Medical comorbidities but not interventions adversely affect survival in patients with intermittent claudication.

Objective: Intermittent claudication (IC) is common and associated with decreased survival. While patients with IC infrequently progress to critical limb ischemia (CLI), many elect to pursue intervention initially or during follow-up. However, controversy exists as to whether intervention in patients with IC adversely impacts survival or limb salvage.

Deriving concentrations of oxygen and carbon in human tissues using single- and dual-energy CT for ion therapy applications.

Dedicated methods of in-vivo verification of ion treatment based on the detection of secondary emitted radiation, such as positron-emission-tomography and prompt gamma detection require high accuracy in the assignment of the elemental composition. This especially concerns the content in carbon and oxygen, which are the most abundant elements of human tissue. The standard single-energy computed tomography (SECT) approach to carbon and oxygen concentration determination has been shown to introduce significant discrepancies in the carbon and oxygen content of tissues.

Diglycolic acid inhibits succinate dehydrogenase activity in human proximal tubule cells leading to mitochondrial dysfunction and cell death.

Diethylene glycol (DEG) is a solvent used in consumer products allowing the increased risk for consumer exposure. DEG metabolism produces two primary metabolites, 2-hydroxyethoxyacetic acid (2-HEAA) and diglycolic acid (DGA). DGA has been shown to be the toxic metabolite responsible for the proximal tubule cell necrosis seen in DEG poisoning.

Improving the quality of the surgical morbidity and mortality conference: a prospective intervention study.

Purpose: Surgical morbidity and mortality conferences (M&MCs) provide surgeons with an opportunity to confront medical errors, discuss adverse events, and learn from their mistakes. Yet, no standardized format for these conferences exists. The authors hypothesized that introducing a standardized presentation format using a validated framework would improve presentation quality and educational outcomes for all attendees.

Current medical and surgical management of Raynaud's syndrome.

Raynaud's syndrome (RS) is characterized by episodic digital ischemia induced by cold or emotional stress. Pathophysiologic mechanisms include temporary vasospasm and fixed digital artery obstruction. A number of pharmacologic and invasive therapies have been studied to treat RS symptoms; however, there are no specific treatments that are currently approved by the U.

Factors affecting healing and survival after finger amputations in patients with digital artery occlusive disease.

Background: Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known.

Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection.

Objective: Lifelong surveillance is recommended for both endovascular aneurysm repair and acute, uncomplicated type B thoracic aortic dissection, though compliance remains a significant challenge. We sought to determine factors associated with failure to obtain recommended surveillance.

Methods: Patients surviving to discharge who had endovascular repair of thoracic (thoracic endovascular aortic aneurysm repair [TEVAR]) or abdominal aortic aneurysms (endovascular aortic aneurysm repair [EVAR]) or medical management for type B dissections from 2004-2011 were reviewed.

Bilateral mechanical rotational vertebral artery occlusion.

Rotational vertebral artery occlusion, or bow hunter's stroke, is reversible, positional symptomatic vertebrobasilar ischemia. The typical mechanism of action is obstruction of a dominant vertebral artery with contralateral head rotation in the setting of baseline ipsilateral vertebral artery stenosis or occlusion. Here we present a rare case of mechanical occlusion of bilateral patent vertebral arteries manifesting as near syncope with rightward head rotation.

Isolated calf muscular vein thrombosis is associated with pulmonary embolism and a high incidence of additional ipsilateral and contralateral deep venous thrombosis.

Objective: Little is known about the natural history of isolated gastrocnemial and soleal vein thrombosis (IGSVT), and recommendations for treatment and follow-up are therefore anecdotal. This study sought to determine the rates of venous thromboembolism (VTE) progression and resolution and the effect of antithrombotic therapy in patients with IGSVT.

Methods: A vascular laboratory database was queried from January 2002 to December 2006 to identify patients with duplex-diagnosed IGSVT and follow-up duplex scan studies.

Outcomes of open operation for aortoiliac occlusive disease after failed endovascular therapy.

Objectives: To compare patient outcomes of primary open operation for aortoiliac occlusive disease (AIOD) with those of secondary open operations for failed endovascular therapy (ET) of AIOD.

Design: A retrospective cohort study was performed analyzing demographic characteristics, comorbidities, and outcomes.

Setting: Affiliated Veterans Affairs Hospital from January 1, 1998, through March 31, 2010.

Layered mass geometry: a novel technique to overlay seeds and applicators onto patient geometry in Geant4 brachytherapy simulations.

A problem faced by all Monte Carlo (MC) particle transport codes is how to handle overlapping geometries. The Geant4 MC toolkit allows the user to create parallel geometries within a single application. In Geant4 the standard mass-containing geometry is defined in a simulation volume called the World Volume.

Scheduled daily mating induces circadian anticipatory activity rhythms in the male rat.

Daily schedules of limited access to food, palatable high calorie snacks, water and salt can induce circadian rhythms of anticipatory locomotor activity in rats and mice. All of these stimuli are rewarding, but whether anticipation can be induced by neural correlates of reward independent of metabolic perturbations associated with manipulations of food and hydration is unclear. Three experiments were conducted to determine whether mating, a non-ingestive behavior that is potently rewarding, can induce circadian anticipatory activity rhythms in male rats provided scheduled daily access to steroid-primed estrous female rats.

A combined dose calculation and verification method for a small animal precision irradiator based on onboard imaging.

Purpose: Novel small animal precision microirradiators (micro-IR) are becoming available for preclinical use and are often equipped with onboard imaging (OBI) devices. We investigated the use of OBI as a means to infer the accuracy of the delivered treatment plan.

Methods: Monte Carlo modeling of the micro-IR including an elliptical Gaussian electron beam incident on the x-ray tube was used to score dose and to continue photon transport to the plane of the OBI device.

Evaluation of a novel triple-channel radiochromic film analysis procedure using EBT2.

A novel approach to read out radiochromic film was introduced recently by the manufacturer of GafChromic film. In this study, the performance of this triple-channel film dosimetry method was compared against the conventional single-red-channel film dosimetry procedure, with and without inclusion of a pre-irradiation (pre-IR) film scan, using EBT2 film and kilo- and megavoltage photon beams up to 10 Gy. When considering regions of interest averaged doses, the triple-channel method and both single-channel methods produced equivalent results.

Symptomatic venous thromboembolism after femoral vein harvest.

Objective: The femoral vein is increasingly utilized as a conduit in major arterial and venous reconstruction. However, perioperative complications, especially venous thromboembolism (VTE) associated with femoral vein harvest (FVH), are not well described. The purpose of this study was to determine the incidence and risk factors for the development of symptomatic VTE in patients who undergo FVH.

Influence of trace elements in human tissue in low-energy photon brachytherapy dosimetry.

The aim of this paper is to determine the dosimetric impact of trace elements in human tissues for low-energy photon sources used in brachytherapy. Monte Carlo dose calculations were used to investigate the dosimetric effect of trace elements present in normal or cancerous human tissues. The effect of individual traces (atomic number Z = 11-30) was studied in soft tissue irradiated by low-energy brachytherapy sources.

ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy.

Task group 43 (TG43)-based dosimetry algorithms are efficient for brachytherapy dose calculation in water. However, human tissues have chemical compositions and densities different than water. Moreover, the mutual shielding effect of seeds on each other (interseed attenuation) is neglected in the TG43-based dosimetry platforms.

In vivo dosimetry for gynaecological brachytherapy using a novel position sensitive radiation detector: feasibility study.

Purpose: In gynecological radiotherapy with high dose rate (HDR)(192)Ir brachytherapy, the treatment complexity has increased due to improved optimization techniques and dose constraints. As a consequence, it has become more important to verify the dose delivery to the target and also to the organs at risk (e.g.

CT-scan prediction of thyroid cartilage invasion for early laryngeal squamous cell carcinoma.

Treatment choice for laryngeal cancer may be influenced by the diagnosis of thyroid cartilage invasion on preoperative computed tomography (CT). Our objective was to determine the predictive value of CT for thyroid cartilage invasion in early- to mid-stage laryngeal cancer. Retrospective study (1992-2008) of laryngeal squamous cell carcinoma treated with open partial laryngectomy and resection of at least part of the thyroid cartilage.

Factors affecting career choice among the next generation of academic vascular surgeons.

Objective: Few studies have examined factors that influence an individual's decision to enter an academic medical career after residency training. We sought to evaluate whether sex, ethnicity, child care issues, and debt burden influenced residents' choice for a career in academic vascular surgery.

Methods: A 39-item Web survey, designed to elucidate which factors motivated residents to seek a career in academic vascular surgery, was sent to 295 vascular surgery residents currently enrolled in Accreditation Council on Graduate Medical Education-accredited training programs.

Results of routine shunting and patch closure during carotid endarterectomy.

Background: The role of shunting and patching during carotid endarterectomy remains controversial.

Methods: This is a retrospective case series evaluating consecutive patients undergoing carotid endarterectomy with routine shunting and patching. The primary endpoints were perioperative stroke, arterial injury, and lesion recurrence by duplex.

Dose reduction in LDR brachytherapy by implanted prostate gold fiducial markers.

Purpose: The dosimetric impact of gold fiducial markers (FM) implanted prior to external beam radiotherapy of prostate cancer on low dose rate (LDR) brachytherapy seed implants performed in the context of combined therapy was investigated.

Methods: A virtual water phantom was designed containing a single FM. Single and multi source scenarios were investigated by performing Monte Carlo dose calculations, along with the influence of varying orientation and distance of the FM with respect to the sources.

Peripherally inserted central catheter usage patterns and associated symptomatic upper extremity venous thrombosis.

Objectives: Peripherally inserted central catheters (PICCs) may be complicated by upper extremity (UE) superficial (SVT) or deep venous thrombosis (DVT). The purpose of this study was to determine current PICC insertion patterns and if any PICC or patient characteristics were associated with venous thrombotic complications.

Methods: All UE venous duplex scans during a 12-month period were reviewed, selecting patients with isolated SVT or DVT and PICCs placed ≤30 days.

Buerger's disease.

Buerger's disease (thromboangiitis obliterans) is a nonatherosclerotic segmental inflammatory disease of small- and medium-sized arteries of the distal extremities of predominantly young male tobacco users. Early symptoms may include episodic pain and coldness in fingers, and late findings may present as intermittent claudication, skin ulcers, or gangrene requiring eventual amputation. Tobacco cessation is the cornerstone of treatment.