Urgent Endovascular Treatment of Iliac Artery Pseudoaneurysm in Patient with Ehlers-Danlos Syndrome: A Case Report

BACKGROUND: Ehlers-Danlos syndrome (EDS) type IV is a heritable disorder of connective tissue that is mainly associated with vascular maladies such as aneurysms, pseudoaneurysms, and dissections with or without spontaneous rupture. Historically, vascular complications in EDS IV have been treated conservatively whenever possible, due to the high morbidity and mortality after vascular interventions, whether open or endovascular. We present a case of a ruptured pseudoaneurysm of the right common iliac artery in a 18-year-old male, who was successfully treated by endovascular approach and later diagnosed with EDS type IV. CASE PRESENTATION: A 18-year-old male patient was admitted in ER with sharp pain in the right hypogastrium, hypotensive and with reduced blood parameters. Multiphasic modern computed tomography (MDCT) scan of abdomen and pelvis revealed massive ride sided pelvic and retroperitoneal hematoma. The presence of pseudoaneurysms on both common iliac arteries (CIA) was detected, with small ulcer on the right side and a focal dissection on the left side. An urgent endovascular repair of the ruptured pseudoaneurysm on the right CIA with covered stent was performed. Patient’s laboratory parameters and clinical status improved significantly within the next few days. CONCLUSIONS: Vascular repair in EDS-IV patients carries significant risk and should be indicated very carefully. Endovascular treatment for these patients is feasible and should be considered as an alternative to open surgery in some challenging cases as this one

Component interface specification in architecture description languages for behavioral validation

ASML is a company that designs, develops and produces photolithography machines, called wafer scanners, used in the process of manufacturing chips and integrated circuits. Wafer scanners are controlled by the ultra-sized TWINSCAN software, whose architecture is described in an Architecture Description Language (ADL). An ADL is a computer language describing the software architecture of a system on a certain level of abstraction. Besides the static structure of the software (i.e., software components and their interfaces through which they communicate) there are several characteristics that have to be ensured during run-time such as performance aspects and expected dynamic behavior of interfaces and components. The description of the last one can be further used for several purposes during different phases of the software design and development process. This report presents an approach to extend the ASML ADL with be havioral description of interfaces. Further, those descriptions are used in generating mocks as test-doubles applied in testing software components. The languages and the tools that were created and integrated within an ASML testing environment have been used in real test-cases. The proposed approach demonstrates that using models of dynamic behavior of interfaces reduces the effort of writing test code, and moreover it enables validating of a run-time trace against a class of valid traces contained within the behavioral description

Rectal prolapse in 89 years old woman - case report

Rectal prolapse is rear condition especially full ticnes. We present a case of 89 years old woman with rectal prolaps

Некротизирачки фасциитис на предниот абдоминален ѕид и модалитети на третман - презентација на случај

Некротизирачките мекоткивни инфекции се познати како едни од најнепосакуваните состојби во хирургијата со многу висока стапка на морталитет и инвалидитет. Според модерната номенклатура, тука спаѓа гасната гангрена, предизвикана од бактерии од родот Clostridium каде главната карактеристика е мионекрозата и обилно формирање на гас во зафатените ткива. Вториот синдром е некротизирачкиот фасциитис, кој може да биде од тип 1 – споро прогресивен, предизвикан од мешовита бактериска флора на анаероби и грам негативни аеробни бацили и тип 2 – рапидно прогресивен, предизвикан од единечна бактерија од група A Streptococci, а во поново време како предизвикувач се појавува и MRSA. Некротизирачкиот фасциитис на предниот абдоминален ѕид е многу ретка и сериозна постоперативна компликација, која за успешно лекување бара рано препознавање и агресивен третман. Морталитетот од оваа компликација се движи од 50 до 80% во светски рамки, при што најчесто како причина за смрт се јавуваат акутната бубрежна инсуфициенција, ARDS и MOF. Во нашиот случај се работи за 73-годишен пациент кај кого на ревизија, поради дехисценција на анастомозата, после десна хемиколектомија направена поради перфориран карцином на цекум лапаротомиската рана беше затворена со ретенциони шавови. Постоперативно, по кратко време, беше препознаена состојба на некротизирачки фасциитис на предниот абдоминален ѕид. Во општа анестезија, по комплетно отворање на лапоротомиската рана, беше направен интензивен дебридман на некротичното ткиво и абдоменот се остави отворен. Абдоминалните органи беа покриени со стерилни полиетиленски кеси, како една модификација на “Bogota bag dressing” без користење на вакуум дренажа. Потоа секојдневно се правеа преврски и дополнителен дебридман на некротичното ткиво. Ова беше поткрепено со интензивна антибиотска терапија, прво од широк спектар, а потоа по антибиограм. По стабилизација на состојбата, локалниот третман беше продолжен со Aquacel – Ag гази, кои беа поставени директно врз абдоминалните органи. Откако целото некротично ткиво беше отстрането, а знаците на инфекција беа смирени, што доведе до значително смалување на површината на раната и целосно повлекување на абдоминалните органи кон внатре, дефектот беше згрижен со ротационен резен, оставајќи вентрална хернија која сепак дозволува пристоен квалитет на живот. Целта на овој труд е детално запознавање со можностите и начините на третман кои во нашите услови му стојат на располагање на хирургот за успешно препознавање и третирање на ваквата состојба

Аденокарцином на почетниот дел на јејунум кај 28 годишен пациент

Аденокарцином на почетниот дел на јејунум кај 28 годишен пациен

Аденокарцином на почетен дел на јејунум кај 28-годишен пациент; презентација на случај

Примарните карциноми ја тенко црево се ретки, 1-3% од сите тумори на дигестивен траткт. Презентираме случај на 28 годишен пациент со примарен аденокарцином на почетен дел на јејунум

Treatment of Complex Perianal Fistula - Case Presentation

A perianal fistula is a pathological canal outlined with granulation tissue and lined with epitilium from anal glands that connects internal opening in the anal canal with external opening or openings at the perianal skin. We are presenting a 51 years old patient with 15 years old history of perianal fistula. On preoperative evaluation by passing a probe trough the fistulous canal and entering the internal opening at the posterior midline it was concluded that the patient has a high posterior transsphincteric fistula with high blind tract. Additionally on DRE excellent resting and squeeze anal pressure were concluded. The operation was done with spinal anesthesia in a lithotomy position. Initially fistulectomy around the probe till the external sphincter was done. Then proceeded fistulotomy of the whole tissue above the probe by cutting through the whole external sphincter after it was concluded that the pressure at the anorectal ring is sufficient. The granulation tissue around the internal opening was thoroughly excised and the additional incision was made toward the coccyx for wide opening of the deep postanal space. Endotracheal tube was put in the rectum and the wound was pack eith petroleum gaze. On the 1th postoperative day the patient was aloud to eat and the tube was removed the second day when 3-4 sitz baths per day were started. On the 5th postoperative day the patient was discharged with advice for weekly visits. Approximately 5 months after the operation the wound is completely sealed and the patient has no trouble with continence for gas, liquid or solid stool. In conclusion if the pressure in the anal canal on the preoperative evaluation is sufficient it is safe to cut through the whole external sphincter posteriorly in order to make a radical operation for complex posterior perianal fistula as long as m. puborectalis is intact

Insights from the IronTract challenge: Optimal methods for mapping brain pathways from multi-shell diffusion MRI

Limitations in the accuracy of brain pathways reconstructed by diffusion MRI (dMRI) tractography have received considerable attention. While the technical advances spearheaded by the Human Connectome Project (HCP) led to significant improvements in dMRI data quality, it remains unclear how these data should be analyzed to maximize tractography accuracy. Over a period of two years, we have engaged the dMRI community in the IronTract Challenge, which aims to answer this question by leveraging a unique dataset. Macaque brains that have received both tracer injections and ex vivo dMRI at high spatial and angular resolution allow a comprehensive, quantitative assessment of tractography accuracy on state-of-the-art dMRI acquisition schemes. We find that, when analysis methods are carefully optimized, the HCP scheme can achieve similar accuracy as a more timeconsuming, Cartesian-grid scheme. Importantly, we show that simple pre-and post-processing strategies can improve the accuracy and robustness of many tractography methods. Finally, we find that fiber configurations that go beyond crossing (e.g., fanning, branching) are the most challenging for tractography. The IronTract Challenge remains open and we hope that it can serve as a valuable validation tool for both users and developers of dMRI analysis methods

Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis

Background and Objectives People with multiple sclerosis (MS) are a vulnerable group for severe coronavirus disease 2019 (COVID-19), particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. Methods Data from 12 data sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl fumarate, glatiramer acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other DMTs) covariates were queried, along with COVID-19 severity outcomes, hospitalization, intensive care unit (ICU) admission, need for artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression adjusted for age, sex, MS phenotype, and Expanded Disability Status Scale (EDSS) score. Results Six hundred fifty-seven (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analyzed. Among suspected plus confirmed and confirmed-only COVID-19, 20.9% and 26.9% were hospitalized, 5.4% and 7.2% were admitted to ICU, 4.1% and 5.4% required artificial ventilation, and 3.2% and 3.9% died. Older age, progressive MS phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl fumarate, ocrelizumab and rituximab were associated with hospitalization (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.01-2.41; aOR 2.43, 95% CI 1.48-4.02) and ICU admission (aOR 2.30, 95% CI 0.98-5.39; aOR 3.93, 95% CI 1.56-9.89), although only rituximab was associated with higher risk of artificial ventilation (aOR 4.00, 95% CI 1.54-10.39). Compared to pooled other DMTs, ocrelizumab and rituximab were associated with hospitalization (aOR 1.75, 95% CI 1.29-2.38; aOR 2.76, 95% CI 1.87-4.07) and ICU admission (aOR 2.55, 95% CI 1.49-4.36; aOR 4.32, 95% CI 2.27-8.23), but only rituximab was associated with artificial ventilation (aOR 6.15, 95% CI 3.09-12.27). Compared to natalizumab, ocrelizumab and rituximab were associated with hospitalization (aOR 1.86, 95% CI 1.13-3.07; aOR 2.88, 95% CI 1.68-4.92) and ICU admission (aOR 2.13, 95% CI 0.85-5.35; aOR 3.23, 95% CI 1.17-8.91), but only rituximab was associated with ventilation (aOR 5.52, 95% CI 1.71-17.84). Associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Stratification by age, MS phenotype, and EDSS score found no indications that DMT associations with COVID-19 severity reflected differential DMT allocation by underlying COVID-19 severity. Discussion Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab with increased risk of hospitalization, ICU admission, and need for artificial ventilation and of ocrelizumab with hospitalization and ICU admission. Despite the cross-sectional design of the study, the internal and external consistency of these results with prior studies suggests that rituximab/ocrelizumab use may be a risk factor for more severe COVID-19