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VASA. Zeitschrift Fur Gefasskrankheiten 2016Diabetes, a state of relative insulin resistance, is negatively associated with both the presence and growth abdominal aortic aneurysms (AAA), which could suggest a... (Review)
Review
Diabetes, a state of relative insulin resistance, is negatively associated with both the presence and growth abdominal aortic aneurysms (AAA), which could suggest a protective role of obesity against AAA presence or growth. A recent meta-analysis demonstrated a trend toward a positive, though statistically non-significant, association between body mass index (BMI) and the presence of AAA. With respect to the association between obesity and AAA growth, however, the evidence had been very limited. To determine whether obesity (or BMI) is associated with AAA growth, we reviewed currently available studies with a systematic literature search. Our comprehensive search identified seven eligible studies reporting the association of BMI and AAA growth rates, which included data on a total of 3,768 AAA patients. All seven identified studies demonstrated no association between BMI and AAA growth. Despite a trend toward a positive association between BMI and AAA presence, the reason why BMI is not associated with AAA growth (suggested in the present review) is unclear. A discrepancy between associated comorbidities (coronary artery disease, peripheral artery disease, and chronic obstructive pulmonary disease) and AAA presence and between the same comorbidities and AAA growth, however, could be identified. Further investigations are required to elucidate why BMI is not associated with AAA growth despite the trend for a positive association with AAA presence.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Body Mass Index; Dilatation, Pathologic; Disease Progression; Humans; Obesity; Risk Assessment; Risk Factors
PubMed: 27058797
DOI: 10.1024/0301-1526/a000505 -
Medicine Sep 2022Multicystic Mesothelioma (MM) is very rare and preoperative diagnosis is difficult.
RATIONALE
Multicystic Mesothelioma (MM) is very rare and preoperative diagnosis is difficult.
PATIENT CONCERNS
We report a case of a 34-year-old man with solid abdominal cystic echo mass. Physical examination showed that the patient had a flat and soft abdomen without tenderness or rebound pain, no fluid wave tremor, and no obvious abdominal mass was touched. The patient complained of repeated abdominal distention with nausea for 5 days. Sonographic examination suspected pseudomyxoma peritoneum.
DIAGNOSIS
Conventional ultrasound examination showed a cystic solid echo mass in the right abdominal cavity of the patient, with uneven internal echo and honeycomb change, and clear boundary with surrounding organs. Color Doppler suggested that the blood flow in the mass was not obvious. Contrast-enhanced computed tomography of the abdomen revealed hypodensity foci in hepatic and renal crypts and right paracolic sulcus.
INTERVENTIONS
Laparoscopic resection of the mass was performed, and the postoperative pathological findings were polycystic mesothelioma (greater omentum).
OUTCOMES
After mass resection, all laboratory tests and abdominal ultrasound were normal, and abdominal distension and nausea disappeared.
LESSONS
Improved ultrasound diagnosis of MM is useful for clinical decision-making.
Topics: Adenomatoid Tumor; Adult; Diagnostic Errors; Humans; Male; Mesothelioma; Nausea; Omentum
PubMed: 36086679
DOI: 10.1097/MD.0000000000030441 -
Journal of Ayub Medical College,... 2022Papillary renal cell carcinoma comprises around 15% of all renal cell carcinomas. Patients are usually asymptomatic, and 25 percent of individuals have advanced...
Papillary renal cell carcinoma comprises around 15% of all renal cell carcinomas. Patients are usually asymptomatic, and 25 percent of individuals have advanced locoregional disease at presentation. Papillary renal cell carcinoma presenting as a huge abdominal cystic mass is uncommon and is reported rarely in literature. We present a case of renal cell carcinoma presenting with abdominal pain, distention, and constipation. A retroperitoneal cystic lesion measuring 23.4×23.8 cm cyst was reported on ultrasonography as potential cause of the symptoms. We now talk about the case of a 57- year-old male who presented to us with abdominal pain, distension, and constipation. He also had a history of on and off low-grade fever for the last seven months. A computed topography (CT scan) of the abdomen and pelvis with intravenous and oral contrast revealed a large retroperitoneal cystic mass extending from the left hypochondrium to the left kidney and into the pelvis crossing the midline. Internal calcific foci, enhancing septa, irregularly thickened walls and hyperdense nodules were also demonstrated. A radical left nephrectomy via a midline laparotomy was performed electively. The cystic mass was excised and the specimen was sent for histopathological evaluation which revealed papillary renal cell carcinoma with PAX-8 and CK-7 positivity. Patient made an uneventful recovery post-operatively and was discharged. Cystic tumors of renal origin can rarely present as a huge abdominal cystic mass confusing them for masses of intestinal or hepatic origin. Timely diagnosis can be made with a detailed history, examination, imaging studies and histopathology, and instigate timely intervention.
Topics: Male; Humans; Middle Aged; Carcinoma, Renal Cell; Kidney Neoplasms; Kidney; Abdominal Pain; Abdomen
PubMed: 36566423
DOI: 10.55519/JAMC-04-10865 -
Revista Espanola de Enfermedades... Jun 2024A 63-year-old man presented with left abdominal pain, abdominal distention, and black stool following emotional stress and strenuous exercise. CT examination revealed a...
A 63-year-old man presented with left abdominal pain, abdominal distention, and black stool following emotional stress and strenuous exercise. CT examination revealed a large cystic mass in the left abdominal cavity, as well as the presence of a teratoma in the hepatogastric space and a descending duodenal diverticulum. Subsequently, he underwent surgical resection, and the pathological findings indicated that the cyst wall consisted of mucinous glandular epithelium and smooth muscle, displaying a structure similar to normal intestinal wall tissue. Furthermore, the cyst was lined with ciliated columnar epithelium, confirming the diagnosis of an isolated enterogenous cyst (EC). Due to the potential trauma associated with excising the EC, the patient did not undergo resection of the teratoma, especially given its proximity to a branch of the trunk abdominal artery.
Topics: Humans; Male; Teratoma; Middle Aged; Cysts; Tomography, X-Ray Computed; Retroperitoneal Space
PubMed: 37539533
DOI: 10.17235/reed.2023.9799/2023 -
Journal of Vascular Surgery Jun 2017This study aimed to determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the...
OBJECTIVE
This study aimed to determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA.
METHODS
A retrospective audit of all abdominal CT scans performed on men and women ≥50 years at Dunedin Public Hospital between January 2013 and September 2014 was carried out. All CT scans for planning of AAA treatment or follow-up were excluded. The maximal anterior-posterior diameter of the infrarenal abdominal aorta was measured in both the sagittal and transverse planes on the picture archiving and communication system. The radiologist reports were analyzed. All detected AAAs were reviewed for clinical relevance.
RESULTS
A total of 3332 scans were performed, of which 86 scans were excluded, resulting in a total cohort of 3246. There were 187 incidental AAAs detected with a prevalence of 5.8%. The prevalence was 8.7% in men and 3.1% in women. Whereas the prevalence increased with age, a significant number were detected in those younger than 65 years, with a prevalence of 1.5%. Of the 187 AAAs, 122 (65%) were reported by radiologists: 100% reporting rate in AAAs ≥50 mm, 87% in AAAs ≥40 to 49 mm, and 52% in AAAs ≥30 to 39 mm. Of these, 15% were specifically recommended for referral to a vascular service. Of the incidentally detected AAAs, 72% were considered to be clinically relevant, which is an overall 4.1% prevalence of AAAs with an ability to benefit. In addition, all 3246 subjects avoided the need for further AAA screening.
CONCLUSIONS
There is a high prevalence of AAAs (5.8%) and clinically relevant AAAs (4.1%) detected on routine abdominal CT. As an opportunistic approach, it is a simple and effective way to detect AAAs and to broaden traditional screening criteria to include women and those younger than 65 years in our region. Furthermore, large numbers of subjects with normal aortic diameters are identified who will not need to be screened. Consequently, we consider routine diagnostic abdominal CT to be an important adjunct to national and community AAA screening strategies.
Topics: Aged; Aged, 80 and over; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortography; Clinical Competence; Computed Tomography Angiography; Dilatation, Pathologic; Female; Humans; Incidental Findings; Male; Mass Screening; Medical Audit; Middle Aged; New Zealand; Patient Selection; Predictive Value of Tests; Prevalence; Reproducibility of Results; Retrospective Studies; Risk Factors
PubMed: 28216357
DOI: 10.1016/j.jvs.2016.11.044 -
Acta Bio-medica : Atenei Parmensis Mar 2022Liposarcoma is a rare tumor that can be treated by surgery in the absence of distant metastases. Management of liposarcoma, including diagnosis and therapy, is...
Liposarcoma is a rare tumor that can be treated by surgery in the absence of distant metastases. Management of liposarcoma, including diagnosis and therapy, is challenging because it has no characteristic symptoms and no established effective treatment. Here, we report two rare cases of primary mesenteric liposarcoma. In the first case, the tumor caused small bowel obstruction, and the patient presented with abdominal distention and severe abdominal pain. The second case is an occasional finding that occurred during laparoscopic surgery for incisional hernia. Both patients underwent successful resection of the tumor. Histopathology found a well-differentiated liposarcoma in both cases.
Topics: Humans; Intestinal Obstruction; Intestine, Small; Lipoma; Liposarcoma; Mesentery
PubMed: 35261391
DOI: 10.23750/abm.v92iS1.12010 -
Journal of the American College of... Nov 2018
Topics: Aortic Aneurysm, Abdominal; Dilatation; Dilatation, Pathologic; Humans; Nanoparticles
PubMed: 30466518
DOI: 10.1016/j.jacc.2018.08.2187 -
Journal of Vascular Surgery Dec 2018Previous in vitro and animal studies have suggested that osteopontin (OPN), an inflammatory extracellular matrix protein, is involved in the formation and growth of...
OBJECTIVE
Previous in vitro and animal studies have suggested that osteopontin (OPN), an inflammatory extracellular matrix protein, is involved in the formation and growth of abdominal aortic aneurysms (AAAs). However, the mechanism by which this occurs continues to be nebulous. The relationship between OPN and inflammation-suppressing lymphocytes present in the human AAA condition was investigated and presented herein.
METHODS
Serum OPN concentrations were measured in healthy, risk factor-matched non-AAA and AAA patients by enzyme-linked immunosorbent assay (ELISA). Immunohistochemistry was used to determine the source of OPN secretion using aortic tissue collected from multiorgan donors and AAA patients undergoing open surgical repair. Vascular smooth muscle cells (VSMCs) were exposed to various inflammatory mediators, and OPN expression was evaluated by quantitative reverse transcriptase-polymerase chain reaction and ELISA. The inflammatory nature of OPN and the aortic wall was determined using a TR1 suppressor cell induction assay as a surrogate and characterized by ELISA and fluorescence-activated cell sorting.
RESULTS
OPN was found to be elevated in both the plasma and aortic homogenate of AAA patients compared with controls. On immunohistochemistry, OPN localized to the tunica media of the diseased aorta but was minimally expressed in healthy aorta. In vitro, cigarette smoke extract was the most potent stimulator of OPN secretion by VSMCs and increased both messenger RNA and supernatant concentrations. OPN demonstrated an ability to inhibit the induction of interleukin 10-secreting TR1 lymphocytes, a depleted population in the AAA patient, from naive precursors. Last, neutralizing receptor targets of OPN in the setting of AAA homogenate coincubation abrogated the inhibition of TR1 induction.
CONCLUSIONS
OPN, secreted by the VSMCs of the tunica media, is elevated in the circulating plasma and aortic wall of patients with AAA. It can inhibit the induction of the TR1 suppressor cell, leading to an overall proinflammatory state contributing to progressive aortic wall breakdown and dilation.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Case-Control Studies; Cells, Cultured; Dilatation, Pathologic; Humans; Interleukin-10; Lymphocyte Activation; Muscle, Smooth, Vascular; Myocytes, Smooth Muscle; Osteopontin; Signal Transduction; T-Lymphocytes; Up-Regulation; Vascular Remodeling
PubMed: 29402664
DOI: 10.1016/j.jvs.2017.10.068 -
Clinical Imaging Jan 2020The magnetic resonance (MR) enterography technique has improved over the past few years to provide an excellent means of evaluating the gastrointestinal tract for... (Review)
Review
The magnetic resonance (MR) enterography technique has improved over the past few years to provide an excellent means of evaluating the gastrointestinal tract for suspected Crohn's disease. Although the prevalent intestinal manifestations of Crohn's disease have been extensively discussed in the radiology literature, some of its rare complications, especially extra intestinal, have received less attention. Uncommon findings that may be seen on MR enterography and abdominal CT examinations performed in patients with Crohn's disease include hepatic sinusoidal dilatation, primary sclerosing cholangitis, fistulas in unusual locations, hepatic and splenic abscesses, and spondylarthritis. Radiologists should be aware of these potentially rare manifestations. They should be kept in mind during clinical examinations and should be routinely searched for and reported if present.
Topics: Abdomen; Adolescent; Adult; Aged; Crohn Disease; Dilatation, Pathologic; Female; Humans; Intestines; Magnetic Resonance Imaging; Male; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed
PubMed: 31715515
DOI: 10.1016/j.clinimag.2019.04.010 -
Journal of Endovascular Therapy : An... Feb 2017To provide an updated systematic literature review and summarize current evidence on proximal aortic neck dilatation (AND) after endovascular aneurysm repair (EVAR). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To provide an updated systematic literature review and summarize current evidence on proximal aortic neck dilatation (AND) after endovascular aneurysm repair (EVAR).
METHODS
A review of the English-language medical literature from 1991 to 2015 was conducted using MEDLINE and EMBASE to identify studies reporting AND after EVAR. Studies considered for inclusion and full-text review fulfilled the following criteria: (1) reported AND after EVAR, (2) included at least 5 patients, and (3) provided data on AND quantification. The search identified 26 articles published between 1998 and 2015 that encompassed 9721 patients (median age 71.8 years; 9439 men).
RESULTS
AND occurred in 24.6% of patients (95% CI 18.6% to 31.8%) over a period ranging from 15 months to 9 years after EVAR. No significant dilatation of the suprarenal part of the aorta was reported by most studies. The incidence of combined clinical events (endoleak type I, migration, reintervention during follow-up) was higher in the AND group (26%) when compared with 2% in the group without AND (OR 28.7, 95% CI 5.43 to 151.67, p<0.001).
CONCLUSION
AND affects a considerable proportion of EVAR patients and was related to worse clinical outcome, as indicated by increased rates of type I endoleak, migration, and reinterventions. Future studies should focus on a better understanding of the pathophysiology, predictors, and risk factors of AND, which could identify patients who may warrant a different EVAR strategy and/or a closer post-EVAR surveillance strategy.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Dilatation, Pathologic; Endoleak; Endovascular Procedures; Foreign-Body Migration; Humans; Odds Ratio; Retreatment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 27974495
DOI: 10.1177/1526602816673325