Liver hydatid cyst perforated into the large bowel: a case report

Perforation of the liver hydatid cyst into hollow abdominal organs is an extremely rare complication. A case of two synchronous hydatid cysts in an old lady is presented. The patient had one multilobular cyst perforated into the right colon and another one uncomplicated located at the right ovary. She underwent partial cystectomy, omentoplasty, right hemicolectomy, and total hysterectomy, and had an uneventful recovery

Reporting of adverse events of treatment interventions in multiple myeloma: an overview of systematic reviews

The present study is an overview of systematic reviews focusing on adverse events of antimyeloma treatments. It provides a systematic description of adverse events as they are reported in the systematic reviews as well as a critical appraisal of included reviews. We conducted a comprehensive literature search in the most widely used electronic databases looking for systematic reviews that had an adverse event of an antimyeloma treatment intervention as primary outcome. Two independent reviewers conducted selection of included studies and data extraction on predesigned online forms and assessed study quality using AMSTAR 2. Overall corrected covered area (CCA) was calculated to examine the overlap of primary studies across systematic reviews. After screening eligible studies, 23 systematic reviews were included in this overview. Seven reviews with overall CCA of 14.7% examined cardiovascular adverse events of different drugs, including immunomodulatory drugs and proteasome inhibitors (mainly carfilzomib). Nine focused on infections, presenting with overall CCA of 5.8%, each one focused on a different drug or drug class. Three studied thromboembolism in patients treated either with lenalidomide, any immunomodulatory drug, or with daratumumab and had an overall CCA equal to 1.5%. Four more reviews focused on bortezomib-associated neurotoxicity, carfilzomib-associated renal toxicity, or second primary malignancies as an adverse event of lenalidomide or anti-CD38 monoclonal antibody treatment. The quality of included studies as judged by AMSTAR 2 was mostly critically low. Absence of a priori registered protocol and formal assessment of risk of bias of included primary studies were the most common shortcomings. Reporting of antimyeloma drug-associated toxicity is supported by multiple systematic reviews; nevertheless, methodological quality of existing reviews is mostly low

Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review

Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned

Reversal of induced myocardial ischemia by intramyocardial administration of angiogenic factors in a rabbit model

A considerable number of patients suffering from coronary artery disease cannot be treated medically or by conventional revascularization methods, i.e. PCI or CABG. Myocardial angiogenesis could become a more suitable therapeutic approach for these patients, but the administration of angiogenic agents basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) at high therapeutic doses has been implicated in the occurrence of side effects that may undermine their safety. The aim of this experimental study was to investigate the angiogenic effect of intramyocardial administration of recombinant human (rh) bFGF or VEGF protein, at low doses, in the ischemic rabbit myocardium. Twenty five New Zealand White rabbits were divided into 5 groups (each of them containing 5 animals) and subjected to coronary artery ligation after lateral thoracotomy inducing acute myocardial ischemia. Five minutes later, the following substances were injected intramyocardially in the ischemic area: a) normal saline (controls), b) 5μg or 10μg rhVEGF­­165 protein (group VEGF-1 or group VEGF-2, respectively), and c) 6.25μg or 12.5μg rhbFGF protein (group bFGF-1 or group bFGF-2, respectively). On the 21st post-operative day the animals were euthanized and their hearts were subjected to histopathological examination and immunohistochemical assessment of vascular density in the ischemic-infarcted area. The alkaline phosphatase-anti-alkaline phosphatase (APAAP) procedure and the primary monoclonal antibody JC70 were used. RESULTS: Histopathological examination confirmed the induction of myocardial infarction. Vascular density was significantly increased (p<0.004) in all treatment groups (mean±SE: VEGF-1=73.4±3.2, VEGF-2=89.5±5.2, bFGF-1=85.8±10.9, bFGF-2=76.6±3.7 vessels/optical field/x200) compared to the controls (58.9±4.9 vessels/optical field/x200). Vascular density in VEGF-2 group was significantly higher than that in group VEGF-1 (p<0.001). CONCLUSIONS: Low doses of VEGF or bFGF protein, when administered intramyocardially in rabbits, stimulate angiogenesis in the injured myocardial area.Ένας μεγάλος αριθμός ασθενών με στεφανιαία νόσο δεν μπορεί να αντιμετωπιστεί φαρμακευτικά, ή με τις επεμβατικές και χειρουργικές τεχνικές επαναιμάτωσης του μυοκαρδίου. Η αγγειογένεση του μυοκαρδίου θα μπορούσε να αποτελέσει μια νέα θεραπευτική προσέγγιση για την ομάδα των ασθενών αυτών. Όμως, η χορήγηση των αγγειογενετικών παραγόντων VEGF και bFGF σε υψηλές δόσεις έχει ενοχοποιηθεί για την εκδήλωση ανεπιθύμητων ενεργειών. Σκοπός της μελέτης μας ήταν η διερεύνηση της αγγειογενετικής δράσης των αυξητικών αυτών παραγόντων σε σχετικά χαμηλές δόσεις, μετά από ενδομυοκαρδιακή ένεσή τους στην πάσχουσα περιοχή. Χρησιμοποιήθηκαν 25 κουνέλια λευκής φυλής Νέας Ζηλανδίας, τα οποία χωρίστηκαν σε 5 ομάδες, των 5 ζώων η καθεμία. Όλα υποβλήθηκαν σε απολίνωση κλάδου στεφανιαίας αρτηρίας, μετά από πλάγια θωρακοτομή υπό γενική αναισθησία, προκειμένου να προκληθεί βαριά ισχαιμία του μυοκαρδίου. Πέντε λεπτά μετά την απολίνωση του αγγείου εγχορηγούντο στην πάσχουσα περιοχή, με ενδομυοκαρδιακή ένεση, 0.4 ml: α) φυσιολογικού ορού (Ομάδα Μ), β) 5 μg VEGF (Ομάδα VEGF-1) ή 10 μg VEGF (Ομάδα VEGF-2) διαλυμένου σε φυσιολογικό ορό, και γ) 6.25μg bFGF (Ομάδα bFGF-1) ή 12.5μg bFGF (Ομάδα bFGF-2) διαλυμένου σε φυσιολογικό ορό. Την 21η μετεγχειρητική ημέρα γινόταν ευθανασία των ζώων με εισπνοή ισοφλουρανίου σε υψηλή συγκέντρωση. Οι καρδιές εξάγονταν και αποστέλλονταν στο Εργαστήριο Παθολογικής Ανατομικής του ΔΠΘ, ώστε να γίνει ιστοπαθολογική εκτίμηση και καταμέτρηση των αγγείων εντός της πάσχουσας περιοχής καθώς και στα όρια αυτής. Χρησιμοποιήθηκαν η ανοσοϊστοχημική μέθοδος της αλκαλικής φωσφατάσης αντι-αλκαλικής φωσφατάσης (APAAP) και το μονοκλωνικό αντίσωμα JC70. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η ιστολογική εξέταση των παρασκευασμάτων επιβεβαίωσε τη δημιουργία εμφράγματος του μυοκαρδίου σε όλα τα ζώα. Η μέση αγγειακή πυκνότητα ήταν σημαντικά αυξημένη (p<0.004) σε όλες τις ομάδες των πειραματοζώων που δέχθηκαν τους παράγοντες (μέση τιμή±SE: VEGF-1=73.4±3.2, VEGF-2=89.5±5.2, bFGF-1=85.8±10.9, bFGF-2=76.6±3.7 αγγεία/οπτικό πεδίο/x200 μεγέθυνση) σε σύγκριση με τους μάρτυρες (58.9±4.9 αγγεία/οπτικό πεδίο/x200 μεγέθυνση). Η μέση αγγειακή πυκνότητα στην ομάδα-VEGF-2 ήταν στατιστικά σημαντικά αυξημένη σε σχέση με την αντίστοιχη στην ομάδα-VEGF-1 (p<0.001). ΣΥΜΠΕΡΑΣΜΑΤΑ: Οι χαμηλές δόσεις των αγγειογενετικών παραγόντων VEGF και bFGF, χορηγούμενες ενδομυοκαρδιακά, διεγείρουν την αγγειογένεση στο ισχαιμικό-εμφραγματικό μυοκάρδιο του κουνελιού

Re-do aortic operation in a young patient for aggressive Takayasu’s arteritis

<p>Abstract</p> <p>Takayasu’s arteritis is an inflammatory arteriopathy which involves the aorta and its major branches, causing mainly stenosis of their lumen, though aneurysmal lesions can also occur. A young female with Takayasu’s disease presented to our hospital with acute lung oedema due to severe aortic insufficiency and ascending aorta dilatation. She had already undergone distal ascending aorta and hemiarch replacement due to Standford type A aortic dissection five years ago. The patient had also undergone reconstruction of abdominal arteries’ stenoses with extraanatomical bypass. We performed a Bentall procedure with a valved conduit and implantation of the coronary ostia as buttons on the conduit. A mechanical valved graft was used instead of a bioprosthesis, due to possible early degradation of a bioprosthesis. The postoperative course was uneventful and the one year follow-up was normal. Valve-sparing aortic root replacement should be avoided in Takayasu’s arteritis due to high rate of recurrent regurgitation.</p

Experimental investigation on the bond in reinforced concrete members for monotonic loading

80 σ.Στην παρούσα διπλωματική εργασία παρουσιάζονται τα πειραματικά αποτελέσματα που έχουν προκύψει για την μελέτη της μηχανικής συμπεριφοράς της συνάφειας ράβδων οπλισμού σε στοιχεία οπλισμένου σκυροδέματος, όπως αυτά έχουν καταγραφεί στην διεθνή βιβλιογραφία. Περιγράφονται οι πειραματικές μεθοδολογίες που έχουν προταθεί για τον ποσοτικό προσδιορισμό των βασικών παραμέτρων που επηρεάζουν την συνάφεια. Στο δεύτερο μέρος της εργασίας παρουσιάζεται η πειραματική δοκιμή της δοκού για τον προσδιορισμό του καταστατικού νόμου συνάφειας - ολίσθησης, που έχει αναπτυχθεί στο εργαστήριο Δομικής Μηχανικής της Σ.Α.Τ.Μ. του Ε.Μ.Π. και εφαρμόζεται τόσο στη περίπτωση της μονότονης όσο στην περίπτωση της ανακυκλιζόμενης φόρτισης. Η πειραματική διάταξη αυτή, χρησιμοποιείται για τον προσδιορισμό των καμπύλων τάσης συνάφειας – ολίσθησης για συγκεκριμένους τύπους ράβδων FRP του εμπορίου, για την περίπτωση της μονότονης φόρτισης.The experimental results obtained on the bond-slip behavior of reinforcing bars in concrete published in the open literature during the last three decades are systematically presented and discussed. The experimental techniques developed to determine the parameters governing the bond-slip behavior of the reinforcing bars in concrete are described. In the second part of the present work, the beam test, which has been developed in the Structural Laboratory of the Rural and Surveying Department of NTUA to determine the local bond-slip curves of the reinforcing bars, for both monotonic and cyclic loading, is presented. In the framework of the present work, the above-mentioned beam test is applied to obtain the bond-slip curves for a specific type of FRP reinforcing bars subjected to monotonic loading.Ιωάννης Γ. Μπουγιούκα

Apigenin Reduces NF-κB and Subsequent Cytokine Production as Protective Effect in a Rodent Animal Model of Lung Ischemia-Reperfusion Injury

Purpose: Lung ischemia–reperfusion injury (LIRI) can complicate lung transplantation or cardiac surgery with cardiopulmonary bypass, increasing morbidity and mortality. In LIRI, pro-inflammatory cytokines are activated, reactive oxygen species are generated and nuclear factor-κB (NF-κB) is up-regulated, altering lung mechanics. We tested the effect of the flavonoid apigenin on a rodent model of LIRI. Methods: Thirty-seven Wistar rats were subjected to LIRI with or without a single or double dose of apigenin. Induction of LIRI involved sternotomy and clamping of either the left lung hilum or the pulmonary artery alone for 30 min, followed by 60 min of reperfusion. Control groups consisted of LIRI plus NaCl, a sham group and a baseline group. At the end of the experiments, both lungs were analyzed by RT-PCR, Western blot, and light microscopy. Results: In placebos, the expression levels of pro-inflammatory markers were increased in both lungs significantly, whereas NF-κB was markedly up-regulated. Administration of apigenin reduced the activation of NF-κB and the expression of TNFα, iNOS, and IL-6. These effects were observed in total lung ischemia. Histology showed greater hemorrhage and exudation in the pulmonary periphery of all groups, whereby damage was practically absent in the central lung regions of the apigenin animals. A second dose of apigenin did not outclass a single one. Conclusions: We conclude that apigenin given intraperitoneally can reduce activation of NF-κB and also attenuate the expression of TNFα, IL-6, and iNOS in a surgical model of LIRI. The surgical procedure itself can induce significant damage to the lungs