Prostheto-ureteral fistula: a rare complication after aortic graft surgery.

Prostheto-ureteral fistula after aortic graft surgery is a potentially life-threatening, rare pathology. We report the successful treatment of a prostheto-ureteral fistula that caused hematuria with hemorrhagic shock in two patients by explantation of aortic prosthetic grafts and implantation of a silver-bonded prosthetic graft (Intergard S, Intervascular). These cases show that this surgical procedure is effective, and that straightforward diagnostic procedures are necessary to initiate correct therapeutic approach without delay. Various different possible risk factors for the formation of a prostheto-ureteral fistula are also discussed.

p53 autoantibodies from patients with colorectal cancer recognize common epitopes in the N- or C-terminus of p53.

Patients with various solid tumors develop antibodies against the growth suppressor protein p53. The percentage of positive sera for patients with colon cancer varied over a wide range, which might be due to the different methods or the different antigens, which were used for the detection of p53 autoantibodies. We analyzed sera from patients with diagnosed colon cancer by ELISA using native p53 from a tumor cell line as well as by Western blotting with full-length or C- or N-terminal fragments of p53. Finally, sera were analyzed with a peptide library consisting of 16-amino-acid peptides, which cover the entire p53 sequence. By using these different methods we found 7 out of 127 sera (5.5%) to be positive for p53 autoantibodies. Two antibodies out of 7 reacted only with epitopes in the N-terminus whereas 5 sera reacted with N- and C-terminal sequences. All of these sera recognized common epitopes, which are also detected by a number of mouse monoclonal antibodies indicating immune-dominant epitopes for mouse and man on the polypeptide chain of p53. The sequences of these epitopes might be useful for the treatment of tumor patients either by neutralizing p53 autoantibodies or for vaccination.

Embolic cerebral ischemia in carotid surgery: a model for human embolic stroke?

BACKGROUND: If carotid endarterectomy (CEA) is a clinical model of embolic stroke, then it should be possible to determine the relevance of embolus size and of the total quantity of embolic material (embolus load) for ischemic stroke. MATERIAL/METHODS: Thirty-one patients underwent a total of 33 CEAs. Diffusion weighted imaging (DWI) was performed on the day before and after CEA. A new hyperintense signal on the postoperative DWI was considered a new ischemic lesion. Intraoperatively detected microembolic signals (MES) were quantified (in cm) by multiplying embolus velocity by the embolus presence within the Doppler sample volume. With this relative index, emboli were classified into small (<0.56 cm), medium-sized (0.56-1.12 cm) and large (1.12-1.70 cm). RESULTS: For each category of embolus size, embolus load (in cm/minute) was expressed as the sum of all quantified emboli divided by minutes of CEA duration. By logistic regression analysis, the occurrence of a new ischemic lesion was related to an embolus load with medium-sized emboli (without lesion, 0.029 cm/minute; with lesion, 0.157 cm/minute; p=0.018), and with large emboli (without lesion, 0.015; with lesion, 0.055; p=0.038), but not to an embolus load with small emboli or the largest embolus per CEA. CONCLUSIONS: The leading reason for cerebral ischemia in CEA is multiple embolism with emboli of medium and large size. This conceptual model may also apply to carotid artery disease.