bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visceral Artery Aneurysms: A Single Center Experience
Authors: Grego F. G. , Lepidi S. , Ragazzi R. , Iurilli V. , Stramanà R. , Deriu G. P. 
Published: September 2022

Background Splanchnic artery areurysm is a rare but clinically relevant disease, showing a high mortality rate in emergency surgery. Reports on splanchnic aneurysms are rare and often anecdotal. The aim of this study is to discuss data obtained from 16 patients in a single vascular surgery center. Materials and methods Between January 1987 and December 2000. 16 patients underwent surgery for splanchnic artery aneurysms. In 13 patients the localization was single (in two associated with an infrarenal abdominal aortic aneurysm) and in 3 patients multiple. The arteries involved were: splenic (8). hepatic (4). celiac (3), superior mesenteric (3), ileocolic (2), and pancreatoduodenal (1). 13 patients were asymptomatic and 3 presentee with abdominal pain. All patients underwent CT scan, and abdominal aortic and selective visceral artery angiography. Before surgery, all patients underwent cerebral MR or cerebral CT scan. 13 patients underwent open vascular surgery; 3 patients (2 splenic and 1 hepatic) underwent endovascular procedure (angioembolization). Histological examination of the aneurysmal wall was obtained in 14 patients. Ultrasound examination was performed after 6 months, then yearly. 14 patients underwent abdominal CT scan during the long-term follow-up. Results Perioperative mortality was absent. 12 cases were classified as displastic, with minor or major secondary atherosclerotic changes, and in many cases severe caseations. 2 cases were classified as atherosclerotic. Cerebral MR did not show any cases of intracerebral displastric aneurismal disease. One patient was lost at follow-up after 9 years. One patient showed a recurrence at 6 years (superior mesenteric artery): the patient underwent a new surgical procedure and died 20 days after surgery for intestinal infarction. All abdominal follow-up CT scans show good results of the vascular reconstruction and escluded other new visceral or aortic aneurysms. Conclusions Visceral artery aneurysms are an uncommon form of abdominal vascular disease showing a high postoperative mortality rate in emergencies. Surgery, and in selected cases, endovascular treatment, can successfully manage splanchnic artery aneurysms with few complications and low recurrence.
The Fontan-Operation: From Intra- to Extracardiac Procedure
Authors: Kuroczynski W. , Kampmann C. , Choi Y. -H. , Pruefer D. , Singelmann J. , Huth R. , Schmid F. -X. , Heinemann M. , Oelert H. 
Published: September 2022

Purpose For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation. Methods From January 1995 until April 2002. 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an Intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed. Principal findings There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, or to 90.5% without fenestration respectively. In patients with fenestration procedure, the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation. Conclusions Modified Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the benefits of less surgical injury and a higher intraoperative flexibility.
Off-Pump Coronary Surgery: Surgical Strategy for the High-Risk Patient
Authors: Van Belleghem Y. , Caes F. , Maene L. , Van Overbeke H. , Moerman A. , Van Nooten G. 
Published: September 2022

Objective In a retrospective study, we compared two groups of consecutive patients operated by the same team during the year 2000 for coronary artery disease with the use of extracorporeal circulation (group 1, n = 230) or on the beating heart using the Octopus II plus stabiliser (group 2. n = 228). High-risk patients were identified by a EuroSCORE plus 6. EuroSCORE definitions and predicted risk models were utilized to compare the variables of the groups. Methods There were no significant differences between the preoperative variables of the groups in age, gender, left ventricular function, diabetes and peripheral vascular and renal disease as is indicated by the Euroscore (resp. 4.7/5.1 p = 0.107). Calcification of the ascending aorta and chronic obstructive lung disease were statistically significant more prevalent in the beating heart group. No differences in preoperative variables in the high-risk patients group (Euroscore 8.5/8.1 p = 0.356) except for calcification of the ascending aorta. Results All patients underwent a full revascularisation through a midline sternotomy. Significant more distal anastomoses were performed in group 1 (3.7 per patient (1–6)) with regard to group 2 (2.9 per patient (1–6)). Anesthesia, postoperative treatment and follow up were equal for both groups. A significant lower incidence of atrial fibrillation ( p = 0.010), shorter ICU stay ( p = 0.031) and renal insufficiency ( p=0.033) was reported in group 2. In the low risk group, we could not diagnose any difference between the two groups, except for atrial fibrillation. The benefits of the beating heart surgery however were more pronounced in the high-risk patient as is indicated by a significant reduction of the ICU stay by 1 day (3.5d/2.5d ( p = 0.028)), better preservation of the renal function ( p = 0.017) and a significant reduction of the length of hospital stay by more than two days ( p= 0.040). A lower incidence of atrial fibrillation, however not significant. Conclusion In our experience, beating heart surgery is a safe alternative for conventional coronary heart surgery. High-risk patients do benefit most from this technique. It became our first choice in the elderly patient and patients presenting with higher co-morbidities.
Amputation for Acute Ischaemia is Associated with Increased Comorbidity and Higher Amputation Level
Authors: Campbell W. B. , Marriott S. , Eve R. , Mapson E. , Sexton S. , Thompson J. F. 
Published: September 2022

Background: There is some evidence that the early outcome of major amputation is worse after failed thromboembolectomy, but the risk factors and results of amputation done for acute ischaemia have never been compared with those for chronic ischaemia in a large series of patients. Method: Retrospective review of 30 day outcome for all 322 primary amputations done for arterial disease during 1992–8. There were 286 patients (163 male; median age 76 years) who had 270 amputations for chronic ischaemia and 52 for acute ischaemia. Results: The acute group had higher prevalences of cardiac disease (48% versus 29%— p<0.02), limiting pulmonary disease (27% versus 13%— p<0.02) and ASA grades 4 and 5 (27% versus 14%— p<0.05). Amputation below the knee was less common after acute ischaemia (31% versus 60%— p<0.001). There were trends towards more revisions (19% versus 11%) and higher mortality (25% versus 19%) in the acute group but neither reached statistical significance. Conclusion: Patients having major amputations for acute ischaemia have higher levels of pre-existing comorbidity than those with chronic ischaemia and are twice as likely to require amputation above the knee. They should be managed as a particularly high risk group.
Surgical Treatment of Ventricular Septal Defect Complicating Acute Myocardial Infarction. Experience of a North Italian Referral Hospital
Authors: Cerin G. , Donato M. Di , Dimulescu D. , Montericcio V. , Menicanti L , Frigiola A. , De Ambroggi L. 
Published: September 2022

The purpose of our study was to evaluate the clinical outcome of postinfarction ventricular septal defect (VSD) of patients referred to our institution for surgical treatment, by assessing the role of several operative, pre- and post-operative variables on mortality. The medical records of 58 consecutive patients (mean age 73±7 years), operated on after 14±12 days from the acute myocardial infarction were retrospectively reviewed and the data were analyzed. Associated procedures were left ventricular reconstruction in 13 patients and aortocoronary bypass grafting in 47 (81%). The overall operative, in-hospital mortality rate was 52% (75% in patients operated on within the first week and 16% if time from infarct to surgery was >3 weeks). Time from AMI to surgery and time from hospital admission to operation were significantly shorter in nonsurvivors ( p=0.003 and 0.012, respectively). Other pre-operative variables significantly associated with mortality were: cardiogenic shock, pulmonary pressure, VSD diameter. In conclusion, time from AMI to operation appears to be a very important prognostic factor. However, size of VSD and hemodynamic conditions significantly influence the mortality. Moreover, concomitant procedures of revascularization can be safely performed, when required, as actually occurs in most cases.
Epidural Analgesia in Patients with Chronic Obstructive Pulmonary Disease Undergoing Transperitoneal Abdominal Aortic Aneurysmorraphy — A Multi-Institutional Analysis
Authors: Bush R. L. , Lin P. H. , Reddy P. P. , Chen C. , Weiss V. J. , Guinn G. , Lumsden A. B. 
Published: September 2022

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop pulmonary morbidity following major abdominal surgery. The purpose of this study was to examine the utility of epidural analgesia in patients with COPD who underwent elective transperitoneal abdominal aortic aneurysm (AAA) repair. Methods: During a 7-year period, all patients diagnosed with COPD undergoing elective AAA repair ( n=425) from three hospitals were reviewed. Inclusion criteria were an FEV1/FVC ratio <75% and/or a PaCO2>45 mmHg. Clinical outcomes were compared between those who received epidural analgesia (epidural group) and those who did not (control group). Primary endpoints measured were duration of intubation, ICU stay, hospital days. and pulmonary complications. Results: Strict inclusion criteria were met by 131 patients, which included 86 patients in the epidural group and 45 patients in the control group. When comparing the epidural vs. control group, the mean AAA size was 6.3±0.9 cm vs. 6.0±1.5 cm (NS), FEV1 was 57.2±24.7% vs. 49.0±10.3% (NS), and the mean FFV1/FVC ratio was 52.0±11.4% vs. 50.6±6.7% (NS), respectively. The epidural group had a significantly lower incidence of post-operative ventilator dependency and ICU stay ( p<0.05), as well as a decreased trend in pulmonary complications when compared to the control group. The overall hospital stay remained similar between the two groups. The relative risk of developing a pulmonary complication in the absence of epidural analgesia was 2.3 Conclusions: Perioperative epidural analgesia is beneficial in patients with COPD undergoing AAA repair by reducing both the post-operative ventilator duration and ICU stay. Epidural analgesia should be considered in all COPD patients undergoing elective transperitoneal AAA repair.
EuroSCORE Overestimates the Cardiac Operative Risk
Authors: Karabulut H. , Toraman F. , Alhan C. , Çamur G. , Evrenkaya S. , Daǧdelen S. , Tarcan S. 
Published: September 2022

Introduction: It was the purpose of our study to assess the validity of EuroSCORE (European system for cardiac operative risk evaluation) in our patient population. Materials and Methods: Between March 1999 and August 2001, information on risk factors and mortality was collected for 1123 consecutive adult patients undergoing heart surgery with cardiopulmonary bypass. EuroSCORE was used for risk stratification. Mean age ± standard deviation was 58.6 ± 10.9 and 29.1% of the patients were female. The area under the receiver operating characteristic (ROC) curve was calculated as an index for the predictive value of the scoring system. Results: The area under the ROC curve was 0.824 for all patients and 0.828 for the isolated CABG subgroup which shows an excellent predictive ability. When the scoring system was applied in low, medium, and high risk groups, there was no overlap between 95% confidence intervals of observed and expected mortality in all three groups both for the isolated CABG cases and for all patients. Decreased left ventricular ejection fraction, emergent operation, and preoperative unstable angina requiring i.v. nitrate treatment were significant predictive variables for early mortality. Conclusion: EuroSCORE is a simple and objective system for predicting the risk of heart surgery. The predictive power of the EuroSCORE is excellent, however it seems that mortally is considerably overestimated by this score.
Eversion Carotid Endarterectomy: A Technical Alternative that may Obviate Patch Closure in Women
Authors: Darling R. Clement , Mehta Manish , Roddy Sean P. , Paty Philip S. K. , Kreienberg Paul B. , Ozsvath Kathleen J. , Chang Benjamin B. , Shah Dhiraj M. 
Published: September 2022

Purpose: Recurrent carotid stenosis following standard longitudinal carotid endarterectomy (s-CEA), with and without patch angioplasty, effects the durability of the procedure and can lead to reintervention. The purpose of this study is to evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) in women. Methods: The records of all patients undergoing elective carotid endarterectomy (CEA) for symptomatic and asymptomatic high-grade carotid stenosis over a 5-year period from July 1994 to June 1999 were reviewed. Eversion endarterectomy was performed preferentially under regional anesthesia in awake patients. Postoperatively, patients were routinely evaluated by duplex scans at 3 months, 6 months, 12 months, and yearly thereafter. Hemodynamically significant restenosis (>70%) via duplex scans was confirmed by standard or magnetic resonance angiography. Student's t-test and Chi square analysis were used to assess statistical significance and assumed for P < 0.05. Results: Over this 5-year period, 3429 eversion carotid endarterectomies were done for symptomatic (female: 375, male: 573) and asymptomatic (female: 1091, male: 1390) high grade carotid stenosis. In the postoperative period 18 (0.9%) male and 12 (0.8%) female patients developed a permanent stroke ( P = NS). Operative mortality was 0.6% ( n = 12) in males and 0.5% ( n = 8) in females ( P= NS). Cranial nerve injuries, wound infections, and neck hematoma occurred in 7 (0.4%), 2 (0.1%), and 26 (1.3%) male and in 3 (0.2%), 3 (0.2%), and 15 (1.0%) female patients, respectively. Recurrent carotid stenosis greater than 70% via duplex scan (PSV >125 cm/s and EDV >100 cm/s) developed in 12 (1.0%) males and 15 (1.5%) females ( P= NS). Conclusion: The eversion technique for CEA requires both the transection and anastomosis of the internal carotid artery at the carotid bulb, and appears to result in a low incidence of restenosis in women. This is a straightforward technique and obviates the need for primary closure of distal smaller caliber internal carotid artery that can lead to narrowing, and the use of patch closure that has its attendant risks.
Repair of Coarctation of the Aorta in Adults and Hypertension
Authors: Özyazicioǧlu Ahmet , Ateş Azman , Yekeler İbrahim , Balci Ahmet Yavuz , Bozkurt Engin 
Published: September 2022

The aim of this study is to determine if surgical repair of coarctation in adults improves systemic hypertension. The charts of 23 consecutive patients (age range 13–36 years, mean 23.6 ± 7) who underwent repair of aortic coarctation at the Atatürk University, Aziziye Hospital, between 1986 and 2000 were reviewed. There were 16 (70%) men and seven (30%) women. All patients had preoperative hypertension. Systolic blood pressure (BP) ranged between 150 and 200 mmHg. with a mean of 176 ± 15 mmHg. Peak systolic gradient across the coarctation was 52 ± 20 mmHg (range from 30 to 112 mmHg). There were no early or late deaths. Mean systolic BP values at the first postoperative evaluation were 176 ± 15 mmHg (p < 0.001 from preoperative values). Exercise testing revealed hypertensive response to exercise in three of 10 patients who had borderline hypertension at rest and without medication. Repair of coarctation of aorta even in adults is safe and improves systemic hypertension. To identify patients with potential hypertension, exercise testing should be performed. Impaired arterial dilatation may be an important contributor to exercise-related hypertension and late morbidity or mortality.
Polyester vs. Bovine Pericardial Patching during Carotid Endarterectomy: Early Neurologic Events and Incidence of Restenosis
Authors: Neuhauser Beate , Oldenburg W. Andrew 
Published: September 2022

Purpose The aim of this report was to compare polyester vs. bovine pericardial patching during CEA with regards to the incidence of early neurologic events and recurrent stenosis. Patients and methods One hundred and twenty-five consecutive patients with high grade symptomatic (14%) or asymptomatic (86%) carotid artery stenosis (>70%) who underwent 139 CEAs by a single surgeon between January 1997 and April 2001 were retrospectively reviewed. Patients were assessed postoperatively clinically and with routine follow-up duplex scanning. Recurrent stenosis was defined as a narrowing in the common or internal carotid artery of more than 50% by duplex ultrasound examination. Results From January 1997 to May 1999, a polyester patch was routinely used in 81 (58%) patients, while between June 1999 and April 2001, a bovine pericardium patch was exclusively used in 59 (42%) patients. There were no ipsilateral postoperative TIAs or strokes in either group. The combined 30-day mortality rate for both groups was 0.8%. One patient in the polyester patch group died from cardiopulmonary complications 10 days after discharge. The length of follow-up in the bovine pericardial patch group was 3–28 months (mean 12 months), while in the polyester patch group was 1–50 months (mean 24.5 month). One patient developed a carotid pseudoaneurysm of the suture line in the bovine pericardium patch group caused by a local infection after previous neck dissection and radiation. The incidence of recurrent stenosis was two patients (4%) in the bovine pericardium group as opposed to six patients (7.6%) in the polyester patch group. Conclusion Although this is a preliminary report, it is concluded that bovine pericardium provides excellent perioperative results and is at least comparable to polyester patching in terms of safety. Our study with short term follow up suggests that bovine pericardium patching during carotid endarterectomy may have a lower restenosis rate compared to knitted polyester patching. Clear superiority of bovine pericardium as a patch material awaits a prospective randomised study with long-term follow-up.
Parental and Child Diagnosis Storytelling and Self-Image in French Children With Cleft lip With or Without Cleft Palate
Authors: Gavelle Pascale , Dissaux Caroline , Dupont Mathilde , Khonsari Roman Hossein , Picard Arnaud 
Published: September 2022

ObjectivePsychosocial adjustment can be challenging for children with cleft lip with or without a cleft palate (CL ± P). Previous studies have linked social integration with self-acceptance and highlighted the impact of the parents’ stress on self-acceptance. Teasing can be linked to children having difficulties explaining their diagnosis to others. This prospective research aimed to gain a better understanding of family communication about cleft, children's oral storytelling about their cleft, and explore their self-image and perceived familial acceptance.ParticipantsParents and their children with CL ± P ( N = 54; average age: 5.6 years).DesignSemistructured interviews with parents and structured interviews with children were conducted regarding their oral storytelling focusing on scars from cleft lip surgery. Children completed a projective test to explore their self-image and perceptions of familial acceptance. Language screening was completed with the French Wechsler Preschool Primary Scale of Intelligence-Fourth Edition.ResultsOnly 30% of children explained their cleft in a way appropriate for peers, including presence at birth, having had surgery, and scar location. Children's ability to explain their cleft was not related to language performance, which was in the average range of 84%. Children's cleft explanations were dependent on parents’ narratives and education methods, including the use of verbal explanations and preoperative photographs. Children's storytelling was related to their self-image and perceived parental acceptance.ConclusionCleft teams should assist families in building their cleft story based on a complete explanation with photographs and a positive and accepting approach.
Optimal Injectable Haloperidol Dose Assessment in the Older Hospitalized Inpatient
Authors: Yuksel Jaylan M. , Brenner Jay M. , Britton Sarah , Bhatti Harneet , Noviasky John 
Published: September 2022

Background: Haloperidol can be used off-label for agitation and/or delirium in older individuals. The recommended initial intramuscular or intravenous dose is 0.5 to 1 mg. However, the evidence to support these doses is nominal. Objectives: The primary outcome was to determine whether low-dose injectable haloperidol (≤0.5 mg) was similar in effect to higher doses by assessing the need for repeat doses within 4 hours as a surrogate marker. Secondary outcomes include comparison of length of stay, utilization of restraints, and discharge outcomes between dosage groups. Methods: This was a retrospective, single-center, cohort study. Patients aged ≥65 years who received haloperidol injectable who were not on antipsychotics prior to admission were reviewed. Results: In the low-dose group (n = 15), no patients required additional haloperidol doses within 4 hours compared with 1 patient each in the medium-dose (n = 23) and high-dose (n = 19) groups ( P = 0.94). There was a difference regarding length of stay, utilization of restraints, and discharge to facility when admitted from home favoring low-dose haloperidol. Conclusions and Relevance: While limited by sample size and retrospective design, patients who received low-dose haloperidol demonstrated similar efficacy to those who received higher doses of haloperidol. In addition, secondary outcomes mentioned above favored the use of low-dose haloperidol as well. Based on these findings, low-dose haloperidol is a reasonable initial dose for the agitated older patient.