our series is the first to show that EVAR for rAIA can be safely performed under LA. This approach allows implantation of commercially available bifurcated SG and improves patient outcome.

Non-delayed or early stent-grafting in acute traumatic rupture of the descending aorta is feasible. This technique seems to be a valuable option, in particular when associated lesions may interfere with the surgical outcome. Immediate post-procedural CT scanning and/or echography should be performed, in order to rule out residual leakage.

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Purpose: First, to apply a breath-hold multislice 2D spiral magnetic resonance (MR) approach in patients acquiring within 16 heartbeats (acquisition window, 116 msec) a 10-mm-thick stack of four slices (resolution, 1.3 ϫ 1.3 mm 2 ); and second, to evaluate the effect of an intravascular Fe-based contrast medium (CM) on a signal-to-noise ratio (SNR) and a contrast-to-noise ratio (CNR). Materials and Methods:In each patient one or two coronary arteries were imaged prior to and following cumulative doses of 0.25, 0.5, and 0.75 mg of Fe/kg of body weight (bw) of an intravascular CM (CLARISCAN™, Nycomed-Amersham, Princeton, NJ, USA) containing ultrasmall superparamagnetic iron oxide (USPIO) particles. Results:On precontrast maximum intensity projection (MIP) images generated from the stack of slices, 10 and 11 stenoses of 12 stenoses confirmed by coronary angiography were detected by readers 1 and 2, respectively. SNR and CNR in the coronary arteries peaked at 0.50 mg of Fe/kg of bw, yielding a slight increase of 15.5% and 18.4%, respectively (P Ͻ 0.05 vs. precontrast), which did not improve detection of coronary artery stenoses. Conclusion:The presented multislice spiral approach allows display of coronary anatomy in MIP formats for convenient display of coronary stenoses. The pulse sequence did not benefit from an intravascular USPIO-based CM, since little improvement in SNR and CNR was achieved.

Summary:Adverse reactions to iodinated contrast media are varied and known to develop in patients with asthma and a history of allergy. We describe three successful allogeneic bone marrow transplantation (BMT) patients, who all developed dermal graft-versus-host disease (GVHD) after receiving contrast media. Cutaneous GVHD triggered by contrast media has not been reported to date and has implications for the assessment, monitoring and treatment of patients during the post-transplant period. Bone Marrow Transplantation (2002) 29, 899-901. DOI: 10.1038/sj/bmt/1703564 Keywords: bone marrow transplantation; graft-versushost disease; contrast media Graft-versus-host disease (GVHD) is a singularly important threat to the successful outcome of allogeneic stem cell transplantation and prevention and treatment of GVHD are of critical importance for transplant physicians and patients. Prophylactic use of cyclosporin A (CsA) and methotrexate (Mtx) successfully reduces the incidence of acute GVHD. Some studies suggest a reduction in chronic GVHD with prolonged CsA prophylaxis. [1][2][3] Additional studies have shown, that random red cell transfusions given shortly before transplantation may be associated with a decreased risk of chronic GVHD, whereas unirradiated donor buffy coat or marrow reinfusions are associated with an increased risk for development of chronic GVHD. 4,5 Splenectomy appeared to increase the risk for development of chronic GVHD, possibly due to increased rates of infection in splenectomized patients. 6 As another possibility, which could be of prophylactic importance, we report three allogeneic BMT patients who experienced contrast mediainduced cutaneous GVHD. Case reports Case 1A 49-year-old patient underwent allogeneic BMT from his HLA-identical brother for AML M4 in first CR. He received GVHD prophylaxis with CsA beginning with 10 mg/kg/day, adjusted to provide serum levels of 150-250 g/l, Mtx (15 mg/m 2 on day 1 and 10 mg/m 2 on days 3, 6 and 11), and IvIgG (0.5 g/kg/week). No serious complications occurred and rapid engraftment was achieved. Pre-existing pulmonary aspergillosis was treated with intravenous amphotericin B. Acute GVHD occurred on day +43 (grade 2, skin) without other organ involvement. The skin rash settled after 4 months. Six months after BMT the patient was still receiving CsA (5 mg/kg/day p.o.). Computed thoracoabdominal tomography was performed for evaluation of the aspergillosis infection. As contrast medium, 120 ml of iodixanolum 550 mg (Visapaque 270) was used. Six hours after application of the contrast medium, the patient developed generalized erythroderma with a pruritic and painful skin rash. Therapy with prednisone 50 mg p.o. and cetirizin 10 mg p.o. was begun. The initial changes were limited to the more superficial skin layers, with formation of new lichen planus-like papules and scaling erythematous plaques involving facial skin, palms and soles. These findings were associated with dryness of mouth and conjunctivae. A skin biopsy showed chronic GVHD with typical epide...

This experience shows that combined CABG and SG of thoracic or infrarenal aortic aneurysm is a safe and less-invasive alternative to the open graft repair, especially in the older patients or patients with severe comorbidities.

Our series is the first to show that EVAR for rAIA can be safely performed under LA. This approach allows implantation of commercially available bifurcated SG and improves patient outcome.

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