Endoleak--a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft.
Explore the source record for details and available documents.
Aneurysm↗
Biomedical subjects
J May
Publications and source records attributed to J May.
DPB1*BR: an Mhc class II DPB1 allele (DPB1*6601) of negroid origin.
Explore the source record for details and available documents.
Alleles↗
Met-11 of HLA class II DP alpha 1 first domain associated with onchocerciasis.
Human infection with the pathogenic tissue nematode Onchocerca volvulus may result in a spectrum of clinical manifestations or in a putatively immune condition. A methionine at amino acid position 11 of the HLA class II DP alpha 1 chain correlates with the occurring disease after infection (relative risk 3.3). The alternative alanine at position 11 is, conversely, associated with protection from disease ("relative protection' 3.5). DPA1*0301 is associated with the localized form of disease after O. volvulus infection.
Amino Acid Sequence↗
[Ultrasonic pregnancy diagnosis (B-mode) in sheep. 2. Comparative studies using transcutaneous and transrectal pregnancy diagnosis].
The aim of this study was to check the earliest time for the ultrasonic pregnancy diagnosis in flock management of sheep after finishing the mating season. Therefore a transcutaneous pregnancy diagnosis (5 MHz) took place on a total of 1060 German merino-mutton sheep between day 10 and 90 after mating (a.m.) and a transrectal diagnosis (5 MHz) took place on a total of 1442 German merino-mutton sheep between day 10 and 70 a.m. At the beginning of the third week a.m. the accuracy of transrectal diagnosis was over 95% and increased to 100% on day 35 a.m. At that time the accuracy of transcutaneous diagnosis was 80% and reached 100% on day 60 a.m. Considering the reached accuracies the pregnancy diagnosis should not take place before day 35 after the end of the breeding season. After day 35 a.m. it is advisable to combine the transcutaneous and the transrectal pregnancy diagnosis. That means that at first all animals are examined by transcutaneous sonography and in the second step the so-called "non-pregnant sheep" are checked by transrectal ultrasound. From the beginning of the third month a.m. a single transcutaneous pregnancy diagnosis is sufficient.
Animals↗
Streptokinase audit at Thames Hospital.
Explore the source record for details and available documents.
Hospitals, Rural↗
Predicting outcomes in thoracic outlet syndrome.
OBJECTIVE: To test the hypothesis that somatosensory evoked potentials (SEP) and results of arterial photoplethysmography (PPG) predict outcome after surgery for thoracic outlet syndrome. DESIGN: A retrospective case series which correlated surgical outcome with preoperative SEP and PPG results using Fisher's exact test. PPG results were considered abnormal when there was complete loss of arterial pulsation, and SEP results when amplitudes were reduced and latencies delayed. SETTING: Royal Prince Alfred Hospital, between March 1984 and February 1992. PATIENTS: Forty-six consecutive patients with clinically diagnosed thoracic outlet syndrome were admitted for surgery; sixteen underwent bilateral operations (total of 63 limbs). INTERVENTIONS: After SEP and PPG tests, all patients underwent thoracic outlet decompressive surgery--excision of the first rib, of the cervical rib (where present), and of other congenital anomalies associated with thoracic outlet syndrome--by the axillary approach. MAIN OUTCOME MEASURES: Surgical outcome was graded as good when symptoms improved and the patient returned to work or pre-illness activities. It was graded as poor when symptoms remained unchanged or worsened, or when there was continued inability to work or engage in usual activities. RESULTS: The follow-up period ranged from 1.9-9.8 years (mean, 5.7 years). Significantly more limbs with abnormal SEP or PPG results had a good outcome (49 of 53 limbs; 93%) than limbs with normal SEP and PPG results (six of 10 limbs; 60%) (P = 0.02). CONCLUSIONS: Abnormal SEP and PPG results correlated with a better postsurgical outcome. These tests may therefore aid in determining prognosis of surgery for thoracic outlet syndrome.
Adolescent↗
Intestinal obstruction promotes gut translocation of bacteria.
PURPOSE: Translocation of enteric organisms has been implicated as a possible source of sepsis in susceptible patients. Animals studies have suggested that intestinal obstruction promotes bacterial translocation from the gut lumen. The aim of this study was to study the prevalence of bacterial translocation in patients with and without intestinal obstruction. METHODS: Serosal scrapings, mesenteric lymph nodes, and peripheral blood cultures were obtained from 254 patients. Scrapings and nodes were homogenized and incubated aerobically and anaerobically. Full-thickness biopsies underwent villous height analysis. The clinical course was followed for at least six weeks. RESULTS: Bacterial translocation to mesenteric nodes occurred more frequently in patients with large bowel obstruction than in patients without obstruction (14 of 36 patients vs. 16 of 218 patients; P < 0.001). Both aerobic and anaerobic bacteria were found to translocate. The more distal the obstruction, the more likely anaerobic bacteria were to be identified. Translocation of bacteria predisposed to postoperative septic complications (P < 0.05). Villous height was not related to bacterial translocation. CONCLUSIONS: Gut translocation of bacteria is more common in patients with intestinal obstruction, and its association with septic complications appears to be of clinical significance.
Adult↗
Randomized trial of pelvic drainage after rectal resection.
UNLABELLED: Most surgeons continue to advocate routine use of drains after pelvic anastomoses. Several recent studies have, however, demonstrated that patients gain little or no benefit from such drainage and that drains may indeed be a source of morbidity to some. PURPOSE: The aim of this trial was twofold: 1) to determine whether use of a high pressure, closed suction pelvic drain was associated with reduced morbidity; 2) to investigate the influence of drainage on postoperative fluid collections after rectal resection. METHODS: A consecutive series of 100 patients was randomized to receive either no drain (n = 48) or a high pressure, closed suction intraperitoneal drain for seven days (n = 52). The two groups were similar in terms of age, sex, diagnosis, and type of anastomosis. Patients underwent postoperative pelvic ultrasound and water-soluble contrast studies on day 7. RESULTS: There were six deaths (three drain, three no drain). Clinically significant anastomotic leak occurred in seven patients (five drain, two no drain), and a radiologic leak was demonstrated in another five patients (two drain, three no drain), each of whom remained well. Presence or absence of a drain did not influence rate of morbidity and mortality. Pelvic fluid collections were more likely to be demonstrated if a drain was used; however, this did not reach statistical significance. Neither pus nor feces emerged from the drain in any patients in whom a leak occurred. CONCLUSION: Use of a pelvic drain after rectal resection did not confer any benefit to the patient.
Adolescent↗
Endoluminal repair of atypical dissecting aneurysm of descending thoracic aorta and fusiform aneurysm of the abdominal aorta.
A 62-year-old male patient was admitted with acute dissociation of the descending thoracic aorta and an infrarenal abdominal aortic aneurysm (AAA). Investigation revealed that the thoracic dissection probably had arisen retrogradely in the posterior wall of the AAA and extended superiorly to the left subclavian artery as a blind sac. Implantation of an endoluminal graft device below the renal arteries enabled simultaneous treatment of the AAA and the thoracic aortic dissection. The patient had an uncomplicated recovery. Postoperative aortography and computed tomography demonstrated normal flow through the aorta and endograft without leak of contrast into the AAA sac or the false lumen of the dissection. Contrast computed tomography 6 months after operation demonstrated that the false lumen was no longer evident.
Aortic Dissection↗
Early outcome and intermediate follow-up of vascular stents in the femoral and popliteal arteries without long-term anticoagulation.
PURPOSE: The role of arterial stenting in the treatment of femoral and popliteal arterial disease is controversial and has been hampered by recommendations for patients to be given anticoagulants (oral warfarin) for several months or more. This study was undertaken to evaluate the immediate and midterm outcomes of vascular stents implanted percutaneously in the femoral and popliteal arteries, without long-term anticoagulation. METHODS: Over a 3-year period, 32 patients admitted to a vascular surgery service had arterial stents implanted in the femoral (n = 22) or popliteal (n = 10) artery for the following indications: recurrent stenosis after angioplasty (n = 13), suboptimal result after angioplasty of occluded (n = 12) or calcified stenotic arteries (n = 2), percutaneous transluminal angioplasty-induced thrombosis or dissection (n = 5). Access to the artery was gained by percutaneous insertion of a hemostatic sheath into the ipsilateral common femoral artery. Systemic heparin was given at the time of stent insertion, and patients were prescribed daily low-dose aspirin. RESULTS: Successful stent implantation was achieved in 31 of the 32 patients. Acute thrombosis (< 30 days) occurred in two patients. There was no incidence of false aneurysm formation, acute leg ischemia, or vessel perforation. All patients were monitored by Doppler scanning index and duplex scanning within 24 hours, and thereafter at 3- to 6-month intervals. The mean ankle-brachial systolic pressure index improved from 0.60 (before treatment) to 0.88 (3 to 6 months after stenting). Stent occlusion has occurred in six patients; two stents were successfully salvaged with urokinase infusion. In follow-up to date (range 3 to 33 months) the primary patency rate by life-table analysis was 75% at 18 months, whereas the secondary patency rate was 89% at the same interval. Restenosis (> 50% lumen diameter) was detected by duplex ultrasonography in seven of 25 patent stents (28%) at a mean interval of 9.5 months (range 4 to 15 months); of these, four patients remained clinically symptom-free despite the ultrasound findings. CONCLUSIONS: We conclude that vascular stents can be implanted into the femoropopliteal arteries with few complications and with acceptable early and intermediate patency rates, without the need for long-term anticoagulation. Restenosis is not prevented by stents, and the main value of stenting at this site appears to be in salvaging acute complications of percutaneous transluminal angioplasty, or to correct suboptimal results after recanalization of occluded arteries.
Aged↗
Surgical management of complications following endoluminal grafting of abdominal aortic aneurysms.
OBJECTIVE: The aim of this study was to report the outcome of endoluminal grafting of abdominal aortic aneurysms (AAA) with special reference to complications. METHODS: Between May 1992 and August 1994 endoluminal repair of aneurysms was undertaken in 61 patients. In 53 the aneurysm was aortic and these are the basis of this report. In patients with AAA all procedures were elective and were performed in the operating room with the patient draped for an open repair in the event of failed endoluminal repair. The configuration of the endografts was tubular 36, tapered aortoiliac/aortofemoral 12 and bifurcated 5. Radiographic guidance was used to pass the endografts into the aorta via a delivery sheath introduced through the femoral or iliac arteries. RESULTS: Successful endoluminal repair of AAA was achieved in 43 of 53(81%) patients. In the remaining 10 patients, endoluminal repair was abandoned in favour of an open repair. There were 17(32%) local/vascular and 13(25%) systemic/remote remote complications. The sum of these complications occurring in successful endoluminal repairs and those complications leading to failure of endoluminal repair was 40(75%). There were two cardiac deaths within 30 days in patients undergoing endoluminal repair (both procedure related) and four late deaths (unrelated to aneurysm repair). Three of the late deaths were in patients undergoing endoluminal repair and one endoluminal converted to open repair. CONCLUSION: Endoluminal repair of AAA in our experience has a low perioperative (< 30 days) mortality rate (3.7%) but a high morbidity rate (75%). It is recommended that complications be classified into three groups: systemic/remote and local/vascular (following successful endoluminal repair) plus those complications leading to failure of endoluminal repair. The first group is composed of medical complications while the latter two groups comprise those surgical complications directly related to the endoluminal technique.
Aged↗
Human atherosclerotic plaque contains both oxidized lipids and relatively large amounts of alpha-tocopherol and ascorbate.
We assessed the antioxidant status and contents of unoxidized and oxidized lipids in freshly obtained, homogenized samples of both normal human iliac arteries and carotid and femoral atherosclerotic plaque. Optimal sample preparation involved homogenization of human atherosclerotic plaque for 5 minutes, which resulted in recovery of most of the unoxidized and oxidized lipids without substantial destruction of endogenous vitamins C and E and 87% and 43% recoveries of added standards of alpha-tocotrienol and isoascorbate, respectively. The total protein, lipid, and antioxidant levels obtained from human plaque varied among donors, although the reproducibility of replicates from a single sample was within 3%, except for ubiquinone-10 and ascorbate, which varied by 20% and 25%, respectively. Plaque samples contained significantly more ascorbate and urate than control arteries, with no discernible difference in the vitamin C redox status between plaque and control materials. The concentrations of alpha-tocopherol and ubiquinone-10 were comparable in plaque samples and control arteries. However, approximately 9 mol percent of plaque alpha-tocopherol was present as alpha-tocopherylquinone, whereas this oxidation product of vitamin E was not detectable in control arteries. Coenzyme Q10 in plaque and control arteries was only detected in the oxidized form ubiquinone-10, although coenzyme Q10 oxidation may have occurred during processing. The most abundant of all studied lipids in plaque samples was free cholesterol, followed by cholesteryl oleate and cholesteryl linoleate (Ch18:2). Approximately 30% of plaque Ch18:2 was oxidized, with 17%, 12%, and 1% present as fatty acyl hydroxides, ketones, and hydroperoxides, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Early experience with the Sydney and EVT prostheses for endoluminal treatment of abdominal aortic aneurysms.
PURPOSE: The aim of this study was to report early experiences with the Sydney and Endovascular Technologies (EVT) prostheses for the treatment of abdominal aortic aneurysms (AAA) deemed suitable for endoluminal tube graft repair. METHODS: Consecutive endoluminal tube graft repairs were analyzed over the first 12 months in which the Sydney and EVT prostheses were used. Patients eligible for the EVT prosthesis had type I AAAs: a proximal neck length > or = 2 cm, a distal cuff length > or = 1.5 cm, and nontortuous iliac arteries > or = 8 mm. Selection criteria for the Sydney device were more liberal and included AAAs that had distal cuffs < 1.5 cm. During the study period, 28 of 91 patients evaluated for AAA repair were thus selected for endoluminal grafting: 18 patients received the Sydney endograft and 10 the EVT device. Medical comorbidities were present in slightly less than one third of patients in both groups. Contrast-enhanced computerized tomography (CT) was performed preoperatively, within 10 days of operation, and at 6 and 12 months postprocedure. RESULTS: All endografts were successfully deployed in both groups. Postprocedural CT scans revealed incomplete aneurysm exclusion in four patients with the Sydney endograft. Subsequent deployment of a second endograft sealed these "leaks" in two cases; the other two were converted to open repair (89% clinical success). No leaks were seen with the EVT device. Local/vascular complications occurred in 33% of the Sydney group compared with 20% for the EVT device (p = 0.001); systemic sequelae were more common in the EVT group (30% versus 17% in the Sydney cohort, p = 0.002). There were no deaths within 30 days; three late deaths were not procedure related. CONCLUSION: AAAs that are suitable for endoluminal tube graft repair may be treated with a high rate of initial success with either the Sydney or EVT prostheses. More liberal selection criteria may increase the likelihood of local/vascular complications.
Aged↗
A prospective study of changes in morphology and dimensions of abdominal aortic aneurysms following endoluminal repair: a preliminary report.
PURPOSE: The aim of this prospective study was to analyze early changes in morphology and dimensions of abdominal aortic aneurysms (AAA) following endoluminal repair. METHODS: Forty-two of 62 patients undergoing endoluminal repair of AAAs between May 1992 and November 1994 were potentially available for follow-up at 6 months or longer after operation. After excluding patients with failed endoluminal repairs, patients who died within 6 months of operation, and patients with anastomotic aneurysms, a study group of 30 patients remained. Contrast-enhanced computed tomography (CE-CT) was performed preoperatively, within 10 days of operation, and at 6 and 12 months postprocedure. Based on the postoperative CE-CT findings, patients were divided into two groups: those with no extravasation of contrast into the aneurysmal sac (group I; n = 26), and those in which there was contrast extravasation ("leak") into the aneurysmal sac (group II; n = 4). RESULTS: The mean maximum diameters of AAAs in group I diminished progressively at 6 and 12 months, while those in group II increased. Twenty-three (88%) patients in group I had decreased diameter of AAA, while all patients in group II had progressive increase in AAA diameter. Patients who had an increase in AAA diameter had a significantly higher incidence of leak compared with those who had a decrease in diameter (p = 0.001). CONCLUSIONS: The majority of AAAs in which the sac has been excluded from the general circulation diminish in size following successful endoluminal repair. An increase in size occurs in those AAAs in which a communication exists between the aortic lumen and the sac. These results suggest that successfully excluded AAAs that continue to increase in size should be suspected of having an undetected leak.
Aortic Aneurysm, Abdominal↗
Results of autopsy 7 months after successful endoluminal treatment of an infrarenal abdominal aortic aneurysm.
PURPOSE: To report the results of a postmortem examination in a patient who died of unrelated causes 7 months following endoluminal treatment of an infrarenal abdominal aortic aneurysm (AAA). METHODS: As part of an FDA Phase I pilot study, a 73-year-old man underwent successful endoluminal exclusion of an infrarenal AAA using a 9-cm-long endograft (Endovascular Grafting System). Seven months later, he succumbed to complications of a spontaneous esophageal rupture. At autopsy, the aorta was dissected in situ by a vascular surgeon and pathologist before being explanted in order to examine the wound healing characteristics at the aorta-endograft interface. Particular attention was also directed to the hooks composing the attachment system at each end of the endograft. RESULTS: Macroscopic and microscopic examination revealed that the graft had completely excluded the aneurysm sac from the circulation and was incorporated into the aortic wall at the proximal neck and distal cuff. A smooth pannus of endothelial cells covered the proximal end of the endograft at the areas of contact with the aorta, while microscopic examination of the distal end of the graft revealed poorly formed, fibrinous pannus. The neointima deep to the endothelium consisted of a collagenous matrix containing myofibroblasts and histiocytes, providing evidence of healing between the endograft and aorta. Both renal arteries were clear of the proximal end of the endograft, but a previously unrecognized right lower pole renal artery with an extremely caudal origin was excluded from the aortic lumen. Each hook of the attachment system was seen protruding through the adventitia of the aorta. There was no evidence of trauma to the aortic wall or the surrounding tissues caused by these hooks. CONCLUSION: There appears to be evidence that an endoluminally placed aortic graft may be incorporated by the host aortic tissue.
Aged↗
[Optimization of embryo transfer programs in ewes by transrectal ultrasonographic ovary diagnosis (B-mode) in superovulated donors].
The aim of this study was to check the accuracy of transrectal ultrasonography for the ovary diagnosis in superovulated sheep during the estrus (n = 10) and on the day 8 after estrus (n = 10). The results were checked by laparoscopic ovary diagnosis. The real-time ultrasound unit CS-9100 OCULUS was used with a linear 7.5 MHz rectal probe. Transrectal ultrasonography was performed at sheep lying in their dorsal position. In 90% of the sheep it was possible to find both ovaries during the estrus and in 60% on the 8th day of the estrus cycle. Correlation for the number of follicle (diameter > or = 4 mm) per ovary during the estrus counted at ultrasonography and laparoscopy were 0.62 (p < 0.05) and for the number of corpora lutea per ovary on day 8 after estrus 0.97 (p < 0.05). The results suggest, that the ultrasonographic ovary diagnosis is an appropriate method to check the results of superovulation in embryo transfer programs. Non-responding or poorly responding donors can be selected.
Animals↗
Endoluminal repair of abdominal aortic aneurysms.
OBJECTIVE: To review the outcome of endoluminal repair of abdominal aortic aneurysm. PATIENTS: Twelve patients with abdominal aortic aneurysms (mean diameter, 5 cm; range, 4.4-7.8 cm) were selected according to strict criteria relating to the morphology of the aneurysm and iliac arteries. The aneurysms all had a proximal neck between the renal arteries and the aneurysm and a distal neck between the aneurysm and the bifurcation of the aorta. The iliac arteries were not tortuous and were 8 mm or greater in diameter. INTERVENTION: The aneurysm was repaired with a graft stent device introduced into the aorta via a sheath in the femoral artery. RESULTS: Successful endoluminal repair was achieved in 10 of 12 patients (83%). The two patients in whom the endoluminal repair was abandoned were treated by standard open repair. All patients have since had an aortogram and duplex ultrasound examination to confirm exclusion of the aneurysm from the general circulation (mean period of follow-up, seven months). There have been no deaths. CONCLUSION: Abdominal aortic aneurysms conforming to strict morphological criteria can be treated safely and successfully by this minimally invasive endoluminal method.
Aged↗
Comparative audit of colorectal resection with the POSSUM scoring system.
Comparison of outcome after colorectal resection between different surgical units is difficult. Crude rates of morbidity and mortality may give a distorted picture as such rates fail to account for variations in case mix and physiological status of patients. The simple and validated scoring system POSSUM (Physiological and Operative Severity Score for enUmeration of Mortality and morbidity) was used to compare outcome after colorectal resection in two units. Consecutive series of patients who underwent colorectal resection in unit 1 (a university teaching hospital) or unit 2 (a district general hospital) were scored with the POSSUM system. Postoperative complications and 30-day mortality were recorded. In unit 1, 66 patients underwent colorectal resection with a mortality rate of 6 per cent and a morbidity rate of 9 per cent. In unit 2 the rates of mortality and morbidity were 9 and 26 per cent respectively for 182 patients undergoing colorectal resection. However, application of POSSUM predicted a mortality rate of 5.2 per cent for patients in unit 1 and 9.8 per cent for those in unit 2 with predicted morbidity rates of 11.2 and 23.9 per cent respectively. Direct comparison of outcome between these two units would be misleading. Application of POSSUM allows more realistic comparative audit of colorectal resection.
Adult↗