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Neurol Med Chir (Tokyo). 2002 Nov;42(11):496-500.
Late recurrence of subarachnoid hemorrhage due to regrowth of aneurysm after neck clipping surgery.
Amagasaki K, Higa T, Takeuchi N, Kakizawa T, Shimizu T.
Kanto Neurosurgical Hospital, Kumagaya, Saitama, Japan. amgskb3.so-net.ne.jp
Late recurrence of subarachnoid hemorrhage (SAH) due to regrowth of aneurysm after neck clipping surgery occurred in four patients. Two patients underwent surgical treatment, and two patients received endovascular treatment. Endovascular treatment was successful in one case, but emergent surgery was necessary for the other case because of possible pseudoaneurysm formation. Postoperative course of all patients was excellent. Late recurrence of SAH can occur even after complete clipping, and further treatment should be considered.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12472214&dopt=Abstract hemorrhage
J Nephrol. 2002 Mar-Apr;15(2):191-3.
Catastrophic visceral involvement secondary to de novo systemic vasculitis in a renal transplant recipient.
Bedani PL, Bergami M, Mugnani G, Cavazzini PL, Stabellini G, Gilli P.
Division of Nephrology, Sant'Anna Hospital, Ferrara, Italy. benife.it
De novo systemic vasculitis after renal transplant is a rare complication. We report a patient who developed rapid, catastrophic necrotizing vasculitis of the gastrointestinal tract 11 months after renal transplant. A 60-year-old man was admitted for persistent pain in the right abdomen and mild intestinal hemorrhage. After some days the patient presented partial intestinal occlusion, severe hypoproteinemia and acute renal insufficiency. The patient was urgently operated with resection of a tract of the jejunum where there was a venous infarct. Laboratory tests were not significant and the search for hepatitis B, C viruses and ANCA was negative. After some days of irrepressible intestinal hemorrhage, total gastrectomy, splenectomy and resection of the duodenum and pancreas were performed. Histological pictures showed vascular lesions pathognomonic of systemic polyarteritis nodosa (PAN). After thirty days the patient died. The autopsy confirmed atypical systemic PAN with involvement of the pulmonary arteries besides the gastrointestinal tract and pancreas. Gastrointestinal (GI) complications are not frequent in renal transplant recipients, but 30% of patients with such lesions die as a direct consequence of visceral vascular damage. To the best of our knowledge, de novo PAN has been reported as the cause of catastrophic gastrointestinal involvement in only one renal transplant recipient. This case therefore raises the number of reports of PAN in kidney transplantation recipients who had no history of underlying connective tissue disease.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12018638&dopt=Abstract hemorrhage
J Thorac Cardiovasc Surg. 2002 May;123(5):973-6.
Interruption of patent ductus arteriosus in children: robotically assisted versus videothoracoscopic surgery.
Le Bret E, Papadatos S, Folliguet T, Carbognani D, Petrie J, Aggoun Y, Batisse A, Bachet J, Laborde F.
Institut Mutualiste Montsouris, Paris, France. emmanuel.lebremm.fr
OBJECTIVES: If robotic surgery is to be widely used, the risks must be equivalent to those of standard techniques. This study analyzes the feasibility, safety, and efficiency of a robotically assisted technique for patent ductus arteriosus closure and compares the results with those of the videothoracoscopic technique. METHODS: During 2000, 56 children weighing 2.3 to 57 kg (mean, 12 kg) underwent surgical closure of a patent ductus arteriosus. They were distributed into 2 groups: 28 patients (group 1) underwent the videothoracoscopic technique, and 28 (group 2) underwent a robotically assisted (Zeus; Computer Motion, Inc, Goleta, Calif) approach. Operative and postoperative surgical data were studied. RESULTS: Operative time was significantly higher in the robotically assisted group. One conversion in videothoracoscopy was necessary, but no thoracotomy was required. Three persistent shunts were detected at postoperative echocardiography and were treated by means of application of a new clip with videothoracoscopy (1 in group 1 and 2 in group 2). No permanent laryngeal nerve injury and no hemorrhage were noted. The mean hospital stay was 3 days in both groups. CONCLUSIONS: Robotically assisted closure of a patent ductus arteriosus is comparable with closure by means of the videothoracoscopic technique. However, it requires a longer operative time because of the increment in complexity.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12019384&dopt=Abstract hemorrhage
J Exp Med. 2002 May 20;195(10):1371-7.
Locally up-regulated lymphotoxin alpha, not systemic tumor necrosis factor alpha, is the principle mediator of murine cerebral malaria.
Engwerda CR, Mynott TL, Sawhney S, De Souza JB, Bickle QD, Kaye PM.
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom. christian.engwerdshtm.ac.uk
Cerebral malaria (CM) causes death in children and nonimmune adults. TNF-alpha has been thought to play a key role in the development of CM. In contrast, the role of the related cyto-kine lymphotoxin alpha (LTalpha) in CM has been overlooked. Here we show that LTalpha, not TNFalpha, is the principal mediator of murine CM. Mice deficient in TNFalpha (B6.TNFalpha-/-) were as susceptible to CM caused by Plasmodium berghei (ANKA) as C57BL/6 mice, and died 6 to 8 d after infection after developing neurological signs of CM, associated with perivascular brain hemorrhage. Significantly, the development of CM in B6.TNFalpha-/- mice was not associated with increased intracellular adhesion molecule (ICAM)-1 expression on cerebral vasculature and the intraluminal accumulation of complement receptor 3 (CR3)-positive leukocytes was moderate. In contrast, mice deficient in LTalpha (B6.LTalpha-/-) were completely resistant to CM and died 11 to 14 d after infection with severe anemia and hyperparasitemia. No difference in blood parasite burden was found between C57BL/6, B6.TNFalpha-/-, and B6.LTalpha-/- mice at the onset of CM symptoms in the two susceptible strains. In addition, studies in bone marrow (BM) chimeric mice showed the persistence of cerebral LTalpha mRNA after irradiation and engraftment of LTalpha-deficient BM, indicating that LTalpha originated from a radiation-resistant cell population.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12021316&dopt=Abstract hemorrhage
J Vasc Surg. 2002 May;35(5):847-52.
Abdominal aortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry.
Noel AA, Gloviczki P, Cherry KJ Jr, Safi H, Goldstone J, Morasch MD, Johansen KH; United States Cryopreserved Aortic Allograft Registry.
Division of Vascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. noel.audrayo.edu
OBJECTIVE: Aortic reconstructions for primary graft infection (PGI), mycotic aneurysm (MA), and aortic graft-enteric erosion (AEE) bear high morbidity and mortality rates, and current treatment options are not ideal. Cryopreserved grafts have been implanted successfully in infected fields and may be suitable for abdominal aortic reconstructions. Registry data from several institutions were compiled to examine results of cryopreserved aortic allograft (CAA) placement. METHODS: The experience of 31 institutions was reviewed for CAAs inserted from March 4, 1999, to August 23, 2001. Indications for CAA, organisms, mortality, and complications were identified. RESULTS: Fifty-six patients, 43 men and 13 women, with a mean age of 66 years (range, 44 to 90 years) had in situ aortic replacement with CAA. Indications for CAA placement were PGI in 43 patients (77%), MA in seven (14%), AEE in four (7%), and aortic reconstruction with concomitant bowel resection in two (4%). Infectious organisms were identified in 33 patients (59%); the most frequent organism was Staphylococcus aureus in 17 (52%). Thirty-one patients (55%) needed an additional cryopreserved segment for reconstruction. The mean follow-up period was 5.3 months (range, 1 to 22 months). One patient died in the operating room, and the 30-day surgical mortality rate was 13% (7/56). Seven additional patients died during the follow-up period, yielding an overall mortality rate of 25% (14 patients). Two patients (4%) had graft-related mortality as the result of hemorrhage from the CAA and persistent infection. Graft-related complications included persistent infection with perianastomotic hemorrhage in five patients (9%), graft limb occlusion in five (9%), and pseudoaneurysm in one (2%). Three patients (5%) needed amputation. CONCLUSION: In situ aortic reconstruction with CAA in infected fields carries a high mortality rate, but most deaths are not the result of allograft failure. However, CAA infection and lethal hemorrhage caused by graft rupture occurs and is concerning. Early reinfection was not reported. Late graft-related complications, such as reinfection, thrombosis, or aneurysmal changes, are unknown. Preliminary data from this registry fail to justify the preferential use of CAA for PGI, MA, or AEE. A multicenter, randomized study is needed to compare results with established techniques.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12021697&dopt=Abstract hemorrhage
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