Abstract:

Our research group has recently reported the partial amino acid sequence of an aortic adventitial collagen-associated fibrillar protein, which may be the target of an autoimmune response in patients with abdommal aortic aneurysms (AAA). Its apparent molecular weight is approximately 40 kDa, so we have named it aneurysm-associated antigenic protein-40 kDa (AAAP-40). It has similarities to microfibril- associated glycoprotein-36 kDa (MAGP-36), which was reported by Kobayashi et al. to have a tissue distribution limited to the aorta in pig; unlike other microfibrillar proteins which appear to distribute ubiquitously throughout the body with elastin. Accordingly, if AAAP-40 is the human homolog of MAGP-36, it would explain how an autoimmune reaction against this protein might have consequences more or less limited to the aorta and its branches.

Authors:

M David Tilson, MD, Shiao Xia, MD, Kathleen J Ozsvath, MD et al.

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Abstract:

Cerebrovascular dysfunction characterized by the loss of endothelial integrity has been observed following ischemic and traumatic insults to the brain, resulting in the net movement of fluid and solute out of the intravascular space and into the interstitium. Following traumatic brain injury, the development of intracranial hypertension secondary to cerebral edema plays a major role in the high morbidity and mortality in these patients. Although the precise mechanisms responsible for the disruption of the normally tightly regulated cerebrovascular tissue interface remain unclear, there is increasing evidence implicating inflammatory events in this process through the transient opening of tight junctional complexes. This article will examine the interaction of astrocytes, activated neutrophils, and inflammatory mediators in inducing endothelial contraction, thereby physically opening the permeability barrier and allowing the net movement of fluid out of the intravascular space.

Authors:

Faizi A. Siddiqi, M.D., Borimir J. Darakchiev, M.D., Robert J. Hariri, M.D., Ph.D., Gary A. Fantini, M.D., F.A.C.S.

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Abstract:

Endovascular intervention has become an increasingly more popular method of diagnosing and treating vascular disease. Its expanding scope includes applications ranging from visualization of the peripheral vascular system to coronary artery interventions. This trend is primarily a result of the limitations of angiography, the current imaging standard, when compared to angioscopy. Multiple disease entities, including atherosclerotic plaque, embolic debris, and thrombus, can not be differentiated between based on angiographic appearance. Angioscopy is a more sensitive method of distinguishing between the above disease states by allowing direct visualization of the luminal surface. The significance of this distinction lies in the fact that the treatment options are notably different based upon the diagnosis. Yet another advantage of angioscopy is its therapeutic value in addition to its diagnostic abilities. Directed embolectomy, guide-wire or catheter placement, or pseudointimal resection are all possible through the angioscope at the time of diagnosis.

Authors:

Sherry D. Scovell, M.D., Leif O. Nordberg, M.D., John White, M.D.

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Abstract:

Prompt aggressive treatment of diabetic ulcerations is mandatory for healing and subsequent limb salvage. Too often the complications involving the lower extremity are overlooked or mistreated and result in amputations. The cost involved in treatment is overwhelming. In 1992, the total health care cost for patients with diabetes in the United States was 105 billion dollars. Lower extremity complications account for 15%-20% of all diabetic admissions.

Authors:

Gina M. Bullock, D.P.M., James Stavosky, D.P.M.

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Abstract:

Coronary artery bypass surgery is an effective treatment for patients with multivessel coronary artery disease. The overall mortality and cardiac morbidity associated with the procedure has progressively declined since the early days, mostly attributable to improvements in surgical and anesthetic techniques. Over the same period, however, the average age of patients undergoing surgery has risen considerably, and with it, the incidence of neurologic complications. Currently, neurologic complications are the leading cause of morbidity associated with the procedure, and death due to neurologic causes has increased from 7% to 20% of all deaths. These complications are reflected in prolonged hospitalization of patients, at dramatic cost both to the patient and to the health system as a whole.

Authors:

Denise Barbut, M.D., M.R.C.P., Jeffrey Gold, M.D., F.A.C.S.

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Abstract:

The rapid evolution of vascular surgical techniques over the last few years coupled with the availability of an adequate venous conduit has allowed a more liberal and successful approach to salvage ischemic limbs caused by advanced atherosclerosis. This aggressive approach can be exemplified by the construction of arterial bypasses to the terminal branches of tibial vessels. However, a significant number of patients will continue to face the threat of a major amputation because of insufficient amounts of vein(s) to perform a totally autogenous bypass to one of the infrapopliteal arteries.

Authors:

Enrico Ascer, M.D.; Patrick S. DePippo, M.D.; William Yorkovich, R.P.A..; Elke Lorenson, M.D.- Maimonides Medical Center, Brooklyn

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Abstract:

In the past decade, laparoscopic and thoracoscopiC technology have significantly and irreversibly altered the approach to many general and thoracic surgical diseases. With advances in laparoscopy and thoracoscopy, the concept of a minimally invasive approach to cardiac surgery has been realized.

Authors:

James I. Fann, M.D., Mario F. Pompili, M.D., John H. Stevens, M.D., Lawrence C. Siegel, M.D., Frederick G. St. Goar, M.D., Thomas A. Burdon, M.D., F.A.C.S.

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Abstract:

In the past six years, laparoscopic surgery has gained widespread acceptance by both surgeon and patient. When com ared to open surgical approaches, laparoscopic techniques for abdominal procedures lessen postoperative pain and morbidity, improve cosmesis, reduce hospital stay, facilitate early rehabilitation and return to normal activities. The application of laparoscopic techniques to intra-abdominal vascular procedures can be expected to provide similar benefits over conventional surgery.

Authors:

Samuel S. Ahn, M.D., Darryl T. Hiyama, M.D., George H. Rudkin, M.D., Eric J. Daniels, M.S., Gerhard J. Fuchs, M.D., Kyung M. Ro, B.Sc.

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