Incidence and risk factors of postimplantation syndrome after elective endovascular aortic aneurysm repair.

BACKGROUND: Postimplantation syndrome (PIS) represents an acute phase systemic inflammatory response following endovascular aortic aneurysm repair (EVAR). Our objective was to investigate the risk factors associated with the manifestation and severity of PIS with various available stent-grafts. METHODS: We performed a retrospective analysis of prospectively collected data covering the period 2016-2020. The study included 191 patients. Body temperature was recorded regularly and blood sample was obtained daily. The imaging protocol included computed tomography aortoiliac angiography before surgery and one month after. The volumes of pre-existing and new-onset mural thrombus were calculated in a semi-automated fashion. Five abdominal aortic stent-graft devices were used: Endurant™ ΙΙ, Anaconda™, Treo®, E-tegra® and AFX® 2. Subgroup analysis was performed between woven polyester and ePTFE lined devices. RESULTS: The incidence of PIS was 21.5%. No significant differences were observed regarding demographics, risk factors, aneurysm anatomy or operative data. The amount of pre-existing and new-onset mural thrombus were not related with PIS (P=0.117 and P=0.096). PIS incidence in the polyester subgroup was 24.2%, significantly higher compared to 8.3% in the ePTFE subgroup. In-subgroup analysis revealed that the use of Anaconda™ was associated with the higher frequency (61.1%, P=0.021). Multivariate logistic regression showed that polyester was the single factor significantly associated with PIS (hazard ratio=2.6, P=0.043), as opposed to the new onset thrombus (hazard ratio=1.29, P=0.101). CONCLUSIONS: PIS is not uncommon and should be taken into consideration in patients presenting with fever after EVAR. The endograft's liner material seems to play the primordial role, with woven polyester to be attributed with significantly higher incidence.

Reflectivity properties of an anisotropic slab waveguide with isolated substrate.

The scattering properties for both TE and TM modes of an abruptly ended two-layered slab waveguide with anisotropic core and isolated substrate are examined by an improved iteration technique, which is based on the integral equation method with accelerating parameters. The relative dielectric constants of the core for the three Cartesian directions are considered to be different, but cases with isotropic core are also considered. The electric field distribution on the terminal plane and the reflection coefficients of the dominant TE and TM guided modes, as well as the near-field distribution and the far-field radiation pattern, are computed, while numerical results are presented for several cases of the core anisotropy.

Malignant triton tumour of the anterior mediastinum as incidental finding.

A rare case of malignant peripheral nerve sheath tumour with rhabdomyoblastic differentiation (malignant triton tumour) of the anterior mediastinum in a 30-year-old male is reported. The tumour was an incidental finding during the diagnostic work-up following a motor vehicle accident. The patient underwent median sternotomy with a tumour resection performed. Local relapse was suspected one month later, as per the chest CT-scan, and post-operative chemoradiation was applied, which produced a response. Twelve months later the patient is doing well while radiological findings remain invariable. Localization of a triton tumour in the anterior mediastinum is extremely rare, adjuvant treatment is necessary, recurrence frequently occurs and the prognosis is dismal.

Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy.

Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement.

Multiple cervical and intrathoracic plexoid neurofibromas. Case report.

A 29-year-old male with known von Recklinghausen's disease is presented. The main symptom of the patient was paroxysmal episodes of pain and numbness in the right upper hand for the last 10 years. Cervical and mediastial magnetic resonance imaging (MRI) revealed 3 large tumors originating from the right vagus nerve and another of the same origin contralaterally. Surgical resection of the masses in the right hemithorax was performed via right posterolateral thoracotomy. The postoperative course was uneventful and symptoms recessed. Plexoid neurofibromas were diagnosed at histological examination. The mass in the left hemithorax is under surveillance according to the patient's preference. The clinical, radiological, surgical, and histopathological features of this rare case are discussed.

Congenital cystic adenomatoid malformation in an adult presenting as lung abscess.

The case of a 21-year-old male with congenital cystic adenomatoid malformation is presented. His medical history started after his birth with recurrent pulmonary infections during his infancy. Lung abscess of the right lower lobe was suspected and right lower lobectomy was performed to remove a sizeable mass infiltrating the largest part of the lobe. The clinical features, diagnostic procedures, differential diagnosis, pathologic characteristics, therapeutic assessment, etiopathology and prognosis of the tumor are discussed.

Surgical management of idiopathic subglottic tracheal stenosis.

A case of idiopathic subglottic tracheal stenosis in a 50-year-old female is presented. A procedure of single-stage resection of the lesion and end-to-end anastomosis was performed with excellent results 1 year after the operation. The clinical, paraclinical, diagnostic, therapeutic and histopathological aspects of this rare pathologic condition are discussed and the literature on this topic is reviewed.

Inflammatory pseudotumor: a controversial entity.

Inflammatory pseudotumor of the lung is considered to be a rare, benign, neoplastic lesion, consisting mainly of spindle mesenchymal cells, sometimes in such a way that its histological appearance mimics that of a spindle cell sarcoma, fibrous histiocytoma or fibrosarcoma. On the occasion of a case managed in our department, the literature is reviewed, in an attempt to clarify some issues concerning this tumor. Emphasis is given to complete resection of the tumor for both diagnostic and therapeutic purposes. Malignant behavior may occur and recurrence is possible.