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

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

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

Minimally Invasive Ablation Treatment for Locally Advanced Pancreatic Adenocarcinoma

Pancreatic adenocarcinoma is an aggressive tumour with an extremely poor prognosis, which has not changed significantly during the last 30 years. Prolonged survival is achieved only by R0 resection with macroscopic tumour clearance. However, the majority of the cases are considered inoperable at diagnosis due to local spread or presence of metastatic disease. Chemoradiotherapy is not tolerated by all patients and still fails to prolong survival significantly; neoadjuvant treatment also has limited results on pain control or tumour downstaging. In recent years, there has been a growing interest in the use of ablation therapy for the treatment of nonresectable tumours in various organs. Ablation techniques are based on direct application of chemical, thermal, or electrical energy to a tumour, which leads to cellular necrosis. With ablation, tumour cytoreduction, local control, and relief from symptoms are obtained in the majority of the patients. Inoperable cases of pancreatic adenocarcinoma have been treated by various ablation techniques in the last few years with promising results. The purpose of this review is to present the current status of local ablative therapies in the treatment of pancreatic adenocarcinoma and to investigate on the efficiency and the future trends

The slow dissociation rate of K-1602 contributes to the enhanced inhibitory activity of this novel alkyl-aryl-bearing fluoroketolide

Ketolides belong to the latest generation of macrolides and are not only effective against macrolide susceptible bacterial strains but also against some macrolide resistant strains. Here we present data providing insights into the mechanism of action of K-1602, a novel alkyl-aryl-bearing fluoroketolide. According to our data, the K-1602 interacts with the ribosome as a one-step slow binding inhibitor, displaying an association rate constant equal to 0.28 × 104M-1 s-1 and a dissociation rate constant equal to 0.0025 min-1. Both constants contribute to produce an overall inhibition constant Ki equal to 1.49 × 10-8M, which correlates very well with the superior activity of this compound when compared with many other ketolides or fluoroketolides. © 2015 Informa UK Ltd