Analysis of 13 C and 14 C labeling in pyruvate and lactate in tumor and blood of lymphoma-bearing mice injected with 13 C- and 14 C-labeled pyruvate.

Measurements of hyperpolarized 13 C label exchange between injected [1-13 C]pyruvate and the endogenous tumor lactate pool can give an apparent first-order rate constant for the exchange. The determination of the isotope flux, however, requires an estimate of the labeled pyruvate concentration in the tumor. This was achieved here by measurement of the tumor uptake of [1-14 C]pyruvate, which showed that <2% of the injected pyruvate reached the tumor site. Multiplication of this estimated labeled pyruvate concentration in the tumor with the apparent first-order rate constant for hyperpolarized 13 C label exchange gave an isotope flux that showed good agreement with a flux determined directly by the injection of non-polarized [3-13 C]pyruvate, rapid excision of the tumor after 30 s and measurement of 13 C-labeled lactate concentrations in tumor extracts. The distribution of labeled lactate between intra- and extracellular compartments and the blood pool was investigated by imaging, by measurement of the labeled lactate concentration in blood and tumor, and by examination of the effects of a gadolinium contrast agent and a lactate transport inhibitor on the intensity of the hyperpolarized [1-13 C]lactate signal. These measurements showed that there was significant export of labeled lactate from the tumor, but that labeled lactate in the blood pool produced by the injection of hyperpolarized [1-13 C]pyruvate showed only relatively low levels of polarization. This study shows that measurements of hyperpolarized 13 C label exchange between pyruvate and lactate in a murine tumor model can provide an estimate of the true isotope flux if the concentration of labeled pyruvate that reaches the tumor can be determined.

Case report of an endovascular repair of a residual type A dissection using a not CE not FDA-approved Najuta thoracic stent graft system.

This report describes an endovascular repair of a residual type A dissection using a medical device that is not marked by european conformity (CE) or Food and Drug Administration (FDA).The patient underwent ascending aortic surgery for acute type A dissection. The 2-year angio-computed tomography demonstrated patency of the residual false lumen with evolution into a 6 cm aneurysm, the extension of the dissection from the aortic arch to the aortic bifurcation with thrombosis of the right common iliac artery. There was no CE- or FDA-marked medical device indicated for this case or any other acceptable therapeutic alternative.We used the Najuta thoracic stent graft and successfully handled the pathology in a multiple-phase treatment.Technology is evolving with specific grafts for the ascending and fenestrated grafts for the aortic arch. In this single case the Najuta endograft, in spite of the periprocedural problems, was a valid therapeutic option.

Endovascular treatment of extracranial vertebral artery aneurysm and aberrant right subclavian artery aneurysm.

We report an endovascular approach that used to treat a symptomatic extracranial vertebral artery aneurysm associated to an asymptomatic aberrant right subclavian artery aneurysm. A 54-year-old man presented with neck pain, vertigo and loss of balance. The computed tomography (CT) scan demonstrated a left extracranial vertebral artery aneurysm that compressed and eroded the C5 vertebra associated to an aberrant right subclavian artery aneurysm. Endovascular exclusion of the vertebral aneurysm using a covered stent and a hybrid treatment of the aberrant subclavian artery aneurysm were performed. The 13th month follow-up CT scan confirmed the stent-grafts and supra-aortic vessels patency. The endovascular treatment represents a good option for these complex pathologies with excellent immediate results, reduces the complication rate and the hospital stay if compared to open repair. Long-term follow-up is necessary. To our knowledge this is a unique case in the literature.

Percutaneous endovascular aneurysm repair with the ultra-low profile Ovation Abdominal Stent-Graft System.

AIM: Aim of the study was to report our single-center experience of the ultra-low profile OvationTM Abdominal Stent-Graft System with totally percutaneous endovascular aneurysm repair (PEVAR). METHODS: Between December 2010 and March 2013 we electively treated 35 patients (male: 89%, mean age: 73±7 years) with abdominal aortic aneurysm (AAA) using bilateral PEVAR with the OvationTM endograft. Most (77%) cases were characterized by challenging femoral artery anatomy. Patients returned for follow-up visits at 1, 3, 6 months and annually thereafter. RESULTS: Technical success was 97.1%. One type Ia endoleak was identified on final angiography, which was treated with an extension cuff. No groin complications were observed, including lymphocele, hematoma, pseudoaneurysm, dehiscence, or wound infection. Mean follow-up was 10 months (range 1-24 months). No death was registered. One type Ia endoleak was identified at the 12-month follow-up, which resolved with placement of a Palmaz balloon-expandible stent. No type II, III, or IV endoleaks were identified. No migration, AAA enlargement, AAA rupture, or conversion to open surgery was reported. Two patients (5.7%) developed monolateral iliac limb occlusion at 58 and 72 days of follow-up, respectively. In one case a limb kinking was observed and treated with iliac kissing stent. The other limb occlusion was due to external iliac artery severe stenosis and was treated with thrombolysis and iliac artery stenting. CONCLUSION: PEVAR with the OvationTM endograft is feasible and safe in patients with unfavorable anatomy.

Endovascular stenting of the ascending aorta for type A aortic dissections in patients at high risk for open surgery.

BACKGROUND: Open repair is the gold standard for type A aortic dissection (TAAD). Endovascular option has been proposed in very limited and selected TAAD patients. We report our experience with endovascular TAAD repair. METHODS: Inclusion criteria were: (1) entry tear in the ascending aorta; (2) proximal landing zone of at least 2 cm; (3) distance between entry tear and brachio-cephalic trunk of at least 0.5 cm; (4) no signs of cardiac tamponade or severe aortic regurgitation and (5) no signs of aortic branches ischaemia. Patients with cardiac revascularisation from ascending aorta were excluded. RESULTS: From April 2009 to June 2012, 37 patients with TAAD were admitted to our hospital. As many as 28 underwent surgical repair and 9 were considered at high surgical risk in a multidisciplinary meeting. Four met our inclusion criteria for an endovascular approach. Two of them had previous ascending aortic repair for TAAD and one had aortic valve replacement. Technical success was achieved in 100% of the patients. No mortality was registered during a median follow-up of 15 months (range 4-39 months), no migration of the graft and complete false lumen thrombosis of the ascending aorta in three patients. CONCLUSION: Endovascular treatment of TAAD is challenging but feasible in a selected subset of patients. Further research remains mandatory.

A NOTES approach for thoracic surgery: transgastric thoracoscopy via a diaphragmatic incision in a survival porcine model.

AIM: Recently the NOTES approach has been extended to mediastinum by a transesophageal access and to the thorax by a transvescical endoscopic approach. The aim of this study was to assess the feasibility and the safety of transgastric endoscopic approach to the thoracic cavity, with lung biopsy, in a survival porcine model. METHODS: The study was performed on four 20-30 kg female pigs (Sus scrofus domesticus). Following gastric wall incision, the muscular pars of the left diaphragmatic dome was incised along with the parietal pleura and the endoscope advanced into the thoracic cavity. In all animals, a thoracoscopy was performed as well as peripheral lung biopsy. At the end of the operation the endoscope was withdrawn from the thoracic cavity after pleural sac decompression and the diaphragmatic incision closed by endoscopic clips under maximal expansion of lungs. The gastric incision was finally closed by endoscopic clips. Chest-tube placement was not utilized. Animals were sacrificed by day 15 postoperatively. RESULTS: The gastroscope was easily introduced into the thoracic cavity that allowed to visualize the pleural cavity and to perform simple surgical procedures such as lung biopsies without complications. There were neither respiratory distress episodes nor surgical complications to report. No adverse event occurred during the survival period. The postmortem examination 15 days after surgery revealed a good closure of the diaphragmatic incision. At necropsy, the lung biopsies were completely healed. There were no signs of infection in both thoracic and peritoneal cavities. The length of follow-up and number of animals studied might have not been sufficient. CONCLUSION: This study demonstrates the feasibility of transgastric thoracoscopy in porcine model. Long-term follow-up of much larger series will be necessary for provision of more reliable answers if this approach should be adopted in the future and eventually translated for humans with advantages for patients.

Temporal approach: a good way to provide cerebral protection for proximal carotid stenosis, the last chance for trackability in CAS.

AIM: The aim of this study was to evaluate the usefulness of the temporal approach during coronary artery stenosis (CAS) to overcome tortuosity in case of difficult arch anatomy or tortuous common carotid artery, and to provide cerebral protection of proximal lesions of the supra-aortic trunks during stenting. METHODS: The superficial temporal artery is exposed through a small incision right in front of the ear and is cannulated. A guidewire is used to descend in the external and common carotid artery and in the arch if needed. Between the end of March 2007 and May 2008 9 patients were treated with the temporal approach: in 5 cases of stenosis of the internal carotid artery with difficult arch anatomy to obtain a through and through guide from the temporal to the femoral artery, in 3 of the supra-aortic trunks to obtain cerebral protection during the procedure and in one case of tandem lesion of the left common and internal carotid artery. RESULTS: The procedure was successful in all 9 cases and there were no complications. CONCLUSIONS: The temporal approach proved to be feasible and at low risk; it represents a new possibility to increase the feasibility of carotid artery stenting in patients with difficult anatomy but, above all, it is a good way to obtain cerebral protection during endovascular treatment of proximal lesions of the supra-aortic vessels.

Pseudoaneurysm of the descending genicular artery after arthroscopic meniscectomy: report of a case.

Vascular injuries in the arthroscopic meniscectomy of the knee are uncommon. A case of pseudoaneurysm of the descending genicular artery in a 39-year-old man, after medial arthroscopic meniscectomy, is reported. The pseudoaneurysm was simple to diagnose with computed tomographic scan and angiography, and treatment was successful surgical resection.

Adventitial cyst of the popliteal artery. Report of a case.

A case of cystic degeneration of the popliteal artery in a 58-year-old male is reported. Symptoms consisted of a claudication of abrupt onset and the correct diagnostic clue was initially given by magnetic resonance of the knee and confirmed by angiography. Treatment consisted of surgical removal of the cyst and saphenous vein angioplasty of the popliteal artery, with good anatomic and functional result at one year follow-up. Diagnostic tools and treatment of the condition are briefly discussed.

[Peritoneal oxygenation-dialysis as a temporary treatment of intestinal infarction]. / L'ossigenazione-dialisi per via peritoneale come trattamento provvisorio dell'infarto dell'intestino.

The interval preceding the growth of irreversible lesions in an abdominal apoplexy is variable (3-48 hours). It may be used to improve the ischaemic viscus oxygenation, also compensating possible metabolic imbalances. 16 rabbits were used for research, in which apoplexy by the ligature of the arteria mesenterica superior was induced. Dialysis-oxygenation peritoneal treatment was carried out for 8 rabbits, the results of which were evaluated on the basis of the intestine macroscopic morphologic aspect; on the basis of the hematic phosphates values and in enteral biopsy. The oxygenation-dialysis produced a rapid improvement in enteral hue and in enteral motility, an important increase of PO2 and a reduction of hematic phosphates compared with the control group. Histologic examination did not show any significant variation. The attempt to increase general oxygenation by supplying PO2 via the peritoneum, was partly successful (10-15%). The aim of oxygenation the ischaemic enteral zone was successful. This due to elimination of CO2 and toxic products using dialysis. This simple method seems to be effective but further tests on swine would be necessary for clinical applications.

Large aneurysm of the superior mesenteric artery.

This report describes a rare case involving a large aneurysm of the superior mesenteric artery (S.M.A.) in a 53-year-old female. Diagnosis was made by X-ray and echography and confirmed by CT-scan and arteriography showing the lesion to be atherosclerotic in origin with several thrombi on the wall of the artery. Resection of the aneurysm and venous reconstruction was performed. Recovery was uneventful. Angiography one month later demonstrated patency of the bypass. At six months the patient is presently asymptomatic.