bluuebunny/crossref_metadata_2025 huggingface dataset:
Some Popliteal Aneurysms are Congenital
Authors: Melliere D. , Cron J. , Lange F. , Qvarfordt P. , Desgranges P. , Becquemin J.-P. , Cavillon A.
Published: September 2024

Although the majority of popliteal aneurysms are of atherosclerotic origin and are discovered in patients aged more than 50, the aetiology of a small minority may be attributed to arterial trauma, septic disruption, Behçet's disease, a medial fibromuscular dysplasia, or popliteal entrapment. The aim of this study was to propose a possible congenital origin for popliteal aneurysms without evidence of any other aetiology. A retrospective review of five younger patients (aged 20–45 years) with seven non-atherosclerotic popliteal aneurysms was performed. In patient nos 1 and 2, histological examination showed that the arterial wall had been replaced by an abundant collagenic tissue. After replacement by a saphenous bypass graft, these patients did well with a follow-up ranging from 1 to 15 years. Patient no. 3 was not operated on because of a symptomless occlusion of the tibial and peroneal arteries, and remains well 10 years later. Patients nos 4 and 5 were treated with a saphenous bypass graft. The last patient also had associated bilateral congenital anomalies of the division of the popliteal arteries. In the absence of any evidence of any classical aetiology, particularly fibromuscular dysplasia and popliteal entrapment, a congenital aetiology is proposed in aneurysms diagnosed in younger patients. The complex composition of the popliteal artery, being composed by an association of three original segments, may induce a fragility of the arterial wall that may be responsible for aneurysmal deterioration as well as abnormal branching or popliteal artery entrapment. These aneurysms are associated with the same risk of thrombosis as atherosclerotic aneurysms and therefore, they should be subjected to the same therapeutic considerations.
Correction of Total Anomalous Pulmonary Venous Connection of the Cardiac Type
Authors: Aeba R. , Katogi T. , Takeuchi S. , Kawada S.
Published: September 2024

Surgical treatment of the cardiac type of total anomalous pulmonary venous connection requires special techniques. The treatment and outcome in 17 consecutive patients who had undergone primary repairs of the cardiac type between 1965 and 1996 were reviewed. The median age was 3 months and median weight 4.2 kg. The connection was the coronary sinus in ten patients, and the right atrium in six. Interatrial communication was routinely augmented. The right atrial cavity was partitioned using a patch to direct the anomalous pulmonary veins into the left atrium through the atrial septal defect in the first 13 patients. In the last four patients, the free wall flap of the right atrium was developed as a neoseptum. There were three early postoperative deaths during the early period of conventional repair. Two patients developed residual or recurrent diffuse obstruction in the individual lobar veins; reoperation to relieve the obstruction was attempted but unsuccessful. One sudden death occurred in a patient with occasional heart block. Ten survivors have been asymptomatic during follow-up, but two incomplete heart blocks and one atrial flutter were noted among patients who underwent conventional repair. The right atrial wall flap technique was not associated with any mortality or morbidity, such as arrhythmia and recurrent pulmonary vein stenosis during 12 to 63 months of postoperative obstruction. In conclusions, a flap technique using the right atrial wall appears to be a promising method to decrease the incidence of supraventricular arrhythmias and pulmonary vein drainage obstruction following repair of the cardiac type.
The Perth HLB Bifurcated Endoluminal Graft: A Review of the Experience and Intermediate Results
Authors: Lawrence-Brown M. , Sieunarine K. , Hartley D. , Schie G. van , Goodman M. A. , Prendergast F. J.
Published: September 2024

Endoluminal grafting for abdominal aortic aneurysm based upon Dacron-coated Z stents was commenced in March 1993. A modular system for treatment of infrarenal aorto-illac aneurysmal disease was developed in 1994. The experimental model, method of delivery, graft construction and initial results were reported. Since 1994, 108 bifurcated HLB (Perth) endografts for infrarenal aortoiliac aneurysmal disease have been implemented. Initial technical success in deployment and exclusion of the aneurysm was achieved in 94 (87%) cases. Secondary endovascular procedures were performed in six cases and were successful in excluding the aneurysm. Ninety patients are alive currently. Twelve have died of co-morbid conditions. Six have died of aneurysmal disease, either from rupture or the result of treatment attempts. Fifteen early endoleaks (within 30 days) have been detected with three persisting. Four have sealed without further intervention, six after the secondary procedure and two patients have died. Conversion to open aneurysmal repair has been performed in five cases: three early and two late. Two of the early group but none of the late intervention group died. No graft infections have been detected to date. With increasing experience criteria for patient selection for endoluminal grafting and the type of graft to be inserted, have been developed. These criteria, lessons learnt and technical points of importance are discussed.
Immunophenotypic Analysis of the Aortic Aneurysm Wail Suggests That Vascular Dendritic Cells are Involved in Immune Responses
Authors: Bobryshev Y. V. , Lord R. S. A. , Pärsson H.
Published: September 2024

Objective:

Inflammatory infiltrates similar to those in atherosclerotic plaques are prominent in the abdominal aortic aneurysm wall. Antigen presenting vascular dendritic cells are present in both early and advanced atherosclerotic lesions but their possible participation in abdominal aortic aneurysms has not been previously examined. This study reports the presence of vascular dendritic cells in abdominal aortic aneurysms and their participation in immune responses.

Methods:

Samples of the anterior wall were collected from 18 atherosclerotic infrarenal abdominal aortic aneurysms ranging in diameter from 5–8 cm. All the patients were operated upon electively and no ruptured or rapidly expanding abdominal aortic aneurysms were included. Specimens were immediately frozen or fixed in 10% buffered formalin. Vascular dendritic cells were identified with anti-CD1a or with S-100. T cells and T cell subpopulations were identified with anti-CD3, anti-CD4 and anti-CD8. B cells were studied with anti-CD20. Analyses were carried out in sets of consecutive parallel sections immunostained with these antibodies and double immunostaining included different combinations of antigens such as CD1a/CD3, S-100/CD4, S-100/CD8.

Results:

Most inflammatory infiltrates were found in the adventitia. These infiltrates contained B cells (CD20+) and T cells (CD3 +) with their CD4 + and CD3 + cell subpopulations. In the aneurysm wall, CD1a + /S-100 + cells exhibiting dendritic appearance were detected and double immunostaining demonstrated that these vascular dendritic cells contained different lymphocyte populations including CD3 +, CD4 +, CD8 + and CD20 + cells. In some inflammatory infiltrates, B cells (CD20 +) represented the predominant cell population (60–80%). Double immunostaining demonstrated that, in these infiltrates, vascular dendritic cells contacted CD20 + cells.

Conclusions:

vascular dendritic cells are involved in immune reactions in the aneurysm wall, and this process mostly occurs in the adventitia. Vascular dendritic cells contact both T cells and B cells, suggesting that these vascular dendritic cells differ from other dendritic cells, subtypes of which associate with T cells (Langerhans cells, interdigitating cells) and B cells (follicular dendritic cells).
Ultrastructural Assessment of the Myocardium Receiving Intermittent Antegrade Warm Blood Cardioplegia
Authors: Yasuda T. , Kawasuji M. , Sakakibara N. , Takemura H. , Tomita S. , Watababe Y.
Published: September 2024

Ultrastructural changes in the myocardium during intermittent warm blood cardioplegia were studied in 12 dogs. During cardiopulmonary bypass, dogs received three 5-minute periods of warm blood cardioplegia, interrupted by three 10-minute episodes of ischemia in group A or three 20-minute episodes of ischemia in group B. Biopsy specimens were taken from the right ventricle before each cardioplegic infusion and at the end of the aortic cross-clamp period to analyze ultrastructural changes. Functional recovery was measured after cardiopulmonary bypass. Mild and principally reversible ultrastructural changes were observed in group A. In group B. moderate ultrastructural changes were observed, and these changes suggested cumulative ischemic injury. Functional recovery was good in group A, but significantly deteriorated in group B. We concluded that three 10-minute interruptions of warm blood cardioplegia cause mild ultrastructural changes and seem to be safe, but three 20-minute interruptions cause cumulative ischemic injury in normal dog hearts.
The Results of Routine Primary Closure in Carotid Endarterectomy
Authors: Anderson A. , Padayachee T. S. , Sandison A. J. P. , Modaresi K. B. , Taylor P. R.
Published: September 2024

Purpose of study:

The aims of this study were to determine the incidence of restenosis following carotid endarterectomy with primary closure of the arteriotomy and to observe the natural history of disease progression in the 1st postoperative year.

Methods:

The study group consisted of a consecutive series of 126 patients undergoing carotid endarterectomy. Duplex imaging was performed preoperatively and at 8 weeks, 6 months and 1 year postoperatively.

Results:

Five patients (4%) had a residual stenosis. At 12 months, the overall restenosis rate was 15%: 8.5% for males and 28.9% for females. None of these restenoses were symptomatic. There was no significant difference in the diameter of the internal carotid artery between male and female patients (U = 896, P = 0.60) and no significant difference in the diameter of the arteries that had restenosed at 12 months and those that had remained patent (U = 391, P = 0.33).

Conclusions:

Carotid endarterectomy with primary closure is associated with a low incidence of restenosis in men, but not in women. Criteria for selective patching should consider both gender and vessel calibre.
Insulin like Growth Factor-1 Activates Nuclear Factor-κB and Increases Transcription of the Intercellular Adhesion Molecule-1 Gene in Endothelial Cells
Authors: Balaram S. K. , Agrawal D. K. , Edwards J. D.
Published: September 2024

A critical early event in the pathogenesis of occlusive vascular disease is the adhesion of monocytes to endothelial cells. The authors have previously reported that insulin-like growth factor-1 increases monocyte-endothelial cell adhesion and increases the expression of intercellular adhesion molecule-1. In this study, it is hypothesized that the upregulation of intercellular adhesion molecule-1 expression after treatment with insulin-like growth factor-1 is caused by an increase in the transcription of intercellular adhesion molecule-1 in endothelial cells, and that this transcription is regulated, at least in part, by activation of nuclear factor-κB. Adherence cell assays were performed using insulin-like growth factor-1 treated human umbilical vein endothelial cells and human monocytes. To determine the role of nuclear factor-κB. Western blotting using the anti-p65 (activated portion of nuclear factor-κB) was performed on cell lysate of human umbilical vein endothelial cells treated with insulin-like growth factor-1. RT-PCR was performed on RNA extracted from insulin-like growth factor-1-treated human umbilical vein endothelial cells. Intercellular adhesion molecule-1 antibody attenuated the increase in monocyte-endothelial cell adhesion of endothelial cells exposed to insulin-like growth factor-1. We observed an increase in expression of the activated nuclear factor-κB p65 protein in response to insulin-like growth factor-1 treatment. Peak increase occurred at 30 min. This effect was sensitive to pretreatment of human umbilical vein endothelial cells with the insulin-like growth factor-1 receptor antibody. Human umbilical vein endothelial cells treated with insulin-like growth factor-1 for 2 and 4 h revealed a significant increase in intercellular adhesion molecule-1 mRNA as compared with untreated human umbilical vein endothelial cells. Tumor necrosis factor-α produced a larger increase in intercellular adhesion molecule-1 mRNA expression. These results suggest that insulin-like growth factor-1 enhances intercellular adhesion molecule-1 transcription and activates nuclear factor-κB in endothelial cells. The intracellular pathways that increase cell adhesion molecule expression may provide a common link to understanding the monocyte-endothelial cell adhesion that occurs in the early stages of atherosclerosis and restenosis.
Genetic Tracing of Arterial Graft Flow Surface Endothelialization in Allogeneic Marrow Transplanted Dogs
Authors: Shi Q. , Wu M. H.-D. , Fujita Y. , Ishida A. , Wijelath E. S. , Hammond W. P. , Wechezak A. R. , Yu C. , Storb R. F. , Sauvage L. R.
Published: September 2024

In order to trace genetically the source of fallout endothelialization on arterial grafts, six beagle dogs with successful autologous bone marrow transplantation received composite tandem aortic grafts with an isolated, totally impervious Dacron graft and a porous Dacron graft for 12 weeks. For impervious segments, five of 12 fresh tissue samples were Factor VIII/von Wille-brand factor + (FVIII/vWF) and seven had faint or negative signals: three of the FVIII/vWF + samples had α-actin + smooth muscle cells. Polymerase chain reaction (PCR) study showed eight had a pure donor DNA genotype and four had donor/host mixed, with the donor predominant. Of 12 AgNO3-stained samples. 11 showed pure donor type and one had donor/host mixed, with the donor predominant. For porous segments, all 12 fresh samples had positive flow surface FVIII/vWF and α-actin cells. PCR showed all these samples and all 12 AgNO3-stained samples had donor/host mixed type, but the host pattern was predominant. Porous graft healing appears to involve both cellular fallout and tissue ingrowth, and bone-marrow-derived cells may be a source for fallout.
Estimation of Intraoperative Aortocoronary Bypass Saphenous Vein Graft Circumference from its Preoperative Compliance
Authors: Lefthériotis G. , Legrand M.-S. , Abraham P. , Vicaut E. , Lelievre L. , de Brux J.-L. , Jardel A. , Saumet J.-L.
Published: September 2024

The aim of this study was to determine if the intraoperative circumference of aortocoronary saphenous vein bypass grafts could be predicted from preoperative measurement with B-mode ultrasound sonography in SO patients. The circumference of the saphenous vein was measured during stepwise increments of a thigh congestive cuff from 0 to 60 mmHg. The circumference of the corresponding segment of the coronary bypass vein graft was measured intraoperatively with callipers. The intraoperative circumference was higher (11.8 ± 2.3 mm) than the preoperative circumference (10.2 ± 2.4 mm, P = 0.006) matched to its corresponding intraoperative mean arterial pressure (57 ± 15 mmHg). The prediction of the intraoperative circumference by estimation from the preoperative pressure-circumference relationship fitted by a linear model ( r = 0.412, P = 0.004) did not improve on the preoperative circumference matched by arterial pressure alone ( r = 0.429, P = 0.003). The intraoperative circumference of the graft vein exceeded its preoperative circumference by 12%. Prediction of the intraoperative graft vein circumference is underestimated by a linear model of its preoperative compliance.
Familial Carotid Body Paragangliomas and Sensorineural Hearing-Loss: A New Syndrome
Authors: Lord R. S. A. , Chambers A. J.
Published: September 2024

Background:

Carotid body paragangliomas are rare tumors that are sometimes familial, the transmission of which is thought to be by genomic imprinting. We have treated a family who exhibited co-inheritance of carotid body paraganglioma and sensorineural hearing-loss, a relationship that has not been previously reported.

Methods:

We studied a large Australian family who exhibited familial carotid body paragangliomas, many of whose members also suffered tinnitus or hearing-loss. This relationship was examined by reviewing the medical records of family members with confirmed tumors, carrying out neck ultrasonic scanning or computed tomography on their relatives to look for previously unrecognized tumors, and arranging audiometric testing. This information was used to characterize the type of hearing-loss present in this family and to construct a pedigree for the two traits.

Results:

The hearing-loss observed in this family was sensorineural in character. Of 15 family members studied over four generations, eight were confirmed positive for both carotid body paraganglioma and sensorineural hearing-loss, two for the tumor only (one of whom did not have his hearing assessed) and one for hearing-loss alone. Four family members were negative for both traits.

Conclusions:

The pedigree provides evidence of a previously undescribed association between familial carotid body paraganglioma and sensorineural hearing-loss, a combination that appears to be co-inherited in this family.
Developments in Diagnosis and Classification of Venous Disorders: Non-Invasive Diagnosis
Authors: Lynch T. G. , Dalsing M. C. , Ouriel K. , Ricotta J. J. , Wakefield T. W.
Published: September 2024

Purpose:

This review examines the many techniques that have been used for the non-invasive diagnosis of acute and chronic venous disease and was conducted by members of the Committee on Research of the American Venous Forum. It proposes to identify those techniques with the greatest clinical potential, to suggest algorithms for the clinical application of non-invasive techniques in the identification of acute deep venous thrombosis and chronic venous insufficiency, and to identify areas of deficient knowledge and potential areas for future research initiatives.

Methods:

Review of pertinent clinical and research material.

Results:

Impedance plethysmography and ultrasonic imaging are the primary non-invasive tools used in the diagnosis of acute deep venous thrombosis. At present, ultrasonic imaging techniques are recommended on the basis of greater diagnostic accuracy in recent comparative clinical trials. Data would suggest that serial evaluation should probably be viewed as the preferred option for symptomatic patients with a negative initial examination and the presence of risk factors or physical findings suggesting a proximal deep venous obstruction/thrombosis. Chronic venous disease is the result of valvular incompetence, with or without associated venous obstruction. Duplex imaging can be used to determine the location and extent of reflux; however, there are reported procedural variations in the performance and interpretation of such studies. Recent innovations in air plethysmography may provide a means of quantifying volume changes, and permit an objective characterization of venous reflux and calf pump efficiency.

Conclusions:

There are still significant questions that need to be answered by well-designed research initiatives. Research applications that incorporate non-invasive diagnostic techniques may involve the diagnosis, treatment and natural history of acute deep venous obstruction/thrombosis and chronic venous insufficiency, assessment prior to and following venous reconstruction, and the basic science aspects of acute and chronic venous disease. At present, a lack of common standards is, by far, the greatest impediment to an organized research approach to venous disease.
Color Flow Scan Diagnosis of the Carotid String Sign May Prevent Unnecessary Surgery
Authors: Samson R. H. , Showalter D. P. , Yunis J. P. , Buselli K. , Perna T.
Published: September 2024

Can the color flow scanner assist in the diagnosis and management of patients with preocclusive lesions of the carotid bifurcation (so-called ‘string sign’)? Twenty-three patients were identified as having a ‘string’ by duplex criteria. Seventeen patients underwent angiography, which confirmed the duplex findings in 14 patients. In three, the angiogram was originally misread as showing an occluded internal carotid Artery. Six patients were managed solely on the basis of the duplex findings. Based on arteriography and/or duplex criteria, 12 involved internal carotid arteries were not explored. One artery went on to occlude asymptomatically. The remaining 11 have remained patent and asymptomatic (follow-up 6–72 months). Five arteries were predicted operable and underwent successful endarterectomy. Six were predicted inoperable yet underwent exploration. All were ultimately treated by ligation ± external carotid endarterectomy without subsequent neurological deficit. Duplex scans can identify internal carotid artery string signs, determine operability and may predict the functionally occluded artery that can be safely observed.
Thoracoscopically-Assisted Thoraco-Femoral Bypass in a Canine Model
Authors: McMillan W. D. , Shaheen S. J. , McCarthy W. J.
Published: September 2024

Interest in minimally invasive procedures for vascular disease has grown tremendously over the past few years. Herein, we report our initial experience with a thoracoscopically-assisted thoraco-femoral bypass in a larger animal model. Included are various approaches to a final recommendation for the technique.
Replacement of the Common Carotid Artery by a Plastic Prosthesis. Report of a Case with Forty Years of Follow-Up
Authors: Jaen Ruben J.
Published: September 2024

An 18-year-old man suffered a 38 caliber gunshot wound to the right side of the neck on 25 September 1957. On 16 October 1957. a traumatic arteriovenous aneurysm between the common carotid artery and the internal jugular vein was resected. The jugular vein was ligated and the common carotid was replaced by a nylon prosthesis. On 16 October 1960. the dilated nylon graft was replaced by a dacron prosthesis. The patient has been followed-up during more than 40 years and his condition is normal. To the best of our knowledge, this operation was the first of its kind performed in the world and has the longest follow-up.
Peripheral Arterial Occlusion in Acute Promyelocytic Leukemia
Authors: DiGiovanni R. J. , Crilley P. , Kerstein M. D.
Published: September 2024

A 16-year-old Caucasian teenager developed fatigue, abdominal pain, pneumonia, and subsequently acute vascular occlusion of the left superficial femoral artery. Vascular assessment and heparin therapy lead to bone marrow aspiration and a diagnosis of acute promyelocytic leukemia. Treatment with chemotherapy prevented loss of limb and avoided further vascular surgery. Young patients with acute vascular occlusion require an in-depth assessment including attention to hematological disorders. Clots obtained on thromboembolectomy should be sent for pathological assessment and not discarded, especially in an unusual-age patient for arterial embolus.
Perforation of the Right Ventricle by a Suction Drain
Authors: Uppal R. S. , O'Keefe P. A. , Young C. P.
Published: September 2024

Suction drains can be used as alternatives to conventional underwater seal drains following cardiac surgery, and may be advantageous under some circumstances. The authors present a case where a suction drain eroded into the right ventricle causing near-fatal haemorrhage following coronary artery surgery. Caution should be exercised in taking the decision to use suction drains, the material from which they are manufactured should be chosen carefully, and close attention paid to their positioning within the mediastinum.
Successful Repair of Blunt Cardiac Rupture Involving Both Ventricles
Authors: Duda A. M. , Iladat P. B. , Molnar R. G. , Bachulis B. L.
Published: September 2024

Blunt cardiac rupture occurs infrequently and is usually lethal. Successful repairs of isolated atrial or ventricular ruptures have been reported when the diagnosis is made early. Our patient sustained blunt cardiac rupture of both ventricles in a motor vehicle accident. The diagnosis was made during emergency exploratory laparotomy when her vital signs deteriorated without obvious cause. A large Satinsky clamp was placed across the apices of the right and left ventricle to control hemorrhage while the repair was done without cardiopulmonary bypass. She survived and was discharged to home with a normal echocardiogram
The Use of the Fogarty Catheter in 1998
Authors: Hill B. , Fogarty T. J.
Published: September 2024

Catheter-mediated thromboembolectomy has evolved over the last three decades along with changes in vascular disease patterns. As in situ arterial thrombosis has become more common both in natural arteries and prosthetic grafts, changes in mechanical thromboembolectomy have been necessary to optimize treatment strategies. A variety of devices and techniques are now available for transluminal clot removal including the original thromboembolectomy catheter, newer adherent clot catheters, graft thrombectomy catheters, thru-lumen balloon catheters and methods that involve fragmentation and removal of fresh thrombus by hydrodynamic means.
Screening for Asymptomatic Carotid Stenosis in Patients with Peripheral Vascular Disease: A Prospective Study and Risk Factor Analysis
Authors: Cheng S. W. K. , Wu L. L. H. , Ting A. C. W. , Lau H. , Wong J.
Published: September 2024

Screening for asymptomatic carotid artery stenosis using color flow duplex scan was performed on 186 Chinese patients with peripheral vascular disease. They consist of 121 male and 65 females, with a mean age of 70.6 years. A carotid bruit was present in 43 (23.1%) of the patients. Internal carotid artery stenosis of 70% or greater was detected in 46 patients (24.7%) including six total occlusions. Another 79 patients (42.5%) had internal carotid artery stenosis in the 30–69% range. Significant internal carotid artery stenosis was associated with age, male sex, the quantity and duration of smoking and a carotid bruit: and inversely with cholesterol, triglyceride and VLDL. Age, the number of cigarettes consumed per day, and carotid bruit were independent significant predictors of ≥ 70% internal carotid artery stenosis on logistic regression analysis. The degree of internal carotid artery stenosis is more severe in patients with a carotid bruit, and correlated positively with age ( P < 0.01), the number of cigarettes smoked ( P = 0.04), and the duration of smoking ( P = 0.03). Multiple linear regression analysis showed that only the age of the patient bears a significant relationship with the degree of internal carotid artery stenosis ( P < 0.01). There was no relationship between the degree of lower limb ischemia with carotid stenosis. The prevalence of ≥ 70% internal carotid artery stenosis in a high risk population with peripheral vascular disease was 24.7%. Routine duplex screening is worthwhile in this group of patients, particularly in male, elderly smokers.
Subclavian Artery Aneurysm: An Unusual Manifestation of Takayasu's Arteritis
Authors: Chiou A. C. , Fantini G. A.
Published: September 2024

Complications of Takayasu's arteritis are typically ischemic in nature because of progressive arterial narrowing, with aneurysm formation occurring as a late sequela. A 30-year-old Black woman with Takayasu's arteritis presented with a progressively enlarging and tender pulsatile mass at the base of the right neck. Upper extremity pulses were intact. Chest computed tomography and aortography demonstrated a 6-cm aneurysm of the right subclavian artery, which originated at the takeoff from the innominate artery, which was also ectatic. There was no evidence of occlusive disease. An operation was performed via the median sternotomy with transverse extension into the supraclavicular area. The distal innominate artery, proximal common carotid artery and entire subclavian artery were resected and replaced with a bifurcated stretch ePTFE graft. The aneurysm was without thrombus or atherosclerosis and all vessels were extremely thick-walled. Pathology revealed healed/healing nonspecific arteritis. Aneurysm formation is an unusual complication of Takayasu's arteritis. Previously reported sites of aneurysm formation include the thoracic and abdominal aorta, the innominate, carotid and superior mesenteric arteries, but not the subclavian artery. Of 28 patients enrolled in a recent clinical protocol at the National Institutes of Health with Takayasu's arteritis, none had aneurysm formation. The authors report surgical repair of a large aneurysm of the right subclavian artery in a young Black woman with Takayasu's arteritis.
Estrogen and Progesterone Receptors in Normal and Varicose Saphenous Veins
Authors: Mashiah A. , Berman V. , Thole H. H. , Rose S. S. , Pasik S. , Schwarz H. , Ben-Hur H.
Published: September 2024

The presence of estrogen and progesterone receptors was investigated in the walls of normal and varicose veins. Cryostat sections from the saphenous veins of 29 normal individuals, and varicose and normal vein segments of 32 patients with varicose veins, were stained with anti-estrogen or anti-progesterone receptor antibodies. Nuclear stain intensity was scored by three independent observers. Receptors to both hormones were detected in the nuclear regions of the intima and media in females and males. In the adventitia, estrogen and the progesterone receptors were found only in nuclei of the vasa vasorum. Estrogen receptor levels were lower in non-varicose segments of varicose veins compared with normal veins. In varicose segments, estrogen receptors were more abundant than in the non-varicose parts of the same vein, especially in females. Similarly, progesterone receptor levels in the non-varicose portions were higher in females. These gender differences may be related to hormonal action. However, these differences may also be age related. These findings may be related to the involvement of sex-hormones in varicosis, by mechanisms as yet unknown.
Recurrent Varicose Veins: Patterns of Reflux and Clinical Severity
Authors: Jiang P. , van Rij A. M. , Christie R. , Hill G. , Solomon C. , Thomson I.
Published: September 2024

Duplex scanning was used to determine patterns of recurrent varicose veins in 264 limbs and to relate these to clinical factors. All limbs had previously undergone sapheno-femoral ligation in the groin. A recurrent sapheno-femoral junction was present in 172 (65.2%). Incompetence was found in long or short saphenous veins in 232 limbs (87.9%), perforators in 176 (66.7%). and deep veins in 156 (59.1%). Residual long saphenous veins were present in 43.4% and 73.6% of limbs that were with and without stripped long saphenous veins, respectively. An incompetent thigh perforator was present in 14.0% and 15.3% of these two groups, respectively. Multiple sites of incompetence were observed in the majority (75.4%). In general, no particular reflux pattern in the groin was related to an increased incidence of ulceration. However, ulceration was more frequent in limbs with deep reflux to knee or below-knee levels. None of those with isolated reflux in the groin that was unrelated to the common femoral vein had ulceration. The pattern of reflux was unrelated to striping or non-striping of the long saphenous veins and the time since initial surgery. A history of deep vein thrombosis was invariably associated with some degree of deep reflux. A system of recurrent patterns in the groin is described for the purpose of surgical audit. In 15.1%, recurrence was attributed with some confidence to inadequate surgery. These results indicate that the pattern of recurrence is highly variable and often with multiple sites of incompetence. In a few instances, the pattern of recurrence was associated with specific clinical factors. A full work-up including duplex scanning is recommended.
Diagnostic and Surgical Approach of Innominate Artery Saddle Embolus
Authors: Hillmann R. , Schlensak C. , Sarai K. , Blum U. , Beyersdorf F.
Published: September 2024

Patients with an acute arterial occlusion of the right upper extremity and absent axillary pulse should have a Doppler scan examination before a balloon catheter embolectomy is performed. If there is no arterial pulse detectable, an angiography should be performed afterwards to localize the embolus. In the case of a proximal arterial occlusion of the right arm, the authors recommend this procedure to prevent an embolus dislocation by catheter embolectomy and subsequent cerebral embolization. For direct surgical embolectomy the authors recommend a supraclavicular incision.
Advantages of Surgical Closure of Patent Ductus Arteriosus without Tube Thoracostomy
Authors: Bolourian A. A.
Published: September 2024

Between June 1994 and June 1995, 30 patients aged 6 months to 21 years (mean age, 6.38 years) underwent surgical closure of patent ductus arteriosus without tube thoracostomy. Comparison of surgical results with the results of 143 previous consecutive cases of patent ductus arteriosus performed with the conventional technique using chest tube thoracostomy revealed a statistically significant difference in postoperative temperature, need for narcotics, hospital stay and certain complications such as pneumothorax. There was no mortality and late results were excellent. It is concluded that patent ductus arteriosus closure without tube thoracostomy is feasible and can be safe, more comfortable and more cost effective than the standard procedure.
Left Subclavian-Aortic Bypass Grafting in Primary Isolated Adult Coarctation
Authors: Elkerdany A. , Hassouna A. , Elsayegh T. , Azab Sh. , Bassiouni M.
Published: September 2024

In the adult patient, bypassing the coarcted segment with a tube graft has been described, among others, as a method of repair in re-do cases and in high-risk patients. Since 1992, and owing to its simplicity, it has become our elected approach in all adult cases. Twenty-two patients (mean age 22.8 ± 7.18 years) with isolated aortic coarctation distal to the left subclavian artery were primarily treated with left subclavian-lower descending thoracic aorta bypass using a Hemashield woven double velour graft. There was no hospital mortality nor major postoperative complications. The patients were followed-up for a mean period of 2.36 ± 1.29 years (range 1–5 years). Systolic blood pressure as well as the pressure gradient across the coarcted segment dropped significantly from 181.82 ± 15.7/65.7 ± 13.3 mmHg to 124 ± 13.63/7.41 ± 6.49 mmHg ( P = 0.009 and 0.001). Sixteen patients (72.6%) were recorded to be symptom-free and normotensive and seven patients (31.8%) did not show any residual pressure gradient when last seen. The postoperative systolic pressure correlated positively with its preoperative value ( P = 0.017) as well as with patient age ( P = 0.015). Partial correlation, however, suggested that advanced age upon surgery was the determinant factor responsible for residual postoperative systemic hypertension ( P = 0.007). Besides being simple, the procedure is low-risk, permits a significant drop in pressure gradient and improves systolic hypertension through an intermediate follow-up period.
Influence of Normothermic Systemic Perfusion Temperature on Cold Myocardial Protection during Coronary Artery Bypass Surgery
Authors: Birdi I. , Caputo M. , Underwood M. , Angelini G. D. , Bryan A. J.
Published: September 2024

Objective:

To determine the effect of normothermic systemic perfusion on myocardial injury when using cold cardioplegic techniques in patients undergoing coronary artery bypass surgery.

Method:

Sixty six patients with stable angina pectoris were prospectively randomized into three groups according to cardiopulmonary bypass temperature: hypothermia (28°C, n = 22). moderate hypothermia (32°C, n = 22) and normothermia (37°C, n = 22). All patients received cold antegrade crystalloid cardioplegia and topical cooling with saline at 4°C. Serum samples were collected for troponin T and I estimation preoperatively, 4 hours after removal of the aortic cross clamp, and 12, 24, 36 and 48 hours postoperatively. In addition, serial electrocardiographic studies were undertaken on days 1, 3 and 5.

Results:

Patients were similar with regard to preoperative and intraoperative characteristics Four patients showed ECG changes typical of perioperative myocardial infarction but remained clinically well (28°C, one; 32°C, one; 37°C, two). In the remaining 62 patients, serum troponin T increased significantly from a mean baseline value of 0.02 ng/ml to 1.5 ± 0.9 ng/ml 4 hours after removal of the aortic cross-clamp ( P < 0.0001). Similarly, troponin I increased from 0.06 ng/ml to 0.63 ± 0.47 ng/ml 12 hours after reperfusion ( P < 0.0001). Serum concentrations of both markers subsequently declined with time but remained higher than preoperative values at 48 hours. There were no differences between the three groups with respect to peak and cumulative serum troponin release. Normothermic cardiopulmonary bypass did not compromise the efficacy of cold myocardial protection when assessed by serum troponin concentrations in low risk patients undergoing coronary revascularization.
Retrocaval Passage of Coronary Bypass Grafts to the Inferior Left Ventricle Wall
Authors: Deleuze P. H. , Bical O. M. , Uva M. S.
Published: September 2024

Revascularization of the inferior side of the left ventricle is performed most often with aortocoronary free grafts. This article describes a technical improvement for anatomical fit and gain of length of these grafts by directing them to the right side of the heart after a passage behind the inferior vena cava.
Third Degree Atrio-Ventricular-Block Caused by Malignant Non-Hodgkin's Lymphoma: An Unusual Indication for Epicardial Pacing
Authors: Aleksic I. , Herse B. , Busch Th. , Lotfi Sh. , Sîrbu H. , Dalichau H.
Published: September 2024

A 59-year old female patient presented with progressive dyspnoea, intermittent fever and third-degree atrio-ventricular-block. On echocardiography she had nodular deposits on the lateral wall of the left and in the entire right atrium. A computed tomography scan demonstrated extensive retrocardial tumour masses infiltrating both atria and the interatrial septum. The patient underwent a diagnostic lateral thoracotomy with concomitant epicardial pacemaker insertion. Histological examination revealed a centroblastic B-cell-lymphoma. The management of this patient is discussed and the literature reviewed.
Changes in Calf Muscle Function in Chronic Venous Disease
Authors: Yang Danian , Vandongen Yvonne K. , Stacey Michael C.
Published: September 2024

The aim of this study was to assess calf muscle function in patients with chronic venous disease and recently healed venous ulcers. Forty-nine consecutive patients with recently healed proven venous leg ulcers and 20 age- and sex-matched control subjects were entered into this study. Both patients and control subjects underwent duplex scan evaluation of their leg veins and isokinetic measurement for calf muscle strength and endurance. Calf muscle function was significantly impaired in patients with chronic venous disease compared with control subjects. Both peak torque/body weight (strength). P = 0.049 (CI 0.3–18.4%) and total work (endurance). P = 0.05 (CI 6.01–97.6 Nm) were reduced. This study has shown that patients with chronic venous disease have a significant impairment of calf muscle function compared with healthy control subjects. This study suggests that there is a need to evaluate whether a programme to improve muscle strength may be of benefit In both healing and preventing the recurrence of chronic venous ulcers.
Characterization of Cellular Density and Determination of Neointimal Extracellular Matrix Constituents in Human Lower Extremity Vein Graft Stenoses
Authors: Gentile A. T. , Mills J. L. , Westerband A. , Gooden M. A. , Berman S. S. , Boswell C. A. , Williams S. K.
Published: September 2024

Arterial restenosis has been attributed to a hyperproliferative smooth muscle cell response. Paradoxically, studies of human coronary atherectomy and vein graft stenotic lesions have demonstrated a relatively low nuclear proliferative rate with the majority of the neointimal mass consisting of extracellular matrix. The purpose of the present study was to characterize the cellular density and determine the relative composition of the extracellular matrix protein constituents in stenotic, human lower extremity vein-bypass graft lesions. Methods: Duplex surveillance of 148 consecutive infrainguinal bypass grafts identified 17 patients with 22 preocclusive autogenous vein graft stenoses (mean graft age 7 months). Morphological analyses of these stenotic lesions were compared with excised samples of 20 greater saphenous vein segments taken at the time of graft implantation from matched control patients. Intimal and medial areas were compared and cell density was determined with fluorescent nuclear (Bisbenzimide) staining. Differential light microscopy with pentachrome staining was performed to determine the relative percent composition of intimal matrix constituents by stereological morphometric (point-count) techniques. Results: The intimal areas for control and stenotic vein segments were 1.64 × 106 μm2 and 3.85 × 106 μm2, P < 0.0001, whereas the intimal nuclear densities (cells/unit volume) were 1.42 × 103 and 1.70 × 103 cells/μm2, P = 0.03. respectively. The corresponding medial area and medial nuclear densities were 5.01 × 106 μm2, 3.31 × 106 μm2; P = 0.08. and 2.27 × 103, 3.29 × 103; P = 0.001, for control and stenotic specimens, respectively. The intima: Media area ratios were much greater, whereas the intimal and medial cell densities were only slightly greater in the stenotic compared with control veins. The relative composition of intimal extracellular matrix proteins of stenotic vein graft segments consisted of 21% cellular (fibrous) material, 33% collagen, and 46% glycosaminoglycan ground substance. Conclusion: The intimal lesions responsible for lower extremity vein graft stenosis are more hypertrophic than hyperplastic. Therapies aimed at preventing arterial and vein graft restenosis may thus need to inhibit matrix biosynthetic processes in addition to cellular proliferation.
Management of Late Complications after Classic Fontan Procedure by Conversion to Total Cavopulmonary Connection
Authors: Conte S. , Gewillig M. , Eyskens B. , Dumoulin M. , Daenen W.
Published: September 2024

Classic Fontan procedures, such as atriopulmonary connection or atrioventricular connection, are associated with right atrial dilatation and several late complications. Seven patients with univentricular heart who presented with exercise intolerance ( n = 7), severely dilated right atrium ( n = 7) with pulmonary vein compression ( n = 3), atrial arrhythmias resistant to medical treatment ( n = 4), cyanosis ( n = 4), diffuse effusions and oedema ( n = 1), and protein-losing enteropathy ( n = 1), underwent conversion to total cavopulmonary connection 5.8–14.4 years after a previous atriopulmonary connection ( n = 6) or atrioventricular connection ( n = 1). A 14-year-old boy who, preoperatively, was in ventricular failure and a very poor state died early after conversion because of low cardiac output. All survivors had either marked or partial clinical improvement with regression of cardiomegaly, absence of pulmonary vein compression or cyanosis, and recovery of sinus rhythm. Conversion to total cavopulmonary connection appears to be effective in the treatment of late complications after classic Fontan procedures. It should be considered early in symptomatic patients, before significant ventricular dysfunction and clinical deterioration ensue.
A Right Atrial Approach in Redo Postinfarction Ventricular Septal Defect
Authors: Frassani R. , Gelsomino S.
Published: September 2024

Despite improvements in surgical techniques, post-infarction ventricular septal defect remains a surgical challenge that is associated with significant early and late mortality. Furthermore, the recurrence of the defect after primary correction occurs in ∼10–25% of patients, and the operative risk increases because of a difficult dissection that is often complicated by previous patent grafts. The repair of recurrent ventricular septal defect has generally been performed by ventriculotomy in the infarcted zone. The authors propose an alternative approach that, when the rupture is posterior, allows its complete visualization, and avoids any further ventriculotomy in an already impaired ventricle.
Corporate Governance, Market Competition and Performance of  Indian Banks
Authors: Bhatia Madhur
Published: September 2024

The purpose of the study is to determine how market competition and corporate governance affect bank performance (measured by profitability and asset quality). Additionally, it seeks to determine how market competition influences the governance and performance link in Indian banks between 2005 and 2022. The study primarily employs a technique of two-step system generalized method of moments, and a propensity score matching technique is applied to support our investigation. The study shows that adhering to corporate governance standards enhances bank profitability and decreases non-performing assets in India, while market concentration adversely impacts bank performance. Furthermore, the study indicates that corporate governance is more significant in low-market competition environments. The study reveals an intriguing ‘substitutive’ link between market competitiveness and corporate governance. Finally, it concludes that effective governance practices such as an effective board, transparency, board committees and shareholder rights are crucial during periods of declining profitability, poor asset quality and bank mergers.
Top end perinatal mental health consultation service: evaluation of services, patient demographics and psychosocial contributors to mental ill-health
Authors: Noel-Gough Laura , Kanakkahewa Nimalee , Mitchell David
Published: September 2024

Objectives

To understand the key descriptors of the Top End Mental Health Service, Northern Territory’s, perinatal mental health consultation service (PMHCS).

Method

A retrospective cross-sectional review of all referrals to the PMHCS in the 12 months period 1 January to 31 December 2021 inclusive was undertaken. The study was descriptive in nature.

Results

From January 2021 to December 2021, there were 266 women referred to the service. There was a large proportion of Aboriginal and Torres Strait Islanders. Mean age was 28.8 (SD = 6.04) years. A statistically significant difference was identified between the average age of the Aboriginal and Torres Strait Islander women ( n = 53, M = 24.6 years, SD = 6.31) which was significantly less than Caucasian women ( n = 161, M = 29.4037, SD = 4.982) and women of other cultural backgrounds ( n = 52, M = 31.154, SD = 6.792), p < .00,001. Sixty two percent of patients managed had a history of trauma with significantly more service contact.

Conclusion

This data gives insight into a unique population group. It also highlights the impact that trauma has on patient care and management.