bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risks and Benefits of Peripheral Arterial Reconstructions in Octogenerians
Authors: Gänger K.H. , Reuteler Ch. , Senn A. 
Published: November 2007

The purpose of this study is to analyze the real benefit of peripheral arterial reconstructions of very old patients in relation to the underlying risk in terms of hospital mortality, long-term survival, amputation rate and level, grade of reha bilitation, and relief of symptoms. In this retrospective analysis, 120 patients with an average age of 85 years were evaluated, 224 peripheral arterial recon structions, repeat-operations, and amputations having been performed. Limb salvage was the leading indication for surgery in 93% of all patients, disabling claudication in only 7%. Twenty-one patients (18%) died in the hospital, 65 (54%) survived the opera tion for an average of 2½ years, and 34 (28%) are still alive at the end of the observation period; 34 (28%) required amputations and 65 (54%) improved; 81 patients (69%) were ambulant on discharge from the hospital, 68 (79%) in the group without amputation but only 13 (38%) in the amputated group. This study comes to the conclusions that more than half of the octogenerians benefited from peripheral arterial reconstructions, that the risk of arterial re constructions is acceptable even in this poor-risk group of patients, and finally that arterial reconstructions should be tried whenever feasible to improve the old patient's chance for rehabilitation.
Technical Considerations in the Use of PTFE
Authors: Taricco Alfred 
Published: November 2007

PTFE grafts should not be used by surgeons with little or no vascular experi ence. Because numerous reports by experienced vascular surgeons have de scribed the positive attributes of this graft material, many inexperienced surgeons have chosen to use it occasionally. Often the results have been less than expected and probably were related to poor case selection for the graft's use. These surgeons also chose a material that is not elastic and therefore not forgiv ing. It is best suited for use by an experienced vascular surgeon. This presentation describes techniques in the use of PTFE grafts to enhance positive results in properly selected cases. It is an outgrowth of personal experi ence and that of others to foster an armamentarium of techniques to facilitate the employment of this sophisticated graft by the inexperienced user of the ma terial. Also included is a discussion of nonvascular graft usage.
Takayasu's Arteriopathy with Associated Descending Thoracic Aortic Dissection During Pregnancy: A Multidisciplinary Approach Leading to a Successful Outcome: A Case Presentation
Authors: Griffith Lee D. , Raney Aidan A. , Dembitsky Walter P. , Hartley-Winkler Mary , Daily Pat O. 
Published: November 2007

Takayasu's arteriopathy is a rare arterial inflammatory disease of unknown etiology that commonly affects the aorta, its major branches, and the pulmo nary artery. Although this process most often causes narrowing and occlusion of the vessels involved, it is associated only rarely with aneurysm formation or dissection of the vessel. Although there are sporadic reports of pregnancy in conjunction with Takayasu's arteriopathy, the combination of this disorder with pregnancy and an aortic dissection is very unusual. This case report and literature review details the clinical management of a gravid female with clinical problems that were managed through close coopera tion among cardiothoracic surgery, anesthesia, obstetrics and gynecology, and perinatology units. This multidisciplinary approach led to the successful opera tive repair of a descending thoracic aortic dissection in a pregnant woman with Takayasu's arteriopathy who later delivered a normal full-term infant.
Cardiac Contusion with Early Ventricular Rupture—A Case Report
Authors: Timberlake Gregory A. , Mandry Cristabal V. , Bellone James L. , Pehr Marcia B. , Martinez Jorge A. , McSwain Norman E. 
Published: November 2007

Myocardial contusion is a common concomitant of high-speed deceleration injuries in our modern society. Despite increasing awareness of this entity among health care professionals, in many cases the diagnosis remains a difficult one to make because of a scarcity of physical signs. The diagnosis is, however, extremely important because of the possible complications, which include low cardiac output state, conduction defects, atrial and ventricular dysrhythmias, and, rarely, even cardiac rupture. Much less common, but also clinically impor tant, is rupture of the free cardiac wall from blunt trauma. A case of cardiac contusion caused by blunt trauma sustained in a motor vehicle accident complicated by early ventricular rupture is presented. Ten hours after arrival at the hospital, this patient abruptly became hypotensive and sustained a cardiopulmonary arrest, which did not respond to the usual medical measures. Upon open thoracotomy the patient was found to have suffered a right ventricular rupture, which was repaired; however, the patient subse quently expired.
An Effective Surgical Technique for Limb Salvage in Femorodistal Bypass
Authors: Ballotta Enzo , Alvino Simonetta , Franceschi Lorenza , Grego Franco , Deriu Giovanni P. , Giovanni P. , Deriu M.D. 
Published: November 2007

Usually, the extension of revascularization of lower extremities to the distal arteries is performed to avoid limb amputation. Technical errors in the performance of the distal anastomosis or poor runoff cause early failure of the bypass; myointimal fibroplasia or new atherosclerosis at the distal suture edges cause long-term failure. A new modified technique was used in 20 patients to facilitate the perform ance of the distal anastomosis. A vein patch is employed to widen the distal arteriotomy, and then, the graft is sutured into the vein patch so that the caliber of the distal artery is increased; potential technical defects and the risk of an early thrombosis are thus avoided. Care is always taken to guarantee a backflow in the vessel, which will permit limb salvage even if the distal runoff is not maintained in long-term follow-up because of occlusion of the outflow. From 1979 to 1985, 20 patients underwent 21 distal arterial reconstructive procedures with this new technique. All patients presented an absolute indica tion for surgery: rest pain (6), gangrene or ulcer (12), and severe ischemia (2). For the bypass procedure, the great saphenous vein was employed in 13 cases and PTFE in 8. Three major amputations were necessary within eight days of the operation. There was no operative mortality. Long-term patency rate was very high (85%).
Free Internal Mammary Artery Graft as Arteriovenous Fistula: An Experimental Study
Authors: Aarnio P. , Harjula A. , Lehtola A. , Sariola H. , Mattila S. 
Published: November 2007

To evaluate the behavior of the free internal mammary artery (IMA) graft in coronary bypass surgery an experiment was carried out in canine arteriovenous shunt position. From 6 dogs the IMA was dissected free from the right side as a naked artery and from the left side with the 2-cm-wide surrounding tissue. Three-cm-long free IMA grafts were anastomosed between the carotid artery and the contralateral external jugular vein as arteriovenous fistulas. After six months the grafts were harvested and studied by light microscopy and scan ning electron microscopy (SEM). Of 12 grafts, 10 were patent. In 1 dog both free IMA grafts were throm bosed. By light microscopy intimal thickening was seen in 2 IMA grafts with the surrounding tissue, and me dial fibrosis was seen in 1 naked IMA graft. In the SEM study in 4 samples of naked IMA grafts and in 2 samples of the IMA grafts with the surround ing tissue, the endothelium covered the luminal surface, although it had degenerated. In other samples the basement membrane was almost de nuded of endothelial cells. This study showed that free IMA grafts main tain their patency well in arterioven ous shunt, although the endothelium was severely degenerated in all grafts.
Nonresective Therapy for Abdominal Aortic Aneurysm in the High-Risk Patients—Case Reports
Authors: Mingoli Andrea , Sciacca Vincenzo , di Marzo Luca , Cisternino Silvestro , Bartoli Stefano , Cavallaro Antonino 
Published: November 2007

Three high-risk patients with an abdominal aortic aneurysm have been man aged with nonresective treatment, including ligation of femoral arteries and, in 2 cases, introduction of Gianturco-Wallace coils into the sac, to induce acute thrombosis of the AAA, and an axillo-bifemoral bypass for restoration of arte rial flow to the lower limbs. One patient died postoperatively. The literature on this alternative treatment is reviewed. It is stressed that there are a high mortality rate and a high incidence of serious and often lethal complications and that rupture of the aneurysm is not fully precluded. Thus noresective treatment of AAA has to be used with extreme precaution in high- risk patients.
Studies on the Survival of Transmetatarsal Amputation Stumps
Authors: Friedmann Lawrence W. , Padula Patricia A. , Weiss Jay M. , Root Barry , Polchaninoff Michael , Shapiro Daniel 
Published: November 2007

Through the use of electrodynog raphy the authors have quantified foot forces in the transmetatarsal am putee with respect to their location, severity, and duration. They have tried to relate this to the potential for foot breakdown. Their aim through electrodynography studies and through their questionnaire is to be gin to find those factors common to those who have not progressed to fur ther amputation. This provides a beginning to the data collection and evaluation of an extremely difficult problem. There is still a great need for further work, and the authors are continuing to ex amine their patients for the other fac tors involved, without which their data only hint at both causation and treatment. A natural extension of these studies is also examining forces in other partial foot, below-knee, and above-knee amputees, and these are also planned as future projects.
In Vivo Study of Expanded Polytetrafluoroethylene Vascular Suture
Authors: di Marzo Luca , Hunter William J. , Schultz Richard D. , Feldhaus Richard J. 
Published: November 2007

Routine use of high-quality suture material has often been described as a factor in preventing complications such as false aneurysms, infection, and me chanical failure of implanted gafts. Optimal characteristics for a vascular su ture are to maintain its strength without causing an important "foreign body" reaction. Polypropylene monofilament has both characteristics and successfully replaced braided sutures for many years. A new monofilament suture material, which is made of expanded polytetrafluoroethylene (EPTFE), has recently been introduced. The purpose of the present study was to evaluate this new vascular suture and compare it with the widely and successfully used polypropylene su ture. The authors implanted a total of 20 infrarenal aortic reconstructions in dogs using both sutures to perform each anastomosis. Two dogs were sacrificed after 3, 7, 10, 14, 21, 30, 60, 120, 285, and 360 days. Light and scanning electron microscopy of the anastomotic site was routinely performed in order to compare the two suture materials. Thickness of inflam matory reaction around the sutures was measured at three different sites of each suture and statistically compared. Inflammatory reaction was minimal for both sutures and no significant difference was noticed by use of the Student's T- test (p=NS). No ingrowth was shown in either suture. EPTFE, in contrast to polypropylene, at scan electron microscopy, showed a nice layer of fibrin sur rounding the suture and a tendency to adapt to mechanical stress by being oval, elliptical, or circular. In the authors' opinion, EPTFE suture is, therefore, a valuable alternative for use in cardiovascular surgery.
Recurrence of Varicose Veins Following Surgery
Authors: Elbaz Cl. 
Published: November 2007

Analysis of 436 recurrent varicose veins shows that the main cause is an inadequate operative technique that fails to ligate the saphenous veins flush to the femoral or the popliteal veins. The recurrence may also be due to a faulty diagnosis that over looks an incompetent short saphe nous vein or incompetent perfora tors. A careful clinical examination and complete investigation through echography and venography are needed. Reoperation should be per formed in order to obliterate all the points of reflux. The surgical approach to the re maining stump of a saphenous vein is very difficult through dense scar tis sue and lymph nodes closely adherent to the recurrent veins, which are fragile and thin-walled. It is a real challenge to the surgeon and requires a great deal of experience and opera tive skill.
Bacterial Growth in Venous Ulcers of the Lower Extremity and Its Sensitivity to Antibiotics
Authors: Annoni Federico , Rosina Mariele , Pezzoni Fabio , Pisani Franco , Montorsi Walter , Marincola Francesco M. 
Published: November 2007

From 154 consecutive patients, 154 different cultures were obtained from the exudate of lower extremity ulcers due to venous insufficiency. Subjects were outpatients with venous ulcers from whom cultures were rou tinely obtained at the first visit in the clinic. This prospective study lasted three years. Forty-two cultures failed to grow bacterial contaminants. Among the remaining 112 samples in which bacterial colonization was demonstrated, 78 grew a single microorganism and 34 grew more than one. A total of 124 bacteria species was recorded. Of the 76 Gram-positive cultures, 50 contained Staphylo coccus aureus ; the second most common organism was Staphylococcus epidermi dis, and this was followed by Candida, Streptococcus hemolyticus, and bacilli. Within the 48 Gram-negative bacteria the most common was Pseudomonas aeruginosa followed by Escherichia coli, Enterobacter, Proteus, Acinetobacter, Klebsiella, and Serratia. Sixteen chemotherapeutic drugs were evaluated by scoring the effect on the bacterial growth and the specificity of activity. The most effective drugs against Gram-positive bacteria were clindamycin (91%), cefotaxime (79%), erythromy cin (76%), and netilmicin (69%), and against Gram-negative bacteria were aztreonan (87%), norphloxacin (85%), netilmicin (79%), and cefotaxime (72%). The combined antibacterial effectiveness for each ulcer, whether growing single or more microorganisms, was 71 % for cefotaxime, 69% for netilmicin, 66% for norphloxacin, 57% for gentamicin, 50% for cotrimoxazole, 38% for tetracyclines, and 21% for amoxicillin. These data have some practical interest: even though antimicrobial treatment is not usually necessary in the authors' experience if the ulcer does not show clinical evidence of infection, in some instances ulcers do present evidence of active infection. In their opinion the best option in these cases is to collect the exudate, culture it, and while waiting for the result, start with an empiric treatment based on the results as presented in this paper. A prospective clinical study evaluating the effect of these antibiotics on ulcers affected by clinical signs of infection is presently ongoing in their institution with the purpose of giving clinical support to these laboratory find ings.
Effect of Pentoxifylline on Treatment of Lower Limb Ulcers in Patients with Thalassemia Major
Authors: Angelides N.S. , Angastiniotis Ch. , Pavlides N. 
Published: November 2007

The possible healing effect of deferoxamine and pentoxifylline on persisting lower limb ulcers was studied in 51 patients with thalassemia major. The results indicated that the regular use of deferoxamine at an intravenous dose of 20 mg/kg did not affect the healing progress and the recurrence rate of these ulcers significantly On the contrary, the oral administration of pentoxifylline at a dose of 1,200 mg daily during the ulcer's healing time and at a low long-term maintenance dose of 400 mg daily during the ulcer-free intervals improved their healing ability impressively and diminished their recurrence rate significantly
A Comparative Analysis of Transcutaneous Oxygen Tension (tcPO2) During Rest and Postischemic Response Test in the Diagnosis of Patients with Mild and Moderate Arteriosclerosis Obliterans (ASO)
Authors: Qian Shuixian , Iwai Takehisa , Inoue Yoshinori , Endo Mitsuo 
Published: November 2007

Transcutaneous oxygen tension (tcPO2) was measured at the foot and chest wall in 12 normal subjects and 62 patients with arteriosclerosis obliterans (ASO). The results showed that the resting tcPO2 at the foot and the chest wall was significantly lower in asymptomatic patients (p < 0.01 at the foot and p < 0.01 at the chest wall) and patients with mild and moderate intermittent claudication (p < 0.01 and p < 0.01, respectively) than in normal subjects. The postischemic response test (T½) was significantly delayed in asymptomatic patients (p < 0.05) and patients with mild and moderate intermittent claudication (p < 0.01 respectively) as compared with normal subjects. The preliminary results of this study suggest that the measurement of resting tcPO2 is useful in the diagnosis of patients with mild and moderate ASO. Measurement of resting tcPO2 coupled to the T½ test is more useful for discrimination in the severity of the disease and may provide information concerning prognosis of the patients.
Quality of Life After Open Heart Surgery
Authors: Sivertssen Egil , Fjeld Nils B. , Abdelnoor Michael 
Published: November 2007

Quality of life was studied at mean follow-up time of thirty months by a postal standard questionnaire, which was answered by 95% of patients. The questionnaire included a visual analog scale (VAS) for self-evaluation of the patients' quality of life. At the time of follow-up 90% of the patients answered that their clinical condition was much better or better than before operation. However, only 24.3% of the patients were without any cardiac symptoms at follow-up. The results of the VAS showed that 90.8% of the patients had a higher score (better quality of life) than before operation without any difference between males and females, between age groups, or between patients who underwent coronary artery bypass surgery (the CABG subgroup) and patients who had valvular replacement (the valve subgroup). A significant relationship was found between the degree of symptoms and VAS values and between working condition and VAS values of quality of life.
Reconstructive Vascular Surgery for Intestinal Angina Associated with Renovascular Hypertension and Intermittent Claudication
Authors: Hiekata Tomizo , Ogawa Noboru , Koyama Teruyuki , Takei Hiroshi 
Published: November 2007

Calcified atherosclerosis producing occlusion of the suprarenal aorta with involvement of the celiac artery (CA), superior mesenteric artery (SMA), and renal artery is an extremely rare entity. The authors report a case of a fifty-five-year-old woman with this lesion who had suffered from renovascular hypertension, intestinal angina, and intermittent claudi cation of the lower extremities. Reconstructive vascular surgery was successfully performed including an aortic bypass from the lower descending thoracic aorta to the distal abdominal aorta and revascularization of the CA, SMA, and bilateral renal and external iliac arteries simultaneously. Only a few similar cases have been reported in the literature, and all the patients were female. It appears that there is an unusual predilection for females in this particular form of arteriosclerosis.
Embolectomy-Induced Pseudoaneurysm Causing a Brachial Plexopathy
Authors: Diedrich Andrea , Dibert Steven , Donofrio Peter 
Published: November 2007

Pseudoaneurysm is a rare cause of compressive brachial plexopathy. The authors describe a thirty-seven-year-old man with hypertension and renal disease who presented with a painful and weak left upper extremity. Examination revealed a cool extremity with absent pulses, profound weakness, and diminished sensation and reflexes restricted to the left upper limb. During emergency exploration, a thromboembolus was extracted from the subclavian artery by means of a brachial artery entrance site. A postoperative arteri ogram revealed persistent subclavian artery occlusion. On reexploration, a second throm boembolus was removed. Postoperatively, the patient regained pulses, and over several days his left upper limb strength improved. On reevaluation several weeks later, the patient complained of greater weakness in the left arm, forearm, and hand, which was confirmed on physical examination. Nerve conduction studies and an electromyogram were interpreted as consistent with a severe left brachial plexopathy. Magnetic resonance imaging of the brachial plexus revealed a left axillary mass displacing the brachial plexus, which also manifested pulsatile flow artifact consistent with a pseudoaneurysm. A pseudoaneurysm arising from a branch of the axillary artery was surgically repaired, resulting in some return of strength. Several cases of brachial plexopathy due to pseudoaneurysm have previously been reported, but none has been iatrogenically induced by embolectomy. A pseudoaneurysm should be considered in any patient who develops focal limb weakness after embolec tomy, particularly those receiving anticoagulation.
Humoral Immunity After Splenorenal Artery Bypass
Authors: Burkhart Harold M. , Wilcox Michael G. , Sawchuk Alan P. 
Published: November 2007

Splenorenal artery bypass is not an uncommon procedure for correctable renal hyper tension. Although it is well known that the removal of the spleen greatly impairs humoral immunity, no data exist regarding the humoral response after a splenorenal artery bypass. The purpose of this study was to assess the humoral response to an intravenous bolus of sheep erythrocytes in Sprague-Dawley rats after they underwent a splenorenal artery bypass. Sixteen male, retired breeder, Sprague-Dawley rats (weight 400 to 450 g) were divided into three groups and successfully studied. The first six rats were the control group and underwent sham operations consisting of a midline laparotomy followed by primary closure. The second group (n=6) underwent splenectomies with suture ligation of the splenic artery at the hilum. A splenic artery to left renal artery bypass was performed on the rats in the last group (n=4). After recovery, the rats were given an intravenous bolus of sheep erythrocytes via direct cannulation of the femoral vein. One week later, their antibody titers were assessed by hemagglutination assays. The antibody titers of the sham-operated rats (939 ±244.4) were significantly different than those of the splenectomized group (16 ±3.6) and the bypassed group (80 ±16.0). Furthermore, there was no significant difference between the bypassed and splenectomized rats. The results suggest that the use of pneumococcal vaccine and early antibiotic treatment may be warranted in splenorenal artery bypass patients in order to avoid infec tious sequelae.