bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extravasation of epirubicin/vincristine and ifosfamide/ mesna from a central venous catheter
Authors: Webster Penelope Jane , D'Souza Deirdre 
Published: November 2007

A 50-year-old female diagnosed with high-grade infil trating ductal carcinoma of the left breast was planned for insertion of a central venous catheter for a 6-week continuous infusion regimen including weekly ifosfamide/mesna alternating with weekly epi rubicin/vincristine via a CADD portable infusion pump; then radiotherapy followed by a further 6 weeks of VIE infusional chemotherapy. The initial 6 weeks of therapy was complicated by infected central venous catheter during week 2. Central venous catheter was removed and chemother apy was administered peripherally. After completion of XRT, a new central venous catheter was inserted and the second cycle of epirubicin/vincristine chemo therapy was commenced. During week 3 of the second cycle the patient developed right neck pain and swelling, which was diagnosed as a haematoma and cellulitis which was treated with cephalexin. The following week she was admitted for intravenous antibiotics and drainage of the haematoma. Exploration of the neck swelling revealed fat necrosis and extravasation of chemother apy into the subcutaneous tissues. Chemotherapy was stopped, and treatment was commenced for extrava sation of an unknown volume of ifosfamide/mesna administered weeks 1 and 3, and epirubicin/vincris tine administered weeks 2 and 4 for unknown period, possibly 3 weeks. The extravasation was treated as per the institu tional policy for anthracycline extravasation; topical dimethyl sulphoxide and cold packs were applied every six hours for 14 days and plastic surgeons were consulted. Central venous catheter was removed 10 days after detection of the extravasation. Inflamma tion and pain resolved slowly over 4 weeks. The patient has had no further chemotherapy, and re mains in CR. There have been no long-term sequelae from the extravasation.
Aspects of quality management: Accuracy in dosing antineoplastic drugs
Authors: Heck Georg , Berger Gabi , Kiemen Ulrike , Latscha Nicole 
Published: November 2007

Introduction. When preparing parenteral antineo plastic preparations, different production techniques are used in hospital pharmacies or oncologic wards. National and International regulations and quality standards define the requirements for drug produc tion, independent of the methods that are used. Materials and Methods. In the present study we compared the precision of a weight-controlled dosing system supported by production and docu mentation software to a conventional volume-con trolled dosing method. The weight-controlled method, where one technician produces the applica tions software-leaded with a connected electronic balance, includes an automatic online control and documentation of each procedure step. The pharma cists role in the production process is reduced to the endcontroller before distributing the drugs. The vol ume-controlled method, mostly used in Germany, is based on dose analogous volume calculation as mea sured by syringes. Lack of automatic control and documentation requires the pharmacist as a control ler at every step of production. To determine the difference in dosing accuracy of both methods, we measured and calculated the deviations of the real from the target doses/masses for both methods. Results. With our weight-controlled method, every single dosage and the cumulative dose for one drug of one patients therapy lay within a 5% deviation limit of the required dose. Without validation of syringe volume and consideration of galenic factors, our volume-controlled method does not consistently meet the deviation limit of 10% required in the pharmacopoeia. Conclusion. The weight-controlled method is superior in dosing accuracy to the conventional method, because syringe-volume deviations, densities of drug solutions, overfillings and other factors are not considered in the volume-controlled method. Only with great expense in manual documentation, the volume-controlled method correspond to the guidelines in Chapters 1, 4, and 5 of the "Guidelines for Good Manufacturing Practice of the European Communities," where requirements on quality assur ance systems, documentation and production are described.
Hypersensitivity to cisplatin on second rechallenge despite a successful first rechallenge
Authors: D'Souza Deirdre C. , Katelaris Connie H. , Harnett Paul R. 
Published: November 2007

Objective. The need for vigilance in patients who exhibit cisplatin drug hypersensitivity, even after successful rechallenge is illustrated. Clinical features. The patient was a 43-year-old woman presenting with relapsed ovarian cancer. On initial presentation 2 years earlier, she had developed a marked allergic reaction on her sixth cycle of cisplatin and cyclophosphamide chemotherapy. She was successfully rechallenged with cisplatin on re lapse, following pretreatment with antihistamines and corticosteroids. On the following cycle she redevel oped a major hypersensitivity reaction with tachycar dia, tachypnoea, hypotension, shakes, sweating and headache acutely into the cisplatin infusion, despite compliance with the previously effective premedica tion regimen. Case progress and outcome. Adrenaline, hy drocortisone, and promethazine were administered intravenously and oxygen and salbutamol were in haled and the patient settled over 10 minutes. Regular oral promethazine therapy was maintained overnight. Further therapy with cisplatin was withheld and the patient went on to complete 4 cycles of single agent paclitaxel, which were well tolerated. Conclusion. Patients exhibiting hypersensitivity reactions to platinum complexes that are successfully rechallenged following steroid and antihistamine pre- medication are still potentially at risk of systemic reactions. Vigilant patient care should be maintained on subsequent cycles and adrenaline, corticosteroids and antihistamines should be made available on stand-by.
A clinical and economic drug usage evaluation of prophylactic G-CSF in non-Hodgkin's lymphoma
Authors: Howitt Karen M , Matthews Jane P 
Published: November 2007

Objective. To identify if prophylactic granulocyte colony-stimulating factor (G-CSF) delivers the same clinical outcome and level of cost-effectiveness in general clinical use as it has under controlled clinical trial conditions in patients with non-Hodgkin's lym phoma. Method. A 6-month prospective study of all patients eligible to receive prophylactic G-CSF for supportive treatment for non-Hodgkin's lymphoma was performed. Outcomes measured included occur rence of febrile neutropenia, length of hospital stay, and cost of admission. The critical values of key pharmacoeconomic parameters were calculated for this patient group and compared with the actual values obtained. Results. The use of G-CSF in all 99 courses, for 35 patients, complied with funding guidelines. Pro phylactic G-CSF was prescribed most frequently for chemotherapy courses which were most likely to result in febrile neutropenia. The percentage of che motherapy courses associated with febrile neutrope nia in patients who did not receive G-CSF increased significantly with treatment intensity. Prophylactic G-CSF appeared to be cost-effective for patients re ceiving high intensity chemotherapy but not for other patients. Conclusion. Clinicians at our institute use G- CSF where clinical benefits are most likely to be obtained. The use of prophylactic G-CSF is more cost-effective than using therapeutic G-CSF to treat febrile neutropenia in high risk patients. The contin ued funding of prophylactic G-CSF for non-Hodgkin's lymphoma is justified clinically and economically in patients receiving intensive chemotherapy.
Rationalisation of chemotherapy services in the University Hospital Birmingham National Health Science Trust
Authors: Baker James P. , Jones Sarah E. 
Published: November 2007

Objectives. To audit chemotherapy prescribing in out-patient clinics in order to develop a novel ap proach for the provision of chemotherapy services to peripheral clinics. Method. Two audits of CMF (cyclophospha mide, methotrexate, and 5-fluorouracil) chemother apy were performed to initially determine the feasi bility and cost effectiveness of a centralised chemotherapy service. Subsequently, an audit was performed to develop a system for the rationalisation of chemotherapy prescribing using dose-banding. Results. The results from the first audit showed that of the 97 courses of chemotherapy prescribed in the peripheral out-patient clinic, 13.5% were de ferred. All deferred chemotherapy was reissued amounting to a saving of £681.00 over the 6 months studied. The second audit compiled data from 380 courses of CMF and enabled a dose-banding system to be developed. A system was devised so that an agreed 5% variance from the dose prescribed enabled pre filled chemotherapy syringes to be supplied, with no more than two syringes being used per dose. Conclusion. In conclusion, the prefilled syringe programme has improved patient waiting times, re duced drug wastage, and has enabled rationalisation of chemotherapy services in this health district.
Statement of Policy
Authors: Boyd A. Michael , Kalmansohn Robert B. , Kalmansohn Richard W. 
Published: November 2007

As a new policy of the Journal, the Board of Editors have decided to invite views of noted experts in the field of actual and controversial problems in vascu lar diseases. These views will be presented as "special editorials." These editorials do not necessarily reflect the consensus of the Board of Editors of the Journal, and the Board will make no efforts to impose its views on them. They are intended to present individual opinions from the leaders of our profession. We will also invite and, if possible, provide a place in the Journal for the expression of opposite viewpoints.
Mural Thrombosis After Experimental Carotid Endarterectomy
Authors: Pollak Erich W. , Webber Milo M. , Pollak Erich W. 
Published: November 2007

The incidence of mural thrombosis following three types of experimental intimal injuries at common carotid arteries, was investigated in a series of 12 dogs. Mural thrombosis was obtained at each of the intimal lesions. Moreover, obstructive thrombosis occurred in three instances. Further investigation of thrombi revealed that partial fragmentation occurred when exposed to hydrodynamic forces. These results suggest that mural thrombosis following carotid endarterectomy in humans, is possibly more frequent and significant than it is generally appreciated, thus leading to the consideration of postoperative anticoagulation after endarterectomy, as a means to minimize the incidence of postoperative embolic cerebrovascular accidents.
Arterial Emboli and Malignant Disease
Authors: Acharya Govind , Garick Edward , Acharya Govind 
Published: November 2007

Four cases of Arterial Emboli are reported. Association is suggested be tween peripheral arterial emboli and malignant disease. No definite mecha nism for this association has been established but a malignancy-induced alteration of the clotting mechanism is postulated. In any general hospital, peripheral arterial embolization is not an uncom mon event. Immediate therapy since the introduction of the Fogarty catheter, has become fairly standardized and has been very successful in salvaging ischemic limbs. The long-range outlook, however, is dependent on the identification of the source of emboli and the institution of appropriate corrective or preventive measures. In many clinical reviews of peripheral arterial embolization, the probable source of the embolus could be reasonably established in 90% of the cases. Nevertheless, in each series there remains 10% of cases in which no source of embolus could be identified. 1 Over the past two years at The Memorial Hospital we have accumulated a series of patients with peripheral arterial embolization and all of whom had proven malignancies. We are presenting this series as a postulated causative association between peripheral arterial embolization and the malignant state.
Recurrent Thoracic Outlet Syndrome Following First Rib Resection
Authors: Sanders Richard J. , Monsour James W. , Gerber William F. 
Published: November 2007

Five years ago, a follow-up study of first rib resections in patients with the thoracic outlet syndrome (TOS) disclosed a recurrence rate of over 15%. Many patients were re-explored supraclavicularly, and in every case the anterior scalene muscle was found reattached to the bed of the first rib. The invariable success of scalenectomy led to a study of this procedure as the first operation for all cases of persistent thoracic outlet syndrome. Most patients with TOS gave a history of neck trauma and had symptoms of paresthesias of the hands and weakness of the arms, as well as neck pains and headaches. The common physical findings were tenderness over the scalene muscles and duplication of symptoms with the arms raised. A scalene muscle block with a local anesthetic was the most useful diagnostic test. The good to excellent long-term results following 239 scalenectomies and 214 first rib resections were almost identical, 68% and 69% respectively, with fair results in 20% and 13% respectively.
Reconstructive Surgery for Combined Aortofemoral and Infrafemoral Occlusion
Authors: Nakata Yukifumi 
Published: November 2007

In reconstructive surgery for combined aortoiliac and infrafemoral occlu sion, there are many reports that only proximal repair with profunda plasty has resulted in a symptomatic improvement.1-5 However, the 5-year patency and the limb salvage rate were low, and some surgeons have reported that many patients had remained without symptomatic improvement. 6-11 This study was made to assess the indication for subsequent repair in peripheral combined lesions and report the prognosis in the reconstructive surgery for tandem lesions.
The Side-to-Side Femoral Anastomosis for Combined Segment Disease
Authors: Poole Galen V. , Goco Ismael , Meredith J. Wayne , Hightower Felda 
Published: November 2007

Combined aortoiliac and femoropopliteal occlusive arterial disease is the most common pattern of atherosclerosis in patients requiring inflow proce dures for ischemic symptoms in the lower extremities. Although most of these patients will be improved by aortobifemoral bypass grafting, subsequent femoropopliteal or distal bypass is often required to save the limb or to relieve rest pain or claudication. Numerous preoperative, noninvasive criteria and derived indices have been used to predict the success of inflow procedures in combined segment disease. Some are partially successful, but none have proved to be adequately sensitive or specific. Because of the inability to foretell which patients with aortoiliac and femoropopliteal occlusive disease will need a "downstream" repair following an inflow procedure, and because of the difficulty and occasional hazards of secondary groin dissection for arterial operations, one of us (IG) has developed a technique of aortofemoral reconstruction that greatly facilitates subsequent femoropopliteal bypass in patients with combined segment disease.
Streptokinase Therapy in Arterial Thromboembolic Disease
Authors: Lally Michael E. , Marrangoni Albert G. , Pellegrini Ronald V. 
Published: November 2007

A review of the world literature on streptokinase treatment of arterial thromboembolic disease is presented, followed by two cases of peripheral arterial thromboembolic disease successfully treated with streptokinase. The role of streptokinase in the treatment of arterial occlusive disease is discussed, and its emerging role as a primary mode of therapy in thromboembolic arterial disease is predicted. The successful management of venous embolic and occlusive disease by treatment with streptokinase is well-known, including its use in treating pul monary emboli, deep venous thromboses and clotted hemodialysis shunts. However, the role of streptokinase in the management of arterial thromboem bolic disease has not received much attention in the United States, although it has been used extensively in Europe. The purpose of this paper is to review the literature on the use of strep tokinase in treating thromboembolic arterial disease, to present two cases successfully treated with this technique, and to discuss the emerging role of streptokinase in arterial thromboembolic disease.
Dextran in Vascular Surgery
Authors: Bergentz Sven-Erik , Bergqvist David 
Published: November 2007

Dextran is a colloid, composed of chain of glucose molecules. These chains are formed by an enzymatic action of the bacteria leuconostoc mesenteroides on sucrose.1 The molecular weight of these molecules can be several millions, but to be used clinically it should not exceed 100.000. A decrease in the molecular weight can be accomplished by fractionation of the molecules. On the other hand the molecular weight should not be lower than about 40.000, in order to remain in the circulation for a reasonable length of time. Rheomacrodex®, or Dextran 40 has the lowest molecular weight of all dextran fractions used clinically. In this review will be summarized the different indications of the use of dextran, and particularly Dextran 40, in vascular surgery, the rationale behind its use will be dis cussed, and the literature on this subject will be reviewed.
Revascularization of the Lower Extremity: A Non-invasive Hemodynamic Comparison of Aorto-Femoral and Femoral-Femoral Bypass
Authors: Hines George L. , Rivera George 
Published: November 2007

Nine patients who underwent bilateral aorto-femoral bypass and seven patients who underwent femoral-femoral bypass were evaluated to determine the increase in ankle/ arm index (a/a index) in symptomatic extremities. All patients underwent pre- and postoperative noninvasive evaluation. There were 13 symptomatic extremities in the 9 patients undergoing aorto-femoral bypass. The mean pre-operative a/a index in the aorto-femoral group was 0.50±0.15. The mean post-operative value was 0.75±0.16 (p<0.0001). The mean pre-operative value in the femoral-femoral group was 0.39±0.30 and the mean post-operative value 0.74±0.24 (p<0.02). The increase in the postoperative a/a index was the same with femoral-femoral bypass as with aorto-femoral bypass. A decision as to whether aorto-femoral or femoral-femoral bypass should be performed should be determined by considerations other than the expected immediate hemodynamic effect. Extra-anatomic bypass has become an alternative to standard aorto-femoral bypass for lower extremity revascularization in selected patients. 1,2 There have been numerous reports which have demonstrated the clinical effectiveness of both of these procedures in relieving ischemia.3 The hemodynamic effects of aorto-femoral bypass have been extensively studied non-invasively by comparing pre- and post-operative values of the ankle/arm index (a/a index).4 We have retrospectively studied the results of both aorto-femoral and femoral-femoral bypass to determine the relative effect of each in increasing the a/a index and to determine whether aorto-femoral bypass raises the a/a index more than does the femoral-femoral bypass.
Preoperative Evaluation of Saphenous Vein Suitability as an Arterial Graft
Authors: Egan T.J. , Nur A. , Anderson M.C. , Corcoran M. , O'Driscoll J. 
Published: November 2007

Thirty patients undergoing reconstructive surgery for occlusive arterial dis ease were studied pre-operatively by saphenous venography to determine the suitability, or otherwise, of the long saphenous vein as an arterial graft. Venog raphy gave a representation of vein calibre which accurately predicted the actual vein diameter, measured at operation. In 44 paired readings — i.e. diameters measured at comparable levels on vein and venogram — the mean venographic diameter was 4.46mm, and the mean diameter of the vein, measured at opera tion, was 4.43mm. There was no significant difference between the two means. In addition, venography identified occlusion of the saphenous vein and also demon strated unfavorable anatomic patterns. In several cases venography was less than satisfactory, though still useful. There were no complications. The authors believe that this technic, in their hands, has been valuable in identifying, pre-operatively, veins suitable for use as arterial grafts.
Patency of Arteriovenous Anastomosis in the Kidneys of Dogs
Authors: Lopez-Majano V. , Delatorre J. , Dulay C. , Rodriguez J. 
Published: November 2007

The patency of arteriovenous anastomosis (AVA) in the renal microcircula tion has been a controversial topic. To study the possibility of AVA as part of the renal microcirculation a cathe ter was placed under radiological control in a renal artery in each of eight anesthetized dogs. Albumin microspheres 15-52 micra in diameter labeled with 3-5 mCi of Tc99m were injected into the renal artery through this catheter. Counts over the lungs, kidneys and bladder were obtained with detectors. The spatial distribution of the radioactivity in the dogs were also studied by scintigraphy and there was imaging of the kidneys which corroborates the find ings obtained with detectors, there was no visualization of the lungs. In some studies the bladder was visualized because of the presence of free Tc99m. The lack of radioactivity in the lungs indicates that there are not patent AVA in canine kidneys because the radioactive microspheres injected in the renal artery became lodged in the arterioles, for being larger than the capillaries they could not cross to the renal veins.
Evaluation of Some Prognostic Indicators in Venous Grafting to Below-The-Knee Arteries
Authors: Cavallaro Antonino , Sciacca Vincenzo , Sterpetti Antonio , Stipa Sergio 
Published: November 2007

45 femoro-popliteal and 30 femoro-tibial by-passes performed by means of autologous reversed saphenous vein were reviewed in order to evaluate the pro gnostic significance (one-year patency) of preoperative ankle pressure index and of angiographic findings. The intraoperative (pre-reconstruction) arteriography appeared as a very useful tool necessary to achieve, in most cases, definite informations about the outflow of the planned reconstruction. The direct connection with pedal arteries (in femoro-popliteal procedures) and the unrestricted outflow through a pedal arch (in femoro-tibial procedures) were, in the Authors' experience, the best indicators, fully reliable, of a fa vourable prognosis.
The Influence of Supporting Rings on the Healing of the Ringed Expanded Polytetrafluoroethylene Vascular Graft
Authors: Takenaka Kenji , Kholoussy A. Mohsen , Yeng Yang  , Emara Medhat , Fusaro James , Matsumoto Teruo 
Published: November 2007

The influence of supporting rings on the healing of the ringed expanded polytetrafluoroethylene (ePTFE) vascular graft (ringed graft) was studied. In 12 dogs (32-42 kgm), a 4cm segment of each common iliac artery was excised and replaced with an equal length of 6mm ePTFE vascular graft. Ringed graft was used on one side and plain on the other. Dogs were sacrificed at intervals of 1, 2, 4, 6, 8 and 12 weeks. All grafts remained patent. The degree of pannus extension and pannus thickness showed no differences between both grafts at each interval. It was covered by a monolayer of endothelial-like cells as seen by scanning electron microscopy. The growth rates of endothelialization measured from the proximal anastomosis were 1.3 and 1.4 mm/week in the plain and ringed grafts, respec tively. Anastomotic intimal hyperplasia (> 50 microns) was noted in 25% and 33% at the proximal and distal anastomoses, respectively, in both grafts. The outer surface was covered by adherent connective tissue particularly encapsu lating the rings without affecting the non-ringed portion in the ringed grafts. We conclude that the supporting rings of the ePTFE graft have no significant influence on the healing and neointimal development.