Substantial understory contribution to the C sink of a European temperate mountain forest landscape.

CONTEXT: The contribution of forest understory to the temperate forest carbon sink is not well known, increasing the uncertainty in C cycling feedbacks on global climate as estimated by Earth System Models. OBJECTIVES: We aimed at quantifying the effect of woody and non-woody understory vegetation on net ecosystem production (NEP) for a forested area of 158 km2 in the European Alps. METHODS: We simulated C dynamics for the period 2000-2014, characterized by above-average temperatures, windstorms and a subsequent bark beetle outbreak for the area, using the regional ecosystem model LandscapeDNDC. RESULTS: In the entire study area, woody and non-woody understory vegetation caused between 16 and 37% higher regional NEP as compared to a bare soil scenario over the 15-year period. The mean annual contribution of the understory to NEP was in the same order of magnitude as the average annual European (EU-25) forest C sink. After wind and bark beetle disturbances, the understory effect was more pronounced, leading to an increase in NEP between 35 and 67% compared to simulations not taking into account these components. CONCLUSIONS: Our findings strongly support the importance of processes related to the understory in the context of the climate change mitigation potential of temperate forest ecosystems. The expected increases in stand replacing disturbances due to climate change call for a better representation of understory vegetation dynamics and its effect on the ecosystem C balance in regional assessments and Earth System Models.

[Prewarming according to the AWMF S3 guidelines on preventing inadvertant perioperative hypothermia 2014 : Retrospective analysis of 7786 patients]. / Vorwärmung entsprechend der "S3 Leitlinie Vermeidung von unbeabsichtigter perioperativer Hypothermie 2014" : Retrospektive Analyse von 7786 Patienten.

BACKGROUND: Inadvertent perioperative hypothermia, which is defined as a core body temperature of less than 36.0 °C, can have serious consequences in surgery patients. These include cardiac complications, increased blood loss, wound infections and postoperative shivering; therefore, the scientific evidence that inadvertent perioperative hypothermia should be avoided is undisputed and several national guidelines have been published summarizing the scientific evidence and recommending specific procedures. The German AWMF guidelines were the first to emphasize the importance of prewarming for surgery patients to avoid inadvertant perioperative hypothermia; however, in contrast to intraoperative warming, prewarming is so far not sufficiently implemented in clinical practice in many hospitals. Furthermore, a recent study has questioned the effectiveness of prewarming. OBJECTIVE: The aim of this retrospective investigation was to evaluate the hypothermia rates that can be achieved when prewarming in the anesthesia induction room is introduced into the clinical practice and performed in addition to intraoperative warming. MATERIAL AND METHODS: The ethics committee of the Medical Faculty of the Martin Luther University Halle Wittenberg gave approval for data storage and retrospective data analysis from the anesthesia database. According to the existing local standard operating procedure, prewarming with forced air was performed in addition to intraoperative warming in the anesthesia induction room in 3899 patients receiving general anesthesia with a duration of 30 min or longer from January 2015 to December 2016. The results were compared with a control group of 3887 patients from July 2012 to August 2014 who received intraoperative warming but were not subjected to prewarming. Tracheal intubation was carried out in all patients and temperature measurements after the induction of anesthesia were performed using esophageal, urinary catheter or intra-arterial temperature probes. RESULTS: The mean duration of prewarming was 25 min in the treatment group. Patients subjected to prewarming showed an intraoperative hypothermia rate of 15.8% and a postoperative hypothermia rate of 5.1%. Patients without prewarming showed an intraoperative hypothermia rate of 30.4% and a postoperative hypothermia rate of 12.4%. This means a 52% reduction of the intraoperative hypothermia rate and a 41% reduction of the postoperative hypothermia rate for patients who received prewarmimg (p < 0.0001). Multivariate logistic regression revealed that the lack of prewarming was independently associated with intraoperative hypothermia with an odds ratio of 2.5 (95% confidence interval CI 2.250-2.841; p < 0.0001) and postoperative hypothermia with an odds ratio of 2.8 (95% CI 2.316-3.277; p < 0.0001). CONCLUSION: Prewarming, as recommended in the AWMF guidelines, resulted in a significant and clinically relevant reduction in the incidence of inadvertent perioperative hypothermia; therefore, prewarming can still be regarded as an effective method to avoid perioperative hypothermia. Hypothermia rates of 15.8% intraoperatively and 5.1% postoperatively can be achieved in clinical practice, when prewarming is performed in addition to intraoperative warming in the anesthesia induction room directly before the start of surgical procedures.

[Implementation of a thermal management concept to prevent perioperative hypothermia : Results of a 6­month period in clinical practice]. / Umsetzung eines Wärmemanagementkonzeptes zur Vermeidung von perioperativer Hypothermie : Ergebnisse eines Sechsmonatszeitraums in der klinischen Praxis.

BACKGROUND: Perioperative hypothermia is defined as a core temperature below 36 °C. The literature shows that perioperative hypothermia is a frequent but potentially preventable complication of the surgical process. The risk of experiencing perioperative hypothermia is inherent for all anesthetized patients, independent of the type of surgery. Unless preventative measures are taken, perioperative hypothermia occurs in 50 to 70 % of all surgical patients. In Germany and Austria the guideline "Preventing inadvertent perioperative hypothermia" has been published. In Wolfsburg we started already in 2012 with a standard operating procedure to prevent perioperative hypothermia in all surgical patients. In two clinical departments we established an additional prewarming-protocol starting prior to induction of anaesthesia on the normal ward on the day of surgery. MATERIAL AND METHODS: For a period of 6 months we analyzed all temperature data of patients having undergone surgery, beginning before the start of general anaesthesia until the end of the operation. RESULTS: In total 3228 patients were enrolled into the study. Prewarming was performed in 1329 patients. In 1902 patients active warming was limited to the intraoperative period. The total rate of hypothermia in all patients was 32.6 %, whereas the rate of hypothermia at the end of the operation was 19.3 %. In the group of patients without prewarming the overall rate was 39.1 vs. 25 % at the end of the operation. In the groups of patients with prewarming the total rates of hypothermia were 25.2 and 24.7 % overall and 14.4 and 12.5 % at the end of the operation. In multifactorial regression it could be shown that patients without prewarming had a 1.8-fold increased risk of perioperative hypothermia compared to patients with intraoperative warming only. CONCLUSION: We conclude that temperature management is a challenge in the clinical situation, and that it is difficult to achieve rates of hypothermia close to zero. The addition of prewarming was very effective in improving the results in our patients.

Wavelength conversion and parametric amplification of optical pulses via quasi-phase-matched four-wave mixing in long-period Bragg silicon waveguides.

We present a theoretical analysis supported by comprehensive numerical simulations of quasi-phase-matched four-wave mixing (FWM) of ultrashort optical pulses that propagate in weakly width-modulated silicon photonic nanowire gratings. Our study reveals that, by properly designing the optical waveguide such that the interacting pulses copropagate with the same group velocity, a conversion efficiency enhancement of more than 15 dB, as compared to a uniform waveguide, can readily be achieved. We also analyze the dependence of the conversion efficiency and FWM gain on the pulse width, time delay, walk-off parameter, and grating modulation depth.

[Quality of OR planning. Avoiding operating room underutilization or overutilization]. / Qualität der OP-Planung. Vermeidung von Unter- oder Uberauslastung des OP-Bereiches.

BACKGROUND: Accurate scheduling of operations is essential for an efficiently used OR. The aim of this investigation was to describe the quality of OR scheduling in the analyzed OR. Furthermore suggestions for avoiding underutilization or overutilization through optimized OR planning should be addressed if possible. METHODS: The planned duration, the real duration and the differences in minutes of 10,831 operations were analyzed. The statistical distribution was determined and the median, the quartiles, the interquartile range and the number of operations with a real duration lasting longer than planned were calculated. All operations were grouped in ascending order from the shortest planned duration. All planning groups were analyzed statistically and the results were compared. RESULTS: The planned OR durations did not show a normal distribution and 34% of all operations showed a real duration lasting longer than planned. The median of the differences was 10 min indicating that 50% of all operations were finished within 10 min earlier than planned. Operations with planned longer durations (>150 min) showed significantly more frequently a real duration lasting longer than planned. Furthermore, the differences between planned and real durations were additionally larger when planned durations were longer than 150 min. CONCLUSION: Prognosis of operations with longer planned duration (>150 min) should be improved in the OR area analyzed. Scheduling of these operations at the beginning of the OR list or with a sufficient time interval towards the end of the appointed OR block time within the OR list can avoid or at least minimize underutilization and overutilization of the OR.

[Operation room management: from degree of utilization to distribution of capacities. Cost reduction without decreasing productivity in the operation room using a new index]. / OP-Management: Vom "Nutzungsgrad-Schnitt-Naht-Zeit" zur OP-Tisch-Verteilung : Kostensenkung ohne Leistungsminderung im OP-Bereich mit einer neuen Kennzahl.

BACKGROUND: The new index "degree of operation room (OR) utilization" describes the ratio between possible and actual OR utilization with purely surgical time. The possible OR utilization with purely surgical time was calculated by eliminating the time necessary for induction and emergence from anaesthesia, the time necessary for surgical measurements directly before the first incision (i.e. skin disinfection) and directly after the last suture (i.e. wound dressing) of an operation from the time an operating room could theoretically be used with purely surgical times (the theoretical block time). The possibility of distributing block time based on the effectiveness of surgeons and to reduce costs by identifying waste of block time was investigated using the "degree of OR utilization" method. METHODS: Using our own anaesthesia data base with an average of 12,000 anaesthetic procedures per annum, the degree of OR utilization and the need for additional block time for each clinic performing operative procedures in the OR centre of the hospital were analyzed. The need for additional block time and the costs for additional OR staff (including anaesthesiologists and nurses) were then calculated in US dollars. RESULTS: After redistribution it was possible to reduce the OR capacities and costs for OR staff (including anaesthesiologists and nurses) by a minimum of 280.142 US dollars per year. CONCLUSIONS: The application of the new index "degree of OR utilization" enables the OR manager to distribute OR capacities to surgeons with effective use of block time. This leads to cost reduction without minimizing surgical productivity or income and therefore to a higher level of OR efficiency.

"Hemosuccus pancreaticus"--primarily ultrasound-guided successful intervention using transcutaneous fibrin glue application and histoacryl injection.

There is a broad spectrum of causes for upper gastrointestinal (GI) bleeding that can be stopped by various approaches. On the basis of the report of an extraordinary case, the favorable minimally invasive approach of applying fibrin glue and histoacryl/lipiodol to the vascular basis of a bleeding pseudoaneurysm leading to "Hemosuccus pancreaticus" as a rare cause of recurrent bleeding in the upper GI tract and dangerous complications in the case of chronic pancreatitis is described. There were recurrent bleeding episodes within the upper GI tract in a 40-year-old female patient. Her medical history was significant for chronic pancreatitis and pseudocyst. Abdominal ultrasound plus duplex ultrasonography revealed a pseudoaneurysm within the tail of the pancreas as the cause of "Hemosuccus pancreaticus". Ultrasound guidance was used to repeatedly apply 2 ml of fibrin glue and 2 x 2 ml of the mixture of lipiodol and histoacryl to the basis of the pseudoaneurysm which led to complete and permanent cessation of the bleeding. Immediate and follow-up control duplex ultrasonographies (up to one year) demonstrated sufficient exclusion of the pseudoaneurysm but a preservation of the lienal artery with no disturbance of the blood perfusion in the splenic parenchyma. In conclusion, this is one of the first reports of the successful cessation of recurrent bleeding into a pseudocyst out of pseudoaneurysm ("Hemosuccus pancreaticus") by an ultrasound-guided transcutaneous fibrin glue and histoacryl/lipiodol application, which 1. is recommended as an alternative but feasible and safe therapeutic tool, 2. can provide sufficient and permanent cessation of bleeding but preserve the perfusion of the natural vessel as an initial step in the possible therapeutic algorithm, and 3. can avoid, in case of success, more invasive approaches such as angiography-guided embolization with coils or implantation of a prosthesis and even open surgical intervention, in particular, in high-risk patients.

Modeling volatile isoprenoid emissions--a story with split ends.

Accurate prediction of plant-generated volatile isoprenoid fluxes is necessary for reliable estimation of atmospheric ozone and aerosol formation potentials. In recent years, significant progress has been made in understanding the environmental and physiological controls on isoprenoid emission and in scaling these emissions to canopy and landscape levels. We summarize recent developments and compare different approaches for simulating volatile isoprenoid emission and scaling up to whole forest canopies with complex architecture. We show that the current developments in modeling volatile isoprenoid emissions are "split-ended" with simultaneous but separated efforts in fine-tuning the empirical emission algorithms and in constructing process-based models. In modeling volatile isoprenoid emissions, simplified leaf-level emission algorithms (Guenther algorithms) are highly successful, particularly after scaling these models up to whole regions, where the influences of different ecosystem types, ontogenetic stages, and variations in environmental conditions on emission rates and dynamics partly cancel out. However, recent experimental evidence indicates important environmental effects yet unconsidered and emphasize, the importance of a highly dynamic plant acclimation in space and time. This suggests that current parameterizations are unlikely to hold in a globally changing and dynamic environment. Therefore, long-term predictions using empirical algorithms are not necessarily reliable. We show that process-based models have large potential to capture the influence of changing environmental conditions, in particular if the leaf models are linked with physiologically based whole-plant models. This combination is also promising in considering the possible feedback impacts of emissions on plant physiological status such as mitigation of thermal and oxidative stresses by volatile isoprenoids. It might be further worth while to incorporate main features of these approaches in regional empirically-based emission estimations thereby merging the "split ends".

Models for forest ecosystem management: a European perspective.

BACKGROUND: Forest management in Europe is committed to sustainability. In the face of climate change and accompanying risks, however, planning in order to achieve this aim becomes increasingly challenging, underlining the need for new and innovative methods. Models potentially integrate a wide range of system knowledge and present scenarios of variables important for any management decision. In the past, however, model development has mainly focused on specific purposes whereas today we are increasingly aware of the need for the whole range of information that can be provided by models. It is therefore assumed helpful to review the various approaches that are available for specific tasks and to discuss how they can be used for future management strategies. SCOPE: Here we develop a concept for the role of models in forest ecosystem management based on historical analyses. Five paradigms of forest management are identified: (1) multiple uses, (2) dominant use, (3) environmentally sensitive multiple uses, (4) full ecosystem approach and (5) eco-regional perspective. An overview of model approaches is given that is dedicated to this purpose and to developments of different kinds of approaches. It is discussed how these models can contribute to goal setting, decision support and development of guidelines for forestry operations. Furthermore, it is shown how scenario analysis, including stand and landscape visualization, can be used to depict alternatives, make long-term consequences of different options transparent, and ease participation of different stakeholder groups and education. CONCLUSIONS: In our opinion, the current challenge of forest ecosystem management in Europe is to integrate system knowledge from different temporal and spatial scales and from various disciplines. For this purpose, using a set of models with different focus that can be selected from a kind of toolbox according to particular needs is more promising than developing one overarching model, covering ecological, production and landscape issues equally well.

Competitive strategies in adult beech and spruce: space-related foliar carbon investment versus carbon gain.

In Central Europe, Fagus sylvatica and Picea abies represent contrasting extremes in foliage type, crown structure and length of growing season. In order to examine the competitive strategies of these two co-occurring species, we tested the following hypotheses: (1) the space occupied by the foliage of sun branches is characterized by greater foliar mass investment compared to shade branches, (2) the carbon (C) gain per unit of occupied space is greater in sun than in shade branches, and (3) annual C and water costs of the foliage for sustaining the occupied space are low, wherever C gain per unit of occupied space is low. These were investigated in a mature forest in Southern Germany. The examination was based on the annual assessment of space-related resource investments and gains of the foliage. The foliated space around branches was regarded as the relevant volume with respect to aboveground resource availability. Occupied crown space per standing foliage mass was higher in shade compared to sun branches of beech, whereas no difference existed in crown volume per foliage mass between sun and shade branches of spruce (hypothesis 1 accepted for beech but rejected for spruce). However, beech occupied more space per foliage mass than spruce. The C gain per occupied crown volume was greater in sun than in shade branches (hypothesis 2 accepted) but did not differ between species. The amount of occupied space per respiratory and transpiratory costs did not differ between species or between sun and shade branches. In beech and spruce, the proportion of foliage investment in the annual C balance of sun and shade branches remained rather stable, whereas respiratory costs distinctly increased in shade foliage. Hence, shade branches were costly structures to occupy space, achieving only low and even negative C balances (rejection of hypothesis 3), which conflicts with the claimed C autonomy of branches. Our findings suggest that competitiveness is determined by the standing foliage mass and the annual branch volume increment rather than annual investments in foliage. Expressing competitiveness in terms of space-related resource investments versus returns, as demonstrated here, has the potential of promoting mechanistic understanding of plant-plant interactions.

The timing of bud burst and its effect on tree growth.

A phenology model for estimating the timings of bud burst--one of the most influential phenological phases for the simulation of tree growth--is presented in this study. The model calculates the timings of the leafing of beech (Fagus sylvatica L.) and oak (Quercus robur L.) and the May shoot of Norway spruce (Picea abies L.) and Scots pine (Pinus sylvestris L.) on the basis of the daily maximum temperature. The data for parameterisation and validation of the model have been taken from 40 climate and 120 phenological stations in southern Germany with time series for temperature and bud burst of up to 30 years. The validation of the phenology module by means of an independent data set showed correlation coefficients for comparisons between observed and simulated values of 54% (beech), 55% (oak), 59% (spruce) and 56% (pine) with mean absolute errors varying from 4.4 days (spruce) to 5.0 days (pine). These results correspond well with the results of other--often more complex--phenology models. After the phenology module had been implemented in the tree-growth model BALANCE, the growth of a mixed forest stand with the former static and the new dynamic timings for the bud burst was simulated. The results of the two simulation runs showed that phenology has to be taken into account when simulating forest growth, particularly in mixed stands.

Comparison of the Cosmed K4 b(2) and the Deltatrac II metabolic cart in measuring resting energy expenditure in adults.

BACKGROUND AND AIMS: The objective of the study was to compare data obtained from the Cosmed K4 b(2) and the Deltatrac II metabolic cart for the purpose of determining the validity of the Cosmed K4 b(2) in measuring resting energy expenditure. METHODS: Nine adult subjects (four male, five female) were measured. Resting energy expenditure was measured in consecutive sessions using the Cosmed K4 b(2), the Deltatrac II metabolic cart separately and the Cosmed K4 b(2) and Deltatrac II metabolic cart simultaneously, performed in random order. Resting energy expenditure (REE) data from both devices were then compared with values obtained from predictive equations. RESULTS: Bland and Altman analysis revealed a mean bias for the four variables, REE, respiratory quotient (RQ), V CO(2), V O(2) between data obtained from Cosmed K4 b(2) and Deltatrac II metabolic cart of 268+/-702 kcal/day, -0.0+/-0.2, 26.4+/-118.2 and 51.6+/-126.5 ml/min, respectively. Corresponding limits of agreement for the same four variables were all large. Also, Bland and Altman analysis revealed a larger mean bias between predicted REE and measured REE using Cosmed K4 b(2) data (-194+/-603 kcal/day) than using Deltatrac metabolic cart data (73+/-197 kcal/day). CONCLUSIONS: Variability between the two devices was very high and a degree of measurement error was detected. Data from the Cosmed K4 b(2) provided variable results on comparison with predicted values, thus, would seem an invalid device for measuring adults.

[Fistula Banding - Success-promoting Approach in Peripheral Steal Syndrome]. / Fisteldrosselung - erfolgversprechendes Konzept bei peripherer Minderperfusion.

AIM: Evaluation of the diagnostic and therapeutic management of peripheral steal syndrome after placement of an autologous arteriovenous (av-) fistula and presentation of treatment results after its surgical correction. METHODS: During a time period from 1994 to 1999, 1 253 av-fistulas for hemodialysis were placed in our surgical department. Twenty-one patients (1.68 %) underwent service operations because of considerable lower perfusion of the hand. In 14 patients the av-fistula was ligated, whereas in 7 patients, a polytetrafluorethylene (PTFE) sleeve was implanted at the venous site for fistula "banding" to diminish blood flow. In addition to the clinical finding, pre-, intra- and postoperative blood flow rates were determined using Duplex ultrasonography. RESULTS: In patients showing flow rates of < 250 ml (carefully disclosed empiric value) ligation was chosen, whereas in cases with distinctly increased flow rates, banding of the arterialized vein was performed (authors' individually selected borderline flow). The extension of the banding was specified according to the intraoperatively determined flow rates. Recurrent steal syndrome was not observed over the entire postoperative observation period of 1-3 years. CONCLUSION: Arterial steal syndrome is a rare complication after placement of an av-fistula. In the majority of cases, surgical therapy is necessary. Pre- and intraoperative analysis of flow rates using Duplex ultrasonography may help to select the appropriate surgical approach and may, thus, determine the success rate of service operation.

Thermoanaerobacter yonseiensis sp. nov., a novel extremely thermophilic, xylose-utilizing bacterium that grows at up to 85 degrees C.

A novel strictly anaerobic, extremely thermophilic, spore-forming and xylose-utilizing bacterium, designated strain KB-1TP (type and patent strain), was isolated from a geothermal hot stream at Sileri on Java island, Indonesia. The cells were rod-shaped, motile and had terminal spores. The newly isolated strain stained gram-positive and the cells occurred singly or in pairs during the exponential growth phase. The temperature optimum for growth was 75 degrees C and growth occurred in the range 50-85 degrees C. The pH range for growth was 4.5-9.0, with an optimum at pH 6.5. Strain KB-1TP grew chemo-organotrophically by fermenting a wide range of substrates such as glucose, fructose, D-xylose, lactose, maltose, sucrose, mannose, galactose, cellobiose, pullulan and soluble starch. Arabinose, xylan, cellulose, olive oil and Tween 80 were not fermented. The predominant fermentation end products after growth on glucose were lactate, acetate, ethanol, CO2 and small amounts of isovaleric acid, butyric acid, propionic acid, 1-pentanol and 2-propanol. Thiosulfate was reduced to H2S. Strain KB-1TP was sensitive to tetracycline, chloramphenicol, penicillin G, neomycin, kanamycin, vancomycin and rifampicin at concentrations of 100 microg ml(-1). No effect was observed with chloramphenicol and neomycin at concentrations of 10 microg ml(-1). This indicates that strain KB-1TP belongs to the bacterial domain. The G+C content of the DNA was 37 mol%. The comparison of the 165 rDNA sequence to that of closely related strains revealed that strain KB-1TP belonged to clostridial cluster V, showing highest sequence identities (92.7%) to members of the genus Thermoanaerobacter. Taking into account the physiological and molecular properties of the new isolate, it is proposed that strain KB-1TP should be classified as a new species of the genus Thermoanaerobacter, designated Thermoanaerobacter yonseiensis. The type strain, KB-1TP, has been deposited in the Korean Federation of Culture Collections (KFCC 11116P) as a patent strain and in the Deutsche Sammlung von Mikroorganismen und Zellkulturen as a type strain (= DSM 13777T).

Diagnostic workup before laparoscopic cholecystectomy--which diagnostic tools should be used?

BACKGROUND/AIMS: A prerequisite for successful laparoscopic cholecystectomy is the exclusion of potential risks such as cholangiolithiasis, anatomical malformations or diseases of the stomach. As there is no general agreement regarding the appropriate preoperative diagnostic workup, we compared different diagnostic methods as to their value in detecting unknown accompanying diseases and complications. METHODOLOGY: Between 9/90 and 8/93, we performed 850 laparoscopic cholecystectomies. The first 700 were included in this study. A prospective comparison was carried out of the diagnostic accuracy of history, physical examination, laboratory tests, upper gastrointestinal endoscopy or barium meal, i.v. cholangiography and abdominal ultrasound. RESULTS: Measurement of the diameter of the common bile duct was found to be a good noninvasive method for diagnosing common bile duct stones (sensitivity 80%, specificity 99%). In combination with the history and the laboratory tests the sensitivity could be improved to 99%. The sensitivity of i.v. cholangiography in detecting common bile duct stones was 80%, the specificity 99.3%. 646/700 patients underwent preoperative endoscopy/barium meal. In 53 (8.2%) patients pathological findings were found, but only in 4 cases (0.6%) they influenced the indication for laparoscopic cholecystectomy. In 1 patient an advanced gastric cancer was diagnosed 6 months after laparoscopic cholecystectomy, the preoperative barium meal did not show any pathological findings. CONCLUSIONS: The results show that routine ultrasonography in combination with history and laboratory tests prior to laparoscopic cholecystectomy can be recommended for detecting common bile duct stones. In patients with 1 or more pathologic finding endoscopic retrograde cholangiopancreatography should be performed preoperatively. A gastroscopy should be done in patients with nonspecific upper abdominal pain, history of peptic ulcer disease and persisting pain after laparoscopic cholecystectomy.

Sequential coil embolization of bilateral internal iliac artery aneurysms prior to endovascular abdominal aortic aneurysm repair.

PURPOSE: To report the endovascular repair of concomitant aneurysms of the abdominal aorta and both internal iliac arteries. CASE REPORT: A 72-year-old man with a 5.5-cm abdominal aortic aneurysm (AAA) extending to the right common iliac artery also presented with separate aneurysms of both internal iliac arteries. The patient refused conventional surgery, so an endovascular strategy was devised. Initially, the iliac aneurysms were sequentially coil embolized, allowing several weeks to elapse between the embolization sessions to encourage collateral development. A bifurcated Talent endograft was inserted successfully 8 months after the initial intervention; no evidence of endoleaks or mesenteric ischemia has been seen over a 1-year follow-up. CONCLUSIONS: This case illustrates the feasibility of inducing collateralization prior to endovascular AAA repair that would jeopardize internal iliac artery circulation bilaterally. Sequential embolization of the internal iliac arteries over several months initiates this response, paving the way for eventual endovascular repair of the primary aortic aneurysm.

Emergency stent-graft repair of a ruptured hepatic artery secondary to local postoperative peritonitis.

PURPOSE: To describe the use of a stent-graft for emergent repair of life-threatening hepatic artery hemorrhage. METHODS AND RESULTS: A 57-year-old man with a 17-year history of myxoid liposarcoma underwent surgery for a recurrent abdominal mass. Multivisceral resection including a Kausch-Whipple procedure with an extended right hemicolectomy was performed. Three weeks later, an episode of gastrointestinal bleeding prompted surgical repair of the hepatic artery, which had been eroded by infection due to a leaking bilioenteric anastomosis. After 3 weeks of programmed abdominal lavage, bleeding recurred. Angiography documented another rupture of the proximal hepatic artery. After an unsuccessful attempt at coil embolization, a Hemobahn stent-graft was implanted percutaneously during simultaneous cardiopulmonary resuscitation. Hemostasis was secured, and the patient recovered. Over the 10-month follow-up, no bleeding or infection has been observed at the site of the repair, and flow through the hepatic artery endograft remains satisfactory. CONCLUSIONS: Percutaneous stent-graft placement can be employed for emergent treatment of visceral artery rupture in patients at high risk for conventional surgical repair.

Alicyclobacillus hesperidum sp. nov. and a related genomic species from solfataric soils of São Miguel in the Azores.

Several acidophilic, slightly thermophilic or thermophilic Gram-positive isolates were recovered from solfataric soil at Furnas on the Island of São Miguel in the Azores. Phylogenetic analysis of the 16S rRNA gene sequence showed that these organisms represented two novel species of the genus Alicyclobacillus. Strains FR-11T and FR-1b had an optimum growth temperature of about 50 degrees C, whereas strains FR-3 and FR-6T had an optimum growth temperature of about 60 degrees C. Biochemical, physiological and chemotaxonomic characteristics did not distinguish isolates FR-3 and FR-6T from the type strain of Alicyclobacillus acidocaldarius; however, strains FR-11T and FR-1b could be easily distinguished from the type strain of Alicyclobacillus acidoterrestris by the carbon source assimilation pattern and the fatty acid composition. On the basis of the phylogenetic analysis, physiological and biochemical characteristics, and fatty acid composition the name Alicyclobacillus hesperidum is proposed for the species represented by strains FR-11T and FR-1b; a formal name for the new genomic species represented by strains FR-3 and FR-6T is not proposed at this time.