Cardiac metastasis of melanoma presenting as acute aortic occlusion

Cardiac diseases are the most common cause of acute arterial emboli, however, cardiac tumors are not as frequent. Cardiac metastases from melanoma are usually silent, and rarely cause symptoms. Only a few reports are found in the literature of metastatic melanoma, causing arterial emboli. Here, we report a case of a cardiac metastasis of melanoma cancer that presented preoperative as arterial emboli. the gross appearance of the emboli already suggested the presence of a cardiac tumor. in selected patients who have a solitary intracardiac melanoma, surgical resection can provide relief from clinical symptoms and minimize potential cardiac sequelae of the tumor.Universidade Federal de São Paulo, Dept Vasc Surg, BR-04038001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Vasc Surg, BR-04038001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, São Paulo, BrazilWeb of Scienc

Kidney weight and volume among living donors in Brazil

CONTEXT AND OBJECTIVE: The present study was performed to measure kidney weight and volume among living donors of both sexes in Brazil. DESIGN AND SETTING: This was a cross-sectional survey carried out between December 2001 and August 2004. METHODS: Kidney transplantations from 219 living donors were analyzed for this study. The kidneys were weighed in grams on a single-pan digital balance just after drainage of the perfusion fluid and removal of the perirenal fat. The kidney volume was determined in milliliters by water displacement. RESULTS: The mean age at nephroureterectomy was 44 ± 9.5. The donor organs came from the left side in 172 cases and from the right side in 47 cases. The weights and volumes of the right and left kidneys were, respectively, 169.83 ± 29.91 g and 157.38 ± 31.84 ml; and 173.00 ± 33.52 g and 160.34 ± 34.40 ml. The differences between the sides were not significant. CONCLUSIONS: According to the present study, kidney weight cannot be the only factor determining the side on which nephroureterectomy is performed, because of the lack of statistical significance between the two sides. On average, females donate lower nephron doses than males do, which could in some transplants result in allograft damage

Angioplasty and stenting for below the knee ulcers in diabetic patients: protocol for a systematic review

Abstract Background The worldwide incidence and prevalence of diabetes mellitus (DM) are increasing. DM has a high social and economic burden due to its complications and associated disorders. Peripheral arterial disease (PAD) is closely related to DM. More than 85% of patients with DM will develop PAD in their lifetime, and between 10 and 25% of patients with DM will have a foot ulcer. In such cases, it is important to determine for each patient whether it is necessary and feasible to revascularise the affected limb as well as the optimal technique. Percutaneous transluminal angioplasty (PTA) is designed to restore blood flow through the vessel lumen by various devices including balloons, drug-coated balloons, bare stents, drug-eluting stents and endovascular atherectomes. This systematic review aims to evaluate the effects of PTA in the treatment of lower limb arterial ulcers in diabetic patients. Methods We will search randomised controlled trials (RCTs) and quasi-RCTs in the following databases (e.g., MEDLINE via PubMed, EMBASE, Lilacs, Cochrane Central Register of Controlled Trials, Ibecs, CINAHL, AMED, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and OpenGrey). Our search strategy will use the following free-text terms and controlled vocabulary (e.g., Emtree, MeSH) for ‘foot ulcer’, ‘leg ulcer’, ‘diabetic foot’, ‘Peripheral Arterial Disease’, ‘Diabetes Complications’, ‘Peripheral Vascular Diseases’, ‘critical limb ischemia’, ‘below the knee ulcer’, ‘angioplasty’, ‘stents’, ‘stenting’, and ‘endovascular procedures’. There will be no limits on date or language of publication. Two authors will, independently, select studies and assess the data from them. Risks of bias (RoB) of included studies will be evaluated using the Cochrane’s RoB tool. If possible, we will perform and report structured summaries of the included studies and meta-analyses. Results are not available as this is a protocol for a systematic review, and we are currently in the phase of building a sensitive search strategy. Discussion While there are several available endovascular techniques for revascularisation, it is unclear which technique has better outcomes for ulcers below the knee in diabetic patients. A systematic review is required to validate and demonstrate these techniques and their outcomes to allow an evidence-based clinical decision. Systematic review registration PROSPERO CRD4201706517

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable