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Background: Hand ischemia following trauma in children is rare, and the natural history after upper extremity arterial bypass in children is unknown. We hypothesize children with brachial artery repair are at long-term risk of developing aneurysmal degeneration or thrombosis, thus necessitating annual duplex ultrasonography and physical examination., Methods: A retrospective review of children who had brachial artery repair (bypass or vein patch) for hand ischemia secondary to trauma at a level I trauma pediatric hospital was performed. Telephone interviews were conducted to assess the presence of arm/hand symptoms (pain, weakness, fatigue, sensory function, limb length discrepancy)., Results: Between 2003 and 2016, 16 children (12 males), mean age 8 years (3-13 years) underwent brachial artery repair (12 bypass with vein, 4 vein patch). Mechanism of injury included 11 supracondylar fractures and 5 lacerations. All patients were seen at 2 weeks with a duplex ultrasound. Thirteen patients were lost to follow-up. The 3 patients with follow-up had patent bypasses, but one patient 6 years out from the repair had aneurysmal degeneration of the vein graft. Seven patients were never seen again. Phone interviews were conducted for the remaining 6 patients and 2 complained of arm fatigue and intermittent hand pain. Only one patient reported that the pediatrician checked pulses in the affected extremity., Conclusions: Eighty percentage of children had no further follow-up after the postoperative visit. Asymptomatic aneurysmal degeneration of the vein graft was noted 6 years following repair in one patient, and 2 patients had unevaluated hand complaints. These patients are at risk for late complications and are unlikely to return for routine follow-up. The importance of graft surveillance must be more clearly emphasized at time of initial surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Lemierre's syndrome is a rare life-threatening condition characterized by internal jugular vein thrombosis and is typically associated with a gram-negative infection with septic metastasis secondary to a retropharyngeal abscess that involves the vasculature of the head and neck. We report a case of Lemierre's syndrome in an 18-year-old female adolescent who developed an internal carotid artery occlusion and ipsilateral external carotid artery (ECA) mycotic aneurysm complicated by fulminant pseudomonal sepsis. The patient was managed with open ligation of the ECA with essentially complete recovery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Arthroscopy of the foot and ankle is a common orthopedic procedure with low complication rates. Arterial injuries from these procedures are an even more rare subset of the complications. Hemophilia A is a genetic disorder of aberrant coagulation, which leads to increased risk of bleeding even after minor trauma. We present the second case of anterior tibial artery pseudoaneurysm formation secondary to ankle arthroscopy in a hemophiliac patient and suggest that these individuals are at higher risk for developing complications associated with arterial injury. Furthermore, potential risk factors include port placement, anatomic variation of the vessels, and nature of the arthroscopic procedure. We recommend steps to prevent complications in hemophiliac patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In order to understand the molecular mechanisms of longevity regulation, we recently performed a screen designed to enrich for genes common to several longevity interventions. Using this approach, we identified the Drosophila melanogaster gene takeout. takeout is upregulated in a variety of long-lived flies, and extends life span when overexpressed. Here, we investigate the mechanisms of takeout-dependent longevity. takeout overexpression specifically in the fat body is sufficient to increase fly longevity and is additive to the longevity effects of Dietary Restriction. takeout long-lived flies do not show phenotypes often associated with increased longevity, such as enhanced stress resistance or major metabolic abnormalities. However, males exhibit greatly diminished courtship behavior, leading to a reduction in fertility. Interestingly, takeout contains a binding domain for Juvenile Hormone, a fly hormone that plays a role in the regulation of developmental transitions. Importantly, the longevity and courtship phenotypes of takeout overexpressing flies are reversed by treatment with the Juvenile Hormone analog methoprene. These data suggest that takeout is a key player in the tradeoff-switch between fertility and longevity. takeout may control fertility via modulation of courtship behavior. This regulation may occur through Juvenile Hormone binding to takeout and a subsequent reduction in Juvenile Hormone signaling activity., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)