A rare case of a right common iliac venous aneurysm imitating a neoplastic tumour.

BACKGROUND: Aneurysms of the deep lower limbs veins are extremely rare. Diagnosis of such conditions may be confusing and suggest the presence of a neoplastic lesion. CASE PRESENTATION: We herein report a case of a 68-year-old woman who was admitted with a large vein tumour revealed by sonography and computed tomography. A direct phlebography revealed a large venous aneurysm of the right common iliac vein with an adhering thrombus and a large collateral circulation. Anticoagulant treatment and compression with an elastic stocking were initiated because the patient refused surgical treatment. A 2-year follow-up showed no aneurysm growth or thromboembolic complications. CONCLUSIONS: We show herein that conservative management can be effective and safe in cases of this rare condition.

The cross-reactivity of binding antibodies with different interferon beta formulations used as disease-modifying drugs in multiple sclerosis patients.

Interferon beta (IFNb) preparations are commonly used as first-line therapy in relapsing-remitting multiple sclerosis (RRMS). They are, however, characterized by limited efficacy, partly due to the formation of anti-IFNb antibodies in patients.In this pilot study, we assessed with the ELISA method the presence of the binding antibodies (BAbs) against interferon beta after 2 years of therapy with subcutaneous interferon beta 1a (Rebif) in 49 RRMS patients. Antibody levels were established again within 1 year after treatment withdrawal. We used 3 interferons that are commercially available for MS therapy, namely Avonex (Biogen Idec Limited), Rebif (Merck Serono), and Betaferon (Bayer Pharma AG), as antigens.BAbs reacting with Rebif were found in 24.4% to 55% of patients, depending on the units of their expression. The levels of anti-Rebif antibodies remained high in 8 patients and in 4 patients they dropped significantly. Strong correlations were obtained in all assays (anti-Rebif-anti-Avonex, anti-Rebif-anti-Betaferon, and anti-Betaferon-anti-Avonex) and the existence of cross-reactivity in the formation of antibodies against all the tested formulations of interferon beta was confirmed. The levels of BAbs remain significant in the clinical context, and their assessment is the first choice screening; however, methods of BAbs evaluation can be crucial for further decisions. More studies are needed to confirm our results; specifically it would be of interest to evaluate methods of neutralizing antibodies identification, as we only assessed the binding antibodies. Nevertheless, our results support the concept that in interferon nonresponders, that are positive for binding antibodies, switching the therapy to alternative disease-modifying agent (for example glatiramer acetate, fingolimod, or natalizumab) is justified, whereas the switch to another interferon formulation will probably be of no benefit.

All dangerous types of endoleaks after endovascular aneurysm repair in a single patient.

Endovascular aneurysm repair (EVAR) has become tremendously popular in recent years. However, the long-term results of these stent grafts are uncertain and are still being evaluated. According to some data, the graft-related complication rate after EVAR could be as high as 43% in long-term observation. In this case report, we present a patient who had all dangerous types of endoleaks after EVAR and required sophisticated management including endovascular and open surgical repairs. After repeated invasive treatment, it was possible to exclude all endoleaks, and now the patient is free from graft-related complications. Although EVAR has become very popular, we should remember about possible complications, which could be very severe and life-threatening. For this reason, the choice between endovascular and open repair of abdominal aortic aneurysm should be well considered.

Can deep vein thrombosis be predicted after varicose vein operation in women in rural areas?

INTRODUCTION: Chronic venous disease is a group of symptoms caused by functional and structural defects of the venous vessels. One of the most common aspects of this disease is the occurrence of varicose veins. There are many ways of prevention and treatment of varicose veins, but in Poland the leading one is still surgery. As in every medical procedure there is the possibility of some complications. One of them is deep vein thrombosis (DVT). The diagnosis of DVT can be difficult, especially when access to a specialist is limited, such as in case of rural patients. The aim of the study. The aim of the study was estimation of the influence of LMWH primary prophylaxis on the formation of postoperative DVT, as well as sensitivity and specificity of clinical examination and D-dimer value in diagnosis of postoperative DVT in women. MATERIALS AND METHODS: The study was conducted in a group of 93 women operated on in the Department of General, Vascular Surgery and Angiology at the Karol Marcinkowski University of Medical Sciences in Poznan, Poland. The patients had undergone a varicose vein operation and were randomly divided into two groups: A - 48 women receiving LMWH during two days of the perioperative period, B - 45 women receiving LMWH during seven days of the perioperative period. RESULTS: There was no significant difference in the postoperative DVT complications in both groups. The value of D-dimer > 0.987 mcg/ml and swelling > 1.5 cm of shin (in comparison to the preoperative period) plays a significant role in diagnosis of DVT. CONCLUSIONS: The extended primary prophylaxis with LMWH does not affect the amount or quality of thrombotic complications after varicose vein operation. If the DVT occurs, the evaluation of the D - dimer and careful clinical examination can be a useful method for its diagnosis.

Hemoptysis as a first symptom of endoleak after thoracic endovascular aortic repair, which caused aortic rupture and required complex management.

Thoracic endovascular aortic repair (TEVAR) has become the most common procedure in the treatment of thoracic aorta aneurysms. However, potential long-term complications of this technique could be life-threatening. Hemoptysis is a common symptom of lung tumor, especially cancer. On the other hand, hemoptysis can also be caused by bronchitis, tuberculosis, mycosis, and trauma. In this case report, we present a patient with hemoptysis and lung tumor suggesting lung cancer, which was a unique symptom of type IA endoleak after TEVAR and led to rupture of the thoracic aneurysm. It was decided to perform next an endovascular procedure due to the severe state of the patient. Next the thoracotomy was performed because drainage of the left pleural cavity was unsuccessful. In the last stage bronchoscopy was needed to remove the thrombus, which occluded the left main bronchi. Successful management has led to the patient's full recovery. Despite justified popularity of endovascular procedures in the treatment of thoracic aorta aneurysms, we should remember about potential long-term complications. Hemoptysis could be a unique symptom of the endoleak after TEVAR and treatment of such complications could be complex and demanding.