bluuebunny/crossref_metadata_2025 huggingface dataset:
Review : Pharmacokinetics and pharmacodynamics of the taxanes
Authors: Lam YW Francis , Chan CY Jennifer , Kuhn John G
Published: November 2007

Objectives. To review the pharmacokinetics and pharmacodynamics of docetaxel and paclitaxel.

Data Sources. We reviewed the literature through a MEDLINE search from 1982 to 1996. The terms docetaxel, paclitaxel, taxanes, and taxoids were used in the search. Relevant articles cited in literature obtained by MEDLINE searching, as well as new articles published in early 1997 in specific oncology journals, were also considered.

Data Extraction. We have reviewed the current literature with regard to the chemistry, mechanisms of action and pharmacology, pharmacokinetics, clini cal use, adverse effects, drug interactions, formula tion, dosage, administration, and pharmaceutical is sues of the taxanes.

Conclusion. Both docetaxel and paclitaxel are novel antineoplastic agents with significant activity in many types of cancer. The pharmacokinetics of both agents are best characterized by a three-compartment disposition profile. However, the pharmacokinetics of paclitaxel, not docetaxel, are non-linear and can be described by a saturation process in distribution and elimination. The nonlinearity appears to be associated more frequently with shorter infusions and/or higher doses. There is evidence suggesting that the time duration of paclitaxel concentrations maintained above 0.1 μM/L (T>0.1 μM ) is associated with improved survival and development of toxicity. On the other hand, currently there is no information relating opti mal systemic exposure of docetaxel to efficacy and toxicity. In addition, these pharmacokinetic-pharma codynamic relationship may change with therapy with antineoplastic agents and other agents adminis tered concurrently, and necessitates additional phar macokinetic-pharmacodynamic investigations.
6-Mercaptopurine hepatotoxicity during acute lymphocytic leukemia maintenance therapy
Authors: Skirvin J. Andrew , Valley Amy W. , Relias Valerie , Morris Ashley K.
Published: November 2007

Purpose. To describe a case of 6-mercaptopurine acute fulminate hepatotoxicity.

Case Summary. A 65-year-old male with adult acute lymphocytic leukemia was receiving mainte nance therapy with 6-mercaptopurine and methotrex ate when he presented with jaundice, nausea, diar rhea, dysuria, right upper quadrant pain, and dark urine. He presented with elevated bilirubin, aspartate aminotransferase, and alanine aminotransferase. The work-up was negative for other causes of liver dam age. His hospital course included antibiotic therapy, vitamin K, and filgrastim. He was discharged without long-term morbidity from the event and had a normal ization of liver enzymes as an outpatient. Methotrex ate maintenance therapy was continued successfully as an outpatient for > 1 year.

Conclusion. 6-Mercaptopurine is not commonly considered as an agent causing acute hepatotoxicity, but should not be ruled out as a causative agent in the setting of concurrent methotrexate therapy. An epi sode of acute hepatotoxicity did not preclude the continued, safe use of methotrexate in this case.
An evaluation of nitrile gloves as an alternative to natural rubber latex for handling chemotherapeutic agents
Authors: Gross Elizabeth R , Groce Don F
Published: November 2007

Introduction. In 1986 and 1995, the Occupational Safety and Health Administration issued guidelines for the handling of chemotherapeutic agents. Natural rubber latex gloves are recommended for all levels of handling these drugs; these gloves provide both pro tection to the health care worker and a high degree of manual dexterity in performing tasks requiring fine motor skills. However, many health care workers experience allergic reactions to natural rubber latex, with symptoms ranging from minor skin irritation to systemic anaphylaxis; the latter is a serious life-threat ening condition. Therefore, it is extremely important that alternative glove materials be found that offer protection against biological and chemical agents and also afford health care workers ease of use and fit.

Methods. In this study, we tested a thin-gauge (0.0045-inch gauge) disposable nitrile glove; this glove, which offers fine motor skill ability to its users, has been tested against a wide range of chemicals but has not yet been tested specifically against chemo therapeutic agents. Using American Society for Test ing and Materials method F739-92, these gloves were tested for permeation resistance at three concentra tions, simulating exposures to Pharmacy, Nursing, and Housekeeping staff. Eleven commonly used che motherapeutic drugs were investigated. Conductivity was used to determine whether drug was present in the test solutions.

Result. Drug was not detected in any of the samples collected. When carmustine was tested, the effluent had a distinct alcohol odor, but no conduc tivity was noted.

Conclusions. These disposable nitrile gloves appear to be acceptable for preparing the chemother apy agents tested. Hospitals must be open to finding replacements to natural rubber latex products and must alert their staff members about the potential for latex sensitivity in both patients and other staff mem bers. Manufacturers of non-latex gloves should be encouraged to conduct chemotherapy permeability studies on their products.
Rote learning, creativity and 'understanding' in classroom foreign language teaching
Authors: Mitchell Rosamond , Martin Cynthia
Published: November 2007

This paper presents some preliminary findings from a longitudinal study of French teaching and learning in two secondary schools in southern England. The main aims of the project were (a) to document the course of development in French of a cohort of 60 11-13-year-old pupils over a two-year period, with a particular focus on the place in their development of prefabricated phrases or 'chunks' of language, and (b) to relate this development to their classroom experiences, which were also documented. In this paper we focus on a subgroup of teachers involved with the project for much or all of the two years, examining their classroom practices and beliefs about effective teaching. In particular we compare teachers' beliefs about classroom learning with the evidence on learner progression derived from the project's own elicitation procedures. The paper is intended as a contribution to the growing literature on language teachers' craft knowledge, which to date has not systematically linked the study of teacher beliefs with second- language learning theory.
Guilt and shame: experiences of parents of self-harming adolescents
Authors: McDonald Glenda , O'Brien Louise , Jackson Debra
Published: November 2007

This paper reports the findings of a qualitative study that used a hermeneutic phenomenological methodology to develop insights into the experience of parents of young people who engage in self-harming behaviour. Six mothers (and one father who accompanied his wife) participated in the study. Findings reveal that mothers experienced guilt and shame, and that these feelings shaped their reactions and responses. These mothers described experiencing emotional dilemmas, such as the degree to which they could be responsible, uncertainty about how to understand self harm, and the best course of action to take with their child. They also encountered difficulties in combating the negative emotional effects for themselves and other family members. Findings provide insights that can help nurses and family health workers to understand and assist parents with greater effectiveness; by maintaining a non-judgemental stance, acknowledging the difficulties of their experiences, encouraging confidence in their parenting abilities, and promoting effective stress management strategies.
Triage
Authors: O'Meara M. , Porter K. , Greaves I.
Published: November 2007

A review of the literature underpinning modern triage methodology is presented. The philosophy and history is described prior to a review of triage scoring methodology relevant to modern day practice. The importance of triage is most acute during major incidents and the triage process is highlighted within this framework. Triage has wide-ranging applications throughout medical practice and these are included as part of the discussion.
Authorizing the Malaysian Rainforest: Configuring Space, Contesting Claims and Conquering Imaginaries
Authors: Sioh Maureen
Published: November 2007

The heart of a Malayan city ..., is always a small clearing wrested from the jungle and, too easily, turns jungle again.1

It is the jungle; the jungle which none can escape, the jungle which reaches to the back of every compound, to the back of every mind; the jungle which blots out the sun over four-fifths of Malaya's 50,850 square miles. Harsh and elemental, implacable to all who dare trifle with its suffocating heat or hissing rains, the jungle alone has remained untamed and unchanged.2
Infrainguinal Bypass in Patients with End-stage Renal Disease: Survival and Ambulation
Authors: Nicholas Gary G. , Bozorgnia Mehrzad , Nastasee Susan A. , Reed James F.
Published: November 2007

The purpose of this study was to evaluate the outcomes of infrainguinal bypass surgery and ambulatory status in patients with end-stage renal disease (ESRD).

Vascular registry data and the medical records of patients requiring infrainguinal bypass surgery from 1985 through 1995 were reviewed retrospectively. Patients with chronic limb-threatening ischemia requiring maintenance hemodialysis or peritoneal dialysis for ≥ 6 months were compared to a randomly selected group of patients under going foot salvage infrainguinal bypass in the absence of ESRD. Primary outcomes were mortality, amputation, and ambulatory status at 30 days and 1 year. Data were analyzed using Pearson's chi-square methods, Fisher's Exact test, Mann-Whitney U, life table analyses, and Quality of Life-Class (QL-Class) ranking.

There were 57 patients with ESRD who underwent 66 infrainguinal bypass proce dures. Mean age was 65.8 ±9.8 years (41-85 years). The 30-day operative mortality rate was 12.3% (7 patients). The cumulative survival at 1 year was 51.8% ±0.9%, and at 2 years it was 32.8% ± 1.3%. The cumulative limb loss was 29.7% ± 1.1% at 1 year and 36.7% ±2.6% at 2 years. In the comparison group, 46 patients without ESRD underwent 50 infrainguinal bypass procedures. The mean age of these patients was 72.3 ±9.1 years (36-90 years). The cumulative survival for the patients without ESRD was significantly higher (p < 0.001) both at 1 year (91.1% ±0.6%) and 2 years (88.8% ±0.8%). The cumulative limb loss for the comparison group was significantly lower (p < 0.001) at 1 year (4.1% ±0.4%) and at 2 years (6.3% ±0.5%). At both 30 days and 1 year, the QL- Class walking status rating was lower for the group with ESRD compared to patients without ESRD (p < 0.001).

Patients with ESRD have a high mortality rate in the first 24 months after infrain guinal bypass grafting for foot salvage surgery compared with a similar group of patients without ESRD. Although foot salvage can be achieved in some survivors with ESRD, the ambulatory rate is low. These results support a very conservative approach when recom mending infrainguinal bypass grafting for foot salvage surgery for patients with ESRD.
A Simple Method of Changing Clotted Intra-Arterial Catheters
Authors: Barman P.C.
Published: November 2007

A simple technique for changing a clotted catheter is presented which has been frequently useful during percutaneous transfemoral coronary angiogra phy. A guide wire is passed through a punched hole in the clotted catheter and a new catheter is inserted over the guide wire after the clotted catheter has been taken out.
Extremity Salvage by Revascularization
Authors: Barner Hendrick B. , Kaminski Donald L. , Ramey Anne E. , Garvin Paul J. , Kaiser George C. , Willman Vallee L. , Codd John E.
Published: November 2007

Advances in prosthetic devices led to our analysis of revascularization in patients presenting with gangrene of the lower extremity. Between 1966 and 1976, 99 grafts were performed on 96 of the 249 patients treated by lower extremity revascularization who presented with the above criteria. Their mean age was 66 years; 46 (48%) were diabetic, 53 (55%) were over the age of 65, and 38 (40%) had angiographically proven disease with one vessel runoff. Initial therapy consisted of intravenous antibiotics and local debridement to control sepsis, followed by detailed arteriography. Femoral-popliteal bypass was per formed in 87 patients, and a more distal vessel was utilized in 9. There were 5 in- hospital deaths. Of these, 4 patients had come to major amputation. Four died as a result of myocardial infarctions, and 1 as a result of a cerebrovascular accident.

Immediate graft patency was achieved in 93 of 99 patients (93%). Minor amputations were required in 44 patients. Early graft failure resulted in major amputations in 7 patients. A late major amputation (mean 13 months) was required in an additional 28 patients, 15 because of graft failure and 13 because of nonhealing minor amputations. Extremity salvage at 2 years was achieved in 72 of the 99 patients (72%).
Five Years Experience with Carotid Endarterectomy in a Small Commltnity Hospital
Authors: Park Yong H.
Published: November 2007

Seventy-nine carotid endarterecto mies were performed for 65 patients in a 140-bed hospital in a predominantly rural community during a 5-year pe riod. The procedure's mortality was 3.8%, and the rate of surgical stroke was 3.8%. In a small community hospital where most assistants have relatively limited experience in vascular surgical procedure, it was felt advisable to use the internal shunt routinely.
Diagnosis of Carotid Arterial Occlusive Disease
Authors: AbuRahma A.F. , Diethrich Edward B. , Diethrich Edward B.
Published: November 2007

A retrospective analysis of 1500 patient records was performed to assess the validity and reliability of combined oculoplethysmography and carotid phonoangiography (OPG/CPA) as indicators of carotid arterial occlusive disease. The tests were interpreted by means of a five-level grading system based on percentage of flow reduction. Reliability statistics were calculated by using arteriography as a comparison in 10% (152) of the patients.

Of the 1500 tests, 477 (32%) were abnormal, but only 252 (17%) were graded as hemodynamically significant (levels II-V). Arteriography confirmed total carotid occlusion in 16 of 19 (84%) grade V patients; the remaining 3 (16%) had significant stenosis but on a less severe level (III or IV). In the inter mediate grade II-IV results, 39 of 44 (89%) were accurate; 2 (4%) false positive and 3 (7%) overestimated cases were in this group. In the normal- grade I patients, 81 of 89 (91%) interpretations were confirmed. The false negatives (9%) in the latter group were attributable to nonstenosing ulcera tive plaques (6 patients) and moderately significant stenosis (2 patients). Overall reliability was 90%, with 1% false positives, 4% false negatives, and about 5% erroneous assessment of severity within the abnormal grades II-V. Thus OPG/GPA testing is a valuable, reliable, noninvasive screening and diagnostic tool for carotid disease detection, but it is sensitive only to stenotic lesions, not to ulcerative plaques.
Clinical Experiences with the Stabilized Human Umbilical Vein in Coronary Bypass Surgery
Authors: Silver Gary M. , Katske Gordon E.
Published: November 2007

Nine patients received 16 aortocoronary bypass grafts utilizing the umbil ical vein. A 4-mm internal diameter Dardik Biograft (Meadox Laboratories, Oakland, NJ) was used in all cases. Eight right coronary arteries, five circumflex, two anterior descending, and one diagonal artery were bypassed. There were no surgical deaths or perioperative myocardial infarctions. Clin ically, all patients are doing well 1 to 16 months postoperatively. Technical aspects of using these grafts are described. In patients lacking satisfactory saphenous veins, the umbilical vein can be used for the aortocoronary position. Continued long-term clinical evaluation is necessary.
Experience With Milliknit Vascular Bifurcation Prostheses
Authors: Rostad Hans
Published: November 2007

Knitted vascular bifurcation prostheses were implanted in 65 patients. In 33 cases the indication was abdominal aortic aneurysm; the remainder had arterial occlusive disease, and 94% of these patients were smokers. All patients were given prophylactic antibiotic therapy postoperatively. One patient with athero sclerotic occlusive disease and 7 with aortic aneurysm died within 30 days of surgery. Furthermore, 4 deaths occurred from 2 months to 3 years after surgery, all due to cardiovascular disease. There were no serious postoperative compli cations. At follow-up one limb of the graft had occluded in 2 patients, probably because of poor runoff. Therefore the value of peroperative blood flow mea surement, which gives an excellent assessment of peripheral runoff, is stressed.
Abnormal Location of Innominate Artery and Azygos Vein Simulating Right Apical Lung Tumor
Authors: Farsad G. Reza H. , Radpour Bijan F.
Published: November 2007

Bronchogenic carcinoma was suspected in a middle-aged black man who was a heavy smoker, a heavy drinker, and met all criteria for the high-risk group. A mass density was apparent in the superior sulcus, right upper lobe. On thoracotomy a tortuous innominate artery and dilated superior vena cava was found simulating a right apical mass. Eng lish literature and sporadic case studies are reviewed. Different noninvasive and invasive diagnostic procedures are described to aid in the diagnosis of possible nonmalignant tumefaction of the thorax mimicking bronchogenic carcinoma, and to help read ers avoid unnecessary thoracotomies.
Carotid Endarterectomy: Emphasis on Necessity of Long-Term Postoperative Evaluation
Authors: Sauer Paul E. , Almond Carl
Published: November 2007

Carotid endarterectomy remains an effec tive means of preventing a stroke in patients with extracranial carotid lesions. Although long-term patency may be assumed, the true incidence of recurrent pathology is not known. In the past, follow-up angiography has been performed only when recommended for recurrent symptoms and some postoper ative bruits. Four different pathologic condi tions found at the endarterectomized bifur cation site are discussed as are their treat ments.

Long-term follow-up evaluation is strongly recommended. Angiography is in dicated for recurrent symptoms. Carotid bruits are difficult to evaluate on a yearly basis. Vascular laboratory studies are recom mended 4 months after surgery and then on a yearly basis. Hopefully, early and late res tenosis will be identified. An artery should be explored when symptoms and angiog raphic findings indicate recurrent pathology.
Diagnosis, Surgical Treatment, and Postoperative Care of Patients with Acute Thrombosis of the Femoral and Iliac Veins
Authors: Horsch S. , Pichlmaier H.
Published: November 2007

The treatment of acute thrombosis of the femoral and iliac veins consists of (1) venous thrombectomy, and (2) thrombolysis. The therapy aims at (1) preventing lethal pulmonary embolism, and (2) restoring venous bloodflow and preserving the valvular system to prevent a post-thrombotic syndrome.

The thrombectomy reduces the rate of embolism and post-thrombotic syndrome when compared to the spontaneous course or conservative treat ment. From a technical aspect, the method has developed into a routine operation. Early and late results in 80 patients, as well as intra- and postop erative complications, are discussed.
Iliac Artery-Iliac Vein Human Umbilical Cord Vein Graft for Hemodialysis in Patients with Exhausted Access Sites
Authors: Mayer John H.
Published: November 2007

A patient who had undergone chronic hemodialysis for renal failure was evaluated for hemodialysis access failure. At the time of his initial examina tion, all available veins and arteries in the patient's arms and legs had been compromised by placement of arteriovenous fistulas or shunts, and he was being maintained with peritoneal dialysis.

By means of a previously unreported technique, a human umbilical vein graft was interposed between the iliac artery and the iliac vein. The external iliac artery was extremely diseased, but pulsation and flow seemed adequate. Postoperatively, there was no evidence of lower extremity ischemia or venous hypertension. After 8 days of peritoneal dialysis, the graft was cannulated in the usual fashion for hemodialysis. However, due to the severe aortoiliac disease, flows were less than desirable, and the patient died.
Ruptured Aortic Aneurysm Complicating Coarctation of the Aorta
Authors: Kaku Takashi , Akahoshi Masazumi , Kuramochi Morio , Hashiba Kunitake , Takagi Toshihiro , Nishimori Issei , Itakura Hideyo
Published: November 2007

Two cases of aortic aneurysm complicating aortic coarctation with unusual rupture were reported. The first case is a 66-year-old female with aneurysm of the descending thoracic aorta. The coarctation of the aorta was located at lower thoracic aorta and the aneurysm was formed proxymal to the coarcta tion. The aneurysm protruded backwards being accompanied by osteolysis of ribs and finally ruptured extracorporeally at the left subscapular region. The second case is a 28-year-old male with mycotic aneurysm that occurred im mediately distal to the coarctation of the aorta. Streptococcus viridans was isolated by blood culture. The aneurysm was ruptured to the esophagus. The mechanisms of aneurysm formation in patients with coarctation of the aorta were discussed.
Congenital Mitral Stenosis Associated with Ventricular Septal Defect, Patent Ductus Arteriosus and Tubular Hypoplasia of the Ascending Aorta
Authors: Meno Hiroshi , Koiwaya Yasushi , Makino Naoki , Orita Yasuhiko , Kikuchi Yutaka , Nakamura Motoomi
Published: November 2007

A 28-year-old female was discovered to have mitral stenosis associated with ventricular septal defect, patent ductus arteriosus and tubular hypoplasia of the ascending aorta. The diagnosis of such complex anomalies was con firmed by an echocardiographic and cardiac catheterization study. Congenital mitral stenosis is a rare cardiac malformation and usually results in early death. This patient is a relatively long survival case in spite of many complications.
Enteroprosthetic Fistula Associated with Hypertrophic Osteoarthropathy
Authors: Leonard Andrea , Trout Hugh H. , Schechter Stephen L. , Nashel David J.
Published: November 2007

Infected vascular grafts with aortoenteric fistulae can be difficult to diagnose. We describe an interesting patient who developed hypertrophic osteoarthropathy of the lower extremities. This occurred one year prior to the diagnosis of an infected vascular prosthesis. With definitive surgical therapy, all symptoms of hypertrophic osteoarth ropathy resolved. Patients with arterial prostheses who present with hypertrophic osteoarthropathy should be carefully evaluated for occult graft infections.
Occupational Ischemic Hand Syndrome
Authors: Shah Pravin M. , Ivatury Rao , Abdul Quader M. , Clauss Roy H.
Published: November 2007

A case of occlusion of the radial artery and palmar arches with gangrene of the index finger due to occupational trauma is presented to emphasize the role of repetitive trauma in the causation of hand ischemia. The diagnosis of occupational hand ischemia should be made by eliciting an occupational history involving chronic repetitive trauma to the hand, angiographic demonstration of the lesion, and the exclusion of all other causes of hand ischemia by history, laboratory investigation, and tissue biopsy. The need for unifying various syndromes associated with traumatic ischemia of the hand is pointed out. The term occupational ischemic hand syndrome is suggested to encompass the spectrum of various clinical entities previously described in the literature.
Abdominal Aortic Aneurysms and Associated Peripheral Occlusive Disease
Authors: Deriu Giovanni P. , Ballotta Enzo , Grego Franco , Alvino Simonetta , Franceschi Lorenza
Published: November 2007

During the past 12 years (1970-1982), one hundred and twenty patients were electively operated by the senior author for abdominal aortic aneurysm (AAA) at the Vascular Surgery Department of the University of Padua. Only in about 50% of cases, the lesion was revealed by the presence of a palpable pulsating mass or a calcium line on the X-ray film, especially in the lateral projection. In the remain ing cases, the diagnosis of AAA was made in patients observed for concomitant occlusive disease of the legs or the mass was casually found during laparotomy for other reasons. In 66 patients, the translumbar aortography revealed occlusive disease of the legs with lesions of the iliac axis in 43 cases (bilaterally in 26) and of the femoropopliteal axis in 33 (bilaterally in 19). The tibioperoneal axis was involved in 2 cases. Associate carotid or coronary lesions were surgically treated in separate operative sessions. For technical reasons, the proximal control of the abdominal aorta required section of the left renal vein in 4 cases, section of the inferior mesenteric vein in 10 cases and bilateral revascularization of the renal arteries in 2 cases. In addition, the patients were subdivided 1) according to the means by which intestinal blood flow was guaranteed: adequate blood flow was always guaranteed at least in one of the hypogastric arteries by revascularization of the iliac bifurcation, backflow or reimplantation, or as a last resort reimplanta tion of the inferior mesenteric artery; 2) according to whether or not the con comitant occlusive disease of the legs is corrected: whereas lesions of the iliac axis were routinely corrected either for technical reasons or because of outflow, correction of the second complete occlusion, never routinely performed in pa tients with peripheral occlusive disease, was only necessary in 11.5% of cases; 3) according to the performance of eight aorto-renal bypasses and one transaortic renal artery endarterectomy either for concomitant renovascular hypertension or almost occlusive stenosis of the renal arteries. Early operative mortality was 4.1%. Follow-up (from 6 months to 12 years) information regarding survival was obtained in 87 patients.
Superficial Temporal Artery To Middle Cerebral Artery Anastomoses in the Sylvian Fissure: Case Report
Authors: Umansky Felix , Diaz Fernando G. , Ausman James I. , Dujovny Manuel
Published: November 2007

An anastomosis between the superficial tem poral artery (STA) and the superior trunk of divi sion of the middle cerebral artery (MCA) resulted in significant clinical improvement and normalization of the impaired cerebral blood flow. Possible indications for this type of anasto mosis and microanatomical data from the proxi mal MCA are discussed.
Non-Traumatic Thoracic Aortic Aneurysms in the Community Hospital
Authors: Hamouda Farouk , McCray Robert , Kuzycz George B. , Asselmeier Glen H. , Dieter Raymond A.
Published: November 2007

Aneurysms involving the thoracic aorta have been highly lethal in the past. The treatment modalities previously available have not been highly successful and have been accompanied by serious side effects. In the past few years, the surgical approach has been utilized to a much greater degree. The results of this surgery have shown continuous improvement with a decrease in both the rate of complications and mortality. Improvement in surgical technique, better defini tion of the anatomy, improved treatment of complications, and knowledge of the techniques for decreasing the incidence of problems have increased the survival of patients with this problem. Most such patients and reports of their problems and subsequent surgical results come from university or teaching centers. We, therefore, have reviewed our patients as seen in the community hospital setting and they are herein reported.
Subclavian Artery Transection Due to Blunt Trauma
Authors: Cunningham J. Richard , McCabe John C.
Published: November 2007

An adult male patient with intrathoracic left subclavian artery transection and thrombosis secondary to blunt trauma is presented. There was a delay in diagnosis of 36 hours because initially there were few physical or radiologic signs ordinarily associated with thoracic vascular injury. Aortography was per formed because of sudden hemothorax and left supraclavicular swelling. Suc cessful repair was performed with autogenous saphenous vein. A high degree of clinical suspicion is necessary to detect subclavian transection from blunt trauma because of the location of this injury, lack of initial bleeding, and the rich collateral blood supply to the arm.
Traumatic Disruption of Aorta with Rupture into Right Pleural Cavity
Authors: Cuasay Ramon S.
Published: November 2007

A rare rupture into the right pleural cavity of a traumatic disruption of the thoracic aorta is reported. Right chest opacification because of malplaced jugu lar venous catheter may mask its presence and delay treatment. Hypotension, wide mediastinum, delayed hemothorax or the mechanism of injury alone sug gest deceleration injury. Recognition that acute traumatic rupture of the aorta may present into the right pleural space offers a chance for salvage.
Patent Femoro-Popliteal Bypass Graft with Inflow Occlusion: Report of Three Cases
Authors: Peterson Gary J. , Smith Michael A.
Published: November 2007

Three cases of late femoro-popliteal bypass graft failure have been reviewed. Each case presented with symptoms of limb-threatening ischemia and had an kle-arm indices of 0.12-0.30. In each instance, aortography revealed inflow oc clusion proximal to the graft, a well-developed collateral circulation, and patent grafts . Each of these cases was managed by extra-anatomic bypass . Etiologies of early, intermediate, and late bypass failure are discussed. With the growing popularity of the "in situ" technique of femoro-popliteal bypass, this observa tion may be made more frequently. These cases emphasize the benefit of regular followup, even in the long-term patency group. The durability of vein grafts is likewise noteworthy.
Management of Renal Transplant Dysfunction Due to Occlusion of Aortoiliac Bypass Graft: A Case Report
Authors: Brown Dennis P. , Harvey Benson , Vaccaro Patrick S. , Smead William L.
Published: November 2007

Progressive atherosclerosis of the aortoiliac system in a patient with a func tioning renal transplant is a vexing problem, but in transplant patients who have had aortoiliac reconstruction, progressive disease can be doubly difficult to treat. Our experience with a patient with an ischemic transplant due to occlu sion of a previously placed aortoiliac bypass limb is recounted. Various surgical approaches were considered, but femoro-femoral bypass was successfully per formed.
Athero-Embolic Renal Failure After Transfemoral Aortography: A Case Report
Authors: Bonser Robert S. , Buckels John A.C. , Woodward David A.K. , Bullen Barry R.
Published: November 2007

Athero-embolic renal failure has been described after various therapeutic and angiographic procedures. We describe a patient who underwent transfe moral aortography and subsequently developed fatal athero-embolism due to disruption of aortic aneurysm contents during pressurised injection of contrast medium.
Cystic Adventitial Disease of the Popliteal Artery: A Case Report
Authors: Cavallaro Antonino , Di Marzo Luca , Sciacca Vincenzo , Mingoli Andrea , Gallo Pietro
Published: November 2007

A case of cystic degeneration of the popliteal artery is presented. The syn ovial origin of the cyst, supported by the presence of a clear connection with the knee joint, was adversed by the microscopy findings which rather suggested a primary degenerative process of the adventitial tissue. The authors agree with the hypothesis of a non-unique aetiologic and pathogenetic mechanism of origin of cystic disease of the popliteal artery.
Primary Aorto-Jejunal Fistula: A Case Report
Authors: Mandava Neil , Ernst Alfred R.
Published: November 2007

Primary aorto-jejunal fistula is a rare complication of abdominal aortic an eurysm. This article describes the tenth reported case. Etiology and diagnosis are discussed. A high index of suspicion, abdominal sonogram, or preferably CAT scan of the abdomen are the most useful aides in diagnosis. Surgery in cludes resection of the aneurysm, aortic grafting, and closure of the fistula. Surgical mortality is in excess of 50%, but there are no reported survivals fol lowing non-surgical management.
Prevention of Early Recurrence of Aneurysmal Subarchnoid Haemorrhage by Tranexamic Acid: A Controlled Clinical Trial
Authors: Chowdhary Upendra Mohan , Sayed Kamaluddin
Published: November 2007

A controlled clinical trial of Tranexamic Acid (TEA) was underaken to as sess its effectiveness in reducing early recurrence of haemorrhage in patients with aneurysmal subarchnoid haemorrhge (SAH). The series of control patients and patients having TEA which were consecutive. Of the 65 patients treated with TEA recurrence occurred in six (9%) and five patients died from recur rence of haemorrhage. Of the 64 patients in the control group, 17 (26%) pa tients had recurrent haemorrhage and eight patients died from it. Administra tion of tranexamic acid is found to have significantly reduced the early recur rence of haemorrhage.
Enlargement of the Breast—A New Side Effect of Transaxillary Cervical Sympathectomy: Case Report
Authors: Kott Itamar , Hauptman Eli , Zelkovsky Avigdor , Reiss Raphael
Published: November 2007

The phenomenon of hyperhidrosis is a pathological state caused by unknown stimulus of the sympathetic nervous system. When a variety of conservative treatments have failed, surgery which involves the removal of some ganglia of the cervical sympathetic chain, is the treatment of choice. In the last four years we operated on 253 patients for palmar hyperhidrosis using the transaxillary approach only.

Recently, a new side effect of surgery has come to our attention. This phe nomenon is enlargement of the breast on the operated side. Our series show seven cases (2.4%) of women operated for palmar hyperhidrosis who mani fested this phenomenon, two of them bilaterally. The enlargement of the breast was found usually by the second follow-up visit after operation when, in most cases, the patient mentioned it.

Examination of the breast revealed enlargement of a few centimeters which in several patients required a change to a larger brassiere size. In both of our patients who underwent bilateral surgery, the breasts enlarged until they were equal in size. The women then did not complain further. In our article we de scribe the cases of two young women with this phenomenon for which we still do not have a clear explanation of the phenomenon, but report our assumption only.
Intravenous Lidocaine Regional Anesthesia for Forearm Arteriovenous Shunts
Authors: Geren Nichols J. , Parks Steven N. , Svoboda James A.
Published: November 2007

Local anesthesia or brachial plexus block may not consistantly provide anes thesia for insertion of the prosthesis for a looped forearm arteriovenous shunt. Intravenous lidocaine regional anesthesia (Bier block) can provide excellent forearm anesthesia.

This study reports 22 cases of looped forearm prosthetic dialysis access shunts performed with Bier blocks. The average operative time was 108 min utes. Anesthesia was reliable and no complications occurred.

The grafts have been followed for 5 to 67 weeks with an average of 36 weeks followup. Two failures have occurred one due to infection, and a second with recurrent thrombosis. Three surviving grafts have required thrombectomy. The predicted 75th percentile survival period is 56 weeks.

Bier block anesthesia is consistent, causes venodilitation and allows surgery without vascular clamps or systemic heparinization all of which have assisted the operative procedure.
Treatment of Persistent Lymphocele Following Saphenous Vein Harvesting: A Case Report
Authors: Deshmukh Narayan
Published: November 2007

A case of lymphocele in the lower thigh, following removal of the saphenous vein, is presented. The pathophysiology and surgical treatment are described. Lymphatic complications after removal of saphenous veins are uncommon. Most of these consist of a temporary leak or subcutaneous collection of lymph. Persistent collection of lymph in the thigh may require an operation. Such a case, successfully treated by an operation, is described. The value of lymphan giogram, both in diagnosis and as an aid in the operation, is discussed.
A New Technique for Selective Venous Drainage of Oesophageal Varices
Authors: Aboul-Enein A.
Published: November 2007

The incidence of haematemesis secondary to oesophageal varices in schistosomiasis is more frequent than its incidence in Loennec's cirrhosis.1 In an endemic area an operation which could decompress the oesophageal varices, and also rid the patients of the hugely enlarged spleen and its complications, is desired.
The Hypoplastic Aorto-Iliac Syndrome: A Critical Approach to Its Pathogenesis
Authors: Di Giacomo Vincenzo , Di Giacomo Maurizio , Sciacca Vincenzo , Meloni Fortunato , Cavallaro Antonino
Published: November 2007

The clinical and angiographic features of 12 patients showing a significant reduction in the diameters of the distal aorta and the common iliac arteries are described. All the patients were women aged between 23 and 63 years (average age: 49 years), heavy smokers in the majority. An associated aortic arch syndrome was observed in 5 patients. Type IV dyslipidemia was found in 5. In 10 patients the erythrocyte sedimentation rate was increased. Claudication of the lower limbs, without dystrophic phenomena, was the most frequent symptom.

Intraoperative biopsies of the distal aorta at the level of the aortic bifurcation were performed in 9 patients who underwent vascular surgery. In all the specimens an extensive fibrosis of the arterial wall was noted, but diffuse or focal lymphoplasmacellular infiltrates were also detected in 7 of them, with giant cells in 2 of the 7.

The profile of small aorta and iliac arteries has recently been identified as an autonomous morbid process due to a developmental deficit with superimposition of atherosclerotic phenomena ("hypoplastic aorto-iliac syndrome" — HAIS). The clinical data and the histopathologic findings suggest, however, that several cases of HAIS can claim an acquired rather than a congenital origin. An arteritic process, causing an extensive fibrosis of the arterial wall, might be able to give rise to a noteworthy reduction in the aortic diameter. Among the possible inflammatory causes, Takayasu's disease (aspecifc aortoarteritis) seems to play an important role.

The denomination HAIS seems, however, to be too restrictive. It should be replaced by "small aorto-iliac syndrome" (SAIS), which is noncommittal as regards the pathogenesis and applicable in any case.
Topical Glyceryl Trinitrate as an Analgesic in Atherosclerotic End-Stage Peripheral Vascular Disease: A Case Report
Authors: Quigley Robert Lawrence
Published: November 2007

An 87-year-old male vasculopath suffering from ischemic rest pain of ather osclerotic origin in the left foot was observed for a five-day period, with a healthy 28-year-old male serving as a control, to evaluate four subjective and objective parameters following nitropaste application for analgesia.

Objective parameters (tissue oxygenation and limb temperature) were as sessed twice daily, morning and evening, in both the supine and erect positions.

The overall average increase in tissue oxygenation in the patient was 111.2% when supine and 100.3% when erect, whereas it was 5% in the normal control when supine and 4.7% when erect. Overall average increase in temperature in the patient was 7.59% in the morning and 4.05% in the evening, position not being a factor. In the control, it was 2.5% when supine and 1.9% when erect.

The patient's interpretation of subjective pain had progressed from moder ate to mild by day 3; this was consistent with the nurse's assessment. Thus the improved analgesia commenced forty-eight hours after institution of nitropaste treatment, despite the fact that tissue oxygenation had increased by an average of 158.9% during the first twenty-four hours and the temperature had increased by an average of 2.9%.

To demonstrate efficacy of this drug as an analgesic; a properly randomized, double-blind study should be performed with a statistically significant sample size.
Revascularization of the Lower Extremity : A Noninvasive Hemodynamic Comparison of Aorto-Femoral, Axillo-Femoral and Femoro-Femoral Bypass
Authors: Rathnasami Palani S. , Hines George L.
Published: November 2007

Thirteen patients who underwent aorto-bifemoral bypass (A-F), 12 who had femoro-femoral bypass (F-F), and 8 who had axillo-femoral bypass (Ax-F) were evaluated to compare the hemodynamic improvement of the individual proce dures by recording mean preoperative and postoperative ankle/arm pressure index (API) in symptomatic extremities..

Hemodynamic improvement as measured by API was the same for A-F, F-F, Ax- F. A decision about whether A-F, F-F, or Ax-F would be appropriate should be made by considerations other than the expected immediate hemodynamic bene fit, for there is no statistically significant difference in the hemodynamic im provement among these three common bypass procedures.
The Klippel-Trenaunay Syndrome: A Case Report and Review of the Literature
Authors: Pollack Charles V. , Timberlake Gregory A. , Kerstein Morris D.
Published: November 2007

An infant was referred for evaluation of a congenital portwine stain of the entire left lower extremity. The infant was subsequently confirmed as having Klippel-Trenaunay syndrome, and the problem was successfully managed by conservative therapy. The patient's clinical course is reviewed and the Klippel- Trenaunay syndrome discussed.
Prevention of Reocclusion After Prosthetic Bypass Operations in the Femoro-Popliteal Region: A Comparative Study of Pentoxifylline Versus Acetylsalicylic Acid
Authors: Raithel D.
Published: November 2007

One hundred eighteen patients (88 males, 30 females, mean age 67.2 years, age range 42 to 87 years) with successfully performed synthetic prosthetic by pass operations in the femoro-popliteal area were submitted in an open random ized study of two groups of 59 subjects to oral treatment by 400 mg pentoxifylline in special patented slow-release formulation or 500 mg ASA tid from two days before operation until twelve months after operation (with par enteral administration of both drugs on the day of surgery and two days after surgery). Effectiveness of prevention of reocclusion was assessed by patency rates and drug tolerability.

The examinations (clinical status, pulse palpation, Doppler-pressure mea surement, arteriography) were carried out before and on days five or six after operation, and also after three, six, nine, and twelve months of the follow-up period.

The life table analysis disclosed no significantly different patency rates (75% for the pentoxifylline-treated group and 74% for the ASA cohort).

A significantly superior tolerability was found in the patients treated with pentoxifylline, 6 patients (10%) reporting adverse reactions as compared with 33 (56%) in the ASA-treated group. The side effects consisted mostly of gastric upset, dizziness, and gastric hemorrhage. The medication was discontinued in 6 patients on pentoxifylline and 12 on ASA.
Cavernous Angioma Presenting as Subarachnoid Hemorrhage in a Child—A Case Report
Authors: Upendra Mohan Chowdhary
Published: November 2007

Cavernous angioma of the brain is a rare lesion. Only a small percentage occur in childhood and less than a quarter present with intracranial hemor rhage. A case of cavernous angioma presenting as subarachnoid hemorrhage in a child is reported here. The author describes the clinical picture and the pitfalls in the management of such cases and comments on the histologic criteria, the radiologic appearances, and the rationale behind the operative management.
Aortic Graft Stenosis From a Dacron Cuff — A Case Report
Authors: Wyman A. , Griffith C.D.M. , Callum K.G.
Published: November 2007

The use of a dacron cuff to reinforce the suture line for aortic inlay grafts is a routine procedure. The case reported here demonstrates a potential complica tion of this technique in that a functional aortic stenosis can occur. The use of routine intraoperative arterial pressure measurements detected this problem, which was resolved by removal of the cuff.
Traumatic Pseudoaneurysm in an In-Situ Femoro-Popliteal Bypass Graft — A Case Report
Authors: Celoria Giovanni M. , Berman Joel
Published: November 2007

Anastomotic false aneurysm is a commonly reported complication of bypass surgery, but blunt trauma has been a rare etiologic mechanism. An unusual case of a traumatic false aneurysm arising in the distal anastomosis of an in-situ femoro-popliteal bypass graft is presented and the pathophysiology of the entity is discussed.
Dealing with Difficulties in Transjugular Kimray-Greenfield Filter Insertion — Case Histories
Authors: Markowitz Ira P. , Baliga Prabhakar K. , Kerstein Morris D.
Published: November 2007

Problems in placement of the Kimray-Greenfield inferior vena cava filter are best averted by taking a venacavogram before attempts at insertion and by using an intravascular retrieval basket for the difficult to move, difficult to place, or misplaced filter.
Experience with Ruptured Thoracoabdominal Aneurysms Involving the Visceral Arteries: Three-Year Experience in a Community Teaching Hospital—Case Reports
Authors: Hines George L.
Published: November 2007

Four patients (3 males and 1 female) with ruptured thoracoabdominal aneu rysms involving the visceral arteries were managed in a three-year period. Ages ranged from sixty-seven to eighty-two years. Two patients had freely ruptured aneurysms and were operated on emergently. Two patients had contained rup tures and were operated on urgently.

Hemodynamic monitoring consisting of Swan-Ganz catheters and arterial lines were employed in all patients. Exposure was obtained through a thoraco abdominal approach. A Gott shunt was employed in 1 patient. All patients re ceived intravenous heparin during aortic clamping, and protamine was rou tinely administered to reverse heparin. Standard techniques for vascular reconstruction were employed.

There was 1 intraoperative death in an eighty-two-year-old male who suf fered a cardiac arrest after replacement of thoracoabdominal aneurysm with reimplantation of the celiac axis.

Three patients survived operation. One patient developed paraplegia and expired forty days postoperatively. One patient had suture line bleeding that required reexploration. He is now alive and well three years postoperatively. The fourth patient did well postoperatively but died nine months after discharge from an acute myocardial infarction.

This study indicates that this difficult and life-threatening condition can be managed with satisfactory results even in the setting of a community teaching hospital.