Use of an Extracorporeal Femoral-carotid Shunt in the Management of Complex Supra-aortic Disease

AbstractManagement of symptomatic multifocal supra-aortic atherosclerotic disease presents a complex surgical challenge. We describe a novel approach where a temporary extra-corporeal femoro-carotid shunt was used to maintain cerebral perfusion during hybrid surgical and endovascular treatment for tandem supra-aortic lesions

Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC)

OBJECTIVE/BACKGROUND: The management of aortic graft infection (AGI) is highly complex and in the absence of a universally accepted case definition and evidence-based guidelines, clinical approaches and outcomes vary widely. The objective was to define precise criteria for diagnosing AGI. METHODS: A process of expert review and consensus, involving formal collaboration between vascular surgeons, infection specialists, and radiologists from several English National Health Service hospital Trusts with large vascular services (Management of Aortic Graft Infection Collaboration [MAGIC]), produced the definition. RESULTS: Diagnostic criteria from three categories were classified as major or minor. It is proposed that AGI should be suspected if a single major criterion or two or more minor criteria from different categories are present. AGI is diagnosed if there is one major plus any criterion (major or minor) from another category. (i) Clinical/surgical major criteria comprise intraoperative identification of pus around a graft and situations where direct communication between the prosthesis and a nonsterile site exists, including fistulae, exposed grafts in open wounds, and deployment of an endovascular stent-graft into an infected field (e.g., mycotic aneurysm); minor criteria are localized AGI features or fever ≥38°C, where AGI is the most likely cause. (ii) Radiological major criteria comprise increasing perigraft gas volume on serial computed tomography (CT) imaging or perigraft gas or fluid (≥7 weeks and ≥3 months, respectively) postimplantation; minor criteria include other CT features or evidence from alternative imaging techniques. (iii) Laboratory major criteria comprise isolation of microorganisms from percutaneous aspirates of perigraft fluid, explanted grafts, and other intraoperative specimens; minor criteria are positive blood cultures or elevated inflammatory indices with no alternative source. CONCLUSION: This AGI definition potentially offers a practical and consistent diagnostic standard, essential for comparing clinical management strategies, trial design, and developing evidence-based guidelines. It requires validation that is planned in a multicenter, clinical service database supported by the Vascular Society of Great Britain & Ireland

Unraveling the crosstalk between cell sheets of human adipose stem cells and keratinocytes

We have previously shown that 3D constructs of human adipose stem cells (hASCs) cell sheets led to the formation of de novo hair follicles and rete-ridges like structures. An up-regulation of keratinocyte growth factor (KGF) was also observed in the experimental condition in relation to the control groups. We hypothesized that the natural adhesive character of the cell sheets promoted the direct interaction between the host and the transplanted cells1. In this sense, the present work aims at elucidating this communication between hASCs and human keratinocytes (hKC) and determining the extent of its mediation by KGF. In an in vitro scratch assays we showed that the secretome of hASCs in contact with hKC promotes cell migration and closure of the scrape. Moreover, when KGF-antibody was added diminished hKC migration was observed, suggesting that KGF might be one of the key cytokines involved in the interaction with hASCs. Furthermore, in order to assess the communication via gap junctions (GJ), a calcein-AM transfer assay was carried out in the presence/absence of a GJ inhibitor. The transference of the dye from hASCs to adjacent hKC, confirmed both by fluorescence microscopy and flow cytometry, showed that these cells also communicate via GJ. Moreover while hKCs expressed connexin (cx)43 and cx26, highly expressed at the wound margins, hASCs were only positive for cx43  as shown by immunocytochemistry and flow cytometry. Finally, the direct communication between transplanted hASCs cell sheets and hKC at the wound margins is being addressed in a human ex-vivo skin model with an artificial wound, to better mimic the previous in vivo conditions and confirm our hypothesis. So far we were able to demonstrate that hASCs and hKCs communicate directly through cx43 and indirectly via KGF secreted by hASCs, which promote KCs migration. (1)       Cerqueira, M. T.; Pirraco, R. P.; Santos, T. C.; Rodrigues, D. B.; Frias, A. M.; Martins, A. R.; Reis, R. L.; Marques, A. P.; Cerqueira   Pirraco, RP,  Santos, TC,  Frias, AM,  Martins, AR,  Reis, RL, Marques, AP, M. T. Biomacromolecules 2013, 14, 3997â 4008.    Portuguese Foundation for Science and Technology (FCT) for MTC (SFRH/BPD/96611/2013),RPP(SFRH/BPD/101886/2014)info:eu-repo/semantics/publishedVersio

Haemostasis in Open Carpal Tunnel Release: Tourniquet vs Local Anaesthetic and Adrenaline

Open carpal tunnel release is one of the commonest performed procedures in hand surgery. We performed a prospective randomised control trial to compare the efficacy and patient satisfaction of the traditional arm tourniquet versus infiltration of adrenaline and local anaesthetic solution to achieve haemostasis during the procedure. Using a combination of objective and subjective measures we concluded that infiltration of local anaesthetic and adrenaline not only provided adequate haemostasis but also provided a significantly more tolerable experience for the patient during the procedure

Haemostasis in Open Carpal Tunnel Release: Tourniquet vs Local Anaesthetic and Adrenaline

Open carpal tunnel release is one of the commonest performed procedures in hand surgery. We performed a prospective randomised control trial to compare the efficacy and patient satisfaction of the traditional arm tourniquet versus infiltration of adrenaline and local anaesthetic solution to achieve haemostasis during the procedure. Using a combination of objective and subjective measures we concluded that infiltration of local anaesthetic and adrenaline not only provided adequate haemostasis but also provided a significantly more tolerable experience for the patient during the procedure

Diagnosis of aortic graft infection : a case definition by the management of aortic graft infection collaboration (MAGIC)

Objective/Background The management of aortic graft infection (AGI) is highly complex and in the absence of a universally accepted case definition and evidence-based guidelines, clinical approaches and outcomes vary widely. The objective was to define precise criteria for diagnosing AGI. Methods A process of expert review and consensus, involving formal collaboration between vascular surgeons, infection specialists, and radiologists from several English National Health Service hospital Trusts with large vascular services (Management of Aortic Graft Infection Collaboration [MAGIC]), produced the definition. Results Diagnostic criteria from three categories were classified as major or minor. It is proposed that AGI should be suspected if a single major criterion or two or more minor criteria from different categories are present. AGI is diagnosed if there is one major plus any criterion (major or minor) from another category. (i) Clinical/surgical major criteria comprise intraoperative identification of pus around a graft and situations where direct communication between the prosthesis and a nonsterile site exists, including fistulae, exposed grafts in open wounds, and deployment of an endovascular stent-graft into an infected field (e.g., mycotic aneurysm); minor criteria are localized AGI features or fever ≥38°C, where AGI is the most likely cause. (ii) Radiological major criteria comprise increasing perigraft gas volume on serial computed tomography (CT) imaging or perigraft gas or fluid (≥7 weeks and ≥3 months, respectively) postimplantation; minor criteria include other CT features or evidence from alternative imaging techniques. (iii) Laboratory major criteria comprise isolation of microorganisms from percutaneous aspirates of perigraft fluid, explanted grafts, and other intraoperative specimens; minor criteria are positive blood cultures or elevated inflammatory indices with no alternative source. Conclusion This AGI definition potentially offers a practical and consistent diagnostic standard, essential for comparing clinical management strategies, trial design, and developing evidence-based guidelines. It requires validation that is planned in a multicenter, clinical service database supported by the Vascular Society of Great Britain & Ireland