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Objectives This report aims to review the management and outcomes of Brucella-associated mycotic aortic aneurysms. Methods This is a retrospective chart review at a tertiary-level healthcare system. IRB approval was waived per policy. Results We describe a case of Brucella aortitis acquired from habitual contact with wild hogs. Clinical presentation included lower back pain and elevated white blood cell count. Diagnosis was confirmed with imaging showing an infrarenal abdominal aortic aneurysm and serology revealing elevated Brucella antibodies titers. The patient was initially managed with endovascular aortic repair and combined oral and intravenous antibiotics therapy. He then underwent explanation and extra-anatomical bypass due to symptomatic periaortic infection and interval development of type I endoleak. The patient was asymptomatic after his final operation at 24 months of follow-up and remained on suppressive oral antibiotic therapy. Conclusions An aortic aneurysm secondary to Brucella is a rare entity. A detailed history of long-term exposure to animals may be a clue to obtain serologic testing. Operative debridement and re-establishing of reliable blood flow combined with long-term antibiotic suppression are the mainstay of treatment.

This is a report of an iatrogenic inferior vena cava (IVC) segmental resection and reconstruction utilizing bovine pericardium. A 48-year-old female patient presented for a planned right nephrectomy by the urology service secondary to xanthogranulomatous pyelonephritis. This was complicated by inadvertent resection of an 8 cm segment of the infrarenal IVC. Postoperatively, the patient did not tolerate IVC ligation due to severe lower extremity edema. She then underwent reconstruction with a bovine pericardium conduit as an interposition graft. The post-operative course was complicated by pulmonary embolism requiring percutaneous intervention. This report addresses the utility of bovine pericardium for IVC reconstruction in an infected field.

The purpose of this paper is to explore the emerging themes within the discipline of retail design. The advent of multiple channels within the physical retail channel (showrooms, kiosks) and digital retail (mobile applications, e-commerce marketplace) pose challenges in the form of consistency of communication of brand identity and values. The research is a combination of thematic maps and qualitative interview techniques. Purposive sampling was considered for the selection of participants. In total 45 interviews have been taken of the various stakeholders – retailers, retail designers, communication designers and customers. Three broad themes emerged from the analysis- Technology, Design Elements and Communication, each having a number of sub-themes. 1. The themes that have emerged are based on views of minor representative of each category 2. Interviews from the social media and ecommerce marketplaces could have been taken. This can be the future research area. 1. The effects of deployment of AR/VR, 3D on the consumer decision-making is still not fully realized by the designers. 2. The consistency in brand imagery across channels can act as market differentiator. 3. The marketing communication managers should seek to enhance brand salience 4. The integration of customer data across various touchpoints (Big data) will be a distinguishing feature in near future. 5. Not all social media platforms are equal in creating and sustaining brandstorm and e-wom (word of mouth). This study is an attempt to make contribution in the area of retail design in the multichannel retail ecosystem. The themes that emerge out of the study are expected to assist in developing the framework wherein the brand image can be communicated consistently across channels.

BACKGROUND: In spite of general decline worldwide, off-pump coronary artery bypass grafting (CABG) surgery is performed in more than 60% of patients undergoing CABG in India; mainly because of shorter operative time and reduced procedure cost. However, paucity of data exists in literature about early outcomes following off-pump CABG from India. METHODOLOGY: We conducted a prospective observational study of 800 consecutive cases that underwent off-pump CABG (OPCAB) from August 2015 to October 2017. Primary end point of the study was the 30-day/in-hospital mortality from any cause. RESULTS: On multivariate analysis, emergency surgery (OR 9.72; CI 1.96–48.21, p value 0.005), severe left ventricular dysfunction (OR 2.28; CI 1.25–4.76, p value 0.026), postoperative atrial fibrillation (OR 9.95; CI 3.12–32.01, p value 0.05), and dialysis-dependent renal failure (OR 29.7, CI 10.02–87.99, p value 0.006) were the factors associated with mortality. The observed mortality was 1.6%, and the expected mortality by EuroSCORE II was 2.6%. The median EuroSCORE II of expired patients was 3.03 and of entire cohort was 1.54 (p value 0.001). Stroke rate was 0.9%. Deep sternal wound infection occurred in 0.9%, and 3.8% patients were readmitted to the hospital after discharge. CONCLUSION: Early outcome of off-pump CABG was excellent in this study. Increased incidence of deep sternal wound infection remains a concern. Multicenter study with a larger sample size is required for a dependable evaluation of the efficacy of off-pump CABG in Indian population.

Coil migration into the colon is an extremely rare complication of aneurysm embolization and only three cases have been reported. Two of these cases were managed with resection of the involved colon and the remaining case was managed with serial imaging. We present a 70-year-old man who developed hematochezia two years after coil embolization of a ruptured left hypogastric artery aneurysm. The patient was successfully treated with diverting colostomy and endoscopic closure of the sigmoid colon defect. We present the only case report of the use of advanced endoscopy to treat endovascular coil migration.

We report a case of mycotic thoracic aortic aneurysm managed by staged hybrid repair. A 30-year-old male patient with polysubstance abuse presented with chest pain and elevated white blood cell count. CTA performed showed a rapidly developing mycotic thoracic aortic pseudoaneurysm. He underwent emergent thoracic endovascular aortic repair followed 24 hours later by surgical debridement of the posterior mediastinum. Cultures grew Methicillin-resistant Staphylococcus aureus and patient was placed on long term antibiotics. The patient was asymptomatic on follow up one year after his final operation with complete exclusion of pseudoaneurysm with no endoleak.

Susceptibility to weld solidification cracking in transformation-induced plasticity steel sheets was studied using a modified standard hot cracking test used in the automotive industry. To vary the amount of self-restraint, bead-on-plate laser welding was carried out on a single-sided clamped specimen at increasing distances from the free edge. Solidification cracking was observed when welding was carried out close to the free edge. With increasing amount of restraint, the crack length showed a decreasing trend, and at a certain distance, no cracking was observed. With the aid of a finite element-based model, dynamic thermal and mechanical conditions that prevail along the transverse direction of the mushy zone are used to explain the cracking susceptibility obtained experimentally. The results indicate that the transverse strain close to the fusion boundary can be used as a criterion to predict the cracking behavior. The outcome of the study shows that optimum processing parameters can be used to weld steels closer to the free edge without solidification cracking.

Like all physicians, radiologists in the United States are subject to frequent and costly medical malpractice claims. Legal scholars and physicians concur that the US civil justice system is neither precise nor accurate in determining whether malpractice has truly occurred in cases in which claims are made. Sometimes, this inaccuracy is driven by biases inherent in medical expert-witness opinions. For example, expert-witness testimony involving "missed" radiology findings can be negatively affected by several cognitive biases, such as contextual bias, hindsight bias, and outcome bias. Biases inherent in the US legal system, such as selection bias, compensation bias, and affiliation bias, also play important roles. Fortunately, many of these biases can be significantly mitigated or eliminated through the use of appropriate blinding techniques. This paper reviews the major works on expert-witness blinding in the legal scholarship and the radiology professional literature. Its purpose is to acquaint the reader with the evidence that unblinded expert-witness testimony is tainted by multiple sources of bias and to examine proposed strategies for addressing these biases through blinding.

Hemodialysis Reliable Outflow (HeRO) grafts (Merit Medical Systems, Inc, South Jordan, Utah) provide a means for access in catheter-dependent hemodialysis patients but typically require several weeks for tissue incorporation. Modifying the HeRO graft with an ACUSEAL graft (W. L. Gore & Associates, Newark, Del) can allow immediate cannulation, thus reducing catheter dependence time and its associated complications. A retrospective review of patients at our institution from 2013 to 2016 who underwent placement of a modified HeRO dialysis system with ACUSEAL graft was performed. Complications and outcomes were analyzed, with patency rates and hours to successful cannulation being major end points. Modified HeRO grafts were successfully placed in 10 catheter-dependent patients. Postoperative complications included two thromboses and one hematoma. At 6 months of follow-up, mean time to graft cannulation was 33.7 hours, with 100% success; the primary and secondary patency rates were 70% and 90%, respectively. Our modification allows an accelerated use of the HeRO system, reducing catheter dependence time with acceptable postoperative complications and patency rates.

Insect pheromonal glomeruli are thought to track the fine spatiotemporal features of one or a few odorants to aid conspecific localization. However, it is not clear whether they function differently from generalist glomeruli, which respond to many odorants. In this study, we test how DA1, a model pheromonal glomerulus in the fruit fly, represents the spatial and temporal properties of its input, compared with other glomeruli. We combine calcium imaging and electrical stimulation in an isolated brain preparation for a simultaneous, unbiased comparison of the functional organization of many glomeruli. In contrast to what is found in other glomeruli, we find that ipsilateral and contralateral stimuli elicit distinct spatial patterns of activity within DA1. DA1's output shows a greater preference for ipsilateral stimuli in males than in females. DA1 experiences greater and more rapid inhibition than other glomeruli, allowing it to report slight interantennal delays in stimulus onset in a “winner-take-all” manner. DA1's ability to encode spatiotemporal input features distinguishes it from other glomeruli in the fruit fly antennal lobe but relates it to pheromonal glomeruli in other insect species. We propose that DA1 is specialized to help the fly localize and orient with respect to pheromone sources.

Surgical revascularization of the upper extremity is uncommon, comprising only 4 to 18 per cent of all vascular surgical interventions. Patients with renal failure have higher rates of atherosclerotic cardiovascular and peripheral arterial disease resulting from chronic inflammation, endothelial damage associated with hemodialysis, and vascular trauma. Upper extremity arterial disease with chronic ischemia may be underrecognized in these patients. We reviewed our experience with upper extremity revascularization in patients with renal failure presenting with chronic ischemia. Four patients with longstanding chronic kidney disease developed chronic severe ischemia affecting the forearm or hand. All had previous dialysis access in the symptomatic arm, although none had a functional ipsilateral access at the time of presentation. All patients had successful revascularization with resolution of symptoms and patent bypass grafts at follow up. There was one death 4 months postoperatively and one patient has not returned for follow up. Patients with renal failure with symptomatic upper extremity arterial occlusion should be considered for revascularization of the infrabrachial arteries.

Objective Data from multicenter studies support observation of small abdominal aortic aneurysms (AAAs) over open repair (OR), but the role of endovascular repair (EVAR) is unclear pending outcome of the Positive Impact of EndoVascular Options for Treating Aneurysm earLy (PIVOTAL) trial. Our goal was to predict the outcome of the trial by comparing results of small AAA repair using EVAR vs OR at a tertiary institution. Methods Using selection criteria of PIVOTAL trial, we reviewed clinical data of 194 consecutive patients, who underwent EVAR or OR for 4.0-5.0 cm AAAs between 1997 and 2004. All-cause and aneurysm-related deaths, complications, reinterventions, ruptures, and conversions were documented; factors affecting outcome were analyzed using χ 2 tests, Wilcoxon rank-sum tests, logistic regression Kaplan-Meier method with log-rank tests, and Cox proportional hazards regression. Median follow-up was 3.9 years (range, 1 month to 9 years). Results A total of 194 patients, 162 males, 32 females (mean age: 71 years, range, 46-86) underwent 162 OR and 32 EVAR. EVAR patients were older (mean 74 ± 6 vs 71 ± 7, P = .002), had lower ejection fraction (mean 54 ± 11 vs 61 ± 13, P = .0002), and less likely to have ever smoked (69% vs 85%, P = .03) than OR patients. Thirty-day mortality was 1.3% (2/162) for OR and 0% for EVAR (0/33) ( P = not significant [NS]). There were 49 systemic complications (7 EVAR, 42 OR, P = NS) and 10 local complications (3 EVAR, 7 OR, P = NS). During follow-up, there were no conversions and no ruptures. Freedom from reinterventions at 5 years was 83.1% ± 6.9% for EVAR and 95.3% ± 1.8% for OR ( P = 0.02). There were 26 deaths (3 EVAR, 23 OR); but no procedure or aneurysm-related death was confirmed after 30 days (cause unknown in 16 deaths, 62%). Survival rates at 1-year were 96.6% ± 3.4% for EVAR and 97.4% ± 1.3% for OR; 5-year rates were 86.9% ± 7.2% ± EVAR and 86.9% ± 3.3% for OR ( P = 0.69). Multivariate analysis revealed age (hazard ratio=1.1 per year, P = .0496) and AAA size (hazard ratio=13.8 per 1 cm, P = .03) were associated with death but EVAR vs OR was not ( P = .23). Conclusion For repair of small AAAs, results of EVAR vs OR are not different at 5 years at a tertiary institution. Multicenter studies confirmed OR were not superior to observation in these patients. We predict the PIVOTAL study will conclude EVAR is not superior to observation.

Our objective was to test vibrometry as a means to measure changes in aneurysm sac pressure in an in vitro aneurysm model. Explanted porcine abdominal aortas and nitrile rubber tubes were used to model an aneurysm sac. An ultrasound beam was used to vibrate the surface of the aneurysm model. The motion generated on the surface was detected either by reflected laser light or by a second ultrasound probe. This was recorded at different aneurysm pressures. The phase of the propagating wave was measured to assess changes in velocity and to see if there was a correlation with aneurysm pressure. The cumulative phase shift detected by laser or Doppler correlated well with increasing hydrostatic pressure in both the rubber and the porcine aorta model. The square of the mean pressure correlated well with the cumulative phase shift when dynamic pressure was generated by a pump. However, the pulse pressure was poorly correlated with the cumulative phase shift. Noninvasive measurement of changes in aortic aneurysm sac tension is feasible in an in vitro setting using the concept of vibrometry. This could potentially be used to noninvasively detect wall stress in native aneurysms and endotension after endovascular aneurysm repair (EVAR) and to predict the risk of rupture.

Iatrogenic aortic injuries after spinal surgery have been described, but are rare. We describe a case of a 77-year-old woman who underwent surgical correction of a debilitating spinal deformity at an outside institution. Postoperative thoracic spine radiographs and computed tomography scans revealed a misplaced pedicle screw at T5, which was impinging on the descending thoracic aortic wall. The patient was brought to the operating room, where a thoracic stent graft was deployed under fluoroscopic guidance as the malpositioned screw was manually retracted. The patient had an uneventful postoperative course, and was discharged within 24 hours. This case represents a rare but potentially morbid vascular complication of spinal instrumentation surgery that was successfully treated without the need for thoracotomy.

Objective Persistent aneurysm perfusion or endoleak is associated with pulsatility of abdominal aortic aneurysm (AAA) after endovascular repair. However, the resultant pulsatile change in aneurysm diameter may be difficult to quantify, and therefore its significance is unknown. In this study cine magnetic resonance angiography (MRA) was used to quantify aneurysm wall motion during the cardiac cycle and to correlate it with the presence and type of endoleak. Methods Cine MRA was performed in 16 patients undergoing endovascular repair of AAA. A 1.5 T magnet and post-processing with GEMS 4.0 Fiesta computerized video image analysis software were used to calculate maximum aortic diameter during systole and diastole. Changes in aortic diameter were determined from these measurements. Cine MRA was performed on aneurysms before treatment and in patients with and without endoleak after endovascular repair. Type of endoleak was confirmed at angiography in all cases. Four patients had antegrade (type I) endoleak, and eight patients had retrograde (type II) endoleak; no endoleak was present in four patients. Endovascular grafts with stent support throughout the entire length of the graft (Talent) were used in all cases (14 bifurcated grafts, 2 tube grafts). Results Cine MRA demonstrated significantly greater wall motion and resultant change in aneurysm diameter in patients with type I endoleak compared with patients without endoleak (type I, 2.14 ± 1.28 mm vs no endoleak, 0.12 ± 0.09 mm, P = .001). Change in aneurysm diameter in patients with type II endoleak was not significantly greater than in patients with no endoleak (type II, 0.26 ± 0.21 mm vs no endoleak, 0.12 ± 0.09 mm, P = NS). Untreated aneurysms demonstrated the greatest change in diameter during the cardiac cycle (3.51 ± 0.79 mm). Conclusion Cine MRA may be used to accurately quantify AAA wall motion before and after endovascular stent-graft treatment. The extent of change in diameter corresponds to the type of endoleak, with antegrade (type I) endoleak generating greater pulsatile change in diameter than retrograde-collateral (type II) endoleak or no endoleak. Cine MRA may provide a noninvasive means of assessing the success of endovascular treatment of AAA. Further studies will be necessary to confirm the utility and efficacy of cine MRA in postoperative assessment of endovascular aneurysm repair.

A standard methodology in systems neuroscience is to establish correlations between the brain and the world. These correlations have been robustly observed when probing the activity of single neurons. For example, there are cells that activate vigorously when subjects are presented with images of certain celebrities (e.g. the "Jennifer Aniston" neuron, Quiroga et al., 2005). While single neuron measurements provide remarkable insights into the functional specificity of different brain areas, it remains unclear how single cell activity arises from, and contributes to, the collective activity of brain networks. New technologies allow for the simultaneous recording of spikes from hundreds of cells, yet we are still far from observing entire neuronal circuits in action. An alternative approach in monitoring neuronal populations is to measure local field potentials (LFPs). These potentials arise from the coordinated activity of thousands of nearby neurons. LFPs often exhibit oscillations of various frequencies, which correlate with different states of awareness, such as alertness, relaxation, or drowsiness. However, establishing correlations between LFPs and specific behavioral events can be challenging, because the contributions of different neurons to the LFP usually cannot be distinguished. In this chapter, we examine LFPs recorded from the rat hippocampus. At first glance, these LFPs appear to bear little relation to the subject's changing environment. However, through appropriate signal processing, we find that carried in the structure of the LFP is a remarkably precise stream of information.

Purpose: To review the outcomes of retrograde supra-aortic vessel stent (RSAS) placement combined with open carotid or subclavian artery revascularization. Methods: Retrospective review of all consecutive patients between 1995 and 2010, excluding transfemoral procedures or isolated retrograde stent placement. Results: There were 11 patients (9 females, mean age 65 years). Open revascularization included carotid endarterectomy in 6 patients, carotid-subclavian bypass in 3, and carotid-carotid bypass in 2 patients. There were no operative deaths or neurological events. All symptomatic patients improved. Over a mean follow-up of 24 months, One patient developed common carotid artery (CCA) in-stent dissection and symptomatic restenosis treated with subclavian-carotid bypass. Another 3 patients had asymptomatic restenosis of the carotid bifurcation but required no intervention. Conclusions: Retrograde stenting of the common carotid or innominate artery is a safe and effective method to provide inflow in selected patients with severe supra-aortic vessel disease who require concomitant open carotid or subclavian artery reconstructions.

This report is the first to describe the clinical, radiographic, operative, and pathologic findings associated with large, bilateral dorsalis pedis artery true aneurysms in a single patient. A 61-year-old African American woman complained of difficulty in wearing shoes. She had a moderately firm, nontender, pulsatile mass on the dorsum of her right foot. Computed tomography and angiography confirmed dorsalis pedis artery aneurysm with sufficient collateralization. She underwent resection without reconstruction. Pathologic analysis revealed a true aneurysm (8 × 5.3 × 4.1 cm(3)) containing intralumenal thrombus. Treatment for small symptomatic and large dorsalis pedis artery aneurysms remains resection with or without reconstruction.

Isolated hypogastric artery aneurysms are extremely rare. A series of 12,000 autopsies reported in 1921 noted only 1 hypogastric aneurysm among 320 aneurysms identified. McLaren reported the first successful ligation of a hypogastric aneurysm in 1913. Since then, fewer than 100 cases of isolated hypogastric aneurysm have been reported in the English literature. Hypogastric aneurysms are often large and associated with significant morbidity and mortality secondary to compression of adjacent structures or rupture into the pelvis. They are technically challenging to repair due to their location deep in the pelvis and difficulty in gaining distal control of the hypogastric artery and its branches.

A promising therapeutic approach to diminish pathological inflammation is to inhibit the synthesis and/or biological activity of macrophage migration inhibitory factor (MIF). Prior studies have shown that intraperitoneal administration of small-molecule inhibitors targeting the catalytic pocket of MIF (e.g., ISO-1) elicits a therapeutic effect in mouse inflammation models. However, it remains to be elucidated whether these tautomerase activity inhibitors block the synthesis and/or biological activity of MIF. In this study, we investigated and compared the activity of representative MIF inhibitors from isoxazole series (fluorinated analog of ISO-1; ISO-F) and substituted quinoline series (compound 7E; 7E). Our results demonstrate that ISO-F is a more potent MIF inhibitor than 7E. Both ISO-F and 7E do not inhibit MIF synthesis but "bind-onto" MIF thereby blocking its recognition. However, in contrast to 7E, ISO-F docks well in the active site of MIF and also has a stronger binding affinity towards MIF. In line with these observations, ISO-F, but not 7E, robustly inhibits the biological function of MIF. Most importantly, ISO-F, when administered orally in a therapeutic regimen, significantly suppresses dextran sulphate sodium (DSS)-induced murine colitis. This study, which provides mechanistic insights into the anti-inflammatory efficacy of ISO-F, is the first documented report of in vivo anti-inflammatory efficacy of a MIF inhibitor upon oral administration. Moreover, the findings from this study reinforce the potential of catalytic site of MIF as a target for eliciting therapeutic effect in inflammatory disorders. Compounds (e.g., ISO-F) that block not only the recognition but also the biological function of MIF are potentially attractive for reducing pathological inflammation.

Aim The aim of the study was to assess the outcome after esophageal replacement using gastric pull-up performed in critically ill neonates with esophageal atresia (EA) and tracheoesophageal fistula. Methods During 1998 to 2005, gastric transposition was performed in 27 neonates (mean birth weight, 2.32 kg [1.86-3.0 kg]; mean age, 6.08 days) for post–EA and tracheoesophageal fistula leaks in 17, long gap in 6, and pure EA in 4, using transhiatal route in all. Pyloromyotomy as the drainage procedure was added for all 27 neonates. Patients were followed up at 3, 6, and 12 months for clinical evaluation, gastric clearance, duodenogastric reflux, and gastric pressure profile. Results Six neonates had ongoing serious chest infection, 3 had lung collapse, and 2 had associated congenital heart disease. Postoperative elective ventilation was provided to all neonates for 2 to 40 days (mean, 10.6 days). Nine neonates developed postoperative leaks in the neck; all healed spontaneously before discharge. Mean hospital stay was 32.6 days (range, 9-87 days). Four newborns died on postoperative days 9, 13, 15, and 29 because of existing severe sepsis in 3 and major congenital heart disease in 1. Functional evaluations were done at 3, 6, and 12 months postoperatively. Values at 6 months revealed normal gastric emptying in 16 of 23, presence of duodenal gastric reflux in 11 of 23, and mass contractions with significant rise in intragastric pressure after bolus feeds in 16 of 23 cases. Values at 12months revealed normal gastric emptying in 14 of 20, presence of duodenal gastric reflux in 8 of 20, and mass contractions with significant rise in intragastric pressure after bolus feeds in 13 (65%) of 20cases. Conclusion Gastric transposition could be a lifesaving alternative to diversion, even in the critically ill newborns after major leaks. However, it requires technical surgical expertise and an effective pain relief and neonatal intensive care.

Transposition of the subclavian artery into the common carotid artery has been used commonly to treat proximal subclavian occlusions. The number of transposition operations has recently increased as part of the debranching procedure associated with placement of a thoracic endograft. The major advantage is the avoidance of a prosthetic graft and the excellent long-term results. Traditionally, the operation has been performed through a transverse neck incision. This report describes the technique of transposition through an oblique neck incision made along the anterior border of the left sternocleidomastoid muscles. The surgeon stands on the opposite side of the table. The approach gives exposure of a long segment of the common carotid artery and an excellent view and exposure of the most proximal segment of the subclavian artery. Division of the sternocleidomastoid muscle is avoided.

Background— Synthetic vascular grafts cannot be used in small vessels because of graft failure caused by thrombosis and neointima formation. Rapid endothelialization may overcome this limitation. We hypothesized that a magnetic graft would be able to capture and retain endothelial cells labeled with paramagnetic particles. Methods and Results— Porcine blood derived endothelial cells were allowed to endocytose superparamagnetic iron oxide microspheres. Cell survival was assessed by trypan blue exclusion and demonstrated a dose-dependent cell survival of 75% to 95%. A flexible magnetic sheet was annealed to the external surface of a knitted Dacron graft. Labeled cells (10 6 /mL) were placed within the graft for 5 minutes. Confocal and electron microscopy confirmed uniform cell capture at the magnetized surface. The effect of shear forces on the adherent cells was evaluated in a flow chamber. The cells remained attached at rates up to 300 mL/min, with cell loss commencing at 400 mL/min. Prototype magnetic grafts were implanted in porcine carotid arteries. Labeled cells were placed within the graft for 10 minutes at the time of implantation. The grafts were evaluated after one day and uniform cell coverage was noted on the magnetized surface. In comparison, relatively few labeled cells were seen attached to a nonmagnetized surface. Conclusions— Magnetic forces can be used to rapidly cover a vascular graft with paramagnetically labeled cells. This biophysical interaction is sufficient to retain cells in the presence of blood flow. Applications of this technique may include rapid endothelialization of synthetic vascular grafts and dialysis fistulas.

Background. Sclerosing stromal tumor of the ovary is a rare benign neoplasm that is usually unilateral in menstruating women with a mean age of 27. Case. An 11-year-old girl presented with asymptomatic bilateral sclerosing stromal tumor of the ovaries prior to menarche. We describe the clinical, radiologic and histologic findings with reference to other reported cases. Conclusion. We herein report a unique case of bilateral sclerosing stromal tumor of the ovaries arising in a premenarchal girl.

Hypothesis During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years. Design Retrospective case series. Setting Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery. Patients and Methods During a 5-year period, EVSG was performed in 595 patients at our institution. One hundred fifty (25.2%) of these patients were older than 80 years. Our prospectively acquired database was reviewed with respect to the demographic, intraoperative, and outcome data of this elderly population. Main Outcome Measures Technical and clinical success, aneurysm-related events (aneurysm-related death, type I or type III endoleaks, aneurysm expansion, or aneurysm rupture), and secondary interventions. Results There were 119 men (79.3%) and 31 women (20.7%) (mean age, 84.6 years). Mean aneurysm diameter was 6.7 cm. Comorbidities including chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency, peripheral vascular disease, hypertension, and hypercholesterolemia were common in these patients, with an average of 2.9 comorbid conditions per patient. Mean follow-up was 16.9 months (range, 1.0-61.4 months). One hundred forty-six patients (97.3%) received only regional anesthesia, and the average intraoperative blood loss was 369 mL. Average hospital and intensive care unit stays were 2.5 days and 0.1 day, respectively. The procedure was performed emergently in 3 patients, and each recovered uneventfully. There were 5 aborted procedures (3.3%) for technical reasons and 4 conversions to open aortic repair (2.6%). In addition to these aborted procedures, there were 2 additional technical failures resulting in a technical success rate of 95.3%. Endoleaks were common and included 9 type I (6.90%), 35 type II (24.10%), and 1 type III (0.69%). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7%) and 8 (5.3%) patients, respectively. There were 5 perioperative deaths (3.3%)( 30 days postoperatively) occurred, which were unrelated to the EVSG procedure. Conclusions Endovascular repair of abdominal aortic aneurysms can be performed safely and successfully in the majority of octogenarians with relatively low complication rates. Improved EVSG devices and operator experience may make this procedure the treatment method of choice for patients in this age group who meet specific anatomical criteria.

Objectives Endovascular stent-graft repair has great potential in treatment of thoracic aortic aneurysms. This study analyzed a single center's experience with first-generation commercially produced thoracic stent grafts used to treat descending thoracic aortic aneurysms. Methods Over 58 months 84 patients underwent endovascular stent-graft repair of descending thoracic aortic aneurysms; 22 patients received the Gore TAG stent graft, and 62 patients received the Talent thoracic endovascular stent-graft system. Each patient was enrolled in one of three distinct US Food and Drug Administration trials at Mount Sinai Medical Center in accordance with strict inclusion and exclusion criteria, including suitability for open surgery, aneurysm anatomy, and presence of comorbid medical illness. Mean age of this cohort was 71 ± 12 years. There were 54 men and 30 women, and 74 (88%) had three or more comorbid illnesses. Primary technical success was achieved in 76 patients (90%). Mean follow-up was 15 months (range, 0-52 months). Results Successful aneurysm exclusion was achieved in 69 patients (82%). Major procedure-related or device-related complications occurred in 32 patients (38%). There were six proximal attachment failures (8%), four distal attachment failures (6%), one intergraft failure (1%), two mechanical device failures (3%), five periprocedural deaths (6%), and five late aneurysm ruptures (6%). At 40 months, overall survival was 67% (±10%), and freedom from rupture or from type I or type III endoleak was 74% (±10%). Conclusion While promising, this midterm experience with commercially available devices highlights the shortcomings of current stent-graft technology. Three significant advancements are required to fulfill the potential of this important treatment method: a stent graft with a durable proximal and distal fixation device, enhanced engineering to accommodate high thoracic aortic fatigue forces, and a mechanism to adapt to aortic arch and visceral segment branches to enable treatment of lesions that extend to or include these vessels.

A parapagus set of male conjoined twins was brought to our institution at 12 h after birth. An extensive sharing of the abdominal viscera (single liver, hindgut), abdominal aorta, pelvis (single rectum and anus), genitalia (one set) and vertebral column was found. The surgical separation was not considered due to medical and ethical issues.