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Concept: Abdominal aorta

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Several complications have been reported regarding the percutaneous closure of secondary atrial septal defects such as erosion, thromboembolic events, arrhythmias, and endocarditis. In this report, we describe the case of a 75-year-old woman who underwent percutaneous closure of a secondary atrial septal defect with a 12 mm Amplatzer septal occluder. Six months after the uneventful implantation of the device, we manifested an asymptomatic late embolization of the device in the abdominal aorta. The device was surgically retrieved.

Concepts: Surgery, Report, Abdominal aorta, Crystallographic defect, Ventricular septal defect, Atrial septal defect, Levo-Transposition of the great arteries, Cardiac shunt

151

The purpose of this prospective study was to establish the ultrasonographic characteristics of the dimension of the right pancreatic lobe with that of the associated anatomic landmarks in healthy dogs. Ultrasonographic examinations were performed on 25 dogs. The thickness of the right pancreatic lobe was compared with that of mural thickness of duodenum, diameters of duodenum, pancreatic duct, abdominal aorta, portal vein, caudal vena cava, and length and width of the right kidney and right adrenal gland. The correlation between each pancreatic parameter and the dimensions of the anatomical landmarks were assessed using linear regression analysis and Pearson’s correlation coefficient ® test. Significant, but weak linear correlations were observed between thickness of right pancreatic lobe with that of duodenum mural thickness (r=0.605, R(2)=0.339, P=0.001); duodenum diameter (r=0.573, R(2)=0.299, P=0.003); and right adrenal gland length (r=0.508, R(2)=0.052, P=0.01). There was no significant dimensional relationship with other selected anatomic landmarks. The ratio between the thickness of right pancreatic lobe and the mural thickness of duodenum, diameter of duodenum and length of right adrenal gland were 2.88 ± 0.53, 1.27 ± 0.27, and 0.81 ± 0.15, respectively. Calculating the ratio of thickness of the right pancreatic lobe with the dimension of significantly correlated anatomic landmarks is a useful and simple method for evaluating the size of the right pancreatic lobe in dogs in clinical practice.

Concepts: Kidney, Pancreas, Spearman's rank correlation coefficient, Abdominal aorta, Correlation and dependence, Pearson product-moment correlation coefficient, Covariance and correlation, Adrenal gland

29

A previously healthy 36-year-old Japanese woman presented with blood pressure that was difficult to control after an emergency cesarean section. CT revealed a disrupted abdominal aorta, severe stenosis of the renal arteries, and development of numerous collateral arteries.

Concepts: Kidney, Artery, Abdominal aorta, Renal artery, Caesarean section, Takayasu's arteritis, Arteritis, Angiology

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A 60 year-old woman presented with large extensive aneurysms in the thoracic aorta and infra-renal abdominal aorta with a normal segment of visceral aorta in between; the entire right common iliac artery was also aneurysmal. Concurrent endovascular repair of all aneurysmal regions was successfully performed using a left common iliac artery conduit to access the aorta, and multiple stent-grafts; a chimney graft preserved blood flow into the left subclavian artery. There were no features of spinal cord ischaemia despite coil embolisation of the right hypogastric artery. CT angiogram at six months showed patent stent-grafts with no endoleaks. The patient continued to do well at one-year clinical follow-up. Concurrent endovascular repair of thoracic and abdominal aortic aneurysms can be safely and successfully performed when anatomically feasible, and is an attractive alternative to staged or hybrid repair.

Concepts: Abdominal aorta, Aortic aneurysm, Brachiocephalic artery, Aorta, Descending aorta, Arteries of the thorax, Arteries of the abdomen, Common iliac artery

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This study employed functional and electrophysiological approaches to investigate the mechanisms by which warifteine, a bisbenzylisoquinoline alkaloid isolated from Cissampelos sympodialis Eichl, causes vasorelaxation in the rat thoracic aorta. Warifteine (1 pM-10 μM) induced a concentration-dependent relaxation (pD(2) =9.40±0.06, n=5) in endothelium-intact aortic rings pre-contracted with noradrenaline (10 - 100 μM). The relaxation effects were not attenuated after endothelium removal. Warifteine also induced relaxations (pD(2) =9.2±0.19,n=8) in rings pre-contracted with PGF2(alfa) (1 - 10 mM). In contrast, the relaxant activity of warifteine was nearly abolished in high-K(+) (80 mM) pre-contracted aortic rings. In preparations incubated with 20 mM KCl or K(+) channel blockers, including: TEA (1, 3 and 5 mM), iberiotoxin (20 nM), 4-aminopyridine (1 mM) or glibenclamide (10 μM), the vasorelaxant activity of warifteine was markedly reduced. Furthermore, BaCl(2) (1 mM) did not affect the relaxant effects of warifteine. In vascular myocytes, warifteine (100 nM) significantly increased whole-cell K(+) currents (at 70 mV). In nominally Ca(2+) -free conditions, warifteine did not reduce extracellular Ca(2+) -induced contractions in high-K(+) or noradrenaline (100 μM) pre-stimulated rings. 4. Taken together, these results indicate that warifteine can induce potent concentration-dependent relaxation in the rat aorta via an endothelium-independent mechanism that involves the activation of K(+) channels. © 2012 The Authors Clinical and Experimental Pharmacology and Physiology © 2012 Wiley Publishing Asia Pty Ltd.

Concepts: Heart, Orders of magnitude, Ion channel, Abdominal aorta, Aorta, Descending aorta, Thoracic aorta, Induced demand

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Nutcracker syndrome (NCS), which is caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, leads to a series of clinical symptoms including hematuria, proteinuria, flank pain, and varicocele. The diagnosis of NCS is difficult due to variations in normal anatomy. Treatment, which ranges from observation to nephrectomy, remains controversial. We conducted a review based on the related literature and our experience with hundreds of cases. We summarize the characteristics of NCS, the different measurements used in diagnosis, and the current treatment options. We present our diagnostic criteria and recommend endovascular stenting as the primary option for NCS.

Concepts: Kidney, Greek loanwords, Abdominal aorta, Renal artery, Renal vein, Inferior vena cava, Superior mesenteric artery, Nutcracker syndrome

27

Little is known regarding the outcomes of endovascular and surgical treatment of penetrating ulcers in the abdominal aorta. The potential benefit of conservative management of asymptomatic disease is also debatable. A systematic review of the literature was undertaken to investigate these issues.

Concepts: Medicine, Abdominal aorta, Aorta, Descending aorta, Nature, Thoracic aorta, History of science, Plato

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BACKGROUND: Statins are not effective in reducing atherosclerotic plaques of the abdominal aorta, and accumulating evidence suggests that bisphosphonates have the potential to induce the regression of atherosclerotic plaques of the abdominal aorta. METHODS AND RESULTS: A prospective, randomized, open-label, blinded-endpoint trial, involving 108 participants with hypercholesterolemia was conducted, participants received either 20 mg of atorvastatin daily, 400 mg of etidronate daily, or both drugs daily. The primary endpoint was the percent change in maximal vessel wall thickness of atherosclerotic plaques in the thoracic and abdominal aortas as measured by magnetic resonance imaging, following 12 months of treatment. In both the combination-therapy and atorvastatin groups, maximal vessel wall thickness of the thoracic aorta was reduced by 13.8% [95% confidence interval [CI] -16.4 to -11.3] and 12.3% [95% CI -14.9 to -9.7], respectively. These reduction rates were comparable between both groups (p=0.61). Meanwhile, in the etidronate group, maximal vessel wall thickness of the thoracic aorta remained unchanged (2.2% [95% CI -0.3 to 4.8%]). Conversely, maximal vessel wall thickness of the abdominal aorta was reduced more effectively in the combination-therapy group (-11.4%) than those achieved in the atorvastatin group (-0.9%; p<0.001) and the etidronate group (-5.5%; p=0.006). CONCLUSIONS: Atorvastatin plus etidronate combination-therapy for 12 months significantly reduced both thoracic and abdominal aortic plaques, while atorvastatin monotherapy reduced only thoracic aortic plaques, and etidronate monotherapy reduced only abdominal aortic plaques. The effectiveness of combination-therapy on reducing atherosclerotic plaques in the abdominal aorta was significantly greater than both atorvastatin and etidronate monotherapy. CLINICAL TRIAL REGISTRATION INFORMATION: http://www.umin.ac.jp/ctr/. Identifier: UMIN 000002635.

Concepts: Clinical trial, Randomized controlled trial, Statin, Abdominal aorta, Aorta, Descending aorta, Thoracic aorta, Hypercholesterolemia

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OBJECTIVE: To further characterize the vascular and ureteral anatomy relative to the mid sacral promontory, a landmark often used during sacrocolpopexy, and suggest strategies to avoid complications. STUDY DESIGN: Distances between the right ureter, aortic bifurcation, and iliac vessels to the mid sacral promontory were examined in 25 unembalmed female cadavers and 100 computed tomography (CT) studies. Data were analyzed using Pearson chi-square, unpaired Student'st test and analysis of covariance. RESULTS: The average distance between the mid sacral promontory and right ureter was 2.7 cm (range 1.6-3.8 cm) in cadavers and 2.9 cm (1.7-5.0) on CT ( P =.209). The closest cephalad vessel to the promontory was the left common iliac vein; average distance of 2.7 cm (0.95-4.75) in cadavers and 3.0 cm (1.0-6.1) on CT ( P =.289). The closest vessel to the right of the promontory was the internal iliac artery, average distance 2.5 cm (1.4-3.9) in cadavers and 2.2 cm (1.2-3.9) on CT ( P =.015). The average distance from the promontory to the aortic bifurcation was 5.3 cm (2.8-9.7) in cadavers and 6.6 (3.1-10.1) on CT ( P <.001). The average distance from the aortic bifurcation to the inferior margin of the left common iliac vein was 2.3 cm (1.2-3.9) in cadavers and 3.5 cm (1.7-5.6) on CT ( P <.001). CONCLUSIONS: The right ureter, right common iliac artery, and left common iliac vein are found within 3 cm from the mid sacral promontory. A thorough understanding of the extensive variability in vascular and ureteral anatomy relative to the mid sacral promontory should help avoid serious intraoperative complications during sacrocolpopexy.

Concepts: Ureter, Abdominal aorta, External iliac artery, Internal iliac artery, Iliac vein, Superior vesical artery, Common iliac artery, Common iliac vein

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In laparoscopic colorectal resection, the medial-to-lateral approach has been largely adopted. This approach can be initiated by the division of either the inferior mesenteric artery (IMA) or the inferior mesenteric vein (IMV). This cadaveric study aimed to establish the feasibility of IMV dissection as the initial landmark of medial-to-lateral left colonic mobilization for evaluating the size of the peritoneal window between the IMV at the lower part of the pancreas and the origin of the IMA (IMA-IMV distance) and the point of origin of the IMA compared to the lower edge of the third part of the duodenum (IMA-D3 distance). These distances were recorded on 30 fresh cadavers. The IMA-D3 distance was 0.4 ± 2.2 cm (mean ± SD). The IMA originated from the aorta at the level of or below the D3 in 21 cases (70%). The IMA-IMV distance was 5.5 ± 1.8 cm and was greater or equal to 5 cm (large window) in 21 cases (70%). IMA-IMV distance was correlated with IMA-D3 showing that a large window was inversely correlated with a low IMA origin (P < 0.001). IMA-D3 distance was not correlated with weight, height and sex. IMA-IMV distance was largerin male (6.7 ± 0.9 vs. 4.9 ± 1.8, P = 0.001) and correlated with weight, (r = 0.60, 95%CI = 0.03-0.10, P < 0.001) and height (r = 0.54, 95%CI = 0.05-0.21, P = 0.002). IMV can be used as the initial landmark for laparoscopic medial-to-lateral dissection in two-thirds of cases. A too-small window can require first IMA division. The choice between the two different medial-to-lateral approaches could be made by evaluating the anatomical relationship between IMA, IMV, and D3. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.

Concepts: Digestive system, Colon, Abdominal aorta, Peritoneum, Dissection, Inferior mesenteric artery, Inferior mesenteric vein, Left colic artery