In Vivo Feasibility of Arterial Embolization with Permanent and Absorbable Suture: The FAIR-Embo Concept

PURPOSE

Arterial embolization has been shown to be effective and safe for the management of bleeding, especially for postpartum and pelvic traumatic bleeding. We propose to evaluate the proof of concept of feasibility and effectiveness of arterial embolization with absorbable and non-absorbable sutures in a porcine model.

MATERIALS AND METHODS

In the acute setting (n = 1), several different arteries (mesenteric, splenic, pharyngeal, kidney) were embolized using non-absorbable sutures (NAS): Mersutures™ braided sutures (polyethylene terephthalate). In the chronic setting (n = 3), only lower pole renal arteries were embolized. On the right side, NAS was used, whereas on the left side embolization was realized with absorbable suture (AS): Vicryl^® braided suture (polyglactin 910). The chronic group was followed for 3 months. The pigs received contrast-enhanced CT the day before embolization (D-1), after the embolization (D0), at 1 month and 3 months after embolization (M1 and M3); digital subtraction angiography (DSA) was done at D0 and M3 and histological analysis at M3.

RESULTS

All vascular targets were effectively embolized without any pre- or postoperative complications. Both DSAs and CTs at M3 showed a 100% recanalization rate for the AS embolization and a partial reversal rate for the NAS embolization. A renal hypotrophy in the embolized region was observed during both the M1 and M3 scans for both sutures (AS and NAS) with a clear hypotrophy for the NAS embolized kidney.

CONCLUSION

Embolization by AS and NAS (FAIR-Embo) is a feasible and effective treatment which opens up the possibility of global use of this inexpensive and widely available embolization agent.

Onchocerca volvulus: microfilariae secrete elastinolytic and males nonelastinolytic matrix-degrading serine and metalloproteases

Host tissue penetration by parasitic nematodes may be mediated by both mechanical processes and proteolytic enzymes released by the parasites. Analysis of excretory-secretory (ES) products of Onchocerca volvulus microfilariae and adult stages on substrate gels demonstrated that they contain several distinct proteolytic enzymes. The analysis of the ES products of the microfilariae revealed one low and two high molecular weight proteolytic bands that degraded gelatin in substrate gels. The low molecular weight protein was found to be an elastinolytic protease cleaving soluble and insoluble elastin. ES products of males contained several high molecular weight proteases in the range of >/= 100-kDa degrading gelatin but lacked the low elastinolytic protease. The ES proteases of both developmental stages degraded the extracellular matrix proteins fibronectin, laminin, and collagen type IV, but not intact immunoglobulin G. The optimal protease activity for each of the proteases was found to be at a neutral pH. Inhibitor studies demonstrated their classification as serine and metalloproteases. Female and male extracts were able to hydrolyze azocasein but not gelatin in substrate gels. Protease activity could not be detected in ES products of females and microfilariae extract.

Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes

STUDY OBJECTIVE

Risk factors associated with treatment failure and multidrug-resistant tuberculosis (MDR-TB) were examined among HIV-seronegative patients who were previously treated for tuberculosis (TB).

DESIGN

Prospective, cohort study of patients referred to the study hospital for retreatment of TB between March 1986 and March 1990.

PATIENTS

The patients belonged to three groups, according to outcomes following their previous treatment: 37 patients who abandoned treatment or suffered relapse after completion of therapy (group A), 91 patients who failed to respond to the first-line drug regimen (group B), and 78 patients who failed to respond to the second-line drug regimen (group C).

RESULTS

Patients with Mycobacterium tuberculosis strains resistant to rifampin and isoniazid were found in 2 (6%) in group A, 29 (33%) in group B, and 49 (65%) in group C. Cure was achieved in 77% in group A, 54% in group B, and 36% in group C. Death occurred in none of the patients in group A, 8% in group B, and 24% in group C. In a multivariate logistic regression analysis, unfavorable response (failure to sterilize sputum culture, death, and abandonment) was significantly associated with infection with a multidrug-resistant M tuberculosis strain (p = 0.0002), cavitary disease (p = 0.0029), or irregular use of medications (p < 0.0001).

CONCLUSIONS

These observations show that a previous treatment outcome and current clinical and epidemiologic histories can be used to predict the development of MDR-TB and adverse outcomes in patients undergoing retreatment for TB. Such information may be useful for identifying appropriate patient candidates for programs such as directly observed therapy.