bluuebunny/crossref_metadata_2025 huggingface dataset:
Why Do Patients With Cancer Visit Emergency Departments? Results of a 2008 Population Study in North Carolina
Authors: Mayer Deborah K. , Travers Debbie , Wyss Annah , Leak Ashley , Waller Anna
Published: May 2011

Purpose

Emergency departments (EDs) in the United States are used by patients with cancer for disease or treatment-related problems and unrelated issues. The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) collects information about ED visits through a statewide database.

Patients and Methods

After approval by the institutional review board, 2008 NC DETECT ED visit data were acquired and cancer-related visits were identified. Descriptive statistics and logistic regressions were performed. Of 4,190,911 ED visits in 2008, there were 37,760 ED visits by 27,644 patients with cancer.

Results

Among patients, 77.2% had only one ED visit in 2008, the mean age was 64 years, and there were slightly more men than women. Among visits, the payor was Medicare for 52.4% and Medicaid for 12.1%. More than half the visits by patients with cancer occurred on weekends or evenings, and 44.9% occurred during normal hours. The top three chief complaints were related to pain, respiratory distress, and GI issues. Lung, breast, prostate, and colorectal cancers were identified in 26.9%, 6.3%, 6%, and 7.7% of visits, respectively, with diagnosis. A total of 63.2% of visits resulted in hospital admittance. When controlling for sex, age, time of day, day of week, insurance, and diagnosis position, patients with lung cancer were more likely to be admitted than patients with other types of cancer.

Conclusion

To the best of our knowledge, this is the first study to provide a population-based snapshot of ED visits by patients with cancer in North Carolina. Efforts that target clinical problems and specific populations may improve delivery of quality cancer care and avoid ED visits.
Missense Mutations Located in Structural p53 DNA-Binding Motifs Are Associated With Extremely Poor Survival in Chronic Lymphocytic Leukemia
Authors: Trbusek Martin , Smardova Jana , Malcikova Jitka , Sebejova Ludmila , Dobes Petr , Svitakova Miluse , Vranova Vladimira , Mraz Marek , Francova Hana Skuhrova , Doubek Michael , Brychtova Yvona , Kuglik Petr , Pospisilova Sarka , Mayer Jiri
Published: May 2011

Purpose

There is a distinct connection between TP53 defects and poor prognosis in chronic lymphocytic leukemia (CLL). It remains unclear whether patients harboring TP53 mutations represent a homogenous prognostic group.

Patients and Methods

We evaluated the survival of patients with CLL and p53 defects identified at our institution by p53 yeast functional assay and complementary interphase fluorescence in situ hybridization analysis detecting del(17p) from 2003 to 2010.

Results

A defect of the TP53 gene was identified in 100 of 550 patients. p53 mutations were strongly associated with the deletion of 17p and the unmutated IgVH locus (both P < .001). Survival assessed from the time of abnormality detection was significantly reduced in patients with both missense (P < .001) and nonmissense p53 mutations (P = .004). In addition, patients harboring missense mutation located in p53 DNA-binding motifs (DBMs), structurally well-defined parts of the DNA-binding domain, manifested a clearly shorter median survival (12 months) compared with patients having missense mutations outside DBMs (41 months; P = .002) or nonmissense alterations (36 months; P = .005). The difference in survival was similar in the analysis limited to patients harboring mutation accompanied by del(17p) and was also confirmed in a subgroup harboring TP53 defect at diagnosis. The patients with p53 DBMs mutation (at diagnosis) also manifested a short median time to first therapy (TTFT; 1 month).

Conclusion

The substantially worse survival and the short TTFT suggest a strong mutated p53 gain-of-function phenotype in patients with CLL with DBMs mutations. The impact of p53 DBMs mutations on prognosis and response to therapy should be analyzed in investigative clinical trials.
Antifeminism in the Service of Anticlericalism in Sir David Lindsay's Ane Satyre of the Thrie Estaitis
Authors: Murphy Sara A.
Published: May 2011

Sir David Lindsay's Scottish drama, Ane Satyre of the Thrie Estaitis (1552-54), includes striking portrayals of uncontrollable women, from noblewoman Dame Sensualitie's usurpation of the Scottish king's secular power on behalf of the Catholic Church to Foly's wife, whose Rabelaisian bodily functions are a visceral metaphor for the disordered state of late medieval Scotland. Despite the theatrical power of such misogynistic stereotypes, antifeminism is not actually the endpoint of Lindsay's political satire. Rather, it is the tool through which Lindsay critiques the corrupt Catholic clergy in Scotland and its superiors in Rome. By focusing on how the clergy's campaign against marriage convinces husbands on all social levels—including the royal court, the world of artisans, and the yeomanry—to reject spousal relations, this reading of the play reveals how the failures of Scotland's men ultimately cause the uncontrollable behavior of the nation's women.
The transcription factor FoxB mediates temporal loss of cellular competence for notochord induction in ascidian embryos
Authors: Hashimoto Hidehiko , Enomoto Takashi , Kumano Gaku , Nishida Hiroki
Published: May 2011

In embryos of the ascidian Halocynthia roretzi, the competence of isolated presumptive notochord blastomeres to respond to fibroblast growth factor (FGF) for induction of the primary notochord decays by 1 hour after cleavage from the 32- to 64-cell stage. This study analyzes the molecular mechanisms responsible for this loss of competence and provides evidence for a novel mechanism. A forkhead family transcription factor, FoxB, plays a role in competence decay by preventing the induction of notochord-specific Brachyury (Bra) gene expression by the FGF/MAPK signaling pathway. Unlike the mechanisms reported previously in other animals, no component in the FGF signal transduction cascade appeared to be lost or inactivated at the time of competence loss. Knockdown of FoxB functions allowed the isolated cells to retain their competence for a longer period, and to respond to FGF with expression of Bra beyond the stage at which competence was normally lost. FoxB acts as a transcription repressor by directly binding to the cis-regulatory element of the Bra gene. Our results suggest that FoxB prevents ectopic induction of the notochord fate within the cells that assume a default nerve cord fate, after the stage when notochord induction has been completed. The merit of this system is that embryos can use the same FGF signaling cascade again for another purpose in the same cell lineage at later stages by keeping the signaling cascade itself available. Temporally and spatially regulated FoxB expression in nerve cord cells was promoted by the ZicN transcription factor and absence of FGF/MAPK signaling.
The MADS box transcription factor MEF2C regulates melanocyte development and is a direct transcriptional target and partner of SOX10
Authors: Agarwal Pooja , Verzi Michael P. , Nguyen Thuyen , Hu Jianxin , Ehlers Melissa L. , McCulley David J. , Xu Shan-Mei , Dodou Evdokia , Anderson Joshua P. , Wei Maria L. , Black Brian L.
Published: May 2011

Waardenburg syndromes are characterized by pigmentation and autosensory hearing defects, and mutations in genes encoding transcription factors that control neural crest specification and differentiation are often associated with Waardenburg and related disorders. For example, mutations in SOX10 result in a severe form of Waardenburg syndrome, Type IV, also known as Waardenburg-Hirschsprung disease, characterized by pigmentation and other neural crest defects, including defective innervation of the gut. SOX10 controls neural crest development through interactions with other transcription factors. The MADS box transcription factor MEF2C is an important regulator of brain, skeleton, lymphocyte and cardiovascular development and is required in the neural crest for craniofacial development. Here, we establish a novel role for MEF2C in melanocyte development. Inactivation of Mef2c in the neural crest of mice results in reduced expression of melanocyte genes during development and a significant loss of pigmentation at birth due to defective differentiation and reduced abundance of melanocytes. We identify a transcriptional enhancer of Mef2c that directs expression to the neural crest and its derivatives, including melanocytes, in transgenic mouse embryos. This novel Mef2c neural crest enhancer contains three functional SOX binding sites and a single essential MEF2 site. We demonstrate that Mef2c is a direct transcriptional target of SOX10 and MEF2 via this evolutionarily conserved enhancer. Furthermore, we show that SOX10 and MEF2C physically interact and function cooperatively to activate the Mef2c gene in a feed-forward transcriptional circuit, suggesting that MEF2C might serve as a potentiator of the transcriptional pathways affected in Waardenburg syndromes.
LEUNIG and SEUSS co-repressors regulate miR172 expression in Arabidopsis flowers
Authors: Grigorova Boyana , Mara Chloe , Hollender Courtney , Sijacic Paja , Chen Xuemei , Liu Zhongchi
Published: May 2011

Central to the ABCE model of flower development is the antagonistic interaction between class A and class C genes. The molecular mechanisms underlying the A-C antagonism are not completely understood. In Arabidopsis thaliana, miR172 is expressed in the inner floral whorls where it downregulates the class A gene APETALA 2 (AP2). However, what controls this predominantly inner whorl-specific expression of miR172 is not known. We show that the LEUNIG (LUG) and SEUSS (SEU) co-repressors repress miR172 expression in the outer whorls of A. thaliana flowers. The recruitment of LUG/SEU to the miR172 promoters is dependent on AP2, suggesting that AP2 represses the expression of its cognate microRNA. Our study provides new insights into the molecular mechanisms underlying the A-C antagonism and shed light on the transcriptional regulation of miR172 during flower development.
Transient congenital hypothyroidism due to thyroid-stimulating hormone receptor blocking antibodies: a case series
Authors: Evans Carol , Gregory John W , Barton John , Bidder Christopher , Gibbs John , Pryce Rebekah , Al-Muzaffar Iyad , Ludgate Marian , Warner Justin , John Rhys , Moat Stuart J
Published: May 2011

We describe seven infants with transient congenital hypothyroidism (CH) due to maternal thyroid-stimulating hormone receptor (TSH-R) blocking antibodies (TRAb) identified over three decades of newborn screening for CH in Wales, UK that represents a minimum incidence of 1.6% of CH cases. Infants with transient CH due to maternal TRAb presented with a spectrum of clinical and biochemical hypothyroidism. Blood spot TSH concentrations ranged 60.5–332 mIU/L. CH was confirmed by plasma thyroid function tests in all cases (plasma TSH ranged 21–752 mIU/L). The seven infants belonged to five different families. On examination, four infants were clinically hypothyroid. Five infants had a thyroid ultrasound, of which three were abnormal. All infants were treated with thyroxine, which was subsequently withdrawn from three. Following thyroxine withdrawal, one infant resumed normal thyroid function and two developed compensated hypothyroidism. Of the five mothers, two had undiagnosed hypothyroidism and three were receiving thyroxine for longstanding hypothyroidism. Thyroid peroxidase antibody (aTPO) was measured in four and was negative in two, borderline positive in one and strongly positive in another. TRAb was measured in all five women and was strongly positive in all of them. This case series highlights the importance of identifying CH due to TRAb by investigating both the infant and the mother following a raised TSH found on newborn screening. The identification of those infants with transient CH caused by maternal transfer of TRAb is essential for optimizing management during childhood (including potential withdrawal of thyroxine replacement in the longer term) and in any subsequent pregnancy.
Temperature preconditioning is optimal at 26°C and confers additional protection to hypothermic cardioplegic ischemic arrest
Authors: Khaliulin Igor , Halestrap Andrew P , Suleiman M-Saadeh
Published: May 2011

We have recently shown that brief episodes of hypothermic perfusion interspersed with periods of normothermic perfusion, referred to as temperature preconditioning (TP), are cardioprotective and can be mimicked by consecutive isoproterenol/adenosine treatment. Here we investigate the optimal temperature for TP and whether TP further enhances protection provided by hypothermic ischemia with or without polarized cardioplegic arrest. Three experimental groups of Langendorff-perfused rat hearts were used. In the first group, hearts were subjected to three episodes of hypothermic perfusion at 7, 17, 26 and 32°C during the TP protocol, followed by 30 min normothermic index ischemia and 60 min reperfusion (37°C). Protein kinase A (PKA) activity and cyclic AMP (cAMP) concentrations were measured prior to index ischemia. In the second group, TP (26°C) hearts were subjected to two hours hypothermic index ischemia at 26°C and two hours normothermic reperfusion. In the third group, TP (26°C) hearts or hearts treated with isoproterenol/adenosine (pharmacological simulation of TP) were subjected to four hours hypothermic index ischemia with procaine-induced polarized cardioplegia at 26°C followed by two hours normothermic reperfusion. Hemodynamic function recovery, lactate dehydrogenase release and infarct size were used to assess cardioprotection. TP at 26°C resulted in highest cardioprotection, increased cAMP concentration and PKA activity, while TP at 7°C exacerbated ischemia/reperfusion damage, and had no effect on cAMP concentration or PKA activity. TP at 26°C also protected hearts during hypothermic ischemia with or without polarized cardioplegia. Isoproterenol/adenosine treatment conferred additional protection similar to TP. In conclusion, the study shows that TP-induced cardioprotection is temperature dependent and is optimal at 26°C; TP confers additional protection to hypothermia and polarized cardioplegia; and that the pharmacological treatment based on the mechanism of TP (consecutive isoproterenol/adenosine treatment) is a potential cardioprotective strategy that can be used during heart surgery and transplantation.
The Absence of Indigenous Histories in Ken Burns's The National Parks: America's Best Idea
Authors: Child Brenda J.
Published: May 2011

The National Parks begins in 1851 and ends with Alaska in the 1970s, yet almost entirely erases Indigenous history from the landscape, allowing Native Alaskans, Indigenous Hawaiians, and American Indians no foothold or voice in the modern story of the parks. This is remarkable, considering that all of the parks were established on Indigenous homelands and that Native people and politics continue to be intertwined with the recent history of the parks. The experiences of Ojibwe people in the Great Lakes suggest that the creation of national parks in their homeland was part of a broader colonial history of appropriating Indigenous lands and resources, and extended the damaging policies of the Indian assimilation and allotment era farther into the twentieth century.
More Evidence of Bias in the Differential Timeliness Measure of Conditional Conservatism
Authors: Patatoukas Panos N , Thomas Jacob K
Published: May 2011

Despite the conceptual appeal and popularity of the differential timeliness (DT) measure of conditional conservatism proposed in Basu (1997), Dietrich et al. (2007) and Givoly et al. (2007) have identified considerable biases associated with that measure. We renew their call to avoid using the DT measure because it is affected unexpectedly by two empirical regularities—namely, scale is negatively related to (1) deflated mean earnings and (2) variance of stock returns. Even though these regularities are unrelated to conditional conservatism, their joint effect is substantial and pervasive. More importantly, prior findings regarding time-series and cross-sectional variation in differential timeliness are confounded by corresponding variation in these regularities.

Data Availability: Data are publicly available from sources identified in the article.
Local Tissue Coverage for the Management of Exposed Endografts
Authors: Costanza Michael , Amankwah Kwame , Gahtan Vivian
Published: May 2011

This case report describes the use of local tissue coverage for the treatment of surgically exposed endografts. In two cases, an endograft used for the treatment of a pseuodaneurysm was visualized through the arterial defect during open surgical evacuation of an abscess in one case and a sterile hematoma in the second case. Obtaining arterial control to remove the endograft was prohibitive owing to the anatomic location and extensive scarring and inflammation. The endografts were preserved and hemostasis was maintained by using a vein patch in one case and a local muscle flap in both cases. Both cases have had satisfactory short-term follow-up (4–12 months). An exposed endograft represents a rare and challenging problem. Local tissue coverage offers a feasible strategy for maintaining hemostasis and avoiding a potentially morbid surgical dissection. Although the short-term results of this approach have been encouraging, the long-term consequences remain unknown.
Plasmin and Matrix Metalloproteinase System in Deep Venous Thrombosis Resolution
Authors: Henke Peter K.
Published: May 2011

Deep venous thrombosis (DVT) is a common event in hospitalized medical and surgical patients. Outside of anticoagulation, few good options exist for decreasing the vein wall damage that results after natural thrombolysis. DVT resolution is complex and involves chemokines, leukocytes, and native vein wall cells. Herein some aspects of DVT resolution related to the intersection of inflammation, the plasminogen and matrix metalloproteinase systems, and their respective inhibitors are reviewed. Ultimately, better knowledge of these natural thrombolytic systems may allow local, directed, and specific acceleration of DVT resolution and decreased vein wall damage.
Medical Therapy Approach for Treating Abdominal Aortic Aneurysm
Authors: Rentschler Mark E. , Baxter B.Timothy
Published: May 2011

Abdominal aortic aneurysm (AAA) is a common and deadly problem. The aortic diameter increases in association with a complex remodeling process that includes changes in the structure and content of key proteins, elastin and collagen. As these changes occur, the tissue mechanical properties also change. The natural history of AAA is progressive enlargement to a point of mechanical tissue failure, typically followed by death. Currently, the marker used to predict the risk of impending rupture is the largest transverse diameter. After reaching a diameter threshold of 5.5 cm, the aneurysm is surgically repaired. This criterion does not consider any patient-specific information or the known heterogeneity of the aneurysm that may, in some cases, lead to rupture before the aneurysm reaches the standard intervention threshold. Conversely, in many patients, continued observation beyond this threshold is safe. Although no medical treatment is yet approved, doxycycline has been shown to greatly reduce aortic aneurysm growth in animal models and has been shown to slow growth in several small clinical trials. Although larger prospective randomized trials are needed, one unknown is what effect doxycycline has on the structural integrity of the aortic wall. That is, does slowed aneurysm growth by doxycycline treatments, in fact, prevent rupture, or does the wall continue to weaken and the aneurysm instead ruptures at a smaller diameter? Research has begun to answer these questions before a large clinical trial begins.
Endovascular Management of a Significantly Kinked Aortomonoiliac Stent Graft
Authors: Bartoli Michel A. , Millon Antoine , Magnan Pierre Edouard , Branchereau Alain
Published: May 2011

We report our endovascular management of a highly kinked aortomonoiliac stent graft. This complication is unusual because kinks generally occur in bifurcated stent grafts and they are managed with extra-anatomic bypass. We will then expose the possible reasons for such complication. With long term follow-up severe kink might be reported more often.
Internal Jugular, Subclavian, and Axillary Deep Venous Thrombosis and the Risk of Pulmonary Embolism
Authors: Major Kevin M. , Bulic Sebina , Rowe Vincent L. , Patel Kevin , Weaver Fred A.
Published: May 2011

The objective of this study was to investigate the risk of acute internal jugular, subclavian, and axillary deep venous thrombosis (upper torso DVT [UTDVT]) and pulmonary embolism (PE) and the role of anticoagulation in a cohort of hospitalized patients.

A 2-year retrospective review of hospitalized patients who underwent upper torso vein duplex scanning was performed. Patient demographics, underlying comorbidities, indication for scanning, diagnostic tests, intensive care unit stay, length of stay, presence of a central line (current or within the last 2 weeks), malignancy (current or former), hypercoaguable condition, postoperative state, renal failure, mortality, and use of anticoagulation were recorded. Univariate and multivariate analyses were performed to investigate significant risk factors for acute UTDVT. The impact of an acute UTDVT and use of anticoagulation on hospital length of stay, survival to 30 days and 1 year, and PE rate were calculated.

One hundred eighty-nine patients were scanned. Sixty-three patients (33%) were found to have an acute UTDVT. The internal jugular vein was the most common site of thrombosis. The presence of a central venous catheter was the only factor found to be a significant risk factor for an acute UTDVT ( p = .03). Five patients (7.9%) with an UTDVT had a PE documented by computed tomographic angiography-pulmonary arteriography, and all had an internal jugular thrombosis (four isolated and one combined with an axillary-subclavian thrombosis). No PE was fatal. Thirty-eight (60%) patients with an acute UTDVT were treated with therapeutic anticoagulation; the remainder were observed. All patients with a PE received anticoagulation. Hospital length of stay, 30-day mortality, and 12-month survival were no different for patients with and without an UTDVT ( p = .7). The use of anticoagulation had no observable effect on survival in patients with UTDVT ( p = .1).

An acute internal jugular, subclavian, or axillary DVT is a relatively common finding in the hospitalized patient. Patients with a central line (current or within the previous 14 days) were at greatest risk, with an internal jugular vein thrombosis being the most common source. The inconsistent use of anticoagulation therapy for UTDVT was associated with a moderate risk of PE. A survival benefit for anticoagulation could not be documented.
Perioperative Microemboli and Platelet Aggregation in Patients Undergoing Carotid Endarterectomy
Authors: Vogten J. Mathys , Gerritsen Wim B.M. , Ackerstaff Rob G.A. , van Dongen Eric P. , de Vries Jean-Paul P.M.
Published: May 2011

In carotid endarterectomy (CEA) patients, platelet aggregation is increased despite heparinization. We investigated whether this phenomenon correlates with the occurrence of perioperative microemboli. Of 27 CEA patients, 18 (67%) used aspirin and 9 also used clopidogrel. Blood was collected at multiple time points before, during, and after CEA. Platelet aggregation and P-selectin expression were determined. Transcranial Doppler monitoring was used to measure microemboli. Platelet aggregation showed a significant increase 5 minutes postheparinization compared with preheparinization (19.7 ± 2.8% vs 8.9 ± 0.9% in the aspirin group and 22.5 ± 4.4% vs 8.7 ± 1.2% in the clopidogrel group; p < .01 and p < .05, respectively). P-selectin expression showed a tendency to increase postheparinization in both groups ( p = .07 and p = .09, respectively). The number of microemboli ranged from 0 to 50. Clopidogrel patients displayed fewer microemboli than aspirin patients (4.1 ± 2.3 vs 17.6 ± 18.2; p < .01). Patients with a high number of microemboli displayed had a tendency toward higher baseline platelet aggregation than patients with a low number of microemboli ( p = .08). In conclusion, platelet aggregation is transiently increased during CEA despite the administration of antiplatelet agents. Clopidogrel is associated with a decreased number of perioperative microemboli. The exact relationships between these findings, postoperative microemboli formation, and the risk for thromboembolic complications after CEA remain to be determined.
Mechanical and Enzymatic Thrombolysis of Acute Pulmonary Embolus: Review of the Literature and Cases from Our Institution
Authors: Rosenblum Jessica K. , Cynamon Jacob
Published: May 2011

Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. Patients with massive PE have a high mortality rate, with two of every three deaths occurring in the first hour. The mainstay of treatment for PE is anticoagulation. However, when the patient is in extremis, intravenous lysis of the clot is indicated. Recently, mechanical fragmentation with or without pharmacologic thrombolysis has been shown to have a role in therapy for patients with massive PE, as well as in those patients who have a contraindication to anticoagulation. We discuss our experience with mechanical fragmentation in the treatment of PE and review the literature.
Remodeling of the Aortic Neck with a Balloon-Expandable Stent Graft in Patients with Complicated Neck Morphology
Authors: Kolvenbach Ralf , Pinter Laslo , Cagiannos Catherine , Veith Frank J.
Published: May 2011

Graft migration and other device-related problems are more frequent in abdominal aortic aneurysm (AAA) patients with a complicated neck. We wanted to evaluate the performance of a balloon-expandable stent graft in these cases. Complicated aortic neck morphology was defined as a combination of short (< 15 mm) and angulated (> 45°) necks with or without circumferential thrombus. Severe aortic angulation was defined as less than 120°. During a 24-month period, 18 consecutive patients with complicated neck anatomy were treated with the Vascular Innovations (VI)-Datascope balloon-expandable endograft. In two patients, a balloon-expandable cuff was implanted to remodel the neck prior to insertion of a bifurcated endograft (Excluder, W.L. Gore & Associates, Flagstaff, AZ). Demographic, procedural, and outcome data were collected prospectively and retrospectively analyzed. All patients had preoperative computed tomographic (CT) angiography to determine aortic neck angulation and were followed with duplex ultrasonography and CT every 3 and 6 months postoperatively to assess aortic neck and sac dilatation, as well as device migration. The VI-Datascope graft consists of an aortounifemoral polytetrafluoroethylene (PTFE) graft sutured to a proximal balloon-expandable stent. The length of the graft is 40 cm; thus, the distal end of the graft always protrudes through the ipsilateral arteriotomy and can be cut to an appropriate length for each patient. The covered portion of the graft was deployed just below the level of the lowest renal artery. The proximal bare metal stent was deployed in the suprarenal area. An endoluminal hand-sewn anastomosis was performed between the aortounifemoral limb and the distal external iliac or the common femoral arteries. An occluder device was placed in the contralateral common iliac artery to prevent retrograde perfusion of the aneurysm. A femorofemoral 8 mm Dacron graft bypass was then performed to establish flow to the contralateral extremity and pelvis. Using this approach, remodeling and straightening of angulated aortic neck morphology were achieved in all cases, including in 44% of patients with severe aortic neck angulation. The average follow-up period was 11.5 months (4–21 months). There was one early occlusion (< 30 days after implantation) of the PTFE limb requiring thrombectomy and one late occlusion (6 months after implantation) requiring thrombectomy and implantation of a Viabahn stent graft (W.L. Gore & Associates). Scheduled CT scans did not show any graft migration or proximal neck dilatation. Neither neck dilatation nor endograft migration was observed with the balloon-expandable stent graft. In patients with complicated aortic neck morphology, balloon-expandable stent grafts such as the VI-Datascope graft provide more secure fixation and better long-term outcomes compared with the more commonly used self-expanding endografts.
Systemic Administration of Heparin Intraoperatively in Patients Undergoing Open Repair of Leaking Abdominal Aortic Aneurysm May Be Beneficial and Does Not Cause Problems
Authors: Chinien Ganessen , Waltham Matthew , Abisi Said , Smith Alberto , Taylor Peter , Burnand Kevin G.
Published: May 2011

The aim of this study was to investigate whether intravenous heparin administration was associated with a reduction in perioperative mortality and late distal thrombectomy in patients with ruptured abdominal aortic aneuryms (AAAs). One hundred thirty-one patients had repair of ruptured AAA between January 1999 and January 2004. Sixty-three received heparin according to the consultant's preference at the time of the operation. Data were prospectively collected, and multivariate analysis was performed for independent predictive factors. Thirty-day mortality was 29%. Patients receiving heparin had lower perioperative mortality (16% vs 42%; p = .001). Heparin administration was not associated with increased hemorrhage or transfusion. Multivariate analysis confirmed that heparin administration was independently predictive of survival ( p = .036). Other factors found to reduce survival were age ( p = .023), smoking ( p = .042), and systolic blood pressure (< 100 mmHg) at presentation ( p = .045). Fewer patients had thrombectomy after heparin (8% vs 12%), but this was not statistically significant. Perioperative complications were similar in both groups. The administration of systemic heparin before the clamp is applied to leaking aneurysms does not appear to increase hemorrhage and subsequent mortality and may reduce the need for early thrombectomy.
Advantages and Pitfalls of Abdominal Aortic Aneurysm Screening in High-Risk Patients
Authors: Badger Stephen A. , O'Donnell Mark E. , Sharif Muhammad A. , Boyd Christopher S. , Soong Chee V.
Published: May 2011

Screening for abdominal aortic aneurysm (AAA) has been suggested for older men. Our aim was to determine the effect of participant selection on prevalence and treatment suitability. Men aged 65 to 75 years attending cardiology clinics composed the high-risk group; the control group was from the community. AAA screening was performed, with follow-up or surgery arranged. Four hundred eight of 651 (62.7%) high-risk men and 109 of 908 (45.0%; p < .0001) men attended from the community. In the high-risk patients, 40 AAAs were diagnosed, with a mean diameter of 41.4 mm (± 10.4 mm). In the control group, 22 new AAAs were found, with an average size of 40.9 mm (± 10.4 mm). Higher polypharmacy existed in the high-risk group (4.6 ± 2.2 vs 2.3 ± 2.0; p < .0001). More aneurysm patients were on dual-antiplatelet therapy (32.5% vs 15.4%; p = .048) compared with the overall high-risk group. In this group, three underwent surgery; one was anatomically unsuitable for endovascular repair and medically unfit for open repair. Two in the control group had surgery. A higher prevalence of AAA is encountered in high-risk men. Most aneurysms are small; however, a significant proportion of the aneurysms detected were of a size that would warrant repair. The decision to perform surgical repair is likely to be influenced by the comorbid medical conditions, which placed the patients in the high-risk category.
Assessment of a Multifactorial Risk Index for Predicting Postoperative Pneumonia after Open Abdominal Aortic Aneurysm Repair
Authors: Markar Sheraz R. , Walsh Stewart R. , Griffin Kathryn , Khandanpour Nader , Tang Tjun Y. , Boyle Jonathan R.
Published: May 2011

Pneumonia is a common postoperative complication, with a mortality of up to 40%. The Post-operative Pneumonia Risk Index (PPRI) was derived from a large cohort of general surgical patients but has not been validated in patients undergoing open abdominal aortic aneurysm (AAA) repair. The PPRI was applied to patients undergoing elective open AAA repair in a tertiary referral vascular unit. Pneumonia occurred in 20% of patients. Receiver operating characteristic curve analysis identified 36 as the optimum PPRI cutoff value. At this cutoff, the likelihood ratio for pneumonia was 1.35 (95% confidence interval 1.08–1.62). However, in a multivariate analysis, only weight loss in excess of 10% over the preceding 6 months was an independent predictor of postoperative pneumonia. Although the PPRI is of some value in identifying high-risk patients undergoing AAA repair, weight loss alone may be predictive, allowing targeted preventive measures in aneurysm patients at increased risk.
Combined Supra-aortic Extra-anatomic Revascularization and Endovascular Hybrid Procedure for Recurrent Hemoptysis Caused by a Symptomatic Aneurysm of the Right Subclavian Artery
Authors: Kopp Reinhard , Meimarakis Georgios , Strauss Tim , Hatz Rudolph , Walter Jauch Karl , Waggershauser Tobias
Published: May 2011

Acute hemoptysis might be caused by aneurysms of the subclavian artery. We report a 75-year-old female patient presenting with recurrent hemoptysis, dyspnea, fever, and episodes of unclear pneumonia. Further examination revealed a large intrathoracic aneurysm of the right subclavian artery. After an initial transfemoral interventional attempt to occlude the entry of the aneurysm, the patient developed persistent thoracic pain. The patient was then treated by a combined extrathoracic hybrid procedure with a left to right carotid-carotid-axillary artery bypass and an endovascular aneurysm exclusion by insertion of two iliac artery occluder stent grafts in the proximal brachiocephalic trunk and the distal right subclavian artery. After this combined intervention, hemoptysis disappeared, and the patient recovered remarkably during a follow-up of 24 months.
Mycotic Pseudoaneurysm of the Superficial Femoral Artery in a Patient with Cushing Disease: Case Report and Literature Review
Authors: Bowden David J. , Hayes Paul D. , Sadat Umar , Choon See Teik
Published: May 2011

Mycotic pseudoaneurysms of the peripheral arteries are rare and can occur as an extension of localized infection or from systemic sepsis. In some cases, no obvious source of infection may be identified. Both endovascular and open surgical management options are available for this important condition. We report a mycotic pseudoaneurysm of the superficial femoral artery in a patient associated with systemic immunosuppression secondary to Cushing disease that was successfully managed with open surgical repair and autologous bypass grafting. This unusual case highlights the potential for serious adverse cardiovascular sequelae of Cushing disease and the need for awareness of such complications in this patient group.
Bilateral Internal Iliac Artery Aneurysm Infected with Campylobacter fetus
Authors: Shiferson Alexander , Ascher Enrico , Hingorani Anil , Puggioni Alessandra , Marks Natalie , Tran Victor , Patel Nirav , Jacob Theresa
Published: May 2011

This is a case report of a patient with Campylobacter fetus involving bilateral internal iliac artery aneurysms. The patient was treated successfully by ligation of the bilateral iliac artery aneurysms and antibiotics. According to a review of the English-language medical literature, this was the first such patient to be reported. A 69-year-old African-American male presented with a past medical history of repair of a 6.6 cm abdominal aortic aneurysm. It had been repaired with a Dacron bifurcated graft in July 2005. The bilateral internal iliac artery aneurysms (right 2.3 cm and left 3.4 cm) were coil embolized intraoperatively. The patient's past medical history was significant for hypertension and coronary artery disease and was status post–stent placement. He re-presented with fever and chills for 8 days in duration at home in March 2007. His fever was 101 to 102°F. He denied vomiting, diarrhea, and a history of recent travel. The patient was admitted to the hospital for a fever workup. After an extensive workup, a left internal iliac artery aneurysm was found to be the source of sepsis. The patient was taken to the operating room for excision of the left internal iliac artery. No purulence was noted, but tissue overlying the aneurysm was thickened and fibrotic. Multiple cultures were taken. The tissue culture came back as C. fetus. Incidentally, the patient's preoperative computed tomographic scan revealed a right internal iliac artery aneurysm that was 4.2 cm on March 28, 2007, and 4.9 cm on April 23, 2007. Postoperatively, the patient's right internal iliac artery aneurysm was noted to be rapidly growing. He was promptly taken to the operating room for ligation of the right internal iliac artery aneurysm. The patient's postoperative course was unremarkable. He was discharged on ciprofloxacin for 14 days.
Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Aneurysm Repair Using the Modified Elephant Trunk Technique
Authors: Estrera Anthony L. , Shah Pallav , Lee Taek-Yeon , Irani Adel D. , Safi Hazim J.
Published: May 2011

We present a case of retrograde type A aortic dissection after thoracic endovascular stenting for acute type B aortic dissection. We describe the specifics of our surgical technique and provide a brief review of the literature.
Popliteal Artery Aneurysm Repair as an Outpatient
Authors: Mukherjee Dipankar , Tallant Tony
Published: May 2011

With the advent of endovascular repair of aneurysmal disease, length of hospital stay is becoming shorter. Inherent morbidity and problems associated with open repair have been minimized, leading to an improved patient experience. We describe a fairly typical patient with a popliteal artery aneurysm who would be expected to have a protracted recovery from open resection but instead underwent endovascular repair as an outpatient.
Effect of Systemic Blood Pressure on Aneurysm Size in the Presence of a Type II Endoleak
Authors: Hiramoto Jade S. , Howell Benjamin , Reilly Linda M. , Chuter Timothy A.M.
Published: May 2011

The objective of this study was to determine whether hypertension is a risk factor for aneurysm enlargement in patients with an untreated type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR). Between January 2000 and December 2005, 296 patients underwent elective EVAR using a bifurcated Zenith stent graft. Forty-nine (17%) patients had a type II endoleak triaged to observation. Patient clinical data and data on endoleak status, aneurysm size, and endoleak intervention were collected prospectively. Aneurysm size remained the same or decreased in 39 of 49 (80%) patients. In the remaining 10 (20%) patients with aneurysm enlargement, 7 required intervention. There was no difference in initial aneurysm size, patient age, gender, or comorbidities between patients with enlarging aneurysms and those with stable or regressing aneurysms. However, patients with enlarging aneurysms had a mean systolic blood pressure (SBP) of 144 ± 14 mm Hg compared with 136 ± 13 mm Hg for patients with stable or regressing aneurysms ( p = .08). Multivariate regression analysis demonstrated increased SBP to be an independent predictor of aneurysm enlargement ( p = .05). Patients with systolic hypertension and an untreated type II endoleak are more likely to demonstrate aneurysm enlargement after EVAR. Aggressive blood pressure control may be an important adjunct in the management of patients with type II endoleak after EVAR.
Gender Differences in Abdominal Aortic Aneurysms
Authors: Hannawa Kevin K. , Eliason Jonathan L. , Upchurch Gilbert R.
Published: May 2011

Abdominal aortic aneurysms (AAAs) comprise the tenth leading cause of death in Caucasian males 65 to 74 years of age and accounted for nearly 16,000 deaths overall in 2000. Therefore, understanding the pathophysiology of AAAs is an important undertaking. Clinically, multiple risk factors are associated with the development of AAAs, including increasing age, positive smoking history, and hypertension. Male gender is also a well-established risk factor for the development of an AAA, with a 4:1 male to female ratio. The reason for this gender disparity is unknown. The pathogenesis of AAAs formation is complex and multifactorial. Histologically, AAAs are characterized by early chemokine-driven leukocyte infiltration into the aortic wall. Subsequent destruction of elastin and collagen in the media and adventitia ensues owing to excessive local production of matrix-degrading enzymes and is accompanied by smooth muscle cell loss and thinning of the aortic wall. At present, no medical therapies are available to treat patients with aortic aneurysms, using only the crude measurement of aortic diameter as a threshold for which patients must undergo life-threatening and costly surgery. Defining the early mechanisms underlying gender-related differences in AAA formation is critical as understanding differences in disease patterns based on gender may allow us to develop new translational approaches to the prevention and treatment of patients with aortic aneurysms.
Can Laboratory Tests Predict the Prognosis of Patients after Endovascular Aneurysm Repair? Current Status and Future Directions
Authors: Huddle Matthew G. , Schlösser Felix J.V. , Dewan Michael C. , Indes Jeffrey , Muhs Bart E.
Published: May 2011

The purpose of this study was to determine what laboratory values predict the prognosis of patients after endovascular aneurysm repair (EVAR). MEDLINE and Cochrane Library databases were searched. This resulted in 13 relevant articles. Data were pooled, and meta-analyses were performed. A meta-analysis including 5,655 patients showed that preoperative serum creatinine > 1.5 mg/dL was a significant risk indicator for increased 30-day mortality (relative risk 3.0, 95% confidence interval 2.3–4.1, p < .0001). Four other studies showed that other cutoff values of creatinine or glomerular filtration rate can predict mortality and complications following EVAR. One study suggested that reduced preoperative hemoglobin is a risk indicator for reduced long-term survival. Increased serum creatinine, reduced glomerular filtration rate, and reduced hemoglobin are significant and strong predictors of mortality and complications after EVAR. Current evidence remains limited, and further research is needed to determine conclusively additional laboratory values that may predict the outcome of patients following EVAR.
Symptomatic Thoracic Aorta Mural Thrombus
Authors: Roche-Nagle Graham , Wooster Douglas , Oreopoulos George
Published: May 2011

Cases of mural aortic arch thromboses are generally associated with diffuse atherosclerosis of the aortic arch and have primarily been detected in elderly patients. However, the presence of mural thrombi in the aortic arch in young patients without diffuse atherosclerosis has rarely been reported. We describe a case of a hypercoagulable young patient with arterial embolism in whom investigations revealed a mural pedunculated aortic arch thrombosis without clear diffuse atherosclerotic lesions.
Acutely Bleeding Aortoduodenal Fistula: Staged Endovascular and Open Surgical Repair
Authors: Antoniadis Pavlos , Geropapas George , Kounougeri Ekaterini , Staramos Dimitrios , Kalamaras Alexios , Dervisis Konstantinos
Published: May 2011

Secondary aortoduodenal fistula is an uncommon but potentially fatal complication that can occur after aortic reconstruction surgery and usually presents with upper gastrointestinal hemorrhage. Taking into account the accompanying multiple comorbidities of those patients, conventional open surgical repair carries with it significant mortality and morbidity rates. The purpose of this case report is to describe the successful combined endovascular and open surgical repair of an acutely ruptured aortoduodenal fistula in a 67-year-old male patient. Four months after the procedure, the patient remains well.
Experimental Measurement and Mathematical Modeling of Pulsatile Forces on a Symmetric, Bifurcated Endoluminal Stent Graft Model
Authors: Liffman Kurt , Šutalo Ilija D. , Bui Anh , Lawrence-Brown Michael M.D. , Semmens James B.
Published: May 2011

The objective of this study was to measure the pulsatile forces acting on a symmetric, bifurcated endoluminal stent graft to validate a computational fluid dynamics (CFD) and analytic model so that they can be used for various graft dimensions. We used a load cell to measure the force owing to the movement of an acrylic model of a bifurcated stent graft under pulsatile flow. This was then simulated with a CFD and analytic model. The main features of the experimental pulsatile force data and the CFD results were consistent. The results showed that the total force was proportional to the inlet pressure cycle. The force rose from 3.32 N at 130 mm Hg systolic to 17.5 N at 250 mm Hg systolic pressure. For the more variable regions of the flow, the experimentally measured forces lagged the computational and analytic results. The CFD and analytic models provide approximate descriptions for the forces acting on a bifurcated stent graft subjected to pulsatile flow. Such models should be of assistance to designers of endoluminal stent grafts.
Duplex Scanning–Derived Access Volume Flow: Novel Predictor of Success Following Endovascular Repair of Failing or Nonmaturing Arteriovenous Fistulae for Hemodialysis
Authors: Ascher Enrico , Hingorani Anil , Marks Natalie
Published: May 2011

The objective of this study was to evaluate the feasibility of duplex scanning–derived access volume flow (DAVQ) to predict the success or failure of arteriovenous fistulae (AVF) after interventions. Eighty-eight DAVQ measurements were available for 60 AVF in 59 patients. In 25 cases, physical examination findings or inadequate dialysis suggested failing (11) or nonmaturing (14) AVF. Outflow stenoses (1–4; mean 1.2 ± 0.8) were confirmed by contrast fistulograms in 23 cases (17 peripheral; 6 central). These 23 cases underwent successful endovascular repair (17 balloon angioplasty; 6 stents) and had pre- and postintervention DAVQ measurements within 2 weeks of the procedure. Each was measured three times in a nontortuous venous segment with laminar flow, and mean values were used for comparison. The overall mean DAVQ for 65 functioning AVF was 1,199 ± 485 mL/min, whereas it was 652 ± 438 mL/min (range 150–1,840 mL/min) for the remaining 23 failing or nonmaturing cases ( p < .0001). Postintervention, the latter values changed to 867 ± 517 mL/min (range 257–2,020 mL/min), with a p < .13. Of these, 11 were still nonfunctional after endovascular procedures and had a mean DAVQ of 404 ± 111 mL/min (range 257–652 mL/min). The remaining 12 cases had a mean DAVQ of 1,280 ± 382 mL/min (range 762–2,020 mL/min) and were functional and usable for at least 6 months of follow-up ( p < .0001). It is interesting to note that none of the AVF cases with postintervention DAVQ < 700 mL/min became functional and usable, whereas all cases with a higher DAVQ underwent successful hemodialysis treatments. This early experience suggests that DAVQ can be used to predict the success or failure of an AVF following endovascular procedures. To our knowledge, this is the first such report.
Endovascular Treatment for Peripheral Pulmonary Artery Aneurysm
Authors: Parakh Rajiv , Gupta Kapil , Yadav Ajay , Grover Tarun , Satwik Ambarish , Agarwal Sandeep
Published: May 2011

A 42-year-old male presented with recurrent hemoptysis owing to a leaking peripheral pulmonary artery aneurysm. He was treated with selective coil embolization of the right posterior basal segmental artery to achieve hemostasis. This case is reported for its unsuspected presentation and rarity and to highlight the use of catheter coil embolization to achieve endovascular exclusion of the aneurysm from pulmonary circulation.