Endovascular treatment of acute type B dissection complicating graft-bypass repair for aortic coarctation

AbstractObjectivesThe early dissection of the descending aorta after the repair of aortic coarctation is very rare. Herein, we present a special endovascular technique used for acute type B dissection complicating graft bypass for aortic coarctation.MethodsThe 48 year-old male patient with the diagnosis of adult type aortic coarctation had bypass procedure between the aortic arch and the descending aorta. Six weeks after the first operation, the patient was readmitted with severe back pain and had the diagnosis of acute type B dissection which involved the descending aorta at the distal part of the graft anastomosis.ResultsTwo separate stent-grafts were deployed respectively 31 × 150 mm and 34 × 200 mm (C-TAG™ WL Gore&Asc., Flagstaff, AZ, USA). The previous Dacron bypass graft was used as a proximal landing zone for the first stent-graft. The distal landing zone for the second stent was the area between the celiac trunk and superior mesenteric artery. Therefore, the covered stent-graft was implanted to the celiac trunk (Viabahn™ 7 × 50 mm WL Gore&Asc, AZ, USA) to maintain its patency before the deployment of the second graft. The segment of coarctation was closed with a vascular plug (Amplatzer™ vascular plug II) to prevent persistent perfusion of aneurysmal false lumen.ConclusionThe endovascular approach offers multiple less invasive options based on a patient-specific problem

Intentionality in Mullā Ṣadrā

The present study reconstructs psychological, linguistic and ontological aspects of Mullā Ṣadrā’s philosophy in the light of Brentano’s theory of intentionality. Brentano used intentionality as a psychological term to denote the ‘mental’ as opposed to the ‘natural’. Later, with Meinong, intentionality took an ontological commitment to assenting that ‘there are things that do not exist’. The chapters that discuss Ṣadrā’s philosophy reflect the two aspects with an investigation for the production process of intentional objects and an investigation of the status of these objects in ontology. The main aim of the research is to give an internalist and monist account for the nature of intentionality demonstrating an alternative approach to the concepts of existence and the soul. Ontologically, there is only one reality (existence) and nothing is left outside it. Accordingly, intentional objects are mental beings that are at a lower level of existence (wujūd ẓillī). The principles behind the monist ontology are: first, the gradational ontology (tashkīk) that all things are determined beings (mutamayyiz) and they are manifestations of a single reality at different levels of intensity (mutashakkik), and, second, the simplicity principle (basīṭ al-ḥaqīqa) in which existence is a simple reality that comprehends all beings whilst being the principle of multiplicity at the same time. Accordingly intentional objects are a level of existence, and share same reality. Epistemologically, all knowledge processes including external senses are regarded as internal processes in which the causal effect of the extra-mental object is reduced to being an accidental preparatory tool and faculties for the soul. Perception is always completed with the touch of imagination and the real object of perception is internally created. The soul is not the receiver of forms, but is the active agent. Moreover, the soul undergoes substantial change as the objects are being produced. The soul is then not a container of forms. It is rather the case that the forms themselves construct the soul. The last point is that knowledge is a mode of existence. This mode of being (knowledge) indeed is the very existence of the human soul. In this explanation, the soul is neither material nor immaterial per se: the soul starts her journey as a material substance and becomes more delicate and immaterial through her journey. The soul’s journey is made possible with the preparatory role of the processes of perception. Intentionality is soul’s action of creating mental forms. The products are identical to soul since soul and knowledge are identical. Consequently, intentional objects are dependent on the soul in their presence and creation.the Ministry of National Education of the Republic of Turke

Amyloid Goiter Due to Familial Mediterranean Fever in a Patient with Byler Syndrome: A Case Report

Background: Familial Mediterranean Fever (FMF), also inherited with autosomal recessive trait, is characterized by recurrent episodes of fever, arthritis, and serositis. Congenital Byler Syndrome (Progressive Familial Intrahepatic Cholestasis) inherited with autosomal recessive trait and characterized by defective secretion of bile acids. FMF associated Amyloid A deposition occurs in many tissues and organs, but amyloid goiter is a rare entity that leads to enlargement and dysfunction of the thyroid. Case Report: We present a rare case of 24 year old male patient who had liver and kidney transplantation due to Byler Syndrome and secondary amyloidosis related to FMF, diagnosed as rapidly growing large amyloid goiter. Deposits of extracellular amyloid and dense adipose metaplasia diagnostic for amyloid goiter are determined upon histopathological examination of thyroidectomy material. Conclusion: When goiter was detected in cases with history of systemic amyloidosis and rapidly growing goitre, amyloid goiter should be remembered at first. This case is unique since two autosomal genetic disorders are together in the same patient and important as it emphasizes the consequences of consanguineous marriage, early diagnosis and treatment compliance of FMF and the awareness of amyloid goiter in patients followed by primary care physicians and healthcare professionals

Post EVAR endovascular revision of late onset stent graft collapse due to Type 1 endoleak in a complicated case with left limb occlusion and solitary kidney

Type 1 endoleak is one of the most frequent complication usually seen at the initial phase of EVAR procedure. B alloon dilatation is mostly used to oversize the proximal or the distal part of the orifice to stabilize the attachment of the graft stent to the aortic wall. Late onset of type 1 endoleak with graft stents may cause severe lumen compression of the stent and aneurysm enlargement which might cause a serious problem especially in a patient whose graft stents left iliac branch is thrombosed and the left leg is supplied by the bypass graft from right CFA. Although operation was advised by the endovascular specialists the procedure was done in our hospital as the patient preferred the endovascular method instead of open surgery

Arbitration in International Commercial Agreements: The Noose Draws Tighter

WOS: 000298822100014PubMed ID: 22166511This study aimed to examine fibroblast growth factor-19 (FGF-19) in type 2 diabetic (T2DM) patients with metabolic syndrome (MetS) and to evaluate the relationship between FGF-19 and other cardiovascular risk factors, such as atherogenic index of plasma (AIP) and hsCRP. 26 T2DM patients with MetS and 12 healthy controls were enrolled in the study. Serum FGF-19 levels were measured by sandwich ELISA, and compared with other cardiovascular risk factors; lipid profile, AIP, glucose, HbA1c, and hsCRP. AIP was calculated as log (TG/HDL-c). The median (1-3.quartile) FGF-19 levels in T2DM patients with MetS and healthy controls were 122.90 (108.63-237.60) pg/ml and 293.45 (153.64-370.31) pg/ml, respectively (P=0.003). Patients were also grouped by body mass index (BMI) = 30 kg/m(2) (n=13) with median (1-3.quartile) FGF-19 values 168.70 (113.54-275.77) pg/mL and 115.89 (97.94-200.40) pg/mL, respectively (P=0.007). Significant negative correlations were found between FGF-19 and BMI, triglyceride, log (TG/HDL-c), hsCRP, and HbA1c (r=-0.526, P=0.001; r=-0.327, P=0.05; r=-0.312, P=0.05; r=-0.435, P=0.006; r=-0.357, P=0.028, respectively). We showed that FGF-19 levels are low in T2DM patients with MerS. The negative relationship between FGF-19 and several known cardiovascular risk factors such as TG, log (TG/HDL-c), hsCRP and HbA1c in diabetic patients with MetS suggests that FGF-19 can be used as a contributing marker

Transcatheter Arterial Embolization of Nonvariceal Upper Gastrointestinal Bleeding with N-Butyl Cyanoacrylate

OBJECTIVE: To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with N-Butyl Cyanoacrylate (NBCA) for nonvariceal upper gastrointestinal bleeding. MATERIALS AND METHODS: Between March 1999 and December 2002, TAE for nonvariceal upper gastrointestinal bleeding was performed in 93 patients. The endoscopic approach had failed or was discarded as an approach for control of bleeding in all study patients. Among the 93 patients NBCA was used as the primary embolic material for TAE in 32 patients (28 men, four women; mean age, 59.1 years). The indications for choosing NBCA as the embolic material were: inability to advance the microcatheter to the bleeding site and effective wedging of the microcatheter into the bleeding artery. TAE was performed using 1:1-1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated. RESULTS: The angiographic and clinical success rates were 100% and 91% (29/32), respectively. There were no serious ischemic complications. Recurrent bleeding occurred in three patients (9%) and they were managed with emergency surgery (n = 1) and with a successful second TAE (n = 2). Eighteen patients (56%) had a coagulopathy at the time of TAE and the clinical success rate in this group of patients was 83% (15/18). CONCLUSION: TAE with NBCA is a highly effective and safe treatment modality for nonvariceal upper gastrointestinal bleeding, especially when it is not possible to advance the microcatheter to the bleeding site and when the patient has a coagulopathy