A Cadaveric Case Report of Retroaortic Left Renal Vein in an Elderly Male With Multiple Known Comorbidities.

This case report describes the discovery of a type 1 retroaortic left renal vein (RLRV) in an 83-year-old male cadaveric donor with multiple comorbidities. RLRV is an anatomical variant with an estimated incidence of 0.5-3.6%, with type 1 RLRV being the most common subtype. RLRV is typically asymptomatic, which aligns with the benign nature of the anatomical variation seen in this case. However, it is important to recognize that RLRV can be symptomatic. The hallmark manifestations of renal vein entrapment, colloquially known as the "nutcracker syndrome," include hematuria, proteinuria, flank pain, and varicocele, which are concurrent with the encasement of the renal vein between the aorta and surrounding anatomical structures. RLRV is typically diagnosed using multidetector CT (MDCT) or Doppler ultrasound (DUS). The therapeutic approach to symptomatic RLRV primarily encompasses conservative strategies, such as the administration of angiotensin-converting enzyme (ACE) inhibitors and aspirin, whereas surgical interventions are generally reserved for refractory cases, i.e., when conservative measures fail to alleviate the symptoms.

Paget-Schroetter Syndrome: A Case of a Young Weightlifter.

Venous thoracic outlet syndrome is a rare type of thoracic outlet disorder that is often overlooked. When an upper extremity deep vein thrombosis (UEDVT) occurs due to thoracic outlet compression, it is commonly referred to as Paget-Schroetter syndrome (PSS). The space between the first rib and the clavicle where the subclavian vein passes through is highly vulnerable to compression and injury. This space often undergoes repetitive trauma due to extrinsic compression which ultimately results in scarring and clot formation. This case report reviews the case of a 26-year-old white male who presented with the chief complaint of right arm swelling and soreness after strenuous bench pressing. He went to urgent care and the initial diagnosis was a strained muscle. An ultrasound was ordered, revealing multiple UEDVTs. At this time, the patient was referred to vascular surgery for further management. Recommended management for PSS is to initiate anticoagulation or thrombolytic therapy depending on the timing between the onset of symptoms and diagnosis. Although there is some disagreement on the next steps after thrombolysis, most physicians agree that decompression of the thoracic outlet with first rib resection is the logical next step to prevent clot recurrence. The patient received the above-mentioned therapy and is progressing well with recovery. Recognizing the thoracic outlet as a potential location for pathology and keeping in mind those who have a presentation similar to this case study is extremely important.

Pharmaceuticals and personal care products: A critical review of the impacts on fish reproduction.

Research in environmental toxicology involving pharmaceuticals and personal care products (PPCPs) has increased greatly over the last 10-15 years. Much research has been focused on the endocrine-disrupting potential of PPCPs, as they relate to negative population impacts of aquatic organisms. This review assesses the current data on the reported effects of PPCPs on fish reproduction with an emphasis on fecundity, a predictor of population effects. Studies of both individual PPCPs and PPCP mixtures are presented. As the majority of individual PPCP studies reviewed demonstrate negative effects on fish fecundity, we relate these findings to detected surface water concentrations of these compounds. Very few studies involving PPCP mixtures have been conducted; however, the need for these types of studies is warranted as fish are most likely exposed to mixtures of PPCPs in the wild. In addition, laboratory and field assessments of wastewater treatment plant (WWTP) effluents, a major source of PPCPs, are reviewed. Much of the data provided from these assessments are variable and do not generally demonstrate negative impacts on reproduction, or the studies are unable to directly associate observed effects with WWTP effluents. Finally, future research considerations are outlined to provide an avenue into understanding how wild populations of fish are affected by PPCPs. These considerations are aimed at determining the adaptation potential of fish exposed to mixtures of PPCPs over multiple generations. As global use of PPCPs continually rises, the need to discern the effects of chronic exposure to PPCPs is greatly increased.

Responses to various exposure durations of levonorgestrel during early-life stages of fathead minnows (Pimephales promelas).

Pharmaceuticals are routinely detected in the environment; and several of these compounds have been extensively researched due to their potential impacts to the endocrine system of aquatic organisms. The negative reproductive consequences of synthetic progestins in teleost species have only recently been investigated. The current study examined different exposure periods that may be most sensitive for levonorgestrel (LNG) in early-life stages of fathead minnow larvae. Larvae were exposed to a single concentration of LNG (125ng/L) for different durations from fertilized egg through 28 days post hatch (dph) with growth and mRNA expression of FSH, 3ß-HSD, 20ß-HSD, and CYP19a1 measured. Regardless of the duration of exposure, LNG significantly decreased growth in the fathead minnow larvae at day 28. For both 20ß-HSD and CYP19a1, mRNA expression was decreased following LNG exposure durations ≥7 days. 3ß-HSD and FSH showed similar trends after exposure to LNG with later stages of development exhibiting decreased expression. 20ß-HSD and 3ß-HSD were the only transcripts to remain down regulated once larvae were moved to clean water after the 7-14dph LNG exposure. This study is the first to investigate the effects of exposure time to a synthetic progestin on developing fish. Future research is needed to understand what impacts these changes have on adult stages of development.

Levonorgestrel exposure to fathead minnows (Pimephales promelas) alters survival, growth, steroidogenic gene expression and hormone production.

Human pharmaceuticals are commonly detected in the environment. Concern over these compounds in the environment center around the potential for pharmaceuticals to interfere with the endocrine system of aquatic organisms. The main focus of endocrine disruption research has centered on how estrogenic and androgenic compounds interact with the endocrine system to elicit reproductive effects. Other classes of compounds, such as progestins, have been overlooked. Recently, studies have investigated the potential for synthetic progestins to impair reproduction and growth in aquatic organisms. The present study utilizes the OECD 210 Early-life Stage (ELS) study to investigate the impacts levonorgestrel (LNG), a synthetic progestin, on fathead minnow (FHM) survival and growth. After 28 days post-hatch, survival of larval FHM was impacted at 462 ng/L, while growth was significantly reduced at 86.9 ng/L. Further analysis was conducted by measuring specific endocrine related mRNA transcript profiles in FHM larvae following the 28 day ELS exposure to LNG. Transcripts of 3ß-HSD, 20ß-HSD, CYP17, AR, ERα, and FSH were significantly down-regulated following 28d exposure to 16.3 ng/L LNG, while exposure to 86.9 ng/L significantly down-regulated 3ß-HSD, 20ß-HSD, CYP19A, and FSH. At 2,392 ng/L of LNG, a significant down-regulation occurred with CYP19A and ERß transcripts, while mPRα and mPRß profiles were significantly induced. No significant changes occurred in 11ß-HSD, CYP11A, StAR, LHß, and VTG mRNA expression following LNG exposure. An ex vivo steroidogenesis assay was conducted with sexually mature female FHM following a 7 day exposure 100 ng/L LNG with significant reductions observed in pregnenolone, 17α,20ß-dihydroxy-4-pregnen-3-one (17,20-DHP), testosterone, and 11-ketotestosterone. Together these data suggest LNG can negatively impact FHM larval survival and growth, with significant alterations in endocrine related responses.

Involvement of ß(3)-adrenergic receptors in in vivo cardiovascular regulation in rainbow trout (Oncorhynchus mykiss).

Currently, we have little information concerning the involvement of ß(3)-adrenergic receptors (AR) in cardiovascular regulation in fishes. The goal of this study was to investigate the effect of ß(3)-AR ligands on in vivo cardiovascular function in larval and adult rainbow trout (Oncorhynchus mykiss). In adult fish, injection of BRL(37344) (ß(3)-AR agonist) resulted in an increase in heart rate (f(H)) (~31%) while stroke volume (Sv) was reduced (-25.9%). Injection of SR(59230A) (ß(3)-AR antagonist) and propranolol (ß(1)/ß(2)-AR antagonist) resulted in increases in dorsal aorta blood pressure (P(DA)) with differing effect on cardiac variables (f(H) and Sv). To confirm specificity of the results, BRL(37344) was injected following sequential injections of phentolamine (α(1)-AR antagonist), atropine (muscarinic antagonist), propranolol and SR(59230A). While phentolamine had no effect on BRL(37344), atropine completely abolished the influence of BRL(37344) on f(H), Sv and cardiac output (Q). In larval trout, BRL(37344) (10 and 100 µM) induced a significant concentration-dependent increase in f(H) while SR(59230A) (1 and 10 µM) and propranolol (1 and 10 µM) separately caused a significant concentration-dependent decrease. These data suggest that ß(3)-ARs have an important role in regulation of cardiovascular function, and provide evidence for a potential interaction between muscarinic and adrenergic receptors in rainbow trout.