bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental autotransplantation of the parathyroid gland
Authors: Prigouris S , Lorentziadis M , Stylogiannis S , Nafas R , Masouras A , Poulantzas I
Published: March 2007

The lateral parathyroid gland of the rabbit was resected and autotransplanted under an ear skin flap. A skin flap at the opposite side was used as control. The success of autotransplantation was established by microangiography of the transplant and by measuring plasma concentrations of parathyroid hormone (PTH), calcium and phosphorus. After 4 months the animals were killed and the transplant was studied histologically and by electron microscopy. Fourteen animals were included in the study. There was an increase in PTH derived from the transplanted gland after 4–6 postoperative days. All animals developed hypocalcaemia during the 3 days after transplantation. There were no significant changes in serum phosphorus. Transplantation did not alter the morphology of the distribution of the cells in the transplanted gland, which functioned normally after the fourth postoperative day.
Intestinal glycosaminoglycans in neonatal necrotizing enterocolitis
Authors: Ade-Ajayi N , Spitz L , Kiely E , Drake D , Klein N
Published: March 2007

Advanced necrotizing enterocolitis (NEC) is a common neonatal surgical emergency of unknown aetiology. Despite improvements in the prognosis, the aggressive form of the disease is still associated with significant rates of morbidity and mortality. Recent evidence indicates that the extracellular matrix (ECM) is important in gastrointestinal development and glycosaminoglycans, major constituents of the ECM, are attenuated in inflammatory bowel disease. The hypothesis of this study was that changes in the nature and distribution of intestinal glycosaminoglycans occur in NEC. The distribution and nature of glycosaminoglycans were determined in 31 sections of well preserved resection margins and severely diseased bowel from eight neonates affected by NEC. An established histological method of glycosaminoglycans analysis using cationic gold with silver enhancement was employed in this study. The identity of specific glycosaminoglycans was also elucidated using a combination of cationic gold staining and glycanase digestion. In well preserved tissue, staining was seen throughout the full thickness of the bowel. The epithelial basement membrane and basolateral surfaces, lamina propria and submucosa were particularly prominent. In moderate disease, patchy loss of anionic sites was frequently observed with glycosaminoglycans-deficient areas adjacent to intact sites. In severe NEC, there was extensive loss of glycosaminoglycans in most of the sections examined. Glycanase analysis revealed that the glycosaminoglycans in well preserved tissue were sensitive to chondroitinase ABC and only vascular sites were sensitive to heparinase III. The consequences of glycosaminoglycans loss in NEC as demonstrated in this study are not known but modulation of gastrointestinal glycosaminoglycans could be important in the pathogenesis of NEC and may underlie some of the clinical manifestations of this condition.
Subrectus pouch for renal transplantation
Authors: Wheatley T J , Doughman T M , Veitch P S , Nicholson M L
Published: March 2007

Correct positioning of a renal transplant following implantation and revascularization is a vitally important and sometimes difficult part of the operation. If the renal vessels are, or become, kinked, acute thrombosis may result in graft loss. Kidney transplants arc normally positioned in the retroperitoneal space of the iliac fossa, lying in the gutter formed by the iliopsoas muscle (the traditional lateral position)1,2. In this position the vessels run medially from the hilum of the kidney and vessel kinking can usually be avoided by rotating the kidney carefully until the correct lie is found. Nevertheless some kidneys are difficult to position in this way and in these cases it is advantageous to place the transplant kidney in a specially fashioned subrectus pouch.
E-cadherin and its associated protein catenins, cancer invasion and metastasis
Authors: Jiang W G
Published: March 2007

E-cadherin is a cell-cell adhesion molecule which is anchored to the cytoskeleton via catenins. There is increasing evidence which suggests that E-cadherin also acts as a suppressor of tumour invasion and metastasis. Both in vitro and in vivo studies have revealed that expression of E-cadherin correlates inversely with the motile and invasive behaviour of a tumour cell; it also correlates inversely with metastasis in patients with cancer. The function of E-cadherin is highly dependent on the functional activity of catenins. This review summarizes progress, from both basic and clinical research, in our understanding of the roles of E-cadherin and catenins, and discusses the clinical relevance of the discoveries.
Role of endoscopic injection therapy in the treatment of bleeding peptic ulcer
Authors: Kubba A K , Palmer K R
Published: March 2007

Of patients with peptic ulceration who are actively bleeding at endoscopy, 80 per cent will continue to bleed or rebleed in hospital; 50 per cent of those who have a non-bleeding visible vessel will also rebleed. Endoscopic injection treatment stops active bleeding and prevents further haemorrhage in most of these patients. The mechanism of action may include tamponade, vaso-constriction, sclerosis, tissue dehydration and thrombogenesis; substances injected include adrenaline, sclerosants, alcohol, thrombin, or a combination of agents. Although trials often define the need for surgery as an injection treatment failure, an alternative view is that endoscopic control may facilitate safe, early, elective surgery. A successful outcome may require a combination of endoscopic and operative approaches.
Hepatic bile acid synthesis and DNA synthetic rate after partial hepatectomy
Authors: Chijiiwa K , Kozaki N , Naito T , Okamoto S , Kuroki S , Yamashita H , Tanaka M
Published: March 2007

The relationship between hepatic DNA synthetic rate and activity of cholesterol 7α-hydroxylase, the rate limiting enzyme for bile acid synthesis, was examined in regenerating liver after partial hepatectomy or sham operation in rats. Hepatic cholesterol 7α-hydroxylase activity was significantly (P < 0·001) suppressed on days 1 and 2, returned to the control level on day 3, and was significantly raised on day 7 after hepatectomy. The rate of DNA synthesis was significantly (P < 0·001) activated during the first 3 days after hepatectomy and returned to the control level on day 7. Enzyme activities regulating hepatic bile acid synthesis and DNA synthesis change inversely during liver regeneration after hepatectomy.
Use of the carbon dioxide laser to manage cutaneous metastases from malignant melanoma
Authors: Hill S , Thomas J Meirion
Published: March 2007

Between October 1988 and November 1994, 100 patients with cutaneous metastases from malignant melanoma were treated by carbon dioxide laser ablation under local or general anaesthesia as appropriate. There were minimal postoperative complications and most wounds healed within 6 weeks. A total of 34 of the 53 patients in this series with stage IIIa disease were controlled with four or fewer laser ablations during the first year from presentation. This technique provides a simple effective alternative to hyperthermic isolated limb perfusion with melphalan. Patients with disease not controlled by laser can be considered for isolated limb perfusion.
Endovascular repair of abdominal aortic aneurysm: An initial experience
Authors: Nasim A , Thompson M M , Savers R D , Bolia A , Bell P R F
Published: March 2007

Endovascular repair of abdominal aortic aneurysm (AAA) was attempted in ten patients over a 12-month period. Median age was 72 (range 61–82) years and median AAA diameter was 5·5 (range 5·2–6·0) cm. An aortoaortic (tube) graft was used in seven patients and a tapered aortoiliac reconstruction in three. There were two failures requiring conversion to open repair. Additional procedures included iliac artery angioplasty (two), coil embolization of an associated common iliac aneurysm (one) and femorodistal bypass (one). Median operating time was 162 (range 95–270) min and median blood loss was 1200 (range 800–2000) ml. Median hospital stay was 9 (range 5–21) days. Complications included death (one), reversible acute tubular necrosis (one) and prolonged ventilation (one). Postoperative evaluation with duplex ultrasonography and computed tomography demonstrated three perigraft leaks (two proximal and one distal). It is concluded that endovascular repair of AAA is feasible but is associated with significant complications and requires careful evaluation before widespread use.
Prognostic value of positive cytology findings from abdominal washings in patients with gastric cancer
Authors: Bonenkamp J J , Songun I , Hermans J , van De Velde C J H
Published: March 2007

The poor prognosis of patients with gastric cancer with free abdominal tumour cells on cytological examination has been described in Japan. In a randomized trial in the Netherlands comparing D1 and D2 lymphadenectomy for gastric cancer, patients were subjected to cytological examination of abdominal washings on an optional basis; findings were of no consequence for scheduled treatment. Cytology results in 535 patients were obtained, in 457 (85·4 per cent) after curative resection and in 78 (14·6 per cent) after palliative operation. There was a clear association of positive cytology results with serosal invasion (12 per cent positive cytology) and lymph node infiltration (7·5 per cent positive cytology). Survival of those with positive cytology results was significantly lower than that of those with negative findings, irrespective of the procedure employed (curative or palliative). Cytological examination of abdominal washings increases the accuracy of staging and improves the selection of patients suitable for curative or palliative resection.
Role of the Should ice technique in inguinal hernia repair: A systematic review of controlled trials and a meta-analysis
Authors: Simons M P , Kleijnen J , van Geldere D , Hoitsma H F W , Obertop H
Published: March 2007

The Shouldice technique for inguinal hernia repair has been suggested by some authors as the best conventional method against which other methods using prostheses should be compared. The paper which follows is a systematic review involving a comprehensive search of the medical literature to identify all clinical trials (article or abstract) evaluating the Shouldice repair. After assessment of certain quality criteria, the best studies were pooled in a meta-analysis. Nine publications were found with 11 study arms. In ten studies the results of the Shouldice technique were better than the results of the control arm. Six studies could be pooled in a meta-analysis of 2500 patients; Shouldice was significantly better than control methods (relative risk 0·62 (95 per cent confidence interval 0·45–0·85)). In spite of possible bias caused by different variables (modifications in operative technique, suture material, level of surgeon, follow-up methods and outcome measurement), the results of this systematic review suggest that the Shouldice method is the best current conventional technique for inguinal hernia repair.
Xanthine oxidase in critically ischaemic and claudicant limbs: Profile of activity during early reperfusion
Authors: Trewick A L , El-Hassan K , Round J M , Adiseshiah M
Published: March 2007

Xanthine oxidase activity in blood from the ipsilateral femoral vein, and the relationship between xanthine oxidase production and the products of lipid peroxidation, were studied before operation and for 60 min following release of clamps after successful revascularization in two groups of patients with claudication or critical ischaemia. Before revascularization, detectable levels of xanthine oxidase were found only in patients with critical ischaemia. Clamping during bypass surgery led to release of xanthine oxidase in claudicants, but this activity reduced after 60 min. There was no evidence of lipid peroxidation during this time. Xanthine oxidase activity in brachial vein blood was higher than in femoral vein blood in patients with critical ischaemia before revascularization.
Diagnostic role of cytology in screen-detected breast cancer
Authors: Yiangou C , Davis J , Livni N , Barrett N K , Sinnett H D
Published: March 2007

Fine-needle aspiration cytology (FNAC) of the breast was performed in 491 patients over a 3-year period. Some 365 examinations (74·3 per cent) were performed by palpation and the remaining 126 (25·7 per cent) by stereotaxis. Ninety-six patients were excluded because of inadequate follow-up. Using a standard method of reporting the results 247 smears were classified as Cl and C2, but based on clinical and radiological criteria excision biopsy was recommended and performed in 122 patients with these lesions. Twenty-two per cent of C2 lesions were found to be malignant after histological examination. Forty-two patients with C3 or C4 cytology were advised to have excision biopsy and 41 had surgery. In all but one case the lesion was found to be malignant histologically. Definitive surgery was performed on 106 patients with C5 cytology and the diagnosis of malignancy was confirmed histologically in 105 of them. FNAC is a useful diagnostic tool in breast screening but in view of the number of false-negative results, cytology alone is unreliable and, therefore, full triple assessment is recommended.
Periductal mastitis and duct ectasia: Different conditions with different aetiologies
Authors: Dixon J M , Ravisekar O , Chetty U , Anderson T J
Published: March 2007

A prospective study of 14225 patients has been undertaken to determine the inter-relationship between periductal mastitis and duct ectasia and to establish whether there is an association between smoking and either of these two conditions. Periductal mastitis affected women at a younger age than did duct ectasia. Of 139 patients with the clinical syndrome of periductal mastitis, 97 (70 per cent) had a past history of previous periductal mastitis, compared with only one (1 per cent) of 186 patients with the clinical syndrome of duct ectasia (P< 0·0001). There was a significant excess of smokers in patients with clinically (124 (89 per cent) of 139) and pathologically (71 (91 per cent) of 78) diagnosed periductal mastitis compared with age-matched controls (both P< 0·001), but there was no such excess in those with clinically (52 (28 per cent) of 186) or pathologically (15 (23 per cent) of 64) diagnosed duct ectasia. These data suggest that periductal mastitis and duct ectasia are separate conditions which affect different age groups, have different aetiologies, and should now be considered as separate entities.
Magnetic resonance imaging of thyroid swellings
Authors: Bagley J S , Ewen S W B , Smith F W , Krukowski Z H
Published: March 2007

The preoperative diagnosis of some thyroid neoplasms remains difficult even with the routine use of fine-needle aspiration cytology. The potential of nuclear magnetic resonance imaging (MRI) to discriminate between different thyroid pathologies was explored prospectively and compared with the final pathology in a series of 37 patients. MRI yielded high-quality images of the thyroid swelling but did not provide additional information to differentiate benign from neoplastic lesions. MRI does not contribute to the routine management of thyroid swellings.
An audit of the management of patients with acute pancreatitis against national standards of practice
Authors: Mofidi R , Madhavan K K , Garden O J , Parks R W
Published: March 2007

Background

The aim of this study was to audit the management of patients with acute pancreatitis against the standards of practice in the British Society of Gastroenterology guidelines.

Methods

The study assessed consecutive patients with acute pancreatitis over 5 years. Audit targets were overall mortality below 10 per cent, mortality for severe acute pancreatitis below 30 per cent, correct diagnosis and severity stratification within 48 h, aetiology determined in more than 80 per cent, availability of computed tomography and high-dependency or intensive therapy units when indicated and definitive treatment of gallstone pancreatitis within 2 weeks.

Results

Of 759 patients with acute pancreatitis, 219 (28·9 per cent) had severe acute pancreatitis (SAP). Overall mortality was 5·9 per cent, and 19·6 per cent in those with SAP. Acute pancreatitis was diagnosed within 48 h of presentation in 96·3 per cent of patients. The definitive aetiology was classified in 87·5 per cent. Of patients with SAP, 95·9 per cent underwent computed tomography within 6–10 days of admission. Of 93 patients with severe gallstone pancreatitis, 48 per cent had urgent endoscopic retrograde cholangiopancreatography, and 89·6 per cent of 359 patients with acute gallstone pancreatitis underwent definitive management within 2 weeks of admission.

Conclusion

Patients with acute pancreatitis can be managed according to revised guidelines with a low associated mortality.
Prolonged coronary splinting in the management of acute coronary closure
Authors: Little Thomas
Published: March 2007

Acute closure is an infrequent but serious complication of PTCA that is often unsuccessfully treated by repeat dilatation. Two patients with acute closure refractory to repeat conventional PTCA were treated with prolonged coronary “splinting” using low‐pressure reperfusion catheter balloon inflations of 11 and 15 h duration. The patients developed no chest pain or ST‐segment changes during this period. The serum creatine kinase rose to 738 and 372 U/L, respectively. Neither patient evolved a Q‐wave myocardial infarction. Both patients remain asymptomatic after 6 months of follow‐up.
Magnum system for routine coronary angioplasty: A randomized study
Authors: Nukta Emad Dean , Meier Bernhard , Urban Philip , Muller Thierry , Dorsaz Pierre A. , Favre Josiane
Published: March 2007

The Magnum system, initially designed for coronary angioplasty (PTCA) of chronic total occlusion, consists of a balloon catheter and a solid steel 0.021 inch (0.53 mm) steerable and removable wire with a soft and moldable distal portion, tipped with a 1 mm olive. To evaluate its performance in routine PTCA, 200 unselected consecutive patients were randomized to two equal groups, i.e., group Magnum (100 patients, 115 vessels) and group Standard (100 patients, 118 vessels) including 18 and 21 patients with chronic total occlusions, respectively.

Randomization was performed by the sealed envelope system in the catheterization laboratory and crossover of system was imposed if it was not possible to place a balloon correctly within 20 min of fluoroscopy time.

There were no significant differences between groups concerning clinical and angiographic baseline characteristics, size of initial balloons (3.0±0.3 mm in both groups), fluoroscopy time to cross the lesion with the wire (Magnum: 4±5, Standard: 5±6 min), total fluoroscopy time (Magnum: 11 ± 9, Standard: 12±12 min), and need for crossover (Magnum: 10%, Standard: 16%). Success rates per lesion were comparable with 90% in group Magnum and 84% in group Standard, as were the complications with one inhospital death in group Standard, occurring three weeks after PTCA and stent implantation. There was no emergency operation. Six patients per group had myocardial infarction of whom two in group Magnum and one in group Standard developed a Q‐wave.

The following variables were significantly in favor of the Magnum system compared with the Standard system: success rate in nontotal lesions (97% versus 90%) crossover success in total occlusions (0 vs. 33%), fluoroscopy time to cross the lesion with the balloon once the wire was in place (1 ± 2 vs. 2 ± 4 min), and use of a single versus 1.2±0.5 wires per lesion. The only advantage of the Standard systems was the more common use of 7 French guiding catheters (Magnum: 40%, Standard: 53%, p = 0.09).

The Magnum system compares favorably with standard systems for routine PTCA. The robust design of the Magnum wire does not impair ease of placement and safety but saves material and facilitates balloon advancement across the lesion.
Preprocedure warfarinization and brachial approach for elective coronary stent placement—a possible strategy to decrease cost and duration of hospitalization
Authors: Rosenschein Uri , Ellis Stephen G.
Published: March 2007

Intracoronary stenting, while potentially beneficial to treat abrupt closure and to prevent restenosis after angioplasty, requires intermediate‐term warfarinization to prevent stent thrombosis. Hospitalization is often prolonged because of the need to establish antico‐agulation. Hospital charges have been reported to be considerably higher with stenting than with balloon angioplasty alone, although the long‐term cost ramifications remain uncertain due to the fact that stenting may limit restenosis. We describe a technique wherein stent placement is performed while the patient is already partially anticoagu‐lated, which may decrease costs associated with stenting.
Virtual real‐time digital processing of hemodynamic data
Authors: Corin William J. , George David T. , Reilley Joanne Y. , Santamore William P.
Published: March 2007

At present, the majority of cardiac catheterization laboratories acquire and store hemo‐dynamic data in analog form. To examine the possibility of performing complex analysis of digital data during the catheterization procedure, we examined whether virtual realtime digital (fast Fourier) analysis improves the accuracy of clinical data. We compared digital filtering of fluid manometry during right heart catheterization with 10‐Hz and 250‐Hz analog filters. Using the simultaneously acquired micromanometry as the “gold standard,” we found that analog filtering is associated with a greater error and time delay than digital filtering. This study demonstrates that digital hemodynamic data analysis performed during cardiac catheterization can improve the quality of data obtained during right heart catheterization, with the results available within seconds. More extensive use of computers in the cardiac catheterization laboratory may be useful for both clinical and research purposes. © 1992 Wiley‐Liss, Inc.
Intracoronary thrombolysis followed by directional atherectomy: A combined approach for thrombotic vein graft lesions considered unsuitable for angioplasty
Authors: Sabri M. Nagui , Johnson Danna , Warner Mark , Cowley Michael J.
Published: March 2007

Eccentric complex vein graft lesions with abundant luminal thrombus have been generally considered unfavorable for balloon angioplasty. We present 3 patients in whom such lesions were successfully treated by a combined approach: intracoronary urokinase (1 million units over 1 hr) administered in the catheterization laboratory followed by directional atherectomy of the residual lesions in 2 separate procedures; with the patients maintained on heparin infusion between the 2 stages. No distal embolizations were encountered. Two of the 3 patients developed a groin hematoma without vascular compromise. This combined approach may prove to be an attractive alternative to reoperation in select patients with unfavorable vein graft lesions. © 1992 Wiley‐Liss, Inc.
A doppler guided retrograde catheterization system
Authors: Frazin Lee J. , Vonesh Michael J. , Khasho Fouad , Lanza Gregory , Chandran Krishnan B. , Talano James V. , McPherson David D.
Published: March 2007

A Doppler guided retrograde catheterization system was developed to accurately cathe‐terize the aortic root and left ventricular chamber without X‐ray. This system consists of a 20 MHz, 0.076 mm thick × 1.016 mm diameter pulsed Doppler crystal integrated into the tip of a 100 cm multipurpose triple lumen catheter. Two lumens (0.61 mm) are used for electrodes; a third lumen (1.245 mm) may be used for guidewire and pressure determination; and the system is attached to a flow velocimeter. In an aortic arch flow model, the principles of Doppler signal guidance were confirmed with flow toward the catheter tip demonstrating positive signals and flow away from the catheter tip demonstrating negative signals. The magnitude and polarity (direction) of the detected phasic and mean velocities were utilized to guide catheterization in six dogs. Using the reversal of Doppler signal polarity to indicate branch entry and manipulating the catheter so as to maintain maximal positive axial velocity, the Doppler catheter was successfully advanced from the femoral artery to the aortic valve. Branches detected by the Doppler system were confirmed by fluoroscopy. The aortic valve was audible when approached and the left ventricular chamber was recognized by its characteristic pressure waveform. The Doppler guided retrograde catheterization system offers new technology to perform left heart catheterization without X‐ray and may prove useful in a variety of settings including the development of invasive ultrasonic diagnostic and therapeutic technology. © 1992 Wiley‐Liss, Inc.
A technique to access severely diseased arteries
Authors: Goudreau Evelyne , Vetrovec George W.
Published: March 2007

Cardiac catheterization performed in patients with severe peripheral vascular disease may represent a difficult technical challenge and is associated with a higher incidence of vascular complications. We describe a technique that uses angioplasty equipment to access severely diseased arteries. This technique allows a percutaneous transluminal coronary angioplasty (PTCA) guide wire to be steered across vascular lesions under direct visualization of the lumen and continuous pressure monitoring, potentially reducing the risk of vascular complications. © 1992 Wiley‐Liss, Inc.
Acquired postoperative coronary arteriovenous fistula
Authors: Pattee P.L. , Chambers R.J.
Published: March 2007

A patient is described who underwent closed mitral valvotomy and presented 21 years later with left ventricular failure. Coronary angiography revealed a coronary artery to pulmonary vein arteriovenous fistula. This is the first report of an acquired fistula of this type developing secondary to trauma associated with cardiac surgery. Diagnosis and treatment implications are discussed. © 1992 Wiley‐Liss, Inc.
A word of caution: Reopening chronic coronary occlusions
Authors: Burger Wolfram , Kadel Christoph , Keul Hans Georg , Vallbracht Christian , Kaltenbach Martin
Published: March 2007

Reopening of chronically occluded coronary arteries by angioplasty, initially considered a low risk procedure, may carry similar risks at PTCA of coronary stenoses. We report 3 cases with ventricular fibrillation or sudden death 2–4 days after reopening of 1‐ to 5‐month‐old coronary occlusions.
Aspiration of a mobile thromboembolus from saphenous vein graft
Authors: Cohen Harry M. , Kleiman Jay H.
Published: March 2007

An 81‐year‐old woman who was 4 years post 3‐vessel coronary artery bypass graft (CABG) surgery suffered a non‐Q‐wave myocardial infarction. Angiography revealed the recent occlusion of a saphenous vein graft (SVG) to an obtuse marginal coronary artery. Five days following failure of intragraft urokinase and systemic heparinization to recanalize the SVG, balloon angioplasty was undertaken. A mobile thrombus was observed to migrate spontaneously in a retrograde manner in the SVG and was removed during PTCA by aspiration through the guiding catheter.
The usefulness of a tracking catheter in complex coronary angioplasty
Authors: Tatineni Satyanarayana , Kern Morton J. , Aguirre Frank , Donohue Thomas , Bach Richard , Bell Calvin
Published: March 2007

Complex lesion angioplasty, such as chronic total occlusions, coronary vessels with right angle take‐offs, tortuous vessels, and tortuous internal mammary artery or saphenous vein grafts is a continuing challenge. The complex problems have been successfully managed with novel guiding catheter shapes and ultralow profile balloons. However, on occasion steerable guidewire placement remains extremely difficult, despite significantly improved means of intracoronary manipulations.
Does the AHA/ACC task force grading system predict outcome in multivessel coronary angioplasty?
Authors: Moushmoush Bassam , Kramer Barry , Hsieh Ann‐Ming , Klein Lloyd W.
Published: March 2007

To assess the ACC/AHA task force grading system as a predictor of outcome in patients undergoing multivessel percutaneous transluminal coronary angioplasty we analyzed all failures (residual stenosis >50%, Q‐wave myocardial infarction, coronary artery bypass grafting during hospitalization, or death) in 97 patients with 328 stenoses. There were 70 males and 27 females; 60 patients had stable angina, and 37 had unstable angina. The mean number of lesions dilated per patient was 3.4 (range 2‐8). The mean preangioplasty percent luminal diameter narrowing was 80 ± 14%. Thirty‐eight stenoses were AHA/ACC classification type A, 192 type B, and 98 type C. One hundred twenty‐eight lesions were located in the left anterior descending artery or its distribution, 89 in the left circumflex, 96 in the right coronary artery, and 15 in other vessels. Procedural success (<50% residual diameter narrowing and no major ischemic complications) was achieved in 266 lesions (81.1%). Major ischemic complications (death, myocardial infarction, or emergency bypass surgery) occurred in 8 patients (8.2%) and in‐hospital mortality was 2%. Analysis on a per stenosis basis demonstrated 84% success in type A, 89% in type B, and 64% in type C (p <0.0001). When type B was divided into type B1 (1 type B characteristic) and type B2 (two or more type B characteristics) the success rate was 90% vs. 88% and the complication rate was 1% vs. 2%, respectively (p = n.s.). Logistic regression analysis showed that the best single predictor of failed angioplasty was total occlusion >3 months, followed by total occlusion <3 months and severely angulated (>90°) segment. No clinical variables (age, sex, angina type, previous PTCA, or previous thrombolytic therapy) were predictive of adverse outcome. Thus, the standard ACC/AHA grading system does predict lesions at increased risk of adverse outcome in multivessel percutaneous coronary angioplasty; however, the use of only a few criteria open to less subjective interpretation would be simpler and more relevant to clinical use.
An unusual cause of recurrent angina two years after coronary artery bypass grafting: Fistula between internal mammary artery graft to pulmonary vasculature
Authors: Birnbaum Yochai , Wurzel Mordechai , Nili Moshe , Vidne Bernardo A. , Menkes Hanoch , Teplitsky Igal
Published: March 2007

A 55‐year‐old man developed recurrent angina pectoris 2 years after coronary artery bypass grafting. Cardiac catheterization demonstrated that the venous grafts were patent, but selective left internal mammary angiogram showed multiple fistulous connections between the internal mammary artery and the pulmonary vasculature of the left upper lobe. After surgical correction of the fistula, the angina resolved. Only three previous cases of acquired internal mammary artery graft fistulas draining to the pulmonary vasculture have been described. The etiology, clinical presentation, and management of an internal mammary artery fistula to the pulmonary vasculature are discussed.
The perfusion pattern in coronary artery occlusion: Comparison of exercise and adenosine
Authors: Iskandrian Abdulmassih S. , Kegel Jeffrey , Heo Jaekyeong , Ogilby J. David , Untereker William J. , Cave Virginia
Published: March 2007

This study compared exercise to adenosine thallium‐201 single photon emission computed tomography in detecting occlusion of left anterior descending or right coronary arteries in patients with no previous myocardial infarction. There were 41 patients who underwent adenosine thallium imaging (adenosine infusion at a rate of 140 μg/kg/min for 6 min), and 143 patients who underwent exercise thallium imaging. There were more patients with right coronary than left anterior descending coronary artery occlusion. Thus, in the adenosine group, there were 15 patients with left anterior descending artery occlusion, and 26 with right coronary artery occlusion, and in the exercise group, there were 46 patients with left anterior descending artery occlusion, and 97 patients with right coronary artery occlusion. In the adenosine group, the thallium images were abnormal in 41 patients (100%), while in the exercise group, the thallium images were abnormal in 125 patients (87%, P < 0.02) in the territories of the occluded arteries. ST segment depression was noted in 19 patients (46%) in the adenosine group, and 69 patients (48%) in the exercise group (P: NS). In patients with isolated single vessel occlusion, the size of the perfusion abnormality was 28 ± 9% with adenosine, and 21 ± 12% with exercise (P: NS). Thus, most patients with occlusion of the left anterior descending or right coronary artery have regional perfusion abnormality during stress; the different role of collaterals with each type of stress may explain the higher percentage of abnormal results with adenosine than exercise.
Early postoperative occlusion of a left internal mammary artery bypass graft with subsequent restoration of patency
Authors: Feld Harry , Navarro Victor , Kleeman Harris , Shani Jacob
Published: March 2007

Total occlusion of a left internal mammary artery (LIMA) bypass graft is a rare complication, and reversal of a documented occlusion has not been reported. This is a case of an early postoperative occlusion of a LIMA graft that was found to be patent 4 months later.

A patient with three vessel disease (including a moderate lesion in the proximal left anterior descending artery and a severe lesion in its mid‐portion) underwent coronary artery bypass grafting with a LIMA to the mid‐left anterior descending artery (LAD) and saphenous vein grafts to the right coronary and left circumflex arteries. Coronary angiography 3 months after surgery revealed a totally occluded internal mammary artery and saphenous vein grafts. The patient then underwent a successful angioplasty of the more distal lesion in the LAD. She subsequently returned with recurrent angina. Repeat coronary angiography revealed rapid progression of the disease in the proximal LAD with the more distal angioplasty site being widely patent. Selective arteriography of the internal mammary artery at that time revealed a patent vessel.

Thus, the internal mammary graft is a physiologically active conduit that is dependent on flow dynamics. Competitive flow through the nonobstructive native LAD in combination with impedance of flow through the internal mammary artery due to a severe lesion in the LAD distal to the anastomosis led to a functionally occluded LIMA. When the obstruction in the proximal LAD progressed and the distal obstruction was successfully angioplastied, the flow dynamics in the internal mammary improved, allowing for its dilatation and restoration of patency. Therefore, an angiographically occluded internal mammary graft may be only functionally occluded and reversible even when the occlusion is demonstrated several days apart.
Parallel angioplasty dilatation catheter and guide wire: A new technique for the dilatation of calcified coronary arteries
Authors: Yazdanfar Shahriar , Ledley Gary S. , Alfieri Anthony , Strauss Clifford , Kotler Morris N.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) of heavily calcified rigid coronary arteries has decreased success and increased complication rates. Three cases are presented describing a new technique for the dilatation of severely calcified coronary arteries that were not dilatable by conventional angioplasty methods. This technique involves the use of a balloon dilatation catheter system parallel to a guide wire. © 1993 Wiley‐Liss, Inc.
Direct deployment of the iliofemoral balloon expandable (PalmazTM) stent utilizing a small (7.5 French) arterial puncture
Authors: Dorros Gerald , Mathiak Lynne
Published: March 2007

A new, smaller (7.5F) stent delivery sheath system is described for deployment of the iliofemoral large balloon expandable (PalmazTM) stainless steel stent which allows a brachial or ipsilateral retrograde femoral or popliteal approach. The procedure described does not require predilatation of the lesion prior to stent deployment. © 1993 Wiley‐Liss, Inc.
Selective coronary angiography via antegrade venous route in congenital cyanotic heart disease
Authors: Loya Yunus S. , Pinto Robin J. , Desai Dhruman M. , Sundaram Usha , Bhagwat Ajit R. , Sharma Satyavan
Published: March 2007

An antegrade venous technique was utilised to perform selective coronary angiography in cyanotic infants and children. The procedure was successful in 88% (37/42) cases and excellent quality angiograms were recorded. The importance of proper catheter selection and details of the technique are discussed. © 1993 Wiley‐Liss, Inc.
Digital geometric measurements in comparison to cinefilm analysis of coronary artery dimensions
Authors: Haase JÜRgen , Nugteren Stineke K. , Swijndregt Eline Montauban Van , Slager Cornelis J. , Mario Carlo Di , De Feyter Pim J. , Serruys Patrick W.
Published: March 2007

Six months follow‐up post‐PTCA angiograms from 31 patients were acquired digitally and on cinefilm and used for a comparison of geometric coronary measurements at the site of the previous dilatation. On 70 images of 34 coronary segments quantitative analysis was performed both on‐line, using the Automated Coronary Analysis package of the Philips Digital Cardiac Imaging System (DCI, pixel matrix 512 × 512) and off‐line, using the Cardiovascular Angiography Analysis System (CAAS). With the CAAS a cine‐video conversion is performed and a 6.9 × 6.9 mm region of interest from the 18 × 24 mm cineframe is digitized into a 512 × 512 pixel matrix. In both systems the vascular contours are assessed by means of operator‐independent edge detection algorithms. The angiographic catheter was used for calibration.

Best agreement between DCI and CAAS was found for obstruction diameter and minimal luminal diameter, respectively (r = 0.82; y = 0.12 + 0.97x; SEE = 0.29). The reconstructed reference diameter related to a computed reference contour yields lower correlation (r = 0.76; y = 0.27 + 0.91x; SEE = 0.37). Worst results were obtained from the relative measure of percent diameter stenosis as well as from the derived parameter of plaque area.

The on‐line digital approach of geometric coronary assessments provides good agreement with cinefilm analysis when direct measurements of coronary dimensions are applied. © 1993 Wiley‐Liss, Inc.
Superior accuracy of anatomic positioning with echocardiographic‐ over fluoroscopic‐guided endomyocardial biopsy
Authors: Bell Calvin A. , Kern Morton J. , Aguirre Frank V. , Donohue Thomas , Bach Richard , Wolford Thomas , Penick Danny , Ofili Elizabeth , Miller Leslie , Labovitz Arthur J. , Anthonis Dennis , Vrain Jan S. T.
Published: March 2007

To assess the superior anatomic positioning of echocardiographic‐guided endomyocardial biopsy compared to traditional fluoroscopic‐guided technique, these two modalities were compared in a blinded fashion during femoral sheath endomyocardial biopsy in 21 patients, 19 being evaluated after orthotopic cardiac transplantation. The simultaneous fluoroscopic and echocardiographic imaging indicated that traditional fluoroscopic positioning of the bioptome against the septum is inaccurate in over half of patients undergoing biopsy. This finding should be considered in cardiomyopathy patients or those at high risk for biopsy‐related complications. © 1993 Wiley‐Liss, Inc.
Characterization of a saphenous vein graft aneurysm by intravascular ultrasound and computerized three‐dimensional reconstruction
Authors: Ennis Bruce M. , Zientek David M. , Ruggie Neal T. , Billhardt Roger A. , Klein Lloyd W.
Published: March 2007

Aneurysmal dilatations in saphenous vein grafts are rare complications of coronary artery bypass surgery that mostly represent thin‐wall pseudoaneurysms at anastomotic sites. We describe a case of an enlarging distal saphenous vein graft aneurysm in which intravascular ultrasound (IVUS) and computerized three‐dimensional reconstruction (3DR) of the IVUS images was performed to conclusively demonstrate true aneurysm morphology. Although both atherosclerotic and nonatherosclerotic mechanisms for vein graft aneurysm formation have been previously suggested, IVUS images and 3DR of the aneurysm in this case did not reveal any of the features typical for atherosclerotic lesions. Further, the IVUS images and 3DR suggest that progressive atherosclerosis is not the likely cause of aneurysm formation in this case. This application of IVUS and 3DR provides detailed information about saphenous vein graft aneurysm structure, clues to aneurysm formation, and suggests a natural history that may differ from that of pseudoaneurysms. © 1993 Wiley‐Liss, Inc.
Tetralogy of fallot in a 71‐year‐old patient with new onset hypoxemia
Authors: Nottestad Sheri Y. , Slife David M. , Rubal Bernard J. , Moody Joe M.
Published: March 2007

This study reports the evaluation and successful surgical management of a 71 year‐old female with known Tetralogy of Fallot and symptomatic hypoxemia. A hybrid (fluid‐micromanometer) catheter system was employed to examine right heart pressure gradients. This case presents unique hemodynamics along with angiography and palliative surgical management. © 1993 Wiley‐Liss, Inc.
Percutaneous embolization of an arteriovenous fistula of the internal mammary pedicle following sternal wire insertion
Authors: Sapoval Marc R. , Jebara Victor A. , Raynaud Alain C. , Chardigny Catherine , Sarkis Antoine , Renaudin Jean‐Marc , Fabiani Jean‐NoëL , Gaux Jean‐Claude
Published: March 2007

A case of traumatic arteriovenous fistula and false aneurysm of the internal mammary artery was encountered following sternal wire insertion during cardiac surgery. The diagnosis was suspected by echodoppler and confirmed by arteriography allowing percutaneous embolization using cyanoacrylate in the same setting. © 1993 Wiley‐Liss, Inc.
Directional coronary atherectomy in a distal right coronary lesion using a shorter standard guide catheter
Authors: Ayres Mike
Published: March 2007

An ulcerated and eccentric distal right coronary artery plaque was found in a 56‐year‐old male with post‐infarction angina. The 100 cm length of present DVI (Devices for Vascular Intervention, Inc., Redwood City, CA) atherectomy guiding catheters limits the ability to reach many complex distal stenoses with the 125 cm Simpson Atherocath. After shortening the proximal portion of a standard DVI Judkins right guiding catheter without changing the distal contour, successful directional coronary atherectomy was performed. © 1993 Wiley‐Liss, Inc.
Safety of cardiac catheterization via peripheral vascular grafts
Authors: Lesnefsky Edward J. , Carrea Frank P. , Groves Bertron M.
Published: March 2007

There are few data concerning the complications and technical difficulties encountered when cardiac catheterization is performed using peripheral bypass grafts for vascular access. All cardiac catheterizations performed at our institution from January 1, 1984 to April 1, 1991 were retrospectively reviewed to assess the in‐hospital clinical outcomes in patients who had arterial access for catheterization achieved via prosthetic graft puncture. Seventeen procedures had percutaneous puncture of a vascular graft from a total of 2,929 arterial catheterizations performed. The interval from graft placement to catheterization was 7.5 ± 1.1 years. Arterial sheaths were employed in all cases and corresponded to the catheter size, with 5F systems used in 53% and 7F or larger systems used in the remaining patients. No intraprocedural or postprocedural complications were recognized. Technical difficulties were limited to the inability to selectively cannulate a nondominant right coronary artery in 1 patient. We conclude that percutaneous introduction of an arterial sheath and left heart catheterization via remotely implanted vascular bypass grafts is not associated with an increased risk of procedural complications or technical difficulties. © 1993 Wiley‐Liss, Inc.
Assessment of thallium scintigraphy and echocardiography during dobutamine infusion for the detection of coronary artery disease
Authors: Warner Mark F. , Pippin John J. , Disciascio Germano , Paulsen Walter H. J. , Arrowood James A. , Tatum James L. , Goudreau Evelyne , Vetrovec George W.
Published: March 2007

Dobutamine infusion was performed in 16 patients following cardiac catheterization, and non‐invasive assessment was performed with thallium SPECT and echocardiography. Dobutamine thallium scintigraphy was abnormal in 93% of patients with significant coronary artery disease. In addition, individual epicardial vessel involvement was identified by a corresponding perfusion defect with 88% sensitivity and 93% specificity. Dobutamine echocardiography revealed segmental wall motion abnormalities in 62% of patients with significant coronary disease. However, in six patients baseline segmental wall motion abnormalities on echocardiography improved during dobutamine infusion. Dobutamine thallium SPECT is a safe and useful test for the detection and localization of coronary artery disease. Dobutamine echocardiography is less useful in screening for coronary disease, but may detect areas of abnormally functioning myocardium having retained viability. © 1993 Wiley‐Liss, Inc.
The use of a new wire in a 6‐year‐old coronary artery occlusion: The Jagwire ™ recanalization guidewire
Authors: Heuser Richard R.
Published: March 2007

Chronic total occlusions are difficult to treat, usually because they cannot be crossed with a guidewire or dilating catheter. A variety of angioplasty systems designed to facilitate coronary angioplasty of chronic total occlusions have been used. We report the case of a 6‐year‐old occlusion of the right coronary artery that was treated with the Jagwire, a new guidewire designed for use in challenging lesions. This device successfully crossed the lesion and resulted in a successful angioplasty. The patient's angina dramatically improved following the procedure. © 1993 Wiley‐Liss, Inc.
Stenting of a renal artery stenosis achieves better relief of the obstructive lesion than balloon angioplasty
Authors: Dorros Gerald , Prince Charles , Mathiak Lynne
Published: March 2007

A balloon‐expandable (Palmaz‐Schatz™) stainless steel stent was utilized following balloon angioplasty (PTRA) to determine if the obstructive lesion, using quantitative methods (automated measuring the diameter stenosis, and transstenotic peak systolic and mean pressure gradients), was significantly further reduced or abolished. Hemodynamic transstenotic gradient and stenoses measurements were made during 21 renal artery stenting procedures; prior and following PTRA, and subsequent to stent deployment. The stent sizes placed in the renal arteries were 5 mm (19%), 6 mm (67%), and 7 mm (14%). The results were as follows:magnified image

The balloon‐expandable (Palmaz‐Schatz™) stent significantly further reduced, and in fact effectively abolished, the obstructive renal artery lesion in comparison to balloon angioplasty (PTRA). The stent's effectiveness with regard lesion recurrence, maintenance, and preservation of renal function; cure or improved management of hypertension; and survival will be determined by careful clinic follow‐up. © 1993 Wiley‐Liss, Inc.
Inflated balloon entrapped in a calcified coronary stenosis
Authors: Breisblatt Warren M.
Published: March 2007

Balloon angioplasty in calcified coronary lesions may have a decreased success rate and an increased incidence of complications. Previous cases have been reported on the phenomena of catheter or wire entrapment, but this report highlights a new problem in association with a calcified stenoses. This case lead to the unusual problem of the inflated balloon being entrapped within the lesion while the distal portion of the balloon remained inflated even after balloon deflation. © 1993 Wiley‐Liss, Inc.