bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mitral and Mitro-Aortic Valve Replacement with Sorin Bicarbon Valves Compared with St. Jude Medical Valves
Authors: Camilleri L.F. , Bailly P. , Legault B.J. , Miguel B. , D'Agrosa-Boiteux M.-C. , de Riberolles C.M. 
Published: September 2024

Objective: We assessed the clinical results of two bileaflet mechanical valves: the St. Jude Medical (SJM) and the Sorin Bicarbon (Sorin Bicarbon) used either in single mitral valve replacement (MVR) or in double, aortic and mitral, valve replacement (DVR). Methods: Between September 1990 and November 1995, 217 patients received either a St. Jude Medical ( n = 134) or a Sorin Bicarbon ( n = 86): 136 mitral valve replacement with 83 St. Jude Medical and 53 Sorin Bicarbon and 84 double valve replacement with 51 St. Jude Medical and 33 Sorin Bicarbon. There was no difference between both St. Jude Medical and Sorin Bicarbon cohorts in respect of mitral valve physiopathology, etiology of valve disease, associated lesions, echocardiographic and hemodynamic data. The only significant preoperative difference was the age of patients within the double valve replacement group and the size of implanted valves within the mitral valve replacement group. Follow-up was 100% complete with a mean of 39±18 months, ranging between 6 and 68 months. The total follow-up was 657 patient-years (pt-y): 396 pt-y in the mitral valve replacement group and 274 pt-y in the double valve replacement group. Results: Hospital mortality (St. Jude Medical: 2.2%; Sorin Bicarbon: 6.9%) and late mortality (St. Jude Medical: 8.4%; Sorin Bicarbon: 6.3%) were not significantly different. Ten deaths were considered valve-related (St. Jude Medical 6, Sorin Bicarbon 4). The estimated 4-yr overall survival, including hospital mortality, was for St. Jude Medical-mitral valve replacement: 89±4% and St. Jude Medical-double valve replacement: 93±4%, and for Sorin Bicarbon-mitral valve replacement: 87±5% and Sorin Bicarbon-double valve replacement: 91±5%. The linearized incidence (% per pt-y) of valve-related complications was 6.39 in the St. Jude Medical cohort and 9.2 in the Sorin Bicarbon cohort. The linearized incidence (% pt-y) of the prevalent complication, valve thromboembolism and bleeding, was for St. Jude Medical-mitral valve replacement: 3.41, St. Jude Medical-double valve replacement: 3.16 and for Sorin Bicarbon-mitral valve replacement: 2.17 and Sorin Bicarbon-double valve replacement: 3.67. The differences between each group of an estimated 4-yr freedom from combined thromboembolism and bleeding were not significant (St. Jude Medical-mitral valve replacement: 90±4%, St. Jude Medical-double valve replacement: 84±6%, and for Sorin Bicarbon-mitral valve replacement: 94±3% and Sorin Bicarbon-double valve replacement: 75±17%). Conclusions: In this clinical non-randomized study, there was no evidence of any significant difference between St. Jude Medical and Sorin Bicarbon valves over a 4-yr follow-up.
Microperfusion Enhancement after TMLR in Chronically Ischemic Porcine Hearts
Authors: Lutter Georg , Martin Juergen , von Samson Patrick , Heilmann Claudia , Sarai Koppany , Beyersdorf Friedhelm 
Published: September 2024

Objective. The purpose of this study was to determine the effect of transmyocardial laser revascularization (TMLR) on myocardial perfusion and function in chronically ischemic myocardium. Methods. In the first operation a stenosis of the left anterior descending artery was created in 20 open-chest anesthetized pigs to implement this ischemic model. In contrast, four pigs served as controls (thoracotomy only). Seven days later (2nd operation), all animals were studied at baseline by analyzing different parameters of perfusion (radioactive microspheres), function, and intramyocardial pressure. Afterwards, pigs who received a left anterior descending artery stenosis were randomized into one of three groups: animals in laser group 1 ( n = 7) received one and in laser group 2 ( n = 7) two laser channels per cm2 in the left anterior descending artery territory. Animals of the ischemic group ( n = 6) underwent the same procedures without transmyocardial laser revascularization. Three months later, the animals were re-studied (3rd operation) and additional analysis of histochemistry and myocardial water content was performed. Results. Regional myocardial blood flow (RMBF) in laser group 2 revealed statistically higher RMBF values compared to the ischemic group (0.39±0.13 versus 0.14±0.12 ml/min/g; P = 0.043), after 3 months, whereas the absolute RMBF had not increased compared to the 1-week baseline values. Left ventricular stroke work index (LVSWI) at rest and under stress did not show any improvement compared to the initial values in all study groups ( P = ns). Nevertheless, laser group 1 demonstrated relatively higher LVSWImax values compared to the ischemic (1.33±0.19 versus 0.93±0.16 mJ/kg; P = 0.03) and laser group 2 (1.33±0.19 versus 1.02±0.15; P = 0.024). Regional contractility of laser groups 1 and 2 recovered after 3 months (which had deteriorated shortly after transmyocardial laser revascularization) and increased under stress (100% versus 144.33±46.42, P = 0.029 and 100% versus 116.26±21.06, P = 0.034; respectively). In contrast, the corresponding ischemic group values were not different from intial values ( P = ns). Conclusions. This model of chronic regional ischemia demonstrates that CO2-laser revascularization significantly improves microperfusion and regional function, whereas the overall perfusion and global LV function is unchanged.
The Utility of the VCS Clip for Creation of Vascular Access for Hemodialysis: Long-Term Results and Intraoperative Benefits
Authors: Schild A. Frederick , Pruett Christopher S. , Newman Martin I. , Raines Jeffrey , Petersen Floyd , Konkin Taylor , Kim Peter , Dickson Cindy , Kirsch Wolff M. 
Published: September 2024

The purpose of this study was to compare the effectiveness of the VCS® vascular clip approximating system for the creation of hemodialysis access fistulas. 173 new vascular accesses were created, 92 prosthetic grafts and 81 autologous fistulas over a 40-month period. 50 sutured and 42 clipped fistulas comprised the prosthetic graft series, and 33 sutured and 48 clipped cases the autologous series. Risk factors associated with access patency were correlated and the primary patencies compared in the suture versus clipped group. A significant improvement in primary patency was noted for the clipped prosthetic group at all time points studied, with a positive trend also noted for clipped autologous fistulae. Conclusions: The vascular clipping system (the VCS system) provides both long-term and immediate advantages for vascular access construction. Clips have been used successfully to treat seven consecutive patients with upper extremity arterial steal syndrome without the technical difficulties associated with traditional methods of repair.
Vena Caval Filter Placement by Intravascular Ultrasound
Authors: Matsuura John H. , White Rodney A. , Kopchok George , Nishinian Gary , Woody Jonathan D. , Rosenthal David , Clark Michael D. 
Published: September 2024

Objective: Placement of vena caval filters under fluoroscopic surveillance incurs significant expense and potential risks associated with the transportation of critically ill patients. Intravascular ultrasound (IVUS) allows direct intraluminal visualization of the vena cava and the renal veins. The purpose of this study is to evaluate the accuracy of vena caval filter placement under IVUS in an animal model. Methods: Fifteen Simon-Nitinol venal cava filters (C.R. Bard, Inc., Covington, GA) were placed under IVUS guidance into four anesthetized sheep. Twelve were placed transfemorally, and three were placed transjugularly. Accuracy of placement was confirmed with fluoroscopy by measurement between the filter tip and the targeted side branch. Results: The vena caval filters placed femorally averaged 0.33±0.42 cm distance from the target vein side branch. Jugular approach filter placement was less accurate. Although two out of three filters placed from the jugular vein were correctly positioned, the distance from the target vein side branch was much greater averaging 2.5±1.04 cm. Conclusion: Femoral placement of vena caval filters under IVUS is extremely accurate. The transjugular route, however, was technically challenging and standard fluoroscopic vena caval filter placement appears to be more appropriate. Our success with the femoral approach merits further clinical investigation in the use of IVUS for critically ill patients that would benefit from bedside vena caval filter placement.
The Impact of Ischaemic Preconditioning on Spinal Cord Blood Flow and Paraplegia
Authors: Ueno Tetsuya , Chao Zhi-Li , Okazaki Yukio , Itoh Tsuyoshi 
Published: September 2024

Purpose: We investigated the effect of ischaemic preconditioning (IP) on ischaemic spinal cord injury in a rabbit model. Methods: Fourteen rabbits were divided into IP and control groups of seven rabbits each. We repeated 3-min clamping of the infrarenal abdominal aorta and 3-min reperfusion twice (preconditioning), followed by 15 min clamping in the IP group. In the control group, the aorta was clamped for 15 min without preconditioning. Lumbar cord blood flow and systemic blood pressure were measured until 3 h of reperfusion. Another 14 rabbits underwent the same procedures with or without IP and neurologic status was assessed on the second postoperative day. Results: The percent change in lumbar cord blood flow after reperfusion was significantly greater ( P = 0.013) in the IP group despite lower mean blood pressure. There was no significant difference in overall neurologic status ( P = 0.461) but the incidence of spastic paraplegia in the IP group was lower (14%. 1/7) than that of control group (43%. 3/7). Conclusion: IP increased postischaemic lumbar cord blood flow and contributed to lower incidence of spastic paraplegia.
Is Deep Hypothermia Necessary for Unilateral Antegrade Cerebral Perfusion during Circulatory Arrest? A Magnetic Resonance Study in a Pig Model
Authors: Ye Jian , Dai George , Yang Luojia , Sun Jiankang , Summers Randy , Deslauriers Roxanne 
Published: September 2024

Objective: Localized 31P magnetic resonance spectroscopy (MRS) was used to investigate whether unilateral antegrade cerebral perfusion (U-ACP) could maintain normal energy metabolism and intracellular pH (pHi) in both hemispheres of the brain during deep (15°C) and moderate (28°C) hypothermic circulatory arrest (HCA). Methods: Eleven pigs were exposed to 120 min of U-ACP during HCA at 15°C (group I, n = 6) or 28°C (group II, n = 5), followed by 60 min of cardiopulmonary bypass (CPS) at 37°C. Localized 31P MR spectra were acquired every 30 min. Histopathology was performed at the completion of each experiment. Results: MR recorded no changes in energy metabolites (phosphocreatine and ATP), or pHi during U-ACP in either group, and no significant differences were found in any of the energy metabolites or pHi between the left and right hemispheres. Histopathology showed no significant morphological changes in the neurons. Conclusions: During either deep or moderate HCA, unilateral ACP through the right axillary artery prevents ischemic events in both hemispheres of normal pig brains. Deep hypothermia may not be necessary when using U-ACP. Crown Copyright
Management of Isolated Common Iliac Artery Aneurysms
Authors: Kasirajan V. , Hertzer N. R. , Beven E. G. , O'Hara P. J. , Krajewski L. P. , Sullivan T. M. 
Published: September 2024

Purpose: Since isolated common iliac artery aneurysms are rare and there is no consensus regarding some aspects of their management, we reviewed our recorded experience with common iliac artery aneurysms from 1977 through 1993. Methods: We were able to identify 25 patients having a total of 33 common iliac artery aneurysms on the basis of information maintained by our medical records staff, old surgical logs and a departmental registry that was implemented in 1989. Follow-up data were collected from outpatient charts and by telephone contact. New imaging studies were obtained for 14 patients who either underwent common iliac artery aneurysm repair without aortic replacement (aortic ultrasound scans, n = 7) or had no surgical treatment whatsoever (computerized tomography of the abdomen and pelvis, n = 7). Results: All 25 patients were men (mean age, 71 years). Eighteen patients (72%) had elective ( n = 14) or urgent ( n = 4) operations to repair common iliac artery aneurysms with mean diameters of 3.8 cm and 5.8 cm, respectively. There was one postoperative death (5.5%) in conjunction with complementary renal revascularization in a patient with preoperative renal insufficiency. During a mean follow-up period of 50 months, two (29%) of the seven patients who had not received bifurcation grafts at the time of their common iliac artery aneurysm procedures had developed infrarenal aortic aneurysms. Seven (28%) of the original 25 patients were observed without intervention for common iliac artery aneurysms measuring 2–2.5 cm in diameter. No common iliac artery aneurysm enlargement or new aortic aneurysms have been documented in any of these patients at a mean follow-up interval of 57 months. Conclusions: In our limited experience, the risk for spontaneous rupture appears to be concentrated among common iliac artery aneurysms exceeding 5 cm in diameter, while those that are less than 3 cm in diameter may fail even to enlarge under observation. Therefore, common iliac artery aneurysms measuring ≥ 3 cm in size probably warrant surgical treatment, at which time simultaneous aortic replacement also should be a serious consideration.
Arterial Reconstruction with Vascular Clips is Safe and Quicker Than Sutured Repair
Authors: Pikoulis E. , Rhee P. , Nishibe T. , Leppäniemi A. K. , Fishback N. , Hufnagel H. V. , Wherry D. C. , Rich N. M. 
Published: September 2024

Background: Non-penetrating, arcuate-legged vascular-closure staple clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger vessels. The purpose of this study was to compare vascular-closure staple clips to sutured anastomoses in common iliac arteries in a porcine model. Methods: In an experimental study, transected iliac arteries on both sides of 11 pigs were randomly assigned to end-to-end anastomosis performed with vascular-closure staple clips or interrupted 6–0 polypropylene sutures. Angiographic, macroscopic and microscopic results were assessed after 2 months. Results: There was no significant difference in the patency rate, tensile strength of the anastomoses, vessel diameter at the repair site, intimal thickness or wall thickness of the arteries after either method of closure. The mean (s.d.) clamp time was 19.8 (6.1) minutes for clip repair, and 36.0 (6.9) seconds for suture repair ( P < 0.001). The times required for the reconstruction of the anastomoses were 17.4 (6.1) and 35.S (7.1) minutes, respectively ( P < 0.001). Conclusions: Arterial anastomoses performed with vascular-closure staple clips are faster than sutured anastomoses, and result in comparable wound healing when assessed for patency, tensile strength, degree of narrowing and intimal reaction.
Autogenous Common Facial Vein or External Jugular Vein Patch for Carotid Endarterectomy
Authors: Sabharwal P. , Mukherjee D. 
Published: September 2024

Background: The purpose of this study was to determine whether common facial vein or external jugular vein are as good a vein patch as a saphenous vein for carotid patch angioplasty. Method: Retrospectively. 19 patients who underwent everted common facial vein or external jugular vein patch were compared with 199 patients who underwent saphenous vein patch carotid endarterectomy during 1989 to 1996. The two groups were compared clinically and by sonographic surveillance. The mean follow-up was 18 ± 4 months for common facial vein/external jugular vein patients and 48 ± 15 months for saphenous vein patch group. Results: No significant differences in mortality or morbidity were observed among patients in whom everted common facial vein or external jugular vein was used as compared with saphenous vein. No bleeding, thrombotic event, dilation of the patch or aneurysmal degeneration and perioperative deaths occurred in either of the two groups. Duplex surveillance studies showed no significant difference in recurrent moderate (50–79%) and severe (80–99%) stenosis. Conclusion: Everted common facial vein or external jugular vein patch was comparable to other vein patches. This eliminates the comorbidity of groin incision. Also, using everted common facial vein or external jugular vein as vein patch saves saphenous vein to be used for other vascular procedures, such as coronary artery or lower extremity bypass.
Application and Reliability of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): An Institutional Study
Authors: Manoharan Elamathi , Krishnamurthy Suganthi , Menon Maya 
Published: September 2024

Introduction: Milan System for Reporting Salivary Gland Cytopathology (MSRGC) was introduced in the year 2015 to facilitate a standardised reporting format and to improve the overall effectiveness of fine-needle aspiration cytology (FNAC) in the preoperative evaluation of salivary gland lesions. Risk of malignancy (ROM) provided in each category guides the physician for appropriate clinical management. This study was performed prospectively for one year to evaluate the diagnostic utility and validate MSRSGC. Materials and Methods: The study included lesions in the salivary gland area, including intraparotid lymph node. Cytology material from both direct FNAC, which had rapid onsite evaluation (ROSE) for adequacy and ultrasonography-guided procedures, was included for analysis. Relevant clinical information and imaging findings were obtained. Slides were reviewed, and one of the six categories was applied using the Milan system. ROM and risk of neoplasm (RON) were calculated for each category. Results: The study included 62 cases of salivary gland FNAC of which 35.5% of the cases had surgical resection specimens. Category IVA formed the major group, and only 1.6% was given category III. The ROM and RON were calculated for each category and were statistically significant and compared with other studies. Conclusion: MSRSGC is the recent classification system, and it suggests less than 10% of cases under category III to avoid it’s over utilisation. MSRSGC is a reliable classification in our population, and it was best with category IVA lesions in our study.
A Prospective Clinicopathological Study of Cervical Lymphadenopathy in a Head and Neck Unit of a Tertiary Referral Centre
Authors: Preethi S  , Narayanan Nithya , Venkatakarthikeyan C  
Published: September 2024

Background and Aims: This study aims to investigate the clinicopathological profile of cervical lymphadenopathy in a tertiary referral centre. The findings will contribute to a deeper understanding of the disease spectrum, aid in accurate diagnosis, and help in improving patient treatment and outcomes. Methodology: This is a prospective study conducted in the Department of ENT, Head and Neck Surgery, Apollo Hospital, Chennai, between June 2022 and May 2023. The clinicopathological profile of all patients was analysed. The final histological diagnosis and the preoperative Fine Needle Aspiration Cytology (FNAC) were correlated. The primary tumour was identified in cases with metastatic secondary tumours in the neck. Results: Among the 80 patients in our study, 67% had a benign aetiology (most common was tuberculosis), and 33% had a malignant aetiology (most common was Hodgkin’s Lymphoma). Gender distribution was equal, with those between the ages of 35 and 60 more frequently affected. The nasopharynx (30%) was the most likely location of the occult primary, followed by the thyroid (20%) and larynx (20%). In detecting TB, FNAC had a sensitivity of 75.5% and a specificity of 98%; in detecting lymphomas, it was 64% and 100%; in detecting metastatic secondaries, it was 80% and 100%; and in detecting reactive lymphadenitis, it was 79% and 86%. Conclusion: Cervical lymphadenopathy is a common entity requiring careful evaluation and treatment. PET scans prove invaluable in detecting occult primary tumours. FNAC is an initial, cost-effective diagnostic tool. However, biopsy is indicated in specific conditions to obtain accurate diagnosis to enable prompt treatment.
Histopathological Correlation of Robotic-Assisted Radical Prostatectomy Specimen with Simultaneous 68GA-PSMA PET/MRI Findings in Cases of Adenocarcinoma Prostate
Authors: Kumar Sharwan , Jena Amarnath , Taneja Sangeeta , Kashyap Vikas , Singh Ashutosh Kumar , Sharma Ankur , Taneja Nilesh , Raheja Apeksha , Taneja Rajesh 
Published: September 2024

Background and Aims: 68Ga-PSMA PET represents a reasonable biomarker for presence of cancer of prostate (CaP). 68Ga-PSMA PET combined with simultaneous ‘multiparametric MRI’ (mpMRI) has the potential to be used for the detection and localisation of primary prostate cancer. It is therefore essential to correlate the histopathological findings of robotic-assisted radical prostatectomy (RARP) specimens with pre-operative PSMA PET/MRI. In addition, imaging with PSMA could be useful in estimating the aggressiveness of CaP. The current study aims at the correlation of histopathologic findings of RARP specimens with pre-operative combined 68Ga-PSMA PET/MRI imaging. Materials and Methods: Specimens retrieved after RARP in 38 patients of localised CaP were synchronised with pre-operative images obtained with simultaneous 68Ga-PSMA PET/MRI. Maximum scores of individual parameters such as PI-RADS, Gleason’s score and PSMA uptake (in SUV) were taken for each sector and used for statistical analysis. Results: The positive predictive value (PPV) and negative predictive value (NPV) of simultaneous 68Ga-PSMA PET and MRI in detecting malignancy were found to be 84.23% (95% CI: 80.74%–87.18%) and 63.92% (95% CI: 57.77%–69.65%), respectively. Combining 68Ga-PSMA PET and mpMRI improves the sensitivity to 81.48% (95% CI: 76.70%–85.67%), but the specificity was found to be 68.24% (95% CI: 60.09%–75.64%). It was found that SUV max correlated with the severity of GS ( P value < .001). Conclusion: Prediction and localisation of histological malignancy in the prostate could be improved pre-operatively by adding 68Ga-PSMA PET to mpMRI imaging. The SUV of abnormal uptake of 68Ga-PSMA radiotracer is predictive of aggressiveness of tumour as reflected in the Gleason score.