Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications, need for intensive care, LOS or mortality after major vascular surgery.

Several reports have established the concept of nitric oxide synthase (NOS) gene transfer for inhibiting smooth muscle cell (SMC) proliferation after vascular injury. To minimize potential risks associated with viral gene transfer, we developed a liposome-based gene transfer approach employing inducible NOS (iNOS) overexpression for inhibition of stent-induced neointimal lesion formation. Therapeutic lipoplexes were transferred to femoral or coronary arteries of Goettingen minipigs, using the Infiltrator local drug delivery device. Efficiency of local iNOS lipoplex transfer was analyzed by iNOS-specific immunohistochemistry. NO-mediated inhibition of stent-induced neointimal lesion formation was analyzed by intravascular ultrasound (IVUS) and computerized morphometry. Gene transfer efficiency increased dose dependently to a maximum of 44.3 +/- 4.2% iNOS-positive vessel area (dose, 2 microg of iNOS lipoplex). Proliferating cell nuclear antigen (PCNA) expression of medial SMCs (immunohistochemistry) was inhibited significantly by transfer of 2 microg of iNOS lipoplexes (111 +/- 27 cells [iNOS] versus 481 +/- 67 cells [control; PCNA-positive medial cells]). IVUS analysis demonstrated that local transfer of iNOS lipoplexes resulted in a significant reduction of femoral in-stent plaque area (control, 40.85 +/- 6.37 mm(2); iNOS, 24.69 +/- 1.8 mm(2); p = 0.03). Coronary in-stent lesion formation was reduced by about 45% as determined by histologic morphometry (control, 4.0 +/- 0.29; iNOS, 2.2 +/- 0.30; p < 0.01). In conclusion, this study demonstrates that local intramural delivery of iNOS lipoplexes can exert therapeutic effects in inhibiting stent-induced neointimal lesion formation. Together with the nonviral character of this gene therapy approach, these findings may have important impact on the transition of NOS-based gene therapy to clinical practice.

Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed.

At 0 degree and 12 degrees visibility is very good for all tested materials. For steeper angulations contrast was partly critical in SLU and significantly enhanced with compound imaging. Thus, SonoCT may be useful to increase precision of ultrasound-guided percutaneous interventions.

No abstract

In this case report the diagnostic difficulties of massive intestinal hemorrhage caused by diverticula of the small intestine are demonstrated. After resuscitation of the patient by transfusion of 8 units of packed red cells the segment of the jejunum bearing the diverticula was resected. There was no complication until discharge nor was any recurrent bleeding or functional disorder of the bowel reported during follow-up. The clinical presentation, the different value of diagnostic tools and the therapy are discussed.

Cooled LITT applicator systems are known to induce complex temperature patterns. Typical for such devices, the temperature maxima are often shifted away from the applicator into the tissue. Therefore, an adequate temperature monitoring is essential. This, however, has not yet been realized for many of the latest MRI systems. We have implemented an improved MR thermometry system using a gradient echo pulse sequence (5 mm slice, FOV 230 mm, TRITE = 80/26 ms, matrix 1 92 x 256) on a 1 .5 T scanner (Magnetom Vision, Siemens, Erlangen, Germany). The recorded temperature expansion during laser irradiation of bovine liver was used as a model setup for LITT. A commercially available watercooled applicator system (Microdome light guide, Huettinger, Umkirch, Germany, in combination with the Power Catheter, Somatex, Berlin, Germany) was used for the delivery of the Nd:YAG laser radiation (A =1064 nm, cw, 15.5 W, Domier 4060N, Germering, Germany) and tissue cooling, respectively. MR phase images were recorded every 30 seconds alternating in axial and radial orientation. The temperature distributions were calculated using the proton resonance frequency (PRF) method. A sensitivity factor of 0.0097 ppm/°C has been determined independently by a comparison with fluorooptic temperature measurements. The temperature accuracy of a single pixel (0.9 mm square) during 1 0 mm laser irradiation ofbovine liver tissue was found to be ( -1 .7 1 .4 ) °C. The final lesion size diameters after 6 mm laser irradiation (15 mm x 26 mm) were found to be in good agreement with the dimensions of the 60°C isotherm of the respective 2D temperature map. This indicates that the implemented MR thermometry might be an essential tool for therapy control of interstitial laser treatment with cooled applicator systems.

THI permits early volumetry of the residual tissue after thyroid surgery comparable with the intraoperative volumetry. Thus, THI may be helpful in guiding the substitution of thyroid hormones.