bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Results of 102 Abdominal Aortic Aneurysms
Authors: O-hara Masaki , Zempo Nobuya , Nakamura Takashi , Fujioka Kentaroh , Takenaka Hiroaki , Esato Kensuke
Published: August 2008

One hundred and two abdominal aortic aneurysmectomy were performed during 1973 to 1988. 87 patients underwent elective surgery (non-ruptured group). Comparatively, emergency surgery was carried out for 15 patients with ruptured aneurysms (Ruptured group).

Bifurcation prostheses were used for the aortic reconstruction following aneurysmectomy in all patients. (Cooley Double Velour Graft)

Postoperative morbidity occurred in 22 % (19/87) of the nonruptured group and in 47 % (7/15) of the ruptured group. Mortality occurred in 4.7% (4/87) of the nonruptured group and in 33% (5/15) of the ruptured group.

In late stage after aneurysmectomy there were two patients with anastomotic aneurysms. There were, however, no deaths related to aneurysmectomy and no graft occlusion. The cumulative 3-year and 5-year survival rate in the non-rup tured group was 80 % and 74 % respectively, whereas, in the ruptured group 73%.

The long-term results following the operative repair of an abdominal aneu rysm were satisfactory, despite the fact that the early operative results for patient having a ruptured aneurysm were poor. The abdominal aortic aneurysmectomy should be performed before ruptured to obtain the highest survival rate.
Late False Aneurysm at the Factory-Sutured Junction in an Umbilical Vein Graft—A Case Report
Authors: Vohra R. , Leiberman D.P.
Published: August 2008

The development of a false aneurysm at the factory-sewn junction in an umbilical vein graft is reported, six years after implantation. This rare complica tion was successfully managed by excision and graft replacement.
Ruptured Femoral Pseudoaneurysm in Behçet's Disease—A Case Report
Authors: Martínez-Sanz R. , Bräutigam I. , Ucelay R. , Fdez. Qunitero J.M. , Martín F. , Batista N.
Published: August 2008

Behçet's disease is an uncommon systemic process of unknown etiology that appears most often in Mediterranean and Asiatic countries. Arterial or venous involvement is rare. Arterial findings are occlusions, aneurysms, and rarely, pseudoaneurysms of the aorta, pulmonary, peripheral , and visceral arteries. The authors report a case characterized by typical cutaneous and orogenital manifes tations in a young man with severe anemia and hypotension. Arteriographic study showed a right femoral pseudoaneurysm. An end-to-end saphenous vein graft from the external iliac to superficial femoral arteries was performed. After six months of follow-up the patient remains well.
Psoas Abscess Caused by an Infected Aortic Graft—A Case Report
Authors: Lundgren Eric , Ricci Michael A. , Deshmukh Narayen
Published: August 2008

The aorta is rarely a cause of pyogenic abscess of the psoas despite their close proximity. The authors report a case of an infected aortic graft, Documented by paraprosthetic gas on computed tomography, that progressed to frank pyogenic psoas abscess. The patient was successfuly treated by graft excision, abscess drainage, and extra-anatomic bypass.

Although rarely reported, clearly an infected aortic graft may be the cause of psoas abscess. Signs and symptoms of psoas abscess may dominate the clinical picture.
Laser Doppler Flowmetry and Transcutaneous Oxygen Tension in Patients with Severe Arterial Insufficiency Treated by Epidural Spinal Cord Electrical Stimulation
Authors: Sciacca Vincenzo , Mingoli Andrea , Maggiore Claudia , Fiume Dario , di Marzo Luca , Tamorri Marco , Cavallaro Antonino
Published: August 2008

Six patients (3 men, 3 women, mean age 74.2 years) affected by severe arterial insufficiency with rest pain and/or necrosis (smaller than 3 cm2) have been studied simultaneously by means of transcutaneous oxygen tension (Tcp02) and laser Doppler flowmetry (LDF) measurements.

They had been submitted to epidural spinal cord electrical stimulation (ESES) device implant from one week to thirteen months previously.

Tcp02 vasodilation index and LDF flow and LDF volume increased in 5 patients in whom the ESES was effective in pain relief and ulcer healing. In 1 diabetic patient the clinical result was poor and neither Tcp02 nor LDF showed any improvement.

The LDF flow and LDF volume increase, coupled with the simultaneous Tcp02 vasodilation index increase, testify to the amelioration of the cutaneous microcir culation, related to a diminished vasomotor tone (sympathetic activity), induced by ESES .

In diabetic patients with neuropathy (autonomic sympathectomy) a high vasodilation index contraindicates ESES implant.
Antioxidant Action of Vitamins A and E in Patients Submitted to Coronary Artery Bypass Surgery
Authors: Federico Ferreira Ricardo , Milei Jose , Llesuy Susana , Gonzalez Flecha Beatriz , Hourquebie Hector , Molteni Luis , de Palma Carlos , Paganini Aldo , Scervino Luis , Boveris Alberto
Published: August 2008

Sixteen patients submitted to coronary artery bypass grafting were divided into two groups: Group 1 served as controls, and patients in Group 2 received 400 mg of vitamin E and 100,000 IU of vitamin A orally each day for five days before surgery. During surgery biopsy samples were obtained from the apex of the left ventricle before the ischemic period and after ten minutes of reperfusion. The samples were assayed for hydroperoxide-initiated chemiluminescence to indirectly determine free radicals activity. Preischemia biopsy specimens showed a photoemission of 40.7±1 cpm/mg of protein x 10-3, and 33.0±6.3 cpm/mg of protein x 10-3 for Groups 1 and 2 respectively (p NS). For rerperfusion samples the values were 89.5±11 cpm/mg of protein x 10-3 and 23.9 ± 5 cpm/mg of protein x 10-3 for Groups 1 and 2 respectively (p<0.001). These results show that the ischemia/reperfusion mechanism increases oxidative stress and this unwished effect may be inhibited with the preoperative administration of vitamins A and E.
Comparison of Aortography, Computed Tomography, and Magnetic Resonance in Abdominal Aortic Aneurysm
Authors: Rosenthal David , Seagraves M. Annette , Bisese John H. , Clark Michael D. , Lamis Pano A.
Published: August 2008

During a three-year period 51 patients with abdominal aortic aneurysm (AAA) underwent magnetic resonance imaging (MRI) computed tomography (CT) and aortography to evaluate the diagnostic accuracy and role of each study.

Ct and MRI were 100% accurate in establishing the diagnosis of AAA, whereas aortography did not visualize the AAA in 3 patients nor the associated iliac aneurysms in 3 other patients. MRI and aortography were superior to CT in evaluating the celiac, superior mesenteric, and renal arteries.

CT should be the screening method of choice to identify AAA, and when operation is contemplated, aortography will best demonstrate the mesenteric and renal anatomy. If aortography is deemed too hazardous, MRI will yield the most information and should then be the noninvasive test of choice.
Arterioenteric Fistula and Abdominal Aortic Aneurysm—A New Association—Case Reports
Authors: Woods W.G.A. , Thomas P.A.
Published: August 2008

Two cases of primary arterioenteric fistulae are presented, in each case associated with, but not arising from, an aneurysm of the abdominal aorta. The authors believe this is the first report of such an association.
Traumatic Thoracic Arteriovenous Fistula—A Case Report
Authors: Klein David F. , Watson Daniel R. , Bonta Marco J.
Published: August 2008

Traumatic thoracic arteriovenous fistula (AVF) is a rare vascular lesion. Proctor first reported a traumatic AVF between the thoracic aorta and left in nominate vein in 1950. Since that time, fewer than 20 such cases have been re ported. The authors present the rare case of a stab-induced AVF between the innominate artery and superior vena cava. The keys to a successful outcome with this injury include a high index of suspicion, careful physical examination, liberal use of angiography, and immedi ate operative repair.
Echogenic Types of Venous Thrombi in the Common Femoral Vein by Ultrasonic B-Mode Imaging
Authors: Ohgi Shigetsugu , Ito Katsuaki , Tanaka Kohichi , Hara Hiroshi , Mori Tohru
Published: August 2008

In order to more precisely evaluate deep venous thrombosis (DVT), venous thrombi in the common femoral vein (CFV) were classified according to size of clots and their echogenicity by means of ultrasonic B-mode imaging, and the echogenic types were correlated with the clinical course and presentation of DVT in 106 lower extremities of 81 patients with DVT. They underwent venous Doppler study, venous outflow measurement, and ultrasonic B-mode imaging. Seven clots in the CFV were removed for histologic examination.

Of 106 lower extremities 71 had clots in the CFV. These were classified into three types (A, B, C) and eight subtypes (A1, A2, B1, B2, B3, C1, C2, C3). Type A was thick and homogeneous (41 %), type B was thick and heterogeneous (35%), and type C was thin (24%). Types A (83%) and B (88%) were more frequently noted within one month from the onset than type C (12%) (p<0.01, p<0.001, respectively): 88 % of type C was identified after more than one month. Types A and B were correlated with the acute symptoms of DVT (pain, swelling, discoloration), but type C was correlated with the chronic symptoms (pigmentation, stasis ulcer).

The echogenic classification of venous thrombi by ultrasonic B-mode imaging is useful for precise evaluation of DVT.
Interventricular Septal Excursions and Velocities During Experimental Myocardial Ischemia. Effects of Nitroglycerin Infusion
Authors: Kounis N.G. , Zavras G.M. , Papadaki P.J. , Soufras G.D. , Vasilakos P.J. , Poulos E.A. , Papadimitriou M.G. , Gouvelou-Deligianni G.V.
Published: August 2008

The effects of intravenous nitroglycerin on the excursions and velocities of the interventricular septum were evaluated by use of ultrasound in 20 open-chest dogs during experimental myocardial ischemia. In 10 dogs with acute septal ischemia the systolic and diastolic excursions and velocities of the interventricular septum were reduced (p<0.01), but with the use of nitroglycerin, they increased as follows, although they did not return to the preischemia levels: Systolic septal excursion (p<0.01), systolic septal velocity (p<0.01), diastolic septal excursion (p = 0.01) and diastolic septal velocity (p<0.01). In 10 dogs with acute posterior wall ischemia, the mobility of the interventricular septum increased (p<0.01). This compensatory hyperactivity increased even more with the use of nitroglycerin as follows: Systolic septal excursion (p = 0.05), systolic septal velocity (p = 0.02), diastolic septal excursion (p = 0.05), and diastolic septal velocity (p<0.01). The measurements were obtained using the recently described method of the specific points. Possible mechanisms for these effects include increased regional blood flow, reduced afterload, and mechanical pulling of the ischemic myocardium.
Patterns of Fluorescence Distribution on the Foot Sole After Intravenous Injection of Fluorescein in Patients with Peripheral Arterial Disease
Authors: Wallin Lena , Westling HÅkan
Published: August 2008

Fluorescein angiography (FA) was performed in 119 patients with peripheral arterial disease. In total 226 lower extremities were examined. The pattern of initial fluorescence distribution on the foot soles was classified, the vascular anatomy of the foot being borne in mind.

The distribution patterns were related to peripheral arterial pressures. At ankle pressure > 100 mm Hg and/or toe pressure >40 mm Hg the first fluorescence on the foot sole appeared equally often at all sites of the foot. At lower pressures the first fluorescence appeared less often at the distal part of the foot. Delayed fluorescence on the medial part of the foot corresponding to the distribution area of the medial plantar artery ("lateral pattern") was found in 24%, and delayed fluorescence corresponding to the distribution area of the lateral plantar artery ("medial pattern") was found in 10%. The frequency of medial or lateral distribution patterns was the same in feet with different levels of ankle pressure. In 26 % of the feet, delayed fluorescence was found in the area where the perforating artery from the dorsal pedal artery joins the plantar arcade between the medial and lateral plantar arteries, and 6 % had early fluorescence at this site with delayed fluorescence in the surrounding area. In 1 foot the pattern of initial fluorescence distribution was compared with the result of contrast angiography. Good correspondence was found between areas with delayed fluorescence in the FA pictures and areas where no contrast appeared in the main foot arteries on the angiogram.
A Reappraisal of Exclusion Angiography in Gunshot Wounds of the Extremities
Authors: Luks Francois I. , Picard Daniel L. , Pizzi Walter F. , Battaglia Steven A. , LaMaute Henry R.
Published: August 2008

The routine use of exclusion angiography in trauma to the extremities has resulted in varying percentages of negative studies, mostly because of a great variability in location and type of injury.

The authors reviewed 117 low-velocity gunshot wounds to the extremities. Twenty-six cases presented with hard signs of vascular injury and underwent immediate exploration. Ninety-one exclusion angiograms were performed (11 for soft signs and 80 for proximity only), 89 (98%) were considered negative. Two cases (2 % ) that presented without hard signs required vascular repair. Physical examination alone was 93 % sensitive and 99 % specific for recognition of vascular injuries. Routine angiography did not substantially improve the diagnostic accuracy and had a positive predictive value of only 2%.

The authors conclude that angiography may be safely omitted in low-velocity gunshot wounds to the extremities if the absence of signs or symptoms of vascular injury can be firmly established.
Creation of Dipolar Vein Graft from Bifid Saphenous Vein System
Authors: Swersky Robert B.
Published: August 2008

The fabrication of a vein graft suitable for distal reconstruction of the lower extremity utilizing a section of bifid saphenous vein system is described. The configuration of the graft resembles a dipole antenna when splayed open, and hence, the name dipolar vein graft. This graft has some attributes of reversed saphenous vein, as well as of translocated vein grafting. The technique is simple and may have a distinct advantage over other alternatives when the greater saphenous vein is unsuitable or unavailable. Further, it provides a long uninterrupted conduit to the lower leg.
Extended Right Hepatic Lobectomy with Resection of Inferior Vena Cava and Its Reconstruction: Case Report
Authors: Polanski Jerzy A. , Kisiel Maciej , Smolen Janusz , Lewandowski Michal , Gorczyca-Wisniewska Ewa , Rowinski Olgierd , Nizienska Elzbieta
Published: August 2008

The authors report a case of hepatocellular carcinoma in which extended right hepatic lobectomy was performed with reconstruction of the inferior vena cava without use of peripheral arteriovenous fistula.
Biological Grafts for Vascular Access in Patients with End-Stage Renal Failure
Authors: Bitker M.O. , Barrou B. , Mouquet C. , Jacobs Cl. , Chatelain Ch.
Published: August 2008

From 1981 until 1987, 52 vascular accesses were created in patients with end stage renal failure; 392 could be studied retrospectively. Of these, 112 were created by using a biological graft: 88 homologous saphenous vein grafts and 24 bovine heterografts.

The overall permeability rate was 94% postoperatively, 62% at 1 year, 45% at 2 and 3 years. There was no statistical difference in the permeability between human saphenous vein grafts and bovine heterografts or between grafts implanted as first access or after failure of an anterior fistula.

The main complication observed during the followup was secondary throm bosis, which occurred after an average duration of 8 months. Aneurysms, infec tions, and high flow were very rare. Compared with the results observed with fistulas using the native veins, biological grafts results are poor. Compared with those of other authors 1/m especially for homologous saphenous vein grafts 1/m the authors' results are poor at 1 year and quite good at 2 and 3 years,

These data should lead to detection of early stenosis before the end of the first year, especially stenosis of venovenous anastomoses, which are probably responsible for late thrombosis in most cases.
Nine Years' Experience with the Valvular Substitution by Technique II in Deep Venous Insufficiency of the Lower Limb
Authors: Psathakis Dimitrios N. , Psathakis Nikolaos D.
Published: August 2008

Venous incompetence of the lower limb is necessarily connected with a popliteal reflux on account of a valvular incompetence of the popliteal vein; the presence of the reflux must be clarified, with initial investigation by Doppler ultrasound. Only patients with popliteal reflux of more than 40% can be fur ther examined by venous pressure measurements and by phlebography, if these are required. An operation in the deep veins is admissible only when a popliteal reflux of more than 40%, an ambulatory venous pressure of more than 60 mmHg, a refilling time of less than fifteen seconds, a venous insufficiency of more than 20%, and a patency or recanalization of the deep veins of more than 70% have been confirmed.

In a series of 52 patients (68 limbs) operated on over the last two years the selection for operation was made successfully by Doppler ultrasound only.

The substitute "valve" operation by Technique II designed to overcome reflux in the popliteal vein was performed on 197 patients (228 limbs) with deep venous incompetence of the lower limbs, primary or postthrombotic. Results were as sessed clinically, by Doppler ultrasound, by venous pressure measurements, and partially by phlebography.

In the first-mentioned series of 52 patients (68 limbs) the results were assessed only by Doppler ultrasound and correlated with the clinical condition, consist ing of abolition or minimizing of the popliteal reflux. Clinical improvement in 216 of 228 limbs was associated with reduction of ambulatory venous pressure and prolongation of refilling time with interruption of the popliteal reflux (Dop pler ultrasound) and with phlebographic evidence of the valve-like effect of the silastic tendon on the popliteal vein.
Pulmonary Sling: Therapeutic Considerations—Case Reports
Authors: Bâ Mamadou , Spier Sheldon , Selman-Houssein Sosa Eugenio , Guérin Ronald , Héry Eric , van Doesburg Nicolaas , Stanley Paul , Chartrand Claude
Published: August 2008

The authors report on 4 infants with the diagnosis of pulmonary sling who were operated in their hospital, and they subsequently review the literature. Considering the poor prognosis of the anomaly, especially when associated with tracheobronchial abnormalities, controversies persist about its management. The authors believe that a conservative approach to these patients cannot improve its prognosis, whereas new surgical technics show promise, and to this end they propose a more aggressive treatment algorithm.
Alterations of Venous Flow in Hemiparetic Patients
Authors: Alexander J. Jeffrey , Sioson Eulogio , Heitz Ronda , Mion Lorraine
Published: August 2008

Unilateral extremity edema and an increased incidence of venous thrombo sis are known to occur in association with hemiparesis. This phenomenon has been ascribed to either loss of muscle pump function, resulting in venous flow stasis, or to alterations in vasomotor tone secondary to the central cerebral le sion. Thirty-five patients with hemiparesis due to stroke were studied with duplex scanning to determine the nature of changes in venous flow. Patients with pre- existing arterial or venous disease were excluded. Femoral and popliteal vein size and peak venous flow velocity were quantitated in the paretic and the unaffect ed limb. Muscle strength and recovery (Brunnstrom staging) were independent ly assessed and compared with venous measurements.

The relative change in vein size was found to be significantly increased at both locations in the femoral (p = .007) and popliteal (p = .019) locations in the paretic as compared to the normal limb. Concurrently, the peak flow velocity was significantly reduced in the popliteal vein (p < 0.05), while only mildly reduced in femoral vein. A mild inverse relationship was apparent between muscle strength and femoral venous size, but otherwise, there appeared to be no significant as sociation between muscle strength and measured venous parameters. These results indicate a reduction in flow velocity and an increase in venous size occurring with hemiparesis. Because these changes do not significantly correlate with muscle strength, it is felt that they are most likely due to alterations of vasomotor func tion rather than of the muscle pump mechanism. Changes of this nature can lead to venous thrombosis.
Iatrogenic Extracranial Carotid Dissection: Report of Two Cases Treated Surgically
Authors: Tiberio Giorgio , Giulini Stefano Maria , Cangiotti Luigi , Floriani Marco , Coniglio Arianna , Mulesan Paolo , Bonardelli Stefano
Published: August 2008

Two patients had an acute dissection of the right common carotid artery due to catheterization of the vessel during Seldinger angiography. Both patients were evaluated immediately after the traumatic event by means of echo-pulsed Dop pler (duplex scan) to check the hemodynamic significance of the lesion. In the first case, the lesion initially appeared insignificant, but on the second day duplex scanning showed a sudden reduction of the flow in the internal carotid artery due to progression of the carotid dissection: the patient, neurologically asymp tomatic, was operated on successfully.

The second patient, also asymptomatic, underwent emergency surgical treat ment after the first duplex scan showed significant reduction of the internal carotid flow. The postoperative course has been uneventful. Both patients are asympto matic eighteen and eight months after surgery.

The authors emphasize the important role that duplex ultrasonography played in the management of these 2 patients.
Cardiac Herniation Following Extended or Radical Pneumonectomy—an Avoidable Complication?
Authors: von Flüe Markus , Stulz Peter , Oehy K. , Huber Andreas , Vogt Bruno
Published: August 2008

Pericardial defects necessarily occur when the great pulmonary vessels are divided within the pericardial sac or when portions of the pericardium are resected because of direct tumor infiltration. As a result cardiac herniation or strangula tion may develop if the heart prolapses through the surgically created defect in the pericardium.

In this report the authors present 5 cases of cardiac herniation following ex tended pneumonectomy. Herniation was left-sided in 3 of 5 patients; all instances occurred within the first twenty-four hours postoperatively. In 3 patients, the complication was associated with change in position for postural drainage, in 2 patients after massive coughing. The initial clinical picture was determined by sudden onset of low cardiac output, cyanosis, tachycardia, and asystole. All pa tients were reexplored without delay. The defects were covered with a substitute patch.

After the critical review of the literature and according to their own experience, the authors draw the following conclusions:

• Sudden onset of low cardiac output without obvious signs of hemorrhage or cardiac failure is suspicious for cardiac herniation after pneumonectomy.

• Change in position onto the operated side, massive coughing, and large pericardium are the main risk factors.

• Emergency reoperation and reposition of the heart offers the only chance of survival.

• Cardiac herniation is most effectively prevented and can be avoided by patch ing the defect.
SPECT Studies in a Patient with Hemichorea: Case Report
Authors: Nakano Shincichi , Kinoshita Kazuo , Jinnouchi Seishi , Hoshi Hiroaki , Watanabe Katsushi
Published: August 2008

The authors present single photon emission computed tomography (SPECT) images in a six-year-old boy with right hemichorea and motor aphasia. Neither computed tomography (CT) scanning nor magnetic resonance (MR) images showed any abnormality. 133Xe SPECT showed only a mild low-flow lesion in the territory of the left middle cerebral artery(MCA). However, 123I N- isopropyl-p-[123I] iodoanphetamine (IMP) SPECT showed a definite low-uptake lesion in the left MCA territory including the striatum and Broca's area. The authors stress the usefulness of 123I IMP SPECT in detecting mild ischemic le sions and discuss the mechanism of occurrence of hemichorea.
Catheter Embolization of Bronchial Arterial Collateral for Chronic Pulmonary Embolism with Massive Hemoptysis— A Case Report
Authors: Sueda Taijiro , Matsuura Yuichiro , Ishihara Hiroshi , Hamanaka Yoshiharu , Kanehiro Keiichi , Kimura Shoujiro
Published: August 2008

A case of catheter embolization of the bronchial arterial collateral for chronic pulmonary embolism (PE) is reported. A patient suffering massive hemoptysis was diagnosed by bronchoscopy and bronchial arteriography as having PE with large bronchial arterial collaterals. Since the left iliac vein was thrombosed and multiple PE was revealed by angiography, it was thought that chronic PE, caused by iliac vein thrombosis, produced large bronchial arterial collaterals and caused bleeding. Catheter embolization of the right bronchial arterial collateral was suc cessfully employed, and hemoptysis ceased.
Effect of Low-Dose Aspirin on Platelet Adherence After Carotid Endarterectomy in Dogs
Authors: Mingoli Andrea , Bailey Robert T. , Kretchmar David H. , Hagen Jeffrey A. , Santoscoy Robert , Hunter William J. , Gupta Naresh , Koe Ronald C. , Sugimoto Jeffrey T.
Published: August 2008

The study was undertaken to determine the influence of various doses of aspi rin (ASA) therapy on platelet adherence to injured endothelium. Twenty-four mongrel dogs were assigned to one of four treatment groups in a randomized, blinded fashion. Each group received ASA in one of three doses: 1 mg/kg, 5 mg/kg, or 10 mg/kg or no ASA therapy (control group). After five days of ASA therapy, the dogs underwent unilateral carotid endarterectomy (CEA), in a ran domized fashion, with the contralateral carotid artery serving as control within each dog. Indium 111 oxine-labeled autologous platelets were injected into the dogs twenty minutes before the reestablishment of flow through the endarterec tomized carotid artery. Platelet scintigraphy was performed at hours 3, 24, 48 and 72 postoperatively. ASA therapy was continued postoperatively for seventy- two hours. Data were analyzed by comparing the mean platelet uptake ratios (operative to nonoperative sites) between groups. When all ASA groups were combined and compared with control values, ASA therapy significantly decreased (p < 0.05) platelet adherence up to seventy-two hours postoperatively. The same effect was observed with low- (1 mg/kg) and medium- (5 mg/kg) dose ASA, which significantly reduced (p < 0.05) platelet adherence to the endarterectomized site at hours 3, 24, 48, and 72. In contrast, there was no significant reduction in platelet uptake in the high-dose (10 mg/kg) ASA group. These results indi cate that ASA therapy given in a dosage of 1 or 5 mg/kg for at least five days preoperatively is beneficial in decreasing platelet adherence after CEA in dogs. Conversely, at a dose of 10 mg/kg, platelet uptake is not consistently inhibited. This study supports previous findings that lower doses of ASA (1-5 mg/kg) are superior to high-dose ASA (10 mg/kg) in inhibiting platelet adherence to injured endothelium in vivo.
Smooth Venous Loop Arterio Venous Fistula for Hemodialysis
Authors: Ansari Maulana Mohd. , Jaspal Singh Viridi  , Hanif Beg Mohd. , Reyazuddin  , Haleem Shahla
Published: August 2008

Venous-end-to-arterial-side, smooth-loop arteriovenous (AV) fistulae were created in 41 patients (33 men, 8 women) just above the wrist between the cephalic vein and the radial artery. Blood flow through these fistulae was quite satisfac tory (200-300 mL/min) and maturation occurred in only two to three weeks. Complications included transitory edema of hand (9 patients), primary failure (2 patients), and late aneurysmal formation (1 patient). The fistulae were in regular use for from one to twenty-eight months, with one to eighty-three dialyses per patient.
Angiosarcoma of the Heart: A Case Presentation and Review of the Literature
Authors: Fox Stewart , Swankoski John
Published: August 2008

Primary tumors of the heart are rare, and only 25% of these are malignant. Angiosarcoma of the heart has been reported in fewer than 100 patients, of whom 23 were treated surgically.

This report reviews the literature and presents a new case of primary angiosar coma of the heart treated with surgical extirpation.
Marfan's Syndrome and Abdominal Aortic Aneurysm— A Case Report
Authors: Nicholas Gary G. , Stefanko Karen E.
Published: August 2008

This patient's course documents the successful repair of an abdominal aor tic aneurysm in a sixty-two-year-old man with Marfan's syndrome. Marfan's syndrome, a connective tissue disorder, is commonly associated with cardiovas cular complications, including ascending aortic aneurysms and dissecting aneurysms of the thoracic aorta with aortic insufficiency. Abdominal aortic aneurysms, are, however, rare. Although this procedure can be hazardous in patients with Marfan's syndrome, the authors encountered no significant com plications with their patient, who was doing well twenty-one months postopera tively.
Vertebral Arteriovenous Fistula: A Case Report
Authors: Koçak H. , Paç M. , Atesal S. , Yekeler I. , Önder A.
Published: August 2008

A case of vertebral arteriovenous fistula (AVF) after a stab wound is pre sented. There was a continuous and loud bruit and thrill on the left side of the patient's neck at physical examination. The neurologic examination revealed no abnormality. An arteriogram showed a left vertebral AVF at the level of C-6. The AVF was closed and the vertebral artery was ligated proximally. The patient was discharged asymtomatic, without cervical bruit.
Importance of the Revascularization of the Hypogastric Artery in Reconstruction of Infrarenal Aortic Aneurysms
Authors: Alemany Jose , Marsal Teresa , Reim Tomas
Published: August 2008

A review of the ischemic complications in the colorectal and gluteal region in patients operated on by the authors for infrarenal aortic aneurysms between 1983 and 1986 showed that in 13 cases the morbidity and in 2 cases the mortality were due to reduction of perfusion in the vascular bed of the hypogastric artery. This fact has made the authors carefully consider the indication for simultane ous revascularization of the internal iliac artery in reconstructions of the aor toiliac segment for aneurysms in the years from 1987 to 1989.

During this latter time period, 161 elective reconstructions for infrarenal aortic aneurysms have been done. The hypogastric artery was revascularized in 82 pa tients, all of whom underwent postoperative angiography. The results show that simultaneous revascularization of this artery may achieve a statistically signifi cant reduction (at least 1-3%) in mortality and morbidity.
Clinical Results of Reconstructive Surgery of the Mitral Valve
Authors: Isik Ömer , Balkanay Mehmet , Zeybek Rahmi , Bayezid Ömer , Yakut Cevat
Published: August 2008

In a four-year period, 720 open cardiac valvular surgical procedures were performed in Kosuyolu Heart and Research Center. In 120 of these 720 cardiac valvular operations, mitral valve reconstruction was performed alone or with other cardiac procedures. The youngest patient was twelve years old and the ol dest was eighty-eight with an average age of thirty-eight. All of the patients but 2—1 with congenital mitral valve lesion and the other with ischemic mitral valve lesion—had rheumatic mitral valve lesions; 80% of the patients were in the third and fourth functional class according to NYHA classification, and nearly 60% of the patients had some other cardiac lesions in addition to the mitral valve lesion. In 60 of the patients some other cardiac surgical procedures were per formed in addition to mitral valve reconstruction. The dominant lesions of the mitral valve were as follows: stenosis, 45%, insufficiently, 15%; and combined lesions, 40%.

The authors used 12 different reconstruction techniques alone or in combi nation with each other in all of the patients. Among these techniques, they used mostly Carpentier's ring implantation. In-hospital mortality was 6%. One pa tient died in the late postoperative period. Three patients had reoperations be cause of unsuccessful reconstruction. Nonfatal thromboembolism occurred in 1 patient. All living patients were reevaluated periodically in the postoperative period. In all these patients mitral valve functions were studied clinically, echocardiographically, and/or hemodynamically. In 80% of the living patients, the reconstruction was successful and in 20% it was partially successful; 95% of the living patients improved their functional class to I or II. In conclusion, mitral valve reconstruction is a good alternative to replacement in selected pa tients in an experienced center.
Distal Anastomotic Hyperplasia in Superficial Femoral-Popliteal Vein Femoropopliteal Bypass Grafts
Authors: Schulman Martin L. , Badhey Mohan Rao , Schulman Lee G. , Lledo-Perez Alfonso M.
Published: August 2008

The incidence of distal anastomotic hyperplasia (DAH) in superficial femoral- popliteal veins (SF-PVs) used as femoropopliteal bypass (FPB) grafts was inves tigated, with particular reference to the form of distal anastomotic construction. Seventy-seven SF-PV grafts that met specific angiographic follow-up criteria quali fied as "studied" grafts. DAH was identified in 13 (17%). Cobra head anastomoses, 2 cm or less in length, were used in 21 grafts and yielded 6 in stances of DAH (29%). When 8 sharply tapered 3 cm (swordfish) anastomoses were constructed, 3 grafts (37.5%) developed DAH. With 3 cm moderately ta pered (fishmouth) anastomoses in 48 grafts, DAH was seen 4 times (8%). Be cause the distal 1 cm of the swordfish configuration was very narrow, the swordfish and cobra head constructions were functionally equivalent and were grouped together as "short" anastomoses. The difference in the incidence of DAH with long and short anastomoses, 8% vs 31%, was statistically significant (p = .016).

In the 48 "studied" grafts with fishmouth anastomoses, the occurrence of all 4 DAHs among the 15 female diabetic limbs was also significant (p = .019).

Constructing 3 cm moderately tapered anastomoses significantly reduced the incidence of DAH, the leading cause of graft failure, in SF-PV FPB grafts. The achievement of primary and assisted patency rates of 84% and 91% at both three and five years in the 93 SF-PVs placed as primary FPB grafts since October, 1982, was largely due to the reduction in DAH that resulted from anastomotic modification.
Aortic Enzyme Activity in Symptomatic and Asymptomatic Atherosclerotic Aneurysms
Authors: Lehnert Bernd , Wadouh Faysal , Dwenger Alexander
Published: August 2008

In the present study, the role of advanced atherosclerosis in increased aortic protease content was evaluated. Forty samples of normal and atherosclerotic aortas and of infrarenal aneurysms were assayed for collagenase and elastase.

Both enzymes proved to have similar activity in normal and atherosclerotic tissue, whereas aneurysms revealed significantly elevated protease content. Preoperative symptoms increased the elastase activity: 6.58 ± 1.58 mU/g were extracted from symptomatic aneurysms in comparison with 2.51 ± 0.57 mU/g from asymptomatic aneurysms. Showed a high correlation (r = 0.96; p<0.01) with the erythrocyte sedimentation rate (ESR) preoperatively.

The data suggest that advanced atherosclerosis in aneurysm samples does not enhance the proteolysis of the aortic wall. Thus, the greater protease amount found in infrarenal aortic specimens may be linked to a more rapid fiber metabolism as compared with the thoracic aorta. High elastase content, detect ed in symptomatic infrarenal aneurysms, seems to be correlated with accelerat ed ESR.
Angioaccess Decision Based on Noninvasive Vascular Studies
Authors: Nguyen Duy D. , Vo Nghia M. , Kim Jin , Kwon Yong
Published: August 2008

Angiography is frequently performed via the femoral or axillary arteries us ing the Seldinger technique. The success of the femoral approach depends on the patency of the ipsilateral iliac segment, which can be evaluated by: the thigh/brachial systolic pressure index, thigh wave forms and amplitude, femoral/brachial systolic pressure index, and femoral wave forms and ampli tude. By reviewing these vascular parameters, along with the angiographic find ings of 102 patients having peripheral vascular disease, the authors have developed an algorithm allowing them to determine the appropriate vessel to be used as access site.
Myocardial Cystic Hydatids Causing Cardiac Tamponade—Report of Cases
Authors: Solak Hasan , Yüksek Tahir , Yeniterzi Mehmet , Akkoç Özkan , Anil Nazif , Ceran Sami
Published: August 2008

Four patients with cystic hydatids located in pericardium and myocardium were admitted. Cardiac tamponade was determined in 1 of these cases. Surgical treatment was instituted for all cases. Transpericardial cardiac palpation was emphasized in cases where thoracotomy was necessary due to the lung cystic hydatids.
Symptomatic Jugular Megabulb Deformity and Contralateral Meniere's Disease: A Misleading Coexistence— A Case History
Authors: Tekkök Ismail H. , Özcan Osman E. , Yüksel Serdar , Turan Ergin
Published: August 2008

The authors report an unusual coincidence of jugular megabulb deformity and jugular vein ectasia with contralateral Meniere's disease. They stress the need for extensive radiologic evaluation in patients who present with pulsatile tinni tus or tinnitus that does not benefit from medical treatment of endolymphatic hydrops. Therapeutic measures are discussed.
Accelerating HIV Infection with Cardiopulmonary Bypass—Case Reports
Authors: Yee Edward S.
Published: August 2008

Five men patients and 1 woman patient who underwent either coronary artery bypass grafting (in 2) or valve replacement (in 3) or combined procedures (in 1) presented with severe HIV infection during the postoperative period. Four patients were NYHA Class III of IV with 3 patients in extremis requiring emergency procedures. All procedures were performed with cardiopulmonary bypass with mean time of 109 ± 48 minutes and aortic cross-clamp of 52 ± 49 minutes. Although the immediate postoperative courses seemed benign or uncomplicated, all presented with severe infections during the late postoperative period following their procedures (twenty-one to ninety days). The opportunistic infections were Pneumocystis carinii pneumonia (2), toxoplasmosis in the central nervous system and lung (1), cryptococcal meningitis (1), Staphylococcus aureus endocarditis (1), and viral encephalitis (1). Three died with two months of surgery.

These complicated postoperative infections have raised the question of the safety of cardiopulmonary bypass in HIV-infected patients. Rational recommendations regarding preoperative HIV antibody testing, operative indications, and postoperative surveillance are offered.
Popliteal Aneurysm Presenting as Thrombophlebitis of the Lower Extremity: A Case Report
Authors: Mingoli Andrea , Farina Carlo , Feldhaus Richard J. , Schultz Richard D.
Published: August 2008

A case of a popliteal aneurysm presenting as a deep vein thrombosis of the lower extremity is reported. Venous insufficiency symptoms, like presenting symptoms of a popliteal artery aneurysm, are an uncommon occurrence but often cause a wrong or delayed diagnosis with severe consequences for limb salvage. The importance of an accurate diagnostic study in any patient with a suspected deep vein thrombosis is emphasized in this report.
Hemodynamic Changes After Valve Replacement and Coronary Bypass Surgery
Authors: Paç M. , Yekeler I. , Koçak H. , Ateş A.
Published: August 2008

At the Department of Cardiovascular Surgery of the Research Hospital of Atatürk University, Erzurum, Turkey, 40 patients were observed and followed up for hemodynamic capacity following valve replacements in 20 cases and cor onary bypass operation (CBPG) in the other 20.

In the former group 23 valves were implanted, of which 12 were mitral (MVR), 10 were aortic (AVR) and 1 was tricuspid type. In the latter, 8 left internal mammarian artery (LIMA) and saphenous veins were used as grafts. The hemodynamic capacity of the patients in both groups was evaluated by employing thermodilution cardiac output (TD CO) and Doppler ultrasonog raphy cardiac output (USG CO) methods in preoperative and early and late postoperative periods. In MVR, AVR, and CBPG, the results were statistically significant at p < 0.05 in the late postoperative period.

In those who underwent AVR and CBAG the results appeared to be statisti cally significant in the early (p < 0.01) and in the late (p < 0.001) postoperative period.
Results with Cryopreserved and Glutaraldehyde-Preserved Allograft Trachea as an Arterial Conduit
Authors: Muralidharan S. , Gu Jiang , Laub Glenn W. , Cichon Romuald , Daloisio Connie , D'Andrea Michael , McGrath Lynn B.
Published: August 2008

The authors evaluated rat tracheas as biological arterial conduits. Forty-eight Wistar rats were used; 24 received cryopreserved trachea (CT) and 24 received glutaraldehyde-treated trachea (CT). The homograft tracheas were procured from two-to-three-week old donor Wistar rats. The homograft tracheal grafts were implanted end-to-end in the infrarenal abdominal aorta. The mean aortic cross- clamp time was thirty-three minutes (range twenty-seven to forty minutes). Four animals from each group were evaluated and sacrificed at weeks 1,2,3,6,12, and 24 after implantation. At necropsy, hemodynamic, angiographic, and histopatho logic examinations were performed. In the CT group, 5 animals (20.8%) had aneurysmal changes in the graft, resulting in 2 sudden deaths. In the GT group, all grafts were patent, and there was no incidence of aneurysm formation or abnormal pressure gradients across the grafts. Histopathologic examinations showed that GT had much slower degeneration of the graft. The cross linking of collagen and slow degeneration of cartilage in GT allow time for fibroblastic proliferation to enhance integrity of GT, preventing aneurysm formation. The authors conclude that the structure and function of GT for six months were ex cellent and superior to those of CT and that GT may be useful as arterial grafts.
Ruptured Abdominal Aortic Aneurysm: Factors Affecting Survival and Long-Term Results
Authors: Rosenthal David , McKinsey James F. , Erdoes Luke S. , Hungerpillar John C. , Clark Michael D. , Lamis Pano A. , Whitehead Travis , Laszlo Pallos L.
Published: August 2008

Although elective resection of an abdominal aortic aneurysm (AAA) is now a safe operation, the mortality related to a ruptured abdominal aortic aneurysm (rAAA) remains significant. To evaluate factors affecting survival and the long- term results after rAAA, a ten-year review of 47 patients was performed.

The operative mortality rate was 43% (20/47) compared with 2.6% for 147 elective AAA patients during this period. Factors adversely affecting survival were blood pressure <90 mmHg on arrival to the hospital, perioperative cardiac arrest, delay in time from diagnosis to treatment > six hours, age > seventy-five years, massive transfusion, and free intraperitoneal rupture.

In follow-up extending to five years the survivors of rAAA at one (92%) and five (53%) years had no discernible differences in quality of life or long- term survival compared with age- and sex-matched patients who had elective AAA resection during the same time interval.

When an rAAA occurs and any three of the adverse variables noted above are present, the mortality rate exceeds 90%. These patients remained ventilator dependent and in the ICU from one to sixty-seven days, accumulating hospital charges from $7,000 to $214,000. It appears that the most effective means of reducing mortality statistics in this inordinately low-salvage, yet high-cost sub group of patients, is to prevent rupture of an AAA by elective resection.
Hypofibrinolytic Activity after Total Joint Replacement
Authors: Kikuchi H. , Tanaka S. , Nakagiri Y. , Yamane T. , Fujiwara S. , Katsuhisa K. , Tan A. , Matsuo O.
Published: August 2008

Tissue-type plasminogen activator (t-PA), tissue-type plasminogen activator inhibitor (t-PAI), and other factors (platelets, fibrinogen, fibrinogen degrada tion products, antithrombin-III, plasminogen, and α2-plasmin inhibitor [α2-PI]) related to the fibrinolytic system were studied in 21 patients undergoing total joint replacement.

Seventeen of the 21 patients revealed an impaired fibrinolytic activity from the first to seventh postoperative day and a subsequent return to the preopera tive level by the fourteenth postoperative day. There were accompanying increases in the level of α2-PI and in the t-PAI/t-PA ratio, and there was decrease in plas minogen level. Such hypofibrinolytic states may be related to a higher incidence of postoperative thrombosis in total joint replacement patients.
Upper Arm Arteriovenous Bridge Grafts for Hemodialysis
Authors: Berman Joel , Celoria Giovanni , Garb Jane
Published: August 2008

Upper arm arteriovenous bridge grafts are often required after failure of more distal access grafts. A retrospective review was performed comparing 57 brachioaxillary bridge grafts fistulas (BAGF) with 79 brachiosubclavian bridge graft fistulas (BSGF) performed over a twelve-year period. There was no statistical difference in primary or secondary patency rates. There was a statically higher rate of infection in the BSGF group (p<05). while thrombosis was more com mon in the BAGF group (p<.05)
A New Surgical Technique for Repair of Aortic Coarctation
Authors: Sarioglu Tayyar , Süzer Kaya , Akçevin Atif , Sarioğlu Ayşe , Polat Bülent , Aytaç Aydin
Published: August 2008

From June, 1987, to February, 1989, 7 patients underwent a new technique of coarctation repair. This technique consists of a complete mobilization of the left subclavian artery (LSA) so that it can be pulled down as much as possible. After all the proper clamping, the anterior wall of the aorta is incised longitudi nally, beginning on the anterior wall of the LSA and extending distally to the descending aorta 2 cm past the coarctation. The coarctation membrane is ex cised carefully. The LSA is pulled down so that the proximal end of the incision can come to the distal end. Then, this longitudinal incision is sutured trans versely with 5/0 polydiaxonone and continuous technique, widening the coarcta tion site and also preserving the blood flow to the left upper limb. If extreme tension occurs, the LSA is transected. After the aortoplasty is completed, a polytetrafluoroethylene (PTFE) graft in size of 6 or 8 mm is interposed between the proximal and the distal parts of the LSA, providing continuity.

The ages of the patients ranged from eighteen months to twenty years (mean: 11.5 years) and their weights ranged from 11 to 83 kg (mean: 37 kg). There were no hospital deaths. There were no significant pressure gradients through the isthmic area after the operation. Mean follow-up was eighteen months, and all patients but 1 were in class I effort capacity (NYHA). The authors have also noticed good blood flow to the left upper limb, including 2 patients who have a PTFE graft interposed in their LSA. The authors' experience indicates that this technique could be a good alternative to the subclavian flap aortoplasty because of preservation of blood flow to the left upper limb.