bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occupational Outcomes and Return to Running Following Internal Fixation of Ankle Fractures in a High-Demand Population
Authors: Orr Justin D. , Kusnezov Nicholas A. , Waterman Brian R. , Bader Julia O. , Romano David M. , Belmont Philip J. 
Published: March 2015

Background: Literature evaluating surgical outcomes after ankle fixation in an active patient population is limited. This study determined occupational outcomes and return to running following ankle fracture fixation in a military cohort. Methods: All service members undergoing ankle fracture fixation at a single military hospital from August 2007 to August 2012 were reviewed. Univariate analysis determined the association between patient demographic information, type of fracture fixation, and the development of posttraumatic ankle arthritis and functional outcomes, including medical separation, return to running, and reoperation. Seventy-two primary ankle fracture fixation procedures were performed on patients with mean age of 29.1 years. The majority of patients were male (88%), were 25 years of age or older (61%), were of junior rank (57%), underwent unimalleolar fracture fixation (78%), and did not require syndesmotic fixation (54%). The average follow-up was 35.9 months. Results: The mean time to radiographic union was 8.6 weeks. Twelve service members (17%) were medically separated from the military due to refractory pain following ankle fracture fixation with a minimum of 2-year occupational follow-up. Among military service members undergoing ankle fracture fixation, 64% returned to running. Service members with higher occupational demands had a statistical trend to return to running (odds ratio [OR] 2.49; 95% CI, 0.93-6.68). Junior enlisted rank was a risk factor for medical separation (OR 11.00; 95% CI, 1.34-90.57). Radiographic evidence of posttraumatic ankle osteoarthritis occurred in 8 (11%) service members. Conclusions: At mean 3-year follow-up, 83% of service members undergoing ankle fracture fixation remained on active duty or successfully completed their military service, while nearly two-thirds returned to occupationally required daily running. Level of Evidence: Level IV, retrospective case series.
A Study of Human Killer Cell Immunoglobulin-Like Receptor and Multidrug Resistance Gene Polymorphisms in Children With Immune Thrombocytopenia
Authors: El-beblawy Nagham Mohamed Samy , Elbarbary Nancy Samir , Kamal Tarek Mostafa , Mahmoud Perehan Mohsen 
Published: March 2015

The objective: This study was undertaken to detect characterization of the different gene polymorphisms in Human killer cell immunoglobulin-like receptor (KIR2) gene and multi-drug resistance (MDR1) gene, among childhood ITP Egyptian patients. In addition to assess the potential role of these polymorphisms in relation to types of ITP and response to different treatment modalities. Patients and Methods: A total of 48 pediatric patients with immune thrombocytopenia (ITP; 24 newly diagnosed and 24 chronic) and 35 healthy controls were investigated via polymerase chain reaction-restriction fragment length polymorphism analysis for multidrug resistance (MDR) 1 and killer cell immunoglobulin-like receptor (KIR) 2 genes. Results: The frequency of MDR1 gene in patients and control was not significant ( P = .090). The CT genotype was the highest distribution among all ITP cases (62.50%, n = 30) and control (48.60%, n = 17). There was a significant difference in age at diagnosis of MDR1 gene with the CC genotype had the eldest age and lowest initial platelets count ( P = .029 and P = .004). The distribution of KIR2 gene among all patients with ITP and controls was significant ( P = .026) with (KIRDL2−/KIRDS2−) genotype was the most prevalent among patients. Conclusion: The frequency of MDR1 polymorphisms was not associated with susceptibility to the development and clinical progression of the disease. However, KIR2 gene polymorphisms were independently associated with childhood ITP in Egyptian patients with highest prevalence among (KIRDL2−/KIRDS2−) genotypes.
Cortical relapses in multiple sclerosis
Authors: Puthenparampil Marco , Poggiali Davide , Causin Francesco , Rolma Giuseppe , Rinaldi Francesca , Perini Paola , Gallo Paolo 
Published: March 2015

Background: Multiple sclerosis (MS) is a white and grey matter disease of the central nervous system (CNS). It is recognized that cortical damage (i.e. focal lesions and atrophy) plays a role in determining the accumulation of physical and cognitive disability that is observed in patients with progressive MS. To date, an association of cortical lesions with clinical relapses has not been described. Results: We report clinical and magnetic resonance imaging (MRI) findings of five relapsing–remitting MS (RRMS) patients who had clinical relapses characterized by the acute appearance of cortical symptoms, due to the development of large, snake-like, cortical inflammatory lesions. Symptoms were: acute Wernicke’s aphasia mimicking stroke; agraphia with acalculia, not associated to a motor deficit nor linguistic disturbance; hyposthenia of the left arm, followed by muscle twitching of the hand, spreading to arm and face; acute onset of left lower limb paroxysmal hypertonia; and temporal lobe status epilepticus, with psychotic symptoms. Conclusions: Cortical relapses may occur in MS. MRI examination in MS should include sequences, such as double inversion recovery (DIR) or phase sensitive inversion recovery (PSIR), that are aimed at visualizing cortical lesions, especially in the presence of symptoms of cortical dysfunction. Our observation further stresses and extends the clinical relevance of cortical pathology in MS.
Carotid Stenting versus Carotid Surgery: A Prospective Cohort Study
Authors: Becquemin Jean-Pierre , Kadi Hassen Ben El , Desgranges Pascal , Kobeiter Hicham 
Published: March 2015

Purpose: To compare the results of carotid stenting and carotid surgery in a consecutive group of 455 patients (482 lesions). Methods: Between January 1995 and July 2002, 107 patients (114 lesions) were treated with carotid stenting and 348 patients (368 lesions) with carotid surgery. A cerebral protection device was routinely used in the last 46 stent cases. All patients were followed with duplex examination at 1 and 6 months postoperatively and yearly thereafter. Results: The stent and surgery groups were similar in terms of mean age (70.5 and 71.1 years, respectively), sex distribution (men 72% versus 75%), and symptoms (transient ischemic attack [TIA] or minor stroke 32.7% versus 42.2%). Median follow-up was 15 months in stent patients and 14 months in the surgical group. At 1 month postoperatively, there were 7 minor strokes (5 temporary lasting <21 days and 2 persistent) and 1 major stroke in the stent group versus 1 persistent minor stroke in the surgical patients. The overall neurological event rate (including TIA) was 10.5% versus 1.9% (p = 0.0002) in the surgical patients; cardiac morbidity was 3.5% versus 1.6% (p = NS), and the death rate was 0% versus 0.8% (p = NS). The combined permanent stroke/death rate was 2.6% in stent patients and 1.1% in surgery patients (p = NS). During follow-up, the cumulative all stroke rate was 8.8% versus 1.9% (p = 0.001), but the 3-year cumulative survival rate free from ipsilateral major neurological events was 95.2% in stent patients and 96.9% in the surgery cohort (p = NS). There was a 7.5% rate of restenosis in stented arteries versus 1.4% in surgery patients (p = 0.001). Conclusions: This series showed encouraging and comparable major stroke and deaths rate of carotid stenting and carotid surgery. However, there was more restenosis in the stented group on midterm follow-up.
Complications after Endovascular Treatment of Thoracic Aortic Aneurysms
Authors: Scharrer-Pamler Reinhard , Kotsis Thomas , Kapfer Xaver , Görich Johannes , Orend Karl-Heinz , Sunder-Plassmann Ludger 
Published: March 2015

Purpose: To retrospectively determine the value of stent-graft repair of descending thoracic aortic aneurysms by analyzing the results and complications. Methods: From May 1997 to July 2002, 45 patients (33 men; mean age 69 years, range 31–88) received endovascular treatment for thoracic aortic aneurysms. In 11 patients, emergency treatment was necessary for a contained rupture. The medical records of these patients were reviewed to gather data on the procedures, immediate results, complications, mortality, and survival in follow-up. Results: In all cases, the stent-grafts were successfully implanted. In 15 (33%) cases, the subclavian artery was covered by the stent-graft without complications. There was no paraparesis/paraplegia; 2 (4.4%) patients suffered a stroke intraoperatively. The in-hospital mortality was 2.2% (n = 1); 3 (6.7%) patients died within 30 days. Primary endoleaks occurred in 8 (17.8%) cases. Procedural success (technical success without endoleak or death) was 80% (93.3% after primary endoleak repair). During follow-up, 2 (4.4%) secondary endoleaks developed. All endoleaks were treated successfully or sealed spontaneously (n = 2). At a mean 24-month follow-up (range 1–62), 84% of patients were alive. Conclusions: The endovascular treatment of thoracic aortic aneurysms appears to be safe and effective, with lower morbidity and mortality than in conventional open operations. For these reasons, endovascular treatment should be administered whenever possible.
Emergency Endovascular Treatment of Traumatic Aortic Arch Rupture with Multiple Arch Vessel Involvement
Authors: Waldenberger Peter , Fraedrich Gustav , Mallouhi Ammar , Jaschke Werner R. , Perkmann Reinhold , Jung Tarzis , Czermak Benedikt V. 
Published: March 2015

Purpose: To report successful endovascular stent-graft placement for emergency treatment of a complex traumatic injury involving the aortic arch and multiple arch vessels. Case Report: An 81-year-old man underwent stent-graft placement for a complex traumatic vascular injury. Computed tomography on admission documented a dissection along the course of the aortic arch, intramural hematoma along the ascending aorta, dissection of the innominate artery, and a right subclavian artery pseudoaneurysm. The dissection of the aortic arch and the pseudoaneurysm of the right subclavian artery were treated immediately, the dissection of the innominate artery 7 days later. The patient did not develop any complications. Follow-up studies performed prior to discharge and at 6 and 12 months after the interventions showed successful repair of the complex vascular injuries. Conclusions: Traumatic injury of the aortic arch with multiple arch vessel involvement can be treated effectively by means of stent-graft placement.
Transseptal Stent Treatment of Anastomotic Stricture after Repair of Partial Anomalous Pulmonary Venous Return
Authors: Dieter Robert S. , Nelson Brian , Wolff Mathew R. , Thornton Frank , Grist Thomas M. , Cohen Daniel M. 
Published: March 2015

Purpose: To report the endovascular treatment of a stenosis of the pulmonary venous anastomosis following surgical treatment for partial anomalous pulmonary venous return. Case Report: A 60-year-old man presented with recurrent pleural effusions after correction of a partial anomalous left pulmonary venous return. Magnetic resonance imaging demonstrated focal stenosis at the anastomosis of the anomalous pulmonary vein to the left atrial appendage. Using a transseptal approach, the pulmonary vein stenosis was accessed and successfully stented. The patient's symptoms improved, and follow-up imaging demonstrated a patent stent without residual pressure gradient. Conclusions: Endovascular repair of a stenosis at the anastomosis of an anomalous pulmonary vein is possible and should be considered as a treatment option for this lesion.
Hypotension and Bradycardia after Elective Carotid Stenting: Frequency and Risk Factors
Authors: Mlekusch Wolfgang , Schillinger Martin , Sabeti Schila , Nachtmann Tassilo , Lang Wilfried , Ahmadi Ramazanali , Minar Erich 
Published: March 2015

Purpose: To investigate the frequency of and risk factors for hypotension and bradycardia in response to elective carotid stenting and their association with neurological complications. Methods: A retrospective analysis was conducted of 471 patients (321 men; median age 72 years, interquartile range 64–77) who underwent elective carotid artery stenting without cerebral protection for high-grade (>70%) symptomatic (n = 147) or asymptomatic (n=324) internal carotid artery stenosis at a single center. Frequency and potential risk factors for severe hypotension (systolic blood pressure <80 mmHg) or bradycardia (heart rate <50 bpm) were studied. Results: Thirty-four (7%) patients had severe hypotension (n=23), bradycardia (n=2), or both (n=9) despite routine premedication with atropine and adequate fluid balance. Intravenous catecholamines (dopamine) were necessary in 8 patients with prolonged hypotension; none of the patients with bradycardia needed pacemaker support. Neurological complications (transient ischemic attack, minor stroke, major stroke, death) occurring in 33 (7%) patients were not significantly associated with hemodynamic instability (4/34 [12%] versus 29/437 [7%], p = 0.26). Age >77 years (fourth quartile; OR 6.40, 95% CI 1.80 to 22.78, p=0.004) and coronary artery disease (OR 2.81, 95% CI 1.29 to 6.14, p=0.010) were associated with an increased adjusted risk for hypotension or bradycardia. Conclusions: Hemodynamic instability due to hypotension and bradycardia in response to carotid artery stenting occurs in a relatively low proportion of patients. Elderly patients and those with coronary artery disease are at highest risk. Although the rate of neurological complications was not significantly increased in patients with hemodynamic instability, the higher frequencies of neurological complications in these patients admonish us to be careful.
Carotid Artery Dynamics during Head Movements: A Reason for Concern with Regard to Carotid Stenting?
Authors: Vos A.W. Floris , Linsen Matteus A.M. , Marcus J. Tim , van den Berg Jos C. , Vos Jan Albert , Rauwerda Jan A. , Wisselink Willem 
Published: March 2015

Purpose: To evaluate carotid artery mobility patterns during head movements following carotid angioplasty/stenting (CAS). Methods: In 7 patients (all men; mean age 69 years, range 65–76) who had undergone unilateral CAS, 3D time-of-flight magnetic resonance angiography was performed, visualizing both carotid arteries in 5 different head positions (neutral, turned left and right, and bent forward and backward). Maximum intensity projection reconstructions were obtained to measure angulation at the proximal and distal stent junction. Configuration changes of the stented section of the carotid artery and the unstented contralateral artery were judged. Secondly, transverse sections at the level of the carotid bifurcation and at the skull base were used to calculate torsion shear in the common and internal carotid arteries (CCA, ICA) during turned left and right head position. Results were expressed as median (range). Results: In neutral head position, maximal angulation at the distal stent junction was 34.3° (32.3°–55.6°). With the head bent forward, this angulation changed to 47.6° (42.6°–85.2°, p=0.028) and when bent backward to 26.5° (25.0°–48.7°, p=0.027). In all patients, configuration changes of the stented sections were absent. The contralateral unstented side showed diffuse configuration changes without specific angulation at one location. With the head turned left and right, the CCA on the stented side was subjected to 28.6° (13.6°–53.7°) and 24.9° (2.0°–50.6°) of torsion shear, respectively. Torsion of the ICA was subsequently 18.1° (12.7°–40.5°) and 15.2° (2.9°–69.4°). Conclusions: Following carotid stenting, sharp ICA angulations that are aggravated by forward bending of the head occur at the distal stent junction. The stented section of the carotid artery shows complete lack of flexibility despite highly flexible features of the stents ex vivo. Both the CCA and ICA are subjected to considerable torsion shear with the head turned left and right. This shear is not accommodated by the current stent designs.
New Post-Imaging Software Provides Fast and Accurate Volume Data from CTA Surveillance after Endovascular Aneurysm Repair
Authors: Yeung Kay K. , van der Laan Maarten J. , Wever Jan J. , van Waes Paul F.G.M. , Blankensteijn Jan D. 
Published: March 2015

Purpose: To quantify intra- and interobserver variabilities when measuring total aneurysm volume after endovascular aneurysm repair using the Vitrea 2 System and to compare it in terms of accuracy and processing time with the gold standard methods using the Easy Vision workstation. Methods: Total aneurysm volumes from 30 postendograft CTA datasets were randomly selected from a database consisting of ∼400 CTA datasets recorded in 89 patients. The intra- and interobserver variabilities were measured on the Vitrea workstation by 2 investigators. The intermodality variability was calculated for the same measurements using the Easy Vision workstation. The differences of each pair of measurements were plotted against their mean, and the repeatability coefficient (RC) was calculated. The mean differences were also expressed as a percentage of the first measurements. Results: The intraobserver mean difference was 1.6 mL (1.4%) with an RC of 10.8 mL (10.1%) and the interobserver mean difference was −1.4 mL (–1.4%) with an RC of 11.7 mL (10.2%). The intermodality mean difference was 1.8 mL (2.0%) with an RC of 15.8 mL (11.1%). The Vitrea workstation required a median of 8 minutes (interquartile range 7–10) for 1 observer and 6 minutes (interquartile range 5–8) for the other to perform a complete volume segmentation of each patient dataset compared to an estimated average of 30 minutes using the Easy Vision workstation. Conclusions: The Vitrea workstation provides fast and accurate volume data from spiral CTA follow-up of endovascular aneurysm repair. This software may enhance the acceptability of volume surveillance in daily practice.
Endovascular Graft Infection: Preliminary Results of an International Enquiry
Authors: Fiorani Paolo , Speziale Francesco , Calisti Annalisa , Misuraca Maria , Zaccagnini Davide , Rizzo Luigi , Giannoni Maria Fabrizia 
Published: March 2015

Purpose: To investigate the frequency of aortoiliac endovascular graft infections and seek the main factors influencing their development. Methods: To augment personal experience (1 case), a questionnaire was sent to 40 international centers of vascular and endovascular surgery. The literature was also reviewed to collect data on infections developing in endovascular grafts. Results: The survey (85% response rate) and literature review identified 62 cases of infected endovascular grafts (0.4% frequency of endograft infection). In 22 (35%) patients, the infection manifested initially with vague symptoms only, but 41 (65%) patients eventually presented with abdominal abscess, groin fistula, and septic embolization. Common bacteria, such as Staphylococcus aureus, were identified as the cause of most infections (54.5%). The majority (49, 79%) of the 62 patients were treated surgically; 11 (17.7%) patients received conservative therapy (no therapeutic data in 2 patients). Overall mortality was 27.4% (17/62), and operative mortality was 16.3% (8/49). Conservative treatment led to a mortality rate of 36.4% (4/11). The mean follow-up for all patients was 47.8 weeks. Possible factors influencing the development of an infection were secondary adjunctive procedures, immunosuppression, treatment of false aneurysms, and infected central lines. Conclusions: Infected endovascular grafts are an urgent problem that has been heretofore underestimated and will probably increase as follow-up lengthens. New techniques should be sought to expedite the diagnosis, and an international registry should be set up to provide validated data.
Retrograde Fenestration of Endoluminal Grafts from Target Vessels: Feasibility, Technique, and Potential Usage
Authors: McWilliams Richard G. , Fearn Shirley J. , Harris Peter L. , Hartley David , Semmens James B. , Lawrence-Brown Michael M.D. 
Published: March 2015

Purpose: To report initial experiments involving a new method for percutaneous intraprocedural stent-graft fenestration from the target vessel. Technique: In bench and canine models, the fabric of an implanted Zenith endograft was punctured easily using the stiff end of a coronary 0.014-inch guidewire delivered through the target vessel (e.g., renal or iliac artery). A 20-G cutting needle was passed over the coronary wire to enlarge the puncture site, followed by a cutting balloon to create a fenestration that was of sufficient size to allow deployment of a stent. Conclusions: In vivo endograft fenestration of a Zenith endograft is feasible. In addition to providing a percutaneous means of intentionally fenestrating a stent-graft from the artery to be perfused, the technique has potential application as a bailout maneuver after inadvertent side branch occlusion. Although the time to achieve successful fenestration in the experimental model was long, refinement may achieve performance times adequate to maintain viability of the end organ.
Chronic Aortic Dissection Complicated by Disseminated Intravascular Coagulation: Successful Treatment with Endovascular Stent-Grafting
Authors: Sakamoto Ichiro , Matsuyama Naohiro , Fukushima Aya , Hayashi Hideyuki , Nishida Akifumi , Hazama Shiro , Noguchi Manabu , Eishi Kiyoyuki , Hayashi Kuniaki 
Published: March 2015

Purpose: To report endovascular repair of a chronic aortic dissection complicated by disseminated intravascular coagulation (DIC). Case Report: A 61-year-old man developed DIC associated with a chronic Stanford type B aortic dissection that occurred during cardiac catheterization 12 years earlier. At the current admission, computed tomography showed a partially thrombosed false lumen extending from the aortic arch to the left common iliac artery. On angiography, entry and re-entry tears were identified at the right subclavian and left common iliac arteries, respectively. After stent-graft implantation at the entry and re-entry sites, not only was the false lumen completely thrombosed but the DIC also resolved. The patient is doing well with no complication at 16 months after treatment. Conclusions: Endovascular stent-grafting is an acceptable alternative to surgical repair for aortic dissection accompanied by DIC.
Chronic Platelet and Neutrophil Adhesion: A Causal Role for Neointimal Hyperplasia in In-Stent Restenosis
Authors: Tanguay Jean-François , Hammoud Talal , Geoffroy Pascale , Merhi Yahye 
Published: March 2015

Purpose: To investigate the relationship between platelets and neutrophils and the progression of neointimal hyperplasia after angioplasty versus stenting of porcine coronary arteries. Methods: Balloon angioplasty or implantation of a balloon-expandable stent was randomly performed in the left and right coronary arteries of 16 Yorkshire swine; the animals were euthanized 1 hour (n=6), 24 hours (n=4), or 1 month (n=6) after the interventions. The adhesion of chromium 51-labeled platelets and indium 111-labeled neutrophils was quantified (per cm2), and histological and morphometric analyses were performed. Results: The acute adhesion of platelets and neutrophils observed on the injured segments 1 hour after the interventions was similar between the treated groups. However, at 24 hours, stenting was associated with 2-fold more platelets and 3-fold more neutrophils (p<0.05) than was dilation, and stented arteries remained more thrombogenic at 1 month (p<0.05). Neointimal formation was more intense after stent implantation (3.80±0.77 mm, p<0.05) than after dilation (0.81±0.21 mm), and it correlated positively with the adhesion of platelets (r=0.81, p<0.002) and neutrophils (r=0.69, p<0.01). Conclusions: These results indicate that stent implantation is associated with a more intense acute and chronic, low-grade inflammatory response than is dilation. It appears that the chronic inflammatory response is, at least in part, platelet- and neutrophil-driven and contributes to the progression of neointimal proliferation after stenting.