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- Incidence and relevance of groin incisional complications following aortobifemoral bypass grafting. [JOURNAL ARTICLE]
- Ann Vasc Surg 2014 Jul 7.
Aortobifemoral bypass (ABFB) for aortoiliac occlusive disease (AIOD) is traditionally accompanied by substantial groin incisional morbidity, which poses a threat to an underlying prosthetic graft. We performed a study to investigate the frequency and define the clinical course and significance of such problems.One hundred twenty consecutive patients undergoing primary, elective ABFB for AIOD were enrolled in a prospective study. The healing of groin wounds was systematically assessed, the occurrence of incisional complications of any type noted and their clinical course and economic consequences documented and analyzed.Early postoperative complications (30 days) affected 35 groin wounds (15%) in 29 patients (24.8%). Lymph fistulas/lymphoceles were observed in 15 (6.4%), infection in 11 (4.7%) and noninfectious wound dehiscence in 9 (3.8%) of groin incisions. The only significant predictor of groin healing impairment was preoperative length of stay. Groin incision-related morbidity significantly increased the duration and cost of hospitalization. Sixty percent of groin healing problems were diagnosed after discharge and they represented the most common cause for early readmissions.The incidence of groin wound complications following ABFB is considerable, their financial impact significant, and delayed onset frequent. Femoral incisional morbidity following ABFB still represents an unremitting nuisance, necessitating further improvements in preventive strategies and techniques and strict adherence to conventional ones, including the minimization of preoperative length of stay.
- A simple technique to prevent torsion and other obstructions of autogenous vein conduits. [JOURNAL ARTICLE]
- Ann Vasc Surg 2014 Jul 7.
During a bypass or a transposed fistula, there is a risk of twisting or torsion of the vein within the tunnel, which may not be easily apparent when incomplete. When valvulotomes are used some non-obstructing leaflets or flaps may remain. These mechanical problems may go undetected at the time and may cause hemodynamic changes or act as a nucleus for thrombosis or obstruction post operatively. These may result in early graft failure. A simple technique to prevent and treat twisting and other obstructions in autogenous venous conduits is described. Use of this method has helped the authors to avoid acute obstructions in vein bypasses and transposed dialysis access fistulas.
- A new approach to measuring vitamin D in human adipose tissue using time-of-flight secondary ion mass spectrometry: A pilot study. [JOURNAL ARTICLE]
- J Photochem Photobiol B 2014 Jun 21.:295-301.
Circulating concentrations of vitamin D, 25(OH)D, and 1,25(OH)2D are lower in obese than lean individuals, but little is known about the adipose tissue content of these molecules. The aim of this study was to explore the possibility to use time-of-flight secondary ion mass spectrometry (TOF-SIMS) to measure vitamin D and its metabolites in fat tissue in obese and lean subjects. Abdominal subcutaneous adipose tissue (SAT) biopsies were obtained from three lean and three obese women, and paired biopsies SAT and visceral adipose tissue (VAT) were obtained from three obese subjects during gastric bypass surgery. TOF-SIMS was used to measure vitamin D3, 25(OH)D3, and 1,25(OH)2D3 in adipose tissue. We found that vitamin D3, 25(OH)D3, and 1,25(OH)2D3 in adipose tissue can be measured with TOF-SIMS. In adipose tissue, vitamin D3 and its metabolites were located in adipocyte lipid droplets. The content of vitamin D3 (P=0.006) and 25(OH)D3 (P=0.018) were lower in SAT in obese compared with lean women. TOF-SIMS has the potential to semi-quantitatively measure vitamin D metabolites in adipose tissue, and offers a possibility to compare vitamin D levels in different depots and groups of individuals. It also gives the opportunity to explore the localization of vitamin D metabolites at a cellular level.
- Nuclear envelope breakdown induced by herpes simplex virus type 1 involves the activity of viral fusion proteins. [JOURNAL ARTICLE]
- Virology 2014 Jun 2.:128-137.
Herpesvirus infection reorganizes components of the nuclear lamina usually without loss of integrity of the nuclear membranes. We report that wild-type HSV infection can cause dissolution of the nuclear envelope in transformed mouse embryonic fibroblasts that do not express torsinA. Nuclear envelope breakdown is accompanied by an eight-fold inhibition of virus replication. Breakdown of the membrane is much more limited during infection with viruses that lack the gB and gH genes, suggesting that breakdown involves factors that promote fusion at the nuclear membrane. Nuclear envelope breakdown is also inhibited during infection with virus that does not express UL34, but is enhanced when the US3 gene is deleted, suggesting that envelope breakdown may be enhanced by nuclear lamina disruption. Nuclear envelope breakdown cannot compensate for deletion of the UL34 gene suggesting that mixing of nuclear and cytoplasmic contents is insufficient to bypass loss of the normal nuclear egress pathway.
- Prognostic value of coronary artery calcium score in patients with stable angina pectoris after percutaneous coronary intervention. [Journal Article]
- J Geriatr Cardiol 2014 Jun; 11(2):113-9.
To evaluate the prognostic value of the coronary artery calcium (CAC) score in patients with stable angina pectoris (SAP) who underwent percutaneous coronary intervention (PCI).A total of 334 consecutive patients with SAP who underwent first PCI following multi-slice computer tomography (MSCT) were enrolled from our institution between January 2007 and June 2012. The CAC score was calculated according to the standard Agatston calcium scoring algorithm. Complex PCI was defined as use of high pressure balloon, kissing balloon and/or rotablator. Procedure-related complications included dissection, occlusion, perforation, no/slow flow and emergency coronary artery bypass grafting. Main adverse cardiac events (MACE) were defined as a combined end point of death, non-fatal myocardial infarction, target lesion revascularization and rehospitalization for cardiac ischemic events.Patients with a CAC score > 300 (n = 145) had significantly higher PCI complexity (13.1% vs. 5.8%, P = 0.017) and rate of procedure-related complications (17.2% vs. 7.4%, P = 0.005) than patients with a CAC score ≤ 300 (n = 189). After a median follow-up of 22.5 months (4-72 months), patients with a CAC score ≤ 300 differ greatly than those patients with CAC score > 300 in cumulative non-events survival rates (88.9 vs. 79.0%, Log rank 4.577, P = 0.032). After adjusted for other factors, the risk of MACE was significantly higher [hazard ratio (HR): 4.3, 95% confidence interval (95% CI): 2.4-8.2, P = 0.038] in patients with a CAC score > 300 compared to patients with a lower CAC score.The CAC score is an independent predictor for MACE in SAP patients who underwent PCI and indicates complexity of PCI and procedure-related complications.
- Novel therapy for non-cirrhotic hyperammonemia due to a spontaneous splenorenal shunt. [Journal Article]
- World J Gastroenterol 2014 Jul 7; 20(25):8288-91.
Spontaneous splenorenal shunts in the absence of cirrhosis have rarely been reported as a cause hyperammonemia with encephalopathy. Several closure techniques of such lesions have been described. Here we report a case of a patient with no history of liver disease who developed significant confusion. After an extensive workup, he was found to have hyperammonemia and encephalopathy due to formation of a spontaneous splenorenal shunt. There was no evidence of cirrhosis on biopsy or imaging and no portal hypertension when directly measured. The shunt was 18 mm and too large for embolization so the segment of the splenic vein between the portal vein and the shunt was occluded using an Amplatzer plug. Thus, the superior mesenteric flow was directed entirely to the liver. After interventional radiology closure of the shunt using this technique there was complete resolution of symptoms. The case represents the first report of a successful closure of splenorenal shunt via percutaneous embolization of the splenic vein with an amplatzer plug using a common femoral vein approach.
- Incidence and outcome of re-entry injury in redo cardiac surgery: benefits of preoperative planning. [JOURNAL ARTICLE]
- Eur J Cardiothorac Surg 2014 Jul 9.
Repeat sternotomy for redo cardiac surgery may be associated with catastrophic injuries to mediastinal structures. The purpose of this study was to determine the frequency of these injuries, associated outcome and if a preoperative computerized tomography (CT) scan reduces the risk of re-entry injury.Five hundred and forty-four patients who underwent redo cardiac surgery between 2001 and 2011 were identified by review of our unit's prospectively maintained cardiac surgery database. Demographic details, surgical strategy, re-entry injuries, hospital stay, in-hospital mortality and long-term survival were analysed.The mean age was 61 years; 326 were male, 218 were female. Four hundred and eighty six patients underwent first time redo surgery, while 58 patients had multiple previous operations. The median logistic EuroSCORE was 11, in-hospital mortality rate was 9.5% and observed to expected mortality rate was 0.8. Re-entry complications occurred in 15 cases (2.7%). These included injuries to the aorta (n = 2), right atrium (n = 1), innominate vein (n = 2), internal mammary artery (n = 2), pulmonary artery (n = 2), lung parenchyma (n = 1), saphenous vein graft (n = 2), right ventricle (n = 2) and ventricular fibrillation (n = 1). The mortality rate in patients with re-entry injury was 26% (n = 4) compared with 9% (n = 48) in those without re-entry complications. Preoperative planning by CT scan was performed in 162 cases and adherence of vital structures to the sternum was found in 60 cases; the right ventricle, innominate vein and bypass grafts in 41, 11 and 8, respectively. The incidence rate of re-entry injury was 0.6% in these patients vs 3.6% in those who did not have a preoperative CT scan (P = 0.046). Peripheral arterial cannulation was carried out in 35 patients (6.4%) to establish cardiopulmonary bypass (CPB) prior to sternotomy, and there were no mediastinal injuries observed in these cases. Multivariate logistic regression analysis revealed re-entry injury as one of the independent predictors of in-hospital mortality (P = 0.039).The incidence of re-entry injury during repeat sternotomy is low; however, it is associated with a significant increase in the risk of in-hospital mortality. Preoperative planning using CT scan reduces the risk by identifying adherent structures, and, in selected patients, establishing CPB prior to sternotomy is a safe strategy in redo cardiac surgery.
- Hiatal Hernia of the Roux-en-Y Gastric Bypass Pouch 8 years After Surgery. [JOURNAL ARTICLE]
- Obes Surg 2014 Jul 10.
- Endovascular repair of thoracoabdominal aortic aneurysms with a novel branched stentgraft design - preliminary experience. [JOURNAL ARTICLE]
- J Cardiovasc Surg (Torino) 2014 Jul 10.
To report our preliminary experience in outcome, safety and mid-term results in the treatment of thoracoabdominal aortic aneurysms (TAAA) with a novel branchedstentgraft (E-xtra, Jotec, Germany).Eight patients (mean age 66 years, 2 female) with TAAA (Crawford type I: 2 cases, type III: 3 cases, type IV: 2 cases), mean aneurysm diameter 61mm, growth over 5mm per year were treated. Implantation was performed under general anesthesia and surgical exposition of the common femoral artery. Brachial access was percutaneous in 5/8 patients. Balloon-expandable (Advanta V12) bridging stentgrafts were employed and lined with self-expanding nitinol stents. All patients except type IV TAAA received a spinal drainage catheter.The device was successfully deployed in 8/8 patients. 29/32 visceral branches were engaged. One stenosed celiac trunk was left untreated without further consequences, two renal arteries which could not be cannulated were revascularised with iliorenal bypass. One patient needed surgical revision of groin hematoma, one patient suffered from permanent protopathic sensory deficit. No renal complications occurred. Since the primary implantation was deliberately kept short and amount of contrast agent was minimised, four patients needed a secondary percutaneous procedure (Palmaz stent implantation for type I endoleak, re-PTA or additional bridging stentgraft implantation for type III endoleak). The assisted primary success rate was 8/8. Mean follow-up was 18 months. Success was stable in 7/8 patients, one patient shows type V endoleak with 5mm sac expansion. No mortality or complication occurred during follow-up.The JotecE-xtrabranchedstentgraft is a promising new candidate for endovascular TAAA treatment with sufficient safety and efficacy. Its short delivery time suggests its use in patients with rapid aneurysm growth or high anxiety.
- Long term results of ptfe trilaminate graft versus venous graft and composite graft for below-the-knee revascularization. [JOURNAL ARTICLE]
- J Cardiovasc Surg (Torino) 2014 Jul 10.
We report our experience with the use of PTFE trilaminate graft Advanta SST (Atrium Maquet™)versus autologous great saphenous vein (AGSV) and composite PTFE trilaminate---vein graft for below---the-knee (BTK) revascularization.Data of all consecutive patients who underwent either a BTK or a distal femoro---popliteal bypass from January 2004 to March 2013 using Advanta SST, AGSV or composite Advanta SST---vein graft were retrospectively reviewed and outcomes were analyzed. Kaplan---Meier method with Log---rank test was used to estimate survival, limb salvage and patency rates. Chi---square test was used to evaluate risk factors affecting outcomes. P value <.05 was considered significant.Sixty---one patients (48 males, 78.7%; median age 73 years, IQR 66---80) underwent a BTK/distal revascularization for peripheral artery disease causing critical limb ischemia (52 patients, 85.2%) or disabling claudication (9 patients). Advanta SST graft was used in 17 patients (Group A), AGSV in 30 (Group B) and composite Advanta---AGSV graft in the remaining 14 (Group C). Patients' demographics and risk factors were similar among the three groups, being hypertension and smoke the most frequent comorbidities. When Advanta SST was employed, the median duration of intervention was significantly lower than using vein or composite grafts (212 minutes, IQR 177---257; 270 minutes, IQR 220---375, P=.02; 327.5 minutes, IQR 252.5---405, P=.003 respectively). At 30---days, wound complications tended to be significantly higher in Group B (13.3%) and C (11.7%) than in group A (0%), P=.02. At long term, survival, primary assisted and secondary patency rates did not differ significantly among the three groups. Limb salvage was similar as well among group A, B and C (P=.29), being 81.2%+9.7%, 89.4%+5.8% and 67.7%+13.5% respectively at 1 year and 81.2%+9.7%, 83.4%+7.9% and 54.2%+16.2% respectively at 3 years. Primary patency rate at 1 year was significantly better for Group B than for group A and C (71.2%+8.6%, 49.6%+12.7% and 47.6%+14.1% respectively, P=.02), but after 1 year the patency rate for Group B and A was similar (55.5%+10.6% and 49.6%+12.7% respectively), being for Group C significantly worse (19%+11.8%). A history of previous or current smoke affected significantly primary patency rate in Group A (RR 0.39, 95%CI 0.08---0.95, P=.03).Long term results of the use of Advanta SST graft for BTK/distal revascularization seems to be promising, with significant lower duration of the operation and wound complications. At long term, survival, limb salvage, primary assisted and secondary patency rates did not differ significantly among the three groups. The AGSV still remains the best graft in terms of primary patency at 1 year, but after one year primary patency rates using the Advanta SST compare favourably to those of AGSV, while composite bypass grafts have the worst performance. These results need to be increased further.