BACKGROUND: Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinica...BACKGROUND: Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinical features that can help physicians to identify these patients.METHODS: We reviewed the discharge notes from two hospitals and identifi ed all patients who had a diagnosis of infected aneurysms of the thoracoabdominal aorta and iliac arteries between July 2009 and December 2013. Eighteen patients, aged from 41 to 93, were reviewed. Only 6 patients were diagnosed accurately in their fi rst visit to our ED.RESULTS: Most patients had at least one underlying illness, and it took 1 to 30(9.9±6.5) days for physicians to diagnose their infected aneurysm. Localized pain and fever were the two most commonly presented symptoms. The majority(92%) of isolated microorganisms were gram-negative bacilli, including Salmonella spp, Klebsiella pneumoniae, and Escherichia coli. Two of the 3 patients who underwent non-operative therapy died, and all of the patients who underwent a combination of medical and operative therapies survived.CONCLUSION: We suggest that physicians liberally use computed tomography scans on patients with unknown causes of pain and inflammatory processes. A combination of surgical and medical treatments is indicated for all patients with infected aortic and iliac aneurysms.展开更多
We report a case of infected iliac artery aneurysm concomitant with liver abscesses caused by Fusobacterium nucleatum. A 58-year-old man developed an aneurysm of the right common iliac artery and liver abscesses. The ...We report a case of infected iliac artery aneurysm concomitant with liver abscesses caused by Fusobacterium nucleatum. A 58-year-old man developed an aneurysm of the right common iliac artery and liver abscesses. The aneurysm was resected and a femoro-femoral crossover bypass with a knitted Dacron graft was performed for impending rupture. Anaerobic cultures obtained from blood and intramural thrombus were positive for Fusobacterium nucleatum. With antibiotics, the liver abscesses disappeared without drainage. Iliopsoas abscesses developed after surgery, but it was controlled with antibiotics. The patient was free of infection 1 year after the surgery. The causative bacterium was suspected to originate in the oral cavity, because the patient had a notable history of poor chronic periodontal conditions. Clinically, infected aortoiliac aneurysm complicated by Fusobacterium is extremely rare relative to the prevalence of the pathogenic bacterium. However, it is noteworthy that Fusobacterium can cause this condition.展开更多
The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and p...The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.展开更多
We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve ...We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.展开更多
Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a ...Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a high mortality rate involving extra-intestinal foci of infection and mycotic aneurysms. We report the case of a 61-year-old man with poorly controlled diabetes mellitus, hypertension, dyslipidaemia, and congestive heart failure, who presented with unilateral left lower limb swelling, extensive deep vein thrombosis, and concomitant Salmonella bacteraemia. An oral anticoagulant and intravenous antibiotic therapy were initiated. Although the patient remained haemodynamically stable, he complained of constant left lower limb weakness and lower back pain. A computed tomography angiography scan of the thorax and abdomen revealed saccular aneurysms with contained hematoma of the left common iliac artery. The oral anticoagulant was discontinued, and an inferior vena cava filter was inserted as part of the venous thrombosis management. The patient was offered aorto-uni-iliac endovascular aneurysm repair and received intravenous antibiotic therapy, postoperatively, for six weeks. The postoperative blood cultures remained negative, and he was discharged with a course of ciprofloxacin administered orally. However, three months after the surgery, the patient died of recurrent septicaemia. This case illustrates the importance of remaining vigilant for potential endovascular complications of Salmonella bacteraemia, such as mycotic aneurysms and deep vein thrombosis, among high-risk patients. Further, this case highlights the challenges of eliminating Salmonella bacteraemia and its related complications, albeit treating it with both a prolonged course of medical therapy and surgical intervention.展开更多
BACKGROUND Allograft artery mycotic aneurysm(MA)represents a rare but life-threatening complication of kidney transplantation.Graftectomy is widely considered the safest option.Due to the rarity of the disease and the...BACKGROUND Allograft artery mycotic aneurysm(MA)represents a rare but life-threatening complication of kidney transplantation.Graftectomy is widely considered the safest option.Due to the rarity of the disease and the substantial risk of fatal consequences,experience with conservative strategies is limited.To date,only a few reports on surgical repair have been published.We describe a case of true MA successfully managed by aneurysm resection and arterial re-anastomosis.CASE SUMMARY An 18-year-old gentleman,on post-operative day 70 after deceased donor kidney transplantation,presented with malaise,low urinary output,and worsening renal function.Screening organ preservation fluid cultures,collected at the time of surgery,were positive for Candida albicans.Doppler ultrasound and contrastenhanced computer tomography showed a 4-cm-sized,saccular aneurysm of the iuxta-anastomotic segment of the allograft artery,suspicious for MA.The lesion was wide-necked and extended to the distal bifurcation of the main arterial branch,thus preventing endovascular stenting and embolization.After multidisciplinary discussion,the patient underwent surgical exploration,aneurysm excision,and re-anastomosis between the stump of the allograft artery and the internal iliac artery.The procedure was uneventful.Histology and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida infection.Three years after the operation,the patient is doing very well with excellent allograft function and no signs of recurrent disease.CONCLUSION Surgical repair represents a feasible option in carefully selected patients with allograft artery MA.Anti-fungal prophylaxis is advised when preservation fluid cultures are positive.展开更多
Although the majority of patients with perimembranous ventricular septal defect and septal aneurysm remained asymptomatic, some of them presented with serious complications during adulthood and thus required high risk...Although the majority of patients with perimembranous ventricular septal defect and septal aneurysm remained asymptomatic, some of them presented with serious complications during adulthood and thus required high risky surgery. In accordance with other rare condition, the incidence and natural history have not been well documented. This case describes the occurrence of a septic pulmonary emboli associated with right ventricular outflow tract obstruction in a young child.展开更多
Background:Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm(post-operative pneumonia[POP])in patients with aneurysmal subarachnoid hemorrhage(aSAH)have been studied,the predict...Background:Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm(post-operative pneumonia[POP])in patients with aneurysmal subarachnoid hemorrhage(aSAH)have been studied,the predictive model of POP after aSAH has still not been well established.Thus,the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio(NLR)to predict the occurrence of POP in aSAH patients.Methods:We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data.We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression.After screening out the prognosis-related factors,the predictive value of these factors for POP was further assessed.Results:POP occurred in 219 patients(30.4%)in this cohort.Patients with POP had significantly higher NLR than those without(14.11±8.90vs.8.80±5.82,P<0.001).Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors,including the age,World Federation of Neurosurgical Societies(WFNS)grade,endovascular treatment,and ventilator use.And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR(NLRvs.WFNS grade×NLR,P=0.011).Conclusions:Regardless of good or poor WNFS grade,patients having NLR>10 had significantly worse POP survival rate than patients having NLR≤10.NLR at admission might be helpful as a predictor of POP in aSAH patients.展开更多
Pseudoaneurysms of the femoral artery usually progress and can rupture if left untreated. Therefore,intraoperative hemostasis is of the paramount importance in the management of these emergent situations, especially f...Pseudoaneurysms of the femoral artery usually progress and can rupture if left untreated. Therefore,intraoperative hemostasis is of the paramount importance in the management of these emergent situations, especially for the patients with poor general health. We present an efficient method of stopping massive bleeding occurring in this patient by balloon catheter.展开更多
Both surgical and endovascular grafts have the rare risk of late secondary infection.Treatment varies based on the clinical setting,but in general the recommendations are that infected endografts be removed and recons...Both surgical and endovascular grafts have the rare risk of late secondary infection.Treatment varies based on the clinical setting,but in general the recommendations are that infected endografts be removed and reconstruction performed.In the abdominal aorta this may vary from homograft or other impregnated grafts to excision and extra-anatomic bypass.We discuss an unusual case which we believe serves as a useful review of this still debated area.A 58-year-old male presented with abdominal and back pain.Prior history was notable for human immunodeficiency virus positive status,pulmonary embolism(currently on Coumadin) and two years previously repair of a saccular infra-renal aneurysm with tube graft.The week prior to the onset of symptoms he suffered a noticeable scratch from his cat.Blood cultures were positive for pasturella multicoda.He was transferred to our institution and underwent resection and explantation,with homograft reconstruction.At one year he is alive and well.展开更多
文摘BACKGROUND: Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinical features that can help physicians to identify these patients.METHODS: We reviewed the discharge notes from two hospitals and identifi ed all patients who had a diagnosis of infected aneurysms of the thoracoabdominal aorta and iliac arteries between July 2009 and December 2013. Eighteen patients, aged from 41 to 93, were reviewed. Only 6 patients were diagnosed accurately in their fi rst visit to our ED.RESULTS: Most patients had at least one underlying illness, and it took 1 to 30(9.9±6.5) days for physicians to diagnose their infected aneurysm. Localized pain and fever were the two most commonly presented symptoms. The majority(92%) of isolated microorganisms were gram-negative bacilli, including Salmonella spp, Klebsiella pneumoniae, and Escherichia coli. Two of the 3 patients who underwent non-operative therapy died, and all of the patients who underwent a combination of medical and operative therapies survived.CONCLUSION: We suggest that physicians liberally use computed tomography scans on patients with unknown causes of pain and inflammatory processes. A combination of surgical and medical treatments is indicated for all patients with infected aortic and iliac aneurysms.
文摘We report a case of infected iliac artery aneurysm concomitant with liver abscesses caused by Fusobacterium nucleatum. A 58-year-old man developed an aneurysm of the right common iliac artery and liver abscesses. The aneurysm was resected and a femoro-femoral crossover bypass with a knitted Dacron graft was performed for impending rupture. Anaerobic cultures obtained from blood and intramural thrombus were positive for Fusobacterium nucleatum. With antibiotics, the liver abscesses disappeared without drainage. Iliopsoas abscesses developed after surgery, but it was controlled with antibiotics. The patient was free of infection 1 year after the surgery. The causative bacterium was suspected to originate in the oral cavity, because the patient had a notable history of poor chronic periodontal conditions. Clinically, infected aortoiliac aneurysm complicated by Fusobacterium is extremely rare relative to the prevalence of the pathogenic bacterium. However, it is noteworthy that Fusobacterium can cause this condition.
文摘The present study aimed to compare the complications and clinical outcomes of serial lumbar puncture（LP） and lumbar cerebrospinal fluid（CSF） drainage（LD） of patients with aneurysmal subarachnoid hemorrhage and provide more evidence to guide clinical management.In this retrospective study,41 and 39 aneurysmal subarachnoid hemorrhage patients were enrolled in the LP and LD group,respectively.Clinical outcomes,including CSF infection,intracerebral hemorrhage,vasospasm,hydrocephalus,death,length of stay,duration of drainage and the Glasgow Outcome Scale score were compared between the two groups.By comparing with the LP group,the LD group showed a significantly higher rate of CSF infection（P= 0.029） and shorter duration of drainage（P〈 0.001）.Both groups displayed similar rates of vasospasm,hydrocephalus,intracerebral hemorrhage,the Glasgow Outcome Scale score one month after endovascular coiling and length of stay（P〉 0.05,respectively）.In conclusion,both LD and serial LP are effective methods in the treatment of aneurysmal subarachnoid hemorrhage; besides,serial LP can reduce the incidence of CSF infection in draining hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling.
文摘We present a case of leaking mycotic aneurysm of abdominal aorta complicated by infective endocarditis in a young boy of 14 years age. This boy with history of rheumatic heart disease with vegetations on mitral valve and severe mitral regurgitation landed up in complications of infective endocarditis like femoral artery thrombo embolism followed by an abdominal aortic aneurysm with contained rupture. This case was successfully managed addressing two problems i.e. valve and aneurysm repair in single sitting.
文摘Salmonella, a food-borne pathogen, can cause mild self-limiting gastroenteritis. However, immunocompromised hosts and older adults with complex medical conditions may develop a complicated form of bacteraemia, with a high mortality rate involving extra-intestinal foci of infection and mycotic aneurysms. We report the case of a 61-year-old man with poorly controlled diabetes mellitus, hypertension, dyslipidaemia, and congestive heart failure, who presented with unilateral left lower limb swelling, extensive deep vein thrombosis, and concomitant Salmonella bacteraemia. An oral anticoagulant and intravenous antibiotic therapy were initiated. Although the patient remained haemodynamically stable, he complained of constant left lower limb weakness and lower back pain. A computed tomography angiography scan of the thorax and abdomen revealed saccular aneurysms with contained hematoma of the left common iliac artery. The oral anticoagulant was discontinued, and an inferior vena cava filter was inserted as part of the venous thrombosis management. The patient was offered aorto-uni-iliac endovascular aneurysm repair and received intravenous antibiotic therapy, postoperatively, for six weeks. The postoperative blood cultures remained negative, and he was discharged with a course of ciprofloxacin administered orally. However, three months after the surgery, the patient died of recurrent septicaemia. This case illustrates the importance of remaining vigilant for potential endovascular complications of Salmonella bacteraemia, such as mycotic aneurysms and deep vein thrombosis, among high-risk patients. Further, this case highlights the challenges of eliminating Salmonella bacteraemia and its related complications, albeit treating it with both a prolonged course of medical therapy and surgical intervention.
文摘BACKGROUND Allograft artery mycotic aneurysm(MA)represents a rare but life-threatening complication of kidney transplantation.Graftectomy is widely considered the safest option.Due to the rarity of the disease and the substantial risk of fatal consequences,experience with conservative strategies is limited.To date,only a few reports on surgical repair have been published.We describe a case of true MA successfully managed by aneurysm resection and arterial re-anastomosis.CASE SUMMARY An 18-year-old gentleman,on post-operative day 70 after deceased donor kidney transplantation,presented with malaise,low urinary output,and worsening renal function.Screening organ preservation fluid cultures,collected at the time of surgery,were positive for Candida albicans.Doppler ultrasound and contrastenhanced computer tomography showed a 4-cm-sized,saccular aneurysm of the iuxta-anastomotic segment of the allograft artery,suspicious for MA.The lesion was wide-necked and extended to the distal bifurcation of the main arterial branch,thus preventing endovascular stenting and embolization.After multidisciplinary discussion,the patient underwent surgical exploration,aneurysm excision,and re-anastomosis between the stump of the allograft artery and the internal iliac artery.The procedure was uneventful.Histology and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida infection.Three years after the operation,the patient is doing very well with excellent allograft function and no signs of recurrent disease.CONCLUSION Surgical repair represents a feasible option in carefully selected patients with allograft artery MA.Anti-fungal prophylaxis is advised when preservation fluid cultures are positive.
文摘Although the majority of patients with perimembranous ventricular septal defect and septal aneurysm remained asymptomatic, some of them presented with serious complications during adulthood and thus required high risky surgery. In accordance with other rare condition, the incidence and natural history have not been well documented. This case describes the occurrence of a septic pulmonary emboli associated with right ventricular outflow tract obstruction in a young child.
基金Key Clinical Specialty Discipline Construction Program of Fujian Province,the Major Project of Fujian Provincial Department of Science and Technology(No.2014YZ0003)Qihan Foundation of Fujian Medical University(No.2018QH1049)National Natural Science Foundation of China(No.81901395)。
文摘Background:Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm(post-operative pneumonia[POP])in patients with aneurysmal subarachnoid hemorrhage(aSAH)have been studied,the predictive model of POP after aSAH has still not been well established.Thus,the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio(NLR)to predict the occurrence of POP in aSAH patients.Methods:We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data.We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression.After screening out the prognosis-related factors,the predictive value of these factors for POP was further assessed.Results:POP occurred in 219 patients(30.4%)in this cohort.Patients with POP had significantly higher NLR than those without(14.11±8.90vs.8.80±5.82,P<0.001).Multivariate analysis revealed that NLR remained a significant factor independently associated with POP following aSAH after adjusting for possible confounding factors,including the age,World Federation of Neurosurgical Societies(WFNS)grade,endovascular treatment,and ventilator use.And the predictive value of NLR was significantly increased after WFNS grade was combined with NLR(NLRvs.WFNS grade×NLR,P=0.011).Conclusions:Regardless of good or poor WNFS grade,patients having NLR>10 had significantly worse POP survival rate than patients having NLR≤10.NLR at admission might be helpful as a predictor of POP in aSAH patients.
文摘Pseudoaneurysms of the femoral artery usually progress and can rupture if left untreated. Therefore,intraoperative hemostasis is of the paramount importance in the management of these emergent situations, especially for the patients with poor general health. We present an efficient method of stopping massive bleeding occurring in this patient by balloon catheter.
文摘Both surgical and endovascular grafts have the rare risk of late secondary infection.Treatment varies based on the clinical setting,but in general the recommendations are that infected endografts be removed and reconstruction performed.In the abdominal aorta this may vary from homograft or other impregnated grafts to excision and extra-anatomic bypass.We discuss an unusual case which we believe serves as a useful review of this still debated area.A 58-year-old male presented with abdominal and back pain.Prior history was notable for human immunodeficiency virus positive status,pulmonary embolism(currently on Coumadin) and two years previously repair of a saccular infra-renal aneurysm with tube graft.The week prior to the onset of symptoms he suffered a noticeable scratch from his cat.Blood cultures were positive for pasturella multicoda.He was transferred to our institution and underwent resection and explantation,with homograft reconstruction.At one year he is alive and well.
