bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Serum Interleukin-6 and Tumor Necrosis Factor α Levels with Abdominal Fat Distribution Evaluated by Ultrasonography in Overweight or Obese Postmenopausal Women
Authors: Fenkci Semin , Rota Simin , Sabir Nuran , Sermez Yurdaer , Guclu Aydin , Akdag Beyza
Published: August 2007

Background

The objective of this study was to measure associations of circulating interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) levels with anthropometric and abdominal fat distribution in overweight or obese postmenopausal women.

Methods

One hundred eight overweight or obese postmenopausal were evaluated. Demographic and anthropometric measurements were done. Serum IL-6, TNF-α, glucose, and insulin levels were measured. Insulin resistance was calculated by using homeostasis model assessment-insulin resistance (HOMA-IR). The assessment of abdominal fat distribution was performed by ultrasonography. Statistical analysis was made with Pearson and partial correlation analysis.

Results

There was a positive correlation between serum IL-6 and TNF-α ( r = .19; p = .047). IL-6 was positively correlated with body mass index (BMI) ( r = .43; p = .0001), waist circumference ( r = .41; p = .0001), and visceral fat layer ( r = .33; p = .0001) measurements and HOMA-IR index ( r = .31, p = .001). A positive relationship between HOMA-IR and visceral fat layer thickness was observed ( r = .320; p = .0001). TNF-α was positively associated with BMI but not with any measures of central obesity. When adjustment for BMI was performed, there were no significant relationships between the studied parameters.

Conclusions

There are no significant correlations between abdominal fat distributions measured by ultrasonography and circulating IL-6 and TNF-α levels. BMI may have a stronger association with circulating inflammatory cytokine concentrations than with different measures of central obesity in overweight or obese postmenopausal women.
Embryonic Exposure to Low-Dose 17β-Estradiol Decreases Fetal Mass Sex Specifically in Male Mice and Does Not Cause Hypospadias
Authors: Blaschko Sarah D. , Willingham Emily J. , Baskin Laurence S.
Published: August 2007

Background

Endocrine-disrupting compounds are synthetic and natural compounds in the environment that can alter endocrine-governed developmental processes. Among these are the natural estrogens genistein, a plant isoflavone, and 17β-estradiol (E2), which is present in dietary animal products, such as eggs and meat. In addition, natural and synthetic steroids are administered to beef cattle to promote growth, and low levels of the estrogens can persist in the beef. Most previous work using E2 has involved injection; however, oral administration results in a different suite of hormone products following first-pass metabolism in the liver.

Methods

Low doses of E2 were administered orally to pregnant dams to determine embryonic effects. As end points of effects, we examined whether embryonic exposure produced hypospadias, an endocrine-linked abnormality of the male genitalia, and we assessed fetal mass.

Results

Male fetuses from the two highest dosage groups were significantly smaller than their control male counterparts, and males from the highest dosage group were also significantly smaller than control females. Control males were significantly larger than all females, and there was no difference in mass among control and treated females. Additionally, the E2 dose was inversely correlated with mass overall. No effect of these doses of E2 on hypospadias was seen.

Conclusions

These results indicate a sex-specific fetal effect of low-dose, orally administered E2, which appears to exert androgen-inhibiting effects on mass in males.
Uremic Vascular Calcification
Authors: Chen Neal X. , Moe Sharon M.
Published: August 2007

Recent evidence suggests that uremic vascular calcification is an active, cell-mediated process resembling osteogenesis in bone rather than passive precipitation. We identified increased expression of bone-associated proteins (osteopontin, bone sialoprotein, alkaline phosphatase, type I collagen) and the bone-specific transcription factor core-binding factor α1 (Cbfα1) in histologic sections of inferior epigastric arteries obtained from patients with stage V chronic kidney disease or calcific uremic arteriolopathy. In in vitro experiments, the addition of uremic serum to cultured vascular smooth muscle cells up-regulated osteopontin and Cbfα1 expression and accelerated mineralization. This implies that the uremic mileau may lead to dedifferentiation of vascular smooth muscle cells, with subsequent mineralization. However, a lack of inhibitors of calcification may also be important. Dialysis patients with low levels of serum fetuin A, a circulating inhibitor of mineralization, have increased coronary artery calcification, and fetuin A can inhibit mineralization of vascular smooth muscle cells in vitro. Further understanding of the pathophysiology of uremic vascular calcification is needed to design effective therapeutic strategies to intervene with this devastating condition in patients with stage V chronic kidney disease.
Cell Biology of Pathologic Renal Calcification: Contribution of Crystal Transcytosis, Cell-Mediated Calcification, and Nanoparticles
Authors: Kumar Vivek , Farell Gerard , Yu Shihui , Harrington Sean , Fitzpatrick Lorraine , Rzewuska Ewa , Miller Virginia M. , Lieske John C.
Published: August 2007

Introduction

The earliest lesion in the kidneys of idiopathic calcium oxalate stone formers is deposition of calcium phosphate in the interstitium, termed a Randall's plaque. Yet the cellular and molecular factors leading to their formation are unknown.

Methods

The influence of urinary proteins on adhesion of preformed calcium oxalate crystals to rat continuous inner medullary collecting duct (cIMCD) cells was studied in vitro, and cIMCD cells were also exposed to calcifying media containing β-glycerophosphate for up to 28 days. Renal tissue was obtained from a stone-forming and non-stone-forming individual at the time of nephrectomy. These nanoparticles, isolated from renal stones obtained at the time of surgical resection, were analyzed and propagated in standard cell culture medium.

Results

Urinary proteins influence crystal adhesion to renal epithelial cells, and this activity is abnormal in the urine of stone-forming patients. cIMCD cells assumed an osteoblastic phenotype when exposed to the calcifying medium, expressing two bone matrix proteins (osteopontin and bone sialoprotein) that were also identified in the kidney of the stone-forming patient and associated with crystal deposition. Nanoparticles were propagated from the majority of renal stones. Isolates were susceptible to selected metabolic inhibitors and antibiotics and contained conserved bacterial proteins and deoxyribonucleic acid (DNA).

Conclusions

These results suggest new paradigms for Randall's plaque formation and idiopathic calcium oxalate stone disease. It seems unlikely that these events are driven solely by physical chemistry; rather, they are critically influenced by specific proteins and cellular responses, and understanding these events will provide clues toward novel therapeutic targets.
Association between Eotaxin (CCL11), C-Reactive Protein, and Antimicrobial Antibodies in Patients Undergoing Coronary Angioplasty
Authors: Kaehler Jan , Tuleweit Anika , Steven Daniel , Krempl Tanja , Haar Antje , Carstensen Marion , Koester Ralf , Terres Wolfram , Meinertz Thomas
Published: August 2007

Eotaxin (CCL11) is a potent chemoattractant for eosinophils and lymphocytes. Apart from its functions in the eosinophilic system, eotaxin has been shown to be overexpressed in atherosclerosis. We therefore sought to determine whether chronic infection with Chlamydia pneumoniae or other infectious agents is correlated with concentrations of eotaxin or C-reactive protein since this mechanism could explain the finding that chronic infection stimulates smooth muscle cell migration and plaque development. Patients undergoing percutaneous coronary angioplasty (PCI) for acute coronary syndrome or stable angina were included in the study. Blood was drawn before PCI, at 6 weeks, and 6 and 12 months after coronary intervention. Eotaxin and C-reactive protein were determined by enzyme-linked immunosorbent assay (ELISA). Antibodies against Candida, C. pneumoniae, cytomegalovirus, Helicobacter pylori, and herpes simplex virus were measured by ELISA or immunofluorescence. Two hundred five consecutive patients undergoing PCI (stable angina, n = 136; acute coronary syndrome, n = 69) and 83 patients with normal coronary arteries were enrolled in the study. Eotaxin concentrations at inclusion were higher in patients with coronary artery disease than in control patients, p = .01, and comparable in patients with stable angina and those with acute coronary syndrome but did not correlate with C-reactive protein. Eotaxin concentrations at inclusion and during follow-up weakly correlated with concentrations of antibodies against C. pneumoniae, H. pylori, and herpes simplex virus but not with concentrations of antibodies against Candida or cytomegalovirus. Eotaxin concentrations and antibody titers against C. pneumoniae significantly increased following angioplasty and remained elevated thereafter. In conclusion, our data demonstrate that eotaxin concentrations are elevated independently from C-reactive protein in patients with coronary artery disease and correlate with antibodies against infectious agents known for chronic infection in humans.
Etiology of Decreased Gastric Nitric Oxide in the Critically Ill
Authors: Boivin Michel A. , Fiack Christopher A. , Kennedy John C. , Iwamoto Gary K.
Published: August 2007

Background

Nitric oxide (NO) is present in the gas phase of the normal human stomach at a high concentration (1-10 ppm). The majority of this NO is produced from the reduction of dietary nitrate to nitrite and finally NO. Generation of this nonenzymatically produced gastric NO occurs only in an acidic environment. We examined NO concentrations in critically ill subjects and the mechanism for the observed perturbations.

Methods

Seven critically ill, intubated intensive care unit (ICU) patients (mean APACHE II score 16) and seven control patients were studied. Gastric NO concentrations were measured with a Sievers NO analyzer (GE, Boulder, CO). Nitrate and nitrite concentrations were determined by a modified Griess assay. Bacterial counts were determined by optical density at 600 nm.

Results

Gastric NO concentration was significantly lower in the critically ill group (102.7 ppb) compared with the control group (953.2 ppb), although this difference was abolished by treating the control group with omeprazole (54 ppb). Gastric nitrate and nitrite concentrations were similar in the control and ICU groups, suggesting that substrate deficiency was not a cause of the low intragastric NO. Gastric pH was significantly lower in the control subjects (3.0) compared with the ICU patients (6.3) and the control subjects after receiving omeprazole (6.5). ICU patients had a trend toward higher gastric bacterial load.

Conclusion

In critically ill patients, markedly decreased NO concentrations are found in the gas of the stomach owing to a failure of gastric acidification.
Clinical Research at a Crossroads: The NIH Roadmap
Authors: Zerhouni Elias A.
Published: August 2007

As a result of the NIH investment in biomedical research, over the past 30 years we have seen many great advances impacting the health of our nation which have been fostered by the effective translation of scientific advances. However, rising costs for both research and health care mean that the NIH must make strategic decisions that maximize the return on its investment. Because treating end-stage disease is so costly, both personally and financially, learning how to pre-empt illness through molecular knowledge and behavioral interventions is the only viable strategy for maintaining the nation's health in the coming years. In order to speed scientific discovery and its efficient translation to patient care, the NIH developed the Roadmap for Biomedical Research. The Roadmap provides an incubator space for funding innovative programs to address a panoply of scientific challenges and has engendered a new culture of cooperation among researchers seeking new avenues for collaboration. An important feature of the Roadmap is the Clinical and Translational Science Awards (CTSA). The program's goals are to eliminate growing barriers between clinical and basic research, to address the increasing complexities involved in conducting clinical research, and to help institutions nationwide create an academic home for clinical and translational science. By adopting a strong strategic vision now, the NIH will be able to stand at the ready as future challenges and opportunities emerge. In keeping with our mission, the NIH's current and future actions will be defined by the requirements of the scientific community and the public health needs of the nation.
Regulation of Vascular Proteoglycan Synthesis by Metabolic Factors Associated with Diabetes
Authors: Wilson Patricia , Drennon Katherine , Tannock Lisa R.
Published: August 2007

Background

Diabetes is associated with accelerated atherosclerosis, but the mechanisms responsible for this are not known. Proteoglycans have been shown to play a critical role in the initiation of atherosclerosis owing to their ability to bind and retain atherogenic lipoproteins in the artery wall. Proteoglycan structure and composition are altered in atherosclerotic lesions compared with adjacent normal regions of the artery wall, and this is exaggerated in diabetes. The purpose of this study was to determine if metabolic factors associated with diabetes lead to altered proteoglycan structure and composition.

Methods

Vascular smooth muscle cells, endothelial cells, and macrophages were exposed to normal (5.6 mmol/L) or high (25 mmol/L) glucose levels, various insulin and free fatty acid levels, and the cytokines transforming growth factor β (TGF-β1) and platelet-derived growth factor, alone or in combination, and proteoglycan synthesis was determined.

Results

Glucose concentrations, insulin, and free fatty acids did not alter proteoglycan synthesis, size, or relative distribution. The effect of TGF-β to increase biglycan and versican synthesis, increase sulfate incorporation, and increase the size of the secreted proteoglycans was not altered by the ambient glucose level in the culture medium, nor did high glucose increase levels of active TGF-β.

Conclusion

Vascular proteoglycan synthesis is not affected by metabolic factors associated with diabetes. We suggest that elevated TGF-β levels in diabetes are responsible for the altered proteoglycan synthesis observed in diabetes.
Plasma Cytokines, Metabolic Syndrome, and Atherosclerosis in Humans
Authors: Reilly Muredach P. , Rohatgi Anand , McMahon Kimberly , Wolfe Megan L. , Pinto Shailesh C. , Rhodes Thomas , Girman Cynthia , Rader Daniel J.
Published: August 2007

Background

Interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) integrate inflammatory and adipose signaling but also have direct vascular effects. We hypothesized that plasma levels of IL-6 and soluble tumor necrosis factor α receptor 2 (sol-TNFR2) would be related to coronary atherosclerosis beyond established risk factors and the metabolic syndrome.

Methods

We examined the association of IL-6 and sol-TNFR2 with metabolic syndrome, C-reactive protein (CRP), and coronary artery calcification (CAC) in 875 asymptomatic participants in the Study of Inherited Risk of Coronary Atherosclerosis.

Results

IL-6 levels were 56% higher ( p < .001) and sol-TNFR2 levels 16% higher ( p < .001) in subjects with metabolic syndrome compared with those without. Both cytokines were associated with CAC beyond age, gender, Framingham risk scores, family history, metabolic syndrome, and CRP (odds ratio and 95% confidence interval of higher CAC for 1 SD increase in log-transformed cytokine levels: 1.23 [1.06-1.43], p = .006 for IL-6 and 1.15 [1.01-1.31], p = .04 for sol-TNFR2). In fact, cytokine levels were independently associated with CAC scores in the subgroup with metabolic syndrome and were additive to the homeostasis model assessment of insulin resistance in predicting CAC.

Conclusions

Plasma IL-6 and sol-TNFR2 levels were independently associated with CAC, suggesting a role in integrating innate immune and adipose signaling in promoting atherosclerosis and cardiovascular risk. Measurement of their levels may facilitate cardiovascular risk prediction and targeting of therapeutic strategies.
Cytokine Concentrations in Bone Marrow of Stable Sickle Cell Anemia Patients
Authors: Dallalio Gail , Brunson Chris Y. , Means Robert T.
Published: August 2007

Inflammation plays a significant role in the clinical manifestations of sickle cell anemia. In studies of anemic patients with other clinical syndromes, measurement of the concentrations of cytokine mediators of inflammation in bone marrow aspirates has provided unique correlations with clinical and laboratory parameters. We determined concentrations of interleukin (IL)-1, IL-6, tumor necrosis factor (TNF), and placental growth factor (PlGF) in bone marrow aspirates from six homozygous sickle cell (SS) patients who were not acutely ill and who were not receiving hydroxyurea, erythropoietin, or chronic transfusion and compared them with specimens from seven healthy controls. We also measured concentrations of soluble transferrin receptor (sTfR) and of marrow erythroid colony-forming units (CFU-E) as markers of erythropoietic activity. sTfR concentration was significantly higher in SS patients ( p = .024). CFU-E concentration was not significantly different between the two groups. Bone marrow concentrations of IL-6 and IL-1 did not differ between the study groups. TNF was undetectable in all specimens, plasma or marrow. Bone marrow PlGF concentrations were significantly higher in SS patients ( p = .004). Since PlGF is a product of erythroid cells, the ratio of marrow PlGF to marrow sTfR was determined and found to be significantly greater in SS patients. This suggests that the observed difference in marrow PlGF concentrations does not reflect increased erythropoiesis but rather represents increased PlGF production per erythroid unit.
Insulin as Initial Therapy in Type 2 Diabetes: Effective, Safe, and Well Accepted
Authors: Lingvay Ildiko , Kaloyanova Polina F. , Adams-Huet Beverley , Salinas Karin , Raskin Philip
Published: August 2007

Background

To achieve glycemic control in type 2 diabetes mellitus (T2DM), multiple oral agents are used in a stepwise approach, but long-term maintenance of normoglycemia is difficult to achieve, and, eventually, most patients require insulin. The aim of this study was to evaluate the feasibility, acceptability, and efficacy of insulin with metformin for newly diagnosed, treatment-naive patients with T2DM.

Methods

Eligible patients were started on insulin NovoLog 70/30 and metformin 1,000 mg twice daily. Biochemical evaluation was performed at baseline and at the end of the 3-month study. Patients were seen monthly to assess side effects and compliance and make insulin dose adjustments. Patient treatment satisfaction was evaluated at the end of the study.

Results

Of 63 patients, 92% completed the study. The hemoglobin A1c (HbA1c) decreased from 10.8 to 5.9% ( p < .0001), and 100% of subjects achieved an HbA1c < 7%. Weight increased from 100.0 to 101.6 kg ( p = .004) but was less than expected given that patients lost an average of 7.2 kg prior to diagnosis and achieved a reduction in HbA1c of 5%. The rate of hypoglycemia was low (1.5 episodes/patient-month). Ninety-seven percent of the patients were satisfied with their insulin treatment, and 88% were willing to continue insulin. Compliance was 96.5% with insulin and 95.1% with metformin.

Conclusion

Outpatient initiation of insulin therapy at the time of diagnosis of T2DM is an effective, safe, and feasible strategy for rapidly lowering HbA1c levels to targets. Insulin was very well accepted by the patients, refuting the misconception of low satisfaction and acceptance of such treatment.
Asymmetry in Scientific Method and Limits to Cross-Disciplinary Dialogue: Toward a Shared Language and Science Policy in Pharmacogenomics and Human Disease Genetics
Authors: Ozdemir Vural , Williams-Jones Bryn , Graham Janice E. , Preskorn Sheldon H. , Gripeos Dimitrios , Glatt Stephen J. , Friis Robert H. , Reist Christopher , Szabo Sandor , Lohr James B. , Someya Toshiyuki
Published: August 2007

Pharmacogenomics is a hybrid field of experimental science at the intersection of human disease genetics and clinical pharmacology sharing applications of the new genomic technologies. But this hybrid field is not yet stable or fully integrated, nor is science policy in pharmacogenomics fully equipped to resolve the challenges of this emerging hybrid field. The disciplines of human disease genetics and clinical pharmacology contain significant differences in their scientific practices. Whereas clinical pharmacology originates as an experimental science, human disease genetics is primarily observational in nature. The result is a significant asymmetry in scientific method that can differentially impact the degree to which gene-environment interactions are discerned and, by extension, the study sample size required in each discipline. Because the number of subjects enrolled in observational genetic studies of diseases is characteristically viewed as an important criterion of scientific validity and reliability, failure to recognize discipline-specific requirements for sample size may lead to inappropriate dismissal or silencing of meritorious, although smaller-scale, craft-based pharmacogenomic investigations using an experimental study design. Importantly, the recognition that pharmacogenomics is an experimental science creates an avenue for systematic policy response to the ethical imperative to prospectively pursue genetically customized therapies before regulatory approval of pharmaceuticals. To this end, we discuss the critical role of interdisciplinary engagement between medical sciences, policy, and social science. We emphasize the need for development of shared standards across scientific, methodologic, and socioethical epistemologic divides in the hybrid field of pharmacogenomics to best serve the interests of public health.
Elevated Lipid Peroxidation Biomarkers and Low Antioxidant Status in Atherosclerotic Patients with Increased Carotid or Iliofemoral Intima Media Thickness
Authors: Polidori M. Cristina , Praticó Domenico , Parente Basso , Mariani Elena , Cecchetti Roberta , Yao Yuemang , Sies Helmut , Cao Piergiorgio , Mecocci Patrizia , Stahl Wilhelm
Published: August 2007

Objectives

Lipid peroxidation plays an important role in the development of atherosclerosis, a chronic, age-related disease process of the arterial wall with onset decades prior to its clinical manifestations. The aim of the study was to assess the association between the intima media thickness (IMT) of the major arteries as a clinical marker of atherosclerosis and markers of lipid peroxidation along with the antioxidant status in humans.

Design

Case-control study.

Setting

A university-affiliated outpatient clinic.

Subjects

Thirty patients (22 males, 8 females; 70.4 ± 7.3 years) with atherosclerosis of the carotid or iliofemoral arteries and 62 healthy controls (30 males, 32 females; 68.3 ± 4.3 years).

Methods

Plasma levels of 8,12-isoprostane F2α-VI (8,12-IPF2α-VI) were measured by gas chromatography/mass spectrometry, whereas levels of malondialdehyde (MDA), vitamins A (retinol) and E (α- and γ-tocopherol), and carotenoids were determined by high-performance liquid chromatography. The IMT was measured by B-mode ultrasonography.

Results

Patients showed, independent of fruit and vegetable intake, significantly lower plasma levels of retinol, α-tocopherol, and all carotenoids excluding β-cryptoxanthin compared with controls. On the contrary, plasma 8,12-IPF2α-VI levels were almost doubled ( p < .001) and MDA levels increased by one-third ( p < .01) in atherosclerotic patients compared with controls.

Conclusions

The analyses of isoprostanes and antioxidant nutrients in plasma as markers of oxidative stress and the parallel evaluation of IMT as a structural marker of atherosclerosis are suitable tools for investigating the role of antioxidants and oxidative stress in atherosclerosis.
Release of Markers of Myocardial Damage Evaluated in the Coronary Sinus during Cardiac Surgery
Authors: Kerbaul François , Collard Frederic , Benard François , By Youlet , Paganelli Frauck , Saadjian Alain , Ruf Jean , Lejeune Pierre-Jean , Mallet Bernard , Carrega Louis , Zouher Ibrahim , Monserrat Colette , Bonnet Jean-Louis , Guieu Regis
Published: August 2007

Myocardial damage is a frequent complication of cardiac surgery by direct mechanical trauma during the surgical procedure and by myocardial ischemia, which occurs during the cardiopulmonary bypass (CBP). Because the concentrations of biomarkers in the blood collected from the coronary sinus are the best witness of the myocardial damages, we measured the levels of specific cardiac troponin I (c-TnI) and nonspecific (adenosine, myoglobin) markers of left ventricular damages in the coronary sinus of patients during cardiac surgery. Thirty patients who underwent aortic valve replacement for aortic stenosis were included. Blood samples were collected in the coronary sinus and in the radial artery at the beginning (T0), at the end of the CBP (T1), and then 24 hours later (T2). At T0 and T1, adenosine, c-TnI, and myoglobin levels were significantly higher in the coronary sinus than in the radial artery (T0: adenosine: mean +27%; c-TnI: +41%; myoglobin: +28%; T1: adenosine: mean +58%; c-TnI: +58%; myoglobin: +25%; p < .001). These parameters were significantly higher in the coronary sinus at T1 compared with T0 (adenosine: +50%; c-TnI: +229%; myoglobin: +94%; p < .01) and in the radial artery (adenosine: +21%; c-TnI: +194%; myoglobin: +98%; p < .01). At T2, c-TnI further increased. Damages to the myocardium during cardiac surgery are minimal in our surgical conditions but are probably underestimated when using markers measured at the peripheral level. However, most of the damages appear several hours after the surgery.
Comparison of Testosterone, Alendronate, and a Combination of Both Therapies in Men with Low Bone Mineral Density
Authors: Welch Brian J. , Denke Margo A. , Kermani Asra , Adams-Huet Beverley , Gazmen Nina M. , Gruntmanis Ugis
Published: August 2007

Background

Both bisphosphonates and testosterone are known to improve bone mineral density (BMD) in men with low bone mass, but whether combination therapy is superior to these agents used alone is not clear. We compared the changes in lumbar spine BMD when men with low bone mass were treated with each agent alone or as combination therapy.

Methods

In a retrospective study, we analyzed serum and BMD data from 149 men who had been evaluated in the Endocrinology Clinic at the Dallas Veterans Affairs Medical Center, Dallas, Texas. The subjects were divided into three cohorts: 59 men receiving testosterone therapy alone, 68 men receiving alendronate therapy alone, and 22 receiving combination therapy.

Results

Compared with the baseline values, the lumbar spine and BMD increased significantly in each of the testosterone, alendronate, and combination therapy cohorts (median annualized rate of change: 2.1% [ p < .001], 2.6% [ p < .001], and 2.5% [ p = .04], respectively). The combination therapy group did not demonstrate any additional increase in BMD at the lumbar spine or total hip compared with either agent alone. The results did not change after adjusting for differences in baseline weight, age, BMD, or baseline testosterone level.

Conclusion

The results suggest that the combination of testosterone and alendronate does not appear to be superior to single-drug therapy in our patient population.
Management of Synchronous Abdominal Aortic Aneurysm and Complicating Colorectal Cancer
Authors: Bali Christina , Matsagas Miltiadis I. , Harissis Haralampos , Lagos Nicolaos , Kappas Angelos M.
Published: August 2007

Concomitant management of synchronous abdominal aortic aneurysm (AAA) and colorectal cancer (CRC) is mandatory in cases in which both entities are life threatening for the patient. The endovascular aneurysm repair (EVAR) method can contribute toward concomitant management by offering the avoidance of an otherwise threatening vascular graft infection. We present a case of a complicating CRC and a synchronous AAA, which were successfully treated at the same hospitalization. The AAA was treated first by EVAR, and the colon resection followed 3 days later. The patient's postoperative course was uneventful. EVAR, if the standard criteria are met, could comprise an alternative and reliable solution for treating concomitant AAA and CRC even in the acute setting.
Critical Bleeding in Vascular Surgery: Expanding the Indication of Recombinant Activated Factor VII
Authors: Tawfick Wael A. , Tawfik Sherif , Hynes Niamh , Mahendran Bhaskarapandian , Sultan Sherif
Published: August 2007

Recombinant activated factor VII (rFVIIa) is considered a universal hemostatic agent. We present our experience with rFVIIa in vascular surgery patients who developed major hemorrhagic complications with no obvious major vessel bleeding as an expansion of the indications of rFVIIa.

Of 973 major complex vascular procedures, 18 patients with intractable bleeding were administered 40 to 80 μg/kg rFVIIa. Blood and by-products transfused, pH, coagulation profile, platelet count, and preoperative antiplatelets and anticoagulants were recorded.

Twelve patients (67%) showed clinical improvement. Six remained unstable despite further hemostatic measures and died perioperatively. Thirty-three percent ( n = 6) received over 20 U of blood before rFVIIa administration. All but one died within the first 24 hours ( p = .0175). Seven patients had acidosis with a pH of 7.3 or less. Five of them died within 24 hours ( p = .05). Six patients had a platelet count below 100,000/cm3, five of whom died perioperatively ( p = .0175). Patients with an international normalized ratio above 1.2 had a better survival rate because rFVIIa was used early. There were no signs of systemic or local thrombotic events. The amount of blood and plasma transfused was significantly reduced after rFVIIa administration.

rFVIIa is a safe adjunct for patients with significant hemorrhagic complications, with a low risk of thrombotic complications. We found it effective if administered early with measures to achieve hemodynamic stability and correction of acidosis.
Regional Anesthesia: Preferred Technique for Venodilatation in the Creation of Upper Extremity Arteriovenous Fistulae
Authors: Hingorani Anil P. , Ascher Enrico , Gupta P. , Alam S. , Marks Natalie , Schutzer Richard W. , Multyala Manykiam , Shiferson Alex , Yorkovich William , Jacob Theresa , Salles-Cunha Sergio
Published: August 2007

Owing to the overall poor medical health of patients with end-stage renal disease, we have sought alternatives to the use of general anesthesia for access procedures. Furthermore, since local anesthesia (1) does not offer the motor block that is sometimes desired and (2) can be difficult to maintain when a large amount of vein needs to be transposed, we examined whether regional blocks can be useful for the creation of new arteriovenous fistulae (AVF).

From August 2002 to January 2005, 41 patients scheduled for AVF placement underwent a regional block with the use of a lidocaine and ropivacaine mixture using a nerve stimulator. Either axillary, interscalene, or infraclavicular blocks or a combination was used. Intraoperative duplex ultrasonography was used to assess the degree of venodilatation of the basilic and cephalic veins before and after the block. The site of each measurement was marked on the skin and selected by a clearly identifiable branch point. Each measurement was recorded three times and was made in the (1) native state, (2) after application of a tourniquet with opening and closing of the hand for 15 seconds, and (3) after placement of the block.

The average age of the patients was 65 ± 14 years (SD), with ages ranging from 33 to 91 years, and the prevalence of diabetes mellitus was 50%. Complete brachial plexus block was achieved in 34 patients (83%). Sensory block was accomplished within 10 to 15 minutes and usually lasted 4 to 6 hours. Motor block was accomplished in 10 to 25 minutes. Venodilatation was not noted in patients whose blocks did not work ( n = 7) or whose vein was found to be phlebitic on exploration ( n = 3). The degree of venodilatation noted as a percentage increase after application of the tourniquet compared with the native state for these 34 patients (in whom the block worked) was 37% for the distal cephalic, 31% for the midcephalic, and 32% for the midbasilic vein. The degree of venodilatation noted as a percentage increase after placement of the block compared with after tourniquet application for these 34 patients was 42% for the distal cephalic, 19% for the midcephalic, and 26% for the midbasilic vein. No instances of systemic toxicity, hematomas, or nerve injury from the block were noted. Accesses placed included 20 radiocephalic AVF, 8 brachiobasilic AVF, 8 brachiocephalic AVF, 2 arteriovenous grafts, 2 radiobasilic AVF, and 1 brachial vein AVF.

Regional block is a safe and, in our opinion, preferred technique for providing anesthesia for upper extremity vascular surgery. The venodilatation observed is augmented compared with that using a tourniquet and may allow more options for access placements.
Paravertebral Blockade with Propofol Sedation versus General Anesthesia for Elective Endovascular Abdominal Aortic Aneurysm Repair
Authors: Falkensammer Juergen , Hakaim Albert G. , Klocker Josef , Biebl Matthias , Lau Louis L. , Neuhauser Beate , Mordecai Monica , Crawford Claudia , Greengrass Roy
Published: August 2007

The objective of this study was to evaluate the applicability of paravertebral blockade (PVB) for endovascular abdominal aortic aneurysm repair compared with general anesthesia (GA).

Data from patients who underwent elective infrarenal endovascular abdominal aortic aneurysm repair between August 2001 and July 2002 using PVB or GA were retrospectively reviewed and compared with respect to risk factors, intraoperative hemodynamic characteristics, operative outcome, and complications.

Ten patients underwent elective infrarenal endovascular abdominal aortic aneurysm repair under PVB, whereas 15 patients were operated on under GA. One conversion from PVB to GA was necessary for block failure. The perioperative (< 30 days) cardiovascular morbidity and overall mortality were zero in both groups. The PVB group benefited significantly with respect to the incidence of intraoperative hypotension ( p < .05) and blood pressure lability ( p < .01), as well as postoperative nausea ( p < .01). Our preliminary results indicate that PVB is feasible and can be performed safely in a patient population with significant comorbidities.
Unusual Case of Right-Sided May-Thurner Syndrome and Review of Its Management
Authors: Burke Renee M. , Rayan Sunil S. , Kasirajan Karthikeshwar , Chaikof Elliot L. , Milner Ross
Published: August 2007

May-Thurner syndrome is a phenomenon commonly described as an acquired stenosis of the left common iliac vein as a result of right common iliac artery compression. We report an unusual case of right-sided May-Thurner syndrome in a patient found to have a left-sided inferior vena cava. We also review the management of this patient using angioplasty, intraoperative thrombolysis, and endoluminal stent placement.
Superior Mesenteric Artery Branch Aneurysm with Absence of the Celiac Trunk
Authors: Armstrong Peter J. , Franklin David P.
Published: August 2007

Superior mesenteric artery and pancreaticoduodenal artery aneurysms are rare. Agenesis of the celiac axis has only been reported four times. The reported etiologies of superior mesenteric artery and branch artery aneurysms include infection, atherosclerosis, inflammatory processes such as pancreatitis, dissection, collagen vascular disorders, polyarteritis nodosa, and trauma. We report an aneurysm of the superior mesenteric artery (SMA) branch, the inferior pancreaticoduodenal artery, arising in a patient with congenital absence of the celiac trunk. The patient presented with intermittent left upper quadrant pain without weight loss or change in bowel habits. The aneurysm was identified on abdominal computed tomography scan with angiographic confirmation of the aberrant anatomy. The patient was treated by aneurysmectomy and pancreaticoduodenal artery reconstruction with an interposition vein graft from the SMA. The patient recovered without complications and is asymptomatic with a patent vein graft 2 years after operation.
Comparison of the Results of Percutaneous Transluminal Angioplasty and Stenting with Medical Treatment for Claudicants Who Have Superficial Femoral Artery Occlusive Disease
Authors: Wilson Samuel , Gelfand Dmitri , Jimenez Juan , Gordon Ian
Published: August 2007

The outcomes of medical management of peripheral vascular disease localized to the superficial femoral artery (SFA) were compared with those obtained by percutaneous transluminal angioplasty (PTA) with or without stenting in a review of selected studies.

The natural history of localized SFA disease is favorable, with major amputation rates less than 10% and revascularization in only 18% of patients over a 10-year interval.

Conservative treatment of claudicants shows increases (150%) in walking distance if the ankle brachial index (ABI) is over 0.6 and patients stop smoking. Analysis of 10 trials (882 patients) of PTA with or without stenting found that the overall primary patency rates at 12 months were 71.1% for PTA plus stenting and 58.3% for PTA alone. Technical success with PTA with or without stenting is over 90%, and early results at 6 months are superior to those with exercise. In three randomized controlled trials, however, the difference between PTA and medical treatment at 2 years, whether measured by walking distance or ABI, was not significant, nor was the quality of life. For long-term improvement in walking distance (> 1 year) in the claudicant, intervention is not superior to medical treatment and a monitored exercise program. Consideration should be given to including a nonintervention control group and 2-year outcomes in the evaluation of new SFA stents.
Prospective Evaluation of Factors Associated with Early Failure of Arteriovenous Fistulae in Hemodialysis Patients
Authors: Elsharawy Mohamed A.
Published: August 2007

Recent guidelines have recommended performing native arteriovenous fistulae (AVF) in hemodialysis patients rather than synthetic grafts whenever possible. However, early failure of AVF may reach up to 50%. The purpose of this study was to assess the factors associated with early failure of such procedures in hemodialysis patients.

A prospective study was performed on all patients with end-stage renal disease who had an AVF between June 2003 and March 2005. Data including patient characteristics and the type of AVF were recorded. The internal diameter of the vein and artery and intraoperative blood flow were measured. Patients were followed up for 3 months.

One hundred twenty-six AVF were included in this study. Early failure was in 14 (9%) patients. The internal diameter of the vein and artery and intraoperative blood flow were significantly lower in the failure group than in the patent group. The failure rate was not significantly related to other parameters.

Our data showed that intraoperative blood flow is a reliable parameter that determines the early failure of an AVF. Careful selection of the vein and the artery may reduce the rate of failure.
Adjunctive Pharmacologic Use in Carotid Endarterectomy: A Review
Authors: Gortler David , Maloney Stephen , Rutland Reuben , Westvik Tormod , Muto Akihito , Kudo Fabio A. , Dardik Alan
Published: August 2007

Although carotid endarterectomy (CEA) is now widely accepted as the surgical therapy for carotid stenosis, the role of and indications and evidence for many pharmacologic agents that are used adjunctively in the perioperative setting have not been conclusively established. Aspirin (acetylsalicylic acid) is the pharmaceutical agent that has been studied most extensively in conjunction with CEA; other than aspirin and dextran, the use of many agents before, during, and after CEA has not been standardized. Prospective randomized trials are still needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in their adjunctive use during CEA to improve patient care and obtain optimal surgical outcomes.
Update on the Diagnosis and Management of Popliteal Aneurysm and Literature Review
Authors: Mousa Albeir Y. , Beauford Robert B. , Henderson Peter , Patel Prem , Faries Peter L. , Flores Lucio , Fogler Richard
Published: August 2007

Popliteal artery aneurysms (PAAs) are the most frequent peripheral aneurysm with a significant morbidity if left untreated. Open surgical technique is still considered the gold standard; however the revolution in endovascular repair has proven to be a valid alternative option in selected patients. The role of endovascular treatment in PAA is still considered in its infancy. In addition, the indications for use of endovascular stents as compared to standard open surgery have not yet been fully defined and more studies are warranted to characterize the durability of this technique. This article describes the general principles of the natural history, clinical presentation, and long-term limb salvage and survival outcomes for patients with such aneurysms. It also details the features and results for the devices in current use and highlights the current consensus in the management of PAA.
Atherosclerotic Aneurysm Formation in a Lower Extremity Saphenous Vein Graft
Authors: Bikk Andras , Rosenthal Martin D. , Wellons Eric D. , Hancock Susan M. , Rosenthal David
Published: August 2007

Saphenous vein is the most widely used conduit for arterial bypass procedures and aneurysms of the vein graft are rare. We report a true aneurysm of a reversed femoropopliteal saphenous vein graft implanted nine years earlier.

Duplex ultrasonography identified an aneurysm of the saphenous vein graft and arteriography confirmed this finding. A consideration for endovascular coiling of the aneurysm was entertained, but no proximal “neck” on the aneurysm was present. The patient, therefore, underwent an uneventful resection of the aneurysm with end-to-end anastomosis. Histopathologic examination of the aneurysm demonstrated atherosclerotic degeneration with endothelial disruption, medial necrosis, and fibrous proliferation.

The cause of a saphenous vein graft aneurysm is rare and unknown. The management of vein graft aneurysms, however, should be subject to the same criteria that apply to other aneurysms because once vein graft dilation occurs, it is followed by a rapid increase in size, which may lead to possible rupture.
Endovascular Treatment of a Symptomatic Suture Aneurysm Caused by an Aortic Isthmus Restenosis
Authors: Kopp Reinhard , Kreuzer Eckart , Oberhoffer Martin , Herrmann Karin Anna , Jauch Karl-Walter , Reichart Bruno
Published: August 2007

After operative treatment of aortic isthmus stenoses, late complications, such as aneurysm formation or aortic restenosis, might occur, with relevant morbidity and mortality rates during open surgical reintervention. We report on the endovascular repair of a symptomatic suture aneurysm caused by an aortic isthmus restenosis by thoracic aortic stent graft implantation and additional intraoperative balloon dilatation. Based on our experience, endovascular repair of thoracic aortic aneuryms caused by native aortic isthmus stenosis or postcoarctation restenosis is a valuable treatment option, especially in symptomatic patients with an imminent risk of rupture or a difficult immediate transthoracic surgical approach. Long-term follow-up is required to assess the durability of the stent graft treatment.
Leg Varices Originating from the Pelvis: Diagnosis and Treatment
Authors: Greiner Milka , Gilling-Smith Geoffrey L.
Published: August 2007

This article reports the investigation and treatment of 24 women presenting with recurrent lower limb varicosities secondary to reflux within the pelvic venous circulation. Diagnosis based on selective retrograde pelvic phlebography enabled precise identification and classification of sites of incompetence. A total of 74 veins were treated by embolization with platinum coils and glue prior to repeat surgery to the lower limb veins. At 4-year follow-up, signs of stasis had disappeared in all patients. Repeat phlebography revealed no evidence of recurrent reflux at the sites of treatment. One patient developed recurrent varices due to incomplete embolization of incompetent pelvic veins. Endovascular occlusion of incompetent pelvic veins is an effective treatment for varicose veins secondary to pelvic venous incompetence.
Long-term Outcome Of Operated Inflammatory Aortic Aneurysms
Authors: Ockert Stefan , Schumacher Hardy , Böckler Dittmar , Ganten Marika , Seelos Robert , Allenberg Jens
Published: August 2007

Inflammatory aortic aneurysms (IAAs) represent a rare form of aortic aneurysms. Compared with atherosclerotic aneurysms, patients with IAA have an increased risk of perioperative and long-term morbidity. This retrospective clinical study analyzed the outcome after conventional and endovascular repair of IAAs.

Patients treated for an abdominal IAA between January 1995 and November 2004 were included. Imaging (computed tomographic angiography or magnetic resonance angiography) was performed preoperatively and at the time of follow-up (mean 2.7 years). Transperitoneal open repair and endovascular aortic repair were the operative procedures used.

Over 10 years, 40 patients were treated with conventional and 5 patients with endovascular repair. The in-hospital morbidity rate was 11.1% (five patients; four conventional, one endovascular). On 10 patients (47.6%), the retroperitoneal fibrosis was no longer detectable.

After operative repair, the majority of cases presented with a distinct regression of inflammation. Endovascular treatment of IAA represents a feasible alternative procedure to open aortic repair.
Endovascular Management Of Blunt Abdominal Aortic Injury
Authors: Halkos Michael E. , Nicholas Jeffrey , Kong Li Sheng , Burke J.Ryan , Milner Ross
Published: August 2007

The endovascular management of blunt aortic injuries is being used more frequently in the trauma patient. Traumatic aortic injuries usually occur in the descending thoracic aorta near the origin of the left subclavian artery. Many reports in the literature demonstrate the efficacy of endovascular repair of blunt thoracic aortic injury. We report here an unusual case of abdominal aortic dissection secondary to blunt abdominal trauma following a fall. The patient also had associated intra-abdominal injuries requiring bowel resection and repair of small bowel mesenteric lacerations. He was treated with a bifurcated abdominal endograft with an excellent result after the initial operation was performed to treat the bowel injuries.
Rupture Of A Popliteal Artery Aneurysm 10 Years After Surgical Repair
Authors: van Santvoort Hjalmar C. , de Vries Jean-Paul P.M. , van de Mortel Rob , Wille Jan , van de Pavoordt Eric D.W.M.
Published: August 2007

The usual method for popliteal artery aneurysm exclusion is distal and proximal ligation followed by bypass grafting via a medial approach. This technique preserves collaterals to the aneurysm, which might cause back-bleeding and symptomatic enlargement. We report the eighth case in the literature of a ruptured popliteal artery aneurysm after previous ligation and bypass grafting. The ruptured aneurysm was successfully excluded via a posterior approach. The advantage of this approach over the medial approach is the possibility of opening the aneurysm sac to oversew patent side branches, thereby excluding back-bleeding. We review the advantages and disadvantages of both the medial and the dorsal technique to treat popliteal aneurysms.