Candida arteritis in a pair of renal transplant recipients.

Graft site candidiasis is a rare but life-threatening complication of renal transplant. We report the course and management of 2 renal transplant recipients, using kidneys from a single donor, both of whom developed vascular complications secondary to Candida infection.

High risk of peripheral arterial disease in the United Kingdom: 2-year results of a prospective registry.

We report a prospective 2-year, multicenter study of patients presenting with intermittent claudication (IC; ankle brachial blood pressure index, ABPI ≤ 0.9). Mean age of the 473 patients enrolled was 68 years, 20% were diabetics, 30% had prior symptomatic coronary heart disease (CHD), 7% had prior stroke, and 39% were current smokers. At baseline, 26.2% of patients had BP ≤ 140/85 mm Hg or lower and at 2 years this figure was 32.5% (P = .01). Current smokers had fallen to 27% (from 39%) at 2 years (P < .001). Use of antiplatelet agents, statins, and angiotensin converting enzyme inhibitors increased significantly during the course of the study as did claudication distance. Death and the composite of death, stroke or myocardial infarction (MI), occurred in 8.4% and 11.6% of patients, respectively. Prognosis was worse in patients with prior history of CHD, older age, those with diabetes and a lower ABPI.

Staged carotid endarterectomy under local anaesthetic in patients requiring cardiac surgery.

INTRODUCTION: There is no clear guidance as to the management of carotid stenotic disease prior to cardiac surgery. We aimed to review the results of a single centre performing carotid endarterectomy (CEA) under local anaesthesia prior to cardiac surgery. PATIENTS AND METHODS: All patients referred for cardiac surgery in our tertiary referral unit between January 1998 and August 2008 were identified and data relating to those 100 undergoing CEA prior to cardiac surgery were reviewed. Eighty had coronary artery bypass grafting (CABG) alone, 15 combined valve surgery and CABG and three underwent isolated valve surgery. Two patients died prior to cardiac surgery. RESULTS: One hundred patients were prospectively identified after screening by clinical features and carotid duplex scanning to require CEA from a total of 11,394. The stroke rate was 1% between CEA and cardiac surgery, 2% following cardiac surgery and 3% in total. Ninety-eight patients proceeded to cardiac surgery (two deaths post-CEA). The cumulative event rate (stroke, myocardial infarct [included in view of the nature of the patients in our cohort] and/or death) was 10.2% following all cardiac surgery (CABG and valve). In 80 patients undergoing CABG only, the cumulative event rate was 7.5% after CABG. Including the two deaths pre-cardiac surgery, the rates were 12% and 8%. The risk of peri-operative stroke and 30-day mortality were reduced to that of patients undergoing cardiac surgery without significant carotid arterial disease, 3% versus 3.3% and 5.1% versus 6.5%, respectively. CONCLUSIONS: This study demonstrates that a policy of selective screening for significant carotid artery disease in cardiac surgical patients combined with a strategy of CEA under local anaesthesia prior to unselected cardiac surgery (CABG with or without valve surgery) leads to rates of peri-operative CVA, myocardial infarction and death comparable to rates published for CEA prior to isolated CABG surgery. Furthermore, it reduces the risk of peri-operative stroke and 30-day mortality to that observed in patients undergoing cardiac surgery without significant carotid arterial disease.

Management of popliteal artery aneurysms.

BACKGROUND: Popliteal artery aneurysms (PAA) are the most common peripheral aneurysm and are recognized as 'the silent killer of the leg circulation'. The timing and type of interventions used in their treatment is still controversial. This review examines the published data on the natural history, epidemiology, clinical presentation and management options available. The aim of this study is to try and reach a consensus with regards to the best management of PAA. METHOD: A systematic review of data in the English published works since 1980. RESULTS: The authors include 53 studies containing 2854 patients with 4291 PAA. Most published data involves retrospective studies and personal experience, with one multicentre study. No randomized controlled studies exist regarding the management of PAA. CONCLUSIONS: 1. Although most PAA are of atherosclerotic origin in old patients, trauma, infection and family history are the main causes in young patients. 2. Great vigilance is needed for diagnosis as only approximately five patients are seen each year by a major vascular centre. There is no place for screening programmes to detect PAA. 3. Approximately 45% of patients are asymptomatic at the time of initial diagnosis. Aortic aneurysms are found in 40% and bilateral PAA in 50% of patients. More than 95% of patients are men with a mean age of 65 years and 45% have hypertension. 4. Surgical reconstruction is recommended for all symptomatic and asymptomatic aneurysms larger than 2 cm. Five-year graft patency rates after surgical repair range from 30 to 97%, with 5-year limb salvage ranging from 70 to 98%. Patient survival rates at 5 and 10 years are 75 and 46%, respectively. 5. If carried out carefully, intra-arterial thrombolysis can safely prepare patients presenting with acute ischaemia from occluded PAA, for surgical revascularization to restore distal run-off. 6. Endovascular repair of a PAA is a feasible option, although little evidence is yet available. 7. Lifelong, careful patient surveillance is essential to detect and treat new aneurysms at other sites.

Popliteal pseudoaneurysm secondary to a tibial osteochondroma: diagnosis with multi-detector row computed tomographic angiography.

A 17-year-old male presented with right knee pain following mild trauma whilst playing badminton. He subsequently developed a popliteal pseudoaneurysm secondary to trauma from a tibial osteochondroma. This is a recognised though very rare occurrence. Its appearance is reported for the first time using multidetector row computed tomographic angiography (MDCTA). The clinical presentation and management of the popliteal pseudoaneurysm are outlined and the imaging findings are illustrated. There is increasing usefulness of MDCTA as an accessible, accurate, noninvasive clinical tool in the emergency diagnostic setting. Its use in the management of this unusual condition is demonstrated with emphasis on 3D, multi-planar reconstruction post-processing techniques.

Intravenous uterine leiomyosarcomatosis with intracardial extension.

Uterine leiomyosarcoma is a rare malignant tumor of smooth muscle origin. We describe the case of a 64-year-old female with intravenous uterine leiomyosarcomatosis with the extension of the tumor mass into the inferior vena cava and right atrium. As initial tissue diagnosis of the tumor obtained from the uterine and right atrial masses suggested intravenous leiomyomatosis, surgical resection was carried out using a one-stage procedure via a laparotomy and median sternotomy with cardiopulmonary bypass and circulatory arrest. Subsequent histology revealed uterine leiomyosarcoma with an intravenous spread, which to our knowledge is only the second case that has been described.