bluuebunny/crossref_metadata_2025 huggingface dataset:
The profile beyond leg pain: In basis of central sensitization, kinesiophobia, and body awareness in patients with chronic venous disease
Authors: Bazancir-Apaydin Zilan , Sakizli Erdal Elif , Keser Ilke , Erer Dilek
Published: September 2024

Objective: Leg pain has long been underestimated despite being one of the most important symptoms of chronic venous disease (CVD). Studies investigating leg pain and psychosocial profile in CVD are limited. The study aimed to investigate leg pain, central sensitization, kinesiophobia, and body awareness in patients with CVD. Methods: The ninety-eight patients (80 female, 18 male) diagnosed with CVD were included in the study. The severity of leg pain was evaluated with the Visual Analog Scale (VAS). The patients were assessed with the Central Sensitization Inventory (CSI-A and B) for central sensitization-related symptoms and -positivity, the Body Awareness Questionnaire (BAQ) for body awareness, and the Tampa Kinesiophobia Scale (TKS) for kinesiophobia. The cut-off score was admitted as 41 for TKS. Results: The leg pain (mean (SD) = 4.3 ± 2) and body awareness (mean (SD) = 82.4 ± 22) were moderate levels in patients with CVD. Nearly half of the patients ( n = 46, 46.9%) had both central sensitization positivity and elevated kinesiophobia ( n = 46, 47%). The CSI was correlated with the VAS (r = 0.32, p = .001), TKS (r = 0.40, p < .001), and BAQ (r = 0.20, p = .048). Significant correlations were determined between Body Mass Index and TKS (r = 0.48, p < .001) and BAQ (r = −0.31, p = .002). Also, the patients with a TKS score ≥41-points had higher CSI-A scores ( p = .002) than those with a TKS score< 41. Conclusions: Leg pain, central sensitization, and kinesiophobia are commonly seen in patients with CVD, and central sensitization seems to have a negative effect on leg pain, kinesiophobia, and body awareness. The profile beyond pain should be evaluated in detail, and various rehabilitation strategies need to be developed to manage central sensitization, interoception, kinesiophobia, and weight control in patients with CVD.
Effect of CaO–Al2O3–SiO2–MgO(–CaF2) refining slag system on inclusions in silicon–manganese deoxidized spring steel
Authors: Wu Huajie , Li Xue , Li Jian , Liu Wei , Sun Yanhui , Li Ming
Published: September 2024

In order to make the refined slag match various grades of spring steel, high-temperature equilibrium experiments were conducted in the laboratory to study the effect of CaO–Al2O3–SiO2–MgO refining slag with varying basicity, Al2O3 content, and CaF2 additives on inclusions containing Al (Al2O3) in silicon–manganese-deoxidised steel. The results show that the control effect of low basicity refining slag on inclusions is better than that of high basicity slag. The soluble aluminium increases with the increase of the basicity of steel slag and the Al2O3 content in inclusions is positively correlated with the Al2O3 content in slag. When the relative adsorption capacity of the refined slag is 6 × 10−3, the area density of Al-containing inclusions in steel is at a low level. Low basicity slag with low Al2O3 is good, and it is more suitable for producing high-end spring steel. To produce middle- and low-end spring steel, the refining slag system with a basicity of about 2–2.5, Al2O3, MgO, and CaF2 content is about 10% can be used. Among them, a small amount of CaF2 improves the liquidity of steel liquid, improves its relative adsorption capacity to Al-containing inclusions, and can control the production of Al-containing inclusions in the steel.
Childhood Sexual Trauma, Substance Use, and Antiretroviral Therapy Adherence Among Older Adults Living With HIV: A Mediational Analysis
Authors: Brown Monique J. , Zhang Josie , Addo Prince Nii Ossah , Kaur Amandeep , Amoatika Daniel , Crouch Elizabeth , Cohen Steven A.
Published: September 2024

Childhood sexual abuse (CSA) is linked to substance use and lower antiretroviral therapy (ART) adherence. However, studies examining the mediational role of substance use between CSA and ART adherence are lacking. Therefore, the aim of this study was to determine the potential mediational role of substance use between CSA and ART adherence among older adults living with HIV (OALH) ( n = 91). Mediation analyses assessed the direct and indirect relationships between CSA, substance use, and ART adherence. Statistically significant differences existed in substance use by gender (male vs. female: 12.3 vs. 9.97) and ART adherence by race (Black vs. White: 98.2% vs. 99.6%) and employment. CSA was associated with ART adherence (β = −3.27, p < .001) and substance use (β = 2.14, p = .035), but substance use was not associated with ART adherence, and did not mediate the pathway between CSA and ART adherence in the adjusted model. Trauma-informed interventions may lower substance use among OALH with CSA.
Brief Introduction to the Second Special Issue–School Psychology and Indigenous Peoples: Critical Perspectives and Indigenous-Led Approaches
Authors: Schroeder Meadow , Lacerda-Vandenborn Elisa , Nelson Melanie , Wendt Dennis C.
Published: September 2024

This issue of the Canadian Journal of School Psychology is the second of two parts of a special issue devoted to the intersection of school psychology and Indigenous Peoples within the Canadian context. It includes an additional five articles that relate to ethical practice, relationship building, and decolonized intervention, as well as an overview of the current state of Indigenous representation in school psychology research. It concludes with a commentary on the special issue. The two issues on the topic of critical perspectives and Indigenous-led approaches contribute to a starting point for dialogue and calls to action within school psychology.
Development and Evaluation of an Automated Protocol Recommendation System for Chest CT Using Natural Language Processing With CLEVER Terminology Word Replacement
Authors: Rogalla Patrik , Fratesi Jennifer , Kandel Sonja , Patsios Demetris , Khalvati Farzad , Carey Sean
Published: September 2024

Purpose: To evaluate the clinical performance of a Protocol Recommendation System (PRS) automatic protocolling of chest CT imaging requests. Materials and Methods: 322 387 consecutive historical imaging requests for chest CT between 2017 and 2022 were extracted from a radiology information system (RIS) database containing 16 associated patient information values. Records with missing fields and protocols with <100 occurrences were removed, leaving 18 protocols for training. After freetext pre-processing and applying CLEVER terminology word replacements, the features of a bag-of-words model were used to train a multinomial logistic regression classifier. Four readers protocolled 300 clinically executed protocols (CEP) based on all clinically available information. After their selection was made, the PRS and CEP were unblinded, and the readers were asked to score their agreement (1 = severe error, 2 = moderate error, 3 = disagreement but acceptable, 4 = agreement). The ground truth was established by the readers’ majority selection, a judge helped break ties. For the PRS and CEP, the accuracy and clinical acceptability (scores 3 and 4) were calculated. The readers’ protocolling reliability was measured using Fleiss’ Kappa. Results: Four readers agreed on 203/300 protocols, 3 on 82/300 cases, and in 15 cases, a judge was needed. PRS errors were found by the 4 readers in 1%, 2.7%, 1%, and 0.7% of the cases, respectively. The accuracy/clinical acceptability of the PRS and CEP were 84.3%/98.6% and 83.0%/99.3%, respectively. The Fleiss’ Kappa for all readers and all protocols was 0.805. Conclusion: The PRS achieved similar accuracy to human performance and may help radiologists master the ever-increasing workload.
Bridges for Transgression: How Community Engagement Strengthened My Conocimiento
Authors: Acosta Katie L.
Published: September 2024

This article is an expansion of the Feminist Lecture that I gave at the Sociologists for Women in Society Meetings in April 2021. I map my journey toward conocimiento, highlighting the centrality of my volunteer work with asylum seekers, traveling to their sponsors after being released from ICE detention, for the development of my identity as a scholar activist. I rely on two theories, intersectionality and spiritual activism—both developed by women of color scholars to guide our efforts toward social change—to illustrate how scholars can reconcile their roles as community activists with their roles as scholars in academia. I bring intersectionality and spiritual activism together, as distinct (albeit complementary) resistant knowledge projects that, in tandem, support my critique of sociology’s competing commitments to objective empirical research and social justice. I chronicle how strengthening my conocimiento has served as a tool in my efforts to transgress the discipline and ultimately how it helped me find a more authentic existence within the academy.
Peritoneal dialysis in children, what's different: Your questions answered
Authors: Wasik Heather L , Harvey Elizabeth , Neu Alicia
Published: September 2024

Maintenance peritoneal dialysis (PD) is the most used kidney replacement therapy for children with kidney failure throughout the world. Underlying causes of kidney failure, indications for dialysis, body size, and nutritional requirements differ between children and adults on PD. These differences, along with the ongoing growth and development that occurs throughout childhood, impact PD access, prescription, and monitoring in children. This review highlights the unique challenges and management approaches to optimize the care of children on maintenance PD.
Comprehensive analysis of morphology, microstructure, and mechanical characterization of parameters in the Inconel 718 laser cladding process on AISI 1050
Authors: Ari Ali
Published: September 2024

In this study, laser cladding of Inconel 718 powder was applied to AISI 1050 fabrication steel. In this process, an empirical study was conducted on 18 different samples produced to analyze the effects of laser power, scanning speed, and powder feeding rate, which are the most effective parameters in the laser cladding process, on morphology, microstructure, and mechanical characterization. The microstructures of these samples were investigated by a scanning electron microscope, and elemental distributions in the coating zone were investigated by energy dispersive spectrometry. In addition, their microhardness was measured throughout the coating. In light of the data obtained, the morphology of the three zones of the coating (clad zone, fusion zone, and heat-affected zone) was affected by the relevant parameters. The present work has given the optimum parameters: High powder feed rates (4.7, 5.2 rev/min), low scanning speeds (8 and 10 mm/s), and high laser power (with an increase from 1500 to 2100 W) all contributed to the maintenance of melt pool stability. A lower powder feed rate (3.8, 4.3 rev/mm) nevertheless assisted in encouraging the creation of a finer microstructure at lower laser powers (1500, 1800 W) and greater scanning speeds (12 mm/s). In all samples, the mean hardness in the fusion zone was higher than in the clad zone. It is stated that this phenomenon is caused by both the cooling rate and the Ni:Fe ratio. The hardness value increased with the increase in the percentage of Fe atoms in the fusion zone. The average hardness measurements were between 210 and 225 Vickers hardness, showing that the clad zone of all samples had a fairly consistent hardness level.
Optimization study of tail-lateral occupant injury and restraint system for an off-road vehicle ramp rollover
Authors: Zhou Yunbo , Zhao Long , Zhang Ming , Fu Yaoyu
Published: September 2024

The process of rollover accidents involving specialized vehicles is characterized by intense motion and long duration. Although these accidents are infrequent, they often lead to a high fatality rate. In this study, we utilized LS-Dyna software to simulate the rollover of a vehicle on a side ramp. This simulation aimed to verify the reliability of our model establishment by comparing the vehicle’s motion attitude and center-of-mass acceleration with experimental results. Additionally, we sought to investigate the lateral occupant injuries that occur in the tail section of a certain type of specialized vehicle during a rollover. Initially, we obtained the vehicle’s motion trajectory and the dummy’s motion state through simulation. Subsequently, we extracted the injury response of each part of the dummy. We then simplified the entire vehicle model and made improvements to the occupant restraint system, ultimately designing an enhanced system. Finally, we approximated and replaced the entire vehicle model by establishing an approximation model. We combined this with an optimization algorithm to optimize the occupant restraint system. The simulation results demonstrate that the improved occupant restraint system significantly reduces the axial force on the neck of the occupant and the comprehensive evaluation index of injury. Furthermore, the simulation results for each component fall below the injury limit value specified in the FMVSS208 crash occupant protection standard. Therefore, the improved occupant restraint system proposed in this study effectively mitigates lateral occupant injury during rollover accidents.
The Cost-Effectiveness of Exclusion Arteriography in Extremity Trauma
Authors: Keen John D. , Keen Richard R.
Published: September 2024

The purpose of this study was to apply decision analysis to an established practice in vascular trauma diagnosis. While exclusion arteriography has resulted in an increase in positive surgical explorations, no formal analysis that determined either the cost-effectiveness of exclusion arteriography or the cost-effectiveness ratio has been reported in the literature. We created a decision model that compared exclusion arteriography and surgical exploration, the standard used prior to the development of extremity arteriography. The decision model used predominantly literature derived estimates for the prevalence of arterial injuries and the accuracy, complications, outcomes and costs of both arteriography and exploration. Exclusion arteriography is cost-effective. This finding is robust to changes in the major model variables. Compared to surgical exploration, exclusion arteriography is a superior strategy by dominance (more effective and costs less). Therefore, a cost-effectiveness ratio cannot be calculated. Under the base case assumption of 28% prevalence of arterial injury requiring operation, exclusion arteriography saves about $2000 and adds 0.3 quality adjusted life years (QALY) for each patient. Decision analysis can be successfully applied to problems in vascular trauma diagnosis.
Carotid Endarterectomy with Bovine Patch Angioplasty: A Preliminary Report
Authors: Kim Geun Eun , Kwon Tae Won , Cho Yong Pil , Kim Do Kyun , Kim Ho Sung
Published: September 2024

Carotid endarterectomy with patch angioplasty is a durable procedure for prevention of recurrent neurological symptoms and stroke. However, no definitive study has demonstrated a clear benefit of one class of the patch material over another. The aim of this study was to evaluate the clinical outcome of carotid endarterectomy with bovine pericardium patch in comparison with autologous vein patch. One hundred and twenty-two carotid endarterectomies were performed using patch closure of the arteriotomy with bovine pericardium (61 cases) and autologous vein (61 cases) between September 1995 and June 1999. Though this is not a double-blind type randomized comparative study, effort was made to achieve a 1:1 ratio in sequence with a few exceptions such as non-available veins at time of surgery or for future use. In bovine pericardium patch closure group, the mean total operating time was significantly shorter than autologous vein closure group ( P<0.01), but the mean carotid clamping time was similar in both groups, regardless of the use of shunt. The incidence of postoperative local complications including groin wound was less in bovine pericardium patch closure group. The patients were followed with duplex scans in one month post-CEA and 6 months interval thereafter. During the follow-up period, three patients developed non-critical stenosis (two in bovine and one in vein patch), and one aneurysmal dilation occurred in vein patch group. The incidence of restenosis was similar in both groups. Although this is a preliminary report, it is concluded that the results of carotid angioplasty using bovine pericardium compare favorably with autologous vein.
Six Hundred Consecutive Carotid Endarterectomies with Temporary Shunt and Vein Patch Angioplasty: Early and Long-Term Results
Authors: Scavée V. , Viejo D. , Buche M. , Eucher Ph. , Louagie Y. , Haxhe J.-P. , De Wispelaere J-F. , Trigaux J-P. , Jamart J. , Schoevaerdts J.-C.
Published: September 2024

Purpose:

This retrospective study evaluates the long-term clinical outcome and the survival of 600 consecutive carotid endarterectomies performed with a temporary shunt. All arteriotomies were closed by vein patch angioplasty.

Materials and methods:

Between November 1989 and November 1998, 600 isolated carotid endarterectomies (CEA) were performed in 540 patients by a uniform surgical technique at the University Clinic of Mont-Godinne. An intraluminal shunt and patch closure were systematically used. The mean age was 68 yr (ranging from 41 to 91 yr), 400 patients were men. The risk factors included hypertension in 73%, smoking history in 60%, coronary artery disease in 51% and hyperlipidemia in 35%. The indications were asymptomatic stenosis in 47%, transient ischemic attack in 40%. vertebrobasilar symptoms in 7% and stroke in 6%.

Early results:

The combined 30-day stroke and death rate was 0.9%. There were four deaths. The stroke and TIAs rates were 0.2% and 1.5% respectively. The incidence of early carotid occlusion was 0.5%. Cranial or cervical nerve dysfunction was identified in 6.3%.

Late results:

The median follow-up was 49 months with a range of 2–124 months. Cumulative survival rates at 5 and 10 yr were 92±1% and 89±2% respectively. Thirty-two patients died during long-term follow-up; the death was stroke-related in only three patients.

Conclusion:

Carotid endarterectomy using an intraluminal shunt and vein patch closure is a safe and effective procedure associated with low morbidity and mortality rates at short and long-term follow-up.
Impact of Myocardial Protection during Coronary Bypass Surgery on Patient Outcome
Authors: Mehlhorn Uwe , Fattah Marcus , Kuhn-Régnier Ferdinand , Südkamp Michael , Geissler Hans-Joachim , Raji M. Reza , Fischer Uwe M. , de Vivie E. Rainer
Published: September 2024

We have recently shown that continuous coronary perfusion with warm blood enriched with the ultra-short acting ß-blocker Esmolol (ES) improves functional and structural myocardial protection during coronary artery surgery as compared with conventional cardioplegia (CP). The purpose of the present study was to compare both myocardial protection techniques in terms of patient outcome. We retrospectively analyzed the charts of 150 consecutive patients subjected to coronary artery surgery using the ES-technique; 150 patients matched for age, gender, preoperative left ventricular function, history of renal failure, and history of neurological symptoms undergoing surgery with conventional CP during the same time period served as control group. There were no significant differences between both groups with respect to perioperative myocardial infarction rate, need for positive inotropic medication, need for mechanical circulatory support, duration of mechanical ventilation, duration of intensive care unit stay, time of mobilization, postoperative renal failure, cardiac arrhythmias, neurological symptoms, infections or in-hospital mortality. ES-patients were less frequently readmitted to the intensive care unit (ES: 3/150; 2.2% [95% confidence interval: 0–4.2%] vs CP: 13/150; 8.7% [4.2–13.2%]; P= 0.010) and total hospital stay was shorter (ES: 12.3±14.8 days [95% CI: 11.5–13.0] vs CP: 13.5±3.8 [12.9–14.1] days; P= 0.0013), thus saving 159 patient days on the normal ward. Procedural costs were less for the ES-technique (US$ 60 per patient) as compared to the cardioplegia technique (US$ 120 per patient). These data suggest that myocardial protection using the ES-technique does not improve clinical outcome in patients subjected to routine coronary artery surgery, but may save costs.
Evolution of Technologies in Endovascular Grafting
Authors: Green R. M. , Chuter T. A. M.
Published: September 2024

The safety, efficacy and utility of inserting a vascular prosthesis through the femoral artery and attaching it to a native artery with stents to treat abdominal aortic aneurysms are under various stages of testing around the world. The potential of these endovascular techniques to reduce the morbidity and cost of care is enormous. Many advances in imaging, catheter techniques, delivery systems and the knowledge about aneurysm morphology are reponsible for the progress to date. The requirements of an endoprosthesis include a small and flexible delivery system that allows retrograde insertion through the iliofemoral arterial system, secure attachments to normal arterial wall, and a fabric which meets Food and Drugs Administration criteria for strength and durability. Application of this technique to large numbers of patients with aneurysms will probably require the development of a bifurcated prosthesis. The long-term behavior of the aneurysm wall after endoprosthesis insertion will not be known until clinical trials are completed. The development of these techniques will undoubtedly fuel the ‘turf battle’ between vascular surgeons and interventionalists. Although each group will lay claim to the technology, a cooperative effort to maximize patient benefit seems to be the most appropriate way to insure that the interests of the patients are best served.
The Role of Endovascular Grafting Technique in the Treatment of Infrarenal Abdominal Aortic Aneurysm
Authors: Moore W. S.
Published: September 2024

The objective of this report is to review the author's initial clinical experience with screening a population of patients with abdominal aortic aneurysm, to describe the selection criteria for endovascular repair and to report results from a single institution. The technique of transfemoral repair of abdominal aortic aneurysm uses the endovascular graft system that is currently in a Food and Drugs Administration approved protocol for investigation in the United States. Some 69 patients with abdominal aortic aneurysm were screened in order to find ten suitable candidates. Ten implantations were carried out, of which eight were successful and two required conversion to conventional open aneurysm repair without complication. There were no deaths or complications. It is concluded that tube graft repair by the transfemoral route is feasible and applicable to approximately one patient in seven. The availability of a bifurcated graft will enhance the percentage of aneurysm patients treatable by this technique. Long-term results, at this time, are unknown.
The Case for Renal Revascularization
Authors: Kuestner L. M. , Stoney R. J.
Published: September 2024

This report reviews renovascular disease, hypertension and renal parenchymal dysfunction. The primary lesions responsible are discussed as well as the strategies for restoring normal renal perfusion. The natural history studies document progressive impairment of renal perfusion and the consequence of renal dysfunction. Renal revascularization interrupts this pathway by relieving or lessening hypertension and preserving renal function which are the therapeutic options.
Experience with Warm Blood Cardioplegia in 480 Patients
Authors: Tolis G. A. , Astras G. , Sfyras N. , Georgiou G.
Published: September 2024

From 1 March 1992 too 31 July 1993 (17 months), 480 consecutive patients underwent various open-heart procedures under anterograde (83 patients) or retrograde (397 patients) continuous warm blood cardioplegia. Some 352 patients (73.3%) had isolated coronary artery bypass grafts (CABG) and 117 (24.3%) had valve replacement either isolated (96) or in combination with other operations (21). Two patients had CABG and ventricular aneurysmectomy, eight had correction of congenital defects, and one had resection of left atrial myxoma. The 30-day postoperative mortality rate was 2.9% (14 deaths). In four patients the cause of death was not cardiogenic. An intra-aortic balloon was used in 11 patients following CABG (3.1%) with six survivors. Perforation of the coronary sinus occurred in one patient. Perioperative myocardial infarction was observed in 5.6% of patients after CABG. No myocardial infarction occurred after valve replacement. Phrenic nerve Injury and wound infection were not observed. These results indicate that warm blood cardioplegia, especially when delivered retrogradely, provides excellent myocardial protection of both ventricles during various open-heart procedures.
A Non-Resective Therapy for Abdominal Aortic Aneurysm: Intravascular Thrombosis by Dropping Inflatable Balloons
Authors: Chocron S. , Claudel S. , Rozette P. , Caplan B. , Baehrel B.
Published: September 2024

A case of subrenal abdominal aortic aneurysm treated by unipolar exclusion and axillobifemoral bypass is reported. The exclusion was performed by inserting inflatable balloons through a femoral access and obstructing the iliac arteries. This technique may be useful in poor-risk patients with a symptom-free aneurysm.
The Non-Invasive Vascular Laboratory: Who Needs it?
Authors: Barnes R. W.
Published: September 2024

This paper attempts to answer the following four questions: Why test? What tests? Whom to test? and What costs? The author briefly reviews the reasons that physicians order tests and the currently acceptable and unacceptable indications and procedures for non-invasive vascular diagnostic testing. The background for economic analysis, including cost-benefit or cost-effective analysis, is reviewed. Finally, a Medline literature search of articles addressing the cost-effectiveness of non-invasive vascular techniques provides a basis for classification of these tests based on economic analysis.
Successful Abdominal Aortic Aneurysm Resection in Long-Term Survivors of Cardiac Transplantation
Authors: Defraigne J. O. , Sakalihasan N. , Demoulin J. C. , Limet R.
Published: September 2024

With the improvement of survival rates following cardiac transplantation, the probability of recipients developing extracardiac disease is increased. Three cases are reported of abdominal aortic aneurysm successfully operated on in cardiac allograft recipients 1 to 4 years after transplantation. Indications for transplantation were valvular, idiopathic and ischaemic cardiomyopathy. Post-transplant hypertension and hyperlipidaemia may have played a role in the rapid growth of the aneurysms. Cardiac function and the incidence of graft atherosclerosis were assessed before surgery by coronary angiography. All three patients were discharged from hospital. Abdominal aortic aneurysm resection may be a safe procedure in cardiac transplant patients. In view of the rapid increase in the size of the aneurysms in transplanted patients, careful screening should be performed during follow-up.
Immediate and Long-Term Results following Repair of Aortic Left Ventricular Discontinuity: A 25-Year Experience
Authors: Symbas P. N. , Justicz A. G. , Anderson N. A.
Published: September 2024

From 1967 to 1993, 21 patients underwent surgical repair of aortic left ventricular discontinuity as a result of acute bacterial endocarditis. Repair of the defect between the aorta and left ventricle was usually with interposition of a patch (prosthetic patch or autologous pericardium), using a continuous monofilament suture. Interrupted pledgetted stitches were used when the ventricular tissue appeared friable. A valve prosthesis was then sewn to the patch and remaining annulus. Three patients died in the immediate perioperative period. Long follow-up ranging from S to 142 months (mean 36 months) is available on 17 of 18 survivors. There were six deaths in this group from 11 to 142 months (mean 67 months) from initial surgery. Of 11 long-term survivors (5 to 61 months (mean 21 months) after operation), nine have had event-free courses. Two cases of recurrent subacute bacterial endocarditis occurred 3 and 52 months after surgery in patients who were intravenous drug abusers, both of whom were managed medically. It is concluded that while aortic left ventricular discontinuity remains a potentially lethal complication of acute bacterial endocarditis, débridement of infected necrotic tissue, patch repair of the defect and prosthetic valve replacement offer satisfactory immediate and late results.
Descending Thoracic Aorta Aneurysmectomy: Left-Left Centrifugal Pump versus Simple Clamping Technique
Authors: Biglioli P. , Spirito R. , Pompilio G. , Agrifoglio M. , Sala A. , Arena V. , Sisillo E.
Published: September 2024

Forty-six patients who had had an elective repair of a descending thoracic aortic aneurysm were reviewed, in order to investigate the efficacy of support by a centrifugal pump on distal organ perfusion and spinal cord protection during cross-clamping of the thoracic aorta. Two concurrent groups were analysed: 36 patients (78%) were supported by left atriofemoral arterial bypass with a centrifugal pump and 10 (22%) had no distal circulatory support. No patient was fully heparinized. The demographic data and preoperative characteristics of the groups, including location and type of aneurysm, were similar. The mean(s.d.) duration of cross-clamping was 37.8(16) min in the centrifugal pump group and 42.3(21) min in the simple clamping group. Preoperative haemodynamic and laboratory data were similar in both groups. During cross-clamping, parameters of pH and blood urea varied but were better in the centrifugal pump group; changes from pre-intervention to early aortic cross-clamping time were not significant (pH, P< 0.0006; bases, P< 0.0003). Differences in creatinine values were caused mainly by the change from pre-intervention to the first postoperative day ( P< 0.03); this continued throughout the hospital stay. The cerebrospinal fluid pressure measurement indicated a significant difference in time change ( P< 0.0001) and mean level over time ( P< 0.0002): levels were significantly lower in the centrifugal pump group throughout aortic cross-clamping. Three patients in the simple clamping group and none in the centrifugal pump group ( P< 0.02) required cerebrospinal fluid drainage. Paraplegia occurred in one patient (3%) in the centrifugal pump group and in one (10%) in the simple clamping group ( P= n.s.). The overall in-hospital mortality rate was 9%, with 71% of all deaths occurring in patients who had an emergency repair of the aneurysm. The cumulative 5-year survival rate was 72% in the centrifugal pump group and 84% in the simple clamp group ( P = n.s.). The results confirm that patients offered centrifugal pump support are better stabilized metabolically, suggesting that spinal cord perfusion is improved.
Risk Factors for Early and Late Mortality in Surgical Treatment of Coronary Artery Disease
Authors: Risum Ø. , Abdelnoor M. , Svennevig J. L. , Nitter-Hauge S. , Levorstad K. , Foerster A. , Frøysaker T.
Published: September 2024

A total of 1025 patients who had coronary bypass surgery at the Surgical Department A, Rikshospitalet, Oslo, between 1982 and 1986, were analysed for factors associated with early mortality and long-term survival. The cumulative follow-up time accounted for 6553 patient-years; the median follow-up was 6.45 years and ranged from the day of admission to 10 years. In total, 31 patients (3%) died within 30 days of surgery. Some 30 possible risk factors were analysed. Univariate analysis followed by a multivariate analysis defined six independent risk factors for early mortality. These were lack of sinus rhythm, previous heart surgery, mitral regurgitation, left main stem stenosis, unstable angina, and an elevated left ventricular end-diastolic pressure. Estimation of attributable risk showed that these factors could identify all patients who died early. Independent risk factors for late death were: lack of sinus rhythm. resection of a left ventricular aneurysm, left main stem stenosis, New York Heart Association (NYHA) class IV on admission, an elevated end-diastolic pressure, and prolonged cross-clamping time. The attributable risk analysis showed that independent risk factors for total mortality explained only about half of the patients who died. This appeared to be because of the competing effect of non-cardiac mortality. Results of the study show that risk factors for early mortality are good indicators for the outcome of coronary artery bypass surgery, identifying all deaths, whereas long-term mortality cannot be predicted. Stratification of independent risk factors allows a better comparison of mortality in different centres, and also better quality control of bypass surgery.
Surgical Therapy for Wolff-Parkinson-White Syndrome in Patients with Bronchial Asthma
Authors: Ohtake H. , Misaki T. , Matsunaga Y. , Tubota M. , Kawasuji M. , Watanabe Y.
Published: September 2024

The surgical therapy for Wolff-Parkinson-White syndrome in patients with bronchial asthma was studied. Between 1974 and 1992, 447 patients with Wolff-Parkinson-White syndrome were treated, seven of whom had associated severe bronchial asthma. Supraventricular tachyarrythmias were induced on occasion by bronchodilating agents such as beta-receptor agonists or theophylline preparations. High-dose steroids were required for acute bronchospasm in three patients, despite possibly leading to cardiac dysfunction. Beta-blockers therapy for Wolff-Parkinson-White syndrome can induce bronchospasm; in patients with Wolff-Parkinson-White syndrome and bronchial asthma, pharmacological agents used to treat one condition may exacerbate the other. Therefore, a non-pharmacological therapy was performed, namely surgical division of the accessory conduction pathway via an endocardial approach, in all seven asthmatic patients with Wolff-Parkinson-White syndrome. In all cases, division of the accessory conduction pathway resulted in disappearance of the delta wave, and there were no further tachyarrhythmias either at rest or after administration of bronchodilators. Since surgery, bronchial asthma has been effectively controlled with standard drug therapy in all patients. Non-pharmacological therapy is recommended for patients with Wolff-Parkinson-White syndrome and bronchial asthma.
Role of Vascular Endoscopy in Aortoiliac and Femoropopliteal Thromboendarterectomy
Authors: Kogel H. , Szombat M.
Published: September 2024

Over the last few years the technique of thromboendarterectomy in the aortoiliac and femoropopliteal position has experienced a renaissance. Nearly 15 years ago thromboendarterectomy was found to have an increased early occlusion rate, especially in the femoropopliteal position (8-10%), and a high late complication of myointimal hyperplasia with subsequent stenosis. Bypass procedures were preferred to thromboendarterectomy because of these reasons. A prospective study was started in Lippstadt after good results of a retrospective study from the University of Ulm (1970-1990), in which angioscopy was used as a means of intraoperative assessment during thromboendarterectomy, were reported. Some 24 aortoiliac, 11 ileofemoral and 26 femoropopliteal semiclosed thromboendarterectomies were admitted to the study. Several technical problems including intimai flaps and incomplete obliteration were detected and treated immediately under direct visualization through the angioscope. During a mean follow-up of 10 months only one patient developed an ileofemoral occlusion. No deep infection or mortality was recorded. Angioscopy reduces the early postoperative occlusion rate after thromboendarterectomy.
A Comparative Study of Endothelium-Derived Relaxing Factor-Mediated Relaxation and Smooth Muscle Cell Function in Arterial and Venous Vein Bypass Grafts
Authors: Davies M. G. , Klyachkin M. L. , Svendsen E. , Hagen P-O.
Published: September 2024

The development of intimal hyperplasia in reversed vein grafts is associated with altered endothelial and vasomotor function. This study examines the effect of surgery on the morphology and vasomotor function of experimental arterial and venous vein bypass grafts. Twelve reversed vein grafts, 12 in situ vein grafts and 12 venovenous grafts were placed in 24 New Zealand White rabbits. All grafts remained patent and were harvested after 28 days. Isometric contraction to norepinephrine, histamine, bradykinin, serotonin and relaxation to acetylcholine and sodium nitroprusside following pre-contraction with prostaglandin F2α were determined on the grafts and on contralateral jugular veins. Compared to the contralateral jugular veins, norepinephrine supersensitivity was induced in the reversed vein grafts and venovenous vein grafts but not in the in situ vein grafts. Decrease in histamine sensitivity occurred in all grafted vessels. Bradykinin responses were significantly reduced in the in situ vein grafts and reversed vein grafts. Contractile responses to serotonin developed in the in situ vein grafts and reversed vein grafts only. Acetylcholine-induced endothelium-derived relaxing factor-mediated relaxation of the contralateral jugular veins was preserved in both venovenous grafts and in situ vein grafts but was lost in reversed vein grafts. All tissues relaxed to sodium nitroprusside in dose-dependent manner. The data suggest that norepinephrine supersensitivity in reversed vein grafts results from excision of the vessel. Attenuation of bradykinin responses and the enhanced contractile responses to serotonin appear predominantly to result from arterialization. Decreases in histamine sensitivity appear related both to excision and to arterialization. Neither the excision of the vein nor arterialization individually influences the alterations in endothelium-derived relaxing factor-mediated relaxation. However, a combination of excision and arterialization results in the altered endothelium-derived relaxing factor-mediated relaxation. This study suggests that the surgical preparation of the vein and the surgical procedure used have significantly different effects on endothelium-derived relaxing factor-mediated relaxation and smooth muscle contractility in vein grafts.
Evaluation of Distal Run-off before Femorodistal Bypass
Authors: Davies A. H. , Magee T. R. , Parry R. , Horrocks M. , Baird R. N.
Published: September 2024

The quality of distal run-off is one of the most important factors in determining outcome of femorodistal bypass. Accurate evaluation is important. Preoperative intra-arterial digital subtraction angiography and Doppler evaluation with pulse-generated augmentation of 90 patients who underwent femorodistal reconstruction were compared with postoperative angiography. Underestimation of distal run-off of the calf vessels occurred in 33% of cases by preoperative intra-arterial digital subtraction angiography. A below-knee pulse-generated run-off score of 3 or less was associated with a 12-month cumulative patency of 73% compared with 85% with a below-knee pulse-generated run-off score of 4 or more ( P= 0.079, log rank test; P= 0.060, Wilcoxon signed rank test). The 12-month cumulative patency for grafts with a complete, incomplete and occluded arch as defined by pulse-generated run-off was 78.90 and 38% respectively (P< 0.0001 log rank and Wilcoxon signed rank tests). Preoperative evaluation of distal run-off before femorodistal bypass should not be based exclusively on intra-arterial digital subtraction angiography.
Cardiac Surgery in the Ninth Decade of Life
Authors: Glock Y. , Faik M. , Laghzaoui A. , Moali I. , Roux D. , Fournial G.
Published: September 2024

This study considers 96 consecutive patients of more than 80 years of age who were referred for surgery for either valve replacement (n = 51) or myocardial revascularization (n = 45) between 1985 and 1992. The patients having valve surgery consisted chiefly or aortic valve replacements (AVR), with a total of 48 (isolated in 44 and combined with another valve in 4 cases) being performed. Some 70% were in New York Heart Association (NYHA) class III and IV and 21.5% had experienced syncope. Bioprosthetic valves were implanted in all patients with an average aortic cross-clamping time of 58 min. The 1-month mortality rate was 9.8% (5/51, one mitral valve replacement and four aortic valve replacements). Death was caused by perioperative haemorrhage (one), low cardiac output (one), cardiopulmonary failure (two) and multiorgan failure (one). The morbidity rate was 64%. The actuarial survival rate was 76, 67 and 46% at 1, 2 and 4 years, respectively. By 4 years 89% were in NYHA stages I and II. Of the 45 patients having coronary artery bypass grafts, 85% were in NYHA class III or IV and 69% had progressive unstable angina. Some 29% had a stenosis of the left main coronary artery and 51% had multivessel disease. Each patient had a mean of two venous grafts. The in-hospital mortality rate was 11% (5/45) and 13% had a postoperative myocardial infarction. The actuarial survival rate was 80, 77, 60 and 58% at 1, 2, 3 and 5 years, respectively, with 85% in NYHA class I or II. In spite of their chronological age, many octogenarian patients who are in good physical condition can be operated upon for coronary artery bypass grafts or aortic valve replacement with an acceptable operative risk, good surgical outcome with improved quality of life.
Surgical Treatment of Ischaemic Valve Disease
Authors: Hachida M. , Endo M. , Bonkohara Y. , Nonoyama M. , Nishida H. , Hanayama N. , Hashimoto A. , Koyanagi H.
Published: September 2024

Mitral valve regurgitation secondary to ischaemic heart disease carries a significant mortality even after open-heart surgery. In this study, 21 patients with mitral regurgitation associated with ischaemic heart disease were evaluated with respect to valvular pathology. Pathological examination of the mitral valve revealed chorda elongation or rupture in seven patients (group 1), papillary muscle dysfunction in 10 (group 2), and papillary muscle rupture in four (group 3). Significant preoperative characteristics in each group were subacute haemodynamic deterioration in group 1, chronic severe left ventricular failure in group 2, and a high incidence of acute renal failure associated with haemodynamic shock in group 3. Mitral valve plasty was performed in six patients and mitral valve replacement, using the St Jude Medical valve, in 15. Fourteen patients underwent mitral valve surgery combined with coronary artery bypass grafting. Mitral plasty was applied to the patients with low left ventricular function with mean(s.d.) fraction shortening of 19.2(6.2)% compared with 30.2(8.4)% in patients with mitral valve replacement. There were no operative deaths. Of four late deaths, two in group 1 resulted from infection and myocardial infarction, respectively, and one in group 2 resulted from arrhythmia. One patient in group 3 died from renal failure. It is suggested that incorporation of these therapeutic concepts may lead to satisfactory results in the surgical treatment of ischaemic mitral regurgitation.
Non-invasive Testing for Cerebrovascular Disease
Authors: Lord R. S. A.
Published: September 2024

Selecting the appropriate investigation for diagnosing occlusive cerebrovascular disease depends on the availability, cost, accuracy, invasiveness and the purpose of the test. Intraarterial digital subtraction angiography remains the gold standard, but for accuracy the stenosis should be measured rather than estimated. Duplex ultrasonography is almost as accurate and can additionally analyse plaque morphology. Of 2651 duplex tests carried out in our laboratory. 12.2% were for reversible ischaemic attacks, 2.7% for amaurosis, 12.1% for cervical bruit and 4.3% for vertebrobasilar ischaemia. Duplex within 30 days of operation was carried out on 607 patients (22.9%) and surveillance on 1000 others (37.7%). Asymptomatic carotid stenosis >60% should be confirmed by intra-arterial digitial subtraction angiography, magnetic resonance angiography or spiral computed tomography angiography. For typical transient ischaemic attacks, duplex or angiography alone is adequate but when the clinical presentation is atypical, a confirming test is required. Routine preoperative brain computed tomography is not cost-effective, being equivalent to US$ 4300–11 840 per perioperative stroke in our institution. Postoperative surveillance is justified, costing only US$ 505 per patient over 4 years.
Clinical and Vascular Laboratory Determinants for Outcome After Infrainguinal Atherectomy
Authors: Myers K. A. , Zeng G. H. , Ziegenbein R. W. , Denton M. J. , Devine T. J. , Matthews R. G.
Published: September 2024

Three surgeons performed 180 atherectomy procedures in 161 patients using the Transluminal Extraction Catheter in 144 and the Auth Rotablator in 36. The primary patency rate was 55% at 1 year and 46% at 2 years, and failure was caused by stenosis in 28 (15.6%) and occlusion in 61 (33.7%) limbs. Multivariate Cox regression analysis showed significantly better outcome if the indication was claudication, the lesion was short or there was associated stenting. Vascular laboratory surveillance was performed in 93 limbs in 83 patients. Cox regression analysis in this subgroup also showed a significant relationship between outcome and the maximum peak systolic velocity from a duplex scan at the last study performed. Receiver operating characteristics curves showed that a raised maximum peak systolic velocity best predicted late failure (sensitivity 84%, specificity 66% for >200cm/s; sensitivity 72%, specificity 84% for >250cm/s); the velocity ratio at the stenosis to that in the segment above or the resting ankle/brachial pressure index were less predictive. For 50 procedures studied in the vascular laboratory which remained successful to the end of the study, maximum peak systolic velocities were >250cm/s from the first postoperative study, suggesting residual stenosis in 6%, or increased to become >250cm/s by the last study, suggesting recurrent stenoses in 12%. For 43 procedures which were studied and later failed, velocities were >250cm/s from the first test in 26% or increased to >250cm/s by the last test before failure in 40%. Vascular laboratory surveillance helps to predict outcome after atherectomy. Failure may be a result of residual disease from the time of the procedure or from restenosis. The apparent high incidence of clinically manifest or developing stenoses raises doubts as to the benefit of atherectomy over balloon dilatation alone.