Emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysms: an institutional experience.

OBJECTIVES: Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still under investigation. Since installation of an urgent eEVAR kit in our hospital, all patients with a rAAA or urgent thoracic aortic aneurysm are candidates for eEVAR or eTEVAR (emergency thoracic EVAR), respectively. For this study, we analyzed all rAAA patients treated with eEVAR. METHODS: Data were recorded prospectively. Criteria for an eEVAR were an infrarenal neck > or = 15 mm, acceptable landing zone, angles below 70 degrees and a good femoral approach. We prefer preoperative angio CT-scan but in case of instability, an intra-aortic balloon can stabilize the patient during angiography (in the OR) to decide between open or eEVAR repair. Follow-up was performed on regular intervals by duplex or CT-scan. Thirty-day mortality and overall survival were calculated. RESULTS: Since 2006, nine male rAAA patients with a mean age of 73 years (range : 62-82) had eEVAR repair. Aneurysm diameter was 8 cm (range : 5.8-11). The Hardman index was 1.5 (range : 0-3). In eight patients an aorto-uni-iliac device was placed succesfully followed by a femorofemoral crossover bypass. The 30-day operative mortality was 12.5% (one patient with septic shock). Three patients showed a type 2 endoleak with stable diameter during follow-up but one patient showed expansion 4 years after treatment. CONCLUSIONS: Treating rAAA with eEVAR in selected patients with acceptable anatomy and a kit permanently available in the operating room yielded good results by a surgical team trained for both open and eEVAR repair. The conversion rate was low (11%) and the survival (immediate and 30-days) was excellent (87.5%).

Stridor due to a bridge-like subglottic stenosis in a 10-week-old male infant.

We present an infant with post-intubation stridor caused by a bridge-like subglottic stenosis. At the age of 6 weeks he suffered from a RSV infection with the need for endotracheal intubation. At week 10 acute respiratory distress required a re-intubation. Flexible endoscopy was suggestive for laryngomalacia. Rigid endoscopy revealed a subglottic laterolateral mucosal bridge resulting in a doubling of the airway lumen. Histopathological examination showed a fibrinoid pseudomembrane. Follow up endoscopy showed a grade 1 posterior subglottic stenosis without respiratory compromise. This is the first case in the literature of an infant with a post-intubation bridge-like fibrinoid pseudomembranous subglottic lesion.

Distribution of PCBs and organochlorine pesticides in umbilical cord and maternal serum.

Polychlorinated biphenyls (PCBs) and organochlorine pesticides, such as hexachlorobenzene (HCB) and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethylene (p,p'-DDE) are compounds widespread in the environment, highly lipophilic, and accumulate in biological systems. The newborn are exposed to these organochlorine compounds across the placenta and through breastfeeding. This study reports the levels of selected PCB congeners, p,p'-DDE and HCB in maternal blood and cord blood samples collected at delivery between November and December 1999 from 44 women living in the urban area of Antwerp, Belgium. Results show that all newborns contained detectable levels of PCBs, p,p'-DDE and HCB. The median concentration of PCBs was 450 pg/ml and ranged between 120 and 1580 pg/ml, while the median concentrations of HCB and p,p'-DDE were 70 and 490 pg/ml, respectively. Concentrations of PCBs and p,p'-DDE in cord blood (ng/ml) were positively associated with concentrations in maternal blood (ng/ml) (coefficients=0.74 and 0.92, P<0.05). We conclude that all investigated organochlorine compounds have an efficient transplacental transfer.

Folate and Vitamin B(12) deficiency presenting as pancytopenia in pregnancy: a case report and review of the literature.

We present a case of extreme pancytopenia in a 27-year-old pregnant woman. The initial picture was compatible with a severe hematological problem in the category of aplastic anemia, paroxysmal nocturnal hemoglobinuria or even acute leukemia. The further biochemical investigations revealed, however, a folate deficiency. Nowadays this is a very rare cause of pancytopenia. Next to this she also had a Vitamin B(12) deficiency due to intrinsic factor failure. The recent literature is discussed.