Endovascular maneuvers for contralateral stent graft limb misplacement in endovascular aortic repair

Cannulation and placement of the contralateral stent graft limb during endovascular aortic repair (EVAR) procedure are crucial steps as mispositioning may lead to conversion to open aortic repair. Endovascular bail-out strategies for stent graft relocation in EVAR are underreported though detailed knowledge may facilitate application and prevent conversion. We present three endovascular bail-out strategies for repositioning of a mispositioned contralateral stent graft limb. (1) Retraction of the mispositioned component with an inflated reliant balloon and placement of an interposition stent graft after successful cannulation; (2) Push-maneuver of the mispositioned stent graft into the infrarenal aortic aneurysm with an inflated reliant balloon supported by a large lumen introducer sheath and (3) Parallel placement of a second contralateral stent graft limb displacing the mispositioned one against the atrial wall in cases with adequate vessel diameter. Prevention of stent graft mispositioning by applying recognized tests to ensure correct placement are essential, following the slogan: check twice, deploy once.     

Alterations in Thyroid Hormones and Thyrotropin (TSH) in Morbidly Obese Patients before and after Vertical Gastroplasty

Background: Published results of studies of thyroid function in obesity and after weight loss have differed. Methods: The circulating concentrations of thyroid hormones and TSH were studied in 30 consecutive, euthyroid morbidly obese patients before and after weight loss from vertical gastroplasty, with the aim to determine the relation between body weight loss and pituitarythyroid axis function. Serum TSH, free T3 (FT3) and free T4 (FT4) were measured before operation and repeated 6 and 18 months postoperatively. Results: A significant increase, but within normal levels, in FT3 value at 6 and, mainly, at 18 months after gastroplasty was observed (p = 0.002). The FT4 value was slightly increased at the same time and serum TSH was found to be significantly decreased (p = 0.03 and p = 0.01 respectively). The relative increase in FT4 was negatively correlated with excess body weight and Body Mass Index reduction. This correlation was only moderate with values ranging from r = 0.34 to r = 0.47. Conclusions: Although there were statistically significant differences in thyroid function tests before and after loss of weight, these were not biologically significant. The hypophyseal/thyroid axis remains always active and contributes to body weight homeostasis and its regulation.     

Phenotypic heterogeneity of leukemias associated with Friend MuLV infection: studies on T-cell lymphomas and null cell leukemias in euthymic and thymus-deficient mice

The development of leukemia/lymphoma in euthymic and congenitally thymus-deficient (nude) mice infected with Friend murine leukemia virus (Friend MuLV) was investigated; both groups developed fatal leukemias within 2-4 months post-infection but the gross and micropathology of lymphoid organs, coupled with cell-surface marker studies indicated the development of two distinct forms of disease. In euthymic mice one group developed lymphosarcomas manifested by thymoma, hepatosplenomegaly and lymphadenopathy whereas the second group developed splenic leukemias manifested only by hepatosplenomegaly. Analysis of surface markers on spleen cells from mice experiencing lymphosarcomas indicated that the majority of cells were positive for Thy 1.2, Moloney cell surface antigen (MCSA), and viral-coded gp70 and p30 antigens but negative for surface immunoglobulin (sIg). Euthymic mice experiencing splenic leukemias yielded spleen cells negative for Thy 1.2, sIg, and MCSA but positive for gp70 and p30. Nude mice uniformly developed splenic leukemias, spleen cells from which were Thy 1.2, MCSA, gp70 and p30 negative, although the proportion of sIg positive cells was higher than that observed in euthymic mice experiencing splenic leukemias. No correlation between the development of lymphosarcoma vs splenic leukemia and a pattern of ecotropic and/or xenotropic MuLV expression was observed. While ecotropic MuLV expression was equivalent in both euthymic and athymic mice, euthymic mice expressed approx. 10-fold higher levels of xenotropic MuLV than nude mice, however. Collectively the data suggest that infection of mice with Friend MuLV results in the development of two possible forms of disease, lymphosarcoma involving T cells vs splenic leukemia involving B and/or null cells.     

Impact of porcine Orexin A on glucagon plasma concentrations in pigs

In 1998, Orexin A was added to the long list of orexigenic neuropeptides of the brain's physiology. Orexin A is involved in the central control of appetite and in energy homeostasis, as well as in the regulation of many other physiological functions. It is produced by a small cluster of the brain's neurons, located mainly in and around the lateral hypothalamic area. This site is known to be involved in regulating feeding in mammals. An intracerebroventricular injection of Orexin A into the rat's brain causes an impressive increase in the consumption of food, while an intravenous injection induces changes on glucagon plasma concentrations in rats. In addition, there are signs of changes on glucagon plasma concentrations when Orexin A acts on individual pancreatic islets of rats. In this study, we investigated the potential effects of the central administration of porcine Orexin A on glucagon plasma concentrations in pigs, and examined whether these changes are associated with the possible effect of the neuropeptide on the enteroinsular axis.     

Industry's View on Using Quality Control,Biorelevant, and Clinically Relevant Dissolution Tests for Pharmaceutical Development,Registration, and Commercialization

This article intends to summarize the current views of the IQ Consortium Dissolution Working Group, which comprises various industry companies, on the roles of dissolution testing throughout pharmaceutical product development, registration, commercialization, and beyond. Over the past 3 decades, dissolution testing has evolved from a routine and straightforward test as a component of end-product release into a comprehensive set of tools that the developer can deploy at various stages of the product life cycle. The definitions of commonly used dissolution approaches, how they relate to one another and how they may be applied in modern drug development, and life cycle management is described in this article. Specifically, this article discusses the purpose, advantages, and limitations of quality control, biorelevant, and clinically relevant dissolution methods.     

Serial magnetic resonance imaging and neurophysiological studies in multiple sulphatase deficiency.

We present serial clinical, magnetic resonance imaging (MRI) and neurophysiological findings of a patient with multiple sulphatase deficiency (MSD), who was first admitted at the age of 9 months, because of psychomotor retardation. MRI demonstrated extensive diffuse symmetrical high signal in the deep white matter of both cerebral hemispheres, as well as of the subcortical white matter and the brainstem, while there was additional enlargement of sulci and subdural spaces and mild atrophy. Assay of arylsulphatase A activity in white blood cell homogenates at the age of 29 months disclosed a marked deficiency of the enzyme, compatible with the diagnosis of early-infantile metachromatic leukodystrophy. During the course of a later admission, the presence of ichthyosis pointed out to the possible diagnosis of MSD; further assays of sulphatases in plasma, leukocytes as well as in cultured fibroblasts, combined with an abnormal excretion of mucopolysaccharides and sulphatides in urine confirmed the diagnosis. Molecular analysis identified a homozygous disease-causing mutation (R349W) of the SUMF1 gene. Serial neurophysiological and MRI studies demonstrated the progressive nature of the disorder (regarding both central and peripheral nervous system), correlating with the clinical deterioration (spastic quadriplegia, optic atrophy and epilepsy) with subsequent death at the age of 4 years.     

Amantadin-induzierte Livedo reticularis

Zusammenfassung Es wird eine 63j?hrige Patientin mit Livedo reticularis nach Einnahme von Amantadin bei Morbus Parkinson vorgestellt. Diese reversible Nebenwirkung von Amantadin wird v.a. bei Frauen beobachtet und geht oft mit therapieresistenten Kn?chel?demen einher. Wir beschreiben die Klinik, Pathogenese und Therapie der Amantadin-induzierten Livedo reticularis, einer Dermatose, der bislang im deutschsprachigen Raum nur wenig Aufmerksamkeit geschenkt worden ist. Eingegangen am 12. Februar 1997 Angenommen am 4. April 1997     

The long-term effects of a prevention program on the number of critical incidents and sick leave days

Background

This study explores the effectiveness of refresher training sessions of an intervention program at reducing the employees’ risk of injury due to patient violence in forensic psychiatric hospital.

Methods

The original safety intervention program that consisted of a 3 days’ workshop was conducted in the maximum—security ward of a psychiatric hospital in Israel. Ever since the original intervention, annual refreshers were conducted highlighting one of the safety elements covered in the original intervention. The study examines the effect of the intervention program along with the refreshers over a period of 10 years in four wards.

Results

Analysis of the data demonstrates that beyond the initial reduction following the original intervention, refreshers seem to have an additional positive long-term effect, reducing both the number of violent incidents and the number of actual employee injuries in forensic psychiatric hospital.

Conclusions

We conclude that such an intervention program followed by refresher training would promote employees’ wellbeing. A healthy work environment is part of management’s commitment to improve employee wellbeing at the workplace.