bluuebunny/crossref_metadata_2025 huggingface dataset:
Streptokinase in the Treatment of Renal Vein Thrombosis: A Case Report
Authors: Abdulnour Elias , Koleilat Nadim , Echavé Vincent , Charron Pierre , Brazeau Lamontagne Lucie
Published: November 2007

A patient with nephrotic syndrome due to membranous glomerulonephritis experienced an acute episode of left flank pain. A venacavogram revealed a large thrombus within the left renal vein, with clot extending into the inferior vena cava. He was treated with streptokinase for 72 hours. Venography verified complete disappearance of the renal and cava clots. Fibrinolytic therapy for renal vein thrombosis is discussed.
"Asanguinous" Open-Heart Surgery
Authors: Chua Philip S. , Carlos Cris J. , Gozo Felix R. , O' Yek Victor K.
Published: November 2007

"Asanguinous" open-heart surgery was initially performed by our team at our institution in January 1982 for mitral valve replacement in a Jehovah's Witness, whose religious beliefs precluded blood transfusion. Since then, we have applied this principle to all of our open-heart cases, with excellent results. Using an IBM 2991 blood cell processor and Sorensen Autologous Transfusion System, our institution has salvaged an average of 92.1 units of blood per month, from January 1982 to December of 1983, with a total of 650 units for 1982 and 1105 units for 1983. From January to August of 1984, a total of 645 units were saved, with an average of 80 units per month. This protocol involved 1121 patients with coronary bypass surgery, 32 of which had concommitant repair of IV aneurysm, and 27 with unilateral carotid endarterectomy. One hundred and sixty-eight underwent cardiac valve replacement, 109 mitral, 57 aortic, and 2 combined MVR-AYR. Eighty-six percent of our entire series did not require homologous, transfusion, other than their own, individual salvaged packed cells. "Asanguinous" open-heart surgery is not only possible and safe, but also a medically prudent technique that is cost-efficient and devoid of the usual hazards associated with homologous transfusion.
Limitations of the Use of Intra-Arterial Fibrinolytic Agents in Acute Lower Limb Ischemia
Authors: Corson John D. , Chang Benjamin B. , Goldman Martin , Sarrafizadeh Mohammad S. , Leopold Peter W. , Leather Robert P. , Shah Dhiraj M. , Karmody Allastair M.
Published: November 2007

The use of direct regional intraarterial low dose fibrinolytic therapy was retrospectively studied in a group of 25 patients with acute lower limb ischemia. Bleeding problems were minimized due to careful monitoring of fibrinogen lev els. However two bleeding complications developed during lytic therapy on pa tients who had undergone recent surgical intervention. Following lysis a surgically correctable lesion was seen in one recently occluded conduit and in four late bypass occlusions. Eighty-three percent of the patients who had some lytic response required surgical intervention. The average time of fibrinolytic infusion was 46.7 hours.
The Penile Brachial Index in the Preoperative Evaluation of Arterial Hypogastric Insufficiency
Authors: Setacci Carlo
Published: November 2007

Two hundred and 30 patients with occlusive arterial disease of the legs were examined by angiography and penile brachial index (P.B.I.) obtained with ul trasound technique.

Forty-two cases had no reduction or less than 20% reduction of the cross section area of hypogastric artery the penile brachial index was 1,01 ± 0,056 in basal conditions, 0,96±0,078 after 5 minutes ischemia and 1,02±0,059 5 min utes after ischemia.

Ninety cases presented a reduction of cross section area of hypogastric artery between 20 and 75% the P.B.I. was 0,85±0,086 in basal conditions, 0,74±0,114 after 5 minutes ischemia and 0,82±0,105 5 minutes after ischemia.

Ninety-eight cases presented a reduction of cross section area of hypogastric artery of 75% and more, the P.B.I. was 0,45±0,15 during basal conditions, 0,26 ± 0,11 after 5 min. ischemia and 0,34±0,13 5 min. after ischemia.

Therefore, determination of P.B.I. can be considered as a valuable tool in the study of the hypogastric circulation.

Such a study is of value particularly before rectum surgery in the preopera tive evaluation of the blood supply to the rectal stump and after hemicolectomy, with ligation of mesenteric artery at the emergency from aorta.
Communications to the Editor and Clinical Case Reports
Authors: Cifiello Bianca Ines , Gessaroli Massimiliano , Cenacchi Giovanna , Loperfido Vincenzo , Mirelli Michele , Stella Andrea
Published: November 2007

Fibro-muscular dysplasia (FMD) is a rare lesion of the subclavian artery. We report the description of histologic and ultrastructural findings in a white young man.

The associated aneurysm is a natural complication of FMD. After the resec tion of the pathologic artery and end-to-end anastomosis a rethrombosis can develop.
Anuloaortic Ectasia as a Late Complication Following Repair of Coarctation of the Aorta
Authors: Lindsay Joseph , Rosenberg Joel , Ross James W. , Garcia Jorge M.
Published: November 2007

Disability and death from aortic dissection or rupture and from aortic valvular dysfunction are known to occur late following repair of coarctation of the aorta. Two cases herein described illustrate successful surgical repair of anuloaortic ectasia in 2 patients nineteen and twenty-five years after repair of congenital aortic coarctation. These observations, together with previously reported experience, suggest the presence of an intrinsic weakness of the aortic wall, perhaps a part of a congenital diathesis that includes bicuspid aortic valve and coarctation of the aorta.
The Effect of Diltiazem on Experimental Intimal Thickening Caused by Common Carotid Artery Investment in Rabbits
Authors: Naito Michitaka , Asai Kanichi , Shibata Kazuaki , Kuzuya Masafumi , Funaki Chiaki , Kuzuya Fumio
Published: November 2007

We studied the prophylactic effect of diltiazem on experimental arteriosclerosis caused by investing the common carotid artery of rabbit with a polyethylene tube for three weeks. The arteriosclerotic lesions consisted mainly of fibrocellular intimal thickening, which is similar to spontaneous arteriosclerosis in human beings.

Diltiazem (100 mg/kg/day orally) suppressed the intimal thickening and the destruction of the internal elastic lamina but not significantly.

This model might be suitable for simulation of human fibrocellular intimal thickening without hyperlipidemia and be useful for the estimation of antiarteriosclerotic effects of various drugs.
True Aneurysm of the Abdominal Aorta Due to Blunt Trauma
Authors: Aseem Wali M. , DeVittorio A.A.
Published: November 2007

Although traumatic aneurysm of the abdominal aorta is rare, it can develop after severe trauma or crushing injury of the abdomen. A case report is presented of a 27-year-old woman who had a steering wheel injury to the abdomen and developed thrombosis of the distal abdominal aorta. After thrombectomy, she did well and was discharged from the hospital. Nearly eight months later, she developed aneurysm and stricture at the site of trauma in the abdominal aorta. The involved segment was resected and a tube graft interposed. The patient did well postoperatively and no longer complains of weakness of her lower extremities.
Protection of Abdominal Aortic Grafts by Omentum Flap
Authors: Khalil Ismail M. , Livingston David H.
Published: November 2007

Prosthetic graft infection is a devastating complication of aortic surgery with a high morbidity and mortality. In selected cases the use of an omentum pedicle provides excellent coverage of the aortic prosthesis and interposes viable tissue between the suture line and abdominal viscera. The omentum is superior to preaortic soft tissue because of its availability, vascularity, and lymphatic drain age. The technique is outlined and an illustrative case presented.
Adductor Canal Compression Syndrome — A Case Report
Authors: Stanton Paul E. , Vo Nghia M. , Finley John , Shannon John
Published: November 2007

Adductor canal compression syndrome is an unusual cause of acute arterial occlusion in younger men. The arterial occlusion results from extrinsic com pression by an abnormal musculotendinous band arising from the adductor magnus muscle. The mechanism of this syndrome is similar to that of thoracic outlet and popliteal fossa entrapment syndromes. The present case report is the sixth in the literature. Treatment consists of division of the abnormal band and restoration of arterial continuity by appropriate means.
Aorto-Enteric Fistulas
Authors: Glock Y. , Fourtanier G. , Puel P.
Published: November 2007

The authors report a series of 10 patients who presented with 4 primary aorto-enteric fistulas (AEFs) and 8 secondary AEFs. Gastrointestinal bleeding is the main feature of this serious complication. The diagnosis is difficult; no single procedure: endoscopy, angiography, CAT scan, or upper gastrointestinal film series is regularly diagnostic for AEF. Acute massive exsanguination needs urgent explorative xyphopubic midline laparotomy without preoperative work- up. The surgical treatment consists of endoaneurysmorraphy or graft prosthesis resection without "in situ" vascular reconstruction. The extraanatomic bypass permits the revascularization of the lower limbs. In this series, the prognosis appeared to be poor. The mortality rate with primary AEF was 50%, and the morbidity consisted, after "in situ" reconstruction, of early or late secondary AEF. In secondary AEF, the mortality rate after extraanatomic reconstruction with graft excision was 62%. The main complications were infection, fistuliza tion, and hemorrhage.
Experimental Study of the Interaction Between Aortic Grafts and the Intestine: Dacron vs PTFE
Authors: Cavallaro Antonino , Sciacca Vincenzo , Cisternino Silvestro , Di Marzo Luca , Mingoli Andrea , Gallo Piero , Alessi Giuseppe
Published: November 2007

The interaction of vascular prostheses (Dacron and PTFE) and the intestine has been investigated in the beagle dog. The experimental conditions implied grafting of the abdominal aorta and apposition of the intestine onto the graft. The maximum follow-up was 150 days.

Dacron manifested a constant trend toward penetration into the intestinal wall; PTFE remained almost unadherent to the intestine.
Microvascular Surgery in Vascular Impotence: Diagnosis, Surgical Technique, Follow-up
Authors: Crespo Enrique Ladislad , Bove Daniel , Farrell Guillermo , Soltanik Enrique
Published: November 2007

The authors describe their microsurgical technique used in 257 patients who had been shown in the sleep laboratory to have an organic cause of impotence and in whom vascular occlusion had been demonstrated by conventional angiog raphy. They used their technique of intraoperative angiography through the dorsal and/or cavernous arteries for making decisions on surgical tactics. Thus guided, they performed microsurgical bypass from the iliac or common femoral artery to the intrapenile arteries by direct microsurgical anastomosis. They de scribe their surgical tactics, results in a nine-year follow-up and complications.
Revascularization Methods in Chronic Intestinal Ischemia—Case Studies
Authors: Borrero Edgar , Chang John B.
Published: November 2007

Chronic intestinal ischemia is an uncommon disease clinically, usually due to advanced atherosclerotic stenosis or occlusion of the intestinal arteries without adequate collateral blood flow to the intestine.

Standard aortography with lateral views remains the definitive diagnostic procedure. Revascularization by bypass to the celiac artery for one of its branches and the superior mesenteric artery with dacron graft is recommended to avoid infarction of the bowel and its catastrophic consequences.

Six patients with chronic intestinal ischemia underwent successful revascu larization. All six intestinal artery bypasses were performed by use of knitted dacron grafts and/or autogenous vein grafts. There were no postoperative com plications or deaths. One patient has subsequently died, fourteen months after discharge, from a massive hemorrhage due to an aortoduodenal fistula. The 5 patients who were still alive are gaining weight, and none has required reopera tion for an occluded graft or has developed bowel necrosis.
Management of Vascular Complications Associated With Use of Intraaortic Balloon Counterpulsation
Authors: Sanfelippo Peter M. , Baker Norman H. , Ewy H. Gene , Moore Patrick J. , Thomas John W. , Brahos George J. , McVicker Robert F.
Published: November 2007

Intraaortic balloon counterpulsation (IABP) has become an accepted modal ity to assist the failing heart. An eleven-year experience in 637 patients with this modality was reviewed.

Vascular complications occurred in 66 (10.4%). Female patients made up 27% of all IABP patients and 29 of the 66 IABP patients (44%) with vascular complications. Vascular complications were four times more frequent when IABP was accomplished percutaneously as contrasted with the use of a sidearm graft.

The factors that predispose patients to vascular complications with IABP, the measures to decrease the incidence of these complications, and the manage ment of these complications to minimize loss of limb and/or life are discussed.
Recurrent Pulmonary Embolism from Thrombi in Greenfield Filter—Case Report
Authors: Schanzer Harry , Knight Richard
Published: November 2007

Vena cava interruption using the Greenfield filter has proved to be a safe and effective method. In a series of 156 patients receiving the filter, published by Greenfield, the patency rate was 98%, and there was no mortality secondary to the filter placement. The incidence of recurrent pulmonary embolism resulting from the proximal propagation of a thrombus has been reported to be 5%. The present work reports on a case of recurrent pulmonary embolism resulting from the proximal propagation of a thrombus originating in a Greenfield filter.
Transaortic Occlusion for Aortic Resection—Case Reports
Authors: Taheri Syde A. , Mueller George A.
Published: November 2007

Prompt control of bleeding from a ruptured abdominal aortic aneurysm is the most important step toward successful operation. In a high percentage of cases, the neck of the aortic aneurysm can be cross-clamped without difficulty. In certain patients, however, particularly those with anterior ruptured aneu rysm, transaortic occlusion with a catheter might be a life-saving procedure.
Urokinase Efficacy for Deep Vein Thrombosis Developing During Streptokinase Therapy—A Case Report
Authors: Behrend A. James , Long David M.
Published: November 2007

A patient with embolic occlusion of the right femoral artery and the left tibial arteries received streptokinase as treatment to lyse the emboli. Blood flow in both lower extremities improved with streptokinase administration. On the fourth day of therapy, however, the patient developed pain and swelling of the right calf. A venogram confirmed the presence of a clot obstructing the right popliteal vein. Streptokinase infusion was stopped, and urokinase infusion was started. Pain and swelling in the right calf disappeared and venous blood flow was greatly improved during urokinase therapy. Urokinase infusion was stopped after sixty hours, and heparin therapy was started. The patient was discharged from the hospital one month after admission. Patients should be closely monitored during thrombolytic therapy to detect any signs of complica tions, including new thrombotic episodes.
Autoperfusion of Kidney with Pruitt-Inahara Shunt in Renal Vascular Reconstruction—A Case Report
Authors: Lai Shiao-Ting , Cheng Kwok-Kei , Chao Zu-Chien
Published: November 2007

A case of renovascular hypertension (RVH) with severe left renal artery stenosis is reported. This problem was managed by renal endarterectomy and patch angioplasty. During the operation, the authors devised a new idea and applied a Pruitt-Inahara shunt to the abdominal aorta and the distal end of the renal artery for autoperfusion of the kidney. The whole course of treatment is presented. The patient had become normotensive by ten months after the opera tion.
Left Internal Carotid Artery Pseudoaneurysm Following a Cervical Lymph Node Biopsy—A Case Report
Authors: Borrero Edgar , Doscher William
Published: November 2007

Pseudoaneurysms of the internal carotid artery are usually due to civilian trauma, but on rare occasions they may be a result of iatrogenic injury during a cervical procedure (diagnostic or therapeutic). Recent reports have, however, demonstrated an increasing incidence of iatrogenic pseudoaneurysms, and pseudoaneurysms of the internal carotid artery may, therefore, be seen more often in the future. The authors present a patient who developed a pseu doaneurysm following a left cervical lymph node biopsy, her subsequent "workup" as an outpatient, and then the definitive workup with an arterio gram. Operative treatment of the pseudoaneurysm is also discussed.
Angioscopy-Assisted Intraoperative Transluminal Angioplasty: Preliminary Report
Authors: Lai Shiau-Ting , Cheng Kwok-Kei
Published: November 2007

Angioscopy as a guide for intraoperative transluminal angioplasty (ITA) was used in the treatment of 13 segmental arterial stenoses in 12 patients (10 men, 2 women). Ages ranged from fifty-eight to seventy-five years (mean: 68.33 ± 4.85). The authors successfully visualized vessels in 100% of the 12 patients, and 11 (92%) of the 12 arterial occlusive lesions were successfully dilated.

Intraluminal anatomic and functional hemodynamic improvement was doc umented in all successful cases. The authors recommend angioscopy as a spe cific ancillary technique in certain cases of peripheral vascular disease during concomitant vascular surgery.
Use of the Subclavian Vein by Percutaneous Puncture for Permanent Cardiac Pacing
Authors: Kouvaras George A. , Chronopoulos George A. , Cokkinos Denis V.
Published: November 2007

One hundred and fifty patients, 85 males and 65 females with a mean age of sixty-six years (range thirty-five to eighty-five years) were paced permanently by use of the subclavian venipuncture technique. The indication for pacing was documented high-grade A-V block (80 patients), sick sinus syndrome (60 pa tients) and carotid hypertensitivity with recurrent syncope (10 patients). In 142 patients multiprogrammable VVI pacemakers and in 8 DDD pacemakers were implanted. The procedure lasted from twenty to fifty-five minutes (mean thirty minutes). Apart from a partial dislodging of the electrode tip in 1 patient, which resulted in intermittent exit block and was corrected by increasing the pulse width of the generator current, no other early complication was observed. The patients have been followed up from three to twenty-six months (mean eleven months). One patient has had the wire repositioned deeper in the subcutaneous tissue owing to imminent skin erosion. No other late complication has been noticed.
Atherosclerotic Narrowings of the Mesenteric Circulation
Authors: Plonka Andrzej J. , Tolloczko Tadeusz , Lipski Marek , Malanowska Sylwia , Adelman Martin H. , Williams James S.
Published: November 2007

To study the incidence of atherosclerotic involvement of the mesenteric ar teries, autopsies were performed on 47 randomly chosen cadavers that were fifty years old or older. The study encompassed: (1) postmortem angiogram; (2) dissection and macroscopic assessment of the main vessels and any possible col laterals ; and (3) a microscopic grading of the cross-sectional area of the proxi mal 2 cm of the mesenteric arteries.

There was a statistically significant preponderance of stenosis among males (83% vs females 67%). The superior mesenteric artery (SMA) had a higher incidence of narrowing (85%) than either the inferior mesenteric artery (IMA) (72%) or the celiac artery (CA) (64%). High-grade stenosis (> 50% of the lumen involved) was most common in the IMA (28%), followed by the SMA (17%) and the CA (11%) .

Despite a high incidence of stenosis, a retrospective review of patient charts did not reveal any convincing reports of abdominal complaints. Moreover, only 1 case had dilated collaterals.
Failure of Percutaneous Transluminal Angioplasty of Radiation-Induced Subclavian Artery Stenosis: Case Report
Authors: Hans S.S. , Tuma Martin A.
Published: November 2007

Radiation-induced subclavian artery stenosis was successfully treated by percutaneous transluminal angioplasty but subsequent recurrence of the lesion three years and nine months later was managed by crossover axillobrachial artery bypass.
Late Complications of Autogenous Vein and Dacron Graft Anastomosis in Renal and Lower Extremity Reconstruction
Authors: Hans S.S.
Published: November 2007

Five late complications of dacron and autogenous vein graft anastomoses used in renal and lower extremity reconstruction were studied. Three patients had recurrent stenoses and 2 patients had anastomotic aneurysms. Surgical treatment was required in all patients. One patient developed aorto-renal-duo denal fistula and died in the immediate postoperative period owing to multiple organ failure. In the remaining 4 patients, secondary procedures were success ful. In patients in whom direct dacron and vein anastomoses have been con structed, careful late follow-up is essential to detect and manage these complications.
Arteriovenous Fistula Following Thyroidectomy Presenting with Cardiac Failure—A Case Report
Authors: Borrero Edgar
Published: November 2007

An arteriovenous fistula between the thyrocervical trunk and the transverse cervical vein is described, diagnosed four years after thyroidectomy. This unu sual fistula produced signs of cardiac failure and the bruit was discovered on careful physical examination. Although a systolic/diastolic bruit may be gener ated by arterial occlusive disease of the carotid artery, the presence of a continu ous cervical bruit in close proximity to a scar should suggest an arteriovenous fistula.
Acute Brachial Artery Occlusion — Diagnosis and Treatment
Authors: Witz Misha , Dinbar Alex , Ashton Frank
Published: November 2007

Over a ten-year period 28 patients with brachial emboli were treated. Twenty-five underwent embolectomy under local or regional brachial plexus block using the Fogarty technique within twenty-four hours of onset of symp toms. Reembolectomy was required and performed successfully in 3 of these patients. Pulses were well restored in 20 of the 25. Three patients were treated conservatively. In 1 of these, chronic upper limb disability was observed. High average age and underlying heart disease are common factors in this pathology. The authors' treatment of choice for such patients is surgical embolectomy un der local or regional anaesthesia. A high index of suspicion and early definitive surgery can optimize the chance of good results in these patients. One-year follow-up of 22 patients showed functioning upper extremity in all but the 1 conservatively treated patient with chronic upper limb disability.
Peripheral Arterial Injuries with Gunshot Wounds: Surgical Treatments and Results
Authors: Özgen Gökalp , Eren Nesimi , Solak Hasan
Published: November 2007

Between 1975 and 1985, 102 consecutive patients with 106 peripheral vascu lar injuries caused by gunshot blasts were treated in the authors' clinic. The average age was 25.6 ± 11.4 (mean ± SD). The average time between arterial injury and arrival to the hospital was 13.2 ± 4.8 hours. Sixty-six (62.3%) arte rial injuries were found in lower extremities and the most commonly injured artery was the superficial femoral artery. Thirty-six (35.3%) patients had com bined arterial and venous trauma. All patients with vascular involvement had some signs and symptoms of vascular trauma. Preoperative angiography was required in 23 cases and demonstrated arterial injury; 98 patients underwent surgical intervention. Resection of the injured arterial segment and end-to-end anastomosis were done in 44 patients. Resection of the arterial segment followed by interposition of autogenous vein graft was done in 34 patients. One case underwent nonbiologic graft (Dacron) replacement (in the left subclavicular ar tery). Primary lateral suture was placed in 6 cases, and ligation was made in 9. In cases associated with venous injury, 22 vascular venous repairs and 14 liga tions were done. Eighty-one (79.4%) patients retained a functional limb. Two cases underwent primary amputation, and 9 cases underwent secondary ampu tation. Six patients died; the causes of morbidity were usually related to associ ated injuries. Four patients refused the surgical approach.
Conservative Treatment of Polytetrafluoroethylene Grafts Infection
Authors: Joffe Boris , Mordechay Israel
Published: November 2007

The treatment of infected syn thetic grafts presents a serious prob lem and there is no single approach to dealing with it.

The authors report on 9 patients who developed infections following bypass operation with a synthetic graft. The infections appeared in var ious places but mainly in the groin. In 2 of the patients who suffered infec tions after implant of dacron grafts, the authors had to remove the graft and then perform an extraanatomic bypass, after conservative treatment had failed. Seven patients, in whom a prosthesis of polytetrafluoroethylene (PTFE) had been implanted, were given conservative treatment that was very successful in dealing with the infection that developed in the wounds.

The treatment included antibiot ics appropriate to the sensitivity of the bacteria, debridement of the wounds, local treatment with wound- cleansing powder and continual irri gation with povidone-iodine. The wounds in these patients healed spon taneously or with the help of second ary closure, and the implants re mained patent.
Microvascular Vasodilatory Function at Three Months and One Year After Cardiac Transplantation
Authors: Mullins Paul , Chauhan Anoop , Large Steven , Wallwork John , Schofield Peter
Published: November 2007

Coronary occlusive disease (COD) is the major complication after the first year in cardiac transplant patients and may be initiated by perioperative factors. Coronary angiography is usually used but is an insensitive monitoring method. Coronary flow measurements allow investigation of the responses of the coronary microvasculature. The authors inves tigated the hypothesis that coronary flow responses (CFR) to papaverine (a nonen dothelial-dependent vasodilator) and acetylcholine (an endothelial dependent vasodilator) are impaired early after cardiac transplantation. Ten patients were studied at three months (3/12) and one year (12/12) after transplantation. No patients had COD on angiography A Doppler flow probe was inserted into the proximal left anterior descending coronary artery in all patients. Incremental doses of intracoronary papaverine (Pap), and glyceryl trinitrate followed by acetylcholine (Ach), were given until maximum hyperemia was achieved. CFR for each drug was defined as the ratio of resting to peak coronary blood velocity. CFRPap was lower at 3/12 as compared with 12/12: 3.1 SD 1.1 versus 3.9 SD 1.3 (P = 0.05, Student's t test). CFRAch was impaired at 3/12 as compared with 12/12: 1.9 SD 0.6 versus 2.6 SD 0.5 (P = 0.01). Endothelial- and nonendothelial dependent microvascular vasodilation are impaired early after cardiac transplantation but subsequently improve. Perioperative coronary damage may play a crucial role in the pathogenesis of COD.
Successful Simultaneous Resection of Abdominal Aortic Aneurysm and Rectal Cancer
Authors: Komori Kimihiro , Okadome Kenichiro , Funahashi Satoru , Itoh Hiroyuki , Mori Masaki , Sugimachi Keizo
Published: November 2007

The surgical approach to patients with an abdominal aortic aneurysm (AAA) and gastrointestinal malignancy remains controversial. The Authors experienced a case with AAA and rectal cancer, which was treated by a successful one-stage operation. At first, the operation for the aneurysm was done through a transperitoneal approach, and then, an abdominoperineal resection for rectal cancer was simultaneously done with a closed-bowel resection by the stapling technique. The postoperative course was uneventful. The patient was discharged on the thirty-second postoperative day. From the standpoint of bacterial contamination, these two operations should be done separately; however, simultaneous operations such as the one described herein are possible if great care is taken.
Elastase and Collagenase Activities in the Wall of the Abdominal Aortic Aneurysm
Authors: Samy Ahmed K. , Finlay Frank , MacBain Gordon
Published: November 2007

Some patients with arteriosclerosis of the abdominal aorta develop occlusive lesions (group O) while others develop aneurysmal dilatation (group A). Defects in the tissue organization, possibly secondary to a familial factor, are demonstrated by enzyme imbalance in the aortic wall.

The authors report their own experience in comparing elastase and collagenase activ ities between the two groups. Tissue from the aortic wall of 24 consecutive patients undergoing surgery for either aneurysmal (8 patients) or occlusive aortic disease (16 patients) was subjected to suitable biochemical assays. Four samples from group O were excluded because of low tissue weight and/or zero protein content. Aortic wall elastase was found to be significantly higher in group A than in group O. When expressed in nmol/gram tissue, the median elastase content in group A was 8.211 (range: 3.4078-14.2049) compared with 3.049 (range: 0-5.6359 of group O (P = 0.0030). This difference was still significant if it was expressed in nmol/gram protein, the comparable figures being 2.303 (range: 0.616-5.171) and 0.559 (0-1.345) respectively (P = 0.0018). On the other hand the authors were unable to confirm previous findings suggesting a variation in collagenase levels between the two groups either by using additive substrate (P = 0.3348) or by using endogenous substrate (P = 0.2170).

This suggest that collagenase may not be implicated in the development of aneurysmal dilatation. Alternatively it may be tightly bound or inhibited in the aortic tissue protein matrix in such a way as to make measurement of its activity difficult, while still contributing to the pathological process. More refined techniques of detecting colla genase may therefore be required.
Obturator Crossover Bypass
Authors: Samy Ahmed K. , Cooper Graham G.
Published: November 2007

A technique of obturator crossover bypass is described with two case reports of its use. This procedure may be considered applicable when unilateral obturator bypass is indicated but a contralateral abdominal approach is required to obtain graft inflow.
Compression of the Superior Mesenteric Artery by the Median Arcuate Ligament: A Cause for Mesenteric Ischemia
Authors: Matsumoto Alan H. , Muehle Casey , Casada David , Navid Forozan , Tegtmeyer Charles J. , Tribble Curtis G.
Published: November 2007

Extrinsic compression of the superior mesenteric artery (SMA) by the median arcuate ligament (MAL) is an uncommon entity. The authors report a case of compression of the SMA by the MAL in a patient with celiac artery occlusion and intestinal angina. Arteriography and computerized tomography were suggestive of the diagnosis. Division of the fibrous bands of the MAL extending onto the anterior surface of the SMA relieved the arterial compression, with subsequent resolution of the patient's symptoms.
Femorofemoral Bypass Graft Improves Malignant Hypertension Secondary to Common Iliac Artery Occlusion in a Renal Transplant Recipient
Authors: Esterl Robert M. , Garvin Paul J.
Published: November 2007

An atherosclerotic lesion in the aortoiliac vasculature proximal to the anastomosis of a transplant renal artery is a rare cause of refractory hypertension. The authors describe a renal recipient who developed refractory hypertension secondary to common iliac artery occlusion proximal to a transplant renal artery. A femorofemoral reconstruction resulted in dramatic improvement in hypertension. Femorofemoral reconstruction for revascu larization of a transplant renal artery has not been previously described in the literature.
Reduced Morbidity and Mortality Following Carotid Endarterectomy: The Value of Preoperative Cardiac Screening
Authors: Carballo Richard E. , Freischlag Julie A. , Seabrook Gary R. , Cambria Robert A. , Towne Jonathan B.
Published: November 2007

Carotid endarterectomy can be recommended for stroke prophylaxis when performed with low perioperative cardiac morbidity and mortality. In this study the authors evaluate the effectiveness of a cardiac screening protocol using dipyridamole-thallium scintig raphy to identify and treat coexistent coronary artery disease (CAD).

The authors reviewed the medical records of 164 patients undergoing carotid endarterectomy between 1988 and 1993 at the John L. Doyne Hospital and at the Zablocki Veterans Administration Hospital in Milwaukee, Wisconsin. Results of the preop erative cardiac evaluations and the incidence of perioperative cardiac events were recorded.

Forty patients without any evidence of cardiac disease by history or electrocardio gram went on to surgery without further screening. Eight patients underwent coronary catheterization without dipyridamole-thallium scan, owing to the severity of their cardiac symptoms. A cardiology consultation and dipyridamole-thallium scan were obtained preoperatively in the remaining 116 patients with a history of CAD. Of these 116 patients, 62 (53.4%) were diagnosed as normal. Thirty-five (30%) scans demonstrated reversible reperfusion defects, leading to preoperative coronary angiography in 17 patients and to cardiac revascularizations in 8. Nineteen (16.4%) scans demonstrated a fixed perfusion defect; 3 of these patients underwent coronary catheterization, leading to cardiac revas- cularization in 1 patient. Of 2 patients (1.7%) who suffered a postoperative myocardial infarction, 1 patient had a fixed perfusion defect and 1 was found to have a two-vessel disease on coronary catheterization. There were no perioperative deaths. In the follow- up period (15.9 months; range one to sixty), no cardiac deaths occurred.

With this treatment algorithm using selective dipyridamole-thallium scan evaluation, perioperative and long-term cardiac morbidity and mortality can be minimized.
Reliability and Accuracy of Physical Examination in Detection of Abdominal Aortic Aneurysms
Authors: Kiev Jonathan , Eckhardt Aric , Kerstein Morris D.
Published: November 2007

Technologic advancement has provided earlier detection and confirmation of aortic aneurysms, fewer physicians seemingly relying on their clinical skills to diagnose abdominal aortic aneurysms. Of 145 infrarenal aortic aneurysms, analysis disclosed that less than 30% were clinically discovered on admission. Fifty-six aortic aneurysms were discovered incidentally, most often during an annual physical examination in the course of evaluation for another problem. Aneurysms measuring less than 4.5 cm were rarely discovered on physical examination. The majority of both clinically discovered and inci dental aneurysms ranged between 5.5 and 6.0 cm. Ultrasound identified most aneurysms. The size of an aneurysm did not appear to have a role in determining whether it was discovered clinically.
Is Complete Wound Healing a Valid Endpoint for Clinical Trials of Venous Stasis Ulcer Treatment?
Authors: Gorin Daniel R. , LaMorte Wayne W. , Barry Maryann , Scott Thayer , Menzoian James O.
Published: November 2007

Complete wound healing is often used as an endpoint in clinical trials comparing different treatments of venous stasis ulcers. The authors have found, however, that determining exactly when a wound is completely healed is often difficult and quite subjective. Because of this concern, they undertook the following survey.

Photographs of 46 venous stasis ulcers were classified by the authors as obviously healed (H, n=5), obviously not healed (NH, n=7), and ambiguous (Amb, n=34). Blinded reviewers were instructed to judge the wounds as if they were conducting a clinical trial, and were asked: (1) Is the wound healed? (yes/no/can't tell), and (2) If forced to decide yes or no for question 1, which would you choose? (yes/no).

Forty-eight reviewers took part in the study: 29 physicians or nurse clinicians with a specialty in wound care (MD/RN) and 19 medical students (MS). When given the three options, they classified 17% of the wounds as "can't tell" (H 27%, NH 5%, Amb 17%). The percentage of reviewers disagreeing with the majority opinion was determined for each wound, when the reviewers were forced to choose either "healed" or "not healed." (The least amount of consensus would be 50% disagreement, with the reviewers split 50/50 on the classification. The greatest consensus would be 0% disagreement, with all reviewers agreeing.) The overall percentage of disagreement was 24%. The percentage of disagreement on Amb wounds was 29%, for H wounds 18%, and for NH wounds 7%. The results were similar when reviewed by MD/RN (Amb 25%, H 9%, NH 4%) or MS (Amb 27%, H 30%, NH 10%). There was >90% consensus for only 3% of Amb wounds (MD/RN 9%, MS 3%).

The precise determination of complete wound healing is quite subjective and variable, even among observers with great experience in wound care. There is great potential to introduce bias into clinical trials that employ complete wound healing as an endpoint. It should, therefore, be used only with great caution.
Temporary Axillofemoral Shunt for Renal Transplant Preservation During Aortic Thromboendarterectomy
Authors: Silvestri Fred , Dardik Herbert , Rabinowitz David , Robertson John , Ibrahim Ibrahim M.
Published: November 2007

Aortic surgery in renal transplant patients introduces a complex problem. Various means to protect the transplant kidney under these circumstances have been described including ex vivo renal perfusion, in situ renal perfusion with aortoiliac shunt, in situ renal perfusion with a pump oxygenator, and axillofemoral bypass. The authors' experience with a temporary axillofemoral bypass to maintain perfusion of a renal transplant during aortothromboendarterectomy with patch angioplasty is described. They believe that the risks for injury to the transplant kidney are substantially reduced with maintenance of renal perfusion during aortic occlusion.
The Internet and Vascular Surgery: A Brief Description of the Internet, the World Wide Web, and Some of the Vascular Surgical Resources Available
Authors: Schneider Joseph R. , Lindsay Thomas F.
Published: November 2007

The 1990s have seen an explosive growth of the Internet and the World Wide Web (WWW). This growth has occurred secondary to dramatic improvements in computer hardware and software in addition to their ready availability to millions of users. The Web has put information and commerce in a medium that is simple to access. A number of web sites are dedicated to vascular surgery. This manuscript describes some of the basic aspects of electronic communications and their potential implications for vascular surgery.
Anterior Abdominal Wall Necrosis Following Bypass for Aortoiliac Occlusive Disease
Authors: Vijay Venkataramana , Nadaf Kutub
Published: November 2007

An uncommon complication of ipsilateral anterior abdominal wall ischemic necrosis ("trash abdominal wall"), following microembolic occlusion of a unilateral patent internal iliac artery and collaterals during aortobifemoral bypass for aortoiliac disease, is presented. Recognition of the presence or lack of a collateral system from lateral thoracic and intercostal arteries to branches of the superficial epigastric on preoperative angiogram and its role in the perfusion of the anterior abdominal wall is stressed. Preserving both or at least one internal iliac artery and avoiding microembolism from endarterectomy will minimize the risk for this complication.
Prognostic Factors of Chronic Upper Limb Ischemia and Endoscopic Thoracic Sympathectomy
Authors: Onohara Toshihiro , Nakahashi Hisashi , Takahashi Ikuo , Nishizaki Takashi , Wakasugi Kenzo , Matsusaka Toshimitsu , Kume Kazuhiro , Fujinaga Yutaka
Published: November 2007

Long-term results of chronic upper limb ischemia and related prognostic factors were evaluated. In addition, the efficacy of endoscopic thoracic sympathectomy was examined. Thirty-one patients with chronic ischemic episodes of 41 upper limbs were reviewed retrospectively. The cause of ischemia included atherosclerosis in 18 limbs, Buerger's disease in 16 limbs, and other causes in seven limbs. Thoracic sympathectomy was under taken in 21 limbs, and bypass grafting was undertaken in five limbs. Fifteen limbs were not treated surgically. Of the 21 thoracic sympathectomies, the transthoracic approach was used in 12 and thoracoscopy was used in seven. In addition, an extrapleural approach was used in two cases because of dense pleural adhesion.

Compared with open sympathectomy, the intraoperative blood loss, the duration of chest tube drainage, and the complication rate were significantly decreased in the endo scopic group. Recurrence rates for all 41 limbs were 14.5% at 1 year, 19.2% at 2 years, and 30.3% at 3 years. Univariate analysis revealed significantly lower recurrence rates for men, cases caused by Buerger's disease, and limbs without contralateral upper limb ischemia. Multivariate analysis also disclosed a significantly lower recurrence rate for limb ischemia caused by Buerger's disease.

The cause of upper limb ischemia influenced the outcome. In cases of Buerger's disease, the recurrence rates were low, and thoracic sympathectomy was effective. Thoracoscopic sympathectomy was safe and less invasive than open sympathectomy and is a valid therapeutic option for treating upper limb ischemia.
Type 1 Aortic Dissection Complicated by Lower Extremity and Renal Ischemia Treated with Surgical Aortic Replacement and Percutaneous Balloon Fenestration
Authors: Khoury Maroon B. , Bailey Yvette D. , Benckart Daniel H. , Savage Edward B.
Published: November 2007

After successful replacement of the ascending aorta and the aortic arch for a Type 1 aortic dissection, a persistent intimal tear resulted in expansion of the false lumen and in lower extremity and renal ischemia. This was successfully treated with percutaneous fenestration of the suprarenal abdominal aorta by means of a transseptal needle and balloon angioplasty. There were no complications, and benefits continued to result from the procedure at 4 months' follow-up.
Possible Involvement of Nitric Oxide (NO) as a Free Radical in the Pathogenesis of Pancreatic Ischemia-Reperfusion Injuries in Rats
Authors: Hirano Tetsuya
Published: November 2007

This study was designed to evaluate the role of nitric oxide (NO) as a free radical in the pathogenesis of pancreatic injuries induced by pancreatic ischemia-reperfusion in rats. Pancreatic ischemia-reperfusion was accomplished by reducing the mean arterial blood pressure approximately to 60% of the control values for 45 minutes with blood removal and by restoring normotension by reinfusion of the shed blood. In this model of pancreatic ischemia-reperfusion, serum amylase concentrations, pancreatic water content, and pancreatic trypsin content were significantly increased as compared with the control animals. Pancreatic superoxide dismutase (SOD) content was significantly decreased. However, pancreatic lipid peroxide (LPO) levels were significantly increased. Moreover, pancreatic subcellular redistribution of lysosomal enzyme, cathepsin B, from the lysosomal fraction to the zymogen fraction was also observed. Pretreatment with NO synthase inhibitor, N ω-nitro-L-arginine (NNA) at a dose of 20 mg/kg, significantly inhibited these changes. These results indicate that NO seems to play an important role as a free radical in the pathogenesis of pancreatic injuries induced by pancreatic ischemia-reperfusion and that NO seems to be involved in the intracellular sorting of lysosomal enzymes in the pancreatic acinar cells during pancreatic ischemia-reperfusion.
Suspended Animation: Thinking and Animality in Neurocultural Selfhood
Authors: Mackenzie Adrian
Published: November 2007

This essay analyzes a genre of self-improvement literature based on scientific models of animal behavior and neurophysiology. Popular science books such as Blink: The Power of Thinking without Thinking, by Malcolm Gladwell, or Mind Wide Open: Why You Are What You Think, by Steven Johnson, and academic books such as Neuropolitics: Thinking, Culture, Speed, by William Connolly, argue that everyday thought or thinking includes animal behaviors and responses. These authors suggest that these behaviors and responses should become the object of managed self-awareness. Their broadened understandings of thought have dramatic implications for contemporary selfhood, sociality, and political life. This essay situates their understandings of animality, selfhood, and thinking through the work of Giorgio Agamben. Agamben's concept of the “anthropological machine” offers an alternative framing of the relation between human and animal and of any attempt to manage that relation. It suggests how this relation changes historically, generating instabilities in political and metaphysical formations, and why the collapsing of human-animal differences encounters obstacles. Drawing on Martin Heidegger's analysis of animals and boredom, Agamben's work implies a different way of thinking this relation. Thinking, for Agamben, is a form-of-life that lies close to animality.
Philosophy as Inspiration: Blaise Pascal and the Epistemology of Aphorisms
Authors: Groarke Louis
Published: November 2007

In five stages, this essay works out an account of the aphorism as a philosophical genre. First, I outline a preliminary, general strategy for elucidating the aphorism as an expression of “aphoristic consciousness.” Then I discuss Blaise Pascal's aphoristic style, concentrating on exegetical issues surrounding his Pensées. Next, I demonstrate that aphoristic consciousness (understood in an appropriately epistemological sense) has been a constant (though now largely unrecognized) theme in the history of Western philosophy. Following this survey of Pascal's predecessors, I show how Pascal's own epistemological account of the aphorism reiterates and encapsulates this traditional understanding in its own distinctive way. And finally, I provide a new theoretical account of the aphorism as a literary and philosophical form, for which Pascal's thought provides both a theoretical framework and an excellent example.
The Role of Sse1 in the de Novo Formation and Variant Determination of the [PSI+] Prion
Authors: Fan Qing , Park Kyung-Won , Du Zhiqiang , Morano Kevin A , Li Liming
Published: November 2007

Yeast prions are a group of non-Mendelian genetic elements transmitted as altered and self-propagating conformations. Extensive studies in the last decade have provided valuable information on the mechanisms responsible for yeast prion propagation. How yeast prions are formed de novo and what cellular factors are required for determining prion “strains” or variants—a single polypeptide capable of existing in multiple conformations to result in distinct heritable phenotypes—continue to defy our understanding. We report here that Sse1, the yeast ortholog of the mammalian heat-shock protein 110 (Hsp110) and a nucleotide exchange factor for Hsp70 proteins, plays an important role in regulating [PSI+] de novo formation and variant determination. Overproduction of the Sse1 chaperone dramatically enhanced [PSI+] formation whereas deletion of SSE1 severely inhibited it. Only an unstable weak [PSI+] variant was formed in SSE1 disrupted cells whereas [PSI+] variants ranging from very strong to very weak were formed in isogenic wild-type cells under identical conditions. Thus, Sse1 is essential for the generation of multiple [PSI+] variants. Mutational analysis further demonstrated that the physical association of Sse1 with Hsp70 but not the ATP hydrolysis activity of Sse1 is required for the formation of multiple [PSI+] variants. Our findings establish a novel role for Sse1 in [PSI+] de novo formation and variant determination, implying that the mammalian Hsp110 may likewise be involved in the etiology of protein-folding diseases.