The Importance of Early Diagnosis and Treatment of Patients with Aortoenteric Fistulas Presenting with Herald Bleeds.

Background: Massive bleeding in patients with aortoenteric fistula (AEF) may be preceded by minor, intermittent gastrointestinal (GI) blood loss, termed the "herald bleed." The aims of this retrospective study were to: (i) analyze the interval between the herald bleed and onset of major GI hemorrhage and/or diagnosis of AEF and (ii) to evaluate the diagnostic roles of endoscopy and computed tomography imaging.

Methods: Analysis of all patients diagnosed with AEF or iliac-enteric fistulas between 1994 and 2013 in a single institution.

Endoscopic thoracic sympathectomy for upper limb ischemia. A 16 year follow-up in a single center.

Introduction: The aim of our study was to evaluate the long term results of Endoscopic Thoracic Sympathectomy (ETS) in the management of upper limb ischemia (ULI).

Methods: We retrospectively reviewed the records of all consecutive patients who underwent ETS for ULI between January 1994 and May 2009. A standardized questionnaire was used to evaluate the long term success, morbidity and overall patient satisfaction.

Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis.

Background: The surgical management of hyperhidrosis is controversial. Robotic surgical systems with their high-definition magnified 3-dimensional view and increased maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology.

The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial.

Background: The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established.The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD) compared with usual care.

Methods: A single centre, two arm, parallel group randomised controlled trial was performed.

S-Adenosylhomocysteine induces apoptosis and phosphatidylserine exposure in endothelial cells independent of homocysteine.

Objective: We have previously shown that homocysteine (Hcy) induces phosphatidylserine (PS) exposure, apoptosis and necrosis in human endothelial cells. Since it has been suggested that S-adenosylhomocysteine (SAH) is the main causative factor in Hcy-induced pathogenesis of cardiovascular disease, we evaluate here whether the cytotoxic Hcy effect in endothelial cells is also SAH dependent.

Methods And Results: Human umbilical vein endothelial cells (HUVECs) were exposed to the following conditions: (1) non-treated control (resulting in 2.

Homocysteine-induced apoptosis in endothelial cells coincides with nuclear NOX2 and peri-nuclear NOX4 activity.

Apoptosis of endothelial cells related to homocysteine (Hcy) has been reported in several studies. In this study, we evaluated whether reactive oxygen species (ROS)-producing signaling pathways contribute to Hcy-induced apoptosis induction, with specific emphasis on NADPH oxidases. Human umbilical vein endothelial cells were incubated with 0.

Homocysteine induces phosphatidylserine exposure in cardiomyocytes through inhibition of Rho kinase and flippase activity.

Aims: Increased levels of homocysteine (Hcy) form an independent risk factor for cardiovascular disease. In a previous study we have shown that Hcy induced phosphatidylserine (PS) exposure to the outer leaflet of the plasma membrane in cardiomyocytes, inducing a pro-inflammatory phenotype. In the present study the mechanism(s) involved in Hcy-induced PS exposure were analyzed.

Homocysteine-induced cardiomyocyte apoptosis and plasma membrane flip-flop are independent of S-adenosylhomocysteine: a crucial role for nuclear p47(phox).

We previously found that homocysteine (Hcy) induced plasma membrane flip-flop, apoptosis, and necrosis in cardiomyocytes. Inactivation of flippase by Hcy induced membrane flip-flop, while apoptosis was induced via a NOX2-dependent mechanism. It has been suggested that S-adenosylhomocysteine (SAH) is the main causative factor in hyperhomocysteinemia (HHC)-induced pathogenesis of cardiovascular disease.

Thoracic sympathectomy for digital ischemia: a summary of evidence.

Background: Thoracic sympathectomy is used in the management of a variety of upper limb disorders. We have analyzed the evidence for thoracic sympathectomy in the management of digital ischemia.

Methods: We reviewed the English literature between 1980 and 2010.

Inhibition of Rho-ROCK signaling induces apoptotic and non-apoptotic PS exposure in cardiomyocytes via inhibition of flippase.

Subsequent to myocardial infarction, cardiomyocytes within the infarcted areas and border zones expose phosphatidylserine (PS) in the outer plasma membrane leaflet (flip-flop). We showed earlier that in addition to apoptosis, this flip-flop can be reversible in cardiomyocytes. We now investigated a possible role for Rho and downstream effector Rho-associated kinase (ROCK) in the process of (reversible) PS exposure and apoptosis in cardiomyocytes.

Transjugular intrahepatic portosystemic shunt-placement increases arginine/asymmetric dimethylarginine ratio in cirrhotic patients.

Aim: To analyze the change of dimethylarginine plasma levels in cirrhotic patients receiving transjugular intrahepatic portosystemic shunt (TIPS).

Methods: To determine arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and nitric oxide (NO) plasma levels, blood samples were collected from the superior cava, hepatic, and portal vein just before, directly after, and 3 mo after TIPS-placement.

Results: A significant increase in the arginine/ADMA ratio after TIPS placement was shown.

Plasma ADMA concentrations at birth and mechanical ventilation in preterm infants: a prospective pilot study.

Rationale: Nitric oxide (NO) produced in the lung is an important mediator of normal lung development, vascular smooth muscle relaxation, and ventilation perfusion matching. NO is synthesized from arginine by the action of NO-synthase (NOS). Asymmetric dimethylarginine (ADMA), an endogenous derivate of arginine, inhibits NOS and is thereby a determinant of NO synthesis.

Hemodynamic changes in ipsi- and contralateral cerebral arterial territories after carotid endarterectomy using positron emission tomography.

Background: The purpose of this study was to characterize ipsi- and contralateral cerebral hemodynamics before and after CEA.

Methods: Cerebral blood flow, CBV, and MVTT were measured in 10 patients before and after CEA using PET. Absolute and relative values of these parameters were calculated bilaterally for the entire arterial territories and hemispheres.

Motives for (not) participating in a lifestyle intervention trial.

Background: Non-participants can have a considerable influence on the external validity of a study. Therefore, we assessed the socio-demographic, health-related, and lifestyle behavioral differences between participants and non-participants in a comprehensive CVD lifestyle intervention trial, and explored the motives and barriers underlying the decision to participate or not.

Methods: We collected data on participants (n = 50) and non-participants (n = 50) who were eligible for inclusion in a comprehensive CVD lifestyle interventional trial.

Suture damage during robot-assisted vascular surgery: is it an issue?

Background: Manipulation of sutures during endoscopic surgery could lead to damage of suture structure, supposedly resulting in loss of strength. Lack of tactile feedback in robotic surgical systems might increase this problem. The objective of this study is to evaluate suture strength after robotic manipulation and to determine which suture material is least susceptible to damage from robotic manipulation.

Modular branched endograft system for aortic aneurysm repair: evaluation in a human cadaver circulation model.

A circulation model was created in 6 nonaneurysmal human cadavers to evaluate the deliverability, deployment, and acute performance of a modular branched endograft system for treatment of aortic aneurysms containing essential branch vessels. Two fenestrations were created in an appropriately sized aortic main endograft. Under fluoroscopic guidance, the main endograft was advanced to the target site and the fenestrations were aligned with the ostia of the renal arteries.

Homocysteine affects cardiomyocyte viability: concentration-dependent effects on reversible flip-flop, apoptosis and necrosis.

Background: Hyperhomocysteinaemia (HHC) is thought to be a risk factor for cardiovascular disease including heart failure. While numerous studies have analyzed the role of homocysteine (Hcy) in the vasculature, only a few studies investigated the role of Hcy in the heart. Therefore we have analyzed the effects of Hcy on isolated cardiomyocytes.

Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.

Objective: To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery.

Design And Setting: A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital.

Patients And Methods: Patients (n=67) were subjected to a 90-min filling pressure-guided fluid challenge with saline 0.

Aprotinin does not diminish blood loss in elective operations for infrarenal abdominal aneurysms: a randomized double-blind controlled trial.

Surgery for abdominal aneurysm is associated with substantial blood loss. In cardiac surgery, aprotinin, a fibrinolysis inhibitor, has shown to reduce blood loss significantly. Our aim was to assess the effect of aprotinin, when administered during elective surgery of infrarenal abdominal aneurysm, on coagulation, blood loss, and morbidity.

Fenestrated and branched endografts: assessment of proximal aortic neck fixation.

Purpose: To investigate proximal fixation characteristics of different aortic endograft designs: a suprarenally placed fenestrated endograft, a modular branched endograft, an infrarenal endograft with suprarenal bare stent fixation, and the gold standard, a conventional hand-sewn anastomosis.

Methods: Ten human cadaveric aortas were obtained at autopsy and transected 20 mm below the renal arteries to mimic an infrarenal aneurysm neck. In random order, the infrarenal, fenestrated, and branched endografts were deployed into the aorta.

Carotid stent mobility with regard to head movements: in vitro analysis.

Given that considerable motion of the carotid artery is present during head movements, we hypothesized that a flexible stent with low torsion might be favorable to avoid stress imparted to the stent and carotid artery. Therefore, we evaluated the flexibility of different expanded carotid stents before and after deployment in a carotid artery in vitro. Subsequently, we evaluated torsion of the bare expanded stents.

False lumen thrombectomy of the superior mesenteric artery followed by iliomesenteric bypass after Stanford type B aortic dissection.

A 55-year-old man with an acute Stanford type B aortic dissection presented with clinical signs of mesenteric ischemia. Computed tomography (CT) revealed a thrombosed false lumen in the superior mesenteric artery. At laparotomy, the dissection was found to be extending into the jejunal branches and medial colic artery.

A temporary hemostatic valve in the short limb of a bifurcated stent-graft to facilitate endovascular repair of ruptured aortic aneurysm: experimental findings.

Purpose: To evaluate a homemade tricuspid valve placed in the short limb of a bifurcated aortic stent-graft to facilitate endovascular treatment of ruptured abdominal aortic aneurysms (AAA).

Methods: A valve consisting of 3 polytetrafluoroethylene cusps was constructed in the short limb of a bifurcated stent-graft. The endoprosthesis was placed into an in vitro circulation model with pulsatile flow.

Gut and liver handling of asymmetric and symmetric dimethylarginine in the rat under basal conditions and during endotoxemia.

Introduction/aim: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) synthase enzymes, whereas symmetric dimethylarginine (SDMA) competes with arginine transport. Although both dimethylarginines may be important regulators of the arginine-NO pathway, their metabolism is largely unknown. In previous studies, evidence was found for the liver in the metabolism of dimethylarginines.