Prevotella intermedia infection causing acute and complicated aortitis—A case report

INTRODUCTIONAortitis is a general term that refers to all conditions involving an inflammation of the aortic wall. This case report describes the surgical approach of a patient with infectious and symptomatic aortitis caused by the rare vector Prevotella intermedia.PRESENTATION OF CASEA 44-year old male patient was admitted with fever and general discomfort after a period of sore throat in a non-teaching hospital. After two weeks he developed acute abdominal and back pain accompanied by sweating and elevated infection parameters. Computed tomography angiography revealed atherosclerotic changes of the infrarenal aorta with a locally contained rupture of the aorta alongside peri-aortal signs of inflammation (and aortitis aspects). An urgent aortic reconstruction was performed according to Nevelsteen. The blood cultures turned out positive for Prevotella intermedia. Postoperatively the patient received antibiotics for six weeks. The patient recovered uneventful from this infection and surgical procedure.DISCUSSIONA complicated and acute aortitis is a rare but potentially life-threatening disease. The aetiology can be ordered into two main groups; inflammatory and infectious. Diagnosis is based upon symptoms, biochemical values, microbiological results and imaging modalities. Treatment depends on aetiology and should be discussed in an experienced multidisciplinary setting. Infectious aortitis should be treated with antibiotics for at least six weeks with close monitoring of the patient’s clinic and biochemical values, even after surgery.CONCLUSIONPrevotella intermedia is a rare causative agent for aortitis. Acute aortitis is a challenging clinical entity which should be managed in an equipped medical center by an experienced multidisciplinary team.     

Recurrent Ruptured Spleen

Regrowth of splenic tissue after splenectomy for trauma and splenectomy for idiopathic thrombocytopenia purpura have been reported. However, rupture of splenic tissue, either spontaneous or traumatic, that requires a second surgical intervention for hemoperitoneum caused by a ruptured splenic nodule or splenosis has rarely been reported. We report the case of a 43-year-old man in whom hemoperitoneum developed 25 years after he underwent an open splenectomy, after a motor vehicle accident, that required removal of a recurrent ruptured splenotic nodule.     

Vacation Appendicitis

Objective:

When someone plans a vacation, one of the last things taken into consideration is the possibility of contracting an illness while away. Unfortunately, if people develop abdominal pain while planning for a vacation, they usually proceed with the vacation and do not consider getting medical attention for their pain. The purpose of this study was to examine the effect of being on vacation and its association with ruptured appendicitis.

Methods:

From January 1, 2007 to December 31, 2008, the incidence of ruptured appendicitis cases at Florida Hospital–Celebration Health, located 5 miles from Walt Disney World, was compared with that of Florida Hospital–Orlando, approximately 30 miles away from Walt Disney World. We evaluated whether patients “on vacation” versus residents of Orlando have an increased incidence of ruptured appendicitis.

Results:

Of patients treated for presumed appendicitis, 60.59% at Florida Hospital–Celebration Health had ruptured appendicitis during this time versus 20.42% at Florida Hospital–Orlando. Of those 266 patients seen at Florida Hospital–Celebration Health, 155 were on vacation versus only 21 at Florida Hospital–Orlando.

Conclusion:

Although there is not a direct cause and effect, it is clear that there is a higher incidence of ruptured appendicitis in patients on vacation versus in the regular community in the Orlando, Florida area.     

Matrix弹簧圈栓塞治疗颅内破裂动脉瘤的并发症

目的评价Matrix弹簧圈栓塞颅内破裂动脉瘤的安全性。方法回顾性分析应用Matrix弹簧圈栓塞的102枚颅内破裂动脉瘤的临床表现、影像学资料、治疗过程、并发症和临床结果,分析与治疗相关并发症的发生、类型、频率、相关因素和后果。结果发生并发症的有16例,其中术中动脉瘤破裂9例,血栓形成3例,弹簧圈脱出1例,载瘤动脉闭塞3例,并发症发生率为15.69%。6例患者无神经功能异常,3例患者具有暂时性神经功能异常,6例患者具有持久性神经功能障碍,1例患者死亡。与治疗相关性持久性神经功能障碍发生率和死亡率分别为5.88%和0.98%。结论应用Matrix弹簧圈栓塞颅内破裂动脉瘤和应用裸金属圈栓塞一样安全,生物活性物质不增加血栓形成的风险,但应用Matix弹簧圈栓塞远段、较小动脉瘤应慎重。     

Coronary angiographic findings in infarct-related arteries following 1 month of medical treatment

Purpose We undertook the present study to determine first whether coronary angiographic (CAG) features, suggestive of ruptured atherosclerotic plaque, develop in infarct-related arteries of patients receiving conventional medical therapy without thrombolytic agents, and if they develop, what the incidence is, and second whether the sites where the CAG features develop are specific to infarct-related lesions.Methods We reviewed the CAG findings of 127 consecutive patients one month after myocardial infarction (MI), including 72 consecutive patients who received medical therapy (Group I) and 55 patients who underwent intracoronary urokinase infusion (Group II).Results Angiographic evidence of ruptured plaque was present in 24/44 (54.5%) patent infarct-related arteries in Group I and in 27/43 (62.8%) in Group II. Similar findings were only noted in 2/52 (3.8%) patent non-infarct-related arteries with significant stenosis in Group I, and in 0/45 (0.0%) in Group II.Conclusion On angiography, ruptured plaque was commonly found in patent infarct-related arteries in both groups, and was highly specific for the site of infarction. Thrombolytic therapy seemed to have no apparent effect on lesion morphology 1 month after MI.     

False Positive Diagnosis of Vegetations on a Myxomatous Mitral Valve Using Two-dimensional Echocardiography*

Abstract: False positive diagnosis of vegetations on a myxomatous mitral valve using two-dimensional echocardiography. A. J. Hickey and J. Wolfers, Aust. N.Z. J. Med., 1982, 12, pp. 540–542. We report a patient with bacterial endocarditis and a myxomatous valve (with ruptured chordae) considered to have vegetations at two-dimensional echocardiography but in whom no vegetations were present at surgery.     

Segmental arterial mediolysis: unrecognized cases culled from cases of ruptured aneurysm of abdominal visceral arteries reported in the Japanese literature

Segmental arterial mediolysis (SAM) is a rare nonatherosclerotic and noninflammatory arteriopathy that was proposed by Slavin et al. [Segmental mediolytic arteritis. A clinical pathologic study, Lab. Invest. 35 (1976) 23-29]. It mainly involves abdominal visceral arteries and is characterized by lytic degeneration of the media, resulting in intraabdominal bleeding. We collected 27 unrecognized cases of SAM by reviewing microscopic slides of cases of ruptured aneurysms of visceral arteries, except splenic and hepatic aneurysms, reported in the Japanese literature. This paper describes the pathological and clinical features of these cases. The symptom at onset was abdominal pain associated with intraabdominal bleeding in all cases. The most involved artery was the middle colic artery, accounting for 14 (50%), followed by gastric and gastroepiploic arteries, (6 and 5, respectively). Seventy-eight percent of aneurysms were of dissecting type and the rest of pseudoaneurysm type, except for one. Multiple aneurysms were found in 9 cases (33.3%). Pathological lesions were acute in all. The outcome of those who had surgery was good, even in those who had surgery for 1 ruptured aneurysm, leaving the others unmanaged. The relationship of SAM to fibromuscular dysplasia is discussed. Secondary changes in the wall of the accompanying vein to the affected artery are briefly described. It is emphasized that the majority of aneurysms of abdominal visceral arteries are gathered together as SAM as a definite clinical and pathological entity.     

室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂的外科治疗

目的总结室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂的治疗体会.方法 118例室间隔缺损患者中合并主动脉瓣脱垂80例,主动脉瓣关闭不全为（＋～＋＋＋）;合并瓦氏窦瘤破裂37例;合并动脉导管未闭3例,三尖瓣关闭不全4例;合并亚急性细菌性心内膜炎7例,合并主动脉-右心室通道1例.结果本组无术后早期死亡,无室间隔缺损残余分流,复查部分病例仍有主动脉瓣关闭不全（＋、＋＋）,2例亚急性细菌性心内膜炎术后3个月再次行主动脉瓣置换术.结论室间隔缺损合并主动脉瓣脱垂及瓦氏窦瘤破裂及早手术治疗总体效果好.术中加强心肌保护、正确处理是治疗