Iraqi National Spinal Cord Injuries Centre (INSCIC) twice destroyed since last war but we refunctioned it again.

STUDY DESIGN: Description of spinal cord injuries in a war situation. SETTING: Baghdad, Iraq.

[Weakly malignant leiomyosarcoma of the inferior vena cava. A case report]. / Niedrigmalignes Leiomyosarkom der V. cava inferior Ein Fallbericht.

Primary vascular leiomyosarcomas of the great vessels are rare and the most common localization is the inferior vena cava. Due to nonspecific clinical signs, diagnosis is often made during operation or autopsy. At present, a radical tumor resection is the first choice of treatment. This is a case report of a 49-year-old woman who suffered from abdominal pain for 10 years because of a weakly malignant leiomyosarcoma of the inferior vena cava. A radical tumor resection and reconstruction with a prosthetic vascular graft were performed. Diagnosis, therapy, and prognosis are discussed.

Tissue engineering: complete autologous valve conduit--a new moulding technique.

OBJECTIVE: The use of fibrin gel, which can be produced from patients' blood, was investigated as an autologous, biodegradable scaffold. A new moulding technique was developed to create a complete aortic root. METHODS: A new moulding technique was generated for the creation of complete valve conduit. On the basis of biomechanical valve design studies, a tricuspid "ventricular" and "aortic" stamp were developed. A silicone-coated aluminum cylinder was used to circumferentially limit the mould. The cell/gel suspension was filled into the mould and polymerization was started. RESULTS: The creation of complex structures such as complete valve conduits is possible with the moulding technique described. With a layer thickness of up to 2 mm, histological investigations showed excellent tissue development with viable fibroblasts surrounded by collagen bundles. CONCLUSION: Fibrin gel unifies many properties of an ideal scaffold: The formation of complex structures is possible, the degradation and polymerization is controllable and the formation of the extracellular matrix is excellent.

The St. Jude "Silzone" valve: midterm results in treatment of active endocarditis.

BACKGROUND: The Silzone-coated St. Jude Medical valve (SJM "Silzone" valve), developed to reduce prosthetic valve endocarditis (PVE), was recalled by SJM due to a higher rate of paravalvular leaks. The aim of this study was to determine the efficacy of the SJM "Silzone" valve in avoiding PVE and to evaluate the frequency of paravalvular leaks, when the valve was used exclusively for active bacterial endocarditis. METHODS: From January 1998 to December 1999, the SJM "Silzone" valve was implanted in 40 consecutive patients with active endocarditis (20 aortic, 14 mitral, and 6 both valves). Late transesophageal echocardiography was performed in 87% of survivors, and transthoracic echocardiography in the remaining 13%. Follow-up was 100%. RESULTS: Hospital mortality was 17.5%. Early PVE occurred in 2 of 40 patients (5%). There were two late deaths without signs of recurrent PVE. A hemodynamic relevant paravalvular leak necessitating reoperation was seen in 2 patients within 6 months after operation. The rate of a minor paravalvular leak was 13% (4 of 31 patients). CONCLUSIONS: The SJM "Silzone" valve when implanted for active bacterial endocarditis does not give better results than other mechanical prostheses with regard to early recurrence of endocarditis. The rate of a hemodynamic relevant paravalvular leak requiring reoperation seems rather high during the early postoperative period, whereas the occurrence of minor paravalvular leaks is comparable with that of other mechanical prostheses. Routine observation, recommended for all patients with mechanical heart valves, is also sufficient for patients with the SJM "Silzone" valve.

Fibrin gel -- advantages of a new scaffold in cardiovascular tissue engineering.

OBJECTIVE: The field of tissue engineering deals with the creation of tissue structures based on patient cells. The scaffold plays a central role in the creation of 3-D structures in cardiovascular tissue engineering like small vessels or heart valve prosthesis. An ideal scaffold should have tissue-like mechanical properties and a complete immunologic integrity. As an alternative scaffold the use of fibrin gel was investigated. METHODS: Preliminary, the degradation of the fibrin gel was controlled by the supplementation of aprotinin to the culture medium. To prevent tissue from shrinking a mechanical fixation of the gel with 3-D microstructure culture plates and a chemical fixation with poly-L-lysine in different fixation techniques were studied. The thickness of the gel layer was changed from 1 to 3 mm. The tissue development was analysed by light, transmission and scanning electron microscopy. Collagen production was detected by the measurement of hydroxyproline. Injection molding techniques were designed for the formation of complex 3-D tissue structures. RESULTS: The best tissue development was observed at an aprotinin concentration of 20 microg per cc culture medium. The chemical border fixation of the gel by poly-L-lysine showed the best tissue development. Up to a thickness of 3 mm no nutrition problems were observed in the light and transmission electron microscopy. The molding of a simplified valve conduit was possible by the newly developed molding technique. CONCLUSION: Fibrin gel combines a number of important properties of an ideal scaffold. It can be produced as a complete autologous scaffold. It is moldable and degradation is controllable by the use of aprotinin.

[Changes in the region and the proximal aneurysm neck after endovascular repair of infrarenal aortic aneurysms]. / Veränderungen im Bereich des proximalen Aneurysmahalses nach endovaskulärer Ausschaltung infrarenaler Aortenaneurysmen.

PURPOSE: To analyze short and mid-term changes of the proximal aneurysm neck and to evaluate renal function after endovascular repair of infrarenal abdominal aortic aneurysms. MATERIALS AND METHODS: 24 of 29 patients, who were treated endoluminally with the bifurcated Vanguard Stent graft between 1997 and 1999 underwent spiral CT follow-up after 1, 3, 6 and every 12 months. Mean follow-up period was 10.5 months (3-32 months). Follow-up included spiral CT scanning. The aortic diameter as well as cross-sectional area were measured. Stent graft position and renal perfusion were checked by spiral CT. Serum creatinine levels were determined preoperatively and during follow-up. RESULTS: Supra- and infrarenal aortic sizes remained stable. No correlation to the distance between the stent-graft and the renal arteries was observed. Caudal migration of the stent-graft with an average of 6.5 (3-15) mm occurred in 13 patients. Cranial migration was observed in 3 patients. Uncovered stent wires partially overlapped at least one renal artery in 18 patients. No renal infarction occurred. No significant increase of the serum creatinine level was found. CONCLUSION: The risk of proximal endoleakage due to post-interventional dilatation of the aorta abdominalis seems to be low. Insufficient stent graft fixation requires a wide distance between the proximal end of the stent graft and the aneurysm. In the mid-term uncovered stent wires overlapping the renal arteries had no relevant influence on renal function.

[Hepatic ischaemia during Whipple resection: case report of a rarely required revascularisation]. / Hepatische Ischämie bei der Whipple-Operation. Kasuistik einer selten notwendigen Revascularisation.

With the performance of a partial duodenopancreatectomy, the collateral vascular bed between the coeliac trunk and the superior mesenteric artery is reduced. Normally, this does not lead to ischaemia of the upper abdominal organs. However, we present the rare case of a patient in whom a Whipple resection in combination with a hyploplastic coeliac trunk led to hepatic and splenal ischaemia and aorto-hepatic bypass grafting. The indication for preoperative arteriography is in discussion, since variations or alteration of the upper abdominal vessels are known to be common but manifest organ ischaemia during resection is a rare complication. Patients with signs of general arteriosclerosis or those in whom upper abdominal resection has been performed previously may benefit from angiography. In other cases a test occlusion before vessel ligation is considered to be suitable in assessing the need for vascular surgical intervention.

Septic endarteritis and fatal iliac wall rupture after endovascular stenting of the common iliac artery.

A 52-year-old female with arterial occlusive disease underwent an uneventful percutaneous transluminal angioplasty and placement of a vascular metallic stent in the left common iliac artery. Ten days later she presented with clinical symptoms of septic endarteritis. Shortly after re-admittance, an emergency laparotomy had to be performed because of an acute retroperitoneal bleeding. Rupture of the common iliac artery directly overlaying the penetrating stent was found but control of haemorrhage was of no avail. In this report of a case, septic endarteritis following placement of a vascular metallic stent preceded fatal rupture of the common iliac artery. This up to now unknown constellation requires surgical intervention without undue delay.

Percutaneous retrieval of a central venous catheter sutured to the wall of the right atrium.

A transjugular central venous catheter was inadvertently sutured to the wall of the right atrium in a 63-year-old female during coronary bypass surgery. Using two nitinol Goose Neck snares via a transfemoral and a transjugular approach the catheter was severed into two pieces and retrieved percutaneously.

[Novel endoluminal stents for the treatment of arterial fistulas and perforations]. / Neuartige ummantelte Endoprothesen zur Behandlung arterieller Fisteln und Perforationen.

PURPOSE: To evaluate the use of polycarbonate-polyurethane (Corethane) stented grafts for the treatment of arteriovenous fistulas and arterial perforations. MATERIALS AND METHODS: 4 patients at the age of 34 to 81 underwent percutaneous insertion of corethane endoluminal grafts. Two patients had an arterial fistula--one iliaco-iliac, one brachio-brachial. Two patients underwent treatment to seal arterial perforations that occurred in the external iliac artery in one and in a femoral venous bypass in another. RESULTS: In all cases the communication or leakage was sealed by the endograft in place but had to be combined with a detachable balloon in om case. In three patients, a longer follow-up became available, one patient died three weeks after treatment from unrelated causes. While two stent grafts remained open for 15 and 24 months, one patient experienced stent graft occlusion three months after treatment. CONCLUSIONS: Corethane stent grafts are helpful to seal short-neck arteriovenous fistulas and arterial perforations even under emergency conditions.

Admission to an intensive care unit after transvenous implantable cardioverter defibrillator implantation: analysis of risk factors.

A retrospective review was undertaken of 90 patients admitted to the cardiothoracic intensive care unit and who comprised 47% of all transvenous implantable cardioverter defibrillator operations performed between March 1991 and August 1995. The review aimed to evaluate the necessity for routine postoperative intensive care unit (ICU) admission after implantable cardioverter defibrillator operation. Pre-, intra- and postoperative data were analysed. Eight of 90 patients (9%) subsequently required care unique to the ICU. None of the variables examined, including the Acute Physiology Score (APACHE II system), was helpful in identifying patients who required unique ICU services. Patients undergoing transvenous implantable cardioverter defibrillator surgery are identified as a low risk group requiring in over 90% of cases monitoring services rather than active therapy in an ICU. As no reliable predictors seem to exist to identify the necessity for postoperative ICU admission, cardioverter defibrillator implantations should only be performed in hospitals where adequate facilities are readily available.

Presence and properties of cAMP phosphodiesterase from promastigote forms of Leishmania tropica and Leishmania donovani.

1. This paper reports the isolation and the partial purification of cAMP phosphodiesterase (EC 3.1.4.17) from the promastigote form of Leishmania tropica and a preliminary result from Leishmania donovani. 2. The activity of the fraction obtained from column chromatography was measured. 3. The effects of pH, temperature, time of incubation and various compounds on its activity in vitro were obtained. 4. Two peaks (I and II) exhibiting cyclic nucleotide phosphodiesterase activity were obtained. 5. Both activities were found to require the addition of Mg2+ ions for full effect. 6. The apparent Km values for the first and second peaks were 1.43 x 10(-3) M and 4.1 x 10(-3) M respectively. L. donovani shows only one peak of activity.

The effect of lindane on nucleic acids, protein and carbohydrate content in Tetrahymena pyriformis.

The effects of four lindane concentrations, i.e. 20, 40, 60 and 80 microg ml(-1), on the nucleic acid, protein and carbohydrate content of Tetrahymena pyriformis have been examined. All the test concentrations inhibited the synthesis of DNA, RNA, protein and carbohydrate contents. The degree of inhibition increased with increasing toxicant concentrations. Protein content was the most sensitive macromolecule affected by lindane.

Alterations of glucose levels in the blood and the anterior eye segment of rabbits exposed to ketamine-xylazine anaesthesia.

In rabbits the blood glucose and consequently the aqueous humour glucose levels were increased under general anaesthesia by Ketanest-xylazine. Between 60 and 90 min of the general anaesthesia the average blood glucose levels were found to be three times and those of the aqueous humour twice the normal values. After more than 75 min of anaesthesia the glucose levels tended to be further elevated.

Catabolism of deoxythymidylate in some trypanosomatids.

An initial observation concerning the failure of [3H]thymidine at high specific activity to be incorporated into the DNA of Crithidia fasciculata for more than a brief initial period has been correlated with the presence at high specific activity in the organism of a thymidine phosphorylase activity with an equilibrium in the direction of catabolism. This enzyme degrades thymidine to thymine which is not utilized by the organism. The enzyme has also been shown to be present in a number of other trypanosomatids, including the culture forms of Trypanosoma cruzi, where the specific activity was nearly as high as that in C. fasciculata. Evidence is presented that in C. fasciculata, the culture forms of T. cruzi and possibly other species of trypanosomatid, the thymidine phosphorylae, together with a thymidylate phosphatase, forms a catabolic pathway which degrades thymine nucleotides to thymine, which is then excreted. About 60% of the thymine nucleotides made by organisms appear to be metabolized through the pathway, suggesting that their synthesis is not subject to completely effective regulatory control.

Presence and properties of thymidylate synthase in trypanosomatids.

High speed centrifugal supernatant fractions of homogenates of a number of trypanosomatids were assayed for thymidylate synthase (5,10-methylene-tetrahydrofolate: dUMP C-methyltransferase, EC 2.1.1.45) activity using the method of Lomax and Greenberg (1967) J. Biol. Chem. 242, 109-113). Similar activities were detected in Crithidia fasciculata, Crithidia oncopelti, the blood forms of Trypanosoma brucei, Trypansoma congolense and Trypanosoma lewisi and the blood, intracellular and culture forms of Trypanosoma cruzi, suggesting that all species synthesize at least some thymidylate de novo. The properties of the activities in C. fasciculata and the three forms of T. cruzi were compared with those of the isofunctional bacterial and mammalian enzymes. The trypanosotamid enzyme was inhibited by Mg2+, was much more sensitive to mercaptoethanol, had higher apparent Km values for substrate (dUMP) and cofactor (tetrahydrofolate), had a higher apparent molecular weight and was markedly more sensitive to inhibition by suramin. It is, therefore a possible target for chemotherapeutic attack, either on its own or in combination with a dihydrofolate reductase inhibitor. No evidence was obtained for the regulation of the trypanosomatid enzyme, either by its product, dTMP, or by dTDP or dTTp. This result agrees with previous studies which suggested that in trypanosomatids, the level of dTMP was regulated, at least in part, by a catabolic pathway consisting of a thymidylate phosphatase and a thymidine phosphorylase which degraded the excess of dTMP to thymine.