Paradigm shifts in abdominal aortic aneurysm management based on vascular registries.

Abdominal aortic aneurysm (AAA) is a relatively common and potentially fatal disease. The management of AAA has undergone extensive changes in the last two decades. High quality vascular surgical registries were established early and have been found to be instrumental in the evaluation and monitoring of these changes, most notably the wide implementation of minimally invasive endovascular surgical technology. Trends over the years showed the increased use of endovascular aneurysm repair (EVAR) over open repair, the decreasing perioperative adverse outcomes and the early survival advantage of EVAR. Also, data from the early EVAR years changed the views on endoleak management and showed the importance of tracking the implementation of new techniques. Registry data complemented the randomized trials performed in aortic surgery by showing the high rate of laparotomy-related reinterventions after open repair. Also, they are an essential tool for the understanding of outcomes in a broad patient population, evaluating the generalizability of findings from randomized trials and analysing changes over time. By using large-scale data over longer periods of time, the importance of centralization of care to high-volume centres was shown, particularly for open repair. Additionally, large-scale databases can offer an opportunity to assess practice and outcomes in patient subgroups (e.g. treatment of AAA in women and the elderly) as well as in rare aortic pathologies. In this review article, we point out the most important paradigm shifts in AAA management based on vascular registry data.

Incidence of and risk factors for stoma-site incisional herniation after reversal.

BACKGROUND: Stoma reversal is often considered a straightforward procedure with low short-term complication rates. The aim of this study was to determine the rate of incisional hernia following stoma reversal and identify risk factors for its development. METHODS: This was an observational study of consecutive patients who underwent stoma reversal between 2009 and 2015 at a teaching hospital. Patients followed for at least 12 months were eligible. The primary outcome was the development of incisional hernia at the previous stoma site. Independent risk factors were assessed using multivariable logistic regression analysis. RESULTS: After a median follow-up of 24 (range 12-89) months, 110 of 318 included patients (34·6 per cent) developed an incisional hernia at the previous stoma site. In 85 (77·3 per cent) the hernia was symptomatic, and 72 patients (65·5 per cent) underwent surgical correction. Higher BMI (odds ratio (OR) 1·12, 95 per cent c.i. 1·04 to 1·21), stoma prolapse (OR 3·27, 1·04 to 10·27), parastomal hernia (OR 5·08, 1·30 to 19·85) and hypertension (OR 2·52, 1·14 to 5·54) were identified as independent risk factors for the development of incisional hernia at the previous stoma site. In addition, the risk of incisional hernia was greater in patients with underlying malignant disease who had undergone a colostomy than in those who had had an ileostomy (OR 5·05, 2·28 to 11·23). CONCLUSION: Incisional hernia of the previous stoma site was common and frequently required surgical correction. Higher BMI, reversal of colostomy in patients with an underlying malignancy, stoma prolapse, parastomal hernia and hypertension were identified as independent risk factors.

[Preliminary study of the safety and immunogenicity of the attenuated VD47/25 strain of camelpoxvirus]. / Etude préliminaire de l'innocuité et du pouvoir immunogène de la souche atténuée VD47/25 de camelpoxvirus.

The safety and immunogenicity of the attenuated VD47/25 strain of camelpoxvirus were tested on 30 camel calves in Mauritania. Post-inoculation clinical symptoms were absent during the 40 days of observation. Serum samples collected during this period showed low levels of neutralizing antibodies (1/4-1/16). In vivo titration of a virulent strain of camelpoxvirus in vaccinated camels and control animals enabled the calculation of the PD50 (50% protective dose) which contained the equivalent of 10(3.7) TCID50 (50% cell culture infective dose). Other studies are still required to determine the dose of this vaccine needed to protect 95% of vaccinated animals.

Development of a competitive ELISA for detecting antibodies to the peste des petits ruminants virus using a recombinant nucleoprotein.

A competitive ELISA based on the reaction between a monoclonal antibody (mAb) and a recombinant nucleoprotein of the peste des petits ruminants virus (PPRV) was developed. This protein was obtained in large quantities from insect cells infected with a PPR nucleoprotein recombinant baculovirus (N-B). The competitive ELISA was compared with the virus neutralisation test (VNT) for detecting specific antibodies to PPRV in sheep and goats. The time consuming VNT is the only prescribed test that is capable of distinguishing between PPRV and the cross-reactive rinderpest virus (RPV). The competitive ELISA involves the simultaneous addition of the mAb and antibodies present in a positive serum, leading to competition for a specific epitope on the N-B. Optimum conditions were obtained by using serum samples which had positive or negative neutralising activity against PPRV or RPV. A negative cut-off point was determined on PPRV-negative sera from RPV-vaccinated cattle. A threshold value of 48 per cent inhibition, calculated from the mean for this population plus 2.7 standard deviations, was used in routine testing. A total of 683 sera were analysed by the competitive ELISA and the VNT. A good correlation (r = 0.94) was observed between the titres obtained in the two tests, with 80 sera that were from laboratory sources. The agreement between the two tests was determined on 271 field sera (kappa = 0.825). Their relative sensitivity (94.5 per cent) and specificity (99.4 per cent) were assessed on the 148 laboratory sera plus the 271 sera used for the determination of kappa.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid differential diagnosis of rinderpest and peste des petits ruminants using an immunocapture ELISA.

An immunocapture ELISA for the diagnosis of rinderpest and peste des petits ruminants is described. Monoclonal antibodies directed against non-overlapping antigenic domains on the nucleocapsid (N) were used to detect the virus N protein in supernatants from infected cells and in field specimens. The assay, which is very sensitive, can be performed in one hour on pre-coated plates. There was no cross reaction between the two viruses in the test and the N protein could be detected in infected cell supernatants kept at ambient temperature for one week. These results show that the ELISA is suitable for routine diagnosis of field samples.