Total Obliteration Research Articles

Susan Suleiman Responds to Judith Herman

Susan Suleiman Responds to Judith Herman Susan Rubin Suleiman (bio) Judith Herman’s comments made me realize that I had expressed myself clumsily in places, and I am glad to have this chance at clarification. My aim in my essay was to try to understand the stakes in a major contemporary debate, not to take sides. As concerns the question of memory and the definition of trauma, the conflicted issue is not memory disturbance, but total obliteration of the traumatic event in consciousness. I’m afraid there is disagreement on this issue among theorists, and the DSM-IV’s listing of “inability to recall an important aspect of the trauma” does not resolve it; it is one thing to be unable to recall an important aspect of a traumatic event, and another not to remember that the event occurred at all. It was clumsy of me to say, without apparent qualification—and Judith Herman is right to reproach me for it—that we live in a “cultural and legal environment where being a victim ‘pays.’” Yet I am not the first to point out that contemporary society, especially in the United States, has a tendency to wallow in stories of victimization—which does not mean that victims don’t suffer and often lead sad and miserable lives, as I think I acknowledge in my essay. Judith Herman herself was a bit hasty in attributing to me the “presumption” that “all patients who recover traumatic memories after a period of amnesia are . . . either overly suggestible (read feminine) or frankly malingering” (284). The link between suggestibility and femininity is not one that I make, nor do I imply it. I am careful to point out that even Richard McNally, who rejects theories of repression and dissociation, recognizes that people may forget an event for many years, and then remember it if there is a “trigger” for remembrance. I explicitly say, in my own name, that the existence of some false claims of posttraumatic stress disorder does not invalidate the many true claims. Finally, I stand by my statement that “wherever possible, it is a good idea to supplement the personal memories of trauma victims with historical research.” On September 27, 2007, the New York Times ran a long article about a woman named Tania Head, [End Page 285] who for the past six years has told a heart-rending story of survival and loss in the World Trade Center to avid audiences. Head was for a time president of the World Trade Center Survivors’ Network and often told the story of how her fiancé died in the North Tower while she herself was on the seventy-eighth floor of the South Tower when the second plane hit. The Times’s careful investigation revealed that every piece of information Head provided about her work, her education, and her involvement with the man she said was her fiancé has turned out to be false. This fact does not discredit or cast “scorn” on all the traumatized survivors of September 11; it does confirm the need for extreme caution in treading on the delicate grounds of memory, imagination, and trauma. [End Page 286] Susan Rubin Suleiman Susan Rubin Suleiman is the C. Douglas Dillon Professor of the Civilization of France and professor of comparative literature at Harvard. Her latest book is Crises of Memory and the Second World (Harvard University Press, 2006). Other books include Authoritarian Fictions: The Ideological Novel as a Literary Genre (Columbia University Press, 1983); Subversive Intent: Gender, Politics, and the Avant-Garde (Harvard University Press, 1990); Risking Who One Is: Encounters with Contemporary Art and Literature (Harvard University Press, 1994); and the memoir Budapest Diary: In Search of the Motherbook (University of Nebraska Press, 1996). Copyright © 2008 Kathryn Abrams & Irene Kacandes

The Effect of Pulp Obliteration on Pulpal Vitality of Orthodontically Intruded Traumatized Teeth

Limited information exists on the impact of pulp obliteration on pulpal vitality of orthodontically treated traumatized teeth. Pulpal condition was examined in 269 traumatized maxillary incisors after orthodontic intrusion (OT group) and in 193 traumatized maxillary incisors without subsequent orthodontic treatment (C group). According to the degree of initial pulp obliteration, the teeth were divided into three categories: teeth without, teeth with partial, and teeth with total pulp obliteration. Teeth in the OT group revealed a significantly higher rate of pulp necrosis than teeth in the C group (p < 0.001). In addition, teeth in the OT group with total pulp obliteration showed a significantly higher rate of pulp necrosis than teeth without (p < 0.001) or only partial pulp obliteration (p = 0.025). The results indicate that traumatized teeth with total pulp obliteration have a higher susceptibility to pulpal complications during orthodontic intrusion than traumatized teeth without or only partial pulp obliteration.

Analysis of X-knife and surgery in treatment of arteriovenous malformation of brain

The goal of treatment in arteriovenous malformation (AVM) is total obliteration of the AVM, restoration of normal cerebral function, and preservation of life and neurological function. To analyze the results of X-knife and surgery for AVM of the brain. The endpoints for success or failure were as follows: success was defined as angiographic obliteration and failure as residual lesion, requiring retreatment, or death due to hemorrhage from the AVM. From May 2002 to May 2007, 54 patients were enrolled for this study. Grade I AVM was seen in 9%, grade II in 43%, grade III in 26%, grade IV in 9%, and grade V in 13%. Thirty-eight patients were treated by microsurgical resection out of which Grade I was seen in 5 patients, Grade II was seen in 17 patients, Grade III was seen in 9 patients and Grade V was seen in 7 patients. Rest of the sixteen patients were treated by linear accelerator radiosurgery out of which Grade II was seen in 6 patients, Grade III was seen in 5 patients and Grade IV was seen in 5 patients. The follow up was in range of 3-63 months. In follow up, digital subtraction angiography/ magnetic resonance angiography (DSA/MRA) was performed 3 months after surgery and 1 year and 2 years after stereotactic radiosurgery (SRS). Among the patients treated with X-knife, 12/16 (75%) had proven angiographic obliteration. Complications were seen in 4/16 (25%) patients. Among the patients treated with microsurgical resection, 23/38 (61%) had proven angiographic obliteration. Complications (both intraoperative and postoperative) were seen in 19/38 (50%) patients. Sixty-one percent of patients were candidates for surgical resection. X-knife is a good modality of treatment for a low-grade AVM situated in eloquent areas of the brain and also for high-grade AVMs, when the surgical risk and morbidity is high.

Total rectal lumen obliteration after stapled haemorrhoidopexy: a cautionary tale

We describe obliteration of the rectal lumen during stapled haemorrhoidopexy in a patient with marked mucosal prolapse. The complication was recognised immediately and continuity was restored by performing a limited Delorme's procedure. The possible cause of this complication is explored and serves as a reminder that meticulous technique is required when performing stapled haemorrhoidopexy to prevent potentially disastrous complications.

Embolization of spinal intramedullary arteriovenous malformations using the liquid embolic agent, Onyx: a single-center experience in a series of 17 patients

The aim of this study was to analyze the endovascular treatment results of using the Onyx liquid embolic system for spinal intramedullary arteriovenous malformations (AVMs). The clinical and radiological records of 17 patients with symptomatic spinal intramedullary AVMs treated exclusively by embolization with Onyx between 1999 and 2003 were retrospectively reviewed. There were 12 females and five males in the patient series (mean age 29 years). Four of these AVMs were located in the cervical spine, eight in the thoracic spine, and five in the lumbar spine. The clinical presentation of these AVMs included upper motor neuron signs and symptoms, and hemorrhage was the initial presentation in 12 patients. Neurological and functional evaluation was performed before and after treatment with Onyx in all patients. Thirteen patients underwent a single endovascular treatment and four patients underwent two endovascular treatments (average 1.23 sessions per patient). Intraprocedural complications occurred on two occasions without neurological consequences. The mean follow-up duration was 24.3 months. Angiographic outcomes included total AVM obliteration in six patients (37.5%), subtotal obliteration in five patients (31.25%), and partial obliteration in five patients (31.25%). Improvement in neurological and/or functional status was noted in 14 patients, resulting in an 82% rate of overall good clinical outcome. Embolization using the Onyx system is a promising treatment method for spinal vascular malformations, even for challenging intramedullary AVMs. Larger studies with longer follow-up durations will further enhance our knowledge on the safety and efficacy of this relatively new liquid embolic agent.

Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients

BackgroundEpidemiological studies show that about 11.6% to 33.0% of all boys and about 3.6% to 19.3% of all girls suffer dental trauma of varying severity before the age of 12 years. Moderate injuries to the periodontium such as concussion and subluxation are usually associated with relatively minor symptoms and hence may go unnoticed by the patient or the dentist, if consulted. Patients with these kinds of injuries present years after a traumatic accident most of the time with a single discoloured tooth. This study sets out to document the incidence of various posttraumatic sequelae of discoloured anterior teeth among adult Nigerian dental patients.MethodsOne hundred and sixty eight (168) traumatized discoloured anterior teeth in 165 patients were studied. Teeth with root canal treatment were excluded from the study. Partial obliteration was recorded when the pulp chamber or root canal was not discernible or reduced in size on radiographs, total obliteration was recorded when pulp chamber and root canal were not discernible. A retrospective diagnosis of concussion was made from patient's history of trauma to the tooth without abnormal loosening, while subluxation was made from patient's history of trauma to the tooth with abnormal loosening.ResultsOf the 168 traumatized discoloured anterior teeth, 47.6% and 31.6% had partial and total obliteration of the pulp canal spaces respectively, 20.8% had pulpal necrosis. Concussion and subluxation injuries resulted more in obliteration of the pulp canal space, while fracture of the teeth resulted in more pulpal necrosis (p < 0.001). Injuries sustained during the 1st and 2nd decade of life resulted more in obliteration of the pulp canal space, while injuries sustained in the 3rd decade resulted in more pulpal necrosis.ConclusionCalcific metamorphosis developed more in teeth with concussion and subluxation injuries. Pulpal necrosis occurred more often in traumatized teeth including fractures.

A Rare Cause of Cauda Equina Syndrome

A Rare Cause of Cauda Equina Syndrome

Anatomical modifications of the mid palatal suture during ageing: a radiographic study

In transverse maxillary deficiencies it is important to know if the mid palatal suture is obliterated or not, to decide which treatment to perform (orthodontic expansion or surgical disjunction of the suture). The maxillary sutures obliteration has been used in forensic medicine in estimating adult age at death. In order to determine the proportion of mid palatal suture obliteration in the elderly in man, we examined 100 consecutive CT scans of the palate. This study has shown that the age of mid palatal total obliteration was variable. The obliteration begins in the anterior and in the superior part of the palate. The inferior part of the junction between the palatal processes is the last part of the suture to be obliterated.

Subtotal obliteration of cerebral arteriovenous malformations after Gamma Knife surgery

Subtotal obliteration of cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS) implies a complete angiographic disappearance of the AVM nidus but persistence of an early filling draining vein, indicating that residual shunting is still present; hence, per definition there is still a patent AVM and the risk of bleeding is not eliminated. The aim of this study was to determine the risk of hemorrhage for patients with subtotal obliteration of AVMs. After GKS for cerebral AVMs, follow-up angiography demonstrated a subtotally obliterated lesion in 159 patients. Of these, in 16 patients a subtotally obliterated AVM developed after a second GKS was performed for the partially obliterated lesion. The mean age of these patients was 35.2 years at the time of the diagnosis of subtotally obliterated AVMs. The lesion volumes at the time of initial GKS treatment ranged from 0.1 to 11.5 cm3 (mean 2.5 cm3). The mean peripheral dose used in the 175 GKS treatments was 22.5 Gy (median 23 Gy, range 15-31 Gy). To achieve total obliteration of the AVM, 23 patients underwent a new GKS targeting the proximal end of the early filling vein. The mean peripheral dose given in these cases was 23 Gy (median 24, range 18-25 Gy). The incidence of subtotally obliterated AVMs was 7.6% from a total of 2093 AVMs treated and in which follow-up imaging was available. The diagnosis of subtotally obliterated AVMs was made a mean of 29.4 months (range 4-178 months) after GKS. The number of patient-years at risk (from the time of the diagnosis of subtotally obliterated AVMs until either the confirmation of a total obliteration of the lesion on angiography or the time of the latest follow-up angiographic study that still visualized the early filling vein) was a mean of 3.9 years, ranging from 0.5 to 13.5 years, and a total of 601 patient-years. There was no case of bleeding after the diagnosis of subtotally obliterated AVMs. Of 90 patients who did not undergo further treatment and in whom follow-up angiography studies were available, the same early filling veins still filled in 24 (26.7%), and the subtotally obliterated AVMs were subsequently obliterated in 66 patients (73.3%). In 19 patients who underwent repeated GKS for subtotally obliterated AVMs and in whom follow-up angiography studies were available, the AVMs were obliterated in 15 (78.9%) and remained patent in four (21.1%). The fact that none of the patients with subtotally obliterated AVMs suffered a rupture is not compatible with the assumption of an unchanged risk of hemorrhage for these lesions, and implies that the protection from rebleeding in patients with subtotal obliteration is significant. Subtotal obliteration does not necessarily seem to be a stage of an ongoing obliteration. At least in some cases it represents an end point of this process, with no subsequent obliteration occurring. This observation requires further confirmation by open-ended follow-up imaging.

Trichoblastic Sarcoma: A High-grade Stromal Tumor Arising in Trichoblastoma

We report a case of primary sarcoma of the skin with a biphasic histological pattern, being composed of areas of mixed mesenchymal-epithelial cell proliferation and areas of purely sarcomatous growth. The tumor occurred in the posterior cervical region of a 93-year-old man, and its history was marked by sudden, rapid enlargement after many years of stable duration. The excised lesion was about 4 cm in diameter, had a firm consistency and was covered by intact skin. Histological examination showed a multifocal proliferation of follicular germinative cells arranged in corymbiform and petaloid shapes with an overall retiform growth pattern. Epithelial cords and strands were composed of cytologically uniform cells with bland nuclear features and were surrounded by a prominent, fibroblast-rich stroma reminiscent of a perifollicular sheath. In many areas of the tumor the stroma showed abrupt transition into a pleomorphic proliferation of large sarcomatous cells with frequent and often atypical mitoses. Multinucleated neoplastic cells infiltrated the epithelial structures to cause their partial or total obliteration in many fields of the lesion. Immunohistochemically, the epithelial cells displayed expression of various keratins, with a particularly intense staining for 34betaE12, and were partly positive for the CD10 antigen. A strong immunostaining for this antigen was also observed in malignant-appearing stromal areas, where no expression of cytokeratins was detected. Moreover, nuclear positivity for p53 protein was seen in sarcomatous cells, whereas it resulted in total lack of epithelial elements. Our case emphasizes that high-grade sarcoma may occur in the spectrum of trichoblastic tumors and that it may share some features of other noncutaneous biphasic neoplasms, such as mammary cystosarcoma phyllodes.

Vitamin E Protects against the Development of Radiation-induced Pulmonary Fibrosis in Rats

Aims To investigate whether the application of vitamin E with or without pentoxifylline could modify the development of radiation-induced pulmonary fibrosis. Materials and methods Wistar albino rats were supplemented with either vitamin E or pentoxifylline or with both vitamin E and pentoxifylline after a single dose of 14 Gy thoracic irradiation. Supplementation was started the day after irradiation and continued until the rats were sacrificed. As a quantitative end point, the extent of fibrosis was evaluated with a scale from 0 (normal lung) to 8 (total fibrous obliteration of the field) at pathological examination of the lung tissue. Results A significant reduction in fibrosis was obtained in the group of rats supplemented with vitamin E with or without pentoxifylline, when compared with the group that had irradiation only. Conclusion This experimental study showed that vitamin E supplementation immediately after irradiation protected rats against radiation-induced pulmonary fibrosis. The combination with pentoxifylline was more effective, although pentoxifylline itself had limited efficacy, which was not statistically significant.

Incidental intracranial aneurysm

The management of of unruptured intracranial aneurysms is one of the most important issues confronting neurosurgeons today. The high mortality and morbidity associated with subarachnoid hemorrhage (SAH) has prompted interest in repair of aneurysms that are discovered before they have ruptured. A strong risk factor for intracranial aneurysm which causes SAH is a positive family history, polycystic kidney disease and patients who have survived a SAH. There is no cutoff size of aneurysm below which rupture is not possible. Presently there are no definitive guidelines in the management of incidental aneurysms and many centers consider each case individually with treatment offered for lesions more than 7 mm in diameter especially if patient is relatively young without major co-morbidities. Even though microsurgery offers the advantage of proven durability and higher rates of total aneurysm obliteration, the choice of treatment modality between open microsurgery and endovascular occlusion is flexibly adjusted to each case.

Long-term results of Gamma Knife surgery for arteriovenous malformations: 10- to 15-year follow up in patients treated with lower doses

Several adverse effects such as brain edema, necrosis, arterial stenosis, hemorrhage after obliteration, and delayed cyst formation have been reported as early and late complications of Gamma Knife surgery (GKS) for arteriovenous malformations (AVMs). These adverse effects seem to be decreased in a lower-dose treatment regimen compared with the classic higher margin doses of 25 Gy because the radiation insult to the surrounding tissue is minimized. Long-term results of lower-dose GKS for AVMs are presented. One hundred fourteen patients with AVMs were treated with lower-dose GKS (< or = 20-Gy margin dose). There were 68 male and 46 female patients, aged 10 to 68 years (mean 35.4 years). The evaluation of AVM nidi and dose planning were performed using both angiography and MR imaging in all cases to exclude the surrounding brain tissue. The mean margin dose was 19.5 Gy. Total angiographically documented obliteration was achieved in 65 (85.5%) of 76 patients. Eleven patients underwent a second treatment, including staged treatment for large AVMs; total AVM obliteration has been achieved in six of them to date. Of 38 patients in whom no follow-up examination could be performed, 19 of them were healthy and 10 were lost from follow up. Nine patients experienced bleeding during the latency period, and four of them suffered lethal hemorrhage. Symptomatic early complications were extensive brain edema after repeated GKS in one patient and an adverse effect on the internal capsule in one. Delayed cyst formation was found in one patient as a late complication 10 years after treatment. No treatment-related death has been noted to date. Lower-dose GKS is an effective and safe treatment for patients with AVMs and may decrease long-term adverse effects to the surrounding brain.

Effects of Zn substitution on the magnetic and transport properties of La 0.6Sr 0.4Mn 1− yZn yO 3−δ (0≤ y≤0.3)

Phase-singular solid solutions of La 0.6Sr 0.4Mn 1− y Zn y O 3−δ(0≤ y≤0.3) [LSMZO] perovskite of rhombohedral symmetry (space group: R 3 ¯ c ) with y up to 30 at.% could be synthesized notwithstanding the differences in ionic radii of Mn V I 3+ (i.r.=0.645 Å) and Zn V I 2+ (i.r.=0.74 Å). The LSMZO≤02 compositions are ferromagnetic metallic (FMM) at room temperature whereas LSMZO-02–08 are ferromagnetic insulators (FMI) and LSMZO>08 are paramagnetic insulators (PMI). Total obliteration of the FM transition is unique to Zn-doping at y > 8 at. % leading to PMI even at low temperatures, measured up to 8 K (presently). The FM to PM transition ( T c ) and the peak ( T p ) in resistivity–temperature curves decreases with the Zn-content. The charge-transport in p -type LSMZO is predictable by variable range hopping (VRH), which changes to nearest-neighbor hopping of small polarons (NNHP) at T > T p . Non-stoichiometry ( 0.005 ≤ δ ≤ 0.21 ) evaluated chemically from redox titrations indicated the prevalence of excess oxygen vacancy ( V O ) rather than charge compensatively predictable values which, in turn, indicates the diminishing Mn 4+ content in LSMZO. The V O ’s act as electron donors in p -LSMZO and this increases the resistivity ( ρ R T ) associated with the shift in T c to low temperatures. Increased ρ R T on annealing in low p o 2 is a clear evidence on the role of V O in LSMZO.

Endovascular embolization of ruptured cerebral aneurysms in patients older than 70 years

The decision to manage ruptured cerebral aneurysms (RCAs) aggressively in elderly patients remains difficult because of inherent procedural risks and patient comorbidities. The purpose of this study was to report our experiences with and outcomes of endovascular embolization of RCAs in patients older than 70 years. We studied 25 patients older than 70 years with RCAs treated by endovascular embolization. There were 10 men and 15 women with a mean age of 77 years. Subarachnoid haemorrhages of grades 1–3 were found in 24 patients, and one patient had grade 4 subarachnoid haemorrhage. Twenty-two RCAs were located in the anterior circulation, and three were in the posterior circulation. Seventeen RCAs were wide-necked aneurysms and five had to undergo stent-assisted coil embolization. Endovascular embolization was technically successful for all RCAs. Total angiographic obliteration of RCAs was achieved in eight (32%) cases, whereas the other 17 RCAs were subtotally or partially occluded. Procedure-related death or severe disability occurred in two patients (8%). There was no rebleeding in any patient on follow-up. Endovascular embolization of RCAs has been proven to be both safe and effective in elderly patients, and should be performed in patients for whom surgical clipping would be difficult.

Treatment of Pharyngocutaneous Fistulae with a Cork-Design Radial Forearm Free Flap

Pharyngocutaneous fistula is a dreaded complication after ablative surgery of the aerodigestive tract including the pharynx and larynx. This is a common problem for the surgeon. Two cases are presented with pharyngocutaneous fistula developing after total laryngectomy and radiation therapy. The fistula was reconstructed using a cork-design radial forearm free flap. Total obliteration of the fistula was obtained without complications. This new design provides the following advantages: extensive contact area between the flap and the inflamed surrounding tissue, discontinuity between the suture lines of the inner lining and the outer cover, and reinforcement of the suture line of the outer covering with skin graft. This method can be useful in reconstructing irradiated pharyngocutaneous fistulas.

Tenascin Is Expressed in Post-Transplant Obliterative Bronchiolitis

Tenascin is expressed in inflammatory and fibroproliferative processes, both contributing to posttransplant obliterative bronchiolitis (OB) in association with epithelial cell injury and airway obliteration. We studied bronchial allografts to elucidate the role of tenascin during this alloimmune response. Bronchial segments were subcutaneously implanted into eight pigs. Allografts and autograft controls were serially obtained until total obliteration in allografts and processed for histology and immunocytochemistry for CD4, CD8, and tenascin. Findings were graded on a scale from 0 to 3. In autografts the operative epithelial damage recovered and bronchi stayed patent with mild-graded fibrosis and inflammation. Partial recovery was observed in allografts on day 4, thereafter the epithelial loss gradually increased. Total recovery was achieved on day 11 ( P < .001). Fibroblast proliferation resulted in total luminal obliteration on day 21 ( P < .001). The number of inflammatory cells increased rapidly ( P < .05) with numerous CD4+ and CD8+ cells on day 14 ( P < .0001). Prior to total epithelial loss in allografts, tenascin expression was observed on day 7 in 69% of epithelial cells, whereas in only 5% of epithelial cells in recovered autografts. Paralleling the most intense fibroproliferation, tenascin-positive cells were observed in the bronchial wall on day 7 and day 11 ( P < .001). Tenascin expression was demonstrated during the inflammatory response and fibroblast proliferation during the early stage of obliterative bronchiolitis showing that tenascin contributes to posttransplant obliterative bronchiolitis development.

Analysis of anomalies of the epididymis and processus vaginalis in human fetuses and in patients with cryptorchidism treated and untreated with human chorionic gonadotrophin

To analyse the incidence of epididymal anomalies and the structure of the processus vaginalis (PV) in patients with cryptorchidism treated or not with human chorionic gonadotrophin (hCG), and to compare these findings with human fetuses with testes in the scrotum. We assessed 24 fetuses with a gestational age of 23-35 weeks, and 114 cryptorchid patients (mean age 10.3 years). The patients were divided into two groups of those who used hCG (55, 65 testes) and those who did not (59, 75 testes). The sample was divided into six groups of possible anatomical relationships between the testis and the epididymis, according to a previous classification. Two situations were considered to analyse the PV: (a) total obliteration between the internal inguinal ring and the upper pole of the testis; and (b) total patency. Epididymal anomalies were found in 35% of patients with cryptorchidism and in only 4% of normal fetuses. Of the 47 cases of epididymal anomalies in patients with cryptorchidism 23 (49%) were treated with hCG and 24 (51%) were not. The PV was patent in 58% of patients with cryptorchidism and in only 5% of fetuses. Considering the three groups, the epididymal anomalies were more frequent when the PV was patent. Patency of the PV and the incidence of epididymal anomalies were more frequent in patients with cryptorchidism. The existence of epididymal anomalies did not influence testicular migration in patients treated with hCG.

Endovenous Laser Ablation of Saphenous Vein is an Effective Treatment Modality for Lower Extremity Varicose Veins

We present our first experiences with the use of a new minimally invasive treatment of lower extremity varicose veins. We studied the occlusion rates of the great saphenous vein (GSV) with laser ablation, its failure rates, and its complications. Sixty-six limbs in 62 consecutive patients were treated and followed-up for 1 year. All of the patients had incompetent GSV proven by means of duplex scanning. The GSV segment from 2 cm distal to the sapheno-femoral junction to just above the knee was ablated by using laser energy. In addition, all patients had stab avulsions of the varicose veins of the leg with Crochet hooks. All patients were followed postoperatively on the 3rd day, 1 month, 3 months, and 1 year after surgery. All patients were treated as day-case surgeries. Among 62 patients studied, 46 patients were women (74%) and 16 were men (26%). The median age of the patients was 53 years (range 28-69 years). Median operation time was 65 min (range 40-140 min). Successful treatment (total obliteration of the GSV on duplex) was accomplished in 64 of 66 limbs (97%). In two cases, recanalization of the lower one-third of the treated segment of the GSV was noted after 3 months. There were no instances of neuropathy or skin burn. Endovenous laser ablation of varicose veins is effective in inducing thrombotic vessel occlusion and is associated with only minor adverse effects. The procedure seems to be a promising alternative for surgical stripping of the GSV.

Immune Cell Infiltration and Broncovascular Remodeling After Nitric Acid Nasal Instillation in a Mouse Bronchiolitis Obliterans Model

Immune cell airway infiltration and the bronchovascular remodeling process have shown to be promising in the understanding of bronchiolitis obliterans (BO) pathogenesis. In this study we sought to validate the importance of immune cells, whether diffusely distributed or forming lymphoid follicles, collagen density, and vascular factors. Eight weeks after a single nitric acid (NA) nasal instillation, lung changes were characterized by lumen distortion, epithelial layer folding, reduction or total obliteration of terminal bronchiole (TB) lumen, and wall thickness increase. The morphologic changes in the TB and TA (terminal artery) lumen coincide with the measurement difference in the three groups. The TB diameter and lumen were significantly decreased in BO when compared with non-BO lungs (0.76 +/- 0.05 microm vs. 0.81 +/- 0.05 microm and 12,286.13 +/- 378.83 microm vs. 18,182.27 +/- 5,593.98 microm, p = 0.05 and p = 0.01, respectively). Equally significant was the increase in TB thickness in BO when compared with the non-BO group (201.72 +/- 35.75 microm vs. 149.75 +/- 40.61 microm, p = 0.007). The morphologic changes in immune cells seen in TB, TA, and bronchus-associated lymphoid tissue (BALT) also coincide with the quantification differences observed in the three groups. We concluded that immune cell infiltration and collagen/vascular remodeling are related to the spectrum of histologic changes in a BO nasal-induced model in mice and may be an appropriate target for prospective studies of human bronchiolitis.