Surgical and endovascular treatment of occlusive aortic syndromes.

Aortic occlusive syndromes encompass a wide variety of aortic and aortoiliac conditions that present with devastating clinical sequale of hypertension coupled with visceral and lower limb ischemia. Clinical presentations, natural history, etio-pathology, diagnosis, management and outcomes of each of these disorders is unique. Risk factor management, endovascular intervention, and/or surgical revascularization compete and complement each other in an exciting manner to give best long-term outcomes. Common causes of aortic occlusion include: 1) atherosclerotic occlusive disease, including aortoiliac occlusive diseases (AIOD); acute aortic occlusion (embolic/thrombotic/dissection; 2) mid aortic syndrome: Takayasu arteritis; congenital aortic hypoplasia; fibromuscular dysplasia; neurofibromatosis; 3) coral reef aorta.

Do Doppler waveforms at the common femoral artery accurately predict iliac stenosis?

OBJECTIVE: Evaluate whether common femoral artery (CFA) Doppler waveform assessment predicted the presence of significant iliac artery stenosis as visualised on magnetic resonance angiography (MRA). METHOD: Three-year retrospective study of patients investigated using CFA Doppler waveforms and MRA. The patients were identified from vascular/radiology databases. Waveforms were reported real time as monophasic, biphasic or triphasic. Results were compared with MRA findings. RESULTS: In 76 patients, 119 waveforms were assessed. MRA demonstrated 37 iliac vessels with significant stenosis. 32 (86%) had abnormal waveforms (monophasic/biphasic), 5 were triphasic. In 82 cases where MRA showed no significant stenosis, waveforms were abnormal in 35 (43%). Abnormal CFA waveforms have sensitivity of 86% and specificity of 57%. Monophasic waveforms alone were more specific (88%) but less sensitive (57%) for predicting iliac lesions. CONCLUSION: Whilst CFA waveform morphology is a useful adjunct in detection of iliac disease, normal triphasic waveforms do not exclude iliac stenosis.

Laparoscopic adrenalectomy for Conn's syndrome: report of the initial six cases.

We report our experience with the initial six cases of transperitoneal laparoscopic adrenalectomy for primary hyperaldosteronism (Conn's syndrome). This is the first report from India of such a series. From 1997 to 2002, 6 patients with primary hyperaldosteronism (Conn's syndrome) were referred to the Department of Endocrine Surgery and underwent laparoscopic adrenalectomy through the transperitoneal approach. In all patients, the adrenal gland and the adenoma were successfully removed laparoscopically, and all patients were normokalemic and normotensive in the first follow-up after 6 months. Laparoscopic adrenalectomy is a feasible option in cases of hyperaldosteronism. In our series, both hypertension and hypokalemia improved in all

Chemometric simultaneous estimation of clopidogrel bisulphate and aspirin from combined dosage form.

Two chemometric methods, inverse least square and classical least square, were applied to simultaneous assay of clopidogrel bisulphate and aspirin in their combined dosage tablet formulation. Twelve mixed solutions were prepared for the chemometric calibration as training set and 10 mixed solutions were prepared as validation set. The absorbance data matrix was obtained by measuring the absorbance at 16 wavelength points, from 220 to 250 nm with the interval of 2 nm (Deltalambda= 2 nm). The developed calibrations were successfully tested for laboratory mixtures as well as commercial tablet formulation for their clopidogrel bisulphate and aspirin concentration. Mean recoveries for clopidogrel bisulphate and aspirin were found to be in good agreement with the label claim.

The treatment of refractory uveitis with intravenous immunoglobulin.

PURPOSE: To study the treatment of uveitis that has not responded to immunosuppressive medication. Intravenous immunoglobulin (IVIg) effectively treats a variety of autoimmune diseases, but it has not been adequately studied in the treatment of uveitis. METHODS: The trial included patients who satisfied criteria that included noninfectious uveitis, active inflammatory disease, and a failure to respond adequately to immunosuppressive medication. We treated two patients with IVIg (0.5 gm/day, 3 days/mo initial dosage) as a pilot study and then treated an additional eight patients with a similar dosage as part of a formal but uncontrolled protocol. RESULTS: Patients on the protocol have been followed for a median of 11 months and have received a median of 7.5 treatment cycles. Five of 10 patients have had a clinically important and sustained improvement in visual acuity, and two of eight protocol patients have markedly reduced their immunosuppressive medication. CONCLUSIONS: Intravenous immunoglobulin can benefit some patients with uveitis that is otherwise refractory to immunosuppressive therapy. Although our preliminary experience is encouraging, the use of IVIg for uveitis should be limited because of cost, toxicity, the requirement for repeated administration, and the absence of controlled trials that demonstrate efficacy.

Ocular immunopathology of Behçet's disease.

A patient developed progressive, severe, recurrent bilateral iridocyclitis, retinal vasculitis, and hemorrhagic infarction of the retina that led to blindness despite immunosuppressive therapy. Histopathology of an enucleated blind and painful eye revealed marked nongranulomatous uveitis with a predominantly CD4+ T-lymphocytic infiltration, as well as B-cell and plasma cell aggregation. Extensive expression of adhesion molecules on vascular endothelial cells were found. This finding suggests that adhesion molecules play an important role in the vasculitic process, the trademark of Behçet's disease. The ocular pathology and the therapeutic approach to Behçet's disease are briefly reviewed.

Primary retinal vasculitis. Systemic associations and diagnostic evaluation.

BACKGROUND: Inflammation of the retinal vasculature without an infectious etiology, systemic disease association, or concomitant ocular disease is termed primary retinal vasculitis, and can result in severe and permanent vision loss. Patients with primary retinal vasculitis usually are subjected to an extensive but unrewarding diagnostic evaluation. This study was undertaken to determine the value of such a diagnostic workup, and to determine whether systemic diseases develop in these patients during the course of their illness. METHODS: The clinical records of 25 patients seen between 1984 and 1994 with the referring diagnosis of primary retinal vasculitis were reviewed retrospectively. Recorded data included patient age, sex, race, medical history, medications, visual acuity, extent of retinal disease, and the results of their diagnostic evaluations. RESULTS: On presentation, none of the patients had an underlying systemic disease attributable as the cause of their retinal vasculitis. Review of systems was suggestive of an underlying systemic disease in 1 of 25 patients. Diagnostic evaluation in this patient showed a positive antinuclear antibody value and a double-stranded DNA, suggestive of systemic lupus erythematosus. Subsequently, systemic lupus erythematosus was diagnosed based on the development of other diagnostic criteria. The review of systems was not suggestive of an underlying systemic disease in 24 of 25 patients. False-positive diagnostic test results were obtained in 5 (20.8%) of these 24 patients. No underlying systemic disease associated with the patients' retinal vasculitis subsequently developed in any of these five patients (mean follow-up, 4 years). CONCLUSION: Few diagnostic tests should be ordered in patients with retinal vasculitis in the absence of a medical history suggestive of underlying systemic disease.

Effect of testosterone on diethylstilbestrol toxicity and comparison to a recovery study in the rat epididymis and vas deferens.

Effects of diethylstilbestrol (DES) treatment (30 daily i.m. injections) in reproductive function in the male rat were investigated. These functions were evaluated with sperm counts, motility, fertility, morphology, serum testosterone, and a number of biochemical tests in rat epididymis and vasa deferentia. DES treatment resulted in a 15% loss of body weight and a 60 to 90% loss of weight of testes, epididymis, and vas deferens. Sperm parameters and fertility were reduced to nil by DES treatment. Likewise, the majority of the biochemical measures were severely depressed by the DES treatment. In general, the measured parameters were less affected or recovered with either testosterone cotreatment or 60 days of recovery, showing the role of androgen in maintaining functional integrity and metabolism. However, sperm parameters and fertility did not recover with testosterone cotreatment, which differs from withdrawal of treatment.

Hydatid cyst obstructing labour: a case report.

A case of pelvic hydatid cyst obstructing labour is described in this report. Medical and surgical aspects of management are also discussed.