Hemophagocytic lymphohistiocytosis in early pregnancy: A rare and fatal diagnostic challenge.

Objective: This report details the complexities of diagnosing and treating rapid-onset multisystemic hemophagocytic lymphohistiocytosis (HLH) during pregnancy, as evidenced by a fatal case in early pregnancy with severe hematological and obstetric complications.

Case Presentation: A 20-year-old pregnant woman in her second pregnancy presented at 8 weeks of gestation with abdominal pain, fever, and rectal bleeding. Laboratory tests revealed leukopenia, thrombocytopenia, and anemia, leading to immediate transfusion and intensive care unit admission.

Palliative Percutaneous Cryoablation and Cementoplasty of Acetabular Metastases: Factors Affecting Pain Control and Fracture Risk.

Purpose: To characterize the response of patients with acetabular metastases following combined cryoablation and cementoplasty (CCC) for pain palliation and fracture risk reduction, based on completeness of ablation and the presence of pre-existing pathologic fracture.

Materials And Methods: Thirty-nine consecutive acetabular CCC procedures were performed in 37 patients (24 M:13F, age 66 ± 8 years). Pain was assessed using a 0-10 numeric rating scale.

Saphenous venous ablation with hot contrast in a canine model.

Purpose: To determine the feasibility, efficacy, and safety of thermal ablation of the saphenous vein with hot contrast medium.

Methods: Twelve saphenous veins of 6 dogs were percutaneously ablated with hot contrast medium. In all animals, ablation was performed in the vein of one leg, followed by ablation in the contralateral side 1 month later.

Surgical treatment of advanced-stage carcinoid tumors: lessons learned.

Objective: To evaluate clinical outcomes in a large group of advanced-stage carcinoid patients (stage IV) following multimodal surgical therapy.

Summary Background Data: Patients with advanced-stage carcinoid have traditionally experienced poor 5-year survival (18%-30%). Few recent series have evaluated a large number of patients treated with aggressive surgical rescue therapy.

Endovascular placement of an extraluminal femoropopliteal bypass graft in human cadavers.

Purpose: A method to create an extraluminal femoropopliteal bypass graft using endovascular techniques was evaluated in situ on cadaver extremities in an attempt to develop a minimally invasive alternative technique for the management of infrainguinal occlusive arterial disease.

Methods: The endovascular placement of an extraluminal femoropopliteal bypass graft was undertaken in 5 cadaver legs. Following percutaneous access to the popliteal artery (PA) or common femoral artery (CFA), a Rosch-Uchida needle was used to perforate the vascular wall, followed by the creation of an extraluminal tract using a looped wire and catheter.

Bifurcated endoprosthesis for treatment of aortoiliac occlusive lesions.

Purpose: To report our initial experience with a bifurcated endoprosthesis in the management of aortoiliac occlusive disease.

Methods: From May 2001 to February 2004, 112 patients were referred to our institution for the management of aortoiliac disease. Among these, 5 (6%) patients (3 men; mean age 57.

Intimal dehiscence in the abdominal aorta following balloon fenestration for type B dissection.

Purpose: To report a case of intimal dehiscence associated with endovascular intervention in patients with aortic dissection.

Case Report: A 65-year-old man presented with a type B dissection extending to the level of the common iliac arteries. Two Talent stent-grafts were placed in the descending thoracic aorta to close the entry point, but 2 lumens remained.

An animal model of abdominal aortic aneurysm created with peritoneal patch: technique and initial results.

The purpose of this study was to develop an abdominal aortic aneurysm model that more closely resembles the morphology of human aneurysms with potential for further growth of the sac. An infrarenal abdominal aortic aneurysm (AAA) model was created with a double-layered peritoneal patch in 27 domestic swine. The patch, measuring in average from 6 to 12 cm in length and from 2 to 3 cm in width, was sutured to the edge of an aortotomy.

Comparison of a new recirculation thrombectomy catheter with other devices of the same type: in vitro and in vivo evaluations.

Rationale And Objectives: To compare a new 7 Fr. Helix thrombectomy catheter with Amplatz thrombectomy devices (ATD) with respect to clot fragmentation efficiency, hemolytic potential, and risk for vascular trauma.

Materials And Methods: Particle size was evaluated following the maceration of 8-to-10-day-old clots, each weighing 6 +/- 0.

Recanalization of thrombosed superficial femoral arteries with a hydraulic thrombectomy catheter in a canine model.

Objective: This experiment was conducted to evaluate efficacy and safety of the Oasis thrombectomy catheter on arterial thrombosis in dogs.

Materials And Methods: 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.

Animal model of bile duct dilatation created with minimally invasive surgery.

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.

Comparison of thrombolytic therapy of lower-extremity acute, subacute, and chronic arterial occlusions.

Our purpose was to study the effectiveness of thrombolytic therapy in treating acute, subacute, and chronic arterial occlusions in a multicenter retrospective study. Intraarterial urokinase infusion was performed in 235 patients for occluded native arteries. There were 70 (30%) with acute and 26 (5%) with subacute occlusions, and 141 (59%) with chronic symptoms for longer than 3 mo.

Treatment of chronic iliac artery occlusions with guide wire recanalization and primary stent placement.

Purpose: To evaluate the results of primary stent placement without initial thrombolysis in the treatment of iliac occlusions.

Materials And Methods: During a 3-year period, 61 iliac artery occlusions were treated in 59 patients. The mean length of the occluded segment was 10 cm (range, 4-25 cm).

Using a symbiotic man/machine approach to evaluating visual clinical research data.

Some candidate medical expert system applications have a significant visual component. Knowledge engineers usually dismiss such task domains as potential expert systems applications. Our success in developing ESCA, a system for evaluating serial coronary angiograms, shows that such task domains should not be dismissed so quickly.

Clinical angiographic regression of atherosclerosis after partial ileal bypass.

Clinical documentation of atherosclerotic plaque regression has been difficult to obtain. This is a report of a patient with severe and early atherosclerotic cardiovascular disease with regression of at least three major atherosclerotic lesions demonstrated by coronary arteriography 10 years after partial ileal bypass operation. The patient's total plasma cholesterol was reduced over these 10 years, ranging from 40% to 23%, from the preoperative level of 757 mg/dl.

Maximal postextrasystolic potentiation following multiple extrasystoles: a simple means of myocardial assessment.

To obtain consistent, reproducible postextrasystolic potentiation (PESP), a single closely coupled extrasystole (ES) must be introduced using transvenous pacing. We hypothesized that multiple ES (spontaneous or catheter induced) produce maximal PESP at all coupling intervals (CI). Differences in PESP between single and double ES were assessed in dogs at varying CI by two different methods [systolic time intervals--PEP/LVET, and endocardial markers--ejection fraction (EF)].

Influence of aspirin and dipyridamole on patency of coronary artery bypass grafts.

A prospective randomized trial was performed to determine if the administration of inhibitors of platelet function would improve the patency of coronary artery bypass grafts. Patients were operated on for intractable angina with angiographically demonstrable lesions. The left internal mammary artery (IMA) was used for bypass of lesions of the left anterior descending coronary artery (LAD).

Percutaneous cervical central venous line placement: a comparison of the internal and external jugular vein routes.

To compare the rate of success and incidence of complications associated with two currently popular routes of percutaneous central venous cannulation, we studied 167 patient in whom either internal or external jugular vein catheterization was attempted. Internal jugular vein (IJV) catheterization (125 patients) was successful in 91%; an intrathoracic location was achieved in 100%; complications occurred in 12.8%.

Redistribution of renal blood flow caused by contrast media.

Rerouting of blood from the renal cortex to the renal medulla (Trueta shunting), observed in 5 cases, may occur in normal kidneys during renal angiography. The temporary nature of this artifact may be proved by performing an abdominal aortogram with the catheter tip inserted farther away from the renal arteries. The exact mechanism of this phenomenon is unknown; it may also occur with various renovascular disorders.

Peripheral angiograph enhancement by long leg pneumatic boots.

In patients with arterial occlusive disease it is virtually impossible to predict the speed of blood flow due to the presence of stenoses, occlusions, and collaterals. Repeated exposures and injections can be avoided by the use of pneumatic boots which increase peripheral blood flow by reactive hyperemia, are well tolerated by patients, and decreases the pain associated with injection of contrast material.