Calcified abdominal aortic aneurysm in a 12-year-old boy.

The authors report a case of an idiopathic, isolated infrarenal abdominal aortic aneurysm with dense intramural calcification and sterile mesenteric lymphadenopathy in a 12-year-old boy. Aneurysmal disease in the pediatric population is very uncommon. The majority of previously reported cases have clear associated causes, such as connective tissue disorders, infectious processes, inflammatory states, or trauma. A minority of cases have no distinguishable cause and are classified as idiopathic. Isolated abdominal aortic aneurysms are very uncommon in children, and those with densely calcified walls are rare, with only 2 case reports in the literature. The authors found no previous reports of abdominal aortic aneurysm with associated sterile mesenteric lymphadenopathy. The etiology of this patient's aneurysm remains unknown.

A complicated case of acute bacterial endocarditis.

Acute bacterial endocarditis continues to be a significant medical and surgical problem in the United States. The authors describe a complicated case of acute Staphylococcus aureus endocarditis in an 18-year-old man. The patient suffered multiple systemic emboli requiring aggressive medical and surgical intervention.

Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair.

PURPOSE: Iliac artery anatomy is a central factor in endoluminal abdominal aortic aneurysm therapy. It serves as the conduit for graft deployment and as the region of distal graft seal. Thirty-eight percent of iliac vessels in our patients require special treatment because of aneurysms, tortuosity, or small size. Bilateral hypogastric artery exclusion has been avoided because of concerns of colorectal ischemia, hip/buttock claudication, and impotence. We suggest that elective, staged, bilateral hypogastric embolization can be performed safely with reasonably low morbidity and can expand the anatomic boundaries for stent-graft abdominal aortic aneurysm repair. METHODS: This study was performed as a retrospective chart review of patients requiring hypogastric artery embolization for endovascular repair of abdominal aortic aneurysms between June 1998 and June 2000. Patients with otherwise appropriate anatomy and common iliac artery aneurysms were informed of the option for stent-graft repair with internal iliac artery embolization with its risks of impotence, hip/buttock claudication, and bowel ischemia. Patients underwent unilateral or staged bilateral coil embolizations of their proximal hypogastric arteries with an approximate 1-week interval between procedures. Hospital and office records were reviewed; phone interviews were performed. Follow-up ranged from 1 to 12 months. RESULTS: During a 24-month period, 65 patients underwent endovascular abdominal aortic aneurysm repair; 18 patients (28%) required hypogastric artery embolization. Seven (39%) of these patients underwent bilateral embolization. There were no episodes of clinically evident bowel ischemia. Lactate levels were normal in all measured patients. Postoperative fevers (> 101.0 degrees F) were documented in 10 (56%) of 18 patients. The average white blood cell count was 12.8 x 10(9)/L (range, 8.5-22.9). There were no positive blood culture results. The return to the full preoperative diet occurred in 1 to 3 days. Hip/buttock claudication occurred in approximately 50% of patients with persistent but improved symptoms at 6 months. Eighty-seven percent of patients had preoperative erectile dysfunction. Only two patients noted worsening of erectile function postoperatively. CONCLUSIONS: Preliminary results indicate that bilateral hypogastric artery embolization can be performed, when necessary, with reasonable morbidity in patients undergoing stent-graft abdominal aortic aneurysm repair.

Mapping the immunodeterminants of the complete streptococcal M6 protein molecule. Identification of an immunodominant region.

The immune response to the complete streptococcal M6 protein was examined by kinetic ELISA to determine the reactivity of rabbit and human sera to M6 peptides representing 82% of the native molecule. The results revealed that rabbits immunized with purified native M6 protein or whole streptococci responded by reacting early and predominantly to one of the three sequence repeat regions of the molecule, the B-repeat, antibodies which have been shown to be non-opsonic. Antibodies to peptides representing the hypervariable N-terminal and adjacent A-repeat regions appear when opsonic antibodies are detected in the serum. Antibodies to peptides located within the conserved C-terminal half of the molecule (proximal to the cell) were restricted even after several immunizations. An examination of human sera from individuals with no recent streptococcal infection (greater than 3 yr), revealed that those sera opsonic for M6 streptococci contained antibodies reactive predominantly to the N-terminal and A-repeat regions, supporting the view that opsonic antibodies are long lived. Nonopsonic human sera to M6 streptococci exhibited a low reactivity to all peptides. However, by Western blot analysis, all human sera tested contained antibodies to the conserved region of the molecule, whereas only sera opsonic for M6 streptococci reacted with the variable region. Evidence is presented supporting the view that antibodies to the conserved regions of the M molecule may be conformation dependent.