Complication Incidences and Treatment Outcomes of Endovascular Aneurysm Repair-A Single-Center Long-Time Follow-Up Study.

BACKGROUND: Few long-time follow-up studies describe all complications, treatment outcome of complications, and mortality in relation to endovascular aneurysm repair (EVAR). The purpose of this study was to evaluate the incidence and treatment outcome including mortality of radiological visible complications related to the EVAR procedure at a single center with up to 10 years' surveillance. MATERIALS AND METHODS: Patients treated with EVAR from March 2006 to March 2016 at a Danish university hospital, 421 in total, were included. Patient and aneurysm characteristics, follow-up, and secondary intervention data were collected from a national database and medical records. Follow-up computed tomography angiography and plain abdominal X-ray reports were reviewed for complications. Scans and X-rays with suspected complications were evaluated by an interventional radiologist. RESULTS: A total of 172 complications in 147 patients, mainly in the beginning of the follow-up period, were found; 35% had a least one complication. The main part of complications (62%) was type II endoleaks, followed by stent graft stenosis (11%), type I endoleaks (9%), and stent graft occlusion (7%). A total of 66 (38%) complications, observed in 55 patients, were treated with reintervention, of which 77% were treated with endovascular procedures and 23% with surgical treatment, that is, 13% of all studied patients had a complication that required a reintervention. The remaining 2 of the 3 complications were treated conservatively. We found no increased all-cause mortality in connection with having a complication including those requiring reintervention. CONCLUSION: We presented a 10-year single-center study of EVAR. Many patients treated with EVAR had a radiological visible complication, mainly in the beginning of the follow-up period. Only a smaller fraction required reintervention and having a reintervention-requiring complication was not connected to increased mortality.

A Long-Time Follow-Up Study of a Single-Center Endovascular Aneurysm Repair (Evar) Endoleak Outcomes.

PURPOSE: The aim of this study was to evaluate the incidence, risk factors, and outcome of endoleaks related to endovascular aneurysm repair (EVAR) procedure at a single center with up to 10 years' surveillance. MATERIALS AND METHODS: All patients treated with EVAR for an abdominal aorta or iliac aneurysm in a 10-year period at a single cardiovascular center in Denmark were included. Data were collected from a national database and patient journals. Follow-up computed tomography angiography and plain abdominal X-ray reports were reviewed. RESULTS: A total of 421 patients were included. There were 125 endoleaks observed in 117 (27.8%) patients after a median 95 days (interquartile range: 90-106 days). There were 16 type I, 107 type II, 1 type III, and 1 type V endoleaks. A total of 33 (7.8%) patients had at least 1 reintervention. Patients with type II endoleaks had significantly fewer active smokers and lower plasma creatinine at baseline. They also more often had one, or both, internal iliac arteries embolized as well as an identified endoleak at the procedural completion angiogram. Non-type II endoleaks were associated with internal iliac artery embolization. There was no association between the occurrence of endoleaks and increased mortality. CONCLUSION: Type II endoleaks are common after EVAR, yet few lead to reintervention. Absence of smoking, low plasma creatinine, embolized iliac arteries, and endoleak on completion angiogram were associated with type II endoleaks, whereas only embolized iliac arteries were associated with non-type II endoleaks. Overall, endoleaks are not associated with increased mortality.

[Aluminium allergy and granulomas induced by vaccinations for children]. / Aluminiumallergi og granulomer som følge af vaccination hos børn.

Vaccination with aluminium-adsorbed vaccines can induce aluminium allergy with persistent itching subcutaneous nodules at the injection site ­ vaccination granulomas. In this article we give an overview of childhood aluminium-adsorbed vaccines available in Denmark. Through literature studies we examine the incidence, the symptoms and the prognosis for the vaccination granulomas and the allergy. Finally we discuss the status in Denmark.

The role of wet wrap therapy in skin disorders ­ a literature review.

Wet wrap therapy, based on skin application of a double layer of tubular bandages or gauze with a moist first inner layer and a dry second outer layer, is utilized to treat various pruritic conditions, in particular severe and refractory atopic dermatitis. This review, by literature search, evaluates current knowledge about wet wrap therapy. Wet wrap therapy superimposed topical corticosteroids appears more efficient than emollients only, at least for short-time treatments. Despite higher efficacy, there is a tendency towards more frequent infections when topical corticosteroids are covered with wet wrap bandages compared to emollients only. While temporary suppression of hypothalamic-pituitary-adrenocortical-axis was seen due to systemic bioactivity of corticosteroids, no long-term observation studies on putative adverse effects were identified. One hypothesis suggests that wet wrap therapy may trigger increased lamellar body secretion resulting in recovery of the damaged intercellular lipid laminar structure. Otherwise, little investigation on mechanisms exists.

A massive neglected giant basal cell carcinoma in a schizophrenic patient treated successfully with vismodegib.

The small molecule vismodegib is a great treatment alternative to patients challenged, e.g. psychiatric disorders, suffering from severe basal cell carcinoma of the skin in which surgery or other treatment modalities is not possible because of patient's wish or condition. We present a case of a 73-year-old schizophrenic patient with a 15-year history of a neglected tumour located at the forehead and scalp, admitted to hospital in a state of inanition because of tumour expansion to the meninges and severe anaemia caused by bleeding, treated successfully with vismodegib.

[Aluminium allergy and granulomas induced by vaccinations for children].

Vaccination with aluminium-adsorbed vaccines can induce aluminium allergy with persistent itching subcutaneous nodules at the injection site - vaccination granulomas. In this article we give an overview of childhood aluminium-adsorbed vaccines available in Denmark. Through literature studies we examine the incidence, the symptoms and the prognosis for the vaccination granulomas and the allergy. Finally we discuss the status in Denmark.

Sampling the stratum corneum for toxic chemicals.

Dermal exposure is an important pathway in environmental health. Exposure comes from contaminated water, soil, treated surfaces, textiles, aerosolized chemicals, and agricultural products. It can occur in homes, schools, play areas, and work settings in the form of industrial sources, consumer products, or hazardous wastes. Dermal exposure is most likely to occur through contact with liquids, water, soil, sediment, and contaminated surfaces. The ability to detect and measure exposure to toxic materials on the skin is an important environmental health issue. The stratum corneum is the skin's first and principal barrier layer of protection from the outside world. It has a complex structure that can effectively protect against a wide variety of physical, chemical, and biological contaminants. However, there are a variety of chemical agents that can damage the stratum corneum and the underlying epidermis, dermis and subcutis, and/or enter systemic circulation through the skin. There are numerous ways of sampling the stratum corneum for these toxic materials like abrasion techniques, biopsy, suction blistering, imaging, washing, wipe sampling, tape stripping, and spot testing. Selecting a method likely depends on the particular needs of the situation. Hence, there is a need to review practical considerations for their use in sampling the stratum corneum for toxins.

Biology of percutaneous penetration.

BACKGROUND: Percutaneous penetration is a passive process that can occur following skin exposure to chemicals used in agriculture, industry, pharmaceuticals, cosmetics, and in the household. Once a penetrant is absorbed into the skin it may cause a local reaction or enter systemic circulation to produce widespread effects. Improved understanding of the skin barrier and biological aspects that impede absorption of topical substances is essential for advancing the fields of dermatotoxicology and dermatopharmacology as they pertain to percutaneous penetration. METHODS: Pubmed search results for "percutaneous penetration", "absorption", "stratum corneum", "xenobiotics", "skin factors", "decontamination", and "transdermal" were reviewed from 1965 to 2014. Relevant articles discussing the influence of biological factors on percutaneous penetration of topical substances were included. RESULTS: Absorption of a topical substance across the skin is most notably influenced by concentration, contact duration, frequency, and the surface area exposed. The interplay between these factors, along with skin biology and the physiochemical properties of the penetrant, can lead to enhanced percutaneous penetration. CONCLUSION: Percutaneous penetration is a highly complicated and dynamic process influenced by numerous skin and environmental factors. Although research over the last few decades has provided plenty of new insights to improve our understanding of percutaneous penetration, many areas lack clarity due to conflicting data.

Percutaneous absorption from soil.

Abstract Some natural sites, as a result of contaminants emitted into the air and subsequently deposited in soil or accidental industrial release, have high levels of organic and non-organic chemicals in soil. In occupational and recreation settings, these could be potential sources of percutaneous exposure to humans. When investigating percutaneous absorption from soil - in vitro or vivo - soil load, particle size, layering, soil "age" time, along with the methods of performing the experiment and analyzing the results must be taken into consideration. Skin absorption from soil is generally reduced compared with uptake from water/acetone. However, the absorption of some compounds, e.g., pentachlorophenol, chlorodane and PCB 1254, are similar. Lipophilic compounds like dichlorodiphenyltrichloroethane, benzo[A]pyrene, and metals have the tendency to form reservoirs in skin. Thus, one should take caution in interpreting results directly from in vitro studies for risk assessment; in vivo validations are often required for the most relevant risk assessment.

Textile allergic contact dermatitis: current status.

MATERIALS AND METHODS: We conducted a thorough review of Pubmed search results for "textile percutaneous penetration" and "textile absorption". We also determined relevant articles that discussed percutaneous penetration of textiles into the skin and their associated disease states. LIMITATIONS: Due to limitations in current and past publications, we are uncertain of the extent of the clinical problem; however, for patients allergic to textile dye, it is of practical importance, both clinically and in their everyday life. CONCLUSIONS: There are many challenges to correctly identifying the offending textile products in a patient with suspected textile dye dermatitis. Different populations may exhibit varying degrees of allergic contact dermatitis (ACD), but more studies must be done to draw further conclusions. This is further complicated when counseling the patient on how to avoid the textile products most likely to cause a recurrence of ACD skin lesions.

Epidemiology, diagnostic delay and outcome of tuberculosis in North Jutland, Denmark.

INTRODUCTION: The objective of this study was to evaluate the clinical outcome of tuberculosis (TB) with regards to epidemiology, symptoms, delay, diagnostics, use of HIV-test, treatment, treatment outcome and mortality in the North Jutland Region from 2000 through 2008. MATERIAL AND METHODS: The present study is a retrospective study of all new TB cases in the 2000-2008 period. RESULTS: The period saw a total of 251 TB patients (an average of 28 per year). Almost 60% of the patients were not Danish-born, being mostly from Somalia and Greenland. The mean age was 43 years. 31% were alcohol abusers. 2% had AIDS. Cough was the most frequent symptom followed by weight loss, fever and fatigue. In 78.5% of the cases, it was possible to retrieve a positive culture, 53% had a positive sputum smear. However, in 8% of all patients, it was not possible to isolate Mycobacterium tuberculosis and these cases were diagnosed in accordance with the clinical signs. Almost all patients received the standard treatment comprising four antibiotics. 83% were treated successfully, while 5% ended their treatment prematurely. At the end of the study, 14% were dead. In all, 55% of all patients were HIV-tested. Two tested positive before their TB diagnosis and three after. CONCLUSION: The incidence of TB did not seem to decrease over the course of the study period as seen in the rest of Europe. The relatively high rate of alcohol abusers as compared with earlier Danish literature seems to be due to previous underreporting. A treatment success of 83% is high. This first study of HIV testing in Danish TB patients revealed that it was an acceptable result compared with other studies in this field, but the result was not satisfactory because we may miss patients with HIV/TB co-infection when only half of the patients are tested.