bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Assessment of Skeletal Muscle Damage after Ischaemia-Reperfusion Injury Using Tc-99m-Glucarate
Authors: Wiersema A.M. , Oyen W.J.G. , Dirksen R. , Verhofstad A.A.J. , Corstens F.H.M. , van der Vliet J. A. 
Published: September 2024

Purpose:After acute arterial obstruction of the lower extremity, muscle damage is the critical determinant for clinical outcome. The extent of muscle damage and limb viability are currently assessed by clinical examination, which is inaccurate. Tc-99m-pyrophosphate (PYP) has been applied for imaging ischaemia-reperfusion damage. More recently, a new imaging agent, Tc-99m-glucarate (GLUC), was introduced for delineating early myocardial infarction after ischaemia-reperfusion. The aim of this study was to determine if GLUC could delineate early skeletal muscle damage after ischaemia-reperfusion. Both tracers were used in a novel murine model of hindlimb ischaemia-reperfusion.Methods:In anaesthetised mice, ischaemia of one hindlimb was maintained for 2, 3 and 4 h using a tourniquet, followed by a reperfusion period of 1 h. Additionally, reperfusion periods of 3, 24 and 96 h were studied after 3 h of ischaemia. PYP or GLUC was injected 45 min before end of reperfusion. Concentrations of both agents were determined in blood, reperfused and contralateral muscle. Reperfused-to-contralateral muscle ratios were calculated. In separate experiments, muscle biopsies were obtained for histologic examination.Results:Ischaemia and reperfusion damage was demonstrated histologically. Using scintigraphy GLUC depicted reperfusion significantly better than PYP. After 2, 3 and 4 h of ischaemia, the reperfused-to-contralateral ratios for GLUC were 10.7 ± 0.9, 8.9 ± 0.9 and 8.6 ± 1.1, as compared to 4.5 ± 0.7, 4.9 ± 0.4 and 4.5 ± 0.4 for PYP ( P < 0.05 at all points). For longer periods of reperfusion, the ratios for GLUC decreased to similar levels as observed for PYP.Conclusion:The present study indicates that GLUC is a specific early marker of myocyte necrosis after ischaemia-reperfusion. GLUC may become an useful agent for clinical, early, non-invasive monitoring of skeletal muscle damage after ischaemia-reperfusion.
Haemodynamic Changes during Minimally Invasive Coronary Artery Bypass Surgery Using High-Dose Esmolol
Authors: Aleksic Ivan , Buhre Wolfgang , Baryalei Mersa M. , Reitmeier Frank , Tirilomis Theodor , Weyland Andreas , Dalichau Harald 
Published: September 2024

We aimed to investigate the effects of high-dose esmolol on haemodynamics and oxygen extraction in minimally invasive direct coronary artery bypass (MIDCAB) surgery patients. Methods: In 18 patients, heart rate (HR), mean arterial (MAP), central venous (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and mixed venous oxygen saturation (SvO2) were prospectively measured after induction of anaesthesia (T1), start of surgery (T2), during bypass grafting with β-blockade (T3), and at the end of surgery (T4). Results: Mean esmolol dose at T3 was 0.44 ± 0.2 mg kg−1 min−1. HR was unchanged, whereas significant decreases in mean CO (3.1 ± 0.8 vs 4.8 ± 1.0 l min−1 m−2 pre-esmolol), MAP (53 ± 10 vs 89 ± 14 mmHg), and SvO2 (65 ± 10 vs 81 ± 4%) were observed during esmolol administration. All haemodynamic parameters normalized immediately after termination of esmolol (T4). Conclusions: Despite unchanged HR esmolol reduced CO and MAP suggesting a favorable reduction of myocardial oxygen consumption. Mean SvO2 during esmolol administration reflects an acceptable ratio of whole-body oxygen delivery and consumption. Haemodynamic changes with high-dose esmolol during MIDCAB surgery remain within safety margins.
Active Infective Endocarditis: Low Mortality Associated with Early Surgical Treatment
Authors: Perić M. , Vuk F. , Huskić R. , Laušević-Vuk Lj. , Nešković A.N. , Borzanović M. , Bojić M. 
Published: September 2024

Background: Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocarditis (PVE). The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE. Methods: During a 3-yr period (January 1 1996–December 31 1998), 57 out of 60 patients (pts) with active, either NVE (46 pts) or PVE (11 pts) underwent surgical treatment. There were 11 women (23.9%), average age of the group being 43.3 ± 9.1 yr (18–73). They were operated on 12–35 days, mean 17.7 ± 7.5 days (for NVE) and 5–33 days, mean 13.2 ± 10.1 days (for PVE) after the diagnosis of endocarditis was first suspected. All pts had at least one absolute indication for early surgical treatment, the most frequent being (in NVE) worsening heart failure (19 cases) and inability to control the infection (10 cases), while in PVE it was valve dehiscence (8 cases). In 8 cases of NVE and 2 cases of PVE fresh, antibiotic sterilized aortic homograft was used to replace the aortic valve. Results: Operative mortality was 1.8% (1/57) and hospital mortality 5.2% (3/57). Three pts with PVE died before they were operated on, giving an overall mortality of 10% (6/60). Postoperative morbidity included valve dehiscence in two pts (probable late onset recurrent endocarditis — 3.5%), three episodes of acute renal failure (5.3%), four cases of respiratory insufficiency (7.0%) and one chronic pleural effusion (1.8%). All pts that were discharged from the hospital (54/60), are still alive and well 1–35 months postoperatively (mean 20.3 ± 9.6 months), including pts with recurrent endocarditis and valve dehiscence, after they were successfully reoperated. Conclusions: Along with early diagnosis and appropriate antibiotic treatment, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients. Our data indicate that early surgical treatment in cases of active endocarditis may be associated with low mortality and morbidity.
Celiac Artery Compression Syndrome
Authors: Kokotsakis J.N. , Lambidis C.D. , Lioulias A.G. , Skouteli E.T. , Bastounis E.A. , Livesay J.J. 
Published: September 2024

Celiac artery compression syndrome occurs when the median arcuate ligament of the diaphragm causes extrinsic compression of the celiac trunk. We report a case of a 65-year-old woman who presented with a three-month history of postprandial abdominal pain, nausea and some emesis, without weight loss. There was a bruit in the upper mid-epigastrium and the lateral aortic arteriography revealed a significant stenosis of the celiac artery. At operation, the celiac axis was found to be severely compressed anteriorly by fibers forming the inferior margin of the arcuate ligament of the diaphragm. The ligament was cut and a vein by-pass from the supraceliac aorta to the distal celiac artery was performed. The patient remains well and free of symptoms two and a half years since operation. In this report we discuss the indications and the therapeutic options of this syndrome as well as a review of the literature is being given.
Percutaneous Transluminal Angioplasty in Patients with Ischemic Tissue Necrosis is Worthwhile
Authors: Mellière D. , Berrahal D. , D'Audiffret A. , Desgranges P. , Allaire E. , Becquemin J.P. 
Published: September 2024

Purpose: Ischemic tissue necrosis is usually associated with long or sequential arterial obstructions. As a result, the role of percutaneous transluminal angioplasty (PTA), which addresses only short lesions, in patients presenting with trophic changes remains questionable. The purpose of this study was to evaluate the effectiveness of PTA in diabetic and non-diabetic patients presenting with grade 4 Fontaine's classification. Method: Between January 1992 and December 1997, 1352 patients with aorto-iliac and/or infrainguinal occlusive diseases were admitted to our institution. Three hundred and ten patients who presented with distal gangrene (95.5%) or ischemic ulcers (4.5%) were identified. The patients consisted of 117 diabetics and 193 non-diabetics. PTA alone was performed In 26 diabetics (group 1) and in 30 non-diabetics (group 2). Their charts were retrospectively reviewed and the patients were recalled for clinical examination and non-invasive monitoring. Results: Follow-up was available for all patients and ranged from 1 to 4 years. The survival rate was significantly higher in diabetic patients than in non-diabetic patients (96% vs 77% at 1 year; p < 0.05 and 91% vs 66% at 3 years; p < 0.05). In group 1, the primary cumulative patency rate at 1 and 3 years was 76%. In group 2, the primary cumulative patency rate at 1 and 3 years were 85% and 80%, respectively. Three patients in group 1 required a redo PTA at 4 months, resulting in an assisted primary patency rate at 1 and 3 years of 88%. In contrast, no patients in group 2 required additional PTA. In group 1, the limb salvage rate at 1 and 3 years was 84%; and in group 2, 80% and 75%, respectively. Conclusion: The results of PTA in both groups were encouraging. Dilation of one or two short stenoses, despite multiple distal lesions, may improve distal flow sufficiently to promote wound healing. Thus, this procedure may be recommended in selected patients suffering from ischemic tissue loss. However, during the first 6 months following PTA, diabetic patients should be followed carefully with Duplex as they are prone to early restenosis.
Endovascular Stenting of Superficial Femoral Artery Stenosis and Occlusions: Results and Risk Factor Analysis
Authors: Cheng Stephen W. K. , Ting Albert C. W. , Wong John 
Published: September 2024

Purpose: To determine the early and midterm results of femoro-popliteal angioplasty with adjunctive stenting and to identify factors affecting early and continuing success. Methods: Sixty-nine consecutive balloon angioplasty procedures on the superficial femoral artery (SFA) were performed in 60 limbs and 55 patients in the operating theater. Fifty-two percent of lesions were occlusions, and 87% involved the distal half or the whole segment of the SFA. Immediate endovascular stenting was used in all procedures, involving the placement of 105 stents, with a mean stented length of 13.8 cm. Twenty-nine procedures (43%) were performed for critical ischemia. Three-monthly duplex ultrasound was used for follow up assessment, with stenosis of > 50% defined as the endpoint for failure. The patient demographic and biochemical data, and procedural details were correlated with success criteria according to Society of Vascular Surgery standards. Results: Initial technical success by intent to treat was 92%, with four procedure-related complications and no deaths. Initial success by anatomic, hemodynamic and clinical criteria were 98.3, 96.7 and 93.3% respectively (92.2, 90.6 and 87.5% by intent to treat). Cumulative primary patency at 6, 12, and 24 months was 73.1, 62.6 and 53.8%, and secondary patency 84.9, 72.1 and 72.1% correspondingly. Significant factors relating to inferior patency were occlusions, stented segment length > 10 cm, procedure in claudicants, and the use of the Memotherm stent. Conclusions: Angioplasty and stenting of the superficial femoral artery has acceptable primary and secondary patency rates even in the presence of long stenosis and occlusions. A duplex surveillance program is recommended for early detection and timely treatment of restenosis.
Surgical Treatment for Popliteal Artery Entrapment Syndrome
Authors: Ohara Nobusuke , Miyata Tetsuro , Oshiro Hidemi , Shigematsu Hiroshi 
Published: September 2024

Purpose: This study was a retrospective review of 11 limbs of 10 patients with popliteal artery entrapment syndrome (PAES) treated surgically in a 20-yr period. Methods: The patients were aged 34.7 ± 17.4 SEM yr. Arteriography findings varied, showing medial deviation in two limbs, poststenotic dilatation in four limbs and occlusion of the popliteal artery in five limbs. In addition, computed tomographic (CT) scanning showed positive findings of PAES in all the limbs. Results: The surgical procedures consisted of musculotendonous section (MTS) with autogenous saphenous vein (ASV) graft in seven limbs, MTS and ASV patch angioplasty with or without thromboendarterectomy in three limbs, and MTS alone in one limb. All the ASV grafts were found to be patent during the postoperative follow-up period (10.9 ± 4.0 yr). Conclusion: CT scanning was demonstrated to be the most sensitive diagnostic modality for PAES, and MTS with or without ASV grafting method was considered to be the best surgical procedure for PAES.
Deep Vein Thrombosis in Airline Passengers — The Incidence of Deep Vein Thrombosis and the Efficacy of Elastic Compression Stockings
Authors: Scurr John H. , Smith P.D. Coleridge , Machin S. 
Published: September 2024

A prospective study to determine the incidence of deep vein thrombosis in passengers on long haul flights, and to determine the efficacy of elastic compression stockings in reducing this incidence. Two hundred patients over the age of 50, with no past history of venous throm-boembolic disease. no co-existing medical problems. and no specific risk factors, undergoing flights of eight hours or more, have been accessed. All patients have undergone Duplex ultra-sound imaging two weeks prior to departure. Immediately prior to departure. a repeat Duplex ultrasound scan was carried out, and blood taken for D-dimer and thrombin antithrombin complex (TAT) as markers of a hypercoagulable state and soluble vascular cell adhesions mol-ecule (VCAM-1). All patients completed a pre-travel questionnaire. The patients were randomly allocated to receive or not receive elastic compression stockings. On return, each patient was again scanned, and a further blood sample taken for analysis. Those patients with high levels of D-dimer, TAT or VCAM-1, underwent a full thrombophilia screen. Those patients with a positive Duplex scan on visit one or two were excluded from the study. Those patients with a positive scan on return were considered to have developed thromboembolic disease, and underwent further investigations. The results are being analysed on an intention to treat basis. The stUdy will conclude when 100 patients have been recruited to each group.
Coronary Reoperations in Patients with a Patent Internal Mammary Artery Graft
Authors: Noyez Luc , van Eck Frans M. , Skotnicki Stefan H. , Brouwer René M. H. J. 
Published: September 2024

Objective:Analysis of short and long term results, clinical, functional and subjective status of patients, with a patent arterial graft, after coronary reoperation (RECABG).Methods:Perioperative and follow-up data of 71 patients, undergoing coronary reoperations (1987–8) were studied. A cross-sectional follow-up was conducted, functional evaluation by the Duke Activity Status Index (DASI). and patient's evaluation of his life situation were registered.Results:Perioperative mortality was 7%. Eleven patients died during follow-up. The 12-month and 60-month survival was 96% and 80%. Event-free survival was 86% and 51%. Family doctors declared that 55/66 (83%) had benefitted from the coronary reoperations. New York Heart Association decreased significantly from 3.4 ± 0.5 preoperative versus 1.5 ± 0.4 postoperative. The mean DASI was 38.06 ± 10.42. At the moment of the cross-sectional follow-up, 45/55 patients (82%) declared to have benefitted from the coronary reoperations.Conclusion:Improvement in New York Heart Association-class, good postoperative functional capacity, and patients positive evaluation, justify coronary reoperations in patients with a patent internal mammary artery graft.
Autotransfusion Decreases Blood Usage following Cardiac Surgery — a Prospective Randomized Trial
Authors: Dalrymple-Hay Malcolm J. R. , Dawkins Sam , Pack Louise , Deakin Charles D. , Sheppard Stuart , Ohri Sunil K. , Haw Marcus P. , Livesey Steven A. , Monro James L. 
Published: September 2024

Introduction: 10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial. Patients and methods: 166 patients undergoing coronary artery bypass grafting (CABG). valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10g/1 or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance. Results: There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid. Conclusion: Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.
Endovascular Treatment of Abdominal Aortic Aneurysms
Authors: May J. , White G. H. , Waugh R. , Stephen M. S. , Chaufour X. , Yu W. , Harris J. P. 
Published: September 2024

Objective: The purpose of this paper is to briefly review the historical aspects and outcome of endoluminal abdominal aortic aneurysm (AM) repair and summarise two studies presented at the 1997 and 1998 meetings of the Society for Vascular Surgery. Patients: Between May 1992 and September 1998 the endoluminal method was used to repair arterial aneurysms in 304 patients at the Royal Prince Alfred Hospital, Sydney, a tertiary referral teaching hospital. The study focuses on 243 patients with true AAA who underwent primary repair. There were 17 females and 226 males with a mean age of 72 years. Co-morbidities leading to rejection for conventional open repair were present in 83 patients. The criteria for inclusion included a segment of thrombus-free aorta between the lowermost renal artery and the commencement of the aneurysm of 1.5 cm or greater and iliac arteries that allowed access to the aorta from the groin. The technique involved the delivery of an endograft into the abdominal aorta by means of a sheath inserted through the femoral or iliac artery. Laparotomy associated with conventional open repair was avoided. Outcome measures included clinical examination and contrast-enhanced computed tomography (CT) within 10 days, at 6. 12, 18 months after operation and then annually thereafter. Results: Endografts were successfully deployed in 226 patients. In the remaining 17 patients endoluminal repair was converted to open repair. There were 8 deaths within 30 days of operation giving a perioperative mortality rate of 3.3%. The two studies presented to the Society for Vascular Surgery concern: (i) a concurrent comparison of the endoluminal versus open methods of treating AAA; and (ii) a comparison of adverse events following endoluminal repair of AAA during two consecutive periods of time.
Elective Surgery for Small Abdominal Aortic Aneurysms
Authors: Ballotta E. , Da Giau G. , Bottio T. , Toniato A. 
Published: September 2024

Background and purpose: Surgical repair for abdominal aortic aneurysm has become more frequent and the mortality associated with elective surgery has been reduced, but the overall mortality for ruptured aneurysm remains unacceptably high. The dilemma for the vascular surgeon is whether to operate early and electively on asymptomatic small aneurysms, less than 5 cm in diameter, or to delay surgery, adopting a wait-and-see attitude. The purpose of this retrospective study was to review a recent 5-year experience of elective aneurysm surgery, with special emphasis on the perioperative outcome of surgical repair of asymptomatic small aneurysms, in order to evaluate whether early mortality and morbidity justify an aggressive approach. Methods. The report concerns a series of 141 consecutive patients who underwent aneurysm repair for small ( n = 65, group I) and large aneurysms ( n = 76, group II). For each group, the age, sex, risk factors and associated diseases, operative and aortic cross-clamping times, estimated blood loss, blood transfusion volume, type of operation and graft, perloperative morbidity and mortality, and causes of death were recorded and compared. Results: The majority of patients were males. The mean age of the patients was lower in group I than in group II. No statistically significant difference was found from the comparison of the risk factors and associated diseases in groups I and 11. The mean operating time was 82 minutes in group I, 98 minutes in group II, and the aortic cross-clamping time was also shorter in group I (37 min versus 52 min), whereas blood loss was greater, with a statistically significant difference ( P < 0.05). The operative mortality rate was higher in group II than in group I (1.3% versus 0%, P = NS). Conclusions: Elective small aneurysm repair is recommended in good-risk patients for the following reasons: (i) the operative mortality and morbidity rates are lower in small than in large aneurysm patients, and (ii) the small aneurysm repair is technically easier and safer to perform. In addition, there are two other considerations that are more difficult to quantify, but may support an aggressive approach: the cost-benefit ratio is better with early diagnosis and elective surgery, before an emergency operation is required, and personal choice and psychological reasons can induce patients to prefer early elective repair to periodic monitoring by ultrasound or computed tomography scans.
On the Use of Instructional Games in Moroccan High Schools: Motives and Barriers
Authors: Lahbibi Khalid , Farhane Hamza , Yeou Mohamed , El Karfa Abderrahim 
Published: September 2024

Background The use of instructional games in foreign language classrooms has a lot of potential. This potential helped pushing the spread of game use, but it was faced with a lot of barriers. Purpose The current study intended to investigate the factors behind the use/nonuse of instructional games by Moroccan high school teachers. Methods This study adopted a mixed methods approach, which was typified in a sequential explanatory design. Data was collected from 215 students and 10 teachers in Allal Loudyi High School in Fes, Morocco, using questionnaire, interview, observation schedule, and focus group. Results The findings disclosed that students reported that instructional games should be used because they motivated them, helped them enjoy learning, and fostered their critical thinking skills. The large number of learners in the classrooms and lack of enough equipment were found to be two major obstacles, in addition to other minor challenges, that prevent Moroccan high school teachers from using instructional games in the classroom. Discussion Crosslinguistic studies confirmed the potential motives and barriers highlighted in the current study. Conclusion The results had direct implications for Moroccan EFL teachers, stakeholders, and students. The implications were discussed at the end of this article.