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The article offers case histories of Internal iliac artery aneurysms. The case includes a 56-year-old man who had been troubled by swelling and cellulitis of the left leg for five weeks, and a man aged 69 who was admitted at a coronary care unit for shortness of breath with chest pain and swelling of the lower limbs. Both patients' medical history were analyzed. Treatment options including anticoagulants and venous surgery were also discussed.

External iliac stenosis due to endofibrosis is a rare condition that predominantly affects top level cyclists. Short term symptomatic relief is reported in an Olympian after percutaneous transluminal angioplasty, which was performed to allow the patient to return to training without delay. [ABSTRACT FROM AUTHOR]

Nephrocalcinosis is uncommon in childhood, the main causes are renal tubular acidosis, hyperparathyroidism and medullary sponge kidney. It is also seen where there is hypercalcaemia or hypercalciuria of any aetiology; We report nephrocalcinosis in an 18-month-old infant with metaphyseal chondrodysplasia type Jansen and also in a neonate with McCune Albright syndrome who displayed atypical skeletal appearances and had multiple ovarian cysts. [ABSTRACT FROM AUTHOR]

Key words: angioplasty; focal segmental glomerulosclerosis; nephrotic syndrome; renal artery stenosis; renin-angiotensin-aldosterone system; renovascular disease [ABSTRACT FROM PUBLISHER]

False aneurysms at anastomoses between synthetic grafts and native arteries are not uncommon. We report a case of true aneurysmal degeneration of a Miller vein cuff. [Copyright &y& Elsevier]

Aims: To evaluate the affect of aortic side branch embolization on the incidence of endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A prospective evaluation of patients undergoing EVAR since 1997. All patients underwent preprocedural spiral CT scanning and calibrated angiography. Patent aortic sidebranches (inferior mesenteric artery and lumbar arteries) were identified. The inferior mesenteric artery was embolized in every case. Our current practice is to embolize patent lumbar arteries but initially this was not routine. Following EVAR patients were followed with ultrasound and dual phase spiral CT, the presence of endoleaks was recorded. Results: Forty patients have undergone EVAR. The IMA was patent in 16 (45 per cent) patients. Lumbar arteries were patent in 21(53 per cent). IMA embolization was attempted in 13 patients and was successful in 11 (85 per cent), the IMA thrombosed during catheterization in the other 2 patients. Lumbar embolization was attempted in 13 patients and was successful in eight. There were no Type II endoleaks in any of the embolized patients. Eight out of 13 (62 per cent) patients with patent lumbar arteries developed endoleaks. Conclusions: Type II endoleaks following EVAR occur in almost half of the patients with patent lumbar arteries. IMA and lumbar endoleaks are preventable by preoperative embolization. [ABSTRACT FROM AUTHOR]

Aims: To assess the safety and durability of endovascular interventions for iliac occlusive disease. Methods: The Department of Vascular Radiology computer database was interrogated to identify 77 consecutive patients who had undergone either angioplasty or stent placement for iliac occlusive disease. The patients were followed up with duplex ultrasound scan at 6-monthly intervals or more frequently if clinically indicated. The anatomic patency of the treated iliac segment in 40 patients who had more than 12 months follow up with duplex scan were analysed. Statistical analysis was by χ[sup 2] analysis with Yates correction. Results: The median age was 70 years (48 men and 29 women). 115 iliac segments (70 common iliac artery, 40 external iliac artery) in 104 limbs were treated. 41 patients (61 iliac segments) were stented. The immediate technical success was 94 per cent. 15 patients (19.4 per cent) developed complications of whom seven patients were managed by stent placement. Three patients needed urgent surgical intervention. There were no deaths within 30 days. 40 patients had a follow-up of over 12 months (median 22.5 months.). In the overall group (PTA alone and stenting) restenosis was noted in 36 per cent of treated external iliacs, 20 per cent of common iliacs and in 64 per cent when both were treated (P < 0.001). By contrast in the stent group alone, restenosis was noted in 20 per cent of external iliac arteries stented, 22 per cent of common iliacs and in 43 per cent of combined CIA/EIA lesions (not significant). Conclusions: Iliac angioplasty and stenting are safe procedures with a high technical success rate. However, endovascular treatment of occlusive lesions of external iliac artery alone or in combination with common iliac artery lesions had a much higher rate of restenosis irrespective of stenting. [ABSTRACT FROM AUTHOR]

Patients with primary immunodeficiencies are especially vulnerable to developing severe coronavirus disease 2019 (COVID-19) after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cytotoxic T lymphocyte antigen-4 (CTLA-4) is an important regulator of immune responses, and patients who suffer from CTLA4 haploinsufficiency have hyperactivation of effector T cells and infiltration of various organs. Overexpression of CTLA4 has been associated with a more severe disease course in patients with COVID-19, but there have only been a few reports on the disease course of COVID-19 in patients with CTLA4 haploinsufficiency. We report on a 33-year-old female with a history of immune thrombocytopenia, autoimmune haemolytic anaemia, granulomatous-lymphocytic interstitial lung disease, and common variable immunodeficiency who developed COVID-19. She was admitted and discharged from the hospital several times in the months thereafter and remained symptomatic and had a positive SARS-CoV-2 PCR for up to 137 days after the first symptoms. No SARS-CoV-2 antibodies were identified in the patients' serum. The disease was finally controlled after repeated infusions of convalescent plasma and treatment of concurrent bacterial and fungal infections. Genetic analysis revealed a likely pathogenic variant in CTLA4, and CTLA4 expression on regulatory T-cells was low. This case illustrates that patients with primary immunodeficiencies who have a protracted disease course of COVID-19 could benefit from convalescent plasma therapy. [ABSTRACT FROM AUTHOR]

In the treatment of severely injured patients, the term ‘damage control radiology’ has been used to parallel the modern concept of damage control surgery and the allied development of continuous damage control resuscitation from patient retrieval, through all transfers, to appropriate primary treatment. The aims of damage control radiology are (i) rapid identification of life-threatening injuries including bleeding sites, (ii) identification or exclusion of head or spinal injury, and (iii) prompt and accurate triage of patients to the operating theatre for thoracic, abdominal, or both surgeries or the angiography suite for endovascular haemorrhage control. If we are to achieve these aims, patients must have immediate access to modern multidetector computed tomography (MDCT) which is without doubt the most potent weapon in the diagnostic armamentarium. The most severely injured patients are those who have the most to benefit from early diagnosis and life-saving therapies. The traditional teaching that these patients should go immediately to surgery is challenged by technological developments in MDCT and recent clinical evidence. [ABSTRACT FROM AUTHOR]

Lung transplant recipients have an increased risk for severe coronavirus disease 2019 (COVID-19) due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A third dose of a SARS-CoV-2 vaccine has been recommended for all solid organ transplant recipients, but data from lung transplant recipients specifically are scarce. In this study, the serologic response to a third dose of an mRNA-based SARS-CoV-2 vaccine was measured in 78 lung transplant recipients. Sixty-two percent (n = 48) had a serological response to vaccination, which was significantly higher than after the second vaccine dose (27 patients (35%); p = 0.0013). A positive serologic response was associated with having had COVID-19 (p = 0.01), and higher serum IgG level and complement mannose binding lectin pathway activity prior to vaccination (p = 0.04 and p = 0.03, respectively). Serologic response was not associated with the dose of mycophenolate mofetil or prednisone or other immune status parameters. Eleven patients (14%) developed COVID-19 after the second or third vaccine dose, but this did not associate with serologic response after the second vaccine dose (9% in patients who developed COVID-19 versus 39% in patients who did not develop COVID-19 (p = 0.09)), or with serologic response above cut-off values associated with clinical protection in previous studies. In conclusion, the response to mRNA-based SARS-CoV-2 vaccines in lung transplant recipients improves significantly after a third vaccine dose. Factors associated with a positive serologic response are having had COVID-19 prior to vaccination, and serum IgG and complement mannose binding lectin pathway activity prior to vaccination. Serologic response did not associate with clinical protection against COVID-19 in this study. [ABSTRACT FROM AUTHOR]

Aim: To establish an expert consensus of what, when, and how the teaching of radiology should be incorporated into the core undergraduate medical curriculum. Methods and Materials: This Delphi survey consisted of four iterative rounds, with feedback given at the start of each successive round in the form of the results of the previous round. The participants consisted of both radiologists and non-radiologists with significant interest and involvement in radiology and undergraduate/Foundation training. The study addressed the questions of how, where, when, and by whom radiology should be taught. Results: The number of responses in rounds 1-4 was 20, 23, 41, and 25 (25, 22, 31, and 61% response rate, respectively). There was good consensus amongst the responders on the following: radiology teaching must be delivered in conjunction with anatomy and clinical case-based teaching, if possible in the department of radiology on picture archiving and communication system (PACS) workstations, and the teaching should be delivered by a competent and credentialled individual. Case-based assessment was the most agreed method of assessment. The majority of the responders concurred that the curriculum should include general indications for commonly requested radiological investigations, consent and safety issues around radiological tests, and their basic interpretation. Conclusion: The consensus points reached by the present study not only serve as directive principles for developing a more comprehensive radiology curriculum, but also places emphasis on a broader range of knowledge required to promote the best use of a department of radiology by junior doctors in an attempt to improve patient experiences and care. [ABSTRACT FROM AUTHOR]

B cell dyscrasias are often refractory to medical treatments, and hematological stem cell therapy (SCT) may be warranted. It is not clear whether an associated polyneuropathy may also profit from SCT. In exceptional cases SCT has been tried in patients with monoclonal gammopathy and progressive polyneuropathy refractory to medical treatments. In a cohort of 225 patients with monoclonal gammopathy and polyneuropathy, we selected the six patients who underwent SCT and retrospectively examined the effects of SCT on the disease course of the associated polyneuropathy. In all patients except one, the indication for SCT was hemato-oncological (multiple myeloma in 4 patients and primary AL amyloidosis in 1). The remaining patient had an IgG monoclonal gammopathy of undetermined significance and a progressive and painful polyneuropathy for which she was treated with SCT. SCT led to improvement of motor scores and autonomic symptoms in one patient; three patients experienced improvement of neuropathic pain or sensory deficits but showed further progression of weakness. One patient showed no improvement at all. One patient died within 100 days after SCT. In conclusion, SCT as a treatment of refractory hematological malignancy may occasionally have a positive effect on the associated progressive polyneuropathy, although the benefits are very limited and the treatment-related mortality is high. [ABSTRACT FROM AUTHOR]

Summary Despite the use of immunosuppressives mainly influencing T and B cell responses, the prevalence of the bronchiolitis obliterans syndrome (BOS) after lung transplantation is high. Mannose-binding lectin (MBL) is a pattern recognition molecule of complement and an important component of the innate immunity. MBL is associated with rejection, infection and survival in other solid organ transplantations. In this study the relation between functional MBL levels and cytomegalovirus (CMV) reactivations and the development of BOS and survival after lung transplantation was investigated. MBL levels were measured in 85 patients before and in 57 of these patients after lung transplantation. The relation of MBL on survival, CMV reactivation and the development of BOS were investigated with Kaplan-Meier (log-rank) survival analysis. MBL levels decreased on average by 20% ( P < 0·001) after transplantation and eventually returned to pretransplant levels. Fourteen of the 85 patients had deficient pretransplant MBL levels and these patients had a tendency towards a better survival compared to those with normal MBL levels ( P = 0·08). Although no correlation was found between MBL deficiency and the development of BOS, more CMV reactivations occurred in recipients with deficient versus normal levels of MBL ( P = 0·03). Our results suggest that MBL deficiency is associated with CMV reactivations and a longer overall survival, but not with the development of BOS. [ABSTRACT FROM AUTHOR]