bluuebunny/crossref_metadata_2025 huggingface dataset:
The Horsley–Clarke stereotaxic apparatus
Authors: Schurr Peter H , Merrington W R
Published: March 2007

Robert Henry Clarke was responsible for the application of mathematical principles to neurophysiology and the invention and construction of an apparatus which would allow Sir Victor Horsley to make electrolytic lesions in the roof nuclei of the cerebellum. In order to be able to make lesions at any other desired point of the brain of a cat or monkey, Clarke and Horsley constructed an atlas based on photographs of sections to be used in conjunction with the instrument. The original apparatus was made in 1905 and papers on its use and on the atlas were published in 1908, 1911 and 1914. This advance was the basis of modern stereotaxic surgery and of a very large part of the work on neurophysiology that is carried out today.

Clarke gave his original apparatus to F. J. F. Barrington, genitourinary surgeon at University College Hospital and neurophysiologist. It was lent to various other workers in Oxford and elsewhere and was last used by Barrington in 1953 or 1954. It then disappeared following his sudden death in 1956. Various other pieces of apparatus were built, some of which are of historical importance in their own right, and these are referred to in the paper.

Some parts of Clarke's apparatus, including a special grid for trnsferring measurements from the atlas to the instrument and a spinal stereotaxic instrument, were found and described by E. R. Hitchcock in 1960. One of us (W. R. M.) succeeded in locating the original apparatus in 1970. It is now in the museum of University College Hospital, London.
Spontaneous rupture of the oesophagus and massive pneumoperitoneum
Authors: Thornley Peter E , Wallwork John
Published: March 2007

A case of spontaneous rupture of the abdominal oesophagus is described. The presentation, after an interval of 4 weeks from the onset of symptoms, was unusual, with massive pneumoperitoneum without peritonitis.
Colour lymphography in clinical surgery
Authors: Leaper D J , Evans Mary , Pollock A V
Published: March 2007

In 38 patients undergoing femoral artery profundaplasty and in 18 having simple mastectomy with pectoral node biopsy, a 6.2 per cent solution of sodium sulphan blue was injected peripherally to outline the lymph nodes in the groin or axilla. Nodes and vessels were easily seen and the technique is now in routine use.
Conservative surgery in reflux stricture of the oesophagus associated with hiatal hernia
Authors: Moghissi K
Published: March 2007

During a 7-year period, 130 patients with oesophageal stricture resulting from long-standing reflux oesophagitis and hiatal hernia were referred for surgery. Eighty-seven of these patients underwent conservative surgery consisting of intraoperative transgastric retrograde dilatation combined with one of two types of anti-reflux operation: in 34 patients (group 1) an Allison-type operation for hiatal hernia was undertaken, and in the remaining 53 patients (group 2), a Nissen-type fundoplication was carried out. In 22 patients in this latter group the oesophagogastric junction could not be brought down into the abdomen in spite of extensive oesophageal mobilization and the fundoplication was finally placed above the diaphragm.

From the successful results in both groups (particularly in group 2), it is concluded that conservative surgery should be considered in cases of hiatal hernia with a reflux stricture that yields to intraoperative dilatation.
Bilio-pancreatic bypass for obesity: II. Initial experience in man
Authors: Scopinaro Nicola , Gianetta Ezio , Civalleri Dario , Bonalumi Umberto , Bachi Virgilio
Published: March 2007

After a successful trial of bilio-pancreatic bypass in dogs, a clinical study has been completed in 18 patients followed for more than 1 year. The operation has been modified to achieve the best weight reduction, and forming the bilio-pancreatic tract of equal length to the alimentary tract with a short common ileal tract, the average weight loss as a percentage of the preoperative body weight was 24·1 ± 5·4 per cent (mean ± s.d.) at 6 months and 33·7 ± 4·1 per cent at 12 months. The only immediate complication was a wound dehiscence, and there were no late complications. Liver function studies showed the absence of hepatic deterioration and liver biopsies showed improvement of liver morphology 1 year after the operation. It is suggested that this procedure may be an alternative to jejuno-ileal bypass in the management of obesity.
The distribution, size and density of the apocrine glands in hidradenitis suppuritiva
Authors: Morgan W P , Hughes L E
Published: March 2007

The distribution, size and density of the apocrine glands in hidradenitis suppuritiva as compared with those in axillary hyperhidrosis and normal controls have been studied. There are no significant differences in the size or density of the apocrine glands in hidradenitis suppuritiva as compared with normal controls. The apocrine glands in axillary hyperhidrosis are significantly larger than those in axillary hidradenitis and in normal controls.

A simple method that can be used to demonstrate the distribution of the apocrine glands preoperatively is described. This has proved useful in delineating the area which it is necessary to excise to obtain complete apocrine gland excision in the diseased area. The apocrine gland-containing skin in the diseased region does not always correspond exactly to the hair-bearing area in that region.
Prophylactic metronidazole in appendicectomy: A controlled trial
Authors: Bates T , Touquet V L R , Tutton M K , Mahmoud S E , Reuther J W A
Published: March 2007

Prophylactic metronidazole was compared with no treatment in a randomly allocated study of patients undergoing appendicectomy. A 1-g suppository of metronidazole was given with the premedication and 200 mg t.d.s. orally for 7 days thereafter.

There were 4 hospital wound infections in the 87 patients receiving metronidazole and 11 out of 83 in the no-treament group (P < 0·05). However, 60 per cent of wound infections occurred at home and the overall infection rates were not significantly different.

The duration of postoperative hospital stay was longer in the control group (5·8 days ± 3·0 s.d.) than in the treated group (4·8·2·3; P < 0·01).

Only one anaerobic infection occurred in a patient receiving metronidazole but late infection was not prevented. Blood levels of metronidazole taken at the end of operation showed a wide variation but there was no correlation with subsequent infection. Culture of the appendix showed aerobic organisms in 88 per cent of cases and anaerobes in 72 per cent.

It is suggested that an antibiotic which is effective against both aerobic and anaerobic organisms might have an advantage over metronidazole in appendicitis.
The prognosis of ileorectal anastomosis in Crohn's disease
Authors: Buchmann Peter , Weterman Irene T , Keighley Michael R B , Peña Salvador A , Allan Robert N , Alexander-Williams John
Published: March 2007

A total of 105 patients have been treated with colectomy and ileorectal anastomosis from 1958 to 1978 in Birmingham, England (48) and in Leiden, Netherlands (57). At the end of 1978 the mean follow-up was 7.6 years (6 months–20 years).

Mild or moderate degrees of proctitis were not considered as contraindications for ileorectal anastomosis. The presence or absence of ileal disease or perianal disease at the time of ileorectal anastomosis did not affect the long term prognosis but patients with sigmoidoscopic proctitis appeared to fare less well (69 per cent still functioning) than those with an apparently normal rectum (87 per cent). However, no statistical significance was obtained.

The risk of reoperation for recurrence of Crohn's disease after ileorectal anastomosis calculated by actuarial methods shows a 50 per cent cumulative reoperation rate after 16–20 years. This result suggests that ileorectal anastomosis is a safe and useful procedure for most patients with Crohn's colitis who do not have severe proctitis.
Dissolution of common bile duct stones
Authors: Motson Roger W
Published: March 2007

Retained common duct stones can now be treated by a number of non-operative techniques, including dissolution by cholesterol solvents, simple irrigation, stone extraction via the T tube tract and by endoscopic sphincterotomy. This paper reviews the various solvents available for stone dissolution and its physicochemical basis.

When a retained stone is found simple irrigation with saline will be successful in about 50 per cent of patients. If this fails, stone extraction via the T tube tract or by endoscopic sphincterotomy are now the methods of choice, with a 90–95 per cent chance of success. Stone dissolution by cholic acid is slow and is only successful in about 60 per cent of patients but can be of value when stone extraction is unavailable or unsuccessful.
The effect of surgical drainage materials on colonic healing
Authors: Smith S R G , Connolly J C , Crane P W , Gilmore O J A
Published: March 2007

The effect of surgical drainage materials on rat colonic healing has been investigated in a prospective randomized and controlled study. Latex, silicone rubber (Silastic), polyvinylchloride (PVC) and polytetrafluoroethylene (Teflon) tubes were implanted alongside a colonic anastomosis and compared with a ‘no drain’ group using mechanical and histological assessments. There was a significant increase in anastomotic leakage in the latex group in which there appears to be a local inhibition of healing. Silastic, PVC and Teflon were not found to interfere with healing. The continued use of latex drains in colonic surgery is therefore questioned.
The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?
Authors: Heald R J , Husband E M , Ryall R D H
Published: March 2007

Five cases are described where minute foci of adenocarcinoma have been demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer. In 2 of these there was no other evidence of lymphatic spread of the tumour. In orthodox anterior resection much of this tissue remains in the pelvis, and it is suggested that these foci might lead to suture-line or pelvic recurrence. Total excision of the mesorectum has, therefore, been carried out as a part of over 100 consecutive anterior resections. Fifty of these, which were classified as ‘curative’ or ‘conceivably curative’ operations, have now been followed for over 2 years with no pelvic or staple-line recurrence.
The effect of local cooling on digital systolic pressure in patients with Raynaud's syndrome
Authors: Hoare M , Miles C , Girvan R , Ramsden J , Needham T , Pardy B , Nicolaides A
Published: March 2007

The effect of local controlled cooling on the digital systolic blood pressure in the hand was studied in 25 healthy volunteers and 25 patients with Raynaud's syndrome.

Arterial systolic pressure was indirectly measured using a digital cuff over the proximal phalanx and a photoplethysmographic probe over the digital pulp to detect pulsation. Pressures were measured after occlusion of the circulation (cuff at 180 mmHg) for 5 minutes with water circulating initially at 30°C and then at 10°C. An airfilled cuff was used simultaneously on a control finger. The digital systolic pressure at 10°C in the patients was significantly lower (P < 0·001 Mann–Whitney U test) than in the normal volunteers whilst calculation of the percentage change in pressure induced by cooling the digit to 10°C allowed complete separation between both groups. The range in the controls was +2 per cent to −26 per cent and in the patients, −33 per cent to −100 per cent. The test gives reproducible results (coefficient of variation 5–11 per cent) and offers an objective method of identifying patients with excessive vasospasm due to a cold stimulus. It may prove useful in studying natural history and the effect of drug therapy.
Lower-limb revascularization and major amputation rates in England
Authors: McCaslin J E , Hafez H M , Stansby G
Published: March 2007

Background

The aim was to establish national data for lower-limb revascularization and major amputation procedures performed in England.

Methods

Data for lower-limb revascularization procedures and major amputations were collected from the Hospital Episode Statistics (finished consultant episodes) which is published yearly by the Department of Health. Transluminal procedures were analysed from 1998 onwards. Age adjustment was performed according to figures for the resident population of England in the interval studied.

Results

In all age groups, revascularization rates initially increased to a peak in the mid-1990s. This was followed by a steady decline in procedures to the present day. However, amputations gradually increased in the 45–64-years age group and showed only a slight decline in the 65–74-years age group. Among patients aged over 75 years there was a marked decline from the mid-1990s to present-day. Data for diabetics showed similar trends.

Conclusion

The national rate of amputation initially rose despite an increasing number of vascular interventions. It is significant, however, that among patients aged over 75 years this has been followed by a decrease in both revascularization procedures and amputation rates to present levels, the lowest for 14 years.
B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery
Authors: Gibson S C , Payne C J , Byrne D S , Berry C , Dargie H J , Kingsmore D B
Published: March 2007

Background

The objective of this study was to determine whether measurement of B-type natriuretic peptide (BNP) concentration before operation could be used to predict perioperative cardiac morbidity.

Methods

A prospective derivation study was performed in high-risk patients undergoing major non-cardiac surgery, with a subsequent validation study. A venous blood sample was taken the day before surgery for measurement of plasma BNP concentration. Screening for cardiac events (non-fatal myocardial infarction and cardiac death) was performed using clinical criteria, cardiac troponin I analysis and serial electrocardiography.

Results

Forty-one patients were recruited to the derivation cohort and 149 to the validation cohort. In the derivation cohort, the median (interquartile range) BNP concentration in the 11 patients who had a postoperative cardiac event was 210 (165–380) pg/ml, compared with 34·5 (14–70) pg/ml in those with no cardiac complications (P < 0·001). In the validation cohort, the median BNP concentration in the 15 patients who had a cardiac event was 351 (127–1034) pg/ml, compared with 30·5 (11–79·5) pg/ml in the remainder (P < 0·001). BNP concentration remained a significant outcome predictor in multivariable analysis (P < 0·001). Using receiver–operator curve analysis it was calculated that a BNP concentration of 108·5 pg/ml best predicted the likelihood of cardiac events, with a sensitivity and specificity of 87 per cent each.

Conclusion

Preoperative serum BNP concentration predicted postoperative cardiac events in patients undergoing major non-cardiac surgery independently of other risk factors.
A Simple Fluorescence‐Spectroscopic Membrane Translocation Assay
Authors: Keller Sandro , Böthe Matthias , Bienert Michael , Dathe Margitta , Blume Alfred
Published: March 2007

We have established a combination of fluorescence‐spectroscopic uptake, release, and dilution experiments as a powerful tool for studying the translocation of fluorescent compounds across lipid membranes, demonstrating this through intrinsic tryptophan fluorescence for the interaction of the cell‐penetrating peptide penetratin with phospholipid membranes, for which conflicting results have been reported. We found that penetratin is not membrane‐permeant under the conditions used here. To confirm this finding and to validate the approach, we also employed an established titration‐calorimetric method, the results of which were in excellent agreement with a thermodynamic analysis of the fluorescence‐spectroscopic experiments. Further support was provided by a comparison with published data obtained under similar conditions by using a variety of techniques. Unlike these methods, however, the new approach allows consistent and simultaneous assessment of membrane binding and transbilayer movement without depending on extrinsic labels attached to the molecule of interest or on reporter moieties inserted into the lipid membrane.
Rotablator® induced “shave” of intraluminal cap exposing intramural plaque crater
Authors: Bucay Moises , Zacca Nadim M. , Trakhtenbroit Anatole D. , Asimacopoulos Panayiotis J. , Master Herbert , Raizner Albert E.
Published: March 2007

A patient with recent onset of unstable angina was found to have a severe, eccentric stenosis of the proximal left anterior descending coronary artery. Rotational atherectomy was performed. After the first passage of the burr across the stenosis, an intraplaque crater was angiographically visualized. It is hypothesized that the patient's clinical presentation may be attributed to plaque rupture and formation of an intraplaque crater which was sealed by a fibrous cap. This cap was “shaved” by the rotating burr, exposing the crater. Adjunctive balloon dilatation expanded the true lumen and compressed the crater.
Percutaneous transluminal coronary angioplasty of coronary artery embolism
Authors: Mamby Sylvia A. , Spears J. Richard
Published: March 2007

A 35‐yr‐old woman with known valvular heart disease presented with acute myocardial infarction. Angiography demonstrated a totally occluded distal left anterior descending coronary artery. Though initially successful, angioplasty ultimately failed to maintain arterial patency, leaving a more distal total occlusion after several balloon inflations. In spite of this, PTCA possibly provided a more localized infarction via a peripheral mobilization of the embolus.
Delayed resolution of obstructing thrombus following acute closure
Authors: Marshall James , Mercuro John , Ogilby J. David , Untereker William J.
Published: March 2007

A case of acute thrombotic closure following percutaneous coronary angioplasty demonstrating delayed clearance of obstructing thrombus is reported. Although common in other clinical scenarios this has not been reported following coronary angioplasty.
Angiographic identification of malpositioned balloon catheters during mitral valvuloplasty
Authors: Tatineni Satyanarayana , Kern Morton J. , Aguirre Frank , Donohue Thomas , Bell Calvin
Published: March 2007

The positioning of balloon catheters for the percutaneous mitral valvuloplasty technique is critical to ensure an adequate result and minimize complications. Passage of two balloon catheters in parallel through a thickened atrial septum and maintenance of satisfactory positioning in the left ventricle can be difficult. We describe unsuspected mal‐positioning of the balloons in two patients documented angiographically in our laboratory. Recognizing and avoiding these positions will reduce the potential for serious complications.
Ventricular relaxation and myocardial ischemia: A comparison of different models of tau during coronary angioplasty
Authors: Simari Robert D. , Bell Malcolm R. , Schwartz Robert S. , Nishimura Rick A. , Holmes David R.
Published: March 2007

This study compares the sensitivity and variability of four models of tau, the time constant of ventricular relaxation, to detect the presence of myocardial ischemia. High fidelity left ventricular pressure recordings were obtained in ten patients undergoing coronary angioplasty at baseline, during balloon inflation, and at recovery. Four models of tau were considered: (1) a semilogarithmic, zero asymptote model (TL), (2) a semilogarithmic model using data from the first 40 ms of isovolumic relaxation (T40), (3) an exponential non‐zero asymptote model (Te), and (4) a derivative non‐zero asymptote model (TD). TL, T40, and TE increased significantly during inflation and returned to near baseline values at recovery. TD showed no change during inflation. Comparisons of TL, T40, and TE using the derived relaxation half‐time (T1/2), failed to reveal significant differences between the models at baseline, during inflation, or at recovery. The non‐zero asymptote models were associated with a greater beat‐to‐beat variability than the semilogarithmic models. Thus, T1/2 using the semilogarithmic zero asymptote models (TL and T40) may be more useful and consistent when measuring the rate of isovolumic relaxation during myocardial ischemia.
Coronary stenting with a balloon‐expandable stent after the recanalization of chronic total occlusions
Authors: Maiello Luigi , Colombo Antonio , Almagor Yaron , Bouzon Ricardo , Thomas Jack , Zerboni Santo , Finci Leo
Published: March 2007

To diminish the restenosis rate after successful recanalization of chronic total coronary occlusion, we have implanted the Palmaz‐Schatz stent in 6 patients. All procedures were successfully done without major complications. The angiographic follow‐up at 6 months showed restenosis in one asymptomatic patient who had had 2 stents implanted. Five other patients had no evidence of restenosis.
Intracoronary stent implantation via the brachial approach: A technique to reduce vascular bleeding complications
Authors: Heuser Richard R. , Mehta Stephen S. , Strumpf Robert K. , Ponder Regina
Published: March 2007

To reduce the incidence of vascular complications of intracoronary stent implantation, we used the brachial approach. We attempted implantation of the Palmaz‐Schatz stent via the brachial artery approach at 10 lesions in 9 patients. Stent delivery was successful at 8 lesions. Balloon angioplasty was successfully performed in the 2 failed cases, 1 of whom required surgical repair of the brachial artery. Intravenous anticoagulation was uninterrupted from the time of stent placement until therapeutic prothrombin times from oral warfarin therapy were obtained. Neither acute nor long‐term major bleeding occurred in the 9 patients. There were no embolic events, myocardial infarctions, or deaths. One subacute thrombosis occurred, and the patient underwent bypass surgery. To evaluate the risks and benefits of the brachial approach, we compared these 9 patients with 41 who had stent placement by the femoral approach during the same period. Lesion characteristics were similar in these 2 groups. There were no significant differences in the success rate or angiographic outcome between the 2 groups. Seven (17%) patients in the femoral group had vascular access complications requiring surgery, compared with 1 (11%) in the brachial group. No patient in the brachial group required transfusion, compared with all 7 of the patients who had femoral vascular complications. The potential reduction in bleeding complications makes the brachial approach to stent implantation attractive in selected patients.
Left ventricular perforation during percutaneous balloon mitral valvuloplasty
Authors: Manga Pravin , Singh Surendra , Brandis Simca
Published: March 2007

Percutaneous balloon mitral valvuloplasty has been reported to be complicated by left ventricular perforation with fatal results. We report two cases of left ventricular perforation following balloon mitral valvuloplasty. In one patient left ventricular perforation occurred silently without any hemodynamic sequelae and was only detected at left ventricular angiography after valvuloplasty. In the second patient left ventricular perforation was caused by the mitral dilating balloon catheter. The subsequent tamponade was relieved by immediate aspiration with hemodynamic stabilization thereafter. Neither patient required surgery. Both patients are well 6 mon after the procedure. We discuss the mechanism of this serious complication in these two patients.
Symptomatic angina secondary to coronary‐subclavian steal syndrome treated successfully by percutaneous transluminal angioplasty of the subclavian artery
Authors: Feld Harry , Nathan Paul , Raninga Dilsukh , Shani Jacob
Published: March 2007

Subclavian artery stenosis causing severely symptomatic angina in a patient with a previous left internal mammary artery bypass to the left anterior descending artery was treated successfully with percutaneous transluminal angioplasty. Baseline arteriography clearly revealed subclavian and coronary steal by evidence of competitive flow of nonopacified blood from the left vertebral artery. Although there was a difference of only 15 mm Hg between the right and left brachial arteries, there was a palpable difference in the upstroke of these pulses. The stenosis in the subclavian artery was successfully dilated with percutaneous transluminal angioplasty. Angiographic evidence of subclavian steal resolved following balloon dilatation, and the patient's angina was completely resolved. © 1992 Wiley‐Liss, Inc.
Coronary angioplasty using an over‐the‐wire balloon catheter through a new 6 french guiding catheter
Authors: Ueno Katsumi , Kotoo Yasunori , Arai Masazumi , Matsubara Tetsuo , Watanabe Sachiro , Ito Hiroyasu , Hirakawa Senri
Published: March 2007

A new 6 French (F) guiding catheter with a large, teflon‐coated internal lumen (4.2F) was developed, permitting use of the standard ultralow profile (< 3F) over‐the‐wire system. This small coronary angioplasty system (6F‐PTCA) was evaluated in 48 lesions in 45 of 137 patients (33%) who underwent coronary angioplasty between September 1990 and January 1991. The mean age was 64 years (range 49 to 82); 37 (82%) were male. The procedure was via the brachial artery in 28 patients (62%). The overall primary success rate was 96%. It was 100% via the brachial artery and 90% via the femoral artery. There were no major complications. The puncture compression time with the 6F‐PTCA via the brachial artery and via the femoral and with 8F‐PTCA via the femoral was 3.8, 9.6, and 16.9 hr, respectively (P<0.001), although the procedure time of the 6F‐PTCA via brachial and via femoral and of the 8F‐PTCA was not significantly different. The mean hospital stay was 3.1, 4.5, and 5.5 days, respectively (P<0.01). A small hematoma occurred in 2 patients (4.4%) after the 6F‐PTCA and in 3 (3.3%) after 8F‐PTCA, and a large hematoma (>5 cm) was noted in 7 patients (7.6%) after 8F‐PTCA. These results indicate that coronary angioplasty using the over‐the‐wire system through the new 6F guiding catheter is technically feasible. Moreover, this approach, especially when advanced via the brachial artery, could shorten the he‐mostasis time and facilitate early ambulation. © 1992 Wiley‐Liss, Inc.
Mobile cardiac catheterization laboratories
Authors: Goss Jerome E. , Cameron Airlie
Published: March 2007

The Society of Cardiac Angiography and interventions proposed guidelines for the establishment of mobile cardiac catheterization laboratories. These laboratories should be established only in areas with genuine need, preferably as determined by an objective medical authority. Safety of the patient should be of paramont importance and specifications as to the selection of patients, transportation of patients with complications, the relationship to a tertiary care center, and quality assurance mechanisms are all addressed. © 1992 Wiley‐Liss, Inc.
Echocardiographic and angiographic evaluation of left ventricular function during percutaneous transluminal aortic valvuloplasty
Authors: Sack Stefan , Henrichs Karl Jürgen , Erbel Raimund , Wittlich Norbert , Meyer Jürgen
Published: March 2007

Transesophageal echocardiography was used to study the effect of the balloon inflation on left ventricular function in 20 patients with critical aortic stenosis undergoing balloon valvuloplasty. Balloon inflation caused an increase of end‐diastolic (15% to 34%) and end‐systolic (57% to 72%) left ventricular volume. Left ventricular wall stress increased from 30 ± 10 × 103 dyn/cm2 at diastole and 121 ± 40 × 103 dyn/cm2 at systole to 44 ± 11 × 103 dyn/cm2 and 191 ± 55 × 103 dyn/cm2, respectively, when the balloon was inflated (P < 0.05). Turbulent regurgitant jet across the mitral valve increased from 15 ± 2% to 25 ± 3% during balloon inflation (P < 0.01). Continued monitoring of left ventricular function after balloon deflation demonstrated prolonged enlargement of left ventricular volumes. Our data show that balloon inflation causes an increase of left ventricular volume and impairment of contraction. Increase of left ventricular wall stress–associated with a reduction of coronary blood flow, due to lower aortic pressure–could result in ischemic myocardial injury. © 1992 Wiley‐Liss, Inc.
Mechanical right coronary artery shortening and vessel wall invagination: A fourth cause of latrogenic coronary obstruction during coronary angioplasty. A case report and review of the literature
Authors: Shea Patrick J.
Published: March 2007

Coronary spasm, dissection, and localized thrombosis are recognized sources of iatrogenic obstruction during coronary angioplasty. A fourth important cause is reported, namely, guidewire‐induced mechanical straightening and shortening of tortuous right coronary artery resulting in the invagination of redundant vascular tissue. Reversal is achieved with guidewire retraction. Recognition of this entity is crucial to avoid unnecessary and potentially harmful intervention. © 1992 Wiley‐Liss, Inc.
Initial experience with a new compression device for hemostasis after femoral arterial puncture
Authors: Roth Robert , Modrosic Karen , Brown Matt , Kern Morton J.
Published: March 2007

We evaluated a new hemostasis device to maintain focused pressure over the femoral artery puncture site for 2–6 hours in 330 cases after diagnostic catheterization or coronary angio‐plasty. No patient developed later hematoma or vascular complications. The initial favorable experience suggests that this hemostasis device has advantageous features of stability and site visualization and is a suitable adjunct to current methods of maintaining puncture site pressure after brief manual compression following arterial catheterization. © 1992 Wiley‐Liss, Inc.
Repeat balloon aortic valvuloplasty
Authors: Koning R. , Cribier A. , Asselin C. , Mouton‐Schleifer D. , Derumeaux G. , Letac B.
Published: March 2007

This paper attempts to determine limitations and indications of performing a second balloon aortic valvuloplasty procedure (BAV2) because of restenosis, which is the major limitation of this technique. From September 1985 to December 1989, 357 patients underwent a primary BAV (BAV1) and 67 patients had a BAV2. Forty‐two patients (group A) had repeat catheterization because they were markedly symptomatic 11 ± 7 months after BAV1. Twenty‐five patients (group B) came from a group of 73 patients who had been systematically scheduled for repeat catheterization in order to evaluate the hemodynamic restenosis rate 8 ± 3 months after BAV. At time of BAV2 most of the patients of group A were severely disabled. Comparison of pre‐BAV2 gradient and aortic valve area with pre‐BAV1 measurements showed in a slightly less severe degree of aortic stenosis in group A and in group B with any difference in cardiac index and ejection fraction. Immediately following BAV2, the gradient decreased from 72 ± 22 to 33 ± 15 mm Hg (P ± and aortic valve area increased from 0.56 ± 0.18 to 0.85 ± 0.28 cm 2) (p < 0.001) in group A. In group B, gradient decreased from 68 ± 15 to 33 ± 15 mm Hg (p < 0.001) and aortic valve area increased from 0.70 ± 0.16 to 0.90 ± 0.25 cm2 (p < 0.001). Comparison of the post‐BAV2 peak systolic gradient, aortic valve area, ejection fraction, and cardiac index with post‐BAV1 measurements revealed no significant differences in the two groups, but the absolute increase in aortic valve area obtained at BAV2 was significantly less than at BAV1 in group B (0.20 ± 0.22 vs 0.31 ± 0.16 cm2 p < 0.02). The larger balloon size used for BAV2 than for BAV1 did not increase the final valve area at BAV2. In‐hospital mortality was 3%. The use of a better profiled catheter with an arterial introducer explained the lower rate of vascular complications (4%). This report demonstrates that when BAV is indicated a second procedure can be performed safely and with low risk in symptomatic patients. © 1992 Wiley‐Liss, Inc.
Use of twenty‐four hour infusions of intracoronary tissue plasminogen activator to increase the application of coronary angioplasty
Authors: Pitney Mark R. , Cumpston Neil , Mews Geoffrey C. , Cope Geoffrey D. , Gibbons Frances
Published: March 2007

Coronary arteries occluded by long lengths of thrombus are usually considered unattractive for angioplasty. Nine patients (8 male, mean age 50.1 years) undergoing angiography for unstable angina were found to have single vessel disease considered unsuitable for angioplasty as the vessel was occluded by a long length of thrombus. These patients were treated with 24 hr intracoronary infusions of 100 mg tPA in an attempt to make angioplasty feasible. Marked thrombolysis occurred in 7 patients who received uncomplicated infusions. One case was unsuccessful due to catheter displacement, while another had the infusion ceased due to an intracerebral bleed from a previously silent A‐V malformation. This was the only major complication. Angioplasty was attempted in 6 of 7 cases where lysis had been achieved, with success in all lesions attempted. This reports shows that intracoronary tPA infused over prolonged periods produces excellent thrombolysis, making angioplasty feasible in some patients who were previously unsuitable. © 1992 Wiley‐Liss, Inc.
Activated clotting times and activated partial thromboplastin times in patients undergoing coronary angioplasty who receive bolus doses of heparin
Authors: Dougherty Kathy G. , Gaos Carlos M. , Bush Howard S. , Leachman D. Richard , Ferguson James J.
Published: March 2007

The accurate assessment of coagulation status is an important part of interventional procedures performed in the cardiac catheterization laboratory. While the traditional clinical means of assessing heparin anticoagulation has been with the activated partial thromboplastin time (APTT), the activated coagulation time (ACT) has come into widespread use in the catheterization laboratory as an assay of whole blood clotting time which can be performed rapidly at the bedside. The purpose of the present study was to (1) assess the anticoagulant effect of a 10,000 U bolus of heparin in PTCA patients and (2) document the relationship between ACTs and APTTs in a subset of these patients. Baseline and postheparin ACTs were measured using a HemoTec coagulation timer in 545 unselected PTCA patients. The average baseline ACT was 120 ± 22 sec. After a 10,000 U bolus of heparin the average ACT was 249 ± 44 sec; 58% of patients had an ACT < 250 sec, 17% had an ACT between 250 and 275 sec, 12% had an ACT between 275 and 300 sec, and 13% had an ACT >300 sec. A total of 175 paired ACT and APTT measurements were obtained in a random subset of these patients at baseline, after heparinization, and at 4–6 hr intervals after the procedure. The APTT was limited by absolute upper and lower limits of 150 and 22 sec; there were no such limits on the ACT. When limiting values were excluded, there was a strong overall correlation between ACT and APTT measurements (r = 0.92, p 0.001). We conclude that the activated coagulation time provides an accurate and reliable assessment of anticoagulation status. This test appears to be ideally suited for patients undergoing interventional procedures. There are, however, substantial differences in the automated systems currently in clinical use. The percent of patients achieving a target ACT of greater than 300 sec, as measured by a HemoTec system, after a 10,000 U bolus of heparin is low. These results are not extrapolatable to other ACT measurement techniques. © 1992 Wiley‐Liss, Inc.
Antegrade selective coronary angiography via the transseptal approach in a patient with severe vascular disease
Authors: Pearce A. Craig , Schwengel Robert H. , Simione Linda M. , Patrick Carol J. , Santiago Carlos , Ziskind Andrew A.
Published: March 2007

We describe a case of a woman with severe vascular disease in whom retrograde access to the aortic root was limited by both aortoiliac and axillary disease. Transseptal cathe‐terization was performed in anticipation of percutaneous aortic valvuloplasty. Selective antegrade angiography was successfully performed using catheters introduced through the transseptal sheath. © 1992 Wiley‐Liss, Inc.
Percutaneous vascular hemostasis device for interventional procedures
Authors: Merino Alvaro , Faulkner Catherine , Corvalan Alejandro , Sanborn Timothy A.
Published: March 2007

A new 11.5F over‐the‐wire vascular hemostasis device was compared to conventional manual compression in normal swine femoral arteries. Using percutaneous techniques, the collagen was deposited and hemostasis achieved in 7 vessels after 1 minute total, plus 4 minutes partial compression, while control manual compression required more than 5 minutes total compression to avoid hematoma formation. One month follow‐up of treated arteries (n = 4) and controls (n = 3) showed no impairment in distal pulse or differences in histology at the puncture site in the control and treated arteries. Thus, the vascular hemostasis device technique is safe and effective, achieves hemostasis with less compression time and complications, and does not interfere with arterial wall healing or compromise the lumen.© 1992 Wiley‐Liss, Inc.
Comparison of angiographic center and local site analysis of PTCA results in a multicenter angioplasty‐restenosis trial
Authors: Martinelli Michael J. , Deutsch Ezra , Ferraro Angelo , Bove Alfred A.
Published: March 2007

We compared three methods of coronary stenosis (S) sizing in a multihopsital PTCA restenosis trial: visual analysis by independent observers, single point caliper measurements, and quantitative coronary angiography (QCA). Cine films from 50 patients were submitted from the clinical site to the quantitative angiographic center, where visual analysis and computer quantitation were performed. Regression analysis revealed a correlation coefficient of .857 for caliper vs. QCA (p <.0001) and .876 for visual observation vs. QCA (p <.0001). No significant differences were found between any of the 3 methods for pre‐ or post‐PTCA stenosis values. However, QCA yielded smaller PTCA changes in stenosis severity than either caliper or visual observation (p <.05). Both caliper and visual methods correlated well with QCA in assessing stenosis size pre‐ and post‐PTCA. Trained observers can visually assess lesion severity with accuracy approaching QCA. QCA is likely to be less expensive when compared to visual analysis by three experienced observers and should be the method used for estimating the results of PTCA in clinical trials.© 1992 Wlley‐LIM, Inc
Acute coronary thrombotic occlusion following exercise testing 6 weeks after percutaneous transluminal coronary angioplasty
Authors: Goodman Shaun G. , Holloway Richard M. , Adelman Allan G.
Published: March 2007

Exercise stress testing is often performed following percutaneous transluminal coronary angioplasty (PTCA) in order to evaluate the efficacy of the procedure [1]. Together with thallium‐201 (T1‐201) scintigraphy, these noninvasive tests provide valuable data for predicting the recurrence of angina and restenosis [2]. However, concerns regarding the safe timing of exercise testing post‐PTCA have been raised in 3 previous case reports [3–5]. Each case documents acute coronary occlusion shortly after stress testing performed within several days of successful angioplasty, leading to the recommendation that such testing be deferred up to 4 weeks following PTCA. This paper reports a patient in whom acute thrombotic occlusion of the left anterior descending coronary artery (LAD) occurred immediately after a mildly abnormal exercise T1‐201 stress test done 6 weeks after PTCA.
Left main coronary artery aneurysm following percutaneous transluminal angioplasty: A report of a case and review of the literature
Authors: Desai Prakash K. , Ro Jae H. , Pucillo Anthony , Weiss Melvin B. , Herman Michael V.
Published: March 2007

Since its introduction in 1977, the number of PTCAs and its indications have grown. Along with more frequent usage, newer complications have been reported. Aneurysm of left main coronary artery is rare. This report describes the formation of a new non‐obstructing aneurysm in the left main coronary artery after PTCA of left circumflex artery. The patient has had 7 yr of follow‐up with a benign clinical course.
Balloon dilation of the completely occluded blalock‐taussig anastomosis: A case report
Authors: Jacob José Luiz Balthazar , Machado Nilton Carlos Spínola , Garzon Sérgio Aloísio Coimbra , Lorga Adalberto Menezes , Braile Domingo Marcolino
Published: March 2007

We report successful balloon dilation of a completely occluded classical Blalock‐Taussig shunt in a 3‐yr and 6‐mo‐old boy with univentricular heart and severe valvar and subvalvar pulmonary stenoses.
Modified “kissing” atherectomy procedure with dependable protection of side branches by two‐wire technique
Authors: Leya F.S. , Lewis B. E. , Sumida C. W. , McKiernan T. L. , Grassman E. D. , Bhatia S. , Killian D. M. , Halle A. A. , Ward K. A. , Johnson S. A. , Scanlon P. J.
Published: March 2007

We report a new two‐wire atherectomy technique for side branch protection. Newer, more resilient wire designs are capable of withstanding cutting forces of the Simpson atherocath device. This technique expands atherectomy application to lesions previously excluded from atherectomy as high risk lesions.
Balloon catheter requirements during contemporary percutaneous transluminal coronary angioplasty
Authors: Kahn Joel K.
Published: March 2007

In order to examine the outcome of utilizing multiple balloon catheters during the percutaneous transluminal coronary angioplasty (PTCA), 300 consecutive PTCAs were analyzed. PTCA was performed in a single lesion in 163 patients (54%), in multiple lesions in 52 patients (18%), and in multiple vessels in 85 patients (28%). A total of 488 balloon catheters were used (1.6/case, range 1–9) and in 112 cases (37%) ≥2 catheters were used. Multiple balloon catheters were needed in 27 single lesion (17%), 24 multilesion (48%), and 61 multivessel (72%) cases (p < .05). There was no difference in the angiographic success rate in cases completed with 1 balloon catheter (238/251, 95%) compared to those requiring ≥2 catheters (260/274, 95%). Emergency bypass was required in 5 patients (1.7%) and there were 2 deaths (0.6%). Thus, although contemporary PTCA frequently requires multiple balloon catheters for completion, success rates remain high and appear to offset the increased procedural expenses.
Measurements of central blood vessels in infants and children: Normal values
Authors: Steinberg Charlotte , Weinstock David J. , Gold Jeffrey P. , Notterman Daniel A.
Published: March 2007

In order to provide physicians interpreting vascular radiographic studies with normal data regarding central blood vessel size in children and to facilitate the design and adaptation of intravascular devices for pediatric use, we measured lengths and diameters of central blood vessels in 141 radiographic studies in 136 children. The diameters of the following vessels were determined: right and left internal jugular veins and common carotid arteries; the inferior vena cava and the descending thoracic aorta; right and left iliac veins; and right and left femoral veins and arteries. In addition, the lengths of the inferior vena cava and the descending aorta were also determined. Blood vessel dimensions were highly correlated with age, height, weight, and body surface area. The linear regression equations for each measured dimension against age, weight, height, and surface area are provided, along with a table of predicted vessel size as a function of age.
Shearing of the plastic coating of a hydrophilic guide wire in a right femoropopliteal bypass graft: Removal from the contralateral side
Authors: Kemper F. J. M. , Tielbeek A. V. , El Biltagiu S. , El Gamal M. I. H. , van Gelder L. M.
Published: March 2007

The plastic coating of a hydrophilic guide wire tore off during introduction through a beveled single wall arterial entry needle in a 75 year old male. The sheared piece of coating got stuck in his femoropopliteal bypass. It was removed by means of a modified arterial filter set from the contralateral side. The technique of its removal is described.
Long‐tip guiding catheter: Successful and safe for left coronary artery angioplasty
Authors: Voda Jan
Published: March 2007

A long‐tip guiding catheter was designed for angioplasty of the left coronary artery. Principal factors of guiding catheter function were identified, and the catheter's shape was designed to utilize them efficiently. Emphasis was placed on an overbent secondary curve (150–180°) for more precise catheter control. The distal tip of the catheter is 2 cm long in the 4.0 size and the primary bend is shallow, ∼20%. A 1.5 cm long segment between the secondary and tertiary curves enhances stability and support. Catheter performance was studied during procedures on 90 patients; 89 patients underwent coronary artery angioplasty and one patient underwent diagnostic angiography. The success rate for angioplasty was 95% with no major complications. Mild pressure damping occurred in 18 patients, and mild catheter displacement from the left main coronary artery occurred in 24 patients. Catheter support was judged as excellent to very good in 82 patients. Judkins or Amplatz catheters were not required during this study. The observed disadvantages of the long‐tip catheter were the risk of catheter buckling up during advancement into the left main coronary artery and, perhaps, a higher risk of pressure damping. Superselective engagement of the catheter in the left anterior descending or circumflex arteries may be a problem when the left main coronary artery is very short. This study showed the long‐tip catheter to be safe and highly successful for angioplasty of the left coronary artery.
Coronary perforation during angioplasty: Angiographic detection and demonstration of complete healing
Authors: Topaz On , Cowley Michael J. , Vetrovec George W.
Published: March 2007

A patient is presented with localized perforation of the left anterior descending artery secondary to angioplasty balloon rupture. Despite a remarkable angiographic picture of coronary tear and dye extravasation into the surrounding pericardial tissue, the patient remained hemodynamically stable, and was medically treated. Five years later she redeveloped angina, and repeated coronary arteriography revealed complete healing of the perforation site. This case attests to the remarkable ability of the coronary artery to completely heal from a major wall trauma. Although a rare complication of coronary angioplasty, perforation can occur, and various management aspects should be considered.
Laser facilitated angioplasty and thrombolysis in acute myocardial infarction complicated by prolonged or recurrent chest pain
Authors: Topaz On , Rozenbaum Eliezer A. , Battista Stephen , Peterson Craig , Wysham Douglas G.
Published: March 2007

To date, application of laser angioplasty in acute myocardial infarction (MI) has not been reported. In nine patients with acute myocardial infarction complicated by continuous or recurrent severe ischemia and chest pain, a mid‐infrared, solid‐state, pulse‐wave holmium/thulium:YAG coronary laser was applied. In six of these patients the laser was specifically utilized for the purpose of coronary thrombolysis. In each case a guidewire was placed across the stenosis and a multifiber laser catheter was utilized, emitting 250–600 mJ/pulse at 5 Hz, followed by adjunctive balloon angioplasty. Laser success (defined as ability to cross the lesion, reduction of ±20% in stenosis and thrombolysis when a thrombus is present) was achieved in all patients. Final angiograms revealed residual stenosis ±30%, adequate thrombolysis and no major complication (MI, perforation, emergency CABGS, CVA, death) in each patient. Clinically, all nine patients improved, survived the acute infarction and were discharged. This initial clinical experience demonstrates the feasibility and safety of holmium/thulium:YAG laser application in thrombolysis and plaque ablation in selected patients who experience acute myocardial infarction complicated by prolonged or recurrent ischemia and chest pain.