Total laparoscopic radical hysterectomy: a change in practice for the management of early stage cervical cancer in a U.K. cancer center.

In order to evaluate the safety, surgical, and oncological outcomes of the introduction of a total laparoscopic radical hysterectomy (TLRH) service, the authors conducted a retrospective review of all TLRHs performed in the present centre from the beginning of the service in August 2010. TLRH appears in this series to be safe. Complication rates were comparable to National Institute for Health and Clinical Excellence (NICE) and literature standards. Oncological outcomes, despite the short follow up period, appear acceptable. TLRH is a valuable alternative to open surgery for the treatment of early cervical cancer.

Innovative endovascular approach for limb salvage in critical limb ischemia.

In the absence of feasible revascularization, nearly one third of patients with critical limb ischemia experienced major amputation at 6 months. In patients with an independent living status, this decision is difficult to support without exhausting all chances to attain limb salvage and preserve functional autonomy. The present report describes a new procedure of revascularization by performing a full endovascular extra-anatomic femoropopliteal bypass for the treatment of limb-threatening ischemia. The patient presented with extensive tissue loss and a short-term risk of major amputation. She had experienced previous failure of conventional surgical and endovascular revascularization procedures and ligation of proximal femoral artery precluded any further revascularization attempt. Limb salvage was achieved with this endovascular revascularization procedure with complete wound closure. The patient still presents an independent living status and preserved functional autonomy without wound recurrence after a follow-up of more than 5 years.

A favorable metabolic and antiatherogenic profile in carriers of CYP21A2 gene mutations supports the theory of a survival advantage in this population.

CONTEXT: The very high carrier frequency of 21-hydroxylase deficiency worldwide has been postulated as indicating a survival advantage. The 'mediators' of such an effect remain speculative. OBJECTIVE: To look for possible differences in the metabolic and atherogenic risk profile of carriers and noncarriers of CYP21A2 gene mutations at puberty in order to identify possible mediators of the presumed survival advantage for the carriers. It is anticipated that by studying atherogenic risk factors at such an early developmental stage, age-related alterations in these factors may be minimized. METHODS: The study group included 45 adolescent girls diagnosed in our center with premature pubarche, 29 of whom were noncarriers and 16 carriers of CYP21A2 mutations. The two groups did not differ in chronological age, age at pubarche or menarche, pubertal stage, body mass index and waist-to-hip ratio. Biochemical and hormonal profile markers as well as markers of endothelial dysfunction were determined by appropriate methodology. Additionally, in each subject, an oral glucose tolerance test and a gonadotrophin-releasing hormone GnRH analogue stimulation test were carried out. RESULTS: Endothelin-1 values were lower in the carriers compared to the noncarriers (p = 0.031). Higher tissue plasminogen activator and lower plasminogen activator inhibitor-1 values were found in carriers compared to noncarriers (p = 0.02 and <0.001, respectively). The ratio of the insulinogenic index/homeostasis model assessment for insulin resistance, which reflects beta-cell function, was higher in carriers (p = 0.048), indicating a more favorable beta-cell function in the carriers. CONCLUSIONS: Our findings that carriers of CYP21A2 gene mutations have a more favorable internal milieu with regard to the metabolic syndrome and atherogenesis support the theory that heterozygous CYP21A2 mutations provide a survival advantage. The mechanisms involved may be related to the insulin secretion-action pathway, hypothalamic-pituitary-adrenal axis responsiveness or other still unrecognized factors.

Endovascular Extra-Anatomic Femoro-Popliteal Bypass for Limb Salvage in Chronic Critical Limb Ischemia.

PURPOSE: To report the initial clinical experience with fully endovascular extra-anatomic femoro-popliteal bypass (FPB) for limb salvage in patients with critical limb ischemia (CLI) and no traditional endovascular or surgical revascularization options. METHODS: Between June 2013 and May 2018, endovascular procedure was proposed for limb salvage during multidisciplinary team meeting in fifteen hospitalized patients (median age 67 years; 73% men) with CLI and a high risk of major amputation. Primary outcome was amputation-free survival at 1 year. Secondary outcomes included mortality, cardiovascular (CV) events and major limb amputation at 1 year, primary/secondary bypass patency and wound healing at the last follow-up visit. Procedure-related complications (deaths, CV events, hemorrhages) were recorded through 30 days. RESULTS: Technical procedure success rate was 100%. Major peri-procedural outcomes occurred in two patients (13%): One patient died secondary to cardiogenic shock; one patient suffered acute coronary syndrome associated with iliopsoas bleeding. No major amputation occurred through 30 days. Median follow-up period was 21.5 (18.25-45.5) months (last follow-up visits on April 2019). Amputation-free survival at 1-year and at the last follow-up visit was 80% and 53%, respectively. Cumulative mortality at 1-year and at the last follow-up visit was 13% and 33%, respectively. Primary and secondary bypass patency was 27% and 60%, respectively. Complete wound healing was achieved in 11 patients (73%). CONCLUSION: Endovascular extra-anatomic FPB represents an innovative approach for limb salvage in CLI with no traditional endovascular or surgical revascularization options. Our clinical experience highlights that this technique remains challenging because of frequent comorbidities and fragility of this patient population. LEVEL OF EVIDENCE: Level 4, Case series.

Ranibizumab and digital ischemia.

Case report of a patient with age-related macular degeneration whose digital ischemia can most plausibly be attributed to ranibizumab. PURPOSE: To report ranibizumab as the probable cause of digital ischemia in a patient treated for age-related macular degeneration. METHODS: Single-patient case report. RESULTS: An 83-year-old woman with an unremarkable medical history suffered acute ischemia in her left hand with necrosis of the distal phalange of the fifth finger after six intravitreal injections of ranibizumab. Her etiological work-up was negative. Her condition improved after endovascular revascularization and remained good at six months' follow-up after three months of dual antithrombotic therapy (low molecular weight heparin then rivaroxaban, both with aspirin) followed by rivaroxaban alone and four courses of intravenous iloprost. CONCLUSION: The increased incidence of peripheral arterial thromboembolic events in patients under ranibizumab treatment is slight but significant, with 0.8-5% of patients affected, most of which suffer strokes. These events seem to occur at a random time after ranibizumab treatment is initiated and no reliable marker has yet been identified. The most probable cause of digital ischemia in our patient was ranibizumab.

[A post-thrombotic pelvic congestion syndrome]. / Un syndrome de congestion pelvienne post-thrombotique.

INTRODUCTION: Pelvic congestion syndrome is a chronic pelvic pain syndrome related to pelvic varices developed in the setting of primary venous insufficiency or secondary to venous obstruction. OBSERVATION: We report the case of a 35-year-old patient undergoing anticoagulant therapy for an extensive unprovoked left iliac vein thrombosis, who developed a disabling pelvic congestion syndrome secondary to chronic obstruction of the left iliac vein. Recanalization with stenting of the left iliac vein, combined with antithrombotic treatment with antiplatelet therapy (aspirin 100mg) and anticoagulation (rivaroxaban 20mg) for three months, followed by antiplatelet therapy alone, led to a complete and lasting regression of symptoms. DISCUSSION: Management of pelvic congestion syndrome secondary to post-thrombotic lesions must take into account its pathophysiology. It involves iliac venous angioplasty with stent placement in combination with antithrombotic therapy, which modalities remain to be specified in long-term follow-up.

Synthesis of inorganic polymers using fly ash and primary lead slag.

The present work reports on the synthesis and properties of inorganic polymers ("geopolymers") made of 100% fly ash from lignite's combustion, 100% primary lead slag and mixtures of the two. In the inorganic polymers with both fly ash and lead slag the main crystalline phases detected are wüstite, magnetite, sodium zinc silicate, quartz, anorthite, and gehlenite; litharge partially dissolves. FTIR analysis in these samples revealed that the main peaks and bands of end members also exist, along with a new amorphous reaction product. In terms of microstructure, both fly ash and lead slag dissolve and contribute in the binding phase whereas the larger particles act as aggregates. For an increasing lead slag in the composition, the binding phase is changing in chemistry and reaches PbO values higher than 50 wt.% for the 100% lead slag inorganic polymer. Regarding the properties of fly ash and lead slag inorganic polymers, compressive strength is higher than 35 MPa in all cases and water absorption diminishes as the lead slag content increases. A comparison of leaching results before and after polymerisation reveals that pH is an important factor as Pb is immobilised in the binding phase, unlike Zn and As.

Valorisation of different types of boron-containing wastes for the production of lightweight aggregates.

Four boron-containing wastes (BW), named as Sieve (SBW), Dewatering (DBW), Thickener (TBW) and Mixture (MBW) waste, from Kirka Boron plant in west Turkey were investigated for the formation of artificial lightweight aggregates (LWA). The characterisation involved chemical, mineralogical and thermal analyses as well as testing of their bloating behaviour by means of heating microscopy. It was found that SBW and DBW present bloating behaviour whereas TBW and MBW do not. Following the above results two mixtures M1 and M2 were prepared with (in wt.%): 20 clay mixture, 40 SBW, 40 DBW and 20 clay mixture, 35 SBW, 35 DBW, 10 quartz sand, respectively. Two different firing modes were applied: (a) from room temperature till 760 °C and (b) abrupt heating at 760 °C. The obtained bulk density for M1 and M2 pellets is 1.2g/cm(3) and 0.9 g/cm(3), respectively. The analysis of microstructure with electron microscopy revealed a glassy phase matrix and an extended formation of both interconnected and isolated, closed pores. The results indicate that SBW and DBW boron-containing wastes combined with a clay mixture and quartz sand can be valorised for the manufacturing of lightweight aggregates.

Valorisation of electric arc furnace steel slag as raw material for low energy belite cements.

In this paper, the valorisation of electric arc furnace steel slag (EAFS) in the production of low energy belite cements is studied. Three types of clinkers were prepared with 0 wt.% (BC), 5 wt.% (BC5) and 10 wt.% (BC10) EAFS, respectively. The design of the raw mixes was based on the compositional indices lime saturation factor (LSF), alumina ratio (AR) and silica ratio (SR). The clinkering temperature was studied for the range 1280-1400°C; firing was performed at 1380°C based on the results regarding free lime and the evolution of microstructure. In order to activate the belite, clinkers were cooled fast by blown air and concurrent crushing. The results demonstrate that the microstructure of the produced clinkers is dominated by belite and alite crystals, with tricalcium aluminate and tetracalcium-alumino-ferrite present as micro-crystalline interstitial phases. The prepared cements presented low early strength development as expected for belite-rich compositions; however the 28-day results were 47.5 MPa, 46.6 MPa and 42.8 MPa for BC, BC5 and BC10, respectively. These values are comparable with OPC CEMI 32.5 N (32.5-52.5 MPa) according to EN 197-1. A fast setting behaviour was also observed, particularly in the case of BC10, whereas soundness did not exceed 1mm.

Valorization of lignite combustion residues and ferroalumina in the production of aggregates.

The present research study investigates the synergy of industrial solid by-products from lignite combustion (fly ash and bottom ash) and aluminum production (ferroalumina) in the production of lightweight aggregates (LWA). The process consists of two stages, pelletization and sintering. Bottom ash (BA) is used as the principal raw material in mixtures while ferroalumina (FAL) is added in lower percentages (5-30 wt%). BA carbon content is used as the fuel of sintering process in high temperatures, around 1250 degrees C, and gas generation is responsible for porous structure formation. Physical properties such as porosity, water absorption and bulk density, of sintering products are measured. Increase of FAL percentage in sintering mixtures results in decrease of porosity from 61% to 35% and of water absorption from 61% to 21% and in increase of bulk density from 1.02 g/cm(3) to 1.80 g/cm(3) of the produced aggregates. Aggregates produced by FAL addition up to 20 wt% are characterized as LWA. Aggregates formed are used in the production of concrete specimens. Compressive strength of concrete increases by increasing FAL addition in aggregates from 5 wt% to 15 wt% (highest strength value), while decrease by increasing FAL addition from 20 wt% to 30 wt%. FAL addition in lignite ashes sintering mixtures (up to 15 wt%) is considered as an important parameter for enhancing aggregates strength.

Utilization of ferroalumina as raw material in the production of Ordinary Portland Cement.

Red mud (RM), the digestion by-product of bauxite processing from "Aluminum Hellas", was dewatered by means of a filter press. The filtrand with water content from 28 to 32 wt% was named ferroalumina (FA). In order to utilize it as a raw material in the production of Ordinary Portland Cement (OPC), mixtures were prepared with limestone, sandstone and 1, 3 and 5 wt% FA addition, respectively. The design of the mixtures was based on the cement's compositional indexes LSF, AM and SM. Burnability tests showed that less than 1 wt% free lime can be obtained in all cases for firing at 1450 degrees C, except for the mixture with 1 wt% FA addition, which requires 1550 degrees C. XRD analysis and optical microscopy examination showed that FA addition did not affect the mineralogical phases of the produced clinkers. The characterisation of the produced Portland cements indicated that differences on surface area, water requirement and setting time are negligible. Compressive strength results after 28 days of curing varies from 55 to 63 MPa, which ranks the produced cements in CEM I 42.5N category. More specifically, the cements with FA addition due to their relatively high 2-day strengths (>20 MPa) can be ranked in CEM I 52.5N category. Addition of FA increases the amount of water-soluble chromium proportionally to the amount of total chromium to the mixture; however, conversion of total Cr to hexavalent Cr remains practically constant, in the range of 32-35 wt%. The results indicate that FA can be used as raw material in the production of OPC up to 5 wt% according to the chemical composition of the other raw materials.

Transcatheter embolization of a large symptomatic pelvic arteriovenous malformation with Glubran 2 acrylic glue.

A young patient affected by a pelvic arteriovenous malformation (pAVM) with recurrent episodes of hematuria following exercise, underwent transcatheter embolization using Glubran 2 acrylic glue (GEM, Viareggio, Italy). All branches of the pAVM were successfully occluded. The patient showed prompt resolution of symptoms and persistent occlusion of the pAVM at the 6 month follow-up.