Stents in Renal Artery Bifurcation Stenosis: A Case Report

A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach

Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

Transplant renal artery stenosis (TRAS) is a well-known cause of posttransplant hypertension accompanied by possible graft dysfunction and is potentially curable when is diagnosed early. Colour Doppler Ultrasonography (CDU) is the screening procedure of choice in most studies whereas some centers employ Magnetic Resonance Angiography (MRA), if available. Although both CDU and MRA can arouse suspicion of disease in less symptomatic cases, angiographic techniques are essential for confirmation of TRAS. Percutaneous Transluminal Angioplasty (PTA) is a good and widespread therapeutic approach for the treatment of TRAS due to its acceptable complication rate and high technical success rate. The purpose of this paper is to assess the safety and efficacy of PTA in the treatment of TRAS, to compare the long-term outcomes between different reports, and to examine the role of PTA with stenting in inhibiting recurrence of the disease

Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS). Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS), whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS). 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension

Το οργανικό κριτήριο στην νομολογία για την οργάνωση και την λειτουργία αγοράς ηλεκτρικής ενέργειας

Στην ελληνική έννομη τάξη ισχύει σύστημα χωριστών δικαιοδοσιών και οι διαφορές που διέπονται από το διοικητικό δίκαιο υπάγονται στην οργανικά και λειτουργικά διακεκριμένη δικαιοδοσία των διοικητικών δικαστηρίων. Ενόψει δε της συνταγματικής κατοχύρωσης του συστήματος των χωριστών δικαιοδοσιών και της κατοχύρωσης της γενικής αρχής ότι η δικαιοδοσία ακολουθεί την ουσία της διαφοράς, ανακύπτουν διάφορα ερμηνευτικά ζητήματα, με κυριότερο την οριοθέτηση της πολιτικής από την διοικητική δικαιοδοσία και την κατανομή των διαφορών μεταξύ των δικαιοδοτικών κλάδων. Η δυσχέρεια αυτή συναρτάται άμεσα με την ασυμφωνία ως προς τα κριτήρια κατανομής των κανόνων του ουσιαστικού δικαίου μεταξύ των δύο υποσυστημάτων της έννομης τάξης, ενώ θα πρέπει επιπλέον να ληφθεί υπόψιν πόσο έχει σχετικοποιηθεί με το πέρας των χρόνων η ίδια η θεμελιώδης διάκριση μεταξύ δημοσίου και ιδιωτικού δικαίου ενόψει και της αλλαγής των αντιλήψεων για τον ρόλο του κράτους. Σε γενικές γραμμές για τον διαχωρισμό των υποθέσεων μεταξύ των δικαιοδοτικών κλάδων και την «ανίχνευση» μιας διοικητικής διαφοράς δύο κριτήρια διαδραματίζουν σπουδαίο ρόλο. Το οργανικό, το οποίο αναφέρεται στην ταυτότητα των εμπλεκομένων σε μια διαφορά μερών και το λειτουργικό κριτήριο, το οποίο συντρέχει εφόσον σε μια έννομη σχέση διαγνωστεί η άσκηση δημόσιας εξουσίας ή εξυπηρέτηση ενός άμεσου δημόσιου σκοπού. Τα δύο αυτά κριτήρια είναι κατά κανόνα συμπληρωματικά, ωστόσο εν αντιθέσει με το λειτουργικό κριτήριο, το οποίο πρέπει επίσης να συντρέχει για την διάγνωση της φύσης μιας διαφοράς ως διοικητικής, αυτό που καταρχήν καθορίζει την αρμοδιότητα των διοικητικών δικαστηρίων είναι το οργανικό κριτήριο, ήτοι η φύση των δρώντων υποκειμένων ως φορέων διοικητικής αρμοδιότητας. Έτσι στην δικαιοδοσία των διοικητικών δικαστηρίων υπάγονται μόνο διαφορές που προέρχονται από την δραστηριότητα μιας διοικητικής αρχής, ενταγμένης στο νομικό πρόσωπο του Κράτους ή στα νομικά πρόσωπα δημοσίου δικαίου ειδικών σκοπών (ΝΠΔΔ). Εξαίρεση, αλλά και ταυτόχρονα επιβεβαίωση του ως άνω κανόνα αποτελεί η θεωρία περί διφυών προσώπων, μέσω της οποίας η νομολογία σχετικοποιεί, αλλά δεν εγκαταλείπει το οργανικό κριτήριο. Η σχετικοποίηση του οργανικού κριτηρίου, δικαιολογείται ιστορικά λόγω της «εισόδου» της δημόσιας διοίκησης σε χώρο που παραδοσιακά ήταν ιδιωτικός και της συνακόλουθης διείσδυσης του ιδιωτικού δικαίου στην οργάνωση και διαχείριση των δημοσίων υπηρεσιών. Λογική δε απόρροια είναι και η, πάντοτε στο μέτρο του απολύτως αναγκαίου, διεύρυνση της διοικητικής δικαιοδοσίας και σε ορισμένα νομικά μορφώματα του ιδιωτικού δικαίου, τα οποία υπάγονται στην "Διοίκηση", θεωρούμενη με την ευρεία του όρου έννοια. Σύμφωνα με την εν λόγω θεωρία, εφόσον διαπιστωθεί ότι όργανο ενός (δημόσιου) νομικού προσώπου ιδιωτικού δικαίου (ΝΠΙΔ) λειτούργησε στο πλαίσιο της σχετιζόμενης με την διαφορά έννομης σχέσης ως φορέας δημόσιας εξουσίας και προκειμένου για την εξυπηρέτηση ενός άμεσου δημόσιου σκοπού, το τελευταίο λογίζεται ως διοικητική αρχή και κατ΄αυτόν τον τρόπο διευρύνεται η διοικητική δικαιοδοσία, ενώ παράλληλα διασώζεται το οργανικό κριτήριο, το οποίο στην ελληνική έννομη τάξη έχει συνταγματική κατοχύρωση. Η παρούσα διπλωματική εργασία με αφορμή πρόσφατη νομολογία, η οποία κατέφυγε στην θεωρία περί διφυών προσώπων όσον αφορά όχι μόνον ορισμένες από τις αρμοδιότητες των Ανεξάρτητων Διαχειριστών της αγοράς ηλεκτρικής ενέργειας (ΔΑΠΕΕΠ Α.Ε, ΔΕΔΔΗΕ Α.Ε, ΑΔΜΗΕ Α.Ε), αλλά ακόμη και την συμβατική δράση των τελευταίων, εξετάζει τα εξής ερωτήματα: α) εάν και σε ποιόν βαθμό μπορεί να δικαιολογηθεί με βάση τα παγίως γενόμενα δεκτά από την νομολογία για τα διφυή νομικά πρόσωπα και το οργανικό κριτήριο, η επέκταση της διοικητικής δικαιοδοσίας και επί των διαφορών που ανακύπτουν από την δραστηριότητα (μονομερή και συμβατική) των συγκεκριμένων μορφωμάτων του ιδιωτικού δικαίου και β) εάν η κατανομή των υποθέσεων μεταξύ των δικαιοδοτικών κλάδων με βάση το οργανικό κριτήριο και την θεωρία περί διφυών προσώπων μπορεί να ανταποκριθεί στις ιδιαιτερότητες του τομέα της ηλεκτρικής ενέργειας. Η προσέγγιση των εν λόγω ερωτημάτων, καθιστά αναγκαία την ανάλυση των νομικών εξελίξεων που έχουν επισυμβεί στον τομέα της ηλεκτρικής ενέργειας λόγω της εφαρμογής τις τελευταίες δεκαετίες πολιτικών απελευθέρωσης και ιδιωτικοποίησης σε αυτόν και την σκιαγράφηση του ρόλου των Ανεξάρτητων Διαχειριστών στην ανοικτή αλλά ρυθμιζόμενη αγορά ηλεκτρικής ενέργειας.The Greek Constitution provides a comprehensive system of administrative justice, within which disputes of an administrative nature shall without exception fall under the jurisdiction of the administrative courts. On the other hand, disputes of a civil nature shall fall under the jurisdiction of the civil courts. Since the Constitution distinguishes between two jurisdictions, the topic of civil and administrative courts and procedure has always raised challenging issues, the most important one being that of the dividing line between civil and administrative disputes. The general principle that the jurisdiction follows the substance of the dispute presupposes knowledge of the applicable law (civil or administrative) to determine the competent court (civil or administrative). That can sometimes be difficult since firstly there is not a sole criterion of administrative law and secondly the modern ideas regarding the role of the state can no longer support a division of public and private that has the same force as it did in the past. From the standpoint of Greek doctrine and jurisprudence two criteria serve in understanding the jurisdiction of the administrative courts: an organic criterion that concerns the public or private nature of the person involved in the dispute and a material criterion that concerns either the nature of the activity (is it a public service?) or the or the nature of the act adopted (did this involve the exercise of public powers?). These two criteria are complementary, but despite some uncertainties in case law, organic criterion remains the benchmark. More specifically, the Greek Council of State has always applied (since 1929) organic rather than material criteria in the assessment of administrative acts and administrative disputes in general. Nevertheless, uncertainties in case law exist. That can be attributed to the fact that the broader intervention of the Administration in economic and social life in Greece led to the multiplication of the purposes of administrative action, as well as the creation of a new type of entities, whose organization and operation are governed in principle by rules of private law. All these entities come under the “Administration”, considered in a broad sense and normally their actions can only result to the genesis of disputes of a civil nature. There is only one exception to this general principle based on a “legal fiction” that deems these entities “as public authorities”, when the legal framework, under which they operate, provides them with public power. In such a case, since they enact “as public authorities”, the judicial control over the legality of their actions belongs to the administrative courts. The main objective of this master dissertation is to answer the question of whether or not the disputes caused by the actions of the state entities that are governed by private law and operate in the electric power industry could fall under the jurisdiction of the administrative courts. This by default demands the analysis of the legal framework, under which they operate in order to detect in which cases they enact “as public authorities”. This is a really interesting topic, given the fact that within the last two decades Greece has made impressive strides in privatizing and introducing competition in the electric power industry

Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature

<p>Abstract</p> <p>Introduction</p> <p>Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.</p> <p>Case presentations</p> <p>Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.</p> <p>Conclusions</p> <p>A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.</p

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS:Systematic Review and Individual Participant Data Meta-analysis

Objective:The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores >= 7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 >= 7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID).Methods:We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 >= 7, pooled SCID major depression prevalence, and the pooled difference in prevalence.Results:A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 >= 7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times.Conclusions:Prevalence estimated based on EPDS-5 >= 7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence

Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item

Item 10 of the Edinburgh Postnatal Depression Scale (EPDS) is intended to assess thoughts of intentional self-harm but may also elicit concerns about accidental self-harm. It does not specifically address suicide ideation but, nonetheless, is sometimes used as an indicator of suicidality. The 9-item version of the EPDS (EPDS-9), which omits item 10, is sometimes used in research due to concern about positive endorsements of item 10 and necessary follow-up. We assessed the equivalence of total score correlations and screening accuracy to detect major depression using the EPDS-9 versus full EPDS among pregnant and postpartum women. We searched Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science from database inception to October 3, 2018 for studies that administered the EPDS and conducted diagnostic classification for major depression based on a validated semi-structured or fully structured interview among women aged 18 or older during pregnancy or within 12 months of giving birth. We conducted an individual participant data meta-analysis. We calculated Pearson correlations with 95% prediction interval (PI) between EPDS-9 and full EPDS total scores using a random effects model. Bivariate random-effects models were fitted to assess screening accuracy. Equivalence tests were done by comparing the confidence intervals (CIs) around the pooled sensitivity and specificity differences to the equivalence margin of δ = 0.05. Individual participant data were obtained from 41 eligible studies (10,906 participants, 1407 major depression cases). The correlation between EPDS-9 and full EPDS scores was 0.998 (95% PI 0.991, 0.999). For sensitivity, the EPDS-9 and full EPDS were equivalent for cut-offs 7–12 (difference range − 0.02, 0.01) and the equivalence was indeterminate for cut-offs 13–15 (all differences − 0.04). For specificity, the EPDS-9 and full EPDS were equivalent for all cut-offs (difference range 0.00, 0.01). The EPDS-9 performs similarly to the full EPDS and can be used when there are concerns about the implications of administering EPDS item 10. Trial registration: The original IPDMA was registered in PROSPERO (CRD42015024785)

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis

Objectives A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. Methods Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. Results Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. Conclusion Different interviews may not classify major depression equivalently

Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis

Objective:The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores >= 7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 >= 7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID).Methods:We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 >= 7, pooled SCID major depression prevalence, and the pooled difference in prevalence.Results:A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 >= 7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times.Conclusions:Prevalence estimated based on EPDS-5 >= 7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence