bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Levels of Sodium Valproate in Childhood Epilepsy
Authors: McQueen Judith K. , Blackwood D. H. R. , Minns R. A. , Brown J. K.
Published: January 2017

Sodium Valproate levels in plasma have been measured in 207 children with epilepsy, only 21 of whom were in-patients. No significant correlation could be found between plasma levels and dose of Sodium Valproate expressed as mg/day, mg/kg body weight or mg/m2 surface area. This finding could not be attributed to irregular compliance, concomitant administration of other anticonvulsant drugs, time of sampling after last dose, duration of treatment or age of the child. We could find no evidence of a therapeutic range of plasma levels of Sodium Valproate and the ranges associated with poor (17%), moderate (44%) or good control (39%) of fits were not significantly different. The average daily dose producing an improvement in seizure control was calculated to be 30 mg/kg.
Surgery for Transposition of the Great Arteries: Recent Experience in the West of Scotland
Authors: Smith G. , Pollok J. C.
Published: January 2017

From January 1980 to May 1983, 38 children underwent corrective surgery for transposition of the great arteries using the Mustard operation at the Royal Hospital for Sick Children in Glasgow. Twenty-nine children (Group 1) had ‘simple’ transposition, four (Group 2) had transposition and ventricular septal defect and five (Group 3) presented with complex anomalies. Operative mortality was zero for Groups 1 and 2. In Group 3, two children died within 30 days of operation. In the follow-up period of between three months and three and a half years there have been three late deaths. This report outlines the presentation, management and short term follow-up of children who have undergone the Mustard operation in this hospital since 1980.
Intracoronary Thrombolytic Therapy Performed within a Coronary Care Unit: One Year's Experience
Authors: Hillis W.S. , Jones C.R. , Been M. , Campbell B.C. , Fulton W.F.M.
Published: January 2017

Acute myocardial infarction is associated with a high incidence of occluding coronary arterial thrombi. Thrombolytic therapy has been advocated to restore coronary artery blood flow and to reduce myocardial damage. Coronary arteriography and intracoronary thrombolytic therapy was administered to 61 patients admitted to a Coronary Care Unit within eight hours of symptoms. Successful reperfusion was obtained in 38 of 46 single vessel occlusions associated with a first coronary attack. Failure of reperfusion occurred in patients with two vessel occlusions or with cardiogenic shock. This study demonstrates the feasibility of applying this technique within a Coronary Care Unit with low capital and running costs, and suggests that its widespread application is possible even within the setting of a District General Hospital.
The Syndrome of Hypertension and Hyperkalaemia without Renal Failure: Long Term Correction by Thiazide Diuretic
Authors: Gordon R. D. , Hodsman G P.
Published: January 2017

An excellent response to treatment with thiazide diuretic for twelve years is described in a patient with Gordon's Syndrome, the first to be reported from Scotland, and only the second to manifest the full clinical picture of short stature, hypertension, hyperkalaemia and hyperchloraemic acidosis without renal failure. The hypertension and biochemical abnormalities were reversed during therapy. Temporary withdrawal after seven years was followed by the immediate return of all the biochemical abnormalities, but not of the hypertension.
Small Bowel Ulceration and Perforation by a Gallstone
Authors: Orringer R. D. , Carle G.
Published: January 2017

Gallstone ileus is a well recognised entity and is responsible for approximately 3 per cent of intestinal obstructions. It is, however, quite rare for a a gallstone to cause numerous ulcerations of the bowel mucosa and perforation especially in the absence of prior clinical or radiological signs of obstruction (1). We report a case of ulceration and perforation of the ileum by a gallstone and presenting as acute peritonitis rather than obstruction.
Survival after Ovarian Granulosa and Theca Cell Tumours
Authors: Dempster J. , Geirsson R.T. , Duncan I.D.
Published: January 2017

Ninety-two cases of ovarian granulosa and theca cell tumours were recorded in the Tayside Gynaecological Tumour Registry during the 30 year period 1948–78. A high follow-up rate was achieved through this centralised registry and exhaustive annual recall. At 20 years after initial treatment patient actuarial survival was 92% for the theca cell tumours and 34% for granulosa cell tumours.
The Neurological Assault on the Great Toe (1893–1911)
Authors: Grant R.
Published: January 2017

The late 19th/early 20th century heralded a period in neurology when there was claim and counter claim about the founders of new reflex movements of the great toe. The cutaneous plantar reflex is undoubtedly one of the most important signs in clinical neurology, and there have been several methods described of eliciting this sign, each with its own eponymous name. This article reviews the background to these claims and the contribution of the various authors, to the discovery, clinical relevance and ease of eliciting reflex movements of the great toe.
The Misuse of Intravenous Cannulae
Authors: Doig J.C. , Slater S.D.
Published: January 2017

The use of indwelling venous cannulae is commonplace and of undoubted value. However, they are associated with complications, notably thrombophlebitis and infection. This study seeks to show that they may now have become overused and abused, especially in general wards. It is recommended that the indications for them be more critically examined, that they must be routinely heparinised and regularly inspected, and be removed without unnecessary delay.
A Practical Approach to Pre-Hospital Coronary Care
Authors: Main G. , McNeill G. P.
Published: January 2017

Prehospital coronary care involving a doctor and nurse team transported from the hospital by taxi has operated in Dundee for 18 months. Comparison of this service with the previous service shows it to be as effective, safe and relatively inexpensive.
Vibration Perception Thresholds in 279 Diabetic Patients
Authors: McKillop G.M. , Jamal G.A. , Kesson C.M.
Published: January 2017

Generalised peripheral neuropathy is a well recognised complication of diabetes mellitus and early detection is important in order that morbidity can be reduced by interventional therapy at an early stage. Since nerve conduction studies are not a feasible option in a busy diabetic clinic, an alternative technique of detection, superior to clinical examination, is beneficial. in this study vibration perception thresholds were measured in 279 diabetic outpatients. Seventy-eight patients (28%) had abnormal results but only 35 (13%) had clinical evidence of neuropathy. While nerve conduction studies remain the most sensitive technique to detect nerve dysfunction, vibration perception threshold determination is a useful screening test to detect subclinical peripheral nerve dysfunction in a routine diabetic outpatient clinic.
Calcium Carbonate 1250mg/1260mg: An Effective Phosphate Binder
Authors: Taylor J.E. , Henderson I.S. , Stewart W.K. , Mactier R.A.
Published: January 2017

Calcium carbonate is currently the first choice phosphate binder in renal failure. In the UK its most widely prescribed formulation is a combination of calcium carbonate 420mg and glycine 180mg (TitralacR 3M Riker). In order to achieve adequate reduction in the serum phosphate level, up to 12 of these tablets may be required daily. In a group of seven patients, we have compared Titralac with two alternative preparations containing calcium carbonate 1250mg (Calcium-500R Macarthy's Medical Ltd) and calcium carbonate 1260mg (CalcichewR Shire Pharmaceuticals Ltd). Given at a third of the daily number of Titralac tablets, both these newer preparations were effective phosphate binders and produced no statistically significant change in serum calcium and phosphate. The important advantage of such a reduced tablet load is improved patient compliance with phosphate binder therapy.

Calcium-500 is also a cost-effective treatment slightly reducing the cost when compared with combined calcium carbonate 420mg and glycine 180mg.
Microangiopathy as a Prognostic Indicator in Diabetic Patients Suffering from Acute Myocardial Infarction
Authors: Brown H.B. , Waugh N.R. , Jennings P.E.
Published: January 2017

Diabetic patients have an increased mortality following myocardial infarction (MI) due to left ventricular failure rather than larger infarcts or dysrhythmias. As this may be due to diabetic microangiopathy affecting the myocardium, we have examined the case records of diabetic clinic patients admitted to the Coronary Care Unit (CCU) with proven MI and compared the hospital outcome of those with and without retinopathy or nephropathy, i.e. markers for generalised microangiopathy. Sixty four consecutive records were traced, for the period when diabetic treatment policy was standardised in CCU, 24 patients had retinopathy (7 proteinuria). When compared to non-retinopathy patients they had similar ages 67 ±12 yr [± SD] v 63 ± 9yr) but were of longer duration of diabetes p<0.05). There were no differences between the groups in size or site of infarct, previous infarct or hypertension history, blood glucose on admission or diabetic treatment before or after admission. Death occurred in 29% of retinopathy patients compared to 3% of non-retinopathy patients (p<0.01). Cardiac failure complicated 75% of retinopathy patients and 25% of non-retinopathy patients (p<0.001). Dysrhythmia occurred in 50% and 33% of patients respectively (P=NS). Nine patients had clinical peripheral vascular disease and five of these died. This study, of a selected group of diabetic clinic attenders admitted to CCU with acute MI, demonstrates that microangiopathy and peripheral vascular disease are important prognostic factors in determining hospital outcome as these patients are at increased risk of cardiac failure and death.
Clinical Features and Epidemiology of Malignant Pleural Mesothelioma in West Glasgow 1987–1992
Authors: McLean A.N. , Patel K.R.
Published: January 2017

Malignant pleural mesothelioma is almost exclusively caused by exposure to asbestos dust. Recent epidemiological studies have suggested that the national incidence of disease may continue to rise until 2020 and that asbestos exposure in the building trade may be replacing shipyard related exposure as the main source of disease. The objective of the study was to determine if the incidence of malignant pleural mesothelioma was rising in the west of Glasgow from 1987–1992 and whether there had been a change in clinical features compared to previous studies from the same population. Case notes identified from coded returns and the local cancer registry were retrospectively examined: 144 cases were identified. This is an increase in incidence of over 50% compared to the previous study but the yearly incidence did not rise over the period studied. The clinical features and survival times have not changed since previous studies: median survival remains 30 weeks. Only three patients were given definitive treatment reflecting the lack of effective therapy. We suggest that the incidence of mesothelioma in the population studied may already have peaked resulting from the decline in the local shipyard industry over 20 years ago. Non-shipyard sources of asbestos exposure may be less important in this area.
Mild Traumatic Brain Injury — the Fife Perspective
Authors: Skelton C.E. , Walley R.M. , Chisholm J.B. , Sloan R.L.
Published: January 2017

Results are reported from a study to identify patients residing in Fife with mild traumatic brain injury in the 16–65 year old age group, who attended an accident and emergency department following their brain injury. Over a two month period 161 such patients attended with minor head trauma, of which 33 entered our study. The major cause of mild traumatic brain injury was assault. We found that over two-thirds of patients in the study had persisting post-concussive symptoms six months post injury. Neuropsychological testing showed problems of concentration and memory, but not at a level that was significantly different from that expected in an average population. Other studies have shown that symptom rates are higher when patients get no explanation of their symptoms and we feel that better co-ordination of services for brain injured patients in Fife is required, to provide the necessary information, education and support.
Patterns in Acute Referral to Hospital
Authors: Duffield J.S. , Craig K. , Plant W.D.
Published: January 2017

This retrospective observational study aimed to assess factors affecting acute referral and subsequent admission to hospital by general practitioners. Data concerning 2,303 consecutive acute referrals to hospital from all GPs in a defined study area were collected over one month. Fund holding practices cared for 13% of the population referred 13% ofall referrals resulting in 14% ofadmissions. Referral through the A&E resulted in significantly more patients being discharged upon initial assessment (p<0.001). A telephone call accompanying referral dramatically increased the chance ofhospital admission (p<0.001). Referral to hospital was more likely the more socially deprived the patient (p<0.001) but had no subsequent bearing on admission.
History of Arthritis and Bone Rarefaction Evidence from Paleopathology Onwards
Authors: MacLennan WJ
Published: January 2017

Review of medical and archaeologicalpapers reveals that osteoarthritis has been common in humans and hominids since Paleolithic times. In the British Isles, there was a particularly high prevalence in remains from Romano-British and Saxon burials suggesting that, whatever genetic factors there may have been, there was an extremely high level ofphysical activity. The prevalence ofthe condition was lower in late Medieval times; and, in at least one study ofsubjects from the 18th and 19th centuries, lower than in the currentpopulation. In early times, there was a reduction in bone density when there was a change from hunter gathering to agriculture which may have resultedfrom a change physical activity. Severe cases ofosteoporosis have been identifiedfrom individual skeletons dated to the Bronze Age. In the Early Medieval period of Nubia there was progressive bone loss in women. Multiple pregnancy, prolonged lactation and dietary deficiency may have been factors. Though women from the 18th and 19th centuries experiencedpost-menopausal bone loss, this was not as severe as in the present day.
A New Model of College Choice for Distance Learners
Authors: Lansing Jill
Published: January 2017

The expansion and diversification of postsecondary education in the United States has led to greater options for students and prospective students for pursuing a college degree. With the roll out and scale up of sophisticated education technology systems, an important trend in higher education today is distance education. Despite the growing prevalence of distance learning opportunities and the expanding body of research on distance education, research on the college-going decisions of distance learners is sparse. As more students enroll in distance-based postsecondary education programs, it is increasingly important to understand how and why students make the decision to enroll in collegiate degree-granting programs. This study bridges the college choice and distance education literatures to posit a new model of college choice to shed light on students’ decisions to enroll in a distance-based, nontraditional degree program.
Procreative Liberty and Harm to Offspring in Assisted Reproduction
Authors: Robertson John A.
Published: January 2017

Assisted reproductive technologies (“ARTs”) have enabled many infertile couples to have children but have long been controversial. Opposition initially focused on the “unnaturalness” of laboratory conception and the doubts that healthy children would result. Once children were born, ethical debate shifted to the status and ownership of embryos and the novel forms of family that could result.

The new century has brought forth both new and old ethical concerns. The growing capacity to screen the genomes of embryos has sparked fears of eugenic selection and alteration. In addition, concerns about safety have reasserted themselves. Several studies suggest that in vitro fertilization (“IVF”) may be associated with lower birth weights and major malformations. Ethical attention has also focused on whether all persons seeking ARTs should be granted access to them, regardless of their child-rearing ability, age, disability, health status, marital status, or sexual orientation.
Patent Buy-Outs for Global Disease Innovations for Low-and Middle-Income Countries
Authors: Outterson Kevin
Published: January 2017

The World Health Organization’s CHOICE program analyzes the cost effectiveness of various health interventions related to the Millennium Development Goals. The program identifies the best strategies for improving health in low-income countries, using a standard set of methodological assumptions. These studies evaluate interventions in many areas, including child health and HIV/AIDS.

For some of these treatments, drug costs are a significant variable: if the drug price doubles, the intervention becomes less cost effective. But if the drug price is reduced by 90%, then more therapies become affordable.

Drug prices are uniquely susceptible to radical price reductions through generic competition. Patented pharmaceuticals may be priced at more than 30 times the marginal cost of production; the excess is thepatent rentcollected by the drug company while the patent and exclusive marketing periods remain. Patent rents are significant. AIDS drugs which sell for US$10,000 per person per year in the US are sold generically for less than US$200. If patented drugs could be sold at the marginal cost of production, cost effective treatments would become even more attractive, and other interventions would become affordable.
How Parallel Trade Affects Drug Policies and Prices in Canada and the United States
Authors: Hollis Aidan , Ibbott Peter
Published: January 2017

U.S. consumers and Canadian pharmacies have rushed to take advantage of the opportunity presented by price differences in patented pharmaceuticals. This rapidly growing parallel trade has brought the Canadian and U.S. systems for determining pharmaceutical pricing under increased scrutiny, and the pressure for change seems to be building. This paper examines why parallel trade in pharmaceuticals has grown and considers some of the policy options confronting both countries.

To do this we begin by identifying similarities and differences in the Canadian and U.S. regulatory frameworks governing trade in pharmaceuticals. While the differences are considerable, we show that they are not the only reason for the emergence of the price disparity that has fuelled the growth in parallel trade. In particular, we argue that the price discrimination strategies of pharmaceutical manufacturers and exchange rate fluctuations have played an underappreciated role. Following this, we examine the claims that this trade represents a threat to American and Canadian interests, and find that there are good reasons for policy makers on both sides of the border to be concerned. Unchecked, this rising trade presents a threat to R&D funding and continued Canadian consumer access to pharmaceutical products.
Fade to Black: Importation and Counterfeit Drugs
Authors: Liang Bryan A.
Published: January 2017

Americans rely extensively upon prescription medications to maintain health and quality of life. According to the National Center for Health Statistics, in 2002, at least 1.5 billion drugs were prescribed to patients in physician offices, 196 million in US emergency departments, and 140 million in outpatient settings. Almost two-thirds of visits to physician offices and hospital outpatient departments had at least one drug associated with the visit, and 7% of visits had five or more drugs. In 2004, US pharmacies dispensed over 3.5 billion prescriptions to patients. Estimates indicate that annual expenditures for prescription drugs in the US top $230 billion dollars each year—and there is every indication that these numbers will only increase.
Conflicts of Interest in International Human Drug Research and the Insufficiency of International Protections
Authors: Gatter Robert
Published: January 2017

The world relies largely on private firms for the development of new medicine, and the system is efficient. Driven by the incentive to profit from sales of new pharmaceuticals, drug companies risk millions of dollars and years of work to shepherd basic scientific discoveries through laboratory and human testing in the hope of developing a marketable drug. For example, it is estimated that in 2002 alone, pharmaceutical companies invested $45 billion the development of new medicine worldwide.

While the profit incentive generates such enormous private investment in human drug development, it also encourages firms to pose inappropriate risks to the safety of human subjects when speeding a new drug to the market. The risks posed by financial conflicts of interest associated with human subjects research on new pharmaceutical products are notable examples, both in the U.S. and internationally.
NAFTA & the Alien Tort Claims Act: Making a Case for Actionable Offenses Based on Environmental Harms and Injuries to the Public Health
Authors: Prussia Kevin Scott
Published: January 2017

Multinational corporations often wield more power than many of the world's nations. Their immense wealth and political capital make them almost hegemonic entities. These domineering enterprises are often able to undertake profit-making endeavors, particularly involving the consumption or extraction of natural resources, in developing nations with little or no regulation, and often without meeting the social and environmental standards adhered to in the United States.

The emergence of multilateral free trade agreements, specifically within the developing world, has further enhanced the ability of multinational corporations to proliferate their business. Concomitant with the rise of free trade, political and legal barriers to multinational entry into the economy of developing nations are rapidly disappearing. In addition, many nations are unwilling and unable to protect their citizens from environmental abuses through domestic law. Therefore, finding a legal mechanism capable of checking the hegemonic power of multinational corporations is extremely important to the vitality of most developing nations.
Healing Medicare Hospital Recidivism: Causes and Cures
Authors: Marciarille Ann Marie
Published: January 2017

The role of Medicare in our national market for acute care hospital services is that of a power buyer. Medicare beneficiaries in 2008 included some 45.2 million people. Total benefits paid in 2008 were $462 billion, including 29% of all hospital spending. Medicare's dominance in the buyer's market for acute care hospital beds renders the program particularly wellsuited to scrutinize the role of acute care hospital services in producing effective and efficient outcomes for Medicare beneficiaries. “[I]f there are to be far-reaching changes in the way medicine is practiced in this country, Medicare will have to drive them.” It is a historical irony that a program, a scaled-down version of national health insurance, could have grown to this power buyer status; but the history of Medicare is full of ironies—the greatest of which may prove to be that Medicare reforms now sit at the very center of the funding mechanisms for the 2010 Patient Protection and Affordable Care Act (PPACA).
Planning for Pandemic: A New Model for Governing Public Health Emergencies
Authors: Gerwin Leslie E.
Published: January 2017

Imagine the following scenario:

The Centers for Disease Control confirms the appearance of a heretofore-unknown virus. It appears highly contagious since it is spreading easily between human beings. At this initial stage, the largest cohort of victims is youth in their late teens.

There is no geographic locus of the disease or single identifiable index case from which the virus's origin can be determined. The disease is independently prevalent in many geographic areas, particularly among those living in the inner cities of major metropolitan areas in the United States and in some of the densely populated immigrant enclaves in European cities.

At this point, the mortality is uncertain although in its early phase it is at least as deadly as a seasonal flu. It is the end of May: young people are dreading final exams, anticipating their high school and college graduations, and looking forward to the many end of the year celebrations. The weather is getting warmer, and the public pools are about to open. Despite the hot weather, the prevalence of the disease is not significantly waning.

Americans are nervous. They want answers. They expect their government to protect them.
The Individual Mandate as Healthcare Regulation: What the Obama Administration Should Have Said in NFIB v. Sebelius
Authors: Moncrieff Abigail R.
Published: January 2017

There was an argument that the Obama Administration's lawyers could have made—but didn't—in defending Obamacare's individual mandate against constitutional attack. That argument would have highlighted the role of comprehensive health insurance in steering individuals' healthcare savings and consumption decisions. Because consumer-directed healthcare, which reaches its apex when individuals self-insure, suffers from several known market failures and because comprehensive health insurance policies play an unusually aggressive regulatory role in attempting to correct those failures, the individual mandate could be seen as an attempt to eliminate inefficiencies in the healthcare market that arise from individual decisions to self-insure. This argument would done a better job than the Obama Administration's of aligning the individual mandate with existing Commerce Clause and Necessary and Proper Clause precedent, and it would have done a better job of addressing the conservative Justices' primary concerns with upholding the mandate. This Article lays out this forgone defense of the individual mandate.
Protective Role of Faecal pH in Experimental Colon Carcinogenesis
Authors: Samelson Scott L , Nelson Richard L , Nyhus Lloyd M
Published: January 2017

There is epidemiological evidence that populations with alkaline stool pH are at greater risk for colon cancer than populations with acid stool pH. This association was investigated in the laboratory using the rat-dimethylhydrazine colon carcinogenesis model. Rats with acid stool pH, produced by consumption of lactulose or sodium sulphate or both, had significantly fewer colon tumours after injections of dimethylhydrazine (DMH) than rats treated with DMH alone. The results confirm the hypothesis that acidification of the stool can protect against the induction of colon cancer.
Ring Uncemented Plastic on Metal Hip Replacements-Results from an Independent Unit
Authors: Mok D W H , Bryant K M
Published: January 2017

We present 251 Ring uncemented plastic on metal (UPM) hip replacements with a follow-up of 2–5 years. Judging the functional results by the Harris hip evaluation for the surviving 234 hips, 79.8% were good to excellent, 11.7% fair, and 8.5% poor at an average of 3 years. The mortality within one month of surgery was 0.79%. There were 4 cases of deep infection (1.59%), 3 of which required excision arthroplasty. At 3 years, 6 hips (2.39%) had required revision, all for aseptic femoral loosening, 2 of which also had acetabular loosening.

Ring UPM hip is both safe and reliable in the hands of many surgeons outside Ring's unit.
Supercritical CO2-involved water–rock interactions at 85℃ and partial pressures of 10–20 MPa: Sequestration and enhanced oil recovery
Authors: Wang Xiaoyu , Wang Xiaolin , Hu Wenxuan , Wan Ye , Cao Jian , Lv Chengyuan , Wang Rui , Cui Maolei
Published: January 2017

Studying the interactions between CO2-rich fluid and reservoir rock under reservoir temperature and pressure is important for investigating CO2 sequestration and the CO2-enhanced oil recovery processes. Using high-concentration CaCl2-type formation water as an example, this study performed a CO2-rich fluid–rock interaction experiment at 85℃ and compared the dissolution of calcite and sandstone samples, as well as sandstone powder and thin-slice samples. This study also investigated the effects of the sample surface area, the CO2 partial pressure ( PCO2 = 10 and 20 MPa), and the composition of formation water (3 mol/kg NaCl and 1 mol/kg CaCl2–2 mol/kg NaCl) on the water–rock interaction mechanism and process by weighing, ion chromatography, and scanning electron microscopy observations. The results showed that the injection of CO2 resulted in the dissolution of reservoir minerals such as carbonate cements and feldspar. The mineral dissolution increased with increasing PCO2. The dissolution of minerals such as calcite in the CaCl2-type formation water was significantly decreased because of the high concentration of Ca2+. Under the same conditions, more sandstone dissolved than calcite and more sandstone powder dissolved than sandstone thin slices. Dissolution of the potassium feldspar occurred in the sandstone, whereas the albite was nearly unaffected. No new minerals formed during the experimental process. The experimental results and a PHREEQC calculation demonstrated that the injection of CO2 causes a significant pH drop in the formation water, which improves the porosity and permeability of the reservoir, increases the capacity of the reservoir to store CO2, and facilitates the progression of the CO2-enhanced oil recovery process. However, if alkaline minerals in the caprocks of the reservoir are also dissolved by the CO2-rich fluid, the sealing capacity of the caprocks may be reduced.
Short-lag Spatial Coherence Ultrasound Imaging with Adaptive Synthetic Transmit Aperture Focusing
Authors: Zhao Jinxin , Wang Yuanyuan , Yu Jinhua , Guo Wei , Zhang Shun , Aliabadi Saeid
Published: January 2017

The short-lag spatial coherence (SLSC) imaging has been demonstrated to be advantageous over the traditional B-mode ultrasound imaging. With focused scanning beams, the SLSC imaging has an excellent performance in clutter reduction and lesion detection, especially in the low signal-to-noise ratio (SNR) scenarios. The synthetic aperture (SA) imaging is an appropriate mode for the SLSC imaging as the dynamic transmit focusing could keep a good focusing quality at any depth. However, the SLSC image may still suffer a bad resolution performance when a low lag value is used in the coherence summation to ensure the contrast enhancement. In this paper, an adaptive synthetic transmit (Tx) aperture focusing strategy is proposed for the SLSC imaging with the SA mode. Based on the achievements of adaptive beamforming, a minimum variance beamformer is applied in the Tx aperture to realize adaptive focusing. Spatial coherence is then measured in the receive aperture to form the SLSC image. Simulation and experimental studies were conducted to evaluate the proposed method. Experiments showed that the proposed method not only improved the poor resolution of the original SLSC image but also enhanced the speckle performance, which led to increased contrast-to-noise ratio and speckle SNR values.
Topical and low-dose intravenous tranexamic acid in cyanotic cardiac surgery
Authors: Patel Jigar , Prajapati Mrugesh , Patel Hardik , Gandhi Hemang , Deodhar Shilpa , Pandya Himani
Published: January 2017

Background

Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both.

Methods

Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg−1 intravenously after sternotomy and 20 mg kg−1 after heparin reversal. Group B patients were given tranexamic acid 50 mg kg−1 in 20 mL of saline intrapericardially before sternal closure, with the drain clamped for 20 min. Group C patients were given tranexamic acid 20 mg kg−1 intravenously after sternotomy and 50 mg kg−1 intrapericardially before sternal closure. A number of clinical variables were recorded in the first 3 postoperative days. Ventilator time, intensive care unit stay, and outcome were also recorded.

Results

Chest tube drainage and blood product requirements were lowest in group C. Blood urea and serum creatinine levels were higher in groups A and C ( p < 0.05). Intensive care unit stay and ventilator time were similar in all 3 groups. No patient died and none had a seizure or other neurological event or thromboembolic complication postoperatively.

Conclusion

The combination of low-dose intravenous and topical tranexamic acid reduces postoperative blood loss and blood product requirement without incurring neurological, renal or thromboembolic complications. We recommend the routine use of topical and low-dose systemic tranexamic acid in cyanotic pediatric cardiac surgery.
Ovarian Vein Embolisation as an Adjunct in the Treatment of Vulval and Atypical Leg Varicosities
Authors: Garrett J. P. , Wetton C. W. N. , Tyrrell M. R.
Published: January 2017

Objective:

To assess the safety and technical success of percutaneous transcatheter embolisation of ovarian veins as an adjunct in the treatment of vulval and leg varicosities.

Design:

Prospective case series.

Setting:

Vascular surgery and radiology departments of a District General Hospital.

Patients:

Thirteen patients with atypical leg and vulval varicosities.

Interventions:

Via a transbrachial approach, selective cannulation of the ovarian veins was performed. If preliminary venography showed ovarian vein incompetence, transcatheter embolisation of the ovarian veins was performed.

Results:

In 12 of 13 cases, venography proved incompetence of the ovarian veins. The ovarian veins were successfully embolised in all of these (8 bilaterally, 4 unilaterally). Complete occlusion requires long (20 cm) coils to the main vessels. There were no significant complications.

Conclusion:

This procedure is safe and well tolerated. It confirms incompetence of the ovarian veins in selected patients and allows for embolisation in the majority.
Treatment of Varicose Veins by Foam Sclerotherapy: Two Clinical Series
Authors: Cavezzi A. , Frullini A. , Ricci S. , Tessari L.
Published: January 2017

Objective:

To assess the efficacy and safety of sclerotherapy of varicose veins (VV) with sclerosing foam (SF) made using Tessari's method (three-way tap and two plastic syringes).

Design:

Two multi-centre prospective clinical series were documented (CS1 and CS2). In CS1, which ran from March to December 2000, 177 patients (39 men, 138 women), mean age 56 years, were treated in three centres for W related to incompetence of saphenous veins, recurrence, perforators or collaterals. Conventional or duplex-guided sclerotherapy was performed using SF made of purified sodium tetradecyl sulphate (PSTS) 0.2−3% (Fibro-vein, STD Pharmaceuticals, UK) and air. An average of 1.6 (SD 0.8) sessions per patient were performed and 2.9 (SD 1.0) ml of SF (i.e. 0.6 ml of PSTS) per session was employed. An elastic stocking providing 20 −30 or 30−40 mmHg compression was worn by patients following treatment. All the patients were reviewed (clinical examination and colour duplex ultrasonography) at 1 month. Sixty-six patients had a further follow-up 45−370 days after treatment. The 17 patients in CS2, a multi-centre study, were treated in March and April 2001. An independent observer assessed patients with major W (CEAP and W type distribution similar to CS1) before and after the treatment, and also observed the treatment, which was carried out using the technique employed in CS1.

Results:

In CS1 at 1 month follow-up there was: (A) obliteration of the vessel or antegrade flow in 161 (91%) patients, (B) minimal retrograde flow in the treated vein, without visible W, in 15 (8.4%) cases and (C) persistence of vessel patency with retrograde flow and visible W (failure) in 1 (0.6%) case. At 45−370 days (mean 138 days) follow-up results were: type A in 44 (67%) cases, type B in 17 (26%) cases and type C in 5 (8%) cases. The main complications were extension of sclerothrombus from superficial to deep veins (n = 2), allergy (n = 1), malaise (n = 1) and scotoma (n = 1). In CS2 at 30 days follow-up 100% of the treated venous segments had a type A outcome after an average of 1.4 sessions. No relevant complication occurred in this series.

Conclusions:

Sclerotherapy of major VV by means of SF prepared by Tessari's method is a safe and effective form of treatment. Low doses and a low concentration of drug may be successfully employed. Further studies are needed to establish the long- term results and overall safety of this form of foam sclerotherapy.
Surgical Treatment of Popliteal Vein Entrapment Causing Symptoms
Authors: Hirokawa M. , Iwai T. , Inoue Y. , Sato S.
Published: January 2017

Objective:

To review series of cases in which surgery was used to treat popliteal vein entrapment (PVE).

Methods:

Between 1984 and 2001, 11 patients (all women; mean age 27.6 years; 14 limbs) underwent surgery for PVE causing calf ache, swelling, and tenderness of the popliteal fossa. Preoperative evidence of PVE included positive results on a passive dorsi-flexion test, compression of the popliteal vein on ascending venography, hypertrophied or aberrant muscle in the popliteal fossa on CT scanning and elevated below-knee venous pressure. The medial or third head of the gastrocnemius muscle was partly or totally resected under the guidance of intraoperative venous pressure measurement and venography.

Results:

No operative complications occurred. During 3-10 years of follow-up, 57% of limbs were symptom-free, 21% were improved and 21% were unchanged.

Conclusion:

Treatment of PVE by resection of muscle fibres under the guidance of objective intraoperative assessments was effective in most patients.
The Incidence, Diagnosis and Management of Sapheno-Popliteal Incompetence
Authors: Sheppard Mark
Published: January 2017

The great variation in the reported incidence of S-P incompetence suggests that it is often overlooked in patients with varicose veins. In a small series of 200 patients the incidence of S-P incompetence was 24%. Recurrent varicose veins were due to primary S-P incompetence in 36% of legs (following S-F ligation) and recurrent S-P incompetence in 14%. The diagnosis is made on clinical and Doppler examination. Surgical management requires a sound knowledge of the anatomical and pathological variations in the popliteal fossa, and a wide exposure to ensure flush S-P ligation. Recurrent S-P incompetence is usually due to inefficient surgery, but may be due to ‘regrowth’ following flush S-P ligation.
Venous Pressure Gradients in Patients with Chronic Venous Disease
Authors: Stranden Einer , Øgreid Per , Seem Egil
Published: January 2017

Venous pressure was measured simultaneously in a vein of the calf and the foot in five healthy controls and 10 patients with superficial chronic venous insufficiency (CVI). In both groups ambulatory venous pressure decreased more in the foot veins than in the calf veins. In patients with CVI the mean difference in foot and calf ambulatory venous pressure reduction (AVPR) was 25.5 mmHg, as was found in the controls (24.6 mmHg). During compression of superficial veins the difference in AVPR was reduced in patients but not in controls (11.6 vs 27.0 mmHg, respectively). About 50% of this difference in AVPR could be ascribed to the difference in cannulation height (except for the meaurement with superficial compression in patients where the whole difference in AVPR could be ascribed to the difference in cannulation height). Pressure changes during ambulation in the dorsal foot vein and calf veins may differ considerably, dependent on the existance of a specific foot vein pump and sufficiency of venous valves at the level of the ankle. Therefore, veins proximal to the ankle should be used for pressure recordings in the evaluation of chronic venous insufficiency in the calf.
Graded compression Stockings with and without Heparin-Dihydroergotamine in the Prevention of Deep Venous Thrombosis following Elective Hip Alloplasty
Authors: Wille-Jørgensen P. , Bjerg-Nielsen A. , Christensen S. Winter , Stadeager C. , Kjær L. , Vestergaard Aa. , Widding A.
Published: January 2017

Two hundred and five patients scheduled for total hip alloplasty were randomized to one of the following two regimes, in order to prevent postoperative thromboembolism. (1) Graded compression stockings and heparin 5000 iu/dihydroergotamine 0.5 mg twice a day subcutaneously. (2) Graded compression stockings and placebo twice a day subcutaneously. Screening for deep venous thrombosis (DVT) was carried out by 99mTc-plasmin scintimetry and whenever this was indicative for DVT, ascending phlebography was performed. The definitive criteria for DVT were intraluminal filling defects on phlebography. If DVT was diagnosed, pulmonary perfusion/ventilation scintigraphy was performed. In the group receiving heparin/dihydroergotamine 11 of 96 patients (11%) developed DVT and in the placebo group 25 of 109 patients (23%) developed DVT (P < 0.05). One patient in the combination treatment group and seven patients in the placebo group developed pulmonary embolism ( P < 0.05). It is concluded that the combination of graded compression stockings, low dose heparin and dihydroergotamine is superior to graded compression stockings alone in preventing thromboembolism following total hip alloplasty.
Are Arterial and Venous Disease Mutually Exclusive?
Authors: Biegeleisen K. , Nielsen R.D.
Published: January 2017

In our private medical practice, which consists of virtually 100% patients with superficial and/or deep venous insufficiency, we have observed incidences of hypertension, angina and intermittent claudication which are so strikingly low that we felt obliged to attempt to validate this observation statistically. We have been able to show that the blood pressures of our patients are lower than those of controls, and that the differences are highly significant. With respect to the low incidences of angina and intermittent claudication in our patients, statistical proof of an inverse relationship with venous disease cannot come from our private practice alone. Proof could be quickly obtained by a statistical study employing existing data in government or health insurance databases, whose cooperation we have thus far not succeeded in obtaining. The main purpose of this article is to stimulate further interest in these relationships, which, if confirmed, have obvious health implications.
How Should Resistant Varicose Veins Be Sclerosed?
Authors: Tournay Raymond
Published: January 2017

In answer to a reader's question, Dr Tournay describes the types of varicose vein likely to be resistant to treatment by injection sclerotherapy and recommends the principles to be followed to achieve good results. These include choice and volume of sclerosant, injection technique, leg elevation and the ‘collapsed vein’ technique and firm compression bandaging.
Complementary Treatment of Varicose Veins — A Randomized, Placebo-Controlled, Double-Blind Trial
Authors: Ernst E. , Saradeth T. , Resch K. L.
Published: January 2017

The aim of this study was to test the effectiveness of a combined homeopathic medication in primary varicosity. A well-defined population of 61 patients was randomized into active medication (Poikiven®) or placebo. Both were given for 24 d. At the start of the trial, after 12 d medication and at the end of the study, objective and subjective parameters were recorded: venous filling time, leg volume, calf circumference, haemorheological measurements and patients' symptoms such as cramps, itching, leg heaviness, pain during standing and the need to elevate the legs. The results show that venous filling time is changed by 44% towards normal in the actively-treated group. The average leg volume fell significantly more in this group, but calf circumferences did not change significantly and blood rheology was not altered in any relevant way. None of the patients reported side-effects. Subjective complaints were relieved significantly more by Poikiven than by placebo. These results suggest that the oral treatment of primary varicosity using Poikiven is feasable.
An Italian Survey on the Prophylaxis of Venous Thromboembolism
Authors: Belcaro G. , Laurora G. , D'Aulerio A. , Ricci A. , Mezzanotte A.
Published: January 2017

Objective:

To determine the current usage of prophylactic regimes to prevent deep vein thrombosis in surgical departments in Italy.

Design:

Survey by questionnaire sent to 500 surgical departments.

Participants:

Surgical departments performing more than 500 surgical operations, selected randomly by the process of quota sampling.

Main outcome measures:

Assessment of the methods or prophylaxis, reasons for use of prophylaxis and assessment of outcome of prophylactic measures.

Results:

There were 326 completed questionnaires returned indicating that prophylaxis was used routinely in 58% of the centres, 29% of centres used more than 1 method of prophylaxis with subcutaneous heparin and elastic compression being the most commonly used modalities.

Conclusion:

Insufficient use of prophylactic measures to prevent deep vein thrombosis in Italy still leads to an excessive number of postoperative venous thromboses.
A Retrospective Follow-up Study of Patients with Suspected Deep Vein Thrombosis and Negative Results of Colour Duplex Ultrasound
Authors: Norén A. , Lindmarker P. , Rosfors S.
Published: January 2017

Objective:

Investigation of the frequency of symptomatic venous thromboembolic disease 3 months after negative results of colour duplex ultrasound investigation of the lower extremities in patients with suspected deep venous thrombosis (DVT).

Design:

Retrospective analyses of consecutive ultrasound investigations and a survey in patients with normal findings.

Setting:

Patients were investigated at two clinical vascular laboratories in teaching hospitals.

Main outcome measures:

Objective verification of symptomatic venous thromboembolism during 3 months follow-up by a questionnaire and retrospective analyses of diagnostic procedures for venous thromboembolism.

Results:

Eighty-seven per cent answered a questionnaire and the majority had temporary symptoms which were explained by other diagnoses than DVT. In one patient a DVT was phlebographically verified 1 week after the ultrasonographic investigation, which showed only superficial thrombophlebitis.

Conclusion:

Patients with suspected DVT and a negative colour duplex investigation of the deep veins are unlikely to develop clinically important venous thromboembolic disease within 3 months.