Coxiella burnetii, the etiologic agent of Q fever, is mainly responsible for endocarditis with negative blood culture results, but only a few cases of C. burnetii infections of aortic aneurysms have been published. We report three cases of abdominal aortic aneurysms treated in patients with Q fever infection with simultaneous endocarditis (n = 1) and previous history of cardiac valve replacement for endocarditis (n = 1). A coeliac aortic aneurysm was diagnosed in one patient treated for acute Q fever with persistent serologic results showing chronic infection despite adequate antibiotic therapy and without endocarditis. Resection of the aneurysm cured the chronic infection, and C. burnetii was identified by culture of the aneurysmal wall. In the two other cases, chronic infection of C. burnetii was diagnosed by serologic examination after surgery for an abdominal aortic aneurysm. One patient with negative blood culture results had amaurosis fugax due to endocarditis and required aortic valve replacement; recurrent fever without evidence of valve dysfunction or infection developed in one patient who had had prosthetic cardiac valve replacement 6 months earlier for endocarditis. Aortic aneurysms were treated with in situ prosthetic grafts and long-term antibiotic therapy. At a mean follow-up of 12 years, no septic aortic complications occurred, and serologic test results have remained negative. The presence of an aortic aneurysm and cardiac valve disease seems to be a predisposing factor for chronic C. burnetii infection. Diagnosis particularly relies on the physician's awareness of this condition and is confirmed by serologic examination. Aortic aneurysm resection is mandatory to cure the chronic infection and must be associated with long-term antibiotic therapy.

ObjectiveThe objective of this study is to explore the feasibility and efficacy of a new technique for sutureless vascular anastomosis, using glued prosthesis, as a sole anastomosis fixation method in rabbits.MethodsTen rabbits were randomly selected to conduct the experiment. Five rabbits underwent direct anastomosis of infrarenal abdominal aorta, with glued prosthesis. In five other rabbits, reconstruction was done by sutured anastomosis. All animals were immediately examined by echo-Doppler for patency of anastomosis. The burst pressure of the glued anastomosis was measured and compared with that of a sutured artery. The animals were euthanized, and tissue samples were taken for histological examination immediately after the experiment.ResultsCompared to conventional anastomoses, sutureless vascular anastomoses required shorter time of creation and significantly reduced blood loss (P<5%). There was no significant difference on the average blood flow through the anastomosis between two groups at the end of surgery. All anastomoses with glued prosthesis, examined by echo-Doppler, were patent at the anastomotic site, except one, which was stenosed immediately after surgery. In the control group, except one with stenosis, all conventional anastomoses were patent. Mean burst pressure at the anastomotic site for sutureless anastomoses was lower than in control group. Macroscopically, the BioGlue did not demonstrate any adhesion to the surrounding tissue as it was covered by the vascular prosthesis. Histological examination showed low-grade inflammatory reaction in glued anastomoses versus no inflammatory reaction at the sutured anastomoses.ConclusionThis technique may provide a feasible and successful alternative in vascular surgery. However, further long-term studies are necessary to elucidate the break pressure and degree of inflammation at the anastomotic site.

Our results suggest that ultrasound therapy and exercise are beneficial in the treatment of tennis elbow.

BackgroundIn recent years, several methods and new techniques have been studied and proposed for establishment of sutureless vascular anastomoses, streaming use of sutureless vascular surgery in the future.Presentation of the hypothesisThe new vascular connector (NVC) is a hypothetical design of a vascular device, proposed for creation and maintenance of sutureless vascular anastomosis. Implication of NVC would introduce a new device and technique in establishment of sutureless vascular anastomosis in which surgical approach is minimized and so post-operation disorders. It would eliminate need for suture; shorten clampage and operation time, consequently reducing stress for both, the surgeon and the patient. It enables the creation of vascular anastomosis fast, simple, safe, reliable, with satisfactory patency and stability of anastomosis.Testing the hypothesisEfficacy of NVC needs to be evaluated in further studies, in order to be confirmed for clinical use. The effectiveness of NVC should be verified firstly in vitro and in vivo tests; and by animal experiments. The likelihood of its negative influence in thrombogenicity should be well evaluated.Implications of the hypothesisImplication of the new vascular connector (NVC) would be of interest to both patients and the surgeon due to the following main achievements: 1) enables the creation of vascular anastomosis fast and simple, 2) significant shortening of clampage time of blood vessels and operation time-this assumption would be followed by reduced risk of operative and post-operative complications and length of hospital stay or admission to Intensive care unit, 3) safe and reliable, 4) compatible with any blood vessel and standard vascular graft, 5) using the NVC we will reduce in minimum need for replaced blood volume, 6) reduces the cost of treatment. It is anticipated that the NVC would provide shorter operation time and least operative and post-operative complications in creation of sutureless vascular anastomosis.