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  • Author: Adrian Mureșan x
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Is There a Risk Factor More Responsible for Disaster?

Abstract

Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension.

Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking.

Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation.

Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

Open access
Aorto-mesenteric Bypass for the Treatment of Chronic Mesenteric Ischemia

Abstract

Chronic mesenteric artery disease has a much lower incidence than the acute one, but it raises the same problems in terms of patient survival. The long-term outcomes for open surgery are crucial for the right choice of a particular technique. We present the case of a 39-year-old female patient with a history of total nephrectomy, chronic kidney failure, and hypertension, who presented in the Emergency Department with abdominal pain with high intensity, for which she was admitted to the General Surgery Department. Abdominal computed tomography angiography was performed, which indicated the diagnosis of partial upper mesenteric artery stenosis. The patient underwent surgery, during which a retrograde aorto-mesenteric bypass with a Gore-Tex 5 mm diameter prosthesis was performed. In situations where the endovascular approach fails or has no indication (multiple incidence lesions from the origin of the superior mesenteric artery), open surgery is the indication in chronic mesenteric ischemia.

Open access
Morpho-Pathological Review on the Healing of Synthetic Vascular Grafts

Abstract

Objective: Tissue integration of vascular grafts partially depends on the host response to injury, which immediately begins after implantation and restoration of the circulation. In an infected environment, the inflammation changes the incorporation patterns. The aim of the study was to observe the tissue incorporation process, in a normal and an infected environment. Methods: We have created an experimental model by performing subfascial implantation of four types of vascular grafts, in rats (woven Dacron®, knitted Dacron®, silver coated Dacron® and expanded Polytetrafloroethylene - ePTFE) and by infecting some of them with three different bacterial strains. We have retrieved the noninfected grafts at two and four weeks after implantation, whilst the infected ones at one, two and three weeks. Results: Detailed microscopic appearences were analysed. The control and infected groups were compared. Statistical significance was calculated for various corelations. Conclusions: The morphopathological findings showed that the ePTFE graft’s structure was best preserved. Statistical significance existed between the bacterial strain and the degree of inflammation. The silver coated Dacron® was not shown to be superior to the knitted Dacron®. The poorest incorporation was the one of the woven Dacron®.

Open access
Tissue Integration of Synthetic Grafts and the Impact of Soft-Tissue Infection – An Experimental Model

Abstract

Objective: Starting with the ‘Vinyon-N-revolution’ of the 50’s, there has been a constant interest in understanting tissue integration, or the so-called graft healing process, as well as its relationship with infection. In this study we present an experimental animal model designed to assess tissue integration of different graft materials, and their reaction to the presence of infection.

Methods: Synthetic grafts (knitted Dacron®, woven Dacron®, silver-impregnated Dacron® and Gore-Tex®) were implanted subfascially in the interscapular region of Wistar rats. Animals were divided into a control group and an infected group, with infection induced using bacterial suspensions of standard strains of Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. Implants were retrieved at 2 and 4 weeks postoperatively in the control group and at 1, 2 and 3 weeks postoperatively in theinfected group. Retrieved grafts were assessed bacteriologically and morpho-pathologically.

Results: All microorganisms produced clinically evident infections, with positive blood cultures in case of E. coli. Staphylococci produced more massive infections on Dacron® grafts, except for the silver-impregnated version, while E. coli produced more significant infections on Gore-Tex® grafts. Morpho-pathologically Dacron® grafts behaved poorly, with ocassional complete structural compromise, and no difference between the conventional and the silver-impregnated type. The Gore-Tex® graft showed a consistent structural resistance throughout the study period.

Conclusions: Although the silver-impregnated graft inhibited bacterial growth, it was poorly tolerated by the host tissue. In contrast, Gore-Tex® grafts showed more massive infection, especially with E. coli, but kept their structural integrity surprisingly well.

Open access
Giant Lower Limb Myxoid Liposarcoma Causing Deep Vein Thrombosis, Complicated with Pulmonary Embolism Case Report

Abstract

Liposarcoma (LPS) is one of the most common histologic subtypes of adult soft tissue sarcoma. Here, we report the case of a 52-year-old woman complaining of shortness of breath, chest pain, painful leg swelling 24 hour before presentation at our institution.

Despite a vascular, soft part ultrasound and CTA, which suspected a voluminous haematoma, a huge tumour was found and a myxoid liposarcoma was identified by surgical excision and a histological examination, respectively.

Open access
Graham Little-Lassueur Syndrome with Hypertrophic Lichen Planus in a Patient with Chronic Hepatitis C

Abstract

Graham Little-Lassueur Syndrome (GLLS) is considered a form of lichen planopilaris which associates follicular lichen planus, cicatricial alopecia of the scalp and noncicatricial alopecia of the axillary and/or pubic regions. We present the case of a 47 years old female patient, known for 5 years with chronic hepatitis C and a poor therapeutic control of the disease due to Interferon intolerance. She presented to our clinic for the occurrence on the shins of some well-defined, intensely pruritic erythematous plaques, covered with thick scales, with a verrucous appearance, accompanied by excoriations. The skin biopsy reveal hypertrophic lichen planus on the shins and lichen planopilaris on the scalp. The patient was treated with systemic antihystamines, topical corticosteroids and salicylic acid under occlusion, emollients, phototherapy UVB narrow band 4 sessions/week for 3 weeks, cryotherapy. From our knowledge this is the first case of GLLS associated with chronic viral hepatis C.

Open access
Use of Circulating and Cellular miRNAs Expression in Forensic Sciences

Abstract

The current practice in the field of forensic medicine imposes the use of modern investigation techniques. The complexity of laboratory investigation methods needed for a final result of the investigation in forensic medicine needed new biomarkers of higher specificity and selectivity. Such biomarkers are the microRNAs (miRNAs), short, non-coding RNAs composed of 19–24 nucleotides. Their characteristics, such as high stability, selectivity, and specificity for biological fluids, differ from tissue to tissue and for certain pathologies, turning them into the ideal candidate for laboratory techniques used in forensic medicine. In this paper, we wish to highlight the biochemical properties and the usefulness of miRNAs in forensic medicine.

Open access