Perforated peptic duodenal ulcer in a paraesophageal hernia--a case report of a rare surgical emergency.

Background: Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare.

Case Presentation: An elderly man with multiple medical conditions was admitted due to severe upper abdominal pain.

Outcome of treatment of ruptured abdominal aortic aneurysms depending on the type of hospital.

Objective: To compare the outcome of patients operated on acutely for ruptured abdominal aortic aneurysms (AAA) or otherwise symptomatic aortic aneurysms in a university hospital and in two county hospitals by the same group of vascular surgeons.

Design: Retrospective study.

Setting: 1 university and 2 county hospitals, Sweden.

Intraoperative angioscopy may improve the outcome of in situ saphenous vein bypass grafting: a prospective study.

Objective: To find out whether intraoperative angioscopic assistance has any effect on graft outcome in patients with critical leg ischemia.

Material And Methods: One hundred one patients requiring a below-knee bypass were assigned to undergo in situ saphenous vein bypass with or without intraoperative angioscopic assistance; otherwise treated similarly including preoperative duplex vein mapping, intraoperative graft flow measurements, and angiography. Data on operative details, morbidity, hospital stay, and graft patency were collected prospectively and compared.

Evidence of calcium phosphate depositions in stenotic arteriovenous fistulas.

This study investigates vascular samples from patients with and without end-stage renal disease (ESRD) to determine the occurrence of calcium depositions. Findings in stenotic arteriovenous (AV)-fistula veins were compared with those of nonstenotic AV-fistula veins, non-AV-fistula veins, and atherosclerotic vessels. Calcium and phosphorus content was measured by means of scanning electron microscopy and its built-in method of energy-dispersive spectrometry (EDS) X-ray analysis.

Percutaneous transluminal angioplasty of crural arteries: diabetes and other factors influencing outcome.

Objective: to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) of the crural arteries.

Patients And Methods: a retrospective review of patients treated with PTA of at least one crural artery during an 8-year period (1990--1997).

Results: one hundred and fifty-five legs in 140 consecutive patients (mean age 74 years, range 38--91 years) were treated.

Intraoperative contamination of synthetic vascular grafts. Effect of glove change before graft implantation. A prospective randomised study.

Objectives: to investigate the incidence of intraoperative graft contamination, bacterial species and the influence of change of surgeon's gloves on contamination.

Design: a prospective randomised study.

Materials And Methods: forty patients had implantation of synthetic vascular grafts.

Exposure of plasma proteins on Dacron and ePTFE vascular graft material in a perfusion model.

Objectives: to compare the exposure of plasma proteins adsorbed onto three vascular graft materials (polytetrafluoroethylene ePTFE and two modifications of polyethyleneterephthalate Dacron).

Methods: surface exposure of fibronectin, vitronectin, thrombospondin, antithrombin III, IgG, high molecular-weight kininogen, fibrinogen, albumin and plasminogen was studied by incubation with radiolabelled antibodies in a perfusion model. Perfusion times with human plasma were 1, 4, 24 and 48 hours.

Percutaneous transluminal angioplasty with or without stenting for femoropopliteal occlusions? A randomized controlled study.

Background: To investigate the-one year outcome of PTA and stenting and PTA alone for femoropopliteal occlusions.

Design: Randomized prospective study

Methods: 32 patients with femoropopliteal occlusions were randomized into two treatment groups: PTA and Strecker-stent (n=15) and PTA alone (n=17). The median age of the patients was 71 years.

Magnetic resonance imaging and MR angiography of endoluminally treated abdominal aortic aneurysms.

Objectives: To evaluate magnetic resonance imaging (MRI) with gadolinium-based contrast medium-enhanced MR angiography (MRA) for the follow-up of endoluminally treated abdominal aortic aneurysms.

Design: MRI/MRA, angiography and computed tomography (CT) were performed 1 month after endoluminal stent-graft placement. MRI/MRA was repeated at 6 and 12 months and angiography and CT were added to confirm unexpected findings.

[Endovascular technique in aortic aneurysm. A promising alternative to open surgery].

The article consists in a presentation of endovascular surgery for abdominal aortic aneurysm repair in 23 cases. Two cases required conversion to open surgery, but the procedure could be completed in the remaining 21 cases, with a current duration of follow-up of up to 30 months. There was early leakage in one case, and late leakage in five cases.

Biological responses differ considerably between endovascular and conventional aortic aneurysm surgery.

Objectives: To determine the inflammatory responses in endovascular abdominal aortic aneurysm (AAA) repair and their relation to clinical findings.

Design: Prospective non-randomised study.

Setting: University Hospital, Department of Surgery.

Secondary aortoenteric fistulae--changes from 1973 to 1993.

Aim: To investigate a series of patients with secondary aortoenteric fistulas and compare it with a previous series (1985-93 vs. 1973-84).

Design: Retrospective study of medical records.

Reduced susceptibility of polytetrafluoroethylene vascular prostheses to colonization by Staphylococcus aureus following in situ endothelialization.

The impact of endothelialization of polytetrafluoroethylene (PTFE) grafts on susceptibility to experimental colonization by Staphylococcus aureus was studied in a rat model. One hundred and eight grafts (2 mm inner diameter, 5 mm length) were implanted into the infrarenal aorta (54 rats) or the infrarenal caval vein (54 rats). The progress of endothelialization following graft implantation was evaluated by SEM at 1, 3, 7, and 14 days on 6 grafts from each group.

Early development of suture holding capacity in vascular anastomoses in the rat.

Early development of suture holding capacity (SHC) of end-to-end anastomoses in the infrarenal aorta and inferior vena cava (IVC) of the rat was studied by measuring the resistance to tensile forces at 0, 3, 5, 8, 11, or 14 days postoperatively. Comparable anastomoses were histologically evaluated. The SHC of the aortic wall decreased following anastomoses and did not regain the strength of nonanastomosed vessels during the first two weeks.

Endothelialization of anastomoses in the aorta and inferior vena cava of the rat.

Denuding endothelial damage at anastomoses may lead to thrombotic complications and failure of microvascular reconstructions. Confluent endothelial healing at anastomoses may reduce thrombotic and other complications. The progress of endothelial coverage of anastomotic structures in the aorta and inferior vena cava (IVC) of the rat was evaluated at 3, 5, 8, 11, and 14 days after completion of the anastomoses, by means of scanning electron microscopy.

Influence of some plasma proteins on in vitro bacterial adherence to PTFE and Dacron vascular prostheses.

The in vitro adherence of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli (one strain of each species) to commercially available, microporous polytetrafluoroethylene (PTFE) and woven Dacron vascular grafts before and after coating with human plasma was compared. Standard size segments of the materials were incubated with 35S-labeled bacteria for 0.5-18 h and, following washes, the radioactivity associated with the segment was measured.

Bacterial adherence to synthetic vascular prostheses and influence of human plasma. An in vitro study.

The in vitro adherence of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli to five commercially available prosthetic vascular graft materials was compared. The influence of precoating the segments with human plasma for 2 h was also studied. S35-methionine was used to radiolabel bacteria.

Surgical treatment versus thrombolysis in acute arterial occlusion: a randomised controlled study.

Thrombolytic treatment has been tried in various forms for acute limb ischaemia with varying degrees of success but is also often accompanied by bleeding problems. The present investigation compares the effect of surgical thrombectomy (TE) and thrombolysis (TL) using recombinant tissue plasminogen activator (rt-PA). Twenty patients with a need for intervention owing to ischaemia lasting more than 24 h but less than 14 days were included.

Endothelialization of microporous polytetrafluoroethylene grafts in the infrarenal aorta and caval vein of the rat.

To study healing and endothelialization of vascular grafts, microporous polytetrafluoroethylene (PTFE) prostheses 2 mm in inner diameter and 5 mm long were implanted into the infrarenal aorta or caval vein of the rat. Patency was assessed in six rats from each group at days 3, 7, 14, 28, and 56 after implantation. Four grafts were occluded, two in the aorta (56 days) and two in the caval vein (3 and 14 days).

Visceral ischemia following aortic surgery.

Intestinal ischemia after aortic surgery is a rare (1-5%) complication, often with a fatal outcome (greater than 50%). During the period 1974-1987, 554 abdominal aortic operations were performed in our department. 17 patients (3%) were reoperated due to bowel ischemia, ten of these patients died.