Acute aortic thrombosis in COVID-19.

Acute aortic occlusion is an infrequent disease but with significant mortality. The new pandemic of the SARS-CoV-2 coronavirus disease (COVID-19) represents a great challenge for health systems. This contagious disease is generating high infection and mortality rates in several countries. It is speculated that the inflammatory process accompanying the infection is triggered by massive macrophage activation and is associated with the development of coagulopathy. We present three cases of COVID-19 patients, treated in our hospital during a period of 2 weeks, who presented with an acute thrombosis of the infrarenal abdominal aorta.

Cadaveric Models for Renal Transplant Surgery Education: a Comprehensive Review.

PURPOSE OF REVIEW: To evaluate the utility of cadaveric models for kidney transplant (KT) surgery training. RECENT FINDINGS: Medline® and PubMed® databases were searched for English and Spanish language articles published describing different learning models used in KT formation. We evaluated the use of cadavers preserved by Thiel's embalming method (TEM) as KT simulation models. Students were divided in groups of 4 people: four trainees mentored by an expert in KT surgery. Among the trainees were surgical residents and low-experience surgeons. A total of 39 TEM preserved bodies were used, of which 75 viable renal grafts were obtained. In each cadaver, two complete transplantation processes were performed, each consisting of en bloc nephrectomy with the trunk of aorta and inferior vena cava, bench surgery and perfusion with saline of the organ, and KT surgery. As with any surgical procedure, learning KT surgery is a stepwise process that requires years of dedication. The models available for the surgical simulation of KT surgery allow to practice and achieve dexterity in performing the procedure in a safe and reproducible way. Training on TEM-preserved corpses offers a highly realistic model for the surgical simulation of KT surgery.

An experimental model for training in renal transplantation surgery with human cadavers preserved using W. Thiel's embalming technique.

OBJECTIVE: To describe a novel cadaver-based model for practicing renal transplant (RT) surgery. DESIGN: A simulating model using cadavers preserved by Thiel's method is developed to teach surgical anatomy and operative skills in RT surgery. Participants were asked to complete a voluntary, anonymous survey evaluating perceptions of the model and comparing cadaver sessions to other types of learning (rating questions from 0-10). SETTING: Large university teaching hospital. PARTICIPANTS: A total of 28 residents, junior transplant surgeons, and faculty members were participants in the cadaver simulation. RESULTS: Overall, 9 cadavers were used with 17 grafts transplanted. Kidney procurement in human cadavers preserved using Thiel's embalming technique was performed following the conventional protocol; en bloc nephrectomy with the trunk of aorta and inferior vena cava. Bench surgery was performed, perfusing artery with saline and checking vascular permeability. Once suitability is established, RT was performed as is done in clinical practice. This embalming method enables tissue dissection that is comparable to the living body and provides suitable conditions for realistic RT simulation; handling human tissues and vessels in the same surgical field as the clinical scenario. This experimental model approximates to in vivo RT, providing a realistic and interesting learning to inexperienced surgeons. Overall, participants held a positive view of the cadaver sessions, believed them to be useful in their daily practice, and felt that the proposed model was similar to the clinical setting. Trainees believed that these practices improved skills and confidence in performing an RT. CONCLUSIONS: The proposed method of kidney procurement and RT in human cadavers preserved by Thiel's embalming technique is a promising, realistic, and reproducible method of practicing RT surgery.

The spectrum of cardiovascular infections due to Salmonella enterica: a review of clinical features and factors determining outcome.

Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known. Mortality associated with aortitis and endocarditis caused by nontyphoidal Salmonella remains exceedingly high. In this review of cases of cardiovascular infections due to Salmonella enterica studied in 2 hospitals in Madrid, we tried to assess the clinical manifestations and the procedures leading to diagnosis in addition to treatment and outcome. To complete the spectrum of infections related to cardiovascular surgery, cases of postoperative mediastinitis, pericarditis, and infections associated with cardiac devices were also included.Twenty-three patients were reviewed: 11 had mycotic aneurysms; 7 had endocarditis; 2 had device-related infections; and 3 had pericarditis, mediastinitis, and infection of an arteriovenous fistula, respectively. The risk of endovascular infection in patients older than 60 years with bacteremia due to nontyphoidal Salmonella was 23%. Most patients with aortitis had risk factors for atherosclerosis, and 6 had preexisting atherosclerotic aortic aneurysms. All except 1 patient with endocarditis had underlying cardiac disorders. Acquired immunodeficiency disease (AIDS) was a major risk factor for salmonella bacteremia in 1 patient with aortitis and 1 with endocarditis. Fever, unremitting sepsis, "breakthrough" and relapsing bacteremia were the most common clinical findings. In addition, abdominal or thoracic pain and cardiac failure and pericarditis were common features in patients with aortitis and endocarditis respectively. Computed tomography (CT) scan, arteriography, and echocardiography were the main diagnostic tools. Mortality associated with mycotic aneurysms and endocarditis due to S. enterica was 45% and 28%, respectively. Thoracic aneurysms, rupture, and shock at the time of diagnosis were associated with increased mortality in patients with aortitis. In situ bypass grafting was successfully performed in most cases. After surgery, antimicrobial therapy was continued for 4-9 weeks. No relapses were observed after a mean follow-up of 64 months. Antimicrobial therapy alone or combined with valve replacement or excision of a ventricular aneurysm was successful treatment for most patients with salmonella endocarditis. Combined medical and surgical treatment was required for patients with mediastinitis and pericarditis, and patients with device-related infections needed removal of the complete device. Diagnosis of aortitis due to nontyphoidal Salmonella should be established as early as possible to reduce mortality. Patients older than 60 years who have positive blood cultures for Salmonella along with fever and back, abdominal, or chest pain should have an extensive workup for infective aortitis. Immediate bactericidal antimicrobial therapy should be started and a CT scan should be performed on an emergency basis. If a mycotic aneurysm is found, surgical resection should follow as soon as possible. Resection of the aneurysm with in situ bypass grafting is the procedure of choice. Postoperative antimicrobial therapy for 6-8 weeks seems enough to avoid relapses. Optimal treatment of patients with endocarditis occurring on ventricular aneurysms must include resection of the aneurysmal sac. Salmonella endocarditis can be successfully treated with antimicrobials alone. Valve replacement should be reserved for patients with cardiac failure or persisting sepsis, and for those who relapse after discontinuation of antimicrobial therapy.

NF-kappaB activation and Fas ligand overexpression in blood and plaques of patients with carotid atherosclerosis: potential implication in plaque instability.

BACKGROUND AND PURPOSE: Apoptosis is present in human atherosclerotic lesions. Nuclear factor-kappaB (NF-kappaB) is involved in the transcriptional regulation of the proapoptotic protein Fas ligand (FasL). We have analyzed NF-kappaB activation and FasL expression in atherosclerotic plaques and peripheral blood mononuclear cells (PBMCs) of patients with carotid stenosis. METHODS: NF-kappaB activation and FasL and active caspase-3 expression were analyzed in 32 human carotid plaques. NF-kappaB activation and FasL mRNA were tested in PBMCs of patients and healthy volunteers. We analyzed whether the NF-kappaB inhibitor parthenolide regulates FasL expression and cytotoxicity in human T cells. RESULTS: The inflammatory region of plaques showed an increase in NF-kappaB activation (3393+/-281 versus 1029+/-100 positive nuclei per mm(2), P<0.001) and FasL (16+/-1.4% versus 13+/-1.8%, P<0.05) and active caspase-3 (3.3+/-0.6 versus 1.5+/-0.3%, P<0.05) expression compared with the fibrous area. Activated NF-kappaB and FasL protein were colocalized in plaque cells. In PBMCs obtained from those patients the day of endarterectomy, NF-kappaB activation and FasL expression were significantly increased compared with healthy controls (1.5+/-0.1 versus 0.5+/-0.1 and 2.1+/-0.1 versus 1.2+/-0.1 arbitrary units, respectively; P<0.001). There was a significant correlation between NF-kappaB activation and FasL expression. In activated T cells, parthenolide decreased NF-kappaB activation, FasL promoter activity, and mRNA expression. Parthenolide also decreased cytotoxicity of activated Jurkat cells on FasL-sensitive cells. CONCLUSIONS: NF-kappaB activation and FasL overexpression occur in PBMCs and atherosclerotic lesions of patients with carotid stenosis. The NF-kappaB-FasL pathway could be involved in the mechanisms underlying plaque instability in humans.