Metabolic Profiling Reveals Changes in Serum Predictive of Venous Ulcer Healing.

OBJECTIVE: The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration. SUMMARY BACKGROUND DATA: Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies. METHODS: Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy. RESULTS: A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy. CONCLUSIONS: This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.

Inferior Vena Cava Filters in Pregnancy: A Systematic Review.

During pregnancy, patients have an increased risk of venous thromboembolism (VTE). This is an important cause of maternal mortality. Inferior vena cava (IVC) filters can be used to prevent pulmonary embolism in complicated cases of VTE during pregnancy. The present systematic review includes all patients reported in the literature who had an IVC filter placed during pregnancy. The indications for IVC filters are discussed, along with practical considerations for placement during pregnancy, filter effectiveness, and maternal and fetal mortality and morbidity. IVC filters can be used safely when appropriate during pregnancy, with complication rates similar to those in nonpregnant patients.

Bilateral Extracranial Internal Carotid Artery Aneurysms in a Patient with Marfan Syndrome: Case Report and Review of the Literature.

INTRODUCTION: Aneurysms of the extracranial carotid artery are rare. They are often asymptomatic but can lead to disabling stroke. This report describes a case of bilateral internal carotid artery aneurysms in a patient with Marfan syndrome. REPORT: A 65 year old woman with Marfan syndrome presented with an asymptomatic swelling in the right anterior triangle of the neck. Imaging revealed bilateral extracranial fusiform internal carotid artery aneurysms. Staged open repair was performed. The right side was repaired by aneurysm excision and primary end to end anastomosis. The left side was repaired with a great saphenous vein interposition graft. The patient is free from aneurysm related complications at six years, although recurrent dilatation is present on surveillance. DISCUSSION: Internal carotid aneurysms can be managed successfully by open repair. In patients with connective tissue disorders surveillance is required to monitor for post-operative aneurysmal dilatation.