Management of thoracoabdominal aneurysm type IV.

BACKGROUND: Thoracoabdominal aneurysm type IV (TAA IV) represents only a minority of aortic aneurysms, but as it is an entirely abdominally located aneurysm, vascular surgeons are likely to see such aneurysms in their practice. The current surgical management of TAA IV is reviewed. METHODS: A PubMed/Medline-literature search for TAA IV. RESULTS AND CONCLUSIONS: A detailed preoperative evaluation to determine the rupture and operative risk is required. A threshold size of 5.5-6 cm is recommended for elective repair of TAA IV, which then is adjusted for age and other risk factors. Operative simplicity with the clamp and sew approach to obtain a short aortic cross-clamp time seems to have most support in the literature. The necessity of adjunct treatment to prevent visceral and spinal cord ischemia seems to be needed rarely. Uncomplicated repair has a minimal risk of neurological injury and a low risk of renal failure requiring dialysis in patients without preoperative renal dysfunction or renal artery stenosis. The role of endovascular repair of these aneurysms remains to be established.     

Interventional treatment of children with portal hypertension secondary to portal vein occlusion.

PURPOSE: To present methods and results of interventional treatment of children with portal hypertension (PH) secondary to portal vein occlusion (PVO). MATERIAL AND METHODS: Five children, four boys and one girl, 8 - 14 years old, with symptomatic PH secondary to PVO were treated. All children had one or more episodes of bleeding from oesophageal varices, enlarged spleen and thrombocytopenia. Partial embolisation of the spleen was performed in four children. Attempts to recanalize the occluded part of the portal vein were done in all children using transjugular (n = 4), transhepatic (n = 4) and transsplenic (n = 3) approaches. RESULTS: All procedures were carried out without serious complications and were followed by normalisation of the platelet count, decrease in splenic size and disappearance of bleeding. Recanalisation of the occluded portal vein with a stent was possible in one child and partial stent recanalisation was possible in another child. Transjugular intrahepatic portosystemic shunt (TIPS) with partly extrahepatic, intraperitoneal route was created in one patient. All children were scheduled for follow-up. During the observation time of 22 months (5 - 46 months), additional balloon dilation and placement of new stents were necessary in two children. CONCLUSION: Interventional procedures are valuable in the treatment of children with symptoms secondary to PVO. Treatment should be customized and scheduled follow-ups of the patients are necessary.     

The human epidermis models EpiSkin, SkinEthic and EpiDerm: an evaluation of morphology and their suitability for testing phototoxicity, irritancy, corrosivity, and substance transport.

The commercially available reconstructed human epidermis models EpiSkin, SkinEthic and EpiDerm demonstrate reasonable similarities to the native human tissue in terms of morphology, lipid composition and biochemical markers. These models have been identified as useful tools for the testing of phototoxicity, corrosivity and irritancy, and test protocols have been developed for such applications. For acceptance of these tests by the authorities, prevalidation or validation studies are currently in progress. Furthermore, first results also indicate their suitability for transport experiments of drugs and other xenobiotics across skin. Still, however, the barrier function of these reconstructed human epidermis models appears to be much less developed compared to native skin. Further adaptation of the models to the human epidermis, especially concerning the barrier function, therefore remains an important challenge in this area of research.     

Timing of CMF chemotherapy in combination with tamoxifen in postmenopausal women with breast cancer: role of endocrine responsiveness of the tumor.

BACKGROUND: Controversy persists about whether chemotherapy benefits all breast cancer patients. PATIENTS AND METHODS: In the International Breast Cancer Study Group (IBCSG) trial VII, 1212 postmenopausal patients with node-positive disease were randomized to receive tamoxifen for 5 years or tamoxifen plus three concurrent courses of cyclophosphamide, methotrexate and 5-fluorouracil ('classical' CMF) chemotherapy, either early, delayed or both. In IBCSG trial IX, 1669 postmenopausal patients with node-negative disease were randomized to receive either tamoxifen alone or three courses of adjuvant classical CMF prior to tamoxifen. Results were assessed according to estrogen receptor (ER) content of the primary tumor. RESULTS: For patients with node-positive, ER-positive disease, adding CMF either early, delayed or both reduced the risk of relapse by 21% (P=0.06), 26% (P=0.02) and 25% (P=0.02), respectively, compared with tamoxifen alone. There was no difference in disease-free survival when CMF was given prior to tamoxifen in patients with node-negative, ER-positive tumors. CONCLUSIONS: CMF given concurrently (early, delayed or both) with tamoxifen was more effective than tamoxifen alone for patients with node-positive, endocrine-responsive breast cancer, supporting late administration of chemotherapy even after commencement of tamoxifen. In contrast, sequential CMF and tamoxifen for patients with node-negative, endocrine-responsive disease was ineffective.     

Eradication of enterococci biofilms by lactic acid alone and combined with chlorhexidine and cetrimide

Objective: The antimicrobial activity of lactic acid (LA) alone or in combination with chlorhexidine (CHX) and cetrimide (CTR) against three Enterococcus faecalis strains, E. faecalis ATCC 29212, E. faecalis EF-D1 and E. faecalis U-1765, one Enterococcus durans strain and one dual-species biofilm was investigated. Study Design: The irrigating solutions tested were 20%, 15%, 10%, 5% and 2.5% LA, alone and in combination with 2% CHX and with 0.2% CTR. The biofilms were grown in the MBECTM high-throughput device for 24 hours and exposed to the solutions for 30 seconds and 1 minute. "Eradication" was defined as 100% bacterial kill. Results: Twenty percent LA eradicated all enterococci biofilms after 30 seconds contact time. The association of LA + 0.2% CTR achieved better results than LA alone, in contrast with the results obtained using LA + 2% CHX. E. durans was eradicated by all the tested solutions at 1 minute. The dual-species biofilm, E. faecalis ATCC 29212 + E. durans, gave intermediate values of the pure cultures. Conclusions: LA is capable of eradicating enterococci biofilm at a concentration of 20%. The combination of lower concentrations with 0.2% CTR achieved eradication after 1 minute.