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Ischaemic stroke is a common cause of death and incapacity and is related in most cases to vascular disease. Intracranial vessel occlusion due to tumour emboli is a rare entity and adequate treatment for this condition is not defined. The use of mechanical thrombectomy devices is considered the treatment of choice for major intracranial vessel occlusion; however, no recommendation can be made in the case of tumour thrombembolia. This report describes two cases who presented with a middle cerebral artery occlusion due to tumour emboli and that were treated using the Solitaire thrombectomy device.

Cardiovascular diseases are a major health concern and therefore an important topic in biomedical research. Large animal models allow researchers to assess the safety and efficacy of new cardiovascular procedures in systems that resemble human anatomy; additionally, they can be used to emulate scenarios for training purposes. Among the many biomedical models that are described in published literature, it is important that researchers understand and select those that are best suited to achieve the aims of their research, that facilitate the humane care and management of their research animals and that best promote the high ethical standards required of animal research. In this resource the authors describe some common swine models that can be easily incorporated into regular practices of research and training at biomedical institutions. These models use both native and altered vascular anatomy of swine to carry out research protocols, such as testing biological reactions to implanted materials, surgically creating aneurysms using autologous tissue and inducing myocardial infarction through closed-chest procedures. Such models can also be used for training, where native and altered vascular anatomy allow medical professionals to learn and practice challenging techniques in anatomy that closely simulates human systems.

BACKGROUND AND PURPOSE: The use of cerebral protection during CAS in the treatment of carotid artery disease is matter of controversy. The purpose of this study was to evaluate the outcome of CASWBAP in a large cohort of patients, with ≤7 years9 follow-up. MATERIALS AND METHODS: Two hundred thirty-six patients with 255 symptomatic carotid stenoses and/or with high-risk-morphology plaques of >50% and asymptomatic plaques of >70% were prospectively identified. Patients underwent neurologic and carotid US examination before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Plain films of the neck were obtained immediately after the procedure and then at 1 and 3 months. RESULTS: Technical success was achieved in 253/255 (99%) patients. Primary stent placement was successful in 248/253 (98%) patients. Neurologic periprocedural complications within 30 days included 1 (0.4%) nondisabling stroke, 1 (0.4%) disabling stroke, 11 (4.3%) TIAs, and 1 (0.4%) death. The mean duration of follow-up was 23 ± 1.4 months (range, 3–84 months). During the follow-up period, there were 9 additional deaths (7 unrelated to the carotid disease and 2 stroke-related) and 2 strokes (in other vascular territories). The degree of stenosis decreased from a mean of 82% before the procedure to a mean of 30% immediately after. During follow-up, 38 (14.8%) angioplasties were performed due to restenosis in 19 (7.4%) patients, lack of stent expansion in 14 (5.4%), or both in 5 (1.9%). CONCLUSIONS: CASWBAP is effective and safe with a low incidence of periprocedural complications, providing satisfactory long-term clinical results.

Our aim was to develop an easy-to-induce, reproducible, and low mortality clinically relevant closed-chest model of chronic myocardial infarction in swine using intracoronary ethanol and characterize its evolution using MRI and pathology. We injected 3-4 mL of 100% ethanol into the mid-LAD of anesthetized swine. Heart function and infarct size were assessed serially using MRI. Pigs were euthanized on days 7, 30, and 90 (n=5 at each timepoint). Postoperative MRI revealed compromised contractility and decreased ejection fraction, from 53.8% ± 6.32% to 43.79% ± 7.72% (P=0.001). These values remained lower than baseline thorough the followup (46.54% ± 11.12%, 44.48% ± 7.77%, and 40.48% ± 6.40%, resp., P<0.05). Progressive remodeling was seen in all animals. Infarcted myocardium decreased on the first 30 days (from 18.09% ± 7.26% to 9.9% ± 5.68%) and then stabilized (10.2% ± 4.21%). Pathology revealed increasing collagen content and fibrous organization over time, with a rim of preserved endocardial cells. In conclusion, intracoronary ethanol administration in swine consistently results in infarction. The sustained compromise in heart function and myocardial thinning over time indicate that the model may be useful for the preclinical evaluation of and training in therapeutic approaches to heart failure.

BACKGROUND & AIMS: Uncontrolled studies suggest that placement of a transjugular intrahepatic portosystemic shunt (TIPS) could be useful in the treatment of variceal bleeding. The aim of this study was to evaluate the efficacy and safety of TIPS in the elective treatment of hemorrhage from esophageal varices in a randomized controlled study that compared the effects of TIPS with those of endoscopic sclerotherapy (ES). METHODS: Sixty-three consecutive cirrhotic patients with hemorrhage from esophageal varices were included. Thirty-two patients were randomly allocated to ES and 31 to TIPS groups. RESULTS: One patient in each group died before the therapeutic procedure could be performed. During a mean follow-up period of 15 months, variceal rebleeding occurred in 51.6% of the patients in the ES group and 23% of those in the TIPS group. Uncontrolled rebleeding occurred in 10 of 31 patients in the ES group, whereas rebleeding did not occur in any patient of the TIPS group. Hepatic encephalopathy was more frequent in TIPS patients (33.3%) than in those treated by ES (13%). However, mortality was similar in both treatment groups. CONCLUSIONS: These preliminary results suggest that TIPS is more effective than ES in the prevention of variceal rebleeding in cirrhotic patients, even though no difference in survival was observed. (Gastroenterology 1996 Mar;110(3):832-9)

A minimally invasive pericardial access and chronic catheterization may enhance the therapeutic effects of intrapericardial drug delivery. We aimed to evaluate the technical feasibility of percutaneous intrapericardial implantation of a drug port system for chronic local drug delivery.Under fluoroscopic guidance, a percutaneous subxiphoid access to the pericardial space was obtained with fine needle and micropuncture set in 6 Göttingen minipigs. A 6.4 Fr silicone tube and its drug port were implanted into the pericardial space and a subcutaneous pocket. One animal was euthanized immediately after procedure for acute macroscopic study. The other 5 animals were followed monthly for 2 months and then euthanized for chronic macroscopic study. Technical success was obtained in all animals. The mean procedure duration was 55.3 ± 9.6 minutes and the mean radiation exposure time was 7.9 ± 1.9 minutes. Acute macroscopic study showed no pericardial laceration at the entry site and no gross injury to the nearby epicardium. Follow-ups demonstrated that the pericardial space was intact and silicone catheters kept patent in all cases. No migration of the catheter tip out of the pericardial space or leakage of contrast was observed. All the catheters were easily removed at the end of study. Infection of the subcutaneous tunnel as a major complication was found in 1 pig. Small scattered adhesions of the pericardial space were observed in 2 pigs at chronic macroscopic study.Percutaneous intrapericardial catheterization for chronic local drug delivery is technically feasible and of potential for clinical trial.

A diabetic foot infection is usually the result of a pre-existing foot ulceration and is the leading cause of lower extremity amputation in patients with diabetes. It is widely accepted that diabetic foot infections may be challenging to treat for several reasons. The devastating effects of hyperglycemia on host defense, ischemia, multi-drug resistant bacteria and spreading of infection through the foot may complicate the course of diabetic foot infections. Understanding the ways in which infections spread through the diabetic foot is a pivotal factor in order to decide the best approach for the patient’s treatment. The ways in which infections spread can be explained by the anatomical division of the foot into compartments, the tendons included in the compartments, the initial location of the point of entry of the infection and the type of infection that the patient has. The aim of this paper is to further comment on the existed and proposed anatomical principles of the spread of infection through the foot in patients with diabetes.Keywords: diabetic foot; infection; osteomyelitis; anatomy; amputation(Published: 1 October 2012)Citation: Diabetic Foot & Ankle 2012, 3: 18693 - http://dx.doi.org/10.3402/dfa.v3i0.18693

Late complications after surgical repair of aortic coarctation are not uncommon. Among these complications pseudoaneurysms are the most frequent complications, occurring between 3 and 38%. Reoperation in these patients is associated with high morbidity and mortality. In the last decade, endovascular techniques emerged as an alternative to conventional surgery with excellent results. We report the case of two patients who presented with pseudoaneurysms after surgical correction for aortic coarctation, which were treated by endovascular means.

[Figure][1] A 46-year-old female patient was admitted with signs of lower limb ischemia. Her examination demonstrated a nonpalpable distal pulse. Computed tomography angiography revealed an anomalous origin of both renal arteries (A, B) and severe aortic narrowing between the renal arteries

The conventional elective open procedures for abdominal aortic aneurysm repair are reliable and yield durable results. The aortoaortic tube graft has the lowest morbidity incidence when compared with different techniques. Albeit infrequent, thrombosis can be present in the first 30 days. Its treatment consists in thrombectomy and anastomosis evaluation, but with an increase in morbidity, especially in patients with urgent reintervention. This is a case report of a patient with aortoaortic tube graft, who present critical left limb ischemia immediately after surgical procedure. Angiography showed complete occlusion of left common iliac artery, affecting the distal graft anastomosis. The occlusion was resolved with endovascular treatment, and a noncovered, self-expanding, nitinol stent was deployed (primary stenting) covering the distal bypass anastomosis, with no complications and complete lower limb perfusion recovery. One month later, the patient was still asymptomatic, with distal pulse palpable and ankle-brachial index 1.

Resumen Introduccion A pesar de exhibir diferencias histologicas con el proceso en humanos, la hiperplasia benigna de prostata (HBP) inducida por hormonas en perros representa el modelo mas utilizado actualmente para la evaluacion de tratamientos. Objetivos El objetivo del presente estudio es determinar el momento optimo para la realizacion de un ensayo terapeutico en este modelo. Material y metodos En el estudio se utilizaron 6 perros beagle, machos mayores de un ano, a los que se administro una combinacion de hormonas, 17β-estradiol y 5α-androsteno 3α 17β-diol, en dias alternos durante 3 (grupo 1, n = 3) o 5 meses (grupo 2, n = 3). Se realizaron seguimientos ultrasonograficos mensuales, con determinacion del tamano prostatico. A los 5 meses se procedio al sacrificio de todos los animales y el estudio histologico de las glandulas prostaticas. Resultados Todos los animales desarrollaron una HBP, con un volumen prostatico que aumentaba con el tiempo de administracion hormonal (r = 0,910), evidenciandose en todos los estudios ecograficos hasta el tercer mes un aumento significativo de tamano frente al estudio anterior. El tamano prostatico disminuyo considerablemente en el grupo 1 al retirar la hormonoterapia, al tiempo que en el grupo 2 continuo aumentando. Los animales del grupo 1 apenas evidenciaron signos histologicos de HBP, frente a los del grupo 2, que presentaron una clara hiperplasia del epitelio glandular. Conclusiones La administracion de una combinacion de hormonas esteroides es efectiva para inducir hiperplasia de prostata en perro, si bien esta desaparece en el momento que se retira la hormonoterapia. Para utilizar este modelo en estudios experimentales, se deben administrar hormonas al menos durante 3 meses antes de la actuacion terapeutica, y continuar durante todo el ensayo.

Gianturco self-expandable stents were used successfully in the management of 5 patients with tracheobronchial pathology. Placement was performed under endoscopic and fluoroscopic guidance. None of the patients has experienced complications secondary to the stent placement, and in all of them the clinical problems resolved satisfactorily. Longer follow-up is required to determine the place of tracheobronchial stenting in patients with respiratory compromise.

BACKGROUND AND PURPOSE: A major concern during carotid artery stent placement is the potential for cerebral embolism. Diminishing the number of device manipulations across the lesion might reduce procedural stroke risk. For this purpose, we report our initial experience with carotid stent placement without the use of either balloon angioplasty or distal protection devices. MATERIALS AND METHODS: Eighty-seven consecutive patients with 100 carotid stenoses compose this series. Ninety four of the 100 hundred stented carotid arteries were either symptomatic (58 [58%]) or had a greater than 70% stenosis (36 [36%]). Six percent of them were asymptomatic and had stenosis between 50% and 70%. Patients underwent neurologic evaluation before the procedure and during follow-up at 1, 3, 6, and 12 months and annually thereafter. Carotid sonography and plain films of the neck were performed immediately after the procedure and then at the same time intervals. RESULTS: Primary stent placement was successful in 98 of 100 case subjects. In 2 case subjects, predilation was necessary before stent deployment. Neurologic periprocedural complications included 1 nondisabling and 1 disabling stroke and 5 transient ischemic attacks. The mean duration of follow-up was 23 months (range: 10–36 months). During the follow-up period, there were 5 deaths, all unrelated to the carotid disease, and no major stroke. The degree of stenosis decreased from a mean of 78.85% before the procedure to a mean of 21.23% immediately after. CONCLUSIONS: In this series, carotid stent placement without the use of either balloon angioplasty or distal protection devices was safe and effective with a low incidence of periprocedural complications.

La retirada percutanea de cuerpos extranos intravasculares es un procedimiento ampliamente utilizado en los ultimos anos que puede evitar la cirugia mayor. Cuando el cuerpo extrano se aloja en las cavidades cardiacas su rescate se ve dificultado por la posibilidad de arritmias. Presentamos un caso en el que un fragmento de un introductor quedo alojado en el ventriculo derecho, atrapado entre las cuerdas tendinosas. No fue posible extraerlo del ventriculo derecho, por lo que fue necesario desplazarlo hacia la arteria pulmonar izquierda desde donde fue retirado sin dificultad.

Endoluminal occlusion has been performed since the early beginning of interventional radiology. Over recent decades, major technological advances have improved the techniques used and different devices have been developed for changing conditions. Most of these occlusion devices have been implemented in the vascular territory. Early embolization materials included glass particles, hot contrast, paraffin, fibrin, and tissue fragments such as muscle fibers and blood clots; today, occlusion materials include metallic devices, particles, and liquid materials, which can be indicated for proximal or distal occlusion, high-flow and low-flow situations, and in large-caliber and small-caliber vessels, based on need. Technological progress has led to a decreased size of delivery catheters, and an increase in safety due to release systems that permit the withdrawing and replacement of embolization material. Furthermore, bioactive embolization materials have been developed to increase the efficacy of embolization or the biological effect of medication. Finally, materials have been modified for changing indications. Intravascular stents were initially developed to keep an artery open; however, by adding a covering membrane, these stents can be used to occlude the wall of a vessel or other endoluminal structures. This article gives an overview of the devices most utilized for occlusion of endoluminal structures, as well as their major purpose in the endovascular territory.

BACKGROUND—Some cirrhotic patients with tense ascites who undergo paracentesis develop a circulatory dysfunction syndrome, manifested by an increase in plasma renin activity. Recently, a significant inverse correlation between postparacentesis changes in plasma renin activity and systemic vascular resistance has been demonstrated in these patients, suggesting that peripheral arterial vasodilatation could be responsible for this circulatory dysfunction, but the mechanisms by which tense ascites removal induces such changes are unknown AIM—To investigate the role of a decrease in intra-abdominal pressure (IAP) in the development of early postparacentesis haemodynamic changes METHODS—Eleven cirrhotic patients with tense ascites received a large volume paracentesis. A specially designed pneumatic girdle was used to compress the abdomen to avoid a decrease in IAP during ascites removal. Haemodynamic studies were performed before paracentesis, one hour after ascites flow stopped, and 30 minutes after pneumatic girdle deflation RESULTS—When IAP was maintained at its original level, no haemodynamic changes were observed, despite large volume paracentesis. However, a significant decrease in systemic vascular resistance was seen immediately after pneumatic girdle deflation CONCLUSIONS—Early haemodynamic changes after paracentesis are avoided if IAP is maintained at its original level. The abrupt decrease in IAP could be the trigger for the development of the initial haemodynamic changes that eventually produce postparacentesis circulatory dysfunction. Keywords: cirrhosis; ascites; postparacentesis circulatory dysfunction; haemodynamic changes; intra-abdominal pressure

This experiment was conducted to evaluate efficacy and safety of the Oasis thrombectomy catheter on arterial thrombosis in dogs.Thrombosis was induced in 18 femoral arteries of nine mongrel dogs. Recanalization of the thrombosed femoral artery was performed using a thrombectomy catheter 7-10 days after thrombus induction. Pre- and postprocedural arterial status was documented by angiography. After mechanical thrombectomy, the animals were sacrificed and the femoral arteries were harvested and examined macro- and microscopically. Additionally, in vitro fragmentation was carried out to determine particle size and distribution from the recovered effluent.Subacute thrombosis was successfully created in 15 femoral arteries. Full recanalization was achieved in 80% (12/15) of the thrombosed femoral arteries without any residual thrombus. No significant downstream embolization was documented angiographically. Endothelial denudation was observed in all the treated arteries along with occasional disruption of the internal elastic lamina. No medial injury was seen. Ninety-eight percent of thrombus was liquefied, defined as particles smaller than 15 microm, by the catheter. Particles larger than 400 microm represented 0.27% of the original clot weight.Occluded femoral arteries with 7- to 10-day-old thrombus can be efficiently recanalized with the Oasis catheter in dogs without any significant complication. This thrombectomy catheter appears to be highly effective and safe and requires no sophisticated equipment. Blood loss was our major concern regarding use of this catheter but can be minimized by strictly controlling activation time and restricting the inflow into the vascular segment being treated.

Rationale and Objectives. The purpose of the study was to evaluate a method of producing obstruction of the common bile duct and concomitant biliary duct dilatation in an animal model. Materials and Methods. Laparoscopic placement of a double-balloon occlusion device was used to produce common bile duct obstruction and bile duct dilatation in pigs. Results. One week after the procedure, common bile duct obstruction and dilatation of the biliary tree were demonstrated with either percutaneous transhepatic cholangiography or percutaneous cholecystography. Conclusion. The use of this method is technically feasible and provides a useful subacute and chronic animal model of common bile duct obstruction and dilatation of the biliary tree for percutaneous interventional training and research purposes.

C arcinomas of the colon and recturn are common in the United States; the estimated annual mcidence is more than I 50,000 new cases [1]. The incidence of obstruction in patients with colonic carcinoma ranges from 7% to 29% [1, 2]. Patients with acute obstruction of the left-sided large bowel pose a challenging medical problem. Emergency surgery in a patient with an unprepared colon is associated with high morbidity and mortality rates [3]. The traditional surgical management of leftsided malignant large-bowel obstruction consists of a two-stage operation (Hartmann’s procedure) that includes primary tumor removal and end colostomy with a subsequent colostomy closure [4, 5]. Approximately 25% of patients undergoing the staged surgeries do not undergo colostomy closure because they are unfit for surgery or refuse further operation [4]. Colostomy closure is not a simple procedure; the morbidity is as high as 37% and the mortality rate is around 7% [4]. Recently, some authors have promoted a single-stage procedure that includes either subtotal colectomy or segmental resection with intraoperative irrigation and primary closure [4, 5]. Although primary resection with immediate anastomosis offers the potential advantages of shortening the hospital stay, reducing the morbidity and mortality rates, and avoiding the colostomy, this option has not found widespread acceptance because of the complexity of the on-table irrigation, which significantly prolongs the operation time. Subtotal colectomy imposes technical challenges in the dissection of the whole obstructed colon and carries the risk of diarrhea or fecal incontinence, particularly in elderly patients [4]. The technical aspects of these operations demand considerable experience in colonic surgery [4, 5]. Metallic stents have been recently used in the treatment of acute malignant colonic obstruction [6]. Metallic stent placement is an interesting alternative that can provide an effective, nonsurgical decompression of the obstructed left-sided large bowel to avoid an emergency colostomy [6]. Once the medical condition of the patient is improved after the colonic decompression, disease staging and colonic cleansing may take place in preparation for an elective single-stage surgery. In patients with inoperable tumors, the placement of these metallic stents offers a potentially effective palliation without the need for a permanent colostomy (Fig. 1). The initial experience with this procedure has been encouraging, with a high

ResumenObjetivoEl objetivo de este estudio fue conocer las concentraciones de los macroelementos magnesio y fósforo, y de los elementos traza arsénico, boro, litio, cesio, rubidio, estaño y estroncio, en orina de sujetos sedentarios y deportistas, que viven en la misma región.MétodoSe analizó la concentración urinaria de los metales descritos antes. La muestra estaba constituida por un grupo de 21 atletas de fondo y un grupo control formado por 26 sujetos sedentarios. Se registraron medidas antropométricas, la frecuencia cardíaca y la presión arterial en reposo. Fueron sometidos a una prueba de esfuerzo para determinar la frecuencia cardíaca máxima, el consumo máximo de oxígeno, la ventilación pulmonar y el cociente respiratorio. Se tomaron muestras de la primera orina de la mañana de todos los sujetos.ResultadosLos atletas presentaron valores significativamente inferiores (p

Computer-based technology has been sufficiently developed in medical training and education. However, as well as in other areas (flight pilots, nuclear energy operators, drivers, etc.) this technology has been included in other educational plans, in medicine it is a pending task yet. We present our work on the introduction of computer-based technology, mainly virtual simulation, into the university teaching plans at University of Las Palmas Medical School, the medicine residency programme and the update of physicians at the four Teaching Hospitals in Canary Islands. Through the realization of virtual simulation courses we have managed to introduce the technology into the health environment as an educational tool. Using commercial haptics devices and customizing and adapting its software, we have developed custom curricula for several medicine specialities.