bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid Measurement of Compartment Pressure — A New Technique
Authors: Dierberg William J. , Brown O. William 
Published: August 2008

Compartment syndrome requires early diagnosis and prompt treat ment to minimize permanent se quelae. The diagnosis is suspected and most often made on clinical grounds alone. Symptoms and find ings include: (1) pain out of propor tion to the severity of the injury and unrelieved by immobilization, (2) sensory deficit distal to the compart ment related to nerves that course through the compartment, (3) pain on passive stretching of muscles in the involved compartment, and (4) tenseness and tenderness to palpation over the compartment. Frequently a clinical situation arises in which these criteria are con sidered invalid. The examination of a frightened, uncooperative child may be inadequate or unreliable. Simi larly, trauma patients who are intoxi cated or have head injuries may be difficult to examine. It may be impos sible to delineate neuropraxia from the compartment syndrome versus primary nerve injury (ie, brachial plexus injury). In these situations an objective measurement of the actual compartment pressure is essential. This paper describes a simple modifi cation of the standard needle-ma nometer method of measuring com partment pressure. By use of this modification, the pressure can be simply and rapidly measured with equipment available in most, if not all, hospital wards and emergency rooms.
CSF-Shunt-Related Thrombophlebitis—Case Reports
Authors: Nguyen Jean-Paul , Goujon Colette , Monsuez Jean-Jacques , Keravel Yves 
Published: August 2008

Two cases of left upper extremity thrombophlebitis following left cerebrospi nal fluid, (CSF) shunt implantation are reported. Signs and symptoms appeared in the early postoperative period (at days 5 and 15 respectively). Thrombosis of the axillary vein was demonstrated by Doppler examination and phlebography. Both patients were given anticoagulant therapy with a favor able clinical outcome . No pulmonary embolism or catheter dysfunction occurred. The patients remained free of any disability after a two and three-year follow-up, respectively, without relapsing thrombosis after discontinuation of therapy. These 2 cases occurred in the only 2 adult-patients in whom a left CSF shunt was implanted. No thrombotic complications occurred among 153 patients with a right implantation of the device. Thus, the course of the catheter through the left brachiocephalic vein has to be taken into account in the pathogenicity of this complication.
Surgical Treatment of Congenital Coronary Artery Anomalies
Authors: Berki Turan , Turan Fikret , Okay Tugrul , Özdemir Mehmet , Yakut Cevat 
Published: August 2008

Ten (0.28%) patients with anomalous origin of a coronary artery were detected from inspection of 3500 selected coronary arteriograms. In 1 patient the left main coronary artery (LMCA) originated from the pulmonary artery (PA). In 1 patient situs inversus totalis was present. This patient had a single coronary artery originating from the right coronary sinus. In 2 patients atrial septal defect (ASD) and aortic stenosis (AS) were additionally present. In 2 patients having an anomalously originated coronary artery, additional atherosclerotic coronary artery disease was present. In 4 patients coronary artery bypass grafting (CABG) operations were per formed. In 2 other patients ASD closure and aortic valve replacement (AVR) were performed. One patient with anomalous LMCA originating from the right coro nary sinus refused operation. There was no mortality or morbidity. All of the patients are symptom free and are having an active life.
Abdominal Aortic Aneurysm with Periaortic Fibrosis and Ureteral Obstruction—Report of Two Cases
Authors: Vulpio Carlo , Venuto Vincenzo , Francesco Federico , Massari Massimo , Destito Carmelo , Borzone Augusto , Marin Alfredo Wiel , Castiglioni Giancarlo 
Published: August 2008

Two cases of ureteral obstruction due to the retroperitoneal fibrosis associated with abdominal aortic aneurysm are described. The clinical findings, etiology, diagnosis, and management are discussed. Preoperative diagnosis of abdominal aortic aneurysm with periaortic fibrosis and ureteral obstruction may be possible with the aid of intravenous urography, ultrasonography, and computed tomography. Aortic replacement with synchronous ureterolysis is the treatment of choice; cortico steroids represent an alternative therapy where aortic replacement is too hazardous.
Surgical Treatment of Multivalvular Rheumatic Heart Disease
Authors: Berki Turan , Kisacikoglu Bülent , Mete Atalay , Irez Aysen , Bayezid Ömer , Yakut Cevat 
Published: August 2008

Of 632 valvular heart disease patients 187 were operated on because of multivalvular rheumatic lesions. The operative mortality was 10.1% and late mortality 4.9%. Left ventricular dysfunction was the common cause in the early operative period. Prosthetic valve endocarditis and thromboembolism were the other common causes of mortality, 5.9% and 6.4% respectively. NYHA Class III-IV, pulmonary hypertension, ejection fraction less than 40%, aortic stenosis and elevated left ventricular end diastolic pressure were significant predictors of poor-prognosis. Tricuspid regurgitation due to right heart decompensation is also another grave sign. The type of the prosthetic valve or additional annuloplasties to double valve replacement did not influence the outcome. Optimal timing of the operation is essential. Urgent operations should always be avoided if possible. Earlier surgical intervention, improved perioperative myocardial preservation, and alternate support methods, and improved surgical techniques may lower the operative mortality and morbidity.
The Predictive Value of Noninvasive Testing in Intermittent Claudication
Authors: Vasli Lars R. , Larsen Stig 
Published: August 2008

Noninvasive tests may be used to aid in deciding the treatment of patients with vascular disease by providing hemodynamic information. The authors stud ied whether the information on the severity of the disease and the location of the diseased segment had any predictive value in regard to the results of nonoper ative treatment of patients with intermittent claudication. Two hundred and one patients suffering from intermittent claudication and not recommended for operative treatment entered the study. They all had nonin vasive tests done, including segmental blood pressure measurements and femo ral velocity waveform analyses. After two years the mortality, surgical intervention rate, patient's subjective assessment, and changes in ankle-brachial index were recorded and analyzed. Twenty-nine patients had died and 12 patients had been operated on during the follow-up. The severity of the disease influenced the mortality; the lower the ankle-brachial index, the higher the mortality. The patients' subjective feel ings of change in symptoms were not affected by the severity of the disease at the start. The location of the disease, whether aortoiliac, femoropopliteal, or femorotibial, did not affect the progression of the disease, but it strongly influenced the patients' subjective assessment of the results of conservative treat ment. Patients with proximal disease were less satisfied with conservative treat ment and more often needed surgical intervention. At the two-year follow-up, 53% of the patients felt better, 35% felt unchanged, and 12% felt worse. Patients' assessments of disease progression are good.
Results of Pulsatile Assist Device Usage In Extracorporeal Circulation
Authors: Isik Ömer , Balkanay Mehmet , Irez Aysen , Yakut Cevat 
Published: August 2008

Some surgeons prefer pulsatile to nonpulsatile flow in extracorporeal circu lation. They believe that pulsatile flow is more physiologic, provides better tis sue perfusion, gives less damage to the blood elements and plasma proteins and causes less complement activation when compared with nonpulsatile perfusion. In order to compare the pulsatile with nonpulsatile flow during extracorporeal circulation, the authors studied two different groups of patients, each consist ing of 20 coronary bypass candidates. The patients in the two groups had almost the same properties and were operated on under the same circumstances. In the first group extracorporeal circulation was established with a nonpulsatile roller pump. In the other group a pulsatile assist device was integrated into the arterial line of the extracorporeal circuit with the roller pump. Extracorporeal circula tion was maintained with pulsatile flow obtained by an intraaortic balloon pump pneumatic console. The patients in the two groups were selected to be similar in terms of sex, age, preoperative clinical characteristics and hemodynamic and angiographic findings. Thirty-two operative and early and late postoperative parameters were compared in these two groups. In conclusion, no superiority of pulsatile flow established with the pulsatile assist device over nonpulsatile flow during extracorporeal circulation was seen.
Late Graft Occlusion: Thrombolytic Treatment
Authors: Pratesi Carlo , Michelagnoli Stefano , Pulli Raffaele , Credi Giovanni , Chiti Emiliano , Stefani Paolo , Bertini Domenico 
Published: August 2008

The frequency of acute ischemic graft thrombosis is increasing owing to the larger number of graft implantations. The possibility of success depends on detection of the reasons for the thrombosis and the ability to repair it. In addition lytic therapy must be considered during diagnosis followed usually by an adjunctive procedure like surgery or percutaneous transluminal angioplasty. With this kind of approach physicians are able to delay the surgery, to get more information about the vascular bed, and so to choose the most proper surgical procedure. At present the authors are using this protocol: 100,000 U bolus of urokinase and then 35,000 U/hour. During the application of this protocol certain laboratory parameters are monitored (fibrinogen, activated partial thromboplastin time, thrombin time, fibrinogen degradation products) in order to evaluate the coagulation system during therapy. Their protocol also includes serial controls by means of clinical examination, Doppler examination, and angiography. Angiography can be considered at the end of the therapy as a means of final evaluation and can detect those cases that need adjunctive therapy. Their experience is based on treatment of 47 graft occlusions in 44 men and 3 women, in whom they used urokinase. They divided the patients with late graft occlusions into two subgroups according to the occlusion level. The clinical results were good in 88.6°10 of cases in proximal and 75 ~Io of cases in distal occlusion. The overall lysis as determined by angiography was 85.707o in proximal and 41.7% in distal grafts. The authors found a significant difference in the time limit for starting efficient therapy of a thrombosed graft versus an atherosclerotic artery. In therapy of an occluded graft they were able to achieve patency by starting the thrombolytic infusion within nine hundred sixty hours after the occlusion. In terms of the Winsor index before and after therapy they noticed that the improvement was less evident than could be imagined from looking at the arteriographic results because of the pathologic status of the artery below the graft. In conclusion they recommend the technique of "low dose" catheter-directed therapy for its good results and its lack of significant systemic effects.
Treatment of Superficial Venous Incompetence with a Hemodynamic Technique on an Outpatient Basis: The SAVAS Technique
Authors: Belcaro G. , Christopoulos D. 
Published: August 2008

Three techniques to treat venous incompetence on an outpatient basis were compared in 138 limbs [107 patients) with superficial venous incompetence. They were treated with the dentist's technique (DT) [Group A, 44 limbs], compres sion sclerotherapy (CS) [Group B, 45 limbs], or the SAVAS [ sectionnement en Ambulatoire des Varices Avec Sclerotherapie] technique [Group C, 49 limbs]. All patients were followed up (five years) with ambulatory venous pressure (AVP) measurements and color duplex scanning. DT consisted of the sectioning under local anesthetic of incompetent veins. CS was done by injecting polidocanol 3% with compression applied for four weeks. The SAVAS was done with a combination of DT and CS with sectioning of the incompetent veins under local anesthetic and retrograde injection in the distal veins of polidocanol 3%. This type of retrograde injection perfuses only incompetent veins. After five years there was a significantly lower refilling time (RT) with AVP in the SAVAS group (average of twenty seconds). RT was 12.5 seconds in group B and fifteen in A. The number of significantly incompetent residual veins was on the average 0.9 in the SAVAS group, significantly lower than in the other two groups. The average cost per treated limb was significantly lower is the SAVAS group. In conclusion, after a five-year follow-up, the SAVAS technique was more effective, its hemodynamic value was superior to DT and CS, and its costs were lower.
Validity of Vascular Prostaglandin Assay Methods
Authors: Fillinger M.F. , Hull T.L. , Mirth C.A. , Reinitz E.R. , Schwartz R.A. 
Published: August 2008

This study directly compares the three major methods of prostaglandin as say for explanted blood vessels in an effort to determine whether reliable assays can be performed on small, localized areas. Under general anesthesia, canine femoral arteries and veins (n =16) were excised after measurement of in vivo dimensions. Each vessel was divided into three segments. Vessel segments were (1) incubated as whole rings ("biopsy" method), (2) incubated with the luminal surface covered by a plexiglass well (well method), or (3) perfused with a pulsa tile pump at physiologic pressure, temperature, and flow rate for two fifteen minute cycles with a balanced salt solution (perfusion method). Perfusion seg ments were also tested by the well and biopsy methods after thirty minutes of ex vivo perfusion. Assays of stable metabolites for prostacyclin (Pc) and throm boxane A2 (Tx) were performed using commercially available radioimmuno assay techniques. Luminal perfusion was used as the "gold standard" for corre lation. Mean values for Pc, Tx, and Pc/Tx ratio were compared for each method on both arteries and veins. In each case, the well method was statistically equiva lent to the perfusion method for the second fifteen-minute cycle, while the biop sy method was significantly different in several groups. Linear regression analysis revealed significant positive correlations between the well method and the per fusion method (r>0.74, P<0.01). The biopsy method did not correlate with the perfusion method in a significant manner (r 0.18 and 0.50, p<0.05). Significant differences between the first and second perfusion cycle were seen in most cases. The wall method revealed trends toward decreased thromboxane production but no change in prostacyclin production for specimens after thirty minutes of perfusion. Conclusions: (1) The well incubation method demonstrates a significant positive corre lation with luminal perfusion while allowing assay of small localized areas. (2) Luminal perfusion is a reproducible technique, but larger vessel areas and more complex appara tus are required. Significant variations in luminal prostaglandin synthesis occur with se quential perfusion cycles, and the mechanism for the decrease in prostacyclin/thromboxane synthetase level or differing mechanisms for prostacyclin and thromboxane synthesis. (3) The vessel biopsy method is not reliable for comparisons with luminal perfusion or as a means of measuring luminal prostaglandin production.
Surgical Outcome for "Normal" Coronary Ventricular Tachyarrhythmias
Authors: Yee Edward S. 
Published: August 2008

Analyses of 75 surgically treated patients for potential life-threatening ven tricular tachyarrhythmias demonstrate a distinct subset of patients with "nor mal" coronary ventricular tachyarrhythmias. This subset of 10 patients (Group A) was compared with the remaining 65 patients (Group B), who had intra luminally obstructed and ischemic lesions. The etiologies for Group A patients included 4 hypertrophic cardiomyopathies, 4 dynamic intramyocardial muscle bridges, and 2 congenital aneurysms or diverticula. The localized arrhythmic foci for Group A were all preoperatively or intraoperatively determined as com pared with only 33 of 65 (51 %, p < 0.05) in Group B. While the specific types of surgical intervention for the two groups were seemingly identical (ie, revascu larization, endocardial resection, aneurysmectomy and reconstruction, and/or insertion of automatic internal cardiac defibrillators), the mortality rates were significantly different (mortality A vs B: early 0/10 vs 5/65, p < 0.05 and late 0/ 10 vs 4/60, p < 0.05). All Group A patients underwent repeated studies demon strating maintained ventricular function, in contrast to Group B patients, who exhibited severe ventricular impairment (7/60, p < 0.05). In summary, "normal" coronary ventricular tachyarrhythmias are found in a distinctive subset of patients. Their different etiologies result in better out comes from direct operation, and hence, these patients should be managed with this important premise. Indirect or non-operative approaches should not be used in place of these potential cures.
Management of Infected Early Postoperative Lymph Leak in the Groin
Authors: Khalil Ismail M. , Sudarsky Laura A. 
Published: August 2008

Lymph leak from a groin incision following vascular procedures on the fem oral vessels can be a difficult postoperative management problem. Eight pa tients (of 198 undergoing vascular reconstructions involving the femoral vessels) developed 9 lymph leaks (4.5%) through the groin skin incision in the first post operative week. Three patients (38%) had a synthetic prosthesis and 5 (62%) had autogenous saphenous vein grafts. Initially, the authors treated the patients with intravenous antibiotics, bed rest, and sterile occlusive dressings. The lym phorrhea persisted in all patients, and serial cultures of the draining lymph became positive within fourteen days postoperatively. Surgical management consisted of radical debridement of the wound and rotation of a muscle flap to cover the vascular repair. The wounds were left open to granulate, then split- thickness skin grafts were applied. During a follow-up period ranging from eighteen to thirty-six months, there was no evidence of graft infection, recurrent lymph leak, or limb loss. Although the patient population is small, the authors feel that when a lymph collection in the groin leaks through the skin incision, the incidence of infection is high. Their surgical approach seems to yield a favorable outcome in control ling the lymph leak and preventing extension of infection to the vascular recon struction.
The Concentration of Blood in Cardioplegia Determines Postoperative Conduction Disturbances
Authors: Gundry Steven R. , Sequeira Alejandro , McLauglin Joseph S. 
Published: August 2008

Blood cardioplegia in conjunction with iced slush topical cooling has been shown by the authors' group and others to cause postoperative conduction disturbances in 50% of patients. Because this is significantly higher than crystalloid cardioplegia, they tested whether a lower concentration of blood in the cardioplegia mix might change the rheology of the solution and hence lower the conduction defects if cold sludging of red blood cells caused the defects. They compared 289 consecutive patients receiving 4:1 blood cardioplegia (BC) with 90 consecutive patients who received 2:1 blood cardioplegia for the presence of postoperative conduction defects. The 4:1 BC caused conduction defects in 141/289 (49%) patients versus 8/90 2:1 BC patients (9%) (p=0.01). Perioperative heart block requiring pacing occurred in 67 patients with 4:1 BC (23%); no patients with 2:1 BC required pacing (p=0.001). Only 10 of 141 (7%) 4:1 BC patients had resolution of conduction defects prior to discharge, whereas all 2:1 patients but 1 resolved their defects within twelve hours of operation (p=0.05). There was no difference in patients' ages, grafts, ischemic time, or cardioplegia amount. Iced slush was used in all patients. The authors conclude that the concentration of blood in cardioplegia solutions appears to have a direct effect on postoperative conduction disturbances; their group now routinely uses a 2:1 mixture. This concentration allows continued use of iced slush topical cooling.
Reduction of Homologous Transfusions in Open-Heart Surgery
Authors: Santoli Edoardo , Di Mattia Daniele G. , Castelli Piero , Condemi Annamaria , Guzzetti Stefano , Meraviglia Paola , Santoli Carmine 
Published: August 2008

Use of homologous blood is relatively frequent in cardiac surgery and represents a potential risk for sensitivity or infective contamination. A prospective study on 744 patients (operated on before September, 1986, and considered as the control group) revealed that the incidence of posttransfusion hepatitis was 12.7% (mean overall blood loss was 1270±115 mL; bank-blood-transfused patients comprised 91.9% of the group; and bank-blood-transfused units averaged 8.6/patient). From September, 1986, to December, 1990, 924 patients underwent elective open-heart operations. Autotransfusion only was used in group A (400 patients). Aprotinin was added to autotransfusion in group B (192 patients). Aprotinin only was used in group C (332 patients). The bank blood requirement was reduced drastically in all groups. In group A, mean blood loss was 870±85 mL, and transfusions were required in 29.7% of patients with a mean bank blood unit/patient of 2.6 ± 1.8. In group B, mean blood loss was 425 ± 55 mL, and transfusions were required in 11.5% of patients, with a mean bank blood unit/patient of 1.8 ± 1.3. In group C, mean blood loss was 405 ± 45 mL, 31.9% of patients had bank blood transfusion, and mean bank blood unit/patient was 2.1±1.2. The incidence of posttransfusion hepatitis was 4.2% in group A, whereas no infective complications were found in the other groups. The basal mean hematocrit value in groups A and B was 42.1±2.7% and 41.4±2.0%, respectively, and preoperatively, after a blood withdrawal of 3 units, was, respectively, 34.8±1.9% and 33.8±1.1%. In group C the mean preoperative hematocrit value was 41.7 ±2.2%. Mean hematocrit values at discharge were similar in all three groups, ranging around 30%. Platelet count dropped in group A after surgery (-41%) and increased in the postoperative period, never reaching the basal value. Patients receiving aprotinin (groups B and C) presented a lower postoperative platelet decrease (respectively -28.6% and - 26.1 %), with a discharge value lower than basal. Autologous blood collection and aprotinin administration proved to be a well-tolerated and uncomplicated method. This represented the most important and effective blood-saving procedure in cardiac surgery, minimizing the bank blood requirement and minimizing or even eliminating posttransfusion complications.