[Endovascular treatment of abdominal aortic aneurysms in octogenarians]. / Die endovaskuläre Behandlung von Bauchaortenaneurysmen bei älteren Patienten (> or = 80 Jahre).

BACKGROUND: The increase in life expectancy results in a higher number of patients with an advanced age over 80 years requiring abdominal aortic aneurysm therapy. The aim of this study was to review the outcome of octogenarians undergoing endovascular treatment for abdominal aortic aneurysms. PATIENTS AND METHODS: Between June 2004 and March 2008 25 patients (24 males, one female), with a mean age of 83 +/- 2.6 years (range: 80-91 years) underwent elective endovascular treatment for abdominal aortic aneurysms. The average preoperative aneurysm diameter was 57 +/- 9.8 mm (range: 40-80 mm). All procedures were carried out in the angiography suite under general anesthesia. RESULTS: Endovascular abdominal aortic aneurysm repair was technically successful in all patients. There was one perioperative death due to an aneurysm-related complication. The perioperative (30 days) mortality rate was 4 %. Intensive care unit admission was required in five patients. The in-hospital morbidity rate was 20 %. Mean follow-up time was 18.7 +/- 14 months (range: 2 to 47 months). Two patients died from unrelated causes. There were no device- or aneurysm-related deaths. A patient with a type I A endoleak underwent correction by additional stent-graft placement four weeks after initial placement. CONCLUSION: Endovascular abdominal aortic aneurysm repair in octogenarians is a valuable alternative to open aortic repair and can be performed safely and successfully. We strongly recommend the endovascular treatment for patients over 80 years of age with an appropriate size of aortic aneurysm.

[Retrospective evaluation of the results of the microbiological meat examination (MFU) from calves and cows]. / Retrospektive Auswertung von Befunden der mikrobiologischen Fleischuntersuchung (MFU) von Kälbern und Kühen.

The microbiological meat examination (MFU), consisting of a bacteriological analysis and a testing for antibiotic residues, is one of several additional analyses used for an edibility rating of carcasses made during meat inspection. Reasons for performing a microbiological meat examination and procedures in the laboratory are defined in the Swiss ordinance for meat examination (FUV). The aim of this study was to analyze the data of 313 microbiological meat examinations from calves and 2882 microbiological meat examinations from cows carried out at the Institute for Food Safety and Hygiene during a period of 8 years. Reasons for microbiological meat examinations as reported by the meat inspectors were mainly classified to the category of "inflammation and necroses" (FUV, Annex 4, Pt 1.2; calves: 73%, cows: 48%). As declarations of the age of the pathological-anatomical changes (that influences directly the probability of detection of pathogens) were generally missing, it is not surprising that the compliance between a particular pathological-anatomical change and a specific detection of pathogens is poor (calves: 19%, cows: 18% of all MFU). About 18% (calves) and 45% (cows) of the reasons for microbiological meat examinations did not correspond to one of the reasons mentioned in the ordinance for meat examination. However, according to the data set, some reasons require a microbiological meat examination due to an often-found specific detection of pathogens. Otherwise, a remarkable number of reasons mentioned were missing the link to bacteriological etiology. Moreover, 14% (calf) and 7% (cow) of microbiological meat examinations with the declaration "no pretreatment" as well as 15% (calf) and 11% (cow) of microbiological meat examinations without declaration showed a positive result in the testing for antibiotic residues.

Prevention of catheter thrombosis increases survival, but does not modify lung injury in rats receiving long-term parenteral nutrition.

It has previously been shown that rats receiving total parenteral nutrition (TPN) or each component of TPN die within 40 days of treatment. Central catheter thrombosis and lung injury were constant findings. The aim of the present study was to examine the impact of central thrombosis on lung injury and survival in rats receiving long-term parenteral nutrition. In the first part of the study TPN was infused via the jugular vein and incidence of central venous thrombosis and rate of survival were recorded. Addition of low molecular weight heparin (LMWH) reduced central thrombosis from 6 out of 7 animals to 2 out of 7 animals (p=0.027) and increased survival from 17.1+/-4.5 days to 32.4+/-4.9 days (p=0.04). In the second part of the study four infusion groups were established. Group 1 (controls) received saline 100 mL/kg/day via the jugular vein (n=6). Group 2 received Intralipid 40 mL/kg/day via the jugular vein (n = 7). Group 3 received Intralipid 40 mL/kg/day via the portal vein (n = 7). Group 4 received Intralipid 40 mL/kg/day with added LMWH 70 U/kg/day (n = 7). Lung injury and occurrence of central thrombosis were investigated. Lung injury was assessed by measuring pulmonary arterial pressure (Ppa), clearance of serotonin by the vascular endothelium and the capillary filtration coefficient (CFC). Either infusion via the portal vein or the addition of LMWH to the infusion via the jugular vein prevented central thrombus formation, but the lung injury was not modified by this method compared with infusing Intralipid via the jugular vein without LMWH. In conclusion, central thrombus formation contributes to death in rats receiving parenteral nutrition. The mechanism of the injurious effect of central thrombosis remains unknown, but central thrombus formation seems not to increase lung injury caused by Intralipid.

Pulmonary function in rats dying from long-term parenteral nutrition.

Infusion of Vamin or Intralipid causes death in a rat model of continuous parenteral nutrition. Morphological investigations have shown vascular injury and thrombus formation in the lungs. In this study, lung function in rats was examined before death due to parenteral nutrition. The rats were fed saline intravenously (group I); 100 mL kg(-1) day(-1) (controls); a 7% amino acid-glucose solution (Vamin-Glukos) (group II); 100 mL kg(-1) day(-1), or 20% fat emulsion (Intralipid) (group III); 40 mL kg(-1) day(-1). The infusion was stopped when the condition of the rats deteriorated. In a saline-perfused, isolated lung model, pulmonary arterial pressure (Ppa), transpulmonary pressure (Ptp), endothelial function, measured as inactivation of serotonin (bioassay), and the capillary filtration coefficient (CFC) were determined. Haematological parameters were also evaluated. Constant findings in group II and III were central thrombus formation, anaemia and thrombocytopenia. Ppa increased from 0.7 (0.04) kPa in group I to 1.4 (0.1) kPa and 1.7 (0.1) kPa in groups II and III, respectively (p<0.001). Inactivation of serotonin was reduced to 36% (2) in group II and 37% (2) in group III compared with 74% (5) in group I (p<0.002). CFC increased to 25 mg min(-1) (5) (group II) and 30 mg min(-1) (6) (group III) compared with 13 mg min(-1) (2) in controls (p=0.01). The study shows that major pulmonary hypertension and severe reduction of the endothelial function are present when rats deteriorate after infusion of parenteral nutrition substrates.

On scattering from a bubble located near a flat air-water interface: laboratory measurements and modeling.

Scattering by a single bubble near a flat air-water interface is investigated theoretically and experimentally. A ray-acoustic interpretation is used to describe the four scattering paths, from source to bubble to receiver, that determine the response of the bubble. Multiple scattering effects are accounted for using a closed-form solution derived from the multiple scattering series. Experiments are performed by placing a bubble with radius a approximately 425 microm on a fine nylon thread, which is approximately 100 microm in diameter and practically transparent to sound, at a distance d from the interface. The primary variable is d and it ranges from 1 a to 100 a. The bubble is excited by tone bursts with a center frequency of 120 kHz, with the transducers arranged in both bistatic and monostatic configurations. Theory and experiment are in good agreement, verifying the dominant effect of the four paths in the response of the bubble, with multiple scattering playing a role for kd < 1, where k is the wave number of the medium. In the long-range limit our simulations agree with those of Ye and Feuillade [J. Acoust. Soc. Am. 102, 798-805 (1997)] including the shifting of the bubble's resonant frequency. The dependence of scattering on transducer arrangement, range to bubble, grazing angle, and phase relation among the four paths, vis-à-vis monostatic and bistatic scattering, is discussed.

Incidence of residual basal cell carcinoma in patients who appear tumor free after biopsy.

BACKGROUND: Basal cell carcinoma (BCC) biopsy sites often heal with no clinical evidence of residual tumor. OBJECTIVE: The purpose of our study is to determine whether such patients require further therapy. If biopsies can be curative, health care costs can be reduced by avoiding unnecessary surgery. METHODS: We prospectively evaluated 41 consecutive subjects with 42 biopsy-confirmed BCCs who appeared disease free. Each biopsy site was excised and processed by the Mohs micrographic technique. The tissue block was sectioned horizontally at 30-micrometer intervals until exhausted. Sections were stained and examined microscopically for residual tumor. RESULTS: Tumor was identified in 28 (66%) of 42 cases. No statistically significant relationship was found between the presence or absence of residual tumor and the following variables: age, sex, tumor location, biopsy technique, histopathologic subtype, scar size, time from biopsy to surgery, and extent of inflammation in histologic sections. CONCLUSION: Our data suggest that patients with small (< 1 cm) primary BCCs that appear to be completely removed after a biopsy procedure are at risk for recurrence without further treatment.

Case-control study on breast cancer and adipose tissue concentrations of congener specific polychlorinated biphenyls, DDE and hexachlorobenzene.

In a case-control study on 43 patients operated for invasive breast cancer (cases) and 35 patients operated for benign breast disease (controls) adipose tissue concentrations of polychlorinated biphenyls (PCBs), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) and hexachlorobenzene (HCB) were investigated. Approximately 10 g of breast tissue free from tumour was taken and frozen until analysis. No significant difference for the sum of non co-planar PCBs or DDE was found between cases and controls. For postmenopausal women the odds ratio (OR) was increased for co-planar PCB #77 > 4.5 pg/g lipid (OR = 5.8, 95% confidence interval (CI) = 0.8-42), PCB #126 > 145 pg/g lipid (OR = 2.2, 95% CI = 0.2-18), PCB #169 > 90 pg/g lipid (OR = 7.8, 95% CI = 0.6-96), and for HCB > 40 ng/g lipid (OR = 1.9, 95% CI = 0.4-7.2) adjusted for age and parity. The risk increased further for postmenopausal women with oestrogen receptor positive tumours yielding for PCB #77 adjusted OR 33 (95% CI 1.8-588), PCB #126 OR not calculable (no unexposed cases), PCB #169 OR 8.6 (95% CI 0.5-136) and hexachlorobenzene OR 7.1 (95% CI 1.1-45). Also for the sum of PCB > 1230 ng/g lipid adjusted OR increased to 1.8 (95% CI 0.4-7.3) whereas the results were similar for DDE.

Exaggerated arthropod-bite lesions in patients with chronic lymphocytic leukemia: a clinical, histopathologic, and immunopathologic study of eight patients.

BACKGROUND: Unusual papulovesicular lesions resembling arthropod bites have been described in patients with chronic lymphocytic leukemia (CLL). OBJECTIVE: Our purpose was to describe and characterize further the clinical, histopathologic, and immunopathologic features of these lesions. METHODS: Eight patients were identified retrospectively who had CLL and characteristic skin lesions. Clinical and histologic features were recorded. Skin biopsy specimens were analyzed immunohistochemically for eosinophil granule major basic protein, eosinophil-derived neurotoxin, neutrophil elastase, and mast cell tryptase. RESULTS: The clinical features, including the lesional distribution, suggested arthropod bites, although most patients could not recall having been bitten. Mixed T- and B-cell lymphoid cell infiltrates were present within lesions, along with prominent eosinophil infiltration and eosinophil granule protein deposition. CONCLUSION: Exuberant papulovesicular lesions develop in patients with CLL apparently as an exaggerated response to arthropod bites. Prominent eosinophil infiltration and degranulation within these lesions likely contribute to the severity of symptoms.

Asteroid bodies and other cytoplasmic inclusions in necrobiotic xanthogranuloma with paraproteinemia.

BACKGROUND: Necrobiotic xanthogranuloma (NXG) with paraproteinemia is a distinctive palisading granuloma of the skin. Extracutaneous lesions are rarely present. OBJECTIVE: The purpose of this study was to confirm the presence and significance of giant cell asteroid bodies and other cytoplasmic inclusions in NXG with paraproteinemia. METHODS: Skin biopsy specimens from 24 patients with NXG with paraproteinemia were reviewed; autopsy and lung biopsy specimens from two patients were stained for iron, calcium, and polysaccharide. RESULTS: Giant cell asteroid bodies were observed in skin biopsy specimens of 8 (33%) of the 24 patients. In addition, large acidophilic polygonal cytoplasmic inclusions were observed in myocardial tissue of one of the autopsy cases. Iron and calcium were not found. CONCLUSION: Asteroid bodies and other inclusions can be present in the giant cells of NXG with paraproteinemia. They are as frequent as, or more frequent than, in other granulomatous diseases and should be considered in the diagnosis of NXG with paraproteinemia.

Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy.

BACKGROUND: Cutaneous metastases develop in 2% to 9% of patients with an internal malignancy. Thyroid carcinoma metastatic to the skin is a rare clinical entity. OBJECTIVE: Our purpose was to study the clinical and pathologic features and outcome in patients with cutaneous metastasis from thyroid carcinoma. METHODS: The study included a retrospective analysis of six patients with skin metastases from thyroid carcinoma and a review of the English-language literature since 1964. RESULTS: Including our six patients, 43 patients with skin metastases from thyroid carcinoma have been reported. Papillary carcinoma was the most common (41%), followed by follicular (28%), anaplastic (15%), and medullary carcinomas (15%). The scalp was the most common site of metastasis. For our patients, the average length of survival after diagnosis of cutaneous metastasis was 19 months. CONCLUSION: Cutaneous metastasis from thyroid carcinoma is rare and occurs in the setting of disseminated neoplastic disease.

Indeterminate cell histiocytosis treated successfully with 2-chlorodeoxyadenosine.

We report the case of a 54-year-old man with a ten-year history of a generalized papular eruption consistent with the diagnosis of indeterminate cell histiocytosis. The patient responded favorably to a course of treatment with 2-chlorodeoxyadenosine.

Localized involutional lipoatrophy: a clinicopathologic study of 16 patients.

BACKGROUND: Localized loss of adipose tissue without antecedent clinical or histologic inflammation is termed idiopathic lipoatrophy. OBJECTIVE: Our purpose was to study the clinical and pathologic features in 16 patients with clinically focal lipoatrophy and a distinct pathologic pattern of fat lobule involution. METHODS: A retrospective study of 16 patients was performed. RESULTS: The buttocks and proximal extremities were involved most frequently. Lesions were solitary in 10 patients and multiple in six. Nine patients had received intramuscular or intraarticular corticosteroid or antibiotic injections in the affected areas before the development of lipoatrophy. Histologic examination showed that individual fat cells were decreased in size and separated by hyaline material. Progressive reduction in the size and number of adipocytes resulted in diminutive fat lobules with prominent vessels resembling embryonic fat lobules. Some adipocyte masses were acidophilic. Scattered macrophages, confirmed by immunoperoxidase staining for CD68 (KP-1), were identified within the fat lobules and surrounding connective tissue. Yellow-gray granules were recognized within the cytoplasm of macrophages in nine cases. Macrophages becoming lipophages were observed by electron microscopy in one case. Other inflammatory cells were not prominent. CONCLUSION: This is a common pattern of postinjury response to fat tissue characterized by macrophage infiltration of the fat lobules in variable numbers. The term involutional lipoatrophy is justified by the resemblance of the distinctive pathologic changes to embryonic fat lobules.

Increased concentrations of octachlorodibenzo-p-dioxin in cases with breast cancer--results from a case-control study.

Organochlorines are persistent and highly lipophilic environmental contaminants which bioaccumulate in the food chain. Some of these chemicals, 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (DDT) and polychlorinated biphenyls (PCBs), have been suggested to be of significance in the aetiology of breast cancer. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is an anti-oestrogen in animal studies and should be thus lower the risk of breast cancer. The other isomers of polychlorinated dibenzo-p-dioxins (PCDDs) or the chemically related polychlorinated dibenzofurans (PCDFs) have not been tested regarding carcinogenesis of the breast. The purpose of this study was to investigate whether PCDDs or PCDFs influence the risk for breast cancer. Consecutive patients who underwent surgery for a breast disease between 1993 and 1995 were recruited for the study. Cases were 22 patients with infiltrative breast cancer and controls were 19 patients operated for a benign breast disease during the same time period. Approximately 10 g of breast tissue free from tumour was taken from the specimen and frozen until analysis. Fat was extracted, cleaned and analysed with a high-resolution gas chromatograph coupled to a high-resolution mass spectrometer. Median concentrations of octachlorinated dibenzo-p-dioxin (OCDD) were 598 (170-14,880) and 396 (103-1,847) pg/g lipid in the cases and in the controls, respectively. In a multivariate logistic regression analysis controlling for other risk factors for breast cancer increased odds ratio (OR) was obtained for OCDD: 401-1000 pg/g lipid yielded OR 3.8, 95% confidence interval (CI) 0.4-39, > 1000 pg/g lipid gave OR 5.2, CI 0.4-72. When the lipid OCDD variable was examined as a continuous risk factor there was a 1.09 (9%), CI 0.95-1.25, increase in the adjusted OR for breast cancer per 100 unit (pg/g lipid) increase in OCDD. No differences were found between cases and controls for the other six tested PCDDs. Mean concentration of TCDD was in the cases 3.6 (1.0-7.9) and in the controls 3.3 (1.1-6.3) pg/g lipid. For PCDFs no significant differences were found between cases and controls. The results were not changed if oestrogen or progesterone receptor status, S-phase fraction and DNA ploidy were considered. Breast tissue concentration of OCDD was increased in cancer patients, whereas the concentrations of other PCDDs and PCDFs were equal in cases and controls.

A new scleral suction trephine for retrieval of corneoscleral donor tissue.

BACKGROUND: Removal of donor corneo-scleral shell from a cadaver, leaving the remainder of the eye in place, has become a popular technique. Manual removal can result in excessive trauma to the corneal endothelium or an uneven scleral rim. METHODS: We describe a new technique for corneal retrieval using a sceral suction trephine. RESULTS: The scleral suction trephine was cut evenly in our eyebank study. There was no additional trauma to the endothelium and the scleral rim was regular. CONCLUSION: Suction trephination of the sclera in retrieval of corneal donor tissue appears to be safe and effective.

Influence of perinatal ochratoxin A exposure on the immune system in mice.

The mycotoxin ochratoxin A (OA) is a well-documented immunotoxic agent which affects both cellular and humoral immunity. In the present study, the effects of maternal exposure to single doses of OA during gestation or lactation were studied in Balb/c offspring. A single dose exposure of the dams to OA (500 micrograms/kg body weight) on day 16 of gestation resulted in decreased proliferation of splenic and thymic lymphocytes in response to mitogens in the pups at 15 days of age. Flow cytometry analysis of thymocyte subpopulations revealed lower percentages of mature CD4+ cells and higher percentages of immature, double-positive (CD4+CD8+) cells in the exposed pups. In contrast, a single exposure of the dams of OA on day 10 postpartum significantly increased the proliferative responsiveness of lymphocytes in the offspring when stimulated with B or T cell mitogens 3 days after the exposure. This effect was most prominent in the highest dose group (500 micrograms/kg body weight). The present results are in accordance with previous observations in rats, and show that the time of exposure significantly influences the immunotoxic effects of OA on the developing immune system in rodents.

Benefits of specular microscopy in evaluating eye donors aged 66 and older.

In the United States of America and worldwide, supplies of quality donor corneas continue to lag behind the demand. Some of what appears to be a shortage in the U.S.A. is really due to the custom of many surgeons to use only tissue from younger donors, thus creating an unnecessary waiting list. In reality, we do have a sizable pool of good donors in the older age group. With improved evaluation techniques, it is possible to identify these donors and to add their tissue to the supply of available corneas. This study shows that large numbers of corneas from donors over the age of 65 can be used successfully to restore vision. Specular microscopy provides valuable quantitative data to the surgeon, who ultimately makes the decision about the suitability of the donor tissue. For an eye bank, specular microscopy makes it easier to place older tissue, resulting in shorter waiting lists.