Rare aneurysm of the hepatic artery with overlap to the gastroduodenal artery in very uncommon coincidence with occurence of hepatomesenteric trunk.

BACKGROUND: Aneurysms of visceral arteries are rare, but in case of rupture, they are potentially life threatening. In addition, there is a broad spectrum of the anatomic variability for the arterial supply of the liver. METHODS: Based on a real but very rare clinical case, including its diagnostic management and short-term course, the extraordinary coincidence of (i) an aneurysm of the gastroduodenal artery at its branching off from the hepatic artery and (ii) occurrence of hepatomesenteric trunk is described by the means of a scientific medical case report as well as an adequate and selective literature search. CASE PRESENTATION, THERAPEUTIC DECISION AND CLINICAL COURSE: A 39-year-old woman (BMI, 24 kg/m) was diagnosed (by coincidence) with an aneurysm of the proper hepatic artery (APHA) with overlap to the gastroduodenal artery in combination with an uncommon hepatomesenteric trunk using abdominal computed tomography (CT) scan (because of slight but recurrent episodes of urinary tract diseases) and, subsequently, systematic diagnostic comprising Duplex ultrasonography, magnetic resonance imaging (MRI), and conventional angiography. However, medical history was not significant for coincidence with possibly relevant chronic occlusive disease, mycotic embolization, trauma, Marfan syndrome, Klippel-Trenaunay syndrome or giant cell arteritis. Despite a moderate progression within a year to a size of actually 18 mm, we still favor watchful-waiting at this size (therapeutic [interventional] consequence, size > 20 mm) with short-term intervals for follow-up investigations using Duplex ultrasonography as the method of choice. CONCLUSIONS: This is the first case in the accessible English-speaking literature to show this very infrequent coincidence especially indicating rare appearance of an APHA in combination with an also infrequent hepatomesenteric trunk (which potentiates the uncommon occurrence of such combination) based on the high anatomic variability of the arterial supply of the liver from the anatomic perspective.

Expression levels of immune markers in Actinobacillus pleuropneumoniae infected pigs and their relation to breed and clinical symptoms.

BACKGROUND: In pigs little is known about the role of innate immune defence in bacterial infections of the respiratory tract, despite their major role in pig production. In the present study we characterized and compared in vitro and in vivo activation of immune markers of different pig breeds 7 days before, and 4 and 21 days after an experimental aerosol infection with Actinobacillus (A.) pleuropneumoniae. RESULTS: In vitro stimulation of bronchoalveolar lavage fluid (BALF) and blood leukocytes with A. pleuropneumoniae, Streptococcus suis, PMA and LPS led to production of different amounts of H2O2, NO and TNF-alpha, depending on the stimulus, individual, breed and time of infection. Generally, significant responses to in vitro stimulation were observed only in blood leukocytes, whereas the alveolar macrophages showed a high basal activation. In addition, the production of haptoglobin and cytokines (TNF-alpha, IFN-gamma and IL-10) in vivo was measured in plasma and BALF. Plasma haptoglobin levels mirrored the clinical manifestations at 4 days post-infection. In plasma and BALF TNF-alpha could not be detected, whereas variable levels of IFN-gamma were found at pre- and post-infection times. IL-10 was found in some plasma but in none of the BALF samples. The different expression levels in individuals within the breeds correlated for some markers with the severity of clinical manifestations, e.g. H2O2, plasma haptoglobin and BALF IFN-gamma for German Landrace pigs. CONCLUSION: Our findings revealed differences in the activation of the immune markers with respect to infection time, individuals and breeds. Moreover, results showed different correlation grades between the immune markers produced in vitro or in vivo and the clinical manifestations. Further analyses will have to show whether these markers may serve as correlates of protection against porcine respiratory infections.