A Rare Case of Brachial Artery Aneurysm in a 9-Month-Old Infant.

An otherwise healthy 9-month-old infant was treated for a true aneurysm of the proximal brachial artery. The swelling was first noted at seven months of age. An ultrasound scan showed a 2 cm × 2 cm aneurysm of the left brachial artery at the level of the mid-upper arm. Whole-body magnetic resonance angiography (MRA) confirmed this was a true aneurysm of the brachial artery; there was good distal runoff and no other aneurysms elsewhere. Vasculitis screen was negative. Surgical excision of the aneurysm and reconstruction of the brachial artery was performed with a reversed cephalic vein graft. The patient made an uneventful recovery and was discharged home. We present an overview of the workup report and emphasise that a multi-disciplinary team approach is imperative for assessing and managing this rare condition.

GLMN causing vascular malformations: the clinical and genetic differentiation of cutaneous venous malformations.

Cutaneous venous malformations frequently present with blue-pink lesions on the skin or mucosal surfaces. They can be problematic for patients who experience pain or unsightly lesions and can also be associated with significant bleeding. A proportion of venous malformations have been noted to occur in families, in particular glomuvenous malformations (GVMs). A 'two-hit' occurrence of genetic pathogenic variants appears to explain the appearance of GVMs, with the initial change in the germline copy of GLMN followed by a second somatic hit. Here we discuss a report of siblings experiencing such lesions, which were diagnosed as GVMs by genetic testing. We include a review of the literature regarding the clinical and genetic differences between these groups of venous malformations.

GC/MS assisted phytochemical analysis of Ajuga parviflora leaves extract along with anti-hepatotoxic effect against anti-tubercular drug induced liver toxicity in rat.

Owing to its traditional applications, the current study focuses on Ajuga parviflora (A. parviflora) leaves extract for phytochemical and pharmacological analysis. The principle constituents were identified through gas chromatography (GC), and gas chromatography/mass spectroscopy (GC/MS), these includes phthalic acid, squalene, α-tocopherol, vitamin E, phytol, 2-methylenecholestan-3-ol, stigmasterol, cholest-22-ene-21-ol and 3,5-dehydro-6-methoxy. Hepatoprotective effect of A. parviflora was evaluated through isoniazid and rifampicin (INH and RFP) induced hepatotoxicity in rat. Animals in group A were treated with INH and RFP 50 mg/kg. Animals in group B, C, and D were pre-treated with A. parviflora extract at 100, 200 and 300 mg/kg dose prior drug administration. A. parviflora extract at 200 and 300 mg/kg in group C and D significantly reduced aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and bilirubin (p<0.001) as compare to group B (100mg/kg). Total protein (TP) was also significantly (p<0.01) reduced in group C and D at dose of 200 and 300 mg/kg, respectively. The extract pre-treated animals with (A. parviflora, 200, and 300 mg/kg) showed that the epithelium of the central portal vein is intact with replete glucagon. The pre-treatment with A. parviflora protected the liver from INH and RFP induced hepatotoxicity. The results of pre-treated animals with A. parviflora 200, and 300 mg/kg dose prettily revert the severely disturb parameters like, cytolysis, lymphocytic infiltration, and lymphoid aggregate in portal vein and hydropic degeneration. The decrease peroxisome proliferator-receptor activator-δ (PPAR-δ) gene expression by INH, and RFP was significantly up regulated by A. parviflora extract in pre-treated animals at 200 and 300 mg/kg dose. These findings provide baseline pharmacological uses of A. parviflora in liver disorders. Further investigations are required for identification and isolation of biologically active components responsible for pharmacological activity.

Endovascular Treatment of a Giant Extracranial Carotid Artery Pseudoaneurysm in a Child Using Vascular Plugs.

Carotid artery pseudoaneurysm is a rare but serious complication of a retropharyngeal abscess in children. We report the first case of treating an unruptured mycotic pseudoaneurysm of the extracranial internal carotid artery (ICA) in a pediatric patient with vascular plugs. A 3-year-old patient presented with airway compromise and signs of neck sepsis. Successful embolization of the pseudoaneurysm was achieved with 2 Amplatzer vascular plugs to close the front and back door. The patient did not have any neurological deficit. Repeat imaging with ultrasound and computed tomography confirmed no recurrence of the pseudoaneurysm.

Outcomes of Percutaneous Portal Vein Intervention in a Single UK Paediatric Liver Transplantation Programme.

INTRODUCTION: Percutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC) following liver transplantation. We aimed to assess long-term outcomes of intervention in paediatric transplant recipients, in a single institution. MATERIALS AND METHODS: 227 children received 255 transplants between November 2000 and September 2016. 30 patients developed PVC of whom 21 had percutaneous intervention. Retrospective clinical and procedural outcome data on these 21 patients were collected. RESULTS: 21 patients, with median age 1.7 years (range 0.4-16.2), underwent 42 procedures with PTA with or without stenting. 36 procedures were for PV stenosis and 6 for PV thrombosis. Treatment was with primary PTA, with stenting reserved for suboptimal PTA result or restenosis within 3 months. 28 procedures were performed with PTA and 13 with stenting. Technical success (>50% reduction in mean pressure gradient, absolute pressure gradient ≤4 mmHg or venographic stenosis <30%) was achieved in 41 procedures. Failure to recanalise a thrombosed PV occurred in 1 procedure. There were no major procedural complications. Patients were followed-up with serial Doppler ultrasound surveillance. Kaplan-Meier estimated median primary patency was 9.9 months, with primary-assisted patency of 95% after median follow-up of 45.5 months (range 11.1-171.6). CONCLUSION: With regular surveillance, excellent patency rates can be achieved following percutaneous intervention for PVC post-paediatric liver transplantation.

Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children.

BACKGROUND: Foreign body inhalation is a common and life-threatening emergency, and is most prevalent in young children. The traditional view is that tracheobronchial anatomy determines that an inhaled foreign body is more likely to enter the right main bronchus. This view has been challenged in young children, in whom the distribution of inhaled objects is more evenly distributed between the bronchi. We, therefore, investigated tracheobronchial anatomy relevant to foreign body inhalation in children. MATERIALS AND METHODS: One hundred and fifty-six normal pediatric chest radiographs were selected from a large electronic database. Eight groups of radiographs were identified: supine (n=76) and erect; males (n=84) and females; aged <3 years (median age 12 [0.5-29] months) and > or =3 years (median age 126 [48-180] months). Tracheobronchial widths and angles were determined using a standardized technique with good reproducibility. RESULTS: Overall, children had a proximal right main bronchus that was consistently steeper and slightly wider than the left (P<0.001), becoming more vertical in the erect position (P=0.0001). In most children, the carina was positioned to the left of the mid-trachea, but in 34% of cases (40% of infants), it was to the right of the mid-trachea. The effects of age and gender were otherwise minimal. CONCLUSION: On the basis of tracheobronchial anatomy, an inhaled foreign body is more likely to enter the right bronchial tree than the left in children of all ages. However, the variability in the position of the carina with respect to the mid-trachea may explain why this right-sided preference is less marked in children compared to adults.

Risk factor awareness and secondary prevention of coronary artery disease: are we doing enough?

We prospectively assessed the patient awareness of risk factors of coronary artery disease (CAD) in this study by performing a voluntary questionnaire survey of 235 patients undergoing first time coronary artery bypass grafting (CABG) between May and December 2003. We assessed patient awareness of smoking, hypertension (HT), hypercholesterolaemia (HC), obesity, family history (FM) and diabetes (DM) and role of medication in secondary prevention. One hundred and eighty-seven ex- or current smokers (79.6%), 175 hypercholesterolaemic (74.5%), 116 had a family history (49.4%), 88 were hypertensive (37.4%), 62 obese (26.4%) and 45 diabetic (19.1%). More patients identified smoking (53.6%) and hypercholesterolaemia (55.3%) as risk factors as compared to hypertension (43%), family history (42.5%), diabetes (14.5%) or obesity (13.6%). A majority of the patients identified their own risk factors correctly. More than 95% of the patients were taking aspirin/clopidogrel and/or a statin. The main sources of information for these patients were hospitals, general practitioners, and booklets. Risk factor awareness in patients undergoing CABG is unsatisfactory. Nearly 95% of patients are taking aspirin/clopidogrel and/or statins, however, just over half realise their role in secondary prevention. For secondary prevention to be effective, more needs to be done to provide patients with necessary information.