Autologous Bone Marrow Stem Cells in Patients With Critical Limb Ischaemia not Eligible for Revascularization: A Single Centre Experience.

We evaluated the use of autologus bone marrow stem cells transplantation in patients with critical limb ischaemia (CLI) not eligible for revascularization. Eighty consecutive patients candidate to amputation were enrolled in a single-centre retrospective study. The primary endpoint was defined as the amputation-free rate from stem cells transplantation. Secondary endpoints were the evaluation of transcutaneous oximetry and its predictive potential for probability of amputation and the evaluation of rest pain. Ankle brachial index, transcutaneous oxygen (TcpO2) and radiological imaging were performed at the enrolment and during the follow-up times. All patients were treated with auto transplant of bone marrow stem cells. Two patients died due to acute renal and acute respiratory failures. 19 patients were amputated from the thigh or leg. In total, 59 of 80 patients intended to thigh amputation saved the limb, preserving the plantar support. TcpO2 was found a predictive metric with an AUC equal to .763, and a threshold for a risk of amputation of 10% and 5% at the values ≤22.7 and ≤26.9 mmHg, respectively. Auto transplant of bone marrow stem cells seems to be a safe and an efficient option for CLI not eligible to revascularizzation.

Intramural haematoma of the thoracic aorta: A case series.

We reported four cases of intramural haematoma of the descending thoracic aorta. Four patients, aged 55-82 years, hypertensive, were transferred from the emergency room of other hospitals due to the appearance of epigastric pain and left thorax pain. All patients underwent computed tomography angiography reporting the presence of intramural haematoma. Three patients underwent a drug therapy to maintain a controlled hypotension. A computed tomography revaluation was performed documenting (1) an increase in the thickness of the intramural haematoma, (2) the appearance of a penetrating ulcer within the haematoma and (3) the appearance of several penetrating lesions throughout the thoracic aorta. Patients required the placement of one or two thoracic aorta endoprosthesis. For the fourth patient, the hyperdense appearance of the intramural haematoma and the presence of pleural effusion suggested an urgent treatment intervention. All patients underwent a placement of cerebrospinal fluid catheter and drainage before treatment. All patients were treated with endovascular intervention with 100% technical success and absence of migration or retrograde type A dissection. There were no complications related to femoral surgical access or access routes. Perioperative mortality was null; no patient had paraplegia. No strokes, transient ischemic attack or perioperative myocardial infarction were observed. The average hospitalization was 5 days. After 3 months, angio-computed tomography reported for all patients a complete reabsorption of the intramural haematoma and a complete exclusion of the penetrating ulcer of the aortic wall present at the time of the intervention. There have been no cases of distant thoracic aortic tears. Endovascular treatment must be considered the preeminent treatment for thoracic aortic haematoma. Best timing to perform the endovascular procedure depends on the patient clinical picture and on stability of hemodynamic parameters.

Isolation of clinically relevant concentrations of bone marrow mesenchymal stem cells without centrifugation.

BACKGROUND: This study examined the quality of bone marrow aspirates extracted using a novel, FDA cleared method to optimally target cells from the inner cortical iliac bone surface without the need for centrifugation. This method employs small draws from a single puncture that promote only lateral flow from multiple sites (SSLM method). The study utilized the Marrow Cellutions bone marrow aspiration system (MC system) which is based on the SSLM method and compared the MC system directly to bone marrow concentrates (BMAC) generated by centrifugation of aspirates harvested with a standard aspiration needle. METHODS: Three direct comparisons were conducted evaluating the SSLM draws and BMACs derived from the same patient from contralateral iliac crests. The levels of TNCs/mL, CD34+ cells/mL, CD117+ cells/mL, and CFU-f/mL were compared between the various bone marrow preparations. The cellular content of a series of SSLM draws was also analyzed to determine the total nucleated cell (TNC) count and the concentration of mesenchymal stem/progenitor cells as measured by colony forming unit fibroblasts (CFU-f). RESULTS: In direct comparisons with BMAC systems, SSLM draws yielded significantly higher CFU-f concentrations and comparable concentrations of CD34+ and CD117+ cells. In addition, the average quantity of TNCs/mL in a series of 30 patients utilizing the SSLM draw was 35.2 × 106 ± 17.1 × 106 and the average number of CFU-f/mL was 2885 ± 1716. There were small but significant correlations between the TNCs/mL and the CFU-fs/mL using the SSLM method as well as between the age of the patient and the CFU-fs/mL. CONCLUSIONS: The MC Device, using the SSLM draw technique, produced concentrations of CFU-fs, CD34+ cells and CD117+ cells that were comparable or greater to BMACs derived from the same patient. Given the rapid speed and simplicity of the MC Device, we believe this novel system possesses significant practical advantages to other currently available centrifugation based systems.

Endovascular treatment of persistent sciatic artery aneurysm with the multilayer stent.

PURPOSE: To describe the successful management of a symptomatic persistent sciatic artery (PSA) aneurysm using the Multilayer Aneurysm Repair System (MARS). CASE REPORT: A 50-year-old man with history of smoking, hypertension, and hypercholesterolemia suddenly developed pain in the buttock radiating to the left lower limb, mimicking sciatica. The ∼57×54-mm incomplete type PSA aneurysm was treated with two 14×80- and 14×60-mm MARS devices through a surgical left axillary artery access. There were no periprocedural complications. Thirty-day imaging documented patency of the stents and a minor reduction (∼47×55 mm) in the aneurysm, with slightly hyperdense content and no signs of perfusion. At 6 months, duplex and computed tomographic angiography showed complete thrombosis of the sac, patency of the multilayer stents, and further aneurysm shrinkage (40×37 mm). CONCLUSION: The multilayer stent can alter the hemodynamics inside a peripheral aneurysm to promote sac thrombosis and redirect flow to collaterals originating from the sac.

[Unusual case of malignant pleomorphic fibrohistiocytoma of the abdominal wall]. / Su un raro caso di fibroistiocitoma maligno pleomorfo della parete addominale.

The authors report their experience with a case of a voluminous malignant pleomorphic histiocytoma of the anterior abdominal wall occurring in an 81-year-old female patient. She presented with a one-year history of a non-painful, poorly mobile tumefaction which had grown in size over the 2 months prior to admission. A preoperative CT scan confirmed the presence of a 10-cm mass located in the anterior abdominal wall. The patient underwent resection of the tumour and was discharged on postoperative day 15. A 12-month follow-up has so far revealed no evidence of recurrence. The authors go on to examine the diagnostic and therapeutic treatments of these rare neoplasms with reference to the international scientific literature. They confirm the validity of radiotherapy but stress the elective role of surgical treatment.