bluuebunny/crossref_metadata_2025 huggingface dataset:
Angiotensin-Converting Enzyme Inhibitors an Angiotensin II-Receptor Antagonists
Authors: Pfaffendorf Martin
Published: October 2008

The renin-angiotensin-aldosterone system (RAAS) is one of the main targets in the pharmacotherapy of cardiovascular diseases. Inhibitors of the angiotensin- converting enzyme (ACE) have been in clinical use for years and a great deal of experience exists with this particular group of drugs. However, the therapeutic effect is based on the inhibition of an enzyme (ACE) that is not very specific. Another substrate is bradykinin, a well-known mediator of inflammation and a potent inductor of vasodilatation and bronchoconstriction. Dur ing therapy with an ACE inhibitor, the inactivation of bradykinin by cleavage of the carboxyterminal end of this nonpeptide is blocked as well, with the result of bradykinin accumulation. The pattern of adverse effects seen with ACE inhibitors is mainly determined by bradykinin-mediated actions such as edema and cough. Therefore, the inhibition of the RAAS at the level of the transmitter-receptor interaction seems to be a logical development. Because nonpeptide (ie, orally active) angiotensin II (AT) receptor antagonists are available, this concept can be proven.
Calcium Antagonists for Perioperative Blood Pressure Control
Authors: Nordlander Margareta , Pfaffendorf Martin , van Wezel Harry B.
Published: October 2008

Calcium entry blockers constitute three major classes of pharmacologic agents: phenylalkylamines (eg, verapa mil), benzothiazepines (eg, diltiazem), and dihydropyri dines (eg, nifedipine). The effectiveness of all types of calcium channel blockers in the prevention and treat ment of coronary artery disease as well as chronic and acute hypertension is undisputable. Their beneficial clinical effects may be due to peripheral and coronary vasodilatation, resulting in reduction in myocardial oxy gen consumption, and an increase in myocardial oxy gen supply in addition to their antispasmodic effect and the ability to prevent intracellular calcium overload. For the management of perioperative hypertension develop ing in patients undergoing cardiac or noncardiac sur gery, the dihydropyridines appear to be especially suit able. Intravenous (IV) formulations of nifedipine, nicardipine, and isradipine have been successfully used in this setting. At the present time, nicardipine is the most widely used IV dihydropyridine. This is due to its potent afterload-reducing activity and relatively short duration of action, although its effect may increase the longer the drug is being infused. The ideal drug for perioperative blood pressure control should be one with the pharmacodynamic profile of the vascular selec tive dihydropyridines, but with an ultrashort duration of action.
ATP-Sensitive Potassium Channel Openers and Blockers in the Cardiovascular System: Physiology, Pharmacology, and Clinical Effects
Authors: Schotborgh Carl E. , Wilde Arthur A.M.
Published: October 2008

Adenosine triphosphate (ATP)-sensitive potassium chan nels (K.ATP channels), a subclass of potassium channels activated by a low intracellular ATP concentration, have been described in various tissue types, including the heart muscle and vascular smooth muscle. In ventricu lar myocytes, activation of these channels is considered protective, because their activation caused by hypoxia or ischemia results in cell energy preservation. Activa tion of K.ATP channels in vascular smooth muscle cells causes hyperpolarization of the cell membrane, muscle cell relaxation, and vasodilation. Potassium channel openers are pharmacologic activators of K.ATP chan nels. Their protective effects on the ischemic myocar dium and their vasodilating properties have been stud ied extensively. Sulfonylurea derivatives, widely used in the treatment of noninsulin-dependent diabetes melli tus, are considered selective blockers of K.ATP channels and have been used in many experiments to show K.ATP channel involvement. This article focuses on these issues and the clinical effects and potentials of K.ATP channel modulation.
Current Hematologic Issues in Cardiac Surgery and Cardiopulmonary Bypass
Authors: Weisinger Andrew S. , Levy Jerrold H.
Published: October 2008

Recently, new attempts have been made to fight old problems of coagulation and hemostasis as they relate to cardiac surgery. These discoveries are timely because the practice of both internists and surgeons has begun to change. Newer and more potent medications are being used by cardiologists in an effort to exert better control over hemostatic mechanisms with the hope that this may eventually improve the chances for sur vival of patients with coronary artery disease. In addi tion, cardiac surgeons have been more aggressive in voicing their concerns that cardiopulmonary bypass (CPB) is nothing more than a necessary evil. More and more surgeons are performing coronary artery bypass surgery (CABG) without the use of a CPB machine when possible. Cardiac anesthesiologists are expected to take patients from the emergency room (where they may have received thrombolytics), from the catheterization laboratory (where they may have received antiplatelet agents), and from the intensive care unit (where they may have received heparin) to the operating room, where they will undergo further anticoagulation therapy and then have their blood exposed to a thrombogenic surface for up to several hours. It is even more impor tant to ensure that this is all reversed at the end of surgery. The answers to these problems are not entirely available yet; however, one piece of the puzzle has been found. What follows is a review of hemostatic balance in patients who present for cardiac surgery and how this relates to thrombin, the center of the coagulation universe. It is believed that by better control of the generation of thrombin during CPB, patients may have better results from anticoagulation therapy during sur gery and have fewer problems with bleeding after surgery. A discussion on the newest attempt at this, antithrombin III, follows.
Blood Substitutes in Cardiac Surgery
Authors: Wahr Joyce A. , Tremper Kevin K.
Published: October 2008

A safe, inexpensive, noninfectious substitute for red blood cells has long been sought. Despite tremendous advances in blood banking, the logistics of collecting, transporting, and storing human red blood cells contin ues to create infection and shortage problems. The two basic types of blood substitutes currently under devel opment are hemoglobin based and fluorocarbon based. Although they each transport oxygen differently, the basic advantages and limitations are the same. Blood substitute advantages include the unique capacity for room temperature storage, noninfectivity, adequate supply, and low toxicity. Restrictions include limited dosing in the acute period, limited intravascular half-life and, for the fluorocarbons, a requirement for a high PaO2. In addition, there remain questions about the relationship of nitric oxide metabolism to hypertension in hemoglobin solutions. Early clinical and laboratory trials have shown that both types of solutions are effective oxygen-delivery agents, with acceptable side- effect profiles. Clinical trials are currently underway to determine the safety and efficacy of these solutions in patients undergoing cardiopulmonary bypass.
Optimal Temperature Management During Cardiopulmonary Bypass: Warm, Cold, or Tepid?
Authors: Mangano Christina Mora
Published: October 2008

Hypothermia permitted the advent of cardiac surgery and is considered by many the mainstay of cerebral protection during cardiopulmonary bypass (CPB). How ever, some clinicians have questioned the importance of reduced temperatures during CPB and advocate "normo thermic" heart surgery. Hypothermia (mild, moderate, and profound) provides protection during periods of inadequate oxygen delivery by at least two mecha nisms. First, metabolic rate is directly related to tempera ture ; therefore, reduced temperatures increase toler ance to inadequate oxygen delivery. Q10 values (the ratio of metabolic rates at temperature X°C and tempera ture X°C - 10°C) are controversial and are reported as varying between 2.0 and 5.0. During profound hypother mia (temperature = 17°C), metabolic requirements are 10% to 15% of normothermic values. Second, reduced temperatures (even minimal reductions [34°C to 35°C]) attenuate the release of glutamate and other excitatory amines from ischemic neuronal cells. This phenomenon is thought to play an important role in hypothermic cerebral protection. Many investigators have assessed the impact of normothermic temperatures on cerebral outcomes in cardiac surgery patients. Although seem ingly conflicting conclusions are reported, this much is clear: cerebral temperatures in excess of 37°C exacer bate ischemic injury and even mild hypothermia re duces central nervous system damage in the ischemic brain.
Quality of Life After Coronary Artery Bypass Surgery: Past Progress and Future Directions
Authors: Cartwright Christopher R. , Mangano Christina Mora
Published: October 2008

Historically, morbidity and mortality have been the primary outcome measures in coronary artery bypass research. Limited health care resources have led to greater emphasis on cost as a primary outcome mea sure. These are each important measures, but they fail to directly assess what patients care about, which is their overall quality of life (QOL). When QOL is used as an outcome in medical research, it should encompass at a minimum the following domains: physical status, mental function, social interaction, and disease-specific measure. Fortunately, QOL assessment instruments already exist that are reliable, valid, and sensitive to change. This article describes how QOL is defined, what instruments are available, how they have been devel oped, and how they are selected. Next, QOL in the coronary artery bypass literature is reviewed. This in cludes both the large randomized trials as well as studies focusing solely on QOL. Finally, future directions for QOL as an outcome measure are examined.
Strategies and Techniques for Neuroprotection in Coronary Artery Surgery
Authors: Murkin John M.
Published: October 2008

Patients undergoing coronary artery bypass grafting are at higher risk of neurologic events than demographi cally similar patients undergoing noncardiac surgery. Postoperative stroke has been shown to occur two to three times more frequently than in age-, gender-, and education-matched patients undergoing noncardiac vas cular or thoracic surgery. The incidence of more subtle brain syndromes, giving rise to symptoms of memory loss and cognitive deterioration as documented in up to 79% of coronary bypass patients, varies depending on whether prospective or retrospective data are analyzed, and whether or not serial cognitive testing is used, and is also significantly higher in coronary bypass patients. Various factors have been identified as causative in the genesis of perioperative neurologic injury in these pa tients. Although there is evidence that microgaseous and microparticulate emboli are instrumental in the production of postoperative cognitive impairment, the role of ascending aortic atherosclerosis is increasingly recognized as being the greatest single risk factor for postoperative stroke.
Heparin-Bonded Circuits Decrease Thromboembolic Complications and Improve Outcomes in Patients Undergoing Coronary Artery Bypass Graft Surgery
Authors: Aldea Gabriel S.
Published: October 2008

Two prospective, randomized studies were performed to definitively evaluate the safety and efficacy of heparin- bonded circuits in patients undergoing primary coro nary artery bypass graft surgery and to clarify the effect of anticoagulation protocol on clinical and neurologic outcomes. These studies showed that the use of heparin- bonded circuits with lower anticoagulation results in markedly improved clinical outcomes in patients under going primary coronary artery bypass graft surgery with a reduction in both clinical and microscopic throm boembolic risks. The mechanisms by which heparin- bonded circuits affect clinical and neurologic outcomes are explored.
Stroke Reduction: Diagnosis and Management of the Atherosclerotic Ascending Aorta During Cardiac Surgery
Authors: Hogue Charles W. , Barzilai Benico , Dávila-Román Victor G.
Published: October 2008

Neurologic injury is the most devastating complication of cardiac surgery, and leads to excessive morbidity, mortality, and increased health care costs. Ascending aorta atherosclerosis is one of the most important risk factors for perioperative stroke, particularly in the el derly. As the number of elderly patients undergoing cardiac surgical procedures continues to increase, it is likely that the frequency of postoperative neurologic complications will increase as well. Strategies aimed toward the identification of high-risk patients include screening for carotid artery disease and ascending aorta atherosclerosis. Epiaortic ultrasound provides high- resolution images of the ascending aorta that allow for evaluation for the presence of atherosclerosis. Minor modifications in the operative technique based on the epiaortic ultrasound findings are easy to perform and require minimal training and relatively inexpensive equipment. Nonrandomized studies that use epiaortic ultrasound have reported perioperative stroke rates that are lower than those in which this approach is not used, suggesting that identification of high-risk patients and minor modifications in the operative technique may lower perioperative stroke rates without increasing operative risk. Prospective, randomized trials are needed to evaluate whether more aggressive changes in surgi cal techniques and/or the use of neuroprotective agents in high-risk patients may prevent neurologic complica tions associated with cardiac surgery.
Thoracoabdominal Aortic Aneurysm Repair: Reducing the Incidence of Paraplegia
Authors: Murray Michael J. , De Ruyter Martin L. , Torres Norman E. , Lunn Jeffrey J. , Harrison Barry A.
Published: October 2008

Paraplegia is a major complication associated with repair of thoracoabdominal aortic aneurysms (TAAA). A number of therapies have been tried over the years, none of which has been successful. Recently, regional lumbar epidural cooling has been tried in an attempt to prolong the safe ischemic time during aortic cross- clamping. In approximately 90 patients in whom the authors have tried this technique, there was no de crease in the incidence of paraplegia in patients with type II TAAAs. This is perhaps not unanticipated be cause the paraplegia is related to a number of factors including the duration of the aortic cross-clamping, the adequacy of collateral circulation, embolization during the procedure, and perhaps thrombosis in situ. Given the multimodal cause of paraplegia, perhaps it is naive to think that a single therapy would be of benefit. Additional studies are necessary to explore the mecha nisms and to prove efficacy or lack of benefit of any techniques designed to decrease the incidence of paraplegia in patients undergoing TAAA repair.
Rationale and Surgical Techniques for Emerging Procedures in Cardiac Surgery
Authors: Singer Raymond L.
Published: October 2008

New techniques continue to emerge in cardiac surgery. This article reviews the history, rationale, techniques, and controversies regarding a variety of novel ap proaches to minimally invasive chest surgery. The suc cess of video-assisted thoracoscopy heralded the mod ern era of these techniques and also serves to illustrate its limitations. Minimally invasive cardiac procedures are outlined with a discussion of the benefits and risks, as well as the media and marketing pressures on surgeons. In addition, robot-assisted surgery and future trends are presented.
Anesthesia and Analgesia for Minimally Invasive Direct Coronary Bypass and Other "Beating Heart" Surgical Procedures
Authors: Smith Mark Stafford
Published: October 2008

Minimally invasive direct coronary artery bypass and transmyocardial laser revascularization are examples of "beating heart" surgery which embrace new medical concepts, and the philosophy that less invasive cardiac procedures (eg, smaller incisions, avoidance of cardio pulmonary bypass) can safely achieve surgical goals. Patient and care provider expectations must be aligned with these issues if potential benefits are to be trans lated into improved patient outcome with accelerated recovery, and reduced cost for health care systems and society. There is a major role for anesthesiologists in this process, including patient and care provider educa tion, anesthetic design to appropriately involve fast- tracking principles and analgesia strategies, and the development of safe postoperative care plans outlining criteria for accelerated recovery and reduced intensive monitoring. Although enthusiasm is currently fuelling the widespread introduction of "beating heart" surgery, evidence for comparison of these procedures to tradi tional techniques is currently insufficient to confirm that they will become the established practice. Copyright© 1999 by W. B. Saunders Company.
Port-Access Cardiac Surgery: Anesthetic Techniques, Equipment, Applications, Experience, and Outcomes
Authors: Siegel Lawrence C.
Published: October 2008

Port-Access (Heartport, Inc, Redwood City, CA) mini mally invasive surgery has been developed to allow surgeons to complete a wide variety of cardiac surgical procedures while avoiding a median sternotomy and the associated trauma and debility. Cardiopulmonary bypass is established using the EndoDirect (Heartport, Inc) or EndoCPB systems which consist of five catheters and cannulae providing the same functions as those used in conventional cardiac surgery. These systems enable surgeons to obtain appropriate myocardial pro tection, circulatory support, and operating conditions while operating through a small intercostal incision or port. Transesophageal echocardiography and/or fluoros copy are used to evaluate patient anatomy including assessment of the aorta, to facilitate the placement of catheters and cannulae, and to monitor during the conduct of cardiopulmonary bypass. Clinical reports have shown broad applicability of Port-Access proce dures with favorable outcomes. Morbidity and mortal ity compare well with reported rates for conventional surgery. Experience with multivessel coronary artery bypass grafting suggests that complete revasculariza tion for all coronary beds can be accomplished using a variety of venous and arterial conduits. Clinical studies suggest that Port-Access surgery is associated with short postoperative duration of tracheal intubation, intensive care unit stay, and hospital stay, a low inci dence of new-onset atrial fibrillation, and rapid return to normal activities. Clinical experience continues to ex pand the indications for Port-Access minimally invasive cardiac surgery as well as to refine and enhance surgical procedures.
Myocardial Preconditioning: Characteristics, Mechanisms, and Clinical Applications
Authors: Chen Huei-Sheng Vincent , Body Simon C. , Shernan Stanton K.
Published: October 2008

Perioperative myocardial ischemia and dysfunction re main prevalent after cardiac surgery despite the use of conventional measures to provide myocardial protec tion. Myocardial preconditioning is a powerful, endog enously regulated means of myocardial protection that may also have some clinical usage for patients undergo ing cardiac surgical procedures. The paradoxical con cept of using ischemia as a stimulus for myocardial protection has been studied extensively in animals and humans. The specific characteristics and constituents of preconditioning have been well identified. The mecha nism remains to be completely elucidated due to differ ences among species and experimental models. Some pharmacologic agents are capable of mimicking the classic mechanism of ischemic preconditioning. Pharma cologic and ischemic preconditioning may have signifi cant clinical use and therapeutic efficacy as a means of providing myocardial protection during cardiac surgery, especially in procedures that do not use cardioplegia and cardiopulmonary bypass, such as minimally inva sive coronary artery bypass grafting. This article re views the characteristics, mechanisms, potential clini cal applications, and therapeutic efficacy of myocardial preconditioning.
Minimally Invasive Cardiac Surgery: Impact on Resource Usage, Costs, Length of Stay, and Return to Function
Authors: Ghotbi Muhammad S. , Ramsay James G.
Published: October 2008

"Minimally invasive" approaches to coronary artery surgery include a number of procedures, most of which avoid the use of extracorporeal circulation. Economic considerations have contributed to the rising interest in these techniques. This article reviews current literature and potential ways in which these procedures may reduce overall costs. Several studies have reported decreased mean length of stay and overall hospital costs in patients undergoing off-bypass or "beating heart" procedures. Most of these studies have included small numbers of patients and have lacked long-term follow-up data. Prospective randomized trials are needed to conclusively establish these early findings. Copyright© 1999 by W. B. Saunders Company.
Complications of Minimally Invasive Cardiac Surgical Procedures
Authors: McLoitghlin Thomas M.
Published: October 2008

All surgical and anesthetic procedures convey some degree of risk. New procedures in cardiac surgery are being developed for which patterns of complications are just beginning to emerge. The experience with minimally invasive direct coronary bypass, transmyocar dial laser revascularization, and Port-Access cardiac surgery is reviewed with emphasis on perioperative complications and causes of early morbidity and mortal ity.
The Pharmacology of New Drugs and New Uses for Older Drugs Used for Thoracic Pain Relief
Authors: Gozal Yaacov , Drenger Benjamin
Published: October 2008

Thoracotomy results in severe pain and deleterious changes in pulmonary physiology. These alterations are inevitable and can be minimized by effective analgesia. There are many options available for the treatment of postthoracotomy pain. Systemic opioids have been extensively used in this context but their side effects have led to the development of various routes of administration; the epidural route in combination with local anesthetics is the most effective. Other techniques include intercostal nerve block and intrapleural analge sia. Drugs such as clonidine, nonsteroidal anti-inflamma tory drugs, and ketamine are promising for the relief of pain after thoracotomy but further investigations are still warranted.
Postthoracotomy Pain Management
Authors: Cohen Edmond
Published: October 2008

In modern medicine, postoperative analgesia is consid ered an integral part of the anesthetic management. Thoracotomy has been reported to be among the most intense clinical postoperative pain experiences. If pain is poorly controlled in the postoperative period, respira tory excursions, movements, and coughing may result in muscle splinting, atelectasis and postoperative pulmo nary dysfunction. This article focuses on the various analgesic modalities that are available for altering the flow of nociceptive information from the periphery to cortex: (1) the transduction of nociceptive information at the peripheral receptor (local anesthetics, nonsteroi dal anti-inflammatory drugs); (2) the transmission of nociceptive information along the afferent sensory neu ral pathways (intercostal, intrapleural, or epidural local anesthetics); and finally, (3) the modulation of nocicep tive input at the level of the dorsal horn of the spinal cord (lumbar or thoracic epidural and intrathecal opi oids) or the brain (systemic opioids). Finally, the role of preemptive analgesia in thoracic surgery is discussed.
Postthoracotomy Syndrome and Postherpetic Neuralgia
Authors: Sands Robert P. , Yarussi Anthony T. , Lema Mark J.
Published: October 2008

Postthoractomy syndrome (PTS) is a multifactorial dis ease process which has never been adequately de scribed. This, in turn, has led to a discrepancy in the literature concerning the signs and symptoms which constitute PTS and what are the most efficacious treat ment modalities that should be used. The most impor tant fact before instituting therapy for PTS, is that recurrent disease must be ruled out. Once this is done, a stepped-treatment regimen can be instituted. Postherpetic neuralgia (PHN) is a disease state which afflicts 10% to 15% of patients who become infected with herpes zoster. At this time, there appears to be no definitive treatment regimen for PHN. However, there are various treatment modalities which can signifi cantly decrease the pain associated with the disease. There seem to be many promising agents undergoing scientific trials, so that a definitive treatment for PHN may soon be available.
Pain Management After Vascular Surgery
Authors: Kahn Ronald A.
Published: October 2008

Patients presenting for vascular surgery usually have concomitant disease processes that may increase the likelihood of adverse outcomes after major surgery. Because of the advanced nature of the underlying medical condition, it is important to optimize postopera tive pain control to adequately control postoperative discomfort, stress response, hypercoagulability, myocar dial ischemia, and graft failure. This article discusses methods of pain control after vascular surgery and their effects on physiology and outcome.
Pain Management in Peripheral Vascular Disease
Authors: Gevirtz Clifford
Published: October 2008

The progression of peripheral vascular disease exacts a terrible toll in accompanying pain in many patients. Various approaches to interventional pain management (diagnostic and neurolytic lumbar sympathectomy, ra diofrequency lesioning of the sympathetic chain, spinal cord stimulation) are reviewed, compared, and con trasted. The impact of concurrent medications (eg, heparin, low-molecular-weight heparin, coumadin, aspi rin, and nonsteroidal anti-inflammatory drugs) on per forming interventional procedures is also considered. An algorithm for disease management is presented.
Evolution of the US Health Care Marketplace: From Antiquity to Present Times
Authors: Cohen Adele
Published: October 2008

To gain a better understanding of the American health care system of today, it is essential to review the chronicle of its development. Before the 20th century, there was very little variation in the basic health care delivery system. In contrast, this century has seen unprecedented changes, forming a unique and complex market-driven health care system. The American health care system is also replete with contrasts, often characterized in both superlative and the poorest of terms. This article chronicles the changes in US health care over the last century, then describes today's market in detail.
Payment for Anesthesia Care of Cardiac Surgical Patients
Authors: Hug Carl C.
Published: October 2008

Federal reimbursement systems are very complex. Congress requires reimbursements to be budget neutral. This article describes some of the problems encountered when seeking federal reimbursement for cardiac surgical procedures and defines what can be done to improve payments for anesthesia care.
The Economics of Cardiac Fast Tracking
Authors: Ghotbi Mohammed , Ramsay James
Published: October 2008

Extubation within a few hours of cardiac surgery is possible in the majority of patients and is not associated with an increased risk for perioperative complications. Duration of intubation is an important factor in overall postoperative length of stay, and when early extubation is instituted as part of a comprehensive clinical pathway, it contributes to significant reductions in both intensive care unit and hospital length of stay. In association with reductions in direct variable costs, these reductions in length of stay have been shown in several studies to significantly reduce overall cost or charge.
Determining the Costs of Residents
Authors: Zaidan James R.
Published: October 2008

Determining the costs associated with a residency program is a very difficult and time-consuming process. Programs have not had to shoulder this responsibility in the past. With costs increasing because of the shortage of trainees and with ever-decreasing reimbursements, it is important for training programs to understand exactly where their costs are located. Several publications have reported the overall costs of residency programs in terms of replacement costs. This is an important concept, but it is equally important to realize how the dollars are spent within the program. Only with this information will the programs be able to make management decisions regarding the education of the residents. This report explains the basic concept of activity-based costing and its application to residency education.
Persistent chronic peri-aortitis (‘inflammatory aneurysm’) after abdominal aortic aneurysm repair: systematic review of the literature
Authors: van Bommel EFH , van der Veer SJ , Hendriksz TR , Bleumink GS
Published: October 2008

Abstract

Data on the outcome of aneurysmal chronic peri-aortitis (‘inflammatory aneurysm’) after open surgical aneurysm repair are few and contradictory. To what extent this inflammatory process is reversed after endovascular aneurysm repair (EVAR) is even more unclear. The objective of this review was to study the outcome of peri-aortic fibrosis (PAF) and ureteral obstruction in patients with aneurysmal chronic peri-aortitis treated with open surgery or EVAR. Medical literature was searched for pertinent articles on the outcome of PAF and ureteral obstruction after open surgery or EVAR from 1970 through October 2007. Studies were included if specific follow-up data were available on outcomes of interest. A total of 19 studies were included comprising 478 patients (open surgical, n = 426; EVAR, n = 52). Age, sex and percentage of patients with ureteral obstruction (31% vs 37%) did not differ between groups. Regression of PAF occurred more frequently after open surgery compared to EVAR (86% vs 60%; p < 0.0001). Complete regression of PAF was more frequent after open surgery compared to EVAR (52% vs 14%; p < 0.0001). After excluding patients in whom concurrent ureterolysis was performed, the frequency of persistent ureteral obstruction remained lower in patients treated surgically compared to patients treated with EVAR, albeit not statistically significant (32% vs 56%; p = 0.09). In conclusion, although open surgery is superior to EVAR in achieving regression of chronic peri-aortitis, the frequency of persistent PAF and/or ureteral obstruction is not negligible. Additional medical and/or urological treatment should be considered in selected cases of aneurysmal chronic peri-aortitis.
Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography
Authors: Jaff Michael R , Goldmakher Gregory V , Lev Michael H , Romero Javier M
Published: October 2008

Abstract

Stenosis of the internal carotid artery represents a major cause of stroke, with atherosclerosis representing the major pathophysiology of this stenosis. It is estimated that over 700,000 Americans suffer a stroke annually. A prompt and accurate diagnosis of carotid artery disease is critical when planning a therapeutic strategy. Physical examination is inaccurate in determining the presence and severity of carotid artery disease. Therefore, reliable imaging tests which offer little risk to the patient are required.
No difference in the association between birth weight and total cholesterol for males and females. A SHARP (Scottish Heart and Arterial Disease Risk Prevention) study
Authors: Libby G , McEwan SR , Morris AD , Belch JJF
Published: October 2008

Abstract

We carried out a cohort study in a relatively young healthy working population to assess any difference between males and females in the association between birth weight and adult total cholesterol. Perinatal data came from the Walker database of babies born between 1952 and 1966 in Dundee, Scotland. This was record-linked to information from the SHARP (Scottish Heart and Arterial Risk Prevention) cohort who had undergone a cardiovascular risk screening between 1991 and 1993. There were 1158 individuals (56% male, mean age 32.1 years). For both males and females there was no association between birth weight and cholesterol either unadjusted or after adjustment for BMI and other potential confounders: B = −0.11 (95% CI −0.03, 0.04) for males, B = −0.15 (95% CI −0.31, 0.01) for females. All individuals together showed a slight decrease in cholesterol for 1 kg increase in birth weight but only after adjustment for BMI: B = −0.13 (95% CI −0.24, −0.01). These results suggest no difference in the relationship between birth weight and total cholesterol for males and females.
Endotension following endovascular aneurysm repair
Authors: Toya Naoki , Fujita Tetsuji , Kanaoka Yuji , Ohki Takao
Published: October 2008

Abstract

Endovascular aneurysm repair (EVAR) is a new and minimally invasive alternative to open repair for patients with abdominal aortic aneurysm (AAA). Soon after its introduction in 1990, it was recognized that EVAR had potential and distinct advantages in the elective and emergency settings. However, long-term follow-up has shown enlargement of the AAA in a substantial percentage of patients who underwent EVAR with the original-permeability Excluder. Of interest is that sac expansion frequently occurs in the absence of endoleak, often referred to as endotension. The pathophysiology of endoleak is beginning to be elucidated and its management is ready to be established, while controversy still exists about the etiology and clinical consequences of endotension. Fortunately, the incidence of endotension is decreasing and it appears that AAA expansion after EVAR with the original Excluder can be arrested by endovascular relining with a low-permeability Excluder endoprosthesis. The aim of this brief review is to provide historical perspective and a good understanding of the etiology, diagnosis, and management of endotension.
Relationship between brachial artery flow-mediated dilatation, hyperemic shear stress, and the metabolic syndrome
Authors: Title Lawrence M , Lonn Evan , Charbonneau Francois , Fung Marinda , Mather Kieren J , Verma Subodh , Anderson Todd J
Published: October 2008

Abstract

Metabolic syndrome (MetSyn) may predispose to cardiovascular disease (CVD) by causing vascular dysfunction. This study aimed to determine the association of MetSyn with vascular function, as assessed by brachial artery flow-mediated dilatation (FMD) and hyperemic shear stress (HSS). A total of 1,417 male firefighters without established diabetes and CVD were classified for MetSyn, according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP) definition. MetSyn was present in 267 individuals (19%). Although FMD was lower in those with versus without MetSyn (8.1 ± 4.1 vs 8.7 ± 4.0%; p = 0.02), this was not significant after adjusting for baseline differences (age, smoking, and brachial artery diameter) ( p = 0.2). However, HSS was significantly lower in those with versus without MetSyn (72.0 ± 27.8 vs 80.9 ± 24.8 dyne/cm2; p < 0.001), and there was a significant inverse graded relationship with the number of NCEP criteria present (mean HSS for those with 0, 1, 2, 3, 4, and 5 criteria: 83.2 ± 22.5, 82.2 ± 24.7, 76.5 ± 27.2, 74.3 ± 27.4, 66.5 ± 28.4, 67.1 ± 27.6 dyne/cm2; p < 0.001 for trend). The individual NCEP criteria of abdominal obesity, systolic hypertension, and impaired fasting glucose were independent predictors for HSS. In conclusion, MetSyn was not associated with impaired FMD. Alternatively, HSS, a measure of microvascular function, was significantly lower in those with MetSyn. Thus, MetSyn may contribute to CVD by causing microvascular dysfunction.
Air Conditioning and the Material Culture of Routine Human Encasement
Authors: Hitchings Russell , Shu Jun Lee
Published: October 2008

There are many factors shaping the relationship between human bodies and their immediate environments and the mechanical control of ambient thermal conditions is playing an increasingly important part. It is with this in mind that this article travels to the tropical island of Singapore where the assumption that the air surrounding people should generally be cooled has quietly become entrenched. Specifically we focus on the young people we find in this country and consider how the presence of air conditioning has become implicated in particular combinations of social practice and sensual expectation amongst this group. The conclusion we draw is that it is only by attending to the contextual interplay of bodies, clothing and immediate climate that we gain the fullest sense of the processes underwriting a much wider retreat into indoor social spaces where these elements could be usefully understood as the material culture of routine human encasement.
Contemporary Engagements Within Corridors of the Past
Authors: Orengo Hector A. , Robinson David W.
Published: October 2008

In a medieval Barcelonan side street, urine, rubbish and a bewildering array of graphic imagery splatters the narrowing walls between two major thoroughfares. A contemporary conflict between residents, unknown artists and others is played out using banners, bottles, stickers, posters, stencils, spray paint and bodily substances. In this shadowy liminality, local and global debates are superimposed upon substructures constructed from disease, prostitution and the Saint of the Plague. The continuing urban struggle constitutes temporal statements of dirt and purity, violence and humour, dominance and resistance, death and salvation. Like the renovated facades masking the crumbling remains of structures long neglected, the local council's literal whitewashing of the art is a temporal cover-up of a discursive symptom stretching from deeply embedded preconditions. However, from his niche in the angular bend of the short side street bearing three names, the statue of St Rock remains unblinkingly staring, raised above the contestations expressed below him.
Qualities of Humanness
Authors: Nanoglou Stratos
Published: October 2008

This article considers the materialization of human representations in Neolithic northern Greece and particularly the materials used in their production. Contending that materialization is contingent upon but not reducible to the materials used, an attempt is made to understand the implications of using different materials to represent humans, especially clay and stone. Thus, it is suggested that in the earlier Neolithic, clay and stone were reserved for different classes of artefacts. Human figures in this period show an interest in action, whereas in the later Neolithic, changes occur that suggest a preoccupation with the substance of the figures. It is suggested that these changes point to the emergence of different subjectivities during the later Neolithic.
The `Cardinauts' of the Western Coast of Wales
Authors: Hurn Samantha
Published: October 2008

This article is concerned with considering non-human animals as examples of inalienable material culture. The non-human animals in question are the horses indigenous to a particular area of West Wales in the UK, where they have been selectively bred for centuries. The purpose of this breeding programme initially was to ensure that they were able to negotiate the obstacles presented by the local landscape, thereby providing a lifeline to the people living on isolated farms and smallholdings in the area. However, now that horses are no longer integral to agricultural production, their selective breeding is continued to achieve different ends — the fame of their human owners who engage in a form of ceremonial exchange reminiscent of the Trobriand kula. Traditionally, kula participants travelled to neighbouring islands to exchange shell items which were, according to Malinowski `possessed for the sake of possession itself, and the ownership of them with the ensuing renown . . . the main source of their value' (1922: 89). As Leip (2001) notes when comparing bird watching in contemporary Sweden to the kula, the two practices are not directly comparable. Nonetheless, comparison is rewarding with regard to the motivations of the players involved. Such a position will form the basis of the discussion.
Political culture and television fiction
Authors: Corner John , Richardson Kay
Published: October 2008

Recently, the study of politics has expanded its scope by recognizing the constitutive power of `political culture' at the same time as cultural studies has become more interested in formal political processes and their relationship to popular culture. This article is a case study of political culture in the United Kingdom, focusing on one example of fictional expression, a television drama series broadcast in 2006: The Amazing Mrs Pritchard . The premise of the article is that the imaginative work of political fiction provides an opportunity to explore the cultural mediation of uncertainties and tensions in contemporary politics and political values. The framing of the series involves a generic mixture of realism and fantasy unusual in the British context and the key themes, which include political trust and the limits of political action, are discussed in relation both to their fictional articulation and their wider reference.
The musicalization of `reality'
Authors: Danielsen Anne
Published: October 2008

A recurring theme in the theorizing of documentary film is the nature of the relation between image and reality. This article deals with reality effects and documentary aspects in reality rap, focusing on Public Enemy's album Fear of a Black Planet (Def Jam, 1990). Specific attention is given to the use of samples from `real life' locations, the inclusion of mass media debates and the use of sonic montage. The article discusses the exchange of music and reality in Public Enemy's music, arguing that the musicalization of reality both enhances the expressive power of their music and makes it possible to produce new meanings in an informational sense.
Descendants of Slaves
Authors: Marselis Randi
Published: October 2008

The aim of the Danish television documentary series Slavernes Slægt ( Descendants of Slaves, 2005) has been to enhance public awareness of Danish colonial history. As is typical of contemporary mediated memories, the account of national history is combined with `small histories' that focus on live stories of individuals and their families. Participating in the series are present-day descendants of enslaved Africans who, as a result of an interest in family historical research, have found information about their black ancestry. The series challenges the supposed historical homogeneity of Nordic nation-states by pointing out the historical presence of black individuals. However, this article will show how discourses of family history (e.g. the focus on bloodlines) converge with old `race' theory; the result of which is that the series inadvertently reproduces processes of visual Othering.
National media events
Authors: Mihelj Sabina
Published: October 2008

Despite the conspicuous presence of nationhood and nationalism in existing studies of media events and rituals, explicit conceptualizations of the link between these media phenomena and nationhood remain scarce. Drawing on existing literature and research on the topic, this article proposes to shift attention away from ceremonial occasions primarily aimed at celebrating national unity, towards the more distressing events and mobilization marathons enacting partition and instituting divisions among nations, ethnicities, cultures, races or religions. It provides a series of propositions regarding the involvement of media events in the transformation of audiences into nations, and discusses two categories of media rituals that are linked closely to contemporary forms of national mobilization: rituals of partition and mobilization marathons. Given the disentanglement of nations and states and the multi-ethnic nature of modern states and media spaces, such media occasions ought to receive more sustained attention in the future.
The nation has two `voices'
Authors: Tzanelli Rodanthi
Published: October 2008

This article explores the contemporary conditions of national self-presentation, inviting students of national identity to reconsider the nature of national self-narration through new conceptual tools. It is argued that contemporary nations have two `voices': one is addressed to their members, another speaks to the nation's external interlocutors. Both voices contribute to the performance of identity: for nations which are the product of colonial and `crypto-colonial' encounters, narration is characterized by a negotiation of the boundaries between private and public voices and slippage in utterance. The article introduces a new concept in the study of culture, `diforia', which accounts for both this split meaning of utterance and national performativity in public. The concept is mobilized to examine and deconstruct a recent case of Greek diforia enacted in the context of the opening and closing ceremonies of Athens 2004.
The Republican ideal?
Authors: Pager Devah
Published: October 2008

In recent years, worsening economic conditions have led to growing tensions between native-born French and a rising tide of immigrants, largely from North Africa and other parts of the developing world. The French criminal justice system has responded to perceived levels of social disorder and delinquency in these ethnic neighborhoods by increasing police surveillance, widening court jurisdiction, and imposing harsher penalties for offenders. In part as a result, France's foreign and immigrant residents, who comprise only about six percent of the population overall, now represent nearly thirty percent of the French prison population. Though the rise in reported crime has no doubt influenced recent trends in crime control, there is reason to believe that the formal orientation toward crime control is more than simply a function of crime itself. Little attention has been given, however, to the broader social and political context in which crime control strategies are developed. In this project, I conduct a comparative analysis of punishment regimes across local jurisdictions ( departements ) in order to assess the relationship between concentrations of national minorities and the institutional response to crime. By exploiting geographic variation in the concentration of national and ethnic minorities across France, I find strong associations between increasing population heterogeneity and the functioning of the local criminal justice apparatus.
Punishment and the cultural limits to state power in late 18th-century Britain
Authors: Willis James J.
Published: October 2008

The late 18th century is widely regarded as a time of rapid and momentous change in European and US penal history. Having identified this as the crucial formative period of the modern penitentiary, scholars naturally have sought to explain the developments that contributed to this modern form of punishment. However, at least in the case of Britain, this was also a time of continuity. Despite the well-publicized efforts of prison reformers, seminal prison legislation, and the end of transportation to America, Britain did not cease conveying its felons overseas. The question arises, 'Why did Britain resume transporting its offenders to New South Wales despite the opportunity and impetus for prison reform?' This article challenges more instrumental economic, strategic, and social control explanations by placing transportation within a broader expressive or cultural context. Since state punishments are some of the clearest and most brutal displays of state coercion, their application can generate questions about the nature of state authority and human freedoms. Using historical documents and secondary sources, this case study seeks to uncover the broader cultural understandings of the State's capacity to punish in order to explain why Britain continued to expel its offenders overseas. In doing so, it draws attention to how transportation operated within existing social relations between rulers and ruled — relations that were centered on the practical experiences of liberty and influenced by emergent democratic sentiments.