Tumor embolus due to uterine cancer.

BACKGROUND: Although the majority of arterial emboli are thrombi originating from the heart, emboli of other origin do occur. The purpose of this paper is to report a case of tumor embolus of a brachial artery. CASE REPORT: A 64-year-old woman was referred for vascular surgery due to acute right upper-limb ischemia. ECG showed sinus rhythm without ischemic changes. Four years earlier the patient had undergone total hysterectomy with bilateral adnexotomy for endometrial adenocarcinoma with subsequent radiotherapy. Emergency embolectomy under local anesthesia was performed with uneventful recovery. Because of an atypical appearance resembling fatty tissue, the embolic material was sent for microscopic examination that revealed carcinoma cells. Chest X-ray and CT-guided biopsy showed previously unknown pulmonary metastasis. In spite of chemotherapy, the patient died one year later due to progression of the neoplastic disease. The literature and common features of tumor embolus are reviewed. This may be the first reported case of tumor peripheral arterial embolus caused by endometrial adenocarcinoma CONCLUSIONS: Although tumor emboli are a rarely described cause of acute limb ischemia, pathological examination of the embolic material seems to be indicated, especially in patients with an unknown source of emboli and in every case of an atypical appearance.

Improved outcome after rupture of abdominal aortic aneurysm over an 18-year period.

The purpose of the study was to analyze changes in in-hospital mortality of patients with ruptured abdominal aortic aneurysm (RAAA) during an 18-year period. A retrospective analysis of 246 patients with RAAA in the years 1987-2005 was performed. The patients were divided into groups that consisted of 111 patients treated in the years 1987-2000 (group I) and 135 patients treated in the years 2001-2005 (group II). The in-hospital mortality rates of all patients and of operated patients in both groups were analyzed. Preoperative variables such as age, gender, size of the aneurysm, duration of symptoms, distance to the vascular surgery department, full blood count, serum creatinine and urea concentrations, and systolic and diastolic blood pressures, as well as the number of all AAAs and RAAAs treated per year, were compared between the groups. The Mann-Whitney U-test and Fisher exact test were used to analyze differences in continuous and categorical variables, respectively. The in-hospital mortality of all patients was significantly lower in group II (p = 0.006) The difference in in-hospital mortality of operated patients was of borderline statistical significance (p = 0.07). The proportion of nonoperated patients decreased from 21% to 6% (p = 0.0008). The patients from group II had significantly higher preoperative levels of hemoglobin, hematocrit, erythrocytes, and platelets, as well as higher systolic and diastolic blood pressure and smaller diameter of aneurysm. The number of both all aneurysms and RAAAs per year was significantly higher in group II. The improved preoperative status of the patients and more aggressive surgical approach are associated with reduction in in-hospital mortality of patients with RAAA. The increased experience of the center may also improve outcome of RAAA.