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The 10-30% of iliac aneurysms involve the internal iliac arteries (IIAs), and their repair still remains a challenge. The endovascular techniques have become the treatment of choice in relation to the improvement of materials, techniques, and less morbidity/mortality compared with open surgery. Regardless of the use of open or endovascular surgery, the preservation of hypogastric blood flow is strongly recommended in the case of occlusion of the contralateral. We describe a case of the use over the instructions for use (IFU), of the GORE Excluder iliac extension for the total successful endovascular exclusion of a voluminous IIA aneurysm in chronic contralateral occlusion. This use over the IFU is applicable and effective in selected patients.

Between 1987 and 1989 data were collected to evaluate risk factors for pelvic endometriosis.A case-control study was conducted on 241 cases with laparoscopically or laparotomically confirmed peritoneal or ovarian endometriosis consecutively admitted to three teaching hospitals in Northern Italy. The control group consisted of 437 women admitted to hospitals for acute conditions covering similar catchment areas.Compared with nulliparous women, the risk of endometriosis decreased with increasing number of births: the point estimates were 0.4 and 0.3, respectively, for those with one and two or more births (X2(1) trend = 50.3, P less than 0.001). No relation emerged with age at first birth and spontaneous miscarriages. Relative to women whose menarche occurred at age 11 or younger, the risk of endometriosis was slightly lower in those who experienced later menarche, but the trend in risk was not significant. Women with irregular menstrual cycles showed a lower frequency of the disease (relative risk, 0.3; 95% confidence interval, 0.2 to 0.5). The role of various factors was largely similar for different disease locations (ovary, peritoneum, and both) and indication for diagnostic surgery (sterility, pelvic pain, and other reasons).This study found that parity and irregular/long menses lower the risk of endometriosis. These findings were similar in different subgroups of disease location and indication for surgery, giving strong evidence of the consistency of the general results.

We have studied the effect of active and passive smoking during pregnancy on post-ischemic vascular reactivity in 40 mother-infant pairs (table). 10 mothers (controls) did not smoke and were not exposed to involuntary smoking; 20 mothers (active smokers) had smoked at least 10 cigarettes/day during pregnancy; and 10 mothers (passive smokers) had been exposed to tobacco smoke from their husbands who smoked more than 10 cigarettes/day. The mothers and the infants were healthy and no complications were recorded during pregnancy delivery or the 1st 5 days after birth. Post-ischemic vascular reactivity was evaluated during the 2nd day after birth. Transcutaneous PO2 (cPO2) was monitored with an Oxymonitor" (Hellige); the skin electrode (Transoxode) was fixed on the forearm and set at 37 degrees Celsius; a pneumatic cuff was applied to the upper arm and inflated to 50 mm Hg above systolic pressure to occlude forearm circulation for 4 minutes. The post-occlusive peak tcPO2 was taken as a measure of post-ischemic reactive hyperemia. This technique has proven useful for evaluating vascular abnormalities in diabetic children. A significant reduction in tcPO2 was found for both the smoking mothers and their infants for mothers indirectly exposed to tobacco smoke and their infants (table). Reactive hyperemia in response to arterial occlusion lasting more than 3 minutes is due to a fall in vessel wall PO2 to O causing direct vascular smooth-muscle relaxation by reduction in oxidative phosphorylation and the local production of vasodilator metabolites such as adenosine histamine or prostaglandins. The reduction in reductive hyperemia in mothers exposed to tobacco smoke and in their infants may therefore be partly related to impairment of prostacyclin production by endothelial cells. The vascular alterations caused by smoke can produce a dysfunction of placental blood flow similar to that observed in the chronic placental insufficiency syndromes; this may explain the reduction of birthweight observed in infants of mothers exposed to active or involuntary tobacco smoking. (full text)