Role of intravascular ultrasound imaging during endovascular interventions of failing hemodialysis access grafts.

Background: Arteriovenous (AV) access graft complications represent a serious complication in patients undergoing hemodialysis. Angiography is one method of visualizing them. However, angiography is not always an effective means of detecting lesions that occur in this context.

A rare presentation of ruptured abdominal aortic aneurysm leading to aortoduodenal syndrome.

Duodenal obstruction is a rare complication of abdominal aortic aneurysm. Obstruction developing acutely from ruptured abdominal aortic aneurysm (RAAA) is exceedingly rare. We present a case of gastroduodenal outlet obstruction developing as the primary presentation for RAAA and a discussion of the relevant literature pertaining to the gastrointestinal complications related to the presence of intact and RAAA.

Single-stage reconstruction of perforated choledochal cyst: case report and review of the literature.

Choledochal cysts represent a rare disease in the Western world. We reviewed our recent experience with a case of perforated choledochal cyst, define the currently accepted treatment options, and review the literature of this unusual disease. An 11-month-old girl presented with abdominal pain and distention as well as non-bilious vomiting.

Management of subclavian and axillary artery injuries: spanning the range of current therapy.

Injuries of the subclavian and proximal axillary arteries are potentially devastating but account for a minority of vascular injuries presenting to trauma centers in the United States. We have reviewed our recent experience with management of subclavian and axillary artery injuries in a state-designated level 1 academic trauma center and report four cases that illustrate the typical arterial injury patterns and the entire therapeutic armamentarium in its current iteration. Subclavian and proximal axillary artery injuries present as interesting surgical problems.

Adenocarcinoid of the appendix: is right hemicolectomy necessary? A meta-analysis of retrospective chart reviews.

The purpose of this study was to determine the efficacy of simple appendectomy versus right hemicolectomy in the treatment of localized adenocarcinoid of the appendix. A literature review of retrospective chart reviews from 1966 to March 1, 2003, was performed. Outcomes of retrospective chart reviews were assessed on the basis of treatment modality.

Native matrix metalloproteinase characteristics may influence early stenosis of venous versus arterial coronary artery bypass grafting conduits.

Purpose: Stenosis and occlusion rates of internal mammary artery (IMA) and saphenous vein (SV) coronary artery bypass grafts (CABGs) are markedly different, which result from respective disparities in vascular remodeling. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) regulate vascular structure and may have important influence on graft patency. However, the MMP milieu and expression profile of the IMA and SV have not been contrasted.

Analyzing prophylactic antibiotic administration in procedures lasting more than four hours: are published guidelines being followed?

Published guidelines for surgical antibiotic prophylaxis recommend that an appropriately selected and administered antibiotic should be repeated in a timely manner in lengthy procedures. To assess concordance with published guidelines we reviewed the prophylactic antibiotic usage in procedures lasting more than 4 hours at a 500-bed university hospital. The records of 300 procedures longer than 4 hours in duration from the gastrointestinal, neurosurgery, and vascular surgery services were retrospectively reviewed.

Decreased vascular matrix metalloproteinase abundance in diabetic patients with symptomatic macroangiopathy.

The incidence of diabetic amputations is 2- to 3-fold higher in African-American patients compared to Caucasians. Vascular remodeling characterized by extracellular matrix (ECM) deposition occurs in diabetes and contributes to vascular complications. The matrix metalloproteinases (MMP) play important roles in the regulation of collagen turnover and vascular remodeling.