Direct comparison of Neuroform and Enterprise stents in the treatment of wide-necked intracranial aneurysms.

AIM: To compare the complications and outcomes of Neuroform and Enterprise stents in the treatment of unruptured wide-necked aneurysms. MATERIALS AND METHODS: Under the auspices of the institutional review board, a review of a prospectively collected patient log identified 130 patients who underwent elective stent-assisted coil embolization of a wide-necked aneurysm, including 53 patients treated with an Enterprise stent and 77 patients treated with a Neuroform stent. Immediate and long-term clinical and radiographic outcomes were recorded for all patients. All patient data were handled in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. RESULTS: The technical success rate was 94%. Overall morbidity was 15% with Enterprise stents and 3% with Neuroform stents (p = 0.020). However, the type of stent used was not predictive of clinical outcomes as measured by the modified Rankin scale. In a multivariate analysis, the use of a Neuroform stent was one of the predictors of retreatment (p = 0.034). CONCLUSION: Multivariate analyses identified the use of Neuroform stents as an independent predictor of the need for retreatment and the use of Enterprise stents as an independent predictor of morbidity. However, the type of stent was not predictive of clinical outcome as measured by the modified Rankin scale.

First Report of Rust Caused by Pucciniastrum boehmeriae on Mamaki (Pipturus albidus) in Hawaii.

Pipturus albidus (Hook. & Arn.) A. Gray or mamaki is a flowering plant species in the Urticaceae (nettles) endemic to the Hawaiian Islands. Mamaki is a forest and agricultural commodity, as well as a traditional medicinal and fiber crop. In August 2013, leaf rust was observed in Kuristown, Hawaii, on 15 mamaki plants. Infected leaves had vein-delimited chlorotic spots on the adaxial surface and yellow to orange uredinia on the abaxial surface. Uredinia were scattered, minute, pulverulent, subepidermal, and dome-shaped with a central pore, consistent with Pucciniastrum. Urediniospores were 16 to 23 × 10 to 14 µm, echinulate, ellipsoid to pyriform, walls hyaline, 0.5 µm thick, contents pale yellow to bright yellow. No teliospores were observed. A voucher specimen was deposited in the U.S. National Fungus Collections (BPI 892695). The only species of Pucciniastrum previously known on Pipturus, Pucciniastrum pipturi Syd. [syn. Uredo pipturi (Syd.) Hirats. f.], has larger urediniospores, 26.5 to 40.0 × 19.5 to 27.5 µm, and is currently reported from Japan and the Philippines (3). The pathogen was identified as Pucciniastrum boehmeriae (Dietel) Syd. & P. Syd., which infects Boehmeria Jacq., also in the Urticaceae, and has urediniospores that are 18 to 27 × 13 to 18 µm and similar in shape (2). DNA was extracted from uredinial lesions and the nuclear ribosomal internal transcribed spacer (ITS2) region and the 5' end of large subunit (28S) rDNA were amplified and sequenced following the protocol of Aime (1). The resulting fragment (GenBank Accession No. KF711854) was 100% identical to authenticated and vouchered P. boehmeriae ITS2/28S rDNA sequences (AB221449 to AB221451 and AB221391 to AB221393) (4). Sequences from P. pipturi are not available for comparison, but host family, molecular, and morphological data support the identification of the rust as P. boehmeriae, which is found throughout eastern Asia. To our knowledge, this is the first report of P. boehmeriae on mamaki and the first report in Hawaii on any host. Plant health professionals and regulatory officials can utilize this information to establish survey methods and implement appropriate management practices for this rust disease. References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) N. Hiratsuka. Revision of Taxonomy of the Pucciniastreae. Kasai Publishing and Printing, Tokyo, 1958. (3) M. Kakishima and T. Kobayashi. Mycoscience 35:125, 1994. (4) Y.-M. Liang et al. Mycoscience 47:137, 2006.

Single-queen introductions characterize regional and local invasions by the facultatively clonal little fire ant Wasmannia auropunctata.

Clonal reproduction may facilitate the spread of invasive species by reducing the minimum population size necessary for successful establishment. We used microsatellite markers to reconstruct the composition of founding populations in two regional (Central Africa and Hawaii) and 23 local (near a Gabonese oilfield) invasions of the facultatively parthenogenetic little fire ant. Central Africa had a single dominant queen clone, which appears to have initiated the regional infestation, and then produced numerous other clones by rare sexual reproduction. This interpretation of the data was also supported by the genotype of a worker from the first collection in Africa (Gabon 1913). We found only a single queen clone in Hawaii, likewise indicating a single-clone introduction, most likely from an earlier infestation in Florida. Single-clone introductions also gave rise to the vast majority (92%) of local infestations at our oilfield study site. These results suggest the unusual, largely clonal, reproductive strategy of the little fire ant may enhance its success as an invasive species. However, the occasional sexual production of novel genotypes after the initial introduction may provide genetic flexibility that overcomes shortcomings of pure clonality.

Unusual presentation of aortic pseudoaneurysm: middle lobe pneumonia.

Pseudoaneurysms of the aorta are rare. We report an unusual presentation of an ascending thoracic pseudoaneurysm found with atypical presenting symptoms.

Resection of left ventricular tumor using videocardioscopy and echocardiography.

Assessment of large cardiac tumors requires careful definition of the extent, cell type, and degree of invasiveness to determine the best operative management. Preoperative magnetic resonance imaging and echocardiography were helpful, but limited in the assessment and management in the case of a 19-year-old pregnant woman with a large (9 x 5.5-cm) left ventricular mass. Intraoperative echocardiography and videocardioscopy facilitated precise operative decisions and management. Successful resection was achieved without the need for cardiac transplantation. This case demonstrates the complexity of the diagnosis and management of large cardiac tumors.

Squamous cell carcinoma of the lung: an unusual metastasis to pectoralis muscle.

A 44-year-old man with clinical T2 N0 M0 squamous cell carcinoma of the lung presented 4 weeks after left pneumonectomy with a single metastasis to his right pectoralis major muscle. Three years after excision and chemotherapy he remains in remission. Muscle metastasis of carcinoma is an infrequent occurrence. Further investigation into the incidence and treatment is warranted.

Repair of aortic transection associated with ductal diverticular aneurysm.

A 14-year-old girl involved in a motor vehicle accident sustained an acute traumatic aortic transection at the site of a congenital ductal diverticular aneurysm. Aortic transection is a lethal injury that is uncommon in children. A ductal diverticular aneurysm is a rare congenital lesion, formed when the ductus arteriosus fails to close with aneurysmal formation at the aortic isthmus. Diagnosis, management, and pathophysiology of both lesions are discussed.

Legionella pericarditis diagnosed by direct fluorescent antibody staining.

Legionella pericarditis is a rare and serious manifestation of Legionnaire's disease. A case is presented in which the diagnosis was established by direct fluorescent antibody staining on a pericardial tissue specimen. Video-assisted thoracoscopy was used safely and effectively in diagnosis and management in this case.

The ascending laparoscope. Modern thoracoscopy.

Developments in laparoscopic endoscopy have increased the interest in thoracoscopy. New techniques and instruments, particularly video endoscopy, have greatly expanded the indications for laparoscopic procedures. These innovations and techniques are being applied and modified for thoracic application.

Thoracoscopic lung biopsy.

Progress in instrumentation and techniques developed for laparoscopic surgery have paved the way for a resurgent interest in thoracoscopic procedures. Traditional thoracoscopy was limited by access, restricted visualization, and surgical devices. Recent cases provided an opportunity to successfully perform thoracoscopic pulmonary wedge excisions using state-of-the-art technology and instruments adapted from laparoscopy. These preliminary cases provided an opportunity to modify and adapt these techniques to thoracic procedures. Video thoracoscopy is rapidly evolving in both methods and instrumentation.

Blunt traumatic rupture of pulmonary vein, left atrium, and bronchus.

A 22-year-old man fell 12.2 m (40 ft), injuring the right lower lobe bronchus, right inferior pulmonary vein, and left atrium. These injuries were not associated with fractures, cardiac tamponade, or pneumothorax. The severity of injury became apparent only upon right thoracotomy for persistent hemorrhage. This case presented special diagnostic and surgical challenges and suggests a role for the increased use of bronchoscopy in major blunt chest trauma.