Adverse events after endoluminal repair of abdominal aortic aneurysms: a comparison during two successive periods of time

PURPOSE: The aim of this study was to document the incidence rate of adverse events after endoluminal repair of abdominal aortic aneurysms (AAAs) during two successive periods of time. METHODS: One hundred ninety patients (175 men, 15 women; mean age, 72 years) underwent endoluminal repair of AAAs in a 5(1/2)-year period. Adverse events were documented prospectively for all the patients throughout this interval. An adverse event was defined as any of the following events: a death within 30 days, a conversion to open repair, the need for further intervention (either open or endovascular), the need for hemodialysis, a failure to cure the AAA, and wound complications. The patients were divided into two groups those who underwent operation in the initial 3-year period (group I; n = 75) and those who underwent operation in the subsequent 2(1/2)-year period (group II; n = 115). The results were analyzed for total adverse events for both periods of time and for difference in incidence rates within categories of adverse events between the two groups. RESULTS: Eight patients (4.2%) died in the perioperative period. The endoluminal repair failed in 17 patients (8.9%), which necessitated a primary conversion to open repair at the original operation. In 88 patients, 110 adverse events occurred. There was no significant difference in the incidence rates of adverse events in patients in group I (37/75) and group II (51/115). Apart from primary conversion (P =.007), there was no significant difference in the incidence rates of adverse events between group I and group II within the following categories: perioperative (within 30 days) deaths, primary conversion, secondary conversion, supplementary endoluminal repair, intervention for lower limb ischemia, hemodialysis necessitated, failure to cure the AAA as a result of persistent endoleak, and wound complications. CONCLUSION: Despite improvements in technology and increasing experience, adverse events continue to occur in a relatively high proportion of patients (45%) who undergo endoluminal repair of AAA. Reporting the incidence rates of adverse events provides a more accurate picture of the morbidity rates of the endoluminal method rather than simply listing the procedures as successes or failures. The similarity in the incidence rates of adverse events in patients in group I and group II suggests that there are inherent risks in the endoluminal method rather than iatrogenic complications that occur during the learning curve with a new technique.     

Fas-FasL interaction involved in pathogenesis of ocular toxoplasmosis in mice

Ocular toxoplasmosis is a potentially blinding intraocular inflammation. The intent of this study was to investigate the role of Fas-FasL interaction in a murine model of acquired ocular toxoplasmosis induced by intracameral inoculation of Toxoplasma gondii. Intraocular inflammation, Fas and FasL expression on lymphocytes and on ocular tissues, the occurrence of apoptosis, and the frequency of CD8(+) and CD4(+) T cells in the infected eyes were analyzed in C57BL/6 (B6) mice. Susceptibility to parasite-induced intraocular inflammation was observed in Fas-deficient (B6-lpr) and FasL-deficient (B6-gld) mice. Inoculation of 5,000 T. gondii tachyzoites induced significant intraocular inflammation associated with increase of Fas and FasL expression in the inoculated eyes of wild-type B6 mice. Flow cytometry demonstrated a significant increase of Fas and FasL expression on the splenocytes from naive mice incubated in vitro with the parasite and on the splenocytes harvested from the infected mice at day 8 after parasite inoculation. Apoptosis of inflammatory cells and cells in ocular tissues was seen, and a greater frequency of CD8(+) than CD4(+) T cells was observed in the infected eyes. The intensity of intraocular inflammation was greater in B6-lpr and B6-gld mice than in wild-type B6 mice (P < 0.05). The results suggest that Fas-FasL interaction associated with apoptosis is involved in the pathogenesis of acquired ocular toxoplasmosis in mice.     

Effect of low‐dose irradiation on shelf life and microbiological safety of sliced carrot

Minimally processed non‐irradiated carrots (sliced) exhibited diverse microflora at initial level. During storage, bacterial number increased with the presence of pathogenic bacteria accompanied by a loss of total solids. On the other hand γ‐irradiation at an optimal dose of 2 kGy offered a pathogen‐free, hygienic product with insignificant losses in nutrients such as in sucrose, total carotenes and ascorbic acid content in comparison to controls and 2‐ to 4‐fold increased in shelf‐life at refrigeration temperature. The D₁₀ values of pathogens like Escherichia coli and Yersinia enterocolitica in carrot paste were in a lower range (0.12–0.26 kGy) compared with that of Listeria monocytogenes (0.3–0.5 kGy). The validity of the processing treatment (2 kGy) was challenged by artificially inoculating Listeria monocytogenes in the product. Thus, minimally processed carrots (sliced) are amenable to radiation treatment for extended storage stability and microbial safety. Copyright © 2005 Society of Chemical Industry     

Memorial consequences of forced confabulation: age differences in susceptibility to false memories

Numerous studies have demonstrated that exposure to misinformation about a witnessed event can lead to false memories in both children and adults. The present study extends this finding by identifying forced confabulation as another potent suggestive influence. Participants from 3 age groups (1st grade, 3rd/4th grade, and college age) viewed a clip from a movie and were "forced" to answer questions about events that clearly never happened in the video they had seen. Despite evidence that participants would not have answered these questions had they not been coerced into doing so, 1 week later participants in all age groups came to have false memories for the details they had knowingly fabricated earlier. The results also showed that children were more prone to this memory error than were adults.     

Morphological characteristics of lungs in embryos and fetuses in women living in regions contaminated with radionuclides after accident at the Chernobyl power plant

The possibility of transplacental passage of Cr-90 and Cs-137 as well as their traces appearance in descendants muscles and bones beginning from the 2nd pregnancy trimester (and this was sometimes associated with teratogenic effects) was demonstrated on the abortion material (human embryos and fetuses) from the controlled zones of the Bryansk region. Statistically significant inhibition of the bronchial branching (according to the morphometry of the lung histological section) this indicating the disturbance of the lung prenatal morphogenesis during the "pseudoglandular" developmental stage was observed in the 1st trimester of the pregnancy in the descendants of the irradiated mothers. Lung hypoplasia was observed in some cases in the 2nd and 3rd trimesters of the pregnancy. Activation of lymphoid cells in the fetal lungs and the tendency to the enhancement in them of the ectopic erythroid hemopoiesis was revealed. These processes are considered as a reflection of the compensatory adaptive cellular reaction in the descendants respiratory organs in response to the tissue hypoxia and antigenic stimuli from the organism of the pregnant woman irradiated after the Chernobyl accident.     

Evaluation of the Biostar Chlamydia OIA assay with specimens from women attending a sexually transmitted disease clinic

Chlamydia trachomatis infections are the most prevalent sexually transmitted diseases (STDs) in the United States. In acute-care settings such as clinics and emergency rooms, a desirable chlamydia screening assay should exhibit good sensitivity and good specificity and should provide test results while the patient is still present. The Biostar Chlamydia OIA (Biostar, Inc., Boulder, Colo.) is an optical immunoassay (OIA) that provides test results in less than 30 min and that uses a test format that allows office-based testing. This assay is performed entirely at room temperature without the need for rotators or other specialized equipment. The goal of this study was to compare the performance of the Biostar Chlamydia OIA for the detection of C. trachomatis with the performance of cell culture, direct fluorescent-antibody (DFA) assay (Syva MicroTrak; Syva Co., Palo Alto, Calif.), and PCR (Roche Amplicor Chlamydia trachomatis; Roche, Branchburg, N.J.) for the detection of C. trachomatis infections in women attending an urban STD clinic. For calculations of relative test performance (sensitivity, specificity, and positive and negative predictive values), patient specimens that yielded positive results by two or more of the four assays (cell culture, DFA assay, PCR, and OIA) were classified as "true infections." By these criteria, 42 of 306 total specimens were classified as positive for C. trachomatis (positive prevalence, 13.7%), 11 (3.6%; 10 by PCR and 1 by DFA assay) were positive by a single assay, and 253 (82.7%) were negative by all four tests. All culture-positive specimens were also positive by at least one other assay. Among the culture-negative specimens, 14(5%) specimens were positive by two of the three non-culture-based assays used. By using the criterion that positivity by at least two of the tests indicated a true infection,the relative sensitivities were as follows: culture and PCR, 92.9% each; Biostar Chlamydia OIA, 73.8%; and DFA assay, 59.5%.     

Plasma transforming growth factor beta1 as a predictor of radiation pneumonitis

PURPOSE: To investigate prospectively the utility of plasma transforming growth factor beta1 (TGFbeta1) as a marker for the development of symptomatic radiation pneumonitis. MATERIALS AND METHODS: Seventy-three patients with lung cancer treated with curative intent are reported herein. Plasma TGFbeta1 samples were obtained before, weekly during, and at each follow-up after radiation therapy (RT). TGFbeta1 was extracted using an acid/ethanol method. An enzyme-linked immunosorbent assay was used to quantify plasma TGFbeta1 concentrations. The TGFbeta1 level at the end of RT was considered "normal" if it was both < or = 7.5 ng/ml and less than the pretreatment value. All patients were followed for at least 6 months, unless symptomatic pneumonitis developed sooner. Pneumonitis was defined by National Cancer Institute (NCI) common toxicity criteria. RESULTS: Fifteen of the 73 patients (21%) developed symptomatic pneumonitis and the remaining 58 (79%) did not. A normal plasma TGFbeta1 by the end of RT, as defined above, was more common in patients who did not develop pneumonitis. A return of the plasma TGFbeta1 to normal accurately identified patients who would not develop pneumonitis with both a sensitivity and positive predictive value of 90%. CONCLUSION: Plasma TGFbeta1 levels appear to be a useful means to identify patients at low risk for the development of pneumonitis from thoracic RT. Thus, monitoring of plasma TGFbeta1 levels may identify candidates for dose escalation studies in the treatment of lung cancer.     

Is visible infarction on computed tomography associated with an adverse prognosis in acute ischemic stroke?

BACKGROUND AND PURPOSE: It is unclear whether visible infarction on a CT scan at any time after the stroke is an adverse prognostic factor once other factors such as stroke severity are taken into consideration. We examined whether visible infarction was associated with a poor outcome after stroke using univariate and multivariate analyses, including easily identifiable clinical baseline variables, and adjusting for time from stroke onset to CT. METHODS: All inpatients and outpatients with an acute ischemic stroke attending our hospital stroke service were examined by a stroke physician and entered into a register prospectively. The CT scan was coded prospectively for the site and size of any relevant recent visible infarct. The patients were followed up at 6 months to ascertain their functional status with the use of the modified Rankin Scale. Analyses of the effect of visible infarction on the outcomes "dead or dependent" or "dead" at 6 months were performed with adjustment for time from stroke to CT, clinical stroke type (lacunar, hemispheric, or posterior circulation), and in a multiple logistic regression model to adjust for confounding baseline variables such as stroke severity. RESULTS: In 993 patients in the stroke registry, visible infarction increased the risk of being dead or dependent at 6 months (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9 to 3.3) or dead (OR, 4.5; 95% CI, 2.7 to 7.5), both on its own and after adjustment for time from stroke to CT, stroke symptoms, and other important clinical prognostic variables (OR for death or dependence in the predictive model, 1.5; 95% CI, 1.0 to 2.0; OR for death, 2.4; 95% CI, 1.4 to 4.1). CONCLUSIONS: Visible infarction on CT is an adverse prognostic indicator (albeit of borderline significance) even after adjustment for stroke severity and time lapse between the stroke and the CT scan.     

Silicone elastomer cerebrospinal fluid shunt systems. Council on Scientific Affairs, American Medical Association

A 1995 resolution of the American Medical Association House of Delegates, introduced by the American Academy of Neurology, the American Association of Neurological Surgeons, and the Congress of Neurological Surgeons, asked the American Medical Association Council on Scientific Affairs to add the use of hardened silicone shunts to its study of the effects of silicone gel used in breast implants. On consideration of the important differences between the two materials, silicone elastomer ("hardened silicone") and silicone gel, the Council on Scientific Affairs elected to address the subject of silicone elastomer shunt systems separately. This report describes the different types of medical-grade silicone used in medical devices, the incidence of hydrocephalus and its causes and treatment, and the use of cerebrospinal fluid shunt systems made of silicone elastomer. Published case reports of possible immunological disease in patients who have had silicone elastomer cerebrospinal fluid shunt systems implanted are reviewed. The Council on Scientific Affairs concluded that the evidence presented does not support the occurrence of immune-mediated systemic reactions to implanted silicone elastomer cerebrospinal fluid shunt systems. The local granulomatous or inflammatory responses observed in some patients with silicone shunt systems have not been shown to be immunologically mediated; similar reactions have been described with other implanted foreign bodies.     

Comparison of two rapid whole-blood tests for Helicobacter pylori infection in Chinese patients

Consecutive Chinese patients undergoing endoscopy for dyspepsia were tested for Helicobacter pylori infection by two rapid whole-blood tests: FlexPack HP (Abbott Laboratories) and Helisal One-Step (Cortecs Diagnostics). Biopsy-based tests (rapid urease test and histology) and the [13C]urea breath test were used as the "gold standard." One hundred sixty-one consecutive patients were studied, and 88 (54.7%) were confirmed to have H. pylori infection. The sensitivities, specificities, and positive and negative predictive values were 81.8%, 83.6% (P = 0.008), 85.7% (P = 0.04), and 79.2% for FlexPack HP and 84.1%, 63.0% (P = 0.008), 73.3% (P = 0.047), and 76.7% for Helisal One-Step, respectively.