bluuebunny/crossref_metadata_2025_split huggingface dataset:
Formulation of a flush solution of heparin, vancomycin, and colistin for implantable access systems in oncology
Authors: Vincentelli J. , Braguer D. , Guillet P. , Delorme J. , Carles G. , Perez R. , Duffaud F. , Nicoara A. , Drancourt M. , Favre R. , Crevat A. 
Published: November 2007

Introduction: Because of the increased use of im plantable access systems, the incidence of blood stream and catheter infections associated with these systems has concomitantly increased. Classically, he parin-lock flush solutions were used to prevent thrombosis; more recently, vancomycin was added to the solution to prevent infections caused by Gram- positive bacteria, particularly coagulase-negative Staphylococci. Disorders due to Gram-negative organ isms have now appeared in oncologic patients. We therefore tested the addition of colistin to heparin- vancomycin solutions. Colistin was chosen for its good activity against Gram-negative bacteria (98% susceptibility in our hospital), its good tolerance due to low systemic passage, and its low cost. Methods: We developed formulations contain ing heparin (100 IU/mL) and various concentrations of vancomycin (10-500 μg/mL) and colistin (10-100 μg/mL) in 0.9% NaCl. Each sterile solution was tested for physical and chemical compatibility (spectropho tometry, nuclear magnetic resonance, and pH mea surements) and its antibacterial activity (against ox acillin-resistant Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae exhibiting broad- spectrum betalactamase (BSBL), imipenem-resistant Pseudomonas aeruginosa) for 2 months at 4°C and at room temperature. Results: The most suitable combination of drugs is heparin (100 IU/mL), vancomycin (100 μg/mL), and colistin (100 μg/mL). This flush solution main tains activity when stored at 4°C for up to 1 month. Conclusions: We feel that the combination of heparin, vancomycin, and colistin can be used as a flush solution for indwelling catheters.
Coping with cancer and developing of cytotoxic reconstitution service at a private hospital in the UK
Authors: Sewell G.J. 
Published: November 2007

Editorial Note. This commentary article was written by an eminent UK pharmacist, Dr Eddie Fullerton and his pharmacist wife Kath, who describe their experi ences during Eddie's treatment for bowel cancer. The positive, negative and practical aspects of ambulatory treatment are portrayed through the eyes of both pharmacist and cancer patient. The article goes on to describe Kath's unique role as "personal pharmacist" and caregiver. To avoid any detraction from the personal and humanistic nature of this article, the manuscript has been published in its original form with minimal editorial intervention. Dr Fullerton died on 9 Novem ber 1996.
Review : Pharmacokinetics and pharmacodynamics of the taxanes
Authors: Lam YW Francis , Chan CY Jennifer , Kuhn John G 
Published: November 2007

Objectives. To review the pharmacokinetics and pharmacodynamics of docetaxel and paclitaxel. Data Sources. We reviewed the literature through a MEDLINE search from 1982 to 1996. The terms docetaxel, paclitaxel, taxanes, and taxoids were used in the search. Relevant articles cited in literature obtained by MEDLINE searching, as well as new articles published in early 1997 in specific oncology journals, were also considered. Data Extraction. We have reviewed the current literature with regard to the chemistry, mechanisms of action and pharmacology, pharmacokinetics, clini cal use, adverse effects, drug interactions, formula tion, dosage, administration, and pharmaceutical is sues of the taxanes. Conclusion. Both docetaxel and paclitaxel are novel antineoplastic agents with significant activity in many types of cancer. The pharmacokinetics of both agents are best characterized by a three-compartment disposition profile. However, the pharmacokinetics of paclitaxel, not docetaxel, are non-linear and can be described by a saturation process in distribution and elimination. The nonlinearity appears to be associated more frequently with shorter infusions and/or higher doses. There is evidence suggesting that the time duration of paclitaxel concentrations maintained above 0.1 μM/L (T>0.1 μM ) is associated with improved survival and development of toxicity. On the other hand, currently there is no information relating opti mal systemic exposure of docetaxel to efficacy and toxicity. In addition, these pharmacokinetic-pharma codynamic relationship may change with therapy with antineoplastic agents and other agents adminis tered concurrently, and necessitates additional phar macokinetic-pharmacodynamic investigations.
6-Mercaptopurine hepatotoxicity during acute lymphocytic leukemia maintenance therapy
Authors: Skirvin J. Andrew , Valley Amy W. , Relias Valerie , Morris Ashley K. 
Published: November 2007

Purpose. To describe a case of 6-mercaptopurine acute fulminate hepatotoxicity. Case Summary. A 65-year-old male with adult acute lymphocytic leukemia was receiving mainte nance therapy with 6-mercaptopurine and methotrex ate when he presented with jaundice, nausea, diar rhea, dysuria, right upper quadrant pain, and dark urine. He presented with elevated bilirubin, aspartate aminotransferase, and alanine aminotransferase. The work-up was negative for other causes of liver dam age. His hospital course included antibiotic therapy, vitamin K, and filgrastim. He was discharged without long-term morbidity from the event and had a normal ization of liver enzymes as an outpatient. Methotrex ate maintenance therapy was continued successfully as an outpatient for > 1 year. Conclusion. 6-Mercaptopurine is not commonly considered as an agent causing acute hepatotoxicity, but should not be ruled out as a causative agent in the setting of concurrent methotrexate therapy. An epi sode of acute hepatotoxicity did not preclude the continued, safe use of methotrexate in this case.
An evaluation of nitrile gloves as an alternative to natural rubber latex for handling chemotherapeutic agents
Authors: Gross Elizabeth R , Groce Don F 
Published: November 2007

Introduction. In 1986 and 1995, the Occupational Safety and Health Administration issued guidelines for the handling of chemotherapeutic agents. Natural rubber latex gloves are recommended for all levels of handling these drugs; these gloves provide both pro tection to the health care worker and a high degree of manual dexterity in performing tasks requiring fine motor skills. However, many health care workers experience allergic reactions to natural rubber latex, with symptoms ranging from minor skin irritation to systemic anaphylaxis; the latter is a serious life-threat ening condition. Therefore, it is extremely important that alternative glove materials be found that offer protection against biological and chemical agents and also afford health care workers ease of use and fit. Methods. In this study, we tested a thin-gauge (0.0045-inch gauge) disposable nitrile glove; this glove, which offers fine motor skill ability to its users, has been tested against a wide range of chemicals but has not yet been tested specifically against chemo therapeutic agents. Using American Society for Test ing and Materials method F739-92, these gloves were tested for permeation resistance at three concentra tions, simulating exposures to Pharmacy, Nursing, and Housekeeping staff. Eleven commonly used che motherapeutic drugs were investigated. Conductivity was used to determine whether drug was present in the test solutions. Result. Drug was not detected in any of the samples collected. When carmustine was tested, the effluent had a distinct alcohol odor, but no conduc tivity was noted. Conclusions. These disposable nitrile gloves appear to be acceptable for preparing the chemother apy agents tested. Hospitals must be open to finding replacements to natural rubber latex products and must alert their staff members about the potential for latex sensitivity in both patients and other staff mem bers. Manufacturers of non-latex gloves should be encouraged to conduct chemotherapy permeability studies on their products.
Authorizing the Malaysian Rainforest: Configuring Space, Contesting Claims and Conquering Imaginaries
Authors: Sioh Maureen 
Published: November 2007

The heart of a Malayan city ..., is always a small clearing wrested from the jungle and, too easily, turns jungle again.1 It is the jungle; the jungle which none can escape, the jungle which reaches to the back of every compound, to the back of every mind; the jungle which blots out the sun over four-fifths of Malaya's 50,850 square miles. Harsh and elemental, implacable to all who dare trifle with its suffocating heat or hissing rains, the jungle alone has remained untamed and unchanged.2
Infrainguinal Bypass in Patients with End-stage Renal Disease: Survival and Ambulation
Authors: Nicholas Gary G. , Bozorgnia Mehrzad , Nastasee Susan A. , Reed James F. 
Published: November 2007

The purpose of this study was to evaluate the outcomes of infrainguinal bypass surgery and ambulatory status in patients with end-stage renal disease (ESRD). Vascular registry data and the medical records of patients requiring infrainguinal bypass surgery from 1985 through 1995 were reviewed retrospectively. Patients with chronic limb-threatening ischemia requiring maintenance hemodialysis or peritoneal dialysis for ≥ 6 months were compared to a randomly selected group of patients under going foot salvage infrainguinal bypass in the absence of ESRD. Primary outcomes were mortality, amputation, and ambulatory status at 30 days and 1 year. Data were analyzed using Pearson's chi-square methods, Fisher's Exact test, Mann-Whitney U, life table analyses, and Quality of Life-Class (QL-Class) ranking. There were 57 patients with ESRD who underwent 66 infrainguinal bypass proce dures. Mean age was 65.8 ±9.8 years (41-85 years). The 30-day operative mortality rate was 12.3% (7 patients). The cumulative survival at 1 year was 51.8% ±0.9%, and at 2 years it was 32.8% ± 1.3%. The cumulative limb loss was 29.7% ± 1.1% at 1 year and 36.7% ±2.6% at 2 years. In the comparison group, 46 patients without ESRD underwent 50 infrainguinal bypass procedures. The mean age of these patients was 72.3 ±9.1 years (36-90 years). The cumulative survival for the patients without ESRD was significantly higher (p < 0.001) both at 1 year (91.1% ±0.6%) and 2 years (88.8% ±0.8%). The cumulative limb loss for the comparison group was significantly lower (p < 0.001) at 1 year (4.1% ±0.4%) and at 2 years (6.3% ±0.5%). At both 30 days and 1 year, the QL- Class walking status rating was lower for the group with ESRD compared to patients without ESRD (p < 0.001). Patients with ESRD have a high mortality rate in the first 24 months after infrain guinal bypass grafting for foot salvage surgery compared with a similar group of patients without ESRD. Although foot salvage can be achieved in some survivors with ESRD, the ambulatory rate is low. These results support a very conservative approach when recom mending infrainguinal bypass grafting for foot salvage surgery for patients with ESRD.
Extremity Salvage by Revascularization
Authors: Barner Hendrick B. , Kaminski Donald L. , Ramey Anne E. , Garvin Paul J. , Kaiser George C. , Willman Vallee L. , Codd John E. 
Published: November 2007

Advances in prosthetic devices led to our analysis of revascularization in patients presenting with gangrene of the lower extremity. Between 1966 and 1976, 99 grafts were performed on 96 of the 249 patients treated by lower extremity revascularization who presented with the above criteria. Their mean age was 66 years; 46 (48%) were diabetic, 53 (55%) were over the age of 65, and 38 (40%) had angiographically proven disease with one vessel runoff. Initial therapy consisted of intravenous antibiotics and local debridement to control sepsis, followed by detailed arteriography. Femoral-popliteal bypass was per formed in 87 patients, and a more distal vessel was utilized in 9. There were 5 in- hospital deaths. Of these, 4 patients had come to major amputation. Four died as a result of myocardial infarctions, and 1 as a result of a cerebrovascular accident. Immediate graft patency was achieved in 93 of 99 patients (93%). Minor amputations were required in 44 patients. Early graft failure resulted in major amputations in 7 patients. A late major amputation (mean 13 months) was required in an additional 28 patients, 15 because of graft failure and 13 because of nonhealing minor amputations. Extremity salvage at 2 years was achieved in 72 of the 99 patients (72%).
Diagnosis of Carotid Arterial Occlusive Disease
Authors: AbuRahma A.F. , Diethrich Edward B. , Diethrich Edward B. 
Published: November 2007

A retrospective analysis of 1500 patient records was performed to assess the validity and reliability of combined oculoplethysmography and carotid phonoangiography (OPG/CPA) as indicators of carotid arterial occlusive disease. The tests were interpreted by means of a five-level grading system based on percentage of flow reduction. Reliability statistics were calculated by using arteriography as a comparison in 10% (152) of the patients. Of the 1500 tests, 477 (32%) were abnormal, but only 252 (17%) were graded as hemodynamically significant (levels II-V). Arteriography confirmed total carotid occlusion in 16 of 19 (84%) grade V patients; the remaining 3 (16%) had significant stenosis but on a less severe level (III or IV). In the inter mediate grade II-IV results, 39 of 44 (89%) were accurate; 2 (4%) false positive and 3 (7%) overestimated cases were in this group. In the normal- grade I patients, 81 of 89 (91%) interpretations were confirmed. The false negatives (9%) in the latter group were attributable to nonstenosing ulcera tive plaques (6 patients) and moderately significant stenosis (2 patients). Overall reliability was 90%, with 1% false positives, 4% false negatives, and about 5% erroneous assessment of severity within the abnormal grades II-V. Thus OPG/GPA testing is a valuable, reliable, noninvasive screening and diagnostic tool for carotid disease detection, but it is sensitive only to stenotic lesions, not to ulcerative plaques.
Carotid Endarterectomy: Emphasis on Necessity of Long-Term Postoperative Evaluation
Authors: Sauer Paul E. , Almond Carl 
Published: November 2007

Carotid endarterectomy remains an effec tive means of preventing a stroke in patients with extracranial carotid lesions. Although long-term patency may be assumed, the true incidence of recurrent pathology is not known. In the past, follow-up angiography has been performed only when recommended for recurrent symptoms and some postoper ative bruits. Four different pathologic condi tions found at the endarterectomized bifur cation site are discussed as are their treat ments. Long-term follow-up evaluation is strongly recommended. Angiography is in dicated for recurrent symptoms. Carotid bruits are difficult to evaluate on a yearly basis. Vascular laboratory studies are recom mended 4 months after surgery and then on a yearly basis. Hopefully, early and late res tenosis will be identified. An artery should be explored when symptoms and angiog raphic findings indicate recurrent pathology.
Diagnosis, Surgical Treatment, and Postoperative Care of Patients with Acute Thrombosis of the Femoral and Iliac Veins
Authors: Horsch S. , Pichlmaier H. 
Published: November 2007

The treatment of acute thrombosis of the femoral and iliac veins consists of (1) venous thrombectomy, and (2) thrombolysis. The therapy aims at (1) preventing lethal pulmonary embolism, and (2) restoring venous bloodflow and preserving the valvular system to prevent a post-thrombotic syndrome. The thrombectomy reduces the rate of embolism and post-thrombotic syndrome when compared to the spontaneous course or conservative treat ment. From a technical aspect, the method has developed into a routine operation. Early and late results in 80 patients, as well as intra- and postop erative complications, are discussed.
Iliac Artery-Iliac Vein Human Umbilical Cord Vein Graft for Hemodialysis in Patients with Exhausted Access Sites
Authors: Mayer John H. 
Published: November 2007

A patient who had undergone chronic hemodialysis for renal failure was evaluated for hemodialysis access failure. At the time of his initial examina tion, all available veins and arteries in the patient's arms and legs had been compromised by placement of arteriovenous fistulas or shunts, and he was being maintained with peritoneal dialysis. By means of a previously unreported technique, a human umbilical vein graft was interposed between the iliac artery and the iliac vein. The external iliac artery was extremely diseased, but pulsation and flow seemed adequate. Postoperatively, there was no evidence of lower extremity ischemia or venous hypertension. After 8 days of peritoneal dialysis, the graft was cannulated in the usual fashion for hemodialysis. However, due to the severe aortoiliac disease, flows were less than desirable, and the patient died.
Enlargement of the Breast—A New Side Effect of Transaxillary Cervical Sympathectomy: Case Report
Authors: Kott Itamar , Hauptman Eli , Zelkovsky Avigdor , Reiss Raphael 
Published: November 2007

The phenomenon of hyperhidrosis is a pathological state caused by unknown stimulus of the sympathetic nervous system. When a variety of conservative treatments have failed, surgery which involves the removal of some ganglia of the cervical sympathetic chain, is the treatment of choice. In the last four years we operated on 253 patients for palmar hyperhidrosis using the transaxillary approach only. Recently, a new side effect of surgery has come to our attention. This phe nomenon is enlargement of the breast on the operated side. Our series show seven cases (2.4%) of women operated for palmar hyperhidrosis who mani fested this phenomenon, two of them bilaterally. The enlargement of the breast was found usually by the second follow-up visit after operation when, in most cases, the patient mentioned it. Examination of the breast revealed enlargement of a few centimeters which in several patients required a change to a larger brassiere size. In both of our patients who underwent bilateral surgery, the breasts enlarged until they were equal in size. The women then did not complain further. In our article we de scribe the cases of two young women with this phenomenon for which we still do not have a clear explanation of the phenomenon, but report our assumption only.
Intravenous Lidocaine Regional Anesthesia for Forearm Arteriovenous Shunts
Authors: Geren Nichols J. , Parks Steven N. , Svoboda James A. 
Published: November 2007

Local anesthesia or brachial plexus block may not consistantly provide anes thesia for insertion of the prosthesis for a looped forearm arteriovenous shunt. Intravenous lidocaine regional anesthesia (Bier block) can provide excellent forearm anesthesia. This study reports 22 cases of looped forearm prosthetic dialysis access shunts performed with Bier blocks. The average operative time was 108 min utes. Anesthesia was reliable and no complications occurred. The grafts have been followed for 5 to 67 weeks with an average of 36 weeks followup. Two failures have occurred one due to infection, and a second with recurrent thrombosis. Three surviving grafts have required thrombectomy. The predicted 75th percentile survival period is 56 weeks. Bier block anesthesia is consistent, causes venodilitation and allows surgery without vascular clamps or systemic heparinization all of which have assisted the operative procedure.
The Hypoplastic Aorto-Iliac Syndrome: A Critical Approach to Its Pathogenesis
Authors: Di Giacomo Vincenzo , Di Giacomo Maurizio , Sciacca Vincenzo , Meloni Fortunato , Cavallaro Antonino 
Published: November 2007

The clinical and angiographic features of 12 patients showing a significant reduction in the diameters of the distal aorta and the common iliac arteries are described. All the patients were women aged between 23 and 63 years (average age: 49 years), heavy smokers in the majority. An associated aortic arch syndrome was observed in 5 patients. Type IV dyslipidemia was found in 5. In 10 patients the erythrocyte sedimentation rate was increased. Claudication of the lower limbs, without dystrophic phenomena, was the most frequent symptom. Intraoperative biopsies of the distal aorta at the level of the aortic bifurcation were performed in 9 patients who underwent vascular surgery. In all the specimens an extensive fibrosis of the arterial wall was noted, but diffuse or focal lymphoplasmacellular infiltrates were also detected in 7 of them, with giant cells in 2 of the 7. The profile of small aorta and iliac arteries has recently been identified as an autonomous morbid process due to a developmental deficit with superimposition of atherosclerotic phenomena ("hypoplastic aorto-iliac syndrome" — HAIS). The clinical data and the histopathologic findings suggest, however, that several cases of HAIS can claim an acquired rather than a congenital origin. An arteritic process, causing an extensive fibrosis of the arterial wall, might be able to give rise to a noteworthy reduction in the aortic diameter. Among the possible inflammatory causes, Takayasu's disease (aspecifc aortoarteritis) seems to play an important role. The denomination HAIS seems, however, to be too restrictive. It should be replaced by "small aorto-iliac syndrome" (SAIS), which is noncommittal as regards the pathogenesis and applicable in any case.
Topical Glyceryl Trinitrate as an Analgesic in Atherosclerotic End-Stage Peripheral Vascular Disease: A Case Report
Authors: Quigley Robert Lawrence 
Published: November 2007

An 87-year-old male vasculopath suffering from ischemic rest pain of ather osclerotic origin in the left foot was observed for a five-day period, with a healthy 28-year-old male serving as a control, to evaluate four subjective and objective parameters following nitropaste application for analgesia. Objective parameters (tissue oxygenation and limb temperature) were as sessed twice daily, morning and evening, in both the supine and erect positions. The overall average increase in tissue oxygenation in the patient was 111.2% when supine and 100.3% when erect, whereas it was 5% in the normal control when supine and 4.7% when erect. Overall average increase in temperature in the patient was 7.59% in the morning and 4.05% in the evening, position not being a factor. In the control, it was 2.5% when supine and 1.9% when erect. The patient's interpretation of subjective pain had progressed from moder ate to mild by day 3; this was consistent with the nurse's assessment. Thus the improved analgesia commenced forty-eight hours after institution of nitropaste treatment, despite the fact that tissue oxygenation had increased by an average of 158.9% during the first twenty-four hours and the temperature had increased by an average of 2.9%. To demonstrate efficacy of this drug as an analgesic; a properly randomized, double-blind study should be performed with a statistically significant sample size.
Revascularization of the Lower Extremity : A Noninvasive Hemodynamic Comparison of Aorto-Femoral, Axillo-Femoral and Femoro-Femoral Bypass
Authors: Rathnasami Palani S. , Hines George L. 
Published: November 2007

Thirteen patients who underwent aorto-bifemoral bypass (A-F), 12 who had femoro-femoral bypass (F-F), and 8 who had axillo-femoral bypass (Ax-F) were evaluated to compare the hemodynamic improvement of the individual proce dures by recording mean preoperative and postoperative ankle/arm pressure index (API) in symptomatic extremities.. Hemodynamic improvement as measured by API was the same for A-F, F-F, Ax- F. A decision about whether A-F, F-F, or Ax-F would be appropriate should be made by considerations other than the expected immediate hemodynamic bene fit, for there is no statistically significant difference in the hemodynamic im provement among these three common bypass procedures.