A patient with three aortoenteric fistulas in a period of five years: case report

Background: Aortoenteric fistula (AEF) is a pathological communication between the aorta and gastrointestinal tract that presents a life-threatening condition. It can be primary or secondary, based on the underlying cause of fistula development. Case study: We present a 67-year-old female patient who suffered from three secondary AEFs in a period of five years. After two abdominal surgeries for gastric ulcer and colorectal adenocarcinoma (TNM stage II), the patient had an open abdominal aortic aneurysm reconstruction. For each AEF presentation, opened surgical reconstruction was performed. Conclusion: Morbidity and mortality rates after AEF surgery are high despite advances in surgical techniques and materials. Three times recurrent AEF in a single patient with 5-years survival after initial reconstructive surgery is rare event

Realistic 3D printed imaging tumor phantoms for validation of image processing algorithms

Medical imaging phantoms are widely used for validation and verification of imaging systems and algorithms in surgical guidance and radiation oncology procedures. Especially, for the performance evaluation of new algorithms in the field of medical imaging, manufactured phantoms need to replicate specific properties of the human body, e.g., tissue morphology and radiological properties. Additive manufacturing (AM) technology provides an inexpensive opportunity for accurate anatomical replication with customization capabilities. In this study, we proposed a simple and cheap protocol to manufacture realistic tumor phantoms based on the filament 3D printing technology. Tumor phantoms with both homogenous and heterogenous radiodensity were fabricated. The radiodensity similarity between the printed tumor models and real tumor data from CT images of lung cancer patients was evaluated. Additionally, it was investigated whether a heterogeneity in the 3D printed tumor phantoms as observed in the tumor patient data had an influence on the validation of image registration algorithms. A density range between -217 to 226 HUs was achieved for 3D printed phantoms; this range of radiation attenuation is also observed in the human lung tumor tissue. The resulted HU range could serve as a lookup-table for researchers and phantom manufactures to create realistic CT tumor phantoms with the desired range of radiodensities. The 3D printed tumor phantoms also precisely replicated real lung tumor patient data regarding morphology and could also include life-like heterogeneity of the radiodensity inside the tumor models. An influence of the heterogeneity on accuracy and robustness of the image registration algorithms was not found

Pseudomonas syringae DC3000 infection increases glucosylated N-glycans in Arabidopsis thaliana

Studying the interaction between the hemibiotrophic bacterium Pseudomonas syringae pv. tomato DC3000 and Arabidopsis thaliana has shed light onto the various forms of mechanisms plants use to defend themselves against pathogen attack. While a lot of emphasis has been put on investigating changes in protein expression in infected plants, only little information is available on the effect infection plays on the plants N-glycan composition. To close this gap in knowledge, total N-glycans were enriched from P. syringae DC3000-infected and mock treated Arabidopsis seedlings and analyzed via MALDI-TOF-MS. Additionally, fluorescently labelled N-glycans were quantified via HPLC-FLD. N-glycans from infected plants were overall less processed and displayed increased amounts of oligomannosidic N-glycans. As multiple peaks for certain oligomannosidic glycoforms were detected upon separation via liquid chromatography, a porous graphitic carbon (PGC)-analysis was conducted to separate individual N-glycan isomers. Indeed, multiple different N-glycan isomers with masses of two N-acetylhexosamine residues plus 8, 9 or 10 hexoses were detected in the infected plants which were absent in the mock controls. Treatment with jack bean alpha-mannosidase resulted in incomplete removal of hexoses from these N-glycans, indicating the presence of glucose residues. This hints at the accumulation of misfolded glycoproteins in the infected plants, likely because of endoplasmic reticulum (ER) stress. In addition, poly-hexose structures susceptible to alpha-amylase treatment were found in the DC3000-infected plants, indicating alterations in starch metabolism due to the infection process

Rijedak slučaj intraneuralnog hematoma medijanog živca nakon stentiranja desne ilijačne arterije: prikaz slučaja

Aim: Brachial artery access is an alternative approach to endovascular interventions when access to the femoral, radial, or ulnar arteries is not feasible, but it carries higher risk of periprocedural complications than other approaches, including median nerve injury. Nerve injuries can occur by direct puncture or by compression, with hematoma being the most common cause. Sometimes the compartment syndrome can accompany the direct nerve injury, masking the signs of a nerve dysfunction. Case report: We present a patient with a false aneurysm of brachial artery, surrounding soft tissue hematoma with volar arm and forearm compartment syndrome and a simultaneous median nerve intraneural hematoma caused by a direct punction. The combination of injuries occurred after brachial artery access for endovascular treatment of bilateral iliac artery steno-occlusive disease. The patient was successfully treated by fasciotomy, arterial sutures, and nerve decompression via paraneuriotomy. Conclusions: Intraneural hematoma caused by direct puncture can be masked by concomitant compartment syndrome. Emphasis should be put on prevention, early recognition, and timely surgical treatment of intraneural hematomas, especially those accompanied by fascial compartment syndrome after endovascular interventions.Cilj: Pristup brahijalnoj arteriji alternativni je pristup endovaskularnim intervencijama kada pristup femoralnoj, radijalnoj ili ulnarnoj arteriji nije izvediv, ali nosi veći rizik od periproceduralnih komplikacija nego drugi pristupi, što uključuje i ozljede medijanog živca. Ozljede živca mogu nastati izravnom punkcijom ili kompresijom, pri čemu je najčešći uzrok hematom. Ponekad sindrom mišićnih odjeljaka može pratiti izravnu ozljedu živca, prikrivajući znakove živčane lezije. Prikaz slučaja: Predstavljamo bolesnicu s lažnom aneurizmom brahijalne arterije, okolnim hematomom mekih tkiva, sindromom volarnog mišićnog odjeljka nadlaktice i podlaktice te s istodobnim intraneuralnim hematomom medijalnog živca koji je bio uzrokovan izravnom punkcijom. Ove udružene ozljede nastale su nakon punkcije brahijalne arterije u sklopu endovaskularnog liječenja bilateralne stenookluzivne bolesti ilijačne arterije. Pacijentica je bila uspješno liječena fasciotomijom, izravnim šavom arterije i dekompresijom živca (paraneuriotomijom). Zaključci: Intraneuralni hematom uzrokovan izravnom punkcijom može biti prikriven znakovima pratećeg sindroma mišićnih odjeljaka. Stoga treba staviti naglasak na prevenciju, rano prepoznavanje i pravodobno kirurško liječenje intraneuralnih hematoma, osobito onih popraćenih sindromom mišićnog odjeljka nakon endovaskularnih intervencija

Qualitative ultrasound elastography assessment of benign thyroid nodules: Patterns and intra-observer acquisition variability

Purpose: To report and evaluate qualitative elastography patterns by using gray-scale and Doppler ultrasound (US) in patients presenting with benign thyroid nodules and to evaluate the reproducibility of US elastography examinations. Materials and Methods: Institutional review board approval was obtained, and all patients provided informed consent. Over a 3-month time period, all consecutive adult patients were referred to our institution to undergo a thyroid nodule fine-needle aspiration biopsy (FNAB) procedure. Patients presenting with benign cytology according to the Bethesda 2008 classification were prospectively enrolled in the study. Each thyroid nodule was assessed by using gray-scale, Doppler US, and elastography acquisitions by a single operator (A. L.). Multiple elastography acquisitions per thyroid nodule were performed and elastography scorings of the nodules were compared with each other. Results: Nineteen patients (16 women and 3 men, mean age 58 years) with 22 thyroid nodules were included in the present study. Elastographic patterns 1, 2, and 3 were reported (23% nodules showed pattern 3). The elastography pattern showed a strong variability in 13 nodules (59%). The elastography acquisition result variability involved the "malignant" pattern 3 in 36% of cases. Conclusion: Almost one-third of benign thyroid nodules displayed pattern 3 on qualitative US elastography. The intra-observer variability of the benign thyroid elastography scoring is wide, thus limiting the thyroid nodule US examination accuracy. In FNAB-proven benign thyroid nodules, elastography pattern 3 is frequent and cannot be used as a strong indicator of thyroid malignancy