Systemic Inflammatory Response and Severe Thrombocytopenia after Endovascular Thoracic Aortic Aneurysm Repair

After Endovascular repair of thoracic aortic aneurysm, a systemic inflammatory response, named postimplantation syndrome, can develop. This syndrome is characterized by fever, leukocytosis, and elevated CRP plasma levels and its pathogenetic mechanisms are still unknown. Although this syndrome generally resolves within few days, some patients develop a persisting severe inflammatory reaction leading to mild or severe complications. Here we describe the case of a male patient who developed postimplantation inflammatory syndrome and severe thrombocytopenia after endovascular repair of thoracic aortic aneurysm. Treatment with prednisone (50\u2009mg/bid) for two weeks did not improve the clinical and laboratory findings. We utilized danazol, a weak androgen that has been shown to be effective in the treatment of immune and idiopathic thrombocytopenic purpura, and after 12 days of treatment with danazol (200\u2009mg/bid), the patient improved progressively and platelet number increased up to 53,000/\u3bcL. Patients undergoing endovascular repair of thoracic aortic aneurysm should be carefully monitored for the development of postimplantation syndrome. This clinical condition is relatively common after the endovascular repair of aortic aneurysm but is rarely observed after endovascular repair of thoracic aortic aneurysms. The different known therapeutical approaches are still empiric, with reported beneficial effects with the use of NSAID, corticosteroids, and danazol

Infrared thermography for indirect assessment of activation of brown adipose tissue in lean and obese male subjects

Brown adipose tissue (BAT) plays a key role in adaptive thermogenesis in mammals, and it has recently been considered as an attractive therapeutic target for tackling human obesity by increasing energy expenditure. Thermal imaging using infrared thermography (IRT) has emerged as a potential safe, rapid and inexpensive technique for detecting BAT in humans. However, little attention has been given to the reliability of this method in obese subjects. To this end, we evaluated the capacity of IRT to detect activated supraclavicular (SCV) BAT in 14 lean and 16 mildly obese young adults after acute cold exposure. Using IRT we measured the temperature of the skin overlying the SCV and sternal areas at baseline and after acute cold stimulation. Additionally, energy expenditure was measured by indirect calorimetry and body composition was estimated using bioelectrical impedance analysis. Energy expenditure and SCV skin temperature significantly increased in lean subjects upon cold exposure, while no significant changes were detected in the obese group. Furthermore, cold-induced variations in SCV skin temperature of obese subjects showed a negative correlation with body mass index. This study suggests that in lean individuals BAT is a rapidly activated thermogenic tissue possibly involved in the regulation of energy balance, and can be indirectly assessed using IRT. In obese subjects, BAT seems less prone to be activated by cold exposure, with the degree of adiposity representing a limiting factor for the indirect detection of BAT activation by measuring the skin temperature overlying BAT