Arterio-Venous Fistula Using Nonpenetrating Titanium Clips (VCS)

Rezumat Fistulã arterio-venoasã cu clipuri metalice nepenetrante Accesul vascular la hemodializã este însoåit în continuare de o morbiditate foarte mare. Tromboza datoratã hiperplaziei neointimale este una din principalele cauze de nefuncåionalitate a accesului vascular. Scopul lucrãrii este de a prezenta tehnica realizãrii anastomozei arterio-venoase folosind clipurile de titan nepenetrante(VCS) şi rezultatul acesteia. Material şi metodã: Pacientului K.L. de 47 ani aflat în evidenåa Clinicii de Nefrologie din 2005 pentru insuficienåã renalã cronicã i s-a efectuat în octombrie 2006 o fistulã arteriovenoasã clasicã între artera radial şi vena cefalicã a antebraåului. Aceastã fistulã nu a funcåionat motiv pentru care în ianuarie 2007 s-a efectuat anastomoza arterio-venoasã cu clipuri de titan nepenetrante între artera brahialã şi vena medianã a antebraåului. Rezultate: Anastomoza a fost realizatã în 17 minute. Dupã declamparea arterelor s-a obåinut puls şi tril la nivelul venei mediane a antebraåului şi la nivelul venei cefalice. Nu au fost complicaåii intraoperatorii şi postoperatorii imediate. La 5 sãptãmâni postoperator s-a efectuat prima hemodializã. Fistula este funcåionalã la 58 de luni de la efectuarea ei. Concluzii: Realizarea anastomozelor arterio-venoase pentru acces la hemodializã cronicã cu material nepenetrant poate fi o soluåie de reducere a complicaåiilor postoperatorii şi de prelungire a patenåei fistulelor. Cuvinte cheie: hemodializã, fistulã arterio-venoasã, clipuri de titan nepenetrante Abstract Vascular access in haemodialysis is still accompanied by a high morbidityrate. Neointimal hyperplasia due to thrombosis is one of the main causes of vascular access failure. The purpose of this paper is to present the use of non-penetrating titanium clips (VCS) forthe creation of an arteriovenous fistula and its outcome. Materials and Methods: A male patient, 47 years old, with end-stage renal disease -ESRD -(2005) was addressed to our service, for a vascular access reintervention, after a failed forearm radio-cephalic fistula performed 3 months before. In January 2007, an arteriovenousfistula between thebrachial artery and themedian cubital vein using non-penetratingtitanium clips (Anastoclip VCS) was created. Results: The vascular anastomosis was performed in 17 min. After unclamping the artery, a solid pulse and consistent thrill were obtained at the level of the cubital fossa. The postoperative course was uneventful. The arteriovenous fistula remains functional 60 months post-surgery. Conclusions: The Anastoclip VCS system is versatile, safe to manipulate and enables fast anastomosis. Arteriovenous anastomosis performed with non-penetrating clips may be a solution with the potential to reduce postoperative complications and extend arteriovenous fistula patency in ESRD

False positive results of real-time elastography in the diagnosis of thyroid nodal lesions

Victor Babes University of Medicine and Pharmacy, Timisoara, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: L’élastographie en temps réel est une méthode de diagnostic qui ajoute de la qualité dans le diagnostic des lésions nodulaires thyroïdiennes. La méta-analyse actuelle suggère une bonne performance diagnostique avec une spécificité générale de 80% et une sensibilité générale de 85%. La présente étude est une analyse rétrospective des causes les plus fréquentes de faux negatifs et faux positifs résultats rencontrés dans l’échographie thyroïdienne. Matériel et méthodes: Nous avons analysé 433 des lésions nodulaires, opérés et évaluées par l’échographie de la thyroïde classique et l’élastographie, avec la même sonde linéaire, multifréquence, Hitachi Preirus machine, Hitachi Inc., Japon. Les résultats de l’échographie n’ont pas été communiqués au pathologiste. Une analyse rétrospective des résultats a été réalisée. Résultats: Nous avons évalué 433 cas avec des nodules avec un volume moyen de 2,14 ml (allant de 0,78 ml à 10,45 ml). 134/433 cas ont été identifiés avec un cancer de la thyroïde, 251/434 étant bénignes. La sensibilité de l’élastographie était de 82,02%, la spécificité de 83,94%, la précision de 83,37%. Nous avons observé 48 cas de lésions bénignes, identifiées par l’élastographie comme des lésions suspectes – 23/48 lésions avec de cellules Hürthle, sans maladies vasculaires, 8/48 lésions prolifératives potentiellement incertaines, 5/48 prolifération folliculaire, 8/48 thyroïdite myxomateuse / granulomateuse et 12/48 cas de maladie thyroïdienne auto-immune. Nous avons également noté 24 résultats faussement négatifs: 19/24T microcarcinomes papillaires, 5/25 carcinomes folliculaires. Être mentionné que les microcarcinomes qui ont été observés dans les nodules, ont de diamètres supérieurs à 3,5 cm. Conclusions: Les proliférations de cellules Hürthle et les microcarcinomes papillaires sont les conditions pour faux diagnostic le plus fréquent chez l’élastographie de la thyroïde.Introduction: Real-time elastography is an imaging method that adds quality to the diagnosis of nodular thyroid lesions. Meta-analysis data suggest a good diagnostic performance with an overall specificity of 80% and sensitivity of 85%. The present study is a retrospective analysis of the most common causes of false negative and false positive results encountered in thyroid ultrasound. Material and methods: We analyzed 433 nodular lesions, operated and evaluated by classical thyroid ultrasound and elastography, using a linear probe on a Hitachi Preirus machine, Hitachi Inc., Japan: The results of the ultrasound were not communicated to the pathologist. A retrospective analysis of the results was performed. Results: We evaluated 433 thyroid nodules with an average volume of 2.14 ml (ranging from 0.78 ml to 10.45 ml). 134/433 cases were identified with thyroid cancer and 251/434 were identified as benign lesions. The sensitivity of the elastography was 82.02%, the specificity – 83.94%, the accuracy being 83.37%. We observed 48 cases of benign lesions, identified by elastography as suspicious lesions : 23/48 – lesions with Hürthle cells, without vascular diseases, 8/48 – proliferative lesions potentially uncertain, 5/48 – follicular proliferation, 8/48 – myxomatous / granulomatous thyroiditis and 12/48 cases of autoimmune thyroid disease. We also noted 24 false negative results: 19 / 24 – papillary microcarcinomas, 5/25 – follicular carcinomas. Of note is that microcarcinomas that have been observed in nodules, had > 3.5 cm in diameter. Conclusions: Hurtle cell proliferations and papillary microcarcinomas are the most common misdiagnosed conditions in thyroid elastography

Clinically Considerations About Induced Experimental Periodontitis in Rats Treated by Photodynamic Therapy

Periodontitis is a chronic inflammatory condition that affects the soft and hard tissue supporting the tooth, favoring the adhesion of bacteria that can generate dental laxity and bone resorption. This study aimed to test an experimental protocol for inducing periodontitis which allows a close clinical assessment and to evaluate the effectiveness of a photodynamic therapy (PDT) protocol to reverse the associated clinical signs. Fifteen Wistar male rats were used for this study, divided into three equal groups. Tooth scaling, rooting and planning of the first superior left molar were performed in all rats, causing the displacement of the gingiva in order to create an accumulation of plaque. A 5-0 cotton ligature was placed, provoking an inflammatory response removed after ten days. One group received one session of PDT; another group received 3 PDT; the last one represented the control group, with no treatment. Clinical evaluation was represented by assessing the body weight, mobility index and bleeding. A rat grimace scale was used to determine the pain. The results showed clinical aspects of periodontitis and healing tissue proved microscopically. The tested procedure can provide all the key biological factors present in periodontal disease and an option for reversing the clinical aspects

Monoamine oxidases contribute to endothelial dysfunction of the vascular access in hemodialysis patients

OBJECTIVES Arteriovenous fistulas (AVF) are the 'lifeline' for patients with terminal end-stage renal disease (ESRD) on chronic hemodialysis. AVF maturation failure is a poorly understood process, and is partially caused by endothelial dysfunction due to oxidative stress. Monoamine Oxidases (MAOs) A and B were recently identified as novel sources of vascular oxidative stress. AIM To assess the contribution of MAOs to endothelial dysfunction in patients with ESDR with indication of hemodialysis. MATERIALS AND METHODS Fragments taken from brachial artery collaterals were harvested from ESRD patients during the surgical procedure that was applied in order to create the AVF in the cubital fossa. The effect of the irreversible MAO-A inhibitor clorgyline (10 µmol/L) and irreversible MAO-B inhibitor selegyline (10 µmol/L) on endothelialdependent relaxation (EDR) in response to cumulative doses of acetylcholine was studied in isolated phenylephrine-preconstricted rings in the presence of diclofenac (10µmol/L). H2O2 production was analyzed using ferrous oxidation xylenol orange assay. MAO expression was assessed by quantitative PCR. RESULTS We showed that both MAO isoforms are expressed in the brachial artery collaterals. Incubation with MAO inhibitors significantly improved EDR and attenuated H2O2 generation in the vascular segments. CONCLUSIONS MAO-related oxidative stress might contribute to the primary dysfunction/lack of maturation of the AVF and MAO inhibitors could improve vascular access maturation and longevity in dialysis patient

AMARANTHUS PLANT – BETWEEN MYTH AND USAGE

Plant species from Amaranthus genus are extremely important from many points of view: from an historical point of view, they were mentioned in ancient cultures such as Inca or Ancient Greece; from a nutritional point of view, they have many usages as food sources or drinks in many cultures from all around the globe; from a cultural point of view, they have been an inspiration source for numerous poets; from an economic point of view, some are used as natural pigments. The present article shortly presents the mythology associated with Amaranthus genus, the usages of its different species as well as the inventory of plates present in INCDS Herbarium from Bucharest

CHLOROPHYLL AND CAROTENOIDS PIGMENTS FROM MISTLETOE (Viscum album) LEAVES USING DIFFERENT SOLVENTS

Abstract. European mistletoe (Viscum album L., family Santalaceae) is native from Europe and is an evergreen, perennial, hemiparasitic shrub that lives on a wide range of woody plants species. In the first part of this study we present the area, length and width of the leaves of five varieties of Viscum album subsp. album that are growing on five different host trees (Acer campestre, Mallus domestica, Fraxinus excelsior, Populus nigra and Robinia pseudoacacia), in order to observe if there are vegetative morphology changes within the same specie (V. album) due to host plant. In the second part, chlorophyll a, chlorophyll b and the total amounts of carotenoids in mistletoe extracts, that was harvesting on February were determined. The buffered aqueous 80% acetone, DMF and methanol were used as solvents. The contribution of these solvents to the extraction of assimilatory pigments and the time of extraction (24, 48 and 72 hours) was examined comparatively. We find, also, the difference between the mistletoe that are growing on different host trees. The highest level of total chlorophyll (a + b), after 48 hours of extraction, were observed in the case of VaM extract, in all the solvents used (21.92 mg/g fresh leaves, in the case of methanol; 20.45 mg/g fresh leaves, in the case of acetone and 16.00 mg/g fresh leaves in the case of DMF). The low concentration of pigments were recorded in the case of VaP extract (15.23 mg/g fresh leaves in methanol extract). It was observed that methanol is the best solvent for chlorophyll, while acetone is a better solvent for the carotenoids

CONTRIBUTION OF MONOAMINE OXIDASES TO VASCULAR OXIDATIVE STRESS IN PATIENTS WITH END-STAGE RENAL DISEASE REQUIRING HEMODIALYSIS

Arteriovenous fistula (AVF) is the 'life line' for patients with end-stage renal disease (ESRD) undergoing hemodialysis. AVF maturation failure is a poorly understood process, one of the contributors being endothelial dysfunction due to oxidative stress. Monoamine oxidases (MAOs) A and B were recently identified as novel sources of vascular oxidative stress. The aim of the present study was to assess the contribution of MAOs to the endothelial dysfunction in patients with ESDR with indication of hemodialysis. Fragments of brachial artery collaterals were harvested from ESRD patients during the surgical procedure aimed at creating the vascular access in the cubital fossa. The effect of increasing concentrations (10, 30, 100 Âľmol/L) of the irreversible MAO-A inhibitor, clorgyline and MAO-B inhibitor, selegyline, respectively on endothelial-dependent relaxation (EDR) in response to cumulative doses of acetylcholine was studied in isolated phenylephrine-preconstricted vascular rings. Hydrogen peroxide (H2O2) production was assessed using ferrous oxidation xylenol orange assay. We showed that incubation of brachial rings with MAO inhibitors significantly improved EDR and attenuated H2O2 generation in patients with ESRD. MAO-related oxidative stress might contribute to the primary dysfunction/non-maturation of the AV fistula and MAO inhibitors could improve maturation and long-term patency of the vascular access in dialysis patients.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author