Complicated acute type B dissections: a single-center experience with endovascular treatment.

BACKGROUND: Complicated acute type B dissections treated surgically carry a high risk of mortality. Endovascular interventions with stent-graft prostheses are a less invasive alternative and may obviate the need for surgery in most cases. We report here on our five years' experience with endovascular stenting in complicated acute type B dissections. PATIENTS AND METHODS: Between March 2001 and January 2006, 32 patients (27 males, 5 females) with a mean age of 61.4+/-11.32 years (range 29-80) underwent stent grafting for complicated acute type B dissections. Indications were progression of dissection with impending rupture (n=10), uncontrollable hypertension (n=9), intractable thoracic pain (n=7), and malperfusion syndrome (n=6). Talent-Medtronic (n=34) and Excluder-Gore (n=3) stent-grafts were used. In 5 patients two stents were necessary. In addition to stent grafting, aortic fenestration was performed in all three cases with lower limb ischemia. RESULTS: Endovascular stent placement was successful in all patients. Hospital mortality was 9.3% (3/32). No deaths occurred during follow-up (mean 32 months). CONCLUSION: Endovascular stenting of complicated acute type B dissections represents a safe alternative to surgery. Endovascular stent-grafts of appropriate sizes should be readily available in the hospital for emergency use, thus avoiding delays in treatment.

Long-term outcome of successful percutaneous transluminal angioplasty of the fibular artery in diabetic foot syndrome and single-vessel calf perfusion depends on doppler wave pattern at the forefoot.

BACKGROUND: In the diabetic foot syndrome (DFS) due to peripheral artery disease, the fibular artery is often the only vessel which can be revascularised. Because the fibular artery does not have a direct connection to the plantar arch, the clinical result of fibular artery PTA is dependent upon the extent of collateralization at the ankle. Therefore, successful PTA of the fibular artery with resulting biphasic doppler waves at the ankle can lead to either biphasic or monophasic post-occlusive doppler wave patterns at the forefoot. We evaluated prospectively the association of the forefoot doppler wave form on long-term clinical outcome in patients with DFS after successful PTA of the fibular artery. PATIENTS AND METHODS: 44 patients with occluded calf vessels and DFS Wagner 2-4 underwent primary successful fibular artery PTA resulting in biphasic ankle doppler wave. According to doppler wave form at the forefoot, patients were divided into 1) a biphasic or 2) a monophasic group. Up to 45 months, we documented doppler wave forms, clinical course, restenosis, reinterventions, wound healing, major- and minor amputations. RESULTS: PTA resulted in a biphasic doppler wave at the forefoot in 26 (59 %), in 18 (41 %) in a monophasic wave pattern. Biphasic forefoot doppler wave was strongly correlated with longer event-free survival (35 bi- vs. 5.5 months monophasic, p = 0.0018) and complete wound healing (69 % s bi- vs. 44 % vs. monophasic p = 0.0309). Major amputations: 2 / 26 (8 %) in the biphasic and in 3 / 18 (17 %) in the monophasic group. Second revascularisation procedures were more often necessary in the monophasic group (7 / 18 (39 % vs. 2 / 26 (8 %)). CONCLUSION: After successful PTA of the fibular artery, monophasic doppler wave patterns at the forefoot denote insufficient collateralization and are associated with poor outcome. If successful fibular artery PTA results only in monophasic forefoot doppler, additional crural or pedal bypass should be strongly contemplated.

Epidemiological study of canine trypanosomosis in an urban area of Ivory Coast.

Following confirmed cases of trypanosomosis in military working dogs, a cross-sectional study was undertaken to evaluate the source of infection and determine the prevalence of canine infection with Trypanosoma congolense in the urban focus of Abidjan, Ivory Coast. Blood from 123 dogs were collected and subjected to PCR using specific primers for Trypanosoma congolense "forest type". In addition, an entomological study was conducted in an urban area near the forest surronding the military camp. The observed prevalence was 30.1% and PCR positivity to Trypanosoma congolense was not significantly associated with sex or age of animals. This study demonstrates the high contamination rate of dogs in enzootic zones, the potential risk of introduction of the disease in free animal populations and the ability of Glossina palpalis to adapt to urban areas and to transmit trypanosomosis in such areas. The factors leading to a possible emergence of canine trypanosomiasis in enzootic zones need further investigations.

[How to recognize POAD? The diagnosis of peripheral occlusive arterial disease in the physician's office]. / Diagnostik der arteriellen Verschlusskrankheit: Mit Stethoskop, Doppler und Laufband der pAVK auf den Fersen.

Peripheral occlusive arterial disease (POAD) encompasses all stenotic and occlusive changes affecting the aorta and arteries supplying the extremities, and in 90% of the cases is due to atherosclerosis. In the majority of patients the lower extremities are involved, andonly every third patient has symptoms. Apart from its significance as an independent disease entity, POAD is also an important coincidence marker, in particular for coronary heart disease. For the diagnostic clarification of POAD, a stepped strategy is recommended, including clinical function testing, such as an exercise treadmill test. Doppler sonography and determination of the Doppler pressure index (ankle-brachial index) make possible a noninvasive accurate staging. Color-coded duplex sonography and imaging procedures provide further information, and are indispensable for establishing the indication for interventional measures.

Characteristics of fatal gunshot wounds in the home in Oklahoma: 1982-1983.

Children are a unique group at risk of injury from firearms because of their immaturity, curiosity, and imitative behavior. All unintentional firearm deaths in persons younger than age 20 years that occurred in Oklahoma in 1982 and 1983 were reviewed. There were 32 unintentional deaths from firearms in children from birth to age 19 years. The death rate in rural counties was four times that of urban counties. Twenty-seven deaths (85%) occurred at home, with an adult present in only two cases. The home death rate for males was 5.2 times that of females, with 15- to 19-year-old males most at risk. The rates among whites and Native Americans were similar, at 1.5 and 1.2 per 100,000, respectively, with no deaths among the black population. This review concurs with previous studies that firearms are a significant cause of mortality in the pediatric age group. Counseling parents about the hazards of firearms may prevent deaths through better supervision and more responsible gun care and storage.

Effects of dimerized lysozyme (KLP-602) on the cellular and humoral defence mechanisms in sheatfish (Silurus glanis): in vitro and in vivo study.

This study examined the effects of the dimerized lysozyme (KLP-602) on the immunocompetence cell activity in sheatfish (Silurus glanis) and its influence in vivo on the non-specific defence mechanisms and protection against motile aeromonad septicaemia (MAS). The in vitro study showed that the lysozyme dimer (KLP-602), at concentrations between 5 and 50 micrograms/mL of medium significantly (P < 0.05) increased the respiratory burst activity and potential killing activity of pronephric macrophages, as well as the proliferative ability of pronephric lymphocytes stimulated by ConA and LPS. The in vivo study showed that injecting lysozyme dimer (Lydium-KLP) intraperitoneally at doses of 50 micrograms/kg bw stimulated cell-mediated and humoral-mediated imunity. On day 5, after application of Lydium-KLP in vivo, a statistically higher (P < 0.05) respiratory burst activity and potential killing activity of blood and pronephros phagocytes were observed. A higher proliferative ability of blood and pronephros lymphocytes stimulated by Concanavaline A (ConA) or lipopolysaccharide (LPS) was also observed. At the same time, the myeloperoxidase activity in the PMN cells and the lysozyme activity and total Ig levels in serum were significantly higher (P < 0.05), compared to the control group. A challenge test with Aeromonas hydrophila showed that dimerized lysozyme increased the protection against MAS. Dimerized lysozyme stimulates non-specific cellular and humoral mechanisms and protection against MAS in sheatfish.

The application of magnetization transfer to MR angiography with reduced total power.

Magnetization transfer (MT) techniques have been shown to significantly reduce background soft-tissue signal in time-of-flight magnetic resonance angiography. To achieve sufficient suppression, radio frequency (RF) pulses with tip angles on the order of 1000 degrees are typically used, resulting in significant RF power deposition in the patient. Although these power deposition levels do not exceed the FDA guidelines, they are significantly higher than those used in typical imaging techniques. The use of these same magnetization transfer pulses in applications at field strengths higher than 1.5 T will require MT power levels which exceed FDA safety standards. This report demonstrates that the total power deposition required to achieve background tissue suppression can be significantly reduced by the application of the saturation pulses only during the phase-encoding steps corresponding to the central portion of "k space." This technique allows equivalent soft tissue suppression with approximately 10% of the energy deposition of conventional magnetization transfer techniques.