bluuebunny/crossref_metadata_2025 huggingface dataset:
The decision for civil commitment by jury trial and the respondent with a diagnosis of dementia
Authors: Mayers Kathleen S.
Published: June 2007

Difficulty communicating with the moderately to severely demented patient in a civil commitment proceeding is discussed. The patient is not always able to indicate whether s/he wants a jury trial or a hearing by judge (or court commissioner). At times, the manner in which the judge or attorney communicates may contribute to the patient 's inability to comprehend. Two cases are provided which demonstrate these difficulties. Suggestions are made to simplify communication in the courtroom and to increase the likelihood that the patient will understand. A brief structured interview is included to facilitate the process of obtaining an indication from the patient as to whether s/he wants a jury trial or a hearing by judge (or court commissioner).
Therapeutic recreation as an intervention for persons with dementia and agitation: An efficacy study
Authors: Buettner Linda L. , Lundegren Herberta , Lago Daniel , Farrell Patricia , Smith Ralph
Published: June 2007

Thirty-six long term care residents with dementia and agitation were selected for participation in this eight week study. During the eight week J period, the participants received two different four week therapeutic recreation interventions in a clinical crossover design. These interventions included a sensorimotor program and a traditional activity program. The effects of these two programs were evaluated in terms of the effect on strength, flexibility, over all functioning, and agitation. The analysis showed that there was a significant improvement of grip strength, flexibility, and a reduction in agitation during the sensorimotor segment of the treatment. The results of this study indicate a new direction for therapeutic recreation specialists working with older adults with dementia and agitation.
Need-driven dementia-compromised behavior: An alternative view of disruptive behavior
Authors: Algase Donna L. , Beck Cormelia , Kolanowski Ann , Whall Ann , Berent Stanley , Richards Kathy , Beattie Elizabeth
Published: June 2007

The disruptive behavior of persons with dementia is a problem of considerable clinical interest and growing scientific concern. This paper offers a view of these behaviors as expressions of unmet needs or goals and provides a comprehensive conceptual framework to guide further research and clinical practice. Empiricalfindings and clinical impressions related to wandering, vocalizations and aggression to support and illustrate the framework are presented
Impacts of a therapeutic environment for dementia care
Authors: Kovach Christine , Weisman Gerald , Chaudhury Habib , Calkins Margaret
Published: June 2007

This study explores the association ofphysical environments with the behaviors and care ofpeople with dementia. In order to have a comparative understanding, environmental settings of a traditional nursing facility and an innovative dementia care unit on the same campus were selected. Behavioral observations were done on 12 residents before and after their move ftrom the traditional facility to the dementia care unit. Resident and staffusage and behaviors in the shared spaces were systematically recorded and analyzed Findings include increased use ofthe activity spaces, increased social interaction among the residents, and more interactive than assistive behavior between the staff and residents
Alzheimer memory training: Quizzes beat repetition, especially with more impaired
Authors: Arkin Sharon M.
Published: June 2007

The present experiment was an attempt to replicate and discover the active agent in a memory/training intervention that had highly significant results with two early stage Alzheimer patients' and subsequently has been used successfully with a total of 12 additional patients.2 Two training methods were incorporated into one tape recorded intervention in an alternating treatments design: one method presented the information twice; the other presented the information once and immediately asked questions about it. Subjects were five mildly to severely impaired male Alzheimer patients and one man with an undiagnosed amnestic disorder. A shortened (quiz only) format was used with the severely impaired subject. To-be-learned information was randomly assigned to the two presentation formats. Taped sessions were presented three times daily for three days. Five of the six subjects learned much of the information presented (55 percent-86 percent) with both methods combined Retention of information learned at one and two week follow up ranged from 49 percent (one subject) to over 75 percent (three subjects). All four of the successful learners who used both methods learned more via quizzes than via repetition, with the lowest functioning subjects benefiting the most from the quizzes. At one week follow-up, the advantage of the quiz method was still substantial for the more impaired subjects, but had virtually disappeared or reversed itself for the high functioning subjects.
Stress, learning style, resilience factors, and ways of coping in Alzheimer family caregivers
Authors: Garity Joan
Published: June 2007

Family caregiving is increasing steadily as our overall population ages. Most research has studied caregivers in relation to stress level, anxiety, and depression. This study investigated the relationship between stress level, learning style, resilience factors, and ways of coping in 76 participants from 11 support groups of the Alzheimer Association of Eastern Massachusetts. The findings of the study show gender differences on burden and learning style, moderately high caregiver resilience, use of both problem-focused and emotion-focused coping, and moderate correlations between levels of resilience and specific use of coping strategies. Both future research directions and the implications of these findings for caregiver support groups are discussed.
Rehabilitation following hip fracture in patients with Alzheimer's disease and related disorders
Authors: Hamman Rosalyn J.
Published: June 2007

This study examines patients who were rehabilitated in a long-term care facility specializing in the care of Alzheimer's disease and related disorders over a two-year period All of the patients were moderately to severely impaired cognitively on a standardized mental exam and were unable to live outside of a secured, long-term care facility. The patients ranged in age from 80 to 90 years old and were predominantly female. There were 19 patients, all but one of whom had had surgery; five patients had prostheses and 13 had ORIFs. All of the patients receivedphysical therapy q.d. and then q. o.d. for periods ranging from one week (patient deceased) to six months. The mean time of rehabilitation was 10 weeks. At the time of discharge from physical therapy, all of the patients who survived (two deceased), were able to ambulate with or without assistive devices at least 100 feet. some required assistance for safety due to decreased judgement and cognition, four were able to ambulate totally independently ad lib, and five needed supervision only. On follow-up of these patients, several improved on their own after discharge from physical therapy or with follow-up by restorative nursing. For Alzheimer patients, ambulation is a significant quality-of-life issue. These patients were all happier ambulating than in a wheelchair, especially since restraints would have been necessary to keep them there. The findings suggest that patients with Alzheimer's and other dementias may require slightly longer periods of rehabilitation but that the results are well worth the effort.
Improving pain control for the elderly patient with dementia
Authors: Gibson Margaret C.
Published: June 2007

Improving pain control for elderly patients, particularly elderly patients with dementia, is still very much a peripheral focus of gerontological health care, despite the prevalence of pain-related chronic conditions in this population. Barriers that impede pain control efforts are identified. Recommendations for more effective pain assessment and intervention practices are presented.
Alzheimer memory training: Positive results replicated
Authors: Arkin Sharon M.
Published: June 2007

In December, 1992, Clinical Gerontologist published the results of my dissertation research single subject experiments in which two early Alzheimer patients (Folstein MMSE scores of 23) were assisted to relearn two sets of forgotten biographical information by means of informational narratives and interactive quizzes presented via audio cassette recorder1I Subsequent articles in this journal have discussed my memory training work in the context of a multi-modal treatment program,2 and presented findings from a research study that compared quizzing to repetition as a means of reteaching forgotten information.3 Since none of the previously published articles referred to memory training in their titles, it is conceivable that researchers and practitioners might not find these articles in routine literature searches.

This article brings together in one place a summary of my memory training work with the 14 Alzheimer's patients and one undiagnosed amnestic patient with whom I have used the tape-recorded intervention. During the next five years, the technique will be tested, among other interventions, with 18 of 28 early stage Alzheimer patients with whom I'll be working under a grant from the National Institute on Aging.

So far, the technique has resulted in substantial learning in 13 of the 15 subjects with whom it was tried. MMSE scores of successful learners ranged from 10 to 27. The two who failed to learn had the highest and lowest mental status scores of the Alzheimer subjects: eight and 26, respectively. One or two week follow-up was done in 12 studies. In 11 of the 12 studies, 78 to 100 percent of questions answered correctly at post-test were answered correctly at follow-up.
Behavior-modifying drug use among elderly nursing home residents with dementia
Authors: Griggs-Smith Carol , Kempf-Coleman Sarah , Hamilton Edith M. , Braun Jean W. , Schwieterman Irma
Published: June 2007

This study examined the relationship of personal characteristics of 107 elderly nursing home residents with dementia and their use of behavior-modifying drugs. A comparative design was used with two groups (receiving or not receiving drugs) to examine differences in cognitive, physical and social functioning. Findings included more hospitalizations among subjects not receiving drugs; and more impaired judgment and irritable behaviors, yet increased independence in moving about the environment, among subjects receiving drugs. These findings underscore the needforfrequent assessment of all residents andfor using non-pharmacological strategies even though drugs are administered.
Location of death as an indicator of end-of-life costs for the person with dementia
Authors: Lane Marcia J. , Davis Dorothy R. , Cornman Carol B. , Macera Caroline A. , Sanderson Maureen
Published: June 2007

Decreasing health resources and an aging population highlight the importance of end-of-life decisions. Estimates suggest that end-of-life care in a hospital is more expensive than other alternatives. This study examined the location of death for 3,109 Medicaid-eligible persons with dementia identified through the South Carolina Alzheimer's Disease Registry between 1988 and 1994 and estimated daily end-of-life costs. Results indicated that (1) daily costs for hospital care are six times higher than hospice/home care and (2) almost half of persons resided at home but only 8 percent died at home while 51 percent died in hospitals, the most expensive option. These findings suggest home or hospice end-of-life care might be a reasonable and cost-effective option for elderly patients with dementia. Families should be encouraged to explore this alternative.
Clinical and neuropathological features of dementia with Lewy bodies
Authors: Gomez-Tortosa Estrella , Newell Kathy , Irizarry Michael , Hyman Bradley T.
Published: June 2007

Dementia with Lewy bodies (DLB) is an increasingly recognized entity which overlaps in clinical, pathological and genetic features with Alzheimer's (AD) and Parkinson's disease (PD). Clinically, it is characterized by progressive cognitive impairment with significant fluctuations in alertness, parkinsonism, and psychosis with recurrent hallucinations. The neuropathological hallmarks are the intracytoplasmic inclusions in substantia nigra typical of PD, known as Lewy bodies (LB), but widely distributed throughout paralimbic and neocortical regions. Most of the cases also coexist with a plaque predominant AD. The evidence of alpha-synuclein in LB and related neurites as well as of a synuclein fragment in AD plaques opens new links among these neurodegenerative diseases. This article will review briefly the clinical and pathologicalfeatures that DLB shares with AD and PD, as well as those that support the idea that it is a distinct disorder.
Outcomes of nighttime physical restraint removal for severely impaired nursing home residents
Authors: Capezuti Elizabeth , Strumpf Neville , Evans Lois , Maislin Greg
Published: June 2007

There is ample evidence that physical restraint reduction does not lead to increased falls or injuries. This study tests the effect of removing nighttime restraints by comparing two groups: Restrained in bed at pre- but not postintervention (n = 51), or restrained in bed at both pre- and post-intervention (n = 11). No differences in nighttime fall rates between the two groups were detected.

Nighttime physical restraint removal does not lead to increases in falls from bed in older nursing home residents. Although markedly reduced in nursing homes, restraint use remains a common practice among hospitalized older adults. We should continue to focus efforts on developing new, individualized approaches to reduce risk of falling from bed among frail elders.
Activity based Alzheimer care: A National Trining Program
Authors: Fazio Sam , Chavin Melanie , Clair Alicia Ann
Published: June 2007

Requests from Alzheimer Association chapters, the general public and subsequent focus groups from around the country articulated a strong need for a standardized, education and training curriculum for activity providers in programs for those who have dementia. The current practices for training and service delivery were defined, target audiences for training were determined, and content areas for growth and development were identified. A curriculum was developed and pilot tested with 285 activity providers in five locations across the country. An assessment for knowledge of content was administered before and after the curriculum was delivered at each site to determine curriculum effectiveness in content delivery. With a possible score of 30-points, a statistical comparison between the pilot pre-test (Mean = 22.888) and post-test (Mean = 25.044) revealed a significant difference at .000 level of confidence. Scores were higher after participation than before participation in the curriculum. Participants indicated that the curriculum met learning objectives either completely or reasonably well. The curriculum will be further refined and available for wide use in the near future.
Vocally disruptive behaviors in people with cognitive impaitment: Current knowledge and future research directions
Authors: Lai Claudia K. Y.
Published: June 2007

This paper is a literature review of vocally disruptive behaviors (VDB) in people with dementia. This area of interest has not caught the full attention of researchers and professionals alike. Thus, the knowledge base being developed is limited. This paper will discuss the prevalence and the severity of the problem. The profiles of persons displaying VDB will be portrayed, as will the context for which VDB frequently occurs. Then, postulations regarding the etiologies for VDB and corresponding interventions will be explicated. Unfortunately, systematic studies are few and the effectiveness of different kinds of intervention strategies has not been supported by empirical data. Finally, issues pertaining to the study of VDB will be examined and directions for future research will be recommended.
Psychosocial factors and the onset of genetic diseases: Dominantly inherited Alzheimer's disease and ataxia—A preliminary investigation
Authors: Nee Linda E. , Higgins Joseph J.
Published: June 2007

Certain psychosocial factors such as marriage and involvement with support groups can influence longevity by unknown cellular mechanisms. To determine whether social factors impact upon the phenotypic expression of neurodegenerative disorders, we organized a standardized database on 43 patients with familial Alzheimer's disease [(FAD) (n = 18)] and spinocerebellar ataxia (SCA) types one and three (n = 25). Variables including information on social factors (marital status, close friends, church attendance and group memberships) were correlated with genetic and clinical data. In the total population (n = 43) higher education was linearly related to a greater income. Social factors did not significantly affect the onset of symptoms in patients with FAD. Regardless of the number of CAG trinuceotide repeats, most SCA patients who regularly attended church related activities and social group activities had a later onset of disease symptoms compared to those individuals with less social interaction.
Strategies for community-based dementia education and creating sustainable change: Lessons learned from the Community Outreach Education Program
Authors: Connell Cathleen M , Walter Benjamin , La Pietra Kunz Margaret , Holmes Sara B.
Published: June 2007

The Community Outreach Education Program (COEP) was established to disseminate information about the diagnosis, assessment, management, and treatment of dementia to health care professionals, service providers, staff of community organizations and voluntary agencies, and family caregivers in communities throughout Michigan. This paper will describe the activities implemented as part of outreach educational interventions in Bay City, Saginaw, Grand Rapids, and Kalamazoo, Michigan. Lessons learned about community-based dementia education and strategies for creating sustainable change are discussed.
Assessing Alzheimer's support group particpation: A retrospective follow-up
Authors: Karlin Nancy J. , Bell Paul A. , Noah Jody L. , Martichuski Diane K. , Knight Barbara L.
Published: June 2007

Conflicting findings have been reported on whether attending an Alzheimer's disease (AD) support group is a positive or negative experience. As a result, the present study provides the results from a retrospective analysis of the effects of caregiver support groups over an eight year period. The results suggest that those in distress are the most likely to attend support groups, and the benefits of attending become more apparent over time. The primary reason given by participants for having stopped attending support groups was the lack of a program for those who no longer are active care providers. Many of these same individuals indicated a marked interest in caregiver issues, but felt that most of the information provided was for those providers early in the care process. Thus, support groups that consider caregiver transitions may prove of interest.
“Changing the Blood”: Language, Literature, and Teaching
Authors: Keck Ray M.
Published: June 2007

The past 30 years have seen develop, flower, and then disappear a rich assortment of theories and strategies dedicated to language teaching. The author offers a panoramic view of these pedagogical approaches and argues in favor of a method to join literature and language from the first weeks of study. Art changes the blood, and the art of a people is most thoroughly transmitted in its language. He analyzes a series of texts that demonstrate how Spanish literature holds out to us a new and different world, giving us new and uncommon options to understand ourselves and our circumstances.
Characteristics of Latina/o Migrant Farmworker Students Attending a Large Metropolitan University
Authors: Zalaquett Carlos P. , Alvarez McHatton Patricia , Cranston-Gingras Ann
Published: June 2007

This article examines research findings from a study of Latina/o farmworker migrant students who have succeeded in gaining access to a college education at a large southern university. Findings reveal students with a strong Latina/o or bicultural identity who attend college seeking a better life, a career path, or to make their family proud. Parents and other family members are the paramount influence in the students' decision to attend college. Specific strategies to help these students pursue a higher education degree are presented.
Modified Human Ureter and Human Saphenous Vein Grafts Tanned with a Polyepoxy Compound or Glutaraldehyde for Small-Diameter Arterial Substitution
Authors: Uematsu Masahisa , Okada Masayoshi
Published: June 2007

The polyepoxy compound is a new cross-linking agent that is now replacing glutaraldehyde, and human ureter is a new potential substitute for small-caliber arterial prostheses. The present study was performed to compare the use of human ureter grafts tanned with a polyepoxy compound, human ureter grafts tanned with glutaraldehyde, and human saphenous vein grafts tanned with a polyepoxy compound for small-diameter arterial substitutions. Human ureter grafts tanned with a polyepoxy compound (n= eight), human ureter grafts tanned with glutaraldehyde (n=six), and human saphenous vein grafts tanned with a polyepoxy compound (n=eight) were implanted in the carotid arteries of Japanese white rabbits. These grafts were sacrificed after either 1 month's or 6 months' observation. There was no evidence of rejection, aneurysmal formation, and/or infection. Human ureter gcafts tanned with a polyepoxy compound after 1 month's observation (n=six) showed excellent patency without stenosis at the anastomotic sites as well as function, and the histologic findings revealed monolayer endothelial-like cells covering the surface of the graft. Human ureter grafts tanned with glutaraldehyde after 1 month's observation (n=six) were completely occluded with severe intimal hyperplasia. Human saphenous vein grafts tanned with a polyepoxy compound after 1 month's observation (n= six) were patent at the time of explantation, but moderate stenosis caused by intimal hyperplasia at the anastomotic sites was observed. The preliminary data also suggest that, with longer observation of up to 6 months, human ureter grafts tanned with a polyepoxy compound (n=two) showed excellent patency. However, a longer observation of up to 6 months for human saphenous vein grafts tanned with a polyepoxy compound (n=two) revealed severe intimal hyperplasia with intramural thrombosis and/or severe calcification. This study suggests that human ureter grafts tanned with a polyepoxy compound could serve as more satisfactory bioprostheses for the reconstruction of smallcaliber vessels than human ureter grafts tanned with glutaraldehyde or human saphenous vein grafts tanned with a polyepoxy compound.
Posttraumatic Pseudoaneurysm of Stenotic Internal Carotid Artery Repair by Stent Graft
Authors: Szopiński Piotr , Iwanowski Jaroslaw , Kielar Maciej , Noszczyk Wojciech
Published: June 2007

The authors report an intravascular treatment in the case of posttraumatic pseudoaneurysm of a stenotic internal carotid artery, using a stent graft.
Treatment of Primary Venous Insufficiency by Endovenous Saphenous Vein Obliteration
Authors: Chandler James G. , Pichot Olivier , Sessa Carmine , Schuller-Petrovicć Sanja , Kabnick Lowell S. , Bergan John J.
Published: June 2007

The objective of this paper is to evaluate treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Three hundred one limbs were treated in 206 women and 67 men with a mean CEAP Clinical Class of 2.4 ±0.9. Endovenous obliteration was combined with high ligation in 67 limbs (22%) and with stab avulsion phlebectomies in 181 (60%). Acute occlusion was achieved in 290 limbs (96%). Obliteration failures in 11 limbs were treated by saphenous stripping or managed expectantly. Paresthesias followed 15% of treatments confined to the thigh and upper leg and affected 30% of limbs when treatment extended to the ankle (p < 0.001). Eight potentially preventable thermal skin injuries occurred, five in particularly superficial venous segments, of which four were in men. At a mean follow-up of 4.9 months, 21 (7.2%) of successfully treated veins have partially or totally (n = two) recanalized, but only 11 (3.8% of 290) have Doppler-detectable reflux. Ninety-one patients have been followed up for 6 months to 1 year, showing significant improvement in CEAP class and progressive relief from clinical symptoms. At their latest visit, 94% rated themselves as being symptom-free or substantially improved. These midterm results with endovenous obliteration in the treatment of primary varicose veins suggest that it may be as effective as surgical stripping in eliminating greater saphenous vein reflux and delaying the appearance of new varicose veins. Simple procedural modifications, such as not treating to the ankle, prophylactic infiltration about superficially placed veins, and early duplex surveillance should diminish the complications observed in this early experience.
Fogarty Balloon Catheter Injury Revisited: A Cause for Progressive Claudication
Authors: Smith Jason C. , Smith Douglas C. , Taylor Frank C. , Ballard Jeffrey L.
Published: June 2007

A 59-year-old competitive ballroom dancer presented with right thigh claudication upon strenuous exercise. Following a diagnostic arteriogram, she underwent aortoiliac reconstruction for an ulcerated and narrowed distal aorta and severely stenotic right common iliac artery. The procedure was complicated by acute graft thrombosis due to a heparininduced “white-clot” syndrome. Several passes were made with Fogarty balloon catheters through each iliac limb and from the femoral arteries down each lower extremity until normal pulses returned. The patient returned 3 months later with a 6-week history of severe disabling bilateral calf claudication. An arteriogram showed diffusely narrowed iliac, femoral, and popliteal arteries, bilaterally, compared to the generous caliber vessels seen 3 months earlier. A diagnosis of myointimal hyperplasia secondary to Fogarty balloon catheter injury was made.
Correction of Coagulation Defect in Thoracoabdominal Aneurysm Repair by Mesenteric Shunting
Authors: Gertler Jonathan P. , Rehring Thomas F. , Davison J. Kenneth , Laposata Michael , Cambria Richard P.
Published: June 2007

The authors have previously characterized laboratory coagulation abnormalities in patients undergoing thoracoabdominal aneurysm (TAA) repair as a reduction in clotting factor activity and an increase in the fibrinolysis that occurs after supraceliac clamping. A return to normal in these patients did not occur until the time of skin closure and was influenced by fresh frozen plasma (FFP) administration. To test the hypothesis that shortening the mesenteric ischemic time would mitigate the defect earlier in the operative course, the authors developed a technique of mesenteric shunting during TAA repair and studied coagulation response prospectively.

Twelve consecutive elective patients had TAA repair carried out in standard fashion. No heparin was used. After completion of the proximal anastomosis, a coronary perfusion catheter was secured inside a previously sewn graft side arm and inserted into either the superior mesenteric artery or the celiac axis; the graft was clamped below the side arm. Blood levels of fibrinogen, F1.2, D-dimer, and Factors II, V, VII, VIII, IX, X, XI, and XII were analyzed at induction, immediately prior to mesenteric shunt insertion, at reimplantation of the visceral button and 30 minutes after visceral button reimplantation. Clamp times, volume and timing of blood products, and clinical outcomes were recorded prospectively. A two-sided, paired t test (pairwise/intersample) was applied for each factor studied.

There was no coagulopathic bleeding. Indicators of fibrinolysis (fibrinogen, D-dimer) continued to rise throughout the procedure as had been true in our previous series. However, clotting factors returned to baseline shortly after mesenteric shunting and prior to administration of exogenous clotting factors.

The return to baseline of the coagulation factors studied began at the time of the insertion of a mesenteric shunt. Visceral perfusion appears to have an impact on coagulation response. Earlier reperfusion may help extend the window of operative time by limiting coagulopathic bleeding that is occasionally seen during TAA repair.
External Carotid Surgery
Authors: Karkos Christos D. , Fearn Shirley J. , McCollum Charles N.
Published: June 2007

External carotid revascularization has been advocated to correct stenoses and obliterate sources of emboli in symptomatic patients with internal carotid artery (ICA) occlusion. Of more than 450 patients undergoing carotid surgery in an 8-year period, eight patients with amaurosis fugax, hemispheric transient ischemic attacks (TIAs), or global symptoms of cerebral ischemia in the presence of ICA occlusion underwent external carotid artery (ECA) reconstruction. There were five external carotid endarterectomies and three bypasses to the ECA, one from the common carotid artery and two from the subclavian artery. There were no operative deaths, but one minor ipsilateral stroke occurred after subclavian-ECA bypass. There was complete resolution of symptoms in all the other patients. Follow-up ranged from 4 months to 10 years (mean 3.4 years). It is concluded that ECA revascularization may be the best treatment option for relieving or improving late neurologic symptoms secondary to cerebral hypoperfusion and/or embolization through ECA collaterals in the presence of ICA occlusion and ECA stenosis.
Simultaneous Redo Carotid Endarterectomy and Coronary Artery Bypass
Authors: Hines George L. , Hartman Alan R. , Schubach Scott L.
Published: June 2007

High-grade (>80%) internal carotid artery stenosis is a risk factor for stroke in patients undergoing coronary artery bypass grafting (CABG). Primary carotid endarterectomy (CE) is frequently and safely performed along with CABG to decrease the risk of perioperative stroke. Whether recurrent carotid stenosis is a risk factor for peri-CABG stroke, and whether combined reoperative carotid surgery and CABG is a higher risk procedure then primary endarterectomy and CABG, is unknown. Seven patients underwent recurrent carotid surgery along with coronary artery bypass (CAB). Five patients were asymptomatic, and two were symptomatic. Four patients underwent patch angioplasty alone and 3 patients underwent endarterectomy and patch angioplasty. Five patients underwent primary CAB and two patients redo CAB. There were no perioperative neurologic events, no episodes of cranial nerve injury, and no reoperations for bleeding. All patients survived the combined procedure and were discharged in 6.2 ±0.8 days. Combined redo CE and CAB can be safely performed in patients with high-grade recurrent carotid stenosis.
Aortopopliteal Bypass Via Obturator Foramina for Limb Salvage After Failed Previous Iliofemoral, Femorofemoral, Femoral-Popliteal Bypasses
Authors: Sottiurai V. S. , McNeil J. , Hatter D.
Published: June 2007

A 65-year-old man with right iliac artery occlusion, left iliofemoral stenosis, and bilateral superficial femoral arteries occlusion, instead of receiving the traditional aortofemoral bypass, underwent in sequence the following operations: left common iliac to femoral bypass, femorofemoral bypass, and bilateral femoropopliteal bypasses with use of polytetrafluoroethylene (PTFE) grafts. Occlusion of the femoropopliteal bypass and stenosis of the iliofemoral bypass at the distal anastomosis resulted in severe leg ischemia with nonhealing toes and leg ulcers. To minimize ischemia time to the lower extremities, pelvic organs, and kidney and avoid the need for multilevel revascularization, the patient received aortobipopliteal bypass via obturator foramina. The aortic anastomosis was intentionally constructed in and end-to-side fashion to avert the need for left accessory renal artery implantation and interruption of the pelvic arterial supply. The patient has palpable ankle pulses and progressed to heal the ischemic ulcers following the aortobipopliteal bypass operation.
Percutaneous Balloon Fenestration and Endovascular Stent Placement for Type B Acute Aortic Dissection with Renal Ischemia
Authors: Passman Marc A. , Marston William A. , Farber Mark A. , Owens Lewis V. , Sandhu Fatejeet S. , Jaques Paul F. , Keagy Blair A.
Published: June 2007

This case illustrates the feasibility and effectiveness of percutaneous balloon fenestration and endovascular renal artery stenting for Type B acute aortic dissection with associated renal ischemia. Percutaneous balloon fenestration and endovascular stent placement should be considered as an alternative to traditional surgical approaches to restore blood flow to arteries compromised by acute aortic dissection.
Endovascular Management of a True Aneurysm of the Profunda Femoris Artery
Authors: Rich Preston B. , Wolk Seth W. , Sarosi Michael J. , Shanley Charles J.
Published: June 2007

Isolated true aneurysms of the profunda femoris artery account for less than 0.5% of all peripheral aneurysms. Because of the high rate of associated complications, open surgical repair has been advocated for all such aneurysms. To general knowledge, this report documents the first case of endovascular management of an isolated true aneurysm of the profunda femoris artery. A 78-year-old man presented with an enlarging pulsation of the proximal left thigh. Physical examination revealed a 5 cm, nontender, expansile mass in the upper medial aspect of the left thigh. Color flow duplex imaging showed a 4.8 x 4.0 cm aneurysm involving the proximal left profunda femoris artery. Biplanar angiography demonstrated generalized arterial ectasia with a 2.2 x 4.4 cm discrete, saccular aneurysm arising from the proximal left profunda femoris artery. Because of the patient's medical comorbidities, an endovascular approach to the management of the aneurysm was elected. Percutaneous angiographic coils were placed in the aneurysm as well as in the profunda femoris artery beyond the aneurysm resulting in aneurysmal thrombosis. The distal profunda femoris artery and superficial femoral artery remained patent. Pedal pulses were normal following the procedure and the patient was discharged 8 hours later in good condition. Subsequent duplex imaging performed 1 month following the intervention demonstrated a patent common femoral artery and superficial femoral artery without flow in the aneurysm. A review of the literature revealed 35 reported cases of isolated true aneurysms of the profunda femoris artery. The natural history of these aneurysms is not well defined; however, exclusion is prudent in most cases because of a high rate of associated complications with conservative management. Endovascular management with coil embolization may necessitate occlusion of the distal profunda femoris artery. Results of this case report suggests that coil embolization of true aneurysms of the profunda femoris artery may offer a safe and effective alternative to open surgical repair in carefully selected patients with minimal occlusive disease.
Leiomyosarcoma of the Inferior Vena Cava
Authors: Halkic Nermin , Scholl Beatrix , Ksontini Riadh , Boumghar Mohamed
Published: June 2007

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant vascular tumor, slow growing and often discovered late. Clinical presentation depends on the level of the IVC involved and diagnosis relies mostly on imaging methods. Two hundred and eighteen cases have been reported in the literature. The authors present the case of a 56-year-old man who underwent surgery for removal of a leiomyosarcoma of the medial caval segment. The procedure involved a radical excision with reconstruction of the IVC and reimplantation of the right renal vein. Clinical presentation, diagnosis and therapeutic modalities are discussed.
Repair of a Traumatic Pseudoaneurysm of a Thoracoaortofemoral Bypass
Authors: Young Richard M. , Hoballah Jamal J. , Sharp W. John , Corson John D.
Published: June 2007

Ten years after placement of a thoracofemoral graft for aortoiliac occlusive disease, a mid graft pseudoaneurysm was identified following new trauma to the left flank. An aortogram confirmed the pseudoaneurysm. An initial attempt at repair with an endovascular stent failed; an open repair was required.
Outpatient Varicose Vein Surgery with Transilluminated Powered Phlebectomy
Authors: Spitz Gregory A. , Braxton Jeffrey M. , Bergan John J.
Published: June 2007

The present study was done to determine the feasibility, efficacy, and safety of varicose vein removal using a minimally invasive, powered, vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compare this to a retrospective group of hook phlebectomy operations. After preliminary development of the procedure, a prospective evaluation was done. There were 59 limbs in 56 patients (51 women, five men) treated with use of the vein extractor aided by transcutaneous illumination. Saphenous reflux was confirmed by preoperative duplex ultrasound using reflux technique and was treated by ligation of the saphenofemoral junction and stripping of the greater saphenous vein to the knee with external hooks. Surgery was performed under general anesthesia on an outpatient basis. Complications were documented. The number of incisions made was recorded and analyzed. Operative time was noted and patient satisfaction analog scores were recorded. Patients were asked to describe their pain and cosmetic results on an analog scale ranging from 1 to 10 with 1 representing no pain and 10 the worst imaginable and a similar scale for the best and worst cosmetic results. Data were analyzed by use of appropriate tests of significance and compared to historical controls of 114 hook phlebectomy operations done over a 12-month period.

The 51 women ranged in age from 23 to 66 years (mean: 46). The men were 48, 48, 54, 59, and 72 years of age, respectively. There were 58 unilateral procedures (98%) and one bilateral operation. Operative time ranged from 23 to 58 minutes (mean: 41.0 minutes). The number of incisions per limb averaged 5.6. Cellulitis, small hematoma formation, and swelling or bruising beyond that expected occurred in four limbs (6.8%). Mean postoperative pain score at 48 hours was 3.0 with a median of 3.0. Mean postoperative pain score at 7 days was 2.0 with a median of 2.0. Postoperative pain scores at 6 weeks and 3 months were zero. Mean cosmetic score at 6 weeks was 2.5 with a median of 2.0. Mean cosmetic score at 3 months was 1.0 with a median of 1.0. These results compare very favorably to a historical control group of 114 similar patients who underwent stab avulsion hook phlebectomy to remove varicose vein clusters.

Varicose vein extraction using transilluminated powered phlebectomy (TIPP) is safe, efficacious, and cosmetically satisfactory. The procedure decreases operating time and number of incisions required to remove varicose clusters.
Artificial Skin (Integra” Dermal Regeneration Template) for Closure of Lower Extremity Wounds
Authors: Prystowsky Janet H. , Nowygrod Roman , Marboe Charles C. , Benvenisty Alan I. , Ascherman Jeffrey A. , Todd George J.
Published: June 2007

Over a 2-year period, 31 lower extremity wounds in 16 patients (12-82 years old) were treated with a dermal regeneration template (IntegraTM) to enhance healing. Wounds treated included chronic leg ulcers (four venous, five ischemic, two rheumatoid), as well as skin cancer (18) and benign lesion (one congenital nevus) excision sites. Once the outer silicone layer was removed from the regenerated dermis, the wounds were autografted (eight patients) or left to heal by secondary intention (23 patients). Of the wounds that were autografted, five were successful. The split-thickness skin grafts that failed involved ischemic wounds in which the dermal regeneration template was used to cover exposed tendon. When the dermal regeneration template was used over exposed tendon, granulation tissue coverage was stimulated but failed to support autografts probably due to tissue movement. When the dermal regeneration template was kept in place for a prolonged time (2.5 months), healing over the tendon in one patient progressed via secondary intention to completion. The dermal regeneration template was a convenient dressing for wounds of the lower extremity because there was less pain, less drainage, and a decreased need for frequent dressing changes; that is, weekly dressing changes were adequate. The longest time the silicone layer of the dermal regeneration template was kept in place as a long-term dressing was for 8 months to treat a venous ulcer. None of the wounds appeared to enlarge or significantly worsen secondary to the dermal regeneration template. Infection was responsible for four early (1 week postoperatively) sloughs of the silicone layer of the dermal regeneration template and one delayed (2.5 months) slough of the silicone. Of all the wounds, 25 are healed, five are under continuing treatment, and one was unavailable for follow-up. Overall, our experience suggests that the dermal regeneration template is a valuable addition to chronic and acute wound management on the lower extremity.
Correction of Steal Syndrome from Hemoaccess with Pulse Oximetry Assistance
Authors: Pomper Stuart R. , Huie Frederick J. , Shalashov Alexander , Kopatsis Anthony
Published: June 2007

There are many techniques described for the correction of steal syndrome. Most of these techniques use subjective criteria to evaluate the return of blood flow to the extremity. This article describes a simple technique to give an objective measurement of blood flow to the extremity. Pulse oximetry was used to help establish return of blood flow to the hand and give an objective endpoint for banding. Both patients had subjective and objective correction of the steal syndrome after surgery.
Intraoperative Duplex Ultrasound During Carotid Endarterectomy
Authors: Panneton Jean M. , Berger Mark W. , Lewis Bradley D. , Hallett John W. , Bower Thomas C. , Gloviczki Peter , Cherry Kenneth J.
Published: June 2007

The purpose of this study was to examine the technical aspects of intraoperative duplex ultrasound (DUS) following carotid endarterectomy (CEA), suggest criteria to differentiate significant lesions requiring immediate surgical revision from normal or benign defects, and evaluate how frequently intraoperative DUS provides useful or unsuspected information. A retrospective study was performed on all patients who had both CEA and intraoperative carotid DUS between January 1,1990. and January 1,1995. A total of 155 DUS examinations were performed in 149 patients. Findings were grouped into three categories: normal; minor/insignificant lesions; and hemodynamically significant lesions based on the presence or absence of elevated peak systolic velocities, visible stenosis/thrombus, or intimal flap/dissection. Postoperative status was correlated with intraoperative DUS findings.

Ninety-one (59%) examinations performed on 87 patients produced normal findings. Forty-seven (30%) examinations performed on 45 patients showed minor abnormalities consisting of insignificant residual plaque, residual external carotid artery stenoses, small intimal flaps, elevated velocities with no associated anatomic lesion, or an arterial kink. Fourteen patients (9%) had significant findings requiring immediate surgical revision. These consisted of large intimal flaps or dissection in six patients, marked residual plaque and significant stenosis in five patients, thrombus in two patients, and a kink in one patient. Three additional patients (2%) had significant findings but were not revised for various reasons. No significant difference was identified in morbidity or mortality rates between those patients with normal findings, those patients with minor technical defects, and those patients with significant abnormalities undergoing immediate surgical revision. However, two of three patients who had significant abnormalities within the common carotid artery that were not revised suffered perioperative ipsilateral strokes.

Intraoperative DUS is a safe and accurate method to assess the technical adequacy of CEA. Intraoperative DUS showed significant lesions in 11% of patients. Identification and immediate repair of significant technical defects may decrease perioperative complication rate and long-term restenosis rate.
Does a Postimplantation Syndrome Following Endovascular Treatment of Aortic Aneurysms Exist?
Authors: Storck M. , Scharrer-Pamler R. , X Kapfer , Gallmeier U. , Görich J. , Sunder-Plassmann L. , Brückner U. , Mickley V.
Published: June 2007

The postimplantation syndrome (PIS) is a weakly defined condition that has been observed following endovascular treatment of aortic aneurysms; the postulated criteria include significant leukocytosis, fever, and/or coagulation disturbances. Among the factors that are supposed to contribute to this syndrome are contact activation by the stent covering with consecutive endothelial activation. Associated clinical parameters of a PIS were perioperatively monitored in the postoperative phase in a total of 69 patients with infrarenal aortic aneurysms treated with Y-stent grafts. C-reactive protein (CRP)-levels, leukocyte concentrations, and body temperature curves were directly compared to those of 50 patients undergoing conventional transperitoneal aneurysm resection. A subgroup of 10 patients of the endovascular group was compared with 13 operated-on patients with regard to an ischemia-reperfusion syndrome of the lower extremities. The mediator determinations were performed on venous (femoral vein) as well as in systemic (arterial) blood samples. The incidence of temperature values above 380C was higher in patients following endovascular treatment (72%) compared to conventionally operated-on patients (28%). CRP levels were not significantly different within the first 8 postoperative days. During open surgery, significantly higher values for lactate and lower pH levels were observed (p<0.01), as well as higher 6 keto prostaglandin Fw (PGF1(x) levels. There was a short peak of PGFia during eventeration of the intestine during the operative procedure that could not be detected during endovascular manipulations. The clinical and biochemical parameters do not prove the presence of a PIS following endovascular treatment of aortic aneurysms. In contrast, during open surgery the unspecific inflammatory reaction is higher, but not long-lasting. In the future, the suggested phenomenon of a decreased antiinflammatory cytokine response during endovascular surgery needs to be further examined.
The Influence of Distal Runoff on Patency of Infrainguinal Vein Bypass Grafts
Authors: Ulus A. Tulga , Ljungman Christer , Almgren Bo , Hellberg Anders , Bergqvist David , Karacagil Sadettin
Published: June 2007

This retrospective study was conducted to analyze a new concept of evaluation of the effect of distal runoff on patency in infrainguinal bypass surgery for arterial insufficiency. Distal runoff was evaluated on postreconstruction angiograms in 191 limbs undergoing femoropopliteal and femorodistal reconstruction. Runoff was characterized as good, fair, or poor. Determination of graft patency was made by clinical examination, ankle-brachial index measurement, or duplex scanning at 1 month and thereafter at 6-month intervals. Cumulative patency rates were calculated according to the actuarial life table method. Patency rates in limbs with good runoff were better than in limbs with fair and poor runoff; at 6 months, patency rates were 88.2%,70.9%, and 21.8%, respectively (p<0.01). Similar patency rates were found for good runoff in femoropopliteal and femorodistal reconstructions (84.7% in femoropopliteal and 75% in femorodistal reconstructions) at 6 months. The authors conclude that this method of angiographic evaluation accurately predicts patency in infrainguinal bypass reconstructions.