An original technique for the treatment of symptomatic common carotid artery occlusion and concomitant ipsilateral internal carotid artery stenosis.

Successful hybrid treatment of the total symptomatic acute occlusion of a common carotid artery (CCA) concomitant to ipsilateral internal carotid artery (ICA) stenosis has only been described once in the literature to date. The management of this anatomic distribution of disease can be a challenge both to plan and perform. The aim of this paper is to report an original hybrid revascularization technique for the treatment of two patients with symptomatic CCA acute occlusion and ipsilateral ICA stenosis. Details of the surgical technique and mid-term follow-up are provided.

An accidental subclavian artery cannulation: successful catheter removal by percutaneous vascular stenting.

Central venous catheterisation may sometimes be associated with life-threatening complications. Of these, subclavian artery puncture (infraclavicular approach), though seldom, (incidence 1-2%) following accidental arterial cannulation, may lead to arterial occlusion, embolism, pseudoaneurysms, vessel laceration or dissection or fatal hemorrhaging. Such complications may be even more severe in critically ill patients requiring systemic anticoagulation therapy or those with acute coagulation dysfunction. The authors report a case of an accidental cannulation of the subclavian artery with a central catheter and its successful removal using an endovascular cover stent positioned via a percutaneous approach. The cover stent can be employed to occlude arterial lacerations. This device was preferred because of the patient's severe clinical condition (a 77-year-old woman with acute right heart thrombosis, atrial hyperkinetic arrhythmia, and cardiogenic shock requiring hemodynamic invasive monitoring and systemic thrombolysis) and because of the presenting anatomical and vascular characteristics (lack of space between introduction site and left ventricle, retroclavicular medial location) that did not permit a safe conventional surgical approach (thoracotomy). Echocolor Doppler sonography was a valuable aid in preoperative assessment, measurement of arterial diameter and cover stent sizing. The procedure was performed under general anesthesia 6 days after admission to the intensive care unit without sequelae. In conclusion, the endovascular procedure permitted safe removal of the arterial catheter without complications. A possible alternative to conventional procedures, the endovascular technique may offer an adequate choice for treating acutely ill patients ineligible for invasive interventions.

[Arteriovenous fistulas for hemodialysis: transposition of the cephalic veins, a personal experience]. / Fistole artero/venose per emodialisi. La trasposizione della vena cefalica nella nostra esperienza.

BACKGROUND: Vascular access for hemodialysis has remarkably developed during these years. Since 1966 we have the Brescia-Cimino fistula which is considered nowadays the best choice for angioaccess. The transposed cephalic vein is the "variant" which has been evaluated in a single stage surgical technique. METHODS: A prospective and randomized study regarding 23 patients submitted to operation for first fistula during 1998. With a median follow-up of 10 months, these fistulas have been studied with echocolordoppler in order to verify their primary patency, diameter and blood flow in artery, in vein and anastomosis. RESULTS: Fistulas have been patented in all cases (15 males e 8 females) and used for dialysis after 3 weeks. No early or late complications have been observed. Mean diameter has been 1.2 cm with mean velocity of 1.8 m/sec, in artery mean velocity 2.3 m/sec and in vein 1.1 m/sec. CONCLUSIONS: Increasing length of life even for high critical patients like these with chronic renal failure underlines the need of surgical strategies which may improve the quality to life. This technique of transposed cephalic vein has the same advantages of direct fistulas also for those patients in which we should have used prosthetic grafts.

Competitive inhibition of Lens culinaris L. copper amine oxidase by amiloride, p-aminobenzamidine, clonidine, 4',6-diamidino-2-phenylindole and gabexate mesylate: a comparative study.

The competitive inhibition of Lens culinaris L. copper amine oxidase by amiloride (Ki = 4.1 x 10(-4) M), p-aminobenzamidine (Ki = 6.0 x 10(-4) M), clonidine (Ki = 5.0 x 10(-4) M), 4',6-diamidino-2-phenylindole (DAPI; Ki = 1.9 x 10(-5) M) and gabexate mesylate (Ki = 2.5 x 10(-4) M) has been investigated, at pH 7.0 and 25 degrees C. The affinity of p-aminobenzamidine, clonidine and DAPI for plant and mammalian copper amine oxidase is closely similar. However, values of Ki for amiloride and gabexate mesylate binding to swine kidney copper amine oxidase are lower than those observed for inhibitor binding to Lens culinaris L. cooper amine oxidase. Thus, amiloride and gabexate mesylate may represent useful model compounds for the development of selective inhibitors of mammalian copper amine oxidase, which may be important in view of the potential use of plant copper amine oxidase as drugs.

Competitive inhibition of swine kidney copper amine oxidase by drugs: amiloride, clonidine, and gabexate mesylate.

Competitive inhibition of swine kidney copper amine oxidase by diuretic, antihypertensive, and anticoagulant drugs, amiloride, clonidine, and gabexate mesylate, respectively, is reported. The affinity of these compounds for swine kidney copper amine oxidase is similar to that observed for inhibitor binding to nitric oxide synthase and trypsin-like serine proteinases. This finding suggests that amiloride, clonidine, and gabexate mesylate should be administrated under careful control, since enzyme cross-inhibition may occur also in vivo.