The Femoral Venoarterial Perfusion During Open Abdominal Aortic Aneurysm Repair in Patient With Renal Transplant.

We report of a patient with abdominal aortic aneurysm and renal transplant who underwent aneurysm repair. These patients can be treated by eather open or endovascular approach, depending on several factors, including aneurysm morphologic suitability for endovascular tretament, age of patient, and comorbidities.The main challange with open repair approach is to maintain renal transplant perfusion during the aortic cross clamping. Several methods of renal transplant perfusion during aneurysm repair have been described. In this case, we opted for open aneurysm repair beacuse of the age of the patient. The femoral venoarterial perfusion technique using extracorporal circulation machine was employed. We found this technique safe and easy in treating such patients.

Thrombotic microangiopathy in adult-onset Still's disease: case report and review of the literature.

Coexistence of thrombotic microangiopathy and adult-onset Still's disease is extremely rare. There is increasing evidence that this association could be more than just coincidental. We report on the case of a 34-year-old male diagnosed with adult-onset Still's disease and successfully treated with intravenous glucocorticoids. Nine months after onset the patient exhibited the presence of asymptomatic thrombocytopenia during treatment with chloroquine. The physical status was unremarkable except for pallor of the skin and mucosa. Laboratory evaluation revealed profound thrombocytopenia and hemolytic anemia. Coombs' tests were negative; renal function tests were all normal. The peripheral blood smear showed frequent schistocytes. Based on the presence of thrombocytopenia and microangiopathic hemolytic anemia, and with the exclusion of other known causes, the patient was diagnosed with thrombotic microangiopathy and successfully treated with plasma exchange and intravenous glucocorticoids. We also review the literature on the association between adult-onset Still's disease and thrombotic microangiopathy; our case is the 15(th) report on such an association. The mean age at onset of adult Still's disease in these cases was 31.60 years and the interval between the diagnosis of Still's disease and the onset of thrombotic microangiopathy ranged from 3 days to 17 years, with a female/male ratio of 2 : 1. In more than half the patients thrombotic microangiopathy occurred within the first 6 months after the diagnosis of the Still's disease. Eleven of the 15 (73%) patients were treated with plasmapheresis in addition to glucocorticoid therapy: eight of 11 (73%) had complete remission, the other three had permanent visual impairment and/or digital ischemia. Of the four patients who were not treated with plasmapheresis, two died, one developed end-stage renal disease and one had complete remission. Awareness of the possible development of thrombotic microangiopathy in patients with adult-onset Still's disease is critical, so that treatment can be initiated early and the complications and recurrence of thrombotic microangiopathy prevented. Patients with adult-onset Still's disease should be closely monitored for signs and symptoms of thrombotic microangiopathy during the first six months after diagnosis of the Still's disease.

Perioperative management with glucose solution and insulin.

The objective of this study was to analyze how preoperative glucose treatment influences the blood glucose level as a measured exponent of surgical stress and to establish the best postoperative replacement considering glucose solutions and insulin. This prospective clinical trial involved 208 non-diabetic patients with normal glucose tolerance, who underwent major surgical procedures and needed 24 hours ICU monitoring postoperatively. Patients were randomly given 5% glucose solution (1000 mL) one day before surgery or after overnight fasting. Group A and group B were randomized to be given 5 different kinds of postoperative replacement with cristalloids and insulin. None of the patients from group A or group B were given glucose solutions during surgical procedures. Blood glucose levels were measured 14 times from the preoperative period until 24 hours after admission to the ICU and the main outcome measure was blood glucose level. All patients had a statistically significant increase in blood glucose levels in comparison to basal levels (p < 0.05) in all measurements. All data were processed with descriptive statistics, chi-square test, parametric ANOVA test and ANOVA test with repeated measure, non parametric Kruskal-Wallis test and Mann-Whitney U-test. Statistically significant change was accepted with p < 0.05. Preoperative glucose infusion decreased metabolic and endocrine response only during surgery; the smallest increase of postoperative blood glucose level was noticed after administering postoperative non-glucose crystalloid solutions; there is no clinical evidence that one specific postoperative replacement is better than the other; there is no clinical evidence that postoperative use of insulin can decrease or attenuate surgical induced insulin resistance.

Morphological characteristics of the acetabulum.

The aim of this research was to accurately measure the surface of the semi lunar articular surface of the pelvis (facies lunata acetabuli) and the variability of the acetabular geometry, as well as to determine the correlation between measured parameters. 30 macerated anatomical specimens of pelvic bones were measured. The radius and depth were measured in the classical way, while cartilaginous surface area was measured using small fragments of measuring paper to avoid errors in measurement due to the curvature of the surface. Computerized calculations provided accurate surface values. In our research, facies lunata acetabuli measured 2294+/-329 mm2. Diameter of the opening of the acetabulum measured 25.8+/-1.9 mm. Acetabular depth was 30+/-3.2 mm. Correlations between the surface area of the facies lunata acetabuli and the radius of the acetabular opening curvature (r=0.71), surface area of the facies lunata acetabuli and the depth of the acetabulum (r=0.80) and the radius of the acetabular opening curvature and the depth of the acetabulum (r=0.80) were confirmed. For precise assessment of the facies lunata acetabuli surface area, the simplest and the cheapest method is the method of measurement using small fragments of measuring paper and software analysis. There is a significant correlation between the depth, opening of the acetabulum and surface area of the facies lunata.

Holistic approach to functional anatomy of the injured ankle joint.

Talocrural joint injuries are among the most common injuries of the joints and therefore there is a need for a holistic approach to analysis of morphology, biomechanics and visualization of the talocrural joint ligamentary apparatus in different positions. The research was carried out on 20 fresh and conserved anatomical specimens of the lower leg on which X-ray, computed tomography, ultrasonography and stress analysis were performed before and after the lesion of ligaments. Also the gait of 130 adults without (100) and with ligament and joint capsule lesion (30) was analyzed by infrared telemetry. After complete discission of the lateral ligaments, arthrography and CT could register the lesion, while X-ray and ultrasonography could not detect it. Gait analysis of healthy and injured leg showed that the injured leg was significantly less loaded.