bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Atorvastatin on the Human Lens After 52 Weeks of Treatment
Authors: Reid Leon , Bakker-Arkema Rebecca , Black Donald 
Published: November 2007

Background: The effect of atorvastatin calcium (Lipitor, Parke-Davis, Morris Plains, NJ) on the crystalline lenses of hypercholesterolemic patients was evaluated and compared with that of lovastatin after 52 weeks of treatment to reduce cholesterol levels. Methods and Results: Six hundred ninety-six atorvastatin-treated and 235 lovastatin- treated patients completed a large safety study that included an ophthalmologic examina tion. Efficacy was evaluated as mean percent change from baseline in low-density lipopro tein (LDL) cholesterol. Patients received atorvastatin, 10 or 20 mg, or lovastatin, 20 or 40 mg, once daily for either 36 or 52 weeks. Patients were evaluated by slit-lamp examination, and a standardized format was used to describe the findings. Best corrected visual acuity was measured using the Snellen chart. Patients treated with atorvastatin had significantly ( P ≤ .05) greater decreases in LDL cholesterol than those treated with lovastatin (37% vs 29%). Although some patients in both groups experienced various lenticular opacities, none were considered unexpected. In addition, there were no significant ( P ≤ .05) differences in the distribution of cortical opacities and spokes right eye (OD) and left eye (OS) and posterior subcapsular opacity (OS) between the atorvastatin and lovastatin groups. In general, the percent deterioration in best corrected visual acuity was similar in both groups. Overall, there were no clinically significant differences in the development of lenticular opacity between patients treated with atorvastatin and those treated with lovastatin. Conclusions: Treatment with atorvastatin, 10 or 20 mg, significantly reduced LDL-cholesterol ( P < .05) and was not associated with an increased risk of lenticular opacity development compared with lovastatin, a widely prescribed compound in the same class of drugs.
The Effect of Melatonin on Hemodynamics, Blood Flow, and Myocardial Infarct Size in a Rabbit Model of Ischemia-Reperfusion
Authors: Dave Ravi H. , Hale Sharon L. , Kloner Robert A. 
Published: November 2007

Background: Melatonin, a hormone, has gained popularity and is being used by millions for a variety of indications. There are few data on its safety or its effects on hemodynamics and coronary blood flow. Also, studies have confirmed that melatonin is a potent antioxidant. Therefore, it may be capable of scavenging free radicals during the reperfusion phase after a heart attack. This study evaluates the safety of melatonin with regard to its cardiovascular effects and tests the hypothesis that melatonin might be protective in the setting of ischemia-reperfusion and reduce myocardial infarct size. Methods and Results: Anesthetized rabbits were treated with melatonin (n = 8, 10 mg/kg, intravenously) 10 minutes before coronary artery occlusion (CAO) and again 15 minutes before reperfusion. Control rabbits received vehicle (n = 8). All rabbits underwent 30 min utes of occlusion and 3 hour reperfusion. Both before and during CAO, melatonin did not alter heart rate compared with control (185 ± 7 beats/min v 181 ± 7 before; and 179 ± 5 v 181 ± 9 during, respectively, P = NS) or blood pressure (70 ± 4 mmHg v 66 ± 6 before and 59 ± 4 v 58 ± 5 during, respectively, P = NS). Regional myocardial blood flow (RMBF) was similar before CAO in the melatonin group (1.18 ± 0.17 mL/min/g) versus the control group (1.15 ± 0.10 mL/min/g). Infarct size, expressed as a fraction of ischemic risk zone, was simi lar in the melatonin (0.29 ± 0.03) and control groups (0.29 ± 0.06, P = NS). At a higher dose of 50 mg/kg in treated (n = 7) versus control (n = 7) rabbits, melatonin treatment did not alter heart rate (204 ± 14 in melatonin group v 181 ± 5 in controls, P = NS) or blood pressure (80 ± 11 in melatonin v 66 ± 7 in controls, P = NS) when compared with control. Melatonin at this dose also did not affect infarct size, 0.38 ± 0.06, when compared with con trol, 0.34 ± 0.07, P = NS. Conclusion: Melatonin's effects on hemodynamics and coronary blood flow were neutral, and it did not exacerbate myocardial ischemia or necrosis in this model. Melatonin appears to be a safe drug with no apparent effects on the cardiovascular system in this model.
Recurrent Miscarriage Syndrome due to Blood Coagulation Protein/Platelet Defects: Prevalence, Treatment and Outcome Results
Authors: Bick Rodger L. 
Published: November 2007

Although first-time miscarriages are usually caused by chromosomal defects, about 55% of recurrent miscarriages are caused by procoagulant defects that induce thrombosis and infarction of placental vessels. Of recurrent miscarriages, about 7% are caused by chromosome defects, 15% to hormonal de fects, and 10% to 15% to anatomical defects. Recurrent mis carriage involves more than 500,000 women in the United States each year. During the past 4 years, 179 patients, pre- screened for chromosomal, hormonal, and anatomical defects, and found to harbor none, underwent hemostasis defect evalu ation. A total of 160 of these have been analyzed. A hemostasis defect was found in 150 of 160 women ( n = 94% of screened women). The mean age was 33 years; the mean number of miscarriages before referral was three. All women with a pro coagulant defect (149) were treated with preconception ASA at 81 mg/d, and unfractionated porcine heparin at 5000 U every 12 hours was added immediately postconception; both agents were used to term delivery. Only two of 149 patients failed therapy. The defects found were as follows: antiphospholipid syndrome, 67%; sticky platelet syndrome, 21 %; tissue plasmin ogen activator (TPA) deficiency, 9%; factor V Leiden, 7%; high PAI-1, 6%; protein S, 5%; high LP(a), 3%; AT, 2%; protein C, 1%. Thirty-eight patients had more than one defect. In the group with antiphospholipid syndrome, 24% only had a subgroup antibody (antiphosphatidyl-serine, -inositol, -ethanol amine, -choline, -glycerol) or antiphosphatidic acid antibody, in the absence of anticardiolipin antibody or lupus anticoagulant. This finding is similar to that recently reported in early age ischemic stroke patients (<50 years old). In summary, about 55% of patients with recurrent miscar riage harbor a procoagulant defect to account for placental vascular occlusion. More than 98% will have a normal term delivery with preconception aspirin (ASA) and addition of postconception heparin to term. Patients should be screened by an obstetrician or by reproductive specialists for hormonal and anatomic defects before initiating a procoagulant evaluation; if such prescreening is done, the yield of a defect is high and appropriate therapy leads to an excellent outcome.
Current perspectives in the management of nausea and vomiting in oncology patients: The New Zealand experience
Authors: Hastie Bruce David 
Published: November 2007

Background. Following the introduction of the 5HT3 (serotonin) receptor antagonists into New Zea land we wished to determine the current role that these and other antiemetic agents have in the preven tion and treatment of nausea and vomiting in oncol ogy patients. Method. Surveys were posted to all medical and radiotherapy oncologists in New Zealand in July 1994 asking for their current approaches and recommen dations to preventing or treating many of the com mon causes of nausea and vomiting that oncology patients may experience. Results. Surveys were posted to 32 oncologists, with replies received from 23 (72%). These results indicate that the 5HT3 antagonists ondansetron and granisetron are now used as primary therapy to prevent nausea and vomiting associated with highly emetogenic chemotherapy and radiotherapy regimes, and may be used either as single agents or in combi nation with a corticosteroid. In less emetogenic re gimes agents such as metoclopramide, prochlorpera zine, or domperidone are effective, and they may also be used in combination with a corticosteriod. When treating other causes of nausea and vom iting, antiemetic agents are usually only used if it is not possible to correct the underlying cause of these symptoms, if an antiemetic agent is required metoclo pramide, prochlorperazine, domperidone, or cycli zine are usually effective. Where nausea is caused by drugs such as nonsteroidal antiinflammatory agents (NSAIA) treatment options would include stopping the offending agent and changing to another agent if necessary, if this is not possible then agents such as metoclopramide or prochlorperazine are usually ef fective. Conclusion. The 5HT3 receptor antagonists are used to control nausea and vomiting in chemo therapy and radiotherapy regimes with a moderate to high emetogenic potential. For chemotherapy and radiotherapy regimes with a lower emetogenic potential metoclopramide or domperidone are used to control nausea and vomiting. For other causes of nausea and vomiting that cannot be corrected by specific treatment strategies metoclopramide, dom peridone, prochlorperazine, or cyclizine are usually effective.
Stability of busulfan injection admixtures in 5 % dextrose injection and 0.9% sodium chloride injection
Authors: Xu Quanyun A. , Zhang Yan-ping , Trissel Lawrence A. , Martinez Juan F. 
Published: November 2007

Objective. The purpose of this study was to deter mine the stability of busulfan injection at 0.5 and 0.1 mg/mL admixed in 5% dextrose injection and 0.9% sodium chloride injection in PVC and polyolefm bags over 24 hours at 23°C. Methods. The busulfan injection was prepared by dissolving the bulk powder in a 1:2 mixture of N,N-dimethylacetamide and polyethylene glycol 400 to form a 6 mg/mL solution. The injection was filtered and admixed in the infusion solutions to yield busulfan concentrations of 0.5 and 0.1 mg/mL. Evaluations were performed initially and after 4, 8, and 24 hours of storage for physical and chemical stability. The admix tures were evaluated for physical stability using visual observation in normal light and using a high-intensity monodirectional light beam as well as measuring turbidity. The chemical stability was evaluated by using a stability-indicating HPLC analytical technique. Results. No physical instabilities were observed. However, busulfan is chemically unstable. At 0.5 mg/mL, potency of at least 95% was retained through 4 hours and at least 90% was retained through 8 hours. After 24 hours, losses of 20% to 30% occurred. At 0.1 mg/mL, drug loss was more rapid. Potency of at least 90% was retained through 4 hours. Losses after 24 hours were about 30% to 40%. Conclusions. Busulfan injection admixed in 5% dextrose injection or 0.9% sodium chloride injection is unstable. At a concentration of 0.5 mg/mL, ade quate drug delivery is provided within 8 hours of admixture. At the lower concentration of 0.1 mg/mL, adequate drug delivery is only provided for 4 hours.
Cardiopulmonary Bypass Hemorrhage: Aggravation by Pre-Op Ingestion of Antiplatelet Agents
Authors: Bick R.L. , Fekete L.F. 
Published: November 2007

A comparison between chest tube blood loss per total blood replacement and the ingestion of antiplatelet drugs before surgery was undertaken in 20 patients undergoing cardiopulmonary bypass (CPB) for coronary artery disease. Ten patients who had ingested antiplatelet agents and 10 patients denying the use of any agent known to interfere with hemostasis or platelet function were studied retrospectively. The average chest tube blood loss in the antiplatelet drug users was 1340 cc per 24 hours, and the average total blood replacement following bypass was 4.8 units. Chest tube blood loss in the non-antiplatelet drug group was 483 cc per 24 hours, and total blood replacement averaged 2.5 units. This study illustrates that the ingestion of antiplatelet agents before CPB may accentuate the defects in hemostasis which are usually present during this procedure, and increased postoperative blood loss may result. In addi tion, this study emphasizes the importance of a careful drug history, espe cially concerning ingestion of antiplatelet agents, before cardiopulmonary bypass.
Noninvasive Estimation of Left Ventricular Function After Mitral and Aortic Valve Replacement With the Hancock Porcine Prosthesis
Authors: Bartall Haim Zeev , Desser Kenneth B. , Benchimol Alberto 
Published: November 2007

Left ventricular function was noninvasively assessed by echocardiography, and left ventricular ejection time index (LVETI) was derived from external carotid pulse tracings in 25 patients before (B) and an average of 17 days after (A) Hancock porcine valve implantation. Fifteen patients had aortic valve replacement and 10 had mitral valve replacement; 4 had a combined procedure. In the aortic and combined group, (n = 15) there were significant (P < 0.0025) changes of mean (± 1 SD) left ventricular end-systolic dimension (ESD), B = 5.1 ± 0.9, A = 4.3 ± 0.9 cm; end-diastolic dimension (EDD), B = 5.7 ± 1, A = 4.9 ± 0.9 cm; mean rate of circumferential fiber shortening (VCF), B = 0.37 ± 0.05, A = 0.75 ± 0.04 circumf/sec and LVETI, B = 0.45 ± 0.05, A = 0.39 ± 0.02 sec. In subgroups with preoperative aortic stenosis (n = 8), combined aortic stenosis and insufficiency (n = 3), and coexisting aortic and mitral disease (n = 4), there was a uniform reduction of ESD, EDD, and LVETI with an increase of VCF. In the isolated mitral valve replacement group (n = 10), the values were ESD (B = 4.6 ± 0.7, A = 4.4 ± 0.8 cm, P = not significant); EDD (B = 5.2 ± 0.6, A = 4.7 ± 0.8 cm, P < 0.0025); VCF (B = 0.36 ± 0.08, A = 0.7 ± 0.04 circumf/sec, P < 0.0025); and LVETI (B = 0.40 ± 0.03, A = 0.37 ± 0.03 sec P < 0.05). Patients with mitral stenosis (n = 2), mitral insufficiency (n = 3), and combined mitral stenosis and insufficiency (n = 5) all had a postoperative decrease in ESD, EDD, and LVETI with augmentation of VCF. We concluded that (1) early noninvasive assessment of left ventricular function after Hancock valve implantation indicates a significant hemody namic improvement, and (2) echocardiography combined with external ca rotid arterial pulse tracing analysis is useful for the follow-up of patients who receive Hancock valves.
Progress in the Management of Peripheral Vascular Disease
Authors: Blau Steven , Kerstein Morris D. 
Published: November 2007

A search of the recent literature reveals a number of significant advances in peripheral vascular surgery. However, today's surgeon continues to find him self battling a disease process he does not understand with diagnostic tools which need improvement. The purpose of this paper is to outline progress in three areas; 1) diagnosis, 2) pathophysiology and 3) surgical therapy. The advances in diagnostic techniques have focused on three questions—(1) what is the nature of the vascular lesion so that an appropriate operation can be designed, (2) what is the status of the disease post-operatively, and (3) in the unreconstructable limb, what amputation may be successfully performed? The second section deals with our increasing knowledge of the underlying disease—atherosclerosis—and its modification through pharmacology. The final section is devoted to improvements in surgical therapy, from pre operative management to the technical details of the operation and post operative care. Concurrently, new ideas in graft preparation and new graft developments are discussed.
Segmental Distribution of Vasa Vasorum to the Canine Abdominal Vena Cava: A Possible Correlation with its Embryogenesis
Authors: Uematsu T. , Takiguchi Y. , Nakashima M. , Shigei T. 
Published: November 2007

The segment of the male canine abdominal vena cava (AVC) between the liver and the renal veins receives vasa vasorum from the right phrenicoabdom inal artery, while the infrarenal segment of AVC does from the right testicular artery. These facts were confirmed by both macroscopic observation with dye injection into the arteries and measurement of contractile responses of the segments in vivo by the method with intravascular cuffs. The segmental dis tribution of vasa vasorum from arteries of the right side may closely correlate with the embryogenesis of the vein. An anomalous dog with totally inverted viscera, which we found during our study, exhibited another anomaly of AVC: It had the segment of AVC between the liver and the renal veins at the left side of the aorta and the infrarenal segment at the right. This anomaly shows that AVC is composed with at least two segments which is formed separately during its embryogenesis and may support our hypothesis.
Replantation Surgery and Microsurgical Technique
Authors: Cunningham Bruce L. , Shons Alan R. 
Published: November 2007

The development of surgery using high magnification has allowed reconstructive surgeons to operate on the small blood vessels of the distal extremity which previously were beyond technical limits. Using this new technology reconstructive surgeons are able to replant amputated upper extremities with a high degree of survival and functional success. The world's first successful clinical replantation was performed by Malt and McKhann1 in 1962. They replaced the arm of a 12 year old boy who had been amputated at the mid-humeral level. In 1965, Komatsu and Tamai2 used the surgical microscope to replant a thumb amputated at the metacarpophalangeal level. This first successful microsurgical replantation was preceded by considerable ex perimental work. Jacobson and Suarez3 using an operating microscope reported a 100 percent patency rate in arteries 1.4 mm in diameter. Harry Buncke, a plastic surgeon continued development of the microsurgical technique, instruments, and sutures, that would result in successful replantation surgery. In 19634 Buncke successfully replanted a rabbit ear anastomosing an artery less than 1 mm. Next he replanted monkey digits5 and even performed a toe to hand transfer with primary arterial and venous anas tomoses.6
Angiographic Anatomy of the Lateral Femoral Circumflex Artery and Preliminary Experience With its Reconstruction During Profundoplasty
Authors: Adar Raphael , Bass Aryeh , Nussinovitz Moshe , Papa Moshe Z. , Schneiderman Jacob 
Published: November 2007

The lateral femoral circumflex artery (LFCA) and its descending branch (DB) are important collaterals of the profunda femoris artery. The success of a profundoplasty may be enhanced by improving LFCA flow, while inadvertant compromise of the LFCA lumen may adversely affect the results of a profundo plasty. The angiographic anatomy of the LFCA was studied in 200 limbs of patients undergoing aortography for leg ischemia. There were four major anatomic var iations of the LFCA and its DB in respect to their origin from the common and deep femoral arteries. Mean length of the LFCA was 2.5 cm and mean diameter 3.5 mm. Atherosclerotic changes, mainly at the orifice, were seen in 15% of LFCAs. The DB of the LFCA was an important collateral in 102 limbs, in 34 it was the main collateral in the thigh. Its diameter was 3 mm or more in 50% of limbs. These data show the anatomic basis for attempting adjunctive surgical procedures on the LFCA. Preliminary results are reported of 36 profundoplasties during which a spe cific surgical maneuver was directed at the LFCA. Intraoperative blood flow measurements were performed to quantify the LFCA flow capacity and to com pare flow through the LFCA to distal profunda flow. The LFCA and its DB are important collaterals and should be given specific attention in selected cases.
Aneurysm of the Aortic Sinuses of Valsalva: Hemodynamics and Long-Term Prognosis After Surgery
Authors: Drummer Eric M. , Hobbs Robert E. , Fitzgerald Rita , Moodie Douglas S. 
Published: November 2007

Seventeen patients with sinus of Valsalva aneurysm are described. All of these patients have had late follow-up to assess prognosis. Twelve patients had congenital aneurysms and five were mycotic. There were 12 males and five females, ranging in age from 20 to 59 years of age (mean of 38 years). Symp toms of congestive heart failure, fatigue, and palpitations were common and were present from three days to seven years before diagnosis (mean of 13.8 months.) All patients had cardiac catheterization including aortography, and 16 had right heart catheterizations. Eleven patients (65%) had aneurysms which ruptured into another cardiac chamber, most frequently the right atrium (six patients). Eleven patients (65%) had aortic insufficiency, and it was moderate to severe in seven. New York Heart Association (NYHA) Functional Class at diag nosis was variable and did not correlate with degree of left-to-right shunt in patients with fistulas to the right heart. Functional Class seemed to correlate with the degree of aortic insufficiency. Fourteen patients required surgery. The surgical procedure usually con sisted of repair of aneurysm and fistula when present, and aortic valve replace ment. There was one death prior to surgery and one operative death (operative mortality of 7%). Ten of the patients (66%) were in NYHA Functional Class I at late follow-up (range 2.5 to 13.1 years, mean 6.5 years). Long-term functional disability occurred more frequently in patients with moderate to severe aortic insufficiency at the time of diagnosis. Patients with aneurysm of the sinus of Valsalva are a heterogenous popula tion. Functional Class at the time of diagnosis as well as long-term prognosis appears to be related to the presence and severity of aortic insufficiency at diagnosis. Catheterization with aortography and right heart catheterization are mandatory for accurate diagnosis. Surgical results are good with low operative mortality and improvement in long-term Functional Class.
The Penile Brachial Index in the Preoperative Evaluation of Arterial Hypogastric Insufficiency
Authors: Setacci Carlo 
Published: November 2007

Two hundred and 30 patients with occlusive arterial disease of the legs were examined by angiography and penile brachial index (P.B.I.) obtained with ul trasound technique. Forty-two cases had no reduction or less than 20% reduction of the cross section area of hypogastric artery the penile brachial index was 1,01 ± 0,056 in basal conditions, 0,96±0,078 after 5 minutes ischemia and 1,02±0,059 5 min utes after ischemia. Ninety cases presented a reduction of cross section area of hypogastric artery between 20 and 75% the P.B.I. was 0,85±0,086 in basal conditions, 0,74±0,114 after 5 minutes ischemia and 0,82±0,105 5 minutes after ischemia. Ninety-eight cases presented a reduction of cross section area of hypogastric artery of 75% and more, the P.B.I. was 0,45±0,15 during basal conditions, 0,26 ± 0,11 after 5 min. ischemia and 0,34±0,13 5 min. after ischemia. Therefore, determination of P.B.I. can be considered as a valuable tool in the study of the hypogastric circulation. Such a study is of value particularly before rectum surgery in the preopera tive evaluation of the blood supply to the rectal stump and after hemicolectomy, with ligation of mesenteric artery at the emergency from aorta.
Communications to the Editor and Clinical Case Reports
Authors: Cifiello Bianca Ines , Gessaroli Massimiliano , Cenacchi Giovanna , Loperfido Vincenzo , Mirelli Michele , Stella Andrea 
Published: November 2007

Fibro-muscular dysplasia (FMD) is a rare lesion of the subclavian artery. We report the description of histologic and ultrastructural findings in a white young man. The associated aneurysm is a natural complication of FMD. After the resec tion of the pathologic artery and end-to-end anastomosis a rethrombosis can develop.