Prostheto-prosthetic and aorto-prosthetic anastomosis using stents, threads, clips and staples. In vitro comparative study

OBJECTIVE: --To evaluate mechanical strength of new potential systems of vascular prostheses anastomosis versus usual suture (4.0 yarn), --To advance objective quantified data in order to establish the specifications of a new quick and reliable mechanical anastomosis device for laparoscopic surgery. MATERIAL AND METHODS: Two experimental studies were conducted in order to quantify the mechanical resistance of anastomoses between two Dacron vascular prostheses and anastomoses between one Dacron vascular prosthesis and one cadaver abdominal aorta segment. Existing materials, which have generally used for other types of surgery, were applied for these studies (clips, staples, stents). These systems of anastomosis were compared to usual suture, used as reference. RESULTS: The mechanical strength of an anastomosis between two Dacron vascular prostheses performed with staples or the same number of stitches is of equivalent magnitude. Anastomoses made with clips or stent are ten to fifteen times weaker than those made with stitches. We did not succeed in performing an anastomosis with staples on cadaver aorta segments because aorta segments tear when staples are applied. In the experiments with a hand-sewn graft, the aorta always tor before the suture, without breakage of the suture. CONCLUSION: From these in vitro trials, we can advance that a continuous suture is probably far too resistant in relation to the aorta own resistance. As we do not know accurately the physiologic strength applied to a vascular prosthesis in vivo, one acceptance criterion from a safety point of view for a new anastomosis system must be that its strength will be equal to the well-proven continuous suture (greater than 150 N) or to the aorta breaking point (between 100 and 160 N). From that point of view, anastomoses performed with clips or a stent are not convenient, unless special clips or stents can be developed for this application. The mechanical strength is of staples sufficient but their design has to be adapted to this particular type of anastomosis.     

Comparison of national antimicrobial treatment guidelines,African Union

ObjectiveTo identify and compare antimicrobial treatment guidelines from African Union (AU) Member States.MethodsWe reviewed national government agency and public health institutes’ websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines.FindingsWe identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes.ConclusionAU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.     

Treatment of an early type II endoleak causing hemorrhage after endovascular aneurysm repair for ruptured abdominal aortic aneurysm

We report a case of ruptured abdominal aortic aneurysm emergently treated by endovascular aneurysm repair (EVAR) that developed a primary type II endoleak leading to persistent blood loss and retroperitoneal hematoma increase. Coil embolization resolved this. Although to our knowledge there are no recommendations regarding this, our report suggests that early type II endoleaks occurring after emergency EVAR for ruptured AAA should be treated when it is associated with blood extravasation outside the aneurysm sac.     

Laparoscopy-assisted left ovarian vein transposition to treat one case of posterior nutcracker syndrome

We report one case of posterior nutcracker syndrome treated by left ovarian vein (LOV) transposition. A 36-year-old woman was suffering from nutcracker syndrome associated with pelvic congestion syndrome. Color duplex scan, computed tomographic scan, and angiography demonstrated a stenosis of a retroaortic left renal vein with proximal dilatation and incompetence of the LOV. The renocaval pullback gradient was 10 mm Hg. The LOV was harvested laparoscopically and transposed into the inferior vena cava. Completion angiography showed a patent reconstruction with no significant gradient. At day 4, an asymptomatic thrombosis was treated by thromboaspiration. Forty months later, the patient remained asymptomatic with a patent transposition. Posterior nutcracker syndrome is a rare condition. When associated with pelvic congestion syndrome due to LOV reflux, it can be treated by LOV transposition.     

Evaluation of antioxidant and antiulcerogenic activities of Opuntia ficus indica f. inermis flowers extract in rats

The Opuntia ficus indica f. inermis methanolic flowers extract (OMFE) was phytochemical studied, in vitro tested for their potential antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH), reducing power, linoleic acid peroxidation assays and in vivo evaluated for its ability to prevent ethanol-induced gastric ulcer in rats. The OMFE was rich in polysaccharide, phenolics and flavonoids contents and exhibited a moderate in vitro antioxidant activity when compared with (+)-catechin and ascorbic acid. Pre-treatment with OMFE at oral doses 250, 500 and 1000 mg/kg body weight was found to provide a dose-dependent protection against ethanol-induced gastric ulcer by averting the deep necrotic lesions of the gastric epithelium, by preserving normal antioxidant enzymes activities, by inhibiting the lipid peroxidation, the oxidation of protein and the DNA fragmentation in gastric mucosa. The antiulcerogenic activity of OMFE might be due to a possible synergistic antioxidant and antihistaminic-like effects.     

A large population-based study on the prevalence of electrocardiographic abnormalities: A result of Mashhad stroke and heart atherosclerotic disorder cohort study

Background

Twelve-lead electrocardiogram (ECG) is a common and inexpensive tool for the diagnostic workup of patients with suspected cardiovascular disease, both in clinical and epidemiological settings. The present study was designed to evaluate ECG abnormalities in Mashhad population.

Methods

ECGs were taken as part of MASHAD cohort study (phase1) and were coded according to the Minnesota coding criteria. Data were analyzed using SPSS.

Results

Total 9035 ECGs were available for final analysis including 3615 (40.0%) male and 5420 (60.0%) female. Among ECG abnormalities precordial Q wave, major T-wave abnormalities, inferior Q wave, sinus bradycardia, and left axis deviation were the most prevalent abnormalities. The frequency of precordial and inferior Q wave, inferior QS pattern, major and minor ST abnormalities, major and minor T abnormalities, Wolff-Parkinson-White and Brugada pattern, sinus bradycardia, sinus tachycardia, left axis deviation, ST elevation, and tall T wave were significantly different between two genders. Moreover, the frequency of Q wave in precordial and aVL leads, QS pattern in precordial and inferior leads, major and minor T-wave abnormalities, Wolff-Parkinson-White, atrial fibrillation, sinus bradycardia, left axis deviation, and ST elevation were significantly different in different age groups. A comparison of the heart rate, P-wave duration, and QRS duration between men and women indicated that there was a significant difference.

Conclusions

Our finding indicated that the prevalence ECG abnormalities are different between men and women and also it varied in different age groups.     

Dilation of woven and knitted aortic prosthetic grafts: CT scan evaluation

Because there are few reports in the literature concerning short- and medium-term outcome of woven and knitted aortic prosthetic grafts, we conducted CT evaluations in 58 asymptomatic patients (53 males and five females with a mean age of 63.5 years) undergoing infrarenal aortic reconstruction between June 1988 and June 1991. Joined CT slices after contrast enhancement, centered on the proximal anastomoses, prosthetic bodies, and prosthetic limbs, were obtained in the early (mean 19 days) and late (mean 19 months, range 6 to 40 months) postoperative periods. In end-to-side aortoprosthetic anastomoses (n=28), early and late CT examinations revealed that the anteroposterior diameter increased 1.9% (p=NS) and 8.8% (p<0.0001) for woven and knitted grafts, respectively. In end-to-end aortoprosthetic anastomoses, the diameter of the prosthetic body on early CT scans increased 12.6% (p<0.0001) and 28% (p<0.0001) for woven and knitted prosthetic grafts, respectively, as compared with diameter values provided by the manufacturer. Dilation continued to progress 2.2% (p<0.04) for woven and 6.2% (p<0.0002) for knitted prosthetic grafts on late CT scans. The mean diameter of the prosthetic graft limbs (n=96) increased 22.3% (p<0.0001) and 34.6% (p<0.0001) for woven and knitted prosthetic grafts, respectively, on early CT scans as compared with manufacturers' values. Secondary increases were 3.2% (p<0.002) and 7.7% (p<0.007) for woven and knitted prosthetic grafts, respectively. These data show that dilation of aortic prostheses occurs early in most cases, most likely soon after declamping of the graft, as shown by recent intraoperative measurements. Secondary progression is slow but more marked for knitted prostheses.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, Reims, France, June 19– 20, 1992.