Urgent endovascular treatment of thoraco-abdominal aneurysms using a sandwich technique and chimney grafts--a technical description.

INTRODUCTION: So far the only endovascular option to treat patients with thoraco abdominal aortic aneurysms is the deployment of branched grafts. We describe a technique consisting of the deployment of standard off-the- shelf grafts to treat urgent cases. MATERIAL AND METHODS: The sandwich technique consists of the deployment of ViaBahn chimney grafts in combination with standard thoracic and abdominal aortic stent grafts. The chimney grafts are deployed using a transbrachial and transaxillary access. These coaxial grafts are placed inside the thoracic tube graft. After deployment of the infrarenal bifurcated abdominal graft a bridging stent-a short tube graft is positioned inside the thoracic graft further stabilizing the chimney grafts. RESULTS: 5 patients with symptomatic thoraco abdominal aneurysms were treated. There was one Type I endoleak that resolved after 2 months. In all patients 3 stentgrafts had to be used When possible all visceral and renal branches were revascularized. A total number of 17 arteries were reconnected with covered branches. During follow up we lost one target vessel the right renal artery. CONCLUSION: The sandwich technique in combination with chimney grafts permits a total endovascular exclusion of thoraco abdominal aortic aneurysms. In all cases off-the shelf products and grafts could be used. The number of patients treated so far is still too small to draw further more robust conclusions with regard to long term performance and durability.

Laparoscopic hybrid techniques for ectopic or accessory renal arteries debranching in complex endovascular aneurysm repair.

The aim of this study was to report an assisted or totally laparoscopic approach for renal revascularization in patients with congenital renal vascular anomalies during endovascular abdominal aneurysm repair (EVAR). In three patients with an ectopic main or a large accessory renal artery (>3mm) arising from the aneurysm, laparoscopic exposure of the target renal artery and the ipsilateral iliac bifurcation was performed. In two patients a small incision was made over the area between the iliac bifurcation and the renal target vessel in order to facilitate the anastomotic procedure. In the third patient a totally laparoscopic bypass between a big left inferior renal polar artery and the left common femoral artery was carried out. In all patients the aneurysm was successfully excluded using an endovascular graft. Technical success was achieved in all three patients. The mean total operative time was 126 min (range 110-152 min). The mean hospital length of stay (HLS) was 3.5 days. Renal function of the patients remained unchanged. All bypasses were found to be patent and endoleaks was not observed at 6-month follow-up. Laparoscopic assisted or totally laparoscopic renal revascularization may increase the applicability of EVAR in complex abdominal aortic aneurysms.

Lifestyle, habitat and farmers' risk of exposure to tick bites in an endemic area of tick-borne diseases in Hungary.

Controlling tick bites on farmers is important to the management of tick-borne diseases and occupational health risks in agriculture. Based on an extensive household survey conducted between June and August 2015 with 219 farmers from western Hungary where tick-borne diseases are endemic, we analysed the pattern of farmers' self-reported contacts with ticks and investigated the potential interactions between farmers, landscape and the risk of exposure to tick bites. We developed a lifestyle typology based on farmers' socioeconomic profiles, farming objectives and time use patterns, and a habitat typology describing different configurations of tick habitats and agricultural areas in place of farming. We found no relationship between tick exposure risk and self-prevention. The lifestyle typology could be used to classify the risk of tick bites and the adoption of prevention measures into different levels, the difference between which could further be modified by the habitat typology. Our results suggest that (i) farmers who are frequently engaged in outdoor recreations and (ii) part-time and inexperienced farmers who have lower rate of preventive actions are likely to experience greater exposure to tick bites either in less cultivated, semi-natural habitats or in agricultural landscape with highly diverse land uses. Future disease prevention practices should take into consideration the interaction of lifestyle and habitat and the need to associate different farmer groups with different landscape configurations.

Production and use of monoclonal antibodies to Microsporum canis.

Microsporum canis NCPF 179 and M. canis NCPF 177 dermatophyte cytoplasmic extracts (DCEs) were used as antigens to generate monoclonal antibodies (mAbs). Hybridomas with supernatants of optical density (OD) > 1 for homologous dermatophyte cytoplasmic extracts (CE) and OD < 0.5 for heterologous CE of Candida albicans tested by the enzyme-linked immunosorbent assays (ELISA) were selected for cloning. mAbs secreted by cloned hybridoma lines were screened against CE of M. canis, M. gypseum, M. equinum, M. distortum, Trichophyton verrucosum, C. albicans, Malassezia pachydermatis and Aspergillus fumigatus. The ELISA performed on clone supernatants identified a variety of different activities between the dermatophyte and other fungal CEs. The selected mAbs were used for immunoblotting of native and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) gels. Immunoblots with some of the mAbs tested allowed the differentiation of strains belonging to different dermatophyte species and isolates belonging to the M. canis.

Detection by ELISA of the humoral immune response in rabbits naturally infected with Trichophyton mentagrophytes.

An indirect enzyme linked immunosorbent assay (ELISA) was developed and its diagnostic potential evaluated for rabbits infected by Trichophyton mentagrophytes. Within-run and between-run coefficient of variance varied from 2.3 to 7.7% and from 5.9 to 8.5%, respectively, indicating satisfactory reproducibility of the ELISA. There was no significant cross-reaction with antigens of Microsporum canis, Malassezia pachydermatis and Aspergillus fumigatus. The level of specific IgG to Trichophyton mentagrophytes was measured in sera of 25 11-week-old and 12 younger infected rabbits. There was no significant difference in the IgG level between 12 5-week-old infected rabbits and controls (p = 0.38). The antibody response was higher in 12 7-week-old rabbits compared with controls (p = 0.001). The IgG level in 25 11-week-old rabbits differed from the controls very significantly (p < 0.0001). Increased specific IgG in 11-week-old rabbits exhibited 96% sensitivity and 94% specificity. Predictive values of a positive and a negative test were 96 and 94%, respectively. Western immunoblotting associated three protein bands (21.5, 31, 44 kDa) with Trichophyton mentagrophytes infection.

Chloramphenicol resistance in Staphylococcus intermedius from a single veterinary centre: evidence for plasmid and chromosomal location of the resistance genes.

A total of seven Staphylococcus intermedius cultures isolated from cases of canine pyoderma were investigated for the genetic basis of chloramphenicol resistance (Cmr). All of these S. intermedius isolates mediated Cmr via the expression of the Cm-inactivating enzyme chloramphenicol acetyltransferase (CAT); the respective cat genes were found to be located on small multicopy plasmids of 3.1 to 4.1 kb in four of the seven cultures. The four Cmr plasmids, designated pSCS20-23, differed upon restriction endonuclease mapping. Hybridization experiments identified all of them to belong to the pC221-family of staphylococcal Cmr plasmids. The expression of all four plasmid-encoded cat genes was inducible with chloramphenicol. The remaining three S. intermedius isolates also harboured an inducible cat gene of the pC221-type which, however, was found to be located in the chromosomal DNA. These differences in the subcellular localisation and consequently in the number of cat gene copies per S. intermedius cell had no influence on the MIC values of Cm exhibited by the respective S. intermedius isolates.

The feasibility of hand-assisted laparoscopic aortic bypass using a low transverse incision.

BACKGROUND: Hand-assisted laparoscopy can be used to perform aortoiliac reconstructive procedures. This study aimed to evaluate the safety and feasibility of a hand-assisted aortofemoral bypass in patients with occlusive disease using a low abdominal transverse incision to reduce postoperative respiratory problems. METHODS: In 18 patients, a modified Pfannenstiel incision was performed. A hand-assist device was inserted, and the aorta was exposed using transperitoneal laparoscopy. Tunneling was performed under laparoscopic control. The anastomosis was always performed proximally to the inferior mesenteric artery. In three patients, the proximal anastomosis had to be performed laparoscopically. The indication for surgery was occlusive disease in 16 patients and a combination of an aneurysm and aortoiliac occlusion in 2 patients. RESULTS: Conversion was required in one patient (1/18). In 13 patients (13/18), the total operating time did not exceed 180 min, and 61% of the patients (11/18) could be discharged by postoperative day 5. None of the patients died perioperatively (0/18). Complications were observed in six patients (6/18). Only one of these patients had respiratory problems (1/18). The remaining five patients had local complications such as wound healing problems. The anastomosis was sutured laparoscopically in three patients (3/18). CONCLUSIONS: Hand-assisted laparoscopy can be performed safely using a low transverse abdominal incision. In our experience this laparoscopic access can reduce the incidence of postoperative respiratory problems and incision-related complications.

Humoral and cell-mediated responses to Malassezia pachydermatis in healthy dogs and dogs with Malassezia dermatitis.

The in vitro proliferative responses of peripheral blood mononuclear cells from seven healthy basset hounds exposed to Malassezia pachydermatis antigen (500 micrograms/ml) exceeded (P < 0.05) those of seborrhoeic basset hounds with high populations of M pachydermatis and eight Irish setters with gluten-sensitive enteropathy. The stimulation indices in the latter two groups and in eight healthy beagles were comparable. The stimulation indices of the four groups after exposure to phytohaemaglutinin did not differ significantly. The serum titres of M pachydermatis-specific IgG and IgA measured by enzyme-linked immunosorbent assays (ELISA) in 21 seborrhoeic basset hounds and 11 affected dogs of various breeds exceeded those of 14 healthy basset hounds and eight healthy beagles (P < 0.01 for IgG, P < 0.05 for IgA). Total serum IgA concentrations measured by ELISA in the affected dogs were not lower than those of healthy dogs.

Leporacarus gibbus and Spilopsyllus cuniculi infestation in a pet rabbit.

A one-year-old male, chequered giant rabbit had a simultaneous infestation with both Leporacarus gibbus and Spilopsyllus cuniculi. Recurrent episodes of mild to severe pruritus had been noted over a period of two months. On clinical examination, partial alopecia and slightly erythematous skin with flea faeces was evident, although microscopic and cultural examinations of skin scrapings were negative for fungi. Parasitological examination, including adhesive tape strips of the rabbit's skin and fur, revealed L gibbus surface dwelling mites and the rabbit flea S cuniculi. The rabbit was successfully treated against both parasites with topical pyrethrin applied three times over a three-week period, and the clinical signs resolved in four weeks.

[Digestive hemorrhage as a complication of a pancreatic pseudocyst]. / L'emorragia digestiva quale complicanza di una pseudo-cisti pancreatica.

A study was made at the Padua University Second Surgical Clinic--located in Verona--on four cases of digestive haemorrhage in patients with pancreatic pseudo-cysts. The psysiopatological, diagnostic and therapeutic problems inherent in this pathology are discussed. In particular, attention is drawn to the need for and difficulty of marking a correct diagnosis in good time, and the utility, for such purpose, of endoscopic examinations and selective arteriography of the coeliac tripod and the superior mesenteric artery. Lastly, the various possibilities that surgery offers in the treatment of this disease are mentioned.

[Synovial metaplasia around breast implants]. / Synoviální metaplazie kolem mamárních implantátu.

Three cases of the periprosthetic breast capsules showing typical features of synovial metaplasia are presented. The histological picture is characterized by the presence of cellular layer mimicking synovial membrane. These elements are devoid of basement membrane, otherwise, nevertheless, they strongly resemble single- or multilayered epithelium. Focally, the differentiation towards giant multinucleated cells is noted. Immunohistochemical profile, as well as the ultrastructure of the cells, confirms their histiocytic origin with advanced differentiation towards elements of the synovial membrane. These histological features are referred to as synovial or synovial-like metaplasia. They are found in considerable fraction of textured breast implant capsules. The pathogenesis remains uncertain; however, similar picture was observed in other locations in association with prolonged or repeated action of mechanical forces. Thus, movement of the implant in situ is the most probable trigger of synovial metaplasia.

[Cavernous lymphangioma]. / Kavernózní lymfangiom.

The authors discuss an extensive cavernous lymphangioma in a two-year-old girl. The lymphangioma was in the left half of the trunk. It was was revealed in the intrauterine stage by ultrasonography, confirmed on histological examination and almost entirely successfully removed by surgical operation.

[The brachial flap in reconstructive surgery]. / Pazní lalok v rekonstrukcní chirurgii.

Radical treatment of tumours in the region of the shoulder joint is a problem. For reconstruction we can use local shifts, microsurgical methods and free skin transplants, unless the surgical operation involves resection of the skeleton. Less frequently a brachial flap is used, calling for amputation of the upper extremity to use the soft tissues of the arm. In the described patient a radical approach to a tumour in the area of the left shoulder with the use of a total brachial flap was involved. The authors draw attention to the importance of the surgical decision to apply this mutilating operation where it is necessary to take into account the clinical finding, subjective complaints as well as possibilities of reconstructive surgery.

First clinical use of a novel neurovascular access and neuroprotection system demonstrates complete absence of emboli by transcranial Doppler during carotid artery stenting.

This article focuses on the first use of the MICHI™ Neuroprotection System in a transcervical carotid artery stenting procedure. The patient presented with an asymptomatic, 80% stenosis of the right internal carotid artery extending into the common carotid artery. The lesion was successfully treated with transcervical carotid access and reverse flow embolic protection and the successful placement of a carotid stent followed by balloon post-dilatation. Transcranial Doppler monitoring was performed throughout the procedure and a total of two micro embolic signals were recorded over the 30 minute procedural period. There were no neurologic complications reported during the 30-day follow-up period.