bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of visual cues in mid-stage Alzheimer's disease
Authors: Bailey Cathy , Haight Barbara K.
Published: June 2007

This study tested the ability of mid-stage Alzheimer's disease patients to recognize bath day through specific visual cues. Reisberg's theory of global cognitive deterioration in concert with Piaget's staging of cognitive development guided this study. A convenience sample of 16 nursing home residents received the MSQ and calendar recognition chart as preand post-test. Eight subjects, randomly assigned to the experimental group, received the intervention of a pictorial cue reinforced on a daily basis for four weeks. The control group was exposed to the bath calendar only during the first week and on post-test. Gain scores on the recognition chart from preto post-test were clearly higherfor the experimental group. A Kruskal-Wallis 1-Way ANOVA of 12.1739 p < .005 demonstrated a direct relationship between pictorial cue reinforcement and recognition of bath day.
Correlates of knowledge of Alzheimer's disease among caregivers
Authors: Hicks Barbara , Miller Barbara Kopp
Published: June 2007

Little research has been conducted involving the effects that knowledge of Alzheimer's disease has on caregivers as well as the possible consequences of this knowledge. The major purpose of the current study was to determine the amount of knowledge caregivers possessed. The second purpose was to explore possible correlates of knowledge of Alzheimer's disease. One hundred and one caregivers participated in the study. Participants were given a 30 item test which consisted of 15 multiple choice items and 15 true/false items. The caregivers answered an average of 46 percent of the items correctly. Female caregivers answered more questions correctly compared to male caregivers. Additional results are presented in the paper Itappears that education about Alzheimer's disease is needed, especially in caregivers of patients diagnosed with possible or probable Alzheimer's disease. Strategies and suggestions for dissemination of this information are presented.
Combativeness in the demented patient
Authors: Mayers Kathleen S.
Published: June 2007

Combative responses in patients with dementia diagnoses pose a major management problem for care-takers. Those individuals who display repeated bouts of combativeness and pose a risk of harm to others often cannot be maintained in a nursing home setting or other less restrictive environment. Factors contributing to combative responses in patients with dementia are discussed. Case studies are provided; these offer a means of understanding why the patient hits in specific situations. Recommended management strtegies ae described.
Bathing the Alzheimer's patient in long term care: Results and recommendations from three studies
Authors: Sloane Philip D. , Honn Vanessa J. , Dwyer Sharon A. R. , Wieselquist Jennifer , Cain Carole , Myers Sue
Published: June 2007

In the management of persons with Alzheimer's disease and related dementias, bathing constitutes a major source of agitation and discomfort for care recipients, and represents a significant job stress for caregivers. This paper reports three studies that were conducted in nursing facilities to help guide staff and administrators in efforts to improve resident bathing. The first study, a mail survey of nursing directors or charge nurses in 71 skilled care facilities, documented a high level of problematic behaviors (43.2 percent) during bathing of residents with dementia, a concomitant low level of satisfaction (50.7 percent) with bathing, and a wide range of recommended environmental modifications to improve bathing areas. The second study, a review of 515 incident reports from bathing areas in 25 nursing homes, found that agitation was rarely reported, and that the majority of injuries occurred when a caregiver was absent. The third study, a critical review of 14 specialized tubs in terms of suitability for the Alzheimer patient, found wide differences in accessibility for caregivers, disinfection times, reported safety and repair records, and suitabilityfor persons at various stages of dementia. The results of these studies provide practical recommendations for nursing facilities, domiciliary care settings, and home caregivers interested in improving the bathing process for persons with Alzheimer's disease.
An examination of a proposed scoring procedure for the clock drawing test: Reliability and predictive validity of the clock scoring system (CSS)
Authors: Todd M. E. , Dammers P. M. , Adams S. G. , Todd H. M. , Morrison M.
Published: June 2007

The clock drawing test (CDT) is usedfor a variety of diagnostic purposes, including screening for dementia. Individuals have relied on subjective judgments in distinguishing between normal and abnormal clocks. This studyproposesaformal, objective scoring procedure called the Clock Scoring System (CSS). The CDTwas administered to 23 dementia patients and 27 normal, elderly controls. The inter-rater reliability estimates of the CSS rangedfrom 82 to .98 across diagnostic groups. Scores discriminated between the patient and comparison groups, even after controlling for age and education. A discussion of the usefulness of this measure as well as ftture research directions is presented.
A survey of the service needs of caregivers of Alzheimer patients in Maryland's capital area
Authors: Palley Howard A.
Published: June 2007

This study is based on a pilot survey of 24 caregivers of community-based Alzheimer's disease patients in Montgomery County and Prince Georges County, Maryland. Service needs indicated by the data are-affordable, reliable respite care, companion programs and homemaker services; available residential care and housing for those not requiring custodial care; legal assistance; policies to alleviate financial burden; day care; transportation assistance; knowledgeable, understanding and sympathetic physicians; and a centralized effort to coordinate services and provide guidance to caregivers in need of assistance.
Guidelines for psychologists working with dementia care nursing staff
Authors: Slone Donald G.
Published: June 2007

There is an increasing emphasis on the use of behavioral techniques to manage problem behaviors in people suffering from a dementing illness. The need to involve psychologists with an expertise in behavioral management techniques is becoming more apparent. Despite this need psychologists are often not involved as a part of the dementia management team. Differences between nursing staff who are often the core of the dementia management team, and psychologists may pose a barrier to psychologists who might practice in this area. Important differences include background, expectations, knowledge base, and perspectives on providing treatment. A mutual awareness and handling of these issues is critical to the successful incorporation of the psychologist into the dementia management team.
Initial legal considerations of Alzheimer patients: Process and form
Authors: Christopher A. Mark
Published: June 2007

The initial legal considerations of a patient who has been diagnosed with Alzheimer's disease or some related form of dementia, typically involve whether and how to establish a mechanism to provide for substitute decision-making, how to most effectively manage the income and assets of the individual, and how to plan the estate of the patient to ensure continuity of support for his or her dependents. Oftentimes a spouse oradult child takes the initiative to contact an attorney. The need to “get our affairs in order” is often the motivation for the initial visit with an attorney. This article will briefly address some of the initial issues which should be considered in designing a legal plan. The plan should, as adequately as possible, be designed to eliminate or reduce adverse legal consequences which arise from diminished capacity The plan should reflect the desires of the Alzheimer's patient in providing support to himselfand to dependents. It should be practical, addressing the possibility of extended longterm care costs. It should be designed to guard against abuse
Perceptions of job satisfaction in a long term care facility: A comparison between a dedicated Alzbeimer's unit and non-Alzheimer's units
Authors: Hays Antoinette M. , Dowling-Williams Theresa
Published: June 2007

The way the caring environment meets the needs of its staff is influential in achieving job satisfaction. Given the current issues in recruitment and retention of nursing staff in long-term care, knowledge of those factors which influence job satisfaction is of great importance.

This study examined factors associated with job satisfaction of nursing staff on a Dedicated Alzheimer's Unit, Special Care Units (SCU's) compared to staff on traditional Nursing Home Units, or using the Stamps and Piedmont Index of Work Satisfaction. The factors of pay, autonomy task requirement, organizational policies, interaction and professional status were examined in their relationship to total job satisfaction between the two groups.

Professional and paraprofessional nursing staff were surveved. Of a total of 125 surveys, 61 LWS's were analyzed utilizing univariate and bivariate descriptive statistics. Differences in factors influencing satisfaction were also examined among caregivers (i.e. professional vs. nonprofessional staff). Staff working on the Alzheimer's Unit had significantly higher total LWS scores than did staff working on traditional units (p<.001). In particular the factors of professional status, interaction and organizational policies were rated significantly higher by Alzheimer's Unit staff as these influenced job satisfaction.

Clearly, the results support further research into factors influencing satisfaction of nursing staff in long term care and serve (is a useful guide for development of programs to recruit and retain nursing staff in nursing home settings. Results also encourage further research into factors which influence successful implementation and management of staff development iln the specialized area of Alzheimer's care.
Anticipatory dementia and well-being Lynne Gershenson Hodgson, PhD
Authors: Hodgson Lynne Gershenson , Cutler Stephen J.
Published: June 2007

This exploratory study examines the relationship between well-being and anticipatory dementia—the fear that normal, age-associated memory change is the harbinger of dementia. The sample is comprised of4O to 60-year-old men and women, 25 of whom are the adult children of a living parent with Alzheimer's disease, and 25 who are a matched group with no family history of dementia. A composite measure of anticipatory dementia was created for this study. It combines scores from measures of concern about developing Alzheimer's disease and subjective assessment of memory functioning. Four measures of well-being were used—depression, psychiatric symptomatology, life satisfaction, and subjective health status. The results show significant bivariate relationships between anticipatory dementia and well-being. Differential associations exist depending on group membership by sample group and sex.
Montessori and Alzheimer's: A partnership that works
Authors: Dreher Barbara Bender
Published: June 2007

Maria Montessori was a precursor of the human rights for children movement. From her work in medicine, psychiatry, hygiene, pedagogy, and anthropology she devised teaching methods that can be used at both ends of the age spectrum. Her philosophy is inherently respectful of the individual; her terminology sheds a positive and analytical perspective on Alzheimer behaviors. Montessori claimed that play was the child's work. For the Alzheimer patient, work has become play. When skills used in former roles are performed, however slowly and imperfectly the person with Alzheimer's is riveted and reassured Activities that merely resemble useful work increase concentration. Sweeping, washing, andkitchen tasks stirmuscle memory andsense ofworth. This paper will review Montessori principles andpractices and suggest many applications to cognitively-impaired elders. While some suggestions are more easily carried out when patients are getting daily care at home, others may be incorporated into adult day care and institutional programs
The effect of natural environments upon agitation and aggression in late stage dementia patients
Authors: Whall Ann L. , Black Margaret E. , Groh Carla J. , Yankou Dawn J. , Kupferschmid Barbara J. , Foster Norman L.
Published: June 2007

Agitated aggressive behavior in late stage dementia occurs in 30 to 50 percent of patients. This behavior often results in the use of chemical and physical restraints (which have a high degree of untoward side effects) and caregiver burnout. Interventions for agitated aggressive behavior are needed that do not have these side effects, which are readily available in nursing homes and are effective and acceptable to caregivers. Environmental psychologists have proposed that natural elements within the environment decrease agitation in the nondemented as well as the demented Since the shower bath is often a time of great agitation in dementia patients, natural elements were used to modify care during the shower bath (n = 31). There was a significant decrease in mean difference scores from baseline to treatments one and two, with the treatment group demonstrating an overall decline in agitated aggressive behavior Additional randomized trials of the effects of natural environments upon agitation and aggression in dementia are needed.
Characteristics of dementia admissions to standard nursing homes and to special care units
Authors: Leon Joel
Published: June 2007

As a result of using admission criteria, the characteristics of special care unit (SCU) admissions are generally different from dementia admissions. As part of the National Evaluation of Special Care Units Project, all dementia admissions to a nationwide sample of SCUs and comparable non-SCU nursing facilities were screened during a 13-month recruitment window. Results show that SCU admissions are younger, more likely to be male, admitted from home, admitted under private-pay status, have recorded AD diagnoses, are independently mobile, and have fewer physical health problems. Program and policy implications of these findings are discussed.
Rocking chair therapy for dementia patients: Its effect on psychosocial well-being and balance
Authors: Watson Nancy M. , Wells Thelma J. , Cox Christopher
Published: June 2007

The use of platform style rocking chairs to improve psychological well-being and balance of nursing home residents with dementia was studied. Despite significant cognitive impairment, most medically stable unrestrained residents accepted the chairs and learned to actively rock. During the six week program, residents were able to rock an average of 101 minutes per day. Using a cross-over design (n=25), there were improvements in depression/anxiety and reductions in PRN pain medication significantly related to amount of rocking. Those who liked rocking and wanted to continue it at the end of the study also demonstrated significant improvements in balance as measured by center of gravity.
Breakaway: A social supplement to caregivers' support groups
Authors: Forde O. Ted , Pearlman Sholom
Published: June 2007

The objective of the Breakaway program is to thwart negative influences of social isolation in caregivers by involving them with peers who share similar burdens. A simple developmental model brings informal groups together monthly for dinners, cultural entertainment, excursions, and other convivial diversions in the empathetic company of others with similar emotional and social pressures. Breakaway is designed to supplement the clinical and emotional assistance provided by the usual support groups. Resultant improvements in interest,joie de vivre, demeanor, personal esteem, depression, and other aspects of social isolation have been observed.

The Breakaway program may be of significant benefit-to participating caregivers who seek relief from the social isolation and other psychosocial burdens associated with constantly caring for the homebound or chronically ill.
Caring for a relative with Alzheimer's disease: The experience of African-American and Caucasian caregivers
Authors: Loukissa D. , Farran C. J. , Graham K. L.
Published: June 2007

Existing research on caregiving and Alzheimer's disease (AD) has focused primarily on Caucasian family caregivers with considerably less information focused on African-American family caregivers. The purpose of this study was to explore African-American caregivers’ perception of caregiving and related care issues. A total of 34-caregivers (the majority being African-American) from the metropolitan area of Chicago, who cared for a close relative with AD at home, participated in five focus groups. Four major themes emerged from the qualitative data analysis:

•Understanding the illness;

•Dealing with the impaired family member;

•Dealing with others and the impact of the disease; and

•Adopting a management philosophy.

Recommendations are made for future family education and outreach efforts for African-American caregivers, as well as for clinicians and researchers.
Male caregivers: Preparing men for nurturing roles
Authors: McFarland Peggy L. , Sanders Sara
Published: June 2007

This article reports the results of a series of focus groups conducted about males who provide care to females with Alzheimer's disease (AD). Male caregiver's coping skills, unique needs, role development, task provision, utilization of services, and potential service gaps were explored. These men were found to focus on the provision of concrete caregiving tasks and to minimize their emotional reactions to caregiving. Obtaining education about AD also proved to be important because it gave them a sense of control over their situation and thus improved their coping abilities. Through these findings, new strategies for practitioners working with male caregivers are suggested including; development of support networks and wellness programs, increased utilization of services, and the design of a male specific support group.
Measuring client satisfaction with home-based respite services
Authors: Bear Mary , Griffin Robin , Sauer Margaret , Milspaugh Charlotte
Published: June 2007

This descriptive study investigates the validity and reliability of the home-based respite services tool (HBRST) which was developed to measure client satisfaction with home-based respite care (HBRC) and determine the degree to which caregivers were satisfied with the respite services they received in a newly-developed AmeriCorps home-based respite program. A convenience sample of 77 caregivers completed the HBRST. Reliability testing showed that the HBRST had high internal consistency (Chronbach's alpha = 0.82 and high stability (r = 0.92; p 0.001). Validity testing with a criterion measure also showed a significant positive correlation (r =.40, p < .01). Thus, the HBRST is a methodologically sound instrument that can be used to evaluate caregiver satisfaction with home-based respite services.
Disruptive behaviors in individuals with Alzheimer's disease: A behavioral approach
Authors: Boucher Louisette A.
Published: June 2007

Many patients with Alzheimer's disease (AD) demonstrate disruptive behaviors that are distressing to themselves and to their caregivers. This article will examine how to use a behavioral approach to help manage such behaviors. The approach is based on four steps involving the clinician and the caregiver:

• Analysis of the behavior

• Identification of behavioral strategies

• Choice and implementation of a behavioral intervention

• Evaluation followed by modification of the plan as required.

A synopsis of available behavioral strategies are included here to help the clinician discuss alternatives with caregivers.
Alzheimer's disease and symptom-seeking
Authors: Hodgson Lynne Gershenson , Cutler Stephen J. , Livingston Kathy
Published: June 2007

Descriptive analyses of qualitative data revealed that adult children of parents with Alzheimer's disease (AD) engage in symptom-seeking behavior regarding their own health. Responses of two groups of adults, one with (n = 25) and one without (n = 25) a parent with a diagnosis of probable AD, were obtained during individual, face-to-face interviews and were compared. Common theme analysis of open- and closed-ended questions on anxieties about developing AD and symptom recognition identified three dimensions of symptom-seeking behavior: repeatedly checking for signs of AD, interpreting signs as symptomatic of AD, and soliciting external validation for concerns. The adult children of afflicted parents and women engaged in more symptom-seeking behaviors than the comparison group and men. Results may be useful to physicians and other health practitioners in the early detection of AD, and in identifying and caring for populations under stress both from caring for a parent with AD and from excessive worry about their own future health.
Increasing Mexican American Doctoral Degrees: The Role of Institutions of Higher Education
Authors: Valverde Michelle R. , Rodriguez Roy C.
Published: June 2007

Mexican Americans continue to be severely underrepresented among doctoral degree recipients. Although much more research is warranted on this topic, the institutional support model presented can serve to provide immediate guidance to personnel in institutions of higher education who want to increase the rates of Mexican American doctoral degree attainment. The model was developed based on a retrospective analysis of the authors' experiences as participants at one of the host institutions in the Hispanic Border Leadership Institute Doctoral Fellowship Program and a review of the literature. The four components of the model include financial support and opportunity, emotional/moral support, mentorship from university faculty or other professionals, and technical support.
An Examination of Neighborhood Effects on Patterns of High School Attrition among Puerto Rican Youth in the New York Metropolitan Area
Authors: Flores Ronald J. O.
Published: June 2007

This study examines the effects of spatial concentration of Puerto Ricans on the likelihood of high school attrition among Puerto Rican adolescents. Using data from the 1990 U.S. Census of Population and Housing, Public Use Microdata Sample B, we found that neighborhoods with very high concentrations of Puerto Ricans did significantly increase the risk of high school attrition among adolescent Puerto Ricans regardless of family background and other relevant characteristics. We also found important differences by gender.
The Postsecondary Preparation of San Joaquin Valley Hispanic Rural High School Students
Authors: Talbot Diane , Kuehn Phyllis
Published: June 2007

In a study of student and school sources of cultural and social capital, small rural high schools were found to prepare college-eligible Hispanic high school students in greater proportions than large urban high schools.
Empowering Hispanic Students Through Student Organizations: Competencies for Faculty Advisors
Authors: Delgado-Romero Edward A. , Hernandez Carlos A.
Published: June 2007

The authors present preliminary competencies for faculty advisors of Hispanic Student Organizations (HSOs). The competencies are presented, defined, and illustrated with examples. The article concludes with implications for research.
The “Subelavian Steal” Syndrome
Authors: Al-Khaffaf H. , Kalra M. , Farrell A. , Charlesworth D.
Published: June 2007

The authors present a retrospective survey of 58 patients who had carotid subclavian bypass operations for “subclavian steal.” Further examination of 43 of the patients after an interval of up to 8 years revealed that in most the steal persisted despite a patent bypass. The authors present a hypothesis based on matched impedances that provides a logical explanation for these observations.
Juxtarenal Aortic Aneurysm Repair
Authors: Rosen Scott F. , Fantini Gary A.
Published: June 2007

Juxtarenal aortic aneurysm (JRAA) is an unusual, but not rare, pattern of aneurysmal disease of the abdominal aorta in which dilatation extends up to, but does not involve, the renal arteries. The objective of this report was to retrospectively analyze experience with JRAA repair at a tertiary referral center over a 5-year period. From November 1990 through December 1995, 12 consecutive patients underwent repair of JRAA by a single surgeon. There were six men and six women, ranging in age from 65 to 82 years (mean = 77 +2 years). All patients underwent preoperative imaging by aortography, ultrasound, or computed transaxial tomographic (CTT) scanning. Mean aneurysm diameter was 6.6 ± 0.3 cm. Three of the aneurysms were ruptured; however, the rupture was contained within the retroperitoneum and hemodynamic stability was maintained. Eleven aneurysms were approached transperitoneally and one retroperitoneally. Aortic clamping was at the suprarenal level in seven instances and at the supraceliac level in five instances. The left renal vein was divided to facilitate exposure in three instances. Warm renal ischemia time was 27 ± 2 minutes. Eight straight and four bifurcation grafts were placed. All patients survived 30 days. Preoperative creatinine was 1.2 ± 0.1 mg/dL. Creatinine peaked on postoperative day 4 at 1.6 ± 0.2 mg/dL and was 1.5 ± 0.3 mg/dL on postoperative day 10. In no instance was temporary dialysis necessary in the postoperative period, nor did chronic renal failure occur. Postoperative CTT scanning in one patient presenting with a ruptured JRAA revealed an infarcted and nonfunctioning left kidney. In the three patients in whom the left renal vein was divided, mean creatinine was 1.1 ± 0.1 mg/dL preoperatively and 0.9 ± 0.2 mg/dL at discharge. JRAA repair can be safely performed by aortic clamping at the suprarenal and supraceliac level. These maneuvers are well tolerated and provide the exposure necessary to facilitate aortic anastomosis at the juxtarenal level.
Endovascular Vein Graft for the Treatment of Popliteal Pseudoaneurysm
Authors: Kwolek Christopher J. , Hill Bradley , Loh Fang , Schwarcz Thomas H. , Hyde Gordon L. , Endean Eric D.
Published: June 2007

Recent reports have documented the use of covered stents for the treatment of traumatic injuries to the vascular system. We report the first use of an autologous vein-covered Palmaz stent for the treatment of a popliteal artery pseudoaneurysm. A 5-foot-2-inch, 320-pound woman was referred to the authors' institution with new onset of pain and ecchymosis in the popliteal fossa while on Coumadin therapy for treatment of a deep venous thrombosis. She had undergone left total knee replacement 13 months previously. A contrast computed tomography (CT) scan confirmed an 8-cm aneurysm behind the knee. The patient was offered endovascular treatment of this aneurysm as an alternative to bypass surgery. Intraoperative arteriography was performed through a superficial femoral artery cutdown and demonstrated a large popliteal pseudoaneurysm. A 2-cm Palmaz stent was attached to a 6-mm-wide-by-2-cm-long side branch of greater saphenous vein and was used to occlude the neck of the pseudoaneurysm. Completion arteriogram confirmed exclusion of the pseudoaneurysm, and the patient regained a dorsalis pedis pulse after the procedure. Patency at 12 months was confirmed by duplex examination, with the presence of a normal ankle-brachial index (ABI) and normal velocities. The use of endovascular stent grafts made with autogenous tissue offers an attractive alternative to open surgical procedures in technically complex cases. This case demonstrates that a combined open surgical and endovascular approach can be successfully used for the management of traumatic injuries to the popliteal artery. Further investigation will be necessary to evaluate the long-term efficacy of this approach in managing popliteal artery injuries.
Subclavian-to-Carotid Transposition for Coronary-Subclavian Steal Syndrome
Authors: Elmore James R.
Published: June 2007

The recurrence of myocardial ischemia has been well described to occur when a proximal subclavian artery stenosis develops in patients who have had coronary revascularization based on an internal mammary artery. Carotid-to-subclavian bypass distal to the mammary artery has been the traditional vascular reconstruction for these patients. Other interventions in the literature have included aorta-subclavian bypass, axilloaxillary bypass, and subclavian angioplasty or stent placement. This case report describes the use of a subclavian-to-carotid transposition for the treatment of a patient with symptomatic coronary-subclavian steal syndrome.

A 56-year-old man was admitted with unstable angina. Eleven years previously he had undergone coronary revascularization with a left internal mammary artery (LIMA) to the left anterior descending artery and a vein graft to the right coronary artery. Cardiac catheterization at this time revealed a 90% stenosis in the midbody of the vein graft and a 90% stenosis of the proximal left subclavian artery with a 40 mm Hg gradient. The LIMA graft had no intrinsic abnormality. Atherectomy of the vein graft stenosis was performed with a 30% residual stenosis. The patient then underwent a subclavian-tocarotid transposition with a temporary shunt. The shunt was placed from the proximal common carotid to the distal subclavian to allow retrograde perfusion of the LIMA during occlusion of the subclavian artery. Transposition was performed with carotid occlusion in standard fashion. Follow-up angiography and duplex ultrasound confirmed a widely patent transposition. The patient remains asymptomatic 5 years later.

The use of a subclavian-to-carotid transposition for treatment of the coronary-subclavian steal syndrome successfully corrected this patient's cardiac symptoms. Advantages of transposition over other forms of subclavian revascularization include (1) an all-autogenous reconstruction, (2) a single anastomosis, (3) proven long-term durability, and (4) subcutaneous surgical exposure. The main disadvantage of this technique is the potential need for a temporary shunt during occlusion of the proximal subclavian artery. Patients with retrograde flow in the LIMA could have the procedure performed without a shunt. The widespread use of subclavian angioplasty does not appear to be justified in these patients owing to recurrent stenoses after angioplasty as compared to the excellent long-term patency rates for subclavian-to-carotid transpositions.
Bilateral Extraanatomic Renal Revascularization Utilizing the Celiac Artery as an Inflow
Authors: Young Richard M. , Hoballah Jamal J. , Sharp William J. , Kresowik Timothy F. , Corson John D.
Published: June 2007

A case of poorly controlled renovascular hypertension and worsening renal insufficiency in a patient with prior aortic aneurysm replacement and a hepatic artery stenosis was treated with bilateral extraanatomic renal revascularization utilizing the celiac artery as an inflow. Three years following revascularization, her blood pressure is well controlled and her renal function is stable. Renal revascularization using the celiac trunk as an inflow source has not been previously reported. This case demonstrates that the celiac artery can be used for bilateral renal artery revascularization if the hepatic or splenic arteries are found to be inadequate as an inflow source.
Surgical Management of Renal Cell Carcinoma with Vena Caval Extension
Authors: Pola'fski Jerzy A. , Borkowski Andrzej , Sitkowski Waclaw , Kuzaka Boleslaw , Kisiel Maciej , Kidawa Andrzej , Biejat Zbigniew
Published: June 2007

Retrohepatic vena cava surgery was performed in nine patients with renal cell carcinoma and with a propagation of the neoplastic thrombus into the inferior vena cava (IVC) up to the confluence with hepatic veins or to the right heart. Surgical treatment consisted of simultaneous radical nephrectomy and exploration of the retrohepatic vena cava with careful removal under direct vision of the thrombus, which was attached to the intima. In two patients cardiopulmonary bypass was used. All procedures were performed under IVC exclusion. Five patients are still alive from 2 up to 48 months after surgery. Surgical technique and postoperative management including vascular complications are discussed.
Budd-Chiari Syndrome
Authors: Rosa Patricio , Gillespie David L. , Kaiser William J.
Published: June 2007

Budd-Chiari syndrome (BCS) is an uncommon condition. It may vary in its presentation from very mild symptomatology, suggestive of a viral illness, to a very acute form with a fulminant course. Early diagnosis and treatment can make the difference between the development of hepatic failure requiring a transplant, and the sparing of hepatic function. The case presented here is that of a patient with a mild initial presentation but with an acute progression. The presentation as well as the management of this case is discussed.
Carotid-Carotid Bypass: An Excellent Procedure for the Treatment of Complex Extracranial Carotid Artery Disease
Authors: Seelig Matthias H. , Seelig Stefanie K. , Oldenburg W. Andrew
Published: June 2007

Carotid-carotid bypass grafting is a procedure only rarely performed. However, in selected cases it may provide an excellent treatment alternative. The authors report on two patients who were treated by carotid-carotid bypass. The first patient had recurrent cerebral emboli from a chronic aortic dissection extending into the right innominate, common carotid, and internal carotid artery. The second patient was symptomatic from a recurrent high-grade internal carotid artery stenosis and an ulcerated plaque in the right common carotid artery following radical neck dissection and radiotherapy. The indications for this procedure are described and the related literature is reviewed.
Angiolymphoid Hyperplasia with Eosinophilia and Radial Artery Pseudoaneurysm
Authors: Petrakis Ioannis E. , Di Gioia Cira R. T. , Sciacca Vincenzo
Published: June 2007

A case of angiolymphoid hyperplasia with eosinophilia arising from the radial artery is presented. Histologically, there was proliferation of atypical endothelial cells forming vascular spaces and solid cords, with a background infiltrate of inflammatory cells and prominent tissue eosinophilia. Immunohistochemical studies demonstrated vimentin and Factor VIII-related antigen in the endothelial cells. The lymphoid infiltrate was polyclonal. The authors discuss the probable nature of this process, which typically occurs in the dermis and subcutaneous tissue of the head and neck and is known by a variety of different names, reflecting disagreement regarding pathogenesis. This case draws attention to the fact that it can arise not only within the dermis and subcutaneous tissue of the head and neck, but also from major peripheral arteries. Angiolymphoid hyperplasia with eosinophilia should be considered promptly in the doubtful case of a pulsatile mass arising from peripheral arteries as it may lead to an earlier diagnosis and timely treatment with lower morbidity.
Superior Vena Caval Placement of a Temporary Filter
Authors: Watanabe Shun-ichi , Shimokawa Shinji , Shibuya Hiroshi , Iguro Yoshifumi , Moriyama Yukinori , Taira Akira
Published: June 2007

Placement of permanent filters in the superior vena cava (SVC) for preventing pulmonary embolism (PE) arising from thrombi superior to the right atrium has rarely been performed. The authors report the first case of temporary filter insertion in the SVC because of upper extremity thrombosis accompanied with PE. After thrombectomy, the temporary filter was successfully removed. It is recommended to use a temporary filter, especially in young patients with upper extremity thrombosis requiring temporary prophylaxis against PE.
Results of Carotid Endarterectomy Performed with Preoperative Duplex Ultrasound Assessment Alone
Authors: Melissano Germano , Castellano Renata , Zucca Roberto , Chiesa Roberto
Published: June 2007

Contrast injection cerebral angiography has been considered for several decades the “gold-standard” technique for diagnosis and operative planning of carotid disease. More recently, however, an increasing number of institutions are using duplex ultrasound as the single independent preoperative test. The objective of this investigation was to evaluate the impact of the utilization of duplex ultrasonography as the only preoperative test on the outcome of the procedure.

Between 1993 and 1996, the authors performed 1,149 carotid procedures. Duplex ultrasound as the only preoperative test was employed with increasing frequency in a total of 728 cases. In 1995 and 1996, a cerebral arteriogram was performed only if duplex ultrasound was technically inadequate or questionable or showed an atypical pattern of disease.

During the 4 years analyzed in this study, the number of the procedures increased from 165 in 1993 to 412 in 1996. The thirty-day mortality rate was 0.43%, and neurologic morbidity was 1.65%. According to the year in which the procedure was performed, the mortality/morbidity rates were 1.2/2.4 in 1993, 0.52/2.08 in 1994, 0.26/1.57 in 1995, and 0.24/1.21 in 1996. Indication to perform an arteriogram became very selective in 1995. Regardless of these changes in the diagnostic work-up, some degree of reduction in both 30day mortality and neurologic morbidity was recorded. Considering a cost of 724 European Currency Units (ECU) per arteriogram, 527,072 ECU were saved in this period.

In the last 4 years, duplex ultrasound has replaced arteriography as the first-choice technique for preoperative assessment of carotid disease at the authors' institution. There was definitely no detrimental effect on the clinical results that, on the contrary, improved during the same period. This policy has allowed a significant reduction in the cost of the procedure and has most likely prevented several arteriography-related complications. The authors recommend this policy to all institutions in which accurate duplex ultrasound is available.
A New Minimally Invasive Method of Aortofemoral Revascularization
Authors: Açikel Ünal , Karabay Özalp , Silistreli Erdem , Turan Akin , Sariosmanoglu Nejat
Published: June 2007

In recent years, minimal invasive surgical applications have been used in every field of surgery and became a routine application for some kinds of operations. Mini-laparotomy has been limited to abdominal incisions between 3 and 10 cm long. Four aortobifemoral and one aortofemoral bypass cases that were performed with mini-laparotomy incision between January 1997 and February 1998 are presented. In all cases, revascularization of lower extremities was performed successfully without enlarging the incision. The average operation time was shorter and the number of transfused blood units was significantly lower in that group when compared to the conventional laparotomy group of 12 cases. In all cases, bowel sounds appeared in 2 to 8 hours and at the end of 24 hours, oral nutrition was started. The mean discharge time from the hospital was 4.7 days. With the advantages of less operation time, optimal aortic exposure, ability in safe cross-clamping, less postoperative pain, less scar tissue occurrence, early resumption of intestinal functions, early mobilization and shorter hospitalization time, the mini-laparotomy technique is a safe reliable method for use in aortobifemoral bypass operations.
Aortocava Fistula
Authors: Sigler Luis , Gutiérrez-Carreño Rafael , Martínez-López Carlos , Lizola Rene I. , Sánchez-Fabela Carlos
Published: June 2007

Combined injuries of the aorta and inferior vena cava are rare. Mortality is over 70%, primarily from exsanguinating hemorrhage. Post-traumatic aortocava fistula can develop in survivors, who present in the postoperative period with manifestations of high output heart failure.

This is a retrospective review of five male patients, age from 9 to 39 years, with aortocava fistulas that were referred with congestive heart failure, 2 days to 6 months after abdominal penetrating injuries. They had undergone surgery at another hospital and several organ injuries were treated. Retroperitoneal hematomas were not seen or were seen and left undisturbed.

Four patients received a gunshot injury, had the fistula at the infrarenal level, and survived surgical repair. In one of the survivors, a left popliteal artery bullet embolism also occurred and was treated. Another patient sustained a thoracoabdominal stab injury and an aortocava fistula developed at the suprarenal level; he was in severe congestive heart failure and died during surgery.

There are very few reports on this sequelae of vascular injuries at the abdominal level. Patients with aortic and cava injuries have a high mortality rate and arteriovenous fistula may develop with communicating pseudoaneurysms. If high output heart failure develops in a patient with a history of abdominal penetrating injury, an arteriovenous fistula must be suspected and arteriography will disclose the location of the fistula. Surgical treatment is necessary to prevent further heart damage. In the future endovascular procedures may have a role in the management of these difficult conditions.
An Extraluminal Lelomyosarcoma of the Iliac Vein Without Thrombosis
Authors: Prandi M. , Scabini S. , Taviani M. P.
Published: June 2007

Vascular leiomyosarcoma (LMS) is a rare malignant tumor arising from the muscle cells of the media of the vessels. Vascular LMS is often diagnosed as a result of the clinical manifestations of impaired venous flow such as edema and phlebothrombosis.

The authors present a case of an LMS in a 72-year-old woman. Physical examination revealed a round mass deep in the left inguinal region close to the inguinal vessels, fixed and not pulsating. There was no sign of left lower-limb edema nor of articular impairment of the hip. Inguinal and distal pulses were normal. Results of laboratory analysis, including values for the oncologic markers, were normal. An ultrasound scan of the left inguinal fossa showed a 50-by30 mm mass of mixed aspect that adhered to the left common iliac artery. An echo color Doppler showed conservative arterial flow. Thus, a thrombotic aneurysm of the left iliac artery was diagnosed. Chest x-ray showed no pathological findings. An abdominal computerized tomograph (CT) scan confirmed the location of the neoplasm and revealed a narrowing of the left iliac vein compressed behind the mass. The finding was interpreted as a colliquative lymph node. The patient underwent explorative laparotomy with midline incision. The finding was a neoplastic bibbed mass compressing and infiltrating the left iliac vein with no cleavage surface between the mass itself and the venous wall. An intraoperative frozen section revealed a necrotic mass with a cortex of ambiguous interpretation. Surgical procedure was then finished with no further venous resection. Histologic examination revealed the presence of leiomyosarcomatous tissue with nuclear pleomorphisms inside necrotic material limited by a thin fibrotic capsule. According to Coindre's classification the tumor was a G3. After six months the patient is fit and a CT scan showed no evidence of recurring disease.
Lower Extremity Bypass Graft Revision in Diabetics
Authors: Toursarkissian Boulos , D'Ayala Marcus , Shireman Paula K. , Schoolfield John , Sykes Mellick T.
Published: June 2007

Revision of lower extremity bypass graft stenoses identified by surveillance duplex scanning is frequently required in diabetic patients. The authors evaluated (1) the value of routine angiography before graft revision in diabetics, (2) factors that predict patients in whom angiography alters management, and (3) the incidence of recurrent stenosis and factors that might predict it. Forty-two infrainguinal primary vein bypasses undergoing primary revision were retrospectively studied. The initial graft stenosis was detected at a mean of 1 1.5 ±3.6 months after the original bypass. Angiograms were obtained in 38 cases, revealing additional findings in 29 of 38 cases (76%), with a resultant alteration of the operative plan in 27 cases (71%). The most frequent additional angiographic finding was the identification or localization of a lesion in the inflow or outflow tracts (18 of 27 cases). Cases where the angiogram altered the management plan had a mean systolic velocity ratio across the stenosis (Vr) of 7.3 ±6.1, versus a Vr of 4.8 ±1.3 for cases where the angiogram did not alter the management plan (p < 0.04). Duplex scanning identified 4 lesions that were not seen on angiography; 3 of 4 were confirmed as webs at surgery. Twenty of 42 grafts (48%) developed recurrent stenoses at a mean of 4.9 ±3.8 months from initial revision. Restenosis occurred in 69% of female limbs as compared to 38% of male limbs (p = 0.06). Recurrent stenosis was not a predictor of ultimate graft failure, unless left untreated. Four of 10 untreated grafts ultimately failed. A total of 9 of the 42 grafts eventually failed (21%), leading to 3 amputations (7%). The authors conclude that failing infrainguinal bypass grafts identified by duplex in diabetics should undergo a detailed angiographic evaluation. This frequently leads to an alteration in the management plan, especially in the presence of a high Vr across stenoses. High rates of limb salvage (93%) and assisted primary graft patency (79%) despite a high recurrent stenoses rate (48%) justify routine duplex surveillance, preoperative angiography, and aggressive graft revision in diabetic patients with infrainguinal grafts.
Ultrasound-Guided Thrombin Injection Is a Safe and Durable Treatment for Femoral Pseudoaneurysms
Authors: Calton William C. , Franklin David P. , Elmore James R. , Han David C.
Published: June 2007

Ultrasound-guided percutaneous thrombin injection has recently been described as a treatment for postcatheterization femoral pseudoaneurysms. Although ultrasound guided compression offers another nonoperative treatment option, thrombin injection has shown superior initial success rates. Reports of follow-up for thrombin injection longer than 30 days are currently lacking. The authors reviewed their initial experience with thrombin injection and prospectively evaluated patients for occult late recurrences of pseudoaneurysm and for distal circulatory complications. Records and vascular laboratory data for all patients treated with ultrasound-guided thrombin injection were reviewed for an 18-month period. Tibial vessel Doppler waveforms and ankle/brachial indices were routinely obtained before and after thrombin injection. Follow-up duplex examinations were performed within 24 hours of initial treatment. In the prospective portion of the study, successfully treated patients underwent a repeat femoral duplex scan and lower extremity arterial examination for comparison with the pretreatment studies. Forty-nine of 52 femoral pseudoaneurysms (94%) were successfully treated with ultrasound guided thrombin injection. One immediate failure and 2 early recurrences were treated surgically. There was 1 thrombotic complication of the native circulation identified at the time of injection. Follow-up studies were obtained in 32 of 46 available patients with a mean length of follow-up of 9 months (range 3-17 months). No late recurrences of the pseudoaneurysms or arterial-venous fistulas were observed. No distal circulatory complications were detected by arterial waveform analysis. Three deaths occurred in the interim (cardiac related). Two patients were lost to follow-up. The remaining 12 patients reported no additional limb complications but declined to be restudied. Ultrasound-guided thrombin injection is a safe, effective, and durable treatment for iatrogenic pseudoaneurysms. Thrombin injection should be the therapy of choice for catheter-related femoral false aneurysms.