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Radiology Case Reports Aug 2024Mid gut volvulus is a rare clinical presentation in adults though it frequently occurs in infants and children. We report a case of 30 years male (post renal transplant...
Mid gut volvulus is a rare clinical presentation in adults though it frequently occurs in infants and children. We report a case of 30 years male (post renal transplant patient) who presented with symptoms of abdominal pain, nausea and vomiting for 3 days. After demonstration of twisting of bowel loops around mesenteric vessels on Ultrasonography (USG). Contrast enhanced computed tomography (CECT) abdomen was done which showed small bowel malrotation, inverted relation of Superior mesenteric artery-Superior mesenteric vein and whirl pool sign of midgut volvulus. However, no significant bowel obstruction was noted. Patient underwent explorative laparotomy with ladd's procedure. Post-operatively, it was uneventful. Patient became symptoms free and was discharged after 5 days of surgery. Intestinal malrotation is a congenital abnormality that arises from disrupting the 270◦ counterclockwise midgut rotation during the embryonic period. In our case malrotation was predisposing factor for volvulus. CECT abdomen is the imaging procedure of choice in adults. Ladd's procedure is the treatment of choice in symptomatic patients though it remains controversial in asymptomatic patients. Though midgut volvulus is rare in adults, it should be kept as differential in adults with symptoms of intestinal obstruction and workup should be done accordingly.
PubMed: 38800079
DOI: 10.1016/j.radcr.2024.04.039 -
Journal of Vascular Surgery Cases and... Aug 2024Pancreaticoduodenal artery aneurysms (PDAAs) are an extremely rare visceral artery aneurysm subtype, usually managed by endovascular techniques. We report the case of a...
Pancreaticoduodenal artery aneurysms (PDAAs) are an extremely rare visceral artery aneurysm subtype, usually managed by endovascular techniques. We report the case of a 57-year-old man with an intrapancreatic, inferior PDAA abutting the superior mesenteric artery (SMA). This location, in relation to the SMA, risks SMA thrombosis using an endovascular-only approach. Our approach consisted of open exploration and ligation of the inferior PDAA junction at the SMA, followed by endovascular coil embolization of the aneurysm. This case serves as a reminder that although many vascular diseases can be treated with less invasive endovascular strategies, open surgery can sometimes be the safer alternative.
PubMed: 38799650
DOI: 10.1016/j.jvscit.2024.101505 -
BioRxiv : the Preprint Server For... May 2024Vasculopathies occur 15 years earlier in individuals with diabetes mellitus (DM) as compared to those without, but the underlying mechanisms driving diabetic...
Vasculopathies occur 15 years earlier in individuals with diabetes mellitus (DM) as compared to those without, but the underlying mechanisms driving diabetic vasculopathy remain incompletely understood. Endothelial cells (ECs) and macrophages (MΦ) are critical players in vascular wall and their crosstalk is crucial in diabetic vasculopathy. In diabetes, EC activation enables monocyte recruitment, which transmigrate into the intima and differentiate into macrophages (MΦ). Beyond this established model of diapedesis, EC-MΦ interplay is highly intricate and heterogenous. To capture these highly context dependent EC-MΦ interactions, we leveraged single-cell (sc)RNA-seq in conjunction with spatial transcriptome (ST)-seq profiling to analyze human mesenteric arteries from non-diabetic (ND) and type 2 diabetic (T2D) donors. We provide in this study a transcriptomic map encompassing major arterial vascular cells, e.g., EC, mononuclear phagocyte (MP), and T cells, and their interactions associated with human T2D. Furthermore, we identified Triggering Receptor Expressed on Myeloid Cells 2 ( as a top T2D-induced gene in MP, with concomitant increase of TREM2 ligands in ECs. TREM2 induction was confirmed in mouse models of T2D and monocyte/MΦ subjected to DM-mimicking stimuli. Perturbing TREM2 with either an antibody or silencing RNA in MPs led to decreased pro-inflammatory responses in MPs and ECs and increased EC migration . In a mouse model of diabetes, TREM2 expression and its interaction with ECs are increased in the ischemic, as compared to non-ischemic muscles. Importantly, neutralization of TREM2 using a neutralizing antibody enhanced ischemic recovery and flow reperfusion in the diabetic mice, suggesting a role of TREM2 in promoting diabetic PAD. Finally, we verified that both TREM2 expression and the TREM2-EC-interaction are increased in human patients with DM-PAD. Collectively, our study presents the first atlas of human diabetic vessels with a focus on EC-MP interactions. Exemplified by TREM2, our study provides valuable insights into EC-MΦ interactions, key processes contributing to diabetic vasculopathies and the potential of targeting these interactions for therapeutic development.
PubMed: 38798611
DOI: 10.1101/2024.05.14.594235 -
Antioxidants (Basel, Switzerland) Apr 2024The NADPH oxidase NOX4 that releases HO can mediate vasoprotective mechanisms under pathophysiological conditions in conductive arteries. However, the role of NOX4 in...
The NADPH oxidase NOX4 that releases HO can mediate vasoprotective mechanisms under pathophysiological conditions in conductive arteries. However, the role of NOX4 in resistance arteries and in perivascular adipose tissue is not well understood. We hypothesized that NOX4 is of functional importance in resistance arteries and perivascular adipose tissue under dyslipidemia conditions. We detected elevated expression in murine and human vessels under dyslipidemia. Diminishing under these conditions led to endothelial dysfunction in resistance arteries. The mesenteric arteries of / mice revealed decreased mRNA expression. Inhibition of eNOS in those vessels did not affect vascular function, while in mice endothelial function was significantly altered. Anticontractile properties of perivascular adipose tissue at resistance arteries were diminished in / compared with mice. In addition, the presence of perivascular adipose tissue further worsened endothelial dysfunction in mesenteric arteries under dyslipidemia conditions. Perivascular adipose tissue from mesenteric arteries revealed a higher expression of markers of white adipocytes compared to markers of beige/brown adipocytes. Among those white adipocyte markers, leptin was significantly less expressed in perivascular adipose tissue from / mice compared with mice. Furthermore, in human perivascular adipose tissue with a profound pattern of white adipocyte marker genes, we detected a correlation of and expression. In addition, incubating arterial vessels with leptin induced nitrite release, indicating increased eNOS activity. In humans, a higher expression of leptin in perivascular adipose tissue correlated with expression in the corresponding left internal mammary artery. In conclusion, vascular function of resistance arteries was dependent on -derived HO, especially under dyslipidemia conditions. Perivascular adipose tissue of the mesenteric arteries with white adipose tissue characteristics further aggravated endothelial function through reduced leptin-eNOS signaling.
PubMed: 38790608
DOI: 10.3390/antiox13050503 -
Cureus Apr 2024Sclerosing mesenteritis, a rare fibroinflammatory disease affecting the mesentery, presents a diagnostic challenge due to its varied clinical manifestations and unknown...
Sclerosing mesenteritis, a rare fibroinflammatory disease affecting the mesentery, presents a diagnostic challenge due to its varied clinical manifestations and unknown etiology. We present a case of a 50-year-old female presenting with epigastric pain and weight loss, initially suspected of abdominal malignancy. Imaging revealed a mesenteric mass, and histopathological examination confirmed dense lymphoplasmacytic infiltrate with storiform fibrosis, along with elevated serum IgG4 levels, indicative of IgG4-related sclerosing mesenteritis. Treatment with thalidomide and prednisolone resulted in significant mass regression and symptom improvement. Our case highlights the importance of considering sclerosing mesenteritis in the differential diagnosis of abdominal masses and suggests a potential therapeutic approach for this rare condition. Further research is warranted to elucidate its pathogenesis and optimize management strategies.
PubMed: 38765330
DOI: 10.7759/cureus.58480 -
World Journal of Gastrointestinal... May 2024The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein, celiac axis-common hepatic artery,...
BACKGROUND
The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein, celiac axis-common hepatic artery, and superior mesenteric artery to improve patient prognosis. Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma (PDAC), data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy (PD).
AIM
To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.
METHODS
This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023, with or without the TRIANGLE operation. Patients were divided into the PD and PD groups. Surgical and survival outcomes were compared between the two groups. Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy ≥ 6 months.
RESULTS
The PD and PD groups included 52 and 55 patients, respectively. There were no significant differences in the baseline characteristics or perioperative indexes between the two groups. Furthermore, the recurrence rate was lower in the PD group than in the PD group (48.1% 81.8%, < 0.001), and the local recurrence rate of PDAC decreased from 37.8% to 16.0%. Multivariate Cox regression analysis revealed that PD (HR = 0.424; 95%CI: 0.256-0.702; = 0.001), adequate adjuvant chemotherapy ≥ 6 months (HR = 0.370; 95%CI: 0.222-0.618; < 0.001) and margin status (HR = 2.255; 95%CI: 1.252-4.064; = 0.007) were found to be independent factors for the recurrence rate.
CONCLUSION
The TRIANGLE operation is safe for PDAC patients undergoing PD. Moreover, it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.
PubMed: 38764839
DOI: 10.4251/wjgo.v16.i5.1773 -
SAGE Open Medical Case Reports 2024Uncommon in nature, retroperitoneal ganglioneuroma represents a neuroblastic benign tumor, predominantly manifesting in young adults, with a notable predilection for...
Uncommon in nature, retroperitoneal ganglioneuroma represents a neuroblastic benign tumor, predominantly manifesting in young adults, with a notable predilection for females. Often asymptomatic, the condition is frequently diagnosed incidentally due to delayed growth. Clinical manifestations arise primarily from the compression exerted on neighboring organs and vessels. The exclusive curative recourse lies in surgical intervention, underscoring the challenging task of achieving complete tumor excision, particularly when the ganglioneuroma attains considerable development and encapsulates significant retroperitoneal vessels. In this instance, we elucidate a case involving a 33-year-old woman, who had previously undergone a triple valve replacement due to rheumatic valvular disease, presenting persistent pelvic pain, unearthing a substantial asymptomatic retroperitoneal ganglioneuroma concomitant with an ovarian endometrioma. A laparotomy procedure was conducted, and to achieve a comprehensive excision of the mass, a meticulous intratumoral circular dissection of the prominent vessels, notably the superior mesenteric artery and celiac trunk, was undertaken. No local recurrence has been reported, 6 months after surgery. The significance of an experienced and well-trained surgical staff is underscored in addressing the complexities associated with this condition.
PubMed: 38756330
DOI: 10.1177/2050313X241252744 -
Cureus Apr 2024Solitary fibrous tumors (SFTs) are rare tumors that predominantly occur in the mesorectum. Few case reports have been published on mesorectal tumors, and this is the...
Solitary fibrous tumors (SFTs) are rare tumors that predominantly occur in the mesorectum. Few case reports have been published on mesorectal tumors, and this is the seventh case report. A 49-year-old female patient presented with a hypervascularized mesorectal tumor discovered incidentally during a routine medical examination. Using preoperative three-dimensional computed tomography (3D-CT), we identified vessels originating from the superior rectal and lateral sacral arteries, which are important sources of nutrients, and performed the procedure safely and without bleeding. Considering the lack of preoperative diagnosis and rectal blood flow, high anterior resection was performed. The histopathological diagnosis confirmed SFT, and the patient is currently doing well with no recurrence. Although SFT of the mesorectum occurs infrequently, it should be included in the differential diagnosis. In addition, the usefulness of preoperative 3D-CT, including the arterial phase, has been emphasized in such cases. This is the seventh reported case of a rare SFT in the mesorectum. Currently, there is no literature highlighting the usefulness of 3D-CT for SFTs of the mesorectum. However, it is a valuable preparatory tool for preoperative evaluation.
PubMed: 38756321
DOI: 10.7759/cureus.58395 -
Cureus Apr 2024Mesenteric ischemia is an urgent event and requires prompt recognition and treatment, in order to reduce the risk of mortality. It results from the sudden onset of small...
Mesenteric ischemia is an urgent event and requires prompt recognition and treatment, in order to reduce the risk of mortality. It results from the sudden onset of small intestinal hypoperfusion, from a reduction or cessation of arterial perfusion, which can occur from an embolic obstruction at the superior mesenteric artery. We present a case of transient mesenteric ischemia from an episode of atrial fibrillation with a rapid ventricular response rate. Despite being on chronic anticoagulation therapy, the patient developed transient mesenteric ischemia from an embolic clot. The patient's heart rate was controlled and no surgical intervention was required, a rare finding; however, it is very important to recognize and treat promptly.
PubMed: 38741839
DOI: 10.7759/cureus.58210 -
Clinical Science (London, England :... May 2024Acute kidney injury (AKI) increases the risk for progressive chronic kidney disease (CKD). MicroRNA (miR)-486-5p protects against kidney ischemia-reperfusion (IR) injury...
AIM
Acute kidney injury (AKI) increases the risk for progressive chronic kidney disease (CKD). MicroRNA (miR)-486-5p protects against kidney ischemia-reperfusion (IR) injury in mice, although its long-term effects on the vasculature and development of CKD are unknown. We studied whether miR-486-5p would prevent the AKI to CKD transition in rat, and affect vascular function.
METHODS
Adult male rats were subjected to bilateral kidney IR followed by i.v. injection of liposomal-packaged miR-486-5p (0.5 mg/kg). Kidney function and histologic injury were assessed after 24 h and 10 weeks. Kidney endothelial protein levels were measured by immunoblot and immunofluorescence, and mesenteric artery reactivity was determined by wire myography.
RESULTS
In rats with IR, miR-486-5p blocked kidney endothelial cell increases in intercellular adhesion molecule-1 (ICAM-1), reduced neutrophil infiltration and histologic injury, and normalized plasma creatinine (P<0.001). However, miR-486-5p attenuated IR-induced kidney endothelial nitric oxide synthase (eNOS) expression (P<0.05). At 10 weeks, kidneys from rats with IR alone had decreased peritubular capillary density and increased interstitial collagen deposition (P<0.0001), and mesenteric arteries showed impaired endothelium-dependent vasorelaxation (P<0.001). These changes were inhibited by miR-486-5p. Delayed miR-486-5p administration (96 h, 3 weeks after IR) had no impact on kidney fibrosis, capillary density, or endothelial function.
CONCLUSION
In rats, administration of miR-486-5p early after kidney IR prevents injury, and protects against CKD development and systemic endothelial dysfunction. These protective effects are associated with inhibition of endothelial ICAM-1 and occur despite reduction in eNOS. miR-486-5p holds promise for the prevention of ischemic AKI and its complications.
Topics: Animals; MicroRNAs; Male; Acute Kidney Injury; Renal Insufficiency, Chronic; Kidney; Reperfusion Injury; Rats, Sprague-Dawley; Intercellular Adhesion Molecule-1; Nitric Oxide Synthase Type III; Rats; Disease Models, Animal; Disease Progression; Endothelial Cells
PubMed: 38739452
DOI: 10.1042/CS20231752