Pattern of arterial occlusion in Buerger's disease

The pattern of arterial occlusion in Buerger's disease was analyzed by simultaneous bilateral femoral arteriography in 210 limbs of 105 patients with Buerger's disease. In 55 limbs of 42 patients, the femoropopliteal segment was affected in addition to the infrapopliteal arterial obstructive lesion. The pattern of crural arterial occlusion was similar in about 40% of both the patients with femoropopliteal occlusion and the patients with crural occlusion. Toes were ulcerated in 4 of 58 limbs with continuous arterial flow, and ulceration occurred in 86 of 152 limbs with a discontinuous flow. The rate of occurrence of bilateral trophic lesion in the group with an arteriographically similar occlusion pattern was not significantly higher than that in the group with a different pattern. The pattern of arterial occlusion in Buerger's disease seemed to be fixed mainly within 1 year after the onset of symptoms, and the skip-lesion in the main artery was favorable to proximal progression of the disease.

Vascular reconstruction in Buerger's disease

In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thromboendarterectomy. To obtain long term patency of revascularaized segments, complete abstinence from tobacco is absolutely essential. The preparatory manoeuvres for antogenous venous graft should be as atraumatic as possible. A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.

Onset and clinicopathological course in Buerger's disease

From clinicopathological study, vasculitis of Buerger's disease seemed to start at small branch arteries and veins and progress to the trunk artery with thrombus. Progress of vascular lesions in trunk artery was gradual in general; the pathogenesis was briefly discussed.

Bone shortening of clavicular fractures: comparison of measurement methods

Background

The indication for operative treatment of clavicular fractures with bone shortening over 2 cm is much debated. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decision-makers. The aim of this study was to investigate if three commonly scientifically used measurement methods were interchangeable to each other.

Methods

A retrospective study using radiographs collected as part of a previous study on clavicular fractures. Two independent raters measured clavicle shortening on 60 patients using conventional radiographs on two separate sessions. The two measurement methods described by Hill et al. and Silva et al. were used on unilateral pictures. Side difference measurements according to Lazarides et al. were made on panoramic radiographs. The measurements were analyzed using intraclass correlation, Weir’s protocol for Standard error of measurement (SEM) and minimal detectable change (MDC), and Bland-Altman plots.

Results

None of the methods were directly interchangeable. The side difference method by Lazarides et al. was the most reliable of the three methods, but had a high proportion of post-fracture bone lengthening that indicated methodological problems. The Hill et al. and Silva et al. methods had high minimal detectable change, making their use unreliable.

Conclusion

As all three measurement methods had either reliability or methodological issues, we found it likely that differences in measurement methods have caused the differences in clavicular length observed in scientific studies.

Universal features of Nsp1-mediated translational shutdown by coronaviruses

Nonstructural protein 1 (Nsp1) produced by coronaviruses inhibits host protein synthesis. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Nsp1 C-terminal domain was shown to bind the ribosomal mRNA channel to inhibit translation, but it is unclear whether this mechanism is broadly used by coronaviruses, whether the Nsp1 N-terminal domain binds the ribosome, or how Nsp1 allows viral RNAs to be translated. Here, we investigated Nsp1 from SARS-CoV-2, Middle East respiratory syndrome coronavirus (MERS-CoV), and Bat-Hp-CoV coronaviruses using structural, biophysical, and biochemical experiments, revealing a conserved role for the C-terminal domain. Additionally, the N-terminal domain of Bat-Hp-CoV Nsp1 binds to the decoding center of the 40S subunit, where it would prevent mRNA and eIF1A accommodation. Structure-based experiments demonstrated the importance of decoding center interactions in all three coronaviruses and showed that the same regions of Nsp1 are necessary for the selective translation of viral RNAs. Our results provide a mechanistic framework to understand how Nsp1 controls preferential translation of viral RNAs.

Traumatic aneurysm of the abdominal aorta with acute thrombosis of bilateral iliac arteries

A traumatic aneurysm of the abdominal aorta resulting in acute peripheral thrombosis is rare. A 29-year-old man suffered a sudden occlusion of the terminal abdominal aorta and bilateral iliac arteries. An infrarenal abdominal aortic aneurysm was found, along with destruction of lumbar vertebrae and an aberrant renal artery. The pathogenesis of this false aneurysm was thought to be traumatic rather than inflammatory because the patient's history and laboratory findings showed no signs of inflammatory reactions. He had been in an automobile accident five years previously, resulting in lumbar vertebral injury. Arterial reconstruction and intraoperative perfusion of the aberrant renal artery were performed successfully. To our knowledge, our case is the seventh one reported in the English literature of a traumatic aneurysm of the abdominal aorta successfully repaired by surgery.

Measurement of blood pressure, blood flow and flow velocity in arterial reconstruction of the lower extremity

Seventy-five limbs of 66 patients undergoing arterial reconstruction of the lower extremity were studied. In 41 of 64 limbs that were not involved in early failure, API returned to normal immediately and the increased API was maintained as long as grafts remained patent. The limbs exhibiting a rise in API of 0.1 or more following proximal reconstruction in the cases with combined iliac and femoral arterial occlusion or bypass grafting to an isolated segment obtained marked improvement of symptoms. Postoperative increase in TPI was not so marked as in API, and TPI remained very low in the limbs with arterial obstructive lesions below the ankle after successful reconstruction. Early or late failure could not be predicted on the basis of preoperative or postoperative API, TPI or A-T gradient. In the limbs with no recovery of TPI, blood flow or flow velocity in the foot was of value predicting which limbs would be salvaged.

Fibrinolytic activity in cystic lesions of jaw bones

The fibrinolytic activity in the tissues of cystic lesions of jaw bones was investigated by the semiquantitative method of Astrup. The specimens examined were ameloblastoma (9 cases), follicular cyst (8 cases) and radicular cyst (14 cases). High fibrinolytic activity was observed in ameloblastoma, while in radicular cyst the activity was variable. It is suggested that in radicular cyst inflammatory episodes play an important role in activating local fibrinolysis, while in ameloblastoma the tissue itself has a great capacity to induce locally activated plasmin.

Arterio-venous fistula formation after hand replantation

Replantation of a completely severed finger, hand or arm is now performed with wide success. We now report an extremely rare complication of this replantation, an arterio-venous (A-V) shunt formation. Pathogenesis of the new A-V fistula formation is discussed.

THE PREVALENCE OF UNDERWEIGHT, OVERWEIGHT AND OBESITY IN A ROMANIAN POPULATION IN THE FIRST TRIMESTER OF PREGNANCY - CLINICAL IMPLICATIONS

Context

Underweight, overweight and obesity are important global public health issues and risk factors for adverse perinatal outcomes.

Objective

To assess the distribution of the body mass index (BMI) in the Romanian obstetric population in the first trimester of pregnancy and its correlation with pregnancy outcomes. We also report the distribution of blood pressure (BP) parameters and their correlation with BMI.

Design

This retrospective study includes 9,064 women attending routine first trimester visit and ultrasound scan at 12.8(±0.6) gestational weeks. Characteristics, parity, method of conception, blood pressure (from 3,650 women), maternal weight and height, BMI and foetal ultrasound were recorded. Pregnancy outcomes were available for 1,607 deliveries. The Pearson correlation coefficient was assessed for each BMI group vs. blood pressure parameters, gestational age and birth weight. ANOVA analysis and post hoc tests were used to determine group differences. Linear regression was applied to estimate the contribution of BMI and gestational age to birth weight variance.

Results

In our population, 66.37% pregnant women had a normal BMI, 19.29% were overweight, and 7.56% were obese. There was a weak-to-medium positive correlation between BMI and blood pressure parameters, for all weight categories. The correlation between maternal BMI and birth weight was positive for normal and overweight.

Conclusions

Our findings highlight the need for more effective health strategies targeting reduction of weight-related problems in women of childbearing age.

Patella fractures treated with suture tension band fixation

BACKGROUND

Patella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures.

METHODS

This technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution.

RESULTS

This technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material.

CONCLUSIONS

We believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

Universal features of Nsp1-mediated translational shutdown by coronaviruses

Nonstructural protein 1 (Nsp1) produced by coronaviruses shuts down host protein synthesis in infected cells. The C-terminal domain of SARS-CoV-2 Nsp1 was shown to bind to the small ribosomal subunit to inhibit translation, but it is not clear whether this mechanism is broadly used by coronaviruses, whether the N-terminal domain of Nsp1 binds the ribosome, or how Nsp1 specifically permits translation of viral mRNAs. Here, we investigated Nsp1 from three representative Betacoronaviruses - SARS-CoV-2, MERS-CoV, and Bat-Hp-CoV - using structural, biophysical, and biochemical assays. We revealed a conserved mechanism of host translational shutdown across the three coronaviruses. We further demonstrated that the N-terminal domain of Bat-Hp-CoV Nsp1 binds to the decoding center of the 40S subunit, where it would prevent mRNA and eIF1A binding. Structure-based biochemical experiments identified a conserved role of these inhibitory interactions in all three coronaviruses and showed that the same regions of Nsp1 are responsible for the preferential translation of viral mRNAs. Our results provide a mechanistic framework to understand how Betacoronaviruses overcome translational inhibition to produce viral proteins.

Long-term prognosis for reconstruction of arterial lesions due to arteriosclerosis

Out of 769 patients with arterial diseases, reconstructive surgery was performed on 100 limbs of 79 patients for arteriosclerosis. The overall patency rate was 59 per cent over a period of 3 to 8 years. Long-term patency was influenced by the condition of the run-off arteries, the site of the operation, and the method of surgery. No relation was found between patency rate and hypertension, cardiac insufficiency, total serum cholesterol, diabetes mellitus, or age. The survival rate was 62 per cent at 5 years and 48 per cent at 7 years. These rates were significantly poor (p less than 0.001), compared with those in the normal population. Mortality was related to the degree of hypertension, with cardiac and renal failure being responsible for 72 per cent of deaths. Aggressive reconstruction may be indicated in cases with hypertension of stage 2 or below based on the WHO classification. However, especially in patients with associated diabetes mellitus close long-term observation of the cardiovascular system is necessary.

Recurrence of the nephrotic syndrome in the renal isograft: A preliminary report

The fifth case of kidney transplantation between monozygotic twins in Japan is presented. Immediately after the transplanation the original disease, nephrotic syndrome, recurred but it was treated with steroids successfully. There have been few cases reported in which recurrence of the original disease in the isograft was treated successfully.

Involvement of the iliac artery in Buerger's disease (pathogenesis and arterial reconstruction)

Out of 216 patients with Buerger's disease, 14 showed the involvement of the iliac artery in addition to the occlusive lesion in the leg arteries. It occurred within 2 to 8 years after the onset of symptom. The obliterative lesion of the iliac artery might owe its cause to a direct proximal progression of thromboangitis obliterans of the femoral artery or to a skip progression of the disease. The skip lesion of the iliac artery might be due to an ascending progress of the thromboangiitic lesion in the branch arteries of the iliac artery. The indication for arterial reconstruction in the case with the involvement of the iliac artery depends on run-off in the deep femoral artery. Out of the 14 cases, 2 underwent thromboendarterectomy with autogenous vein patch grafting of the external iliac artery and 6 underwent bypass grafting, but their long-term follow-up result was poor.

Factors influenced on prognosis of reconstructive surgery for peripheral arterial occlusion: comparative study between arteriosclerosis obliterans and thromboangiitis obliterans

Reconstructive surgery was carried out in 93 patients of ASO and TAO. Factors influenced on prognosis were studied being compared with ASO and TAO. Cumulative 5-year patency was 60% in ASO and 25% in TAO. Distal patency was shown by total score given in each site of arteriogram. Patency rate was well correlated with combinated factors such as total score of arteriogram and back flow at site of surgery. Period from onset of symptom to surgery and site of operation also correlated with patency statistically, though total serum cholesterol, ischemic time at reconstructive surgery, and amount of bleeding at operation did not relate to prognosis. Causes of early failure and special problems of late failure in TAO were studied.

[Pharmaceutical preparations from plant products employed in stomatologic diseases]

Two preparations for stomatological use have been introduced, obtained from vegetal extracts of Ocimum basilicum L., Tilia sp., and Symphytum officinalis L. Their stability in time was evaluated, and the microbiological activity was assessed in vitro on microbial strains involved in stomatological affections. In clinical experiments good results were obtained in parodonthopathies, in the therapy of lesions developing under prostheses, and in other affections.

Treatment of ilio-femoral venous occlusion

During the past thirteen and a half years, 222 cases of iliofemoral venous occlusion were treated. Diagnosis was based mainly on clinical symptoms and phlebography. Surgery, injury, malignancy and heavy muscular exercise were the chief etiologic factors of this disease. As therapeutic maneuvres: (1) thrombectomy, (2) Palma's operation, (3) conservative procedures, (4) extirpation of a tumor, and (5) removal of secondary varicose veins were performed. Long-term results of treatment were reviewed. Thrombectomy and Palma's operation obtained good results in 59% and in 42% of cases respectively, while conservative procedures showed a favorable outcome in 36% of cases where followed. Results of thrombectomy were statistically better than those of conservative procedures (p less than 0.05).

[The effects of failure of arterial reconstruction on limb status]

During the last 8 years, arterial reconstructive operations such as bypass grafting, thrombendarterectomy and percutaneous transluminal angioplasty were performed on 282 lower extremities with chronic arterial occlusion. Operative indications were intermittent claudication in 57.1% and limb salvage in 42.9%. Early and late failure rate following operations was 31.2%: for claudication group 24.0% and for limb salvage group 40.7%. In 30.6% of claudication group and in 45.7% of limb salvage group, ischemia of limbs, compared to their preoperative status, worsened following occlusion. These limb worsening-rates were high and not negligible. Main causes of failures were poor run off and poor graft. Because chronic arterial occlusion is not a malignant disease, it is not forgivable to worsen limb status by surgery. Therefore, the operative indication for claudicant should be the need of patients in their daily life. For femoro-popliteal bypass grafting in claudicant, not artificial graft but auto vein graft should be used. When no suitable vein is available, conservative therapy is the choice of treatment. In case of limb salvage, artificial graft may be used.