Endovascular repair of abdominal aortic aneurysm in renal transplantation.

Successful endovascular correction of a 12-cm abdominal aortic aneurysm (AAA) is described in a 76-year-old man with a functional pelvic renal transplant and 18-month follow-up. Endovascular treatment is a safe alternative to surgery for AAA correction in the elderly post-transplantation patient since it does not require flow interruption during the procedure.

Effect of cefamandole, cefuroxime and cefoxitin on yeast fecal flora of surgical patients.

Aim of the present study was to evaluate the effect of cefamandole, cefuroxime and cefoxitin on the level of gastrointestinal (GI) colonization by Candida albicans in humans. Twenty-eight adult patients received one of these three cephalosporins for 10 days, as treatment of infection, and were studied prospectively. Quantitative stool cultures for yeasts were performed immediately before, at the end, and 1 week after discontinuation of treatment. All three antibiotics caused an increase of the yeast concentration in the fecal flora. The increase caused by cefoxitin was the highest (2.5 log10 CFU/g of stool). Our results suggest that the cephalosporins tested cause minor increases of the colonization of the GI tract by C. albicans.

Evidence of apoptosis in human carotid atheroma.

PURPOSE: Apoptosis is a morphologically distinct form of programmed cell death that plays a major role in cellular development and homeostasis. In this study, we examined the role that apoptosis may have in the pathogenesis of atherosclerosis. METHODS: We examined immunohistochemically 20 normal carotid arteries and the carotid arteries of 86 patients (mean age, 68 years; range, 52 to 80 years) who underwent atherectomy for primary atherosclerosis. The expression of two genes, BCL2, which inhibits apoptosis, and BAX, which induces apoptosis, was examined and correlated to the presence of risk factors that included hypertension, smoking, hyperlipidemia, and diabetes mellitus. RESULTS: BAX expression was found in 26 of 86 cases (30%), and no immunoreactivity was found in the normal carotid specimens. BCL2 expression was not seen in any examined tissues (atherosclerotic or normal carotid arteries). Of the 26 patients who expressed the BAX gene, 22 were hypertensive (85%), and hypertension (>160/95 mm Hg) was present in 25 of 60 patients (41%) who did not express the BAX gene (p < 0.01). No significant correlation was found between the expression of the BAX gene and other risk factors (smoking, hyperlipidemia, diabetes mellitus) or presenting symptoms. CONCLUSIONS: In a significant number of stenosed carotid arteries (30%), we found no evidence of apoptosis suggested by the presence of BAX expression. Hypertension was more prevalent in those patients with BAX gene expression than in those patients without BAX gene expression. BCL2 expression, which inhibits apoptosis, was not found. Further study of this phenomenon may contribute to the discovery of new treatments for atherosclerosis.

[Indications and early results of splenectomy in hematologic diseases]. / Indications et résultats précoces des splénectomies pour affections hématologiques.

In this retrospective study, we present 245 patients with various hematological diseases, who had undergone splenectomy for diagnostic or therapeutic purpose in our Department during the last 20-year period (1971-1991). There were 138 men (56%) and 107 women (44%), with a mean age of 49 years. The hematological diseases, for which the splenectomy had been performed, were according to the frequency of admittance: hemolytic anemia, complicated or not by gallstone formation, Werlhoff disease (thrombocytopenic purpura), Hodgkin's disease, hairy-cell leukemia, chronic lymphatic leukemia, non-Hodgkin lymphoma. A drain was placed in the splenic bed in all patients. All patients received anticoagulant therapy and antibiotics as well. Pneumococcal vaccination had been done systematically during the preoperative period. All patients received prophylaxis with a Penicillin for two years postoperatively. During the immediate postoperative period the mortality (1.2% OPSI: 1 case) and the morbidity (3.5% OPSI: 1 case) rates were very low. In conclusion, splenectomy in patients with hematological diseases is a safe procedure, even in high risk patients, but it requires a preoperative preparation and a close cooperation between surgeon and hematologist during the peri- and postoperative periods. Additionally, we have to notice that the possibility of an acute serious infection exists for any patient during the rest of his life.

Risk factors of peripheral arterial occlusive disease: a case-control study in Greece.

A case-control study concerning peripheral arterial occlusive disease (PAOD) was conducted in Athens, Greece. The case series consisted of 100 patients with PAOD as principle diagnosis admitted consecutively to a major teaching hospital in Athens during an 18-month period. The controls were patients hospitalized in the same hospital during the same period as the index cases for conditions requiring minor surgical care. All cases and controls were interviewed by the same person about several socioeconomic, demographic and medical variables; blood pressure and blood glucose values were also recorded. Data were analysed using multiple logistic regression procedures, controlling for age, sex and years of schooling. Tobacco smoking, systolic blood pressure, diabetes mellitus, heavy alcohol drinking and excessive coffee consumption were all strong independent risk factors with eight-fold or more differences in risk. It appears that PAOD as an atherosclerotic disease with low short-term fatality reveals in more contrasting terms the aetiological importance of factors involved in the atherosclerotic process as compared to atherosclerotic conditions with higher short-term fatality like coronary heart disease (CHD) which may also have stronger thrombotic components.