Six-year progression of medically treated infective aortitis.

OBJECTIVE: To report a medically treated case of infective aortitis with mycotic aneurysms that went on to have many years of surveillance imaging. This has not yet been documented as current recommendations for infective aortitis strongly suggest operative intervention combined with aggressive antibiotics, with very high reported mortality for non-operative management. Thus, the natural progression of sac growth during the acute infective period and in the long-term has had an opportunity to be explored. METHODS: A 77-year-old patient presented with infective aortitis confirmed on computed tomography angiography and refused operative intervention despite being explained the associated risks and benefits. She was treated aggressively with antibiotics and monitored in the community, successfully clearing the infection. RESULTS: She received a total of 6 weeks of ceftriaxone intravenously and 1 year of oral ciprofloxacin. She rapidly developed mycotic aneurysmal disease both infrarenal and suprarenal which stabilised within 1 year after diagnosis and did not progress further. CONCLUSIONS: Infective aortitis with mycotic aneurysms is usually treated surgically due to the significant risk of rupture in the acute period. This case suggests that if the acute infective period is passed, the aneurysmal disease stabilises and does not progress.

Venous thromboembolism: A problem in the Indian/Asian population?

Venous thromboembolism (VTE) is a common and potentially life threatening condition. It continues to be under diagnosed and undertreated. Awareness among Indians regarding this potentially life-threatening disease is low. Contrary to earlier belief, the incidence of VTE in Asia and India is comparable to that in Western countries. The risk of VTE is especially high in hospitalized patients, in a majority of whom it is clinically silent. It is one of the commonest causes of unplanned readmission and preventable death. In the United States, it is responsible for more deaths than accidents. Thromboprophylaxis is highly effective in reducing the incidence of VTE without any increase in clinically significant bleeding. It is worth emphasizing that prevention of VTE is much easier and cheaper than its treatment.

The scrotum in pancreatitis: a case report and literature review.

CONTEXT: An acute inguinoscrotal swelling appearing during the course of acute pancreatitis is rare. There are only three case reports of this in the English literature. CASE REPORT: We report a case of right inguinoscrotal swelling appearing during an attack of acute pancreatitis. CONCLUSIONS: A correct diagnosis and appropriate management will prevent unnecessary surgical intervention.

Iliac artery dissection on noncontrast CT.

A case of acute limb ischemia secondary to iliac artery dissection is presented along with its management. Images highlighting the features of dissection on a noncontrast computed tomography (CT) scan are presented and discussed.

A 7-year experience with thoracoscopic sympathectomy for critical upper limb ischemia.

BACKGROUND: Severely symptomatic arterial insufficiency of an upper limb not suitable for revascularization is a difficult condition to manage. Thoracoscopic sympathectomy (TS) can be an effective procedure in this setting. METHODS: Our experience with 18 consecutive thoracoscopic sympathectomy (TS) procedures over a period of 7 years has been reviewed. Indications, operative technique, complications, and outcome of surgery are analyzed. RESULTS: We performed 18 TS procedures on 17 patients during this period. There were no deaths. One patient had intraoperative hemorrhage necessitating conversion to open thoracotomy. Mean postoperative hospital stay was 2.3 days. Follow-up ranged from 6 to 72 months. All patients demonstrated clinical benefit from the procedure. CONCLUSIONS: Thoracoscopic sympathectomy is a useful option in patients with severely symptomatic hand and digital ischemia from occlusive small arterial disease like thromboangitis obliterans.