Successful endovascular treatment of intralobar pulmonary sequestration : an effective alternative to surgery

Introduction: Pulmonary sequestration is a rare congenital malformation characterised by the presence of non-functional and dysplastic pulmonary tissue that lacks communication with the tracheobronchial tree and has an aberrant non-pulmonary blood supply. Depending on its location, presence of the pleura covering, and venous drainage, 2 forms of pulmonary sequestration have been described: intra- and extralobar. Traditionally, surgical resection was performed; however, a growing number of cases have been treated with endovascular intervention. Case report: A 38-year-old female patient was admitted to the hospital with severe haemoptysis for several hours. Examination at admission revealed tachycardia and tachypnoea. Computed tomography-examination disclosed the presence of an area of consolidation in the left lower lobe with a tortuous feeding artery arising from the descending aorta. Visible ground glass opacification indicated diffuse alveolar haemorrhage. Based on these findings, a diagnosis of intralobar sequestration of the left lung was made. The patient was consulted by a cardiothoracic surgeon and an interventional radiologist and qualified for endovascular treatment. In local anaesthesia femoral access was obtained and selective angiography of the common trunk of both bronchial arteries was performed. It depicted a dilated left bronchial artery supplying the sequestration and visible contrast extravasation. Embolisation of the vessel was performed with Glubran (n-butyl-cyanoacrylate). Control contrast injection showed complete elimination of the sequestration’s blood supply with no residual capillary blush. Clinical improvement was observed. No complications were encountered, and the patient was discharged 7 days after the procedure. Conclusions: Arterial embolisation is a promising alternative to surgery in the treatment of symptomatic pulmonary sequestration

Endovascular embolization of renal cell carcinoma in a patient with solitary kidney

Background: Kidney tumors account for about 3% of tumors in adults. The primary therapy of renal cancer is the surgical removal. Traditionally, and also modern procedures are performed to remove the kidneys, especially when the tumor involves the entire kidney. In the cases of unresectable tumors embolization is used as a palliative procedure. Case Report: The aim of this study is to present the case of endovascular treatment of renal cell carcinoma in patient with solitary kidney. 77-years old patient had an ultrasound examination because of the pain in left lumbar region. MRI confirmed the presence of tumor size 29×45 mm in the left kidney. The right kidney had been removed eight years earlier because of clear cell carcinoma. Histopathological diagnosis was renal clear cell carinoma. The patient did not consent to surgical treatment. Tumor embolization was proceeded as a minimally invasive procedure. Pathological tumor vessels were closed using particles filling the entire vascular tumor. Next, the blood vessels supplying the tumor were closed using a mixture of lipiodolu and glubranu. Control angiographiy of the left renal artery confirmed the effective closure of all vascular pathology. In a recent ultrasound examination which was done 15 months after surgery no evidence of vascular pathology was found. Conclusions: Embolization of kidney cancer in particular cases may be an alternative way of treatment and give a good result in the form of stopping the growth of the tumor with simultaneous retaining the remaining parenchyma and renal function

Acute renal artery stenting recovered renal function after spontaneous rupture of renal artery aneurysm : case report

Purpose: Renal artery aneurysms (RAAs) are a rare vascular pathology with an estimated prevalence of 0.1% to 2.5%. Rupture of RAA is an extremely unusual cause of acute flank pain and haemodynamic instability with acute kidney failure and high mortality rate (20%). Case report: A 37-year-old male with no relevant history presented to the Emergency Room with acute right flank pain. Initial examination revealed BP 90/60 mm Hg and tachycardia. Initial blood testing was unremarkable, with a haemoglobin level of 9.4 g/dl. Urinalysis revealed moderate blood. Ultrasound (US) examination depicted aneurysm of the right renal artery 6 x 6 cm, with signs of blood extravasation visible in colour and power Doppler. The patient was referred for urgent computed tomography angiography, which revealed active bleeding from the ruptured aneurysm with haematoma spreading into the right retroperitoneum. He was subjected to emergency endovascular treatment. The patient was treated by successful implantation of a Viabahn stent (GORE, Daleware, USA). Selective nephrography revealed lack of flow through one of the segmental arteries resulting from vasospasm due to the placement of the guiding wire necessary for safe stent implantation. Conclusions: The authors present a rare case of spontaneous RAA rupture in a young male successfully treated with endovascular methods. Stent implantation required selective catheterisation of segmental arteries of the kidney, which resulted in the loss of one of them. However, control Doppler US disclosed no ischaemia and successful exclusion of the aneurysm

Role of electronic factor in soot oxidation process over tunnelled and layered potassium iron oxide catalysts

This paper describes the investigations of the catalytic activity in soot oxidation over well-defined iron oxide based materials. The nanostructuration of iron oxide by potassium into tunnelled (KFeO 2 ) and layered (K 2 Fe 22 O 34 ) ferrites and the surface promotion with CeO 2 results in the marked increase in the catalytic activity (decrease of the ignition temperature down to 210 ° C and T 10 % to 310 ° C). The measurements of the catalysts work function showed that both nanostructuration and surface promotion with ceria of the best KFeO 2 phase led to increase of the electron availability (decrease of the work function). Strong correlation of the catalytic activity in soot combustion of the Ce–K–Fe–O systems with the work function value was revealed for the first time in the model studies, and can be used as a guideline for optimisation of the real catalytic filters

Embolization in post-traumatic epistaxis

Wstęp. Krwawienie z nosa (epistaxis) często występuje po urazach twarzoczaszki, które prowadzą do uszkodzenia gałęzi tętnicy szyjnej zewnętrznej. W zależności od nasilenia krwawienia, jego miejsca oraz doświadczenia ośrodka stosuje się leczenie zachowawcze, chirurgiczne lub wewnątrznaczyniowe. Celem pracy jest ocena możliwości i skuteczności embolizacji wewnątrznaczyniowej u chorych z krwotokiem z nosa w następstwie urazu twarzoczaszki. Materiał i metody. Badaniem objęto 22 chorych (15 mężczyzn i 7 kobiet) w wieku 21–64 lat (średnia 41 lat) z pourazowym krwotokiem z nosa. U 13 osób stwierdzono angiograficznie w obrębie gałęzi tętnicy szyjnej zewnętrznej obecność tętniaka rzekomego, u 6 wynaczynienie się środka cieniującego, a u 3 chorych — przetokę szyjno-jamistą. U 3 pacjentów po angiografii diagnostycznej odstąpiono od embolizacji ze względu na zbyt duże ryzyko zabiegu. U 19 pozostałych zabieg embolizacji przeprowadzono przy użyciu koreczków z gąbki żelatynowej, cząstek alkoholu poliwinylowego, cząstek polimeru akrylowego oraz mikrospiral platynowych. Wyniki. U wszystkich embolizowanych chorych natychmiastowo opanowano krwawienie. W 4 przypadkach (20%) doszło do nawrotu krwawienia, które w 2 przypadkach opanowano poprzez ponowną embolizację. U 9 chorych (42%) wystąpiły niekorzystne objawy w postaci bólu i obrzęku twarzy, parestezji, szczękościsku, gorączki. Objawy te ustąpiły w ciągu kilku do kilkunastu dni od zabiegu. U 3 chorych (15%) wystąpiły trwałe zaburzenia czucia w obrębie policzka. U 1 pacjenta pojawiło się niewielkie owrzodzenie podniebienia, które skutecznie leczono zachowawczo. Nie zaobserwowano poważnych powikłań neurologicznych. Wnioski. Embolizacja jest skuteczną metodą leczenia krwotoków pourazowych z nosa i powinno się ją uwzględniać przy planowaniu postępowania leczniczego. Acta Angiol 2011; 17, 1: 89–97Background. Epistaxis is a common consequence of craniofacial injury involving damage to the external carotid artery branches. Conservative treatment or surgical or endovascular procedures can be applied, depending on the intensity and the site of bleeding as well as on the experience of the medical team. The applicability of endovascular embolization and its efficacy in the treatment of epistaxis following craniofacial injury are discussed in this paper. Material and methods. The study group included 22 patients (15 men, 7 women) with mean age of 41 years (range of 21–64 years), who suffered from post-traumatic epistaxis. Angiography disclosed pseudoaneurysms of the external carotid branches in 13 patients, extravasation of contrast media in 6 persons, and cavernous carotid fistulae in three patients. Based on diagnostic angiography findings, the risk related to endovascular embolization procedure was considered too high in three patients. In the remaining 19 patients, embolization was performed with the use of gelatine foam, polyvinyl alcohol, acrylic polymer, and platinum microcoils. Results. Immediate arrest of epistaxis was achieved in all embolised patients. In four cases (20%) the bleeding recurred, of which two cases were controlled with repeated embolization. Nine patients (42%) experienced adverse effects in the form of transient facial pain and swelling, paresthesiae, trismus, and fever, which regressed within several days. Three patients (15%) had permanent sensory disturbances in the cheek area. One patient developed a small ulceration of the palate, treated conservatively with success. There were no major neurological complications. Conclusions. Endovascular embolization is an effective method for managing post-traumatic epistaxis and should be considered when planning therapy. Acta Angiol 2011; 17, 1: 89–9

Early fetal cardiac scan as an element of the sonographic first-trimester screening

Early fetal cardiac scan (EFCS) is becoming an increasingly common element of the first trimester ultrasound screening carried out at 11-14 gestational weeks. It offers the first possibility to detect congenital heart defects (CHD) or, in ambiguous cases, to identify those pregnancies where a more detailed cardiac scan would be required later in pregnancy. The size of the fetal heart at the end of the first trimester and the associated relatively low image resolution make it impossible to capture all cardiac data to inform the ultimate picture. However, even at this stage, cues of anatomical and functional abnormalities can be picked up, which suggest not only a CHD, but also a likelihood of cardiovascular symptoms typical of genetic disorders. EFCS should focus on cardiac position, atrioventricular (AV) connections, AV valve function, initial assessment of ventriculo-arterial (VA) connections and the presence of red flag signs in the three vessel and trachea view (3VTV). Proper use of color Doppler mapping makes it possible to overcome the low resolution of B-mode to a certain extent. Here we present our long-term experience in EFCS

Toxicity of the bacteriophage λ cII gene product to Escherichia coli arises from inhibition of host cell DNA replication

AbstractThe bacteriophage λ cII gene codes for a transcriptional activator protein which is a crucial regulator at the stage of the “lysis-versus-lysogeny” decision during phage development. The CII protein is highly toxic to the host, Escherichia coli, when overproduced. However, the molecular mechanism of this toxicity is not known. Here we demonstrate that DNA synthesis, but not total RNA synthesis, is strongly inhibited in cII-overexpressing E. coli cells. The toxicity was also observed when the transcriptional stimulator activity of CII was abolished either by a point mutation in the cII gene or by a point mutation, rpoA341, in the gene coding for the RNA polymerase α subunit. Moreover, inhibition of cell growth, caused by both wild-type and mutant CII proteins in either rpoA+ or rpoA341 hosts, could be relieved by overexpression of the E. coli dnaB and dnaC genes. In vitro replication of an oriC-based plasmid DNA was somewhat impaired by the presence of the CII, and several CII-resistant E. coli strains contain mutations near dnaC. We conclude that the DNA replication machinery may be a target for the toxic activity of CII

Endovascular treatment of visceral artery aneurysms — a single-centre experience

Background. Visceral artery aneurysms (VAAs) are intra-abdominal aneurysms that occur in the coeliac trunk and the superior and inferior mesenteric arteries or their branches. They are uncommon vascular anomalies but can be life-threatening, with mortality ranging from 10 to 25% and up to 75% in pregnant women. Currently available treatment options include transcatheter embolisation, percutaneous implantation of covered stent, or surgical resection. The aim of our study was to demonstrate methods of minimally invasive endovascular treatment of visceral artery aneurysms and to assess their applicability and efficacy. Material and methods. Between January 2000 and September 2009, 34 patients with VAAs (aged 23–79 years) underwent endovascular treatment. Different techniques were used: 14 aneurysms were embolised with coils, covered stents were implanted in 12 patients, and in 8 cases transcatheter direct thrombin injection into the sack of the aneurysm was implemented. Results. Almost all aneurysms (33/34) were successfully excluded from the circulation. Follow-up examinations with Doppler USG or angio-CT were performed in 31 patients between 3 and 18 months after treatment. No reperfusion of aneurysmal sac was observed in any of the followed-up patients. Satisfactory results were observed in all 31 examined patients. Conclusions. Our experience shows that percutaneous treatment of visceral artery aneurysms is both safe and effective. Endovascular treatment of these lesions should be considered as the primary treatment option. Good treatment results depend on proper assessment of the aneurysm’s morphology by means of angio-CT or angiography as well as on selection of the appropriate vascular approach and endovascular technique. Acta Angiol 2011; 17, 3: 209–218Wstęp. Tętniaki tętnic trzewnych występują w pniu trzewnym, tętnicy krezkowej górnej i dolnej oraz gałęziach tych naczyń. Mimo że są rzadką patologią naczyniową, stanowią poważne zagrożenie dla życia (wskaźnik śmiertelności waha się od 10% do 25%, nawet do 75% u kobiet ciężarnych). Wśród dostępnych metod leczenia tych wad naczyniowych należy wymienić: przezcewnikową embolizację, przezskórną implantację stentów pokrywanych (stentgraftów) lub chirurgiczne wyłączenie tętniaka. Celem niniejszego badania było przedstawienie możliwości leczenia wewnątrznaczyniowego oraz ocena skuteczności tej metody leczenia. Materiał i metody. W okresie od stycznia 2000 r. do września 2009 r. 34 chorych (w wieku 23–79 lat) z tętniakami tętnic trzewnych poddano leczeniu wewnątrznaczyniowemu. Zastosowano różne metody: 14 tętniaków embolizowano za pomocą spiral, u 12 chorych implantowano stenty pokrywane, a u pozostałych 8 podano trombinę do worka tętniaka. Wyniki. Prawie wszystkie tętniaki (33/34) skutecznie wyłączono z krążenia. W okresie 3–18 miesięcy po zabiegu u 31 chorych przeprowadzono badanie kontrolne: USG metodą doplerowską lub angio-CT. U żadnego chorego nie stwierdzono napływu krwi do worka tętniaka. Wnioski. Doświadczenie autorów w leczeniu tętniaków tętnic trzewnych pokazuje, że zabiegi przezskórne są metodą zarówno skuteczną, jak i bezpieczną. Leczenie wewnątrznaczyniowe tętniaków powinno się rozważać jako pierwszą z możliwości terapeutycznych. Dobre wyniki leczenia zależą od poprawnie ocenionej morfologii tętniaka na podstawie angio-CT lub angiografii oraz właściwie wybranej metody leczenia wewnątrznaczyniowego. Acta Angiol 2011; 17, 3: 209–21

Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract

Purpose: In the present study, the effectiveness and safety of minimally invasive percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract were assessed. Material and methods: Between 2000 and 2015, 12 patients (seven women and five men, mean age 78 ± 8 years) after open cholecystectomy with common bile duct exploration and T-tube drainage underwent percutaneous extraction of residual gallstones through the T-tube tract. Results: The intervention was successful in 92% (11/12). In seven patients complete extraction of the retained gallstones was achieved, and in four cases partial extraction combined with passage of small residual fragments to the duodenum was obtained. In one case the extraction attempt was ineffective. Mild haemobilia was observed in two patients. No mortality or major complications were observed. Conclusions: Our findings are consistent with literature data and confirm that percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract is an effective and safe treatment method. Although the presented technique is not a novel approach, it can be beneficial in patients unsuitable for open surgery or laparoscopic intervention when ERCP attempt occurs ineffective or there exist contraindications to ERCP