Percutaneous stenting of a dissected superior mesenteric artery in a patient with previous surgical repair of Stanford type a aortic dissection

Background/Aim: We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. Description of case: The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in the acute phase of the dissection. Postoperatively, he developed non-specific abdominal pain that was not related to meals but led to weight loss of 20 kg within the first five post-operative months. Follow-up computerized tomography scan revealed a chronic subphrenic aortic dissection extending to the celiac axis (with involvement of the left gastric and the splenic artery), the left renal artery and the superior mesenteric artery (SMA). The hepatic artery took origin from the SMA and received blood from the true lumen of the vessel, and the right renal artery was entirely supplied from the true aortic lumen. After exclusion of other causes of abdominal pain, the patient was treated with percutaneous stent placement in the dissected SMA with significant improvement of his symptoms. Conclusion: This case report emphasizes the role of visceral artery endovascular techniques in the management of patients with complicated chronic aortic dissectio

Comparison of Two Reciprocating and Anatomical Single File Techniques in Cleaning Oval Anatomies

Introduction: The present study aimed to compare the capability of two single-file shaping systems in disinfecting and cleaning long oval root canals. Materials and Methods: Fifty single-rooted teeth were prepared, contaminated with Enterococcus faecalis and divided into two groups. Two samplings were obtained; S1 before chemo-mechanical preparation and S2 after the preparation. Depending on the group, chemo-mechanical preparation was performed with XP-endo Shaper (XPS) and Wave One Gold (WOG). Five teeth from each group were observed under scanning electron microscopy (1000×) to evaluate the cleanliness of root canals at 3, 6 and 9 mm from the apex. All probability (P-values) were two-tailed, statistical significance was set at 0.05 and analyses were conducted using SPSS statistical software. Results: A significant reduction in the colony forming units was observed from S1 to S2 in both tested groups. In S2, XPS group obtained significantly lower colony forming units (P<0.001). In the cleanliness study, XPS group resulted in significantly cleaner canals compared to WOG. Conclusions: Based on this in vitro study XPS system was more effective in disinfecting and cleaning long oval canals

Late migration of a covered stent into the stomach after repair of a splenic artery pseudoaneurysm

We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare

Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries

Objectives: To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries. Methods: From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery. Results: PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %. Conclusions: PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity. Key Points: • Endovascular treatment is a validated technique in post-partum haemorrhage. • Abnormal placental implantation is a risk factor for post-partum haemorrhage. • We propose an interventional radiologist standby in the delivery room. © 2015, European Society of Radiology

Percutaneous Treatment of Malignant Jaundice Due to Extrahepatic Cholangiocarcinoma: Covered Viabil Stent Versus Uncovered Wallstents

To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement

Self-adjusting file (SAF) compared to newly designed rotary and reciprocating files: composition and microstructure, microbial biofilm removal capability and shaping effectiveness.

Σκοπός αυτής της μελέτης είναι η σύγκριση του Self adjusting file (SAF) με το Wave One (WO), το BT-Race (BTR) και τις ρίνες χειρός (MAN) στη βασική τους σύνθεση μέσω της φασματοσκοπίας SEM-EDX, την ικανότητα απολύμανσης ex vivo μακρύς οβάλ σωλήνες μετά από μόλυνση με E.Faecalis μέσω καλλιεργειών και την καθαριότητα του χώρου του ριζικού σωλήνα για τα συντρίμμια και το στρώμα επιχρίσματος μέσω SEM και οπτικής μικροσκοπίας μετά από χημεικομηχανική επεξεργασίας. Τα αρχεία αναλύθηκαν μέσω φασματοσκοπίας SEM-EDX για τη βασική σύνθεση. Όλα τα εργαλεία που αναλύθηκαν περιείχαν Ni και Ti. Το WO περιείχε 52,14% κατά βάρος. του Ni και 46,79% κατά βάρος. του Ti, το SAF 51,99% κατά βάρος. του Ni και 47,12% κατά βάρος. Ti και BTR 51,49% κ.β. του Νι και 47,31% κατά βάρος. του Ti. Δεν παρατηρήθηκαν διαφορές μεταξύ των ομάδων. Για το μικροβιολογικό πείραμα συλλέχθηκαν 100 μακρά οβάλ δόντια και μετά την αρχική προετοιμασία και μόλυνση με E.Faecalis διαιρέθηκαν τυχαία σε τέσσερις ομάδες (n = 25). Πριν από τη χημεικομηχανική προετοιμασία πραγματοποιήθηκε η πρώτη μικροβιολογική δειγματοληψία (S1). Στη συνέχεια πραγματοποιήθηκε η διαμόρφωση σύμφωνα με το πρωτόκολλο κάθε εργαλείου και η δεύτερη δειγματοληψία εκτελείται στη συνέχεια (S2). Από τα αποτελέσματα στο S1 μεταξύ των ομάδων δεν παρατηρήθηκε καμία διαφορά. η μείωση από το S1 σε S2 και στις τέσσερις ομάδες ήταν σημαντική, ενώ στη σύγκριση στο S2 μεταξύ των ομάδων ο ΜΑΝ μείωσε σημαντικά λιγότερο τον αριθμό των CFU σε σύγκριση με τις άλλες ομάδες ρινών (p <0,001) και το SAF μείωσε σημαντικά λιγότερο τους αριθμούς των βακτηρίων σε σύγκριση με BTR (Ρ <0,01). Για το πείραμα καθαριότητας επιλέχθηκαν πέντε δόντια από κάθε ομάδα και διαχωρίστηκαν στον επιμήκη άξονά τους και παρατηρήθηκαν κάτω από το οπτικό μικροσκόπιο (200x) για τα συντρίμμια και κάτω από το SEM (200x και 1000x) για τα συντρίμμια και το επίχρισμα. Δύο ανεξάρτητοι εξεταστές αξιολόγησαν τα ευρήματα που αποδίδουν βαθμολογίες από 1-4. Από τις μέσες βαθμολογίες προέκυψε ότι το MAN και το SAF ήταν σημαντικά λιγότερο αποτελεσματικά από τα BTR και WO στον καθαρισμό του ριζικού σωλήνα στη μελέτη των συντριμμιών και του επιχρίσματος. Η θέση καθαρισμού ήταν η μηλική με σημαντική διαφορά με την ακροριζική. Μεταξύ των δύο τεχνικών παρατήρησης στη μελέτη των συντριμμιών δεν βρέθηκε καμία σημασία. Συμπερασματικά και τα τρία εργαλεία Ni-Ti έχουν καλύτερη απόδοση σε σύγκριση με τα χειροκίνητα. Το Self adjusting file δεν απέδωσε όσο κάλα το παλινδρομικό και το περιστρεφόμενο σύστημα διαμορφωσης. Κανένα από τα εργαλεία που δοκιμάστηκαν δεν πέτυχε τέλεια βαθμολογία στον καθαρισμό του ριζικού σωλήνα και στην απολύμανση των μακρών οβάλ σωλήνων.The aim of this study is to compare the Self adjusting file (SAF) to Wave One (WO) , BT-Race (BTR) and manual instrumentation (MAN) in their basic composition through SEM-EDX spetroscopy, the ability in disinfecting ex vivo long oval canals after E.Faecalis contamination though cultures and the cleanliness of the root canal space for debris and smear layer through SEM and Optical microscopy after chemomechanical preparation. Files were analysed through SEM-EDX spectroscopy for the basic composition. All files analysed contained Ni and Ti. The WO contained 52,14%wt. of Ni and 46,79%wt. of Ti, the SAF 51,99%wt. of Ni and 47,12 %wt. Ti and the BTR 51,49%wt. of Ni and 47,31%wt. of Ti. No differences were observed between the groups. For the microbiological experiment 100 long oval teeth were collected and after initial preparation and contamination with E.Faecalis were divided into four groups randomly (n=25). Before chemomechanical preparation the first microbiological sampling was performed (S1). Afterwards instrumentation was performed according to the protocol of each instrument and the second sampling performed afterwards (S2). From the results in S1 between the groups no difference was observed. the reduction from S1to S2 in all four groups was significant while in the comparison in S2 between the groups MAN reduced significantly less the CFU counts in comparison to the other tree groups (p<0,001) ant the SAF reduced significantly less the bacterial counts compared to BTR (P<0,01). For the cleaningness experiment five teeth from each group were selected and separated in their longitudinal axis and observed under the optical microscope (200x) for debris and under the SEM (200x and 1000x) for debris and smear layer. Two independent examiners evaluated the findings attributing scores from 1-4. From the average scores resulted that MAN and SAF were significantly less effective to BTR and WO in cleaning the root canal in the debris and smear layer study. The cleaner location was the coronal with significant difference to the apical. Between the two observation techniques in the debris study no significance was found. Concluding all three Ni-Ti instruments performed better compared to manual instrumentation. The self adjusting file did non perform as well as the reciprocating and the rotating system. None of the instruments tested achieved perfect score in cleaning the root canal and disinfecting long oval canals

Adhesive restoration of endodontically treated premolars: influence of posts on cuspal deflection

To determine, by means of a non-destructive experimental procedure, the effectiveness of adhesive restorations in reducing the cuspal deflection of endodontically treated premolars, with or without root canal fiber posts.To determine, by means of a non-destructive experimental procedure, the effectiveness of adhesive restorations in reducing the cuspal deflection of endodontically treated premolars, with or without root canal fiber posts. MATERIALS AND METHODS: The cuspal deflection of ten sound, intact maxillary premolars was evaluated. A loading device induced deformation by axial force (ranging from 98 to 294 N) applied on the occlusal surface of teeth while laser sensors registered the amount of deflection. Once tested, teeth were endodontically treated and the marginal ridges were removed. The teeth were randomly divided into two groups and restored with: group 1) dual curing adhesive, flowable composite, and microhybrid composite; group 2) the same materials associated with root canal glass fiber post and composite cement. The cuspal deflection test was repeated with the same protocol after restorative procedures, allowing a direct comparison of the same samples. Statistical analysis was performed using ANOVA at a significance level of 0.05. RESULTS: Different average cuspal deflection was detected in the two groups: composite resin with post insertion resulted in lower deformation compared with composite alone. Mean deflection ranged from 3.43 to 12.17 μm in intact teeth, from 14.42 to 26.93 μm in group 1, and from 15.35 to 20.39 μm in group 2. ANOVA found significant differences (p = 0.02). CONCLUSION: Bonded composite restorations with fiber posts may be more effective than composite alone in reducing the cuspal deflection in endodontically treated premolars in which the marginal ridges have been lost

(Z)-tert-Butyl 2-(4-amino-9H-fluoren-9-yl­idene)acetate

The title compound, C19H19NO2, obtained as an almost equimolar mixture (as shown by 1H NMR) with the E isomer through a Wittig reaction between 4-amino-9H-fluoren-9-one and the stabilized ylide Ph3P=CHCO2C(CH3)3, was obtained pure in the Z configuration following crystallization from toluene. The mol­ecule shows a planar arrangement of the ring system and the new double bond, whereas the carbonyl O atom forms a 45.1 (3)° dihedral angle with it. The mol­ecules are linked by N—H⋯O hydrogen bonds, forming cyclic structures with R 4 4(24) graph-set motifs. These motifs are connected to each other, giving rise to a sheet structure parallel to the ab plane. The linkage within the sheets is further enhanced by π–π stacking inter­actions between the fluorene units [centroid–centroid distance = 3.583 (2) Å]

Endovascular management of giant visceral artery aneurysms

Endovascular management of small visceral artery aneurysms is an established treatment with satisfactory outcomes. However, when size exceeds 5 cm visceral aneurysms are considered as “giant” (giant visceral artery aneurysms or GVAAs) and management is significantly more complex. Between August 2007 and June 2019 eleven cases of GVAAs that were endovascularly treated were retrospectively reviewed and included in this single center study. Mean size was 80 mm (± 26.3 mm) x 46 mm (+ -11.8 mm). Nine of the lesions were true aneurysms, and two were pseudoaneurysms. In 8 patients, the lesion was causing compression symptoms in the surrounding organs, one patient developed a contained rupture while 2 patients were completely asymptomatic. However, all patients were hemodynamically stable at the time of treatment. Technical success was defined as immediate complete exclusion of the aneurysmal sac, and clinical success as complete relief from clinical symptoms. Follow-up was performed with CT angiography, ultrasound and clinical examination. Mean follow-up was 45 months (range 6–84). Technical and clinical success were both 91%. Complications were one lack of control of contained rupture that was subsequently operated, one case of self-limiting non-target spleen embolization and one case of splenic abscess. Three patients died, one due to the contained rupture 15 days after procedure, the other two for other causes and occurred during the long-term follow-up. This series suggests that endovascular treatment of giant visceral artery aneurysms and pseudoaneuryms is a valid minimally invasive solution with very satisfactory immediate and long-term outcomes unless the aneurysm is already ruptured. A variety of endovascular tools may be required for successful treatment