The aim of this study was to evaluate clinical features, angiographic findings, surgical treatment, and the long-term results of surgical procedures in chronic phase of Takayasu Arteritis. Between 1989 and December 2000, 14 young female patients (mean age, 31 years) with occlusive lesions caused by Takayasu Arteritis were observed and treated at our department. All patients met the American College of Rheumatology 1990 criteria of classification of Takayasu Arteritis. Systemic symptoms were reported in fewer than 15%. All patients were evaluated by a routine full aortography. Occlusive disease was dominant (92.8%) and the subclavian and carotid arteries were mostly involved. All our patients underwent surgery and 30 vascular procedures were done. Polytetrafluoroehylene was the most common synthetic graft. The ipsilateral carotid artery was the most common proximal anastomotic site and the ascending aorta was used twice. Follow-up ranged from 1 to 9 years (mean 6 years) and there was no death. All patients had serial duplex and 6 at least one postoperative angiogram. Twenty percent of the bypass procedures were followed by complications. There was no difference between the complication rate using synthetic grafts or autologous veins. The actuarial graft patency rate was 96.4% at one year and 72% at 4 years. At side of the medical treatment which remains, to date, a subject of discussion, the long-term prognosis of Takayasu Arteritis depends on an elective surgical treatment, which requires full and accurate assessment of the lesions, best done by digital full arteriography. Surgical results are excellent with minimal morbidity and mortality.
BACKGROUND: Hydatid disease is caused by the larval form of Echinococcus granulosus. The reported occurrence of bony hydatidosis is 0.5–3% of all the cases and 50% of them affect the spine. Nevertheless, lumbar vertebral involvement is extremely rare. The most common occurrence is the dorsal level.
CASE REPORT: We present the case of a 32-year-old-military dog handler, who presented in 2018 to the urology department with an abdominal retroperitoneal mass. The MRI showed multilocular cystic lesions. The patient underwent surgery, and all of the cysts were removed. The anatomopathological evaluation concluded to hydatic cysts. He was briefly relieved from his symptoms. He was addressed to our department in 2020 suffering from lumbar-radicular pain and functional impotence of both lower limbs. MRI was performed showing multiple big cysts with inhomogeneous contents. CT scan showed destruction of the l5 vertebra. The patient underwent surgery. Initially, we performed through a posterior approach, an L4 to S1 laminectomy, posterior stabilization, and then total L5 corpectomy, anterior l4-s1 fusion through a xipho-pubic laparotomy after 2 months. Antihelminthic therapy was administrated. The patient’s symptoms completely disappeared. No signs of reoccurrence were noted at the 2-year follow-up.
CONCLUSION: The primary extrahepatic cystic echinococcosis of bone is an extremely rare disease. Diagnosis can be long and difficult. It can lead to serious complications and should be highly considered in case of a cystic vertebral lesion in an endemic region. Spinal involvement is extremely rare but potentially curable with surgery and anthelmintic drug therapy.
Infection with hepatitis B virus has a major implication for transplant recipients due to the risk of reactivation under immunosuppression, progression to chronic liver disease, development of liver cirrhosis and hepatocellular carcinoma. We report two cases of renal transplantation patients who were hepatitis B surface antigen positive before transplantation and were treated by Lamivudine.
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