Stenting of Iliac Artery through Brachial Approach.

In some cases the iliac artery occlusive disease cannot be approached through standard access. The preferred access sites are the ipsilateral retrograde femoral and the contralateral antegrade cross-over, although occasionally these approaches do not allow an effective engagement of the lesion, especially when there is a total occlusion or complex aortoiliac lesion. We are reporting a case of iliac artery stenting through brachial approach.This technique is safe and effective. It provides enough support for stiff balloon or stent catheter to be advanced through this long sheath.

A Case Report of Middle Aortic Syndrome: A Rare Vascular Disorder.

The middle aortic syndrome (MAS) is rare (about 0.5-2% of all the cases of aortic coarctation) vascular disorder characterized by severe narrowing in the descending thoracic aorta, abdominal aorta, or both. It can be congenital or acquired due to several conditions.MAS may present clinically as uncontrolled hypertension, abdominal angina or lower limb claudication. Surgical treatment is effective in controlling symptom and improves life expectancy.

Aorto-bi-Femoral Bypass for Aorto-Iliac Occlusive Disease: Recent Experience at the National Institute of Cardiovascular Diseases (NICVD).

Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.

A simultaneous ex vivo model of embryogenesis: II. Vasculogenesis.

Vasculogenesis was simultaneously studied with embryogenesis in in ovo chick embryo culture, which was harvested at 40 hours. Endodermal cells and vascular endothelial cells were studied using a new combination of stains, immunohistochemistry (for nuclei and basement membrane) and NADPH-diaphorase activity in whole-mounts, paraffin sections and etched semithin sections. The model can be used for the study of developmental process of blood vessels as well as embryonic physiology of blood vessels vis-a-vis organogenesis in response to different angiogenic agents, drug trials, cancer therapy by angiostatic chemicals/radiations and toxins. Considering that vasculogenesis/angiogenesis as one of the fundamental phenomena in physiology, pathophysiology, toxicology and pharmacology of developmental sciences, the model in developing embryo is presented.

A simultaneous ex vivo model of embryogenesis: I. Organogenesis.

In vivo culture of chick embryo was carried out to develop an experimental interphase between in vitro and in vivo study of embryonic physiology. In the process, a simultaneous model of vasculogenesis and organogenesis has been worked out, which is impossible to achieve in mammalian system. Both early (40 hours of incubation) and late (64 & 88 hours of incubation) hours of cultures were conducted for morphological and morphometric studies. A new combination of stains was used in place of conventional haematoxylin and eosin in 40 hours old whole-mount of embryos. Semithin plastic sections were etched for haematoxylin/pyronin stain in addition to paraffin (both normal and enblock) sections. Specific stains (histological, enzyme histochemical or immunohistochemical) were chosen according to the specific organs/areas studied. Immunohistochemistry and NADPH-diaphorase activity were standardized in whole-mount of embryos. Morphometry was done using camera lucida and quantitative image analysis system. A parallel preparation of extra embryonic whole-mounts, paraffin and semithin plastic sections with different types of stainings provides evidence for the scope of the simultaneous study of vasculogenesis. Thus the morphological and morphometric data presented in this and the succeeding article describe the scope and avenues for the use of ex vivo model in various aspects of embryonic physiology, preliminary drug trials/metabolism, radiology, teratology and toxicology.

Maturation-dependent goat epididymal sperm autoagglutination and its inhibition by a glycoprotein factor.

The maturing goat epididymal spermatozoa were isolated from different segments of epididymis and these cells dispersed in a modified Ringer's solution, were incubated at 37 degrees C for 60 min to evaluate their autoagglutination efficacy. Distal corpus-epididymal spermatozoa specifically showed high order of head-to-head autoagglutination property whereas all other sperm cells did not show any detectable aggregation. The goat epididymal plasma has been shown to possess an anti-agglutinin that markedly inhibits sperm agglutination phenomenon and also dissociates the cells from the sperm clusters. Epididymal plasma is the most potent source of the anti-agglutinin which is a heat-stable specific glycoprotein. Like the autoagglutination phenomenon, the initiation of sperm forward progression also starts in the distal-corpus epididymis. The temporal correlation of these two events suggests that sperm autoagglutination may be a prerequisite for the induction of flagellar motility during the epididymal maturity of male gametes.

A study of caesarean section cases with special reference to maternal and neonatal outcome.

Two hundred cases of lower uterine segment caesarean section were studied in SSKM Hospital and IPGME&R, Calcutta (a referral hospital) during the period 1986-1987. All were unselected cases of which 192 were booked and 8 were unbooked. The maximum number of caesarean sections were done in the age group of 21-30 years ie, in 154 cases (77.00%). Of total number of cases 53.5% were primigravida, and rest were multipara. Postoperative complications were noted in 42 cases (21%). Complications were more in unbooked and emergency cases ie, 7 (87.5%) and also in cases of antepartum haemorrhage (3 out of 8 cases) and where foetal distress (12 out of 51 cases) ie, prolonged labour, difficult labour was present. Neonatal mortality and morbidity (8 and 26 out of 154 total births respectively) were high in the age group of 21-30 years. Neonatal complications following caesarean section were found in 21.8% patients in emergency caesarean section and 15.5% in elective caesarean section. Neonatal morbidity was 15% and perinatal mortality was 4% in this study. Asphyxia (11 cases) and respiratory distress syndrome (10 cases) were more dangerous complications in caesarean section. There was no maternal mortality in this series.