bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic benefit of a centralized reconstitution unit of cytotoxic drugs in isolator
Authors: Favier Mireille , Fliche Elisabeth , Bressolle Francoise
Published: November 2007

Introduction. A cytotoxic drug reconstitution sys tem generates a saving in drugs due to a reduction in drug wastage by reusing partly used vials. We con ducted a study at a 1900-bed Hospital Medical Center and we compared, from January to June 1995, cyto toxic drug cost reduction due to a centralized system with data obtained by handling preparation in an uncon trolled environment.

Method. Partially used vials were reused based on our stability and sterility procedures. For the reconstitution in the centralized unit, high dosages of cytostatics were preferentially used, while for the handling preparation in an uncontrolled environment high and low dosages of cytostatics were used and selected according to the prescriptions.

Results. A total of 1127 courses were evaluated corresponding to 3743 preparations. The average saving of the drug acquisition cost was $21,287, ie, 9.2% of the cytotoxic acquisition cost during the 6 months of the study period.

Conclusion. The use of stability data in a cen tralized system (isolator) leads to a decrease in the cost of chemotherapy treatment compared with handling preparation in an uncontrolled environ ment.
An analysis of drug costs for the management of chemotherapy-related side effects in advanced colorectal cancer
Authors: Elliott Rachel
Published: November 2007

Purpose. To assess whether there is a difference in associated drug costs for the management of chemo therapy-related side effects for patients with advanced colorectal cancer treated with raltitrexed (Tomudex, Zeneca Limited) or 5-FU plus folinic acid (Mayo regimen).

Data Sources. The drugs used for the manage ment of side effects were determined using a UK cohort (n = 62) taken from a large phase III ralti trexed clinical study. This study compared the toler ability and efficacy of raltitrexed vs 5-FU plus low- dose folinic acid and reported a significantly lower incidence of WHO grade 3/4 mucositis and leucope nia with raltitrexed. Drug costs were sourced using the British National Formulary, the Monthly Index of Medical Specialities and the Chemist and Druggist. Drug costs for the management of individual chemo therapy-related side-effects were calculated for both treatment groups and the total mean cost was com pared using the Student t test. Costs associated with the use of drugs for the management of clinically similar side effects, for example, nausea and vomiting were also investigated.

Results. There was a significant reduction in the mean total drug cost per patient for the management of chemotherapy-related side effects in the raltitrexed group compared to the 5-FU/folinic acid treatment group (£,64.27 vs £139.14; P = .0016). Infection was the most costly individual side effect for both treat ment groups but was lower in the raltitrexed cohort (£25.46 vs £59.93). Drug costs for the management of nausea and vomiting, pain and abdominal pain, and mucositis side effects were also considerably lower in the raltitrexed cohort.

Conclusion. The significantly lower drug cost for the management of chemotherapy-related side effects for the raltitrexed patients in the UK cohort suggests that the lower WHO grade 3/4 toxicity observed with raltitrexed in the phase III study would also be associated with a reduction in drug costs for the management of chemotherapy-related side ef fects.
Adaptation of the ASHP Residency Learning System (RLS) to an oncology pharmacy specialty residency program
Authors: Solimando Dominic A. , Waddell Aubrey , Strickland William R. , Nelson Bruce A. , Dydek George J.
Published: November 2007

ASHP has designed the Residency Learning Sys tem (RLS) to be a standard for pharmacy practice residencies. Key features of the RLS include: for mal goal statements, specific learning objectives for each goal, standard evaluation procedures, and formal feedback to residents. During adaptation of the Walter Reed Army Medical Center (WRAMC) Pharmacy Practice Residency to the RLS, the pro gram for the specialty residency in oncology phar macy practice was also revised to conform to the RLS format. The review resulted in the complete revision of all oncology residency core rotation outlines and creation of a new mandatory rota tion. WRAMC's oncology residency goals and objectives were screened against ASHP's Goals, Terminal and Enabling Objectives for Oncology Specialty Residencies. Each oncology rotation requirement now identifies the specific Resi dency Goal(s) and Objective(s) covered. The procedures described may serve as a model for other specialty residency programs faced with the need to make revisions in their syllabuses to meet evolving residency standards.
Review : Topoisomerase I inhibitors: 1. Topotecan
Authors: Relias Valerie , Andrew Skirvin J.
Published: November 2007

Purpose. The primary objective of this article is to discuss the pharmacology, pharmacokinetics, clin ical use, and adverse effects of the approved topoisomerase I inhibitors. This is the first in a series of two articles and will focus on topotecan.

Data Sources. We reviewed the literature through a MEDLINE search of English language articles from 1985 through 1997. Relevant articles cited in the titles obtained from the MEDLINE search were also used. The following terms were used for purpose of conducting the MEDLINE search: topoisomerase inhibitors, topotecan, topo isomerase I, Hycamtin, SKF 104864.

Data Extraction. We reviewed the current literature in order to discuss the pharmacology, pharmacokinetics, clinical use, toxicity, drug inter actions, indications, formulation, dosage and ad ministration, and pharmaceutical issues surround ing the use of topotecan.

Data Synthesis. The topoisomerase I inhibi tors are new antineoplastic agents with a unique mechanism of action. Promising areas of applica tion include ovarian cancer, lung cancer, radiation sensitization, and refractory leukemias. Clinical tri als detailing its activity in these areas are pre sented.
Review : Cremophor: Pharmacological activity of an "inert" solubiliser
Authors: Webster Lorraine K , Woodcock David M , Rischin Danny , Millward Michael J
Published: November 2007

Objective. To provide an overview of the known pharmacological activity of the solvent for pacli taxel, Cremophor, and the implications for therapy with paclitaxel.

Data Sources. Following an outline of the chemistry of Cremophor and its potential to cause hypersensitivity, we present a summary of our own results from studies on the effect of Cremophor as an MDR modulator.

Data Extraction. The pharmacokinetic inter actions of paclitaxel and Cremophor are discussed, with reference to our own preclinical and clinical studies of Cremophor, and literature reports of altered drug disposition following combination therapy with paclitaxel are examined.

Data Synthesis. Cremophor is not an inert solubiliser. Cremophor may contribute to drug interactions by altering drug disposition, and it has the ability to modulate multidrug resistance. As a consequence of the presence of Cremophor in the paclitaxel formulation, the use of paclitaxel should be considered as the administration of two agents.
Viability of microorganisms in novel antineoplastic and antiviral drug solutions
Authors: Krämer Irene
Published: November 2007

Introduction. In determining the expiration-dates of ready-to-use antineoplastic and antiviral drug solu tions, microbiological aspects must be considered. This is especially true because many antineoplastic drugs introduced into the market are already known to lack antimicrobial activity. The purpose of this study is to evaluate the growth of four different microorganisms in ready-to-use solutions of 14 differ ent novel antineoplastic and antiviral drugs.

Methods. The lowest concentrations of 14 dif ferent antineoplastic and antiviral drugs prescribed in our hospital were prepared in polyvinyl chloride bags or a polyethylene container (paclitaxel) containing 0.9% sodium chloride or 5% dextrose solution. Inoc ulations were performed by adding 9 mL of a freshly prepared drug solution to a 1 mL suspension of bacteria or fungi (Staphylococcus aureus, Enterococ cus faecium, Pseudomonas aeruginosa, Candida albicans). Resulting concentrations were about 104 microorganisms per milliliter. Pure 0.9% sodium chlo ride and 5% dextrose solutions served as positive controls. Inoculated solutions were stored at elevated temperatures (22°C or 37°C). Samples of each test solution were withdrawn at 0, 15, 30, and 60 minutes and at 2, 3, 4, 24, 48, and 120 hours after inoculation, transferred to tryptic soy agar, and incubated at 37°C. After 24 hours, colony-forming units were counted.

Results. In the concentrations tested, no antimi crobial activity was registered with most of the drugs tested. There were only two cases of significant antibacterial activity, involving treosulfan and oxali platin against P. aeruginosa, respectively. Moderate antifungal activity was seen with foscarnet, ganciclo vir, pentostatin, and treosulfan.

Conclusions. The lack of antimicrobial proper ties should be considered when assigning extended expiration dates to ready-to-use antineoplastic and antiviral drug solutions. Solutions should be kept under refrigeration whenever possible to minimize the growth of any contaminating microorganism. With the exception of treosulfan, end-product steril ity testing may be performed without further dilution or inactivation.
Stability of three cytotoxic drug infusions in the Graseby 9000 ambulatory infusion pump
Authors: Priston Melanie J , Sewell Graham J
Published: November 2007

Objective. The purpose of this study was to deter mine the stability of three cytotoxic infusions in the Graseby 9000 ambulatory pump (Graseby Medical, Watford, UK) under both refrigerated storage and in-use conditions. The infusions studied were: (a) doxorubicin (2 mg/mL) plus vincristine (0.2 mg/mL) and (b) ifosfamide (20 mg/mL) plus mesna (20 mg/ mL) and etoposide (0.5 mg/mL). In each case, the diluent was water for injection.

Methods. Graseby 9000 medication cassettes, each containing one of three infusions studied, were incubated at either 8°C or 37°C to represent refriger ated storage or 'in-use' temperatures, respectively. Samples were withdrawn for chemical and physical analysis at various intervals. Chemical stability was determined using validated, stability-indicating high performance liquid chromatography methods. The assessment of physical stability included pH, appear ance, moisture loss from cassettes, subvisual particu late counts, and leaching of diethylhexylphthalate (DEHP) plasticiser from the medication cassettes.

Results. Both the doxorubicin plus vincristine and the ifosfamide plus mesna infusions were physi cally and chemically stable in Graseby 9000 medica tion cassettes for 14 days at 8°C and for 7 days at 37°C. The etoposide infusion caused significant leach ing of DEHP plasticiser from the Graseby cassette; in addition, one of the infusion cassettes stored at 8°C exhibited precipitation of etoposide by day 10.

Conclusion. Infusions of doxorubicin (2 mg/ mL) plus vincristine (0.2 mg/mL) and ifosfamide (20 mg/mL) plus mesna (20 mg/mL) demonstrated ac ceptable stability in the Graseby 9000 device under refrigerated storage and ambulatory infusion condi tions. Precipitation under refrigerated storage and significant leaching of DEHP would preclude the combination of etoposide infusion (0.5 mg/mL) and the Graseby 9000 pump for ambulatory administra tion.
Second language teaching and research relationships: a North American view
Authors: Pica Teresa
Published: November 2007

This article discusses the relationship between second language (L2) teaching and research from the multiple perspectives of a North American context, with particular focus on: coexistence of teaching and research activities, on similar topics, but with different goals; collaboration of teaching and research efforts, toward understanding and addressing mutual interests and concerns, through shared data collection, analysis, and interpretation, action research, and ethnographic studies; complementarity of teaching and research contributions, toward a more complete picture of L2 learning and retention, through theoretically motivated treatments, designed and initiated in the research context, and studied in the classroom; and compatibility of teaching and research interests, with respect to the cognitive and social processes of L2 learning, and the materials and activities through which work with L2 learners is carried out. The article begins with a brief overview of the relationship between L2 teaching and research as it has unfolded over time.
Discussing childhood overweight and obesity with parents: a health communication dilemma
Authors: Mikhailovich Katja , Morrison Paul
Published: November 2007

Childhood obesity has reached alarming levels and the problem has assumed great significance for health care staff who work with overweight children and their families. Anecdotal accounts of the difficulties that may emerge when health care providers communicate that a child's weight is outside of the normal range, were a key stimulus for this review. A local government health department commissioned a review of literature on communicating with parents about childhood overweight and obesity. Literature concerned with communicating a child's overweight to parents was limited and, as a result, this review draws upon a disparate body of literature to examine what is known and what might be helpful for health care providers when discussing a child's weight with the child and parents. This paper identifies a range of factors influencing communication between health care workers and parents and offers a number of practical approaches and strategies for facilitating successful communication between health practitioners and the parents of children.
Sudden traumatic death: caring for the bereaved
Authors: Scott Tricia
Published: November 2007

Supporting relatives following sudden and traumatic death is one of the most daunting aspects of emergency care. Relatives are devastated by the suddenness of the event, a situation often compounded by the mutilation of the body of their loved one. Managing the practical aspects of death pronouncement, explaining the cause of death, performing last offices, and representing the body to relatives can be emotionally draining for even the most experienced emergency practitioner who is required to remain composed whilst supporting grieving relatives through their tragedy. This article considers how emergency personnel may effectively offer emotional presence and support at a time when the sheer magnitude of the event annihilates the possibility of any sense of order. The juxtaposition of communication with caring and the impact of caring on healing should not be underestimated. This concept will be discussed in relation to how relatives are cared for in the emergency department.
No Place of the Mind: Contested Protestant Representations of Ulster
Authors: Graham Brian J.
Published: November 2007

Ulster will be ... a geographical fact.1

This Ulster is a thing of the mind only, non-existent in the world of reality.2
Between East and West: the Border Writing of Yeoryios Vizyinos
Authors: Peckham Robert Shannan
Published: November 2007

Events have anew directed attention to those frontier lands of Eastern Europe where diverse races, professing conflicting faiths, meet and mingle, and where for centuries rival empires have contended for ascendency.1
Symptomatic Aneurysm of the Abdominal Aorta
Authors: Bangash Mahmud
Published: November 2007

Three cases of symptomatic aneurysm of the abdominal aorta are pre sented. One patient age 96, described with this condition, is perhaps the oldest patient in the literature. In another patient the aneurysm measured two feet in length, extending from the diaphragm to the pelvic outlet. This was perhaps the biggest aneurysm yet recorded. All three patients presented dif ficult medical problems, withstood the operation, and were discharged from the hospitals with successful results.

Aneurysm of the abdominal aorta is a serious condition. It is commonly found in patients in their seventh decade. The condition carries a high mor tality with advancing age, especially when associated with other diseases. In symptomatic aneurysms where expansion, dissection or frank hemorrhage is suspected, emergency resection and replacement with dacron graft is carried out.

We are reporting three cases, two aged 96 and 91, perhaps the oldest pa tients in the world literature operated upon for expanding aneurysms of the abdominal aorta with beginning dissection. The third patient had an aneurysm measuring two feet in length, perhaps the biggest aneurysm reported. All patients survived the operation and are living.
Electrocardiographic Changes in Coronary Care Unit Patients During Defecation
Authors: Singman Henry , Kinsella Eileen , Goldberg Emanuel
Published: November 2007

Fifty-one consecutive patients admitted to a coronary care unit were mon itored for ECG changes while having a total of 63 bowel movements (BM's). Twenty-three patients had proven myocardial infarction while 28 had no acute cardiac disease. ECG changes in patients using either commode or bedpan facilities were compared during defecation. Patients using the commode were found to have a greater increase in heart rate and other nonspecific ECG abnormalities compared to those using the bedpan.

Electrocardiographic changes and occasional deaths have been reported during defecation 1 and instrumentation 2,3 of the rectum.4 The sudden increase in intrathoracic pressure while straining is thought to initiate the cardiovascular changes that lead to these events. The alterations in cardiovas cular dynamics which follow a "strain" are similar to those occurring during a Valsalva maneuver. 5 The published studies in this area present observations of subjects performing the Valsalva maneuver under controlled conditions, or in individuals without heart disease.6 With this in mind, patients with known or suspected acute myocardial infarction admitted to a coronary care unit were studied for electrocardiographic and heart rate changes during defecation. In addition an effort was made to compare changes occurring while using the bedpan to those observed while sitting on a commode.
The Large Spontaneous Aorta Inferior Vena Caval Fistula
Authors: Harrison William H.
Published: November 2007

The subject of spontaneous aortocaval fistula due to a ruptured abdominal aortic aneurysm into the inferior vena cava is reviewed and discussed. An interesting case is presented with particular emphasis on the pre-operative findings which include lower body cyanosis; pain, numbness, and paralysis of the lower extremities; a cyanotic partial penile erection; and moderate shock. The cause of this syndrome is postulated.
Valve Replacement and Coronary Revascularization: Combined Surgical Approach
Authors: Janke Walter H. , Cafoncelli Antonio
Published: November 2007

Report is presented of sixteen patients who had coronary bypass procedures performed in combination with valvular surgery. There was a hospital mortality of two patients or 12.5%. Significant improvement occurred in the remaining fourteen patients or 87.5%. Of these fourteen patients, one patient required re-operation for mitral valve replacement following an open mitral commissurotomy two years previously.

Coronary arteriosclerosis complicating the outcome of patients undergoing valvular surgery is well recognized (1). Hall and associates (2) reported the results of seventy-two patients undergoing combined procedures with seven teen operative deaths, an operative mortality rate of 23.6%. Merin's group (3) reported on a series of fifty patients from the Mayo Clinic with an operative mortality rate of 14%. Loop and coworkers (4) reported an operative mortality rate of 8% in fifty patients undergoing combined procedures. Crouch and associates (5) reported on thirty-six patients with four hospital deaths, an operative mortality of 11%.

At the Heart Institute of Michigan, five hundred fifty-six patients under went coronary bypass surgery from December, 1969 to September, 1974. This is an all inclusive, consecutive experience. Overall mortality in this group was nine patients or 1.6%. Of five hundred forty patients who did not have associated valvular surgery, the mortality was seven patients or 1.3%. The purpose of this presentation is to elaborate on the sixteen patients who had coronary surgery combined with valvular surgery. Mortality in this group was two patients or 12.5%.
The Effect of Postural Changes Upon the Ankle Arterial Perfusion Pressure
Authors: Pollak Erich W. , Chavis Patrick , Wolfman Earl F.
Published: November 2007

The normal arterial blood pressure at the ankle, (AP), right brachial arterial pressure (RBP) and pressure index (PI) were investigated in 50 healthy young volunteers under basal conditions and during certain positions of the legs, utilizing Doppler ultrasound flow determination and standard size blood pressure cuff.

The mean AP was 10 mm Hg higher than the mean RBP in 76 instances but AP was smaller than RBP in 24 out of 100 investigated lower extremities. Mean PI was 1.069 ± 0.158. There was no statistically significant difference between PI of heavier and leaner patients although increased weight was associated with a significantly higher brachial and ankle arterial pressure. Departure of the lower extremity from the horizontal position resulted in AP changes explained by gravitational effects. If the new posture was maintained, the new AP persisted, thus indicating an absence of significant corrective circulatory adaptation to the posture changes. Extreme flexion of hip and knee joints resulted in a marked decrease of AP and PI, suggesting arterial kinking. This change was not affected by the weight:height ratio of the subject. It is concluded, therefore, that the presence of a greater amount of periarterial soft tissues does not significantly prevent arterial kinking. These tensional shifts indicate changes of flow pattern occurring in normal subjects during extreme flexion. Even more marked shifts can be anticipated in arteriosclerotic patients under similar circumstances.
Pathogenesis of Coarctation of the Aorta
Authors: Smith Laurence H.
Published: November 2007

This report concerns the pathogenesis of aortic coarctation. Normal aortic arch development and perinatal circulation are described, and current interpretations of coarctation are examined. Finally, an explana tion of the cause of coarctation is proposed. Coarctation is not a primary disease, but rather the result of some pathologic state which reduces the amount of blood crossing the prenatal aortic valve.
Surgical Management of Ischemia Secondary To Bovine Arteriovenous Fistula
Authors: Rubio Pedro A. , Mesh Charles L. , Quast Marian J. , Dichoso Carmelo C.
Published: November 2007

Ischemia of the hand may be sec ondary to angioaccess for chronic he modialysis. A case of circulatory steal by a loop bovine graft in the forearm is described. The flow through the graft was decreased with an interpo sition graft, and a banding procedure was performed with excellent results. Chronic hemodialysis has continued successfully with no ischemic pain.
Popliteal Entrapment Syndrome: a Case Report
Authors: Pieroni Pier , Vieux Ulrick , Singer Adolf , Kaynan Arieh
Published: November 2007

We report a case of bilateral popliteal entrapment syndrome due to a varia tion of Type III anomaly. Review of the literature revealed that this condition is not well known. The clinical picture and mechanism are presented, and di agnostic modalities and surgical ap proaches are discussed.
Comprehensive Assessment of the Safety, Durability, Clinical Performance, and Healing Characteristics of a Double Velour Knitted Dacron Arterial Prosthesis
Authors: Mitchell R. Scott , Miller Craig , Billingham Margaret E. , Mehigan John T. , Olcott Cornelius , Stinson Edward B.
Published: November 2007

A resurgence of clinical reports documenting various modes of prosthetic graft failure have appeared recently in the literature. Increasing federal scrutiny and patient longevity make evaluation of graft durability and graft- related complications timely and imperative. Between October 1975 and February 1979, 298 patients underwent 310 arterial reconstructions using a single model of a porous double velour knitted Dacron graft. Average age was 61 ± 11 years (±SD) and males comprised 65% of the patient population. Two hundred forty-seven prosthetic grafts (80%) were used for aorto-iliac femoral reconstruction. Indications for operation included disabling claudi cation in 105 patients (35%), limb salvage in 71 patients (24%), aneurysm in 97 patients (33%), and other conditions in 25 patients. Follow-up averaged 1.8 years, extended to a maximum of 3.6 years, and yielded an aggregate of 475 graft-years of follow-up for analysis. Operative and late mortality rates were 10 and 10.8%, respectively; overall actuarial survival rate was 72 ± 4% (±SEM) at 3.1 years. Actuarial analysis showed that the probability of being free of unsalvageable graft thrombosis was 97 ± 1% at 1.7 years; of being free of graft infection, 96 ± 2% at 2.9 years; and of being free of major amputation, 95 ± 1% at 2.4 years. No late deaths or amputations were attributable to intrinsic graft failure, but one late death was related to reoperation for graft infection. Ongoing follow-up has failed to reveal any propensity for late graft dilatation, hemorrhage, or structural failure. Gross and histologic character istics of explanted grafts were uniformly favorable (in the absence of graft infection) including a thin, smooth, and translucent neointimal lining and densely adherent external encapsulation.
Spontaneous Rupture of the Iliac Vein
Authors: McDonald Richard T. , Vorpahl Thomas E. , Caskey John
Published: November 2007

The fourth known case of spontaneous iliac vein rupture is reported. Prodromal symptoms, etiology, and treatment are dis cussed. The three previously reported cases are reviewed.
Abdominal Aortic Aneurysms Mimicking Acute Intraperitoneal Inflammation
Authors: Bass A. , Rosenman Y. , Adar R.
Published: November 2007

Four cases of abdominal aortic aneurysm misdiagnosed as acute intraperitoneal in flammation secondary to cholecystitis or di verticulitis are presented. Three were rup tured, and in the fourth there was impending rupture. The presentation of ruptured ab dominal aortic aneurysm as intraperitoneal inflammation with fever has been described, but it is rare and scarcely reported. This mis diagnosis tends to delay diagnosis and treat ment and compounds the poor prognosis of these patients.

Angiography led to the correct diagnosis in all cases but was done only 5 days after presentation in 2 of the patients. One patient (Case 4) died from complication of a septic graft, and 2 of the other 3 had markedly pro longed hospitalizations and stormy post operative courses. Physician awareness of this possibility may help prevent this misdi agnosis or reduce its future occurrence.
Diagnosis of Ureteral Injury after Aortic Bypass Surgery
Authors: Taheri Syde A. , Elias Steven M.
Published: November 2007

One of the most severe, life-threatening post-operative complications of abdominal aortic surgery is infection. Symptoms may occur weeks or years later and include back pain, fever, and lethargy.

Since symptoms presented by the patient may be linked to graft or ureteral infection or may be due to obstruction or injury to the ureter, it is essential than an accurate, prompt diagnosis be made.

If the patient has at some time undergone abdominal aortic surgery, computerized tomography of the retroperitoneum combined with retrograde urography can be helpful in a differential diagnosis. In one such case, diagnosis of ureteral injury accompanied by infection was made using the computerized tomography with retrograde urography.

We believe that computerized tomography of the retroperitoneum should be used to help delineate causes of post-operative symptoms in patients who have undergone aortic bypass surgery.
The Heart Transplant: Eleven-Year Progress Report
Authors: Jamieson Stuart W. , Reitz Bruce A. , Bieber Charles P. , Oyer Philip E. , Stinson Edward B. , Shumway Norman E.
Published: November 2007

Cardiac transplantation was introduced as a therapeutic procedure 12 years ago. More than 400 cardiac transplant operations have now been performed by 68 units throughout the world. After the initial enthusiasm for transplantation in 1968 and 1969, realization of the immense challenges and obstacles to a successful outcome and the generally low survival rates achieved resulted in the abandonment of transplantation in all but a few centers. At Stanford University Medical Center, an active clinical program in heart transplantation was initiated in 1968 and has continued. By August 1980, a total of 212 cardiac transplant operations had been performed in 194 patients, with 74 patients then surviving. Changes in the management of cardiac transplant recipients over the past 10 years have resulted in a substantial improvement in the outlook for survival. Imuran and prednisone remain the primary immunosuppressive agents, but rabbit antithymocyte globulin is used initially and reinstituted during rejection. Endomyocardial biopsy has allowed more precise diagnosis and management of rejection, and, more recently, immunologic monitoring has been introduced to provide more frequent assessment of the host immune response. Infection is the major cause of death, and its diagnosis and treatment is managed aggressively. Current survival figures justify the use of cardiac transplantation in an experienced unit when other measures have been exhausted in the treament of terminal cardiac failure.
Recognition and Management of Ruptured Infected Aneurysm of the Abdominal Aorta
Authors: Bridges Robert A. , McTamaney J. Paul , Barnes Robert W.
Published: November 2007

A patient with a ruptured abdominal aortic aneurysm with clostridial infection was successfully managed by oversewing the aorta, debridement, and axillobifemoral bypass. Infected aneurysms of the abdominal aorta may present a confusing clinical picture, causing a delay in correct diagnosis. A history of fever and a palpable aneurysm should suggest the diagnosis. In obese individuals, abdominal roentgenograms and sonography may be helpful in establishing the presence of an aneurysm. Aortography may support the diagnosis of infection by the presence of a lobulated saccular aneurysm. Occasionally, the operative appearance of the aorta may be the only indica tion of an infected aortic aneurysm. The decision to oversew the aorta and perform an extra-anatomic bypass as the initial surgical procedure is essential for the proper management of these patients.
Coin Lesion of the Right Lower Lung as a Manifestation of Aortic Aneurysm: A Case Report
Authors: Abu-Dalu K. , Gordon R. , Romanoff H. , Borman J.B.
Published: November 2007

A saccular aneurysm extending from the descending aorta into the right lower lung field presented an unusual cause of a pulmonary coin lesion.
Aneurysms of the Hypogastric Artery: Etiology Presentation and Management
Authors: Nelson Robert P.
Published: November 2007

Twenty-seven patients with isolated hypogastric artery aneurysms and 35 patients with multiple aneurysms associated with hypogastric lesions previ ously reported are analyzed. The incidence and etiology of hypogastric aneurysms in addition to the age, symptoms, physical findings, evaluation, and treatment of patients with such lesions are discussed. The high incidence of rupture is noted, and operative considerations for such patients are stressed. Anatomical considerations influencing maintainence of the pelvic circulation in the presence of bilateral hypogastric aneurysms or those in conjunction with aortic aneurysms are discussed.
Inferior Vena Cava Thrombectomy for Pulmonary Embolism
Authors: Hans Sachinder S. , Wolfe Stanley B.
Published: November 2007

Significant pulmonary embolism during adequate anticoagulation is an indication of inferior vena cava interruption. If a nonadherent thrombus is detected in the inferior vena cava, an attempt should be made to remove the thrombus at the time of inferior vena cava interruption to prevent the migration and fragmentation of the thrombus to the pulmonary circulation.
Management of Draining Wounds in Vascular Surgery
Authors: Schaberg Frank J. , Wong Richard , Phillips Martin R. , Healey Eugene H. , Healey Paul J.M.
Published: November 2007

Drainage from a wound overlying a prosthetic vascular graft is a source of major concern in vascular surgery, often heralding serious complications in cluding hemorrhage, thrombosis or infection. Despite improvement in graft design and surgical technique, healing problems are reported to occur in about 2 % of cases.1 Perigraft fluid collections may be secondary to infection, ac cumulation of lymph or serum, to failure of the graft material or to allergy to graft material or some foreign substance adherent to its surface.1-6

The management of draining wounds remains controversial. Early experi ence with infected grafts treated locally was uniformly unsuccessful, and resulted in significant morbidity and mortality.1 This led to the classic teaching that grafts underlying infected wounds must be removed and replaced through extra anatomic pathways. Recently local treatment has received renewed interest in an attempt to salvage an otherwise functioning graft.2,3 We have utilized an early aggressive local approach to draining wounds with salvage of grafts that would otherwise have been removed and a considerable decrease in morbidity.
The Below- Knee Transposition of a Vein Bypass— A New Therapeutic Principle
Authors: Rendl Karl-Hans , Prenner Konrad
Published: November 2007

The autologous femoro-popliteal vein bypass is a proven treatment concept for the correction of the chronical, and more seldom, of the acute arterial occlusion with good long-term results. 1,2

Recurrent operations show a clearly worse prognosis than the first opera tion. The reasons are the technical difficulties of the revision, the absence of an autologous vessel graft and the less favourable prognosis of the lengthy desob literation, which is recommanded by certain authors as second operation.3,4 The pseudo-recurrent occlusion represents a rather rare indication for a new opertion. Because of an obliteration of the outflow artery, it is considered clinically and oscillographically as a recurrent occlusion. Only the direct Doppler-ultrasound-sonography or the angiography show the patency of the primary bypass, which can flow through small collateral vessels or backward over the distal anastomosis.

This paper is meant to be a contribution to the operative treatment of this occlusion kind in case of missing autologous graft after a short femoro-popliteal vein bypass.
Prophylaxis Against Thromboembolism in Vascular Surgery
Authors: Urbanyi B. , Spillner G. , Schleinzer P. , Freidank H. , Schlosser V.
Published: November 2007

Thrombosis prophylaxis is indicated in vascular surgical patients for two general considerations: to prevent thromboembolism from the venous system and occlusion of reconstructed arterial vessels.

The purpose of this randomized, prospective study was to compare the effectiveness of low-dose heparin, heparin in combination with dihyder gotamine, and dextran-60 in the prevention of postoperative venous throm bosis and pulmonary embolism after vascular operations. In addition, any adverse effects of each medication on patency after arterial reconstruction was to be determined.
Canine Venous Graft Transplated into the Arterial System: Factors Related to Lipid Deposition and Patency
Authors: Nakata Yukifumi
Published: November 2007

For clarifying the influences of nutritional changes in the venous graft on lipid deposition and patency, 12 dogs were bilaterally grafted with the autogen ous femoral veins into the femoral arteries, and the venous grafts on the left side were then wrapped with a Tetron sheet to impede the reconstruction of vasa vasorum. After feeding 4% cholesterol and 2% coconut oil to the dogs for 7 to 15 weeks, the serum cholesterol increased significantly (P<0.01) from 131.2 ± 12.8 to 222.9 ± 33.1 mg/dl, though it still remained relatively low. No statistical difference in patency was recognized between the two sides. In the left patent grafts, vascular lesions were not uniformly seen. Dilatation of the graft without intimal thickening was seen in 3 dogs, while marked intimal thickening without dilatation was noted in 5. Wide lipid deposition was ob served in 8 of 10 grafts on the right side showing a statistical difference (P<0.01). The distribution of vasa vasorum in the left grafts varied widely on microangiography. Intimal thickening and deposition of lipids were observed correlatively in the area with a poor distribution of vasa vasorum. From the above results, the disturbance of vasa vasorum may be an important underly ing condition in lipid deposition in the vascular wall. For preventing occlusion, it was recommended to exercise care so as to avoid stripping the adventitial layers in the venous graft and to place the graft through well vascularised tissues, and also to control the serum cholesterol before and during the first 3 months after the operation. Consideration and discussion of the causes of the confusing results relating lipid deposition and intimal thickening in the grafts have been done from a view of disturbance of vasa vasorum.
Surgical Treatment of Kinked Carotid Arteries: A Case Report
Authors: Yakirevich V. , Vidne B.A.
Published: November 2007

Arteriosclerotic occlusive lesions of the brachiocephalic system were well described by Broadbent in 1875 and Penzoldt in 1881. The significance of these lesions in the production of cerebral insufficiency was later emphasized by Chiari in 1905, and Hunt in 1914.1 The most common pathological process is an occlusive atheromatous plaque at the level of the common carotid bifurcation and the surgical management of this lesion is well established. Obstruction of the extracranial portions of the carotid artery can also occur as a result kinking of these vessels. Elongation with kinking or coiling of the carotid arteries, is a frequent radiological finding in patients with clinical signs of cerebrovascular insufficiency, 20% of them showing such a vascular anomaly.2 The natural history of this particular anomaly and the results of its surgical treatment have clearly shown the pathological significance of certains forms of kinking and coiling in the production of cerebrovascular symptoms.3,4 We wish to report a case of cerebrovascular insufficiency due to kinking of the internal carotid arteries which was successfully corrected surgically.
Surgical Treatment of Post Phlebitic Syndrome
Authors: Taheri Syde A. , Lazar Louis , Elias Steven M.
Published: November 2007

Sequelae of deep vein thrombophlebitis, such as post phlebitic syndrome with or without ulceration, can be treated by direct surgery on the valve. Present surgical treatment of stasis ulcer includes removal of the incompetent communicating veins with excision of the ulcer and skin graft. This procedure is usually associated with a high incidence of leg ulcer among the patients with an incompetent deep venous system.

Experimental studies to restore venous valve function, such as autogenous vein valve transplant, valvoplasty, homologous vein transplant and synthetic valve procedures, have been tried. It has been shown that the patency rate with autogenous vein graft is higher than with other procedures.

The authors have operated on ten patients utilizing autogenous vein valve from the upper extremities to restore a normal functioning venous system of the distal leg. Data on pre- and post-operative, non-invasive, and ascending and descending venography with the results of surgery will be presented and discussed.
Controlled Preoperative Occlusion of an Infected Vascular Graft: A Rational Approach to Treatment
Authors: Aukland A. , McCollum C.N. , Slaney G.
Published: November 2007

The presence of infection in a vascular prosthesis usually necessitates its removal. When the graft is still patent collaterals have no time to develop and limb perfusion following its removal cannot be predicted.

We present a case in which an infected axillo-femoral graft was gradually occluded over a period of six days using a Silastic loop snare with Doppler control. Peripheral perfusion was satisfactory following graft thrombosis and it was subsequently removed without revascularisation.
A Simple Surgical Procedure for Relief of a Combined Ileo- Femoral Arterial Occlusion
Authors: Bogokowsky H. , Slutzki S. , Negri M.
Published: November 2007

An unconventional procedure of endarterectomy of the external iliac and deep femoral arteries, in combination with bougienage dilatation of the superficial femoral artery, was used to relieve severe claudication in a 35 year old patient. This obliviated the need to perform a double graft bypass.
Angiography, Thermography and Other Circulation Tests in Vascular Tumours of the Hand
Authors: Niechajev Igor A. , Lindell Sven-Eric , Karlsson Sten
Published: November 2007

Studies were undertaken to compare and evaluate angiographic findings, thermography, systolic digital pressure and blood flow measurements in the assessment of patients with vascular tumours in the upper extremity. Fourteen patients, eight with hemodynamically active and six with hemodynamically slow tumours were investigated. Angiography was necessary to establish the preoperative diagnosis and estimate the spread of these vascular tumours. Small arterio-venous shunts with diffuse spread in the extremity caused a moderate temperature increase over the whole area, whereas large or medium-sized shunts and conglomerates of small shunts were visible as "hot spots" on the thermograms obtained by high resolution, infrared thermo graphic technique. In such cases thermography, a non-invasive and inexpen sive procedure, can replace angiography in the post-operative follow-up examinations, or can be used to follow the course of disease in non-operated patients. In two cases thermograms indicated presence of arterio-venous shunts, while no such communications could be seen on the preoperative angiograms. It is therefore assumed that thermography is a more sensitive method for the detection of very small shunts.
Orthotopic Heart Transplant in Dogs After a Short-Term Storage with Cardioplegia
Authors: Morishita Yasuo , Taira Akira , Poirier Robert A.
Published: November 2007

The purpose of this study was to assess potassium-induced cold cardio plegia as the modality for myocardial protection of canine hearts during an ischemic interval (2½ hours) through orthotopic transplantation. The hearts were preserved for one hour by two coronary infusions (at 0 and 45 minutes) both in Group I (5 animals) with cold lactated Ringer's solution and Group II (8 animals) with cold cardioplegia. In Group III (8 animals) hearts were treated similarly to Group II, but an additional infusion of cold cardioplegia was given during implantation. The grafts in all groups supported the recipient circulation after transplantation for a minimum of a 2-hour observation period. Group III exhibited approximately 85-90% recovery of ventricular function from the pretransplant baseline level.

This study indicates that potassium-induced cold cardioplegia and hypothermia is effective for myocardial protection of the heart during ischemia through orthotopic transplantation.
Autologous Fibrinogen for Tissue-Adhesion, Hemostasis and Embolization
Authors: Gestring Gidon F. , Lerner R.
Published: November 2007

The use of commercially produced fibrin glue, successfully used for many surgical procedures in European operating theatres, is prohibited in the USA due to FDA regulations. In this presentation the authors demonstrate the extraction of fibrinogen from the patient's own blood, thus avoiding possible viral contamination and allergenisity. Clinical and experimental applications are demonstrated.
An Unusual Case of Systemic Embolism During Cardio-Pulmonary Bypass
Authors: Kabbani S.S. , Ellertson D.G. , Crew J.R. , Hanna E.S.
Published: November 2007

An unusual case of systemic arterial embolism of a plastic ring that got detached from an aortic cannula at the completion of an aorto-coronary bypass procedure is presented. The patient was successfully managed with aortic embolectomy.
A Case of latrogenic Fistula Between the Left Internal Mammary Artery and the Pulmonary Vessels
Authors: Di Giacomo V. , Carmenini G. , Vastano M. , Rossi P.
Published: November 2007

In 1977 Angiology published a paper of Edmiston et al.1 entitled "Angiographic demonstration of an acquired internal mammary-to-pulmonary artery fistula." These authors described a case of a 25 year old man in whom a spontaneous left pneumothorax was treated with a chest tube placed anteriorly at the level of the second intercostal space. Twenty months later, a continuous murmur was appreciated at the level of the third intercostal space, 2 cm medial to the midclavicular line. A selective catheterization of the left internal mammary artery revealed a network of vessels connected with the pulmonary artery. A relationship between the previous placement of the tube and the development of the fistula was hypothesized, whereas this malformation is thought to be usually congenital.

In the present report we describe another case of fistula between the left internal mammary artery and the pulmonary vessels, following to a spontaneous pneumothorax. Also in this case it may be hypothesized as an iatrogenic origin.
Spontaneous Aorto-Venous Fistula: An Occult Diagnosis
Authors: Thomas John M. , Gillott Anthony , Heaney Steven
Published: November 2007

Intravenous rupture of abdominal aortic aneurysms are an uncommon occurrence. The classic syndrome of recent high output heart failure, pulsatile abdominal mass, continuous bruit, oliguria and regional venous hypertension should raise the suspicion of this diagnosis. Our experience of four cases are presented with two survivors. None of the four patients had preoperative aortograms. In only one patient was the diagnosis considered preoperatively. The others were variants in that one had the fistula occluded by thrombus, while the remaining two presented with clinical signs of ruptured aneurysm. The diagnosis, in the variants, was established intraoperatively when profuse venous bleeding ensued upon removing the clot from within the aneurysm. Our experi ence revealed that aorto-venous fistula is many times an occult diagnosis. Successful results depend upon prompt surgical intervention and high index of suspicion especially in cases of ruptured aneurysms.
Axillary Vein Thrombosis
Authors: Collier Paul E. , Diamond Daniel L. , Young Joseph C.
Published: November 2007

Three patients with venographically proven axillary vein thromboses were treated with low-dose streptokinase infused directly into the involved vein. These veins had been occluded from twelve hours to three weeks. No complications and no marked systemic effects occurred. Patency was achieved in all three patients. Directly infused, low-dose streptokinase may provide an alternative to treatment with heparin and may eliminate the sequela of chronic venous thrombosis.