PTA and stenting after previous aortoiliac endarterectomy.

OBJECTIVES: to evaluate the feasibility and long-term results of angioplasty and stenting in the treatment of restenosis following aortoiliac endarterectomy. MATERIALS AND METHODS: between 1991 and 1999 19 patients underwent angioplasty with selective stenting for recurrent stenosis after previous aortoiliac endarterectomy. Aortic lesions were treated five times in four patients. At the iliac level 28 lesions (25 stenosis and three occlusions) were treated in 16 patients (one patient had a stenosis at the aortic as well as iliac level). All patients were followed clinically and by ultrasound. In the second half of 1999, an angiogram or spiral CT-angiography was performed in all patients to determine long-term outcome. RESULTS: technical success was obtained in all patients and clinical success was achieved in 18 of the 19 patients. Angiographic cumulative primary patency for aortoiliac lesions was 96% at 1 year and 76% at 3 years. CONCLUSIONS: angioplasty with selective stenting of recurrent aortoiliac disease after previous aortoiliac endarterectomy is feasible and safe. Long-term clinical and angiographic patency rates are in accordance with results of aortoiliac angioplasty in general.

Treatment of ruptured anastomotic aneurysm by endograft.

Ruptured anastomotic aneurysms after aortobifemoral surgery are potentially life threatening. The preferred technique consists of resection of the pseudoaneurysm and interposition of a new graft. We present a case in which an endovascular approach was chosen for treatment of a ruptured femoral false aneurysm. An endograft was inserted and complete exclusion of the pseudoaneurysm was achieved.

Endograft exclusion of residual common iliac artery aneurysms.

PURPOSE: To describe an endovascular approach for residual common iliac artery (CIA) aneurysm. METHODS AND RESULTS: A residual CIA was discovered in a 73-year-old man during routine examination following straight interposition graft placement for a ruptured abdominal aortic aneurysm (AAA). An aortobifemoral bypass was performed with ligation of both aneurysmal iliac arteries. A year later, aneurysms of both CIA stumps were found. On each side, a Hemobahn stent-graft was percutaneously positioned from the external to the internal iliac artery via the superficial femoral artery. Control angiography at 2 months and spiral computed tomographic angiography at 6 and 18 months confirmed exclusion of the aneurysms and patency of the endoprostheses. CONCLUSIONS: Successful endovascular treatment of residual CIA aneurysm is possible with flexible stent-grafts.

Incidence of invasive versus non-invasive carcinoma in comparing palpable and non-palpable solid breast lesions.

A retrospective study was done of all patients with a suspicious mammographic breast lesion surgically biopsied in our institution within the last 5 years. Incidence of invasive versus non-invasive carcinoma and stage at presentation (according to TNM classification system) of palpable and non-palpable lesions were compared. We found a significant difference of non-invasive carcinoma in non-palpable and palpable cancers: 42.2% versus 4.3% (p < 0.001). Patients with a non-palpable invasive carcinoma presenting at stage I (i.e. pT1 with no axillary metastasis) rated significantly higher compared to those with palpable lesions 51.8% versus 9.4% (p < 0.001). The true positive biopsy rate is 30%. As low as 10% has been considered reasonable. We have a total of 56% carcinomas detected on all biopsies: 30% for non-palpable lesions and 66.8% for palpable lesions. A more aggressive approach towards screening and biopsy of breast lesions might increase early detection of carcinoma and so improve survival.

Acute pneumoperitoneum without peritonitis. A case report.

An uncommon case of pneumoperitoneum without peritonitis, related to small bowel diverticulosis is presented. Pneumoperitoneum is usually a life-threatening incident, most frequently attributed to a perforated viscus and generally requiring emergency surgery. Non surgical pneumoperitoneum, however, is known to be caused by a variety of pathological and non pathological entities. Small bowel diverticulosis is an extremely rare cause of chronic pneumoperitoneum without peritonitis. In the presence of mechanical bowel obstruction, the latter kind of pneumoperitoneum can suddenly become impressively increased. A conservative attitude is generally advocated in the presence of such a benign pneumoperitoneum. However, laparoscopic exploration may be helpful for the diagnosis.

Cloning and characterization of the promoter region of the murine alpha-4 integrin subunit.

To study the differential expression of the murine VLA-4 (alpha 4 beta 1) integrin, the 5'-flanking region of the gene for the alpha subunit (alpha 4m) was isolated and a cDNA for alpha 4m was obtained with reverse transcriptase polymerase chain reaction (RT-PCR). The cDNA sequence contained a difference in the signal peptide region compared to the previously described cDNA (Neuhaus et al., 1991). As a consequence, another start codon is predicted, resulting in a decrease in size of the signal peptide. This was confirmed by genomic sequencing. The promoter region was delimited by ribonuclease protection assay (RPA) and transfection experiments fusing 5'-upstream fragments to the luciferase gene. A fragment extending from -936 to +221 was capable of controlling the expected cell-type-specific expression. Sequence comparison of the mouse alpha 4m promoter region with the human alpha 4h promoter revealed little homology. Like most integrin subunits, alpha 4m lacks TATA anc CCAAT boxes. Putative recognition sites for DNA-binding nuclear factors (AP1, AP2, Sp1, and PU1) were identified. The characterization of the promoter region and further identification of the transcription regulatory elements should provide insight in the regulation of alpha 4m integrin gene expression.