The inflammatory aneurysm, as a distinct entity separate from the usual atherosclerotic type, was first described by Walker et al. ' in 1972. It is characterized by a thick white fibrotic sac with an inflammatory process often extending beyond the aortic wall. Despite the reported incidence of 10 per cent of all aneurysms, there is uncertainty as to the best course of action to be taken with those found to be inoperable at laparotomy.A successful resection of an inflammatory aneurysm following treatment with steroids is reported. Case reportA 56-year-old diamond technician presented with a short history of left loin and lower back pain. This was initially intermittent, then became more severe and continuous. He was otherwise asymptomatic and had previously been well. He had smoked twenty cigarettes per day for nearly forty years.Examination confirmed the presence of an abdominal aortic aneurysm with normal distal pulses and no arterial bruits. An ultrasound scan showed a 6 cm infrarenal abdominal aortic aneurysm. An intravenous urogram performed because of loin pain was normal apart from ureteric deviation caused by the aneurysm. He was admitted for elective resection but at laparotomy the aneurysm was found to be of the inflammatory type. Prolonged dissection proved that it was impossible to separate the duodenum from the aortic wall. Vascular fibrous tissue extended from the aneurysm to retroperitoneal tissues and there was no plane of dissection between the aorta and the inferior vena cava. The aneurysm was deemed inoperable and he was started on Prednisolone 15 mg/day. His back pain resolved and the erythrocyte sedimentation rate (ESR) fell from 65 mm in the first hour to 8 mm/h, 8 weeks later. The steroid dose was then reduced to 5mg/day. A postoperative computerized scan (CAT scan) was performed ( Figure I), as a baseline for future monitoring.Six months postoperatively the patient developed back pain again. A repeat CAT scan, (Figure 2). demonstrated an increase in overall diameter to 7cm and thinning of the aortic wall posteriorly. The ESR was 12 mm/h and the back pain did not respond to an increase in steroid dose. In view of the probability of rupture, a further laparotomy was planned. At operation the fibrous tissue was much less marked and had softened considerably. Dissection was relatively easy and an 18 mm knitted Dacron straight tube graft was inserted uneventfully. The left ureter required extensive ureterolysis and was placed intraperitoneally wrapped in omentum. He subsequently made an uneventful recovery and 7 months postoperatively is asymptomatic on 5 mg prednisolone per day. DiscussionFollowing the first description of inflammatory aneurysms' there have been few published accounts, and little is known of the natural history of the condition. Walker eta/.' described the pathology and reported an incidence of 10 per cent of all aneurysms. Goldstone et a/.' described the condition and stressed the need for accurate pre-operative diagnosis as he found that the majority of these aneurysms were...
Breast cancer surgery is an emotive topic and rather than just simple cosmetic issues, the final appearance of the operated breast has been shown to have a significant impact on psychologic well-being and overall quality of life. Wide local excision (WLE) is a popular conservative approach to small tumors, which do not involve the nipple-areolar complex. This study compares WLE via an anterior and lateral approach. A retrospective survey of patient satisfaction was performed using a recognized and validated Body Image Score (BIS), which was sent to a total of 267 patients who had undergone WLE by either the anterior or lateral approach. The response rate was 57%, of which 89 women had undergone surgery via the anterior and 80 by the lateral approach. There was no significant difference in BIS when comparing the anterior and lateral approaches, despite concerns regarding the physical appearance of the scar and postoperative breast expressed by patients. Generally, surgery on the upper part of the breast was associated with less satisfaction than the lower, but "hiding" the scar with a lateral approach did not improve satisfaction. Surgeons should be reassured that the approach to WLE of early breast cancers has no impact on the patients overall body image and that the choice of technique should be based on the patient's personal preference and the surgeons experience and skill.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.