bluuebunny/crossref_metadata_2025 huggingface dataset:
Journalism ethics and the emerging new media culture of radio talk shows and public debates (Ekimeeza) in Uganda
Authors: Goretti Nassanga Linda
Published: August 2008

The article examines the rationale for journalism ethics and discusses challenges in professionalizing journalism, with particular reference to conditions in the developing countries. The article explores how an effective media regulatory body can be constituted to serve the interests of the various stakeholders.

Looking at Uganda's ethical code, the major interest from the public has been on the provisions restricting media practice and the article discusses issues regarding the implementation of the code, within the context of the new media culture of Ekimeeza (Radio Talk Shows and Public Debates).

In conclusion, some suggestions are given on the way forward to ensure that ethical codes are not thrown overboard in the media on the pretext that they apply to journalists only. Among the suggestions discussed are media education and media literacy, which would enhance the public's participation and enable them to benefit from the Ekimeeza.
Polydioxanone and Polypropylene Suture Materials in Experimental Coronary Artery Surgery with Free Internal Mammary Artery
Authors: Aarnio P. , Harjula A. , Lehtola A. , Sariola H. , Merikallio E. , Huusari H. , Mattila S.
Published: August 2008

Some experimental and clinical reports have shown the feasibility of the use of polydioxanone in vascular surgery. In this study polydioxanone and polypropylene suture materials were used in free internal mammary artery (IMA) graft anastomoses, which were made in 8 dogs from the left IMA to the left anterior descend ing coronary artery one free graft af ter another. Nine polydioxanone and nine polypropylene anastomoses were studied at six months with light mi pylene anastomoses, in which the su ture material was seen bulging up from the flow surface. According to this experimental study polydiox anone is as reliable as polypropylene and has some superior features over polypropylene in small luminal vas cular anastomoses.
A New Operative Procedure for Correction of Kinked Carotid Artery
Authors: Bakst Alvin A.
Published: August 2008

The historical development of sur gical correction of the kinked carotid artery is traced. A new procedure for the straightening of the kinked ca rotid artery with atheromatous plaque and cannulation of the vessel to ensure cerebral perfusion during arteriotomy is presented.
Treatment of Radiation Induced Arterial Occlusion: Importance of Extraanatomic Approach: Case Reports
Authors: Katras Tony , Blount Steven M. , Yee Edward S. , Vo Nghia M. , Stanton Paul E.
Published: August 2008

Radiation injury is an uncommon but increasingly important cause of arterial insufficiency. Radiation-in duced vascular compromise can threaten limbs once thought salvaged by radiotherapy in the course of treating neoplasms. Two cases of la tent arterial occlusion secondary to radiotherapy are reported. The alter ation of tissue architecture surround ing this type of arterial injury requires a different approach to vas cular repair afforded only by ex traanatomic bypass grafting.
Venous Thrombi—A Cause of Intestinal Infarction After Aortic Valve Replacement—A Case Report
Authors: Morishita Yasuo , Moriyama Yukinori , Taira Akira , Yonezawa Suguru
Published: August 2008

This report deals with a case of massive intestinal infarction without appar ent occlusion of the mesenteric artery after aortic valve replacement. Fibrin thrombi in the small veins of the gangrenous intestinal wall, which might be induced by vasospasm of the splanchnic vascular bed, seem to be a causative factor of this uncommon complication. The authors call attention to this compli cation in open-heart surgery because of the difficulty in diagnosis and its cata strophic consequence. Arteriography is essential for both diagnosis and therapy.
A New Assessment of Arteriographic Runoff for Predicting Fate of Femoropopliteal Arterial Reconstructions
Authors: Okadome Kenichiro , Mii Shinsuke , Onohara Toshihiro , Fukuda Atsushi , Muto Yoichi , Sugimachi Keizo
Published: August 2008

The preoperative arteriogram has been widely used to estimate distal vascu lar runoff in reconstructions of the lower extremity arteries. Based on the authors' previous reports that the intraoperative electromagnetically determined flow waveform of the reconstructed artery is a reliable predictor for the prognosis of the reconstructed artery, the correlation between intraoperative flow waveform pattern and preoperative arteriographic runoff in 60 femoropopliteal arterial reconstructions was analyzed. Preoperative arteriographic runoff was classified into five groups (Groups A, B, C, D, and E), according to presence of continuity of the popliteal artery with the calf arteries and the number of patent calf arteries and of patent calf arteries connecting the pedal arch. Arteriographic runoff with Type 0 or I flow waveform (n = 34) showed that two or three calf arteries were patent to the ankle and that at least two had continuity to the pedal arch (Groups A and B). On the contrary, the arteriograms showing Type II flow waveform (n = 26) revealed a variety of distal runoff from one patent calf artery connecting with the pedal arch to the isolated popliteal artery (Groups C, D, and E). Arteriographic runoff of two groups of flow waveform 0/I vs II could be clearly distinguished. These results were taken to mean that continuity of patent calf arteries with the pedal arch can serve as an important factor for evaluating vascular distal runoff in femoropopliteal arterial reconstructions. The authors' assessment of arteriographic runoff is a simple preoperative predic tor for intraoperative flow waveform, namely, the outcome, of the reconstructed artery.
Mycotic Aneurysm of the Femoral Profunda Artery in Active Infectious Endocarditis—A Case Report
Authors: Cozacov Carlos , Canaan Gabi , Man Boris
Published: August 2008

This case report describes a twenty-seven-year-old male who pre sented with a mycotic aneurysm of the right femoral profunda artery (FPA) appearing in the course of ac tive infectious endocarditis (Staphy loccus aureus). The aneurysm, 6 x 4 cm at the origin of the FPA, exerted growing pressure on the superficial femoral artery, causing its complete compression by the end of the third week following onset of symptoms. After resection of the mycotic aneu rysm and use of an interpolated re versed saphenous vein graft, the patient recovered uneventfully and was found in good condition on a five-year follow-up.
Decreasing the Risk of Aortic Arch Replacement
Authors: Scheld H.H. , Görlach G. , Boldt J. , Dapper F. , Moosdorf R.
Published: August 2008

Eight patients underwent surgical therapy because of acute dissection of the aortic arch. In all cases surgery was performed using hypothermic circulatory arrest. Seven patients survived without neurologic defi ciency. Postoperative angiography confirmed the complete resection of the diseased part of the aorta. This method of operative treatment allows inspection of the operative field with out disturbance by blood flow and es tablishes adequate cerebral protec tion. By using presealed prostheses, application of fibrin glue, and auto- transfusion, the authors were able to limit the risk of bleeding, which is the leading cause of death in surgery of acute aortic dissection.
Seat-Belt Dissection and Thrombosis of the Abdominal Aorta — A Case Report
Authors: Almazán Arturo , Ramos Manuel , Estella Rafael , Marin Antonio , González-Orús José Maria , Gómez-Alonso Alberto
Published: August 2008

Aortic injury is very rare in blunt abdominal trauma, but dissection and thrombosis of the aorta from a seat belt is exceptional and could be explained by the joint action of opposing forces. Anatomically, the lesions could go from aor tic wall hematoma to complete rupture.

The authors describe a case of acute presentation with loss of both femoral pulses and signs of lower limb ischemia due to circumferential dissection of the intima at the aortic bifurcation and secondary thrombosis. Small bowel rupture was associated. The patient did well with bowel resection and simple suture of the intimal tear.
Spontaneous Vertebrovertebral Arteriovenous Fistula Treated by Steel Coil Embolization: Case Report
Authors: Van Romphey A. , Delcour Ch. , Vandenbosch G. , Bellens B. , Dereume J.P.
Published: August 2008

The authors report 1 case of a spontaneous vertebrovertebral arteriovenous fistula in a fifty-seven-year-old woman. Embolization with a steel coil resulted in complete occlusion of the fistula while maintaining vertebral artery patency.
Age as High-Risk Factor in the Treatment of Abdominal Aortic Aneurysm
Authors: Noppeney T. , Raithel D.
Published: August 2008

During the last thirty years, a distinct increase in the frequency of operative treatment of abdominal aortic aneurysm (AAA) has been caused by the overall increase in AAA, its more frequent diagnosis, progress in intensive care, and technical developments in vascular surgery. The mean age of the patients has risen over the same time to sixty-nine years.

An analysis of the authors' patients with AAA reveals that resection of an aneurysm and interposition of a prosthesis represent nowadays, even in high- risk patients, the therapy of choice.
Femoropopliteal Laser Angioplasty: Initial Clinical Results with Large Probes as "Sole Therapy"
Authors: Rosenthal David , Wheeler William G. , Seagraves Annette , Lamis Pano A. , Jones Michael
Published: August 2008

Laser-assisted balloon angioplasty has been shown to be effective in the treatment of superficial femoral artery (SFA) occlusive disease.

In order to avoid the inherent trauma of balloon angioplasty, 30 patients underwent laser angioplasty of the SFA as "sole therapy." Laser angioplasty was performed using a laser coupled to a 600 micron fiber and a 3.5 mm probe (22-28 watts). Fourteen patients had laser angioplasty for claudication and 16 for limb salvage. The initial success rate was 83% (25/30) (lesion length 2-14 cm). In follow-up extending to nine months, 84% (21/25) of laser angioplastied SFAs have remained patent.

By avoiding the disruptive effect on the arterial wall architecture caused by balloon angioplasty, while at the same time ablating and vaporizing more atheromatous material with larger laser probes, the long-term patency rates of laser angioplasty as sole therapy may prove to be superior to those of laser- assisted balloon angioplasty.
Comparison of Penile:Brachial Index and Pelvic Angiogram
Authors: Haynes Daniel F. , Lewis Ronald W. , Balkin Peter W. , Rice Janet C. , Kerstein Morris D.
Published: August 2008

After an initial evaluation indicating potential vasogenic impotence, 27 pa tients were identified as having had both penile:brachial index (PBI) and pelvic angiography done. All patients had also undergone psychiatric and hormonal evaluation, as well as nocturnal penile tumescence monitoring. If the PBI was consistent with vasogenic impotence (≤ 0. 7), an angiogram was performed. Twenty-one patients were found by angiogram to have impaired arterial inflow on at least one side, yielding a prevalence of 84%. Angiogram findings, in rela tion to PBI for each side, demonstrated that 30/49 (61%) sides had impaired inflow. Of the 24 patients for whom bilateral data were available, 9 (38%) had impaired inflow to both sides, while 12 (50%) had impaired inflow on only one side. Of these 21 patients who had impaired inflow, 16 (76%) had lesions of the internal pudendal artery or more proximally. Of the 30 sides with impaired inflow, 24 (80%) had lesions proximal to the internal pudendal artery, 1 (3%) had a lesion of the common penile artery, and 11 (37%) had lesions of the penile arteries either dorsal or deep.

Vascular disease may be missed by the PBI by singling out arteries other than the deep artery of the penis. The PBI has an important role in assignment of patients to angiography; at the 0.6 threshold, especially, PBI is shown to be a specific tool with a high positive predictive value in this patient population. The significant number of arterial lesions demonstrated in these patients lends sup port to a broader role for angiography in evaluation of men with impotence.
Carotid Resection for the Elongated Internal Carotid Artery
Authors: Wandschneider W. , Veit F.H. , Hollaus P. , Raynoschek H. , Denck H.
Published: August 2008

Thirty-four patients underwent resection of the internal carotid artery (ICA) because of symptomatic elongation; 61.8% had suffered a stroke and 38.2% transient ischemic attacks (TIA). There were no asymptomatic patients; 35.3% were operated on for stenotic plaques without manifest elongation in preopera tive angiography but developed ICA kinking after endarterectomy. There was no mortality and no permanent neurologic deficit during the perioperative per iod.

Within a follow-up interval with a mean of seventeen months there was 1 ipsihemispherical stroke (2.9%); in another asymptomatic patient duplex sono graphy revealed low-grade carotid stenosis. Thus 92% of the 35 patients who were followed up showed normal neurologic and sonographic findings during follow-up.

The authors concluded that their technique of ICA resection, especially the use of an intraluminal shunt, is a safe method yielding satisfactory long-term results. Attention should be paid to the possibility of ICA kinking following local endarterectomy.
Vein Valve Graft for Primary Femorosaphenous Incompetence
Authors: Ananthakrishnan N. , Srinivasan K. , Hadke N.S. , Govind Krishna S.R. , Srivastava K.K.
Published: August 2008

Primary femorosaphenous incompetence (FSI) is a rare cause of venous stasis and ulceration and is conventionally managed by ligation of the saphenofemoral junction with or without stripping of the long saphenous vein (LSV).

The authors present here 9 patients with FSI documented by phlebography who were managed by the alternate procedure of vein valve graft from the basilic vein to the long saphenous system to restore competency of the femorosaphenous (FS) junction . This procedure has hitherto not been tried for primary varicosity of the LSV.

There was cosmetic improvement in all patients. Chronic ulcers in 5 patients seen preoperatively remained healed during a follow-up period of one to five years. There was symptomatic improvement of heaviness of the limb in 5 of 6 patients . Phlebography at one year postoperatively showed competency of the FS junction in all 9 patients and graft patency in 8 of 9 patients.

This procedure has the added advantage of preserving the LSV for future use in arterial bypass surgery and avoids complications like saphenous nerve injury and lymphatic disruption associated with stripping of the LSV.
Acute Effect of Intraabdominal Pressure on Liver and Systemic Circulation
Authors: Shimizu Masafumi , Yohizu Hiroshi , Hatori Nobuo , Haga Yoshiyuki , Okuda Eriya , Uriuda Youzou , Tanaka Susumu
Published: August 2008

Intraabdominal and retroperitoneal hematoma due to abdominal trauma and surgery increase patients' intraabdominal pressure (IAP) and worsen their condition. In some cases, these hepatic and renal dysfunctions without primary shock. To clarify the pathogenicities, 7 mongrel dogs were subjected to the fol lowing experimental proctocol. Systemic blood pressure (BP), cardiac output (CO), portal vein flow (PVF), portal vein pressure (PVP), bile duct pressure (BDP), and femoral vein pressure (FVP), were measured at IAP levels of 0, 10, 20, 30, and 40 mmHg by infusing colloid sollution into the abdominal cavity. Analysis of the relationship between IAP and those factors showed the follow ing : (1) Although there was a poor relationship between IAP and BP, IAP had good correlation with PVP (p < 0.001; (2) IAP had an inverse relation to CO (p < 0.001) and PVF (p < 0.02); and (3) FVP was the most sensitive indicator in monitoring IAP (p < 0.05). These results suggest that the increased IAP should have an influence on liver function without producing shock, because of it effect on PVP and PVF.
The Popliteal Approach: A New Approach to Percutaneous Laser-Assisted Angioplasty
Authors: Stagg Samuel J. , Chaisson Gary , Ladd William R. , Murray Gary , Pharo Wayne , Fudge Tommy , Abben Richard , Couvillon Michael A. , Allie David , Walker Craig M.
Published: August 2008

"Hot-tip" laser angioplasty has been proven safe and effective in treating periperal vascular disease. There is, however, a group of patients with lesions or occlusions at the origin of the superficial femoral artery (SFA) that are difficult to approach from a standard antegrade femoral approach. The authors have developed a new retrograde popliteal approach that allows laser angioplasty to be performed percutaneously in these patients; 51 consecutive cases have been treated and followed up for more than one year. There were 40 cases with lesions greater than 9 cm long (Group A), while 11 cases had lesions less than 9 cm long (Group B). The mean lesion length was 15 cm. The initial success rate was 32 of 51 cases (63%): 24 of 40 cases (60%) in Group A and 8 of 11 cases (73%) in Group B proved successful. A three-month follow-up showed that clinical patency was 100% in initially successful cases (32 of 32 cases overall, 24 of 24 cases in Group A, and 8 of 8 cases in Group B). A twelve-month follow-up showed clinical patency in 20 of 32 initally successful cases (63%); 14 of 24 cases (58%) in Group A and 6 of 8 cases in Group B (75%) remained patent at twelve months.

The authors conclude that the popliteal approach to laser-assisted angioplasty is a safe and effective method of treating lesions at the origin of the SFA that could not be treated with any other percutaneous approach. One-year follow-up results in these patients are encouraging.
Echocardiographic and Color Flow Doppler Features of Bioprosthetic Valve Degeneration
Authors: Alam Mohsin , Rosman Howard S.
Published: August 2008

Serial echocardiographic and color flow Doppler studies were performed in 38 mitral and aortic bioprosthetic valves. In the ensuing three to four months of follow-up, 7 patients developed clinical, angiographic evidence of severe valve regurgitation due to structural valve degeneration. Analysis of ultrasound studies revealed that increased thickness of the cusp by echocardiography and presence of mild to moderate color flow Doppler regurgitation preceded clinical regurgi tation in 5 and 4 bioprostheses respectively.

In conclusion, echo and cardiac Doppler features of thickened and/or regur gitant valves are markers for degenerating bioprostheses and these features usually precede clinical dysfunction.
Allogenic, Multidonor In Vitro Endothelialization of Small Diameter PTFE Grafts in Baboons
Authors: Fasol Roland , Zilla Peter , Preiss Petra , von Oppell Ulrich , Odell John , Reichart Bruno
Published: August 2008

The early effect of allogenic in vitro endothelialization was assessed in small- diameter vascular prostheses. Cryopreserved and pooled venous endothelial cells (ECs) from 13 baboons of similar blood group were used for confluent in vitro endothelialization of fibrin glue-coated polytetrafluoroethylene vascular grafts. Bilateral femoral interpositions (12 cm) of experimental and control grafts were subsequently implanted into a separate group of 18 male baboons with the same blood group as that of the pooled cells. After sixteen days of implantation the patency rate of grafts of the endothelialized group was similar to that of the control group (55.6% vs 61.1%, p>0.1). Scanning electron microscopy revealed that 44.4% of experimental grafts were completly free of endothelium, while the remaining grafts showed a moderate mean EC coverage of 34.4 17.1%. These remaining ECs were found mainly as small islands densely covered by leukocytes. The majority of these white cells resembled granulocytes, although adherent lymphocytes were also regularly observed. Since surface morphology does not explain the mechanism of EC loss, further experiments must elucidate this question.

If rejection is found to be the primary cause for this cell loss, the use of major histocompatibility complex (MHC) matched EC subpools might be considered.
Giant Pseudoaneurysm of the External Pudendal Artery Associated with Homocystinuria: A Case Report
Authors: O'Laughlin Richard L. , Sniekus Peter , Esposito William J.
Published: August 2008

A case of a giant pseudoaneurysm of the external pudendal artery in a fifty-three-year old man with homocystinuria is presented and discussed. As this case study demonstrates, patients with homocystinuria are prone to develop pseudonaneurysms following minor trauma to diseased vessels. Prolonged clinical follow-up of homocystinuria patients is recommended to avoid potential serious complications associated with pseudoaneurysms.
Loss of Tachyphylaxis and Increased Sensitivity to Angiotensin II in Experimental Vein Grants
Authors: O'Donohoe Martin K. , Radic Zeljko S. , Stein Adam D. , Schwartz Lewis B. , McCann Richard L. , Hagen Per-Otto
Published: August 2008

Intimal hyperplasia and atherosclerosis have been implicated in the pathophysiology of vein graft failure. Several recent studies have also reported alterations in the vasoreactivity of vein grafts. These alterations in vasoreactivity could contribute to vein graft spasm and lead to graft occlusion. This study examined the vasomotor responses of experimental vein grafts to angiotensin II, the most potent natural vasoconstrictor known. The right carotid artery was divided and bypassed in 12 rabbits with use of the right external jugular vein. The left external jugular vein was used as a control.

Eight vein grafts and jugular veins were harvested after fourteen days and 4 vein grafts after twenty-eight days. Segments of vein graft and control vein were mounted under isometric tension in an organ bath, and the dose response curves to angiotensin II obtained. On day 14, the response of the jugular veins was triphasic, while the respnse of the vein grafts was sigmoidal. The vein grafts were hypersensitive to angiotensin II. The ED50 was reduced from 8.4 ± 2.5 x 10-6 M in the jugular veins to 1.62 ± 0.24 x 10-8 M in the vein grafts (p < 0.005). The maximal response to angiotensin II was also increased from 342 ± 24 mg in the jugular veins to 558 ± 108 mg in the vein grafts on day 14 (p < 0.05). There was no significant difference in either the ED50 or the maximal response of the vein grafts on day 14 or 28. Tachyphylaxis (desensitization with repeated doses of agonist) was observed in the jugular veins but not in the vein grafts. The results show that experimental vein grafts are hypersensitive to angiotensin II, with either single or repeated exposure. This increased vasoreactivity to angiotensin II may have important clinical implications, particularly when vein grafts are used in patients with renovascular hypertension.
Surgical Treatment of Postinfarct Ventricular Tachycardia—Seven Years of Experience
Authors: Renzulli A. , D'Onofrio A. , Glenville B.E. , Naik S. , Bourke J.P. , McComb J.M. , Campbell R.W.F. , Hilton C.J.
Published: August 2008

The results of surgery for postischemic drug-resistant ventricular arrhythmias (VA) are still controversial. The operative mortality in the literature ranges between 10% and 40% because of selection of patients. The authors reviewed their experience at Freeman Hospital where all patients with drug-refractory ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent surgical treatment regardless of left ventricular function (LVF) and of time from infarction and operation.

Between March, 1981, and March, 1988, 65 patients [53 men, 12 women aged thirteen to seventy-five years (mean fifty-four)] underwent surgery. All of them had a previous myocardial infarct (MI). Mean preoperative ejection fraction was 28% ± 11, and 32 % had single-vessel, 44 % double-vessel, and 24% triple-vessel disease. In 16 surgical treatment was undertaken on an emergency basis. All had intraoperative mapping based on activation sequence or, when this was not possible (noninducible VT/VF), on analysis of fragmented potentials. LV endocardial resection was performed in 64 patients. Heart transplant (HTx) was necessary in 1. Associated procedures were aneurysmectomy in 40 patients (62%), multiple cryoablation in 13 (20%), encircling ventriculotomy in 8 (12%), right ventricular endocardial resection in 1, coronary artery bypass grafting in 43 (66%), mitral valve replacement in 5 (8%), and closure of postinfarct ventricular septal defect (VSD) in 2.

The operative mortality was 26% (17 patients}. The main cause of death was left ventricular failure, 13 (20%). The mortality was higher in patients with previous anterior MI 15/49 (31%) and in emergency operations 9/16 (56%).

The follow-up ranged between four and forty months (mean twenty-two months) with 6 late deaths (2 arrhythmia related). In 11 patients (17%) postoperative arrhythmic episodes were observed, but only in 6 (5 drug controlled, 1 without therapy) was there recurrence of preoperative arrhythmia. Surgery for life-threatening VA allows good long-term results for relief of arrhythmias. Perioperative mortality is still high in unselected patients; it depends mainly on the preoperative LVF. HTx in cases with very depressed LVF is an option, but in the majority of patients in this group it was contraindicated.
Right Heart Bullet Embolus: A Model for Management — Case Report
Authors: Francis Kenneth R. , Lee Hon S. , Steinberg Harold D. , Lang Samuel J. , Pizzi Walter F.
Published: August 2008

Bullet embolism to the right heart from a distal vein is a rare event. Its diagnosis requires a high index of suspicion and use of various radiographic modalities. The many complications associated with a retained intracardiac foreign body argue strongly for its retrieval.
Measurement of the Lumen Diameter in Vessels and Grafts: A New in Situ Method
Authors: Al-Ali Jassem , Inacio Jorge , Strömberg Lennart , Swedenborg Jesper
Published: August 2008

A method and an equipment for measuring lumen diameters of vessels and vascular grafts in situ in experimental and clinical situations have been designed and tested on animals.

The measurements were performed with a balloon catheter inserted in the lumen of the vessel. Saline was injected into the balloon, which increases in size spherically. The relationship between the hydrostatic pressure in the balloon, the volume of the injectate and the diameter of the balloon was registered and processed by a computer. The diameters were recorded graphically and digitally.

The method and the designed equipment showed good precision. The meas uring procedure is not time consuming and the equipment is easy to handle.
Management of Coexistent Carotid and Coronary Artery Atherosclerotic Disease: An Unresolved Controversy: Report of Clinical Experience and Literature Review
Authors: Berman Scott S. , Gregory Roger T. , Wheeler Jock R. , Snyder Stanley O. , Gayle Robert G.
Published: August 2008

The outcomes of 44 patients undergoing concomitant carotid endarterecto my and coronary artery bypass grafting were reviewed along with significant liter ature to date. In the 44 patients receiving concomitant procedures there were no deaths, no myocardial infarctions, 3 transient neurologic deficits (6.8%), and 1 permanent neurologic deficit (2%). In the world experience with concomitant procedures, the incidence of myocardial infarction is 3.7% (64 of 1742) and the incidence of cerebral infarction is 6.7% (116 of 1742). These results compare favorably with an incidence of myocardial infarction as high as 20% in similar patients undergoing isolated carotid endarterectomy, and similarly, to an inci dence of cerebral infarction as high as 25% in similar patients undergoing iso lated coronary artery bypass grafting. Concomitant carotid endarterectomy and coronary artery bypass grafting offers an approach to the management of coex istent carotid and coronary artery occlusive disease with improved results when compared with isolated or staged procedures performed in the setting of coexis tent disease. A rational approach for preoperative evaluation is suggested that emphasizes the value of noninvasive carotid testing.
Myocardial Response to Pretreatment with L-Carnitine in Patients with Cardiac Valve Replacement
Authors: Sunamori Makoto , Nakagawa Tetsuro , Fujisawa Shigeki , Suzuki Akio
Published: August 2008

Twenty-one patients undergoing mitral valve replacement (MVR) with either isolated or combined valvular procedure were investigated to determine the ef fect of randomized and prospective administration of L-carnitine (car) chloride on myocardial function. Carnitine chloride (1800 mg/day, for seven consecu tive days just prior to MVR) was given orally to 9 patients (car-treated group) who were compared with 12 car-untreated patients (control group) subjected to the same procedure. Valve replacement was performed using the Bjork-Shiley mechanical prosthesis in aortic and mitral position and bioprosthesis in tricuspid position in both groups under cardiopulmonary bypass (CPB) associated with cold potassium-magnesium cardioplegia and systemic hypothermia. Preopera tive and intraoperative clinical profile (age, functional class, duration of aortic clamp and CPB, and level of hypothermia) was well matched in both groups. Free, short-chain acyl, long-chain acyl, and total Car were measured in the papil lary muscle excised adjacent to the free wall of the left ventricle at the time of valvular surgery. Heart rate and mean arterial pressure did not differ between the two groups. Cardiac index was 3.44 ± 0.08 and 3.82 ± 0.13 L/m2/min in the control and car-treated groups, respectively, (p < 0.05). Dobutamine (DOB) infusion rate was 8.55 ± 0.73 and 5.57 ± 0.95 μg/kg/min in the control and car-treated groups, respectively (p < 0.05). Left ventricular stroke work index (LVSWI)/DOB ratio was 4.50 ± 0.65 and 8.16 ± 1.72 g*m/m 2/beat/unit of DOB, in the control and car-treated groups, respectively (p < 0.05). Long-chain acyl carnitine was 0.224 ± 0.031 and 0.460 ± 0.096 nmoL/mg noncollagenous protein in the control and the car-treated groups, respectively (p<0.05). LVSWI/DOB ratio was well correlated with long-chain acyl carnitine in the tis sue, r = 0.74, n = 18, p<0.001.

These findings suggest that pretreatment with L-carnitine chloride appears to be effective in improving myocardial function in the early phase of reperfu sion following surgery and that long-chain acyl carnitine may play a key role in the enhancement of carnitine-meditated mitochondrial metabolic process.
Cryopreserved Trachea—A New Arterial Conduit: Early Hemodynamic and Radiographic Performance
Authors: Laub Glenn W. , Muralidharan S. , Daliosio Connie , Perritt Alison , Jiang Gu  , Fernandez Javier , Pollock Samuel , Adkins Mark S. , McGrath Lynn B.
Published: August 2008

Synthetic arterial conduits perform well in a vast range of applications; however, there are certain situations where these grafts are not ideal. In an ef fort to find a superior graft, the authors evaluated the use of rat tracheas as cryopreserved homograft arterial conduits.

Twenty-four retired breeder Wistar rats received cryopreserved homograft tracheas as arterial grafts in the infrarenal abdominal aorta. After graft implan tation, the animals were allowed to recover and assigned to groups of 4 animals to be sacrificed at the end of one, two, three, six, twelve and twenty-four weeks. The animals were followed up clinically and then the grafts were evaluated hemodynamically, angiographically, and by gross histolog. Four animals (17%) died owing to ruptured aneurysmal grafts—1 in the two-week group, 1 in the six-week group, and 2 in the twelve-week group. One animal in the six week group had a patent but aneurysmal graft at the time of sacrifice. There were no pressure gradients, graft stenoses, or anastomotic strictures in any of the surviving animals. The authors conclude that the use of cryopreserved tracheal homograft as an interposition graft, while feasible, is associated with an unac ceptably high incidence of aneurysm formation.
"Salem Operations"—A New "Salem Endothelial Stripping Operation" for Surgical Treatment of Primary Varicose Veins of the Lower Limbs
Authors: El-Sayed Salem Mohamed
Published: August 2008

A new instrument called a "Salem stripper" and a new operation called "Salem endothelial stripping operation" are described. The "Salem operation" was invented by the author. Both are designed for the surgical treatment of primary varicose veins of the lower limbs to avoid many of the complications of the vein-stripping operation.
Critical Stenosis and Blood Flow in Experimental Microvascular End-to-Side Arterial Anastomosis
Authors: Tahta Kadir , Ozgen Tunçalp , Baskurt Oguz K. , Ozgen Canan
Published: August 2008

End-to-side microvascular anastomosis, which is accepted as a suitable model for extra-intracranial arterial anastomosis was performed on 12 rats. The carotid artery was narrowed progressively with a micrometer, and blood flow was recorded continuously during the experiments. In the anastomosed group, the critical stenosis ratio (the percent narrowing at which the blood flow began to decrease) was found to be 26.5 ± 3.2% and the critical stenosis ratio in the intact common carotid arteries of the control group was found to be 21.3 ± 2.7%. In the theoretical model, the critical stenosis was found to be 16%.
A New Approach for Abdominal Aortic Aneurysm by a Ringed Y Graft
Authors: Kurata Satoru , Hongo Hiroshi , Furutani Akira , Kaneda Yosikazu , Sakai Hidenori , Kuroda Utaka , Nakayasu Kiyoshi , Esato Kensuke
Published: August 2008

Nonsuture technique with ringed Y graft (RYG) was applied to 20 high-risk patients with abdominal aortic aneurysm (AAA). All showed marked arteri osclerotic changes. In 4 cases, there was no normal infrarenal segment of the aorta.

Concomitant diseases were: chronic obstructive pulmonary disease in 6 pa tients, moderate renal failure in 6, heart failure in 6, gastric ulcer in 3, thoracic aortic aneurysm in 1, and ruptured AAA in 1. Five patients were more than eighty years old.

The RYG method, except in the ruptured case, was evaluated (19 cases) by comparing age, size of aneurysm, operating time, blood loss, and aorta cross- clamping time with the conventional Y graft (CYG) method (21 cases).

The mean age was 75 ± 1.7 years in the RYG group and 69 ± 1.5 years in the CYG group (p < 0.05). Sizes and operating times in the RYG group were identi cal with those in the CYG group. Mean blood loss was 755 ± 88 mL in the RYG group and 1204 ± 170 mL in the CYG group (p < 0.05). Aorta-clamping time was 37 ± 3.4 minutes in the RYG group and 56 ± 3.1 minutes in the CYG group (p < 0.001).
The Superficial Dermal Microcirculation in Suction Blister Wounds on Healthy Volunteers
Authors: Kutlu Necmettin , Svedman Paul
Published: August 2008

Skin blisters can be formed painlessly and in a standardized way by suction ing. The dermal blister bed can be used experimentally as a wound model in humans and in clinical practice as a means of delivering certain drugs transder mally. The superficial dermal microcirculation in blister wounds (healthy volun teers, forearm lesions, diameter: 4 mm, vacuum: 200 mmHg below atmospheric for 2.5-3.0 hours) was followed up for four days after injury by intravital video microscopy aided by computerized image analysis. On day 0 the functional microvessel length (FML [total]), assessed from wounds in different individuals, was 1687 ±403 μm/mm 2 (mean±SD), the diameter 11±1 μm, and the density of papillary loops 29±5 per mm2. Red blood cell velocity (RBC-V) was 0.61±0.17 mm/s. Time courses for these parameters were described. The earliest signs of neovascularization were noted on day 1, and by day 4 papillary loops with new formations were in the majority. Wounds that had been occlusively covered with polyester film were more edematous and had lower RBC-V values than wounds where the epidermal roof had remained in situ. All lesions healed rapidly with out complications or visible scar. The means of quantitating neovascularization is of particular interest for the wound model application. Clinically, the pres ence of a functioning superficial microvessel network may facilitate an even drug resorption.
Repair of Traumatic Ventricular Septal Defect and Associated Tricuspid Insufficiency: A Case Report
Authors: Yee Edward S.
Published: August 2008

Penetrating cardiac trauma often results in serious and life-threatening sequelae. Traumatic ventricular septal defect and valvular insufficiency are among the rarest. The author presents a case of a young man who sustained cardiac arrest from ventricular tamponade secondary to a penetrating left ventricular stab wound. This patient was successfully resuscitated after open manual massage. A significant ventricular septal defect and associated tricuspid regurgitation were detected on the following day. Serial echocardiograms were used to evaluate the evolution of these two hemodynamic defects. The patient underwent operative repair for patch closure of a defect the size of a quarter and repair of the associated tricuspid papillary muscle dysfunction. His pulmonary status and right ventricular failure improved with resolution of his ascites. The operative and medical considerations are discussed for these unique traumatic intracardiac defects.
Arterial Reconstruction in the Lower Extremity by Means of Multiple Distal Anastomoses for Limb Salvage
Authors: Alemany J.
Published: August 2008

Long femoropopliteal occlusions also involving the trifurcation are circum vented by means of femorodistal bypasses. Despite good function of the bypass, the result is occasionally disappointing in cases in which necroses on foot or lower leg have not regressed and have finally led to amputation.

To optimize the perfusion of the lower leg, the author performed, between 1980 and 1990, a multilevel or multiple bypass on the lower limbs in 92 cases. By creation of several anastomoses in the lower leg and popliteal arteries, he at tained a better perfusion in the lower limb.

His results show that multilevel reconstruction or bypass with multiple distal anastomoses in case of "limb salvage" achieves a statistically significant reduc tion of amputations.
Prophylactic Interruption of the Inferior Vena Cava: Immediate and Long-Term Results
Authors: Rosenthal David , Hungerpiller John C. , Seagraves Mary Annette , Erdoes Luke S. , Baird David R. , McKinsey James F. , Lamis Pano A. , Clark Michael D.
Published: August 2008

To determine the effects of prophylactic interruption of the inferior vena cava (IVC) the hospital course of 340 patients who underwent aortic operations with placement of a Moretz IVC clip between 1980 and 1988 was removed: 175 patients had had abdominal aortic aneurysm resection; 143, aortobifemoral by pass; and 22, aortobiiliac endarterectomy or bypass. There were no complica tions related to placement of the IVC clip. After operation, any clinical suspicion of deep vein thrombosis (DVT) or pulmonary embolus (PE) was docu mented by phlebography or pulmonary arteriography, respectively. In the im mediate postoperative period ( < thirty days), only 2 (0.5%) patients had a PE and 10 (2.9%) a DVT. For long-term follow-up extending to eight years (mean ± 42.8 months), 308 patients were available. During long-term follow-up, 2 (0.6%) patients had a PE and 7 (2.2%) a DVT. Limb edema without evidence of DVT occurred in another 7 (2.2%) patients. B-mode ultrasonography of the IVC was performed in 163 patients. The IVC was clearly patent in all but 5 (3%): 1 had had a documented PE in the immediate postoperative period, and the other 4, an asymptomatic occlusion of the IVC during late follow-up.

Prophylactic IVC interruption in aortic surgical patients appears not to cause IVC thrombosis, to initiate DVT, or to cause chronic venous insufficiency. The results indicate that it is a safe method of decreasing the incidence of PE, without increasing operative morbidity.
Effects of Alprostadil Infusion During Extracorporeal Circulation on Blood Rheology and Postoperative Blood Loss
Authors: El-Gatit Abdusalam , Al-Khaja Najib , Belboul Ali , Roberts Donald , William-Olsson Göran
Published: August 2008

The authors have investigated the effects a low dose of alprostadil (synthetic prostaglandin E1: S-PGI1) infusion during cardiac surgery on blood rheology and postoperative blood loss. S-PGE1 (20 ng/kg/minute) was given to 13 patients undergoing aortocoronary bypass. Another 13 patients who received no S-PGE1 during bypass surgery served as controls. To assess blood rheology, blood samples for red and white cell filterability (RFR and WFR) and for platelet count were collected preoperatively, immediately after the end of extracorporeal circulation (ECC), and twenty-four hours later. Records of blood loss were taken twelve and twenty-four hours postoperatively. RFR, WFR, and platelet counts at twenty-four hours were significantly reduced in the control group as compared with the S-PGE1 group, p = 0.002, p = 0.004, and p = 0.0026, respectively. Concomitantly, the means of the postoperative blood loss at twelve and twenty-four hours were lower in the S-PGE1 group, p= 0.0001 and p=0.0004, respectively. Furthermore, the use of blood transfusion products was significantly less in the S-PGE, group, p < 0.02. These results showed that the use of S-PGE, during ECC preserves blood rheology in association with significant reductions in blood loss and in the need for blood transfusion postoperatively.
Direct Phlebography for Visualization of the Deep Veins in the Lower Extremities
Authors: Matsuda Hitoshi , Ota Toshiaki , Okada Masayoshi , Nakamura Kazuo
Published: August 2008

A new method of phlebography, which the authors have named "direct phlebography," was developed as a means of obtaining accurate information on the deep vein system, as well as on the communicating veins in the lower extremities. This method consists of two techniques: one is a retrograde insertion of a catheter into the deep veins and the other is a direct injection of the contrast medium into the deep veins. For these techniques, use of a thin, soft guidewire and catheter; injection of a low-osmolar contrast medium; and systemic administration of heparin are important. In cases of varix cruris, the deep veins and the insufficient communicating veins were clearly visualized by this method. In cases of deep vein thrombosis, a "narrowed" but patent common or superficial femoral vein was detected, which had often been diagnosed as "occluded" by conventional ascending phlebography. The deep femoral vein was usually patent.

The authors have used this method in 54 limbs, but no serious complications such as venous valve injury, severe extravasation, or thrombus formation have been encountered so far, except for a small extravasation in 1 patient with superficial femoral vein thrombosis. This new method, used to visualize the deep vein system directly, is thought to provide correct and useful information about the lesions in the deep vein system of the lower extremities.
The Kasabach-Merritt Syndrome: Report of 2 Familial Cases
Authors: Chello Massimo , Romano Rossana , Panza Antonio , Mastroroberto Pasquale , Marchese Antonietta R.
Published: August 2008

In this report the authors describe a rare case of Kasabach-Merritt syndrome that occurred in two brothers, with the cavernous hemangioma localized in the left forearm. The report emphasizes the role of technetium 99m-labeled red blood cells in an accurate method of evaluating cutaneous lesions and detecting occult hemangiomas.
Indications for Carotid Endarterectomy: Surgeons vs Neurologists
Authors: Zelkovic Mark A. , Nicholas Gary G. , Reed James F.
Published: August 2008

The purpose of this study was to evaluate the indications for carotid endarterectomy (CEA) in the authors' geographic area and compare responses of vascular surgeons and neurologists. Results were also compared with the recommendations of the Rand panel.

Vascular surgeons and neurologists agreed that multiple transient ischemic attacks (TIA) in patients receiving medical treatment and in those with crescendo ischemic attacks were appropriate indications for endarterectomy. However, surgeons favored CEA significantly more (p < 0.0001) than neurologists for other symptomatic patients. No agreement could be found between surgeons and neurologists for endarterectomy in patients with asymptomatic carotid disease.

Although a national panel of experts has identified appropriate indications for CEA, the authors' medical community (Eastern Pennsylvania) has significant variations when responses of vascular surgeons and neurologists are compared. Therefore, patient treatment depends mainly on the referral patterns of the primary care physician. Further prospective studies are required to achieve unanimity regarding indications for this operation.
The Effect of Substrate Load and Blood Glucose Management on Cerebral Dysfunction Following Cardiopulmonary Bypass
Authors: Griffin Steven , Klinger Louise , Newman Stanton , Hothersall John , McLean Patricia , Harrison Michael , Sturridge Marvin , Treasure Tom
Published: August 2008

Seventy patients undergoing elective coronary artery bypass grafting were prospectively randomized into either of two primes: 5% dextrose or Hartmann's solution. The groups were comparable. Neuropsychological assessment was performed before and eight weeks after surgery. During bypass blood glucose concentrations rose to a mean of 26 mmol/L in the 5% dextrose group and 6 mmol/L in the Hartmann's group. No deaths occurred in either group; 2 clinically evident neurological events were noted, both taking place in the hyperglycemic group. Detailed analysis of the results showed differences between the groups. When score changes between tests were assessed it was found that in 17 of the 18 versions of the tests more patients in the hyperglycemic group deteriorated than the normoglycemic controls. With a two-tailed binomial statistic this difference was significant at the 5% level. Learning ability was likewise found to worsen in the hyperglycemic group after surgery.

Hyperglycemia may be a detrimental factor in the development of postcardiac surgical intellectual dysfunction. The authors would advocate the avoidance of glucose-containing bypass primes and the close monitoring of blood glucose during cardiopulmonary bypass.
Protective Effect of the Iron Chelator Deferoxamine on Cerebral Vasospasm
Authors: Caner Hakan , Senaati Sasan , Bolay Hayrunnisa , Kilinc Kamer , Benli Kemal
Published: August 2008

Experimental studies suggest the primary role of free radical products in the development of vasospasm. In the present study, the iron chelator deferoxamine was used at the time of subarachnoid hemorrhage to prevent chronic cerebral vasospasm. Cats were anesthetized to obtain a baseline digital subtraction angiography of cerebral arteries. Arterial blood was injected into the cisterna magna of all cats. Group 1 (15 cats) received deferoxamine solution intrathecally, and the other 15 were kept as a group 2. Two days later a second angiography was performed that revealed vasospasm in group 2 but no vasospasm in group 1 and the control group. A significant increase in the level of lipid peroxides was found in group 2 as compared with the others in the brain samples. These results suggest that deferoxamine can prevent vasospasm.