Leiomyosarcoma of the Great Saphenous Vein: Case Report and Literature Review.

Vascular leiomyosarcomas are extremely rare, and involve veins 5 times more often than arteries. In the lower extremity, the great saphenous vein is the most frequent site of origin. We report the case of a healthy 45-year-old patient who presented with a painless mass located proximally in the right thigh in line with the great saphenous vein. At surgery, the treatment consisted of wide local excision. Histopathological studies confirmed mass as leiomyosarcoma. In light of this report, we draw attention to this rare disease, though with a poor prognosis.

Follow-up of aortic stent grafts: comparison of the volumetric analysis of the aneurysm sac by ultrasound and CT.

BACKGROUND: The long-term follow-up of patients with endovascular aneurysm repair (EVAR) and a normal surgical risk was defined by the French National Authority for Health (Haute Autorité de Santé) in 2009. The monitoring of the volume of the aneurysm sac theoretically avoids the bias related to the measurement of its diameter alone. The objective of this study was to evaluate how reliable and reproducible the volumetric measurement of the aneurysm sac by ultrasound was compared with computerized tomography angiography (CTA). METHODS: We carried out a retrospective diagnosis study of 75 consecutive patients treated with EVAR in our institution who were monitored with 3-dimensional ultrasonography (3DU) and CTA between January 2010 and December 2012. The measurement of the volume (cm(3)) of the aneurysm sac with a Toshiba Aplio XG ultrasound system equipped with a 3-MHz 3-dimensional probe was compared with the volume obtained by CTA. Interoperator reproducibility was studied in the last 45 enrolled patients; 2 different blinded operators made 2 volumetric measurements on the same patients, on the same day. An analysis of a 48-patient subgroup in which at least two 3DU were performed during follow-up was also carried out to determine the threshold value of the increase in the volume of the aneurysm sac, making it possible to suspect the presence of an endoleak. RESULTS: A total of 116 pairs of examinations were compared (the patients who had the longest postoperative follow-up had 4 pairs of compared examinations). The correlation between volumetric ultrasound and CTA measurements was excellent (r = 0.931; P < 0.0001) in the 116 pairs of examinations, and so was the reproducibility of volumetric echography (r = 0.949; P < 0.0001) in 45 patients. The subgroup study highlighted the fact that a 6.5-cm(3) increase of the aneurysm sac made it possible to suspect the presence of an endoleak in comparison with CTA as the gold standard (sensitivity and specificity were 85.7% and 85.3%, respectively). The area under the curve was 0.854 (95% confidence interval, 0.793-0.915). In the 116 examinations, a good correlation between volume and diameter was calculated with CTA (r = 0.733; P < 0.0001) and between ultrasound volumetric and CTA diameter (r = 0.660; P < 0.0001). CONCLUSIONS: Volumetric echography is comparable with CTA for the evaluation of the aneurysm sac after EVAR, reproducible and inexpensive. When a significant increase of the volume of the sac is detected by ultrasound, the examination can be supplemented by an injection of ultrasound contrast agent or by CTA to visualize an endoleak.

Chronic renoprotective effect of pulsatile perfusion machine RM3 and IGL-1 solution in a preclinical kidney transplantation model.

BACKGROUND: Machine perfusion (MP) of kidney graft provides benefits against preservation injury, however decreased graft quality requires optimization of the method. We examined the chronic benefits of MP on kidney grafts and the potential improvements provided by IGL-1 solution. METHOD: We used an established autotransplantation pig kidney model to study the effects of MP against the deleterious effects of warm ischemia (WI: 60 minutes) followed by 22 hours of cold ischemia in MP or static cold storage (CS) followed by autotransplantation. MPS and IGL-1 solutions were compared. RESULTS: Animal survival was higher in MPS-MP and both IGL groups. Creatinine measurement did not discriminate between the groups, however MPS-MP and both IGL groups showed decreased proteinuria. Chronic fibrosis level was equivalent between the groups. RTqPCR and immunohistofluorescent evaluation showed that MP and IGL-1 provided some protection against epithelial to mesenchymal transition and chronic lesions. IGL-1 was protective with both MP and CS, particularly against chronic inflammation, with only small differences between the groups. CONCLUSION: IGL-1 used in either machine or static preservation offers similar levels of protection than standard MP. The compatibility of IGL-1 with both machine perfusion and static storage could represent an advantage for clinical teams when choosing the correct solution to use for multi-organ collection. The path towards improving machine perfusion, and organ quality, may involve the optimization of the solution and the correct use of colloids.