Morphological Differences in the Aorto-iliac Segment in AAA Patients of Caucasian and Asian Origin.

OBJECTIVE: The objective was to quantify aorto-iliac morphology differences between AAA patients of Caucasian and Asian origin. Additionally, the impact of patient demographic characteristics was assessed, which could influence the morphological differences. METHODS: This international multicentre study included two tertiary referral institutions from Europe and one from China. CT scans with 3D reconstruction of 296 patients with infrarenal AAA >5 cm were analysed. Eighteen measurements were recorded from each CT scan and compared between Caucasian and Asian patients. RESULTS: Caucasian patients had longer common iliac arteries (right: 65.0 vs. 33.1 mm, p < .001 left: 65.0 vs. 35.2 mm, p < .001), longer aneurysm neck (33.0 vs. 28.4 mm, p < .001), greater aneurysm to aortic axis angle (153.0° vs. 142.2°, p < .001), and longer combined aorto-iliac length (195.7 vs. 189.2 mm, p < .001). However, Asian patients had a longer infrarenal abdominal aorta (152.0 vs. 130.0 mm, p < .001), longer AAA (126.2 vs. 93.0 mm), and greater linear distance from renal artery to aorto-iliac bifurcation (143.6 vs. 116.0 mm, p < .001). Caucasian patients had a larger inner common iliac artery diameter (right: 16.0 vs. 14.9 mm, p < .001, left: 16.0 vs. 15.2 mm, p < .001), larger inner exernal iliac artery diameter (right: 9.0 vs. 7.5 mm, p < .001 left: 9.0 vs. 7.7 mm, p < .001), and larger inner common femoral artery diameter (right: 10.0 vs. 5.9 mm, p < .001 left: 10.0 vs. 6.1 mm, p < .001). No difference was observed in AAA transverse diameter (62.0 vs. 63.1 mm, p = .492). CONCLUSION: The results showed that aorto-iliac anatomy in Caucasians differs significantly from Asians, particularly in the length of the common iliac arteries and infrarenal abdominal aorta, and in the transverse diameter of the common, external iliac, and common femoral arteries. Therefore, the exact criteria for stent graft design are dependent on the racial origin of the patient.

[Stricture recanalisation of the distal urether with various endoprothesis].

INTRODUCTION: Application of the metallic stents in the interventional uroradioligy is the result of continous development of the new generation methods percutaneous nephrostomy (PCN), ballon catheter dilatation (BCD), methal and covered stent application. Application of metal stents in the renal canal system was attempted in order to eliminate BCD and PCN--related limitations as well as poor therapeutic results of these methods in a number of etiopathogenic groups of urinary stasis. Years--long application of interventional uroradiology methods, until the development of metallic stengts had shown the following therapeutics facts: PCN is incapable to resolve the caus of urinary obstruction. Permanent good therapeutic BCD results mostly depend on pathohistological aspect of the stricture, metallic stents are most frequently the last choice in therapeutics approch to urinary tract obstructions and their application is directly dependent on previous therapeutics results accomplished by PCN and BCD. In therapeutical sequences new generation of covered stents have important place as method of selection in patients of irreversibile uroopstruction of distal ureter. OBJECTIVE: The main goal of this study was to analize therapeutics results, advanteges and shortages of insercion plastics and opened metallic endoprothesis, and to analize results of covered methal applications on the contrary of using older interventional uroradiology methods. METHOD: Sixthytwo patients with distal urether strictures threated in the Deparment of interventional uroradiology Institute od Radiology Clinical centre of Serbia in Belgrade, participated in the study. Results were analized with Person's 2-test, Fisher test and Student T-test. RESULTS: In our study we had highly significant differences in comparison with number of patients and type of stents during the time after recanalization was reached. Also it was highly significant differences acorrding the type od used interventional uroradiology method that treated proliferation and the success of recanalization. CONCLUSION: Application of covered temporary uretheral stents have number advanteges against using generation older permanent methal endoprothesis.

[Extracorporeal percutaneous biliary-gastric "bypass" in patients with irreversible cholestasis of malignant etiology].

Authors present rarely and unusual original methods for billiary drainage type as combination of exsternal drainage and percutaneus gastrostomy. Method used in four patients with irreversibile obstruction during the last 3 years in Inteventional Radiology Dept. Clinical Center of Serbia. In all cases we have satisfactory results with survival time of about 30 days.

[How to prevent tissue overgrowth and incrustation of metal stents in the urinary tract in patients with pelvic malignancy] b ].

At the current level of stent application in urology each irreversible urostasis contraindicated for surgical therapy implies consideration of indications for metal stent insertion. Stent incrustation which leads directly into a new uroobstruction is a characteristic complication of this method. Available experience in different uroobstructive conditions has shown that very different clinical aspects of stent usage may directly determine the possibility of their incrustation. Stent incrustation may occur in the early postprocedural course or several months later. After that, prevention of stent incrustation starts with postprocedural evaluation, selection of the stent type, and it is subsequently continued by insertion technique and lasts practically permanently after the insertion (infection control, promotion of diuresis and maintenance of normal urodynamics). Authors present own experianse in clinical aplication of metal stents in uroradiology strictures for period of last 15 years.

[The effect of septic complications on recovery in acute renal insufficiency in patients with multiple injuries]. / Uticaj septickih komplikacija na oporavak akutne insuficijencije bubrega kod politraumatizovanih bolesnika.

Septic complication in patients (pts) with ARF are among the most important causes of mortality, especially in pts with polytrauma and multiple-organ failure. Prevention procedures, early and accurate diagnosis and persistent treatment in time are necessary to avoid septic shock. During the period od 27 months (1992-1994), 25 pts with wounds inflicted in war and AFT were treated by haemodialysis. Eighteen (72%) pts had septic complication. Eleven (71%) of them recovered from ARF, while 7 (39%) pts died despite the undertaken procedures. Nine pts (81%) with septic complication and ARF who improved their renal function were treated by one or more nephrotoxic antibiotics. Haemodialysis was initiated when average BUN concentration was 35.7 mmol/l and plasma creatinine level about 0.8 mmol/l. Simultaneously with symptomatic and substituting therapy, and surgical correction of polytrauma, approximately 9 haemodialysis in the period of 21 day were necessary for ARF recovery. In the group of pts who had no improvement of renal function, 6 (85%) received 1 or more nephrotoxic drugs. Approximately 5 haemodialysis were done in these pts, in a shorter period of time. In polytraumatized pts with ARF with septic complication, factors which potentiate hypercatabolism aggravate the prognosis of ARF, increase mortality, require a greater number of haemodialysis and significantly prolong the recovery time of ARF.