Abdominal Great Vessels Research Articles

Physiological iodine uptake of the spine's bone marrow in dual-energy computed tomography - using artificial intelligence to define reference values based on 678 CT examinations of 189 individuals.

The bone marrow's iodine uptake in dual-energy CT (DECT) is elevated in malignant disease. We aimed to investigate the physiological range of bone marrow iodine uptake after intravenous contrast application, and examine its dependence on vBMD, iodine blood pool, patient age, and sex. Retrospective analysis of oncological patients without evidence of metastatic disease. DECT examinations were performed on a spectral detector CT scanner in portal venous contrast phase. The thoracic and lumbar spine were segmented by a pre-trained neural network, obtaining volumetric iodine concentration data [mg/ml]. vBMD was assessed using a phantomless, CE-certified software [mg/cm3]. The iodine blood pool was estimated by ROI-based measurements in the great abdominal vessels. A multivariate regression model was fit with the dependent variable "median bone marrow iodine uptake". Standardized regression coefficients (β) were calculated to assess the impact of each covariate. 678 consecutive DECT exams of 189 individuals (93 female, age 61.4 ± 16.0 years) were evaluated. AI-based segmentation provided volumetric data of 97.9% of the included vertebrae (n=11,286). The 95th percentile of bone marrow iodine uptake, as a surrogate for the upper margin of the physiological distribution, ranged between 4.7-6.4 mg/ml. vBMD (p <0.001, mean β=0.50) and portal vein iodine blood pool (p <0.001, mean β=0.43) mediated the strongest impact. Based thereon, adjusted reference values were calculated. The bone marrow iodine uptake demonstrates a distinct profile depending on vBMD, iodine blood pool, patient age, and sex. This study is the first to provide the adjusted reference values.

Middle Aortic Syndrome: Pathogenesis, Visceral Manifestations, and Management

AbstractMiddle aortic syndrome (MAS) is characterized by severe narrowing of the abdominal aorta, frequently involving the great abdominal vessels. Although increasingly implicated in primary hypertension, up to one-third of cases affect the mesenteric vasculature, and the resultant manifestations may be underrecognized. Early intervention with interdisciplinary medical management and invasive arterial reconstruction affords preservation of end-organ function and improvement in patient survival. This article reviews the embryology of the thoracoabdominal aorta and major abdominal arteries, as well as the pathogenesis, clinical manifestations, and management of the nonatherosclerotic abdominal coarctation otherwise known as MAS.

Horseshoe Kidney: A Fusion Anomaly

&lt;p&gt;&lt;span&gt;A horseshoe shaped kidney was found in an approximately 35 years old female cadaver during routine dissection at anatomy lab of our department. Further careful dissection was done in situ and ureter and related blood vessels were identified and painted for identification. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;The isthmus connecting the inferior poles of the kidneys was ventral to the great abdominal vessels. There were multiple vessels supplying the horseshoe kidney on either side, the ureteric drainage pattern was also not symmetrical. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;Horseshoe kidney is the commonest renal fusion anomaly found in 1 in 400-600 individuals, it is twice common in males than females. It occurs when kidneys are pushed too close to each other during their relative ascent through arterial fork of umbilical arteries in fetal life. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;span&gt;Horseshoe kidney is associated with increased risk of renal calculus. Surgical division of the isthmus improves the renal function even in the absence of any pathology. Due to vascular variations, Angiographyor CT scanning with vascular reconstruction is very helpful when planning surgery on horseshoe kidney.&lt;/span&gt;&lt;/p&gt;

Horseshoe Kidney: A Fusion Anomaly

A horseshoe shaped kidney was found in an approximately 35 years old female cadaver during routine dissection at anatomy lab of our department. Further careful dissection was done in situ and ureter and related blood vessels were identified and painted for identification. The isthmus connecting the inferior poles of the kidneys was ventral to the great abdominal vessels. There were multiple vessels supplying the horseshoe kidney on either side, the ureteric drainage pattern was also not symmetrical. Horseshoe kidney is the commonest renal fusion anomaly found in 1 in 400-600 individuals, it is twice common in males than females. It occurs when kidneys are pushed too close to each other during their relative ascent through arterial fork of umbilical arteries in fetal life. Horseshoe kidney is associated with increased risk of renal calculus. Surgical division of the isthmus improves the renal function even in the absence of any pathology. Due to vascular variations, Angiographyor CT scanning with vascular reconstruction is very helpful when planning surgery on horseshoe kidney.

Resection of a Late Retroperitoneal Metastatic Leydig–Sertoli Cell Sex Cord–Stromal Tumor With Concomitant Aortocaval Reconstruction

Leydig–Sertoli cell tumors are rare, with only a few cases reported in the literature. We here present a 41-year-old man who underwent a right orchiectomy for a testicular tumor at the age of 34 years. Seven years later, he presented at our institution with a large retroperitoneal mass encasing the abdominal great vessels. The patient underwent en bloc resection of the mass and concomitant infrarenal aorta, and inferior vena cava reconstruction. Pathology report revealed a Leydig–Sertoli cell sex cord–stromal tumor. The patient recovered well from the surgery and was discharged home in stable condition. To our knowledge this is the first report of a Leydig–Sertoli cell sex cord–stromal tumor with late retroperitoneal metastasis treated by en bloc resection and vascular reconstruction of the abdominal great vessels.

Operative Technique and Literature Overview of the Lateral Access Surgery for Anterior Interbody Fusion

Based on the concept of minimally invasive spinal surgery, the retroperitoneal lateral transpsoas access was developed to approach the lumbar spine in a less invasive way. This technique allows access to the intervertebral disc laterally through the fibers of the psoas muscle. This approach is reported to offer adequate disc exposure, with the benefit of reduced iatrogenic injury to abdominal great vessels, sympathetic plexus (reducing incidence of retrograde ejaculation), and neural structures. Here we minutely pass through the lateral interbody fusion technique, illustrate and highlight some hot points in the literature, while presenting clinical and radiological results and complications inherent to the technique. Similarly to other minimally invasive approaches, learning curve consist a real barrier to accomplish surgery objectives. So, complete knowledge of the steps and tricks are primordial to perform and evolve this procedure. Patient positioning regards to a critical point of the surgery, when truly perpendicular way to the level has to be set. Safe crossing of the psoas muscle is assured with intraoperative use of EMG, avoiding lumbar plexus and direct neural damage. Ipsilateral and contralateral annulus release provides cortical bone support to the interbody cage at apophyseal ring to prevent cage subsidence. The use of the lateral access has become popular and usual throughout the orthopedic and neurosurgery practice. However, as every incoming technology and technique, the users of it have to be attentive to its benefits and pitfalls.

Postmortem CT morphometry of great vessels with regard to the cause of death for investigating terminal circulatory status in forensic autopsy.

Postmortem CT (PM-CT) is useful to investigate the viscera in situ before opening the body cavities at autopsy. The present study involved a virtual morphometric analysis of thoracic and abdominal great vessels with regard to the cause of death as a possible index of terminal circulatory status in forensic autopsy cases, using PM-CT data of forensic autopsy cases within 3 days postmortem (n = 93). Perimeters and cross-sectional areas of the aorta and vena cava depended on the age and/or gender of subjects; however, when the vessel flattening index (vFI) was calculated as the ratio of the cross-sectional area (a) to the estimated circle area having the same perimeter (l), using the formula vFI = 4πa/l(2), the vFI showed distinct differences among the causes of death without significant postmortem time dependence. The index was low for each vessel in fatal bleeding, while the vFI of the abdominal aorta and inferior vena cava was low in hyperthermia (heatstroke), but higher in drowning, hypothermia (cold exposure) and sudden cardiac death. These CT findings provide quantitative data as supplementary indicators to reinforce autopsy findings for interpreting terminal circulatory status.

Value of hypo-perfusion signs of abdominal vessels on enhanced spiral CT in evaluation of hypovolemic shock in severe traumatic patients

Objective To investigate the significance of hypo-perfusion signs of abdominal vessels on enhanced spiral CT in evaluation of hypovolemic shock in severe traumatic patients.Methods Clinical and spiral CT image data of 63 patients with severe trauma treated between January 2008 and December 2011 were reviewed retrospectively.According to the occurrence of shock at 24 hours after spiral CT scan,the patients were divided into shock group (34 cases) and stable group (29 cases).Blood pressure,heart rate,ISS,blood pH value,blood lactate (Lac),and buffer excess (BE) and other indices on admission were analyzed and compared between the two groups.Diameter of abdominal great vessels including aorta,inferior vena cava,superior mesenteric artery and superior mesenteric vein were measured on enhanced spiral CT images as well as their CT values in both early and delayed phase of enhancement.Results The shock group showed significantly higher ISS and blood Lac level,but significantly lower BE as compared with the stable group (P ＜ 0.05).Inferior vena cava in the shock group presented signs of deformity and collapse.Minimal diameters of the four abdominal levels were all shorter in the shock group than in the stable group (P ＜0.01).In the early enhancement on spiral CT,the CT value of superior mesenteric artery was lower in the shock group than in stable group [(133.2 ± 32.4) HU vs (186.3 ± 23.3) HU,(P ＜ 0.05)],while the CT value of inferior vena cava above the upper edge of the liver was significantly higher in shock group than in stable group [(133.4 ± 20.3) HU vs (112.0 ± 21.9) HU,(P ＜ 0.01)].In the delayed enhancement on spiral CT,the CT value of each vessel presented no statistical differences between the two groups.Conclusion Some hypo-perfusion signs of abdominal vessels on enhanced CT have some reference value on the early diagnosis of hypovolemic shock in severe traumatic patients. Key words: Wounds and injuries ; Tomography, spiral computed; Shock ; Hypovolemia

Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma

Background and purposeHypofractionated radiotherapy (RT) of pancreatic adenocarcinoma is limited by the tolerance of adjacent normal tissues. A better understanding of the influence of dosimetric variables on the rate of toxicity after RT must be considered an important goal. Methods and materialsSixty-one patients with histologically proven locally advanced disease (LAPD) were analyzed. The therapeutic strategy consisted of induction chemotherapy (ChT) followed by concurrent chemoradiotherapy (CRT). In 39 out of 61 patients the target volume was based on a four-dimensional CT (4D-CT) procedure. Delivered dose was 44.25Gy in 15 fractions to PTV2, which consisted of pancreatic tumor and regional lymph nodes considered radiologically involved; 23 out of 61 patients received a simultaneous integrated boost (SIB) to a tumor sub-volume infiltrating the great abdominal vessels (PTV1) with dose in the range of 48–58Gy. RT was delivered with Helical Tomotherapy. Dose–volume histograms (DVHs) of target volumes and organs at risk (OARs) were collected for analysis. The predictive value of clinical/dosimetric parameters was tested by univariate/multivariate analyses. ResultsThe crude incidence of acute gastrointestinal (GI) grade 2 toxicity was 33%. The 12-month actuarial rate of “anatomical” (gastro-duodenal mucosa damage) toxicity was 13% (95% CI: 4–22%). On univariate analysis, several stomach and duodenum DVH endpoints are predictive of toxicity after moderately hypofractionated radiotherapy. Multivariate analysis confirmed that baseline performance status and the stomach V20[%] were strong independent predictors of acute GI grade ⩾2 toxicity. The high-dose region of duodenum DVH (V45[%]; V40[%]) was strongly correlated with grade ⩾2 “anatomical” toxicity; the best V40[%] and V45[%] cut-off values were 16% and 2.6% respectively. ConclusionRegarding dosimetric indices, stomach V20[%] correlates with a higher rate of acute toxicity; more severe acute and late anatomical toxicities are related to the high dose region of duodenum DVH.

Surgical strategies for tumors with invasion of thoracic and abdominal great vessels

To summarize the vascular surgical strategies for chest and abdomen tumors with the invasion of great vessels. The clinical data were collected for 67 patients undergoing surgical treatment for tumors with the invasion of thoracic and abdominal great vessels at our hospital from January 2001 to June 2009. Then a retrospective analysis was performed. Among this dataset, there were 31 cases with only vessel wall invasion and 20 cases with only intravascular tumor thrombus. In the meanwhile, both the invasion of vascular walls and the formation of tumor thrombus were located in 16 patients. Among 67 operated patients, various strategies were used, including surgical adhesion lysis (n = 15), vascular resection direct suture (n = 24), artificial blood vessel patch (n = 10), pericardial patch (n = 3), artificial vascular replacement or bypass (n = 15) and cavity thrombectomy (n = 36). Cavity thrombectomy was performed under cardiopulmonary bypass for 8 patents with tumor invasion of right atrium. Among them, 58 patients received radical tumor resection while palliative resection was performed for 9 patients with a rate of complete resection at 86.6%. There was no intraoperative mortality with the perioperative death of 8 cases. A follow-up study was successfully conducted for 52 patients. And 7 patients were lost to follow-up. The overall follow-up rate was 88.1%. By June 2009, the survival period of this group of patients was as follows: 18 cases (> 48 months), 29 cases (> 24 months), 38 cases (> 12 months), 50 cases (> 6 months) and 2 cases (≤ 6 months). Among these patients, the major cause of mortality was tumor metastasis. The patients with kidney cancer showed the most favorable surgical outcomes. Managed by a variety of vascular surgical techniques, the patients with tumors involving major blood vessels may achieve an excellent success rate of tumor resection and a better postoperative quality-of-life.

Diagnostic influence of cardiovascular screening by pocket-size ultrasound in a cardiac unit

AimsWe aimed to study the diagnostic influence of adding a routine cardiovascular ultrasound screening of the cardiac anatomy and function, the pericardium, the pleura and the abdominal great vessels by the new pocket-size ultrasound device (pUS) with grey scale and colour Doppler imaging.Methods and resultsIn 119 randomly selected patients admitted to a cardiac unit at a non-university hospital, routinely adding a cardiovascular ultrasonography of only 4.4 min with a pocket-size device corrected the primary diagnosis in 16% of patients. In addition, 29% had the primary diagnosis verified and in 10% an additional important diagnosis was made. Higher age predicted any diagnostic influence of pUS screening with an increase of 61% (P = 0.003) per 10 years of higher age. Overall, the pUS screening had a sensitivity and specificity with respect to detecting at least moderate pathology of 97 and 93%. Positive and negative predictive values were 93 and 87%, respectively. In the sub-group of subjects with a change in the primary diagnosis following pUS there was no false-negative or false-positive findings.ConclusionScreening by pUS assessed vascular and cardiac anatomy and function accurately and enabled correction of the diagnosis in 16% of patients admitted to a cardiac unit. In 55% of the participants, the cardiovascular ultrasound screening had important diagnostic influence. We suggest that it would be appropriate to implement strategies and systems for routinely adding an ultrasound cardiovascular examination to patients in cardiac units.

Study on relation between the fetal abdominal great vessels anormalities and heterotaxy

Objective To investigate the relation between anormalities of fetal abdominal great vessels and heterotaxy, the clinical significance of screening fetal heterotaxy by the abnormalities of fetal abdominal great vessels. Methods 6532 fetuses from our hospital were scanned and the fetuses with abdominal great vessels abnormalities were included. Parameters of fetal growth, abdominal great vessels and anatomical survey were detected. Results Forty-five cases (0.7%) of fetal abdominal great vessels abnormalities were detected prenatally. Forty-two cases were confirmed postnatally, including 35 cases of heterotaxy syndrome and 7 cases of situs inversus totalis and 3 cases missed. The incidences of the abnormal fetus,heterotaxy syndrome and situs inversus totalis of the fetuses with abnormal abdominal great vessels were higher than that of the fetuses with normal abdominal great vessels, the differences were statistically significant( P＜ 0.001). The incidence of both type Ⅰ and type Ⅱ of the heterotaxy syndrome were significantly higher than that of type Ⅳ (P＜0.001). There was a high incidence of left isomerism in abnormal type Ⅰ and of right isomerism in abnormal type Ⅱ , the differences were statistically significant (P＜ 0.001). Conclusions Abnormal great vessels abnormalities have strong relations to heterotaxy and situs inversus which can be used as effective and simple indicator in screening heterotaxy syndrome. Key words: Ultrasonography, prenatal; Cardiovascular abnormalities; Situs inversus

Recombinant activated factor VII in the treatment of intractable non-surgical bleeding following major vascular procedures

A recombinant form of activated factor VII (rFVIIa) is a haemostatic drug that is approved for use in haemophiliacs with antibodies to factor VIII or factor IX. Most recent studies and clinical experience have shown that rFVIIa (NovoSeven, Novo Nordisk A/S, Denmark) gives extreme haemostatic effect in patients with severe "non-haemophilic" bleeding produced after trauma and major surgery. We present our preliminary experience of the use of rFVIIa in vascular surgery when conventional haemostatic measures are inadequate. There were 32 patients divided into five groups: Group I--14 patients with ruptured abdominal aortic aneurysms; Group II--10 patients with thoracoabdominal aortic aneurysms; Group III--5 patients with retroperitoneal tumours involving great abdominal vessels; Group IV--2 patients with portal hypertension and Group V--one patient with iatrogenic injury of brachial artery and vein during fibrinolytic treatment, because of myocardial infarction. Clinical improvement was detected following treatment in 29 patients. Bleeding was successfully controlled as evidenced by improved haemodynamic parameters and decreased inotropic and transfusion requirements. In vascular patients more liberal use of rFVlla is limited, because no randomized controlled trial has proved its efficacy and safety in such patients; while also keeping in mind that the price of a 4.8 mg of rFVIIa is $4080. We recommend the use of rFVIIa in vascular surgery only during and after operative treatment of thoracoabdominal aortic aneurysms, ruptured abdominal aortic aneurysms, retroperitoneal tumours involving the aorta and/or inferior vena cava, as well as portal hypertension, when non-surgical massive uncontrolled bleeding are present.

Quiste de vesícula seminal con agenesia renal asociado a malformaciones vasculares: Presentación de un caso

We report a case of seminal vesicle cyst with ipsilateral renal agenesis associated wit abnormalities of the abdominal great vessels, not described previously in the bibliography.33 year-old-male with history of abdominal pain and fever. This case was evaluated by ultrasound, IV urography, CT scan and MRI. RESULTS/CONCLUSIONS. Congenital cystic disease of the seminal vesicle is an uncommon disorder. It is associated with genitourinary anomalies, often renal agenesis, and even anomalies of the lower spine. However, anomalies of the abdominal great vessels have not been described previously. CT scan provided excellent demonstration of associated anomalies.

Aorto-iliac thrombo-endarterectomy.

Abstract A series of 46 patients, all of whom underwent thrombo-endarterectomy for occlusive atherosclerotic disease of the abdominal aorta and iiiac arteries, is presented. The operative mortality of the whole series is 10 per cent but in the last 32 cases only 3 per cent. This compares favourably with other published series and other reconstructive procedures. The follow-up ranges from 6 months to 9 years and averages 2 years 6 months in the 42 postoperative survivors. In this group the patency rate is 90 per cent. The incidence and causation of impotence post-operatively are discussed and measures suggested for avoiding this complication. Emphasis is laid on the anatomical distribution of the atheroma and its haemodynamic effects as determining factors in the prognosis and the suitability of this disease for treatment by thrombo-endarterectomy. Further advance in the operative treatment of atherosclerosis of the great abdominal vessels should continue to take an ever-increasing account of the perfusion and flow problems intimately associated with the disease and its relief.

Three-Dimensional Computed Tomographic Anatomy of the Abdominal Great Vessels Pertinent to L4-L5 Anterior Lumbar Interbody Fusion

A recent accumulation of surgical and radiological literature has helped spine surgeons to better understand the anatomy and establish surgical trajectories to the anterior L4-L5 disc space. However, the preoperative display of anatomic data in individual subjects in the three-dimensional (3-D) mode has rarely been attempted. The objective of this study was to acquire 3-D images of the abdominal great vessels pertinent to the L4-L5 anterior lumbar interbody fusion (ALIF), and to better define the radiological vascular anatomy. The 3-D images of 100 subjects with non-spinal diseases, generated from abdominal computed tomography angiography (CTA), were analyzed retrospectively. The anatomy of the great vessels pertinent to the L4-L5 ALIF procedure was investigated by measuring the level of the abdominal aorta (AA) bifurcation and that of the inferior vena cava (IVC) confluence in relation to the lumbar vertebral body. These two complexes were segmented into upper or lower parts, or disc level. The visibility of the middle sacral artery (MSA) and the left L4 lumbar artery on the 3-D images was also assessed. The AA bifurcation level was above L4 in 4, at L4 in 55, at L4-L5 in 23, and at L5 in 18 subjects. The IVC confluence level was at L4 in 17, at L4-L5 in 14, at L5 in 68 and below L5 in 1 subject. Levels of the bifurcation of the AA/IVC as combined data showed that the AA bifurcation was usually located 1 - 2 segments above the IVC confluence. The MSA and L4 segmental artery were identified in 79 and 83 subjects, respectively. The 3-D images of the abdominal great vessels together with the lumbar spinal column were reliably depicted. Anatomic data obtained from this study are in accordance with those obtained from conventional 2-D studies, and the 3-D images can serve as a versatile tool for preoperative evaluation for the ALIF candidates and can contribute to the reduction of surgical time and perioperative vascular complications.

The implications for fetal outcome of an abnormal arrangement of the abdominal vessels

In a prospective audit of consecutive referrals for fetal echocardiography between 1997 and 2003, we documented all instances of an abnormal arrangement of the abdominal vessels. We then established the structure of the heart in these fetuses, noting any extra-cardiac associations, and the eventual outcomes. We found a cardiac abnormality in 572 of the 2,136 fetuses examined during this period (27 percent), with 16 (0.8 percent) having an abnormal arrangement of the abdominal great vessels. Mirror-imaged arrangement was found in 3, while the arrangement suggested right isomerism in 6, and left isomerism in 7. Of these 16 fetuses, 14 had cardiac malformations. Isomerism of the right atrial appendages was found in 7 fetuses, all with either a right-sided stomach or cardiac apex, and 6 with a common atrioventricular junction guarded by a common valve. Only 1 of these fetuses survived. Of the 3 fetuses with mirror-imaged abdominal great vessels, 2 also had mirror-imaged atrial arrangement, while the 3rd had isomeric right appendages. Only one of 7 fetuses with an abdominal great vein posterior to the aorta had bilateral left atrial appendages. The remaining 6 had usual atrial arrangement, with normal pulmonary venous connections in all but one, who had infra-diaphragmatic totally anomalous pulmonary venous connection. Of these fetuses, 2 had coarctation of the aorta, and 2 others had complex cardiac malformations resulting in neonatal death. One died in childhood from biliary atresia, and three are alive. Abnormal arrangements of the abdominal great vessels, therefore, were found in 0.8 percent of our total fetuses, and in 2.4 percent of those with cardiac malformations. Those with an abnormal arrangement of the abdominal vessels combined with an abnormal arrangement of the atrial appendages, however, made up only 0.5 percent and 1.6 percent, respectively. While screening for an abnormal arrangement of the abdominal vessels overestimated the incidence of left, but not right, isomerism of the atrial appendages, it did predict the presence of important extra-cardiac malformations that required urgent recognition and management after birth.

P‐60 Hypercalcaemia associated with disseminated Lagenidium spp. infection in a dog: case report

Oomycetes such as Pythium insidiosum are soil‐ or water‐dwelling organisms that belong to the Kingdom Stramenopila. Recently, a member of the genus Lagenidium has been recognized as a second canine pathogen in the class Oomycetes, causing multifocal ulcerative cutaneous lesions, subcutaneous pyogranulomatous nodules and draining tracts, often with dissemination to lymph nodes and abdominal great vessels. This report describes the clinical, cytologic and pathologic features of Lagenidium spp. infection associated with hypercalcaemia in a dog. A 1.5‐year‐old female border collie was referred for evaluation of progressive ulcerative skin lesions. Physical examination revealed pyrexia, generalized lymphadenopathy and multiple draining tracts, nodules and ulcers with eschars involving the distal aspect of all four limbs. Serum biochemical analysis revealed hyperglobulinaemia, hypoalbuminaemia and hypercalcaemia. Cytologic evaluation of fine‐needle aspirates from lymph nodes and cutaneous lesions revealed pyogranulomatous inflammation surrounding multiple poorly staining broad (14–21 μm) hyphae. These right‐angle branching hyphae were infrequently septate with irregular nonparallel walls. Thoracic radiography was normal. Abdominal ultrasonography showed no great vessel involvement. Euthanasia was elected, and necropsy revealed severe pyogranulomatous dermatitis and lymphadenitis involving the prescapular, popliteal, superficial inguinal, gastric, lumbar and external iliac lymph nodes. Histologically, all lesions were characterized by severe pyogranulomatous inflammation centred around broad, poorly septate hyphae. Parathyroid glands were histologically normal. Granulomatous disease associated with oomycosis should be considered as a differential diagnosis for hypercalcemia in canine patients with subcutaneous nodules or ulcerative dermatopathy associated with lymphadenopathy. Funding: Self‐funded.

Melatonin in vivo prolongs cardiac allograft survival in rats.

Melatonin, secreted by the pineal gland, is a multifunctional agent which (i) protects tissues from damage through free radical scavenging and attenuates ischemia/reperfusion injury in organ grafts; (ii) acts synergistically with cellular antioxidants; and (iii) displays complex, dose-dependent immunoenhancing and suppressing effects in vitro and in vivo. We analyzed the immunomodulatory effect of melatonin on acute allograft rejection. Cardiac grafts were transplanted from LBNF1 to LEW rats and anastomosed to the abdominal great vessels. The effect of low-dose (LD; 20 mg/kg/day) and high-dose (HD; 200 mg/kg/day) melatonin treatment in recipients compared with untreated controls was investigated. HD melatonin therapy abrogated acute rejection, significantly prolonging allograft survival (mean survival: 12.3 +/- 1 days S.D., n = 8, P < 0.0001) compared with untreated controls, which rapidly reject the transplant (6.3 +/- 1 days n = 12). LD therapy did not extend survival significantly (7.3 +/- 1.1 days, n = 12). Allospecific IgM showed a significant decrease in animals receiving HD therapy versus untreated recipients at days 10 and 14 post-transplantation (P < 0.01), whereas in the LD group at day 10, a significant increase in allospecific IgM (P < 0.01) over the HD cohort was demonstrated. HD treatment markedly reduced lymphocyte proliferative capacity compared with controls and the LD group. HD melatonin treatment abrogated acute allograft rejection and significantly prolonged graft survival. Our results suggest an involvement of melatonin in humoral and cellular immune pathways following perfused organ transplantation. These findings may indicate a novel therapeutic approach, based on modulation of the neuroendocrine/immune axis through melatonin as a possible future immunosuppressant in organ transplantation.

Postpartum ovarian vein thrombophlebitis: sonographic diagnosis.

We describe our experience with sonographic diagnosis of ovarian vein thrombosis, an uncommon but dangerous postpartum complication. We retrospectively reviewed the medical records of seven patients in our institution who developed postpartum ovarian vein thrombophlebitis within the past 5 years. In all cases the diagnosis was made by ultrasound, which showed tubular hypoechoic masses lateral to the great abdominal vessels. The postpartum ovarian vein thrombophlebitis was on the right side in six cases and on the left side in one. In five cases, it protruded into the inferior vena cava. The first three cases were referred to computed tomography after the sonographic diagnosis. In the last four cases, the diagnosis relied solely on sonography and no further evaluation was necessary. Sonographic examination can be diagnostic for ovarian vein thrombosis if performed very carefully in symptomatic postpartum patients.