bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Ischaemia and Reperfusion on Vasoactive Neuropeptide Levels in the Canine Infrarenal Aortic Revascularization Model
Authors: Dovgan P. S. , Edwards J. D. , Rowley J. M. , Agrawal D. K. , Adrian T. E.
Published: September 2024

Infrarenal aortic cross-clamping is associated with remote vascular events, including myocardial infarction and renal insufficiency. The purpose of this study was to determine whether hindlimb ischaemia and reperfusion associated with infrarenal aortic cross-clamping results in the production of vasoactive regulatory neuropeptides. A canine model of infrarenal aortic cross-clamping was used for the study. Serial blood samples were drawn, prior to, at the time of, and serially following placement of the clamp and subsequent release of the clamp and reperfusion. Ischaemia resulted in increased mean(s.e.m.) plasma levels of neuropeptide Y (NPY) (initial 10.0(1.8)pmol/l versus ischaemia 24.7(2.3)pmol/l, P<0.001) and vasoactive intestinal polypeptide (VIP) (initial 2.53(0.5)pmol/l versus ischaemia, 7.3(1.3) pmol/l, P<0.05). Reperfusion produced three-fold elevation of VIP (initial 2.5(0.5) pmol/l versus reperfusion 9.6(1.5) pmol/l. P<0.001). two-fold elevation in the plasma levels of endothelin-1 (initial 1.3(0.1) pmol/l versus reperfusion maximum 2.5(0.3) pmol/1, P<0.01) and NPY (initial 10.0(0.8) pmol/l versus reperfusion maximum 23.9(2.3) pmol/l, P<0.001). Ischaemia and reperfusion did not alter calcitonin gene-related peptide (CGRP) (a potent vasodilator) levels. Endothelin-1 (ET-1) plasma levels were also increased following haemorrhagic shock (initial 1.3(0.1) pmol/1 versus exsanguination 3.4(0.4) pmol/1. P<0.001), but not during ischaemia (initial 1.3(0.1)pmol/1 versus ischaemia maximum 1.7(0.2)pmol/1, P=0.7). It was concluded that vasoactive regulatory peptides are released following ischaemia, reperfusion and shock in the canine infrarenal aortic revascularization model and, therefore could contribute to remote vascular events observed with infrarenal aortic cross-clamping.
Composite Graft Replacement of the Aortic Root in Patients with Marfan's Syndrome
Authors: Sekine S. , Abe T. , Kuribayashi R. , Seki K. , Shibata Y. , Yamagishi I. , Aida H.
Published: September 2024

Between October, 1979 and September 1994, 18 consecutive patients with Marfan's syndrome underwent replacement of the ascending aorta and aortic valve with a composite graft. There were 11 men and seven women; the mean age was 38.7 years. All patients had annuloaortic ectasia with significant aortic regurgitation. Ten of the 18 patients had aortic dissection. Concomitant procedures were performed in three patients. The hospital mortality rate was 17%, and two patients with concomitant procedures died early after surgery. There were three late deaths, two of which were related to late aortic complications. The actuarial 8-year survival rates in patients with and without aortic dissection were 58.3% and 77.8%, respectively. Since aortic dilatation and its complications are progressive in patients with Marfan's syndrome, improved surgical results can be obtained early in the course of the disease before cardiac disturbances and aortic dissections emerge.
Ruptured Inferior Mesenteric Artery Aneurysm Due to Segmental Mediolytic Arteritis
Authors: Kato T. , Yamada K. , Akiyama Y. , Kobayashi M. , Yamamoto M. , Hirai H. , Kitano H. , Kadone K. , Kodama K.
Published: September 2024

Segmental mediolytic arteritis is a rare non-inflammatory arteriopathy. Only eight cases have been reported so far. The authors report a case of a ruptured inferior mesenteric artery aneurysm due to segmental mediolytic arteritis in which preoperative angiography revealed lesions and successful surgical treatment was performed. A review of the clinical features of segmental mediolytic arteritis is also presented.
Surgical Treatment of Abdominal Aortic Aneurysms of Octogenarians
Authors: Falk V , Vettelschoß M. , Walther T. , Schorn B. , Autschbach R. , Dalichau H. , Mohr F. W.
Published: September 2024

The purpose of this study was to determine whether elective abdominal aortic aneurysmectomy in octogenarians is justified or may even be advisable. Between January 1986 and August 1993, 30 octogenarians of mean age 83.1 (range 80–93) years underwent abdominal aortic aneurysmectomy. Patients were divided into two groups: group 1 ( n = 9) underwent elective surgical repair; group 2 ( n = 21) underwent emergency procedure. In 28 patients location of the abdominal aortic aneurysm was infrarenal; two patients presented with a juxtarenal aneurysm. The average aneurysm diameter was similar in both groups (group 1, 68.8 mm; group 2, 83.5 mm, P = n.s.). In group 2, two patients had free peritoneal rupture, one presented with rupture into the duodenum and one with penetration into the vena cava. Rupture was confined to the retroperitoneum in another 15 patients. Two patients had an expanding aneurysm. Hospital mortality rate was zero in group 1 and 42.8% in group 2 ( P = 0.011). Most early deaths were related to cardiac disease. The overall complication rate was 22% in group 1 and 62% in group 2. Mean intensive care unit time was 1.8 (range 1–3) days in group 1 and 3.6 (range 1–8) days in group 2 ( P = 0.047). The 5-year survival rate was 67% in the electively managed group and 34% in the emergency group.
Treatment Alternatives for Axillary—Subclavian Vein Thrombosis: Long-Term Follow-up
Authors: AbuRahma A. F. , Short Y. S. , White J. F. , Boland J. P.
Published: September 2024

Spontaneous axillary—subclavian vein thrombosis in young patients produces long-term disability. Patients with secondary axillary—subclavian vein thrombosis usually require prolonged venous catheterization for chemotherapy or pacemaking. This study aimed to compare the early and late results of lytic versus anticoagulant therapy in the treatment of axillary—subclavian vein thrombosis, both spontaneous and secondary to central venous cannulation. Nine patients underwent conventional treatment (heparin and warfarin) (group 1), and 10 had initial lytic therapy followed by heparin and warfarin (group 2). Three patients had cervical or first rib resection. Thirteen patients had spontaneous thrombosis and six were secondary to central venous catheterization. The mean follow-up was 36 months. Two of nine patients (22%) in group 1 and eight of 10 patients (80%) in group 2 had total venous recanalization and symptom resolution ( P = 0.018). In the spontaneous axillary—subclavian vein thrombosis subset, one of six patients (17%) in group 1 and five of seven patients (71%) in group 2 had total venous recanalization and symptom resolution ( P = 0.078). The average difference in cost per patient between groups 1 and 2 was $19039. In conclusion, lytic therapy appears superior to anticoagulation in the treatment of axillary—subclavian vein thrombosis. However, such treatment is more expensive and its benefits should be carefully weighed against the cost in each case.
Arterial Homografts — A Possible Solution to an Infective Dilemma
Authors: Wagstaff S. A. , Grigg M. J.
Published: September 2024

Seven patients with infected arterial conduits (six with prosthetic bypass grafts and one autogenous vein anastomosis) with ten limbs at risk (three patients with bilateral groin infection) are reported. The most common site for infection was the groin and the most frequent organism cultured was Staphylococcus aureus. These patients were selected for arterial homograft implantation through infected fields as they were unsuitable for extra-anatomical prosthetic bypass or had inadequate autogenous tissue available for use as a bypass conduit, i.e. the alternative to homograft insertion was arterial ligation and potential limb sacrifice. The arterial homografts were obtained from brain-dead organ donors (human immunodeficiency virus, hepatitis B- and hepatitis C-negative) and stored at −80°C until ready for use. All seven patients had initial success with their homograft procedures in terms of graft patency, limb salvage and control of infection, although two required early reoperation for haemorrhage. During the follow-up period (mean 24.5, range 6–52 months) three homografts have occluded at 6, 13 and 29 months resulting in limb loss. Two patients have died at 48 and 52 months from causes unrelated to their homograft procedures with functioning homografts and limb salvage. Two further patients remain alive with patent homografts at 7 and 20 months. The authors' experience suggests that arterial homografts have a role in overcoming arterial bypass infection, achieving wound healing and maintaining limb viability rather than resorting to arterial ligation and accepting major limb amputation.
Racial Differences in Operation for Peripheral Vascular Disease: Results of a Population-Based Study
Authors: Brothers T. E. , Robison J. G. , Sutherland S. E. , Elliott B. M.
Published: September 2024

Operation for non-coronary atherosclerotic peripheral vascular occlusive disease may vary among race and gender groups. Using a state-wide registry, the authors identified all operations performed for infrarenal peripheral vascular disease over a 12-month period in a single south-eastern state. Procedures performed included reconstruction for aortoiliac ( n = 641) and infrainguinal ( n = 1129) disease and major amputation ( n = 1077). The incidence for patients over age 50 was calculated using census data. Operation for aortoiliac disease was significantly more likely for white patients (relative risk 3.79, 95% C.I. 2.84–5.15), but less likely for infrainguinal peripheral vascular disease (relative risk 0.64, 95% C.I. 0.56–0.73) and amputation (relative risk 0.17, 95% C.I. 0.15–0.19). Trends toward lower operative mortality in blacks with aortoiliac disease (10.6% versus 12.0%), PVD (3.2% versus 3.5%), and amputation (5.5 versus 8.7%) failed to attain statistical significance. Patient race was associated with the type and location of operation performed for peripheral vascular disease.
Artery Wall Damage and Platelet Uptake from So-Called Atraumatic Arterial Clamps: An Experimental Study
Authors: Margovsky A. I. , Lord R. S. A. , Meek A. C. , Bobryshev Y. V.
Published: September 2024

A ‘traumatic’ clamps are routinely used to control arteries during reconstruction, but little is known about the arterial damage caused and the effects on platelet uptake. This experiment used sheep carotid arteries to correlate the degree of histologic damage observed with the level of indium-111-labelled platelet uptake in clamped arterial segments. Scanning electron microscopy and light microscopy enabled three degrees of injury to be recognized. In mild injuries, endothelial cell orientation was changed but local platelet uptake was little different from controls. In moderate injuries, the endothelial cells directly squeezed by the clamp were morphologically altered, superficial fissures developed which extended into the media, and local platelet uptake was usually increased. Severe injuries caused extensive endothelial cell desquamation, formation of deep cavities in the media and increased platelet uptake (mean 5.51 times that of control). Platelet uptake at the site of clamp application was not significantly different from non-clamped carotids for mild injuries. However, the increased platelet uptakes for moderate ( P = 0.007) and severe ( P = 0.005) injuries were statistically significant when compared with non-clamped control arterial segments.
Carotid Eversion Endarterectomy and Reimplantation: A Safe and Simple Technique to Prevent Acute Thrombosis—Occlusion and/or Early and Late Restenosis
Authors: Ballotta E. , Da Giau G. , Guerra M. , Toffano M.
Published: September 2024

The purpose of this report is to consider the technical aspects of carotid eversion endarterectomy and reimplantation into the common carotid artery for surgical treatment of atherosclerotic occlusive disease, in light of previous early and late results. In the past 2 years, the authors have more frequently used carotid eversion endarterectomy and reimplantation to minimize the risk of perioperative stroke due to acute occlusion–thrombosis, and the incidence of early and late restenosis. Some 88 patients underwent 95 carotid eversion endarterectomies and reimplantation (seven bilateral): 59 internal carotid arteries were surgically corrected for ischaemic symptoms while 36 patients were symptomless but presented with a haemodynamically significant stenosis at the internal carotid artery bifurcation. The ischaemic preoperative symptoms consisted of one or more transient ischaemic attack's in 39 patients (66%), amaurosis fugax in 15 (25%) and mild stroke in five (8%). Associated elongation of the internal carotid artery beyond the end of the plaque was present in 81 cases (85%). After freeing the internal carotid artery sufficiently beyond the distal limit of the lesion, the vessel was transected obliquely to its origin, the extramedial cleavage plane opened and the endarterectomized arterial wall everted beyond the natural end of the plaque, which was gently removed. The artery was dilated distally and finally reimplanted end-to-side into the common carotid artery, 1–2 cm or more above the original site. This technique has provided excellent early and late results: no deaths, no acute thrombosis–occlusion, no minor or major stroke occurred perioperatively. No restenosis, no symptomless or symptomatic late occlusion was found during late follow-up (mean 28 (range 6–44) months). The performance of this vascular technique must be encouraged and recommended because of its speed, effectiveness and success. Carotid eversion endarterectomy and reimplantation should be performed routinely when the internal carotid artery is elongated.
Bidirectional Cavo-Pulmonary Anastomosis with an Additional Flow Source to the Lungs: Clinical Experience in 21 Cases
Authors: Borini I. , Marasini M. , Dalmonte P. , Bava G. L. , Lerzo F. , Cervo G. , Moretti R. , Bertolini A. , Zannini L
Published: September 2024

The Fontan operation is considered a palliative procedure for the treatment of complex congenital heart diseases with a morbidity and mortality that are not negligible, expecially in high-risk patients. In these cases, a bidirectional cavopulmonary anastomosis with additional source of blood flow to the lungs can represent a valuable surgical option. Between November 1992 and December 1995, 21 patients with univentricular heart physiology were submitted to bidirectional cavopulmonary anastomosis with additional blood flow the additional flow consisted of an aortopulmonary shunt in 13 cases, pulmonary artery banding in seven cases, and pulmonary artery stenosis in one case. Mean age at operation was 35.5 months (range 4 months to 12 years) and mean body weight 10.9 (range 4–24.4) kg. Hospital mortality was zero. Morbidity (pleuropericardial effusions) was significant in one case. There were three late deaths (14%) caused by worsening atrioventricular valve regurgitation: two of these occurred in patients with right isomerism. Late haemodynamic evaluation documented a significant increase in cardiac output ( P < 0.01) and oxygen saturation ( P < 0.05) during pharmacological stress testing. Angiographic characterization of blood flow distribution to the lungs showed better results when the additional blood flow was represented by an anterograde source (pulmonary artery banding or native pulmonary artery stenosis). In conclusion, bidrectional cavopulmonary anastomosis with additional blood flow is a good alternative to classic or fenestrated Fontan technique in high-risk patients. Secondly, the diagnosis of isomerism could be a contraindication to this type of surgery, because the persistent volume overload could worsen atrioventricular valve regurgitation. Thirdly, the pharmacological stress testing shows a favourable behaviour of cardiac output and arterial oxygen saturation. Fourth, the type of additional blood flow seems to condition both pulsatility and distribution of pulmonary blood flow.
Determining Variations in Colonic Circulation during Aortic Surgery
Authors: Inoue Y. , Iwai T. , Endo M.
Published: September 2024

The aim of this study was to compare transanal Doppler examination, intraoperative angiography via the inferior mesenteric artery, and the inferior mesenteric artery stump pressure measurement during abdominal aortic surgery to assess the collateral circulation to the inferior mesenteric artery bed. Transanal Doppler examination revealed that the collateral circulation depended on the superior mesenteric artery in 25 patients (superior mesenteric artery-dominant group), the inferior mesenteric artery in two patients (inferior mesenteric artery-dominant group), and the internal iliac artery in one patient (internal iliac artery-dominant group). The mean (±S.D.) inferior mesenteric artery stump pressure index was 0.65 (±0.12) in the superior mesenteric artery-dominant group, which was significantly different from 0.43 (±0.00) in the inferior mesenteric artery- and internal iliac artery-dominant groups. The Intraoperative angiography showed the meandering mesenteric artery clearly in the superior mesenteric artery-dominant group. The Transanal Doppler examination as well as inferior mesenteric artery stump pressure measurement were useful methods to assess a dominant artery to the inferior mesenteric artery bed and colonic viability.
Coronary Bypass with Arterial Conduits
Authors: Rizzo D. F. Del , Fremes S. E. , Christakis G. T. , Sever J. , Goldman B. S.
Published: September 2024

To assess the efficacy of arterial revascularization 368 patients were studied who underwent myocardial revascularization with two or more arterial conduits (group M) and compared with 2092 patients in whom a single internal mammary artery ± veins (group S), and to a third group in which only saphenous vein conduits (group V, n = 602) were used. Group M patients were younger (aged 54.0(9.5) years: 4.1% aged > 70 years) than either group V (67.6(8.9) years, 40.7% > 70 years, P < 0.0001) or group S patients (62.0(8.5) years. 15.7% > 70 years, P < 0.0001). Furthermore, this cohort group had the lowest percentage of females (8.4%), of urgent cases (21.7%), of preoperative myocardial infarction (6.0%), and of redo surgery (0.8%). In contrast, patients who received only saphenous vein conduits had the highest proportion of female patients (29.2%), of urgent cases (47.4%), of preoperative myocardial infarction (16.5%), and of redo surgery (5.5%). By multivariate logistic regression analysis (odds ratio in parentheses), redo surgery (6.06, P = 0.0001), preoperative intra-aortic balloon pump assist (6.11, P = 0.0001), diabetes (1.97, P = 0.03), urgent surgery (1.80, P = 0.05), and advanced age (2.14, P = 0.01) were all predictors of operative mortality. In contrast, while choice of conduit appeared to influence outcome by univariate analysis (4.2% mortality in group V, P < 0.001), it was not found to be a predictor of either mortality or morbidity by regression analysis. The present results indicate that, in carefully selected patients, despite increased technical demands with longer periods of aortic occlusion and longer pump times, multi-arterial grafting (compared with conventional revascularization) is a safe and efficacious procedure. Whether or not this approach to revascularization will increase long-term survival and freedom from reoperation will require further study.
Primary Palmar Hyperhidrosis Presenting with Unilateral Symptoms: A Report of Two Cases and Review of the Literature
Authors: Kopelman D. , Hashmonai M. , Assalia A. , Bahous H.
Published: September 2024

Two cases of primary palmar hyperhidrosis are presented. T2-T3 sympathetic ganglionectomy of the affected side completely alleviated perspiration of the palms, but oversweating of the contralateral palms appeared a few weeks later. A similar sympathetic ganglionectomy of the second side, 1 month and 1 year later, resulted in renewed oversweating of the palm on the first operated side within 3 months of the second operation. During the same period, 127 other patients with primary palmar hyperhidrosis underwent a bilateral upper dorsal sympathectomy, though the condition did not recur in any of these patients. The possible mechanism(s) of why overperspiration of the second hand developed after the first sympathectomy in these two patients, and why it recurred in the first hand after the second operation are examined, but remain obscure.
An Optimal Inflow Procedure for Multi-Segmental Occlusive Arterial Disease: Ilio-Femoral versus Aorto-Bifemoral Bypass
Authors: Zukauskas G. , Ulevicius H. , Janusauskas E.
Published: September 2024

Treatment of chronic critical limb ischemia still remains one of the most serious problems of vascular surgery. Most often, chronic critical limb ischemia is caused by multi-segmental disease of arterial tree, involving both the aorto-femoral and infrainguinal vessels. In the majority of these cases, proper correction of aortoiliac arteries is sufficient to restore the circulation in lower limbs. However, in 10–15% it is necessary to perform multi-segmental reconstructions. In these cases it is extremely important to choose the optimal inflow procedure. The aim of this retrospective study was to compare perioperative and long-term results of multi-segmental reconstructions, using aorto-bifemoral, unilateral ilio-femoral, and extra-anatomical bypass as inflow procedures. During the 10-year period (1984–1994), 4074 aorto-femoral reconstructions were performed for treatment of occlusive arterial disease. In 449 cases (11%), multi-segmental aorto-femoro-poplteal/tibial reconstructions were undertaken. Aorto-bifemoral bypasses was performed in 131, unilateral ilio-femoral bypasses in 288, and extra-anatomical bypasses in 30 cases. In 221 cases, the operations were performed in one stage, and in 228 cases a two-stage procedure took place. Postoperative mortality was 3.8% in the aorto-bifemoral bypass group, 1.3% in the unilateral ilio-femoral group, and 3,3% in the extra-anatomical group. Primary inflow graft patency rate after 12 months was 94.7% in the aorto-bifemoral bypass group, 94.1% in the unilateral ilio-femoral group, and 80% in the extra-anatomical group. Secondary inflow graft patency rate was 97.8% in the aorto-bifemoral bypass group, 96.2% in unilateral ilio-femoral group, and 96.7% in extra-anatomical group. The 5-year primary and secondary graft patency rates were 90.9% and 94.7% in the aorto-bifemoral bypass group, 88.5% and 93.4% in the unilateral ilio-femoral group, and 66.7% and 77.3% in the extra-anatomical group, respectively.

Conclusion:

Unilateral ilio-femoral bypass as an inflow procedure for treatment of multilevel occlusive arterial disease is as effective as aorto-bifemoral bypass, with lower perioperative mortality and morbidity rates. Extra-anatomical bypasses are, however, less effective.
Reconstruction for Lower Limb Occlusive Disease in the Elderly
Authors: Smith J. J. , Toogood G. J. , Galland R. B.
Published: September 2024

Objectives:

To determine the acceptability of performing distal limb bypass for occlusive vascular disease in the over 75's.

Method:

Patients undergoing surgery between January 1988 and December 1996 were included. Data were obtained from a card system, operating ledgers, admission diaries and hospital notes.

Results:

A total of 166 patients were identified. There were 69 women and 97 men, 79 were aged 75–79 years, 81 were 80–89 years and six older than 90 years. A total of 171 procedures were performed: infrainguinal bypass in 131 (77%), aorto-femoral bifurcation grafts in 10 (6%) and extra-anatomic bypass in 30 (17%). This represents 28.1% of all reconstructions for occlusive disease during this time. Nine patients (5.4%) died within 30 days and one (0.6%) required a major amputation. During the follow-up period (median 12 months). 14 major and 10 minor amputations were required. Ten patients underwent a second successful reconstructive procedure.

Conclusion:

Reconstruction in this group of older patients can be carried out with acceptable 30-day mortality and limb salvage rates.
Infection of Endovascular Stents: An Uncommon but Important Complication
Authors: Latham J. A. , Irvine A.
Published: September 2024

In this review article, four cases of peripheral endovascular stent infection (including a case presented in this issue of the journal) reported in the medical literature are reported. While the actual incidence of endovascular stent infection is probably low, when it occurs it can have serious consequences. This complication may result in the death of a patient, as seen in two of the case reports. The presentation of this complication, the site of stent deployment, the treatment given and the outcome in each of these cases are discussed. Stent infection should be recognized early to avoid the high morbidity and mortality of this complication.
The Relationship between Abdominal Aortic Aneurysm Wall Compliance, Maximum Diameter and Growth Rate
Authors: Wilson K. , Whyman M. , Hoskins P. , Lee A. J. , Bradbury A. W. , Fowkes F. G. R. , Ruckley C. V.
Published: September 2024

Aim:

Aortic compliance as measured by the pressure—strain elastic modulus (Ep) and stiffness (β), may allow a more precise estimate of rupture risk. The aim of this study was to determine the relationships between compliance, maximal aneurysm diameter and growth rate.

Methods:

Sixty abdominal aortic aneurysm patients of median age 73 years, were studied. Growth rate was derived from repeat ultrasound scans obtained over a median period of 21 months (range 6–48). At the end of follow-up, patients underwent measurement of maximum aortic diameter, Ep and β using the Diamove echo-tracking system.

Results:

Growth rate correlated positively ( r = 0.6, P < 0.01) with maximum diameter on entry to the study There was a positive correlation between mean arterial pressure and Ep ( r = 0.3. P = 0.03), but not between mean arterial pressure and β ( r = 0.8, P = 0.61). A positive correlation was found between final maximum diameter and Ep ( r = 0.22, P = 0.04) but not β ( r = 0.16. P = 0.11). There was no significant relationship between growth rate and Ep or β.

Conclusion:

Large aneurysms tended to be less compliant. Within a population of abdominal aortic aneurysm of similar maximum diameter there was a 10-fold variation in Ep and β. Compliance and growth rate were not related. If aortic compliance is related to risk of rupture then this predictive information is likely to be largely independent of that currently obtained from size and growth rate.
The Visceral Perfusion System and Distal Bypass during Thoracoabdominal Aneurysm Surgery: An Alternative for Physiological Blood Flow?
Authors: Leijdekkers V. J. , Wirds J. W. , Vahl A. C. , van Genderingen H. R. , Siebenga J. , Westerhof N. , Tangelder G. J. , Bulder E. R. , Rauwerda J. A.
Published: September 2024

There are potential benefits to addition of visceral organ perfusion, by means of a 9-Fr. catheter system (octopus), to distal aortic perfusion during thoracoabdominal aneurysm surgery. However, in the literature there are reports of adverse effects. The authors therefore compared two groups of patients who underwent thoracoabdominal aneurysm surgery with and without visceral organ perfusion. In the group in which the visceral perfusion was applied, the use of platelets (26 versus 11 units; P < 0.05), fresh frozen plasma (3.4 versus 1.5 units: P < 0.05) and packed cells (20 versus 8 units, P < 0.05) was significantly increased. An equal number of patients in both groups developed renal failure postoperatively. An explanation for this adverse effect can be found in the high shear rates in the catheters used, mainly as a result of the small diameter. High shear rates cause haemolysis. Also, the flow through the catheters is insufficient to maintain adequate perfusion of the visceral organs. A higher flow in these catheters would result in an even higher shear rate. It is therefore concluded that coagulopathy and insufficient bloodflow is caused by the small internal diameter of the catheters, which renders the device insufficient.
Arteriography in Chronic Renal Failure: A Case for Carbon Dioxide
Authors: Fitridge R. A. , Petrucco M. , Dunlop C. M. , Thompson M. M. , Sebben R. A.
Published: September 2024

Purpose:

The aim of this study was to assess the utilisation of carbon dioxide arteriography, performed with a simple injection system, as the imaging technique of choice in patients with chronic renal failure.

Methods:

Patients with chronic renal impairment who required arterial imaging or intervention were recruited for carbon dioxide angiography. Demographic data were prospectively recorded and pre- and post-arteriogram renal function was quantified. Radiographic images were graded by an independent radiologist.

Results:

Twenty-eight patients underwent renal or aorto-femoral studies with only one failure. There were no cases of contrast-induced nephropathy. Twenty-two of the films (79%) were graded as excellent or good, four as acceptable and two were considered to be poor (non-diagnostic).

Conclusions:

This study has demonstrated that carbon dioxide angiography is a safe and clinically effective procedure in patients with chronic renal failure.
Aortic Valvular Replacement in Octogenarians. Short-Term and Mid-Term Results in 140 Patients
Authors: Bessou J. P. , Bouchart F. , Angha S. , Tabley A. , Dubar A. , Mouton-Schleifer D. , Redonnet M. , Fournier J. F. , Arrignon J. , Soyer R.
Published: September 2024

Aortic valvular replacements were performed between 1986 and 1995 at Rouen University Hospital on 140 octogenarians (52 male and 88 female). Pure or predominant aortic stenosis was present in 115 patients, 25 had associated aortic stenosis and insufficiency or predominant aortic insufficiency. Significant coronary lesions were present in 42% of patients. An isolated aortic valvular replacement was performed in 74% of patients, associated with a bypass in 23% and a bioprosthesis was used in 90%. Valvular lesions were mainly caused by Mönckeberg disease. Thirteen operative deaths occurred (9.3%). Functional recovery was satisfactory in 78%. mean hospital stay was 12 days. All well-known risk factors for aortic valvular replacement: age, coronary lesions, cardiac insufficiency, impaired ejection fraction and aortic insufficiency, led to an increase in operative mortality but were not statistically significant. Late mortality occurred in 28 patients. 99 patients are still alive at 4–91 months after surgery. The actuarial survival curve shows a 56.5% probability of surviving 5 years. Eighty per cent of survivors are able to live independently at home.
Reinterventions for Recurrent Ischemic Heart Disease following a Successful First Re-Do Myocardial Revascularization: Predictors, Indications and Results
Authors: Kaul T. K. , Fields B. L. , Riggins L. S. , Wyatt D. A. , Jones C. R.
Published: September 2024

Predictors for a reintervention following a successful first re-do surgical revascularization (CABG) were examined. Success and limitations of the reintervention procedures were evaluated. Between 3/88 and 3/95, 16.81% (302/1796) patients who had undergone a first re-do CABG surgery in the authors' center, required a reintervention. Graft angioplasty was performed in 158 (52.32%) patients and a second re-do CABG in 47.68% ( n = 144). Graft angioplasty was preferred over surgery in patients aged 70 years or older (43% versus 24.3%, P < 0.001) and in patients with unstable angina (55.6% versus 33.3%. NS) or a Left Ventricular Ejection Fraction (LVEF) < 30% (34.8% versus 20%, P < 0.05). Re-do CABG was preferred over graft angioplasty for multivessel revascularization (3 ± 0.3 versus 1 ± 0.6, P < 0.001), proximal occlusive disease ( P < 0.001) and for graft disease of a longer duration (7.18 ± 1.7 years versus 3 ± 0.6 years, P < 0.01). The independent predictors of a reintervention were (i) lack of arterial revascularization and (ii) inability to achieve a complete revascularization in a previous operation. The predictors of a failed graft angioplasty were diameter stenosis > 70% long occlusive lesions (multivariate), angulation, calcification and asymmetrical lesions (univariate). Failed graft angioplasty required a re-do CABG ( n = 48: early 21. late 27). repeat graft angioplasty ( n = 34: early 8. late 26) or transplant ( n = 1). Recurrent symptoms following a second re-do CABG required a graft angioplasty ( n = 6: early 2, late 4), a subsequent re-do CABG ( n = 32) or a transplant ( n = 4). Cumulative incidence of cardiac events at 1 month, and 1 and 8 years were: 20, 40.45 and 66.44% following graft angioplasty and 5.5, 10 and 56.55% following a second re-do CABG, respectively ( P < 0.05). Actuarial survival at 1 month and 6 years following graft angioplasty were 97.15 and 77.22%, and 94.7 and 83.26% after a second re-do CABG, respectively (NS). Re-do CABG was more effective and durable. Graft angioplasty provided a good palliation in suitable cases and also postponed the need for a high-risk surgical intervention for more favorable conditions.
Does Hypothermia Prevent Cerebral Ischaemia during Cardiopulmonary Bypass?
Authors: McCleary A. J. , Gower S. , McGoldrick J. P. , Berridge J. , Gough M. J.
Published: September 2024

It is believed that moderate hypothermia (25–32°C) during cardiopulmonary bypass provides cerebral protection by reducing the cerebral metabolic rate (CMRO2). Nevertheless episodes of ischaemia do occur and thus it has been suggested that cerebral oxygenation should be monitored by jugular venous oximetry. However, this technique is cumbersome and invasive. Near infrared spectroscopy (NIRS) provides a non-invasive assessment of cerebral oxygenation and this was used together with continuous Jugular venous oximetry in 21 patients undergoing hypothermic cardiopulmonary bypass. During the hypothermic period, jugular venous oximetry indicated reduced oxygen extraction consistent with a reduction in CMRO2 (Increase from 61 ± 2.5% to 74 ± 2.5%). In contrast, near infrared spectroscopy demonstrated increased oxygen extraction (HbO2 − 11.5 ± 1 μM. HHb + 3.2 ± 0.3 μM) and a fall in the cerebral concentration of oxidized cytochrome oxidase (– 1.7 ± 0.3 μM) indicating ischaemia. These results suggest that cerebral ischaemia occurs during hypothermic cardiopulmonary bypass with a spurious rise in jugular venous oxygen saturation, which represents arterio-venous shunting. Thus if hypothermia does facilitate cerebral protection it does not appear to be a direct result of a reduction in CMRO2 and oxygen requirement.
Angina and Coronary Ostial Lesions in a Young Woman as a Presentation of Takayasu's Arteritis
Authors: Jolly M. , Bartholomew J. R. , Flamm S. D. , Olin J. W.
Published: September 2024

Diagnostic considerations in young patients presenting with coronary artery disease have conventionally included familial dyslipidemias, lipoprotein(a) elevation, hyperhomocysteinemia, cocaine toxicity, hypercoagulable states, connective tissue disorders, vasculitis and the presence of other established risk factors for coronary artery disease. The case of a young woman with unstable angina and a left main coronary artery ostial lesion on cardiac catheterization is discussed. She was subsequently diagnosed with Takayasu's arteritis 4 years later.
Gentamicin Beads in Vascular Surgery: Long-Term Results of Implantation
Authors: Benaerts P. J. , Ridler B. M. F. , Vercaeren P. , Thompson J. F. , Campbell W. B.
Published: September 2024

The authors conducted a prospective study, with a subsequent review of case-notes and follow-up of patients, to review the results of insertion of gentamicin beads for the prevention and treatment of infection in vascular surgery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15 and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were followed up for 1–44 months (median 15) later. There was no further infection at 60% of the sites where gentamicin beads were used to treat proven graft sepsis, and 50% of sites in various sinuses. Infection developed at 16% of the sites where gentamicin beads were used prophylactically. Adverse effects were observed in three cases of long-term implantation: one chain of beads caused discomfort that required removal, the skin failed to heal over one chain, and one may possibly have caused a bypass graft to kink and occlude. In conclusion, gentamicin beads are a useful adjunct In the management of vascular graft infection and in prophylaxis for some high risk cases. Chains of beads can be implanted long term with few adverse sequelae.
Coronary Arteriovenous Fistulas with Giant Aneurysm: Two Case Reports
Authors: Katoh T. , Zempo N. , Minami Y. , Suzuki K. , Fujimura Y. , Tsuboi H. , Esato K. , Gondo T.
Published: September 2024

Coronary arteriovenous fistulas are rare, particularly in association with coronary aneurysms. Two rare cases of patients with coronary arteriovenous fistulas and giant aneurysmal formation are described. A right coronary fistula that drained into the superior vena cava was demonstrated in one patient. The remaining patient had a documented left coronary fistula that drained into a main pulmonary artery and had evidence of several plexal vessels that transversed through the pulmonary trunk and toward the pericardial reflex. Under cardiopulmonary bypass, the fistulas and plexal vessels were successfully ligated without any injury to the native coronary circulation.
Thoracoabdominal Aortic Aneurysm Repair: How I do it
Authors: Cambria R. P.
Published: September 2024

There remains no consensus on the operative management of Thoracoabdominal aortic aneurysm (TAA). Our approach emphasizes operative expediency and simplicity (without circulatory assist techniques), avoiding anticoagulation and systemic hypothermia. The technique involves a fundamental clamp/sew method with specific adjuncts directed against the principle complications: epidural cooling (introduced in 1993) for spinal cord protection, regional renal hypothermia, and in-line mesenteric shunting to minimize visceral ischemia. In a cohort of over 200 TAA patients (50% Types 1 & 11) treated during the past decade perioperative mortality has been 8% and paraparesis/paraplegia occured in 7%. These figures are halved for patients treated in elective circumstances.
Reckoning with rights: the Voice Referendum
Authors: Hunter Ernest
Published: September 2024

Objective

Many Aboriginal and Torres Strait Islander Australians are dismayed by the rejection of the 2023 Voice Referendum and its amplification of social divisions. This article considers a recent article in Australasian Psychiatry in which matters of motivation, process and outcome are raised that provides the scaffolding to explore these issues.

Conclusions

The breakdown of bipartisan political support and subsequent politicisation of the Referendum process resulted in claims regarding the reasons for and consequences of the Referendum that were not consistent with the process leading to the Uluru Statement. The outcome has been socially divisive and a cause of significant distress for many Aboriginal and Torres Strait Islander Australians, the majority of whom voted in support of the Voice.
Design, Development, and Validation of a Military Orientated Re-configurable Cognitive Task Battery
Authors: Sabine Graham , Thompson David J.
Published: September 2024

The United Kingdom’s Defence Science and Technology Laboratory (Dstl) has developed an innovative military cognitive task battery tool titled: Interactive Measures of Performance and Assessment of Cognitive Tasks (IMPACT). The purpose of the tool is to support the objective assessment of cognitive task performance and task demand across a range of military system types, use cases and experimental settings. IMPACT consists of six, reconfigurable, generic military tasks, and an intuitive user interface for the experimenter to configure the tool and collect data. Initial validation of the IMPACT tool has been undertaken and a number of early adopters have used the tool to support trials, system development and experimentation. The validation results show that the six individual IMPACT tasks broadly stimulate the associated cognitive attributes; as mapped and originally conceived during the design and development of the tool; as measured by subjective assessment techniques, psychophysiological monitoring, and performance measures. IMPACT continues to be refined in response to feedback from the validation exercise and early adopters of the tool.
Neuronal Death: Now You See It, Now You Don’t
Authors: Balena Trevor , Staley Kevin
Published: September 2024

Fatally injured neurons may necrose and rupture immediately, or they may initiate a programmed cell death pathway and then wait for microglial phagocytosis. Biochemical and histopathologic assays of neuronal death assess the numbers of neurons awaiting phagocytosis at a particular time point after injury. This number varies with the fraction of neurons that have necrosed vs initiated programmed cell death, the time elapsed since injury, the rate of phagocytosis, and the assay’s ability to detect neurons at different stages of programmed cell death. Many of these variables can be altered by putatively neurotoxic and neuroprotective interventions independent of the effects on neuronal death. This complicates analyses of neurotoxicity and neuroprotection and has likely contributed to difficulties with clinical translation of neuroprotective strategies after brain injury. Time-resolved assays of neuronal health, such as ongoing expression of transgenic fluorescent proteins, are a useful means of avoiding these problems.
New directions for the Journal of Health Psychology
Authors: Annunziato Rachel A , Locke Abigail , Treharne Gareth J
Published: September 2024

This editorial reflects on the current and future directions of the Journal of Health Psychology. As the Co-Editors in Chief, we briefly outline our positionality and the importance of our Editorial Board and other peer reviewers in ensuring the rigour of accepted articles. We comment on the middle-ground that has to be struck when considering the scope of open science given that data sharing has to be tempered by ethical and methodological considerations. We re-visit the aims and scope of the journal and reflect on some of the key aspects of diversity that set the journal apart from others. We showcase a selection of Editors’ picks that are published in this issue and available as a special collection. The Journal of Health Psychology has a bright future because of the contributions we receive from around the world as well as the outstanding support of peer reviewers.
Emergent bilingual preschoolers’ verbal and embodied engagement behaviors in read aloud
Authors: Sembiante Sabrina F , Theophile Kimberly , Gort Mileidis
Published: September 2024

Shared reading is a crucial site for children’s emerging reading skills when children engage affectively, behaviorally, and cognitively in the reading process. To inform a more holistic, collective, and inclusive view of observable engagement in read aloud (RA) behaviors, authors examined EB preschoolers’ micro-moment engagement behaviors to understand how they recruit their verbal and embodied modes to attend to RAs and how these behaviors align with prior engagement typologies. A phenomenological approach was implemented to examine EB preschool students’ moment-to-moment, multimodal forms of engagement across three video recorded RAs that consisted of 258 units of analysis. Findings reveal that EB preschoolers’ attentiveness and attention divergence during RA activities were showcased across a multimodal continuum but did not necessarily indicate disengagement or inattention. Opportunities for children’s contemplation were constrained by social and behavioral expectations of their compliance, and within less dialogic RAs, these expectations undermined children’s multimodal means of textual engagement in favor of their quiet, undivided display of attention. Findings have implications for recognizing the role of young children’s multimodal expression in supporting their engagement and interactions in RA in ways that may contribute to their developing reading skills and outcomes.
Guideline on managing thumb ulnar collateral ligament injuries: the British Society of Surgery for the Hand Evidence for Surgical Treatment (BEST) findings and recommendations
Authors: Dean Benjamin , Rodrigues Jeremy , Riley Nicholas , Rabey Nicholas , Donnison Ella , Challen Kirsty , Bradford Steph ,   on behalf of the BSSH BEST UCL Guideline Developmnent Group
Published: September 2024

The development of the ulnar collateral ligament (UCL) guideline was undertaken in accordance with the British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) Process Manual, which has been accredited by the National Institute for Health and Care Excellence, UK. This review article serves as a summary of the systematic reviews and the final guideline. The group included two patients, a radiologist, a commissioner, an emergency medicine doctor, hand therapists and hand surgeons. The group’s recommendations are that patients with acute UCL injuries should be assessed with a history, clinical examination and radiographs. Patients without significant joint laxity can be treated non-surgically. Patients with significant joint laxity on clinical examination may be treated with non-surgical joint immobilization or surgical repair and should reach a shared decision with their clinician about the definitive treatment within 2 weeks of presentation.
Adverse event profiles of CDK4/6 inhibitors: data mining and disproportionality analysis of the FDA adverse event reporting system
Authors: Shen Jun , Luo Pingli , Xu Jianmei
Published: September 2024

Background:

Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors are targeted therapies designed to selectively block CDK4/6, crucial regulators of the cell cycle. These inhibitors play a pivotal role in restoring cell cycle control, particularly in breast cancer cases marked by abnormal CDK regulation, ultimately inhibiting uncontrolled cell division and tumor growth.

Objectives:

This analysis aimed to comprehensively examine adverse effects in CDK4/6 inhibitors using the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database.

Design:

Disproportionality analysis was conducted to analyze the adverse event (AE) reports related to CDK4/6 inhibitor submitted to the FAERS database.

Methods:

We collected AE reports regarding palbociclib, ribociclib, abemaciclib, trilaciclib, and dalpiciclib submitted to the FAERS from 2015Q1 to 2023Q1. We used the system organ class and the Standardized MedDRA Query to perform a comprehensive search for AEs at the preferred term (PT) level, using case reports as our data source. After removing duplicate reports, we performed disproportionality analysis and sensitivity analysis to identify safety signals.

Results:

A total of 85,635 reports encompassing 280,211 AEs were extracted for analysis. Among 3681 scrutinized PTs, approximately 484 were detected as statistically significant signals associated with CDK4/6 inhibitors. It was noteworthy that palbociclib and ribociclib had comparable safety profiles, whereas abemaciclib exhibited distinctive safety patterns. Notably, our analysis found novel safety signals linked to CDK4/6 inhibitors, including nail-related disorders such as onychoclasis, nail disorder, and nail discoloration, and psychiatric concerns, including eating disorders and emotional disorder.

Conclusion:

Overall, the present study identified several new safety signals of CDK4/6 inhibitors, as well as differences among various drugs within the CDK4/6 category, through the use of the FDA FAERS, which deserve more careful monitoring in the clinic.