bluuebunny/crossref_metadata_2025 huggingface dataset:
Indications and Results with Cryoplasty in the Treatment of Infrainguinal Arterial Occlusive Disease
Authors: Lyden Sean P.
Published: August 2007

Percutaneous transluminal angioplasty of the superficial femoral and popliteal arteries has been an accepted therapy for short focal stenosis. Elastic recoil and flow-limiting dissection have limited the durability of angioplasty, especially in long lesions and total occlusions. Cryoplasty couples cold therapy with angioplasty to induce mechanical and biologic effects to reduce elastic recoil and potentially to reduce restenosis. The mechanical and biologic mechanisms of this therapy are discussed. The results of cryoplasty for femoropopliteal lesions from a single-center series and a multicenter registry are reviewed. Cryoplasty appears to improve patency over conventional angioplasty and to reduce the need for bailout stenting in femoropopliteal stenoses and occlusions < 10 cm in length. Cryoplasty appears to be promising to treat critical limb ischemia in patients with tibial disease.
Aneurysm Sac Pressure Measurement with a Pressure Sensor in Endovascular Aortic Aneurysm Repair
Authors: Carnero Lisandro , Milner Ross
Published: August 2007

Aortic endograft surveillance is a necessity for the lifetime of a patient owing to the risk of endoleaks and device complications. The current standard of care for surveillance is radiologic imaging. The most commonly used modality is computed tomographic angiography. Magnetic resonance angiography and ultrasonography have also been used as surveillance tools. These imaging techniques have risks and limitations, and alternative surveillance tools are being investigated. Remote pressure sensing is a promising technology that can provide adjunctive support to the current imaging modalities. The technology is applicable to both abdominal and thoracic endograft implantation and surveillance. It has recently gained clearance from the US Food and Drug Administration for acute aneurysm exclusion during an abdominal endograft insertion. As more data are accumulated, it may be possible for remote pressure sensing to replace current imaging techniques as the sole modality for endograft surveillance.
Endovascular Treatment Of Popliteal Artery Aneurysms
Authors: Nelson Peter R. , Anthony Lee W.
Published: August 2007

Popliteal artery aneurysms are relatively uncommon but potentially limb-threatening lesions that can thrombose or cause distal embolization. Identification of these aneurysms, especially in patients with abdominal aortic aneurysms, is imperative, and prophylactic treatment with either surgical exclusion and bypass or endoluminal stent grafting is critical to prevent these poor outcomes. Endovascular approaches currently using the Viabahn stent graft offer several advantages, including a minimally invasive approach, fewer perioperative complications, and a faster recovery. This must be balanced with a potentially higher failure rate or requirement for reintervention, although contemporary series report comparable short-term outcomes. We present our approach to the evaluation and diagnosis of popliteal aneurysms, the technical aspects of endovascular popliteal aneurysm repair, and a representative case study.
Transcervical Carotid Stenting with Flow Reversal for Neuroprotection: Technique, Results, Advantages, and Limitations
Authors: Pipinos Iraklis I. , Bruzoni Matias , Johanning Jason M. , Matthew Longo G. , Lynch Thomas G.
Published: August 2007

Carotid angioplasty and stenting are progressively earning a role as a less invasive alternative in the treatment of carotid occlusive disease. The most common approach for carotid artery stenting involves transfemoral access and use of a filter or balloon device for neuroprotection. This approach has limitations related to both the site of access and the method of neuroprotection. Specifically, an aortoiliac segment with advanced occlusive or aneurysmal disease or an anatomically unfavorable or atheromatous arch and arch branches can significantly limit the safety of the retrograde transfemoral pathway to the carotid bifurcation. Additionally, data provided by the use of transcranial Doppler monitoring and diffusion-weighted magnetic resonance imaging in patients undergoing filter- or balloon-protected carotid artery stenting demonstrate that currently available devices are associated with a considerable incidence of cerebral embolization. To address these limitations, we, along with others, have employed a direct transcervical approach for carotid artery stenting that incorporates the principle of flow reversal for neuroprotection. The technique bypasses all of the anatomic limitations of transfemoral access and simplifies the application of flow reversal, which is one of the safest neuroprotection techniques. The purpose of this review is to describe our method of transcervical carotid artery stenting, review the accumulating outcomes data, and discuss the clinical advantages of and indications for this increasingly popular technique.
Percutaneous Thoracic and Abdominal Aortic Aneurysm Repair: Techniques and Outcomes
Authors: Hogg Melissa E. , Kibbe Melina R.
Published: August 2007

Endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) has become a widely accepted treatment modality. The conventional approach of an EVAR involves bilateral groin incisions to expose the femoral arteries followed by introducer sheath placement, which is typically performed with the use of general or epidural anesthesia. As technology trends toward less invasive methods and sheath sizes become smaller, the use of a total percutaneous approach to endovascular repair of aortic pathology is becoming more common. In this review, we present a brief history of percutaneous closure devices for common femoral artery access, factors important in patient selection, the technique of performing a percutaneous EVAR procedure, early and late complications, and overall outcomes of percutaneous approaches for the endovascular treatment of aortic pathology.
Infrainguinal Arterial Intervention: Is There a Role for an Atherectomy Device?
Authors: Mureebe Leila , McKinsey James F.
Published: August 2007

Excision of atheromatous plaque is an attractive option for the minimally invasive treatment of peripheral arterial disease. Approved for use in 2003, the SilverHawk Plaque Exicison System (FoxHollow Technologies, Redwood City, CA) is a catheter-based plaque excision device allowing percutaneous removal of atheromatous material. This device represents the most recent generation of atherectomy tools. Overall experience with plaque debulking in the peripheral arteries spans almost two decades, and understanding of the technique continues to evolve. This article reviews the technology, current practices, and data on plaque excision.
Hypoxia-Inducible Factor 1 in Lower Limb Ischemia
Authors: Ho Teik K. , Abraham David J. , Black Carol M. , Baker Daryll M.
Published: August 2007

In the Western world, peripheral vascular disease (PVD) has a high prevalence and is associated with high morbidity and mortality. More patients are presenting with critical limb ischemia (CLI), the end stage of PVD, because of an increased life expectancy owing to improved medical care. In a large percentage of these patients, lower limb amputation is still required, despite current advances in surgery and interventional radiology. Studies of ischemic skeletal muscles disclosed evidence of endogenous angiogenesis and adaptive skeletal muscle metabolic changes in response to hypoxia. Many of the genes responsible for these responses are regulated by hypoxia-inducible factor (HIF)-1. HIF-1, consisting of HIF-1α and HIF-1β subunits, is a major transcription factor that functions as a master regulator of oxygen homeostasis that plays essential roles in cellular and systemic pathophysiology. HIF-1α expression and HIF-1 transcriptional activity increase exponentially as cellular oxygen concentration is decreased. More than 60 target genes that are transactivated by HIF-1 have been identified. Many of the target genes, such as vascular endothelial growth factor, have been studied extensively, especially in tumors. However, only recently that interest in HIF-1 is growing in relation to ischemic diseases. Most of the studies concentrated mainly on the angiogenic property of HIF-1. In contrast, there is a lack of information on the role of HIF-1 in skeletal muscle metabolic adaptive changes as the end-organ in PVD. This review aims to summarize our current understanding of HIF-1 roles and the therapeutic potential in PVD.
Hyperbaric Oxygen and Bone Marrow–Derived Endothelial Progenitor Cells in Diabetic Wound Healing
Authors: Gallagher Katherine A. , Goldstein Lee J. , Thom Stephen R. , Velazquez Omaida C.
Published: August 2007

Endothelial progenitor cells (EPCs) are the key cellular effectors of postnatal vasculogenesis and play a central role in wound healing. In diabetes, there is a significant impairment in the number and function of circulating and wound-tissue EPC. Recent evidence indicates, that tissue-level hyperoxia achieved by therapeutic hyperbaric oxygen protocols (HBO2) can increase the mobilization of EPC from the bone marrow into peripheral blood. In this paper we review the recent reports on hyperoxia-mediated mobilization of bone marrow-derived EPC and postulate avenues of future research in this area as it applies to improving healing in chronic wounds affected by diabetes and peripheral arterial disease (PAD).
Emerging Vascular Applications of Magnetic Resonance Imaging: A Picture is Worth More than a Thousand Words
Authors: Fitzgerald Tamara N. , Muto Akihito , Kudo Fabio Akimaro , Pimiento Jose Mario , Constable Robert Todd , Dardik Alan
Published: August 2007

Vascular applications of magnetic resonance (MR) imaging are reviewed, with emphasis on algorithms that use nonpictorial information contained in the MR data set. Current clinical vascular practice generally limits use of MR angiography and three-dimensional vessel images to qualitative pictorial rendering without routinely using the available quantitative information contained within the MR data. This review is dedicated to recent advances that include characterization of vessel histology, assessment of carotid plaque vulnerability, characterization of blood flow dynamics, quantitative analysis of disease severity, and prediction of vascular intervention outcome. Examples from histologic preparation, in vitro and in vivo experiments, are discussed, with an emphasis on potential clinical applications and advances in acquisition technology.
Nontraumatic Aneurysms Affecting Crural Arteries: Case Report and Review of the Literature
Authors: Leon Luis R. , Benn Psalms Shemuel , Stevenson Shawn , Mills Joseph L.
Published: August 2007

Aneurysms involving the infrapopliteal arteries are rare, with most cases being attributed to a previous traumatic event. Mycotic aneurysms in this location are even more uncommon. Owing to their infrequency, these aneurysms represent a difficult diagnostic challenge. We present a case of a symptomatic anterior tibial artery aneurysm in a 59-year-old male with a medical history significant only for an episode of bacterial endocarditis, subsequently requiring an aortic valve replacement. Surgical repair was performed with a popliteal to anterior tibial bypass with a reversed saphenous vein graft. The patient's recovery was uneventful. We also reviewed the literature on this type of aneurysm to assess the incidence, etiology, options for treatment, and outcomes.
Deep Leg Vein Reconstruction for an Isolated Mycotic Common Iliac Artery Aneurysm in an HIV-Positive Patient
Authors: Brant-Zawadzki Peter , Kinikini Daniel , Kraiss Larry W.
Published: August 2007

Isolated mycotic common iliac artery aneurysms are rare, and as such, there is no consensus opinion on management. Traditional surgical options include resection with extra-anatomic bypass, placement of allograft or antibiotic treated synthetic graft, or autogenous vein reconstruction. We report the case of a 46-year-old, human immunodeficiency virus-positive male who presented with a recurrent pneumonia and new onset of right lower quadrant abdominal pain associated with right lower extremity swelling. computed tomographic scan revealed an isolated 9.5 cm right common iliac artery aneurysm with no evidence of rupture. Preoperative blood cultures grew out Streptococcus pneumoniae. Operative repair included aneurysm resection and reconstruction using an autogenous femoropopliteal vein interposition graft from the ipsilateral thigh. The patient had an uneventful recovery with resolution of his lower extremity swelling and a normal duplex exam at follow-up. Large mycotic common iliac artery aneurysms can be successfully treated with aneurysm resection and reconstruction using an autogenous femoropopliteal vein conduit. This technique obviates the need for extra-anatomic bypass or other forms of reconstruction using prosthetic material.
Surgical and Endovascular Treatment of Symptomatic Aberrant Right Subclavian Artery (Arteria Lusoria)
Authors: Kopp Reinhard , Wizgall Ingrid , Kreuzer Eckart , Meimarakis Georgios , Weidenhagen Rolf , Kühnl Andreas , Conrad Claudius , Jauch Karl Walter , Lauterjung Lutz
Published: August 2007

Right aberrant subclavian artery, also called arteria lusoria, is one of the most common intrathoracic arterial anomalies. Although mostly asymptomatic, the retroesophageal and retrotracheal course of the lusorian artery might result in unspecific thoracic pain, dysphagia, dyspnea, arterioesophageal or arteriotracheal fistulae with hematemesis or hemoptysis, and aneurysmal formation with relevant risk of rupture. The purpose was to present our experience with six patients with a symptomatic aberrant right subclavian artery, two patients with dysphagia or dyspnea caused by a nonaneurysmal lusorian artery, and four patients with arteria lusoria aneurysms. The operative procedures performed are described and discussed in view of the data reported in the literature. According to the classification of the lusorian artery pathology, a combined intervention with right subclavian artery transposition, distal or proximal lusorian artery ligation or proximal endovascular occlusion for nonaneurysmal disease, or endovascular thoracic aortic stent graft implantation for lusorian artery aneurysms seems to be an additional and minimally invasive approach with promising midterm results.
Use of the Internal Mammary Vein for Access Outflow in a Hemodialysis Fistula
Authors: Jaffers Gregory J. , Reiter Charles , Buckley Clifford J.
Published: August 2007

A patient with occlusion of multiple central veins from both dialysis and nondialysis catheters required permanent access for hemodialysis. Magnetic resonance imaging showed a patent left innominate vein. He underwent creation of a left axillary artery to internal mammary vein transposition fistula using the basilic vein from his right arm. The fistula has required one revision for outflow stenosis and one for aneurysmal degeneration. It continues to function well 3 years after placement. The internal mammary vein is an option for outflow when permanent hemodialysis access has failed in the presence of a patent innominate vein with occluded or severely stenotic ipsilateral subclavian and jugular veins.
Visceral Artery Aneurysms: A Symptomatic Aneurysm of the Ileocolic Artery
Authors: Roche-Nagle Graham , O'Donnell David , O'Hanrahan Timothy
Published: August 2007

Visceral artery aneurysm is a rare but clinically important form of vascular pathology, showing a high mortality rate in emergency surgery. Most often these aneurysms cause no symptoms and are therefore incidental findings. Reports on ileocolic artery aneurysms are rare and often anecdotal. Therapeutic procedures can be performed either surgically or by interventional therapeutic techniques. This article presents a case of ruptured ileocolic artery aneurysm and reviews the literature on this topic.
Endovascular Repair of Late Abdominal Aortic Aneurysm Rupture Owing to Mixed-Type Endoleak Following Endovascular Abdominal Aortic Aneurysm Repair
Authors: Klonaris Chris , Georgopoulos Sotiris , Markatis Fotis , Katsargyris Athanasios , Tsigris Chris , Bastounis Elias
Published: August 2007

We report the successful endovascular repair of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 8 months after endovascular abdominal aortic aneurysm repair (EVAR). A 74-year-old man with a history of EVAR 8 months earlier presented with hypotension, severe back pain, and tenderness on abdominal palpation. A contrast-enhanced computed tomographic scan showed a large retroperitoneal hematoma and confirmed the diagnosis of secondary abdominal aortic rupture. Because the patient had severe comorbidities, the endovascular method was chosen for further management. Two stent grafts were placed appropriately to eliminate a type 1a and a type 3 endoleak owing to modular separation of the left iliac graft limb from the main body stent graft. An additional self-expanding stent was deployed in the solitary right renal artery to open its origin, which was partially overlapped by the proximal cuff. The patient was discharged on the tenth postoperative day and is alive and well 1 year postoperatively. This case indicates that endovascular repair is feasible not only in cases of primarily ruptured AAAs but also in secondarily ruptured AAAs after failure of EVAR.
Acute Device-Based Blood Pressure Reduction: Electrical Activation of the Carotid Baroreflex in Patients Undergoing Elective Carotid Surgery
Authors: Schmidli Jürg , Savolainen Hannu , Eckstein Friedrich , Irwin Eric , Peters Tim K. , Martin Roy , Kieval Robert , Cody Robert , Carrel Thierry
Published: August 2007

Carotid sinus baroreceptors are involved in controlling blood pressure (BP) by providing input to the cardiovascular regulatory centers of the medulla. The acute effect of temporarily placing an electrode on the carotid sinus wall to electrically activate the baroreflex was investigated. We studied 11 patients undergoing elective carotid surgery. Baseline BP was 146+30/66±17 mm Hg and heart rate (HR) 72±7 bpm (mean ± standard deviation). An electrode was placed upon the carotid sinus and after obtaining a steady state baseline of BP and HR, an electric current was applied and increased in 1-volt increments. A voltage dependent and highly significant reduction in BP was observed which averaged 18±26* and 8.0±12 mm Hg for systolic BP and diastolic BP, respectively. Maximal reductions occurred at 4.4±1.2 V: 23±24 mm Hg*, 16±10 mm Hg* and 7±12 bpm* for systolic BP, diastolic BP and HR, respectively (= p <.05). Thus, electrical stimulation of the carotid sinus activates the carotid baroreflex resulting in a reduction in BP and HR. This presents a proof of concept for device based baroreflex modulation in acute BP regulation and adds to the available data which provide a rationale for evaluating this system in the context of chronic BP reduction in hypertensive patients.
Multiple Giant Anastomotic Pseudoaneurysms of the Carotid and Femoral Arteries: Combined Endovascular and Open Surgical Approach
Authors: Guerrero Marlon A. , Zhou Wei , Kougias Panagiotis , El Sayed Hosam , Lin Peter H.
Published: August 2007

Anastomotic pseudoaneurysm is a known complication following carotid artery endarterectomy and aortobifemoral bypass surgeries. However, giant concurrent carotid and femoral artery anastomotic pseudoaneurysms are rare. We herein report a case of successful treatment of multiple giant anastomotic pseudoaneurysms using a combined endovascular and surgical approach. Our case highlights the fact that endovascular techniques can facilitate open surgical repair of complex anastomotic pseudoaneurysms.
Carotid Duplex Velocity Criteria Revisited for the Diagnosis of Carotid In-Stent Restenosis
Authors: AbuRahma Ali F. , Maxwell Damian , Eads Kris , Flaherty Sarah K. , Stutler Tabitha
Published: August 2007

Carotid percutaneous transluminal angioplasty/stenting has become an accepted treatment modality for carotid artery stenosis in high-risk patients. There has been an ongoing debate regarding which duplex ultrasound (DUS) criteria to use to determine the rate of in-stent restenosis. This prospective study revisits DUS criteria for determining the rate of in-stent restenosis. In analyzing a subset of 12 patients (pilot study) who had both completion carotid angiography and DUS within 30 days, 10 patients with normal post-stenting carotid angiography (< 30% residual stenosis) had peak systolic velocities (PSVs) of the stented internal carotid artery (ICA) of ≤ 155 cm/s and two patients with ≥ 30% residual stenosis had internal carotid artery (ICA) PSVs of > 155 cm/s. Eighty-three patients who underwent carotid stenting as part of clinical trials were analyzed. All patients underwent post-stenting carotid DUS that was done at 1 month and every 6 months thereafter. PSVs and end-diastolic velocities of the ICA and common carotid artery were recorded. Patients with PSVs of the ICA of > 140 cm/s underwent carotid computed tomographic (CT) angiography. The perioperative stroke rate was 1.2%. When the old DUS velocity criteria for nonstented carotid arteries were applied, 54% of patients had ≥ 30% restenosis (PSV of > 120 cm/s), but when our new proposed DUS velocity criteria for stented arteries were applied (PSV of > 155 cm/s), 33% had ≥ 30% restenosis at a mean follow-up of 18 months ( p = .007). The mean PSVs for patients with normal stented carotid arteries based on CT angiography, were 122 cm/s versus 243 cm/s for ≥ 30% restenosis and 113 cm/s versus 230 cm/s for ≥ 30% restenosis based on our new criteria. The mean PSVs of in-stent restenosis of 30 to < 50%, 50 to < 70%, and 70 to 99%, based on CT angiography, were 205 cm/s, 264 cm/s, and 435 cm/s, respectively. Receiver operating curve analysis demonstrated that an ICA PSV of > 155 cm/s was optimal for detecting ≥ 30% in-stent restenosis, with a sensitivity of 100%, a specificity of 90%, a positive predictive value of 74%, and a negative predictive value of 100%. The currently used carotid DUS velocity criteria overestimated the incidence of in-stent restenosis. We propose new velocity criteria for the ICA PSV of > 155 cm/s to define ≥ 30% in-stent restenosis.
Prevalence of Hyperhomocysteinemia in Vascular Disease: Comparative Study of Thrombotic Venous Disease Vis-è-Vis Occlusive Arterial Disease
Authors: Bhargava Seema , Parakh Rajiv , Manocha Anjali , Ali Arif , Srivastava Lalit Mohan
Published: August 2007

Studies on hyperhomocysteinemia in vascular occlusive disease have included mostly patients with arterial occlusion. However, more recent studies have included cases of venous occlusive disease as well. Our present study is aimed at comparing the prevalence of hyperhomocysteinemia in venous occlusive disease vis-è-vis arterial occlusive disease in the North Indian urban population. Homocysteine was estimated by chemiluminescent immunoassay in 205 normal controls and 536 patients, 244 presenting with arterial occlusion and 292 with venous thrombotic disease. The mean homocysteine in patients with arterial occlusion was 21.79 ± 0.09 μmol/L (mean ± standard error of measurement), in patients with venous thrombosis was 25.53 ± 0.1 μmol/L, and in controls was 11.33 ± 0.18 μmol/L. The prevalence of hyperhomocysteinemia (> 15 μmol/L) was 56.38% in arterial occlusive disease and 54.64% in venous thrombosis. In patients with peripheral vascular occlusive disease, patients with deep venous thrombosis (DVT) had the highest mean homocysteine level (25.51 μmol/L), which was even higher (32.14 μmol/L) when associated with pulmonary embolism (PE). There is a high prevalence of hyperhomocysteinemia in arterial and venous occlusive disease. Hence, in all patients with vascular occlusive disease, hyperhomocysteinemia should be elucidated and treated. In addition, long-term follow-up is required to ascertain whether the reduction in homocysteine decreases the thrombotic events and whether homocysteine levels can actually be of prognostic or predictive value in cases of DVT with PE.
Surgical and Endovascular Management of Arteriovenous Malformation: Case Series from a Single Center
Authors: Elsharawy Mohamed A. , Moghazy Khaled M.
Published: August 2007

Management of arteriovenous malformation (AVM) remains a major challenge to vascular surgeons. A multidisciplinary approach was introduced in our hospital to manage these cases from October 2003 to date. This is a report of our experience in their management. A prospective study was done on all patients with symptomatic AVM admitted to our unit between October 2003 and May 2006. All patients had preoperative duplex scanning and magnetic resonance imaging with or without conventional angiography. A multidisciplinary team assessed and treated these cases according to the type of malformation. Thirty-two cases were included in this study, with a mean follow-up of 18.3 months. Of these, 20 cases were predominantly venous and treated with surgical excision ( n = 14) or ethanol sclerotherapy ( n = 6). Twelve cases were predominantly arterial or arteriovenous shunting; 10 were treated with preoperative embolization followed by surgical excision and the remaining 2 with superselective embolization alone. The overall complication rate was high (31%). However, all were minor and settled down conservatively. No recurrence was observed in the early follow-up period. Management of AVM by a surgical and endovascular approach can deliver excellent results, with acceptable morbidity and no recurrence in the early follow-up period.
Laparoscopy-Assisted Hybrid Technique for Renal Revascularization Using an Endovascular Graft: Report of Three Cases
Authors: Bakoyiannis Chris N. , Cagiannos Catherine , Wasilljew Sergej , Pinter Laslo , Kolvenbach Ralf
Published: August 2007

Atherosclerotic renal artery stenosis (RAS) is relatively common and often associated with hypertension and progressive renal insufficiency. Technical improvements of interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization. Sometimes an endovascular procedure for (RAS) may fail. We report 3 cases successfully treated with laparoscopic assisted aortorenal bypass using an endovascular graft.
Outcome of Ilizarov Ankle Arthrodesis
Authors: Eylon Sharon , Porat Shlomo , Bor Noam , Leibner Efraim David
Published: August 2007

Background: Many operative techniques have been described for ankle arthrodesis, with varying fusion rates. In revisions, the fusion rate is lower than in primary arthrodesis. Recent reports have described good results after Ilizarov ankle arthrodesis. However, descriptions were qualitative, with none using an accepted score. We describe our experience with this technique and functional outcomes in our patients. Methods: Seventeen patients (average age 48 years) had primary or revision unilateral ankle arthrodesis using the Ilizarov technique at two centers. Diagnoses included post-traumatic arthritis and Charcot arthropathy. Three patients had talar osteonecrosis. Time in the frame averaged 15 weeks and in a cast 4 weeks. Followup averaged 6 years. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results: All ankles achieved solid fusion. The average AOFAS score was 65 out of 86 possible. Based on this, results were defined as excellent in three patients, good in eight, fair in four, and poor in two. Minor complications were common, all resolving with local treatment. No deep infection developed. One fusion malunited in 8 degrees of varus. Conclusions: The Ilizarov external fixator has numerous advantages applicable to ankle fusion, including: stable fixation, respect for soft tissues, and the possibility of postoperative alignment ‘fine-tuning’. Additionally, the ability to direct forces through or around skeletal elements allows varying of the load through the skeletal elements, allowing early weightbearing. The Ilizarov technique, with its high union rate, may be considered for any ankle arthrodesis but is especially useful in complex cases such as revisions, talar osteonecrosis, soft-tissue compromise, and infection. Early weightbearing is an added benefit.
Physical Properties, Durability, and Energy-Dissipation Function of Dual-Density Orthotic Materials Used in Insoles for Diabetic Patients
Authors: Brodsky James W. , Pollo Fabian E. , Cheleuitte Domingo , Baum Brian S.
Published: August 2007

Background: Patients with neuropathic conditions may develop plantar bony deformities through neuropathic collapse, frequently placing the skin and soft tissues at risk. Orthoses have been used to accommodate and distribute plantar pressures over a large surface area, thereby minimizing peak loading pressures in small regions and reducing the risk of ulceration. Methods: A previously described bony prominence model (Brodsky et al.) was used to test the pressure-absorbing and force-transmission properties of various orthotic material combinations used in our outpatient clinic. Six materials were tested in five combinations of materials for their compressive properties: [MS]: medium plastazote (M) + soft plastazote (S); [MN]: medium plastazote (M) + nickelplast (N); [NP] nickelplast (N) + Poron (P); [MO] medium plastazote (M) + Spenco (O); and [MC] medium plastazote (M) + P-cell (C). Materials were tested for 100,000 cycles using a materials-testing system (MTS) apparatus (MTS Systems Corporation, Cary, NC) and software. Stress-strain curves comparing the measured peak pressure to the elastic deformation, or the percentage of compression a material experiences with respect to its original thickness, were plotted for each orthotic combination. Results: For MS, MN, MO, and to a lesser extent, MC, a trend was noted for decreased elastic deformation with increased testing. Additionally, the peak pressures before and after testing for each 10,000 testing cycle for each of the orthotic combinations were plotted. For both MN and NP, no demonstrable difference was noted in the peak pressures in the pretesting and post-testing for the 100,000 cycles. The MO showed a trend for increased peak pressures after each testing cycle. Both the MC and MS peak pressures markedly increased with respect to pretesting value. Also, the MN, MO, and MS all showed an overall trend for increased load cell values with increasing cycles at fast loading. Conclusions: These data showed that some orthotic combinations are more effective than others at reducing peak pressures during compression testing using our bony prominence model. Further studies are needed to test the orthotic combinations for shear and combined shear and compression modes.
Spherical Ceramic Interpositional Arthroplasty for Basal Fourth and Fifth Metatarsal Arthritis
Authors: Shawen Scott B. , Anderson Robert B. , Cohen Bruce E. , Hammit Matthew D. , Davis W. Hodges
Published: August 2007

Background: Arthrosis of the fourth and fifth tarsometatarsal joints is difficult to treat. Arthrodesis is both difficult to achieve as well as disabling. Tendon interpositional arthroplasty has been performed with some success. A new technique using ceramic ball interpositional arthroplasty was evaluated. Methods: Between 2001 and 2003, 13 patients in whom nonoperative treatment had failed had resection arthroplasty of the base of the fourth or fifth metatarsals with ceramic ball interposition (Orthosphere, Wright Medical Technology, Arlington, Tennessee). Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analogue scale, a satisfaction index, physical examination, and radiographs. Results: At an average 34-months followup, 11 of the 13 patients were available for evaluation. The five men and six women had an average age of 48 years. Seven patients reported a traumatic etiology. Average postoperative AOFAS score was 53 points, an 87% improvement over preoperative values. Visual analogue scale pain improved 42%. All 11 patients were satisfied and would undergo the operation again. One of the patients demonstrated subsidence of the implant into the cuboid but continued to have improvement in symptoms. To date there have been no implant dislocations. Three of the 11 patients had differential injections before surgery. Conclusions: Lateral column tarsometatarsal interpositional arthroplasty is an effective salvage operation for lateral column midfoot arthrosis and should be considered in this patient population. The use of the ceramic ball allows a technically simple procedure and rapid recovery.
Evaluation of Periprosthetic Lucency After Total Ankle Arthroplasty: Helical CT Versus Conventional Radiography
Authors: Hanna Robin S. , Haddad Steven L. , Lazarus Martin L.
Published: August 2007

Background: Osteolysis after total ankle arthroplasty (TAA) has become a major concern regarding long-term implant survival. The primary goal of this study was to determine whether CT was more sensitive than plain films in detecting the presence and extent of periprosthetic lucency. A secondary goal was to determine whether lack of syndesmotic fusion was associated with more extensive lucency. Methods: Seventeen patients (19 ankles) who had TAA between 2001 and 2003 were consecutively recruited and evaluated as part of a prospective study. Plain radiographs and helical CT with metal-artifact minimization were obtained. Evidence of lucent lesions and syndesmotic fusion was compared using the different imaging techniques. Results: Of the 19 ankles imaged, a total of 29 lesions were detected by CT, whereas plain radiographs detected 18 lesions. CT detected 21 lesions less than 200mm 2 , of which plain radiographs detected only 11. The mean size of the lesions detected on CT was over three times larger than the size on plain radiographs. With the small sample size used, there were no statistically significant differences between ankles with and without fusion of the syndesmosis and the extent ( p = 0.84) and location ( p = 0.377) of lucency. Conclusion: CT is a more accurate method for early detection and quantification of periprosthetic lucency than plain radiographs. Accurate evaluation of lucent lesions may identify patients at high risk for lack of syndesmotic fusion with subsequent loosening and implant failure.
Recent advances in piezospectroscopy
Authors: Clarke David R. , Gardiner Derek J.
Published: August 2007

Strain produces small but systematic changes in the Raman and luminescence spectra of solids. Piezospectroscopy is a technique that exploits these changes for determining stresses, usually from shifts in a characteristic spectral line. In this review in honor of Wolfgang Pompe, recent advances in piezospectroscopy applied to the determination of stresses in alumina materials are described.
Characteristic Curves based on 3D Non-isothermal Flow Computations in Single-screw Extruder for Non-Newtonian Fluids
Authors: Khalifeh A. , Clermont J.-R.
Published: August 2007

This paper presents numerical applications of a finite-volume method to steady three-dimensional non-isothermal inertial flows in geometries related to a single-screw extruder, with the purpose to provide characteristic curves related to rheological parameters, geometrical and operating conditions. We consider incompressible fluids obeying Newtonian, non-Newtonian Carreau-Yasuda equations with different shear-thinning properties. The temperature dependence is described by a Williams-Landel-Ferry (WLF) equation. For discretizing the equations and unknowns, we use a staggered grid and solve the set of governing equations by a decoupled algorithm. The numerical results are presented in different gap conditions and allow us to state the rheological parameters, the screw parameters and the rotational velocity on the flow characteristics in a screw-barrel system.
Investigation on the Structure and Properties of Different PE Blown Films
Authors: Fatahi S. , Ajji A. , Lafleur P. G.
Published: August 2007

Molecular orientation and structure development during film blowing have a major effect on mechanical and physical properties of polyethylene films. In this work the structures and morphology of three different polyethylene blown films; linear low-density polyethylene (LLDPE), low-density polyethylene (LDPE), and high density polyethylene (HDPE) were studied. A series of blown films were produced at different process conditions. The orientation of lamellae and lamellar stacks and the morphology of the films were characterized by SEM, AFM and X-ray diffraction. SEM images of the film plane surface MT (Machine-Transverse) and cross section slices in TN (Transverse- Normal) and MN (Machine-Normal) planes were made and compared with AFM images. It was observed that the surface morphology reflects a continuation of the bulk morphology for the cases studied. Changes in the blown film process parameters, such as take up ratio (TUR), blow up ratio (BUR) and frost line height (FLH) have an effect on structural parameters, crystallinity and mechanical properties.
Preparation of Foam from PVC Plastisol
Authors: Nakajima N.
Published: August 2007

The results of physical measurements and microscopic observation are presented to elucidate material behaviour at each stage of the foam preparation from PVC plastisol for use as a part of the cushion flooring. The paper also describes how the problems were solved by overcoming contradicting requirements in the process.
Multiple trajectories of physical aggression among adolescent boys and girls
Authors: Martino Steven C. , Ellickson Phyllis L. , Klein David J. , McCaffrey Daniel , Edelen Maria Orlando
Published: August 2007

Latent growth mixture modeling was used to identify discrete patterns of physical aggression from Grades 7 to 11 among a sample of 1,877 youth. Four trajectory classes adequately explained the development of physical aggression in both boys and girls: Low/No Aggression; Persistent High Aggression; Desisting Aggression, characterized by decreasing risk throughout adolescence; and Adolescent Aggression, characterized by low early risk that increases until Grade 9, levels out, and then declines in late adolescence. Girls were less likely than boys were to be in any trajectory besides the Low/No Aggression trajectory. Parental supervision, deviant peer association, academic orientation, impulsivity, and emotional distress at Grade 7 were all strongly associated with trajectory class membership. These associations did not differ by gender. These findings strongly suggest that the processes involved in the development of physical aggression in adolescence operate similarly in boys and girls. Aggr. Behav. 34:61–75, 2008. ©2007 Wiley‐Liss, Inc.
ICF syndrome: High variability of the chromosomal phenotype and association with classical Hodgkin lymphoma
Authors: Schuetz C. , Barbi G. , Barth T.F.E. , Hoenig M. , Schulz A. , Möeller P. , Smeets D. , de Greef J.C. , van der Maarel S.M. , Vogel W. , Debatin K.‐M. , Friedrich W.
Published: August 2007

We report on two sibs with ICF syndrome (immunodeficiency, centromeric heterochromatin instability, and facial anomalies) diagnosed in the elder brother based on the typical chromosomal abnormalities present in 56% of metaphases from cultured lymphocytes. In a previous cytogenetic analysis this diagnosis had been missed due to low manifestation of the ICF chromosomal phenotype. Hypomethylation of classical satellites 2 and 3, and of α‐satellite DNA was shown in the lymphocytes of the younger sister. At 7 years of age the boy presented with hemiplegia due to tumerous invasion of the right brachial plexus. Histopathology revealed classical Hodgkin lymphoma, a neoplasia which might have been facilitated by the underlying genetic defect. © 2007 Wiley‐Liss, Inc.
Prevalence of encephalocele in Texas, 1999–2002
Authors: Wen Shu , Ethen Mary , Langlois Peter H. , Mitchell Laura E.
Published: August 2007

Encephaloceles are congenital malformations characterized by a sac‐like protrusion of the brain and/or its' covering membranes through an opening in the skull. The etiology of encephalocele is considered to be complex, and in most cases the causes of this condition remain elusive. The present study was undertaken to determine the prevalence of encephalocele among deliveries to Texas residents during 1999–2002, and to identify maternal and demographic factors associated with encephalocele. Data were examined from 125 infants and fetuses with encephalocele and no identified chromosome abnormality; identified in Texas and delivered in 1999–2002. During the same period there were 1,449,943 live births. The birth prevalence of encephalocele and both crude and adjusted prevalence ratios were estimated from these data. Compared with the offspring of White women, encephaloceles were significantly more common among the offspring of Hispanic women (adjusted prevalence ratio: 1.91, 95% confidence interval (CI) 1.34–2.70). In addition, compared to the offspring of women 25–29 years of age, encephaloceles were more common among the offspring of women 20–24 years of age (adjusted prevalence ratio: 1.52, 95% CI 1.01–2.27) and those less than 20 years of age (adjusted prevalence ratio: 1.55, 95% CI 0.98–2.45). These findings add to the existing literature on the descriptive epidemiology of encephalocele. © 2007 Wiley‐Liss, Inc.
Zellweger syndrome resulting from maternal isodisomy of chromosome 1
Authors: Turner Claire L.S. , Bunyan David J. , Thomas N. Simon , Mackay Deborah J.G. , Jones Huw P. , Waterham Hans R. , Wanders Ronald J.A. , Temple I. Karen
Published: August 2007

Zellweger syndrome (ZS) is an autosomal recessive peroxisomal disorder that results from mutations in one of the peroxisome biogenesis (PEX) genes. This is the first patient reported with uniparental disomy (UPD) resulting in ZS, in this case maternal isodisomy of chromosome 1 involving reduction to homoallelism of a frameshift mutation within PEX 10. Other reported cases of UPD1, and evidence for the imprinting of genes on chromosome 1, are reviewed. The molecular findings in this patient have important implications for molecular testing and genetic counseling in ZS. © 2007 Wiley‐Liss, Inc.
Hemineglect: take a look at the back space
Authors: Viaud‐Delmon Isabelle , Brugger Peter , Landis Theodor
Published: August 2007

Visual hemineglect, the failure to explore the half of space, real or imagined, contralateral to a cerebral lesion with respect to body or head, can be seen as an illustration of the brain's Euclidean representation of the left/right axis. Here we present two patients with left‐sided neglect, in whom only the left hemispace in front of an imagined and/or real body position was inaccessible, but the space behind them remained fully represented. These observations suggest that of the three Euclidean dimensions (up/down, left/right, and front/back), at least the latter two are modularly and separately represented in the human brain. Ann Neurol 2007
Evolution of hippocampal CA‐1 diffusion lesions in transient global amnesia
Authors: Bartsch Thorsten , Alfke Karsten , Deuschl Guenther , Jansen Olav
Published: August 2007

Objective

Selective focal MR‐Signal (diffusion‐) changes in the CA‐1 sector of the hippocampus have been described in transient global amnesia (TGA), but the pathophysiological substrate of these lesions is largely unknown. As several imaging and epidemiological findings point to a vascular origin an analysis of the temporal evolution of the hippocampal apparent diffusion coefficient (ADC) changes may offer new understanding of the pathomechanisms of TGA.

Methods

The time course of the ADC of hippocampal DWI lesions in TGA patients was studied using serial 3 T high‐resolution MR‐imaging within 1‐10 days as well as 4‐6 months after TGA. ADC values from 76 MR‐studies were analyzed and expressed as ratio ADC (rADC) in reference to the unaffected hemisphere.

Results

Twenty‐nine patients with TGA showed 34 DWI lesions with corresponding T2 lesions in the CA‐1 sector of the hippocampal cornu ammonis within a time window of 24‐72 h after onset. Ratio ADC decreased below 1.0 (0.66 ± 0.08) 24 h after the acute TGA episode and did show a further significant decrease to 0.57 ± 0.1 after 3 days (p < 0.05). After 72 h, rADC increased and normalized around day 10 with rADC values of 1.0 (p < 0.05).

Interpretation

The temporal evolution of the rADC in hippocampal signal changes in TGA shows a time course previously described for ischemic lesions in human stroke patients. This might imply a vascular origin of diffusion changes leading to a transient perturbation of memory relevant circuits in the hippocampus. Ann Neurol 2007
Hierarchische Nanofertigung: von geformten Zeolithnanopartikeln zu hochleistungsfähigen Trennmembranen
Authors: Snyder Mark A. , Tsapatsis Michael
Published: August 2007

Seit über einem Jahrzehnt wird verstärkt an Alternativen zu energieintensiven industriellen Trennungen geforscht, die auf der hochauflösenden Selektivität dünner Zeolithfilme beruhen. Allerdings haben Membranen aus verwachsenen, orientierten Zeolithkristallen weder eine breite kommerzielle Anwendung gefunden, noch sind sie in Nischenmärkten verbreitet. Ursache dafür sind unbefriedigende Trennleistungen, hohe Kosten und Probleme bei der Maßstabsvergrößerung. Ein rationales Materialdesign war bis vor kurzem wegen des schwer aufzuklärenden Zeolithwachstumsmechanismus kaum möglich, sodass weitgehend empirisch vorgegangen wurde. Neue Einblicke in das Zeolithwachstum und jüngste Fortschritte beim Aufbau von Kristallmikrostrukturen und ‐morphologien, bei der Konstruktion kristalliner Monoschichten und der Synthese geordneter Filme bieten jedoch gute Ansätze, um auch die strikten Anforderungen industrieller Anwendungen zu erfüllen. Im Zusammenspiel mit neuartigen Verarbeitungmöglichkeiten sollte somit die Herstellung industriell nutzbarer Zeolithmembranen in hierarchischen Verfahren möglich werden. Diese Entwicklungen eröffnen vielversprechende Perspektiven nicht nur für Trennungen, sondern auch für den Aufbau neuartiger und komplexer Funktionsmaterialien wie molekularer Sensoren, mechanisch stabiler Dielektrika und neuartiger Reaktionsdiffusionssysteme.
Synthesis and nonlinear optical characterization of copolymers containing alternating 3,4‐dialkoxythiophene and (1,3,4‐oxadiazolyl)benzene units
Authors: Udayakumar D. , Kiran A. John , Adhikari A. V. , Chandrasekharan K. , Shashikala H. D.
Published: August 2007

We report the synthesis and linear and third‐order nonlinear optical (NLO) characterization of two novel copolymers containing alternating 3,4‐dialkoxythiophene and 1,4‐bis(1,3,4‐oxadiazolyl)benzene units. The copolymers were synthesized with a precursor polyhydrazide route. Both copolymers exhibited fluorescence around 430 nm under the irradiation of UV light. The NLO measurements were made with the single‐beam Z‐scan technique with Nd:YAG nanosecond laser pulses at 532 nm. The nonlinear refractive index of the investigated copolymers was negative, and the magnitude was as high as 10−10 esu. The samples exhibited strong reverse saturation absorption and very good optical limiting properties at the wavelength used. The concentration dependence of third‐order NLO parameters was studied. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci, 2007
Effect of thiophenol on thermal fragmentation of polyisoprene
Authors: Asano Yasuhiro , Yamazaki Hiroki , Nagasawa Tomomi , Wonmum Choi , Endo Takeshi
Published: August 2007

As a fundamental study for chemical recycle of waste vulcanized rubber to reproduce functional polymers, polyisoprene (PI) was thermally fragmented to obtain low molecular weight PI in the presence of thiophenol (PhSH). PI (Mw = 51,000) was heated at 140°C under air atmosphere to give low molecular weight PI. The fragmentation in the presence of PhSH effectively decreased the molecular weight (Mw = 7400), which is significantly lower than that in the fragmentation in the absence of PhSH. The fragmented PI contained phenyl sulfide moieties based on the addition of phenyl thiyl radical to the hydrogen abstracted methylene or the double bond moieties. Tgs of the fragmented polymers were higher than that of the original PI, despite the lower molecular weights, probably because of the introduction of the rigid phenyl sulfide moieties and the terminal polar carbonyl groups formed by oxidation. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci, 2007