Our analysis provides evidence to motivate the adoption of an EVAR-first policy in a nonelective setting and the establishment of standardized protocols for the management ruptured AAAs.

We investigated the effect of the diverse definition criteria of the dipping and non-dipping status on the assessed differences in inflammatory activation between dippers and non-dippers with essential hypertension. 269 consecutive subjects (188 males, aged 50 ± 7 years) with untreated stage I-II essential hypertension underwent ambulatory blood pressure (BP) monitoring and high-sensitivity C-reactive protein (hs-CRP) level determination. The population was classified into dippers and non-dippers based on the three following different definitions: true non-dippers (TND): non-dippers (nocturnal fall of systolic and diastolic BP of o10% of the daytime values, n ¼ 95) and dippers (the remaining subjects, n ¼ 174); true dippers and true non-dippers (TD-TND): non-dippers (nocturnal fall of systolic and diastolic BPo10%, n ¼ 95) and dippers (nocturnal fall of systolic and diastolic BPX10%, n ¼ 75); systolic nondippers (SND): non-dippers (nocturnal systolic BP fall of o10% of the daytime values, n ¼ 145) and dippers (the remaining subjects, n ¼ 124). Non-dippers compared to dippers in the TND, TD-TND and SND classification exhibited higher levels of log hs-CRP (by 0.11 mg l À1 , P ¼ 0.02; 0.13 mg l À1, P ¼ 0.03 and 0.14 mg l À1, P ¼ 0.02, respectively) and 24 h pulse pressure (PP) (by 4 mm Hg, P ¼ 0.006; by 5 mm Hg, P ¼ 0.003 and by 5 mm Hg, Po0.0001, respectively). Twenty-four hour PP and nocturnal systolic BP fall were independent predictors of log hs-CRP (Po0.05 for both) in multiple regression analysis. In conclusion, essential hypertensive nondippers compared to dippers exhibit higher hs-CRP values, irrespective of the dipping status definition. Furthermore, ambulatory PP and nocturnal systolic BP fall interrelate and participate in the inflammatory processes that accompany non-dipping state.

No abstract

The rupture risk of abdominal aortic aneurysms (AAA) depends primarily on their diameter and increases substantially in large aneurysms. Only a few cases of giant AAAs, with a maximum diameter > 13 cm have been reported in the English literature. This case series report describes 3 cases of giant AAAs presented with rupture. All cases were managed with open surgical repair, since anatomic factors prevented us from choosing an endovascular approach. The huge size of the aneurysm, the short length of the neck and the dislodgement of abdominal organs, that may be densely adhered to its surface with fistula formation, make surgery of this entity very challenging. Open repair of giant AAAs is often the only available treatment, though not always with good results.