Constrictive Pericarditis from an Atraumatic Hemopericardium After Systemic Thrombolysis for a Massive Pulmonary Embolism.

Constrictive pericarditis most commonly results from fibrosis and adhesions of the parietal and visceral pericardium due to long-standing inflammation. Common etiologies include idiopathic, post-surgical, radiation injury and infectious etiologies including tuberculosis. Traumatic hemopericardium is a rare cause of constrictive pericarditis but atraumatic hemopericardium causing constrictive pericarditis has not been reported in the literature to date. We present a case of constrictive pericarditis from an atraumatic hemopericardium after systemic thrombolysis for a massive pulmonary embolism.

Superior Vena Cava Syndrome and Wallstent: A Systematic Review.

Purpose: To elucidate the indication, presentation, demographics, Stanford classification, technical efficacy, morbidity, mortality and long term patency of Wallstent for superior vena cava (SVC) syndrome. Materials and Methods: A systematic review of literature in Pubmed and Embase, CINAHL and Cochrane Library in accordance to PRIMSA was conducted. Retrieval and extraction was performed by two independent reviewers with inter-rater reliability test. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data was subjected to pooled prevalence analysis, Cox regression, Kaplan-Meir survival and test of probability using log rank analytics. This review is registered with International prospective register of systematic review: CRD42021271009. Results: A total of n=701 individuals with n=930 stents with median age of 60 (interquartile range (IQR): 26-89) years and male predominance 3.5 : 1 were identified in n=30 articles. The most common venographic classification was Stanford type II (n=344, 50%) and complete symptomatic resolution was achieved in 48 h. The 30-day morbidity was (n=62, 8%) and mortality was (n=21, 3%). Female gender was associated with higher 30-day morbidity (p<0.03). The cumulative median patency of Wallstent for non-malignant aetiology was [550 days (IQR: 14-1080) vs. 120 days (IQR: 0-925)] for malignancy (p<0.03). Conclusion: The use of Wallstent for resolution of malignancy induced SVC syndrome as a first line therapy is feasible and associated with low mortality. Their use for non-malignant aetiology demands a more in depth review and advocates further investigation.

Sonographic findings of necrotizing fasciitis in the breast.

Necrotizsing fasciitis is a rapidly developing, fatal bacterial infection of deep subcutaneous tissues. It may occur at any site in the body. We describe a case of necrotizing fasciitis in the breast that was diagnosed on the basis of sonographic findings. Sonographic examination revealed fluid collection in deep tissues with bright echoes likely to represent gas microbubbles. The diagnosis of necrotizing fasciitis was subsequently confirmed on surgical exploration.

Left Gastric Artery Embolisation for the Treatment of Obesity: a Systematic Review.

BACKGROUND: Endovascular left gastric artery (LGA) embolisation has gained significant attention in the treatment of obesity/morbid obesity and reduction of ghrelin. The objective of this systematic review is to evaluate the recent literature, strengths, limitations and practical aspects of this new procedure in combination with its physiological and anatomical paradigm. METHODS: A systematic electronic search of literature from 1966 to June 2017 in Medline, CINHAL, Embase, Scopus and Cochrane library in English language and adult subjects was conducted. This search was conducted in accordance with Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment of the articles was performed, using Oxford critical appraisal skills programme (CASP), and their recommendation for practice was examined through National Institute for health Care Excellence (NICE). Inter-related reliability (Cronbach's Alpha) was assessed between the two independent reviewers. RESULTS: A total of n = 62 individuals were subjected to LGA embolisation. At 1-3 months, 7-11% and, at 12 months, 2% weight reduction was associated with ghrelin concentration reduction of 36% at 6 months. There was Haemoglobin A1c reduction (7.4 to 6.3%) and improved quality of life (SF-36 questionnaire) at 6 months (9.5 points) (range, 3.2-17.2). Despite immediate epigastric pain and mucosal ulceration, no long-term adverse outcome was identified. The overall length of stay was 2-3 days. CONCLUSIONS: The outcome of this review (level of evidence 3) suggests LGA embolisation is feasible and effective and perhaps a safe procedure in the treatment of obesity and reduction of ghrelin. However, further trials are highly advocated.

A rare presentation of an acute appendicitis.

Paraumbilical hernia sac usually contains omentum, bowel loop and rarely appendicular epiploicae, metastatic deposits and vermiform appendix. Presentation of acute appendicitis in a paraumbilical hernia is rare and limited to few case reports in the literature. Herein, we would like to report a case of a successfully treated acute appendicitis presenting in a paraumbilical hernia in an 84-year-old lady with 6-month follow-up.

Successful ultrasound-guided drainage of an intra-abdominal collection in late pregnancy.

Pregnancy complicated by an intra-abdominal collection is uncommon and poses a challenge in the management. We present a case that illustrates successful treatment via ultrasound-guided drainage of a collection associated with a dermoid cyst in a 30 weeks pregnant patient presenting with fever and right-sided abdominal pain. Following treatment, the patient clinically improved rapidly. The drain was removed 3 days later and a repeat ultrasound scan showed no collection.

Nonunion of the tibial facture as a consequence of posterior tibial artery pseudoaneurysm.

Pseudoaneurysm of the posterior tibial artery (PTA) is uncommon, and they mainly occur following high-velocity trauma, open fractures and can be iatrogenic in nature. To the best of our knowledge, this is the first reported and successfully treated case of PTA pseudoaneurysm identified as a consequence of tibia fracture nonunion in an otherwise healthy young individual 6 months following the original incident with a novel intraoperative technique.

Donor artery aneurysm formation following the ligation of haemodialysis arteriovenous fistula: a systematic review and case reports.

PURPOSE: The purpose of this study is to investigate the pathogenesis, presentation and diagnosis of donor artery aneurysm formation following arteriovenous fistula (AVF) ligation and reach a consensus on their management. METHODS: A systematic review of literature in Ovid, MedLine, Embase, Scopus and CINHAL in the English language from 1951 to 2014 was performed. This was accompanied by two case reports. A total of 12 articles with 23 case reports were identified. Variables including patient's demographics, signs, symptoms, fistula type, duration of fistula use, time to aneurysm formation, renal transplantation, diagnostic modality, aneurysm type and size, type of surgery and outcome were reviewed. RESULTS: The data demonstrate a male predominance (5:1) and a median age of 47 years (range, 27-75 years). The median duration of access was 54 months (range, 6-300 months). The median time from ligation to aneurysm was 120 months (range, 6-280 months). The commonest aneurysm was of the brachial artery (BA, n = 21, 84%). The commonest type of AVF was radiocephalic (n = 15, 60%) followed by brachiocephalic AVF (n = 9, 36%). The management of choice was aneurysmectomy followed by interposition vein grafting (n = 12, 50%) with a median reported patency of 12 months (range, 1-38 months). This was followed by polytetrafluoroethylene (PTFE) grafting (n = 6, 25%) with a median reported patency of 6 months (range, 1-48 months). CONCLUSIONS: The pathogenesis of donor artery aneurysms remains contentious. This review suggests that duplex is the investigative modality of choice and aneurysmectomy with interposition grafting is preferred over bypass.

Cryptogenic mycotic aneurysm of the superior mesenteric artery.

Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1-2%), and superior mesenteric artery (SMA) accounts for 3.2% of all reported series. However, mycotic SMA aneurysms (SMAAs) are even rarer, and to the best of our knowledge, this is the first report of cryptogenic mycotic aneurysm of SMA by Enterococcus faecalis (EF). We report a case of 77-year-old man with 6-week history of supra pubic/left iliac fossa pain, weight loss and fever. The computed tomography demonstrated an incidental finding of 4.4 × 3-cm SMAA with no primary foci. The subsequent serology and specimen confirmed EF. Aneurysmectomy without bypass grafting along with antimicrobial therapy resulted in full recovery of the patient.