Innovation in pathogenesis and management of aortic aneurysm.

Aortic aneurysm (AA) refers to the persistent dilatation of the aorta, exceeding three centimeters. Investigating the pathophysiology of this condition is important for its prevention and management, given its responsibility for more than 25000 deaths in the United States. AAs are classified based on their location or morphology. various pathophysiologic pathways including inflammation, the immune system and atherosclerosis have been implicated in its development. Inflammatory markers such as transforming growth factor ß, interleukin-1ß, tumor necrosis factor-α, matrix metalloproteinase-2 and many more may contribute to this phenomenon. Several genetic disorders such as Marfan syndrome, Ehler-Danlos syndrome and Loeys-Dietz syndrome have also been associated with this disease. Recent years has seen the investigation of novel management of AA, exploring the implication of different immune suppressors, the role of radiation in shrinkage and prevention, as well as minimally invasive and newly hypothesized surgical methods. In this narrative review, we aim to present the new contributing factors involved in pathophysiology of AA. We also highlighted the novel management methods that have demonstrated promising benefits in clinical outcomes of the AA.

An Unusual Presentation of Streptococcus gallolyticus in Infective Endocarditis.

Background. Streptococcus gallolyticus (previously known as Streptococcus bovis type-1) bacteremia has a well-established, almost pathognomonic association with colorectal carcinoma, with the most common hypothesized mechanism being ulceration of polyps leading to hematologic dissemination. There are few reported cases of streptococcus bacteremia from other, seemingly benign sources like cellulitis or colonic adenomas. Hence, there is limited focus on skin and soft tissue infections leading to potentially fatal infective endocarditis. Case Presentation. We present a novel case of streptococcus bacteremia from uncommon sources like abdominal wall cellulitis or colonic adenoma leading to infective endocarditis as well as other manifestations, including osteomyelitis and discitis. This report highlights a unique case of streptococcus bacteremia with an uncommon origin, arising from abdominal wall cellulitis or colonic adenoma, ultimately resulting in the development of infective endocarditis. Furthermore, the patient presented with additional clinical manifestations, including osteomyelitis and discitis. Conclusions. Through our case report, we emphasize the importance of investigating uncommon sources like cellulitis when initial malignant workup is negative in streptococcus bacteremia and further elucidate the pathophysiology of streptococcus bacterial dissemination from nonmalignancy-related sources.

A Rare Case of Severe Hypokalemia and Hypomagnesemia due to Venetoclax and Polypharmacy Leading to Life-Threatening Cardiac Arrhythmias.

Venetoclax is a novel agent used in hematologic malignancies. Although no long-term studies have directly implicated venetoclax, few studies show possible association with electrolyte abnormalities. Severe derangements in serum electrolyte levels can cause cardiac dysrhythmias, which can be potentially fatal. We present a case of venetoclax in association with the other medications causing life-threatening arrhythmias. Hypothesized mechanisms include damage to the distal tubules causing loss of potassium and magnesium. Our patient required modification of his medications and aggressive repletion of electrolytes with good outcomes. For patients on venetoclax, especially those with polypharmacy, caution should be exercised to prevent severe electrolyte derangements, which can lead to life-threatening arrhythmias.

Excessive Dynamic Airway Collapse Severity Scoring System: A Call Out for an Overall Severity Determination.

BACKGROUND: Severe excessive dynamic airway collapse (EDAC) is defined as airway narrowing due to posterior wall protrusion into the airway lumen, >90%. We aimed to establish an overall severity score to assess severe EDAC and the need for subsequent intervention. METHODS: A retrospective study of patients who underwent dynamic bronchoscopy for evaluation of expiratory central airway collapse between January 2019 and July 2021. A numerical value was given to each tracheobronchial segmental collapse: 0 points (<70%), 1 point (70% to 79%), 2 points (80% to 89%), and 3 points (>90%) to be added for an overall EDAC severity score per patient. We compared the score among patients who underwent stent trials (severe EDAC) and those who did not. Based on the receiver operating characteristics curve, a cutoff total score to predict severe EDAC was calculated. RESULTS: One hundred fifty-eight patients were included. Patients were divided into severe (n = 60) and nonsevere (n = 98) EDAC. A cutoff of 9 as the total score had a sensitivity of 94% and a specificity of 74% to predict severe EDAC, based on an area under the curve 0.888 (95% CI: 0.84, 0.93; P < 0.001). CONCLUSION: Our EDAC Severity Scoring System was able to discern between severe and nonsevere EDAC by an overall score cutoff of 9, with high sensitivity and specificity for predicting severe disease and the need for further intervention, in our institution.

Cinematic CT as a valuable protocol for severe ECAC.

Expiratory central airway collapse (ECAC) is a pathology gaining recognition in the medical community due to its unspecific symptoms and diagnostic challenges. Its current gold standard for diagnosis, dynamic bronchoscopy, is invasive. Current non-invasive techniques such as computed tomography (CT) protocols have shown limited reproducibility. We present a case of a 77-year-old man with suspected ECAC who underwent evaluation with two different expiratory CT protocols. The initial standard end-expiratory CT could not detect airway collapsibility. However, dynamic bronchoscopy detected severe ECAC. Afterwards, we implemented a novel CT protocol, called dynamic forced expiratory CT (cinematic), comprising detailed, consecutive helical imaging of the central airway throughout the entire respiratory cycle, detecting severe ECAC, as proven by the earlier dynamic bronchoscopy. We hypothesize this may reduce the risks and need for performing multiple invasive procedures such as dynamic bronchoscopy. Extensive studies are required to evaluate the feasibility of its implementation for diagnosing ECAC.