bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced pharmacy resource utilization associated with raltitrexed treatment of advanced colorectal cancer
Authors: Summerhayes Maxwell , Wanklyn Steven J , Shakespeare Roselyn A , Lovell Jacqueline 
Published: November 2007

Objective. The pharmacy resources needed for prep aration of the direct, specific thymidylate synthase inhibitor raltitrexed (`Tomudex' ; Zeneca Pharmaceu ticals, Ltd., Macclesfield, UK); the Mayo, Machover, and De Gramont regimens of 5-fluorouracil (5-FU) and calcium leucovorin (LV); and continuous intravenous 5-FU for the treatment of advanced colorectal cancer were compared. Design. The pharmacy time spent on prepara tion, the disposables used, and associated drug wast age were recorded and costed for a treatment cycle. Patients. Colorectal cancer patients receiving standard treatment or included in a clinical trial in a large teaching hospital were considered. Outcome Measures. The pharmacy preparative time, labor, disposable, and drug wastage costs per treatment cycle, prepared extemporaneously and us ing a batch process, were measured. Results. A cycle of raltitrexed was much quicker to prepare than any other regimen (P < .05). The labor costs were significantly less (£2.87 for ralti trexed compared with £5.24-19.67 for the 5-FU regi mens) particularly with respect to the Machover regimen, which incurred costs seven times those of raltitrexed. The cost of disposables was significantly lower for raltitrexed, with continuously infused 5-FU incurring the greatest cost. As expected for a new treatment assessed within a clinical trial rather than in a routine setting, drug wastage was higher for ralti trexed (P < .05) except when compared with batch- preparation for the Machover regimen. Conclusions. Raltitrexed was quicker and sim pler to prepare than 5-FU- based regimens for colo rectal cancer. This resulted in lower pharmacy labor and disposable costs, although in this study drug wastage was higher for raltitrexed prepared under clinical trial conditions.
Complications Encountered During Arterial Embolectomy with the Fogarty Balloon Catheter
Authors: Schweitzer Daniel L. , Aguam Abul S. , Wilder Joseph R. 
Published: November 2007

The Fogarty arterial embolectomy catheter, while indispensible in the armamentarium of the vascular surgeon, is not an entirely benign instrument. A case is described in which the balloon was lost in its entirety from the catheter and immediately retrieved using a second identical instrument. A comprehensive survey of the literature reveals that a variety of arterial injuries have occurred during the use of the Fogarty catheter. Each of the major ones is discussed in depth. Amongst the most serious are arterial perforation and rupture occasionally followed by loss of the involved extremity. All previously reported complications following use of the Fogarty catheter are tabulated and reviewed. Additionally, a formal classification of these complications is proposed. Since the time of its introduction in 19631 the Fogarty balloon-tipped catheter has become an indispensible tool in the armamentarium of the vascular surgeon. Its use for arterial embolectomy has been responsible for the salvage of many thousands of limbs. Over the course of the past decade, however, a number of complications referable to this instrument have appeared in the literature. These include perforation of vessels, intimal disruption and foreign body embolization amongst others. To our knowledge, however, there has been only one reported case of a balloon having been lost intra-arterially in toto without obvious cause.2 It is the purpose of this paper to present the second such case where the balloon, which had separated entirely from the catheter during the course of an arterial embolectomy, was later retrieved by passage of a second Fogarty catheter. In addition, a comprehen sive review of the literature is undertaken, and all arterial complications reported to date summarized and tabulated.
A New Self-Anchoring Endocardial Electrode
Authors: Robicsek Francis , Tarjan Peter , Harbold Norris B. , Masters Thomas N. , Robicsek Steven A. , Ferrari Herbert A. 
Published: November 2007

We describe a new electrode which uses the self-anchoring property of an ejectable dart to remain in permanent contact with the right ventricular myocardium. In longrange animal experiments, there were neither disloca tions nor mechanical failures. Both acute and chronic threshold measure ments, as well as sensing characteristics, remained acceptable. The experi mental lead was applied in a clinical case refractory to treatment by other electrodes. The application of this dart-electrode appears to be indicated when elec trode instability occurs. Further well-controlled clinical trials appear to be necessary before it could be recommended for routine clinical use for all patients requiring transvenous pacemaker implants.
Limb Salvage after Massive Soft Tissue, Bone, and Vascular Injury from an Airplane Propeller—3-Year Survival with a Popliteo-Peroneal Saphenous Vein Graft
Authors: Taricco Alfred 
Published: November 2007

A 33-year-old male pilot instructor was injured by an airplane propeller which resulted in massive injury to his right lower lateral leg, leaving in its wake a destroyed peroneal nerve, macerated muscle, open fractures of the tibia and fibula, and severe vascular injury. The latter involved complete transsection and destruction of the anterior tibial artery and the tibiopero neal trunk plus a laceration of the distal popliteal and proximal posterior tibial veins. After his arrival to the hospital he was treated for shock, underwent arteriography and reconstructive vascular surgery which resulted in limb salvage. Further surgery for skin grafting was required and he was discharged from the hospital six weeks after he was admitted and he was ambulating without aid. Two years later his popliteo-peroneal saphenous vein graft continues to function and he performs all activities including sports with little difficulty. He requires no foot or leg brace and has no limp. Leg injuries as a result of automobile, motorcycle, and hunting accidents along with war-related injuries are well known to all surgeons who deal with injuries of the extremities. However, an injury to an extremity from a rotating airplane propeller is most unusual as the following case report will reveal. Even more so is the fact that the leg was not traumatically amputated but had all of its vital arterial supply destroyed. Without reconstruction he would have had to go on to complete amputation by normal surgical means. The psychologic impact of such an injury is almost as severe as the physical injury and requires treatment as well.
FemoroPopliteal and FemoroTibial Arterial Bypasses for Limb Salvage
Authors: Chang John B. 
Published: November 2007

Personal experiences with femoropopliteal and tibial artery bypasses to save limbs are reviewed. There were 315 consecutive bypass procedures in 249 patients over a period of 5 years and 6 months. Femoropopliteal bypasses were done with autogenous greater saphenous vein grafts in 102 cases and with PTFE (expanded polytetrafluoroethylene, Gore-Tex) grafts in 100 cases. Femoropopliteal artery bypasses were done with superficial femoral vein grafts in three cases, with bank veins in two cases, and with arm veins in three. In two cases proximal bypasses were made above the inguinal ligament, and these were included in the series of femoropopliteal artery bypasses. There were 70 cases of femorotibial artery bypasses with autogenous greater saphenous vein grafts, two cases with arm veins, and 19 cases with PTFE grafts. In seven cases sequential bypasses were done (femoropoplitealtibial arte rial bypasses) with autogenous greater saphenous vein grafts. In 15 cases popliteal-distal tibial artery bypasses were done with autogenous greater saphenous vein grafts. In 15 cases popliteal-distal tibial artery bypasses were done with autogenous greater saphenous vein grafts. Accumulated patency rates at 5 years were 83% and 68.7% in femoropopli teal and femorotibial artery bypasses with autogenous greater saphenous vein grafts. The accumulated patency rates at 3 years were 83% and 22% in femoropopliteal and femorotibial artery bypasses with PTFE grafts.
Femoral Blood Flow Determination with a Multichannel Digital Pulsed Doppler: An Experimental Study on Anesthetized Dogs
Authors: Marquis C. , Meister J.J. , Mirkovitch V. , Depeursinge C. , Mooser E. , Mosimann R. 
Published: November 2007

Since Satomura first described an ultrasonic device using the Doppler effect to detect blood flow in 1959, more recent advances in medical engineer ing have met the need for non-invasive, quantitative measurement of blood flow in peripheral arteries.1 This goal can now be achieved with the use of a pulsed Doppler combined with an A-mode scan to estimate the angle of the ultrasound beam and the dimensions of the vessel. Although several authors have already published data concerning blood flow volume obtained by continuous wave or pulsed Doppler devices in human peripheral arteries2,3,4 or in animal experiments,5,6,7 the accuracy of their meas urements was only correlated with indirect blood flow determinations such as electromagnetic flowmetry or venous occlusion plethysmography. The present study compares the values of blood flow volume obtained by a Multichannel Digital Pulsed Doppler (MDPD) and by direct timed blood collec tion (DTBC) in the canine common femoral artery.
PTFE Prostheses in Leg Arteries Reconstruction
Authors: Cavallaro Antonino , Gallo Pietro , Sciacca Vincenzo , Garofalo Mariano , Sterpetti Antonio , Stipa Sergio 
Published: November 2007

The authors report their experience of 67 consecutive patients submitted to reconstruction of the below-the-knee arteries by means of expanded PTFE (Gore-Tex) prostheses. Results in terms of patency and limb salvage are not of absolute value owing to the lack of selection of patients, most of whom were at very high risk. However, a lower performance in comparison to autologous vein graft was evident. A pathologic study of patent, occluded and infected grafts is presented: the high level of "biocompatibility" of such grafts is confirmed. A high incidence of infection both of patent and occluded grafts was a relevant feature of the casuistic.
Spinal Cord Injury Following Abdominal Aortic Surgery: A Case Report
Authors: Borrero Edgar , Chang John B. 
Published: November 2007

The incidence of spinal cord injury following abdominal aortic surgery is 0.25%.8 Szilagyi's world literature search yielded 36 case reports, and he added 8 case reports to that number. In Szilagy's series, all of the postoperative cases of spinal cord injury were observed after abdominal aortic aneurysm surgery. The incidence in cases of ruptured aneurysms was ten times greater (5 of 247 or 2%) than that noted in cases of unruptured aneurysms (3 of 1,477 or 0.2%) . No spinal cord injury occurred in the patients operated on for aorto-iliac occlusive disease, and the rarity of occurrence of this complication in aorto-iliac occlusive disease is reflected in the number of cases reported in the literature. 2,3,5,6,9 The lower extremity neurologic deficit may occur with or without bowel and bladder paralysis, and may be temporary or permanent. The object of this paper is to present a case report of spinal cord injury following surgery for aorto-iliac occlusive disease, and a discussion of the pathophysiology of this complication.
Can Aortography Precipitate Mesenteric Infarction in Patients With Chronic Intestinal Ischemia? Case Studies
Authors: Collier P.E. , Ryan J.J. , Fazi B. , Diamond D.L. 
Published: November 2007

Three patients with symptoms suggesting chronic mesenteric ischemia underwent diagnostic aortography. All three patients were well-hydrated before, during and after the procedure, and no technical or physiologic mishaps occurred during the performance of the aortogram. The arteriograms demonstrated occlusion of two mesenteric vessels and severe stenosis of the remaining vessel in each patient. Bowel infarction occurred shortly after the radiographic procedure in all three patients. Angiographic contrast agents are hyperosmolar and can induce both localized and systemic hypovolemic states. These dyes also induce changes in the blood cells and vessel walls, especially in areas distal to critical stenoses, that tend to shift the ratio of prostacyclin to thromboxane in favor of thromboxane. It is recommended that operative intervention be planned soon after arteriographic confirmation of the diagnosis of chronic mesenteric ischemia because the radiographic contrast agent may induce changes that cause bowel infarction. Otherwise, the patient should be anticoagulated with heparin or volume expanded with low molecular weight dextran until operative intervention is undertaken.
Stab Wounds of the Heart. Report of Two Consecutive Survivors Involving Heroic Measures and Seemingly Fatal Acidemia
Authors: Velez Augustine , Pizzi Walter F. , Sze Kenneth C. , Nambisan Ramachandran , Hovaguimian Hagop , Jacobowitz Israel J. , Richman Howard 
Published: November 2007

There are four major considerations in the effective resuscitation of the patient with penetrating wounds of the heart. Prehospital care and transport must be appropriate and rapid, using a modified load-and-go approach. Emergency Department thoracotomy must be considered and performed immediately upon the patient's arrival at the hospital. Descending thoracic aortic occlusion is the most useful maneuver in maintaining perfusion of the heart and brain until hypoperfusion can be corrected. The severe acidemia frequently exhibited by agonal patients was corrected in both cases presented (in our first case, the pH was initially 6.47, the lowest ever recorded in a deficit-free survivor) by application of the above-mentioned modalities. In conclusion, we found that the use of these heroic measures in treating two victims of stab wound of the heart, despite the discouraging results published by some other centers, achieved deficit-free survival for both patients. We believe that in cases of penetrating chest trauma, it is inappropriate to base the use of Emergency Department thoracotomy solely on the observance of signs of life in transit to the hospital. Mandatory thoracotomy should be applied in these cases.
Surgical Treatment of Infected Aortofemoral Grafts: A Fifteen-Year Experience
Authors: di Marzo Luca , Feldhaus Richard J. , Schultz Richard D. 
Published: November 2007

During the last fifteen years, we performed a total of 855 aortofemoral re constructions. Fifteen (1.75%) grafts were surgically removed (completely or partially) owing to a severe infection (Szilagyi: Grade 3) at a mean of 66.3 months (SD ± 37.9) after their implantation. Diagnosis was always clinically evident. In 10 patients, the graft was partially removed (one or two limbs). In 3 of the 10, graft infection progressed requiring complete graft removal after a mean of 18.6 days. In the other 5 patients, the graft was removed "in toto" at the time of the first operation. In 9 cases, revascularization was accomplished by means of a "remote" takeoff reconstruction (thoracic aorta or axillary ar tery), whereas in 8 cases (3 recurred) reconstruction was performed with a "local" takeoff reconstruction (stump or aortoiliofemoral arteries). One patient was not revascularized, because the limb was already amputated. Recurrence of infection was higher in the patients treated by partial removal of the graft (p < 0.05), even though the stump sterility was always evaluated by means of intraoperative culture. The mortality of patients with recurrence of infection was 66.6%. Multiple operations of the femoral site were considered a factor in causing aortofemoral graft infection (p < 0.01). Diabetes was not considered a factor in causing infection (p n.s.). Grafts with remote takeoff reconstruction have better long-term results in terms of limb salvage and survival when compared with local takeoff recon struction (p < 0.05).
Effect of Graded Aortic Occlusion on the Reticuloendothelial System
Authors: Vo Nghia M. , Chi David S. , Stanton Paul E. 
Published: November 2007

To evaluate the effect of graded aortic occlusion on the reticuloendothelial system (RES), 21 Sprague Dawley rats were subjected to fifteen (GI), thirty (GII), or sixty (GIII) minutes of distal aortic occlusion or to a sixty-minute sham operation (GIV) under general anesthesia. Chromium 51-labeled sheep red blood cells (SRBC) were injected twenty-four hours later, and SRBC half-life (T½) was measured as an index of RES function. Decreased RES function was (1) dependent upon the duration of clamping time, (2) most pronounced at sixty minutes' clamping time, (3) characterized by a marked increase in SRBC half-life, along with a decreased radioactive uptake by the spleen and liver.
Long-term Intraarterial Infusion Therapy with Prostaglandin E1 in Patients with Ischemic Ulcer of the Extremities
Authors: Nakata Y. , Sakurai T. , Yamada I. 
Published: November 2007

There is confusion about blood flow of the foot during intraarterial infusion of prostaglandin E 1. The authors studied blood flow in the dorsalis pedis arter ies of patients with ischemic ulcer during the infusion and report the results in this paper. Prostaglandin E1 was continuously infused intraarterially for a mean of 30.9 ±14.5 days in 17 lower extremities of 11 patients with intractable ischemic ulcers. Thirteen of the 17 cases responded to the treatment—especially the cases in which peripheral arteries near the foot joint were patent. In the dorsalis pedis artery, the blood flow increased by 266.3% during the arterial infusion, but no differences were seen in the peak frequency or the percent window denoting the degree of spectral broadening in the infused lower limb. On the other hand, there was no statistically significant difference between the blood flow, peak frequency, or percent window of the contralateral lower limb before, and those parameters during, the infusion. The authors observed complications in 9 of 17 cases, which necessitated the discontinuation of the infusion.
Abdominal Aortic Aneurysms with Primary Arteriovenous Fistula—Case Reports
Authors: Ohgi Shigetsugu , Ito Katsuaki , Maruyama Shigeki , Tanaka Kohichi , Tsujimoto Minoru , Hara Hiroshi , Mori Tohru 
Published: November 2007

Abdominal aortic aneurysms with primary arteriovenous fistula can be clas sified into three types (ruptured, shunted, and occult) according to clinical man ifestations. Two cases, in the authors' experience, belonged to the shunted type. Abdominal continuous bruits were the most definite sign to suggest the compli cation of the fistula. B-mode imaging system, combined with directional color Doppler flowmeter, was applied to a test for precise evaluation regarding the fistula and clearly showed the location and size of the fistula, the mural thrombi, and the specific blood flow patterns through the fistula. To prevent both massive bleeding and critical pulmonary emboli through the fistula, com plete venous interruption at the bilateral common iliac veins, as well as of the inferior vena cava, was performed by means of transsaphenous insertion of three balloon catheters so that a better operative field was obtained without any complications. Precise preoperative evaluation of the fistula, as well as prevention of pe rioperative complications, can facilitate postoperative improvement.
Pretreatment of Dacron Prostheses with Gelatin: Experimental Research and Clinical Evaluation
Authors: Cavallaro A. , Sciacca V. , Gallo P. , Cisternino S. , di Marzo L. , Mingoli A. , Alessi G. , Stipa S. 
Published: November 2007

Experimental evaluation of a new type of dacron graft, pretreated with mod ified mammalian gelatin, has been performed on the beagle dog. After grafting of the infrarenal aorta, dogs were monitored from three days to three months. Pretreatment with gelatin effectively avoided the need for preclotting and did not affect the normal healing of the prosthesis as compared with similarly tex tured not pretreated grafts. This graft, when applied in man as an abdominal aortic substitute, has yielded uniformly gratifying results (within a follow-up range of twenty to twenty-seven months).
Ruptured Dissecting Hepatic Artery Aneurysm: A Rare Cause of Abdominal Apoplexy—A Case Report
Authors: Carty G. , Meland B. , Tong G. , Wilson W. 
Published: November 2007

This is a case report of a sixty-five-year-old white male who was hospitalized for elective surgery of a recurring left inguinal hernia. On the sixth postopera tive day he was struck by sudden abdominal pain, followed by rapidly progress ing hypovolemic shock, secondary to abdominal apoplexy from a ruptured dis secting aneurysm of the common hepatic artery. His resultant death, approxi mately twenty-four hours following emergency laparotomy, was secondary to persistent hypotension, followed by multiple organ system failure. It represents the eighth case reported of this entity in the English literature. The previous 7 cases are reviewed. The association with cystic medial degenera tion, essential hypertension, and postoperative status is discussed. Also summa rized are the symptomatology, diagnosis, and management of this very rare and almost invariably lethal condition.
Outcome in the Management of Penetrating Venous Injury
Authors: Khaneja Satish C. , Arrillaga Abenamar , Ernst Alfred , Picard Daniel L. , Pizzi Walter F. 
Published: November 2007

The authors report on the management of 33 patients with penetrating venous injuries, 25 due to gunshot wounds and 8 due to stab wounds. During the period of this study we treated 35 venous injuries and two patients, both following femoral artery and vein repairs and limb salvage were lost to follow-up and are excluded. Thirty-two had associ ated thoracic, intraabdominal, or arterial injuries. Duplex imaging was performed in 14 patients and venography in 12. They assessed all 27 survivors for postoperative sequelae. Mean follow-up time was twenty months, ranging from three months to three years. Four patients had suprarenal inferior vena cava injuries. All 4 underwent repair and 2 survived. Seven others had infrarenal vena cava injuries. Three of 5 survived following repair and the other 2 survived after caval ligation. Three patients had iliac vein injuries. Two died after repair and 1 survived with ligation. Seventeen patients had injuries of the femoral vein. Thirteen underwent repair, 7 of whom remained patent. Four had ligations performed. There were 2 injuries of the popliteal vein; both were repaired, but neither remained patent. All 19 patients with femoral and popliteal vein injuries survived with limb salvage. Postoperative sequelae (persistent edema, skin discoloration) were observed in 4 failed venous repairs—2 femoral and 2 popliteal. Ligation of the infrarenal vena cava and iliac veins, as compared with repair, yielded a greater patient salvage rate. There was no increased morbidity with ligation of the femoral veins, which was undertaken only on unstable patients.