Combined endovascular and operative infrainguinal revascularization in the management of multilevel atherosclerotic disease

Between January 1997 and March 1999, primary intraoperative iliac artery balloon angioplasty with or without stent replacement was performed in 40 patients undergoing infrainguinal revascularization, 25 stents and 15 angioplasty without stent. The infrainguinal revascularization included 25 femoropopliteal bypass grafts, eight femorodistal bypass grafts, four femorofemoral bypass grafts and three profundoplasty and femoral endarterectomy. The results indicated that the initial technical success of primary iliac artery angioplasty and stenting was 90%. The improvement of ankle brachial index ranged from 0.35 preoperatively to 0.85 postoperatively. Clinical success based on the criteria suggested by the society of cardiovascular surgery was achieved in 36 patients and there was no operative death. Five patients required a secondary procedure to maintain limbs salvage during the two follow up years. Three patients underwent amputation, one due to early graft thrombosis and two due to late graft occlusion. It was concluded that combined endovascular and operative infrainguinal revascularization optimize the therapeutic option to patients with multilevel atherosclerotic disease

Beta-glucuronidase and hyperbilirubinemia in breast-fed versus formula-fed babies

Breast milk and formula milk and the corresponding serum samples from 20 breast-fed babies, 20 formula-fed babies, and their mothers were examined at 3 days of age for beta-glucuronidase enzyme. Serum indirect bilirubin levels were also examined for all the infants. Serum indirect bilirubin concentrations were significantly higher [p < 0.001] in breast-fed [4.87 +/- 2.4mg/dl] than in formula-fed infants [1.04 +/- 0.5 mg/dl]. beta-glucuronidase activity in formula milk was negligible, while that in human milk was considerable [468.26 +/- 220.8 Sigma units/ml] and was correlated [p < 0.05] with that in the serum of the breast-fed [66.13 +/- 18.1 Sigma units/ml] than in formula fed infants [52.08 +/- 11.9 Sigma units/ml] and a significant [p < 0.05] correlation was found between its serum level and serum indirect bilirubin in both breast and formula fed infants. Also in breast-fed infants serum bilirubin concentrations were related to beta-glucuronidase activity in breast milk [p < 0.05]: Breast milk beta-glucuronidase - by facilitating intestinal reabsorption of bilirubin - seems to be an important factor in the neonatal hyperbilirubinemia of breast-fed babies