Search

A case of a new technique for branched endovascular aneurysm repair with a retrograde approach and ostial stenosis of the target vessel is reported. An angioplasty balloon was placed within the target vessel and used to give added stability to catheter advancement to place the stiff guidewire needed for placement of a bridging stent graft. In brief, a standard guidewire was first placed inside the target vessel through the retrograde approach. Next, the balloon was placed from outside the stent graft, again through a contralateral retrograde approach. Then, the angioplasty balloon was inflated, and a support catheter was advanced to the balloon and then slowly deflated to allow the catheter to advance. Finally, the stiff guidewire was placed. Subsequently, the bridging stent was placed and deployed. This technique is feasible and can be used in selected cases to use a retrograde approach when ostial stenosis of the target vessel is present.

Diagnostics of Multiple Sclerosis (MS) are essentially based on the gold standard magnetic resonance imaging. Few alternative simple assays are available to follow up disease activity. Considering that the disease can remain elusive for years, identification of antibodies fluctuating in biological fluids as relevant biomarkers of immune response is a challenge. In previous studies, we reported that anti- N -glucosylated ( N -Glc) peptide antibodies that can be easily detected in Solid-Phase Enzyme-Linked ImmunoSorbent Assays (SP-ELISA) on MS patients' sera preferentially recognize hyperglucosylated adhesin of non-typeable Haemophilus Influenzae . Since multivalency can be useful for diagnostic purposes to allow an efficient coating in ELISA, we report herein the development of a collection of Multiple N -glucosylated Peptide Epitopes ( N -Glc MEPs) to detect anti- N -Glc antibodies in MS. To this aim, a series of N -Glc peptide antigens to be represented in the N -GlcMEPs were tested in competitive ELISA. We confirmed that the epitope recognized by antibodies shall contain at least 5-mer sequences including the fundamental N -Glc moiety. Using a 4-branched dendrimeric lysine scaffold, we selected the N -Glc MEP 24 , carrying the minimal epitope Asn(Glc) anchored to a polyethylene glycol-based spacer (PEG) containing a 19-atoms chain, as an efficient multivalent probe to reveal specific and high affinity anti- N -Glc antibodies in MS.

Portal hypertension, which is a common finding in children awaiting liver transplantation, is also found after transplantation. It's reported the case of a 6-year-old girl, transplanted for biliary atresia, who had a severe obscure-overt bleeding presenting with melena. An esophagogastroduodenoscopy showed several duodenal small, bulging lesions, with some red signs. Near the lesions, a depressed area of 2 cm, covered with mixed hyperemic and white mucosa, was observed. To better evaluate these lesions, we performed an endoscopic ultrasonography (EUS) that showed multiple, round hypoechoic areas 0.5-5 mm in diameter, compatible with duodenal varices, and several periduodenal anechoic lesions compatible with collaterals. A consecutive computed tomography scan showed a stenosis of the portal vein anastomosis confirmed with a transhepatic portography, which was successfully treated with balloon angioplasty. No further episodes of bleeding were observed during the follow-up. This case report suggests that EUS is safe and feasible in young children when using echoendoscopes designed for use in adults. However further studies are needed to validate the employment of this technique in the management and follow-up of pediatric portal hypertension.