Endovascular treatment for chronic cerebrospinal venous insufficiency: is the procedure safe?

OBJECTIVES: The aim of this report is to assess the safety of endovascular treatment for chronic cerebrospinal venous insufficiency (CCSVI). Although balloon angioplasty and stenting seem to be safe procedures, there are currently no data on the treatment of a large group of patients with this vascular pathology. METHODS: A total of 564 endovascular procedures (balloon angioplasty or, if this procedure failed, stenting) were performed during 344 interventions in 331 CCSVI patients with associated multiple sclerosis. RESULTS: Balloon angioplasty alone was performed in 192 cases (55.8%), whereas the stenting of at least one vein was required in the remaining 152 cases (44.2%). There were no major complications (severe bleeding, venous thrombosis, stent migration or injury to the nerves) related to the procedure, except for thrombotic occlusion of the stent in two cases (1.2% of stenting procedures) and surgical opening of femoral vein to remove angioplastic balloon in one case (0.3% of procedures). Minor complications included occasional technical problems (2.4% of procedures): difficulty removing the angioplastic balloon or problems with proper placement of stent, and other medical events (2.1% of procedures): local bleeding from the groin, minor gastrointestinal bleeding or cardiac arrhythmia. CONCLUSIONS: The procedures appeared to be safe and well tolerated by the patients, regardless of the actual impact of the endovascular treatments for venous pathology on the clinical course of multiple sclerosis, which warrants long-term follow-up.

[Inflammatory abdominal aortic aneurysm]. / Zapalny tetniak aorty brzusznej.

The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

Prolactin and insulin levels in lactating sows in relation to nursing frequency.

It has been established that sows up- or down-regulate their milk production as the frequency of nursings is changed. The amount of udder massage by piglets might also influence milk production. To investigate whether these effects are associated with changes in prolactin or insulin levels, we enforced five sows each to nurse either every 35 min (MIN35) or every 70 min (MIN70) over a 26- to 28-hr period. Milk production was measured during the first 24 hr of this period. During the last three to four nursings, blood was collected every 5 min. Plasma prolactin levels increased after milk ejection (P < 0.05), whereas insulin levels increased only briefly in MIN70 sows. Sows nursing every 35 min had lower basal (P < 0.001) and maximal (P < 0.05) concentrations of insulin than MIN70 sows. There were no differences between the two groups in prolactin levels. Nursings with a postejection udder massage longer than 90 s tended to induce a higher increase in prolactin (P < 0.1) than nursings with a shorter massage. When the effects of imposed nursing frequency were removed, there was an across-sows positive residual correlation between average prolactin levels (P < 0.05) and the duration of post-ejection udder massage during the preceding 24 hr. We conclude that when milk production of a sow is changed by altering the nursing frequency within natural limits, the necessary alteration in catabolic state of energy metabolism may be associated with altered insulin levels. The duration of udder massage in a single nursing might have only a slight immediate impact on prolactin levels, but may influence prolactin levels more substantially if increased for a period of 24 hr.

[Popliteal artery entrapment syndrome]. / Zespól usidlenia tetnicy podkolanowej.

The popliteal artery entrapment syndrome is observed in about 0.5% of patients suffering from intermittent claudication, most often in young fit people. Significant diagnostic problems are the reason of frequent underestimation of the patients complaints. The development of the disease may further lead to lower leg arteries thrombosis or popliteal artery aneurysm. The latter condition is caused by abnormal course of the popliteal artery. Preliminary diagnostic procedures may comprise the examination with most simple Doppler apparatus. The diagnostic should be confirmed with the use of colour-Doppler ultrasonography or computed tomography (with contrast). The treatment of choice is an operation restoring normal anatomy within the popliteal space.