bluuebunny/crossref_metadata_2025 huggingface dataset:
A Population‐Based Study of Periodontal Care Among Those With and Without Diabetes
Authors: Newton Katherine M. , Chaudhari Monica , Barlow William E. , Inge Ronald E. , Theis Mary Kay , Spangler Leslie A. , Hujoel Philippe P. , Reid Robert J.
Published: May 2011

Background: Our objectives were to describe the prevalence of periodontal care (a marker of periodontitis) among persons with and without diabetes and to examine the association between periodontal care and diabetes.

Methods: We conducted a cross‐sectional analysis, using 5 years of electronic data from a population‐based cohort (N = 46,132), aged 40 to 70 years, with dental and medical insurance, and ≥1 dental and ≥1 medical visit. Periodontal care (yes/no) was defined by dental claims codes for procedures used to manage periodontitis. The association between periodontal care and diabetes was determined using logistic regression adjusted for and stratified by age, sex, insurance type, smoking status, body mass index (BMI) (in kilograms per square meter), and resource utilization band (RUB) (a measure of expected health care utilization attributable to comorbidity).

Results: Overall, 11.2% (5,153 of 46,132) met diabetes criteria. The age‐adjusted prevalence of periodontal care among those with and without diabetes was 39.1% and 32.5%, respectively (P <0.0001). The association between diabetes and periodontal care decreased with increasing age (interaction, P <0.0001), adjusting for BMI and RUB. The aged‐stratified, adjusted odds ratio (OR) for periodontal care associated with diabetes was highest among those aged 40 to 44 years [OR, 1.6; confidence interval (CI), 1.30 to 1.97] and lowest among those aged 60 to 64 years (OR, 0.97; CI, 0.81 to 1.15) and was significant only among those aged 40 to 54 years.

Conclusion: We found that the prevalence of periodontal care was significantly higher among those with diabetes compared to those without diabetes and that the magnitude of this association decreased with increasing age.
Clinical Efficacy of 1% Alendronate Gel in Adjunct to Mechanotherapy in the Treatment of Aggressive Periodontitis: A Randomized Controlled Clinical Trial
Authors: Sharma Anuj , Pradeep A.R.
Published: May 2011

Background: Bisphosphonates represent a class of pharmacologic agents that have a potentially important role in the treatment of periodontitis and bone disorders. The present study aims to explore the clinical efficacy of 1% alendronate (ALN) gel as a local drug delivery system in adjunct to scaling and root planing for the treatment of patients with aggressive periodontitis (AgP) compared to placebo gel.

Methods: Fifty‐two intrabony defects from 17 patients with AgP were treated either with 1% ALN gel or placebo gel. ALN gel was prepared by adding ALN to a polyacrylic acid–distilled water mixture. Clinical parameters (modified sulcus bleeding index, plaque index, probing depth [PD], and clinical attachment level [CAL]) were recorded at baseline, 2 months, and 6 months, and radiographic parameters were recorded at baseline and 6 months. Defect fill at baseline and at 6 months was calculated on standardized radiographs by using image analysis software.

Results: Mean PD reduction was greater in the ALN group (3.88 ± 1.39 mm) compared to placebo (1.65 ± 1.35 mm) at 6 months. Similarly, mean CAL gain was greater in the ALN group (3.27 ± 1.11 mm) than the placebo group (1.42 ± 1.70 mm) at 6 months. Furthermore, significantly greater mean percentage of bone fill was found in the ALN group (46.1% ± 9.48%) compared to the placebo group (2% ± 1.02%).

Conclusions: The results of the present study show local delivery of 1% ALN stimulates a significant increase in PD reduction, CAL gain, and improved bone fill compared to placebo gel as an adjunct to scaling and root planing in patients with AgP. However, long‐term, multicentered, randomized, controlled clinical trials are required to know the clinical, histologic, and radiographic effect on bone regeneration in patients with AgP.
Controls as Exit Barriers in Multiperiod Outsourcing Arrangements
Authors: Phua Yee Shih , Abernethy Margaret A , Lillis Anne M
Published: May 2011

This study explores how initial control choice influences the ease with which outsourcing firms switch suppliers. We recognize that firms invest in controls to manage collaborative relationships, and argue that these investments generate switching costs, namely, opportunity and reinvestment costs. We collect data on outsourcing transactions by conducting semi-structured interviews across multiple field sites. Observed patterns across 53 cases show that firms with trust-based controls experience the most difficulty in switching suppliers, whereas firms with market-based controls experience the greatest ease. Firms with bureaucratic-based and hybrid controls generally lie between these extremes. Furthermore, in nearly 50 percent of our sample (25 cases), respondents indicate that the switching costs associated with control choices increase the difficulty of switching suppliers. We also find evidence that the magnitude and nature of switching costs vary with the types of controls chosen.

Data Availability: Data used in this study cannot be made public due to confidentiality agreements with participating firms.
Unusual Forms of Ruptured Abdominal Aortic Aneurysms
Authors: Davidović Lazar B. , Marković Miroslav D. , Jakovljević Nenad S. , Cvetković Dragan , Kuzmanović Ilija B. , Marković Dragan M.
Published: May 2011

Over 95% of abdominal aortic aneurysms (AAAs) rupture into the retroperitoneal space. Rare types of AAA ruptures comprise ruptures into the inferior vena cava with aortocaval fistula formation (ACF), ruptures into the duodenum with formation of a primary aortoduodenal fistula (ADF), and chronic contained ruptures (CCRs). This article presents a study of 41 cases with unusual forms of ruptured AAA of a series of 506 patients with AAA rupture treated within a 14-year period. There were 11 cases of CCR, 5 cases with ADF, and 25 cases with ACF. The correct preoperative diagnosis was established in 6 (of 11) cases of CCR, in 2 (of 5) cases of primary ADF, and in 13 (of 25) cases of ACF. AAA replacement was performed in 8 cases using a tube graft, whereas a bifurcated graft was used in 31 patients because of the distant extent of the atherosclerotic/aneurysmatic lesions engaging iliac arteries. Two patients had an axillobifemoral bypass. The overall 30-day mortality rate was 19% (8 of 41), with subgroup mortality rates of 0 (CCR), 60% (ADF), and 20% (ACF). Diagnosis and treatment are simplest in cases of CCR and the most complicated in cases of ADF.
Hypothenar Hammer Syndrome: Apropos of Six Cases and Review of the Literature
Authors: Nitecki Samy , Anekstein Yoram , Karram Tony , Peer Amir , Bass Arie
Published: May 2011

Hypothenar hammer syndrome (HHS) is a rather rare condition and is a term used to describe an aneurysm or thrombosis of the ulnar artery. It is considered an occupational or recreational injury and is usually a result of a repetitive trauma to the hypothenar region where the unique anatomy of the Guyon canal allows arterial injury. HHS is one of the less common causes of symptomatic ischemia of the upper extremity. The aim of this article is to describe our experience with six patients. Presenting signs, symptoms, differential diagnoses, and literature review of this probably underdiagnosed syndrome are described. There are two pathologic entities: the aneurysmal type and the thrombotic type. Although most authors recommend watchful observation for the thrombotic type, reconstructive surgery is the treatment of choice for the aneurysmal type.
Inflammatory Aneurysm of the Common Iliac Artery Mimicking Appendicitis
Authors: Mieog J. Sven D. , Stoot Jan H.M.B. , Bosch Jacobus J. , Koning Olivier H.J. , Hamming Jaap F.
Published: May 2011

Isolated inflammatory aneurysm of the common iliac artery is a rare condition. Previously reported cases presented with urologic complications owing to entrapment of the ureter in the perianeurysmal fibrosis. We report a case of a healthy young man who presented with acute abdominal pain in the right lower quadrant without urologic complications mimicking acute appendicitis. The pain was caused by an isolated inflammatory aneurysm of the right common iliac artery measuring 4 cm in diameter. Three years after open aneurysmal resection and graft interposition, the patient is doing well, with excellent peripheral circulation. The available literature on presentation, diagnosis, and treatment is reviewed.
Fractured Internal Carotid Artery Stent
Authors: Nazzal Munier , Abbas Jihad , Nazzal Mustafa , Afridi Sophia , Ritter Marilyn
Published: May 2011

Carotid artery stenting is gaining wider acceptance as an alternative option in the treatment of carotid artery stenosis. Conventional complications such as stroke and recurrent in-stent restenosis are well documented in the literature. However, we believe that carotid stent complications are underreported. The carotid artery segment has features that are relatively smilar to the femoropopliteal segment with respect to forces affecting the stented segment, which can contribute to stent complications such as fracture. In this article, we present a case of internal carotid artery stent fracture and thrombus formation after the patient was exposed to direct trauma to the chest and neck.
Use of StarClose for Brachial Artery Closure after Percutaneous Endovascular Interventions
Authors: Puggioni Alessandra , Boesmans Evelyne , Deloose Koen , Peeters Patrick , Bosiers Marc
Published: May 2011

The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5±7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08±0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge.
Sirolimus-Loaded Polyurethane Graft for Hemodialysis Access in Sheep
Authors: Schuman Earl , Babu Jayaraman
Published: May 2011

Intimal hyperplasia is the most common final pathway for hemoaccess occlusion in dialysis patients. Drug eluting stents have been shown to decrease intimal hyperplasia in coronary arteries and possibly in peripheral arteries. We evaluated the use of a sirolimus loaded polyurethane graft as prophylaxis in hemodialysis access. Grafts were loaded with sirolimus and elution curves were determined for the polyurethane material. The arteriovenous grafts were then placed in the neck of 20 sheep. A non-loaded graft was placed in the contralateral neck. Patency rates, ultrasound evaluation, angiography and histomorphometry were determined for each graft. At 30, 60 and 90 days the drug loaded graft had improved patency rates compared to the control, with a 25% improvement noted at 3 months. Life table analysis showed the drug loaded graft consistently better patency than the control (p = .136). The control graft had greater neointimal stenosis (14.5% vs 9.17%) over the course of the study (p = .157). Although none of these findings was statistically significant in this pilot study, the sirolimus coated graft out-performed the control in every measured parameter at each time point evaluated. Further work to asses the validity of drug coated materials to prevent intimal hyperplasia in hemodialysis access is warranted.
Early Computed Tomographic Angiography after Endovascular Aneurysm Repair: Worthwhile or Worthless?
Authors: Waasdorp Evert J. , van Herwaarden Joost A. , van de Mortel Rob H.W. , Moll Frans L. , de Vries Jean-Paul P.M.
Published: May 2011

This study evaluated the value of computed tomographic angiography (CTA) early after an endovascular aneurysm repair (EVAR) in relation to CTA 3 months after EVAR. We retrospectively reviewed all elective EVAR patients with available postprocedural and 3-month follow-up CTAs who were treated between 1996 and 2006. CTAs were analyzed for EVAR-related complications in terms of endoleaks, migration, and stent graft thrombosis. Secondary procedures and other complications within a 4-month time interval after EVAR were noted and analyzed for any association with the postprocedural CTA. During the study period, 291 patients (275 men), with a mean age of 71 years, underwent elective EVAR. All had postprocedural and 3-month follow-up CTAs, which detected 93 (32%) endoleaks (8 type I, 84 type II, 1 type III) and 1 stent graft thrombosis. These findings resulted in four secondary interventions (one interposition cuff, two extension cuffs, one conversion). All reinterventions were successfully done in an elective setting. During the first 3 postoperative months, five other reinterventions were required for acute ischemia in four patients (three Fogarty procedures, one femorofemoral crossover bypass) or groin infection in one patient. Eight patients died, but none of the deaths were related to abdominal aortic aneurysm or EVAR (four cardiac, two pulmonary, one gastric bleeding, one carcinoma). At 3 months, 43 endoleaks (3 type I, 40 type II), 3 stent graft thromboses, and 1 stent graft migration were seen. In two patients (0.7%), a new endoleak was diagnosed compared with the postprocedural CTAs. In 287 (99%) of 291 patients, the postprocedural CTA did not influence our treatment policy in the first 3 months after EVAR. More than half of the early endoleaks were self-limiting, and new endoleaks were seen in only two patients (< 1%) at the 3-month follow-up CTA. After an uneventful EVAR procedure, it is safe to leave out the early postprocedural CTA.
Endovascular Repair of a Tracheoinnominate Fistula with a Stent Graft
Authors: Guimaraes Marcelo , Schönholz Claudio , Phifer Travis , D'Agostino Horacio
Published: May 2011

Massive bleeding from a tracheostomy developed in a 65-year-old woman with stroke after successful conservative management of a minor tracheostomy bleeding episode. Temporary hemostasis was achieved, and angiography showed a tracheoinnominate fistula (TIF), a rare complication of tracheostomy. Open surgery was contraindicated in this patient, so endovascular repair using a stent graft was performed. Permanent hemostasis was obtained, and there were no immediate complications from the procedure. The patient never recovered from her stroke and died 2 weeks later. The endovascular approach may be a feasible alternative to surgical repair of TIF, especially in patients unable to tolerate an open procedure.
Schwannoma of the Vagus Nerve Masquerading as a Carotid Body Tumor
Authors: Schupp Daniela J. , Mukherjee Dipankar , Sharma Gopesh K.
Published: May 2011

A 45-year-old male presented with increasing hoarseness and swelling of his right neck over 5 months. He was noted to have right vocal cord paralysis and hemiatrophy of his tongue. He was found to have a schwannoma of the vagus nerve with compression of the right hypoglossal nerve. One month after his surgery, the patient's tongue mobility was improving, he was not aspirating, his voice was better and his right vocal cord remained abducted. A discussion of this case is followed by a review of the literature surrounding this rare disease and this unique presentation.
Truncus Bicaroticus and an Aberrant Right Subclavian Artery Contributing to Internal Jugular Venous Line Misplacement into the Carotid Artery
Authors: Baldwin Keith , Volchok Japa
Published: May 2011

Truncus bicaroticus, or common origin of the carotid arteries, is extremely rare and has been described sparsely in the literature. It has been reported as an incidental finding during cadaveric dissection and as an anatomic variant found during routine angiography. We report the case of a 75-year-old woman with a previously unknown truncus bicaroticus and an aberrant right subclavian artery in whom the anatomic variations contributed to an arterially placed central venous catheter remaining undetected. This catheter misplacement was suspected after the patient developed an embolic stroke, and subsequent studies demonstrated the truncus bicaroticus and intra-arterial catheter placement. To our knowledge, this is the first case reporting a truncus bicaroticus associated with an aberrant right subclavian artery.
Conventional or Endovascular Treatment of Ongoing Mycotic Aortic Aneurysmal Disease?
Authors: Kuizenga Kirsten , Reijnen Michel M.P.J. , Tielliu Ignace F.J. , Verhoeven Eric L.G. , van den Dungen Jan J.A.M. , Zeebregts Clark J.
Published: May 2011

We report a case in which conventional and endovascular exclusion techniques were used to treat ongoing mycotic aortic aneurysmal disease. A 51-year-old man presented with an infrarenal mycotic aortic aneurysm that was excluded and reconstructed with a superficial femoral vein. Two years later, he developed a symptomatic mycotic aneurysm of the descending thoracic aorta, which required emergent treatment with a stent graft. The patient died 5 months later of massive bleeding owing to an aortobronchial fistula deriving from a new thoracic aneurysm proximal to the stent graft. Choices and different modes of treatment are discussed. Endovascular treatment of symptomatic mycotic aortic aneurysm might provide a valid alternative to open repair but may be unsuccessful owing to ongoing infection. In situ replacement using autologous material seems appealing whenever feasible.
Autologous Basilic Vein for In Situ Replacement of Infected Prosthetic Vascular Grafts: Initial Experience
Authors: Parmar Chetan D. , Kumar Senthil , Torella Francesco
Published: May 2011

Successful treatment of prosthetic vascular infection usually requires graft removal with or without replacement. A variety of materials have been used for in situ replacement, with femoral vein being the preferred autologous conduit in the literature for the aortoiliac segment. We present three cases of prosthetic infection treated successfully by in situ replacement with autologous basilic vein harvested from the upper arm. This vessel, which closely matches the iliofemoral arteries in diameter, may be a suitable alternative to femoral vein for in situ replacement of infected iliac and femoral grafts.
Aortic Aneurysm–Induced Disseminated Intravascular Coagulopathy: Successful Surgical Repair
Authors: Yuan Shi-Min , Shinfeld Amihay , Tager Salis , Raanani Ehud
Published: May 2011

Aortic aneurysm is a rare cause of disseminated intravascular coagulopathy (DIC). We present the developmental course of DIC in a 70-year-old male patient who had a thoracoabdominal aortic aneurysm characterized by a progressive descending aortic aneurysm presenting as subcutaneous hemorrhage of acute onset. He was diagnosed as having aortic aneurysm–induced DIC. After adequate infusion of blood components, surgical repair of the descending aortic aneurysm was carried out successfully. The patient's bleeding tendency stopped dramatically in the early postoperative period as identified by clinical and laboratory findings. We concluded that the occurrence of DIC was due mainly to the progressive descending aortic aneurysm in the present patient and that surgical repair could be the definitive treatment of DIC in this setting.
Periprocedural Drug Therapy in Carotid Artery Stenting: The Need for More Evidence
Authors: Gortler David , Schlösser Felix J.V. , Muhs Bart E. , Nelson Michael A. , Dardik† Alan
Published: May 2011

Carotid artery stenting (CAS) is a widely accepted alternative for patients at high risk for carotid endarterectomy (CEA). However, the role, indications, and evidence for many pharmacologic agents that are used adjunctively in the periprocedural setting have not been established. Several drugs are commonly used before, during, and after CAS, but their uses have not been standardized. Large prospective cohort studies with good validity or randomized trials are needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in patients undergoing CAS to improve patient care and obtain optimal outcomes. Several conclusions can be made: (1) dual-antiplatelet therapy (aspirin and clopidogrel) is commonly used for CAS; (2) the most commonly used regimen is aspirin 325 mg and clopidogrel 75 mg per day, but the optimal time of therapy is unknown; and (3) the dose and regimen of other agents used for CAS are not established.
Hemodynamically Driven Vein Graft Remodeling: A Systems Biology Approach
Authors: Berceli Scott A. , Tran-Son-Tay Roger , Garbey Marc , Jiang Zhihua
Published: May 2011

Despite intense investigation over several decades to understand the mechanisms of vein graft failure, few therapeutic modalities have emerged. Emphasis using standard reductionist approaches has been focused on cataloging the components involved in the early events following vein graft implantation, but limited insight has been gained in understanding the dynamic interaction of these components. We propose that the application of systems theory offers the opportunity for significant advances in this area. Focused on modeling the dynamic relationships that define living organisms, systems biology provides the necessary tools to further our understanding of the complex series of overlapping biologic events on surgical implantation of the vein graft. Through the use of ordinary differential equation and agent-based modeling techniques, we present our ongoing efforts to define the nonlinear interactions between hemodynamics and vascular adaptation.
Thoracic Aortic Dissection: Are Matrix Metalloproteinases Involved?
Authors: Zhang Xiaoming , Shen Ying H. , LeMaire Scott A.
Published: May 2011

Thoracic aortic dissection, one of the major diseases affecting the aorta, carries a very high mortality rate. Improving our understanding of the pathobiology of this disease may help us develop medical treatments to prevent dissection and subsequent aneurysm formation and rupture. Dissection is associated with degeneration of the aortic media. Recent studies have shown increased expression and activation of a family of proteolytic enzymes-called matrix metalloproteinases (MMPs)-in dissected aortic tissue, suggesting that MMPs may play a major role in this disease. Inhibition of MMPs may be beneficial in reducing MMP-mediated aortic damage associated with dissection. This article reviews the recent literature and summarizes our current understanding of the role of MMPs in the pathobiology of thoracic aortic dissection. The potential importance of MMP inhibition as a future treatment of aortic dissection is also discussed.
Venous and Arterial Identity: A Role for Caveolae?
Authors: Rivera Mariangela , Muto Akihito , Feigel Amanda , Kondo Yuka , Dardik Alan
Published: May 2011

Venous and arterial identity is predetermined in the embryo, with embryonic vessels expressing Eph-B4 differentiating into veins and vessels expressing ephrin-B2 differentiating into arteries. The specialized membrane organelles lipid rafts and caveolae serve as localized domains for proteins to interact with one another and play a role in signal transduction and vesicular trafficking. Several tyrosine kinase membrane receptors, including Eph-B1, have been colocalized to caveolae. These data suggest that caveolae and Eph receptors may have coordinated roles in determining vessel identity, not only during embryogenesis but perhaps also during adult vascular remodeling and angiogenesis.
Predictive Factors of Femoropopliteal Patency after Suboptimal Duplex–Guided Balloon Angioplasty and Stenting: Is Recoil a Bad Sign?
Authors: Ascher Enrico , Hingorani Anil P. , Marks Natalie , Puggioni Alessandra , Shiferson Alexander , Tran Victor , Jacob Theresa
Published: May 2011

Currently, the value of stenting during femoropopliteal balloon angioplasty (FPBA) remains unclear. Herein we evaluate the patency rates of successful duplex–guided balloon angioplasty (DAGBA) alone versus suboptimal DAGBA followed by stenting and the prestenting dissection versus recoil as potential indicators of stent success or failure. Over a period of 27 months, we performed 291 duplex–guided FPBAs (194 stenoses; 97 occlusions) on 244 limbs in 220 patients. Disabling claudication was the indication in 67%. Critical limb ischemia was the indication in the remaining 33%. Self-expanding nitinol stents were used when plaque dissection and/or recoil caused diameter reduction ≥ 40%. Serial follow-up duplex scans were obtained. Severe restenosis (> 70%) was measured by B-mode imaging and a peak systolic velocity ratio > 3. Follow-up ranged from 1 to 41 months (mean 10 ± 8.3 months). The overall mean interval for restenosis and occlusion was 6.5 ± 4.2 months and 5.6 ± 6.1 months, respectively. Stents did affect overall patency results compared with not using stents. Reasons for stenting were plaque recoil, dissection, or both in 98 (53%), 44 (24%), and 42 (23%) cases, respectively. Six-month patency was 59%, 94%, and 69%, respectively. The difference between plaque recoil and dissection was significant ( p < .04). The use of stents during FPBA may be associated with balloon angioplasty site failure in the femoropopliteal segment. To our knowledge, this is the first report ever to document plaque recoil as a predictor of balloon angioplasty site failure notwithstanding stent placement.
Effect of Patient Transfer on Outcomes after Open Repair of Ruptured Abdominal Aortic Aneurysms
Authors: Azizzadeh Ali , Miller Charles C. , Villa Martin A. , Estrera Anthony L. , Coogan Sheila M. , Meiner Sean T. , Safi Hazim J.
Published: May 2011

Patients with ruptured abdominal aortic aneurysms (RAAAs) benefit from treatment in high-volume facilities. This study explored the effect of patient transfer on outcomes and the relationship between hemodynamic status and mortality. We performed a retrospective review of 83 consecutive patients who had open repair for RAAA at a single tertiary facility. The patients were divided into two groups based on arrival in the local emergency department, “local” ( n = 44) versus “transfer” ( n = 39) from an outside institution, and into three categories of hemodynamic status: (a) no obtainable blood pressure, “pulseless”; (b) requiring vasopressor support, “pressors”; and (c) no vasopressor support, “no pressors.” Thirty-day mortality was 21.4%. There was no difference in mortality between the local (18.2%) and transfer (25.6%) patients ( p = .41). There were no deaths during transfer. There was no difference in the hemodynamic status of the transfer versus the local group ( p = .34). The mortality by category was pulseless, 100% (3 of 3); pressors, 71.4% (10 of 14); and no pressors, 7.6% (5 of 66) ( p < .0001). Actuarial survival was 66%, 64%, and 62% at 1, 3, and 5 years, respectively. Patient transfer does not adversely affect mortality after RAAA repair. Patients without a palpable pulse and those requiring hemodynamic support have a significantly higher mortality.
Two-Stage Combined Basilic-Brachial Vein Transposition
Authors: Kakkos Stavros K. , Haddad Georges K.
Published: May 2011

In the present report, we describe a two-stage technique of combined basilic and brachial vein transposition. Our patient had a brachial-basilic vein fistula created, but during the second stage for the transposition, a low basilic-brachial vein confluence was found. Instead of abandoning the procedure, the brachial vein was mobilized and transposed to primarily constitute a usable fistula, which subsequently was successfully used for hemodialysis. A detailed description of our technique is provided. Surgeons should be aware of this alternative procedure to maximize fistula creation rates.
Complex Abdominal Aortic Pathologies: Operative and Midterm Results after Pararenal Aortic Aneurysm and Type IV Thoracoabdominal Aneurysm Repair
Authors: Ockert Stefan , Riemensperger Marcel , von Tengg-Kobligk Hendrik , Schumacher Hardy , Eckstein Hans-Henning , Böckler Dittmar
Published: May 2011

The aim of the study was to describe the clinical outcome of pararenal aortic aneurysm (PAAA) and type IV thoracoabdominal aneurysm (TAAA) repair, with special consideration placed on disease-related complications and midterm follow-up. Data were collected retrospectively between 1997 and 2004 for patients with PAAA or type IV TAAA repair. Comorbidities, operative details, and early and late outcome were analyzed to predict disease-related complications. During the study period, 63 patients (33 PAAAs, 30 type IV TAAAs) underwent aortic repair. The 30-day mortality rate of 7.9% was acceptable for complex aortic entities compared with other series. The morbidity for cardiac events was 3.2%, for pulmonary complications 17.5%, and the need for reoperation was 14.3%. With regard to disease-related complications, two patients (3.2%) required dialysis and one patient (1.6%) developed paraplegia (spinal cord ischemia) after type IV TAAA repair. Complex aortic repair for PAAAs and type IV TAAAs showed acceptable perioperative mortality, morbidity, and midterm survival rates. Patients with type IV TAAAs suffered more major complications, such as postoperative dialysis or spinal cord ischemia.
Arterial Thrombosis and Gangrene Secondary to Arachnidism
Authors: Eckermann Jan M. , Teruya Theodore H. , Bianchi Christian , Abou-Zamzam Ahmed M.
Published: May 2011

Spider bites can cause local tissue damage as well as life-threatening complications. This is a case report of a female with no history of lower extremity vascular disease who presented with a spider bite on the dorsum of her foot. She developed progressive necrosis and eventually suffered limb loss despite attempts at revascularization.
False Aneurysm at the Origin of the Anterior Tibial Artery after Opening Wedge Osteotomy
Authors: Bartoli Michel A. , Lerussi Gilles B. , Gulino Roberto , Schroeder Marc , Branchereau Alain
Published: May 2011

We report the case of a false aneurysm at the origin of the anterior tibial artery complicating upper tibial osteotomy. The proximally located lesion compressed the posterior tibial nerve, and despite successful decompression, the patient suffers from probably irreversible neurologic after-effects. Even though it is rare, this complication must be considered when faced with leg pain consecutive to upper tibial osteotomy without deep venous thrombosis.
Iatrogenic Venous Pseudoaneurysm: Case Report And Review Of The Literature
Authors: Ward William H. , Platz Timothy A. , Pond Kathryn T. , Southern Frederick A. , Moore Erin M.
Published: May 2011

Iatrogenic venous pseudoaneurysm following venipuncture is an extremely rare complication of a very common medical procedure. A review of the vascular surgical literature revealed that only two cases of venous pseudoaneurysm secondary to venipuncture have been reported in the past half-century. We report the case of a 64-year-old anticoagulated male with a 7-month history of right arm swelling after venipuncture. The patient, on warfarin therapy for chronic atrial fibrillation, described progressive swelling at a previous venipuncture site. He eventually underwent limited two-dimensional ultrasonography, performed for a suspected hematoma, revealing a 4.3 × 3.3 × 2.0 cm pseudoaneurysm of the right basilic vein. These findings were later confirmed by a formal venous duplex sonogram. Similar to other forms of aneurysm and focal vascular dilation, the risks of venous psuedoaneurysm include embolism, thrombosis, and the compression of adjacent structures. Although both thrombin injection and coil embolization have been described as nonsurgical treatment options for arterial pseudoaneurysms, surgical resection may be the most appropriate approach for those with a venous equivalent. The segment of basilic vein containing the pseudoaneurysm was resected. This case demonstrates the need for physicians to consider venous pseudoaneurysm as a possible complication of venipuncture in individuals undergoing anticoagulation therapy.
Delayed Abdominal Closure in the Management of Ruptured Abdominal Aortic Aneurysm
Authors: Kimball Edward J. , Adams Danielle M. , Kinikini Daniel V. , Mone Mary C. , Alder Stephen C.
Published: May 2011

The objective of this study was to compare initial use of the open abdomen using the vacuum-pack technique followed by delayed abdominal closure with standard primary abdominal closure in the treatment of ruptured abdominal aortic aneurysm (rAAA) repair. A retrospective review identified 122 rAAA cases, which were divided into two management eras: era 1 (primarily closed) and era 2 (47% open abdomen).

One hundred three patients were included in this review: 58 in era 1 and 45 in era 2. Evidence of one of three ischemia-reperfusion (IR) criteria, preoperative hypotension, estimated blood loss ≥ 6 L, or intraoperative resuscitation with ≥ 12 L, predicted mortality. These criteria were also used as surrogate clinical markers for abdominal compartment syndrome. The in-hospital mortality was higher in those with at least one IR criterion: 43% versus 10% ( p = .0003). In those with at least one IR criterion, the initial 24-hour mortality was 21% for era 1 versus 0% for era 2 ( p = .03), and the 30-day mortality was 40% for era 1 and 32% for era 2 ( p = .77).

Three IR criteria were identified and were associated with increased mortality. Patients with these risk factors who were treated with delayed abdominal closure had an improved acute survival rate and a trend for improved long-term survival.
Percutaneous Treatment of Varicocele with Microcoil Embolization: Comparison of Treatment Outcome with Laparoscopic Varicocelectomy
Authors: Bechara Carlos F. , Weakley Sarah M. , Kougias Panagiotis , Athamneh Husam , Duffy Patrick , Khera Mohit , Kobayashi Katsuhiro , Lin Peter H.
Published: May 2011

Successful treatment of a testicular varicocele, which can result in scrotal pain and swelling as well as male subfertility, can be accomplished via operative ligation of the varicocele or interventional treatment with coil embolization of the testicular vein. This study compared the treatment outcome of percutaneous embolization treatment versus laparoscopic varicocelectomy in patients with symptomatic varicoceles. Patients with varicoceles undergoing either laparoscopic varicocelectomy or percutaneous coil embolization of the testicular vein during a recent 5-year period were analyzed. Treatment outcome and hospital costs of these two minimally invasive treatment modalities were compared. Forty-one patients underwent percutaneous coil embolization of the testicular vein, which were compared with a cohort of 43 patients who underwent laparoscopic varicocelectomy. Technical success in interventional and laparoscopic treatment was 95% and 100%, respectively. The mean operative time or procedural time was 63 ± 13 minutes and 52 ± 25 minutes for interventional and laparoscopic cohorts (not significant), respectively. Embolization treatment resulted in two recurrent varicoceles (4.8%) compared to one patient following laparoscopic repair (2.3%, not significant). Embolization treatment was associated with a lower complication rate than laparoscopic repair (9.7% vs 16.3%, p = .03). Regarding cost analysis, no significant difference in hospital cost was noted between the interventional or laparoscopic treatment strategies. Both laparoscopic varicocelectomy and coil embolization are effective treatment modalities for varicoceles. With lower treatment complication rates in the interventional treatment group, coil embolization of the testicular vein offers treatment advantage compared with laparoscopic repair in patients with varicoceles.
Vascular Injuries in an Urban Combat Setting: Experience from the 2006 Lebanon War
Authors: Nitecki Samy S. , Karram Tony , Ofer Amos , Engel Ahuva , Hoffman Aaron
Published: May 2011

Vascular injuries are manifested by life-threatening hemorrhage or limb loss and their diagnosis and treatment are challenging. Angiography is beyond the capability of available teams during wartime. Thus, computed tomographic angiography (CTA) may become a major triage tool. This study reports on the presentation, diagnosis, management and outcome of combat vascular injuries with emphasis on the utility of CTA. Presenting signs and symptoms, means of diagnosis, treatments and results of all combat sustained vascular cases were collected and compiled with follow-up.

Of 511 patients, 39 patients (7.6%) with vascular injuries were admitted. Injuries were penetrating and accompanied by soft tissue and bone insult. Diagnosis was made by CTA in 62% and by surgical exploration in 38%. Extremity arteries were injured in 72% of cases. Treatment included surgical and endovascular techniques. Complications: one late amputation, 5% thrombosis, 24% wound infections with no mortalities or early amputations.

Although similarities exist between this experience and recent wartime reports, differences are apparent including the effectiveness of CTA. High index of suspicion and liberal use of CTA allows for an early and accurate diagnosis of a vascular injury resulting in high rates of limb salvage and low mortality. CTA should be the first line modality for diagnosis of vascular injuries, reserving angiography for endovascular treatment.
Internal Sealing of Acute Aortic Bleeding with a Catheter-Delivered Liquid to Solid Embolic Agent (Onyx)
Authors: Larzon Thomas , Mathisen Sven R.
Published: May 2011

Occasionally, standard stent grafts are not usable in emergency aortic bleeding, and custom-made stent grafts are not practical as a replacement. We describe a novel technique for the repair of such aneurysms by using the catheter-delivered liquid to solid embolic agent Onyx (Micro Therapeutics Inc., Irvine, CA). Two patients with ruptured aortic aneurysm, where endovascular or open repair was not considered as feasible, were treated by internal sealing of the aneurysm with Onyx, resulting in stoppage of bleeding and further expansion of the aneurysm-the plugging and sealing technique.
Role of Superficial Femoral Artery Stents in the Management of Arterial Occlusive Disease: Review of Current Evidence
Authors: Perrio Stephen , Holt Peter J.E. , Patterson Benjamin O. , Hinchliffe Robert J. , Loftus Ian M. , Thompson Matthew M.
Published: May 2011

The objectives of this study were to compare the 1-year patency of superficial femoral artery (SFA) stent placement with percutaneous transluminal angioplasty (PTA) alone and to attempt to define the role of stents in arterial occlusive disease. Literature searches of the Embase, Medline, and Cochrane databases identified relevant articles, which were split into two subgroups: those containing case-controlled matches for stenting and PTA and those considering only stent placement. The review conformed to the QUORUM statement. One-year patency rates were 219 of 383 (57%) in the stented group and 319 of 607 (53%) in the PTA group for matched cases (odds ratio 1.206 [95% CI 0.932–1.559; p = .115]). The patency of stents deployed secondarily was 554 of 909 (61%). The combined 1-year patency of primary and secondary SFA stents for matched and unmatched case series was 816 of 1,282 (64%). One-year patency rates following stent placement or PTA alone in well-matched patient groups demonstrated no significant difference. This would suggest that the routine use of primary SFA stenting should be undertaken only in selected cases and should mainly be used in “bailout” situations or for complex lesions where surgery is precluded. However, the studies used displayed a high degree of heterogeneity, and some used stent technology that is now considered obsolete. Ongoing randomized controlled trials will provide a more definitive answer to this important problem.
Logistic Considerations for a Successful Institutional Approach to the Endovascular Repair of Ruptured Abdominal Aortic Aneurysms
Authors: Mayer Dieter , Rancic Zoran , Pfammatter Thomas , Hechelhammer Lukas , Veith Frank J. , Donas Konstantin , Lachat Mario
Published: May 2011

The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.
Duplication Of The Superficial Femoral Artery
Authors: Huynh Khiem D. , Alfaqawi Marina , Paaske William P.
Published: May 2011

A computed tomographic angiogram for pseudoaneurysm after previous puncture in the groin showed duplication of the superficial femoral artery in a 52-year-old man without symptoms or signs of arterial insufficiency. It is doubtful whether this very rare anatomic variant has clinical relevance, but it should be known by vascular specialists.
Surgical Treatment Of Symptomatic Coiling Or Kinking Internal Carotid Artery
Authors: Tetik Omer , Yurekli Ismail , Yilik Levent , Akhan Galip , Gurbuz Ali
Published: May 2011

Coiling of the artery is a rare morphologic entity most frequently described in the internal carotid artery. Herein we present two cases with symptomatic kinked internal carotid artery: one suffering from paresthesia of the right arm and speech disturbances and the other suffering from weakness of the left half of the body and speech disturbances. Both patients were treated surgically. None of the patients experienced any peri- or postoperative complications.
Carotid Artery Wire Injury Mouse Model with a Nonmicrosurgical Procedure
Authors: Yin Yangguang , Zhao Xiaohui , Fang Yuqiang , Huang Lan
Published: May 2011

A mouse model of endothelial denudation in the common carotid artery is usually established with a flexible wire under a dissecting microscope. In this article, we introduce a modified procedure to establish a carotid arterial injury mouse model in which no dissecting microscope is used. In the nonmicrosurgical procedure, carotid clamps, which were used to block the blood flow of the common carotid artery and the internal carotid artery, were substituted with silk slipknots. Curved flexible wire, which was used to introduce carotid artery injury, was tailored so that it could be inserted into the external carotid artery easily. A tailored hook was used to place silk around the external carotid artery and the internal carotid artery. The data show that the nonmicrosurgical procedure could achieve an effect in endothelial denudation and neointima formation similar to that of the microsurgical procedure. The operating achievement ratio and survival rates at 1 day and 4 weeks are also similar between the two groups. The operating time was reduced significantly in the nonmicrosurgical group compared to the microsurgical group. The present study suggests that establishing a carotid arterial injury mouse model with a nonmicrosurgical procedure is simple, effective, and time-saving.
Epithelioid Hemangioma Of The Ulnar Artery
Authors: Walker Stuart R.
Published: May 2011

This case report describes a rare vascular tumor (epithelioid hemangioma) in the ulnar artery of a young male patient, treated by excision and bypass grafting.
Price elasticity of pinewood demand on the retail timber market: an example from the Regional Directorate of State Forests in Zielona Góra
Authors: Adamowicz Krzysztof , Cierniak Natalia
Published: May 2011

Elastyczność cenowa popytu na drewno sosnowe sprzedawane na rynku detalicznym surowca drzewnego na przykładzie RDLP w Zielonej Górze
Nouvelles données à propos du Quaternaire et de la tectonique récente dans la chaîne de Metlaoui (sud-ouest de la Tunisie)
Authors: Ben Ouezdou H. , Zargouni F.
Published: May 2011

Cinq niveaux quaternaires, datant du Pléistocène moyen à la période historique, sont identifiés sur le piémont méridional de la chaîne de Metlaoui. Postérieurement à la phase de compression post-villafranchienne, une tectonique distensive affecte les dépôts quaternaires au Pléistocène moyen et à la fin du Pléistocène supérieur.
L'expansion du vignoble des Côtes du Rhône méridionales
Authors: Durbiano Claudine
Published: May 2011

Les Côtes du Rhône sont un vignoble jeune et dynamique. De 1956 à 1986, les superficies ont progressé de 240% et la production a quintuplé. Cette progression s'est réalisée par la transformation d' une polyculture sèche méditerranéenne en une monoculture viticole associée à de nombreux défrichements. Toutefois, le vignoble rhodanien reste à la recherche d'une identité. Il doit finir de se débarasser de l'héritage issu de sa longue dépendance vis à vis du négoce bourguignon, créer un véritable comportement «vigneron» chez des exploitants essentiellement producteurs de raisins. Les organisations professionnelles souhaitent aujourd' hui mieux maîtriser l'appellation et faire du vignoble des Côtes du Rhône «un grand parmi les grands» pour mieux se démarquer des nouvelles appellations contrôlées qui se multiplient depuis une dizaine d'années dans les vignobles du sud-est de la France.
Genèse d'un haut lieu
Authors: Vidal-Naquet Pierre
Published: May 2011

C'est au cours du XXe siècle que la montagne Sainte-Victoire a vu se transformer sa fonction sociale. Espace rural «sans qualités» avant Cézanne, Sainte-Victoire est devenu, par la suite, un territoire hautement qualifié, un espace emblématique, saturé de sens. Les mesures étatiques de protection et de classement, prises entre 1958 et 1983, ont consacré l'identité de cette montagne en même temps qu'elle l'ont réifiée.
Las residencias secundarias en la isla de Mallorca : tipos y procesos de crecimiento
Authors: Salvà I Tomàs Pere A. , Binimelis Sebastian Jaume
Published: May 2011

After the introduction of the mass-tourism as the main economic activity in Mallorca, there was a hard process of demand for space destined as secondary residence, process due to the external demand (foreign and-or resident tourists) as to the internal demand (natural residents). Both kinds of demand had been developped simultaneously and had produced a very important expansion of secondary residence in all the island. While the external, and too the internal, demand are located in the touristic areas of the coast, the natural residents demand for secondary residence become localized in the inner spaces of Mallorca
Une population poudrière: l'Algérie
Authors: Côte Marc
Published: May 2011

During the last four decades, the Algerian population has shown strong transformations : threefold increase, saturation of the countrysides, multiplication and growth of the cities, which have converted the country to an urban one. The effect of the growth of the population and of its large spatial redistribution have been enhanced during the last decade by a sharp drop in the quality of life. It is therefore not surprising that the Algerian population has now become a kind of powder keg.