bluuebunny/crossref_metadata_2025 huggingface dataset:
A simple score system for clock drawing in patients with Alzheimer's disease
Authors: Shua-Haim Joshua , Koppuzha G. , Shua-Haim Vered , Gross Joel
Published: June 2007

Objective: To develop a simple clock drawing score system for patients with Alzheimer's disease, that correlates with the MMSE (Folstein Mini Mental Status Examination).1

Design: A retrospective analysis of 88 patients with the diagnosis of Alzheimer's disease

Setting: Outpatient Memory Disorder Institute of a large community teaching hospital.

Measurements: MMSE score and two different clock drawing ratings. The MMSE and the clock drawing scoring were performed by different raters. We present a “simple clock scoring system” and compared it with a previously published scoring system by Sunderland et al,2 referred to as the standard score system.

Results: There is a strong correlation between the “new score system” and the standard scoring (Pearsons Correlation Coefficient r = 0.91, p < 0.001). However, when both systems were evaluated in a multivariate linear regression analysis, the “ simple score system “ was a significant predictor of Folstein MMSE (P < 0.01), while the standard scoring system was not.

Conclusion: The “simple score system” is an easy to use, accurate predictor of the MMSE score, in patients with the diagnosis of Alzheimer's disease.
The effect of a walled garden on behavior of individuals with Alzheimer's
Authors: Mather Jennifer A. , Nemecek Dana , Oliver Kathy
Published: June 2007

Provision of Special Care Units for people with Alzheimer's is seen as a solution to difficulties with their behavior, but the effect of such a unit is rarely tested. After Southland Care Center built an enclosed garden next to such a locked-in unit, residents' behavior was observed to look for such an effect. No pre-post-differences in disruptive behaviors were observed over the summer high-use period However, residents averaged only 14 percent of the peak afternoon use time in the garden, and those using it more displayed less disruptive behavior. As well, residents slept less in the daytime in summer compared to winter and spent more time in winter looking out the window and trying the handle of the door to the garden. Garden use appeared to have had a general positive effect on morale but little effect on disruptive behaviors, perhaps because of limited use by residents.
Donepezil (AriceptTM): The caregivers voice and clinical impression
Authors: Shua-Haim Joshua R. , Comsti Eric , Shua-Haim Vered , Ross Joel S.
Published: June 2007

The purpose of this study is to investigate the clinical and caregiver impression on AriceptTM treatment. In a prospective study, 57 consecutive Alzheimer's disease patients were treated with Donepezil for 16 weeks, using a 5mg tablet, administered once daily at bedtime. Patients met the criteria of NINCDS-ADRDAI for probable Alzheimer's disease. There were no exclusion criteria for the study. After 16-weeks of treatment, the caregiver completed a questionnaire regarding the effectiveness of the drug. Subjective cognitive improvement, MMSE,2 ADL,3 and IADL4 outcomes were all assessed before and after treatment.

Behavioral improvements included those of depression, agitation, violence, anxiety, and paranoid thoughts. Functional and overall family satisfaction was also evaluated Side effects and reason for discontinuation of the medication were also reported.

Out of the 57 patients in the study, 15 patients (26 percent) terminated participation due to side-effects. Total adverse event was reported in 24 (42 percent) of the patients. Cognitive improvement was reported in 27 (47 percent) of patients. Verbal skills and attention were the most commonly-reported cognitive improvement. Average MMSE declined by two points after 16 weeks of treatment. No behavioral improvement was reported Behavioral deterioration was reported in three (5 percent) of patients. Functional improvement was reported in 21 (37 percent) of patients. Favorable overall family satisfaction was reported in 27 (47 percent) patients.

Although the overall clinical impression from AriceptTM (Donepezil) treatment (as measured by the MMSE, ADL, IADL and behavior) was unfavorable, there was a high family and caregiver satisfaction. This satisfaction was due mainly to functional improvement. The main cognitive improvement reported was in verbal skills and attention span.
Caregiver and physician perspectives of medical encounters involving dementia patients
Authors: Glasser Michael , Miller Baila
Published: June 2007

This study provides information on the expectations that family caregivers of Alzheimer's and dementia patients and primary care physicians have of each other in relation to the medical encounter. In many respects, caregiver and physician recollections of what transpired in the medical encounter are similar. Overall, caregivers tend to evaluate their encounters with physicians positively. However, compared to physicians, caregivers tend to rate more highly the amount of information given to and the attention paid to the concerns and expectations of family caregivers. This is particularly true in relation to issues such as physician sensitivity to caregiver distress, making caregivers feel that what they say is important, telling caregivers all they need to know about the illness, and verbal acknowledgement of the caregivers' contributions. In an era of managed care, physicians may have to devise new strategies to effectively meet the needs and expectations of their Alzheimer V/dementia patients and their family caregivers.
Caregiver stress, Alzheimer's disease, and elder abuse
Authors: Wolf Rosalie S.
Published: June 2007

More than two decades have passed since elder abuse first emerged as a social problem. Although found to be a very complex phenomenon of multiple types occurring in various settings, the original formulation of elder abuse as caregiver stress still resonates strongly with the public, the press and policy makers. In examining elder mistreatment within the context of caregiving and Alzheimer's disease (AD), we not only have the opportunity to learn more about the caregiver stress model, but also to gain greater understanding about prevention and treatment of elder abuse in families with AD members.
Consent and competency in elders with Alzheimer's disease
Authors: Kane Michael N.
Published: June 2007

This article will examine the elements of informed consent as they affect elders with Alzheimer's disease. The components of voluntariness, information, and competency will be reviewed. Case examples involving involuntary psychiatric treatment, institutionalization, and guardianship are examined as they relate to this vulnerable population. Important themes involve the presumption of competence, autonomy, beneficence, paternalism, and the power differential in the relationship between service provider and service recipient.
Problems encountered in the implementation of dementia care programs
Authors: Hoffman Stephanie B. , Kaplan Mary
Published: June 2007

A survey was conducted in order to identify the problems encountered in the implementation of dementia care programs, as well as some of the solutions that have proven to be successful. A total of 77persons involved in the operation of dementia care programs in the United States and Canada responded to the survey. The 10 most frequently reported problems in order of prevalence were: inadequate staffing, lack of staff training, inadequate programming for residents, poor physical environment/design, lack of support from facility staff inadequate funding, lack of supportfrom administration, excessive staff turnover, conflict with families, and inadequate admission criteria. This article also examines the correlation between these problems and respondents' perception of the quality of their programs. Creative strategies utilized by the programs to address these problems are also discussed.
A theory of caring and dementia
Authors: Ryden Muriel B.
Published: June 2007

This paper explores the applicability of Swanson's mid-range theory of caring to work with persons with dementing illness. The definition of caring and the caring process inductively derived by Swanson from research with samples of women in a perinatal context have relevance for both formal and informal caregivers of persons with dementia. The nature of severe dementia necessitates modifications in applying the theory. However, the well-being of this vulnerable population may be enhanced when practice and research are based on this rich conception of caring. This theory of caring provides structure to the sometimes amorphous characterization of an ethic of care and gives meaning and direction for work with persons affected by dementia.
Using outcome measures to provide excellence in Alzheimer care
Authors: Hyde Joan , Hillygus Jennifer , Levy Becca , Levkoff Sue
Published: June 2007

Outcome measures have been widely touted as a valuable tool to guarantee quality assurance in healthcare settings. Recently, a number offactors have conspired to make outcome-based measurement more feasible. This paper describes the advantages of utilizing outcome measures, continuous quality improvement methods and consumer based input to ensure excellence in long term care.
A content analysis of an Alzheimer family caregivers virtual focus group
Authors: Mahoney Diane Feeney
Published: June 2007

A content analysis of the messages posted by family caregivers on an Alzheimer's disease (AD) electronic network wan, undertaken for a 12-month period. The purpose was to let 17 about their caregiving issues and experience. Data frovr 566 subject postings were categorized into topics that varied by stage of caregiving. New caregivers sought in ormation about verifying the diagnosis of AD and anticipatory planning, middle stage caregivers sought specific problem solving assistance, and later stage caregivers struggled with decisions surrounding whether to continue or release caregiving responsibilities. A conceptual model of caregiving transitions emerged from the data. Key themes were normalizing, managing, surviving, with “being there “ and vigilance central concepts. Fiidings suggest that virtual focus groups offer access to geographically diverse caregivers and compliment traditional methods
Service needs and use: A further look at the experiences of African American and white caregivers seeking Alzheimer's assistance
Authors: Cox Carole
Published: June 2007

The experiences of 150 African American and 150 white caregivers of persons with dementia indicate that although they differ in several characteristics, they are seeking assistance at comparable periods in their caregiving careers. Reasons for calling Alzheimer's Associations were similar although African Americans have a greater interest in services such as home help and day care. However, both report high levels of interest in chapter services and are positive about their plans to use them. At the end of 12 months, neither group has followed through on these plans with both groups stating that they were not ready for services or did not need services, while during the same period, both their own status and that of their relative had deteriorated.
The “Co-pilot driveer syndrome:” A newly-reported driving habit in patients with Alzheimer's diseas
Authors: Shua-Haim Joshua R. , Shua-Haim Vered , Ross Joel S.
Published: June 2007

When should I take away the car keys? Is it still safe for him/her to drive? Are all patients diagnosed with Alzheimer's disease (AD) a hazard on the road? What about driving for short distances in a familiar territory? Can people with AD drive with family or caregiver supervision? Those are but a few of the difficult questions asked by caregivers of people with AD. There is confusion regarding the optimal time to recommend that a patient with AD stop driving.1-5 In an attempt to assist caregivers with this difficult question, guidelines have been issued, although they frequently have conflicting recommendations in this matter.6-10
Caregivers of wives diagnosed with Alzheimer's dosease: Husband's perspectives
Authors: Siriopoulos George , Brown Yvonne , Wright Karen
Published: June 2007

Recent statistics reveal a growth in the incidence of Alzheimer's disease (AD) and related dementia amongst the elderly. 1 Although women are more likely than men to develop AD, 1 there is limited literature available on husbands as caregivers for wives with the disease. 2,3 Therefore, the need to conduct research in the area of male caregivers is essential if nurses are to understand and provide appropriate support and care for male caregivers.

A qualitative study which focused on the experience of husbands who are home caregivers of wives diagnosed with AD was conducted using phenomenological research methods. The study was based on the experiences of eight husbands, six of whom were caregiving for their wives at home, while two cared for wives in an institutional setting. Data collected during in-depth tape recorded interviews with the participants was analyzed using Giorgi's4 method. Five major themes emerged from the participants' stories: loss, caregiver burden, coping methods, quality of previous relationship, and effects of AD. These themes were inter-related to form a whole that described the experiences of caregiving from the husbands' points of view. A discussion of the benefits of the study to nursing practice and nursing research, as well as the relevance to male caregivers are also provided.
Prayer and religious coping for caregivers of persons with Alzheimer's disease and related disorders
Authors: Stolley Jacqueline M. , Buckwalter Kathleen C. , Koenig Harold G.
Published: June 2007

This study examined the use of prayer and religious coping among caregivers of persons with Alzheimer's disease (AD) and related disorders. A repeated measures correlational design was used, combined with data from a larger, experimental study (NIH, R01-NR-3434). This expansion study and secondary analysis added two instruments, the Springfield Religiosity Schedule (SRS)1 and the Jalowiec Coping Scale (JCS)2 to the original study, as well as structured interviews to determine the role of prayer and religious coping in the caregiving stress and coping process. A modification of Lazarus and Folkman's3 Stress and Coping model was used that included religious variables. Results showed that caregivers (N = 64) used prayer and religious coping frequently, that they perceived prayer and trusting in God as effective coping mechanisms, and that internal religious activities helped them get through the caregiving situation. Clinical implications are discussed.
Prevalence and incidence of Alzheimers disease and other dementing disorders in Pylea, Greece
Authors: Tsolaki Magda , Fountoulakis Constantinos , Pavlopoulos Ilias , Chatzi Eleni , Kazis A.
Published: June 2007

We investigated the prevalence and incidence of dementing disorders in the city of Pylea, Greece, using a door-to-door three-phase approach, and explored the relationship between age and gender. From the initial cohort of 704-subjects, 112-subjects (15.9 percent) were excluded because they had moved out of town or could not be traced, 102-subjects (14.4 percent) died before the time of actual contact, and 110-subjects (15.6 percent) refused to be contacted. We were able to visit and examine 380-subjects (54 percent); each of them were administered the MMSE by one of three nurses and the CAMCOG by one of three physicians. We selected January 1, 1993, as the study prevalence day. Using specified diagnostic criteria, NINCDS-ADRDA and DSMIIIR, the study neurologists extensively investigated 118 from 380-subjects, who screened positive on MMSE (MMSE < 23) and CAMCOG (< 65). We found 35-subjects affected by dementia, 20 had Alzheimer's disease (AD), 11 had vascular or mixed dementia and four had secondary dementia (one Parkinson's disease, one Vitamin B12 deficiency, and two had Tumors). The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples was 57/1,000 persons aged > 70, made up of dementia of Alzheimer type (39.9/1,000), vascular dementia (13.9/1,000) and other forms (3.5/1,000). The prevalence of both dementia and AD increased steeply with advancing age and was consistently higher in women. The incidence of dementia increases with age, even in the oldest age groups and women have a higher risk of developing dementia than men. AD was the most common type of dementia. Our prevalence and incidence figures for dementia and AD are almost similar to those previously reported in Europe, the United States and Canada.
Special Care Units as places for social interaction: Evaluating an SCU's social affordance
Authors: Moore Keith Diaz , Verhoef Rianne
Published: June 2007

This study is a multi-method, intrinsic case study evaluation of social interaction understood as a global dimension of Quality of Life (QOL) in a special care unit (SCU) for cognitively impaired older persons. The study proposes an initial means for describing and evaluating the social affordance of a place. Through the accumulation of similar case studies, care practice can make better informed decisions because of an awareness of successful or unsuccessful patterns that begin to emerge in the descriptive data. Reflecting the improvement-orientation of the evaluation, the SCU in question is found to have several factors-organizational and physical in nature which unwittingly thwart the therapeutic benefit of social interaction. The case study adopts an environment behavior perspective following the theoretical development. The focus of the evaluation is the consensual and social-normative aspects of social interaction.
Los Helados del Norte (The Frozen Ones from the North): Latino Students at the University of Alaska, Fairbanks
Authors: Reyes Marĺa Elena
Published: June 2007

In Alaska, Latinos represent about 4% of the state's population and have been identified as the second fastest growing minority group in the state. This descriptive study looked at a small sample of Latino students attending the University of Alaska, Fairbanks, where they constituted2% of the student enrollment in 2001. In conclusion, Alaska, generally perceived as having a hostile environment due to its geographic isolation and extreme weather conditions, appears to be a hospitable state for many Latinos.
Latinos in Higher Education: An Evaluation of a University Faculty Mentoring Program
Authors: Santos Silvia J. , Reigadas Elena T.
Published: June 2007

The purpose of this study was to understand the student-faculty mentoring process and how mentoring facilitates Latino students' adjustment to college. Thirty-two Latino students participating in a university Faculty Mentoring Program (FMP) were surveyed. The findings showed that (a) students experienced an increase in college self-efficacy and academic goal definition as a result of participating in the FMP; (b) students with same-ethnic mentors perceived them to be significantly more supportive in furthering their personal and career development and reported significantly greater program satisfaction than nonmatched students; and (c) frequency of student-mentor contact was positively correlated with students' adjustment to college, perceived mentor supportiveness, and program satisfaction.
Learning and Earnings: How College Matters in Earnings Gap between Hispanic Workers and Non-Hispanic White Workers
Authors: Kim Jongsung
Published: June 2007

This article uses Current Population Survey Outgoing Rotation Group files to investigate the role of higher education in explaining the earnings gap between Hispanic workers and non-Hispanic White workers. Based on the decomposition method developed by Cotton, it was found that human capital takes precedence over labor market discrimination in explaining the earnings gap. A policy implication is that equal compensation of Hispanic workers as non-Hispanic White workers is as important as the improvement of educational attainment.
A Brief Examination of Institutional Advancement Activities at Hispanic Serving Institutions
Authors: Mulnix Michael William , Bowden Randall G. , López Esther Elena
Published: June 2007

Clearly, increased funding at the local, state, and federal levels would go a long way to ensure the future success of Hispanic Serving Institutions (HSIs) of higher education in the United States. Private funding and strong support from alumni groups are also a critical part of this funding mix. In addition, sophisticated and adequately funded marketing, public relations, and enrollment management efforts are needed. The funding of most HSIs is closely tied to the political process. Successful lobbying efforts and the structuring of a strong advancement effort is instrumental in building healthy institutions and ensuring high graduation rates. With this in mind, the goal of this study was to determine what level of importance is placed on institutional advancement activities by college and university presidents at select HSIs throughout the United States.
Language as Power for Hispanic Students in Higher Education
Authors: Fredericksen Elaine
Published: June 2007

Hispanic students often experience discomfort as they enter institutions of higher education. Designed to increase their comfort and success, a new program at the University of Texas at El Paso offers English-Spanish background students opportunities to excel in both languages and helps them develop new attitudes about the academic and professional power of dual language abilities. This model program has implications for all institutions with significant Hispanic populations.
Hispanic Women: Building a Room for Self-Efficacy
Authors: Suarez-Mccrink Carmen
Published: June 2007

In America, women did not enter the realm of higher education until the mid-to late1800s. Today, women constitute more than 40% of the student population across campuses as they prepare to assume leadership positions. This article describes Bandura's self-efficacy theory as it applies specifically to the career advancement of Hispanic women in higher education as they contend with the socialization and cultural processes that are inherent in this ethnic group.
Midwives and Legal Medicine in México, 1740-1846
Authors: Penyak Lee M.
Published: June 2007

This study examines the participation of midwives as medical examiners in Mexican courts during the colonial period and their replacement by university-trained physicians in the 19th century. The author suggests that midwives were slowly eliminated as experts in sex crime cases when legal medicine became incorporated into the curriculum for male medical students in the 1830s. Criminal documents also prove to be an excellent source for obtaining socioeconomic information on midwives.
Graduating Students' Perceptions of Outcomes of College Experiences at a Predominantly Hispanic University
Authors: Abraham John P. , Lujan Sylvia S. , López Esther Elena , Walker Mary T.
Published: June 2007

This study was done at a university located at the United States/Mexican border of South Texas, where more than 80% of the residents are of Hispanic origin. This article reports partial results of surveys administered to graduating students over a 3-year period to assess perceptions of the outcome of their college experiences. The surveys revealed that an over- whelming majority of the graduates believed the quality of their lives was definitely enhanced because of their college experiences. The survey further revealed that the majority of graduates believed that, as a result of their education and contributing factors, they learned the value of independence, working cooperatively with others, and persistence amid difficulties.
Investigating Postgraduate College Admission Interviews
Authors: Arce-Ferrer Alvaro J. , Castillo Irene Borges
Published: June 2007

The use of face-to-face interviews is controversial for college admissions decisions in light of the lack of availability of validity and reliability evidence for most college admission processes. This study investigated reliability and incremental predictive validity of a face-to-face postgraduate college admission interview with a sample of Hispanic applicants and approaches from generalizability theory and multiple regression models. Results showed a complex measurement paradox surrounding face-to-face college admission interviews.
A Tale of Two Visions: Harland Bartholomew, Robert Moses, and the Development of the American Freeway
Authors: Brown Jeffrey
Published: June 2007

For sixty years, engineers and planners have debated the freeway’s role in the city. Engineers have tended to view freeways strictly in traffic service terms. Planners, on the other hand, have long viewed freeways not only as a means of facilitating automobile transportation but also as a tool for reshaping the city. This article uses the plans of Harland Bartholomew and Robert Moses to illustrate these competing visions of the freeway and to assess the implications of these visions on the development of the freeway and its long-term influence on our cities. The traffic-service vision of the engineers emerged victorious through the creation of the interstate highway system, but this victory has carried with it a high price for many American cities.
The Relationship of the Inferior Vena Cava and Its Branches to Aortoiliac Surgery
Authors: Andros George
Published: June 2007

Knowledge of the normal and abnormal anatomy of the inferior vena cava and its branches increases the ease and effectiveness of the surgical treatment of occlusions and aneurysms of the aortoiliac segment.

The surgical anatomy and techniques for dealing with renal vein anomalies, vena cava duplication, transpositions and arteriovenous fistulas are presented; these aids to the early recognition of venous abnormalities simplify appropriate dissection and forestall inadvertent hemorrhage and vascular injury.
Traumatic Massive Atheroembolism
Authors: Thomas Bruce , Vaccaro Patrick , Falcone Robert E. , Vasquez Donald G.
Published: June 2007

The authors discuss a rare case of massive atheroembolization to the lower extremities occurring in a golfer after a relatively minor low-impact accident. Delayed presentation led to major limb loss.
Middle Aortic Syndrome
Authors: Papavassiliou Vassilios G. , Liapis Christos D. , Kakissis John D. , Kaperonis Elias A. , Androulaki Athina N. , Gogas John G.
Published: June 2007

A 47-year-old woman presented with a 2-year history of severe proximal claudication symptoms in both legs. Digital subtraction aortography (DSA) showed a localized occlusion of the infrarenal abdominal aorta. A longitudinal arteriotomy and an endarterectomy of the aorta were performed. The arteriotomy was closed with a polytetrafluoroethylene (PTFE) patch. Postoperatively, the follow-up demonstrated a normal aorta with all pedal pulses palpable. In patients with the above symptoms, middle aortic syndrome should be included in the differential diagnosis.
Reanalysis of Factors Predicting Recurrent Stenosis in a Prospective Randomized Trial of Carotid Endarterectomy Comparing Primary Closure and Patch Closure
Authors: AbuRahma Ali F. , Robinson Patrick A. , Richmond Bryan K.
Published: June 2007

Several factors have been implicated in the pathogenesis of recurrent carotid stenosis after carotid endarterectomy. This study examines the factors that predict recurrent stenosis in a prospective randomized trial of carotid endarterectomy comparing primary closure and patch closure. Patients undergoing 399 carotid endarterectomies were randomized into primary closures (n=135), polytetrafluoroethylene (PTFE) patch closures (n=134), and vein patch closures (n=130). Postoperative duplex ultrasounds were done at 1, 6, and 12 months, and then yearly. The mean follow-up was 41 months. Univariate analyses of potential risk factors were examined for possible association with ≥50% recurrent stenosis, and factors most associated with recurrent stenosis were examined by multivariate analyses using multiple linear regression. Primary closure had a higher incidence of recurrent stenosis (37%) than vein patch closure (13%) and PTFE patch closure (3%, p<0.001). Women with primary closure had a higher incidence of recurrent stenosis than men (49% versus 26%, p=0.008). With use of multiple linear regression models, the occurrence of ≥50% stenosis and increasing degrees of stenosis were associated most strongly with primary closure (p<0.001) and female gender (p=0.007). Carotid artery diameter, patch closure, age, coronary artery disease, or atherosclerosis risk factors (smoking, hyperlipidemia, hypertension, and diabetes mellitus) were not significantly associated with recurrent stenosis. Female gender and primary closure after carotid endarterectomy were the two factors most strongly associated with recurrence.
A Novel Approach in the Treatment of Abdominal Aortic Aneurysms with Coexisting Cholelithiasis
Authors: Garner Charles M. , Reil Todd D. , Quifiones-Baldrich William J.
Published: June 2007

The treatment of abdominal aortic aneurysms (AAAs) with concomitant biliary tract disease remains controversial. Treatment of both conditions in a single stage has been reported by use of a transabdominal approach, closing the retroperitoneum and then removing the gallbladder. The authors report a case of combined AAA repair and cholecystectomy using retroperitoneal exposure to operate on the aorta and then laparoscopic removal of the diseased gallbladder. This approach was associated with rapid recovery and decreased concern with infection inherent with simultaneous transperitoneal exposure of both lesions.
Relationship Between Preoperative Duplex Vein Mapping and Intraoperative Longitudinal Impedance in Infrainguinal Vein Grafts
Authors: Meyerson Shari L. , Shakur Umar M. , Skelly Christopher L. , Loth Francis , McKinsey James F. , Schwartz Lewis B.
Published: June 2007

The importance of favorable vein size, resistance, and impedance for the sustained success of infrainguinal vein grafting procedures has repeatedly been demonstrated. Estimating these properties preoperatively, however, has been problematic. Ultrasonic vein mapping is a reliable technique for measuring vein diameters at venous pressures, but it is unknown whether these data accurately assess the resistive potential of the conduit in the arterial circulation. The purpose of this study was to compare vein diameter measured preoperatively with vein graft longitudinal impedance measured intraoperatively.

Patients who had undergone both preoperative vein mapping and intraoperative impedance studies at the time of infrainguinal bypass were included (December 1995-April 1999). Vein mapping was performed using B-mode ultrasound with a 10 MHz probe. The dimensions of the specific vein segment used for reconstruction were tabulated and its mean diameter (D̄) was calculated. At the time of operation, following reconstruction, transgraft blood pressure gradient (δP) and blood flow (Q) waveforms were recorded by using digital data acquisition. Longitudinal impedance (ZL) was calculated as δP/Q at each harmonic following Fourier transformation and the area under the curve from 0 to 4 Hz designated as ∫ZL.

Twenty-three bypasses in 22 patients were studied (D̄ = 3.5 ±0.2 mm, range 1.6-5.5 mm; ∫ZL= 37 ±4 x 103 dyne cm-5, range 13-95 X 103 dyne cm-5). D̄ significantly correlated with ∫ZL (slope = -0.454, p < 0.05), albeit with a fairly low correlation coefficient ( r2 = 0.23). D̄ > 3.6 mm was predictive of graft patency at 12 months (D̄ > 3.6 mm 100% vs D̄ < 3.6 mm 57 ±20%; p = 0.02).

Larger veins identified by preoperative mapping have, in general, more favorable intraoperative resistive characteristics as defined by a lower JZL. However, some veins thought to have small diameters (< 3.6 mm) may still demonstrate sufficiently low ∫ZL when grafted to remain patent.
Correlation of Cerebral Oximetry Measurement with Carotid Artery Stump Pressures During Carotid Endarterectomy
Authors: Lee Eugene S. , Melnyk Dean L. , Kuskowski Michael A. , Santilli Steven M.
Published: June 2007

Cerebral oximetry and internal carotid artery stump pressures were measured during carotid endarterectomy to assess whether cerebral oximetry could be used as a noninvasive and reliable alternative to monitor cerebral blood flow and the need for selective carotid artery shunting. Carotid endarterectomy procedures were performed in 27 patients wherein a cerebral oximeter was placed on the ipsilateral forehead preoperatively. Stump pressure data as well as cerebral oximetry readings at baseline and before and after carotid artery clamping were gathered. The differences between baseline and clamped carotid artery oximetry readings were calculated for each subject and divided by the baseline reading to provide an adjusted measure of percent oximetry change. This normalized percent change in cerebral oximetry readings was then correlated with stump pressure. Carotid artery stump pressures correlated closely with the normalized change in cerebral oximetry readings ( r = -0.57, p = 0.002). Based on the regression analysis, stump pressure readings of 50 and 25 mm Hg were predicted by at least a 15% and 30% drop in cerebral oximetry readings, respectively. Based on low intraoperative stump pressure and changes in cerebral oximetry readings, arterial shunt placement was used in eight patients. There was no morbidity or mortality from the 27 carotid endarterectomy procedures performed. Carotid endarterectomy can be performed safely with cerebral oximetry as a simple, noninvasive, and reliable alternative to internal carotid artery stump pressure measurements in determining the need for selective carotid artery shunting.
Alterations in Lower Extremity Venous Hemodynamics Associated with Normal Pregnancy
Authors: Ballard Jeffrey L. , Papa Diane M. , De Lange Marie
Published: June 2007

This study was performed to define physiologic changes in lower extremity venous hemodynamics during and after normal, healthy pregnancy. Lower extremity venous physiology was evaluated by using air plethysmography in 24 healthy primigravid females (48 extremities) with no known venous disease. All patients were studied during their first, second, and third trimester, and at 6 weeks, 3 months, and 6 months postpartum. Data were evaluated for changes over time and for differences between the right and left lower extremity by use of repeated measures analysis of variance.

None of the patients developed overt signs of venous reflux during pregnancy although there was an increase in venous filling index in advanced stages of pregnancy. All values remained within normal range (1.0-1.7 mL/sec, p = 0.52). There was a statistically significant decrease in residual volume fraction that reached a nadir during the third trimester and returned to below-baseline values immediately postpartum (p = 0.02). An increase in venous outflow fraction was demonstrated as pregnancy progressed (p = 0.05). This trend peaked during the third trimester. Calf muscle pump function did not change appreciably during the study period (p = 0.61). There was no difference between right and left lower extremities with regard to venous filling index (p = 0.25), residual volume fraction (p = 0.33), venous outflow fraction (p = 0.17), or calf muscle pump function (p = 0.33).

Some alterations in venous hemodynamics are associated with pregnancy. Venous outflow fraction overall is increased coincident with a decrease in residual volume fraction. The significant decrease in residual volume fraction and augmentation in venous filling index may be related to venous dilation and an increase in venous capacitance secondary to hormonally influenced smooth muscle relaxation.
Histologic Evaluation of Dacron® and PTFE Graft Material Explanted From Humans After 4 to 20 Years In Vivo
Authors: Blumenberg Robert M. , Anderson James M. , Gelfand Michael L. , Skudder Paul S. , Bowers Carol A.
Published: June 2007

The objective of this study was to evaluate long-term integrity of knitted Dacron® and polytetrafluoroethylene (PTFE), as used in arterial prostheses, 4 to 20 years following graft implantation in patients. Graft durability following prosthetic graft placement is a frequently asked question from patients. In an effort to make a determination, the authors surgically obtained representative specimens of grafts clinically implanted 4 to 20 years before graft retrieval for histopathologic study. Eleven prosthetic arterial grafts, seven Dacron® and four PTFE, were retrieved from 10 patients and stained for study using paraffin-embedded histology sections. These were examined with light microscopy and polarized light microscopy. Graft specimens were taken, which prompted graft exploration and retrieval; these included thrombosis, stenosis, graft infection, and pseudoaneurysmal formation. No loss of integrity, fragmentation, or distortion of Dacron® or PTFE graft material was detected. Normal foreign-body reactions and healing with fibrosis were noted within the interstices of the Dacron® grafts and outer surfaces of Dacron® and PTFE grafts. No evidence of resorption or biodegradation was noted in any graft. Pseudointima was present on the luminal surface of Dacron® but not of PTFE grafts. Although no atherosclerotic changes were identified in the Dacron® grafts, focal areas of dystrophic calcification were present within the interstices of the PTFE grafts. The longterm (4 to 20 years) in vivo structural integrity of the Dacron® and PTFE grafts studied is supported by our data. Whereas the foreign-body reaction macrophages and foreign-body giant cells of the material interface have the potential to resorb or biograde the material, data in these studies suggest Dacron® and PTFE are resistant to biodegradation for at least two decades. These data support the continued use of these materials in fabrication of arterial prostheses.
Long-Term Results of Infrapopliteal Bypass Using Polytetrafluoroethylene and Taylor Vein Patch for Critical Lower Extremity Ischemia
Authors: Passman Marc A. , Marston William A. , Carlin Robert E. , Farber Mark A. , Burnham Steven J. , Archie Joseph P. , Keagy Blair A.
Published: June 2007

Although distal anastomotic vein patch and cuff techniques have been advocated to improve the patency of lower extremity bypass grafts with polytetrafluoroethylene (PTFE), use of this approach in the infrapopliteal position remains unproven. The purpose of this study is to evaluate the results of infrapopliteal bypass grafting using PTFE and Taylor vein patch for critical lower extremity ischemia. All patients undergoing infrapopliteal bypass grafting with PTFE and Taylor vein patch for ischemic rest pain or tissue loss were identified from the vascular surgery registry. This report describes results for surgical morbidity and mortality, patency, limb salvage, and survival for procedures performed from 1993 through 1998. Forty-two infrapopliteal bypass grafts with PTFE and Taylor vein patch were placed for critical lower extremity ischemia during the 6-year period. Surgical indications were rest pain in 25 (60%) patients and ischemic tissue loss in 17 (40%). Distal arterial anastomosis included 17 (40%) anterior tibial, 10 (24%) peroneal, eight (19%) posterior tibial, and seven (17%) tibioperoneal arteries. Follow-up ranged from 1 to 52 months (mean 17 months). Life-table primary patency, secondary patency, limb salvage, and survival at 3 years were 25%, 31%, 44%, and 66%, respectively. Infrapopliteal bypass with PTFE and Taylor vein patch for critical lower extremity ischemia has poor long-term results that are comparable to those reported for PTFE without Taylor vein patch.
Noonan's Syndrome Associated with Spontaneous Rupture of the Ascending Aorta
Authors: Tousimis Eleni , Deshmukh Narayan
Published: June 2007

Noonan's syndrome associated with spontaneous rupture of the ascending aorta is rare. Review of the literature reveals only one such reported case. The authors describe a 41-year-old male with Noonan's syndrome who initially presented with lower extremity claudication. Computed tomography and digital subtraction angiography disclosed an abnormal dilation of the ascending thoracic aorta and a distal abdominal aortic dissection. The patient underwent successful aortoiliac bypass graft. Seven months later, he suffered rupture of his ascending aorta, resulting in death.
Laparoscopic Clipping of the Inferior Mesenteric Artery for Persistent Endoleak After Endovascular Stent-Graft Treatment of Abdominal Aortic Aneurysm
Authors: Thomas Mussack , Peter Biberthaler , Arnold Trupka , Ulrike Szeimies , Bernd Steckmeier , Klaus Hallfeldt
Published: June 2007

As an alternative to surgical resection with prosthesis implantation in high-risk patients, infrarenal abdominal aortic aneurysms (AAAs) could be excluded less invasively by endovascular stent-grafts. Persistent perigraft leaks remain a significant complication because of potential aneurysmal growth and rupture. The authors describe a 49-yearold high-risk patient who was treated with Talent endograft for increasing AAA. A residual retrograde filling of the aneurysm sac, caused by patent inferior mesenteric and lumbar arteries, was detected during follow-up. Four months after primary endovascular treatment they successfully carried out laparoscopic clipping of the inferior mesenteric artery (IMA) while maintaining the sigmoidal and superior rectal arteries. The postoperative computed tomography angiography 2 days later showed complete sealing of the aneurysm sac without a change of size of the AAA.
False Aneurysm of the Posterior Tibial Artery Following Closed Fracture of the Tibia: Magnetic Resonance Diagnosis
Authors: Abascal Faustino , Cerezal Luis , Canga Ana , Rodrï'guez-Alt'naga Josä' R. , Gonz'lez-Tutor Andr's , Bustamante Manuel
Published: June 2007

A case of false aneurysm of the posterior tibial artery complicating a tibial fracture in a 19-year-old man is reported. The diagnosis of false aneurysm was made by magnetic resonance imaging (MRI) and confirmed posteriorly by magnetic resonance angiography (MRA). No MRA image of false aneurysm of the posterior tibial artery has been, to the authors' knowledge, previously reported.
Endovascular Management of an Aortobronchial Fistula Arising After Resection of a Primary Aortic Sarcoma
Authors: Caiati Joseph M. , Marin Michael L. , Flores Raja M. , Smith Craig R. , Martin Eric C. , Todd George J.
Published: June 2007

The experience with the use of endovascular covered stents for aortic lesions has been growing. The early results of using endovascular covered stents for the exclusion of thoracic and infrarenal abdominal aortic aneurysms have been promising and are being investigated in multiple ongoing trials. Their usage for other aortic lesions has been reported sporadically, often as resourceful options in unusual and difficult clinical situations. The authors report a patient who had previously undergone resection of a thoracic aortic sarcoma and subsequently presented in extremis from an aortobronchial fistula. The evaluation and treatment of an aortic sarcoma and the successful urgent exclusion of an aortobronchial fistula through use of an endovascular covered stent are discussed.
Rare Manifestation of Abdominal Aortic Aneurysm and Popliteal Aneurysm in a Patient with Marfan's Syndrome
Authors: Wolfgarten Bernd , Krüger I. , Gawenda M.
Published: June 2007

A 37-year-old patient with back pain and somatomegaly was found to have a penetrating aneurysm of sections IV and V of the abdominal aorta. Results of a family history and clinical examination confirmed suspicions of Marfan's syndrome. Further angiologic studies depicted an aneurysmatic dilatation of the left popliteal artery. Aneurysmatic dilatations are primarily located in sections I and 11 of the thoracic aorta, whereas aneurysms in sections IV and V are much rarer. The rare combination of an abdominal aortic aneurysm and left-sided popliteal aneurysm accompanying Marfan's syndrome is presented.
Extended Iliac Exposure from the Groin
Authors: Schneider Darren B. , Sarkar Rajabrata , Messina Louis M. , Stoney Ronald J.
Published: June 2007

Knowledge of iliac artery and inguinal anatomy enables extraperitoneal exposure of the iliac arteries for surgical treatment of unilateral inflow disease. A method is presented for exposing the distal common iliac artery, the iliac bifurcation, and the full length of the external iliac artery by detachment and retraction of the inguinal ligament though a single extended groin incision. The indications for unilateral iliac artery exposure, revascularization, surgical anatomy, and technique of iliofemoral exposure through a single, extended groin incision are presented. Extended iliac exposure through a single, eXtraperitoneal exposure facilitates all methods of unilateral iliac revascularization and provides access for delivery of endovascular devices.
Arterial Access Site Closure with a Novel Sealing Device: DuettTM
Authors: Heyer Gunter , Atzenhofer Karl , Meixl Herbert , Lampersberger Christian , Gershony Gary
Published: June 2007

Management of arterial access sites following percutaneous endovascular procedures is associated with patient discomfort and local complications. A new vascular sealing device, comprised of a balloon delivery catheter and a flowable procoagulant consisting of thrombin and collagen, was tested. Immediately following catheterization 200 patients (age, 66.1 ±11.2 years) were treated with the sealing device (Duett). Of these 200 patients, 132 underwent diagnostic catheterization, 67 underwent percutaneous transluminal coronary angioplasty, and one underwent percutaneous transluminal angioplasty. The sheath sizes included 2-5 Fr, 166-6 Fr, 25-7 Fr and 7-8 Fr. All patients undergoing diagnostic procedures received at least 5,000 U of intravenous heparin during the procedure. The Duett was used successfully in 198/200 (99%) patients immediately following completion of the endovascular procedure. In two patients a device malfunction resulted in uncomplicated crossover to manual compression. The time to hemostasis ranged from 3 to 5 minutes. All patients were walking 2 to 5 hours following the procedure unless a complication had occurred. No patient experienced leg ischemia, required surgical repair of the arterial access site, or had an infection at the site. In three patients (1.5%), a pseudoaneurysm occurred and was successfully treated with ultrasound-guided compression and three patients received a blood transfusion. No late complications were observed following hospital discharge.

This novel vascular sealing device successfully achieves rapid hemostasis and allows early ambulation following percutaneous endovascular procedures with a low incidence of complications.
Thoracoabdominal Aortic Aneurysms Repair Under Abdominal Cavity Cooling with Visceral Shunting Technique
Authors: Moriyama Yukinori , Yotsumoto Goichi , Hisatomi Koichi , Matsumoto Hitoshi , Toda Riichiro , Kaieda Mamoru
Published: June 2007

Mild hypothermia induced by abdominal cavity cooling together with a selective visceral shunting technique can be a useful adjunct for thoracoabdominal aortic aneurysm repair. The authors adopted this combined technique for repair of selected Crawford type III and type IV aneurysms to reduce visceral ischemic damage and minimize the incidence of postoperative complications.
Buerger's Disease Affecting Mesenteric Arteries: A Rare Cause of Intestinal Ischemia
Authors: Siddiqui Mohamed Z. , Reis Ernane D. , Soundararajan Krish , Kerstein Morris D.
Published: June 2007

Buerger's disease is a recurrent, inflammatory, segmental, vasoocclusive disease. Typically, the disease affects middle-aged male smokers and involves arteries and veins of extremities. Buerger's disease involving visceral vessels is rare. The authors report on a 51-year-old man with peripheral arterial disease and recurrent intestinal ischemia secondary to Buerger's disease. Clinical and histopathologic features of this case illustrate the life-threatening nature of visceral involvement in Buerger's disease.