Intraoperative and intermediate-term angiographic results of coronary artery bypass surgery with Symmetry proximal anastomotic device

OBJECTIVE: The objective of this study was to investigate the patency in saphenous vein coronary bypass grafts in which the proximal anastomoses were performed with automatic connector devices or with a traditional suture technique. METHODS: Forty-six patients underwent coronary artery bypass grafting without cardiopulmonary bypass by using one thoracic graft and one or more saphenous vein grafts. Grafts were attached to the aorta with a Symmetry connector (St Jude Medical, Inc, St Paul, Minn) in 23 patients, and partial occlusion of the aorta and sutured anastomoses were used in 23 other patients. Grafts were studied intraoperatively with transit time flowmetry and angiography and revised if necessary. Angiography was repeated after 3 to 5 months. RESULTS: Intraoperative graft patency did not differ between the 2 groups. Follow-up angiography demonstrated excellent thoracic graft patency. Vein graft patency decreased to 50% in the Symmetry group, whereas it was 90% in the suture group ( P = .01). Twenty-five percent of the Symmetry grafts had significant stenosis in the connector. CONCLUSION: Saphenous vein grafts anastomosed to aorta with the Symmetry proximal connector have low intermediate patency compared with those with traditionally sutured anastomoses. We do not recommend the routine use of this device in coronary artery bypass operations.     

Therapeutic angiogenesis using autologous bone marrow stromal cells: improved blood flow in a chronic limb ischemia model

BACKGROUND: We evaluated the effect of autologous marrow stromal cells (MSCs) on neovascularization and blood flow in an animal model of chronic limb ischemia. METHODS: Chronic hind limb ischemia was created by ligating the left common iliac artery of male Lewis rats. Three weeks after ligation, 5.0 million LacZ+MSCs (n = 10) or culture medium (n = 10) were injected into the anteromedial muscle compartment of the left thigh. At 4 and 6 weeks after injection, half the animals (n = 5) from each group underwent femoral artery ultrasonic blood flow measurements of the ischemic and nonischemic limbs to obtain a flow ratio. The animals also underwent angiography and measurements of blood vessel density and arteriolar density. Qualitative histologic assessment of the limb muscles was performed. RESULTS: LacZ+MSCs were found to differentiate into endothelium (F VIII+), vascular smooth muscle (positive a-smooth muscle actin), skeletal muscle (positive desmin), and adipocytes. Ischemic hind limbs where MSCs were implanted had greater vascular density and arteriolar density than control limbs (p < 0.001). Femoral artery flow index (left femoral artery flow/right femoral artery flow) was 0.89 +/- 0.12 and 0.90 +/- 0.06 for rats injected with MSCs measured at 4- and 6-weeks, respectively, compared with 0.50 +/- 0.15 and 0.50 +/- 0.10 for the control rats (p < 0.001). Angiography demonstrated reconstitution of the left femoral artery in rats that received MSC implantation through pelvic and abdominal wall collateral formation. CONCLUSIONS: Local MSC implantation induces a neovascular response resulting in a significant increase in blood flow to the ischemic limb. Marrow stromal cells are also capable of spontaneously regenerating the various components of muscular tissues.     

Fully endoscopic endonasal vs. transseptal transsphenoidal pituitary surgery.

A long-term retrospective study of 300 patients who underwent fully endoscopic endonasal pituitary adenoma resection between November 1998 and October 2004. The patients' records as well as the data obtained from postoperative follow-up visits was used to determine outcomes. Additionally, the data were then compared to mean values calculated from several transseptal-transsphenoidal reports. From a total of 300 pituitary adenomas, 139 (46 %) were hormonally active, while 161 (54 %) were non-functioning. Mean follow-up period was 38.2 months. The average length of hospital stay (LOS) was 1.4 days. All patients had postoperative magnetic resonance imaging (MRI) studies to assess residual or recurrent disease; all patients with hormonally active tumors had additional postoperative hormonal studies. Remission, being defined as no hormonal or radiological evidence of recurrence within the time-frame of the follow-up, was demonstrated in 127/134 (95 %) of enclosed and 144/166 (87 %) of invasive adenomas. A comparison of fully endoscopic endonasal vs. transseptal-transsphenoidal remission results revealed an improved outcome using the fully endoscopic endonasal technique: ACTH (86 % vs. 81 %), PRL (89 % vs. 66 %) and GH (85 % vs. 77 %). The remission rate for non-functioning adenomas was 149/161 (93 %). Additionally, we noted a marked reduction in complications related to the endoscopic procedure. Our results conclude that the fully endoscopic endonasal technique is a safe and effective method for removal of pituitary adenomas providing more complete tumor removal and reducing complications.     

Psychometric Properties of an Arabic Pain Anxiety Symptoms Scale-20 (PASS-20) in Healthy Volunteers and Patients Attending a Physiotherapy Clinic

Purpose

The aim of this study was to cross-culturally adapt the PASS-20 questionnaire for use in Libya.

Methods

Participants were 71 patients (42 women) attending the physiotherapy clinic, Ibn Sina Hospital, Sirt, Libya for management of persistent pain and 137 healthy unpaid undergraduate students (52 women) from the University of Sirt, Libya. The English PASS-20 was translated into Arabic. Patients completed the Arabic PASS-20 and the Arabic Pain Rating Scales on two occasions separated by a 14-day interval. Healthy participants completed the Arabic PASS-20 on one occasion.

Results

The internal consistency (ICC) for pain patient and healthy participant samples yielded a good reliability for the total score, cognitive anxiety, fear of pain, and physiological anxiety. The test-retest reliability of the Arabic PASS-20 score showed high reliability for the total score (ICC = 0.93, p < 0.001), escape/avoidance (ICC = 0.93, p < 0.001), fear of pain (ICC = 0.94, p < 0.001), and physiological anxiety subscales (ICC = 0.96, p < 0.001) and good reliability for the cognitive anxiety (ICC = 0.85, p < 0.001). Inspection of the Promax rotation showed that each factor comprised of five items were consistent with the theoretical constructs of the original PASS-20 subscales.

Conclusion

The Arabic PASS-20 retained internal consistency and reliability with the original English version and can be used to measure pain anxiety symptoms in both pain and healthy individual samples in Libya.

     

A series of 112 fully endoscopic resections of vestibular schwannomas.

We report a consecutive series of 112 patients with unilateral vestibular schwannoma (VS) having undergone fully endoscopic resection of their tumors in the period from October, 2001 to January, 2005. Patients' outcomes were evaluated especially with regards to cochlear nerve (hearing) preservation, facial nerve preservation, postoperative complications and completeness of the resection. The patient population consisted of 112 consecutive cases with unilateral, "de novo" VS(s); patients with neurofibromatosis type 2 (NFT2) or with a recurrent tumor were excluded from this study. Tumors ranged in size from 0.6-5.7 cm, most tumors were less than 3 cm in diameter (mean: 2.6 cm). This shift towards smaller and also less symptomatic tumors may be due to an increase in the awareness of patients and earlier detection of their tumors (MRI era). Tumors were removed via 1.5-cm "keyhole" retrosigmoid craniotomies. Utilizing the fully endoscopic technique, 106/112 (95%) tumors were completely removed; subtotal removal was performed in 6/112 (5%) patients in an attempt to preserve their hearing. Anatomic preservation of the facial nerve was achieved in all of the patients and of the cochlear nerve in 83/101 (82%) hearing ears. Functionally, measurable hearing (serviceable/some) was preserved in 59/101 (58%) cases who had either "serviceable" or "some" hearing preoperatively, 2 patients who had "some" hearing preoperatively had an improvement that was more than 30 db in their hearing postoperatively. There were no major neurological complications such as quadriparesis, hemiparesis, bacterial or aseptic meningitis, lower cranial nerve deficits, or deaths. From our experience, we conclude that the endoscope is ideally suited for a minimally invasive approach for the resection of vestibular schwannomas.     

Quantification and validation of nine nonsteroidal anti‐inflammatory drugs in equine urine using gas chromatography–mass spectrometry for doping control

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are commonly used in therapeutic doses in human and veterinary medicine for the treatment of inflammation, pain, and fever. A method for the simultaneous determination of nine NSAIDs, known as therapeutic prohibited substances, in equine urine was developed and fully validated according to the European Commission Decision 2002/657/EC and Association of Official Racing Chemists criteria. The validation was performed for naproxen, flunixin, ketoprofen, diclofenac, eltenac, meclofenamic acid, phenylbutazone, vedaprofen, and carprofen in equine urine in accordance with the International Screening Limits (ISL) regulated by International Federation of Horseracing Authorities. After basic hydrolysis, samples were extracted with a C18 cartridge using automated solid‐phase extraction. Several derivatization reagents were investigated, and trimethylphenylammonium hydroxide/methanol (20/80, v/v) was selected. Analyses were carried out using gas chromatography–mass spectrometry with selected ion monitoring mode, but the method can be applied to a large number of analytes. The within‐laboratory reproducibility was not more than 12.8% (≤15%), and mean relative recoveries ranged from 91.1% to 104.1% for inter‐day and intra‐day precision. The decision limits (CCα) and detection capabilities (CCβ) were evaluated at concentrations near the ISL for each therapeutic substance. The validation results demonstrated that the method is highly reproducible, easily applicable, and suitable for the analysis of some NSAIDs in equine urine that have not been previously published. Finally, the method was also applied to known positive samples.