bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alterations of Venous Flow in Hemiparetic Patients
Authors: Alexander J. Jeffrey , Sioson Eulogio , Heitz Ronda , Mion Lorraine 
Published: August 2008

Unilateral extremity edema and an increased incidence of venous thrombo sis are known to occur in association with hemiparesis. This phenomenon has been ascribed to either loss of muscle pump function, resulting in venous flow stasis, or to alterations in vasomotor tone secondary to the central cerebral le sion. Thirty-five patients with hemiparesis due to stroke were studied with duplex scanning to determine the nature of changes in venous flow. Patients with pre- existing arterial or venous disease were excluded. Femoral and popliteal vein size and peak venous flow velocity were quantitated in the paretic and the unaffect ed limb. Muscle strength and recovery (Brunnstrom staging) were independent ly assessed and compared with venous measurements.The relative change in vein size was found to be significantly increased at both locations in the femoral (p = .007) and popliteal (p = .019) locations in the paretic as compared to the normal limb. Concurrently, the peak flow velocity was significantly reduced in the popliteal vein (p < 0.05), while only mildly reduced in femoral vein. A mild inverse relationship was apparent between muscle strength and femoral venous size, but otherwise, there appeared to be no significant as sociation between muscle strength and measured venous parameters. These results indicate a reduction in flow velocity and an increase in venous size occurring with hemiparesis. Because these changes do not significantly correlate with muscle strength, it is felt that they are most likely due to alterations of vasomotor func tion rather than of the muscle pump mechanism. Changes of this nature can lead to venous thrombosis.
Iatrogenic Extracranial Carotid Dissection: Report of Two Cases Treated Surgically
Authors: Tiberio Giorgio , Giulini Stefano Maria , Cangiotti Luigi , Floriani Marco , Coniglio Arianna , Mulesan Paolo , Bonardelli Stefano 
Published: August 2008

Two patients had an acute dissection of the right common carotid artery due to catheterization of the vessel during Seldinger angiography. Both patients were evaluated immediately after the traumatic event by means of echo-pulsed Dop pler (duplex scan) to check the hemodynamic significance of the lesion. In the first case, the lesion initially appeared insignificant, but on the second day duplex scanning showed a sudden reduction of the flow in the internal carotid artery due to progression of the carotid dissection: the patient, neurologically asymp tomatic, was operated on successfully. The second patient, also asymptomatic, underwent emergency surgical treat ment after the first duplex scan showed significant reduction of the internal carotid flow. The postoperative course has been uneventful. Both patients are asympto matic eighteen and eight months after surgery. The authors emphasize the important role that duplex ultrasonography played in the management of these 2 patients.
Cardiac Herniation Following Extended or Radical Pneumonectomy—an Avoidable Complication?
Authors: von Flüe Markus , Stulz Peter , Oehy K. , Huber Andreas , Vogt Bruno 
Published: August 2008

Pericardial defects necessarily occur when the great pulmonary vessels are divided within the pericardial sac or when portions of the pericardium are resected because of direct tumor infiltration. As a result cardiac herniation or strangula tion may develop if the heart prolapses through the surgically created defect in the pericardium. In this report the authors present 5 cases of cardiac herniation following ex tended pneumonectomy. Herniation was left-sided in 3 of 5 patients; all instances occurred within the first twenty-four hours postoperatively. In 3 patients, the complication was associated with change in position for postural drainage, in 2 patients after massive coughing. The initial clinical picture was determined by sudden onset of low cardiac output, cyanosis, tachycardia, and asystole. All pa tients were reexplored without delay. The defects were covered with a substitute patch. After the critical review of the literature and according to their own experience, the authors draw the following conclusions: • Sudden onset of low cardiac output without obvious signs of hemorrhage or cardiac failure is suspicious for cardiac herniation after pneumonectomy. • Change in position onto the operated side, massive coughing, and large pericardium are the main risk factors. • Emergency reoperation and reposition of the heart offers the only chance of survival. • Cardiac herniation is most effectively prevented and can be avoided by patch ing the defect.
Angiosarcoma of the Heart: A Case Presentation and Review of the Literature
Authors: Fox Stewart , Swankoski John 
Published: August 2008

Primary tumors of the heart are rare, and only 25% of these are malignant. Angiosarcoma of the heart has been reported in fewer than 100 patients, of whom 23 were treated surgically. This report reviews the literature and presents a new case of primary angiosar coma of the heart treated with surgical extirpation.
Importance of the Revascularization of the Hypogastric Artery in Reconstruction of Infrarenal Aortic Aneurysms
Authors: Alemany Jose , Marsal Teresa , Reim Tomas 
Published: August 2008

A review of the ischemic complications in the colorectal and gluteal region in patients operated on by the authors for infrarenal aortic aneurysms between 1983 and 1986 showed that in 13 cases the morbidity and in 2 cases the mortality were due to reduction of perfusion in the vascular bed of the hypogastric artery. This fact has made the authors carefully consider the indication for simultane ous revascularization of the internal iliac artery in reconstructions of the aor toiliac segment for aneurysms in the years from 1987 to 1989. During this latter time period, 161 elective reconstructions for infrarenal aortic aneurysms have been done. The hypogastric artery was revascularized in 82 pa tients, all of whom underwent postoperative angiography. The results show that simultaneous revascularization of this artery may achieve a statistically signifi cant reduction (at least 1-3%) in mortality and morbidity.
Clinical Results of Reconstructive Surgery of the Mitral Valve
Authors: Isik Ömer , Balkanay Mehmet , Zeybek Rahmi , Bayezid Ömer , Yakut Cevat 
Published: August 2008

In a four-year period, 720 open cardiac valvular surgical procedures were performed in Kosuyolu Heart and Research Center. In 120 of these 720 cardiac valvular operations, mitral valve reconstruction was performed alone or with other cardiac procedures. The youngest patient was twelve years old and the ol dest was eighty-eight with an average age of thirty-eight. All of the patients but 2—1 with congenital mitral valve lesion and the other with ischemic mitral valve lesion—had rheumatic mitral valve lesions; 80% of the patients were in the third and fourth functional class according to NYHA classification, and nearly 60% of the patients had some other cardiac lesions in addition to the mitral valve lesion. In 60 of the patients some other cardiac surgical procedures were per formed in addition to mitral valve reconstruction. The dominant lesions of the mitral valve were as follows: stenosis, 45%, insufficiently, 15%; and combined lesions, 40%. The authors used 12 different reconstruction techniques alone or in combi nation with each other in all of the patients. Among these techniques, they used mostly Carpentier's ring implantation. In-hospital mortality was 6%. One pa tient died in the late postoperative period. Three patients had reoperations be cause of unsuccessful reconstruction. Nonfatal thromboembolism occurred in 1 patient. All living patients were reevaluated periodically in the postoperative period. In all these patients mitral valve functions were studied clinically, echocardiographically, and/or hemodynamically. In 80% of the living patients, the reconstruction was successful and in 20% it was partially successful; 95% of the living patients improved their functional class to I or II. In conclusion, mitral valve reconstruction is a good alternative to replacement in selected pa tients in an experienced center.
Distal Anastomotic Hyperplasia in Superficial Femoral-Popliteal Vein Femoropopliteal Bypass Grafts
Authors: Schulman Martin L. , Badhey Mohan Rao , Schulman Lee G. , Lledo-Perez Alfonso M. 
Published: August 2008

The incidence of distal anastomotic hyperplasia (DAH) in superficial femoral- popliteal veins (SF-PVs) used as femoropopliteal bypass (FPB) grafts was inves tigated, with particular reference to the form of distal anastomotic construction. Seventy-seven SF-PV grafts that met specific angiographic follow-up criteria quali fied as "studied" grafts. DAH was identified in 13 (17%). Cobra head anastomoses, 2 cm or less in length, were used in 21 grafts and yielded 6 in stances of DAH (29%). When 8 sharply tapered 3 cm (swordfish) anastomoses were constructed, 3 grafts (37.5%) developed DAH. With 3 cm moderately ta pered (fishmouth) anastomoses in 48 grafts, DAH was seen 4 times (8%). Be cause the distal 1 cm of the swordfish configuration was very narrow, the swordfish and cobra head constructions were functionally equivalent and were grouped together as "short" anastomoses. The difference in the incidence of DAH with long and short anastomoses, 8% vs 31%, was statistically significant (p = .016). In the 48 "studied" grafts with fishmouth anastomoses, the occurrence of all 4 DAHs among the 15 female diabetic limbs was also significant (p = .019). Constructing 3 cm moderately tapered anastomoses significantly reduced the incidence of DAH, the leading cause of graft failure, in SF-PV FPB grafts. The achievement of primary and assisted patency rates of 84% and 91% at both three and five years in the 93 SF-PVs placed as primary FPB grafts since October, 1982, was largely due to the reduction in DAH that resulted from anastomotic modification.
Aortic Enzyme Activity in Symptomatic and Asymptomatic Atherosclerotic Aneurysms
Authors: Lehnert Bernd , Wadouh Faysal , Dwenger Alexander 
Published: August 2008

In the present study, the role of advanced atherosclerosis in increased aortic protease content was evaluated. Forty samples of normal and atherosclerotic aortas and of infrarenal aneurysms were assayed for collagenase and elastase. Both enzymes proved to have similar activity in normal and atherosclerotic tissue, whereas aneurysms revealed significantly elevated protease content. Preoperative symptoms increased the elastase activity: 6.58 ± 1.58 mU/g were extracted from symptomatic aneurysms in comparison with 2.51 ± 0.57 mU/g from asymptomatic aneurysms. Showed a high correlation (r = 0.96; p<0.01) with the erythrocyte sedimentation rate (ESR) preoperatively. The data suggest that advanced atherosclerosis in aneurysm samples does not enhance the proteolysis of the aortic wall. Thus, the greater protease amount found in infrarenal aortic specimens may be linked to a more rapid fiber metabolism as compared with the thoracic aorta. High elastase content, detect ed in symptomatic infrarenal aneurysms, seems to be correlated with accelerat ed ESR.
Accelerating HIV Infection with Cardiopulmonary Bypass—Case Reports
Authors: Yee Edward S. 
Published: August 2008

Five men patients and 1 woman patient who underwent either coronary artery bypass grafting (in 2) or valve replacement (in 3) or combined procedures (in 1) presented with severe HIV infection during the postoperative period. Four patients were NYHA Class III of IV with 3 patients in extremis requiring emergency procedures. All procedures were performed with cardiopulmonary bypass with mean time of 109 ± 48 minutes and aortic cross-clamp of 52 ± 49 minutes. Although the immediate postoperative courses seemed benign or uncomplicated, all presented with severe infections during the late postoperative period following their procedures (twenty-one to ninety days). The opportunistic infections were Pneumocystis carinii pneumonia (2), toxoplasmosis in the central nervous system and lung (1), cryptococcal meningitis (1), Staphylococcus aureus endocarditis (1), and viral encephalitis (1). Three died with two months of surgery. These complicated postoperative infections have raised the question of the safety of cardiopulmonary bypass in HIV-infected patients. Rational recommendations regarding preoperative HIV antibody testing, operative indications, and postoperative surveillance are offered.
Hemodynamic Changes After Valve Replacement and Coronary Bypass Surgery
Authors: Paç M. , Yekeler I. , Koçak H. , Ateş A. 
Published: August 2008

At the Department of Cardiovascular Surgery of the Research Hospital of Atatürk University, Erzurum, Turkey, 40 patients were observed and followed up for hemodynamic capacity following valve replacements in 20 cases and cor onary bypass operation (CBPG) in the other 20. In the former group 23 valves were implanted, of which 12 were mitral (MVR), 10 were aortic (AVR) and 1 was tricuspid type. In the latter, 8 left internal mammarian artery (LIMA) and saphenous veins were used as grafts. The hemodynamic capacity of the patients in both groups was evaluated by employing thermodilution cardiac output (TD CO) and Doppler ultrasonog raphy cardiac output (USG CO) methods in preoperative and early and late postoperative periods. In MVR, AVR, and CBPG, the results were statistically significant at p < 0.05 in the late postoperative period. In those who underwent AVR and CBAG the results appeared to be statisti cally significant in the early (p < 0.01) and in the late (p < 0.001) postoperative period.
Ruptured Abdominal Aortic Aneurysm: Factors Affecting Survival and Long-Term Results
Authors: Rosenthal David , McKinsey James F. , Erdoes Luke S. , Hungerpillar John C. , Clark Michael D. , Lamis Pano A. , Whitehead Travis , Laszlo Pallos L. 
Published: August 2008

Although elective resection of an abdominal aortic aneurysm (AAA) is now a safe operation, the mortality related to a ruptured abdominal aortic aneurysm (rAAA) remains significant. To evaluate factors affecting survival and the long- term results after rAAA, a ten-year review of 47 patients was performed. The operative mortality rate was 43% (20/47) compared with 2.6% for 147 elective AAA patients during this period. Factors adversely affecting survival were blood pressure <90 mmHg on arrival to the hospital, perioperative cardiac arrest, delay in time from diagnosis to treatment > six hours, age > seventy-five years, massive transfusion, and free intraperitoneal rupture. In follow-up extending to five years the survivors of rAAA at one (92%) and five (53%) years had no discernible differences in quality of life or long- term survival compared with age- and sex-matched patients who had elective AAA resection during the same time interval. When an rAAA occurs and any three of the adverse variables noted above are present, the mortality rate exceeds 90%. These patients remained ventilator dependent and in the ICU from one to sixty-seven days, accumulating hospital charges from $7,000 to $214,000. It appears that the most effective means of reducing mortality statistics in this inordinately low-salvage, yet high-cost sub group of patients, is to prevent rupture of an AAA by elective resection.
Hypofibrinolytic Activity after Total Joint Replacement
Authors: Kikuchi H. , Tanaka S. , Nakagiri Y. , Yamane T. , Fujiwara S. , Katsuhisa K. , Tan A. , Matsuo O. 
Published: August 2008

Tissue-type plasminogen activator (t-PA), tissue-type plasminogen activator inhibitor (t-PAI), and other factors (platelets, fibrinogen, fibrinogen degrada tion products, antithrombin-III, plasminogen, and α2-plasmin inhibitor [α2-PI]) related to the fibrinolytic system were studied in 21 patients undergoing total joint replacement. Seventeen of the 21 patients revealed an impaired fibrinolytic activity from the first to seventh postoperative day and a subsequent return to the preopera tive level by the fourteenth postoperative day. There were accompanying increases in the level of α2-PI and in the t-PAI/t-PA ratio, and there was decrease in plas minogen level. Such hypofibrinolytic states may be related to a higher incidence of postoperative thrombosis in total joint replacement patients.
A New Surgical Technique for Repair of Aortic Coarctation
Authors: Sarioglu Tayyar , Süzer Kaya , Akçevin Atif , Sarioğlu Ayşe , Polat Bülent , Aytaç Aydin 
Published: August 2008

From June, 1987, to February, 1989, 7 patients underwent a new technique of coarctation repair. This technique consists of a complete mobilization of the left subclavian artery (LSA) so that it can be pulled down as much as possible. After all the proper clamping, the anterior wall of the aorta is incised longitudi nally, beginning on the anterior wall of the LSA and extending distally to the descending aorta 2 cm past the coarctation. The coarctation membrane is ex cised carefully. The LSA is pulled down so that the proximal end of the incision can come to the distal end. Then, this longitudinal incision is sutured trans versely with 5/0 polydiaxonone and continuous technique, widening the coarcta tion site and also preserving the blood flow to the left upper limb. If extreme tension occurs, the LSA is transected. After the aortoplasty is completed, a polytetrafluoroethylene (PTFE) graft in size of 6 or 8 mm is interposed between the proximal and the distal parts of the LSA, providing continuity. The ages of the patients ranged from eighteen months to twenty years (mean: 11.5 years) and their weights ranged from 11 to 83 kg (mean: 37 kg). There were no hospital deaths. There were no significant pressure gradients through the isthmic area after the operation. Mean follow-up was eighteen months, and all patients but 1 were in class I effort capacity (NYHA). The authors have also noticed good blood flow to the left upper limb, including 2 patients who have a PTFE graft interposed in their LSA. The authors' experience indicates that this technique could be a good alternative to the subclavian flap aortoplasty because of preservation of blood flow to the left upper limb.
The Atrial Natriuretic Peptide and Its Relation to Hemodynamic and Laboratory Values in Mitral Valve and Coronary Surgery
Authors: Paç M. , Ateş A. , Koçak H. , Yiğitoğlu M.R. , Yekeler I. 
Published: August 2008

In 22 patients who underwent mitral valve replacement (13) or coronary bypass surgery (9), preoperative and postoperative plasma atrial natriuretic peptide (p-ANP) concentration, hemodynamic changes, plasma aldosterone, and twenty-four-hour urine sodium-potassium concentrations were studied. Preoperative ANP levels were 261±172 pg/mL in mitral valve replacement (MVR) and 68±22 in coronary artery bypass grafting (CABG); control levels were 15±4.7 (p < 0.001). After the induction of anesthesia, ANP levels decreased to 154.5±96.7 pg/mL in MVR and 51±17.5 in CABG (p < 0.01) patients. In the early postop erative period ANP increased to 332±217 pg/mL in MVR and to 94.3 ± 29.7 in CABG (p < 0.001). In the late postoperative period, the p-ANP of both groups returned to nor mal levels (16 ± 8.05, 11.2 ± 2.82 pg/mL, respectively). Negative correlations were detected in both MVR and CABG groups be tween p-ANP, p-aldosterone (p < 0.001), p—ANP—cardiac output (p < 0.001), and p—ANP—cardiac index (p < 0.001).
Cardiopulmonary Bypass Using Centrifugal Pump
Authors: Berki Turan , Gürbüz Ali , Işik Ömer , Akkaya Hakan , Bayezid Ömer , Yakut Cevat 
Published: August 2008

Centrifugal pumps are nonocclusive pumps that offer centrifugal blood pumping known as the constrained force vortex principle. Of 2405 open heart procedures, 370 (15.4%) were performed with a centrif ugal pump (CP). In the rest of the cases extracorporeal circulation (ECC) was established with conventional roller pump (RP). The operations performed with a CP were: 34 reoperations, 11 ascending aortic aneurysms + coronary artery bypass graft (CABG), 47 multivalve replacements, 125 CABG + left ventricu lar aneurysmectomies, and 153 CABGs alone. This prospective study consisted of two groups, each group including 50 patients undergoing CABG surgery. In group I ECC was established with a CP and in group II with a conventional RR The two selected groups of patients were considered to be similar in terms of clinical, hemodynamic, and angio graphic data. Hemodynamic study concerned flow rate, systemic vascular re sistance (SVR), and urinary output. No difference was found between the CP and RP hemodynamically. Nevertheless, the alteration of the flow rate in re sponse to variation of SVR is accepted as an advantage. As for hemolytic effect during ECC of CP compared with RP: Plasma free hemoglobin, hemotocrit, platelet count, platelet factor 4, and fibrinogen levels, were investigated. These parameters revealed that there was significant hemoly sis and trauma to the blood components in the RP group when compared with the CR (p < 0.05, p < 0.01). There was no significant difference in psychoneurologic complications, but behavioral and sensory disorders were encountered sevenfold more in the RP group. This might be due to spoliation of the tubing set or to microair embo lism. Compared with the conventional RP the CP proved to have no hemodynamic advantage. The effects on blood components showed significant trauma to the RP group. Postoperative drainage verified this observation (p < 0.05). In this study the CP appears to be superior to the RP especially in compli cated and prolonged ECC.
Simultaneous Bilateral Carotid Endarterectomy: A Revision of Concepts and Strategies
Authors: Pizzetti Franco 
Published: August 2008

The results of 156 bilateral cases of carotid endarterectomy are reported: 71 patients had staged operations and 85 patients had simultaneous endarterectomies. The results in these two groups of bilateral cases were very similar. In each of the two groups no patient died and the major neurologic complications (stroke) were less than 2% in regard to patient risk, and therefore less than 1% in regard to procedure risk. Indications for and against bilateral carotid surgery as a simultaneous or a staged procedure are discussed. The parameters for selecting patients likely to undergo simultaneous surgery are indicated. The main parameter to consider is the probability for the patient to have a serious post-operative hyperperfu sion, especially if a cerebral ischemia coexists.
Rupture of an Internal Iliac Artery Aneurysm into the Rectum: Fatal Consequence of an Ilioenteric Fistula —A Case Report
Authors: Aseem Wali M. , Schachter Larry G. , Devlin James E. , Costa Jose 
Published: August 2008

Fistulization of a true aneurysm or pseudoaneurysm of major arteries into the gastrointestinal tract has been reported in the literature since 1943. More common is the fistulization of a true abdominal aortic aneurysm and pseu doaneurysm at an anastomotic site, proximally at the aortic level or distally at the site of iliac arteries, after a vascular reconstructive procedure. Rupture of an isolated aneurysm of the common iliac arteries is less fre quent, and rupture of an internal iliac artery aneurysm into the gastrointestinal tract is rare. In searching the literature, the authors did not find documentation of any previous report of rupture of an internal iliac artery aneurysm into the rectum. They report a case of an acute rupture of a left internal iliac artery aneurysm into the rectum with a fatal outcome.