Conservative Management of Type 2 Endoleaks is not Associated with Increased Risk of Aneurysm Rupture

AbstractObjectiveEndovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) has led to a reduction in the perioperative mortality when compared with open repair. However, re-intervention for complications, such as endoleak, may be required in up to 20% of the cases. Controversy exists over the management of Type 2 endoleaks. This study examined the outcomes of patients with Type 2 endoleaks treated conservatively to inform the ongoing management debate.MethodsAll patients with a confirmed Type 2 endoleak after EVAR for an infrarenal AAA were included in the study. Data regarding device details, endoleak and time point, aneurysm sac growth, intervention and outcome were collected retrospectively from case notes and the vascular research database.ResultsForty-one Type 2 endoleaks were seen in 369 EVARs performed for infrarenal AAA between March 1994 and June 2006. Twenty-five were isolated Type 2 endoleaks and 16 occurred in conjunction with other endoleaks. Of the 25 isolated Type 2 endoleaks, 18 (72%) patients demonstrated no increase in sac size, six (24%) patients showed an enlargement of the sac and one patient was lost to follow-up. Only one patient underwent intervention for an isolated Type 2 endoleak. After a mean follow-up period of 4 years, approximately half of the patients (48%) remain under observation (with an enlarging or stable sac), whilst the others (48%) have spontaneously sealed. Only five patients under surveillance (20%) have an enlarging sac. There were no ruptured aneurysms or aneurysm-related deaths and no patients required conversion to open repair.ConclusionsIn this study, a policy of regular surveillance for Type 2 endoleaks was not associated with any adverse events. We therefore advocate the conservative approach for Type 2 endoleaks

Producción de ácido cítrico utilizando Aspergillus Niger ATTC 9642 usando lactosuero y fosfato dipotásico en fermentación sumergida

El lactosuero se ha constituido en el principal residuo de la industria láctea en nuestra localidad a pesar de los constantes esfuerzos por aprovecharlo. Nuestro presente trabajo tiene por objetivo estudiar y evaluar los efectos de lactosuero y fosfato dipotásico (K2HPO4) a diferentes concentraciones, sobre la producción de ácido cítrico por fermentación sumergida utilizando el hongo del género Aspergillus niger ATCC 9642. Los medios de fermentación fueron sometidos a condiciones de 35°C y 150 rpm por 96 h. Se evaluó la concentración de biomasa celular, el consumo de lactosa, la producción de ácido cítrico (Cp) y se estimaron los parámetros cinéticos y estequiométricos. Se aplicó un diseño experimental aleatorio con un arreglo factorial 2^K, los datos se procesaron a través del paquete estadístico Minitab 17. En el análisis estadístico se muestra que la concentración de lactosuero y K2HPO4 no se ajustan a un modelo de primer orden debidoa que en el análisis de Pareto no superan el efecto estandarizado. Las concentraciones de lactosuero y K2HPO4 a 90%-380 ppm respectivamente, fueron las mejores. Los valores de acidez se mantuvieron en un rango de 3.8-4.9 con inoculación de Aspergillus niger de 2,6x10^6 esporas/mL en todos los medios de fermentación. El medio de fermentación con 90%lactosuero y 380ppm K2HPO4 alcanzó un pH de 4.2 en el menor tiempo (96h). Demostrando que las altas concentraciones de lactosuero y K2HPO4 favorecieron la acidificación mostrando la mayor producción (1.072 gCp/L), Y´p/s=0.03649 g/g, Qp=0.011 gCp/L*h; mientras las menores concentraciones de lactosuero y K2HPO4 mostraron menor crecimiento microbiano, menor gasto de lactosa, menor producción de ácido cítrico

Selective embolization of the internal iliac arteries for the treatment of intractable hemorrhage in children with malignancies

PurposeAcute internal hemorrhage is an occasionally life-threatening complication in pediatric cancer patients. Many therapeutic approaches have been used to control bleeding with various degrees of success. In this study, we evaluated the efficacy of selective internal iliac artery embolization for controlling acute intractable bleeding in children with malignancies.MethodsWe retrospectively evaluated the cases of 6 children with various malignancies (acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myelogenous leukemia, T-cell prolymphocytic leukemia, Langerhans cell histiocytosis, and rhabdomyosarcoma), who had undergone selective arterial embolization (SAE) of the internal iliac artery at the Chonnam National University Hwasun Hospital between January 2004 and December 2009. SAE was performed by an interventional radiologist using Gelfoam® and/or Tornado® coils.ResultsThe patients were 5 boys and 1 girl with median age of 6.9 years (range, 0.7-14.8 years) at the time of SAE. SAE was performed once in 4 patients and twice in 2, and the procedure was unilateral in 2 and bilateral in 4. The causes of hemorrhage were as follows: hemorrhagic cystitis (HC) in 3 patients, procedure-related internal iliac artery injuries in 2 patients, and tumor rupture in 1 patient. Initial attempt at conservative management was unsuccessful. Of the 6 patients, 5 (83.3%) showed improvement after SAE without complications.ConclusionSAE may be a safe and effective procedure for controlling acute intractable hemorrhage in pediatric malignancy patients. This procedure may obviate the need for surgery, which carries an attendant risk of morbidity and mortality in cancer patients with critical conditions

An investigation into candidate genes for abdominal aortic aneurysms

There is growing evidence to suggest that abdominal aortic aneurysm (AAA) is a complex disease with multiple environmental and genetic risk factors. Susceptibility genes have been investigated through multiple underpowered candidate gene studies, which has led to the association of numerous genes with conflicting evidence. This study aimed to investigate the commonly cited associations between polymorphisms of the matrix metalloproteinase-9; MMP9(-1562C>T), tissue inhibitor of metalloproteinase-1; TIMP1(+434C>T) and TIMP1(rs2070584), platelet activating factor acetylhydrolase; PLA2G7(- 994G>T), estrogen receptor beta; ESR2(+1730 A-G) and Heme oxygenase 1; HMOX1(GT)n genes and AAA in a large powered study to provide definitive evidence of any association. Materials & Methods A case-control study was performed of 1,202 patients with AAA and 1,059 screened control subjects. DNA was extracted from whole blood and genotyping was performed using polymerase chain reaction based restriction fragment length polymorphisms (PCR-RFLP). Results Two polymorphisms (ESR2 (OR 1.42, P<0.0001) and HMOX1 (OR 1.99, P<0.0001)) showed a potential association with AAA. One polymorphism (TIMP1 rs2070584) could not be genotyped despite using 2 different methods. Polymorphisms of the MMP9 (OR 0.99, P=0.82), PLA2G7 (OR 0.76, P=0.29) and TIMP1 (+434C>T) (OR 0.94, P=0.46) genes did not show an association with AAA. Conclusion We have demonstrated an association between polymorphisms of the ESR2 and HMOX1 genes and AAA, although further work is essential to confirm this association. Contrary to other published data, no such association was seen in common polymorphisms of the MMP9, TIMP1, and PLA2G7 genes and AAA