bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with family caregivers' choice not to use services
Authors: Hamilton Edith M. , Braun Jean W. , Kerber Paul , Thurlow Christine , Schwieterman Irma 
Published: June 2007

The purpose of this descriptive study was to determine adaptation by family caregivers of persons with Alzheimer's disease who did not use community services. Previous research has focused on the use of services, highlighting the need for studies examining factors associated with service nonuse. Lawton and Nahemow's ecology model of adaptation and aging served as the foundation for this study; the relationship between personal competence and environmental press depicts a level of adaptation. A mail and telephone survey of 70 caregivers revealed reasons for not using services to which they had been referred, as well as patterns of adaptation to caregiving. Personal competence, measured as perception of caregiving mastery, emerged as a significant factor in service nonuse. Caregiver gender and daily hours of caregiving, an environmental press factor combined with perception of mastery to most often correctly classify respondents' high and low adaptation. Strategies for enhancing caregiver competence should be given highest priority by primary health care professionals.
A simple score system for clock drawing in patients with Alzheimer's disease
Authors: Shua-Haim Joshua , Koppuzha G. , Shua-Haim Vered , Gross Joel 
Published: June 2007

Objective: To develop a simple clock drawing score system for patients with Alzheimer's disease, that correlates with the MMSE (Folstein Mini Mental Status Examination).1 Design: A retrospective analysis of 88 patients with the diagnosis of Alzheimer's disease Setting: Outpatient Memory Disorder Institute of a large community teaching hospital. Measurements: MMSE score and two different clock drawing ratings. The MMSE and the clock drawing scoring were performed by different raters. We present a “simple clock scoring system” and compared it with a previously published scoring system by Sunderland et al,2 referred to as the standard score system. Results: There is a strong correlation between the “new score system” and the standard scoring (Pearsons Correlation Coefficient r = 0.91, p < 0.001). However, when both systems were evaluated in a multivariate linear regression analysis, the “ simple score system “ was a significant predictor of Folstein MMSE (P < 0.01), while the standard scoring system was not. Conclusion: The “simple score system” is an easy to use, accurate predictor of the MMSE score, in patients with the diagnosis of Alzheimer's disease.
Donepezil (AriceptTM): The caregivers voice and clinical impression
Authors: Shua-Haim Joshua R. , Comsti Eric , Shua-Haim Vered , Ross Joel S. 
Published: June 2007

The purpose of this study is to investigate the clinical and caregiver impression on AriceptTM treatment. In a prospective study, 57 consecutive Alzheimer's disease patients were treated with Donepezil for 16 weeks, using a 5mg tablet, administered once daily at bedtime. Patients met the criteria of NINCDS-ADRDAI for probable Alzheimer's disease. There were no exclusion criteria for the study. After 16-weeks of treatment, the caregiver completed a questionnaire regarding the effectiveness of the drug. Subjective cognitive improvement, MMSE,2 ADL,3 and IADL4 outcomes were all assessed before and after treatment. Behavioral improvements included those of depression, agitation, violence, anxiety, and paranoid thoughts. Functional and overall family satisfaction was also evaluated Side effects and reason for discontinuation of the medication were also reported. Out of the 57 patients in the study, 15 patients (26 percent) terminated participation due to side-effects. Total adverse event was reported in 24 (42 percent) of the patients. Cognitive improvement was reported in 27 (47 percent) of patients. Verbal skills and attention were the most commonly-reported cognitive improvement. Average MMSE declined by two points after 16 weeks of treatment. No behavioral improvement was reported Behavioral deterioration was reported in three (5 percent) of patients. Functional improvement was reported in 21 (37 percent) of patients. Favorable overall family satisfaction was reported in 27 (47 percent) patients. Although the overall clinical impression from AriceptTM (Donepezil) treatment (as measured by the MMSE, ADL, IADL and behavior) was unfavorable, there was a high family and caregiver satisfaction. This satisfaction was due mainly to functional improvement. The main cognitive improvement reported was in verbal skills and attention span.
Caregivers of wives diagnosed with Alzheimer's dosease: Husband's perspectives
Authors: Siriopoulos George , Brown Yvonne , Wright Karen 
Published: June 2007

Recent statistics reveal a growth in the incidence of Alzheimer's disease (AD) and related dementia amongst the elderly. 1 Although women are more likely than men to develop AD, 1 there is limited literature available on husbands as caregivers for wives with the disease. 2,3 Therefore, the need to conduct research in the area of male caregivers is essential if nurses are to understand and provide appropriate support and care for male caregivers. A qualitative study which focused on the experience of husbands who are home caregivers of wives diagnosed with AD was conducted using phenomenological research methods. The study was based on the experiences of eight husbands, six of whom were caregiving for their wives at home, while two cared for wives in an institutional setting. Data collected during in-depth tape recorded interviews with the participants was analyzed using Giorgi's4 method. Five major themes emerged from the participants' stories: loss, caregiver burden, coping methods, quality of previous relationship, and effects of AD. These themes were inter-related to form a whole that described the experiences of caregiving from the husbands' points of view. A discussion of the benefits of the study to nursing practice and nursing research, as well as the relevance to male caregivers are also provided.
The Relationship of the Inferior Vena Cava and Its Branches to Aortoiliac Surgery
Authors: Andros George 
Published: June 2007

Knowledge of the normal and abnormal anatomy of the inferior vena cava and its branches increases the ease and effectiveness of the surgical treatment of occlusions and aneurysms of the aortoiliac segment.The surgical anatomy and techniques for dealing with renal vein anomalies, vena cava duplication, transpositions and arteriovenous fistulas are presented; these aids to the early recognition of venous abnormalities simplify appropriate dissection and forestall inadvertent hemorrhage and vascular injury.
Relationship Between Preoperative Duplex Vein Mapping and Intraoperative Longitudinal Impedance in Infrainguinal Vein Grafts
Authors: Meyerson Shari L. , Shakur Umar M. , Skelly Christopher L. , Loth Francis , McKinsey James F. , Schwartz Lewis B. 
Published: June 2007

The importance of favorable vein size, resistance, and impedance for the sustained success of infrainguinal vein grafting procedures has repeatedly been demonstrated. Estimating these properties preoperatively, however, has been problematic. Ultrasonic vein mapping is a reliable technique for measuring vein diameters at venous pressures, but it is unknown whether these data accurately assess the resistive potential of the conduit in the arterial circulation. The purpose of this study was to compare vein diameter measured preoperatively with vein graft longitudinal impedance measured intraoperatively. Patients who had undergone both preoperative vein mapping and intraoperative impedance studies at the time of infrainguinal bypass were included (December 1995-April 1999). Vein mapping was performed using B-mode ultrasound with a 10 MHz probe. The dimensions of the specific vein segment used for reconstruction were tabulated and its mean diameter (D̄) was calculated. At the time of operation, following reconstruction, transgraft blood pressure gradient (δP) and blood flow (Q) waveforms were recorded by using digital data acquisition. Longitudinal impedance (ZL) was calculated as δP/Q at each harmonic following Fourier transformation and the area under the curve from 0 to 4 Hz designated as ∫ZL. Twenty-three bypasses in 22 patients were studied (D̄ = 3.5 ±0.2 mm, range 1.6-5.5 mm; ∫ZL= 37 ±4 x 103 dyne cm-5, range 13-95 X 103 dyne cm-5). D̄ significantly correlated with ∫ZL (slope = -0.454, p < 0.05), albeit with a fairly low correlation coefficient ( r2 = 0.23). D̄ > 3.6 mm was predictive of graft patency at 12 months (D̄ > 3.6 mm 100% vs D̄ < 3.6 mm 57 ±20%; p = 0.02). Larger veins identified by preoperative mapping have, in general, more favorable intraoperative resistive characteristics as defined by a lower JZL. However, some veins thought to have small diameters (< 3.6 mm) may still demonstrate sufficiently low ∫ZL when grafted to remain patent.
Alterations in Lower Extremity Venous Hemodynamics Associated with Normal Pregnancy
Authors: Ballard Jeffrey L. , Papa Diane M. , De Lange Marie 
Published: June 2007

This study was performed to define physiologic changes in lower extremity venous hemodynamics during and after normal, healthy pregnancy. Lower extremity venous physiology was evaluated by using air plethysmography in 24 healthy primigravid females (48 extremities) with no known venous disease. All patients were studied during their first, second, and third trimester, and at 6 weeks, 3 months, and 6 months postpartum. Data were evaluated for changes over time and for differences between the right and left lower extremity by use of repeated measures analysis of variance. None of the patients developed overt signs of venous reflux during pregnancy although there was an increase in venous filling index in advanced stages of pregnancy. All values remained within normal range (1.0-1.7 mL/sec, p = 0.52). There was a statistically significant decrease in residual volume fraction that reached a nadir during the third trimester and returned to below-baseline values immediately postpartum (p = 0.02). An increase in venous outflow fraction was demonstrated as pregnancy progressed (p = 0.05). This trend peaked during the third trimester. Calf muscle pump function did not change appreciably during the study period (p = 0.61). There was no difference between right and left lower extremities with regard to venous filling index (p = 0.25), residual volume fraction (p = 0.33), venous outflow fraction (p = 0.17), or calf muscle pump function (p = 0.33). Some alterations in venous hemodynamics are associated with pregnancy. Venous outflow fraction overall is increased coincident with a decrease in residual volume fraction. The significant decrease in residual volume fraction and augmentation in venous filling index may be related to venous dilation and an increase in venous capacitance secondary to hormonally influenced smooth muscle relaxation.
Arterial Access Site Closure with a Novel Sealing Device: DuettTM
Authors: Heyer Gunter , Atzenhofer Karl , Meixl Herbert , Lampersberger Christian , Gershony Gary 
Published: June 2007

Management of arterial access sites following percutaneous endovascular procedures is associated with patient discomfort and local complications. A new vascular sealing device, comprised of a balloon delivery catheter and a flowable procoagulant consisting of thrombin and collagen, was tested. Immediately following catheterization 200 patients (age, 66.1 ±11.2 years) were treated with the sealing device (Duett). Of these 200 patients, 132 underwent diagnostic catheterization, 67 underwent percutaneous transluminal coronary angioplasty, and one underwent percutaneous transluminal angioplasty. The sheath sizes included 2-5 Fr, 166-6 Fr, 25-7 Fr and 7-8 Fr. All patients undergoing diagnostic procedures received at least 5,000 U of intravenous heparin during the procedure. The Duett was used successfully in 198/200 (99%) patients immediately following completion of the endovascular procedure. In two patients a device malfunction resulted in uncomplicated crossover to manual compression. The time to hemostasis ranged from 3 to 5 minutes. All patients were walking 2 to 5 hours following the procedure unless a complication had occurred. No patient experienced leg ischemia, required surgical repair of the arterial access site, or had an infection at the site. In three patients (1.5%), a pseudoaneurysm occurred and was successfully treated with ultrasound-guided compression and three patients received a blood transfusion. No late complications were observed following hospital discharge. This novel vascular sealing device successfully achieves rapid hemostasis and allows early ambulation following percutaneous endovascular procedures with a low incidence of complications.
Matrix Metalloproteinase Expressions in Arteriosclerotic Aneurysmal Disease
Authors: Saito Satoshi , Zempo Nobuya , Yamashita Akimasa , Takenaka Hiroaki , Fujioka Kentaro , Esato Kensuke 
Published: June 2007

Medial degeneration of extracellular matrix (ECM) proteins in the wall of abdominal aortas results in smooth muscle cell destruction, a loss of architectural integrity, and abdominal aortic aneurysm (AAA) formation. It has been theorized that an imbalance between proteinases and their naturally occurring inhibitors is the cause of these observed histologic abnormalities. Therefore, the purpose of this investigation was to determine if differences in the matrix metalloproteinase (MMP) -2 and -9, tissue inhibitor of metalloproteinase-1 (TIMP-1), tissue-type plasminogen activator (tPA), and urokinase-type plasminogen activator (uPA) protein and activity levels existed between infrarenal AAA and normal abdominal aortic tissue specimens. Between November 1995 and January 1997, 10 patients undergoing elective infrarenal AAA repair had a portion of their aneurysm walls snap frozen in liquid nitrogen and processed for subsequent western blot or zymographic analysis. Tissue specimens from 6 normal abdominal aortas obtained from fresh cadaver specimens were similarly processed and served as controls. Protein levels for MMP-2, MMP-9, TIMP-1, uPA, and tPA were analyzed by western blotting. The degree of MMP-2 and MMP-9 gelatinolytic activity was analyzed by zymography. Detection and immunolocalization for MMP-2, MMP-9 and CD68 was performed on tissue sections of AAA and normal infrarenal abdominal aortas fixed in 10% formalin. MMP-9 and tPA protein levels were increased in AAAs compared to controls by western blotting. However, uPA levels were slightly increased in controls. No differences in TIMP-1 protein levels were identified. Similarly, zymography demonstrated increased MMP-2 and MMP-9 gelatinolytic activity in AAAs compared to controls (p<0.05). CD68-positive cells (macrophages) in the adventitia and media demonstrated immunoreactivity to MMP-9. This investigation demonstrated increased MMP-9 proteinase activity and tPA protein levels in the walls of AAAs, as well as inflammatory leukocyte invasion of the adventitia and media compared to controls. These data suggest that leukocyte-derived MMP-9 is associated with aortic wall degeneration and aneurysm formation. Furthermore, activation of MMP-9 may be caused by increased tPA levels in the walls of AAAs.
Carotid Artery Endarterectomy Solely Based on Duplex Scan Findings
Authors: Logason Karl , Karacagil Sadettin , Hårdemark Hans-Göran , Boström Annika , Hellberg Anders , Ljungman Christer 
Published: June 2007

The purpose of this study was to review experience with carotid artery surgery based on findings obtained solely from duplex scanning with special regard to unexpected findings during surgery and the early outcome. From January 1993 through December 1999, 271 consecutive patients underwent 287 carotid endarterectomies (CEAs), 229 (80%) of which were performed solely based on duplex scan findings. During the study period 5,932 carotid artery duplex scans were performed in 4,466 patients. Of 589 patients with internal carotid artery (ICA) stenosis? 70%, 246 underwent CEA compared to 25 of 156 with 50-69% ICA stenosis. The indications for CEA were transient ischemic attack (TIA) in 88 (30.7%), amaurosis fugax in 60 (20.9%), previous stroke in 91 (31.7%) and asymptomatic disease in 48 (16.7%) cases. There were no statistically significant differences between the groups operated on with and without preoperative angiography with respect to the indications for surgery, associated risk factors, or the degree of stenosis on the contralateral side. In patients undergoing surgery without angiography, there were no unexpected findings that influenced the performance of surgery, in all except 1. There were no significant differences in perioperative morbidity and mortality in patients undergoing surgery with and without conventional angiography. The combined mortality and major stroke rates were 3.4% and 2.2%, respectively. It is concluded that CEA can safely be performed without preoperative angiography in cases with conclusive duplex scan findings.
Microcirculatory Effects of Iloprost in Patients with Suspected Secondary Raynaud Phenomenon
Authors: Arpaia Guido , Cimminiello Claudio , Sardina Marco , Rossi Florica , Aloisio Manuela , Curri Sergio B. , Bonfardeci Giuseppe 
Published: June 2007

Background: The clinical efficacy of iloprost, a stable analogue of prostacyclin, in patients with Raynaud's phenomenon (RP) has been widely reported. However, its mechanism of action is still unclear, and also unknown is why the benefit lasts for many weeks after therapy is discontinued. The aim of the present study was to learn what kind of microcirculatory changes occur in the skin of the affected hand one month after the end of iloprost treatment in patients with RP. Patients and Methods: Eleven subjects (8 women, 3 men, mean age forty-four years) with RP suspected to be secondary to a collagen disease entered the study and were infused with iloprost up to 2.0 ng/kg/minute for six hours on five consecutive days. At baseline and one month after treatment discontinuation, laser Doppler flowmetry, thermography, and computer-assisted video capillaroscopy of the affected hand were performed. Results: At the end of follow-up, the mean capillary density as recorded by video capillaroscopy was significantly increased as was the skin temperature in the different areas (fingertip, nailbed, tenar, hypotenar). In contrast, laser Doppler flowmetry revealed no significant changes after therapy. Comment: The improvement of vascularization of the skin and, therefore, the decrease in avascular areas in patients with RP suspected to be secondary to a connective tissue disease appear to be associated with enhancement of nutritional flow. Rather than rely on an angiogenetic effect of iloprost, these modifications may be related to the drug-induced normalization of the described dysfunctional arteriolar-venular anastomoses in the skin of RP patients through redistribution of flow.
Treatment of “Trash-Hand” Following Intraarterial Injection of Drugs in Addicts
Authors: Borrero E. 
Published: June 2007

As intravenous drug abusers grow older, they develop a paucity of superficial veins for access, which compels them to guess at the location of deeper veins for access. On occasion, the drug is injected into an artery, resulting in limb-threatening ischemia. Five patients (3 men/2 women) with an average age of 35.6 years (range twenty-eight to forty-three years) who inadvertently injected illicit drugs into an upper extremity artery developed a “trash-hand.” The injected drugs include crushed meperidine (2), crushed codeine (2), and crushed haloperidol (1). The patients initially treated with heparin alone (2) or dextran-40 alone (1) had progressive ischemia resulting in amputation of their hand. Patients initially treated with a combination of heparin and dextran-40 had limb salvage. This small group of patients demonstrates that the combination of heparin and dextran-40 may be advantageous for treatment of patients with “trash-hand.”
Thermal Laser Angioplasty of the Lower Extremities: Comparison of Early and Late Experience
Authors: Bowles M. H. , Smith J. A. M. , Downing G. C. , Galichia J. P. 
Published: June 2007

Thermal laser angioplasty (TLA) experience of 59 hospital cases in 1988 (Group A) was compared with 113 outpatient cases treated from March 1989 to September 1991 (Group B). Angiographic success was higher in Group B (66.4%) as compared with Group A (55.9%). Complications of major dissection, perforation, and local thrombus were similar. Distal emboli (P=0.04), retroperitoneal hematomas (P=0.02), and urokinase administration (P=0.03) were more prevalent in Group A. At follow-up (six to thirty-six months), 57% of Group B patients were symptom free but only 36 of Group A were. Symptomatic improvement, despite recurrence of intermittent claudication (IC), was present in 21% of group A and 6% of Group B subjects. Though unpredictable, the mean ankle/arm indices were found in the following clinical categories: 100% reocclusion by angiography, 0.46; IC same as before TLA, 0.56; IC with mild-marked improvement, 0.70%; asymptomatic, 0.94. Average length of lesion-Group A, 10.5 cm versus Group B, 17 cm. This review does show improved primary success rates with further operator experiences despite tackling of more difficult lesions. The reduction in complications is related to the decreased use of urokinase and the availability of trained support personnel.
Superior Mesenteric Artery Syndrome Complicated by Pancreatitis
Authors: Bermanski Paul , Golden Richard L. , Ricca Richard J. 
Published: June 2007

The threefold purpose of this study is to review the history of the existence and diagnosis of superior mesenteric artery (SMA) syndrome, to add to the weight of evidence of such a syndrome, and to describe the unusual complication of pancreatitis in SMA syndrome. The authors' methods include the review of historical and current literature and a case presentation. Their patient, who presented with small bowel obstruction after profound weight loss, was evaluated. She was found to have cutoff of the third portion of the duodenum by the superior mesenteric artery. This was complicated by an elevated amylase level. After conservative treatment to restore her weight with enteral and parenteral nutrition was unsuccessful, the authors opted for surgical repair to correct the obstruction. This was successful. They conclude that SMA syndrome is a real entity. It may be complicated by pancreatitis. Surgical correction may be needed and can be successful in restoring bowel function.
Cardioprotective Effects of Phosphocreatine in Vascular Surgery
Authors: Mastroroberto Pasquale , Chello Massimo , Zofrea Saverio , Bevacqua Egidio , Marchese Antonietta R. 
Published: June 2007

The pharmacologic use of phosphocreatine (Pcr) in cardiology and cardiac surgery, along with other so-called metabolic drugs, to prevent the ultrastructural and clinical effects of ischemia on the myocardium has been the aim of many studies during recent years. To evaluate the protective action of Pcr in a series of surgical vascular patients with an associated heart disease, the authors have included in this study 62 patients undergoing vascular operations and have randomly divided them into a Pcr-treated group and a control group. The cardiac index (L x min-1 x m-2), the use of inotropic drugs (number of patients), the EKG alterations (ST ≥ 2 mm, arrhythmias) with a Holter registration, and the measurement of ejection fraction by 2D-Echo Doppler analysis were examined. A statistically significant improvement in the central hemodynamics during the immediate postoperative course was observed in the Pcr group, preserving a good left ventricular function and preventing severe arrhythmias. The results revealed that the use of Pcr induced a more efficacious protection of the myocardium with an improved functional recovery, a positive inotropic effect, and an antiarrhythmic action. Nevertheless there is need for further studies to demonstrate the real benefit of using Pcr for myocardial protection in vascular surgery.