Isolated orchidodynia as the initial symptom of aneurysm of the abdominal aorta

A 67-year-old man presented with isolated pain of the right testicle. He was admitted and treated for epididymitis. His symptoms did not improve and lower abdominal pain developed. After hypotension and severe anaemia (Hb 2.1 mmol/l) had developed, abdominal echography was carried out, revealing a ruptured abdominal aortic aneurysm. The patient underwent surgical repair with an aortic-bifemoral prosthesis and was ultimately discharged without further complications. This is the fourth report in the literature of orchidodynia as referred pain from an aneurysm of the abdominal aorta.     

Salmonella dublin infection of calves: use of small doses to simulate natural infection on the farm.

Small numbers of Salmonella dublin were used to infect calves in an attempt to simulate natural infection on the farm. Twenty calves were exposed to S. dublin by one or more of the following methods: Sucking cows which were excreting S. dublin in their faeces (less than 10(2)-10(5) organisms/g). Housing on S. dublin contaminated bedding. Drinking S. dublin contaminated water (10(2)-10(4) organisms/ml). During this experiment some calves were given therapeutic does of oxytetracycline. After exposure the calves were examined for faecal excretion of S. dublin (in some instances mouth swabs and blood samples were also examined) and for clinical signs of illness. Most of the calves became infected with S. dublin but excretion was usually sporadic and the numbers of salmonellas excreted were small. No clinical signs of salmonellosis were observed by S. dublin was isolated from one calf at post-mortem. Another six calves, dosed orally with either 10(6) or 10(8) S. dublin, showed signs of mild illness and although three calves had diarrhoea excretion of salmonellas was intermittent. S. dublin was isolated from one of these calves at post-mortem.     

Salmonellosis in wild mammals.

One thousand two hundred and sixty-nine freeliving, wild mammals, representative of 16 species from estates in Berkshire, Oxfordshire and Surrey, were examined for the presence of salmonellas. Salmonella typhimurium was isolated from 1 and S. dublin from 7 house mice (Mus musculus). There were no isolations from the other species examined. It was concluded that the house-mice infected with S. dublin acquired the organism from experimentally infected cattle. The wild mammal population does not at present appear to constitute a reservior for infection of domestic animals.     

Endovascular treatment of 2 patients with an aneurysm of the descending thoracic aorta]

Two men, aged 71 and 70, who had previously experienced an abdominal aneurysm were found to have thoracic aortal aneurysms of respectively 8 cm and 7.5 cm in length. For the first patient an endovascular operation was carried out due to a high operative risk: with the help of a radiograph, four endoprostheses were inserted into the thoracic descending aorta via the femoral artery, after which the aorta diameter became more normal. A month later, the patient died from persistent renal failure, which had developed as a result of the previously ruptured abdominal aneurysm. In the second patient with an aneurysm of the proximal descending aorta, a left decompensation arose following aortal clamping during open surgical repair. Ten weeks later an endoprosthesis was inserted via the femoral artery. A year later the aortal diameter had decreased to 6.5 cm; the patient functioned well. The insertion of an endoprosthesis in the thoracic aorta is a minimally invasive procedure in which the patient experiences little perioperative inconvenience.     

Acute abdominal and back pain in a patient with an aortic aneurysm and a duodenum perforation on CT-scan

An 82-year old man with a known aneurysm of the abdominal aorta (AAA) presented with a history of acute onset abdominal and back pain of a few hours. He was haemodynamically stable and had pain on pressure over the aneurysm. Ultrasound confirmed the AAA, but could not demonstrate or exclude rupture. Subsequent CT-scan confirmed a non-ruptured AAA and demonstrated a small, curvilinear, hyperdense structure thought to be a fish bone or chicken bone which had perforated the duodenum. On gastroduodenoscopy, a fish bone was found and removed. The patient's symptoms resolved completely within two days. In patients with a possible ruptured AAA, echographic or CT-scan investigations can confirm or exclude the condition thus avoiding unnecessary surgery. These investigations also gather preoperative data for potential endovascular reconstruction. Before the introduction of new visualization techniques a duodenum perforation resulting from the unnoticed swallowing of a sharp object could only be diagnosed by explorative laparotomy. Delay in diagnosis leads to high mortality.     

Endovascular prostheses and extra-anatomical bypasses to mesenteric and renal vessels in a patient with a thoraco-abdominal aortic aneurysm: a possible alternative to the standard operation

A 57-year-old male had a thoraco-abdominal aortic aneurysm that was increasing in diameter, accompanied by pain in the right lower abdomen and groin. Ten years earlier he had had a dissecting thoraco-abdominal aneurysm that extended from the left subclavian artery to the aortic bifurcation. A CT-scan revealed further growth of the aneurysm. He was treated by an open and an endovascular operation. The distal aorta was replaced by a bifurcation prosthesis via a laparotomy, with 2 other bifurcation prostheses to 2 mesenteric and 2 renal arteries. In a second session, a carotid-subclavian bypass was constructed and the aorta was reinforced by an endograft from the left subclavian artery to the bifurcation prosthesis. Postoperatively he suffered a transient ischaemic attack, hypertension, pneumonia, and vocal cord paresis. At follow-up 1.5 years later, the patient was free of symptoms, with the exception of slight hoarseness during forced speech, and the aneurysm was totally under control. This procedure may be an alternative to the classical thoracophrenicolaparotomy.     

The serology of experimental Salmonella dublin infections of cattle.

Agglutinating antibodies to somatic "O" and flagellar "H" antigens of S. dublin were measured in the serum of 43 pregnant heifers before intravenous or oral infection with S. dublin and in the serum of 21 uninfected control animals. The data from these animals were analysed statistically and a titre of 1/80, to both antigens, has been interpreted as of doubtful significance and a titre of 1/160 to both antigens, has been interpreted as significantly raised. Animals in which fetal infection occurred after challenge by either the intravenous or oral route developed significant increases in "H" and "O" titres indicating the value of measure "H" titres in the diagnosis of S. dublin abortion. In animals which were infected orally and in which infection appeared to be confined to the alimentary tract the "H" titre did not become significantly raised. Lack of correlation between antibody titres and faecal excretion of S. dublin and persistence of infection in carcasses confirms that the serum agglutination test is of no value in detecting latent carriers.     

MSCT诊断不典型主动脉夹层的价值

目的 回顾性分析不典型主动脉夹层的CT表现,探讨MSCT诊断不典型主动脉夹层的价值.方法 分析42例不典型主动脉夹层,并参照Stanford分类法进行分型.结果 42例不典型主动脉夹层,26例为A型,16例为B型.CT表现:(1)主动脉呈半月形或环形增厚,CT平扫时呈高密度,CT值约为50～80 Hu,增强后无强化,与强化主动脉管腔对比反呈低密度.治疗后复查,壁内血肿因吸收而演变为慢性血肿,厚度及长度减小,CT平扫时密度较前降低而呈低密度.(2)内膜钙化向内移位7例.(3)主动脉管腔狭窄、变形16例.(4)全部病例主动脉均有不同程度的动脉粥样硬化改变:主动脉壁不规则增厚、钙化.(5)并发心包、纵隔及胸腔积液和积血共38例.结论 MSCT清楚显示血肿部位、厚度、累及范围及有无并发症,为临床诊治及预后提供了重要的信息,是一种安全、有效和无创的诊断方法.     

Salmonellosis in two dairy herds associated with a sewage farm and water reclamation plant.

Two dairy herds, situated on a sewage farm, were monitored for the presence of salmonellas following outbreaks of Salmonella dublin infection. In addition an S. dublin control scheme, which involved examination of adult animals and calf vaccination, was instigated. During the period 1975-84, 12 salmonella serotypes and 10 phage types of S. typhimurium were isolated from the cattle and their environment although their presence was seldom associated with disease. Two adult S. dublin excreters were detected but it was concluded that none of the tests employed to examine the adult animals was sensitive enough. The prevalence of disease in the calves was low and although vaccination may have been beneficial it did not eradicate S. dublin infection. Thus S. dublin persisted in adults and calves during the 8-year period but its presence was seldom associated with disease. The results are discussed with regards the disease risk to animals from the agricultural use of sewage sludge and the public health aspects.     

Salmonellosis in two dairy herds associated with a sewage farm and water reclamation plant

Two dairy herds, situated on a sewage farm, were monitored for the presence of salmonellas following outbreaks of Salmonella dublin infection. In addition an S. dublin control scheme, which involved examination of adult animals and calf vaccination, was instigated. During the period 1975-84, 12 salmonella serotypes and 10 phage types of S. typhimurium were isolated from the cattle and their environment although their presence was seldom associated with disease. Two adult S. dublin excreters were detected but it was concluded that none of the tests employed to examine the adult animals was sensitive enough. The prevalence of disease in the calves was low and although vaccination may have been beneficial it did not eradicate S. dublin infection. Thus S. dublin persisted in adults and calves during the 8-year period but its presence was seldom associated with disease. The results are discussed with regards the disease risk to animals from the agricultural use of sewage sludge and the public health aspects.     

Treatment of abdominal aortic aneurysms

Three treatment options are available for an asymptomatic abdominal aortic aneurysm (AAA): an expectant approach with ultrasonographic check-ups, reconstruction of the abdominal aorta via the conventional ('open') approach and endovascular repair. For aneurysms less than 5.5 cm in diameter the annual rupture risk is less than 1%. For these patients a better alternative to the expectant approach does not seem to exist. The risk of rupture needs to be weighed up against the risks of a conventional operation. The operation mortality of patients with a non-ruptured AAA is about 7% while other serious complications occur in about 10%. The short to medium-term results of endovascular aneurysm repair are characterized by high reintervention rates, material fatigue and device failure. The three treatment options described are currently being investigated in several large-scale randomised studies for AAAs greater than 5.5 cm in diameter.     

A Rapid Pulse After Coronary Bypass Surgery

Abstract

A secondary aortoenteric fistula is a complication of earlier aortic grafting due to an aortic abdominal aneurysm. A primary aortoduodenal fistula (ADF) is a rare clinical entity that usually causes gastrointestinal bleeding that can be occult, intermittent, or massive. This article presents the case of a 68-year-old man with acute onset of a massive hematemesis and hematochezia. Eight years earlier he had undergone the implantation of an aortobifemoral prosthesis to treat an aortic aneurysm. The patient's condition was unstable, and it was during emergency surgery that the diagnosis of an ADF was made. An infected graft was removed in its entirety, and a new prosthesis was implanted. An omentoplasty with a pedunculated flap was performed. After 8 months, the patient had a recurrent ADF. He underwent another operation, but hemorrhaging from the aortic anastomosis occurred, so he required emergency surgery. Eventration occurred on the 14th postoperative day. The resection of the transversal colon was performed with a cecostomy for the decompression of the end-to-end anastomosis. Three months later the patient suffered a recurrent ADF. An aortobifemoral stent graft was implanted. Periaortal flow-drainage was established for the irrigation of the retroperitoneal space. A microjejunostomy tube was also inserted. The patient recovered without any complications. This case represents an example of a rare serious complication of aortic abdominal aneurysm. This case report covers pathophysiology, diagnostic evaluation, and management of an aortoenteric fistula.     

Rupture of thoracic aneurysm in a 10-year old boy]

A 10-year-old boy with a medical history of fatigue became nauseous, short of breath and cyanotic within 24 hours after a frightening incident. He was successfully resuscitated after a cardiac arrest. A CT scan revealed a ruptured aneurysm of the ascending aorta. During emergency surgery the ascending aorta and aortic arch were replaced with a 22 mm synthetic graft. No postoperative complications occurred. There was no associated trauma, syphilis, collagen diseases (Marfan's syndrome, Ehlers-Danlos syndrome), congenital heart disease or autoimmune disease. The cause of the aneurysm and rupture remain unclear.     

Assessment of the excess risk of Salmonella dublin infection associated with the use of certified raw milk

The risk of serious illness attributable to infection with Salmonella dublin associated with the consumption of certified raw milk in California was evaluated. Data were derived from case reports of S. dublin isolations from persons in the State of California during the period 1980-83 and from production figures for raw milk from the major supplier. It is estimated that more than one-third of reported S. dublin infections in California in the first 4 years of this decade were attributable to raw milk consumption. Among raw milk consumers, it is estimated that more than 95 percent of reported S. dublin infections were acquired from raw milk; this proportion corresponds to a rate of reported S. dublin infections acquired from raw milk in the range of 8 to 35 cases per 100,000 users per year. It appears that immunocompromised persons are at exceptionally high risk of becoming seriously ill or dying from S. dublin exposure, and therefore raw milk is a particular health hazard for such persons.     

Klebsiella pneumoniae pseudoaneurysm of the ascending aorta after coronary artery bypass graft

Mycotic pseudoaneurysm of the ascending aorta is rare in patients undergoing coronary artery bypass graft (CABG) and usually caused by staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after CABG. Culture from the sinus tract of the sternum and from the aneurysm sac was Klebsiella pneumoniae. Surgical technique was patch repair of aorta under hypothermic circulatory arrest. He is asymptomatic at 24 months follow-up.     

类鼻疽伯克霍尔德菌致感染性动脉瘤3例并文献复习

目的总结类鼻疽伯克霍尔德菌致感染性动脉瘤的临床特征,为该病的诊治提供依据,以期减少误诊率和病死率。方法收集2013年1月—2017年12月海南省人民医院确诊的类鼻疽伯克霍尔德菌致感染性动脉瘤病例3例,同时检索自1990—2017年国内外类鼻疽伯克霍尔德菌致感染性动脉瘤患者的病例报道,回顾性分析以上所有病例的临床特点。结果共纳入23例患者,其中男性患者占95. 7%,平均发病年龄(62. 2±5. 8)岁,主要伴随疾病是高血压和糖尿病,均占39. 1%,动脉瘤主要病变节段是腹主动脉(65. 2%),其次是胸主动脉(17. 4%)和主动脉弓(13. 0%),21例患者(91. 3%)接受手术治疗,病死率21. 7%。结论类鼻疽伯克霍尔德菌致感染性动脉瘤病死率较高,患有高血压和糖尿病的中老年男性为其高危人群,主要病变节段为腹主动脉。早期经验性抗感染治疗应注意覆盖该菌,一旦确诊后应在积极抗感染的基础上手术治疗。     

Abdominal aortic aneurysm as incidental finding in abdominal ultrasonography]

Abdominal aortic aneurysm is a life-threatening condition, which usually remains without symptoms until rupture occurs. The only way to reduce the high mortality rate (estimated at over 80%) is elective surgery on suitable patients. Therefore the presence of such an aneurysm has to be detected. For this ultrasonography is the method of choice. We studied 4399 consecutive patients aged 50 years and older, who underwent abdominal ultrasonography for the first time. According to the recommendation of the Dutch Society for Radiodiagnostics the whole abdomen was screened. In 4026 patients (1717 men and 2309 women) the ultrasound examination was performed for non-vascular reasons. In 199 of these patients (4.9%) an abdominal aortic aneurysm was an adventitious finding (133 men (7.7%) and 66 women (2.9%)). In men aged 60 years and older it was even found in 10.2%. When abdominal ultrasonography is performed for the first time in a patient aged 50 years or older, the aorta has to be screened for presence of an aneurysm.     

Relation of Common Carotid Artery Lumen Diameter to General Arterial Dilating Diathesis and Abdominal Aortic Aneurysms: The Tromso Study

In a cross-sectional, population-based study in Tromsø,Norway, the authors investigated correlations between lumendiameter in the right common carotid artery (CCA) and the diametersof the femoral artery and abdominal aorta and whether CCA lumendiameter was a risk factor for abdominal aortic aneurysm (AAA).Ultrasonography was performed in 6,400 men and women aged 25–84years during 1994–1995. An AAA was considered presentif the aortic diameter at the level of renal arteries was greaterthan or equal to 35 mm, the infrarenal aortic diameter was greaterthan or equal to 5 mm larger than the diameter of the levelof renal arteries, or a localized dilation of the aorta waspresent. CCA lumen diameter was positively correlated with abdominalaortic diameter (r = 0.3, P < 0.01) and femoral artery diameter(r = 0.2, P < 0.01). In a multivariable adjusted model,CCA lumen diameter was a significant predictor of AAA in bothmen and women (for the fifth quintile vs. the third, odds ratioswere 1.9 (95% confidence interval: 1.2, 2.9) and 4.1 (95% confidenceinterval: 1.5, 10.8), respectively). Thus, CCA lumen diameterwas positively correlated with femoral and abdominal aorticartery diameter and was an independent risk factor for AAA. aorta, abdominal; aneurysm; blood vessels; carotid arteries; ultrasonography     

Poorer self assessed health in a prospective study of men with screen detected abdominal aortic aneurysm: a predictor or a consequence of screening outcome?

Study OBJECTIVES: To assess the extent to which poorer self assessed health in men in whom an abdominal aortic aneurysm (AAA) is detected at screening is a consequence or a predictor of screening outcome. DESIGN: Prospective study. SETTING: Community based screening. PARTICIPANTS: 23 654 men who attended for AAA screening as part of the UK multicentre aneurysm screening study completed a measure of self assessed health before screening. A total of 1156 had an aneurysm detected. A sub-sample of screened men (571 with an aneurysm and 609 with a normal aorta) also completed the measure of self assessed health six weeks after screening. MAIN RESULTS: Men in whom an aneurysm was detected at screening perceived their health to be poorer before screening than those with a normal aorta. Adjusting for risk factors for AAA made no difference to this RESULT: self assessed health remained a strong predictor of having an aneurysm (odds ratio 1.7 comparing the extreme quartiles of self assessed health, 95% confidence intervals: 1.4 to 2.0). Men with an aneurysm also perceived their health to be poorer after screening had detected their aneurysms, but only to an extent in line with their pre-screening perceptions. CONCLUSIONS: Self assessed health seems to predict having an aortic aneurysm, independently of known risk factors. This emphasises the importance of assessing baseline perceptions of health to prevent erroneously inferring that poorer self assessed health in those who screen positive is a consequence as compared with a predictor of screening outcome.     

The diagnosis of salmonella abortion in cattle with particular reference to Salmonella dublin. A review.

The diagnosis of abortion in cattle caused by Salmonella dublin depends upon the isolation of the organism from either the products of conception, uterine discharges, vaginal mucus or milk together with serological evidence of active infection. S. dublin may be isolated when an active or a latent carrier cow abourts but in these cases an active infection will not be demonstrable. The retrospective identification of a case of S. dublin abortion may prove difficult as excretion of the organism is usually transient and the serum agglutinating antibodies frequently fall to low titres soon after the abortion.