The role of simvastatin in suppressing the development and expansion of abdominal aortic aneurysm

Introduction: Abdominal aortic aneurysm (AAA) is a common and lethal disorder. AAAs are associated with atherosclerosis, chronic inflammation and tissue destruction. The aim of this study is to determine whether treatment with simvastatin can influence the development of experimental aortic aneurysms in a rabbit model.Materials and methods: A total of 76 rabbits were randomized in four groups: in group I (n=12) where the abdominal aortas were exposed to 0,9 NaCl and in group II (n=24), group III (n=24) and group IV (n=18) where the aortas were exposed to CaCl2 0.5 mol/L for 15 minutes after laparotomy. Group III received 2mg/kg simvastatin daily starting 7 days prior to laparotomy and in group IV the daily treatment with simvastatin started 7 days after laparotomy Animals were sacrificed at intervals of first, second, third and fourth week to obtain measurements of aortic diameter and histological examination. Moreover, immunohistochemistry was used in order to examine the relative distribution of MMP-2, MMP-9 and TIMP-1 within the aortic aneurysms.Results: The increase of aortic diameter in animals of group I was ranging from 4.6% to 7.6%, in group II from 1.2±0.27mm (41%) to 2.33±0.26 mm (85%) (p0.05 for all comparisons. Conclusions: Simvastatin may prove clinically significant in suppressing the development and expansion of AAAs and thereby, in reducing the risk of rupture and the need for surgery.Εισαγωγή :Το ανεύρυσμα κοιλιακής αορτής (ΑΚΑ) αποτελεί μια συχνή και θανατηφόρο νόσο.Τα ανευρύσματα συνοδεύονται από αθηροσκλήρυνση, χρόνια φλεγμωνή και ιστική αποδόμηση του τοιχώματος του αγγείου.Σκοπός της παρούσας διατριβής είναι να καθοριστεί εάν η θεραπεία με σιμβαστατίνη μπορεί να επηρεάσει την ανάπτυξη αορτικού ανευρύσματος σε πειραματικό μοντέλο με κόνικλους.Υλικό και Μέθοδος: Εβδομήντα οκτώ (78) κουνέλια κατανεμήθηκαν με τυχαίο τρόπο σε τέσσερεις ομάδες: στην ομάδα I (n=12) στα οποία η κοιλιακή αορτή εκπλύθηκε με 0,9 NaCl και στην ομάδα II (n=24), ομάδα III (n=24) και ομάδα IV (n=18) στις οποίες οι αορτές εκτέθηκαν σε CaCl2 0.5 mol/L για 15 λεπτά μετά την λαπαροτομία. Τα πειραματόζωα της ομάδας III έλαβαν per os 2mg/kg σιμβαστατίνη καθημερινά ξεκινώντας 7 μέρες πριν τη λαπαροτομία ενώ στα πειραματόζωα της ομάδας IV η καθημερινή θεραπεία με σιμβαστατίνη ξεκίνησε 7 μέρες μετά τη λαπαροτομία. Τα πειραματόζωα ευθανατώθηκαν σε χρονικά διαστήματα της πρώτης ,δεύτερης ,τρίτης και τέταρτης εβδομάδας ώστε να υποβληθούν σε μέτρηση της αορτικής διαμέτρου και ιστολογική εξέταση αυτής.Επιπρόσθετα ανοσοιστοχημεία χρησιμοποιήθηκε ώστε να εξεταστεί πιθανός συσχετισμός των MMP-2, MMP-9 and TIMP-1 με το αορτικό ανεύρυσμα.Αποτελέσματα: Η αύξηση της αορτικής διαμέτρου στα πειραματόζωα της ομάδας I κυμενόταν από 4.6% μέχρι 7.6%, της ομάδας II από 1.2±0.27mm (41%) μέχρι 2.33±0.26 mm (85%) (p0.05 σε όλες τις περιπτώσεις). Συμπεράσματα: Η σιμβαστατίνη μπορεί να παρουσιάσει σημαντικό κλινικό όφελος καταστέλοντας την ανάπτυξη και επέκταση των ΑΚΑ και επομένως μειώνοντας τον κίνδυνο ρήξης και την ανάγκη για χειροργική αντιμετώπιση

Radioguided Occult Lesion Localization Techniques for Nonpalpable Breast Cancer Identification

Background: The main goal of successful management of nonpalpable breast tumors is accurate preoperative localization. A hooked wire inserted under radiographic guidance has been the technique used most often to remove occult breast lesions. Because of several disadvantages of wire-guided localization (WGL), new modalities have been investigated. These include radioguided occult lesion localization (ROLL) and radioguided seed localization (RSL). Objective: The aim of this review is to elucidate the diagnostic efficacy of ROLL and RSL techniques and to evaluate the results of subsequent surgical procedures in cases of nonpalpable breast lesions, with special reference to the extent of histologic spread and adequate excision. Methods: A comparison with the standard of care, WGL, as well as an assessment of the recent literature was performed in order to provide an update on the current concepts of diagnostic approach of early breast cancer. Results: The ROLL technique is as effective as WGL for excision of nonpalpable breast lesions, reduces localization time, and probably reduces the incidence of pathologically involved margins of excision. Therefore, ROLL is an attractive alternative to WGL. Moreover, a statistically significant benefit for RSL versus WGL in the form of involved surgical margin status, reoperation rates, and operative time has been documented. Conclusions: This systematic review provides evidence that both ROLL and RSL techniques are not only useful methods for three-dimensional localization of impalpable breast tumors but also are superior in terms of surgical-margin status, reoperation need, and operative duration, compared to WGL. (J GYNECOL SURG 20XX:000

Giant Intracystic Papillary Carcinoma of the Breast Report of a Case and Review of the Literature

Background: Intracystic papillary carcinoma (IPC) is a distinctive variant of a papillary ductal neoplasm confined to a dilated cystic space. This rare mammary tumor typically appears as a discrete solitary mass in the central region of the breast in a postmenopausal woman. This article presents the case of a female patient with a giant IPC. Relevant literature is briefly reviewed. Case: A 65-year-old woman was admitted for the management of a palpable mass of the left breast. On clinical examination, it was noted that the entire left breast was replaced by an extremely large, irregularly shaped, relatively mobile lesion. The mass was almost fixed to surrounding tissues including skin and pectoral muscle. Due to the size of the tumor the patient underwent a left modified radical mastectomy. Results: The final histopathologic diagnosis was defined as an IPC. Concomitant vascular invasion or metastasis to 19 removed lymph nodes were not noted. Conclusions: Because of its relevant growth pattern and indolent clinical behavior, IPC is conventionally regarded as a variant of intraductal papillary carcinoma with an absence of myoepithelial cells. There have been several cases that indicated a slow evolution of the mass, verifying the perception that IPC is associated with a favorable clinical outcome. Differential diagnoses include colloid or medullary carcinoma, invasive ductal carcinoma, hematoma, benign cyst, or adenofibroma. Axillary lymph-node metastases and markers related to invasion have been documented. Due to the rarity of the tumor and variability observed in treatment strategies, only a few surveys have assessed the significance of lymph-node status and the role of adjuvant treatment. (J GYNECOL SURG 2017:1

An Unusual Case of Acute Thrombosis of Abdominal Aortic Aneurysm without Acute Limb Ischemia.

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a rare and often devastating complication with high morbidity and mortality. In some cases, however, it may be associated with a silent course without signs of acute limb ischemia. The aim of this report is to describe an unusual case of acute thrombosis of AAA without signs of acute limb ischemia. Preoperative anxiety, stress, and phobia for surgery may be factors predisposing to acute thrombosis of an AAA

Prognostic Benefit of Surgical Management of Renal Cell Carcinoma Invading the Inferior Vena Cava

Renal cell carcinoma (RCC) accounts for approximately 3 % of adult malignancies and 90-95 % of neoplasms arising from the kidney. One of the unique features of RCC is the tumor thrombus formation that migrates into the venous system including renal vein (RV) and inferior vena cava (IVC). Only 10 % of patients with RCC present with the classic triad of flank pain, hematuria and defined mass, while 25-30 % of affected patients are asymptomatic. Signs of para-neoplastic syndrome such as hypercalcemia, hypertension, anemia, cachexia and increased erythrocyte sedimentation rate (ESR) are often apparent. Extension of tumor thrombus into the venous system is depicted by radiological examinations, such as contrast enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and vena cavography. The level of the thrombus is mostly determined according to the Mayo classification. Despite recent research on the therapeutic strategies against advanced RCC, surgical resection appears the only potentially curative approach. Aggressive surgical management including nephrectomy with thrombectomy is currently the standard therapeutic approach for RCC patients with tumor thrombus extending to the RV or the IVC. Pre-surgical down-staging with the use of molecular targeted therapy has also been proposed. Alternative therapies, such as radio- and chemotherapy proved insufficient. The aim of this review is to evaluate the results of surgical treatment for RCC invading IVC with special reference to the extent of its histological spread. Review of recent world literature was accomplished to provide an update on the current concepts of surgical management of the disease

The value of near-infrared spectroscopy for the assessment of calf muscle function in venous patients

Objective: Near-infrared spectroscopy (NIRS) is a noninvasive technique with the potential to determine the degree of tissue oxygenation. The aim of the current study was to investigate the use of NIRS as a reliable method of detecting calf muscle pump dysfunction in groups of patients with venous disease. Methods: Patients with superficial venous insufficiency (SW) or history of deep venous thrombosis (DVT) were classified according to the comprehensive classification system for chronic venous disorders (clinical class, etiology, anatomy, and pathophysiology) and compared with controls (GROUP variable). A 10-stage evaluation of ambulatory venous function was performed, and corresponding values of calf regional oxygen saturation (crSaO(2), %) at each phase were recorded (TIME variable). Thereafter, the percentage changes of crSaO(2) values (A scores, %) between a given phase and the reference phase were estimated. Differences among groups and phases were evaluated using analysis of variance. Subgroup analysis between C0-C2 and C3-C6 patients was performed. The receiver operating characteristic curve analysis was used to detect the best predictive capability for SW and DVT. Results: A total of 30 patients with SW, 31 patients with DVT, and 34 controls were included in the study. A statistically significant effect of TIME (F = 382.4; P < .001) and TIME x GROUP interaction (F = 6.3; P < .001) was recorded. Concerning prediction, we found a statistically significant area under the curve (AUC) for SW (AUC = 0.72; 95% confidence interval, 0.58-0.83; P = .003) and for DVT (AUC = 0.83; 95% confidence interval, 0.71-0.92; P < .0001) patients. Conclusions: The measurement of crSaO(2) using NIBS detected alterations in calf muscle pump oxygenation during exercise and differences in tissue oxygenation among SW patients, DVT patients, and controls. NIBS may represent a reliable noninvasive tool for the study of calf muscle dysfunction in venous disease and a useful vehicle for generating testable hypotheses in the laboratory setting

Treatment With Simvastatin Inhibits the Formation of Abdominal Aortic Aneurysms in Rabbits

Background: Abdominal aortic aneurysm (AAA) is a common and lethal disease. AAAs are associated with atherosclerosis, chronic inflammation, and extracellular matrix degradation. The aim of this study was to determine whether treatment with simvastatin can influence the development of experimental aortic aneurysms in a rabbit model. Materials and Methods: A total of 76 rabbits were randomized in four groups: in group I (n = 12), where the abdominal aortas were exposed to 0.9% NaCl, and in group II (n = 24), group III (n = 24) and group IV (n = 18), where the aortas were exposed to CaCl2 0.5 mol/L for 15 minutes after laparotomy. Group III received 2 mg/kg simvastatin daily starting 7 days before laparotomy, and in group IV, the daily treatment with simvastatin started 7 days after laparotomy. Animals were sacrificed at intervals of first, second, third, and fourth week to obtain measurements of aortic diameter and histological examination. Moreover, immunohistochemistry was used in order to examine the relative distribution of matrix metalloproteinases (MMPs) 2 and 9 (MMP-2 and MMP-9, respectively) and tissue inhibitor 1 of MMPs within the aortic aneurysms. Results: The increase of aortic diameter in animals of group I ranged from 4.6% to 7.6%; in group II, from 41% to 85% (P < 0.001 vs. group I); in group III, from 9% to 18% (group II vs. group III, P < 0.001); and in group IV; from 36% to 38%. Moreover, aortic specimens of group II presented a statistically significant increase in MMP-2 and MMP-9 immunoexpression compared with other groups (I, III, IV) (P < 0.05 for all comparisons), with the exception of animals of group IV at the end of second week. Immunoreactivity of tissue inhibitor 1 of MMPs was not statistically different among groups II, III, and IV. Conclusions: Simvastatin may prove clinically significant in suppressing the development and expansion of AAAs and, thereby, in reducing the risk of rupture and the need for repair