scholarly journals Popliteal Aneurysms: From John Hunter to the 21st Century

2007 ◽  
Vol 89 (5) ◽  
pp. 466-471 ◽  
Author(s):  
RB Galland
Keyword(s):  
21St Century ◽  
Collateral Circulation ◽  
Older Men ◽  
Graft Patency ◽  
Acute Thrombosis ◽  
Co Morbidity ◽  
John Hunter ◽  
Ultrasound Surveillance ◽  
Arterial Thrombolysis

Popliteal aneurysms are rare and tend to occur in older men with significant co-morbidity. Historically, management of popliteal aneurysms can be considered in three broad groups: (i) the technique of Antyllus; (ii) techniques relying upon a collateral circulation; and (iii) techniques involving maintenance or restoration of circulation. Bypass and exclusion is currently been challenged by endovascuiar techniques which show promise in selected cases. Current controversies in popliteal aneurysms management are: when to repair asymptomatic aneurysms, what operation to do and how to manage acute thrombosis. These have been addressed by studying, prospectively, 73 patients presenting with 116 popliteal aneurysms. Diameter greater than 2 cm is often stated as being an indication for elective operation in asymptomatic popliteal aneurysms. However, distortion of the aneurysm appears to be at least as important as size in determining whether symptoms are likely to develop. Of 17 popliteal aneurysms followed for a median of 34 months with a diameter 2–3 cm and distortion less than 45°, none thrombosed. This is no worse than patency following elective bypass (P= 0.064). Popliteal aneurysms greater than 3 cm in diameter in patients who are unfit or who declined an operation were significantly more likely to develop thrombosis or any other symptom (P = 0.01 and P = 0.004, respectively). Popliteal aneurysms less than 3 cm in diameter with distortion less than 45° can safely be managed by ultrasound surveillance. Popliteal aneurysms with greater diameter or distortion are best operated upon. Bypass, combined with proximal and distal ligation of the aneurysm, resulted in 5-year graft patency of 78% and 65% for popliteal aneurysms originally patent or thrombosed, respectively, with good long-term exclusion of the aneurysm. In addition to the general complications of intra-arterial thrombolysis, acute deterioration of the limb during lysis appears to be a particular problem when dealing with thrombosed popliteal aneurysms. It occurs in about 13% of cases which compares with 2% when dealing with thrombosed grafts or native arteries. Intra-arterial thrombolysis for thrombosed popliteal aneurysms is associated with unacceptabiy high numbers of complications and thrombolysis should be reserved for intra-operative use only.

scholarly journals Delayed Anastomotic Occlusion after Direct Revascularization in Adult Hemorrhagic Moyamoya Disease

2021 ◽  
Vol 11 (5) ◽  
pp. 536
Author(s):  
Yu Chen ◽  
Fa Lin ◽  
De-Bin Yan ◽  
He-Ze Han ◽  
Ya-Hui Zhao ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Moyamoya Disease ◽  
Collateral Circulation ◽  
Multivariate Logistic Regression Analysis ◽  
Graft Patency ◽  
Considerable Proportion ◽  
Multivariate Logistic Regression ◽  
Grade Iii

Delayed anastomotic occlusion occurred in a considerable proportion of hemorrhagic moyamoya disease (MMD) patients undergoing direct revascularization. This study aimed to investigate the predictors and outcomes of delayed anastomotic occlusion in adult hemorrhagic MMD. The authors retrospectively reviewed 87 adult hemorrhagic MMD patients. Univariate and multivariate logistic regression analyses were performed. After an average of 9.1 ± 6.9 months of angiographic follow-up, the long-term graft patency rates were 79.8%. The occluded group had significantly worse angiogenesis than the non-occluded group (p < 0.001). However, the improvement of dilated anterior choroidal artery–posterior communicating artery was similar (p = 0.090). After an average of 4.0 ± 2.5 years of clinical follow-up, the neurological statues and postoperative annualized rupture risk were similar between the occluded and non-occluded groups (p = 0.750; p = 0.679; respectively). In the multivariate logistic regression analysis, collateral circulation Grade III (OR, 4.772; 95% CI, 1.184–19.230; p = 0.028) and preoperative computed tomography perfusion (CTP) Grade I–II (OR, 4.129; 95% CI, 1.294–13.175; p = 0.017) were independent predictors of delayed anastomotic occlusion. Delayed anastomotic occlusion in adult hemorrhagic MMD might be a benign phenomenon. Good collateral circulation (Grade III) and compensable preoperative intracranial perfusion (CTP Grade I–II) are independent predictors for this phenomenon. Moreover, the delayed anastomotic occlusion has no significant correlations with the long-term angiographic and neurological outcomes, except neoangiogenesis.

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

scholarly journals The Challenge of Educating Purposeful Teachers in Finland

2021 ◽  
Vol 11 (1) ◽  
pp. 29
Author(s):  
Elina Kuusisto ◽  
Kirsi Tirri
Keyword(s):  
Teacher Education ◽  
Student Teachers ◽  
21St Century ◽  
School Community ◽  
The Self ◽  
Moral Commitment ◽  
Mediating Factor

This article discusses the challenges of educating teachers in Finland. As a goal in teacher education for the 21st century we propose the purposeful teacher, referring to a teacher who has a long-term moral commitment to serve students, the school community and society. Our data collected from student (N = 912) and practising (N = 77) teachers yielded information on the purposes they identified as important in their lives. The survey included quantitative instruments and open- ended questions. The teachers identified happiness, relationships, work and self-actualisation as the most important contents of their aspirations. All the content categories could be understood as potential purposes in that the benefit extended beyond the teachers themselves. However, almost half of the student teachers (46%) and over half of teachers (55%) revealed only self-orientation. Less than half of them (43%, 36%, respectively) showed a beyond-the-self orientation, which is indicative of a purposeful teacher. Among the practising teachers, teaching appeared to be mainly a mediating factor in realising their purposes or aspirations. These results have implications related to contemporary teacher education in Finland. Both pre- and in-service teachers need to know about purposeful teaching in order to find meaning in their work.

scholarly journals Future Changes in Wave Conditions at the German Baltic Sea Coast Based on a Hybrid Approach Using an Ensemble of Regional Climate Change Projections

Water ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 167
Author(s):  
Norman Dreier ◽  
Edgar Nehlsen ◽  
Peter Fröhle ◽  
Diana Rechid ◽  
Laurens M. Bouwer ◽  
...  
Keyword(s):  
21St Century ◽  
Wind Wave ◽  
Regional Climate ◽  
Hybrid Approach ◽  
Wave Modelling ◽  
Long Term Changes ◽  
Mean Wave Period ◽  
Wave Conditions ◽  
Sea Coast

In this study, the projected future long-term changes of the local wave conditions at the German Baltic Sea coast over the course of the 21st century are analyzed and assessed with special focus on model agreement, statistical significance and ranges/spread of the results. An ensemble of new regional climate model (RCM) simulations with the RCM REMO for three RCP forcing scenarios was used as input data. The outstanding feature of the simulations is that the data are available with a high horizontal resolution and at hourly timesteps which is a high temporal resolution and beneficial for the wind–wave modelling. A new data interface between RCM output data and wind–wave modelling has been developed. Suitable spatial aggregation methods of the RCM wind data have been tested and used to generate input for the calculation of waves at quasi deep-water conditions and at a mean water level with a hybrid approach that enables the fast compilation of future long-term time series of significant wave height, mean wave period and direction for an ensemble of RCM data. Changes of the average wind and wave conditions have been found, with a majority of the changes occurring for the RCP8.5 forcing scenario and at the end of the 21st century. At westerly wind-exposed locations mainly increasing values of the wind speed, significant wave height and mean wave period have been noted. In contrast, at easterly wind-exposed locations, decreasing values are predominant. Regarding the changes of the mean wind and wave directions, westerly directions becoming more frequent. Additional research is needed regarding the long-term changes of extreme wave events, e.g., the choice of a best-fit extreme value distribution function and the spatial aggregation method of the wind data.

Long-term survival after radical prostatectomy compared to other treatments in older men with local/regional prostate cancer

2008 ◽  
Vol 97 (7) ◽  
pp. 583-591 ◽  
Author(s):  
Liqian Liu ◽  
Ann L. Coker ◽  
Xianglin L. Du ◽  
Janice N. Cormier ◽  
Charles E. Ford ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Older Men ◽  
Term Survival ◽  
Long Term Survival

Abstract O.73: Long-term Results Of Percutaneous Transluminal Coronary Rotational Atherectomy For Localized Stenosis Caused By Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Etsuko Tsuda ◽  
Shinsuke Hoshino ◽  
Yasuhide Asaumi ◽  
Yosuke Hayama ◽  
Osamu Yamada
Keyword(s):  
Kawasaki Disease ◽  
Graft Patency ◽  
Rotational Atherectomy ◽  
Long Term Results ◽  
Cardiac Events ◽  
Main Trunk ◽  
One Year ◽  
Percutaneous Transluminal ◽  
Localized Stenosis

We report the results of percutaneous transluminal coronary rotational atherectomy (PTCRA) for localized stenosis caused by Kawasaki disease (KD). Thirteen male and a female, aged 5 to 29 years (median 13 years), underwent PTCRA and the interval from the PTARA to the latest angiogram ranged from 3 months to 16 years (median 6 years). The target vessels were the left anterior descending artery (3 patients), the left circumflex (2), left main trunk (2) and the right coronary artery (7). The immediate results of PTCRA were successful in all patients, and the mean stenosis degree improved from 86 ± 11% to 36 ± 13%. Five cardiac events occurred within one year (acute myocardial infarction 2, transient complete atrioventricular block 1 and re-PTCRA 2). The survival rate and cardiac event free rate at 15 years after PTCRA were 93% and 71%, respectively. For the graft patency, 4 pts who underwent PTCRA within 10 yeas old, had asymptomatic occlusion within 1 year. The patency rate at 15 years after PTCRA was 69%, in 10 pts who underwent it more than 10 years old. Cardiac events and restenosis occurred within a year after PTCRA. The results in patients less than 10 years old was poor. If a graft is patent in one year after procedure, long-term patency may be expected in patients more than 10 years old.

The Policy Capacity of Bureaucracy

2021 ◽  
Author(s):  
Sharma Shubham ◽  
Lei Shi ◽  
Xun Wu
Keyword(s):  
21St Century ◽  
Policy Decision ◽  
Active Role ◽  
Organizational Level ◽  
Everyday Functioning ◽  
Global Issues ◽  
Policy Problem ◽  
Policy Capacity ◽  
The Individual

Bureaucracy is one of the oldest institutions of a government system. Its role and importance have grown immensely in modern government systems. Bureaucrats or public administrators are indispensable in the policy decision making process in the 21st century. From the early conception as a branch of government responsible for the implementation of policy decisions and everyday functioning, bureaucracy has assumed a more active role in the policymaking process. It has gone through many reforms; however, these reforms have been largely incremental and static. While the external environment or the problems faced by bureaucracy is continuously evolving, the change in bureaucracy has not been in the same proportion. In the 21st century, many issues confronting bureaucracy are not only wicked but also global in nature. Moreover, challenges posed by technological disruptions and long-term processes such as climate change put bureaucracy at all levels of a government in a far trickier position than their earlier envisaged basic functions. In dealing with such challenges, the policy capacity of bureaucracy cannot be taken for granted. There are often significant gaps in capacity to anticipate a policy problem, to ensure coordination and preserve legitimacy, to translate global issues at local levels, and to learn from the past. It is crucial to strengthen analytical capacity at the individual and organizational level, operational capacity at the organizational level, and political capacity at the systems level to address these gaps. Tackling capacity gaps systematically would enable bureaucracy to design and implement policy and administrative reforms with a long-term vision of adaptation and evolution instead of merely in reactive mode. The policy capacity framework presented in this article is useful in identifying the capacity gaps that inhibit bureaucracy from evolving and the remedies to address these gaps.

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