Use of health-related quality-of-life measurements to estimate individuals' health on screening.

OBJECTIVES: to investigate the utility of assessing Health-Related Quality of Life (HRQoL) in a large group of subjects participating in a screening program for aneurysm and the relationship between HRQoL, diagnosis of aneurysm and related risk factors. METHODS: subjects involved in this screening program were submitted the EQ-5D questionnaire to report their own HRQoL. HRQoL was reported also a second time by the subjects who were diagnosed with aneurysm during screening and who returned for a monitoring follow up visit a few months later. We evaluated compliance with HRQoL data collection and performed multiple regression analyses in order to investigate the possible relationship between demographic and clinical data with HRQoL. RESULTS: 1,633 subjects screened (6.1% diagnosed with aneurysm) and 125 subjects diagnosed with aneurysm and attending a follow-up visit reported their HRQoL. Completion of the EQ-5D questionnaire was well accepted by both physicians and subjects undergoing screening. HRQoL was not significantly different between the screening and followup visits, on adjusting for age and sex. At the screening visit, HRQoL was associated with ASA class, heart condition, BMI and respiratory diseases. No associations were found at the follow-up visit. CONCLUSION: Assessing HRQoL in screening programs is feasible and well accepted and add useful information on health of large numbers of subjects from general population. This could be considered as a routine approach to optimizing the informative role of screening programs in guiding other investigations or interventions.

Endoscopic examination of the nasolacrimal duct in ten horses.

REASONS FOR PERFORMING STUDY: No endoscopic examination of the nasolacrimal duct has been described before. In contrast with other imaging techniques, endoscopy provides a direct inspection of the intralumen and ductal mucosa in standing sedation. OBJECTIVES: To provide a reference against which the endoscopic and clinical features of obstructive nasolacrimal disease in the horse may be compared. METHODS: Endoscopic examination of the nasolacrimal duct was performed in 10 French Thoroughbred bay mares with a 3 mm shaft diameter flexible fibrescope. The duct was divided into 3 zones (1, 2 and 3) from the nostril to the lacrimal sac. RESULTS: Endoscopic examination of the nasolacrimal duct appeared to be quite easy to perform in Zones 1 and 2, while the ease or difficulty of examining Zone 3 depended on the weight and size of the horse for the position of the endoscope in the lacrimal canal. CONCLUSIONS: Endoscopic inspection has provided the possibility of a novel diagnostic approach to conditions of the nasolacrimal duct in horses. POTENTIAL RELEVANCE: Endoscopic examination of the nasolacrimal duct could help to diagnose and treat nasolacrimal diseases by performing sample withdrawal and duct irrigation.

Cross-sectional area of the tendons of the tarsal region in Standardbred trotter horses.

REASONS FOR PERFORMING STUDY: The assessment of a normal range for cross-sectional area (CSA) of tendons in the tarsal region is important in order to use them as reference values in the identification of pathological changes of dimensions. OBJECTIVES: To provide normal reference values for the CSA of the tendons of the tarsus of Standardbred trotter horses (STH) by means of ultrasonography. METHODS: Transverse echographic images of the tendons were obtained at different levels proximodistally; these images were digitised and CSA values (mean ± s.d.) were obtained for each structure. RESULTS: The largest structure corresponded with the lateral digital flexor/caudal tibial tendon complex at Level 1 and the smallest was the medial digital flexor tendon at Level 4. Almost all tendons showed a slight decreasing in their CSA when crossing the tarsus. CONCLUSIONS: The normal CSA values of tendinous structures in the tarsal region of the STH are reported. These data could be used as anatomical references. POTENTIAL RELEVANCE: The establishment of reference values could serve as a tool to discriminate between normal and abnormal dimensions of tarsal tendons in STH. Other horse breeds should need their own reference values.

District-based abdominal aortic aneurysm screening in population aged 65 years and older.

AIM: Screening for abdominal aortic aneurysms (AAAs) has been carried out in an area of Genoa (Italy) for subjects aged 65 years or more to evaluate prevalence of this disease. METHODS: Between March 2007 and September 2009 8234 subjects were screened. Ultrasound examination of the abdominal aorta and the iliac arterial segments was carried out on each subject and all data related to risk factors were collected. RESULTS: Five hundreds-twelve (6.2%) subjects were found to have an AAA: 469 (10.8%) males and 43 (1.1%) females (significant difference, P < 0.01). Based on the aortic diameter, 403 (4.9%), 80 (1.0%) and 29 (0.3%) had an AAA of 3.0-3.9 cm, 4.0-4.9 cm and ≥ 5.0 cm diameter, respectively. With regards to risk factors, family history of cardiovascular disease only resulted more frequent in subjects with AAA than in those without AAA. CONCLUSION: The prevalence of patients with AAA (6.2%) was similar to previously published estimates. Nevertheless, AAA resulted very high in males. This observation is likely due to screening in a city with a very high percentage of elderly subjects. Family predisposition to cardiovascular disease resulted significant risk factor for AAA. Results of our epidemiological study provide evidence of the usefulness of AAA screening thanks to early diagnosis and appropriate treatment of AAA.

Endovascular treatment for ruptured abdominal aortic aneurysm. Review of literature.

UNLABELLED: Endovascular repair (EVAR) has produced increasing interest in the treatment of ruptured abdominal aortic aneurysms (rAAAs). Experiences to support EVAR as first approach for patients with rAAA is drawn from three sources: results of single-centre series, systematic reviews, and population-based studies. In order to validate EVAR, this technique was compared to open repair (OR), considered as the conventional treatment. These studies are heterogeneous, and often failed to demonstrate any significant difference between EVAR and OR. More recently, some population-based studies from the USA suggested advantages of EVAR over OR with regard to 30-day mortality and morbidity. Some bias have influenced the reported RESULTS: Criteria for choice of EVAR varied across the studies according to the policy of the authors. Therefore, any meta-analysis should be interpreted with caution. Patients' conditions have directed the authors towards a technique instead of the other, i.e. pathophysiological factors of the patients, and anatomical conditions of the AAAs. Availability of the required endovascular equipment and trained staff allows EVAR and not always were present. Currently, according to the literature the role of EVAR in the management of rAAAs must to be further checked. Randomized trials could provide the evidence to define adequate indication to EVAR. EVAR could play an important role in the treatment of rAAAs, providing adequate selection of cases suitable for this technique.

Carotid endarterectomy: results of the Italian Vascular Registry.

AIM: The aim of this study was to evaluate the results of carotid endarterectomy (CEA) carried out in centers dedicated to vascular surgery. METHODS: The study was supported by the Italian Registry for Vascular Activity, which collected the data of 89 centers of vascular surgery (almost all of the existing centers in Italy) during 2007. Data were collected for 5962 CEAs. A total of 5,809 patients (153 were operated bilaterally in two staged procedures), 3990 (68.7%) males and 1,819 (31.3%) females, whose ages ranged from 33 to 100 years (mean 72.7+/-7.78) underwent the surgery procedure. Several surgical techniques were used: i.e., standard CEA with direct suture (1477 cases, 24.8%), standard CEA with patch (2242 cases, 37.6%), and eversion technique (2243 cases, 37.6%). RESULTS: Combined perioperative mortality and stroke rate were also evaluated (1.1% [stroke 0.9%, mortality 0.2%]). CONCLUSIONS: These results are very good and are comparable to what has been reported in the literature during the last few years. This observation provides further proof of the effectiveness of CEA in the management of extracranial carotid disease. Moreover, these results have to be taken into account when evaluating any new therapeutic options, such as carotid stenting, before accepting them as valid alternatives.

Rupture of the lateral lobe of the biceps brachii tendon in an Arabian horse.

Rupture of the lateral lobe of the proximal tendon of the biceps brachii muscle was diagnosed in an Arabian horse. To the authors' knowledge, this is the only report of this condition in horses. Although clinical signs were helpful in the identification of the location of disease, ultrasonographic examination was a more definitive and non- invasive means of diagnosing the pathological condition. Bursoscopic examination of the intertubercular bursa was also useful in obtaining confirmation of the diagnosis, and for debridement and lavage of the bursa.

Evaluation of mean echogenicity of tendons and ligaments of the metacarpal region in neonatal foals: A preliminary study.

The aims of this research were to evaluate mean echogenicity (ME) of the deep and superficial digital flexor tendons (DDFT and SDFT), the interosseous muscle (IM), and the accessory ligament of the deep digital flexor tendon (ALDDFT) of the metacarpal region in neonatal foals, and determine the effect of sex, side and body weight on this quantitative ultrasonographic evaluation. Thirteen orthopedically sound neonatal foals were examined. Four areas of study (1A, 1B, 2A, 2B) were identified. Transverse scans of the DDFT, SDFT, IM and ALDDFT were obtained, recorded, and analyzed. The most echogenic structures were the ALDDFT and DDFT, while the SDFT was significantly less echogenic than all other structures (P<0.05). No influence of sex, forelimb, or body weight was observed. The echogenicity of the tenodesmic structures of foals partially overlapped that reported in the metacarpal region in adult horses, except for IM.

Delayed hearing loss after neurovascular decompression.

We report two unusual cases of delayed hearing loss after neurovascular decompression of structures within the cerebellopontine angle. In the first case, the patient noted a unilateral hearing loss 3 weeks after undergoing vascular decompression of the trigeminal nerve for tic douloureux. This gradually improved over an 18-month period. In the second case, the patient awoke on the 4th day after vascular decompression of the facial nerve for hemifacial spasm with a bilateral hearing loss that has remained unchanged after the onset. These are examples of delayed acoustic dysfunction occurring with a shift in surgically freed vessels and may have been induced by newly directed neurovascular compression or distortion.

Research on screening and diagnosis in autism: a work in progress.

In June 1998, the National Institutes of Health Autism Coordinating Committee (NIH/ACC) invited representatives of 13 major medical and other professional academies and associations and six national autism parent research organizations to review research data on screening and diagnosis of autism spectrum disorders. Ten review papers and more than 4,000 publications were consulted in this effort. This paper highlights some promising areas for research identified in this process. One of the highest priorities is the search for the ultimate diagnostic indicator, a biological marker(s), for example, genetic, metabolic, immunologic, neurologic, that will distinguish autism unequivocally from other developmental disabilities. In the interim, research on infant screening and diagnosis might lower the threshold age for diagnosis to 8-12 months. The role of sensory-motor disorders in early diagnosis needs further research. Earlier and better diagnosis of co-occurring, potentially treatable disorders, including epileptic and epileptiform disorders, has implications both for diagnosis and treatment. Pharmacogenetic and pharmacogenomic research strategies could help diagnose subtypes and responders versus nonresponders to potential treatments. Better endpoints and outcome measures are needed, including improved procedures for cognitive and neuropsychological testing, more knowledge about verbal and nonverbal communication milestones, and less invasive and more sensitive neuroimaging measures. Critical questions remain regarding regression after apparently normal development, and about possible environmental precipitants. Finally, field trials of the reliability and validity of screening and diagnosis using the newly developed practice guidelines are needed.

Early and long-term outcomes after open or endovascular repair for abdominal aortic aneurysms in high-risk patients.

AIM: The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met. METHODS: Between January 2005 and January 2010, 593 patients underwent procedures for elective abdominal aortic aneurysm (AAA) repair; 172 of these were considered at high risk according to the American Society of Anesthesiology (ASA) score (ASA III and IV): 150 high-risk patients were males (mean age 72.7, range 53-93 years) and 22 females (mean age 72.9 years, range 60-90 years). The median AAA diameter was 64 (53-75) mm in the open repair group and 62 (55-70) mm in the EVAR group. 121 patients underwent open repair and 51 EVAR, respectively. RESULTS: The 30-day mortality rate was 0% in the EVAR group and 2.4% (3/121) in the open repair group (P=0.26). Long-term results showed: no EVAR-related mortality, no late conversion to open repair in the EVAR group was required during follow-up. No aneurysmal expansion was observed. In the open repair group, no graft-related events were observed during follow-up. The mean follow-up for survival analysis was 1542 days. Overall 5-year survival was 71.7% (SE=4.2%). Survival during follow-up was 92.2%, 86.1%, 76.2%, 65.9% and 61.8% at 12, 24,36,48,60 months respectively in EVAR Group. Open Group present long term survival of 95%, 88.9%, 83.9%, 79.7%, 76% at 12, 24, 36, 48, 60 months respectively. CONCLUSION: Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.

Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study.

AIM: The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. METHODS: Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. RESULT: FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes' count (P<0.02). Carotid metabolism was directly correlated with monocytes' count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). CONCLUSION: The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.

Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient.

The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients.

Cross-sectional area and mean echogenicity of shoulder and elbow tendons in adult German Shepherd dogs.

The aim of this study was to describe the cross-sectional area and mean echogenicity of the main tendons of the shoulder and elbow joints in adult German Shepherd dogs and to determine the effects of sex, weight, and age on these parameters. No previous publications in the veterinary literature have reported information regarding quantitative ultrasonographic tendon measurements in dogs. Thirty German Shepherd dogs were examined: 13 males and 17 females. The cross-sectional area was significantly higher in males than in females (p <0.05) for the distal tendon of the triceps brachii muscle and the tendons of the flexor carpi ulnaris and common digital extensor muscles. The influence of sex on mean echogenicity was not significant. According to age, mean echogenicity was higher in older dogs, while the cross-sectional areas were similar in the two groups. Cross-sectional area and mean echogenicity of the tendons showed a direct increase with an increase in body weight. The data gained from this study can help support the clinician to discriminate between normal and pathological conditions.

Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience.

AIM: This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU). METHODS: Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy. RESULTS: One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture. CONCLUSION: PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.

Treatment of penetrating aortic ulcer by endoprosthesis: a single center experience.

AIM: This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU). METHODS:Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy. RESULTS:One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture. CONCLUSION:PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.