Use of modified Sandwich-graft technique to preserve hypogastric artery in EVAR treatment of complex aortic aneurysm anatomy.

AIM: Since the introduction of the first endoprosthetic devices, continuous development in techniques and implants has occurred, such as the introduction of a stent graft with branches designed to preserve antegrade flow in the hypogastric artery, a stent-graft designed to treat extreme neck angulation and iliac tortuosity, as well as "Sandwich" and "Chimney" techniques used to maintain perfusion in branch vessels originating in the region to be treated. This paper describes how the Sandwich-Graft technique was adapted, as described by Lobato et al., employing the Aorfix™ system (Lombard Medical) and the Viabahn™ (W.L.Gore) to preserve hypogastric flow in cases with extreme neck angulation and iliac tortuosity. METHODS: The study included four patients treated from April 2010 until November 2010 with the modified Sandwich technique. All patients eligible for this approach were considered unfit for open repair and were not suitable for an iliac branch graft (Z-BIS Zenith™ Cook Medical). RESULTS: A bifurcated endograft was implanted with specific, in-situ, branching to the target hypogastric artery and achieved clinical and technical success, in all the patients. After a 11-month follow-up in two cases and a six-month follow-up in the other two, clinical results were successful. All patients were endoleak-free, had patent hypogastric branches and had shrinking or stable aneurysms. CONCLUSION: The initial experience shows that the Sandwich technique with the Aorfix™ stent-graft demonstrated to be effective in endovascular repair of abdominal aortic aneurysms in patients with aortoiliac anatomy hostile to preserving hypogastric artery patency. This graft allows a broader group of patients to be treated with endovascular repair without potential complications of hypogastric artery occlusion; however, further studies are needed to evaluate long-term results in larger numbers of patients.

[Uveal lymphoid infiltration with systemic extension]. / Infiltración uveal linfoide con extensión sistémica.

CASE REPORT: We report the case of a patient who was surgically treated in his right eye because of an uncontrollable glaucoma and a retinal detachment without retinal break. Ultrasound and computed tomography showed diffuse choroidal thickening. During 6 years of follow-up, he developed a major ocular and orbitary invasion and bone marrow infiltration. He was treated by enucleation and chemotherapy with apparent total remission. DISCUSSION: Reactive lymphoid hyperplasia of the uvea consists of a lymphocytic proliferation that primarily involves the uveal tract. This process is regarded as a low malignant condition, but this case of late diagnosis showed a tendency to orbital and systemic extension.

Infiltración uveal linfoide con extensión sistémica / Uveal lymphoid infiltration with systemic extension

Caso clínico: Se describe el caso de un paciente, intervenido en ojo derecho de glaucoma incontrolable y de desprendimiento de retina sin rotura aparente, que presenta un engrosamiento coroideo en ecografía y en la tomografía computerizada. A lo largo de 6 años desarrolló una gran invasión ocular, orbitaria e infiltración de médula ósea y fue tratado mediante enucleación y quimioterapia con aparente remisión completa. Discusión: La hiperplasia linfoide reactiva de la úvea consiste en una proliferación linfocitaria que se inicia primariamente en el tracto uveal. Aunque se considera un proceso poco maligno, este caso de diagnóstico tardío demuestra su tendencia a la extensión orbitaria y sistémica (AU)

[Pentachlorophenol poisoning. Report of 4 cases and review of the literature]. / Intoxicación por pentaclorofenol. Descripción de cuatro casos y revisión de la literatura.

Pentachlorophenol (PCP) was, and still is, one of the most frequently used fungicides and pesticides. The use of PCP has been more restricted during the last few years. PCP's most important industrial application is as a wood preservative. The pentachlorophenol can be absorbed into the body by all the routes of occupational exposure. Some epidemiological observations suggest that exposure to PCP solutions may result in an increased risk for certain diseases in humans, e.g., immunodeficiency, blood disorders, malignancies, congenital anomalies. Chronic poisoning is difficult to detect since symptoms are often vague. Acute poisoning is due to interference with oxidative phosphorylation and can present itself as an unexpected case of sudden death. Four cases of PCP poisoning, including one fatalitie, occurred in two small wood preservative plants. All cases presented with increased serum creatinine phosphokinasa. The clinical finding are reported, and treatment modalities commented. At present there is no antidote for PCP. The basis for treatment is intensive supportive care to maintain vital bodily function. In one patient plasmapheresis was used and rapid recover was obtained. It is suggested that such therapy may be lifesaving in such intoxications.

Intoxicación por pentaclorofenol. Descripción de cuatro casos y revisión de la literatura / Pentachlorophenol intoxication: report of four cases and literature review

El pentaclorofenol (PCP) era, y todavía es, uno de los fungicidas y pesticidas más usados. El empleo de PCP ha sido más restringido en los últimos años. La aplicación industrial más importante del PCP es como conservante de la madera. El pentaclorofenol puede ser absorbido por todas las rutas de exposición ocupacional. Algunas observaciones epidemiológicas sugieren que la exposición a soluciones de PCP puede incrementar el riesgo de algunas enfermedades (inmunodeficiencia, trastornos sanguíneos, tumores, anomalías congénitas, etc). La intoxicación crónica es difícil de detectar ya que los síntomas a menudo son vagos. La intoxicación aguda es debida a la interferencia de la fosforilación oxidativa y puede presentarse como muerte súbita inesperada. Cuatro casos de intoxicación por PCP, uno de ellos fatal, ocurrieron en dos empresas madereras. Todos los casos cursaron con CPK elevada. La base del tratamiento son las medidas de soporte para mantener las funciones vitales. En un paciente se usó la plasmaféresis y se obtuvo una rápida mejoría. Se sugiere que esta terapia puede salvar la vida en este tipo de intoxicación (AU)

Tubérculos coroideos en la tuberculosis miliar / Choroidal tubercles in miliary tuberculosis

Objetivo/Método: Se presentan 2 casos clínicos con múltiples tubérculos coroideos debidos a tuberculosis miliar. Resultados/Conclusiones: La tuberculosis miliar representa una grave enfermedad que normalmente se cura con un tratamiento adecuado; mientras que, cuando no se diagnostica, suele conducir a la muerte del paciente. El diagnóstico requiere un alto índice de sospecha y la presencia en el fondo de ojo de los típicos tubérculos coroideos puede resultar fundamental en el correcto y rápido tratamiento del proceso (AU)

[Recurrent Budd-Chiari syndrome as a complication of nocturnal paroxysmal hemoglobinuria]. / Síndrome de Budd-Chiari recidivante como complicación de una hemoglobinuria paroxística nocturna.

Budd-Chiari syndrome is a frequent complication of nocturnal paroxysmal hemoglobinuria, histologic and angiographic study being fundamental for diagnosis. We emphasize the importance of ultrasonography and abdominal CAT as noninvasive methods of early diagnosis, and the value of ultrasonography in the follow-up of these patients. Radical therapy of the disease from onset is a determinant of the final prognosis of these patients, as well as early treatment of thrombosis with thrombolytics and/or anticoagulants.

[Whipple's disease and splenomegaly with negative intestinal biopsies]. / Enfermedad de Whipple y esplenomegalia con biopsias intestinales negativas.

A case is presented of a patient with a picture of acute gastroenteritis and splenomegaly. Microscopic study of the spleen and a lymph node showed the characteristic findings of Whipple's disease, although no digestive alteration was found, in spite of performing several duodenal and jejunal biopsies. The etiopathogenesis of this entity is commented on and discussed.