Petr Hoffmann

Integration of Endovascular Therapy of Ruptured Abdominal and Iliac Aneurysms in the Treatment Algorithm: A Single-Center Experience in a Medium-Volume Vascular Center

Purpose: To evaluate the influence of endovascular therapy of ruptured abdominal or iliac aneurysms on total mortality. Materials and Methods: We analyzed the mortality of 40 patients from 2005 to 2009, when only surgical treatment was available. These results were compared with the period 2010 to 2013, when endovascular aneurysm repair (EVAR) was assessed as the first option in selected patients. Results: During 2005 to 2009, the mortality was 37.5%. From 2010 to 2013, 45 patients were treated with mortality 28.9%. Open repair was performed in 35 (77.8%) patients and EVAR in 10 (22.2%) patients. The 30-day and 1-year mortality rates of the EVAR group were 0% and 20%, respectively, and the total mortality rate was 30% during follow-up (median 11 months, range 1-42 months). The 30-day mortality in the surgical group remained unchanged, at 37.1%, and 1-year and total mortality rates were 45.7% and 51.4%, respectively. Conclusion: Following integration in the treatment algorithm, EVAR decreased total mortality in our center by 8.6%.

Ruptured bronchial artery aneurysm: case report.

Bronchial artery aneurysm is a very rare condition. Its rupture can cause a life threatening hemorrhage. We report a case of a 50-year-old patient with a ruptured bronchial artery aneurysm who presented with epigastric pain. It is the first published case with such signs of a rupture of a bronchial artery aneurysm. CT scan confirmed the diagnosis. The patient was treated with endovascular embolization.

Long-term experience with endovascular therapy of the descending thoracic aorta

BackgroundTo review single centre experience of endovascular treatment of descending thoracic aorta.MethodsBetween May 1999 and September 2012, 72 patients were treated overall (53 men, 19 women, mean age 60.1 years) for degenerative aneurysms (n = 5), ruptured aneurysms (n = 4), aortic ulcers (n = 8), infected aneurysms (n = 4), type B aortic dissections (n = 23), and traumatic aortic injuries (n = 28).ResultsThe technical success rate was 98.6%, 30-day mortality was 8.3%, 1-year mortality was 13.8%, and overall mortality was 22.2%. Mortality caused by the treatment of aortic diseases was 6.9%. Permanent stroke occurred in 1 patient, and paraplegia developed in 1 patient. In a group of 23 patients whose left subclavian artery (LSA) was covered, claudication of the left upper extremity developed in 2 cases.ConclusionsEndovascular therapy offers a very effective and less invasive alternative to the surgical approach for a wide range of the thoracic aortic disease. The main advantage of using TEVAR seems to be in acute conditions when a stent graft stabilizes the aorta and prevents further bleeding and organ ischemia. Regular follow-up is mandatory for early recognition of specific TEVAR complications.

Case 3-2011: Invasive mucormycosis (zygomycosis) after bone marrow transplantation in a 26-year-old man with relapsing acute myeloid leukaemia.

Patient J.S., 26-year-old man, was first seen by his general practitioner because of chest pain, dyspnoea, weakness, vomiting, headache, dizzines and recent fever on January 29th 2010. Blood samples were taken and revealed leukocytosis 149 × 109/L. His previous medical history was unremarkable. He was immediately referred to our University Hospital with suspicion of acute leukaemia. On admission in the evening of the same day, his leukocyte blood count was already 248 × 109/L and mild anaemia and thrombocytopenia was present. The diagnosis of acute myeloid leukaemia (myelomonocytic according to WHO classification) was made. There also was a severe syndrome of leukostasis on admission, and the patient developed acute myocardial infarction and respiratory insufficiency. Immediate leukoreduction with leukapheresis and hydroxyurea was started. When leukocyte count was reduced below 50 × 109/L chemotherapy with intermediate dose cytarabine (total dose 24 g) and idarubicin (total dose 70 mg) was started. Despite drastic leukoreduction our patient developed systemic inflammatory response syndrome (SIRS) with multiorgan failure reflecting tumor lysis syndrome following chemotherapy. He received artificial ventilation for respiratory failure caused by diffuse alveolar haemorrhage, and continuous renal replacement therapy for renal failure was started. The course of his disease was further complicated by shock, disseminated intravascular coagulation and liver failure. With full supportive care and corticosteroids patient was stabilised and eventually, after 5 days, he was successfully extubated and his renal and liver function recovered. Unfortunately, the induction chemotherapy did not lead to remission of the leukaemia. Patient received reinduction chemotherapy with FLAG IDA regimen (fludarabine, cytarabine, idarubicin, G-CSF) on March 6th. The remission was not achieved once again and another reinduction with HAM chemotherapy (cytarabine, mitoxantrone) was instituted on April 18th. Finally, there was a complete remission on bone marrow examination on May 27th. Patient obtained consolidation treatment (again HAM chemotherapy) and was scheduled for allogeneic stem cell transplantation. On August 18th he was admitted for allogeneic peripheral blood stem cell transplantation. His donor was unrelated woman with 3 mismatches (7/10). Unfortunately, before transplantation his bone marrow examination revealed a relapse of acute leukemia, and we decided to proceed to fully ablative approach enforced with cytarabine and mitoxantrone. The remission with 96% donor chimerism was achieved on September 29th. After transplantation he developed grade 3 skin acute graft versus host disease and BK virus hemorrhagic cystitis. Graft versus host disease resolved with corticosteroids treatment and hemorrhagic cystitis with reduced immunosupression. On November 11th, second relapse of the disease was diagnosed. The patient received chemotherapy and again developed multiorgan failure with respiratory failure and was artificially ventilated. He recovered and still cytopenic he refused further hospital stay and was discharged. Voriconazol was used as a prophylaxis during neutropenia. He was admitted shortly afterwards with the clinical signs of sepsis. Physical examination and X-ray revealed left side pneumonia and pericarditis. On pulmonary high resolution CT scan (HRCT), there was bilateral pneumonia with atypical pattern (Fig. 1). He also complained of vision disturbance, and an ischemic lesion in the occipital area on brain CT scan was found (Fig. 2). Lumbar puncture did not reveal any pathogen. Immediate treatment with antibiotics (meropenem and amikacin) and amphotericin B in combination was started. The patient died within 2 days (November

Endovascular Treatment of Symptomatic Thoracic Aneurysm Due to Periaortic Lymphoma

An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography–guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.

CT-guided biopsy of the mediastinal masses. Can anatomical relationships predict complications?

AIM To retrospectively evaluate the technical features, feasibility, efficacy, accuracy and appropriate complications of CT-guided biopsies of mediastinal masses and correlate them with anatomical relationships in the mediastinum. METHODS Over the course of ten years, 81 percutaneous biopsy procedures in 78 patients for tumors sizes 27 - 189 mm in diameter (median length 57.5 mm) were performed using only local anesthesia. These interventions were done under the guidance of computed tomography. The patients were men in 30 cases and women in 48 cases, aged 19 to 90 years. RESULTS In 78 cases (96.3%) results were either true positive or true negative; in only 3 cases (3.7%, 3 biopsies of 2 tumors in 2 patients) were histological findings false negative. In 2.3% of the patients, complications were revealed in the anterior part of the mediastinum, 43.7% occurred in the middle region, and 14.3% in the posterior region of the mediastinum. Statistical data analysis verified there was a 3.74 times chance of an increase in complications in the middle mediastinal section in correlation with other anatomical localizations. In only one case was therapeutic intervention for complication necessary. For all other cases, a conservative approach was suitable. CONCLUSION Percutaneous CT guided biopsies of the mediastinal tumors has a high accuracy rate in establishing the correct diagnosis. Masses in the middle mediastinum are associated with statistically higher incidences of postprocedural complications, which are not serious.

Percutaneous radiofrequency and microwave ablation in the treatment of renal tumors – 10 years of experience

Introduction The standard radical treatment of renal cell carcinoma is surgical resection, but it is not suitable for patients with serious medical comorbidities and solitary kidney tumors. Minimally invasive ablation techniques could be an appropriate therapeutic alternative. Aim To retrospectively evaluate the technical success, mid-term and long-term efficacy and safety of radiofrequency and microwave ablation in patients with small renal tumors. Material and methods Over the course of 10 years, 91 ablation procedures in 64 patients for 68 tumors, of size 12–60 mm, were performed using only conscious sedation. These ablations were done under the guidance of computed tomography. We treated 41 males and 23 females with solitary kidney tumors (14 cases) and tumors in non-surgical candidates (54 cases). Results In 50 (73.5%) tumors single treatment was successful; in 13 (19.1%) cases a second procedure was used successfully, and in the 5 largest tumors (sizes 45–60 mm, 7.4%) a third treatment was necessary. Within the follow-up 10 (15.6%) patients died, but none due to metastatic renal cell carcinoma. Only 1 serious complication was observed – retroperitoneal and psoatic hematoma. Early recurrence occurred in 18 (26.5%) tumors. Late recurrence was detected in 5 (7.4%) cases. In all cases complete local control of the renal tumors was reached. Conclusions Percutaneous ablation is a very effective treatment for patients with small renal tumors of the T1a group with a minimal complication rate.

Power of S-kR-RRWW-automata

Single k-reversible restarting automata are a special version of restarting automata which can be effectively learned from samples. We show that their power lies between GCSL and CSL. We show that their subclasses form an infinite hierarchy of classes of languages with respect to the reversibility level k and we also show that limiting types of allowed rewrites lowers the power of the model. Finally, we study their relation to strictly locally testable restarting automata.

Learning Analysis by Reduction from Positive Data Using Reverible Languages

The analysis by reduction of P. Jancar et al (1999) is a method for checking correctness of a sentence from a natural language. To model the analysis by reduction so-called restarting automata can be used. We propose a method for learning special kind of restarting automata called single zero-reversible restarting automata (S-ZR-RRWW-automata). Interesting learning results achieved by using our implementation of the method are given. In addition the power of the model is investigated.