Ivica Sjekavica

Post-traumatic high-flow priapism treated by endovascular embolization using N-butyl-cyanoacrylate

Post-traumatic high-flow priapism treated by endovascular embolization using N-butyl-cyanoacrylate Background. Priapism, persistent erection without arousal, can be classified into low-flow (venous or ischemic) and high-flow (arterial or non-ischemic). The diagnosis of high-flow priapism can be confirmed by colour Doppler and arteriography and it is usually treated by the endovascular embolization. Case report. We present a case of a 20-year-old man with a post-traumatic high-flow priapism as a result of the previous perineal trauma. After a period of watchful waiting and an unsuccessful attempt at endovascular embolization using the resorptive gelatinous foam he was successfully treated by the endovascular embolization using N-butylcyanoacrylate. Conclusions. High-flow priapism can be successfully treated by the endovascular embolization, but the optimal choice of the embolization agent and a careful technique is essential.

Rat inferior caval vein (ICV) ligature and particular new insights with the stable gastric pentadecapeptide BPC 157

Rat inferior caval vein (ICV) ligation (up to the right ovarian vein (ROV)) commonly represents a recapitulation of Virchow: with ligation leading to vessel injury, stasis, thrombosis and hemodynamic changes. We revealed that BPC 157s therapy collectively attenuated or counteracted all these events and the full syndrome. METHODS We applied BPC 157 (10 μg, 10 ng/kg) as an early regimen or as a delayed therapy. Assessment includes gross assessment by microcamera; microscopy, venography, bleeding, blood pressure, ECG, thermography, MDA and NO-level in plasma and ICV, and gene expression. RESULTS Direct vein injury, thrombosis, thrombocytopenia, prolonged bleeding were all counteracted. Also, rapid presentation of collaterals and redistribution of otherwise trapped blood volume (bypassing through the left ovarian vein (LOV) and other veins), with venous hypertension, arterial hypotension and tachycardia counteraction were shown. BPC 157-rats presented raised plasma NO-values, but normal MDA-values; in ICV tissue reverted low NO-values and counteracted increased MDA-levels. Altered expression of EGR, NOS, SRF, VEGFR and KRAS in ICV, ROV and LOV revealed increased or decreased levels, while some genes continuously remained unchanged. CONCLUSION As a new insight, BPC 157 application largely attenuated or even completely eliminated all consequences of ICV ligation in rats.

Resistance index in mural arteries of thickened bowel wall: predictive value for Crohn disease activity assessment in pediatric patients

SummaryObjectiveTo define reliable Doppler parameters in mural arteries of affected bowel loops for quantitative assessment of Crohn disease (CD) activity in pediatric population and compare Doppler parameters with Pediatric Crohn Disease Activity Index (PCDAI).Patients and methodsThirty-four pediatric patients (7 with inactive, 27 with active disease of different severity; 13 male and 21 female; mean age 13; range 7–18) with CD were prospectively evaluated by Doppler ultrasound (DUS) of affected bowel segments. Using semiquantitative color and power Doppler assessment of vascularization of thickened bowel wall and mesentery, patients were divided in four grades. Spectral measurements (peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI)) of mural arteries were compared with PCDAI.ResultsThere was a significant difference in distribution of semiquantitative color values between inactive and active group. PSV and EDV values showed no significant difference between inactive and active group, while mean RI was significantly higher in the inactive group. RI was also significantly negatively correlated with PCDAI.ConclusionIntensity of color and power Doppler signals and RI measurement of mural arteries in thickened bowel wall is linked to CD activity and therefore might be of use in pediatric patients.ZusammenfassungZielDas Ziel dieser Studie war es, die zuverlässigen Doppler-Parameter in den intramularen Arterien der betroffenen Darmschlingen zur quantitativen Bewertung der Aktivität des Morbus Crohn (CD) bei der pädiatrischen Population zu definieren und die Doppler-Parameter mit dem pädiatrischem Morbus Crohn Aktivitätsindex (PCDAI) zu vergleichen.Patienten und MethodenDer Zustand von 34 pädiatrischen Patienten (7 mit inaktiver, 27 mit aktiver Erkrankung unterschiedlichen Schweregrades, 13 männliche und 21 weibliche, Alter 7–18, Durschnittsalter 13) mit M. Crohn wurde prospektiv anhand des Doppler-Ultraschall (DUS) betroffener Darmsegmente ausgewertet. Anhand der semi-quantitativen Farb- und Power-Doppler-Beurteilung der Vaskularisation der verdickten Darmwand und des Mesenteriums wurden die Patienten in 4 Gruppen unterteilt. Die spektrale Messungen (die maximale systolische Strömungsgeschwindigkeit – PSV, die enddiastolische Strömungsgeschwindigkeit – EDV, der Resistance-Index – RI) intramuraler Arterien wurden mit PCDAI verglichen.ErgebnisseEs bestand ein signifikanter Unterschied in der Verteilung der semi-quantitativen Farbwerte zwischen der inaktiven und aktiven Gruppe. PSV und EDV-Werte zeigten keinen signifikanten Unterschied zwischen der inaktiven und der aktiven Gruppe, während der mittlere RI in der inaktiven Gruppe signifikant höher war. Der RI war ebenfalls signifikant negativ mit dem PCDAI korreliert.SchlussfolgerungDie Intensität der Farb- und Power-Doppler-Signale und die RI-Messung in den intramuralen Arterien der verdickten Darmwand stehen im Zusammenhang mit der Aktivität des Morbus Crohn und können daher bei pädiatrischen Patienten von Nutzen sein.