bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler Ultrasound, Ophthalmic Arteries and Temporal Giant Cell Arteritis: A Report of 31 Cases
Authors: Dany François , Liozon Frederic , Adenis Jean Paul , Hammel Jean
Published: November 2007

A prospective study of continuous-wave Doppler ultrasound was performed on 31 patients with histologically confirmed temporal arteritis (TA). Patients were divided into three groups according to ophthalmoscopy:

group A: no ophthalmic anomalies, 20 cases

group B: nonspecific symptoms, 15 cases

group C: ocular specific lesions of TA, 6 cases (amauroses with optic neuropathy)

Doppler ultrasound showed normal velocity curves in patients of groups A and B. No major morphologic anomalies were obtained. Mean amplitude of systolic peaks was 7.93 mm in group A and 10.30 mm in group B (p/NS), with no significant difference from a reference population of 22 patients with no TA.

Group C had very significant anomalies: no perception of ocular arteries in 1 case, very low blood flow in 4 cases, and disturbances in 1 case. Mean amplitude of systolic peaks was very low: 1.81 mm.

A significant increase in blood velocities was observed after steroid therapy with a normalization of curves in most cases, including patients of group C.

This paper suggests that Doppler ultrasound is the single reliable technique for the evaluation of ophthalmic consequences of TA. It allows discrimination between high-risk patients with anomalies of blood flow in the optic vessels and low-risk patients with normal Doppler curves.

High-risk cases have to be treated vigorously and quickly with high doses of steroids and need regular ultrasonic studies during the first weeks.
A New Method for Renal Protection During Renal Artery Revascularization
Authors: Deriu Giovanni P. , Ballotta Enzo , Bonavina Luigi , Grego Franco , Alvino Simonetta , Franceschi Lorenza
Published: November 2007

An original method for renal protection during renal artery revasculariza tion is described. Temporary reperfusion of the renal artery (three to five min utes) after critical periods of cross-clamping (thirty minutes), using a balloon T-shunt, permits prolongation of the total time of renal ischemia. A more care ful operative technique is permitted; if necessary, technical errors can be cor rected during the surgical procedure. Accordingly, this method is useful for providing renal protection during resection of thoracoabdominal aneurysms. On the basis of their experimental and clinical results, the authors conclude that this method is safe and suitable for clinical application.
Prophylaxis of Pulmonary Embolism with Partial Interruption of the Inferior Vena Cava: Indications and Results
Authors: Alemany J. , Teubner K. , Marsal T.
Published: November 2007

From 1970 to 1985, the authors performed 440 partial interruptions of the inferior vena cava for prophylaxis of embolisms. An extraluminal clip was im planted in 248 patients, an intraluminal filter in 138 patients, and an intra luminal umbrella in 54 patients.

Long-term clinical, phlebographic, and hemodynamic results are described. Situations indicating, and situations contraindicating, this prophylactic sur gical procedure are listed.

The extraluminal clip and the intraluminal filter were associated with less than 1% postoperative mortality, whereas a mortality rate of 7% was associated with the extraluminal umbrella. The permeability of the inferior vena cava and the hemodynamic status were not much compromised over a five- to fifteen-year period with the extraluminal clip or the intraluminal filter.
Long-Term Follow-Up of Intraarterial Infusion of Streptokinase in Acute Lower Limb Ischemia
Authors: Delcour C. , Bellens B. , Vandenbosch G. , Dereume J.P. , Struyven J.
Published: November 2007

Twenty-two patients suffering from acute ischemia of the lower limbs were treated with local selective low-dose streptokinase, 2,000 U/min, with a maxi mum dose of 200,000 U, the average time of fibrinolytic infusion being 1.8 hours. Bleeding problems were minimized because of the low dose of fibrino lytic agent. Lysis, demonstrated by radiology, was achieved in 73%, but a good clinical result was obtained only when local fribrinolysis was associated with percutaneous transluminal angioplasty or surgery. Whether or not they had some lytic response, 16 patients required surgical intervention. Limb salvage was achieved in all cases. The long-term follow-up (twenty-six months) in 19 patients was entirely satisfactory with further surgery required later in only 2 cases.
Methods for the Initiation and Maintenance of Human Endothelial Cell Culture
Authors: Vaccaro Patrick S. , Joseph Laurie B. , Titterington Lynda , Stephens Ralph E.
Published: November 2007

The culture of human endothelial cells for the in vitro investigation of the metabolic, synthetic, and physiologic functions of these cells has grown increas ingly common. Model systems investigating the pathogenesis of atherosclerosis are being developed. Methods for the initiation and maintenance of human en dothelial cell cultures are described. The roles of cryopreservation, microcar rier culturing, and roller bottle mass culturing are discussed.
Symptomatic Carotid Stenosis Secondary to an Intraluminal Web—A Case Report
Authors: Karlson Karl J. , Wolf Barbara , Neptune Wilford B.
Published: November 2007

A thirty-four-year-old man presented with symptoms of carotid occlusive disease. Work-up revealed 90% stenosis of the left internal carotid artery, which was found to be caused by a heretofore undescribed web of the carotid artery. The patient was treated with operative excision of the web and patch angio plasty of the carotid artery.
Streptokinase Lysis of Arterial Thrombus Threatening Renal Allograft — A Case Report
Authors: Mandelbaum Jonathan A. , Henry Mitchell L. , Sommer Bruce G. , Smead William L. , Ferguson Ronald M.
Published: November 2007

This case report describes a diabetic patient with an arterial thrombus lo cated in the common iliac artery, just proximal to the takeoff of the renal artery to a transplanted kidney. The clinical problem was how to preserve both lower extremity perfusion and allograft function while lysing the thrombus. Thera peutic options considered were: (1) blind femoral thrombectomy using a Fo garty Catheter, (2) renal artery isolation and open thrombectomy, (3) selective intraarterial streptokinase infusion, and (4) systemic intravenous streptokinase infusion. The fourth option was chosen and resulted in complete dissolution of the thrombus while avoiding further distal embolization and renal transplant infarction.
The Role of Percutaneous Transluminal Angioplasty and Femoropopliteal Bypass in Patients with Threatened Limb
Authors: Fletcher J.P. , Fermanis G. , Little J.M. , Kershaw L.Z.
Published: November 2007

Fifty-two patients with no history of percutaneous transluminal angioplasty (PTA) or vascular surgery presented with a threatened limb and arteriographic findings showing suitability for femoropopliteal arterial reconstruction. Twenty-seven patients were treated by PTA (Group 1) and 25 were treated by femoropopliteal bypass (Group 2). The technical success rate was 85% for PTA and 100% for surgery. The hemodynamic success rate was 63% for PTA and 88% for surgery; the mean increase in ankle systolic pressure index (ASPI) was 0.34 following PTA and 0.57 following surgery. Complications occurred in 11 % of patients following PTA and 32% of patients following surgery. Follow-up ranged from six months to five years with a mean of two years. A clinically successful result was evident in 67% of patients having PTA and 76% of oper ated patients. The overall amputation rate for Group 1 was 7.4% and for Group 2 was 20%. It is concluded that, in the management of femoropopliteal occlusive disease, surgery is more likely to be initially successful than PTA and will give rise to a greater increase in ASPI and a higher incidence of clinically successful outcome; however, because the complication rate is higher for surgery, and fail ure is more likely to lead to amputation, PTA should be considered as a first-line treatment, particularly in patients who are at increased risk for surgery.
Pseudoaneurysm of the High Extracranial Internal Carotid Artery: A Case Report and Literature Review
Authors: Van Damme H. , Lecomte M. , DeKoster G. , Limet R.
Published: November 2007

A case of pseudoaneurysm of the cervical internal carotid artery in a sixteen- year-old girl is reported. The enormous neck mass was initially misdiagnosed as a lymphomatous tumor; neck biopsy was compounded by a massive hemor rhage. The neck wound became secondarily infected, rendering the pseu doaneurysm mycotic. In the presence of infection any attempt of vascular reconstruction was pointless, so the internal carotid artery was doubly ligated. Recovery was uneventful, without neurologic deficit.
Effects of Hemodilution on Peripheral Circulation
Authors: Kouraklis Gregory , Sechas Michael , Skalkeas Gregory
Published: November 2007

In 7 anesthetized dogs the authors produced anemia by exchanging isovo lemic blood with plasma substitute and thus reducing hemoglobin gradually from 17.9 ± 0.7 to 8.5 ± 0.7 gr/dL in three steps. Samples were taken from pe ripheral blood at the animals' normal hemoglobin and at different degrees of hemodilution for the determination of Hb, viscosity, fibrinogen, venous blood lactate and pyruvate, pH, pO2, and oxygen saturation, while cardiac output, heart rate, and aortic pressure were measured. Total peripheral resistance, oxy gen content, and oxygen transport were calculated. Progressive hemodilution resulted in a significant increase in cardiac output from 2.5±0.1 to 4.2±0.2 L/min (p < 0.001), while peripheral resistance decreased clearly parallel with the whole blood viscosity (from 2.2±0.1 to 1.2±0.1 mm Hg/mL/sec, p < 0.001). The value of arterial oxygen content was decreased from 22.6±1.1 to 10.1 ±0.7 mL/dL of blood (p < 0.001), but the systemic oxygen transport was completely compensated at hemodilution step A, and moderately at steps B and C, because of the increased cardiac output. Oxygen consumption was slightly decreased, while aortic pressure, pH, pO2, and oxygen saturation did not change. These data support the concept that moderate normovolemic hemodilution improves the peripheral circulation and does not jeopardize tissue oxygenation.
In Vivo Study of Collagen-Impregnated Double Velour Prosthesis
Authors: di Marzo Luca , Hunter William J. , Schultz Richard D. , Risavy Joseph
Published: November 2007

Cross-linked bovine collagen treatment of double velour prosthesis has re cently been introduced to help the graft ingrowth and neointima development in high-porosity graft without any need of preclotting. The authors have im planted (end-to-end) a total of 18 double velour 6-mm grafts (length 6 cm) in the infrarenal aorta of 18 dogs (15-25 kg). Nine prostheses were treated with colla gen (DVC) and 9 were untreated (DV). Animals with both kinds of prosthesis were sacrificed 3, 7, 10, 14, 21, 30, 60, 120, and 360 days after the implant. Preclotting was required only in DV grafts even though both grafts had some porosity (1,900 cc/min/cm2). Organization of the neointima of both grafts was studied and compared by light and scanning electron microscopy. DVC grafts showed an earlier (3-10 days) deposition of neoendothelial cells and a signifi cantly thicker neointima development within the first week from graft implant (p < 0.02).

No statistical differences were noted in later neoendothelialization. Both grafts had a multifocal neoendothelial surface development around the neovasa vasorum in longer survival (days 21-360) whereas the ingrowth started from anastomoses in the early survival (days 3-14).

In conclusion, DVC grafts, owing to the collagen treatment, do not require any preclotting despite their high porosity (equal to DV) and successfully accel erate short-term neointima development (> DV).
Cardiovascular and Metabolic Adequacy and Survival After Aorto-Aortic Bypass
Authors: Borzone A. , Giovannini I. , Iannace C. , Vulpio C. , Chiarla C. , D'Andrea G. , Salgarello G. , Sbarra G. Morelli , Castagneto M. , Castiglioni G.C.
Published: November 2007

Hemodynamic, metabolic, and respiratory parameters were measured be fore aortic cross-clamping and after declamping in 14 pigs undergoing experi mental aorto-aortic bypass procedures.

The changes observed at declamping provided cumulative evidences of a loss of myocardial competence and of peculiar metabolic alterations, which were more pronounced in the cases with a lethal outcome.

These findings emphasize the need for perioperative support of physiologic functions and for the use of protective measures during aortic cross-clamping and ischemia. They also imply the possibility of using new parameters as indica tors of the severity of the alterations induced by ischemia and as prognostic indicators.
Experimental Study of Ascending Aortic Dissection: Hemodynamics and Pathologic Aspects
Authors: Senoo Masaaki , Teramoto Shigeru , Uchida Hatsuzo
Published: November 2007

The purpose of this study is to clarify the predisposing factors and the mechanism of progression of aor tic dissection and the pathologic changes of the dissected lumen. An experimental model of acute and chronic ascending aortic dissection was prepared in 49 mongrel dogs (weighing from 7 to 30 kg, mean 15.0 kg). They were divided into two groups: the acute group (n=25) and the chronic group (n=24). After the progression of dissection the period of observation was from three days to one year. Medial dissection of the as cending aorta was surgically initiated by using the modification of Blan ton's method.

Dissection progressed in 39 dogs (15 dogs in the acute and 24 in the chronic group) with intravenous mi crodrip administration of noradrena line and adrenaline. In the acute group, the %DS (the length of dissec tion divided by distance from the ori gin to the celiac artery) was definitely correlated with aortic systolic and aortic diastolic and left ventricular systolic pressures (r=0.73, p < 0.01; r=0.73, p<0.01; r=0.81, p < 0.001, respectively; n =14).

The location of the intimal tear and the width, length, and dissected layer of the surgical pocket were ret rospectively examined. The dissected layer of the pocket was not important as a factor influencing the progres sion of dissection, but the width was important. Histologically the dis sected aortic wall revealed ischemic changes in three days and the false lumen was covered with pseudoin tima constituted by collagen and elas tic fibers in about two weeks. The authors concluded that the effective control of acute aortic dissection re quires the reduction of systolic and diastolic pressure, and it takes about two weeks for the organization of the aortic wall after dissection.
Predictive Model for Colonic Ischemia Following Abdominal Aortic Aneurysm Repair
Authors: Gerhart Clark D. , Nicholas Gary G. , Reed James F.
Published: November 2007

Colonic ischemia is a complication of abdominal aortic aneurysm (AAA) repair that results in significant morbidity and mortality. Numerous causes of colonic ischemia have been reported, but no attempt has been made to identify factors that predict its development. This study identifies those factors that increase risk for colonic ischemia following AAA repair and develops a predictive model for identification of patients who need more aggressive intervention.

The records of 12 patients who underwent AAA repair at the authors' institution from 1987 to 1991 and developed colonic ischemia after surgery were reviewed along with a control group of 67 randomly chosen patients who also underwent AAA repair. Clinical factors in the following categories: vascular disease risk factors, medical history, presentation of aortic aneurysm, operative procedure, and postoperative course were examined. Fifteen factors, found to be significantly associated with the development of colonic ischemia (p<0.01), were used for the logistic analysis. Three factors: aneurysm rupture as indication for repair, coagulopathy, and intraoperative hypotension were identified as independent predictors. The presence of one of these factors gave an approximate probability of 10%, two factors 50%, and three factors 90% for development of colonic ischemia.
Transthoracic Revascularization for Brachiocephalic Occlusive Disease
Authors: Schneider Thomas A. , Peterson Gary J. , Marbarger John P.
Published: November 2007

Brachiocephalic occlusive disease is an uncommon but serious problem, particularly for patients with multiple vessels involved who require transthoracic reconstruction. From 1983 to 1990, the authors treated 10 such patients, who had complex stenotic and occlusive lesions and required transthoracic reconstruction of multiple brachiocephalic arteries. Five patients had symptoms of hemispheric transient ischemic attacks, 4 had upper extremity ischemic symptoms, and 3 had prior cerebrovascular accidents. All patients had complex chronic occlusive lesions that precluded extraanatomic recon struction in the neck. The ascending aorta was the proximal anastomotic site in all cases. Bypass grafting to two or more distal sites was performed in 3 patients and to a single site in 7 patients. An additional carotid thromboendarterectomy was performed in 4 patients. One patient suffered an irreversible hemispheric infarction on the third postoperative day due to carotid artery thrombosis ipsilateral to the aortoinnominate bypass graft, for a perioperative stroke rate of 10%. Only 1 patient was found to have a graft occlusion four years postoperatively. Thus the graft patency rate was 90%. All 10 patients are alive postoperatively with a mean follow-up of seventy-two months. This direct approach to revascularization is an acceptable, durable alternative for those patients with lesions precluding standard extraanatomic reconstruction, but it is associated with an occasional perioperative stroke.
Double Clamping of the Ascending Aorta During Coronary Artery Bypass Surgery
Authors: Olearchyk Andrew S.
Published: November 2007

The double aortic clamp technique during coronary artery bypass grafting refers to the performance of distal vein anastomoses with a cross-clamp on the distal ascending aorta and proximals with an added partial occlusion clamp or its modification or the incorpo ration of a partial into a total occlusion clamp. It ensures the elimination of a warm ischemia time during the construction of proximal vein anastomoses as well as a bloodless operative field.
Emergency Abdominal Aortic Aneurysm Repair: Factors Affecting Survival and Long-Term Results
Authors: Moriyama Yukinori , Toyohira Hitoshi , Saigenji Hideaki , Shimokawa Shinji , Taira Akira
Published: November 2007

Elective surgery for abdominal aortic aneurysm (AAA) has become a safe operation, although the mortality related to ruptured AAA remains considerably high. Factors affecting survival of 32 consecutive patients with ruptured AAAs were evaluated. The postoperative mortality was 50% (16/32) compared with 1.9% for 103 elective AAA patients. Factors associated with poor prognosis were systolic blood pressure of less than 90 mmHg and severe metabolic acidosis on arrival to the hospital, size of the aneurysm, and massive blood transfusion. The high mortality and morbidity rates of the ruptured AAA patients emphasize the need for early and aggressive treatment of AAA in the elective setting in the patient at high risk. In follow-up study, however, the actuarial survival following ruptured AAA surgery, excluding hospital mortality, was 77% at five years. It did not differ statistically from that of patients who had elective AAA surgery. The quality of life survey following surgery showed no discernible differences between ruptured and elective AAA surgery.
Deep Vein Thrombosis: Intraarterial Application of a Thrombolytic Agent
Authors: Vojko Flis
Published: November 2007

A case of an older patient with developing venous gangrene of the left upper extremity and contraindications to systemic thrombolytic therapy are presented. Intraarterial application of a lytic agent was successfully applied. It is concluded that, in selected high-risk patients with developing venous gangrene and failed anticoagulation therapy, the intraarterial application of a thrombolytic agent may be the therapy of choice.
Screening for Carotid Artery Stenosis with the Continuous Wave Doppler Listening Examination
Authors: Huber Thomas S. , Harward Timothy R. S. , Read Cindy D. , Werts Stephen G. , Flynn Timothy C. , Seeger James M.
Published: November 2007

The Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated that carotid endarterectomy was beneficial for selected asymptomatic patients with carotid artery stenoses greater than 60%. However, the optimal technique for identifying these asymp tomatic lesions remains undefined. Carotid duplex is the current standard, but cost limits its use for screening large populations. This study prospectively examines the audible interpretation of the continuous wave (CW) Doppler signal as a screening tool for carotid artery stenoses.

Carotid artery listening examinations were performed using CW Doppler immedi ately before standard carotid duplex examinations in 207 patients (414 examinations) by two certified vascular technologists. Stenosis in the extracranial internal carotid artery was classified as <50°/a or ≥50% based on the listening examination alone, and the results were correlated with the duplex findings (duplex ≥50% stenosis—peak systolic frequency [PSF] ≥5 KHz). The results were analyzed in two groups to determine whether accuracy improved with experience (phase I: 107 patients; phase II: 100 patients).

The overall sensitivity (95% confidence interval), specificity, positive predictive value, and negative predictive value of the CW Doppler listening examination compared with carotid duplex was 76% (67.4-83.8), 97% (94.4-98.6), 91% (83.0-95.6), and 92% (87.9-94.3), respectively, for the 414 examinations. The sensitivity (phase I: 68% vs phase II: 85%, P<0.05) increased during the second phase of the study although no significant change was noted in the specificity (phase I: 98% vs phase II: 96%, P=0.44), positive predictive value (phase I: 93% vs phase II: 89%, P=0.71), or negative predictive value (phase I: 89% vs phase II: 95%, P=0.11). Twenty-one of the 27 false-negative listening examinations (CW Doppler <50%, duplex ≥50%) occurred in arteries with stenoses between 50% and 69% (PSF 5-<7 KHz) on duplex. There were only six false- negative examinations among 80 lesions ≥70% on duplex (PSF ≥7 KHz). The time (2.1 ±1.0 vs 12.6 ±9.6 min, P<0.05, Student's t test) and cost ($22.95 vs $166.47) of the listening examination were both less than those of duplex.

The CW Doppler carotid listening examination is an accurate, cost-effective alterna tive to the carotid duplex examination for screening asymptomatic patients for significant carotid artery stenoses.
Iliac Artery Laceration Secondary to Retained Femoral Artery Sheath
Authors: Cikrit Dolores F. , Lalka Stephen G. , Dalsing Michael C. , Sawchuk Alan P.
Published: November 2007

Four patients required surgery to control bleeding from an iliac artery laceration. All patients had an 8 Fr or larger femoral artery sheath left within the iliac artery system for at least 8 hours. Symptoms included lower back or abdominal pain. Patients were taken emergently to the surgical suite for control of their bleeding episode. The bleeding was occurring from a laceration of the iliac artery wall at its bifurcation into the external and internal iliac arteries, which appeared to have resulted from the tip of the retained sheath. All patients had recently received heparin or urokinase. Primary repair was possible in three patients; another required an ileoileo bypass graft. Despite successful repair of the vessel, one patient died. Retained femoral artery sheaths can lead to lacerations of the iliac artery. The length of time that sheaths are left in the artery should be minimized to prevent laceration of the arterial wall by the tip of the sheath.
Reendothelialization and Platelet-Derived Growth Factor Activity Associated with Intra-arterial Stented Grafts
Authors: Ombrellaro Mark P. , Stevens Scott L. , Freeman Michael B. , Goldman Mitchell H.
Published: November 2007

The purpose of this study was to determine whether intraluminal placement affects reen dothelialization rate and platelet-derived growth factor (PDGF) secretion in polytetra fluoroethylene (PTFE) grafts.

Thirty dogs underwent infrarenal abdominal aorta PTFE interposition (12) or intra luminal stented (18) grafting. Grafts were explanted at four and eight weeks and rates of endothelial ingrowth calculated. Cell-specific immunohistochemical stains were used to quantitate perianastomotic endothelial (CD 31 +), proliferating (PCNA+), and PDGF secreting cell content.

Mean endothelial cell resurfacing rates were 1.1 ±0.2, 3.9 ±0.2, 1.4 ±0.2, and 2.4 ±0.2 mm/week for the four-week control (6), stented (7), eight-week control (6), and eight-week stented (8) grafts at the proximal anastomosis, and 1.2 ±0.2, 3.8 ±0.2, 1.2 ±0.2, and 2.6 ±0.2 mm/week, respectively, at the distal anastomosis. Reendothel ialization was greatest with intra-arterial stented grafts at both four and eight weeks (P<0.01). Between four and eight weeks, the decline in resurfacing rates among stented grafts was attributed to the complete reendothelialization observed in eight-week specimens. PDGF+ cell content was similar among four-week control and stented grafts, and greatest in eight-week controls (P<0.05). An inverse correlation was noted between PDGF+ and endothelial (CD 31 +) cell content at both anastomotic sites ( r=-0.34, P<0.01). Trends between increasing reendothelialization rates with decreasing PDGF+ cell content did not achieve statistical significance (P=0.08).

Intra-arterial graft placement accelerates reendothelialization of PTFE grafts. PDGF secretion decreases with progressive endothelial cell coverage.
Endovascular Treatment of Chronic Superior Vena Cava Syndrome Associated with Hemodialysis Access
Authors: Laronga Christine , Ciocca Rocco , Warner Sloan , Nosher John , Graham Alan M.
Published: November 2007

Superior vena cava (SVC) syndrome was first described in 1757 by William Hunter as a complication of a syphilitic aneurysm. With the advent of antibiotics, 74% to 93% of reported cases are now secondary to a malignant process. Benign causes include goiter, mediastinal fibrosis, pericardial constriction, Behçet's disease, polyarteritis nodosa, and thrombosis secondary to catheter placement, most notably pacing wires.

This case report describes a patient who was diagnosed with chronic SVC syndrome after multiple hemodialysis access procedures were performed over a short span of time. The patient is a fifty-five-year-old man with hypertension and end-stage renal disease, etiology unknown, who presented with left upper limb swelling one week after placement of an arteriovenous (AV) graft in his left forearm. One month prior he had had an AV fistula created in the left distal forearm. Owing to difficulty in accessing the fistula, a Shiley catheter was placed in the left internal jugular vein for temporary dialysis. The AV graft was placed later that week. He presented the following week with progressive left upper limb edema associated with limitation of hand movement and pain/numbness of the fingers. The pain was relieved with upper limb elevation.

An outpatient fistulogram showed a patent AV graft and AV fistula, a small amount of thrombosis around the Shiley catheter tip, and occlusion of the SVC. Collaterals were noted involving the right innominate vein, SVC, and the left innominate vein. A catheter and guidewire were then passed through the venous limb of the AV graft into the SVC. Urokinase was delivered as a bolus and then as a continuous infusion into the left innom inate vein and SVC to dissolve any clots that might be in the SVC or around the Shiley catheter. A computed tomography scan of the chest failed to reveal any pathology around the SVC. Systemic heparin therapy was also started.

Twenty-four hours later the patient underwent repeat venography, which demon strated some clot lysis and a patent but severely narrowed SVC. Three self-expanding Wallstents were then placed. The stents were dilated to 14 mm. Completion venography revealed adequate patency of the SVC. After the procedure the patient did well with prompt resolution of his left upper limb swelling and pain. The Shiley catheter was removed during this hospitalization and his dialysis was initiated via the AV graft.

Endovascular treatment of chronic SVC syndrome manifesting after hemodialysis access procedures is a viable option that is associated with excellent short-term patency.
Plication for Correction of Excessive Carotid Artery Kinking, Unacceptable Torn End Point, and Perforation from Plaque Erosion: Techniques and Results
Authors: Sottiurai V.S. , Gonzales J. , Omlie W. , Cooper M. , Lyon R. , Ross C. , McNeil J. , Hatter D.
Published: November 2007

The purpose of this study was to introduce carotid plication as a simpler alternative approach to internal carotid resection, reimplantation, graft replacement in the management of symptomatic carotid kink, carotid perforation, and unacceptable end point.

Fifty-two carotid plications (internal carotid = 49, common carotid = three) were performed on 50 patients (29 men, 21 women) and followed up for 8-129 months (mean 67). Carotid plications were performed for kink (n: 43), carotid perforation from plaque erosion (n: three), and unacceptable end point of endarterectomy (n: six). The operation was performed with 100% shunting and vein patch angioplasty.

There was no death, stroke, aneurysm, pseudoaneurysm, rupture, or stenosis in the 52 carotid plications. Symptomatic relief was successful in amaurosis fugax, transient ischemic attack, global ischemia, and vertebral-basilar symptoms. Only partial relief was achieved in carotid throbbing.

Carotid plication is a simple, dependable, and durable procedure for symptomatic carotid kink, carotid perforation due to plaque erosion not amendable to lateral repair, and unacceptable distal end point in carotid endarterectomy.
Endofibrosis of the External Iliac Artery in Sportsmen Clinical Review and Four New Cases
Authors: Wille Jan , de Jong Justin R. , Moll Frans L. , Hammacher Eric R. , van der Zwan Albert , Fick Tom E. , Ugahary Franz
Published: November 2007

Endofibrosis of the external iliac artery is an unusual condition associated with competition cyclists. There seems to be a good prognosis after surgical therapy, consisting of endarterectomy and vein patching in combination with resection if the artery is lengthened. However, absence of well-documented long-term follow-up studies makes surgical treatment controversial. The authors describe four new patients with endofibrosis of the external iliac artery (EIA) with a review of relevant literature.
Synergistic Impairment of Glucose Homeostasis in ob/ob Mice Lacking Functional Serotonin 2C Receptors
Authors: Wade Jennifer M. , Juneja Punita , MacKay Adrienne W. , Graham James , Havel Peter J. , Tecott Laurence H. , Goulding Evan H.
Published: November 2007

To investigate how serotonin and leptin interact in the regulation of energy balance and glucose homeostasis, we generated a genetic mouse model, the OB2C mouse, which lacks functional serotonin 2C receptors and the adipocyte hormone leptin. The OB2C mice exhibited a dramatic diabetes phenotype, evidenced by a synergistic increase in serum glucose levels and water intake. The severity of the animals’ diabetes phenotype would not have been predicted from the phenotypic characterization of mice bearing mutations of either the leptin (OB mutant mice) or the serotonin 2C receptor gene (2C mutant mice). The synergistic impairment in glucose homeostasis developed at an age when OB2C mice did not differ in body weight from OB mice, suggesting that this impairment was not an indirect consequence of increased adiposity. We also demonstrated that the improvement in glucose tolerance in wild-type mice treated with the serotonin releaser and reuptake inhibitor fenfluramine was blunted in 2C mutant mice. These pharmacological and genetic findings provide evidence that the serotonin 2C receptor has direct effects on glucose homeostasis.
Preimplantation Embryos Cooperate with Oviductal Cells to Produce Embryotrophic Inactivated Complement-3b
Authors: Tse Pui-Keung , Lee Yin-Lau , Chow Wang-Ngai , Luk John M. C. , Lee Kai-Fai , Yeung William S. B.
Published: November 2007

Human oviductal epithelial (OE) cells produce complement protein 3 (C3) and its derivatives, C3b and inactivated complement-3b (iC3b). Among them, iC3b is the most potent embryotrophic molecule. We studied the production of iC3b in the oviductal cell/embryo culture system. In the immune system, C3 convertase converts C3 into C3b, and the conversion of C3b to iC3b requires factor I (fI) and its cofactors, such as factor H or membrane cofactor protein. Human oviductal epithelium and OE cells expressed mRNA and protein of the components of C3 convertase, including C2, C4, factor B, and factor D. The OE cell-conditioned medium contained active C3 convertase activity that was suppressed by C3 convertase inhibitor, H17 in a dose and time-dependent manner. Although the oviductal epithelium and OE cells produced fI, the production of its cofactor, factor H required for the conversion of C3b to iC3b, was weak. Thus, OE cell-conditioned medium was inefficient in producing iC3b from exogenous C3b. On the contrary, mouse embryos facilitated such conversion to iC3b, which was taken up by the embryos, resulting in the formation of more blastocysts of larger size. The facilitatory activity was mediated by complement receptor 1-related gene/protein Y (Crry) with known membrane cofactor protein activity on the trophectoderm of the embryos as anti-Crry antibody inhibited the conversion and embryotrophic activity of C3b in the presence of fI. In conclusion, human oviduct possesses C3 convertase activity converting C3 to C3b, and Crry of the preimplantation embryos may be involved in the production of embryotrophic iC3b on the surface of the embryos.
Rhetoric and Philosophical Discourse in Giordano Bruno's Italian Dialogues
Authors: Canone Eugenio , Spruit Leen
Published: November 2007

The Renaissance writers adapted the dialogue form to represent the culture they were creating, using it for numerous subjects: philosophy, ethics, politics, religion, the arts, the study of language, and literature. The dialogue was an appropriate form for works which are at once serious, ironical, and critical. Giordano Bruno's Italian dialogues are a case in point. This essay scrutinizes the structure of these works, with special attention to the role of the interlocutors in his rhetoric.
A Proline-based Macrocyclic Amide with S4 Symmetry
Authors: Ahn Hee Choon , Yun Sun-mi , Choi Kihang
Published: November 2007

A new square-shaped macrocyclic amide was prepared from N-(4-amino-2-nitrophenyl)proline (ANPP). The two enantiomers of ANPP were connected in an alternating sequence and then cyclized to the corresponding macrocyclic tetramer with S4 symmetry. In this design, there is a central cavity approximately 7 Å in diameter and rigid aromatic rings and intramolecular hydrogen bonding help to reduce the conformational flexibility of the molecule.
Things that go bump on the right
Authors: Chan Derek J
Published: November 2007

Groin masses are common and the differential diagnosis is wide. It is important to distinguish surgical and medical causes. A rare surgical cause – that may be associated with cryptorchidism – is presented here.
The Limits of Central Government Intervention in the Land and Development Market: the case of the Land Commission
Authors: Cox Andrew
Published: November 2007

This article looks at the ability of central governments to intervene in the land and development market to fulfil specific policy goals. In particular, after introducing the ideological controversy which has plagued the issue of compensation and betterment and state intervention into the land market, the article considers the complex range of social, economic, administrative and political constraints, which limited the Labour government’s attempts to create a dominant central government agency in the market in the shape of the 1967 Land Commission Act. In conclusion it is argued that the ideological background to any such intervention precludes central government attempts to rationalise and modify market relationships through managerial/reformist interventions.
Approaches to the Study of Social Policy Making
Authors: Ham Chris
Published: November 2007

The aim of this paper is to suggest possible future approaches to the study of social policy making. The paper’s main argument is that students of social policy who are interested in policy making could usefully draw on concepts and theories from the developing field of policy analysis. Social policy and policy analysis have so far developed separately as fields of study, yet they share some common concerns. In particular, both are concerned with the processes of policy making and policy implementation, and it is on this common ground that students of social policy may gain insights from policy analysis.

The paper is divided into three parts. In the first part a typology of traditions in the study of social policy is put forward. This is followed by a review of approaches to the study of social policy making, which examines critically the work of a number of writers who have contributed to this area of work. Then, in the third part of the paper, some suggestions are made for the closer linking of policy analysis and social policy.
The Politics of Pay Beds: Labour Party Policy and Legislation
Authors: Butcher Tony , Randall Ed
Published: November 2007

In 1976 the Labour Government introduced a Bill into the House of Commons which proposed the separation from National Health Service hospitals of accommodation and facilities used for the private practice of medicine. When this measure received the Royal Assent in the same year it marked the culmination of a two year struggle over an issue which had been effectively contained for more than 20 years. Despite the fact that the continued existence of private practice within the framework of the National Health Service (NHS) had been a source of controversy within the Labour Party since the inception of the NHS, it was not until the mid-1970s that it came to the forefront of political debate and the phasing out of pay beds in NHS hospitals was unequivocally accepted by the Labour Party as a priority for government action.

It is the purpose of this article to provide an account of the pay beds issue since 1946 and, arising from this, to explain why the introduction of legislation to provide for the withdrawal of private practice from NHS hospitals was accorded priority by the Labour Government in the mid-1970s.

Pay beds have a long history in Britain.
Calcium Diacylglycerol Guanine Nucleotide Exchange Factor I (CalDAG-GEFI) Gene Mutations in a Thrombopathic Simmental Calf
Authors: Boudreaux M. K. , Schmutz S. M. , French P. S.
Published: November 2007

Simmental thrombopathia is an inherited platelet disorder that closely resembles the platelet disorders described in Basset Hounds and Eskimo Spitz dogs. Recently, two different mutations in the gene encoding calcium diacylglycerol guanine nucleotide exchange factor I (CalDAG-GEFI) were described to be associated with the Basset Hound and Spitz thrombopathia disorders, and a third distinct mutation was identified in CalDAG-GEFI in thrombopathic Landseers of European Continental Type. The gene encoding CalDAG-GEFI was sequenced using DNA obtained from normal cattle and from a thrombopathic calf studied in Canada. The affected calf was found to have a nucleotide change (c.701 T°C), which would result in the substitution of a proline for a leucine within structurally conserved region two (SCR2) of the catalytic domain of the protein. This change is likely responsible for the thrombopathic phenotype observed in Simmental cattle and underscores the critical nature of this signal transduction protein in platelets.
‘The Samuel F. B. Morse Papers,’
Authors: Meyer Lars
Published: November 2007

The Library of Congress recently digitized about 6,500 documents from its holdings of
Conjugation potential and class 1 integron carriage of resident plasmids in river water copiotrophs
Authors: Mukherjee Shriparna , Chakraborty Ranadhir
Published: November 2007

Plasmid content was investigated in hundred copiotrophic Gram-negative river water isolates that exhibited resistance to four or more antibiotics. A total of seventy-seven isolates were found to carry plasmids of varying sizes. These isolates were primarily grouped as Pseudomonads and members of Enterobacteriaceae on the basis of physiological and biochemical tests. Fifty-six isolates that were rifampicin-sensitive and belonged to Enterobacteriaceae family were chosen as donors for the conjugal transfer assay. Eighteen of the isolates successfully transferred conjugable plasmids to the
E. coli
DH5
α
recipient. Countable multiple antibiotic resistant transconjugants arose readily and conjugal transfer frequency was in the range of 3.75 × 10
−6
to 1.0 × 10
−1
. The most common carriage of resistances conferred by transmissible R plasmids was against ampicillin, cefotaxim and cephalexin. The residence of class 1 integrons on conjugative R plasmids was confirmed in only six transconjugants. Gene cassettes borne on the integrons were identified to be dihydrofolate reductases
(dhfrs)
. The major concern of this study was about the copiotrophs containing self-transmissible R plasmids which may be potential reservoirs of antibiotic-resistance genes and instrumental in dissemination of the same in the environment.
Clinical Outcomes and Cost Minimization with an Alternative Dosing Regimen for Meropenem in a Community Hospital
Authors: Patel Gita Wasan , Duquaine Susan M. , McKinnon Peggy S.
Published: November 2007

Study Objective. To compare outcomes and cost for the traditional United States Food and Drug Administration‐approved dosing regimen for meropenem versus an alternative dosing regimen providing similar pharmacodynamic exposure with a lower total daily dose.

Design. Retrospective cohort study with a cost‐minimization analysis.

Setting. A 417‐bed, privately owned community hospital.

Patients. One hundred patients who received meropenem 1 g every 8 or 12 hours (traditional dosing regimen) between January 1 and September 30, 2004 (historical controls), and 192 patients who received meropenem 500 mg every 6 or 8 hours (alternative dosing regimen) between October 1, 2004, and September 30, 2005.

Measurements and Main Results. Demographic and clinical data were collected for all patients. Cost‐minimization analysis was performed by using the drug acquisition cost for meropenem. Demographics, sources of infection, distributions of organisms, and Charlson Comorbidity Index scores were similar between patients in the traditionally and alternatively dosed groups. Concomitant therapy, duration of therapy, success rates, lengths of stay, and in‐hospital mortality rates were also similar between groups. Median time to the resolution of symptoms was 3 days for traditional dosing and 1.5 days for alternative dosing (p<0.0001). A logistic regression model including the dosing strategy showed that only polymicrobial infections and sepsis were associated with increased failure rates. The median cost for antibiotics was $439.05/patient for traditional dosing and $234.08/patient for alternative dosing (p<0.0001).

Conclusion. An alternative dosing regimen for meropenem with a lower total daily dose yielded patient outcomes, including success rates and duration of therapy, equivalent to those of the traditional dosing regimen. Alternative dosing decreased total drug exposure, costs for antibiotics, and time to the resolution of infections.
Dr. Mefloquine‐Induced Eosinophilic Pneumonia
Authors: Katsenos Stamatis , Psathakis Kostas , Nikolopoulou Melita I. , Constantopoulos Stavros H.
Published: November 2007

Mefloquine has been widely used for prophylaxis and treatment of patients with chloroquine‐resistant malaria; the drug is usually well tolerated. Rarely, adverse effects may be severe, including gastrointestinal disturbances, neuropsychiatric reactions, cardiovascular manifestations, skin lesions, musculoskeletal symptoms, and bone marrow toxicity. We describe a 67‐year‐old woman with fever, dyspnea on exertion, peripheral blood eosinophilia, and diffuse pulmonary infiltrates on chest radiography. She had taken mefloquine for malaria prophylaxis for an 8‐week trip to South Africa. A thorough work‐up led to the diagnosis of eosinophilic pneumonia caused by the mefloquine. Her condition improved after the drug was discontinued. To our knowledge, this is the first report of mefloquine‐induced eosinophilic pneumonia. Clinicians should be aware of this rare, potential adverse effect of mefloquine.
Spatial distribution of geological resources in northwestern Serbia, Jadar block terrene, and its relation to tectonic structures
Authors: Filipovic Ivan
Published: November 2007

This work presents new information about the interconnection between diverse geological resources and tectonic structures framing the Jadar block terrene. Deep fault zones are found to have been principal bearers of geothermal, thermo mineral and metallic ore resources. Increased bitumen and hydrocarbon concentrations in pre-Tertiary deposits, which may be potential oil/gas zones, are also associated with these areas.
Thermodynamic predicting of Si-Me (Me = Ti, Al) binary systems
Authors: Kostov A. , Zivkovic D. , Friedrich B.
Published: November 2007

Thermodynamic predicting analysis of Si-based binary systems - Ti-Si, and Al-Si, are shown in this paper. Thermodynamic analysis involved thermodynamic determination of activities, coefficient of activities, partial and integral values for enthalpies and Gibbs energies of mixing and excess energies at different temperatures: 2000K, 2400K and 2473K, as well as calculation of phase diagrams for the investigated binaries. The FactSage was used for all thermodynamic calculations. .
USB-based radiation monitor
Authors: Drndarevic Vujo , Jevtic Nenad , Djuric Radivoje
Published: November 2007

The Universal Serial Bus has become a dominant interface for the connection of standard peripheral devices to a PC computer. This paper analyzes the possibilities of USB bus applications in the field of measurement and environmental monitoring. As a result, a gamma radiation monitor consisting of an USB-based universal peripheral device and a gamma probe with a GM counter, has been designed. For the interfacing monitor with the powerful and easy to use LabVIEW software package, an instrument driver as a set of virtual instruments has been developed. The proposed monitor is a flexible instrument which can be used for laboratory measurements, as an environ mental radiation monitor or for training purposes. Connected to the laptop computer, the monitor becomes a portable instrument suitable for field measurements. Basic measurements and functionality properties of the radiation monitor are presented here.