Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture.

OBJECTIVE: Endoluminal aortic stent grafting offers a potentially less invasive alternative to open chest surgery, especially in patients with polytrauma. We compare the results of conventional surgical repair and endovascular treatment of traumatic aortic rupture. METHODS: Retrospectively, 74 patients with acute traumatic aortic rupture were analyzed. Most of the patients had a rupture limited to the isthmus, and severe associated injuries. Thirty-five patients (6 female, 29 male, mean age 36 years) underwent surgical repair. Two patients were operated upon without cardiopulmonary bypass. In 39 patients (5 female, 34 male, mean age 36 years) thoracic endografts were implanted. The delay between trauma and treatment was comparable in the two groups. RESULTS: Hospital mortality was 20% (7 of 35 patients) in the surgical group and 7.7% (3 of 39 patients) in the endovascular group. The most common cause of death in the surgical group was brain death in severe traumatic patients. Ten surgical complications occurred in 5 patients: respiratory insufficiency (n=3), pulmonary infection (n=2), recurrent nerve palsy (n=2), repeat thoracotomy (n=2), and compartment syndrome (n=1). No patient in this group had paraplegia. Except for one case, which required conversion to conventional surgery, stent-graft implantation was successful in all cases, without peri-interventional complications or procedure-induced paraplegia. In 9 patients the left subclavian artery was covered with the device. Two patients underwent surgical repair 15 days and 4 months after endografting because of injury of the aortic wall by the stent and development of a spurious aneurysm, respectively. CONCLUSIONS: In the treatment of traumatic thoracic aortic rupture, the early outcome of patients treated with endovascular stent grafts appears to be better than that with conventional surgical repair. The new technique allows safe and successful repair of this life-threatening injury in the early phase of trauma management. How far this potential benefit is sustained in the long term remains unclear at present.     

Association between changes in global femoral offset after total hip arthroplasty and function,quality of life,and abductor muscle strength: A prospective cohort study of 222 patients

Background and purpose — There is no consensus on the association between global femoral offset (FO) and outcome after total hip arthroplasty (THA). We assessed the association between FO and patients’ reported hip function, quality of life, and abductor muscle strength.

Patients and methods — We included 250 patients with unilateral hip osteoarthritis who underwent a THA. Before the operation, the patient’s reported hip function was evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life was evaluated with EQ-5D. At 1-year follow-up, the same scores and also hip abductor muscle strength were measured. 222 patients were available for follow-up. These patients were divided into 3 groups according to the postoperative global FO of the operated hip compared to the contralateral hip, as measured on plain radiographs: the decreased FO group (more than 5 mm reduction), the restored FO group (within 5 mm restoration), and the increased FO group (more than 5 mm increment).

Results — All 3 groups improved (p?Interpretation — A reduction in global FO of more than 5 mm after THA appears to have a negative association with abductor muscle strength of the operated hip, and should therefore be avoided.     

Impact of Dietary Arachidonic Acid on Gut Microbiota Composition and Gut–Brain Axis in Male BALB/C Mice

Although arachidonic acid (ARA) is the precursor of the majority of eicosanoids, its influence as a food component on health is not well known. Therefore, we investigated its impact on the gut microbiota and gut–brain axis. Groups of male BALB/c mice were fed either a standard diet containing 5% lipids (Std-ARA) or 15%-lipid diets without ARA (HL-ARA) or with 1% ARA (HL + ARA) for 9 weeks. Fatty acid profiles of all three diets were the same. The HL-ARA diet favored the growth of Bifidobacterium pseudolongum contrary to the HL + ARA diet that favored the pro-inflammatory Escherichia–Shigella genus in fecal microbiota. Dietary ARA intake induced 4- and 15-fold colic overexpression of the pro-inflammatory markers IL-1β and CD40, respectively, without affecting those of TNFα and adiponectin. In the brain, dietary ARA intake led to moderate overexpression of GFAP in the hippocampus and cortex. Both the hyperlipidic diets reduced IL-6 and IL-12 in the brain. For the first time, it was shown that dietary ARA altered the gut microbiota, led to low-grade colic inflammation, and induced astrogliosis in the brain. Further work is necessary to determine the involved mechanisms.     

Outcome after surgery for metastatic spinal cord compression in 54 patients with prostate cancer

Background and purpose

The criteria for selecting patients who may benefit from surgery of spinal cord compression in metastatic prostate cancer are poorly defined. We therefore studied patients operated for metastatic spinal cord compression in order to evaluate outcome of surgery and to find predictors of survival.

Patients and methods

We reviewed the records of 54 consecutive patients with metastatic prostate cancer who were operated for spinal cord compression at Umeå University Hospital. The indication for surgery was neurological deficit due to spinal cord compression. 41 patients had hormone-refractory cancer and 13 patients had previously untreated, hormone-naïve prostate cancer. 29 patients were operated with posterior decompression only, and in 25 patients posterior decompression and stabilization was performed.

Results

Preoperatively, 6/54 of patients were able to walk. 1 month after surgery, 33 patients were walking, 15 were non-ambulatory, and 6 had died. Mortality rate was 11% at 1 month, 41% at 6 months, and 59% at 1 year. In the hormone-naïve group, 8/13 patients were still alive with a median postoperative follow-up of 26 months. In the hormone-refractory group, median survival was 5 months. Patients with hormone-refractory disease and Karnofsky performance status (KPS) of ≤ 60% had median survival of 2.5 months, whereas those with KPS of 70% and KPS of ≥ 80% had a median survival of 7 months and 18 months, respectively (p < 0.001). Visceral metastases were present in 12/41 patients with hormone-refractory tumor at the time of spinal surgery, and their median survival was 4 months—as compared to 10 months in patients without visceral metastases (p = 0.003). Complications within 30 days of surgery occurred in 19/54 patients.

Interpretation

Our results indicate that patients with hormone-naive disease, and those with hormone-refractory disease with good performance status and lacking visceral metastases, may be helped by surgery for metastatic spinal cord compression.Bone metastasis occurs in more than 80% of patients with advanced prostate cancer, most commonly in the spine (Bubendorf et al. 2000). Spinal cord compression usually occurs in patients with advanced hormone-resistant disease, causing neurological complications detrimental to quality and duration of life (Clarke 2006). However, spinal cord compression may also be the first clinical manifestation of metastases in patients with previously localized disease, or may occasionally be the presenting sign in patients with previously unrecognized prostate cancer. Spinal cord compression in patients with prostate cancer has been reported to have an incidence of 3–7% (Kuban et al. 1986, Honnens de Lichtenberg et al. 1992, Loblaw et al. 2003).The outcome of surgery for spinal cord compression is usually reported in series involving different tumors, making it difficult to draw conclusions on specific tumor types (Jansson and Bauer 2006, Chaichana et al. 2009). In some studies limited to prostate cancer, surgical treatment has been analyzed together with results of radiation treatment, with a low number of patients operated (Huddart et al. 1997, Cereceda et al. 2003, Tazi et al. 2003). There have only been a few studies that have specifically addressed surgical treatment of metastatic spinal cord compression in prostate cancer (Shoskes and Perrin 1989, Williams et al. 2009). Furthermore, the criteria for selecting patients who may benefit from surgical therapy of spinal cord compression are poorly defined.We therefore studied patients with prostate cancer who were operated for metastatic spinal cord compression to evaluate outcome of surgery and to find predictors of survival and neurological restitution.     

Interaction between amphotericin B, carboplatin, and radiation in human osteosarcoma xenografts in nude mice

In order to evaluate and modify the radiosensitizing effect of carboplatin, amphotericin B (AmB) was given as pre-treatment to nude mice with bilateral subcutaneous human osteosarcoma xenografts. One of the two tumours in each animal was irradiated with a single dose of 12 Gy following treatment with AmB (5 mg kg(-1)), or carboplatin (20 mg kg(-1)), or AmB (5 mg kg(-1)) plus carboplatin (20 mg kg(-1)), respectively. Tumour growth was compared with non-treated tumours. A significant reduction of tumour growth was observed after irradiation. Carboplatin in itself reduced tumour growth and also added to the effect of radiation. An unexpected interaction was seen where AmB obviously decreased the effect of either carboplatin or radiation alone or the two given concomitantly. The presented results are contradictory to some earlier in vitro studies and imply that the interactive effect in general and especially with regard to AmB can not be universally applied to all experimental situations.     

Prevalence of chronic hepatitis B and hepatitis C among first time blood donors in Northeast Bosnia and Herzegovina: an estimate of prevalence in general population

Background

Data on the epidemiology of hepatitis B and C in Bosnia and Herzegovina (B&H) are lacking.

Objectives

To assess the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (anti-HCV) in blood samples of first time blood donors in a well-defined region of B&H. Our secondary goal was to estimate the prevalence of HBsAg and anti-HCV in the general population of the same region.

Patients and Methods

We evaluated 8196 blood samples for the presence of HBsAg and/or anti-HCV, adjusted for differences in gender, and used the ratio estimation method to determine the prevalence in the general population.

Results

We analyzed 1263 (15.4%) female and 6933 (84.6%) male blood donors (male-to-female ratio: 5.49 to 1). The adjusted prevalence of HBsAg among blood donors was 0.787% (95% CI = 0.535-1.038), while the prevalence of anti-HCV was 0.267% (95% CI = 0.016-0.519). There was no difference in the prevalence of HBsAg or anti-HCV between men and women. We estimate that the prevalence of HBsAg and anti-HCV in the general population is 1.057% to 1.535% and 0.29% to 0.89%, respectively.

Conclusions

The prevalence of HBsAg and anti-HCV among blood donors suggests that our region has low endemicity for both hepatitis B and hepatitis C.     

Radiographic Evaluation of Crestal Bone Loss Around Dental Implants in Maxilla and Mandible: One Year Prospective Clinical Study

Purpose

The aim of the study was to analyze the amount of maxillary and mandibular crestal bone loss around Bredent Sky Blue type of implants of different dimensions one year after implantation.

Materials and Methods

36 implants of diameter 3.5 x 10 mm were inserted in the maxilla and 12 in the mandible. 52 implants of diameter 4.0 x 8 mm were inserted in the maxilla, and 61 in the mandible (two-stage implant surgery).

Results

No statistically significant differences were found between the right and left side of the maxilla and between the right and left side of the mandible at the implant sites regarding distal and mesial bone losses as shown by analysis of variance (ANOVA).

Conclusion

Statistically significant differences were found between anterior maxilla, posterior maxilla and anterior mandible and posterior mandible at implant sites regarding distal and mesial bone losses as shown by analysis of variance (ANOVA).Key words: Alveolar Bone Loss, Bone Resorption, Dental Implants, Maxilla, Mandible     

Genome organization, serology and phylogeny of Grapevine leafroll-associated viruses 4 and 6: taxonomic implications

Complete nucleotide sequences of the type isolate of Grapevine leafroll-associated virus 4 (GLRaV-4) and of an isolate of GLRaV-6 from cv ‘Estellat’ (GLRaV-6Est) were generated and compared mutually and with related viruses. The genome organization of both viruses resembled that of members of Subgroup I in the genus Ampelovirus (fam. Closteroviridae). The availability of these sequences, along with previously existing data on related GLRaVs, allowed critical review of the taxonomy and nomenclature of these viruses. In phylogenetic analyses, GLRaV-4 and -6Est consistently grouped with GLRaV-5, -9, and -Pr forming a poorly resolved sub-cluster (“GLRaV-4 group”) within the genus Ampelovirus. In-depth study showed that genetic distances between these viruses do not exceed the intra-species diversity observed in other closteroviruses. In Western blots, partially purified preparations of GLRaVs -4, -5, -6 and -9 reacted only with homologous monoclonal antibodies, but were all recognized by polyclonal antisera to GLRaV-5 and GLRaV-9. Serological relatedness among these viruses was further confirmed in DAS-ELISA. In immuno-electron microscopy, GLRaV-6 particles appeared uniformly decorated with homologous monoclonal antibodies, whereas GLRaV-2, used as a control, showed “bipolar” morphology of the virion. Results of this study challenge taxonomy and nomenclature of several GLRaVs suggesting that they are divergent isolates of Grapevine leafroll-associated virus 4 and not, as has been assumed, distinct species (definitive and/or putative) in the genus Ampelovirus.     

Severe chronic pulmonary hypertension caused by pulmonary embolism of hydatid cysts

Severe pulmonary hypertension caused by chronic pulmonary thromboembolism may still present an indication for lung transplantation. We report a rare case in which severe pulmonary hypertension developed after pulmonary embolism of hydatid cysts. Successful treatment in this patient was achieved by complete pulmonary endarterectomy of the hydatid cysts.