Juxtarenal aortic aneurysms: preliminary experience with fenestrated E-vita abdominal stent-graft.

Endovascular aneurysm repair (EVAR) offers a minimally invasive treatment to patients with improved short-term and similar mid-term results compared to conventional, open repair. Approximately 20% of patients have an aneurysm neck morphology inadequate for a standard stent-graft and requires an endograft to cross vital aortic side branches to achieve a seal. This work describes the promising single center preliminary results in the management of juxtarenal aortic aneurysm using E-vita stent-graft.

Double renal chimney graft using only femoral approach.

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment that can be offered to most patients with an aortic aneurysm. Patients who are rejected from standard EVAR often have more extensive aortic pathology and more medical comorbidities. The advent of fenestrated and branched stent grafts gives us an opportunity to treat the most demanding aortic aneurysms endovascularly. Fenestrated stent-grafts, however, are costly and time-consuming to manufacture, which limits their applicability, especially in the emergency setting. The chimney graft is a stent placed parallel to the aortic stent-graft to preserve flow to a vital aortic branch that was overstented to obtain an adequate seal. The technique can be used as a planned operation but also as a rescue procedure to salvage a side branch unintentionally covered during EVAR. As visceral branches of the aorta are usually directed caudally these vessels are, therefore, preferably catheterized from a brachial approach. We describe a case of a successful positioning of the chimney graft using only the femoral approach. The only femoral approach to position a renal chimney graft isn't recommended for the routine procedure but it is proved to be useful in selected case and when other treatment options are excluded.

Prevalence, species differentiation, and toxigenicity of Aeromonas strains in cases of childhood gastroenteritis and in controls.

In a 1-year period (January to December 1984), Aeromonas strains were isolated from feces of 21 of 561 (3.7%) children with gastroenteritis and from 12 of 576 (2.1%) children without intestinal disturbances (controls). The difference between the two isolation rates was not significant (X2 = 2.2; P greater than 0.05). In five cases of illness other intestinal pathogens were isolated together with Aeromonas in the same stool sample. A total of 39 Aeromonas strains were detected since in some cases aeromonads with different biochemical characteristics were obtained from the same stool sample. Of the 39 Aeromonas isolates, 6 strains (5 from patients) were Aeromonas hydrophila, 5 strains (3 from patients) were Aeromonas sobria, and 26 strains (18 from patients) were Aeromonas caviae; 2 strains isolated from controls did not ferment sucrose and were considered a distinct group of Aeromonas. We found no significant difference between the prevalence of each of these species from patients and the prevalence from controls. We found no significant difference in the prevalence of enterotoxin-producing strains (suckling mouse model), cytotoxin-producing strains (HEp-2 cell model), or hemolysin-producing strains (rabbit erythrocyte model) between patients and controls. In our geographical region there is no evidence that Aeromonas species are primary intestinal pathogens in children.