Aneurysms of the distal branches of the external carotid artery

Aneurysms of the distal branches of the external carotid artery are rare and usually traumatic in origin. We present two cases which were treated in our clinic. The first case is about a traumatic aneurysm of the left superficial temporal artery (STA) in a young boy 8 years old. The young patient developed a pulsatile mass above his left eyebrow ten clays after a bite by a boy of the same age. The second case is referred in a 36-year old woman with a pulsatile mass behind the right ear; which was an aneurysm of the posterior auricular artery. The treatment was ligation and resection under local anesthesia in the first case and under general anesthesia in the latter Surgeons’ familiarity with this entity is important for diagnosis and treatment

Ampullary carcinoid and jejunal stromal tumour associated with von Recklinghausen's disease presenting as gastrointestinal bleeding and jaundice

We report a very rare case of a 36-year-old woman with von Recklinghausen’s disease, synchronous carcinoid of the ampulla of Vater and stromal tumour of the jejunum, who presented with gastrointestinal bleeding and jaundice. (C) 2000 Harcourt Publishers Ltd

Changes of the infrarenal aortic segment after conventional abdominal aortic aneurysm repair

Objectives: To delineate the natural history of the residual infrarenal aortic segment after conventional abdominal aortic aneurysm (AAA) repair. Design: Open prospective study. Patients and methods: Between 1990 and 1997, 100 patients, who underwent conventional infrarenal AAA repair at our department, were followed annually by means of colour duplex ultrasonography. Data from 76 patients who had at least 3 scans were analysed. Results: Mean duration of follow-up was 4.7 years (range: 3-8 years). The residual infrarenal aorta dilated a mean of 0.57 mm annually. No patient required reoperation. There was no significant correlation between dilatation and any of the recorded risk factors except for the initial neck diameter (p = 0.03). Conclusions: Conventional AAA surgery is durable so that surveillance, during the first 5 postoperative years, is not justified in terms of cost-effectiveness. The impact of such a dilatation on endovascular AAA repair requires further investigation

Inflammation and Chlamydia pneumoniae infection correlate with the severity of peripheral arterial disease

Background: Our aim was to investigate the association of inflammation and Chlamydia pneumoniae infection with the presence and severity of peripheral arterial disease. Methods: Twenty-eight patients Whose initial claudication distance (ICD) in the traditional constant-load treadmill test was < 200 m, underwent femoral endarterectomy as part of their interventional treatment (group A). Group B consisted of 23 patients whose ICD was > 200 m and were put on medication and a daily exercise program. The control group consisted of 30 non-vascular patients of the Ophthalmology Department (group C). We measured the levels of C-reactive protein, fibrinogen, vascular cell adhesion molecule-1 and tumor necrosis factor-alpha, and the titers of IgA and IgG antibodies against C. pneunioniae in the serum of all the patients, Finally, the atheromas and vein segments of group A patients, were immunohistochemically (IHC) examined for the presence of C. pneumoniae. Results: Peripheral arterial disease (PAD) patients, had significantly higher CRP (p = 0.026) and anti-Cp TgA levels (p 0,001) when compared to control subjects, after a multiple linear regression analysis. The odds ratio for the prevalence of femoral atherosclerosis was 3.1.6 for IgA seropositive patients (Cl 1.15-8.67). When comparing group A and group B patients, CRP (p=0.003) and IgA (p=0.011), were significantly correlated with severe PAD. Group A patients with positive immunohistochemical examination of the plaque, had higher anti-Cp TgA levels (p=0.023) and TNF-alpha values (p= 0.031), compared to the IHC negative patients. C. pneumoniae was detected in 50% of the femoral atheromas, but in only 3.6% of the veins. Conclusion: This study supports the hypothesis that inflammation (CRP) and chronic C. pneumoniae infection (IgA seropositivity), have an important role in lower limb atherosclerosis and correlate with the severity of the disease

Immunosuppressive regimens based on Cyclophospamide or Calcineurin inhibitors: Comparison of their effect in the long term outcome of Primary Membranous Nephropathy

Introduction Management of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term followup. Aim The aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN. Patients-methods Clinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens. Results Twenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14- 87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, p<0.0001, and no response rate: 22.5% vs. 13.6%, p = 0.04, respectively. Conclusions Long term follow up showed that administration of Cyclo in PMN is followed by better preservation of renal function, increased response rate and less frequent relapses, compared to CNIs. © 2019 Stangou et al