In situ reconstruction for aortic graft infection with autologous FV presents acceptable rates of morbidity and mortality, and remains the treatment of choice for AGI at Helsinki University Hospital.

No abstract

Combined surgical and conservative therapy (voice therapy, treatment of infections, allergy, oesophageal reflux, and psychogenic stress) has been used in the treatment of non-specific vocal cord granuloma. Such tumors have a great tendency to recur. The 41 patients with vocal cord granuloma in our study (4 women, 37 men, mean age 56 years) were treated at our hospital during 1980-1986. Nine patients were healed with conservative treatment, 32 were treated by laryngomicrosurgery under general anesthesia and jet-ventilation. The latter group was divided into three treatment groups; 8 of these patients were treated with cryotherapy, 9 with postoperative steroids (Prednisolone 40 mg/day in decreasing doses) and antibiotics, and 15 only with microsurgery. At some phase in their treatment 41% of the patients were able to participate in voice therapy. The most recurrences were found in the group treated with cryotherapy, 2.7 rec./pat.; 1.8 rec./pat. were found in the group that underwent surgery, and 1.7 rec./pat. among the patients treated with steroid-antibiotics. In all three groups, some patients experienced recurrences. In the cryotherapy group, however, recurrent granulomas were large and required reoperation, while those in patients treated with steroid-antibiotics were small and could be cured using conservative therapy. If granuloma does not disturb the voice, cause respiratory obstruction or demand histopathological diagnosis, surgery is contraindicated. Cryotherapy does not help traditional surgery, while steroid-antibiotics administered postoperatively seem to help the healing process.

No abstract

Objectives: Genetic background has been identified to be a major predictor of post-clopidogrel platelet inhibition in patients undergoing coronary stenting. However, there is a lack of data on clopidogrel response regarding genotype in patients undergoing carotid artery stenting (CAS). The influence of the most common allelic variants of CYP2C19 phenotypes and genotypes on response to baseline clopidogrel and on the pharmacodynamic effect of dose adjustment (high or standard dose of clopidogrel) in patients with high on-treatment reactivity after CAS was investigated.Methods: Platelet reactivity was assessed before and 30 days after carotid stenting using the VerifyNow P2Y12 assay to obtain P2Y12 reactivity unit (PRU) values.Results: A total of 209 patients (79.4% male, 44.1% currents smokers) were treated by CAS. Smokers improved responsiveness to clopidogrel (P ¼ .034). With respect to CYP2C19 enzymatic function, 61 subjects (29.1%) were ultra-rapid metabolizers, 95 patients (45.5%) were extensive metabolizers, 51 (24.4%) were intermediate metabolizers, and two (0.96%) were poor metabolizers. Baseline PRU was significantly higher among intermediatedpoor metabolizers compared with ultra-rapid (P ¼ .001) or extensive metabolizers (P ¼ .005). At 30 days follow up, in non-responding patients with the intermediatedpoor metabolizer phenotype, the PRU value and inhibition percentage were significantly reduced with standard dose (P ¼ .008; P ¼ .0029) and high dose of clopidogrel (P ¼ .00 0; P ¼ .000). However, high dose clopidogrel did not achieve a more intense pharmacodynamic effect at 30 days (P ¼ .994) compared with standard dose.Conclusions: In patients undergoing carotid stenting, those with the CYP2C19*2 allele had increased basal PRU values and in fact clopidogrel non-responders increased significantly among intermediatedpoor metabolizers. Although high dose and standard dose clopidogrel therapy was effective in lowering the 30 day PRU values in patients with high on-treatment reactivity who are intermediatedpoor metabolizers, the use of high dose clopidogrel did not result in statistically significantly greater reductions in reactivity compared with the standard dose. Aortic Curvature Instead of Angulation Allows Improved Estimation of the True Aorto-iliac Trajectory Schuurmann R.C.L., Kuster L., Slump C.H., Vahl A., van den Heuvel D.A.F., Ouriel K., de Vries J.-P.P.M. Eur J Vasc Endovasc Surg 2016;51:216-24.Objective: Supra-and infrarenal aortic neck angulation have been associated with complications after endovascular aortic aneurysm repair. However, a uniform angulation measurement method is lacking and the concept of angulation suggests a triangular oversimplification of the aortic anatomy. (Semi-)automated calculation of curvature along the center luminal line describes the actual trajectory of the aorta. This study proposes a methodology for calculating aortic (neck) curvature and suggests an additional method based on available tools in current workstations: curvature by digital calipers (CDC).Methods: ...