bluuebunny/crossref_metadata_2025 huggingface dataset:
Staff attitudes towards the provision of nutritional care to Alzheimer patients
Authors: Zahler Lucy P. , Keiser Alexis V. , Gates Gail E. , Holdt Candace S.
Published: June 2007

Patients with Alzheimer's disease (AD) are particularly vulnerable to many of the risk factors of malnutrition. The delivery of nutritional care to these patients is an essential component in reversing or averting the development of malnutrition in this population group. The attitudes of the staff involved in the care of these patients may greatly influence the quality of care provided. Staff of special care units (SCU) for dementia patients and of adult day care programs (ADC) filled out a questionnaire designed to determine their attitudes towards the provision of nutritional care to AD patients. SCU staff scored significantly higher (p < .05) than ADC staff in only two of the twenty attitude statements: “Iprefer feeding residents who are restrained” and “I am concerned about the nutritional status of the residents” which may be explained by the possible differences in the severity of the disease of the client population served. Overall, results of this survey indicate that staff of ADC and SCU have relatively positive attitudes toward the provision of nutritional care for those with dementia and that they enjoy situations that allow positive interactions with clients. These results suggest that staff may have the inclination to increase their nutritional care efforts and to participate in training programs designed to reduce or to avert the development of malnutrition in AD.
Balancing psychosocial and psychopharmacologic measures in Alzheimer's disease
Authors: Weiner Myron F. , Gray Kevin F.
Published: June 2007

The behavioral and emotional symptoms of Alzheimer's disease (AD) are frequently the most important clinical considerations for physicians, who can choose to employ behavioral/environmental (psychosocial) or psychopharmacologic measures to deal with such symptoms. The appropriate use of these modalities to treat behavioral/emotional symptoms isfacilitated by using a frame of reference that includes information as to where, when, and with whom symptoms occur, with what medication or medical condition, how often, and how troubling or dangerous to patient, caregiver; or others. It should also include patients' ability to communicate, learn and comprehend. This frame of reference can help clinicians appropriately balance their use of psychosocial and psychopharmacologic interventions with AD patients.
Intimacy: Nursing home resident issues and staff training
Authors: Hellen Carly R.
Published: June 2007

Expressions of intimacy involving nursing home residents with dementia are often ignored or handled with limitedfinesse. This article describes issues affecting residents, families and staff. A pre-admission intimacy profile and LifeStory outline is included. Reaction to self directed intimacy and considerations when responding to a confused resident 's involvement with a cognitively alert resident are described. Recommended guidelines for addressing intimate situations between residents with dementia are outlined. Understanding the effects on families and staff focuses the challenge of offering support and education. Creative staff training modules are included with practical caregiving suggestions.
Volunteers in partnership: An Alzheimer's rehabilitation program delivered by students
Authors: Arkin Sharon M.
Published: June 2007

This article describes a “partnered volunteering,” student-delivered language, and memory stimulation program for Alzheimer patients that is easy to replicate and administer low in cost, and beneficial to the patients, students, family members, and participating community agencies involved. The program took place during two consecutive semesters at the University of Arizona. Positive pre- to post-test patient language changes and improvements on memory test performance are reported. Twelve early stage Alzheimer patients-six each semester-were matched with 12 undergraduate speech and hearing and psychology students. The pairs were each assigned to 10 one-hour weekly sessions of volunteer service or other community activity meaningful to the patient. During each session, students engaged partners in 30 to 40 minutes of structured conversation-stimulating activities. During the second semester, four patients also worked with biographical memory tapes and quizzes produced and administered by their student partners.1-2 Parallel discourse samples were taken of subjects before and after participation. Small to massive gains in number of substantive on-topic statements produced were achieved by seven out of 11 subjects who completed the program: 9 percent, 14 percent, 48 percent, 58 percent, 93 percent, 161 percent, and 238 percent over baseline, respectively. Eight subjects improved on picture description and eight on proverb interpretation tasks. Three of the four patients who worked with biographical memory tapes substantially improved performance from pre- to post-training. All participants-patients, students, and caregivers-benefited effectively and socially.
Needs, morale and coping strategies of caregivers for persons with Alzheimer's disease in isolated communities in Canada
Authors: Bowd Alan D. , Loos Cynthia H.
Published: June 2007

This study reports perceived needs, morale and strategies for coping with stress for 68 caregivers of persons with Alzheimer's disease living in relatively isolated communities in Northwestern Ontario, Canada. Participants express needs for educational and social support, experience significant difficulties with morale, and employ coping strategies which reflect an inadequate social support system. Some implications for social policy are described.
The content and properties of the Caregiver Activities Time Survey (CATS): An outcome measure for use in clinical trial research on Alzheimer's disease
Authors: Clipp Elizabeth C. , Moore Michael J. , George Linda K.
Published: June 2007

The CaregiverActivities Time Survey (CATS) was developed in 1990, pilot tested and revised twice before its use in a long-term study of Mentaneo (velnacrine maleate), conducted by Hoechst Roussel Pharmaceuticals Inc. (currently Hoechst Marion Roussel Pharmaceuticals). The instrument yields ratio level data and, by relying on caregivers' reports of minutes per task, is more objective and theoretically less ambiguous than other subjective ratings. Overall alpha of the informal scale is .51 suggesting modest internal consistency which is not surprising given that caregiving tasks are more discrete than items on scales presumed to tap one dimension. Test-retest reliability of individual items suggests good reproducibility of scores over a J0-week period Criterion-related validity was demonstrated by the strmng relationships shown between the CATS and several measures of cognitive functioning. Longitudinal data support the CATS'sensitivity to change in disease severity. Ratings by a panel of experts suggest very good to excellent content validity of both informal caregiving andformal or paid caregiving CATS scales
Spouses' self-perceptions as caregivers: The influence of feminine and masculine sex-role orientation on caring for confused and non-confused partners
Authors: Wilken Carolyn S. , Altergott Karen , Sandberg Jonathan
Published: June 2007

This study examines the spousal caregiving system in search offactors which contribute to perceived caregiver competence in performing the daily tasks of caregiving. The maintenance of a competent caregiver is vital in preventing the breakdown of the caregiving system. Questionnaire data was collected from 23 husbands and 41 wives providing full time care for 25 confused and 39 non-confused spouses. Results indicate that having a masculine sex-role orientation is predictive ofthe caregiver having greater perceived competence. In addition, providing care for a confused spouse is predictive of less perceived competence. Implicationsfor practice and research are discussed
The concepts and benefits of dementia specific programming within an assisted living setting
Authors: Forbes Celeste S.
Published: June 2007

This paper focuses on the concepts, specifics and effects of dementia programming within an assisted living setting. The target population consists of 20 people, 60 years of age and older, who reside at Kensington Cottages, Rochester, Minnesota, a residential assisted living facility for people with Alzheimer's disease and other forms of dementia. The residents at Kensington Cottages are unable to live independently and require assistance with their daily cares in varying degrees. They also need to be provided with homemaker services and recreational stimulation. This 24-hour assistance is provided by staff caregivers; these residents do not require the degree of skilled nursing supplied in a nursing home.

The paper begins with an analysis of the concept of dementia programming. This concept is then applied to the specifics of the program which is presently being used at Kensington Cottages Rochester The effects of dementia specific programming are shown through case studies of two Kensington Cottages residents diagnosed with Alzheimer's disease. These case studies demonstrate the positive effects of dementia programming on individuals through program involvement, the results of which are analyzed through the eyes of family members. Further information is derived from a January 1996, Kensington Cottages Corporation survey of Kensington Cottages Rochester family members which elicits information concerning the general well being of their relatives with dementia.
Perceptions of family caregivers of persons with Alzheimer's disease: Communication with physicians
Authors: Beisecker Analee E. , Chrisman Susan Kasal , Wright Linda J.
Published: June 2007

Telephone interviews with 104 family caregivers of Alzheimer's disease patients revealed that physicians progressively communicated more with caregivers and less with patients. We identified four levels of physician interaction with patients and five levels of interaction with caregivers. Caregivers wanted more information from physicians about expected progress of the disease, financial/legal issues, available services, research projects and their own personal needs. Half the caregivers had discussed advance directives with physicians, three-quarters of them had legal decision making powers for the patient, and one-third of the patients had living wills.
Housing and care variants for older people with dementia
Authors: van der Voordt Theo J.M.
Published: June 2007

In the Netherlands, as in many other countries, the field of housing and care for the elderly is changing dramatically. The prolongation of independence, care to measure, upgraded housing, and substitution from residential care to various degrees of external care are key-concepts in innovative initiatives. This article shows what this actually means for the housing of older persons suffering from dementia and who are no longer able to live independently. An examination of various projects leads to the formulation of focal points for further research and discussion. Finally the similarities and differences with developments in the United States will be briefly discussed.
Video RespiteM for cognitively impaired persons In nursing homes
Authors: Hall Lynn , Hare Jan
Published: June 2007

The purpose of this study is to examine the usefulness of Video Respite™ in reducing agitated behaviors and increasingpositive social behaviors in cognitively impairednursing home residents. Video RespiteTM is a series of 10 videotapes specifically designed to capture long term memory and maintain the attention ofpatients with dementia. Remembering when, a 21-minute Video Respite™ tape was utilized as the intervention. For this study, 36 residents in three nursing homes were observedpre-, during andpostintervention. Findings revealed that the video was not significantly effective in reducing agitation; however, it was significantly effective in increasing positive behaviors during the intervention. We offer suggestions to practitioners for use of this video in the context of nursing homes
Slowly progressive aphasia heralding dementia
Authors: Nagaratnam Nages , Nagaratnam Kujan
Published: June 2007

Controversy still surrounds the issue of whether slowly progressive aphasia should be grouped with the dementias or if it constitutes a disease entity. Three patients with slowly progressive aphasia were studied in relation to their progress and evaluation. Initially all three had a non-fluent aphasia with relative preservation of non-verbal cognitive abilities and activities of daily living (ADLs). The diagnosis of slowly progressive aphasia in our patients predicted a course of illness with increasing attrition of cognitive abilities and occurrence of behavioral and neurological deficits embedded in the language dysfunction, culminating in dementia. The progression was not uniform. Slowly progressive aphasia reflects a manifestation of different neurodegenerative processes in this study.
Procedural discourse of men and women with Alzheimer's disease: A longitudinal study with clinical implications
Authors: Ripich Danielle N. , Carpenter Brian D. , Ziol Elaine W.
Published: June 2007

Measures of procedural discourse, verbal instructions that tell how a task is accomplished, in 60 persons with Alzheimer's disease (AD) (29 men, 31 women) and 50 non demented elderly persons (21 men, 29 women) were compared at entry and 18 months later The measures included seven linguistic elements (statements, abandoned utterances, mazes, number of different words used in relation to total words, length of utterances, questions, and interrupted utterances) and four procedural elements (essential steps, optional steps, off topic utterances, and repetitions of steps). Gender patterns were examined in both groups over time. Results showed that AD subjects used fewer statements and produced longer utterances; AD subjects provided fewer essential and optional steps; AD subjects showed a sharp decline over time with fewer statements, more questions, and fewer essential steps. AD men and women performed similarly. Clinicians can gain significant information about language and cognitive function of persons with AD by including procedural discourse in the evaluation protocol.
Continuing or refusing to care: The meaning of placing a spouse in long term care
Authors: Tilse Cheryl
Published: June 2007

A recognition that caregiving takes place within the context of a relationship and a history raises the issue of the meanings of caregiving within these contexts. This paper reports on in-depth interviews with 18-spouses exploring the meaning of placing and visiting a long term partner in residential care. The research concludes that, for spouse carers, an understanding of how the transition is framed by the decision-making process, the actual relocation and the prior caregiving history is essential to understanding the impact of the placement and the stress associated with visiting. A comparison of the reports of carers of spouses with dementia with those of spouses who cared for a physically disabled partner suggests that the former experience the transition differently because it is more likely to be constructed as a refusal to, rather than a continuation of, care for a long term partner.
Effects of peripheral tactile nerve stimulation on affective behavior of patients with probable Alzheimer's disease
Authors: Scherder Erik , Bouma Anke , Steen Louis
Published: June 2007

In the present study, the hypothesis was tested that peripheral tactile nerve stimulation by massage would improve various aspects of affective behavior in patients with probable Alzheimer's disease. It was assumed that peripheral tactile stimulation might activate higher-level brain structures (e.g. the hypothalamus). The present study revealed that patients who were stimulated with tactile stimulation felt less depressed, less anxious, more well tempered, and were more alert. Apart from that, their personal orientation and their environmental orientation in place improved, they were more interested in social contacts and they participated more in activities of daily living. However, the observed effects could not be maintained over a period of six weeks following treatment.
Latent grief: The unique and hidden grief of carers of loved ones with dementia
Authors: Dempsey Marge , Baago Sylvia
Published: June 2007

This paper provides a preliminary model of latent grief, the very unique and hidden grief experience of family caregivers of individuals with dementia. This model is based on a critical review of both grief and dementia care literature, as well as our own clinical experience in working with these families. The model describes three dimensions of loss and a number of dynamics that contribute to the latency of the grief process. We see latent grief as a major factor in caregiver stress and burnout, and believe that an understanding of this process will help to validate the ongoing grief that is part of the caregivers' experience. This will allow caregivers to recognize that their emotional turmoil, which they perceive to be a result of the burden of care, is also in large part due to the losses they endure on a daily basis.
Improving nursing home quality of life: Residents helping residents
Authors: Oleson Marjorie , Torgerud Rita , Bernette Doris , Steiner Patricia , Odiet Marta
Published: June 2007

Is it possible to have a positive impact on the quality of life (QOL) of nursing home residents? This pilot project tested a goal-focused intervention designed to improve QOL. In a sample of nursing home residents with cognitive impairments, investigators compared outcomes of residents who experienced the intervention as pairs with those who experienced it as singles. To various degrees, all 16 male residents (mean age = 66.6) who participated in the project attained individualized goals. Pre- to post-intervention, mean ratings for QOL measures increased for the total group, with the exception of perceived health, which decreased slightly. Pairs had greater frequency of increased ratings than singles. Further, nurses reported pairs initiated social and helping behaviors more frequently than singles.
Psychiatric and behavioral aspects of dementia of the Binswanger type
Authors: Nagaratnam Nages , Nagaratnam Kujan
Published: June 2007

Binswanger's disease or subacute arteriosclerotic encephalopathy is characterized by diffuse demyelination of the white matter together with lacunar lesions in the basal ganglia and brain stem. Clinically it is a dementing illness associated with vascular riskfactors together with varied clinical and radiological abnormalities. The clinical features of Binswanger's disease are highly variable and the psychiatric and behavioral manifestations have been less well described. Review of the literature together with the study offour cases revealed four symptom-clusters, namely, late-onset paranoid psychosis, confusional state, depression and a behavioral syndrome of the frontal lobe type. However, the symptomatology cannot be regarded as mutually exclusive since features may overlap. The symptoms may precede the intellectual deterioration and motor disturbances that are seen with Binswanger's disease. White matter lesions and, hence, cortical-cortical and cortical-sub-cortical connectivities in the genesis of psychosis, is potentially an interesting topic.
An overview of Therapeutic Touch and its application to patients with Alzheimer's disease
Authors: Griffin Randy L. , Vitro Evelyn
Published: June 2007

Therapeutic Touch, a modern application of the ancient technique of “Laying on of Hands, “ has proven to be a successful adjunct to current medical treatments, ranging from post-operative pain control and tension headaches2 to anxiety reduction in hospitalized cardiovascular patients.3 While Therapeutic Touch has gained acceptance and has been integrated into many major medical centers, it has not been widely used or documentecl with people afflicted with Alzheimer's disease. The AlZheimer's Resource Center of Connecticut has trained staff (and alsofamilies of patients) in the practice of Therapeutic Touch, beginning with a six-month training periodfor staff in July 1996. During this time, staff performed the technique strictly on each other to learn and refine their skills. In February 1997, the group began to perform Therapeutic Touch on patients. On a case-by-case basis, staff have observed that, following treatments of Therapeutic Touch, patients have demonstrated visible signs of well-being and relaxation-often leading to sleep. Staff also found Therapeutic Touch a way to positively forge emotional connections with patients who are verbally uncommunicative and who sufferfrom varying degrees of dementia.
Effect of light therapy upon disturbed behaviors in Alzheimer patients
Authors: Rheaume Yvette L. , Manning Barbara C. , Harper David G. , Volicer Ladislav
Published: June 2007

Alzheimer's disease (AD) causes sleep and behavioral disturbares which may be related to abnormalities of circadian rhythms caused by damage of the suprachiasmatic nucleis. Exposure to bright light may compensate for this danlage by improving synchronization, timing and amplijude of circadian rhythms. Three case studies, presented in this paper, demonstrate the beneficial effect of light therapy on sleep and one of the cases also suggests that light therapy may be effective in the treatment of agitated behavior. The clinical observations also suggest a need for increased level of lighting in long term care facilites.
Neuropsychological correlates of wandering in persons with Alzheimer's disease
Authors: Edgerly Elizabeth S. , Donovick Peter J.
Published: June 2007

Dementia is a common disorder affecting an estimated 20 to 47 percent of persons over the age of 85.1 In addition No the pervasive cognitive deficits found in dementia, various behavioral disturbances are common.2 Wandering is one of the most troubling behaviors associate with dementia and has been found to lead to institutionalization and increased risk for injury. It continues to Tee common practice for wanderers to be physically or chemically restrained in order to prevent them from leavings home. This practice leads to extreme limitations on nobility and freedom for the client as well as extra demands on caregivers. To develop less restrictive and efficient interventions it is essential to understand how to assess, predict, and alter wandering patterns.4 We examined the relationship between cognitive impairments and wandering. Neuropsychological tests were administered to 29 residents of two special care units. Exiting attempts, the level of activity, and staff ratings of wandering were correlated with measures of global impairments (as measured by the Mini Mental State Examination) as well as focal deficits (assessed by the Token Test, the Benton Visual Retention Test-revised, the nine item dementia form of the California Test of Verbal Learning, and the Information Subtest of the WAIS-R).

The Mini Mental State Examination was the best predictor of staff ratings of wandering. Poor performance on the CVLT-AD best predicted the level of activity. Exiting did not significantly correlate to staff ratings of wandering or cognitive deficits. Data were analyzed also by means of a principal components analysis and entered into a multiple regression equation. Neuropsychological tests loaded heavily on one factor relating to global deterioration which was predictive of staff ratings of wandering as well as behavioral observations of activity. Exit-seeking behavior was not associated with this index of the severity of dementia.
Delays in the diagnosis of dementia: Perspectives of family caregivers
Authors: Boise Linda , Morgan David L. , Kaye Jeffrey , Camicioli Richard
Published: June 2007

Obtaining a diagnosis of dementia for a relative can be a protracted and anxious time for family members. This paper reports results from a focus group study and a subsequently mailed survey of family caregivers on factors which delayed obtaining a diagnosis for a dementing illness. The average time between initial symptom recognition and diagnosis was 30 months. Four kinds of factors were identified as delaying diagnosis, including the caregiver's lack of knowledge or reluctance to seek help, and patient, family, and physician-related factors. Of the 57 percent of survey respondents who reported a delay of at least 12 months between initial symptom recognition and diagnosis, 68 percent reported at least one factor related to their interaction with physicians. Qualitative data provide insight into family caregiver perspectives on factors delaying diagnosis.
Intact social, cognitive ability, and selfhood: A case study of Alzheimer' s disease
Authors: Sabat Steven R. , Collins Michelle
Published: June 2007

An in-depth case study of the discourse of an Alzheimer's disease (AD) sufferer reveals a variety of intact social and cognitive abilities as well as intact manifestations of selfhood as viewed from a social constructionist point of view. Intact social and cognitive abilities included those which have been referred to by Kitwood and Bredin as being indicators of relative well-being— indicators understood to be abilities typically found among the healthy, and whose presence thus signals common ground between the healthy and the afflicted. Such abilities are found to exist despite the sufferer's severe losses of cognitive function as measured by standard tests. Possible brain mechanisms supporting such intact abilities are discussed as well as the importance of recognizing such intact abilities. Such recognition can enhance the interaction between AD sufferers and caregivers.
What decisions are made by family caregivers?
Authors: Wackerbarth Sarah
Published: June 2007

Before decision support can be offered, we need to understand what decisions family caregivers face, which are considered challenging, and what causes the challenge. To address these issues, 100 caregivers were asked to:

• Indicate decisions faced;

• Describe challenging decisions; and

• Describe specific decision making questions.

Eighty surveys (80 percent) were returned and used in the analysis. The most prevalent decisions involved nursing home placement, communicating the diagnosis, and driving. The most challenging decisions involved providing care and relocation. The most prevalent question involved the timing of actions. These results will guide the design of decision aids for family caregivers.
Is there a Truly “Latino” Canon? Language, Literature, and the Search for Latino Identity and Power
Authors: Destephano Mark T.
Published: June 2007

Whereas some scholars see canon formation as a form of ideological control, discussions surrounding the essential works of what may be considered the literary canon of the “New Latino” will also contribute positively to the construction of a Latino cultural identity. Clearer articulation of the Latino literary heritage cannot but increase pride within the Latino community itself, and will also contribute to greater familiarity and acceptance in mainstream American culture, education, and politics.
Antecubital Jump Revisions for Salvaging Hemodialysis Grafts
Authors: Barone Gary W. , Hudec Wayne A. , Webb John W.
Published: June 2007

When expanded polytetrafluoroethylene (PTFE) is used for hemodialysis access, the authors' initial preference is a forearm loop arteriovenous (AV) graft below the antecubital fossa. However, AV graft thrombosis remains a significant problem caused mainly by venous outflow hyperplasia and managed often by either surgical or radiologic thrombectomy and angioplasty. At the time of surgical revision, the lack of an adequate superficial or deep forearm outflow vein below the elbow would require an antecubital (across the elbow) jump bypass revision to a more proximal upper arm vein to salvage the original forearm AV graft. With an increasing interest in monitoring the specific outcomes of the different surgical interventions used to salvage thrombosed hemoaccess, the authors reviewed their most recent 24--month experience of 32 antecubital jump revisions using ring reinforced PTFE. The mean primary patency of these antecubital jump revisions was 8.2 months with 18 presently patent. AV grafts revisions using antecubital jump grafts confer additional patency; they are another important method for salvaging thrombosed AV hemodialysis grafts.
Femoral Neuropathy Secondary to Nontraumatic Retroperitoneal Hemorrhage Following Intravenous Heparin Therapy
Authors: Razuk Alvaro , Coimbra Raul , Karakhanian Walter , Aidar Orlando Jorge
Published: June 2007

A 53-year-old woman with deep venous thrombosis who was receiving IV heparin developed a large retroperitoneal hematoma, which compressed the femoral nerve. Symptoms of femoral neuropathy were present and an abdominal computed tomography scan confirmed the diagnosis. The development of retroperitoneal hematomas following heparin IV use is rare; however, physicians must be aware of this complication, which may determine definitive neurologic deficits.
Transcutaneous Oximetry, Laser Doppler Fluxmetry, and Capillary Microscopy: Variability in Patients with Advanced Atherosclerotic Disease of the Lower Extremity
Authors: Klomp Houke M. , Wittens Cees H. A. , van Urk Hero
Published: June 2007

Purpose. Noninvasive methods of studying the microcirculation have been advocated in patients with advanced peripheral vascular disease to assess skin viability. Good reliability is a prerequisite for such parameters. This study was carried out to evaluate the variability of three methods: transcutaneous oxygen tension measurement (tc.pO9, diode laser Doppler fluxmetry (dLDF), and capillary microscopy (CM).

Methods. Repeated measurements were performed in 20 patients with restpain or severe disabling intermittent claudication (ankle/brachial pressure index <0.5). Tc.pO2 was performed on the dorsum of the foot and measured under baseline conditions, during 4 minutes of O2-inhalation, and during reperfusion after 3 minutes of tourniquet occlusion. dLDF was performed on the palmar skin of the hallux, at rest, and during reperfusion after 3 minutes of tourniquet occlusion. CM was performed at the nailfold of the hallux; capillary density, morphologic changes of the capillaries, and perfusion with fluorescein were studied.

Results. Increased tc.pO2 rates during the oxygen inhalation and reperfusion tests are well-reproducible and show discriminative power. Resting tc.pO2 seems less valuable. Some dLDF parameters are highly reproducible, but only resting flux and the flux increase rate during reperfusion demonstrate discriminative power. CM is highly reproducible as performed by one observer. The capillary morphology score allows for severity grading.

Conclusion. Controversies on interpretation and cutoff values of microcirculatory parameters could well be associated with the variability of some of the parameters. Only parameters with adequate reproducibility and discriminatory power can be used to evaluate intervention procedures or to determine amputation levels.
Continuous Loop of Basilic-Cephalic Vein for Lower Extremity Bypass
Authors: Hossain Azhar , Harrington Martin E. , Harrington Elizabeth B. , Soundararajan Krish , Hollier Larry H.
Published: June 2007

Finding a suitable conduit for lower extremity arterial bypass can be a challenge, especially when the greater saphenous vein has been used for other bypasses. Several different types of conduits have been tried with variable success rates. Autologous vein grafts seem to have a higher patency rate than prosthetic grafts. In this article, a case is presented in which a continuous loop of basilic-cephalic vein was used to bypass superficial femoral artery to dorsalis pedis. This innovative conduit has the advantage of being autologous and without any intervening venovenous anastomoses and its associated complications. A review of such vein loop grafts and other types of conduits is presented in the text.
A Congenital Arteriovenous Malformation of the Right Subclavian Artery
Authors: Stanley Andrew C. , Menzoian James O.
Published: June 2007

This is a case of a 67-year-old woman with a congenital arteriovenous fistula of the right upper extremity arising from the right subclavian artery. It was treated successfully with catheter-directed embolization techniques. In reviewing the literature, a high incidence of right-sided congenital arteriovenous malformations of the proximal upper extremity was identified. This high incidence may be related to the complexity of the embryologic development of the right subclavian artery.
Complication Analysis in Primary Vascular Access Surgery in Patients Requiring Hemodialysis
Authors: Ebner Heinrich , Mani Gabriele
Published: June 2007

The present study retrospectively analyzes data from 149 primary vascular access operations to evaluate the effect of surgical approach and surgical expertise on the rates of success and of complication for this surgery. All but 10 of the 149 operations involved construction of Cimino-Brescia (C-B) fistulae, the remaining 10 were loop-shunts. All operations were performed consecutively by five different surgeons who were categorized according to skill level as expert (ES), less expert (LES), or trainee (TS) surgeons. The authors recorded the types of complications, duration of patency, types and incidence of repeat surgery, adequacy of vascularization during all surgeries, time of onset of complications, surgical technique, and surgical skill level. Early complications were defined as those occurring within 30 days of surgery and late complications as those manifested thereafter. The presence of low flow in the fistulae on postoperative dialysis prompted angiography, color-Doppler echocardiography, or fistulography to diagnose the source of complication and determine surgical management. Total complications numbered 35 (23.5%), 13 (8.7%) early and 22 (14.8%) late. Inadequate vascularization resulted in a 53% complication rate, including both stenosis and thrombosis. Expert surgeons achieved 79% patency compared with 59% patency for less expert surgeons. The success rate for correction of stenosis (91.7% primary patency) was greater than that for thrombosis (50% primary patency). To preserve vascular capability, the authors prefer construction of a new, more proximal fistula for repeat surgery or (rarely) intraoperative angioplasty. If the fistula cannot be salvaged, they recommend construction of a C-B fistula on the contralateral limb. A loop-shunt is the least preferred alternative.
Distal Aortic Perfusion and Theophylline in the Augmentation of Postischemic Renal Blood Flow
Authors: Wilcox Gwen M. , Harlin Stuart A. , Miller Michael L. , Newton William D. , Peyton Brian D. , Lane Alexis G.
Published: June 2007

This study was designed to determine the efficacy of pulsatile versus nonpulsatile perfusion in augmenting renal blood flow following renal ischemia. Theophylline was added to assess the additive effect on postischemic renal blood flow. A porcine model was divided into six experimental groups encompassing a total of 48 pigs. Each group underwent cross clamping of the suprarenal aorta for 60 minutes. The control group underwent cross clamping of the suprarenal aorta without femoral cannulation and half of this group received theophylline. The remaining four groups underwent cross clamping of the suprarenal aorta and were placed on pulsatile or nonpulsatile distal perfusion with or without theophylline. Theophylline (2 mg/kg) was administered 30 minutes before the cross clamping of the suprarenal aorta. Renal blood flow was measured by utilizing a flow probe placed on the renal artery and data were recorded for 20 minutes. Baseline recordings were taken as well as recordings during cross clamp and immediately postclamp. Renal ischemia was measured by using serum urea nitrogen, serum creatinine, and urine alpha glutathione-S-transferase (alpha-GST).

Postclamp renal blood flow measurements were standardized as a percentage of preclamp renal blood flow. Treatment with either distal perfusion or distal perfusion with theophylline demonstrated increased renal blood flow in comparison to the controls (p < 0.001). Pulsatile perfusion with theophylline was superior to pulsatile perfusion alone (p < 0.023). Pulsatile perfusion with theophylline was superior to nonpulsatile perfusion with theophylline (p < 0.030). Creatinine 6 hours postoperative showed a significant decrease with both forms of distal aortic perfusion when compared to the control groups (p = 0.002). Creatinine values at 18 hours postoperative were not significant (p = 0.237). Serum urea nitrogen values at 6 (p = 0.239) and 18 (p = 0.460) hours postoperative were not significant. Alpha-GST values at 6 (p = 0.034) and 18 (p = 0.035) hours postoperative showed a significant difference between the control and treatment groups.

Pulsatile distal aortic perfusion with theophylline is superior to nonpulsatile distal aortic perfusion with theophylline in augmenting renal blood flow following renal ischemia in the porcine model.
Arterioureteral Fistula
Authors: Brown Kellie R. , Jean-Claude Jessie M. , Rilling William S. , Donnell Robert F. , Seabrook Gary R. , Towne Jonathan B. , Cambria Robert A.
Published: June 2007

Arterioureteral fistula is a rare clinical entity that has been reported more frequently over the past decade. The risk factors for arterioureteral fistula include previous pelvic or urologic surgery, ureteral stenting, pelvic irradiation, and previous vascular pathology. All patients who present with this clinical entity have at least one of these risk factors, and the majority of patients have more than one risk factor. Radiographic demonstration of an arterioureteral fistula may be difficult and often requires more than one diagnostic modality. Angiography and retrograde ureterography appear to be the most helpful in establishing a diagnosis. The literature suggests that patients with a diagnosis of arterioureteral fistula before surgery have an increased incidence of renal salvage and decreased mortality. Methods of repair have been varied, but in the past several years, endovascular approaches to this problem have become more common. The authors report two cases of arterioureteral fistulae, one managed operatively, and one managed by endovascular placement of a covered stent. The literature is reviewed, and etiology, diagnosis, surgical therapy, and endovascular therapy are discussed.
Subhepatic Inferior Vena Cava Resection with Left Renal Vein Reimplantation to a Large Ascending Lumbar Collateral
Authors: Young Richard M. , Sharp W. John , Sandler Anthony D. , Hoballah Jamal J. , Corson John D.
Published: June 2007

A 6-year-old girl, postnephrectomy for a Wilms tumor, demonstrated a recurrence involving the liver and inferior vena cava by ultrasound. Reoperation for removal of the recurrence required further resection and a bypass using an ascending lumbar collateral as an outflow vessel.
Histopathologic Features of the Popliteal Artery Entrapment Syndrome
Authors: Nayler S. J. , Levien L. J. , Cooper K.
Published: June 2007

Surgically occluded popliteal arteries, resected from five patients with clinical and radiologic evidence of the popliteal entrapment syndrome, were examined histologically. Degenerative changes and neovascularization appear to be the initial changes in the adventitia of the artery, which then seem to progress to involve the entire vessel wall. Three distinct stages of progression were identified. Stage 1 is the earliest phase, comprising neovascularization of the adventitia, with no medial fibrosis or destruction. In stage 2 there is transmural vascular proliferation with accompanying fibrous replacement of the media. Stage 3 shows similar neovascularization, with extensive fibrous replacement of the media, fragmentation of the internal elastic lamina, and extensive fibrointimal proliferation, with superimposed thrombus. Recognition of each of the varying stages allows for distinction of this uncommon condition from other clinical mimics of an acutely threatened lower limb.
Conservative Management of Popliteal Aneurysm: Is There a Role for Selective Observation?
Authors: Ginzburg Enrique , Cheanvechai Vasana , Parra-Davila Eduardo
Published: June 2007

Popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, comprising 70% of these lesions. More than two thirds of these patients have bilateral aneurysms and the most common etiology is atherosclerosis. Elderly men in their sixth and seventh decade of life constitute over 90% of these patients, and up to 55% will have an aneurysm in other portions of the vascular tree. Only 3% to 5% of these aneurysms are found in women. The abdominal aorta will be involved in 30% to 75% of cases and, therefore, dictate a full work-up when a PAA is found.

The authors report a case of an 80-year-old man with a chief complaint of intermittent calf pain that occurred without any pattern of distance. This atypical pattern of claudication had been recurring for more than three months. The patient underwent a duplex ultrasound that showed a dilation of his arteries measuring 1.7 cm and 2.3 cm on the right and left sides, respectively. Further work-up with a magnetic resonance image demonstrated a 4 cm x 3 cm left PAA with thrombus and a smaller aneurysm on the right side. An angiogram demonstrated single peritoneal artery runoff on the left side and posterior tibial artery runoff on the right side. The patient was cleared for surgery with an ejection fraction of 40%; however, he refused to undergo reconstruction. The patient ehas been followed up for the past four years without change in his symptomatology and repeated ultrasounds have not shown any significant size change.
Subclavian Arterial Injury Associated with Blunt Trauma
Authors: Katras Tony , Baltazar Ulises , Rush Daniel S. , Davis Duncan , Bell Teresa D. , Browder I. William , Compton Raymond P. , Stanton Paul E.
Published: June 2007

Blunt subclavian artery trauma is an uncommon but challenging surgical problem. The purpose of this study was to retrospectively review the management of blunt subclavian artery injuries treated by the Trauma and Vascular Surgery Services at the East Tennessee State University-affiliated hospitals between 1992 and 1998. Six patients with seven blunt subclavian artery injuries were identified. Physical signs indicating blunt subclavian artery injury were pain or contusion around the shoulder joint; fractures of the clavicle, scapula, or ribs; periclavicular hematomas; and ipsilateral pulse or neurologic deficits. Seven subclavian artery injuries were treated-two arterial transections, two pseudoaneurysms, and three intimal dissections. Associated injuries included four clavicle fractures, one humerus fracture, one combined rib and scapular fractures, and two pneumothoraxes. Vascular surgical treatment included three primary arterial repairs, two saphenous vein interposition grafts, and one polytetrafluoroethylene (PTFE) graft. One patient was treated nonoperatively with anticoagulation. No deaths occurred. Morbidity occurred in two patients with chronic upper extremity neuropathy producing prolonged disability from pain and weakness; one patient had reflex sympathetic dystrophy, and the other had a brachial plexus injury. In conclusion, blunt subclavian artery trauma can be successfully managed with early use of arteriography and prompt surgical correction by a variety of vascular techniques. Vascular morbidity is usually low, but long-term disability because of chronic neuropathy may result from associated brachial plexus nerve injury despite a successful arterial repair.
Treatment of Varicose Veins: Proximal Saphenofemoral Ligation Comparing Adjunctive Varicose Phlebectomy with Sclerotherapy at a Military Medical Center
Authors: Brethauer Stacy A. , Murray James D. , Hatter Douglas G. , Reeves T. Roland , Hemp James R. , Bergan John J.
Published: June 2007

There is no consensus as to the single best approach to the treatment of varicose veins. There has been a trend toward less invasive procedures to reduce the number of incisions and provide more selective ablation of varicosities. Ultimately, therapeutic decisions have depended on surgeon preference and the patient population. The active duty military population presents a unique challenge in the treatment of varicose veins. This mobile and active population requires a treatment method that provides maximum relief with the lowest possible morbidity and rapid recovery. The authors previously reported their experience with 104 patients who underwent saphenofemoral ligation combined with perforator point ligation and staged sclerotherapy. This group was compared to 103 patients who underwent saphenofemoral ligation, point perforator ligation, and stab avulsion phlebectomy as a single procedure. Follow-up for the sclerotherapy group included patient satisfaction surveys and documentation of recurrent varicosities. All ambulatory phlebectomy patients responded positively with respect to symptomatic and cosmetic results. Overall satisfaction was favorable and there was no significant difference in patient satisfaction between the ambulatory phlebectomy and sclerotherapy groups. Twelve per cent of the sclerotherapy patients developed true recurrences or new varicosities compared to 1 1% in the ambulatory phlebectomy group. The most common complication was superficial thrombophlebitis (20% ambulatory phlebectomy,16. sclerotherapy) which was mild in all cases. All but three patients in the ambulatory phlebectomy group returned to work within 7 days and 75% returned to full duty within 72 hours. Completion of therapy was accomplished in a much shorter period for the ambulatory phlebectomy group. Overall patient satisfaction was achieved for both ambulatory phlebectomy and sclerotherapy patients. Completion of therapy was achieved in a shorter period with fewer clinic visits in the ambulatory phlebectomy group and this has become our procedure of choice for active duty military patients.
Acute Hemiballismus After Carotid Endarterectomy
Authors: Paramo Juan Carlos , Carey Donna , Sivina Manuel
Published: June 2007

A 72-year-old woman who experienced a postoperative stroke after a carotid endarterectomy with the presenting symptom of hemiballismus is described. This unusual presentation was likely the result of a hypotensive episode coupled with a predisposing anatomic variant in the circle of Willis, which compromised blood flow in the posterior cerebral circulation. She responded well to treatment with haloperidol with complete resolution of hemiballistic movements.
Amaurosis Fugax and Stenosis of the Ophthalmic Artery
Authors: Braat Andries E. , Hoogland Peter H. , de Vries A. C. , de Mol van Otterloo J. C. Alexander
Published: June 2007

Amaurosis fugax has many causes. Its most common cause is transient hypoperfusion of the eye, caused by thromboemboli from atherosclerotic carotid arteries. Thromboembolism from carotid arteries is a risk factor for cerebral infarction, and preventive endarterectomy could be performed. This report describes a patient with a rare ophthalmic artery stenosis, which was the probable origin of thromboemboli. This finding prevented surgical intervention.
Bilateral Spontaneous Dissection of the Internal Carotid Arteries
Authors: Woll Michael M. , Goff James M. , Gillespie David L. , Minken Stanley L.
Published: June 2007

A 41-year-old African American man presented with an acute stroke secondary to bilateral spontaneous internal carotid artery dissections following exercise. Spontaneous bilateral carotid artery dissection is an unusual and uncommon occurrence that can be successfully diagnosed by color-flow duplex ultrasonography and magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) imaging. A review of the literature and the authors' experience supports initial medical management of these patients. Surgery should be considered for those patients who exhibit progressive neurologic symptoms during medical management or when significant carotid artery complications, aneurysms, or flow-limiting stenoses persist.