bluuebunny/crossref_metadata_2025 huggingface dataset:
A pharmacokinetic-pharmacodynamic study on carboplatin administered in prolonged continuous infusion regimens with synchronous radiotherapy
Authors: Allsopp M.A. , Sewell G.J.
Published: November 2007

A clinical and pharmacokinetic study was conducted on an outpatient basis in which carboplatin was administered by continuous infusion (20, 25, or 30 mg/d X 5 days X 4 weeks) with synchronous radio therapy. Responses were obtained in 8 of 15 patients, and dose-limiting toxicity was not reached. Leukope nia (grade 1 or 2) occurred in 8 patients, nausea (grade 1 or 2) in 2 patients, and no other toxicity was evident. AUC (area under plasma concentration X time curve) and elimination half-life (1.68 to 2.97 hours) data were similar to values obtained for the rapid intravenous (IV) infusion of carboplatin at an equivalent dose in previous studies. Values of volume of distribution at steady-state (Vdss) were higher following continuous infusion administration as com pared with rapid IV infusion. This was consistent with results from other studies and may possibly be ex plained by altered drug distribution and disposition following continuous infusion therapy. Data were fitted to a mono-exponential elimination curve that was also in agreement with previous reports on carboplatin pharmacokinetics. Relationships between pharmacokinetic variables and pharmacodynamic variables (haematological toxicity) were investigated in order to explore the possibility of developing pharmacokinetically guided dosage schemes for car boplatin given by continuous infusion in a combined modality treatment. A linear correlation (r = 0.71) was evident between the percentage decrease in platelets (at the nadir 4 weeks after the start of infusion) and AUC X normalised radiation field area. Wtih further studies, it is possible that a formula could be derived from this relationship for dose individual isation in patients receiving carboplatin by continu ous infusion with synchronous radiotherapy.
Extravasation of epirubicin/vincristine and ifosfamide/ mesna from a central venous catheter
Authors: Webster Penelope Jane , D'Souza Deirdre
Published: November 2007

A 50-year-old female diagnosed with high-grade infil trating ductal carcinoma of the left breast was planned for insertion of a central venous catheter for a 6-week continuous infusion regimen including weekly ifosfamide/mesna alternating with weekly epi rubicin/vincristine via a CADD portable infusion pump; then radiotherapy followed by a further 6 weeks of VIE infusional chemotherapy.

The initial 6 weeks of therapy was complicated by infected central venous catheter during week 2. Central venous catheter was removed and chemother apy was administered peripherally. After completion of XRT, a new central venous catheter was inserted and the second cycle of epirubicin/vincristine chemo therapy was commenced.

During week 3 of the second cycle the patient developed right neck pain and swelling, which was diagnosed as a haematoma and cellulitis which was treated with cephalexin. The following week she was admitted for intravenous antibiotics and drainage of the haematoma. Exploration of the neck swelling revealed fat necrosis and extravasation of chemother apy into the subcutaneous tissues. Chemotherapy was stopped, and treatment was commenced for extrava sation of an unknown volume of ifosfamide/mesna administered weeks 1 and 3, and epirubicin/vincris tine administered weeks 2 and 4 for unknown period, possibly 3 weeks.

The extravasation was treated as per the institu tional policy for anthracycline extravasation; topical dimethyl sulphoxide and cold packs were applied every six hours for 14 days and plastic surgeons were consulted. Central venous catheter was removed 10 days after detection of the extravasation. Inflamma tion and pain resolved slowly over 4 weeks. The patient has had no further chemotherapy, and re mains in CR. There have been no long-term sequelae from the extravasation.
Aspects of quality management: Accuracy in dosing antineoplastic drugs
Authors: Heck Georg , Berger Gabi , Kiemen Ulrike , Latscha Nicole
Published: November 2007

Introduction. When preparing parenteral antineo plastic preparations, different production techniques are used in hospital pharmacies or oncologic wards. National and International regulations and quality standards define the requirements for drug produc tion, independent of the methods that are used.

Materials and Methods. In the present study we compared the precision of a weight-controlled dosing system supported by production and docu mentation software to a conventional volume-con trolled dosing method. The weight-controlled method, where one technician produces the applica tions software-leaded with a connected electronic balance, includes an automatic online control and documentation of each procedure step. The pharma cists role in the production process is reduced to the endcontroller before distributing the drugs. The vol ume-controlled method, mostly used in Germany, is based on dose analogous volume calculation as mea sured by syringes. Lack of automatic control and documentation requires the pharmacist as a control ler at every step of production. To determine the difference in dosing accuracy of both methods, we measured and calculated the deviations of the real from the target doses/masses for both methods.

Results. With our weight-controlled method, every single dosage and the cumulative dose for one drug of one patients therapy lay within a 5% deviation limit of the required dose. Without validation of syringe volume and consideration of galenic factors, our volume-controlled method does not consistently meet the deviation limit of 10% required in the pharmacopoeia.

Conclusion. The weight-controlled method is superior in dosing accuracy to the conventional method, because syringe-volume deviations, densities of drug solutions, overfillings and other factors are not considered in the volume-controlled method. Only with great expense in manual documentation, the volume-controlled method correspond to the guidelines in Chapters 1, 4, and 5 of the "Guidelines for Good Manufacturing Practice of the European Communities," where requirements on quality assur ance systems, documentation and production are described.
Hypersensitivity to cisplatin on second rechallenge despite a successful first rechallenge
Authors: D'Souza Deirdre C. , Katelaris Connie H. , Harnett Paul R.
Published: November 2007

Objective. The need for vigilance in patients who exhibit cisplatin drug hypersensitivity, even after successful rechallenge is illustrated.

Clinical features. The patient was a 43-year-old woman presenting with relapsed ovarian cancer. On initial presentation 2 years earlier, she had developed a marked allergic reaction on her sixth cycle of cisplatin and cyclophosphamide chemotherapy. She was successfully rechallenged with cisplatin on re lapse, following pretreatment with antihistamines and corticosteroids. On the following cycle she redevel oped a major hypersensitivity reaction with tachycar dia, tachypnoea, hypotension, shakes, sweating and headache acutely into the cisplatin infusion, despite compliance with the previously effective premedica tion regimen.

Case progress and outcome. Adrenaline, hy drocortisone, and promethazine were administered intravenously and oxygen and salbutamol were in haled and the patient settled over 10 minutes. Regular oral promethazine therapy was maintained overnight. Further therapy with cisplatin was withheld and the patient went on to complete 4 cycles of single agent paclitaxel, which were well tolerated.

Conclusion. Patients exhibiting hypersensitivity reactions to platinum complexes that are successfully rechallenged following steroid and antihistamine pre- medication are still potentially at risk of systemic reactions. Vigilant patient care should be maintained on subsequent cycles and adrenaline, corticosteroids and antihistamines should be made available on stand-by.
Guidelines for the treatment of hypercalcemia associated with malignancy
Authors: Nakashima Lynne
Published: November 2007

Hypercalcemia is a common complication of cancer and occurs in 10—20% of patients. Although treatment of the underlying cancer is the optimal therapy, this may not be prac tical or available for many patients. This re port details our approach to the management of hypercalcemia at the British Columbia Can cer Agency, Vancouver Cancer Centre. The recommended approach to therapy is hydra tion followed by pamidronate and if needed, calcitonin. If no response is noted, plicamy cin may be used as a second line agent. In patients with multiple myeloma and lym phoma, prednisone is also suggested.
A clinical and economic drug usage evaluation of prophylactic G-CSF in non-Hodgkin's lymphoma
Authors: Howitt Karen M , Matthews Jane P
Published: November 2007

Objective. To identify if prophylactic granulocyte colony-stimulating factor (G-CSF) delivers the same clinical outcome and level of cost-effectiveness in general clinical use as it has under controlled clinical trial conditions in patients with non-Hodgkin's lym phoma.

Method. A 6-month prospective study of all patients eligible to receive prophylactic G-CSF for supportive treatment for non-Hodgkin's lymphoma was performed. Outcomes measured included occur rence of febrile neutropenia, length of hospital stay, and cost of admission. The critical values of key pharmacoeconomic parameters were calculated for this patient group and compared with the actual values obtained.

Results. The use of G-CSF in all 99 courses, for 35 patients, complied with funding guidelines. Pro phylactic G-CSF was prescribed most frequently for chemotherapy courses which were most likely to result in febrile neutropenia. The percentage of che motherapy courses associated with febrile neutrope nia in patients who did not receive G-CSF increased significantly with treatment intensity. Prophylactic G-CSF appeared to be cost-effective for patients re ceiving high intensity chemotherapy but not for other patients.

Conclusion. Clinicians at our institute use G- CSF where clinical benefits are most likely to be obtained. The use of prophylactic G-CSF is more cost-effective than using therapeutic G-CSF to treat febrile neutropenia in high risk patients. The contin ued funding of prophylactic G-CSF for non-Hodgkin's lymphoma is justified clinically and economically in patients receiving intensive chemotherapy.
Rationalisation of chemotherapy services in the University Hospital Birmingham National Health Science Trust
Authors: Baker James P. , Jones Sarah E.
Published: November 2007

Objectives. To audit chemotherapy prescribing in out-patient clinics in order to develop a novel ap proach for the provision of chemotherapy services to peripheral clinics.

Method. Two audits of CMF (cyclophospha mide, methotrexate, and 5-fluorouracil) chemother apy were performed to initially determine the feasi bility and cost effectiveness of a centralised chemotherapy service. Subsequently, an audit was performed to develop a system for the rationalisation of chemotherapy prescribing using dose-banding.

Results. The results from the first audit showed that of the 97 courses of chemotherapy prescribed in the peripheral out-patient clinic, 13.5% were de ferred. All deferred chemotherapy was reissued amounting to a saving of £681.00 over the 6 months studied. The second audit compiled data from 380 courses of CMF and enabled a dose-banding system to be developed. A system was devised so that an agreed 5% variance from the dose prescribed enabled pre filled chemotherapy syringes to be supplied, with no more than two syringes being used per dose.

Conclusion. In conclusion, the prefilled syringe programme has improved patient waiting times, re duced drug wastage, and has enabled rationalisation of chemotherapy services in this health district.
Talking to second language wrjters: using interview data to investigate contrastive rhetoric
Authors: Holyoak Stephen , Piper Alison
Published: November 2007

The tradition of studying contrastive rhetoric through the analysis of texts is now broadening out to address more dynamic and complex issues of context and personal experience. Focusing on expository text, this paper examines the potential of using data from interviews with second-language writers to explore the ways in which writing differs between languages and cultures. It reports on a study of 17 university staff and postgraduate students, all seasoned academic writers in both their mother tongue and English, who were interviewed about their understanding of rhetorical differences between the two languages and the implications of these differences for their own experience as writers. It concludes that, while interview-based data on cross-cultural rhetoric have limitations in terms of generalizability, productivity, and verification, the process and its outcomes can contribute both to research and to the teaching of writing.
Task type and task processing conditions as influences on foreign language performance
Authors: Skehan Peter , Foster Pauline
Published: November 2007

This paper examines the effects of planning and post-task activity on task-based performance. It is motivated by the need, given recent claims that task-based instruction has desirable pedagogic qualities, to investigate the effects of choosing different types of tasks, as well as different task implementation conditions, on the fluency, accuracy and complexity of the language which is produced when tasks are carried out. Three tasks are investigated: a personal task, a narrative task and a decision task. A 2-by-2 research design was used, with two planning conditions (10 minutes' planning time vs no planning time) and two post-task conditions (plus or minus knowledge of a post-task). Performance was assessed through the number of pauses (as a measure of fluency), the percentage of error-free clauses (to measure accuracy) and the level of subordination (as a measure of complexity). Confirming hypotheses and previous research, planning had clear effects on almost all measures. The hypothesis that foreknowledge of a post-task activity would selectively influence accuracy received only partial confirmation. Data from the present study was also related to results reported in an earlier study. This revealed that there is strong evidence of trade-off effects between the different dependent variables used, in that fluency, accuracy and complexity seem to enter into competition with one another, given the limited attentional capacities of second language users. Finally, there are indications that task characteristics interact with planning time and lead to selective improvements in particular areas. Tasks which contain clearer inherent structure, when planned, seem to favour accuracy, whereas tasks which require more on-line processing or which have complex outcomes, when planned, produce greater complexity.
Resection of Aneurysm of Left Aortic Arch in Patient with a Vascular Ring
Authors: Berghuis Jacob , Allen Chester B.
Published: November 2007

A double aortic arch discovered for the first time in adulthood is rare. Vascular rings in the human are usually asymptomatic, and since Gross first treated the vascular ring surgically, the condition has been quite amenable to surgical therapy. Asymptomatic vascular rings are even more rare. If a vascular ring is discovered and if it is asymptomatic, treatment need not be instituted. For this reason, the following case, which represents a vascular ring first discovered in at 64 in a man, is presented.
Anomalous Origin of Left Pulmonary Artery From the Ascending Aorta
Authors: Schiller Medad , Williams Thomas E. , Craenen Josepha , Hosier Don M. , Sirak Howard D.
Published: November 2007

A patient whose left pulmonary artery arose from the ascending aorta is described. The embryology and a review of the literature concerning this unusual anomaly is presented. This is the third reported case of an anomalous origin of the left pulmonary artery without associated intracardiac defects and the sixth one successfully corrected. This patient presented the interesting opportunity to compare histologically the ef fects of having one lung connected to the lesser circulation and the other to the systemic circulation in the same patient. The severe cardiac symptoms usually en countered and the otherwise fatal outcome makes surgical correction of this lesion mandatory.
Statement of Policy
Authors: Boyd A. Michael , Kalmansohn Robert B. , Kalmansohn Richard W.
Published: November 2007

As a new policy of the Journal, the Board of Editors have decided to invite views of noted experts in the field of actual and controversial problems in vascu lar diseases. These views will be presented as "special editorials."

These editorials do not necessarily reflect the consensus of the Board of Editors of the Journal, and the Board will make no efforts to impose its views on them. They are intended to present individual opinions from the leaders of our profession.

We will also invite and, if possible, provide a place in the Journal for the expression of opposite viewpoints.
Mural Thrombosis After Experimental Carotid Endarterectomy
Authors: Pollak Erich W. , Webber Milo M. , Pollak Erich W.
Published: November 2007

The incidence of mural thrombosis following three types of experimental intimal injuries at common carotid arteries, was investigated in a series of 12 dogs.

Mural thrombosis was obtained at each of the intimal lesions. Moreover, obstructive thrombosis occurred in three instances. Further investigation of thrombi revealed that partial fragmentation occurred when exposed to hydrodynamic forces. These results suggest that mural thrombosis following carotid endarterectomy in humans, is possibly more frequent and significant than it is generally appreciated, thus leading to the consideration of postoperative anticoagulation after endarterectomy, as a means to minimize the incidence of postoperative embolic cerebrovascular accidents.
Arterial Emboli and Malignant Disease
Authors: Acharya Govind , Garick Edward , Acharya Govind
Published: November 2007

Four cases of Arterial Emboli are reported. Association is suggested be tween peripheral arterial emboli and malignant disease. No definite mecha nism for this association has been established but a malignancy-induced alteration of the clotting mechanism is postulated.

In any general hospital, peripheral arterial embolization is not an uncom mon event. Immediate therapy since the introduction of the Fogarty catheter, has become fairly standardized and has been very successful in salvaging ischemic limbs.

The long-range outlook, however, is dependent on the identification of the source of emboli and the institution of appropriate corrective or preventive measures.

In many clinical reviews of peripheral arterial embolization, the probable source of the embolus could be reasonably established in 90% of the cases. Nevertheless, in each series there remains 10% of cases in which no source of embolus could be identified. 1

Over the past two years at The Memorial Hospital we have accumulated a series of patients with peripheral arterial embolization and all of whom had proven malignancies.

We are presenting this series as a postulated causative association between peripheral arterial embolization and the malignant state.
Aortic and Iliac Graft Fistulae
Authors: Jackson Donald C. , Thompson William M. , Johnsrude Irwin S.
Published: November 2007

Sixteen patients with aortic and iliac graft fistulae were diagnosed from a series of over 886 abdominal aortic reconstructive operations. A preoperative diagnosis was established in 12, eleven by radiographic studies. Angiography and barium intestinal studies were the most helpful. The two most important features in diagnosis are a high index of suspicion and an aggressive radio graphic approach.
Coronary Artery Aneurysms: A Report of 15 Cases
Authors: Dabizzi R.P. , Padeletti L. , Aiazzi L. , Caprioli G. , Baldrighi V. , Fantini F.
Published: November 2007

Fifteen cases of coronary aneurysms are reported. Coronary arterio graphy demonstrated saccular aneurysms in 2 patients and fusiform, not poststenotic aneurysms in the others. Four patients underwent successful bypass surgery.
Obstructive Vascular Disease Treated by Urokinase
Authors: Mazel M.S. , Riera R.
Published: November 2007

Eleven cases of obstructive peripheral vascular disease were treated with urokinase, including seven cases of occlusion of iliofemoral arteries and four cases of occlusion of femoral and popliteal veins. There was one additional case of complete obstruction of carotid arteries. In every case the patency of the vessels was reestablished by angiography, or by a striking improvement in symptoms and signs in those patients who refused repeat angiógraphy. Urokinase may be effective in chronic as well as acute vascular occlusions. The safety of the procedure indicates that a trial of this therapy is justified.
Popliteal-To-Dorsalis Pedis Bypass for Limb Salvage: a Case Report
Authors: Schanzer Harry , Heimann Tomas
Published: November 2007

This is a case report of a successful popliteal-to-dorsalis pedis artery by pass. The patient had a previous fem oropopliteal bypass which remained patent but failed to halt the ischemic disease. Distal revascularization al lowed a transmetatarsal amputation, which preserved the limb. Bypass to the level of the ankle and foot should always be considered in patients with severe ischemic disease before ampu tation is performed.
Local Microcirculation in Chronic Venous Incompetence and Leg Ulcers
Authors: Fagrell Bengt
Published: November 2007

Most chronic leg ulcers (90 to 95%) are caused by incompetence of the deep venous system and/or the perforators of the lower leg. Superficial venous incompetence does not give rise to necrotic skin ulcers. The primary cause of venous leg ulcers is the marked increase in pressure that builds up in the deep veins of the lower leg during walking. This pressure is transformed to the skin vessels through the ankle perforators, out to the nutritional vascular bed of the skin. The intracapillary pressure increases tremendously and this causes the capillaries to dilate and become tortuous. The blood elements leak out through the capillary wall into the surrounding tissue and form a specific microedema, which gives rise to an effective nutritional block between the capillaries and the skin cells. This microedema is most probably the main cause of the development of venous leg ulcers.
Complications of Middle Cerebral Artery-Superficial Temporal Artery Anastomosis
Authors: Slade Walter R. , Enker Stanley
Published: November 2007

Microvascular bypass surgery for occlusive cerebral vascular disease has aroused considerable interest in the past decade. This interest has been accompanied by considerable experience. Improvements in the technique, together with experience, has refined the indications for the procedure and made us aware of the complications of bypass surgery for occlusive cerebral vascular disease.
Recurrent Thoracic Outlet Syndrome Following First Rib Resection
Authors: Sanders Richard J. , Monsour James W. , Gerber William F.
Published: November 2007

Five years ago, a follow-up study of first rib resections in patients with the thoracic outlet syndrome (TOS) disclosed a recurrence rate of over 15%. Many patients were re-explored supraclavicularly, and in every case the anterior scalene muscle was found reattached to the bed of the first rib. The invariable success of scalenectomy led to a study of this procedure as the first operation for all cases of persistent thoracic outlet syndrome.

Most patients with TOS gave a history of neck trauma and had symptoms of paresthesias of the hands and weakness of the arms, as well as neck pains and headaches. The common physical findings were tenderness over the scalene muscles and duplication of symptoms with the arms raised. A scalene muscle block with a local anesthetic was the most useful diagnostic test.

The good to excellent long-term results following 239 scalenectomies and 214 first rib resections were almost identical, 68% and 69% respectively, with fair results in 20% and 13% respectively.
The External Carotid Artery in Revascularization of the Upper Extremity
Authors: Szuchmacher Pinkus H. , Freed Jeffrey S. , Szuchmacher Pinkus H.
Published: November 2007

The ipsilateral external carotid artery can be used for revascularization of the axillary and brachial arteries when the contralateral axillary artery is not available. A successful case is presented and the technique described.
Comparative Evaluation of Vascular Clamps on the Arteriosclerotic Aortic Walls
Authors: Masuoka Susumu , Yokoyama Akira , Shimomura Tadao , Kuromoto Narihito , Kawai Satoshi
Published: November 2007

Seven different vascular clamps selected from among those in routine use in vascular surgery (Satinsky clamp, Satinsky rubber clamp, Fogarty clamp, Bull dog clamp, Bulldog rubber clamp, Potts clamp, and Potts rubber clamp) were applied to arteriosclerotic rabbit abdominal aortae to evaluate both grossly and histologically the relative degree of injury thus caused to the vessel wall at dif ferent levels of clamping pressure. Of the vascular clamps examined, the Satin sky clamp and the Fogarty clamp, followed by the Bulldog rubber clamp, proved to cause the least damage to the vessel wall. The Satinsky clamp and Fogarty clamp, in particular, appeared to be the most suitable for arterioscle rotic vessels. The Potts clamp, the Potts rubber clamp, and the Bulldog clamp, which were highly traumatic, should probably not be applied to peripheral or other small-sized blood vessels.
A New Method for the Treatment of False Femoral Aneurysms
Authors: Hines George L. , Mohtashemi M.
Published: November 2007

A new technique for repairing anastomotic femoral aneurysms is de scribed.The procedure consists of initial exposure and control of the graft limb through a suprainguinal incision, and control of the common femoral artery and its branches by insertion of Fogarty catheters into the individual lumens. This technique has been used successfully in 3 patients.
Reconstructive Surgery for Combined Aortofemoral and Infrafemoral Occlusion
Authors: Nakata Yukifumi
Published: November 2007

In reconstructive surgery for combined aortoiliac and infrafemoral occlu sion, there are many reports that only proximal repair with profunda plasty has resulted in a symptomatic improvement.1-5 However, the 5-year patency and the limb salvage rate were low, and some surgeons have reported that many patients had remained without symptomatic improvement. 6-11

This study was made to assess the indication for subsequent repair in peripheral combined lesions and report the prognosis in the reconstructive surgery for tandem lesions.
The Surgical Anatomy of the Coronary and the Inferior Mesenteric Veins by the Injection-Corrosion Method
Authors: Papadopoulos Nicholas J.
Published: November 2007

The surgical anatomy of the coronary and the inferior mesenteric veins has been studied in situ and after injection-corrosion casts in 50 embalmed human cadavers, in view of the recent use of these veins occasionally as alternative methods of portal-systemic shunts. Parameters studied and not included in the conventional description of these veins are discussed from the surgical point of view and patterns for their variational anatomy are proposed.
Fibromuscular Dysplasia of the Renal Artery: a Case Report
Authors: Pessina Achille Cesare , Pagnan Antonio , Visona Adriana , Feltrin Giampietro , Thiene Gaetano , Pauletto Pauolo , Dal Palu Cesare
Published: November 2007

We describe the case of a woman who developed in only 1 year focal fi bromuscular dysplasia stenosing the lu men of the renal artery by 70%. The clinical implications of such findings are discussed.
New Method of Determining the Success of Carotid Endarterectomy in Alleviating Symptoms Referable to the Vertebral System
Authors: Bush Ronald G. , Coyle Frank L.
Published: November 2007

Alleviating vertebrobasilar insufficiency with carotid endarterectomy alone has ranged from a success rate of only 56% to a success rate of over 90%. Successful therapy depends on an intact circle of Willis, absence of stenotic lesions in the small vessels of the posterior and anterior system, and the occurrence of posterior symptoms as a result of hypoperfusion of the vertebral artery. Barring variables, an increase in perfusion through the internal carotid artery should result in an increase in perfusion of the vertebral system. If this occurs, we should expect symptomatic relief of posterior symptoms secondary to an increase in blood flow. We believe measurements of back pressures in the vertebral artery before and after endarterectomy may identify those patients needing a combined approach.
The Side-to-Side Femoral Anastomosis for Combined Segment Disease
Authors: Poole Galen V. , Goco Ismael , Meredith J. Wayne , Hightower Felda
Published: November 2007

Combined aortoiliac and femoropopliteal occlusive arterial disease is the most common pattern of atherosclerosis in patients requiring inflow proce dures for ischemic symptoms in the lower extremities. Although most of these patients will be improved by aortobifemoral bypass grafting, subsequent femoropopliteal or distal bypass is often required to save the limb or to relieve rest pain or claudication. Numerous preoperative, noninvasive criteria and derived indices have been used to predict the success of inflow procedures in combined segment disease. Some are partially successful, but none have proved to be adequately sensitive or specific.

Because of the inability to foretell which patients with aortoiliac and femoropopliteal occlusive disease will need a "downstream" repair following an inflow procedure, and because of the difficulty and occasional hazards of secondary groin dissection for arterial operations, one of us (IG) has developed a technique of aortofemoral reconstruction that greatly facilitates subsequent femoropopliteal bypass in patients with combined segment disease.
The Role of Fasciotomy for Limb Salvage in Phlegmasia Cerulea Dolens
Authors: Ferstenberg Henry , Lozman Harvey
Published: November 2007

Phlegmasia cerulea dolens, a complication of ileofemoral thrombosis, fre quently results in venous gangrene and limb loss.1,2,3 The ischemia associated with phlegmasia cerulea dolens is secondary to venous occlusion, increased pressure in muscle compartments and diminished capillary perfusion. 1,2,3 Fas ciotomy should theoretically be a logical adjunct to therapy when anticoagula tion or venous thrombectomy is contraindicated or ineffective. Benefits attri buted to compartment decompression have been reported.2,4 Nevertheless, publicized failures of fasciotomy to reverse the ischemia of phlegmasia cerulea dolens have discouraged its use.5,1
Accelerated Atherosclerosis in a Tortuous Iliac Artery Following Femorofemoral Bypass
Authors: Scher Larry A. , Samson Russell H. , Goldstein Robert D. , Gupta Sushil K. , Veith Frank J.
Published: November 2007

Unilateral iliac artery occlusive disease can be successfully treated with femorofemoral bypass. Although the results of this extraanatomic reconstruc tion have generally been excellent, a case is presented in which tortuosity of the donor iliac artery may have produced hemodynamic factors which caused accelerated atherosclerosis. Implications of this finding in selecting patients for femorofemoral bypass are discussed.
The Inferior Mesenteric Vein as a Conduit for Variceal Decompression: A Preliminary Report
Authors: Sarfeh I. James , Mason G. Robert
Published: November 2007

The inferior mesenteric vein — to — renal vein anastomosis with partial gastric devascularization was evaluated in ten cirrhotics. Rebleeding rates were unacceptably high, but when the appropriate indications are used, the operations may be an alternative in a limited number of patients.
Thrombosis of the Internal Carotid Artery Due to Blunt Trauma
Authors: Wittenstein George J.
Published: November 2007

Thrombosis of the internal carotid artery (ICA) due to blunt trauma is more common than generally appreciated. Mortality is high (about 50%) and so is the morbidity in those that survive. Because of the varied clinical picture and the frequent lucid interval, a definitive diagnosis is often made too late for curative intervention. Our experience with a successfully treated case provided the stimulus for a review of the subject.
Streptokinase Therapy in Arterial Thromboembolic Disease
Authors: Lally Michael E. , Marrangoni Albert G. , Pellegrini Ronald V.
Published: November 2007

A review of the world literature on streptokinase treatment of arterial thromboembolic disease is presented, followed by two cases of peripheral arterial thromboembolic disease successfully treated with streptokinase. The role of streptokinase in the treatment of arterial occlusive disease is discussed, and its emerging role as a primary mode of therapy in thromboembolic arterial disease is predicted.

The successful management of venous embolic and occlusive disease by treatment with streptokinase is well-known, including its use in treating pul monary emboli, deep venous thromboses and clotted hemodialysis shunts. However, the role of streptokinase in the management of arterial thromboem bolic disease has not received much attention in the United States, although it has been used extensively in Europe.

The purpose of this paper is to review the literature on the use of strep tokinase in treating thromboembolic arterial disease, to present two cases successfully treated with this technique, and to discuss the emerging role of streptokinase in arterial thromboembolic disease.
Limb Salvage in Octagenarians— A 4 Year Review
Authors: Hines George L.
Published: November 2007

The records of 12 consecutive patients over 80 years of age who were operated on for limb threatening lower extremity ischemic vascular disease were reviewed. Mean age was 82.7 years. All patients underwent abdominal peripheral angiography. Fourteen operative procedures were performed in the 12 patients. Ten patients required 1 operation and 2 patients required 2 opera tions. An attempt was made to perform the least major operative procedure possible because of the age and poor medical condition of the patient popula tion. Procedures included femoral-femoral bypass-5, aorto-femoral bypass-2, axillary-femoral bypass-1, femoral-tibial bypass-2, and femoral-distal popliteal bypass-2. Secondary procedures included axillary-femoral bypass in 1 patient and a femoral-popliteal bypass in 1 patient. There was 1 post-operative mortal ity and 1 major post-operative amputation. Six patients are alive from 3 months to 4 years post-op. Although several digital amputations have been performed, there have been no major amputations. None of the 4 late deaths have been due to the complications of ischemic lower extremity vascular disease.
Dextran in Vascular Surgery
Authors: Bergentz Sven-Erik , Bergqvist David
Published: November 2007

Dextran is a colloid, composed of chain of glucose molecules. These chains are formed by an enzymatic action of the bacteria leuconostoc mesenteroides on sucrose.1 The molecular weight of these molecules can be several millions, but to be used clinically it should not exceed 100.000. A decrease in the molecular weight can be accomplished by fractionation of the molecules. On the other hand the molecular weight should not be lower than about 40.000, in order to remain in the circulation for a reasonable length of time. Rheomacrodex®, or Dextran 40 has the lowest molecular weight of all dextran fractions used clinically.

In this review will be summarized the different indications of the use of dextran, and particularly Dextran 40, in vascular surgery, the rationale behind its use will be dis cussed, and the literature on this subject will be reviewed.
Revascularization of the Lower Extremity: A Non-invasive Hemodynamic Comparison of Aorto-Femoral and Femoral-Femoral Bypass
Authors: Hines George L. , Rivera George
Published: November 2007

Nine patients who underwent bilateral aorto-femoral bypass and seven patients who underwent femoral-femoral bypass were evaluated to determine the increase in ankle/ arm index (a/a index) in symptomatic extremities. All patients underwent pre- and postoperative noninvasive evaluation. There were 13 symptomatic extremities in the 9 patients undergoing aorto-femoral bypass. The mean pre-operative a/a index in the aorto-femoral group was 0.50±0.15. The mean post-operative value was 0.75±0.16 (p<0.0001). The mean pre-operative value in the femoral-femoral group was 0.39±0.30 and the mean post-operative value 0.74±0.24 (p<0.02). The increase in the postoperative a/a index was the same with femoral-femoral bypass as with aorto-femoral bypass. A decision as to whether aorto-femoral or femoral-femoral bypass should be performed should be determined by considerations other than the expected immediate hemodynamic effect.

Extra-anatomic bypass has become an alternative to standard aorto-femoral bypass for lower extremity revascularization in selected patients. 1,2 There have been numerous reports which have demonstrated the clinical effectiveness of both of these procedures in relieving ischemia.3 The hemodynamic effects of aorto-femoral bypass have been extensively studied non-invasively by comparing pre- and post-operative values of the ankle/arm index (a/a index).4 We have retrospectively studied the results of both aorto-femoral and femoral-femoral bypass to determine the relative effect of each in increasing the a/a index and to determine whether aorto-femoral bypass raises the a/a index more than does the femoral-femoral bypass.
Preoperative Evaluation of Saphenous Vein Suitability as an Arterial Graft
Authors: Egan T.J. , Nur A. , Anderson M.C. , Corcoran M. , O'Driscoll J.
Published: November 2007

Thirty patients undergoing reconstructive surgery for occlusive arterial dis ease were studied pre-operatively by saphenous venography to determine the suitability, or otherwise, of the long saphenous vein as an arterial graft. Venog raphy gave a representation of vein calibre which accurately predicted the actual vein diameter, measured at operation. In 44 paired readings — i.e. diameters measured at comparable levels on vein and venogram — the mean venographic diameter was 4.46mm, and the mean diameter of the vein, measured at opera tion, was 4.43mm. There was no significant difference between the two means. In addition, venography identified occlusion of the saphenous vein and also demon strated unfavorable anatomic patterns.

In several cases venography was less than satisfactory, though still useful. There were no complications.

The authors believe that this technic, in their hands, has been valuable in identifying, pre-operatively, veins suitable for use as arterial grafts.
Intracoronary Lysis
Authors: Rentrop K. Peter
Published: November 2007

Intracoronary infusion of streptokinase is associated with acute recanaliza tion rates of 60 to 90%. Mortality data in the published trials have been conflict ing. In an analysis of ejection fraction changes in 125 registry patients who had contrast angiography prior to streptokinase infusion and a repeat study prior to hospital discharge, improvement of ejection fraction was found to correlate with incomplete coronary obstruction prior to angiography, the presence of col laterals to the infarct area and recanalization of complete obstruction. In assess ing the risk/benefit ratio of intracoronary streptokinase infusion, the risks of acute angiography, reperfusion arrhythmias in patients with severe depression of left ventricular function, reocclusion, bleeding and secondary interventions such as angioplasty or bypass surgery have to be considered.
The Redo-Surgery of Expanded Polytetrafluoroethylene (PTFE) Arteriovenous Fistulas for Hemodialysis
Authors: Rendl Karl-Hans , Prenner Konrad V.
Published: November 2007

The Brescia-Cimino fistula, 1 which is considered the best modality of vascu lar access for chronic hemodialysis available up to now, is not always feasible unfortunately principally for anatomical reasons. A second-choice technique must therefore be selected in 3% to 25%.2,3,4 We have applied the E-PTFE pro stheses (expanded polytetrafluoroethylene) which were recommended at an early stage for chronic vascular accesss 5,6 after saphenous loops and bovine grafts have tended to provide disappointing results after initial enthusiasm.7,8,9,10 How ever, this specially prepared teflon prosthesis which has simple technical proc essing and into which with limitations a needle can be introduced at an early point in time is also an operation-specific problem which will be discussed in the present paper.
Patency of Arteriovenous Anastomosis in the Kidneys of Dogs
Authors: Lopez-Majano V. , Delatorre J. , Dulay C. , Rodriguez J.
Published: November 2007

The patency of arteriovenous anastomosis (AVA) in the renal microcircula tion has been a controversial topic.

To study the possibility of AVA as part of the renal microcirculation a cathe ter was placed under radiological control in a renal artery in each of eight anesthetized dogs.

Albumin microspheres 15-52 micra in diameter labeled with 3-5 mCi of Tc99m were injected into the renal artery through this catheter.

Counts over the lungs, kidneys and bladder were obtained with detectors. The spatial distribution of the radioactivity in the dogs were also studied by scintigraphy and there was imaging of the kidneys which corroborates the find ings obtained with detectors, there was no visualization of the lungs. In some studies the bladder was visualized because of the presence of free Tc99m.

The lack of radioactivity in the lungs indicates that there are not patent AVA in canine kidneys because the radioactive microspheres injected in the renal artery became lodged in the arterioles, for being larger than the capillaries they could not cross to the renal veins.
Evaluation of Some Prognostic Indicators in Venous Grafting to Below-The-Knee Arteries
Authors: Cavallaro Antonino , Sciacca Vincenzo , Sterpetti Antonio , Stipa Sergio
Published: November 2007

45 femoro-popliteal and 30 femoro-tibial by-passes performed by means of autologous reversed saphenous vein were reviewed in order to evaluate the pro gnostic significance (one-year patency) of preoperative ankle pressure index and of angiographic findings.

The intraoperative (pre-reconstruction) arteriography appeared as a very useful tool necessary to achieve, in most cases, definite informations about the outflow of the planned reconstruction.

The direct connection with pedal arteries (in femoro-popliteal procedures) and the unrestricted outflow through a pedal arch (in femoro-tibial procedures) were, in the Authors' experience, the best indicators, fully reliable, of a fa vourable prognosis.
Oscillating Ring Stripping for Thromboendarterectomy An Experimental Study
Authors: Ericsäter Jan , Grant Crawford , Strömberg Lennart , Swedenborg Jesper
Published: November 2007

The superficial femoral arteries of recently deceased patients with severe peripheral arteriosclerosis were thrombendarterectomized. Two different methods were compared, a closed with an oscillating ring stripper (Amsco Hall Arterial Oscillator) and an open, the traditional, originating from dos Santos. Care was taken to avoid postmortem changes of significance for the study. The efficacy of the former method was evaluated in relation to the traditional open endarterectomy. The two methods seem to give the same result in terms of dis section planes and reopened collateral orifices. The authors consider that the oscillating ring stripper method has obvious advantage over the open method and seems to be a good alternative to synthetic by-pass when the saphenous vein is unaviable.
Noninvasive Evaluation for the Therapeutic Effect Using Thallium-201 in the Ischemic Foot
Authors: Ohta Takashi , Matsubara Junichi , Shionoya Shigehiko
Published: November 2007

Arterial insufficiency of the foot was examined by radioisotope study with intravenous administration of thallium-201. We observed the immediate distri bution during postocclusive reactive hyperemia and the redistribution in the foot after a 3 hours interval. Seventy-seven feet were examined: 18 normal feet, 24 feet with claudication, 31 feet with rest pain or ischemic ulcers, 4 feet with diabetic ulcers. The distribution index (D.I.), which defined the ratio of uptake counts of the immediate distribution to those of the redistribution, was of use to evaluate quantitively the degree of ischemia. Using these parameters to assess the therapeutic effects, 23 feet with ischemic ulcers were examined before and after treatment.: 5 feet with arterial reconstruction, 4 feet with lumbar sympa thectomy, 14 feet undergoing medical treatment. The effect index (E.I.) was defined as the ratio of the D.I. after treatment to before treatment. When the E.I. value was more than 1.0, 18 of 20 ischemic ulcers were improved and two were unchanged whereas all four ulcers with the E.I. value less than 1.0 became worse. The D.I. is a reliable indicator to estimate the degree of ischemia and the E.I. is of use to predict therapeutic effect particularly following lumbar sympa thectomy or medical treatment, which are frequently difficult to be evaluated by other noninvasive diagnostic methods.
Does Short-Term Pre-Operative Aspirin in Coronary Bypass Patients Increase Post-Operative Bleeding?
Authors: Fuller James K. , Copeland Jack G.
Published: November 2007

A prospective physician blinded study was undertaken to evaluate post-oper ative bleeding in coronary artery bypass patients treated with aspirin pre-oper atively. Thirty patients were randomized: nine received no aspirin, eleven received 325 mg twelve hours pre-operatively, and ten received 650 mg aspirin every six hours beginning 48 hours pre-operatively and ending six hours prior to operation. There were no differences among the groups in patient age, grafts per patient, pre and post-operative hematocrit, platelet counts, aortic cross- clamp times, perfusion times, heparin dose, protamine dose, or units of blood transfused. Twenty-four hour chest tube drainage was 704 ± 235 cc in the un treated group (I), 874 ± 459 cc in the low dose aspirin group (II) and 1218 cc ± 892 cc in the high dose aspirin group (III). A t-test comparison of groups was conducted as follows: I vs. II (p = 0.7), II vs. III (p = .05), I vs. III (p = .001). Groups II and III required more units of platelets than Group I (4 units vs. 1 unit per patient) and more fresh frozen plasma (2 units vs. 0.2 units per pa tient). Low dose aspirin did not significantly increase bleedng above controls, but it was associated with an increased requirement for component therapy. High dose aspirin did significantly increase post-operative blood loss and also caused an increased requirement for platelets and fresh frozen plasma. The amount of post-operative bleeding appears to be dose related. Low dose pre- operative therapy may be used without excessive bleeding.
Technical Aspects of Carotid Artery Surgery
Authors: Barnes Robert W.
Published: November 2007

This article reviews the step-by-step description of the author's operative technique in performing a carotid endarterectomy. Technical precision remains the most important factor in reducing the risk of perioperative stroke. An in dwelling shunt is used selectively based upon the internal carotid back pressure or intraoperative monitoring of the electroencephalogram. Intraoperative use of a sterile Doppler probe permits comfirmation of flow abnormalities detected in noninvasive examinations preoperatively, documents flow in an indwelling shunt, and assures patency of the carotid artery and its branches after endar terectomy. Postoperatively noninvasive diagnostic techniques permit assessment of carotid integrity in patients suffering neurologic deficits, and serial studies provide objective evidence of the incidence of recurrent stenosis or disease pro gression. Using these diagnostic and therapeutic principles the author reviews the results of his series of patients in a residency training program.