Combined Aorto-Iliac and Anterior Lumbar Spine Reconstruction: A Case Series.

BACKGROUND: Treatment options for aortic-iliac pathology may include endovascular repair and open surgical repair. Treatment options for degenerative disc disease (DDD) are varied but commonly include anterior reconstruction. When both the aortic-iliac and spinal pathologies are significant and surgical intervention is indicated for each pathology, the opportunity exists for concurrent treatment of both the aortic-iliac pathology and DDD in the same operation. The purpose of this case series was to document the safety and feasibility of a surgical strategy whereby a combined elective reconstructive procedure was performed for aortic and anterior lumbar spinal pathologies. METHODS: The case histories of 5 patients who were treated for both spinal and vascular pathology are presented. Surgical outcome measures included operative time, blood loss, length of stay, and complications. Spine-specific outcome measures included Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analogue scores (back and leg). RESULTS: The spinal reconstructions performed included 1 L4-5 total disc replacement (TDR), 1 L4-5, L5-S1 anterior lumbar interbody fusion (ALIF), 1 L5-S1 ALIF, and 2 hybrid procedures (L4-5 TDR with L5-S1 ALIF). Vascular reconstructions included 4 aorto-bi-iliac bypass grafts and 1 aortic tube graft. The average operative time was 365 minutes (ranging between 330 and 510 minutes), the average blood loss was 1699 mL (range between 1160 and 2960 mL), and the average length of hospital stay was 14 days (range from 8 to 22 days). There were no in-hospital complications, and all patients experienced significant improvement in both back and leg pain. One patient developed kinking of the iliac limbs of the vascular graft 1 year postoperatively, which was managed with endovascular stenting of the graft. CONCLUSIONS: Aortic-iliac pathology and DDD are significant pathologies often treated in isolation. This study illustrates that, despite its complexity, highly trained individuals in a specialized setting can perform combined surgery to achieve a satisfactory outcome for the patient. LEVEL OF EVIDENCE: Level IV evidence.

A decadal view of biodiversity informatics: challenges and priorities.

Biodiversity informatics plays a central enabling role in the research community's efforts to address scientific conservation and sustainability issues. Great strides have been made in the past decade establishing a framework for sharing data, where taxonomy and systematics has been perceived as the most prominent discipline involved. To some extent this is inevitable, given the use of species names as the pivot around which information is organised. To address the urgent questions around conservation, land-use, environmental change, sustainability, food security and ecosystem services that are facing Governments worldwide, we need to understand how the ecosystem works. So, we need a systems approach to understanding biodiversity that moves significantly beyond taxonomy and species observations. Such an approach needs to look at the whole system to address species interactions, both with their environment and with other species.It is clear that some barriers to progress are sociological, basically persuading people to use the technological solutions that are already available. This is best addressed by developing more effective systems that deliver immediate benefit to the user, hiding the majority of the technology behind simple user interfaces. An infrastructure should be a space in which activities take place and, as such, should be effectively invisible.This community consultation paper positions the role of biodiversity informatics, for the next decade, presenting the actions needed to link the various biodiversity infrastructures invisibly and to facilitate understanding that can support both business and policy-makers. The community considers the goal in biodiversity informatics to be full integration of the biodiversity research community, including citizens' science, through a commonly-shared, sustainable e-infrastructure across all sub-disciplines that reliably serves science and society alike.

Endoluminal repair of mycotic thoracic aneurysms.

PURPOSE: To report a series of endoluminally repaired mycotic thoracic aneurysms. CASE REPORTS: Four patients with presumed mycotic aneurysms of the thoracic aorta were treated with endovascular grafts owing to overly high risk for open repair. All aneurysms were successfully excluded at the initial intervention. In one case, which required endograft fenestrations for the superior mesenteric and renal arteries, the patient died 53 days after the procedure, following graft migration and occlusion of major branch vessels. The other 3 patients remain alive and well at a mean follow-up of 16 months with no signs of ongoing sepsis. CONCLUSIONS: Endoluminal repair of thoracic mycotic aneurysms is technically feasible and, in association with long-term antibiotics, offers at least temporary protection against imminent rupture.