bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Dipyridamole Thallium 201 Scintigraphy and Clinical Examination in the Determination of Cardiac Risk Before Arterial Reconstruction
Authors: Madsen Poul Vasehus , Vissing Michael , Munck Ole , Kelbaek Henning 
Published: November 2007

Preoperative clinical examination, including a 12-lead resting ECG, and planar dipyridamole thallium imaging (DTI) were compared in a prospective study of 65 vascular surgical patients in regard to their value for predicting postoperative cardiac complications. Fifty-three patients underwent abdominal vascular procedures and 12 were operated on for peripheral artery disease. Thirty-six patients had ischemic heart disease (IHD) and/or abnormal findings from 12-lead resting ECG. Of these 36 patients, 11 had nonfatal cardiac complications. The remaining 29 patients were free of IHD and had normal results from ECG. No complications occurred among these 29 patients. There was no postoperative death. Thallium imaging results were abnormal in 45 patients, showing either redistribution and/or scar tissue or low washout. In 18 of these patients major changes with redistribution were present in all projections. Among these patients, 9 had a nonfatal cardiac complication. In the 27 patients with abnormalities in only one or two projections, only 2 had a cardiac event postoperatively. No cardiac complications occurred in patients with normal thallium scintigraphy findings. The patients were operated on irrespective of the results of the scans, and all recovered from any cardiac complications that occurred. In vascular surgical patients with previous IHD and/or abnormal findings from resting ECGs further risk stratification is achieved with DTI.
Ultrastructural Analysis of an in Vitro Endothelialized PTFE Graft: Presence of Viable Endothelium Five Months Following Graft Implantation
Authors: Kadletz Margit , Magometschnigg Heinrich , Grabenwöger Martin , Vodrazka Martin , Wolner Ernst 
Published: November 2007

A sixty-four-year-old man underwent aortoprofundal reconstruction for occlusive vascular disease. Prior to graft implantation, autologous endothelial cells were harvested and cultivated for twenty-five days and used to seed an 8 mm polytetrafluoroethylene (PTFE) prosthesis in vitro. Following implantation of the seeded prosthesis the patient had an uneventful postoperative course and was discharged from the hospital fourteen days after the procedure. Five months later, a second surgical procedure was performed for progressive occlusive disease in the femoral artery. At this operation, femoropopliteal reconstruction was performed using autologous saphenous vein. The proximal anastomosis was constructed 5 cm above the distal end of the previously inserted, endothelialized aortoprofundal graft. A piece of the aortoprofundal graft, removed during the second operation, was examined by electron microscopy This revealed complete coating of the inner graft surface with viable endothelial cells. The authors believe their findings significant, since they could demonstrate adherence of viable endothelial cells on the inner surface of a PTFE prosthesis five months after implantation.
Age-Related Changes in the Abdominal Aortic Diameter
Authors: Kanaoka Yasushi , Ohgi Shigetsugu , Mori Tohru 
Published: November 2007

As yet no clear criteria are available for differentiation of normal from abnormal abdominal aortic diameter in relation to the development of aortic aneurysm. The purpose of this study was to elucidate the age-related changes in the abdominal aortic diameter. A total of 194 individuals (97 men and 97 women) aged twenty years or more with no abnormalities in the abdominal aorta on physical examination were measured by B-mode two-dimensional ultrasonography for the maximum anteroposterior diameter of the abdominal aorta. Results were as follows: 1. A multiple regression analysis demonstrated that the age, height, and body weight were factors influencing the aortic diameter. The most significant factor among them was the age (the partial correlation coefficient was +0.811, P<0.01), and the next was the height (the partial correlation coefficient was +0.453, P < 0.01) . 2. The relationship between the diameter and the height was evaluated by stratification of the subjects at ten-year intervals. The correlation coefficients showed significant positive correlations observed in all age groups (P< 0.001) . 3. The relationship between the diameter and the age was studied according to the height by dividing the subjects into five height groups. The correlation coefficients showed significant positive correlations observed in all height groups (P < 0.001 ) .
Noninvasive Estimation of the Internal Mammary Artery Bypass Graft Patency
Authors: Ciccone Marco , di Noia Domenico , Corriero Francesco , Federici Antonio , Rizzon Paolo 
Published: November 2007

Echo Doppler of the internal mammary artery (IMA) can be considered a good clinical and diagnostic tool in detecting the flow in the IMA bypass graft. The aim of the present study was to evaluate the reliability of transcutaneous echo- Doppler ultrasonography in the detection of early and long-term pathologies of the IMA bypass graft. The study was carried out on 161 consecutive patients (127 men and 34 women, mean age fifty-two ±ten years) who had undergone surgical myocardial revascular ization by anastomosis of the left IMA pedicle to the left anterior descending coronary artery. All patients underwent echo-Doppler examination in resting conditions, during forced hyperventilation and Valsalva maneuver four times per year. Supine exercise test was performed annually for five years, and selective angiography of the IMA graft (IMAg) was done when symptoms and/or conventional stress test and/or echo-Doppler examination required it. The results showed that, for anatomic reasons only, in 87% (140 patients), it was possible to study the IMAg. In these patients, 16 stenoses ≥ 40%-99%, 5 occlusions, and 3 intercostal steals were detected. These results, compared with selective angiography, showed high sensitivity, specificity, and accuracy of echo-Doppler of the IMAg.
Reconstruction of the Carotid Artery Following Extracorporeal Membrane Oxygenation (ECMO)
Authors: Armainsson Lars T. , Ilbawi Michel N. , Hernandez-Argudin Gonzalo , Ostrowski Diane , Tubeszewski Katherine , Roberson David A. , Ramilo Jose L. , Sulayman Rabi F. 
Published: November 2007

Although ligation of the carotid artery following extracorporeal membrane oxygenation (ECMO) procedures has not been associated with any apparent acute neurologic changes, its long-term sequelae on cerebral function are still unknown. The authors have adopted a policy of repairing all carotid arteries following ECMO. Between April 1990 and June 1993, 34 consecutive patients underwent carotid artery reconstruction. Indications for ECMO were respiratory distress syndrome in 18, meconium aspiration in 8, pneumonia in 6, myocardial failure in 1, and sickle cell anemia in 1. All patients were neonates (ages seventy-two ± sixty-three hours), except 5 (2, three months; 1, two years; and 2, four years old). Duration of ECMO was (mean ± SD, 156 ± 68 hours). Arterial cannulation was performed after extended mobilization of the carotid artery by using a Biomedicus (8- 10F) cannula. Following decannulation the traumatized segment was resected and the artery repaired by means of multiple interrupted nonabsorbable 7-0 sutures. No heparin was given. There were no complications related to repair. Follow-up is available on all patients (7.6 ±4.1 months). Detailed neurologic evalu ation and ultrasound and Doppler studies of the carotid artery were performed on all patients at discharge, at two months, at six months, and at one year following ECMO. All carotid arteries were patent with good flow, except one. Transient communicating hydro cephalus developed in 1 patient but responded readily to medical treatment. The rest have normal-for-age neurologic evaluation. The authors' experience suggests that carotid reconstruction following ECMO is feasible, safe, and probably advantageous in the long term. Further follow-up is necessary before this technique can be applied to all infants undergoing ECMO procedure.
Long-Term Prevention of Sequelae of Chronic Venous Disease with Graduated-Compression Stockings
Authors: Hanley Terrance P. , Kiev Jonathan , Rice Janet C. , Kerstein Morris D. 
Published: November 2007

Chronic venous insufficiency (CVI) with associated venous hypertension may lead to stasis dermatitis and ulceration. This sixty-month study determined whether compliance with the use of below-the-knee graduated-compression hosiery affected long-term clinical manifestations. At one year, 105 patients of 284 (37%) were compliant and 179 (63%) were not. At 2 years, of the available compliant patients (89), none had skin changes; 28% of the available (51) noncompliant patients had skin changes; and 13 of this group (51) had ulceration. At sixty months, of 79 compliant patients available, none had ulceration and 11 had stasis changes. Of noncompliant patients (119) available for assessment, 63 (53%) have chronic skin changes. Compliance with the use of gradient compression below-the-knee stockings reduces the incidence of venous stasis disease and ulceration.
Laparotomy for Presumed Ruptured Abdominal Aortic Aneurysm: Outcome of Deceptive Emergencies
Authors: Melin Matthew M. , Gloviczki Peter , Cherry Kenneth J. , Bower Thomas C. , Hallett John W. , Baerga Yvonne , Zietlow Scott P. , Stanson Anthony W. 
Published: November 2007

Medical and surgical emergencies occasionally present as ruptured abdominal aortic aneurysms (RAAA). To assess benefits of laparotomies and adverse effects of unnecessary operations, the authors reviewed their experience. Thirteen patients, 9 women, 4 men (mean age: 72 years, range: 41-85) underwent emergency laparotomy between 1988 and 1996 for presumed RAAA and were found to have other surgical or medical emergencies. All the patients presented with hypotension, 12 had abdominal or back pain, four had pulsatile abdominal mass. Rupture was not excluded by computed tomography scan in three or by ultrasonography in two patients. Laparotomy disclosed intact abdominal aorta in all, but seven patients had abdominal aortic aneurysm. Of five surgical emergencies, laparotomy was indicated in four: three for ruptured visceral artery aneurysms, one for perforated duodenal ulcer. The fifth patient required thoracotomy for ruptured thoracic aneurysm. Four of eight medical emergencies were myocardial infarctions. One iatro genic complication required reoperation for bleeding. Mean hospital stay was 18 days; mean hospital charges were $40,771. Seven (54%) early deaths occurred; none were caused directly by the operation. Laparotomy was indicated in one third of deceptive emergencies that present as RAAA. Although mortality, morbidity, and costs were high, iatrogenic surgical complica tions were rare and deaths were not caused by unnecessary operations.
How Essential Is the Intensive Care Unit After Carotid Endarterectomy?
Authors: Collier Paul E. 
Published: November 2007

This study was designed to determine whether a short recovery room stay could safely and accurately predict which patients required the Intensive Care Unit (ICU) after carotid endarterectomy (CEA). After review of the records of all patients who underwent CEA at the author's insti tution between 1988 and 1990, a set of criteria was developed for selecting which patients required the ICU postoperatively. These indications included postoperative neurologic changes, cardiac irritability or ischemia, prolonged need for vasoactive medication, and wound hematomas that might compromise the patient's airway. Between January 1, 1991 and June 30, 1996, 342 CEAs were performed at the author's institution. Forty-two (12%) patients required the ICU postoperatively; 23 had unstable blood pressure, seven had cardiac problems, 10 had neurologic problems (7 permanent, 3 transient), and three had neck hematomas. One patient originally in the ICU for hypertension was transferred back after developing an intracerebral hemorrhage on postoperative day 2, and one patient was transferred into the ICU for unstable blood pressure that developed on the vascular floor. Preoperative risk factors, indications for operation, and anesthetic technique did not predict which patients would need the ICU. Two patients died within 30 days. There were no readmissions after discharge. Selection of patients for ICU admission after CEA can be safely and accurately deter mined during a 3-hour stay in the recovery room postoperatively. This selection results in efficient use of ICU resources and tremendous cost savings. By adherence to the protocol, 88% of patients did not need ICU after CEA.
Office Removal of Silastic Catheters and Ports is Safe and Cost Effective
Authors: Collier Paul E. 
Published: November 2007

Dual-lumen Silastic catheters and ports are being increasingly implanted for long-term infusion of medications and hyperalimentation and for dialysis. These have traditionally been removed in the operating room. The purpose of this study was to determine whether these catheters and ports could be removed safely in the surgeon's office. The records of all 42 patients who had their catheters and ports removed in the operating room in 1991 were reviewed. No episodes of pulmonary or air embolism, bleeding problems, infections, or returns to the Emergency Department after removal were reported. One seroma developed in a port site after removal. No reason could be found for not doing these procedures in the surgeon's office. Between January 1, 1992 and July 31, 1996, 169 catheters were removed in the office. Forty-nine ports were removed in the office and 12 were removed in an outpatient surgery center by one surgeon who did not feel comfortable doing this procedure in the office. No patients suffered any embolic or bleeding complications, and none returned to the office or Emergency Department for problems. One patient developed a persistent draining sinus after removal of a contaminated catheter. Surgical charges were $273 for removal in the office or operating room. Charges for use of the surgery center were $1,000. Office removal of Silastic catheters and ports is extremely safe and cost efficient. This method results in convenience for the patient and saves time for the surgeon.
Investigation of Laboratory Parameters in Primary Raynaud's Phenomenon: Their Changes and Clinical Significance
Authors: Dalamanga Androniki , Dimakakos Panos , Kostoglou-Papalambrou Maria , Papageorgiou Anthony , Davea-Mela Filanthi , Rizos Demetrios 
Published: November 2007

Results were as follows: 77 (62%) patients had cryofibrinogen in their blood plasma, 50 (40%) patients had precipitation of cryoglobulins, and 65 (52%) patients had an increase of α2 globulin in the serum electrophoresis. Of the immunoglobulins, IgM was found increased in 42 patients (34%). Of the clotting time inhibitors, antithrombin III (AT III) had a lower activity in 50 (40%) patients as compared with that of normal subjects. Protein C, protein S, and α1 antitrypsin levels were lower in 21 (16.8%), 13 (10.4%), and 10 (8%) of patients, respectively. Statistical analysis of the results showed that all the protein fractions except for γ-globulin presented a statistically significant difference as compared with those of the controls (P < 0.0001). Immunoglobulins IgG and IgA of the patients were significantly lower than those of the normal controls (P < 0.001). The C3 and C4 factors of the complement presented statistically significant lower values (P < 0.001 and P < 0.0001 respectively). Finally, AT III appeared in lower values than those of the normal controls, being statistically significant (P < 0.0001). These results suggest that patients with primary Raynaud's phenomenon present changes in the levels of certain hematologic parameters, a fact that is probably connected with etiology. Thus further study and assessment might contribute to the diagnosis, discovery of the subjective systemic etiology, and better therapeutic management of Raynaud's phenomenon.
Failed Vascular Reconstructive Procedures with Profoundly Ischemic Limbs—Treated by Lumbar Sympathectomy
Authors: Polsky Stuart , Heller Lloyd , Gahtan Vivian , Roberts Andrew , Sariego Joaquin , Matsumoto Teruo , Kerstein Morris D. 
Published: November 2007

The purpose of this study was to assess the impact of lumbar sympathectomy on limb loss in patients with prior reconstructive vascular surgery. One hundred and one patients underwent 118 lumbar sympathectomies. The 118 limbs were grouped presympathectomy into: rest pain (41), tissue breakdown (55), and gangrene (22). All vascular procedures were femoral-popliteal or femoral-distal bypass. No change in segmental Doppler pressures occurred after lumbar sympathectomy. Sixty-nine of 118 (58%) limbs underwent amputation following sympathectomy, a mean of two (range: one to twenty-two) months following the procedure. Of those limbs with an amputation (69/118), 14/69 (20%) had one reconstructive procedure, 41/69 (60%) had two reconstructive procedures, and 14/69 (20%) had three reconstructive procedures. Of those without an amputation (49/118 limbs), 27 had one vascular recon structive procedure, 9 had two reconstructive procedures, and 3 had three reconstructive procedures before sympathectomy. (continued on next page) Of the patients with diabetes (47), 44/47 (94%) underwent amputation, 35/44 (80%) with below-the-knee and 9/44 (20%) with above-the-knee amputation. Limb loss (69 limbs) by category was: rest pain, 21/41 (51%); nonhealing ulcers, 38/55 (69%); and gangrene, 10/12 (83%). Lumbar sympathectomy may be a useful procedure in very selected patients; diabetic patients who undergo reconstructive vascular surgery are not good candidates. Segmental Doppler pressures do not help predict successful or improved outcome following lumbar sympathectomy.
Comparison of Saphenous Veins Removed for Primary Venous Insufficiency with Cadaver Saphenous Veins
Authors: Ortega Francisco , Mompeo Blanca , Sarmiento Lourdes , Centol Aurelia , Saavedra Pedro , Bergan John J. 
Published: November 2007

The purpose of this study was to determine the location of valves and to assess valve abnormalities in veins removed for treatment of primary venous insufficiency and cadaver saphenous veins. Twenty-nine saphenous veins from lower extremities of adult cadavers and 39 greater saphenous veins obtained from patients undergoing surgery for primary venous insufficiency were examined. Extremities were chosen from cadavers with no signs of chronic venous insufficiency. All greater saphenous veins from patients were demonstrated to have reflux throughout the length of the greater saphenous vein from ankle to groin. The total number of valves in surgically removed saphenous veins and those in cadavers was similar—cadaver 8.82 ± 1.31, varicose 8.79 ± 1.67. Varicose saphenous veins had more abnormal valves (2.56 ±1.23 vs 1.51 ±1.18) and the cadaver saphenous veins had more well-preserved valves above the knee (4.45 ±1.27 vs 3.00 ±1.41). Varicose saphenous veins demonstrate fewer valves in total and more damaged veins in the above-knee segment than a comparable group of cadaver saphenous veins. The cadaver saphenous veins and varicose saphenous veins below the knee are similar with regard to total number of valves and total number of damaged valves.
Histologic Evidence Suggesting That the Right Gastroepiploic Artery is Less Suitable and Less Long Lasting Than the Internal Mammary if Used as a Bypass Conduit
Authors: Ferro Maurizio , Forni Marco , Crivello Roberta , Palladin Daniela , Conti Maggiorino , Palestro Giorgio 
Published: November 2007

This study compares the thicknesses of the intima and media and their ratio in the right gastroepiploic (GEA), internal mammary (IMA), left coronary (LCA), and renal (RA) arteries as part of a histologic study of the structure of these vessels at necropsy in 11 newborns aged twenty-one ±22.6 days. No significant differences were found between the LCA and the other arteries, apart from its media thickness and that of the IMA (P = 0.023). The media was thinnest in the IMA, thickest in the LCA. The values for the GEA were much the same as those for the LCA. The particular structure of the IMA compared with the LCA and GEA, evident in the newborn, explains its resistance to atherosclerotic deposition. The fact that the structure of the GEA is similar to that of the LCA indicates that its resistance to atherosclerosis will be less than that of the IMA when used as a bypass conduit.
Generation of Reactive Oxygen Metabolites by the Layers of Vascular Polyester Grafts
Authors: Glowinski Jerzy , Glowinski Stanislaw , Farbiszewski Ryszard , Chwiecko Marek 
Published: November 2007

The continuous exposure to blood components, including pro-oxidants, makes the blood vessel wall susceptible to oxidative stress and free-radical-mediated reactions.The aim of this study was to determine the ability of reactive oxygen metabolite generation, expressed by the content of malonaldehyde (MDA) and 4-hydroxyalkenals in principal layers of polyester grafts during 12 months' observation. The experiments were carried out on 24 mongrel dogs, in which polyester grafts were implanted into abdominal aorta. Seven days and 1, 4, and 12 months after the operation the grafts were excised. The MDA and 4-OH-alkenal concentrations were determined by the LPO-586 method (Bioxytech, France). It was found that the MDA concentration in the graft neointima was much higher than in the aorta in the early phase after the operation (P<0.01). With the passage of time this concentration decreased and after 4 months was similar to the values of the normal aorta. On the other hand the MDA concentration in the neomedia and neoad ventitia was much higher than in their aorta counterparts and became even higher in later periods (P<0.01). (continued on next page) The investigations indicate that the generation of large amounts of lipid peroxides in graft neointima occurs only in the early postoperative period. However, intensive lipid peroxidation in neomedia and neoadventitia was observed throughout the whole exper iment. These changes can suggest that the reactive oxygen metabolites in graft principal layers are generated by neutrophils, while endothelial cells are of less importance.
Conclusions of a Consensus Conference on Subfascial Endoscopy of Perforating Veins in the Medial Lower Leg
Authors: Fischer Reinhard , Schwahn-Schreiber Christine , Sattler Gerhard 
Published: November 2007

On June 1, 1996, a workshop of the Association for Fasciotomy and Endoscopy (AFE) in Venous Surgery with predominantly German-speaking participants took place in Natters/Innsbruck/Austria. At present, a considerable number of endoscopes are used for subfascial endoscopic perforator vein surgery (SEPS). Five of those in most common use were discussed at the consensus meeting. These included the Hauer instrument (ETB Berlin), the Sattler and Lang instruments (Storz, Tuttlingen), the Langer instruments (Wolf Knittlingen), and laparoscopic instruments as used in Australia and the United States (Ethicon). All of these use TV endoscopic monitoring. Only the Fischer instrument (Storz, Tuttlingen) is designed for direct vision without video monitoring. Indications for SEPS range from isolated incompetent perforating veins with or without greater saphenous system varicosities to third-degree chronic venous insufficiency (CVI), which includes venous ulceration and lipodermatosclerosis. The latter is the most important indication. The advantage of SEPS is that diagnosis of perforator incompetence and surgical obliteration of the perforators can be done simultaneously through one or more small remote incisions away from the trophic skin changes. The SEPS technique is now beginning to be used worldwide. The AFE conference was a valuable and informative meeting that provided a venue for discussion of indications, technique, and complications.