Superior mesenteric artery mycotic aneurysm repaired with bifurcated saphenous vein graft.

A mycotic aneurysm of the superior mesenteric artery caused by Enterococcus faecalis was successfully treated with aneurysmectomy and reconstruction with a bifurcated saphenous vein graft. A 49-year-old man with a history of type 2 diabetes mellitus and a recent left transmetatarsal amputation for osteomyelitis presented to the emergency department with severe abdominal pain, an unexplained 30-lb weight loss, and wound dehiscence. Computed tomography angiography showed an aneurysm of the superior mesenteric artery and a splenic abscess. The patient underwent splenectomy, surgical resection of the aneurysm, and reconstruction with a bifurcated saphenous vein. Follow-up revealed normal gastrointestinal function and graft patency.

Onychodystrophy as the Presenting Sign of Steal Syndrome.

A man in his 70s presented to the dermatology nail clinic with a 1-month history of worsening onychodystrophy, leukonychia, and pain in his left fifth finger. Physical examination revealed a cool hand and absent radial pulse. Ischemia was suspected, and the patient was sent to the emergency department where the diagnosis of steal syndrome was made and his previously required arteriovenous fistula was ligated. This case highlights the clinical features of steal syndrome, that nail changes should be recognized as clinical features, and that urgent triage of these patients to vascular surgery is of critical importance.

The effect of ultrasonic irradiation on doxorubicin-induced cytotoxicity in three human bladder cancer cell lines.

Although ultrasonic irradiation has been proven to increase membrane permeability and enhance chemotherapeutic cytotoxicity in a number of cell lines, this effect has never been demonstrated in bladder cancer cells. Bladder cancer may offer a unique setting for ultrasound enhancement of chemotherapy, since intravesicular rather than intravenous administration of chemotherapy is used in superficial cases. The aim of this study was to investigate whether a non-toxic dose of ultrasound could increase membrane permeability, and potentiate the cytotoxicity of doxorubicin to three human bladder carcinoma cell lines (TCC-SUP, T24, and RT4) in vitro. An EuTDA-Efflux assay, which measures the amount of a chemical that is allowed to seep out of labeled cells, was used to analyze membrane permeability, and an MTS assay, which directly measures cell viability, was used to determine the effect of chemotherapy on cells after they were treated with a variety of doxorubicin concentrations and ultrasonic exposures. Ultrasound treatment for 5min and 10min at an intensity of approximately 0.3W/cm(2) resulted in a significant increase in EuTDA efflux in all three cell lines. However, no ultrasonic enhancement of doxorubicin growth inhibition in these human bladder carcinoma cells was observed. This suggests that either ultrasound does not increase doxorubicin uptake by the cell or that doxorubicin uptake is increased but in insufficient amounts to affect growth inhibition. Further investigation should focus on explaining these results.