bluuebunny/crossref_metadata_2025_split huggingface dataset:
Limitations of Percutaneous Treatment for Peripheral Arterial Vein Graft Stenoses
Authors: Mckinsey James F. , Christian Caprice , Leef Jeffrey , Rosenblum Jordan D. , Szymski George , Piano Giancarlo , Bassiouny Hisham S. , Schwartz Lewis B. , Gewertz Bruce L. 
Published: June 2007

Peripheral arterial bypass vein graft stenosis is the leading cause of graft failure within the first 2 years following implantation. These lesions are generally secondary to myointimal hyperplasia and have historically been treated with graft revision or operative patch angioplasty. Unfortunately, graft revision or angioplasty requires reoperation through a scarred incision and usage of additional portions of autologous conduit. The purpose of this study is to assess the effectiveness of percutaneous transluminal angioplasty (PTA) in the treatment of vein graft stenosis. PTA was performed in 17 patent vein grafts in 16 patients for the treatment of perianastomotic and/or midvein graft stenoses occurring 7 ± 1 months (range 0.5-18 months) after graft implantation. Criteria for follow-up and patency adhered to the standards of the Ad Hoc Committee on Reporting Standards of the SVS/NAISCVS. After a mean follow-up of 17 ±3 months (range 2-44 months), the procedure-specific 18-month primary patency, primary-assisted patency, secondary patency, and limb salvage rates were 48 + 17%, 63 + 12%, 67 ± 12%, and 78 ± 15%, respectively. Subgroup analysis revealed favorable lesions (one or two focal lesions, < 1 cm length) in 11 grafts. Life-table analysis for this subgroup revealed primary patency, primary-assisted patency, secondary patency, and limb salvage rates of 68 ±20%, 90 ±9%, 90 ±9%, and 100%, respectively. The overall results of PTA for vein graft stenosis are poor and PTA should not be liberally applied to complex lesions. PTA may be a reasonable alternative to operative repair for focal vein graft stenoses in high-risk patients or in patients with limited remaining autologous conduit.
New Duplex Criteria for Threshold Stenoses Used in the Asymptomatic Carotid Atherosclerosis Study
Authors: Aburahma Ali F. , Pollack James A. , Robinson Patrick A. , Richmond Bryan K. , Alberts Stephanie , Young Lori 
Published: June 2007

The current Doppler frequency spectral criteria used to classify internal carotid artery (ICA) stenosis into 1%-15%, 16%-49%, 50%-79%, 80%-99% stenoses may not be applied to stenoses of >60%, which is used by the Asymptomatic Carotid Atherosclerosis Study (ACAS) to justify carotid endarterectomy. Therefore, this study was done to determine the best duplex frequency criteria to identify? 60% stenosis. Three hundred fifty-six carotid arteries were studied in patients who had both carotid color duplex and arteriography. Correlation of duplex and arteriography was done in blind fashion. Four different duplex criteria were analyzed: (1) the peak systolic frequency (PSF) of the ICA, (2) end-diastolic frequency (EDF) of the ICA, (3) PSF times EDF of the ICA, and (4) the ratio of the PSF of the ICA to the PSF of the common carotid artery. Four optimum criteria were noted: (1) PSF of the ICA of >5 kHz with 98% sensitivity, 75% specificity, 83% positive predictive value (PPV), 96% negative predictive value (NPV), and 87% overall accuracy; (2) EDF of ICA of?2.5 kHz with 82% sensitivity, 96% specificity, 96% PPV, 81% NPV, and 89% overall accuracy; (3) PSF x EDF of the ICA of 15 kHz with 84% sensitivity, 96% specificity, 97% PPV, 83% NPV, and 89% overall accuracy; (4) the ratio of the PSF of the ICA/PSF of the common carotid artery of?2.7 with 85% sensitivity, 86% specificity, 89% PPV, 82% NPV, and 86% overall accuracy. There was no statistically significant difference among these four parameters. A PSF of the ICA of?6.5 kHz had a PPV of 95% and an overall accuracy of 87%, which can be used for clinicians who perform carotid endarterectomy without a preoperative arteriogram. A PSF of the ICA of?5.0 kHz, an EDF of the ICA of >2.5 kHz, and a ratio of the PSF of the ICA/PSF of the common carotid artery of?2.7 have the best overall accuracy in identifying?60% carotid stenosis. A PSF of the ICA of?6.5 kHz had a PPV of 95%, which can be used for clinicians who perform a carotid endarterectomy without preoperative arteriography.
Propagation of Tibial Vein Thrombus in Patients Systemically Anticoagulated or Receiving Antiplatelet Therapy
Authors: Hirko Mark K. , Kasirajan Karthikeshwar , Turner John J. , Rubin Jeffrey R. 
Published: June 2007

The objective of this study was to evaluate the incidence of infrapopliteal deep vein thrombus propagation in postoperative orthopedic patients. This was a retrospective study of patients undergoing noninvasive venous testing to rule out phlebothrombosis. Venous duplex scans and Doppler studies to record thrombus location were performed at the end of treatment, which lasted from 2 weeks to 1 year (mean: 6 months). The study included 28 postoperative orthopedic patients; 21 men and seven women with a mean age of 52 years (range: 14 to 92 years). Patients received three different treatment regimens. Group I received heparin and warfarin (n = 17; 60.7%); Group II received warfarin (n = seven; 25%); Group III received aspirin (n = four; 14.3%). Isolated tibial vein thrombosis was found in 10 patients, (36%) and 18 patients (64%) exhibited multiple tibial veins involvement. Follow-up venous duplex and Doppler studies revealed a single episode (5.9%) of thrombus propagation from an isolated tibial vein to multiple tibial veins in Group I. There were four Group II patients with isolated and three with multiple tibial vein thrombi. Clot propagation occurred in three (42.9%) instances; two originated from isolated tibial vein thromboses and all extended into the popliteal and femoral veins. No propagation occurred in the limbs of Group III. Statistical analysis of treatment protocols revealed a significant difference in outcome (clot propagation) based on management. Warfarin therapy alone (Group II) resulted in a significantly increased risk for clot propagation (p < 0.04), whereas there was no difference in the incidence of clot propagation based on the number of involved tibial veins (p < 0.12). Warfarin treatment alone was not found to be an effective method of preventing thrombus propagation in postoperative orthopedic patients with tibial vein thrombosis. The treatments using heparin/warfarin or aspirin alone were found to be equally effective for preventing this complication.
Evaluation of Collagen-Coated Woven Velour Polyester and Expanded Polytetrafluoroethylene Grafts During Early Lytic Therapy in an Animal Model
Authors: Rummel Mark C. , Ikeda Yasuharu , Ierardi Ralph P. , Grotkowski Caroline , Khoury Paul A. , Matsumoto Teruo , Kerstein Morris D. 
Published: June 2007

This study was conducted to determine the relative safety of early urokinase lytic therapy in expanded polytetrafluoroethylene (ePTFE) and collagen-impregnated woven velour polyester (CIWVP) grafts. Twelve mixed-breed dogs were selected and implanted with thin-wall ePTFE and CIWVP grafts in the external iliac artery position. At 3, 4, 6, and 12 weeks, three dogs were selected for lytic therapy. After exposure of the previously implanted grafts, lytic therapy was initiated with a bolus of 100,000 units of urokinase, followed by 4000 units/minute for two hours, then reduced to 2000 units/minute for a subsequent two hours. Hypertension was induced by methoxamine hydrochloride at the conclusion of lytic therapy. Direct observation and angiography were used to assess for bleeding and contrast extravasation hourly until completion. The animals were then sacrificed and the grafts excised and microscopically examined for incorporation, pseudointimal deposition, and accelerated collagen layer degradation. None of the implanted grafts showed evidence of transluminal or suture line bleeding or extravasation of contrast material. Hypertension did not change these results. Analysis demonstrated a thicker pseudointimal, giant cell infiltration, extensive incorporation, and occasional fragmentation of the CIWVP graft when compared with the ePTFE grafts. The systemic fibrinolytic state did not cause collagen layer degradation. No evidence existed of suture line or transluminal bleeding from CIWVP or ePTFE grafts during urokinase lytic therapy conducted at 3, 4, 6, or 12 weeks in a canine model. Microscopic examination demonstrated a difference in pseudointima, graft incorporation, and inflammatory response when the two conduits were compared. Urokinase did not appear to accelerate collagen layer breakdown.
Pathogenesis of Homeostatic Disorders Following Surgery for Aortic Arch and Thoracoabdominal Aneurysm During Profound Hypothermia and Circulatory Arrest
Authors: Dementieva Inna I. , Roitman Eugene V. , Belov Jury V. 
Published: June 2007

This study examined dynamics for blood gas, parameters of acid-base equilibration, water-and-electrolyte balance, glucose, hemocoagulation, and blood rheology at surgery for aortic arch and thoracoabdominal aneurysm during profound hypothermia and circulatory arrest. Frequency for development of homeostatic disorders was related to the temperature (r = -0.71; P < 0.05), and to the duration of circulatory arrest period (r - 0.77; P <0.05). Also, it established the dependencies from duration of cooling time (r = 0.59; P < 0.05), and from warming time when temperature has attained more than 28±C (r = -0.65; P < 0.05). It was shown that long hypoxia and reperfusion disorder stipulated the decrease of utilization for main metabolites, the increase of oxygen failure in tissues, the increase of the permeability of cells membranes, and the increase of blood viscosity and disseminated intravascular coagulation (DIC), which are the main reasons for homeostasis disorders during the same surgery. In the period from the start to the end of the second extracorporeal circulation, there exists the heaviest probability for hypoxic failure in tissues and thrombohemorrhagic complications. For aortic aneurysm surgery with circulatory arrest and profound hypothermia, the adequacy for the correction of homeostatic disorders is expressed only in complex therapy of hypoxical and thrombohemorrhagic complications that enable one to execute simultaneous reduction of the tissue's oxygen deficit and failures of hemocoagulation and blood rheology.
Management of the Femoral Artery After Transluminal Repair of Abdominal Aortic Aneurysms
Authors: Smith Bruce M. , Gray Richard J. , Laird John R. , Kohlman-Trigoboff Debra , Deforty Debra , Stanford Jon L. 
Published: June 2007

Catheter-based treatment of abdominal aortic aneurysms (AAA), in which an endograft is placed into the aneurysmal aorta through one or more femoral arteriotomies, is gaining acceptance rapidly. This technique has the advantage of avoiding the morbidity and prolonged recovery of conventional repair, but subjects the femoral arteries to significant surgical and catheter trauma that may compromise the outcome of the procedure. We review our experience with management of the femoral arteries following endovascular aneurysmal repair. Thirty patients undergoing endovascular repair of their AAA with the modular bifurcated Aneu Rxg (Medtronic AneuRx, Sunnyvale, CA) endovascular prosthesis had their femoral arteries exposed through bilateral groin incisions to permit insertion of the device. Proximal and distal control of the femoral arteries was achieved, and guidewire passage and sheath access obtained using standard angiographic techniques. The endovascular components, ensheathed in a 22F (primary device) or 16F (secondary device) catheter were positioned and deployed from bilateral common femoral arteriotomies. The 22F insertion system was used in the right femoral artery in 18 and left femoral artery in 12 of the 30 procedures. Repair of the femoral arteriotomies was accomplished following standard vascular surgical principles, and femoral and pedal pulses and ankle-brachial indices (ABI) recorded postoperatively. All 30 patients were men (mean age: 73 ±8 years), and all had evidence of extra-aortic atherosclerosis. The endovascular prosthesis was deployed successfully in 29 of the 30 patients. One limb was lost in the postoperative period secondary to severe pre-existing arterial occlusive disease in the popliteal and tibial arteries, and one patient thrombosed an associated popliteal aneurysm requiring emergent repair on the first postoperative day. No patient experienced a permanent change in the pulse examination or reduction in the ABI. Thirteen of the 60 (22%) arteries required repair other than simple closure of the arteriotomy to restore arterial continuity. Complex repair was more common in the initial 15 (10 of 30 arteries, 33%) patients than in the latter 15 (3 of 30 arteries, 10%, p=0.01) and on the side of the larger, primary device (8 of 30 arteries, p=NS). Technically successful repair was achieved in all vessels. Although associated with shorter recovery times and brief hospital stays, endovascular repair of AAA, not unexpectedly, may require complex management of the sites of access for the prosthesis. The need for complex repair appears to diminish both with increasing experience with the device and smaller device size. Simplifying management of the femoral artery requires significant advances in the design of the currently available devices.
Comparison of Costs and Healing Rates of Two Forms of Compression in Treating Venous Ulcers
Authors: DePalma Ralph G. , Kowallek Donna , Spence Richard K. , Caprini Joseph A. , Nehler Mark R. , Jensen Jeffrey , Goldman Mitchel P. , Bundens Warner P. 
Published: June 2007

The objective of this study was to compare healing rates and costs of treating venous ulcers with traditional Unna boots (UB) or a CircAid Thera-Boot (TB). A multicenter, prospective, randomized parallel-group study was performed in three university medical center vascular surgery clinics and three private medical offices. Patients presented with unilateral venous leg ulcers 5 cm or less in diameter. Patients with severe arterial, metabolic, or neuropathic diseases, and those who would not be expected to heal with conservative treatment, were excluded. Conservative treatment of the leg ulcer consisted of a nonadherent topical dressing and compression with either a traditional Unna's boot or a Thera-Boot. The main outcome measures were the following: time to healing, rate of area decrease, rate of percent area decrease, linear healing rate, costs of labor, materials, and overhead. Of 38 enrolled patients seven were withdrawn (five UB, two TB). Three patients were still in treatment when the study was stopped. Eleven UB patients and 17 TB patients completed the study. Healing rates were for UB and TB patients (mean (Meeting ± sd) were, respectively: time to healing (weeks) 9.69 ± 3.28, 7.98 ± 4.41 (p = 0.41), area healing rate (cm2/day) 0.0239 ± 0.0534, 0.0433 ± 0.0910 (p = 0.27),% area healing rate (%/day) 1.0493 ± 1.5583, 2.0357 ± 1.9520 (p = 0.56), and linear healing rate (cm/day), 0.0060 ± 0.0092, 0.0109 ± 0.0125 (p = 0.27). Costs for UB and TB (dollars to completion) were, respectively: clinician labor 331.37 ± 255.75, 201.91 ± 131.17 (p = 0.09), materials 160.86 ± 96.86, 122.79 ±27.59 (p= 0.14), overhead (number of visits) 11.70 ± 6.40, 6.71 ±3.77 (p = 0.02), and total costs 901.73 ± 576.45, 559.41 ±290.75 (p= 0.05). Treatment of venous ulcers with Circ Aid Thera-Boots is significantly less costly than treatment with traditional Unna's boots. Trends toward faster healing were noted.
Acute Aortic Dissection Presenting as Left Upper Limb Ischemia
Authors: Sultan Sherif , O'Donohoe Martin , Deeb Maged El , Din Ahmed Saad El , Mehairy Nabil El 
Published: June 2007

Acute upper limb ischemia is most frequently the result of an embolus that originates in the heart. Ascending aortic dissection is a life-threatening vascular emergency that must be treated immediately. Isolated upper limb ischemia secondary to acute aortic dissection has not been previously reported. Two cases of DeBakey type I aortic dissection presenting as unilateral upper limb ischemia are reported. This presentation may result in delayed diagnosis of aortic dissection and, consequently, in high mortality. The possibility should be borne in mind when dealing with all cases of acute arm ischemia because embarking on a brachial embolectomy which may delay the diagnosis of a more serious and fatal condition. The etiology of this unusual presentation and possible therapeutic interventions are discussed.
Liturgical Uniformity
Authors: Buchanan Colin 
Published: June 2007

ABSTRACTThe uniformity of worship which we accept as part of the Anglican tradition was an entirely new idea when it was introduced in the sixteenth century. Few had asked for a single book of worship, but it was enforced by top-down, often draconian measures. This article traces the changing circumstances which have led to the loss of such uniformity not only in England, but in the worldwide Anglican Communion. In this process the equation of Anglican identity with a particular liturgical ethos may have disappeared. That process can be illustrated from the experience of the last Lambeth Conference.
Social capital and risk for chronic illnesses
Authors: Ahern Melissa M. , Hendryx Michael S. 
Published: June 2007

Objectives: This study used an ecological model of social capital to examine the relationship between social capital and chronic illness. The model hypothesizes that personal social support and collective social capital are related to risk for chronic illnesses. Methods: Data were taken from the American Changing Lives public use database. Seven hundred and sixty-nine persons meeting inclusion criteria were included. Dependent variables were the reported presence of hypertension and diabetes. Logistic regression analysis was used to identify correlates of these chronic illnesses, including demographic variables, and social capital and social support variables measured at both the personal and collective levels. Results: Significant results were usually consistent with model hypotheses; that is, measures of social capital and social support were related to the presence of diabetes and hypertension in expected ways. However, in other cases, the hypothesized relationships were not statistically significant, due to limitations in the model or data. Discussion: Social support and social capital both serve as protective factors against chronic illness. Development of social capital may proceed from the personal family and social environment to collective measures of trust and engagement, and this suggests that family relationships are the foundation on which to base efforts to build social capital.
Initial validation of an instrument to identify barriers to self-management for persons with co-morbidities
Authors: Bayliss Elizabeth A. , Ellis J.L. , Steiner J.F. , Main D.S. 
Published: June 2007

Objective: To develop and initially validate a questionnaire designed to assess barriers to self-management perceived by persons with multiple chronic medical conditions. We hypothesized that persons who reported increased barriers to self-management would also report lower general health status and a greater disease burden. Methods: A cross-sectional survey was done of Health Maintenance Organization members aged 65 years or older with varying numbers of chronic medical conditions. On the basis of a previous qualitative investigation, we have identified 13 domains representing potential barriers to self-management. We developed questions to assess each of these domains and, for each, calculated coefficients alpha and assessed correlation of that domain with self-reported general health status and disease burden. Results: Respondents reported an average of 5.9 chronic conditions. Eight domains demonstrated acceptable internal consistency in this population. Nine of 13 domains correlated significantly in the expected direction with health status and/or disease burden. Discussion: These results provide an encouraging first step in developing a tool that will be clinically useful in assessing and addressing barriers to medical self-management for persons with co-morbidities. Use of assessments such as this in clinical settings may facilitate appropriate and efficient care management and improved health outcomes for this growing and vulnerable patient population.
Experiences of Australian parents caring for children with asthma: it gets easier
Authors: Barton Christopher , Sulaiman Nabil , Clarke David , Abramson Michael 
Published: June 2007

Objective: To describe the experiences of Australian parents caring for children with asthma. Methods: A combination of random sampling, purposeful sampling and quota sampling was used to select care-givers from general practices in Melbourne's north and north-western suburbs. Data collection involved a single semi-structured in-depth interview with 21 parents caring for a child with asthma. Thematic analysis was aided by QSR NVivo. Results: Children experienced predominantly mild-to-moderate, episodic asthma. Six themes emerged from the interviews: emotions and behaviours, coping strategies, disruption to activities, health and treatment beliefs, problems with asthma management, and relationships with doctors. Parents' experiences and health beliefs impacted on their management of asthma. These may act as barriers to optimal asthma care in some families. The overriding theme to emerge was `it gets easier'. It got easier with time because the children could communicate more effectively, and were better able to take care of themselves, and their asthma became less severe or less of a problem. Discussion: This research has highlighted the need for health professionals to emphasize the chronic nature of asthma, but negotiate strategies with care-givers to optimize the use of asthma medications, with consideration being given to care-givers' fears, frustrations and health beliefs.
Use of telephone care in a cardiovascular disease management programme for type 2 diabetes patients in Santiago, Chile
Authors: Piette John D. , Lange Ilta , Issel Michelle , Campos Solange , Bustamante Claudia , Sapag Jaime , Poblete Fernando , Tugwell Peter , O'Connor Annette M. 
Published: June 2007

Objectives: In 2004, the Chilean National Ministry of Health instituted a cardiovascular disease (CVD) management programme aimed at improving diabetes care among patients treated in the public healthcare system. We sought to identify the characteristics of patients participating in the CVD programme and the feasibility of extending its reach through structured nurse telephone contacts between outpatient encounters. Methods: We surveyed 569 low-income adults with type 2 diabetes treated in public clinics of Santiago, to assess patients' participation in the CVD programme and willingness to use telephone care services. Surveys were linked to information from medical records. Results: One-third of patients met the target of two visits to the CVD programme in the previous 6 months, and an additional 32% made more than three visits. Use of the CVD programme was associated with greater patient satisfaction, even after controlling for potential confounders. However, 27% of patients had inadequate programme contact, and many of these patients were in poor health. Many CVD programme participants reported difficulties with lifestyle changes, and greater contact with the CVD programme was not associated with healthier behaviours. Most patients (95%) reported telephone access and 37% had used the telephone to contact their clinic. The majority of patients would be willing to use telephone care for additional behaviour change and emotional support. Patients with fewer CVD programme visits were particularly likely to report willingness to use telephone care. Discussion: Clinic-based CVD disease management services reach a large number of socio-economically vulnerable Chileans with diabetes. However, barriers to access remain, and planned telephone care services may increase the reach of self-management support.