Young African American Males Research Articles

Multidisciplinary approach to severe intracranial, intraorbital allergic fungal sinusitis

BackgroundAllergic fungal sinusitis (AFS) is a form of paranasal mycosis that often involves bone destruction and can extend into the orbit and anterior skull base. Intracranial and intraorbital involvement are published but not both in each included patient of a series. The purpose of the present study was to review cases of extensive AFS with orbital or/and skull base erosion, including the presenting symptoms, patient socioeconomic background, imaging features, surgical technique, and post-operative outcomes. MethodsThe records of 30 patients with the histological diagnosis of AFS and both intracranial and intraorbital involvement were reviewed. ResultsThe average age of the patients was 25.2 years. 83 % of patients were male. 70 % were African American. 66 % of patients had Medicaid or were uninsured. Presenting symptoms were headaches (80 %), nasal obstruction (33 %), proptosis (40 %), vision change (23 %), facial pressure (10 %), and decreased sense of smell (7 %). 100 % of patients had bone erosion observed on computerized tomography scans with disease extending intracranially through the anterior skull base or posterior wall of the frontal sinus along with disease that eroded through the lamina papyracea. All patients had failed medical management. All patients underwent surgery by Otolaryngology, Ophthalmology, and Neurosurgery with transnasal endoscopic approaches and orbitotomy. 80 % also underwent a bifrontal craniotomy for removal of intracranial extradural disease with cranialization. 53 % of patients had orbital implants remaining after surgery; 23 % had nasal stents. There were no postoperative cerebrospinal fluid leaks. Average hospital stay was 4.8 days. Preoperatively, 13 % of patients underwent allergy testing. 94 % saw an Allergist postoperatively. 21 % required follow up surgery. ConclusionsA team approach of Otolaryngologists, Ophthalmologists, and Neurosurgeons is recommended for this slowly growing but locally destructive disease. Most patients with AFS will present with headaches and nasal obstruction. While most cases of AFS can be successfully managed with transnasal endoscopic techniques, orbitotomy and craniotomy represents an effective treatment for severe AFS cases with extensive intracranial and intraorbital involvement. This disease is found most commonly in young African American males and in the underinsured.

“You Can Put a Price Tag on Complexion”: Understanding Colorism Among African-Born and African American Black Men in America

ABSTRACT: This study explores how young Black men talk about colorism and identity. Few studies have investigated how men of color make meaning of colorism. Providing an open-arena for dialogue about colorism, we conducted two focus groups to examine the perceptions of colorism among young African American and African-born Black males. One focus group consisted of African-born Black men, the other consisted of African American Black men. Participants were recruited from a public four-year research university in the northwestern region of the US and ranged in age from 18 to 25. Findings indicate that to this day, young African American and African-born Black males are significantly impacted by their skin tone in their pursuit of access and opportunity in society, and just like women of color, skin tone influences their relationships, identity, and social mobility.

“You Can Put a Price Tag on Complexion”: Understanding Colorism Among African-Born and African American Black Men in America

ABSTRACT: This study explores how young Black men talk about colorism and identity. Few studies have investigated how men of color make meaning of colorism. Providing an open-arena for dialogue about colorism, we conducted two focus groups to examine the perceptions of colorism among young African American and African-born Black males. One focus group consisted of African-born Black men, the other consisted of African American Black men. Participants were recruited from a public four-year research university in the northwestern region of the US and ranged in age from 18 to 25. Findings indicate that to this day, young African American and African-born Black males are significantly impacted by their skin tone in their pursuit of access and opportunity in society, and just like women of color, skin tone influences their relationships, identity, and social mobility.

86 - Multiple organ involvement as an initial presentation of systemic lupus erthyematosus in a young African American male

86 - Multiple organ involvement as an initial presentation of systemic lupus erthyematosus in a young African American male

Abstract 9850: Predictors of Inpatient Mortality for Patients Admitted With Traumatic Femoral Artery Injury

Introduction: Femoral artery injury (FAI) after trauma is one of the most common vascular injuries evaluated in Trauma Centers. Data at the national level are lacking. Methods: We used Nationwide Inpatient Sample (NIS) data for 2016-2019 in our cross-sectional study. First, we extracted all cases older than 18-years that include the diagnosis of FAI. Then, we kept only the observations with a primary diagnostic category suggestive of trauma or cases that have a concurrent presence of trauma-related diagnoses. Baseline characteristics were evaluated as well as predictors of inpatient mortality. Exclusion criteria included transferred out cases and elective admissions. Appropriate survey and domain analyses were applied to obtain and study national estimates using SAS 9.4. Results: We identified 3,850 weighted admissions that contain a diagnosis of traumatic FAI. The mean age of surviving patients was 37-years (84% were male) in comparison to the mean age of 45-years (80% were male) for non-survival (p<0.0001). African American patients represented the majority (40%), followed by Caucasians (36%). Most patients were of low socioeconomic status (47%) and receiving Medicaid (37%). In-patient mortality was high, 9.5%, and more than 75% of death was within a week of admission. Although documentation of associated femoral vein, nerve, or femur injuries was not statistically significant, age >40-years, presence of comorbidities (especially cirrhosis), and intubation (indicating critical illness with acute respiratory failure or low Glasco-coma scale) were associated with inpatient mortality (p<0.0001). Lower extremity amputation (BKA/ AKA) was associated with higher mortality (not statistically significant). Neither open nor percutaneous femoral artery procedures (individually or combined) were associated with favored outcomes. On the other hand, thigh procedures on musculoskeletal tissues (muscles, fascia, femur) were associated with higher survival. The Area Under the Curve (AUC) of our model was 0.84. Conclusions: Our study suggests that young African American males are more likely to have traumatic FAI. Independent mortality predictors are age, Elixhauser comorbidities, and femur, muscular, soft tissues, and fascia procedures.

ODP535 Thyrotoxic Periodic Paralysis (TPP) in A Young African American Male: Post Exercise

Abstract Thyrotoxic periodic paralysis (TPP) is a rare fatal disorder with hypokalemia as the hallmark feature associated with thyrotoxicosis. Compared with existing studies that TPP is prevalent among younger men of Asian descent, this study intends to complement this area of study by addressing aspects currently not fully covered involving the existence of TPP among men of African descent. This study documents the case of a 37year old African American Man with no previous history of hyperthyroidism who presented with sudden onset lower extremity paralysis and hypokalemia. It is particularly important to note that while majority of patients with TPP have preexisting hyperthyroidism, our patient presented with no history of overactive thyroid. The finding of this work fills a gap in literature highlighting the importance of separating Familial Hypokalemic periodic paralysis (FPP) and TPP at its earliest detection. We find strong and robust evidence suggesting that patients may be easily termed FPP in view of its similarity to TPP thereby leading to a delay in the diagnosis and treatment. TPP has been linked with genetic mutations in specific ion channels (calcium channels and KIR) and increased Na-K ATPase pump activity. This leads to a massive intracellular shift in potassium causing hypokalemia under the influence of excess thyroid hormone. We find that both TPP and FPP have similar clinical presentations and same precipitants hence the need for a high index of suspicion in patients with hypokalemia and sudden onset paralysis with no history of hyperthyroidism to prevent lethal complications. Our results suggest that prompt correction of hypokalemia and treatment of hyperthyroidism is key in resolving attacks and preventing lethal complications. Presentation: No date and time listed

Abstract P331: Racism Associated With Blood Pressure Risk For Renal Injury In African American Males

Young hypertensive African American (AA) males have approximately a 10-fold greater risk for end-stage renal disease compared to white males. The reason for this disparity remains elusive, but environmental stress has been identified as a contributor to disease risk among Blacks. Male (n=80) and female (n=91) AAs were administered the perceived racism scale (PRS) to investigate the association of perceived racism with systolic and diastolic blood pressure (SBP/DBP, respectively) and urinary albumin/creatinine ratio (UAC). Resting SBP and DBP were measured and urine was collected for measuring albumin to creatinine ratio (UAC, index of renal injury). There were no sex differences in age (36 ± 2 vs 33 ± 2 yrs), SBP (127± 13 vs 124 ± 2 mmHg), and DBP (72 ± 1 vs 69 ± 1 mmHg), but males had higher UAC (28 ± 12 vs 21 ± 4 mg/g; p<0.003; males vs females, respectively). Workplace PRS scores were higher in males compared to females (20 ± 2 vs 14 ± 1, p<0.01 male vs female, respectively). PRS in the workplace was positively correlated with SBP (r=0.530, p=0.002) and DBP (r=0.447, p=0.002) in males but not females (r=-0.01, p=NS; r=0.01, p=NS, respectively). Moreover, SBP (r=0.399, p=0.024) and DBP (r=0.612, p=0.0002) were positively correlated with UAC in males but not in females (r=0.387, p=NS; r=0.207, p=NS, respectively). Our findings show that racism in the workplace is strongly associated with a biomarker of kidney injury in AA males. Furthermore, our findings support the idea that racism may be the driver of the greater risk of kidney disease in young hypertensive males. Thus, we conclude that increased risk for kidney injury in young hypertensive AA males is due to the environmental stress of racism that leads to activation of biological pathways causing cardiovascular and kidney diseases. More studies are needed to identify the underlying pathways between perception of racism and cardiometabolic and kidney diseases.

Abstract P2089: Sex Differences In Racism And Renal Injury Biomarker Association In African Americans

Among the general population of African Americans (AAs) the risk for kidney disease is approximately 4-fold greater than Caucasians. However, the risk for kidney disease can be as high as 10-fold greater among hypertensive young African American (AA) males. The reason for this disparity remains elusive, but environmental stress has been identified as a contributor to disease risk among Blacks. Male (n=78) and female (n=91) AAs were administered the perceived racism scale (PRS) to investigate the relationship between perceived racism and biomarkers of stress (cortisol), hypertension (systolic and diastolic blood pressure; SBP/DBP, respectively), obesity (body mass index, BMI), and diabetes (CRP, and C peptide). Resting heart rate (HR) and BMI were measured; a blood sample collected to measure cortisol as well as C reactive protein (CRP) and C peptide (both biomarkers of diabetes); and urine was collected for measuring albumin to creatinine ratio (A:C, index of renal injury). There were no sex differences in age (36 ± 2 vs 33 ± 2), SBP (127± 13 vs 124 ± 2), DBP (72 ± 1 vs 69 ± 1), but A:C was higher in males (28 ± 12 vs 21 ± 4; p<0.003; males vs females, respectively). Males had higher job domain PRS scores (20 ± 2 vs 14 ± 1, p<0.01 male vs female, respectively) and PRS was positively correlated with cortisol (r=0.54, p<0.05) in males only. Furthermore, job PRS was positively correlated with biomarkers of obesity (BMI: r=0.419, p<0.004), hypertension (SBP, DBP: r=0.521, r=0.480; p<0.002, <0.009, respectively), and diabetes (C peptide: r=0.468, p<0.03) in males but not females. Interestingly, job PRS scores (r=0.498, p<0.005) as well as hypertension (SBP/DBP: r=0.398, r=0.611; p<0.03, p<0.001, respectively) and diabetes (CRP: r=0.812, p<0.001) biomarkers were positively correlated with A:C in males but not females. These findings support the idea that the increased risk for kidney injury in young hypertensive AA males results from environmental stress of racism that activates biological pathways leading to cardiovascular and kidney disease. More studies are needed to identify the underlying pathways between perceived racism and promotion of cardiometabolic disease.

Giant Squamous Cell Carcinoma on The Scalp of A Young African American Male

Abstract Introduction/Objective Skin cancer comprises 1-2% of all cancers in African American (AA) patients. Among all skin cancers, squamous cell carcinoma (SCC) is the most common one in AA, with an incidence of approximately 3 per 100,000. It mainly affects patients over 50-year-old. The most common locations of SCC (60-70% of cases) in AA were the sun-protected areas such as the lower limbs and anogenital region, rather than sun-exposed areas. Methods/Case Report We report a case of a 40-year-old AA male with longstanding folliculitis decalvans presenting with giant SCC. In 2016, the patient noted the enlargement of the atrophic hyperpigmented plaques on the right posterior scalp. They grew into a 10.5 x 10 x 4.5 cm exophytic, verrucous-like mass when the patient presented to the clinic in 2021. A skin biopsy of the giant mass showed pseudoepitheliomatous hyperplasia with cytologic atypia. CT scan ruled out underlying bone invasion. After that, the mass was resected with minimal 3-cm negative margins. Histological evaluation reveals a moderately differentiated keratinizing SCC with clear cell changes in a background of severe acute and chronic inflammation, folliculitis, and scar. No lymphovascular invasion is noted. An over 10-cm SCC arising within folliculitis decalvans on the scalp of a young AA patient is rare. To our knowledge, this the first report of such a case. Despite the limited data available, chronic scarring process and inflammation, instead of sun damage, are believed to be the most important risk factors for SCC development in the AA population. SCC greater than 4cm in chronic inflammation/scar is strongly associated with a poor prognosis. Therefore, early diagnosis, treatment, and close follow-up are critical. Results (if a Case Study enter NA) NA Conclusion Our report emphasizes (1) biopsy has limitations in diagnosing giant cutaneous neoplasms due to inadequate sampling; (2) the need for growing awareness, earlier diagnosis, and skin cancer treatment in people of color.

The Value of Education Between Two African American Male Populations in a Rural Southern Community

This study identified perceptions of education by low performing and college track African American males in a rural town in Southern Kentucky. Through the lens of Critical Race Theory and Symbolic Interactionism, the researchers explored how 16 young men value a secondary and postsecondary education. Selected by their administrator at two high schools, the males were identified as college track or low performing. The findings revealed that both groups identify racial relations as a barrier to educational achievement; however, college track males believed education would assist in overcoming racial divides. Additional findings highlight a difference in perception based upon the presence of a male role model, the home environment, and the felt need for survival. Based on the findings, recommendations include model programs and collaborations among societal groups within the young age; a need for male social programs that foster and encourage positivity throughout a young male’s life; and the need for local resources to assist and encourage young African American males to pursue a postsecondary education.

DNA methylation and exposure to violence among African American young adult males

Exposure to violence (ETV) has been linked to epigenomics mechanisms such as DNA methylation (DNAm). We used epigenetic profiling of blood collected from 32 African American young adult males who lived in Washington DC to determine if changes in DNAm at CpG sites affiliated with nervous and immune system were associated with exposure to violence. Pathway analysis of differentially methylated regions comparing high and low ETV groups revealed an enrichment of gene sets annotated to nervous system and immune ontologies. Many of these genes are known to interact with each other which suggests DNAm alters gene function in the nervous and immune system in response to ETV. Using data from a unique age group, young African American adult males, we provide evidence that lifetime ETV could impact DNA methylation in genes impacted at Central Nervous System and Immune Function sites. MethodMethylation analysis was performed on DNA collected from the blood of participants classified with either high or low lifetime ETV. Illumina®MethylationEPIC Beadchips (~850k CpG sites) were processed on the iScan System to examine whole-genome methylation differences. Differentially methylated CpG-sites between high (n ​= ​19) and low (n ​= ​13) groups were identified using linear regression with violence and substance abuse as model covariates. Gene ontology analysis was used to identify enrichment categories from probes annotated to the nearest gene. ResultsA total of 595 probes (279 hypermethylated; 316 hypomethylated) annotated to 383 genes were considered differentially methylated in association with ETV. Males with high ETV showed elevated methylation in several signaling pathways but were most impacted at Central Nervous System and Immune Function affiliated sites. Eight candidate genes were identified that play important biological roles in stress response to violence with HDAC4 (10%), NR4A3 (11%), NR4A2 (12%), DSCAML1(12%), and ELAVL3 (13%) exhibiting higher levels in the low ETV group and DLGAP1 (10%), SHANK2 (10%), and NRG1(11%) having increased methylation in the high ETV group. These findings suggest that individuals subjected to high ETV may be at risk for poor health outcomes that have not been reported previously.

Social Media Preference and Condom Use Behaviors: An Analysis of Digital Spaces With Young African American Males.

Background. African American adolescents and young adults have an increased likelihood of engaging in risky sexual behaviors. With rising rates of sexually transmitted infections among this population, deeper consideration is now being focused on using social media to engage, educate, and improve sexual behavior in this group. Purpose. To determine why social media is useful and how it may affect the attitude, norms, and perceived behavioral control on condom use among young African American males (YAAMs) ages 18 to 21. Method. Group-depth interviews (n = 41, mean age = 19, SD = 1.2) were conducted in metro Detroit to understand and describe the who, what, where, why, and how regarding social media use and preference among YAAMs) ages 18 to 21, and their condom use behaviors. Results. The most popular reasons for using social media were for educational purposes, entertainment, browsing the site, self-expression, seeking out or maintaining relationships with friends and family, and social justice. YouTube was stated as the easiest site to promote condom use education. YAAMs would seek out condom use education on social media sites if someone respected in the community or someone famous promoted condom use messages on the sites or if it was used to show where condoms were available for free or for purchase. Conclusion. Understanding how YAAMs use social media may help researchers design better questions to address disparities within this population. More important, it can help health care providers, families, and the community promote healthy behaviors and lifestyle changes among YAAMs.

Critical Race Theory, Wrongful Convictions and Disparate Exonerations of Minority and White Youths in the United States

Race is central to every aspect of the criminal justice system in the United States. According to the U.S. Bureau of Justice Statistics (BJS), in 2013, black males accounted for 37 percent of the total male prison population in the United States with white males accounting for only 32 percent followed by Hispanic males at 22 percent respectively. In the general population, however, Black males comprise only 6 percent of the total males population while White males constitute 31 percent of the total males population in the U.S. followed by Hispanic males who make up 8.4 percent of the total male population. The conviction of innocent defendants is quite disturbing regardless of race or ethnicity. Nothing is more glaring of this phenomenon than when one considers that African American males make up only 6 percent of the total males population but are reported as committing 52 percent of the murders. It is widely known that the lack of formal processes and constitutional due process in the juvenile justice system and the potential for substantial deprivations of children’s liberty through extensive periods of incarceration has been pervasive, persistent, and ongoing in this country (Juvenile Justice Center, 2020). Critical Race Theory has done nothing less than shed more light on the predictability of youth treatment landing them behind bars for lengthy prison sentences for crimes in which they frequently did not commit. Critical Race Theory falls short, however, of offering any plausible explanations for why so many minority youths are falsely imprisoned. Other theories must be considered as plausible explanations for this phenomenon of disparate treatment between the races whether it be police shooting, disparate convictions and incarceration or racial profiling. These theories include Racial Conflict Theory, Racial Threat Theory and Petit Apartheid Theory. The core idea of Critical Race Theory is that racism does not stop at the individua level, but it is systemic or system-wide and ingrained in our policies, in our legal systems and institutions. Critical Race Theory has absolutely nothing to do with “punishing kids for their skin color or making young white kids feel guilty for being white no more than critical thinking is criticizing someone for well thinking. Critical Race Theory is a dialogue for raising awareness of policies and practices that have had a disproportionately negative impact on racial minorities in particular and youth in general irrespective of race. There were 2,310 people serving life-without-parole sentences for crimes committed as juveniles (known as JLWOP) at the end of 2016. This study examines the data extracted from the national registry of exonerations in the United States on every known exoneration from 1989 to 2020. Contributing factors to such disparate convictions among young African American males such as false confessions, mistaken identity, false accusations, witness tampering, perjury or false statements under oath particularly by police officers, prosecutorial misconduct, inadequate legal defense, and mistaken witness identification are highlighted and discussed as major contributing factors to the exoneree’s eventual release. This study assumes the position that, although all lives matter, it appears that African American Male Youths are more disproportionate among the population of those exonerated for crimes that they did not commit. The study proffers policy implications and policy changes that appear to be viable solutions to this egregious and tragic abuse of humankind.

Depicting "the system": How structural racism and disenfranchisement in the United States can cause dynamics in community violence among males in urban black communities.

A complex system of factors interacting across time shapes community violence. It is not well understood how features of persons, institutions and communities interact as a "system" to produce escalating community violence. We aimed to integrate theoretical and experiential knowledge among young African-American urban males to develop a concept model of key causal structures driving dynamics of community violence escalation over time in a context of historical racism. We analyzed three published sources (two documentary films and one ethnography) containing lived experience perspectives on community violence escalation among African American males in three U.S. cities experiencing civil unrest due to structural racism. Qualitative descriptive analysis identified features in three key thematic categories: racialized policies and practices, economic and social disenfranchisement, and intrapsychic factors. We used causal loop diagramming, a system dynamics method designed for depicting dynamic hypotheses about the system structure producing observed trends over time, to represent the dynamic relationships among identified individual and community variables. The concept model contained key feedback structures capable of generating exponential growth in violence - providing detailed dynamic hypotheses about how violence can beget more violence ("violence escalation") within a community. Referred to as reinforcing feedback loops, these dynamics involved development of kill-or-be-killed norms, civil unrest emerging from racially oppressive policies, internalizing the code of the streets to seek outward displays of power, and processes that get one "stuck" or not able to break out of the system of violence. Qualitative system dynamics methods offered an approach to uncover and hypothesize the complex, dynamic relationships between variables shaping violence escalation trends. The resulting causal loop diagram hypothesized dynamic mechanisms capable of creating and perpetuating racial disparities in community violence escalation, that can be tested in future research to inform action to break observed cycles of community violence.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses.

This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage. The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses. Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry. The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

The Relationship Between the Repeated Social Defeat Stress Experimental Model, Delegitimization, and Neuroresilience in Experiences of Young African-American Males

Repeated Social Defeat Stress is a mouse model in which depressive phenotyping is elicited by the application of stressful procedures and stressful events. Delegitimization is the process of egregiously and negatively stereotyping one group with the intention of excluding and harming a particularly targeted group by depriving it of visibility, legitimacy, and resources through dehumanization and marginalization. Based on a survey on delegitimization, the characterization and the experiences of delegitimized groups, it can be said that through the RSDS model we can understand the psychology and the real-life experiences of those in delegitimized groups like young African American males.

Thyrotoxic Periodic Paralysis with Sensory Deficits in Young African American Male: A Case Report and Literature Review.

Thyrotoxic periodic paralysis is a sporadic entity characterized by hypokalemia and paralysis in the setting of hyperthyroidism. TPP is most commonly described in young Asian males. Studies have shown an association with mutations affecting inward rectifying potassium channels. The pathophysiology involves Na+-K+- ATPase channel causing an increased intracellular shift of potassium ions in the hyperthyroid state and in the presence of another precipitating condition. Most cases of thyrotoxic periodic paralysis are defined in young Asian males of 20–40 years of age, here we present an interesting case of thyrotoxic periodic paralysis in 32-year-old African American male, who presented with sudden onset weakness in the bilateral lower extremity and left upper extremity. Interestingly, the patient also has sensory deficits, a feature not known to be associated with thyrotoxic periodic paralysis.

Recurrent hypoglycemia, a rare case of insulin autoimmune syndrome in a young African American male

Insulin autoimmune syndrome (IAS) is an uncommon cause of spontaneous hypoglycemia from hyperinsulinemia due to autoantibodies against endogenous insulin (Jian-Ping Chu, 2016). These individuals have no prior exposure to exogenous insulin. We report a case of a 35-year-old African American male, who presented to Vaughn Regional Medical Center in Selma, AL, after he was found to have seizures from hypoglycemia, with a blood sugar of 63 on presentation. He was never diagnosed with diabetes in the past, nor did he have a history of seizure disorder. He continued to be hypoglycemic during the initial period of his hospital stay. His fasting insulin level was 27 mIU/l (normal is less than 25, with presence of insulin autoantibodies (IAA), and a negative workup otherwise. This led us to include IAS as one of our differentials for his hypoglycemia.

Cocaine use is associated with worse outcomes in patients treated with thoracic endovascular repair for type B aortic dissection

ObjectiveTo describe and compare the clinical and anatomical characteristics and outcomes of patients with and without known cocaine use who underwent thoracic endovascular repair for type B aortic dissections. MethodsBetween January 2012 and January 2017, 186 patients underwent thoracic endovascular repair for type B aortic dissection at our institution. Clinical data and anatomical characteristics were collected under an institutional review board-approved protocol. Survival, reintervention, complications, and characteristics of dissection were compared between patients with cocaine use (C+; n = 14) and those with no known cocaine use (C−; n = 172). ResultsCocaine users were more likely to be young African American males who smoked. They tended to present with more extensive dissections as evidenced by larger false lumen diameters. They also had higher rates of endoleaks and more reinterventions. ConclusionsThese results suggest that special care should be taken to provide close follow-up for these patients.

Acute Kidney Failure in a Young African American Male

Retroperitoneal fibrosis (RPF) is a condition characterized by chronic inflammatory and fibrotic changes in the retroperitoneum that can lead to serious complications including kidney failure, mesenteric and limb ischemia, and deep venous thrombosis among others. Affected individuals may present with nonspecific symptomology that would require a high clinical index of suspicion for prompt diagnosis. We herein discuss a case of a young African-American man with recurrent deep venous thrombosis who presents with a 4-week history of constant aching pain of abdomen and back and kidney failure. Initial noncontrast computed tomogram (CT) only revealed mild bilateral hydroureteronephrosis with inflammatory changes but without obvious mass or lymphadenopathy. At the insistence of the renal consulting team to rule out RPF, a CT-urogram was performed which revealed an infiltrative mass encasing the aorta, inferior vena cava, and common iliac vessels. Laparoscopic biopsy revealed dense fibroadipose tissue, lymphocytic aggregates, focal scattered IgG4-positive plasma cells, and fibrin deposition. Patient underwent bilateral nephrostomy placement and empirical corticosteroid therapy with resolution of kidney failure. Our case illustrates a classic presentation of RPF with relatively benign findings on noncontrast CT that could have been missed if clinicians did not keep a high index of suspicion for the condition.