bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient self-management and pharmacist-led patient self-management in Hong Kong: A focus group study from different healthcare professionals' perspectives
Authors: Wong Fiona YY , Chan Frank WK , You Joyce HS , Wong Eliza LY , Yeoh EK
Published: May 2011

Background

Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM) practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong.

Methods

Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly.

Results

The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients.

Conclusions

An effective chronic disease management model should involve patients in stable condition to participate in self-management in order to prevent health deterioration and to save healthcare costs. The role of pharmacists should not be limited to drugs and should be extended in the primary healthcare system. Pharmacist-led patient self-management could be developed gradually with the support of government by enhancing pharmacists' responsibilities in health services and developing public-private partnership with community pharmacists. Developing facilitating measures to enhance the implementation of the pharmacist-led approach should also be considered, such as allowing pharmacists to access electronic health records, as well as deregulation of more prescription-only medicines to pharmacy-only medicines.
Hypoglycaemia and severe plasmodium falciparum malaria among pregnant sudanese women in an area characterized by unstable malaria transmission
Authors: Ali Aziem A , Elhassan Elhassan M , Magzoub Mamoun M , Elbashir Mustafa I , Adam Ishag
Published: May 2011

Background

Pregnant women are more susceptible to severePlasmodium falciparummalaria, which can lead to poor maternal and fetal outcomes. Few data exist on the epidemiology of severeP. falciparummalaria in pregnant women.

A hospital-based study was carried out to assess the pattern of severeP. falciparummalaria among pregnant women at the Kassala and Medani maternity hospitals, which are located in areas of unstable malaria transmission, in eastern and central Sudan, respectively. Pre-tested questionnaires were used to gather socio-demographic, clinical and obstetrical data. Suitable tests were performed for clinical and biochemical investigations.

Results

Among 222 pregnant women diagnosed with malaria at the two hospitals, 40 (18.0%) women at mean (SD) gestational age of 29.3 (6.7) weeks fulfilled one or more of the WHO criteria for severeP. falciparummalaria. These were hypoglycaemia (14; 35.5%), severe anaemia (12; 30%), hypotension (10; 25%), jaundice (9; 22.5%), cerebral malaria (6; 15%), repeated convulsions (4; 10%), hyperparasitaemia (4; 10.0%) and more than one manifestation (9; 22.5%). While the mean (SD) presenting temperature was significantly lower for women presenting with hypoglycaemia [38.2(0.6) versus 38.8(0.7) °C,P= 0.04], other clinical and biochemical characteristics were not significantly different among women with different manifestations of severeP. falciparummalaria.

Conclusion

Preventive measures for pregnant women such as insecticide-treated bednets and chemoprophylaxis may be beneficial in areas of unstable malaria transmission. Early detection and prompt treatment of severe malaria, especially in pregnant women with hypoglycaemia, are needed.
An eye on the head: the development and evolution of craniofacial muscles
Authors: Sambasivan Ramkumar , Kuratani Shigeru , Tajbakhsh Shahragim
Published: May 2011

Skeletal muscles exert diverse functions, enabling both crushing with great force and movement with exquisite precision. A remarkably distinct repertoire of genes and ontological features characterise this tissue, and recent evidence has shown that skeletal muscles of the head, the craniofacial muscles, are evolutionarily, morphologically and molecularly distinct from those of the trunk. Here, we review the molecular basis of craniofacial muscle development and discuss how this process is different to trunk and limb muscle development. Through evolutionary comparisons of primitive chordates (such as amphioxus) and jawless vertebrates (such as lampreys) with jawed vertebrates, we also provide some clues as to how this dichotomy arose.
BMP and non-canonical Wnt signaling are required for inhibition of secondary tail formation in zebrafish
Authors: Yang Yi , Thorpe Chris
Published: May 2011

The role of bone morphogenetic protein (BMP) signaling in specifying cell fate in the zebrafish tailbud has been well established. In addition to a loss of ventral tissues, such as ventral tailfin and cloaca, some embryos with compromised BMP signaling produce an additional phenotype: a ventrally located secondary tail containing both somitic muscle and notochord. This phenotype has been proposed to reflect a fate-patterning defect due to a change in a hypothesized BMP activity gradient. Here, we show that a defect in morphogenetic movements, not fate patterning, underlies the formation of secondary tails in BMP-inhibited embryos. Our data indicate that BMP signaling is activated in the ventroposterior tailbud to promote cell migration during tailbud protrusion, and that defective migration of these cells in BMP mutants ultimately leads to bifurcation of the caudal notochord. Additionally, we show that non-canonical Wnt signaling is also required for proper tail morphogenesis, possibly by maintaining cohesion of notochord progenitors by regulation of cadherin localization. We propose a model in which BMP and the non-canonical Wnt pathway regulate tail morphogenesis by controlling cell migration and cell adhesion within the tailbud.
FGF-dependent midline-derived progenitor cells in hypothalamic infundibular development
Authors: Pearson Caroline Alayne , Ohyama Kyoji , Manning Liz , Aghamohammadzadeh Soheil , Sang Helen , Placzek Marysia
Published: May 2011

The infundibulum links the nervous and endocrine systems, serving as a crucial integrating centre for body homeostasis. Here we describe that the chick infundibulum derives from two subsets of anterior ventral midline cells. One set remains at the ventral midline and forms the posterior-ventral infundibulum. A second set migrates laterally, forming a collar around the midline. We show that collar cells are composed of Fgf3+ SOX3+ proliferating progenitors, the induction of which is SHH dependent, but the maintenance of which requires FGF signalling. Collar cells proliferate late into embryogenesis, can generate neurospheres that passage extensively, and differentiate to distinct fates, including hypothalamic neuronal fates and Fgf10+ anterior-dorsal infundibular cells. Together, our study shows that a subset of anterior floor plate-like cells gives rise to Fgf3+ SOX3+ progenitor cells, demonstrates a dual origin of infundibular cells and reveals a crucial role for FGF signalling in governing extended infundibular growth.
Non-glycemic effects of insulin therapy: a comparison between insulin aspart and regular human insulin during two consecutive meals in patients with type 2 diabetes
Authors: Sourij H , Schmoelzer I , de Campo A , Tripolt N J , Stojakovic T , Scharnagl H , Kettler-Schmut E , Forst T , Wascher T C
Published: May 2011

Objective

To control postprandial hyperglycemia in insulin-treated type 2 diabetic patients, prandial therapy with regular human insulin (HI) or fast acting insulin analogs is used. Postprandial hyperglycemia seems to be reduced more effectively with insulin analogs than with normal insulin, but there are no data concerning the effect on lipolysis or pancreatic insulin and proinsulin secretion of normal insulin in comparison to insulin analogs.

Design and methods

We included 13 patients with type 2 diabetes mellitus (age 62.2±10.3 years) with preexisting insulin therapy in this crossover, prospective, open-labeled, randomized trial comparing regular HI with insulin aspart (IA) in the setting of a standardized breakfast and a standardized lunch 4 h later. Blood samples for determination of glucose, free fatty acids (FFA), triglycerides, C-peptide, and intact proinsulin were drawn during fasting and every 30 min until 4 h after the second test meal. Statistical analysis was performed with ANOVA for repeated measurements and paired Student's t-test.

Results

The mean increase in blood glucose was significantly lower after IA (24.18±16.33 vs 34.92±29.07 mg/dl, P=0.02) compared with HI. Both therapies reduced FFA; however, the mean reduction was significantly higher after IA than after HI (−0.47±0.16 vs −0.35±0.15 μmol/l, P<0.001). The mean increase in intact proinsulin was significantly lower after IA than after HI (10.53±5 vs 15.20±6.83 pmol/l, P<0.001). No differences were observed in the C-peptide levels between the two groups.

Conclusion

In the setting of two consecutive meals, IA reduces lipolysis and proinsulin secretion more effectively than HI.
Limitations of and Lessons Learned from Clinical Experience of 1,020 Duplex Arteriography
Authors: Hingorani Anil P. , Ascher Enrico , Marks Natalie , Puggioni Alessandra , Shiferson Alexander , Tran Victor , Jacob Theresa
Published: May 2011

Objective: Due to the inherent risks, deficiencies and cost associated with contrast arteriography (CA), our group has been utitilizing duplex arteriography (DA) for evaluating the arteries of the lower extremity for patients undergoing lower extremity revascularization. In an effort to further explore the strengths and weaknesses of DA, we reviewed our evolving experience with DA from January 1, 1998, to January 1, 2005.

Patients and Methods: The arterial segments starting from mid-abdominal aorta to the pedal arteries were studied in cross-sectional and longitudinal planes using a variety of scanheads of 7–4, 10–5, 12–5, 5–2 and 3–2 MHz extended operative frequency range to obtain high-quality B-mode, color and power Doppler images as well as velocity spectra. In 906 patients, 1,020 duplex arteriograms were obtained. The ages ranged from 30–98 years old with a mean of 73±11 (SD) years. Fifty percent of the patients were diabetics. Indications for the examination included: tissue loss (409), rest pain (221), claudication (310), acute ischemia (74), popliteal aneurysm (45), SFA aneurysm (2), abdominal aortic aneurysms (AAA) (10) and failing bypass (55). Prior procedures had been performed in 262. DA was performed by six technologists (4 of whom are MDs). In all, 207 DA were performed intraoperatively and the remainder, preoperatively.

Results: The resultant procedures based upon DA included: bypass to the popliteal artery (262) and bypass to an infrapopliteal artery (325), endovascular procedures (363), thrombectomy (11), embolectomy (9), inflow bypass procedures to the femoral arteries (46), débridment (4), amputation (8) and no intervention (75). The areas not visualized well included: iliac (73), femoral (26), popliteal (17), and infrapopliteal (221). Additional imaging after DA was deemed necessary in 102 cases to obtain enough information to plan lower extremity revascularization. Factors associated with increased need to obtain CA included: DM ( p<.001), infrapopliteal calcification ( p<.001), older age ( p = .01) and limb threatening ischemia ( p<.001). Factors not associated with the need to obtain CA included: which technologist performed the exam, whether the technologist has a medical degree and whether the patient underwent prior revascularization.

Conclusions: In 90% of patients reviewed, DA is able to obtain the needed information to plan lower extremity revascularization. Severe tibial vessel calcification is the most common cause of an incomplete DA exam and determines when alternative imaging modalities need to be obtained.
Effect of Catheter-Directed Arterial Embolization and Laparoscopic Endovascular Stapling on Stapled Vessel Integrity in a Porcine Model
Authors: Dominguez Edward P. , Barshes Neal R. , Sherman Vadim , Albo Daniel , Kougias Panagiotis , Chen Changyi , Sweeney John F. , Lin Peter H.
Published: May 2011

Arterial embolization is a frequently performed adjunctive maneuver prior to laparoscopic splenectomy or nephrectomy to facilitate laparoscopic dissection and reduce intraoperative bleeding. However, little is known regarding the effect of laparoscopic stapling across thrombosed vessels with imbedded embolic materials. This study analyzed the stapled line integrity by comparing visceral arteries treated with either platinum coils or polyvinyl alcohol (PVA) particles. Using a porcine model, 30 visceral vessels including splenic and renal arteries were treated with either coil or PVA embolization, which was followed by laparoscopic stapling. Vessel integrity and bursting pressure analysis was performed using an in vitro flow circuitry. The mean bursting pressure of the coil and the PVA group was 158 ± 56 and 350 ± 34 mm Hg, respectively ( p < .001). The lowest bursting pressure in the coil and the PVA group was 70 and 280 mm Hg, respectively. The highest bursting pressure in the coil and the PVA group was 225 and 420 mm Hg, respectively. The bursting pressure in the splenic artery between the PVA and the coil group was 345 ± 29 and 150 ± 54 mm Hg, respectively ( p < .001). Significant difference in the bursting pressure in the renal artery was noted in the PVA and the coil group, which was 350 ± 40 and 160 ± 40 mm Hg, respectively ( p < .001). Our findings showed that preoperative coil embolization followed by laparoscopic vessel stapling sustained a poor busting pressure. Such a practice appears to be unsafe based on our findings and should be performed with caution in a clinical setting.
Collective Experience with Hybrid Procedures for Suprarenal and Thoracoabdominal Aneurysms
Authors: van de Mortel Rob H.W. , Vahl Anco C. , Balm Ron , Buth Jaap , Hamming Jaap F. , Schurink Geert W.H. , de Vries Jean-Paul P.M.
Published: May 2011

Not every patient is fit for open thoracoabdominal aortic aneurysm (TAAA) repair, nor is every TAAA or juxtarenal abdominal aortic aneurysm suitable for branched or fenestrated endovascular exclusion. The hybrid procedure consists of debranching of the renal and visceral arteries followed by endovascular exclusion of the aneurysm and might be an alternative in these patients.

Between May 2004 and March 2006, 16 patients were treated with a hybrid procedure. The indications were recurrent suprarenal or thoracoabdominal aneurysms after previous abdominal and/or thoracic aortic surgery ( n = 8), type I to III TAAAs ( n = 3), proximal type I endoleak after endovascular repair ( n = 2), penetrating ulcer of the juxtarenal aorta ( n = 1), visceral patch aneurysm after type IV open repair ( n = 1), and primary suprarenal aneurysm ( n = 1). Eight (50%) of 16 patients were judged to be unfit for open TAAA repair.

The hospital mortality rate was 31% (5 of 16). Four of five deceased patients were unfit for thoracophrenic laparotomy. Two patients died from cardiac complications and three from visceral ischemia. No spinal cord ischemia was detected, and temporary renal failure occurred in four patients (25%). The mean follow-up was 13 months (range 6–28 months). During follow-up, no additional grafts occluded and no patients died.

Hybrid procedures are technically feasible but have substantial mortality (31%), especially in patients unfit for open repair (80%). They might be indicated when urgent TAAA surgery is required or when vascular anatomy is unfavorable for fenestrated endografts in patients with extensive previous open aortic surgery.
Calcium Channel Blockers and Angiotensin-Converting Enzyme Inhibitors May Be Associated with Altered Atherosclerotic Plaque Size and Morphology
Authors: Eagleton Matthew J. , Bishop Paul D. , Bena James F. , Nassoiy Sean P. , Clair Daniel G. , Kashyap Vikram S. , Ouriel Kenneth
Published: May 2011

Correlations of atherosclerotic plaque attributes with clinical presentation have not been studied in peripheral arterial disease (PAD). The aim of the current study was to identify clinical variables associated with alterations in PAD plaque morphology. Thirty-one patients underwent intravascular ultrasonography (IVUS) at the time of arteriography for symptomatic PAD. IVUS data were analyzed with radiofrequency techniques for quantification of plaque composition, plaque volume, and total vessel volume. Associations between plaque characteristics and clinical variables were evaluated. Univariable and multivariable analyses were performed using t-test, Pearson correlations, F-tests, and analysis of variance. Calcium (Ca2+) channel blocker use was associated with a smaller total atherosclerotic plaque burden (44.2 ± 2.7 vs 52.9 ± 2.5%; p < .05), and decreased fibrous plaque content (18.2 ± 1.8% vs 24.0 ± 1.9%; p < .05). Angiotensin-converting enzyme (ACE) inhibitor use, however, was associated with a larger total atherosclerotic plaque burden (58.3 ± 2.2% vs 42.9 ± 2.1%; p < .01) and larger fibrous plaque content (27.2 ± 2.0% vs 17.7 ± 1.6%; p < .001). Multivariable analysis was performed to evaluate which factors may differentially impact the response variable measurements of plaque volume to vessel volume. Based on this model, those without the use of an antihyperlipidemic agent or ACE inhibitor had an average total atherosclerotic plaque burden of 47.7%. Those on an antihyperlipidemic agent had an average decrease of 7.0% ( p < .05), whereas those on ACE inhibitors had an average increase of 16.2% from the baseline value ( p < .001). The use of calcium channel blockers is associated with significantly decreased atherosclerotic plaque burden and decreased fibrous plaque content, whereas the use of ACE inhibitors was associated with an increase in plaque burden and an increased fibrous plaque content. The use of these medications in PAD may alter plaque morphology with the potential to affect clinical outcomes.
Diagnostic Accuracy of Sigmoidoscopy Compared with Histology for Ischemic Colitis after Aortic Aneurysm Repair
Authors: Assadian Afshin , Senekowitsch Christian , Assadian Ojan , Hartleb Helmut , Hagmüller Georg W.
Published: May 2011

Clinically relevant rates of ischemic colitis (IC) causing diarrhea, systemic involvement, colon necrosis, and, ultimately, death by multiple organ failure affect only a small proportion of patients after aortic reconstructions, with reported incidences of 2.7 to 3.3%. The key to treating and saving patients with this complication remains early detection and consequent treatment. The aim of this retrospective analysis of prospectively collected data was to compare the diagnostic accuracy of colonoscopy for detecting postoperative IC compared with histology and to evaluate the interobserver difference of two experienced surgeons. One hundred patients with infrarenal aortic aneurysms, operated on electively from March 2001 to December 2003, who had on postoperative days 3 to 6 a sigmoidoscopy by two independent surgeons and a histologic sample of the sigmoid mucosa, were included in the study. Patients with previous colon resection or inflammatory bowel disease were excluded from the study. All patients gave written informed consent. The study was approved by the Institutional Review Board. Histologic examination of the sigmoid mucosa revealed IC in 13 patients. The combined sensitivity of both investigators for detecting IC by sigmoidoscopy compared with histology was 84%, the specificity was 92.0%, the positive predictive value was 61.1%, the negative predictive value was 97.6%, and the diagnostic accuracy was 91.0%. There was no statistically significant difference between investigator 1 and investigator 2 ( p = 1.0) and between both investigators and histology ( p = .380). Histology remains the gold standard for detecting IC after aortic surgery. Sigmoidoscopy, however, is a valid diagnostic tool allowing immediate clinical decision making with a negative predictive value of more than 94% and a diagnostic accuracy of 92%.
Stenting for Stenosing Takayasu Aortitis Following Carotid Artery Stenosis in a 32-Year-Old Patient
Authors: Us Melih , Numan Furuzan , Goksel Onur S. , Basaran Murat , Yılmaz Ahmet Turan
Published: May 2011

Takayasu arteritis is a chronic granulomatous vasculitis with multivessel involvement, causing significant mortality and morbidity in affected individuals. A 32-year-old patient with severe right common carotid stenosis underwent expanded polytetrafluoroethylene graft interposition to the carotid artery. A bare Wallstent endoprosthesis (Boston Scientific Medi-Tech, Natick, MA) was implanted for the abdominal aortic stenosis incidentally diagnosed during follow-up 1 year after the carotid operation while the disease was inactive. Close follow-up of the activity of the vasculitic process is warranted owing to the progression of the vascular lesions or formation of de novo lesions in Takayasu disease.
Novel Technique for Arch and Visceral Artery Debranching Using Ascending Aortic Inflow
Authors: Mussa Firas F. , Walkes Jon-Cecil , Lumsden Alan B. , Reardon Michael J.
Published: May 2011

Aortic arch aneurysms extending proximally to the left subclavian artery have traditionally been approached through a median sternotomy and a staged elephant trunk procedure requiring a left thoracotomy or thoracoabdominal incision. We describe a novel technique for repair of such aneurysms in a single-stage, hybrid approach using bypass grafts arising from the ascending aorta to all arch and upper abdominal visceral arteries followed by endovascular exclusion of the aortic aneurysm.
Successful Treatment of Phlegmasia Cerulea Dolens with Combination Surgical and Catheter-Assisted Thrombectomy
Authors: Gociman Barbu , Castillo-Sang Mario , Margni Mohmmed , Almaroof Babatunde , Nazzal Munier
Published: May 2011

Phlegmasia cerulea dolens is a rare condition caused by complete venous occlusion that leads to impaired arterial flow. Prompt diagnosis and treatment initiation are paramount in preventing progression to gangrene, the need for amputation, and possibly the death of the patient. Thrombolysis or surgical thrombectomy, for advanced disease and cases in which anticoagulation is contraindicated, represent the current standard treatment. Here we report the case of a 47-year-old male who sustained severe trauma during a car accident. After having a prophylactic retrievable inferior vena cava filter placed, he developed caval thrombosis with progression to phlegmasia cerulea dolens. He was successfully treated with a combination of surgical thrombectomy of the lower extremity veins and catheter-assisted thrombectomy of the iliac veins and inferior vena cava, in the setting in which an initial attempt at balloon thrombectomy of the iliac veins and inferior vena cava failed. He was discharged from the hospital in stable condition and on follow-up visits had full resolution of symptoms. Ultrasound evaluation showed no residual venous clot. The presented case illustrates how the use of catheter-assisted thrombectomy alleviated the need for a laparotomy and direct caval evacuation of the thrombus and provided a timely and effective treatment of phlegmasia cerulea dolens with impending gangrene.
Lower Extremity Glomus Tumors: Comprehensive Review for Surgeons
Authors: Luis Leon R. , Kaoru Goshima R. , Shemuel Psalms B. , Mills Joseph L.
Published: May 2011

The diagnosis of a lower extremity glomus tumor (GT) is often delayed owing to the lack of awareness and low level of suspicion by the treating physician. GT is thought to arise from cutaneous arteriovenous connections, often involving the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. Surgical excision of GT is often curative and provides significant symptomatic relief. There is a paucity of information in regard to GT in general, especially among vascular surgeons. The aim of this report is to make the surgical community more aware of this disease entity based on the analysis of our own experience and review of the literature.
The Upside-Down Zenith Stent Graft Limb
Authors: Hiramoto Jade S. , Reilly Linda M. , Schneider Darren B. , Rapp Joseph H. , Chuter Timothy A.M.
Published: May 2011

None of the commercially available stent grafts are supplied in a tapered configuration suitable for the endovascular repair of common iliac artery aneurysms. We describe a simple technique for reversing the proximal and distal orientation of a standard flared bell-bottom stent graft limb from the Zenith system of abdominal aortic aneurym repair. When reloaded in this fashion, the stent graft is deployed just like any other Zenith (Cook, Inc., Bloomington, IN) stent graft limb. However, we caution that this departure from standard use introduces new sources of potential device failure, requires several additional precautions, and should not be attempted by those unfamiliar with the routine use of the unmodified device.
Intraoperative Cell Salvage versus Allogeneic Transfusion during Abdominal Aortic Surgery: Clinical and Financial Outcomes
Authors: Marković Miroslav , Davidović Lazar , Savić Nebojša , Sindjelić Radomir , Ille Tatjana , Dragaš Marko
Published: May 2011

The objective of this study was to assess the clinical and financial outcomes of intraoperative cell salvage (ICS) during abdominal aortic surgery. In this study, 90 patients were operated on with the use of ICS (group 1, prospective) and 90 patients without ICS (group 2, historical control). According to the type of operation, the patients were subdivided into three consecutive 30-patient subgroups (1, aortoiliac occlusive disease [AOD]; 2, elective abdominal aortic aneurysm [AAA]; or 3, ruptured abdominal aortic aneurysm [RAAA]). Transfusion requirements and postoperative complications were recorded. The total amounts of perioperatively transfused allogeneic blood were higher in all patient subgroups that underwent surgery without ICS ( p = .0032). In the ICS group, 50% of AOD patients and 60% of elective AAA patients received no allogeneic transfusions. There were no significant differences in the incidence of postoperative complications in any group examined. ICS significantly reduced the necessity for allogeneic transfusions during abdominal aortic surgery. ICS use was most valuable in urgent situations with high blood losses, such as RAAA, for which only small amounts of allogeneic blood were initially available. In patients with more than 3 units of autologous blood reinfused, this method was cost effective.
Angiolymphoid Hyperplasia with Eosinophilia Presenting as a Giant Axillary Artery Aneurysm
Authors: Bhat Seetharama P.S. , Moorthy Nagaraja , Ramalingam Rangaraj , Jayapal Mithravrinda , Nanjappa Manjunath Cholenahalli
Published: May 2011

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an unusual vascular tumor most frequently located in the superficial head and neck. Noncutaneous localization of this pathology in large arteries presenting as a pulsatile mass is extremely rare. We describe an adult male with a giant left axillary artery tumor secondary to ALHE. ALHE should be considered in the differential diagnosis of localized peripheral arterial masses, especially in young patients.
Patients with Abdominal Aortic Aneurysm and Chronic Obstructive Pulmonary Disease Have Improved Outcomes with Endovascular Aneurysm Repair Compared with Open Repair
Authors: Jonker Frederik H.W. , Schlösser Felix J.V. , Dewan Michael , Huddle Matthew , Sergi Michael , Dardik Alan , Muhs Bart E.
Published: May 2011

The purpose of our study was to evaluate outcomes in abdominal aortic aneurysm (AAA) patients with chronic obstructive pulmonary disease (COPD) undergoing open or endovascular abdominal aortic aneurysm repair (EVAR). We retrospectively examined the records of consecutive patients with AAA and COPD who underwent either open repair or EVAR between 2001 and 2008. In-hospital and follow-up outcomes were compared between open repair and EVAR using SPSS (SPSS Inc, Chicago, IL). Sixty-nine patients were included for analysis (mean age 71 ± 1.0 years; 93% [ n = 64] male). Open surgery was performed in 63% ( n = 43). In-hospital mortality was 4%. All-cause mortality did not differ significantly between the open repair and EVAR groups during 3 years of follow-up ( p = .491). In-hospital death and major complications occurred in 30% ( n = 13) after open repair compared with 12% ( n = 3) after EVAR ( p = .075). Pneumonia occurred in 19% ( n = 8) after open repair and in 0% after EVAR ( p = .019); pneumonia was associated with increased mortality during the first year after AAA repair (log-rank test p = .003). Hospital length of stay was increased in the open repair group compared with the EVAR group (16 vs 5 days, p < .001), as was intensive care unit length of stay (11 vs 2 days, p < .001) and need for ventilation (61% vs 12%, p < .001). Patients with COPD and anatomically suitable AAAs should be preferentially offered EVAR.
Combined Endovascular and Vascular Surgical Therapy of a Blister-like Distal Internal Carotid Aneurysm in a Patient with a Right-Sided Aortic Arch
Authors: Zhu Yue-Qi , Li Ming-Hua , Fang Chun , Wang Wu , Tan Hua-Qiao , Cheng Ying-Sheng
Published: May 2011

Blood blister–like aneurysms (BBAs) are rare but challenging to treat owing to their fragile, thin walls and poorly defined necks. A right-sided aortic arch is an uncommon congenital cardiac anomaly with an estimated incidence of only 0.1% and presents a challenge to intubation at vessels above the aortic arch. This represents an extremely rare case of a BBA at the left internal carotid artery with a right-sided aortic arch treated with combined endovascular and vascular surgical therapy. We report the case and provide a short review of the relevant literature.
The departments of the State Forests in a market economy
Authors: Kocel Janusz
Published: May 2011

Zakłady Lasów Państwowych w warunkach gospodarki rynkowej
Premières datations du Pléistocene et de l'Holocène sur le littoral du Rif oriental (Maroc) et interprétations morphoclimatiques
Authors: Barathon Jean-Jacques , Delibrias Georgette , Weisrock André
Published: May 2011

L'évolution morphoclimatique post-tyrrhénienne en domaine littoral débute par le dépôt de colluvions rubéfiées plus anciennes que 42 000 ans B.P. (Soltanien ancien). Le Soltanien moyen correspond à une remontée marine (dune intra-soltanienne) tandis que de nouvelles couches rouges marquent la régression du Soltanien supérieur. La dune holocène s'accumule avant 6 800 ans B.P., âge des limons gris qui la recouvrent. Enfin, les importants remblaiements limoneux des basses plaines alluviales se poursuivent encore après 3 170 ans B.P. Ces résultats reliés à ceux du Maroc atlantique et de la Tunisie démontrent l'existence de conditions morphoclimatiques comparables à l'échelle des littoraux maghrébins au Pléistocène supérieur et à l'Holocène.
Datation d'un glacis par un outillage acheuléen évolué dans la coupe du barrage de Bir-Mcherga (oued Miliane, Tunisie nord-orientale)
Authors: Bourgou M. , Gragueb Abderrazak
Published: May 2011

The discovrey, on the piedmont of the jbel el Oust, of an archeological site with a developed acheulean industry, permits the dating of a glacis, in the site of Bir-Mcherga 's barrage.
Les héritages continentaux et marins d'âge quaternaire dans les environs du système lacustre de Bizerte (extrême nord-est tunisien)
Authors: Mathlouthi S.
Published: May 2011

Aux alentours du sytème lacustre de Bizerte, le Quaternaire est représenté par des dépôts continentaux et des dépôts marins. Les premiers sont bien développés, surtout dans la basse vallée de l'Oued Sejnane. Ici nous signalons, en particulier, la présence de quatre terrasses fluviatiles emboîtées dont les trois les plus récentes (T. 3), (T. 2) et (T. 1) renferment des industries préhistoriques et historiques. Les seconds affleurent essentiellement autour du lac de Bizerte. Ce sont des héritages de la transgression eutyrrhénienne. Au nord de la dépression lacustre, non loin de Ras el Korrane, existent deux éolianites couvertes par deux couches colluviales rouges. Toute la séquence appartient au Pléistocène supérieur.
Vignes et vins en Grèce
Authors: Péchoux Pierre-Yves , Katsaros Dimitri
Published: May 2011

The Greekvineyard area is now reduced to 170.000 ha. It produces dessert grapes, currants, sultanas and ay early amount of about 5.000.000 hi of wines. Few of these are specific mavrodafni and retsina wines; most of them are white wines and 90% are tables wines. Peasant-produced wines recently decreased sharply down to less than half of the production only; wines produced by merchants and cooperatives share almost equally the larger half : they generally prepare blended rather than vintage wines.
Bilan hydrologique du bassin du Loukkos (Maroc atlantique)
Authors: Hufty André
Published: May 2011

Pour équilibrer les bilans hydrologiques annuels du bassin du Loukkos, l'auteur utilise un cœfficient de réduction de l' évapotranspiration hivernale et une réserve en eau variable. Les corrections semblent d'autant plus grandes que les pluies hivernales sont tardives et de courte durée. Ces hypothèses permettent de corriger le bilan mensuel hydrologique de Thornthwaite et de mieux ajuster le calcul des débits.
Frontal depressions over the Mediterranean sea and central southern Europe. Les perturbations frontales au-dessus de la mer Méditerranée et de l'Europe centrale méridionale
Authors: Flocas A. A.
Published: May 2011

An analysis of the frequency of occurrence of frontal depressions over central-southern Europe and the Mediterranean Sea was carried out based on daily synoptic charts for a nine year period from 1971 to 1979. The frontal depressions are classified into five types (A, B, C, D, E) based on the regions in which they originally formed. Tables and charts are presented showing the annual and seasonal frontal depression frequencies over the area. Also, the variation of average frequency of frontal depressions with latitude and longitude is demonstrated. The distribution of the frequency of frontal depressions fits in with generally accepted models of hemispheric circulation. The mean tracks of the frontal depression centres were determined. The ten individual tracks are shown together in a map and they emphasize the way in which so many frontal depression centres migrate towards Corsica and nothern Italy from various points in the west of the study area.
Les carbonates continentaux du pourtour méditerranéen : microfaciès et milieux de formation
Authors: Freytet Pierre , Verrecchia Eric
Published: May 2011

Les carbonates continentaux ont été étudiés par des spécialistes différents (géochimistes, pédologues, sédimentologues, stratigraphes, biologistes, etc.), qui ont tous un vocabulaire particulier, ce qui rend difficile la lecture des publications et l'application à l'ancien. Il est proposé ici une description objective à partir de la lame mince, en utilisant très simplement les données de la pétrographie sédimentaire et de la micromorphologie des sols. Après une étude des constituants primordiaux (micrite et sparite), on passe aux grains, aux vides et à la texture, matrice et ciment, plasma et enduits. Ces divers éléments sont replacés dans leur milieu élémentaire deformation : submergé, pédologique, de surface (stromatolites désertiques). On aborde ensuite leur répartition dans les milieux continentaux réels : suintant, chenal, plaine d'inondation, lac et littoral lacustre, glacis, interfluve. En conclusion, la lame mince permet de déterminer ce qui revient à chacun des milieux élémentaires, la succession des événements, et les effets éventuels de la diagenèse tardive.
Réinterprétation des conditions de dépôt des calcaires fluviatiles, lacustres et palustres du bassin plio-quaternaire du Saïss de Fès (Maroc)
Authors: Ahmamou M. , Conrad Georges , Plaziat J.-Cl.
Published: May 2011

L'étude des calcaires du Saïss oriental, réputés pliocènes et lacustres, a conduit à distinguer deux grandes types d'environnements de dépôt : des carbonates palustres au centre et des carbonates fluviatiles (sables oncolithiques, barrages travertineux, calcaires boueux de biefs) sur les bordures N et S. L'organisation paléogéographique se modifie en trois étapes (Pliocène supérieur, Pléistocène et Holocène) mises en relation avec la tectonique, la morphogenèse et une évolution climatique, qui rythment en particulier le développement des dépôts fluviatiles originaux sur le versant N du Moyen Atlas.
Étude de quelques croûtes calcaires complexes des environs de Madrid (Páramo de la Alcarria et "Campiña" du Henares, Espagne): complémentarité des données géomorphologiques et pétrographiques
Authors: Vaudour J , Verrecchia Eric , Freytet Pierre
Published: May 2011

Six coupes sont présentées : quatre sur le Plateau (Páramo), une sur un glacis emboîté dans le Plateau, et une sur une moyenne terrasse alluviale. Ces coupes renferment toutes des calcaires pédologiques (croûtes calcaires) et des enduits stromatolitiques superficiels («croûte zonaire»). A partir de lames minces, diverses précisions sont apportées : alternance de phases sédimentaires et pédologiques, de diagénèses phréatiques et vadoses. La confrontation des deux types d'informations n'est pas contradictoire, et la dynamique des milieux peut être souvent précisée. Il n'y a pas de différence importante entre les croûtes calcaires de plateau, de glacis et de terrasse alluviale. Seules diffèrent les conditions de mise en place des matériaux sédimentaires servant de roches mères - ou de support - aux croûtes calcaires.
Les stations de ski «communales» et leur insertion dans le monde rural des Alpes du Sud. Le cas de St-Michel-de-Chaillol, Chabanon, Montclar-Col-St-Jean
Authors: de Reparaz André
Published: May 2011

Les stations de ski communales, éléments importants du monde rural sub-alpin, présentent bien des caractéristiques positives: foncier assez bien contrôlé par les «locaux», maintien généralement convenable de l'activité agricole et pastorale, création d'emplois secondaires et tertiaires et pluriactivité, gestion municipale entre les mains des familles locales, taille et qualité du bâti globalement en harmonie avec un environnement naturel peu atteint. Mais leurs faiblesses sont réelles: espace skiable limité et médiocres dénivelées; remontées mécaniques insuffisantes actuellement, et vieillissantes; endettement nécessaire pour les renouveler, vulnérabilité aux crises climatiques, faiblesse de la promotion, immobilier stagnant.
Versants aménages et déprise rurale dans l'est des Alpes-Maritimes
Authors: Rebours Françoise
Published: May 2011

L'est des Alpes-Maritimes dispose d'un patrimoine important de versants aménagés en terrasses qui subissent les effets de la déprise rurale. Une réflexion sur l'avenir de ces aménagements passe par l'étude des conditions de leur mise en place et de leur abandon qui conditionnent entièrement leur capacité de résistance et de réactivation à des fins agricoles, résidentielles ou de protection.
Érosion du sol et sédimentation fluviale dans les «ramblas» du sud-est espagnol
Authors: Conesa Garcia Carmelo
Published: May 2011

L'importance de l'érosion hydrique dans les terres semi-arides du Sud-Est espagnol est très connue. L'évaluation quantitative de cette érosion est complexe parce qu'elle pose de graves problèmes d'ajustement empirique et d outils pratiques abordés dans cet article. L' évaluation de l'érosion potentielle, les indices de libération d'apports fluviaux et de production de sédiments sont calculés pour différentes unités hydrologiques. Le modèle GAMES a été utilisé pour calculer les paramètres d'érosion et appliqué à cinq bassins dont les caractéristiques physiques et l'utilisation du sol sont différents, pendant l'automne (saison qui montre la plus grande quantité d'érosion hydrique annuelle dans cette région méditerranéenne).
Tourisme et peuplement de la côte en Sardaigne: les tendances en cours
Authors: Gentileschi Maria Luisa
Published: May 2011

Dopo alcune considerazioni generali sui rapporti tra turismo e popolamento stabile della costa, si esaminano gli sviluppi in alto in Sardegna, dove gran parte del popolamento tradizionale è lontano dalla fascia costiera. Dopo la nascita di insediamenti di villeggiatura presso le maggiori città costiere (Cagliari, Sassari, Oristano), si assiste oggi alla crescita di nastri di seconde case che si trasformano presto in case permanentemente abitate per un processo di suburbanizzazione. II popolamento della costa si lega infatti strettamente alla crescita urbana, in particolare al decentramento del capoluogo régionale e all'attrattiva esercitata dai porti, tramite del turismo oltre che del commercio. In definitiva, in Sardegna la costa è sempre più il luogo delle innovazioni nel quadro residenziale oltre che in quello produttivo.
Parcs et réserves naturelles en Sicile. Un patrimoine culturel, économique et social
Authors: Cavallaro Carmelo
Published: May 2011

Dans cette recherche , l'Auteur fait une critique de la situation de l'environnement en Sicile, avec ses retards dans les programmations et le manque de volonté de la part des politiques à les combler. L'Auteur analyse les lois qui régulent la mise en place des parcs et réserves naturelles, les compétences, les attributions, les moyens d'interventions des divers organismes en présence, ainsi que leurs rapports hiérarchiques. Il fait référence en particulier aux parcs de l'Etna, des Nebrodes et des Madonies en soulignant les caractéristiques du territoire et de l'environnement ainsi que les critères de leur zonage et de leur organisation. L'Auteur décrit, en outre, les réserves naturelles programmées et traite des réserves naturelles futures qui viendront compléter le plan régional relatif aux parcs et aux réserves. La clé du rapport Homme/Environnement est non seulement la sauvegarde du territoire mais aussi la programmation des besoins des populations qui y vivent.
Marseille et son développement : les incertitudes d'un avenir nécessairement particulier
Authors: Herbulot Joël T.
Published: May 2011

L'article présente un tableau de la situation actuelle de Marseille du point de vue urbain et évoque les grandes orientations et questions de son développement futur.
L'espace du spectacle à Marseille, deux siècles d'évolution
Authors: Echinard Pierre
Published: May 2011

L'article étudie les lieux de spectacle à Marseille au XIXe et au XXe siècle. Il montre le rôle des spectacles dans la centralité de la ville à la fin du XIXe siècle, élargi jusqu'aux années 1920. Il invite à faire du «spectacle» et des activités ludiques un moteur du renouveau du centre de Marseille.
Marseille en 1990, crises et métamorphoses
Authors: Tirone Lucien
Published: May 2011

L'article brosse un tableau des «crises» marseillaises en cette fin du XXe siècle et dessine les voies d'un renouveau pour le XXIe siècle.
Un ancien bassin minier devenu un espace périurbain
Authors: Ferreira Claude
Published: May 2011

Entre les agglomérations de Marseille et d'Aix-en-Provence subsiste le deuxième bassin minier français. Des activités industrielles se maintiennent grâce à des efforts de modernisation et à une reconversion précoce, mais leur impact socio-économique s'est réduit. C'est un cas assez unique d'ancien bassin minier transformé par une périurbanisation de proximité récente, importante et généralisée. Elle a engendré un nouveau dynamisme démographique, une forte urbanisation diffuse et pose des problèmes d'aménagement.
Mouvement de terrain ancien et héritages glaciaires sur le versant méridional du Granon (Briançonnais). Tentative d'établissement d'une chronologie relative
Authors: Lahousse Philippe
Published: May 2011

Le versant méridional du Granon (Briançonnais) présente de nombreux indices de mouvements de terrain successifs (glissements rotationnels et coulées). Outre le levé cartographique détaillé (1/10.000) auquel ont donné lieu ces formes, les recherches ont également été axées sur le cadre géomorphologique initial (empreinte glaciaire). Cette approche nous a permis d'établir une chronologie relative qui, au-delà de l'intérêt scientifique qu'elle comporte, nous fournit un critère supplémentaire de classification et de gradation des aléas naturels. Pour illustrer cette démarche, nous avons choisi d'exposer une monographie de mouvement de masse.
La variabilité des pécipitations dans le désert syrien
Authors: Traboulsi Myriam
Published: May 2011

In the Syrian desert, the total precipitations fall during only one period of the year (Oct - May), but the height varies under from one year to another one. However there is no absolutely dry year. Within one month the situation is quite different: one month can be humid one year and completely dry another one. The observation of pluviometrie data from a dozen of stations during a significant period (between 20 to 40 years) shows that there are clusters of dry years and humid years, though of varying importance and without any rythm.
L'occupation du sol dans le massif de Sainte-Victoire de l'époque de La Tène à la fin de l'Antiquité
Authors: Leveau Philippe , Mocci Florence , Muller Anke , Strobel Michaël
Published: May 2011

This article presents a progress report on archaeological fieldwork carried out on the southern flank of Montagne Sainte-Victoire following the forest fire of 1990. The work to date has led to the identification of a significant number of new sites and has modified in important respects the traditional picture of human occupation and exploitation of the mountain. The revised archaeological map presents three hilltop villages (essentially of La Tene III date) in their wider environmental and settlement context. The research in progress is particularly orientated towards the question of the agricultural exploitation of the area, with geomorphological work providing evidence for the consequences of that land-use on the evolution of the landscape (erosion of slopes, drainage of upland basins).
Typologie des stations du massif Sainte-Victoire
Authors: Ladier Jean , Boisseau Bénédicte
Published: May 2011

Le but d'une typologie de stations est de fournir au forestier tous les éléments dont il a besoin pour optimiser les choix de gestion sylvicole, en particulier le choix d'une espèce d'arbre. Il s'agit d'une étude technique basée sur un grand nombre de relevés ponctuels où sont décrits la situation, le sol et la végétation. 26 types de stations ont été définis sur Sainte-Victoire à la lumière du diagnostic synthétique fourni par la composition floristique; celle-ci permet déjuger de l'importance relative des facteurs écologiques tels que l'exposition, la position topographique ou les qualités physiques du substrat.