Case series of seven women with uterine fibroids associated with venous thromboembolism and chronic thromboembolic disease.

Uterine fibroids have been described as an associate to acute venous thromboembolism (VTE), with case reports showing an association between large uterine fibroids, acute deep venous thrombosis (DVT), and acute pulmonary embolism (PE). However, there is little known about the association or causation between uterine fibroids, chronic thromboembolic disease (CTED), and chronic thromboembolic pulmonary hypertension (CTEPH). We report on six women with uterine fibroids and CTEPH, as well as one woman with CTED, all of whom presented with exertional dyspnea, lower extremity swelling, and in the cases of CTEPH, clinical, echocardiographic, and hemodynamic evidence of pulmonary hypertension and right heart failure. Compression of the pelvic veins by fibroids was directly observed with invasive venography or contrast-enhanced computed tomography in five cases. All seven women underwent pulmonary thromboendarterectomy (PTE) followed by marked improvement in functional, clinical, and hemodynamic status.

Analysis of an in-house technique for temporary mandibulotomy and its impact on postoperative radiotherapy.

The purpose of this study was to describe a newly developed procedure for temporary mandibulotomy and subsequent osteosynthesis. Clinical outcomes were evaluated, including complications and the impact on postoperative treatment, particularly postoperative radiotherapy. Twenty-four patients underwent temporary mandibulotomies for the surgical resection of malignancies located in the posterior oral or oropharyngeal region. All were treated with postoperative radiotherapy. An angulated median mandibulotomy was followed by osteosynthesis with three anchor screws directed towards the inferior aspect of the mandible. Anchor screws are modified conventional lag screws that include an additional biconcave washer. This modification prevents the screw heads from cracking into the cancellous bone during tightening, improving their biomechanical qualities considerably. Insertion of screws at any angle to the bony surface therefore becomes possible, which is a precondition for this technique. Minor complications occurred in two patients in the early postoperative period. However, complications causing bony non-union, leading to postponed postoperative radiotherapy were not noted in this cohort.

Características das lesões em acidentes motociclísticos: uma revisãointegrativa da literatura / Types of injuries in motorcycle accidents: an integrative review of literature

Objetivo: conhecer as lesões ocorridas em acidentes motociclísticos no Brasil. Métodos: revisãointegrativa cujas buscas foram realizadas em novembro de 2016 com os descritores motocicletas;acidente de trânsito; ferimentos e lesões. Resultados: 13 publicações foram encontradas naLiteratura Latino-Americana e do Caribe em Ciências da Saúde e 337 na Medical Literature Analysisand Retrieval System Online, e após serem usados os critérios de seleção, restaram seis artigos. Podese perceber que as lesões predominam em membros superiores e inferiores, em homens jovens,durante o período da tarde e noite, sendo mais evidenciados na sexta-feira e no sábado.Considerações finais: o público mais acometido, as características das lesões mais frequentes einformações importantes relacionadas, foram identificadas neste estudo, as quais podem auxiliar noplanejamento e desenvolvimento de estratégias a fim de diminuir esses altos índices de ocorrências.

Objective: to determine the types of injuries caused by motorcycle accidents in Brazil. Methods: anintegrative review study carried out in November of 2016 with the descriptors motorcycles; trafficaccidents; wounds and injuries. Results: 13 publications were found in Latin American and CaribbeanHealth Sciences Literature and 337 in Medical Literature Analysis and Retrieval System Online, andafter applying the selection criteria, six articles remained. It can be seen that the lesionspredominate in upper and lower limbs in young men during the afternoon and evening, being moreevident on Friday and Saturday. Final considerations: the most affected patients, thecharacteristics of the most frequent lesions and important related information were identified inthis study, which can help in the planning and development of strategies in order to reduce thesehigh incidence rates.

Towards an in vitro fibrogenesis model of human vocal fold scarring.

BACKGROUND: Vocal fold (VF) scarring remains a therapeutic dilemma and challenge in modern laryngology. To facilitate corresponding research, we aimed to establish an in vitro fibrogenesis model employing human VF fibroblasts (hVFF) and the principles of macromolecular crowding (MMC). METHODS: Fibrogenesis was promoted by addition of transforming growth factor-ß1 to standard medium and medium containing inert macromolecules (MMC). Hepatocyte growth factor (HGF) and Botox type A were tested for their antifibrotic properties in various doses. Experiments were analyzed with respect to the biosynthesis of collagen, fibronectin, and α-smooth muscle actin using immunofluorescence, silver stain and western blot. RESULTS: MMC led to favourable enhanced deposition of collagen and other extracellular matrix components, reflecting fibrotic conditions. Low doses of HGF were able to dampen profibrotic effects. This could not be observed for higher HGF concentrations. Botox type A did not show any effects. CONCLUSION: Based on the principles of MMC we could successfully establish a laryngeal fibrogenesis model employing hVFF. Our finding of dose-dependent HGF effects is important before going into clinical trials in humans and has never been shown before. Our model provides a novel option to screen various potential antifibrotic compounds under standardized conditions in a short time.

Effectiveness of educational and lifestyle interventions to prevent paediatric obesity: systematic review and meta-analyses of randomized and non-randomized controlled trials.

OBJECTIVE: This review and meta-analysis aim at updating a previous meta-analysis carried out by Waters et al. on the efficacy of interventions aimed at preventing childhood obesity and at identifying predictors of outcome. METHODS: Using an ad-hoc search string, PubMed database was searched for studies assessing body mass index reduction associated with programmes lasting ≥12 weeks in overweight and obese children aged 2-18 years. Studies designed for children with eating disorders or relevant comorbidities were excluded. Studies meeting inclusion criteria were classified according to patient age (<6, 6-12 and 13-18 years), and intervention type (physical activity, diet or both), setting (educational, family or both) and duration (≤1 or >1 year). The search was also extended to other databases. Hand-searching techniques were also applied. The Cochrane 'risk of bias' was applied for quality assessment. RESULTS: Seventy-two studies were meta-analysed. Overall, the best results were achieved by programmes combining diet and physical activity (n = 39). With regard to the setting, programmes involving both school and family and lasting ≤1 year were the most efficacious for 6- to 12-year-old children (n = 26); family-based-only interventions were also effective in children <6 years old (n = 2), although results have to be interpreted cautiously because of the small number of patients enrolled and the high study heterogeneity. In 13- to 18-year-old patients, interventions delivered at school (n = 8) were substantially unsuccessful. CONCLUSIONS: Interventions for childhood obesity prevention should include both diet and physical activity, be preferentially targeted towards school age children and involve both the school and family setting. However, because of the important methodological limitations associated with currently available literature, additional studies are needed to draw definite conclusions.

Right Axillary Artery Cannulation for Endovascular Repair of an Acute Type A Aortic Dissection.

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.

Anterior Leaflet Augmentation With CorMatrix Porcine Extracellular Matrix in Twenty-Five Patients: Unexpected Patch Failures and Histologic Analysis.

BACKGROUND: This study reported on the treatment of Carpentier type IIIa and type IIIb mitral regurgitation (MR) with a large patch anterior mitral valve leaflet augmentation technique using CorMatrix (CorMatrix Cardiovascular Inc, Alpharetta, GA) extracellular matrix (ECM). METHODS: A single-site chart review was conducted on patients who underwent anterior leaflet augmentation performed with the Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA) or through a median sternotomy. Only patients who had anterior leaflet augmentation with porcine intestine ECM or autologous pericardium were included. Follow-up echocardiography was performed on all patients. Histologic specimens were available on ECM patches from a subset of patients who required reoperation. RESULTS: Between August 2011 and April 2014, 44 patients (mean age, 62.6 ± 12.2 years) underwent anterior leaflet augmentation with either porcine intestinal ECM or autologous pericardium at the Temple University Hospital in Philadelphia. Two (4%) late deaths occurred, one in each group. One patient who underwent ECM augmentation died of non-cardiac-related causes 7 months after discharge as a result of complications of chronic renal failure. The second late death occurred 5 months after discharge because of complications of a stroke in a patient in the pericardial augmentation group. Eight (32%) of the patients with ECM had recurrence of severe MR on echocardiography at an average time of 201 ± 98 days. Seven (28%) patients required reoperation because of failure of the ECM patch including perforation (4%), excessive patch dilation (20%), and suture line dehiscence (4%). In contrast, none of the patients with pericardial augmentation developed severe MR or required operation. Statistical analysis of the patients with ECM augmentation demonstrated no correlation of the following: age; sex; comorbid conditions such as diabetes, chronic obstructive pulmonary disease, and hypertension; left ventricular ejection fraction; surgical approach; annuloplasty size; or type of MR with patch failure. A lower body mass index was the only factor associated with recurrent severe regurgitation on univariate analysis (p = 0.039). Histologic study of the four available explants demonstrated intense inflammation without evidence of host integration. The remaining 15 (60%) patients had normal mitral leaflet structure and function on follow-up echocardiograms out to 12 months. CONCLUSIONS: For type III MR, a large anterior leaflet patch technique with porcine ECM was associated with a 32% recurrence rate of severe MR related directly to patch failure. Further research and development should be performed on the use of ECM materials with a goal to decrease the failure rate experienced in this study.

Ascending Aortic Endoballoon Occlusion Feasible Despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery.

OBJECTIVE: Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm. METHODS: A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 38 mm. Computed tomography was done preoperatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, to occlude the ascending aorta, and to deliver cardioplegia. RESULTS: From October 2011 through June 2015, 196 patients underwent totally endoscopic mitral valve surgery using an endoballoon at our institution. Twenty-two patients (11.2%) had ascending aortic diameters greater than 38 mm (range, 38.1-46.6 mm; mean, 40.5 ± 2.5 mm). In these cases, there were no instances of aortic dissection or other injury due to balloon rupture, balloon migration, device movement leading to loss of occlusion, or inability to complete planned surgery due to occlusion failure. CONCLUSIONS: Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning.

Evidence from the very beginning: endoglandular trophoblasts penetrate and replace uterine glands in situ and in vitro.

STUDY QUESTION: How is histiotrophic nutrition of the embryo secured during the first trimester of pregnancy? SUMMARY ANSWER: Rather than specifically focusing on invasion into spiral arteries, extravillous trophoblasts also invade into uterine glands (endoglandular trophoblast) from the very beginning and open them toward the intervillous space. WHAT IS KNOWN ALREADY: Extravillous trophoblasts can be found in close contact and within the lumen of uterine glands, sometimes replacing glandular epithelial cells. STUDY DESIGN, SIZE, DURATION: As well as extensive screening of specimens from first trimester placentation sites in situ we used a previously established three-dimensional co-culture in vitro model system of first trimester villous explants with non-invaded decidua parietalis. PARTICIPANTS/MATERIALS, SETTING, METHODS: First trimester placentas were obtained from elective terminations of pregnancies (n = 48) at 5-11 weeks of gestational age. A subset was processed for confrontation co-culture (n = 31). Invaded decidua basalis was obtained from 20 placentas. All tissues were sectioned, subsequently immunostained and immunodoublestained with antibodies against keratin 7 (KRT7), major histocompatibility complex, class I, G (HLA-G), matrix metallopeptidase 9 (MMP9), von Willebrand factor (VWF) and the appropriate Immunoglobulin G (IgG) negative controls. Replacement of endothelial/epithelial cells by extravillous trophoblasts was quantified semi-quantitatively. Additionally, hematoxylin and eosin-stained archival specimens from early implantation sites were assessed. MAIN RESULTS AND THE ROLE OF CHANCE: The earliest available specimen was from around Day 10 after conception; already at this stage trophoblasts had penetrated into uterine glands and had started to replace the epithelium of the glands. Endoglandular trophoblasts replaced uterine glands in vitro and in situ and could be found in the lumen of invaded glands. Quantitative analysis revealed significantly more replacement of epithelial cells in glands (63.8 ± 22.1%) compared with endothelial cells in vessels (26.4 ± 8.8%). Accumulated detached glandular epithelial cells could be repeatedly observed in the lumen of invaded glands. Additionally, in areas of trophoblast invasion the glandular epithelium seemed to be completely disintegrated compared with glandular epithelium in the non-invaded parts of the decidua. Whole tissue specimens were used in vitro and in situ instead of cell lines; these systems mostly maintain the context of the in vivo situation. LIMITATIONS, REASONS FOR CAUTION: This is a descriptive study supported by in vitro experiments. However, a histological section will always only be a snapshot and quantification from histological sections has its limitations. WIDER IMPLICATIONS OF THE FINDINGS: This study further strengthens the hypothesis of histiotrophic nutrition of the embryo prior to the establishment of the maternal blood flow toward the placenta. Invasion of uterine glands by endoglandular trophoblasts may have more impact on the outcome of early pregnancy than assumed up to now.

Cardiac catheterization in patients with ascending aortic aneurysms: safety, success, and prevalence of coronary artery disease.

BACKGROUND: Evaluation for coronary artery disease (CAD) is recommended prior to surgery for ascending aortic aneurysms. Concerns regarding the use of coronary angiography in this population include safety and the ability to successfully selectively engage the coronary arteries. Additionally, the prevalence of CAD is not well described. METHODS: We retrospectively reviewed all patients referred for cardiac catheterization prior to elective surgery for an ascending aortic aneurysm at our institution over a 4-year period. Catheter selection was based on knowledge of the aneurysm size. Images were screened for whether selective coronary engagement was achieved and for the presence of significant coronary disease. RESULTS: A total of 205 patients met the inclusion criteria. The mean age was 61 years and 63% were male. There were no adverse events related to catheterization. The left coronary artery was selectively engaged in 98% of patients, and the right coronary in 92%. On average, 3.1 catheters were used for angiography per patient. Coronary artery disease was present in 19% of patients (n = 39). Increasing age was the only risk factor significantly associated with the presence of disease. Coronary bypass was required in 15% of patients at the time of aortic aneurysm surgery. CONCLUSIONS: Coronary angiography can be performed safely and the coronary arteries can be successfully selectively engaged in patients with ascending aortic aneurysms. The findings frequently impact the surgical approach. We believe that coronary angiography should be part of the routine preoperative evaluation in appropriate patients.

Distribution of decidual natural killer cells and macrophages in the neighbourhood of the trophoblast invasion front: a quantitative evaluation.

STUDY QUESTION: Do decidual natural killer (dNK) cells and decidual macrophages (dMph) become enriched in the vicinity of the trophoblast invasion front? SUMMARY ANSWER: Morphometric image analysis and areal cell density calculations, which excluded observer bias, showed an enrichment of decidual leukocytes in the neighbourhood of the trophoblast invasion front. WHAT IS KNOWN ALREADY: In previous studies, the number of decidual leukocytes was visually counted in medium- or high power fields. These methods, however, cannot reveal the exact spatial relationship between leukocytes and invasive trophoblast cells, and are therefore prone to subjective errors. Thus, a more objective approach is required. STUDY DESIGN, SIZE, DURATION: Applying a new method of morphometric image analysis, leukocyte populations were studied in human tissue fragments derived from first trimester placentation sites (n = 7) as well as in co-cultures of first trimester decidual tissue with placental villi of the same pregnancy representing an appropriate in vitro model of trophoblast invasion (n = 15). PARTICIPANTS/MATERIALS, SETTINGS, METHODS: First trimester decidual tissue was obtained from women undergoing elective terminations of pregnancy at 7-10 weeks of gestational age. Tissue sections were double-stained immunohistochemically for markers of dNK cells or dMph on one hand, and for invasive extravillous trophoblast cells on the other. To analyse the distribution of leukocytes, distinct cell compartments as well as cell neighbourhood areas were defined. Finally, relative areal cell densities were calculated and these data were compared with those of an in vitro model of trophoblast invasion as well as with tissue fragments derived from decidua parietalis without trophoblast cells. MAIN RESULTS AND THE ROLE OF CHANCE: At first trimester placentation sites, a higher density of dNK cells as well as of dMph was found in close proximity to the invasive trophoblast (P ≤ 0.01), compared with the average areal cell density of decidual leukocytes in the tissue with exclusion of the trophoblast. The highest areal cell density of leukocytes was determined up to a distance of 20 µm from the trophoblast cells, whereas in more distant regions it was even lower than average, indicating a migration of these leukocytes towards the trophoblast invasion front. In the three-dimensional co-culture model, however, we found an enrichment of dMph (P ≤ 0.01) but not of dNK cells (P > 0,05) in the neighbourhood of the invasive trophoblast. LIMITATIONS, REASONS FOR CAUTION: The morphometric image analysis depends on intense immunohistochemical staining that is free of background and cross-reactivity. WIDER IMPLICATIONS OF THE FINDINGS: The presented method will be useful not only for the investigation of recurrent miscarriage but also in the fields of tumour immunology and inflammation. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by the European Commission (Network of Excellence 'The Control of Embryo Implantation (EMBIC)', FP6-512040, lead researcher: P.S.), and by the Franz Lanyar Foundation of the Medical University of Graz, Austria (Grant #347). None of the authors declared a conflict of interests.

[Maternal-placental interactions and fetal programming]. / Mütterlich-plazentare Interaktionen und fetale Programmierung.

Pregnancy-related complications not only represent a risk for maternal and fetal morbidity and mortality, but are also a risk for several diseases later in life. Many epidemiological studies have shown clear associations between an adverse intrauterine environment and an increased risk of diabetes, hypertension, cardiovascular disease, depression, obesity, and other chronic diseases in the adult. Some of these syndromes could be prevented by avoiding adverse stimuli or insults including psychological stress during pregnancy, intake of drugs, insufficient diet and substandard working conditions. Hence, all of these stimuli have the potential to alter health later in life. The placenta plays a key role in regulating the nutrient supply to the fetus and producing hormones that control the fetal as well as the maternal metabolism. Thus, any factor or stimulus that alters the function of the hormone producing placental trophoblast will provoke critical alterations of placental function and hence could induce programming of the fetus. The factors that change placental development may interfere with nutrient and oxygen supply to the fetus. This may be achieved by a direct disturbance of the placental barrier or more indirectly by, e. g., disturbing trophoblast invasion. For both path-ways, the respective pathologies are known: while preeclampsia is caused by alterations of the villous trophoblast, intra-uterine growth restriction is caused by insufficient invasion of the extravillous trophoblast. In both cases the effect can be undernutrition and/or fetal hypoxia, both of which adversely affect organ development, especially of brain and heart. However, the mechanisms responsible for disturbances of trophoblast differentiation and function remain elusive.

Reintervention for endograft failures after thoracic endovascular aortic repair.

OBJECTIVE: Thoracic endovascular aortic repair has emerged as an effective therapy for a variety of thoracic aortic pathologic entities. However, endograft failure remains a concern, and its treatment is often challenging. We examined our experience with endograft failure and its treatment by endovascular and open repair. METHODS: From January 2000 to January 2012, 680 patients underwent thoracic endovascular aortic repair at the University of Pennsylvania, and their charts were reviewed for the late outcomes and follow-up data. RESULTS: Of the 680 patients, 73 underwent 80 reinterventions (11.7%) during follow-up. The indications for index thoracic endovascular aortic repair were thoracic aortic aneurysms in 381, type A dissection with frozen elephant trunk in 52, type B dissection in 111, hybrid arch repair in 46, traumatic transection in 37, infection in 10, penetrating atherosclerotic ulcer in 25, and others in 18. The median interval from index thoracic endovascular aortic repair to reintervention was 210 days. Endograft failures included endoleak in 45, proximal aortic events in 11, distal aortic events in 15, endograft infection in 3, and others in 6. Endovascular reintervention (n = 80) was performed in 60 patients. In 20 patients, open aortic reconstructive procedures were performed. The overall 30-day mortality was 8.7% (7/80). During follow-up, 10 late deaths occurred. The overall survival in all patients was 81%, 60%, and 52% at 1, 5, and 7 years, respectively. The late survival for patients after reintervention for endograft failure was similar that for the patients who did not require reintervention (P = .31). CONCLUSIONS: Reintervention for endograft failure can be performed with acceptable early outcomes. The mid-term survival for patients requiring reintervention for endograft failure was similar to that of the patients without endograft failure. Thus, reintervention for endograft failure should be aggressively considered when indicated.

Field theory of bicritical and tetracritical points. IV. Critical dynamics including reversible terms.

This article concludes a series of papers [Folk, Holovatch, and Moser, Phys. Rev. E 78, 041124 (2008); 78, 041125 (2008); 79, 031109 (2009)] where the tools of the field theoretical renormalization group were employed to explain and quantitatively describe different types of static and dynamic behavior in the vicinity of multicritical points. Here we give the complete two-loop calculation and analysis of the dynamic renormalization-group flow equations at the multicritical point in anisotropic antiferromagnets in an external magnetic field. We find that the time scales of the order parameters characterizing the parallel and perpendicular ordering with respect to the external field scale in the same way. This holds independent whether the Heisenberg fixed point or the biconical fixed point in statics is the stable one. The nonasymptotic analysis of the dynamic flow equations shows that due to cancellation effects the critical behavior is described, in distances from the critical point accessible to experiments, by the critical behavior qualitatively found in one-loop order. Although one may conclude from the effective dynamic exponents (taking almost their one-loop values) that weak scaling for the order parameter components is valid, the flow of the time-scale ratios is quite different, and they do not reach their asymptotic values.

Changes in phytoplankton composition in response to tides, wind-induced mixing conditions, and freshwater outflows in an urbanised estuarine complex.

Recent reports have shown an increase in potentially harmful phytoplankton in Santos bay (Southeastern Brazilian Coast), located in a highly urbanised estuarine complex. Prediction of blooms is, thus, essential but the phytoplankton community structure in very dynamic regions is difficult to determine. In the present work, we discriminate bloom forming microphytoplankton dominance and their relationship to physical and meteorological variables to look for patterns observed in different tides and seasons. Comparing 8 distinct situations, we found five scenarios of dominance that could be related to winds, tides and rainfall: i) Surfers, diatoms occurring during high surf zone energies; ii) Sinkers, represented by larger celled diatoms during spring tide, after periods of high precipitation rates; iii) Opportunistic mixers, composed of chain forming diatoms with small or elongate cells occurring during neap tides; iv) Local mixers, microplanktonic diatoms and dinoflagellates which occurred throughout the 298 sampling stations; and v) Mixotrophic dinoflagellates, after intense estuarine discharges. Results suggest alterations in the temporal patterns for some bloom-forming species, while others appeared in abundances above safe limits for public health. This approach can also illustrate possible impacts of changes in freshwater discharge in highly urbanised estuaries.

Thoracic endovascular aortic repair: evolution of therapy, patterns of use, and results in a 10-year experience.

OBJECTIVE: The introduction of aortic stent grafting in the treatment of thoracic aortic disease has pioneered unique treatment options and gained rapid clinical adoption despite a paucity of long-term outcome data. The purpose of this analysis is to examine all operations performed using thoracic aortic stent grafts at the University of Pennsylvania Health System. METHODS: A total of 502 operations involving thoracic aortic stent grafting were performed between April 1999 and April 2009. Patients were followed in a prospectively collected clinical perioperative registry, and long-term outcomes were determined from administrative data sources. Aortic pathologies included aortic aneurysm, acute aortic dissection (types A and B), hybrid arch repairs, reinterventions with additional stents, pseudoaneurysm, chronic type B dissection, traumatic transection, penetrating aortic ulcer, and other unique indications. RESULTS: Patients' mean age at the time of thoracic endovascular aortic repair was 70.1 ± 12.4 years, and 51% of the patients were aged more than 70 years. Some 41% of patients were female, and the majority of patients (87%) were hypertensive. Overall 30-day mortality was 10.1%. Multivariable risk factors for 30-day mortality included urgent/emergency, Stanford type A aortic dissection, perioperative spinal ischemia, type C aortic coverage, hybrid arch operation, aortic transection, chronic renal failure, and age. Neurologic complications included permanent complete or incomplete paraplegia in 17 patients (3.4%), reversible spinal cord ischemia in 26 patients (5.1%), transient stroke in 16 patients (3.2%), and permanent stroke in 23 patients (4.6%). Greater extent of aortic coverage was not associated with risk of spinal cord ischemia. Access complications, stroke, and endoleaks diminished with increased operative experience over time. Risk factors for late mortality included urgent/emergency indications, hybrid procedures, traumatic aortic transection, age, perioperative paralysis, and chronic renal failure. Patients undergoing stent grafting for type B dissection were more likely to survive than patients undergoing stent grafting for aneurysms or other indications. CONCLUSIONS: Thoracic aortic stent grafting has evolved to be a viable option to complement, augment, or even replace traditional treatments for aortic disease. These data illustrate the applicability of this evolving technology in the establishment of new treatment paradigms for complex aortic pathologies.

[Recommendations on therapy for chronic constipation--working group for functional diagnosis and psychosomatics of the austrian society of gastroenterology and hepatology]. / Empfehlungen zur Therapie der chronischen Obstipation der Arbeitsgruppe für Funktionsdiagnostik und Psychosomatik der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie.

Constipation is one of the most frequent gastroenterological problems, especially among elderly people. Chronic constipation is now defined by the new Rome III criteria. Life style counselling is usually only effective in early stages of disease and for mild types. In patients with constipation one should actively screen for possible causative, medically adverse events. Recently new effective opioid antagonists were introduced to act against constipation in patients on long-term opioid therapy. If these actions fail, medical therapy with polyethylene glycol or lactulose should be favoured in the long-term treatment. Psychodiagnostic queries concerning fear should be included in the diagnostic procedures. Biofeedback is an effective therapy in these cases and especially with pelvic floor dyssynergia. Surgical interventions are rarely indicated or successful with the exception of chronic outlet obstruction with severe anatomic changes.