bluuebunny/crossref_metadata_2025 huggingface dataset:
The management of subcapital fractures in the elderly — with an emphasis on economic aspects
Authors: Chaudhry Samena
Published: November 2007

About 86 000 hip fractures occur each year in the United Kingdom (Donaldson et al., 1990) and approximately half are intracapsular (Singer et al., 1994). Mortality is 5—10% after 1 month and one third of patients will have died by 1 year (Johnell et al., 1992; French et al., 1995, 2006). The total estimated cost to society is almost £726 million per annum with over half of the cost attributed to social care of patients recovering from a broken hip as more than 10% of survivors will be unable to return to their previous residence (Keene et al.,1993). Hip fractures account for approximately 20% of orthopaedic bed occupancies in the UK, and based on current population trends, the number of hip fractures may rise to 120 000 per annum by 2015 (Johnell et al., 1992). In this article the management of elderly patients with subcapital or intracapsular type fractures is described with an emphasis on economic aspects.
Between Two Cultures: Geography, Computing, and the Humanities
Authors: Gilbert David
Published: November 2007

Literary intellectuals at one pole - at the other scientists, and as the most representative, the physical scientists. Between the two a gulf of mutual incomprehension - sometimes ... hos tility and dislike, but most of all lack of understanding. Their attitudes are so different that, even on the level of emotion they can't find much common ground.1
Visions of Darkness: the Representation of Nature in the Films of Werner Herzog
Authors: Gandy Matthew
Published: November 2007

I think in the movies we have a possibility to go beyond our own existence in our collective dreams, in our nightmares. We can somehow reach beyond, and we can look through a win dow into entire new worlds and see ourselves elevated and stylized.1
Comparison of Preoperative Three-Dimensional Gadolinium-Enhanced Magnetic Resonance Imaging to the Operative Assessment of Abdominal Aortic Aneurysm Anatomy: A Retrospective Study
Authors: Bhirangi Kiran , Gilfeather Maryellyn , Siegelman Evan S. , Schnall Mitchell D. , Holland George A. , Carpenter Jeffrey P. , Golden Michael A.
Published: November 2007

The purpose of this paper was to compare gadolinium-enhanced magnetic resonance angiography (MRA) and operative evaluation of the anatomic extent of abdominal aortic aneurysms (AAA) and assessment of other visceral arteries and common iliac arteries. A retrospective study was performed on 47 patients who had preoperative gadolinium- enhanced MRA and subsequent AAA repair. The original MRA interpretations were compared to the operative findings. In cases where there was a discrepancy, the MRAs were reassessed. MRA correctly evaluated the proximal extent (distance from renal vessels) of the AAA in 45 of 47 patients (96%), and in all (100%) patients MRA identified the distal extent (relation to aortic bifurcation or extension into iliac vessels) of the aneurysm. Ten of 15 accessory renal arteries were correctly identified (67%). Four of the five missed accessory renal arteries were identified on reassessment. MRA correctly diagnosed 10/12 cases of inferior mesenteric artery (IMA) occlusion. Two, which were called occluded, were found to be patent on reassessment. MRA correctly diagnosed six retroaortic left renal veins. Three-dimensional magnetic resonance angiography with intravenous admin istration of gadolinium is a noninvasive method for the preoperative evaluation of abdominal aortic aneurysms. MRA with IV gadolinium can accurately evaluate AAA anatomy before surgical repair.
Autologous Blood Donation with Erythropoietin in Abdominal Aortic Aneurysm Repair: Special Reference to Blood Pressure and Hormonal Changes
Authors: Urayama Hiroshi , Ohtake Hiroshi , Tawaraya Kanae , Watanabe Yoh
Published: November 2007

Recombinant erythropoietin (rEPO) is used in autologous blood donation, but its useful ness and side effects have not been evaluated thoroughly. A prospective clinical study was conducted in 20 patients with abdominal aortic aneurysm who underwent surgery following autologous blood predonation with rEPO therapy. The patients were 19 men and one woman ranging in age from 59 to 79 years old. The blood pressure was measured before and after blood withdrawal and rEPO injection, and before and after rEPO injection alone. The levels of endogenous EPO, prolactin, growth hormone, and thyroid hormones were compared before the first blood withdrawal and just before surgery. The volume of blood withdrawn was 800 mL (400 mL at each of two with drawals) within 2 weeks, while 6,000 units of rEPO were injected four times. The blood pressure dropped after blood withdrawal and rEPO injection, but it showed no marked change after rEPO injection alone. The mean value of hemoglobin was decreased from 13.8 to 12.4 g/dL in 2 weeks, and all patients received autologous blood transfusion during surgery. No declamping shock was noticed, and only 2 of the 20 patients needed homologous blood transfusion. The levels of growth hormone and thyroid hormones did not change, but that of prolactin increased following blood predonation with rEPO therapy. No significant change of endogenous EPO was observed.
Long-Term Recurrence and Nerve Injury After Total and Partial Stripping of the Great Saphenous Vein by External Phleboextractor
Authors: Canonico Silvestro , Luminello Felice , Mainelli Rosa , Canonico Raffaele , Campitiello Ferdinando
Published: November 2007

The objective of this study was to assess the efficacy of an external phleboextractor (EP) in improving the results of total and short stripping of the great saphenous vein (GSV) with particular reference to saphenous nerve injury occurring during the operations. Two hundred fifty-seven consecutive patients affected by varicose veins in the lower limbs (of which 22 had bilateral diseases) underwent total (Group A) or partial (Group B) saphenectomies by means of the Corcos' EP. The interventions were selected on the basis of type of reflux diagnosed by clinical and Doppler ultrasound examinations. The results were assessed 6 months and 3 years after operation. One hundred four limbs were evaluated in Group A and 160 limbs in Group B. After 3 years, 101 limbs in Group A (97.1%) and 155 in Group B (96.8%) had excellent-to-good results in terms of recurrent varices. Neurological examinations were comparable between Group A (11 saphenous nerve injuries = 10.6%) and Group B (10 nerve injuries = 6.3%). This study shows that total or short stripping of the GSV reduced varicose vein recurrence and neural compli cation using the EP.
Treatment of Inferior Vena Cava Filter Thrombosis by Mechanical Thrombectomy and Temporary Vena Cava Filter Protection
Authors: Myers Jeff L. , Mukherjee Dipankar , Karnaze Michael G. , Joseph Allen E.
Published: November 2007

Inferior vena cava (IVC) filter thrombosis presents a difficult management problem and is associated with a significant incidence of pulmonary embolism. Treatment options in less extensive clots include anticoagulant or thrombolytic therapy, often in combination with placement of a filter above the clot. However, propagation of the clot to the level of the right atrium or the existence of a free-floating thrombus and continued pulmonary embolism may require surgical intervention including vena caval ligation and thrombec tomy. A thrombus that extends to the right atrium may also require thoracotomy and cardiopulmonary bypass. Contraindications to anticoagulant or thrombolytic therapy, as in our patient with a significant bleeding risk from a colon carcinoma and heme-positive stools, further complicate treatment decisions. The authors report the first successful treatment of an IVC filter thrombosis using the combination of mechanical thrombec tomy and temporary vena cava filter protection.
Stewart-Treves Syndrome
Authors: Papavassiliou Vassilios G. , Liapis Christos D. , Kakissis John D. , Kaperonis Elias A. , Piperidou Eugenia L. , Vgenopoulou Stephanie E. , Gogas John G.
Published: November 2007

Malignant tumors of the vascular endothelium complicating lymphedema (Stewart- Treves syndrome) are very rare events. A 72-year-old woman and a 52-year-old man developed angiosarcoma of the right and left lower extremity, respectively, after long standing lymphedema. The first patient had pulmonary metastases and was initially treated with chemotherapy with no response. She died of her disease 5 weeks after the biopsy. The second patient underwent disarticulation of the left leg. Four months later he developed pulmonary metastases and died.
A Report of an Anomalous Bifurcation of the Right Axillary Artery in Man Lyno E. Maraspin
Authors: Maraspin Lyno E.
Published: November 2007

The present report describes a variation of the axillary artery and its distribution to the axilla and thorax. In an adult white male cadaver an anomalous bifurcation was found to arise from the second part of the axillary artery. The artery bifurcated into superficial brachial and deep brachiothoracic branches. The lateral thoracic artery had a direct origin from the first part of the axillary artery. From the deep brachio-thoracic branch the following offshoots were evident: the independent anterior and posterior humeral circumflex, the subscapular, and a common trunk for the profunda branchii and superior ulnar collateral. The superficial brachial artery was the apparent con tinuation of the axillary artery in that it bifurcated into the radial and ulnar ar teries.
Fatal Hemorrhage as a Complication of Neurofibromatosis
Authors: Leier Carl V. , Dewan Charles J. , Anatasia Louis F.
Published: November 2007

Rupture of a major artery occurred in a patient with Von Recklinghausen's disease. The adventitia and media of the artery in the region of the rupture were invaded by neurofibroma.

Numerous cases of hemorrhage into neurofibromata have been reported1 2, 3, several of these with a fatal outcome. Cases have been reported describing neurofibromatous involvement of the adventitia of blood vessels with the devel opment of aneurysms 4, 5 and hypertension 5,6. In 1882, Frederick Von Reckling hausen reported a case of neurofibromatosis with rupture of a pulmonary artery aneurysm 7, 8. Unfortunately, microscopic examination of the vessel was not performed. We report a fatal case of rupture of a major artery secondary to neurofibromatous involvement of the adventitia and media of the vessel.
Statement of Policy
Authors: Boyd A. Michael , Friedmann Lawrence W.
Published: November 2007

As a new policy of the Journal, the Board of Editors have decided to invite views of noted experts in the field of actual and controversial problems in vascu lar diseases. These views will be presented as "special editorials."

These editorials do not necessarily reflect the consensus of the Board of Editors of the Journal, and the Board will make no efforts to impose its views on them. They are intended to present individual opinions from the leaders of our profession.

We will also invite and, if possible, provide a place in the Journal for the expression of opposite viewpoints.
An Ideal Catheter: the Simple Curve
Authors: Ayella Robert J.
Published: November 2007

A complex variety of catheter shapes has developed in the short period since Seldinger first introduced percutaneous angiography. The author has discov ered in the course of several thousand selective arteriograms that only one catheter is needed: the original simple curve.
Statement of Policy
Authors: Boyd A. Michael
Published: November 2007

As a new policy of the Journal, the Board of Editors have decided to invite views of noted experts in the field of actual and controversial problems in vascu lar diseases. These views will be presented as "special editorials."

These editorials do not necessarily reflect the consensus of the Board of Editors of the Journal, and the Board will make no efforts to impose its views on them. They are intended to present individual opinions from the leaders of our profession.

We will also invite and, if possible, provide a place in the Journal for the expression of opposite viewpoints.
Celiac Artery Obstruction After Arteriography
Authors: Gierson Eugene D.
Published: November 2007

The first case of celiac artery obstruction due to selective arteriography is reported. Impairment of flow to liver and duodenum was present; but the patient recovered uneventfully with non-operative treatment. Management of this problem centers around careful observation, liver support, and putting the gut at rest. If non-operative treatment is failing, operation should be done, vascular reconstruction carried out, and the duodenum inspected to ensure its viability.
Bovine Artegraft Arteriovenous Fistulas for Hemodialysis in One-Hundred Patients After "Conventional" Arteriovenous Fistulas Failed
Authors: Katzman Howard E. , Schild A. Frederick , Vanderwerf Ben A.
Published: November 2007

The use of the Bovine artegraft for creation of arteriovenous fistulas in the hemodialysis patient was first carried out in the midsummer of 1971. Since that time, there has been considerable material reported in the use of this substitute as an access for hemodialysis. In this article information gained from an ongoing study of the first 100 patients in chronic hemodialysis who had Bovine artegraft arteriovenous fistulas was reviewed. The indications for operation, the standard technique, the results, the complications, and the future plans for study of the physiology and hemodynamics of this type of fistula are described. The Bovine artegraft, AV fistula can be created successfully in a high percentage of patients, offers ease of needle placement, and effective dialysis with very little complication.
Obliteration of a Mycotic Aneurysm by Means of Intra-Arterial Balloon Catheters
Authors: Buetow Gerald W. , Maitem Avelino , Vahid Dara
Published: November 2007

Intra-arterial balloon catheters were used to prevent massive exsan guinating hemorrhage from an intrathoracic, mycotic aneurysm of the right subclavian artery in a patient with massive, recurrent ulcerating carcinoma of the upper, anterior chest wall, secondary to carcinoma of the breast.
Vascular Clamping: A New Concept with Manometric Studies Comparing Available Instruments with a Novel Design
Authors: Berlin Richard Barnard , Berlin Richard B.
Published: November 2007

Pressures exerted by conventional instruments to control blood vessels during vascular procedures are frequently excessive and vary greatly from one type to another. Static pressure measurements on human arteries illustrate these factors. Consequent tissue damage may be a serious source of surgical failures. A new instrument is described which holds securely with minimal trauma.
Anomalous Origin of the Left Coronary Artery Arising from the Main Pulmonary Artery
Authors: Chan Tak-Sek
Published: November 2007

Anomalous left coronary artery arising from the main pulmonary artery, although rare, should be differentiated from other diseases caus ing cardiomegaly or myocardial infarction in an acyanotic infant. A definitive diagnosis can be established by typical electrocardiographic, radioisotopic, and angiocardiographic findings. The clinical course is variable, depending on the age of onset and on the direction and magni tude of the blood flow through the anomalous vessel. Recent surgical advances offer new hopes for a better prognosis. Echocardiography and systolic time intervals are noninvasive means suitable for monitoring the myocardial functions periodically. The author suggests the use of nitro glycerin ointment as an important part of medical management, and the adoption of a modified surgical technique for coronary transferral in selected patients.
Successful Repair of Spontaneous Iliac Artery- Iliac Vein Fistula
Authors: Hines George L. , Merritts L. Lynn , Mohtash-Emi M.
Published: November 2007

This is the first reported case of an iliac artery-iliac vein arteriovenous fistula secondary to rupture of an iso lated atherosclerotic iliac artery aneurysm. The patient presented with systemic and local signs of a large fistula. The operative treatment of fistulas between large vessels has been associated with a high mortality rate because of massive, uncontrolla ble hemorrhage. For this reason an autotransfuser was used. The opera tion was performed with only 1 to 2 minutes of hypotension, and the post operative result was excellent.
Intraaortic Balloon Counterpulsation: A Review
Authors: Smith James M. , Joyce Lyle D. , Mauer Henry G. , Lillehei Richard C.
Published: November 2007

The intraaortic balloon counterpulsation pump (IABP) was successfully placed in 54 patients from 1972 to January 1978. Total overall survival was 46% (25/54). In the past 3 years survival was doubled (54% — 21/39) compared to the initial experience from 1972 through 1975 (27% — 4/15). Eleven percent (6/54) of the patients died after the IABP was removed, 19% (10/54) became balloon-dependent, and 24% (13/54) had either a poor response or no re sponse to IABP.

Indications for IABP were cardiogenic shock secondary to myocardial infarction (CS-MI), preinfarction angina, postoperative cardiopulmonary bypass dependency (CPBD), the most common indication, or post cardi otomy cardiogenic shock. Preoperative prophylactic placement of the balloon was used in 7 patients with a 57% (4/7) survival. None of the 10 patients treated for CS-MI survived to discharge. Fifty-one percent (18/35) of CPBD patients were long-term survivors.

Complications including difficulty passing the device (15/54), thrombosis (6/54), minor dissection (3/54), or combinations of these problems occurred in 41% (22/54) of the patients. Hemodynamic and metabolic parameters were also reviewed. Early recognition of cardiogenic shock and prompt placement of the IABP are essential to insure decreased morbidity and increased survival in these critically ill patients.
The 125I-Fibrinogen Method for Early Diagnosis of Venous Thrombosis
Authors: Bernstein Kurt , Mattsson Sören , Ulmsten Ulf , Åstedt Birger
Published: November 2007

In vitro and in vivo experiments were performed with a scintillation detector designed for 125I-fibrinogen measurements. The sensitivity of the detector was tested in a water phantom. The relative count rate of 100 when the 125I point source was applied to the water surface decreased to 50 at a water depth of 1 cm to 14 at 2.5 cm, and to 4 at 4 cm. Measurements on normal patients showed that the individual standard deviation of day-to-day measurements of the count rate on the calf was ±2.0% of the count rate over the heart. Based on these data, we decided that a 10% increase in this "percentage count rate" between preoperative recordings and recordings made at 2 consecutive days was suggestive of thrombosis. Of 36 high-risk patients subjected to surgery, 7 (20%) filled this criterion.
Streptokinase and Heparin in the Treatment of Pulmonary Embolism: A Randomized Comparison
Authors: Dotter Charles T. , Seaman Arthur J. , Rösch Josef , Porter John M.
Published: November 2007

Treatment with streptokinase followed by heparin was compared on a randomized basis with treatment with heparin alone in patients with acute pulmonary embolism. The diagnosis and results of treatment were established by pulmonary angiography. Fifteen patients received streptokinase and 16 received heparin alone. Complications included bleeding and pyrexia in both treatment groups and anaphylaxis in a patient receiving streptokinase. There were three deaths attributed to the disease its treatment. Patients in the strepto kinase group had significantly greater angiographic improvement (P = 0.0125) than those in the heparin group.
Left Atrial Myxoma Causing Left Ventricular Outflow Tract Obstruction
Authors: Burke David W. , Karo James , Diaz Pedro , Goldstein Sidney , Stein Paul D.
Published: November 2007

Echocardiography showed that a patient with left atrial myxoma had intermittent ob struction of the left ventricular outflow tract. Obstruction was caused either by the tumor itself or by displacement of the anterior leaflet of the mitral valve into the outflow tract. Outflow tract obstruction, in con tradistinction to inflow tract obstruction, may be a cause of syncope and sudden death in left atrial myxoma.
Recanalization and Aneurysmal Dilitation of the Bovine Vascular Graft After Its Complete Occlusion
Authors: Farsad G. Reza H.
Published: November 2007

Bovine heterograft was widely used in the past for angio-access, revascular ization, and in some other different vas cular procedures. At first the technique was promising, but it ultimately became discouraging because of a high number of complications related to the use of foreign protein. This report describes a case in which bovine heterograft was used as an angio-access for chronic renal dialysis; its natural course and complication are reviewed in detail.
Aortic Saddle Embolus From a Mestastatic Cardiac Tumor: Report of a Case
Authors: Greif Jon M. , Kahn Mark , Lozman Harvey
Published: November 2007

A case of urinary tract carcinoma metastatic to the endocardial surface of the left ventricle resulted in an aortic saddle embolus in a 51-year-old man with congenital hypogammaglobu linemia. Aortic saddle embolism is a rare complication of tumor metastatic to the heart.
Use and Limitations of Dextranomer in Cutaneous Ulcerations
Authors: Lewis Victor L. , Gavron Joseph , Yao James S. T. , Lim Leonardo T. , Bergan John J.
Published: November 2007

In an attempt to evaluate the limitations and utility of dextranomer, 39 patients with a variety of cutaneous ulcerations were studied. Highly exu dative venous stasis ulcers (11 patients) responded best, with clearing of superficial infection within 48 hours and development of granulation tissue in the ulcer bed within 5 days. Nonexudative venous stasis ulcers (7 patients) responded more slowly to this therapy. Ischemic ulcerations and pressure sores as well as ulcers containing bone or tendon were not improved by dextranomer therapy. Rapid relief of pain and uniform patient acceptance of the method of treatment recommend it for further evaluation.
Postoperative Aneurysms of Right Ventricular Outflow Following Total Correction of Fallot's Tetralogy
Authors: Nair K.K.
Published: November 2007

Four cases of postoperative aneu rysms of the right ventricular outflow tract developed from among 55 cases of Fallot's tetralogy operated on during a 3-year period. The different etiology of each aneurysm is discussed and the cor rective treatment described. Three are doing well up to 7 years after reopera tion, and 1 died during the early post operative period as a result of massive uncontrolled hemorrhage.
Rigid Circumferential Constriction of the Arterial Wall: Part II
Authors: Edmondson H.T. , Moretz W.H. , Nesbit R.R. , Otken L.B. , Pittman V.
Published: November 2007

The distal thoracic aorta was partially occluded in 51 mongrel dogs. In some dogs single strands of size 00 Dacron, Teflon, and black silk were used, and in others the vessel was constricted by banding with a 2-cm long aluminum cylinder. In all instances the resultant diameter was 50% of the original diameter in systole. This study was performed as a sequel to similar experimentation reported by the authors in 1970 in which stainless steel mesh cylinders and single stainless steel strands were used.

Because of unpromising results of earlier investigators—destructive changes of the vessel wall with fatal hemorrhage—we were surprised that all 86 dogs in our first study, and all 51 dogs in the current study, were alive and well at controlled intervals, some for up to 2 years.
Chronic Aortic Dissection Complicating Coronary Bypass Surgery
Authors: Rubenstein Richard B. , Robicsek Francis , Daugherty Harry K. , Cook Joseph W. , Selle Jay G.
Published: November 2007

A middle-aged knitting mechanic under went replacement of his mitral valve with a Bjork-Shiley prosthesis as well as insertion of multiple autogenous saphenous vein grafts to bypass the occluded coronary arter ies. Eight months after cardiac surgery, the patient was re-evaluated because of transient ischemic attacks. Repeat studies revealed a normally functioning mitral disk prosthesis and aortic dissection involving the descend ing and transverse arch with the saphenous vein graft emerging from the outer lumen. It was decided to continue to treat him con servatively, and he has been doing well for 14 months.
Arteriovenous Fistula Following Lumbar Disc Surgery
Authors: Samant Anil R. , DeSa'Neto Artur , Steinhoff Neil G. , Desser Kenneth B. , Benchimol Alberto
Published: November 2007

Six months after lumbar disc surgery, a 43-year-old woman presented with signs and symptoms of high-output circulatory failure secondary to an acquired abdominal arteriovenous fistula. Unusual findings in this case included a continuous murmur, which was transmitted to the soles of both feet and pericardial effusion, both of which disappeared after corrective surgery. Echocardiography demonstrated resolution of chamber enlargement following repair of the fistula. The mechanism of vascular injury during disc surgery and hemodynamic effects of such A-V fistulas are discussed.
Superior Vena Cava Thrombosis Secondary To Peritoneal Venous Shunting H. Jane Bussey, M.D., Webster S. Lowder, M.D., and Fred J. Wolma, M.D., Faca Galveston, Texas
Authors: Wolma Fred J.
Published: November 2007

Peritoneal venous shunts are effec tive in providing lasting relief to pa tients with medically intractable as cites. Nutrition and renal function im prove. Reported complications are var ied. As far as we know, the complication of superior vena cava obstruction re ported here has not been reported be fore. Response to conservative therapy resulted in amelioration of edema of the upper trunk and face.
Clinical and Morphologic Assessment of Long-Term Human Umbilical Cord Vein Implants Employed as Vascular Conduits
Authors: Dardik Herbert , Ibrahim Ibrahim M. , Sussman Barry , Turner Richard J. , Israel Michael , Kahn Mark , Dardik Irving
Published: November 2007

Clinical experience employing glutaraldehyde-stabilized human umbilical cord veins as vascular prostheses for popliteal, tibial, and peroneal recon structions continues to show promise and remarkable morphologic stability for periods exceeding 4 years. Cumulative graft patency rates are similar to those achieved with autologous saphenous vein. Angiographic studies as well as analysis of explant specimens by microscopy and biophysical techniques demonstrate the durability of these protheses. Although some changes do occur, such as lipid imbibition, these may reflect the metabolic status of the host more than the graft itself.
Maintenance Hemodialysis With Modified Human Umbilical Vein Graft Angioaccess
Authors: Rubio Pedro A. , Farrell Edward M.
Published: November 2007

This series includes 60 patients with end-stage renal disease in whom 63 looped forearm modified human umbilical vein graft arteriovenous fistulas were constructed for maintenance hemodialysis. After a 26-month follow-up, 46 of the 63 grafts (73.0%) were free of complications. Twenty-eight of the 33 complications (84.8%) were corrected with minor surgical procedures. These results demonstrate a significantly lower complication rate when compared with other currently available graft materials.
Pre- and Postoperative Left Ventricular Bypass Support in Patients With Myocardial Infarction
Authors: Taguchi Kazumi
Published: November 2007

Pre- and postoperative circulatory support employing ventricular bypass with local heparinization and blood filtration for 5 to 72 hours was conducted in 5 patients with myo cardial infarction. All of these patients had critical cardiac conditions due to cardiogenic shock. Postoperative introduction of ven tricular bypass support was not effective in 2 patients because of bleeding due to removal of hemorrhagic infarcted myocardium, or because of failure to gain sufficient blood re turn from the ventricle. However, the pre operative use of ventricular bypass was ef fective in promoting the ultimate survival of 2 of the 3 patients who underwent surgery.
Thoracic Outlet Syndrome With Negative Adson's and Hyperabduction Maneuvers
Authors: Youmans C. Roger , Smiley Robert H.
Published: November 2007

The thoracic outlet syndrome is a prevalent entity. Most cases respond to conservative methods of therapy. Surgical decompression, when necessary, is effective in the majority of cases, and morbidity and mortality are low. The diagnosis of thoracic outlet compression syndrome is usually made on the basis of an adequate history and physical examination. Neuroelectric studies are inconsistently helpful. The predominant symptoms are neuro logic, not vascular. Pulse obliteration does indicate some element of anatomic tightness. However, without symptom reproduction, pulse change has no diagnostic relationship to thoracic outlet syndrome. Conversely, the inability to obliterate or diminish the radial pulse in positions of thoracic outlet tightness, when symptoms are reproduced in those positions, has no corre lation to the results of decompression.
Buerger's Disease: A Distinct Clinical Entity
Authors: Lysak Steven Z. , Welling Richard E.
Published: November 2007

Retention of thromboangiitis obliter ans as a distinct clinical entity contin ues to have considerable value in the logical planning of treatment and long- term care of these patients. Throm boangiitis obliterans has a unique prog nosis and associated factors, especially tobacco consumption, are extremely important. It is hoped that further re search may delineate the pathogenesis of Buerger's disease so that patients can be properly educated and reas sured.
Veno-Venous Bypass for Drainage of Occluded Common Iliac Vein: a Case Report
Authors: Assa J. , Iuchtman M. , Zoireff L. , Simon J.
Published: November 2007

A case of postiliac vein ligation, DVT recanalization, and its sequelae was suc cessfully treated 15 years after onset by a veno-venous crossover bypass with AV fistula. Previous reports on such a procedure were discouraging even when implemented within three years of on set. The inconsistent practice of venous revascularization is the main cause of failures. The advent of AV fistula con struction brings with it much hope for this kind of surgery.

This case report discusses hemody namic studies by phlebography, opera tive technique, and problems arising with the construction of AV fistula; the literature is reviewed as well. We con clude that venous reconstructions can be carried out at any time, provided that increased flow is maintained. This increase in flow (by the AV fistula) should be limited in time to avoid de velopment of reversed flow.
Spontaneously Ruptured Carotid Artery of Undetermined Etiology
Authors: Sung James P. , Crutchlow Paul F. , Keech Marsha A.
Published: November 2007

A 66-year-old man developed severe airway obstruction, right hemothorax, and hemorrhagic shock due to spontaneous rupture of a normal-appearing right common carotid artery. Surgery disclosed a sharp, 1-cm vertical rupture in the anterior wall of the right common carotid artery, 1.5 cm proximal to the carotid bifurcation. Otherwise the artery appeared normal. A biopsy was done around the perforated vessel, and the defect was closed with a patch graft taken from the right external carotid artery. The patient had an uneventful recovery. Subsequent clinical and laboratory studies gave no clue to the cause of the rupture. We believe this to be a case of a spontaneous rupture of undetermined cause in a normal carotid artery.
Experimental and Clinical Evaluations of Superior Vena Caval Replacement
Authors: Tanabe Tatsuzo , Kubo Yoshihiko , Hashimoto Masato , Sugie Saburo
Published: November 2007

Replacement of the superior vena cava is difficult, and the results of operative treatment for superior vena caval syndrome are rather disappoint ing. This report describes extensive experimental and clinical experiences with superior vena caval revascularization, with special reference to the favorable results of patch angioplasty.
Antithrombin III as a Factor in Recurrent Thromboembolism
Authors: Raine Tal , Kerstein Morris D.
Published: November 2007

A 43-year-old man with recurrent pulmonary emboli associated with antithrombin III deficiency is presented. After laparotomy for penetrating abdominal trauma, thrombophlebitis and emboli were treated with heparin. Subsequent failure of therapy resulted in application of an inferior vena cava clip. Recurrent emboli from the site of the clip were managed by vena cava division and reconstruction. The primary problem was antithrombin III deficiency with levels less than 40% of normal.

The first recorded case of ligation of the inferior vena cava (IVC) for pulmonary embolus was by Trendelenburg in 1911.12 Homans2 suggested prevention of pulmonary embolus with ligation of the IVC in 1944. Since then, treatment of deep vein thrombosis with or without pulmonary embolus has focused on anticoagulant therapy. Recent studies have demonstrated a lower morbidity and mortality with anticoagulation than with any surgical procedure.3 The primary indications for IVC interruption are contraindica tion to anticoagulation or failure of anticoagulation to prevent pulmonary embolus. Partial interruption of the IVC with extraluminal plication or clip, or intraluminal device, is the usual surgical approach.

We present a case of recurrent pulmonary embolus managed by IVC ligation with difficulties in anticoagulation due to an antithrombin III defi ciency and subsequent clot propogation above an IVC clip. This case illus trates the management of thrombus above a vena cava interuption as well as underlining Virchow's lessons of hypercoagulability and stasis as predisposing factors of deep vein thrombosis.
Lumbar Sympathectomy as a Surgical Approach in Hereditary Sensory Neuropathy (Thevenard Syndrome)
Authors: Kott Itamar , Kott Edna , Zandbank Uri
Published: November 2007

Hereditary sensory neuropathy (HSN) as described by Thevenard is characterized by the appearance of a painless corn on the great toe or sole which develops into an ulcer with purulent discharge. This is accompanied by the occurrence of pathologic fractures, and amputation is frequently necessary. Chronic neuritis of the nerve roots and the loss of sensation have been thought to be responsible. Recently, capillary arteriovenous (A-V) anastomosis and a poor capillary network were demonstrated to have caused poor circulation in the skin of the affected feet. Three patients, 1 female and male and female siblings (from 2 unrelated families) whose age ranged from 15-20 years and who suffered from ulcers in the soles and big toe, with purulent discharge and loss of sensation were studied by femoral angiogra phy. Poor vascularization was found in the feet of both females as well as in the male, who had an amputated toe and earlier had undergone surgery because of an A-V fistula in the foot. Macroaggregates (Technecium 99) were injected during angiography and traced with a gamma camera. In the extremities of all 3 patients, the demonstrable material was markedly dimin ished when compared with that seen in the controls. A lumbar sympathec tomy was performed in the 3 patients in order to improve blood flow in the skin and prevent further deterioration. Ten days after surgery the purulent discharge had disappeared and within 5 months the ulcers were healed. After 3 years of follow-up these patients lead normal lives and have no complaints except for the remaining sensory loss. Lumbar sympathectomy is therefore suggested as a new method of treatment for this disabling disease.
Carotid-Cavernous Fistula Complicating Thromboendarterectomy for an Occluded Internal Carotid Artery
Authors: Diethrich Edward B. , Koopot Ravi , Pierce Stephen A.
Published: November 2007

Thromboendarterectomy for revascularization of the totally occluded in ternal carotid artery is becoming more prevalent. New studies have attested to its efficacy in properly selected patients; however, the procedure has a potential for significant morbidity if improperly executed. One particularly rare complication of this opertion is the creation of an internal carotid artery to cavernous sinus fistula. Atherosclerotic changes in the arterial walls and the natural convolutions of the intracranial carotid arteries predispose to this iatrogenic rupture, especially with the rather stiff Fogarty catheter used to remove thrombi.

In a recent case of iatrogenic carotid-cavernous fistula following an internal carotid thromboendarterectomy, the fistula proved difficult to close. Initial ligation of the common carotid appeared to resolve the defect, but collateral circulation had been established so that the fistula was fed by retrograde flow via the vertebral and external carotid arteries. A second ligation proce dure on both the internal and external carotid branches was necessary to successfully close the fistula.

This case report exemplifies not only a complication of thromboendarter ectomy in the totally occluded internal carotid artery but also the types of problems which can arise when dealing with an intracranial fistula.
Femoral Axillary Bypass: An Alternative Approach to Occlusive Disease of the Aortic Arch Vessels in High-Risk Patients
Authors: Machleder Herbert I. , Hassan Philip W. , Kearny John
Published: November 2007

Although axillo-femoral bypass grafts have proven to be an effective alternative to the usual anatomic reconstructions for peripheral vascular insufficiency, there are only a few scattered case reports of the reversed flow, femoro-axillary bypass for treatment of the potentially more serious condi tions of cerebral ischemia associated with occlusive disease of the major aortic arch branches. This unique alternative approach becomes particularly compelling in the high-risk patient with occlusive lesions of all the aortic arch vessels. Although theoretically feasible, the effectiveness, practicality, safety, and long-term patency of this approach remain to be proven.

The case of a 59-year-old woman with cerebral ischemia secondary to occlusive disease of all aortic arch branches treated by femoro-axillary bypass is presented, and some of the observations of previous case reports are reviewed. The operative course, clinical and hemodynamic changes, and important observations in this unusual case are described. The availability of noninvasive tests for the measurement of cerebral flow and pressure has made it possible, in this case, to correlate clinical changes with objective evidence of concomitant hemodynamic alterations.
Total Occlusion of the Left Main Coronary Artery
Authors: Sohi Gurbachan S. , Flowers Nancy C.
Published: November 2007

An extremely rare case with total occlusion of the left main coronary artery is described. The role of collaterals from the right coronary artery in the maintenance of adequate left ventricular function and in the patient's survival is discussed. The need for emergency aortocoronary bypass surgery, once the lesion is discovered, is stressed. An excellent clinical result of aortocoronary bypass surgery in a patient followed for more than 2 years with a usually fatal condition is shown.
Changing Etiology of Anastomotic Aneurysms
Authors: Berni George A. , Thiele Brian L. , Bodily Kenton C. , Radke Hubert M. , Strandness D.E. , Thiele Brian L.
Published: November 2007

Anastomotic aneurysms in patients at the Seattle Veterans Administration Medical Center between 1974-1979 were analyzed to determine their etiol ogy. Thirty-nine aneurysms occurred in 29 patients with 19 aneurysms presenting in 15 patients who had vascular reconstruction at our institution. The site most commonly involved was the femoral anastomosis (5%/anas tomosis) followed by the iliac (2%) and the aortic (0.5%) anastomoses. Mechanical forces appear to be the most common cause (76%) followed by graft infection (23%) with suture failure being very uncommon (2%) Histo logic examination of the aneurysms thought to be produced by mechanical forces disclosed normal host artery wall in 1 group and aneurysmal degen erative change in the remainder. The generation of disruptive forces at anastomoses between compliant and stiff materials and their role in produc ing anastomotic disease is discussed. A disturbing feature is the incidence of commensal infections seen previously in other prosthetic surgery.
Leiomyosarcoma of the Inferior Vena Cava
Authors: Vreede Anton A. , Vaziri Dariush , Cornwall Claude C.
Published: November 2007

Leiomyosarcoma of the inferior vena cava is a rare tumor. Though gener ally not aggressive this malignancy will ultimately be fatal unless resected. Surgical resection is possible when the tumor is located in the middle or lower segment of the inferior vena cava. The symptomatology produced by the tumor is variable. The patient may present with only minimal pain or may develop a wide spectrum of findings. The lesion may present as a diagnostic problem.

The authors have recently seen a case of leiomyosarcoma of the inferior vena cava in whom computerized axial tomography was helpful in identifying the location of the tumor.
Mallory Weiss Syndrome in a Patient with a Previous Aortic Graft (Case Report)
Authors: Hans Sachinder S.
Published: November 2007

Significant hematemesis occurred in a patient who had undergone aorto bifemoral grafting: it was presumed to be due to aorto-duodenal fistula forma tion. At exploration an esophago-gastric mucosal tear was identified, with active arterial bleeding, and prompt control of the bleeding was obtained by suture ligature.
Thrombolytic Therapy in Severe Arterial Insufficiency With Absent Distal Pulses
Authors: Long David M.
Published: November 2007

Streptokinase therapy was used in 16 patients with severe ischemia of the limbs with undetectable ankle or wrist pressures. All patients had symptoms at rest with neurological deficits and the thrombolysis was considered an alterna tive to amputation. Limb salvage was achieved in 13 patients with 15 usages. Thrombolytic therapy was useful primarily as an adjunct to surgical therapy and was effective in lysing clots in small arteries not amenable to surgical methods. Thrombolysis was effective in relieving ischemic pain and in restor ing pedal pulses in most instances. Streptokinase was used safely preopera tively, intraoperatively and postoperatively.
Assessing Hemodynamic Properties of a Small Diameter Arterial Graft by Means of an Implanted Doppler Probe
Authors: Paulat K. , Gabriel S. , Schiebe M. , Voss E. , Pauschinger P. , Vollmar J.
Published: November 2007

Small diameter arterial grafts are commonly in use for replacing occluded arteries in the lower limbs. Their application, however, is limited due to the fact of relatively poor long-time patency. We tried in this study to find a better and non-invasive method to elucidate the hemodynamical status of an implanted arterial graft. By continuously monitoring hemodynamical changes during the time of patency, we can obtain more information about the way the observed arterial graft is finally occluded. This may give us valuable news about the interaction of the vascular system with the implanted arterial graft; thus suggestions about the composition of an improved graft may become possible.
Axillo-Profunda Bypass for the Management of an Infected Aorto-Femoral Graft
Authors: Baker J. Dennis
Published: November 2007

The axillo-profunda bypass provides a good solution to distal revasculari zation when it is necessary to remove an infected aorto-femoral graft in a patient with occluded superficial femoral arteries. This modification of the standard axillo-femoral procedure provides revascularization through a clean field while avoiding the additional length of an axillo-popliteal graft. Two important technical considerations are the lateral placement of the tunnel so as to avoid contamination from the infected inguinal site and the selection of a small diameter graft.
Ruptured Carotid Artery Aneurysm
Authors: Sechas Michael N.
Published: November 2007

Aneurysms of the extracranial carotid artery continue to be rare vascular lesions.2,4,6 Rhodes and associates collected only 19 cases during a 15-year experience at the University of Michigan Medical Center.

Recently, there have been many reports of successful resection and recon struction of carotid artery aneurysms. These resections have been carried out electively.2,3,4,6

There are only a few reports about emergency operations for ruptured or expanded aneurysms.5,7,9,11,12 A patient was recently managed at this institu tion for a ruptured carotid aneurysm, treated by excision and end-to-end anastomosis.
Ischemic Necrosis of the Anterior Tibial Compartment
Authors: Serra J.M. , Llorens R. , Enriquez A. , Sanado L.
Published: November 2007

When there is progressive necrosis in the lower extremity whose etiology is atherosclerosis the ultimate mode of treatment is generally amputation of that part of the extremity.

This paper presents case reports of extensive necrosis at the antero-lateral part of the lower extremity which corresponds to the tibial compartment.1 The compartmental syndrome comprises the muscles between the tibia, internal ligament, the external intermuscular septum, and the skin which covers them.

The proposed surgical management is debridement of necrotic tissues except the tibial periosteum and external intermuscular septum so that skin graft, Thiersch type, covers the oozing substances, or a muscle flap and skin graft.
Coping with Amputation
Authors: Wilson Peter G. , Krebs M.J.S.
Published: November 2007

Surgery of any kind is accompanied by fantasies of helplessness, mutilation, loss of control, body image distortion, castration, rejection and death. All of these fantasies, in or out of awareness, create massive anxiety leading to certain behaviors characteristic of an individual's coping style. For the lower limb amputee, a number of these fantasies become real. The person who has lost a leg needs to depend upon others at least until he has mastered a prosthesis. He must confront not only the physical reality of mutilation, but also the body image changes associated with it and the personal meanings they carry. He must integrate the idea of being "different" so that he may comfortably continue with life. In their work with amputees, both authors have found that some people have greater difficulty than others in accomplishing these tasks. The coping styles which lead to successful coping with an amputation and the other variables that contribute to this success have not been clearly described in the literature. In fact, there is very little on lower extremity amputation and even less on preoperative evaluation, which might be useful in identifying these significant variables.
Glutaraldehyde Treated Cat Small Bowel as an Arterial Graft
Authors: Dagan R. , Kott I. , Schechter I. , Ben Bassat M. , Kaplan I.
Published: November 2007

The materials used up to now for grafting arteries have not proved entirely satisfactory. It was the purpose of the project described here to find a more satisfactory method for replacing arteries. Previous experience has shown that glutaraldehyde-treated grafts are non-viable, avascular, and known to pre serve their general structure. In this study small bowel taken from a cat and treated with glutaraldehyde was used to replace the aorta in dogs.

Ten dogs were used. The G.A. treated graft in a length of 10 cm bypassed the abdominal aorta. The dogs were sacrificed from 20 days up to one year. Repeated angiographies showed the patency of the graft. After sacrificing the dogs, the grafts were examined macroscopically and microscopically. The site of the anastomosis was strong and no aneurysms were seen. The graft is easy to handle and can be tailored to size.
Sutureless End-to-Side Microvascular Anastomosis Using Neodymium-YAG Laser
Authors: Jain K.K.
Published: November 2007

A technique for sutureless anastamosis of the rat carotid arteries using Neodymium-YAG laser is described. It has certain advantages over the con ventional suture technique and potential application in human extra- intracranial bypass surgery.

Techniques for the repair of injuries to small arteries1 and end-to-end microvascular anastamosis 2 have been described previously. A technique for sutureless end-to-side laser anastamosis has been developed now.