Hepatic and mesenteric fibromuscular dysplasia: an uncommon entity.

Dissection of the common hepatic artery is a rare cause of acute abdomen. In this case report, we discuss a 58-year-old woman who presented with severe epigastric and back pain, for which she had an abdominal computed tomography (CT) scan. On CT images, a dissection of the common hepatic artery, extending to its right and left dividing branches and a diffusely pathological aspect of the hepatic and digestive arterial network was noted. A diagnosis of extensive fibromuscular dysplasia (FMD) was suggested. FMD is a non-atherosclerotic, non-inflammatory arterial disease that most commonly involves the renal and extracranial carotid arteries, but almost all arterial beds may be affected. There is a high prevalence of aneurysm and dissection among patients with FMD.

Transilluminated powered phlebectomy: not enough advantages? Review of the literature.

BACKGROUND: Recently, new procedures for the treatment of varicose veins have been developed. The purpose of this review is to analyse the data available concerning the transilluminated powered phlebectomy (TIPP). DESIGN: Review of the English literature. RESULTS: The number of studies is limited. Currently, no trial has proven any significant advantage of TIPP technique when compared with conventional surgery, except for the number of surgical incisions. TIPP procedure seems to be shorter than conventional surgery, particularly for the extensive or recurrent varicose veins. CONCLUSIONS: Several questions regarding TIPP technique remain. Further randomised trials are needed to determine the benefit of this procedure.

External iliac artery endofibrosis: a new possible predisposing factor.

External iliac artery endofibrosis (EIAE) is an uncommon disease that affects a large number of athletes. The pathogenesis of EIAE is unclear. We offer an additional possible cause, with a direct relationship between EIAE and psoas muscle hypertrophy.

Off-pump coronary artery bypass grafting: a case-matched comparison of hemodynamic outcome.

OBJECTIVE: The objective of this study was to assess improved myocardial protection by performing coronary artery bypass grafting (CABG) on the beating heart. A case-matched study was conducted among patients who underwent CABG either on-pump (group 1), or off-pump (group 2). METHODS: Forty-five pairs of patients, having a similar clinical profile, were selected on the basis of five variables: age, gender, body surface area, ejection fraction, extent of coronary disease. Operative risk predicted by the The Society of Thoracic Surgeons national database was 1.80+/-0.35% in group 1, and 1.89+/-0.37% in group 2 (NS). Cold blood cardioplegia and 28 degrees C cardiopulmonary bypass were used in group 1. In group 2, beating heart coronary grafting was achieved with the Octopus 1 and 2 stabilizers. The average number of distal anastomoses was 2.8+/-0.1 in group 1 and 2.3+/-0.1 in group 2 (P=0.015). RESULTS: There was no significant difference among the groups regarding the trend in cardiac index, left and right ventricular stroke work indexes, and systemic and pulmonary vascular resistance indexes. However, heart rate trend was slower in group 2 (P=0.05). Pharmacological support was required in 65% of the patients in group 1, and in 33% in group 2 (P<0.001). The total amount of Dobutamine and/or Dopamine administered during the first 48 h was 3914+/-1306 gamma/kg in group 1 and 1645+/-697 gamma/kg in group 2 (P=0.049). Release of creatine kinase MB mass isoenzyme (CK-MB mass) was markedly reduced in group 2 (P<10(-4)). CONCLUSIONS: Hemodynamic outcome following off-pump CABG is similar to on-pump CABG but the need for inotropic support is significantly reduced and CPK-MB mass release is markedly lower.