bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Superoxide Dismutase on Reperfusion Injury in Donor Hearts Preserved with Bretschneider-HTK Cardioplegic Solution
Authors: Möllhoff T. , Sukehiro S. , Borgers M. , Vandeplassche G. , Van Belle H. , Van Aken H. , Flameng W.
Published: September 2022

The ability of superoxide dismutase to prevent reperfusion injury after long-term cold storage of donor hearts was evaluated in canine hearts. Whole blood reperfusion was performed using a «support animal’. Twelve dog hearts were arrested by a single dose of Bretschneider cardioplegic solution and stored cold (0.5°C) for 24h. Thereafter they were reperfused for 60 min without ( n = 6) or with ( n = 6) superoxide dismutase treatment. Myocardial tissue biopsies were taken for determination of high-energy phosphates before explantation, after the preservation period and during reperfusion. Early reperfusion in both groups resulted in an initial recovery of high-energy phosphates and was followed by a decrease during the subsequent reperfusion phase. The latter was associated with the appearance of left ventricular contracture, and cessation of heart beat. Electron microscopic examination of the myocardial tissues after reperfusion revealed a severe reperfusion injury in both groups. It is concluded, that in donor hearts preserved with Bretschneider solution, reperfusion injury cannot be prevented by administration via the perfusate of superoxide dismutase.
Experimental Femoral Vein Reconstruction with Expanded Polytetrafluoroethylene Grafts Seeded with Endothelial Cells
Authors: Li J.-m. , Menconi M. J. , Wheeler H. B. , Rohrer M. J. , Anderson F. A. , Cutler B. S.
Published: September 2022

The effect of endothelial cell seeding on the patency of small-caliber expanded polytetrafluoroethylene (ePTFE) grafts used for venous replacements in a canine experimental model was evaluated. Grafts were implanted bilaterally In 12 dogs as femoral vein interpositions. In each animal, one graft was seeded with enzymatically derived homologous endothelial cells which had been cultivated for 3 days in vitro before implantation, whereas the contralateral graft was not seeded. In five dogs, venography was performed at 2 weeks, and grafts were then excised. In the remaining seven dogs, venography was performed at both 2 and 4 weeks, with graft excision at 4 weeks. Graft patency at 2 weeks for seeded grafts was 75% (nine of 12) compared with only 33% (four of 12) for unseeded grafts ( P < 0.02). There were no new episodes of thrombotic occlusion between 2 and 4 weeks. Five dogs with thrombus in the control graft did not develop thrombus in the contralateral seeded graft. Furthermore, each dog with a patent control graft had no thrombus in the seeded graft. It is concluded that the early patency of seeded ePTFE grafts is superior to that of unseeded ePTFE grafts in the femoral vein.
Surgical Treatment of Buerger's Disease: Experience with 216 Patients
Authors: Sayin A. , Bozkurt A. K. , Tüzün H. , Vural F. S. , Erdog G. , Özer M.
Published: September 2022

Buerger's disease (thromboangiitis obliterans) is a rare peripheral vascular disease that usually affects young male smokers. It is characterized by multiple occlusions distal to the knee and elbow. Although rarely encountered in this condition, major arterial occlusions can be corrected by arterial revascularization. The hospital records of 216 patients (214 men and 2 women) with Buerger's disease were reviewed retrospectively, 142 (66%) between 1 and 120 (mean(s.d.) 72.8(24)) months after diagnosis. Of these patients 21 had had an arterial revascularization: 183 lumbar and 20 thoracic sympathectomies had been performed. In 30 of the patients a total of 29 minor and four major amputations had been performed. In appropriate cases arterial reconstruction provides better healing of ischaemic lesions. Although vasomotor tone is usually normalized in 2 weeks to 6 months after sympathectomy, the temporary increase in blood flow is often sufficient to heal ischaemic lesions during this period.
Rejection of a Gelatin-Impregnated Dacron Graft
Authors: Landau O. , Haddad M. , Landau M. , Lerner M. , Stelman E. , Livn E. , Nakash R. , Zelikovsky A.
Published: September 2022

Sealing of the synthetic vascular graft is important to solve problems of leakage. The use of a new vascular graft — Dacron impregnated by gelatin — is described. After operation the patient developed a febrile reaction, and in spite of a thorough investigation no septic foci could be identified. It is believed that the fever was immunological in origin.
Deep Femoral Artery Pseudoaneurysm Caused by Acute Trunk and Hip Torsion
Authors: Calligaro K. D. , Savarese R. P. , Goldberg D. , Doerr K. J. , Dougherty M. J. , DeLaurentis D. A.
Published: September 2022

Spontaneous pseudoaneurysm is extremely uncommon. Apparently the first case of a deep femoral artery pseudoaneurysm, caused by acute trunk and hip torsion during a golf swing, is reported. The lesion was documented by computed tomography, arteriography and surgical investigation. The present report is aimed at making known the possibility of such a complication following this and similar types of physical activity in order to enable prompt assessment and treatment of the lesion.
Late Results of Coronary Artery Bypass Surgery with Maximal Follow-Up of 7 Years: Analysis of Determinants Affecting Late Survival
Authors: Hosoda Y. , Nukariya M. , Watanabe M. , Sasaguri S. , Kazui M. , Tahara M. , Watanabe T. , Sato T. , Goto M. , Takazawa K. , Sato H. , Hayashi I.
Published: September 2022

A total of 806 primary coronary artery bypass graft operations were performed between January 1984 and December 1989. Excluding eight hospital deaths (1.0%) and three patients lost in follow-up, a total of 795 patients were contacted, with a follow-up rate of 99.6%. The mean follow-up period was 53.6 months, the longest being 92 months. Of the patients 42 died in late follow-up. Malignant neoplasm was the major cause of death ( n = 17, 40% of total late deaths), which far exceeded the number of cardiac deaths ( n = 6, 14%). The actuarial survival, excluding the initial hospital deaths, was 95% at 5 years and 91% at 7 years by the Kaplan-Meier method. By multivariate logistic analysis, four clinical variables were identified as significant in influencing the late survival, in the following order: (1) presence or absence of diabetes mellitus ( P = 0.00008); (2) age ≥65 years or <65 years ( P = 0.002); (3) left ventricular function with ejection fraction <45% or ≥45% ( P = 0.014); and (4) use or non-use of left internal mammary arteries to bypass the left anterior descending artery ( P = 0.016). Sex (male versus female), severity of anginal symptoms (mild versus severe) and number of diseased vessels (single and double versus triple vessel and left main trunk disease) did not significantly influence the late survival of the patients.
Acute Type A Dissecting Aortic Aneurysm Requiring Emergency Arch Replacement
Authors: Boulafendis D. , Bastounis E. , Panayiotopoulos Y. P. , Papalambros E. L.
Published: September 2022

The intimal disruption is located or extends to the aortic arch in 10-20% of acute type A aortic dissections. Multiple tears are extremely rare. The reported mortality rate of emergency arch replacement varies from 25% to 40%, and therefore many surgeons elect to perform ascending aortic replacement only in these cases. However, with such an approach, the operative mortality rate of 10% is followed by a late mortality rate of up to 30% from residual aneurysm formation. Emergency arch replacement was carried out in five of 14 patients with an acute type A aortic dissection in whom the intimal tear either originated or extended into the arch, or in whom multiple tears existed. The ascending dissections were resected under moderate hypothermia, whereas the arch was explored under profound hypothermia, surface cooling and circulatory arrest. None of these five patients died; one developed slight hemiparesis, but no patient developed recurrent aneurysm in the follow-up period. These results appear to justify this aggressive approach, if it can be performed with an acceptable mortality rate <25%, by avoiding the late deaths associated with more conservative surgical treatment.
Hypersensitivity Reaction to Sternal Wires: A Possible Cause of Persistent Postoperative Pain
Authors: Ancalmo N. , Perniciaro C. , Ochsner J.
Published: September 2022

Persistent postoperative incisional pain after aortocoronary bypass surgery was reported by a patient in whom allergies to metals contained in the stainless steel suture used for sternal closure were confirmed by patch testing. The symptoms resolved promptly after the sutures were removed.
Successful Surgical Management of Thoracic Aortic Aneurysm in a Right-Sided Aortic Arch
Authors: Takano H. , Ohnishi K. , Ohkubo N. , Kato M. , Yasuda H.
Published: September 2022

A 24-year-old woman with a multilocular sacciform aneurysm in a right-sided aortic arch was successfully treated by aneurysmorrhaphy. Although the cause of the aneurysm could be attributed to congenital factors, its growth was considered to be related to the features of the right-sided aortic arch; strong haemodynamic forces were caused by sharp curving of the aorta which started from an unusually high position and subsequently had a decreased radius.
Management of Major Arterial Injuries of Limbs: A Study of 166 Cases
Authors: Yupu L. , Yaotian H. , Rensheng Z. Li L. , Kaijun S. , Ping M. , Xiaochao C.
Published: September 2022

Case records of 166 patients with 180 major arterial limb injuries inflicted between 1959 and 1991 were reviewed. A total of 167 (95.4%) repaired arteries initially remained patent. Nine patients developed ischaemic contracture of their limbs, which required amputation. Late follow-up of 6 months — 30 years (mean 5 years) was obtained for 75 patients; 73 of these repairs remained patent. Early diagnosis, prompt treatment, complete débridement, appropriate coverage of the repaired vessels, fasciotomy when indicated and simultaneous treatment of concomitant injuries are crucial factors in successful limb salvage and in maintaining patency of the repaired vessels.
Femoropopliteal Bypass with a Compliant, Composite Polyurethane/Dacron Graft: Short-Term Results of a Multicentre Trial
Authors: Dereume J. P. , van Romphey A. , Vincent G. , Engelmann E.
Published: September 2022

A new, compliant, highly porous, non-woven, polyurethane vascular prosthesis has been developed in an effort to improve on the performance of currently available prosthetic grafts for infrainguinal reconstruction. From April 1990 to August 1991, 57 femoropopliteal bypass grafts were implanted in 47 patients by surgeons at five university centres. In all instances, the saphenous vein was unavailable, unusable or reserved for use elsewhere. An empirical perioperative risk score for acute occlusion (0–20) was developed, based on such factors as severity of clinical ischaemia, quality of inflow and outflow, site of distal anastomosis and associated drug therapy. Primary cumulative patency was calculated according to standard life-table analysis. Poor inflow and a distal anastomosis below the knee were significant factors affecting graft patency ( P= 0.001 and P= 0.001 respectively). Six-month cumulative patency for the 25 grafts with good inflow and above or mid-knee anastomoses (79%) was superior to the cumulative patency for all 57 grafts (59%). There was a significant improvement in patency rates between ‘low’ (22 grafts) and ‘medium risk’ (27 grafts) patients and ‘high risk’ (eight grafts) ones (risk scores 0–10 and 11–20 respectively) at a level of P= 0.001. There were two operative deaths (4%). Of the 19 postoperative occlusions, six occurred within 30 days and 18 within 6 months. These data indicate that the patency rates achieved with this new graft compare favourably with other available prosthetic grafts. In addition, the graft demonstrates superior handling characteristics and eliminates bleeding through suture holes. There is also the possibility that rapid tissue ingrowth, neointima formation and compliance will reduce intimal hyperplasia and increase long-term patency.
Use of Varicose Veins as Arterial Bypass Grafts
Authors: Moritz A. , Grabenwöger F. , Raderer F. , Ptakovsky H. , Magometschnigg H. , Ullrich R. , Staudacher M.
Published: September 2022

Varicose veins are not generally used as arterial bypass grafts despite their physiological endothelial flow surface. The large, irregular diameter and the thin wall renders these veins inadequate. Experimental studies have shown that a considerable reduction in the diameter of veins can be achieved by external wrapping without the generation of obstructing folds of the vein wall. A Dacron mesh tube surrounding varicose veins was used as a bypass graft in 13 infrainguinal arterial reconstructions. Ligated larger side branches and connections of the mesh segments caused irregularities of the otherwise smooth flow surfaces. Ten grafts were patent after a mean follow-up of 17 months. Two grafts have remained patent despite severe outflow obstruction in one and proximal occlusion in the other; both underwent successful interventions. The antithrombogenic properties of these grafts were partly due to a marked increase of the vasa vasorum. Externally constricted varicose veins may be used as arterial bypass conduits with good intermediate-term patency.
Phlegmasia Cerulea Dolens: The Role of Non-Operative Therapy
Authors: Patel K. R. , Paidas C. N.
Published: September 2022

Thrombectomy and thrombolysis are often advocated in the treatment of phlegmasia cerulea dolens, but frequently result in incomplete clot removal, recurrence of thrombosis, local and systemic hemorrhagic complications and chronic venous stasis; this state is associated with a rate of major amputation and death of up to 50%. Non-operative therapy includes elevation, hydration and heparinization and excludes all methods aimed at surgical removal or chemical lysis of the thrombus. In 1982 It was decided to use non-operative therapy as the first line of treatment for phlegmasia cerulea dolens. In the last 9 years seven extremities in six patients with this condition have been treated. One patient had advanced gangrene on presentation and one underwent emergency thrombectomy. Five extremities (in five patients) were treated with non-operative therapy. Ischemia was rapidly corrected in all five patients. Edema resolved completely after 3–4 days in four patients. There were no complications attributable to the therapy. Two of six (33%) patients died from terminal disease. Non-operative therapy appears to be effective in preventing limb loss and avoiding the risks of thrombectomy and thrombolysis in critically ill patients.
Critical Evaluation of Axilloaxillary Artery Bypass for Surgical Management of Symptomatic Subclavian and Innominate Artery Occlusive Disease
Authors: Lowell R. C. , Mills J. L.
Published: September 2022

The use of axilloaxillary artery bypass grafting as a successful approach for patients with symptomatic atherosclerosis of the brachiocephalic arteries has been described but remains limited as a result of concern over its subcutaneous, trans-sternal position and long-term patency. The aim of this study was to help define the indications, complications and patency of axilloaxillary artery bypass grafting for the treatment of subclavian and innominate artery occlusive disease. A retrospective review was performed of ten patients who underwent this operation over a 15-year period at the authors' institution and of 253 cases reported in the literature. The most common complication was transient brachial plexopathy, occurring in 3.5% of patients, and graft infection or skin erosion was noted in 1.6%. Incidence of perioperative myocardial infarction, stroke and death was <2%, in contrast to other approaches which may involve thoracotomy, sternotomy, or carotid dissection and clamping. Recent series, including the authors', report a long-term primary patency rate (> 5 years) of around 90%. Because of its ease of performance, low morbidity and mortality, and excellent long-term patency, the authors propose that the axilloaxillary artery bypass is the procedure of choice in appropriately selected patients with symptomatic occlusive disease of the innominate and subclavian arteries.
Inferior Mesenteric Artery Back Pressure and Collateral Circulation to the Distal Colon
Authors: Pereira A. H. , Cutin J. , Eggers E.
Published: September 2022

The contribution of the hypogastric and superior mesenteric arteries to inferior mesenteric artery collateral (back) pressure (r-IMA) was measured in eight patients who were free from arterial disease and were operated on for small sigmoid carcinoma. Peak and mean r-IMAs were measured after clamping both common iliac arteries and the middle colic artery together with the marginal artery of Drummond. Measurements were repeated after the injection of 50 mg papaverine into the inferior mesenteric artery. For comparison the r-IMA was normalized against the radial artery pressure to create the r-IMA:radial artery pressure ratio. At peak systolic pressure the r-IMA:radial artery pressure was approximately 0.6. This fell with crossclamping of the middle colic artery and marginal artery of Drummond; a slightly greater fall was observed when the common iliac arteries were clamped. The findings were similar when mean pressures were compared. The changes in pressure ratio observed after collateral clamping were slightly amplified by injection of papaverine. These data suggest that the hypogastric arteries make at least as great or a slightly greater contribution to r-IMA than do the middle colic artery plus marginal artery of Drummond. The data also indicate the presence of other substantial collaterals. These findings stress the importance of the hypogastric collateral supplying the sigmoid colon when the inferior mesenteric artery is acutely occluded as it is during aneurysm resection.
Recanalization of Occluded Superficial Femoral Arteries Using the Rotational Transluminal Angioplasty Catheter System (ROTACS)
Authors: Batt M. , Coulbois P. M. , Reix T. , Marcade J. P. , Giraud C. , Castellani L. , Fasquel J. L. , Cardon J. M.
Published: September 2022

A total of 85 occluded superficial femoral arteries were treated using the rotational transluminal angioplasty catheter system (ROTACS). The mean length of the occlusions was 7cm; 76% were uncalcified or only slightly calcified whereas 24% were calcified or highly calcified. The mean preoperative ankle:brachial index was 0.51. Primary success was achieved in 62 of 85 cases (73%). The mean length of reperfused occlusions was 6.2 cm: 26% of these lesions were calcified. The mean ankle:brachial index was 0.91. There were 23 primary failures (27%): reperfusion was impossible in 11 cases (Including one complicated by perforation) and there were eight dissections, three cases where residual stenosis exceeded 50%, and one other unspecified failure. The mean length of these occlusions was 10.5 cm; 17% were calcified. Two patients developed a distal embolus and one died 10 days after reperfusion. The probability of primary patency of a reperfused artery was 44% at 1 year. Forty-two of the 62 patients who achieved primary success remained symptom free; the mean length of the original occlusion was 4.5 cm. Fifteen patients developed a new area of stenosis whereas five others exhibited new occlusion after a mean interval of 6 months. The mean length of these reperfused arteries was 9 cm. The probability of secondary patency at 1 year was 58%. Arterial calcification did not appear to influence the feasibility of reperfusion using the catheter. The main factor determining successful reperfusion was the length of the occlusal defect ( P <0.05). Reperfusion using the ROTACS did not improve the feasibility of reperfusion by conventional transluminal angioplasty. Although venous bypass remains the method of choice for treatment of an occluded superficial femoral artery, reperfusion using the ROTACS is a valid alternative for short, calcified occlusions in elderly patients with no remaining venous capital.
Direct Thrombolytic Revascularization of the Occluded Basilar Artery
Authors: Hayashi J. , Oguma F. , Miyamura H. , Eguchi S. , Koike T.
Published: September 2022

Successful direct revascularization in a 54-year-old man with embolism of the basilar artery following St Jude Medical valve replacement for mitral regurgitation 6 years earlier is reported. He arrived at the hospital in a deep coma. Computed tomography showed no new lesions, but subsequent angiography revealed occlusion of the basilar tip, bilateral posterior cerebral arteries and right superior cerebellar artery. Direct thrombolytic therapy was performed using 420000 units urokinase through an infusion catheter placed in the basilar artery. The patient immediately regained consciousness, with only slight diplopia. Direct thrombolytic therapy is considered to be an effective treatment for thromboembolism following prosthetic valve replacement in certain selected cases.
Haemodynamic Evaluation of Retrograde versus Anterograde Delivery of Cardioplegic Solution in Aortic Valve Replacement
Authors: Noyez L. , van Son J. A. M. , van der Werf T. , van Asten W. N. J. C. , Lacquet L. K.
Published: September 2022

A total of 44 patients undergoing isolated aortic valve replacement received either anterograde (20 patients) or retrograde (24 patients), cold St Thomas's Hospital cardioplegia. The patients were similar with respect to age, sex, left ventricular ejection fraction, left ventricular-aortic pressure gradient, cross-clamping time and mean dose of cardioplegia. After surgery, there were no differences in enzyme release, low cardiac output syndrome, rhythm disturbances or clinical outcome between the two groups. Analysis of the postoperative haemodynamic data, however, suggests better preservation of left ventricular contractility with retrograde delivery of cardioplegic solution.
Six Years' Experience with the Omnicarbon Valve Prosthesis
Authors: Otaki M. , Kitamura N.
Published: September 2022

Between January 1985 and March 1990, isolated Omnicarbon valve replacement operations were performed on 90 patients aged 25–72 years. There were 53 aortic valve replacements (AVR) and 37 mitral valve replacements (MVR). The cumulative follow-up was 320 patient-years, with a mean(s.d.) follow-up of 3.7(1.4) years. There were three operative and hospital deaths (3.3%) resulting from retrograde aortic dissection during cardiopulmonary bypass, postoperative renal failure and postoperative mediastinitis. Seven patients died during the late postoperative period, four from valve-related causes. Two of these patients died from prosthetic valve endocarditis, and the others died from thromboembolism and valve thrombosis. The mean(s.d.) actuarial survival rate at 6 years was 86.2(4.3)% (98.8(0.8)% for AVR, 82.1(4.8)% for MVR). The mean(s.d.) actuarial survival rate of freedom from all valve-related mortality at 6 years was 93.5(2.6)% (100% for AVR, 88.1 (2.9)% for MVR). There were two thromboembolic events (one mesenteric artery thrombosis and one valve thrombosis). The standardized incidence of thromboembolism was 0.63% per patient-year. Prosthetic valve endocarditis occurred in three patients (0.94% per patient-year). One patient (0.31% per patient-year) was found to have a paravalvular leak resulting from aortitis syndrome. The mean(s.d.) actuarial rate of freedom from all valve-related complications at 6 years was 89.2(2.0)% (98.6(1.0)% for AVR, 86.4(2.2)% for MVR). There were no instances of anticoagulant-related haemorrhage, valve-related haemolysis, or structural failure. Results of a follow-up period of 6 years indicated that good clinical results and a low incidence of valve-related complications can be demonstrated with the Omnicarbon valve.
Isolated Pulmonary Valve Endocarditis without Cardiac Anomaly in an Infant
Authors: Fukaya Y. , Iida F. , Yanagiya N. , Nobara H. , Nisimura K. , Nakano H. , Morimoto M.
Published: September 2022

A patient with isolated pulmonary valve infective endocarditis without congenital heart disease was diagnosed at an early stage. Simple valvulectomy without replacement was successfully performed during the active stage of infection.
Sternal Closure: Comparison of two Techniques
Authors: Noyez L. , Verkroost M. W. A. , Van Asten W. N. J. C. , Kaan G. L. , Lacquet L. K.
Published: September 2022

A clinical trial was performed to evaluate sternal closure with the controlled tension osteosynthesis system and closure with twisted stainless steel wires. Some 451 consecutive patients who underwent isolated coronary bypass surgery between January 1991 and December 1991 were subdivided into three groups. Patients in group A (94 patients) and group B (98 patients) were all operated on by one surgeon, to reduce variability before, at the time of and after surgery, which might influence sternal wound healing. To exclude a possible preference of the surgeon in the study, group C was formed, consisting of 259 patients operated on by other hospital surgeons. In groups A and C, sternal closure was performed with the controlled tension osteosynthesis system. In group B. sternal closure was performed with (six) twisted stainless steel wires. Among groups A. B and C, no statistical significant difference could be found between the rate and the type of sternal wound complications. Despite this finding, there were significantly more reoperations, a longer cross-clamp time and more extensive use of the internal mammary artery as a graft in group B. Despite the non-randomization of the study, and the small patient numbers being a limitation, the use of the controlled tension osteosynthesis system in adults did not result in a decrease of early sternal wound complications.
Surgical Treatment of Acute Aortic Dissection: Efficacy of Retrograde Cardioplegia for Myocardial Protection
Authors: Sakurada T. , Kuribayashi R. , Sekine S. , Aida H. , Seki K. , Goto Y. , Abe T.
Published: September 2022

The operative morbidity and mortality of patients with Stanford type A acute aortic dissection undergoing urgent operation using retrograde cadioplegia for myocardial protection were evaluated to assess the efficacy of such surgery. A total of 18 patients (12 men and six women. 19–71 years of age) were operated on 9–137 h after onset of dissection using cardiopulmonary bypass with deep hypothermia and retrograde cardioplegia. Graft replacement was performed in ten patients, primary anastomosis in three, and Cabrol and Bentall operations in five. All patients were weaned from cardiopulmonary bypass, but four died in hospital (mortality rate 22%). Thirteen patients were in good health at follow-up ranging from 3 to 98 months, and the remaining patient died from rectal cancer 5 months after surgery. It is concluded that urgent operation of patients with Stanford type A acute aortic dissection can be performed with reasonable operative and excellent follow-up results. Retrograde cardioplegia is an easy and reliable method of myocardial protection to repair the fragile aortic wall.
Mediastinitis in Heart Transplant Recipients: Successful Treatment by Closed Local Irrigation
Authors: Albat B. , Trinh-Duc Ph. , Boulfroy D. , Picard E. , Wintrebert P. , Thevenet A.
Published: September 2022

Following cardiac transplantation bacterial mediastinitis is a severe early complication. Between March 1986 and September 1993, cardiac transplant operations were performed in 101 patients, of whom six developed purulent mediastinitis. Treatment consisted of surgical débridement, closed local irrigation, drainage and systemic antibiotics. No patient died as a result of bacterial mediastinitis. Low cardiac output and requirements for resternotomy for bleeding and prolonged artificial ventilation were significantly higher in the group with sternal infection. In contrast, since January 1991 the dose of corticosteroid was decreased from 5 mg/kg per day to 1.5 mg/kg per day beginning on the first day after operation. A total of 51 heart transplant operations have been subsequently performed without sign of mediastinal infection.
Two-Stage Sternal Closure after Repair of Congenital Heart Disease in Neonates
Authors: Korbmacher B. , Rammos S.
Published: September 2022

Closure of the longitudinal sternal incision can lead to unacceptable impairment of the haemodynamic state after prolonged operation for complex congenital heart disease associated with decreased cardiac function which is caused by cardiac dilatation. Between 1981 and 1991, a two-stage sternal closure was used in 21 neonates with dilatation of the heart and low cardiac output after correction of congenital heart disease. The mean age at operation was 14 (range 4–30) days. In 15 patients (group 1), primary closure of the sternum was considered impossible in the operating room; in the remaining six (group 2). the sternum was reopened on the day of operation or on the first or second day after repair. Three of these newborn infants had a total anomalous pulmonary venous connection and 18 a simple transposition of the great arteries. In all patients, temporary closure of the thorax with a dura mater patch was performed. The patch was usually removed on day 4 after operation in the intensive care unit and followed by uncomplicated routine chest closure. There were no problems with mediastinitis, wound infection, osteomyelitis or instability of the sternum. Subsequent deformity of the thorax was not observed. Some 11 of 15 children (73%) of group 1 and four of six (66%) of group 2 survived. Leaving the sternum open resulted In a significant improvement in the haemodynamics in all patients. The technique of two-stage closure of the sternum is very effective after lengthy corrective operation in children with congenital malformations of the heart who require long periods of perfusion or ischaemia.
Preoperative Colour-Coded Duplex Examination of the Saphenopopliteal Junction in Recurrent Varicosity of the Short Saphenous Vein
Authors: De Maeseneer M. G. , De Hert S. G. , Van Schils P. E. , Vanmaele R. G. , Eyskens E. J.
Published: September 2022

Undetected anatomical variations of the short saphenous vein (SSV) are a major contributing factor to recurrent varicose veins in the SSV area. Peroperative venography and varicography of the SSV have been proposed as a means of exact localization of its termination. The present study evaluated whether colour-coded duplex (CCD) examination constituted a reliable alternative for localization of the saphenopopliteal (SP) junction. Between 1989 and 1990, 12 patients were reoperated on after previous classical ligation of the SSV. Preoperative CCD examination revealed an abnormally high SP junction with persistent reflux in 11 patients and a Giacomini vein in one patient. When comparing these results with venographic and operative findings an accuracy of 100% was reached in these specific cases. It is concluded that for patients with recurrent varicosis of the SSV preoperative CCD examination provides a reliable non-invasive alternative for venography in the exact localization of the SP junction.
Incidence of Bilateral Intraplaque Hemorrhage in Carotid Artery Disease
Authors: Ammar A. D. , Mullins J. R.
Published: September 2022

Stroke is an important source of morbidity and mortality in the USA. Carotid occlusive disease is associated with most cerebrovascular accidents, and carotid artery intraplaque hemorrhage is particularly important in the pathogenesis of cerebral ischemic symptoms. The authors' experience with intraplaque hemorrhage in patients undergoing bilateral carotid endarterectomy was reviewed to determine whether unilateral intraplaque hemorrhage is predictive of the condition occurring on the contralateral side. Forty-seven patients underwent staged bilateral carotid endarterectomy performed by one vascular surgeon. Each plaque was reviewed by a pathologist for the presence of intraplaque hemorrhage. Of these patients, 33 demonstrated intraplaque hemorrhage on the side of initial endarterectomy; 27 of these 33 (82%) had bilateral hemorrhage. It was concluded that intraplaque hemorrhage in the initially operated carotid atheroma is highly predictive of the condition occurring in the contralateral atheroma. Furthermore, aggressive follow-up in this patient population may be warranted.
Influence of Dexamethasone on Intimal Thickening in Experimental Vein Graft
Authors: Norman P. E. , House A. K.
Published: September 2022

The influence of dexamethasone on vein graft intimal hyperplasia was studied in a rat model. The iliolumbar vein was grafted to the common iliac artery in 42 rats. Twenty animals were treated with dexamethasone 0.1 mg/kg per day by injection for 3 weeks; 22 control animals received saline injections. Grafts were harvested at 3 weeks and longitudinal sections prepared. Five deaths and considerable morbidity was seen in the dexamethasone-treated animals. All grafts in the surviving animals in both groups were patent at 3 weeks. Intimal thickening, measured in the proximal, mid and distal graft, was found to be maximal in the proximal graft and least in the mid-portion of the graft. Dexamethasone reduced intimal thickening throughout the graft; the median thickness of the proximal graft was 30 μm (control 50 μm), in the mid-graft 10 μm (control 30 μm) and in the distal graft 20 μm (control 30 μm). This reduction was statistically significant in the mid-graft only ( P <0.05; Mann—Whitney U test). The small effect on anastomotic intimal thickening suggests that dexamethasone is of limited use in the prevention of vein graft intimal hyperplasia in clinical practice.
A variable kinematic model for the prediction of capacitance variations in embedded PZT sensors
Authors: Najd Jamal , Zappino Enrico , Carrera Erasmo , Harizi Walid , Aboura Zoheir
Published: September 2022

This paper proposes the use of a two-dimensional refined finite element model, based on the Carrera Unified Formulation (CUF), to predict the variation in capacitance of embedded piezoelectric sensors. The accurate stress field of laminated structures with embedded sensors has been evaluated by exploiting the capabilities of refined layer-wise models. A fully coupled electro-mechanical formulation has been adopted to predict the piezoelectric response of embedded sensors. Different piezoelectric materials have been considered and a parametric analysis has been carried out including geometrical and physical parameters. The results show that the variation in capacitance is highly affected by the through-the-thickness deformations, that is, classical models cannot be used to predict this phenomenon. The variation in the capacitance value has been confirmed by experimental results proposed in the literature and can be used as a parameter for evaluating the internal stress field.
Effectiveness of TSL Program in Improving Child Abuse, Cortisol, and Dehydroepiandrosterone Sulfate (DHEA-s): A Biomedical Perspective
Authors: Ryu Wonjung , Kim Jae Yop
Published: September 2022

Objective: This study evaluated the Thank You, Sorry, Love (TSL) program's effect on child abuse and the levels of oxidative stress hormone (cortisol, dehydroepiandrosterone sulfate) among North Korean refugee parents. Method: The participants, North Korean refugees ( N  =  45), were assigned to an experimental group with 10 sessions of TSL program intervention ( n  =  15), a comparison group with 10 sessions of Program A intervention ( n  =  15), or a control group with no intervention ( n  =  15). Effectiveness tests included a pre-test, post-test, and 4-week follow-up test. Results: Child abuse scores and cortisol levels differed significantly between the groups in the post-test and follow-up tests. It was confirmed that the group in the TSL program showed statistically significant improvements in child abuse and cortisol compared to the other groups. Conclusion: The TSL program can be used as a practical intervention to prevent child abuse in North Korean refugee families.
Parental and Child Diagnosis Storytelling and Self-Image in French Children With Cleft lip With or Without Cleft Palate
Authors: Gavelle Pascale , Dissaux Caroline , Dupont Mathilde , Khonsari Roman Hossein , Picard Arnaud
Published: September 2022

Objective

Psychosocial adjustment can be challenging for children with cleft lip with or without a cleft palate (CL ± P). Previous studies have linked social integration with self-acceptance and highlighted the impact of the parents’ stress on self-acceptance. Teasing can be linked to children having difficulties explaining their diagnosis to others. This prospective research aimed to gain a better understanding of family communication about cleft, children's oral storytelling about their cleft, and explore their self-image and perceived familial acceptance.

Participants

Parents and their children with CL ± P ( N = 54; average age: 5.6 years).

Design

Semistructured interviews with parents and structured interviews with children were conducted regarding their oral storytelling focusing on scars from cleft lip surgery. Children completed a projective test to explore their self-image and perceptions of familial acceptance. Language screening was completed with the French Wechsler Preschool Primary Scale of Intelligence-Fourth Edition.

Results

Only 30% of children explained their cleft in a way appropriate for peers, including presence at birth, having had surgery, and scar location. Children's ability to explain their cleft was not related to language performance, which was in the average range of 84%. Children's cleft explanations were dependent on parents’ narratives and education methods, including the use of verbal explanations and preoperative photographs. Children's storytelling was related to their self-image and perceived parental acceptance.

Conclusion

Cleft teams should assist families in building their cleft story based on a complete explanation with photographs and a positive and accepting approach.
Optimal Injectable Haloperidol Dose Assessment in the Older Hospitalized Inpatient
Authors: Yuksel Jaylan M. , Brenner Jay M. , Britton Sarah , Bhatti Harneet , Noviasky John
Published: September 2022

Background:

Haloperidol can be used off-label for agitation and/or delirium in older individuals. The recommended initial intramuscular or intravenous dose is 0.5 to 1 mg. However, the evidence to support these doses is nominal.

Objectives:

The primary outcome was to determine whether low-dose injectable haloperidol (≤0.5 mg) was similar in effect to higher doses by assessing the need for repeat doses within 4 hours as a surrogate marker. Secondary outcomes include comparison of length of stay, utilization of restraints, and discharge outcomes between dosage groups.

Methods:

This was a retrospective, single-center, cohort study. Patients aged ≥65 years who received haloperidol injectable who were not on antipsychotics prior to admission were reviewed.

Results:

In the low-dose group (n = 15), no patients required additional haloperidol doses within 4 hours compared with 1 patient each in the medium-dose (n = 23) and high-dose (n = 19) groups ( P = 0.94). There was a difference regarding length of stay, utilization of restraints, and discharge to facility when admitted from home favoring low-dose haloperidol.

Conclusions and Relevance:

While limited by sample size and retrospective design, patients who received low-dose haloperidol demonstrated similar efficacy to those who received higher doses of haloperidol. In addition, secondary outcomes mentioned above favored the use of low-dose haloperidol as well. Based on these findings, low-dose haloperidol is a reasonable initial dose for the agitated older patient.
Safety Comparison of Monotherapy Aspirin to Dual Antiplatelet Therapy Following Coronary Artery Bypass Surgery
Authors: Nei Scott D. , Wamsley Kyle S. , Mara Kristin C. , Stulak John M. , Zieminski Joseph J.
Published: September 2022

Background

Dual antiplatelet therapy (DAPT) is recommended over single antiplatelet therapy (SAPT) in patients following coronary artery bypass grafting (CABG). The compilation of evidence has focused on the efficacy of DAPT to limit risk of graft occlusion, however the safety, especially in the on-pump CABG population, is less well described. The aim of this study was to assess the safety of DAPT versus SAPT after on-pump CABG.

Methods

This was a single-center, retrospective cohort analysis of adult patients following isolated on-pump CABG between January 2012 and December 2019 not on oral anticoagulation at discharge. The primary endpoint was occurrence of a composite bleeding event identified by pre-specified ICD codes. Secondary endpoints consisted of 30-day and 1-year mortalities along with individual bleeding components.

Results

Of the 2341 patients included 1250 patients were in the SAPT arm and 1091 patients in the DAPT arm. The study populations differed by age, prior MI, PAD, and CHF status/stage. Bleeding events occurred in a total of 70 patients (3.0%), with 36 patients (2.9%) in the SAPT arm and 34 patients (3.1%) in the DAPT arm ( P = .74). 30-day (SAPT 0.7% vs DAPT 0.4%) and 1-year (SAPT 3.3% vs DAPT 2.3%) mortality were not significantly different between groups. The most frequent bleed event was in the gastrointestinal tract.

Conclusion

In this study, DAPT was not associated with an increase in composite bleeding compared to SAPT. This study could reduce the barrier to prescribing of DAPT given previous efficacy data.
Comparing Response Modes During Functional Communication Training: Efficacy of Acquisition and Preference for Students with Autism
Authors: Bethune Keri S. , Boyle Jessica
Published: September 2022

This study evaluated acquisition, preference, and generalization of two forms of augmentative and alternative communication (AAC) during functional communication training (FCT) with two students with autism spectrum disorder (ASD). Acquisition of FCT responses, using a picture-based communication system and speech-generating device (SGD; Apple iPod Touch with the Proloquo2Go), was compared. Following acquisition, preference of response mode was evaluated for each participant. Both AAC systems were made available simultaneously during FCT sessions, and data were collected on participants’ initiation of functional communication (FC) on each modality. Findings indicated FC responses with the picture-based communication system and the SGD were acquired with similar rates by both participants. Furthermore, both participants demonstrated a consistent preference for the SGD as compared with the picture-based communication system. Both participants generalized the preferred FCT mode (i.e., SGD) to their classroom setting with their classroom teacher. Results indicate it is important to assess both acquisition efficiency and preference when selecting AAC systems for individuals with autism.
Effect of a stabilizer on the structure, synthesis, and tribological properties of silver nanoparticles
Authors: Kuzharov Andrey A. , Milov Aleksey A. , Gerasina Julia S. , Soldatov Mikhail A. , Butova Vera V. , Soldatov Alexander V.
Published: September 2022

The structure and properties of nanoparticles are greatly influenced by the synthesis method and the stabilizer used in their preparation. The paper presents the results of the effect of various stabilizers (gelatin, sodium citrate, sodium borohydride) on the structure, synthesis, and tribotechnical properties of silver nanoparticles. The mechanism of the formation and growth of silver nanoclusters was investigated using quantum-chemical calculations with full optimization of all parameters using the density functional theory (DFT) PBEPBE/Lanl2DZ method. It is shown that the use of organic stabilizers (for example, gelatin) leads to an increase in the stability of stabilized silver clusters. Such systems have greater conformational flexibility and a large number of molecular donor oxygen centres in their composition. The effect of the stabilizer on the structure of the Ag13 silver cluster was revealed in four model systems: gelatin, ammonium chloride NH4Cl, sodium borohydride NaBH4, and trisodium citrate Na3C6H5O (Na3Cit). Silver nanoparticles (AgNPs) obtained by the sonoelectrochemical, citrate, borohydride, and citrate-borohydride method varied in size from nanometers to several tens of nanometers. As a result of tribotechnical tests of lubricants with the obtained silver nanoparticles, a positive effect of stabilized silver clusters was revealed in the composition of lubricant compositions. The best tribotechnical characteristics were shown by lubricating compositions containing AgNPs stabilized with gelatin. It was found that a decrease in the size of gelatin stabilized AgNPs, when added to lubricants, leads to an increase in the tribological properties.
Antiretroviral therapy achieved metabolic complete remission of hepatic AIDS related Epstein-Barr virus-associated smooth muscle tumor
Authors: Ara Takahide , Endo Tomoyuki , Goto Hideki , Kasahara Kohei , Hasegawa Yuta , Yokoyama Shota , Shiratori Souichi , Nakagawa Masao , Kuwahara Ken , Takakuwa Emi , Hashino Satoshi , Teshima Takanori
Published: September 2022

Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal tumor which occurs in immunocompromised patients. The immune status is an important factor in the treatment of EBV-SMTs, but the efficacy of antiretroviral therapy (ART) is not elucidated in acquired immune deficiency syndrome (AIDS) related EBV-SMTs. Here, we report the first successful case of a 29-year-old man with hepatic AIDS related EBV-SMT treated with ART solely. Positron emission tomography scan was useful for the evaluation of disease status. Recent advances in ART that enables to restore patient’s immune status rapidly may change the treatment strategy in AIDS related EBV-SMT.
Development and validation of a new prognostic tool for impacted maxillary canines, ‘Easy box’: A cone-beam computed tomographic study
Authors: P Muhammed Shibin , Sundareswaran Shobha , Mohammed Faraj , Jisha Baby
Published: September 2022

Objective:

To develop a tool to facilitate simple, easy and rapid assessment of the level of difficulty in disimpaction of an impacted canine using cone-beam computed tomography (CBCT).

Design:

A cross-sectional study.

Methods:

A panel of four experienced orthodontists formulated a questionnaire capable of portraying the limits of a three-dimensional (3D) area around impacted maxillary canines on CBCT images, which would determine the disimpaction difficulty level. In total, 14 experienced orthodontists graded each item in the questionnaire and assigned scores in the range of 0–5. Average scores obtained outlined the limits of a 3D area, within which an impaction was deemed favourable. This area was termed ‘Easy box’. The disimpaction difficulty level of 170 impacted maxillary canines was then assessed using ‘Easy box’ and the existing tool KPG index for convergent validation.

Results:

Perfect inter-examiner agreement was obtained as evidenced by Fleiss kappa value of 0.984 for the tool ‘Easy box’ and 0.948 for the KPG index. There was also perfect agreement between the two methods of assessment (Cohen weighted kappa, k>0.86). The average time taken for assessment using ‘Easy box’ was 3.3 min compared to 8.8 min for the KPG index.

Conclusion:

‘Easy box’ proves to be a simple, accurate and rapid assessment tool for the prognostic evaluation of impacted canines, using CBCT images. Impacted maxillary canines with cusp tips that lie beyond the limits of the 3D ‘Easy box’ area with a beta angle greater than 45°, were rated to be more difficult to align.