Thoracic outlet syndrome: a multidisciplinary problem with a perspective for microsurgical management without rib resection.

Background: Thoracic outlet syndrome (TOS) refers to a group of complex symptoms in the upper extremity caused by compression of the brachial plexus, subclavian artery and vein. Different surgical approaches were described for the management of TOS. There is, however, no "gold standard" procedure for this complicated and multidisciplinary problem.

Intravascular stapler for "open" aortic surgery: preliminary results.

Objectives: The aim of this study was to assess the efficacy of a new stapling device using a pig model.

Methods: Straight 12 mm Gore-Tex grafts were inserted end to end into the aorta of 12 pigs. One anastomosis was performed with the stapler and the other using 4/0 prolene sutures and 13 mm needles.

Laparoscopic assisted aortic surgery. A review.

We give an overview of different laparoscopic assisted techniques to perform aortic surgery. In a meta-analysis the paper describes the combined experience of two vascular surgical centers who together have performed more than 524 laparoscopic assisted aortic procedures. Basically the following techniques can be used to perform a laparoscopic assisted procedure: 1) transperitoneal approach (the Alimi procedure); 2) hand assisted laparoscopy (the Ferrari technique); 3) left retrocolic laparoscopic assisted; 4) combining laparoscopic assisted and total laparoscopy techniques.

Optimal dosing as a necessary condition for the efficacy of hyperbaric oxygen therapy in acute ischemic stroke: a critical review.

The effectiveness of hyperbaric oxygen therapy (HBOT) in clinical and experimental acute ischemic stroke (AIS) has been controversial for many years. However, in the literature, no data was found on the dose/effect of HBOT in patients with AIS. We analyzed retrospectively the published data of clinical studies performed in different hyperbaric centers (a total of 265 patients).

Determinants of incident vulvovaginal candidiasis in human immunodeficiency virus-positive women.

Objective: Mucosal infections including vulvovaginal candidiasis are a common problem for women with human immunodeficiency virus (HIV) infection. Our objective was to determine which factors predict the development of symptomatic disease among HIV-infected women.

Materials And Methods: In a prospective study from 1991 to 1995, 205 HIV-positive women were evaluated every 6 months for occurrences of vulvovaginal candidiasis.

Physiologic and biochemical monitoring during hyperbaric oxygenation: a review.

Hyperbaric oxygenation (HBO2) is an important treatment given to various groups of patients exposed to pathologic situations (i.e., carbon monoxide exposure).

Carotid endarterectomy without angiography.

Between 1 January 1990 and 1 September 1994 a total of 109 carotid endarterectomies were performed without preoperative angiography. Only two cases were considered by the surgeon to have a poor correlation between the duplex examination results and intraoperative findings; the outcome was good in both. The perioperative mortality rate was 1.

[Carotid endarterectomy without angiography].

Duplex scanning has emerged as an accurate noninvasive method of evaluating patients with extracranial cerebrovascular disease; it has research, clinical and economic implications. The risks associated with cerebral angiography are numerous and well-known. During 1990-1995, 227 carotid endarterectomies (CEA) were performed without preoperative arteriography in 192 patients.

Is transcranial Doppler effective in avoiding the hazards of carotid surgery?

The middle cerebral artery flow velocities were measured to test the hypothesis that transcranial Doppler is a useful technique for intraoperative monitoring in 50 consecutive carotid endarterectomies which were performed under local anaesthesia. The patients' neurological status was continuously monitored. The peak middle cerebral artery velocities were measured before clamping, during clamping and after restoration of flow, and again 24 h and 4 weeks later.

Angiographic and duplex grading of internal carotid stenosis: can we overcome the confusion?

The stroke risk reduction benefit of surgical intervention in carotid occlusive disease has been validated in multicenter trials for various angiographically defined lesion severity categories. The two divergent angiographic grading methods used for internal carotid artery stenosis in these trials have caused confusion in the clinical application of their recommendations. Moreover, while today's highly accurate carotid duplex scanning can obviate the need for preoperative angiography in many cases, the duplex criteria must be tailored to achieve sufficiently reliable results on which therapeutic decisions can be made.

Renal vein occlusion: a review.

Purpose: The different etiologies of renal occlusion are reviewed. A special category, division of the left renal vein in abdominal aortic surgery, is also discussed in the review.

Materials And Methods: The various diagnostic modalities used in cases of renal vein occlusion include excretory urography, ultrasound, nuclear scan, angiography, venography, computerized tomography and magnetic resonance imaging.

Revascularisation for a poorly functioning solitary kidney.

Renovascular disease in a solitary kidney is a difficult and challenging problem. In six patients, with a mean age of 62 years, revascularisation was undertaken. In four of them, one to three attempts at PTA were made before the operation but all were unsuccessful.

Cerebral angiography with gaseous carbon dioxide CO2.

Large quantities of gaseous carbon dioxide CO2 were rapidly injected into the ascending aorta or common carotid artery of 14 dogs. Good filling of the arteries and intracranial veins was documented by cineangiography or digital subtraction angiography. No adverse effects occurred as a result of this procedure: the electroencephalogram showed no changes throughout the experiments and the dogs were neurologically normal for up to 6 months of follow-up.

[Surgical treatment of chronic mesenteric ischemia].

A 44-year-old woman with chronic abdominal pain and weight loss is presented. 1 year after onset of symptoms and following multiple diagnostic procedures, angiography revealed high grade stenosis of the celiac and superior mesenteric arteries at their origins. Bypass grafts of Goretex were implanted from the infrarenal aorta to both arteries beyond the narrowed segments.

CT guided periaortic fluid aspiration diagnosing aortic graft infection.

CT guided diagnostic aspiration was performed on a patient suspected of aortic graft infection. The positive aspiration prompted aggressive successful surgical intervention.

Colonic ischemia following abdominal aortic reconstruction for ruptured aneurysm in a patient with previous right colectomy. Case report.

Reconstruction of the abdominal aorta after rupture of aneurysm was followed by colonic ischemia in a patient who had undergone right hemicolectomy 6 years previously. The mechanism and management of this rare complication are discussed.

The use of the venous stripper for graft removal in arterial reoperations.

A simple technique for removal of synthetic grafts using a standard venous stripper inside the graft is described. The method permits the simultaneous placement of a drainage tube in the canal after graft removal in cases where the graft is infected.

Urgent abdominal aortic aneurysm repair in patients over the age 80.

We present three patients with successful surgical repair of abdominal aortic aneurysms with signs of imminent rupture in octogenarians. The patients presented with evidence of severe left ventricular dysfunction and reduced compliance either before or during surgery. Extremely cautious delivery of fluids and of after-load reducing agents was employed under the guidance of measurements of cardiac output and filling pressures from a pulmonary arterial catheter inserted prior to surgery.

Ruptured inflammatory abdominal aortic aneurysm due to acute myelomonoblastic leukemia.

The extremely rare case of ruptured abdominal aortic aneurysm of inflammatory nature in patient with discovered acute myelomonoblastic leukemia is presented. The difficult problems arising from these, frequently terminal diseases, are discussed.

Practice and theory of "delayed" embolectomy. A 22-year perspective.

A study was made of delayed embolectomy in 45 patients (55 limbs). In 5 patients (11%) the cause of arterial embolization was rheumatic heart disease, and 40 patients (89%) suffered from atherosclerotic cardiovascular disease. The study was divided into 3 phases: I (1960-1964), II (1965-1974) and III (1975-1981).

Extrathoracic approach in surgical treatment of subclavian steal.

Between 1979 and 1985 11 selected patients underwent axilloaxillary and carotid-subclavian bypass grafting [dacron or Gore-Tex (USA), 8 mm inner diameter]. Nine patients had lesions in the left subclavian artery and two patients presented with innominate artery obstruction with subclavian-carotid recovery phenomenon. All patients were symptomatic before surgery, and all were relieved of both cerebrovascular and upper extremity ischemic symptoms following surgery.

Congenital aplasia of the deep veins of lower extremities in children: the role of ascending functional phlebography.

Eighty-two children with vascular diseases underwent phlebography. Congenital aplasia of the deep venous system of the lower extremities was diagnosed in 10 children. With ascending functional phlebography, three anatomic variations with different degrees of venous dysfunction were defined: aplasia of the femoral vein with collateral drainage into the common femoral vein, aplasia of the femoral vein with drainage into the internal iliac vein, and total aplasia with drainage into the axillary vein.