bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortocava Fistula
Authors: Sigler Luis , Gutiérrez-Carreño Rafael , Martínez-López Carlos , Lizola Rene I. , Sánchez-Fabela Carlos 
Published: June 2007

Combined injuries of the aorta and inferior vena cava are rare. Mortality is over 70%, primarily from exsanguinating hemorrhage. Post-traumatic aortocava fistula can develop in survivors, who present in the postoperative period with manifestations of high output heart failure. This is a retrospective review of five male patients, age from 9 to 39 years, with aortocava fistulas that were referred with congestive heart failure, 2 days to 6 months after abdominal penetrating injuries. They had undergone surgery at another hospital and several organ injuries were treated. Retroperitoneal hematomas were not seen or were seen and left undisturbed. Four patients received a gunshot injury, had the fistula at the infrarenal level, and survived surgical repair. In one of the survivors, a left popliteal artery bullet embolism also occurred and was treated. Another patient sustained a thoracoabdominal stab injury and an aortocava fistula developed at the suprarenal level; he was in severe congestive heart failure and died during surgery. There are very few reports on this sequelae of vascular injuries at the abdominal level. Patients with aortic and cava injuries have a high mortality rate and arteriovenous fistula may develop with communicating pseudoaneurysms. If high output heart failure develops in a patient with a history of abdominal penetrating injury, an arteriovenous fistula must be suspected and arteriography will disclose the location of the fistula. Surgical treatment is necessary to prevent further heart damage. In the future endovascular procedures may have a role in the management of these difficult conditions.
An Extraluminal Lelomyosarcoma of the Iliac Vein Without Thrombosis
Authors: Prandi M. , Scabini S. , Taviani M. P. 
Published: June 2007

Vascular leiomyosarcoma (LMS) is a rare malignant tumor arising from the muscle cells of the media of the vessels. Vascular LMS is often diagnosed as a result of the clinical manifestations of impaired venous flow such as edema and phlebothrombosis. The authors present a case of an LMS in a 72-year-old woman. Physical examination revealed a round mass deep in the left inguinal region close to the inguinal vessels, fixed and not pulsating. There was no sign of left lower-limb edema nor of articular impairment of the hip. Inguinal and distal pulses were normal. Results of laboratory analysis, including values for the oncologic markers, were normal. An ultrasound scan of the left inguinal fossa showed a 50-by30 mm mass of mixed aspect that adhered to the left common iliac artery. An echo color Doppler showed conservative arterial flow. Thus, a thrombotic aneurysm of the left iliac artery was diagnosed. Chest x-ray showed no pathological findings. An abdominal computerized tomograph (CT) scan confirmed the location of the neoplasm and revealed a narrowing of the left iliac vein compressed behind the mass. The finding was interpreted as a colliquative lymph node. The patient underwent explorative laparotomy with midline incision. The finding was a neoplastic bibbed mass compressing and infiltrating the left iliac vein with no cleavage surface between the mass itself and the venous wall. An intraoperative frozen section revealed a necrotic mass with a cortex of ambiguous interpretation. Surgical procedure was then finished with no further venous resection. Histologic examination revealed the presence of leiomyosarcomatous tissue with nuclear pleomorphisms inside necrotic material limited by a thin fibrotic capsule. According to Coindre's classification the tumor was a G3. After six months the patient is fit and a CT scan showed no evidence of recurring disease.
Vascular Tone and Contractility During Exposure to Cardioplegia and Hyperkalemic Solutions
Authors: He Guo-Wei , Yang Cheng-Qin 
Published: June 2007

Hyperkalemic cardioplegic solutions have been widely used for myocardial protection. A commonly accepted concept is that cardioplegic solutions may evoke vasospasm due to the high potassium (K+) concentration in the solutions. However, little has been known about coronary vascular tone and contractility during ischemia and reperfusion. The present study was designed to test the hypothesis that hyperkalemic cardioplegic solutions may increase the vascular tone during exposure and increase the contractility during reperfusion. Porcine coronary artery (PCA) and neonatal rabbit aortic (RAO) rings were set up in organ baths under a physiologic pressure. In addition, the effect of reexposure to K+ on contractility was studied in the human internal mammary artery (HIMA). The solutions were continuously aerated with 95% 02 and 5% Co2 to exclude the effects of ischemia and hypoxia. The effect of Krebs containing 5.9 or 50 mM K+, or St. Thomas' cardioplegic solution No. 2 (ST) containing 16 or 50 mM K+ on vascular tone for four hours was examined. In other groups, after two-hour-incubation, the rings (n= 5 in PCA and n= 6 in RAO in each subgroup) were washed and cumulative concentrationcontraction curves were established. During four-hour-exposure to ST, the rings were relaxed (−0.38 ±0.07 g in PCA and -0.43 ±0.13 g in RAO, n = 6, P ≥ 0.001). In comparison with 50 mM K+ in Krebs, ST with 50 mM K+ induced a significantly reduced contraction with a slow onset in both vessels. After two-hour-exposure to ST the RAOs had almost unchanged contractility whereas those exposed to 50 mM K+ had enhanced contractility. Reexposure to K+ (100 mM) significantly enhanced the contraction in the HIMA. These results suggest that despite its high K+ concentration St. Thomas cardioplegic solution does not evoke vasoconstriction during exposure in either PCA or RAO. In contrast, it relaxes these vessels during four-hour exposure. The study also demonstrates that although two-hour-exposure to extra−-K±added (50 mM) physiologic or cardioplegic solutions enhances the contractility in RAO, the exposure to ST is unlikely to do so. It remains to study whether microvasculature has similar reaction during and after exposure to hyperkalemia and whether combined factors such as ischemia affect the reaction.
Oxygen-Derived Free Radicals as Mediators of Varicose Vein Wall Damage
Authors: Farbiszewski Ryszard , Glowinski Jerzy , Makarewicz-Plonska Marzena , Chwiecko Marek , Ostapowicz Roman , Glowinski Stanislaw 
Published: June 2007

Varicose saphenous vein segments, segments of those veins with thrombophlebitis, and segments of normal veins obtained during operation on 23 patients were studied to define the pattern of pro-oxidative and antioxidative systems in these tissues. In segments of varicose veins (VV) the activity of superoxide dismutase (SOD) was significantly decreased as compared with normal veins: 7.8 ±2.9 vs 13.5 ±4.3 U/mg of protein (P < 0.05), but it was almost unchanged in the segments of W with thrombophlebitis. The activity of glutathione reductase (GSH-R) in all studied segments was similar and amounted to about 12.0 IU. The content of free sulfhydryl (SH) groups, the concentration of ascorbic acid, and thiobarbituric acid-reactive substances (TBA-RS) in segments of VV were significantly decreased by 40%, 48%, and 47%, respectively (P < 0.05) as compared with segments of normal veins. The values of ascorbic acid and TBA-RS in the segments of W with thrombophlebitis were increased by 13% and 16%, respectively, as compared with segments of normal veins. Decreased activities of SOD and reduced levels of free SH-groups and of ascorbic acid concentration in W may indicate impaired antioxidant mechanisms in this tissue.
Prostacyclin Usage for Spinal Cord Protection During Experimental Thoracic Aortic Cross-Clamping
Authors: Katircioğlu Salih Fehmi , Gökce Perran , Özgencil Eser , Saritas Zuilfikar , Sener Erol , Yilmazkaya Bayram , Koc Bahattin , Tasdemir Oğuz , Bayazit Kemal 
Published: June 2007

The risk of paraplegia associated with thoracic aortic cross-clamping is high even when various methods of spinal cord protection are used. In this study prostacyclin 12 (PGI2) was selected as an agent to reduce the spinal cord injury because of its vasodilator, antiaggregant, and cytoprotective properties. Twelve dogs underwent sixty-minute aortic occlusion. Six dogs received PGI2 whereas the other 6 did not (controls). PG12 administration was started at a rate of 5 ng/kg/minute five minutes before aortic occlusion. This dosage was increased to 25 ng/kg/minute during aortic occlusion. PGI2 at a dosage of 5 ng/kg/minute was maintained for a period of five minutes after the aortic occlusion was released. Three dogs in the control group were paraplegic. There were no paraplegic dogs in the PGI2 group. Distal aortic perfusion pressure was 31 ± mmHg in the PGI2 group and 22 ±3 in the control group (P <0.008). As a result of this study the authors conclude that PGI2 is a valuable agent for decreasing the risk of spinal cord injury during thoracic aortic cross-clamping lasting sixty minutes.
Transcranial Doppler in the Acute Phase and Follow-up of Internal Carotid Artery Dissection
Authors: Viola Stefano , Uncini Antonino , Matta Edgar , Aquilone Lucio , Gambi Domenico 
Published: June 2007

Internal carotid artery dissection (ICD) causes transient ischemic attack (TIA) or stroke by hemodynamic or thromboembolic mechanisms. Diagnosis of ICD is made by angiography. The aim of this study was to evaluate the role of three-dimensional transcranial Doppler (TCD-3D) in ICD. The authors report a fifty-seven-year-old man presenting sudden aphasia, left neck pain, and homolateral headache and a sixty-year-old man presenting sudden right neck pain, homolateral headache, and Horner's syndrome. Selective digital subtraction angiography showed the typical elongated regular stenosis (string sign) of ICD. At onset TCD-3D revealed in both patients: (1) decreased blood flow velocity over the internal carotid dissected segment and inverted flow velocity over the homolateral anterior cerebral and ophthalmic artery; (2) reduced pulsatility index with normal blood flow velocity over the homolateral middle cerebral artery suggestive of valid autoregulation of cerebral blood flow (CBF). TCD-3D at days 15 and 40 and at months 2 and 6 after stroke showed progressive recanalization beginning from the day 40 in the first patient and from the day 15 in the second patient with successive complete normalization of Doppler parameters. Although angiography remains the most reliable diagnostic study, TCD-3D results are useful for evaluating, in the acute phase, the efficacy of collateral blood supply and autoregulation of CBF, which are important as prognostic indexes and as indications for therapeutic strategy, and, afterward, for the timing of recanalization indicative of a good long-term prognosis.
Percutaneous Transluminal Angioplasty in the Treatment of Vein Graft Stenosis
Authors: Gahtan Vivian , Weiss Jeffrey P. , Kerstein Morris D. , Harpavat Mona , Roberts Andrew B. 
Published: June 2007

Vein graft stenosis is a precursor to graft failure and its management is controversial. The authors reviewed their experience with percutaneous transluminal angioplasty (PTA) for these lesions. Thirty-one infrainguinal vein grafts (30 patients) underwent 59 PTAs at 44 different sites. Mean patient age was 66.7 years, and 17 (57%) were men. Hemodynamically significant lesions (>50% diameter reduction) were established by duplex scan or angiography. All patients had follow-up duplex graft surveillance. Determination of recurrence was based on duplex criteria (peak systolic velocity >200 cm/sec, velocity ratio >2). PTA outcomes at 3 months were divided into successful and unsuccessful categories. Eight stenoses were excluded from this assessment secondary to follow-up < 3 months. All bypass grafts were patent through their last evaluation. Ninety percent of lesions (46/51) received adequate initial dilations. The successful group (41/51 lesions, 80%) had a mean follow-up of 10.8 months (range 3.0-26.3). In this group, 12 lesions recurred with a mean time from PTA of 5.3 months (range 3.0-13.6). Of the 10 unsuccessfully treated lesions, five were angioplasty failures and five recurred within 3 months. The distal anastomosis was the most unsuccessful location to be treated (P=0.01). The length of the lesions and the age of the graft did not influence outcome (P>0.05). There were two complications from PTA: an occlusion effectively treated with thrombolytic therapy and one distal embolization. In conclusion, 80% (41/51) of stenoses treated with PTA were successful for at least 3 months. Two thirds of first-time lesions were stenosis-free at 1 year. PTA is a safe, reasonable method for the management of vein graft stenosis. The distal anastomosis is the most difficult site to manage.
Quality of the Long Saphenous Vein Conduits Used for Coronary Artery Bypass Grafting Operations
Authors: Giannoukas Athanasios D. , Stavridis George T. , Labropoulos Nicos , Bailey David , Glenville Brian , Nicolaides Andrew N. 
Published: June 2007

The aim of this study was first to select preoperatively suitable long saphenous vein (LSV) segments by using color flow duplex imaging (CFDI) and second to evaluate the quality of the harvested LSVs histologically. Forty LSVs in 38 consecutive patients (mean age 63 years) were examined by CFDI for patency and luminal diameter. None of the patients had documented previous deep venous thrombosis or superficial thrombophlebitis. Perioperatively, 79 LSV specimens were harvested from the ankle, knee, and midthigh regions and examined histologically for wall calcification and fibrosis. According to the amount of fibrosis present the specimens were classified as being normal or mildly, moderately, or severely affected. All LSVs were found patent and nonvaricose, and their diameter ranged from 0.18 to 0.54 cm at the ankle, 0.29 to 0.69 cm at the knee, and 0.25 to 0.77 cm at the midthigh level. On histology 11% of the specimens were found to be normal, and 43% were mildly, 38% moderately, and 8% severely fibrotic. Also, various grades of fibrosis were found in different sites of the same vein. None of the specimens had calcification. It is concluded that the majority of the LSVs used for coronary artery bypass grafting have some degree of fibrosis. The histologic appearance of the LSV wall in a particular site cannot predict the condition of vein throughout its length. CFDI can be useful in the perioperative conduit selection.
The Use of Preoperative Noninvasive Vascular Studies for the Evaluation of Radial Artery Conduits for Coronary Artery Bypass Grafting
Authors: Wolk Seth W. , Moores Harold K. , Lampman Richard M. , Misare Bruce D. , Erlandson Errol E. , Kong Bobby K. , Fowler Jennifer J. , Page Jeanne M. , Babcock Shelly L. , Whitehouse Walter M. 
Published: June 2007

Background: The increased use of the radial artery for coronary artery bypass conduits has heightened the awareness of potential resultant hand ischemia. The Allen test and subsequent modifications have been used to evaluate the patency of the superficial palmar arch (SPA). The purpose of this study was to determine if changes in blood flow patterns of the SPA assessed by the modified Allen test parallel changes in blood pressures of the first and second digits following radial artery occlusion. Methods: Continuous-wave Doppler ultrasound and photoplethysmography (PPG) were used to evaluate blood flow in the SPA and first and second digits, respectively, before and after manual occlusion of the radial artery in 60 extremities. A second continuouswave Doppler probe was used to ensure complete occlusion of the radial artery. Digit skin temperature was controlled between 36° and 37.5°0. A reduction of >20 mmHg in blood pressure was arbitrarily chosen to reflect a clinically significant change in digit arterial pressure. Results: Six of the 60 extremities (10%) studied showed a decrease in the audible Doppler signal over the SPA following radial artery occlusion. Reduction in digit arterial pressure following radial artery occlusion occurred in 13 of 60 extremities (21.7%). Digit arterial pressure reductions ranged from 20 to 58 mmHg (mean ±SD, 35.2 ±12.8 mmHg), demonstrating a 40% decrease in digital pressure. Changes in SPA flow did not parallel digital pressure changes following occlusion of the radial artery. Conclusion: Continuous-wave Doppler ultrasound of the SPA following radial artery compression alone does not accurately predict digit ischemia. Digit arterial pressure measurement of the first and second digits of upper extremities offers a relatively simple and objective method for evaluation of potential ischemic complications following radial artery harvest. This finding is important because many physicians only use a modified Allen test with radial artery compression to assess potential digit ischemia.
Comparison of Transcutaneous Oxygen-Tension Measurements and Ankle/Arm Indices in the Perioperative Period
Authors: Sano Chiaki , Ugaeri Hidehiro , Samuels Louis , Matsumoto Teruo , Kerstein Morris D. 
Published: June 2007

Transcutaneous oxygen tensions (TcPo2) were compared with ankle blood pressures in 160 lower extremities of 36 diabetic and 48 nondiabetic patients in the perioperative period. TcPo2 measurements were related to regional perfusion indices (RPI) (RPI = TcPO2 foot/TcPO2 chest), and ankle pressures were used to calculate ankle/arm systolic pressure indices (AAI). Severity of disease: Group I: claudication, 57/160 (36%); Group II: rest pain, 66/160 (41%); Group III: tissue loss, 37/160 (23%). In Groups I, II, and III, preoperative mean AAI and RPI were 0.46, 0.23, 0.32 and 0.41, 0.21, 0.16, respectively. The net mean increases in AAI and RPI with revascularization for Groups I, II, and III were 0.42, 0.51, 0.41 and 0.46, 0.49, 0.62, respectively. Groups I, II, and III extremities exhibited drops in RPI with limb elevation both preoperatively and postoperatively, which averaged 0.06, 0.05, 0.14 and 0.16, 0.11, 0.14, respectively. The diabetic extremities, postoperatively, exhibited significantly greater drops in RPI (p < 0.05). RPI measurements correlated more precisely than AAI with preoperatively and postoperative perfusion.
Patient Outcomes Following Placement of a Second Inferior Vena Cava Filter
Authors: Haase Steven C. , Wolk Seth W. , Lampman Richard M. , Sarosi Michael G. , Misare Bruce D. , Erlandson Errol E. , Whitehouse Walter M. 
Published: June 2007

Inferior vena cava (IVC) interruption is being performed with increasing frequency. Indications for this procedure have expanded since the introduction of percutaneous placement techniques. Indications for placement of a second IVC filter are less well defined. It has been reported that a second filter can be placed safely. The purpose of this study was to investigate the intermediate and long-term follow-up of these patients. Five patients underwent placement of a second IVC filter at one institution from 1992 to 1996. During the same period a total of 439 patients underwent IVC filter placement. The five patients, ranging in age from 46 to 67 years, included three men and two women. The indication for the second filter placement was a confirmed or strongly suspected recurrent pulmonary embolus (PE), with thrombus in and above the previously placed IVC interruption device in all patients. Three of the five patients suffered from poorly controlled malignancies. One patient had an ependymoma of the spinal cord that was completely excised. The fifth patient had a documented hypercoagulable state: factor V resistance to activated protein C. The mean time between placement of the first and second filters was 31 weeks (range: 1-65 weeks). Mean follow-up was 94 weeks (range: 0-252 weeks). One patient died within 24 hours of filter placement from profound hypoxemia from a preexistent PE. No fatal PE occurred in any of the four remaining patients. Two patients in this study, following placement of a second IVC filter, had documented pulmonary emboli that were nonfatal. Two patients died as a result of their underlying malignancies. While placement of a second IVC interruption device is an infrequently performed procedure, it appears to be efficacious in preventing death from pulmonary emboli in this extremely high-risk group of patients.
Greater Saphenous Vein Aneurysms
Authors: Alonso-Pέrez Manuel , Caeiro Santiago , Guitian Maria D. , Sάnchez Mercedes , Segura Ramόn J. 
Published: June 2007

Unlike arterial aneurysms, the venous aneurysms are a much less frequent pathology and clinical experiences are limited to isolated cases. Those involving veins of the neck and extremities are the most frequent. The authors report one case of two greater saphenous vein aneurysms and comment on the literature. The patient was a 43-year-old man with an antecedent right inguinal hernia repair, who had been presenting for the last 4 years because he had a growing mass in the right groin, currently measuring 6 cm in diameter, causing local discomfort; this mass was reduced in a recumbent position or with manipulation; and 7 cm lower there was another similar painless mass measuring 5 cm in diameter. Duplex scanning showed two aneurysms in the greater saphenous vein, which did not contain thrombus. Phlebography was not carried out. The surgical approach was a complete extraction of the greater saphenous vein. From the review of the literature it is concluded that uncomplicated greater saphenous vein aneurysms are not associated with pulmonary embolism (unlike popliteal vein aneurysms) the surgical treatment is indicated when they cause discomfort or for aesthetic reasons.