M pneumoniae infection, pulmonary thromboembolism and antiphospholipid antibodies.

A 28-year-old, hypertensive and hypercholesterolaemic patient, was referred to our emergency unit with a mild thoracic pain, productive cough and a body temperature of 37.3°C. Laboratory examinations showed normal white cell count and moderate elevation of C reactive protein (CRP).

A large and massive abdominal venous thrombosis associated with the presence of a big axillary mass, lupus-like syndrome and antiphospholipid antibodies.

This case report concerns a 40-year-old patient with an unspecific abdominal pain, diarrhoea, a big axillary mass and a previous pulmonary infection. After biopsy of the axillary mass the diagnosis of lymphoma was excluded based on the presence of cells expressing polyclonal antibodies. Abdominal CT scans and angionuclear magnetic resonance showed an extensive intestinal venous thrombosis.

Atorvastatin reduces proinflammatory markers in hypercholesterolemic patients.

Background: Reduction in cardiovascular events with statins has been in part attributed to their anti-inflammatory properties.

Objective: Evaluate the effects of atorvastatin on levels of inflammatory markers, such as tumor necrosis factor-alpha (TNF), interleukins (IL-1 and IL-6), soluble intercellular adhesion molecule-1 (sICAM-1) and C-reactive protein (CRP) in hypercholesterolemic patients (LDL-cholesterol >160 mg/dL).

Methods And Results: Two lipid-lowering regimens were taken for 8 weeks.

Complementary distal arterio-venous fistula combined with deep vein interposition to improve infrapopliteal prosthetic bypass patency.

The rapid evolution of vascular surgical techniques over the last few years coupled with the availability of an adequate venous conduit has allowed a more liberal and successful approach to salvage ischemic limbs caused by advanced atherosclerosis. This aggressive approach can be exemplified by the construction of arterial bypasses to the terminal branches of tibial vessels. However, a significant number of patients will continue to face the threat of a major amputation because of insufficient amounts of vein(s) to perform a totally autogenous bypass to one of the infrapopliteal arteries.

Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: a preliminary report from the North American registry.

Purpose: The North American Subfascial Endoscopic Perforator Surgery (NASEPS) Registry was established to evaluate the safety, feasibility, and efficacy of minimally invasive endoscopic Linton operations for treatment of chronic venous insufficiency.

Methods: Retrospective analysis was performed on the clinical data of 151 patients who underwent attempt at 158 SEPS in 17 medical centers in the United States and Canada between June 1993 and February 1996.

Results: SEPS was completed on 155 limbs of 148 patients, 81 male and 67 female (mean age, 56 years; range, 27 to 87 years).

[Acute embolic stroke treated with rt-PA during elective coronary angiography].

A 56-year-old female with unstable angina, presented an acute embolic ischaemic stroke of right medium cerebral artery during elective coronary angiography. Complete patency was achieved after an intraarterial infusion of rt-PA (60mg/60min) with important functional improvement.

Complementary distal arteriovenous fistula and deep vein interposition: a five-year experience with a new technique to improve infrapopliteal prosthetic bypass patency.

Purpose: In an attempt to improve graft patency results of prosthetic bypasses to infrapopliteal arteries, we used a new type of adjunctive technique that combines an arteriovenous fistula and vein interposition (AVF/VI).

Methods: Over the past 5 years, 68 such reconstructions were performed in 62 patients with critical ischemia in whom a totally autogenous vein bypass was not feasible. Forty-seven patients (76%) had one or more failed ipsilateral infrainguinal bypasses.

Perfluorocarbon emulsion prevents eicoasanoid release in skeletal muscle ischemia and reperfusion.

Eicosanoids play an important role in mediating deleterious effects following skeletal muscle ischemia-reperfusion injury. It has previously been shown that oxygenated perfluorocarbon emulsion (O2 Fluosol-DA 20%) decreases the amount of muscle necrosis and neutrophil sequestration when given during the reperfusion phase following skeletal muscle ischemia. As thromboxane is known to alter the endothelial cytoskeleton, thereby favoring diapedesis of neutrophils, the effects of O2 Fluosol-DA 20% on thromboxane release in a canine gracilis muscle model were investigated.

The natural history of the external carotid artery after carotid endarterectomy: implications for management.

Purpose: Most surgeons perform some type of endarterectomy of the external carotid artery (ECA) routinely during standard carotid endarterectomy (CEA). This approach has been shown to result in a small percentage of ECA occlusions, the clinical significance of which remains poorly understood. We have modified our approach to the management of the ECA during standard CEA by averting any attempt at external CEA.

Superior vena caval Greenfield filters: indications, techniques, and results.

Purpose: This study assessed the clinical feasibility of placement of the titanium Greenfield filter within the superior vena cava (SVC) in patients with upper extremity deep venous thrombosis and evaluated the short-term results.

Methods: During the past 14 months, we have encountered 6 patients who had upper extremity central venous thrombosis in whom anticoagulation was deemed either contraindicated or ineffective in preventing recurrent pulmonary embolism. All patients underwent percutaneous insertion of a Greenfield filter into the SVC for prophylaxis for pulmonary embolism.

Preliminary results of a nonoperative approach to saphenofemoral junction thrombophlebitis.

Purpose: A prospective, nonrandomized study was conducted to evaluate the efficacy of a nonoperative approach of anticoagulation therapy to manage saphenofemoral junction thrombophlebitis (SFJT).

Methods: Over a 2-year period between January 1993 and January 1995, 20 consecutive patients with SFJT were entered into the study. They were hospitalized and given a full course of heparin.

Noninvasive predictors of patency for infrapopliteal PTFE bypasses with combined arteriovenous fistula and vein interposition technique.

Background: Despite recent increased indications for infrapopliteal prosthetic bypass grafts with complementary arteriovenous fistulas, objective documentation of improved perfusion to the foot is lacking. In addition, the value of post operative noninvasive testing in the prediction of bypass success remains unclear.

Patients And Methods: Over a 3-year period, 41 patients with limb-threatening ischemia were treated with 41 infrapopliteal 6-mm polytetrafluoroethylene (PTFE) bypasses with a complementary arteriovenous fistula at our institution.

The value and limitations of L-arginine infusion on glomerular and tubular function in the ischemic/reperfused kidney.

Purpose: The nitric oxide precursor, L-arginine, has been shown to have a salutary effect on ischemia and reperfusion injury in skeletal muscle, skin, and intestines. Because L-arginine also increases renal blood flow, glomerular filtration, and urine flow in experimental animals with normal renal function, we postulated that L-arginine may also improve renal function after renal ischemic injury.

Methods: Eighteen adult New Zealand white rabbits weighing 3 to 3.

Outcome of patients with abnormal ocular pneumoplethysmographic measurements undergoing coronary artery bypass grafting.

A total of 1780 patients without symptoms of cerebral ischemia undergoing coronary artery bypass grafting (CABG) were screened before surgery for carotid stenosis by pneumophlethysmography. An abnormal test was defined as a difference in ophthalmic artery pressures of > or = 5 mmHg or ophthalmic-brachial pressure index < or = 0.69.

Unilateral renal artery revascularization can salvage renal function and terminate dialysis in selected patients with uremia.

Revascularization of renal arteries to salvage glomerular function in patients with chronic renal failure is performed infrequently. However, during the past 12 months we have encountered three patients over 60 years of age known to have chronic renal failure who were on dialysis for 2 weeks, 3 weeks, and 2 months, respectively. All three patients were hypertensive, requiring between four and five antihypertensive medications.

Acute mesenteric ischemia after cardiopulmonary bypass.

Three thousand sixty-six patients underwent cardiopulmonary bypass at the Maimonides Medical Center over a 5-year period from January 1, 1987, to January 1, 1992. Of these patients, 1,890 (62%) were less than 70 years of age, 969 (32%) ranged from 70 to 79 years of age, and 207 (7%) were 80 years of age or older. The overall 30-day mortality rate was 8%.

The preferential use of the external iliac artery as an inflow source for redo femoropopliteal and infrapopliteal bypass.

Purpose: It is believed that secondary operations involving the inguinal region are associated with a significant morbidity that includes infection, lymphatic obstruction, lymphorrhea, and neurovascular injury. To prevent these potentially important complications we have avoided a redo groin incision in 38 patients with severely symptomatic disease who had primary (23 cases) or secondary (15 cases) femoropopliteal bypass thrombosis during the past 3 years.

Methods: All patients were candidates for prosthetic bypasses because of lack of a suitable vein.

The relationship between timing of repair of disruptions and subsequent aneurysm formation in laser-assisted microvascular anastomoses.

In this study we investigated the effects of duration of bleeding after laser-assisted microvascular anastomoses and the amount of laser energy used to control bleeding on aneurysm formation. Eighty femoral arteries were exposed in 40 Sprague-Dawley rats anesthetized with chloral hydrate. The arteries were transected and then anastomosed end-to-end with three nylon stay sutures followed by irradiation of the vessels with energy from a CO2 laser.

Association of intra-abdominal pathologies and vascular anomalies with infrarenal aortic aneurysm: a computed tomographic study.

The prevalence of potentially significant intra-abdominal pathologies or vascular anomalies in candidates for infrarenal aortic aneurysm repair remains unclear. This study retrospectively reviewed 130 consecutive patients with aortic aneurysms (4.5-10.

Silent myocardial ischemia is not predictive of myocardial infarction in peripheral vascular surgery patients.

Continuous ambulatory ECG (CAECG) monitoring has been advocated as an effective low-cost preoperative method for detecting silent myocardial ischemia in patients undergoing peripheral vascular surgery. In addition, silent ischemic events are associated with an increased incidence of postoperative myocardial infarctions. Ninety-six patients (mean age 73 years) admitted for elective aortic (24) or infrainguinal (72) operations over a 2-year period underwent 24-hour two- or three-lead CAECG monitoring.

Intrathecal perfusion of an oxygenated perfluorocarbon prevents paraplegia after aortic occlusion.

A canine model was used to evaluate the effects of continuous intrathecal perfusion of an oxygenated perfluorocarbon emulsion on systemic and cerebral hemodynamics and neurologic outcome after 70 minutes of normothermic aortic occlusion. Twelve mongrel dogs were instrumented to monitor proximal and distal arterial blood pressure, cerebrospinal fluid pressure, spinal cord perfusion pressure, and somatosensory evoked potentials. The intrathecal perfusion apparatus consisted of two perfusing catheters, placed in the intrathecal space through a laminectomy, and a draining catheter percutaneously inserted in the cisterna cerebellomedullaris.

Do cytokines play a role in skeletal muscle ischemia and reperfusion?

Cytokines, interleukin-1 (IL-1) and tumor necrosis factor (TNF) are known to mediate host cell response to sepsis, trauma, and myocardial ischemia. We have previously found increased levels of IL-1 in the venous effluent during the reperfusion phase of skeletal muscle ischemia in a canine model. This study was done to evaluate whether TNF also played a role in skeletal muscle ischemia-reperfusion injury since IL-1 and TNF have inter-related functions.

Reduction of the extent of ischemic skeletal muscle necrosis by perfusion with oxygenated perfluorocarbon.

Oxygenated perfluorocarbon emulsion has been shown to preserve feline cerebral function after ischemia. The postulated protective effects of perfluorocarbons include improvement of blood rheology and prevention of neutrophil adherence by nonchemical inhibition of surface receptors. In this study, we used a well-described gracilis muscle model to investigate whether oxygenated perfluorocarbon can minimize skeletal muscle necrosis by mitigating the degree of leuko-sequestration.

Does iloprost mediate thromboxane activity and polymorphonuclear leukocyte sequestration in ischemic skeletal muscle?

Thromboxane is known to alter the endothelial cytoskeleton, thereby causing increased endothelial permeability and polymorphonuclear leukocyte (PMN) sequestration in the lungs. We investigated whether iloprost (a stable prostacyclin analog) can decrease thromboxane activity and consequently PMN sequestration because of its anti-platelet aggregation effect. This premise was investigated in a canine isolated gracilis muscle model using 18 animals.