Revascularization of internal iliac arteries during aortoiliac surgery: a multicenter study

Prenatal screening for fetal abnormalities in an accepted part of modern obstetric management. Improvements on current screening procedures need to address increased diagnostic efficacy and earlier diagnosis. This study evaluates diagnostic efficacy of PAPP-A and F beta-hCG in the detection of first trimester pregnancy abnormalities, including Down syndrome (DS). Of 731 pregnant volunteers, obtained from a mature age population undergoing chorionic villus sampling (CVS), 17 DS and 11 compromised (six numerical (excluding sex chromosome) aneuploidies, five spontaneously failed) pregnancies were detected. Application of an algorithm, which combines PAPP-A and F beta-hCG levels with material age, detected 66.6 per cent of DS pregnancies for a five per cent false positive rate. Similarly, for a 1-2 per cent recall rate, 72.2 per cent of compromised pregnancies were detected. This report supports the notion that prenatal screening at 9-12 weeks of pregnancy is achievable with PAPP-A and F beta hCG quantitation. Whereas mid-gestational screening targetted the detection of fetal abnormalities, screening earlier in pregnancy will detect other pregnancy-related abnormalities, in addition to aneuploidy.     

Endovascular treatment of internal iliac artery aneurysms

BACKGROUND: Homeless people with mental illness have relatively high rates of human immunodeficiency virus, comorbid antisocial personality disorder, and may be homeless more frequently and for greater lengths of time. All of these factors may increase the risk of tuberculosis. METHODS: Our study was done to ascertain if homeless men with psychotic disorders are at an increased risk for tuberculosis infection. One hundred fifty homeless men were interviewed and given purified protein derivatives (PPDs) at a downtown shelter in New Orleans, Louisiana, during a 3-month period. RESULTS: The findings show a strong relationship between psychotic disorders and positive PPDs, with a relative risk of 4.48. CONCLUSIONS: Homelessness and mental illness present barriers to seeking and completing treatment for medical illnesses such as tuberculosis. Use of services may be low even when available; therefore, homeless men with psychotic disorders may be serving as a reservoir for tuberculosis.     

Medium-term patency and anatomic changes after direct bronchial artery revascularization in lung and heart-lung transplantation with the internal thoracic artery conduit

OBJECTIVE: To examine the relationship of estrogen-induced changes in lipids and lipoproteins with alterations in the coagulation system. METHODS: Coagulation and lipid indices were measured in 31 postmenopausal women, ages 40-60 years, after a 3-month course of 0.625-mg conjugated equine estrogen. We analyzed changes in variables from baseline to 3 months using t tests for paired samples or the Wilcoxon matched-pairs signed-rank test. RESULTS: Unopposed estrogen replacement therapy produced statistically significant decreases in antithrombin-III antigen (P = .006) and activity (P = .001) and total protein S (P = .003) and a significant increase in protein C antigen (P = .017). C4b-binding protein also decreased significantly from baseline to 3 months (P < .001). Mean fibrinogen level decreased by 18.2 mg/dL, not a statistically significant change (P = .213). Estrogen produced the expected statistically significant changes in lipids and lipoproteins. Several correlations between changes in lipids and lipoproteins and coagulation indices were statistically significant. Protein C antigen and activity changes correlated directly with high-density lipoprotein cholesterol changes (r = .52, P < or = .005; r = .38, P < or = .05; respectively), and protein C antigen also correlated directly with increases in apoprotein A-I (r = .54, P < or = .005). Triglyceride changes correlated directly with changes in protein C antigen (r = .36, P < or = .05) and activity (r = .49, P < or = .005) and inversely with C4b-binding protein (r = -.58, P < or = .01). Apoprotein B was correlated with free protein S (r = .48, P < or = .01). CONCLUSIONS: Although several estrogen-induced changes may decrease atherosclerotic potential and hypercoagulability, others may promote coagulability. These divergent effects may be manipulated pharmacologically by other estrogen compounds or by the addition of various progestins.     

Noninvasive hemodynamic assessment of the internal mammary artery in myocardial revascularization

Using transthoracic B-mode imaging and Doppler spectrum analysis it was found that the luminal diameter of the internal mammary artery and its hemodynamics were not significantly different among 15 preoperative patients (64 +/- 10 years) who underwent myocardial revascularization using the left internal mammary artery and young and older control groups (25 +/- 3 years and 61 +/- 9 years, respectively). These data indicate that older age does not significantly adversely influence the degree of intimal thickening and compliance in the internal mammary artery. Doppler spectrum analysis of the internal mammary artery in the patients who were operated on revealed conversion from a triphasic systolic waveform preoperatively to a unidirectional combined systolic/diastolic waveform at 1 week and 2 and 6 months postoperatively, characterized by a significant increase in the diastolic blood flow velocity and a significant decrease in the systolic blood flow velocity and the pulsatility and resistance indices. This study indicates that transthoracic B-mode imaging and Doppler spectrum analysis are promising noninvasive techniques in the preoperative assessment of internal mammary artery morphology and physiology. In addition, Doppler spectrum analysis can also be used in the long-term serial assessment of the internal mammary artery conduit after myocardial revascularization.     

Doppler spectrum analysis versus direct femoral artery pressure measurement for rapid assessment of aortoiliac obstruction

Adequate patient selection is required to limit the clinical workload and improve the cost-effectiveness of noninvasive hemodynamic evaluation of the aortoiliac system. In a prospective blinded fashion the traditional invasive technique of direct femoral artery pressure measurements and the computerized Doppler spectrum analysis of blood flow velocities in the common femoral artery were studied. Both tests for rapid assessment of aortoiliac obstruction were compared with duplex ultrasonographic imaging, using a peak systolic velocity ratio of 2.5 to demonstrate stenoses of 50% or more. In a series of 17 consecutive patients (34 aortoiliac segments) with suspected aortoiliac obstructive disease, a good level of agreement (kappa = 0.6) was found for both methods when compared with duplex scanning. Analysis of deviations from the duplex registrations indicated an overestimation of the pathologic cases using femoral artery pressure measurements and an underestimation using Doppler spectrum analysis of blood flow velocities in the common femoral artery. Both methods were well tolerated, but femoral artery pressure measurements had a higher technical failure rate. Because of its noninvasive character and its feasibility the Doppler technique is preferred for the selection of patients for more extensive duplex sonographic investigation.     

Percutaneous mechanical revascularization of chronic iliac artery occlusion with "first intention" stent placement

The selective inactivation of genes, in a tissue-specific or temporally controlled manner, is now an important requirement for the analysis of nervous system development and function. Hammerhead ribozymes--catalytic RNA enzymes that specifically bind to and then cleave target RNAs--may provide a way to meet this requirement, particularly for organisms in which gene inactivation by homologous recombination is not feasible. However, ribozyme application has to some extent been hampered by limited knowledge as to the base-pairing accessibility of RNA target sites in vivo. In an attempt to circumvent this limitation, we have used a computer program based on free energy minimization to predict secondary structures for 128 RNA sequences for which corresponding ribozymes or antisense oligonucleotides have been synthesized, tested, and reported in the literature. A comparative analysis of the predicted structures of these targets with the reported efficacy of their corresponding antisense reagents has allowed us to formulate a set of rules for the rational choice of hammerhead ribozyme flanking arms and cleavage sites.     

Minimally invasive direct coronary artery bypass surgery

Traditional coronary artery bypass surgery involves a median sternotomy and the use of a heart-lung machine to stabilize the heart during suturing. Minimally invasive coronary artery surgery employs small incisions directly over the target vessels and avoids the use of a heart-lung machine, which can cause postoperative complications. The target coronary vessels are stabilized in alternative ways, potentially hazardous manipulation of the ascending aorta is avoided, and the subclavian and axillary arteries provide alternative inflow sources. Other new techniques used in minimally invasive procedures include a coronary artery cannula to avoid intraoperative ischemia and wound irrigation catheters to administer postoperative bupivacaine hydrochloride. Perioperative nurses need to become familiar with these new techniques to be able to plan and implement effective patient care.     

Bovine internal mammary artery as a conduit for coronary revascularization: long-term results

Preterm infants may become apneic during immediate postoperative period. We studied prospectively postoperative apneic attack in 167 preterm infants after inguinal herniorrhaphy with nitrous oxide-halothane anesthesia. Their mean gestational age was 30 +/- 3 weeks. The mean postnatal age at operation was 14 weeks. The post-conceptual age varied between 36 and 56 weeks. The mean birth weight was 1351 +/- 395 kg. Although many of them had a risk factor of postoperative apneic attack, i.e.a young post-conceptual age (less than 41 weeks), a light weight at operation (below 3000g), only one infant who had received emergency operation had an episode of apneic attack up to 2 postoperative days. For preventing postoperative apneic attack in preterm infants after inguinal hernia, we recommend the use of halothane anesthesia and the attention until a complete awakening.     

Preoperative evaluation of the right internal thoracic artery for coronary surgery

In general, the right internal thoracic artery (ITA) is used less frequently as a graft than the left ITA in coronary artery bypass grafting. To determine whether there is an anatomic or hemodynamic rationale for the underuse of the right ITA, noninvasive measurements of right and left ITAs were performed in 171 patients before the bypass procedure. Transthoracic visualization of both vessels was accomplished using a color-flow duplex scanner (5.0-MHz probe) through the third intercostal space. The diameter (in millimeters), peak systolic velocity (in centimeters per second), and end-diastolic velocity (in centimeters per second) were measured in all but 2 patients. The mean right ITA diameter was 2.7 +/- 0.6 mm, the mean peak systolic velocity was 100 +/- 29 cm/s, and the mean end-diastolic velocity was 6 +/- 5 cm/s. Diameter and flow velocity measurements for the right and left ITA were similar in all patients (p = not significant). The measured values for both sites were independent of age and sex, or the presence of hypertension or diabetes mellitus (p = not significant). We conclude that no morphologic or physiologic differences exist between the right and left ITAs. The findings from this study indicate that color-flow duplex ultrasound imaging is a safe and reliable noninvasive technique in the preoperative assessment of the anatomic and functional characteristics of the right ITA before coronary artery bypass grafting.     

Internal iliac revascularization during aortic aneurysm replacement: a review and description of a useful technique

The coexistence of infrarenal aortic aneurysm and internal iliac artery aneurysm may represent a management problem with regard to preservation of the pelvic blood supply. In this article, we review the methods available for maintaining the pelvic blood flow and describe a useful technique that we have successfully utilized in seven patients to preserve the hypogastric artery blood flow.     

Coronary artery bypass surgery during pregnancy

A 32-year-old woman, in the 22nd week of pregnancy, underwent emergency coronary artery bypass grafting to the left anterior descending artery (LAD). She had suffered an acute myocardial infarction 10 days previously, and continued to suffer from intractable angina pectoris afterwards. Cardiac catheterization revealed spontaneous dissection of the LAD. The left internal mammary artery was used to bypass the LAD, and the operation was performed on a beating heart without the use of cardiopulmonary bypass. The patient's recovery was uneventful, and ultrasound examination and pulse monitoring of the fetus were both normal. She subsequently gave birth to a healthy term baby. To our knowledge this is the second report of coronary artery bypass surgery performed successfully in a pregnant woman. We believe the unique surgical approach avoided the risk of cardiopulmonary bypass to the fetus and placenta.     

Use of an internal mammary artery graft in the revascularization of the myocardium. A ten-year follow up study

Between September 1986 and August 1996, 233 patients (187 males, 46 females) ranging in age from 32 to 81 (mean 54.7) years received at least one internal mammary artery (IMA) graft for coronary artery bypass procedures. The mean left ventricular ejection fraction was 55.1% (range, 17 to 75%). An average of 3.1 distal anastomoses per patient was constructed. Hospital mortality was 2.1%. Perioperative myocardial infraction was seen in 2.1%. The mean follow-up of hospital survivors was 39.2 (range, 4 to 123) months. Ten-year actuarial survival for patients discharged from the hospital was 96%. Recurrence of angina occurred in 18 patients and reoperation or PTCA was performed in 3 patients in the late follow-up period. These results support the continuing use of IMA grafts for myocardial revascularization.     

Fusiform dilatations of the internal carotid artery following surgery for pediatric suprasellar tumors

Fusiform dilatations of the internal carotid artery (FDCA) represent a vascular complication following surgery for suprasellar tumors in children. In a long-term follow-up of 62 children we identified 7 children (11.3%) with a FDCA. In all children the FDCA was present within 15 months following surgery. It was not related to radiotherapy or a distinct histology. In 3 children the FDCA remained unchanged during the follow-up, in 3 children there was a progression and 1 child revealed a regression within 6 months. Clinically the FDCA was inapparent in all cases and not treated. In a follow-up study of an adult population who underwent surgery for suprasellar tumors no case of FDCA was encountered. Potential pathomechanisms and indications for treatment are discussed.     

Blood flow in the internal mammary artery after the administration of papaverine during coronary artery bypass grafting

Vaccination against Newcastle disease with the thermotolerant LaSota/A300 and V4/276 coated-millet vaccines was tried in Ouagadougou, Burkina Faso, by feeding 298 European broiler chickens exhibiting maternal antibodies. Opportunistic infections, such as colibacteriosis, decimated 70-81% of the three vaccinated groups and 24% of control, before being eradicated by antibiotic therapy. The surviving chickens were challenged two months after vaccination with the Hertz 33/56 virus strain. This resulted in 100% deaths in the control group, 78% in birds vaccinated with the V4/276, 7% in birds fed with LaSota/A300, and in no death in the group given both vaccines at one week interval. These last two groups also exhibited high titres of 1HA antibodies before the challenge. The lyophilized LaSota/A300 and V4/276 vaccines kept high viral titres after 8-34 days' ambient temperature exposure during the cool season in Ouagadougou.