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Infection is the most serious complication arising in long-term continuous ambulatory peritoneal dialysis (CAPD), specifically peritonitis and exit-site infection. The initial weeks after implantation is the crucial period during which bacterial colonization of the catheter results in maximal morbidity, with Staphylococcus aureus being the most virulent organism. We developed an antimicrobial-impregnated CAPD catheter by impregnating the cuff and tubing with chlorhexidine, silver sulfadiazine, and triclosan in a polymer matrix. The antimicrobial spectrum and duration were shown by measuring zones of inhibition to various bacteria and fungi over the course of 5 to 10 days. Activity also was assessed subsequent to soaking in trypticase soy broth containing 20% bovine serum over the course of 1, 3, and 7 days. Significant antimicrobial activity was shown against all organisms tested for, with particular efficacy against gram-positive bacteria. Catheters were implanted in rats followed by inoculation of the exit site with S aureus. Seven days postimplantation, 0% of the impregnated catheters were colonized intraperitoneally compared with 100% of the control catheters. Similarly, 12.5% of the impregnated catheters were colonized at the exit site, whereas 100% of the controls were colonized. Histologic analysis showed that this combination and concentration of antimicrobials did not retard healing or cause increased inflammation compared with control catheters after 3, 10, and 24 days postimplantation in noninoculated rats.

and previous conservative therapies (rest, anti-inflammatory drugs, corticosteroid injections, and physical therapy) applied for at least three months and persisted moderateto-severe pain (Visual Analog Scale 4 50) before treatments. Adverse events, changes in Visual Analog Scale scores of night pain and overall shoulder pain, changes in range of motion, and changes in American Shoulder and Elbow Surgeons (ASES) scores were assessed at 1 week and at 1, 3, and 6 months after the procedure. Results: Abnormal neovessels were identified at the rotator interval in all cases. No major or minor adverse events were related to the procedures. Transcatheter arterial embolization rapidly decreased nighttime pain scores from 66.6 12.9 mm to 26.7 13.4 mm at 1 week after the procedure, with further improvement at 1 and 6 months. ASES scores significantly improved from 18.9 4.6 to 40.8 12.6 at 1 month (P o .001), to 65.9 13.1 at 3 months (P o .001), and to 77.8 4.9 at 6 months (P o .001). Conclusion: Transcatheter arterial embolization of this lesion was feasible, effectively relieved unrelenting pain, and restored shoulder function.

Differences in gender, age and MELD scores of the two groups were statistically insignificant. The technical and hemodynamic success rates for the transplant group were 93% and 100% respectively. In the single patient with initial technical failure, TIPS attempt the following week was successful. Mortality rates at 6 and 12 months were higher in the transplant group, 25% vs. 15% (p 1⁄4 0.4) and 55% vs. 22% (p 1⁄4 0.025) respectively. There was lower primary patency at 3, 6, and 12 months in the transplant group, measuring 72% vs. 91%, 60% vs. 86%, and 45% vs. 81% respectively (p 1⁄4 0.022). There was lower primary assisted patency at 3, 6, and 12 months in the transplant group, measuring 89% vs. 99%, 76% vs. 97%, and 76% vs. 96% respectively (p 1⁄4 0.003). Clinical success was lower in the transplant group (50% vs. 83%, p 1⁄4 0.023). The transplant group had increased rate of HE requiring TIPS reduction (14% vs. 4%), although not statistically significant (p 1⁄4 0.112). Conclusion: There is lower efficacy of PTFE-covered TIPS in OLT patients compared with those with native livers. Despite high technical and hemodynamic success, there is increased mortality, decreased primary and primary assisted patency, and decreased clinical success.

The purpose of this project was to determine whether bacteriophage can reduce bacterial colonization and biofilm formation on central venous catheter material. Twenty silicone discs were inoculated for 24 h with broth culture of Methicillin sensitive staphylococcus aureus (0.5 McFarland standard). The inoculate was aspirated and discs placed into two equal groups for 24 h: (1) untreated controls; (2) bacteriophage treatment (staphylococcal bacteriophage K, propagated titer > 108). At the completion of the experiment discs were processed for quantitative culture. Statistical testing was performed using the rank sum test. Mean colony forming units (CFU) were significantly decreased in experimental compared with controls (control 6.3 × 105 CFU, experimental 6.7 × 101, P ≤ 0.0001). Application of bacteriophage to biofilm infected central venous catheter material significantly reduced bacterial colonization and biofilm presence. Our data suggests that bacteriophage treatment may be a feasible strategy for addressing central venous catheter staph aureus biofilm infections.

Purpose The purpose of our study is to identify histopathologic sequelae and immunohistochemical changes that occur in the wall of the gastric fundus, antrum, and proximal duodenum after bariatric embolization—a procedure to suppress systemic levels of the hunger hormone, ghrelin, and modulate weight. Materials and Methods This post-necropsy study was performed on 12 swine stomach and duodenum specimens. 6 of the swine had previously undergone targeted bariatric embolization, and 6 other swine had undergone a sham procedure with saline. Gross pathologic examination of the stomach mucosa was performed post necropsy in all animals. In addition, contiguous tissue sections from 11 stomachs (fundus and antrum) and duodena were processed for HandE staining for histopathologic analysis. Mouse antighrelin IgG (Millipore, Billerica, MA) was used for immunohistochemical detection of ghrelin. Ghrelin-immunoreactive cell density was expressed as the average number of positive cells per high power field (400x, 0.49 mm field diameter). Results Histopathologic evaluation of treatment animals demonstrated mucosal ulceration in 2/6 (33%), and mild-moderate gastritis in 6 animals (100%). Control animals demonstrated mild-moderate gastritis in 5 animals (100%), with no ulceration. Ghrelin-immunoreactive mean cell density was significantly lower in the gastric fundus in the treatment animals 15.3, versus control animals, 22.0 (p=0.001). Ghrelin-immunoreactive mean cell density in the gastric antrum was similar in treatment animals, 9.3, versus control animals, 14.3 (p=0.075). Ghrelin-immunoreactive mean cell density in the duodenum was similar in treatment animals, 8.5, versus control animals, 8.6 (p=0.89). Conclusion Bariatric embolization can result in gastric mucosal ulceration as complications were seen in 33% of treated animals in the form of gastric ulcers, possibly due to non-target embolization. Immunohistochemical staining of the gastric fundi, antrums, and duodena confirms a significant reduction in the number of ghrelin-immunoreactive cell density in the gastric fundus after embolization. Furthermore, there is no compensatory upregulation of ghrelin-expressing cells in the gastric antrum or duodenum of treated animals.

Purpose Bacteriophages are viruses that selectively infect and kill bacteria. The purpose of this project was to determine whether a bacteriophage antimicrobial lock technique can reduce bacterial colonization and biofilm formation on indwelling central venous catheters in a rabbit model. Materials and Methods This study was performed in 10 female New Zealand white rabbits (weight range 3-4 kg). Broviac catheters (4.2 French, BARD access systems, NJ) were inserted into the jugular vein under image guidance and tunneled in an intrascapular position. Catheters were then inoculated for 24h with broth culture of Methicillin sensitive staphylococcus aureus (0.5 McFarland standard). The inoculate was aspirated and rabbits were randomized into two equal groups for 24h: (i) untreated controls (heparinized saline lock), (ii) Bacteriophage antimicrobial-lock (Staphylococcal Bacteriophage K, propagated titer > 10 8 ). At the completion of the experiment blood cultures were obtained via peripheral veins, the catheters were removed for quantitative culture and scanning electron microscopic analyses, and the animals were sacrificed. Statistical testing for substantial differences in distal catheter segment colonization was carried out using the rank sum test. Results Mean distal catheter segment colony forming units (CFU) per cm 2 as a measure of biofilm was significantly decreased in experimental animals compared to controls (control 1.2 × 10 5 CFU/cm 2 , experimental 7.58 × 10 3 , P=0.016). Scanning electron microscopic analysis of the catheter segments demonstrated qualitative reduction of biofilm in treated catheter segments compared to untreated controls. Blood culture results were not significantly different between the groups (control 3/5 positive (60%), experimental 4/5 positive (80%), (p=1.0). Conclusion In a rabbit model, treatment of infected central venous catheters with a bacteriophage antimicrobial-lock technique significantly reduced bacterial colonization and biofilm presence. Our data suggests that bacteriophage lock solution may be a feasible strategy for prevention and treatment of central venous catheter infections.

Purpose To determine the difference in hepatic venous pressures measured with the use of an end-hole diagnostic catheter versus a balloon catheter. Materials and Methods A total of 92 patients underwent transjugular hepatic venous pressure measurements with a 5-F diagnostic end-hole catheter and a balloon catheter, with the catheter type used initially determined randomly. With both catheters, free and wedged systolic, diastolic, and mean pressures were collected. Hepatic venous pressure gradients were calculated from each pressure set. Eighty-five patients (92%) also underwent concurrent transjugular biopsy after pressures were recorded. Demographic, histologic, and specific procedural information were also collected. Results The study included 47 men and 45 women, with a mean age of 52.7 years (range, 19–84 y). For the entire population, there were statistically significant differences in mean measurements between the two catheters in wedged systolic ( P = .004), diastolic ( P = .021), and mean ( P = .036) pressures. However, the differences between the means were only 0.783, 0.609, and 0.207 mm Hg, respectively. A subanalysis based on histologic stage revealed no difference between catheter types for normal or cirrhotic livers, but a significant ( P = .017) difference in systolic wedged pressure (absolute difference of 0.67 mm Hg) in patients with mild to moderate fibrosis (stages 1–3). In all differences, the balloon catheter had the greater pressure reading. Conclusions There was a significant difference in wedged pressure measurements between the two catheter systems in the overall population and among patients with a histologic grade indicating fibrosis. However, the absolute value differences between the two systems were comparatively small (

Embolization of the left gastric artery with the intent of decreasing hunger, termed bariatric embolization, has experienced a recent surge of attention in the literature and at medical conferences. This endovascular treatment for obesity has demonstrated promising data as a potentially new and effective minimally invasive treatment for obesity. The goal of this review article is to discuss the background, rationale, and existing data on this new topic.

Purpose: To determine whether exclusion of pseudoaneurysms with the use of a covered stent in prosthetic arteriovenous (AV) hemodialysis access grafts impacts the incidence of eventual AV graft infection. Materials and Methods: Review of an interventional radiology database for prosthetic AV graft interventions involving stent deployment anywhere within the AV graft circuit revealed 235 interventions in 174 patients between November 2004 and December 2008. Incidence of AV graft infection was analyzed based on stent type (bare metal vs covered), location, and indication for stent deployment on a per-stent, per-procedure, and per-graft basis. Results: A total of 16.3% of the stent-implanted AV grafts were eventually surgically excised as a result of graft infection. Covered stents used to treat an intragraft pseudoaneurysm were more commonly associated with subsequent graft infection compared with bare or covered stents deployed within the graft for other reasons: 42.1% versus 18.2% (P .011). Stents deployed in an intragraft location were also associated with a higher incidence of graft infection compared with those deployed at the venous anastomosis or outflow vein: 26.9% versus 6.9% (P .001). No significant difference was identified in infection rates between bare and covered stents. Conclusions: Covered stent exclusion of intragraft pseudoaneurysms demonstrated a significant correlation with eventual prosthetic AV graft infection.