Intermittent thymoglobulin therapy, based on peripheral blood CD3+ lymphocyte counts, is safe and associated with low acute rejection rate in high-risk kidney and kidney-pancreas transplant recipients. A mean of three doses resulted in adequate suppression of CD3+ lymphocytes permitting delayed introduction of CI in low doses until recovery of renal function occurred. When compared to traditional daily administration, intermittent therapy results in significant cost savings and reduces the total cumulative dose of this potent immunosuppressive agent.
This report describes our results with covered endoluminal stents in the management of 4 patients with carotid artery pseudoaneurysms (PSAs) following carotid endarterectomy (CEA). Two patients had symptomatic embolization of thrombus from the PSA's into branches of the middle cerebral arteries (MCA) during deployment of the stents. Endoluminal stents were deployed uneventfully in the other two. At 12 month follow-up, one patient had an occlusion of the stent. While endoluminal therapy of carotid PSAs in an effective method to exclude PSAs, embolization of thrombus is a potential hazard. The long-term patency of covered stents in the carotid artery is unknown.
A case of a symptomatic 5.1-cm left subclavian venous aneurysm, which was treated with surgical excision, is presented. Most venous aneurysms in the head and neck region involve the internal or external jugular veins and are asymptomatic. Aneurysms involving the subclavian or axillary veins are rare. The natural history of these aneurysms is benign with no reported instances of rupture or thromboembolic events. Operative treatment is most often undertaken for cosmetic reasons or for the development of symptoms.
Patients who use the palms of their hands as a hammer may cause irreversible damage to the radial or ulnar arteries. Damage to the intima may lead to arterial thrombosis, whereas damage to the media may cause aneurysm formation with embolization to the digital arteries, causing symptoms of ischemia. These patients may have symptoms of Raynaud syndrome, or they may have ischemic ulcerations of their fingers. Hypothenar hammer syndrome with involvement of the ulnar artery is much more frequently encountered than thenar hammer syndrome, which is caused by damage to the radial artery. We report a patient with symptomatic occlusion of both the radial and ulnar arteries secondary to repetitive trauma to the palm of his hand. In our review of the literature, we found two reports involving a total of four patients with similar findings. Both conservative and surgical treatments have been used successfully. Avoidance of the precipitating activities is important in long-term management of these patients.
Biologic patches that undergo active remodeling in the carotid artery require greater thickness than was anticipated to decrease wall stress and suture hole elongation. Patches exceeding this minimum thickness will be required to ensure the safety of new SIS patch designs for vascular operations.
Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm. We present a case of a 6.1-cm infected splenic artery aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery aneurysm resection, and splenectomy. We reviewed five other reported infected splenic artery aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, infected splenic artery aneurysms require prompt treatment.
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