Endovascular treatment of a ruptured para-anastomotic aneurysm of the abdominal aorta

We report a case of a ruptured para-anastomotic aortic aneurysm treated with implantation of a bifurcated stent-graft. A 72-year-old patient, who had undergone aortobifemoral bypass for aortoiliac occlusive disease 16 years ago, presented with a ruptured para-anastomotic aortic aneurysm. A bifurcated stent-graft was successfully deployed into the old bifurcated graft. This is the first report of a bifurcated stent-graft being placed through an "end-to-side" anastomosed old aortobifemoral graft. Endovascular treatment of ruptured para-anastomotic aortic aneurysms can be accomplished successfully, avoiding open surgery which is associated with increased mortality and morbidity.     

Transient acantholytic dermatosis (Grover's disease) in a renal transplant patient

Grover's disease ("transient acantholytic dermatosis") is a transient dermatosis of unknown cause manifesting clinically as a papular skin eruption located usually on the anterior chest and abdomen and histologically with dyskeratosis and acantholysis. Grover's disease has occasionally been reported in patients with chronic renal failure, HIV infection, hematological malignancies and bone-marrow allotransplantation. We report herein a new case of Grover's disease that developed in a renal transplant patient. To the best of our knowledge, this is the first observation of Grover's disease developing in the setting of solid organ transplantation.     

The efficacy of iron chelator regimes in reducing cardiac and hepatic iron in patients with thalassaemia major: a clinical observational study

Background

Available iron chelation regimes in thalassaemia may achieve different changes in cardiac and hepatic iron as assessed by MR. The aim of this study was to assess the efficacy of four available iron chelator regimes in 232 thalassaemia major patients by assessing the rate of change in repeated measurements of cardiac and hepatic MR.

Results

For the heart, deferiprone and the combination of deferiprone and deferoxamine significantly reduced cardiac iron at all levels of iron loading. As patients were on deferasirox for a shorter time, a second analysis ("Initial interval analysis") assessing the change between the first two recorded MR results for both cardiac and hepatic iron (minimum interval 12 months) was made. Combination therapy achieved the most rapid fall in cardiac iron load at all levels and deferiprone alone was significantly effective with moderate and mild iron load. In the liver, deferasirox effected significant falls in iron load and combination therapy resulted in the most rapid decline.

Conclusion

With the knowledge of the efficacy of the different available regimes and the specific iron load in the heart and the liver, appropriate tailoring of chelation therapy should allow clearance of iron. Combination therapy is best in reducing both cardiac and hepatic iron, while monotherapy with deferiprone or deferasirox are effective in the heart and liver respectively. The outcomes of this study may be useful to physicians as to the chelation they should prescribe according to the levels of iron load found in the heart and liver by MR.     

Predictors and outcomes of jejunostomy tube placement at the time of pancreatoduodenectomy

BackgroundClinically relevant postoperative pancreatic fistula and delayed gastric emptying cause substantial morbidity after pancreatoduodenectomy. Per international guidelines, the placement of jejunostomy tubes may be considered for patients at risk for malnutrition, such as those with a high risk for clinically relevant postoperative pancreatic fistula and related complications. This study determined predictors and postoperative outcomes of jejunostomy tube placement.MethodsPatients undergoing pancreatoduodenectomy in 2014 to 2015 were identified using the American College of Surgeons National Surgical Quality Improvement Program and Procedure-Targeted Pancreatectomy Participant Use Files. Multivariable logistic regressions were used to identify factors associated with concurrent jejunostomy tube placement and postoperative outcomes.ResultsOf 3,600 patients, 8.9% underwent jejunostomy tube placement. Patients given a jejunostomy tube were more likely white (odds ratio 1.46, P = .016), to have low preoperative serum albumin levels (odds ratio 2.13, P < .001), to have received neoadjuvant radiotherapy (odds ratio 2.14, P < .001), and to have received an intraoperative transfusion (odds ratio 1.50, P = .004). We observed no association between jejunostomy tube placement and an increasing number of risk factors for clinically relevant postoperative pancreatic fistula (P = .96) or delayed gastric emptying (P = .54). Overall, jejunostomy tube placement was associated with increased morbidity (odds ratio 1.34, P = .020) and duration of stay (P < .001), but not mortality (P = .12). Among patients with low serum albumin or those who developed clinically relevant postoperative pancreatic fistula or delayed gastric emptying, jejunostomy tube utilization was not associated with morbidity or mortality.ConclusionJejunostomy tube placement during pancreatoduodenectomy was not driven by risk factors for clinically relevant postoperative pancreatic fistula or delayed gastric emptying, suggesting that practice patterns play a role. Among patients with at-risk preoperative albumin or who developed these complications, jejunostomy tube placement was not associated with worse outcomes, supporting selective utilization per guideline recommendations.     

Evaluating Mediterranean diet adherence in university student populations: Does this dietary pattern affect students' academic performance and mental health?

Adherence to a healthy diet such as Mediterranean Diet (MD) may exert beneficial effects in university students, promoting their academic performance and quality of life, as well as their mental and physical health status. In this aspect, the present study aimed to critically analyze the current epidemiological evidence concerning MD adherence of university students' populations. PubMed database was comprehensively searched, using relative keywords. Students' dietary habits are moving away from MD guidelines towards unhealthy eating patterns, especially for those living away from home and even for students with a Mediterranean country origin. Most of the available studies have documented that poorer students' health status was associated with lower MD adherence. Higher MD adherence was correlated with lower depression risk, while higher perceived stress score with lower fruit and vegetables intake. The access of students to information and knowledge provided by courses and lectures did not effectively enhance their compliance to MD. Alarmingly enough, the majority of students, even from medical and nutritional university departments, showed inadequate knowledge on healthy eating habits. Due to the influence of diet on the quality of life and the mental and physical health of students, it is crucial to redirect research focus on this important aspect.     

On shared gamma-frailty conditional Markov model for semicompeting risks data

Semicompeting risks data are a mixture of competing risks data and progressive state data. This type of data occurs when a nonterminal event is subject to truncation by a well-defined terminal event, but not vice versa. The shared gamma-frailty conditional Markov model (GFCMM) has been used to analyze semicompeting risks data because of its flexibility. There are two versions of this model: the restricted and the unrestricted model. Maximum likelihood estimation methodology has been proposed in the literature. However, we found through numerical experiments that the unrestricted model sometimes yields nonparametrically biased estimation. In this article, we provide a practical guideline for using the GFCMM in the analysis of semicompeting risk data that includes: (a) a score test to assess if the restricted model, which does not exhibit estimation problems, is reasonable under a proportional hazards assumption, and (b) a graphical illustration to justify whether the unrestricted model yields nonparametric estimation with substantial bias for cases where the test provides a statistical significant result against the restricted model. This guideline was applied to the Indianapolis-Ibadan Dementia Project data as an illustration to explore how dementia occurrence changes mortality risk.     

Talimogene Laherparepvec (T-VEC) for the Treatment of Advanced Locoregional Melanoma After Failure of Immunotherapy: An International Multi-Institutional Experience

Annals of Surgical Oncology - Talimogene laherparepvec (T-VEC) is an oncolytic virus approved for the treatment of unresectable, recurrent melanoma. The role of T-VEC after progression on systemic...     

ASO Visual Abstract: Talimogene Laherparepvec (T-VEC) for Treatment of Advanced Locoregional Melanoma after Failure of Immunotherapy: An International Multi-institutional Experience

Annals of Surgical Oncology -     

Melanoma Surgery in the Emerging Era of Effective Neoadjuvant Therapy

Annals of Surgical Oncology -