bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem?
Authors: Wald Heidi L. , Epstein Anne M. , Radcliff Tiffany A. , Kramer Andrew M. 
Published: December 2007

Objectives.To explore the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters.Design.Retrospective cohort study.Setting.US acute care hospitals and skilled nursing facilities.Patients.A total of 170,791 Medicare patients aged 65 years or more who were admitted to skilled nursing facilities after discharge from a hospital with a primary diagnosis code indicating major cardiac, vascular, orthopedic, or gastrointestinal surgery in 2001.Main Outcome Measures.Patient-specific 30-day rate of rehospitalization for urinary tract infection (UTI) and 30-day mortality rate, as well as the risk of having an indwelling urinary catheter at the time of admission to a skilled nursing facility.Results.A total of 39,282 (23.0%) of the postoperative patients discharged to skilled nursing facilities had indwelling urinary catheters. After adjusting for patient characteristics, the patients with catheters had greater odds of rehospitalization for UTI and death within 30 days than patients who did not have catheters. The adjusted odds ratios (aORs) for UTI ranged from 1.34 for patients who underwent gastrointestinal surgery (P<.001) to 1.85 for patients who underwent cardiac surgery (P<.001); the aORs for death ranged from 1.25 for cardiac surgery (P= .01) to 1.48 for orthopedic surgery (P= .002) and for gastrointestinal surgery (P< .001). After controlling for patient characteristics, hospitalization in the northeastern or southern regions of the United States was associated with a lower likelihood of having an indwelling urinary catheter, compared with hospitalization in the western region (P= .002 vsP= .03).Conclusions.Extended postoperative use of indwelling urinary catheters is associated with poor outcomes for older patients. The likelihood of having an indwelling urinary catheter at the time of discharge after major surgery is strongly associated with a hospital's geographic region, which reflects a variation in practice that deserves further study.
Randomized Controlled Trial and Meta-analysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of Ventilator-Associated Pneumonia
Authors: Tantipong Hutsaya , Morkchareonpong Chantana , Jaiyindee Songyod , Thamlikitkul Visanu 
Published: December 2007

Objective.To determine the effectiveness of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia (VAP).Design.Randomized controlled trial and meta-analysis.Setting.A tertiary care university hospital in Bangkok, Thailand.Participants.Adult patients who received mechanical ventilation and who were hospitalized in intensive care units and general medical wards.Methods.The patients were randomized to receive oral decontamination with 2% chlorhexidine solution or normal saline solution 4 times per day until their endotracheal tubes were removed. The outcome measures were the development of VAP and oropharyngeal colonization with gram-negative bacilli. Meta-analysis was performed by combining the results of the present study with those from another randomized controlled trial that also used a 2% chlorhexidine formulation for oral decontamination.Results.The characteristics of the patients in the chlorhexidine group (n= 102) and the normal saline group (n= 105) were not significantly different. The incidence of VAP in the chlorhexidine group was 4.9% (5 of 102), and the incidence in the normal saline group was 11.4% (12 of 105) (P= .08). The rate of VAP in the chlorhexidine group was 7 episodes per 1,000 ventilator-days, and the rate in the normal saline group was 21 episodes per 1,000 ventilator-days (P= .04). Irritation of the oral mucosa was observed in 10 (9.8%) of the patients in the chlorhexidine group and in 1 (0.9%) of the patients in the normal saline group (P= .001). Oropharyngeal colonization with gram-negative bacilli was either reduced or delayed in the chlorhexidine group. Overall mortality of the patients did not differ significantly between the groups. Meta-analysis of 2 randomized controlled trials revealed an overall relative risk of VAP for patients in the chlorhexidine group of 0.53 (95% confidence interval, 0.31-0.90;P= .02).Conclusion.Oral decontamination with 2% chlorhexidine solution is an effective and safe method for preventing VAP in patients who receive mechanical ventilation.
Remarks on Extensions of the Himmelberg Fixed Point Theorem
Authors: Komiya Hidetoshi , Park Sehie 
Published: December 2007

AbstractRecently, Jafari and Sehgal obtained an extension of the Himmelberg fixed point theorem based on the Kakutani fixed-point theorem. We give generalizations of the extension to almost convex sets instead of convex sets. We also give generalizations for a large class "Equation missing" of better admissible multimaps instead of the Kakutani maps. Our arguments are based on the KKM principle and some of previous results due to the second author.
On the Question of the Stylistic Influences reflected in the Architecture and Art of Chersonesos: 'Snake-legged Goddess' or Rankenfrau
Authors: Buiskikh Alla 
Published: December 2007

AbstractThis article is devoted to the publication of two Sofa-capitals from Chersonesos, to their stylistic analysis and date. The study of the decorative motifs and compositional structure of these architectural details has made it possible to propose various ideas as to how they might have made their way into the architecture of Chersonesos – via mainland Greece and Asia Minor. Of particular interest is the Sofa-capital bearing a depiction of a Rankenfrau in relief. This decorative motif was interpreted over a long period as the "snake-legged goddess", who embodied the mythical progenitrix of the Scythians in examples of Graeco-Scythian metalwork and consequently provided the basis for conclusions regarding the anthropomorphization of Scythian art. New analysis of well-known depictions of the Rankenfrau in examples of North-Pontic metalwork – gold plaques originating from Chersonesos, the Bosporan Kingdom and the Dnieper region – enables us to agree with those authors who had called attention to the absence of "snake-like" features in these artefacts. At the present time various artefacts from the material culture of the North Pontic region have been coming to light which, while containing the decorative motif of the Rankenfrau brought in from Asia Minor in the second half of the 4th Century BC, are not linked in any way with the mythical Great Goddess of the Scythians.
Academician G. F. Miller and the Treasures from Litoi Kurgan
Authors: Tunkina Irina 
Published: December 2007

AbstractThe burial-mound "Litoi Kurgan" was excavated in 1763 on the instructions of Lieutenant-General A.P. Mel'gunov 30 metres from the fortress of Saint Elizabeth (now known as Kirovograd, Ukraine). It cotained an assemblage of gold and silver articles of the Early Scythian period: examples of oriental metal-work and articles which had been fashioned in the traditions of the Scythian Animal Style. The prestigious nature of these finds was on a par with the grave-goods found in royal Scythian burial-mounds. The artefacts were presented to Empress Catherine II, who commanded that Academician G.F. Miller (1705-1783) should draw up a description of them and that they should be held in the Kunstkammer of the St. Petersburg Academy of Sciences. One hundred years later the hoard was transferred in installments to the Hermitage Museum. In this article information regarding the assemblage from the Litoi Kurgan site is pieced together on the basis of archive documents and publications dating from the 18th and 19th century. Modern interpretations of this information and attempts to date the finds are also included: some of the artefacts were transferred from the Hermitage to museums in Kharkov and then lost during the Second World War. It is precisely with the excavations of the Litoi Kurgan burial-mound that the birth of a separate branch of archaeology is associated – namely Scythian studies. Litoi Kurgan is one of the sites from the Scythian Archaic period, which link together the Dnieper region and the Northern Caucasus. It is possible that it is a cenotaph burial-mound associated with the era of the Scythian campaigns into the Near East and dating from the second half of the 7th century BC.
Seashells and Nomads of the Steppes (Early Scythian Culture and Molluscs of the Cyprea family in Eastern Europe)
Authors: Bruyako Igor 
Published: December 2007

AbstractThis article is devoted to the question of the sudden and relatively large-scale spread of pendants made of cowrie shells, which is to be observed in the southern parts of Eastern Europe in the Early Scythian period – the 7th-6th Centuries BC. The traditional use of these shells was characteristic of the population of the cultures and civilizations of the Ancient East starting in the Neolithic and Chalcolithic periods. The appearance of cowrie shells in Eastern Europe is associated with the spread in this part of the world of sites of the Early Scythian Culture: the Early Scythians had adopted this kind of adornment during the Cimmerian-Scythian campaigns into Transcaucasia and the Near East in the 7th Century BC.
Femoral Tunnel Placement in Single-Bundle Anterior Cruciate Ligament Reconstruction
Authors: Rue John-Paul H. , Ghodadra Neil , Bach Bernard R. 
Published: December 2007

Background There is controversy regarding the necessity of reconstructing both the posterolateral and anteromedial bundles of the anterior cruciate ligament. Hypothesis A laterally oriented transtibial drilled femoral tunnel replaces portions of the femoral footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Study Design Descriptive laboratory study. Methods Footprints of the anteromedial and posterolateral bundles of the anterior cruciate ligament were preserved on 7 matched pairs (5 female, 2 male) of fresh-frozen human cadaveric femurs (14 femurs total). Each femur was anatomically oriented and secured in a custom size–appropriate, side-matched replica tibia model to simulate transtibial retrograde drilling of a 10-mm femoral tunnel in each specimen. The relationship of the tunnel relative to footprints of both bundles of the anterior cruciate ligament was recorded using a Microscribe MX digitizer. The angle of the femoral tunnel relative to the vertical 12-o'clock position was recorded for all 14 specimens; only 10 specimens were used for footprint measurements. Results On average, the 10-mm femoral tunnel overlapped 50% of the anteromedial bundle (range, 2%–83%) and 51% of the posterolateral bundle (range, 16%–97%). The footprint of the anteromedial bundle occupied 32% (range, 3%–49%) of the area of the tunnel; the footprint of the posterolateral bundle contributed 26% (range, 7%–41%). The remainder of the area of the 10-mm tunnel did not overlap with the anterior cruciate ligament footprint. The mean absolute angle of the femoral tunnel as measured directly on the specimen was 48° (range, 42°–53°) from vertical, corresponding to approximately a 10:30 clock face position on a right knee. Conclusion Anterior cruciate ligament reconstruction using a laterally oriented transtibial drilled femoral tunnel incorporates portions of the anteromedial and posterolateral bundle origins of the native anterior cruciate ligament. Clinical Relevance A laterally oriented transtibial drilled femoral tunnel placed at the 10:30 position (1:30 for left knees) reconstructs portions of the anteromedial and posterolateral bundles of the anterior cruciate ligament.
Open Reduction and Posterior Capsular Shift for Cases of Neglected Unreduced Posterior Shoulder Dislocation
Authors: El Shewy Mohamed Taha , El Barbary Hassan Magdy , El Meligy Yasser Hassan , Khaled Sherif Ahmed 
Published: December 2007

Background Neglected unreduced posterior shoulder dislocation is a challenging orthopaedic problem. Purpose To evaluate the results of open reduction with posterior cruciate capsular repair for such cases. This corrects the wide posterior capsule, which is the main pathologic entity. Study Design Case series; Level of evidence, 4. Methods Over a period of 5 years, 17 patients with unreduced neglected posterior shoulder dislocation with an impression fracture involving less than 25% of the humeral head were treated by open reduction together with posterior cruciate capsular repair as described by Neer. The patients’ average age was 48.5 years (range, 32.5–66 years). There were 14 men and 3 women. The dominant shoulder was affected in 14 cases. Results After a minimum follow-up of 5 years (range, 5–10 years), the average UCLA score improved from 18 preoperatively to 33 postoperatively. The average modified Rowe score changed from 42.2 to 78.4 points. The American Shoulder and Elbow Surgeons Shoulder score showed an average of 40.3 points preoperatively and an average of 79.8 points at final follow-up. Three patients developed late osteoarthritic changes. Two had changes of mild degree, and 1 needed a total shoulder replacement. Conclusion Open reduction with posterior cruciate capsular repair offers a good solution for the problem of neglected unreduced posterior shoulder dislocation excluding cases with osteoarthritic changes and those with impression fracture involving less than 25% of the head.
Stent-Assisted Gugliemi Detachable Coil Repair of Wide-Necked Renal Artery Aneurysm Using 3-D Angiography
Authors: Clark Timothy W. I. , Sankin Alex , Becske Tibor , Nelson Peter Kim , Fox Martin 
Published: December 2007

Purpose To report a wide-necked renal artery aneurysm treated successfully with stent-assisted Gugliemi detachable coil occlusion, assisted by three-dimensional (3-D) angiography. Case Report A 56-year-old woman with history of hypertension presented with a 2.5-cm wide-necked saccular aneurysm involving her distal right renal artery. A balloon-expandable stent was positioned across the neck of the aneurysm and multiple Gugliemi detachable coils were deployed through a microcatheter inserted through the interstices of the stent into the aneurysm sac, guided by 3-D angiography. Follow-up 3-D angiography at 6 months revealed a patent renal artery with continued exclusion of the aneurysm and preservation of renal blood flow. Conclusion Stent-assisted coil occlusion assisted by 3-D angiography is a potential renal-sparing endovascular approach to treating wide-necked renal artery aneurysms with complex vascular anatomy.
Acute Thrombosis of a Mesenteric Artery Drug-Eluting Stent Following Clopidogrel Cessation
Authors: Sutphin Daniel , Stevens Scott , Kirzeder Daniel , Gash Judson 
Published: December 2007

Learning Objective To describe thrombosis of sirolimus-coated mesenteric arterial stents following cessation of clopidogrel therapy. Background Cardiac drug-eluting stent thrombosis following cessation of antiplatelet therapy with clopidogrel has been associated with increased mortality. The application of such stents in the mesenteric arterial system and the subsequent need for clopidogrel therapy has not been studied. This is the first case report of acute thrombosis of a drug-coated stent in the mesenteric circulation. Clinical Findings Acute mesenteric ischemia secondary to thrombosis of a mesenteric arterial stent following clopidogrel cessation is described. Conclusion Drug-eluting stents represent an option for mesenteric revascularization in the surgically complicated abdomen. As in the setting of cardiac stenting, acute thrombosis of these devices following cessation of clopidogrel therapy is a concern. Indefinite clopidogrel therapy following deployment of drug-coated stents should be considered.
Reliability of Selective Surveillance Colonoscopy in the Early Diagnosis of Colonic Ischemia After Successful Ruptured Abdominal Aortic Aneurysm Repair
Authors: Megalopoulos Angelos , Vasiliadis Konstantinos , Tsalis Konstantinos , Kapetanos Dimitrios , Bitzani Militsa , Tsachalis Theodor , Batziou Eleni , Botsios Dimitrios 
Published: December 2007

Purpose To evaluate the reliability of selective surveillance colonoscopy based on 6 specific perioperative risk factors in the early diagnosis of colonic ischemia (CI) after successful ruptured abdominal aortic aneurysm (rAAA) repair. Patients and Methods From 1999 to 2005, 62 consecutive patients underwent rAAA repair. In 59 of them, routine aggressive surveillance colonoscopy was offered every 12 hours within the first 48 hours, and CI was graded consistently. Patients with stage I or stage II CI were treated conservatively and were followed up with repeat colonoscopy, whereas patients with stage III CI underwent immediate laparotomy and colectomy. In parallel, 6 specific perioperative risk factors (PRFs) were retrospectively analyzed. Results Overall mortality was 33.9%. Nineteen patients (32.2%) developed CI and 12 (63.2%) of them survived. Thirteen (22%) had grade III CI and among these 6 survived. In patients with CI the mortality rate was 36.2%. Patients with less than 3 PRFs had no CI whereas all instances of CI could be diagnosed if colonoscopy was offered selectively in patients with more than 3 PRFs. The positive predictive value of CI increased with the number of PRFs. Patients with 5 or 6 PRFs were about 101 times more likely to develop CI compared with patients with 0 to 4 PRFs ( P < .001). Conclusion Our study showed that CI is a frequent complication after successful rAAA repair and could reliably be early diagnosed if surveillance colonoscopy was offered selectively in patients with more than three PRFs.
No Difference in Medium-Term Outcome Between Zenith and Talent Stent-Grafts in Endovascular Aneurysm Repair
Authors: Badger Stephen A. , O'Donnell Mark E. , Loan William , Hannon Raymond J. , Lau Louis L. , Lee Bernard , Soong Chee V. 
Published: December 2007

Background Many devices are available for endovascular aneurysm repair (EVAR). Our aim was to analyze morphological effects of the Zenith and Talent systems. Methods Patients included underwent EVAR from June 1999 to June 2005 using a Zenith or Talent stent-graft, with computed tomography follow-up. Aortic dimensions over time and clinical outcome were analyzed. Results Twenty-nine patients with Zenith stent-grafts and 33 with Talent devices were included. Mean preoperative age was similar (75.5 ± 6.0 years vs 74.2 ± 6.7 years; P = .29). Preoperative neck length was longer in the Zenith group (29.9 ± 15.2 mm vs 25.5 ± 10.8 mm; P = .10), and stent-graft oversizing was greater in the Talent patients (20.2% ± 7.9% vs 23.0% ± 11.3%). There was proximal aortic dilatation and aneurysm sac shrinkage in each group. Complication rates were comparable, with 83% of both groups free from 10-mm migration. Conclusion Although device designs differ, there is no difference in clinical outcome between Zenith and Talent stent-grafts. Migration rates were not influenced by suprarenal fixation.
Metalloproteinase Expression in Carotid Plaque and Its Correlation With Plasma Levels Before and After Carotid Endarterectomy
Authors: Taurino Maurizio , Raffa Salvatore , Mastroddi Massimo , Visco Vincenzo , Rizzo Luigi , Torrisi Maria Rosaria , Faraglia Vittorio 
Published: December 2007

Purpose To assess baseline and follow-up plasma concentrations of metalloproteinase-9 (MMP-9), MMP-2, and tissue inhibitor of metalloproteinase-2 (TIMP-2) in patients undergoing carotid thromboendarterectomy (TEA) in relation to tissue expression and diagnostic features. Basic Methods Using sandwich enzyme-linked immunosorbent assay, plasma levels of enzymes were determined in 15 patients undergoing carotid TEA. Tissue sections were incubated with specific antibodies and fluorescence intensity was analyzed. Principal Findings MMP-9 levels were higher in patients with carotid stenosis versus controls, significantly in those with cerebral lesions at neuroimaging. MMP-9 levels decreased in 93.4% of the patients at 1 month. MMP-2 levels tended to increase 30 days after surgery. TIMP-2 showed no difference. Conclusions High concentrations of MMP-9 found in patients with carotid stenosis and cerebral lesions suggest that MMP-9 assay could be useful in the evaluation of all carotid lesions to help identify those at highest risk of a neurologic event.
Acute respiratory distress syndrome secondary to antisynthetase syndrome is reversible with tacrolimus
Authors: Guglielmi S. , Merz T. M. , Gugger M. , Suter C. , Nicod L. P. 
Published: December 2007

Polymyositis and interstitial lung diseases, predominantly nonspecific interstitial pneumonia (NSIP), are known to be frequent in antisynthetase syndrome, where anti-aminoacyl-tRNA synthetase antibodies are often identified.An unusual case of acute respiratory distress syndrome, secondary to such proven NSIP of cellular type with predominant CD8 lymphocytes, is described herein.The patient described in the present case study initially had a poor recovery with high dose of steroids, but this was followed by a good improvement after the prescription of tacrolimus and a low dose of prednisone.A precise diagnosis in similar circumstances may be life-saving, allowing the successful application of new immunosuppressants.
Clinical relevance ofMycobacterium simiaein pulmonary samples
Authors: van Ingen J. , Boeree M. J. , Dekhuijzen P. N. R. , van Soolingen D. 
Published: December 2007

The aim of the present study was to determine the clinical relevance ofMycobacterium simiaeisolation from clinical samples.The medical files of patients in the Netherlands from whomM. simiaewas isolated between 1999 and 2006 were reviewed in order to assess frequency and clinical relevance. Clinical relevance was defined as fulfilment of the diagnostic criteria of the American Thoracic Society.From the files, 28 patients were identified, of whom six (21%) met the American Thoracic Society diagnostic criteria. A slight (54%) female predominance was observed, which is uncommon for nontuberculous mycobacteria isolation. Fulfilment of the diagnostic criteria and initiation of treatment were not in agreement; treatment results were poor.Only a minority of clinicalM. simiaeisolates are clinically relevant and, applying the American Thoracic Society diagnostic criteria, the number of true infections is overestimated. Physicians in the Netherlands do not always use these criteria in daily practice, resulting in both over- and underdiagnosis ofM. simiaeinfection. Further studies are required in order to improve diagnostic criteria and treatment regimens.