P10.09.B Retroelement expression in glioma tumors exhibits subtype specific patterns

Background

There are ~3 million transposable elements in the human genome constituting about 42% of all basepairs. Retroelements (REs) are ~90% of the transposable elements present in the human genome. Active REs are considered highly mutagenic and have been implicated in multiple steps of cancer development and progression, as well as in neurologic diseases. RE activity has functional effects on the genome, including the maintenance of centromere and telomere integrity, and deleterious gene expression. Previous studies have shown that certain families of RE (HERVK, L1, Alu) are expressed in gliomas, however, their specific role as arbitrators of oncogenesis or promoters of the innate anti-tumor immune response remains uncertain. Moreover, it has been shown that a soluble form of PD-L1 (sPD-L1) that blocks its inhibitory activity is produced by exaptation of an intronic endogenous retroelement (LINE-2A) in the gene encoding PD-L1, highlighting the importance of REs as potential therapeutic targets. In this analysis we aim to identify the unique patterns of RE expression across major subtypes of glioma.

Material and Methods

We conducted a differential expression analysis of 49 RE families using RNA-seq data measured in glioma tumors from The Cancer Genome Atlas (TCGA). RE counts were produced using the software REDiscoverTE. Pairwise comparisons between glioma subtypes (defined by WHO2021) were done using in 625 tumor samples adjusting for age, sex and race.

Results

10 of the 49 considered RE families exhibited significantly different (false discovery rate, FDR, <0.05) expression in at least one glioma subtype. Alu(Fold change, FC=1.5), RNA(FC=11.3), PiggyBac(FC=1.6), rRNA(FC=5.23) and Dong-R4(FC=1.8) were overexpressed in IDH-wildtype glioblastoma while Gypsy(FC=0.4) and CRP1(FC=0.26) were decreased in expression. scRNA (FC=2.7) were overexpressed in IDH-mutant oligodendroglioma compared to glioblastoma while Dong-R4 (FC = 0.53) showed decreased expression. LTR (FC=2.02) and tRNA-Deu (FC=1.46), showed increased expression in IDH-wildtype diffuse astrocytomas compared to IDH-mutant, 1p/19q-codeleted oligodendrogliomas while Gypsy (FC =0.41) showed decreased expression.

Conclusion

We have shown that expression of certain RE families within gliomas have subtype-specific patterns. While it is well established that RE expression is dysregulated in cancer, our analysis is the first at exploring a wide range of retroelements in the context of glioma by subtype. Given the important role of REs in transcriptional control, genomic instability, chromosomal rearrangements, and oncogenic activation, the identification of individual families and specific REs in glioma holds an intrinsic value to potential biomarkers and immunotherapy targets.

European Experience with a System for Bifurcated Stent-Graft Insertion

Purpose:

To test an endovascular aneurysm exclusion system in the presence of a wide range of challenging anatomic features.

Methods:

Bifurcated endovascular stent-grafts were inserted in 52 patients and followed with serial computed tomography for up to 3 years. The device underwent several modifications during this time, the most significant of which represent the difference between the homemade (n = 42) and industry-made (n = 10) versions.

Results:

The initial procedural success rate was 92% in the homemade group and 100% in the industry-made group. In the 3 years of follow-up, the long-term success rate was 64% in the homemade group and 90% in the industry-made group. The primary reasons for failure in the homemade group were graft thrombosis due to kinking early in the series and proximal stent migration later in our experience. All cases of migration occurred when the neck was < 15 mm in length, the neck was lined with thrombus, or the stent was implanted > 15 mm from the renal arteries. Kinking was subsequently overcome by implanting Wallstents throughout the graft limbs. The sole failure in the industry-made group was a case in which collateral perfusion reached the aneurysm through patent lumbar arteries.

Conclusions:

The fruits of this experience are a better technique, a better device, and, most importantly, a better understanding of the system's limits, as reflected in the current selection criteria.

First description of posterior reversible encephalopathy syndrome as a complication of glycerolnitrate patch following open cardiac surgery

BACKGROUND

Posterior reversible encephalopathy syndrome (PRES) affects predominantly the parietal and occipital lobes. Frequent clinical features are epileptic seizure, altered mental status and visual disturbances.

CLINICAL PRESENTATION

We present the first case of a patient with pericarditis and mitral valve insufficiency, who developed PRES after application of a glycerolnitrate patch day three post-operatively and whose neurological deficits improved within 2 days after withdrawal of patch therapy.

CONCLUSION

The precise pathomechanism of PRES is unknown. The lower sympathetic innervation of the posterior circulation may be one explanation for its particular vulnerability to vasodilatation caused by glycerolnitrate.

[Limits in cementless hip revision total hip arthroplasty. Midterm experience with an oblong revision cup]

Revision of an acetabular component in a patient who has severe periacetabular bone loss is a complex problem, particularly when there is not enough bone stock to allow placement of an acetabular component near the normal anatomical hip center. To fill the defect, a valuable option for revision arthroplasty is the cementless oblong revision cup (LOR).

METHODS

50 consecutive revisions of the acetabular component were performed in 48 patients. The mean age at the time of revision was sixty-one years (range, thirty-three to seventy-eight years). Forty-eight hips were available for follow-up, at a mean of thirty-two months (range, eighteen to sixty-one months). The acetabular defect classified according to Paprosky, the migration and the radiolucencies were followed radiologically.

RESULTS

8 hips (16 %) were revised again: two because of infection (4 %) and six because of instability (12 %). The revised hips are not associated to the preoperative degree of acetabular defect (34 % defect type III) (P > 0.05). The mean Harris Hip score was corrected from 36.5 (range, 7.5 to 92.5) to 78.2 points (range, 47.6 to 97.6) (P < 0.01). The mean d'Aubigné Score was corrected from 8.3 (range, 4 to 6) to 15 points (range, 10 to 18) (P < 0.01). Neither pre- nor postoperative results were associated to the degree of acetabular defect (P > 0.05). However, patients with multiple revisions had a significantly reduced clinical outcome than patients with the first revision (P < 0.05). The hip center of rotation, cranially placed to the contralateral side (0.92 cm) was corrected by the revision to a more normal anatomic rotation center (0.27 cm). Partial zonal radiolucencies, always smaller than 1.5 mm were seen in 30 % of the patients. The mean migration of the acetabular component was not significant (P > 0.05).

CONCLUSION

The authors support the use of the cementless oblong revision cup if contact can be made with host bone to more than 50 %. If this is not possible, acetabular bone reconstruction combined with a roof ring and a cemented cup is the component of choice.

Using digital certificates for radiology result receipt confirmation

The implementation of this system provides a cost-effective and easy-to-use mechanism for verifying the receipt of radiology results. This provides the radiology department with assurance that their use of internet technologies is secure, effective, and reliable. Likewise, the approach outlined can be integrated into an enterprise-wide solution for the deployment of digital certificate technologies.

Automatic generation of teaching files during routine clinical dictation

It is possible to implement a system that facilitates the automatic generation of teaching files through routine clinical dictation. While some training is required, user -specific options make the transition to this system relatively easy. Once the training and system is in place, control of the images and display of the images are done through the same dictation mechanism. Additionally, patient demographic data can be safely removed from the study information. Since the studies are readily available on the web immediately after the dictated report for the study is transcribed there is no additional time required for the radiologist to manage teaching file creation.

Results of photoprovocation and field studies on the efficacy of a novel topically applied antioxidant in polymorphous light eruption

BACKGROUND

UVA-induced photooxidation is considered to play an essential role in the pathogenesis of polymorphous light eruption (PLE), and topical pretreatment of skin with alpha-glucosylrutin (AGR), a potent plant-derived antioxidant, has been shown to significantly suppress photoprovoked PLE eruption.

AIM

In order to further elucidate the optimum pretreatment regimen and to investigate the efficacy and skin compatibility of topical preparations containing AGR under field conditions, two controlled clinical studies were conducted in PLE patients.

METHODS

In the first study, photoprovocation of PLE was performed in 20 patients, using UVA irradiation (4 x 60-100 J/cm(2)), applied to four test sites at the individual areas of predilection. One site served as an untreated control. The remaining three sites received treatment with a SPF 15 sunscreen containing 0.25% AGR (Eucerin Gel Cream Phase 2) 30 minutes before irradiation. Two of these sites were additionally pretreated with the corresponding AGR-containing vehicle (Eucerin Gel Cream Phase 1) twice daily for 3 and 7 days, respectively. The second study was conducted as a controlled in-use-test in patients with PLE (n = 27) or acne aestivalis (n = 3), who had suffered from the disease during their last year's vacation. They were educated to apply the pre-sun preparation to the formerly affected skin areas twice daily for 1 week before their planned vacation and to use the SPF 15 sunscreen 30 minutes before each vacation sun exposure. Symptoms were recorded in patients' diaries throughout the vacation and documented by a physician after their return.

RESULTS

In the first study, protection of skin with the SPF 15 sunscreen alone led to a significant prevention of PLE symptoms, especially itch, compared with the control area. Pretreatment further reduced the severity of PLE significantly and led to total prevention in 19 patients. In the second study, whereas 92.6% had reported severe and 7.4% mild PLE in the last year, there were currently only 7.4% severe cases, with 25.9% mild and 29.6% questionable cases; 37% had no symptoms at all. Also, two out of three acne aestivalis patients had diminished symptoms after treatment.

CONCLUSION

The results confirm the prophylactic efficacy of the antioxidant AGR in PLE, applied as SPF 15 sunscreen alone or additionally to pretreatment with a corresponding pre-sun preparation, and also show an effect in acne aestivalis patients.

Effect of focal and nonfocal cerebral lesions on functional connectivity studied with MR imaging

BACKGROUND AND PURPOSE

Functional connectivity MR (fcMR) imaging is used to map regions of brain with synchronous, regional, slow fluctuations in cerebral blood flow. We tested the hypothesis that focal cerebral lesions do not eradicate expected functional connectivity.

METHODS

Functional MR (fMR) and fcMR maps were acquired for 12 patients with focal cerebral tumors, cysts, arteriovenous malformations, or in one case, agenesis of the corpus callosum. Task activation secondary to text listening, finger tapping, and word generation was mapped by use of fMR imaging. Functional connectivity was measured by selecting "seed" voxels in brain regions showing activation (based on the fMR data) and cross correlating with every other voxel (based on data acquired while the subject performed no task). Concurrence of the fMR and fcMR maps was measured by comparing the location and number of voxels selected by both methods.

RESULTS

Technically adequate fMR and fcMR maps were obtained for all patients. In patients with focal lesions, the fMR and fcMR maps correlated closely. The fcMR map generated for the patient with agenesis of the corpus callosum failed to reveal functional connectivity between blood flow in the left and right sensorimotor cortices and in the frontal lobe language regions. Nonetheless, synchrony between blood flow in the auditory cortices was preserved. On average, there was 40% concurrence between all fMR and fcMR maps.

CONCLUSION

Patterns of functional connectivity remain intact in patients with focal cerebral lesions. Disruption of major neuronal networks, such as agenesis of the corpus callosum, may diminish the normal functional connectivity patterns. Therefore, functional connectivity in such patients cannot be fully demonstrated with fcMR imaging.

Active hair growth (anagen) is associated with angiogenesis

After the completion of skin development, angiogenesis, i.e., the growth of new capillaries from pre-existing blood vessels, is held to occur in the skin only under pathologic conditions. It has long been noted, however, that hair follicle cycling is associated with prominent changes in skin perfusion, that the epithelial hair bulbs of anagen follicles display angiogenic properties, and that the follicular dermal papilla can produce angiogenic factors. Despite these suggestive observations, no formal proof is as yet available for the concept that angiogenesis is a physiologic event that occurs all over the mature mammalian integument whenever hair follicles switch from resting (telogen) to active growth (anagen). This study uses quantitative histomorphometry and double-immunohistologic detection techniques for the demarcation of proliferating endothelial cells, to show that synchronized hair follicle cycling in adolescent C57BL/6 mice is associated with substantial angiogenesis, and that inhibiting angiogenesis in vivo by the intraperitoneal application of a fumagillin derivative retards experimentally induced anagen development in these mice. Thus, angiogenesis is a physiologic event in normal postnatal murine skin, apparently is dictated by the hair follicle, and appears to be required for normal anagen development. Anagen-associated angiogenesis offers an attractive model for identifying the physiologic controls of cutaneous angiogenesis, and an interesting system for screening the effects of potential antiangiogenic drugs in vivo.

Implementing a Java-based image and report distribution system in a non-picture archiving and communication system environment

The benefits and pitfalls of implementing a Java-based system to distribute results and images to referring physicians are addressed. The basic requirements for and barriers to implementing this system in a non-picture archiving and communication system (PACS) environment will also be discussed. The majority of radiology information systems (RIS) and hospital information systems (HIS) currently only distribute the text data for radiology examinations. This is generally adequate for low-acuity exams in a relatively healthy patient; however, many clinicians prefer to review images so they can correlate the reported findings with the image data, as well as review the exam themselves. A web-based solution eliminates the need for specialized review software and/or hardware at each review site. In addition, there is no need for support personnel to travel to each site to set up and upgrade software.

Pneumonectomy in cystic fibrosis

A 17-year-old boy and a 12-year-old girl with cystic fibrosis (forced expiratory volume in 1 sec, 36% and 14% of predicted values, respectively) developed severe right-sided lung infections with abscess formations and complete atelectases unresponsive to medical therapy. In both patients, unilateral emergency pneumonectomy resulted in rapid clinical improvement. Despite her severe underlying lung disease, the girl experienced a remarkable increase in quality of life; 2 years after surgery, she died from respiratory failure. The male patient has now survived for 4 years, and lung transplantation still remains a therapeutic option for him. We believe that pneumonectomy is a valuable rescue therapy for patients with cystic fibrosis and intractable unilateral lung infections who are at high risk of dying while waiting for lung transplantation.

The clinical applications of functional MR imaging

Functional MR imaging, similar to positron-emission tomography, shows the regions in which cerebral blood flow changes as neurons are active in the performance of cognitive tasks. Blood flow increases (activation) exceed that needed to supply oxygen for the increased metabolic needs for the increased neuronal activity. Therefore, in regions with activation, the deoxyhemoglobin concentration in the capillary blood decreases below levels found in the brain where neurons are not active.

Basic concepts of functional arteriovenous MR imaging malformations

This article reviews the technical features of functional MR imaging. Examples are presented demonstrating how MR imaging may be used to identify primary cortical regions adjacent to AVMs. Preliminary results suggest that cortical functions may undergo translocation when the AVM involves eloquent cortex. This finding underscores the importance of cortical mapping prior to surgical excision.

[Ambulatory sports in asthma improves physical fitness and reduces asthma-induced hospital stay]

Physical training is a well established method in the rehabilitation of patients with chronic obstructive pulmonary disease. In adult asthmatics its efficacy has been shown by intensive training programmes lasting for 2-12 weeks. No data exist on the effect of long-term physical training once a week. 31 patients (f = 24, m = 7; mean age 55 +/- 2 years; mean FEV1.0 82 +/- 4% pred.) participated in a physical training programme for at least 2 years. (8 patients had mild, 12 moderate and 11 severe asthma according to the International Consensus Report of 1993 [13]). Training time was 1 hour per week. The physical training programme consisted of breathing techniques like pursed-lip breathing and diaphragmatic exercise, progressive muscle relaxation, circuits and endurance training. According to the health insurance records 9 patients had been hospitalised for their disease two years prior to the study for a total number of 218 in-hospital days. During the 2 years of the study 2 patients had been hospitalised for a total number of 29 days (p < 0.001). A comparison group of 10 patients who did not participate in the rehabilitation programme had been hospitalised for their disease two years prior to and during the study period for a total number of 236 and 201 in-hospital days (p > 0.2). In a subgroup of 9 patients bicycle exercise testing was performed once a month and work load at a submaximal heart-rate (200-age) was recorded. During the two years mean work rate improved from 48 watts to 83 watts for 15 minutes (p < 0.01). We conclude from our findings that long-term physical training of adult patients with asthma in an outpatient setting once a week is effective in reducing hospitalisation days as well as in increasing cardiorespiratory fitness.

Bifurcated stent-graft for abdominal aortic aneurysm

The purpose of this study was to examine bifurcated stent-graft implantation for abdominal aortic aneurysm. Fifty-seven patients were treated and followed with serial computed tomography scans for up to 3 years. Patients were allocated to three groups (first 20, second 20, last 17) according to when the repair was performed. Successful treatment is defined as exclusion of the aneurysm from the circulation, based on contrast computed tomography. Success rates in the three groups were 55%, 70% and 100%. Perigraft leak (endoleak) was present on initial assessment in 4/20, 2/20 and 1/17. Two of these aneurysms ruptured early in the postoperative period. Thereafter, leaks were sought and treated aggressively. Kinking and thrombosis occurred in six of the first 20 patients, but did not occur in any of the last 37 patients, in whom the graft limbs were routinely stent-supported throughout. Infrarenal implantation in very a short neck (< 10 mm), or a thrombus-lined neck was associated with proximal stent migration. In conclusion, changes in patient selection and technique have led to a steady rise in the short-term success rate of the stent-grafted implantation.

European experience with a system for bifurcated stent-graft insertion

PURPOSE

To test an endovascular aneurysm exclusion system in the presence of a wide range of challenging anatomic features.

METHODS

Bifurcated endovascular stent-grafts were inserted in 52 patients and followed with serial computed tomography for up to 3 years. The device underwent several modifications during this time, the most significant of which represent the difference between the homemade (n = 42) and industry-made (n = 10) versions.

RESULTS

The initial procedural success rate was 92% in the homemade group and 100% in the industry-made group. In the 3 years of follow-up, the long-term success rate was 64% in the homemade group and 90% in the industry-made group. The primary reasons for failure in the homemade group were graft thrombosis due to kinking early in the series and proximal stent migration later in our experience. All cases of migration occurred when the neck was < 15 mm in length, the neck was lined with thrombus, or the stent was implanted > 15 mm from the renal arteries. Kinking was subsequently overcome by implanting Wallstents throughout the graft limbs. The sole failure in the industry-made group was a case in which collateral perfusion reached the aneurysm through patent lumbar arteries.

CONCLUSIONS

The fruits of this experience are a better technique, a better device, and, most importantly, a better understanding of the system's limits, as reflected in the current selection criteria.

Direct invasion of the renal vein by metastatic testicular cancer

We report a case of metastatic seminoma with direct invasion of the left renal vein. A tumor thrombus was found in the renal vein while the vena cava thrombosis proved to be a noncancerous blood clot developing as an extension of the tumor thrombus. Primary chemotherapy could not be completed because of thrombotic growth requiring surgical intervention. Although surgical specimens were free of viable tumor and two cycles of adjuvant chemotherapy were applied, the tumor relapsed in the area of renal vein invasion.

Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair

PURPOSE

The purpose of this study was to test a transfemoral system of bifurcated endovascular graft insertion for aortic aneurysm repair.

METHODS

Bifurcated endovascular grafts were inserted through bilateral femoral artery cutdowns in 41 patients. The results were assessed by completion angiography and follow-up computed tomography.

RESULTS

The second half of the study included more aneurysms 6 cm or larger (p < 0.05) and more instances of short proximal neck (p < 0.05), proximal neck angulation (p < 0.05), and iliac angulation (p < 0.05). Despite the increasingly challenging anatomy, the results were better in the second half of the study as illustrated by the lower overall combined morbidity/mortality rate (15% vs 50%) and higher overall success rate (85% versus 65%). The mortality rate for the series as a whole was 7.5%. Mean follow-up was 18.8 months for the first 20 patients and 10.9 months for the second 20. The commonest complication in the first half of the study was graft thrombosis (n = 5). This complication was absent from the second half of the study because of routine adjunctive stenting. Two patients died of complications of endovascular repair. In both cases aneurysm rupture on the third postoperative day was associated with coagulopathy and angiographic signs of perigraft leak.

CONCLUSION

Aneurysm exclusion with a bifurcated endovascular graft was feasible in a wide range of patients, but when the aneurysm was not entirely excluded from the circulation, the risk of rupture persisted.

Excretion and metabolism of remikiren, a potent orally active inhibitor of primate renin

1. Following intravenous administration of 14C-remikiren to the male rat, 78% of the administered radioactivity was recovered in faeces, indicating high biliary elimination. Of the 25 +/- 0.1% of the dose recovered in urine, the majority (16.5% of dose) was intact drug. 2. After oral administration to the male rat the urinary recovery was markedly reduced (8.5 +/- 2.0% of dose), and virtually all of the material was excreted as an inactive hydrolysis product. Intact drug was non-detectable, suggesting extensive first-pass metabolism. 3. Perfusion of isolated rat liver confirmed high biliary elimination, coupled with extensive metabolism. Although intact remikiren was the major component in bile (20% of the 'dose'), the majority of the radioactivity was recovered as a series of mono- and di-hydroxylated metabolites. 4. When screened against human renin, only one of the metabolites in bile and urine (mono-hydroxylated in the t-butyl side chain, and synthesized as Ro 44-0444) showed comparable activity to remikiren. The remaining ten metabolites tested were at least one order of magnitude less active than the parent drug. 5. In comparative in vitro studies Ro 44-0444 was formed by rat, but not human or cynomolgus monkey, liver microsomes. The primate microsomes also produced more of the remaining mono- and di-hydroxy products, suggesting that metabolites make little contribution to the oral activity of remikiren which is observed in these species in vivo.

Iliocaval stenosis and iliac venous thrombosis in retroperitoneal fibrosis: percutaneous treatment by use of hydrodynamic thrombectomy and stenting

A case of bilateral iliac stenosis and caval stenosis due to retroperitoneal fibrosis was treated by caval stenting and iliac balloon angioplasty, but was complicated by subsequent iliac thrombosis. Venous thrombectomy was successfully achieved by hydrodynamic thrombectomy, and iliac patency was stabilized by bilateral stent insertion.

Aortic and iliac stenoses: follow-up results of stent placement after insufficient balloon angioplasty in 118 cases

PURPOSE

To demonstrate follow-up results of stent placement in aortic and iliac stenoses.

MATERIALS AND METHODS

A total of 109 patients with 118 aortoiliac stenoses underwent placement of self-expanding stents. Mean length of the stenotic segments was 3 cm +/- 2 (standard deviation). Mean ankle-arm index at rest was 0.58 +/- 0.2. A total of 101 patients were followed up angiographically or clinically.

RESULTS

A mean of 1.2 stents +/- 0.5 were inserted per case. Clinical stage improved in 112 cases; it improved two or more stages in 89 cases. Mean ankle-arm index improved to 0.92 +/- 0.17. Total and major complication rates were 6.8% and 3.4%, respectively. Subacute occlusion occurred in four patients. Late stent obstruction occurred after a mean of 27 months (range, 16-48 months) in 10 cases. Primary patency was 95% after 1 year and 88% after 2 years; 4-year patency was 82%. Secondary patency was 96% after 1 year and 93% after 2 years. Three- and 4-year secondary patency were both 91%.

CONCLUSION

Placement of self-expanding stents in iliac stenoses is technically safe and offers sufficient follow-up patency.

[Secondary stabilization of aortic bifurcation Chuter endoprostheses by implantation of self-expanding metal stents]

The use of conventional graft fabric for the bifurcated Chuter endovascular graft may result in a kink instability since crimping has been removed. Especially in elongated arteries that are frequently found with aortic aneurysms this may cause stenosis of the kinked graft and subsequent thrombosis. Bilateral stabilisation of the graft limbs along its total length proved sufficient to stabilise the graft thus preventing secondary thrombosis.

Late reobstruction in iliac arterial stents: percutaneous treatment

PURPOSE

To retrospectively analyze in a nonrandomized fashion the efficacy of percutaneous reintervention in obstructed iliac stents.

MATERIALS AND METHODS

In 21 symptomatic patients with iliac lesions, 26 reinterventions (16 for stent occlusion and 10 for stent stenosis) were performed. Restenoses were treated with balloon dilation and either atherectomy or stent placement. Reocclusions were treated with atherectomy or aspiration thrombectomy and then recanalization with balloon dilation and selective stent placement.

RESULTS

Balloon angioplasty for stent stenosis was effective in all but one patient. Recanalization was successful in 14 of 16 patients with stent occlusion. The mean period of patency after reintervention was 18 months +/- 15. Cumulative stent stenosis patency after reintervention was 87% after 1 year. Stent occlusion patency was 57%. Recurrent stent obstruction occurred in eight of 24 (33%) patients with successful primary interventions.

CONCLUSION

Percutaneous reintervention for both stent stenosis and occlusion is feasible with a moderate complication rate and may be attempted before surgery.

[Therapy of an abdominal aortic aneurysm using transfemoral endovascular implantation of a bifurcation prosthesis]

Transfemoral intraluminal placement of a woven-dacron bifurcation prosthesis was undertaken to bridge an infrarenal aortic aneurysm (4.6 cm diameter) in a 65-year-old man with chronic coronary heart disease. The Chuter-Gianturco introducing system was used via the right femoral artery to anchor the prosthesis immediately below the origins of the renal arteries. After fixing the right branch of the prosthesis the left one was secured via the left femoral artery. No leakage was demonstrated on the 7th post-operative day and the aneurysm was satisfactorily bridged. Regular follow-up tests showed a normal circulation. Spiral computed tomography after 18 months confirmed complete thrombosis of the aneurysm.--This case shows that the described method is a promising alternative in the treatment of abdominal aneurysm.

Transfemoral insertion of a bifurcated endovascular graft for aortic aneurysm repair: the first 22 patients

The purpose of this study was to evaluate and optimize a system of transfemoral bifurcated graft insertion for endovascular repair of infrarenal aortic aneurysm. Grafts were inserted through bilateral femoral arteriotomies in 22 patients. Placement was guided by fluoroscopy. Results were assessed by completion angiography, with computed tomography scanning or duplex ultrasonography at 1, 3 and 6 months. The first 11 insertions were complicated by failed insertion in two cases, proximal leakage in one, graft limb thrombosis in five and wound infection in one. The second 11 insertions were complicated by retrograde leakage around the distal graft orifice in two patients. One of these was associated with aneurysm rupture, leading to the sole mortality of the series. There were no instances of graft migration or embolism. In conclusion, the lessons learned during the first 11 insertions were responsible for the improved results apparent in the second 11 insertions. When applied in properly selected patients, transfemoral insertion of a bifurcated graft is a reliable method of isolating an aortic aneurysm from the circulation.

Primary stent placement for chronic iliac artery occlusions: follow-up results in 103 patients

PURPOSE

To report results of primary stent placement for treatment of chronic iliac artery occlusions.

MATERIALS AND METHODS

The authors placed 154 primary stents in 103 patients with iliac artery occlusions of at least 3 months duration. Mean length of the occluded segments was 5.1 cm. All patients had symptoms, with claudication or trophic changes. Mean ankle-arm index at rest was 0.48. Follow-up included angiography, Doppler ultrasound, and clinical examination.

RESULTS

Ninety-nine patients demonstrated clinical improvement, with relief or improvement of claudication. Complications that required percutaneous or surgical intervention occurred in six patients; minor complications occurred in another six. Embolization occurred in five patients. Primary patency was 87% after 1 year, 83% after 2 years, and 78% after 4 years; secondary patency was 94%, 90%, and 88% at 1 year, 2 years, and 4 years, respectively.

CONCLUSION

Primary stent placement should be the treatment of choice in unilateral chronic iliac artery occlusion.

Chronic aortoiliac dissection treated by self-expanding stent placement

A 47-year old male patient presented with claudication from a right-sided aortoiliac dissection secondary to transfemoral cardiac angiography. Placement of two self-expanding stents led to immediate compression of the false channel. The patient has been free of symptoms for 18 months.

[Relative bioavailability of paracetamol in suppositories preparations in comparison to tablets]

Relative Bioavailability of Paracetamol as Suppositories Compared to Tablets. The relative bioavailability of paracetamol (CAS 103-90-2) in ben-u-ron 500 mg and ben-u-ron 1000 mg suppositories (test formulations) was compared with that of Benuron tablets 500 mg (reference product) in an open, intraindividual, 3-period-changeover-study in 18 healthy subjects. Plasma concentrations of paracetamol were determined using a specific and sensitive HPLC method with UV detection. For the assessment of bioavailability AUC, Cmax, tmax and HVD were used as pharmacokinetic characteristics. Bioequivalence of the rectal formulations was tested by calculating 90% confidence intervals using the Two-one-sided-t-tests-procedure and log-transformed data of AUC and Cmax. For AUC the confidence intervals were required to be in the 80 and 125% range, for Cmax between 70 and 143% (inclusion rule). Data from 17 subjects could be evaluated. Bioavailability of paracetamol was 89 and 90% for the 500 and 1000 mg suppositories, respectively compared with that of the 500 mg reference tablets. Mean maximum paracetamol plasma concentrations (Cmax) were 3.55 and 6.02 or 7.16 mg/l after administration of the 500 and 1000 mg suppositories or the 500 mg tablets, respectively. These maximum concentrations were achieved 2.0, 2.7 and 0.6 h (tmax) after administration of the respective preparations. The corresponding HVD values were 4.3, 5.2 and 2.0 h, respectively. After dose adjustment of the results for the 1000 mg suppositories relative bioavailabilities of paracetamol from both rectal formulations exceeded 80% of that from the tablets.(ABSTRACT TRUNCATED AT 250 WORDS)