Perinatal omphalocele rupture is a rare occurrence. We present a case of a baby delivered at 35 weeks with a known giant omphalocele, transverse lie, and the omphalocele downward in the birth canal who suffered rupture of the omphalocele and liver injury around the time of delivery. The pregnancy was complicated by one day of preterm labor, preterm premature rupture of the membranes, and the omphalocele was the presenting part. Despite pulmonary hypertension, rupture of the omphalocele, and a significant liver injury, individualized management with decompression of the liver hematoma allowed successful early closure with mesh followed by delayed reconstruction. (C) 2016 The Authors. Published by Elsevier Inc.

Pancreatic pseudocyst is a common complication of pancreatitis. Pseudocysts may require decompression when they become painful, infected, or start compressing surrounding organs. Decompression is achieved by endoscopic cystogastrostomy. Recently, the use of lumen-apposing metal stent (LAMS) for cystogastrostomy has gained popularity due to ease of use and high technical success. LAMS has a wider lumen, which allows for direct endoscopic necrosectomy in the cases of walled-off necrosis. Our patient is a 30-year-old male who presented with massive hematemesis and dizziness. He had a history of chronic alcohol-induced pancreatitis. Three weeks before the presentation, he underwent a cystogastrostomy with LAMS placement to treat a 10-cm walled-off necrosis. Urgent computed tomography (CT) scan did not reveal any acute finding suggestive of bleeding. Esophagogastroduodenoscopy showed blood protruding from the LAMS with a large clot formation. Attempts to stop bleeding were unsuccessful. He underwent CT angiography of the abdomen. CT angiography showed a bleeding pseudoaneurysm (PA) believed to be a complication of the LAMS. Subsequently, multiple coils were placed in the splenic artery near the PA. The patient continued to improve without a further drop in hemoglobin and was eventually discharged. PA formation and subsequent rupture is a rare delayed complication of LAMS. It may lead to massive gastrointestinal bleeding with a high mortality rate. Diagnostic delays have resulted in increased mortality by 60%. In this article, we present a case of massive gastrointestinal bleeding due to a ruptured splenic artery PA presenting as a delayed complication of LAMS.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 5 uppsatser.

Background: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. Methods: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. Results: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). Conclusion: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity.

Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH. Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study. Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5). Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment.

Aim of the study was to analyze the influence of comorbidities, demographic and surgical risk factors on early and late results of non-ruptured and ruptured abdominal aortic aneurysm. In the introduction the aim of the study and objectives are listed. In the review of the literature main problems of pending topic are analyzed. The methodology is described in a special chapter. The results of 373 patients’ surgical treatment of abdominal aortic aneurysm were analyzed. Eighty-four of them were operated due to the abdominal aortic aneurysm rupture. Follow-up results of 153 patients were analyzed in a special chapter. The influence of comorbidities, demographic and surgical risk factors on mortality and complication rate after operations for ruptured abdominal aortic aneurysm were assessed. Analysis of follow-up results clarified risk factors influencing survival after operation of abdominal aortic aneurysm. Assessment of the results showed that mean age of patients is lower and comorbidities is more severe as compared with the data presented for Western countries. The patients’ age, condition of cardiac and pulmonary systems, volume of operation were the most influencing risk factors on the outcome of surgical treatment of the abdominal aortic aneurysm. / Tyrimo tikslas – išanalizuoti gretutinių ligų ir demografinių bei chirurginių rizikos veiksnių įtaką neplyšusios bei plyšusios pilvinės aortos aneurizmos artimiems bei atokiesiems chirurginio gydymo rezultatams. Įvade išdėstomi tyrimo tikslai bei uždaviniai, pateikiama literatūros apžvalga, kurioje apibendrinamos pagrindinės su nagrinėjama tema susijusios problemos. Atskirame skyriuje aprašyta tyrimo metodika. Disertacijoje išnagrinėti 373 pacientų, operuotų dėl pilvinės aortos aneurizmos, gydymo rezultatai. Aštuoniasdešimt keturi jų gydyti dėl plyšusios pilvinės aortos aneurizmos. Atskirai išnagrinėta 153 pacientų vėlyvieji gydymo rezultatai. Nustatyta mirtingumo ir komplikacijų po plyšusių pilvinės aortos aneurizmų operacijų priklausomybė nuo įvairių rizikos veiksnių artimuoju pooperaciniu laikotarpiu. Skyriuje, kur analizuojami vėlyvieji operacijų rezultatai, nustatyti svarbiausieji veiksniai, nulemiantys išgyvenamumą. Išsamūs šių tyrimų rezultatai pateikti dviejuose disertacijos skyriuose. Nustatyta, kad tiriamųjų pacientų amžiaus vidurkis buvo mažesnis, o gretutinės patologijos buvo daugiau palyginus su duomenimis, pateiktais Vakarų šalių literatūroje. Taip pat nustatyta, kad didžiausią įtaką gydymo rezultatams darė paciento amžius, širdies bei plaučių patologija, operacijos apimtis.

Tyrimo tikslas – išanalizuoti gretutinių ligų ir demografinių bei chirurginių rizikos veiksnių įtaką neplyšusios bei plyšusios pilvinės aortos aneurizmos artimiems bei atokiesiems chirurginio gydymo rezultatams. Įvade išdėstomi tyrimo tikslai bei uždaviniai, pateikiama literatūros apžvalga, kurioje apibendrinamos pagrindinės su nagrinėjama tema susijusios problemos. Atskirame skyriuje aprašyta tyrimo metodika. Disertacijoje išnagrinėti 373 pacientų, operuotų dėl pilvinės aortos aneurizmos, gydymo rezultatai. Aštuoniasdešimt keturi jų gydyti dėl plyšusios pilvinės aortos aneurizmos. Atskirai išnagrinėta 153 pacientų vėlyvieji gydymo rezultatai. Nustatyta mirtingumo ir komplikacijų po plyšusių pilvinės aortos aneurizmų operacijų priklausomybė nuo įvairių rizikos veiksnių artimuoju pooperaciniu laikotarpiu. Skyriuje, kur analizuojami vėlyvieji operacijų rezultatai, nustatyti svarbiausieji veiksniai, nulemiantys išgyvenamumą. Išsamūs šių tyrimų rezultatai pateikti dviejuose disertacijos skyriuose. Nustatyta, kad tiriamųjų pacientų amžiaus vidurkis buvo mažesnis, o gretutinės patologijos buvo daugiau palyginus su duomenimis, pateiktais Vakarų šalių literatūroje. Taip pat nustatyta, kad didžiausią įtaką gydymo rezultatams darė paciento amžius, širdies bei plaučių patologija, operacijos apimtis. / Aim of the study was to analyze the influence of comorbidities, demographic and surgical risk factors on early and late results of non-ruptured and ruptured abdominal aortic aneurysm. In the introduction the aim of the study and objectives are listed. In the review of the literature main problems of pending topic are analyzed. The methodology is described in a special chapter. The results of 373 patients’ surgical treatment of abdominal aortic aneurysm were analyzed. Eighty-four of them were operated due to the abdominal aortic aneurysm rupture. Follow-up results of 153 patients were analyzed in a special chapter. The influence of comorbidities, demographic and surgical risk factors on mortality and complication rate after operations for ruptured abdominal aortic aneurysm were assessed. Analysis of follow-up results clarified risk factors influencing survival after operation of abdominal aortic aneurysm. Assessment of the results showed that mean age of patients is lower and comorbidities is more severe as compared with the data presented for Western countries. The patients’ age, condition of cardiac and pulmonary systems, volume of operation were the most influencing risk factors on the outcome of surgical treatment of the abdominal aortic aneurysm.

Οι μηνισκικές ρήξεις διακρίνονται σε τραυματικές και εκφυλιστικές. Κλινικά δεδομένα υποδηλώνουν ότι η εκφύλιση των μηνίσκων συσχετίζεται με την οστεοαρθρίτιδα του γόνατος. Παρ’ όλα αυτά, τα μοριακά γεγονότα που καθορίζουν την παθογένεια της εκφύλισης των μηνίσκων σε ανθρώπους παραμένουν αδιευκρίνιστα. Στη μελέτη εξετάστηκε ανοσοϊστοχημικά η έκφραση της p38 MAPKινάσης, της ενεργού φωσφορυλιομένης μορφής της p-p38, του στόχου NF-kB (με τα διμερή p50-p65) καθώς και της COX-2 σε μηνισκικές ρήξεις, και διερευνήθηκε η συμμετοχή τους στην ανάπτυξη εκφύλισης. Τα ευρήματα απέδειξαν αυξημένη έκφραση του άξονα p38-NF-kB και της COX-2 στον αποδιοργανωμένο και εκφυλισμένο ινοχόνδρινο μηνισκικό ιστό, υποδεικνύοντας ένα ρόλο των μορίων αυτών στην παθοβιοχημεία της εκφύλισης και της επακόλουθης ρήξης. Η μελέτη είχε σκοπό να διερευνήσει και να χαρακτηρίσει την έκφραση και την ενεργοποίηση του σηματοδοτικού μονοπατιού της p38 MAPK-NF-kB και της COX-2 στα ινοχονδροκύτταρα των ανθρώπινων μηνίσκων με ρήξη. Επιπρόσθετα συσχετίσαμε τα επίπεδα έκφρασης των πρωτεϊνών αυτών με παθολογοανατομικές και κλινικές παραμέτρους, όπως η ύπαρξη εκφύλισης και η συνύπαρξη κλινικά εξακριβωμένης ΟΑ. Χρησιμοποιήθηκαν 57 ανθρώπινοι μηνίσκοι. 43 (75,4%) άνδρες και 14 (24,6%) γυναίκες, με μέσο όρο ηλικίας 32,6 έτη, με διάρκεια πόνου 17,36 μήνες. Σε 39 ασθενείς (68,4%) η ρήξη αποδόθηκε σε τραύμα και σε 18 (31,6%) σε προϋπάρχουσα κλινικά διαγνωσμένη ΟΑ. Η ιστοπαθολογοανατομική διευκρίνιση της μηνισκικής εκφύλισης βασίστηκε σε καθιερωμένα μικροσκοπικά κριτήρια. Εκφύλιση παρατηρήθηκε σε 34 μηνίσκους (59,4%). Χρησιμοποιήθηκαν τα αντισώματα, anti p38, anti p-p38 (μονοκλωνικά αντισώματα έναντι της ενεργοποιημένης μορφής), anti NF-kB, p50 πολυκλωνική, anti NFkBp65 πολυκλωνική και antiCOX-2. Η ένταση της χρώσης και η αναλογία των ανοσοθετικών ινοχονδροκυττάρων εκτιμήθηκε μικροσκοπικά και βαθμολογήθηκε σε κλίμακα 0-3 (0= χωρίς ανοσοδραστικότητα, 1= ήπια, 2= μέτρια, 3= ισχυρή). Στατιστική ανάλυση έγινε με τη δοκιμασία Mann-Whitney και η ισχύς της συσχέτισης των μεταβλητών με το Kendall’s T test, χρησιμοποιώντας το SPSS. 1.Η έκφραση της p38 ήταν στατιστικά σημαντικά υψηλότερη στους εκφυλισμένους συγκριτικά με μη εκφυλισμένους μηνίσκους. Μηνίσκοι σε ασθενείς με προϋπάρχουσα ΟΑ έδειξαν επίσης στατιστικά σημαντικά αυξημένη p38 σε σύγκριση με αυτούς με μη προϋπάρχουσα ΟΑ. 2.Η p-p38 είχε σημαντικά αυξημένη έκφραση σε εκφυλισμένους μηνίσκους έναντι μη εκφυλισμένων και σε ραγέντες μηνίσκους με ΟΑ σε σχέση με μη ΟΑ. 3.Οι υπομονάδες p50 και p65 ως τροποποιητές του άξονα p38-NFkB έδειξαν σημαντικά υψηλότερα επίπεδα στην εκφύλιση και την οστεοαρθρίτιδα. 4.Τα επίπεδα της COX-2 ήταν σημαντικά διαφορετικά μεταξύ εκφυλισμένων και μη εκφυλισμένων και σε οστεοαρθριτικές και μη αρθρώσεις, και συσχετίζονται απόλυτα με τη διακύμανση των προηγούμενων βημάτων του άξονα. 5.Η στατιστική ανάλυση αποκάλυψε σημαντική και θετική συσχέτιση μεταξύ COX-2 και p38-NF-kB και παράλληλη διακύμανσή της. / Meniscal tears are attributed to either trauma or degeneration processes. Clinical data suggest that meniscal degeneration (MD) is associated with knee osteoarthritis; however, the molecular events underpinning the pathogenesis of MD in humans remain elusive. Here we immunohistochemically examined the expression of p38 MAPK, its phosphorylated activated form p-p38, its target NF-kB (p50-p65 dimer), and COX-2 in ruptured menisci and investigated their involvement in MD development. Our findings demonstrate increased expression of the p38-NF-kB axis elements and COX-2 in disintegrated fibrocartilage suggesting a role of these molecules in the pathobiochemistry of MD and consequential rupture. We undertook this study to explore and characterize the expression and/or activation profile of the p38 MAPK-NF-kB signaling path away constituents and COX-2 in the fibrochondrocytes of human torn menisci. Furthermore we correlated the expression levels of the examined proteins with pathologic and clinical parameters, such as the presence of fibrocartilaginus degeneration and the coexistence of clinically identified OA. 57 human menisci were used for this study. Among the patients 43 (75,4%) were male and 14 (24,6%) female with mean age 32,6 years, with pain duration 17,36 months. In 39 patients (68,4%) meniscal tearing was attributed to trauma and in 18 (31,6%) to a background of clinically diagnosed OA. The histopathologic identification of meniscal degeneration (MD) was based on established microscopy criteria. MD was observed in 34 (59,4%) of the menisci. The following available antibodies were employed (anti-p 38), anti p-p38 (activated form monoclonal), anti NF-kB, p50 polyclonal, anti NFkBp65 polyclonal and anti COX-2. Strain intensity and proportion of immunopositive fibrochondrocytes was assessed by light microscopy and graded on a scale 0-3 (0= no immunoreachivity, 1= mild, 2= moderate, 3= strong). Statistical analysis was made with Mann-Whitney tests and the strength of association between the variables by Kendall’s T test, using SPSS for Windows. 1.Expression of p-38 was significantly higher in degenerated compared with non degenerated menisci. Menisci from patients with preexisting OA showed significantly increased p38 expression levels compared to those with no preexisting OA. 2.p-p38 expression was considerably elevated in degenerated compared with non degenerated and in OA compared with non OA ruptured menisci. 3.The downstream effectors of p38 NF-kB subunits p50 and p65, exhibited significantly higher levels in degenerated and OA fibrocartilage. 4.COX-2 levels were significantly different between degenerated and non degenerated menisci, as well as between OA and non OA joints. 5.Statistical analysis revealed significant and positive correlation between COX-2 and p-38 and NF-kB.

Background: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. Methods: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. Results: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). Conclusion: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity.