bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischemia-Activated Platelets in Normal and in Naturally Occurring Hypertrophied Myocardium
Authors: Yee Edward S. , Hsieh Wen-Ren 
Published: August 2008

Substantial myocardial platelet aggregations in the coronary microvascula ture of normal and of naturally occurring hypertrophied myocardia have been documented after ischemia and reperfusion. Eleven normal canine (group I) hearts underwent an isolated cardiac bypass preparation and were compared with 5 myocardia (Group II) hypertrophied by congenital aortic stenosis. All 16 hearts experienced transient ischemia during the isolated cardiac bypass and produced platelet aggregations (111 In tagged: p < 0.05). Hypothermic (25°C) potassium crystalloid cardioplegia did not wash out these depositions, and with the onset of reperfusion, both platelet and erythrocyte (99mTc tagged) radioactiv ity profoundly increased (p=0.0101). These increases progressed during the hour of reperfusion (p = 0.0369) and, specifically, in the endocardium. In summary, intracoronary platelets are activated after transient ischemic episodes, in particular the vulnerable hypertrophied myocardium in naturally occurring aortic stenotic hearts. These ischemia-activated platelet aggregations persist despite the application of hypothermic crystalloid cardioplegia. These depositions, in turn, allowed an ongoing pattern of platelet and erythrocyte aggregations during the reperfusion period. These data have important clinical implications for myocardial protection and reperfusion during acute myocar dial ischemia and infarction for the normal and hypertrophied myocardium.
Intraoperative Coronary Angiography Using Fluorescein: Basic Studies and Clinical Application
Authors: Takayama Tetsuro , Wanibuchi Yasuhiko , Suma Hisayoshi , Terada Yasushi , Saito Tsutomu , Fukuda Sachito , Furuta Shoichi 
Published: August 2008

To improve the safety and reliability of coronary artery bypass grafting (CABG), intraoperative coronary angiography using fluorescein was investi gated both experimentally and clinically. Results. In experiments using mongrel dogs, the optimal procedures were determined to be as follows. 1. Complete all distal anastomoses. 2. Under the illumination of a 6-watt black light hung 10 cm above the heart, 0.06% fluorescein (0.5 mg/kg BW) is injected as a bolus from the proximal end of the graft. Histologically the direct injection of fluorescein into the coronary artery was shown to cause no injury to the vascular wall. In clinical application, the distribution of the graft flow, the area perfused through the graft, and the patency of the anastomoses were well evaluated in real time by observing the fluorescence. Unexpected narrowing of the anasto mosis and the maldistribution of graft flow were detected in 2 patients by this examination during cardioplegic arrest, and the necessity for additional graft ing, as well as the extent of revascularization, could be evaluated on the operat ing table. It was concluded that intraoperative coronary angiography using fluorescein rapidly provided essential information for the real-time evaluation of CABG surgery without any side effects.
Splenic Artery Aneurysms: Favorable Outcome After Two Different Types of Rupture—Case Reports
Authors: Del Gaudio G.-A. , Boschi L. , Del Gaudio A. 
Published: August 2008

Splenic artery aneurysms are rare lesions and their main complications are rupture and embolization. Two cases of rupture with a favorable outcome are reported. In one patient, the splenic artery aneurysm ruptured into the renal vein, and in the other, it ruptured into the abdominal cavity, causing massive hemoperitoneum.
Unusual Autogenous Vein Grafts
Authors: Schulman Martin L. , Schulman Lee G. , Lledo-Perez Alfonso M. 
Published: August 2008

Since 1973 the authors have used 32 unusual autogenous veins for infrainguinal reconstruction. Grafts used were 2 nondominant profunda femoris, 10 profunda femoris-popliteal, 1 nondominant superficial femoral, 2 contralateral superficial femoral, 1 common femoral, 1 posterior tibial, 5 axillary, 4 tibioperoneal trunk, and 6 saphenous "spare tires." The popliteal vein normally drains into the superficial femoral vein, forming a superficial femoral-popliteal vein that merges with the smaller, nondominant profunda femoris vein; in 7% of limbs, however, the popliteal vein flows directly into the profunda femoris vein, resulting in a dominant profunda femoris-popliteal vein and a nondominant superficial femoral vein that originates in the thigh. Saphenous "spare tires" are saphenous veins harvested after prior deep vein resection; their unique characteristics are responsible for their inclusion in this report. Three grafts presented unacceptable intraoperative or early postoperative problems; all others proved to be satisfactory conduits. Meaningful evaluation of function in this diverse group of grafts was difficult, but in the 17 grafts placed since 1982, which represent a modern experience, primary and secondary patency rates were 87% and 94%, respectively, at three years. Of equal significance is the clinical utility of these grafts: their use has enabled the authors to use autogenous lower extremity veins exclusively in 114 of 115 consecutive infrainguinal reconstructions. No clinically significant late sequelae resulted from resecting these major veins, suggesting that the reserve and the regenerative capacity of the normal venous system is greater than generally appreciated. These grafts expand the pool of autogenous alternatives and may further reduce the need for prosthetic use.
Influences of Intraaortic Balloon Pumping on Peripheral Hemodynamics
Authors: Shimamoto Hiroyuki , Kawazoe Kohei , Kito Yoshitsugu , Ohara Kuniyoshi , Kosakai Yoshio , Kito Hiroyuki , Fujita Tsuyoshi 
Published: August 2008

The influences of intraaortic balloon pumping (IABP) on peripheral hemodynamics were assessed by Doppler techniques. The subjects were 21 patients requiring postoperative IABP support to control low cardiac output state. The flow velocity-time integral in systole (IntS) and that in diastole (IntD) were measured from the left common carotid, superior mesenteric, and terminal aortic flow patterns, and the sum of IntS and IntD (IntS + IntD) was calculated on and off IABP. IABP increased cardiac output significantly (p < 0.01). 1. Left common carotid flow. IABP increased IntS significantly (p < 0.01). Neither IntD nor IntS + IntD changed significantly with IABP. 2. Superior mesenteric flow. IABP increased IntD significantly (p < 0.01). Both IntS and IntS + IntD remained unchanged with IABP. 3. Terminal aortic flow. IntS, IntD, and IntS + IntD did not change significantly with IABP. The authors' data suggest that the carotid area can receive much of the increase in cardiac output in systole with IABP and that the superior mesenteric area can receive much of the volume of blood displaced in the aorta by balloon inflation in diastole.
Primary Radiocephalic Arteriovenous Fistulas for Hemodialysis
Authors: Bilgel Halil , Korun Nusret , Kilicturgay Sadik , Ozen Yilmaz , Cengiz Mete , Yurtkuran Mustafa 
Published: August 2008

The authors review their experience with 318 direct radiocephalic arteriovenous fistulas created for chronic maintenance hemodialysis over the past six years. Thirty-five of the fistulas (11 %) never functioned or thrombosed within the first month. The early failure rate was significantly different between groups older and younger than fifty years of age (p < 0.05). Moreover, the early thrombosis rate was related to the suture techniques used: 8.62% for the interrupted suture group and 20.63% for the running suture group (p < 0.05). Average patency duration for still functioning fistulas in 120 patients is 38.8 months; for the 58 patients who had late failure it was 14.9 months.
Extraperitoneal Access to the Abdominal Aorta
Authors: De Toledo Francisco Victor , Pereira De Araujo Adalberto , Werneck Eduardo , Batista Rogerio Veras , Torres Antonio Barra 
Published: August 2008

The authors report their experience with the use of the extraperitoneal ap proach to the abdominal aorta and iliac arteries in 52 patients, observed between 1980 and 1989. In all the cases a left paramedian incision was done. In 35 pa tients with aortoiliac occlusive disease some type of aortoiliac or aortofemoral bypass was done. In 14 cases of infrarenal aneurysm of the abdominal aorta, aorto-aortic replacement was done in 5, aortoiliac bypass in 7, and aortofemoral bypass in 2 patients. In 3 patients with occlusive disease of the iliac arteries, throm boendarterectomy was performed. The results with extraperitoneal approach to the abdominal aorta and its main branches in the 52 patients were considered very good, when compared with those when the transperitoneal route was used in 72 cases. In the evaluation of results the authors used the following parameters: blood and fluid loss, operative time, intensive care unit time, pulmonary and cardiac complications, postoperative ileus, beginning or oral feeding, time of hospitalization, and mortality. The extraperitoneal group was associated with less blood less (1,120 mL) than that with the transperitoneal route (1,850 mL) (p<0.01). The operative time was longer with the transperitoneal route. The intensive care unit time was less with the extraperitoneal approach (1.6 days) than with the transperitoneal route (3 days). The cardiopulmonary support time was longer the transperitoneal (2.5 days) than in the extraperitoneal group (1.3 days). Postoperative ileus was not observed in the extraperitoneal group but was present in several cases in the trans peritoneal group. The period of time for the patients to start a solid diet was significantly less in the extraperitoneal group. Finally, the number of deaths was smaller in the extraperitoneal group. Their experience cooroborates the similar conclusions of other authors that the extraperitoneal access is the better option in elective aortic reconstruction.
Angioscopy-Assisted In-Situ Saphenous Vein Bypass
Authors: Lai Shiau-Ting , Yu Tarn-Jenn , Weng Zen-Chung , Chang Yen , Cheng Bor-Chi 
Published: August 2008

In recent years considerable interest has been directed toward in-situ saphe nous vein arterial bypass as the best method of revascularization. But this pro cedure requires adequate exposure of the saphenous vein to allow valve incision and venous branch ligation. The authors used a LeMaitre valvulotome to find the superficial venous branches under direct angioscopy assistance. They found this procedure ideal for performing in-situ venous bypass surgery, for the following reasons: (1) It is a simple, time-saving technical procedure. (2) Small skin incisions have caused no problems with postoperative healing. (3) It is easy to locate competent or nondisrupted valves, perforators, and branches. (4) There is a decreased rate of arteriovenous fistulas after in-situ vein bypass graft.
Direct Arterial Reconstruction in Buerger's Disease
Authors: Bozkurt A. Kürsat , Tuzun Hasan , Ozer Mehmet , Karaozbek Yilmaz 
Published: August 2008

During the last six years the authors surgically treated 132 patients with Buerger's disease. They were able to perform arterial reconstruction in 14. Nonhealing ulcers and impending gangrene were the most frequent indications (62.2%). The type and number of surgical procedures were as follows: aorto femoral (1), iliofemoral (2), femoropopiteal (3), femorocrural (3), by-passes and throm boendarterectomy with patch angioplasty (5). There were no perioperative or postoperative deaths. Early thrombosis oc curred in 3 patients. Of the 11 patients with patent arterial reconstructions, 3 showed occlusion within the first year. The cumulative patency rate was 57%. Although the patency rates for direct arterial surgery in Buerger's disease are not as good as those reported for arteriosclerosis obliterans, the authors believe that, in appropriate cases, arterial reconstructive procedures should be tried to achieve better healing of the trophic lesions without major amputation.
Indices of Sympathetic Vascular Innervation in Scleroderma Patients Treated by Epidural Spinal Cord Electrical Stimulation (ESES)
Authors: Sciacca Vincenzo , Vignotto Fulvia , Mingoli Andrea , di Marzo Luca , Di Gianferrari Paola , Maggiore Claudia , Sapienza Paolo , Maritano Mario 
Published: August 2008

In an attempt to explain the epidural spinal cord electrical stimulation (ESES) mechanism of action on microcirculation, the authors measured arterial and venous plasma concentration of norepinephrine (NE), by chromatography, in 17 patients (16 women - 1 man, mean age forty-seven years, range: twenty- four to sixty-four years) affected by scleroderma (15 patients) and Raynaud's disease (2 patients), treated by ESES (mean follow-up 29.3 months, range: one to forty-nine months). Blood was sampled with the patient in the supine position, resting at least for thirty minutes, in environmental standard conditions, from a brachial vein (without tourniquet) and a radial artery, with pacemaker off for twelve hours and pacemaker on for thirty minutes. Microcirculatory modifications induced by ESES were also evaluated in all patients by transcutaneous oxygen tension (TcPO2) and laser Doppler flow (LDF), simultaneously measured with the pa tient in the supine position, on the palm (thenar and hypothenar eminences) during three thirty-minute consecutive phases at 42 ° C and 45°C (phase I: pace maker off for twelve hours; phase II: pacemaker on; phase III: pacemaker off). For technical reasons, NE dosages were available in only 12 patients. Cate gorizing the patients on the basis of clinical results (group A, excellent-good, 9 patients; group B, poor-null, 3 patients) the authors noted after the ESES stim ulation: 1. The vasodilatation index (TcPO2 42°C/TcPO2 45 ° C) increased in phase II and phase III (phase I vs phase II, p < 0.001; phase I vs phase III, p < 0.01). 2. The LDF flow differences between 42°C and 45°C were statistically sig nificant in responders between phase I and phase III (p < 0.01). 3. The physiologic norepinephrine arteriovenous ratio was inverted in 7 of 9 patients of group A and in none of group B (p < 0.05). TcPO2 and LDF are useful noninvasive techniques to evaluate microcircula tory modifications induced by ESES. Moreover, the arteriovenous ratio de crease in plasma norepinephrine may explain the ESES effect on microcircula tion and the reduced vasomotor tone.
Reverse Saphenous Vein Homografts as Bypass Conduits: A Preliminary Report
Authors: Saunders Craig R. , Tedesco Dominic J. , Yee Edward S. 
Published: August 2008

Reverse saphenous vein homografts (RSVH) were needed in 16 patients during the past two years to offer a more thorough myocardial revascularization procedure since autogenous donor material was limited either because of previous surgeries or unuseable harvested conduits. All patients (11 men/5 women, mean age of 71.1 years) presented with severe coronary insufficiency. Nine patients were having reoperations after having previous successful operations (mean 6.9 years), and 2 were having third-time redo surgery about fifteen years after their initial procedures. RSVH were selected by ABO blood typing and were supported postoperatively by antiplatelet therapy. RSVH allowed additional bypass grafting in all patients and yielded an average of 4.1 grafts per patient. To minimize the operative risks, RSVH were mainly used for occluded targeted vessels or nondominant arteries. Three early deaths (less than thirty days) occurred from (1) progressive heart failure after emergent bypass and mitral valve repair for cardiogenic shock, (2) stroke after redo surgery, and (3) renal failure after urgent redo bypass. Although the mean follow-up was only 11.5 months, the remaining 13 patients have clinically improved. Five selected patients have been restudied with arteriography and have demonstrated successful revascularization, ie, patent internal mammary arteries (6/6) and autogenous venous grafts (5/5). However, 4/10 RSVH conduits were nonfunctional and the other 6 were patent. RSVH are effective conduits for cardiovascular reconstruction with excellent immediate hemodynamic characteristics similar to those of autogenous veins. They have been extremely effective in patients with limited autogenous donor material and, in selected cases, when a quick source of bypass material is needed in an emergent fashion. While the initial patency rates have been acceptable, long-term follow-up is needed for comparative rates.
Free Radicals in Reperfusion Injury After Acute Aortic Occlusion
Authors: Nishimaki Keiji , Urayama Hiroaki , Makuuchi Masatoshi , Numata Minoru 
Published: August 2008

This investigation aims to evaluate the role of free radicals and the influence of radical scavengers in reperfusion injury of the skeletal muscle in male Wistar rats. Various parameters, including tissue blood flow, serum and calf muscle tissue levels of thiobarbituric acid (TBA) reactants, and the water content of calf muscles, were measured in the experimental setting, where infrarenal abdominal aorta was occluded for two hours followed by reperfusion with and without intraperitoneal administration of radical scavengers (superoxide dismutase or catalase). The rats were divided into four groups: group A: single laparotomy; group B: two-hour occlusion; group C: two-hour occlusion with superoxide dismutase; group D: two-hour occlusion with catalase. The increases in both serum and calf muscle tissue levels of TBA reactants following reperfusion were diminished in groups C and D as compared with those in group B. The water content of calf muscles showed a significant increase after reperfusion in group B, whereas it did not change in group D. The calf muscle tissue blood flow after reperfusion was significantly lower in group C than that in group B. These results indicate that oxygen-derived free radicals may be responsible for reperfusion injury in the lower extremity and that the attenuated blood flow during reperfusion produced by these scavengers seems to play an important role in reducing lipid peroxidation . In a clinical setting, limiting the rate of reperfusion blood flow may reduce the reperfusion injury in skeletal muscle.
Percutaneous Laser Angioplasty of Peripheral Vessels: Primary Success and Follow-up Results
Authors: Visona Adriana , Liessi Guido , Bonanome Andrea , Lusiani Luigi , Miserocchi Luigi , Breggion Giovanni , Pagnan Antonio 
Published: August 2008

Excimer laser angioplasty was attempted in 59 patients (43 men, 16 women, mean age sixty-three ± eight years, range thirty-nine to seventy-seven years), affected by peripheral vascular disease. Forty-nine patients had a total occlusion of one superficial femoral artery, 3 of one iliac artery, and 1 of one popliteal artery; 6 patients showed a subocclusive stenosis of a superficial femoral artery. Occlusive and subocclusive stenoses were classified by length: < 10 cm (39 cases), > 10 cm (20 cases). A commercial excimer laser was used at the xenon-chloride wavelength of 308 nm. Successful recanalization was obtained in 53 of 59 patients (90%). Hemodynamic improvement was confirmed by a significant increase of the ankle/ brachial systolic pressure index (from 0.60 ± 0.17 to 0.79 ± 0.20, p < 0.005). The success rate was higher for lesions < 10 cm in length. Early reocclusion was observed in 7 patients and was associated with poor runoff. The cumulative patency rate was 81 % at one month, 67% at six months, and 51 % at one year.
Mycotic "Mycotic" Aneurysm of the Superior Mesenteric Artery: A Case Presentation
Authors: Calcagno David , Magnant Colette M. , Lack Ernest E. 
Published: August 2008

A sixty-two-year-old man was found to have an aneurysm of the superior mesenteric artery that was histologically shown to be of fungal etiology. Although the term mycotic is often used to describe infected aneurysms of any etiology, the authors cannot find in the literature a prior report of a fungal, or truly mycotic, aneurysm of the superior mesenteric artery. Clinical, angiographic, and histologic findings are reported with a review of the English literature.
The Relationship of Human Saphenous Vein Intimal Area to Age and Gender
Authors: Davies Mark G. , Brockbank Kelvin G.M. , Hagen Per-Otto 
Published: August 2008

The saphenous vein is an essential element in arterial bypass surgery. It is known to develop intimal thickening following transplantation to the arterial circulation. No data are available on the relationship of normal saphenous vein intimal area and the age or the gender of the patient. One hundred sixty-two consecutive, donated, cadaveric, midtibial samples of the long saphenous vein were harvested. The donors ranged in age from twelve to eighty-two years; there were 121 males and 41 females. The areas of the intima and media and the intimal ratio (intimal area/[intimal + medial area]) were calculated by computer videomorphometry. There was no correlation between the three variables and age, but there was a significant correlation between the gender of the donor and the intimal area (r2=0.25, P=0.0012) and the intimal ratio (r2=0.34, p = 0.0001) showing that females have a greater intimal area than males. These findings suggest that gender should be considered as a variable in the choice of suitable control values in subsequent human studies on the development of intimal hyperplasia in venous bypass grafts.
Ischemic Colitis Following Ruptured Abdominal Aortic Aneurysm
Authors: Rosenthal David , McKinsey James F. , Clark Michael D. , Hungerpiller John C. , Lamis Pano A. , Laszlo Pallos L. 
Published: August 2008

During a six-year period, 47 patients underwent operation for ruptured abdominal aortic aneurysm (rAAA) with a mortality rate of 38% (18/47): of the 39 patients surviving the initial surgery, 9 (23%) developed ischemic colitis. All 9 patients demonstrated hyperdynamic cardiovascular changes consistent with sepsis: decreased systemic vascular resistance (SVR) (mean 852 dynes/sec/cm2) and increased cardiac index (mean 3.8 L/min/m2). This "septic picture" in the postoperative period, before the onset of any gastrointestinal (GI) symptoms (diarrhea with/without blood), led the authors to question bowel viability. Flexible sigmoid colonoscopy identified ischemic colitis in all patients and sigmoid colectomy was performed in 4; 3 of these patients survived. Of the 5 remaining patients managed nonoperatively, 3 survived. When hyperdynamic cardiovascular changes were recognized "early" (< forty-eight hours) and ischemic colitis was diagnosed (5 patients), all patients survived. However, when ischemic colitis was diagnosed "late" (> forty-eight hours) after operation in 4 patients, only 1 (25%) survived. In patients who suffer an rAAA and demonstrate cardiodynamic signs of sepsis (especially falling SVR) in the immediate postoperative period (< forty-eight hours), immediate bedside sigmoid colonoscopy to rule out ischemic colitis is warranted. Similarly, when patients develop "late" cardiodynamic signs of sepsis during recuperation from rAAA, even before the onset of GI symptoms, sigmoid colonoscopy should be performed. If severe ischemic colitis is documented, aggressive management with frequent colonoscopy and possibly sigmoid resection is indicated, for this may offer the only chance of survival in these catastrophically ill patients.