bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Ulnar Collateral Ligament Surgery in Nonthrowing Athletes
Authors: Rothermich Marcus A. , Pharr Zachary K. , Mundy Andrew C. , Fleisig Glenn S. , Mussell Eric A. , Ryan Michael K. , Bernier Hunter M. , Ostrander Brook , Slowik Jonathan S. , Emblom Benton A. , Cain E. Lyle , Dugas Jeffrey R. 
Published: September 2022

Background: Ulnar collateral ligament (UCL) surgery continues to demonstrate excellent clinical outcomes and a high return-to-play (RTP) rate with a low complication rate. Recent studies have demonstrated similar clinical outcomes for baseball players who have undergone either UCL reconstruction or UCL repair. In comparison, few studies have assessed the clinical outcomes of UCL surgery for nonthrowing athletes. Purpose/Hypothesis: The primary objective of this study is to provide clinical outcomes of UCL surgery performed in nonthrowing athletes at a single institution with a minimum 2-year follow-up. Our hypothesis was that these patients would have similar clinical outcomes, complication rates, and RTP rates when compared with throwing athletes. Level of Evidence: Case series; Level of evidence, 4. Methods: From our longitudinal elbow registry, 40 nonthrowing athletes were identified who underwent UCL surgery (repair or reconstruction) between 2011 and 2019. Participant characteristics were recorded: age, sex, laterality, arm dominance, sport, level of competition, and type of surgery (UCL repair or reconstruction). Outcomes included RTP rate and average time, American Shoulder and Elbow Surgeons (ASES) scores, and complications. Results: From the 40 patients eligible for inclusion in this study with a minimum 2-year follow-up, 37 (93%) were successfully contacted: 16 male (43%) and 21 female (57%). Mean ± standard deviation age at the time of surgery was 18.0 ± 3.7 years. From the 37 technical procedures, 28 (76%) were UCL repairs and 9 (24%) were UCL reconstructions. For these patients, 15 (41%) had partial tears, 20 (54%) had complete tears, 1 (3%) had a medial epicondyle avulsion, and 1 (3%) had an unspecified pathology. Sports included football (n = 11), gymnastics (11), cheerleading (7), wrestling (4), volleyball (2), basketball (1), and acrobatics (1). Quarterbacks were excluded from the football patients, as quarterbacks are throwing athletes. Level of competition included high school (n = 26), college (8), professional (2), and youth sports (1). The RTP rate was 93% (26/28) at a mean 7.4 months for UCL repair and 100% (9/9) at a mean 10.0 months for UCL reconstruction. Mean ASES scores were 94.4 and 98.7 for UCL repair and reconstruction, respectively. Complications were low, with 2 patients in the UCL repair group requiring ulnar nerve transposition for ulnar nerve paresthesia. Conclusion: In nonthrowing athletes, patients undergoing UCL repair and UCL reconstruction show favorable outcomes at minimum 2-year follow-up. RTP and clinical outcomes are consistent with previous studies in baseball players as well as a parallel ongoing study conducted on non–baseball throwing athletes.
Low Preoperative HSP70 Atrial Myocardial Levels Correlate Significantly with High Incidence of Postoperative Atrial Fibrillation after Cardiac Surgery
Authors: St. Rammos Kyriakos , Koullias George J. , Hassan Moustafa O. , Argyrakis Nikolaos P. , Voucharas Christos G. , Scarupa Steven J. , Cowte Tomas G. 
Published: September 2022

Purpose of the study. Atrial fibrillation after cardiac surgery is still a frequent encountered complication and has been associated with increased hospital length of stay and numerous postoperative complications. The pathogenesis of atrial fibrillation involves an overall sequence of perioperative events, collectively termed as ischemia-reperfusion injury. Heat-shock proteins have been found to provide increased protection during ischemia-reperfusion as well as increased postischemic cardiac functional recovery. We sought to determine whether preoperative atrial heat shock levels were correlated with the appearance of postoperative atrial fibrillation Basic methods. Preoperative atrial myocardial samples obtained just before cannulation from 101 patients were used to detect immunohistochemically the expression of heat-shock proteins. The derived results were compared statistically with the incidence of postoperative atrial fibrillation, its time of appearance, duration and resistance to administered antiarrhythmics. Principal findings. The overall incidence of postoperative atrial fibrillation was 22.3%. Of these patients, 58.3% had no detectable heat shock proteins in their cytoplasm, in sharp contrast with 100% of the patients with no atrial fibrillation who were positive for heat shock proteins ( p<0.01). Four percent of our patient group had prolonged atrial fibrillation (defined as duration >48 h). These patients had significantly less ( p<0.01) nuclear heat shock protein expression compared with the non-atrial fibrillation group. However, the difference of the heat shock protein expression between the prolonged atrial fibrillation and the rest of the atrial fibrillation patients was not significant ( p = 0.891). Conclusions. Our results indicate that patients with low preoperative atrial heat shock protein expression have a significantly greater incidence of postoperative atrial fibrillation. Heat shock protein expression did not, however, correlate with the onset of atrial fibrillation and the resistance to administered medications. Heat shock protein preoperative induction as a measure of myocardial preconditioning may potentially decrease the incidence of postoperative atrial fibrillation.
Left Retroperitoneal Approach for Aortic Surgery
Authors: Wheeler J. M. D. , Williams I. M. , Shandall A. A. 
Published: September 2022

Twenty-eight consecutive patients underwent sugery of the abdominal aorta by the left retroperitoneal approach. There were 11 suprarenal. 12 juxtarenal, three complicated infrarenal aneurysms and two occlusive aortoiliac disease (considered to be at high risk) undergoing surgical repair. Twenty-one underwent a tube graft repair whilst seven had a bifurcation graft. There were five deaths in this series; four of which occurred in the initial 12 patients. In our initial experience using the left retroperitoneal approach the overall mortality rate was 17%, though this reduced to 6% for the latter half of the study. The retroperitoneal approach allows access to the supracoeliac aorta without the need for thoracotomy and this approach should be considered for all aortoiliac reconstructive surgery. The transabdominal route to the abdominal aorta remains the most commonly used approach. However, the left retroperitonal approach offers advantages in high-risk patients and suprarenal and juxtarenal abdominal aortic aneurysms (AAA). This is our initial experience of 28 patients undergoing surgical repair of the abdominal aorta via the left retroperitoneal approach.
Direct Reconstruction of the Innominate Artery
Authors: Cherry Kenneth J. 
Published: September 2022

Purpose of this study. Occlusive disease of the innominate artery requiring reconstruction is relatively uncommon. Data concerning these lesions has come from retrospective reviews at larger institutions. The purpose of this paper is to review the most recent experience at the Mayo Clinic, as well as to review the experiences of other large centers in the recent past, and to determine which patients are benefited by direct reconstructions and which patients might be better served by indirect methods or by endovascular techniques. Basic methods: A retrospective analysis of the trends at the Mayo Clinic concerning reconstruction of the innominate artery since 1976 was undertaken. Two reviews from our institution, published in 1989 and 1999, of all patients seen since 1976, were analyzed. This retrospective analysis also included papers from other referral centers dealing with innominate artery reconstruction, both here and in France. Principal findings and conclusions: The great majority of patients with symptomatic disease of the innominate artery are well treated by direct reconstruction. Stroke and death rates are acceptable. Early results are excellent, and the durability of the operation is also excellent, with impressive stroke-free survival rates. There are subsets of patients who might be treated by medical techniques or techniques other than direct reconstruction, such as cervical reconstruction or endovascular repair. Coronary artery disease remains the main determinate of early and late morbidity.
Surgical Repair of Thoracoabdominal Aneurysms: Patient Selection, Techniques and Results
Authors: Gloviczki Peter 
Published: September 2022

Background: Repair of thoracoabdominal aortic aneurysms (TAAAs) continues to be a challenging task. Hemorrhagic shock, cardiac arrest and multisystem organ failures are the most frequent causes of death, and paraplegia and renal failure are the most devastating complications. Methods: Flawless surgical technique and the use of adjuncts to protect key organs including the brain, heart, spinal cord, liver and kidneys affect outcome. Perfection in exposure and suturing technique decreases bleeding complications, shortens cross-clamp time and assures optimal, visceral, renal and lower extremity perfusion. Technical details include retroperitoneal abdominal aortic exposure, double thoracotomy for Type I and Type II aneurysms, and preservation of the diaphragm. The kidneys are protected by perfusion of iced lactated Ringers; visceral ischemia in Type 1 and Type II, aneurysms is diminished by using pulmonary vein-femoral artery pump with sequential clamping. Spinal cord protection is attempted by spinal fluid pressure monitoring and drainage, moderate general hypothermia, selective left heart bypass, reimplantation of critical intercostal arteries, monitoring somatosensory and somatomotor evoked potentials and epidural cooling of the spinal cord. Results: Outcome in 203 patients (Group I) who underwent repair of TAAAs without epidural cooling was compared with outcome in 97 patients, 27 with thoracic aortic aneurysms and 70 with TAAA (Group II) who underwent repair using epidural cooling. In Group II paraplegia/parapesis occurred in 11.6%. not different from the 8.9% in Group I. Thirty day mortality for elective cases decreased from 14.6% (Group I) to 7.2% (Group II, P<0.05). Conclusions: Open surgical repair of TAAA carries elevated mortality and complication rates. The etiology of ischemic and reperfusion injury to the spinal cord is multifactorial and its prevention remains a formidable and as yet unresolved task. To select patients for surgical repair, the risk of TAAA rupture should be balanced against risks of perioperative mortality, paraplegia and renal failure.
Leukocyte Activation and Phagocytotic Activity in Cardiac Surgery and Infection
Authors: Rothenburger Markus , Trösch Frank , Markewitz Andreas , Berendes Elmar , Schmid Christof , Scheld HansHeinrich , Tjan Tonny D. T. 
Published: September 2022

Background Cardiac surgery (CS) using cardiopulmonary bypass (CPB) is associated with cellular and humoral defense reactions termed the systemic inflammatory response syndrome. Leukocyte activation is one of its causative mechanisms which may be aggravated by additional infection. Methods and results Eighty-five patients undergoing CS with CPB were prospectively investigated. Leukocyte counts, elastase. and phagocytotic activity were measured from 24 hpreoperatively up to 7 days postoperatively. Seventy-nine patients had an uneventful course (group 1) while six patients developed a systemic infection (group 2). Leukocytes and elastase levels increased postoperatively (p<0.01) and were significantly higher in group 2 (p<0.01). In both groups a decrease of leukocyte/elastase ratio occurred (p<0.002), no differences between groups were observed. The phagocytotic activity, representing the circulating cells of the reticuloendothelial system (RES), dropped on day 1 (p<0.05), and increased thereafter above baseline levels (p<0.001). No differences of RES function between groups was observed, the initial drop on day 1 in both groups was compensated by the quality of phagocytotic ability of each cells. Conclusion Leukocyte activation after CS with CPB occurs. It is associated with a regular RES function and similarly leukocyte/elastase ratios in both groups, suggesting an adequate immune response. Therapeutic interventions resulting in depletion of leukocytes to alleviate reperfusion injury might impair the immune response of those patients acquiring perioperative infection and should be approached with caution. Leukocyte depletion maybe effective in patients for whom an extended period of CPB was required. Further investigations to prove this hypothesis awaits confirmation.
Consequences of PTFE Membrane Used for Prevention of Re-Entry Injuries in Rheumatic Valve Disease
Authors: Ozeren Murat , Han Unsal , Mavioglu Ilhan , Simsek Erdal , Soyal M. F. Tolga , Guler Gulcin , Yucel Ertan 
Published: September 2022

Background. The value of polytetrafluoroethylene (PTFE) surgical membrane as a pericardium substitute in patients who undergo reoperation for rheumatic valve disease is reported in this observational study. Methods. PTFE was used for pericardial closure in 56 rheumatic valve patients. During reoperation of seven cases, adhesions were classified as none, minimal, moderate to severe and scored in the sections of heart. Data found at reoperations were collected prospectively in all patients. Results. Seven of 56 patients reoperated mean period of 67.1 ±23.4 (SD) months later. No infection, complication and operative or late death attributable to the membrane were observed. There were two right ventricular, three minimal right atrial and one innominate vein lacerations during resternotomy and all of them were controlled. During histological examination, a microscopically significant foreign body reaction was found. Conclusion. PTFE membrane produced an undesirable fibrous membrane that obscured the epicardial anatomy and hardened the dissection in patients with rheumatic heart disease.
Single-Stage Unifocalization and Correction with Median Sternotomy in Complex Pulmonary Atresia
Authors: Tireli Emin , Basaran Murat , Kafali Eylul , Soyler Ilksen , Camci Emre , Dayioglu Enver 
Published: September 2022

Objective: This study assessed the surgical and post-operative outcome of single-stage complete unifocalization and repair procedure in patients with complex pulmonary atresia. Methods: From 1999 to 2001. we performed complete unifocalization and correction in 10 patients with complex pulmonary atresia. Their ages ranged from 10 months to 17 years. All patients were evaluated with pulmonary angiography and divided into two groups according to the development of native pulmonary arteries. Group I patients had hypoplastic pulmonary arteries and MAPCAs and Group II patients had only MAPCAs without native pulmonary arteries. With median sternotomy, all MAPCAs were prepared and anastomozed to native pulmonary arteries in group I patients or on a pericardial roll in group II patients without using cardiopulmonary bypass. Right ventricle to pulmonary arterial continuity was established with a valved conduit under CPB. VSD was closed in two patients. Results: Eight patients had complete repair without VSD closure. They were followed periodically with pulmonary angiography. Two patients developed congestive heart failure. One of them was reoperated and VSD was closed. The other patient died because of untraceable congestive heart failure. The decision for VSD closure was made in two patients due to suitable pulmonary arterial vascular tree. However, one of them had to be reoperated and VSD patch was removed. This patient died because of sepsis on the postoperative 26th day. We are following the rest of the patients with echocardiography and pulmonary angiography. Conclusion: Single stage complete unifocalization and repair should be the treatment of choice in patients with complex pulmonary atresia. This procedure provides a significant development in neopulmonary arterial system. However, the accurate criterias for VSD closure are still controversial. After the operation, these patients had to be followed closely with echocardiography and pulmonary angiography because of the absolute risk of congestive heart failure in patients with VSD left open.
Is Aortic Angiography Necessary for Accurate Planning of Endovascular Aortic Aneurysm Stents?
Authors: Brown Wendy A. , Miller Robert , Birch Simone , Scott Alan 
Published: September 2022

Endovascular management of abdominal aortic aneurysms (AAA) relies upon accurate stent design. We hypothesized the length of the stent could be measured from computed tomogram (CT) generated 3D surface rendered images of the abdominal vessels, eliminating the need for digital subtraction angiography (DSA). Methods The CT scans from a consecutive series of 54 patients considered for endovascular AAA repair were reviewed. A TRIFAB Zenith (™Cook) endovascular aortic stent was designed, using the manufacturer's sizing computer program. These hypothetical stents were compared to those that had been implanted, using measurements from both angiogram and CT (Spearman's test of correlation ( p<0.05)). Results The stent body size and short limb extension (SLE) of stents in each group was similar (correlation coefficient 0.70( p<0.01) and 0.50 ( p=0.014)), however. CT alone significantly underestimated the length of the long limb extension (LLE) (correlation coefficient 0.095) Conclusion These data suggest that CT underestimates the tortuosity of iliac vessels. Aortic angiography is necessary for accurate AAA endovascular stent design.
Pelviureteric Junction Disruption as a Complication of Chemical Lumbar Sympathectomy
Authors: Antao B. , Rowlands T. E. , Singh N. P. , McCleary A. J. 
Published: September 2022

Chemical lumbar sympathectomy is a commonly performed procedure in vascular surgery and pain management. This case report discusses the management of a patient who suffered pelviureteric junction disruption following phenol injection for ischaemic leg pain despite radiological evidence of correct placement. The authors suspect this is an underreported complication, which could be relevant in obtaining informed consent.
Combined Surgical Approach to Coexistent Carotid and Coronary Artery Disease: Early and Late Results
Authors: Vitali E. , Lanfranconi M. , Bruschi G. , Colombo T. , Russo C. 
Published: September 2022

Background: The management of patients with simultaneous coronary artery and carotid artery disease is still controversial. Methods: A retrospective review of the records and follow-up data of 139 consecutive patients undergoing simultaneous coronary artery bypass graft and carotid endarterectomy from 1981 to 1999 was carried out. Results: Early mortality was 2.1%, perioperative myocardial infarction and stroke rates were 2.8 and 1.4%, respectively. Survival at 7 years was 74.7 ±5.1% and event-free survival at 7 years was 67.9 ± 5.6%. Conclusions: The combined surgical approach has proved to be effective and safe allowing the treatment of both diseases in a single operative procedure.
Coronary Reoperations without the Use of Cardiopulmonary Bypass
Authors: Iscan H. Z. , Kandemir O. , Gol M. K. , Saritas A. , Tasdemir O. 
Published: September 2022

Background: Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity. Materials and methods: Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3 ± 5 and 57.4 ± 7.3 years, respectively. Results: Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively. Conclusion: Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.
Management of Infected Grafts and Mycotic Aneurysms of the Aorta Using Cryopreserved Homografts
Authors: Arbatli Harun , DeGeest Raphaël , Demirsoy Ergun , Wellens Francis , Degrieck Ivan , VanPraet Frank , Korkut Ali Kubilay , Vanermen Hugo 
Published: September 2022

Objective: To evaluate the efficacy of the treatment of infected prosthetic grafts and mycotic aneurysms of the aorta with cryopreserved homografts. Materials and methods: Between April 1994 and May 2002, 15 cryopreserved aortic homografts were used in 13 patients in the thoracic and abdominal aortic position with supplementary omental or pectoral muscle wrapping for infected grafts (n = 11), and mycotic aneurysms (n = 2) (mean age: 57.5). Results: One patient died due to multiorgan failure and the other due to cerebral hemorrhagia postoperatively (15.38%). Another patient died four months after the operation due to septic arthritis, and coronary heart disease. Ten patients are still alive without evidence of infection (76.92%) during a follow up of 44±23.03 (range 4–71) months. Conclusion: The use of cryopreserved homografts with supplementary omentum and/or muscle flap coverage, assures an anatomical reconstruction with good results in this difficult group of patients.
Natural History of the Ectatic Aorta
Authors: Basnyat P. S. , Aiono S. , Warsi A. A. , Magee T. R. , Galland R. B. , Lewis M. H. 
Published: September 2022

Objectives To define the natural history of ectatic abdominal aortas and to assess the clinical need for follow-up. Design Abdominal aortas were considered ectatic if they were diffusely and irregularly dilated with a diameter less than 3 cm. Ectatic aortas were identified either by AAA screening or as incidental findings. Patients who had only one scan were excluded from the study. Clinical data were analysed. Setting Two district general hospitals in Wales and England. Subjects 116 patients (90 men). Results The median age of patients was 71 years (range 48–90). Co-existing risk factors included hypertension (75), IHD (22), PVD (8), diabetes (3), COAD (14), stroke (5), popliteal aneurysm (1), malignant disease (3) and 4 had a family history of AAA. The median follow-up was 24 months (range 5–72). The median and maximum growth rate of the ectatic aortas were 0.65 and 14.4 mm/year respectively. In three patients the expansion rate was more than 5 mm/year. In 22 patients the ectatic aorta became aneurysmal, reaching a diameter greater than 3 cm. There were no ruptures and no elective repairs. Two deaths occurred due to IHD. Conclusions: This study demonstrates that if ectatic aortas do expand they do so very slowly. However, 22 of the 116 (19%) became aneurysmal in a follow-up of twp years. Once identified ectatic aortas should be scanned at intervals of three years.