Reduced efficacy of clinical probability score and D-dimer assay in elderly subjects suspected of having deep vein thrombosis.

The combined strategy of a pretest clinical probability (PCP) score and D-dimer has shown to be of value in the diagnosis of deep vein thrombosis (DVT). As D-dimer concentrations increase with age, the effect of age on the usefulness of this strategy was retrospectively investigated in outpatients suspected of having DVT. In all patients, participants of a prospective management trial, a PCP score and D-dimer (Tina-quant) were performed.

Is there a role for mechanical valved conduits in the pulmonary position?

Background: The use of allografts or xenografts is the treatment of choice for pulmonary valve replacement. However, the limited durability is responsible for multiple reoperations associated with increased morbidity. In search of a definitive solution, the implantation of a mechanical valved conduit might be an option in highly selected patients.

Elevated levels of D-dimer and fragment 1+2 upon central venous catheter insertion and factor V Leiden predict subclavian vein thrombosis.

Background And Objectives: Subclavian vein thrombosis is a well-recognized complication following central venous catheter insertion. We studied whether the determination of D-dimer levels, fragment 1+2 levels and factor V Leiden can identify patients at high risk of developing subclavian vein thrombosis.

Design And Methods: The presence of central venous catheter associated thrombosis was analyzed in 235 patients undergoing allogeneic bone marrow transplantation, of whom 30 (13%) developed thrombosis.

The predictive value of D-dimer measurement for cancer in patients with deep vein thrombosis.

Background And Objectives: Venous thromboembolism can be related to malignancy, but routine screening for cancer in patients with deep vein thrombosis (DVT) is not a recommended practice. The aim of this study was to evaluate the value of D-dimer concentration in predicting cancer in patients with DVT.

Design And Methods: D-dimer levels were measured in outpatients presenting with DVT.

Understanding the legal implications of living wills.

This article explains the legality of living wills and clarifies the conditions that make an advance statement valid. The practical application of a living will is explored using examples illustrating the necessary considerations. In recognising the legality of advance refusals of treatment, nurses need to be aware that they must abide by such a refusal.

What was the impact of the introduction of extracardiac completion for a single center performing total cavopulmonary connections?

Background: Creation of an extracardiac cavopulmonary connection has been proposed as a superior alternative to the lateral intracardiac tunnel for the completion of total cavopulmonary connection.

Methods And Results: We made a retrospective review of our experience with 125 patients undergoing a total cavopulmonary connection between June 1994 and January 2003. Our experience with the extracardiac connection for completion began in 1999.

Markers of inflammation and oxidative stress in exacerbated chronic obstructive pulmonary disease patients.

COPD is characterised by damage to small airways due to an inflammatory process as well as an imbalance between oxidants and antioxidants. Several cytokines and cell adhesion molecules enhancing a mainly neutrophilic inflammation have been associated with COPD. The aim of the study was to investigate whether inflammation or oxidative markers gave an indication of the course of COPD during an exacerbation.

The posterior interosseous artery in the distal part of the forearm. Is the term "recurrent branch of the anterior interosseous artery" justified?

In 1993 Angrigiani raised the question as to whether the distal part of the posterior interosseous artery (AIP) is a recurrent branch of the anterior interosseous artery (AIA) and forms a "choke"--anastomosis with the AIP in the middle of the forearm. A dissection study was conducted on 66 upper extremities to evaluate the diameters of the dorsal branch of the anterior interosseous artery, the anastomotic branch, the diameter of the posterior interosseous artery at the point of origin of the septocutaneous perforators in the middle of the forearm and the diameter of the posterior interosseous artery at the point of emergence in the dorsal compartment. We further tried to identify different forms and types of the "distal" anastomosis and the connections to the dorsal carpal arch and the ulnar artery.

Mini extracorporeal circuit for coronary artery bypass grafting: initial clinical and biochemical results: a comparison with conventional and off-pump coronary artery bypass grafts concerning global oxidative stress and alveolar function.

Background: The new concept of mini-extracorporeal circulation (MECC) for coronary artery bypass grafts (MCABG) consists of minimal priming volume, a heparin-coated closed circuit, a centrifugal pump, active drainage, blood cardioplegia and a cell-saving device. The potential organ protective effect of this technique during CABG is unknown. Initial clinical outcomes, oxidative stress, alveolar shunting and need for blood transfusion were investigated for MCABG patients.

Low molecular weight heparin (dalteparin) is equally effective as unfractionated heparin in reducing coagulation activity and perfusion abnormalities during the early treatment of pulmonary embolism.

Little is known about the differences between unfractionated heparin (UFH) and low molecular weight heparin (LMWH) with regard to their effects on coagulation activity during treatment for pulmonary embolism. The objective of this study was to compare UFH and LMWH (dalteparin) in the early treatment of pulmonary embolism in terms of control of coagulation markers and perfusion abnormalities. Thirty-seven patients with acute pulmonary embolism were randomized to receive intravenous UFH or subcutaneous dalteparin, each accompanied by acenocoumarol.

Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients.

Objective: Heparin-induced thrombocytopenia (HIT) is the most common form of drug-induced immune-mediated thrombocytopenia. HIT may be aggravated by life-threatening arterial and venous thrombosis and, to a lesser extent, hemorrhagic complications. We investigated the incidence of thromboembolic and hemorrhagic complications in critically ill patients with the multiple organ dysfunction syndrome and HIT.

The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery.

The pedicled lower trapezius musculocutaneous flap is a standard flap in head and neck reconstruction. A review of the literature showed that there is no uniform nomenclature for the branches of the subclavian artery and the vessels supplying the trapezius muscle and that the different opinions on the vessels supplying this flap lead to confusion and technical problems when this flap is harvested. This article attempts to clarify the anatomical nomenclature, to describe exactly how the flap is planned and harvested, and to discuss the clinical relevance of this flap as an island or free flap.

Automatic particle selection: results of a comparative study.

Manual selection of single particles in images acquired using cryo-electron microscopy (cryoEM) will become a significant bottleneck when datasets of a hundred thousand or even a million particles are required for structure determination at near atomic resolution. Algorithm development of fully automated particle selection is thus an important research objective in the cryoEM field. A number of research groups are making promising new advances in this area.

Clinical application of the retrograde arterialized venous flap.

Retrograde arterialized venous flaps were applied to skin and soft-tissue defects in 13 patients with an average age of 34.4 years. Ten defects were located on the hand, and three on the lower leg.

Defects on the dorsum of the hand--the posterior interosseous flap and its alternatives.

There are conditions that preclude the use of the posterior interosseous flap for reconstruction of the dorsum of the hand. Based on a series of 34 cases, these conditions are outlined and alternative solutions discussed. The posterior interosseous flap was employed for closure in 30 cases.

Antiretroviral activity of the anti-CD4 monoclonal antibody TNX-355 in patients infected with HIV type 1.

Background: We wished to determine the safety and anti-human immunodeficiency virus (HIV) type 1 activity of single doses of TNX-355, a humanized IgG4 anti-CD4 monoclonal antibody with potent activity against HIV-1 in vitro, in HIV-infected subjects.

Methods: Sequential cohorts of 6 HIV-1-infected subjects each received infusions of TNX-355. Data included plasma HIV-1 RNA level, CD4+ T cell count, TNX-355 coating of CD4+ T cells, and serum TNX-355 levels.

Necrotizing fasciitis after ambulatory phlebectomy performed with use of tumescent anesthesia.

The high cost of treatment of varicose veins has an important role in public health care. The search for a less expensive and office-based procedure led to introduction of tumescent local anesthesia for use in ambulatory phlebectomy. Although the overall infection rate is low, severe infection has been reported after liposuction with tumescent anesthesia.

Reconstruction of combined defects of the Achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous lateral arm flap.

A new approach to reconstruction of the Achilles tendon and overlying soft tissue is presented. A fascia lata graft is used to reconstruct the tendon and is enwrapped by the fascia that is included in a fasciocutaneous lateral arm flap. Five patients were treated with this technique; three of them after surgical Achilles tendon repair, rerupture, and consecutive infection, one after a full-thickness burn with loss of the tendon and one with a history of ochronosis and necrosis of the whole tendon and overlying soft tissue.

A controlled Phase II trial assessing three doses of enfuvirtide (T-20) in combination with abacavir, amprenavir, ritonavir and efavirenz in non-nucleoside reverse transcriptase inhibitor-naive HIV-infected adults.

Enfuvirtide is a novel antiretroviral that blocks HIV-1 cell fusion and viral entry. This Phase II, controlled, open-label, randomized, multicentre dose-ranging trial explored the safety, antiviral activity and pharmacokinetics of enfuvirtide, administered by subcutaneous (s.c.

The usefulness of five D-dimer assays in the exclusion of deep venous thrombosis.

D-Dimer measurement is a promising tool in the exclusion of venous thrombosis. New d-dimer assays have been introduced, but need clinical validation. Our objective was to evaluate the clinical usefulness of four relatively new d-dimer assays and a classical ELISA in outpatients suspected for deep venous thrombosis.

Treatment of painful neuroma by resection and nerve stump transplantation into a vein.

Twenty-three patients (14 men, 9 women) with 24 painful neuromas underwent resection of neuroma and transposition of the nerve stump into an adjacent vein. The neuromas resulted from amputations (N = 7), tumor excision (N = 5), laceration injuries (N = 4), different types of wrist surgery (N = 3), vein-stripping procedures (N = 2), open fracture of the radius (N = 1), and toe harvest for thumb reconstruction (N = 1). The duration of painful symptoms averaged 66.