Axillobifemoral bypass for total abdominal occlusion secondary to Takayasu's arteritis: A case report.

INTRODUCTION: Takayasu's arteritis (TA) is a rare disease that mainly affects large arteries. Approximately 20% of TA patients will require surgical intervention secondary to arterial complications such as intermittent claudication, persistent hypertension refractory to treatment, and heart failure. PRESENTATION OF CASE: The case of a 22-year-old female with TA of five years of evolution is presented. The patient deteriorated clinically after five years of corticosteroid and immunosuppressant management requiring surgical intervention with an axillobifemoral bypass for a total abdominal occlusion. Onset, pre-surgical and post-surgical Doppler ultrasonography as well as abdominal angiotomographies document and corroborate the patient's clinical and hemodynamic improvement. DISCUSSION: Very limited literature exists regarding surgical interventions for TA patients. While most reported cases present an endovascular surgical management. Open surgical procedures have lower rates of restenosis than endovascular management. Although endovascular management is less invasive than extra-anatomical axillobifemoral bypass, the patient was not a candidate for endovascular stent graft placement due to the increased risk for vascular injury and subsequent perforation. Approximately a fifth of TA patients are candidates for surgical intervention over time. CONCLUSION: Vascular surgery in TA cases becomes an option when the patient does not improve clinically after administration of medical treatment. Although endovascular management has fewer complications, the rate of restenosis is higher. Patients at risk of restenosis and who have increased perioperative vascular risk can benefit from open surgical procedures. Surgical management should be tailored to the patient's needs.

Monitoring of chemotherapy leukemia treatment using Raman spectroscopy and principal component analysis.

In this research, we used the Raman spectroscopy to distinguish between normal and leukemia blood serum and identify the different types of leukemia based on serum biochemistry. In addition, monitoring of patients under chemotherapy leukemia treatment (CHLT) was studied. Blood samples were obtained from seven patients who were clinically diagnosed with three leukemia types and 21 healthy volunteers. In addition, other five leukemia patients were monitored during the CHLT, two patients were declared healthy, one patient suspended it; the health of the other two patients worsened, and no improvement was observed along CHLT. The serum samples were put under an Olympus microscope integrated to the Raman system, and several points were chosen for the Raman measurement. The Horiba Jobin Yvon LabRAM HR800 Raman system is equipped with a liquid nitrogen-cooled detector and a laser of 830 nm with a power irradiation of 17 mW. It is shown that the serum samples from patient with leukemia and from the control group can be discriminated when multivariate statistical methods of principal component analysis (PCA) and linear discriminant analysis (LDA) are applied to their Raman spectra obtaining two large clusters corresponding to the control and leukemia serum samples and three clusters inside the leukemia group associated with the three leukemia types. The major differences between leukemia and control spectra were at 1,338 (Trp, α-helix, phospholipids), 1,447 (lipids), 1,523 (ß-carotene), 1,556 (Trp), 1,587 (protein, Tyr), 1,603 (Tyr, Phe), and 1,654 (proteins, amide I, α-helix, phospholipids) cm(-1), where these peaks were less intense in the leukemia spectrum. Minor differences occurred at 661 (glutathione), 890 (glutathione), 973 (glucosamine), 1,126 (protein, phospholipid C-C str), 1,160 (ß-carotene), 1,174 (Trp, Phe), 1,208 (Trp), 1,246 (amide III), 1,380 (glucosamine), and 1,404 (glutathione) cm(-1). Leukemia spectrum showed a peak at 917 cm(-1) associated with glutathione, but it was absent in the control spectrum. The results suggest that the Raman spectroscopy and PCA could be a technique with a strong potential of support for current techniques to detect and identify the different leukemia types by using a serum sample. Nevertheless, with the construction of a data library integrated with a large number of leukemia and control Raman spectra obtained from a wide range of healthy and leukemic population, the Raman-PCA technique could be converted into a new technique for minimally invasive real-time diagnosis of leukemia from serum samples. In addition, complementary results suggest that using these techniques is possible to monitor CHLT.

Cervical cancer detection based on serum sample Raman spectroscopy.

The use of Raman spectroscopy to analyze the biochemical composition of serum samples and hence distinguish between normal and cervical cancer serum samples was investigated. The serum samples were obtained from 19 patients who were clinically diagnosed with cervical cancer, 3 precancer, and 20 healthy volunteer controls. The imprint was put under an Olympus microscope, and around points were chosen for Raman measurement.All spectra were collected at a Horiba Jobin-Yvon LabRAM HR800 Raman Spectrometer with a laser of 830-nm wavelength and 17-mW power irradiation. Raw spectra were processed by carrying out baseline correction, smoothing, and normalization to remove noise, florescence, and shot noise and then analyzed using principal component analysis (PCA). The control serum spectrum showed the presence of higher amounts of carotenoids indicated by peaks at 1,002, 1,160, and 1,523 cm(-1)and intense peaks associated with protein components at 754, 853, 938, 1,002, 1,300-1,345, 1,447, 1,523, 1,550, 1,620, and 1,654 cm(-1). The Raman bands assigned to glutathione (446, 828, and 1,404 cm(-1)) and tryptophan (509, 1,208, 1,556, 1,603, and 1,620 cm(-1)) in cervical cancer were higher than those of control samples, suggesting that their presence may also play a role in cervical cancer. Furthermore, weak bands in the control samples attributed to tryptophan (545, 760, and 1,174 cm(-1)) and amide III (1,234-1,290 cm(-1)) seem to disappear and decrease in the cervical cancer samples, respectively. It is shown that the serum samples from patients with cervical cancer and from the control group can be discriminated with high sensitivity and specificity when the multivariate statistical methods of PCA is applied to Raman spectra. PCA allowed us to define the wavelength differences between the spectral bands of the control and cervical cancer groups by confirming that the main molecular differences among the control and cervical cancer samples were glutathione, tryptophan, ß carotene, and amide III. The preliminary results suggest that Raman spectroscopy could be a highly effective technique with a strong potential of support for current techniques as Papanicolaou smear by reducing the number of these tests; nevertheless, with the construction of a data library integrated with a large number of cervical cancer and control Raman spectra obtained from a wide range of healthy and cervical cancer population, Raman-PCA technique could be converted into a new technique for noninvasive real-time diagnosis of cervical cancer from serum samples.