Transealing: a novel and simple technique for embolization of type 2 endoleaks through direct sac access from the distal stent-graft landing zone.

OBJECTIVE: Type 2 endoleak (T2EL) is the Achilles' heel of endovascular abdominal aortic aneurysm repair. Experience with transealing, an alternative technique for the treatment of T2ELs, is described. METHODS: The outcome of a group of patients treated with transealing has been reviewed. Femoral access was obtained with a 9-Fr sheath. A super-stiff guide wire and a stiff hydrophilic wire were placed inside the stent-graft and a Piton GC catheter inserted. The stiff hydrophilic wire was retrieved to allow the catheter to regain its curvature and the catheter tip was placed against the iliac wall, at the edge of the stent-graft. The hydrophilic wire was then forced between the stent-graft and arterial wall into the sac. A 5/6-Fr introducer was inserted inside the sac and angiography was performed to evaluate the leak. Coils, cyanoacrylate, or fibrin glue were deployed. After removal of the catheters, the iliac limb was ballooned. RESULTS: Seventeen patients were treated between February 2009 and April 2013. It was possible to access the aneurysm in 16/17 attempts. One patient treated with acrylic glue suffered from colon ischemia. One intraoperative secondary type 1b endoleak was treated with an iliac extension. Mean follow-up was 21.5 months. Three months of follow-up were completed in 14 patients with a 53% freedom from endoleak rate. At 1 year, the rate was 45%. During the study period, there was one surgical conversion, one aneurysm growth, and one re-embolization procedure. The remaining leaks remained stable. CONCLUSIONS: This study shows that transealing is feasible and represents a valid alternative in selected patients. The advantages of this technique are mainly its low invasiveness, reduced costs, and ease of use.

Structure of a ribulose 5-phosphate 3-epimerase from Plasmodium falciparum.

The crystal structure of Pfal009167AAA, a putative ribulose 5-phosphate 3-epimerase (PfalRPE) from Plasmodium falciparum, has been determined to 2 A resolution. RPE represents an exciting potential drug target for developing antimalarials because it is involved in the shikimate and the pentose phosphate pathways. The structure is a classic TIM-barrel fold. A coordinated Zn ion and a bound sulfate ion in the active site of the enzyme allow for a greater understanding of the mechanism of action of this enzyme. This structure is solved in the framework of the Structural Genomics of Pathogenic Protozoa (SGPP) consortium.

Dissimilar behavior of lymph cells in response to the action of aluminium. In vitro and in vivo studies.

In order to detect possible immunological effects of aluminum (Al) on lymph cells, mice were orally overloaded with pharmacological doses for 22 weeks. The in vitro response of lymph cells to mitogens (phytohemmaglutinin, PHA and concanavaline A, Con A) was examined at the end of the treatment. The chronic ingestion of Al affected the lymphatic nodes that were found to be 2- to 10-fold larger than those of the control mice. Concurrently, the in vitro proliferation of lymphatic node cells was found enhanced, while spleen cell cultures were unaffected. An acute direct action of Al on lymph cells from different sources was also examined. The blastogenic response to PHA of human peripheral lymphocytes was not disturbed by the presence of Al concentrations ranging from 0.09 to 900 microM. However, the response of mouse lymph cells was quite different, given that an Al dose-dependent inhibition was observed for lymphatic node cells, whereas for spleen cells the inhibition was only detected at Al concentrations higher than 90 microM. This work shows that Al might induce alterations in cell immune responses. The opposite results observed in mouse lymphatic node cells after in vitro and in vivo Al treatment, let us suggest that either the stimulating or suppressing effects of Al on the immune system might depend on the dose, route of administration and length of exposure, as well as on the cell population assayed.

Cervical cerclage for malformed uterus.

The role of cervical cerclage was evaluated in six pregnant women with anomalous uterus. Early prophylactic cerclage according to the Shirodkar and McDonald technique was done on all cases of uterine malformation (except septate uterus) with or without cervical incompetence in association with progesterone and antispastic therapy. Improvement in obstetrical outcome was noted after cerclage. Even if no doubt exists as to the need for cerclage in cases of cervical incompetence, the concept of routine prophylactic cerclage in all cases of uterine anomalies should be considered.

Microinvasive carcinoma of the uterine cervix. Diagnostic and therapeutic dilemma.

Squamous microcarcinomas of the uterine cervix represent a focus of controversy regarding a useful clinical definition. The confusion of terminology and numerous pathological definitions have led to a great variety of surgical treatments from the cone to the radical hysterectomy, with pelvic adenectomy. This report analyses retrospectively 133 cases of Stage IA cervical cancers which have been followed up for 10-240 months. The purpose of this work is to seek a uniform therapeutical approach to cervical microcarcinoma with the review of International Literature.

Two cases of ovarian cysts in postmenopausal patients under antiestrogen treatment.

In 20% of premenopausal breast cancer women on Tamoxifen (TAM) treatment there is an ovarian enlargement: in literature one case of acutely cystic ovaries is described. We observed 2 cases of acutely cystic ovaries in postmenopausal women surgically treated during a long-term adjuvant therapy with TAM.

Leiomyomas in patients receiving Tamoxifen.

In literature there have been only 8 cases of unavoidable laparotomy due to uterine leiomyomas performed in patients with breast cancer on Tamoxifen (TAM). Our article describes two cases of rapidly growing leiomyomas in patients treated with TAM: one of these underwent abdominal hysterectomy while the second stopped taking TAM and began therapy with Triptorelin. This therapeutical alternative could be a useful choice.

Endometrial carcinoma in breast cancer patients treated with tamoxifen. Two case report and review of the literature.

Recent reports suggest an increased incidence of endometrial cancer in breast cancer patients under long-term adjuvant tamoxifen (TAM) treatment. The Authors describe two cases of endometrial adenocarcinoma among 80 post-menopausal patients affected with breast cancer and treated with TAM.

Advanced primary squamous carcinoma of the vagina treated with carboplatinum (JM 8). A case report.

Primary cancer of the vagina is one of the rarest malignant neoplasms: radiotherapy is the most frequently used treatment and local recurrences remain a constant problem. We describe a case of invasive squamous carcinoma of the vagina submitted to neoadjuvant therapy with carboplatinum. Pathological findings after surgery were completely negative for cancer.

[New aspects concerning the corpus luteum]. / Nuovi aspetti riguardanti il corpo luteo.

We have summed up current knowledge about the formation and lysis of corpus luteum with the co-ordinate intervention of luteotrophic and luteolytic factors. Then we re-examined the function of the corpus luteum in the physiologic menstrual cycle and in the first period of pregnancy, with special attention to luteal insufficiency as a cause of endocrine miscarriage.

[Transcervical vs. transabdominal amniocentesis in the bacterial evaluation of the amniotic fluid]. / L'amniocentesi per via trans-cervicale versus l'amniocentesi per via trans-addominale nella valutazione batteriologica del liquido amniotico.

The authors compare the results of bacteriological research on amniotic fluid by transcervical and trans-abdominal amniocentesis. Eighty women at term of their pregnancy, scheduled for cesarean section, underwent a bacteriological vaginal test and a trans-cervical amniocentesis before and a trans-abdominal amniocentesis during cesarean section. The results obtained from both specimens of the amniotic fluid were the same in 90% of the cases. A negative bacteriological result of trans-cervical amniocentesis excluded a positive result of trans-abdominal amniocentesis. Instead, when a positive bacteriological result was obtained in trans-cervical amniocentesis, trans-abdominal amniocentesis gave a positive result in only 60% of the cases. We conclude that trans-cervical amniocentesis, besides being less dangerous, easy to perform and easily repeated, is sufficiently secure and reliable in bacteriological results as compared with trans-abdominal amniocentesis.

Immunomodulatory activity of plasmatic substances.

In order to study circulating substances which could be involved in uremic immunodeficiency, the activity of plasma and plasmatic fractions of different molecular weight MW (A and B) from 12 patients with chronic renal failure (CRF) and 12 normal subjects (N) was assayed in vitro on PHA stimulated normal lymphocyte cultures. Plasma from CRF patients inhibited lymphoproliferation compared to normal plasma activity (mean +/- SD: 9,990 +/- 3,980 cpm vs. 22,163 +/- 3,054 cpm; p < 0.001). Nevertheless, the corresponding plasmatic fractions failed to induce similar effects. Both normal fractions showed inhibitory effects on proliferation while most of the CRF fractions allowed greater cellular proliferation than the former. The dose-response curves showed that all the normal fractions contained inhibitor(s) whose effect decreased with increasing dilution. Most of the B normal fractions also produced stimulatory effects when they were diluted between 1:5 and 1:25. Variable dose-response curves were obtained in the presence of CRF fractions. However, the lack of inhibitory activity in 9 of 12 patients and the stimulatory effects produced by several A-CRF fractions suggest qualitative differences between CRF and normal fractions. Present findings demonstrate inhibitory and stimulatory activities in the normal fractions which might be due to immunomodulator substances. Disorders in this immunomodulator system could be responsible for the immunodeficiency described in CRF patients.