Malignant Solitary Fibrous Tumor of the Renal Vein Presenting as a Giant Renal Artery Aneurysm: A Case Report and Review of Literature.

OBJECTIVES: To discuss an unusual presentation of solitary fibrous tumor (SFT) as well as the first description of SFT originating from the renal vein. CASE REPORT: In this article, we report the case of a 56-year-old man who presented with nonspecific epigastric pain and was found on computed tomography to have a large 10-cm renal artery aneurysm with evidence of contained rupture, segmental ischemia of the kidney, and suggestion of renal vein thrombosis. This was treated by a multidisciplinary team of urologists, vascular surgeons, and interventional radiologists with both renal artery coil embolization and radical nephrectomy. The thrombosis was found on pathologic review to be a malignant SFT originating from the renal vein with likely erosion into the renal artery. CONCLUSION: This report describes the first case of SFT originating from the renal vein and demonstrates the potential for mimicry as a giant renal artery aneurysm.

Incidence of low vitamin A levels and ocular symptoms after Roux-en-Y gastric bypass.

BACKGROUND: Previous reports have demonstrated a significant incidence of fat-soluble vitamin deficiency after bariatric surgery. The purpose of the present study was to determine the incidence of vitamin A deficiency after Roux-en-Y gastric bypass and to correlate the laboratory findings with ocular symptoms potentially related to vitamin A deficiency. METHODS: All patients who had undergone Roux-en-Y gastric bypass were invited to participate in a nutritional screening. The patients completed a detailed survey concerning ocular symptoms and had their vitamin A level evaluated. RESULTS: A low vitamin A level was identified in 7 (11%) of 64 RYBG patients. Ocular xerosis was present in 18 patients (27%), with night vision changes reported in 45 (68%). Visual disturbances were present in 7 patients (11%) found to have low vitamin A levels, with hypovitaminosis A present in 22% of patients with xerosis (P <.05). CONCLUSION: Low vitamin A levels and frequent ocular complaints that might be associated with decreased vitamin A are common findings in the post-RYBG patient population. Additional study is needed to assess the role of routine vitamin A screening and replacement in the postbariatric surgery patient.

Bioprosthetic repair of complex duodenal injury in a porcine model.

BACKGROUND: Complex duodenal injury remains a challenging problem for the trauma surgeon. Although primary repair of small injuries is often possible, extensive damage requires complex enteric reconstruction and drainage procedures. We sought to determine the efficacy of a bioprosthetic repair for large duodenal wounds in a porcine model. METHODS: A 60% circumferential wall defect in the second portion of the duodenum was created in eight female Yorkshire swine (38 kg +/- 5 kg). After 30 minutes of peritoneal soilage, a bioprosthetic repair using 1.5 mm porcine acellular dermal matrix was performed. Animals were recovered and resumed a normal diet on day 3. Repeat abdominal exploration and anastomotic bursting pressure strength was performed at 1-, 2-, 3-, and 6-week intervals. Pathologic analysis of all specimens was performed. RESULTS: All animals tolerated a normal diet postoperatively, with progressive weight gain and normal bowel function. On re-exploration, no animal had evidence of duodenal stenosis, proximal dilation, or abscess formation. Pathologic analysis demonstrated progressive in-growth of native bowel tissue, with almost complete incorporation at 6 weeks. Mean bursting pressure (202 mm Hg +/- 60 mm Hg) occurred at native bowel, not patch repair site, in three of eight animals. CONCLUSION: Bioprosthetic repair of enteric wall defects, even in proximity to upper intestinal secretions, allows successful recovery of bowel function and injury repair without extensive anatomic reconstruction. This technique may provide a more conservative approach to the treatment of complex duodenal injuries after trauma.

Cardiovascular risk factor screening and follow-up in a military population aged 40 years and older.

OBJECTIVE: This study analyzed a worksite-based cardiovascular risk assessment offered to soldiers aged 40 and older to identify unrecognized cardiovascular risk and evaluate compliance with instructions to follow up for further evaluation. METHODS: Participants had fasting blood tests, waist circumference and blood pressure measurement and a carotid artery duplex scan performed at their worksite. A healthcare professional discussed the participants' results with them and, if indicated, recommended follow up within the following one month. RESULTS: Seventy-six (46%) of the 163 eligible soldiers agreed to participate. Twenty-nine (38%) of the 76 participants were instructed to follow up for elevated blood pressure, glucose, or lipids. Only 7 of 29 (24%) complied with follow-up instructions. CONCLUSION: Voluntary worksite-based interventions can effectively identify soldiers with unmanaged cardiovascular risk factors, but a more aggressive follow-up strategy should be used to ensure these soldiers receive indicated medical intervention.

Advances in vascular imaging.

Advances in vascular surgery have mirrored advances in diagnostic imaging. Indeed, the endovascular revolution has been made possible largely by advances in computed tomography, magnetic resonance imaging, and vascular ultrasound. As technology allows better noninvasive vascular diagnosis, conventional angiography, once the gold standard for the diagnosis of vascular disease, is now reserved largely for intervention. This article discusses the current state of vascular imaging. Specific emphasis is placed on the comparative clinical utility of different imaging modalities in the detection and management of vascular disease.