ( P < 0.01 CC vs. AC and CC vs. RC). The priming volume was 1485 ± 64 ml (CC), 1317 ± 44 ml (RC) and 1318 ± 30 ml (AC) ( P < 0.05 CC vs. AC and CC vs. RC). The haematocrit during CPB was 28.9 ± 0.9 (CC), 32.5 ± 0.8 (RC) and 32 ± 0.7 (AC) ( P < 0.05 CC vs. AC and CC vs. RC). The volume of crystalloid delivered was 735 ± 85 ml (CC), 362 ± 67 ml (RC) and 357 ± 105 ml (AC) ( P < 0.05 CC vs. AC and CC vs. RC). The incidence of ventricular fibrillation on aortic unclamping was 61.9% (CC), 9.5% (RC) and 0% (AC) ( P < 0.01 CC vs. AC and CC vs. RC). The transfusion rate, duration of intubation, postoperative troponin level, complication rate and mortality were not significantly different between the three groups. Haemodynamic parameters at H2, H4, H8 did not vary significantly between the three groups.

Conclusion

These three techniques appear to be comparable in terms of myocardial protection. Anterograde cardioplegia ensures an identical degree of security to retrograde cardioplegia regardless of the coronary lesions, apart from redo lesions. CC requires greater haemodilution of the patients during CPB.
In Situ Saphenous Vein Bypass for Limb Salvage
Authors: Sarcina A. , Carlesi R. , Bellosta R. , Agrifoglio G.
Published: September 2022

A total of 130 infrapopliteal in situ saphenous vein bypasses were performed in 128 patients between January 1980 and June 1991. The indication for surgery was critical ischaemia with impending limb loss in 121 patients; seven suffered from severe claudication. The distal anastomosis was to the popliteal artery below the knee in 60 cases (46.2%) and in 70 (53.8%) to the tibioperoneal arteries. The results, in terms of secondary patency and limb salvage rates, of the first 68 procedures (1980–1985) and subsequent 62 (1986–June 1991) were compared. In the first period, a secondary patency rate of 42.6% and a limb salvage rate of 67.0% were obtained, compared with 71.3 and 80.8% respectively in the second. These differences are significant for patency ( P < 0.005) and limb salvage ( P < 0.01). These results show that the in situ technique can give acceptable results but a learning period with a high percentage of early failures is to be expected.
Cerebral Metabolism and Function during Normothermic Retrograde Cerebral Perfusion
Authors: Usui A. , Hotta T. , Hiroura M. , Murase M. , Maeda M. , Koyama T. , Tanaka M. , Takeuchi E. , Abe T.
Published: September 2022

Retrograde cerebral perfusion through a superior vena cava (SVC) cannula is a new technique used to protect the brain during circulatory arrest. Cerebral blood flow, oxygen consumption, blood sugar consumption and auditory brain stem responses were measured at various rates (100, 200 and 300 ml min−1) of retrograde cerebral perfusion in normothermic mongrel dogs ( n = 12, body-weight 13–15 kg). During perfusion about 20% of the perfusate from the SVC was returned via the aorta, while the rest drained into the inferior vena cava. External jugular venous pressure increased as the perfusion rate increased (mean(s.d.) 26.0(6.4) mmHg at a rate of perfusion of 300 ml min−1). Oxygen and blood sugar consumption also increased as the rate of perfusion increased. Retrograde cerebral perfusion at 300 ml min−1 provided half of the cerebral blood flow (mean(s.d.) 14.7(6.4) versus 34.3(7.8)ml min−1) of antegrade cardiopulmonary bypass (CPB). Analysis of the blood returned through the aorta during perfusion at a rate of 300 ml min−1 showed that mean(s.d.) oxygen consumption was about one-third (4.4(2.1) versus 12.3(7.1) ml min−1) and blood sugar consumption about 15% (17(22) versus 114(54) mg min−1) of that seen in blood returned through the SVC during CPB. Auditory brain stem responses disappeared immediately when perfusion was started but recovered completely as soon as CPB was resumed. Although the oxygen provided by perfusion was not sufficient to maintain cerebral function, it should help protect the brain during circulatory arrest.
Venous Surgery in Resection for Abdominal Malignancy
Authors: Sakaguchi S. , Nakamura S.
Published: September 2022

Vascular surgical techniques were applied to the radical resection of carcinoma of the liver, biliary tract and pancreas. Distal and proximal portal vein reconstruction, respectively, was carried out in 16 patients with carcinoma of the pancreas and 16 with cancer of the liver and biliary tract. Hepatic vein trunks with tumour involvement were resected and reconstructed by various techniques in six patients. A suprarenal segment of the inferior vena cava was completely replaced by a prosthetic graft in three patients with retroperitoneal malignancy. Venous surgery increased the resectability of malignant tumours and preserved circulation in the organ remnant, although the long-term effect on survival is not yet clear. Vascular surgical techniques should be applied more widely in the field of general abdominal surgery.
Axillary-Contralateral Brachial Artery Bypass for Radiation-Induced Occlusion of the Subclavian Artery
Authors: Stein J. S. , Jacobson J. H.
Published: September 2022

Symptomatic occlusion of the subclavian artery is a rare complication of radiation therapy for carcinoma of the breast. The first case of revascularization of this entity using saphenous vein was described In 1974. A total of only 24 patients have been reported in the English literature, of whom 14 have undergone successful arterial reconstruction. Three additional cases of occlusion of the subclavian artery 27, 18 and 7 years after radical mastectomy and postoperative radiotherapy are reported. These patients presented with pain, coldness, paresthesia and absence of pulses in the affected arm, and angiographic evidence of complete occlusion of the subclavian artery. All patients underwent axillary-contralateral brachial artery reconstruction using a 6-mm polytetrafluoroethylene graft tunneled subcutaneously through the previously irradiated area. In each case, the patient noted complete resolution of symptoms with the return of palpable distal pulses. One patient had a thrombosed graft 5 weeks after initial surgery and underwent successful thrombectomy. There were no complications associated with the subcutaneous tunnel or the production of a subclavian steal syndrome. Although there are other possibilities for the origin of the bypass, this technique avoids extensive dissection in previously irradiated areas and does not require complicated dissection of the subclavian artery or clamping of the carotid artery.
Selective Topical Cooling for Myocardial Protection
Authors: McLean T. R. , Jones J. W. , Svensson L. G. , Beall A. C.
Published: September 2022

Limitations of myocardial cooling using antegrade infusion cardioplegia have led to the routine use of topical myocardial cooling. However, topical myocardial cooling can injure the phrenic nerves, lungs and heart. Red blood cells are also discarded with the irrigation fluid. To evaluate the selective use of topical cooling, data were collected prospectively from 67 consecutive patients undergoing isolated coronary artery bypass operation. All patients received an inductive dose of 1 liter blood cardioplegia solution. Intramyocardial temperatures were determined in the distribution of the three major coronary arteries after the first 500 ml of cardioplegia solution was administered. If the three temperature readings were all ≤20° C, patients (group 1, n = 31) received no topical myocardial cooling. If any temperature was >20°C, patients (group 2. n = 36) received topical cooling while the second 500 ml cardioplegia solution was administered. Cardioplegia solution was subsequently administered at approximately 20-min intervals, at which time the patient did or did not receive topical myocardial cooling, depending on the selected group. Although patients in group 2 were older (mean (s.e.m.) age 63.3(1.6) versus 56.8(1.8) years, P<0.05), the two groups were not significantly different with respect to sex. ejection fraction, risk factors, and class of the New York Heart Association. There were also no significant differences in the mean number of grafts per patient, use of the internal mammary artery, and cross-clamp or pump times. There were no deaths and only one patient (3%) in group 2 developed new Q waves. Patients in group 2 received significantly more homologous blood transfusions (mean(s.e.m.) 1.03(0.4) versus 0.06(0.04) units, P<0.05). Postoperative hemodynamics and creatinine phosphokinase isozyme profiles did not significantly differ between groups. In patients with adequate myocardial cooling using cardioplegia alone, the omission of topical myocardial cooling did not increase operative risk, spared the patient from potential hypothermia-induced injury, and may have helped to reduce the need for homologous blood transfusion.
Peripheral Aneurysms in Behçet's Disease
Authors: Tüzün H. , Saym A. , Karaözbek Y. , Erdaǧ A. , Çoşkun H. , Vural F. Sami
Published: September 2022

In this report, 14 patients with Behçet's disease with a total of 16 aneurysms are presented. The most common site of aneurysm formation was the femoral artery. Patients with Behçet's disease and aneurysm formation carry the highest morbidity and mortality rates among all those with the disease. The results of reconstructive surgery in the treatment of aneurysms are discouraging, with many anastomotic aneurysms and grafts occluding. In this study, it was possible to ligate major arteries such as the common iliac, superficial femoral and popliteal without limb loss. It is suggested that ligature either at initial surgery or reoperation should be performed to avoid complications of reconstructive surgery. Adjuvant immunotherapy is required to control relapses responsible for new aneurysm formation.
Ruptured Abdominal Aortic Aneurysm: A Community Experience
Authors: Burke P. M. , Sannella N. A.
Published: September 2022

A retrospective review of a community experience with ruptured abdominal aortic aneurysm (AAA) identified 117 cases from five community hospitals over a 12-year period. There were 90 men (77%) and 27 women (23%), ranging in age from 49 to 87 years. In the initial 6 years, the majority of operations were performed by general surgeons, with a survival rate of 35%. In the latter 6 years, most operations were performed by vascular surgeons, with a survival rate of 61%. For the entire period, patient survival with vascular surgeons was significantly greater than that with general surgeons ( P< 0.05). Preoperative risk factors assessed in terms of their impact on survival were similar to those of previously reported series. Patients in the latter half of the study were older (72.8 versus 69.9 years), with survivors requiring a longer length of hospital stay than those in the initial 6-year period (34.5 versus 22.5 days), indicative of the changing patient population and having diagnostic-related group implications. There was also increased reliance by emergency room physicians on computed tomography for diagnosis, with increased survival rates. Misdiagnosis (patient sent home or admitted with incorrect diagnosis) occurred in 12 patients with no deleterious impact on survival. Some 15 patients with known AAA who either refused surgery for medical reasons or were considered to be at excessive risk for elective resection had a survival rate of 33%, indicating a definite potential for survival. It is concluded that there is continuing evolution of care for patients with ruptured AAA in the community setting. Prompt computed tomography in uncertain cases and management by vascular surgeons have had a positive impact on survival. A survival rate > 60% can be achieved in a community hospital.
In Vivo free Radical Production after Cross-Clamping and Reperfusion of the Renal Artery in the Rabbit
Authors: Defraigne J.O. , Pincemail J. , Franssen C. , Meurisse M. , Defechereux T. , Philippart C. , Serteyn D. , Lamy M. , Deby C. , Limet R.
Published: September 2022

Postischaemic reperfusion injury is often attributed to the generation of oxygenated free radicals which may subsequently promote lipid peroxidation in cell membranes. Electron paramagnetic resonance spectroscopy in association with the spin trap molecule α-phenyl- N-tert-butyl-nitrone allowed direct confirmation of lipid free radical production after renal ischaemia-reperfusion in an in vivo rabbit model. A 60-min period of ischaemia followed by reperfusion caused free radical production twofold greater than after 15min of ischaemia. Glutathione and a-tocopherol have been measured in renal tissue, as indirect markers of lipid peroxidation. After 15min of ischaemia followed by 10min of reperfusion, the mean(s.e.m.) glutathione content of the ischaemic kidney was slightly but significantly reduced by 11.9(2.5)% ( P < 0.003). The content of α-tocopherol was unchanged. However, 10min of reperfusion following 60 min of ischaemia led to significant decrease in mean(s.e.m.) content of both glutathione (30.4(3.7)%) (2.23(0.2) versus 3.14(0.18) μmol/g wet tissue, ( P < 0.001) and α-tocopherol (46.1(7.8)%) (0.57(0.10) versus 1.09(0.14) μg/g wet tissue. P < 0.001) when compared to the control kidney. Under these experimental conditions, desferrioxamine (15mg/kg administered intravenously before inducing ischaemia), a drug known to limit free radical production, significantly limited the decrease of α-tocopherol to 20.8(6.4)% (0.83(0.08) versus 1.05(0.04) μg/g wet tissue. P < 0.05), but did not prevent glutathione consumption in the reperfused kidney.
Hormonal versus Genetic Factors in Limb and Heart Anomalies
Authors: El-Gindi E. , Ahmed-Nasr M.
Published: September 2022

Three men, aged 18, 21 and 27 years, underwent surgery for atrial septal defect of the ostium secundum. All had bilateral absence of the forearm and thumb, with the rest of the hand directly attached to the upper arm. The patients had been exposed to synthetic progestogens during early intrauterine development. The oldest patient is described, together with a 6-year-old boy with limb reduction and Fallot's tetralogy who was exposed to the contraceptive pill during the first 2 months of gestation. During surgery he was found to have atrial septal defect of the ostium secundum. The most plausible diagnosis in such cases is the Holt-Oram syndrome, but the teratogenic effect of the synthetic hormones may be an important aetiological factor. Both hypotheses are discusssed.
Postoperative Chylothorax: A Case for Recycling?
Authors: Thomson I. A. , Simms M. H.
Published: September 2022

Postoperative chylothorax in a patient who was rapidly deteriorating despite conservative treatment is described. A system of recycling chyle from the pleural space through a filter and pump into the subclavian vein is discussed. The history of reinfusion of chyle is reviewed.
Surgical Treatment of Cardiac Myxoma and its Complications
Authors: Sugimoto T. , Ogawa K. , Asada T. , Mukohara N. , Nishiwaki M. , Higami T. , Kawamura T.
Published: September 2022

A total of 20 patients (15 women, five men) were operated on for cardiac myxoma. Their ages ranged from 17 to 74 (mean 56) years. Myxoma was located in the left atrium in 18 patients and in the right in two. Systemic embolism occurred in eight patients, causing cerebral infarction in three, ischaemia of the extremities in two, occlusion of the external carotid artery with cerebral infarction in one, myocardial infarction in one and pulmonary infarction in one. Five patients with severe congestive heart failure required emergency surgery. All myxomas were removed using cardiopulmonary bypass with excision of the attachment walls. Details are given of additional surgery performed on some of the patients. Two patients died, one from pulmonary insufficiency after emergency surgery and the other from an unrelated problem. The remaining 18 patients showed a good recovery and are doing well with no intracardiac recurrence, although one with cerebral infarction underwent clipping of an aneurysm, which was detected later in the infarcted area.
Preoperative Management and Surgical Therapy in Complicated Acute Infective Endocarditis: A 5-Year Experience
Authors: Arena V. , Gerometta P. S. , Pompilio G. , Zanobini M. , Parolari A. , Antona C. , Polvani G. L. , Susini G. , Biglioli P.
Published: September 2022

Twenty-five patients underwent early and elective valve replacement for infective endocarditis during a 5-year period between April 1985 and March 1991. Indications for urgent surgical intervention performed at a mean 32 (range 6–47) days after admission were intractable heart failure, systemic emboli, septic multiorgan failure and the presence of vegetations. Indication for elective surgery was persistent (mean 42 (range 17–56) days) infection after appropriate antibiotic therapy. Twenty patients (80%) had a native valve endocarditis; five (20%) had prosthetic valve involvement. A total of 30 valvular prostheses were implanted: 22 (73.3%) were aortic (21 mechanical and one biological): eight (26.7%) were mitral (all mechanical). All unstable patients referred were treated before surgery in the intensive care unit and subjected to blood ultrafiltration to restore satisfactory circulatory parameters. No patient underwent cardiac catheterization; all patients were operated upon on the basis of echocardiography data alone. One patient (4%) died during hospitalization; two (8%) died later at 48 and 12 months after the first intervention. The reoperation rate was 12%. After a mean follow-up of 49 (range 1–71) months, 21 of the survivors (95%) were in New York Heart Association functional class I or II: the actuarial 5-year survival rate was 87%. Precise preoperative assessment of early operative indications and timely association of medical therapy in unstable patients could represent a step forward in the treatment of acute infective endocarditis.
Evaluation of the Effects of Different Cardioplegic Techniques on Left Ventricular Function during Coronaiy Artery Bypass Surgery Using Transesophageal Echocardiography
Authors: Nakashima Y. , Maldarelli W. , Oka Y. , Sisto D.A.
Published: September 2022

Fifty consecutive patients undergoing coronary artery bypass grafting surgery were studied to evaluate the effects of intermittent anterograde cold cardioplegia (IACCH) and intermittent combined anterograde-retrograde cold cardioplegia (IRCCN) on left ventricular function using transesophageal echocardiography. Global function did not significantly change in both groups, but significantly more inotropes were required in IACCH. Newly developed abnormalities of regional wall motion after cardiopulmonary bypass, which were indicative of ischemic myocardium, were detected in the segments supplied by the right coronary artery in both groups (IACCH, 20%; IRCCN, 16%), by the left circumflex coronary artery only in IACCH (12%) and by the left anterior descending coronary artery only in IRCCN (12%). It is concluded that although global evaluation of left ventricular function did not show any significant change after IACCH and IRCCN under routine management, analysis of abnormalities of regional wall motion provided specific information. In both groups, complete protection of the myocardium was not achieved, and the characteristics of poorly protected areas were dependent on the difference in the two methods. Myocardium supplied by the right coronary artery seemed to be particularly vulnerable, and a special effort to protect these segments is mandatory for a successful outcome.
Evaluation of Haemodynamic Effects of Extracranial—Intracranial Arterial Bypass in Unilateral Internal Carotid Artery Occlusion
Authors: Cooperberg E. B. , Rudenev I. N. , Lavrentev A. V. , Yarustousky M. B. , Tutova M. G. , Haidashev A. E.
Published: September 2022

Sixty-four patients with unilateral atherosclerotic occlusion of the internal carotid artery were studied at the Bakulev Institute for Cardiovascular Surgery with transcranial Doppler (TCD) ultrasonography and angiography before and after extracranial-intracranial arterial bypass (EIAB). TCD assessed accurately the extent of the collateral circulation in 95% of cases. The haemodynamic effectiveness of EIAB depends on the preoperative state of the collateral circulation; the greatest effect was achieved in patients with the lowest levels. EIABs improved the outcome in patients in the present series; hence vascular and neurosurgeons may be persuaded of the benefit of this treatment in patients with unitaleral atherosclerotic occlusion of the internal carotid artery.
Use of an ex Situ, Non-Reversed Great Saphenous Vein Bypass Graft for Lower-Limb Ischaemia
Authors: Katsamouris A. N. , Drositis J.
Published: September 2022

Use of an ex situ, non-reversed, great saphenous vein as an arterial bypass graft for arterial ischaemia of the lower limb is described. After exposing the inflow and outflow arteries of the ischaemic limb, the great saphenous vein of the contralateral healthy limb is prepared. The proximal end of the vein is anastomosed with the inflow artery of the ischaemic limb after incising the valves of the proximal vein. The distal part of the vein is then divided, the remaining valves retrogradely transected and, after ensuring that all vein valves have been rendered incompetent, the distal end of the vein is anastomosed with the outflow artery of the ischaemic limb.
Energy harvesting using integrated piezoelectric transducer in a composite smart structure for self-powered sensor applications
Authors: Yan Linjuan , Rodriguez Jonathan , Billon Kevin , Lallart Mickaël , Collet Manuel , Jean-Mistral Claire , Chesné Simon
Published: September 2022

Self-sensing structures are tremendously needed in transport or energy applications. Nevertheless, structures are rarely designed in advance to harvest energy in realistic operational conditions, leading to sensing functions using most of the time batteries. Thus, this paper proposes a complete application of self-powered sensing using an integrated piezoelectric transducer on a representative composite structure, namely a smart composite reduced-model car. Based on an optimized self-powered Synchronized Switch Harvesting on Inductor circuit (SSHI) coupled with a complete electromechanical behavior study, up to 40[Formula: see text] W can be harvested on a resistive load of 3 M[Formula: see text] for a linear velocity of 12.5 km.h−1. This power allows supplying a temperature sensor and its wireless transmitter, whose data can be sent each 60s. Our functionalized car is a first step toward real industrial application cases and demonstrates the ability of the proposed method to enhance the energy harvesting process on an existing weakly coupled structure and use the vibrations as an energy source for relevant embedded microgenerators and associated self-powered sensors.
Differences Between Incarcerated and Nonincarcerated Youth in the English-Speaking Caribbean
Authors: Freemon Kayla R. , Cheon Hyunjung , Katz Charles M. , Nuño Lidia E.
Published: September 2022

Incarcerated youth across the English-speaking Caribbean engage in high levels of offending before their detention. However, we know little about whether youth detained in juvenile justice systems in the region are those with the highest offending levels. As in nations beyond the region, some groups of youth in the Caribbean may be disproportionately overrepresented in the system despite their offending levels, such as by race or gender. Using samples of secondary school students and incarcerated youth, the present study examines: (1) do incarcerated youth self-report engaging in more delinquency prior to being detained than those not incarcerated and (2) are there demographic or risk/protective factors differences between incarcerated and nonincarcerated youth? We find that, compared to nonincarcerated youth, incarcerated youth self-report higher levels of delinquency, in general, and across violent offending, property offending, and drug involvement. When we used propensity score matching to match youth by their involvement in delinquency, disparities in multiple demographic and risk/protective factors emerge between incarcerated and nonincarcerated youth. Our findings point toward racial disparities in the use of incarceration, with African descent youth more likely to be incarcerated. We contextualize our results for youth justice in the Caribbean.
Providing Physical Assistance for Family or Friends: An Overview for the Home Health Care Professional—Part 1
Authors: Weir Rodney L. , Hoover Donald L.
Published: September 2022

Informal caregivers in the community provide assistance for loved ones in a number of ways, depending on the needs of the individual receiving care. Assistance provided can include managing medications, assisting with physical mobility such as walking and transfers, and generally monitoring health conditions. Informal caregivers provide a crucial societal need, as without this assistance healthcare facilities would be unable to meet the broad-based demand for services. This 2-part article summarizes contemporary research on informal caregiving and makes recommendations for lessening this burden within home health environments. Part 1—covered here—addresses the impact of informal caregiver burden and needed educational and training support for informal caregivers who provide physical assistance in the home. Part 2—covered in a subsequent issue of Home Health Care Management & Practice (HHCMP)—addresses—within a framework of contemporary leadership theory—suggestions for successfully lessening informal caregiver burden in home health environments.
Evaluation of Telehealth Delivery of Group Parent-Led Cognitive-Behavioral Therapy During COVID-19: A Pilot Study
Authors: Byrne Gary , Vickers Louise , Ni Longphuirt Eithne , Cunningham Roisin
Published: September 2022

The COVID-19 pandemic has led to governments around the world imposing varying levels of restrictions and lockdowns leading to home confinement and closure of schools. Children with autism spectrum disorder (ASD) and their families may be particularly susceptible to increased anxiety. A growing evidence base has developed for parent-led cognitive-behavioral therapy (CBT) for child anxiety disorders. The current pilot study aimed to evaluate the preliminary clinical utility (acceptability, feasibility, and efficacy) of a parent-led CBT program in Dublin, Ireland, through an online format. Parents of nine children completed the program. The child did not participate in any part of the online program. Acceptability was strong, and although technical issues were problematic at times, all families completed the program. Preliminary efficacy analysis is mixed, with significant reductions on youth anxiety as measured by clinician-administered questionnaire but no reduction in parent-report measures. Findings suggest that the online program is acceptance, feasible, and effective.
Depth of focus of four novel extended range of vision intraocular lenses
Authors: Schmid Ruediger , Fuchs Christin , Luedtke Holger , Borkenstein Andreas F.
Published: September 2022

Purpose

To assess the depth of focus of four latest non-diffractive extended range of vision IOLs on the optical bench. Such comparison had not been done before.

Methods

We assessed and compared the through focus modulation transfer function (MTF) of the following novel IOLs with a nominal power of 22 D: Acrysof Vivity, LuxSmart Crystal, RayOne EMV and Tecnis Eyhance. An ISO-2 model eye was applied with apertures of 3 and 4.5 mm with monochromatic light of 546 nm. Measurements were done on OptiSpheric IOL PRO 2 optical bench.

Results

For the aperture of 3 mm, Eyhance and RayOne EMV showed the most pronounced peak in MTF with only little enlarged depth of power. Vivity and LuxSmart showed two peaks of about 1.7 D respectively 1.3 D depth of focus, yet reduced MTF and with maxima differently located. For 4.5 mm, MTF values for Eyhance and particularly for RayOne EMV dropped. For Vivity and LuxSmart, only the peak for the secondary focus decreased.

Conclusion

Vivity and LuxSmart showed a larger depth of focus for our measuring conditions than Eyhance and RayOne EMV. Correspondingly, the peak MTF was best for Eyhance and RayOne ERV with small aperture. With the larger aperture, RayOne EMV considerably lost performance.
Combined intense pulsed light and low-level light therapy for the treatment of refractory Meibomian gland dysfunction
Authors: Meduri Alessandro , Oliverio Giovanni William , Tedesco Giovanni , Aragona Pasquale
Published: September 2022

Purpose

To evaluate the efficacy of combined Intense Pulsed Light (IPL) and Low-Level Light Therapy (LLLT) in treatment of Meibomian Gland Dysfunction (MGD).

Methods and Analysis

In this prospective study , 70 patients with refractory MGD were enrolled; group 1 received 3 consecutive sessions of IPL + LLLT treatment using Eye-light® on day 1, day 15 and day 45; group 2 received hyaluronate sodium 2 mg/ml drops 3 times a day for 6 months. Patients underwent at baseline, and after 3 and 6 months Ocular Surface Disease Index (OSDI) questionnaire, Symptom Assessment in Dry Eye (SANDE), tear-film breakup time (TBUT), fluorescein ocular surface staining, meibum expressibility and quality evaluations. Keratograph 5M (Oculus, Germany) was used to assess NIBUT, tear meniscus height (TMH), meibography, and bulbar redness score.

Results

At 6 months a significant improvement of OSDI ( p = 0.03), SANDE ( p = 0.02), NIBUT ( p =  p < 0.0001), TMH ( p = 0.04), TBUT ( p = 0.02), corneal-conjunctival staining score ( p = 0.02), lid margin score ( p < 0.0001), and bulbar redness score ( p = 0.001) were recorded in group 1. Comparing the two groups, statistically significant differences were observed at 6 months in TBUT ( p = 0.03), lid margin score ( p < 0.001), Meibum expressibility ( p = 0.03) and NIBUT ( p < 0.001). No adverse events were recorded throughout the follow-up period.

Conclusion

This study confirmed the efficacy and safety of combined IPL and LLLT demonstrating its superiority compared to topical treatment.
Stakeholder theory, strategy, and organization: Past, present, and future
Authors: Bridoux Flore , Stoelhorst JW
Published: September 2022

We reflect on the past, present, and future of stakeholder theory, focusing on its link to strategy and organization scholarship. Stakeholder theory was originally conceived as a theory of strategic management, but for most of its history it largely developed without having a noticeable impact on strategy research. This has changed in the past decade, however, with the strategy field making a “stakeholder turn.” We highlight the streams of research at the forefront of this turn, including work on “behavioral stakeholder theory,” ‘stakeholder strategy theory,’ and “stakeholder governance.” We conclude with an outlook on how stakeholder theory can help strategy scholars develop a theory of managing value creation that explicitly acknowledges both the economic and moral nature of relationships in and around organizations.
Orchestrating ongoing interaction flows of strategy formation in and between meetings
Authors: Skov Maria Bak , Bjerregaard Toke , Hansen Jesper Rosenberg
Published: September 2022

Research has addressed how the practices and organization of strategy meetings shape strategy processes and outcomes. However, how interactive processes run between and feed into meetings—an integral aspect of how managers shape ongoing strategy emergence—remains relatively poorly understood. Through a strong processual-interactionist approach, we thus examine how in- and between-meeting practices interact and create combined effects in orchestrating ongoing flows of strategy formation. By considering strategy meetings as part of and punctuating chain-like, interactive processes of strategy formation, we develop an understanding of how in- and between-meeting practices dynamically interact—they enable, balance the effects of, and shape one another through the interaction flows in which they are engaged. The longitudinal case study reveals and explains the role of cross-over effects and coalescing between multiple simultaneous interaction flows, thereby advancing extant research on how series of interaction sequences shape strategy emergence and evolution.
Vagal milieu or electrophysiologic substrate? The link between atrial fibrillation and obstructive sleep apnea
Authors: Ifedili Ikechukwu , Ingram Eva , Blount Courtland , Kayali Sharif , Heckle Mark , Levine Yehoshua C
Published: September 2022

Atrial fibrillation is the most common cardiac arrhythmia with its prevalence expected to increase to 12.1 million people in the United States by 2030. Chronic underlying conditions that affect the heart and lungs predispose patients to develop atrial fibrillation. Obstructive sleep apnea is strongly associated with atrial fibrillation. Several pathophysiological mechanisms have been proposed to elucidate this relationship which includes electrophysiological substrate modification and the contribution of the autonomic nervous system. In this comprehensive review, we highlight important relationships and plausible causality between obstructive sleep apnea and atrial fibrillation which will improve our understanding in the evaluation, management, and prevention of atrial fibrillation. This is the most updated comprehensive review of the relationship between obstructive sleep apnea and atrial fibrillation.