bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparative Evaluation of Femorofemoral Crossover Bypass and Iliofemoral Bypass for Unilateral Iliac Artery Occlusive Disease
Authors: Nazzal Munier M. , Hoballah Jamal J. , Jacobovicz Claudio , Mohan Chittur R. , Martinasevic Mario , Ryan Stephen M. , Sharp William J. , Kresowik Timothy F. , Corson John D. 
Published: July 2008

The purpose of this study was to compare the results of extra-anatomic femorofemoral crossover bypass grafting to the anatomic iliofemoral bypass grafting procedure in the treatment of patients with unilateral iliac artery occlusive disease with respect to patency and limb salvage. The records of all patients with unilateral iliac artery disease who underwent revas cularization between January 1988 and December 1995 at the University of Iowa Hospitals and Clinics (UIHC) were retrospectively reviewed; 108 patients were identified and divided into two groups. Group I (n=68; male/female=44/24) was composed of all patients who underwent a femorofemoral crossover extra-anatomic bypass. All patients who underwent an iliofemoral anatomic bypass constituted group II (n=40; male/female=24/16). The mean age for group I was 60 years (range 28-87) and for group II, 54 years (range 14-86). The medical risk factors between both groups were comparable. Except for the higher incidence of gangrene in group II the indications for surgery were comparable between both groups. (continued on next page) A polytetrafluoroethylene graft was used in 88% of group I patients and in 90% of group II patients (NS). In the remaining patients, an autogenous vein conduit was used. Two patients from group I (2.9%) died in the perioperative period (NS). Graft patency was assessed by clinical evaluation, Doppler-derived ankle/brachial indices, and color duplex imaging. The cumulative primary and secondary patency rates, limb salvage, and patient survival were calculated by use of life table analysis (SE<0.1). The need for simultaneous outflow and inflow procedures at the time of surgery was comparable between both groups. The proportion of patients who underwent further revasculariza tion during follow-up was also comparable. The 5-year primary and secondary graft patency rates were 81.7% and 90.3%, in group I and 61.3% and 80.5% in group II. Although the difference between both groups was not significant there was a tendency toward higher rates with femorofemoral bypass. The 5-year survival rates of 80.3% for group I and 73.3% for group II were comparable. These data suggest that there is no significant difference in the long-term results between the femorofemoral crossover bypass grafts and iliofemoral grafts. Both procedures result in acceptable patency and limb salvage rates. The femorofemoral bypass is, however, more attractive, for it can be performed under local anesthesia if needed and does not involve the creation of the retroperitoneal incision necessary with the iliofemoral bypass.
Fast Rotating Atherectomy Catheter Tip Inhibits Platelet Aggregation and ATP Release: A Study Using Platelet-Rich Plasma
Authors: Latif A.B. , Rees M.R. , Gehani A.A. 
Published: July 2008

The interaction of atherectomy devices with the arterial wall is the focus of many studies, but their effect on the surrounding blood is largely unknown. This is a detailed investi gation on the effects of a rotational atherectomy device with a fast rotating tip on platelet structure and function. Platelet-rich plasma (PRP) was obtained from six volunteers, divided into 5 mL samples, and subjected to the atherectomy tip rotating at 20, 40, or 80 thousand rpm for 30 or 60 seconds. Platelet aggregation to collagen or adenosine diphos phate (ADP) was obtained in all samples by means of a dual-chamber optical aggre gometer. The fast rotating catheter tip caused marked inhibition of platelet aggregation to both collagen and ADP. The maximum extent of aggregation was reduced from 85% ±2.8 in control to 46% ±4.8 with collagen (p<0.01) and from 86.1% ±6.9 to 25.1% ±4.3 with ADP (p<0.01). The rate of aggregation (measured at 4 minutes) dropped from 81.3% ±2.7 to 40% ±4.5 and from 73.9% ±8.5 to 12.5% ±2.6 (p<0.005) with collagen and ADP, respectively. These effects were related to rotating speed and duration of exposure. ATP release in response to collagen fell from 2.63 ±0.13 nMol in control to 0.7 ±0.1 nMol, p<0.001 after exposure to the rotating tip. There was no significant change in platelet count, nor was there formation of platelet aggregates (platelet aggregate ratio remained unchanged) to account for these phenomena. Furthermore, transmission electron microscopy showed no significant platelet disruption or release of granules, and little signs of activation were seen even after addition of collagen. This is the first study to demonstrate that exposure to a fast rotating catheter tip inhibits in vitro platelet aggregation and ATP release. There were no apparent loss of integrity of platelet structure, release of granules, or formation of platelet aggregates. This phenomenon and its clinical implication justify further investigation.
Contrast Echoes Detected During Percutaneous Mitral Balloon Commissurotomy with Inoue Balloons and Their Relation to Cerebral Microembolic Signals
Authors: Gencbay Murat , Turan Fikret , Degertekin Muzaffer , Yaymaci Bengi , Dindar Ismet 
Published: July 2008

The aim of this study was to find out the mechanism of genesis of contrast echoes detected with echocardiography during percutaneous mitral balloon commissurotomy (PMBC) procedures with Inoue balloons and to assess their association with cerebral microembolic signals with transcranial Doppler examinations. Ten Inoue balloons (Toray Instruments) were used in 10 patients (mean age 36 ± 10 years). In all patients transesophageal echocardiographies with a multiplane 5 MHz probe were performed immediately before and during the PMBC procedure. None of the patients had left atrial thrombus during the PMBC. All of the balloons were inflated within the left atriums and left ventricles and were tested in saline to see whether there was a visible air leak after the PMBC procedures. Transcranial Doppler examinations were done with 2 MHz probes from the middle cerebral artery. Contrast echoes were detected in all patients during inflation and/or deflation, independent of the intracardiac sites. After a few cardiac cycles there was a very intense shower of microembolic signals detected with the transcranial Doppler examination, which persisted for all inflations and/or deflations. All balloons yielded visible air leaks from the two small holes at the waist of the balloons in saline. There were a few contrast echoes recorded in some of the patients during the exchange of equipment, and one patient had a transient neurologic and coronary ischemic event following the introduction of the stretcher tube of the Inoue balloon. Intracardiac contrast echoes and transcranial microembolic signals during the PMBC procedure were detected in all PMBC procedures and were due to air that was entrapped between the two latex layers of the Inoue balloons and air introduced from outside during the exchange of the equipment.
Symptomatic Hypertrophic Obstructive Cardiomyopathy: The Role of Dual-Chamber Pacing
Authors: Park Myung H. , Gilligan David M. , Bernardo Nelson L. , Topaz On 
Published: July 2008

Background and Purpose: The management of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) has traditionally consisted of beta blockers and calcium channel blockers. Surgical treatment has been employed for operable patients who became refractory to medical therapy. However, associated complications, mortality rate, and recurrence of functional limitations have shifted the focus toward alternative therapy modalities. Recently, permanent dual-chamber (DDD) pacemaker has been intro duced as an alternative treatment option. Patients and Methods: This study comprises clinical, angiographic, echocardiographic, and electrophysiologic data obtained at a single center on 10 symptomatic patients with HOCM who received a DDD pacemaker after medical therapy failed to relieve symptoms. Presenting symptoms were exertional dyspnea and chest pain (60%), syncope (20%), and presyncope (20%). These symptoms were documented for 8.9 ± 7.1 years before pacemaker implantation. All patients were in New York Heart Association functional class III or IV before pacemaker therapy Results: Placement of a permanent DDD pacemaker decreased the left ventricular outflow tract gradient from 83 ± 44 mm Hg (range: 35-180 mm Hg) to 47.1 ± 25.3 mm Hg (range: 10-75 mm Hg) in these patients. Within 1 to 30 months, follow-up found that the functional status of eight out of the 10 patients had improved to New York Heart Association class 0 or I. Conclusion: In selected patients with symptomatic HOCM who fail to respond to medical therapy, DDD pacemaker may offer a nonsurgical alternative treatment option. Large- scale multicenter, prospective, randomized trials are needed to establish the role of this modality in the treatment of hypertrophic obstructive cardiomyopathy.
Intravenous Hydroxyethylrutosides Combined with Long-Term Oral Anticoagulation in Atherosclerotic Nonreconstructable Critical Leg Ischemia: A Retrospective Study
Authors: Lund Fredrik , Glenne Per-Olov , Inácio Jorge , Larsson Ulla-Britt , Lavstedt Stig , Qian Zhaomei , Schiötz Jörn , Tillgren Carl 
Published: July 2008

Objective. To evaluate in a group of seriously diseased patients with nonreconstructable chronic critical leg ischemia (CLI), treated by a combination of IV hydroxyethylrutosides (HR)* and oral anticoagulation (AC) by warfarin, the short-term effects on the cutaneous microvascular blood perfusion of the soles of feet and especially the long-term clinical outcome in terms of amputation and death. Design. A retrospective comparison between two groups of patients, HR + AC and a comparable reference group, fulfilling the same inclusion and exclusion criteria corre sponding to the definition of CLI according to the Second European Consensus Document (1991). Clinical follow-up in both groups was made after 1, 3, 6, 12, and 24 months. Setting. Patients were examined at university departments of clinical physiology with special interest in peripheral vascular disease, in cooperation with colleagues at univer sity departments of surgery, internal medicine and dermatology of Karolinska Hospital, Södersjukhuset and Huddinge Hospital. (continued on next page) Patients. A total of seventy patients with CLI according to the definition of the Second European Consensus Document, 1991, ie, besides severe rest pain or ischemic lesions also a toe blood pressure < 30 mg Hg. Group with HR + anticoagulation (AC): 42 patients (19 diabetics, 23 nondiabetics). Reference group: 28 patients (18 diabetics, 10 nondiabetics). For distribution of age and toe blood pressure at baseline, see Table I. Interventions. Therapy group: besides ordinary standard therapy, daily HR infusions for a mean period of 3.6 weeks + oral anticoagulation continued to the end of the study at 24 months. A comparable reference group on the same basic therapy but without the combination HR + AC. Parameters In Evaluation. Short-term parameters: clinical data, skin temperature, and fluorescein imaging. Long-term outcome: amputation or death. Results. Short-term and long-term results with HR + AC indicated that patients with severe CLI and very poor prognosis benefited in terms of survival and limb salvage from initial therapy with HR infusion combined with long-term oral anticoagulation. Results of this combined treatment seem at least comparable with those with IV prosta cyclin analogies.
Evaluation of Left Atrial Wall Elasticity Using Acoustic Microscopy
Authors: Masugata Hisashi , Mizushige Katsufumi , Senda Shoichi , Xin Lu  , Kinoshita Aki , Sakamoto Haruhiko , Nozaki Shiro , Sakamoto Seiji , Matsuo Hirohide 
Published: July 2008

Left atrial wall elasticity is one of the important factors regulating left atrial stiffness and functions. The authors evaluated left atrial wall elasticity by measuring the sound speed through the left atrial wall, based on the hypothesis that high elasticity tissues will yield larger sound speed values through the tissue, and examined age-associated changes in left atrial wall elasticity. Left atrium specimens were obtained from 30 normal subjects (age, 15-95 years) at autopsy. An acoustic microscope, operating at 450 MHz, was used to measure the sound speed in the endocardium and the myocardium of the left atrium. The sound speeds in endocardium and myocardium demonstrated significant correlation with age (r=0.74, p<0.0001 and r=0.47, p<0.01, respectively). These findings indicate that left atrial wall elasticity increased with advancing age. These changes may lead to deterioration of left atrial compliance and eventual left atrial failure in older subjects. Katsufumi Mizushige, MD Second Department of Internal Medicine Kagawa Medical University 1750-1, Miki-cho, Kita-gun Kagawa 761-0793, Japan
Performance characteristics of intermittent pneumatic compression systems
Authors: Sayegh A. , Rithalia Svs , Andrews K. 
Published: July 2008

Intermittent pneumatic compression is widely used in the prevention of deep vein thrombosis and treatment of chronic oedema and peripheral vascular disease. The effect depends on the ability of the equipment to produce sufficient inflation pressure in the inflatable garment during a specified time interval. The performance characteristics of four intermittent compression systems intended for hospital use were assessed at inflation pressures ranging from 30 to 100 mmHg. Considerable differences in the shape of the pressure/time curves were found between the various machines. Clinical results from various researchers should, therefore, be interpreted within the context of the equipment performance and the shape of the pressure/time cycles generated by each pump. The characteristics often recommended to produce optimum venous pulsatility and prevention of deep vein thrombosis were achieved by only one of the pumps tested.
The causes, pattern and effects of spinal injury in Singapore
Authors: Eng Seng Tan  , Balachandran N. 
Published: July 2008

A retrospective study of all spinal injury cases admitted to the Department of Rehabilitation Medicine at the Tan Tock Seng Hospital, Singapore, between 1973 and 1984 was carried out. As this department is the only one in Singapore which manages all unstable spinal fractures, it would be reasonable to assume that the data collected over these 12 years would suffice to reflect the causes, pattern and effects of spinal injuries in Singapore. Altogether 813 cases were collected for this study, of which 83.9% (682) were males and 16.1% (131) were females. Of these, 71.1% (583) were within the productive age group of 45 and below. The most common causes of spinal injuries in Singapore were industrial accidents (34.5% or 280) and road traffic accidents (33.1% or 269). We have more cervical injuries than in the USA and Australia; 44.1% had cervical injuries, 29.6% had thoracolumbar injuries (TIO-LI), 20.8% had lumbar injuries and 0.9% had sacral injuries. 75% had neurological deficits ranging from loss of skin sensation to complete tetraplegia. Compression fracture was the most common type of fracture (42.8% or 438). Our emphasis on early admission to the Centre to ensure better chance of recovery resulted in 53.9% (438 cases) being admitted from the various hospitals within one week of injury, and this in turn helped us to discharge 72.8% (592 cases) home within three months of stay in the Centre. On discharge 82.4% (670 cases) were independent in activities of daily living and 52.4% (426 cases) were independent in ambulation. Of the 610 cases who were gainfully employed before their injuries, 53% (325) were able to return to gainful employment within one year after the onset of the accident and 17% (106) returned to work after more than a year.
Dysphagia and multiple sclerosis: a study and discussion of its nature and impact
Authors: Hughes JC , Enderby PM , Hewer R. Langton 
Published: July 2008

Dysphagia by any cause is at least unpleasant, may be frightening and can be life-threatening. This study attempted to highlight dysphagia as a symptom of multiple sclerosis. Seven patients were identified with multiple sclerosis and dysphagia. Their notes were reviewed. One patient was deceased; the six remaining were visited at home. This enabled a detailed questionnaire to be applied and simple examination to be performed. The home visit allowed carers to be interviewed also and provided insight into the full impact of this symptom. By these means we delineated several types of swallowing problem, choking being predominant. The pattern of the problem was shown to vary, being continuous or intermittent. Associated symptoms were noted to reflect brain stem involvement. We looked at the consequences of the symptom, which ranged from embarrassment and distress to pneumonia and death. We discussed with the patients and their carers compensating mechanisms. Our study suggests the importance of this easily overlooked symptom in multiple sclerosis. It should be actively sought even in early multiple sclerosis, particularly where other brain stem features exist, since it may be palliated by simple, conservative means. More research on the nature, prevalence and palliation of dysphagia in multiple sclerosis is required because of its effects on patients, families and carers.
Assessing quadriceps muscles recruitment order using rectified averaged surface EMG in young normals and 'weak' and healthy elderly subjects
Authors: Smith GP , Howe TE , Oldham JA , Petterson T. , Tallis RC , Vickers GA 
Published: July 2008

The purpose of this study was to investigate whether measurement of the surface electromyogram (EMG) reveals a specific quadriceps femoris (QF) recruitment pattern during various activities and whether this pattern is affected by age and QF wasting. Surface EMG from the rectus femoris (RF1, vastus lateralis (VL) and vastus medialis oblique (VMO) was recorded in 24 subjects (eight young normals, eight healthy elderly and eight 'weak' elderly) during isometric QF activations at 90° and 0° flexion and simple functional activities such as standing from a seated position and stepping up onto a low block. The raw EMG from each muscle during each activity was full-wave rectified and averaged over successive 10 ms periods to produce a running average EMG signal. The recruitment times of the three muscles were determined at the points at which the EMG signal departed from the baseline recorded prior to the activity. A total of 216 measures of muscle recruitment times were made and the differences between recruitment times were analysed to assess whether they were significantly different. Results within each subject group failed to reveal significant differences, at the p<0.05 level, in the times of recruitment of the three muscles studied during the activities tested. Close visual inspection of both the raw and averaged electromyograms appeared to indicate that VL and VMO are activated almost simultaneously.
Behaviour problems after brain injury: incidence and need for treatment
Authors: Johnson Roger , Balleny Heather 
Published: July 2008

The aim of this study was to identify the incidence and nature of behaviour problems following severe head injury. All severe head injuries in a known population were identified from a three-year period. Sixteen patients were assessed for behavioural problems shortly after injury, while still in hospital. The relatives' judgements of behavioural change observed at home, for a total of 33 patients from three consecutive years, was collected to compare the extent of behavioural problems during the years following injury. More behavioural problems were reported at home, by families, than by nursing and therapy staff in hospital. Relatives identified behaviour change in about 80% of the patients and significant practical problems were reported at home in about half of all severely head-injured people. Symptoms appeared to be persistent and tended to worsen over a three-year period following the injury. In particular, aggressive behaviour increased. Behaviour change did not correlate with either age or the severity of the injury as measured by post-traumatic amnesia. The results of this study draw attention to the need for treatment and support for the families of brain-injured patients showing behavioural disturbance, at home, after they have been discharged from hospital.
Home rehabilitation project for home-bound physically disabled people in Yokohama
Authors: Hakuno A. , Ito T. , Koike J. , Matsuba T. , Watanabe S. , Fujii S. 
Published: July 2008

Objective: To evaluate the effectiveness of home-visit rehabilitation. Design: Before/after trial. Setting: Home-visit rehabilitation in Yokohama city. Subjects: Four hundred and seventy-five of 601 cases that received services during 1992, and 141 of 186 cases that received sequential visits. Interventions: Comprehensive home-visit rehabilitation. Main outcome measures: (1) Carer's response on change in care burden; (2) improvement in personal care performance. Results: Care burden decreased in 40.8% of 475 subjects. All of the 141 cases that received sequential visits gained proficiency in personal care. Conclusion: Improved performance of daily activities and reduction of care burden were found for most subjects after the rehabilitation visits.
Hip muscle strength and function in very elderly women
Authors: Smith Rachael , Scott Oona M , Skelton Dawn , Young Archie 
Published: July 2008

Objective: To establish normative data for hip abductors and extensors and to investigate the relationship between these muscles, quadriceps femoris and functional ability. Subjects: Twenty healthy elderly women, mean age 84 ± 3.1 years took part; test-retest reliability was established in six healthy elderly women, mean age 75 ± 9.1 years. Main outcome measures: Isometric hip abductor, hip extensor and quadriceps femoris strength, leg extensor power (LEP), walking speed over 6 m, functional reach and stepping on to blocks of differing height. Results: Intraclass correlations of 0.98 and 0.99 and coefficient of variations (CV) between occasions of 4.7% and 7.2% were established for hip abductor and extensor measurements. The best correlations were between walking speed and strength of quadriceps femoris (p <0.001), between function reach and LEP (p <0.001). LEP was the most significant predictor of functional reach and step height climbed; quadriceps strength was the most significant predictor of walking speed. Conclusions: The data provide a baseline for future studies with less healthy women.