Risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair

PURPOSEWe aimed to identify the risk factors associated with late aneurysmal sac expansion after endovascular abdominal aortic aneurysm repair (EVAR).METHODSWe retrospectively reviewed contrast-enhanced computed tomography (CT) images of 143 patients who were followed for ≥6 months after EVAR. Sac expansion was defined as an increase in sac diameter of 5 mm relative to the preoperative diameter. Univariate and multivariate analyses were performed to identify associated risk factors for late sac expansion after EVAR from the following variables: age, gender, device, endoleak, antiplatelet therapy, internal iliac artery embolization, and preprocedural variables (aneurysm diameter, proximal neck diameter, proximal neck length, suprarenal neck angulation, and infrarenal neck angulation).RESULTSUnivariate analysis revealed female gender, endoleak, aneurysm diameter ≥60 mm, suprarenal neck angulation >45°, and infrarenal neck angulation >60° as factors associated with sac expansion. Multivariate analysis revealed endoleak, aneurysm diameter ≥60 mm, and infrarenal neck angulation >60° as independent predictors of sac expansion (P < 0.05, for all).CONCLUSIONOur results suggest that patients with small abdominal aortic aneurysms (<60 mm) and infrarenal neck angulation ≤60° are more favorable candidates for EVAR. Intraprocedural treatments, such as prophylactic embolization of aortic branches or intrasac embolization, may reduce the risk of sac expansion in patients with larger abdominal aortic aneurysms or greater infrarenal neck angulation

Dual Microcatheter Retrograde Transvenous Obliteration of Gastric Varices: Coil Embolization as a Substitute for Balloon Occlusion

Dual microcatheter retrograde transvenous obliteration (DMRTO) of gastric varices enables dual microcatheters to be advanced to the gastric varices themselves or to a site adjacent to the varices. The sclerosing agent is infused through the first microcatheter following coil embolization of the outflow vessels through the second microcatheter, which is placed several centimeters back from the varices. We present two cases of gastric varices in whom balloon-occluded retrograde transvenous obliteration failed, because of angulated gastrosubphrenic shunt in case 1 and a tortuous and elongated gastrorenal shunt in case 2. DMRTO successfully achieved eradication of the gastric varices in both cases

Efficacy and safety of topical acetylcysteine combined with the use of an overcurvature-correcting device in patients with pincer nail deformity: a randomized, vehicle-controlled, investigator-blinded study

Background While pincer nails may be treated using overcurvature-correcting devices, it takes several months to achieve successful outcomes. Nail-softening drugs may reduce the treatment duration required. Objective To evaluate the efficacy and safety of treatment with acetylcysteine (AC) gel added to an overcurvature-correcting device, and define the optimal AC concentration. Methods In this investigator-blinded study, 70 patients with hallux pincer nail were fitted with an overcurvature-correcting device for 7 days and were randomly assigned to receive a single 24-h administration of a gel containing 10%, 20% or 30% AC or vehicle. Nail improvement was objectively evaluated by calculating the distal narrowed nail width (dNNW) ratio. Results All three AC concentrations plus device showed earlier sustained improvement of pincer nails versus vehicle plus device. There was no observable correlation between AC concentration and effectiveness. No clinically problematic adverse events were observed at any AC concentration, and we recommended AC gel at a concentration of 10%. Conclusions By adding AC gel application to an overcurvature-correcting device, early and sustained reductions in transverse curvature were produced compared with using a device alone (vehicle control). The dNNW ratio used in this study was an appropriate objective index for evaluating therapeutic effects

Portal Vein Replacement with Expanded Polytetrafluoroethylene (e-PTFE) Graft

This study was conducted to assess the efficacy of portal vein reconstruction with an expanded polytetrafluoroethylene (e-PTFE) graft. Five patients underwent interposition of the portal vein with e-PTFE graft following en bloc resection of the entire pancreas and the portal vein for advanced pancreatic cancer. The length of the excised vein ranged from 5 to 7 cm and that of the implanted graft (8 or 10 mm in diameter), 3 to 7.5 cm. In 4 of the 5 cases, the graft was patent at five to eighteen months following implantation. One patient died of respiratory failure two months after operation, and partial occlusion of the graft was noted at autopsy. Four patients died of recurrence of the original disease five to eighteen months after operation. The implanted graft taken at autopsy eighteen months after operation was covered uniformly with thin neointima on the internal surface. Microscopic examination showed endothelial cells covering the surface of the neointima, and capillary vessels had developed in the neointimal layer. Experimentally, five grafts, 0.8 cm in diameter and 2.5 cm in length with external ring support, were interposed in the portal vein in pigs. All grafts were patent during a four-month follow-up period. The authors conclude that the e-PTFE graft is a suitable prosthesis for replacement of the portal vein following its resection

Biliary Tract Cancer Accompanied by Anomalous Junction of Pancreaticobiliary Ductal System in Adults

Background: Anomalous junction of the pancreaticobiliary ductal system (AJPBDS) is a congenital anomaly in which the junction is located outside the duodenal wall. Recently, attention has been focused on the high incidence of malignancy in this anomaly. The purpose of this study was to clarify the clinicopathological features of this anomaly and to determine the appropriate surgical approach for biliary tract cancer associated with AJPBDS. Methods: The data for 38 patients with AJPBDS, including 14 who had been treated for biliary tract cancer (2 with bile duct cancer and 12 with gallbladder cancer), were retrospectively reviewed. We assessed the clinical features, characteristics of the tumor, operative procedure, and outcome for each patient. Results: The incidence of malignancy in AJPBDS was 17.8% (2 patients with bile duct cancer and 3 with gallbladder cancer) in the bile duct dilatation group (n = 28) and 90% (9 patients with gallbladder cancer) in the no-dilatation group (n = 10). The mean length of the common channel was 24.7 mm (range 20 to 35 mm). Resection with lymphadenectomy was performed in 9 (64.3%) of 14 patients, and curative resection in 5 of these 9 patients. Ten (71%) of the 14 patients had lymph node involvement noted either at the time of initial diagnosis or at surgery. The incidence of lymph node metastasis was closely related to the depth of tumor involvement. Ten patients died of recurrence or primary cancer, from 3 to 30 months after operation. Four patients are still alive without recurrent disease from 2.5 to 13 years after operation. Conclusion: For patients with AJPBDS without bile duct dilatation, prophylactic cholecystectomy is recommended even if no malignant lesion is found in the gallbladder because of the high incidence of gallbladder cancer and the poor prognosis. Both early detection and curative resection of the tumor are essential for successful treatment of biliary tract cancer

Abdominal multivisceral transplantation in pigs

We investigated the technical aspects of porcine abdominal multivisceral transplantation, in terms of pathophysiological features in animals given no immunosuppresant. The splanchnic organs of the donor animal were flushed in situ with University of Wisconsin solution via the abdominal aorta, using a pump. After a relatively short period of cold storage in saline, multivisceral grafts, including the liver, pancreas, and gastrointestinal tract, were transplanted orthotopically. Of the 18 recipient pigs that underwent the operation, 9 (50%) died within 24 h, mainly because of respiratory insufficiency (n = 5) and circulatory shock (n = 3). Three animals (17%) were lost to acute renal failure between the second and fifth postoperative days. Six pigs (33%) survived for more than 1 week, and the causes of death in these animals were bowel obstruction (n = 1), pneumonia (n = 2), rejection of the intestinal graft (n = 2), and deterioration (n = 1). Although the results of this study were not satisfactory, abdominal multivisceral transplantation using pigs is practical and may lead to the possible resolution of various problems, in regard to the immunologic aspects and the interrelationship of transplanted complex organs

Sex Differences in the Distribution of Subcutaneous and Internal Fat

One-hundred twenty-one male and 93 female subjects, aged 18-23 years, were selected for an investigation of the proportion of subcutaneous to total fat in the whole body. Body fat mass was calculated from body density using the Siri equation. Subcutaneous fat mass was calculated by measuring skinfold thickness at 15 sites and using a modification of the equation derived by Skerjl, Brozek, and Hunt. The main modification to this equation was the introduction of a midlayer area of subcutaneous tissue that is multiplied by fat thickness to give fat volume. The outermost body surface area, which has been utilized in previous research, results in an overestimation of the true subcutaneous fat mass. The average percentages of fat situated subcutaneously (PFSSs) were calculated as 53.7% for males and 62.6% for females. This sex difference is also seen in correlationregression analysis of PFSS and percentage of fat. In females PFSS decreases with increasing total percentage of fat, whereas in males there is no significant relationship between PFSS and total percentage of fat. This suggests that the proportion of subcutaneous to total fat distribution is negatively related to fatness in females

Evaluation of Cultivar Differences in Preharvest Sprouting of Common Buckwheat (Fagopyrum esculentum Moench)

Preharvest sprouting of buckwheat (Fagopyrum esculentum Moench) is an important problem, but cultivar differences in preharvest sprouting and their causes have not been investigated. We detected cultivar differences under natural field conditions. Preharvest sprouting of three cultivars was significantly lower than that of the current main cultivar. Seeds collected before rainfall were threshed and incubated on a wet filter paper in a petri dish for 10 days at 10, 20, 30 and 40ºC in the dark, or at an alternating light and temperature condition of 8 h light at 30ºC and 16 h darkness at 20ºC. Germination was promoted by a higher temperature except for 40ºC, suggesting that the risk of preharvest sprouting in buckwheat is higher at a relatively higher temperature. The risk of preharvest sprouting in the field was highly correlated with germination at 20ºC (r = 0.98***) and 30ºC (r = 0.99***) in the dark, suggesting that germination test can be used to predict preharvest sprouting in the field. Preharvest sprouting was significantly correlated (r = −0.77**) with main stem length, suggesting that ecotype is partly responsible for this phenomenon