bluuebunny/crossref_metadata_2025 huggingface dataset:
Under the Smokescreen of Horizontality: Gendered Leading Tasks within the Yellow Vest Movement
Authors: Melby Eli
Published: September 2024

There is little scholarship on how gender impacts the construction of leadership in supposedly leaderless, horizontal social movements. In this study, I expand the concept of leading tasks, to get at the ways in which gender intersects with the critical organizing work of maintaining horizontal movements. Drawing on comparative data from 7 months of fieldwork conducted with two grassroots groups in the French Yellow Vest movement, I argue that horizontal organizing in the Yellow Vests (YVM) functions as a gendered structure which opens possibilities for women to take on important leading tasks: caring management, attentive listening, and superintendence. These analytically constructed, gendered leading tasks point to a tension inherent in horizontality: It creates leeway for women’s participation, while also functioning as a smokescreen for a process where group members reproduce traditional gendered expectations of women to do a “third shift” in organizing, characterized by nurturing and caring for participants and activist spaces. The study documents how women can be disadvantaged by this mode of organization. Thus, the concept of gendered leading tasks contributes to investigating how leadership is a gendered construct shaped by those who enact it, and the social structure that surrounds it.
Preparation, characterization and thermal properties of the PS+Si based polymer nanocomposites
Authors: Shirinova HA , Surkhayli AE , Pashayev BG , Mammadov HM , Jafarov MA , Gahramanli LR
Published: September 2024

Polymer nanocomposites based on polystyrene and polycrystalline Si nanoparticles have been successfully synthesized using the solution-casting method. The scanning electron microscope and x-ray diffraction methods show that the Si nanoparticle size in the obtained nanocomposite was up to 50 nm. The thermostability of the obtained nanocomposite was studied depending on the concentration of Si nanoparticles in the PS matrix. It was found that Si nanoparticles that are distributed homogeneously in the polymer matrix act as a thermal barrier. By adding 3% Si nanoparticles into polystyrene polymer, the thermal degradation temperature of PS increases by 20°, and the decomposition rate reduces from −42,460 mg/min to −35,099 mg/min. In addition, it was shown that Si nanoparticles do not affect the PS glass transition temperature, which explains that the porous Si does not reduce the free volume for the polymer molecules to move. The polymer macromolecules just are adsorbed on the porous silicon surface, which partially limits their mobility.
The silk roads and shared heritage in Europe: Beyond ‘China to Rome’
Authors: Brown Melissa Shani , O’Brien David
Published: September 2024

This article offers critical engagement with ideas of shared heritage, considering representation of the silk roads in Europe as a counterpoint to their representation in China. Often cast as a ‘bridge’ between ‘East and West’ or ‘China and Rome’ (e.g. UNESCO’s description of the Silk Road Heritage Corridors), the silk roads are regularly depicted as an abstraction of interconnection. And as an abstraction, the idea of shared heritage is often emptied of its potential to communicate greater understanding of the past, respect for cultural difference and co-dependency, or to invite reflection on forms of community constituted through shared histories. Exploring the Sinicization of the silk roads, we argue that much of the rhetoric of shared heritage is deceptively exclusive. We turn to consider the depiction of these histories of trade within Europe, offering a discursive analysis of metatexts around the United Nations World Tourism Organization/European Commission Western Silk Road tourism project, with some discussion of the representation of ancient trade at different European museums. We argue that an enduring legacy of the silk roads’ romanticized image and the transcription of this into commercial tourism inhibit their potential as a useful metanarrative for the future because it fails to communicate the complexity of the past, particularly histories of violence and inequality. However, considering recent depiction of the amber roads, we argue that histories of trade can nevertheless be mobilized towards a more nuanced understanding of the past and a critical reflection on the past and present.
How Can Early Christian Thought Inform Doughnut Economics?
Authors: Stuart David
Published: September 2024

Doughnut Economics is an economic model designed to overcome the negative impact that the crude use of Gross Domestic Product (GDP) can have on both society and the environment. As the model becomes more widely adopted it is important to explore the model from a theological perspective. Early Christian economic thought provides a way of exploring and challenging many of the fundamental ideas and conceptualisations of the DE model. DE has much to learn from early Christian thinkers. Firstly, a non-absolutist understanding of property can fuel calls for a more radical distribution of wealth than called for in DE, with an even greater emphasis on the process and benefits of individual almsgiving. Secondly, it shows how the limitations of the social foundation of DE has much to learn from the positive value of the ascetic lifestyle promoted by some early Christian thinkers. Finally, at a time when there are understandable concerns about the limits of the ecological ceiling, early Christian thought offers both hope and a call to action.
The Global Humanization Event (GHE)
Authors: Rull Valentí
Published: September 2024

The recent rejection of the “Anthropocene Series/Epoch,” as proposed by the Anthropocene Working Group (AWG), by the International Commission on Stratigraphy (ICS) and the International Union of Geological Sciences (IUGS), has reopened discussion about the Anthropocene as a geological event. This event has been referred to as the “Anthropocene Event” (AE) or the “Anthropogenic Modification Episode” (AME). This essay briefly discusses these terms and concepts, and proposed to use new terms such as “Earth System Humanization Event” (ESHE) or “Global Humanization Event” (GHE), which are more specific and terminologically more consistent with the already defined geological events.
Paraanastomotic Aneurysms of the Abdominal Aorta: A 15-Year Experience Review
Authors: Locati P. , Socrate A. M. , Costantini E.
Published: September 2024

The aim of the study is a retrospective review of clinical presentation and management of paraanastomotic aneurysms of the abdominal aorta (PAAA) surgically treated in our Department.

From January 1984 to December 1998, 2183 aortic prosthetic grafts were implanted. During the same period. 24 patients were treated for PAAA, 19 false and five true aneurysms. Symptoms were present in 10 patients. Surgical management included tube grafting interposition (14), aortobifemoral bypass (2), graft removal with extraanatomic bypass (2) and with in situ revascularization by arterial homograft (4).

Nine patients died during operation or in the early postoperative period, six died during follow-up. Mortality in symptomatic patients was 70%, while in asymptomatic group was 14% ( P = 0.01). Rupture of false PAAA was very frequent (47% of cases).

PAAA are infrequent complications of proximal aortic graft revascularization and tend to be asymptomatic until rupture occurs. The incidence of mortality is very different in asymptomatic versus symptomatic group; rupture is particularly frequent in false PAAA, which must soon undergo surgery when diagnosed. Since PAAA may develop at any time after surgery, their incidence increase in relationship with the length of postoperative interval: therefore, all patients submitted to abdominal graft revascularization need a lifetime surveillance program.
Aortic Graft Infections: Replacement with Autogenous Vein
Authors: Valentine R. James , Clagett G. Patrick
Published: September 2024

The purpose of this review article is to summarize our published experience with the use of the superficial femoral-popliteal vein (SFPV) to replace infected aortic prostheses. The SFPV has proven to be resistant to infections of all types and has shown no signs of degeneration over the long term. Since SFPV bypass and prosthetic graft excision are performed as a single stage, operative times are extensive. Therefore, it may not be appropriate for the sickest patients with severe medical comorbidities. Nevertheless, the operation has been associated with gratifyingly low mortality and amputation rates that are far better than published rates associated with graft excision and extra-anatomic bypass. It is particularly suited to patients with complex aortofemoral graft reconstructions who cannot undergo extra-anatomic revascularization for technical reasons. The venous sequella of SFPV harvest are minimal. These data and those from three other centers support the conclusion that graft excision and replacement with SFPV is an excellent alternative for treatment of aortic graft infections.
Thromboprophylaxis in an Academic Medical Center
Authors: Proctor Mary C. , Greenfield Lazar J.
Published: September 2024

Introduction:

Questions regarding which patients require prophylaxis for thromboembolism, what methods should be used and the appropriate duration of treatment remain unanswered.

Methods and Materials:

A retrospective review from a single academic medical center was undertaken to evaluate prophylactic strategies. Multiple sources of data were used to identify patients who were prophylaxed and those who developed deep vein thrombosis or pulmonary embolism. These data were analyzed to determine factors associated with successful prophylaxis including age, type of prophylaxis and admitting services.

Results:

A total of 22,030 patients were admitted of whom 7520 (36%) received prophylaxis and there were 523 thromboembolic events. Pneumatic compression devices and antiembolic stockings had the lowest incidence of failure, 2.2% and 3.2% respectively. There were significant differences in the rates of prophylaxis used by the five admitting services, being highest in surgery (40.8%) and lowest in gynecology (11.4%). However, these groups had the lowest incidence of venous thromboembolism (4.3%, 2.3%). Both of these groups used pneumatic compression as the method of choice (64.3% and 65.2%).

Conclusions:

Thromboembolism prophylaxis reduces the incidence of DVT and PE, however, our study demonstrates the variable effectiveness of each method in different types of patients. Our data suggest that patient risk of DVT should be individually assessed and an appropriate method of prophylaxis should be applied when warranted.
Surgical Outcome of Infectious Aneurysm of the Abdominal Aorta with or without SIRS
Authors: Ihaya Akio , Chiba Yukio , Kimura Tetsuya , Morioka Koichi , Uesaka Takahiko
Published: September 2024

The surgical outcome of infectious abdominal aortic aneurysms was evaluated based on the preoperative presence or absence of systemic inflammatory response syndrome (SIRS). Nine patients were divided into two groups according to the criteria for SIRS such as body temperature, heart rate, respiratory rate, and white blood cell count. In the group with SIRS, rupture and impending rupture of aneurysms occurred in three of the four patients (75%). All aneurysms were resected with a small part as a remnant; two in situ and two extraanatomic reconstructions were performed. Three patients died after surgery: one after in situ (cerebral infarction) and two after extraanatomic reconstruction (sepsis and multiple organ failure). In the group without SIRS, closed en bloc resection in two patients and resection of the aneurysm with a small part as a remnant in three patients were performed. In situ reconstruction in all patients and omentum wrapping in two patients were performed. One of the five patients died of massive hematemesis 70 days after surgery. The overall mortality rate was 75% in the group with SIRS versus 20% in the group without SIRS. The surgical outcome of infectious abdominal aortic aneurysm depends upon the severity of underlying infection. A possibility exists that SIRS is a useful indicator for predicting the surgical outcome of patients.
A Simple Method to Determine Anastomotic Quality of Coronary Artery Bypass Grafting in the Operating Room
Authors: Takami Yoshiyuki , Ina Hiroshi
Published: September 2024

Anastomotic quality of coronary artery bypass grafting is directly associated with peri-operative and long-term clinical results. In this study, we investigated a cut-off value for intra-operative flow measurement. This value could be of use to a surgeon in determining the anastomotic quality of grafts. Intra-operative transit-time flow variables (mean flow, pulsatility index, % efficiency, fast Fourier transformation (FFT) of the flow curve) and the 2-week post-operative angiographic findings were examined in 66 coronary artery bypass grafts, including 33 internal thoracic arteries. There were significant differences between patent and non patent grafts in all of the intra-operative flow parameters. Only the FFT ratio, the ratio of powers of the fundamental frequency and its first harmonic, could be utilized as a cut-off value to distinguish patent from non patent grafts. All stenotic or occluded grafts showed an intra-operative FFT ratio of <1.0, while all patent grafts yielded a ratio of >1.0. Based upon these results, we concluded that power spectral analysis of flow measurement might be useful for intra-operative differential diagnosis of the anastomotic quality in coronary artery bypass grafting.
The Impact of Hypertension on the Operative and Early Postoperative Outcome of Aortic Valve Surgery
Authors: Tosson R. , Buchwald D. , Klak K. , Laczkovics A.
Published: September 2024

Hypertension is a known risk factor in heart disease. It can lead to pressure overload and hypertrophy of the left ventricle. The aim of this study is to examine the effect of hypertension on the operative and early postoperative outcome after aortic valve surgery using the retrograde cardioplegia.

All the data of all the patients who had aortic valve surgery in our department were retrospectively examined during the period from January 1994 until April 1996 and received retrograde blood cardioplegia. 397 patients were included in this study. 213 of them had arterial hypertension, as preoperatively diagnosed by the referring cardiologist. There were 163 females and 234 males. 142 were above 70 yr of age. 22 patients had an ejection fraction (EF) ≤0.4 and in 168 patients the LVEDP was >15 mmHg. Hypertension alone proved to be no risk factor. Decreased EF in hypertensive patients leads to an increase in the occurrence of prolonged ICU-stay, low cardiac output and neurological complications. Hypertension alone does not increase the risk of operative and early postoperative aortic valve surgery.
Surgical Management of Left Ventricular Free Wall Rupture after Acute Myocardial Infarction
Authors: Coletti G. , Torracca L. , Zogno M. , La Canna G. , Lorusso R. , Pardini A. , Alfieri O.
Published: September 2024

Left ventricular rupture after acute myocardial infarction occurs more often than suspected and diagnosis is rarely made before death. Left ventricular rupture has been reported to contribute to the overall in-hospital mortality after acute myocardial infarction in up to 24% of cases and to be present in 40% of patients dying within the first week after infarction. Only prompt diagnosis and aggressive surgical treatment can be lifesaving under these circumstances. Between February 1991 and August 1993 five patients underwent emergency operation for left ventricular rupture after acute myocardial infarction using exclusively transoesophageal echocardiography as a diagnostic tool. All patients had evidence of cardiac tamponade and electrocardiography showed signs of anterolateral acute myocardial infarction in one, inferolateral acute myocardial infarction in three and lateral acute myocardial infarction in one. In two cases the infarcted area was débrided and an interrupted pledgetted 2/0 polypropylene suture was placed from inside of the ventricle outward to the epicardial surface and then through the pericardial patch. In the other three cases an original technique was used: an autologous glutaraldehyde-stiffened pericardial patch was sealed over the infarcted area using fibrin glue and fixed with running suture on the surrounding healthy myocardium. One patient died in the operating room because of low cardiac output syndrome which was possibly the result of an excessively extended area of infarction. Left ventricular rupture is a catastrophic complication of acute myocardial infarction and prompt diagnosis with transoesophageal echocardiography followed by emergency operation can be lifesaving. The surgical technique with pericardial patch and fibrin glue, without infarct excision, used in three patients, can be a useful and simple surgical option in this pathology when no active bleeding is observed from the tear.
Warm Heart Surgery in Cold Haemagglutinin Disease
Authors: Donatelli F. , Mariani M. A. , Triggiani M. , Pocar M. , Santoro F. , Grossi A.
Published: September 2024

Continuous warm retrograde blood cardioplegia and systemic normothermia are a promising method for heart surgery in patients with cold autoimmune disorders in order to avoid the adverse effects of both systemic and coronary hypothermia during cardiac arrest and cardiopulmonary bypass. A 59-year-old white man with cold haemagglutinin disease who underwent coronary surgery using continuous retrograde normothermic blood cardioplegia and systemic normothermia is reported.
Oxygen Free Radicals Regulate Splanchnic Nitric Oxide Synthesis and Blood Flow
Authors: Myers S. I. , Hernandez R. , Castaneda A.
Published: September 2024

This study examines the hypothesis that oxygen radicals down-regulate splanchnic nitric oxide synthesis and contribute to splanchnic vasoconstriction following hemorrhage/reperfusion injury. Anesthetized rats underwent placement of flow probes around the superior mesenteric artery and abdominal aorta. Animals were bled to 30 mmHg for 30 min, reperfused without or with superoxide dismutase. an oxygen radical scavenger, 15 min before reperfusion and compared with sham-treated rats. Animals were sequentially teated with the nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) at 10 mg/kg and L-arginine, a nitric oxide precursor, at 200 mg/kg or 400 mg/kg. L-NAME increased systemic pressure and decreased superior mesenteric artery blood flow whereas L-arginine decreased arterial pressure and increased superior mesenteric artery blood flow in the sham animals. Hemorrhage/reperfusion injury attenuated the pressure and superior mesenteric artery blood flow changes following L-NAME and L-arginine dosing, which was reversed by superoxide dismutase treatment. These data suggest that oxygen free radicals regulate splanchnic nitric oxide synthesis, thus contributing to splanchnic vasoconstriction following hemorrhage/reperfusion injury.
Microvascular Changes in Chronic Venous Insufficiency—A Review
Authors: Leu A. J. , Leu H.-J. , Franzeck U. K. , Bollinger A.
Published: September 2024

Chronic venous insufficiency is the result of an impairment of the main venous conduits, causing microvascular changes. The driving force responsible for the alterations in the microcirculation is probably the intermittently raised pressure propagated from the deep system into the capillaries. The capillaries are dilated, elongated and tortuous and their endothelium is injured (irregular luminal surface, increased cytopempsis, dilated interendothelial spaces). Through the latter an increased extravasation can be observed, leading to an enlarged pericapillary space, oedema in the interstitial tissue and to the clinical finding of swelling. Haemoglobin from extravasated erythrocytes and erythrocyte fragments in the pericapillary space is degraded to haemosiderin which is responsible for hyperpigmentation. Microthrombosis in the capillaries causes microinfarction and micronecrosis. Skin areas with severe microangiopathy have reduced numbers of perfused nutritional capillaries and are characterized by a low transcutaneous (tc) Po2e increased blood flow in the deeper skin layers does not contribute to nutrition of the superficial skin layers. The microvascular ischaemia is patchy and appears to be the main factor determining trophic changes and venous ulceration. The process of microinfarction and micronecrosis is followed by the formation of a granulation tissue, proliferation of capillaries and fibroblasts and finally wound healing by formation of scar tissue destroying the microlymphatic network. Clinically this process leads to lipodermatosclerosis, atrophy and in its most extreme form to ulceration where the compensating mechanisms are no longer able to repair the damage.
The Second Decade of Experience with the Umbilical Vein Graft for Lower-Limb Revascularization
Authors: Dardik H.
Published: September 2024

Some 20 years have elapsed since the initial concept and development of the human umbilical vein graft. Experience with 1074 umbilical vein grafts forms the basis of this report as the indications for this prosthesis have been refined and its performance defined. In 1988, the author and colleagues published their 10-year experience with umbilical vein which described the results of 907 bypasses constructed in 715 patients (799 limbs). Over the past 5 years, the use of umbilical vein has decreased because of a commitment to autologous saphenous vein. A total of 167 additional umbilical vein bypasses were performed at Englewood Hospital and Medical Center between 1985 and June 1993. Secondary patency rates for popliteal and crural reconstructions at 5 years showed a trend of continuous improvement — 65% and 45% respectively compared with 57% and 33% as reported during the first decade of experience. Rates of infection, stenosis and pseudoaneurysm decreased and only two aneurysms have been discovered during this period. Umbilical vein is an acceptable alternative to the absent or deficient autologous vein. Patency rates are second only to autologous vein rates and the fear of failure due to aneurysm formation has not only been overstated, but also significantly exaggerated.
Aortofemoral Graft Occlusion: Strategy and Timing of Reoperation
Authors: Erdoes L S. , Bernhard V. M. , Berman S. S.
Published: September 2024

The authors' experience with 46 patients treated over 8.5 years was reviewed to determine the optimal secondary revascularization procedure after occlusion of a unilateral aortobifemoral graft limb. A total of 64 procedures was performed on these patients to restore and maintain graft patency. Repetitive operations for reocclusion were needed in 14 patients (30%). Transcatheter thrombolytic therapy was used in 14 patients, four as sole therapy and 10 in conjunction with operation. The mean time from aortofemoral grafting to presentation with graft limb occlusion was 59.4 months. Rest pain or severe ischemia was present in 85%. and severe claudication in the remainder. Some 78% had urgent operation after diagnostic angiography and catheter-directed thrombolytic therapy was attempted in 22%. The etiology of graft thrombosis was outflow obstruction in 78.2% of cases. Inflow was obtained by surgical thrombectomy in 35 and by lytic therapy in 13. Extra-anatomic inflow was used in 11 and intra-abdominal thrombectomy or redo aortofemoral grafting in five. Outflow procedures, mainly profundaplasty, were performed in all but five cases (four urokinase and one surgical). Infrainguinal bypass was needed in 10 cases in addition to the groin reconstruction. Catheter-directed thrombolysis was successful in 13 of 14 instances; however, in nine of these residual stenosis was disclosed in the outflow requiring surgical repair. Ultimately, 12 of 14 cases treated with thrombolysis required surgical intervention. Cumulative patency for all procedures was 68%. Complications were seen in 14% of cases. Operative mortality was 5%, and limb salvage was obtained in 85%. The most common cause of graft limb occlusion is outflow obstruction at or just below the femoral anastomosis. Aggressive attempts at complex groin reconstructions with inflow thrombectomy are indicated and yield excellent results. Thrombolytic therapy is useful in selected patients, but is not routinely indicated.
Effects of Completion Angiography on the Outcome of Carotid Endarterectomy
Authors: Lohr J. M. , Albers B. , Roat T. W. , Byrne M. P. , Roedersheimer L R. , Piercefield G. G.
Published: September 2024

The carotid endarterectomy results of a single surgeon were analyzed over an 8-year period to determine how routine completion angiography affected endarterectomy outcome. Completion angiography was performed in 80% of cases. A total of 145 patients (86%) were symptomatic while 23 (14%) were symptom-free. Of 131 completion angiographies performed, 94 were interpreted as normal and 37 abnormal. The arteries were reopened In 23 patients with abnormal results. In the 14 patients with abnormal angiograms who were not reopened, two showed no flow into the internal carotid artery and the vessels were ligated. The remaining 12 patients had abnormalities in the external carotid artery or normal Doppler signals along the common carotid artery and internal carotid artery segments. Among the 37 patients with abnormal angiograms, arteries were re-explored in four; there were no neurologic complications. In the entire group, there were three mortalities, one stroke, one transient ischemic attack, two wound complications, four myocardial infarctions, two occurrences of cerebral edema, two pneumonias and nine transient local nerve injuries. Completion angiography has allowed an improved technique while also enhancing the ability to identify technical problems during surgery without increasing morbidity. These results support the use of intraoperative completion angiography to evaluate carotid endarterectomy sites.
Carotid Endarterectomy in the Presence of a Contralateral Occlusion: A Review of 315 Cases over a 27-Year Experience
Authors: Adelman M. A. , Jacobowitz G. R. , Riles T. S. , Imparato A. M. , Lamparello P. J. , Baumann F. G. , Landis R.
Published: September 2024

Recent data from the North American Symptomatic Carotid Endarterectomy Trial revealed a 14.3% perioperative risk of stroke or death with carotid endarterectomy contralateral to a carotid artery occlusion. Since last reporting on this topic in the mid-1980s, the authors have reviewed 180 patients with occlusion of one internal carotid artery (ICA) and who underwent endarterectomy of the stenotic contralateral ICA operated from 1965 to 1984 (group A) compared with 135 operated on from 1985 to 1991. The two groups were similar with respect to age, sex. incidence of coronary artery disease, hypertension, diabetes and history of smoking. but group B had a significantly increased incidence of patients who were neurologically symptom-free before surgery (21.5% versus 7.8%, P< 0.001). The combined perioperative stroke or death rate for patients in group B was significantly lower than for those in group A (0.7% versus 6.7%. P<0.01). Comparison of the operative techniques showed more frequent placement of intra-arterial shunt (52.6% versus 29.4%, P< 0.001) and increased use of general anesthesia (20.0% versus 9.4%, P< 0.01) in patients of group B. Analysis of the etiology of the complications, however, showed that shunting alone could not account for the improved results. Lower incidences of postoperative thrombosis, embolization and intracerebral hemorrhage were equally important. From these data and a review of the literature, it is concluded that: (1) complications from carotid endarterectomy In patients with ICA stenosis and contralateral occlusion cannot be attributed to a single technical problem; (2) the reported high incidence of perioperative stroke or death with these patients reflects the added risk that any ischemic insult may result in a neurologic event; and (3) improved selection of patients and careful attention to cerebral perfusion and reconstruction of the carotid artery after endarterectomy can reduce the operative risks.
Dissecting Thoracic Aorta and Fusiform Aneurysm of the Abdominal Aorta
Authors: Kawasaki T. , Kambayashi J. , Goda K. , Kang J. , Watase M. , Tsuji Y. , Shinozaki K. , Iwazawa T. , Fukuda H. , Miyamoto M. , Mori T.
Published: September 2024

A 59-year-old woman with dissection of the thoracic aorta and a fusiform aneurysm of the abdominal aorta without evidence of Marian's syndrome underwent aneurysmorrhaphy with a bifurcated expanded polytetrafluoroethylene graft. Histological specimens of the aneurysmal wall revealed the presence of idiopathic cystic medial necrosis. As typical findings of idiopathic cystic medial necrosis in the aortic wall are very rare except in cases of Marian's syndrome, the present case is reported and the implications of this condition are discussed.
Femoral Vein Aneurysm: A Case Report and Review of the Literature
Authors: Castle J. M. , Arous E. J.
Published: September 2024

Primary venous aneurysms are rarely encountered lesions. Case reports have been described throughout the venous system. The lesions are usually symptom-free being found as a subcutaneous mass, an incidental finding on an imaging study, or during the work-up for deep venous thrombosis. However, embolism and rupture have been rarely described. A femoral vein aneurysm is reported, along with a current review of the literature of venous aneurysms.
Effect of Prior Sternotomy on Mortality and Morbidity after Heart Transplantation
Authors: Vijayanagar R. R. , Chan G. L. , Weinstein S. S. , Sears N. J. ,   Cardiac Transplant Team
Published: September 2024

A retrospective analysis to evaluate the impact of prior sternotomy on the outcome of cardiac transplantation was undertaken. Some 165 patients who received primary heart transplantation were classified into three groups. There were 102 patients in group 1 (no prior sternotomy). 47 in group 2 (one prior sternotomy), and 16 in group 3 (more than one prior sternotomy). The three groups were demographically similar. Coronary artery bypass was the indication for prior sternotomy in 77% of patients in group 2 and in 94% in group 3. Mortality within 30 days post-transplant was significantly different among the three groups (group 1, 7.8%; group 2, 8.5%; group 3. 31%; P= 0.0148). The 1-year actuarial survival was also significantly lower in group 3 (52%) compared with groups 1 (83%) and 2 (81%) ( P= 0.0311). Multivariate analysis identified more than one prior sternotomy and pulmonary hypertension as risk factors for death within 30 days post-transplant. Patients who had prior sternotomy also had a higher incidence of coagulopathy (group 1. 17%; group 2, 49%; group 3, 38%; P= 0.0002), and re-exploration due to excessive bleeding (group 1.5%; group 2, 11%; group 3. 25%; P= 0.0225). Requirement for blood products for transfusion was also higher in groups 2 and 3. There was no significant difference among the three groups in the incidence of early infections (50% versus 53% versus 44%). renal failure (6% versus 11% versus 19%). or allograft rejection in patients who survived the first 30 days (95% versus 86% versus 82%). The present findings suggest that patients with more than one prior sternotomy are at increased risk of early death after heart transplantation. Prior sternotomy is also associated with increased incidence of post-transplant bleeding.
Cytokine Therapy for Arterial Restenosis: Inhibition of Neointimal Hyperplasia by Gamma-Interferon
Authors: Castronuovo J. J. , Guss S. B. , Mysh D. , Sawhney A. , Wolff M. , Gown A. M.
Published: September 2024

Inhibition of neointimal hyperplasia by gamma-interferon (gIFN) treatment was evaluated. Four groups of Sprague-Dawley rats (n= 72) weighing 500 g underwent endothelial injury of the carotid artery using the previously described Fogarty catheter technique. Group I (controls, n = 8) received one phosphate-buffered saline (PBS) injection 24 h before injury and every 24 h thereafter for a total of eight injections. Groups II ( n = 8) and III ( n = 8) received daily injections of 200000 units of gIFN according to the same schedule except that group III did not receive the preoperative dose. Animals were Killed on postoperative day 14. Histologic sections were analyzed morphometrically and immunohistochemically. Both gIFN groups had a statistically significant 50% reduction of the cross-sectional area of the neointimal hyperplasia compared with that of the controls ( P< 0.01). Cell replication analysis of smooth muscle cells in the media and neointima revealed no statistically significant difference between controls and gIFN-treated groups. Group IV consisted of 48 rats that were treated with either PBS or gIFN on a schedule similar to that of groups I and II. Animals were killed at frequent time intervals during the first 7 days after injury. Their arteries were analyzed histologically and immunohistochemically. The results confirm previous findings that gIFN reduces the development of neointimal hyperplasia following arterial injury. The results also indicate that smooth muscle cells restore their proliferative activity by 7 days after discontinuation of gIFN treatment. It is proposed that efficacy of gIFN can be enhanced by lengthening the period of treatment.
Long QT Syndrome: An Indication for Cervicothoracic Sympathectomy
Authors: Ouriel K. , Moss A. J.
Published: September 2024

β-blockade represents the primary treatment modality in patients with long QT syndrome, but left cervicothoracic sympathectomy (LCS) has been employed in refractory cases and in cases with malignant arrhythmias. LCS was performed in ten patients (six male, four female) with long QT syndrome, ranging in age from 1 month to 40 years (median 15 years). Familial long QT syndrome was present in seven patients (70%). The mean(s.e.m.) (range) preoperative corrected QT interval (QTc) was 0.52(0.01) (0.46–0.60) s. The mean(s.e.m.) duration of symptoms was 4.4(1.1) years with a mean(s.e.m.) of 4.1(0.9) syncopal episodes and 1.2(0.2) cardiac arrests per patient. LCS was carried out for refractory symptoms on β-blockers in nine cases; a single patient was unable to tolerate β-blockers and LCS represented the primary treatment modality. A left supraclavicular approach was utilized in each patient, resecting a portion of the stellate and all of the T2 and T3 ganglia. The median(range) length of hospitalization following operation was 2(2-6) days. There were no unexpected complications of operation, although nine (90%) of the patients developed Horner's syndrome. The QTc decreased a mean(s.e.m.) of 0.03(0.01)s following operation ( P<0.01). The frequency of symptomatic episodes decreased from a mean(s.e.m.) of 7.1(3.1)/year before LCS to 0.1(0.1) after operation (P< 0.001). Patients have been followed for a mean of 1.3(0.3) years, and all but one patient remains symptom-free; the youngest patient died suddenly 10 months after surgery. These results suggest that LCS is associated with significant clinical benefits in patients with long QT syndrome and the procedure should be considered when symptoms are refractory and malignant, or when contraindications to β-blockers are present.
Dosage and Timing of Photofrin for Photodynamic Therapy of Intimal Hyperplasia
Authors: Hsiang Y. N. , Crespo M. T. , Todd M. E.
Published: September 2024

Photodynamic therapy has been recommended as a method of preventing intimai hyperplasia. The purpose of this study was to determine the dose and timing of Photofrin porfimer sodium needed to achieve a 3:1 or higher ratio between injured and control arteries after balloon endothelial injury. New Zealand White rabbits were anesthetized and their right femoral artery surgically exposed. A 4Fr Fogarty balloon catheter was passed retrograde into the lower abdominal aorta, inflated and pulled distally into the external iliac artery six times. All rabbits received heparin 100 IU/kg. Arteriotomies were closed and the animals recovered. Rabbits ( n = 5 per group) were given intravenous Photofrin at a dose and time according to the following scheme: group I, 5.0 mg/kg immediately after balloon injury: group II. 2.5 mg/kg immediately after injury; group III, 5.0 mg/kg after 1 week; group IV, 5.0 mg/kg after 2 weeks; or group V, 2.5 mg/kg after 2 weeks. Animals were killed 24 h after drug administration and the aortoiliac segments removed for spectrophotofluorometric determination of Photofrin levels from injured and control segments. Mean(s.d.) ratios of injured: control arteries for groups I to V were 4.8 (2.6). 2.8 (1.2), 3.0 (1.0), 1.4 (0.3) and 1.0 (0.0) respectively. This ratio was significantly higher for group I rabbits compared with groups IV and V ( P<0.01, ANOVA). Fluorescence and light microscopy showed that Photofrin was localized primarily in the tunica media, and that the drug must be administered before significant intimal hyperplasia occurs. This study suggested that the Photofrin dose of 5 mg/kg given immediately or within 7-days of injury achieved at least a 3:1 ratio between injured to control arterial segments. Ratios based on this dose were significantly higher than those from rabbits who received Photofrin 2 weeks after endothelial injury.
Valve Replacement for Acute Left Heart Endocarditis
Authors: Detry O. , Defraigne J. O. , Limet R.
Published: September 2024

Between January 1982 and June 1993, 66 patients (48 men and 18 women of mean(range) age 50 (21-77) years) underwent valve replacement for acute infective endocarditis. There were 45 aortic valve and 17 mitral valve infections. Four patients had bivalvular involvement. Fifty-three patients suffered from native valve endocarditis, with underlying valvular lesions documented for 31 patients. Staphylococci and Streptococci spp. were responsible for 68% of infection, and 20% of blood and valve cultures were negative. Refractory congestive heart failure was the leading surgical indication in 86% of patients. The mean follow-up period was 44 months. The perioperative mortality rate was 6%. Actuarial survival rates were 88.5% at 1 year and 83% at 3 years. No early recurrence of infection was noted. Six patients (9%) needed reoperation. Satisfactory results confirm that early surgical management should be considered in patients with complicated infective endocarditis.
Superior Vena Cava Stenosis after Orthotopic Heart Transplantation: Complication of an Alternative Surgical Technique
Authors: Blanche C. , Tsai T.-P. , Czer L. S. C. , Valenza M. , Aleksic I. , Trento A.
Published: September 2024

Superior vena cava stenosis presented as a postoperative complication of orthotopic heart transplantation in a patient in whom a new surgical technique was used. This alternative technique consists of total excision of the recipient's atria, with donor heart implantation performed using bicaval and pulmonary venous anastomoses. This rare complication required surgical repair 1 month after transplantation. The patient remains well on long-term follow-up. The pathogenesis, surgical management and modifications of the alternative technique to prevent this potentially serious complication are discussed.
Intracardiac Pheochromocytoma with Dual Coronary Blood Supply: Case Report and Literature Review
Authors: Fitzgerald P. J. , Ports T. A. , Cheitlin M. D. , Magilligan D. J. , Tyrrell J. B.
Published: September 2024

An intracardiac pheochromocytoma is extremely rare. This patient first presented postpartum at age 28 with clinical signs, symptoms and biochemical evidence suspicious for the diagnosis of pheochromocytoma. Multiple radiologic studies and laparotomy failed to confirm the diagnosis. Some 20 years later the patient presented with complaints of chest pain, palpitations, and flushing. Cardiac catheterization demonstrated a ‘tumor blush’ superior to the left atrium with a blood supply derived from the coronary arteries. Open-heart surgery was performed and the tumor successfully removed.
Congenital Aneurysm of the Sinus of Valsalva Dissecting into the Interventricular Septum
Authors: Abad C.
Published: September 2024

The case of a 57-year-old man with a congenital aneurysm of the right sinus of Valsalva dissecting into the interventricular septum is presented. The patient had a previous heart block and aortic insufficiency. The diagnosis was made by echocardiography and cardiac catheterization. Open-heart surgery was performed, closing the entrance of the aneurysm and replacing the aortic valve. The patient survived surgery and is in New York Heart Association functional class II 3 years after surgical repair. Other cases of this uncommon congenital heart disease are reviewed.
A Comparative Study of the Effect of Autologous Platelet-rich Plasma and Fresh Autologous Whole Blood on Haemostasis After Cardiac Surgery
Authors: Yamamoto K. , Hayashi J. , Miyamura H. , Eguchi S.
Published: September 2024

The effects of fresh autologous platelet-rich plasma and autologous whole blood on haemostasis afer cardiopulmonary bypass were examined in adult cardiac surgery patients. Platelet count adenosine diphosphate 10μM maximum aggregation rate and clotting Factor VIII were greater in the platelet-rich plasma group (n = 11) than in the whole blood group ( n = 8) after platelet-rich plasma or whole blood reinfusion. Blood loss after heparin neutralization was less in the platelet-rich plasma group than in the whole blood group, Blood loss from heparin neutralization to 12h after surgery was correlated with platelet count, fibrinogen and ADP aggregation rate. The number of patients who required homologous blood transfusion was less in the platelet-rich plasma group. In conclusion, the reinfusion of autologous platelet-rich plasma improves haemostasis after cardiopulmonary bypass, and may enable surgery to be performed without homologous blood transfusion.
Impact of Preoperative Risk and Perioperative Morbidity on ICU Stay following Coronary Bypass Surgery
Authors: Christakis G. T. , Fremes S. E. , Naylor C. D. , Chen E. , Rao V. , Goldman B. S.
Published: September 2024

Prolonged intensive care unit treatment (> 3 days) contributes to increased health costs and resource utilization. In order to devise strategies to limit intensive care unit stay, and provide cost-effective medical care, it is necessary to identify the pre- and perioperative risk factors of prolonged treatment. Over 100 potential risk variables were collected prospectively in 889 consecutive patients undergoing isolated coronary bypass surgery between 1990 and 1992. The incidence of intensive care unit therapy lasting > 3 days was 6.8%. Univariate statistics identified 23 pre- and perioperative variables that were potential contributors to prolonged intensive care unit therapy. However, multivariate analysis of preoperative risk variables identified only recent myocardial infarction (within 30 days of surgery) and continued preoperative smoking (within 30 days of surgery) to be independent risk factors. Only 6.3% of patients without preoperative myocardial infarction and 6.1% of non-smokers required prolonged Intensive care unit treatment, compared with 14.8% of patients with preoperative myocardial infarction (P= 0.01) and 10.1% of smokers (P= 0.07). When multivariate analysis was repeated with both pre- and perioperative variables, only ischemic morbidity (inotropes, myocardial infarction and low-output syndrome; 138 patients) and non-ischemic morbidity (infection, stroke or bleeding: 37 patients) predicted prolonged intensive care unit treatment. Intensive care unit treatment for > 3 days occurred in 26.8% of patients with ischemic morbidity compared with 3.2% of patients without ischemic morbidity ( P=0.001). Prolonged intensive care stay occurred in 32.4% of patients who suffered non-ischemic complications compared with 5.7% of patients who did not suffer these complications. The multiple logistic regression analysis odds ratio for ischemic morbidity was 7.4(95% c.i. 4.0–13.4) compared with 4.8(95% c.i. 1.9–10.1) for non-ischemic morbidity. Strategies designed to reduce the incidence of prolonged intensive care unit treatment should include prevention of stroke, Infection and bleeding. However, the greatest reduction of intensive care unit utilization would be mediated by prevention of ventricular dysfunction secondary to myocardial ischemia or inadequate myocardial preservation.
Mechanical Circulatory Assistance in Paediatric Patients with Cardiac Failure
Authors: Khan A. , Gazzaniga A. B.
Published: September 2024

Extracorporeal membrane oxygenation (ECMO) was initially developed for respiratory failure. Its use, however, has evolved into an excellent method of preoperative and postoperative support in the treatment of infants and children with acquired and congenital heart disease. Along with ECMO, the left ventricular assist device (LVAD) and the intraaortic balloon pump (IABP) have also found a place in the management of paediatric patients with heart failure. This report documents 15 patients who were treated with one or a combination of these mechanical devices, either preoperatively or postoperatively. There is a 74% survival rate and the long-term outcome has been excellent in most cases. The use of heparin-coated devices and tight regulation of heparin has allowed the transfer of infants and children from standard cardiopulmonary bypass to assist devices in the operating room. Mechanical devices are an essential adjunct for the preoperative and postoperative treatment of infants and children with cardiac disease.
Preservation of the Pelvic Circulation during Infrarenal Aortic Surgery
Authors: Connolly J. E. , Ingegno M. , Wilson S. E.
Published: September 2024

Paraplegia, ischemia of the colon, and gluteal necrosis are uncommon but devastating sequelae of surgery of the infrarenal aorta. These complications are ischemic in nature, secondary to the following technical maneuvers, individually or in combination: bilateral occlusion of the hypogastric arteries; division of a patent inferior mesenteric artery; or proximal end-to-end aortic to common femoral artery bypass grafting accompanied by stenosis of the external iliac arteries. The etiology of paraplegia after infrarenal aortic surgery is of particular interest since it now appears that it is more likely due to interruption of flow to lumbosacral branches of the hypogastric arteries supplying the conus of the spinal cord and/or to division of a low-lying ‘conus medullaris artery’ rather than to occlusion of the higher-lying great radicularis artery of Adamkiewicz. Knowledge of the pelvic circulation to the colon, buttocks, and terminal spinal cord allows the surgeon prophylactically to avoid or reconstruct critical branches during operations on the infrarenal aorta. While rare, severe complications cannot be completely eliminated; hopefully their incidence can be reduced by an understanding of their etiology.
Screening for Abdominal Aortic Aneurysm in the Jeddah Area, Western Saudi Arabia
Authors: Zahrani H. A. Al , Rawas M. , Maimani A , Gasab M. , Khail B. Aba Al
Published: September 2024

Atherosclerosis and its complications are associated with high morbidity and mortality in the elderly. One of these complications is abdominal aortic aneurysm which may be prevented from rupturing if diagnosed early. Screening for aortic aneurysm was carried out in Jeddah, which is in the western region of Saudi Arabia, to identify the magnitude of this problem. Three groups were studied: patients with hypertension (n= 101), patients with peripheral vascular disease (n = 71) and a third group of controls (n = 220). The mean (range) age of the whole sample was 66.0 (60-80) years. Evidence of aortic aneurysm was found in seven participants: five in the peripheral vascular disease group (7.0%), one in the hypertensive group (1.0%) and one in the controls (0.5%). In view of the expected increase in the elderly population of Saudi Arabia, as a result of improvements in health care which have recently been achieved, it is expected that a similar increase in the incidence of abdominal aortic aneurysm may occur. Routine screening for abdominal aortic aneurysm in the elderly, especially in those with peripheral vascular disease, may be worthwhile.