Management of endograft infections.

Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) have become well-accepted alternatives to traditional open surgery because of the diminished perioperative complications. Aortic stent-graft infection is an uncommon complication and little is known about the general features of and potential risk factors for aortic stent-graft infection, and treatment is administered on a case-by-case basis with no consensus guidelines. Despite a low infection rate, the associated mortality rates are extremely high and the morbidity rate, even with aggressive surgical interventions, is also high. Since 1991 only 117 cases of thoracic and abdominal endograft infections have been reported in the literature. This paper presents a detailed analysis of the features of all cases reported to date and reviews the epidemiology, diagnosis, management, and outcomes of thoracic and abdominal endograft infections.

Detection of bladder cancer recurrence with real-time three-dimensional ultrasonography-based virtual cystoscopy.

This prospective study evaluated the accuracy of grey-scale two-dimensional (2D) ultrasonography and real-time threedimensional (3D) ultrasonography-based virtual cystoscopy for detecting early recurrence of bladder cancer in previously treated patients (n = 40). Real-time 3D ultrasonography-based virtual cystoscopy images were compared with both 2D ultrasonography and interval conventional cystoscopy pathology results. Ultrasound examinations were performed before routine follow-up with conventional cystoscopy. Overall sensitivity for real-time 3D ultrasonography-based virtual cystoscopy was lower than for 2D ultrasonography, indicating it did not provide additional information. The results of combined (2D and 3D) ultrasonography and conventional cystoscopy differed significantly. Where lesions were detected with combined ultrasonography, the number of previous cystoscopies was lower and the tumour stage was significantly higher at initial diagnosis, compared with cases where no lesions were detected. The results suggest that ultrasonography before cystoscopy can be performed more frequently - or, if no lesions are detected by ultrasonography, the interval between cystoscopies can be prolonged - in patients at high risk of bladder cancer recurrence.

Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis.

A woman aged 68 years who experienced recurrent right hemiparesis caused by hypoglycemia was admitted to our hospital. When she was experiencing a low level of glucose, diffusion-weighted MR imaging showed the presence of hyperintensity lesions in the bilateral internal capsule. Diffusion-weighted MR imaging has been infrequently performed in patients with hypoglycemia. We report the reversible hyperintensity lesions on diffusion-weighted MR imaging in a hypoglycemic period in a patient with reversible hemiparesis. A reduction of apparent diffusion coefficient in a hypoglycemic period was clearly shown.

Vasculopathic changes in the cerebral arterial system with neurobrucellosis.

Brucellosis is a zoonotic disease characterized by multisystem involvement. Nervous system involvement is rare, with a reported incidence of 3%-13%. Brucellosis can also be manifested in the form of vasculopathy. Cerebral vasculopathy due to brucellosis is a very rare entity, with only a few cases reported in the literature. We present a patient with neurobrucellosis who had involvement of cerebral vasculature demonstrated by angiography.