bluuebunny/crossref_metadata_2025 huggingface dataset:
The Atrial Natriuretic Peptide and Its Relation to Hemodynamic and Laboratory Values in Mitral Valve and Coronary Surgery
Authors: Paç M. , Ateş A. , Koçak H. , Yiğitoğlu M.R. , Yekeler I.
Published: August 2008

In 22 patients who underwent mitral valve replacement (13) or coronary bypass surgery (9), preoperative and postoperative plasma atrial natriuretic peptide (p-ANP) concentration, hemodynamic changes, plasma aldosterone, and twenty-four-hour urine sodium-potassium concentrations were studied.

Preoperative ANP levels were 261±172 pg/mL in mitral valve replacement (MVR) and 68±22 in coronary artery bypass grafting (CABG); control levels were 15±4.7 (p < 0.001).

After the induction of anesthesia, ANP levels decreased to 154.5±96.7 pg/mL in MVR and 51±17.5 in CABG (p < 0.01) patients. In the early postop erative period ANP increased to 332±217 pg/mL in MVR and to 94.3 ± 29.7 in CABG (p < 0.001).

In the late postoperative period, the p-ANP of both groups returned to nor mal levels (16 ± 8.05, 11.2 ± 2.82 pg/mL, respectively).

Negative correlations were detected in both MVR and CABG groups be tween p-ANP, p-aldosterone (p < 0.001), p—ANP—cardiac output (p < 0.001), and p—ANP—cardiac index (p < 0.001).
Smooth Muscle Function in Short- and Long-term Stored Cryopreserved Veins
Authors: Brockbank K.G.M. , Carpenter J.F. , Schwartz L.B. , Nardiello C. , Hagen P.-O.
Published: August 2008

There is considerable interest in banking of allograft veins for vascular recon struction procedures in patients for whom there are no suitable autologous or prosthetic vessels available. A major obstacle to vein banking has been posed by the lack of long-term storage studies and by a prior report indicating that veins deteriorated rapidly during liquid nitrogen storage. This study was, there fore, initiated to determine the effects of long-term liquid nitrogen storage on tissue viability. Viability was assessed by measurement of smooth muscle func tion in fresh, short-term (one to twenty-eight days), and long-term (> two years) cryopreserved canine saphenous veins. There were no significant differences in the median effective doses of norepinephrine, serotonin, and KCL for genera tion of isometric force by vein rings from short- and long-term stored groups. Similarly, the maximum forces generated by long-term-stored cryopreserved veins in response to each reagent were the same as in short-term-stored veins. These results demonstrate that vein viability is maintained in cryopreserved banked veins.
Cardiopulmonary Bypass Using Centrifugal Pump
Authors: Berki Turan , Gürbüz Ali , Işik Ömer , Akkaya Hakan , Bayezid Ömer , Yakut Cevat
Published: August 2008

Centrifugal pumps are nonocclusive pumps that offer centrifugal blood pumping known as the constrained force vortex principle.

Of 2405 open heart procedures, 370 (15.4%) were performed with a centrif ugal pump (CP). In the rest of the cases extracorporeal circulation (ECC) was established with conventional roller pump (RP). The operations performed with a CP were: 34 reoperations, 11 ascending aortic aneurysms + coronary artery bypass graft (CABG), 47 multivalve replacements, 125 CABG + left ventricu lar aneurysmectomies, and 153 CABGs alone.

This prospective study consisted of two groups, each group including 50 patients undergoing CABG surgery. In group I ECC was established with a CP and in group II with a conventional RR The two selected groups of patients were considered to be similar in terms of clinical, hemodynamic, and angio graphic data. Hemodynamic study concerned flow rate, systemic vascular re sistance (SVR), and urinary output. No difference was found between the CP and RP hemodynamically. Nevertheless, the alteration of the flow rate in re sponse to variation of SVR is accepted as an advantage.

As for hemolytic effect during ECC of CP compared with RP: Plasma free hemoglobin, hemotocrit, platelet count, platelet factor 4, and fibrinogen levels, were investigated. These parameters revealed that there was significant hemoly sis and trauma to the blood components in the RP group when compared with the CR (p < 0.05, p < 0.01).

There was no significant difference in psychoneurologic complications, but behavioral and sensory disorders were encountered sevenfold more in the RP group. This might be due to spoliation of the tubing set or to microair embo lism.

Compared with the conventional RP the CP proved to have no hemodynamic advantage. The effects on blood components showed significant trauma to the RP group. Postoperative drainage verified this observation (p < 0.05).

In this study the CP appears to be superior to the RP especially in compli cated and prolonged ECC.
Simultaneous Bilateral Carotid Endarterectomy: A Revision of Concepts and Strategies
Authors: Pizzetti Franco
Published: August 2008

The results of 156 bilateral cases of carotid endarterectomy are reported: 71 patients had staged operations and 85 patients had simultaneous endarterectomies.

The results in these two groups of bilateral cases were very similar. In each of the two groups no patient died and the major neurologic complications (stroke) were less than 2% in regard to patient risk, and therefore less than 1% in regard to procedure risk.

Indications for and against bilateral carotid surgery as a simultaneous or a staged procedure are discussed. The parameters for selecting patients likely to undergo simultaneous surgery are indicated. The main parameter to consider is the probability for the patient to have a serious post-operative hyperperfu sion, especially if a cerebral ischemia coexists.
Preoperative Dynamic Assessment of Cardiac Reserve in Patients Following Abdominal Aortic Surgery. A Probability Analysis
Authors: Joyce William , Provan John , Ameli F. Michael , McEwan Patricia , Jelinich Sandra , Jones Donald
Published: August 2008

In order to estimate cardiac reserve preoperatively the authors studied 33 con secutive patients aged forty-four to eighty-one years (mean ± SD, 67.2 ± 7.3) scheduled for elective infrarenal abdominal aortic surgery. All patients had pul monary artery catheters inserted on the morning of surgery and had Starling curves constructed by plotting of the rate of change in cardiac output against the rate of change in pulmonary artery wedge pressure (PAWP) with a specific volume loading protocol. The slope of the curve and the PAWP, which cor responded to the maximum cardiac output (PAWPmax), were carefully noted in each patient. A deliberate effort was made perioperatively to maintain each patient on the upslope of the curve and not to exceed their estimated PAWP max. Four patients developed a major postoperative cardiac complication and 1 patient died. All complications occurred in patients with a Starling slope of < 0.035 (p = 0.0003). By utilization of this slope in a derived probability model the authors could accurately and quantitatively predict which patients were at greatest risk of developing a postoperative cardiac complication following ab dominal aortic surgery.
Rupture of an Internal Iliac Artery Aneurysm into the Rectum: Fatal Consequence of an Ilioenteric Fistula —A Case Report
Authors: Aseem Wali M. , Schachter Larry G. , Devlin James E. , Costa Jose
Published: August 2008

Fistulization of a true aneurysm or pseudoaneurysm of major arteries into the gastrointestinal tract has been reported in the literature since 1943. More common is the fistulization of a true abdominal aortic aneurysm and pseu doaneurysm at an anastomotic site, proximally at the aortic level or distally at the site of iliac arteries, after a vascular reconstructive procedure.

Rupture of an isolated aneurysm of the common iliac arteries is less fre quent, and rupture of an internal iliac artery aneurysm into the gastrointestinal tract is rare. In searching the literature, the authors did not find documentation of any previous report of rupture of an internal iliac artery aneurysm into the rectum.

They report a case of an acute rupture of a left internal iliac artery aneurysm into the rectum with a fatal outcome.
Surgical Excision of the Inferior Vena Cava for Primary Leiomyosarcoma—A Case Report
Authors: Anain Joseph M. , Anain Paul M.
Published: August 2008

Leiomyosarcomas of the inferior vena cava are rare tumors that have been reported with increased frequency. A case of a sixty-two-year-old woman pre senting with back pain and weight loss is discussed. Treatment with resection of the inferior vena cava below the renal vein has left the patient asymptomatic. The preoperative diagnosis was suspected from the computed tomographic scan of the abdomen. A review of the literature of leiomyosarcoma of the inferior vena cava and its presentation is provided.
Ischemia-Activated Platelets in Normal and in Naturally Occurring Hypertrophied Myocardium
Authors: Yee Edward S. , Hsieh Wen-Ren
Published: August 2008

Substantial myocardial platelet aggregations in the coronary microvascula ture of normal and of naturally occurring hypertrophied myocardia have been documented after ischemia and reperfusion. Eleven normal canine (group I) hearts underwent an isolated cardiac bypass preparation and were compared with 5 myocardia (Group II) hypertrophied by congenital aortic stenosis. All 16 hearts experienced transient ischemia during the isolated cardiac bypass and produced platelet aggregations (111 In tagged: p < 0.05). Hypothermic (25°C) potassium crystalloid cardioplegia did not wash out these depositions, and with the onset of reperfusion, both platelet and erythrocyte (99mTc tagged) radioactiv ity profoundly increased (p=0.0101). These increases progressed during the hour of reperfusion (p = 0.0369) and, specifically, in the endocardium.

In summary, intracoronary platelets are activated after transient ischemic episodes, in particular the vulnerable hypertrophied myocardium in naturally occurring aortic stenotic hearts. These ischemia-activated platelet aggregations persist despite the application of hypothermic crystalloid cardioplegia. These depositions, in turn, allowed an ongoing pattern of platelet and erythrocyte aggregations during the reperfusion period. These data have important clinical implications for myocardial protection and reperfusion during acute myocar dial ischemia and infarction for the normal and hypertrophied myocardium.
Intraoperative Coronary Angiography Using Fluorescein: Basic Studies and Clinical Application
Authors: Takayama Tetsuro , Wanibuchi Yasuhiko , Suma Hisayoshi , Terada Yasushi , Saito Tsutomu , Fukuda Sachito , Furuta Shoichi
Published: August 2008

To improve the safety and reliability of coronary artery bypass grafting (CABG), intraoperative coronary angiography using fluorescein was investi gated both experimentally and clinically.

Results. In experiments using mongrel dogs, the optimal procedures were determined to be as follows.

1. Complete all distal anastomoses.

2. Under the illumination of a 6-watt black light hung 10 cm above the heart, 0.06% fluorescein (0.5 mg/kg BW) is injected as a bolus from the proximal end of the graft. Histologically the direct injection of fluorescein into the coronary artery was shown to cause no injury to the vascular wall.

In clinical application, the distribution of the graft flow, the area perfused through the graft, and the patency of the anastomoses were well evaluated in real time by observing the fluorescence. Unexpected narrowing of the anasto mosis and the maldistribution of graft flow were detected in 2 patients by this examination during cardioplegic arrest, and the necessity for additional graft ing, as well as the extent of revascularization, could be evaluated on the operat ing table.

It was concluded that intraoperative coronary angiography using fluorescein rapidly provided essential information for the real-time evaluation of CABG surgery without any side effects.
Venous Thromboembolic Complications After Open Heart Surgery
Authors: Canver Charles C. , Fiedler Roger C.
Published: August 2008

The incidence and impact of venous thromboembolic complications on pa tient survival following cardiac operations remains unclear. During a five-year period (1984-1988) 4,393 patients underwent open heart surgery; of these, 13 patients had either pulmonary embolus (PE) (5 patients) or deep-vein thrombo sis (DVT) (8 patients). In the PE group, coronary artery bypass grafting was performed in 3 patients, aortic valve replacement in 2. Seven patients had myocardial revascularization and 1 had aortic valve replacement in the DVT group. Postoperative diagnosis was established by means of lung scan (4) or pulmonary angiogram (1) for PE or venous Doppler (4) or contrast venography (4) for DVT. Treatment was supportive with anticoagulation in all patients; 2 underwent interruption of the vena cava. Hospital stay was prolonged in all with an average of thirty-four days. PE accounted for the death of 1 patient. Actuarial survival at five years among the survivors was 92%. This experience suggests that the occurrence of venous thromboembolic events after open heart surgery is rare (overall incidence of 0.3%); however, an awareness of this poten tially lethal complication is still necessary.
Spontaneous Rupture of the Left External Iliac Vein: Case Report and Review of 13 Cases
Authors: Arikawa Kazuhiro , Yamashita Masafumi , Nishida Seigou , Kawashima Sumihiro , Shiota Kazuto , Tabata Denjirou , Taira Akira
Published: August 2008

An eighty-year-old woman with spontaneous rupture of the left iliac vein is described as the first case reported in Japan. The 12 cases previously reported are also reviewed, and clinical and possible etiologic findings are discussed.
Aneurysm of External Jugular Vein: Case Report and Review of Literature—A Case Report
Authors: Regina Guido , Rizzo Salvatore , Impedovo Giovanni
Published: August 2008

Aneurysms of external jugular vein in absence of hemodynamic changes are rare. A case of such a lesion is described. In this instance echo-color-Doppler examination gave sufficient information for final diagnosis and surgical treat ment. Microscopic study showed a localized structural alteration of the venous wall. These findings support the hypothesis of a focal congenital defect in the formation of the venous wall.
Splenic Artery Aneurysms: Favorable Outcome After Two Different Types of Rupture—Case Reports
Authors: Del Gaudio G.-A. , Boschi L. , Del Gaudio A.
Published: August 2008

Splenic artery aneurysms are rare lesions and their main complications are rupture and embolization.

Two cases of rupture with a favorable outcome are reported. In one patient, the splenic artery aneurysm ruptured into the renal vein, and in the other, it ruptured into the abdominal cavity, causing massive hemoperitoneum.
Magnetic Resonance Imaging (MRI) in Diagnosis of Dissecting Aneurysm of Abdominal Aorta in a Patient with Diffuse Aneurysmal Disease: Case Report
Authors: Alò Francesco Paolo , De Carolis Giorgio , Giovagnoni Andrea , Yu Robin Chan , Caporelli Sandro , Di Emiddio Marco , Guerrieri Mario , Ercolani Paola , Ioannidis Giorgio , Occhipinti Salvatore
Published: August 2008

The authors describe a case of dissecting aneurysm of the abdominal aorta observed by magnetic resonance imaging (MRI) in a patient with diffuse aneu rysmal disease. A dissected atherosclerotic plaque confined to the infrarenal aorta occasioned an antegrade and an unusual retrograde dissection. MRI properly indicated this condition, showing the tear inside the aortic wall, ex cluding the thoracic entry of dissection, and assessing aortic and iliac artery aneurysmal involvement.
Obliteration of the Mediastinal Pleural "Sac" in Internal Mammary Artery Coronary Bypass
Authors: Gatzinsky Pantalei , Al Khaja Najib
Published: August 2008

A technique for avoiding angulation of the internal mammary artery and tension over the mammary-coronary anastomosis caused by the lung is described.
Unusual Autogenous Vein Grafts
Authors: Schulman Martin L. , Schulman Lee G. , Lledo-Perez Alfonso M.
Published: August 2008

Since 1973 the authors have used 32 unusual autogenous veins for infrainguinal reconstruction. Grafts used were 2 nondominant profunda femoris, 10 profunda femoris-popliteal, 1 nondominant superficial femoral, 2 contralateral superficial femoral, 1 common femoral, 1 posterior tibial, 5 axillary, 4 tibioperoneal trunk, and 6 saphenous "spare tires." The popliteal vein normally drains into the superficial femoral vein, forming a superficial femoral-popliteal vein that merges with the smaller, nondominant profunda femoris vein; in 7% of limbs, however, the popliteal vein flows directly into the profunda femoris vein, resulting in a dominant profunda femoris-popliteal vein and a nondominant superficial femoral vein that originates in the thigh. Saphenous "spare tires" are saphenous veins harvested after prior deep vein resection; their unique characteristics are responsible for their inclusion in this report. Three grafts presented unacceptable intraoperative or early postoperative problems; all others proved to be satisfactory conduits. Meaningful evaluation of function in this diverse group of grafts was difficult, but in the 17 grafts placed since 1982, which represent a modern experience, primary and secondary patency rates were 87% and 94%, respectively, at three years. Of equal significance is the clinical utility of these grafts: their use has enabled the authors to use autogenous lower extremity veins exclusively in 114 of 115 consecutive infrainguinal reconstructions.

No clinically significant late sequelae resulted from resecting these major veins, suggesting that the reserve and the regenerative capacity of the normal venous system is greater than generally appreciated. These grafts expand the pool of autogenous alternatives and may further reduce the need for prosthetic use.
Prognosis for Limb Loss in Patients with Chronic Critical Ischemia Considered Technically Inoperable
Authors: Sørensen Steffen , Lorentzen Jørgen E. , Schroeder Torben V.
Published: August 2008

Of 427 patients with chronic critical ischemia of the lower extremity, admitted for infrapopliteal bypass surgery, 34 (8%) were considered technically inoperable : in 26 cases due to total occlusion of the runoff vessels and in 8 due to a poor runoff and no suitable vein. The symptoms were rest pain in 24 cases and gangrenous ulceration in 10. During a follow-up from eight to twenty-eight months 5 (15%) patients improved significantly and complained only of claudication. Three patients, suffering rest pain, were unchanged up to nine months, and 25 (74%) patients had a major amputation performed. The remaining patient died the day after admission. The mortality rate of these patients was significantly increased compared with that of the 393 patients who underwent infrapopliteal bypass surgery, who in turn had a higher mortality rate than that of an age- and sex-matched Danish population. Clinical judgment, together with ankle and toe pressure measurements, could not identify the group of patients who preserved their limb.
Structural Microvessel Response in Dermis of Suction Blister Wounds on Upper and Lower Limbs in Healthy Volunteers
Authors: Kutlu Necmettin , Svedman Paul
Published: August 2008

Structural aspects of the superficial microvasculature in suction blister wounds on forearm and lower leg in healthy volunteers (n=8) were studied by means of intravital microscopy. Functional microvessel lengths were quantitated, as was the number of established papillary loops and neovascularization sites. On the day of infliction, structural differences between the upper and lower limb wounds were small and insignificant, and the papillary loops spread out relatively richly over the surface. The changes that occurred over time on the two sites followed the same general pattern. Between day 2 and day 4 the loops became redistributed and more perpendicularly oriented within what appeared to be a larger tissue volume, and new vessel formation was increasingly evident. Redistribution and neovascularization occurred more quickly in the upper limb wounds, and the differences may be explained by the lower limb microvessels' being more fixed in the tissue.
Influences of Intraaortic Balloon Pumping on Peripheral Hemodynamics
Authors: Shimamoto Hiroyuki , Kawazoe Kohei , Kito Yoshitsugu , Ohara Kuniyoshi , Kosakai Yoshio , Kito Hiroyuki , Fujita Tsuyoshi
Published: August 2008

The influences of intraaortic balloon pumping (IABP) on peripheral hemodynamics were assessed by Doppler techniques. The subjects were 21 patients requiring postoperative IABP support to control low cardiac output state. The flow velocity-time integral in systole (IntS) and that in diastole (IntD) were measured from the left common carotid, superior mesenteric, and terminal aortic flow patterns, and the sum of IntS and IntD (IntS + IntD) was calculated on and off IABP. IABP increased cardiac output significantly (p < 0.01).

1. Left common carotid flow. IABP increased IntS significantly (p < 0.01). Neither IntD nor IntS + IntD changed significantly with IABP.

2. Superior mesenteric flow. IABP increased IntD significantly (p < 0.01). Both IntS and IntS + IntD remained unchanged with IABP.

3. Terminal aortic flow. IntS, IntD, and IntS + IntD did not change significantly with IABP.

The authors' data suggest that the carotid area can receive much of the increase in cardiac output in systole with IABP and that the superior mesenteric area can receive much of the volume of blood displaced in the aorta by balloon inflation in diastole.
Primary Radiocephalic Arteriovenous Fistulas for Hemodialysis
Authors: Bilgel Halil , Korun Nusret , Kilicturgay Sadik , Ozen Yilmaz , Cengiz Mete , Yurtkuran Mustafa
Published: August 2008

The authors review their experience with 318 direct radiocephalic arteriovenous fistulas created for chronic maintenance hemodialysis over the past six years.

Thirty-five of the fistulas (11 %) never functioned or thrombosed within the first month. The early failure rate was significantly different between groups older and younger than fifty years of age (p < 0.05). Moreover, the early thrombosis rate was related to the suture techniques used: 8.62% for the interrupted suture group and 20.63% for the running suture group (p < 0.05).

Average patency duration for still functioning fistulas in 120 patients is 38.8 months; for the 58 patients who had late failure it was 14.9 months.
Extraperitoneal Access to the Abdominal Aorta
Authors: De Toledo Francisco Victor , Pereira De Araujo Adalberto , Werneck Eduardo , Batista Rogerio Veras , Torres Antonio Barra
Published: August 2008

The authors report their experience with the use of the extraperitoneal ap proach to the abdominal aorta and iliac arteries in 52 patients, observed between 1980 and 1989. In all the cases a left paramedian incision was done. In 35 pa tients with aortoiliac occlusive disease some type of aortoiliac or aortofemoral bypass was done. In 14 cases of infrarenal aneurysm of the abdominal aorta, aorto-aortic replacement was done in 5, aortoiliac bypass in 7, and aortofemoral bypass in 2 patients. In 3 patients with occlusive disease of the iliac arteries, throm boendarterectomy was performed.

The results with extraperitoneal approach to the abdominal aorta and its main branches in the 52 patients were considered very good, when compared with those when the transperitoneal route was used in 72 cases. In the evaluation of results the authors used the following parameters: blood and fluid loss, operative time, intensive care unit time, pulmonary and cardiac complications, postoperative ileus, beginning or oral feeding, time of hospitalization, and mortality.

The extraperitoneal group was associated with less blood less (1,120 mL) than that with the transperitoneal route (1,850 mL) (p<0.01). The operative time was longer with the transperitoneal route. The intensive care unit time was less with the extraperitoneal approach (1.6 days) than with the transperitoneal route (3 days). The cardiopulmonary support time was longer the transperitoneal (2.5 days) than in the extraperitoneal group (1.3 days). Postoperative ileus was not observed in the extraperitoneal group but was present in several cases in the trans peritoneal group. The period of time for the patients to start a solid diet was significantly less in the extraperitoneal group.

Finally, the number of deaths was smaller in the extraperitoneal group. Their experience cooroborates the similar conclusions of other authors that the extraperitoneal access is the better option in elective aortic reconstruction.
Suction Blister Wounding, Morphological and Functional Aspects
Authors: Kutlu Necmettin , Rausing Alf , Svedman Paul
Published: August 2008

The blister wound (eclited by vacuum, 200 mmHg below atmospheric for 2.5 hours, diameter of exposed skin site 4 mm, epidermal blister roof excised) can be used both as a standardized human wound model for study of micro- circulatory events and as a clinical means of achieving efficient transdermal drug delivery. In this study, vital microscopy assessment of the superficial micro- vessels of the wound bed in volunteers revealed that only a small proportion of the papillary loops was damaged when epidermis was split off. Histological ly, in the pig, a mild inflammatory reaction was noted, reaching only the mid- dermis, and subsiding within a few days. By means of laser Doppler flowmetry, two separate peaks of dermal hyperemia were observed during the suctioning. Once the negative pressure had been released, a hyperemic reaction was observed that lasted for several days. The wound flowmetry values were distinctly above those observed after an arterial occlusion on adjacent, intact skin. Slight itching and pricking sensations in the wound may be associated with activation of a pain- related local axon reflex, which in turn may be a major cause of the hyperemia.
Quantitative Pulsed Doppler Measurement of Arterial Blood Flows in Humans
Authors: Shimamoto Hiroyuki , Kito Hiroyuki , Kawazoe Kohei , Fujita Tsuyoshi , Shimamoto Yoriko
Published: August 2008

Doppler flowmetry was assessed in 11 adult patients whose admission diag noses included aneurysm of the aorta or dissections. During surgery, regional blood flows of the left common carotid artery, terminal aorta, common iliac artery, external iliac artery, or common femoral artery were measured by Dop pler method and electromagnetic flowmeter. Eighty-four arterial flow determi nation were obtained from the 11 patients studied. On comparison of simultaneous electromagnetic and Doppler measurements of blood flow, an ex cellent correlation (r=0.93) was found between the two methods. The slope of the regression line was about 0.587. Regional blood flows were measured with Doppler flowmetry in another 11 patients. The values of the left common carotid, celiac, superior mesenteric, and terminal aortic flows were 255 ± 59, 618 ± 384, 670 ± 380, and 810 ± 325 mL/min, respectively. This method seems to be valua ble clinically in quantitative measurements of arterial flows in humans.
Femoral Superficial Traumatic Arteriovenous Fistulas—A Case Report
Authors: Bertoletti Giovanni Battista , Nesi Fabrizio , Rabitti Giorgio , Pierri Michele Danilo , Antignani Pier Luigi , Bassano Carlo , D'Alessandro Luigi Claudio
Published: August 2008

From 1969 to 1989, 3 patients were operated on in the Cardiac Surgery Depart ment for femoral superficial arteriovenous fistula. They represent 3.4% of the vascular traumas operated on in the same period at the author's institution. In these patients the symptoms were due to swelling; there were no general altera tions. The echo Doppler method was very useful for diagnostic evaluation. Sur gical technique avoided large venous manipulations and ensured anatomical continuity of arteries and veins.
Ruptured Mycotic Extracranial Carotid Aneurysm Treated by Excision, PTFE Graft Interposition, and Local Antibiotic Application—A Case Report
Authors: Pasic Miralem , Schwitter Jürg , Vogt Marcus , Carrel Tierry , von Segesser Ludwig , Turina Marko
Published: August 2008

A very rare case of ruptured mycotic extracranial carotid aneurysm caused by Streptococcus pneumoniae is described. An eighty-one-year-old man with a painful swelling of the right side of the neck was operated upon. There was no available vein for graft interposition and no retrograde flow in the internal carotid artery. The patient was successfully treated by resection of the aneurysm, 6 mm ringed polytetrafluoro-ethylene prosthesis interposition, and preoperative and postoperative antibiotic therapy combined with local antibiotic application. Seven months after the operation the patient remains free from complications.
Angioscopy-Assisted In-Situ Saphenous Vein Bypass
Authors: Lai Shiau-Ting , Yu Tarn-Jenn , Weng Zen-Chung , Chang Yen , Cheng Bor-Chi
Published: August 2008

In recent years considerable interest has been directed toward in-situ saphe nous vein arterial bypass as the best method of revascularization. But this pro cedure requires adequate exposure of the saphenous vein to allow valve incision and venous branch ligation.

The authors used a LeMaitre valvulotome to find the superficial venous branches under direct angioscopy assistance. They found this procedure ideal for performing in-situ venous bypass surgery, for the following reasons: (1) It is a simple, time-saving technical procedure. (2) Small skin incisions have caused no problems with postoperative healing. (3) It is easy to locate competent or nondisrupted valves, perforators, and branches. (4) There is a decreased rate of arteriovenous fistulas after in-situ vein bypass graft.
Direct Arterial Reconstruction in Buerger's Disease
Authors: Bozkurt A. Kürsat , Tuzun Hasan , Ozer Mehmet , Karaozbek Yilmaz
Published: August 2008

During the last six years the authors surgically treated 132 patients with Buerger's disease. They were able to perform arterial reconstruction in 14. Nonhealing ulcers and impending gangrene were the most frequent indications (62.2%).

The type and number of surgical procedures were as follows: aorto femoral (1), iliofemoral (2), femoropopiteal (3), femorocrural (3), by-passes and throm boendarterectomy with patch angioplasty (5).

There were no perioperative or postoperative deaths. Early thrombosis oc curred in 3 patients. Of the 11 patients with patent arterial reconstructions, 3 showed occlusion within the first year. The cumulative patency rate was 57%.

Although the patency rates for direct arterial surgery in Buerger's disease are not as good as those reported for arteriosclerosis obliterans, the authors believe that, in appropriate cases, arterial reconstructive procedures should be tried to achieve better healing of the trophic lesions without major amputation.
Indices of Sympathetic Vascular Innervation in Scleroderma Patients Treated by Epidural Spinal Cord Electrical Stimulation (ESES)
Authors: Sciacca Vincenzo , Vignotto Fulvia , Mingoli Andrea , di Marzo Luca , Di Gianferrari Paola , Maggiore Claudia , Sapienza Paolo , Maritano Mario
Published: August 2008

In an attempt to explain the epidural spinal cord electrical stimulation (ESES) mechanism of action on microcirculation, the authors measured arterial and venous plasma concentration of norepinephrine (NE), by chromatography, in 17 patients (16 women - 1 man, mean age forty-seven years, range: twenty- four to sixty-four years) affected by scleroderma (15 patients) and Raynaud's disease (2 patients), treated by ESES (mean follow-up 29.3 months, range: one to forty-nine months).

Blood was sampled with the patient in the supine position, resting at least for thirty minutes, in environmental standard conditions, from a brachial vein (without tourniquet) and a radial artery, with pacemaker off for twelve hours and pacemaker on for thirty minutes. Microcirculatory modifications induced by ESES were also evaluated in all patients by transcutaneous oxygen tension (TcPO2) and laser Doppler flow (LDF), simultaneously measured with the pa tient in the supine position, on the palm (thenar and hypothenar eminences) during three thirty-minute consecutive phases at 42 ° C and 45°C (phase I: pace maker off for twelve hours; phase II: pacemaker on; phase III: pacemaker off).

For technical reasons, NE dosages were available in only 12 patients. Cate gorizing the patients on the basis of clinical results (group A, excellent-good, 9 patients; group B, poor-null, 3 patients) the authors noted after the ESES stim ulation:

1. The vasodilatation index (TcPO2 42°C/TcPO2 45 ° C) increased in phase II and phase III (phase I vs phase II, p < 0.001; phase I vs phase III, p < 0.01).

2. The LDF flow differences between 42°C and 45°C were statistically sig nificant in responders between phase I and phase III (p < 0.01).

3. The physiologic norepinephrine arteriovenous ratio was inverted in 7 of 9 patients of group A and in none of group B (p < 0.05).

TcPO2 and LDF are useful noninvasive techniques to evaluate microcircula tory modifications induced by ESES. Moreover, the arteriovenous ratio de crease in plasma norepinephrine may explain the ESES effect on microcircula tion and the reduced vasomotor tone.
Aortoiliac Aneurysm Infected with Listeria Monocytogenes: Three Consecutive Cases
Authors: Bossavy J.P. , Mazeres F. , Cuq Ph. , Barret A.
Published: August 2008

Three consecutive patients with aortoiliac aneurysms, operated on for hypovo lemic shock or intensive pain, were infected with Listeria monocytogenes. They were treated by resection and in situ graft replacement with success in 2 cases. High- dose specific antibiotics over a long period were associated with surgery. Preoperative diagnosis was misleading but an immunosuppressive context was present in all cases.
Intraoperative Balloon Dilation as an Adjunct to Bypass Surgery
Authors: Sariego Joaquin , Kerstein Morris , Sano Chiaki , Matsumoto Teruo
Published: August 2008

Intraoperative balloon dilation (with or without laser assistance) was performed on 30 lesions in 20 patients in whom proposed bypasses distal to the tibioperoneal trunk were revised to more proximal bypasses (above- or below-knee femoropopliteal) following successful dilation. Only 3 patients overall required subsequent amputation—at one month, nine months, and one year postoperatively, respectively. There were 3 deaths from unrelated causes; all had patent grafts at time of death. Two patients were lost to follow-up. This experience reinforces the beneficial adjunctive role of intraoperative balloon dilation in patients who require long bypasses, allowing less extensive reconstructive procedures to be performed and consequently yielding better long-term results than surgery alone.
Reverse Saphenous Vein Homografts as Bypass Conduits: A Preliminary Report
Authors: Saunders Craig R. , Tedesco Dominic J. , Yee Edward S.
Published: August 2008

Reverse saphenous vein homografts (RSVH) were needed in 16 patients during the past two years to offer a more thorough myocardial revascularization procedure since autogenous donor material was limited either because of previous surgeries or unuseable harvested conduits. All patients (11 men/5 women, mean age of 71.1 years) presented with severe coronary insufficiency. Nine patients were having reoperations after having previous successful operations (mean 6.9 years), and 2 were having third-time redo surgery about fifteen years after their initial procedures. RSVH were selected by ABO blood typing and were supported postoperatively by antiplatelet therapy. RSVH allowed additional bypass grafting in all patients and yielded an average of 4.1 grafts per patient. To minimize the operative risks, RSVH were mainly used for occluded targeted vessels or nondominant arteries. Three early deaths (less than thirty days) occurred from (1) progressive heart failure after emergent bypass and mitral valve repair for cardiogenic shock, (2) stroke after redo surgery, and (3) renal failure after urgent redo bypass. Although the mean follow-up was only 11.5 months, the remaining 13 patients have clinically improved. Five selected patients have been restudied with arteriography and have demonstrated successful revascularization, ie, patent internal mammary arteries (6/6) and autogenous venous grafts (5/5). However, 4/10 RSVH conduits were nonfunctional and the other 6 were patent.

RSVH are effective conduits for cardiovascular reconstruction with excellent immediate hemodynamic characteristics similar to those of autogenous veins. They have been extremely effective in patients with limited autogenous donor material and, in selected cases, when a quick source of bypass material is needed in an emergent fashion. While the initial patency rates have been acceptable, long-term follow-up is needed for comparative rates.
Thromboangiitis Obliterans (Buerger's Disease) in a Cigarette Factory Worker: A Case Report
Authors: Yorukoglu Yavuz , Ilgit Erhan , Zengin Mustafa , Nazliel Kemal , Salman Ergun , Yucel Ertan
Published: August 2008

Thromboangiitis obliterans (Buerger's Disease) is an occlusive vascular disease of unknown etiology. It occurs predominantly in male heavy cigarette smokers. The relationship between heavy cigarette smoking and Buerger's disease has been well established and emphasized by many authors. Only rare cases of this disease in nonsmokers have been reported. The authors report a case of Buerger's disease in a cigarette factory worker. The course of disease in this patient suggests that the tobacco-rich environment and the handling of large quantities of tobacco on a daily basis was the main factor triggering the disease process.
Replacement of Unilateral Glassy-Carbon-Stented Intraluminal Grafts for Thoracic Aneurysm—Case Reports
Authors: Katsumoto Keiichiro , Niibori Tatsuru , Minhaz Mohammed Uddin
Published: August 2008

Glassy-carbon-stented intraluminal grafts were used for the treatment of thoracic aortic aneurysms. As a stent, glassy carbon tubes 22 and 24 mm in outer diameter were cut to a length of 25 mm. The center of each tube was shaved by 5 mm in width and several notches were made. The stents were prepared for use in the assembly of intraluminal grafts, using conventional artificial vascular prostheses. Five cases of thoracic aortic aneurysm are presented as case reports. The location of the stents was always at the distal end of the aorta, but every proximal end-to-end anastomosis was performed with a conventional suture technique. The longest follow-up term is three years and more than one year in the other cases. Complications such as thromboembolism, graft detachment, and pseudoaneurysm formation have not been encountered to date. These new stents performed quite satisfactorily and showed a great advantage over commercially available intraluminal grafts.
Heparin-Induced Thrombocytopenia: A Spectrum of Hemorrhage and Thrombosis—Case Presentations
Authors: Samuels Louis E. , Shektman Arthur , Amrom George , DiGiovanai Robert J. , Dupont Jean-Rene , Kerstein Morris D.
Published: August 2008

Three cases of the heparin-induced thrombocytopenia syndrome are presented. Two of the patients died of thrombotic sequelae and 1 patient survived but suffered a significant bleeding complication. Several significant features are identified: (1) clinical presentation of the syndrome was apparent just before a fall in the platelet count; (2) platelet counts below 100,000/mm3 were not necessary for complications to occur; (3) antiplatelet IgM antibody was identified with the bleeding complication, as opposed to IgG in the thrombotic complication ; (4) despite cessation of heparin and institution of coumadin in 1 patient, platelet counts remained depressed and thrombotic complications continued to occur; and (5) superior vena cava thrombosis occurred in 1 patient, a condition previously unreported. These findings offer a means of suspecting the diagnosis before complications occur, raise questions regarding mechanism and management of the disorder, and add to the spectrum of thrombohemorrhagic sequelae associated with this syndrome.
Free Radicals in Reperfusion Injury After Acute Aortic Occlusion
Authors: Nishimaki Keiji , Urayama Hiroaki , Makuuchi Masatoshi , Numata Minoru
Published: August 2008

This investigation aims to evaluate the role of free radicals and the influence of radical scavengers in reperfusion injury of the skeletal muscle in male Wistar rats.

Various parameters, including tissue blood flow, serum and calf muscle tissue levels of thiobarbituric acid (TBA) reactants, and the water content of calf muscles, were measured in the experimental setting, where infrarenal abdominal aorta was occluded for two hours followed by reperfusion with and without intraperitoneal administration of radical scavengers (superoxide dismutase or catalase).

The rats were divided into four groups: group A: single laparotomy; group B: two-hour occlusion; group C: two-hour occlusion with superoxide dismutase; group D: two-hour occlusion with catalase.

The increases in both serum and calf muscle tissue levels of TBA reactants following reperfusion were diminished in groups C and D as compared with those in group B. The water content of calf muscles showed a significant increase after reperfusion in group B, whereas it did not change in group D. The calf muscle tissue blood flow after reperfusion was significantly lower in group C than that in group B.

These results indicate that oxygen-derived free radicals may be responsible for reperfusion injury in the lower extremity and that the attenuated blood flow during reperfusion produced by these scavengers seems to play an important role in reducing lipid peroxidation . In a clinical setting, limiting the rate of reperfusion blood flow may reduce the reperfusion injury in skeletal muscle.
Percutaneous Laser Angioplasty of Peripheral Vessels: Primary Success and Follow-up Results
Authors: Visona Adriana , Liessi Guido , Bonanome Andrea , Lusiani Luigi , Miserocchi Luigi , Breggion Giovanni , Pagnan Antonio
Published: August 2008

Excimer laser angioplasty was attempted in 59 patients (43 men, 16 women, mean age sixty-three ± eight years, range thirty-nine to seventy-seven years), affected by peripheral vascular disease. Forty-nine patients had a total occlusion of one superficial femoral artery, 3 of one iliac artery, and 1 of one popliteal artery; 6 patients showed a subocclusive stenosis of a superficial femoral artery. Occlusive and subocclusive stenoses were classified by length: < 10 cm (39 cases), > 10 cm (20 cases).

A commercial excimer laser was used at the xenon-chloride wavelength of 308 nm. Successful recanalization was obtained in 53 of 59 patients (90%). Hemodynamic improvement was confirmed by a significant increase of the ankle/ brachial systolic pressure index (from 0.60 ± 0.17 to 0.79 ± 0.20, p < 0.005). The success rate was higher for lesions < 10 cm in length. Early reocclusion was observed in 7 patients and was associated with poor runoff. The cumulative patency rate was 81 % at one month, 67% at six months, and 51 % at one year.
The Level of Thrombus Formation in Experimental Carotid Artery Occlusion Done by Ligation and Endarterectomy Method
Authors: Tahta Kadir , Ozgen Tuncalp , Ozbay Gamze , Önol Behsan
Published: August 2008

The purpose of this study was to develop thrombus formation by ligation and endarterectomy (L + E) in carotid artery in rats. Unilateral common carotid artery (CCA) ligation and endarterectomy were performed in 15 rats with microsurgical techniques, and 15 rats were used as a control group. The thrombus formation was examined after days 1, 3, and 7 and months 1 and 3. Local thrombus was revealed in ligation of the common carotid artery. The thrombus formation did not extend further than the bifurcation of the CCA in the L + E group.
Mycotic "Mycotic" Aneurysm of the Superior Mesenteric Artery: A Case Presentation
Authors: Calcagno David , Magnant Colette M. , Lack Ernest E.
Published: August 2008

A sixty-two-year-old man was found to have an aneurysm of the superior mesenteric artery that was histologically shown to be of fungal etiology. Although the term mycotic is often used to describe infected aneurysms of any etiology, the authors cannot find in the literature a prior report of a fungal, or truly mycotic, aneurysm of the superior mesenteric artery.

Clinical, angiographic, and histologic findings are reported with a review of the English literature.
Concomitant Carotid and Popliteal Artery Aneurysms in a Patient with Behçet's Syndrome—A Case Report
Authors: Böke Erkmen , Sarigül Ali , Ugurlu Baran , Günay Ilhan , Balkanci Ferhun
Published: August 2008

Behçet's syndrome is a multisystem disorder of unknown etiology with a worldwide distribution. It is considered a systemic vasculitis affecting the skin, joints, eyes, gastrointestinal tract, neural tissue, and blood vessels. About 30% of the patients have vascular involvement, mainly as venous thrombosis, but aneurysms of the aorta, peripheral, and pulmonary arteries have also been reported. The authors present a patient with Behçet's syndrome who had aneurysms both of the popliteal artery and the carotid artery treated surgically.
The Relationship of Human Saphenous Vein Intimal Area to Age and Gender
Authors: Davies Mark G. , Brockbank Kelvin G.M. , Hagen Per-Otto
Published: August 2008

The saphenous vein is an essential element in arterial bypass surgery. It is known to develop intimal thickening following transplantation to the arterial circulation. No data are available on the relationship of normal saphenous vein intimal area and the age or the gender of the patient. One hundred sixty-two consecutive, donated, cadaveric, midtibial samples of the long saphenous vein were harvested. The donors ranged in age from twelve to eighty-two years; there were 121 males and 41 females. The areas of the intima and media and the intimal ratio (intimal area/[intimal + medial area]) were calculated by computer videomorphometry. There was no correlation between the three variables and age, but there was a significant correlation between the gender of the donor and the intimal area (r2=0.25, P=0.0012) and the intimal ratio (r2=0.34, p = 0.0001) showing that females have a greater intimal area than males.

These findings suggest that gender should be considered as a variable in the choice of suitable control values in subsequent human studies on the development of intimal hyperplasia in venous bypass grafts.
Ischemic Colitis Following Ruptured Abdominal Aortic Aneurysm
Authors: Rosenthal David , McKinsey James F. , Clark Michael D. , Hungerpiller John C. , Lamis Pano A. , Laszlo Pallos L.
Published: August 2008

During a six-year period, 47 patients underwent operation for ruptured abdominal aortic aneurysm (rAAA) with a mortality rate of 38% (18/47): of the 39 patients surviving the initial surgery, 9 (23%) developed ischemic colitis. All 9 patients demonstrated hyperdynamic cardiovascular changes consistent with sepsis: decreased systemic vascular resistance (SVR) (mean 852 dynes/sec/cm2) and increased cardiac index (mean 3.8 L/min/m2). This "septic picture" in the postoperative period, before the onset of any gastrointestinal (GI) symptoms (diarrhea with/without blood), led the authors to question bowel viability. Flexible sigmoid colonoscopy identified ischemic colitis in all patients and sigmoid colectomy was performed in 4; 3 of these patients survived. Of the 5 remaining patients managed nonoperatively, 3 survived. When hyperdynamic cardiovascular changes were recognized "early" (< forty-eight hours) and ischemic colitis was diagnosed (5 patients), all patients survived. However, when ischemic colitis was diagnosed "late" (> forty-eight hours) after operation in 4 patients, only 1 (25%) survived.

In patients who suffer an rAAA and demonstrate cardiodynamic signs of sepsis (especially falling SVR) in the immediate postoperative period (< forty-eight hours), immediate bedside sigmoid colonoscopy to rule out ischemic colitis is warranted. Similarly, when patients develop "late" cardiodynamic signs of sepsis during recuperation from rAAA, even before the onset of GI symptoms, sigmoid colonoscopy should be performed. If severe ischemic colitis is documented, aggressive management with frequent colonoscopy and possibly sigmoid resection is indicated, for this may offer the only chance of survival in these catastrophically ill patients.