Traumatic thoracolumbar projectile with concomitant vertebral body and aortic injury.

Penetrating subdiaphragmatic aortic trauma is associated with high morbidity and mortality with studies having reported a 50%-70% associated mortality. We describe a case of a patient with a subdiaphragmatic aortic injury caused by a 7.4-cm common nail that traversed through his L1 vertebral body into the aorta. His aortic injury was managed jointly with vascular surgery and neurosurgery teams.

Descending thoracic aortic mural thrombus presentation and treatment strategies.

BACKGROUND: Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. Early treatment is therefore crucial; however, there is not a consensus on ideal initial treatment. METHODS: A review of the literature using PubMed was conducted, and all relevant publications describing descending TAMT of the past 15 years were reviewed. Variables included for this analysis were presentation, initial treatment strategy employed, outcome measures of thrombus resolution or regression, recurrence of symptomatic emboli, and mortality. RESULTS: Seventy-four patients were included in this analysis. Women were significantly more likely to be described with descending TAMT. The majority (82.4%) of cases reported were diagnosed after an embolic event. Patients were equally likely to receive medical, open surgical, or endovascular therapy as the initial treatment modality. However, there is a trend within the past 5 years to report cases describing successful thoracic endovascular aortic repair for initial management. Of patients who initially underwent medical management, nine patients (34.6%) had persistent thrombus. Of the patients who initially underwent open surgical repair, six patients (31.6%) had persistent thrombus; of these patients, four underwent endovascular repair. Twenty-nine patients (39.2%) with descending TAMT initially underwent thoracic endovascular aortic repair. Twenty-seven (93.1%) had fully excluded thrombus at the time of the procedure, with no recurrence or evidence of repeated embolic phenomena at follow-up. CONCLUSIONS: Whereas mural thrombus of the thoracic aorta is uncommon, it must be considered in the differential diagnosis of embolic events. Although endovascular therapy may be a useful first-line option for TAMT with reports of positive outcomes in select literature, further study of this treatment option is required.

Aneurysmal degeneration of type B aortic dissections after thoracic endovascular aortic repair: A systematic review.

BACKGROUND: Promising results of thoracic endovascular aortic repair (TEVAR) in patients with complicated type B aortic dissection (TBAD) have been well documented. However, whereas early results have led many to hypothesize a benefit of TEVAR in uncomplicated patients, the natural history of TEVAR after the treatment of TBAD has yet to mature. In this review, we evaluated the available data to investigate whether longer term TEVAR warrants enthusiasm for all comers with TBAD. METHODS: A systematic review of the literature was performed searching specifically for studies assessing medium- and long-term outcomes after TEVAR for the treatment of TBAD. Studies were included if changes in aortic volume or diameter were recorded. Any publications recording only changes in mean aortic diameter across the study population were excluded. RESULTS: A total of 17 studies examining growth in the thoracic aorta were included. This event occurred in 6.6% to 84% of patients across studies. Six studies examined growth in the abdominal aorta after TEVAR, which occurred in 10% to 54% of patients. When viewed by chronicity, a significant number of patients treated for chronic and acute dissection experienced aneurysmal degeneration. CONCLUSIONS: Based on the available data to date, TEVAR for TBAD does not prevent aneurysmal degeneration of the thoracic or abdominal aorta. Therefore, the treatment of uncomplicated patients with this goal in mind is currently contrary to the available data. Given the variability of manuscript reporting styles for TBAD, the development of reporting standards is necessary to homogenize available data and to strengthen our understanding of this complex disease process.

Treatment of Abdominal Aortic Pathology.

Abdominal aortic pathology is a diverse topic, ranging through a broad span of possible pathologies. The treatment options are equally vast, particularly with the ever-expanding endovascular techniques. In this article, we discuss management strategies for abdominal aortic aneurysms and aortic occlusive disease, because they represent some of the most common pathologies encountered in clinical scenarios.

Intake at a single, palatable buffet test meal is associated with total body fat and regional fat distribution in children.

Previous studies testing the relationship between short-term, ad libitum test-meal intake and body composition in children have shown inconsistent relationships. The objective of this study was to determine whether children's intake at a palatable, buffet meal was associated with body composition, assessed by dual-energy X-ray absorptiometry (DXA). A sample of 71 children (4-6 years) participated in 4 sessions where ad libitum food intake was measured. Children's intake at two of the test-meals was retained for the present analysis: a baseline meal consisting of moderately palatable foods and a highly palatable buffet including sweets, sweet-fats, and savory-fats. On the last visit, anthropometrics and DXA were assessed to determine child body composition. Children consumed significantly more calories at the palatable buffet compared to the baseline test-meal. Children's total fat-free mass was positively associated with intake at both the baseline meal and the palatable buffet meal. Total energy intake at both meals and intake of savory-fats at the palatable buffet were positively associated with children's total fat mass, total percent body fat, and percent android fat. Intake of sweet-fats was associated with child fat-free mass index. Intake of sweets was not correlated with body composition. Children's intake at a palatable test-meal, particularly of savory-fat foods, was associated with measures of total and regional body fat.

Bitter taste phenotype and body weight predict children's selection of sweet and savory foods at a palatable test-meal.

Previous studies show that children who are sensitive to the bitter taste of 6-n-propylthiouracil (PROP) report more frequent intake of sweets and less frequent intake of meats (savory fats) relative to children who are PROP insensitive. Laboratory studies are needed to confirm these findings. In this study, seventy-nine 4- to 6-year-olds from diverse ethnicities attended four laboratory sessions, the last of which included a palatable buffet consisting of savory-fats (e.g. pizza), sweet-fats (e.g. cookies, cakes), and sweets (e.g. juices, candies). PROP phenotype was classified by two methods: 1) a common screening procedure to divide children into tasters and nontasters, and 2) a three-concentration method used to approximate PROP thresholds. Height and weight were measured and saliva was collected for genotyping TAS2R38, a bitter taste receptor related to the PROP phenotype. Data were analyzed by General Linear Model ANOVA with intake from savory fats, sweet-fats, and sweets as dependent variables and PROP status as the independent variable. BMI z-score, sex, age, and ethnicity were included as covariates. Adjusted energy intake from the food group "sweets" at the test-meal was greater for tasters than for nontasters. PROP status did not influence children's adjusted intake of savory-fats, but BMI z-score did. The TAS2R38 genotype did not impact intake at the test-meal. At a palatable buffet, PROP taster children preferentially consumed more sweets than nontaster children, while heavier children consumed more savory fats. These findings may have implications for understanding differences in susceptibility to hyperphagia.

Predictors of parental perceptions and concerns about child weight.

Appropriate levels of parental perception and concern about child weight are important components of successful obesity treatment, but the factors that contribute to these attitudes need clarification. The aim of this study was to identify child and parent characteristics that best predict parental perceptions and concerns about child weight. A cross-sectional design was used to assess characteristics of parents (e.g. age, income, and feeding attitudes) and children (e.g. body composition, ad libitum intake, and reported physical activity). Results are reported for 75, 4-6year-olds from diverse ethnicities. Perceived child weight and concern were measured with the Child Feeding Questionnaire (CFQ). Multiple linear regression was used to identify the best models for perceived child weight and concern. For perceived child weight, the best model included parent age, children's laboratory intake of sugar-sweetened beverages (SSBs) and palatable buffet items, and two measures of child body composition (ratio of trunk fat-to-total fat and ratio of leg fat-to-total fat). For concern, child android/gynoid fat ratio explained the largest amount of variance, followed by restrictive feeding and SSB intake. Parental perceptions and concerns about child weight are best explained by models that account for children's eating behavior and body fat distribution.

Manipulating fat content of familiar foods at test-meals does not affect intake and liking of these foods among children.

We investigated effects of manipulating fat content of familiar foods at two test-meals in 74, 4-6-year-old children. Liking, energy intake, and weight-based food intake were assessed for a meal consisting of macaroni and cheese, pudding, chocolate milk and regular milk in high-fat and low-fat versions. Liking ratings and consumption by weight did not differ between versions, but energy intake was 59% greater with the high-fat version. We conclude that manipulating fat content had little effect on liking and weight-based food intake, but markedly influenced overall energy intake, and thus might provide a means of lowering children's energy consumption.