Fenestrated endovascular repair of complex aortic aneurysms.

BACKGROUND: Fenestrated endovascular aneurysm repair (FEVAR) provides an endovascular solution for patients with large abdominal aortic aneurysms and challenging neck anatomy in addition to repair of endoleaks and pseudoaneurysms. This article reports the midterm outcomes of FEVAR from a single-tertiary referral centre in Ireland. METHODS: From 2006 to 2012, nine consecutive asymptomatic patients with neck anatomy unfavourable for standard EVAR underwent endovascular repair with a customised fenestrated Zenith stent graft. An additional three patients had fenestrated grafts for repair of pseudoaneurysms (n = 2) following open AAA repair and a type I endoleak (n = 1). All patients were prospectively enrolled in a computerised database. Outcomes including mortality, morbidity, renal function, target vessel patency, endoleak and reintervention were analysed. FINDINGS: The mean age and aneurysm size in the primary repair group were 74 years (65-84 years) and 6 cm (5-8.3 cm), respectively, and in the secondary repair group, the mean age was 66 years (61-75 years). No procedures required open conversion, and no visceral arteries were lost. On completion angiography, two patients in group 1 had a type I endoleak and one had a type III endoleak. There were no endoleaks in the secondary repair group. Follow-up ranged from 30 days to 6 years. There was one death within 30 days (8 %) and two deaths at 3 years from non-aneurysm-related causes. Six patients required secondary interventions. Three patients had a transient post-operative creatinine rise of >30 %. CONCLUSION: Our study supports FEVAR as a feasible and effective therapy in the management of patients with complex aortic aneurysms.

Synaptophysin is phosphorylated in rat cortical synaptosomes treated with botulinum toxin A.

Phosphorylation and dephosphorylation of neuronal proteins have been implicated in regulation of synaptic transmission. Studies were performed to determine if synaptophysin was phosphorylated or dephosphorylated during exposure of synaptosomes to botulinum toxin A (BoTX/A). Cholinergic-enriched synaptosomes were preincubated in the presence of 3H-choline to label newly synthesized acetylcholine (3H-ACh). This was followed by incubation with low or high potassium to stimulate release of newly synthesized 3H-ACh. BoTX/A inhibited total Ach release by 15-19% and inhibited release of newly synthesized 3H-ACh by 35%. A 165% increase in synaptophysin phosphorylation occurred in a dose-dependent manner over a range of doses (0.2 nM, 2 nM, 20 nM, 100 nM) of BoTX/A. When 4-Aminopyridine was added to synaptosomes that were BoTX/A treated, synaptophysin was dephosphorylated to control levels. Synaptosomes incubated with BoTX/A exhibited an inhibition of potassium stimulated ACh release and an increase in synaptophysin phosphorylation. Synaptophysin phosphorylation may be involved in inhibition of acetylcholine release.

The corruption process of a law enforcement officer: a paradigm of occupational stress and deviancy.

The public does not want all laws enforced. In the closed society of law enforcement institutions, police discretion, the conspiracy of silence, the lack of an administration with integrity, and susceptible law enforcement officers contribute to the development of corruption from occupational deviance. Corruption in law enforcement agencies may have similar roots in business, law, medicine, and other professions. Understanding the law enforcement corruption paradigm may therefore be helpful in correcting and curbing corruption in other professions.

Corruption in law enforcement: a paradigm of occupational stress and deviancy.

In the closed society of a law enforcement agency, factors such as the conspiracy of silence, authoritarian supervision, and police discretion contribute to corruption. This article describes various types of corrupt behavior by police officers, reports the incidence of corruption in law enforcement agencies, discusses psychiatric conditions that may arise from corruption and also contribute to further corruption, and reviews proposed remedies for corruption. It also suggests that an understanding of corruption in law enforcement might be helpful in understanding, correcting, and preventing corruption in other professions, including medicine.

Congestive heart failure: a continuum of care.

Congestive heart failure is the nation's most rapidly growing category of cardiovascular disorders. As more and more people are surviving cardiac insults, health care providers are called upon to improve the health status of this population. The article describes a program at Advocate Health Care that follows the patient beyond the four walls of the hospital after discharge and into the most appropriate care environment for him or her. The evolution of a clinical quality improvement project aimed at partnering with patients in the care of this chronic illness is discussed.

Electrophoretic analysis of the major outer membrane protein of Chlamydia psittaci reveals multimers which are recognized by protective monoclonal antibodies.

Purified major outer membrane protein, detergent solubilized and reduced with dithiothreitol but not heated, gave an apparent molecular weight in sodium dodecyl sulfate (SDS)-polyacrylamide gels almost three times that observed for the heat-denatured SDS-treated peptide. This is similar to the behavior of porin trimers from gram-negative bacteria. Two protective monoclonal antibodies showed strong binding to the proposed trimer but not to denatured, monomeric major outer membrane protein.

The development of proliferative responses of ovine peripheral blood mononuclear cells to Chlamydia psittaci during pregnancy.

In vitro lymphoproliferative responses to Chlamydia psittaci elementary bodies were detected in the peripheral blood mononuclear cells of pregnant sheep infected with C. psittaci. These responses were suppressed in cells collected in the immediate peri-parturient period, but returned to levels significantly above background within 14 days. Infection also suppressed the lymphoproliferative response to the T-cell mitogen Con A until abortion or lambing, but did not affect the proliferative response to the B-cell mitogen LPS.

The importance of interferon-gamma in an early infection of Chlamydia psittaci in mice.

Athymic mice (nu/nu) and their hairy littermates (nu/+) were infected experimentally with Chlamydia psittaci and the role of endogenous interferon-gamma (IFN-gamma) on the resolution of the infection was studied. The pathological changes produced in the spleen, liver and lung were exacerbated by administration of a monoclonal antibody (mAb) to IFN-gamma and an increased number of viable chlamydiae were recovered from the tissues of both nu/+ and nu/nu mice treated in this way.

Stress and suicide in police officers: paradigm of occupational stress.

All occupations are associated with stress, but certain occupations are significantly more stressful than others. Stress is not always harmful. It is the individual's reaction to stress that determines the outcome, ie, whether the individual will adapt or become maladaptive. Individuals who feel they can control events or are in control of their lives are better able to handle stress than individuals who believe they are the victims of fate or chance and who feel powerless and helpless. For those individuals who feel powerless or helpless, suicide may be a means of taking control over their helplessness. Police officers, who are subject to extraordinary stress, present a paradigm for the study and treatment of stress in other occupations.

Immunity to Chlamydia psittaci with particular reference to sheep.

Chlamydia psittaci, a zoonotic bacterium, is the causal agent of enzootic abortion of ewes, an important disease of sheep in many European countries. The major thrust of current chlamydial research is directed towards the human pathogen Chlamydia trachomatis. This review attempts to bring together relevant information concerning the host immune response to all members of the genus Chlamydiae and show how this has led to an increased understanding of the ovine humoral and cell mediated immune responses to C. psittaci while emphasising areas where there is still a lack of knowledge. Specifically the review looks at the common immuno-accessible antigens of the Chlamydiae and the antibody responses produced during infection, as well as covering the role of T cells and cytokines in the protective immune response.

Mechanism of acute depletion of plasma fibronectin following thermal injury in rats. Appearance of a gelatinlike ligand in plasma.

Plasma fibronectin was depleted within 15 min following sublethal burn, followed by partial recovery at 8 h and complete restoration by 24 h in anesthetized rats. Radiolabeled 75Se-plasma fibronectin, injected intravenously before burn, was rapidly sequestered in burn skin as well as the liver. Fibronectin levels at 2 h postburn as detected by immunoassay vs. 75Se-plasma fibronectin indicated that more fibronectin was in the plasma than detected by electroimmunoassay. Crossed immunoelectrophoretic analysis of fibronectin in early postburn plasma demonstrated a reduced electrophoretic mobility of the fibronectin antigen. Addition of heparin or fibrin, both of which have affinity for fibronectin, to normal plasma was unable to reproduce this altered fibronectin electrophoretic pattern. In contrast, addition of gelatin or native collagen to normal plasma reproduced the abnormal electrophoretic pattern of fibronectin seen in burn plasma. Extracts of burned skin, but not extracts of normal skin, when added to normal plasma, elicited a similar altered electrophoretic pattern for fibronectin. By gel filtration, fibronectin in burn plasma had an apparent molecular weight approximately 40% greater than that observed in normal plasma. These data suggest the release into the blood of a gelatinlike ligand from burned skin, which complexes with plasma fibronectin. Thus, fibronectin deficiency acutely postburn appears mediated by (a) its accumulation at the site of burn injury; (b) its removal from the circulation by the liver; and (c) its presence in the plasma in a form that is less detectable by immunoassay.

Normal fibronectin levels as a function of age in the pediatric population.

Fibronectin is an important non-immune opsonic protein influencing phagocytic clearance of blood-borne nonbacterial particulates which may arise in association with septic shock, tissue injury, and intravascular coagulation. In the present study, serum fibronectin was measured by both electroimmunoassay as well as rapid immunoturbidimetric assay in healthy children (n = 114) ranging in age from 1 month to 15 years in order to delineate the temporal alterations in fibronectin with age. Normal adult serum fibronectin concentrations are typically 220 micrograms/ml +/- 20 micrograms/ml. Serum concentration is 35-40% lower than normal plasma concentration due to the binding of fibronectin to fibrin during clot formation. Children between 1-12 months of age had significantly (P less than 0.05) lower serum fibronectin levels than children between the ages of 1-15 years. Progressive elevation in fibronectin levels was observed within the last 8 months of the first year of age. Fibronectin levels in children older than 1 year of age remained constant up to 15 years and were within the lower limit of the normal adult concentration. No significant (P greater than 0.05) difference in serum fibronectin was observed between male and female children at all age groups. Fibronectin levels thus, increase during the first year of age and normal levels of this blood protein in the infant are less than the normal range for adults.

Influence of septic peritonitis on circulating fibronectin, immunoglobulin, and complement: relationship to reticuloendothelial phagocytic function.

This study was designed to quantify the changes in the major serum opsonins--ie, fibronectin, IgG, and C3--during Staphylococcus aureus and Escherichia coli peritonitis as they may functionally relate to RES phagocytic function. Both forms of peritonitis were characterized by acute depletion of fibronectin, IgG, and C3 within 6 h. By 24 h, C3 levels had returned to control levels in both groups. IgG levels remained depressed 24 h following the induction of E coli peritonitis but had normalized by 24 h after Staph aureus challenge. In contrast, fibronectin was markedly elevated by 24 h with both E coli and Staph aureus peritonitis. Hepatic RES phagocytic function was significantly stimulated following induction of either Staph aureus or E coli peritonitis. The rapid increase in fibronectin as well as RES activation during septic peritonitis may represent a generalized host-defense response.