Assessment of in vitro growth characteristics of Mycoplasma ovipneumoniae.

Mycoplasma ovipneumoniae (Movp) is an emerging pathogen that causes respiratory disease in small ruminants worldwide. It is considered to be difficult and time consuming to grow, which complicates diagnostic and control measures including isolation (an essential step required prior to the characterisation of strains), antimicrobial susceptibility testing and the development of vaccines. The objectives of this study were to analyse in vitro growth patterns of Movp strains, and the effects of different media used to support their growth. The study was conducted on 20 ovine and caprine Movp strains, isolated using Thiaucourt's medium. The rapid growth phase varied among the strains from 24 h to 72 h, although 60% of strains (12 of 20) reached a peak at 48 h. All strains were viable at 72 h after incubation, and declining viability was observed at 96 h (13 of 20 remained viable; 65%), 120 h (9 of 20; 45%) and 144 h (4 of 20; 20%). Growth was not detected at 168 h. All strains were able to grow in modified tryptone soy broth, while PH mycoplasma medium-Hayflick modified medium supported the growth of only two strains. Improved techniques of Movp cultivation require consideration of the growth variability among strains, the time of subculturing (during the first three days of incubation) and selection of appropriate media.

Mycoplasma ovipneumoniae (Movp) est un agent pathogène émergent qui provoque une maladie respiratoire chez les petits ruminants du monde entier. Sa croissance est lente et jugée difficile à obtenir, ce qui complique le diagnostic et les mesures de lutte, en particulier l'isolement (étape indispensable pour caractériser les souches), le recours aux antibiogrammes et le développement de vaccins. L'étude présentée par les auteurs a pour objectifs d'analyser in vitro les profils de croissance de différentes souches de Movp et d'observer l'effet sur cette croissance des milieux utilisés. L'étude a porté sur 20 souches de Movp provenant d'ovins et de caprins isolées sur milieu de Thiaucourt. La phase de croissance rapide variait de 24 h à 72 h suivant les souches, avec néanmoins un pic de croissance atteint en 48 h pour 12 des 20 souches (soit 60 %). La totalité des souches étaient viables 72 h après l'incubation ; une perte de la viabilité a été observée à 96 h (13 souches sur 20 demeurant viables, soit 65 %), à 120 h (9 souches viables sur 20, soit 45 %) et à 144 h (4 souches viables sur 20, soit 20 %). Aucun signe de croissance n'était détecté à 168 h. L'ensemble des souches ont présenté des signes de croissance sur bouillon tryptone soja modifié, tandis que deux souches seulement ont présenté des signes de croissance sur milieu PH mycoplasma-milieu de Hayflick modifié. L'amélioration des techniques de mise en culture des Movp passe par la prise en compte de la variabilité de la croissance suivant les souches, par un repiquage réalisé au bon moment (dans les trois premiers jours d'incubation) et par le choix approprié du milieu.

Mycoplasma ovipneumoniae (Movp) es un patógeno emergente que afecta a pequeños rumiantes del mundo entero, en los que provoca una enfermedad respiratoria. Su cultivo está considerado difícil y exige tiempo, lo que complica su diagnóstico y las medidas de lucha, en particular el aislamiento (paso previo indispensable para la caracterización de las cepas), la realización de pruebas de sensibilidad a los antimicrobianos y la obtención de vacunas. Los autores describen un estudio encaminado a analizar las modalidades de crecimiento in vitro de cepas de Movp y los efectos del uso de diferentes medios de cultivo, utilizando para ello 20 cepas ovinas y caprinas de Movp aisladas con empleo de medio de Thiaucourt. La fase de crecimiento rápido, variable en función de la cepa, iba de 24 a 72 horas, aunque un 60% de las cepas (12 de 20) alcanzaba el pico de crecimiento a las 48 horas. Todas las cepas eran viables a las 72 horas de incubación. Se observó asimismo que la viabilidad menguaba al cabo de 96 horas (seguían siendo viables 13 de las 20 cepas, un 65%), 120 horas (9 de 20, un 45%) y 144 horas (4 de 20, un 20%). Al cabo de 168 horas no se detectaba crecimiento alguno. Todas las cepas podían crecer en caldo de triptona de soja modificado, mientras que solo dos cepas crecían en un medio PH mycoplasma-medio Hayflick modificado. Para poder perfeccionar las técnicas de cultivo de Movp es preciso tener en cuenta la variabilidad entre las cepas por lo que respecta a las características de crecimiento, así como el tiempo de subcultivo (durante los tres primeros días de incubación) y la selección del medio apropiado.

Expression of Matrix Metalloproteinases and Endogenous Inhibitors in Abdominal Aortic Aneurysm and Aortoiliac Occlusive Disease (Syndrome Leriche).

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play a complex role in the pathogenesis of atherosclerosis. We compared (1) the histopathological findings in patients with abdominal aortic aneurysms (AAA) and aortoiliac occlusive disease (AOD); (2) the expression of MMP-2/MMP-9 and TIMP-1/TIMP-2 in aortic layers, inflammatory cells and smooth muscle cells (SMCs), aiming to identify the common underlying pathogenic mechanisms of the disease development. Samples were obtained from 30 patients with AAA and 30 with AOD. Aortic histology and immunohistochemistry were performed to evaluate inflammatory changes and MMP and TIMP expression. Thrombosis and ulceration were more frequent in AOD than in AAA. The MMP-9 expression was elevated in all aortic layers of AAA patients and in media/adventitia of AOD patients, mainly followed by lower expression of its inhibitor TIMP-1. Higher MMP-9 expression was also found in SMCs and macrophages of both AAA and AOD specimens, while higher TIMP-1/TIMP-2 were predominantly observed in the lymphocytes and macrophages of the aneurysm. These results showed that both conditions exhibited increased MMP-9 expression; however, the MMP expression pattern differed to some degree between the aneurysms and occlusive disease. The variations in molecular mechanisms underlying dilatative/stenosing disease warrant further investigation.

The apparent role of climate change in a recent anthrax outbreak in cattle.

An anthrax outbreak recently occurred in cattle in a region that had previously been free of the disease for more than two decades. This event followed heavy springtime rains that had caused flooding, and a hot, dry summer. These temporally connected events may indicate a new link between climate change and an increased incidence of bacterial diseases with environmental reservoirs.

Récemment, un foyer de fièvre charbonneuse a affecté les bovins d'une région précédemment indemne de cette maladie depuis au moins deux décennies. De fortes précipitations printanières accompagnées d'inondations et suivies d'un été chaud et sec ont précédé cet événement. La relation chronologique entre ces événements semble indiquer un nouveau lien entre le changement climatique et l'incidence en hausse des maladies bactériennes ayant des réservoirs dans l'environnement naturel.

En fechas recientes se produjo un brote de carbunco bacteridiano que afectó al ganado vacuno de una región que hasta entonces llevaba más de dos décadas libre de la enfermedad. Ese episodio ocurrió después de intensas lluvias primaverales, que causaron inundaciones, y de un verano seco y caluroso. Estos fenómenos conectados en el tiempo podrían ser indicativos de la existencia de un nuevo vínculo entre el cambio climático y una mayor incidencia de enfermedades bacterianas que disponen de reservorios en el medio natural.

Surgical treatment of ovarian cancer and early detection of venous thromboembolism.

INTRODUCTION: Deep vein thrombosis (DVT) is present in 10.6% patients after operative treatment for ovarian malignancy. We undertook the present study to find the risk factors for venous thromboembolism (VTE) after surgical treatment for ovarian cancer and to clarify the prognostic value of D-dimer and a positive PTP test (Wells score) in these patients. MATERIAL AND METHODS: A total of 31 consecutive patients with histologically confirmed ovarian cancer after surgery, clinically suspicious for DVT were followed from January 2006 to December 2008. All patients were operatively treated at the Clinical Center of Serbia. Study variables included age, cardiovascular disease, FIGO stage, histology, BMI, presence of massive ascites and tumor size, D-dimer level and Wells score. All patients were postoperatively administered anticoagulant therapy. RESULTS: DVT was found in nine of 31 patients (29.0%). High BMI and presence of massive ascites were significantly associated with DVT. D-dimer (DD) levels were high in 27 of out 31 patients (87.1%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100, 18.2, 33.3 and 100%. Results of the PTP test (according to Wells score) was positive in 20 out of 31 patients (64.5%). PTP score was not significantly different in patients with or without VTE (p = 0.606). Sensitivity, specificity, PPV and NPV were 66.7, 36.4, 30.0 and 72.7%, respectively. CONCLUSION: Incidence of VTE after gynecological operations for ovarian cancer in our study was similar to other investigators. Obesity and the massive ascites are statistically significant risk factors. Measurement of DD level and ultrasonography could become the standard in predicting VTE in ovarian cancer surgery. The use of Wells score is not satisfying in these patients. Prediction of VTE after gynecological surgery needs further confirmation in randomized controlled trials.

Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy.

AIM: Several studies, comparing early and long-term results of the conventional carotid endarterectomy (CEA) and eversion carotid endarterectomy (EEA), were conducted for past 10 years. Nevertheless, it still remaining difficult to choose optimal endarterectomy technique. Choice yet mainly depends of experience of attending surgeon. The aim of this study was the comparison early and long-term results of the EEA and CEA. METHODS: Randomly, 103 patients were operated on in the eversion, and 98 patients in the conventional technique; 97 (48.3%) patients were asymptomatic and 104 (51.7%) had symptomatic lesions. All patients underwent preoperative cervical duplex scanning and neurological examination. The surgical procedure was carried out under general anesthesia. In cases with retrograde blood pressure less than 20 mmHg shunt was used; 78.6% of all CEA were finished up with ''patch'' angioplasty and 21.4% by primary suture. The primary outcomes were perioperative and late mortality, perioperative and late central neurological complications, a long-term survival rate and late restenosis incidence. RESULTS: The mean follow-up was 38 months. Mortality and long-term survival rate were similar in compared groups. The perioperative central neurological complications incidence were comparable in study groups (3.9% vs 12.1% , odds ratio 3.45, 95% confidence interval 1.1-11.1; P=0.029). The late restenosis incidence was significantly lower in eversion group (0.0% vs 6.1%). CONCLUSION: EEA has an advantage over the conventional procedure. The authors recommend CEA in cases when retrograde pressure indicated the use of the intraluminal shunting.

Comparison of phenotypic and genotypic profiles among caprine and ovine Mycoplasma ovipneumoniae strains.

Mycoplasma ovipneumoniae (Movp) is considered to be one of the most important mycoplasmas causing respiratory disease in small ruminants. Most epidemiologic and characterisation studies have been conducted on strains collected from sheep. Information on the presence and characteristics of Movp in healthy and pneumonic goats is limited. Phenotypic or genotypic differences between sheep and goat isolates have never been studied. The objective of our study was to characterise and compare the similarities and differences between caprine and ovine Movp strains isolated from affected and asymptomatic animals in order to elucidate phenotypic and genotypic variability. Four different techniques were used on a set of 23 Movp isolates. These included SDS-PAGE, Western blotting, random amplified polymorphic DNA and the heat shock protein 70 gene sequence-based method. A high degree of phenotypic and genotypic heterogeneity among Movp strains was demonstrated in this study. Our results demonstrated differences between goat and sheep strains, revealing not only a link between strains and host ruminant species, but by geographical origin as well. However, the finding of immunodominant antigens of molecular masses 36, 38, 40 and 70 kDa (±3 kDa) in Movp isolates from sheep and goats foretells their potential use in the development of serological diagnostic tests and vaccines.

Kidney length in healthy members of Balkan endemic nephropathy families.

BACKGROUND: Kidney size may differ between healthy members of Balkan endemic nephropathy (BEN) and non-BEN families. The present study was designed to elucidate this, in comparison with values for BEN patients. METHODS: A total of 71 BEN patients (34 males, 64.4 ± 12.0 years), 74 healthy BEN family members (39 males, 49.1 ± 12.2 years), and 59 non-BEN family members (19 males, 49.2 ± 12.3 years) were involved. We measured the longest craniocaudal length and minimal parenchymal thickness on each kidney of all examined subjects using ultrasound. RESULTS: No significant difference was found between the kidney length of healthy subjects from BEN (11.0 ± 0.8 cm) and non-BEN families (10.9 ± 0.8 cm), but kidneys were significantly longer than in BEN patients (9.9 ± 1.3 cm). Minimal parenchymal thickness was similar in all three groups. When subjects from each group were divided according to estimated glomerular filtration rate (eGFR), kidney length of the healthy groups was significantly longer than in BEN patients both in stage 1 (p =0.039) and stage 2 (p =0.044) of chronic kidney disease. The parental history of BEN was not associated with kidney dimensions, eGFR, or urinary excretion of albumin and alpha1-microglobulin. CONCLUSION: Kidneys of BEN patients were significantly shorter than in healthy members of both BEN and non-BEN families, but no difference was found in kidney length and parenchymal thickness between healthy members of BEN and non-BEN families. No significant association was found between parental history of BEN and kidney size and function either in BEN patients or in healthy members from BEN families. Hippokratia 2015; 19 (4): 304-308.

Selenium deficiency and Balkan endemic nephropathy.

Data on selenium (Se) deficiency in Yugoslavia are summarized. These data include the selenium contents of stream sediments, rocks, soils, cereal crops grown in these soils, and human serum and scalp hair from several towns and regions. Analyses of human tissues in Yugoslavia show very low Se concentrations in both endemic and nonendemic areas. In some regions, including those with endemic villages, selenium contents of grains and human serum and hair are extremely low, approaching those in the low-selenium zone in China. According to the biological function of selenium, a very low intake of selenium may be a fundamental underlying condition that would predispose persons to attack by other agents in the development of Balkan endemic nephropathy.

Selenium research in Serbia, Yugoslavia.

Data on selenium (Se) deficiency in Serbia are presented following 10 years of research. We studied the Se content in ores, stream sediment, soil, cereal crops, and garlic grown in these soils, food, and human serum and hair from 55 communities. Most of the results indicated a serious Se deficiency. In some communities, the Se content of grain, garlic, and human serum and hair approached that of the low-Se belt in China. We assume that an extremely low Se level in the human population could be a risk factor for the development of Balkan nephropathy (BN) and for the very high incidence of urinary tract tumors (UTT) in endemic areas, as well as high mortality rates of malignant diseases. On the other hand, some regions with relatively higher serum Se levels had significantly lower mortality rates of cancer and cardiovascular diseases.

Selenium in soil, grass, and human serum in the Zlatibor mountain area (Serbia): geomedical aspects.

The Zlatibor district in Serbia has lower mortality rates of malignant and cardiovascular diseases (CVD) compared with other regions in Serbia. To better understand the influence of the geochemical environment, we collected and analyzed soil from various bedrocks and the grass growing on them. We also analyzed spring and stream waters, including large water supply accumulations, for major chemical elements and examined the serum of healthy adults in the large area of Zlatibor for selenium (Se) and magnesium (Mg). Our studies included villages, small towns, and the town of Uzice. Our results showed a variable Se content in the soil over different bedrocks. In general, soil in this area has a higher Se content than in other regions of Serbia. The Se content of the grass is influenced by bedrock and soil mineralogy, but mostly by soil pH and the date of collection. For example, in late summer, grass contains twice as much Se than in spring. Mg2+HCO3(-)-type waters occur in the ultramafic massif of Zlatibor in a concentration of 44 to 68 mgMg/L. The serum Se values were higher in the Zlatibor area than in other regions of Serbia (62.6 +/- 14.9 microgSe/L; n = 158). The serum Mg content (22.7 +/- 2.2 mg/L; n = 158) was in the uppermost part of the reference range. Taking into account their biological role, the Se and Mg levels in the human population in the Zlatibor area could influence the lower mortality rates of cancer and CVD in this region compared with other regions in Serbia.

Early surgery and other indicators influencing the outcome of war missile skull base injuries.

BACKGROUND: The aim of this study was to analyze the effect of early surgical management protocol and other important clinical features on the prognosis of patients suffering from war missile skull base injuries. METHODS: Twenty-one patients who suffered from war missile skull base injuries were analyzed in this study. The wounds were mainly caused by shells and/or bullets. Craniotomy represented the standard treatment in all patients. Investigated clinical features included Glasgow Coma Scale score on admission, the mode and the extent of brain injury, time to patient admission to hospital, and the presence of an intracranially retained foreign body. The prognostic importance of complications such as infection, intracranial hemorrhage, cerebrospinal fluid leak, and epileptic seizures was also investigated. RESULTS: The outcome of 21 skull base injuries was as follows: death in seven patients, vegetative state in three, severe disability in two, moderate disability in seven, and good recovery in two patients. The clinical characteristics that implied favorable outcome were: Glasgow Coma Scale score greater than 12, location of injury in the anterior cranial fossa, time to admission shorter than 1 hour, and absence of an intracranially retained foreign body and postoperative complications. The statistical significance of those predictors was at the level of p < 0.001 in all cases. CONCLUSIONS: Although the wounds were associated with a high mortality rate, this study showed that there are major differences in prognosis of patients with war missile skull base injuries with respect to certain presenting clinical features.

Selenium deficiency in Yugoslavia.

Data on selenium (Se) deficiency in Yugoslavia are presented. The results include Se content of soil, cereal crops, and garlic grown in these soils, and human serum and scalp hair from several towns and regions. All data indicate a serious Se deficiency: soil (n = 140), the mean value of 200 +/- 69.6 micrograms/kg Se; wheat, (58) mean = 20.5 +/- 12.4 micrograms/kg; corn, (79) mean = 13.7 +/- 13.6 micrograms/kg; and garlic, (66) mean = 13.7 +/- 17.1 micrograms/kg Se. Analyses of human tissue show a very low Se status of the Yugoslav population: serum, (n = 875) mean = 50.0 +/- 18.0 micrograms/L and scalp hair, (388) mean = 94 +/- 16 micrograms/kg Se. In some regions, Se contents of grain, garlic, and human serum and hair are approaching those in the low-Se belt in China. It is assumed that very low Se status of a human population could be a risk factor in the development of Balkan Endemic Nephropathy (BEN) and in a high incidence of urinary tract tumors (UTT) in endemic areas.

Environmental factors, health-related habits, and serum selenium levels in cancer patients and healthy controls.

Previous studies conducted in Yugoslavia indicated that the concentration of selenium in soil, food items, and serum of the population is very low. The aim of the study was to investigate the possible relationship among environmental, health-related habits, nutrition, and selenium serum levels in cancer patients and the healthy population. The case-control study included a group of cancer patients and a matched group of healthy controls: 57 cancer patients and 41 healthy controls living in Stari Grad (an urban area of Belgrade), as well as 17 cancer patients and 13 healthy controls living in Barajevo (a rural community in the vicinity of Belgrade). The healthy controls were matched to cancer patients in sex and age; they were not blood related. The selenium serum levels were measured by atomic absorption spectrophotometry. Health-related habits and relevant dietary factors ("food frequency" method) that may influence the selenium serum levels were assessed by questionnaires. The differences in average values of selenium serum levels between the cancer patients and healthy controls were not significantly different, but both were below the lowest recorded in referential studies. A significant difference between the values obtained from urban and rural subgroups was noted. The most important factors that influenced the level of selenium included the residence place in the region with selenium deficiency (Barajevo), age, associated chronic diseases, and some dietary factors potentially related to the intake of selenium. The results obtained in this investigation pointed out that use of selenium supplementation in this area should be seriously considered.

Selenium deficiency in Serbia and possible effects on health.

Ten years study of selenium status in stream sediments, rocks, soils, water, cereal crops and food, as well as in the human tissues, has shown a Se deficiency in most parts of this country. Some of the results are presented and discussed, especially in connection with etiology of Balkan nephropathy and high incidence of urinary tract tumors in endemic areas.

Preliminary assay on the antioxidative activity of Maydis stigma extracts.

Antioxidative effects of Maydis stigma methanolic extracts were studied on the level of lipid peroxidation in liposomes, induced by Fe(2+)/ascorbate system and measured spectrophotometrically by the TBA-test. The most significant inhibition of lipid peroxidation was observed when methanolic extracts of fully developed, mature corn silk were applied. The same test, performed after fractionation of the most active extract, showed that most of the activity was concentrated in fractions with moderate lipophilicity, containing phenolic acids, flavonoid aglyca and resembling monosides.

Quantification of allantoin in various Zea mays L. hybrids by RP-HPLC with UV detection.

A RP-HPLC method for quantification of allantoin in silk of fifteen maize hybrids (Zea mays L., Poaceae) was described. Following extraction of the plant material with an acetone-water (7:3, VN) mixture, filtration and dilution, the extracts were analyzed without previous chemical derivatization. Separation and quantification were achieved using an Alltech Econosil C18 column under isocratic conditions at 40 degrees C. The mobile phase flow (20% methanol--80% water with 5 mM sodium laurylsulfate added at pH 2.5, adjusted with 85% orthophosphoric acid; pH of water phase was finally adjusted at 6.0 by addition of triethylamine) was maintained at 1.0 mL/min. Column effluent was monitored at 235 nm. This simple procedure afforded efficient separation and quantification of allantoin in plant material, without interference of polyphenols or other plant constituents of medium to high polarity, or similar UV absorption. Our study revealed that the silk of all investigated maize hybrids could be considered relatively rich in allantoin, covering the concentration range between 215 and 289 mg per 100 g of dry plant material.

Diuretic activity of Maydis stigma extract in rats.

Maydis stigma (corn silk) is a herbal drug reputed for the treatment of urinary ailments in various traditional medicine systems. To determine its influence on urinary volume and the excretion of sodium, potassium and chloride, 5% and 10% decoctions were administered daily to adult male Wistar rats for eight days. The concentration of electrolytes and urea in plasma, the influence of treatment on urinary pH value as well as creatinine clearance were also investigated. Daily oral administration of 5% decoction at the dose of 10 ml/kg led to a significant and acute diuresis in rats, reaching the peak value in the first 24 h of treatment. Over a similar period, application of 10% decoction did not affect urinary excretion of water, but significantly increased the pH value of excreted urine. A significant decrease in sodium and chloride plasma levels was observed in both treated groups. The creatinine clearance was markedly increased after the treatment with both extracts. Our findings indicate that the diuretic effect of 5% aqueous Maydis stigma extract is in accordance with the increase in glomerular filtration rate and inhibition of sodium and chloride tubular reabsorption, caused a by still unidentified intrinsic factor, but not the salt-loading effect.

Pantoprazole versus omeprazole in the treatment of reflux esophagitis.

Pantoprazole is a new proton pump inhibitor with a potent antisecretory activity, well defined pharmacokinetics and safety profile. The aim of this single blind, randomized clinical trial was to compare the efficacy of pantoprazole (PAN) 40 mg/day and omeprazole (OME) 20 mg/day in patients with grade I and II GERD (Savary-Miller classification). A total of 120 patients were included (PAN = 60 and OME = 60). In the per protocol/analysis, healing rates at 4 weeks were 76.3% PAN and 71.2% OME (ns), and at 8 weeks 94.7% PAN and 92.9% OME (ns). In the intention to treat analysis, healing rates at 4 weeks were 75% PAN and 70% OME (ns), and at 8 weeks 90% PAN and 86.6% OME (ns). Both pantoprazole and omeprazole were well tolerated with no serious drug related adverse events. Pantoprazole 40 mg/day was found to be safe and effective therapy comparable to omeprazole 20 mg/day in the short-term treatment for reflux esophagitis (grade I and II).

[Treatment of complications of in situ saphenous by-pass]. / Tratamiento de las complicaciones del "by-pass" safeno "in situ".

The early and late (2-12 months) complications of in situ bypass for 24 patients (limb salvage procedures) were presented. The early complications were: 1. Overlook branches of saphenous vein developed into A-V fistulas which religated (2 patients). 2. Graft occlusions (2 patients). A successful thrombectomy was carried out on one patient, while an above knee amputation was performed on the other patient. 3. A deep venous thrombosis (one being crural, the other femoral) was treated with medication therapy. We recorded late complications: two graft occlusions (after 3 and 6 months) where redo surgery was impossible for distal progression of occlusion disease. The following procedures must be done: per-operative angiography, adequate technique of anastomoses and defects of the femoral vein, postoperative application of medication therapy, observation of patients in the later post-operative period and routine control with Doppler US (1, 3, 6, 12 months).

[Reinterventions for the late failures of femoral-distal grafts]. / Reintervenciones para fallos posteriores de los injertos femorodistales.

In this retrospective study of 195 patients treated for late failure of a previous femoral-distal reconstruction, there were 178 men and 17 women ranging in age from 42 to 79 years. The graft material utilised for initial operation was an autogenous vein reversed saphenous vein (75), in situ (1), and arm veins (4) in 80, polytetrafluoroethylene in 51, Dacron in 46, Biografts in 12 and composite grafts in 6 patients. The previous site for distal anastomosis was above the knee in 79, and tibial or peroneal arteries in 18 cases. The most common cause of graft failure was late thrombosis (95), progression of the underlying disease (64), deterioration of the graft (15), pseudoaneurysms (8), and rarely perigraft reactions, hemodynamic insufficiency, late infection, etc. The aim of the reoperation was: graft extension for distal disease (68) desobstruction and patch angioplasty (21), thrombectomy (9) exchange of the graft (17), local repair of the graft (3). Seventeen patients required inflow procedures. Other reinterventions (sympathectomy, catheterisation and prostaglandin perfusion) were used in patients with no chance for reconstructive arterial surgery. Secondary reoperations were performed in 12, tertiary operations in 7 patients. Major amputations rate, operation mortality, wound morbidity and hemodynamic success rates with limb salvage in reoperated patients support usefulness of repeated revascularisation when femoro-distal bypass failure occurs.