bluuebunny/crossref_metadata_2025 huggingface dataset:
Between Idyll and Abyss: The Greek Land, as seen from the Ionian Islands
Authors: Güthenke Constanze
Published: May 2008

Here I turn to the vantage point of two writers of the Ionian Islands (until the 1860s outside the territorial confines of the new Greek state). Although both are considered ‘national’ poets in the canon of Greek literary history, they are in this study given a new reading that highlights their conceptual distance from any ‘homeland’. Andreas Kalvos's Odes, rich in allusions to European neoclassicism, were written, much as they should be read, with an eye to European philhellenic discourse. Dionysios Solomos, while silent on classical antiquity, ostensibly treats of specific Greek localities in his highly fragmentary, hybrid poetry (such as the ‘Hymn to Freedom’, or ‘The Free Besieged’); but he does so by relying on a practice of the symbol that renders the representation of the Greek land fractured to the point of absence.
1 Introduction
Authors: Guha‐Khasnobis Basudeb , Acharya Shabd S. , Davis Benjamin
Published: May 2008

Despite the scale of human suffering inflicted by malnutrition, hunger receives less attention than poverty by donors, lending agencies, and the research community. In this work, world hunger is addressed from a variety of perspectives that are new and relatively under-researched, including attempts to improve measurement tools, the applications of existing tools for empirical analysis using household data, and the impact of trade openness on national food security in developing countries. The book addresses hunger and food security at three distinct levels — national, household, and individual — and presents several technical, regional, and country case studies that facilitate comparisons.
10 Agricultural Support Measures of Developed Countries and Food Insecurity in Developing Countries
Authors: Hermann Michael
Published: May 2008

Many developing nations, especially the least developed countries, are subjected to recurrent spells of food insecurity. In order to understand food insecurity in these countries it is necessary to consider not only immediate or trigger-causes of food crises, but also its underlying or systemic causes. This chapter argues that the agricultural support measures of advanced countries may act as a systemic cause for food insecurity in developing countries. While the import of subsidized foods by developing countries and/or the provision of food aid by developed countries are frequently necessary options to address food crises in the short run, they can adversely affect economic development in the long run. Access to cheap foods can undermine agricultural production and contribute to the recurrence of food shortages. This chapter examines these developments and makes proposals to address them.
14 Food Retailing, Supermarkets, and Food Security: Highlights from Latin America
Authors: Arda Mehmet
Published: May 2008

The importance of supermarkets in the world food economy has increased radically since the early 1990s. They are now major sellers and buyers of food items not only in developed but also in developing countries. Urbanization and the liberalization of the services sector have been important facilitators of this process. This chapter examines the emerging importance of supermarkets in Latin America, and their impact on both producers and consumers.
Ghost Resurrected: Bulgar–Yugoslav Negotiations for Federation, and the British Response, 1944–1945
Authors: Livanios Dimitris
Published: May 2008

This chapter focuses on the turbulent Bulgar-Yugoslav relations in the second half of 1944 and Tito's attempt to construct a Balkan federation, with Macedonia as a federal unit. Given that the protection of Greece was the only major British strategic interest in the area, these developments alarmed Britain profoundly. It was feared that a South-Slav federation under Russia's tutelage would threaten the territorial integrity of the country by absorbing Greek Macedonia too, thus placing her into Russian orbit. The chapter analyses the Bulgar-Yugoslav negotiations for federation, highlights their major differences concerning its shape and the position of Macedonia in it, and details the British diplomatic intervention, which succeeded in preventing it from materializing.
Implicit Conceptions
Authors: Peacocke Christopher
Published: May 2008

An implicit conception is a state of tacit knowledge required for possession of a given concept. This chapter elaborates the notion of an implicit conception, argues for the existence of implicit conceptions, and presents a case for their significance in psychological and philosophical explanations involving the nature of concepts. It examines further the subclass of cases in which an implicit conception underlying a concept has a certain character: that in which its content specifies, or contributes to the specification of, the reference of the concept in question.
‘Another I’: Representing Perception and Action
Authors: Peacocke Christopher
Published: May 2008

The question of what it is to possess the concept of perception is also of interest to the philosophy of mind more generally. A perceiving thinker who has the capacity to appreciate that others also perceive is on the way to thinking of others as subjects like himself — to thinking of another person as ‘another I’, in Zeno's phrase. The chapter begins by considering the first-person case, that in which a thinker judges that he himself sees. After proposing a treatment of the first-person case, and some of its epistemic and metaphysical ramifications, it goes on to compare it with Evans's account. It discusses the relation between first-person and third-person ascription, and explains some developmental phenomena. Finally, the extension of the model presented to the self-ascription and other-ascription of action and intentionality is discussed.
Mental Action
Authors: Peacocke Christopher
Published: May 2008

This chapter explores the theory that the distinctive awareness that subjects have of their own mental actions is a form of action-awareness. Subjects' awareness of their own mental actions is a species of the same genus that also includes the distinctive awareness of bodily actions. The chapter begins by articulating some distinctive features of bodily action-awareness and then characterizing the range of mental actions. It argues that all of these distinctive features of action-awareness in the bodily case are present also for mental actions. It considers some of the attractions and consequences of the Principal Hypothesis; to draw upon it in an account of our understanding of our own and others' mental actions, in a way that accords with the role of reference and identity in understanding discussed in earlier chapters of this book; to apply it in the characterization of some pathological states; and finally to consider some aspects of its significance for the nature of first-person thought and rationality.
Conclusion
Authors: Peacocke Christopher
Published: May 2008

This concluding chapter presents a synthesis of discussions in the preceding chapters. Among these are that fundamental reference rules for concepts can provide a substantive account of understanding. They can support a realistic treatment of truth and reference, and can do so in a way that is superior to justificationist, pragmatist, and pure conceptual-role theories of content. Current issues in philosophy and its adjacent cognitive sciences that require a substantive theory of sense for its resolution are presented.
Expressivism
Authors: Wedgwood Ralph
Published: May 2008

Many philosophers think that internalism supports a non-cognitivist account of normative judgments, according to which these judgments do not count as genuine beliefs, but rather as non-cognitive states of some kind. Such non-cognitivist accounts of normative judgments naturally accompany an expressivist account of the meaning of normative statements. This chapter considers the prospects of such an expressivist theory, taking as its paradigm the most recent theory of Allan Gibbard. It is argued that this theory is vulnerable to a strengthened form of the objection that P. T. Geach derived from the work of Frege. This makes it plausible that expressivist accounts face insuperable problems, and so that both expressivism and non-cognitivism should be rejected.
The Normativity of the Intentional
Authors: Wedgwood Ralph
Published: May 2008

This chapter argues for a version of the idea of the normativity of the intentional. First, it explores a particular version of this idea in greater detail. According to this version of the idea, the nature of every concept is given, in part, by a requirement about how it is rational to use that concept; and to possess that concept, one must have some disposition to use it in accordance with the requirement of rationality that is built into the nature of the concept(a similar pair of claims would also be true of each of the various types of attitude — such as belief, desire, intention, and so on). The chapter then argues in favour of this idea; according to this argument, the possession of a concept is a cognitive power, and so cannot rest of any irrational disposition.
Non‐reductive Naturalism
Authors: Wedgwood Ralph
Published: May 2008

This chapter attempts to answer the central objection that many philosophers will raise against the idea (which was defended in the previous chapter) that there are irreducible normative facts. According to a plausible naturalistic conception of the world, the natural facts in some sense determine the fundamental nature of the world. But how can this idea of irreducible normative facts be reconciled with such a naturalistic conception of the world? A modest form of naturalism implies only that all contingent facts are realized in (and so also supervene on) natural facts. It is argued here that this view can be reconciled with the thesis that there are irreducible normative facts and properties (although the reconciliation requires some far-reaching reflections on the nature of the concepts of ‘essence’ and ‘metaphysical necessity’, and even on the question of which is the right modal logic for metaphysical necessity).
Christology and Coptic Art: Images of the Incarnation on Egyptian Bodies and Monuments
Authors: Davis Stephen J.
Published: May 2008

Human bodies were contested commodities in the ancient church, Early Christian writers frequently wrangled over the ethical implications of dress and bodily adornment, and sought to regiment various forms of physical interaction and movement within their communities, from sexual contact to pilgrimage travel. Bodies — and how they were used — functioned as privileged markers of Christian identity, as valuable capital in the complex economies of Christian discourse and practice. Nowhere was this more the case than in discussions about Christ's body and its relation to his divinity. This chapter examines visual representation of Christ's body among Coptic communities, and the relation that representation had to Egyptian Christian understandings of the Incarnation. It focuses on two particular contexts for such visual representation: (1) images of Christ on Coptic textiles and clothing, and (2) images of Christ on the walls of Coptic churches. In each of these two cases, the ritualized contexts for the wearing and viewing of christological images are explored.
‘[T]his Insanum Bellum, this mad Warre’
Authors: Donagan Barbara
Published: May 2008

This introductory chapter begins with a discussion of the similarities and differences between the English civil war and other European wars during the first half of the 17th century. It then explains the objective of the book, which is to examine what kind of war the English civil war was. An overview of the topics covered by the book is presented.
An Integrated War
Authors: Donagan Barbara
Published: May 2008

This chapter discusses the characteristics of the English civil war. The war was a mixture of the static and the mobile, combining innumerable sieges with peripatetic armies engaging in minor skirmishes and major battles. Soldiers were constantly on the move, with many gaining a wider knowledge of their country in the process. The experience of war was widely diffused, with the impact of soldiers and strangers on local populations intensified by the fact that most of the communities that experienced their presence were small. The lack of a linguistic barrier between fellow English speakers also enhanced and made distinctive the physical closeness characteristic of 17th century war.
Outside the Law?
Authors: Donagan Barbara
Published: May 2008

This chapter examines the observance of the laws of war. It considers the distinction between prejudice against certain groups and outlawry from the codes of war. For instance, Parliamentarian publicists may claim that ‘French, Irish, Papists’ were responsible for all the ‘plunderings, ravishings, butcherings, murtherings, firings, and depopulation’ inflicted on the English. However, in practice, neither religion, ethnicity, nor tradition antipathy was sufficient to justify abandonment of those laws. The English, like other nations, were chauvinist at best and xenophobic at worst. They employed a range of stereotypes of citizens of other countries, as of non-English-speaking residents of Britain, that confirmed in their minds their own moral and social superiority. It is argued that perfect observance of the laws of war could not be secured by self-interest, honour, or morality. Both sides in the English civil war recognized the disutility of abandoning rules directed to the cohesion of an orderly army and the preservation of a civil society, but they could not consistently control the conduct of either soldiers or civilians.
Men
Authors: Donagan Barbara
Published: May 2008

This chapter focuses on the soldiers in the civil war. It argues that soldiers constantly behaved better than unflattering convention predicted. Even raw troops could win praise for dogged resolution in adversity, while ordinary soldiers could show exemplary enthusiasm. The character of a solider, how soldiers failed, encouraging performance, and roundheads and cavaliers are discussed.
Colchester 1648: ‘The Mournfull City’
Authors: Donagan Barbara
Published: May 2008

This chapter details the siege of the city of Colchester, which was a focus of national attention when war was renewed in the spring and summer of 1648. It was a nasty, long, and major military operation that exposed parliamentarian shock, anger, and sense of betrayal, and royalist desperation.
The West and Islam
Authors: Black Antony
Published: May 2008

This history of political thought — philosophical argument and everyday attitudes — examines what the Western and Islamic approaches to politics had in common and where they diverged. Byzantium is also compared. In all three civilizations, political and religious ideas were intertwined and issues of ‘church and state’ were crucial. This book considers how various ancient and medieval thought-patterns did or did not lead to modern developments; and how sacred monarchy, justice — revealed or natural — the legitimacy of the state, and the role of the people were looked upon in each culture. The book examines in particular the period from the rise of Islam to the end of the European Middle Ages, but account is taken of all genres of political thought up to the present. Up to the mid-11th century, Europe, Islam, and the Byzantine world had more in common than is commonly thought. What made the West different was the papal revolution of the late 11th century, Europe's 12th-century ‘renaissance’ and the gradual secularization of political thought which followed; while Islam, after an early blossoming, interpreted its revelation more and more narrowly. With a few major exceptions (Ibn Rushd, Ibn Khaldun), Islamic political philosophy declined after c.1100. European or Western political thought developed more slowly, but it developed continuously. It underwent major transformations and encompasses a wide variety of opinions. These influenced both the Islamic world (except for fundamentalists) and the post-Byzantine world of Russia.
Introduction
Authors: Black Antony
Published: May 2008

Comparison between cultures throws light on each one. It helps to explain similarities and divergences. To do so effectively, one needs to compare all relevant genres and periods. There has been no systematic comparison between Western, Islamic, and Byzantine political thought, at least since Weber. Political thought here includes both philosophical argument and everyday beliefs. Each of these cultures was monotheistic and neoplatonic, but they applied these features differently.
3 Society: Tribe, Commune, and Nation
Authors: Black Antony
Published: May 2008

Islam retained clans and often tribes whereas Europe moved towards nuclear families. In Europe, significant social and political relationships were based on oath rather than kinship, whether between lords and followers (‘feudalism’) or among householders in city communities. Church and 'umma remained as universal societies. In Europe, territorial units of government became more entrenched, and, unlike in Islam, the nation sometimes became a political unit. Islam was well-disposed towards commerce. In Europe, the idea of the corporation as a legal body with specific legitimate powers favoured the city-state. In both societies, social inequalities and classes were justified, in Christendom by the organic metpahor, in Islam by a theory of the four social ‘orders’.
3 Inequality and Redistribution
Authors: Krugman Paul
Published: May 2008

At the time John Williamson introduced the famous concept of the ‘Washington Consensus’, discussions of economic inequality did not play a large role in economic debate. The focus instead was on macroeconomic stability and growth, with the assumption that progress on these fronts would benefit everyone. Today, given the evidence of widening inequality in many countries, coupled with disappointments on the growth front, inequality has become a more obviously crucial subject. This chapter summarizes the reasons for a renewed focus on inequality, our (limited) understanding of why it has increased in some developing countries, and what the implications for a ‘post-Washington Consensus’ policy consensus might be. Using Latin America as a case study, it focuses on how Washington Consensus liberalization policies failed to deliver broad-based gains. It concludes that what is now needed is not a reversal of liberalization, but rather deliberate policies such as aid programmes, to help the poor.
7 The Wild Ones: Industrial Policies in the Developing World
Authors: Amsden Alice H.
Published: May 2008

Globalization can only be realized by developing countries if they have their own nationally-owned companies that invest abroad. The devil lies in the details to assess the virtues for economic development of foreign multinationals versus private national firms. In perfectly competitive, labour intensive industries, both types of firms should be welcomed for their job formation. But in the broad range of mid-tech industries, where inputs are scarce and tacit technologies and brand-names act as entry barriers, one type of firm can ‘crowd out’ another type of firm. The best professionally-managed local companies outshine the multinational subsidiaries in terms of entrepreneurship, time to market, and an absence of bureaucracy. In high-tech, the type of research foreign multinationals undertake even in countries like China and India tend to be less innovative than what local leaders undertake. Governments should, and do (through loopholes in WTO law), promote private nationally-owned enterprises. The world is better as a result because as Third World companies thrive, there is more genuine competition.
10 The World Trading System and Implications of External Opening
Authors: Frankel Jeffrey A.
Published: May 2008

Countries can still reap substantial economic benefits from external opening — an estimated 0.3% increase in income over twenty years for each 0.01 increase in the ratio of trade to GDP. Non-economic effects of trade are more complicated. Taking the case of SO2 pollution, trade can be on net beneficial, while for CO2 the outlook is worse, absent effective global governance, due to the international free rider problem. This chapter considers what should be priorities for the form and content of trade negotiations. The conclusion is to favour multilateral negotiations, as in the WTO. The chapter's back-of-the-envelope attempt to take into account dynamic gains says that the increase in welfare from comprehensive multilateral liberalization, such as the Doha Round if it had been successful, might have been 2% of global income. Environmental issues increasingly need to be addressed through multilateral institutions as well; they cannot be addressed through the assertion of national sovereignty.
11 The World Trading System and Development Concerns
Authors: Khor Martin
Published: May 2008

This chapter deals with trade policy and the world trading system from a development perspective, and concludes with proposals for making the global trading system more development-oriented, beginning with a re-orientation of the WTO. As trade is a means to development, not an end in itself, the Organization's policies should be judged not on whether they are ‘trade-distorting’ but whether they are ‘development-distorting’. Second, the WTO must make structural changes to compensate for the handicaps of developing countries in the WTO system; reciprocity among members with different capacities leads to unequal outcomes. Thirdly, developing countries need policy space, and must be allowed to consider national treatment, subsidies, and tariffs when these are development-inducing. Finally, the WTO should stick to trade issues — not intellectual property and other non-trade issues. Other agencies exist to handle other issues. With these changes, the WTO could better play its role in the design and maintenance of fair rules for trade, and thus contribute towards a balanced, predictable international trading system which is designed to produce and promote development.
13 International Migration and Economic Development
Authors: Nayyar Deepak
Published: May 2008

This chapter situates international migration in the wider context of the world economy to analyze what it means for economic development, with an approach and focus which represent a departure from the conventional literature on the subject. It begins with a historical profile of international labour migration during the second half of the 20th century. It examines the underlying factors with an emphasis on structural determinants at a macro level. It argues that globalization has set in motion forces which are creating a demand for labour mobility across borders and is, at the same time, developing institutions on the supply side to meet this demand, to suggest that the ageing of industrial societies may reinforce this process through demographic change and population imbalances. In the international context, it highlights some important asymmetries — between the free movement of capital and the restricted movement of labour, legal migration and illegal immigration, migrants' rights, and labour standards — which need to be addressed. The essential point to emerge from the discussion is that migration has significant implications and consequences for development in home countries, not only for output and employment but also for growth and development. In shaping distributional outcomes, remittances are the most important channel of transmission, while the impact of international migration on income distribution within and between countries depends on the skills composition of migrants. The chapter suggests that it is worth contemplating a multilateral framework for immigration laws and consular practices that govern the cross-border movement of people.
14 The Future of Global Governance
Authors: Stiglitz Joseph E.
Published: May 2008

Today we have come to understand better not only why there is such discontent with globalization, but why globalization has not worked as well as it could for so many of the world's people. It is essentially a problem of governance. The international rules of the game are often unfair, and the international institutions are undemocratic and have pushed an ideology that has resulted in policies ill-suited to many developing countries. In spite of increasing global collective action, change has been slow. This chapter focuses on the forces that may actually lead to meaningful reform of global government, and discusses a few of the elements of the system of governance that may or should evolve. These reforms include increased transparency and democracy in the official and unofficial global governance institutions, improved financing of global public goods, better management of global natural resources and public knowledge, and the creation of a global legal infrastructure. Unless these reforms are made, the already palpable disillusionment with globalization will spread, with untold consequences, both for those in the developed and the less developed countries.
Diagnosis and Management of COPD
Authors: Lynch Jeannette
Published: May 2008

Chronic obstructive pulmonary disease (COPD) is characterized by an airflow obstruction and is caused by a mixture of small airways disease and emphysema. Emphysema is the breakdown of alveoli and results in a reduced area for oxygen transfer. ‘Small airways disease’ is the narrowing of the small airways due to chronic or repeated inflammation, scarring and blocking by mucous secretions. The contribution of emphysema and small airways disease to COPD varies between patients but the clinical significance of this is not yet known.
The Quality and Outcomes Framework
Authors: Simon Chantal
Published: May 2008

Introduction of the Quality and Outcomes Framework (QOF) with the General Medical Services (GMS) contract in 2004 brought a new dimension to target driven pay in general practice. QOF is a voluntary process for all surgeries in England and was introduced as part of the new GP contract.
Video-Assisted Thoracoscopic Splanchnicectomy for Pain Control in Chronic Pancreatitis
Authors: Huffman Lynn C. , Reed Michael F. , Howington John A.
Published: May 2008

Background

Management of pain in patients with chronic pancreatitis can be frustrating. The authors retrospectively evaluated their experience with video-assisted thoracoscopic surgery (VATS) for pain secondary to chronic pancreatitis.

Methods

From September 1999 to August 2004, 16 patients underwent VATS for pain associated with chronic pancreatitis. Data were collected retrospectively.

Results

Eight patients were female and 8 were male. Their ages ranged from 17 to 81 years, with a mean age of 40 years. There were 22 VATS splanchnicectomies performed: 7 right, 10 left, and 5 bilateral. The average operative time was 75 minutes for right VATS splanchnicectomy, 86 minutes for left VATS splanchnicectomy, and 88 minutes for bilateral VATS splanchnicectomies. The average length of stay (LOS) was 2.6 days after right VATS splanchnicectomy, 2.2 days after left VATS splanchnicectomy, and 1 day after bilateral VATS splanchnicectomies. Two cases were nonelective and not included in the determination of LOS. No postoperative complications occurred in any of the patients admitted for elective operations. Postoperative mortality was zero. Complete resolution of pain occurred in 4 patients (25%): 1 right splanchnicectomy, 1 left splanchnicectomy, and 2 bilateral splanchnicectomies. Total pancreatectomy with islet cell transplant was subsequently performed in 5 patients (31%), who improved but then had recurrent pain. Continued chronic pain managed with nonsteroidal antiinflammatory drugs and narcotic analgesics was the result in 7 patients (44%)

Conclusions

Video-assisted thoracoscopic splanchnicectomy surgery may alleviate pain in patients with chronic pancreatitis. It can be performed with minimal morbidity and mortality, and has been safe and useful in the workup, evaluation, and management of pain associated with chronic pancreatitis.
Skeletonized Radial Artery Graft Prepared with Phosphodiesterase-III Inhibitors Indicates Favorable Results Compared with Pedicled Radial Artery Graft in Angiographic Studies
Authors: Yamaguchi Shohjiro , Watanabe Go , Higasidani Kohichi , Tomita Shigeyuki , Iino Kenji , Ujiie Toshimi , Yamamoto Shinichiro
Published: May 2008

Objectives

The technique used to harvest the radial artery was modified, with improved results. Skeletonized radial artery conduits prepared with phosphodiesterase-III inhibitor were compared with pedicled conduits by angiography.

Methods

Isolated coronary artery bypass graft surgery that used the radial artery for conduits was performed on 83 consecutive occasions from March 2003 to February 2004. The mean age of the patients was 68 ± 7 years; 65% were male. The radial arteries were harvested randomly for skeletonized (group SPD and group SPa) or pedicled (group PPD). A phosphodiesterase-III inhibitor, olprinone hydrochloride, was used as an antispastic agent during harvesting of the radial artery for both in groups SPD and PPD. Papaverine was used in group SPa. Postoperative angiograms were performed within 1 month. Diameters of the radial artery were scaled at proximal, mid, and distal sections and averaged. Optical stenosis was measured as a percent stenosis value.

Results

There were no significant differences among groups SPD, SPa, and PPD in morbidity or mortality rates. Graft patency rates were 97.4% in group SPD, 98.6% in group SPa, and 95.4% in group PPD (P = 0.67). Diameters of the radial artery conduits were significantly wider in group SPD compared with group PPD (P < 0.001). Spasm and stenosis were less frequent in group PPD (P < 0.05).

Conclusions

Skeletonized radial artery grafting prepared with a phosphodiesterase-III inhibitor indicated favorable results in angiographic studies.
Patency Outcomes of Aortic Connectors
Authors: Zenati Marco A. , Sonel Ali , Hattler Brack , Shroyer A. Laurie , Collins Joseph , Messenger John , Baltz Janet H. , Mohr Lisa M. , Gabany Jennifer M. , Novitsky Dimitri , Grover Frederick
Published: May 2008

Objective

Controlled outcome analysis of mechanical aortic connectors for proximal saphenous vein bypass graft anastomosis is lacking. We report the clinical and angiographic outcome of patients receiving the Symmetry aortic connector (St. Jude Medical, Inc St. Paul, MN, US) within a multicenter, prospective, randomized study.

Methods

Twenty-five patients at 3 study sites received aortic connectors at the time of coronary artery bypass surgery. Protocol-defined angiographic follow-up was completed in 19 of 25 patients (76%) at time-points up to 14 months postoperatively; 32 connector anastomoses were evaluated in these 19 patients. Beating heart surgery was performed in 17 patients, and 2 were performed with cardiopulmonary bypass. Age was 69.7 ± 8.1 year; all patients were males.

Results

The connector anastomosis patency rate was 15.6% (5/32). There were no deaths during the follow-up period. Four patients (21%) suffered myocardial infarction and 2 additional patients (10.5%) required percutaneous coronary interventions; one of who required 3 percutaneous coronary interventions, the other received one percutaneous coronary intervention.

Conclusions

In this nonrandomized cohort of patients, occlusion rate with Symmetry connectors was significantly greater than anticipated. Patients who have received these connectors during coronary artery bypass surgery may require closer follow-up and evaluation. While the manufacturer has stopped producing this device, there has been no recall of the product, clinical support remains ongoing, and next generation connectors have now been marketed. Consideration should be given to discontinuation of the clinical use of Symmetry connectors.
Complex Bileaflet Mitral Valve Repair (Barlow's) Using the da Vinci Robotic Surgical System
Authors: Masroor Saqib , Nifong L. Wiley , Chitwood W. Randolph
Published: May 2008

Robotic mitral valve repair (RMVR) is less invasive and potentially more precise. However, RMVR lengthens both cardiopulmonary bypass and arrested heart times. In our initial experience, only posterior leaflet repair and/or annuloplasty were performed. With increasing experience, we have performed more complex bileaflet RMVR. A 50-year-old man presented with severe mitral regurgitation. Transesophageal echocardiography (TEE) demonstrated a complex bileaflet prolapse and preserved left ventricular function. Through a 4 cm working port and with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA) RMVR was performed. Details of the technique and patient's hospital course are described. The repair comprised closure of clefts between A3 and P3, quadrangular resection of P2, transfer of multiple chords from P2 to A2/A3 and a #38 Cosgrove-Edwards (Edwards Lifesciences, Irvine, CA) band annuloplasty. Nitinol U-Clips (Medtronic, Minneapolis, MN) were used to complete the annuloplasty. Postoperative TEE showed no mitral regurgitation. The patient was discharged on the third postoperative day. Cardiopulmonary bypass and arrested heart times were 3 hours and 29 minutes and 2 hours and 59 minutes, respectively. Complex bileaflet repair of mitral valve with Barlow's disease can be successfully performed with the da Vinci Robotic Surgical System. Long-term follow-up is needed to assess the durability of repair.
Initial Experience with Robotic Epicardial Off-Pump Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation
Authors: Casselman Filip , Bakir Ihsan , Brugada Pedro , Geelen Peter , Wellens Francis , Van Praet Frank , Gegrieck Ivan , Vermeulen Yvette , Vanermen Hugo
Published: May 2008

Objective

To evaluate the feasibility and results of isolated endoscopic pulmonary vein isolation for paroxysmal atrial fibrillation using robotics.

Methods

Between November 2004 and December 2005, 13 patients (38.5% female) underwent robotic pulmonary vein isolation at our institution. Mean age was 46.8 ± 8.4 years and mean preoperative duration of atrial fibrillation was 52.7 ±31.5 months. Indication for surgery was symptomatic drug-refractory paroxysmal atrial fibrillation or recurrence after percutaneous treatment (n = 3). Mean preoperative left atrial dimension was 38.5 ± 6.9 mm. The surgical procedure was performed off-pump as an isolated right chest approach. All procedures were performed using the Flex 10 microwave ablator (Guidant, Indianapolis, IN), which was positioned from the right side through the transverse sinus and around the 4 pulmonary veins. Postoperative drug regimen included sotalol and Coumadin. Mean follow-up was 8.5 ± 3.4 months.

Results

The procedure was successful in 11 patients. One patient needed conversion to median sternotomy for right pulmonary artery bleeding and a second patient had severe transverse sinus adhesions requiring conversion to a bilateral video-assisted small thoracotomy approach. No other morbidity occurred. Mean procedure time in successful cases was 2.7 ± 0.8 hours (range 1.7 to 4 hours). Permanent sinus rhythm was successfully restored in 10 of 13 patients (76.9% beyond 6 months). Nonsuccessful patients had markedly reduced symptoms and frequency of events. One patient required a left and another a right atrial flutter ablation during follow-up.

Conclusions

Robotic pulmonary vein isolation is a feasible procedure that has the potential to become a valid option in the treatment of paroxysmal atrial fibrillation.
Displacement of the Beating Heart with a Low-Profile Suction-Based Apical Positioning Device in a Closed Chest
Authors: Mykytenko James , Vassiliades Thomas A. , Vinten-Johansen Jacob
Published: May 2008

Background

Off-pump, multivessel, endoscopic coronary artery bypass requires cardiac displacement within an intact chest. The current study evaluated right ventricular performance and systemic hemodynamics while exposing the posterior surface of the heart using a novel, low-profile, apical suction-based cardiac positioner in a closed-chest, beating-heart model.

Methods

Six pigs underwent instrumentation with continuous monitoring of arterial pressure by fluid-filled transducer and cardiac output and coronary blood flow by ultrasound transit time flow probe. Right ventricular (RV) pressure-volume loops were generated by an impedance catheter. Heart rate was maintained between 80 and 100 beats per minute pharmacologically. The cardiac positioner displaced the heart endoscopically through a port. Data were obtained in 5 sequential phases: (1) baseline/free-beating, (2) positioner coaptation, (3) addition of Trendelenburg, (4) cardiac displacement with Trendelenburg, and (5) cardiac displacement without Trendelenburg.

Results

Cardiac displacement without Trendelenburg (Phase 5) resulted in a significant (P < 0.05) decrease in cardiac output, coronary blood flow, RV systolic pressure (RVSP), mean arterial pressure, RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) compared with baseline (Phase 1). With Trendelenburg added to cardiac displacement (Phase 4), all parameters improved, but only RVSP, mean arterial pressure, and RVEDV were comparable to baseline (Phase 1). There were no local complications from device coaptation.

Conclusions

The low-profile endoscopic cardiac positioner is safe and effective in the closed-chest, beating-heart porcine model. Nevertheless, cardiac displacement in a closed chest does cause impairment in ventricular performance that can be ameliorated by the addition of Trendelenburg and further technological progress.
Videothoracoscopic Resection of Benign Neurogenic Tumors of the Posterior Mediastinum
Authors: Ciriaco Paola , Negri Giampiero , Bandiera Alessandro , Casiraghi Monica , Ferla Luca , Torracca Lucia , Zannini Piero
Published: May 2008

Objective

Videothoracoscopy is becoming the preferred approach for the removal of neurogenic mediastinal tumors. Tumors extending into the spinal canal (dumbbell type) require a combined neurosurgical approach. The aim of the study was to evaluate the feasibility of videothoracoscopic resection of benign neurogenic tumors (BNT) of the posterior mediastinum, including dumbbell-type tumors, through a retrospective review of our experience.

Methods

Between January 1993 and November 2005, 30 patients underwent resection of a BNT of the posterior mediastinum at our institution. Twenty-five tumors developed in the costovertebral sulcus, and five were dumbbell type. Preoperative assessment included chest CT scan, nuclear magnetic resonance for dumbbell-type tumors, and spinal angiography when the tumor was located in the vicinity of the Adamkiewicz artery.

Results

Mean tumor size was 5.6 ±1.4 cm (range, 4 to 11). Videothoracoscopic resection was possible in 26 patients, 5 of whom had dumbbell-type tumors requiring a combined neurosurgical approach. Reasons for conversion to thoracotomy were pleural adhesions in one case and bleeding in three. Mean operative time was 215 ± 42 minutes (range, 180 to 280) for the patients with dumbbell-type tumors and 140 ± 55 minutes (range, 95 to 230) for those without. There were no operative and/or postoperative complications. Histology showed 25 schwannomas, 4 ganglioneuromas, and 1 neurofibroma. Mean postoperative stay was longer for the patients with dumbbell-type tumors (6.5 ± 1 versus 4 ± 1 day).

Conclusions

BNT of the posterior mediastinum, including dumbbell-type tumors, can be safely resected thoracoscopically. The feasibility of a videothoracoscopic approach should be assessed on the basis of the preoperative evaluation. Pleural adhesions and bleeding may determine conversion to thoracotomy.
Outcomes after Off-Pump Reoperative Coronary Artery Bypass Grafting
Authors: Morris Cullen D. , Puskas John D. , Pusca Sorin V. , Lattouf Omar M. , Cooper William A. , Vassiliades Thomas A. , Chen Edward P. , Thourani Vinod H. , Kilgo Patrick D. , Guyton Robert A.
Published: May 2008

Objective

Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG.

Methods

A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score.

Results

A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB.

Conclusions

OPCAB can be safely and effectively applied to reoperative CABG in selected cases.
Routine Off-Pump Coronary Artery Bypass: Reasons for On-Pump Conversion
Authors: Hirose Hitoshi , Amano Atsushi
Published: May 2008

Objective

To assess the feasibility of routine off-pump coronary artery bypass (OPCAB) and investigate risk factors for on-pump conversion.

Methods

Between July 1, 2002, and June 30, 2004, OPCAB was attempted for all patients who required isolated coronary artery bypass in our institution. The perioperative results of patients were prospectively entered into a structured database, and the results were analyzed to identify the risks of requirement for cardiopulmonary bypass.

Results

Off-pump coronary artery bypass was successfully performed in all but 9 patients, giving an OPCAB success rate of 97.3% (329/338). The reason for cardiopulmonary bypass was hemodynamic instability occurring during reoperative surgery in 7, and cardiogenic shock in 2. The OPCAB success rate was significantly higher in primary coronary artery bypass grafting (99.3%, 314/316) than in reoperative coronary artery bypass grafting (68.1%, 15/22; P < 0.0001), and higher in patients without cardiogenic shock (97.9%, 329/336) than in those with cardiogenic shock (0%, 0/2; P < 0.0005). Mean number of distal anastomoses performed under OPCAB was 3.5 ± 1.4. There were 2 hospital deaths (0.6%). During a mean follow-up period of 1.0 ± 0.4 years, 7 patients developed angina, which was treated with catheter intervention; there were no other cardiac events.

Conclusion

Routine OPCAB is feasible with acceptable short-term results. Patients undergoing reoperation or in persistent cardiogenic shock are more likely to require conversion to on-pump coronary artery bypass grafting.
Effects on Lung Function in Patients Undergoing Coronary Artery Surgery on versus off Cardiopulmonary Bypass: A Randomized Trial
Authors: Niranjann Gunaratnam , Asimakopoulos George , Madden Brendan , Cockerill Gillian , Thompson Matthew , Chandrasekaran Venkatachalam
Published: May 2008

Background

Coronary revascularization is associated with respiratory dysfunction and poor gas exchange postoperatively. Cardiopulmonary bypass (CPB) has been implicated as a possible explanation for this phenomenon. This study investigated respiratory function in patients undergoing coronary artery bypass grafting (CABG) on-CPB versus off-CPB to determine whether the off-CPB condition results in improved postoperative pulmonary function.

Methods

Forty patients were randomized into 1 of 2 groups: CABG on-CPB (group A) or off-CPB (group B). Pulmonary function tests, including spirometry and diffusion studies, were performed preoperatively and on postoperative day 5. Arterial blood gases on 100% oxygen were taken preoperatively (TP1), 15 minutes after sternal closure (TP2), and 3 hours postoperatively (TP3).

Results

The arterial partial pressure of oxygen (PaO2) on FiO2 1.0 decreased from 59.5 ± 11.5 kPa and 55.7 ± 12.2 kPaat TP1 to 39.5 ± 16 kPa and 39.7 ± 13 kPa at TP2 in groups A and B, respectively (P < 0.001), with no significant difference between groups. At TP3, the PaO2 partially recovered toward preoperative levels (P < 0.05). Spirometry revealed a significant reduction in FEV1 and FVC on the fifth postoperative day (P < 0.001), with no significant difference between groups. The corrected transfer factor for carbon monoxide reduced significantly in group A from 7.9 ± 2.5 mmolmin–1 · kPa–1 preoperatively to 5.1 ± 1.6 mmolmin–1 · kPa–1 postoperatively (P < 0.05). This reduction was not seen in group B.

Conclusions

Coronary artery surgery is associated with a marked reduction in lung function as measured by pulmonary function tests and PaO2. Diffusion studies revealed that on-CPB patients had significantly reduced diffusion capacities postoperatively compared with patients in the off-CPB group.
A Comparative Study of Imaging Techniques in Aortic Dissection, DeBakey Type I: Intraoperative Live Three- Dimensional Epicardial Echocardiography, Multiplane Transesophageal Echocardiography, and Multislice Computed Tomography
Authors: Mishra Manisha , Khurana Poonam , Meharwal Zile S. , Trehan Naresh
Published: May 2008

Objective

To compare the accuracy of intraoperative live 3-dimensional epicardial echocardiography, multiplane transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) imaging in the detection of thoracic aortic dissection, site of intimal tear, and involvement of arch vessel.

Methods

Of 24 patients studied from October 2003 to September 2004, 12 had aortic dissection. They were examined preoperatively with contrast material-enhanced MSCT and multiplane TEE. Intraoperative live 3-dimensional epicardial echocardiographic evaluation of the ascending aorta and arch was performed. Imaging results in terms of detection of aortic dissection, site of intimal tear, and involvement of coronary arteries and arch vessels were confirmed at intraoperative exploration by the operating surgeon as the reference standard.

Results

Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 92%, 92%, and 100% for live 3-dimensional epicardial echocardiography, multiplane TEE, and MSCT imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 92%, 58%, and 92%, and specificity was 75%, 50%, and 83%, respectively. For the detection of the site of intimal tear, sensitivity was 92%,92%, and 58%, and specificity was 83%,75%, and 50%, respectively.

Conclusion

Intraoperative live 3-dimensional epicardial echocardiography is as valuable as multiplane TEE and MSCT imaging in the detection of thoracic aortic dissection. In the assessment of the aortic arch vessel involvement, MSCT and live 3-dimensional epicardial echocardiography are superior (P < 0.05), whereas live 3-dimensional epicardial echocardiography and TEE are superior in detection of site of intimal tear (P < 0.05).