ITalian Excluder Registry and results of Gore Excluder endograft for the treatment of elective infrarenal abdominal aortic aneurysms

BackgroundTo report the midterm results of elective endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) in a multicenter, clinical unsponsored registry using the Gore Excluder endograft.MethodsThis study is a retrospective analysis of a multicenter, prospective registry that involved nine centers in Italy. Periodic clinical and radiographic follow-up with computed tomography scans were performed at 1, 6, and 12 months after the procedure, and on a yearly basis thereafter.ResultsA total of 872 patients underwent elective EVAR. Primary technical success was 97.5%, and hospital mortality was 1.0% (9/872). At least 816 (93.6%) patients underwent a follow-up control. Freedom from all-cause death was estimated to be 97.9% at 1 year, 93.4% at 3 years, and 88.5% at 5 years. Aneurysm-related mortality was 1.6% (n = 13) with only two late AAA-related deaths observed at 21 and 36 months. Significant predictors of all-cause mortality included age (P < .001) and AAA maximum diameter (P = .027). Overall conversion rate was 2.3% (n = 19). Mean elapsed time from initial intervention to surgical conversion was 23 ± 18 months (range, 0-52 months). Late rupture was detected in four (0.5%) cases: two of these patients died after conversion. The rate of any reintervention was 9.4% (n = 77); most of them were required within the first 24 months. The leading cause of reintervention was endoleak (n = 41; 5.0%). Limb thrombosis occurred in nine (1.1%) cases. Freedom from reintervention at 1, 3, and 5 years of follow-up were 98.6%, 94.6%, and 86.5%.ConclusionsThe ITalian Gore Excluder Registry is the largest clinical unsponsored registry using a single device, with the longest follow-up period so far. The present experience confirms the effectiveness of EVAR using the Gore Excluder with low rates of mortality, migration, reintervention, and limb thrombosis

Morphological evolution of discs in clusters

The recent discovery of hidden non-axisymmetric and disc-like structures in bright Virgo dwarf elliptical and lenticular galaxies (dE/dSph/dS0) indicates that they may have late-type progenitors. Using N-body simulations we follow the evolution of disc galaxies within a A cold dark matter (ACDM) cluster simulated with 107 particles, where the hierarchical growth and galaxy harassment are modelled self-consistently. Most of the galaxies undergo significant morphological transformation, even at the outskirts of the cluster, and move through the Hubble sequence from late-type discs to dwarf spheroidals. None of the discs is completely destroyed, therefore they cannot be the progenitors of ultracompact dwarf (UCD) galaxies. The time evolution of the simulated galaxies is compared with unsharp masked images obtained from Very Large Telescope (VLT) data and the projected kinematics of our models with the latest high-resolution spectroscopic studies from the Keck and Palomar telescopes

Morphological evolution of discs in clusters

The recent discovery of hidden non-axisymmetric and disc-like structures in bright Virgo dwarf elliptical and lenticular galaxies (dE/dSph/dS0) indicates that they may have late-type progenitors. Using N-body simulations we follow the evolution of disc galaxies within a Λ cold dark matter (ΛCDM) cluster simulated with 107 particles, where the hierarchical growth and galaxy harassment are modelled self-consistently. Most of the galaxies undergo significant morphological transformation, even at the outskirts of the cluster, and move through the Hubble sequence from late-type discs to dwarf spheroidals. None of the discs is completely destroyed, therefore they cannot be the progenitors of ultracompact dwarf (UCD) galaxies. The time evolution of the simulated galaxies is compared with unsharp masked images obtained from Very Large Telescope (VLT) data and the projected kinematics of our models with the latest high-resolution spectroscopic studies from the Keck and Palomar telescope

Giant Aneurysm of the Extracranial Carotid Artery: Case Report

AbstractWe report a case of giant extracranial carotid aneurysm treated by carotid aneurysmectomy. A 70-year-old female was referred with a palpable swelling on left lateral region of the neck, associated with dizziness and dysarthria. Spiral-CT scan showed a 5-cm aneurysm of the internal carotid artery (ICA), kinking of ICA and increased flow in the right vertebral artery. Angiography showed, a fusiform ICA aneurysm, with lengthening and tortuosity of intracranial vessels. An aneurysmectomy was performed with end-to-end repair of ICA. The patient was discharged on the 12 post-operative day. Twelve months after the operation, the patient showed a complete recovery from the neurological deficit and patency of ICA. We recommend surgical treatment in order to avoid rupture, thromboembolism and cerebrovascular insufficiency

Estimation of cost-of-illness in patients with psoriasis in Switzerland

BACKGROUND: Evaluation of the current clinical treatment of psoriasis in Switzerland remains to be measured with the parameters cost-of-illness and quality of life. Objective: To obtain data on out-of-pocket expenses, costs of outpatient/office-based care and inpatient care for psoriasis, and to extrapolate total costs by state of severity to the entire Swiss population. METHODS: 1200 retrospective surveys were distributed to patient members of the Swiss Psoriasis and Vitiligo Society, and 400 surveys to office-/hospital-based Swiss dermatologists. The reference year for data collection was 2005. Patients were stratified into three subgroups according to severity of disease. Costs of inpatient care were measured by the amount of hospital days of psoriatic patients from the Swiss Federal Hospital Statistics. RESULTS: 383 patient questionnaires, and 170 cases documented by 57 dermatologists were analyzed. Out-of-pocket expenses/costs for ambulatory care per patient and year ranged from CHF 600-1100 for mild psoriasis to CHF 2400-9900 for severe psoriasis. Including costs for inpatient care of approximately CHF 60 million, the total annual costs for psoriasis in Switzerland in 2004/5 amounted to approximately CHF 314-458 million. CONCLUSIONS: Moderate-to-severe psoriasis is associated with a significant impact on the quality of life and at least 4-fold higher costs than mild psoriasis, indicating the need for efficient control of the disease. This cost-of-illness study provides specific health economic data for future healthcare decision making, particularly with the advent of new therapeutic agents for effective psoriasis control

Estimation of cost-of-illness in patients with psoriasis in Switzerland

BACKGROUND: Evaluation of the current clinical treatment of psoriasis in Switzerland remains to be measured with the parameters cost-of-illness and quality of life. Objective: To obtain data on out-of-pocket expenses, costs of outpatient/office-based care and inpatient care for psoriasis, and to extrapolate total costs by state of severity to the entire Swiss population. METHODS: 1200 retrospective surveys were distributed to patient members of the Swiss Psoriasis and Vitiligo Society, and 400 surveys to office-/hospital-based Swiss dermatologists. The reference year for data collection was 2005. Patients were stratified into three subgroups according to severity of disease. Costs of inpatient care were measured by the amount of hospital days of psoriatic patients from the Swiss Federal Hospital Statistics. RESULTS: 383 patient questionnaires, and 170 cases documented by 57 dermatologists were analyzed. Out-of-pocket expenses/costs for ambulatory care per patient and year ranged from CHF 600-1100 for mild psoriasis to CHF 2400-9900 for severe psoriasis. Including costs for inpatient care of approximately CHF 60 million, the total annual costs for psoriasis in Switzerland in 2004/5 amounted to approximately CHF 314-458 million. CONCLUSIONS: Moderate-to-severe psoriasis is associated with a significant impact on the quality of life and at least 4-fold higher costs than mild psoriasis, indicating the need for efficient control of the disease. This cost-of-illness study provides specific health economic data for future healthcare decision making, particularly with the advent of new therapeutic agents for effective psoriasis control

Current Opinions in Open and Endovascular Treatment of Major Arterial Injuries in Pediatric Patient

Pediatric major arterial vascular injuries may belong to the same principal categories as adults, but have been poorly documented, with an estimated overall incidence of &lt;2% of all vascular traumas. Open surgery has been the mainstay of treatment, but no clear guidelines have been developed to recommend the best practice patterns in terms of strategy or repair as well as postoperative pharmacological regimen. Herein, we report three cases and a narrative review of the available literature regarding the main aspects when dealing with pediatric arterial injuries based on the predominant series available from the most recent published literature

Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm

OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases. METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of 6550 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter &lt;50 mm, but with &gt;50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention. RESULTS: Twenty-two patients were included in the analysis. The mean aortic diameter was 66 \ub1 26 mm (range 42-130; IQR 51-64). The in hospital TEVAR related mortality was 14% (n = 3). The mean radiological follow-up was 56 \ub1 45 months (range 6-149; IQR 12-82), and the follow-up index 0.97 \ub1 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% (n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5-93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66-95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5-95) at 1 year, and 77% (95%CI: 50-92) at 5 years. CONCLUSIONS: In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up

Spherical Accretion with Anisotropic Thermal Conduction

We study the effects of anisotropic thermal conduction on magnetized spherical accretion flows using global axisymmetric MHD simulations. In low collisionality plasmas, the Bondi spherical accretion solution is unstable to the magnetothermal instability (MTI). The MTI grows rapidly at large radii where the inflow is subsonic. For a weak initial field, the MTI saturates by creating a primarily radial magnetic field, i.e., by aligning the field lines with the background temperature gradient. The saturation is quasilinear in the sense that the magnetic field is amplified by a factor of $\sim 10-30$ independent of the initial field strength (for weak fields). In the saturated state, the conductive heat flux is much larger than the convective heat flux, and is comparable to the field-free (Spitzer) value (since the field lines are largely radial). The MTI by itself does not appreciably change the accretion rate $\dot M$ relative to the Bondi rate $\dot M_B$. However, the radial field lines created by the MTI are amplified by flux freezing as the plasma flows in to small radii. Oppositely directed field lines are brought together by the converging inflow, leading to significant resistive heating. When the magnetic energy density is comparable to the gravitational potential energy density, the plasma is heated to roughly the virial temperature; the mean inflow is highly subsonic; most of the energy released by accretion is transported to large radii by thermal conduction; and the accretion rate $\dot M \ll \dot M_B$. The predominantly radial magnetic field created by the MTI at large radii in spherical accretion flows may account for the stable Faraday rotation measure towards Sgr A* in the Galactic Center.Comment: accepted in MNRAS with some modifications suggested by the referee; 15 pages, 16 figure