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Purpose: Subintimal angioplasty is becoming more frequently used treatment option for patients with long arterial occlusions or diffuse atherosclerotic changes as an alternative to surgical treatment in claudicants especially in patients with critical limb ischemia. The aim of our article is to retrospectively assess mid-term outcomes of subintimal angioplasty of chronic arterial occlusions in femoropopliteal region followed clinically and by Doppler ultrasonography., Materials and Methods: From May 2002 to December 2007, 133 femoropopliteal artery occlusions in 123 patients were indicated for subintimal recanalisation. The indications for treatment were intermittent claudications in 84 patients (63.15%) and critical limb ischemia in 49 patients (36.85%). The median length of lesions was 11.4 cm, range 2-30 cm. Except doppler ultrasonographic examination done 24h after the procedure and clinical examination before discharge, both clinical and ultrasonographic examinations were performed 6 and 12 months after the procedure and yearly thereafter. Statistical analysis of our cohort was performed by Kaplan-Meier analysis, log-rank test and Cox regression., Results: Technical success was achieved in 86.46%. Primary patency rate was 83.1% (SE: 3.9%), 67.5% (SE: 5%), 58% (SE: 5.9%) a 48.4% (SE: 7.1%) at 6, 12, 24 and 36 months respectively. No statistically significant difference of primary patency was found between the group of claudicants and the group of patient with critical limb ischemia. Statistically significant prediction factors for primary patency were only the quality of the run off and the length of the occlusion. Limb salvage rate in our group of patients with critical limb ischemia was 80.8% at 12 months., Conclusion: : Subintimal recanalisation is a simple and safe procedure for treatment of chronic peripheral arterial occlusions with high primary technical success rate, acceptable primary patency rate, low percentage of complications and mortality is as low as nil. Subintimal angioplasty is definitely advantageous and fast method in patients with critical limb ischemia with high possibility of limb salvage. Surgical treatment can be replaced by subintimal angioplasty in claudicants with high risk of operative treatment, without suitable autologous vein graft or where distal femoropopliteal or femorocrural bypass is needed., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Aim: The aim of the presented work was to assess the causes of injury to great nerves during varicose vein surgery and comment on the consequences., Methods: This was a retrospective study of 2344 patients operated on for primary varicose veins between the years 1980 and 2005., Results: In three patients out of 2344 the peroneal nerve was injured. The three patients underwent neurosurgery. In the first patient transplantation of the sacral nerve was performed. In the second patient the nerve was released from ligatures, and in the third patient the nerve was first released from the cicatrice and the transposition of the tendon of the posterior tibial muscle followed. All three patients went through intensive rehabilitation. The first patient still wears peroneal splint, the limb is atrophic. In the second patient the function has been well restored and he is not disabled anymore. However, the restitution of the lower limb function is not sufficient for him to work as a teacher of physical education. The third patient still suffers from serious paresis of the peroneal nerve., Conclusions: Even a frequent and relatively simple intervention such as varicose vein surgery may be accompanied by serious complications affecting patients for the rest of their lives. Serious motor nerve injuries are encountered only in operations in the popliteal fossa and the fibula head. Complications are more frequent when operations are performed by young general surgeons than when they are performed by an experienced surgeon or an expert in vascular surgery. The affected patients should be referred for neurosurgery; however, results are unpredictable. In spite of an intensive rehabilitation and possible plastic surgery the patients are permanently affected.

Introduction: The incidence of vascular replacement infection is reported between 0.5-6.0%. The infection of aortal valve replacement is usually managed by its removal and axilofemoral reconstruction. Replacement removal and reconstruction in situ is another alternative. The aim of our work is to give the comparison of the results obtained with the extra-anatomic reconstruction and alternative techniques., Materials and Methods: Between January 1987 and August 2008 1324 abdominal aortal replacements were performed in our department. In 14 patients (1.05%) the infection of the replacement occurred; one of the patients was operated on in another hospital. In eight patients axilobifemoral/axilopoplietal by-pass was applied (Group A). In two patients the whole replacement was removed together with in situ reconstruction (ISR) using a new bifurcation replacement. In two patients a partial resection of the replacement and the resected part substitution or femoro-femoral cross-over by-pass was performed. Three patients were treated with a total or partial replacement removal without the following reconstruction., Results: In Group A no haemorrhage from the aortal stub occurred. The mean value of surgical management due to the replacement infection was 3.5 (1-6). For Group B the number was 5 (1-16). In Group B there were three reinfections, in Group A none. In both Group A and B one patient died; one thigh amputation was necessary in Group A, two in Group B., Conclusions: The partial or total removal of the replacement followed with in situ reconstruction is considered a safe and good method solving the infection of the aortal replacement in some patients. The results are comparable to those obtained with extra-anatomic reconstruction that remains the method of choice in patients with virulent infections.

We interpret the nucleus properties and jet activity from the Stardust spacecraft imaging and the onboard dust monitoring system data. Triangulation of 20 jets shows that 2 emanate from the nucleus dark side and 16 emanate from sources that are on slopes where the Sun's elevation is greater than predicted from the fitted triaxial ellipsoid. Seven sources, including five in the Mayo depression, coincide with relatively bright surface spots. Fitting the imaged jets, the spikelike temporal distribution of dust impacts indicates that the spacecraft crossed thin, densely populated sheets of particulate ejecta extending from small sources on the rotating nucleus, consistent with an emission cone model.

Images taken by the Stardust mission during its flyby of 81P/Wild 2 show the comet to be a 5-kilometer oblate body covered with remarkable topographic features, including unusual circular features that appear to be impact craters. The presence of high-angle slopes shows that the surface is cohesive and self-supporting. The comet does not appear to be a rubble pile, and its rounded shape is not directly consistent with the comet being a fragment of a larger body. The surface is active and yet it retains ancient terrain. Wild 2 appears to be in the early stages of its degradation phase as a small volatile-rich body in the inner solar system.

The authors emphasize the need for the investigation of the central venous system prior to the insertion of an avfistula, this they consider to be of utmost importance in patients with anamnesis of central vessel access. After the av-fistula is inserted, an unrecognized obstacle (stenosis or thrombosis) may result in the occurrence of venous hypertension and hypofunction, this may lead to av-fistula malfunction.

At least 16 fragments were detected in images of comet C/1999 S4 (LINEAR) taken on 5 August 2000 with the Hubble Space Telescope (HST) and on 6 August with the Very Large Telescope (VLT). Photometric analysis of the fragments indicates that the largest ones have effective spherical diameters of about 100 meters, which implies that the total mass in the observed fragments was about 2 x 10(9) kilograms. The comet's dust tail, which was the most prominent optical feature in August, was produced during a major fragmentation event, whose activity peaked on UT 22.8 +/- 0.2 July 2000. The mass of small particles (diameters less than about 230 micrometers) in the tail was about 4 x 10(8) kilograms, which is comparable to the mass contained in a large fragment and to the total mass lost from water sublimation after 21 July 2000 (about 3 x 10(8) kilograms). HST spectroscopic observations during 5 and 6 July 2000 demonstrate that the nucleus contained little carbon monoxide ice (ratio of carbon monoxide to water is less than or equal to 0.4%), which suggests that this volatile species did not play a role in the fragmentation of C/1999 S4 (LINEAR).

The authors present their experience in late infection of aortoilliacofemoral reconstruction by means of the Dacron vascular prosthesis. They found such complication in 8 of 620 (1.5%) reconstructions in that region in period 1988-1998. There is essential position of scintigraphy (Le 99mTc-HMPAO) and CT in diagnostic of location and extent of an affection. Conservative approach and local surgery were not permanently successful. The alternative approach is radical removing of the whole graft. The alternative of aortofemoral reconstruction is axillobifemoral bypass using ePTFE graft in case of an infection of the bifurcation graft.

The authors give an account of their experience with establishment of an arteriovenous fistula for dialysis using interposition with a DIASTAT-GORE prosthesis between the axillary artery and the contralateral axillary or inner jugular vein and its localization on the anterior thoracic wall. The method is apt in patients with a primarily unsuitable or secondarily surgically exhausted autologous circulation of the upper extremities.

The authors use, when establishing secondary arteriovenous anastomoses for haemodialysis, the blood vessels of the cubital fossa. If it is possible from the anatomical and functional aspect, they connect the superficial venous vessels to the arterial ones by means of a perforating vein. If the blood vessels of the forearm are of poor quality, they use this procedure as the primary approach. After two years the group of 38 established fistulas comprises 87% which can be completely used and none of them had to be modified.

In this information we wanted to call your attention to the newer method of treatment of chronic renal insufficiency--CAPD. The process of execution, the advantages and disadvantages by using this method as well as our experience during last two years are described. The number of cured patients is 22 persons with very good results. The longest time of treatment has been 22 month, the complications by 4 persons only, that is 18 per cent. For the patient the method is relatively unpretentious, safe, effective and from the economic point of view advantageous. It is possible to recommend this method for larger use.

The Hubble Space Telescope observed the fragmented comet P/Shoemaker-Levy 9 (1993e) (P indicates that it is a periodic comet) on 1 July 1993. Approximately 20 individual nuclei and their comae were observed in images taken with the Planetary Camera. After subtraction of the comae light, the 11 brightest nuclei have magnitudes between approximately 23.7 and 24.8. Assuming that the geometric albedo is 0.04, these magnitudes imply that the nuclear diameters are in the range approximately 2.5 to 4.3 kilometers. If the density of each nucleus is 1 gram per cubic centimeter, the total energy deposited by the impact of these 11 nuclei into Jupiter's atmosphere next July will be approximately 4 x 10(30) ergs ( approximately 10(8) megatons of TNT). This latter number should be regarded as an upper limit because the nuclear magnitudes probably contain a small residual coma contribution. The Faint Object Spectrograph was used to search for fluorescence from OH, which is usually an excellent indicator of cometary activity. No OH emission was detected, and this can be translated into an upper limit on the water production rate of approximately 2 x 10(27) molecules per second.

Analysis of the data from Giotto's Dust Impact Detection System experiment (DIDSY) is presented. These data represent measurement of the size of dust grains incident on the Giotto dust shield along its trajectory through the coma of comet P/Halley on 1986 March 13/14. First detection occurred at some 287000 km distance from the nucleus on the inbound leg; the majority of the DIDSY subsystems remained operational after closest approach (604 km) yielding the last detection at about 202000 km from the nucleus. In order to improve the data coverage (and especially for the smallest grains, to approximately 10(-19) kg particle mass), data from the PIA instrument has been combined with DIDSY data. Flux profiles are presented for the various mass channels showing, to a first approximation, a 1/R2 flux dependence, where R is the distance of the detection point from the cometary nucleus, although significant differences are noted. Deviations from this dependence are observed, particularly close to the nucleus. From the flux profiles, mass and geometrical area distributions for the dust grains are derived for the trajectory through the coma. Groundbased CCD imaging of the dust continuum in the inner coma at the time of encounter is also used to derive the area of grains intercepted by Giotto. The results are consistent with the area functions derived by Giotto data and the low albedo of the grains deduced from infrared emission. For the close encounter period (-5 min to +5 min), the cumulative mass distribution function has been investigated, initially in 20 second periods; there is strong evidence from the data for a steepening of the index of the mass distribution for masses greater than 10(-13) kg during passage through dust jets which is not within the error limits of statistical uncertainty. The fluences for dust grains along the entire trajectory is calculated; it is found that extrapolation of the spectrum determined at intermediate masses (cumulative mass index alpha = 0.85) is not able to account for the spacecraft deceleration as observed by the Giotto Radio Science Experiment and by ESOC tracking operations. Data at large masses (>10(-8) kg) recently analysed from the DIDSY data set show clear evidence of a decrease in the mass distribution index at these masses within the coma, and it is shown that such a value of the mass index can provide sufficient mass for consistency with the observed deceleration. The total particulate mass output from the nucleus of comet P/Halley at the time of encounter would be dependent on the maximum mass emitted if this change in slope observed in the coma were also applicable to the emission from the nucleus; this matter is discussed in the text. The flux time profiles have been converted through a simple approach to modeling of the particle trajectories to yield an indication of nucleus surface activity. There is indication of an enhancement in flux at t approximately -29 s corresponding to crossing of the dawn terminator, but the flux detected prior to crossing of the dawn terminator is shown to be higher than predicted by simple modelling. Further enhancements corresponding to jet activity are detected around +190 s and +270 s.

The model for dust comets, formulated by Finson and Probstein, which had previously been tested only on Comet Arend-Roland 1957 III, has been successfully applied to three calibrated photographic plates of Comet Bennett. The size distribution, emission rate, and initial velocities of dust particles emitted from the comet's nucleus are given.