Stent Graft Placement by Pseudoaneurysm of the Hepatic Arteries: Efficacy and Patency Rate in Follow-up.

PURPOSE: To investigate efficacy and patency status of stent graft implantation in the treatment of hepatic artery pseudoaneurysm. MATERIALS AND METHODS: A retrospective analysis of patients who had undergone endovascular treatment of hepatic artery pseudoaneurysms between 2011 and 2020 was performed. Medical records were examined to obtain patients' surgical histories and to screen for active bleeding. Angiographic data on vascular access, target vessel, material used and technical success, defined as the exclusion of the pseudoaneurysm by means of a stent graft with sufficient control of bleeding, were collected. Vessel patency at follow-up CT was analyzed and classified as short-term (< 6 weeks), mid-term (between 6 weeks and 1 year), and long-term patency (> 1 year). In case of stent occlusion, collateralization and signs of hepatic hypoperfusion were examined. RESULTS: In total, 30 patients were included and of these, 25 and 5 had undergone stent graft implantation and coiling, respectively. In patients with implanted stent grafts, technical success was achieved in 23/25 patients (92%). Follow-up CT scans were available in 16 patients, showing stent graft patency in 9/16 patients (56%). Short-term, mid-term, and long-term short-term stent patency was found in 81% (13/16), 40% (4/10), and 50% (2/4). In patients with stent graft occlusion, 86% (6/7) exhibited maintenance of arterial liver perfusion via collaterals and 14% (1/7) exhibited liver abscess during follow-up. CONCLUSION: Stent graft provides an effective treatment for hepatic artery pseudoaneurysms. Even though patency rates decreased as a function of time, stent occlusion was mainly asymptomatic due to sufficient collateralization.

[Tissue condition of human corneas before and after organ culture. Effect of donor cause of death]. / Gewebezustand humaner Hornhäute vor und nach Organkultur. Einfluss der Todesursache des Spenders.

UNLABELLED: Recent studies have shown that the human cornea reflects the metabolic status of the donor. Nevertheless, it has not yet been shown whether this leads to a different tolerance of organ culture and whether these changes are reversible or not. MATERIALS AND METHODS: Eighty-five organ-cultured human corneas were investigated. Endothelial cell density and the concentrations of glucose, lactate, ATP and ADP were determined in each cornea by enzymatic-optical methods. Obduction protocols were examined and five groups of donors could be determined: (1) donors who had died suddenly; (2) donors who had died of malignant processes; (3) donors with septicaemia; (4) renal-insufficient donors; and (5) diabetic donors. RESULTS: Endothelial cell density decreased significantly after 28 days of organ culture. Deswelling for 1 day in a medium containing dextran 500 caused additional cell loss. On the basis of biochemical parameters, the corneas showed recovery after organ culture: especially ATP and ADP concentrations increased. Glucose concentrations decreased and lactate concentration increased in the closed organ culture system. Best recovery was observed in corneas from septic donors and from those who had died of carcinoma. Overall, an equalization of all corneas after the culture period was observed. In contrast, the deswelling period causes deterioration of metabolic status; ATP concentration decreased dramatically, and ADP increase was higher than expected. CONCLUSION: From these data we conclude that there is no donor disease that could lead to exclusion of the cornea from organ culture. In fact, organ culture leads to a recovery of the metabolic status of the human cornea.

[Effect of donor illness on endothelial cell number of human corneas]. / Einfluss der Grunderkrankung des Spenders auf die Endothelzellzahl bei humanen Hornhäuten.

BACKGROUND: In most clinical centers donor material can not be obtained in necessary amounts. Therefore corneas from long-suffering donors have to be accepted, too. It was the aim of this study to demonstrate the influence of the cause of death on the endothelial cell density of fresh human corneas. MATERIAL AND METHODS: The endothelial cell count of 81 donor corneas was determined after preparation of the corneo-scleral disc. For all donors the premortal history was evaluated concerning the cause of death and therapy. In this manner donors were divided into five groups: sudden death, carcinoma, septicemia, renal insufficiency and diabetes mellitus. RESULTS: There were no significant differences in endothelial cell count between these five groups. Even chemotherapy and radiatio of the donor had no influence on the cell density. CONCLUSION: It may be concluded, that clear corneas have a sufficient endothelial cell density and that the cause of death has no influence on this parameter. Therefore also corneas from donors with long-standing diseases may be accepted for transplantation.

Understanding the AIDS / HIV pandemic.

PIP: HIV infection and AIDS are problems of global magnitude and concern. A globally cooperative approach is therefore needed to control and prevent the expansion of the ongoing pandemic. 138,976 AIDS cases were reported globally at the end of 1988, and 203,599 by the end of 1989. It is estimated that by early 1994, at least two million cases of AIDS had occurred in sub-Saharan Africa since the beginning of the epidemic. Spreading rapidly, AIDS threatens to be one of the most costly diseases of all time and has already caused more political and religious problems than any other disease. The author considers the epidemic, impact on mortality, projections, and prevention.^ieng