Fatty-acid biomarkers and tissue-specific turnover: validation from a controlled feeding study in juvenile Atlantic croaker Micropogonias undulatus.

Fatty-acid (FA) profiles of liver and muscle tissue from juvenile Atlantic croaker Micropogonias undulatus were examined over a 15 week diet-switch experiment to establish calibration coefficients (CC) and improve understanding of consumer-diet relationships for field applications. Essential FAs [docosahexaenoic acid (DHA), 22:6n-3 and eicosapentaenoic acid (EPA) , 20:5n-3] decreased and 18:2n-6 increased in tissues of M. undulatus fed diets with increasing proportions of terrestrial v. marine lipid sources. Non-linear models used to estimate the incorporation rate and days to saturation of per cent 18:2n-6 in tissues showed that livers incorporated 18:2n-6 faster than muscle, but the proportions of 18:2n-6 in muscle were higher. CCs were established to determine proportions of FA deposition in tissues relative to diet. Many CCs were consistent amongst diet treatments, despite growth and dietary differences. The CCs can be used to discern FA modification and retention within tissues and as tools for future quantitative estimates of diet histories. Incorporation rates and CCs of 18:2n-6 were applied to a sub-set of field samples of wild M. undulatus to understand habitat use and feeding ecology. Altogether, these results suggest that FAs provide a time-integrated measure of diet in aquatic food webs and are affected by tissue type, growth rate and the influence of mixed diets.

Balloon-expandable common iliac artery occluder device for endovascular aneurysm repair.

This study was performed to evaluate the efficacy of a balloon-expandable Palmaz stent common iliac artery occluder device for endovascular stent-graft repair of aortoiliac aneurysms. Eighty-four patients (79 men, 5 women; age range 60-95 yr; mean age, 76 yr) with aortoiliac aneurysms underwent endovascular stent-graft repair. The repair consisted of a stent-graft extending from the abdominal aorta to the iliac or common femoral artery, a cross-femoral bypass graft, and an endovascular arterial occluder device within the contralateral common iliac artery. The occluder device consisted of a 5-cm segment of 6-mm diameter polytetrafluoroethylene (PTFE) graft with a purse-string suture occluding the leading end and a Palmaz stent sutured to the trailing end. The occluder device was delivered through a 17F catheter via an arteriotomy. Eighty-three of the 84 patients received aortic endografts. In one case, infrarenal aortic rupture occurred during deployment of the aortic stent requiring conversion to an open surgical repair. Initial technical success for occluder device insertion was achieved in 78 of the remaining 83 patients. Failure to advance the occluder device delivery sheath through a diseased iliac artery occurred in one patient. Common iliac artery rupture occurred during balloon expansion and occluder device deployment in two patients. Two patients required additional coil embolization of the common iliac artery adjacent to the occluder device at the time of stent-graft insertion to correct incomplete iliac occlusion. Delayed occluder device-related complications included one patient with a postoperative iliac endoleak who required percutaneous coil embolization and one patient with a postoperative iliac endoleak in whom a contained aortic aneurysm rupture developed that was treated by surgical ligation of the common iliac artery. Use of the Palmaz stent-based iliac artery occluder device is an effective technique to induce common iliac artery thrombosis to facilitate endoluminal stent-graft aneurysm repair.

Injury to the popliteal artery.

During a 32 year period, 164 patients with 165 popliteal artery injuries were treated. One hundred twenty-five injuries were due to penetrating trauma, and 40 to blunt force. During the first decade reviewed, with ligation the main method of management, the amputation rate was 74 percent. Almost routine attempts at vascular repair over the ensuing 10 years reduced the amputation rate to 28 percent. During the final 12 years, six amputations were required for 81 injuries, thereby producing an amputation rate of only 6 percent. From this experience, the following principles of management have evolved: (1) early diagnosis is best accomplished by a careful history and detailed physical examination, not by arteriography; (2) thrombectomy followed by distal heparinization before repair is the best method for guaranteeing an adequate arterial outflow tract and thus successful revascularization; (3) resection of all injured vessels with reconstitution of continuity by the use of an interposed saphenous vein graft is often warranted to avoid tension; (4) popliteal vein repair should be performed when practical; and (5) subperiosteal fibulectomy-fasciotomy should be done routinely immediately after vascular repair.

Ruptured hepatic artery aneurysm with hepatic artery-to-portal vein fistula. Preservation of portal flow by autogenous vein reconstruction.

Hepatic artery aneurysms are uncommon lesions that have varied clinical presentations. Rupture into the portal vein has occasionally been reported, as has associated gastrointestinal bleeding. A case is described in which an unusually large hepatic artery aneurysm ruptured into the portal vein, destroying a major portion of its wall. Reconstruction was accomplished successfully by use of an autogenous saphenous vein patch with preservation of hepatopetal portal flow.

Abdominal aortic surgery and horseshoe kidney.

Seventy cases, including the six reported here, of aortic operations in patients with horseshoe kidney were reviewed. Anomalous renal arteries were encountered in 42 (60%) of these patients. We concluded that accurate preoperative diagnosis and angiographic delineation of aberrant renal arteries facilitate preservation of renal blood supply. When accessory or anomalous arteries cannot be preserved in situ, they should be reimplanted into the aortic prosthesis. Symphysiotomy may improve operative exposure and when necessary is a safe maneuver.