1,720,969 research outputs found
RR5. Surgical Treatment of Popliteal Aneurysms Using a Posterior Approach: Thirteen Years' Follow-up
No full textOBJECTIVES : Long-term results of posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We compared our results with this access with those from a standard medial approach over a 13-years’ period.
METHODS: Clinical data of all patients treated for a popliteal aneurysm between 2/1998 and 10/2011 were retrospectively reviewed and outcomes analyzed: Kaplan-Meier method with log-rank, chi2 and Wilcoxon test were employed for analysis.
RESULTS : A total of 78 aneurysms were treated in 66 patients (65 men). Mean age was 68 years (range 48-96 years).
Thirty-six aneurysms were asymptomatic (46%). Mean sac diameter was 2.9±1 cm. A PA was used in 43 cases (55%) and a medial approach (MA) in 35. All PA consisted in aneurysmectomy with an interposition graft with end to end anastomoses; among MA 25 interposition grafts and 10 bypass were performed. A PTFE graft was used mostly (57 cases). The two groups differed for age only (median 65.4 for PA vs. 72.9 for MA p=0.01). Five patients had an early thrombosis and required a Fogarty thrombectomy (2 PA and 3 MA, all PTFE grafts). Mortality rate at 30 days was 0%.
One patient suffered a peroneal nerve lesion (permanent) and another one a major wound necrosis with tissue loss (both PA). There were no early amputations. Median follow-up was 58.8 months (range 5 days-166.7 months).
Nine patients died during follow-up for unrelated causes. The 5-year primary and secondary patency rates were 58.9%±8,7% and 96.4%±3.5% respectively for PA, and 67.4%±10,4% and 81.3%±8,9% respectively for MA (p=0.41 for primary patency rate and 0.28 for secondary patency rate). Limb salvage was 100% and 93.3%±6.4% at 5 and 10 years respectively for PA and 91.5%±5.6% at both time points for MA (p=0.3).
CONCLUSIONS : PA in our experience was burdened by a few more early complications compared to MA. However in the long term it provided results which compare favorably to MA.
AUTHOR DISCLOSURES: I. Barbetta, Nothing to disclose; M. Carmo, Nothing to disclose; R. Dallatana, Nothing to disclose; G. Grava, Nothing to disclose; D. Mazzaccaro, Nothing to disclose; A. M. Settembrini, Nothing to disclose; P. Settembrini, Nothing to disclose
Outcomes of Urgent Carotid Endarterectomy for Stable and Unstable Acute Neurological Deficits : A Single-Centre Retrospective Analysis
No full textOBJECTIVES: Urgent carotid endarterectomy (CEA performed within 2 weeks
after the onset of acute neurological deficits) seems to yield better long-term
results than if delayed or not performed.
We retrospectively analysed the results of all urgent CEAs performed in our institution since the establishment of an operative protocol with our Stroke Unit.
METHODS: From January 2002 to July 2011 all the patients coming to our ER
with acute neurological symptoms underwent a diagnostic work-up consisting of:
neurologic evaluation, head computed tomography (CT), and carotid duplex
scanning. Assessment of National Institute of Stroke Scale (NHISS) was
performed at admission and discharge for neurologically stable patients.
88 patients with a carotid stenosis >50% and no contraindication to surgery (NHISS
>15 or hemorrhagic infarction at CT scan) underwent urgent CEA.
The mean age was 70.8 years (range 37–89 years) with 63 (71.6%) men and 25
(28.4%) women.
Patients were grouped according to presentation: Group1 single transient
ischemic attack (TIA), Group2 minor and moderate stroke, Group3 unstable
symptoms (crescendo TIA or stroke in evolution).
We considered the timing of surgery as emergent (CEA < 24h) or non emergent.
End points were NHISS score modification, postoperative morbidity and mortality.
RESULTS: Urgent CEAs were performed at a median time of 50 hours (IQR
16–116 hours) from the onset of symptoms.
Median NHISS was 4 (IQR 2–6,2) on admission and 2 (IQR 0,7–3,2) on
discharge with a median improvement of 2 points (IQR 0–4).There was a total of 11 (12,5%) neurologic complications: 0/16 for GROUP1, 6/55
(10.9%) for GROUP2 and 5/17 (29.4%) for GROUP3.
In patients with minor to moderate stroke a timing of intervention >24 h was significantly associated with a higher rate of complications (P < 0,4), while in
patients with unstable symptoms we we found no relation between timing of
surgery and clinical outcomes.
Total mortality was 4 (4,5%): 3 deaths due to neurologic complications and 1
death do to myocardial infarction.
CONCLUSIONS: Urgent CEA is a safe and effective therapeutic strategy for
patients presenting with mild to moderate stable neurologic deficits, especially if
performed in the very first hours of presentation. We need more accurate studies
to identify that subset of patients presenting with unstable symptoms who may
not benefit from early surger
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Ultrasonic Debridement for the Treatment of Infected Vascular Graft
No full textIntroduction :
Vascular surgical site infection (SSI) is a feared complication of major vascular surgery procedures. Depending on the
virulence of the infectious pathogen and the site of surgery, its presentation is extremely variable, ranging from severe
sepsis to slow-evolving prosthetic colonisation by bacterial biofilm. Usually it is associated with poor patients’
prognosis and low rates of limb salvage. Medical treatment alone is not effective, given the very low penetration of
antibiotic into the bacterial biofilm. Radical surgical treatment is the current mainstay, consisting of complete graft
removal and reconstruction with autogenous or extra-anatomic conduits. Unfortunately it is burdened by high morbidity
and mortality rates, especially in those patients who are unfit for open major vascular procedures, furthermore recurrent
SSI is not to be ruled out. Less invasive surgical techniques, allowing partial or no graft excision, have therefore been
recently introduced. Aim of our study is to evaluate the results of a novel SSI treatment consisting of associated
ultrasonic debridement and antibiotic therapy in a subset of patients considered at extremely high risk for major surgery.
We used this technique to achieve the best tissue and or graft debridement while minimising the invasiveness of
surgery.
Materials/Methods
Ultrasound (US) technology and its interaction with living tissues has been already studied: the largest experience
comes from dentistry for cleansing purpose and lately ultrasonic debridement has gained a role in the treatment of nonhealing chronic leg ulcers. When applied to infected wounds, US generate mechanical and cavitational energy that
preferentially disrupts necrotic tissues, due to their lower tensile strength, and stimulate formation of granulation tissue.
Besides, US enhancement of antibiotic action against bacterial biofilms associated with implant infection has been well
documented by several in-vivo experimental studies. We used an ultrasonic generator operating through a piezoelectric
probe vibrating at 26 KHz with a vibratory amplitude of 15-30 μm and irrigating normal saline. Patients with a
prosthetic vascular graft infection and poor medical condition or unavailable autogenous graft underwent an extensive
US debridement on the graft and wound tissues to allow a less invasive reconstruction. Non incorporated vascular
prostheses and surrounding tissues were treated with this device by moving the probe over their surfaces until all
necrotic parts and fibrin were removed and the colour of the graft and tissue returned to appear normal. Ultrasonic
debridement was followed by local antibiotic irrigation and was associated to antibiogram-oriented systemic
antimicrobial treatment. Graft removal and Sartorius muscle flap to cover the inguinal region were selectively employed
Patients’ charts were reviewed to extract their history, lab data, operative details, cultures and follow up.
Results
Our study involved 12 patients with a mean age of 73 years (range 57-92) composed of 7 males and 5 females. SSI
onset was early in 8 cases and late in 4. Possible clinical presentations were draining sinus tract (5 patients), wound
dehiscence (5 patients) and acute hemorrhage due to prosthesis’ detachment (2 patients). Prosthetic materials were
Dacron (8 patients), PTFE (1 patient), composite Dacron-PTFE (2 patients) and bovine pericardium (1 patient). US
debridement was performed after partial graft excision in order to allow an in situ reconstruction with a Silver prosthetic
graft in 5 patients, while 7 patients underwent US debridement without graft removal. A Sartorius flap to cover the
groin was carried out in 5 cases. Cultures revealed a single infectious pathogen (4 patients) or ≥2 pathogens (6 patients);
in the two remaining patients no microorganism was found. We noticed no harm on Dacron grafts even when an
intensive and prolonged debridement was done; PTFE grafts needed a special attention, because of a slight loss of
impermeability after long ultrasound exposure. However no major damage occurred to any of our grafts.
Estimated freedom from recurrent infection was 91.6% at 6 months (1 early recurrence) and 83.3% at 1 and 2 years (1
late recurrence). Limb survival was 81.8% at 6 months, 72.7% at 1 year and 63.6% at 2 years. Early post-operative
mortality was 8.3% (1 patient died because of cardiac complications).
Conclusions
In our experience ultrasonic debridement of infected grafts obtained promising results. We believe that it can be
considered as another viable option for the treatment of this dramatic complication. An extensive debridement of the
graft and of surrounding tissues allowed us to treat patients more conservatively without compromising the chance of
eradication of the infectious pathogen
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