Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms: comparison of transarterial and translumbar techniques.

OBJECTIVE: The exact significance of collateral endoleaks is unknown and a topic of great debate. Because of this uncertainty, some physicians choose to watch and wait while others aggressively treat these leaks. The purpose of this investigation was the evaluation of the efficacy of the two techniques used in the treatment of collateral endoleaks that occur after endovascular aneurysm repair. METHODS: Patients with 33 angiographically proven type 2 endoleaks underwent treatment with either transarterial inferior mesenteric artery embolization (n = 20) or direct translumbar embolization (n = 13) during an 18-month period. Embolization success was defined as resolution of endoleak on all subsequent computed tomography angiogram results. The likelihood of embolization failure between the two treatments was expressed as a risk ratio and was compared with Fisher exact test. RESULTS: Sixteen of 20 transarterial inferior mesenteric artery embolizations (80%) failed with recanalization of the original endoleak cavity over time. A single failure (8%) in the direct translumbar embolization group occurred in a patient in whom a new attachment site leak developed. The remaining 12 translumbar endoleak embolizations (92%) were successful and durable, with a median follow-up period of 254 days. The patients who underwent transarterial inferior mesenteric artery embolization were significantly more likely to have persistent endoleak than were the patients who underwent treatment with direct translumbar embolization (risk ratio, 4.6; 95% confidence interval, 1.9 to 11.2; P =.0001). CONCLUSION: The transarterial embolization of inferior mesenteric arteries for the repair of type 2 endoleaks is ineffective and should not be performed. Direct translumbar embolization of the endoleak is effective in the elimination of type 2 leaks and should be the therapy of choice when aggressive endoleak management is indicated.     

Fluorescent in situ hybridization and cytogenetic studies of trisomy 12 in chronic lymphocytic leukemia

Cytogenetic studies (CG) of 475 chronic lymphocytic leukemia (CLL) cases showed trisomy 12 in 6.1% or 26% of patients with abnormal karyotypes. Fluorescence in situ hybridization (FISH) detected trisomy 12 in 35% of 117 CLL patients. Only 34.6% of cases detected by FISH were detected by CG. Twelve patients had low levels of trisomic cells (4% to 11%) relative to clonal B cells (47.5% to 86%), suggestive of clonal evolution. Untreated patients with trisomy 12 were predominantly male (P < .05) and had an increased incidence of splenomegaly (P < .03). Patients with trisomy 12 were more likely to be previously treated and had advanced Binet stage compared with those without trisomy 12. The median survival was shorter in patients with trisomy 12 (7.8 years) and patients with other chromosomal abnormalities without trisomy 12 by FISH (5.5 years) than in patients with diploid karyotypes (14.4 years). The response to fludarabine was similar to that of patients with diploid karyotypes, but there was a trend for earlier disease progression. FISH detected residual disease in all patients with trisomy 12 in complete (n = 6) or partial remission (n = 4). As few as 1 trisomic cell in 5,000 was detected by performing FISH on fluorescence-activated cell sorter-sorted cells. Trisomy 12 was absent in T cells in patients with trisomy 12. We conclude that FISH identifies trisomy 12 approximately 2.6 times more often than CG, readily identifies minimal residual disease, and predicts for a shorter median survival.     

Liposarcoma Causing Left Ventricular Outflow Tract Obstruction and Syncope: a Case Report and Review of the Literature

Metastatic cardiac myxoid liposarcoma is rare. We present the case of a 56-year-old woman who was admitted for angina and syncope, and in whom a mobile intracardiac mass obstructing the left ventricular outflow tract and protruding into the aortic root during systole was detected by transesophageal echocardiography (TEE). She reported an antecedent of the complete excision of a myxoid liposarcoma of the thigh 12 years before. A surgical resection procedure was performed through an excision of the anterior wall of the left ventricle. The histopathological analysis of the specimens obtained during surgery revealed a low-grade malignancy myxoid liposarcoma, similar to the one resected in the thigh 12 years before. The present case is the first one to report syncope due to left ventricular outflow tract as a cause for admission. TEE was able to visualize the metastatic tumor to the heart, accurately localize its position and allow for prompt surgical treatment that produced relief of the symptoms.     

股骨远端轴位X射线片对全膝关节假体置换术中股骨假体旋转力线的评估价值

目的:探讨股骨远端轴位X射线片对于确定股骨后髁扭转角的价值及在全膝关节假体置换术中的意义。方法:选择2004-01/2005-05在南方医院接受全膝关节置换术的患者22例,共30例膝(均可以弯曲到90°)行术前的股骨远端轴位X射线检查和膝关节CT扫描。轴位X射线片在膝关节屈曲90°,小腿重力牵引下拍摄,CT采用1mm薄层扫描。在X射线片和CT片上,分别标记出临床上髁轴和后髁轴,并计算出股骨后髁扭转角。应用SPSS13.0软件两组数据进行方差分析和相关性分析。结果:受检股骨远端在轴位X射线片上都得到了良好的显示,患者在检查过程中没有感到明显的不适。由轴位X射线片和CT片上测得的股骨后髁扭转角分别为(6.9±1.6)°,(6.8±1.5)°,两种方法测得的股骨后髁扭转角平均差值为(0.6±0.5)°,无显著性差异,且存在强相关(r=0.903,P<0.001)。结论:股骨远端轴位X射线片可用于全膝关节置换术前确定股骨假体旋转力线,具有同CT相当的准确性。     

个体经营药店参与结核病控制的阻碍因素:定性抽样调查分析

目的:分析阻碍个体经营药店参与结核病控制的潜在因素。方法:实验于2005-07在重庆市区完成。调查主要采用了定性的方法,共调查了29名对象,采用方便抽样和滚雪球抽样的方法对15家经营时间1年以上的个体经营药店的管理人员或者工作人员进行了个人深入访谈;采用目的性抽样的方法对4名卫生监督所,药监局以及结核病防治所的相关官员及领导进行了关键人物访谈;采用专题小组访谈的形式,对2家结防专业机构的10名医护人员进行访谈。采用定性方法对采访对象进行了个人深入访谈、小组访谈、关键人物访谈。借助MAXqda软件,采用主体框架法进行分析。主要调查内容:①药店参与结核控制的现状,包括宣传结核病知识,发现、转诊结核病例。②药店参与结核病例发现的能力,包括员工的专业背景知识,对结核病知识的了解,接受新知识的机会。③药店参与结核病控制的客观阻碍因素,包括利益冲突、消费者的态度等。结果:29名受访对象均进入结果分析。①药店是患者接受健康教育的一个潜在的、重要的部门,绝大部分顾客在购药时都会咨询药店工作人员的意见,药店在发现以及转诊结核病患者中也起到一定促进作用,药店工作人员曾有发现结核病疑似患者并建议其接受医生治疗的经历。②药店从业人员仅了解部分结核病基础知识,缺少对结核病相关知识的知晓。但部分员工有医学或护理方面的专业背景,并且接受新知识的渠道也较多,如定期职能部门培训、电视以及报纸宣传等,但结核病知识的专题培训却相当少。③虽然绝大多数药店从业人员都认为推荐患者去结防所治疗不会对药店生意造成太大的影响,但也有部分人认为利益冲突会间接影响到药店参与结核病控制的行为。结论:药店在结核病控制工作中起到一定促进作用,但药店从业人员对结核病相关知识的了解有必要加强,采取一系列可行性措施解除这些阻碍因素,利益冲突会间接影响到药店参与结核病控制的行为。