Pregnancy after uterine artery embolization: a case report in a woman with leiomyomata

Background. Several pregnancies have been reported after embolization of uterine artery. This procedure is an accepted nonsurgical treatment for symptomatic uterine fibroids but its safety in women desiring future childbearing is not well established. Case Report. We present a 40-year-old woman with leiomyomata who became pregnant after previously undergone uterine artery embolization for three times. The placenta was previa and the fetus was in transverse position. She had a cesarean delivery of an appropriately grown fetus at 37 weeks, which was followed by uterine atony requiring hysterectomy. Conclusion. Although pregnancy-related outcomes remain understudied, the available reports evidence that pregnancies after uterine artery embolization may be at significantly increased risk for postpartum hemorrhage, cesarean delivery, abnormal placentation, and malpresentation. In patients who are undergoing this type of treatment and contemplating pregnancy, the possibility of adverse complications should be taken in consideration and women should be appropriately advised.

Spontaneous Dissection of the Renal Artery in Vascular Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) is a rare heterogeneous group of connective tissue disorders. The vascular type (vEDS) is an autosomal dominant disorder caused by heterozygous mutations in the COL3A1 gene predisposing to premature arterial, intestinal, or uterine rupture. We report a case of a 38-year-old woman with a recent diagnosis of vEDS admitted in the Emergency Department with a suspicion of a pyelonephritis that evolved to a cardiopulmonary arrest. A fatal retroperitoneal hematoma related with a haemorrhagic dissection of the right renal artery was found after emergency surgery. This case highlights the need to be aware of the particular characteristics of vEDS, such as a severe vascular complication that can lead to a fatal outcome.

Computed Tomography Perfusion Can Guide Endovascular Therapy in Bilateral Carotid Artery Dissection

Carotid artery dissection (CAD) is a major cause of stroke in those under age 45, accounting for around 20% of ischaemic events[1,2]. In the absence of known connective tissue disorders, most dissections are traumatic[2]. First-line management is comprised of antiplatelet or anticoagulation therapy, but many traumatic dissections progress despite this and carry the risk of long-term complications from embolism or stenosis[3]. We report a case of traumatic bilateral carotid dissection leading to progressive neurological symptoms and hypoperfusion on computed tomography perfusion (CTP), despite escalation in anticoagulation, which led to emergency carotid stenting.

A Case of Internal Carotid Artery Thrombosis associated with Thalidomide Administration in Multiple Myeloma

Thalidomide is an effective chemotherapeutic agent used to achieve remission in multiple myeloma. However, its administration is associated with several adverse effects including venous thromboembolism, while arterial thrombosis has also, although rarely, been described in the literature. We report a case of internal carotid artery occlusion within 1 week of starting thalidomide with prophylactic low molecular weight heparin in a patient who had no other prothrombotic risk factors. It is not known why this complication occurs despite the administration of anticoagulant prophylaxis. The role of factor VIII, von Willebrand factor antigen levels and fibrinogen in multiple myeloma patients should be studied in order to determine if these factors should be targeted in future prophylactic treatment.

Differential mechanisms of angiotensin II and PDGF-BB on migration and proliferation of coronary artery smooth muscle cells

Angiotensin II (Ang II) and platelet-derived growth factor-BB (PDGF-BB) are associated with excessive cell migration, proliferation and many growth-related diseases. However, whether these agents utilise similar mechanisms to trigger vascular pathologies remains to be explored. The effects of Ang II and PDGF-BB on coronary artery smooth muscle cell (CASMC) migration and proliferation were investigated via Dunn chemotaxis assay and the measurement of [3H]thymidine incorporation rates, respectively. Both atherogens produced similar degrees of cell migration which were dramatically inhibited by mevastatin (10 nM). However, the inhibitory effects of losartan (10 nM) and MnTBAP (a free radical scavenger; 50 μM) were found to be unique to Ang II-mediated chemotaxis. In contrast, MnTBAP, apocynin (an antioxidant and phagocytic NADPH oxidase inhibitor; 500 μM), mevastatin and pravastatin (100 nM) equally suppressed both Ang II and PDGF-BB-induced cellular growth. Although atherogens produced similar changes in NADPH oxidase, NOS and superoxide dismutase activities, they differentially regulated antioxidant glutathione peroxidase activity which was diminished by Ang II and unaffected by PDGF-BB. Studies with signal transduction pathway inhibitors revealed the involvement of multiple pathways i.e. protein kinase C, tyrosine kinase and MAPK in Ang II- and/or PDGF-BB-induced aforementioned enzyme activity changes. In conclusion, Ang II and PDGF-BB may induce coronary atherosclerotic disease formation by stimulating CASMC migration and proliferation through agent-specific regulation of oxidative status and utilisation of different signal transduction pathways.

Factors associated with an increased risk of vertebral fracture in monoclonal gammopathies of undetermined significance

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Surgical treatment of a pseudoaneurysm of the femoral artery secondary to a gunshot wound: clinical case report

We report a case of a 18-year-old male patient with a diagnosis of pseudoaneurysm of the right supericial femoral artery secondary to penetrating injury by gunshot, which was treated in our Hospital with an aneurysm resection and a saphenous vascular graft inverted with a satisfactory evolution.

Pediatric Coronary Artery Revascularization Surgery: Development and Effects on Survival, Cardiac Events and Graft Patency for Children With Kawasaki Disease Coronary Involvements

Pediatric coronary artery bypass surgery gained wide acceptance with the introduction of internal thoracic arteries (ITAs) for bypass operations for post Kawasaki disease (KD) lesions. The technique is now established as the standard surgical choice, and its safety even in infancy, graft patency, growth potential, graft longevity and clinical efficacy have been well documented. In this article the author reviews the development of pediatric coronary bypass as the main indication for the treatment of coronary lesions due to KD. I believe that coronary revascularization surgery in pediatric population utilizing uni- or bilateral ITAs is the current gold-standard as the most reliable treatment, although percutaneous coronary intervention with or without a stent has been tried with vague long-term results in children.

Age and growth of the bigeye thresher shark, Alopias superciliosus, from the pelagic longline fisheries in the tropical northeastern Atlantic Ocean, determined by vertebral band counts

The bigeye thresher, Alopias supercilious, is commonly caught as bycatch in pelagic longline fisheries targeting swordfish. Little information is yet available on the biology of this species, however. As part of an ongoing study, observers sent aboard fishing vessels have been collecting set of information that includes samples of vertebrae, with the aim of investigating age and growth of A. supercilious. A total of 117 specimens were sampled between September 2008 and October 2009 in the tropical northeastern Atlantic, with specimens ranging from 101 to 242 cm fork length (FL) (176 to 407 cm total length). The A. supercilious vertebrae were generally difficult to read, mainly because they were poorly calcified, which is typical of Lamniformes sharks. Preliminary trials were carried out to determine the most efficient band enhancement technique for this species, in which crystal violet section staining was found to be the best methodology. Estimated ages in this sample ranged from 2 to 22 years for females and 1 to 17 years for males. A version of the von Bertalanffy growth model (VBGF) re-parameterised to estimate L(0), and a modified VBGF using a fixed L(0) were fitted to the data. The Akaike information criterion (AIC) was used to compare these models. The VBGF produced the best results, with the following parameters: L(inf) = 293 cm FL, k = 0.06 y(-1) and L(0) = 111 cm FL for females; L(inf) = 206 cm FL, k = 0.18 y(-1) and L(0) = 93 cm FL for males. The estimated growth coefficients confirm that A. supercilious is a slow-growing species, highlighting its vulnerability to fishing pressure. It is therefore urgent to carry out more biological research to inform fishery managers more adequately and address conservation issues.

Age and growth of the smooth hammerhead shark, Sphyrna zygaena, in the Eastern Equatorial Atlantic Ocean, using vertebral sections

The smooth hammerhead shark Sphyrna zygaena (Sphyrnidae) is regularly caught as bycatch in pelagic longline fisheries, but is one of the least studied of all pelagic sharks. Recently, ICCAT (International Commission for the Conservation of Atlantic Tunas) issued recommendations underlining the need for more studies on the life history parameters of this and other pelagic shark species. To this end, the age and growth of S. zygaena were studied in the Eastern Equatorial Atlantic Ocean, in an area where growth parameters were not yet available for this species. Data from 139 specimens, caught between June and September 2009, ranging in size from 136 to 233 cm fork length (FL), were analysed. Preliminary trials were carried out to assess the most efficient growth band enhancement technique. These indicated that sectioning the vertebrae into 500 μm sections followed by staining with crystal violet produced the best results. Growth models were fitted using the traditional von Bertalanffy growth equation and a modification of this equation using a known size at birth. Growth models were compared using the Akaike information criterion (AIC). The von Bertalanffy growth equation seemed to be the most adequate model to describe growth in this species, with resulting growth parameters of L inf = 272 cm FL, k = 0.06 year for males and L inf = 285 cm FL, k = 0.07 year for females. In the first four years of life, S. zygaena grows 25 cm per year on average, but its growth slows down in later life. Future stock assessment models should incorporate these age and growth parameters for species management and conservation.

Congenital thoracic vertebral malformations in brachycephalic “screw-tailed” dog breeds: Validation of a human classification scheme and a method of Cobb angle measurement in the assessment of vertebral column deformity

Congenital vertebral malformations are common in brachycephalic “screw-tailed” dog breeds such as French bulldogs, English bulldogs, Boston terriers, and Pugs. Those vertebral malformations disrupt the normal vertebral column anatomy and biomechanics, potentially leading to deformity of the vertebral column and subsequent neurological dysfunction. The initial aim of this work was to study and determine whether the congenital vertebral malformations identified in those breeds could be translated in a radiographic classification scheme used in humans to give an improved classification, with clear and well-defined terminology, with the expectation that this would facilitate future study and clinical management in the veterinary field. Therefore, two observers who were blinded to the neurologic status of the dogs classified each vertebral malformation based on the human classification scheme of McMaster and were able to translate them successfully into a new classification scheme for veterinary use. The following aim was to assess the nature and the impact of vertebral column deformity engendered by those congenital vertebral malformations in the target breeds. As no gold standard exists in veterinary medicine for the calculation of the degree of deformity, it was elected to adapt the human equivalent, termed the Cobb angle, as a potential standard reference tool for use in veterinary practice. For the validation of the Cobb angle measurement method, a computerised semi-automatic technique was used and assessed by multiple independent observers. They observed not only that Kyphosis was the most common vertebral column deformity but also that patients with such deformity were found to be more likely to suffer from neurological deficits, more especially if their Cobb angle was above 35 degrees.