Search

Infective native abdominal aortic aneurysms are a life-threatening condition with a high mortality rate. We report the case of a 53-year-old male patient who presented with abdominal pain and fever. Laboratory results showed an elevated white blood cell count and C-reactive protein levels. Blood cultures detected Salmonella species, and computed tomography revealed a saccular abdominal aortic aneurysm. After 14 days of preoperative antibiotic therapy, the patient underwent a successful surgical bypass from the descending thoracic aorta, through the diaphragm and muscle layers of the anterior abdominal wall, to the bilateral common femoral arteries. The patient was discharged after 30 days of hospitalization and continued antibiotic treatment for another 30 days. Follow-up clinical evaluations and imaging studies showed good recovery and no signs of infection. This case highlights the importance of combining appropriate antibiotic therapy with surgical intervention in managing infective native aortic aneurysms. In particular, an extra-anatomical approach from the descending aorta can be a viable option in selected cases of infected aortic aneurysms, providing an effective means to achieve thorough debridement and prevent future graft infections.

A 50-year-old woman was admitted to our institute because of a large tumour in her neck. This patient had been diagnosed with thyroid goitre for 5 years, but no treatment was administered. No specific medical history was noted. A large mass in the neck region was found during clinical examination, which restricted neck movement. Computed tomography revealed a diffuse, large, multinodular goitre with tracheal compression. Results from the fine-needle aspiration procedure showed benign cytology. Laboratory tests revealed normal results, including serum thyroid-stimulating hormone, free triiodothyronine, and free thyroxine levels. The patient underwent surgery for the removal of the entire thyroid tumour. The patient's postoperative period was uneventful. The patient was discharged on the 5th postoperative day. In conclusion, surgical management remains the standard treatment for giant thyroid tumours with compressive symptoms. Careful dissection and awareness of the high risk of postoperative complications in these cases are crucial for achieving good outcomes.

Surgical treatment is indicated for both symptomatic and asymptomatic bronchogenic cysts. The goal of treatment is total removal of the cyst. Percutaneous aspiration and absolute ethanol sclerotherapy is an effective, minimally invasive, and safe alternative method. We present the case of a 74-year-old woman with a symptom of persistent dry cough for 5 months. Plain and contrast-enhanced chest computed tomography revealed a large superior mediastinal cyst that could be easily accessed percutaneously. The cyst was treated by aspiration and ethanol sclerotherapy under ultrasound guidance and fluoroscopy. The patient was discharged a day later without complications. Chest CT at 6 months follow-up showed complete regression of the cyst.

Traumatic rupture of the thoracic aorta is a rare condition, with a high mortality rate. Over the last 2 decades, strategies for managing aortic injury caused by blunt chest trauma have changed substantially, resulting in significantly improved outcomes. The recent development of endovascular repair offers a less invasive alternative to conventional open repair, particularly in patients with multiple injuries. Here, we report the case of a 31-year-old man who was referred to our emergency department with blunt chest trauma following a motorcycle-truck collision. Computed tomography confirmed acute traumatic rupture of the thoracic aorta, and the patient was successfully treated with endovascular repair.

Sternal cleft is a rare congenital chest wall deformity, with a reported incidence of 1 in 100,000 live births, accounting for less than 1% of all chest wall deformities. Patients with sternal clefts can be asymptomatic; however, most cases have recurrent respiratory infections and cosmetic disfigurement. Therefore, surgical correction of this deformity is still necessary to address cosmetic issues, assuage parental concerns, and prevent repeated respiratory infections caused by paradoxical breathing patterns. Here, we report a case of complete sternal cleft associated with pectus excavatum that was successfully treated with sternal reconstruction and pectus bar insertion.

Selecting treatment options in acute arterial thrombosis of the lower extremity, which threatens limb viability, is still a challenge for vascular surgeons. Early restoration of blood flow is crucial and is conducted by surgical thrombectomies or endovascular procedures, depending on patient condition. Catheter-directed thrombolysis with or without percutaneous mechanical thrombectomy for acute limb ischemia has been widely implemented from the early 1990s. Here, we present 2 cases of acute thrombosis of below-the-knee arteries, where we successfully saved the involved limbs using catheter-directed thrombolysis and thrombus aspiration.

Surgical treatment of abdominal aortic aneurysm in patients with a transplanted kidney is true a challenge. Conventional open repair of the aneurysm requires aortic cross-clamping. Therefore, it can pose a risk of ischemic injury to the transplanted kidney. Endovascular repair, which limits the duration of interruption of blood flow to the transplanted kidney, is a suitable alternative for repair of abdominal aortic aneurysm, if feasible anatomically. Here, we present a case of a 62-year-old woman who was transferred to our hospital because of abdominal pain and had a history of renal transplant 14 years ago. Computed tomography confirmed a large infrarenal fusiform abdominal aortic aneurysm 6 cm in maximal diameter and another 4 cm fusiform aneurysm in the left common iliac artery. We successfully performed endovascular aneurysm repair combined with femoro-femoral bypass. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day.

Venous malformation is considered the most common congenital vascular anomaly. The most common region is the head and neck region involving the lips. Venous malformation of the lips always leads to cosmetic and functional issues. A multidisciplinary approach is recommended in the treatment of this malformation. In this report, we describe two cases of large venous malformation in the lower lip that were successfully treated by percutaneous sclerotherapy followed by plastic surgery. In our two-case presentation, sclerotherapy was performed prior to plastic surgery to improve the efficiency and reduce excessive bleeding, which resulted in significantly improved appearance and physical function. Keywords: Venous malformation, Sclerotherapy, Plastic surgery

Objective: Environmental factors that drive obesity are often studied individually, whereas obesogenic environments are likely to consist of multiple factors from food and physical activity (PA) environments. This study aimed to compose and describe a comprehensive, theory‐based, expert‐informed index to quantify obesogenicity for all neighborhoods in the Netherlands. Methods: The Obesogenic Built Environment CharacterisTics (OBCT) index consists of 17 components. The index was calculated as an average of componential scores across both food and PA environments and was scaled from 0 to 100. The index was visualized and summarized with sensitivity analysis for weighting methods. Results: The OBCT index for all 12,821 neighborhoods was right‐skewed, with a median of 44.6 (IQR = 10.1). Obesogenicity was lower in more urbanized neighborhoods except for the extremely urbanized neighborhoods (>2500 addresses/km2), where obesogenicity was highest. The overall OBCT index score was moderately correlated with the food environment (Spearman ρ = 0.55, p <0.05) and with the PA environment (ρ = 0.38, p <0.05). Hierarchical weighting increased index correlations with the PA environment but decreased correlations with the food environment. Conclusions: The novel OBCT index and its comprehensive environmental scores are potentially useful tools to quantify obesogenicity of neighborhoods. [ABSTRACT FROM AUTHOR]

In this observational cross-sectional study, we investigated the relationship between combined obesogenic neighbourhood characteristics and various cardiovascular disease risk factors in adults, including BMI, systolic blood pressure, and blood lipids, as well as the prevalence of overweight/obesity, hypertension, and dyslipidaemia. We conducted a large-scale pooled analysis, comprising data from five Dutch cohort studies (n = 183,871). Neighbourhood obesogenicity was defined according to the Obesogenic Built-environmental CharacterisTics (OBCT) index. The index was calculated for 1000m circular buffers around participants' home addresses. For each cohort, the association between the OBCT index and prevalence of overweight/obesity, hypertension and dyslipidaemia was analysed using robust Poisson regression models. Associations with continuous measures of BMI, systolic blood pressure, LDL-cholesterol, HDL-cholesterol, and triglycerides were analysed using linear regression. All models were adjusted for age, sex, education level and area-level socio-economic status. Cohort-specific estimates were pooled using random-effects meta-analyses. The pooled results show that a 10 point higher OBCT index score was significantly associated with a 0.17 higher BMI (95%CI: 0.10 to 0.24), a 0.01 higher LDL-cholesterol (95% CI: 0.01 to 0.02), a 0.01 lower HDL cholesterol (95% CI: −0.02 to −0.01), and non-significantly associated with a 0.36 mmHg higher systolic blood pressure (95%CI: −0.14 to 0.65). A 10 point higher OBCT index score was also associated with a higher prevalence of overweight/obesity (PR = 1.03; 95% CI: 1.02 to 1.05), obesity (PR = 1.04; 95% CI: 1.01 to 1.08) and hypertension (PR = 1.02; 95% CI: 1.00 to 1.04), but not with dyslipidaemia. This large-scale pooled analysis of five Dutch cohort studies shows that higher neighbourhood obesogenicity, as measured by the OBCT index, was associated with higher BMI, higher prevalence of overweight/obesity, obesity, and hypertension. These findings highlight the importance of considering the obesogenic environment as a potential determinant of cardiovascular health. • Our study adds value to the existing evidence by considering combined exposure to obesogenic environmental factors. • We used the Obesogenic Built-environmental CharacterisTics (OBCT) index to combine various exposures based on theory and evidence. • We found that a higher OBCT index score is associated with higher BMI, prevalence of overweight/obesity, and hypertension. • The results also show minimal associations with blood lipids, and a potential relationship with systolic blood pressure. • This study highlights the potential use of the OBCT index in identifying areas at risk for CVD risk factors. [ABSTRACT FROM AUTHOR]